ABSTRACT
Obesity and its comorbidities are humans' most prevalent cardio-metabolic diseases worldwide. Recent evidence has shown that chronic low-grade inflammation is a common feature in all highly prevalent chronic degenerative diseases. In this sense, the gut microbiota is a complete ecosystem involved in different processes like vitamin synthesis, metabolism regulation, and both appetite and immune system control. Thus, dysbiosis has been recognised as one of the many factors associated with obesity due to a predominance of Firmicutes, a decrease in Bifidobacterium in the gut, and a consequent short-chain fatty acids (SCFA) synthesis reduction leading to a reduction in incretins action and intestinal permeability increase. In this context, bacteria, bacterial endotoxins, and toxic bacterial by-products are translocated to the bloodstream, leading to systemic inflammation. This review focuses on gut microbiota composition and its role in obesity, as well as probiotics and prebiotics benefits in obesity.
ABSTRACT
BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. METHODS: We undertook an international, prospective study of 15,103 patients ≥45 years of age who had inpatient noncardiac surgery; 3,092 underwent orthopaedic surgery. Non-high-sensitivity TnT assays were performed on postoperative days 0, 1, 2, and 3. Among orthopaedic patients, we determined (1) the prognostic relevance of the MINS diagnostic criteria, (2) the 30-day mortality rate for those with and without MINS, and (3) the probable proportion of MINS cases that would go undetected without troponin monitoring because of a lack of an ischemic symptom. RESULTS: Three hundred and sixty-seven orthopaedic patients (11.9%) had MINS. MINS was associated independently with 30-day mortality including among those who had had orthopaedic surgery. Orthopaedic patients without and with MINS had a 30-day mortality rate of 1.0% and 9.8%, respectively (odds ratio [OR], 11.28; 95% confidence interval [CI], 6.72 to 18.92). The 30-day mortality rate was increased for patients with MINS who had an ischemic feature (i.e., symptoms, or evidence of ischemia on electrocardiography or imaging) (OR, 18.25; 95% CI, 10.06 to 33.10) and for those who did not have an ischemic feature (OR, 7.35; 95% CI, 3.37 to 16.01). The proportion of orthopaedic patients with MINS who were asymptomatic and in whom the myocardial injury would have probably gone undetected without TnT monitoring was 81.3% (95% CI, 76.3% to 85.4%). CONCLUSIONS: One in 8 orthopaedic patients in our study had MINS, and MINS was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most MINS cases (>80%) are asymptomatic and would go undetected without routine measurements. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Subject(s)
Cardiovascular Diseases/epidemiology , Orthopedic Procedures , Postoperative Complications/epidemiology , Aged , Biomarkers/blood , Cardiovascular Diseases/mortality , Female , Humans , Male , Middle Aged , Orthopedic Procedures/mortality , Postoperative Complications/mortality , Prognosis , Prospective Studies , Troponin T/bloodABSTRACT
INTRODUCTION: We assessed the efficacy of fibrin sealant (FS) and tranexamic acid (TXA) administered topically in patients with a hip fracture treated with prosthetic replacement. MATERIALS AND METHODS: Parallel, multicentre, open label, randomised, clinical trial. We compared three interventions to reduce blood loss: (1) 10 ml of FS, (2) 1 g of topical TXA, both administered at the end of the surgery, and (3) usual haemostasis (control group). The main outcome was blood loss collected in drains. Other secondary variables were total blood loss, hidden blood loss, transfusion rate, average hospital stay, complications, adverse events, and mortality. RESULTS: A total of 158 patients were included, 56 in the FS group, 52 in the TXA group, and 50 in the control group. The total amount of blood collected in drains was lower in the TXA group (148.6 ml, SD 122.7 in TXA; 168.2 ml, SD 137.4 in FS; and 201.5 ml, SD 166.5 in control group) without achieving statistical significance (p = 0.178). The transfusion rate was lower in the TXA group (32.7%), compared with FS group (42.9%) and control group (44.0%), without statistical significance (p = 0.341). There were no complications or adverse effects related to the evaluated interventions. CONCLUSIONS: The use of TXA and FS administered topically prior to surgical closure in patients with a sub-capital femoral fracture undergoing arthroplasty did not significantly reduce either postoperative blood loss or transfusion rate, compared with a group that only received usual haemostasis.
Subject(s)
Arthroplasty, Replacement, Hip , Fibrin Tissue Adhesive/administration & dosage , Hemostatics/administration & dosage , Hip Fractures/surgery , Postoperative Hemorrhage/prevention & control , Tranexamic Acid/administration & dosage , Administration, Topical , Aged , Aged, 80 and over , Antifibrinolytic Agents/administration & dosage , Blood Loss, Surgical/prevention & control , Female , Hemostasis, Surgical/methods , Hip Fractures/complications , Humans , Male , Postoperative Hemorrhage/etiology , Treatment OutcomeABSTRACT
BACKGROUND: Several hemostatic treatments intended to reduce the bleeding associated to total knee arthroplasty have been investigated with varying degrees of success. TT-173 is a new topical agent based on recombinant tissue factor that activates the extrinsic pathway of coagulation. This trial aim is to evaluate the efficacy and safety of TT-173 in total knee arthroplasty. METHODS/DESIGN: This is a phase II/III, sequential, simple blind, randomized, multicenter, placebo controlled and parallel clinical trial that will recruit 189 evaluable patients. Those randomized to treatment group will receive 2mg of TT-173 over the surgical surfaces of the knee. Control patients will receive physiologic saline. The follow up will consist in 6 visits during a period of 35 (±7) days. Primary endpoints will be the total blood loss and the incidence and severity of adverse events. Secondary and exploratory endpoints will include drainage production, decrease in hemoglobin level, transfusion ratio, analytical alterations, pain intensity, motion range, immunogenicity of TT-173 and the occurrence of systemic absorption. At the end of phase II, results will be evaluated by an independent committee that will recommend the continuation or the discontinuation of the trial. DISCUSSION: The design proposed maximizes the safety of the participants, avoids the risk of bias derived from the limitations of masking and enable the eventual discontinuation of the trial if this is recommended by the Interim Analysis Committee. If TT-173 proves its efficacy and safety in this indication, it would become a useful tool to improve the bleeding control in total knee arthroplasty. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02687399. Registered the 9th of February 2016.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Hemostasis, Surgical/methods , Hemostatics/therapeutic use , Thromboplastin/therapeutic use , Humans , Research Design , Single-Blind MethodABSTRACT
Total knee arthroplasty is a common operation for all types of arthritis, including chronic gouty arthritis. Tophi deposits are a well-known cause of joint destruction, but simultaneous subcutaneous and articular tophaceous gout is exceptional. We report a patient who required bilateral total knee replacement for this rare condition.
Subject(s)
Arthroplasty, Replacement, Knee , Gout/surgery , Knee Joint/surgery , Aged, 80 and over , Biomechanical Phenomena , Gout/diagnosis , Gout/physiopathology , Humans , Knee Joint/diagnostic imaging , Knee Joint/physiopathology , Male , Radiography , Range of Motion, Articular , Recovery of Function , Treatment OutcomeABSTRACT
The effectiveness of Tranexamic Acid (TXA, antifibrinolytic drug) in reducing allogeneic blood transfusion requirements has not been tested in revision total knee arthroplasty. The aim of this study was to assess the effectiveness of TXA after two intravenous doses of 1 g each. Between April 2006 and February 2010, 68 consecutive patients (19 male, 49 female) of 74 +/- 6 [m +/- SD] years of age were included and divided into three groups: control (28 patients), in which TXA was not administered but was not contraindicated; TXA (19 patients) who received TXA, and NO-TXA (21 patients), who were not administered TXA because of a contraindication. The proportions of patients transfused were 54%, 32% and 62% respectively in the control, TXA and NO-TXA group; the median numbers of RBC units transfused were respectively 2 [range: 1-4], 2 [range: 2-2] and 2.5 [range: 1-5], (p = 0.057). Mean total estimated blood loss was 1693 mL (SD: 689) in the control group, 1196 mL (SD: 665) in the TXA group and 2454 mL (SD: 2166) in the NO-TXA group, (p = 0.015). No adverse events were reported. TXA administration appeared as an effective and safe means of reducing blood transfusion requirements and blood loss in revision total knee arthroplasty.
Subject(s)
Antifibrinolytic Agents/therapeutic use , Arthroplasty, Replacement, Knee , Blood Loss, Surgical/prevention & control , Tranexamic Acid/therapeutic use , Aged , Aged, 80 and over , Blood Transfusion/statistics & numerical data , Female , Humans , Reoperation , Retrospective StudiesABSTRACT
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Subject(s)
Humans , Male , Adult , Azathioprine/adverse effects , Fever/chemically induced , Immunosuppressive Agents/adverse effects , Crohn Disease/drug therapy , Crohn Disease/complicationsABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Stomach Neoplasms/diagnosis , Carcinoma/diagnosis , Stomach Neoplasms/virology , Carcinoma/virology , Epstein-Barr Virus Infections/complicationsABSTRACT
La poliposis linfomatosa múltiple es una forma rara de linfoma no hodgkiniano, con un comportamiento biológico agresivo, una diseminación sistémica precoz y un mal pronóstico. En la mayoría de los casos se considera una manifestación gastrointestinal de un linfoma de células del manto. A continuación se describe el caso de un varón de 55 años de edad, con evolución favorable tras tratamiento quimioterapeútico(AU)
Multiple lymphomatous polyposis is a rare type of non Hodgkin lymphoma that has aggressive biological behavior, early systemic dissemination and poor prognosis. In most cases it is considered to be a gastrointestinal manifestation of mantle cell nodal lymphoma. We describe a case of a 55 year old man, with favorable outcome after chemotherapy(AU)
Subject(s)
Humans , Male , Middle Aged , Lymphoma, Non-Hodgkin/pathology , Colonic Polyps/pathology , Antineoplastic Agents/therapeutic use , Disease-Free SurvivalABSTRACT
Multiple lymphomatous polyposis is a rare type of non Hodgkin lymphoma that has aggressive biological behavior, early systemic dissemination and poor prognosis. In most cases it is considered to be a gastrointestinal manifestation of mantle cell nodal lymphoma. We describe a case of a 55 year old man, with favorable outcome after chemotherapy.
Subject(s)
Antineoplastic Agents/therapeutic use , Intestinal Polyposis/drug therapy , Lymphoma, Mantle-Cell/drug therapy , Humans , Intestinal Polyposis/diagnosis , Lymphoma, Mantle-Cell/diagnosis , Male , Middle Aged , Remission InductionABSTRACT
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Humans , Female , Middle Aged , Anti-Obesity Agents/adverse effects , Pancreatitis/chemically induced , Pancreatitis/diagnosis , Acute DiseaseABSTRACT
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Subject(s)
Humans , Male , Adult , Herpesvirus 3, Human/pathogenicity , Hepatitis, Viral, Human/virology , Acute DiseaseABSTRACT
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