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Lüthin S, Zollinger A, Basso W, Bisig M, Caspari N, Eng V, Frey CF, Grimm F, Igel P, Lüthi S, Regli W, Roelfstra L, Rosskopf M, Steiner B, Stöckli M, Waidyasekera D, Waldmeier P, Schnyder M, Torgerson PR, Hertzberg H. Strongyle faecal egg counts in Swiss horses: A retrospective analysis after the introduction of a selective treatment strategy. Vet Parasitol 2023; 323:110027. [PMID: 37837729 DOI: 10.1016/j.vetpar.2023.110027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 07/17/2023] [Accepted: 09/09/2023] [Indexed: 10/16/2023]
Abstract
The standard parasite management of horses based on regular anthelmintic treatments, now practiced for decades has resulted in a worrying expansion of resistant helminth populations, which may considerably impair control on the farm level. The aim of the present study was to obtain a retrospective (year 2010 - 2016) nationwide analysis of faecal egg count (FEC) data from the Swiss adult horse population, related to horse age and geographic region. Thirteen labs provided a total of 16,387 FEC data of horses aged four to 39 years (average: 13.6 years). The annual number of performed FEC tests increased from 38 to 4,939 within the observation period. Independent of the annual sample size the yearly patterns of the FEC were very similar. Seventy-eight percent (n = 12,840) of the samples were negative and 90 % (n = 14,720) showed a FEC below 200 strongyle eggs per gram (EPG) of faeces. The annual mean strongyle FEC ranged between 60 and 88 EPG with a total mean of 75 EPG. Horses aged 4-7 years showed a significantly (p < 0.00001) higher mean FEC compared with the other age groups, differences were not significant among the older horses. Based on ZIP codes, samples were allocated by 70.0 %, 6.0 % and 0.2 % to the German-, French- and Italian-speaking regions of Switzerland, respectively. With 222 EPG the mean FEC in the French part of Switzerland was significantly higher (p < 0.05) than in the German-speaking region (60 EPG). Eggs of Parascaris spp., anoplocephalids and Strongyloides westeri were found in 0.36 %, 0.32 % and 0.01 % of the samples, respectively. Based on 3,813 questionnaire feedbacks from owners in 2017 covering a total of 12,689 horses, sixty-eight percent (n = 8,476) were dewormed without diagnosis, two percent (n = 240) were not dewormed at all, whereas for 30 % (n = 3,721) the selective anthelmintic treatment (SAT) concept was applied. The SAT implementation rate differed significantly (p < 0.0005) between regions, with 33 %, 20 % and 25 % for the German-, French- and Italian-speaking areas, respectively. The rate of horses spending 16-24 h on pasture per day was significantly higher in the French-speaking region compared to the German-speaking part of Switzerland (p < 0.0001). In addition, pasture hygiene was practiced at a significantly lower rate in the French-speaking part compared to the German- and Italian-speaking regions (both p < 0.0001). Overall, the shift towards the SAT-concept represents a very promising development with respect to mitigating the further spread of anthelmintic resistance.
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Affiliation(s)
- S Lüthin
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, 8057 Zurich, Switzerland
| | - A Zollinger
- Agroscope, Swiss National Stud Farm SNSF, Les Longs-Prés, 1580 Avenches, Switzerland
| | - W Basso
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, 3012 Berne, Switzerland
| | - M Bisig
- Bisig Tierärzte AG, Wildbrunnstrasse 3, 8722 Kaltbrunn, Switzerland
| | - N Caspari
- IDEXX Diavet Labor AG, Schlyffistrasse 10, 8806 Bäch SZ, Switzerland
| | - V Eng
- Tierarztpraxis Arche, Sonnenrain 4, 6133 Hergiswil b. Willisau, Switzerland
| | - C F Frey
- Institute of Parasitology, Vetsuisse Faculty, University of Berne, Länggass-Strasse 122, 3012 Berne, Switzerland
| | - F Grimm
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, 8057 Zurich, Switzerland
| | - P Igel
- Tierärztliche Gemeinschaftspraxis Zücken, Zückerain 5, 6017 Ruswil, Switzerland
| | - S Lüthi
- Tierarztpraxis Dr. med. vet. Sybil Lüthi, Attenreute 6, 9315 Neukirch (Egnach), Switzerland
| | - W Regli
- Labor Zentral, Stationsweg 3, 6232 Geuensee, Switzerland
| | - L Roelfstra
- Animal Diagnostic Sàrl, Avenue de Beauregard 28, 2036 Cormondrèche, Switzerland
| | - M Rosskopf
- IDEXX Diavet Labor AG, Schlyffistrasse 10, 8806 Bäch SZ, Switzerland
| | - B Steiner
- Zoetis Schweiz GmbH, Rue de la Jeunesse 2, 2800 Delémont, Switzerland
| | - M Stöckli
- Pferdeklinik Dalchenhof, Talchenweg 7, 4805 Brittnau, Switzerland
| | - D Waidyasekera
- Tierarztpraxis am Pfannenstil, Zelgmatt 69, 8132 Egg b. Zürich, Switzerland
| | - P Waldmeier
- Tierarztpraxis Waldmeier GmbH, Hauptstrasse 15, 5273 Oberhofen AG, Switzerland
| | - M Schnyder
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, 8057 Zurich, Switzerland
| | - P R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 270, 8057 Zurich, Switzerland
| | - H Hertzberg
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, 8057 Zurich, Switzerland; Health Balance Tiergesundheit, Flawilerstrasse 35, 9244 Niederuzwil, Switzerland.
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2
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Mulder L, Carrères B, Muggli F, Zollinger A, Corthésy J, Klijn A, Togni G. A Comparative Study of Nine SARS-CoV-2 IgG Lateral Flow Assays Using Both Post-Infection and Post-Vaccination Samples. J Clin Med 2022; 11:jcm11082100. [PMID: 35456192 PMCID: PMC9032267 DOI: 10.3390/jcm11082100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Since the SARS-CoV-2 pandemic, lateral flow assays (LFA) detecting specific antibodies have entered the market in abundance. Despite being CE-IVD-labeled, the antigenic compounds of the assays are often unknown, the performance characteristics provided by the manufacturer are often incomplete, and the samples used to obtain the data are not detailed. Objective: To perform a comparative evaluation of nine lateral flow assays to detect IgG responses against SARS-CoV-2. For the evaluation, a carefully designed serum panel containing post-infection samples and post-vaccination (both mRNA vaccine and inactivated virus vaccine) samples was used. Results: The sensitivity of the assays overall ranged from 9 to 90.3% and the specificity ranged from 94.2 to 100%. Spike protein-containing assays performed generally better than the assays with only nucleocapsid protein. The sensitivity of some assays was higher on post-infection samples, while other assays had a higher sensitivity to post-vaccination samples. Conclusion: A comparative approach in the verification of LFAs with an adequately designed serum panel enabled the identification of the antigens used in the assays. Sensitivities differed between post-infection and post-vaccination samples, depending on the assays used. This demonstrates that the verification of assays must be performed with samples representative of the intended use of the assay.
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Affiliation(s)
- Leontine Mulder
- Clinical Laboratory, Medlon BV, P.O. Box 50000, 7500 KA Enschede, The Netherlands;
- Clinical Chemistry, Ziekenhuis Groep Twente, P.O. Box 7600, 7600 SZ Almelo, The Netherlands
| | - Benoit Carrères
- Société de Produits Nestlé S.A., Nestlé Research, Route du Jorat 57, 1000 Lausanne, Switzerland; (B.C.); (A.Z.); (J.C.); (A.K.)
| | - Franco Muggli
- Faculty of Biomedical Science, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Alix Zollinger
- Société de Produits Nestlé S.A., Nestlé Research, Route du Jorat 57, 1000 Lausanne, Switzerland; (B.C.); (A.Z.); (J.C.); (A.K.)
| | - John Corthésy
- Société de Produits Nestlé S.A., Nestlé Research, Route du Jorat 57, 1000 Lausanne, Switzerland; (B.C.); (A.Z.); (J.C.); (A.K.)
| | - Adrianne Klijn
- Société de Produits Nestlé S.A., Nestlé Research, Route du Jorat 57, 1000 Lausanne, Switzerland; (B.C.); (A.Z.); (J.C.); (A.K.)
| | - Giuseppe Togni
- Unilabs Central Laboratory, 1296 Coppet, Switzerland
- Correspondence:
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Raymond F, Lefebvre G, Texari L, Pruvost S, Metairon S, Cottenet G, Zollinger A, Mateescu B, Billeaud C, Picaud JC, Silva-Zolezzi I, Descombes P, Bosco N. Longitudinal Human Milk miRNA Composition over the First 3 mo of Lactation in a Cohort of Healthy Mothers Delivering Term Infants. J Nutr 2022; 152:94-106. [PMID: 34510208 DOI: 10.1093/jn/nxab282] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/12/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND MicroRNAs (miRNAs) are small noncoding RNAs involved in posttranscriptional regulation. miRNAs can be secreted and found in many body fluids, and although they are particularly abundant in breastmilk, their functions remain elusive. Human milk (HM) miRNAs start to raise considerable interest, but a comprehensive understanding of the repertoire and expression profiles along lactation has not been well characterized. OBJECTIVES This study aimed to characterize the longitudinal profile of HM miRNA between the second week and third month postpartum. METHODS We used a new sensitive technology to measure HM miRNAs in a cohort of 44 French mothers [mean ± SD age: 31 ± 3.5; BMI (in kg/m2) 21.8 ± 2.3] who delivered at term and provided HM samples at 3 time points (17 ± 3 d, 60 ± 3 d, and 90 ± 3 d) during follow-up visits. RESULTS We detected 685 miRNAs, of which 35 showed a high and stable expression along the lactation period analyzed. We also described for the first time a set of 11 miRNAs with a dynamic expression profile. To gain insight into the potential functional relevance of this set of miRNAs, we selected miR-3126 and miR-3184 to treat undifferentiated Caco-2 human intestinal cells and then assessed differentially expressed genes and modulation of related biological pathways. CONCLUSIONS Overall, our study provides new insights into HM miRNA composition and, to our knowledge, the first description of its longitudinal dynamics in mothers who delivered at term. Our in vitro results obtained in undifferentiated Caco-2 human intestinal cells transfected with HM miRNAs also provide further support to the hypothesized mother-to-neonate signaling role of HM miRNAs. This trial was registered at clinicaltrials.gov as NCT01894893.
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Affiliation(s)
- Frederic Raymond
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Gregory Lefebvre
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Lorane Texari
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Solenn Pruvost
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Sylviane Metairon
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Geoffrey Cottenet
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Alix Zollinger
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Bogdan Mateescu
- Brain Research Institute, University of Zurich, Zurich, Switzerland
| | - Claude Billeaud
- Neonatology Nutrition, Lactarium Bordeaux-Marmande, Bordeaux, France
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, University Hospital Croix Rousse, Lyon, France.,CarMeN unit, Claude Bernard University Lyon 1, 69310 Pierre Benite, France
| | | | - Patrick Descombes
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Nabil Bosco
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland.,Nestlé Research, Singapore
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Hauser J, Pisa E, Arias Vásquez A, Tomasi F, Traversa A, Chiodi V, Martin FP, Sprenger N, Lukjancenko O, Zollinger A, Metairon S, Schneider N, Steiner P, Martire A, Caputo V, Macrì S. Sialylated human milk oligosaccharides program cognitive development through a non-genomic transmission mode. Mol Psychiatry 2021; 26:2854-2871. [PMID: 33664475 PMCID: PMC8505264 DOI: 10.1038/s41380-021-01054-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 12/13/2022]
Abstract
Breastmilk contains bioactive molecules essential for brain and cognitive development. While sialylated human milk oligosaccharides (HMOs) have been implicated in phenotypic programming, their selective role and underlying mechanisms remained elusive. Here, we investigated the long-term consequences of a selective lactational deprivation of a specific sialylated HMO in mice. We capitalized on a knock-out (KO) mouse model (B6.129-St6gal1tm2Jxm/J) lacking the gene responsible for the synthesis of sialyl(alpha2,6)lactose (6'SL), one of the two sources of sialic acid (Neu5Ac) to the lactating offspring. Neu5Ac is involved in the formation of brain structures sustaining cognition. To deprive lactating offspring of 6'SL, we cross-fostered newborn wild-type (WT) pups to KO dams, which provide 6'SL-deficient milk. To test whether lactational 6'SL deprivation affects cognitive capabilities in adulthood, we assessed attention, perseveration, and memory. To detail the associated endophenotypes, we investigated hippocampal electrophysiology, plasma metabolomics, and gut microbiota composition. To investigate the underlying molecular mechanisms, we assessed gene expression (at eye-opening and in adulthood) in two brain regions mediating executive functions and memory (hippocampus and prefrontal cortex, PFC). Compared to control mice, WT offspring deprived of 6'SL during lactation exhibited consistent alterations in all cognitive functions addressed, hippocampal electrophysiology, and in pathways regulating the serotonergic system (identified through gut microbiota and plasma metabolomics). These were associated with a site- (PFC) and time-specific (eye-opening) reduced expression of genes involved in central nervous system development. Our data suggest that 6'SL in maternal milk adjusts cognitive development through a short-term upregulation of genes modulating neuronal patterning in the PFC.
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Affiliation(s)
- Jonas Hauser
- grid.419905.00000 0001 0066 4948Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Edoardo Pisa
- grid.416651.10000 0000 9120 6856Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy ,grid.7841.aDepartment of Physiology and Pharmacology “Vittorio Erspamer”, “Sapienza” University of Rome, Rome, Italy
| | - Alejandro Arias Vásquez
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Departments of Psychiatry and Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Flavio Tomasi
- grid.416651.10000 0000 9120 6856Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Alice Traversa
- grid.413503.00000 0004 1757 9135Laboratory of Clinical Genomics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG Italy
| | - Valentina Chiodi
- grid.416651.10000 0000 9120 6856National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Francois-Pierre Martin
- grid.419905.00000 0001 0066 4948Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Norbert Sprenger
- grid.419905.00000 0001 0066 4948Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | | | - Alix Zollinger
- grid.419905.00000 0001 0066 4948Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Sylviane Metairon
- grid.419905.00000 0001 0066 4948Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Nora Schneider
- grid.419905.00000 0001 0066 4948Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Pascal Steiner
- grid.419905.00000 0001 0066 4948Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Alberto Martire
- grid.416651.10000 0000 9120 6856National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Viviana Caputo
- grid.7841.aDepartment of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Simone Macrì
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy.
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5
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Faiss R, Saugy J, Zollinger A, Robinson N, Schuetz F, Saugy M, Garnier PY. Prevalence Estimate of Blood Doping in Elite Track and Field Athletes During Two Major International Events. Front Physiol 2020; 11:160. [PMID: 32161553 PMCID: PMC7052379 DOI: 10.3389/fphys.2020.00160] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Abstract
In elite sport, the Athlete Biological Passport (ABP) was invented to tackle cheaters by monitoring closely changes in biological parameters, flagging atypical variations. The hematological module of the ABP was indeed adopted in 2011 by World Athletics (WA). This study estimates the prevalence of blood doping based on hematological parameters in a large cohort of track and field athletes measured at two international major events (2011 and 2013 WA World Championships) with a hypothesized decrease in prevalence due to the ABP introduction. A total of 3683 blood samples were collected and analyzed from all participating athletes originating from 209 countries. The estimate of doping prevalence was obtained by using a Bayesian network with seven variables, as well as "blood doping" as a variable mimicking doping with low-doses of recombinant human erythropoietin (rhEPO), to generate reference cumulative distribution functions (CDFs) for the Abnormal Blood Profile Score (ABPS) from the ABP. Our results from robust hematological parameters indicate an estimation of an overall blood doping prevalence of 18% in 2011 and 15% in 2013 (non-significant difference) in average in endurance athletes [95% Confidence Interval (CI) 14-22 and 12-19% for 2011 and 2013, respectively]. A higher prevalence was observed in female athletes (22%, CI 16-28%) than in male athletes (15%, CI 9-20%) in 2011. In conclusion, this study presents the first comparison of blood doping prevalence in elite athletes based on biological measurements from major international events that may help scientists and experts to use the ABP in a more efficient and deterrent way.
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Affiliation(s)
- Raphael Faiss
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Jonas Saugy
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Alix Zollinger
- Bioinformatics Core Facility, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Neil Robinson
- Swiss Laboratory for Doping Analyses, University Centre of Legal Medicine, Lausanne and Geneva, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Frederic Schuetz
- Bioinformatics Core Facility, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Martial Saugy
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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6
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Abstract
The Abnormal Blood Profile Score (ABPS) is used to identify blood doping in sport. It combines seven hematological markers, including hemoglobin level, reticulocytes percent, and haematocrit level, using two different machine learning algorithms in order to create a single score that has a better ability to identify doping than each parameter taken alone. The resulting score allows the detection of several types of doping using a single score and is part of the current Athlete Biological Passport program managed by World Anti-Doping Agency (WADA). We describe ≪ ABPS ≫, an R package that allows the calculation of this score. This is the first software implementation calculating this score that is released publicly. The package also contains functions to calculate the OFF-score (another score used for detection of doping), as well as several test datasets. The package is useful for laboratories conducting anti-doping analyses and for researchers working on anti-doping research projects. In particular, it has been successfully used in projects estimating the prevalence of blood doping.
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Affiliation(s)
- Frédéric Schütz
- Bioinformatics Core Facility, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Alix Zollinger
- Bioinformatics Core Facility, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
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7
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Schlumpf R, Candinas D, Zollinger A, Keusch G, Retsch M, Decurtins M, Largiadèr F. Kidney procurement from non-heartbeating donors: transplantation results. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.424] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Zollinger A, Davison AC, Goldstein DR. Automatic module selection from several microarray gene expression studies. Biostatistics 2018; 19:153-168. [PMID: 29106444 DOI: 10.1093/biostatistics/kxx032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/23/2017] [Indexed: 11/14/2022] Open
Abstract
Independence of genes is commonly but incorrectly assumed in microarray data analysis; rather, genes are activated in co-regulated sets referred to as modules. In this article, we develop an automatic method to define modules common to multiple independent studies. We use an empirical Bayes procedure to estimate a sparse correlation matrix for all studies, identify modules by clustering, and develop an extreme-value-based method to detect so-called scattered genes, which do not belong to any module. The resulting algorithm is very fast and produces accurate modules in simulation studies. Application to real data identifies modules with significant enrichment and results in a huge dimension reduction, which can alleviate the computational burden of further analyses.
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Affiliation(s)
- Alix Zollinger
- Swiss Institute of Bioinformatics, SIB-BCF, Genopode Building, 1015 Lausanne, Switzerland and Ecole Polytechnique Fédérale de Lausanne, EPFL-FSB-MATHAA-STAT, Station 8, 1015 Lausanne, Switzerland
| | - Anthony C Davison
- Ecole Polytechnique Fédérale de Lausanne, EPFL-FSB-MATHAA-STAT, Station 8, 1015 Lausanne, Switzerland
| | - Darlene R Goldstein
- Ecole Polytechnique Fédérale de Lausanne, EPFL-FSB-MATHAA-STAT, Station 8, 1015 Lausanne, Switzerland
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9
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Zollinger A, Mohn D, Zeltner M, Zehnder M. Short-term storage stability of NaOCl solutions when combined with Dual Rinse HEDP. Int Endod J 2017; 51:691-696. [DOI: 10.1111/iej.12875] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Zollinger
- Clinic for Preventive Dentistry, Periodontology and Cariology; University of Zurich; Center for Dental Medicine; Zurich Switzerland
| | - D. Mohn
- Clinic for Preventive Dentistry, Periodontology and Cariology; University of Zurich; Center for Dental Medicine; Zurich Switzerland
- Department of Chemistry and Applied Biosciences; Institute for Chemical and Bioengineering; ETH Zurich; Zurich Switzerland
| | - M. Zeltner
- Department of Chemistry and Applied Biosciences; Institute for Chemical and Bioengineering; ETH Zurich; Zurich Switzerland
| | - M. Zehnder
- Clinic for Preventive Dentistry, Periodontology and Cariology; University of Zurich; Center for Dental Medicine; Zurich Switzerland
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10
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Abstract
Meta-analysis of microarray studies to produce an overall gene list is relatively straightforward when complete data are available. When some studies lack information-providing only a ranked list of genes, for example-it is common to reduce all studies to ranked lists prior to combining them. Since this entails a loss of information, we consider a hierarchical Bayes approach to meta-analysis using different types of information from different studies: the full data matrix, summary statistics, or ranks. The model uses an informative prior for the parameter of interest to aid the detection of differentially expressed genes. Simulations show that the new approach can give substantial power gains compared with classical meta-analysis and list aggregation methods. A meta-analysis of 11 published studies with different data types identifies genes known to be involved in ovarian cancer and shows significant enrichment.
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Affiliation(s)
- Alix Zollinger
- Ecole Polytechnique Fédérale de Lausanne, EPFL-FSB-MATHAA-STAT, Station 8, 1015 Lausanne, Switzerland
| | - Anthony C Davison
- Ecole Polytechnique Fédérale de Lausanne, EPFL-FSB-MATHAA-STAT, Station 8, 1015 Lausanne, Switzerland
| | - Darlene R Goldstein
- Ecole Polytechnique Fédérale de Lausanne, EPFL-FSB-MATHAA-STAT, Station 8, 1015 Lausanne, Switzerland
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11
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Geisen M, Schmid UM, Dzemali O, Zollinger A, Hofer CK. Fluid responsiveness during weaning from mechanical ventilation. Crit Care 2012. [PMCID: PMC3363654 DOI: 10.1186/cc10843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M Geisen
- Triemli City Hospital, Zürich, Switzerland
| | - UM Schmid
- Triemli City Hospital, Zürich, Switzerland
| | - O Dzemali
- Triemli City Hospital, Zürich, Switzerland
| | | | - CK Hofer
- Triemli City Hospital, Zürich, Switzerland
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13
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Dzemali O, Schurr U, Biry M, Ritter S, Häussler A, Zollinger A, Genoni M. High incidence of severely prolonged QT interval after cardiac surgery. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Bischof D, Dalbert S, Zollinger A, Ganter MT, Hofer CK. Thrombelastography in the surgical patient. Minerva Anestesiol 2010; 76:131-137. [PMID: 20150854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Coagulopathy in surgical patients is an important factor in triggering major perioperative complications, i.e., intra- or postoperative bleeding and thrombo-embolic events associated with an increased mortality and morbidity. Different methods exist to assess the coagulation status of patients before, during and after surgery. Routine coagulation tests have long been considered to be the clinical standard. However, these tests have considerable limitations. Information regarding the kinetics of clot formation, clot strength, interaction of the coagulation components, platelet function and fibrinolysis is not available. Moreover, there is an important delay in obtaining test results. In contrast, thrombelastography and thrombelastometry, which both measure the visco-elastic properties of whole blood, allow the dynamic assessment of a developing clot, from fibrin formation to clot strengthening and clot lysis. Both techniques are increasingly being used in daily clinical practice in order to detect perioperative coagulopathy and to guide predominantly pro-coagulant therapy in different settings. This article provides an overview of both techniques, thrombelastography (TEG) and thrombelastometry (ROTEM), and their field of perioperative application considering of recently published data.
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Affiliation(s)
- D Bischof
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
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Biry M, Schurr U, Ritter S, Baenziger K, Zollinger A, Genoni M. High incidence of severely prolonged QT interval after cardiac surgery. Crit Care 2010. [PMCID: PMC2934116 DOI: 10.1186/cc8366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Senn A, Zollinger A, Hofer C. Evaluation of a modified FloTrac™ algorithm for cardiac output measurement in cardiac surgery patients. Crit Care 2008. [PMCID: PMC4088468 DOI: 10.1186/cc6318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hofer C, Senn A, Zollinger A. Prediction of fluid responsiveness by FloTrac™ and PiCCOplus™ in cardiac surgery patients. Crit Care 2008. [PMCID: PMC4088465 DOI: 10.1186/cc6315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nakahara R, Weibel L, Zollinger A, Hofer C. Quality of life after prolonged ICU stay: preliminary results of a prospective survey in critically ill patients. Crit Care 2008. [PMCID: PMC4088876 DOI: 10.1186/cc6726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Hofer CK, Zollinger A. Less Invasive Cardiac Output Monitoring: Characteristics and Limitations. Intensive Care Med 2007. [DOI: 10.1007/0-387-35096-9_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zingg U, Hofer CK, Seifert B, Metzger U, Zollinger A. High dose N-acetylcysteine to prevent pulmonary complications in partial or total transthoracic esophagectomy: results of a prospective observational study. Dis Esophagus 2007; 20:399-405. [PMID: 17760653 DOI: 10.1111/j.1442-2050.2007.00690.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cancer of the esophagus has a poor long-term prognosis and a high peri-operative morbidity in which pulmonary complications play a major role. The combination of the surgical approach, pre-existing pulmonary disorders, poor nutritional status and the release of pro-inflammatory cytokines may be contributing factors. N-acetylcysteine ((NAC) has been shown to have oxygen scavenging abilities. In severe sepsis and acute respiratory distress syndrome, positive effects of NAC on morbidity and mortality were discovered. In this observational study peri-operative high dose NAC was administered in 22 patients. The effects of this treatment on respiratory function, morbidity and survival were studied. These prospectively collected data were compared with data of a matched, retrospective group without NAC treatment. There were no significant differences between the groups in terms of socio-demographic data, preoperative pulmonary function, intra-operative course and oncologic characteristics. The oxygenation indices at the postoperative hours 2 (P = 0.019), 4 (P < 0.001), 8 (P = 0.035), 12 (P = 0.035) and 24 (P = 0.046) were significantly higher in the NAC group. After 36 h, the difference between groups was no longer significant (P = 0.064). NAC-treated patients showed significant lower overall pulmonary morbidity, 45.5% versus 81.8% (P = 0.027). Surgical morbidity, intensive care unit and hospital stay were not significantly different between groups, mortality was zero. Kaplan-Meier curves showed no significant difference in survival 12 months postoperatively. These data indicate that postoperative oxygenation can be improved and rate of overall pulmonary complications is reduced using peri-operative high dose NAC in transthoracic esophagectomy.
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Affiliation(s)
- U Zingg
- Department of Surgery, Triemli City Hospital Zurich, Switzerland.
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Button D, Weibel L, Reuthebuch O, Genoni M, Zollinger A, Hofer CK. Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth 2007; 99:329-36. [PMID: 17631509 DOI: 10.1093/bja/aem188] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Assessment of cardiac output (CO) by the FloTrac/Vigileo system may offer a less invasive means of determining the CO than either the pulmonary artery catheter (PAC) or the PiCCOplus system. The aim of this study was to compare CO measurements made using the FloTrac/Vigileo system with upgraded software (FCO, Edwards Lifesciences, Irvine CA, USA), the PiCCOplus system (PCO, Pulsion Medical Systems, Munich, Germany) and continuous CO monitoring using a PAC (CCO; Vigilance monitoring, Edwards Lifesciences, Irvine CA, USA) with intermittent pulmonary artery thermodilution (ICO). The study was conducted in patients undergoing elective cardiac surgery. METHODS Thirty-one patients with preserved left ventricular function were enrolled. CCO, FCO, and PCO were recorded in the perioperative period at six predefined time points after achieving stable haemodynamic conditions; ICO was determined from the mean of three bolus injections. Bland-Altman analysis was used to compare CCO, FCO, and PCO with ICO. RESULTS Bland-Altman analysis revealed a comparable mean bias and limits of agreement for all tested continuous CO monitoring devices using ICO as reference method. Agreement for all devices decreased in the postoperative period. CONCLUSION The performance of the FloTrac/Vigileo system, the PiCCOplus, and the Vigilance CCO monitoring for CO measurement were comparable when tested against intermittent thermodilution in patients undergoing elective cardiac surgery.
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Affiliation(s)
- D Button
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Zurich, Switzerland
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Rist A, Schneider S, Fodor P, Weibel L, Zollinger A, Hofer C. CeVOX for continuous central venous oxygenation measurement in patients undergoing off-pump coronary artery bypass grafting. Crit Care 2007. [PMCID: PMC4095355 DOI: 10.1186/cc5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
To date, only a few published studies have been concerned with the anaesthesiological aspects of lung volume reduction surgery. This review summarizes the different anaesthetic concepts and offers a general strategy to meet specific requirements. Limitation of peak inspiratory pressure, tolerance of hypercapnia and avoidance of hypoxia during one-lung ventilation, and the immediate postoperative tracheal extubation of these patients, are considered to be crucial. However, many aspects of the procedure and of anaesthesiological management remain to be elucidated.
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Affiliation(s)
- A Zollinger
- Department of Anaesthesiology, University Hospital, Zürich, Switzerland.
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Abstract
BACKGROUND In order to improve perioperative subjective quality of care it seems desirable to shorten preoperative fasting times as much as possible within acceptable safety limits. These efforts should result in a measurable reduction of preoperative thirst and hunger as well as in improvements of patient well-being. It is unknown to what extent preoperative patient comfort is limited by thirst and hunger from a patient point of view. The purpose of this study was to determine the impact of a traditional fasting regimen on preoperative patient discomfort. PATIENTS AND METHODS We conducted a survey on preoperative thirst and hunger in 412 adult American Society of Anesthesiologists ASA I and II patients scheduled for minor elective surgery. RESULTS Of the patients 33% complained of moderate to strong thirst, whereas 19% had moderate to strong hunger, 47% of the participants would have liked to have been able to drink and 72% would have appreciated a light breakfast before surgery. Mean preoperative fasting times were 12.8+/-3.4 h for fluids and 15.5+/-4.4 h for solids. "Thirst" was named by 3.3% and "hunger" by 0.8% of patients as the most important factor for preoperative discomfort but "long wait" (8.5%), "tenseness" (6.5%) and "anxiety" (4.8%) were the most frequently named factors. Answers were independent of the duration of preoperative fasting. CONCLUSION Patient comfort is compromised by traditional fasting rules and liberalization of these policies is desired by patients. However, efforts to reduce preoperative anxiety and tenseness might have an additional, important potential to improve perioperative quality of care from a patient's perspective.
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Affiliation(s)
- L Furrer
- Institut für Anästhesiologie und Intensivmedizin, Stadtspital Triemli, Birmensdorferstrasse 497, 8063 Zürich
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Hofer CK, Ganter MT, Matter-Ensner S, Furrer L, Klaghofer R, Genoni M, Zollinger A. Volumetric assessment of left heart preload by thermodilution: comparing the PiCCO-VoLEF system with transoesophageal echocardiography. Anaesthesia 2006; 61:316-21. [PMID: 16548948 DOI: 10.1111/j.1365-2044.2006.04537.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The new Volumetric Ejection Fraction monitoring system (VoLEF), when combined with the Pulse Contour Cardiac Output monitoring system (PiCCO) system, allows measurement of left and right heart end-diastolic volumes by thermodilution. The aim of this study was to evaluate whether the left heart end-diastolic volume index determined by the VoLEF system (LHEDI) better reflects left ventricular end-diastolic area index (LVEDAI) measured by transoesophageal echocardiography than does global end-diastolic volume index (GEDI) measured by the PiCCO system alone. Following induction of anaesthesia, PiCCO, VoLEF and transoesophageal echocardiography measurements were performed before and after a fluid challenge in 20 patients scheduled for elective cardiac surgery. Both left ventricular end-diastolic area index and global end-diastolic volume index, but not left heart end-diastolic volume index, significantly increased after fluid administration. Mean bias +/- 2 SD for DeltaLHEDI-DeltaLVEDAI was -2.2 +/- 32.0% and for DeltaGEDI-DeltaLVEDAI -0.6 +/- 16.8%. In contrast to global end-diastolic volume index, the use of left heart end-diastolic volume index determined by the VoLEF system cannot be recommended as an estimate of left ventricular preload.
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Affiliation(s)
- C K Hofer
- Consultant, Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstr. 497, 8063 Zurich, Switzerland.
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Dalbert S, Ganter MT, Furrer L, Klaghofer R, Zollinger A, Hofer CK. Effects of heparin, haemodilution and aprotinin on kaolin-based activated clotting time: in vitro comparison of two different point of care devices. Acta Anaesthesiol Scand 2006; 50:461-8. [PMID: 16548858 DOI: 10.1111/j.1399-6576.2006.00990.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND During cardiopulmonary bypass (CPB), measurement of kaolin-based activated clotting time (kACT) is a standard practice in monitoring heparin-induced anticoagulation. Despite the fact that the kACT test from the Sonoclot Analyzer (SkACT) has been commercially available for several years, no published data on the performance of SkACT are available. Thus, the aim of this in vitro study was to compare SkACT with an established kACT from Hemochron (HkACT). METHODS Blood was withdrawn from 25 patients before elective cardiac surgery. SkACT and HkACT were measured in duplicate after in vitro administration of heparin (0, 1, 2 and 3 U/ml), calcium-free lactated Ringer's solution (25% and 50% haemodilution) and aprotinin (200 kIU/ml). RESULTS A total of 600 duplicate kACT measurements were obtained from 25 cardiac surgery patients. Overall, mean bias +/- SD between SkACT and HkACT was 7 +/- 70 s (1.3% +/- 14.1%). Administration of heparin, haemodilution and aprotinin induced a comparable effect on both activated clotting time (ACT) tests. Mean bias ranged from -4 +/- 39 s (-1.7% +/- 12.9%) to 4 +/- 78 s (3.2% +/- 15.6%) for heparinzed blood samples after haemodilution or aprotinin application and increased after combined aprotinin administration and haemodilution. After haemodilution and administration of aprotinin, both ACT tests were less reliable for values >480 s in heparinized blood samples. CONCLUSION Accuracy and performance of SkACT and HkACT were comparable after in vitro administration of heparin, aprotinin and haemodilution. Both ACT tests were considerably affected by aprotinin and haemodilution.
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Affiliation(s)
- S Dalbert
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Zurich, Switzerland
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Hofer C, Ganter M, Fodor P, Tavakoli R, Genoni M, Zollinger A. Crit Care 2006; 10:P340. [DOI: 10.1186/cc4687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hofer CK, Worn M, Tavakoli R, Sander L, Maloigne M, Klaghofer R, Zollinger A. Influence of body core temperature on blood loss and transfusion requirements during off-pump coronary artery bypass grafting: a comparison of 3 warming systems. J Thorac Cardiovasc Surg 2005; 129:838-43. [PMID: 15821652 DOI: 10.1016/j.jtcvs.2004.07.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this prospective randomized trial was to evaluate the efficacy of 3 intraoperative warming systems (Warm-Touch, Thermamed SmartCare OP system, and Allon 2001) on maintenance of normothermia and to investigate their effects on perioperative bleeding and transfusion requirements in patients undergoing off-pump coronary artery bypass grafting. METHODS With institutional approval/patient informed consent, 90 patients presenting for elective multiple off-pump coronary artery bypass grafting were randomly assigned to 1 of the 3 warming systems. Active warming was started after the induction of anesthesia. Perioperative transfusion was based on international guidelines. Body core temperature was recorded every 30 minutes during operation. Perioperative blood loss, autotransfusion, and allogenic transfusions were recorded. Analysis of variance was performed with post hoc Scheffé tests and chi 2 tests. RESULTS Normothermia could be sufficiently maintained during operation by the Allon 2001 only. Final body core temperature was 34.7 degrees C +/- 0.9 degrees C (Warm-Touch), 35.6 degrees C +/- 0.8 degrees C (Thermamed SmartCare OP), and 36.5 degrees C +/- 0.4 degrees C (Allon 2001; P < .001, Warm-Touch vs Thermamed SmartCare OP, Warm-Touch vs Allon 2001, and Thermamed SmartCare OP vs Allon 2001). Perioperative blood loss was 2683 +/- 1049 mL (Warm-Touch), 2300 +/- 788 mL (Thermamed SmartCare OP), and 1497 +/- 497 mL (Allon 2001; P = .195, Warm-Touch vs Thermamed SmartCare OP; P < .001, Warm-Touch vs Allon 2001; P = .001, Thermamed SmartCare OP vs Allon 2001). Transfusion requirements were 1097 +/- 874 mL (Warm-Touch), 986 +/- 744 mL (Thermamed SmartCare OP), and 431 +/- 387 mL (Allon 2001; P = .838, Warm-Touch vs Thermamed SmartCare OP; P = .003, Warm-Touch vs Allon 2001; P = .013, Thermamed SmartCare OP vs Allon 2001). Free of allogenic transfusion were 15 (51.7%; Warm-Touch), 18 (60%; Thermamed SmartCare OP), and 24 (82.8%; Allon 2001) patients ( P = .037). CONCLUSIONS The goal of normothermia during off-pump coronary artery bypass grafting was best achieved by the Allon system. With this concept, overall blood loss and transfusion requirements were reduced, hence indicating improved quality of perioperative care.
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Affiliation(s)
- C K Hofer
- Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland.
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Hofer CK, Furrer L, Matter-Ensner S, Maloigne M, Klaghofer R, Genoni M, Zollinger A. Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography. Br J Anaesth 2005; 94:748-55. [PMID: 15790674 DOI: 10.1093/bja/aei123] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND End-diastolic volume indices determined by transpulmonary thermodilution and pulmonary artery thermodilution may give a better estimate of left ventricular preload than pulmonary capillary wedge pressure monitoring. The aim of this study was to compare volume preload monitoring using the two different thermodilution techniques with left ventricular preload assessment by transoesophageal echocardiography (TOE). METHODS Twenty patients undergoing elective cardiac surgery with preserved left-right ventricular function were studied after induction of anaesthesia. Conventional haemodynamic variables, global end-diastolic volume index using the pulse contour cardiac output (PiCCO) system (GEDVI(PiCCO)), continuous end-diastolic volume index (CEDVI(PAC)) measured by a modified pulmonary artery catheter (PAC), left ventricular end-diastolic area index (LVEDAI) using TOE and stroke volume indices (SVI) were recorded before and 20 and 40 min after fluid replacement therapy. Analysis of variance (Bonferroni-Dunn), Bland-Altman analysis and linear regression were performed. RESULTS GEDVI(PiCCO), CEDVI(PAC), LVEDAI and SVI(PiCCO/PAC) increased significantly after fluid load (P<0.05). An increase >10% for GEDVI(PiCCO) and LVEDAI was observed in 85% and 90% of the patients compared with 45% for CEDVI(PAC). Mean bias (2 SD) between percentage changes (delta) in GEDVI(PiCCO) and deltaLVEDAI was -3.2 (17.6)% and between deltaCEDVI(PAC) and deltaLVEDAI -8.7 (30.0)%. The correlation coefficient (r2) for deltaGEDVI(PiCCO) vs deltaLVEDAI was 0.658 and for deltaCEDVI(PAC) vs deltaLVEDAI 0.161. The relationship between deltaGEDVI(PiCCO) and deltaSVI(PiCCO) was stronger (r2=0.576) than that between deltaCEDVI(PAC) and deltaSVI(PAC) (r2=0.267). CONCLUSION GEDVI assessed by the PiCCO system gives a better reflection of echocardiographic changes in left ventricular preload, in response to fluid replacement therapy, than CEDVI measured by a modified PAC.
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Affiliation(s)
- C K Hofer
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland.
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Garcia C, Julier K, Bestmann L, Zollinger A, von Segesser LK, Pasch T, Spahn DR, Zaugg M. Preconditioning with sevoflurane decreases PECAM-1 expression and improves one-year cardiovascular outcome in coronary artery bypass graft surgery. Br J Anaesth 2005; 94:159-65. [PMID: 15556966 DOI: 10.1093/bja/aei026] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac preconditioning is thought to be involved in the observed decreased coronary artery reocclusion rate in patients with angina preceding myocardial infarction. We prospectively examined whether preconditioning by sevoflurane would decrease late cardiac events in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS Seventy-two patients scheduled for elective CABG surgery were randomized to preconditioning by sevoflurane (10 min at 4 vol%) or placebo. For all patients, follow-up of adverse cardiac events was obtained 6 and 12 months after surgery. Transcript levels for platelet-endothelial cell adhesion molecule-1 (PECAM-1/CD31), catalase and heat shock protein 70 (Hsp70) were determined in atrial biopsies after sevoflurane preconditioning. RESULTS Pharmacological preconditioning by sevoflurane reduced the incidence of late cardiac events during the first year after CABG surgery (sevoflurane 3% vs 17% in the placebo group, log-rank test, P=0.038). One patient in the sevoflurane group and three patients in the placebo group experienced new episodes of congestive heart failure and three additional patients had coronary artery reocclusion. Perioperative peak concentrations for myocardial injury markers were higher in patients with subsequent late cardiac events [NTproBNP, 9031 (4125) vs 3049 (1906) ng litre(-1), P<0.001; cTnT, 1.31 (0.88) vs 0.46 (0.29) microg litre(-1), P<0.001]. Transcript levels were reduced for PECAM-1 and increased for catalase but unchanged for Hsp70 in atrial biopsies after sevoflurane preconditioning. CONCLUSIONS This prospective randomized clinical study provides evidence of a protective role for pharmacological preconditioning by sevoflurane in late cardiac events in CABG patients, which may be related to favourable transcriptional changes in pro- and antiprotective proteins.
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Affiliation(s)
- C Garcia
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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Abstract
BACKGROUND This prospective survey aimed at elucidating the patients' expectations and needs regarding the pre-anaesthetic visit and the forthcoming anaesthesia. The same questionnaire was answered by both patients and anaesthesiologists. METHODS A total of 200 ASA I-III patients were interviewed prior to the preoperative anaesthetic visit. The questionnaire consisted of the topics preoperative affective situation, information and self-estimation of anaesthesia knowledge, expectations regarding the pre-anaesthetic visit/anaesthesia and extent of information concerning the perioperative course including risk and possible complications. The same questionnaire was presented to 35 certified anaesthesiologists with the request to estimate the patients' answers. Answers were rated using a Likert-scale, a comparison of patients' and anaesthesiologists' replies was performed. RESULTS For all 5 topics considerable differences between patients' answers and anaesthesiologists' rating were found (e.g. for the assessment of the affective situation, the relevance of family physicians as information source, the desired anaesthetic technique or the extent of anaesthesia-related risk information). No differences were observed for the importance of an anaesthesiologist as information source and fear reduction by the pre-anaesthetic visit. CONCLUSIONS Anaesthesiologists tend to misinterpret many patients' expectations and attitudes. The results demonstrate the potential for quality improvement of the pre-anaesthetic visit.
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Affiliation(s)
- C K Hofer
- Institut für Anästhesiologie und Intensivmedizin, Stadtspital Triemli, Zürich, Schweiz.
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Hofer CK, Bühlmann S, Klaghofer R, Genoni M, Zollinger A. Pulsed dye densitometry with two different sensor types for cardiac output measurement after cardiac surgery: a comparison with the thermodilution technique. Acta Anaesthesiol Scand 2004; 48:653-7. [PMID: 15101865 DOI: 10.1111/j.1399-6576.2004.00371.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assessment of cardiac output (CO) by the indocyanine green (ICG) dye dilution technique (IDD) with transcutaneous signal detection may be a less invasive alternative to the pulmonary artery catheter (PAC). The aim of this study was to determine the accuracy and reliability of the DDG2001 analyzer (Nihon Kohden Corp, Tokyo, Japan) using a finger (IDDf) and a nose (IDDn) sensor as compared with the thermodilution technique by PAC. METHODS In 31 consecutive patients after routine cardiac surgery, CO measurements were performed by IDD compared with the thermodilution technique following postoperative haemodynamic stabilization in the intensive care unit. Repeated measurements were made at 30-min intervals. CO was determined by iced water bolus (IWB: mean of three repeated injections) and IDDf or IDDn, respectively (mean of three repeated ICG injections). RESULTS Thirty-three per cent of all measurements for IDDf and 9% for IDDn failed due to a missing signal detection. Mean bias for IDDf to IWB was -0.5 l min(-1).m(-2) (limits of agreement: -1.8/0.8 l min(-1).m(-2)) and for IDDn to IWB was -0.1 l min(-1).m(-2) (limits of agreement: -1.6/1.5 l min(-1).m(-2)). Correlation between IDDf and IWB (r = 0.2) was found to be inferior to the correlation between IDDn and IWB (r = 0.5). CONCLUSION The IDD showed a systematic bias compared with the IWB and its performance was limited due to signal detection failure. Therefore, the DDG2001 analyzer cannot be recommended as a substitute for the PAC in routine monitoring of cardiac output after cardiac surgery.
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Affiliation(s)
- C K Hofer
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland.
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Hofer CK, Zollinger A, Rak M, Matter-Ensner S, Klaghofer R, Pasch T, Zalunardo MP. Therapeutic impact of intra-operative transoesophageal echocardiography during noncardiac surgery. Anaesthesia 2004; 59:3-9. [PMID: 14687091 DOI: 10.1111/j.1365-2044.2004.03459.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The impact of transoesophageal echocardiography on haemodynamic management during elective noncardiac surgery was assessed during this observational prospective database analysis. Ninety-nine consecutive patients were studied, who were at risk of intra-operative myocardial ischaemia or haemodynamic instability (Class II indications) and were undergoing vascular, visceral or chest surgery. A total of 165 new echocardiographic findings were recorded. Based on these findings changes in drug therapy were made in 47% and changes in fluid therapy in 24% of patients. Left ventricular wall motion abnormalities were seen in 32% and other relevant diagnoses made in 10%. Echocardiography showed a significant impact on drug therapy in patients with pre-operative systolic wall motion abnormalities (vasodilators: OR = 7.1, CI 95% = 2.1/24.0; vasopressors: OR = 3.3, CI 95% = 1.2/9.1) and patients with a history of left heart failure (vasodilators: OR = 5.2, CI 95% = 1.0/31.4). Fluid therapy was significantly influenced by echocardiographic findings during liver and lung transplantation (50% compared with 24% during other surgical interventions, p < 0.05).
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Affiliation(s)
- C K Hofer
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Switzerland
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Hofer CK, Zollinger A, Büchi S, Klaghofer R, Serafino D, Bühlmann S, Buddeberg C, Pasch T, Spahn DR. Patient well-being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia. Br J Anaesth 2003; 91:631-7. [PMID: 14570783 DOI: 10.1093/bja/aeg243] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to assess postoperative patient well-being after total i.v. anaesthesia compared with inhalation anaesthesia by means of validated psychometric tests. METHODS With ethics committee approval, 305 patients undergoing minor elective gynaecologic or orthopaedic interventions were assigned randomly to total i.v. anaesthesia using propofol or inhalation anaesthesia using sevoflurane. The primary outcome measurement was the actual mental state 90 min and 24 h after anaesthesia assessed by a blinded observer using the Adjective Mood Scale (AMS) and the State-Trait-Anxiety Inventory (STAI). Incidence of postoperative nausea and vomiting (PONV) and postoperative pain level were determined by Visual Analogue Scale (VAS) 90 min and 24 h after anaesthesia (secondary outcome measurements). Patient satisfaction was evaluated using a VAS 24 h after anaesthesia. RESULTS The AMS and STAI scores were significantly better 90 min after total i.v. anaesthesia compared with inhalation anaesthesia (P=0.02, P=0.05, respectively), but equal 24 h after both anaesthetic techniques (P=0.90, P=0.78, respectively); patient satisfaction was comparable (P=0.26). Postoperative pain was comparable in both groups 90 min and 24 h after anaesthesia (P=0.11, P=0.12, respectively). The incidence of postoperative nausea was reduced after total i.v. compared with inhalation anaesthesia at 90 min (7 vs 35%, P<0.001), and 24 h (33 vs 52%, P=0.001). CONCLUSION Total i.v. anaesthesia improves early postoperative patient well-being and reduces the incidence of PONV.
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Affiliation(s)
- C K Hofer
- Institute of Anaesthesiology, Triemli City Hospital, Birmensdorferstr. 497, CH-8063 Zurich, Switzerland
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Ganter M, Zollinger A. Continuous intravascular blood gas monitoring: development, current techniques, and clinical use of a commercial device. Br J Anaesth 2003; 91:397-407. [PMID: 12925481 DOI: 10.1093/bja/aeg176] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This review focuses on the development, current techniques, and clinical use of continuous intravascular blood gas monitoring (CIBM) devices in anaesthesia and intensive care. The operating principles, range of application, performance, limitations, costs, and impact on patient treatment and outcome, are discussed. Studies of early and currently available CIBM devices were analysed. At present, the Paratrend 7+ (PT7+) for adults and Neotrend (NT) for newborns are the only commercially available CIBM systems. The PT7+ contains three optical sensors to measure PO(2), PCO(2) and pH, as well as a thermocouple to measure temperature. The NT is a modification of the PT7+ to continuously monitor PO(2), PCO(2), pH and temperature in newborns. Under laboratory conditions, good performance over a wide range of blood gas values was observed with the Paratrend 7 (PT7. Performance in the clinical setting was not as satisfactory, especially for PO(2) values. However, the performance and accuracy of CIBM devices appear to be sufficient for clinical use and they are being used clinically in selected patient groups. Several factors affecting the performance of CIBM are considered.
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Affiliation(s)
- M Ganter
- Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland
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Abstract
Complete atrioventricular block occurred during spinal and subsequent general anaesthesia in a 74-year-old patient with known arterial hypertension but without heart conduction abnormality. Drug therapy and intermittent transcutaneous pacing was successful. A decrease of arterial pressure by more than 40% preceded the heart blockade in the course of both events. Subsequent cardiologic examination revealed evidence of a discrete hypertensive heart disease. Relative ischemia of the atrioventricular region during anaesthesia was suggested as an aetiology. When the patient presented for the next operation, again general anaesthesia was applied, and invasive arterial blood pressure monitoring as well as catecholamine support were used and no further atrioventricular blockade occurred. The case demonstrates the possible recurrence of an intraoperative complete atrioventricular blockade in an older patient without pre-existing conduction abnormalities and only minor signs of heart disease, irrespective of the anaesthesia technique. Under these circumstances transcutaneous pacing should always be in place. Maintenance of coronary perfusion pressure is essential and invasive blood pressure monitoring is recommended.
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Affiliation(s)
- C K Hofer
- Institut für Anästhesiologie und Intensivmedizin, Stadtspital Triemli, Zürich, Switzerland.
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Hofer CK, Straumann E, Genoni M, Zollinger A. Profound drug-induced thrombocytopenia before urgent cardiopulmonary bypass. Interact Cardiovasc Thorac Surg 2002; 1:63-5. [PMID: 17669961 DOI: 10.1016/s1569-9293(02)00016-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A patient with acute coronary syndrome scheduled for urgent coronary artery bypass grafting developed a profound thrombocytopenia during therapy with intravenous heparin and the glycoprotein IIb/IIIa inhibitor tirofiban. Heparin-induced thrombocytopenia and all other possible aetiologies were unlikely and the low platelet count had to be attributed to tirofiban. Anticoagulation during cardiopulmonary bypass was successfully managed with standard heparin. Implications for the diagnosis of coagulation disorders and the management of perioperative anticoagulation are discussed.
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Affiliation(s)
- Cristoph K Hofer
- Institute of Anaesthesiology, Triemli City Hospital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland.
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Hofer CK, Zollinger A, Tucci M, van Gessel E, Alon E, Klaghofer R. Is traditional fasting policy changing? Results of a Swiss survey on current practice. Eur J Anaesthesiol 2002; 19:894-6. [PMID: 12510909 DOI: 10.1017/s0265021502211436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hofer CK, Zalunardo MP, Klaghofer R, Spahr T, Pasch T, Zollinger A. Changes in intrathoracic blood volume associated with pneumoperitoneum and positioning. Acta Anaesthesiol Scand 2002; 46:303-8. [PMID: 11939922 DOI: 10.1034/j.1399-6576.2002.t01-1-460313.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND It is still controversial whether elevated cardiac filling pressures after the onset of pneumoperitoneum are the consequence of increased intrathoracic pressure or of increased venous return. The aim of this study was to assess the effects of pneumoperitoneum and body positioning on intrathoracic blood volume (ITBV). METHODS Thirty anesthetized patients were randomly assigned to have CO2-pneumoperitoneum (13 mmHg) either in a supine, in a 15 degrees head-up tilt or in a 15 degrees head-down tilt position. Measurements of ITBV and hemodynamics by the double indicator method were recorded after induction of anesthesia and application of a fluid bolus (Lactated Ringer's solution 10 ml/kg), after positioning and after induction of pneumoperitoneum. RESULTS Intrathoracic blood volume index (ITBVI) increased significantly after induction of pneumoperitoneum in all body positions (supine: from 18.5 +/- 3.3 -20.2 +/- 5.2 ml/kg (+6%) head-up from 16.7 +/- 3.8 - 17.4 +/- 3.7 ml/kg (+16%) and head-down: from 19.8 +/- 5.6 - 20.5 +/- 5.9 ml/kg (+14%)). Heart rate did not change significantly in any of the groups. Cardiac index showed a statistically significant change in the head-down position with pneumoperitoneum (-11%). A good correlation was found for stroke volume (SV) with ITBV (r = 0.79), but not with central venous pressure (r = 0.26). Systemic vascular resistance index increased significantly in all three groups (supine +6%, head-up +16%, head-down position +14%). CONCLUSION The present study indicates that the onset of pneumoperitoneum, even with moderate intra-abdominal pressures, is associated with an increased intrathoracic blood volume in ASA I/II patients.
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Affiliation(s)
- C K Hofer
- Institute of Anesthesiology, Triemli City Hospital, Zurich, Switzerland
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Held J, Brüesch M, Zollinger A, Pasch T, Krueger H. [Participation--oriented analysis of the anesthesia workplace. A work system for anesthesia in a multidisciplinary operating room]. Anaesthesist 2002; 51:110-5. [PMID: 11963302 DOI: 10.1007/s00101-001-0265-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of this study was the detection and understanding of weak points in the ergonomic design of anaesthesia workplaces in a multidisciplinary operating room facility. METHODS Analysis of workplaces and of working processes by means of observations, computer-supported task recording and video-photo documentation. During guided interviews the participants were provided with material for naming-by-pointing and drawing. Subsequently, the background of the problems encountered and possible improvements were visualised. RESULTS Important deficits were devices not positioned within reach and view, difficulties in operating the lines connecting the patient and the devices, and inconsistent workplace layouts. These were caused by erroneous planning of the facility and disregarding ergonomic principles in equipment design. The initial improvements implemented were the development of a new concept for a flexible equipment positioning and the design of a tool for cable handling. DISCUSSION AND CONCLUSION Although from the very beginning of the study the anaesthesia personnel quoted the handling of the lines connecting patients and devices as the main cause for working difficulties, the external ergonomist could contribute to a broader view of the problems. The method presented here initiated a mutual learning process between ergonomist and users and resulted in a common understanding of the problems and their causes. Compared to the traditional consulting process, more time and efforts were necessary but were offset by the users' acceptance of the improvements and the prevention of design errors.
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Affiliation(s)
- J Held
- Institut für Hygiene und Arbeitsphysiologie, Eidgenössische Technische Hochschule Zürich, Clausiusstrasse 25, 8092 Zürich.
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Hofer CK, Ganter M, Tucci M, Klaghofer R, Zollinger A. How reliable is length-based determination of body weight and tracheal tube size in the paediatric age group? The Broselow tape reconsidered. Br J Anaesth 2002; 88:283-5. [PMID: 11878662 DOI: 10.1093/bja/88.2.283] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Broselow tape was designed to estimate body weight and tracheal tube size on the basis of the body length of emergency paediatric patients. The tape was validated previously in US populations. We assessed its accuracy in a sample of European children by reviewing paediatric anaesthetic charts at the Triemli City Hospital for 1999. METHODS Age, body length and body weight measured before surgery as well as the size of the tracheal tube used were recorded. The body weight was estimated on the basis of body length using the Broselow tape and was compared with the measured weight. Tracheal tube size selections using the Broselow tape and an age-based formula were compared with the size of the tube used. RESULTS A good correlation was found between the Broselow weight and the measured weight (r2=0.88). Bland-Altman analysis revealed a mean bias of -0.52 kg for the entire study population. For children < or = 20 kg the mean bias was -0.05 kg, and for children > 20 kg was -1.05 kg. The Broselow weight was found to be within a 10% error of the measured weight in 65% of children. Tracheal tube selection by the Broselow tape method was adequate in 55% but underestimated the actual tube size in 39%. The age-based formula matched the actual tracheal tube size in 41% of children but overestimated it in 57%. CONCLUSIONS The Broselow tape is an accurate means to assess body weight from length in smaller children; in older children it underestimated body weight. Endotracheal tube size selection by the Broselow tape appears to match the size of the tube used better than the age-based formula. The results in a European sample of children are comparable to the US data.
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Affiliation(s)
- C K Hofer
- Institute of Anaesthesiology, Triemli City Hospital, Zürich, Switzerland
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Hofer C, Zalunardo MP, Zollinger A. Total intravenous anaesthesia in a patient with familial hypokalaemic periodic paralysis*. Anaesthesia 2001. [DOI: 10.1111/j.1365-2044.2001.02268.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A 35-year-old woman with known familial hypokalaemic periodic paralysis received general anaesthesia for reduction of bilateral breast hyperplasia. Uncomplicated general anaesthesia was performed using a propofol target-controlled infusion, remifentanil infusion and bolus doses of mivacurium with neuromuscular function monitoring. Plasma potassium concentrations were controlled intermittently in the peri-operative period and supplemented to achieve normokalaemia. Despite continuous substitution, an episode of low plasma potassium concentration occurred during the recovery period; this was without any clinical signs of muscle paralysis or respiratory distress.
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Affiliation(s)
- C Hofer
- Institute of Anaesthesiology, Triemli City Hospital Zurich, Birmensdorferstr. 497, 8063 Zurich, Switzerland.
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Weiss M, Bernoulli L, Zollinger A. [The NACA scale. Construct and predictive validity of the NACA scale for prehospital severity rating in trauma patients]. Anaesthesist 2001; 50:150-4. [PMID: 11315486 DOI: 10.1007/s001010170030] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The NACA-scale is used in many Austrian, German and Swiss emergency medical systems for demographic description of emergency patients. Little attention has been payed to the evaluation of its construct and predictive validity. In 427 consecutive trauma patients rescued in primary mission the NACA-Scale and the Injury Severity Score (ISS) were determined. Outcome data were obtained from medical charts and by written or telephone requests. Data were analysed with Spearman-Rank-Correlation. NACA-Grade and ISS-values showed only a moderate correlation with a considerably large spread (Rho = 0.721). Both severity scores demonstrated a good correlation to mortality (Rho = 0.976/0.994) and to transfer to an ICU (Rho = 0.964/0.943), as well a moderate correlation to the duration of ICU-stay (Rho = 0.722/0.756) and of hospital stay (Rho = 0.558/0.694). The NACA-scale adequately describes life threat in trauma victims and correlates well with morbidity and mortality. Thus, it is a valuable tool for demographic purposes in emergency medical systems. For more precise prehospital severity rating in trauma patients, the NACA-scale should be supplemented or replaced by a physiologically based prehospital severity score.
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Affiliation(s)
- M Weiss
- Intensivstation und Neonatologie-Abteilung, Universitäts-Kinderklinik, Steinwiesstrasse 75, CH-8032 Zürich, Schweiz.
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Abstract
This review summarizes recent reports on preoperative pulmonary evaluation focusing on the impact on outcome in thoracic and non-thoracic surgery. Data suggest that hitherto widely accepted pulmonary function tests do not predict perioperative complications. Therefore, they may not be considered alone to decide on the patient's operability. So-called prohibitive lung function parameters should no longer be used to deny a potentially curative lung resection. A more clinically oriented, interdisciplinary approach to severely compromised patients may be best suited to discuss and solve their problems.
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Affiliation(s)
- A Zollinger
- Institute of Anaesthesiology, Triemli City Hospital Zürich, University Hospital, Zürich, Switzerland.
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Hofer C, Tucci M, van Gessel E, Alon E, Zollinger A. Is traditional preoperative fasting policy changing? Results of a Swiss survey on current practice. Eur J Anaesthesiol 2001. [DOI: 10.1097/00003643-200100001-00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zalunardo MP, Zollinger A, Szelloe P, Spahn DR, Seifert B, Pasch T. [Cardiovascular stress protection following anesthesia induction. Comparison of clonidine and esmolol]. Anaesthesist 2001; 50:21-5. [PMID: 11220254 DOI: 10.1007/s001010050958] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alpha-2-adrenoceptor-agonists as well as cardioselective betareceptor-antagonists have been shown to blunt stress response due to tracheal intubation. The purpose of our study was to investigate,whether clonidine or esmolol is more efficient to attenuate stress response due to intubation.44 patients were randomly assigned to receive either clonidine (n=22; 3 microg/kg) or esmolol (n=22; 2 mg/kg) immediately prior to a standardized induction of anaesthesia. Heart rate, arterial blood pressure, cardiac output, epinephrine and norepinephrine plasma concentrations were measured before,during and 10 min after intubation. Blood pressure was measured invasively and cardiac output was determined by transthoracic echocardiography. Absolute values and increase of mean arterial pressure and norepinephrine plasma concentrations were significantly less in the clonidine group (p<0,05). Clonidine (3 microg/kg) is more efficient than esmolol (2 mg/kg) in blunting stress response due to endotracheal intubation.
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Affiliation(s)
- M P Zalunardo
- Institut für Anästhesiologie, Universitätsspital Zürich.
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Jamnicki M, Bombeli T, Seifert B, Zollinger A, Camenzind V, Pasch T, Spahn DR. Low- and medium-molecular-weight hydroxyethyl starches: comparison of their effect on blood coagulation. Anesthesiology 2000; 93:1231-7. [PMID: 11046211 DOI: 10.1097/00000542-200011000-00016] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than medium-molecular-weight HES. The authors compared medium molecular weight HES (200 kd [HES200]) and low-molecular-weight HES (70 kd [HES70]). METHODS In a prospective, double-blind, randomized-sequence crossover study, 22 male volunteers received 15 ml/kg HES200 and HES70. Blood samples were taken before and 5 min, 30 min, 1 h, 2 h, 4 h, 8 h, and 24 h after infusion. The following parameters were analyzed at all time points: prothrombin time, activated partial thromboplastin time, fibrinogen, factor VIII, antigenetic and functional von Willebrand factor, platelets, Thrombelastograph analysis parameters (reaction time, coagulation time, maximum amplitude, angle alpha, and clot lysis 30 and 60 min after maximum amplitude), ionized calcium, hematocrit, HES plasma concentration, molecular weight (weight average and number average), molar substitution, and polydispersity (weight average/number average). Repeated-measures analysis of variance (P < 0.05) was used to compare the response of the aforementioned parameters to the infusion of HES70 and HES200. RESULTS Both HES solutions had a significant impact on all parameters. A slightly greater compromise with HES200 was found in activated partial thromboplastin time (P = 0.010), factor VIII (P = 0.009), antigenetic von Willebrand factor (P = 0.041), functional von Willebrand factor (P = 0.026), maximum amplitude (P = 0.008), and angle alpha (P = 0.003). No difference was established with the other parameters. HES concentration (P < 0.001), weight average (P < 0.001), number average (P < 0.001), and polydispersity (P < 0.001) were higher with HES200. There was no difference with molar substitution (P = 0.091). CONCLUSIONS Low-molecular-weight hydroxyethyl starch (70 kd) compromises blood coagulation slightly less than HES200, but it is unclear whether this is clinically relevant.
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Affiliation(s)
- M Jamnicki
- Institute of Anesthesiology, University Hospital, Zurich, Switzerland
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