Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study.

Atlantoaxial segments have not been discussed in existing studies on prevertebral soft tissue (PVST) swelling after cervical operations. This study aimed to investigate the characteristics of PVST swelling after anterior cervical internal fixation at different segments. This retrospective study included patients who underwent transoral atlantoaxial reduction plate (TARP) internal fixation (Group I, n=73), C3/C4 anterior decompression and vertebral fixation (Group II, n=77), or C5/C6 anterior decompression and vertebral fixation (Group III, n=75) at our Hospital. The PVST thickness at C2, C3, and C4 segments was measured before and 3 days after the operation. Time of extubation, number of patients with postoperative re-intubation and dysphagia were collected. Results show that all patients had significant postoperative PVST thickening (all P<0.01). PVST thickening at C2, C3, and C4 was significantly greater in Group I than in Groups II and III (all P<0.01). PVST thickening at C2, C3, and C4 in Group I was 1.87 (14.12mm/7.54mm), 1.82 (12.90mm/7.07mm) and 1.71 (12.09mm/7.07mm) times of that in Group II, respectively. PVST thickening at C2, C3, and C4 in Group I was 2.66 (14.12mm/5.31mm), 1.50 (12.90mm/8.62mm) and 1.32 (12.09mm/9.18mm) times of that in Group III, respectively. The patients in Group I had significantly later postoperative extubation (Both P<0.01) than the patients in Groups II and III. None of the patients had postoperative re-intubation or dysphagia. We conclude that PVST swelling was greater in patients who underwent TARP internal fixation than in patients who underwent anterior C3/C4 or C5/C6 internal fixation. Hence, after TARP internal fixation, patients should be given proper respiratory tract management and monitoring.

Anti-inflammatory action of geniposide promotes wound healing in diabetic rats.

CONTEXT: As a major active iridoid glycoside from Gardenia jasminoides J. Ellis (Rubiaceae), geniposide possesses various pharmacological activities, including anti-platelet aggregation and anti-inflammatory action. OBJECTIVES: This study explores the effect of geniposide in diabetic wound model by anti-inflammatory action. MATERIALS AND METHODS: Diabetic rodent model in Wistar rats was induced by streptozotocin combined with high-fat feed. The selected rats were divided into control group, the diabetic model group and geniposide subgroups (200, 400 and 500 mg/kg), and orally administrated once daily with saline or geniposide. Wound area and histochemical indicators were measured on day 7 after continuous administration, to assess lesion retraction, inflammatory cells and fibroblasts. RESULTS: Geniposide notably enhanced lesion retraction by 1.06-1.84 times on day 7 after surgical onset in diabetic rats (p < 0.05). In the pathological experiment by HE staining, geniposide significantly reduced inflammatory cell infiltration and proliferation of fibroblasts in the central lesion regions. In diabetic rats treated with geniposide, the levels of pro-inflammatory factors (tumour necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß)) and IL-6 were significantly reduced (p < 0.05), followed with the increment of IL-10 in a dose-dependent manner. The IC50 of geniposide on TNF-α, IL-1ß and IL-6 could be calculated as 1.36, 1.02 and 1.23 g/kg, respectively. It assumed that geniposide-induced IL-10 expression contributed to inhibiting the expression of pro-inflammatory factors. DISCUSSION AND CONCLUSIONS: Geniposide promoted diabetic wound healing by anti-inflammation and adjusting blood glucose. Further topical studies are required to evaluate effects on antibacterial activity and skin regeneration.

Cuff-leak test combined with interventional bronchoscopy benefits early extubation for patients who received tarp surgery.

PURPOSE: This study explored the performance characteristics of a cuff-leak test (CLT) combined with interventional fiberoptic bronchoscopy (FBS) for evaluating whether early nasoendotracheal extubation was possible for patients who had received transoral atlantoaxial reduction plate (TARP) internal fixation surgery. METHODS: 318 patients who underwent surgery were retrospectively analyzed (between January 2006 and December 2012). Extubation was performed by conventional approach (CA group, until December 2008) and improved approach (IA group, from January 2009) including CLT and an interventional FBS procedure. The extubation success within 1-3 days after surgery, incidence of postextubation stridor and tracheal reintubation were examined. RESULTS: More IA-treated patients experienced extubation during the first 2 days than those CA-treated, median extubation time was 3 (2, 3) days in the CA group and 2 (1, 2) days in the IA group (all P < 0.01). The incidence of stridor and reintubation was 5.69 and 0.57 % in IA and 11.98 and 4.93 % in CA, respectively (both P < 0.05). For the CLT-positive patients in the IA group that remained intubated until day 3-4, interventional FBS was applied for safe extubation and achieved 100 % success. CONCLUSION: Early extubation through IA is safe and interventional FBS assists successful extubation for CLT-positive patients who underwent TARP surgery.

Case report: intraoperative management of extreme hemodilution in a patient with a severed axillary artery.

We present a case of extreme hemodilution in which appropriately crossmatched blood was not available. A 53-year-old man was admitted to our hospital because of hemorrhagic shock due to multiple stab wounds. His blood type was B, Rh negative, and his intravascular fluid volume was maintained with balanced salt solution and plasma substitutes, i.e., hydroxyethyl starch. His hemoglobin reached a nadir of 0.7 g/dL and hematocrit 2.2% before being transfused. No evidence of cardiac ischemia was noted and he was discharged in good condition. Extreme hemodilution can be successfully managed by maintaining a normal blood volume, 100% oxygen, and the use of plasma substitutes.

[Risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders].

OBJECTIVE: to evaluate the risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders. METHODS: total 104 cases were collected from January 2005 to June 2009. Twelve variables among patients with PPCs and without PPCs were analyzed by logistic regression analysis. RESULTS: the incidence of postoperative pulmonary complications following transoral operation for the atlanta-axis disorders was 22.1% (23/104). There was significantly difference in 9 variables between patients with PPCs and without PPCs, and 5 variables as serum albumin < 35 g/L (OR = 15.185, P = 0.003), tracheotomy (OR = 32.254, P = 0.015), Frankle grade (OR = 8.866, P = 0.001), the duration of intubation > 4 d (OR = 7.934, P = 0.002), the duration of surgery > 6 h (OR = 16.889, P = 0.006) were found to be significantly related to the development to postoperative pulmonary complications by multivariate analysis. CONCLUSION: serum albumin < 35 g/L, tracheotomy, Frankle grade, the duration of intubation > 4 d, the duration of surgery > 6 h are the risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders.

Pharmacodynamics of tigecycline alone and in combination with colistin against clinical isolates of multidrug-resistant Acinetobacter baumannii in an in vitro pharmacodynamic model.

The objectives of this study, which were based on the hypothesis of mutant prevention concentration (MPC), were to compare tigecycline and colistin monotherapy and combination therapy against multidrug-resistant Acinetobacter baumannii (MDR-AB) and to identify changes in the susceptibility of the organism using an in vitro pharmacodynamic model. Human free-drug concentration profiles of colistin and tigecycline used alone and in combination were simulated against four clinical MDR-AB isolates over 24 h. Pharmacodynamic activity was measured as log10 CFU/mL and as the area under the bactericidal curve (AUBC). The minimum inhibitory concentration (MIC) for all isolates was determined in triplicate by the broth microdilution method. All isolates grew to control levels in the tigecycline and colistin monotherapy conditions, and the combination of colistin plus tigecycline 100 mg every 12 h (q12h) or 50 mg q12h achieved a greater reduction in bacterial density than colistin alone (-2.65 ± 1.73 or -2.09 ± 1.47 vs. 0.98 ± 0.64 log10 CFU/mL; P <0.01). Likewise, both combinations significantly reduced the AUBC compared with that achieved using colistin alone (106.9 ± 24.5 or 117.7 ± 23.5 vs. 168.1 ± 14.2 log10 CFU⋅h/mL; P <0.05). When tigecycline or colistin monotherapy concentrations were below MPC, tigecycline MICs increased 4-32-fold and colistin MICs increased >16-fold. No loss in susceptibility to tigecycline was found with combination therapy. A combination of tigecycline (high dose) and colistin may be an effective therapy to synergistically prevent the emergence of resistance during treatment of MDR-AB (tigecycline MIC < 2 mg/L) infections.

Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus.

The pre- and post-operative cardiac autonomic nervous functions were compared in elderly, non-cardiac surgery patients with diabetes mellitus (DM) and without diabetes mellitus (NDM). A group of 30 unpremedicated elderly patients scheduled to undergo elective non-cardiac surgery were studied, including 15 DM patients and 15 NDM patients. Each component of heart rate variability (HRV) analysis in the frequency domain was monitored with Holter during the nights of the day before and on 1st and 2nd day after operation. After surgery, total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) significantly decreased as compared to the baseline values before operation in both groups (p<0.05). The LF/HF ratio was significantly changed in DM group but did not change in NDM group. On the 2nd postoperative day, TP, HF, LF and VLF in DM group were further decreased as compared to those on the 1st postoperative day and were significantly lower than those in NDM group (p<0.01 or 0.05), but these indices in NDM group did not show significant decreases. Surgery induced the cardiac autonomic nervous dysfunction in elderly patients not only with DM but also without diabetes. On the 2nd postoperative day, the disturbances of cardiac autonomic nervous activity were more sever in DM patients, compared to the 1st postoperative day, but was not significantly more sever than in the NDM patients.