The effects of sugammadex vs. neostigmine on postoperative respiratory complications and advanced healthcare utilisation: a multicentre retrospective cohort study

Reversing neuromuscular blockade with sugammadex can eliminate residual paralysis, which has been associated with postoperative respiratory complications. There are equivocal data on whether sugammadex reduces these when compared with neostigmine. We investigated the association of the choice of reversal drug with postoperative respiratory complications and advanced healthcare utilisation. We included adult patients who underwent surgery and received general anaesthesia with sugammadex or neostigmine reversal at two academic healthcare networks between January 2016 and June 2021. The primary outcome was postoperative respiratory complications, defined as post-extubation oxygen saturation < 90%, respiratory failure requiring non-invasive ventilation, or tracheal re-intubation within 7 days. Our main secondary outcome was advanced healthcare utilisation, a composite outcome including: 7-day unplanned intensive care unit admission; 30-day hospital readmission; or non-home discharge. In total, 5746 (6.9%) of 83,250 included patients experienced postoperative respiratory complications. This was not associated with the reversal drug (adjusted OR (95%CI) 1.01 (0.94-1.08); p = 0.76). After excluding patients admitted from skilled nursing facilities, 8372 (10.5%) patients required advanced healthcare utilisation, which was not associated with the choice of reversal (adjusted OR (95%CI) 0.95 (0.89-1.01); p = 0.11). Equivalence testing supported an equivalent effect size of sugammadex and neostigmine on both outcomes, and neostigmine was non-inferior to sugammadex with regard to postoperative respiratory complications or advanced healthcare utilisation. Finally, there was no association between the reversal drug and major adverse cardiovascular events (adjusted OR 1.07 (0.94-1.21); p = 0.32). Compared with neostigmine, reversal of neuromuscular blockade with sugammadex was not associated with a reduction in postoperative respiratory complications or post-procedural advanced healthcare utilisation.

Zur Altersdiagnostik lebender Personen: der Einfluss des sozioökonomischen Status auf die Skelett- und Zahnentwicklung in einer deutschen Studienkohorte

Die forensische Altersdiagnostik kann ein entscheidendes Instrument zur Durchführung rechtstaatlicher Verfahren sein. Bei der Altersdiagnostik wird die Entwicklung von Skelett- und Zahnmerkmalen einer zu begutachtenden Person mit Daten von Referenzpopulationen verglichen. Als möglicher Einflussfaktor auf die Altersdiagnose ist der sozioökonomische Status (SES) der zu begutachtenden Person zu berücksichtigen. Allerdings ist die Studienlage zu diesem Einflussfaktor bislang spärlich. Prospektiv wurde der Zusammenhang zwischen der Skelett- bzw. Zahnentwicklung und dem SES innerhalb einer deutschen Studienpopulation aus freiwilligen Teilnehmern ermittelt. Dazu wurde die Entwicklung der medialen Epiphyse des Schlüsselbeins, der distalen Epiphyse des Radius, der distalen Epiphyse des Femurs, der proximalen Epiphyse der Tibia und des linken unteren dritten Molaren bei 294 Frauen und 287 Männern im Alter von 12 bis 24 Jahren mittels 3‑Tesla-Magnetresonanztomographie (MRT) untersucht. Zusätzlich wurde der SES der Teilnehmer erfasst. Hierzu wurde das Bildungsniveau der Eltern erfragt. Der Einfluss des SES auf die Einzelmerkmale sowie die Gesamtheit der untersuchten Skelettmerkmale wurde mittels linearer Regression ermittelt. Für alle untersuchten Merkmale und Kombinationen konnte keine Evidenz für einen Zusammenhang festgestellt werden. Es wurde geschlussfolgert, dass sich die Lebensumstände der Studienteilnehmer offenbar nicht ausreichend stark unterschieden, um einen Einfluss des SES auf das Skelettalter darzustellen.

Beta 3 Adrenergic Receptor Activation Rescues Metabolic Dysfunction in Female Estrogen Receptor Alpha-Null Mice

Metabolic disease risk escalates following menopause. The mechanism is not fully known, but likely involves reduced signaling through estrogen receptor alpha (ERα), which is highly expressed in brown and white adipose tissue (BAT and WAT).

Objective: Test the hypothesis that uncoupling protein (UCP1) activation mitigates metabolic dysfunction caused by loss of signaling through ERα.

Methods: At 8 weeks of age, female ERα knock out (KO) and wild-type mice were housed at 28°C and fed a Western-style high-fat, high sucrose diet (HFD) or a normal low-fat chow diet (NC) for 10 weeks. During the final 2 weeks, they received daily injections of CL 316,256 (CL), a selective β3 adrenergic agonist, or vehicle control (CTRL), creating eight groups: WT-CTRL, WT-CL, KO-CTRL, and KO-CL on HFD or NC; n = 4–10/group.

Results: ERαKO demonstrated exacerbated HFD-induced adiposity gain (P < 0.001) and insulin resistance (P = 0.006). CL treatment improved insulin sensitivity (P < 0.05) and normalized ERαKO-induced adiposity increase (P < 0.05). In both genotypes, CL increased resting energy expenditure (P < 0.05) and induced WAT beiging indicated by increased UCP1 protein in both perigonadal (PGAT) and subcutaneous (SQAT) depots. These effects were attenuated under HFD conditions (P < 0.05). In KO, CL reduced HFD energy consumption compared to CTRL (P < 0.05). Remarkably, CL increased WAT ERβ protein levels of both WT and KO (P < 0.001), revealing CL-mediated changes in estrogen signaling may have protective metabolic effects.

Conclusion: CL completely restored metabolic dysfunction in ERαKO mice. Thus, UCP1 may be a therapeutic target for treating metabolic dysfunction following loss of estrogen receptor signaling.