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Shi X, Li Y, Chen S, Xu H, Wang X. Desflurane alleviates LPS-induced acute lung injury by modulating let-7b-5p/HOXA9 axis. Immunol Res 2024:10.1007/s12026-024-09474-9. [PMID: 38676899 DOI: 10.1007/s12026-024-09474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Abstract
Acute lung injury (ALI) is characterized by acute respiratory failure with tachypnea and widespread alveolar infiltrates, badly affecting patients' health. Desflurane (Des) is effective against lung injury. However, its mechanism in ALI remains unknown. BEAS-2B cells were incubated with lipopolysaccharide (LPS) to construct an ALI cell model. Cell apoptosis was evaluated using flow cytometry. Enzyme-linked immunosorbent assay (ELISA) was employed to examine the levels of inflammatory cytokines. Interactions among let-7b-5p, homeobox A9 (HOXA9), and suppressor of cytokine signaling 2 (SOCS2) were verified using Dual luciferase activity, chromatin immunoprecipitation (ChIP), and RNA pull-down analysis. All experimental data of this study were derived from three repeated experiments. Des treatment improved LPS-induced cell viability, reduced inflammatory cytokine (tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6)) levels, decreased cell apoptosis, down-regulated the pro-apoptotic proteins (Bcl-2-associated X protein (Bax) and cleaved caspase 3) expression, and up-regulated the anti-apoptotic protein B-cell-lymphoma-2 (Bcl-2) expression in LPS-induced BEAS-2B cells. Des treatment down-regulated let-7b-5p expression in LPS-induced BEAS-2B cells. Moreover, let-7b-5p inhibition improved LPS-induced cell injury. let-7b-5p overexpression weakened the protective effects of Des. Mechanically, let-7b-5p could negatively modulate HOXA9 expression. Furthermore, HOXA9 inhibited the NF-κB signaling by enhancing SOCS2 transcription. HOXA9 overexpression weakened the promotion of let-7b-5p mimics in LPS-induced cell injury. Des alleviated LPS-induced ALI via regulating let-7b-5p/ HOXA9/NF-κB axis.
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Affiliation(s)
- Xiaoyun Shi
- Department of Anesthesiology, Medical Center of Anesthesiology and PainDonghu DistrictJiangxi Province, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, People's Republic of China
| | - Yundie Li
- Department of Anesthesiology, Medical Center of Anesthesiology and PainDonghu DistrictJiangxi Province, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, People's Republic of China
| | - Shibiao Chen
- Department of Anesthesiology, Medical Center of Anesthesiology and PainDonghu DistrictJiangxi Province, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, People's Republic of China
| | - Huaping Xu
- Department of Rehabilitation, Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Xiuhong Wang
- Department of Anesthesiology, Medical Center of Anesthesiology and PainDonghu DistrictJiangxi Province, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, People's Republic of China.
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Burns KEA, Khan J, Phoophiboon V, Trivedi V, Gomez-Builes JC, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2356794. [PMID: 38393729 PMCID: PMC10891471 DOI: 10.1001/jamanetworkopen.2023.56794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
Importance Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use. Objective To summarize trials comparing alternative SBTs. Data Sources Several databases (MEDLINE [from inception to February 2023], the Cochrane Central Register of Controlled Trials [in February 2023], and Embase [from inception to February 2023] and 5 conference proceedings (from January 1990 to April 2023) were searched in this systematic review and meta-analysis. Study Selection Randomized trials directly comparing SBT techniques in critically ill adults or children and reporting at least 1 clinical outcome were selected. Data Extraction and Synthesis Paired reviewers independently screened citations, abstracted data, and assessed quality for the systematic review and meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA guidelines). Data were pooled using random-effects models. Main Outcomes and Measures Primary outcomes included SBT success, extubation success, and reintubation. Results The systematic review and meta-analysis identified 40 trials that included 6716 patients. Low-quality evidence (14 trials [n = 4459]) suggested that patients were not more likely to pass a pressure support (PS) compared with a T-piece SBT (risk ratio [RR], 1.04; 95% CI, 0.97-1.11; P = .31; I2 = 73%), unless 1 outlier trial accounting for all heterogeneity was excluded (RR, 1.09; 95% CI, 1.06-1.12; P < .001; I2 = 0% [13 trials; n = 3939]; moderate-quality evidence), but were significantly more likely to be successfully extubated (RR, 1.07; 95% CI, 1.04-1.10; P < .001; I2 = 0%; 16 trials [n = 4462]; moderate-quality evidence). Limited data (5 trials [n = 502]) revealed that patients who underwent automatic tube compensation/continuous positive airway pressure compared with PS SBTs had a significantly higher successful extubation rate (RR, 1.10; 95% CI, 1.00-1.21; P = .04; I2 = 0% [low-quality evidence]). Compared with T-piece SBTs, high-flow oxygen SBTs (3 trials [n = 386]) had significantly higher successful extubation (RR, 1.06; 95% CI, 1.00-1.11; P = .04; I2 = 0%) and lower reintubation (RR, 0.37; 95% CI, 0.21-0.65; P = <.001; I2 = 0% [both low-quality evidence]) rates. Credible subgroup effects were not found. Conclusions and Relevance In this systematic review and meta-analysis, the findings suggest that patients undergoing PS compared with T-piece SBTs were more likely to be extubated successfully and more likely to pass an SBT, after exclusion of an outlier trial. Pressure support SBTs were not associated with increased risk of reintubation. Future trials should compare SBT techniques that maximize differences in inspiratory support.
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Affiliation(s)
- Karen E. A. Burns
- Department of Critical Care, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeena Khan
- Department of Critical Care, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Vorakamol Phoophiboon
- Department of Critical Care, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vatsal Trivedi
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Benedetta Giammarioli
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Dipayan Chaudhuri
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Kairavi Desai
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jan O. Friedrich
- Department of Critical Care, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Decker H, Trang K, Ramirez J, Colley A, Pierce L, Coleman M, Bongiovanni T, Melton GB, Wick E. Large Language Model-Based Chatbot vs Surgeon-Generated Informed Consent Documentation for Common Procedures. JAMA Netw Open 2023; 6:e2336997. [PMID: 37812419 PMCID: PMC10562939 DOI: 10.1001/jamanetworkopen.2023.36997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Importance Informed consent is a critical component of patient care before invasive procedures, yet it is frequently inadequate. Electronic consent forms have the potential to facilitate patient comprehension if they provide information that is readable, accurate, and complete; it is not known if large language model (LLM)-based chatbots may improve informed consent documentation by generating accurate and complete information that is easily understood by patients. Objective To compare the readability, accuracy, and completeness of LLM-based chatbot- vs surgeon-generated information on the risks, benefits, and alternatives (RBAs) of common surgical procedures. Design, Setting, and Participants This cross-sectional study compared randomly selected surgeon-generated RBAs used in signed electronic consent forms at an academic referral center in San Francisco with LLM-based chatbot-generated (ChatGPT-3.5, OpenAI) RBAs for 6 surgical procedures (colectomy, coronary artery bypass graft, laparoscopic cholecystectomy, inguinal hernia repair, knee arthroplasty, and spinal fusion). Main Outcomes and Measures Readability was measured using previously validated scales (Flesh-Kincaid grade level, Gunning Fog index, the Simple Measure of Gobbledygook, and the Coleman-Liau index). Scores range from 0 to greater than 20 to indicate the years of education required to understand a text. Accuracy and completeness were assessed using a rubric developed with recommendations from LeapFrog, the Joint Commission, and the American College of Surgeons. Both composite and RBA subgroup scores were compared. Results The total sample consisted of 36 RBAs, with 1 RBA generated by the LLM-based chatbot and 5 RBAs generated by a surgeon for each of the 6 surgical procedures. The mean (SD) readability score for the LLM-based chatbot RBAs was 12.9 (2.0) vs 15.7 (4.0) for surgeon-generated RBAs (P = .10). The mean (SD) composite completeness and accuracy score was lower for surgeons' RBAs at 1.6 (0.5) than for LLM-based chatbot RBAs at 2.2 (0.4) (P < .001). The LLM-based chatbot scores were higher than the surgeon-generated scores for descriptions of the benefits of surgery (2.3 [0.7] vs 1.4 [0.7]; P < .001) and alternatives to surgery (2.7 [0.5] vs 1.4 [0.7]; P < .001). There was no significant difference in chatbot vs surgeon RBA scores for risks of surgery (1.7 [0.5] vs 1.7 [0.4]; P = .38). Conclusions and Relevance The findings of this cross-sectional study suggest that despite not being perfect, LLM-based chatbots have the potential to enhance informed consent documentation. If an LLM were embedded in electronic health records in a manner compliant with the Health Insurance Portability and Accountability Act, it could be used to provide personalized risk information while easing documentation burden for physicians.
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Affiliation(s)
- Hannah Decker
- Department of Surgery, University of California, San Francisco
| | - Karen Trang
- Department of Surgery, University of California, San Francisco
| | - Joel Ramirez
- Department of Surgery, University of California, San Francisco
| | - Alexis Colley
- Department of Surgery, University of California, San Francisco
| | - Logan Pierce
- Department of Medicine, University of California, San Francisco
| | - Melissa Coleman
- Department of Surgery, University of California, San Francisco
| | | | - Genevieve B. Melton
- Department of Surgery, Institute for Health Informatics, and Center for Learning Health System Sciences, University of Minnesota, Minneapolis
| | - Elizabeth Wick
- Department of Surgery, University of California, San Francisco
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Sun S, Liu Z, Wu Y, Sun X, Zhao S, Huang Y. Characteristics of Pupil Offset in Young Asian Adults With Mild-Moderate and High Myopia. Transl Vis Sci Technol 2022; 11:13. [PMID: 35696132 PMCID: PMC9202332 DOI: 10.1167/tvst.11.6.13] [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] [Indexed: 11/27/2022] Open
Abstract
Purpose The purpose of this study was to explore the characteristics of pupil offset in young Asian adults with myopia. Methods In total, 1200 eyes (600 young adults, 18–35 years old) were divided into mild-moderate and high groups according to equivalent spherical diopters (SEQ). The pupil offset and its X and Y components were compared between the groups. Linear correlation was analyzed among pupil offset, X and Y components, and SEQ. Multiple linear regression analysis was conducted for pupil offset and eye parameters. Results The mean age of all subjects was 22.5 ± 4.8 years. The mean magnitude of the pupil offset (0.18 ± 0.09 mm vs. 0.15 ± 0.08 mm) and Y component (0.12 ± 0.08 mm vs. 0.10 ± 0.07 mm) were larger in the high group than in the mild-moderate group (P < 0.05). The magnitude of pupil offset, X and Y components, and SEQ were positively correlated. The pupil center (PC) of the right eye in the mild-moderate group was mainly superotemporal to the corneal vertex and mainly superonasal for the left eye and both eyes in the high group. Multiple linear regression analysis revealed that the magnitude of pupil offset correlated with central corneal thickness, intraocular pressure, and mean corneal curvature (P < 0.05). Conclusions The magnitude of the pupil offset that correlated with partial eye parameters and its X and Y components increased as the SEQ increased, and the PC gradually shifted toward the superonasal direction in young Asian adults with myopia. Translational Relevance Subjects with high myopia with a larger pupil offset should be considered for better postoperative visual quality during refractive surgery.
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Affiliation(s)
- Shengshu Sun
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin, China
| | - Zhanglin Liu
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin, China
| | - Yuan Wu
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin, China
| | - Xiaowen Sun
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin, China.,Department of Ophthalmology, People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Shaozhen Zhao
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin, China
| | - Yue Huang
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin, China
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Campbell BR, Shinn JR, Kimura KS, Lowery AS, Casey JD, Ely EW, Gelbard A. Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation. JAMA Otolaryngol Head Neck Surg 2021; 146:160-167. [PMID: 31855261 DOI: 10.1001/jamaoto.2019.3969] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Endotracheal intubation and mechanical ventilation are life-saving treatments for acute respiratory failure but are complicated by significant rates of dyspnea and dysphonia after extubation. Unilateral vocal fold immobility (UVFI) after extubation can alter respiration and phonation, but its incidence, risk factors, and pathophysiology remain unclear. Objectives To determine the incidence of UVFI after prolonged (>12 hours) mechanical ventilation in a medical intensive care unit and investigate associated clinical risk factors for UVFI after prolonged mechanical ventilation. Design, Setting, and Participants This subgroup analysis of a prospective cohort study was conducted in a single-center medical intensive care unit from August 17, 2017, through May 31, 2018, among 100 consecutive adult patients who were intubated for more than 12 hours. Patients were identified within 36 hours of extubation and recruited for study enrollment. Those with an established tracheostomy prior to mechanical ventilation, known laryngeal or tracheal pathologic characteristics, or a history of head and neck radiotherapy were excluded. Exposure Invasive mechanical ventilation via an endotracheal tube. Main Outcomes and Measures The incidence of UVFI as determined by flexible nasolaryngoscopy. Results One hundred patients (62 men [62%]; median age, 58.5 years [range, 19.0-87.0 years]) underwent endoscopic evaluation after extubation. Seven patients had UVFI, of which 6 cases (86%) were left sided. Patients with hypotension while intubated (odds ratio [OR], 10.8; 95% CI, 1.6 to ∞), patients requiring vasopressors while intubated (OR, 16.7; 95% CI, 2.4 to ∞), and patients with a preadmission diagnosis of peripheral vascular disease (OR, 6.2; 95% CI, 1.2-31.9) or coronary artery disease (OR, 5.1; 95% CI, 1.0-25.5) were more likely to develop UVFI. Conclusions and Relevance Unilateral vocal fold immobility occurred in 7 of 100 patients in the medical intensive care unit who were intubated for more than 12 hours. Unilateral vocal fold immobility was associated with inpatient hypotension and preadmission vascular disease, suggesting that ischemia of the recurrent laryngeal nerve may play a role in disease pathogenesis.
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Affiliation(s)
- Benjamin R Campbell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin R Shinn
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle S Kimura
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne S Lowery
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jonathan D Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - E Wesley Ely
- Tennessee Valley Veteran's Affairs Geriatric Research Education and Clinical Center, Nashville.,Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University, Nashville, Tennessee
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Laryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, Sánchez-Martín R, Logroño-Egea M, Catalá-Bauset JC, García-Orallo S, Bisbe E, Martín N, Suárez-de-la-Rica A, Cuéllar-Martínez AB, Gil-Trujillo S, Estupiñán-Jiménez JC, Villanova-Baraza M, Gil-Lapetra C, Pérez-Sánchez P, Rodríguez-García N, Ramiro-Ruiz A, Farré-Tebar C, Martínez-García A, Arauzo-Pérez P, García-Pérez C, Abad-Gurumeta A, Miñambres-Villar MA, Sánchez-Campos A, Jiménez-López I, Tena-Guerrero JM, Marín-Peña O, Sánchez-Merchante M, Vicente-Gutiérrez U, Cassinello-Ogea MC, Ferrando-Ortolá C, Berges-Gutiérrez H, Fernanz-Antón J, Gómez-Ríos MA, Bordonaba-Bosque D, Ramírez-Rodríguez JM, García-Erce JA, Aldecoa C. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA Surg 2020; 155:e196024. [PMID: 32049352 DOI: 10.1001/jamasurg.2019.6024] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. Objective To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design, Setting, and Participants This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Exposures Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. Main Outcomes and Measures The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. Results During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). Conclusions and Relevance An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.
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Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | - Ane Abad-Motos
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | - Yolanda Díez-Remesal
- Department of Anaesthesia and Critical Care, Ramón y Cajal University Hospital, Madrid, Spain
| | - Marta Aseguinolaza-Pagola
- Department of Anaesthesia, Donostia University Hospital/Donostia Unibertsitate Ospitalea, San Sebastián, Spain
| | - Lidia Padin-Barreiro
- Department of Anaesthesia, Complejo Hospitalario Universitario De Vigo-Eoxi Vigo, Vigo, Spain
| | - Rubén Sánchez-Martín
- Department of Anaesthesia, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Juan C Catalá-Bauset
- Department of Anaesthesia, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Silvia García-Orallo
- Department of Anaesthesia, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Elvira Bisbe
- Department of Anaesthesia, Hospitales del Parc de Salut Mar, Barcelona, Spain
| | - Nuria Martín
- Department of Anaesthesia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alejandro Suárez-de-la-Rica
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Critical Care, La Paz University Hospital, Madrid, Spain
| | - Ana B Cuéllar-Martínez
- Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Silvia Gil-Trujillo
- Department of Anaesthesia, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Cristina Gil-Lapetra
- Department of Anaesthesia, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | - Alvaro Ramiro-Ruiz
- Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carla Farré-Tebar
- Department of Anaesthesia, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | | | | | | | - Alfredo Abad-Gurumeta
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | | | | | | | | | - Oliver Marín-Peña
- Department of Orthopedia, Infanta Leonor University Hospital, Madrid, Spain
| | | | | | | | - Carlos Ferrando-Ortolá
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Jesús Fernanz-Antón
- Department of Anaesthesia, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - Manuel A Gómez-Ríos
- Department of Anaesthesia, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | | | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.,Department of Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
| | - José Antonio García-Erce
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Perioperative Medicine, Río Hortega University Hospital, Valladolid, Spain
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Chiewchalermsri C, Sompornrattanaphan M, Wongsa C, Thongngarm T. Chlorhexidine Allergy: Current Challenges and Future Prospects. J Asthma Allergy 2020; 13:127-133. [PMID: 32210588 PMCID: PMC7069565 DOI: 10.2147/jaa.s207980] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/11/2020] [Indexed: 12/14/2022] Open
Abstract
Chlorhexidine is a synthetic bisbiguanide antiseptic and was introduced in healthcare use in 1954. Allergy to chlorhexidine has been increasingly reported particularly in the perioperative and medical procedural settings. The hypersensitivity reactions range from mild cutaneous reactions to anaphylaxis or death. There are many products and medical devices containing chlorhexidine that sometimes lack standardized labeling. With the various routes of chlorhexidine exposure, accidental or recurrent reactions in chlorhexidine-allergic patients have been reported. Therefore, we aim to review the most recent evidence in clinical manifestations, diagnostic methods, management, and preventive measures with a focus on the unique features of chlorhexidine allergy.
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Affiliation(s)
- Chirawat Chiewchalermsri
- Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand.,Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chamard Wongsa
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Torpong Thongngarm
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Importance The US Food and Drug Administration (FDA) conducts ongoing public health safety surveillance for drug and therapeutic biologic products. Identifying cases of acute and subacute noninfectious pneumonia supports the public health mission of the FDA. Objective To identify and analyze postmarketing cases of noninfectious pneumonia associated with ustekinumab use. Design, Setting, and Participants This retrospective analysis of postmarketing (spontaneous) case reports reviewed the FDA Adverse Event Reporting System (FAERS) and the PubMed databases from September 25, 2009, through November 20, 2017. Twelve cases of new-onset acute and subacute noninfectious pneumonia were identified after general marketing of ustekinumab. Cases were excluded if the time to symptom onset was more than 2 years from ustekinumab initiation and if an alternative origin for the noninfectious pneumonia (other than drug-induced) was reported. Main Outcomes and Measures Cases of noninfectious pneumonia associated with ustekinumab use were analyzed for baseline and demographic information, reason for ustekinumab use, symptoms, time to onset, dose sequence, laboratory and diagnostic information, and clinical outcome. Results Of the 12 cases, 8 were identified from the FAERS database and 4 from PubMed. The 12 cases (7 men [58%] and 5 women [42%], with a median [range] age of 63 [27-80] years) included 7 interstitial pneumonia (58%), 3 eosinophilic pneumonia (25%), 1 organizing pneumonia (8%), and 1 hypersensitivity pneumonitis (8%) diagnoses. All 12 cases reported a serious outcome, including 7 hospitalizations (58%) and 1 respiratory failure requiring mechanical ventilation (8%). No outcome of death was reported. All 12 cases were supportive of a temporal association; specifically, in 9 cases (75%), the pulmonary symptoms appeared after 1 to 3 doses of ustekinumab. In addition, 7 cases (58%) of positive dechallenge were reported, including 1 case of a positive rechallenge. Conclusions and Relevance The postmarketing cases suggest an association between noninfectious pneumonia and use of ustekinumab; these findings have led to the addition of a new warning for ustekinumab users regarding the risk of developing noninfectious pneumonia.
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Affiliation(s)
- Allen Brinker
- Office of Surveillance and Epidemiology, Division of Pharmacovigilance, FDA Center for Drug Evaluation and Research, Silver Spring, Maryland
| | - Carmen Cheng
- Office of Surveillance and Epidemiology, Division of Pharmacovigilance, FDA Center for Drug Evaluation and Research, Silver Spring, Maryland
| | - Vicky Chan
- Office of Surveillance and Epidemiology, Division of Pharmacovigilance, FDA Center for Drug Evaluation and Research, Silver Spring, Maryland
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Piao D, Hawxby A, Wright H, Rubin EM. Perspective review on solid-organ transplant: needs in point-of-care optical biomarkers. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-14. [PMID: 30160078 DOI: 10.1117/1.jbo.23.8.080601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Solid-organ transplant is one of the most complex areas of modern medicine involving surgery. There are challenging opportunities in solid-organ transplant, specifically regarding the deficiencies in pathology workflow or gaps in pathology support, which may await alleviations or even de novo solutions, by means of point-of-care, or point-of-procedure optical biomarkers. Focusing the discussions of pathology workflow on donor liver assessment, we analyze the undermet need for intraoperative, real-time, and nondestructive assessment of the donor injuries (such as fibrosis, steatosis, and necrosis) that are the most significant predictors of post-transplant viability. We also identify an unmet need for real-time and nondestructive characterization of ischemia or irreversible injuries to the donor liver, earlier than appearing on morphological histology examined with light microscopy. Point-of-procedure laparoscopic optical biomarkers of liver injuries and tissue ischemia may also facilitate post-transplant management that is currently difficult for or devoid of pathological consultation due to lack of tools. The potential and pitfalls of point-of-procedure optical biomarkers for liver assessment are exemplified in breadth for steatosis. The more general and overarching challenges of point-of-procedure optical biomarkers for liver transplant pathology, including the shielding effect of the liver capsule that was quantitated only recently, are projected. The technological and presentational benchmarks that a candidate technology of point-of-procedure optical biomarkers for transplant pathology must demonstrate to motivate clinical translation are also foreseen.
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Affiliation(s)
- Daqing Piao
- Oklahoma State University, School of Electrical and Computer Engineering, Stillwater, Oklahoma, United States
- Oklahoma State University, Department of Veterinary Clinical Sciences, Center for Veterinary Health, United States
| | - Alan Hawxby
- University of Oklahoma Health Sciences Center, Oklahoma Transplant Center, Oklahoma City, Oklahoma, United States
| | - Harlan Wright
- University of Oklahoma Health Sciences Center, Oklahoma Transplant Center, Oklahoma City, Oklahoma, United States
| | - Erin M Rubin
- University of Oklahoma Health Sciences Center, Department of Pathology, Oklahoma City, Oklahoma, United States
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Wise R, Bishop D, Joynt G, Rodseth R. Perioperative ARDS and lung injury: for anaesthesia and beyond. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1449463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Robert Wise
- Perioperative Research Unit, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, University of KwaZulu-Natal, Discipline of Anaesthesiology and Critical Care, Durban, South Africa
| | - David Bishop
- Perioperative Research Unit, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, University of KwaZulu-Natal, Discipline of Anaesthesiology and Critical Care, Durban, South Africa
| | - Gavin Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Reitze Rodseth
- Perioperative Research Unit, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, University of KwaZulu-Natal, Discipline of Anaesthesiology and Critical Care, Durban, South Africa
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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