Perioperative intravenous dexamethasone for patients undergoing colorectal surgery: a systematic review and meta-analysis.

PURPOSE: Dexamethasone is a glucocorticoid that is often administered intraoperatively as prophylaxis for postoperative nausea and vomiting (PONV). Several randomized controlled trials (RCTs) have examined its use in colorectal surgery. This systematic review aims to assess the postoperative impacts of dexamethasone use in colorectal surgery. METHODS: MEDLINE, Embase, and CENTRAL were searched from database inception to January 2023. Articles were included if they compared perioperative intravenous dexamethasone to a control group in patients undergoing elective colorectal surgery in terms of postoperative morbidity. The primary outcomes were prolonged postoperative ileus (PPOI) and PONV. Secondary outcomes included postoperative infectious morbidity and return of bowel function. A pair-wise meta-analysis and GRADE assessment of the quality of evidence were performed. RESULTS: After reviewing 3476 relevant citations, seven articles (five RCTs, two retrospective cohorts) met the inclusion criteria. Overall, 1568 patients received perioperative dexamethasone and 1459 patients received a control. Patients receiving perioperative dexamethasone experienced significantly less PPOI based on moderate-quality evidence (three studies, OR 0.46, 95%CI 0.28-0.74, p < 0.01). Time to first flatus was significantly reduced with intravenous dexamethasone. There was no difference between groups in terms of PONV (four studies, OR 0.90, 95%CI 0.64-1.27, p = 0.55), postoperative morbidity (OR 0.93, 95%CI 0.63-1.39, p = 0.74), or rate of postoperative infectious complications (seven studies, OR 0.74, 95%CI 0.55-1.01, p = 0.06). CONCLUSION: This review presents moderate-quality evidence that perioperative intravenous dexamethasone may reduce PPOI and enhance the return of bowel function following elective colorectal surgery. There was no significant observed effect on PONV or postoperative infectious complications.

Pathway Commons 2019 Update: integration, analysis and exploration of pathway data.

Pathway Commons (https://www.pathwaycommons.org) is an integrated resource of publicly available information about biological pathways including biochemical reactions, assembly of biomolecular complexes, transport and catalysis events and physical interactions involving proteins, DNA, RNA, and small molecules (e.g. metabolites and drug compounds). Data is collected from multiple providers in standard formats, including the Biological Pathway Exchange (BioPAX) language and the Proteomics Standards Initiative Molecular Interactions format, and then integrated. Pathway Commons provides biologists with (i) tools to search this comprehensive resource, (ii) a download site offering integrated bulk sets of pathway data (e.g. tables of interactions and gene sets), (iii) reusable software libraries for working with pathway information in several programming languages (Java, R, Python and Javascript) and (iv) a web service for programmatically querying the entire dataset. Visualization of pathways is supported using the Systems Biological Graphical Notation (SBGN). Pathway Commons currently contains data from 22 databases with 4794 detailed human biochemical processes (i.e. pathways) and ∼2.3 million interactions. To enhance the usability of this large resource for end-users, we develop and maintain interactive web applications and training materials that enable pathway exploration and advanced analysis.

Development of tonic firing behavior in rat soleus muscle.

Tonic firing behavior in soleus muscle of unrestrained rats aged 7 to >or=100 days was studied by chronic single-motor-unit and gross-electromyographic (EMG) recordings. Median motor-unit firing frequency at 10 days was 19-26 Hz and did not change appreciably after this time, whereas interval-to-interval firing variability was reduced with age. Two units with median frequencies 40 and 59 Hz were encountered in one 7-day-old rat. Integrated rectified gross EMG developed from being phasic only to predominantly tonic during the second and third postnatal week. From the end of the third week, rather short tonic periods with irregular amplitude were replaced by longer lasting constant-amplitude periods. Quantitatively, median duration of gross-EMG activity episodes more than doubled, while 90th-percentile values for episode duration increased 19-fold, from 7.4 s at 7 days to 140 s in adults. The main part of this increase took place after 22 days. Previous work in adult rats has indicated that descending monoaminergic innervation is essential for maintained tonic motoneuron activity, which probably is caused by depolarizing plateau potentials. Such innervation of the lumbar spinal cord matures gradually to an adult pattern and density approximately 3-4 wk after birth. The present results, describing a concurrent considerable development of tonic firing behavior, support and extend these findings.

Acute passive stretching alters the mechanical properties of human plantar flexors and the optimal angle for maximal voluntary contraction.

The purpose of this study was to investigate whether acute passive stretching (APS) reduced maximal isometric voluntary contraction (MVC) of the plantar flexors (PF) and if so, by what mechanisms. The PF in 15 female volunteers were stretched for 10 min (5 x 120 s) by a torque motor to within 2 degrees of maximum dorsiflexion (D) range of motion (ROM). MVC with twitch interpolation, maximal Hoffmann reflex (H(max)) and compound action potentials (M(max)) were recorded at 20 degrees D. Stretch reflexes (SR) were mechanically induced at 200 degrees s(-1) between 0 degrees and 10 degrees ( )D and SR torque and EMG amplitude were determined. All tests were assessed pre- (pre) and post-APS (post-test(1)). MVC, SR, and M(max) were again assessed after additional stretch was applied [mean 26 (1) degrees D; post-test(2)] to test if the optimal angle had been altered. EMG was recorded from soleus (SOL), medial gastrocnemius (MG) and tibialis anterior (TA) using bipolar surface electrodes. APS resulted in a 27% decrease in mean peak passive torque (P<0.05). MVC and SR torque were 7% (P<0.05) and 13% lower at post-test(1) (P<0.05), respectively. SR EMG amplitude of SOL and MG was reduced by 27% (P<0.05) and 22% (P<0.05), respectively. The H(max)/M(max) EMG and H(max)/M(max) torque ratios were unchanged at post-test(1). At post-test(2), MVC and SR EMG recovered to pre-APS values, while the SR and M(max) torque increased by 19% and 13%, respectively (P<0.05). The decrease in MVC during post-test(1) was attributed to changes in the mechanical properties of PF and not to reduced muscle activation.

Contributing factors to muscle weakness in children with cerebral palsy.

The aim of this study was to determine the extent of ankle muscle weakness in children with cerebral palsy (CP) and to identify potential causes. Maximal voluntary contractions of plantar (PF) and dorsiflexors (DF) were determined at optimal angles in knee flexion and extension in both legs of 14 children with hemiplegia (7 males, 7 females) and 14 with diplegia (8 males, 6 females). Their results were compared to 14 age- and weight-matched control participants (5 males, 9 females). Muscle cross-sectional areas of soleus, posterior, and anterior compartment muscles were determined from MRIs in 14 children with CP (eight diplegia, six hemiplegia) and 18 control children. Specific tension (torque/unit area) of PF and DF was determined from torque and cross-sectional area results. Muscle volumes of PF and DF were also determined in both legs of five control children and five with hemiplegia. Muscle EMG was recorded from soleus, medial gastrocnemius, and tibialis anterior during each maximal voluntary contraction. Mean amplitude was significantly reduced in PF and DF in both CP groups and significantly higher levels of coactivation of antagonists were found compared to control participants. Strength of PF and DF was significantly reduced in both CP groups, but more importantly the muscles were found to be weak based on significantly reduced specific tensions. The PF were most affected, particularly in the group with hemiplegia. It is believed that an inability to maximally activate their muscles contributed to this weakness. A combination of incomplete activation and high levels of PF coactivation are thought to have contributed to DF weakness.