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[Effect of anesthesia on tumor recurrence.]. Orv Hetil 2023; 164:843-846. [PMID: 37270776 DOI: 10.1556/650.2023.32805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 06/06/2023]
Abstract
Cancers cause nearly a quarter of all deaths in Hungary. The long-term success of tumor resection operations, i.e., the absence of recurrence and metastasis as well as survival, are also influenced by anesthetic methods. This was confirmed by experiments on cell cultures and animal models. Propofol and local anesthetics have been shown to reduce tumor cell viability and metastatic potential compared to inhalation anesthetics and opioids. However, studies conducted on patient groups only confirmed the advantage of propofol compared to inhalation anesthetics. Unfortunately, the epidural, additional use of local anesthetics for general anesthesia did not reduce the recurrence-free and survival time of the patients. Further clinical studies are necessary to reveal the actual effect of surgical anesthesia in each type of cancer in the future. Orv Hetil. 2023; 164(22): 843-846.
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Can we predict critical care mortality with non-conventional inflammatory markers in SARS-CoV-2 infected patients? Clin Hemorheol Microcirc 2023:CH231697. [PMID: 36846995 DOI: 10.3233/ch-231697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Severe COVID-19 disease is associated with multiple organ involvement,then failure and often fatal outcomes.In addition,inflammatory mechanisms and cytokine storms,documented in many COVID-19 patients,are responsible for the progression of the disease and high mortality rates.Inflammatory parameters,such as procalcitonin(PCT) and C-reactive protein(CRP), are widely used in clinical practice. OBJECTIVE To evaluate the predictive power of non-conventional inflammatory markers regarding mortality risk. METHODS In our prospective study 52 patients were followed for 5 days after admission to an intensive care unit immediately with severe SARS-CoV-2 infection.We compared leukocyte-,platelet antisedimentation rate (LAR, PAR),neutrophil lymphocyte ratio(NLR), CRP, PCT levels. RESULTS In non-surviving(NSU) patients LAR remained largely constant from D1 to D4 with a statistically significant drop(p < 0.05) only seen on D5.The NSU group showed statistically significant(p < 0.05) elevated LAR medians on D4 and D5, compared to the SU group.NLR values were continually higher in the non-survivor group.The difference between the SU and NSU groups were statistically significant on every examined day.PAR, CRP and PCT levels didn't show any significant differences between the SU and NSU groups. CONCLUSIONS In conclusion, this study suggests that LAR and NLR are especially worthy of further investigation as prognostic markers.LAR might be of particular relevance as it is not routinely obtained in current clinical practice.It would seem beneficial to include LAR in data sets to train prognostic artificial intelligence.
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“Growth-Promoting Effect” of Antibiotic Use Could Explain the Global Obesity Pandemic: A European Survey. Antibiotics (Basel) 2022; 11:antibiotics11101321. [PMID: 36289981 PMCID: PMC9598085 DOI: 10.3390/antibiotics11101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/24/2022] [Accepted: 09/24/2022] [Indexed: 11/23/2022] Open
Abstract
Clinical observations indicated a higher rate of obesity among children who received antibiotics at early ages. Experimental studies supported the role of the modified gut microbiome in the development of obesity as well. For identifying antibiotic classes that might promote or inhibit obesity-related dysbiosis, a database of the average yearly antibiotic consumption (2008–2018) has been developed using the European Center for Disease Prevention and Control (ECDC) yearly reports of antibiotic consumption in the community for the major antibiotic classes in 30 European countries, which were compared to the childhood and adult obesity prevalence featured in the Obesity Atlas. Pearson’s chi-square test was applied to estimate positive/negative correlations between antibiotic consumption and obesity. One-way ANOVA has been applied to test the differences in antibiotic consumption between groups, and logistic regression analysis was performed to determine the odds ratios (OR) of antibiotic consumption for obesity. Strong, positive associations were estimated between childhood obesity and the total consumption of systemic antibiotics, broad-spectrum, beta-lactamase-resistant penicillin, cephalosporin, and quinolone, and a negative correlation was found with the consumption of tetracycline, broad-spectrum, beta-lactamase-sensitive penicillin, and narrow-spectrum, beta-lactamase-sensitive penicillin. Our observation indicated that the “growth-promoting effect” of the consumption of certain antibiotic classes might be identified as a possible etiology in the development of obesity and might be the explanation for the obesity “pandemic”.
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Könyvismertetés. Orv Hetil 2022. [DOI: 10.1556/650.2022.16m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Alzheimer's Disease-Related Dysbiosis Might Be Triggered by Certain Classes of Antibiotics with Time-Lapse: New Insights into the Pathogenesis? J Alzheimers Dis 2022; 87:443-451. [PMID: 35275547 DOI: 10.3233/jad-220018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several putative factors are identified in the literature as causative agents or risk factors for the development of Alzheimer's disease (AD). The amyloid cascade hypothesis has been the main hypothesis about the pathophysiology of AD for decades, but recent studies raised the possible role of dysbiosis in the development of AD, which prevents memory loss. OBJECTIVE Finding possible associations between antibiotic consumption patterns and the prevalence of AD in European countries. METHODS Antibiotic consumption (European Centre for Disease Prevention and Control, ECDC) for 1997-2007, 2008-2018, and as the whole 1997-2018 period, has been compared to the AD prevalence for 2018 expressed in percentage of the population and statistically analyzed by Pearson calculation. RESULTS A significant positive correlation has been found between the AD prevalence (2018) and the average quinolone consumption for the years 1997-2007 (r: 0.37, p: 0.044). A similar association was not observed for the entire 22 years (1997-2018) of the average quinolone consumption, and the years 2008-2018, indicating 10-20 years of time-lapse between the antibiotic exposure and the development of AD. The ratio of broad-spectrum and narrow-spectrum antibiotics (B/N) estimated in the ECDC database for the years of 2008-2018 showed a strong positive association with AD prevalence (2018) (r: 0.406, p: 0.026) and a positive correlation tendency for the entire 22 years 1997-2018 (r: 0.344, p: 0.063), but none for the years 1997-2007 (r: 0.256, p: 0.241). CONCLUSION Our study indicated the possible sequential role of certain classes of antibiotics in the development of dysbiosis leading to amyloid deposits of AD, which strengthen the possible role of different mediator molecules (short-chain fatty acids, lipopolysaccharides, etc.) produced by the altered microbiome in the development of AD.
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Antibiotic Consumption Patterns in European Countries Might Be Associated with the Prevalence of Type 1 and 2 Diabetes. Front Endocrinol (Lausanne) 2022; 13:870465. [PMID: 35600582 PMCID: PMC9120822 DOI: 10.3389/fendo.2022.870465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Several publications have raised the issue that the development of diabetes precedes the alteration of the microbiome (dysbiosis) and the role of environmental factors. Antibiotic use induces dysbiosis, and we wanted to estimate the associations between the consumption of antibiotics and the prevalence of diabetes (both types 1 and 2; T1D and T2D, respectively) in European countries. If such an association exists, the dominant use antibiotic classes might be reflected in the prevalence rates of T1D and T2D in different countries. Comparisons were performed between the prevalence of diabetes estimated for 2019 and featured in the Diabetes Atlas and the average yearly consumption of antibiotic classes between 2010 and 2109, calculated from the European Centre for Disease Prevention and Control (ECDC) yearly reports on antibiotic consumption in Europe. Pearson's correlation and variance analyses were used to estimate the possible relationship. Strong positive (enhancer) associations were found between the prevalence of T1D and the consumption of tetracycline (J01A: p = 0.001) and the narrow-spectrum penicillin (J01CE: p = 0.006; CF: p = 0.018). A strong negative (inhibitor) association was observed with broad-spectrum, beta-lactamase-resistant penicillin (J01CR: p = 0.003), macrolide (J01F: p = 0.008), and quinolone (J01M: p = 0.001). T2D showed significant positive associations with cephalosporin (J01D: p = 0.048) and quinolone (J01M: p = 0.025), and a non-significant negative association was detected with broad-spectrum, beta-lactamase-sensitive penicillin (J01CA: p = 0.067). Countries showing the highest prevalence rates of diabetes (top 10) showed concordance with the higher consumption of "enhancer" and the lower consumption of "inhibitor" antibiotics (top 10), as indicated by variance analysis. Countries with high prevalence rates of T1D showed high consumption of tetracycline (p = 0.015) and narrow-spectrum, beta-lactamase sensitive penicillin (p = 0.008) and low consumption of "inhibitor" antibiotics [broad-spectrum, beta-lactamase-resistant, combination penicillin (p = 0.005); cephalosporin (p = 0.036); and quinolone (p = 0.003)]. Countries with high prevalence rates of T2D consumed more cephalosporin (p = 0.084) and quinolone (p = 0.054) and less broad-spectrum, beta-lactamase-sensitive penicillin (p = 0.012) than did other countries. The development of diabetes-related dysbiosis might be related to the higher consumption of specific classes of antibiotics, showing positive (enhancer) associations with the prevalence of diabetes, and the low consumption of other classes of antibiotics, those showing negative (inhibitory) associations. These groups of antibiotics are different in T1D and T2D.
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Changes of pituitary adenylate cyclase activating polypeptide (PACAP) level in polytrauma patients in the early post-traumatic period. Peptides 2021; 146:170645. [PMID: 34478801 DOI: 10.1016/j.peptides.2021.170645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 12/18/2022]
Abstract
In polytrauma patients who survive the primary insult, the imbalance between the pro- and anti-inflammatory processes seems to be responsible for life-threatening complications such as sepsis or multiple organ dysfunction syndrome. Measurement of C-reactive protein (CRP) and procalcitonin (PCT) is a standard way for differentiating between infectious (bacterial) and non-infectious inflammation. Monitoring of immune cell functions, like leukocyte anti-sedimentation rate (LAR) can also be useful to diagnose infectious complications. Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide with well-known immunomodulatory and anti-inflammatory effects. The aim of our study was to determine the changes of PACAP38 levels in polytrauma patients in the early post-traumatic period in intensive care unit and analyse possible correlation of its level with conventional (CRP, PCT) and unconventional (LAR) laboratory parameters. Twenty polytrauma patients were enrolled. Blood samples were taken daily for five days. We observed significant correlation between PACAP38 and CRP levels on day 4 and 5 as well as between PACAP38 and LAR levels all of the days. This could be due to the anti-inflammatory and cytoprotective functions of PACAP38 as part of an endogenous response to the trauma induced systemic inflammatory response syndrome. These significant correlations could have clinical importance in monitoring the dynamic balance of pro- and anti-inflammatory processes in case of polytraumatic patients.
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Lack of early platelet and leukocyte activation can indicate complications after major burn injury. Clin Hemorheol Microcirc 2021; 77:17-26. [PMID: 32538824 DOI: 10.3233/ch-190779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Major burn injury causes massive tissue destruction consequently enhanced platelet function and leukocyte-mediated inflammatory response. METHODS In a prospective, observational study 23 consecutive patients with more than 20% body surface burn injury were followed for five days (T1-T5) after admission to a university intensive care (ICU). Platelet and leukocyte antisedimentation rate (PAR and LAR) was measured by one-hour gravity sedimentation. It detects the percentage of total platelet and leukocyte number crossed the half line of blood sample column, therefore, they can be regarded as cells of decreased specific gravity. We aimed to investigate the time course of PAR and LAR after burn injury, as the trend of platelet and the leukocyte activation in the early post-burn period. RESULTS Daily mean PAR and LAR values continuously increased in the observation period (T1 to T5). Daily mean PAR and LAR were lower in ICU non-survivors (n = 7) compared to survivors (n = 16) between T2 and T4 (p < 0.05 and p < 0.01). PAR values of septic patients (n = 10) were lower than that of non-septic ones (n = 13, p < 0.01 at T5). CONCLUSIONS Both PAR and LAR, as novel bedside test can predict septic complications and unfavorable outcome after major burn injury. Further studies with higher sample size are warranted.
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Endoscopic sphincterotoMy for delayIng choLecystectomy in mild acute biliarY pancreatitis (EMILY study): protocol of a multicentre randomised clinical trial. BMJ Open 2019; 9:e025551. [PMID: 31289058 PMCID: PMC6629406 DOI: 10.1136/bmjopen-2018-025551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. METHODS/DESIGN EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications. ETHICS AND DISSEMINATION The trial has been registered internationally ISRCTN 10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176-5). TRIAL REGISTRATION NUMBER ISCRTN 10667869; Pre-results.
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Comparison of the perioperative time courses of matrix metalloproteinase-9 (MMP-9) and its inhibitor (TIMP-1) during carotid artery stenting (CAS) and carotid endarterectomy (CEA). BMC Neurol 2018; 18:128. [PMID: 30157791 PMCID: PMC6114896 DOI: 10.1186/s12883-018-1133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 08/20/2018] [Indexed: 12/29/2022] Open
Abstract
Background Our aim was to compare the perioperative time courses of matrix metalloproteinase-9 (MMP-9) and its inhibitor (TIMP-1) in during carotid endarterectomy (CEA) and carotid artery stenting (CAS). Methods In our prospective study, twenty-five patients who were scheduled to undergo CAS were enrolled. We used a matched, historical CEA group as controls. Blood samples were collected at four time points: T1: preoperative; T2: 60 min after stent insertion; T3: first postoperative morning; and T4: third postoperative morning. Plasma MMP-9 and TIMP-1 levels were measured by ELISA. Results In the CEA group, the plasma levels of MMP-9 were significantly elevated at T3 compared to T1. In the CAS group, there was no significant difference in MMP-9 levels in the perioperative period. MMP-9 levels were significantly higher in the T3 samples of the CEA group compared to the CAS group. Significantly lower TIMP-1 levels were measured in both groups at T2 than at T1 in both groups. MMP-9/TIMP-1 at T3 was significantly higher than that at T1 in the CEA group compared to both T1 and the CAS group. Conclusions CAS triggers smaller changes in the MMP-9-TIMP-1 system during the perioperative period, which may correlate with a lower incidence of central nervous system complications. Additional studies as well as cognitive and functional surveys are warranted to determine the clinical relevance of our findings. Trial registration NIH U.S. National Library of Medicine, Clinicaltrials.gov,NCT03410576, 24.01.2018, Retrospectively registered
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Perioperative time course of matrix metalloproteinase-9 (MMP-9), its tissue inhibitor TIMP-1 & S100B protein in carotid surgery. Indian J Med Res 2017; 143:220-6. [PMID: 27121520 PMCID: PMC4859131 DOI: 10.4103/0971-5916.180212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background & objectives: Ischaemic stroke is a life burdening disease for which carotid endarterectomy (CEA) is considered a gold standard intervention. Pro-inflammatory markers like matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) and S-100 Beta (S100B) may have a role in the early inflammation and cognitive decline following CEA. This study was aimed to describe the perioperative time courses and correlations between of MMP-9, TIMP-1 and S100B following CEA. Methods: Fifty four patients scheduled for CEA were enrolled. Blood samples were collected at four time points, T1: preoperative, T2: 60 min after cross-clamp release, T3: first postoperative morning, T4: third postoperative morning. Twenty atherosclerotic patients were included as controls. Plasma MMP-9, TIMP-1 and S100B levels were estimated by ELISA. Results: TIMP-1 was decreased significantly in the CEA group (P<0.01). Plasma MMP-9 was elevated and remained elevated from T1-4 in the CEA group (P<0.05) with a marked elevation in T3 compared to T1 (P<0.05). MMP-9/TIMP-1 was elevated in the CEA group and increased further by T2 and T3 (P<0.05). S100B was elevated on T2 and decreased on T3-4 compared to T1. Interpretation & conclusions: Our study provides information on the dynamic changes of MMP-9-TIMP-1 system and S100B in the perioperative period. Preoperative reduction of TIMP-1 might be predictive for shunt requirement but future studies are required for verification.
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Can leukocyte antisedimentation rate (LAR) predict septic complications and critical care survival early in polytrauma and burn victims? Clin Hemorheol Microcirc 2017; 64:875-885. [PMID: 27767977 DOI: 10.3233/ch-168024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In polytrauma and burn injury Systemic Inflammatory Response Syndrome (SIRS) develops. SIRS is presented in many hospitalized patients, including those who never develop infection or sepsis. Both in SIRS and sepsis the leukocyte activation occurs. In acute phase reaction leukocytes' upward flotation i.e. leukocyte antisedimentation rate (LAR) can indicate infectious origin. OBJECTIVE To evaluate the predictive power of LAR, serum C-reactive protein (CRP) and procalcitonin (PCT) levels regarding mortality risk and development of septic complications. METHODS In a prospective, observational study, 36 patients were followed for 5 days (T1-T5) after admission to a critical care unit immediately with severe polytrauma or burn injury. Eleven patients developed septic complications, their LAR, CRP and PCT levels were analyzed before and after 3 days of sepsis was declared. RESULTS Ten patients died due to septic complications. In survivors LAR at T1 (p < 0.001) and T2 (p < 0.001) as well as CRP at T1 (p < 0.05) were significantly higher compared to controls and non survivors. In septic patients LAR (p < 0.05) and CRP (p < 0.05) showed a significant drop one day before sepsis was declared. PCT levels failed to predict this. CONCLUSIONS Drop in LAR and CRP levels may be warning signs regarding the onset of septic complications after severe polytrauma and burn injury.
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A randomized placebo-controlled phase II study of a Pseudomonas vaccine in ventilated ICU patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:22. [PMID: 28159015 PMCID: PMC5291979 DOI: 10.1186/s13054-017-1601-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022]
Abstract
Background Currently, no vaccine against Pseudomonas is available. IC43 is a new, recombinant, protein (OprF/I)-based vaccine against the opportunistic pathogen, Pseudomonas aeruginosa, a major cause of serious hospital-acquired infections. IC43 has proven immunogenicity and tolerability in healthy volunteers, patients with burns, and patients with chronic lung diseases. In order to assess the immunogenicity and safety of IC43 in patients who are most at risk of acquiring Pseudomonas infections, it was evaluated in mechanically ventilated ICU patients. Methods We conducted a randomized, placebo-controlled, partially blinded study in mechanically ventilated ICU patients. The immunogenicity of IC43 at day 14 was determined as the primary endpoint, and safety, efficacy against P. aeruginosa infections, and all-cause mortality were evaluated as secondary endpoints. Vaccinations (100 μg or 200 μg IC43 with adjuvant, or 100 μg IC43 without adjuvant, or placebo) were given twice in a 7-day interval and patients were followed up for 90 days. Results Higher OprF/I IgG antibody titers were seen at day 14 for all IC43 groups versus placebo (P < 0.0001). Seroconversion (≥4-fold increase in OprF/I IgG titer from days 0 to 14) was highest with 100 μg IC43 without adjuvant (80.6%). There were no significant differences in P. aeruginosa infection rates, with a low rate of invasive infections (pneumonia or bacteremia) in the IC43 groups (11.2-14.0%). Serious adverse events (SAEs) considered possibly related to therapy were reported by 2 patients (1.9%) in the group of 100 µg IC43 with adjuvant. Both SAEs resolved and no deaths were related to study treatment. Local tolerability symptoms were mild and rare (<5% of patients), a low rate of treatment-related treatment-emergent adverse events (3.1–10.6%) was observed in the IC43 groups. Conclusion This phase II study has shown that IC43 vaccination of ventilated ICU patients produced a significant immunogenic effect. P. aeruginosa infection rates did not differ significantly between groups. In the absence of any difference in immune response following administration of 100 μg IC43 without adjuvant compared with 200 μg IC43 with adjuvant, the 100 μg dose without adjuvant was considered for further testing of its possible benefit of improved outcomes. There were no safety or mortality concerns. Trial registration ClinicalTrials.gov, NCT00876252. Registered on 3 April 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1601-9) contains supplementary material, which is available to authorized users.
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[The effect of anesthesia on cognitive functions]. IDEGGYOGYASZATI SZEMLE-CLINICAL NEUROSCIENCE 2016; 69:255-260. [PMID: 29465890 DOI: 10.18071/isz.69.0255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Aim of the study - General anesthetics, arterial hypotension and hypoxia developing during anesthesia may result in impaired memory and a decline in other abilities (such as attention, concentration, linguistic and writing abilities). Our aim was to detect changes in cognitive functions due to surgery and anesthesia with controlled arterial hypotension. Materials and methods - We studied combined and intravenous anesthesia detecting pre-and postoperative cognitive functions, intraoperative haemodynamic parameters, demographic data, other data of case history and surgical data. The Montreal Cognitive Assessment test was applied in the randomized, prospective study. The preoperative data served as basis for comparison. The second test was performed following surgery when patients were fully awake. Both groups included 30 patients. Results and conclusion - After both narcosis methods (postoperative second hour) cognitive functions were significantly deteriorated (p<0.05). Median MoCA before sevoflurane anesthesia was 24 points (interquartile range: 22-25), postoperative value was 20 (19-21) (p<0.05). Median MoCA before propofol anesthesia was 24 points (23-26), postoperative value was 20 (18-22) (p<0.01). Intraoperative arterial blood pressure, pulse rate and oxygen saturation values did not correlate with worsening of cognitive function (Pearson correlation coefficient values between -0.19 and 0.42). Execution is influenced by age (negative correlation) and education (positive correlation).
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Abstract
OBJECTIVES Sepsis is associated with oxidative stress. Due to oxidative stress, three tyrosine isoforms, para-, meta-, and ortho-tyrosine (p-, m-, and o-Tyr), can be formed non-enzymatically in smaller amounts. p-Tyr is mainly formed physiologically in the kidneys through the activity of the phenylalanine hydroxylase enzyme. The three tyrosine isoforms may undergo different renal handling. METHODS Twenty septic patients were involved in the study and 25 healthy individuals served as controls. Blood and urine levels of p-, m-, and o-Tyr were measured on admission and four consecutive days. RESULTS Serum m-Tyr levels were higher in septic patients than in controls on days 2 (P = 0.031) and 3 (P = 0.035). Serum p-Tyr levels were lower in the cases than in controls on days 1 (P = 0.005) and 2 (P = 0.040), and subsequently normalized due to a day-by-day elevation (P = 0.002). The tendency of urinary m-Tyr concentration was decreasing (P = 0.041), while that of urinary p-Tyr concentration was increasing (P = 0.001). Fractional excretion of m-Tyr (FEm-Tyr) showed a decreasing tendency (P = 0.009), and was, on all days, higher than FEp-Tyr, which remained near-normal, less than 4%. Procalcitonin showed significant correlation with FEm-Tyr (r = 0.454; P < 0.001). DISCUSSION Our data suggest that the oxidative stress marker m-Tyr and physiologic p-Tyr may be handled differently in septic patients. The excretion of m-Tyr correlates with inflammation. m-Tyr may be actively secreted or produced in the kidney in some patients, whereas the decreased serum level of p-Tyr is a consequence of diminished renal production and not of renal loss.
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Role of Tyrosine Isomers in Acute and Chronic Diseases Leading to Oxidative Stress - A Review. Curr Med Chem 2016; 23:667-85. [PMID: 26785996 PMCID: PMC4997921 DOI: 10.2174/0929867323666160119094516] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/05/2016] [Accepted: 01/18/2016] [Indexed: 12/19/2022]
Abstract
Oxidative stress plays a major role in the pathogenesis of a variety of acute and chronic diseases. Measurement of the oxidative stress-related end products may be performed, e.g. that of structural isomers of the physiological para-tyrosine, namely meta- and ortho-tyrosine, that are oxidized derivatives of phenylalanine. Recent data suggest that in sepsis, serum level of meta-tyrosine increases, which peaks on the 2(nd) and 3(rd) days (p<0.05 vs. controls), and the kinetics follows the intensity of the systemic inflammation correlating with serum procalcitonin levels. In a similar study subset, urinary meta-tyrosine excretion correlated with both need of daily insulin dose and the insulin-glucose product in non-diabetic septic cases (p<0.01 for both). Using linear regression model, meta-tyrosine excretion, urinary meta-tyrosine/para-tyrosine, urinary ortho-tyrosine/para-tyrosine and urinary (meta- + orthotyrosine)/ para-tyrosine proved to be markers of carbohydrate homeostasis. In a chronic rodent model, we tried to compensate the abnormal tyrosine isomers using para-tyrosine, the physiological amino acid. Rats were fed a standard high cholesterol-diet, and were given para-tyrosine or vehicle orally. High-cholesterol feeding lead to a significant increase in aortic wall meta-tyrosine content and a decreased vasorelaxation of the aorta to insulin and the glucagon-like peptide-1 analogue, liraglutide, that both could be prevented by administration of para-tyrosine. Concluding, these data suggest that meta- and ortho-tyrosine are potential markers of oxidative stress in acute diseases related to oxidative stress, and may also interfere with insulin action in septic humans. Competition of meta- and ortho-tyrosine by supplementation of para-tyrosine may exert a protective role in oxidative stress-related diseases.
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Dynamics of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) after cardiopulmonary resuscitation. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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A comparison of pre-operative nutritional status with post-operative morbidity and mortality in obese esophageal surgery patients. ADV CLIN EXP MED 2014; 23:763-8. [PMID: 25491691 DOI: 10.17219/acem/37244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The nutrition state of obese patients scheduled to undergo esophageal surgery was evaluated using two nutritional score systems: the mini nutritional assessment (MNA) and the prognostic and nutritional index (PINI). A further comparison of various proteins, lymphocytes and cholesterol was performed using biochemical tests. These factors were compared with post-operative morbidity and mortality in a prospective, descriptive clinical study. MATERIAL AND METHODS The study included 34 obese patients undergoing esophagus resection due to cancer, who were examined over four years using both scoring systems to analyze whether nutritional status influences the outcome of surgery. The patients were divided into four groups based on the severity of the outcome and their MNA and PINI scores were analyzed. RESULTS There were no significant differences between the nutritional status of survivors and deceased patients. The European Society for Parenteral and Enteral Nutrition (ESPEN) nutritional risk score was 1.35 ± 0.47 for Group I and 1.47 ± 0.58 for Group II (p = 0.62). With respect to severe morbidity there was no significant difference between Group III and Group IV: 2.01 ± 2.28 vs. 1.02 ± 3.67 (p = 0.54). Although there were minor differences, there were no major variations seen in the MNA or PINI scores comparing the four examined groups. No significant changes were observed in the biochemical parameters. CONCLUSIONS The study found no differences between post-operative morbidity or mortality and the pre-operative nutrition status of obese patients who underwent surgery due to esophageal cancer.
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Sedation of children for auditory brainstem response using ketamine-midazolam-atropine combination - a retrospective analysis. SPRINGERPLUS 2013; 2:178. [PMID: 23646294 PMCID: PMC3642359 DOI: 10.1186/2193-1801-2-178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 04/07/2013] [Indexed: 11/10/2022]
Abstract
Authors investigated sedation quality in children for auditory brainstem response testing. Two-hundred and seventy-six sedation procedures were retrospectively analyzed using recorded data focusing on efficacy of sedation and complications. Intramuscular ketamine-midazolam-atropine combination was administered on sedation preceded by narcotic suppository as pre-medication. On using the combination vital parameters remained within normal range, the complication rate was minimal. Pulse rate, arterial blood pressure and pulse oxymetry readings were stable, hypoventilation developed in 4, apnoea in none of the cases, post-sedation agitation occurred in 3 and nausea and/or vomiting in 2 cases. Repeated administration of narcotic agent was necessary in a single case only. Our practice is suitable for the sedation assisting hearing examinations in children. It has no influence on the auditory brainstem testing, the conditions necessary for the test can be met entirely with minimal side-effects. Our practice provides a more lasting sedation time in children during the examination hence there is no need for the repetition of the narcotics.
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Microparticles and acute renal dysfunction in septic patients. J Crit Care 2012; 28:141-7. [PMID: 22951018 DOI: 10.1016/j.jcrc.2012.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/13/2012] [Accepted: 05/13/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE The role of microparticles (MPs) in the pathogenesis of sepsis is not completely elucidated. We aimed to assess changes in the number of MPs during severe sepsis to follow the effect of sepsis-related organ failures, particularly renal impairment, an independent mortality factor of sepsis. MATERIALS AND METHODS Thirty-seven severe septic patients and 20 controls were enrolled. Patient status as well as organ failure-related laboratory markers was followed up to 5 consecutive days. Microparticles (annexin V+ events in MP size gate) of platelet (CD41, CD42a, and PAC1), monocyte (CD14), and myeloid cell line (CD13) origin were measured using flow cytometry. RESULTS Significantly increased total MP and CD41-, CD42a-, and PAC1-positive particle numbers were found in septic patients compared with controls. Actual number of organ dysfunctions on sample collection showed no correlation with MP numbers. Septic patients with renal dysfunction showed an increase in total MP, CD41(+), and CD13(+) particle numbers on admission. Amounts of platelet-derived CD42a(+) particles from patients with sepsis-related renal injury correlated negatively with actual blood urea nitrogen and creatinine concentrations. CONCLUSION The increased numbers of platelet-derived MPs in severe septic patients emphasize the possible contribution of the hemostasis system in the development of sepsis-related renal impairments.
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Variations and determinants of antibiotic consumption in Hungarian adult intensive care units. Pharmacoepidemiol Drug Saf 2011; 21:104-9. [PMID: 21796720 DOI: 10.1002/pds.2192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/18/2011] [Accepted: 05/25/2011] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this work was to study the use of systemic antibacterials and its possible determinants in Hungarian intensive care units (ICUs). METHODS Hospital pharmacy. departments provided package level dispensing data for their corresponding ICU (2006). Data were converted into defined daily doses (DDDs) and expressed as DDD per 100 patient-days and DDD per 100 admissions. Antibiotics were ranked by volume of DDDs, and the agents responsible for 90% of total use (DU90%) were noted. To explore differences and relationships between antibiotic use and antibiotic policy elements/ICU characteristics, the analysis of variances or the Pearson correlation analysis was performed. RESULTS Valid data were obtained for 44 ICUs. Antibiotic use varied widely (from 27.9 to 167.8 DDD per 100 patient-days and from 104.7 to 1784.6 DDD per 100 admissions). In total, 11-34 different antibacterials per ICUs were used, of which, 5-15 were in the DU90% segment. The proportional use of parenteral agents ranged from 46.2 to 98.3%. The mean of overall antibiotic use was highest for penicillins with beta-lactamase inhibitors, followed by quinolones and third-generation cephalosporins. Of the studied factors, only the ICU category (i.e., level of care) showed significant association with total antibacterial use. CONCLUSIONS The striking differences in total antibiotic use and the extensive use of the oral agents in some ICUs may indicate room for improvement. As none of the antibiotic policy elements were accompanied by lower antibiotic use in the pooled analysis, it suggests that--beside the ICU category--other unrevealed factors determine antibiotic use.
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Comparison of oxidative stress & leukocyte activation in patients with severe sepsis & burn injury. Indian J Med Res 2011; 134:69-78. [PMID: 21808137 PMCID: PMC3171920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND & OBJECTIVES We evaluated pro- and anti-oxidant disturbances in sepsis and non-sepsis burn patients with systemic inflammatory response syndrome (SIRS). Adhesion molecules and inflammation markers on leukocytes were also analyzed. We hypothesized that oxidative stress and leukocyte activation markers can lead to the severity of sepsis. METHODS In 28 severe sepsis and 27 acute burn injury patients blood samples were collected at admission and 4 days consecutively. Oxidative stress markers: production of reactive oxygen species (ROS), myeloperoxidase, malondialdehyde and endogenous antioxidants: plasma protein sulphydryl groups, reduced glutathione, superoxide dismutase and catalase were measured. Flow cytometry was used to determine CD11a, CD14, CD18, CD49d and CD97 adhesion molecules on leukocytes. Procalcitonin, C-reactive protein, fibrinogen, platelet count and lactate were also analyzed. RESULTS Pro-oxidant parameters were significantly elevated in sepsis patients at admission, ROS intensity increased in burn patients until the 5th day. Endogenous antioxidant levels except catalase showed increased levels after burn trauma compared to sepsis. Elevated granulocyte activation and suppressed lymphocyte function were found at admission and early activation of granulocytes caused by increasing activation/migration markers in sepsis. Leukocyte adhesion molecule expression confirmed the suppressed lymphocyte and monocyte function in sepsis. INTERPRETATION & CONCLUSIONS Severe sepsis is accompanied by oxidative stress and pathological leukocyte endothelial cell interactions. The laboratory parameters used for the evaluation of sepsis and several markers of pro- and antioxidant status were different between sepsis and non-sepsis burn patients. The tendency of changes in these parameters may refer to major oxidative stress in sepsis and developing SIRS in burns.
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Abstract
BACKGROUND Macrophage migration inhibitory factor (MIF) was originally described as a cytokine that inhibits migration of macrophages at the site of inflammation. Subsequently it was also identified as a stress-induced hormone released from the anterior pituitary lobe in response to some pro-inflammatory stimuli like endotoxins and tumour necrosis factor (TNF-α). AIM To compare postoperative changes in serum MIF levels of patients undergoing bowel and liver resections. It has clinical relevance to describe the kinetics of this crucial mediator of systemic inflammation in surgery. METHODS A total of 58 patients were studied over 4 years. Group A (28 patients) underwent only hepatic resection without enterotomy. Group B (30 patients) had bowel resection with enterotomy. MIF, IL-1β, IL-8, prealbumin, albumin, α1-glycoprotein, fibrinogen, and C-reactive protein levels were measured preoperatively, immediately following surgery, and postoperatively for three consecutive days. To evaluate organ functions, multiple organ dysfunction score was used. RESULTS A significantly higher level of MIF (4,505 pg/mL) was found in group A when compared to that of group B immediately following surgery. Other parameters monitored in this study were not statistically different between the two groups. CONCLUSION Higher elevations in MIF levels with liver resections, compared to bowel resections, might be attributable to MIF release from damaged liver cells. The presumably minimal endotoxin exposure during bowel surgery was either insufficient or inefficient to induce relevant MIF elevations in our patients. To fully delineate implications of this finding further studies are needed.
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Hungarian web-based nationwide anaesthesia and intensive care data collection and reporting system: its development and experience from the first 5 yr. Br J Anaesth 2010; 104:711-6. [PMID: 20421226 DOI: 10.1093/bja/aeq085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Annual data collection is obligatory in Hungary for every department in the fields of anaesthesia and intensive care. A new, web-based data-reporting system was introduced in Hungary in 2003. The present paper summarizes experience from the first 5 yr of its operation. METHODS The Information Technology Working Group of Hungarian Society of Anaesthesia and Intensive Care developed a data collection system, which was Internet-based, provided web surface for every accredited department, and used the integration of international code systems. The analysis mode summarized the data automatically at loco-regional, national, or both levels. In 2008, a questionnaire was sent to the users in order to evaluate the usefulness of, and user satisfaction with, the web-based system. RESULTS The examples of anaesthetic and intensive therapy workload activities reflect the status of the discipline in Hungary. There have been no significant changes in the total number of anaesthesias per year in the past 5 yr, except that the number of combined general and regional anaesthesias has been elevated by more than 30%. The physicians' workload has increased by 13.2% in relation to the total number of anaesthetic procedures per physician per year. In this field, our data have verified that the number of physicians has decreased in Hungary. On the basis of the opinion of the users, the web-based data collection system has increased the effectiveness and accuracy of annual data collection. CONCLUSIONS The developed web-based system is an effective tool for data collection. Its usefulness was also borne out by its users on the basis of experience from the first 5 yr.
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Abstract
Az intenzív osztályon az infekciók hatékony kezeléséhez elengedhetetlen a megbízható mikrobiológiai háttér, a mikrobiológiai leletek értékeléséhez infektológus vagy mikrobiológus szakember. A hazai felnőtt intenzív osztályok antibiotikum-politikájáról, mikrobiológiai hátteréről, infektológiai/mikrobiológiai konzultációs lehetőségeiről 97 kérdést tartalmazó kérdőív alapján készült felmérés. Az intenzív osztályok 62%-a (60/96) küldte vissza a kitöltött kérdőívet. A kérdésekre válaszoló osztályok 55%-ában működik az anyaintézetben mikrobiológiai laboratórium. Az antibiotikum-választáshoz a mikrobiológiai lelet szolgáltat elsősorban információt, míg a gyakori nosocomialis pneumoniák kórokozójának kimutatására szolgáló pozitív tenyésztésű alsó légúti minta eredménye hét közben 50%-ban, hétvégén <20%-ban érkezik optimális időben vissza az osztályokra. Az eredmények értelmezését segítő infektológus-mikrobiológus konzíliumra munkaidőben >90%-ban, munkaidőn kívül infektológus 70%-ban, mikrobiológus 55%-ban érhető el. Az osztályok közel fele veszi igénybe az infektológus, kevesebb mint egyharmada a mikrobiológus segítségét. A mikrobiológiai laboratóriumi diagnosztikai háttér messze nem optimális a magyarországi intenzív osztályok esetében, ezt a működési minimumfeltételek sem írják elő. Nagyon kevés a személyes szakmai konzultáció lehetősége is.
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The kinetics and prognostic role of IL-10 in patients with burn injury. J Crit Care 2009. [DOI: 10.1016/j.jcrc.2008.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Evaluation of the effectiveness of different volume replacement therapies in postoperative hypovolemic patients using the PiCCO monitoring system. Crit Care 2009. [PMCID: PMC4084106 DOI: 10.1186/cc7384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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[The participation of pharmacist in antibiotic related activities of Hungarian hospitals and intensive care units]. ACTA PHARMACEUTICA HUNGARICA 2009; 79:57-62. [PMID: 19634635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present paper describes the antibiotic related activities of Hungarian adult intensive care units (ICUs) and their parent hospitals, specially focusing on the role of hospital pharmacists. Information was gathered by a structured questionnaire, which was sent to the head of ICU departments by post and by email. The multidisciplinary team of authors developed and validated the questions. Results were compared to recommendations set up by the Antibiotic Resistance Prevention And Control (ARPAC) project. Minimal requirements appointed by the ARPAC have not been fulfilled by many aspects: multidisciplinary hospital commitees were not realized and the activity of these committees in antibiotic guideline developments was not satisfactory. Continuous education and calculation of standardized antibiotic use was rarely performed at ICUs. The role of pharmacist remained marginal in every field. All these findings suggest the need for appointment of a responsible, multidisciplinary antibiotic manamement team including also a pharmacist.
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[Hemodynamic effects of N-acetylcysteine and ischemic preconditioning in a liver ischemia-reperfusion model]. Orv Hetil 2008; 149:2245-9. [PMID: 19004747 DOI: 10.1556/oh.2008.28495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED The aim of the study was to investigate whether repeated ischemic preconditioning or N-acetylcysteine (NAC) prevents ischemic-reperfusion injury as determined by having favourable hemodynamic effects during reperfusion in canine livers. METHODS The control group ( n = 10) underwent 60 minutes of hepatic ischemia followed by 180 minutes reperfusion. In the NAC group ( n = 5) 150 mg kg -1 of NAC was administered intravenously before inducing ischemia. In the preconditioned group ( n = 5) animals received ischemic preconditioning (10 minutes of ischemia followed by 10 minutes of reperfusion repeated three times) before clamping the portal triad. RESULTS 18 dogs survived the study period. One dog in the NAC group died due to circulatory failure unresponsive to inotropic drugs. The cardiac index and the intrathoracic blood volume index were significantly higher in the preconditioning group compared to the controls throughout the study period. CONCLUSIONS Repeated ischemic preconditioning might improve hemodynamic parameters, whereas we were unable to find any significant differences between the groups regarding N-acetylcysteine.
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Influence of dextran-70 on systemic inflammatory response and myocardial ischaemia-reperfusion following cardiac operations. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R87. [PMID: 17697359 PMCID: PMC2206488 DOI: 10.1186/cc6095] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 07/26/2007] [Accepted: 08/14/2007] [Indexed: 11/16/2022]
Abstract
Introduction Experimental studies have demonstrated that dextran-70 reduces the leukocyte–endothelium interaction, but clinical evidence is still lacking. Our objective was to justify the anti-inflammatory effect of dextran-70 following cardiac operations. Methods Forty patients undergoing coronary bypass surgery (n = 32) or aortic valve replacement (n = 8) were enrolled in this prospective, randomized, double-blind study. Two groups were formed. In group A (n = 20), dextran-70 infusion was administered at a dose of 7.5 ml/kg before the initiation of cardiopulmonary bypass and at a dose of 12.5 ml/kg after the cessation of cardiopulmonary bypass. Group B served as a control with identical amounts of gelatin infusion (n = 20). The plasma concentration of procalcitonin, C-reactive protein, IL 6, IL 6r, IL 8, IL 10, soluble endothelial leukocyte adhesion molecule-1, soluble intercellular adhesion molecule-1, cardiac troponin-I and various haemodynamic parameters were measured in the perioperative period. Multivariate methods were used for statistical analysis. Results In group A, lower peak (median) plasma levels of procalcitonin (0.2 versus 1.4, p < 0.001), IL 8 (5.6 versus 94.8, p < 0.001), IL 10 (47.2 versus 209.7, p = 0.001), endothelial leukocyte adhesion molecule-1 (88.5 versus 130.6, p = 0.033), intercellular adhesion molecule-1 (806.7 versus 1,375.7, P = 0.001) and troponin-I (0.22 versus 0.66, p = 0.018) were found. There was no significant difference in IL 6, IL-6r and C-reactive protein values between groups. Higher figures of the cardiac index (p = 0.010) along with reduced systemic vascular resistance (p = 0.005) were noted in group A. Conclusion Our investigation demonstrated that the use of dextran-70 reduces the systemic inflammatory response and cardiac troponin-I release following cardiac operation. Trial registration number ISRCTN38289094.
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Time course of platelet aggregation during thrombolytic treatment of massive pulmonary embolism. Blood Coagul Fibrinolysis 2007; 18:661-7. [PMID: 17890954 DOI: 10.1097/mbc.0b013e3282e38e61] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We studied changes in platelet aggregation and fibrinogen levels during thrombolysis with massive or submassive pulmonary embolism. Fifteen patients were randomized into ultrahigh-dose streptokinase (UH-SK n = 8) or alteplase (tPA n = 7) groups. Arterial blood samples were taken before and after thrombolysis every 4 h between 4 and 36 h, and once daily between 2 and 30 days. In-vitro platelet aggregation was examined as spontaneous (0.9% NaCl) and induced aggregation with adrenaline 10 micromol/l, collagen 2 microg/ml and ADP 10 micromol/l. D-dimer and fibrinogen were measured every 8 h on first day, and later as above. In the UH-SK group, adrenaline-induced platelet aggregation decreased at 4 and 8 h compared with baseline (P < 0.03). Adrenaline-induced platelet aggregation was significantly lower in the UH-SK group than in the tPA group at 36 h and on day 3 (P < 0.03). Platelet aggregation induced by ADP was lower at 4 h than at baseline in the UH-SK group (P < 0.05). Collagen-induced platelet aggregation was lower at 4 and 8 h than at baseline (P < 0.05) in the UH-SK group. Compared with baseline, fibrinogen levels decreased in both groups after thrombolysis. D-dimer levels were elevated in both groups at 8 h (tPA group, P < 0.0004; UH-SK group, P < 0.05). Spontaneous platelet aggregation, major bleeding or re-embolism was not documented. Platelet aggregation decreased after thrombolysis with UH-SK for 12 h, in comparison tPA caused an insignificant decrease. Fibrinogen level decreased with UH-SK treatment for 5 days but in case of tPA we could not measure significant changes. According to our findings, tPA is a more suitable drug but streptokinase is also effective because of its cost-benefit ratio.
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Abstract
BACKGROUND To analyse leukocyte function parameters and oxidative stress (OS) in patients with acute pulmonary embolism (PE) treated with thrombolytics. METHODS Fifteen patients undergoing thrombolysis (TL) with ultra-high dose streptokinase (n = 8), or alteplase (tPA) (n = 7) treatment were studied. Blood samples were collected prior to TL, and then 8 h, 1, 3, 5 and 30 days after treatment. Malondialdehyde (MDA), reduced glutathione (GSH), plasma protein sulfhydryl groups (PSH) levels, superoxide dismutase (SOD) and myeloperoxidase enzyme (MPO) activities were measured in plasma or whole blood for monitoring of the OS markers. Production of reactive oxygen species (ROS) in whole blood was measured by luminol dependent chemiluminescence. Flow cytometry was used to determine CD11a, CD18, and CD97 surface antigen expression on leukocytes. RESULTS The elevated MDA, ROS and MPO, decreased GSH and PSH levels indicated the presence of OS in patients with PE. MDA significantly (P < 0.05) increased, GSH significantly (P < 0.05) decreased following thrombolysis. ROS production peaked on the 3rd and 5th days. TL was accompanied by significant decrease in granulocyte and monocyte CD11a and CD18 as well as in granulocyte CD97 expression (P < 0.05). CONCLUSION PE led to OS that was augmented following TL. Decreased adhesion molecule expression of circulating leukocytes in the early phase of TL reflects the pathological leukocyte endothelial cell interactions.
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[Indications for peri-operative temporary pacemakers]. Orv Hetil 2002; 143:1866-7; author reply 1867-8. [PMID: 12187581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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[Effect of fructose-1,6-diphosphate on myocardial purin and pyrimidin metabolism during coronary artery bypass grafting surgery]. Orv Hetil 2000; 141:2021-5. [PMID: 11037610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
During ischaemia, the glycolytic pathway (Embden-Meyerhof) is up regulated in an attempt to produce ATP anaerobically. However, this is short-lived due to negative feedback on the key glycolytic enzyme phosphofructokinase by accumulating lactate. Fructose-1,6-diphosphate (FDP), a high energy intermediary metabolite of this pathway, is unique in that is enters glycolysis distal to this inhibitory site. Exogenously administered FDP should therefore theoretically yield ATP independent of lactate accumulation and thereby ameliorate ischaemic injury. Clinical benefit has been shown in coronary artery bypass grafting (CABG) surgery, congestive cardiac failure and adult respiratory distress syndrome. Ischaemia-reperfusion injury induced by cardiopulmonary bypass (CPB) presents clinically as an impairment of myocardial function in the postoperative period. At a cellular level this reflects myocardial metabolic changes and nucleotide degradation (directly linked to high energy phosphate turnover). Quantification of myocardial nucleotide catabolite release therefore provides useful information regarding intermediary metabolism and cytoprotection conferred to myocardial (inosine, uridine) and endothelial (hypoxanthine) tissue. The authors investigated the myocardial cytoprotective effects of FDP in 16 patients scheduled for elective CABG surgery. Aortic and coronary sinus blood were collected directly into liquid nitrogen and analysed by high performance liquid chromatography prior to CPB and at different time points after reperfusion. FDP was administered intravenously in 8 patients and 5% dextrose was administered in 8 other patients. Analysis of transmyocardial (coronary sinus-aortic) nucleotide metabolite levels showed increased release of inosine, hypoxanthine and uridine in both the FDP and the control groups following reperfusion. However, compared to baseline (pre-aortic clamping) values, hypoxanthine and inosine concentrations were significantly elevated at 0, 1, 5 and 10 minutes following reperfusion in the control group. This was in contrast to earlier recovery to baseline levels (after 5 minutes of reperfusion) in the FDP group. Furthermore, when compared to control group, the hypoxanthine and inosine concentrations were significantly decreased by FDP treatment. Uridine concentrations were significantly elevated at 1 and 5 minutes in the control group and no significant change was observed in the FDP group. In conclusion, these data suggest that FDP, through an intermediary metabolic effect, may contribute to myocardial and endothelial cytoprotection during the ischaemic insult of cardiac surgery.
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Acute renal failure in patients with multiorgan failure: risk factors influencing survival. Nephrol Dial Transplant 1998; 13:526. [PMID: 9509484 DOI: 10.1093/ndt/13.2.524a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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[Comparative study of verapamil and bisoprolol in the secondary prevention of myocardial infarction]. Orv Hetil 1997; 138:1939-45. [PMID: 9280886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The effect of Ca-antagonist, long-acting verapamil and the selective beta-1 blocking bisoprolol were investigated and compared in the secondary prevention after myocardial infarction. Eighty-seven patients were enrolled, 27 patients were not included because of the exclusion criteria, 30 patients were treated with verapamil and 30 patients with bisoprolol. During the 540 days of follow up period treadmill ergometry and dobutamine stress-test with SPECT investigation were performed two times. Both clinically and the data of our investigations the effect of the two drugs in the secondary prevention was good, and even at the 540th day the protective effect was still excellent.
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[Leukocyte migration during erythrocyte sedimentation]. Orv Hetil 1997; 138:861-5. [PMID: 9162895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Sedimentation properties of leukocytes was measured with a new, simple and reproducible method. The increment of leukocyte concentration was determined in the upper 100 mm section of the sedimentation blood column after one hour gravity sedimentation of the whole blood. The result (leukocyte antisedimentation rate, LAR) was expressed in percentage of the original, presedimentation leukocyte concentration. Blood samples taken from 35 healthy adults were investigated and 12.5% and 17.4% increments were found in total leukocyte count and in granulocyte concentration respectively in the upper half of the sedimentation blood column. The mean coefficient of variation of LAR measurements was 3.2% LAR was found significantly higher in a mixed group of patients than in healthy controls. The sedimentation properties of leukocytes were in significant correlation with leukocyte adherence (p < 0.01), with whole blood viscosity, hematocrit, and erythrocyte sedimentation rate (each p < 0.05) when blood samples of healthy individuals and postoperative intensive care patients were analysed in combination. In vitro pre-treatment of patients' blood samples with prednisolone and lidocaine resulted in a significant diminishment of LAR in a concentration dependent manner.
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[Analysis of costs of drug therapy in patients with acute respiratory insufficiency]. Orv Hetil 1996; 137:129-33. [PMID: 8721864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In a retrospective study, the authors analysed the clinical data of 38 patients who were admitted to a surgical intensive care unit (SICU) for mechanical ventilation lasted for at least 72 hours. The APACHE III score was calculated on the basis of clinical data documented during the first 24 hour of the treatment and the cost of drug administrations per patients per day was also determined by analysing all the drugs prescribed on the first 5 days of intensive care. The patients admitted to SICU with polytrauma or with abdominal septic focus required significantly higher cost of drug treatment than the patients after cardiopulmonary resuscitation or with bronchial asthma or pneumonia. The APACHE III score of the patients died at the SICU was significantly higher compared to the survivors who needed more expensive drug therapy than the non-survivors required. Antibiotic treatment, blood transfusions, and human plasma proteins caused the highest drug expenditure. There was no significant correlation between the APACHE III score and the cost of drug treatment.
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[Treatment possibilities for extensive pulmonary embolism as an alternative to the Trendelenburg operation]. Orv Hetil 1995; 136:2553-9. [PMID: 8532320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors describe the clinical course of successfully treated patients with extensive, subtotal pulmonary embolism. After the diagnosis was confirmed by isotopic scan or pulmonary angiography, mechanical thrombus destruction was applied followed by low dose loco-regional thrombolysis in 11 patients by streptokinase. Five patients were treated with ultrahigh dose of streptokinase through peripheral vein, one patient via pulmonary artery catheter and one patient was treated with high dose urokinase by pulmonary catheter in combination with mechanical thrombus destruction by guide wire. All the treatment procedures were proved to be successful. After detailed case reports, the authors review the life saving thrombolytic treatment of acute subtotal pulmonary embolism as an alternative of Trendelenburg operation.
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[Management of extensive, potentially fatal, pulmonary embolism]. Orv Hetil 1995; 136:1049-54. [PMID: 7761068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Extensive pulmonary embolisms were suspected in 11 patients with severe cardiogenic shock admitted to an intensive care unit. The urgently established diagnosis was always based on clinical symptoms and on a complex criteria system elaborated by the authors. The "blind" diagnosis of subtotal pulmonary embolism was confirmed by further noninvasive examinations in 10 cases. During the measures of complex resuscitation, the authors administered high doses of streptokinase in 10 cases and ultra-high dose of streptokinase for one patient. The emergency treatment was successful in four cases.
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[Total gastrectomy with esophageal exclusion following corrosive injury to the upper gastrointestinal tract]. Orv Hetil 1994; 135:751-3. [PMID: 8170675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case report of a young male patient is demonstrated who has drunk hydrochloric acid with intention of suicide. Because of an extensive necrosis of the stomach, total gastrectomy with double exclusion of the esophagus and with jejunostomy was performed as an acute intervention. 6 weeks after the acute operation, a successful esophagojejunal bypass was carried out using the right colon. It is well-known from the literature that a mucocele can develop in the excluded esophagus after such an operation. In some cases the mucocele causes compression signs. For this reason, a regular control of these patients is suggested.
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[Prospective hemorheological study in the third pregnancy trimester]. Orv Hetil 1991; 132:2901-5. [PMID: 1766659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The prospective hemorheological study was performed in the third trimester of pregnancy. Whole blood viscosity, haematocrit, plasma viscosity and haemoglobin were measured. They did not find significant changes of these parameters in healthy pregnancy. The rheological parameters in the macrosomic group (75%) were same than in the normal group at 37th weeks, but later were significantly higher. Higher blood viscosity has been found in those pregnant women, who delivered retarded fetuses. They suggest, that the progressively increasing blood viscosity in the third trimester of pregnancy causes the disturbances in the intervillous microcirculation, and produces intrauterine growth retardation.
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[Hemorrheologic parameters in myocardial infarct during the hospitalization phase]. Orv Hetil 1990; 131:15-9. [PMID: 2105476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The changes of the rheological parameters (whole blood and plasma viscosity, fibrinogen level, red cell count, hematocrit) of 22 AMI patients (mean age: 59 years) were studied during the hospital phase of acute myocardial infarction. The measurements were carried out after the admission, after the beginning of the mobilization and before the discharge from the hospital. Looking at the results of all of the patients they could not find any statistically significant change, although in the first phase improving hemorheological parameters were measured and this way the discharge values were similar to the admission ones. In men significantly worse starting values were found than in women and the deterioration of these parameters in their group was also expressed. The deliberate use of diuretics and the administration of high dose nitroglycerin may be one part of the less worsening rheological parameters in comparison with the literature.
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[Analysis of the function of the circulatory system and its components based on rheologic viewpoints]. Orv Hetil 1989; 130:2187-8, 2191-4. [PMID: 2682436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors analyse from hemorheological viewpoint the vascular system and the blood, its special circulating medium. The most important anatomical and physiological characteristics are referred to completing them with the presentation of the basic rheophysical parameters and correlations. Factors determining the viscosity of blood are specified and discussed separately. The definition based on literary data according to which the viscosity of blood is greater with lower circulation gradient and lower--in view of the non-Newtonian character of bloodat a higher rate is discussed. The significance of the adaptability of blood cells is emphasized in the determination of the rheological characteristics of blood.
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[The roots, concept, subject, and history of hemorheology, current tasks and further perspectives]. Orv Hetil 1989; 130:491-5. [PMID: 2657546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors give a reviewing summary on the origin of hemorrheology and its relationship to basic sciences. Its concept is defined, recognitions and endeavours of this character in the history are analysed and followed up. The names of the scientists whose merit was significant in the creation of rheology-hemorrheology are presented referring briefly to the main points of their activity. The general, international situation of the discipline is outlined, countries leading and determining its development are indicated and the main points of the situation in Hungary are described. The examinational fields of clinical hemorrheology are presented, describing briefly the future directions.
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[Acute and chronic hemorrheological effects of clopamide in ischemic heart disease]. Orv Hetil 1987; 128:2523-7. [PMID: 3696712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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