Inadvertent perioperative hypothermia and surgical site infections after liver resection.

BACKGROUND: In the overall surgical population, inadvertent perioperative hypothermia has been associated with an increased incidence of surgical site infection (SSI). However, recent clinical trials did not validate this notion. This study aimed to investigate the potential correlation between inadvertent perioperative hypothermia and SSIs following liver resection. METHODS: This retrospective cohort study included all consecutive patients who underwent liver resection between January 2019 and December 2021 at the First Affiliated Hospital, Zhejiang University School of Medicine. Perioperative temperature managements were implemented for all patients included in the analysis. Estimated propensity score matching (PSM) was performed to reduce the baseline imbalances between the normothermia and hypothermia groups. Before and after PSM, univariate analyses were performed to evaluate the correlation between hypothermia and SSI. Multivariate regression analysis was performed to determine whether hypothermia was an independent risk factor for postoperative transfusion and major complications. Subgroup analyses were performed for diabetes mellitus, age > 65 years, and major liver resection. RESULTS: Among 4000 patients, 2206 had hypothermia (55.2%), of which 150 developed SSI (6.8%). PSM yielded 1434 individuals in each group. After PSM, the hypothermia and normothermia groups demonstrated similar incidence rates of SSI (6.3% vs. 7.0%, P = 0.453), postoperative transfusion (13.3% vs. 13.7%, P = 0.743), and major complications (9.0% vs. 10.1%, P = 0.309). Univariate regression analysis revealed no significant effects of hypothermia on the incidence of SSI in the group with the highest hypothermia exposure [odds ratio (OR) = 1.25, 95% confidence interval (CI): 0.84-1.87, P = 0.266], the group with moderate exposure (OR = 1.00, 95% CI: 0.65-1.53, P = 0.999), or the group with the lowest exposure (OR = 1.11, 95% CI: 0.73-1.65, P = 0.628). The subgroup analysis revealed similar results. Regarding liver function, patients in the hypothermia group demonstrated lower γ-glutamyl transpeptidase (37 vs. 43 U/L, P = 0.001) and alkaline phosphatase (69 vs. 72 U/L, P = 0.016). However, patients in the hypothermia group exhibited prolonged activated partial thromboplastin time (29.2 vs. 28.6 s, P < 0.01). CONCLUSIONS: In our study of patients undergoing liver resection, we found no significant association between mild perioperative hypothermia and SSI. It might be due to the perioperative temperature managements, especially active warming measures, which limited the impact of perioperative hypothermia on the occurrence of SSI.

Wireless Power Transfer and Energy Harvesting: Current Status and Future Prospects.

The rechargeable battery is the conventional power source for mobile devices. However, limited battery capacity and frequent recharging requires further research to find new ways to deliver power without the hassle of connecting cables. Novel wireless power supply methods, such as energy harvesting and wireless power transfer, are currently receiving considerable attention. In this article, an overview of recent advances in wireless power supply is provided, and several promising applications are presented to show the future trends. In addition, to efficiently schedule the harvested energy, an energy scheduling scheme in the EH-powered D2D relay network is proposed as a case study. To be specific, we first formulate an optimization problem for energy scheduling, and then propose a modified two stage directional water filling algorithm to resolve it.

Primary observation of early transtympanic steroid injection in patients with delayed treatment of noise-induced hearing loss.

Approximately 5% of the population worldwide suffer from varieties of noise-induced hearing loss (NIHL). Prevention and early identification remain the best methods of approaching NIHL. Over the years, numerous methods of improving the outcome in patients presenting with NIHL have been evaluated; however, these are far from sufficient. The present trial aimed to evaluate the effectiveness of early transtympanic steroid injection in patients with delayed treatment of NIHL. Because systemic steroid treatment is the most common treatment of choice in the management of NIHL, it was considered unethical to replace the first-line systemic steroid treatment with transtympanic treatment. Therefore, the present study evaluated the combination of conventional steroid treatment with a transtympanic steroid injection. A total of 53 patients diagnosed with delayed treatment of NIHL were randomized into a transtympanic group (TR group, n=27) and a control group (n=26). The TR group received the conventional steroid treatment plus four courses of additional transtympanic injections of methylprednisolone 3 days after NIHL onset, and the control group received the conventional steroid treatment. Transtympanic injection was performed through laser-assisted myringotomy (a 0.5- to 1-mm perforation was made in the tympanic membrane) under an operation microscope. A total of 51.9% of the patients in the TR group had a ≥15-dB HL improvement in pure-tone average, compared with 23.1% of the patients in the control group, at the 8-week follow-up audiogram. A total of 66.7% of the patients in the TR group had an improvement of ≥15% in the speech discrimination score, compared with 30.8% of patients in the control group, 8 weeks after the treatment. The differences between the two groups were statistically significant. The outcome of this trial indicates that delayed treatment of NIHL may be preferable if transtympanic therapy can be applied earlier. The large variability in the individual results indicates that additional carefully controlled studies with larger sample sizes are needed to understand the effect of early transtympanic therapy in patients with delayed treatment of NIHL.

Early transtympanic steroid injection in patients with 'poor prognosis' idiopathic sensorineural sudden hearing loss.

OBJECTIVE: The present trial is aimed to evaluate the effectiveness of early transtympanic steroid injection in patients with 'poor prognosis' idiopathic sensorineural sudden hearing loss (ISSHL). METHODS: Seventy-six patients, diagnosed as having ISSHL with 'poor prognosis', were randomized into a transtympanic group and a control group. Thirty-nine patients received conventional steroid treatment and 37 patients received 4 courses of additional transtympanic injections of methylprednisolone 7 days after conventional steroid treatment. RESULTS: In the transtympanic group 45.9% of the patients had at least 15 dB improvement in pure tone average compared with 20.5% of the patients in the control group at the 8-week follow-up audiogram. In the transtympanic group 43.2% of the patients had an improvement of ≥ 15% in speech discrimination, compared with 17.9% of the patients in the control group 8 weeks after the treatment. The differences between the 2 groups were statistically significantly. CONCLUSION: The outcome was better for the patients with 'poor prognosis' ISSHL if the transtympanic steroid therapy could be applied early.

Functional and structural changes in the chinchilla cochlea and vestibular system following round window application of carboplatin.

OBJECTIVE: In chinchillas, moderate doses of carboplatin administered systemically selectively destroy inner hair cells and type I vestibular hair cells; however, it is unclear whether this unique damage pattern persists if carboplatin is applied directly to the cochlea, how quickly the damage develops and what cell death pathways are involved. STUDY DESIGN: To address these questions, carboplatin (5 mg/ml, 50 µl) was applied to the round window. RESULTS: Carboplatin caused a rapid decline in distortion product otoacoustic emissions, significantly increased compound action potential thresholds and caused massive inner hair cell loss and less severe outer hair cell loss. Hair cell loss was initially more severe in the base than the apex of the cochlea, but by 28 days post-treatment most cochlear hair cells were missing and hair cell density in the utricle, saccule and lateral crista was greatly reduced. At one day post-treatment, many hair cell nuclei were condensed or fragmented indicative of apoptosis, and expressed initiator caspase-8 and executioner caspase-3, but not initiator caspase-9. Carboplatin-treated animals circled towards the treated ear and during the swim test rolled towards the treated ear. CONCLUSION: These results indicate that local application of carboplatin causes loss of hair cells that begins near the base of the cochlea and spreads towards the apex with increasing survival time. Hair cell loss is initiated by caspase-8 followed by executioner caspase-3.

Short-term effect of relatively low level air pollution on outpatient visit in Shennongjia, China.

BACKGROUND: Many cities in China are currently experiencing severe air pollution due to modernization. Previous studies investigating the effects of air pollutants exposure were particularly conducted in severe air polluted area and studies in low pollution areas were sparse. METHODS: To quantitatively assess the short-term effects of ambient air pollutants (PM2.5, PM10, SO2, NO2, CO and O3) on outpatient visits in low pollution area, we conducted a time-series analysis from Jan 1, 2015 to Dec 31, 2016 in Shennongjia, China. Generalized additive model (GAM) was used to evaluate the influence of PM2.5 on daily hospital outpatient visits with different lag structures. We also conducted stratified analysis to explore the association between PM2.5 concentration and outpatient visits in different seasons. RESULTS: In the present study, per IQR increment of PM2.5, PM10, NO2, CO and O3 were related with 1.92% (0.76%-3.09%), 1.92% (0.77%-3.07%), 2.74% (95% CI: 1.65%-3.83%), 1.89% (95% CI: 0.68%-3.10%) and 2.30% (95% CI: 0.65%-3.95%) increase on respiratory outpatient visits. Significant associations were found between PM2.5, PM10, NO2 and respiratory outpatient visits at lag0:1, lag0:2 days. The effects of PM2.5 were more evident in the cool season than in the warm season. CONCLUSIONS: Our study showed that short-term exposures to PM2.5, PM10, NO2, CO and O3 were related with increased risk of outpatient visits of respiratory diseases, and highlighted the adverse effect of air pollutants exposure, especially PM2.5 exposure in cool season on health in low pollution area.

Endobronchial removal of a metallic needle using a flexible diagnostic bronchoscope and biopsy forceps. A case report from Djibouti.

Foreign body removal is a challenging procedure. Firstly we have to identify properly the foreign body and the position of the obstruction. Secondly we have to choose the proper removal equipment and finally the appropriate method of patient ventilation during the procedure. In our case report we present a challenging procedure with the removal of a metallic needle with minimum resources and equipment in a young girl in Djibouti, Africa.

[Hair cells apoptosis and the activation of P53 protein in intensive impulse noise induced cochlear lesion].

OBJECTIVE: To explore the pattern of hair cell injury and expression of P53 apoptosis protein in intensive impulse noise injured cochlear hair cells in guinea pigs. METHODS: Twelve adult guinea pigs were exposed to a series of 40 pairs of impulse noise (2 second intervals) at the intensity of 168 dB (SPL). Animals were terminated at 3, 6 and 12 hours after noise exposure, respectively. Cochlear surface preparations were performed with a double staining of FITC-conjugated phalloidin and propidium iodide for the observations of the stereocilia and the nucleus. P53 immunochemical staining was also performed 12 hours post-noise exposure to observe if there was expression of p53 protein in injured hair cells. Results Three hours after noise exposure, the outer hair cells at the end of basal turn and beginning of second turn were destroyed first with a character of nuclear condensation. Six hours post-noise exposure, many hair cells in the center of damage region had nuclear fragmentations, and the damaging area expanded towards to basal turn and apical turn. Twelve hours after noise exposure, the nucleus in most outer hair cells and inner hair cells at the region of damage center were missing. The nuclear condensation and fragmentation were appeared in hair cells in both sides of the center region of degeneration. P53 immunoreactive products were also found in damaged hair cells, not only in the central damage area, but also in the basal turn and the third turn. CONCLUSIONS: Intensive impulse noise resulted in apoptosis of cochlear hair cells that initiated between the end of basal turn and the beginning of second turn. Hair cell degeneration spread to basal and third turn along the basilar membrane. P53 may play an important role in impulse noise induced-hair cell apoptosis.

Intratympanic administration of methylprednisolone reduces impact of experimental intensive impulse noise trauma on hearing.

CONCLUSION: The present findings demonstrated that intratympanic methylprednisolone (MP) reduces the impact of impulse noise trauma on hearing and in part preserves the hair cells from death 1 h after exposure to intensive impulse noise. OBJECTIVE: To examine the treatment efficiency of intratympanic MP (IT-MP) with different methods of administration on cochlear injury induced by exposure to intensive impulse noise. MATERIALS AND METHODS: Fifty-five guinea pigs were assigned into six groups and exposed to intensive impulse noise, i.e. 60 impulses at 165 dB SPL peak pressure with 0.5 ms duration and 2 s intervals. The auditory brainstem response (ABR) was used to examine the hearing thresholds. Cochlear morphology was examined to estimate the inner and outer hair cell loss induced by impulse noise exposure. MP was applied as a rescue agent via different modalities of administration. RESULTS: The ABR threshold value of IT-MP1 or IT-MP4 groups significantly decreased at 4 weeks as compared with the IT-NS (IT 0.9% physiological saline) group. The ABR threshold value of the group that received intramuscular administration of MP (IM-MP) also decreased at 4 weeks as compared with the IT-NS group. Significant hair cell loss was observed at the region 40-50% from the apex in the present model. Within this region, the residual hair cell number in the IT-MP1 or IT-MP4 groups was significantly greater than that in the IT-NS group.