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1.
Clin Interv Aging ; 16: 1085-1093, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34163152

RESUMO

Purpose: Postoperative delirium (POD) is common in elderly patients undergoing laparoscopic surgery for gastric and colorectal malignancies. POD may be affected by different fraction of inspired oxygen (FiO2). The purpose of this study was to compare the effects of different FiO2 on POD. Patients and Methods: A randomized, double-blind controlled trial was performed in Qingdao Municipal Hospital Affiliated to Qingdao University. A total of 662 patients aged 65 to 85 years old underwent isolated laparoscopic radical gastrectomy, radical resection of colon cancer, or radical resection of rectal cancer only. A random number table method was used to divide the patients into two groups: 40% FiO2 (group A) and 80% FiO2 (group B). The primary endpoint was the incidence of POD, which was assessed by the Confusion Assessment Method (CAM) twice daily during the first 7 postoperative days, and POD severity was measured by the Memorial Delirium Assessment Scale (MDAS). The secondary endpoints were the intraoperative regional cerebral oxygen saturation (rSO2), Bispectral (BIS) index, invasive arterial blood pressure (IABP), oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PETCO2), the number of atelectasis cases and visual analogue scale (VAS) scores on days 1-7 after surgery. Results: The incidence of POD was 19.37% (122/630), including 20.38% (64/314) in group A and 18.35% (58/316) in group B. No statistical significance was found in the incidence of POD between the two groups (P > 0.05); compared with group B, SpO2, rSO2 and PaO2 decreased at T2 to T4 time point (P < 0.01), and the incidence of postoperative atelectasis decreased (P < 0.05) in group A. Conclusion: The incidence of POD was not significantly affected by different FiO2 and the incidence of postoperative atelectasis was decreased at low FiO2.


Assuntos
Delírio/sangue , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Oxigênio/sangue , Complicações Pós-Operatórias/sangue , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Delírio/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Método Duplo-Cego , Humanos , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório
2.
Anesth Analg ; 133(1): 19-28, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34127586

RESUMO

Cryoprecipitate has been the gold standard for treating acquired hypofibrinogenemia in cardiac surgery for nearly 50 years. More recently, fibrinogen concentrate has been used off-label in the United States and is the standard in European countries and Canada to treat the acquired hypofibrinogenemia during cardiac surgery. Fibrinogen concentrate has multiple potential advantages including rapid reconstitution, greater dose predictability, viral inactivation during processing, and reduced transfusion-related adverse events. However, because fibrinogen concentrate lacks the other components contained in the cryoprecipitate, it may not be the "ideal" product for replacing fibrinogen in all cardiac surgical patients, particularly those with longer cardiopulmonary bypass duration. In this Pro-Con commentary article, we discuss the advantages and disadvantages of using fibrinogen concentrate and cryoprecipitate to treat acquired hypofibrinogenemia in cardiac surgical patients.


Assuntos
Afibrinogenemia/tratamento farmacológico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fibrinogênio/administração & dosagem , Fibronectinas/administração & dosagem , Hemostáticos/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Afibrinogenemia/sangue , Afibrinogenemia/etiologia , Procedimentos Cirúrgicos Cardíacos/tendências , Fator VIII/administração & dosagem , Fator VIII/química , Fibrinogênio/química , Fibronectinas/química , Hemostáticos/química , Humanos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(25): e26426, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160431

RESUMO

INTRODUCTION: Esophagectomy is a major surgery with a high degree of catabolic and post-surgical inflammatory response accompanied by high morbidity and significant mortality. Post-surgical nutritional support via enteral administration of ω-3 fatty acids has been seen to be effective although its bad tolerance. There are few clinical trials with parenteral ω-3 fatty acids in these patients. We propose to investigate the effect of combining a parenteral fish oil lipid emulsion with the standard enteral nutrition (EN) support. MATERIALS AND METHODS: Prospective, single-center, randomized, double-blind study in esophagectomized patients, and treated after surgery with parenteral lipid emulsions of ω-3 fatty acids or a mixture of ω-6 long-chain triglycerides/short-chain triglycerides 50%. These emulsions will be added to the standard nutritional support in continuous infusion until 5 days of treatment have been completed. Patients will be randomized 1:1:1 in Group A receiving 0.4 g/kg/d of fish-oil lipid emulsion and 0.4 g/kg/d of a lipid emulsion mixture of ω-6 long-chain fatty acids (LCT) plus medium-chain fatty acids (MCT) (total dose of 0.8 g/kg/d of lipid emulsion); Group B receiving 0.8 g/kg/d of fish oil lipid emulsion and Group C receiving 0.8 g/kg/d of LCT/MCT emulsion.The main objective is to determine whether 5 days administration of intravenous ω-3 fatty acid lipid emulsion is effective in normalizing interleukin-6 levels compared with LCT/MCT emulsions, and whether a 0.8 g/kg/d dose is more effective than 0.4 g/kg/d. Secondary outcomes include other inflammatory markers such as C-reactive protein, tumor necrosis factor alpha and interleukin-10, and parameters of morbidity, safety, nutrition and mortality.Samples will be collected at the time when surgery is indicated and on days 0, 1, 3, 5 and 21 to determine inflammatory, nutritional, hepatic and safety parameters. In addition, clinical follow-up will be continued throughout the hospital admision and up to 1 year after surgery. DISCUSSION: Studies of ω-3 fatty acids administered parenterally in esophagectomized patients are scarce. This study proposes to investigate the effect of combining fish-oil lipid emulsions administered parenterally with EN support. Potential benefits include fast incorporation of lipids to the cellular membranes and to the inflammatory cascade, and the use of only 1 pharmaconutrient. TRIAL REGISTRATION: FAR-NP-2017-01 EudraCT number: 2016-004978-17.https://reec.aemps.es/reec/public/detail.html searching the EudraCT number. VERSION IDENTIFIER: Version 2, 08/06/2017.


Assuntos
Esofagectomia/reabilitação , Emulsões Gordurosas Intravenosas/administração & dosagem , Óleos de Peixe/administração & dosagem , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/terapia , Adulto , Terapia Combinada/métodos , Método Duplo-Cego , Nutrição Enteral , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Feminino , Humanos , Interleucina-6/sangue , Interleucina-6/imunologia , Masculino , Nutrição Parenteral/métodos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/imunologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
J Clin Neurosci ; 89: 113-121, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119253

RESUMO

Pituitary tumors and subsequent treatment with endoscopic transsphenoidal surgery (ETSS) may cause injury to suprasellar structures, causing long-term fatigue and neurocognitive impairment. A method to quantify brain injury after ETSS is not available. In this prospective, exploratory study of patients undergoing ETSS for pituitary tumors, a novel approach to detect possible neuronal damage is presented. Plasma concentrations of brain injury biomarkers (glial fibrillary acidic protein [GFAP], tau, and neurofilament light [NFL]) were measured the day before surgery, immediately after surgery, at day 1 and 5, and at 6 and 12 months after surgery, using enzyme-linked immunosorbent assays. The association between the increase of biomarkers with preoperative tumor extension and postoperative patient-perceived fatigue was evaluated. Suprasellar tumor extension was assessed from MRI scans, and self-perceived fatigue was assessed using the Multidimensional Fatigue Inventory before and 6 months after surgery. Thirty-five patients were included in the analysis. Compared to baseline, GFAP showed a maximal increase at day 1 after surgery (p = 0.0005), tau peaked postoperatively on the day of surgery (p = 0.019), and NFL reached its maximum at day 5 after surgery (p < 0.0001). The increase in GFAP correlated with preoperative chiasmal compression (p = 0.020). The increase in tau was correlated with preoperative chiasmal (p = 0.011) and hypothalamus compression (p = 0.016), and fatigue score 6 months after surgery (p = 0.016). In conclusion, the concentrations of brain injury biomarkers in blood increased after ETSS for pituitary tumors. The results indicate that postoperative plasma GFAP and tau might reflect astroglial and neuronal damage after ETSS.


Assuntos
Lesões Encefálicas/sangue , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/sangue , Adulto , Biomarcadores/sangue , Lesões Encefálicas/etiologia , Endoscopia/efeitos adversos , Proteína Glial Fibrilar Ácida/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Proteínas tau/sangue
5.
Plast Reconstr Surg ; 148(1): 14e-18e, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34003808

RESUMO

SUMMARY: Autologous breast reconstruction has evolved considerably from pedicled muscle-based approaches to microsurgical perforator-based techniques. Patients with documented coagulopathy, however, remain a particularly challenging population. The authors present their experience in microsurgical breast reconstruction in patients with coagulopathy and discuss their treatment protocol. A prospectively maintained database was queried for patients with coagulopathy who underwent microsurgical breast reconstruction between 2016 and 2019. Information regarding patient demographics, type of coagulopathy, and anticoagulation regimen were retrieved, and clinical outcomes were investigated. Nineteen patients who underwent 34 microsurgical breast reconstructions with free abdominal flaps were included in the study. The most common coagulopathy was factor V Leiden [n = 7 (38.6 percent)]. Nine patients (47.4 percent) developed thrombotic complications (the majority occurring intraoperatively); notably, arterial and venous thrombosis in four (21.1 percent) and two patients (10.5 percent), respectively. Postoperative thrombotic complications included pulmonary embolism [n = 2 (10.5 percent)] and flap congestion secondary to venous thrombosis [two flaps (5.9 percent)]. Only one flap loss was observed secondary to delayed venous thrombosis on postoperative day 6 (2.9 percent). The anticoagulation regimen in the majority of patients consisted of intraoperative intravenous administration of heparin (2000 U [bolus]) followed by a 5-day heparin infusion at 500 U/hour [n = 10 (52.6 percent)]. The high rate of thrombotic complications in patients with coagulopathy who underwent microsurgical breast reconstruction is contrasted by a low flap loss rate. Although coagulopathy is a risk factor for thrombotic complications, successful microsurgical breast reconstruction is still possible in the majority of patients.


Assuntos
Transtornos da Coagulação Sanguínea/complicações , Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Microcirurgia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Trombose/epidemiologia , Administração Intravenosa , Adulto , Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/epidemiologia , Neoplasias da Mama/complicações , Feminino , Retalhos de Tecido Biológico/transplante , Sobrevivência de Enxerto , Heparina/administração & dosagem , Humanos , Mamoplastia/métodos , Microcirurgia/métodos , Pessoa de Meia-Idade , Retalho Perfurante/transplante , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Trombose/sangue , Trombose/etiologia , Trombose/prevenção & controle , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
6.
AJR Am J Roentgenol ; 217(1): 164-171, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33978451

RESUMO

OBJECTIVE. The purpose of the present study was to identify the subset of a wide range of serial Doppler, laboratory, and clinical parameters most predictive (both individually and in combination) of TIPS dysfunction in a large patient sample. MATERIALS AND METHODS. The medical records of 189 patients who had undergone TIPS procedures were analyzed. The patients (mean age, 52 years; 62% of whom were men) had undergone 1139 Doppler studies and 323 portovenograms. Laboratory parameters included model for end-stage liver disease (MELD) scores, serum albumin levels, presence of ascites, and time since last intervention. Doppler parameters included intrashunt velocities, temporal change in intrashunt velocities, main portal vein velocity, direction of flow in the left portal hepatic vein, and venous pulsatility index. Statistical analysis used ROC, univariate, and multivariate regression models to assess the parameters both individually and in combination. Shunt dysfunction was defined by a portosystemic gradient of more than 12 mm Hg. RESULTS. The laboratory and clinical parameters of greatest predictive value included the MELD score and the time since the last intervention. The Doppler parameters that were of greatest predictive value included the change in velocity at the hepatic venous end and the left portal vein flow direction. Multivariate models produced an AUC of 0.74. Differences between functional and dysfunctional shunts were also statistically significant for absolute velocity at the hepatic venous end, the change in velocity within the stent, and the temporal change in the mid shunt velocity. CONCLUSION. The subset of serial parameters most predictive of TIPS dysfunction are the temporal change in the velocity at the hepatic venous end, the absolute velocity at the hepatic venous end, the direction of flow in the left portal venous branch, and changes in the MELD score.


Assuntos
Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/fisiopatologia , Derivação Portossistêmica Transjugular Intra-Hepática , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Ultrassonografia Doppler/métodos , Ascite/sangue , Velocidade do Fluxo Sanguíneo/fisiologia , Doença Hepática Terminal/sangue , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Complicações Pós-Operatórias/sangue , Albumina Sérica , Fatores de Tempo
8.
J Cardiothorac Surg ; 16(1): 146, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044881

RESUMO

OBJECTIVES: The relationship between inflammatory cytokines and postoperative delirium (POD) remains to be further investigated, especially in patients undergoing acute type A aortic dissection (AAD). Interleukin-6 (IL-6) is involved in the inflammatory process and has recently been identified as a biomarker of cerebral dysfunction. We explored the hypothesis that IL-6 was one of the critical causes of POD after surgical repair of AAD. METHODS: Plasma IL-6 was measured using electrochemiluminescence technology in patients preoperatively and 24 h, 48 h, and 72 h after surgical repair of acute type A aortic dissection. After the first three postoperative days, delirium was evaluated twice daily using the Confusion Assessment Method. ROC curves were used to evaluate the ability of IL-6 measurements to distinguish POD. RESULTS: The incidence of POD was 14.03% (31 of 221 patients). The patients in the POD group were significantly older than the patients in the non-POD group (56.48 ± 11.68 years vs 52.22 ± 10.50 years, P = 0.040). Plasma IL-6 concentrations were significantly higher in the POD group than in the non-POD group at three time points: preoperatively, after 24 h, and after 48 h. The AUC values corresponding to IL-6 preoperatively and 24 h after surgery were 0.73 and 0.72, respectively. CONCLUSIONS: Cerebral dysfunction after the surgical repair of AAD shows elevated stress levels and inflammatory responses. Plasma IL-6 is a potential biomarker to predict the onset of POD in acute type A aortic dissection patients following surgical repair.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Delírio/sangue , Interleucina-6/sangue , Adulto , Idoso , Área Sob a Curva , Biomarcadores/sangue , Delírio/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Curva ROC , Estudos Retrospectivos
9.
Anticancer Res ; 41(5): 2605-2610, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952490

RESUMO

BACKGROUND/AIM: Recently, elevated levels of postoperative inflammatory markers have been reported to be associated with poorer long-term survival outcomes, regardless of the occurrence of infectious complications, in gastroenterological malignancies. The aim of this study was to evaluate the association between postoperative inflammation and shorter long-term survival after resection of colorectal liver metastases. PATIENTS AND METHODS: A total of 104 patients who underwent R0 resection for colorectal liver metastases were enrolled. The CRPmax levels were defined as the highest postoperative serum C-reactive protein levels during hospital stay. RESULTS: The high-CRPmax group had a significantly lower relapse-free survival rate than the low-CRPmax group, regardless of the occurrence of infectious complications. CONCLUSION: In colorectal liver metastasis as well as other malignancies, elevated postoperative levels of serum C-reactive protein are associated with shorter long-term survival, regardless of the occurrence of infectious complications.


Assuntos
Proteína C-Reativa/metabolismo , Neoplasias Colorretais/cirurgia , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/sangue , Neoplasias Colorretais/microbiologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Inflamação/sangue , Inflamação/microbiologia , Inflamação/patologia , Inflamação/cirurgia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/cirurgia
10.
Leuk Res ; 105: 106574, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33836480

RESUMO

INTRODUCTION: Procalcitonin (PCT) and C-reactive protein (CRP) are known inflammatory markers of severe infection; however, their ability to differentiate between infections of different origins is not clear yet. In this study, we evaluated PCT and CRP as markers of infection in hematopoietic stem cell transplantation (HSCT) patients. METHODS: Blood samples were collected to determine serum concentrations of PCT, CRP, d-Dimer, and to perform blood culture analysis. Based on blood culture results, the patients were divided into two groups-positive blood culture (n = 271) patients and negative blood culture patients (n = 668); the negative blood culture group served as the control. The positive blood culture group was further divided into three groups based on the etiological agent of infection. PCT and CRP concentrations were compared, and ROC curve, sensitivity, specificity, and cutoff values were calculated. RESULTS: PCT levels in infected patients were significantly higher than those in control patients (p < 0.001); similarly, CRP and d-Dimer levels were also higher among infected patients when compared with those in the controls. A PCT level of 0.51 ng/mL was the best threshold for detecting the infection, with an AUC-ROC of 0.877, whereas the best threshold for CRP was 49.20 mg/L. PCT levels were the highest in patients with gram-negative bacteremia as compared to in those with gram-positive bacteremia and fungal infection. The optimal cutoff value of PCT for the detection of gram-negative and gram-positive infection was 1.63 ng/mL. CONCLUSION: PCT seems to be a useful marker for the diagnosis of systemic infection in HSCT patients, probably better than CRP and d-Dimer.


Assuntos
Biomarcadores/sangue , Proteína C-Reativa/análise , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções/etiologia , Complicações Pós-Operatórias/sangue , Pró-Calcitonina/sangue , Adolescente , Adulto , Idoso , Feminino , Humanos , Infecções/sangue , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Sensibilidade e Especificidade , Adulto Jovem
11.
Cardiovasc Intervent Radiol ; 44(8): 1165-1173, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33855582

RESUMO

PURPOSE: Diabetic patients are at increased risk of developing lower extremity peripheral arterial disease (PAD) requiring revascularization. This study assessed the effect of insulin dependence in diabetics on post-procedural outcomes following infra-inguinal endovascular intervention. MATERIALS AND METHODS: The American College of Surgeon's National Surgical Quality Improvement Program database was used to identify 8022 patients undergoing infra-inguinal endovascular interventions between 2014 and 2017. Thirty-day post-procedural outcomes for patients without diabetes, with non-insulin-dependent diabetes mellitus (NIDDM), and with insulin-dependent diabetes mellitus (IDDM) were compared. RESULTS: At presentation, IDDM patients were more likely to present with critical limb ischemia compared to NIDDM and non-diabetic patients. In propensity score-weighted logistic regression analysis, IDDM status was an independent predictor for increased renal complication (odds ratio [OR] = 3.08, confidence interval [CI] = 1.44-6.65), sepsis (OR = 1.68, CI = 1.13-2.48), wound complication (OR = 1.57, CI = 1.09-2.25, p = 0.006), UTI (OR = 2.07, CI = 1.09-3.94, p = 0.03), and readmission (OR = 1.21, CI = 1.03-1.42). NIDDM status was an independent predictor for increased risk of renal complications (OR = 2.80, CI = 1.18-6.63). CONCLUSIONS: IDDM status is an independent predictor for increased risk of 30-day post-procedural complications and readmission compared to both NIDDM and non-diabetic status in patients undergoing lower extremity endovascular interventions for PAD.


Assuntos
Diabetes Mellitus/sangue , Procedimentos Endovasculares/métodos , Insulina/sangue , Isquemia/etiologia , Doença Arterial Periférica/complicações , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Isquemia/sangue , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Doença Arterial Periférica/sangue , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
12.
Transplant Proc ; 53(5): 1562-1569, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33892933

RESUMO

OBJECTIVE: Endothelial disturbance is well known as one of the causes of thrombosis. This study measured von Willebrand factor (vWF) and soluble thrombomodulin (sTM) in renal vein blood to evaluate for the risk of thrombosis after kidney transplantation. METHODS: A cross-sectional study that included 61 consecutive recipients of kidney transplant. The sTM and activity of vWF were evaluated in blood of the renal vein at the time of reperfusion. RESULTS: The renal vein blood had higher values of vWF activity and sTM concentration than the peripheral blood. In the first minutes of reperfusion, the concentration of thrombomodulin was the highest but activity of vWF was the lowest. As the reperfusion continued, thrombomodulin gradually decreased, but vWF increased. The strong correlations of TMs and vWF with warm ischemia were observed (r = 0.5577 and r = 0.3429, respectively). Thrombosis was found in about 10% of all recipients. However, other complications, such as delayed graft function or ureter necrosis, were associated with high values of vWF and sTM. They were correlated with increased sTM concentration and activity of vWF (P < .006 and P < .05, respectively). This was confirmed by analysis of the receiver operator characteristic curve. The area under the curve values for TMs and vWF were 0.762 and 0.602, respectively (P < .0001 and P < .015, respectively). The cutoff points for sTM and vWF were 14.89 ng/mL and 129.89%, respectively. Positive prediction value sTM and vWF were 76% and 66% and negative prediction value 69% and 59%, respectively. CONCLUSIONS: The endothelium of a transplanted kidney could be involved in the pathogenesis of renal thrombosis. Endothelial protection during harvesting can greatly contribute to the improvement of transplantation outcomes. The renal pool of sTM and vWF could be a useful marker of the risk of renal thrombosis.


Assuntos
Nefropatias/etiologia , Complicações Pós-Operatórias/etiologia , Trombomodulina/análise , Trombose/etiologia , Fator de von Willebrand/análise , Adulto , Biomarcadores/sangue , Estudos Transversais , Endotélio Vascular/metabolismo , Feminino , Humanos , Rim/irrigação sanguínea , Nefropatias/sangue , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Período Pré-Operatório , Veias Renais/metabolismo , Medição de Risco , Fatores de Risco , Trombose/sangue
13.
Viruses ; 13(2)2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33672313

RESUMO

BACKGROUND: Kidney transplant recipients (KTRs) are exposed to a high risk of BK polyomavirus (BKPyV) replication, which in turn may lead to graft loss. Although the microRNAs (miRNAs) bkv-miR-B1-3p and bkv-miR-B1-5p are produced during the viral cycle, their putative value as markers of viral replication has yet to be established. In KTRs, the clinical relevance of the changes over time in BKPyV miRNA levels has not been determined. METHODS: In a retrospective study, we analyzed 186 urine samples and 120 plasma samples collected from 67 KTRs during the first year post-transplantation. Using a reproducible, standardized, quantitative RT-PCR assay, we measured the levels of bkv-miR-B1-3p and bkv-miR-B1-5p (relative to the BKPyV DNA load). RESULTS: Detection of the two miRNAs had low diagnostic value for identifying patients with DNAemia or for predicting DNAuria during follow-up. Seven of the 14 KTRs with a sustained BKPyV infection within the first year post-transplantation showed a progressive reduction in the DNA load and then a rapid disappearance of the miRNAs. DNA and miRNA loads were stable in the other seven KTRs. CONCLUSIONS: After the DNA-based diagnosis of BKPyV infection in KTRs, bkv-miR-B1-3p and bkv-miR-B1-5p levels in the urine might be valuable markers for viral replication monitoring and thus might help physicians to avoid an excessive reduction in the immunosuppressive regimen.


Assuntos
Vírus BK/fisiologia , MicroRNAs/genética , Infecções por Polyomavirus/virologia , Complicações Pós-Operatórias/virologia , RNA Viral/genética , Adulto , Idoso , Vírus BK/genética , Biomarcadores/sangue , Biomarcadores/urina , Feminino , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/estatística & dados numéricos , Masculino , MicroRNAs/sangue , MicroRNAs/urina , Pessoa de Meia-Idade , Infecções por Polyomavirus/sangue , Infecções por Polyomavirus/etiologia , Infecções por Polyomavirus/urina , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/urina , RNA Viral/sangue , RNA Viral/urina , Estudos Retrospectivos , Transplantados/estatística & dados numéricos , Carga Viral , Replicação Viral
14.
PLoS One ; 16(3): e0247304, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33661913

RESUMO

INTRODUCTION: High residual platelet reactivity (RPR) in patients after percutaneous coronary intervention (PCI) receiving antiplatelet agents has been associated with a high risk of developing acute kidney injury (AKI). STUDY AIM: This study aimed at identification of independent prognostic predictors of AKI risk in patients with acute coronary syndrome (ACS) after PCI. STUDY DESIGN, SETTING AND PATIENTS: This was a prospective single-center clinical trial that included 155 patients (n = 119 without AKI, n = 36 with AKI, mean age 64.0±10.6 years, of whom 74.2% were males), who underwent PCI with stenting. We prospectively evaluated RPR using optical aggregometry. Development of AKI was the primary endpoint. RESULTS: Acute renal dysfunction was observed in 36 patients (23.2%) after PCI, the risk factors of which according to univariate regression analysis were: age (p = 0.040), low diastolic blood pressure (DBP) (p = 0.001), having severe heart failure (HF) according to Killip (p<0.001), low level of hemoglobin (p = 0.026) and erythrocytes (p = 0.005), increased creatinine (p<0.001), low baseline glomerular filtration rate (GFR) (p<0.001), low left ventricular ejection fraction (LV EF) (p = 0.003), high residual platelet reactivity (RPR) (p<0.001) and platelet aggregation area under the curve (AUC) with 10 µg/mL ADP (p<0.001), as well as dose of X-ray contrast medium (XCM) (p = 0.008). As a result of multivariate regression analysis the following independent predictors of AKI were established with the inclusion of the above factors: baseline creatinine level [OR 1.033 at 95% CI from 1.017 to 1.049; p<0.001], RPR with 10 µg/mL ADP [OR 1.060 at 95% CI from 1.027 to 1.094; p = 0.001], dose of an XCM [ОR 1.005 at 95% CI from 1.001 to 1.008; р = 0.014], diastolic blood pressure (DBP) [OR 0.926 at 95% CI from 0.888 to 0.965; p<0.001]. CONCLUSION: ADP-induced high residual platelet reactivity, baseline creatinine level, X-ray contrast medium, low diastolic blood pressure were independent predictors of AKI in patients with ACS after PCI.


Assuntos
Síndrome Coronariana Aguda , Injúria Renal Aguda , Plaquetas/metabolismo , Pressão Sanguínea , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/cirurgia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Plaquetária , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos
15.
Anticancer Res ; 41(3): 1593-1598, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33788754

RESUMO

BACKGROUND/AIM: We previously showed that an elevated postoperative serum C-reactive protein (CRP) level has a negative impact on long-term survival outcomes, regardless of the occurrence of infectious complications in colorectal cancer. However, the cause of postoperative inflammation could not be properly evaluated, because patient background factors, such as the surgical approach (open/laparoscopic), were not unified. PATIENTS AND METHODS: A total of 277 patients who underwent laparoscopic surgery for stage II/III colorectal cancer were enrolled. RESULTS: The high-CRP group had lower relapse-free and overall survival rates in comparison to the low-CRP group. A high postoperative serum CRP level was significantly associated with a larger tumor diameter and longer operation time, and tended to be associated with a higher T stage and larger amount of bleeding. CONCLUSION: Larger tumor volume, longer operation time and larger amount of bleeding were associated with the promotion of postoperative inflammation, which worsened long-term survival outcomes in colorectal cancer.


Assuntos
Infecções Bacterianas/sangue , Proteína C-Reativa/análise , Neoplasias Colorretais/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/mortalidade , Neoplasias Colorretais/sangue , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/mortalidade , Adulto Jovem
16.
Expert Rev Med Devices ; 18(3): 291-298, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33666537

RESUMO

Introduction: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies.Areas covered: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. Forty-nine studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism was reported in 15 studies and 4 studies, respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism, respectively, and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group.Expert opinion: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies, respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.


Assuntos
Cálcio/sangue , Glândulas Paratireoides/fisiopatologia , Glândulas Paratireoides/cirurgia , Tireoidectomia/instrumentação , Ultrassom , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Tireoidectomia/efeitos adversos
17.
Aging (Albany NY) ; 13(4): 5250-5262, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526720

RESUMO

Inflammation plays an important role in the pathogenesis and growth of intracranial aneurysms (IAs). We investigated the clinical value of the neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic subclinical inflammation in patients with IAs. Consecutive patients with IAs who underwent endovascular treatment (EVT) were enrolled in the study. The evaluation indicators were aneurysm size and rupture, a poor outcome at 3 to 6 months, and delayed cerebral ischemia (DCI) during hospitalization. In total, 532 patients with IAs underwent EVT (mean age, 54.0 years; 62.4% female). Among patients with ruptured IAs, those with a higher NLR had an increased risk of a poor outcome at 3 to 6 months and DCI during hospitalization than those with a lower NLR. A higher NLR was significantly more strongly associated with the size of unruptured aneurysms and aneurysm rupture than a lower NLR. The NLR and C-reactive protein concentration showed similar predictive ability for aneurysm size and treatment prognosis. The NLR was lower at discharge than admission for patients with ruptured IAs and DCI. An elevated NLR was significantly associated with the size of unruptured IAs, an increased risk of a poor outcome, and DCI in patients with ruptured IAs.


Assuntos
Aneurisma Roto/sangue , Isquemia Encefálica/sangue , Procedimentos Endovasculares , Aneurisma Intracraniano/sangue , Linfócitos , Neutrófilos , Complicações Pós-Operatórias/sangue , Adulto , Idoso , Aneurisma Roto/cirurgia , Isquemia Encefálica/epidemiologia , Proteína C-Reativa/metabolismo , Feminino , Hospitalização , Humanos , Aneurisma Intracraniano/cirurgia , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Ruptura Espontânea
18.
Biomed Res Int ; 2021: 9241259, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33575357

RESUMO

High-density lipoprotein- (HDL-) cholesterol measurements are generally used in the diagnosis of cardiovascular diseases. However, HDL is a complicated heterogeneous lipoprotein, and furthermore, it can be converted into dysfunctional forms during pathological conditions including inflammation. Therefore, qualitative analysis of pathophysiologically diversified HDL forms is important. A recent study demonstrated that serum amyloid A (SAA) can remodel HDL and induce atherosclerosis not only over long periods of time, such as during chronic inflammation, but also over shorter periods. However, few studies have investigated rapid HDL remodeling. In this study, we analyzed HDL samples from patients undergoing orthopedic surgery inducing acute inflammation. We enrolled 13 otherwise healthy patients who underwent orthopedic surgery. Plasma samples were obtained on preoperative day and postoperative days (POD) 1-7. SAA, apolipoprotein A-I (apoA-I), and apolipoprotein A-II (apoA-II) levels in the isolated HDL were determined. HDL particle size, surface charge, and SAA and apoA-I distributions were also analyzed. In every patient, plasma SAA levels peaked on POD3. Consistently, the HDL apoA-I : apoA-II ratio markedly decreased at this timepoint. Native-polyacrylamide gel electrophoresis and high-performance liquid chromatography revealed the loss of small HDL particles during acute inflammation. Furthermore, HDL had a decreased negative surface charge on POD3 compared to the other timepoints. All changes observed were SAA-dependent. SAA-dependent rapid changes in HDL size and surface charge were observed after orthopedic surgery. These changes might affect the atheroprotective functions of HDL, and its analysis can be available for the qualitative HDL assessment.


Assuntos
Inflamação/sangue , Lipoproteínas HDL/análise , Lipoproteínas HDL/química , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/sangue , Proteína Amiloide A Sérica/análise , Cromatografia Líquida de Alta Pressão , Humanos , Inflamação/etiologia , Tamanho da Partícula
19.
Transplant Proc ; 53(3): 927-932, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33602527

RESUMO

BACKGROUND: In renal transplantation, monitoring procalcitonin (PCT) in the early post-transplant period can be a promising method for early tracking of infectious complications. However, the correlation between PCT and infection-related factors and immune components and renal function remains unclear. PATIENTS AND METHODS: Between November 2017 and December 2018, 62 early-stage renal transplant recipients were selected, and 4 mL peripheral blood samples were collected to detect the changes of specific immune cells and cytokines. Our study was in compliance with the Helsinki Congress and the Declaration of Istanbul; no prisoners were used, and participants were neither paid nor coerced in our study. RESULTS: According to serum PCT levels, recipients were divided into a high group (PCT ≥ 0.5 ng/mL) and a low group (PCT < 0.5 ng/mL). Compared with the low group, creatinine, cystatin C, urea, T helper type (Th) 22 cells, IL-22 + Th17 cells, interleukin (IL)-22, tumor necrosis factor alpha, and IL-17A increased while estimated glomerular filtration rate (eGFR) was decreased in the high group. In addition, PCT was significantly correlated with eGFR in the high group. CONCLUSIONS: Serum PCT is related with renal function and seems to be associated with immune components in early-stage renal transplant recipients.


Assuntos
Biomarcadores/sangue , Transplante de Rim , Complicações Pós-Operatórias/sangue , Pró-Calcitonina/sangue , Adulto , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/imunologia , Transplantados
20.
ANZ J Surg ; 91(5): E260-E270, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33576156

RESUMO

BACKGROUND: Aim of this meta-analysis was to compare diagnostic accuracy C-reactive protein and procalcitonin between postoperative days 3 and 5 to predict infectious complications post pancreatic surgery. METHODS: A systemic literature search was performed using MEDLINE, EMBASE and SCOPUS to identify studies evaluating the diagnostic accuracy of procalcitonin and C-reactive protein to predict infectious complications between postoperative days 3 and 5 following pancreatic surgery. A meta-analysis was performed using random-effect model and pooled predictive parameters. RESULTS: Fifteen studies consisting of 2212 patients were included in the final meta-analysis. Pooled sensitivity, specificity, area under curve and diagnostic odds ratio (DOR) for day 3 C-reactive protein were 62%, 67%, 0.772 and 6.54, respectively. Pooled sensitivity, specificity, area under curve and DOR for day 3 procalcitonin were 74%, 79%, 0.8453 and 11.03, respectively. Sensitivity, specificity, area under the curve and DOR for day 4 C-reactive protein were 60%, 68%, 0.8022 and 11.90, respectively. Sensitivity, specificity and DOR of postoperative day 5 procalcitonin level for predicting infectious complications were 83%, 70% and 12.9, respectively. Pooled sensitivity, specificity, Area Under Receiver Operating Curve and DOR were 50%, 70%, 0.777 and 10.19, respectively. CONCLUSION: Postoperative procalcitonin is a better marker to predict postoperative infectious complications after pancreatic surgeries.


Assuntos
Proteína C-Reativa , Infecções/diagnóstico , Pâncreas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Pró-Calcitonina/sangue , Biomarcadores/sangue , Proteína C-Reativa/análise , Humanos , Complicações Pós-Operatórias/sangue , Período Pós-Operatório , Curva ROC , Sensibilidade e Especificidade
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