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Wenzel L, Sandriesser S, Glowalla C, Gueorguiev B, Perl M, Stuby FM, Augat P, Hungerer S. Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating. Eur J Trauma Emerg Surg 2022; 48:3185-3192. [PMID: 35037075 PMCID: PMC9360095 DOI: 10.1007/s00068-021-01872-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A common surgical treatment in anterior column acetabular fractures with preexisting osteoarthritis is THA, which is commonly combined with plate osteosynthesis. Implantation of a solitary revision cup cranially fixed to the os ilium is less common. The purpose of this study was to compare the stabilization of anterior column acetabular fractures fixed with a cranial socket revision cup with flange and iliac peg or with a suprapectineal plate osteosynthesis combined with an additional revision cup. METHODS In 20 human hemipelves, an anterior column fracture was stabilized by either a cranial socket revision cup with integrated flange (CF = Cup with Flange) or by a suprapectineal plate combined with a revision cup (CP = Cup and Plate). Each specimen was loaded under a stepwise increasing dynamic load protocol. Initial construct stiffness, interfragmentary movements along the fracture line, as well as femoral head movement in relation to the acetabulum were analyzed. RESULTS Both groups showed comparable initial construct stiffness (CP: 3180 ± 1162 N/mm and CF: 3754 ± 668 N/mm; p = 0.158). At an applied load of 1400 N, interfragmentary movements at the acetabular (p = 0.139) and the supraacetabular region (p = 0.051) revealed comparable displacement for both groups and remained below 1 mm. Femoral head movement in relation to the acetabulum also remained below 1 mm for both test groups (p = 0.260). CONCLUSION From a biomechanical point of view, both surgical approaches showed comparable fracture reduction in terms of initial construct stiffness and interfragmentary movement. The potential benefit of the less-invasive cranial socket revision cup has to be further investigated in clinical studies.
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Affiliation(s)
- Lisa Wenzel
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.,AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland
| | - Sabrina Sandriesser
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany. .,Institute for Biomechanics, Paracelsus Medical University, Strubergasse. 21, 5020, Salzburg, Austria.
| | - Claudio Glowalla
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland
| | - Mario Perl
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Maximiliansplatz. 2, 91012, Erlangen, Germany
| | - Fabian M Stuby
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Strubergasse. 21, 5020, Salzburg, Austria
| | - Sven Hungerer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.,Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Strubergasse. 21, 5020, Salzburg, Austria
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Martin C. [Perioperative Management: From the Operating Room to Postanesthesia Care Unit/to the Normal Ward]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:186-199. [PMID: 33725739 DOI: 10.1055/a-1114-4509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The early postoperative period is of increasing importance in modern operative medicine with a continuously increasing surgical spectrum and patients with increasingly complex comorbidities. Even with optimal preoperative evaluation and intraoperative care, postoperative complications are not uncommon. The fastest possible diagnosis, including possible differential diagnoses and any combined disorders, is essential in order to initiate the indicated therapeutic measures. The spatial correlate of the postoperative phase is the post-anaesthesia care unit (PACU). The qualification of the medical staff and spatial structure must meet the recommended minimum and must be in line with the existing operational structures. Good interdisciplinary and interprofessional communication reduces the loss of information and a good error reporting culture helps to reduce critical incidents.
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Perioperative neurocognitive functions in patients with neuroepithelial intracranial tumors. J Neurooncol 2020; 147:77-89. [DOI: 10.1007/s11060-020-03398-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
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Saleh AJ, Tang GX, Hadi SM, Yan L, Chen MH, Duan KM, Tong J, Ouyang W. Preoperative cognitive intervention reduces cognitive dysfunction in elderly patients after gastrointestinal surgery: a randomized controlled trial. Med Sci Monit 2015; 21:798-805. [PMID: 25782136 PMCID: PMC4373157 DOI: 10.12659/msm.893359] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preoperative conditions may play a significant role in postoperative cognitive dysfunction (POCD) development in elderly patients. We aimed to investigate whether preoperative cognitive training could lower the incidence of POCD one week after surgery. MATERIAL AND METHODS A total of 141 ASA I-III elderly patients who underwent gastrointestinal surgery were enrolled into the study. Patients were randomized into either the Intervention group (69 analyzed) or the Control group (72 analyzed). Patients in the intervention group were instructed and trained in a cognition mnemonic skill for a total of three 1-hour sessions with the method of loci (MoL). Controls did not receive any cognitive training during hospitalization. All patients were tested using neuropsychological battery tests (NPTs) on admission and one week after surgery. RESULTS The incidence of POCD in the intervention group (15.9%) was significantly lower than in the controls (36.1%) (P<0.05). Patients' performance in Brief Visuospatial Memory Test-Revised and Symbol-Digit Modalities Test were improved by the cognitive training. Increasing age, longer length of anesthesia and surgery, and lack of cognitive training were associated with a significantly higher risk of POCD (P<0.05). CONCLUSIONS Cognitive training with MoL can reduce the decline of early postoperative cognitive function in elderly patients undergoing major gastrointestinal surgery.
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Affiliation(s)
- Amin J Saleh
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Guan-Xiu Tang
- Department of Nurse, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Sally M Hadi
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Liao Yan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Ming-Hua Chen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Kai-Ming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Jianbin Tong
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Wen Ouyang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
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JIANG PENG, LING QIONG, LIU HONGBO, TU WEIFENG. Intracisternal administration of an interleukin-6 receptor antagonist attenuates surgery-induced cognitive impairment by inhibition of neuroinflammatory responses in aged rats. Exp Ther Med 2015; 9:982-986. [PMID: 25667664 PMCID: PMC4316944 DOI: 10.3892/etm.2014.2149] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/30/2014] [Indexed: 11/09/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is common in elderly patients, and may persist or even evolve into Alzheimer's disease. It has been hypothesized that POCD is mediated by surgery-induced inflammatory processes. As a pro-inflammatory cytokine, the detailed role of interleukin (IL)-6 in POCD remains largely unknown. In this study, laparotomy was used to mimic human abdominal surgery in aged Sprague-Dawley rats. It was found that memory and learning were impaired following surgery, accompanied by the significant upregulation of the pro-inflammatory cytokines tumor necrosis factor α (TNF-α), IL-1β, IL-4, and IL-6. Moreover, the intracisternal administration of the IL-6 receptor (IL-6R) antagonist (tocilizumab, also know as MRA) at the time of surgery notably attenuated the surgery-induced cognitive deficit, and significantly inhibited the upregulated expression of pro-inflammatory cytokines. Further investigation indicated that the intracisternal administration of MRA inhibited the activation of the NF-κB signaling pathway in aged rats following surgery. In summary, the findings of this study suggest that IL-6 plays a crucial role in POCD, and that IL-6R antagonists may serve as novel agents for the prevention or treatment of POCD.
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Affiliation(s)
- PENG JIANG
- Department of Anesthesiology, Huizhou Municipal Central Hospital, Huizhou, Guangdong 516001, P.R. China
| | - QIONG LING
- Department of Anesthesiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong 510010, P.R. China
| | - HONGBO LIU
- Department of Anesthesiology, Huizhou Municipal Central Hospital, Huizhou, Guangdong 516001, P.R. China
| | - WEIFENG TU
- Department of Anesthesiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
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YU LUYUAN, SUN LEI, CHEN SULI. Protective effect of senegenin on splenectomy-induced postoperative cognitive dysfunction in elderly rats. Exp Ther Med 2014; 7:821-826. [PMID: 24660030 PMCID: PMC3961123 DOI: 10.3892/etm.2014.1501] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/16/2013] [Indexed: 12/15/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is common in elderly patients. Senegenin, an active component of extracts from Polygala tenuifolia root, a traditional Chinese medicine, has neuroprotective and neuroregenerative effects. However, the mechanism underlying the effects of senegenin against postoperative cognitive impairment in elderly individuals has yet to be elucidated. The aim of this study was to investigate the protective effects of senegenin on the cognitive functions of elderly rats with splenectomy-induced POCD. Results from a Morris water maze test suggested that splenectomy induced a transient cognitive deficiency in the elderly rats; however, when the rats were treated with senegenin, the cognitive impairment was notably attenuated. Further experiments showed that senegenin significantly inhibited the mRNA and protein expression of several key pro-inflammatory cytokines, specifically, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6 and IL-8, in the hippocampal tissues of elderly rats following splenectomy. In order to investigate the molecular mechanism involved, the expression and activity of the Toll-like receptor 4 (TLR4) signaling pathway was assessed. On day 1 postoperatively, it was observed that senegenin markedly suppressed the mRNA and protein expression of TLR4, myeloid differentiation factor 88 (MyD88) and TIR domain-containing adaptor-inducing interferon-β (TRIF). Furthermore, the phosphorylation levels of nuclear factor-κB (NF-κB) p65 and inhibitor of NF-κB (IκBα) were also decreased following senegenin treatment on the first day subsequent to surgery. These results suggest that senegenin suppressed splenectomy-induced transient cognitive impairment in elderly rats, possibly by downregulating two signaling pathways involved in inflammation, TLR4/MyD88/NF-κB and TLR4/TRIF/NF-κB, to further inhibit the expression of key pro-inflammatory cytokines, specifically, TNF-α, IL-1β, IL-6 and IL-8, and ultimately the neuroinflammation in the hippocampal tissues. In conclusion, the present study revealed that senegenin exhibited neuroprotective effects against splenectomy-induced transient cognitive impairment in elderly rats, which indicated that senegenin may be a promising agent for the treatment of POCD.
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Affiliation(s)
- LUYUAN YU
- Department of Anesthesiology, Haidian Hospital, Haidian, Beijing 100080, P.R. China
| | - LEI SUN
- Department of Anesthesiology, Coal General Hospital, Chaoyang, Beijing 100028, P.R. China
| | - SULI CHEN
- Department of Anesthesiology, Beijing Aerospace General Hospital, Fengtai, Beijing 100076, P.R. China
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Wang Y, He H, Li D, Zhu W, Duan K, Le Y, Liao Y, Ou Y. The role of the TLR4 signaling pathway in cognitive deficits following surgery in aged rats. Mol Med Rep 2013; 7:1137-42. [PMID: 23426570 DOI: 10.3892/mmr.2013.1322] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 01/31/2013] [Indexed: 11/06/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD), common in elderly patients, refers to a decline in cognitive function following surgery, which may persist or even evolve into Alzheimer's disease (AD). Despite great efforts, the mechanism of POCD remains unclear. In the present study, we tested the hypothesis that Toll-like receptor 4 (TLR4) on microglia contributes to POCD. Shortly after surgery, aged rats demonstrated significant deficits in memory and learning, accompanied by the activation of microglia, marked upregulation of TLR4 on microglia in the hippocampus, as well as an increased expression of two downstream factors [myeloid differentiation factor 88 (MyD88) and TIR-domain-containing adapter-inducing interferon-β (TRIF)] and pro-inflammatory cytokines [including tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β)]. With an increase in time following surgery, the expression of TLR4 and the aforementioned factors and pro-inflammatory cytokines gradually returned to normal, as did the cognitive function of the aged rats. In conclusion, our study suggests that the activation of TLR4 signaling on microglia may act as an underlying mechanism of POCD.
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Affiliation(s)
- Yi Wang
- Department of Anesthesiology, The Third‑Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
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Eckle VS, Grasshoff C. [Developmental abnormalities in children following surgery under general anesthesia: anesthesiological problem?]. Anaesthesist 2013; 62:89-90. [PMID: 23354489 DOI: 10.1007/s00101-013-2138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- V-S Eckle
- Sektion Experimentelle Anaesthesiologie, Klinik für Anästhesie und Intensivmedizin, Eberhard-Karls-Universität, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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