1
|
Santos L, Zheng H, Singhal S, Wong M. Remifentanil for tracheal intubation without neuromuscular blocking drugs in adult patients: a systematic review and meta-analysis. Anaesthesia 2024; 79:759-769. [PMID: 38403817 DOI: 10.1111/anae.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/27/2024]
Abstract
There is increasing interest in the use of short-acting opioids such as remifentanil to facilitate tracheal intubation. The aim of this systematic review was to determine the efficacy and safety of remifentanil for tracheal intubation compared with neuromuscular blocking drugs in adult patients. We conducted a systematic search for randomised controlled trials evaluating remifentanil for tracheal intubation. Primary outcomes included tracheal intubation conditions and adverse events. Twenty-one studies evaluating 1945 participants were included in the analysis. Use of remifentanil (1.5-4.0 μg.kg-1) showed no evidence of a difference in tracheal intubation success rate compared with neuromuscular blocking drugs (risk ratio (95%CI) 0.97 (0.94-1.01); six studies; 1232 participants; I2 28%; p = 0.16; moderate-certainty evidence). Compared with neuromuscular blocking drugs, the use of remifentanil (2.0-4.0 μg.kg-1) makes little to no difference in terms of producing excellent tracheal intubation conditions (risk ratio (95%CI) 1.16 (0.72-1.87); two studies; 121 participants; I2 31%, p = 0.54; moderate-certainty of evidence). There was no evidence of an effect between remifentanil (2.0-4.0 μg.kg-1) and neuromuscular blocking drugs for bradycardia (risk ratio (95%CI) 0.44 (0.01-13.90); two studies; 997 participants; I2 81%; p = 0.64) and hypotension (risk ratio (95%CI) 1.05 (0.44-2.49); three studies; 1071 participants; I2 92%; p = 0.92). However, the evidence for these two outcomes was judged to be of very low-certainty. We conclude that remifentanil may be used as an alternative drug for tracheal intubation in cases where neuromuscular blocking drugs are best avoided, but more studies are required to evaluate the haemodynamic adverse events of remifentanil at different doses.
Collapse
Affiliation(s)
- L Santos
- Dental Anaesthesia, University of Toronto, Toronto, ON, Canada
| | - H Zheng
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - S Singhal
- Dental Public Health, University of Toronto, Toronto, ON, Canada
| | - M Wong
- Dental Anaesthesia, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Nijakowski K, Owecki W, Jankowski J, Surdacka A. Salivary Biomarkers for Alzheimer's Disease: A Systematic Review with Meta-Analysis. Int J Mol Sci 2024; 25:1168. [PMID: 38256241 PMCID: PMC10817083 DOI: 10.3390/ijms25021168] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Alzheimer's Disease (AD) is the most common neurodegenerative disease which manifests with progressive cognitive impairment, leading to dementia. Considering the noninvasive collection of saliva, we designed the systematic review to answer the question "Are salivary biomarkers reliable for the diagnosis of Alzheimer's Disease?" Following the inclusion and exclusion criteria, 30 studies were included in this systematic review (according to the PRISMA statement guidelines). Potential biomarkers include mainly proteins, metabolites and even miRNAs. Based on meta-analysis, in AD patients, salivary levels of beta-amyloid42 and p-tau levels were significantly increased, and t-tau and lactoferrin were decreased at borderline statistical significance. However, according to pooled AUC, lactoferrin and beta-amyloid42 showed a significant predictive value for salivary-based AD diagnosis. In conclusion, potential markers such as beta-amyloid42, tau and lactoferrin can be detected in the saliva of AD patients, which could reliably support the early diagnosis of this neurodegenerative disease.
Collapse
Affiliation(s)
- Kacper Nijakowski
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland;
| | - Wojciech Owecki
- Student’s Scientific Group in Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland (J.J.)
| | - Jakub Jankowski
- Student’s Scientific Group in Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland (J.J.)
| | - Anna Surdacka
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland;
| |
Collapse
|
3
|
Acari A, Almammadov T, Dirak M, Gulsoy G, Kolemen S. Real-time visualization of butyrylcholinesterase activity using a highly selective and sensitive chemiluminescent probe. J Mater Chem B 2023. [PMID: 37377112 DOI: 10.1039/d3tb01022h] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Butyrylcholinesterase (BChE), one of the critical human cholinesterases, plays crucial roles in numerous physiological and pathological processes. Accordingly, it is a striking and at the same time challenging target for bioimaging studies. Herein, we developed the first ever example of a 1,2-dixoetane-based chemiluminescent probe (BCC) for monitoring BChE activity in native biological contexts such as living cells and animals. BCC was initially shown to exhibit a highly selective and sensitive turn-on response in its luminescence signal upon reacting with BChE in aqueous solutions. Later, BCC was utilized to image endogenous BChE activity in normal and cancer cell lines. It was also shown through inhibition experiments that BChE can detect fluctuations of BChE levels successfully. In vivo imaging ability of BCC was demonstrated in healthy and tumor-bearing mice models. BCC enabled us to visualize the BChE activity in different regions of the body. Furthermore, it was successfully employed to monitor tumors derived from neuroblastoma cells with a very high signal to noise ratio. Thus, BCC appears as a highly promising chemiluminescent probe, which can be used to further understand the contribution of BChE to regular cellular processes and the formation of diseased states.
Collapse
Affiliation(s)
- Alperen Acari
- Koç University Research Center for Translational Medicine (KUTTAM), 34450 Istanbul, Turkey.
| | - Toghrul Almammadov
- Koç University, Department of Chemistry, 34450 Istanbul, Turkey
- Univesity of Zurich, Department of Chemistry, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Musa Dirak
- Koç University, Department of Chemistry, 34450 Istanbul, Turkey
| | - Goktug Gulsoy
- Koç University, Department of Chemistry, 34450 Istanbul, Turkey
| | - Safacan Kolemen
- Koç University Research Center for Translational Medicine (KUTTAM), 34450 Istanbul, Turkey.
- Koç University, Department of Chemistry, 34450 Istanbul, Turkey
- Koç University Surface Science and Technology Center (KUYTAM), 34450 Istanbul, Turkey
| |
Collapse
|
4
|
Mokeem LS, Garcia IM, Melo MA. Degradation and Failure Phenomena at the Dentin Bonding Interface. Biomedicines 2023; 11:biomedicines11051256. [PMID: 37238927 DOI: 10.3390/biomedicines11051256] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
Damage in the bonding interface is a significant factor that leads to premature failure of dental bonded restorations. The imperfectly bonded dentin-adhesive interface is susceptible to hydrolytic degradation and bacterial and enzyme attack, severely jeopardizing restorations' longevity. Developing caries around previously made restorations, also called "recurrent or secondary caries," is a significant health problem. The replacement of restorations is the most prevailing treatment in dental clinics, leading to the so-called "tooth death spiral". In other words, every time a restoration is replaced, more tooth tissue is removed, increasing the size of the restorations until the tooth is eventually lost. This process leads to high financial costs and detriment to patients' quality of life. Since the complexity of the oral cavity makes prevention a challenging task, novel strategies in Dental Materials and Operative fields are required. This article briefly overviews the physiological dentin substrate, features of dentin bonding, challenges and clinical relevance. We discussed the anatomy of the dental bonding interface, aspects of the degradation at the resin-dentin interface, extrinsic and intrinsic factors affecting dental bonding longevity, perspectives on resin and collagen degradation and how these subjects are connected. In this narrative review, we also outlined the recent progress in overcoming dental bonding challenges through bioinspiration, nanotechnology and advanced techniques to reduce degradation and improve dental bonding longevity.
Collapse
Affiliation(s)
- Lamia Sami Mokeem
- Ph.D. Program in Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Isadora Martini Garcia
- Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Mary Anne Melo
- Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| |
Collapse
|
5
|
Clevenger SK, Brandt JS, Khan SP, Shingala P, Carrick J, Aluwalia R, Heiman GA, Ashkinadze E. Rate of manifesting carriers and other unexpected findings on carrier screening. Prenat Diagn 2023; 43:117-125. [PMID: 36529847 DOI: 10.1002/pd.6289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To ascertain the rate of unexpected findings on carrier screening (CS) and assess whether implications are disclosed to patients. METHODS We performed a retrospective observational study of subjects who had CS after pre-test counseling from a licensed genetic counselor at a large tertiary care center. We quantified the rate of unexpected finding on CS, defined as manifesting carriers (MCs), genotypes predicting phenotype, and chromosome abnormalities. We determined how often patients were informed of implications. We performed subgroup analyses by type of unexpected finding and calculated odds ratios (OR) and 95% confidence intervals (CI) for carrier testing methodology (genotype) and number of genes tested. RESULTS A total of 4685 patients had CS over the selected time frame. Of those patients, 412 patients (8.8%) had one unexpected finding and 29 patients (0.6%) had two or more findings. In total, 466 unexpected findings were identified, including 437 MC conditions, 23 genotypes predicting phenotype, and 6 chromosome abnormalities. Patients were informed of the implications for MCs, genotypes predicting phenotype, and chromosome abnormalities in 27.6%, 91.3%, and 100% of cases, respectively. More unexpected findings were detected with sequencing compared to genotyping (OR 2.21 and 95% CI 1.76-2.76) and with ≥200 gene panels compared to <200 gene panels (OR 1.79 and 95% CI 1.47-2.17). CONCLUSION This study highlights that nondisclosure of unexpected findings on CS is common and underscores the need for further research to improve post-test counseling and follow-up.
Collapse
Affiliation(s)
- Sydney K Clevenger
- Oncology Support Services, Morristown Medical Center, Morristown, New Jersey, USA.,Rutgers University Genetic Counseling Master's Program, Piscataway, New Jersey, USA
| | - Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Shama P Khan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pranali Shingala
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jillian Carrick
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Ruchi Aluwalia
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Gary A Heiman
- Rutgers University Genetic Counseling Master's Program, Piscataway, New Jersey, USA.,Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Elena Ashkinadze
- Rutgers University Genetic Counseling Master's Program, Piscataway, New Jersey, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| |
Collapse
|
6
|
Biodegradation of Dental Resin-Based Composite—A Potential Factor Affecting the Bonding Effect: A Narrative Review. Biomedicines 2022; 10:biomedicines10092313. [PMID: 36140414 PMCID: PMC9496159 DOI: 10.3390/biomedicines10092313] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 12/02/2022] Open
Abstract
In recent years, although resin composite has played an important role in the restoration of tooth defects, it still has several disadvantages, including being biodegraded by saliva, bacteria and other enzymes in the oral cavity, which may result in repair failure. This factor is not conducive to the long-term survival of the prosthesis in the mouth. In this article, we review the causes, influencing factors and prevention methods of resin biodegradation. Biodegradation is mainly caused by esterase in saliva and bacteria, which breaks the ester bond in resin and causes the release of monomers. The mechanical properties of the prosthesis can then be affected. Meanwhile, cathepsin and MMPs are activated on the bonding surface, which may decompose the dentin collagen. In addition, neutrophils and residual water on the bonding surface can also aggravate biodegradation. Currently, the primary methods to prevent biodegradation involve adding antibacterial agents to resin, inhibiting the activity of MMPs and enhancing the crosslinking of collagen fibers. All of the above indicates that in the preparation and adhesion of resin materials, attention should be paid to the influence of biodegradation to improve the prosthesis’s service life in the complex environment of the oral cavity.
Collapse
|
7
|
Prolonged Paralysis After Electroconvulsive Therapy Due to Butyrylcholinesterase Gene Mutation. J Clin Psychopharmacol 2021; 41:610-611. [PMID: 34176872 DOI: 10.1097/jcp.0000000000001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Break the Spasm with Succinylcholine, but Risk Intraoperative Awareness with Undiagnosed Pseudocholinesterase Deficiency. Case Rep Anesthesiol 2020; 2020:8874617. [PMID: 33014473 PMCID: PMC7520683 DOI: 10.1155/2020/8874617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/09/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Succinylcholine is a commonly used medication in all aspects of anesthetic care, and there are a number of known side effects and complications associated with its use. However, when succinylcholine is used emergently, anesthesia providers must remain vigilant to undiagnosed conditions that pose additional risks to patients. We report the use of succinylcholine to treat acute, refractory laryngospasm after extubation leading to prolonged neuromuscular paralysis. There are unique challenges presented by this case including the risk of anesthesia awareness with recall due to the cognitive biases that prevent the clinical diagnosis of pseudocholinesterase deficiency.
Collapse
|
9
|
Cornelius BW, Jacobs TM. Pseudocholinesterase Deficiency Considerations: A Case Study. Anesth Prog 2020; 67:177-184. [PMID: 32992329 DOI: 10.2344/anpr-67-03-16] [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] [Received: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 11/11/2022] Open
Abstract
Pseudocholinesterase deficiency, sometimes called butyrylcholinesterase deficiency, is a rare disorder in which the neuromuscular blocking drugs succinylcholine and mivacurium cannot be metabolized properly in the blood plasma. This disorder can either be acquired as a result of certain comorbidities or it can be inherited genetically. Anesthesia providers must understand the pathophysiology of pseudocholinesterase deficiency and be prepared to safely and effectively manage patients who show signs and symptoms consistent with the disorder after the use of the indicated neuromuscular blocking drugs. This article summarizes the pharmacologic and physiologic data relevant to understanding the basic pathophysiology associated with pseudocholinesterase deficiency and illustrates a case study of a young woman suspected of having the disorder after a prolonged delay in emergence from general anesthesia.
Collapse
Affiliation(s)
- Bryant W Cornelius
- Assistant Professor and Program Director of Oral Maxillofacial and Dental Anesthesiology, The Ohio State University College of Dentistry and Wexner Medical Center, Columbus, Ohio
| | - Todd M Jacobs
- Oral Surgery Resident, The Division of Oral Maxillofacial Surgery and Dental Anesthesiology, The Ohio State University College of Dentistry and Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
10
|
Matsuo M, Yamagami T. Low serum cholinesterase predicts complication risk after orthopedic surgery in elderly patients: an observational pilot study. JA Clin Rep 2019; 5:39. [PMID: 32025927 PMCID: PMC6967189 DOI: 10.1186/s40981-019-0259-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serum cholinesterase (ChE) in elderly adults is associated with geriatric conditions such as sarcopenia and malnutrition. The aim of this study is to examine the impact of preoperative serum ChE on the development of complications after noncardiac surgery in elderly patients without liver cirrhosis. METHODS We retrospectively identified all patients aged ≥ 65 years who underwent orthopedic surgery over a 1.5-year period in our hospital. The main outcome was postoperative complications, defined as a deviation from the normal postoperative course within 30 days postoperatively. RESULTS A total of 313 patients (median age 79 years) were included. The incidence of all-cause postoperative complications was 15.7% (49/313 patients). Receiver operating characteristic curve analysis showed that serum ChE was a univariable factor that predicted all-cause complications with moderate accuracy (area under the curve = 0.694, 95% confidence interval (CI) 0.604-0.783), with an optimal serum ChE cutoff level of 200 units/L. After multivariate analyses adjusted by baseline characteristics, low serum ChE remained a significant risk factor for postoperative complications (odds ratio = 2.99, 95% CI 1.41-6.33, P = 0.004). CONCLUSIONS Low serum ChE (< 200 unit/L) is a significant risk factor for postoperative complications after orthopedic surgery in patients aged ≥ 65 years.
Collapse
Affiliation(s)
- Mitsuhiro Matsuo
- Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan.
| | - Tohru Yamagami
- Department of Orthopedic Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| |
Collapse
|