Can We Really Predict Postoperative Acute Kidney Injury after Aortic Surgery? Diagnostic Accuracy of Risk Scores Using Gray Zone Approach.

Background Several risk scores have been developed to predict acute kidney injury (AKI) after cardiac surgery. We evaluated the accuracy of eight prediction models using the gray zone approach in patients who underwent aortic surgery. Patients and Methods We retrospectively applied the risk scores of Palomba, Wijeysundera, Mehta, Thakar, Brown, Aronson, Fortescue, and Rhamanian to 375 consecutive adult patients undergoing aortic surgery with cardiopulmonary bypass. The area under the receiver operating characteristic curve (AUC) and gray zone approach were used to evaluate the accuracy of the eight models for prediction of AKI, as defined by the RIFLE criteria. Results The incidence of AKI was 29% (109/375). The AUC for predicting AKI requiring dialysis ranged from 0.66 to 0.84, excluding the score described by Brown et al (0.50). The AUC for predicting the RIFLE criteria of risk and higher ranged from 0.57 to 0.68. The application of gray zone approach resulted in more than half of the patients falling in the gray zone: 275 patients (73%) for Palomba, 221 (59%) for Wijeysundera, 292 (78%) for Mehta, 311 (83%) for Thakar, 329 (88%) for Brown, 291 (78%) for Aronson, 205 (54%) for Fortescue, and 308 (82%) for Rhamanian. Conclusion More than half of the patients in our study sample were in the gray zone of eight scoring models for AKI prediction. The two cutoffs of the gray zone can be used when using risk models. A surgery-specific and more accurate prediction model with a smaller gray zone is required for patients undergoing aortic surgery.

Obesity is independently associated with spinal anesthesia outcomes: a prospective observational study.

The influence of body-mass index (BMI) on spinal anesthesia is still controversial, with discrepant results reported in previous studies. To compare spinal anesthesia in obese and non-obese subjects, the anesthesia profiles in patients who underwent spinal anesthesia using intrathecal hyperbaric bupivacaine were compared. A total of 209 patients undergoing elective total knee replacement arthroplasty (TKRA) surgery under spinal anesthesia were divided into an NO (non-obese) group (BMI < 30 kg/m2, n = 141) and an O (obese) group (BMI ≥ 30 kg/m2, n = 68). Anesthesia was deemed successful if a bilateral T12 sensory block occurred within 15 minutes of intrathecal drug administration, and if the level of sensory block was higher than T12 when the surgery ended. Logistic regression analysis with multiple variables known to influence spinal anesthesia was performed to identify which parameters independently determined the spinal anesthesia outcome. Similar doses of bupivacaine were administered to the NO and O groups. The incidence of anesthesia failure was significantly lower in the O group [n = 43 (30.5%) in the NO group vs. n = 10 (18.9%) in the O group, p = 0.014]. The independent predictors for successful anesthesia in all patients were dose of hyperbaric bupivacaine [odds ratio (OR) 2.12, 95% CI: 1.64-2.73] and obese status (BMI ≥ 30 kg/m2, OR 2.86, 95% CI: 1.25-6.52). Time to first report of postoperative pain and time to first self-void were significantly longer in the O group. These results suggest that the duration of block with hyperbaric bupivacaine is prolonged in obese patients and obesity is independently associated with spinal anesthesia outcomes, as is bupivacaine dosage. A further study enrolling patients with morbid obesity and using a fixed bupivacaine dosage is required to confirm the effect of obesity on spinal anesthesia.

Anti-neuroinflammatory activity of a novel cannabinoid derivative by inhibiting the NF-κB signaling pathway in lipopolysaccharide-induced BV-2 microglial cells.

Microglial-mediated neuroinflammation has recently been implicated as one of the important mechanisms responsible for the progression of neurodegenerative diseases. Activated microglia cells produce various neurotoxic factors that are harmful to neurons. Therefore, suppression of the inflammatory response elicited by activated microglia is considered a potential therapeutic target for neurodegenerative diseases. The cannabinoid (CB) system is widespread in the central nervous system and is very crucial for modulating a spectrum of neurophysiological functions such as pain, appetite, and cognition. In the present study, we synthesized and investigated a novel CB derivative (CD-101) for its ability to suppress lipopolysaccharide (LPS)-mediated activation of BV-2 microglial cells and subsequent release of various inflammatory mediators. CD-101 significantly inhibited the production of inflammatory markers such as nitric oxide, cyclooxygenase-2, and pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin-1ß, and interleukin-6. The anti-neuroinflammatory effect of this novel cannabinoid derivative occurred by inhibiting p38MAPK phosphorylation and by decreasing nuclear translocation of p65 subunit of nuclear factor kappa-B in LPS-stimulated BV-2 microglial cells. These results suggest that the use of the cannabinoid derivative CD-101 might be a potential therapeutic target against neuroinflammatory disorders.