Intraoperative Hemodynamic Instability and Higher ASA Classification Increase the Risk of Developing Non-Surgical Complications following Orthopedic Surgeries.

(1) Background: Either pre-operative physical status or unstable hemodynamic changes has been reported to play a potential role in causing vital organ dysfunction. Therefore, we intended to investigate the impact of the American Society of Anesthesiologist (ASA) classification and intraoperative hemodynamic instability on non-surgical complications following orthopedic surgery. (2) Methods: We collected data on 6478 patients, with a mean age of 57.3 ± 16, who underwent orthopedic surgeries between 2018 and 2020. The ASA classification and hemodynamic data were obtained from an anesthesia database. Non-surgical complications were defined as a dysfunction of the vital organs. (3) Results: ASA III/IV caused significantly higher odds ratios (OR) of 17.49 and 40.96, respectively, than ASA I for developing non-surgical complications (p < 0.001). Non-surgical complications were correlated with a 20% reduction in systolic blood pressure (SBP), which was intraoperatively compared to the pre-operative baseline ((OR) = 1.38, p = 0.02). The risk of postoperative complications increased with longer durations of SBP < 100 mmHg, peaking at over 20 min ((OR) = 1.33, p = 0.34). (4) Conclusions: Extended intraoperative hypotension and ASA III/IV caused a significantly higher risk of adverse events occurring within the major organs. The maintenance of hemodynamic stability prevents non-surgical complications after orthopedic surgeries.

Application of serologic assays for diagnosing acute hepatitis E in national surveillance of a nonendemic area.

Variant performance of immunoglobulin M (IgM) and immunoglobulin G (IgG) hepatitis E virus (HEV) assays may impact the diagnosis. The present study aimed to evaluate four different IgM/IgG assays for HEV infection for application in national surveillance in nonendemic areas. Sera from 300 patients that were stored in the Centers for Disease Control (CDC) of Taiwan for suspected acute HEV infection from 2004 to 2008, and 18 serum samples from acute cases of HEV infection in Taipei Veteran General Hospital were evaluated. Performances of EIAgen HEV IgG/M (Adaltis, Bologna, Italy), recomWell HEV IgG/M (Mikrogen, Neuried, Germany), MP HEV IgG/M (MP Biomedicals, Singapore), and in-house kits, HEVLPs (HEV virus-like particles) IgG/M were compared. Positive results of serum RNA detected by reverse transcription-polymerase chain reaction were defined as the definite diagnosis. There were five genotype 1, one genotype 3, and nine genotype 4 HEV samples. The four different IgM/IgG assays had excellent performance in terms of negative predictive value (98.4-100%) and varying performance in relation to sensitivity (66.7-93.3%) and specificity (62.9-95.6%). RecomWell IgM had the best overall performance. In addition, the combination of anti-HEV IgM ELISA with anti-HEV IgG or another anti-HEV IgM ELISA provided better screening performance, especially the recomWell IgM and HEVLPs IgM combination (area under the receiver operating curve: 0.94; sensitivity: 100%, specificity 88.1%). In conclusion, anti-HEV IgM ELISA is a good screening test for the national surveillance of acute HEV infection in nonendemic areas and not limited by inconsistent performances of sensitivity and specificity among different assays.

Management of postvitrectomy diabetic vitreous hemorrhage with volume homeostatic fluid-fluid exchanger.

BACKGROUND: To evaluate the clinical outcome of patients with postvitrectomy diabetic vitreous hemorrhage (PDVH) who underwent vitreous cavity lavage (VL) by volume homeostatic fluid-fluid exchange. METHODS: We performed a retrospective chart review for 88 eyes of 80 consecutive patients who underwent VL for PDVH. Final best-corrected visual acuity after VL was compared to those before VL. Anatomic outcome, including rate of fundus clear-up, recurrent vitreous hemorrhage, increased intraocular pressure, iris neovacularization and anterior hyaloid fibrovascular proliferation were considered. RESULTS: Between July 1999 and January 2006, 88 eyes of 80 patients underwent this procedure. Significant visual improvement was observed after VL (2.86 +/- 0.40 logMAR at baseline vs 1.71 +/- 0.97 logMAR at last visit, p < 0.0001). The fundus clear-up rate after VL was achieved in 84 out of 109 times (77.1%). Recurrent vitreous hemorrhage was found in 17 of 88 eyes (19.3%) with the mean interval of 92.6 +/- 126.7 days after VL. CONCLUSIONS: For patients suffering from postvitrectomy diabetic vitreous hemorrhage, volume homeostatic vitreous cavity lavage can be an alternative method for removing the bloody content in the vitreous cavity efficiently and permitting rapid visual recovery.