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Zhang M, Liu H, Han X, Guo J, Ge Y. Reversing the triad of anaesthesia in a cannot intubate, cannot oxygenate emergency. Br J Anaesth 2024:S0007-0912(24)00220-4. [PMID: 38760265 DOI: 10.1016/j.bja.2024.04.020] [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: 03/12/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/19/2024] Open
Affiliation(s)
- Moqiang Zhang
- Department of Anesthesiology, Zhoushan Dinghai Central Hospital, Dinghai District of Zhejiang Provincial People's Hospital, Zhoushan, Zhejiang, China
| | - Huizi Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xue Han
- Department of Anesthesiology, Zhoushan Dinghai Central Hospital, Dinghai District of Zhejiang Provincial People's Hospital, Zhoushan, Zhejiang, China
| | - Jinfeng Guo
- Department of Anesthesiology, Zhoushan Dinghai Central Hospital, Dinghai District of Zhejiang Provincial People's Hospital, Zhoushan, Zhejiang, China
| | - Yunfen Ge
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
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2
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Zhang Y, Yang J, Fan S, Gao Y, Cai C, Li H, Li X, Yang X, Xing Y, Huang M, Bi H. The reversal of PXR or PPARα activation-induced hepatomegaly. Toxicol Lett 2024:S0378-4274(24)00091-2. [PMID: 38734220 DOI: 10.1016/j.toxlet.2024.05.006] [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: 01/16/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
The activation of pregnane X receptor (PXR) or peroxisome proliferator-activated receptor α (PPARα) can induce liver enlargement. Recently, we reported that PXR or PPARα activation-induced hepatomegaly depends on yes-associated protein (YAP) signaling and is characterized by hepatocyte hypertrophy around the central vein area and hepatocyte proliferation around the portal vein area. However, it remains unclear whether PXR or PPARα activation-induced hepatomegaly can be reversed after the withdrawal of their agonists. In this study, we investigated the regression of enlarged liver to normal size following the withdrawal of PCN or WY-14643 (typical agonists of mouse PXR or PPARα) in C57BL/6 mice. The immunohistochemistry analysis of CTNNB1 and KI67 showed a reversal of hepatocyte size and a decrease in hepatocyte proliferation after the withdrawal of agonists. In details, the expression of PXR or PPARα downstream proteins (CYP3A11, CYP2B10, ACOX1, and CYP4A) and the expression of proliferation-related proteins (CCNA1, CCND1, and PCNA) returned to the normal levels. Furthermore, YAP and its downstream proteins (CTGF, CYR61, and ANKRD1) also restored to the normal states, which was consistent with the change in liver size. These findings demonstrate the reversibility of PXR or PPARα activation-induced hepatomegaly and provide new data for the safety of PXR and PPARα as drug targets.
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Affiliation(s)
- Yifei Zhang
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Jie Yang
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Shicheng Fan
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism & Guangdong Provincial Key Laboratory of New Drug Screening & Guangdong-Hongkong-Macao Joint Laboratory for New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Yue Gao
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism & Guangdong Provincial Key Laboratory of New Drug Screening & Guangdong-Hongkong-Macao Joint Laboratory for New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Chenghui Cai
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Huilin Li
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Xuan Li
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism & Guangdong Provincial Key Laboratory of New Drug Screening & Guangdong-Hongkong-Macao Joint Laboratory for New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Xiao Yang
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism & Guangdong Provincial Key Laboratory of New Drug Screening & Guangdong-Hongkong-Macao Joint Laboratory for New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China; The State Key Laboratory of Chemical Oncogenomics, School of Chemical Biology and Biotechnology, Shenzhen Graduate School of Peking University, Shenzhen, 518005, China
| | - Yunhui Xing
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Min Huang
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Huichang Bi
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism & Guangdong Provincial Key Laboratory of New Drug Screening & Guangdong-Hongkong-Macao Joint Laboratory for New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, China; The State Key Laboratory of Chemical Oncogenomics, School of Chemical Biology and Biotechnology, Shenzhen Graduate School of Peking University, Shenzhen, 518005, China.
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3
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Sylvester KW, Grandoni J, Rhoten M, Coakley L, Matiello-Lyons E, Frankel K, Fortin B, Jolley K, Park HS, Freedman RY, Mehra MR, Givertz MM, Connors JM. Assessment of Temporary Warfarin Reversal in Patients With Left Ventricular Assist Devices: the KVAD Study. J Card Fail 2024:S1071-9164(24)00087-3. [PMID: 38521486 DOI: 10.1016/j.cardfail.2024.02.022] [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: 01/13/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients with left ventricular assist devices (LVADs) require interruption of warfarin for invasive procedures, but parenteral bridging is associated with many complications. Four-factor prothrombin complex concentrate (4F-PCC) can temporarily restore hemostasis in patients undergoing anticoagulation with warfarin. OBJECTIVES This pilot study evaluated the strategy of using variable-dose 4F-PCC to immediately and temporarily reverse warfarin before invasive procedures without holding warfarin in patients with LVADs. The duration of effect of 4F-PCC on factor levels and time to reestablish therapeutic anticoagulation post procedure were assessed. METHODS Adult patients with LVADs and planned invasive procedures were enrolled from a single center. Warfarin was continued uninterrupted. The 4F-PCC dose administered immediately pre-procedure was based on study protocol. International normalized ratio (INR)- and vitamin K-dependent factor levels were collected before and during the 48 hours after 4F-PCC administration. The use of parenteral bridging, International Society for Thrombosis and Haemostasis major and clinically relevant nonmajor bleeding (CRNMB) and thromboembolic events at 7 and 30 days were collected. RESULTS In 21 episodes of 4F-PCC reversal, median baseline INR was 2.7 (IQR 2.2-3.2). The median dosage of 4F-PCC administered was 1794 units (IQR 1536-2130). At 24 and 48 hours post 4F-PCC administration, median INRs were 1.8 (IQR 1.7-2.0) and 2.0 (IQR 1.9-2.4). Two patients required postoperative bridging. One patient experienced major bleeding within 72 hours, and 2 experienced CRNMB within 30 days. There were no thromboembolic events. Baseline and post 4F-PCC vitamin K-dependent factor levels corresponded with changes in INR values. The median time to achieve therapeutic INR post-procedure was 2.5 days (IQR, 1-4). CONCLUSION Administration of 4F-PCC for temporary reversal of warfarin for invasive procedures in patients with LVADs allowed for continued warfarin dosing with minimal use of post-intervention bridging, limited bleeding and no thromboembolic events.
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Affiliation(s)
- Katelyn W Sylvester
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA. https://twitter.com/KatelynSylvester4
| | - Jessica Grandoni
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA
| | - Megan Rhoten
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA
| | - Lara Coakley
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA
| | | | - Katie Frankel
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA
| | - Brooke Fortin
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | - Kate Jolley
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | - Hae Soo Park
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | | | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA. https://twitter.com/MRMehraMD
| | - Michael M Givertz
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA. https://twitter.com/GivertzMichael
| | - Jean M Connors
- Division of Hematology, Brigham and Women's Hospital, Boston, MA.
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Subramani Y, Rajarathinam M, Dabirzadeh A, Tawfic Q, Krause S, Avci Y, Nagappa M. Comparison of Different Weight Scalars to Dose Sugammadex for the Reversal of Neuromuscular Blockade in Morbidly Obese Patients: A Systematic Review. Cureus 2024; 16:e57057. [PMID: 38681306 PMCID: PMC11051669 DOI: 10.7759/cureus.57057] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
This systematic review was conducted to evaluate the optimal weight scalar to dose sugammadex in a morbidly obese (MO) patient population (BMI≥40 kg/m2). The primary outcome was recovery time from moderate neuromuscular blockade (NMB) or deep NMB. Secondary outcomes included time to extubation and incidence of postoperative residual curarization (PORC). Eight randomized controlled trials (RCTs) involving 645 participants were included. The different dose scalars included were total body weight (TBW), ideal body weight (IBW), 20% corrected body weight (CBW) and 40% CBW). A dose of 2 mg/kg of sugammadex based on 40% CBW and a 4 mg/kg dose of sugammadex based on 40% CBW provide a reliable and timely reversal of moderate and deep NMB respectively in the MO patients.
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Affiliation(s)
- Yamini Subramani
- Anesthesiology and Perioperative Medicine, London Health Sciences Centre, Western University, London, Canada
| | - Manikandan Rajarathinam
- Anesthesiology and Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
| | - Anita Dabirzadeh
- Anesthesiology and Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
| | - Qutaiba Tawfic
- Anesthesiology and Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
| | - Sarah Krause
- Medical Sciences, Western University, London, CAN
| | - Yasin Avci
- Interdisciplinary Arts and Science, Western University, London, CAN
| | - Mahesh Nagappa
- Anesthesiology and Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
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Manigrasso M, Degiuli M, Maione F, Venetucci P, Roviello F, De Palma GD, Milone M. Is proctoscopy sufficient for the evaluation of colorectal anastomosis prior to ileostomy reversal? A nationwide retrospective analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative group (SICO-CCN). Colorectal Dis 2024; 26:439-448. [PMID: 38229251 DOI: 10.1111/codi.16864] [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: 01/15/2023] [Revised: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 01/18/2024]
Abstract
AIM Several methods for assessing anastomotic integrity have been proposed, but the best is yet to be defined. The aim of this study was to compare the different methods to assess the integrity of colorectal anastomosis prior to ileostomy reversal. METHOD A retrospective cohort analysis on patients between 1 January 2010 and 31 December 2020 with a defunctioning stoma for middle and low rectal anterior resection was performed. A propensity score matching comparison between patients who underwent proctoscopy alone and patients who underwent proctoscopy plus any other preoperative method to assess the integrity of colorectal anastomosis prior to ileostomy reversal (transanal water-soluble contrast enema via conventional radiology, transanal water-soluble contrast enema via CT, and magnetic resonance) was performed. RESULTS The analysis involved 1045 patients from 26 Italian referral colorectal centres. The comparison between proctoscopy alone versus proctoscopy plus any other preoperative tool showed no significant differences in terms of stenoses (p = 0.217) or leakages (p = 0.103) prior to ileostomy reversal, as well as no differences in terms of misdiagnosed stenoses (p = 0.302) or leakages (p = 0.509). Interestingly, in the group that underwent proctoscopy and transanal water-soluble contrast enema the comparison between the two procedures demonstrated no significant differences in detecting stenoses (2 vs. 0, p = 0.98), while there was a significant difference in detecting leakages in favour of transanal water-soluble contrast enema via CT (3 vs. 12, p = 0.03). CONCLUSIONS We can confirm that proctoscopy alone should be considered sufficient prior to ileostomy reversal. However, in cases in which the results of proctoscopy are not completely clear or the surgeon remains suspicious of an anastomotic leakage, transanal water-soluble contrast enema via CT could guarantee its detection.
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Affiliation(s)
- Michele Manigrasso
- Department of Advanced Biomedical Sciences, 'Federico II' University of Naples, Naples, Italy
| | - Maurizio Degiuli
- Department of Oncology, University of Turin, Turin, Italy
- San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Turin, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Pietro Venetucci
- Dipartimento di Oncoematologia, Diagnostica per Immagine, Radioterapia e Medicina Legale, "Federico II" University Hospital, Naples, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | | | - Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
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Salaün JP, Décary E, Veyckemans F. Recurarisation after sugammadex in children: review of case reports and recommendations. Br J Anaesth 2024; 132:410-414. [PMID: 38170632 DOI: 10.1016/j.bja.2023.09.028] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Jean-Philippe Salaün
- Normandie Univ, UNICAEN, INSERM UMR- S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen- Normandie (BB@C), GIP Cyceron, Caen, France; Department of Anesthesiology and Critical Care Medicine, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France; Department of Pediatric Anesthesiology, Sainte-Justine Mother and Child University Hospital, University of Montreal, Montreal, Quebec, Canada.
| | - Elizabeth Décary
- Department of Pediatric Anesthesiology, Sainte-Justine Mother and Child University Hospital, University of Montreal, Montreal, Quebec, Canada
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Abelman T, Skidmore A. Endoscopic reversal of the modified Long vertical gastroplasty. J Surg Case Rep 2024; 2024:rjae097. [PMID: 38434253 PMCID: PMC10904347 DOI: 10.1093/jscr/rjae097] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Endoscopic techniques are revolutionizing bariatric surgery because of the significant risks that obesity places on both anaesthesia and surgery. Due to the high number of long-term complications that may be associated with bariatric surgery, and the relative safety of endoscopy compared to operative management, endoscopic methods for reversal of previous bariatric techniques are becoming the favoured approach. We describe the use of an endoscopic stent to assist with endoscopic reversal of a modified Long vertical gastroplasty. The modified Long vertical gastroplasty was a restrictive bariatric procedure that was effective to promote weight loss, but had adverse effects including dysphagia, reflux, indigestion and weight regain. The use of an adjunct stent not only treated the patient's reflux by dilating the stricture but allowed for erosion of the sutures intra-luminally to be removed endoscopically. The endoscopic reversal of this technique is safe and helped to relieve the patient's symptoms of reflux and dysphagia.
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Affiliation(s)
- Talia Abelman
- Department of General Surgery, Albury Wodonga Health, 201 Borella Road, Albury, NSW 2640, Australia
| | - Adam Skidmore
- Department of General Surgery, Albury Wodonga Health, 201 Borella Road, Albury, NSW 2640, Australia
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8
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Martin-Flores M. Sugammadex for reversal of moderate-to-deep rocuronium block in a clinical setting: A retrospective report of 10 dogs. Vet Anaesth Analg 2024; 51:60-63. [PMID: 38072747 DOI: 10.1016/j.vaa.2023.11.008] [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: 08/23/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare recovery times of sugammadex with spontaneous recovery from rocuronium-induced neuromuscular block (NMB) in dogs. STUDY DESIGN Retrospective, unmatchedcase-control study. ANIMALS A total of 10 dogs administered sugammadex and 10 dogs recovering spontaneously from rocuronium-induced NMB. METHODS Files of dogs administered rocuronium between March and August 2023 were inspected. The train-of-four (TOF) count at the time of sugammadex administration and the time between administration and TOF ratio >90% (recovery time) were recorded. The recovery time for those not administered reversal agents was considered from the first TOF value >0 until TOF ratio >90%. The dose of sugammadex and the cumulative dose of rocuronium were recorded. Rocuronium doses and recovery times were compared using Mann-Whitney tests. The coefficient of determination (R2) between the cumulative rocuronium dose and sugammadex dose and the recovery time were calculated. RESULTS Dogs in the sugammadex and spontaneous recovery groups were administered intravenously (IV) 0.76 (0.4-2.6) and 0.61 (0.3-2.9) mg kg-1 of rocuronium, respectively (p = 0.325). Recovery time after 3.9 (2.9-5.5) mg kg-1 of sugammadex IV was 1 (1-3) minutes and was 20 (10-35) min for spontaneous recovery (p < 0.0001). The R2 for rocuronium and sugammadex doses and recovery times were 0.19 (p = 0.2) and 0.012 (p = 0.758). CONCLUSIONS AND CLINICAL RELEVANCE Sugammadex 2.9-5.5 mg kg-1 reversed moderate (TOF count 1-3) or deep (TOF count 0) rocuronium-induced NMB within 3 minutes, substantially faster than spontaneous recovery.
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Affiliation(s)
- Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
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Hunter JM, Sneyd JR. Is adamgammadex the brother of sugammadex or the next generation of reversal agent? Br J Anaesth 2024; 132:15-17. [PMID: 38171649 DOI: 10.1016/j.bja.2023.11.006] [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: 10/16/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024] Open
Abstract
Sugammadex is now in widespread use to reverse the neuromuscular blocking effects of rocuronium. Adverse effects from sugammadex are rare, but anaphylactic and cardiovascular reactions to the drug have been reported. In an attempt to reduce such side-effects, a modified gamma-cyclodextrin, adamgammadex, has been developed. Phase 3 clinical trials suggest that it is slightly less potent than sugammadex and has a non-inferior speed of onset. In a multicentre trial of 310 patients, there was a suggestion of a lower incidence of allergic responses and recurarisation after adamgammadex compared with sugammadex. The clinical implications of this study are discussed in this editorial.
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Affiliation(s)
- Jennifer M Hunter
- Department of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - J Robert Sneyd
- Faculty of Health, University of Plymouth, John Bull Building, Plymouth Science Park, Plymouth, UK
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Zhang Y, Jiang Y, Lei Q, Li C, Jin S, Wang Q, Huang Y, Li Y, Hong Y, Wang S, Lin H, Li H, Ou Y, Zou X, Sun Q, Guo Q, Chen Z, Min S, Qi Y, Jie Q, Liu J, Liu B, Zhang W. Phase III clinical trial comparing the efficacy and safety of adamgammadex with sugammadex for reversal of rocuronium-induced neuromuscular block. Br J Anaesth 2024; 132:45-52. [PMID: 38007377 DOI: 10.1016/j.bja.2023.10.022] [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: 09/07/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Preliminary clinical trials of adamgammadex, a new cyclodextrin-based selective reversal agent, have demonstrated its efficacy in reversing neuromuscular block by rocuronium. METHODS This multicentre, randomised, double-blind, positive-controlled, non-inferiority phase III clinical trial compared the efficacy and safety of adamgammadex and sugammadex. We randomised 310 subjects to receive adamgammadex (4 mg kg-1) or sugammadex (2 mg kg-1) at reappearance of the second twitch of the train-of-four (TOF), and standard safety data were collected. RESULTS For the primary outcome, the proportion of patients with TOF ratio ≥0.9 within 5 min was 98.7% in the adamgammadex group vs 100% in the sugammadex group, with a point estimate and 95% confidence interval (CI) of 1.3% (-4.6%, +1.3%); the lower limit was greater than the non-inferiority margin of -10%. For the key secondary outcome, the median (inter quartile range) time from the start of administration of adamgammadex or sugammadex to recovery of TOF ratio to 0.9 was 2.25 (1.75, 2.75) min and 1.75 (1.50, 2.00) min, respectively. The difference was 0.50 (95% CI: 0.25, 0.50); the upper limit was lower than the non-inferiority margin of 5 min. In addition, there were no inferior results observed in secondary outcomes. Adamgammadex had a lower incidence of adverse drug reactions compared with sugammadex (anaphylactic reaction, recurarisation, decreased heart rate, and laryngospasm; P=0.047). CONCLUSIONS Adamgammadex was non-inferior to sugammadex with a possible lower incidence of adverse drug reactions compared with sugammadex. Adamgammadex may have a potential advantage in terms of its overall risk-benefit profile. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2000039525. Registered October 30, 2020. https://www.chictr.org.cn/showproj.html?proj=56825.
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Affiliation(s)
- Yujun Zhang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yingying Jiang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Lei
- Department of Anaesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chaoyu Li
- Department of Anaesthesiology, Second People's Hospital of Neijiang, Neijiang, China
| | - Shu'an Jin
- Department of Anaesthesiology, Central Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Ji'nan, China
| | - Qin Wang
- Department of Anaesthesiology, Central Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Ji'nan, China
| | - Yidan Huang
- Department of Anaesthesiology, Liuzhou People's Hospital, Liuzhou, China
| | - Yalan Li
- Department of Anaesthesiology, First Affiliated Hospital of Jinan University (Guangzhou Overseas Chinese Hospital), Jinan University, Guangzhou, China
| | - Yi Hong
- Department of Anaesthesiology, First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Urumqi, China
| | - Shoushi Wang
- Department of Anaesthesiology, Qingdao Central Hospital Group, Qingdao, China
| | - Han Lin
- Department of Anaesthesiology, Second Affiliated Hospital of WMU, Wenzhou Medical University, Wenzhou, China
| | - Hong Li
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yangwen Ou
- Department of Anaesthesiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaohua Zou
- Department of Anaesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qiang Sun
- Department of Anaesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Qulian Guo
- Department of Anaesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhigang Chen
- Department of Anaesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Su Min
- Department of Anaesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Youmao Qi
- Hangzhou Adamerck Pharmlabs Inc. Hangzhou, China
| | - Qing Jie
- Hangzhou Adamerck Pharmlabs Inc. Hangzhou, China
| | - Jin Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Wensheng Zhang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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11
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Brett S, Taylor M, Pamela M, Michael G. Comparison of Fixed Versus Weight-Based Prothrombin Complex Concentrate Dosing Strategies for Factor Xa Inhibitor Reversal. Clin Appl Thromb Hemost 2024; 30:10760296241243368. [PMID: 38710155 DOI: 10.1177/10760296241243368] [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] [Indexed: 05/08/2024] Open
Abstract
Background: Our institution introduced fixed-dose prothrombin complex concentrate (PCC) to streamline order verification and medication administration. Previous studies using fixed-dose PCC for vitamin K antagonist reversal showed comparable efficacy to weight-based dosing. Objective: To compare fixed versus weight-based PCC dosing for reversal of Factor Xa Inhibitor (FXaI) effects. Methods: Retrospective cohort study conducted at a tertiary care academic medical center. Patients who received PCC to reverse the effects of apixaban or rivaroxaban were eligible. Subjects in the fixed-dose group (5000 units or 2000 units) were compared to weight-based PCC (50 units/kg). The primary outcome was time between order entry and medication administration. Secondary outcomes included: average PCC dose, postadministration procedures, achieved hemostasis, 30-day mortality, hospital length of stay, and adverse drug events. Results: 72 patients received fixed-dose PCC and 101 received weight-based PCC. Median time between order entry and administration was 4.5 min shorter in the fixed-dose group compared to weight-based (34.5 vs 39 min, P = .10). In patients who received fixed-dose, 79.2% achieved hemostasis versus 71.3% in the weight-based group (RR = 1.11, 95% CI = 0.94-1.32). There was no difference in the number of subsequent hemorrhage-related surgeries (29.2% vs 36.7%, RR = 0.80, 95% CI = 0.51-1.24) or mortality rate (26.4% vs 35.6%, RR = 0.73, 95% CI = 0.46-1.17). There were zero adverse drug events reported. Rates of thrombosis were 2.8% and < 1% (P = .57) in the fixed and weight-based groups, respectively. Conclusion and Relevance: The fixed-dosing strategy did not reduce time to PCC administration nor impact hemostasis or mortality. These data support that the fixed-dosing method is a viable option.
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Affiliation(s)
- Snyder Brett
- Department of Pharmacy, UPMC Mercy, Pittsburgh, PA, USA
| | - Miller Taylor
- Department of Pharmacy, UPMC Mercy, Pittsburgh, PA, USA
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Edavettal JM, Harris NR, Cohen SE, Paloczi J, Chandrasekar B, Gardner JD. Abstinence Restores Cardiac Function in Mice with Established Alcohol-Induced Cardiomyopathy. Cells 2023; 12:2783. [PMID: 38132102 PMCID: PMC10742080 DOI: 10.3390/cells12242783] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Alcohol-induced cardiomyopathy (ACM) has a poor prognosis with up to a 50% chance of death within four years of diagnosis. There are limited studies investigating the potential of abstinence for promoting repair after alcohol-induced cardiac damage, particularly in a controlled preclinical study design. Here, we developed an exposure protocol that led to significant decreases in cardiac function in C57BL6/J mice within 30 days; dP/dt max decreased in the mice fed alcohol for 30 days (8054 ± 664.5 mmHg/s compared to control mice: 11,188 ± 724.2 mmHg/s, p < 0.01), and the dP/dt min decreased, as well (-7711 ± 561 mmHg/s compared to control mice: -10,147 ± 448.2 mmHg/s, p < 0.01). Quantitative PCR was used to investigate inflammatory and fibrotic biomarkers, while histology was used to depict overt changes in cardiac fibrosis. We observed a complete recovery of function after abstinence (dP/dt max increased from 8054 ± 664 mmHg/s at 30 days to 11,967 ± 449 mmHg/s after abstinence, p < 0.01); further, both inflammatory and fibrotic biomarkers decreased after abstinence. These results lay the groundwork for future investigation of the molecular mechanisms underlying recovery from alcohol-induced damage in the heart.
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Affiliation(s)
- Joshua M. Edavettal
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Nicholas R. Harris
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Sarah E. Cohen
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Janos Paloczi
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Bysani Chandrasekar
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA;
- Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, and Harry S. Truman Memorial Veterans Hospital, Columbia, MO 65212, USA
| | - Jason D. Gardner
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
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13
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Lucas F, Lewis J, Grandoni J, Sylvester KW, Bernier TD, Ting C, Sek R, Ballard K, Connors JM, Battinelli EM. One-year retrospective analysis of anti-FXa apixaban and rivaroxaban levels demonstrates utility for management decisions in various urgent and nonurgent clinical situations. Am J Clin Pathol 2023; 160:571-584. [PMID: 37549067 DOI: 10.1093/ajcp/aqad085] [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: 03/02/2023] [Accepted: 06/23/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Quantification of direct oral anticoagulant (DOAC) plasma levels can guide clinical management, but insight into clinical scenarios surrounding DOAC-calibrated anti-FXa assays is limited. METHODS Apixaban- and rivaroxaban-calibrated chromogenic anti-Xa assays performed over a 1-year period were retrospectively analyzed. Patient demographics, DOAC history, concomitant medications, and renal/liver comorbidities were obtained. Indications for testing and associated clinical actions were reviewed. Machine learning (ML) models predicting clinical actions were evaluated. RESULTS In total, 371 anti-FXa apixaban and 89 anti-FXa rivaroxaban tests were performed for 259 and 67 patients in recurring urgent (acute bleeding, unplanned procedures) and nonurgent situations, including several scenarios not captured by existing testing recommendations (eg, drug monitoring, recurrent thromboembolic events, bleeding tendency). In urgent settings, andexanet reversal was guided by radiologic and clinical findings over DOAC levels in 14 of 32 instances, while 51% of apixaban patients qualified for nonreversal strategies through the availability of levels. Levels also informed procedure/intervention timing and supported management decisions when DOAC clearance or DOAC target levels were in question. The importance of clinical context was emphasized by exploratory ML models predicting particular clinical actions. CONCLUSIONS Although clinical situations are complex, DOAC testing facilitates clinical decision-making, including reversal, justifying more widespread implementation of these assays.
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Affiliation(s)
- Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, US
| | - Joshua Lewis
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, US
| | - Jessica Grandoni
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, US
| | - Katelyn W Sylvester
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, US
| | - Thomas D Bernier
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, US
| | - Clara Ting
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, US
| | - Rebecca Sek
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, US
| | - Kathleen Ballard
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, US
| | - Jean M Connors
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
| | - Elisabeth M Battinelli
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
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Bast T, Grasmeder Allen R, Maggi S, Renstrom J. Impaired reversal learning in the Dlg2+/- rat model of genetic risk for psychiatric disorder: Important questions regarding the neuro-behavioral mechanisms of reversal learning. Genes Brain Behav 2023; 22:e12870. [PMID: 38123893 PMCID: PMC10733561 DOI: 10.1111/gbb.12870] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 12/23/2023]
Abstract
In this issue, Griesius et al report that heterozygous Dlg2+/- rats showed a reversal learning impairment on a specific bowl-digging task, whereas other reversal tasks were unaffected. The study suggests that Dlg2 gene disruption, which has been linked to neuropsychiatric disorders, including schizophrenia, may cause relatively specific impairments in reversal learning, an important aspect of cognitive flexibility. The study draws attention to two important issues regarding the neuro-behavioral mechanisms of reversal learning, namely that hippocampal dysfunction, which is prominent in Dlg2+/- rats, may contribute to reversal learning impairments and that, depending on the task and previous experience, brain and behavioral mechanisms of reversal learning may differ.
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Affiliation(s)
- Tobias Bast
- School of Psychology and Neuroscience@NottinghamUniversity of NottinghamNottinghamUK
| | | | - Silvia Maggi
- School of Psychology and Neuroscience@NottinghamUniversity of NottinghamNottinghamUK
| | - Jacco Renstrom
- School of Psychology and Neuroscience@NottinghamUniversity of NottinghamNottinghamUK
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15
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Ali E, Orfi J, AlAnsary H, Baakeem S, Alsaadi AS, Ghaffour N. Concept and analysis of hybrid reversal multi-stage flash and membrane distillation desalination system. Environ Technol 2023:1-14. [PMID: 37970835 DOI: 10.1080/09593330.2023.2284688] [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: 03/23/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
The concept and analysis of integrating membrane distillations (MD) with reversal once-through Multistage Flash (RV-MSF) desalination is presented. The analysis is based on numerical simulation. The MD vessels are integrated into the terminal ends of the RV-MSF system to leverage the thermal energy associated with these terminal streams. Hybridisation at the last MSF stage, i.e. by replacing the brine cooler, contributes marginally to the overall production rate which amounts to 2%. However, it is found that hybridisation at stage one, i.e. utilising the energy of the MSF reject brine can increase the overall production rate by 65%. For seawater feed temperature of 80 oC and 24 MSF stages, 5 MD vessels in series can be integrated with the RV-MSF process. This ultimate hybridisation helped improve the recovery ratio from 7 to 23%, decreasing the specific cooling water requirement from 23 to 12 kg/kg and reducing the specific energy consumption from 129 to 41 kWh/m3 with respect to the stand-alone RV-MSF system. However, this achievement incurs an additional specific area for heat transfer which increased from 29 to 65 m2/(kg/s). This is because a large number of MD modules are incorporated into the hybridisation.
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Affiliation(s)
- Emad Ali
- Chemical Engineering Department, King Saud University, Riyadh, Saudi Arabia
| | - Jamel Orfi
- Mechanical Engineering Department, King Saud University, Riyadh, Saudi Arabia
| | - Hany AlAnsary
- Mechanical Engineering Department, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Baakeem
- Department of Chemical and Petroleum Engineering, University of Calgary, Calgary, Canada
| | - Ahmad S Alsaadi
- Chemical Engineering Department, University of Jeddah, Jeddah, Saudi Arabia
| | - Noreddine Ghaffour
- King Abdullah University of Science and Technology (KAUST), Water Desalination and Reuse Center (WDRC), Biological and Environmental Science and Engineering Division (BESE), Thuwal, Saudi Arabia
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16
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Barr CA, Haughan J, Gianotti G, Varner K, Drobatz KJ, Stefanovski D, Robinson M, Pennington M, McGuire A, Otto CM. Pharmacokinetics and pharmacodynamics of intranasal and intramuscular administration of naloxone in working dogs administered fentanyl. J Vet Intern Med 2023; 37:2422-2428. [PMID: 37861360 PMCID: PMC10658493 DOI: 10.1111/jvim.16901] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Working dogs exposed to narcotics might require reversal in the field. OBJECTIVE To explore the pharmacokinetic and pharmacodynamic effects of naloxone administered intramuscularly (IM) or intranasally (IN) to reverse fentanyl sedation in working dogs. ANIMALS Ten healthy, working dogs aged 1.7 ± 1 year and weighing 26 ± 3 kg. METHODS In this randomized, controlled cross-over study dogs received either 4 mg of naloxone IN or IM 10 minutes after fentanyl (0.3 mg IV) administration. Sedation was assessed at baseline and 5 minutes after fentanyl administration, then at 5, 10, 15, 20, 25, 30, 60 and 120 minutes after reversal with naloxone. Blood samples for naloxone detection were obtained at 0, 5, 10, 30, 60 and 120 minutes. Pharmacokinetic parameters and sedation scores were compared between IM and IN naloxone groups. RESULTS There was a significant increase in sedation score from baseline (0.25 [-4 to 1] IM; 0 [-2 to 1] IN) after fentanyl administration (11 [5-12] IM; 9.25 [4-11] IN), followed by a significant reduction at 5 (0.5 [-0.5 to 1.5] IM; 1.25 [-1.5 to 4.5] IN) through 120 minutes (-0.5 [-2 to 1] IM; 0 [-4.5 to 1] IN) after reversal with naloxone. Route of administration had no significant effect on sedation score. Maximum plasma concentration was significantly lower after IN administration (11.7 [2.8-18.8] ng/mL IN, 36.7 [22.1-56.4] ng/mL IM, P < .001) but time to reach maximum plasma concentration was not significantly different from IM administration. CONCLUSION AND CLINICAL IMPORTANCE Although IM administration resulted in higher naloxone plasma concentrations compared to IN, reversal of sedation was achieved via both routes after administration of therapeutic doses of fentanyl.
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Affiliation(s)
- Ciara A. Barr
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joanne Haughan
- New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Giacomo Gianotti
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kelley Varner
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kenneth J. Drobatz
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Darko Stefanovski
- New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Mary Robinson
- New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Mark Pennington
- US Army Medical Research Institute of Chemical DefenseAberdeen Proving GroundMarylandUSA
| | - Amanda McGuire
- US Army Medical Research Institute of Chemical DefenseAberdeen Proving GroundMarylandUSA
| | - Cynthia M. Otto
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Penn Vet Working Dog CenterSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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17
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Brown SES, Spellman K, Cassidy R, Nause-Osthoff R, Bailey M, Mentz G, Wagner D, Haydar B, Chimbira W, Kheterpal S, Colquhoun D. A retrospective observational cross-sectional study of intraoperative neuromuscular blocking agent choice and dosing in a US paediatric referral hospital before and after introduction of sugammadex ☆. Br J Anaesth 2023; 131:e117-e120. [PMID: 37574423 PMCID: PMC10624852 DOI: 10.1016/j.bja.2023.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Sydney E S Brown
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - Kevin Spellman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ruth Cassidy
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Meridith Bailey
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Graciela Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Deborah Wagner
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Bishr Haydar
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Wilson Chimbira
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Douglas Colquhoun
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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18
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Pham C, Vien P, Hielscher A. A Cadaveric Case of Palmaris Longus Agenesis and Reversal. Cureus 2023; 15:e47664. [PMID: 38022366 PMCID: PMC10667948 DOI: 10.7759/cureus.47664] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
The palmaris longus frequently exhibits anatomical variations with palmaris longus agenesis and reversal being the most prevalent. These variations are relevant clinically, as the muscle is often used during plastic surgeries for grafting tendons. They are also relevant in pathology, as hypertrophy of the reversed muscle is related to median nerve compression. In this report, we describe an unusual case in which a male cadaver-donor exhibited a right-sided palmaris longus reversal and left-sided palmaris longus agenesis. Review of the literature documents no previous co-occurrence of these anomalies. Since the muscle has relevance in a variety of contexts within medicine and surgery, reporting on a variation like this carries significant educational and clinical value.
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Affiliation(s)
- Christopher Pham
- Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, USA
| | - Peter Vien
- Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, USA
| | - Abigail Hielscher
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, USA
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19
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Poelaert J, Hunter JM. Educating anaesthetists on neuromuscular monitoring: the challenges continue. Br J Anaesth 2023; 131:429-431. [PMID: 37380566 DOI: 10.1016/j.bja.2023.05.019] [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: 03/30/2023] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023] Open
Abstract
The need to introduce guidelines on neuromuscular monitoring emphasising the use of quantitative techniques that record the train-of-four ratio is now recognised by an increasing number of national anaesthetic societies in the Western world. But the challenge of convincing individual anaesthetists to adopt and use this practice routinely remains. For >10 yr, it has been recognised that all staff in anaesthetic departments need to have regular training in modern neuromuscular monitoring techniques. We discuss a publication in this journal that describes the challenges of setting up multicentre training in Spain to expand the use of quantitative neuromuscular monitoring and their short-term results.
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Affiliation(s)
- Jan Poelaert
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Anaesthesia, ICU and Chronic Pain Therapy, Hospital Maria Middelares, Ghent, Belgium.
| | - Jennifer M Hunter
- Department of Aging and Chronic Disease, University of Liverpool, Liverpool, UK
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20
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Guan W, Yuan J, Li X, Gao X, Wang F, Liu H, Shi J, Xu G. Cyclin dependent kinase 14 as a paclitaxel-resistant marker regulated by the TGF-β signaling pathway in human ovarian cancer. J Cancer 2023; 14:2538-2551. [PMID: 37670966 PMCID: PMC10475357 DOI: 10.7150/jca.86842] [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: 06/06/2023] [Accepted: 07/27/2023] [Indexed: 09/07/2023] Open
Abstract
Cyclin dependent kinase 14 (CDK14) plays a central role in the control of cell proliferation and cell cycle progression. However, the specific function and regulatory mechanism of CDK14 on paclitaxel (PTX) resistance in ovarian cancer (OC) remain unclear. The present study demonstrated that CDK14 was overexpressed in OC tissues and cells at mRNA and protein levels detected by qRT-PCR, Western blot, and immunohistochemistry. Survival analysis showed that elevated CDK14 was related to the poor prognosis of OC patients. Overexpression of CDK14 was correlated with chemoresistance in OC. The expression level of CDK14 was higher in PTX-resistant OC cells (SK3R-PTX and OV3R-PTX) than in their counterpart-sensitive cells (SK-OV-3 and OVCAR-3). Knockdown of CDK14 decreased multidrug resistance 1 (MDR1) and β-catenin expression in SK3R-PTX and OV3R-PTX cells and resensitized OC cells to PTX by decreasing cell proliferation and inducing cell apoptosis. Administration of transforming growth factor (TGF)-β1 decreased CDK14 protein in PTX-resistant OC cells. The inhibitory effect of TGF-β1 on CDK14 expression was abolished in the presence of a TGF-β type I receptor kinase inhibitor (SB-431542). Furthermore, TGF-β signal transducer Smad2 protein directly bound to the region -437 to -446 upstream of the CDK14 transcription start site (TSS), resulting in downregulating the expression of CDK14. These data indicate that CDK14 is a PTX-resistant marker and is regulated by the TGF-β signaling pathway. Targeting CDK14 to enhance the sensitivity of PTX may provide a new therapeutic strategy for reversing the PTX resistance in OC.
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Affiliation(s)
- Wencai Guan
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Jia Yuan
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xin Li
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xuzhu Gao
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Fanchen Wang
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Huiqiang Liu
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jimin Shi
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Guoxiong Xu
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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21
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Jiang W, Fang J, Rastrick SPS, Samuelsen OB, Liang B, Mao Y, Strand Ø, Fang J, Jiang Z. CO 2-Induced Ocean Acidification Alters the Burrowing Behavior of Manila Clam Ruditapes philippinarum by Reversing GABA A Receptor Function. Environ Sci Technol 2023. [PMID: 37276348 DOI: 10.1021/acs.est.3c00707] [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] [Indexed: 06/07/2023]
Abstract
Biological burrowing behavior is an important driver shaping ecosystems that is being threatened by CO2-induced ocean acidification; however, the effects of ocean acidification on burrowing behavior and its neurological mechanism remain unclear. This study showed that elevated pCO2 significantly affected the burrowing behaviors of the Manila clam Ruditapes philippinarum, such as increased foot contraction, burrowing time, and intrabottom movement and decreased burrowing depth. Delving deeper into the mechanism, exposure to elevated pCO2 significantly decreased extracellular pH and increased [HCO3-]. Moreover, an indicator GABAA receptor, a neuroinhibitor for movement, was found to be closely associated with behavioral changes. In situ hybridization confirmed that the GABAA receptor was widely distributed in ganglia and foot muscles, and elevated pCO2 significantly increased the mRNA level and GABA concentration. However, the increase in GABAA receptor and its ligand did not suppress the foot movement, but rather sent "excitatory" signals for foot contraction. The destabilization of acid-base homeostasis was demonstrated to induce an increase in the reversal potential for GABAA receptor and an alteration in GABAA receptor function under elevated pCO2. This study revealed that elevated pCO2 affects the burrowing behavior of Manila clams by altering GABAA receptor function from inhibitory to excitatory.
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Affiliation(s)
- Weiwei Jiang
- State Key Laboratory of Mariculture Biobreeding and Sustainable Goods, Yellow Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Qingdao 266071, China
| | - Jinghui Fang
- State Key Laboratory of Mariculture Biobreeding and Sustainable Goods, Yellow Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Qingdao 266071, China
- Laboratory for Marine Fisheries Science and Food Production Processes, Qingdao Pilot National Laboratory for Marine Science and Technology, Qingdao 266200, China
| | | | - Ole B Samuelsen
- Institute of Marine Research, Nordnes, Bergen NO-5817 1870, Norway
| | - Bo Liang
- State Key Laboratory of Mariculture Biobreeding and Sustainable Goods, Yellow Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Qingdao 266071, China
| | - Yuze Mao
- State Key Laboratory of Mariculture Biobreeding and Sustainable Goods, Yellow Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Qingdao 266071, China
- Laboratory for Marine Fisheries Science and Food Production Processes, Qingdao Pilot National Laboratory for Marine Science and Technology, Qingdao 266200, China
| | - Øivind Strand
- Institute of Marine Research, Nordnes, Bergen NO-5817 1870, Norway
| | - Jianguang Fang
- State Key Laboratory of Mariculture Biobreeding and Sustainable Goods, Yellow Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Qingdao 266071, China
- Laboratory for Marine Fisheries Science and Food Production Processes, Qingdao Pilot National Laboratory for Marine Science and Technology, Qingdao 266200, China
| | - Zengjie Jiang
- State Key Laboratory of Mariculture Biobreeding and Sustainable Goods, Yellow Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Qingdao 266071, China
- Laboratory for Marine Fisheries Science and Food Production Processes, Qingdao Pilot National Laboratory for Marine Science and Technology, Qingdao 266200, China
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22
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Mitrovic D, van Elp M, Visser L, van Rein N, van den Bemt P, van Hulst M, Dreijer A, Lameijer H, Veeger N, Meijer K, van Roon E. Adherence to protocols for the use of reversal agents in patients treated with direct oral anticoagulants. Curr Med Res Opin 2023; 39:865-871. [PMID: 37114434 DOI: 10.1080/03007995.2023.2204767] [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: 12/29/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES This study aimed to evaluate the adherence to protocols for the use of reversal agents in direct oral anticoagulant (DOAC) users in Dutch hospitals. METHODS A retrospective cohort study was conducted in seven hospitals in the Netherlands. Treatment protocols for bleeding and (urgent) procedures in patients on DOAC were collected from each hospital. All patient data on the use of reversal agents were retrospectively collected from September 2021 to April 2022 and compared to the protocols. The degree of per-protocol adherence (compliance score) was categorized into four levels as follows: poor (<45%), moderate (45-79%), high (80-89%), and full (> 90%) adherence rates. RESULTS A total of 290 patients were included in our study. In patients with bleeding under DOAC, the protocol adherence for prothrombin complex concentrate (PCC) was "moderate" (61%). In the remaining cases (39%), non-adherence was mainly caused by underdosing (68%), overdosing (12%), and a lack of indication (14%). Furthermore, idarucizumab was administered for bleeding with "full" adherence (96%). For andexanet alfa, adherence to the hospital bleeding protocol was "moderate" (67%), with a lack of indication being the only reason for non-adherence. In case of reversal for an urgent procedure, the protocol adherence for PCC was "low" (45%), with underdosing, a lack of indication, and missing lab data being the main reasons for non-adherence. Missing lab data on dabigatran plasma concentration before reversal was the main reason for "low" adherence (26%) in idarucizumab. The adherence for andexanet alfa was also "low" (0%). CONCLUSION In case of reversal for bleeding under DOAC, overall adherence to the protocol was "moderate"; however, in patients needing an urgent procedure, it was "low." The major reasons for non-adherence were underdosing, off-label use, and a lack of specific lab testing. The results of this study can assist in improving the implementation of hospital protocols.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, The Netherlands
| | - Margriet van Elp
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, The Netherlands
| | - Loes Visser
- Department of Hospital Pharmacy, Haga Hospital, The Hague, The Netherlands
| | - Nienke van Rein
- Department of Hospital Pharmacy, University Medical Centre Leiden, Leiden, The Netherlands
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marinus van Hulst
- Department of Hospital Pharmacy, Martini Hospital Groningen, Groningen, The Netherlands
- Department of Hospital Pharmacy, Treant Hospital Emmen, Emmen, The Netherlands
| | - Albert Dreijer
- Department of Hospital Pharmacy, Treant Care Group, Hoogeveen, The Netherlands
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- MCL Academy Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric van Roon
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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23
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van ’t Wout-Frank M, Garnaat SL, Faucher CR, Arulpragasam AR, Cole JE, Philip NS, Burwell RD. Transcranial direct current stimulation impairs updating of avoidance-based associative learning. Front Hum Neurosci 2023; 17:1104614. [PMID: 37169017 PMCID: PMC10164989 DOI: 10.3389/fnhum.2023.1104614] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Exposure-based psychotherapies for the treatment of anxiety- and fear-based disorders rely on "corrective" associative learning. Namely the repeated confrontation with feared stimuli in the absence of negative outcomes allows the formation of new, corrected associations of safety, indicating that such stimuli no longer need to be avoided. Unfortunately, exposure-facilitated corrective learning tends to be bound by context and often poorly generalizes. One brain structure, the prefrontal cortex, is implicated in context-guided behavior and may be a relevant target for improving generalization of safety learning. Here, we tested whether inhibition of the left prefrontal cortex causally impaired updating of context-bound associations specifically or, alternatively, impaired updating of learned associations irrespective of contextual changes. Additionally, we tested whether prefrontal inhibition during corrective learning influenced subsequent generalization of associations to a novel context. Methods In two separate experiments, participants received either 10 min of 2 mA cathodal transcranial direct current stimulation (tDCS) over EEG coordinate F3 (Experiment 1 n = 9, Experiment 2 n = 22) or sham stimulation (Experiment 1 n = 10, Experiment 2 n = 22) while previously learned associations were reversed in the same or a different context from initial learning. Next, to assess generalization of learning, participants were asked to indicate which of the previously seen images they preferred in a novel, never seen before context. Results Results indicate that tDCS significantly impaired reversal irrespective of context in Experiment 2 only. When taking learning rate across trials into account, both experiments suggest that participants who received sham had the greatest learning rate when reversal occurred in a different context, as expected, whereas participants who received active tDCS in this condition had the lowest learning rate. However, active tDCS was associated with preferring the originally disadvantageous, but then neural stimulus after stimulus after reversal occurred in a different context in Experiment 1 only. Discussion These results support a causal role for the left prefrontal cortex in the updating of avoidance-based associations and encourage further inquiry investigating the use of non-invasive brain stimulation on flexible updating of learned associations.
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Affiliation(s)
- Mascha van ’t Wout-Frank
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | - Sarah L. Garnaat
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
| | - Christiana R. Faucher
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | - Amanda R. Arulpragasam
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, RI, United States
| | - Julia E. Cole
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
| | - Noah S. Philip
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | - Rebecca D. Burwell
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, RI, United States
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24
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Fu H, Aboelmagd T, Malhas A. Subscapularis Lengthening with Synthetic Augmentation for Reversal of Putti-Platt Procedure: A Case Report. J Orthop Case Rep 2023; 13:11-15. [PMID: 37193381 PMCID: PMC10182582 DOI: 10.13107/jocr.2023.v13.i04.3596] [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: 01/25/2023] [Revised: 02/10/2023] [Indexed: 05/18/2023] Open
Abstract
Introduction The Putti-Platt procedure is a historical technique for anterior shoulder stabilization, largely abandoned because it severely restricts movement, and causes arthritis and chronic pain. Patients continue to present with these sequelae, which can be difficult to manage. Here, we present the first published subscapularis re-lengthening for the reversal of Putti-Platt. Case Report Patient: A 47-year-old Caucasian manual worker presented 25 years post-Putti-Platt, with chronic pain and movement restriction. External rotation was 0°, abduction was 60°, and forward flexion was 80°. He was unable to swim and struggled to work. Multiple arthroscopic capsular releases had provided no benefit. Technique: The shoulder was opened through the deltopectoral approach, and a coronal Z-incision lengthening tenotomy was made in subscapularis. The tendon was lengthened by 2 cm and the repair was reinforced using a synthetic cuff augment. Results External rotation improved to 40°, and abduction and forward flexion to 170°. Pain resolved almost completely; Oxford Shoulder Score at 2-year follow-up was 43 (22 pre-operative). The patient returned to normal activity and reported complete satisfaction. Conclusion This is the first application of subscapularis lengthening to Putti-Platt reversal. Two-year outcomes were excellent, demonstrating potential for significant benefit. Although presentations like this one are rare, our results support the potential of subscapularis lengthening (with synthetic augmentation) in the management of stiffness resistant to conventional treatment after Putti-Platt procedure.
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Affiliation(s)
- Howell Fu
- Department of Orthopaedics, South West London Elective Orthopaedic Centre, Epsom, England
- Address of Correspondence: Dr. Howell Fu, Department of Orthopaedics, South West London Elective Orthopaedic Centre, Epsom, England. E-mail:
| | - Tariq Aboelmagd
- Department of Orthopaedics, Royal Berkshire Hospital, Reading, England
| | - Amar Malhas
- Department of Orthopaedics, Royal Berkshire Hospital, Reading, England
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25
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Clancy C, Connelly TM, Jia X, Lipman J, Lightner AL, Hull T, Steele SR, Holubar SD. Prolonged diversion after ileal pouch-anal anastomosis: Is it safe to wait? Colorectal Dis 2023. [PMID: 36992540 DOI: 10.1111/codi.16560] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/28/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023]
Abstract
AIM Diverting loop ileostomy reversal (DLI-R) is routinely performed from 2-6 months following ileal pouch-anal anastomosis (IPAA). The safety of delayed reversal after IPAA is not well-defined. The aim of this study was to determine if prolonged diversion is associated with adverse outcomes compared to routine closure. METHODS Adult patients undergoing primary IPAA with DLI from 2000 to 2021 were included in this retrospective cohort study from our institutional database. Patients were stratified into tertiles based on timing of reversal: Routine (56-116 days), Delayed (117-180 days), or Prolonged (>6 months). Univariate analysis compared categorical variables between groups. Patients reversed at <8 weeks were excluded. RESULTS In total, 2615 patients underwent DLI-R following IPAA (3-stage 61%, 2-stage 39%; mean age 39.9 years). DLI-R was performed as Routine, Delayed and Prolonged in 1908 (72.9%), 426 (16.4%) and 281 (10.8%), respectively. Overall, DLI-R related complications occurred in 12.4% (n = 324). The complication rate in the Routine group was 11% (n = 210), in the Delayed group was 12.2% (n = 52) and in the Prolonged group was 22.1% (n = 62). Reasons for prolonged diversion in the Prolonged group were complications at the time of IPAA in 207 (73.9%) or patient preference/scheduling in 73 (26.1%). DLI-R >6 months after IPAA due to complications had higher rates of overall complications following ileostomy reversal (OR 2.6, 95% CI 1.85-3.72, p < 0.001) whereas when DLI-R was delayed due to preference/scheduling outcomes were not different than the Routine group (p = 0.28). CONCLUSION Prolonged time to ileostomy reversal after IPAA is probably safe without increased risk of complications when due to patient preference.
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Affiliation(s)
- Cillian Clancy
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tara M Connelly
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xue Jia
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeremy Lipman
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amy L Lightner
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tracy Hull
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott R Steele
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan D Holubar
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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26
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Xi J, Li Y, Zhang H, Bai Z. Dynamic variations of the gastric microbiota: Key therapeutic points in the reversal of Correa's cascade. Int J Cancer 2023; 152:1069-1084. [PMID: 36029278 DOI: 10.1002/ijc.34264] [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: 03/31/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 01/21/2023]
Abstract
Correa's cascade is a dynamic process in the development of intestinal-type gastric cancer (GC), and its pathological features, gastric microbiota and interactions between microorganisms and their hosts vary at different developmental stages. The characteristics of cells, tissues and gastric microbiota before or after key therapeutic points are critical for monitoring malignant transformation and early tumour reversal. This review summarises the pathological features of gastric mucosa, characteristics of gastric microbiota, specific microbial markers, microbe-microbe interactions and microbe-host interactions at different stages in Correa's cascade. The markers related to each Correa's cascade point were analysed in detail. We attempted to identify key therapeutic points for early cancer reversal and provide a novel approach to reduce the incidence of GC and improve precise treatment.
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Affiliation(s)
- Jiahui Xi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.,Key Laboratory of Biotherapy and Regenerative Medicine, Gansu Province, Lanzhou, China
| | - Yonghong Li
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumour, Gansu Provincial Hospital, Lanzhou, China
| | - Hui Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.,General Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhongtian Bai
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.,Key Laboratory of Biotherapy and Regenerative Medicine, Gansu Province, Lanzhou, China.,General Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China
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27
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Barnard J, Milne T, Teo K, Weston M, Israel L, Peng SL. Causes and costs of delayed closure of ileostomies in rectal cancer patients in Australasian units. ANZ J Surg 2023; 93:636-642. [PMID: 36203387 DOI: 10.1111/ans.18092] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Defunctioning loop ileostomies (DLIs) are a frequent adjunct to rectal cancer surgery. Delayed closure of DLIs is common and associated with increased morbidity. The reasons for delayed DLI closure are often unknown. The economic burden of delayed DLI closure is not quantified. The present study aimed to determine the reasons for, and economic burden of, delayed DLI closure. METHODS Clinical and economic data were audited from a prospective database of patients in two Australasian colorectal cancer centres. Patients treated at each unit with low/ultra-low anterior resection for rectal cancer with formation of DLI between January 2014 and December 2019 were included. Post-operative complication rate, stoma-related complication rate and costs of hospital admissions and stoma care were recorded and analysed. Multivariate linear regression analysis was used to investigate risk factors for delay to closure. RESULTS 146 patients underwent low/ultra-low anterior resection with DLI; 135 patients (92.5%) underwent reversal. The median duration to reversal was 7 months (IQR 4.5-9.5). Sixty-six percent of patients underwent reversal >6 months after their index surgery. Neoadjuvant and adjuvant chemotherapy were associated with delayed reversal (P < 0.001). Non-English speakers waited longer for DLI closure (P = 0.028). The costs of outpatient stoma care (P < 0.001), post-operative care (P = 0.004), and total cost of treatment (P = 0.014) were significantly higher in the delayed closure group, with a total cost of treatment difference of $3854 NZD per patient. CONCLUSIONS Causes of delay include systemic factors and demographic factors that can be addressed directly, addressing such causes may alleviate a significant economic burden.
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Affiliation(s)
- Jon Barnard
- Coloreectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tony Milne
- General Surgery, Nelson Hospital, Nelson, New Zealand
| | - Keith Teo
- General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Maree Weston
- General Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Lincoln Israel
- General Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Sze-Lin Peng
- General Surgery, Middlemore Hospital, Auckland, New Zealand
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28
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Cerpa JC, Piccin A, Dehove M, Lavigne M, Kremer EJ, Wolff M, Parkes SL, Coutureau E. Inhibition of noradrenergic signalling in rodent orbitofrontal cortex impairs the updating of goal-directed actions. eLife 2023; 12:81623. [PMID: 36804007 PMCID: PMC9988255 DOI: 10.7554/elife.81623] [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: 07/05/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
In a constantly changing environment, organisms must track the current relationship between actions and their specific consequences and use this information to guide decision-making. Such goal-directed behaviour relies on circuits involving cortical and subcortical structures. Notably, a functional heterogeneity exists within the medial prefrontal, insular, and orbitofrontal cortices (OFC) in rodents. The role of the latter in goal-directed behaviour has been debated, but recent data indicate that the ventral and lateral subregions of the OFC are needed to integrate changes in the relationships between actions and their outcomes. Neuromodulatory agents are also crucial components of prefrontal functions and behavioural flexibility might depend upon the noradrenergic modulation of the prefrontal cortex. Therefore, we assessed whether noradrenergic innervation of the OFC plays a role in updating action-outcome relationships in male rats. We used an identity-based reversal task and found that depletion or chemogenetic silencing of noradrenergic inputs within the OFC rendered rats unable to associate new outcomes with previously acquired actions. Silencing of noradrenergic inputs in the prelimbic cortex or depletion of dopaminergic inputs in the OFC did not reproduce this deficit. Together, our results suggest that noradrenergic projections to the OFC are required to update goal-directed actions.
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Affiliation(s)
| | | | | | - Marina Lavigne
- Institut de Génétique Moléculaire de Montpellier, CNRS, University of MontpellierMontpellierFrance
| | - Eric J Kremer
- Institut de Génétique Moléculaire de Montpellier, CNRS, University of MontpellierMontpellierFrance
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29
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Motamed C. Sugammadex in Emergency Situations. J Pers Med 2023; 13:jpm13010159. [PMID: 36675820 PMCID: PMC9867288 DOI: 10.3390/jpm13010159] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequence intubation, the tendency to use rocuronium followed by sugammadex instead of succinylcholine has been increasing. In other emergency situations such as anaphylactic shock caused by rocuronium or if intubation or ventilation is not possible, priority should be given to resuming ventilation maintaining hemodynamic stability, in accordance with the traditional guidelines. If necessary for the purpose of resuming ventilation, reversal of neuromuscular blockade should be done in a timely fashion.
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Affiliation(s)
- Cyrus Motamed
- Departement of Anesthesia, Gustave Roussy Cancer Campus, 94080 Villejuif, France
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30
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Starita F, Pirazzini G, Ricci G, Garofalo S, Dalbagno D, Degni LAE, Di Pellegrino G, Magosso E, Ursino M. Theta and alpha power track the acquisition and reversal of threat predictions and correlate with skin conductance response. Psychophysiology 2023:e14247. [PMID: 36604803 DOI: 10.1111/psyp.14247] [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: 07/22/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
The ability to flexibly adjust one's threat predictions to meet the current environmental contingencies is crucial to survival. Nevertheless, its neural oscillatory correlates remain elusive in humans. Here, we tested whether changes in theta and alpha brain oscillations mark the updating of threat predictions and correlate with response of the peripheral nervous system. To this end, electroencephalogram and electrodermal activity were recorded in a group of healthy adults, who completed a Pavlovian threat conditioning task that included an acquisition and a reversal phase. Both theta and alpha power discriminated between threat and safety, with each frequency band showing unique patterns of modulations during acquisition and reversal. While changes in midcingulate theta power may learn the timing of an upcoming danger, alpha power may reflect the preparation of the somato-motor system. Additionally, ventromedial prefrontal cortex theta may play a role in the inhibition of previously acquired threat responses, when they are no longer appropriate. Finally, theta and alpha power correlated with skin conductance response, establishing a direct relationship between activation of the central and peripheral nervous systems. Taken together these results highlight the existence of multiple oscillatory systems that flexibly regulate their activity for the successful expression of threat responses in an ever-changing environment.
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Affiliation(s)
- Francesca Starita
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Gabriele Pirazzini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Giulia Ricci
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Sara Garofalo
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Daniela Dalbagno
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Luigi A E Degni
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Giuseppe Di Pellegrino
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Elisa Magosso
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Mauro Ursino
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
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31
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Rodriguez Silva JA, Maykel JA. Loop ileostomy reversal. Colorectal Dis 2023; 25:160. [PMID: 35901219 DOI: 10.1111/codi.16287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Jetsen A Rodriguez Silva
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Justin A Maykel
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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32
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Robinson S, Winer JL, Kitase Y, Brigman JL, Jantzie LL. Neonatal administration of erythropoietin attenuates cognitive deficits in adult rats following placental insufficiency. J Neurosci Res 2022; 100:2112-2126. [PMID: 33611820 PMCID: PMC10097461 DOI: 10.1002/jnr.24815] [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] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 01/07/2023]
Abstract
Preterm birth is a principal cause of neurological disability later in life, including cognitive and behavioral deficits. Notably, cognitive impairment has greater impact on quality of life than physical disability. Survivors of preterm birth commonly have deficits of executive function. Difficulties with tasks and planning complexity correlate positively with increasing disability. To overcome these barriers for children born preterm, preclinical and clinical studies have emphasized the importance of neurorestoration. Erythropoietin (EPO) is a endogenous cytokine with multiple beneficial mechanisms of action following perinatal brain injury. While most preclinical investigations have focused on pathology and molecular mechanisms, translational studies of repair using clinically viable biobehavioral biomarkers are still lacking. Here, using an established model of encephalopathy of prematurity secondary to placental insufficiency, we tested the hypothesis that administration of EPO in the neonatal period would attenuate deficits in recognition memory and cognitive flexibility in adult rats of both sexes. We assessed cognition and executive function in two ways. First, using the classic test of novel object recognition and second, using a touchscreen platform. Touchscreen testing allows for rigorous testing of cognition and executive function in preclinical and clinical scenarios. Data show that adult rats exhibit deficits in recognition memory and cognitive flexibility following in utero placental insufficiency. Notably, neonatal treatment of EPO attenuates these deficits in adulthood and facilitates functional repair. Together, these data validate EPO neurorestoration using a clinically relevant outcome measure and support the concept that postnatal treatment following in utero injury can improve cognition and executive function through adulthood.
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Affiliation(s)
- Shenandoah Robinson
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jesse L Winer
- Division of Pediatric Neurosurgery, Oregon Health and Science University, Portland, OR, USA
| | - Yuma Kitase
- Division of Neonatal-Perinatal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan L Brigman
- Department of Neuroscience, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Lauren L Jantzie
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Neonatal-Perinatal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Kennedy Krieger Institute, Baltimore, MD, USA
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Zhang Y, Fang X, Wei J, Miao R, Wu H, Ma K, Tian J. PDX-1: A Promising Therapeutic Target to Reverse Diabetes. Biomolecules 2022; 12. [PMID: 36551213 DOI: 10.3390/biom12121785] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 12/02/2022] Open
Abstract
The pancreatic duodenum homeobox-1 (PDX-1) is a transcription factor encoded by a Hox-like homeodomain gene that plays a crucial role in pancreatic development, β-cell differentiation, and the maintenance of mature β-cell functions. Research on the relationship between PDX-1 and diabetes has gained much attention because of the increasing prevalence of diabetes melitus (DM). Recent studies have shown that the overexpression of PDX-1 regulates pancreatic development and promotes β-cell differentiation and insulin secretion. It also plays a vital role in cell remodeling, gene editing, and drug development. Conversely, the absence of PDX-1 increases susceptibility to DM. Therefore, in this review, we summarized the role of PDX-1 in pancreatic development and the pathogenesis of DM. A better understanding of PDX-1 will deepen our knowledge of the pathophysiology of DM and provide a scientific basis for exploring PDX-1 as a potential target for treating diabetes.
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Sun T, Xu W, Chen Y, Niu Y, Wang T, Wang S, Xu H, Liu J. Reversal of idiopathic hypogonadotropic hypogonadism in a Chinese male cohort. Andrologia 2022; 54:e14583. [PMID: 36123965 DOI: 10.1111/and.14583] [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: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Idiopathic hypogonadotropic hypogonadism (IHH) is a rare genetically heterogeneous disease and characterized by incomplete or absent puberty and infertility. It is worth noting that partial IHH patients could recover reproductive endocrine function following treatment, which is termed reversal. This study aimed to investigate clinical and genetic characteristics of IHH reversal patients. A total of 141 IHH male patients were enrolled and followed up regularly. Their clinical and genetic features were collected and analysed to discover something in common in reversal cases. These IHH patients with a median age of 21 years (interquartile range: 18-24) were divided into reversal group (n = 13) and non-reversal group (n = 128). IL17RD, ERBB4, DLX5, EGFR, SEMA4D, B3GNT1 and CCKAR RSVs were demonstrated in reversal cases for the first time. Pathogenic/likely pathogenic (P/LP) RSVs consisted of 3 RSVs (one each patient, including PROKR2 p.W178S, EGFR p.G630R and CCKAR p.S291del) in reversal group. Reversal of IHH could not be ignored in clinical follow-up. Patients with high levels of basal LH and T may harbour more possibility of reversal and worthy extra attention to identify whether reversal occurs or not. Relapse after reversal also needs to be monitored.
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Affiliation(s)
- Taotao Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenchao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinwei Chen
- Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yonghua Niu
- Department of Paediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Setiawan A, Vohra V, Winograd EJ. Massive warfarin overdose management in an adolescent patient. Clin Toxicol (Phila) 2022; 60:1159-1162. [PMID: 36069749 DOI: 10.1080/15563650.2022.2116337] [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: 11/03/2022]
Abstract
INTRODUCTION Warfarin is a widely used oral anticoagulant with established reversal guidelines in the setting of a supratherapeutic international normalized ratio (INR). Limited literature exists on managing acute warfarin overdoses in patients who are not chronically anticoagulated. CASE A 15-year-old male, with no indication for anticoagulation, presented to a pediatric emergency department after an acute 1,000 mg warfarin ingestion. He had no significant complaints upon presentation aside from a mild intermittent headache. His past medical history was significant for anxiety, depression, Tourette syndrome, attention deficit hyperactivity disorder, and polysubstance misuse. Computed tomography of his head was unremarkable and serum acetaminophen, salicylate, and ethanol concentrations were negative. Approximately 16 h post-ingestion, his INR was 1.9 with an increase to 3.3 by 26 h. The regional poison center was consulted and recommended, consistent with the CHEST guidelines, holding treatment with vitamin K until INR was >10 or if signs or symptoms of bleeding occurred. The patient was admitted for monitoring and by hospital day (HD) #4, his INR had risen to >11.8 at which point oral vitamin K 10 mg was administered. On HD #7, the patient was deemed stable for transfer to inpatient psychiatry after repeat INRs of 2.9 and 3.4. DISCUSSION Case reports have demonstrated early administration of vitamin K can temporarily lower INR and prevent detection of rebound. The CHEST warfarin reversal guidelines describe the risks and benefits with respect to bleeding and thrombosis in the non-intentional overdose patient. Application and extrapolation of these guidelines to acute overdose in patients who lack an indication for anticoagulation may or may not be warranted. CONCLUSION While established clinical guidance exists on reversing a supratherapeutic INR in patients chronically anticoagulated with warfarin, the risks and benefits of extrapolating this approach are unclear in those who lack an indication for anticoagulation.
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Affiliation(s)
- Andrea Setiawan
- Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
| | - Varun Vohra
- Michigan Poison & Drug Information Center, Detroit, MI, USA.,Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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McKeever C, Aziz M. Effect of Multilayered Structure on the Static and Dynamic Properties of Magnetic Nanospheres. ACS Appl Mater Interfaces 2022; 14:35177-35183. [PMID: 35879264 PMCID: PMC9354015 DOI: 10.1021/acsami.2c05715] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The development of flexible and lightweight electromagnetic interference (EMI)-shielding materials and microwave absorbers requires precise control and optimization of core-shell constituents within composite materials. Here, a theoretical model is proposed to predict the static and dynamic properties of multilayered core-shell particles comprised of exchange-coupled layers, as in the case of a spherical iron core coupled to an oxide shell across a spacer layer. The theory of exchange resonance in homogeneous spheres is shown to be a limiting special case of this more general theory. Nucleation of magnetization reversal occurs through either quasi-uniform or curling magnetization processes in core-shell particles, where a purely homogeneous magnetization configuration is forbidden by the multilayered morphology. The energy is minimized through mixing of modes for specific interface conditions, leading to many inhomogeneous solutions, which grow as 2n with increasing layers, where n represents the number of magnetic layers. The analytical predictions are confirmed using numerical simulations.
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Affiliation(s)
- Conor McKeever
- Department
of Physics and Astronomy, University of
Exeter, Exeter EX4 4QL, United Kingdom
- MaxLLG,
Exeter Science Park, Exeter EX5 2FN, United Kingdom
| | - Mustafa Aziz
- Department
of Engineering, University of Exeter, Exeter EX4 4QF, United Kingdom
- MaxLLG,
Exeter Science Park, Exeter EX5 2FN, United Kingdom
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Barletta JF, Erstad BL. Dosing Medications for Coagulopathy Reversal in Patients with Extreme Obesity. J Emerg Med 2022; 63:541-550. [PMID: 35906122 DOI: 10.1016/j.jemermed.2022.04.036] [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: 02/17/2022] [Revised: 03/22/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The reversal of anticoagulant or antiplatelet medications is a priority in the management of patients with severe injury with the goal of minimizing further bleeding without thrombotic complications. There are few studies, however, evaluating the dosing of reversal agents in the setting of trauma specific to patients with extreme obesity. Nevertheless, clinicians must still make decisions, balancing concerns of ongoing bleeding with excessive thrombosis. OBJECTIVES We describe the literature pertaining to dosing of medications used for the reversal of both drug-induced and trauma-related coagulopathy with the intent of providing a framework for clinicians to make dosing decisions in this challenging population. DISCUSSION Obesity is known to impact both the volume of distribution and the clearance of medications, but these changes are not usually linear with size nor are they uniform across drugs. Current strategies for dosing reversal agents in obesity include a capped dose (e.g., prothrombin complex concentrates), fixed dosages (e.g., andexanet alfa, idarucizumab, and tranexamic acid), and weight-based dosing (e.g., desmopressin). Extreme obesity, however, was not highly prevalent in the studies that have validated these dosing strategies. In fact, many of the clinical studies fail to report the average weight of the patients included. CONCLUSION Future studies should make efforts to increase reporting of patients with obesity included in clinical trials along with results stratified by weight class. In the meantime, doses listed in product labels should be used. Desmopressin should be dosed using either ideal body weight or a dose-capping strategy.
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Affiliation(s)
- Jeffrey F Barletta
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale
| | - Brian L Erstad
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona
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Powell L, Kidd L. Reversal of neuromuscular block with neostigmine versus sugammadex: comment on Br J Anaesth 2021; 127: 316-23. Br J Anaesth 2022; 129:e8-e10. [PMID: 35469673 DOI: 10.1016/j.bja.2022.03.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Laura Powell
- Anaesthetics Department, Gloucestershire Royal Hospital, Gloucester, UK.
| | - Lawrence Kidd
- Anaesthetics Department, Gloucestershire Royal Hospital, Gloucester, UK
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Røed-Undlien H, Schultz NH, Lunnan A, Husebråten IM, Wollmann BM, Molden E, Bjørnstad JL. In Vitro Apixaban Removal By CytoSorb Whole Blood Adsorber: An Experimental Study. J Cardiothorac Vasc Anesth 2022; 36:1636-1644. [PMID: 35272914 DOI: 10.1053/j.jvca.2022.01.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The use of unopposed oral anticoagulants while undergoing cardiothoracic surgery is associated with severe bleeding and increased morbidity. The aim of this experimental study was to examine if the apixaban concentration in reconstituted blood could be reduced in an in vitro setup by the use of CytoSorb whole blood adsorber, and to study how this affected global coagulation assays. DESIGN AND SETTING An experimental study performed in a laboratory. PARTICIPANTS An in vitro setup with reconstituted whole blood. INTERVENTIONS Reconstituted whole blood spiked with apixaban circulated in an in vitro circuit with the CytoSorb 300 mL device connected. MEASUREMENTS AND MAIN RESULTS Blood samples were drawn at 0, 5, 15, 30, 60, and 120 minutes of adsorption. The apixaban concentration was measured at each time point. In addition, the global coagulation assays, thromboelastometry clotting time and thrombin generation, were performed, and the results were compared with baseline values obtained before spiking blood with apixaban. After 30 minutes of adsorption, the mean apixaban concentration was reduced from 414.3 (±69.1) ng/mL to 33 (±11.4) ng/mL. Thrombin generation showed maximum effect after 60 minutes, and the thromboelastometry clotting time was close to baseline values after 120 minutes. CONCLUSIONS In this in vitro study, apixaban concentrations were effectively reduced, and the clotting time and thrombin generation assays were normalized by the use of CytoSorb whole blood adsorber.
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Affiliation(s)
| | - Nina Haagenrud Schultz
- Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway; Department of Haematology, Akershus University Hospital, Lørenskog, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Asbjørn Lunnan
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Department of Pharmacy, University of Oslo, Norway
| | - Johannes Lagethon Bjørnstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.
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Algera MH, Cotten JF, van Velzen M, Niesters M, Boon M, Shoham DS, Dandrea KE, van der Schrier R, Dahan A. Are thyrotropin-releasing hormone (TRH) and analog taltirelin viable reversal agents of opioid-induced respiratory depression? Pharmacol Res Perspect 2022; 10:e00974. [PMID: 35621218 PMCID: PMC9137104 DOI: 10.1002/prp2.974] [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: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Opioid‐induced respiratory depression (OIRD) is a potentially life‐threatening complication of opioid consumption. Apart from naloxone, an opioid antagonist that has various disadvantages, a possible reversal strategy is treatment of OIRD with the hypothalamic hormone and neuromodulator thyrotropin‐releasing hormone (TRH). In this review, we performed a search in electronic databases and retrieved 52 papers on the effect of TRH and TRH‐analogs on respiration and their efficacy in the reversal of OIRD in awake and anesthetized mammals, including humans. Animal studies show that TRH and its analog taltirelin stimulate breathing via an effect at the preBötzinger complex, an important respiratory rhythm generator within the brainstem respiratory network. An additional respiratory excitatory effect may be related to TRH’s analeptic effect. In awake and anesthetized rodents, TRH and taltirelin improved morphine‐ and sufentanil‐induced respiratory depression, by causing rapid shallow breathing. This pattern of breathing increases the work of breathing, dead space ventilation, atelectasis, and hypoxia. In awake and anesthetized humans, a continuous infusion of intravenous TRH with doses up to 8 mg, did not reverse sufentanil‐ or remifentanil‐induced respiratory depression. This is related to poor penetration of TRH into the brain compartment but also other causes are discussed. No human data on taltirelin are available. In conclusion, data from animals and human indicate that TRH is not a viable reversal agent of OIRD in awake or anesthetized humans. Further human studies on the efficacy and safety of TRH’s more potent and longer lasting analog taltirelin are needed as this agent seems to be a more promising reversal drug.
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Affiliation(s)
- Marieke Hyke Algera
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joseph F Cotten
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Monique van Velzen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn Boon
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel S Shoham
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaye E Dandrea
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
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41
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Ibarra F, Cruz M, Ford M, Wu MJ. Fixed-Dose Factor Eight Inhibitor Bypassing Activity (FEIBA) in the Management of Warfarin-Associated Coagulopathies. Pharmacy (Basel) 2022; 10:pharmacy10030050. [PMID: 35645329 PMCID: PMC9149897 DOI: 10.3390/pharmacy10030050] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 01/27/2023] Open
Abstract
This retrospective review evaluated our institutions’ practice of administering low fixed-dose FEIBA (high (1000 units) or low dose (500 units) for an INR ≥ 5 or <5, respectively) for the management of warfarin-associated coagulopathies. The primary outcome was the percentage of patients who had a post-FEIBA INR ≤ 1.5. In the total population, 55.6% (10/18) of patients achieved a post-FEIBA INR ≤ 1.5. In the subgroup analysis, significantly more patients in the low dose FEIBA group achieved a post-FEIBA INR ≤ 1.5 compared to the high dose FEIBA group (71.4% vs. 45.5%, respectively, p < 0.001). In the post hoc analysis, there was a significant difference in the number of patients who achieved a post-FEIBA INR ≤ 1.5 when comparing those who received high dose FEIBA with a baseline INR 5−9.9 to those who received high dose FEIBA with a baseline INR ≥ 10 (60% vs. 33.3%, respectively, p < 0.001). The existing literature and our findings suggest that patients who present with lower baseline INR values and receive additional reversal agents are more likely to meet post-reversal INR goals. Current low fixed-dose protocols may be oversimplified and may need to be revised to provide larger fixed-doses.
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Affiliation(s)
- Francisco Ibarra
- Community Regional Medical Center, Fresno, CA 93721, USA; (M.C.); (M.-J.W.)
- Correspondence:
| | - Mallory Cruz
- Community Regional Medical Center, Fresno, CA 93721, USA; (M.C.); (M.-J.W.)
| | - Matthew Ford
- Clovis Community Medical Center, Clovis, CA 93611, USA;
| | - Meng-Jou Wu
- Community Regional Medical Center, Fresno, CA 93721, USA; (M.C.); (M.-J.W.)
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Liu J, Elsamadisi P, Philips E, Bauer KA, Eche IM. Four-factor prothrombin complex concentrate plus andexanet alfa for reversal of factor Xa inhibitor-associated bleeding: Case series. Am J Health Syst Pharm 2022; 79:1323-1329. [PMID: 35291008 DOI: 10.1093/ajhp/zxac079] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To manage factor Xa (FXa) inhibitor-associated bleeding, andexanet alfa or 4-factor prothrombin concentrate (4F-PCC) has been used to restore hemostasis. However, literature on the outcomes for patients who received both andexanet alfa and 4F-PCC is limited. SUMMARY We report a case series of 5 patients who received andexanet alfa plus 4F-PCC for reversal of FXa inhibitor-associated bleeding. Patients were included in this case series if they received both andexanet alfa and 4F-PCC for reversal of FXa inhibitor-associated bleeding. They were followed to either discharge or death, and in-hospital complications related to concurrent use of andexanet alfa and 4F-PCC were documented. We report an incidence of thromboembolism of 40% (2 of 5 cases) and an in-hospital mortality rate of 60% (3 of 5 cases). Taking these cases together with those in the existing literature, we found a total of 23 reported cases of safety outcomes with andexanet alfa plus 4F-PCC. The overall incidence of thromboembolism was 35% (8 of 23 cases). CONCLUSION This case series adds to the limited literature describing the outcomes for patients receiving andexanet alfa plus 4F-PCC. We encourage other institutions to report safety data on administering both agents.
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Affiliation(s)
- JiTong Liu
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Pansy Elsamadisi
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eli Philips
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth A Bauer
- Division of Hematology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ifeoma M Eche
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ansari AS, Hussain M, Khan SR, Badar A, Khilwani B, Lohiya NK. Studies on biochemical, oxidative and genotoxicity alterations following vas blockage with reversible inhibition of sperm under guidance and reversal in rats. Indian J Pharmacol 2022; 54:33-40. [PMID: 35343205 PMCID: PMC9012424 DOI: 10.4103/ijp.ijp_557_20] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
CONTEXT: Vas obstruction with reversible inhibition of sperm under guidance (RISUG) for contraception and its reversal, may cause oxidative stress or inimical effects on male reproductive functions. OBJECTIVE: To evaluate the biochemical and genotoxicity at the level of reactive oxygen species (ROS) following vas occlusion with RISUG and its reversal by Dimethyl sulphoxide (DMSO) and 5% NaHCO3 in Wistar albino rats. SETTINGS AND DESIGN: Animals were divided into seven groups (n = 10), namely sham-operated control, short-term vas occlusion with RISUG for 90 days, reversal with DMSO and 5% NaHCO3, long-term vas occlusion with RISUG for 360 days, reversal with DMSO and 5% NaHCO3. MATERIALS AND METHODS: Biochemical markers in reproductive tissues, hematology, serum biochemistry, serum electrolytes and ROS measuring indicators, e.g., lipid peroxidation, superoxide dismutase, catalase, glutathione peroxidase, and glutathione S-transferase were examined. STATISTICAL ANALYSIS USED: One-way analysis of variance test was performed for analyses of data obtained in this study using the SPSS 10.0 software (SPSS Inc., Chicago, IL, USA). RESULTS: The tissue and clinical chemistry did not show appreciable alterations in RISUG injected and reversal Groups (II-VII) as compared to sham control. The genotoxicity and various ROS markers fluctuated within control limits following short- and long-term vas occlusion and reversal. CONCLUSIONS: The study suggested that the reversal procedures, following RISUG contraception, were not associated with any kind of toxicological manifestations.
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Affiliation(s)
- Abdul S Ansari
- Department of Zoology, Centre for Advanced Studies, University of Rajasthan, Sitapura, Jaipur, Rajasthan, India
| | - Mubarik Hussain
- Department of Zoology, S. S. Jain Subodh College of Global Excellence, Sitapura, Jaipur, Rajasthan, India
| | - Sadi Rehan Khan
- Department of Zoology, Centre for Advanced Studies, University of Rajasthan, Sitapura, Jaipur, Rajasthan, India
| | - Ayesha Badar
- Department of Zoology, Centre for Advanced Studies, University of Rajasthan, Sitapura, Jaipur, Rajasthan, India
| | - Barkha Khilwani
- Department of Zoology, Centre for Advanced Studies, University of Rajasthan, Sitapura, Jaipur, Rajasthan, India
| | - Nirmal Kumar Lohiya
- Department of Zoology, Centre for Advanced Studies, University of Rajasthan, Sitapura, Jaipur, Rajasthan, India
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Spyropoulos AC, Hartaigh BÓ, Cao Z, Caberwal H, Lipkin C, Petrini M, Wang C. Costs and Healthcare Resource Utilization Associated with Idarucizumab or Andexanet Alfa Oral Anticoagulant Reversal in Patients Hospitalized with Life-Threatening Bleeds. Clin Appl Thromb Hemost 2022; 28:10760296221110568. [PMID: 35792949 PMCID: PMC9272054 DOI: 10.1177/10760296221110568] [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: 11/17/2022] Open
Abstract
Purpose: To assess costs and healthcare resource utilization (HCRU) associated with the use of idarucizumab for the reversal of dabigatran and andexanet alfa for the reversal of direct oral Factor Xa inhibitors. Methods: This retrospective study utilizing Premier Healthcare Database (PHD) included patients aged ≥18 years on direct oral anticoagulants (DOACs) who experienced life-threatening bleeds, discharged from the hospital during 5/1/2018–6/30/2019, and received idarucizumab or andexanet alfa. Inverse of treatment probability weighting (IPTW) method was used to balance patient and clinical characteristics between treatment cohorts. Results: Idarucizumab patients were older than andexanet alfa patients (median age 81 vs 77 years; p < 0.001), and less likely to experience intracranial hemorrhage (ICH) (37.1%vs 73.8%; p = 0.001). After IPTW adjustment, idarucizumab patients incurred lower mean total hospital costs ($30,413 ± $33,028 vs $44,477 ± $30,036; p < 0.001),and mean intensive care unit (ICU) cost ($25,114 ± $30,433 vs $43,484 ± $29,335; p < 0.001). Conclusions: Anticoagulant reversal therapy with idarucizumab was associated with significantly lower adjusted mean total hospital and ICU costs compared with andexanet alfa. However, a higher prevalence of ICH bleeds was noted in the andexanet alfa group. Trial Registration: Not applicable.
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Affiliation(s)
- Alex C Spyropoulos
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Zhun Cao
- 43690Premier, Inc, Charlotte, NC, USA
| | - Harjeet Caberwal
- 6893Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | | | - Michaela Petrini
- 6893Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - Cheng Wang
- 6893Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
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Ansems LFM, van den Bos K, Mak E. The Importance of Perceived Procedural Justice Among Defendants With a Non-Western Background Involved in Dutch Criminal Cases. Front Psychol 2021; 12:746364. [PMID: 34912270 PMCID: PMC8666687 DOI: 10.3389/fpsyg.2021.746364] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
This study aims to put perceived procedural justice to a critical test in the context of Dutch criminal court hearings. To that end, we surveyed 198 criminal defendants to examine whether their perceptions of procedural fairness were significantly associated with trust in judges and intentions to protest against judicial rulings, among other variables. We also examine the possibility that sometimes unfair procedures may have nice aspects, because they offer opportunities to attribute negative outcomes to external causes. Previous studies conducted in different settings support this line of reasoning by showing that associations between perceived procedural justice and other variables are sometimes attenuated or even reversed, particularly when people feel strongly evaluated. The current study takes these insights into the novel context of Dutch criminal court hearings by focusing on defendants with a non-Western ethnic-cultural background. Some of these defendants may feel negatively evaluated by society, which can manifest as a high level of perceived discrimination. Thus, we examine whether the associations between perceived procedural justice and important other variables may be attenuated or reversed depending on respondents' perceptions of everyday discrimination and their outcome judgments. Our results revealed significant associations between perceived procedural justice on the one hand and trust in judges and protest intentions on the other hand, which remained intact regardless of perceptions of everyday discrimination and outcome judgments. Hence, even in this real-life courtroom context, procedural justice was a relevant concern. Taken together, our findings support the importance of perceived procedural justice, even when it is put to a critical test.
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Affiliation(s)
| | - Kees van den Bos
- School of Law, Utrecht University, Utrecht, Netherlands.,Department of Psychology, Utrecht University, Utrecht, Netherlands
| | - Elaine Mak
- School of Law, Utrecht University, Utrecht, Netherlands
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Kalra S, Bantwal G, Kapoor N, Sahay R, Bhattacharya S, Anne B, Gopal RA, Kota S, Kumar A, Joshi A, Sanyal D, Tiwaskar M, Das AK. Quantifying Remission Probability in Type 2 Diabetes Mellitus. Clin Pract 2021; 11:850-859. [PMID: 34842637 PMCID: PMC8628725 DOI: 10.3390/clinpract11040100] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St Johns Medical College & Hospital, Bengaluru 560034, India;
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India;
- Non Communicable Disease Unit, The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad 500095, India;
| | | | - Beatrice Anne
- Department of Endocrinology, Nizams Institute of Medical Sciences, Hyderabad 500082, India;
| | - Raju A Gopal
- Department of Endocrinology, Endodiab Clinic, Kozhikode 673016, India;
| | - Sunil Kota
- Department of Endocrinology, Diabetes and Endocare Clinic, Berhampur 760004, India;
| | - Ashok Kumar
- Department of Endocrinology, CEDAR Diabetes Thyroid & Hormone Clinic Panipat, Panipat 132103, India;
| | - Ameya Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai 401107, India;
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata 700032, India;
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai 400068, India;
| | - Ashok Kumar Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry 605014, India;
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Zhu Y, Sui B, Liu X, Sun J. The reversal of drug resistance by two-dimensional titanium carbide Ti 2 C (2D Ti2C) in non-small-cell lung cancer via the depletion of intracellular antioxidant reserves. Thorac Cancer 2021; 12:3340-3355. [PMID: 34741403 PMCID: PMC8671908 DOI: 10.1111/1759-7714.14208] [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] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background Chemoresistance is a major barrier limiting the therapeutic efficacy of late stage non‐small cell lung cancer (NSCLC). In this study, we sought to use two‐dimensional titanium carbide (2D Ti2C) to reverse cisplatin resistance in NSCLC. Methods We first achieved favorable properties as a potential anti‐tumor agent. We then compared cell viability and cisplatin uptake in chemoresistant NSCLC cells before and after the use of 2D Ti2C. Afterwards, we explored the effects of 2D Ti2C on intracellular antioxidant reserves, followed by evaluating the subsequent changes in the expression of core drug resistance genes. Finally, we confirmed the tumor inhibitory effect and bio‐safety of 2D Ti2C in a drug‐resistant lung cancer model in nude mice. Results Due to the properties of thin layer, large specific surface area, and abundant reactive groups on the surface, 2D Ti2C can deplete the antioxidant reserve systems such as the glutathione redox buffer system, γ‐glutamylcysteine synthetase (γ‐GCS), glutathione peroxidase (GPx), glutathione‐S‐transferase‐Pi (GST‐π), and metallothionein (MT), thereby increasing the intracellular accumulation of cisplatin and decreasing the expression of drug resistance genes. Conclusions 2D Ti2C can reverse NSCLC chemoresistance both in vitro and in vivo, suggesting that it may potentially become a novel and effective means to treat chemoresistant NSCLC in the clinic.
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Affiliation(s)
- Yue Zhu
- Department of Dental Materials, Shanghai Biomaterials Research & Testing Center, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Baiyan Sui
- Department of Dental Materials, Shanghai Biomaterials Research & Testing Center, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xin Liu
- Department of Dental Materials, Shanghai Biomaterials Research & Testing Center, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jiao Sun
- Department of Dental Materials, Shanghai Biomaterials Research & Testing Center, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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Subramani Y, Querney J, He S, Nagappa M, Yang H, Fayad A. Efficacy and Safety of Sugammadex versus Neostigmine in Reversing Neuromuscular Blockade in Morbidly Obese Adult Patients: A Systematic Review and Meta-Analysis. Anesth Essays Res 2021; 15:111-118. [PMID: 34667357 PMCID: PMC8462431 DOI: 10.4103/aer.aer_79_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 12/19/2022] Open
Abstract
Context: Sugammadex is known to reverse neuromuscular blockade (NMB) more rapidly and reliably than neostigmine. However, data remain limited in bariatric patients. In this review, we systematically evaluated the efficacy and safety of sugammadex versus neostigmine in reversing NMB in morbidly obese (MO) patients undergoing bariatric surgery. Aims: Our primary objective was to determine the recovery time from drug administration to a train-of-four (TOF) ratio >0.9 from a moderate or deep NMB. Settings and Design: This systematic review and meta-analysis (SR and MA) was conducted in accordance with the Preferred Items for SRs and MAs guidelines. Subjects and Methods: A systematic search was conducted within multiple databases for studies that compared sugammadex and neostigmine in MO patients. Statistical Analysis Used: We reported data as mean difference (MD) or odds ratios (OR) and corresponding 95% confidence interval (CI) using random-effects models. A two-sided P < 0.05 was considered statistically significant. Results: Seven studies with 386 participants met the inclusion criteria. Sugammadex significantly reduced the time of reversal of moderate NMB-to-TOF ratio >0.9 compared to neostigmine, with a mean time of 2.5 min (standard deviation [SD] 1.25) versus 18.2 min (SD 17.6), respectively (MD: −14.52; 95% CI: −20.08, −8.96; P < 0.00001; I2 = 96%). The number of patients who had composite adverse events was significantly lower with sugammadex (21.2% of patients) compared to neostigmine (52.5% of patients) (OR: 0.15; 95% CI: 0.07–0.32; P < 0.00001; I2 = 0%). Conclusions: Sugammadex reverses NMB more rapidly with fewer adverse events than neostigmine in MO patients undergoing bariatric surgery.
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Affiliation(s)
- Yamini Subramani
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jill Querney
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Susan He
- Schulich school of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Homer Yang
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ashraf Fayad
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Patel P. Successful Use of Virtual Shared Medical Appointments for a Lifestyle-Based Diabetes Reversal Program. Am J Lifestyle Med 2021; 15:506-509. [PMID: 34646098 DOI: 10.1177/15598276211008396] [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] [Indexed: 11/17/2022] Open
Affiliation(s)
- Padmaja Patel
- Medical Director, Lifestyle Medicine Program, Midland Health, Midland, Texas
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Meregalli C, Maricich Y, Cavaletti G, Canta A, Carozzi VA, Chiorazzi A, Newbold E, Marmiroli P, Ceresa C, Diani A, Papapetropoulos S, Lee MS. Reversal of Bortezomib-Induced Neurotoxicity by Suvecaltamide, a Selective T-Type Ca-Channel Modulator, in Preclinical Models. Cancers (Basel) 2021; 13:5013. [PMID: 34638498 DOI: 10.3390/cancers13195013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Chemotherapy-induced peripheral neurotoxicity (CIPN) is a side-effect of anti-cancer medications, which can lead to pain, disruptions to movement, and eventually results in the need to interrupt or stop chemotherapy. This study sought to test whether the drug suvecaltamide could help to reduce the impact of the chemotherapy agent bortezomib (BTZ) on symptoms of CIPN using animal models and human cells. Suvecaltamide did reverse negative changes in nerve conduction velocity and intraepidermal nerve fiber density indicative of CIPN in rats, and did not interfere with the anti-cancer effect of BTZ. These results indicate that suvecaltamide could potentially be useful for patients experiencing CIPN, although further mechanistic and molecular studies in vitro and in vivo are required before clinical trials. Abstract This study evaluated suvecaltamide, a selective T-type calcium channel modulator, on chemotherapy-induced peripheral neurotoxicity (CIPN) and anti-cancer activity associated with bortezomib (BTZ). Rats received BTZ (0.2 mg/kg thrice weekly) for 4 weeks, then BTZ alone (n = 8) or BTZ+suvecaltamide (3, 10, or 30 mg/kg once daily; each n = 12) for 4 weeks. Nerve conduction velocity (NCV), mechanical threshold, β-tubulin polymerization, and intraepidermal nerve fiber (IENF) density were assessed. Proteasome inhibition was evaluated in peripheral blood mononuclear cells. Cytotoxicity was assessed in human multiple myeloma cell lines (MCLs) exposed to BTZ alone (IC50 concentration), BTZ+suvecaltamide (10, 30, 100, 300, or 1000 nM), suvecaltamide alone, or vehicle. Tumor volume was estimated in athymic nude mice bearing MCL xenografts receiving vehicle, BTZ alone (1 mg/kg twice weekly), or BTZ+suvecaltamide (30 mg/kg once daily) for 28 days, or no treatment (each n = 8). After 4 weeks, suvecaltamide 10 or 30 mg/kg reversed BTZ-induced reduction in NCV, and suvecaltamide 30 mg/kg reversed BTZ-induced reduction in IENF density. Proteasome inhibition and cytotoxicity were similar between BTZ alone and BTZ+suvecaltamide. BTZ alone and BTZ+suvecaltamide reduced tumor volume versus the control (day 18), and BTZ+suvecaltamide reduced tumor volume versus BTZ alone (day 28). Suvecaltamide reversed CIPN without affecting BTZ anti-cancer activity in preclinical models.
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