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Wang L, Zhong X, Yang H, Yang J, Zhang Y, Zou X, Wang L, Zhang Z, Jin X, Kang Y, Wu Q. When can we start early enteral nutrition safely in patients with shock on vasopressors? Clin Nutr ESPEN 2024; 61:28-36. [PMID: 38777444 DOI: 10.1016/j.clnesp.2024.03.007] [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: 09/23/2023] [Revised: 02/17/2024] [Accepted: 03/03/2024] [Indexed: 05/25/2024]
Abstract
Shock is a common critical illness characterized by microcirculatory disorders and insufficient tissue perfusion. Patients with shock and hemodynamic instability generally require vasopressors to maintain the target mean arterial pressure. Enteral nutrition (EN) is an important therapeutic intervention in critically ill patients and has unique benefits for intestinal recovery. However, the initiation of early EN in patients with shock receiving vasopressors remains controversial. Current guidelines make conservative and vague recommendations regarding early EN support in patients with shock. Increasing studies demonstrates that early EN delivery is safe and feasible in patients with shock receiving vasopressors; however, this evidence is based on observational studies. Changes in gastrointestinal blood flow vary by vasopressor and inotrope and are complex. The risk of gastrointestinal complications, especially the life-threatening complications of non-occlusive mesenteric ischemia and non-occlusive bowel necrosis, cannot be ignored in patients with shock during early EN support. It remains a therapeutic challenge in critical care nutrition therapy to determine the initiation time of EN in patients with shock receiving vasopressors and the safe threshold region for initiating EN with vasopressors. Therefore, the current review aimed to summarize the evidence on the optimal and safe timing of early EN initiation in patients with shock receiving vasopressors to improve clinical practice.
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Affiliation(s)
- Luping Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Xi Zhong
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Hao Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Jing Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Yan Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Xia Zou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Lijie Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Xiaodong Jin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
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Stančiaková L, Othman M, Kubisz P. Management of Venous and Arterial Thrombosis. J Clin Med 2024; 13:2744. [PMID: 38792286 PMCID: PMC11122507 DOI: 10.3390/jcm13102744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/11/2024] [Indexed: 05/26/2024] Open
Abstract
A thrombus is a hemostatic plug localized in a blood vessel [...].
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Affiliation(s)
- Lucia Stančiaková
- National Centre of Haemostasis and Thrombosis, Department of Haematology and Transfusion Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, 036 59 Martin, Slovakia;
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Peter Kubisz
- National Centre of Haemostasis and Thrombosis, Department of Haematology and Transfusion Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, 036 59 Martin, Slovakia;
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3
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Kochetkov FD, Suchkov IA, Zaitsev OV, Koshkina AV. [Modern biochemical markers of acute mesenteric ischemia]. Khirurgiia (Mosk) 2024:58-63. [PMID: 38258689 DOI: 10.17116/hirurgia202401158] [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: 01/24/2024]
Abstract
OBJECTIVE To analyze modern literature data on biochemical markers of critical mesenteric ischemia. MATERIAL AND METHODS We analyzed the most promising, highly specific and sensitive biochemical markers of total and segmental intestinal damage following acute mesenteric ischemia. Analysis included domestic and foreign literature data between 2015 and 2023. RESULTS We identified the most easy-to-use for any hospitals biochemical markers with at least 90% sensitivity and specificity for further practical research. CONCLUSION Further prospective research will provide a new step in solving the problem of timely diagnosis of acute mesenteric circulatory disorders.
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Affiliation(s)
- F D Kochetkov
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - I A Suchkov
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - O V Zaitsev
- Pavlov Ryazan State Medical University, Ryazan, Russia
- Regional Clinical Hospital, Ryazan, Russia
| | - A V Koshkina
- Pavlov Ryazan State Medical University, Ryazan, Russia
- Regional Clinical Hospital, Ryazan, Russia
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Novotny T, Staffa R, Tomandl J, Krivka T, Kruzliak P, Tomandlova M, Slaby O, Sponiar J, Caprnda M, Gaspar L, Rodrigo L, Mozos I, Kubicek L, Biros E, Vlachovsky R, Radova L, Konieczna A. Procalcitonin kinetics following abdominal aortic surgery and its value for postoperative intestinal ischaemia detection. Vascular 2023; 31:1061-1068. [PMID: 35594244 DOI: 10.1177/17085381221102812] [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: 11/17/2022]
Abstract
OBJECTIVE The purpose of our study was to describe perioperative kinetics of procalcitonin (PCT) in patients undergoing aortic surgery, to compare the kinetics in the open abdominal aortic aneurysm (AAA) repair and aortobifemoral bypass for aortoiliac occlusive disease (AIOD), and to evaluate the ability of PCT to detect intestinal ischaemia. METHODS A prospective non-randomized observational cohort study in 80 patients (62 men and 18 women) undergoing elective aortic surgery was performed. Serum PCT was measured at baseline and defined intraoperative and postoperative timepoints up to postoperative day 7. MRI contrast-enhanced imaging was used to detect intestinal ischaemia. RESULTS The comparison of the AAA and AIOD cohort did not show any significant difference in PCT levels. Patients with intestinal ischaemia had higher serum PCT at multiple timepoints postoperatively. The most accurate timepoints for early diagnosis were postoperative day 3, followed by 24 h after declamping of the vascular reconstruction, and postoperative day 7. The sensitivity and negative predictive values were 100% in all mentioned timepoints. However, event at the best timepoint the specificity was 89% and the positive predictive value 43%. CONCLUSIONS Procalcitonin levels in the postoperative period at proper timepoints might help to detect postoperative intestinal ischaemia. The limitation of this marker is its low specificity for intestinal ischaemia and low positive predictive value. The highest value of this marker is that it can rule out this complication because normal PCT levels mean that intestinal ischaemia is very unlikely.
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Affiliation(s)
- Tomas Novotny
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Staffa
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Josef Tomandl
- Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Krivka
- Department of Medical Imaging, St. Anne's University Hospital Brno, Czech Republic
- Department of Medical Imaging, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Peter Kruzliak
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marie Tomandlova
- Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Slaby
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Sponiar
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Caprnda
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Ludovit Gaspar
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Luis Rodrigo
- Faculty of Medicine, University of Oviedo and Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | - Ioana Mozos
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Lubos Kubicek
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ernest Biros
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Vlachovsky
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Radova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Anna Konieczna
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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Smalcova J, Belohlavek J. Non-Occlusive Mesenteric Ischemia in Cardiac Arrest Patients. Rev Cardiovasc Med 2023; 24:262. [PMID: 39076401 PMCID: PMC11270105 DOI: 10.31083/j.rcm2409262] [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: 04/01/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 07/31/2024] Open
Abstract
Non-occlusive mesenteric ischemia (NOMI) is a severe complication in patients after cardiac arrest (CA). The diagnosis is complicated, the treatment options are limited. Given the susceptibility of enterocytes to ischemia, the incidence and severity of NOMI in the post-resuscitation period may reflect the intensity and duration of both ischemia and subsequent reperfusion injury. NOMI is considered to be associated with adverse neurological outcomes in CA patients. Therefore, NOMI should not only be regarded as a post-resuscitation complication but also as one of the prognostic markers in CA patients.This paper summarizes current knowledge on NOMI's pathophysiology, diagnosis, treatment, and prognostic significance in CA patients.
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Affiliation(s)
- Jana Smalcova
- Anaesthesiology and Resuscitation Department, Cardiac
Centre, Institute for Clinical and Experimental Medicine, 14000 Prague, Czech
Republic
- First Faculty of Medicine, Charles University, 12108 Prague, Czech
Republic
| | - Jan Belohlavek
- First Faculty of Medicine, Charles University, 12108 Prague, Czech
Republic
- 2nd Department of Medicine –
Department of Cardiovascular Medicine, General University Hospital, 12800 Prague,
Czech Republic
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Turban A, Gaubert S, Luque-Paz D, René C, Collet N, Pawlowski M, Bendavid C, Lefèvre CR. Validation of a short turnaround time automated method for the 24/7 determination of plasma d-lactate on Roche Cobas c502. Pract Lab Med 2023; 36:e00317. [PMID: 37425622 PMCID: PMC10329164 DOI: 10.1016/j.plabm.2023.e00317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/29/2022] [Accepted: 06/19/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Adrien Turban
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Sophie Gaubert
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - David Luque-Paz
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Céline René
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Nicolas Collet
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Maxime Pawlowski
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Claude Bendavid
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Charles R Lefèvre
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
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Reichert M, Roller FC, Kalder J, Hecker M, Bala M, Catena F, Biffl W, Coccolini F, Moore EE, Ansaloni L, Damaskos D, Sartelli M, Padberg W, Hecker A. [Acute mesenteric ischemia-An overview and recommendations (S2k analogous) of the World Society of Emergency Surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01913-x. [PMID: 37335317 DOI: 10.1007/s00104-023-01913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
Acute mesenteric ischemia is a severe illness, which if untreated, rapidly leads to a critical condition with sepsis, multiple organ failure and death in affected patients. The diagnosis and initiation of treatment of acute mesenteric ischemia should be performed as early and expeditiously as possible and follows the principle of the shortest possible time to reperfusion. Otherwise, the outcome of the patient rapidly deteriorates. The treatment algorithm should be adapted to the pathogenesis of the ischemia, the clinical condition and symptoms of the patients. With clinical signs of peritonitis, intestinal gangrene must be assumed and the abdomen should be surgically explored to detect and treat possible foci of sepsis at an early stage. The treatment of acute mesenteric ischemia should always be performed by an interdisciplinary team with all surgical and interventional options for intestinal revascularization as well as comprehensive intensive care medicine according to the standards of the Intestinal Stroke Center described in the literature. A short duration to revascularization and treatment in this interdisciplinary concept improves the outcome of patients with acute mesenteric ischemia. The World Society of Emergency Surgery provides expert consensus-based recommendations for the diagnosis and treatment of acute mesenteric ischemia; however, there is still a significant lack of broad high-quality evidence for this critical illness. Recommendations of the German specialist societies are urgently needed to ensure appropriate care, from the initial diagnostics to treatment and aftercare, for patients with suspected mesenteric ischemia in this country.
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Affiliation(s)
- Martin Reichert
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - Fritz C Roller
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - Johannes Kalder
- Klinik für Herz‑, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - Matthias Hecker
- Klinik für Innere Medizin II - Pneumologie, Gastroenterologie, Nephrologie und internistische Intensivmedizin, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Fausto Catena
- Department of General and Emergency Surgery, "Maurizio Bufalini" Hospital, Cesena, Italien
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, USA
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italien
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, USA
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, Pavia, Italien
| | - Dimitrios Damaskos
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, Schottland, United Kingdom
| | | | - Winfried Padberg
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - Andreas Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland.
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8
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Treffalls RN, Stonko DP, DeMartino RR, Morrison JJ. Acute management of mesenteric emergencies: Tailoring the solution to the problem. Semin Vasc Surg 2023; 36:234-249. [PMID: 37330237 DOI: 10.1053/j.semvascsurg.2023.04.007] [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: 03/17/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per 10,000, the morbidity and mortality rates are high. Arterial embolic etiology composes nearly one-half of AMIs, with a sudden onset of severe abdominal pain considered the most common symptom. Arterial thrombosis is the second most common cause of AMI, which presents similarly to arterial embolic AMI, although often more severe due to anatomic differences. Veno-occlusive causes of AMI are the third most common and are associated with an insidious onset of vague abdominal pain. Each patient is unique, and the treatment plan should be tailored to their individual needs. This may include considering the patient's age, comorbidities, and overall health, as well as their preferences and personal circumstances. A multidisciplinary approach involving specialists from different fields, such as surgeons, interventional radiologists, and intensivists, is recommended for the best possible outcome. Potential challenges in tailoring an optimal treatment plan for AMI may include delayed diagnosis, limited availability of specialized care, or patient factors that make some interventions less feasible. Addressing these challenges requires a proactive and collaborative approach, with regular review and adjustment of the treatment plan as needed to ensure the best possible outcome for each patient.
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Affiliation(s)
- Rebecca N Treffalls
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - David P Stonko
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jonathan J Morrison
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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Nafae RM, Shouman W, Abdelmoneam SH, Shehata SM. Conservative versus conventional oxygen therapy in type I acute respiratory failure patients in respiratory intensive care unit, Zagazig University. Monaldi Arch Chest Dis 2023; 94. [PMID: 37144390 DOI: 10.4081/monaldi.2023.2536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
The present study aimed to assess the effect of a conservative (permissive hypoxemia) versus conventional (normoxia) protocol for oxygen supplementation on the outcome of type I respiratory failure patients admitted to respiratory intensive care unit (ICU). This randomized controlled clinical trial was carried out at the Respiratory ICU, Chest Department of Zagazig University Hospital, for 18 months, starting in July 2018. On admission, 56 enrolled patients with acute respiratory failure were randomized in a 1:1 ratio into the conventional group [oxygen therapy was supplied to maintain oxygen saturation (SpO2) between 94% and 97%] and the conservative group (oxygen therapy was administered to maintain SpO2 values between 88% and 92%). Different outcomes were assessed, including ICU mortality, the need for mechanical ventilation (MV) (invasive or non-invasive), and ICU length of stay. In the current study, the partial pressure of oxygen was significantly higher among the conventional group at all times after the baseline reading, and bicarbonate was significantly higher among the conventional group at the first two readings. There was no significant difference in serum lactate level in follow-up readings. The mean duration of MV and ICU length of stay was 6.17±2.05 and 9.25±2.22 days in the conventional group versus 6.46±2.0 and 9.53±2.16 days in the conservative group, respectively, without significant differences between both groups. About 21.4% of conventional group patients died, while 35.7% of conservative group patients died without a significant difference between both groups. We concluded that conservative oxygen therapy may be applied safely to patients with type I acute respiratory failure.
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Affiliation(s)
| | - Waheed Shouman
- Chest Department, Faculty of Medicine, Zagazig University.
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Muhtaroğlu A, Çapoğlu R, Uygur FA, Harmantepe AT, Bayhan Z, Gönüllü E. FAR Ratio as Prognostic Biomarker in AMI. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:109. [PMID: 36970580 PMCID: PMC10031717 DOI: 10.1007/s42399-023-01451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/28/2023]
Abstract
Acute mesenteric ischemia (AMI) is a vascular emergency resulting from decreased blood flow caused by the occlusion of the mesenteric vessels, hypoperfusion, or vasospasm. This study aimed to investigate the prognostic value of the fibrinogen-to-albumin (FAR) ratio in patients with acute mesenteric ischemia. A total of 91 patients were enrolled in the study. Patients' demographics such as age and gender, pre- and postoperative hemoglobin, CRP, white blood cell (WBC), neutrophils, preoperative lymphocyte, alanine transaminase (ALT), aspartate transaminase (AST), thrombocytes, and postoperative D-dimer values were recorded. In addition, pre- and postoperative fibrinogen and albumin levels were recorded, and FAR was calculated. Patients were divided into two groups, survivors and non-survivors. The mean pre- and postoperative fibrinogen levels were statistically significantly higher in the non-survivor group than in the survivor group (p < 0.001). The mean pre- and postoperative albumin levels were significantly lower in the non-survivors than in the survivors (p = 0.059, p < 0.001; respectively). The mean pre- and postoperative FAR ratios were considerably higher in the non-survivor than in the survivor groups (p < 0.001). The change between pre- and postoperative fibrinogen, albumin, and FAR values was statistically significant between the non-survivors and the survivors (for all, p < 0.05). The preoperative and postoperative fibrinogen levels were significantly lower, and albumin levels were significantly higher in the survivor compared to the non-survivor patients with AMI. Furthermore, the preoperative and postoperative FAR ratio was significantly higher in the non-survivors. The FAR ratio may be a valuable prognostic biomarker for patients with AMI.
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Affiliation(s)
- Ali Muhtaroğlu
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun University Training and Research Hospital, Aksu District, Mehmet İzmen Street, Number: 145, 28100 Giresun, PC Turkey
| | - Recayi Çapoğlu
- General Surgery Clinic, Sakarya Training and Research Hospital, Adapazari, Turkey
| | - Furkan Ali Uygur
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun University Training and Research Hospital, Aksu District, Mehmet İzmen Street, Number: 145, 28100 Giresun, PC Turkey
| | | | - Zülfü Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Adapazari, Turkey
| | - Emre Gönüllü
- Department of Gastroenterological Surgery, Sakarya University Faculty of Medicine, Adapazari, Turkey
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Yi M, Wu Y, Li M, Zhang T, Chen Y. Effect of remote ischemic preconditioning on postoperative gastrointestinal function in patients undergoing laparoscopic colorectal cancer resection. Int J Colorectal Dis 2023; 38:68. [PMID: 36899148 DOI: 10.1007/s00384-023-04346-4] [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] [Accepted: 02/12/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Patients undergoing laparoscopic colorectal cancer resection have a high incidence of postoperative gastrointestinal dysfunction (POGD). Remote ischemic preconditioning (RIPC) is an organ protection measure. The study investigated the effect of RIPC on postoperative gastrointestinal function. METHODS In this single-center, prospective, double-blinded, randomized, parallel-controlled trial, 100 patients undergoing elective laparoscopic colorectal cancer resection were randomly assigned in a 1:1 ratio to receive RIPC or sham RIPC (control). Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the right upper arm served as RIPC stimulus. Patients were followed up continuously for 7 days after surgery. The I-FEED score was used to evaluate the patient's gastrointestinal function after the surgery. The primary outcome of the study was the I-FEED score on POD3. Secondary outcomes include the daily I-FEED scores, the highest I-FEED score, the incidence of POGD, the changes in I-FABP and the inflammatory markers (IL-6 and TNF-α), and the time to first postoperative flatus. RESULTS A total of 100 patients were enrolled in the study, of which 13 patients were excluded. Finally, 87 patients were included in the analysis, 44 patients in the RIPC group and 43 patients in the sham-RIPC group. Patients assigned to the RIPC group had a lower I-FEED score on POD3 compared with the sham-RIPC group (mean difference 0.86; 95% CI: 0.06 to 1.65; P = 0.035). And patients in the RIPC group were also associated with a lower I-FEED score on POD4 vs the sham-RIPC group (mean difference 0.81; 95% CI: 0.03 to 1.60; P = 0.043). Compared with the sham-RIPC group, the incidence of POGD within 7 days after surgery was lower in the RIPC group (P = 0.040). At T1, T2, and T3 time points, inflammatory factors and I-FABP were considerably less in the RIPC group compared to the sham-RIPC group. The time to the first flatus and the first feces was similar in both groups. CONCLUSION RIPC reduced I-FEED scores, decreased the incidence of postoperative gastrointestinal dysfunction, and lowered concentrations of I-FABP and inflammatory factors.
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Affiliation(s)
- Mengyao Yi
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 182 Tongguan North Road, Lianyungang , Jiangsu, 222002, China
| | - Yong Wu
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 182 Tongguan North Road, Lianyungang , Jiangsu, 222002, China
| | - Meng Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 182 Tongguan North Road, Lianyungang , Jiangsu, 222002, China
| | - Tianyu Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 182 Tongguan North Road, Lianyungang , Jiangsu, 222002, China
| | - Ying Chen
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 182 Tongguan North Road, Lianyungang , Jiangsu, 222002, China.
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12
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Demelo-Rodríguez P, Ordieres-Ortega L, Oblitas CM. Mesenteric venous thrombosis. Med Clin (Barc) 2023; 160:400-406. [PMID: 36849315 DOI: 10.1016/j.medcli.2023.01.020] [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: 01/09/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/27/2023]
Abstract
Mesenteric vein thrombosis (MVT) is a rare condition that can present acutely, subacutely, or chronically. MVT can be isolated or within a splanchnic thrombosis (spleno-porto-mesenteric). Symptomatic cases usually present as nonspecific abdominal pain, with or without signs of intestinal ischemia, and the diagnosis is usually made by imaging test (abdominal CT or MRI) in patients with high clinical suspicion. An early clinical-surgical approach is recommended to screen those patients with warning signs and who benefit from an exploratory laparotomy in addition to anticoagulant treatment, which is the cornerstone of medical treatment. MVT is usually associated with prothrombotic states, with hematological disorders (myeloproliferative syndromes and/or JAK2 gene mutations) being of special clinical relevance. On the other hand, the 5-year survival rate is 70-82% and early overall 30-day mortality from MVT can reach 20-32%.
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Affiliation(s)
- Pablo Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Facultad de Medicina, Universidad CEU San Pablo, Madrid, España.
| | - Lucía Ordieres-Ortega
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Crhistian-Mario Oblitas
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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13
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Feng R, Chang G, Hu Z, Yao C, Ma R, Li D, Wang S, Wang S. The Influencing Factors and Prognostic Evaluation in the Treatment Decisions for Acute and Subacute Nondissection-Related Superior Mesenteric Artery Thromboembolism. Ann Vasc Surg 2023:S0890-5096(23)00023-7. [PMID: 36681269 DOI: 10.1016/j.avsg.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The unclarified treatment strategy for acute and subacute ndSMA-TE limits the therapeutic efficacy and worsens the prognosis. This study aimed to determine the predictive factors impacting the treatment strategy for acute and subacute ndSMA-TE. METHOD A database of 116 patients with nonchronic ndSMA-TE admitted between January 2001 and December 2021 was retrospectively analyzed. Univariate/multivariate logistic regression and the predictive models constructed by stepwise backward regression were used to explore the influencing factors of the treatment decisions and the risk factors for failed conservative treatment. The EuroQol-5 Dimension questionnaire was used to evaluate the long-term quality of life. RESULTS Only the white blood cell (WBC) levels were significantly different between the conservative group and the surgical group (P = 0.013 < 0 .05, odds ratio (OR) = 1.153, 95% confidence interval (CI) [1.038, 1.306]). The WBC levels (P < 0.001, OR = 1.169, 95% CI [1.080, 1.286]) and heart diseases (except atrial fibrillation) (P = 0.011 < 0 .05, OR = 5.116, 95% CI [1.541, 20.452]) were included in the predictive model of the treatment decision. The hemoglobin levels (P = 0.005 < 0 .05, OR = 1.095, 95% CI [1.040, 1.187]) and no flatus or stool (P = 0.007 < 0 .05, OR = 0.031, 95% CI [0.002, 0.296]) were significant risk factors for the conservative treatment outcome. The EuroQol-5 Dimension evaluation demonstrated a fairly high long-term quality of life in both treatment strategies. CONCLUSIONS Elevated WBC levels, decreased hemoglobin levels, and no flatus or stool can be used as predictive indicators for the surgical treatment of nonchronic ndSMA-TE to avoid a misdiagnosis and an inappropriate treatment.
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Affiliation(s)
- Ruijia Feng
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zuojun Hu
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chen Yao
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruixia Ma
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Di Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Siwen Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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14
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Ludwig EK, Hobbs KJ, McKinney-Aguirre CA, Gonzalez LM. Biomarkers of Intestinal Injury in Colic. Animals (Basel) 2023; 13:227. [PMID: 36670767 PMCID: PMC9854801 DOI: 10.3390/ani13020227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Biomarkers are typically proteins, enzymes, or other molecular changes that are elevated or decreased in body fluids during the course of inflammation or disease. Biomarkers pose an extremely attractive tool for establishing diagnoses and prognoses of equine gastrointestinal colic, one of the most prevalent causes of morbidity and mortality in horses. This topic has received increasing attention because early diagnosis of some forms of severe colic, such as intestinal ischemia, would create opportunities for rapid interventions that would likely improve case outcomes. This review explores biomarkers currently used in equine medicine for colic, including acute phase proteins, proinflammatory cytokines, markers of endotoxemia, and tissue injury metabolites. To date, no single biomarker has been identified that is perfectly sensitive and specific for intestinal ischemia; however, L-lactate has been proven to be a very functional and highly utilized diagnostic tool. However, further exploration of other biomarkers discussed in this review may provide the key to accelerated identification, intervention, and better outcomes for horses suffering from severe colic.
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Affiliation(s)
| | | | | | - Liara M. Gonzalez
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
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15
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Demiryas S, Orhan A. Advancements in Gastrointestinal System Biomarkers. Biomark Med 2022. [DOI: 10.2174/9789815040463122010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The requirement for diagnostic surgical operations of gastrointestinal system
diseases significantly decreases with the help of proper diagnostic tools. These
modalities are also beneficial for identifying postoperative complications, allowing us
to diagnose them in earlier stages, and increasing the postoperative survival rates.
Biomarkers are considered an integral part of diagnostic examinations. Developments
of biomarkers used for diagnosing and treating abdominal diseases are essential for
improving our capabilities in non-invasive monitoring. In this chapter, we review both
the novel and the routine biomarkers in the diagnosis and follow-up of gastrointestinal
system diseases.
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Affiliation(s)
- Suleyman Demiryas
- Department of General Surgery, Cerrahpaşa School of Medicine, IIstanbul University –
Cerrahpaşa, Istanbul, Turkey
| | - Anıl Orhan
- Department of General Surgery, Haseki Training and Research Hospital, University of Health
Sciences, Istanbul, Turkey
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16
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Praxenthaler J, Kirchner C, Schwier E, Altmann S, Wittmer A, Henzler D, Köhler T. Case report: Early detection of mesenteric ischemia by intravital microscopy in a patient with septic shock. Front Med (Lausanne) 2022; 9:985977. [PMID: 36091703 PMCID: PMC9458872 DOI: 10.3389/fmed.2022.985977] [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: 07/04/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Gut ischemia is a frequent but underdiagnosed complication, especially in critically ill intensive care patients, and represents a special diagnostic challenge that can only be solved in an interdisciplinary manner. We report a case of a 54-year-old woman with acute mesenteric ischemia (AMI) as a cause of septic shock diagnosed by intravital microscopy (IVM) 2 days before visible necrotic changes in a multimodality approach. We show that intravital microscopy can be a serious alternative for the early diagnosis of mesenteric ischemia in the hands of the skilled. We use this case to discuss the value and clinical perspective of IVM in the intensive care setting.
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Affiliation(s)
- Janina Praxenthaler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
- Department of Anesthesiology, Intensive Care and Pain Medicine, Kliniken Südostbayern, Klinikum Traunstein, Traunstein, Germany
| | - Carmen Kirchner
- Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Klinikum Herford, Ruhr University Bochum, Herford, Germany
| | - Elke Schwier
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
| | - Simon Altmann
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
- Department of Anesthesiology, Intensive Care and Pain Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Axel Wittmer
- Institute of Pathology, Klinikum Herford, Herford, Germany
| | - Dietrich Henzler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
| | - Thomas Köhler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
- Department of Anesthesiology and Intensive Care Medicine, AMEOS-Klinikum Halberstadt, Halberstadt, Germany
- *Correspondence: Thomas Köhler,
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17
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Kazmi SSH, Safi N, Berge ST, Kazmi M, Sundhagen JO, Julien K, Thorsby PM, Ånonsen KV, Medhus AW, Hisdal J. Plasma α-Glutathione S-Transferase in Patients with Chronic Mesenteric Ischemia and Median Arcuate Ligament Syndrome. Vasc Health Risk Manag 2022; 18:567-574. [PMID: 35903288 PMCID: PMC9315055 DOI: 10.2147/vhrm.s365625] [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: 03/09/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic mesenteric ischemia (CMI) due to either atherosclerosis of the mesenteric arteries or median arcuate ligament syndrome (MALS) is an underdiagnosed entity. The etiology of MALS and its existence have been debated and questioned. We aimed to identify plasma biomarkers indicating mesenteric ischemia in patients with CMI and MALS. Methods Plasma α-glutathione S-transferase (α-GST), intestinal fatty acid-binding protein (I-FABP), citrulline, and ischemia modified albumin (IMA) were analyzed in fifty-eight patients with CMI (Group A, n=44) and MALS (Group B, n=14) before and after revascularization. The plasma levels of these potential biomarkers were compared with those of healthy individuals (Group C, n=16). Group comparison was performed with the Mann–Whitney U-test. Cross-tabulation and its derivatives were obtained. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated. Results Plasma levels of α-GST were significantly raised in the patients with CMI (7.8 ng/mL, p<0.001) and MALS (8.4 ng/mL, p<0.001), as compared with the control Group C (3.3 ng/mL). The threshold for normal median plasma α-GST levels of 4 ng/mL yielded a sensitivity of 93% and 86%, specificity of 86% and 88%, respectively, for the diagnosis of CMI due to atherosclerosis and MALS. AUC of ROC curves was 0.96 (p<0.0001) for CMI and 0.85 (p<0.002) for MALS. The patient groups did not differ from the healthy controls in any other biomarkers. Conclusion Plasma α-GST levels are elevated in CMI and MALS patients. Elevated plasma levels of α-GST suggest ischemia as the etiology of MALS.
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Affiliation(s)
- Syed Sajid Hussain Kazmi
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nathkai Safi
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Simen Tveten Berge
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marryam Kazmi
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.,Faculty 2, Poznan University of Medical Sciences, Poznan, Poland
| | - Jon Otto Sundhagen
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Kari Julien
- The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker, Oslo, Norway
| | - Per Medbøe Thorsby
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker, Oslo, Norway
| | - Kim Vidar Ånonsen
- Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Asle Wilhelm Medhus
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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18
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Kayali F, Sarodaya V, Shah HI, Hayat MY, Leung MST, Harky A. Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review. J Card Surg 2022; 37:2025-2039. [PMID: 35488799 DOI: 10.1111/jocs.16516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery. METHODS A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review. RESULTS Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end-stage renal disease, preoperative left ventricular ejection fraction <35%. Cardiopulmonary bypass (CPB) time, preoperative/operative intra-aortic balloon pump (IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross-clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH <7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid-binding protein (IFABP) levels were found to be strongly associated with bowel ischemia. CONCLUSION This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.
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Affiliation(s)
- Fatima Kayali
- UCLan Medical School, University of Central Lancashire, Preston, UK
| | - Varun Sarodaya
- Department of Critical Care Medicine, Barts Health NHS Trust, London, UK
| | - Hussain I Shah
- UCL Medical School, University College London, London, UK
| | - Muhammad Y Hayat
- Faculty of Medicine, St George's Hospital Medical School, London, UK
| | - Marco S T Leung
- Department of Surgery, Imperial Healthcare Trust, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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19
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Yıldırım MA, Kocabas R, Kılınc I, Şimşek G, Sentürk M, Cakir M, Belviranlı M. Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study. ULUS TRAVMA ACIL CER 2022; 28:403-410. [PMID: 35485506 PMCID: PMC10443137 DOI: 10.14744/tjtes.2020.44025] [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: 07/28/2020] [Accepted: 12/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which has previously proven reliability for AMI. METHODS The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. TDH, IMA, and serum lactate values were measured at h 0, 1, 3, and 6. RESULTS In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. CONCLUSION TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.
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Affiliation(s)
- Mehmet Aykut Yıldırım
- Department of General Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey
| | - Rahim Kocabas
- Necmettin Erbakan University Meram Faculty of Medicine, KONUDAM Experimental Medicine Application and Research Center, Konya-Turkey
| | - Ibrahim Kılınc
- Department of Biochemistry, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey
| | - Gürcan Şimşek
- Department of General Surgery, Konya Training and Research Hospital, Konya-Turkey
| | - Mustafa Sentürk
- Department of General Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey
| | - Murat Cakir
- Department of General Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey
| | - Metin Belviranlı
- Department of General Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey
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20
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Mehdorn M, Gockel I, Jansen-Winkeln B, Meyer HJ. Akute Mesenterialischämie. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Kaçer İ, Çağlar A, Akıllı NB. The Prognostic Value of C-Reactive Protein/Albumin Ratio in Acute Mesenteric Ischemia. Am Surg 2022:31348221074220. [DOI: 10.1177/00031348221074220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Diagnosis of acute mesenteric ischemia (AMI) in its early stages is important for reversing ischemic damage. The CRP to albumin (CRP/Alb) ratio has been defined as an inflammatory indicator and is associated with the severity of inflammation and mortality rates. However, the prognostic value of CRP/Alb has not been evaluated in patients with AMI. Here, we aimed to examine the prognostic significance of CRP/Alb and compare it with other inflammatory markers. Materials and Methods In this retrospective, case-control study, we included patients diagnosed with AMI at the emergency department between January 1, 2016, and December 31, 2020. In addition to demographic characteristics, lactate, D-dimer, white blood cell (WBC), CRP/Alb, and neutrophil/lymphocyte ratio (NLR) were recorded. Testing characteristics of CRP/Alb in predicting in-hospital mortality were studied. Results The mean age of 132 patients was 66.48 ± 15.95 years and 71 (53.8%) of them were male. The cut-off value obtained using the receiver operating characteristic (ROC) curve for in-hospital mortality was a CRP/Alb ratio of >1.32 (sensitivity, 93.65%; specificity, 69.57%; +LR, 3.08; −LR, .091; AUC, .782; 95% CI, .70-.85; P < .0001). The comparison of ROC curves between CRP/Alb and WBC, NLR, and lactate revealed a statistically significant difference ( P < .05), whereas there was not any statistically significant difference between the ROC curves of CRP/Alb and D-dimer ( P = .47). Conclusion C-reactive protein/albumin ratio is a powerful predictor of in-hospital mortality for AMI patients. It was superior to WBC, NLR, and lactate. It could be used to determine low-risk patients and help clinicians with treatment options.
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Affiliation(s)
- İlker Kaçer
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Ahmet Çağlar
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Nazire Belgin Akıllı
- Department of Emergency Medicine, University of Health Science, Konya Training and Research Hospital, Konya, Turkey
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22
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Araki R, Iwanaga K, Ueda K, Isaka M. Intestinal Complication With Myxomatous Mitral Valve Diseases in Chihuahuas. Front Vet Sci 2021; 8:777579. [PMID: 34888377 PMCID: PMC8649761 DOI: 10.3389/fvets.2021.777579] [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: 09/15/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
The effects of cardiac disease on the intestine have been reported in humans but not in dogs. We investigated the effects of myxomatous mitral valve disease (MMVD), which is capable of causing congestion and tissue hypoperfusion, on the intestine in Chihuahuas, a breed frequently encountered in clinical practice as the preferred breed for MMVD. In this study, 69 Chihuahuas were divided into four groups based on echocardiography and chest radiography: 19 healthy Chihuahuas (H) and 50 Chihuahuas with MMVD classified according to the ACVIM consensus (stage B1, B2, C/D). In all the cases, serum intestinal fatty acid-binding protein (I-FABP) and D/L-lactate concentrations, markers of intestinal mucosal injury, were measured. I-FABP was significantly higher in stage C/D Chihuahuas than in other groups (p < 0.05), and stage B2 was significantly higher than H (p < 0.05). D-lactate was significantly increased in stages B2 and C/D compared to H and stage B1 (p < 0.05). L-lactate was significantly higher in stage C/D Chihuahuas than in any other group (p < 0.05), and stage B2 was significantly higher than that in H and stage B1 (p < 0.05). Intestinal mucosal injury risk was significantly higher in Chihuahuas with heart failure due to MMVD, suggesting that the risk could increase with worsening heart disease. This is the first study to investigate the intestinal complications of MMVD, and further investigations a needed in the future.
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Affiliation(s)
- R Araki
- Yokohama Yamate Dog & Cat Medical Center, Yokohama, Japan.,Tokyo Veterinary Cardiology Center, Fukazawa, Japan.,Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - K Iwanaga
- Tokyo Veterinary Cardiology Center, Fukazawa, Japan
| | - Kazunori Ueda
- Yokohama Yamate Dog & Cat Medical Center, Yokohama, Japan
| | - M Isaka
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
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23
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Joyeux L, Belfort MA, De Coppi P, Basurto D, Valenzuela I, King A, De Catte L, Shamshirsaz AA, Deprest J, Keswani SG. Complex gastroschisis: a new indication for fetal surgery? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:804-812. [PMID: 34468062 DOI: 10.1002/uog.24759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Gastroschisis (GS) is a congenital abdominal wall defect, in which the bowel eviscerates from the abdominal cavity. It is a non-lethal isolated anomaly and its pathogenesis is hypothesized to occur as a result of two hits: primary rupture of the 'physiological' umbilical hernia (congenital anomaly) followed by progressive damage of the eviscerated bowel (secondary injury). The second hit is thought to be caused by a combination of mesenteric ischemia from constriction in the abdominal wall defect and prolonged amniotic fluid exposure with resultant inflammatory damage, which eventually leads to bowel dysfunction and complications. GS can be classified as either simple or complex, with the latter being complicated by a combination of intestinal atresia, stenosis, perforation, volvulus and/or necrosis. Complex GS requires multiple neonatal surgeries and is associated with significantly greater postnatal morbidity and mortality than is simple GS. The intrauterine reduction of the eviscerated bowel before irreversible damage occurs and subsequent defect closure may diminish or potentially prevent the bowel damage and other fetal and neonatal complications associated with this condition. Serial prenatal amnioexchange has been studied in cases with GS as a potential intervention but never adopted because of its unproven benefit in terms of survival and bowel and lung function. We believe that recent advances in prenatal diagnosis and fetoscopic surgery justify reconsideration of the antenatal management of complex GS under the rubric of the criteria for fetal surgery established by the International Fetal Medicine and Surgery Society (IFMSS). Herein, we discuss how conditions for fetoscopic repair of complex GS might be favorable according to the IFMSS criteria, including an established natural history, an accurate prenatal diagnosis, absence of fully effective perinatal treatment due to prolonged need for neonatal intensive care, experimental evidence for fetoscopic repair and maternal and fetal safety of fetoscopy in expert fetal centers. Finally, we propose a research agenda that will help overcome barriers to progress and provide a pathway toward clinical implementation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division Maternal-Fetal Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - P De Coppi
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Paediatric Surgery Unit and NIHR Biomedical Research Center, Great Ormond Street Hospital, and Great Ormond Street Institute of Child Health, University College London, London, UK
| | - D Basurto
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - I Valenzuela
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - A King
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - L De Catte
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - A A Shamshirsaz
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division Maternal-Fetal Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - J Deprest
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
| | - S G Keswani
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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de Holanda GS, dos Santos Valença S, Carra AM, Lichtenberger RCL, de Castilho B, Franco OB, de Moraes JA, Schanaider A. Translational Application of Fluorescent Molecular Probes for the Detection of Reactive Oxygen and Nitrogen Species Associated with Intestinal Reperfusion Injury. Metabolites 2021; 11:metabo11120802. [PMID: 34940560 PMCID: PMC8705498 DOI: 10.3390/metabo11120802] [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: 11/08/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Acute mesenteric ischemia, caused by an abrupt interruption of blood flow in the mesenteric vessels, is associated with high mortality. When treated with surgical interventions or drugs to re-open the vascular lumen, the reperfusion process itself can inflict damage to the intestinal wall. Ischemia and reperfusion injury comprise complex mechanisms involving disarrangement of the splanchnic microcirculatory flow and impairment of the mitochondrial respiratory chain due to initial hypoxemia and subsequent oxidative stress during the reperfusion phase. This pathophysiologic process results in the production of large amounts of reactive oxygen (ROS) and nitrogen (RNS) species, which damage deoxyribonucleic acid, protein, lipids, and carbohydrates by autophagy, mitoptosis, necrosis, necroptosis, and apoptosis. Fluorescence-based systems using molecular probes have emerged as highly effective tools to monitor the concentrations and locations of these often short-lived ROS and RNS. The timely and accurate detection of both ROS and RNS by such an approach would help to identify early injury events associated with ischemia and reperfusion and increase overall clinical diagnostic sensitivity. This abstract describes the pathophysiology of intestinal ischemia and reperfusion and the early biological laboratory diagnosis using fluorescent molecular probes anticipating clinical decisions in the face of an extremely morbid disease.
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Affiliation(s)
- Gustavo Sampaio de Holanda
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
- Correspondence: ; Tel.: +55-21-9657-13794
| | - Samuel dos Santos Valença
- Redox Biology Laboratory, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (S.d.S.V.); (J.A.d.M.)
| | - Amabile Maran Carra
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - Renata Cristina Lopes Lichtenberger
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - Bianca de Castilho
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - Olavo Borges Franco
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - João Alfredo de Moraes
- Redox Biology Laboratory, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (S.d.S.V.); (J.A.d.M.)
| | - Alberto Schanaider
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
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Karasawa S, Nakada TA, Sato M, Miyasho T, Shimada T, Oshima T, Suda K, Shinozaki K, Oda S. Early Elevation of Cell-free DNA After Acute Mesenteric Ischemia in Rats. J Surg Res 2021; 269:28-35. [PMID: 34517186 DOI: 10.1016/j.jss.2021.07.020] [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: 01/21/2021] [Revised: 06/22/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is challenging to diagnose in the early phase. We tested the hypothesis that blood levels of cell-free DNA would increase early after AMI. In addition, proteome analysis was conducted as an exploratory analysis to identify other potential diagnostic biomarkers. METHODS Mesenteric ischemia, abdominal sepsis, and sham model were compared in Sprague-Dawley rats. The abdominal sepsis model was induced by cecum puncture and mesenteric ischemia model by ligation of the superior mesenteric artery. Blood levels of cell-free DNA were measured 2 h and 6 h after wound closure. Shotgun proteome analysis was performed using plasma samples obtained at the 2 h timepoint; quantitative analysis was conducted for proteins detected exclusively in the AMI models. RESULTS Blood cell-free DNA levels at 2 h after wound closure were significantly higher in the AMI model than in the sham and the abdominal sepsis models (P < 0.05). Cell-free DNA was positively correlated with the pathologic ischemia severity score (correlation coefficient 0.793-0.834, P < 0.001). Derivative proteome analysis in blood at 2-h time point revealed higher intensity of paraoxonase-1 in the AMI models than in the abdominal sepsis models; the significantly high blood paraoxonase-1 levels in the AMI models were confirmed in a separate quantitative analysis (P = 0.015). CONCLUSIONS Cell-free DNA was demonstrated to be a promising biomarker for the early diagnosis of mesenteric ischemia in a rat model of AMI. Paraoxonase-1 may also play a role in the differential diagnosis of mesenteric ischemia from abdominal sepsis. The current results warrant further investigation in human studies.
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Affiliation(s)
- Satoshi Karasawa
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan.
| | - Mamoru Sato
- Division of Clinical Mass Spectrometry, Chiba University Hospital, Chiba 260-8677, Japan
| | - Taku Miyasho
- Laboratory of Animal Biological Responses, Department of Veterinary Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan
| | - Tadanaga Shimada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Koichi Suda
- Division of Upper GI, Department of Gastroenterological Surgery, Fujita Health University, Toyoake, Aichi
| | - Koichiro Shinozaki
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
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26
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Chen XL, Zhang BL, Meng C, Huang HB, Du B. Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials. J Intensive Care 2021; 9:47. [PMID: 34294147 PMCID: PMC8295978 DOI: 10.1186/s40560-021-00563-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients. Methods We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Results We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. Conclusions Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00563-7.
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Affiliation(s)
- Xiao-Li Chen
- Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bei-Lei Zhang
- Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chang Meng
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Hui-Bin Huang
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, China
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27
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Prado Rodríguez A, Mato Búa R, Mera Mujico L, Arca Suárez J, López Sánchez M, Sampayo Rodríguez L, Rama-Maceiras P. Postoperative lactate elevation as a marker of underlying acute mesenteric ischemia. Description of two cases. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:361-366. [PMID: 33168179 DOI: 10.1016/j.redar.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity. We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain -a non-specific symptom in the postoperative context- and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test. These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.
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Affiliation(s)
- A Prado Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - R Mato Búa
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - L Mera Mujico
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - J Arca Suárez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - M López Sánchez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - L Sampayo Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - P Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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Prado Rodríguez A, Mato Búa R, Mera Mujico L, Arca Suárez J, López Sánchez M, Sampayo Rodríguez L, Rama-Maceiras P. Postoperative lactate elevation as a marker of underlying acute mesenteric ischemia. Description of two cases. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:361-366. [PMID: 34148854 DOI: 10.1016/j.redare.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/04/2020] [Indexed: 06/12/2023]
Abstract
Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity. We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain -a non-specific symptom in the postoperative context- and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test. These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.
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Affiliation(s)
- A Prado Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - R Mato Búa
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - L Mera Mujico
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J Arca Suárez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - M López Sánchez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - L Sampayo Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Zaigham H, Olsson Regnér Å, Ekelund M, Regnér S. The role of citrulline, intestinal fatty acid-binding protein, and D-dimer as potential biomarkers in the diagnosis of internal herniation after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2021; 17:1704-1712. [PMID: 34167910 DOI: 10.1016/j.soard.2021.05.028] [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: 02/02/2021] [Revised: 04/21/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diagnosing internal herniation (IH) in Roux-en-Y gastric bypass (RYGB) patients with acute abdominal pain poses a diagnostic challenge. Diagnostic laparoscopy is often required for a definitive diagnosis. We hypothesized that intestinal ischemia biomarkers would aid in the diagnosing of IH. OBJECTIVES To explore intestinal ischemia biomarkers in diagnosing IH. SETTING University Hospital, Sweden. METHODS Prospective inclusion of 46 RYGB patients admitted for acute abdominal pain between June 2015 and December 2017. Blood samples for analysis of citrulline, intestinal fatty acid-binding protein (I-FABP), and D-dimer were drawn <72 hours from admission and compared between patients with IH (n = 8), small bowel obstruction (SBO) (n = 5), other specified diagnoses (n = 12), or unspecified abdominal pain (n = 21). Levels of white blood cell count (WBC), C-reactive protein (CRP), and lactate at admission were compared. A prospective pain questionnaire for time of pain onset and level of pain at onset and at admission was analyzed. RESULTS None of the investigated biomarkers differed significantly between diagnosis categories. Most patients with IH had normal CRP, WBC, and D-dimer levels while their lactate levels were significantly lower (P = .029) compared with the rest of the cohort. Neither pain level nor pain duration differed between the groups. CONCLUSION This study shows that citrulline, I-FABP, and D-dimer cannot be used to diagnose IH and indicates that CRP, D-dimer, and lactate are rarely elevated by an IH. Furthermore, pain intensity and duration cannot differentiate patients with IH. A diagnostic laparoscopy remains the gold standard to diagnose and rule out an IH.
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Affiliation(s)
- Hassan Zaigham
- Department of Clinical Sciences, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Åsa Olsson Regnér
- Department of Clinical Sciences, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mikael Ekelund
- Department of Clinical Sciences, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sara Regnér
- Department of Clinical Sciences, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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Spangler R, Manning S. Disaster Diagnoses in Geriatric Patients with Abdominal Pain. Emerg Med Clin North Am 2021; 39:347-360. [PMID: 33863464 DOI: 10.1016/j.emc.2021.01.011] [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: 02/07/2023]
Abstract
Care of geriatric patients with abdominal pain can pose significant diagnostic and therapeutic challenges to emergency physicians. Older adults rarely present with classic signs, symptoms, and laboratory abnormalities. The incidence of life-threatening emergencies, including abdominal aortic aneurysm, mesenteric ischemia, perforated viscus, and other surgical emergencies, is high. This article explores the evaluation and management of several important causes of abdominal pain in geriatric patients with an emphasis on high-risk presentations.
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Affiliation(s)
- Ryan Spangler
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Sara Manning
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
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Chai L, Wang Y, Fan FD, Wang DJ. Acute type A aortic dissection with mesenteric malperfusion syndrome: a case report. Shijie Huaren Xiaohua Zazhi 2021; 29:152-158. [DOI: 10.11569/wcjd.v29.i3.152] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with acute type A aortic dissection and mesenteric malperfusion syndrome (mesMPS) have a high mortality rate. Therefore, the analysis of the timing of open aortic repair and intestinal operation is of great significance for the timely selection of clinical treatment.
CASE SUMMARY The chief complaints of the patient were sudden chest and back bursting pain for 15 h. Emergency "ascending aorta replacement + total arch replacement (island flap anastomosis) + descending aorta stent implantation + coronary artery bypass grafting + autologous vascular access" was performed. The patient's postoperative occult blood test was positive. His blood stool was visible to the naked eye on the 11th day after the open aortic repair. He had abdomen tenderness on the 12th postoperative day. He had abdominal pain and was diagnosed by CT with intestinal obstruction on the 13th postoperative day. Then, he underwent an emergency laparotomy for right hemicolectomy + partial resection of small intestine + cholecystectomy + ileostomy. He was discharged with diagnoses of aortic dissection (type A), coronary dissection, multiple perforations of the colon, congenital ectopic small bowel glands, and acute attack of chronic cholecystitis. More than a year later, he underwent "intestinal adhesion lysis + ileostomy closure + incisional hernia repair". The patient recovered well at the 1-year follow-up.
CONCLUSION We have reported a case of acute type A aortic dissection with mesenteric malperfusion syndrome. In the early stage of mesenteric hypoperfusion syndrome, specific laboratory examination indexes and clinical manifestations are lacking, and mesenteric multidetector CT angiography is a first-line examination method for mesenteric malperfusion. Through the detailed analysis of the patient's condition and the review of the relevant literature, we hope to have a deeper understanding of this condition and provide evidence supporting the formulation of clinical treatment plan.
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Affiliation(s)
- Lin Chai
- Nanjing Drum Tower Hospital, Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Nanjing 210008, Jiangsu Province, China,Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yue Wang
- Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Fu-Dong Fan
- Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Dong-Jin Wang
- Nanjing Drum Tower Hospital, Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Nanjing 210008, Jiangsu Province, China,Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Changes in gastrointestinal cell integrity after marathon running and exercise-associated collapse. Eur J Appl Physiol 2021; 121:1179-1187. [PMID: 33512586 DOI: 10.1007/s00421-021-04603-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/10/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Endurance exercise and hyperthermia are associated with compromised intestinal permeability and endotoxaemia. The presence of intestinal fatty acid-binding protein (I-FABP) in the systemic circulation suggests intestinal wall damage, but this marker has not previously been used to investigate intestinal integrity after marathon running. METHODS Twenty-four runners were recruited as controls prior to completing a standard marathon and had sequential I-FABP measurements before and on completion of the marathon, then at four and 24 h later. Eight runners incapacitated with exercise-associated collapse (EAC) with hyperthermia had I-FABP measured at the time of collapse and 1 hour later. RESULTS I-FABP was increased immediately on completing the marathon (T0; 2593 ± 1373 ng·l-1) compared with baseline (1129 ± 493 ng·l-1; p < 0.01) in the controls, but there was no significant difference between baseline and the levels at four hours (1419 ± 1124 ng·l-1; p = 0.7), or at 24 h (1086 ± 302 ng·l-1; p = 0.5). At T0, EAC cases had a significantly higher I-FABP concentration (15,389 ± 8547 ng.l-1) compared with controls at T0 (p < 0.01), and remained higher at 1 hour after collapse (13,951 ± 10,476 ng.l-1) than the pre-race control baseline (p < 0.05). CONCLUSION I-FABP is a recently described biomarker whose presence in the circulation is associated with intestinal wall damage. I-FABP levels increase after marathon running and increase further if the endurance exercise is associated with EAC and hyperthermia. After EAC, I-FABP remains high in the circulation for an extended period, suggesting ongoing intestinal wall stress.
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Xu Y, Xiong L, Li Y, Jiang X, Xiong Z. Diagnostic methods and drug therapies in patients with ischemic colitis. Int J Colorectal Dis 2021; 36:47-56. [PMID: 32936393 PMCID: PMC7493065 DOI: 10.1007/s00384-020-03739-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Ischemic colitis (IC) is the most prevalent ischemic injury of thegastrointestinal tract. Clinical features of IC such as acute abdominal pain, hematochezia,and diarrhea are similar to those of acute mesenteric ischemia, inflammatorybowel disease, or infectious bowel disease, and their relative ambiguity candelay diagnosis and treatment. To comprehensively detail the current state ofdiagnostic methods and available drug therapies for detecting and treating IC,this review aims to provide a concise and practical summary of thecorresponding literature. METHODS PubMed and Cochrane Library were searched toretrieve all published studies reporting the diagnostic methods and drugtherapies in patients with ischemic colitis. The search strategy of drugtherapy includes human and animal data. RESULTS Colonoscopy combined with histopathologicalbiopsy is the standard of diagnosis for the IC. Most patients respond well tothe conservative treatment, and surgical consultation is needed when conservativetreatment is ineffective. Studies of potential drug therapy have beendeveloped, including phosphodiesterase type 5 inhibitors, pentoxifylline,rebamipide, prostaglandin E1, and polydeoxyribonucleotide. CONCLUSION Accurate diagnoses and effective treatmentshave helped reduce the mortality rate and improve prognoses for patientsafflicted with IC, and corresponding drug therapies have been constantlyupdated as new research has emerged.
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Affiliation(s)
- YuShuang Xu
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
- Institute of Geriatrics of Hubei Province, YanHu Avenue & (027)86785587, Wuhan, 430077, Hubei, China
| | - LiNa Xiong
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
| | - YaNan Li
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
- Institute of Geriatrics of Hubei Province, YanHu Avenue & (027)86785587, Wuhan, 430077, Hubei, China
| | - Xin Jiang
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
| | - ZhiFan Xiong
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China.
- Institute of Geriatrics of Hubei Province, YanHu Avenue & (027)86785587, Wuhan, 430077, Hubei, China.
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Cekic AB, Gonenc Cekic O, Aygun A, Pasli S, Yaman Ozer S, Caner Karahan S, Turedi S, Acar S, Tatli O, Yulug E, Turkmen, Suha. The Diagnostic Value of ischemia-modified albumin (IMA) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in an Experimental Model of Strangulated Mechanical Bowel Obstruction. J INVEST SURG 2020; 35:450-456. [PMID: 33190564 DOI: 10.1080/08941939.2020.1847218] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mechanical bowel obstruction (MBO) is one of the principal pathologies requiring emergency surgery and a significant worldwide cause of morbidity. The identification of patients in whom bowel obstruction resolves spontaneously is important in terms of preventing unnecessary surgical interventions and future potential adhesions. The decision-making process is difficult in patients presenting without classic examination findings. METHODS 36 female Sprague-Dawley rats randomly divided into six experimental groups. In Group 1, 3 and 5, laparotomy was performed, with blood and tissue specimens being collected after 1, 2 and 6 h, respectively. In Group 2, 4 and 6, the ileum segment was ligated following laparotomy, and blood and tissue specimens were collected after 1, 2 and 6 h, respectively. The ileum specimens were examined macroscopically, after which 1-cm sections were taken and examined in terms of histopathological changes. IMA and SCUBE-1 levels were determined for each group, and macro- and microscopic tissue examination findings were compared between the groups. RESULTS Comparison within the groups exposed to waiting times of 1 h (groups 1 and 2), 2 h (groups 3 and 4) and 6 h (groups 5 and 6) revealed higher mean IMA and SCUBE-1 levels in rats undergoing ligation together with incision (groups 2, 4, and 6) compared to those undergoing laparotomy only (groups 1, 3, and 5). Correlation analysis was applied to determine the relationship between total scores obtained from histopathological examination and IMA and SCUBE-1 values. The analysis revealed strong, significant and positive correlation between histopathological examination scores and IMA (r=0.643, p=0.000) and SCUBE-1 (r=0.509, p=0.002) values. CONCLUSION The study findings showed that both IMA and SCUBE-1 values increased in a strangulated MBO model in rats. We think that IMA and SCUBE-1 values can be used as a markers of damage in the early period in strangulated MBO, and that the patient's surgery requirement can thus be determined in the early period.
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Affiliation(s)
- Arif Burak Cekic
- Department of General Surgery, Faculty of Medicine, Kardeniz Technical University, Trabzon, Turkey
| | - Ozgen Gonenc Cekic
- Department of Emergency Medicine, Kanuni Training and Education Hospital, Trabzon, Turkey
| | - Ali Aygun
- Department of Emergency Medicine, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Sinan Pasli
- Department of Emergency Medicine, Gumushane State Hospital, Gumushane, Turkey
| | - Serap Yaman Ozer
- Department of Medical Biochemistry, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Suleyman Caner Karahan
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Suleyman Turedi
- Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sami Acar
- Department of General Surgery, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Ozgur Tatli
- Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Esin Yulug
- Department of Histology and Embryology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | | | - Suha
- Department of Emergency Medicine School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.,Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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Liao Z, Sun H, Chang Y, Chen H. The expression and clinical significance of miRNA-183 in cerebral ischemia-reperfusion injury patients with cerebral small vessel disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1005. [PMID: 32953805 PMCID: PMC7475471 DOI: 10.21037/atm-20-5335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background To investigate the expression and clinical significance of micro (mi)RNA-183 in cerebral ischemia-reperfusion injury (CIRI) in patients with cerebral small vessel disease (CSVD). Methods A total of 138 patients with CSVD complicated with CIRI admitted to our hospital from May 2018 to May 2019 were selected and divided into the CIRI group (138 cases of patients with cerebral vascular disease complicated with CIRI) and the control group [60 cases with no abnormalities in cranial magnetic resonance imaging (MRI) in healthy volunteers]; the results of craniocerebral MRI were subsequently recorded. The serum levels of miRNA-183 were detected by quantitative real-time polymerase chain (RT-qPCR), and the levels of interleukin-6 (IL-6), IL-8, IL-1β, and tumor necrosis factor-α (TNF-α) were determined by enzyme-linked immunosorbent assay (ELISA). A correlation analysis of serum miRNA-183 level and imaging lesion characteristics in patients with CSVD was also conducted. Results RT-qPCR showed that the peripheral blood miRNA-183 level in the CIRI group was increased compared to that in the control group; the level of miRNA-183 in the control group was 30.03±6.32, while the level of miRNA-183 in the CIRI group was 36.78±10.11, which was a statistically significant difference (t=2.475, P<0.05). Compared with the control group, the patient levels of TNF-α, IL-6, IL-8, and IL-1β in the CIRI group were significantly increased (P<0.05). Correlation analysis showed that the serum miRNA-183 level in the CIRI group was positively correlated with an increase of imaging lesions (r=0.997, P<0.05). Conclusions The level of miRNA-183 in CIRI patients with CSVD was higher than that of controls, and the level of miRNA-183 was positively correlated with the increase of imaging lesions.
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Affiliation(s)
- Zigen Liao
- Department of Neurology, Second Affiliated Hospital, University of South China, Hengyang, China
| | - Hui Sun
- Department of Pathophysiology, Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hengyang Medical College, University of South China, Hengyang, China
| | - Yanqun Chang
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Hui Chen
- Department of Emergency, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Song YY, Zhang B, Gu JW, Zhang YJ, Wang Y. The predictive value of procalcitonin in ventilator-associated pneumonia after cardiac valve replacement. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:423-426. [PMID: 32425062 DOI: 10.1080/00365513.2020.1762242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to evaluate the predictive value of procalcitonin (PCT) in ventilator-associated pneumonia (VAP) after cardiac valve replacement. A total of 80 patients who underwent cardiac valve replacement in our department were enrolled in this study. Of these patients,40 were diagnosed with VAP and assigned to the observation group, while the other 40 patients not diagnosed with VAP were assigned to the control group. The changes in serum PCT, white blood cell count and C-reactive protein (CRP) were observed before each operation (T0), on the first day after the operation (T1), the second day after the operation (T2) and the third day after the operation (T3). After the operation, the serum PCT in the observation group was significantly higher than those at different time points after the operation, and also significantly higher than those in the control group (p < .05). In the control group, PCT was significantly higher after the operation than before the operation (p < .05), but the differences among the different postoperative time points were not statistically significant (p > .05). In the two groups, the white blood cell count and CRP were significantly higher after the operation than before the operation (p < .05), but the differences between the two groups were not statistically significant (p > .05). Serum PCT is an early, sensitive and highly specific high-risk monitoring index and has an early prediction value for VAP after cardiac valve replacement.
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Affiliation(s)
- Yan-Yan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Bin Zhang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ji-Wei Gu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yu-Jing Zhang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yun Wang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
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