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Kinoshita H, Saito J, Kushikata T, Oyama T, Takekawa D, Hashiba E, Sawa T, Hirota K. The Perioperative Frontal Relative Ratio of the Alpha Power of Electroencephalography for Predicting Postoperative Delirium After Highly Invasive Surgery: A Prospective Observational Study. Anesth Analg 2023; 137:1279-1288. [PMID: 36917508 DOI: 10.1213/ane.0000000000006424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND We investigated the associations between postoperative delirium (POD) and both the relative ratio of the alpha (α)-power of electroencephalography (EEG) and inflammatory markers in a prospective, single-center observational study. METHODS We enrolled 84 patients who underwent radical cancer surgeries with reconstruction for esophageal cancer, oral floor cancer, or pharyngeal cancer under total intravenous anesthesia. We collected the perioperative EEG data and the perioperative data of the inflammatory markers, including neutrophil gelatinase-associated lipocalin, presepsin, procalcitonin, C-reactive protein, and the neutrophil-lymphocyte ratio (NLR). The existence of POD was evaluated based on the Intensive Care Delirium Screening Checklist. We compared the time-dependent changes in the relative ratio of the EEG α-power and inflammatory markers between the patients with and without POD. RESULTS Four of the 84 patients were excluded from the analysis. Of the remaining 80 patients, 25 developed POD and the other 55 did not. The relative ratio of the α-power at baseline was significantly lower in the POD group than the non-POD group (0.18 ± 0.08 vs 0.28 ± 0.11, P < .001). A time-dependent decline in the relative ratio of α-power in the EEG during surgery was observed in both groups. There were significant differences between the POD and non-POD groups in the baseline, 3-h, 6-h, and 9-h values of the relative ratio of α-power. The preoperative NLR of the POD group was significantly higher than that of the non-POD group (2.88 ± 1.04 vs 2.22 ± 1.00, P < .001), but other intraoperative inflammatory markers were comparable between the groups. Two multivariable logistic regression models demonstrated that the relative ratio of the α-power at baseline was significantly associated with POD. CONCLUSIONS Intraoperative frontal relative ratios of the α-power of EEG were associated with POD in patients who underwent radical cancer surgery. Intraoperative EEG monitoring could be a simple and more useful tool for predicting the development of postoperative delirium than measuring perioperative acute inflammatory markers. A lower relative ratio of α-power might be an effective marker for vulnerability of brain and ultimately for the development of POD.
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Affiliation(s)
- Hirotaka Kinoshita
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junichi Saito
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tetsuya Kushikata
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tasuku Oyama
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daiki Takekawa
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Hashiba
- Division of Intensive Care, Hirosaki University Medical Hospital, Hirosaki, Japan
| | - Teiji Sawa
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyoshi Hirota
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Chen L, Wang M, Zhong Z, Liu B, Zhang W, Zhu B, Jiao C, Yu C, Guan B. Role of Exosomes in Pharyngucutaneous Fistula After Total Laryngectomy. Int J Nanomedicine 2022; 17:4119-4135. [PMID: 36118178 PMCID: PMC9480600 DOI: 10.2147/ijn.s372042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
Pharyngocutaneous fistula is the most common complication after total laryngectomy and is difficult to heal. Although conservative treatment and surgical repair are effective, they often take longer and additional trips to the operating room, which undoubtedly increases the financial burden on patients. Especially in combination with diseases such as diabetes and hypertension, which affect the efficacy of surgery. Adding growth factors into the repair material can promote fibroblast proliferation, angiogenesis, and accelerate wound healing. A substantial number of studies have shown that a type of nanoscale extracellular vesicle, called exosomes, facilitates organization repair by promoting blood vessel production, protein polysaccharides, and collagen deposition, thereby representing a new type of cellular therapy. At present, there is little research on the application of exosomes in pharyngocutaneous fistula regeneration after total laryngectomy. In this review, we summarize the biological characteristics of exosomes and their application in biomedical science, and highlight their application prospects in pharyngocutaneous fistula regeneration after total laryngectomy.
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Affiliation(s)
- Li Chen
- Department of Otolaryngology, Head and Neck Surgery, Dalian Medical University, Dalian, 116000, People's Republic of China
| | - Maohua Wang
- Department of Otolaryngology, Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Zhenhua Zhong
- Department of Otolaryngology, Head and Neck Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Baoxu Liu
- Department of Otolaryngology, Head and Neck Surgery, Dalian Medical University, Dalian, 116000, People's Republic of China
| | - Wentao Zhang
- Department of Otolaryngology, Head and Neck Surgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, People's Republic of China
| | - Bin Zhu
- Department of Otolaryngology, Head and Neck Surgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, People's Republic of China
| | - Cheng Jiao
- Department of Otolaryngology, Head and Neck Surgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, People's Republic of China
| | - Chenjie Yu
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
| | - Bing Guan
- Department of Otolaryngology, Head and Neck Surgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, People's Republic of China
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Harvey J, Mellody KT, Cullum N, Watson REB, Dumville J. Wound fluid sampling methods for proteomic studies: A scoping review. Wound Repair Regen 2022; 30:317-333. [PMID: 35381119 PMCID: PMC9322564 DOI: 10.1111/wrr.13009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 01/02/2023]
Abstract
Understanding why some wounds are hard to heal is important for improving care and developing more effective treatments. The method of sample collection used is an integral step in the research process and thus may affect the results obtained. The primary objective of this study was to summarise and map the methods currently used to sample wound fluid for protein profiling and analysis. Eligible studies were those that used a sampling method to collect wound fluid from any human wound for analysis of proteins. A search for eligible studies was performed using MEDLINE, Embase and CINAHL Plus in May 2020. All references were screened for eligibility by one reviewer, followed by discussion and consensus with a second reviewer. Quantitative data were mapped and visualised using appropriate software and summarised via a narrative summary. After screening, 280 studies were included in this review. The most commonly used group of wound fluid collection methods were vacuum, drainage or use of other external devices, with surgical wounds being the most common sample source. Other frequently used collection methods were extraction from absorbent materials, collection beneath an occlusive dressing and direct collection of wound fluid. This scoping review highlights the variety of methods used for wound fluid collection. Many studies had small sample sizes and short sample collection periods; these weaknesses have hampered the discovery and validation of novel biomarkers. Future research should aim to assess the reproducibility and feasibility of sampling and analytical methods for use in larger longitudinal studies.
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Affiliation(s)
- Joe Harvey
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kieran T Mellody
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Nicky Cullum
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Rachel E B Watson
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, UK
| | - Jo Dumville
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
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Banjonjit S, Taweechotipatr M, Rungsiyanont S. Effect of probiotic <i>Lactobacillus paracasei</i> on tumor necrosis factor-alpha level in gingival crevicular fluid of patients undergoing impacted third molar removal. J Oral Sci 2022; 64:185-189. [DOI: 10.2334/josnusd.21-0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Susama Banjonjit
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University
| | | | - Sorasun Rungsiyanont
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University
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Spencer H, Moshkbouymatin N, Webb WR, Joshi A, D'Souza A. Update on the role of emerging stem cell technology in head and neck medicine. Head Neck 2021; 43:1928-1938. [PMID: 33751726 DOI: 10.1002/hed.26674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Head and neck surgery is a broad discipline that involves the management of complex conditions such as burns, skin cancer, head and neck cancer, congenital abnormalities, and facial rejuvenation. For patients with cancer, surgery, radiotherapy, and chemotherapy are often the main modes of treatment. Many patients require follow-up reconstructive surgery, and the use of stem cells offers novel treatments that could aid recovery. Laryngeal, tracheal, and neuronal tissues are frequently damaged by surgery in the head and neck and these tissues have little intrinsic regenerative ability. Pluripotent embryonic stem cells retain the ability to differentiate into a wide variety of cells meaning that large tissue defects can be reduced by stimulating new cell growth. Research has demonstrated potential benefits of using stem cells in facial rejuvenation procedures and the management of burns sequelae. The advancements made in the use of adult progenitor stem cells as a possible source for pluripotent stem cells (induced pluripotent stem cells) mean that ethical considerations around the use of embryological tissue can be minimized, allowing for more research to take place. Currently, the evidence base for the use of stem cells in head and neck surgery is limited, but it has now been proven that stem cells can act as a source for lost or damaged tissue in the head and neck. With continuous advancements being made in the fields of tissue engineering, it is likely that stem cells will play a major role in head and neck surgery in the future.
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Affiliation(s)
- Harry Spencer
- Department of Vascular Surgery, St Georges Hospital, London, UK
| | | | - William Richard Webb
- Faculty of Medicine, Health and Social Sciences, Canterbury Christ Church University, Chatham, UK
| | - Anil Joshi
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
| | - Alwyn D'Souza
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
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de Carvalho CS, Silva TH, André JCS, de Barros LAS, Ferreira AA, Murad LB, Peres WAF. Preoperative Fasting Abbreviation With Whey Protein Reduces the Occurrence of Postoperative Complications in Patients With Head and Neck Cancer: A Randomized Clinical Trial. Nutr Clin Pract 2020; 36:665-672. [PMID: 33373478 DOI: 10.1002/ncp.10624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Surgery has become the treatment of choice for head and neck cancer (HNC) in most cases. Preoperative fasting abbreviation and nutrition screening have been suggested to reduce the occurrence of postoperative complications. This study aimed to evaluate the addition of whey protein in the preoperative fasting abbreviation and to analyze the association of nutrition status on postoperative complications in patients with HNC. METHODS A randomized, single-blind clinical trial was performed. Patients recruited from March to November 2018 at a national cancer reference center in Brazil were divided into 2 groups: intervention group (clear fluids with carbohydrate plus whey protein [CHO-P]) and control group (clear fluids with carbohydrate only [CHO]). All patients were evaluated by the Patient-Generated Subjective Global Assessment (PG-SGA) and body mass index. Logistic regression analyses were performed to assess associations between the studied variables, generating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 49 patients met the eligibility criteria and enrolled in the study. A PG-SGA score of 4-8, indicating moderate malnutrition (OR, 10.91; 95% CI, 1.05-112.91), was an independent factor that increased the risk of postoperative complication, whereas the CHO-P group (OR, 0.04; 95% CI, 0.01-0.26) was found to be an independent factor in reducing such risk. CONCLUSION The addition of whey protein to clear fluids (CHO-P group) was associated with a reduced risk of postoperative complications compared with the CHO group. Furthermore, moderate malnourishment was associated with an increased risk of postoperative complications for patients with HNC.
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Affiliation(s)
| | - Thiago Huaytalla Silva
- Departamento de Nutrição e Dietética, Instituto de Nutrição, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Larissa Alves Soares de Barros
- Departamento de Nutrição e Dietética, Instituto de Nutrição, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline Alves Ferreira
- Departamento de Nutrição e Dietética, Instituto de Nutrição, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Wilza Arantes Ferreira Peres
- Departamento de Nutrição e Dietética, Instituto de Nutrição, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Ding H, Li H, Yu H, Zhang W, Li S. Cytokines in abdominal exudate and serum predict small bowel obstruction following appendectomy. ANZ J Surg 2020; 90:1991-1996. [PMID: 32808444 DOI: 10.1111/ans.16241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to investigate the value of inflammatory markers for the prediction of small bowel obstruction (SBO) following appendectomy. METHODS We included cases of acute appendicitis that underwent laparoscopic appendectomy (LA) in the Qingdao Municipal Hospital between January 2017 and January 2019. The cases were divided into an SBO group and a non-SBO group depending on whether patients had or did not have SBO, and patients were followed up for at least 1 year. The levels of interleukin (IL)-1β, IL-6 and tumour necrosis factor-alpha (TNF-α) in abdominal exudate and venous blood were examined using enzyme-linked immunosorbent assay. RESULTS After 1 year of follow-up, there were 985 cases in the non-SBO group and 16 cases in the SBO group. The levels of IL-1β, IL-6 and TNF-α in abdominal exudate on post-operative day 1 in the SBO group were 172.5 ± 14.7, 2167.3 ± 372.1 and 253.9 ± 12.9 pg/mL, respectively, which were significantly higher than that in the non-SBO group. The serum levels of IL-1β, IL-6, TNF-α and C-reactive protein (CRP) in the SBO group were significantly higher than that in the non-SBO group before surgery. Post-operatively, the inflammatory markers above decreased significantly and became similar with time in both groups. The logistic regression showed that the levels of peritoneal IL-6, preoperative serum CRP and perforated appendicitis were significant risk factors of SBO. The specificity and sensitivity of peritoneal IL-6 were 0.81 and 0.921, respectively. CONCLUSION The IL-1β, IL-6, TNF-α and CRP in serum and abdominal exudate played an important role in SBO after LA. The peritoneal IL-6 was the most reliable prediction marker for SBO.
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Affiliation(s)
- Hui Ding
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Hongbo Li
- Department of Colorectal Surgery, Qingdao Municipal Hospital, Qingdao City, China
| | - Hualong Yu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Wenwei Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Siyuan Li
- The First Department of General Surgery, Qingdao Municipal Hospital, Qingdao City, China
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Galli J, Settimi S, Tricarico L, Almadori G, Paludetti G. Clinical and surgical management of patients with head and neck cancer in a COVID-19 dedicated center in Italy. Head Neck 2020; 42:1466-1470. [PMID: 32476204 PMCID: PMC7300905 DOI: 10.1002/hed.26263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction For the EARs NOSE AND THROAT (ENT) surgeon, there are many challenges that show‐up in the clinical management of a patient affected by a head and neck cancer during COVID‐19 pandemic, especially in the postoperative period. Methods During the acute COVID‐19 emergency phase in Italy, we analyzed the management of a patient affected by a head and neck cancer. We reported several clinical data about the hospitalization period, pointing out the difficulties encountered both from clinical and management point of view. Results During pandemic, we admitted 27 oncological patients at our ENT Department. Delays in surgical procedures, complications of hospitalizations, need for radiological studies, and possible transfer to other hospital ward, due to suspect SARS‐CoV‐2 infection, were registered. Conclusions The changes in the whole health care system during the COVID‐19 pandemic have impacted the management of patients with head and neck cancer, generating several clinical challenges for the ENT surgeon.
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Affiliation(s)
- Jacopo Galli
- Otorhinolaryngology and Head and Neck Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Settimi
- Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Tricarico
- Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Almadori
- Otorhinolaryngology and Head and Neck Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology and Head and Neck Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
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