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Xing XC, Liu ZY, Yang Q, Jia BW, Qiu L, Zhang LL, Gao W. Ac2-26 reduced the liver injury after cardiopulmonary bypass in rats via AKT1/GSK3β/eNOS pathway. J Cardiothorac Surg 2024; 19:312. [PMID: 38824570 PMCID: PMC11143710 DOI: 10.1186/s13019-024-02801-z] [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: 12/27/2023] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE About 10% of patients after cardiopulmonary bypass (CPB) would undergo acute liver injury, which aggravated the mortality of patients. Ac2-26 has been demonstrated to ameliorate organic injury by inhibiting inflammation. The present study aims to evaluate the effect and mechanism of Ac2-26 on acute liver injury after CPB. METHODS A total of 32 SD rats were randomized into sham, CPB, Ac, and Ac/AKT1 groups. The rats only received anesthesia, and rats in other groups received CPB. The rats in Ac/AKT1 were pre-injected with the shRNA to interfere with the expression of AKT1. The rats in CPB were injected with saline, and rats in Ac and Ac/AKT1 groups were injected with Ac2-26. After 12 h of CPB, all the rats were sacrificed and the peripheral blood and liver samples were collected to analyze. The inflammatory factors in serum and liver were detected. The liver function was tested, and the pathological injury of liver tissue was evaluated. RESULTS Compared with the sham group, the inflammatory factors, liver function, and pathological injury were worsened after CPB. Compared with the CPB group, the Ac2-26 significantly decreased the pro-inflammatory factors and increased the anti-inflammatory factor, improved liver function, and ameliorated the pathological injury. All the therapeutic effects of Ac2-26 were notably attenuated by the shRNA of AKT1. The Ac2-26 increased the GSK3β and eNOS, and this promotion was inhibited by the shRNA. CONCLUSION The Ac2-26 significantly treated the liver injury, inhibited inflammation, and improved liver function. The effect of Ac2-26 on liver injury induced by CPB was partly associated with the promotion of AKT1/GSK3β/eNOS.
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Affiliation(s)
- Xi-Chun Xing
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246Xuefu Road, Harbin, 150081, Heilongjiang, China
| | - Zi-Ying Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246Xuefu Road, Harbin, 150081, Heilongjiang, China
| | - Qing Yang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Bao-Wei Jia
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246Xuefu Road, Harbin, 150081, Heilongjiang, China
| | - Lin Qiu
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246Xuefu Road, Harbin, 150081, Heilongjiang, China
| | - Lu-Lu Zhang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Wei Gao
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246Xuefu Road, Harbin, 150081, Heilongjiang, China.
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Bock K, Wedemeyer H, Mederacke YS, Mederacke I. Elevated liver enzymes in a German tertiary-care hospital: Distribution, diagnostic steps and diagnosis groups. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:919-929. [PMID: 38198801 DOI: 10.1055/a-2150-2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND The determination of liver blood tests is frequently performed in hospitalized patients, and abnormal values require further diagnostics. Yet, analyses considering the management of elevated liver enzymes are missing. Therefore, this study aimed to analyze the distribution of abnormal liver function tests and the subsequent diagnostic steps across different medical specialties. METHODS From our Hannover liver-injury database, we identified 63,300 cases of patients who were hospitalized between January 2008 and July 2021 with AST or ALT > 3 ULN or AP or TBI > 2 ULN at any time point during hospitalization. Of these, 29,547 cases fulfilled the inclusion criteria and were subjected to further analysis. Cases were analyzed according to the three groups: internal medicine, surgery and others. Analyses were performed regarding baseline characteristics, liver-related diagnostics and factors influencing hospital mortality. RESULTS Elevated liver blood tests were mainly observed in internal medicine (n=17,762, 60.1%), followed by the surgery department 34.2% (n=10,105). Notably, 40.2% (n=11,896) developed liver enzyme elevation above the cut-offs during the hospital stay. Testing for hepatitis B and C was more often performed in the surgery department compared to in internal medicine. In total, 5.6% of the cases (n=1,640) had a liver biopsy. Hyperbilirubinemia (total bilirubine ≥ 2ULN) and AST/ALT ratios >2 were associated with in-hospital mortality. CONCLUSION Clinicians are often faced with elevated liver enzymes. However, diagnostic steps differ between different specialties. Physicians should be aware of the increased in-hospital mortality in cases with hyperbilirubinemia or elevated AST/ALT ratios.
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Affiliation(s)
- Kilian Bock
- Gastroenterology, Hepatology, Infectious diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Gastroenterology, Hepatology, Infectious diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Young-Seon Mederacke
- Gastroenterology, Hepatology, Infectious diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Gastroenterology, Hepatology, Infectious diseases and Endocrinology, Hannover Medical School, Hannover, Germany
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Villani R, Loizzi D, Sacco AF, Mirabella L, Santoliquido M, Mongiello D, Sollitto F, Serviddio G. Prevalence and clinical relevance of liver dysfunction after thoracic surgery: a retrospective study. Sci Rep 2023; 13:23045. [PMID: 38155193 PMCID: PMC10754851 DOI: 10.1038/s41598-023-49427-0] [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: 07/02/2023] [Accepted: 12/07/2023] [Indexed: 12/30/2023] Open
Abstract
Postoperative elevation of serum aminotransferase or alkaline phosphatase levels after liver and heart surgeries has been widely reported. The prevalence and clinical significance of hypertransaminasemia/liver dysfunction after thoracic surgery remains largely unknown. Significant differences in surgical procedures between thoracic and extra-thoracic surgeries may suggest different risks of liver dysfunction. We retrospectively analyzed data from 224 consecutive patients who underwent thoracic surgery. Liver function tests were recorded the day before surgery, 12 h, 1 day, 5, and 10 days after the surgical procedure. Patients were studied to identify the frequency of hypertransaminasemia and/or hyperbilirubinemia and/or increase of INR levels. 37,5% of patients showed an increase in serum alanine aminotransferase (ALT) level after thoracic surgery, whereas an increase in gamma glutamyl transferase (GGT) serum levels of any grade was observed in 53,6% of patients. Approximately 83% of patients who experienced an increase in the serum GGT or ALT levels showed a grade 1 or 2 change. Operative time was associated with hypertransaminasemia in the univariate and multivariate analyses, whereas the use of metformin was associated with a lower risk of ALT increase.
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Affiliation(s)
- Rosanna Villani
- C.U.R.E. (University Center for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy.
| | - Domenico Loizzi
- Institute of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonia Federica Sacco
- C.U.R.E. (University Center for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Lucia Mirabella
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mariateresa Santoliquido
- C.U.R.E. (University Center for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Diletta Mongiello
- Institute of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Sollitto
- Institute of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Serviddio
- C.U.R.E. (University Center for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
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Hyzny EJ, Chan EG, Malik SM, Morrell M, Furukawa M, Ryan JP, Sanchez PG. Risk Factors and Outcomes of Postoperative Hepatic Dysfunction After Lung Transplantation. Ann Thorac Surg 2023; 116:1277-1284. [PMID: 37000464 DOI: 10.1016/j.athoracsur.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/18/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hepatic dysfunction is a morbid complication of lung transplantation. Little is known about risk factors for postoperative hepatic dysfunction or its impact on survival after lung transplantation. METHODS This retrospective analysis of 1406 adult lung transplant recipients was performed at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania between January 1, 2007 and December 1, 2019. Patients were excluded for redo lung transplantation, concomitant cardiac surgery, or concurrent solid organ transplantation. Postoperative liver dysfunction was classified as either ischemic liver injury or nonischemic dysfunction (transaminitis, hyperbilirubinemia). RESULTS Among the 1155 primary lung transplant recipients included, postoperative hepatic dysfunction developed in 96 (8.3%) after lung transplantation. A history of liver disease was the greatest predictor of postoperative hepatic dysfunction (odds ratio, 6.19; CI, 2.13-17.4; P < .001). Patients with postoperative hepatic dysfunction had a greater need for intraoperative blood products (ischemic, 12 U [range, 6-21 U]; nonischemic, 10 U [range, 4-28 U]; vs none, 4 U [range, 1-12 U]; P < .001) and an increased need for postoperative circulatory support (ischemic, 16 [76%]; nonischemic, 25 [33%]; none, 117 [11%]; P < .001). Both ischemic liver injury and nonischemic dysfunction were associated with diminished 1-, 3-, and 5-year term survival (ischemic, 27.5%, 16.5%, and 0%, respectively; nonischemic, 60%, 49.6%, and 46.9%, respectively; none, 87.3%, 72.3%, and 59.5%, respectively; P < .001). CONCLUSIONS Hepatic dysfunction after lung transplantation is associated with significant morbidity and mortality. A history of liver disease was the best positive predictor for postoperative dysfunction. Additional studies are necessary to identify the best treatment algorithm to avoid hepatic dysfunction more effectively in the postoperative setting after lung transplantation.
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Affiliation(s)
- Eric J Hyzny
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ernest G Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shahid M Malik
- Division of Gastroenterology Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew Morrell
- Division of Pulmonary and Critical Care, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Masashi Furukawa
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John P Ryan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pablo G Sanchez
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Wang Z, Xu J, Cheng X, Zhang L, Wang D, Pan J. Hyperbilirubinemia after surgical repair for acute type a aortic dissection: A propensity score-matched analysis. Front Physiol 2022; 13:1009007. [PMID: 36299262 PMCID: PMC9589278 DOI: 10.3389/fphys.2022.1009007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Inflammation and oxidative stress are known to participate in the pathogenesis of hyperbilirubinemia. It has been known that acute type A aortic dissection (ATAAD) surgical repair often associates with complications which might affect the long-term prognosis. However, the clinical significance of postoperative hyperbilirubinemia (PH) has not been evaluated. Here in this study, we examined the incidence, risk factors, and prognosis of PH after ATAAD surgery. Methods: This retrospective study enrolled a total of 970 patients who received ATAAD surgical repair from January 2014 to December 2019. PH was defined as serum total bilirubin >3.0 mg/dl within the first week after the surgery. Propensity score matching was used to reduce selection bias and eliminate potential confounding factors. Kaplan–Meier survival and Cox proportional hazards regression analyses were conducted to explore the association between PH and postoperative long-term survival. Results: Development of PH (183 patients) was associated with a higher 30-Day mortality (20.8% vs. 9.0%, p < 0.001). Advanced age [odds ratio (OR) 1.538, p = 0.006], higher baseline total bilirubin level (OR 1.735, p = 0.026), preoperative pericardial tamponade (OR 3.192, p = 0.024), prolonged cardiopulmonary bypass (CPB) duration (OR 2.008, p = 0.005), and elevated postoperative central venous pressure (CVP) level (OR 2.183, p < 0.001) were associated with PH. The Kaplan-Meier analysis showed patients who developed PH were associated with poor long-term survival (p = 0.044). Cox analysis showed that the presence of PH (hazard ratio 2.006, p = 0.003) was an independent risk factor for increased mortality. Conclusion: PH is a common complication in patients undergoing ATAAD surgical repair that associates with worse short- and long-term prognosis. Our data indicated that age, preoperative total bilirubin level, pericardial tamponade, CPB duration, and postoperative CVP level were risk factors for the development of PH.
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Affiliation(s)
- Zhigang Wang
- Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingfang Xu
- Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaofeng Cheng
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lifang Zhang
- Department of Psychiatry, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Dongjin Wang
- Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Jun Pan, ; Dongjin Wang,
| | - Jun Pan
- Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Jun Pan, ; Dongjin Wang,
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Liang S, Liu Y, Zhang B, Dun Y, Guo H, Qian X, Sun X. Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection. Front Cardiovasc Med 2021; 8:739606. [PMID: 34881302 PMCID: PMC8645859 DOI: 10.3389/fcvm.2021.739606] [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: 07/11/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study was aimed to investigate the incidence, risk factors, and outcomes of patients with postoperative hepatic dysfunction (PHD) after frozen elephant trunk (FET) for type A aortic dissection (TAAD). Method: A retrospective study was performed with 492 patients who underwent FET for TAAD between 2015 and 2019. Independent risk factors for PHD were determined by multivariate mixed-effect logistic analysis with surgeon-specific factor as a random effect. Results: The incidence of PHD was 25.4% (n = 125) in our cohort. Patients with PHD presented higher early mortality (10.4 vs. 1.1%, p < 0.001), rates of acute kidney injury (42.4 vs. 12.8%, p < 0.001), and newly required dialysis (23.2 vs. 3.0%, p < 0.001) compared with those without PHD. Moreover, with the median follow-up period of 41.3 months, the survival curve was worse in patients with PHD compared with no PHD group (log-rank p < 0.001), whereas it was similar after excluding patients who died within 30 days (log-rank p = 0.761). Multivariable analyses suggested that PHD was predicted by preoperative aspartate transferase [odds ratio (OR), 1.057; 95% confidence intervals (CI), 1.036–1.079; p < 0.001], celiac trunk malperfusion (OR, 3.121; 95% CI, 1.008–9.662; p = 0.048), and cardiopulmonary bypass time (OR, 1.014; 95% CI, 1.005–1.023; p = 0.003). Retrograde perfusion (OR, 0.474; 95% CI, 0.268–0.837; p = 0.010) was associated with a reduced risk of PHD. Celiac trunk malperfusion was an independent predictor for PHD but not associated with early mortality and midterm survival. Conclusions: PHD was associated with increased early mortality and morbidity, but not with late death in midterm survival. PHD was predicted by preoperative aspartate transferase, celiac trunk malperfusion, and cardiopulmonary bypass (CPB) time, and retrograde perfusion was associated with a reduced risk of PHD.
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Affiliation(s)
- Shenghua Liang
- Department of Cardiovascular Surgery, The National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
| | - Yanxiang Liu
- Department of Cardiovascular Surgery, The National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
| | - Bowen Zhang
- Department of Cardiovascular Surgery, The National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
| | - Yaojun Dun
- Department of Cardiovascular Surgery, The National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- Department of Cardiovascular Surgery, The National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
| | - Xiangyang Qian
- Department of Cardiovascular Surgery, The National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- Department of Cardiovascular Surgery, The National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
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Shang L, Ao Y, Lv L, Lv L, Zhang Y, Hou J, Yao J, Wu Z. Preoperative Liver Function Test Abnormalities Were Associated With Short-Term and Long-Term Prognosis in Cardiac Surgery Patients Without Liver Disease. Front Cardiovasc Med 2021; 8:772430. [PMID: 34790710 PMCID: PMC8591306 DOI: 10.3389/fcvm.2021.772430] [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: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: To explore the value of preoperative liver function tests (LFTs) for the prognosis of cardiac surgery patients without liver disease. Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) database was used to extract the clinical data. Adult cardiac patients (≥18 years) without liver disease in the database were enrolled. The association of LFTs with the time of hospital stay and ICU stay was analyzed with the Spearman correlation. Survival curves were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariable logistic regression was used to identify LFTs that were independent prognostic factors of mortality. Results: A total of 2,565 patients were enrolled in this study. Albumin (ALB) was negatively associated with the time of hospital stay and ICU stay, while alanine transaminase (ALT), aspartate aminotransferase (AST), and total bilirubin were positively associated with the time of hospital stay and ICU stay (all p < 0.001). Abnormal ALB, ALT, AST, and total bilirubin were associated with lower 90-day and 4-year survival (all p < 0.001) and could be used as independent risk factors for hospital mortality and 90-day mortality. However, only ALB and total bilirubin were independent risk factors for 4-year mortality. Conclusion: Preoperative LFT abnormalities were associated with short-term and long-term prognosis of cardiac surgery patients without liver disease.
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Affiliation(s)
- Liqun Shang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuanhan Ao
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Linhua Lv
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Lihua Lv
- Department of Pharmacy, Shaoyang University, Shaoyang, China
| | - Yubi Zhang
- Department of Hematology Oncology, Shaoyang Central Hospital, Shaoyang, China
| | - Jian Hou
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Jianping Yao
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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Demeekul K, Sukumolanan P, Bootcha R, Panprom C, Petchdee S. A Cardiac Protection of Germinated Brown Rice During Cardiopulmonary Bypass Surgery and Simulated Myocardial Ischemia. J Inflamm Res 2021; 14:3307-3319. [PMID: 34290516 PMCID: PMC8289443 DOI: 10.2147/jir.s321241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The potential cardio-protective property of germinated brown rice (GBR) has been revealed by ameliorating risk factors related to cardiovascular diseases. This study hypothesized that the combination of GBR and cardioplegic solution could protect the cardiomyocytes exposed to simulated ischemic reperfusion injury in vitro study and preserve cardiac function during cardiopulmonary bypass surgery in animal models. Methods Primary porcine cardiomyocytes were isolated and experimented cell viability against simulated ischemic reperfusion injury. In a cardiac surgical animal model, six pigs were randomly assigned to receive the two types of cardioplegic solution: i) St. Thomas cardioplegic solution (20 cc/kg); and ii) St. Thomas cardioplegic solution plus GBR (1 mg/kg). During open-heart surgery, the aorta was cross-clamped for 20 minutes, followed by reperfusion for 1 hour. Cardiopulmonary bypass parameters were recorded until the end of the procedure. Furthermore, hemodynamic parameters and arterial blood gas characteristics of animals among groups were monitored at different time points, including baseline before cardiopulmonary bypass (T1), during cardiopulmonary bypass (T2), during aortic clamp on (T3), and aortic clamp off (T4). Results Primarily, GBR cotreatment with cardioplegic solution essentially resulted in the improvement of cell viability in primary porcine cardiomyocytes against simulated ischemic reperfusion induction. The findings from cardiac surgery demonstrated that mean arterial pressure and heart rate are constantly stable in cardioplegic solution combined with the GBR group, while the trend of potassium and lactase concentration was decreased in the animals receiving GBR group. Consistently, all parameters from arterial blood gas showed better outcomes in animals receiving GBR; however, there were no statistically significant differences between groups, except hepatic enzymes. Conclusion Therefore, GBR might exert cardio-protective effects against ischemic reperfusion injury in the porcine cardiac surgery model due to anti-inflammatory response. These protective actions of GBR may explain the benefits gained from applying GBR products as a possible therapeutic supplement on cardiac diseases.
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Affiliation(s)
- Kanokwan Demeekul
- Graduate School, Program of Bio-Veterinary Science, Kasetsart University, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Pratch Sukumolanan
- Veterinary Clinical Study Program, Faculty of Veterinary Medicine, Kasetsart University, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Ratikorn Bootcha
- Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Chattida Panprom
- Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Soontaree Petchdee
- Department of Large Animal and Wildlife Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, KamphaengSaen Campus, Kamphaeng Saen, Thailand
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Prevalence and Clinical Significance of Drug-Drug and Drug-Dietary Supplement Interactions among Patients Admitted for Cardiothoracic Surgery in Greece. Pharmaceutics 2021; 13:pharmaceutics13020239. [PMID: 33572247 PMCID: PMC7914879 DOI: 10.3390/pharmaceutics13020239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Drug interactions represent a major issue in clinical settings, especially for critically ill patients such as those with cardiovascular disease (CVD) who require cardiothoracic surgery (CTS) and receive a high number of different medications. Methods: A cross-sectional study aimed at evaluating the exposure and clinical significance of drug–drug (DDIs) and drug–dietary supplement interactions (DDSIs) in patients admitted for CTS in the University Hospital of Crete Greece. DDIs were evaluated regarding underlying pharmacological mechanisms upon admission, preoperation, postoperation, and discharge from CTS clinic. Additionally, upon admission, the use of dietary supplements (DSs) and if patients had informed their treating physician that they were using these were recorded with subsequent analysis of potential DDSIs with prescribed medications. Results: The study employed 76 patients who were admitted for CTS and accepted to participate. Overall, 166 unique DDIs were identified, with 32% of them being related to pharmacokinetic (PK) processes and the rest (68%) were related to possible alterations of pharmacodynamic (PD) action. CVD medications and drugs for central nervous system disorders were the most frequently interacting medications. In total, 12% of the identified DDIs were of serious clinical significance. The frequency of PK-DDIs was higher during admission and discharge, whereas PD-DDIs were mainly recorded during pre- and postoperation periods. Regarding DS usage, 60% of patients were using DSs and perceived them as safe, and the majority had not informed their treating physician of this or sought out medical advice. Analysis of medical records showed 30 potential combinations with prescribed medications that could lead in DDSIs due to modulation of PK or PD processes, and grapefruit juice consumption was involved in 38% of them. Conclusions: An increased burden of DDIs and DDSIs was identified mostly upon admission for patients in CTS clinics in Greece. Healthcare providers, especially prescribing physicians in Greece, should always take into consideration the possibility of DDIs and the likely use of DS products by patients to promote their well-being; this should only be undertaken after receiving medical advice and an evidenced-based evaluation.
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10
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Omar AS, Taha A, Al-Khulaifi A. High Transaminases Following Cardiac Surgery: A Narrative Review. JOURNAL OF CARDIAC CRITICAL CARE TSS 2020. [DOI: 10.1055/s-0040-1715931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractElevation of liver enzymes after cardiac surgery is encountered infrequently. Acute heart failure during and after surgery may be the culprit responsible for liver dysfunction. However, it may create clinical confusion whether acute liver dysfunction could induce some sort of cardiac dysfunction through mechanisms similar to those encountered in chronic liver disease. We searched through the Medline, Cochrane, and Embase databases up to January 2018. We included review articles, meta-analyses, and original trials on the elevation of liver enzymes after cardiac surgery, and combined the following MESH terms: “intensive care, “cardiac surgery,” “high liver enzymes,” “ischemia,” “left ventricular dysfunction,” and “critical illness.” Case reports were excluded. Language restrictions were not applied. References were examined for other potentially useful articles. We did not find any articles that supported the cardiac decompensation phenomenon after acute liver injury. In contrast, low-hepatic flow, hypoxemia, or pump-induced inflammation could induce hepatic dysfunction in acute settings after cardiac surgery. In conclusion, a rise in the transaminases following cardiac surgery would favor an ischemic etiology for the condition.
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Affiliation(s)
- Amr S. Omar
- Department of Cardiothoracic Surgery/Cardiac Anesthesia and ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Critical Care Medicine, Beni Suef University, Beni Suef, Egypt
- Department of Clinical Medicine, Weill Cornell Medical College, Qatar
| | - Adel Taha
- Department of Critical Care Medicine, King Khaled Specialized Hospital, Dammam, KSA
| | - Abdulaziz Al-Khulaifi
- Department of Cardiothoracic Surgery/Cardiac Anesthesia and ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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11
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Amer GF, Elawady MS, ElDerie A, Sanad M. Normothermia versus Hypothermia during Cardiopulmonary Bypass in Cases of Repair of Atrioventricular Septal Defect. Anesth Essays Res 2020; 14:112-118. [PMID: 32843803 PMCID: PMC7428111 DOI: 10.4103/aer.aer_123_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/23/2019] [Accepted: 10/15/2019] [Indexed: 11/04/2022] Open
Abstract
Background Cardiopulmonary bypass (CPB) used for cardiac surgery is now uniformly carried out under normothermic conditions in adult patients; however, the temperature applied in pediatric CPB vary significantly, ranging from deep hypothermia to normothermia due to the lack of a consistent approach to CPB temperature in pediatric cardiac surgery, which is related to a lack of supportive evidence. Organs protection aim to decrease metabolic requirement and provide energy and oxygen, hypothermia has reached these goals by arresting and cooling the heart, delivering oxygen, and modifying reperfusion. Recently, a large number of studies investigated effect of hypothermia to decrease the negative impact of hypothermia. It has been suggested that the degree of hypothermia affects the inflammatory responses triggered by CPB. However, the use of normothermia during CPB had been introduced and resulted in acceptable results. We hypothesized that the use of normothermia during corrective surgery of AV septal defects improves the outcome of the CPB. Objective The study aimed to compare the outcome of normothermic technique and mild hypothermic technique during (CPB) in pediatric cardiac patients undergoing repair of atrioventricular (AV) septal defect and their effect on tissue perfusion, serum lactate level, duration of patient intubation, and postoperative hospital stay. Patients and Methods Forty patients presented for repair of AV defect aged from 1 month to 36 months were divided randomly into two equal groups (20 patients in each): Group I (Normothermic group) of body temperature more than 35°C up to 37°C and Group II (mild Hypothermic group) body temperature between (32°C-35°C). Basal data include complete blood count, electrolytes, arterial blood gases (ABGs), coagulation profile, and liver function tests were collected. Hemodynamic variables, ABG, serum lactate, and activated clotting time (ACT) measured in different time intervals related to CPB. With the termination of CPB, aortic cross-clamping time (minutes), CPB time (minutes), spontaneous regaining of the heart function, need for inotropic administration, and/or vasopressor requirements to wean the heart from CPB were reported in all patients. Results This study showed statistically significant lower PH and HCO3 levels and significantly higher serum lactate levels in Group II (hypothermic) than Group I (normothermic) after weaning from CPB. Furthermore, ACT level was statistically significantly higher in Group II than Group I after weaning of CPB. During postoperative period, hypothermic group showed significantly higher liver enzymes than the normothermic group. The duration of inotropes administration and duration of intubation were significantly longer in Group II than Group I. Conclusion Normothermia during CPB showed better global tissue perfusion than hypothermia in elective surgeries for repair of AV defects in the form of less degree of lactic acidosis, less effect on coagulation system, shorter duration of inotropic support, shorter intubation period, and shorter stay in the intensive care unit.
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Affiliation(s)
- Ghada F Amer
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Mostafa S Elawady
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Ahmad ElDerie
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Mohammed Sanad
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
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12
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Chor CYT, Mahmood S, Khan IH, Shirke M, Harky A. Gastrointestinal complications following cardiac surgery. Asian Cardiovasc Thorac Ann 2020; 28:621-632. [DOI: 10.1177/0218492320949084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastrointestinal complications after cardiac surgery may be uncommon but they carry high mortality rates. Incidences range from 0.5% to 5.5%, while mortality rates of such complications vary from 0.3% to 87%. They range from small gastrointestinal bleeds, ileus, and pancreatitis to life-threatening complications such as liver failure and ischemic bowel. Due to the vague and often absence of specific signs and symptoms, diagnosis of a gastrointestinal complication is often late. This article aims to review and summarize the literature concerning gastrointestinal complications after cardiac surgery. We discuss the causes, risk factors, diagnosis, preventative measures, and management of these complications. In general, risk factor identification, preventive measures, early diagnosis, and swift management are the keys to reducing the occurrence of gastrointestinal complications and their associated morbidity and mortality.
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Affiliation(s)
| | - Saira Mahmood
- Department of Medicine, St George’s Hospital Medical School, London, UK
| | | | - Manasi Shirke
- Department of Medicine, Queen’s University Belfast, School of Medicine, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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13
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Chai J, Wang K, Kong X, Pan C, Jiang W, Zhou W, Chen H, Xue F, Zhang L, Shen Z. Coronary artery bypass graft combined with liver transplantation in patients with advanced alcoholic liver cirrhosis: A case report. Exp Ther Med 2020; 19:3197-3202. [PMID: 32266015 PMCID: PMC7132228 DOI: 10.3892/etm.2020.8594] [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: 11/23/2018] [Accepted: 08/30/2019] [Indexed: 11/17/2022] Open
Abstract
Performing cardiothoracic surgery on patients with advanced liver failure and liver cirrhosis is high-risk for patients. Coronary artery bypass grafting is the most effective treatment for patients with liver failure that is complicated with severe coronary heart disease, and who cannot be treated using coronary stent intervention. In the current study, one case of coronary artery bypass grafting combined with liver transplantation was assessed, with the patient exhibiting advanced alcoholic liver cirrhosis. A coronary artery bypass graft was performed to relieve angina pectoris. Following surgery, wound exudation, secondary infection, liver failure, pleuroperitoneal fluid leakage, hypoproteinemia and other adverse treatment results occurred, and the chest wound did not heal. Allograft liver transplantation was subsequently performed and, following surgery, the chest wound healed gradually after debridement, and the patient recovered.
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Affiliation(s)
- Junwu Chai
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin Clinical Research Center for Organ Transplantation, Tianjin, 300074, P.R. China
| | - Kai Wang
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin Clinical Research Center for Organ Transplantation, Tianjin, 300074, P.R. China
| | - Xiangrong Kong
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin Clinical Research Center for Organ Transplantation, Tianjin, 300074, P.R. China
| | - Cheng Pan
- Department of Liver Transplantation, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Wentao Jiang
- Department of Liver Transplantation, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Wei Zhou
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin Clinical Research Center for Organ Transplantation, Tianjin, 300074, P.R. China
| | - Honglei Chen
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin Clinical Research Center for Organ Transplantation, Tianjin, 300074, P.R. China
| | - Fenlong Xue
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin Clinical Research Center for Organ Transplantation, Tianjin, 300074, P.R. China
| | - Li Zhang
- Department of Liver Transplantation, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Zhongyang Shen
- Department of Liver Transplantation, Tianjin First Central Hospital, Tianjin 300192, P.R. China
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14
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Ruth ND, Drury NE, Bennett J, Kelly DA. Cardiac and Liver Disease in Children: Implications for Management Before and After Liver Transplantation. Liver Transpl 2020; 26:437-449. [PMID: 31872564 DOI: 10.1002/lt.25666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 10/16/2019] [Indexed: 02/06/2023]
Abstract
There is close interaction between the functions of the liver and heart affecting the presentation, diagnosis, and outcome of acute and chronic cardiac and liver disease. Conditions affecting both organ systems should be considered when proposing transplantation because the interaction between cardiac disease and liver disease has implications for diagnosis, management, selection for transplantation, and, ultimately, for longterm outcomes after liver transplantation (LT). The combination of cardiac and liver disease is well recognized in adults but is less appreciated in pediatric patients. The focus of this review is to describe conditions affecting both the liver and heart and how they affect selection and management of LT in the pediatric population.
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Affiliation(s)
- Nicola D Ruth
- Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, United Kingdom.,Institute of Infection and Immunity, University of Birmingham, Birmingham, United Kingdom
| | - Nigel E Drury
- Department of Paediatric Cardiac Surgery, Birmingham Women's & Children's Hospital, Birmingham, United Kingdom.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - James Bennett
- Department of Anaesthesia, Birmingham Women's & Children's Hospital, Birmingham, United Kingdom.,Department of Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Deirdre A Kelly
- Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, United Kingdom.,Institute of Infection and Immunity, University of Birmingham, Birmingham, United Kingdom
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15
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Biswas D, Tozer K, Dao KT, Perez LJ, Mercer A, Brown A, Hossain I, Yip AM, Aguiar C, Motawea H, Brunt KR, Shea J, Legare JF, Hassan A, Kienesberger PC, Pulinilkunnil T. Adverse Outcomes in Obese Cardiac Surgery Patients Correlates With Altered Branched-Chain Amino Acid Catabolism in Adipose Tissue and Heart. Front Endocrinol (Lausanne) 2020; 11:534. [PMID: 32903728 PMCID: PMC7438793 DOI: 10.3389/fendo.2020.00534] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Predicting relapses of post-operative complications in obese patients who undergo cardiac surgery is significantly complicated by persistent metabolic maladaptation associated with obesity. Despite studies supporting the linkages of increased systemic branched-chain amino acids (BCAAs) driving the pathogenesis of obesity, metabolome wide studies have either supported or challenged association of circulating BCAAs with cardiovascular diseases (CVDs). Objective: We interrogated whether BCAA catabolic changes precipitated by obesity in the heart and adipose tissue can be reliable prognosticators of adverse outcomes following cardiac surgery. Our study specifically clarified the correlation between BCAA catabolizing enzymes, cellular BCAAs and branched-chain keto acids (BCKAs) with the severity of cardiometabolic outcomes in obese patients pre and post cardiac surgery. Methods: Male and female patients of ages between 44 and 75 were stratified across different body mass index (BMI) (non-obese = 17, pre-obese = 19, obese class I = 14, class II = 17, class III = 12) and blood, atrial appendage (AA), and subcutaneous adipose tissue (SAT) collected during cardiac surgery. Plasma and intracellular BCAAs and BC ketoacids (BCKAs), tissue mRNA and protein expression and activity of BCAA catabolizing enzymes were assessed and correlated with clinical parameters. Results: Intramyocellular, but not systemic, BCAAs increased with BMI in cardiac surgery patients. In SAT, from class III obese patients, mRNA and protein expression of BCAA catabolic enzymes and BCKA dehydrogenase (BCKDH) enzyme activity was decreased. Within AA, a concomitant increase in mRNA levels of BCAA metabolizing enzymes was observed, independent of changes in BCKDH protein expression or activity. BMI, indices of tissue dysfunction and duration of hospital stay following surgery correlated with BCAA metabolizing enzyme expression and metabolite levels in AA and SAT. Conclusion: This study proposes that in a setting of obesity, dysregulated BCAA catabolism could be an effective surrogate to determine cardiac surgery outcomes and plausibly predict premature re-hospitalization.
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Affiliation(s)
- Dipsikha Biswas
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- IMPART Investigator Team Canada, Saint John, NB, Canada
| | - Kathleen Tozer
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Khoi T. Dao
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Lester J. Perez
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Angella Mercer
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- IMPART Investigator Team Canada, Saint John, NB, Canada
| | - Amy Brown
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Intekhab Hossain
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Alexandra M. Yip
- New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, NB, Canada
| | - Christie Aguiar
- IMPART Investigator Team Canada, Saint John, NB, Canada
- New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, NB, Canada
| | - Hany Motawea
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- IMPART Investigator Team Canada, Saint John, NB, Canada
| | - Keith R. Brunt
- IMPART Investigator Team Canada, Saint John, NB, Canada
- Department of Pharmacology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Jennifer Shea
- Department of Pathology, Dalhousie University, Saint John, NB, Canada
- Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - Jean F. Legare
- IMPART Investigator Team Canada, Saint John, NB, Canada
- New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, NB, Canada
| | - Ansar Hassan
- IMPART Investigator Team Canada, Saint John, NB, Canada
- New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, NB, Canada
| | - Petra C. Kienesberger
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- IMPART Investigator Team Canada, Saint John, NB, Canada
| | - Thomas Pulinilkunnil
- Department of Biochemistry and Molecular Biology, Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- IMPART Investigator Team Canada, Saint John, NB, Canada
- *Correspondence: Thomas Pulinilkunnil
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16
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Adam EH, Meier J, Klee B, Zacharowski K, Meybohm P, Weber CF, Pape A. Factor XIII activity in patients requiring surgical re-exploration for bleeding after elective cardiac surgery - A prospective case control study. J Crit Care 2019; 56:18-25. [PMID: 31805464 DOI: 10.1016/j.jcrc.2019.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Surgical re-exploration due to postoperative bleeding is associated with increased morbidity and mortality. The aim of our study was to assess a potential association between the level of postoperative FXIII activity and need for re-exploration due to bleeding in patients undergoing cardiothoracic surgery. MATERIALS AND METHODS In our prospective single center observational cohort study, we enrolled patients who underwent elective cardiothoracic surgery. Patients who required re-exploration (RE group) were matched to patients from the study population (non-RE group). RESULTS The study included 64 patients, out of a cohort of 678 patients, of whom 32 required surgical re-exploration due to bleeding within the first 24 h. Between patients of the RE and non-RE group, a significantly reduced FXIII activity was observed postoperatively (59.0 vs 71.1; p = .014). Multivariable analysis revealed reduced FXIII activity (p = .048) as a parameter independently associated with surgical re-exploration. Further, reduced FXIII activity (p = .037) and surgical re-exploration (p = .01) were significantly associated with increased 30 day mortality. In multivariable analysis re-exploration was independently associated with increased risk of 30 day mortality (p = .004, HR 9.68). CONCLUSIONS Reduced postoperative FXIII activity may be associated with the need for surgical re-exploration. Postoperative assessment of FXIII activity should therefore be considered in patients undergoing elective cardiothoracic surgery.
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Affiliation(s)
- Elisabeth H Adam
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt/Main, Germany.
| | - Jens Meier
- Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4021 Linz, Austria.
| | - Bernd Klee
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt/Main, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt/Main, Germany.
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt/Main, Germany.
| | - Christian F Weber
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt/Main, Germany; Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Asklepios Clinics Hamburg, AK Wandsbek, Alphonsstr. 14, 22043 Hamburg, Germany.
| | - Andreas Pape
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt/Main, Germany.
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17
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Yang L, Li J, Wang G, Zhou H, Fang Z, Shi S, Lei G, Zhang C, Chen Y, Yang X. Postoperative liver dysfunction after total arch replacement combined with frozen elephant trunk implantation: incidence, risk factors and outcomes. Interact Cardiovasc Thorac Surg 2019; 29:930-936. [PMID: 31504538 DOI: 10.1093/icvts/ivz209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 01/20/2023] Open
Abstract
Abstract
OBJECTIVES
The authors aimed to clarify the incidence and risk factors of postoperative liver dysfunction (PLD) in patients undergoing total arch replacement combined with frozen elephant trunk implantation and to determine the association of PLD with short-term outcomes.
METHODS
Data from 672 adult patients undergoing total arch replacement with frozen elephant trunk from January 2013 until December 2016 at Fuwai Hospital were analysed retrospectively. A multivariable logistic regression model was used to identify the risk factors for PLD.
RESULTS
The overall incidence of PLD was 27.5%, which was associated with higher in-hospital mortality (PLD 4.9% vs No PLD 0.8%, P = 0.002) and 30-day mortality (PLD 9.2% vs No PLD 2.5%, P < 0.001) and a higher incidence of major adverse events (PLD 54.6% vs No PLD 23.4%, P < 0.001). In the multivariable analysis, preoperative hypotension [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.14–3.41; P = 0.02), coronary artery disease (OR 2.64, 95% CI 1.17–5.96; P = 0.02), prolonged cardiopulmonary bypass duration (OR 1.01, 95% CI 1.00–1.01; P < 0.001), increased preoperative alanine transferase (OR 1.01, 95% CI 1.00–1.01; P < 0.001), preoperative platelet count <100 × 109/l (OR 3.99, 95% CI 1.74–9.14; P = 0.001) and increased intraoperative erythrocyte transfusion (OR 1.07, 95% CI 1.01–1.12; P = 0.02) were identified as independent risk factors for PLD.
CONCLUSIONS
PLD was associated with increased mortality and morbidity. Among the independent risk factors for PLD, cardiopulmonary bypass duration and erythrocyte transfusion could be modifiable. A skilled surgical team and an ideal blood protection strategy may be helpful to protect liver function.
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Affiliation(s)
- Lijing Yang
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Li
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guyan Wang
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Zhou
- Department of Anaesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhongrong Fang
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Shi
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guiyu Lei
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congya Zhang
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yimeng Chen
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiying Yang
- Department of Anaesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Seppelt PC, Zappel J, Weiler H, Mas‐Peiró S, Papadopoulos N, Walther T, Zeiher AM, Fichtlscherer S, Vasa‐Nicotera M. Aortic valve replacement in patients with preexisting liver disease: Transfemoral approach with favorable survival. Catheter Cardiovasc Interv 2019; 95:54-64. [DOI: 10.1002/ccd.28319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 12/31/2018] [Accepted: 04/15/2019] [Indexed: 12/13/2022]
Affiliation(s)
| | - Jessica Zappel
- Division of Cardiology, Department of Medicine IIIGoethe University Frankfurt Germany
| | - Helge Weiler
- Division of Cardiology, Department of Medicine IIIGoethe University Frankfurt Germany
| | - Silvia Mas‐Peiró
- Division of Cardiology, Department of Medicine IIIGoethe University Frankfurt Germany
| | - Nestoras Papadopoulos
- Department of Thoracic and Cardiovascular SurgeryUniversity Hospital Frankfurt Frankfurt Germany
| | - Thomas Walther
- Department of Thoracic and Cardiovascular SurgeryUniversity Hospital Frankfurt Frankfurt Germany
| | | | - Stephan Fichtlscherer
- Division of Cardiology, Department of Medicine IIIGoethe University Frankfurt Germany
| | - Mariuca Vasa‐Nicotera
- Division of Cardiology, Department of Medicine IIIGoethe University Frankfurt Germany
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19
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Nazer RI, Alburikan KA, Ullah A, Albarrati AM, Hassanain M. Transient liver dysfunction increases surgical site infections after coronary surgery. Asian Cardiovasc Thorac Ann 2018; 26:439-445. [DOI: 10.1177/0218492318793305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Surgical site infections can have a significant impact on cardiac surgical outcome. The liver plays an important role in infection prevention. This study aimed to retrospectively determine whether transient postoperative liver dysfunction after coronary bypass surgery increased surgical site infections. Methods A modified version of the Schindl scoring scale for liver dysfunction was adapted to objectively quantify transient liver dysfunction in the first 7 days after on-pump coronary artery bypass grafting. A retrospective analysis of clinical outcomes at 30 months postoperatively was performed on data of 575 patients who underwent coronary artery bypass between 2014 and 2016. The patients were categorized into a liver dysfunction group (Schindl score ≥ 4) and a non-liver dysfunction group (Schindl score < 4). Results The liver dysfunction group (47.3%) had significantly more patients who were obese, current smokers, and had diabetes, renal impairment, and peripheral vascular disease. Surgical site infections occurred predominantly in the liver dysfunction group (12.1% vs. 0.3%, p < 0.001). The independent predictors of surgical site infection were liver dysfunction, body mass index > 30 kg m−2, and coronary bypass surgery combined with other cardiac procedures. Conclusions Surgical wound infections can be precipitated by multiple factors before, during, and after coronary bypass surgery. Transient liver dysfunction in the perioperative period is associated with an increased rate of surgical infections even after adjusting for known risk factors. Considering this factor as well as other known risks may help to identify and stratify patients with a potentially higher risk of surgical site infections.
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Affiliation(s)
- Rakan I Nazer
- Department of Cardiac Science, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Alburikan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Science, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali M Albarrati
- Department of Rehabilitation Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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20
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Chacon MM, Schulte TE. Liver Dysfunction in Cardiac Surgery – What Causes It and Is There Anything We Can Do? J Cardiothorac Vasc Anesth 2018; 32:1719-1721. [DOI: 10.1053/j.jvca.2018.02.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Indexed: 11/11/2022]
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21
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Pimentel MF, Soares MJF, Murad JA, Oliveira MABD, Faria FL, Faveri VZ, Iano Y, Guido RC. Predictive Factors of Long-Term Stay in the ICU after Cardiac Surgery: Logistic CASUS Score, Serum Bilirubin Dosage and Extracorporeal Circulation Time. Braz J Cardiovasc Surg 2018; 32:367-371. [PMID: 29211215 PMCID: PMC5701110 DOI: 10.21470/1678-9741-2016-0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/21/2017] [Indexed: 11/04/2022] Open
Abstract
Objective To test the capacity of the Logistic CASUS Score on the second postoperative
day, the total serum bilirubin dosage on the second postoperative day and
the extracorporeal circulation time, as possible predictive factors of
long-term stay in Intensive Care Unit after cardiac surgery. Methods Eight-two patients submitted to cardiac surgery with extracorporeal
circulation were selected. The Logistic CASUS Score on the second
postoperative day was calculated and bilirubin dosage on the second
postoperative day was measured. The extracorporeal circulation time was also
registered. Patients were divided into two groups: Group A, those who were
discharged up to the second day of postoperative care; Group B, those who
were discharged after the second day of postoperative care. Results In this study, 40 cases were listed in Group A and 42 cases in Group B. The
mean extracorporeal circulation time was 83.9±29.4 min in Group A and
95.8±29.31 min in Group B. Extracorporeal circulation time was not
significant in this study (P=0.0735). The level of
P significance of bilirubin dosage on the second
postoperative day was 0.0003 and an area under the ROC curve of 0.708 with a
cut-off point at 0.51 mg/dl was registered. The level of P
significance of Logistic CASUS Score on the second postoperative day was
0.0001 and an area under the ROC curve of 0.723 with a cut-off point at
0.40% was registered. Conclusion The Logistic CASUS Score on the second postoperative day has shown to be
better than the bilirubin dosage on the second postoperative day as a
predictive tool for calculating the length of stay in intensive care unit
during the postoperative care period of patients. Notwithstanding,
extracorporeal circulation time has failed to prove itself as an efficient
tool to predict an extended length of stay in intensive care unit.
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Affiliation(s)
| | | | - Jamil Alli Murad
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
| | | | - Fernanda Luiza Faria
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
| | - Vinicius Zani Faveri
- Faculdade de Engenharia Elétrica e de Computação da Universidade Estadual de Campinas (FEEC-Unicamp), Campinas, SP, Brazil
| | - Yuzo Iano
- Faculdade de Engenharia Elétrica e de Computação da Universidade Estadual de Campinas (FEEC-Unicamp), Campinas, SP, Brazil
| | - Rodrigo Capobianco Guido
- Instituto de Biociências, Letras e Ciências Exatas da Universidade Estadual Paulista (IBILCE-UNESP), São José do Rio Preto, SP, Brazil
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22
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Fujishiro J, Sugiyama M, Ishimaru T, Watanabe M, Sato K, Hoshino N, Uotani C, Kutsukake M, Hirata Y, Oka A. Direct hyperbilirubinemia in infants with congenital heart disease. Pediatr Int 2018; 60:179-182. [PMID: 29178522 DOI: 10.1111/ped.13462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/29/2017] [Accepted: 11/22/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The association between congenital heart disease (CHD) and infantile cholestasis, a key finding for the diagnosis of biliary atresia (BA), has not been previously investigated. The aim of this study was therefore to investigate the characteristics of direct hyperbilirubinemia (D-HB) in infants with CHD. METHODS All neonates admitted to the present hospital and diagnosed with CHD in 2015 and 2016 were included. D-HB (direct bilirubin ≥ 2.0 mg/dL) at ≤60 days of age and other clinical parameters were retrospectively reviewed. Statistical analysis according to presence of D-HB was performed using chi-squared test or Wilcoxon rank sum test. RESULTS Seventy-six patients (M:F, 36:40) were included in this study. CHD consisted of ventricular septal defect in 17, patent ductus arteriosus in 10, and other in 49. Thirteen patients (17.1%) had D-HB at ≤60 days of age. Resolution of D-HB (DB < 2.0 mg/dL) occurred in 10 of the 13 patients during the hospital stay, and this occurred in ≤7 days in eight of the 10 patients. Sex, gestational age, birthweight, chromosomal anomalies, need for Fontan operation for CHD repair, and/or cardiac operation were not associated with D-HB at ≤60 days of age. CONCLUSION While D-HB was frequently observed in infants with CHD, the majority of D-HB cases resolved spontaneously in ≤1 week. Neonatal clinical parameters or CHD status was not predictive of D-HB. D-HB lasting >1 week in infants with CHD should be evaluated for the cause.
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Affiliation(s)
- Jun Fujishiro
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiko Sugiyama
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Sato
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriko Hoshino
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chizue Uotani
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mai Kutsukake
- Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Oka
- Department of Pediatrics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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23
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Greenberg RG, Wu H, Laughon M, Capparelli E, Rowe S, Zimmerman KO, Smith PB, Cohen-Wolkowiez M. Population Pharmacokinetics of Dexmedetomidine in Infants. J Clin Pharmacol 2017; 57:1174-1182. [PMID: 28444697 PMCID: PMC5561462 DOI: 10.1002/jcph.904] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/02/2017] [Indexed: 12/31/2022]
Abstract
Despite limited pharmacokinetic (PK) data, dexmedetomidine is increasingly being used off-label for sedation in infants. We aimed to characterize the developmental PK changes of dexmedetomidine during infancy. In this open-label, single-center PK study of dexmedetomidine in infants receiving dexmedetomidine per clinical care, ≤10 blood samples per infant were collected. A set of structural PK models and residual error models were explored using nonlinear mixed-effects modeling in NONMEM. Covariates including postmenstrual age (PMA), serum creatinine, and recent history of cardiac surgery requiring cardiopulmonary bypass were investigated for their influence on PK parameters. Univariable generalized estimating equation models were used to evaluate the association of hypotension with dexmedetomidine concentrations. A total of 89 PK samples were collected from 20 infants with a median PMA of 44 weeks (range, 33-61). The median maximum dexmedetomidine infusion dose during the study period was 1.8 μg/(kg·h) (0.5-2.5), and 16/20 infants had a maximum dose >1 μg/(kg·h). A 1-compartment model best described the data. Younger PMA was a significant predictor of lower clearance. Infants with a history of cardiac surgery had ∼40% lower clearance compared to those without a history of cardiac surgery. For infants with PMA of 33 to 61 weeks and body weight of 2 to 6 kg, the estimated clearance and volume of distribution were 0.87 to 2.65 L/(kg·h) and 1.5 L/kg, respectively. No significant associations were found between dexmedetomidine concentrations and hypotension. Infants with younger PMA and recent cardiac surgery may require relatively lower doses of dexmedetomidine to achieve exposure similar to older patients and those without cardiac surgery.
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Affiliation(s)
- Rachel G. Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Huali Wu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Matthew Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edmund Capparelli
- Department of Pediatrics and Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, CA, USA
| | - Stevie Rowe
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Kanecia O. Zimmerman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - P. Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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24
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Qi W, Tian L, An W, Wu Q, Liu J, Jiang C, Yang J, Tang B, Zhang Y, Xie K, Wang X, Li Z, Wu W. Curing the Toxicity of Multi-Walled Carbon Nanotubes through Native Small-molecule Drugs. Sci Rep 2017; 7:2815. [PMID: 28588210 PMCID: PMC5460272 DOI: 10.1038/s41598-017-02770-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 04/19/2017] [Indexed: 12/21/2022] Open
Abstract
With the development and application of nanotechnology, large amounts of nanoparticles will be potentially released to the environment and possibly cause many severe health problems. Although the toxicity of nanoparticles has been investigated, prevention and treatment of damages caused by nanoparticles have been rarely studied. Therefore, isotope tracing and improved CT imaging techniques were used to investigate the biodistribution influence between oMWCNTs(oxidized multi-walled carbon nanotubes) and 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC)/or simvastatin (TD) in vivo. What’s more, biochemical indices in plasma and tissue histology were measured to further study therapeutic effects on the damages of oMWCNTs in mice. Isotope tracing and improved CT imaging results showed that low dosages of DOPC and TD didn’t affect the distribution of oMWCNTs in mice; conversely, the distribution and metabolism of DOPC and TD were influenced by oMWCNTs. Moreover, DOPC and/or TD improved the biocompatibility of oMWCNTs in erythrocyte suspension in vitro. Biochemical index and histopathological results indicated that DOPC and TD didn’t prevent injuries caused by oMWCNTs effectively. But TD showed a good therapeutic effect for damages. This study is the first to investigate prevention and treatment effects of drugs on damages caused by oMWCNTs and provides new insights and breakthroughs for management of nanoparticles on health hazards.
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Affiliation(s)
- Wei Qi
- School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan City, 430074, Hubei Province, P.R. China.
| | - Longlong Tian
- Lanzhou University, Lanzhou City, 730000, Gansu Province, P.R. China
| | - Wenzhen An
- Lanzhou University, Lanzhou City, 730000, Gansu Province, P.R. China
| | - Qiang Wu
- Lanzhou University, Lanzhou City, 730000, Gansu Province, P.R. China
| | - Jianli Liu
- Lanzhou University Second Hospital, Lanzhou City, 730000, Gansu Province, P.R. China
| | - Can Jiang
- Non-power Nuclear Technology Research & Development Center, Hubei University of Science and Technology, Xianning City, 437000, Hubei Province, P.R. China
| | - Jun Yang
- Institue of Applied and Electromagnetic Engineering, Huazhong University of Science and Technology, Wuhan City, 430074, Hubei Province, P.R. China
| | - Bing Tang
- Institue of Applied and Electromagnetic Engineering, Huazhong University of Science and Technology, Wuhan City, 430074, Hubei Province, P.R. China
| | - Yafeng Zhang
- Institue of Applied and Electromagnetic Engineering, Huazhong University of Science and Technology, Wuhan City, 430074, Hubei Province, P.R. China
| | - Kangjun Xie
- School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan City, 430074, Hubei Province, P.R. China
| | - Xinling Wang
- College of Pharmacy, Xinjiang Medical University, Urumqi, 830011, Xinjiang Province, P.R. China
| | - Zhan Li
- Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, P.R. China.
| | - Wangsuo Wu
- Lanzhou University, Lanzhou City, 730000, Gansu Province, P.R. China.
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25
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Asgeri M. Post Cardiopulmonary Bypass Changes in Liver Function: Comment on "J Cardiovasc Thorac Res 2015;7:49-54". J Cardiovasc Thorac Res 2015; 7:132-3. [PMID: 26430504 PMCID: PMC4586602 DOI: 10.15171/jcvtr.2015.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mehrdad Asgeri
- Department of Medicine, Gastroenterology Section, Strong Memorial Hospital, University of Rochester, Rochester, NY, USA
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