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Hua X, Chen Y, Wu Z, Zheng G, Yang D, Li J, Wu Q, Fan W. Effects of intra-operative magnesium sulfate infusion on orthognathic surgery: A prospective and randomized controlled trial. Heliyon 2024; 10:e30342. [PMID: 38707412 PMCID: PMC11066664 DOI: 10.1016/j.heliyon.2024.e30342] [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: 03/06/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose To comprehensively understand the effects of intra-operative infusion of magnesium sulfate on patients who underwent orthognathic surgery, including remifentanil consumption, postoperative pain, postoperative nausea and vomiting (PONV), inflammatory response, and serum magnesium levels. Methods Seventy-five adult patients undergoing orthognathic surgery under general balanced anesthesia were randomly divided into two groups. One group (Group M) received 50 mg/kg of magnesium sulfate in 20 mL 0.9 % saline after intubation, followed by a continuous infusion at a rate of 15 mg/kg/h until 30 min before the anticipated end of surgery. The other group (Group C) received an equal volume of isotonic saline as a placebo. (Clinical trial registration number: chiCTR2100045981). Results The primary outcome was remifentanil consumption. The secondary outcomes included the pain score assessed using the verbal numerical rating scale (VNRS) and PONV assessed using a Likert scale. Remifentanil comsumption in Group M was lower than Group C (mean ± SD: 0.146 ± 0.04 μg/kg/min vs. 0.173 ± 0.04 μg/kg/min, P = 0.003). At 2 h after surgery, patients in Group C suffered more severe PONV than those in Group M (median [interquartile range, IQR]: 1 [3] vs. 1 [0], mean rank: 31.45 vs. 42.71, P = 0.040). At post-anesthesia care unit (PACU), postoperative pain in Group C was severe than Group M (3 [1] vs. 3 [0], mean rank: 31.45 vs. 42.71, P = 0.013). Changes in haemodynamics and surgical field scores did not differ between the groups (all P > 0.05). The levels of cytokines (IL-4, IL-6, IL-8, IL-10, TNF-a, and MIP-1β) were not significantly different between the groups after surgery (all P > 0.05). Postoperative serum magnesium levels in Group C were lower than those in Group M (0.74 ± 0.07 mmol/L vs. 0.91 ± 0.08 mmol/L, P = 0.000) and the preoperative level (0.74 ± 0.07 mmol/L vs. 0.83 ± 0.06 mmol/L, P = 0.219). Conclusions In orthognathic surgery, magnesium sulfate administration can reduce remifentanil requirement and relieve PONV and postoperative pain in the early postoperative phase.
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Affiliation(s)
- Xiaoxiao Hua
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yanling Chen
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Zhi Wu
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Guangsen Zheng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Dongye Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Qiaomei Wu
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Wenguo Fan
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
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Frazure M, Greene CL, Iceman KE, Howland DR, Pitts T. Dysphagia as a Missing Link Between Post-surgical- and Opioid-Related Pneumonia. Lung 2024; 202:179-187. [PMID: 38538927 PMCID: PMC11135177 DOI: 10.1007/s00408-024-00672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/21/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE Postoperative pneumonia remains a common complication of surgery, despite increased attention. The purpose of our study was to determine the effects of routine surgery and post-surgical opioid administration on airway protection risk. METHODS Eight healthy adult cats were evaluated to determine changes in airway protection status and for evidence of dysphagia in two experiments. (1) In four female cats, airway protection status was tracked following routine abdominal surgery (spay surgery) plus low-dose opioid administration (buprenorphine 0.015 mg/kg, IM, q8-12 h; n = 5). (2) Using a cross-over design, four naive cats (2 male, 2 female) were treated with moderate-dose (0.02 mg/kg) or high-dose (0.04 mg/kg) buprenorphine (IM, q8-12 h; n = 5). RESULTS Airway protection was significantly affected in both experiments, but the most severe deficits occurred post-surgically as 75% of the animals exhibited silent aspiration. CONCLUSION Oropharyngeal swallow is impaired by the partial mu-opioid receptor agonist buprenorphine, most remarkably in the postoperative setting. These findings have implications for the prevention and management of aspiration pneumonia in vulnerable populations.
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Affiliation(s)
- Michael Frazure
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, USA
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, College of Medicine, University of Louisville, Louisville, KY, USA
| | - Clinton L Greene
- Department of Speech Language and Hearing Sciences and Dalton Cardiovascular Center, University of Missouri, 701 S Fifth St, Columbia, MO, 65203, USA
| | - Kimberly E Iceman
- Department of Speech Language and Hearing Sciences and Dalton Cardiovascular Center, University of Missouri, 701 S Fifth St, Columbia, MO, 65203, USA
| | - Dena R Howland
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, College of Medicine, University of Louisville, Louisville, KY, USA
| | - Teresa Pitts
- Department of Speech Language and Hearing Sciences and Dalton Cardiovascular Center, University of Missouri, 701 S Fifth St, Columbia, MO, 65203, USA.
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Cardoso AHDLS, Palinkas M, Bettiol NB, Lima PSD, Vasconcelos PBD, Xavier SP, Silva GS, Branco T, Regalo IH, Siessere S, Regalo SC. Bichectomy Surgery and EMG Masticatory Muscles Function in Adult Women: A Longitudinal Study. J Contemp Dent Pract 2024; 25:207-212. [PMID: 38690691 DOI: 10.5005/jp-journals-10024-3656] [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] [Indexed: 05/02/2024]
Abstract
AIM This longitudinal study aimed to evaluate the electromyographic activity of the masseter and temporal muscles in adult women who underwent buccal fat removal. MATERIALS AND METHODS The sample consisted of 20 healthy adult women with no temporomandibular dysfunction and normal occlusion, who were assessed before, 30, and 60 days after the surgery. The electromyographic signal of the masseter and temporal muscles was captured through mandibular tasks including rest, protrusion, right and left laterality, and maximum voluntary contraction with and without parafilm. The results obtained were tabulated and the Shapiro-Wilk normality test was performed, which indicated a normal distribution. Statistical analysis was performed using the repeated measures test (p < 0.05). RESULTS Significant differences were observed between time periods in maximum voluntary contraction for the left masseter muscle (p = 0.006) and in maximum voluntary contraction with parafilm for the right temporal (p = 0.03) and left temporal (p = 0.03) muscles. CONCLUSION Bichectomy surgery did not modify the electromyographic activity of the masseter and temporal muscles during the rest task but may have influenced variations in the electromyographic signal during different mandibular tasks after 60 days of surgery, suggesting compensatory adaptations and functional recovery. CLINICAL SIGNIFICANCE Understanding the impact of buccal fat removal surgery on the stomatognathic system function provides insights into postoperative functional recovery and potential compensatory adaptations, guiding clinical management and rehabilitation strategies for patients undergoing such procedures. How to cite this article: Cardoso AHDLS, Palinkas M, Bettiol NB, et al. Bichectomy Surgery and EMG Masticatory Muscles Function in Adult Women: A Longitudinal Study. J Contemp Dent Pract 2024;25(3):207-212.
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Affiliation(s)
| | - Marcelo Palinkas
- Department of Basic and Oral Biology, School of Dentistry of Ribeirão Preto of the University of São Paulo; Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão, Ribeirão Preto, Brazil, Phone: +55 16 33150281, e-mail:
| | - Nicole B Bettiol
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil
| | - Patrícia S de Lima
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil
| | - Paulo B de Vasconcelos
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil
| | - Samuel P Xavier
- Department of Oral and Maxillofacial Surgery and Traumatology and Periodontics, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Gabriella Sg Silva
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil
| | - Thamyres Branco
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil
| | - Isabela H Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil
| | - Selma Siessere
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo; Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão, Ribeirão Preto, Brazil
| | - Simone Ch Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo; Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão, Ribeirão Preto, Brazil
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Choi H, Lee JY, Sul Y, Kim SH, Ye JB, Lee JS, Yoon SY, Seok J, Choi JH. Mean corpuscular volume as a prognostic factor for 30-day mortality in major trauma patients: a retrospective cohort study. Sci Rep 2024; 14:3951. [PMID: 38365858 PMCID: PMC10873376 DOI: 10.1038/s41598-024-54057-1] [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] [Received: 06/11/2023] [Accepted: 02/08/2024] [Indexed: 02/18/2024] Open
Abstract
We investigated the clinical implications of the mean corpuscular volume (MCV) in patients with major trauma. This single-center retrospective review included 2021 trauma patients admitted to the intensive care unit between January 2016 and June 2020. We included 1218 patients aged [Formula: see text] 18 years with an injury severity score [Formula: see text] 16 in the final analysis. The clinical and laboratory variables were compared between macrocytosis (defined as MCV [Formula: see text] 100 fL) and non-macrocytosis groups. Cox regression analysis was performed to calculate the hazard ratios (HRs) of variables for 30-day mortality, with adjustment for other potential confounding factors. The initial mean value of MCV was 102.7 fL in the macrocytosis group (n = 199) and 93.7 fL in the non-macrocytosis group (n = 1019). The macrocytosis group showed a significantly higher proportion of initial hypotension, transfusion within 4 and 24 h, and 30-day mortality than the non-macrocytosis group. Age ([Formula: see text] 65 years), hypotension (systolic blood pressure [Formula: see text] 90 mmHg), transfusion (within 4 h), anemia (Hb < 12 g/day in women, < 13 g/day in men), and macrocytosis were significantly associated with 30-day mortality (adjusted HR = 1.4; 95% confidence interval 1.01-1.94; p = 0.046) in major trauma patients. Thus, initial macrocytosis independently predicted 30-day mortality in patients with major trauma at a Level I trauma center.
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Affiliation(s)
- Hanlim Choi
- Department of Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jin Young Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea.
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
| | - Younghoon Sul
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Se Heon Kim
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea
| | - Jin Bong Ye
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea
| | - Jin Suk Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea
| | - Soo Young Yoon
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Junepill Seok
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jung Hee Choi
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Lu Y, Luo Y, Zhang Q, Chen W, Zhang N, Wang L, Zhang Y. Decoding the immune landscape following hip fracture in elderly patients: unveiling temporal dynamics through single-cell RNA sequencing. Immun Ageing 2023; 20:54. [PMID: 37848979 PMCID: PMC10580557 DOI: 10.1186/s12979-023-00380-6] [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: 08/03/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Hip fractures in the elderly have significant consequences, stemming from the initial trauma and subsequent surgeries. Hidden blood loss and stress due to concealed injury sites could impact the whole osteoimmune microenvironment. This study employs scRNA-seq technique to map immune profiles in elderly hip fracture patients from post-trauma to the recovery period, investigating the dynamic changes of immune inflammation regulation subgroups. METHODS We collected peripheral blood samples from four elderly hip fracture patients (two males and two females, all > 75 years of age) at three different time points (24 h post-trauma, 24 h post-operation, and day 7 post-operation) and applied scRNA-seq technique to analyze the cellular heterogeneity and identify differentially expressed genes in peripheral blood individual immune cells from elderly hip fracture patients. RESULTS In this study, we analyzed the composition and gene expression profiles of peripheral blood mononuclear cells (PBMCs) from elderly hip fracture patients by scRNA-seq and further identified new CD14 monocyte subpopulations based on marker genes and transcriptional profiles. Distinct gene expression changes were observed in various cell subpopulations at different time points. C-Mono2 monocyte mitochondria-related genes were up-regulated and interferon-related and chemokine-related genes were down-regulated within 24 h post-operation. Further analysis of gene expression profiles at day 7 post-operation showed that C-Mono2 monocytes showed downregulation of inflammation-related genes and osteoblast differentiation-related genes. However, the expression of these genes in cytotoxic T cells, Treg cells, and B cell subsets exhibited a contrasting trend. GZMK+CD8+ cytotoxic T cells showed downregulation of chemokine-related genes, and Treg cells showed upregulation of genes related to the JAK/STAT signaling pathway. Furthermore, we examined interactions among diverse immune cell subsets, pinpointing specific ligand-receptor pairs. These findings imply cross-talk and communication between various cell types in the post-traumatic immune response. CONCLUSIONS Our study elucidates the notable alterations in immune cell subpopulations during different stages of hip fracture in elderly patients, both in terms of proportions and differential gene expressions. These changes provide significant clinical implications for tissue repair, infection prevention, and fracture healing in clinic.
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Affiliation(s)
- Yining Lu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yang Luo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Qi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Ning Zhang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Ling Wang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
- Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
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Ravikumar RH, Maitra S, Prasanna M, Anand RK, Bansal VK, Baidya DK. Ultrasonographic assessment of brachial artery reactivity as a predictor of adverse outcome in patients undergoing emergency laparotomy for perforated peritonitis - Prospective observational study. Indian J Anaesth 2023; 67:905-912. [PMID: 38044920 PMCID: PMC10691603 DOI: 10.4103/ija.ija_625_23] [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: 07/01/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/05/2023] Open
Abstract
Background and Aims This study aimed to assess if pre- and postoperative parameters of brachial artery reactivity (BAR), like flow-mediated dilation (FMD) and hyperaemic velocity (HV), could predict in-hospital mortality in perforation peritonitis patients undergoing emergency laparotomy. Methods In this prospective observational study, adult patients with perforation peritonitis undergoing emergency laparotomy were recruited. FMD and HV were measured preoperatively, postoperatively and at 24 and 48 h post-surgery. Adult patients undergoing elective laparotomy served as the control group. The primary outcome was in-hospital mortality. Baseline and BAR parameters were compared between survivors and non-survivors. Risk factors for mortality were identified by univariate analysis. Prognostic performances of BAR parameters were assessed by different models using logistic regression. All statistical analyses were performed on STATA version 13 for Mac OS. Results Seventy-six emergency laparotomy patients were recruited, and 26 died during the hospital stay. FMD and HV were comparable at all time points between survivors and non-survivors, except that HV was higher in survivors at 48 h post-surgery (median [interquartile range] 1.28 [1.16-1.49] vs. 1.16 [0.86-1.35], P = 0.010]. HV at 48 h predicted mortality (adjusted odds ratio [OR] [95% confidence interval] 21.05 [1.04-422.43], P = 0.046), and a model consisting of age, Acute Physiology and Chronic Health Evaluation (APACHE) score and HV at 48 h was the best predictor of mortality (area under the receiver operating characteristic (AUROC) curve 0.82). Conclusion HV, as measured by ultrasonography of the brachial artery at 48 h postoperatively, is a good predictor of mortality in patients undergoing emergency laparotomy for perforation peritonitis.
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Affiliation(s)
- Rajathadri Hosur Ravikumar
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mrudula Prasanna
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul K. Anand
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder K. Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K. Baidya
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Wier J, Firoozabadi R, Duong A, Patterson JT. Underweight patients experience higher inpatient complication and mortality rates following acetabular fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03739-z. [PMID: 37773420 DOI: 10.1007/s00590-023-03739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Underweight patients experience poor outcomes after elective orthopaedic procedures. The effect of underweight body mass index (BMI) on complications after acetabular fracture is not well-described. We evaluate if underweight status is associated with inpatient complications after acetabular fractures. METHODS Adult patients (≥ 18 years) presenting with acetabular fracture between 2015 and 2019 were identified from Trauma Quality Program data. Adjusted odds (aOR) of any inpatient complication or mortality were compared between patients with underweight BMI (< 18.5 kg/m2) and normal BMI (18.5-25 kg/m2) using multivariable logistic regression and stratifying by age ≥ 65 years. RESULTS The 1299 underweight patients aged ≥ 65 years compared to 11,629 normal weight patients experienced a 1.2-times and 2.7-times greater aOR of any complication (38.6% vs. 36.6%, p = 0.010) and inpatient mortality (7.9% vs. 4.2%, p < 0.001), respectively. The 1688 underweight patients aged 18-64 years compared to 24,762 normal weight patients experienced a 1.2-times and 1.5-times greater aOR of any inpatient complication (38.9% vs. 34.8%, aOR p = 0.006) and inpatient mortality (4.1% vs. 2.5%, p < 0.001), respectively. CONCLUSION Underweight adult patients with acetabular fracture are at increased risk for inpatient complications and mortality, particularly those ≥ 65 years old. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Julian Wier
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Reza Firoozabadi
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Andrew Duong
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA.
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Cogo E, Elsayed M, Bhardwaj S, Cooley K, Aycho C, Liang V, Papadogianis P, Psihogios A, Seely D. Mistletoe Extracts during the Oncological Perioperative Period: A Systematic Review and Meta-Analysis of Human Randomized Controlled Trials. Curr Oncol 2023; 30:8196-8219. [PMID: 37754510 PMCID: PMC10529072 DOI: 10.3390/curroncol30090595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND We aim to evaluate the safety and efficacy of mistletoe extract (ME) use during the oncological perioperative period. METHODS Details registered a priori on PROSPERO (CRD42018086168). RESULTS Seven RCTs (comprising 663 participants in nine reports) and three nonrandomized studies were included. In five RCTs, ME was evaluated as adjunctive care and the control group had no additional intervention, whereas in two RCTs, ME was compared head-to-head against common cancer treatments (i.e., etoposide or bacillus Calmette-Guérin) with the intervention groups not receiving standard care. Meta-analyses found no evidence for a difference between ME and no added therapy for mortality and recurrence (RR, 95% CI: 1.00, 0.79-1.27; and 1.03, 0.79-1.33, respectively). Two RCTs reported beneficial effects of ME on immune cells, specifically natural killer cells, in colorectal cancer, and one RCT reported quality of life improvement. Two RCTs reported ME discontinuations due to adverse events and grade 3/4 toxicities. Nevertheless, no safety signals were detected from these 10 studies. Quality appraisal revealed a substantial risk of bias. CONCLUSIONS Preliminary data are encouraging for mistletoe extracts, particularly in the context of colorectal cancer. However, the evidence is limited by the number of studies, an evaluation of different outcomes, and methodological limitations. Further high-quality research is warranted.
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Affiliation(s)
- Elise Cogo
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
| | - Mohamed Elsayed
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
- The Centre for Health Innovation, Ottawa, ON K2P 0M7, Canada
| | - Sukriti Bhardwaj
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
| | - Kieran Cooley
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
- Pacific College of Health Sciences, San Diego, CA 92108, USA
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore 2480, Australia
- School of Public Health, University of Technology Sydney, Ultimo 2007, Australia
| | - Christilynn Aycho
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
| | - Vivian Liang
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
| | - Peter Papadogianis
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
| | - Athanasios Psihogios
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
| | - Dugald Seely
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada; (E.C.); (M.E.); (S.B.); (K.C.); (C.A.)
- The Centre for Health Innovation, Ottawa, ON K2P 0M7, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
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9
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Cui H, Zhao D, Jian J, Zhang Y, Jian M, Yu B, Hu J, Li Y, Han X, Jiang L, Wang X. Risk factor analysis and construction of prediction models for short-term postoperative complications in patients undergoing gastrointestinal tract surgery. Front Surg 2023; 9:1003525. [PMID: 36684321 PMCID: PMC9845637 DOI: 10.3389/fsurg.2022.1003525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose To identify risk factors associated with short-term postoperative complications in patients with gastrointestinal cancer and develop and validate prediction models to predict the probability of complications. Methods A total of 335 patients enrolled in the primary cohort of this study were divided into training and validation sets in a chronological order. Using univariate and multivariate logistic regression analyses, the risk factors for postoperative complications were determined, and nomogram prediction models were constructed. The performance of the nomogram was assessed with respect to the receiver operator characteristic and calibration curves. Results Patients with complications had a stronger postoperative stress response and a longer duration of daily fluid intake/output ratio >1 after surgery. Logistic analysis revealed that body mass index (BMI), body temperature on POD4 (T.POD4), neutrophil percentage on POD4 (N.POD4), fasting blood glucose on POD4 (FBG.POD4), and the presence of fluid intake/output ratio <1 within POD4 were risk factors for POD7 complications, and that BMI, T.POD7, N.POD7, FBG.POD4, FBG.POD7, and the duration of daily fluid intake/output ratio >1 were risk factors for POD30 complications. The areas under the curve of Nomogram-A for POD7 complications were 0.867 and 0.833 and those of Nomogram-B for POD30 complications were 0.920 and 0.918 in the primary and validation cohorts, respectively. The calibration curves showed good consistency in both cohorts. Conclusion This study presented two nomogram models to predict short-term postoperative complications in patients with gastrointestinal cancer. The results could help clinicians identify patients at high risk of complications within POD7 or POD30.
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Affiliation(s)
- Hongming Cui
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Dawei Zhao
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Jingren Jian
- Department of Surgical Department, Jinxiang Hongda Hospital Affiliated to Jining Medical University, Jining, China
| | - Yifei Zhang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Mi Jian
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Bin Yu
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Jinchen Hu
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yanbao Li
- Department of Surgical Department, Yantai Yeda Hospital, Yantai, China
| | - Xiaoli Han
- Department of Surgical Department, Yantai Yeda Hospital, Yantai, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Department of Surgical Department, Yantai Yeda Hospital, Yantai, China,Correspondence: Lixin Jiang Xixun Wang
| | - Xixun Wang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Correspondence: Lixin Jiang Xixun Wang
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10
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Sakata T, Tanikawa M, Yamada H, Fujinami R, Nishikawa Y, Yamada S, Mase M. Minimally invasive treatment for glioblastoma through endoscopic surgery including tumor embolization when necessary: a technical note. Front Neurol 2023; 14:1170045. [PMID: 37153685 PMCID: PMC10160401 DOI: 10.3389/fneur.2023.1170045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
Background Although there have been some reports on endoscopic glioblastoma surgery, the indication has been limited to deep-seated lesions, and the difficulty of hemostasis has been a concern. In that light, we attempted to establish an endoscopic procedure for excision of glioblastoma which could be applied even to hypervascular or superficial lesions, in combination with pre-operative endovascular tumor embolization. Methods Medical records of six consecutive glioblastoma patients who received exclusive endoscopic removal between September and November 2020 were analyzed. Preoperative tumor embolization was performed in cases with marked tumor stain and proper feeder arteries having an abnormal shape, for instance, tortuous or dilated, without passing through branches to the normal brain. Endoscopic tumor removal through a key-hole craniotomy was performed by using an inside-out excision for a deep-seated lesion, with the addition of an outside-in extirpation for a shallow portion when needed. Results Endoscopic removal was successfully performed in all six cases. Before resection, endovascular tumor embolization was performed in four cases with no resulting complications, including ischemia or brain swelling. Gross total resection was achieved in three cases, and near total resection in the other three cases. Intraoperative blood loss exceeded 1,000 ml in only one case, whose tumor showed a prominent tumor stain but no proper feeder artery for embolization. In all patients, a smooth transition to adjuvant therapy was possible with no surgical site infection. Conclusion Endoscopic removal for glioblastoma was considered to be a promising procedure with minimal invasiveness and a favorable impact on prognosis.
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11
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Acute Systemic White Blood Cell Changes following Degenerative Cervical Myelopathy (DCM) in a Mouse Model. Int J Mol Sci 2022; 23:ijms231911496. [PMID: 36232808 PMCID: PMC9570488 DOI: 10.3390/ijms231911496] [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: 09/05/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is caused by age-related degeneration of the cervical spine, causing chronic spinal cord compression and inflammation. The aim of this study was to assess whether the natural progression of DCM is accompanied by hematological changes in the white blood cell composition. If so, these changes can be used for diagnosis complementing established imaging approaches and for the development of treatment strategies, since peripheral immunity affects the progression of DCM. Gradual compression of the spinal cord was induced in C57B/L mice at the C5-6 level. The composition of circulating white blood cells was analyzed longitudinally at four time points after induction of DCM using flow cytometry. At 12 weeks, serum cytokine levels were measured using a Luminex x-MAP assay. Neurological impairment in the mouse model was also assessed using the ladder walk test and CatWalk. Stepping function (* p < 0.05) and overground locomotion (*** p < 0.001) were impaired in the DCM group. Importantly, circulating monocytes and T cells were affected primarily at 3 weeks following DCM. T cells were two-fold lower in the DCM group (*** p < 0.0006), whereas monocytes were four-fold increased (*** p < 0.0006) in the DCM compared with the sham group. Our data suggest that changes in white blood cell populations are modest, which is unique to other spinal cord pathologies, and precede the development of neurobehavioral symptoms.
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12
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Shan Y, Chen G, Shi Q, Huang J, Mi Y, Zhang W, Zhang H, Jia B. Heparin/Collagen-REDV Modification of Expanded Polytetrafluoroethylene Improves Regional Anti-thrombosis and Reduces Foreign Body Reactions in Local Tissues. Front Bioeng Biotechnol 2022; 10:916931. [PMID: 35992343 PMCID: PMC9386153 DOI: 10.3389/fbioe.2022.916931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Prosthetic implants of expanded polytetrafluoroethylene (ePTFE) in the cardiovascular system have a high failure rate over the long term because of thrombosis and intimal hyperplasia. Although multiple surface modification methods have been applied to improve the anti-thrombotic and in situ endothelialization abilities of ePTFE, none have delivered outstanding results in vivo. Our previous study combined heparin/collagen multilayers and REDV peptides to modify ePTFE, and the in-vitro results showed that modification ePTFE with heparin/collagen-REDV can promote the cytocompatibility and antiplatelet property. This study illustrated the physical change, selective endothelial cells capture ability, and in vivo performance in further. The physical test demonstrated that this modification improved the hydrophilicity, flexibility and strength of ePTFE. A competition experiment of co-cultured endothelial cells and vascular smooth muscle cells verified that the heparin/collagen-REDV modification had high specificity for endothelial cell capture. A rabbit animal model was constructed to evaluate the in vivo performance of modified ePTFE implanted in the right ventricular outflow tract. The results showed that heparin/collagen-REDV modification was safe, promoted endothelialization, and successfully achieved regional anti-thrombosis without influencing body-wide coagulation function. The pathologic manifestations and mRNA expression pattern in tissues in contact with modified ePTFE indicated that this modification method may reduce M2-type macrophage infiltration and the expression of genes related to immune and inflammatory responses. The heparin/collagen-REDV modification may lower the incidence of complications related to ePTFE implantation and has good prospects for clinical use.
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Affiliation(s)
| | | | | | | | | | | | | | - Bing Jia
- *Correspondence: Huifeng Zhang, ; Bing Jia,
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13
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Lanini I, Amass T, Calabrisotto CS, Fabbri S, Falsini S, Adembri C, Di Filippo A, Romagnoli S, Villa G. The influence of psychological interventions on surgical outcomes: a systematic review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:31. [PMID: 37386591 DOI: 10.1186/s44158-022-00057-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/10/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND An amplified and/or prolonged surgical stress response might overcome the organs' functional reserve, thus leading to postoperative complications. The aim of this systematic literature review is to underline how specific psychological interventions may contribute to improve surgical outcomes through the positive modulation of the surgical stress response in surgical patients. METHODS We conducted a comprehensive literature search in the Cochrane Register of Controlled Trials, PubMed, EMBASE, Scopus, PsycINFO, and CINAHL databases. Only studies published in English from Jan 2000 to Apr 2022 and reporting pain and/or anxiety among outcome measures were included in the review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioral therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis, and (6) coping strategies. RESULTS Among 3167 records identified in the literature, 5 papers were considered eligible for inclusion in this review because reporting the effects that psychological features have on neurochemical signaling during perioperative metabolic adaptation and those metabolic and clinical effects that the psychological interventions had on the observed population. CONCLUSION Our findings confirm that psychological interventions may contribute to improve surgical outcomes via the positive influence on patients' metabolic surgical stress response. A multidisciplinary approach integrating physical and non-physical therapies can be considered a good strategy to successfully improve surgical outcomes in the perioperative period.
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Affiliation(s)
- Iacopo Lanini
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
| | - Timothy Amass
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO, USA
| | - Caterina Scirè Calabrisotto
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
| | - Sergio Fabbri
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy.
| | - Silvia Falsini
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Chiara Adembri
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alessandro Di Filippo
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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14
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Liu J, Wang J, Deng Z, Liu S, Li G, Sun Y, Gao L, Li C, Shi B. Differences in the Impact of Heart Rate Variability on the Surgical Approach in Patients With Early Cervical Cancer: Laparoscopic versus Open Surgery. Front Oncol 2022; 12:804242. [PMID: 35720009 PMCID: PMC9205605 DOI: 10.3389/fonc.2022.804242] [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: 10/29/2021] [Accepted: 05/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Evidence suggests that the risk of recurrence and death in patients with early cervical cancer (ECC) undergoing minimally invasive surgery is significantly higher than that in patients undergoing open surgery. However, the mechanisms underlying such a difference remain unclear. Heart rate variability (HRV) represents autonomic nerve activity, which is related to tumorgenesis and can be used as a prognostic indicator for various cancers. The main purpose of this study was to explore the difference in the effects of laparoscopic and open surgery on HRV in ECC patients. Methods A total of 68 ECC (FIGO IA1 with lymphovascular space invasion -IIA2) patients undergoing radical hysterectomy for the first time (84% open group vs. 16% laparoscopic group) were included. A single-lead micro-ECG recorder was used to collect 5 min electrocardiograms 1 day before the operation and 3 days after the operation, and then HRV time domain and frequency domain indices were analyzed, including mean heart rate (MeanHR), maximum heart rate (MaxHR), minimum heart rate (MinHR), the standard deviation of all normal-to-normal intervals (SDNN), the root mean square of successive interval differences (RMSSD), very low-frequency power (VLF), low-frequency power (LF), high-frequency power (HF), total power (TP), and the ratio of LF to HF (LF/HF). Results Heart rate (i.e., MeanHR, MaxHR, and MinHR) were significantly higher, and HRV (i.e., SDNN, RMSSD, LF, HF, and TP) were significantly lower after the operation than before the operation in both the laparoscopic and open groups (P < 0.05). The postoperative reduction in RMSSD and HF was significantly higher in the laparoscopic group than in the open group (P < 0.05). Conclusions These data suggest that radical hysterectomy can lead to increased heart rate and decreased HRV in patients with ECC, which can negatively affect cardiac autonomic regulation. Compared with open surgery, laparoscopic surgery has a greater negative impact on the HRV of ECC patients.
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Affiliation(s)
- Jian Liu
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Jingfeng Wang
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Zhaoya Deng
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Shiqi Liu
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Yilin Sun
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Longfei Gao
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Chenghui Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
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15
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A Multidimensional Bioinformatic Platform for the Study of Human Response to Surgery. Ann Surg 2022; 275:1094-1102. [PMID: 35258509 DOI: 10.1097/sla.0000000000005429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To design and establish a prospective biospecimen repository that integrates multi-omics assays with clinical data to study mechanisms of controlled injury and healing. SUMMARY BACKGROUND DATA Elective surgery is an opportunity to understand both the systemic and focal responses accompanying controlled and well-characterized injury to the human body. The overarching goal of this ongoing project is to define stereotypical responses to surgical injury, with the translational purpose of identifying targetable pathways involved in healing and resilience, and variations indicative of aberrant peri-operative outcomes. METHODS Clinical data from the electronic medical record combined with large-scale biological data sets derived from blood, urine, fecal matter, and tissue samples are collected prospectively through the peri-operative period on patients undergoing fourteen surgeries chosen to represent a range of injury locations and intensities. Specimens are subjected to genomic, transcriptomic, proteomic, and metabolomic assays to describe their genetic, metabolic, immunologic, and microbiome profiles, providing a multidimensional landscape of the human response to injury. RESULTS The highly multiplexed data generated includes changes in over 28,000 mRNA transcripts, 100 plasma metabolites, 200 urine metabolites, and 400 proteins over the longitudinal course of surgery and recovery. In our initial pilot dataset, we demonstrate the feasibility of collecting high quality multi-omic data at pre- and post-operative time points and are already seeing evidence of physiologic perturbation between timepoints. CONCLUSIONS This repository allows for longitudinal, state-of-the-art genomic, transcriptomic, proteomic, metabolomic, immunologic, and clinical data collection and provides a rich and stable infrastructure on which to fuel further biomedical discovery.
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16
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Surgical Antimicrobial Prophylaxis in Neonates and Children with Special High-Risk Conditions: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11020246. [PMID: 35203848 PMCID: PMC8868320 DOI: 10.3390/antibiotics11020246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Surgical site infections (SSIs), which are a potential complications in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they also have a significant economic impact on health systems. Data in literature regarding risk factors for SSIs in pediatric age are scarce, with consequent difficulties in the management of SSI prophylaxis and with antibiotic prescribing attitudes in the various surgical procedures that often tend to follow individual opinions. The lack of pediatric studies is even more evident when we consider surgeries performed in subjects with underlying conditions that may pose an increased risk of complications. In order to respond to this shortcoming, we developed a consensus document to define optimal surgical antimicrobial prophylaxis (SAP) in neonates and children with specific high-risk conditions. These included the following: (1) colonization by methicillin-resistant Staphylococcus aureus (MRSA) and by multidrug resistant (MDR) bacteria other than MRSA; (2) allergy to first-line antibiotics; (3) immunosuppression; (4) splenectomy; (5) comorbidity; (6) ongoing antibiotic therapy or prophylaxis; (7) coexisting infection at another site; (8) previous surgery in the last month; and (9) presurgery hospitalization lasting more than 2 weeks. This work, made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, represents, in our opinion, the most up-to-date and comprehensive collection of recommendations relating to behaviors to be undertaken in a perioperative site in the presence of specific categories of patients at high-risk of complications during surgery. The application of uniform and shared protocols in these high-risk categories will improve surgical practice with a reduction in SSIs and consequent rationalization of resources and costs, as well as being able to limit the phenomenon of antimicrobial resistance.
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Pentobarbital may protect against neurogenic inflammation after surgery via inhibition of substance P release from peripheral nerves of rats. Neurosci Lett 2022; 771:136467. [DOI: 10.1016/j.neulet.2022.136467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/28/2021] [Accepted: 01/15/2022] [Indexed: 11/23/2022]
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18
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Sandy-Hodgetts K, Andersen CA, Al-Jalodi O, Serena L, Teimouri C, Serena TE. Uncovering the high prevalence of bacterial burden in surgical site wounds with point-of-care fluorescence imaging. Int Wound J 2021; 19:1438-1448. [PMID: 34962067 PMCID: PMC9493216 DOI: 10.1111/iwj.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023] Open
Abstract
Detection of bacterial burden within or near surgical wounds is critical to reducing the occurrence of surgical site infection (SSI). A distinct lack of reliable methods to identify postoperative bioburden has forced reliance on clinical signs and symptoms of infection (CSS). As a result, infection management has been reactive, rather than proactive. Fluorescence imaging of bacterial burden (FL) is positioned to potentially flip that paradigm. This post hoc analysis evaluated 58 imaged and biopsied surgical site wounds from the multi‐centre fluorescence imaging assessment and guidance clinical trial. Diagnostic accuracy measures of CSS and FL were evaluated. A reader study investigated the impact of advanced image interpretation experience on imaging sensitivity. Forty‐four of fifty‐eight surgical site wounds (75.8%) had bacterial loads >104 CFU/g (median = 3.11 × 105 CFU/g); however, only 3 of 44 were CSS positive (sensitivity of 6.8%). FL improved sensitivity of bacterial detection by 5.7‐fold compared with CSS alone (P = .0005). Sensitivity improved by 11.3‐fold over CSS among clinicians highly experienced with FL interpretation (P < .0001). Surgical sites that reach the stage of referral to a wound specialist frequently harbour asymptomatic high bacterial loads that delay healing and increase infection risk. Advanced imaging of pathological bacterial burden improves surgical site monitoring and may reduce the rate of SSIs.
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Affiliation(s)
- Kylie Sandy-Hodgetts
- School of Biomedical Sciences, Pathology and Laboratory Science, University of Western Australia, Perth, Western Australia, Australia.,Centre for Molecular Medicine & Innovative Therapeutics, Murdoch University, Murdoch, Western Australia, Australia
| | - Charles A Andersen
- Wound Care Clinic, Madigan Army Medical Center, Joint Base Lewis-McChord, Renton, Washington, USA
| | - Omar Al-Jalodi
- SerenaGroup Research Foundation, Cambridge, Massachusetts, USA
| | - Laura Serena
- SerenaGroup Research Foundation, Cambridge, Massachusetts, USA
| | | | - Thomas E Serena
- SerenaGroup Research Foundation, Cambridge, Massachusetts, USA
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19
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Lohchab V, Singh J, Mahapatra P, Bachhal V, Hooda A, Jindal K, Dhillon MS. Thermal imaging in total knee replacement and its relation with inflammation markers. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:7759-7773. [PMID: 34814274 DOI: 10.3934/mbe.2021385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Total knee replacement is an end-stage surgical treatment of osteoarthritis patients to improve their quality of life. The study presents a thermal imaging-based approach to assess the recovery of operated-knees. The study focuses on the potential of thermal imaging for total knee replacement and its relation with clinical inflammatory markers. A total of 20 patients with bilateral knee replacement were included for thermal imaging and serology, where data was acquired on pre-operative day and five post-operative days. To quantify the inflammation, the temperature-based parameters (like mean differential temperature, relative percentage of raised temperature) were evaluated from thermal images, while the clinically proven inflammation markers were obtained from blood samples for clinical validation. Initially, the knee region was segmented by applying the automatic method, subsequently, the mean skin temperature was calculated and investigated for a statistical relevant relationship with inflammatory markers. After surgery, the mean skin temperature was first increased (>2.15 ℃ for different views) then settled to pre-operative level by 90th day. Consequently, the mean differential temperature showed a strong correlation with erythrocyte sedimentation rate (r > 0.893) and C-reactive protein (r > 0.955). Also, the visual profile and relative percentage of raised temperature showed promising results in quantifying the temperature changes both qualitatively and quantitatively. This study provides an automatic and non-invasive way of screening the patients for raised levels of skin temperature, which can be a sign of inflammation. Hence, the proposed temperature-based technique can help the clinicians for visual assessment of post-operative recovery of patients.
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Affiliation(s)
- Viney Lohchab
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
- CSIR-Central Scientific Instruments Organisation, Sector 30 C, Chandigarh 160030, India
| | - Jaspreet Singh
- CSIR-Central Scientific Instruments Organisation, Sector 30 C, Chandigarh 160030, India
- Sant Longowal Institute of Engineering and Technology, Punjab 148106, India
| | - Prasant Mahapatra
- CSIR-Central Scientific Instruments Organisation, Sector 30 C, Chandigarh 160030, India
| | - Vikas Bachhal
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Aman Hooda
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Karan Jindal
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - M S Dhillon
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Low body mass index is associated with increased mortality in patients with pelvic and acetabular fractures. Injury 2021; 52:2322-2326. [PMID: 34083023 DOI: 10.1016/j.injury.2021.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
AIMS Fractures of the pelvis and acetabulum are often the consequence of high energy trauma in young individuals or fragility fractures in osteoporotic bone. They can be life-threatening or life changing injuries. No published data exists comparing body mass index (BMI) and mortality for this patient group. The aim of this study was to identify if low BMI (<18.5) was a predictor of morbidity and mortality for patients with these injuries. PATIENTS AND METHODS Of the 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre (MTC) over a 4.5-year period (August 2015 - January 2020); we retrospectively analysed data for all admitted patients. Data was collected on demographics, injury pattern, operative intervention and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not. Both in-hospital and post discharge complications were recorded including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months. RESULTS 569 patients admitted to the MTC with a pelvic or acetabular fracture were included in our analysis. Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with triple the in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659). CONCLUSION This is the first published study that demonstrates a statistically significant increase in mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should carefully consider appropriate peri-operative optimisation for these patients. Further investigation into the effects of low BMI and response to trauma is required.
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Administration of Low-Dose Dexmedetomidine Did Not Affect Acute Inflammatory Response after Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy: A Double-Blind Randomized Controlled Trial. J Clin Med 2021; 10:jcm10143145. [PMID: 34300310 PMCID: PMC8303433 DOI: 10.3390/jcm10143145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
During cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), attenuation of inflammatory responses that increase susceptibility to postoperative complications, morbidity, and mortality is important. We aimed to evaluate whether intraoperative dexmedetomidine infusion impacted inflammatory response in patients undergoing CRS with HIPEC. Fifty-six patients scheduled for CRS with HIPEC were randomly assigned to the control (n = 28) and dexmedetomidine (n = 28) groups. The primary endpoint was the effect of dexmedetomidine on the interleukin-6 (IL-6) level measured at pre-operation (Pre-OP), before HIPEC initiation (Pre-HIPEC), immediately after HIPEC; after the end of the operation; and on postoperative day (POD) 1. In both groups, the IL-6 levels from Pre-HIPEC until POD 1 and the C-reactive protein (CRP) levels on PODs 1, 2, and 3 were significantly higher than the Pre-OP values (all Bonferroni corrected, p < 0.001). However, total differences in IL-6 and CRP levels, based on the mean area under the curve, were not detected between the two groups. The continuous intraoperative infusion of dexmedetomidine (0.4 μg/kg/h) in patients undergoing CRS with HIPEC did not significantly lower the inflammatory indices. Further dose investigative studies are needed to find the dexmedetomidine dose that provides anti-inflammatory and sympatholytic effects during HIPEC.
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Shekhar A, Srivastava S, Kumar Bhati L, Chaturvedi A, Singh S, Agarwal B, Arora K. An evaluation of the effect of ozone therapy on tissues surrounding dental implants. Int Immunopharmacol 2021; 96:107588. [PMID: 33812261 DOI: 10.1016/j.intimp.2021.107588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/20/2021] [Accepted: 03/10/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dental implant surgery despite its growing popularity poses several challenges like include tissue inflammation, pain discomfort and tissue injury. OBJECTIVE To evaluate the effect of ozone therapy on inflammation, pain and wound healing after implant surgery. METHODS A clinical study was conducted on 60 systematically healthy patients- 30 patients treated with ozone (Experimental group) and 30 patients without ozone treatment (control group). In the control group osteotomy procedure was performed with saline irrigation and in the experimental group irrigation was done with ozonated water at 25 µg/mL concentration, along with ozone gas. Clinical assessment was done by evaluating C-reactive Protein (CRP) for inflammation, pain using Visual Analogue Scale (VAS) score and tissue wound healing using wound healing index. Side effects, if any, were noted. RESULTS Postoperative increment in CRP levels was 0.10 and 0.63 mg/dl in Experimental and control groups respectively (p < 0.001). At 24-hr, 48-hr and 7 day post-operative intervals mean VAS scores for pain were significantly higher in Control group as compared to that in Experimental Group (p < 0.001). At day 7, mean VAS scores for pain were 3.50 ± 0.63 and 37.70 ± 4.17 in Experimental and Control groups respectively (p < 0.001). Mean tissue healing indices were significantly higher on Day 7 and Day 14 in Experimental Group (4.23 ± 0.43 and 4.97 ± 0.18) as compared to that in control group (3.07 ± 0.45 and 4.03 ± 0.18) (p < 0.001). No potential side effects were noted in either of two groups. CONCLUSION Ozone therapy accelerated the tissue wound healing, minimized tissue inflammation and decreased pain.
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Affiliation(s)
- Abhinav Shekhar
- Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, India
| | - Shitij Srivastava
- Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, India
| | - Love Kumar Bhati
- Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, India
| | - Anshuman Chaturvedi
- Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, India
| | - Shivesh Singh
- Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, India
| | - Bhaskar Agarwal
- Department of Prosthodontics, King George's Medical University, Lucknow, India.
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Burcharth J, Falkenberg A, Schack A, Ekeloef S, Gögenur I. The effects of early enteral nutrition on mortality after major emergency abdominal surgery: A systematic review and meta-analysis with Trial Sequential Analysis. Clin Nutr 2021; 40:1604-1612. [PMID: 33744604 DOI: 10.1016/j.clnu.2021.02.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Early oral or enteral nutrition (EEN) has been proven safe, tolerable, and beneficial in elective surgery. In emergency abdominal surgery no consensus exists regarding postoperative nutrition standard regimens. This review aimed to assess the safety and clinical outcomes of EEN compared to standard care after emergency abdominal surgery. METHODS The review protocol was performed according to the Cochrane Handbook and reported according to PRISMA. Clinical outcomes included mortality, specific complication rates, length of stay, and serious adverse events. Risk of bias was assessed by Cochrane risk of bias tool and Downs and Black. GRADE assessment of each outcome was performed, and Trial Sequential Analysis was completed to obtain the Required Information Size (RIS) of each outcome. RESULTS From a total of 4741 records screened, a total of five randomized controlled trials and two non-randomized controlled trials were included covering 1309 patients. The included studies reported no safety issues regarding the use of EEN. A significant reduction in the mortality rate of EEN compared with standard care was seen (OR 0.59 (CI 95% 0.34-1.00), I2 = 0%). Meta-analyses on sepsis and postoperative pulmonary complications showed non-significant tendencies in favor of EEN compared with standard care. GRADE assessment of all outcomes was evaluated 'low' or 'very low'. Trial Sequential Analysis revealed that all outcomes had insufficient RIS to confirm the effects of EEN. CONCLUSION EEN after major emergency surgery is correlated with reduced mortality, however, more high-quality data regarding the optimal timing and composition of nutrition are needed before final conclusions regarding the effects of EEN can be made.
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Affiliation(s)
- Jakob Burcharth
- Department of Surgery, Zealand University Hospital, Denmark.
| | | | - Anders Schack
- Department of Surgery, Zealand University Hospital, Denmark
| | - Sarah Ekeloef
- Department of Surgery, Zealand University Hospital, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Denmark
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24
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Effects of Water-Circulating Cooling Mask on Postoperative Outcomes in Orthognathic Surgery and Facial Trauma. J Craniofac Surg 2021; 31:1981-1985. [PMID: 32604311 DOI: 10.1097/scs.0000000000006624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD -1.75, CI 95% -2.69 to -0.81; Swelling: MD -21.16 mL, CI 95% -38.91 to -3.41) and in the final evaluation (Pain: MD -0.31, CI 95% -0.44 to -0.18; MD -4.45 mL, CI 95% -7.87 to -1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.
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25
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Barden A, Corcoran TB, Preuss J, Phillips M, Mas E, Mori TA. Increased inspired oxygen concentration does not adversely affect oxidative stress and the resolution of inflammation during reperfusion in patients undergoing knee replacement surgery. Free Radic Res 2021; 55:131-140. [PMID: 33356676 DOI: 10.1080/10715762.2020.1868451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The level of inspired oxygen during surgery may modify free radical release, and reperfusion injury. This controlled trial examined the effect of inspired oxygen on F2-isoprostanes (F2-IsoPs), isofurans (IsoFs), and specialized mediators of inflammation resolution (SPM) during knee replacement surgery. Patients received either 30% O2 (control n = 21), 50% O2 (n = 20), or 80% O2 (n = 19) O2, in a parallel design. Hemoglobin (Hb) was measured throughout the surgery and F2-IsoPs, IsoFs and SPM were analyzed by mass spectrometry. The effect of O2 on F2-IsoPs and IsoFs was examined during tourniquet inflation and after tourniquet release. SPM were measured at baseline and the end of surgery. There was a significant interaction between O2 and Hb concentrations with plasma IsoFs during tourniquet inflation. An increase in plasma IsoFs over time was attenuated in the 80% O2 group (p=.012) compared with the 30% O2 group after adjusting for Hb concentration. After tourniquet release, plasma F2-IsoPs were significantly lower in the 50% and 80% O2 groups (p=.009 and p=.001, respectively) compared with the 30% O2 group after adjustment for Hb concentration. The SPM RvD2 and RvE2 were increased with 50% and 80% O2 (RvD2, p=.014 and p=.002, respectively; RvE2, p=.032 with 50% O2) compared with the 30% O2 group, in analyses that corrected for Hb concentration. We have shown for the first time that higher O2 levels may be beneficial in reducing oxidative stress and increasing resolution of inflammation during surgery that involves reperfusion after application of a tourniquet.
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Affiliation(s)
- Anne Barden
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Tomas B Corcoran
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia
| | - James Preuss
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia.,Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Michael Phillips
- Harry Perkins Institute for Medical Research, University of Western Australia, Perth, Australia
| | - Emilie Mas
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Trevor A Mori
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
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Webb AJ, Seisa MO, Nayfeh T, Wieruszewski PM, Nei SD, Smischney NJ. Vasopressin in vasoplegic shock: A systematic review. World J Crit Care Med 2020; 9:88-98. [PMID: 33384951 PMCID: PMC7754532 DOI: 10.5492/wjccm.v9.i5.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/10/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vasoplegic shock is a challenging complication of cardiac surgery and is often resistant to conventional therapies for shock. Norepinephrine and epinephrine are standards of care for vasoplegic shock, but vasopressin has increasingly been used as a primary pressor in vasoplegic shock because of its unique pharmacology and lack of inotropic activity. It remains unclear whether vasopressin has distinct benefits over standard of care for patients with vasoplegic shock.
AIM To summarize the available literature evaluating vasopressin vs non-vasopressin alternatives on the clinical and patient-centered outcomes of vasoplegic shock in adult intensive care unit (ICU) patients.
METHODS This was a systematic review of vasopressin in adults (≥ 18 years) with vasoplegic shock after cardiac surgery. Randomized controlled trials, prospective cohorts, and retrospective cohorts comparing vasopressin to norepinephrine, epinephrine, methylene blue, hydroxocobalamin, or other pressors were included. The primary outcomes of interest were 30-d mortality, atrial/ventricular arrhythmias, stroke, ICU length of stay, duration of vasopressor therapy, incidence of acute kidney injury stage II-III, and mechanical ventilation for greater than 48 h.
RESULTS A total of 1161 studies were screened for inclusion with 3 meeting inclusion criteria with a total of 708 patients. Two studies were randomized controlled trials and one was a retrospective cohort study. Primary outcomes of 30-d mortality, stroke, ventricular arrhythmias, and duration of mechanical ventilation were similar between groups. Conflicting results were observed for acute kidney injury stage II-III, atrial arrhythmias, duration of vasopressors, and ICU length of stay with higher certainty of evidence in favor of vasopressin serving a protective role for these outcomes.
CONCLUSION Vasopressin was not found to be superior to alternative pressor therapy for any of the included outcomes. Results are limited by mixed methodologies, small overall sample size, and heterogenous populations.
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Affiliation(s)
- Andrew J Webb
- Department of Pharmacy, Oregon Health and Science University, Portland, OR 97239, United States
| | - Mohamed O Seisa
- Robert D and Patricia E Kern Center For The Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States
| | - Tarek Nayfeh
- Robert D and Patricia E Kern Center For The Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States
| | | | - Scott D Nei
- Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, United States
| | - Nathan J Smischney
- Department of Anesthesia, Mayo Clinic, Rochester, MN 55905, United States
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Patients' perceptions of barriers to enhanced recovery after emergency abdominal surgery. Langenbecks Arch Surg 2020; 406:405-412. [PMID: 33215245 DOI: 10.1007/s00423-020-02032-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The patient-perceived barriers towards an optimized short-term recovery after major emergency abdominal surgery are unknown. The purpose was to investigate which patient-perceived barriers dominated concerning nutrition, mobilization, and early discharge after major emergency abdominal surgery. METHODS An explorative study, which focused on patient-perceived barriers for early discharge, mobilization, and nutrition, was performed within an enhanced recovery perioperative setting in major emergency abdominal surgery. Patients were asked daily from postoperative day (POD) 1 to POD 7 of their self-perceived barriers towards getting fully mobilization and resuming normal oral intake. From POD 3 to POD 7, patients were asked regarding self-perceived barriers towards early discharge. RESULTS A total of 101 patients that underwent major emergency abdominal surgery were included for final analysis from March 2017 to August 2017. The main patient self-perceived barrier towards sufficient nutrition was dominated by food aversion (including loss of appetite). The main patient self-perceived barrier towards sufficient mobilization throughout the study period was fatigue. The patient self-perceived barriers towards early discharge were more diffuse and lacked a dominant variable throughout the study period; however, fatigue was the most pronounced barrier throughout the study period. The leading initial variables were postoperative ileus, insufficient nutrition, and epidural catheter. The leading later variables besides fatigue included awaiting normalization of biochemistry values, pain, and the perception of insufficient oral intake. CONCLUSIONS The major patient-perceived factors that limited postoperative recovery after major emergency abdominal surgery included food aversion regarding normalization of oral intake and fatigue regarding mobilization and early discharge.
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Simultaneous LC-MS/MS-Based Quantification of Free 3-Nitro-l-tyrosine, 3-Chloro-l-tyrosine, and 3-Bromo-l-tyrosine in Plasma of Colorectal Cancer Patients during Early Postoperative Period. Molecules 2020; 25:molecules25215158. [PMID: 33167555 PMCID: PMC7663926 DOI: 10.3390/molecules25215158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022] Open
Abstract
Quantification with satisfactory specificity and sensitivity of free 3-Nitro-l-tyrosine (3-NT), 3-Chloro-l-tyrosine (3-CT), and 3-Bromo-l-tyrosine (3-BT) in biological samples as potential inflammation, oxidative stress, and cancer biomarkers is analytically challenging. We aimed at developing a liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based method for their simultaneous analysis without an extract purification step by solid-phase extraction. Validation of the developed method yielded the following limits of detection (LOD) and quantification (LOQ) for 3-NT, 3-BT, and 3-CT: 0.030, 0.026, 0.030 ng/mL (LODs) and 0.100, 0.096, 0.098 ng/mL (LOQs). Coefficients of variation for all metabolites and tested concentrations were <10% and accuracy was within 95-105%. Method applicability was tested on colorectal cancer patients during the perioperative period. All metabolites were significantly higher in cancer patients than healthy controls. The 3-NT was significantly lower in advanced cancer and 3-BT showed a similar tendency. Dynamics of 3-BT in the early postoperative period were affected by type of surgery and presence of surgical site infections. In conclusion, a sensitive and specific LC-MS/MS method for simultaneous quantification of free 3-NT, 3-BT, and 3-CT in human plasma has been developed.
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Weissinger GM, Carthon JMB, Brawner BM. Non-psychiatric hospitalization length-of-stay for patients with psychotic disorders: A mixed methods study. Gen Hosp Psychiatry 2020; 67:1-9. [PMID: 32866772 PMCID: PMC7722147 DOI: 10.1016/j.genhosppsych.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with psychotic disorders experience higher rates of chronic and acute non-psychotic diseases and have frequent non-psychiatric hospitalizations which result in both longer and more varied length-of-stay (LoS) than other patients. This study seeks to use a patient-centered perspective to examine LoS. METHODS This article reports Phase Two of a mixed methods, exploratory sequential study on non-psychiatric hospitalizations for individuals with psychotic disorders. Patients' experiences were used to guide a quantitative analysis of LoS using a general linear model. RESULTS Medical comorbidities were the patient characteristics which had the largest effect on LoS. Certain processes of care highlighted by patients from Phase One were also associated with longer LoS, including: physical restraints (105%), psychiatric consults (20%) and continuous observation (133%). Only recent in-system outpatient appointments were associated with shorter LoS. Data integration highlighted that factors which were important to patients such as partner support, were not always quantitatively significant, while others like medical comorbidities and use of physical restraints were points of congruence. CONCLUSIONS Medical comorbidities were highly associated with LoS but processes relating to longer LoS are those that are used to manage symptoms of acute psychosis. Clinicians should develop policies and procedures that address psychosis symptoms effectively during non-psychiatric hospitalizations. Further research is needed to understand which patients with psychotic disorders are at highest risk of extended length-of-stay.
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Affiliation(s)
- Guy M Weissinger
- Drexel University, College of Nursing and Health Professions, 3020 Market Street, Suite 510, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America.
| | - J Margo Brooks Carthon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
| | - Bridgette M Brawner
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
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30
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Bossy M, Nyman M, Madhuri TK, Tailor A, Chatterjee J, Butler-Manuel S, Ellis P, Feldheiser A, Creagh-Brown B. The need for post-operative vasopressor infusions after major gynae-oncologic surgery within an ERAS (Enhanced Recovery After Surgery) pathway. Perioper Med (Lond) 2020; 9:26. [PMID: 32939254 PMCID: PMC7487584 DOI: 10.1186/s13741-020-00158-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypotension following major abdominal surgery is common, and once hypovolaemia has been optimally treated, is often due to vasodilation which can be treated with vasopressor infusions. There is unpredictability in the dose and duration of post-operative vasopressor infusions, and factors associated with this have not been determined. METHODS We present a case series of consecutive patients who received major gynae-oncology surgery delivered within an Enhanced Recovery After Surgery (ERAS) pathway at a single institution. Patients were electively admitted from theatre directly to the intensive care unit (ICU). Data was collected prospectively into electronic databases (Philips ICCA, Wardwatcher) and then retrospectively collated and appropriate statistical analyses were performed. In the absence of a consensus definition of vasoplegia, we, necessarily arbitrarily, chose a noradrenaline dose of > 0.1 mcg/kg/min at 08:00 on the first post-operative day. The rationale is that this would be more than would typically be expected to counteract the vasodilatory effects of epidural analgesia, which is commonly used at our institution. RESULTS Data was collected from 324 patients, all treated between February 2014 and July 2016. The average age was 67 years and 39% received neoadjuvant chemotherapy. The commonest tumour type was ovarian (58%). The median estimated blood loss was 800 ml and epidural analgesia was used in 71%. Fifty per cent received post-operative vasopressor infusions: factors associated with this included epidural use and estimated blood loss. Nineteen per cent met our criteria for vasoplegia: factors associated with this included CRP on post-operative day 1 and P-POSSUM morbidity score. Hospital and ICU length of stay was prolonged in those who had vasoplegia. CONCLUSIONS Patients commonly receive vasopressors following major gynae-oncologic surgery, and this can be at relatively high doses. Clinical factors only accounted for a minority of the variability in vasopressor usage-suggesting considerable biological variability. Optimal care of patients having major abdomino-pelvic surgery may include advanced haemodynamic monitoring and ready availability of infused vasopressors, in a suitable environment.
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Affiliation(s)
- Michèle Bossy
- Department of Anaesthesia and Intensive Care Medicine, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX UK
| | - Molly Nyman
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thumuluru Kavitha Madhuri
- Department of Gynae-oncology Surgery, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Anil Tailor
- Department of Gynae-oncology Surgery, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX UK
| | - Jayanta Chatterjee
- Department of Gynae-oncology Surgery, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Simon Butler-Manuel
- Department of Gynae-oncology Surgery, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX UK
| | - Patricia Ellis
- Department of Gynae-oncology Surgery, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX UK
| | - Aarne Feldheiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Evang. Kliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ben Creagh-Brown
- Department of Anaesthesia and Intensive Care Medicine, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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De Munck TJI, Soeters PB, Koek GH. The role of ectopic adipose tissue: benefit or deleterious overflow? Eur J Clin Nutr 2020; 75:38-48. [PMID: 32801303 DOI: 10.1038/s41430-020-00713-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
Abstract
Ectopic adipose tissues (EAT) are present adjacent to many organs and have predominantly been described in overweight and obesity. They have been suggested to be related to fatty acid overflow and to have harmful effects. The objective of this semi-comprehensive review is to explore whether EAT may play a supportive role rather than interfering with its function, when the adjacent organ is challenged metabolically and functionally. EAT are present adhered to different tissues or organs, including lymph nodes, heart, kidney, ovaries and joints. In this review, we only focused on epicardial, perinodal, and peritumoral fat since these locations have been studied in more detail. Evidence was found that EAT volume significantly increased, associated with chronic metabolic challenges of the corresponding tissue. In vitro evidence revealed transfer of fatty acids from peritumoral and perinodal fat to the adjacent tissue. Cytokine expression in these EAT is upregulated when the adjacent tissue is challenged. In these tissues, glycolysis is enhanced, whereas fatty acid oxidation is increased. Together with more direct evidence, this shows that glucose is oxidized to a lesser degree, but used to support anabolic metabolism of the adjacent tissue. In these situations, browning occurs, resulting from upregulation of anabolic metabolism, stimulated by uncoupling proteins 1 and 2 and possibly 3. In conclusion, the evidence found is fragmented but the available data support the view that accumulation and browning of adipocytes adjacent to the investigated organs or tissues may be a normal physiological response promoting healing and (patho)physiological growth.
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Affiliation(s)
- Toon J I De Munck
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands. .,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - Peter B Soeters
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ger H Koek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Surgery, Klinikum RWTH Aachen, Aachen, Germany
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32
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Dobson GP. Trauma of major surgery: A global problem that is not going away. Int J Surg 2020; 81:47-54. [PMID: 32738546 PMCID: PMC7388795 DOI: 10.1016/j.ijsu.2020.07.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 12/21/2022]
Abstract
Globally, a staggering 310 million major surgeries are performed each year; around 40 to 50 million in USA and 20 million in Europe. It is estimated that 1–4% of these patients will die, up to 15% will have serious postoperative morbidity, and 5–15% will be readmitted within 30 days. An annual global mortality of around 8 million patients places major surgery comparable with the leading causes of death from cardiovascular disease and stroke, cancer and injury. If surgical complications were classified as a pandemic, like HIV/AIDS or coronavirus (COVID-19), developed countries would work together and devise an immediate action plan and allocate resources to address it. Seeking to reduce preventable deaths and post-surgical complications would save billions of dollars in healthcare costs. Part of the global problem resides in differences in institutional practice patterns in high- and low-income countries, and part from a lack of effective perioperative drug therapies to protect the patient from surgical stress. We briefly review the history of surgical stress and provide a path forward from a systems-based approach. Key to progress is recognizing that the anesthetized brain is still physiologically ‘awake’ and responsive to the sterile stressors of surgery. New intravenous drug therapies are urgently required after anesthesia and before the first incision to prevent the brain from switching to sympathetic overdrive and activating secondary injury progression such as hyperinflammation, coagulopathy, immune activation and metabolic dysfunction. A systems-based approach targeting central nervous system-mitochondrial coupling may help drive research to improve outcomes following major surgery in civilian and military medicine.
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Affiliation(s)
- Geoffrey P Dobson
- Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Queensland, 4811, Australia.
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Toyoda D, Maki Y, Sakamoto Y, Kinoshita J, Abe R, Kotake Y. Comparison of volume and hemodynamic effects of crystalloid, hydroxyethyl starch, and albumin in patients undergoing major abdominal surgery: a prospective observational study. BMC Anesthesiol 2020; 20:141. [PMID: 32493281 PMCID: PMC7271551 DOI: 10.1186/s12871-020-01051-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The volume effect of iso-oncotic colloid is supposedly larger than crystalloid, but such differences are dependent on clinical context. The purpose of this single center observational study was to compare the volume and hemodynamic effects of crystalloid solution and colloid solution during surgical manipulation in patients undergoing major abdominal surgery. METHODS Subjects undergoing abdominal surgery for malignancies with intraoperative goal-directed fluid management were enrolled in this observational study. Fluid challenges consisted with 250 ml of either bicarbonate Ringer solution, 6% hydroxyethyl starch or 5% albumin were provided to maintain optimal stroke volume index. Hematocrit derived-plasma volume and colloid osmotic pressure was determined immediately before and 30 min after the fluid challenge. Data were expressed as median (IQR) and statistically compared with Kruskal-Wallis test. RESULTS One hundred thirty-nine fluid challenges in 65 patients were analyzed. Bicarbonate Ringer solution, 6% hydroxyethyl starch and 5% albumin were administered in 42, 49 and 48 instances, respectively. Plasma volume increased 7.3 (3.6-10.0) % and 6.3 (1.4-8.8) % 30 min after the fluid challenge with 6% hydroxyethyl starch and 5% albumin and these values are significantly larger than the value with bicarbonate Ringer solution (1.0 (- 2.7-2.3) %) Colloid osmotic pressure increased 0.6 (0.2-1.2) mmHg after the fluid challenge with 6% hydroxyethyl starch and 0.7(0.2-1.3) mmHg with 5% albumin but decreased 0.6 (0.2-1.2) mmHg after the fluid challenge with bicarbonate Ringer solution. The area under the curve of stroke volume index after fluid challenge was significantly larger after 6% hydroxyethyl starch or 5% albumin compared to bicarbonate Ringer solution. CONCLUSIONS Fluid challenge with 6% hydroxyethyl starch and 5% albumin showed significantly larger volume and hemodynamic effects compared to bicarbonate Ringer solution during gastrointestinal surgery. TRIAL REGISTRATION UMIN Clinical Trial Registry UMIN000017964. Registered July 01, 2015.
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Affiliation(s)
- Daisuke Toyoda
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro, Tokyo, 153-8515, Japan.
| | - Yuichi Maki
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro, Tokyo, 153-8515, Japan
| | - Yasumasa Sakamoto
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro, Tokyo, 153-8515, Japan
| | - Junki Kinoshita
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro, Tokyo, 153-8515, Japan
| | - Risa Abe
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro, Tokyo, 153-8515, Japan
| | - Yoshifumi Kotake
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro, Tokyo, 153-8515, Japan
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Myatchin I, Abraham P, Malbrain MLNG. Bio-electrical impedance analysis in critically ill patients: are we ready for prime time? J Clin Monit Comput 2020; 34:401-410. [PMID: 31808061 PMCID: PMC7223384 DOI: 10.1007/s10877-019-00439-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Ivan Myatchin
- Department Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, 1090, Jette, Belgium
- Department Anaesthesiology, Sint-Trudo Regional Hospital, Sint-Truiden, Belgium
| | - Paul Abraham
- Anaesthesiology and Critical Care Medicine Department, Hôpital Edouard-Herriot, Lyon Cedex 03, France
| | - Manu L N G Malbrain
- Department Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, 1090, Jette, Belgium.
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Elsene, Belgium.
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Giustiniano E, Procopio F, Morenghi E, Gollo Y, Rocchi L, Ruggieri N, Lascari V, Torzilli G, Cecconi M. Renal resistive index as a predictor of postoperative complications in liver resection surgery. Observational study. J Clin Monit Comput 2020; 35:731-740. [PMID: 32430788 DOI: 10.1007/s10877-020-00529-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/13/2020] [Indexed: 12/25/2022]
Abstract
Mortality after liver surgery reduced during the last three decades to less than 2%, but post-operative morbidity occurs in 20-50% of cases. Patients are often considered eligible for post-operative intensive-care unit (ICU) admission. Predicting which patients that are at higher risk could lead to a more precise perioperative management. We investigated whether renal resistive index (RRI), alone or along with other items, can predict post-operative complication after hepatic resection. All consecutive patients undergoing hepatectomy for primary or metastatic neoplasm at our Institution between February 2015 and March 2017 were enrolled. They received RRI measurement before entering in operative room and after awakening from general anesthesia. 183 Patients were enrolled. High surgical invasiveness, surgery time > 360 min, pre-operative RRI and postoperative serum lactate clearance < - 6%, showed to be associated with postoperative complications. Pre-operative RRI, complex liver resection, long-lasting surgery and poor lactate clearance (cLac) close to awakening from general anesthesia, all together may permit to classify the risk of post-operative adverse outcome after hepatic resection surgery.
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Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Fabio Procopio
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Hepato-Biliary & Pancreatic Surgery Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Milan, Italy
| | - Emanuela Morenghi
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Biostatistic Unit, Humanitas Clinical and Research Center, IRCCS, via manzoni 56, 20089, Milan, Italy
| | - Yari Gollo
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Laura Rocchi
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Nadia Ruggieri
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Valeria Lascari
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Guido Torzilli
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Hepato-Biliary & Pancreatic Surgery Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
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Burcharth J, Ohm Oreskov J, Falkenberg A, Schack A, Ekeloef S, Gögenur I. Respiratory function following major emergency abdominal surgery. J Perioper Pract 2020; 30:389-394. [PMID: 32096439 DOI: 10.1177/1750458919888818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the timewise postoperative respiratory function measured by spirometry and peak flow during the first postoperative week after major emergency abdominal surgery. Patients were tested daily with forced expiratory volume (FEV) and peak flow (PEF) from postoperative day (POD) 1 through to POD7. FEV1, FEV6, FEV1/FEV6 ratio and PEF were analysed by unadjusted linear regression with 95% confidence interval (CI) on mean values for each postoperative day. A total of 35 consecutive patients were included in the study. The FEV at 1 second was 51% of predicted at POD1, which increased to 67% at POD7 (p = 0.005), whereas FEV6 was 55% of predicted at POD1, which increased to 70% at POD7 (p = .008). Respiratory function was not significantly correlated to synchronous pain scores. In conclusion, respiratory function following major emergency abdominal surgery was reduced throughout the first postoperative week irrespective of pain scores.
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Affiliation(s)
- Jakob Burcharth
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Jakob Ohm Oreskov
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Andreas Falkenberg
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Anders Schack
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Sarah Ekeloef
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
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Cho H, Lee S, Sheen S, Choi YH. Differences in Vancomycin Clearance between Trauma and Medical Intensive Care Unit Patients. Infect Chemother 2020; 52:48-58. [PMID: 31997602 PMCID: PMC7113446 DOI: 10.3947/ic.2020.52.1.48] [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: 10/29/2019] [Accepted: 01/12/2020] [Indexed: 11/24/2022] Open
Abstract
Background To identify the differences in the vancomycin pharmacokinetics between multiple trauma patients and medically ill patients in the intensive care unit (ICU) stratified by the use of continuous renal replacement therapy (CRRT), and the factors affecting vancomycin clearance (CLvan). Materials and Methods All the included patients received at least three consecutive doses of vancomycin, then, therapeutic drug monitoring was conducted. Patients' serum vancomycin trough levels and other clinical variables were identified retrospectively. The vancomycin pharmacokinetics and associated factors were compared and analyzed between trauma ICU (TICU) and medical ICU (MICU) patients. Results In the non-dialyzed group, the CLvan was higher among the TICU patients than the MICU patients. However, in the continuous renal replacement therapy group, there was no significant difference in the CLvan between the multiple trauma and medically ill patients. The only factor associated with CLvan in the non-dialyzed group was creatinine clearance; none of the factors was associated with CLvan in the CRRT group. Conclusion In the case of non-dialyzed patients in the TICU, vancomycin dosages must be adjusted, depending on the patient's actual body weight changes. In the case of patients undergoing CRRT in both ICUs, vancomycin can be infused with fixed doses regardless of the patients' characteristics.
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Affiliation(s)
- Hundo Cho
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Suna Lee
- Department of Pharmacy, Ajou University Medical Center, Suwon, Korea
| | - Seungsoo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea.
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Yang L, Zhang Z, Kong J, Wang W. Systematic Review and Meta-Analysis of the Benefit and Safety of Preoperative Administration of Steroid in Patients Undergoing Liver Resection. Front Pharmacol 2019; 10:1442. [PMID: 31849683 PMCID: PMC6894012 DOI: 10.3389/fphar.2019.01442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/12/2019] [Indexed: 02/05/2023] Open
Abstract
Objective: To evaluate the benefit and safety of preoperative administration of steroid in patients undergoing liver resection. Methods: Randomized controlled trials (RCTs) which comparing preoperative administration of steroid in patients undergoing liver resection with control group were identified through a systematic literature search in PubMed, Embase, and Cochrane Library Central databases. This meta-analysis was carried out to assess the liver function, inflammatory response, and postoperative complications after liver surgery. Results: Six RCTs including 411 patients were reviewed. The pooled result showed that there was no significant difference in the incidence of overall complications between the steroid group and the control group (OR, 0.57; 95% CI, 0.27–1.17; P = 0.13). With respect to specific complications, no significant difference was detected between the two groups in infection complications (OR, 0.95; 95% CI, 0.13–6.95; P = 0.96), wound complications (OR, 0.65; 95% CI, 0.32–1.33; P = 0.24), liver failure (OR, 0.41; 95% CI, 0.10–1.64; P = 0.21), bile leakage (OR, 0.57; 95% CI, 0.17–1.89; P = 0.36), and pleural effusion (OR, 1.24; 95% CI, 0.55–2.78; P = 0.60). For liver function, the level of serum total bilirubin (TB) on postoperative day 1 (POD 1) was significantly decreased associated with the intervention of steroid (MD, −0.54; 95% CI, −0.94 to −0.15; P = 0.007). However, no significant difference was found in the level of alanine aminotransferase (ALT) (MD, −69.39; 95% CI, −226.52 to 87.75; P = 0.39) and aspartate aminotransferase (AST) (MD, −93.44; 95% CI, −275.68 to 88.80; P = 0.31) on POD 1 between the two groups. Serum IL-6 level on POD 1 (MD, −57.98; 95% CI, −73.04 to −42.91; P < 0.00001) and CRP level on POD 3 (MD, −4.83; 95% CI, −6.07 to −3.59; P < 0.00001) were significantly reduced in the steroid group comparing to the control group. Compared with the control group, the level of early postoperative IL-10 was significant higher in the steroid group (MD, 17.89; 95% CI, 3.89 to 31.89; P = 0.01). Conclusion: Preoperative administration of steroid in liver resection can promote the recovery of liver function and inhibit the inflammatory response without increasing postoperative complications. Further studies should focus on determining which patients would benefit most from the steroid.
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Affiliation(s)
- Lingpeng Yang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zifei Zhang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China.,Department of General Surgery, The Affiliated Hospital of Xizang Minzu University, Xianyang, China
| | - Junjie Kong
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wentao Wang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
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Weyers BW, Marsden M, Sun T, Bec J, Bewley AF, Gandour-Edwards RF, Moore MG, Farwell DG, Marcu L. Fluorescence lifetime imaging for intraoperative cancer delineation in transoral robotic surgery. TRANSLATIONAL BIOPHOTONICS 2019; 1. [PMID: 32656529 PMCID: PMC7351319 DOI: 10.1002/tbio.201900017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study evaluates the potential for fluorescence lifetime imaging (FLIm) to enhance intraoperative decisionmaking during robotic-assisted surgery of oropharyngeal cancer. Using a custom built FLIm instrument integrated with the da Vinci robotic surgical platform, we first demonstrate that cancer in epithelial tissue diagnosed by histopathology can be differentiated from surrounding healthy epithelial tissue imaged in vivo prior to cancer resection and ex vivo on the excised specimen. Second, we study the fluorescence properties of tissue imaged in vivo at surgical resection margins (tumor bed). Fluorescence lifetimes and spectral intensity ratios were calculated for three spectral channels, producing a set of six FLIm parameters. Current results from 10 patients undergoing TORS procedures demonstrate that healthy epithelium can be resolved from cancer (P < .001) for at least one FLIm parameter. We also showed that a multiparameter linear discriminant analysis approach provides superior discrimination to individual FLIm parameters for tissue imaged both in vivo and ex vivo. Overall, this study highlights the potential for FLIm to be developed into a diagnostic tool for clinical cancer applications of the oropharynx. This technique could help to circumvent the issues posed by the lack of tactile feedback associated with robotic surgical platforms to better enable cancer delineation.
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Affiliation(s)
- Brent W Weyers
- Department of Biomedical Engineering, University of California, Davis, California
| | - Mark Marsden
- Department of Biomedical Engineering, University of California, Davis, California
| | - Tianchen Sun
- Department of Computer Science, University of California, Davis, California
| | - Julien Bec
- Department of Biomedical Engineering, University of California, Davis, California
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California, Davis, California
| | | | - Michael G Moore
- Department of Otolaryngology, University of California, Davis, California
| | - D Gregory Farwell
- Department of Otolaryngology, University of California, Davis, California
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, California
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Abstract
BACKGROUND The restrictive and/or malabsorptive nature of bariatric surgery may increase the risk for micronutrient deficiencies. This systematic review aimed to identify and critique the evidence for vitamin A, B1, C or E deficiencies associated with bariatric surgery. METHODS This review utilised PRISMA and MOOSE frameworks with NHMRC evidence hierarchy and the American Dietetic Association bias tool to assess the quality of articles. RESULTS Twenty-one articles were included and once critiqued all studies were of level IV grade and neutral or negative in quality. The relevance of measuring micronutrient supplementation and inflammatory markers for validity of serum vitamins is absent within the literature. CONCLUSIONS Future research is needed to investigate the risk of deficiency for these procedures with focus on confounders to serum micronutrients.
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The systemic impact of a surgical procedure in older oncological patients. Eur J Surg Oncol 2019; 45:1403-1409. [PMID: 31104780 DOI: 10.1016/j.ejso.2019.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/26/2019] [Accepted: 04/28/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND An excessive inflammatory response accounts partially for the increased morbidity and mortality seen in elderly surgical patients. The aim of this study was to investigate the association between a range of pre- and peroperative factors and the extent of the inflammatory response, and to identify patients at risk of a greater inflammatory response following surgery. METHODS Patients 65 years and older undergoing a surgical procedure for a solid malignant tumour were prospectively included in an observational cohort study. Inflammatory markers were measured in plasma samples pre- and postoperatively: C-reactive protein (CRP), Interleukin-1 beta (IL-1β), IL-6, IL-10, IL-12, and Tumour necrosis factor alpha (TNF-α). Preoperative and postoperative inflammatory factor assay results were compared, and associations between inflammatory markers and pre- and peroperative factors were explored using multivariate linear regression analysis. RESULTS Between July 2010 and April 2014, plasma samples of 224 patients were obtained. Median age was 72 (65-89) years and 108 (48.2%) patients were male. The predominant diagnosis was carcinoma, 156 (69.6%). Anaesthesia duration was associated with increase in CRP, IL-1β and IL-6; intracavitary surgery with increase in IL-6; blood loss with decrease in CRP and IL-1β; total fluid volume administered with a decrease in IL-1β and disease stage was associated with increase in IL-6. CONCLUSIONS The perioperative inflammatory response is related more to surgical characteristics rather than to preoperative factors (with the exception of disease stage). Elderly oncological patients undergoing longer lasting, intracavitary surgical procedures for more advanced disease stages develop the most intense inflammatory response.
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Li J, Zhu X, Yang S, Xu H, Guo M, Yao Y, Huang Z, Lin D. Lidocaine Attenuates Cognitive Impairment After Isoflurane Anesthesia by Reducing Mitochondrial Damage. Neurochem Res 2019; 44:1703-1714. [PMID: 30989480 DOI: 10.1007/s11064-019-02799-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Abstract
Mitochondrial dysfunction has been proposed to be one of the earliest triggering events in isoflurane-induced neuronal damage. Lidocaine has been demonstrated to attenuate the impairment of cognition in aged rats induced by isoflurane in our previous study. In this study, we hypothesized that lidocaine could attenuate isoflurane anesthesia-induced cognitive impairment by reducing mitochondrial damage. H4 human neuroglioma cells and 18-month-old male Fischer 344 rats were exposed to isoflurane or isoflurane plus lidocaine. Cognitive function was tested at 14 days after treatment by the Barnes Maze test in male Fischer 344 rats. Morphology was observed under electron microscope, and mitochondrial transmembrane potential, electron transfer chain (ETC) enzyme activity, complex-I-IV activity, immunofluorescence and flow cytometry of annexin V-FITC binding, TUNEL assay, and Western blot analyses were applied. Lidocaine attenuated cognitive impairment caused by isoflurane in aged Fischer 344 rat. Lidocaine was effective in reducing mitochondrial damage, mitigating the decrease in mitochondrial membrane potential (ΔΨm), reversing isoflurane-induced changes in complex activity in the mitochondrial electron transfer chain and inhibiting the apoptotic activities induced by isoflurane in H4 cells and Fischer 344 rats. Additionally, lidocaine suppressed the ratio of Bax (the apoptosis-promoting protein) to Bcl-2 (the apoptosis-inhibiting protein) caused by isoflurane in H4 cells. Lidocaine proved effective in attenuating isoflurane-induced POCD by reducing mitochondrial damage.
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Affiliation(s)
- Jin Li
- Department of Anesthesiology, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China
| | - Xiaoqiu Zhu
- Department of Anesthesiology, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China
| | - Shangze Yang
- Department of Anesthesiology, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China
| | - Hui Xu
- Department of Anesthesiology, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China
| | - Mingyan Guo
- Department of Anesthesiology, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China
| | - Yiyi Yao
- Department of Anesthesiology, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China.
| | - Daowei Lin
- Department of Anesthesiology, Sun-Yat sen Memorial Hospital, Sun-Yat sen University, Guangzhou, 510120, Guangdong, China.
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Ioannidis A, Arvanitidis K, Filidou E, Valatas V, Stavrou G, Michalopoulos A, Kolios G, Kotzampassi K. The Length of Surgical Skin Incision in Postoperative Inflammatory Reaction. JSLS 2019; 22:JSLS.2018.00045. [PMID: 30518991 PMCID: PMC6251478 DOI: 10.4293/jsls.2018.00045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background and Objectives: Surgery provokes inflammatory and immune responses, so efforts have been made to reduce host response by using less invasive techniques. The purpose of this experimental study was to investigate the surgical stress induced by skin incision and the role of liver response in this process. Methods: Seventy male anesthetized Wistar rats were subjected to a midline incision confined strictly to the skin (dermis) of either 1 cm long (n = 20), 10 cm long (n = 20), or no incision (n = 20) or served as controls (n = 10). Skin trauma was left open for a 20-minutes period, and then was meticulously sutured. At 3 and 24 hours later, laparotomy was performed on half the rats of each group, for blood and liver sampling. In serum and liver homogenates, cytokine-induced neutrophil chemoattractant (CINC)1/interleukin (IL)-8 and tumor necrosis factor (TNF)-α levels were measured with enzyme-linked immunosorbent assays and nitric oxide (NO) using a Griess reaction. Results: Skin trauma was found to significantly (P < .01) increase all inflammatory mediators tested (CINC1/IL-8, TNF-α, NO) in serum of operated rats versus controls, the increase being proportionally dependent on the length of skin incision. In liver homogenates, CINC1/IL-8 was significantly (P < .01) increased in operated animals versus controls, similarly to serum levels. In contrast, liver TNF-α levels were inversely related to serum levels, and a significant (P < .01) decrease in TNF-α was observed in liver homogenates of operated animals compared with the controls, indicating that the increased TNF-α in blood reflects liver TNF-α secretion. Conclusion: Our findings suggest that inflammatory and immune reactions induced by skin-only surgical trauma are closely correlated to the length of skin incision.
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Affiliation(s)
- Aristidis Ioannidis
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Eirini Filidou
- Laboratory of Pharmacology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vassilis Valatas
- Gastroenterology Laboratory, Medical Department, University of Crete, Heraklion, Greece
| | - George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George Kolios
- Laboratory of Pharmacology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Alvarez J, Baluja A, Selas S, Otero P, Rial M, Veiras S, Caruezo V, Laboada M, Rodriguez I, Caslroagudin J, Lome S, Rodriguez A, Rodriguez J. A Comparison of Doubutamine and Levosimendan on Hepatic Blood Flow in Patients with a Low Cardiac Output State after Cardiac Surgery: A Randomised Controlled Study. Anaesth Intensive Care 2019; 41:719-27. [DOI: 10.1177/0310057x1304100606] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. Alvarez
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - A. Baluja
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - S. Selas
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - P. Otero
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - M. Rial
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - S. Veiras
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - V. Caruezo
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - M. Laboada
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - I. Rodriguez
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - J. Caslroagudin
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - S. Lome
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - A. Rodriguez
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
| | - J. Rodriguez
- Department Anesthesia and Surgical ICU, University Hospital, University of Santiago de Compostela, Spain
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Abad-Gurumeta A, Gómez-Ríos MÁ, Calvo-Vecino JM. Intravenous dexmedetomidine: can it modulate the effects of inflammation, or is it only an antinociceptive agent? Minerva Anestesiol 2018; 85:226-228. [PMID: 30484298 DOI: 10.23736/s0375-9393.18.13217-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alfredo Abad-Gurumeta
- Department of Anesthesiology and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain -
| | - Manuel Á Gómez-Ríos
- Department of Anesthesiology and Perioperative Medicine, University Hospital of A Coruña, A Coruña, Spain.,Anesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, Spain.,Spanish Difficult Airway Group (GEVAD), A Coruña, Spain
| | - José M Calvo-Vecino
- Department of Anesthesia and Perioperative Medicine, University Care Complex of Salamanca, Salamanca, Spain
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Wang SX, Yang RC. [Advances in Hemophilia A inhibitors]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 38:444-448. [PMID: 28565748 PMCID: PMC7354181 DOI: 10.3760/cma.j.issn.0253-2727.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - R C Yang
- Institute of Hematology & Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
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Two-way Interaction Effects of Perioperative Complications on 30-Day Mortality in General Surgery. World J Surg 2018; 42:2-11. [PMID: 28755257 DOI: 10.1007/s00268-017-4156-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple perioperative complications increase mortality risk, and certain complications synergistically increase this risk to a greater degree than might be expected if the complications were independent, but these effects are not well established. METHODS This is a retrospective cohort study of 422,827 intraabdominal general surgery patients (American College of Surgeons National Surgical Quality Improvement Program 2005-2011). Eight complications were evaluated: acute respiratory failure (ARF), acute kidney injury (AKI), sepsis/septic shock, stroke, cardiac arrest (CA), myocardial infarction (MI), deep vein thrombosis/pulmonary embolus, and transfusion. Each combination of two complications (28 total) was modeled using a Cox model for 30-day mortality, with adjustment for preoperative comorbidities and risk factors. Additive interaction was determined with the relative excess risk due to interaction (RERI). A positive RERI indicates that the mortality risk with both complications is greater than the sum of the individual mortality risks. Bonferroni correction was applied (α = 0.05/28 = 0.0018). RESULTS Seven combinations demonstrated positive interaction: sepsis-CA (RERI 88.1; p < 0.0001), ARF-AKI (RERI 50.5; p < 0.0001), AKI-sepsis (RERI 33.9; p < 0.0001), sepsis-stroke (RERI 33.9; p < 0.0001), ARF-stroke (RERI 32.3; p < 0.0001), AKI-MI (RERI 24.5; p = 0.0013), and ARF-sepsis (RERI 19.2; p < 0.0001). Two combinations demonstrated negative interaction: ARF-CA (RERI -65.1; p = 0.0017) and CA-transfusion (RERI -52.0, p < 0.0001). CONCLUSIONS Interaction effects exist between certain complications to increase the risk of short-term mortality. ARF, AKI, sepsis, and stroke were most likely to be involved in positive interactions. Further research into the mechanisms for these effects will be necessary to develop strategies to minimize the compounding effects of multiple complications in the perioperative period.
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Vidal PM, Ulndreaj A, Badner A, Hong J, Fehlings MG. Methylprednisolone treatment enhances early recovery following surgical decompression for degenerative cervical myelopathy without compromise to the systemic immune system. J Neuroinflammation 2018; 15:222. [PMID: 30081922 PMCID: PMC6080373 DOI: 10.1186/s12974-018-1257-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Degenerative cervical myelopathy (DCM) is caused by degenerative or congenital changes to the discs and soft tissues of the cervical spine, which leads to chronic compression of the spinal cord. The current treatment for moderate to severe DCM consists of surgical decompression, which, while effective in most cases, can result in neuroinflammation and spinal cord reperfusion injury, leading to perioperative neurological complications and suboptimal neurological recovery. The primary objective of this study was to assess, in a translationally relevant animal model of DCM, the efficacy of perioperative methylprednisolone (MP) in enhancing neurological recovery and to evaluate its effect on the inflammatory response following decompression. Methods DCM was induced in C57BL/6 mice. Briefly, an aromatic polyether material was implanted underneath the C5-C6 laminae to cause progressive compression of the cervical spinal cord due to focal ossification. Decompressive surgery was undertaken at 12 weeks post initial biomaterial implantation. Animals received one dose of MP (30 mg/kg) or vehicle 30 min before decompression and at 2 weeks after decompression. Acute analysis of secreted cytokines and spinal cord microvasculature was complemented with immunohistochemistry for glial and neuronal cell markers. Locomotor outcomes were measured using the CatWalk system. The composition of circulating white blood cells was analyzed by flow cytometry. Results A single dose of MP before decompression significantly sped locomotor recovery (*p < 0.05) and reduced the incidence of perioperative motor complications, without affecting the composition of circulating white blood cells. Histological assessment of the spinal cord showed significant neuronal preservation and a modest reduction in parenchymal inflammation. Conclusions Our data suggest that MP reduces perioperative neurological complications following decompressive surgery for DCM by protecting neurons from inflammation, without compromising the composition of circulating immune cells. We propose that MP, which is commonly used for neurological disorders including spinal cord injury, be considered as a perioperative adjunct to decompressive surgery to attenuate neurological complications.
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Affiliation(s)
- Pia M Vidal
- Division of Genetics & Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Laboratory of Neuroimmunology, Fundación Ciencia & Vida, Santiago, Chile
| | - Antigona Ulndreaj
- Division of Genetics & Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Anna Badner
- Division of Genetics & Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - James Hong
- Division of Genetics & Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Genetics & Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada. .,Head, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Joliat GR, Sauvain MO, Petermann D, Halkic N, Demartines N, Schäfer M. Surgical site infections after pancreatic surgery in the era of enhanced recovery protocols. Medicine (Baltimore) 2018; 97:e11728. [PMID: 30075582 PMCID: PMC6081186 DOI: 10.1097/md.0000000000011728] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Few data exist on risk factors (RF) for surgical site infections (SSI) among patients treated in an enhanced recovery after surgery (ERAS) pathway. This study aimed to assess RF for SSI after pancreas surgery in a non-ERAS group and an ERAS cohort.An exploratory retrospective analysis of all pancreas surgeries prospectively collected (01/2000-12/2015) was performed. RF for SSI were calculated using uni- and multivariable binary logistic regressions in non-ERAS and ERAS patients.Pancreas surgery was performed in 549 patients. Among them, 144 presented a SSI (26%). In the non-ERAS group (n = 377), SSI incidence was 27% (99/377), and RF for SSI were male gender and preoperative biliary stenting. Since 2012, 172 consecutive patients were managed within an ERAS pathway. Forty-five patients (26%) had SSI. On multivariable analysis no RF for SSI in the ERAS cohort was found. In the ERAS group, patients with a pathway compliance ≤70% had higher occurrence of SSI (30/45 = 67% vs. 7/127 = 6%, p < 0.001) and patients with and without SSI had similar median overall compliances (77%, IQR 71-80 vs. 80%, IQR 73-83, p = 0.097).In the non-ERAS cohort, male gender and preoperative biliary stenting were RF for SSI, whereas in the ERAS group no RF for SSI was found. In an ERAS pathway, having an overall compliance >70% might diminish the SSI rate.
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Affiliation(s)
| | | | - David Petermann
- Department of Visceral Surgery, University Hospital CHUV, Lausanne
- Department of Surgery, Morges Hospital, Morges, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital CHUV, Lausanne
| | | | - Markus Schäfer
- Department of Visceral Surgery, University Hospital CHUV, Lausanne
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Lambden S, Creagh-Brown BC, Hunt J, Summers C, Forni LG. Definitions and pathophysiology of vasoplegic shock. Crit Care 2018; 22:174. [PMID: 29980217 PMCID: PMC6035427 DOI: 10.1186/s13054-018-2102-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022] Open
Abstract
Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition.
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Affiliation(s)
- Simon Lambden
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ben C. Creagh-Brown
- Surrey Perioperative Anaesthetic Critical care collaborative group (SPACeR), Intensive Care, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Julie Hunt
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Charlotte Summers
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lui G. Forni
- Surrey Perioperative Anaesthetic Critical care collaborative group (SPACeR), Intensive Care, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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