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Ashy CC, Morningstar JL, Gross CE, Scott DJ. The association of ASA score and outcomes following to.tal ankle arthroplasty. Foot Ankle Surg 2024:S1268-7731(24)00072-9. [PMID: 38594104 DOI: 10.1016/j.fas.2024.03.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/16/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND This study seeks to evaluate the relationship between American Society of Anesthesiologist (ASA) score and postoperative outcomes following TAA. METHODS The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2020 to identify 2210 TAA patients. Patients were stratified into low (n = 1328; healthy/mild systemic disease) or high (n = 881; severe/life-threatening systemic disease) ASA score cohorts. RESULTS There was no statistically significant difference in complications, readmission, or reoperation rate based on ASA score. Increased ASA score was significantly associated with longer length of stay (low = 1.69 days, high = 1.98 days; p < .001) and higher rate of adverse discharge (low = 95.3 %, high = 87.4 %; p < .001). CONCLUSION Higher ASA scores (3 and 4) were statically significantly associated with increased length of stay and non-home discharge disposition. These findings are valuable for physicians and patients to consider prior to TAA given the increased utilization of resources and cost associated with higher ASA scores. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Cody C Ashy
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
| | - Joshua L Morningstar
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
| | - Christopher E Gross
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
| | - Daniel J Scott
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
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Duan C, Li Y, Ma J, Song Y, Zhou L. The Impact of Laparoscopic Appendectomy and Open Appendectomy on B7-H3-Mediated Intrinsic Immune Response in Children with Acute Suppurative Appendicitis. J Inflamm Res 2024; 17:1577-1587. [PMID: 38495342 PMCID: PMC10941988 DOI: 10.2147/jir.s446199] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/01/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Surgery impairs immune function and increases postoperative complications. B7H3, a co-stimulatory molecule, plays a crucial role in immune regulation. The present study examined the impact of B7H3 on the postoperative immune response in children with acute suppurative appendicitis (ASA) by comparing preoperative and postoperative B7H3 levels in laparoscopic surgery (LA) and open appendectomy (OA). Patients and Methods 198 pediatric ASA patients were enrolled. The researcher group performed LA, while the control group performed OA. Perioperative time, recovery time of gastrointestinal function, time to pass gas, length of incision, and length of hospitalization were compared in the perioperative period. Additionally, an ELISA assay was conducted to examine the levels of inflammatory factors and B7H3 and CD28. Short-term postoperative complications were also evaluated. Results Compared with the control group, the research group had a short operative time, gastrointestinal function recovery time, gas time, and hospitalization time. The short-term complication rate was significantly lower in the research group. More importantly, B7H3 and CD28 were insignificantly different preoperatively, but they were all reduced postoperatively. Moreover, the reduction was more pronounced in the research group. The same results were noted in inflammatory factors and immune markers, which were non-significant different preoperatively and were typically reduced postoperatively, particularly in the research group. Finally, postoperative B7H3 was positively correlated with both inflammatory factors and immune cell levels. Conclusion B7H3 was reduced in both postoperative periods, and the reduction was more pronounced in the LA group. B7H3 may be involved in postoperative recovery by modulating postoperative inflammation and immune responses.
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Affiliation(s)
- Chunsheng Duan
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Yuan Li
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Jiansu Ma
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Yanglin Song
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Lixia Zhou
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
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Sium AF, Gudu W, Tolu LB, Birara M, Bekele D. Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa. AJOG Glob Rep 2024; 4:100295. [PMID: 38205131 PMCID: PMC10777106 DOI: 10.1016/j.xagr.2023.100295] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recent studies showed that aspirin for preeclampsia prevention is underused despite its effectiveness in preventing preeclampsia among patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. OBJECTIVE This study aimed to determine the missed opportunity for aspirin prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. STUDY DESIGN This was a cross-sectional study on pregnant women who had preeclampsia and who were managed at the St. Paul's Hospital Millennium Medical College (Ethiopia) over a 6-month period (April 1-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was the proportion of women who had an indication for aspirin prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for aspirin) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. RESULTS A total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded based on the study criteria. Among the 395 pregnant women with preeclampsia who were included in the final analysis, 195 (50.6%) had an indication for aspirin prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressure measurements at presentation were 153.8±12.8 and 100.6±8.5 mm Hg, respectively. Most patients had proteinuria (51.7% of the participants had a urine test-strip protein level of +2, whereas 18.5% [74/395] had a urine test-strip protein level of +1 and 10.9% had 24-hour urine protein levels in the preeclampsia range). Among the women who had an indication for aspirin prophylaxis, only 1.1% received aspirin (the missed opportunity for aspirin prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9%, whereas the neonatal intensive care unit admission rate was 20.5%. The rate of a low Apgar score at 5 minutes was 8.9%. Eight mothers (2.1%) developed hemolysis, elevated liver enzymes, and low platelet count syndrome, whereas another 3 (0.8%) mothers developed a pulmonary edema. CONCLUSION In this study, the missed opportunity for administration of aspirin prophylaxis for the prevention of preeclampsia was high although more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates of adverse perinatal outcomes and serious maternal morbidity.
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Affiliation(s)
- Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Malede Birara
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Ziegler A, Carollo E, Adams W, Bier‐Laning C. The total amount of fluid administered is associated with postoperative complications in head and neck cancer surgery. World J Otorhinolaryngol Head Neck Surg 2023; 9:288-294. [PMID: 38059145 PMCID: PMC10696273 DOI: 10.1002/wjo2.86] [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: 06/20/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Patients with head and neck cancer often undergo extensive ablative and reconstructive surgery. Many risk factors are unalterable, but some operative variables are possible to adjust. The goal of this study was to estimate the association between operative variables and the incidence of perioperative complications in a contemporary tertiary care university-based head and neck patient population and a Veteran Administration hospital head and neck patient population from an earlier time period. Methods We retrospectively reviewed all patients who underwent major head and neck surgery. Results Two-hundred-two university patients and 122 veteran patients were reviewed. On multivariable analysis, the total amount of intravenous (IV) fluid received during the procedure was associated with postoperative complications as were patients' weight, American Society of Anesthesiologists (ASA) score, and adult comorbidity evaluation-27 (ACE-27) score. These associations did not depend on whether the patient was treated at the university or veteran hospital. Conclusion Our study suggests that the odds of a postoperative complication increase as the total amount of IV fluid increases.
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Affiliation(s)
- Andrea Ziegler
- Department of OtolaryngologyLoyola University Medical CenterMaywoodIllinoisUSA
| | - Erin Carollo
- Department of Otolaryngology, Stritch School of MedicineLoyola University Medical CenterIllinoisMaywoodUSA
| | - William Adams
- Department of Public Health SciencesLoyola University Medical CenterMaywoodIllinoisUSA
| | - Carol Bier‐Laning
- Department of OtolaryngologyLoyola University Medical CenterMaywoodIllinoisUSA
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Binneböse M, Schott J, Wallis H, Kaiser C, Vogel M. [A naturalistic study on the effects of antidepressants (e. g. SSRI) and acetyl salicylic acid ( ASA) on the self-rated perception of the psychotherapeutic process of inpatient psychosomatic treatment and its results: Could ASA be beneficial?]. Z Psychosom Med Psychother 2023; 69:369-382. [PMID: 38214019 DOI: 10.13109/zptm.2023.69.4.369] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Objectives: Psychic perceptions are at the core of psychotherapeutic processes and modifiable by certain psychopharmacologic agents including antidepressants and cyclooxygenase (COX) inhibitors like acetylsalicylic acid (ASA). Methods: We analyzed the medical records of 208 participants, and used the weekly mean dosages and the number of weeks in therapy to predict ward experience (Stationserfahrungsbogen) and symptom burden (symptom-check list 90-R) by means of linear regression analyses and four repeated measures. Results: Time predicted symptom relief. ASA signified a more favorable ward experience and a trend towards less suffering. Antidepressants did not predict symptom burden or ward experience, except for amitriptyline's inverse relationship with process perception. Discussion: Regarding process perception and therapy outcome, amitriptyline might have unfavorable effects at dose reductions, whereas COX-inhibition could be beneficial at higher dosages. Similar findings have already been described with regard to COX-inhibition in depression and schizophrenia.
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Affiliation(s)
- Marius Binneböse
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Magdeburg Deutschland
| | - Jan Schott
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Magdeburg Deutschland
| | - Hannah Wallis
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Magdeburg Deutschland
| | - Christian Kaiser
- Universitätsklinik für Psychiatrie und Psychotherapie, Magdeburg; Deutschland
| | - Matthias Vogel
- Ameos-Klinikum Haldensleben, Abteilung für Psychiatrie und Psychotherapie Kiefholzstr.4 39340 Haldensleben Deutschland
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de Souza RMC, Frassei RD, da Silva LDCM, Rahal MA, Silva JDS, Kojima KE. Clinical data or scoring system for predicting mortality in elderly patients with hip fracture: A prospective study. Injury 2023; 54 Suppl 6:110844. [PMID: 37263869 DOI: 10.1016/j.injury.2023.110844] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Hip fracture in elderly individuals is frequent and is related to a high rate of mortality. Finding the best predictor of death will help to develop better patient care. Aim - To analyze the reliability of the clinical data and assessment scores to predict mortality in acute hip fracture in elderly patients. PATIENT AND METHODS Prospective data were collected from all patients > 65 years with acute hip fracture from May to October 2020. The clinical data collected were age, sex, comorbidities, medication, type of fracture and presence of delirium. The assessment scores were ASA, Lee, ACP and Charlson. RESULTS The statistically significant results were age > 80 years (OR 1.121 IC95% [1.028-1.221] p = 0.0101) and number of medications (OR5.991 95% CI [2.422-14.823] p <0.001). Three scores showed a correlation with mortality: ASA score (p = 0.017), Lee score (p = 0.024) and ACP score (p = 0.013). The Charlson Comorbidity Index did not correlate with mortality (p = 0.172). CONCLUSION To stratify the risk of death, both clinical data and scores should be used. The best clinical indicators are age and number of medications, and the scores are ASA, Lee and ACP.
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Affiliation(s)
| | - Renan Dias Frassei
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Luiza de Campos Moreira da Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Miguel Antonio Rahal
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Jorge Dos Santos Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Kodi Edson Kojima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
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Hansted AK, Storm N, Burcharth J, Diasso PDK, Ninh M, Møller MH, Vester-Andersen M. Validation of the NELA risk prediction model in emergency abdominal surgery. Acta Anaesthesiol Scand 2023; 67:1194-1201. [PMID: 37353882 DOI: 10.1111/aas.14294] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/25/2023]
Abstract
Risk prediction models are frequently used to identify high-risk patients undergoing emergency laparotomy. The National Emergency Laparotomy Audit (NELA) developed a risk prediction model specifically for emergency laparotomy patients, which was recently updated. In this study, we validated the updated NELA model in an external population. Furthermore, we compared it with three other risk prediction models: the original NELA model, the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) model, and the American Society of Anesthesiologists Physical Status (ASA-PS). We included adult patients undergoing emergency laparotomy at Zealand University Hospital, from March 2017 to January 2019, and Herlev Hospital, from November 2017 to January 2020. Variables included in the risk prediction models were collected retrospectively from the electronic patient records. Discrimination of the risk prediction models was evaluated with area under the curve (AUC) statistics, and calibration was assessed with Cox calibration regression. The primary outcome was 30-day mortality. Out of 1226 included patients, 146 patients (11.9%) died within 30 days. AUC (95% confidence interval) for 30-day mortality was 0.85 (0.82-0.88) for the updated NELA model, 0.84 (0.81-0.87) for the original NELA model, 0.81 (0.77-0.84) for the P-POSSUM model, and 0.76 (0.72-0.79) for the ASA-PS model. Calibration showed underestimation of mortality risk for both the updated NELA, original NELA and P-POSSUM models. The updated NELA risk prediction model performs well in this external validation study and may be used in similar settings. However, the model should only be used to discriminate between low- and high-risk patients, and not for prediction of individual risk due to underestimation of mortality.
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Affiliation(s)
- Anna K Hansted
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital-Herlev Hospital, Copenhagen, Denmark
| | - Nicolas Storm
- Department of Surgery, Copenhagen University Hospital-Herlev Hospital, Copenhagen, Denmark
| | - Jakob Burcharth
- Department of Surgery, Copenhagen University Hospital-Herlev Hospital, Copenhagen, Denmark
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille D K Diasso
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mian Ninh
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital-Herlev Hospital, Copenhagen, Denmark
| | - Morten H Møller
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten Vester-Andersen
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital-Herlev Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pahwa B, Das S, Singh G, Anu MM. Association of predictive factors and neurosurgical postoperative infections: A retrospective analysis. Clin Neurol Neurosurg 2023; 232:107880. [PMID: 37454601 DOI: 10.1016/j.clineuro.2023.107880] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To identify the factors that predispose neurosurgical patients to surgical site infections (SSI) as well as assess the risk factors attached to infection by a specific microorganism. METHODOLOGY A retrospective case-control study was conducted at University College of Medical Sciences and G.T.B. Hospital, Delhi. Adult patients (>18 years) undergoing a neurosurgical procedure with a diagnosis of SSI in the year 2021 having a minimum follow up of 30 days postoperatively or until death if they survived less than 30 days were included. Statistical analysis was performed using the SPSS 16 software with level of significance at 0.05. RESULTS An incidence of 3.15% was observed at our center. Mean age of the study population was 39.2 ± 13.07 years (range 22-70 years) with a male: female ratio of 3:1. Having an underlying infection (p = 0.024), ASA score> 2 (p = 0.041), duration of surgery> 4 h (p = 0.025), diabetes (p = 0.027) and preoperative stay at the hospital (p = 0.036) were found to be statistically significant risk factors in the prediction of SSI in neurosurgical patients which were utilised to create a regression model with an accuracy of 70% and AUC of 0.833. Deep infections were found to have a significant association with positive culture on the collected samples (p = 0.035). CONCLUSIONS This study is a starting point to identify which factors could predict the presence of a particular organism isolated from the site of infection in neurosurgical patients, thereby minimizing AMR.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India.
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Gurbachan Singh
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - M M Anu
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
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Avendano JP, Monica J, Varghese B. Revisiting the Importance of the Pre-Operative Assessment - A Case Report. J Orthop Case Rep 2023; 13:52-55. [PMID: 37521399 PMCID: PMC10379242 DOI: 10.13107/jocr.2023.v13.i07.3750] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/27/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction The available literature underscores the importance of optimizing surgical outcomes through a pre-operative checklist, which includes a review of the medical records and recent test results, changes in medical history, and a physical examination of the cardiovascular system, pulmonary system, and airway. Case Report We report a case of a 47-year-old man who decompensated during an outpatient wrist procedure and needed to remain intubated requiring transfer to a hospital. On follow-up with the patient, laboratory work revealed a positive HIV test and CD4 count of 11 cells/mm3, along with a pneumonia consistent with pneumocystis pneumonia, which was unbeknownst to the surgical team before the procedure. Conclusion This case emphasizes the importance of a thorough history and physical update and pre-operative assessment before operating.
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Affiliation(s)
- John P Avendano
- Department of Orthopaedic Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - James Monica
- Department of Orthopaedic Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Bobby Varghese
- Department of Orthopaedic Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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Aggelakopoulou C, Perivoliotis K, Stergiannis P, Intas G, Mouzakis G, Tepetes K. Comparison of Selected Older and Younger Patients Regarding Optimal Surgical Treatment of Colorectal Cancer: A Prospective Cohort Study. Cancer Diagn Progn 2023; 3:504-513. [PMID: 37405213 PMCID: PMC10316050 DOI: 10.21873/cdp.10247] [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] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND/AIM Current evidence regarding the optimal management of older colorectal cancer patients, is conflicting. Functional deficits impact long-term survival prognosis, while frailty often results to optimal treatment postponement. Thus, the characteristics of this subgroup combined with treatment deviations further perplex optimal oncological management. The study aim was to compare survival and optimal surgery rates between older and younger colorectal cancer patients. PATIENTS AND METHODS This study was designed as a prospective cohort. All adult (³18 years) colorectal cancer patients operated, during the 2016-2020 period, in the Department of Surgery, University Hospital of Larissa, were considered as eligible. The primary endpoint of the study was the difference in terms of the overall survival between older (>70 year) and younger (<70 years) colorectal cancer patients. RESULTS Overall, 166 patients (60 younger and 106 older) were enrolled. Although the older subgroup displayed a higher rate (p=0.007) of ASA II and ASA III patients, mean CCI scores were comparable (p=0.384). The two subgroups were similar in terms of performed operations (p=0.140). No delay in surgery was noted. Most operations were performed using an open approach (open: 57.8% vs. laparoscopic: 42.2%), under an elective status (elective: 91% vs. emergency: 1.8%). There was no difference in terms of overall complications rate (p=0.859). Overall survival was similar (p=0.227) between the older and younger subgroups (25.68 vs. 28.48 months). CONCLUSION Older operated patients did not differ from their younger counterparts with regard to their overall survival. Due to several study limitations, further trials are required to confirm these findings.
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Affiliation(s)
| | | | | | - George Intas
- General Hospital of Nikaia "Agios Panteleimon", Athens, Greece
| | - George Mouzakis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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Omkaram S, Reddy CG, Murthy PS, Chaudhury S. Prevalence of preoperative anxiety in patients posted for surgical procedures and its relation to the doses of anesthetic drugs: A cross-sectional study. Ind Psychiatry J 2023; 32:260-265. [PMID: 38161448 PMCID: PMC10756625 DOI: 10.4103/ipj.ipj_109_22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 02/19/2023] Open
Abstract
Background In patients undergoing surgical procedures, preoperative period is one of the most worrying periods. There are only few studies which revealed that increased preoperative anxiety is associated with increased requirements of doses of anesthetic agents. Aim The aim of this study is to assess the prevalence of preoperative anxiety in patients posted for surgical procedures and its relation to the doses of anesthetic drugs. Materials and Methods This is a cross-sectional, analytical study done between January 2021 and April 2021. A total of 100 patients undergoing surgery have given consent to participate in the study by filling self-designed questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS). Data analysis was done by SPSS version 24 using appropriate statistical tests. Results Preoperative anxiety was noted in 21% of the patients who were undergoing surgery. The association between preoperative anxiety and need for increase in the doses of anesthetic agents during intraoperative period was found to be statistically significant (P < 0.004). Conclusion A significant number of patients required increased amounts of anesthetic drugs to reduce anxiety during intraoperative period. Therefore, appropriate methods have to be introduced to address the concerns of patients undergoing surgery and thereby reducing anxiety.
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Affiliation(s)
- Sindhuja Omkaram
- Department of Psychiatry, Santhiram Medical College and General Hospital, Nandyal, Andhra Pradesh, India
| | - C. Gowtham Reddy
- Department of Psychiatry, Santhiram Medical College and General Hospital, Nandyal, Andhra Pradesh, India
| | - P. S. Murthy
- Department of Psychiatry, Santhiram Medical College and General Hospital, Nandyal, Andhra Pradesh, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
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Shakhtour LB, Mamidi IS, Lee R, Li L, Jones JW, Matisoff AJ, Reilly BK. Implication of American Society of Anesthesiologists Physical Status ( ASA-PS) on tonsillectomy with or without adenoidectomy outcomes. Am J Otolaryngol 2023; 44:103898. [PMID: 37068319 DOI: 10.1016/j.amjoto.2023.103898] [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: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The American Society of Anesthesiologists Physical status classification (ASA-PS) is a simple categorization of a patient's physiological status during the perioperative period. The role of ASA-PS in predicting operative risk and complications following tonsillectomy with or without adenoidectomy (T ± A) has not been studied. The objective of the study was to identify the association of the pre-operative ASA-PS with 30-day complication rates and adverse events following T ± A. STUDY DESIGN A retrospective analysis was performed using data from the American College of Surgeons' National Surgical Quality Improvement Program database (ACS NSQIP) of patients aged 16 years or older who underwent T ± A between 2005 and 2016. Patients were stratified into ASA-PS Classes I/II and III/IV. Patient demographics, preoperative comorbidities, pre-operative laboratory values, operation-specific variables, and postoperative outcomes in the 30-day period following surgery were compared between the two subsets of ASA-PS groups. RESULTS On multivariate analysis, patients with ASA class III and IV were more likely to experience an unplanned readmission (OR 1.39, 95 % CI 1.09-1.76; p = 0.007), overall complications (OR 1.49, 95 % CI 1.28-1.72; p < 0.001), major complications (OR 1.52, 95 % CI 1.31-1.77, p ≤ 0.001), reoperation (OR 1.33, 95 % CI 1.04-1.69; p = 0.022), and extended length of stay >1 day (OR 1.78, 95 % CI 1.41-2.25; p < 0.001) following a T ± A. CONCLUSION Higher ASA-PS classification is an independent predictor of complications following T ± A. Surgeons should aim to optimize the systemic medical conditions of ASA-PS classes III and IV patients prior to T ± A and implement post-operative management protocols specific to these patients to decrease morbidity, complications, and overall health care cost.
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Affiliation(s)
- Leyn B Shakhtour
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Ishwarya S Mamidi
- Department of Otolaryngology, Louisiana State University, New Orleans, LA, United States of America
| | - Ryan Lee
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Lilun Li
- Division of Otolaryngology, The George Washington University Hospital, Washington, DC, United States of America
| | - Joel W Jones
- Department of Otolaryngology, Louisiana State University, New Orleans, LA, United States of America
| | - Andrew J Matisoff
- Division of Cardiac Anesthesia, Children's National Hospital, Washington, DC, United States of America
| | - Brian K Reilly
- Division of Otolaryngology, Children's National Hospital, Washington, DC, United States of America.
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Stanković P, Hoch S, Rudhart S, Stojković S, Wilhelm T. The pattern of epistaxis recurrence in patients taking prophylactic acetylsalicylic acid ( ASA) from a 10 year cohort. Eur Arch Otorhinolaryngol 2023; 280:1723-1730. [PMID: 36181528 PMCID: PMC9988998 DOI: 10.1007/s00405-022-07666-3] [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: 05/20/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Epistaxis is the most common otolaryngological emergency and one-third of epistaxis patients regularly take low-dose acetylsalicylic acid (ASA) for the prevention of cardiovascular disease (CVD). The shift in contemporary guidelines identifies little benefit of ASA intake in patients who have not previously had an infarction. Existing evidence confirms ASA intake as a factor for severe epistaxis, while the evidence concerning its impact on recurrence is ambiguous. There are no available studies which justify the administration of these drugs nor are there any studies correlating the effects of these drugs to the SCORE2 CVD risk stratifying scale. STUDY DESIGN A retrospective analysis of all admitted epistaxis patients in a tertiary academic hospital for the 10 year period 2011 to 2021. METHODS Patient data were analysed using the hospital information software. A recurrence was defined as an epistaxis episode requiring hospital readmittance for at least one night. Patients taking anticoagulants were excluded (N = 421). RESULTS 444 patients were included: 246 were taking ASA and 198 were not (NoASA). ASA patients had more frequent recurrence in general (p = 0.03), more recurrences per patient (p = 0.002), and more changes in bleeding localisation (p = 0.04). Recurrence in the ASA group was associated with lower haemoglobin values (HR 0.62, p < 0.0001), while surgery (HR 6.83, p < 0.0001) was associated with recurrence in the NoASA group. ASA patients had a statistically significant (r 0.33, p = 0.032) correlation between the total number of epistaxis recurrences and SCORE2. The indication for drug intake was highly questionable in as much as 40% of ASA patients. Follow-up time was 5.27 years. CONCLUSIONS Epistaxis patients taking prophylactic ASA are significantly more burdened by recurrence, because they have more frequent recurrences, a greater number of recurrences per patient, and more changes in bleeding localisations when compared to control patients. The drug indication is questionable in up to 40% of ASA patients, exposing them unnecessarily to recurrence. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Petar Stanković
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Philipps-University, Marburg, Germany
| | - Stefan Rudhart
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Philipps-University, Marburg, Germany
| | | | - Thomas Wilhelm
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany. .,Medical Faculty, Philipps-University, Marburg, Germany.
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14
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Jatana S, Verhoeff K, Mocanu V, Jogiat U, Birch DW, Karmali S, Switzer NJ. Does ASA classification effectively risk stratify patients undergoing bariatric surgery: a MBSAQIP retrospective cohort of 138,612 of patients. Surg Endosc 2023:10.1007/s00464-023-10017-w. [PMID: 36961601 DOI: 10.1007/s00464-023-10017-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/12/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION It is important to appropriately risk stratify bariatric surgery patients, as these patients often have obesity-related comorbidities which can increase postoperative complication risk but also benefit the most from bariatric surgery. We aimed to evaluate the utility of risk stratification using ASA class for bariatric surgery patients and assessed predictive factors of postoperative complications. METHODS The 2020 MBSAQIP database was analyzed, and an ASA-deemed high-risk cohort (class IV) and normal-risk (ASA class II and III) cohort were compared. Univariate analysis was performed to characterize differences between cohorts and to compare complication rates. Multivariate logistic regression analysis was performed to determine factors associated with increased odds of postoperative complications. RESULTS We evaluated 138 612 patients with 5380 (3.9%) considered high-risk and 133 232 (96.1%) normal-risk. High-risk patients were more likely to be older (46.2 ± 12.0vs.43.4 ± 11.9, p < 0.001), male (30.9%vs.18.4%, p < 0.001), have higher BMI (51.4 ± 10.2vs.44.9 ± 7.4, p < 0.001), and have more comorbidities. High-risk patients were more likely to have increased 30-day serious complications (4.5%vs.2.8%, p < 0.001) and death (0.2%vs.0.1%, p = 0.001) but not anastomotic leak (0.2%vs.0.2%, p = 0.983). Multivariate models showed ASA class IV patients were at higher odds for any serious complication by 30 days (aOR 1.36, 95%CI 1.18-1.56, p < 0.001) but not for death (aOR 1.04, 95%CI 0.49-2.21, p = 0.921). The factor independently associated with the highest odds of complication in both models was functional status preoperatively (partially dependent aOR 2.06, 95%CI 1.56-2.72, p < 0.001; fully dependent aOR 3.19, 95%CI 1.10-9.28, p = 0.033 for any serious complication; partially dependent aOR 5.08, 95%CI 2.16-12.00, p < 0.001 for death). CONCLUSIONS While elevated ASA class correlates with increased serious complications, pre-operative functional status appears to have a much greater contribution to odds of serious complications and mortality. These findings question the utility of using ASA to risk stratify patients peri-operatively and provides evidence for using a simpler and more practical functional status approach.
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Affiliation(s)
- Sukhdeep Jatana
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
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15
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Kane AD, Soar J, Armstrong RA, Kursumovic E, Davies MT, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Cook TM. Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2023; 78:701-711. [PMID: 36857758 DOI: 10.1111/anae.15989] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.
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Affiliation(s)
- A D Kane
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - R A Armstrong
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - E Kursumovic
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - M T Davies
- Department of Critical Care and Anaesthesia, North West Anglia NHS Trust, UK
| | - F C Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - L Cortes
- Royal College of Anaesthetists, Red Lion Square, UK
| | - C Taylor
- Royal College of Anaesthetists, Red Lion Square, UK
| | - I K Moppett
- Royal College of Anaesthetists, Red Lion Square, UK.,University of Nottingham, UK
| | - S Agarwal
- Department of Anaesthesia, Manchester University Hospitals Foundation Trust, Manchester, UK
| | - J Cordingley
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - J Dorey
- Royal College of Anaesthetists, Red Lion Square, UK
| | - S J Finney
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - G Kunst
- Department of Cardiovascular Anaesthesia, Kings College London, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, UK
| | - G Nickols
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - R Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - J P Nolan
- Resuscitation Medicine, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - B Patel
- Royal College of Anaesthetists, Red Lion Square, UK
| | - V J Pappachan
- Southampton Children's Hospital, NIHR Biomedical Research Centre, Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - F Plaat
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - B R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - J H Smith
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - L Varney
- Department of Anaesthesia, University College London Hospitals, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,University of Bristol, UK
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Nay I, Hutchinson D, Rondina M, Kim K, Kroencke R, Kirkham A, Trujillo T, Tolley ND, Munger M. Prospective, randomized, controlled, trial to assess ASA DOSing by body mass index in HEalthy volunteers (DOSE study). Pharmacotherapy 2023; 43:215-225. [PMID: 36755519 DOI: 10.1002/phar.2777] [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: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
STUDY OBJECTIVE: Aspirin (ASA) has demonstrated inconsistent results in primary prevention of cardiovascular disease (CVD). Guidelines are also inconsistent in the recommendation of routine ASA use for primary prevention of CVD, but advocate dosing as a "one-size-fits-all" approach. DESIGN An intention-to-treat, double-blind, randomized, controlled, clinical trial comparing three treatment arms of ASA 81, 325, and 500 mg daily dosed for 14 days were evenly randomized across the dosing categories to measure the impact of dosing by body mass index (BMI) (20-24.9, 25-29.9, ≥30 kg/m2 ) on ASA anti-platelet effects. SETTING University Ambulatory Clinic. PATIENTS Healthy volunteers defined as individuals who were medication free without acute or chronic significant health problems. INTERVENTION Change in ASA reactivity unit (ARU), salicylate levels, and thromboxane B2 (TxB2) levels were measured across BMI dosing categories and time. MAIN RESULTS: Fifty-four participants with a mean (±SD) age of 34.4 ± 10.9 years (M:F; 23:31) completed the study. Baseline ARU and TxB2 levels were not significantly different between obese and non-obese individuals. BMI was not a predictor of platelet inhibition. There was no interaction between gender and platelet activation at baseline or following ASA treatment. ASA 81 mg was associated with a lower ARU response (approximate 50% lower response) than either the 325-mg or the 500-mg doses of ASA. TxB2 and salicylate levels exhibited lower trends at 81 mg compared with higher doses. CONCLUSIONS In healthy male and female participants administered ASA for 14 days, obesity is not associated with increased basal platelet activation or ASA resistance. ASA 81 mg was significantly less effective in reducing platelet aggregation compared with ASA 325 and 500 mg, independent of BMI.
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Affiliation(s)
- Isaac Nay
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
| | - Doug Hutchinson
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
| | - Matthew Rondina
- Molecular Medicine Program, Salt Lake City, Utah, USA.,Departments of Internal Medicine and Pathology, Salt Lake City, Utah, USA
| | - Kibum Kim
- University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Rachel Kroencke
- University of Utah Associated Regional University Pathologists, University of Utah Health, Salt Lake City, Utah, USA
| | - Amanda Kirkham
- University of Utah Associated Regional University Pathologists, University of Utah Health, Salt Lake City, Utah, USA
| | - Toby Trujillo
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colorado, USA
| | - Neal D Tolley
- Molecular Medicine Program, Salt Lake City, Utah, USA
| | - Mark Munger
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA.,University of Utah Associated Regional University Pathologists, University of Utah Health, Salt Lake City, Utah, USA
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Nguyen TV, Torabi SJ, Goshtasbi K, Lonergan AR, Salehi PP, Haidar YM, Tjoa T, Kuan EC. Frailty, Age, ASA Classification, and BMI on Postoperative Morbidity in Mandibular Fracture ORIF. Otolaryngol Head Neck Surg 2023; 168:1006-1014. [PMID: 36939550 DOI: 10.1002/ohn.181] [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: 07/07/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess how traditional, simple markers of health independently affect postoperative morbidity of mandibular fracture open reduction-internal fixations (ORIFs). STUDY DESIGN Cohort study. SETTING National Surgical Quality Improvement Project (NSQIP) Database. METHODS The 2005 to 2017 NSQIP database was queried for patients who underwent mandibular ORIF. To control for the severity of the trauma, an additional "concurrent surgery" variable was created. A modified 5-item frailty index was calculated based on the following: presurgery-dependent functional status, chronic hypertension, diabetes mellitus, history of chronic obstructive pulmonary disease, and history of congestive heart failure. RESULTS Among 1806 patients with mandibular ORIFs (mean age 34.8 ± 15.4 years), modified frailty index (mFI) was associated with 30-day medical complications (p < .001), reoperation (p < .001), and readmission (p = .005) on univariate analysis. Increased age was associated with prolonged hospitalization (p < .001) and medical complications (p < .001). The increased American Society of Anesthesiologists (ASA) score was associated with all endpoints (p ≤ .003), while increased body mass index (BMI) was associated with none. On multivariate analysis, only increased ASA was associated with any adverse event (reference: ASA 1; ASA 2, odds ratio [OR]: 2.17 [95% confidence interval, CI: 2.17-3.71], p = .004; ASA 3-4, OR: 3.63 [95% CI: 1.91-6.91], p < .001). Similarly, mFI and BMI were not independently associated with prolonged hospitalization (≥2 days) (p ≥ .015), but 65+ age (reference: 18-49; OR: 2.33 [95% CI: 1.40-3.86], p = .001) and ASA 3 to 4 groups (reference: ASA 1; OR: 3.26 [95% CI: 2.06-5.14], p < .001) were. CONCLUSION ASA status and age are more useful modalities than mFI or BMI in predicting poor postoperative morbidity in mandibular ORIF. These simple metrics can assist with managing surgeons' expectations for mandibular ORIF patients.
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Affiliation(s)
- Theodore V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Ashley R Lonergan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Parsa P Salehi
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
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Wang D, Zhao H, Xu C, Lin S, Guo Y. Enhancing neuroprotective effect of aminosalicylic acid-grafted chitosan electrospun fibers for spinal cord injury. Mater Today Bio 2023; 18:100529. [PMID: 36686034 PMCID: PMC9850028 DOI: 10.1016/j.mtbio.2022.100529] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/05/2023] Open
Abstract
The hyperinflammation microenvironment after spinal cord injury (SCI) remains a great challenge for neural regeneration. Methylprednisolone has been used to reduce the inflammatory response after SCI, but it is controversial due to side effects associated with off-specific targeting effects. In this study, we synthesized in situ 5-ASA grafted chitosan electrospun fibers (ASA-EF) with excellent injectable and self-healing properties to reprogram nerve cells via displaying biological distribution, gene expression, and functional changes. With the support of ASA-EF, the downregulation of inflammatory cytokines expression and the upregulation of anti-inflammatory and regenerative gene expression were found in vitro studies. Moreover, ASA-EF administration polarized macrophages toward proregenerative phenotypes in the injured lesion, and significantly reduced cavity area. In addition, ASA-EF administration increased myelination and regenerating axons and improved motor function (score of 5 versus 2 for SCI group). These results illustrate that the neuroprotective effect of this artificial nanoplatform will facilitate the clinical treatment of traumatic-related diseases via forming a recycled microenvironment that supports regeneration and functional recovery. These particles may be applied to trauma and potential other inflammatory diseases.
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Affiliation(s)
- Dahao Wang
- Department of Orthopedic, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China,Key Laboratory of Medical Tissue Engineering, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
| | - Haosen Zhao
- Key Laboratory of Medical Tissue Engineering, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
| | - Chang Xu
- Department of Orthopedic, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Sen Lin
- Key Laboratory of Medical Tissue Engineering, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China,Corresponding author.
| | - Yue Guo
- Department of Orthopedic, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China,Key Laboratory of Medical Tissue Engineering, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China,Corresponding author. Department of Orthopedic, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
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von Glinski M, Wallner C, Wagner JM, Dadras M, Sogorski A, Drysch M, Reinkemeier F, Voigt M, Lehnhardt M, Behr B. Free-flap reconstruction of the lower limb in octogenarians - A comparative analysis of indications, management, and outcomes. J Plast Reconstr Aesthet Surg 2023; 76:230-7. [PMID: 36527905 DOI: 10.1016/j.bjps.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Impaired microcirculation, along with an increase in chronic medical conditions in the geriatric cohort, may favor the development of soft-tissue defects in the lower extremity and equally impair the options for plastic-reconstructive surgery. In particular, outcome analyses in the increasing patient cohort ≥ 80 years (octogenarians) are limited. METHODS Setting 80 years as the cutoff, we conducted an age-related outcome analysis of all patients undergoing free-flap reconstruction of the lower extremity from 2014 to 2020, comprising the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI) as the possible outcome predicting factors. RESULTS During the study period, a total of 424 free flaps were performed in 385 patients (∅: 54.7 years ± 16.1; range: 9-89), including 19 octogenarians. Compared with the younger patient cohort, there was a significantly higher rate of early flap revision (p = 0.023) and flap loss (p = 0.028). Furthermore, the mean length of hospital (60.6 ± 37.6 vs. 51.1 ± 37.0) and intensive care unit/intermediate care stay (6.5 ± 15.0 vs. 3.5 ± 8.5) was extended (n.s.). The ASA score presented an independent predictor for major surgical [odds ratio (OR): 1.66; p = 0.041) and medical complications (OR: 3.97; p<0.001). Neither the CCI nor the ASA served as an independent predictor for total flap loss. CONCLUSION Free-flap reconstruction of the lower extremity in octogenarians is associated with a higher risk of flap revision and flap loss. Considering the prolonged immobilization associated with increased morbidity following limb amputation, it presents still a reasonable option to achieve limb salvage in carefully chosen patients. An adequate tool to predict the success of free-flap survival is still unavailable.
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20
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Chung K. Calibration matters: II. Measurement of ambient noise in test rooms/areas. J Commun Disord 2023; 101:106293. [PMID: 36580859 DOI: 10.1016/j.jcomdis.2022.106293] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Ambient noise measurement is a part of audiometric calibration in which one measures the ambient noise level in a sound room/test area intended for audiometric testing and then decides whether the background noise in the test room meets the maximum permissible ambient noise level (MPANL) requirements specified in national or international standards, e.g., ANSI/ASA S3.1:1999(R2018) or ISO 8253-1:2010 (R2021). If the ambient noise levels are below the MPANLs, clinicians can be sure that the test stimuli they present to patients are not masked by the background noise in the test room/area and their test results are valid and the subsequent clinical decisions are sound. Audiometric testing, however, may not always be carried out in sound rooms/test areas with ambient noise levels below the MPANLs, especially during community outreach or humanitarian services. A thorough understanding on the MPANL requirements for different transducers can help clinicians determine which equipment is appropriate for the test area. This tutorial discusses the rationale and assumptions behind the MPANL specifications, how to measure ambient noise levels of test rooms/areas, and how to apply the national and international standards to determine if the test room is suitable for audiometric testing. Alternative strategies are discussed when the ambient noise levels exceed the specified MPANLs. The rationale and procedures are explained using examples on how to lower the ambient noise levels in test areas, and how to determine the suitable test frequency range and the lowest threshold levels that can be assessed in the test area.
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Affiliation(s)
- King Chung
- Department of Allied Health and Communication Disorders, Northern Illinois University, United States.
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21
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Dominiak M, Gędek A, Sikorska M, Mierzejewski P, Wojnar M, Antosik-Wójcińska AZ. Acetylsalicylic Acid and Mood Disorders: A Systematic Review. Pharmaceuticals (Basel) 2022; 16. [PMID: 36678565 DOI: 10.3390/ph16010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
The effects of acetylsalicylic acid (ASA) on mood disorders (MD) and on inflammatory parameters in preclinical and clinical studies have not yet been comprehensively evaluated. The aim of this study was to systematically summarize the available knowledge on this topic according to PRISMA guidelines. Data from preclinical and clinical studies were analyzed, considering the safety and efficacy of ASA in the treatment of MD and the correlation of inflammatory parameters with the effect of ASA treatment. Twenty-one studies were included. Both preclinical and clinical studies found evidence indicating the safety and efficacy of low-dose ASA in the treatment of all types of affective episodes in MD. Observational studies have indicated a reduced risk of all types of affective episodes in chronic low-dose ASA users (HR 0.92, 95% CI: 0.88, 0.95, p < 0.0001). An association between ASA response and inflammatory parameters was found in preclinical studies, but this was not confirmed in clinical trials. Further long-term clinical trials evaluating the safety and efficacy of ASA in recurrent MD, as well as assessing the linkage of ASA treatment with inflammatory phenotype and cytokines, are required. There is also a need for preclinical studies to understand the exact mechanism of action of ASA in MD.
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22
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Su Z, Zhang Y, Zhao R, Zhou J. Enhancement of dissimilatory nitrate/nitrite reduction to ammonium of Escherichia coli sp. SZQ1 by ascorbic acid: Mechanism and performance. Sci Total Environ 2022; 853:158423. [PMID: 36055483 DOI: 10.1016/j.scitotenv.2022.158423] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Dissimilatory nitrate reduction to ammonium (DNRA) can be used for nitrogen recovery. However, due to the low conversion efficiency of the DNRA process of microorganisms, the process cannot be industrially applied. Ascorbic acid (ASA) can improve DNRA efficiency of Escherichia coli sp. SZQ1 (E. coli). Experimental studies suggest that 10 g L-1 ASA promoted DNRA process of E. coli at high concentrations of nitrite (10-20 mM). In the 5 g L-1 ASA system, 9.2 mM nitrite was reduced to 8.21 mM ammonium by E. coli in 120 h. Mechanistic studies reveal that ASA reduced the oxidation-reduction potential (ORP) of the system and scavenged reactive oxygen species (ROS) in the cell of E. coli. Meanwhile, ASA was utilized by E. coli as the sole carbon source and provided electrons to DNRA process through ASA metabolic pathways. This study proposes a new strategy for increasing the efficiency of DNRA.
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Affiliation(s)
- Zhiqiang Su
- Key Laboratory of Industrial Ecology and Environmental Engineering (MOE), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian 116024, PR China
| | - Yu Zhang
- Key Laboratory of Industrial Ecology and Environmental Engineering (MOE), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian 116024, PR China.
| | - Ruizhi Zhao
- Key Laboratory of Industrial Ecology and Environmental Engineering (MOE), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian 116024, PR China
| | - Jiti Zhou
- Key Laboratory of Industrial Ecology and Environmental Engineering (MOE), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian 116024, PR China.
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23
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Teoh JY, Ng CF, Eto M, Chiruvella M, Capitanio U, Esen T, Zeng G, Lechevallier E, Andonian S, de la Rosette J. Radical nephroureterectomy for UTUC conferred survival benefits irrespective of age and comorbidities. World J Urol 2022; 40:2657-65. [PMID: 36125506 DOI: 10.1007/s00345-022-04152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE We investigated the effects of age, American Society of Anesthesiologists Physical Status Classification (ASA) grading and Charlson Comorbidity Index (CCI) on the survival outcomes of upper tract urothelial carcinoma (UTUC). METHODS The CROES-UTUC registry was an international, multicenter study on patients with UTUC. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to their age (≤ 70 and > 70 years old) and ASA grade (I-II and III-V)/CCI (0-1 and ≥ 2). RESULTS A total of 2352 patients were included in this study. Patients aged ≤ 70 years with ASA grading of I-II (p = 0.002), and patients aged ≤ 70 years with a CCI of 0-1 (p = 0.002) had the best OS. Upon multivariate analysis, both in patients aged ≤ 70 and > 70 years, ASA grading and CCI were not significantly associated with OS. Patients aged ≤ 70 years with ASA grading of III-IV (p = 0.024) had the best DFS. When stratified according to age and CCI, no significant difference in DFS was noted. Upon multivariate analysis, radical nephroureterectomy (RNU) was significantly associated with better DFS in patients aged ≤ 70 and > 70 years; CCI of ≥ 3 was significantly associated with worse DFS in patients ≤ 70 years; ASA grading was not associated with DFS in patients aged ≤ 70 and > 70 years. CONCLUSIONS A high ASA grading and CCI should not be considered contraindications for RNU. RNU should be considered even in elderly patients when it is deemed feasible and achievable after a geriatric assessment.
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Elamin A, Tsoutsanis P, Sinan L, Tari SPH, Elamin W, Kurihara H. Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population. Surg J (N Y) 2022; 8:e270-e278. [PMID: 36172534 PMCID: PMC9512589 DOI: 10.1055/s-0042-1756461] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/28/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Numerous scoring systems have been created to predict the risk of morbidity and mortality in patients undergoing emergency general surgery (EGS). In this article, we compared the different scoring systems utilized at Humanitas Research Hospital and analyzed which one performed the best when assessing geriatric patients (>65 years of age). The scoring systems that were utilized were the APACHE II (Acute Physiology and Chronic Health Evaluation II), ASA (American Society of Anesthesiologists), ACS-NSQIP (American College of Surgeons-National Surgical Quality Improvement Program), Clinical Frailty Score, and the Clavien-Dindo classification as control. Materials and Methods We compiled a database consisting of all patients over the age of 65 who underwent EGS in a consecutive 24-month period between January 1, 2017 and December 31, 2018. We used the biostatistical program "Stata Version 15" to analyze our results. Results We found 213 patients who matched our inclusion criteria. Regarding death, we found that the ACS-NSQIP death calculator performed the best with an area under the curve of 0.9017 (odds ratio: 1.09; 95% confidence interval: 1.06-1.12). The APACHE II score had the lowest discriminator when predicting death. Considering short-term complications, the Clavien-Dindo classification scored highly, while both the APACHE II score and Clinical Frailty Score produced the lowest results. Conclusion The results obtained from our research showed that scoring systems and classifications produced different results depending on whether they were used to predict deaths or short-term complications among geriatric patients undergoing EGS.
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Affiliation(s)
- Abubaker Elamin
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Nottingham University Hospitals, Nottingham, United Kingdom,Address for correspondence Abubaker Elamin, MD Nottingham University HospitalsHucknall Rd, Nottingham NG5 1PBUnited Kingdom
| | - Panagiotis Tsoutsanis
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Ipswich Hospital, Ipswich, United Kingdom
| | - Laith Sinan
- Nottingham University Hospitals, Nottingham, United Kingdom
| | | | - Wafa Elamin
- Teesside University, Middlesbrough, United Kingdom
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25
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Nishibeppu K, Sakuramoto S, Matsui K, Ebara G, Fujita S, Fujihata S, Oya S, Lee S, Miyawaki Y, Sugita H, Sato H, Yamashita K. Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists ( ASA) 3. Langenbecks Arch Surg 2022; 407:3413-3421. [PMID: 36066671 DOI: 10.1007/s00423-022-02672-9] [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: 10/23/2021] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although the American Society of Anesthesiologists (ASA) score of 3 is relatively common in elderly patients, there have been few debates on the indications for gastrectomy in elderly gastric cancer (GC) patients with ASA3. Therefore, this study aimed to investigate gastrectomy's clinical relevance in elderly patients with GC and ASA3. METHODS We retrospectively analyzed 228 consecutive elderly GC patients (aged ≥ 75 years) without prior treatments who underwent curative gastrectomy between 2013 and 2017. RESULTS Thirty-three patients with ASA3 showed significantly poorer prognosis than those with ASA1 and 2 (p = 0.004). The multivariate Cox proportional hazards model showed that ASA3 (p = 0.021) and pStage (p = 0.007) were independent prognostic factors, respectively. Elderly GC patients with pStage III and ASA3 exhibited uniquely dismal prognosis (p < 0.001); however, several survivors were still confirmed. Postoperative complications (PCs) were only the final remnant independent prognostic factor (p = 0.020) among the 33 elderly GC patients with ASA3, where dead patients included cancer-specific and other deaths, especially pneumonia. PCs were independently associated with prognostic nutritional index (PNI) (< 42.7) in elderly GC patients, and the most frequent complication was pneumonia, which was significantly associated with ASA3 and marginally associated with PNI in a multivariate analysis. CONCLUSIONS ASA3 has a dismal prognosis after curative gastrectomy in the elderly GC patients, but the number of survivors was confirmed. Curative gastrectomy is not considered contraindicated even in elderly GC with ASA3. Preoperative malnutrition is associated with PCs, which proposing preoperative nutritional intervention in the context of treatment strategy for the elderly GC patients with ASA3.
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Affiliation(s)
- Keiji Nishibeppu
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Shinichi Sakuramoto
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kazuaki Matsui
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Gen Ebara
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shohei Fujita
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shiro Fujihata
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Seigi Lee
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keishi Yamashita
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
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26
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Biernawska J, Kotfis K, Szymańska-Pasternak J, Bogacka A, Bober J. Long-Term Consequences of Increased Activity of Urine Enzymes After Cardiac Surgery - A Prospective Observational Study. Ther Clin Risk Manag 2022; 18:867-877. [PMID: 36051850 PMCID: PMC9427009 DOI: 10.2147/tcrm.s371288] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Cardiac surgery associated AKI (CSA-AKI) complicates recovery and may be associated with a greater risk of developing chronic kidney disease and mortality. The aim of this study was to assess long-term clinical consequences of transient increased activity of urinary enzymes after cardiac surgery (CS). Methods An observational study was conducted in a group of 88 adult patients undergoing planned coronary artery bypass grafting (CABG), but all samples were obtained from 79 patients. The activity of urinary enzymes: N-acetyl-beta-glucosaminidase (NAG), arylsulfatase A (ASA) and beta-glucuronidase was evaluated in sequential urine samples. A comparative analysis of biochemical parameters was performed regarding the occurrence of acute kidney injury (AKI) defined by KIDGO at 24 hours, at day 30 and 5-years after the operation. Results During the first 24 hours after CS AKI was diagnosed in 13 patients. A comparison of the activity of urinary enzymes in pre-defined time-points showed significant differences for ASA and NAG (post OP-sample p < 0.028 and p < 0.022; POD 1 sample p < 0.004 and p < 0.001 respectively). No patient had any biochemical or clinical features of kidney failure at day 30. In the AKI group kidney failure was diagnosed in 36% of patients within 5 years of follow-up as opposed to 5% in the no AKI group. The activities of tubular enzymes in urine reflect a general injury of kidney tubules during and after the operation. However, they are not ideal biomarkers for prediction of the degree of kidney injury and further poor prognosis of CS-AKI.
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Affiliation(s)
- Jowita Biernawska
- Department of Anesthesiology and Intensive Therapy, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | | | - Anna Bogacka
- Department of Commodity Science, Quality Assessment, Process Engineering and Human Nutrition, West Pomeranian University of Technology, Szczecin, Poland
| | - Joanna Bober
- Department of Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
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Moreno-Sanchez D, Sanz de León A, Moreno Nieto D, Delgado FJ, Molina SI. B asalt Fiber Composites with Reduced Thermal Expansion for Additive Manufacturing. Polymers (Basel) 2022; 14:polym14153216. [PMID: 35956730 PMCID: PMC9370959 DOI: 10.3390/polym14153216] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/27/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
Fused filament fabrication (FFF) is gaining attention as an efficient way to create parts and replacements on demand using thermoplastics. This technology requires the development of new materials with a reliable printability that satisfies the requirement of final parts. In this context, a series of composites based on acrylonitrile styrene acrylate (ASA) reinforced with basalt fiber (BF) are reported in this work. First, several surface modification treatments are applied onto the BF to increase their compatibility with the ASA matrix. Then, once the best treatment is identified, the mechanical properties, coefficient of thermal expansion (CTE) and warping distortion of the different specimens designed and prepared by FFF are studied. It was found that the silanized BF is appropriate for an adequate printing, obtaining composites with higher stiffness, tensile strength, low CTE and a significant reduction in part distortion. These composites are of potential interest in the design and manufacturing of final products by FFF, as they show much lower CTE values than pure ASA, which is essential to successfully fabricate large objects using this technique.
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Affiliation(s)
- Daniel Moreno-Sanchez
- Departamento de Ingeniería Mecánica y Diseño Industrial, Escuela Superior de Ingeniería, IMEYMAT, Universidad de Cádiz, Campus Río San Pedro s/n, 11510 Puerto Real, Spain
- Correspondence:
| | - Alberto Sanz de León
- Departamento de Ciencia de los Materiales e I. M. y Q. I., Facultad de Ciencias, IMEYMAT, Universidad de Cádiz, Campus Río San Pedro s/n, 11510 Puerto Real, Spain
| | - Daniel Moreno Nieto
- Departamento de Ingeniería Mecánica y Diseño Industrial, Escuela Superior de Ingeniería, IMEYMAT, Universidad de Cádiz, Campus Río San Pedro s/n, 11510 Puerto Real, Spain
| | - Francisco J. Delgado
- Departamento de Ciencia de los Materiales e I. M. y Q. I., Facultad de Ciencias, IMEYMAT, Universidad de Cádiz, Campus Río San Pedro s/n, 11510 Puerto Real, Spain
| | - Sergio I. Molina
- Departamento de Ciencia de los Materiales e I. M. y Q. I., Facultad de Ciencias, IMEYMAT, Universidad de Cádiz, Campus Río San Pedro s/n, 11510 Puerto Real, Spain
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Miilunpohja S, Jyrkkä J, Kärkkäinen JM, Kastarinen H, Heikkinen M, Paajanen H, Rantanen T, Hartikainen J. Discontinuing low-dose acetylsalicylic acid after gastrointestinal bleeding is associated with increased mortality. Scand J Gastroenterol 2022; 57:618-624. [PMID: 35041575 DOI: 10.1080/00365521.2022.2026461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrointestinal bleeding is a common clinical problem in patients using low-dose acetylsalicylic acid (ASA). It is uncertain whether aspirin should continue to be used in patients who develop acute gastrointestinal bleeding during low-dose ASA therapy. AIMS To assess whether ASA should be continued in patients who develop GI bleeding during low-dose ASA. METHODS All patients admitted to an academic hospital for acute gastrointestinal bleeding between 2009 and 2011 were reviewed retrospectively. Clinical characteristics, comorbidities, medications and treatments were recorded from the patient records. Patients were divided into two groups based on continuing or discontinuing ASA after discharge. RESULTS A total of 548 patients were included. ASA was continued in 282 (51.5%) (ASAc group) and discontinued in 266 (48.5%) patients (ASAd group). ASAc patients had more often coronary artery disease (57.8% vs. 42.5%, p < .001) and peripheral artery disease (17.4% vs. 9.0%, p = .004) than ASAd patients, whereas no differences were found in other comorbidities. There was no difference in 30-day all-cause mortality between ASAd and ASAc groups. However, after adjustment for age, gender and comorbidities, one-year all-cause mortality was double in the ASAd group (hazard ratio 2.16, 95% confidence interval 1.39-3.35). ASAd and ASAc groups did not differ with respect to cardiovascular mortality (4.9% vs. 5.3%, p = .811, respectively) or re-bleeding (10.2% vs. 9.2%, p = .713, respectively). CONCLUSION Continuing low-dose ASA after gastrointestinal bleeding was associated with lower all-cause mortality during the first year without increasing the risk of re-bleeding.
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Affiliation(s)
- Sami Miilunpohja
- Heart Centre, Kuopio University Hospital, Kuopio, Finland.,Emergency Department, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland
| | - Jussi M Kärkkäinen
- Heart Centre, Kuopio University Hospital, Kuopio, Finland.,Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Helena Kastarinen
- Insurance Medicine Unit, The Social Insurance Institution of Finland, Kuopio, Finland
| | - Markku Heikkinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Paajanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- Heart Centre, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Taylor GA, Acevedo E, Kling SM, Kuo LE. Predicting Outcomes in Thyroidectomy and Parathyroidectomy: The Modified Five-Point Frailty Index Versus American Society of Anesthesiologists Classification. J Surg Res 2022; 276:83-91. [PMID: 35339784 DOI: 10.1016/j.jss.2022.02.044] [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: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Thyroidectomy and parathyroidectomy are relatively safe procedures, with overall morbidity rates of 2%-5%. The increasing age is associated with higher likelihood of poor outcomes. The modified five-point frailty index (mFI-5) is associated with complications, but many surgeons are unfamiliar with mFI-5. We assessed the accuracy of the mFI-5 versus the commonly-used American Society of Anesthesiologists (ASA) classification to predict complications following thyroidectomy and parathyroidectomy. METHODS Patients undergoing thyroidectomy or parathyroidectomy in 2015-2018 NSQIP datasets were identified. The mFI-5 scores were calculated by adding the number of the following comorbidities: congestive heart failure, hypertension requiring medication, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status. Receiver operating characteristics curves were plotted for 30-d mortality and serious morbidity (defined as deep surgical site infection, dehiscence, unplanned intubation, failure to wean from the ventilator 48-h postoperatively, acute renal failure, pneumonia, pulmonary embolism, myocardial infarction, cardiac arrest requiring cardiopulmonary resuscitation, sepsis, septic shock, cerebrovascular accident, or reoperation) using mFI-5 and ASA classification. Areas under these curves (AUC) were compared. RESULTS Ninety-two thousand, six hundred and ninety-one patients were studied. The mFI-5 and ASA were fair predictors of 30-d mortality (AUC 0.75 and 0.82, respectively) and good predictors of serious morbidity (AUC 0.61 and 0.64). After stratification by age, ASA was superior to mFI-5 in predicting mortality for patients aged 65, 70, 80 y, and older, for the entire population and for thyroidectomy and parathyroidectomy separately. CONCLUSIONS The ASA classification is a better predictor of mortality and serious morbidity than mFI-5 among patients undergoing thyroidectomy or parathyroidectomy and may be a better prognostic indicator to use when counseling patients before low-risk neck surgery.
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Affiliation(s)
- George A Taylor
- Temple University Hospital, Department of Surgery, Philadelphia, Pennsylvania.
| | - Edwin Acevedo
- Temple University Hospital, Department of Surgery, Philadelphia, Pennsylvania
| | - Sarah M Kling
- Temple University Hospital, Department of Surgery, Philadelphia, Pennsylvania
| | - Lindsay E Kuo
- Temple University Hospital, Department of Surgery, Philadelphia, Pennsylvania; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Rios-Ibarra CP, Verduzco-Garza B, Ortiz-Lopez R, Grondin Y, Salinas-Santander M, Arvizu-Gutierrez LA, Sanchez-Salazar MG, Cervantes-Astorga E, Orozco-Nunnelly DA, Rivas-Estilla AM. Transcriptional Profile of HCV Replicon Cells after Treatment with Acetylsalicylic Acid. Ann Clin Lab Sci 2022; 52:222-229. [PMID: 35414501] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE It has been demonstrated in vitro that acetylsalicylic acid (ASA) treatment halves hepatitis C virus (HCV) expression in hepatocarcinoma cells. However, the signaling pathway that promotes this ASA-induced antiviral effect has not yet been identified. AIM The aim of this work was to identify alterations in the transcriptional profile of Huh-7-HCV-subgenomic replicon cells with vs. without ASA treatment. This comparison sheds light onto the signaling pathways and molecular mechanisms involved in the antiviral effects of ASA. METHODS Human hepatocellular carcinoma (Huh-7) cells that express non-structural HCV proteins (Huh-7-HCV-replicon cells) were exposed to 4 mM ASA for 0, 24, 48, and 72 hours. Total RNA was isolated, and cDNA was synthesized. Transcripts were then tagged with biotin and purified. Thereafter, they were fragmented and hybridized on HG-U133 Plus 2 Gene Expression chips. Hybridization signals were captured using a GeneChip 3000 7G Scanner and analyzed via Expression Console and dChip Software. RESULTS When exposed to ASA, hepatocarcinoma cells with non-structural HCV proteins were found to differentially regulate genes with oxidative roles in the cell. The most upregulated genes were interleukin 8 (IL-8), cytochrome P450 (CYP450), and metallothioneins (MTs), while the most downregulated genes were ribonucleotide reductases (RRs). CONCLUSION These results show that ASA modulates the expression of genes with antioxidant functions. This suggests that ASA induces a remodeling of the antioxidant microenvironment, which may in turn interfere with the replication of HCV.
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Affiliation(s)
- Clara Patricia Rios-Ibarra
- Department of Biochemistry and Molecular Medicine, School of Medicine, Autonomous University of Nuevo Leon, Mexico, USA
| | | | - Rocio Ortiz-Lopez
- CIDCS, Autonomous University of Nuevo Leon, Mexico, USA
- Tecnologico de Monterrey, Escuela de Medicina, campus Monterrey, Mexico, USA
| | | | | | | | | | | | | | - Ana Maria Rivas-Estilla
- Department of Biochemistry and Molecular Medicine, School of Medicine, Autonomous University of Nuevo Leon, Mexico, USA
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Di Bella S, Luzzati R, Principe L, Zerbato V, Meroni E, Giuffrè M, Crocè LS, Merlo M, Perotto M, Dolso E, Maurel C, Lovecchio A, Dal Bo E, Lagatolla C, Marini B, Ippodrino R, Sanson G. Aspirin and Infection: A Narrative Review. Biomedicines 2022; 10:biomedicines10020263. [PMID: 35203473 PMCID: PMC8868581 DOI: 10.3390/biomedicines10020263] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
Acetylsalicylic acid (ASA) is one of the most commonly used drugs in the world. It derives from the extract of white willow bark, whose therapeutic potential was known in Egypt since 1534 BC. ASA’s pharmacological effects are historically considered secondary to its anti-inflammatory, platelet-inhibiting properties; however, human studies demonstrating a pro-inflammatory effect of ASA exist. It is likely that we are aware of only part of ASA’s mechanisms of action; moreover, the clinical effect is largely dependent on dosages. During the past few decades, evidence of the anti-infective properties of ASA has emerged. We performed a review of such research in order to provide a comprehensive overview of ASA and viral, bacterial, fungal and parasitic infections, as well as ASA’s antibiofilm properties.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy;
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Elisa Meroni
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy;
| | - Mauro Giuffrè
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
- Correspondence: ; Tel.: +39-040-3994-305
| | - Lory Saveria Crocè
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Marco Merlo
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Maria Perotto
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Elisabetta Dolso
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Cristina Maurel
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Antonio Lovecchio
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Eugenia Dal Bo
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Cattinara University Hospital, 34149 Trieste, Italy;
| | - Cristina Lagatolla
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Bruna Marini
- Ulisse BioMed Labs, Area Science Park, 34149 Trieste, Italy; (B.M.); (R.I.)
| | - Rudy Ippodrino
- Ulisse BioMed Labs, Area Science Park, 34149 Trieste, Italy; (B.M.); (R.I.)
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
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Chapman EK, Scherschinski L, Gal JS, Shuman WH, Doctor T, Neifert SN, Martini ML, McNeill IT, Yuk FJ, Schupper AJ, Caridi JM. The Impact of ASA Status on Cost of Care and Length of Stay Following Posterior Cervical Decompression and Fusion. World Neurosurg 2021; 161:e54-e60. [PMID: 34856400 DOI: 10.1016/j.wneu.2021.11.100] [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: 09/25/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Increasing numbers of posterior cervical decompression and fusion (PCDF) over the past decade have raised the prospect of bundled payment plans. The American Society of Anesthesiologists (ASA) Physical Status Classification system may enable accurate estimation of healthcare costs, length of stay, and other postoperative outcomes in PCDF patients. OBJECTIVE To evaluate correlations between ASA and postoperative outcomes, length of stay (LOS), and healthcare costs in patients undergoing PCDF. METHODS 971 patients that underwent PCDF between 2008 and 2016 at a single institution were evaluated by low (I and II) versus high (III and IV) ASA. Demographics were compared using univariate analysis. Cost of care, LOS and postoperative complications were compared using multivariable logistic and linear regression, controlling for gender, age, length of surgery and number of segments fused. RESULTS The high ASA cohort had greater mean age (62 vs. 55, p<0.0001) and higher Elixhauser comorbidity index (ECI) scores (p<0.0001). ASA was independently associated with longer LOS (+2.1 days, CI: 1.3-2.9; p<0.0001) and higher cost (+$2,936, CI: $1,457-$4,415; p<0.0001). High ASA patients were more likely to have a non-home discharge (3.9, 95% CI 2.8-5.6, p<0.0001), delayed extubation (3.2, 95% CI 1.4-7.3, p=0.006), ICU stay (2.4, 95% CI 1.5-3.7, p=0.0001), in-hospital complications (1.5, 95% CI 1.0-2.2, p=0.03) and 30-day (3.2, 95% CI 1.5-6.8, p=0.003) and 90-day (3.2, 95% CI 1.8-5.7, p=0.0001) readmission. CONCLUSIONS High ASA is strongly associated with increased costs, LOS and adverse outcomes following PCDF. Therefore, ASA could be useful for preoperative prediction of these outcomes.
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Affiliation(s)
- Emily K Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Lea Scherschinski
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tahera Doctor
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ian T McNeill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Frank J Yuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Caridi
- Department of Neurosurgery, UT Health, Houston, TX, USA
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Clements H, El Boghdady M, Alijani A. Acute surgical admissions at the end of life-an analysis of non-operative hospital deaths. Surgeon 2021; 20:351-355. [PMID: 34840066 DOI: 10.1016/j.surge.2021.09.003] [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: 06/05/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. METHODS This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. RESULTS A total of 72 patients were included in this study, of which 68.1% died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. CONCLUSION Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.
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Affiliation(s)
- Hollie Clements
- Department of General Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Michael El Boghdady
- Department of General Surgery, Kingston Hospital NHS Foundation Trust, London, UK; St George's University, London, UK.
| | - Afshin Alijani
- Department of General Surgery, Ninewells Hospital and Medical School, Dundee, UK
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Martin EC, Goshtasbi K, Birkenbeuel JL, Abiri A, Lehrich BM, Mohyeldin A, Hsu FPK, Kuan EC. The association of frailty, age, and ASA classification with postoperative outcomes in minimally invasive pituitary surgery. Int Forum Allergy Rhinol 2021; 12:780-783. [PMID: 34821057 DOI: 10.1002/alr.22916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Elaine C Martin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Orange, Irvine, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Orange, Irvine, California, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Orange, Irvine, California, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Orange, Irvine, California, USA
| | - Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Orange, Irvine, California, USA
| | - Ahmed Mohyeldin
- Department of Neurological Surgery, University of California, Orange, Irvine, California, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Orange, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Orange, Irvine, California, USA.,Department of Neurological Surgery, University of California, Orange, Irvine, California, USA
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Gangakhedkar GR, Solanki SL, Divatia JV. ASA-ECOG as a combined tool for peri-operative risk stratification in COVID-19 survivors - A step towards optimizing healthcare resource utilization. Int J Surg 2021; 95:106062. [PMID: 34403792 PMCID: PMC8364169 DOI: 10.1016/j.ijsu.2021.106062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Gauri R Gangakhedkar
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
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Peppas S, Sagris M, Bikakis I, Giannopoulos S, Tzoumas A, Kokkinidis DG, Ahmed Z, Korosoglou G, Malgor EA, Malgor RD. A Systematic Review and Meta-analysis on the Efficacy and Safety of Direct Oral Anticoagulants in Patients with Peripheral Artery Disease. Ann Vasc Surg 2021; 80:1-11. [PMID: 34644644 DOI: 10.1016/j.avsg.2021.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND-OBJECTIVE PAD is a significant cause of morbidity and mortality affecting over 200 million people worldwide. Current guidelines recommend at least a single antiplatelet or anticoagulant agent in symptomatic PAD and lifelong antithrombotic treatment after a revascularization procedure. The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with peripheral artery disease (PAD). PAD is a significant cause of morbidity and mortality affecting over 200 million people worldwide. METHODS The present systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Risk ratios (RR) were calculated using the random effects model. RESULTS Overall, ten studies were included in this systematic review and meta-analysis. In four studies, 14,257 patients with PAD were enrolled and they were assigned to receive either aspirin (ASA)+/- clopidogrel (N=5,894) or DOAC+/- anti-platelet (e.g., ASA, clopidogrel) (N=8,363). Non DOAC users were found to have higher reintervention rates (RR 1.12; 95% CI 1.01-1.24; p=0.025) compared to DOAC users. No statistically significant difference was observed between the two groups, in terms of major bleeding (RR 0.78; 95% CI 0.50-1.23; p=0.285), all-cause mortality (RR 0.98; 95% CI: 0.83-1.16; p=0.818) and cardiovascular mortality (RR: 0.99; 95% CI: 0.73-1.333; p=0.946) mortality. In addition, two real-world studies comparing DOAC with warfarin showed decreased rates of major cardiovascular events in the DOAC group. CONCLUSIONS DOAC use alone or combined with an anti-platelet agent could be associated with lower re-intervention rates, without increasing the risk for adverse bleeding events. However, this study failed to detect any difference in terms of all-cause mortality, MACEs and MALEs between DOAC users and DOAC naïve patients. Future studies are needed to better determine the efficacy and safety of DOACs in patients with PAD.
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Affiliation(s)
- Spyros Peppas
- Second Department of Internal Medicine, Athens Naval Hospital, Athens, Greece
| | | | - Iosif Bikakis
- 401 General Military Hospital of Athens, Athens, Greece; Society of Junior Doctors, Athens, Greece
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | | | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, New Haven, CT, USA
| | - Zain Ahmed
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, New Haven, CT, USA
| | | | - Emily A Malgor
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz Medical Center, Aurora, CO
| | - Rafael D Malgor
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz Medical Center, Aurora, CO.
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Cher EWL, Carson JA, Sim EY, Abdullah HR, Howe TS, Koh Suang Bee J. Developing a Simpler Prognosticating Tool: Comparing the Combined Assessment of Risk Encountered in Surgery Score with Deyo-Charlson Comorbidity Index and The American Society of Anesthesiologists Physical Status Score in Predicting 2 years Mortality after Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2021; 12:21514593211036235. [PMID: 34595044 PMCID: PMC8477708 DOI: 10.1177/21514593211036235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo–Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. Age, gender, time to surgery, ASA-PS score, D-CCI, and CARES score were obtained. Univariate and multivariable logistic regression analyses were used to assess statistical significance of scores and risk factors, and area under the receiver operating characteristic (ROC) curve (AUC) was used to compare ASA-PS, D-CCI, and CARES as predictors of mortality at 2 years. Results: 763 surgically treated hip fracture patients were included in this study. The 2-year mortality rate was 13.1% (n = 100), and the mean ± SD CARES score of surviving and demised patients was 21.2 ± 5.98 and 25.9 ± 5.59, respectively. Using AUC, CARES was shown to be a better predictor of 2-year mortality than ASA-PS, but we found no statistical difference between CARES and D-CCI. A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for “high” risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.
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Affiliation(s)
- Eric Wei Liang Cher
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - John Allen Carson
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Eileen Yilin Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | | | - Tet Sen Howe
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Joyce Koh Suang Bee
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
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Matijakovich D, Solomon D, Benitez CL, Huang HH, Poeran J, Berger N, Lebaschi A, Seneviratne A. Long-term follow-up of perianchor cyst formation after rotator cuff repair. JSES Int 2021; 5:863-868. [PMID: 34505097 PMCID: PMC8411048 DOI: 10.1016/j.jseint.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/24/2022] Open
Abstract
Background Perianchor cyst formation (PCF) can occur after arthroscopic rotator cuff repair with poly-L-lactic acid (PLLA) anchors; however, little is known about PCF after all-suture anchor (ASA) use. Methods We reviewed patients who underwent double-row arthroscopic rotator cuff repair from 2012 to 2017 with ASAs implanted in the medial row and PLLA anchors in the lateral row. We evaluated PCF (graded on magnetic resonance imaging) and compared physical examination and functional surveys between patients with PCF (WC) and without PCF (WoC) at long-term follow-up. Results Among twenty-two patients (23 shoulders), 93% of PLLA anchors (vs. 79% ASA) displayed a grade 0 PCF, P = .100. No PLLA anchors had a grade 3 or 4 PCF, compared to 11% of ASAs, P = .158. At a mean postoperative follow-up time of 113 weeks, there was no significant difference between WC and WoC cohorts with regard to range of motion, rotator cuff strength, American Shoulder and Elbow Surgeons survey scores, or retear rates. However, the WoC cohort had a significantly higher University of California at Los Angeles shoulder survey score at final follow-up (34.3 WoC vs. 30.9 WC, P = .024). Conclusion No difference was found in PCF between ASAs and PLLA anchors. At long-term follow-up, WoC patients had significantly improved functional outcome scores, based on the University of California at Los Angeles survey, but equivalent range of motion and rotator cuff strength examinations compared with WC patients.
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Affiliation(s)
| | - David Solomon
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | | | - Hsin-Hui Huang
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalie Berger
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amir Lebaschi
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Aruna Seneviratne
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
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Haugan K, Klaksvik J, Foss OA. 30-day mortality in patients after hip fracture surgery: A comparison of the Charlson Comorbidity Index score and ASA score used in two prediction models. Injury 2021; 52:2379-2383. [PMID: 33581871 DOI: 10.1016/j.injury.2021.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) Physical Status Classification used in two prediction models for 30-day mortality after hip fracture surgery. STUDY DESIGN AND SETTING Data from 3651 patients (mean age: 83 years) from a Norwegian University Hospital were retrospectively obtained and randomly divided into two cohorts: a model cohort (n = 1825) to develop two prediction models with CCI and ASA as the main predictors, and a validation cohort (n = 1826) to assess the predictive ability of both models. A receiver operating characteristic (ROC) curve determined the best model to predict mortality. RESULTS Area under the ROC curve at 30 days was 0.726 (p = 0.988) for both the CCI- and ASA-model. The chosen cut-off-points on the ROC curve for CCI- and ASA-model corresponded to similar model sensitivities of 0.657 and specificities of 0.680 and 0.679, respectively. Hence, each model predicts correctly 66% (n = 96) of the mortalities and 68% (n = 1132 and n = 1131) of the survivals. 23% (n = 33) of the mortalities were predicted by neither model. CONCLUSION The CCI- and ASA-model had equal predictive ability of 30-day mortality after hip fracture. Considering the effort involved in calculating Charlson Comorbidity Index score, the ASA score may be the preferred tool to predict the 30-day mortality after hip fracture.
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Affiliation(s)
- Kristin Haugan
- Orthopaedic Department, Orthopaedic Research Centre, St.Olavs Hospital, Trondheim University Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Faculty of Medicine and Health Sciences, N-7491 Trondheim, Norway.
| | - Jomar Klaksvik
- Orthopaedic Department, Orthopaedic Research Centre, St.Olavs Hospital, Trondheim University Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway
| | - Olav A Foss
- Orthopaedic Department, Orthopaedic Research Centre, St.Olavs Hospital, Trondheim University Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Faculty of Medicine and Health Sciences, N-7491 Trondheim, Norway
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Qi Y, Zhang R, Zhang M, Wen Q, Shen J. Effects of exogenous ascorbic acid on the mycelia growth and primordia formation of Pleurotus ostreatus. J Basic Microbiol 2021; 61:736-744. [PMID: 34252217 DOI: 10.1002/jobm.202100143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/23/2021] [Revised: 05/21/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
Primordia formation is the first and most critical step in the development of fruiting bodies of edible fungi. In this study, the effects of exogenous ascorbic acid (ASA) on the Pleurotus ostreatus mycelia growth and primordia formation were researched and the results showed that the growth rate of P. ostreatus mycelia was accelerated and the time of primordia formation was advanced. The protein content and ascorbate oxidase (AAO) activity analysis showed that with the increase of ASA concentration, the protein content of mycelia first decreased and then increased, and in a certain concentration range, exogenous ASA could significantly promote the activity of AAO. Further expression analysis of the development regulating genes (Pofst3 and Pofst4) as well as blue light receptor coding genes (PoWC-1 and PoWC-2) showed the expression levels of those four genes all changed after the exogenous ASA addition, which indicated that the expression changes of PoWC-1 and PoWC-2, two key genes in the light morphogenesis, might affect the expression levels of development regulating genes Pofst3 and Pofst4, so as to lead to the formation of primordia in advance.
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Affiliation(s)
- Yuancheng Qi
- College of Life Sciences, Henan Agricultural University, Zhengzhou, China
| | - Ruixia Zhang
- College of Life Sciences, Henan Agricultural University, Zhengzhou, China
| | - Mengke Zhang
- College of Life Sciences, Henan Agricultural University, Zhengzhou, China
| | - Qing Wen
- College of Life Sciences, Henan Agricultural University, Zhengzhou, China
| | - Jinwen Shen
- College of Life Sciences, Henan Agricultural University, Zhengzhou, China
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Heise D, Bednarsch J, Kroh A, Eickhoff R, Coolsen MME, van Dam R, Lang SA, Neumann UP, Ulmer F. Safety of laparoscopic hepatectomy in patients with severe comorbidities - A propensity score matched analysis. J Hepatobiliary Pancreat Sci 2021; 29:609-617. [PMID: 34245125 DOI: 10.1002/jhbp.1020] [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] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/22/2021] [Accepted: 07/06/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Laparoscopic hepatectomy (LH) is nowadays considered as the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after LH in patients with severe comorbidities are still sparse. METHODS 247 patients, who underwent LH between January 2016 and March 2020 at European surgical center Aachen Maastricht (ESCAM) were retrospectively analyzed regarding surgical outcome. All patients were categorized according to the ASA guidelines and a propensity score matched (PSM) analysis was performed to compare patients with severe comorbidities with patients with minor or no comorbidities. RESULTS After PSM, no statistically significant differences regarding clinical characteristics were observed. We performed major resections in 26.4% of h-ASA (ASA > 2) patients and 19.4% of l-ASA (ASA≤2) patients, respectively (P = .322). Overall morbidity (Clavien-Dindo≥1) was observed more frequently in the h-ASA group (h-ASA: 25.0% vs. l-ASA: 8.3%; P = .007) while analysis of major morbidity (Clavien-Dindo≥3b) showed a non-significant tendency for more complications in h-ASA patients (h-ASA: 8.3% vs. l-ASA: 1.4%; P = .053). A subgroup analysis identified major resection (HR = 5.05; P = .006) as an independent risk factor for the occurrence of any postoperative complication and chronic kidney disease (HR = 22.59; P = .030) and liver fibrosis (HR = 30.16; P = .031) as risk factors for the occurrence of major complications in h-ASA patients. CONCLUSION LH in patients with severe systemic comorbidities shows a strong tendency towards an increased rate of major complications. Careful patient selection with respect to the planned extent of resection and the presence of chronic kidney disease and liver fibrosis should be performed to improve perioperative results.
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Affiliation(s)
- Daniel Heise
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Kroh
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Roman Eickhoff
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Marielle M E Coolsen
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Ronald van Dam
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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Goshtasbi K, Birkenbeuel JL, Abiri A, Lehrich BM, Kuan EC. The association of frailty, age, and ASA classification with postoperative outcomes in endoscopic sinus surgery. Int Forum Allergy Rhinol 2021; 11:1596-1598. [PMID: 34047453 DOI: 10.1002/alr.22829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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Siwik D, Gajewska M, Karoń K, Pluta K, Wondołkowski M, Wilimski R, Szarpak Ł, Filipiak KJ, Gąsecka A. Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting-Beyond Platelet Inhibition. J Clin Med 2021; 10:2317. [PMID: 34073241 PMCID: PMC8198192 DOI: 10.3390/jcm10112317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/23/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/05/2023] Open
Abstract
Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients.
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Affiliation(s)
- Dominika Siwik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Magdalena Gajewska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Katarzyna Karoń
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Kinga Pluta
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Mateusz Wondołkowski
- Department of Cardiac Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.W.); (R.W.)
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.W.); (R.W.)
| | - Łukasz Szarpak
- Bialystok Oncology Center, 15-027 Bialystok, Poland;
- Maria Sklodowska-Curie Medical Academy in Warsaw, 00-001 Warsaw, Poland
| | - Krzysztof J. Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
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Gupta P, Kang KK, Pasternack JB, Klein E, Feierman DE. Perioperative Transfusion Associated With Increased Morbidity and Mortality in Geriatric Patients Undergoing Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2021; 12:21514593211015118. [PMID: 34035979 PMCID: PMC8132085 DOI: 10.1177/21514593211015118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/11/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Both conservative and liberal transfusion thresholds, in regard to hematocrit and hemoglobin levels, have been widely studied with varying outcomes. The aim of this study was to evaluate if transfusion administered peri- (anytime during the admission), pre-, intra-, or postoperatively an its association with morbidity and mortality in the geriatric population undergoing hip surgery. Methods: This study was an institutional review board approved retrospective analysis of data collected from 841 patients at a single urban institution who underwent surgical repairs for hip fractures from 2008 to 2010. Results: Our analysis included data from 841 surgical patients. Mean patient age was 83, 74% were female, 48% received spinal anesthesia while 52% underwent general anesthesia. Out of 841 patients, 425 were transfused during the perioperative period. Most transfusions occurred postoperatively. Perioperative, intraoperative and postoperative transfusion was associated with an increase in post-operative AKI. Intraoperative blood transfusion was associated with an increase in morbidity (11.6% increased to 22.2%) by 1.9 fold, AKI (3.9% increased to 11.1%) by 2.8 fold, as well as an increase in mortality (5.2 increased to 15.6%) within 60 days by 3 fold. Conclusions: This may suggest that patients transfused prior to surgery, despite having met a specific trigger hemoglobin level earlier, may have been treated before deteriorating to a point that would cause future systemic implications.
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Affiliation(s)
- Piyush Gupta
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kevin K Kang
- Department of Orthopedics, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Elliot Klein
- Department of Anesthesiology, Donald and Barbara Zucker School of Medicine at Hofstra, Queens NY, USA
| | - Dennis E Feierman
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
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Hopman SR, de Windt TS, van Erp JHJ, Bekkers JEJ, de Gast A. Uncemented total hip arthroplasty; increased risk of early periprosthetic fracture requiring revision surgery in elderly females. J Orthop 2021; 25:40-44. [PMID: 33867753 DOI: 10.1016/j.jor.2021.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/12/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose The preferred method of stem fixation in total hip arthroplasty (THA) remains debatable. Uncemented THA favors a lower rate of aseptic loosening but has an increased risk of early periprosthetic fractures (EPF). We hypothesize that routine placement of uncemented THA by experienced surgeons diminishes this EPF-risk. The purpose of this study is to investigate the effect of age, gender, ASA classification and BMI of THA performed by experienced surgeons on the risk of EPF. Methods A retrospective cohort study including all primary THAs and revision surgeries performed between 2012 and 2018. Possible predictive factors included are age, gender, BMI, ASA classification, presence of osteoporosis, Dorr classification, revision surgery type and clinical outcome. A number needed to treat (NNT) analysis was conducted assuming that cementing THA prevents EPF. Results 2635 primary THAs were performed. Indications for 70 revisions included 18 EPF in uncemented THA female patients. Periprosthetic fractures without a relevant trauma occurred within six weeks in 16 patients. There was a statistically significant correlation between EPF-risk and age (P = 0.032), female gender (P = 0.001) and ASA classification (P = 0.015). For age ≥75, there was an increase in EPF (P = 0.047). With the assumption that cementing would prevent EPF, the NNT is 48. No statistically significant correlation was found between EPF and BMI, osteoporosis or Dorr classification. Conclusion Female patients aged ≥75 have an increased EPF-risk after uncemented THA and would therefore benefit from treatment with a cemented stem. An ASA score of III-IV is an independent risk factor for EPF after uncemented THA.
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Affiliation(s)
- S R Hopman
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - T S de Windt
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - J H J van Erp
- Clinical Orthopedic Research Center - mN, Zeist, Jagersingel 1, 3707, HL, Zeist, the Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - J E J Bekkers
- Clinical Orthopedic Research Center - mN, Zeist, Jagersingel 1, 3707, HL, Zeist, the Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center - mN, Zeist, Jagersingel 1, 3707, HL, Zeist, the Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Brčić M, Kršćanski S, Brnić J. Rotating Bending Fatigue Analysis of Printed Specimens from Assorted Polymer Materials. Polymers (Basel) 2021; 13:polym13071020. [PMID: 33806096 PMCID: PMC8037379 DOI: 10.3390/polym13071020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022] Open
Abstract
Fused filament fabrication (FFF), as a form of additive manufacturing (AM), in recent years, has become a popular method to manufacture prototypes, as well as functional parts. FFF is an extrusion process, commonly known as 3D printing, where the object is built by depositing melted material layer by layer. The most common materials, i.e., the materials that are most widely used, are polylactic acid (PLA), acrylonitrile butadiene styrene (ABS) and acrylonitrile styrene acrylate (ASA). Although there are lot of research papers that cover the subject of the determination of mechanical properties and characteristics, theoretically and experimentally, as well as the fatigue characteristics of aforementioned materials, there is a lack of research and scientific papers dealing with the problematics of S–N curves based on the rotating bending fatigue analysis of those materials. Consequently, this paper covers the topic of rotating bending fatigue data for 3D printed specimens of given materials, under different loading values.
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Katna R, Singh S, Bhosale B, Deshpande A, Kalyani N. Microvascular reconstruction for head and neck cancers in high risk population: clinical outcomes and complications. Ann R Coll Surg Engl 2021; 103:278-281. [PMID: 33682450 DOI: 10.1308/rcsann.2020.7078] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. METHODS This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. RESULTS Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. CONCLUSIONS A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.
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Affiliation(s)
- R Katna
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - S Singh
- Vedant Hospital, Thane, India
| | - B Bhosale
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - A Deshpande
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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Yavasoglu NG, Eren Y, Tatar IG, Yalcınkaya I. Infarct Volumes of Patients with Acute Ischemic Stroke Receiving Direct Oral Anticoagulants due to Non-Valvular Atrial Fibrillation. Ann Indian Acad Neurol 2021; 24:27-31. [PMID: 33911376 PMCID: PMC8061530 DOI: 10.4103/aian.aian_568_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/29/2020] [Accepted: 10/14/2020] [Indexed: 12/03/2022] Open
Abstract
Direct oral anticoagulants (DOACs) have been shown to decrease the risk of ischemic stroke in non-valvular atrial fibrillation (NVAF). This study aims to investigate whether DOACs result in a significant change in lesion volume and the severity of the subsequent disability in patients who have experienced a stroke.
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Affiliation(s)
- Nese G Yavasoglu
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Yasemin Eren
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Idil G Tatar
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Irfan Yalcınkaya
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Israel Y, Quintanilla ME, Ezquer F, Morales P, Santapau D, Berríos‐Cárcamo P, Ezquer M, Olivares B, Herrera‐Marschitz M. Aspirin and N-acetylcysteine co-administration markedly inhibit chronic ethanol intake and block relapse binge drinking: Role of neuroinflammation-oxidative stress self-perpetuation. Addict Biol 2021; 26:e12853. [PMID: 31733014 DOI: 10.1111/adb.12853] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 07/22/2019] [Revised: 09/18/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Abstract
Chronic alcohol intake leads to neuroinflammation and cell injury, proposed to result in alterations that perpetuate alcohol intake and cued relapse. Studies show that brain oxidative stress is consistently associated with alcohol-induced neuroinflammation, and literature implies that oxidative stress and neuroinflammation perpetuate each other. In line with a self-perpetuating mechanism, it is hypothesized that inhibition of either oxidative stress or neuroinflammation could reduce chronic alcohol intake and relapse. The present study conducted on alcohol-preferring rats shows that chronic ethanol intake was inhibited by 50% to 55% by the oral administration of low doses of either the antioxidant N-acetylcysteine (40 mg/kg/d) or the anti-inflammatory aspirin (ASA; 15 mg/kg/d), while the co-administration of both dugs led to a 70% to 75% (P < .001) inhibition of chronic alcohol intake. Following chronic alcohol intake, a prolonged alcohol deprivation, and subsequent alcohol re-access, relapse drinking resulted in blood alcohol levels of 95 to 100 mg/dL in 60 minutes, which were reduced by 60% by either N-acetylcysteine or aspirin and by 85% by the co-administration of both drugs (blood alcohol: 10 to 15 mg/dL; P < .001). Alcohol intake either on the chronic phase or following deprivation and re-access led to a 50% reduction of cortical glutamate transporter GLT-1 levels, while aspirin administration fully returned GLT-1 to normal levels. N-acetylcysteine administration did not alter GLT-1 levels, while N-acetylcysteine may activate the cystine/glutamate transport xCT, presynaptically inhibiting relapse. Overall, the study suggests that a neuroinflammation/oxidative stress self-perpetuation cycle maintains chronic alcohol intake and relapse drinking. The co-administration of anti-inflammatory and antioxidant agents may have translational value in alcohol-use disorders.
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Affiliation(s)
- Yedy Israel
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine University of Chile Santiago Chile
| | - María Elena Quintanilla
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine University of Chile Santiago Chile
| | - Fernando Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina, Universidad del Desarrollo Santiago Chile
| | - Paola Morales
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine University of Chile Santiago Chile
- Department of Neuroscience, Faculty of Medicine University of Chile Santiago Chile
| | - Daniela Santapau
- Centro de Medicina Regenerativa, Facultad de Medicina, Universidad del Desarrollo Santiago Chile
| | - Pablo Berríos‐Cárcamo
- Centro de Medicina Regenerativa, Facultad de Medicina, Universidad del Desarrollo Santiago Chile
| | - Marcelo Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina, Universidad del Desarrollo Santiago Chile
| | - Belen Olivares
- Centro de Química Médica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo Santiago Chile
| | - Mario Herrera‐Marschitz
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine University of Chile Santiago Chile
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Arslani N. Influence of gender, ASA physical status, the location of a tumor and stage of the disease on the survival rate in patients with rectal cancer after surgery. Niger J Clin Pract 2020; 23:1514-1516. [PMID: 33221774 DOI: 10.4103/njcp.njcp_437_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background There are limited data describing different factors that influence survival rate of patients with rectal cancer. Aims Our aim was to determine the influence of patient gender, American Society of Anesthesiologists (ASA) physical status, the location of the tumor and stage of the disease on the patient survival rates after excision of rectal cancer. Settings and Design We included 385 patients who were operated between 2004 and 2014 in the University Clinical Center Maribor. The patients were treated due to rectal adenocarcinoma. We assessed survival rates according to gender, ASA physical status, the location of the tumor and stage of the disease with different statistical methods. Subjects and Methods To find the extent of correlation between factors and survival rate, we used means and medians, Log Rank test, Breslow test and Tarone-Ware test. Results According to patient gender, survival rate did not differ significantly (P > 0.05), however ASA physical status (P < 0.05), location of the tumor (P < 0.05) and stage of the disease (P < 0.05) significantly affected the survival rates. Conclusions Our study showed that gender does not have a significant impact on survival rate as oposed to ASA physical status, the location of the tumor and stage of the disease.
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Affiliation(s)
- N Arslani
- Department of Abdominal Surgery, UCC Maribor, University of Maribor, Medical Faculty, Maribor, Slovenia
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