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Pubblicazioni recenti - cardiac surgery
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Did radiation exposure increase with chest computed tomography use among different ages during the COVID-19 pandemic? A multi-center study with 42028 chest computed tomography scans.
Diagn Interv Radiol2023 Mar;29(2):373-378. doi: 10.5152/dir.2022.211043.
Co?kun Mehmet, Çilengir Atilla H, Çetino?lu Kenan, Horoz Merve, Sinci Ayberk, Demircan Betül, Uluç Engin, Gelal Faz?l,
Abstract
PURPOSE:
To determine whether radiation exposure increased among different ages with chest computed tomography (CT) use during the coronavirus disease-2019 (COVID-19) pandemic.
METHODS:
Patients with chest CT scans in an 8-month period of the pandemic between March 15, 2020, and November 15, 2020, and the same period of the preceding year were included in the study. Indications of chest CT scans were obtained from the clinical notes and categorized as infectious diseases, neoplastic disorders, trauma, and other diseases. Chest CT scans for infectious diseases during the pandemic were compared with those with the same indications in 2019. The dose-length product values were obtained from the protocol screen individually.
RESULTS:
The total number of chest CT scans with an indication of infectious disease was 21746 in 2020 and 4318 in 2019. Total radiation exposure increased by 573% with the use of chest CT for infectious indications but decreased by 19% for neoplasia, 12% for trauma, and 43% for other reasons. The mean age of the patients scanned in 2019 was significantly higher than those scanned during the pandemic (64.6 vs. 50.3 years). A striking increase was seen in the 10-59 age group during the pandemic (
CONCLUSION:
Chest CT was excessively used during the COVID-19 pandemic. Young and middle-aged people were exposed more than others. The impact of COVID-19-pandemic-related radiation exposure on public health should be followed carefully in future years.
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Feasibility study of percutaneous thoracic duct embolization with lower-limb intermittent pneumatic compression devices.
Diagn Interv Radiol2023 Mar;29(2):326-330. doi: 10.5152/dir.2022.21975.
Balasubramaniam Ravivarma, Mossad Mona,
Abstract
PURPOSE:
To demonstrate intranodal thoracic duct embolization (TDE) for treating chyle leaks following thoracic surgery and the feasibility of applying lower-limb intermittent pneumatic compression devices during TDE.
METHODS:
Between December 2017 and October 2020, 12 consecutive TDEs for post-operative chyle leaks were performed in 11 patients using intranodal lymphangiogram (IL) with an intermittent pneumatic compressive device applied to the lower limb. The procedure's duration, technical/clinical success, and complications were retrospectively evaluated.
RESULTS:
IL was successful at imaging the thoracic duct in all procedures (100%), and TDE had an intention- to-treat success rate of 92% (11/12). No related complications were observed during follow-up, which took place at a mean of 27 days. The time from the commencement of lymphangiogram until visualization of the thoracic duct was a mean of 21.6 min, and the mean overall procedure time was 87.3 min.
CONCLUSION:
This study supports IL-guided TDE as a safe and effective option to treat post-thoracic surgery chyle leaks. We revealed shorter lymphangiogram times compared with previously published studies, and we postulate that the application of intermittent lower-limb pneumatic compressive devices contributed toward this study's results by expediting the return of lymph from the lower limb. This study is the first to illustrate this approach in TDE and advocates for randomized controlled studies to further evaluate the influence of intermittent pneumatic compressive devices on the procedure.
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Outcomes of aortic arch repair using the frozen elephant trunk technique: analysis of a Scandinavian center's results over 14 years.
J Cardiovasc Surg (Torino)2023 Apr;64(2):215-223. doi: 10.23736/S0021-9509.23.12490-6.
Hellgren Tina, Wanhainen Anders, Astudillo Rafael, Vikholm Per, Hellgren Laila, Mani Kevin,
Abstract
BACKGROUND:
The frozen elephant trunk (FET) technique enables repair of aortic arch pathology, with possibility for endovascular treatment of distal thoracic aortic disease. We aimed to study outcomes of FET repair of complex aortic arch disease at a Scandinavian tertiary referral center.
METHODS:
All patients who underwent FET repair of the aortic arch 2006-2020 were included. Survival, complication and reintervention rate, and aortic remodeling were analyzed.
RESULTS:
Fifty patients were included: 23 complex thoracic aortic aneurysms involving the aortic arch (TAA), 19 with chronic aortic dissections (CAD) (16 Stanford type A, 3 type B) and 8 acute aortic dissections (AAD) (7 Stanford type A, 1 type B). Thirty-day mortality was: TAA=22% (N.=5), CAD=5% (N.=1), AAD=37% (N.=3). Rate of disabling stroke: TAA=22% (N.=5), CAD=5% (N.=1), AAD=25% (N.=2). Rate of permanent spinal cord injury: TAA=9% (N.=2), CAD=5% (N.=1), AAD=0%. 5-year survival: TAA=53%, CAD=83%, AAD=63%. 5-year reintervention-free survival was TAA=83% and CAD=36%. There were no reinterventions in the AAD group. 13/19 (68%) of CAD patients underwent distal stent graft extension during follow-up. On last CT follow-up (median 32 months), 78% of CAD had false lumen thrombosis along the stent graft and 11% in the abdominal aorta. In thoracic aorta there was a mean 64% expansion (P
CONCLUSIONS:
Despite the advantages of the FET technique, repair of extensive aortic arch disease remains associated with high rates of mortality and major neurologic complications. FET repair of CAD induces favorable remodeling in the thoracic aorta.
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Determination of the gained proximal sealing zone length after debranching of the left subclavian artery in thoracic endovascular aortic repair.
J Cardiovasc Surg (Torino)2023 Apr;64(2):134-141. doi: 10.23736/S0021-9509.23.12578-X.
Dieleman Isabel M, Zuidema Roy, de Beaufort Hector W, Gallitto Enrico, Spath Paolo, Logiacco Antonino, Gargiulo Mauro, Heijmen Robin H, de Vries Jean-Paul Pm, Schuurmann Richte Cl,
Abstract
BACKGROUND:
For descending thoracic aortic aneurysms (TAA) in proximity of the aortic arch, debranching of the left subclavian artery (LSA) may be necessary to extend proximal sealing in zone 2. The aim of this study was to determine the added proximal apposition length gained from LSA debranching during thoracic endovascular aortic repair (TEVAR).
METHODS:
This multicenter retrospective study (2010-2020) included patients who underwent elective TEVAR in zone 2 for a degenerative TAA where the LSA was surgically debranched. The endograft position on the first postoperative computed tomography angiography (CTA) scan was assessed using post-processing software. The analysis included the shortest apposition length (SAL), the tilt of the proximal edge of the endograft, and the distance between the endograft and the left common carotid artery. Clinical endpoints (neurological complications and endoleaks) at 30 days were also reported.
RESULTS:
Twenty-two patients were included. The median interval between TEVAR and the first postoperative CTA was 3 days (2-10 days). Median SAL was 9.2 mm (1.3-26.4 mm), of which 8.6 mm (1.3-16.2 mm) was gained proximal of the LSA, including the LSA orifice. In 12 patients (55.5%) the SAL was
CONCLUSIONS:
Debranching the LSA adds valuable sealing length in zone 2, but the SAL was still relatively short in many patients, putting these patients at risk for a future type Ia endoleak. Accurate assessment of the circumferential apposition on postoperative CTA follow-up in these high-risk patients with short, complex landing zones seems mandatory. Evaluation of apposition in a larger population with longer follow-up is advised.
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Comparation Among Opioid-Based, Low Opioid and Opioid Free Anesthesia in Colorectal Oncologic Surgery.
Pril (Makedon Akad Nauk Umet Odd Med Nauki)2023 Mar;44(1):117-126. doi: 10.2478/prilozi-2023-0013.
Toleska Marija, Dimitrovski Aleksandar, Dimitrovska Natasha Toleska,
Abstract
: Opioids are the "gold standard" for pain treatment during and after colorectal surgery. They can inhibit cellular and humoral immunity and it is assumed that can promote cancer cell proliferation and metastatic spread. Adequate pain management can be achieved not only with opioids, but also with non-opioid drugs, which can be used together in small doses, i.e., multimodal analgesia, and can lower the need for opioids during and after surgery. Opioid free anesthesia (OFA) is part of multimodal analgesia, where opioids are not used in the intraoperative period. : In this prospective and randomized clinical study 60 patients scheduled for open colorectal surgery were enrolled. They were between the ages of 45 and 70 with the American Association of Anesthesiologists (ASA) classifications 1, 2 and 3, divided in three groups. The first group of patients, or Opioid-based anesthesia group (OBAG), received the following for induction to anesthesia: lidocaine at 1 mg/kg, fentanyl 100 at µgr, propofol at 2mg/kg and rocuronium bromide at 0.6 mg/kg. They intermittently received 50-100 µgr fentanyl intravenously and 0.25 % bupivacaine 2-3 ml every 30-45 minutes, given in the epidural catheter during surgery. The second group of patients, or Low opioid anesthesia group (LOAG), received the following for induction to anesthesia: lidocaine at 1 mg/kg, fentanyl at 100 µgr, propofol at 2mg/kg and rocuronium bromide at 0.6 mg/kg. Prior to surgery, 50 µgr of fentanyl with 5 ml 0.25% bupivacaine was given into the epidural catheter, and the same dose was received at the end of surgery. The third group, or Opioid free anesthesia group (OFAG), received the following before the induction to general anesthesia: dexamethasone at 0.1 mg/kg and 1 gr of paracetamol. Induction to general anesthesia was with lidocaine at 1 mg/kg, propofol at 2mg/kg, ketamine at 0.5 mg/kg and rocuronium bromide at 0.6 mg/kg. After intubation, intravenous continuous infusion with lidocaine was at 2 mg/kg/h, ketamine 0.2 mg/kg/h and magnesium 15 mg/kg/h loaded on and intermittently 0.25 % bupivacaine 2-3 ml every 30-45 minutes given in the epidural catheter during surgery. The primary goal was to measure the patients' pain after the first 72 postoperative hours in all three groups (2, 6, 12, 24, 36, 48 and 72 hours after surgery). The secondary goal was to measure the total amount of morphine given in the epidural catheter in the postoperative period in all three groups. Other secondary goals were: to compare the total amount of fentanyl given intravenously during surgery in the first and second groups, determine if there was a need to use rescue analgesia in the postoperative period, measure the occurrence of PONV, and to measure the total amount of bupivacaine given in the epidural catheter during operation in all three groups. : Visual Analogue Scale (VAS) score comparisons between groups showed patients from the OBA and LOA groups had significantly higher VAS scores, compared to the patients from the OFA group 2, 12, 24 and 48 hours after operation. After 6 hours postoperatively, patients from the LOA group had significantly higher VAS scores, compared to patients from the OBA and OFA groups. After 36 hours postoperatively, patients from the OBA group had significantly higher VAS scores compared to patients from the LOA and OFA groups. At the last follow-up point, 72 hours after the intervention, the patients from the OBA and LOA groups had significantly higher VAS scores compared to the patients from the OFA group. All patients from the OBA and LOA groups, and only 9 from the OFA group received morphine in the postoperative period via epidural catheter. Patients from the Opioid group received significantly higher amounts of fentanyl during surgery. Additional administration of another analgesic drug in the postoperative period was prescribed in 55% of patients in the OBAG, in 50% in the LOAG and in 35% of the OFA group. PONV was registered in 60% of patients from the OBAG and in 40% of patients from the LOAG. In the OFA group did not register PONV in any of the patients. The biggest amount of bupivacaine given during surgery was in the OBAG (26.37 ± 2.6 mg), in LOAG was 25.0 ± 0 and the less in OFAG group (24.50 ± 4.3). : Patients from OFA group, compared with patients from OBAG and LOAG, have the lowest pain score in first 72 hours after open colorectal surgery, received fewer opioids via an epidural catheter in the postoperative period, had less need for rescue analgesia, no occurrence of PONV, and less need for bupivacaine via an epidural catheter in the intraoperative period.
© 2023 Marija Toleska et al., published by Sciendo.
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Is robotic assistance an added value in minimally invasive mitral valve surgery? A meta-analysis from propensity score-matched series.
Asian Cardiovasc Thorac Ann2023 Mar;():2184923231166352. doi: 10.1177/02184923231166352.
Jegaden Olivier, Al Shamry Adel, Ashafy Salah, Mahdi Alhaitham, Eker Armand,
Abstract
OBJECTIVES:
There is still ongoing debate about the benefits of robotic assistance (R-MVS) in comparison with video assistance (V-MVS) in minimally invasive mitral valve surgery. This study aims to update the current evidence.
METHODS:
Three propensity score-matched studies published from 2011 to 2021 were included with a total of 1193 patients operated on from 2005 (R-MVS: 536, V-MVS: 657). Data regarding early mortality, postoperative event, and time-related outcomes were extracted and submitted to a meta-analysis using weighted random-effects modeling.
RESULTS:
The incidence of early mortality, stroke, renal failure, conversion, atrial fibrillation, and prolonged ventilation were similar, all in the absence of heterogeneity. Reoperation for bleeding (odds ratio [OR]: 0.36, 95% confidence interval [CI] 0.16-0.81, ?=?0.01) and the need for blood transfusion (OR: 0.30, 95% CI, 0.20-0.56, ?=?0.001) were significantly lower in V-MVS group. Regarding time-related outcomes, there was evidence for important heterogeneity of treatment effect among the studies. Operative times were longer in R-MVS: differences in means were 20.7?min for cross-clamp time (95% CI, 9.07-32.3, ?=?0.001), 20.7?min for cardiopulmonary bypass time (95% CI, 2.5-38.9, ?=?0.03) and 40.2?min for total operative time (95% CI, 24.5-55.8, ?0.001). Intensive care unit stay and hospital stay were reported in one study, and longer after R-MVS compared to V-MVS; the differences in means were 0.17 days (?=?0.005) and 0.6 days (?=?0.017), respectively. Total cost of both procedures was reported in an additional dedicated propensity score-matched series including 448 patients; it was 21% higher for R-MVS than for V-MVS.
CONCLUSIONS:
This meta-analysis showed excellent outcomes of both video and robotic techniques with low incidence of morbidity and mortality. However, there is no evidence for an added value of robotic assistance in comparison with video assistance; the drawbacks of mini access are reported higher regardless the induced over cost.
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Expanding the scope of preoperative localization.
J Surg Oncol -
CT-guided indocyanine green and lipiodol marking of ground glass opacity before robotic-assisted lung resection.
J Surg Oncol2023 Mar;():. doi: 10.1002/jso.27249.
Gallina Filippo Tommaso, Cappelli Federico, Forcella Daniele, Tajè Riccardo, Bruschi Mattia, Gennari Valeria, Vallati Giulio Eugenio, Facciolo Francesco, Melis Enrico,
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Diffuse Coronary Vasospasm After Mitral Valve Replacement, Maze Procedure, and Tricuspid Valve Repair.
Cureus2023 Feb;15(2):e35405. doi: 10.7759/cureus.35405.
Gorton Andrew J, Rodgers-Fischl Peter, Gurley John, Dorfling Johannes, Keshavamurthy Suresh,
Abstract
Coronary vasospasm is a known complication after coronary artery bypass grafting surgery but has rarely been described in non-coronary cardiac operations. We report the case of a 51-year-old male with nonischemic cardiomyopathy and paroxysmal atrial fibrillation. He presented with severe mitral and tricuspid regurgitation and was taken for mitral valve replacement, tricuspid valve repair, and Maze procedure. Postoperative emergent coronary angiography demonstrated diffuse coronary vasospasm. Injection of intracoronary nitroglycerin led to clinical and angiographic improvement. This demonstrates the possibility of coronary vasospasm following mitral valve replacement and effective treatment with intracoronary administration of vasodilating agents.
Copyright © 2023, Gorton et al.
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Myocardial Inflammation on FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 Vaccination.
Radiol Cardiothorac Imaging2023 Apr;5(2):e220247. doi: 10.1148/ryct.220247.
Marschner Constantin Arndt, Thavendiranathan Paaladinesh, Gustafson Dakota, Howe Kathryn L, Fish Jason E, Iwanochko Robert M, Wald Rachel M, Abdel-Qadir Husam, Epelman Slava, Cheung Angela M, Hong Rachel, Hanneman Kate,
Abstract
PURPOSE:
To evaluate potential cardiac sequelae of COVID-19 vaccination at 2-month follow-up and relate cardiac symptoms to myocardial tissue changes on fluorodeoxyglucose (FDG) PET/MRI, blood biomarkers, health-related quality of life, and adverse outcomes.
MATERIALS AND METHODS:
In this prospective study (ClinicalTrials.gov: NCT04967807), a convenience sample of individuals aged ?17 years were enrolled after COVID-19 vaccination and were categorized as symptomatic myocarditis (new cardiac symptoms within 14 days of vaccination and met diagnostic criteria for acute myocarditis), symptomatic no myocarditis (new cardiac symptoms but did not meet criteria for myocarditis), and asymptomatic (no new cardiac symptoms). Standardized evaluation was performed 2 months after vaccination, including cardiac fluorine 18 FDG PET/MRI, blood biomarkers, and health-related quality of life. Statistical analysis included Kruskal-Wallis and Fisher exact tests.
RESULTS:
Fifty-four participants were evaluated a median of 72 days (IQR: 42, 91) after COVID-19 vaccination, 17 symptomatic with myocarditis (36±[SD]15 years, 13 males), 17 symptomatic without myocarditis (42±12 years, 7 males), and 20 asymptomatic (45±14 years, 9 males). No participants in the symptomatic without myocarditis or asymptomatic groups had focal FDG-uptake, myocardial edema or impaired ventricular function. Two participants with symptomatic myocarditis had focal FDG-uptake, and three had high T2 on MRI. Health-related quality of life was lower in the symptomatic myocarditis group than the asymptomatic group. There were no adverse cardiac events beyond myocarditis in any participant.
CONCLUSIONS:
At two-month follow-up, FDG PET/MRI showed evidence of myocardial inflammation in 2/17 participants diagnosed with acute myocarditis early after COVID-19 vaccination, but not in symptomatic and asymptomatic participants without acute myocarditis. Myocarditis, Vaccination, COVID-19, PET/MRI, Cardiac MRI, FDG-PET.
© 2023 by the Radiological Society of North America, Inc.
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Invasive Giant B-Cell Lymphoma Mimicking Fulminant Pulmonary Embolism.
Thorac Cardiovasc Surg Rep2023 Jan;12(1):e21-e23. doi: 10.1055/s-0043-1764473.
Irqsusi Marc, Gerlach Susanne von, Rastan Ardawan Julian, Ghazy Tamer,
Abstract
?Cardiac non-Hodgkin's lymphoma is rare and has a poor prognosis. Here we report a rare case mimicking pulmonary embolism. ?A 38-year-old woman suffered from severe dyspnea after cesarean section. With the clinical picture of fulminant central pulmonary embolism, lysis therapy was initiated. Further deterioration necessitated extracorporeal membrane oxygenation (ECMO) support and cardiosurgical intervention. Intraoperatively, a massive intravascular tumor obstructed the pulmonary bifurcation and was found to be B-cell lymphoma. Aggressive excision and pulmonary tree reconstruction improved the critical condition and initiated convalescence. ?High suspicion in central pulmonary embolism and early cardiosurgical therapy after ineffective lysis are essential.
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).
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A Novel Trans-Tracheostomal Retrograde Inhalation Technique Increases Subglottic Drug Deposition Compared to Traditional Trans-Oral Inhalation.
Pharmaceutics2023 Mar;15(3):. doi: 903.
Allon Raviv, Bhardwaj Saurabh, Sznitman Josué, Shoffel-Havakuk Hagit, Pinhas Sapir, Zloczower Elchanan, Shapira-Galitz Yael, Lahav Yonatan,
Abstract
Subglottic stenosis represents a challenging clinical condition in otolaryngology. Although patients often experience improvement following endoscopic surgery, recurrence rates remain high. Pursuing measures to maintain surgical results and prevent recurrence is thus necessary. Steroids therapy is considered effective in preventing restenosis. Currently, however, the ability of trans-oral steroid inhalation to reach and affect the stenotic subglottic area in a tracheotomized patient is largely negligible. In the present study, we describe a novel trans-tracheostomal retrograde inhalation technique to increase corticosteroid deposition in the subglottic area. We detail our preliminary clinical outcomes in four patients treated with trans-tracheostomal corticosteroid inhalation via a metered dose inhaler (MDI) following surgery. Concurrently, we leverage computational fluid-particle dynamics (CFPD) simulations in an extra-thoracic 3D airway model to gain insight on possible advantages of such a technique over traditional trans-oral inhalation in augmenting aerosol deposition in the stenotic subglottic region. Our numerical simulations show that for an arbitrary inhaled dose (aerosols spanning 1-12 µm), the deposition (mass) fraction in the subglottis is over 30 times higher in the retrograde trans-tracheostomal technique compared to the trans-oral inhalation technique (3.63% vs. 0.11%). Importantly, while a major portion of inhaled aerosols (66.43%) in the trans-oral inhalation maneuver are transported distally past the trachea, the vast majority of aerosols (85.10%) exit through the mouth during trans-tracheostomal inhalation, thereby avoiding undesired deposition in the broader lungs. Overall, the proposed trans-tracheostomal retrograde inhalation technique increases aerosol deposition rates in the subglottis with minor lower-airway deposition compared to the trans-oral inhalation technique. This novel technique could play an important role in preventing restenosis of the subglottis.
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Cyclocreatine Phosphate: A Novel Bioenergetic/Anti-Inflammatory Drug That Resuscitates Poorly Functioning Hearts and Protects against Development of Heart Failure.
Pharmaceuticals (Basel)2023 Mar;16(3):. doi: 453.
Elgebaly Salwa A, Van Buren Charles, Todd Robert, Poston Robert, Arafa Reem K, El-Khazragy Nashwa, Kreutzer Donald, Rabie Mostafa A, Mohamed Ahmed F, Ahmed Lamiaa A, El Sayed Nesrine S,
Abstract
Irreversible myocardial injury causes the exhaustion of cellular adenosine triphosphate (ATP) contributing to heart failure (HF). Cyclocreatine phosphate (CCrP) was shown to preserve myocardial ATP during ischemia and maintain cardiac function in various animal models of ischemia/reperfusion. We tested whether CCrP administered prophylactically/therapeutically prevents HF secondary to ischemic injury in an isoproterenol (ISO) rat model. Thirty-nine rats were allocated into five groups: control/saline, control/CCrP, ISO/saline (85 and 170 mg/kg/day s.c. for 2 consecutive days), and ISO/CCrP (0.8 g/kg/day i.p.) either administrated 24 h or 1 h before ISO administration (prophylactic regimen) or 1 h after the last ISO injection (therapeutic regimen) and then daily for 2 weeks. CCrP protected against ISO-induced CK-MB elevation and ECG/ST changes when administered prophylactically or therapeutically. CCrP administered prophylactically decreased heart weight, hs-TnI, TNF-?, TGF-?, and caspase-3, as well as increased EF%, eNOS, and connexin-43, and maintained physical activity. Histology indicated a marked decrease in cardiac remodeling (fibrin and collagen deposition) in the ISO/CCrP rats. Similarly, therapeutically administered CCrP showed normal EF% and physical activity, as well as normal serum levels of hs-TnI and BNP. In conclusion, the bioenergetic/anti-inflammatory CCrP is a promising safe drug against myocardial ischemic sequelae, including HF, promoting its clinical application to salvage poorly functioning hearts.
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Oxygen Consumption Predicts Long-Term Outcome of Patients with Left Ventricular Assist Devices.
Nutrients2023 Mar;15(6):. doi: 1543.
Veraar Cecilia, Fischer Arabella, Bernardi Martin H, Worf Isabella, Mouhieddine Mohamed, Schlöglhofer Thomas, Wiedemann Dominik, Dworschak Martin, Tschernko Edda, Lassnigg Andrea, Hiesmayr Michael,
Abstract
Reduced oxygen consumption (VO), either due to insufficient oxygen delivery (DO), microcirculatory hypoperfusion and/or mitochondrial dysfunction, has an impact on the adverse short- and long-term survival of patients after cardiac surgery. However, it is still unclear whether VO remains an efficient predictive marker in a population in which cardiac output (CO) and consequently DO is determined by a left ventricular assist device (LVAD). We enrolled 93 consecutive patients who received an LVAD with a pulmonary artery catheter in place to monitor CO and venous oxygen saturation. VO and DO of in-hospital survivors and non-survivors were calculated over the first 4 days. Furthermore, we plotted receiver-operating curves (ROC) and performed a cox-regression analysis. VO predicted in-hospital, 1- and 6-year survival with the highest area under the curve of 0.77 (95%CI: 0.6-0.9; = 0.0004). A cut-off value of 210 mL/min VO stratified patients regarding mortality with a sensitivity of 70% and a specificity of 81%. Reduced VO was an independent predictor for in-hospital, 1- and 6-year mortality with a hazard ratio of 5.1 ( = 0.006), 3.2 ( = 0.003) and 1.9 ( = 0.0021). In non-survivors, VO was significantly lower within the first 3 days ( = 0.010,
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An Assessment of Carotid Flow Time Using a Portable Handheld Ultrasound Device: The Ideal Tool for Guiding Intraoperative Fluid Management?
Micromachines (Basel)2023 Feb;14(3):. doi: 510.
Gibson Lauren E, Mitchell James E, Bittner Edward A, Chang Marvin G,
Abstract
Volume resuscitation is a cornerstone of modern anesthesia care. Finding the right balance to avoid inadequate or excess volume administration is often difficult to clinically discern and can lead to negative consequences. Pulse pressure variation is often intraoperatively used to guide volume resuscitation; however, this requires an invasive arterial line and is generally only applicable to patients who are mechanically ventilated. Unfortunately, without a pulmonary artery catheter or another costly noninvasive device, performing serial measurements of cardiac output is challenging, time-consuming, and often impractical. Furthermore, noninvasive measures such as LVOT VTI require significant technical expertise as well as access to the chest, which may not be practical during and after surgery. Other noninvasive techniques such as bioreactance and esophageal Doppler require the use of costly single-use sensors. Here, we present a case report on the use of corrected carotid flow time (ccFT) from a portable, handheld ultrasound device as a practical, noninvasive, and technically straightforward method to assess fluid responsiveness in the perioperative period, as well as the inpatient and outpatient settings.
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Distinctive Signs of Disease as Deterrents for the Endothelial Function: A Systematic Review.
Metabolites2023 Mar;13(3):. doi: 430.
Nappi Francesco, Avtaar Singh Sanjeet Singh,
Abstract
Endothelial integrity plays a major role in homeostasis and is responsive to the numerous endogenous factors released. While its functional role in vascular tone is well described, its role in the pathophysiology of cardiovascular disease is of interest as a potential therapeutic target. We performed a systematic review to provide an overview of new therapeutic and diagnostic targets for the treatment of coronary artery disease related to endothelial dysfunction. Databases of PubMed, Ovid's version of MEDLINE, and EMBASE were interrogated with appropriate search terms. Inclusion criteria have been met by 28 studies that were included in the final systematic review. We identified inflammation, pulmonary hypertension, diabetes mellitus and Fabry disease as pathophysiological mechanisms and explored the therapeutic options related to these conditions including medications such as Canakinumab. Endothelial dysfunction has a key role in several different pathophysiological processes which can be targeted for therapeutic options. Ongoing research should be targeted at making the transition to clinical practice. Further research is also needed on understanding the amelioration of endothelial dysfunction with the use of cardiovascular medications.
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The Immunosuppressive Niche Established with a Curcumin-Loaded Electrospun Nanofibrous Membrane Promotes Cartilage Regeneration in Immunocompetent Animals.
Membranes (Basel)2023 Mar;13(3):. doi: 335.
Zhang Yu, Cai Renzhong, Li Jun, Wu Xu,
Abstract
Inflammatory cells mount an immune response against in vitro engineered cartilage implanted into immunocompetent animals, consequently limiting the usage of tissue-engineered cartilage to repair cartilage defects. In this study, curcumin (Cur)-an anti-inflammatory agent-was mixed with poly(lactic-co-glycolic acid) (PLGA) to develop a Cur/PLGA nanofibrous membrane with nanoscale pore size and anti-inflammatory properties. Fourier-transform infrared spectroscopy and high-performance liquid chromatography analyses confirmed the successful loading of Cur into the Cur/PLGA nanofibrous membrane. The results of the in vitro assay demonstrated the sustained release kinetics and enhanced stability of Cur in the Cur/PLGA nanofibrous membrane. Western blotting and enzyme-linked immunosorbent assay analyses revealed that the Cur/PLGA nanofibrous membrane significantly downregulated the expression of inflammatory cytokines (IL-1?, IL-6, and TNF-?). A chondrocyte suspension was seeded into a porous PLGA scaffold, and the loaded scaffold was cultured for 3 weeks in vitro to engineer cartilage tissues. The cartilage was packed with the in vitro engineered Cur/PLGA nanofibrous membrane and subcutaneously implanted into rats to generate an immunosuppressive niche. Compared with those in the PLGA-implanted and pure cartilage (without nanofibrous membrane package)-implanted groups, the cartilage was well preserved and the inflammatory response was suppressed in the Cur/PLGA-implanted group at weeks 2 and 4 post-implantation. Thus, this study demonstrated that packaging the cartilage with the Cur/PLGA nanofibrous membrane effectively generated an immunosuppressive niche to protect the cartilage against inflammatory invasion. These findings enable the clinical translation of tissue-engineered cartilage to repair cartilage defects.
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Management of Coronary Artery Disease in CADASIL Patients: Review of Current Literature.
Medicina (Kaunas)2023 Mar;59(3):. doi: 586.
Servito Maria, Gill Isha, Durbin Joshua, Ghasemlou Nader, Popov Aron-Frederik, Stephen Christopher D, El-Diasty Mohammad,
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia in adults. It is well-established that CADASIL results in neurocognitive dysfunction and mood disturbance. There is also cumulative evidence that CADASIL patients are more susceptible to ischemic heart disease. The aim of this study is to review the current literature regarding the incidence of coronary artery disease in CADASIL patients with a focus on the various management options and the clinical challenges associated with each of these treatment strategies. We conducted a literature search using Cochrane, MEDLINE, and EMBASE for papers that reported the occurrence of coronary artery disease in patients with CADASIL. We supplemented the search with a manual search in Google Scholar. Only case reports, case series, and original articles were included. The search resulted in six reports indicating the association between coronary artery disease and CADASIL and its management. Evidence suggests that extracranial manifestations of CADASIL may include coronary artery disease, presenting as a more extensive burden of disease in younger patients. Surgical and percutaneous revascularization strategies are feasible, but the incidence of peri-procedural stroke remains significant and should be weighed against the potential benefit derived from either of these strategies. A multidisciplinary approach to therapy, with perspectives from neurologists, cardiologists, and cardiac surgeons, is needed to provide the appropriate treatment to the CADASIL patient with severe coronary artery disease. Future studies should be directed toward the development of targeted therapies that may help with the early detection and prevention of disease progress in these patients.
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Predictive Value of Gene Databases in Discovering New Biomarkers and New Therapeutic Targets in Lung Cancer.
Medicina (Kaunas)2023 Mar;59(3):. doi: 547.
Liu Mengfeng, Yu Xiran, Qu Changfa, Xu Shidong,
Abstract
: The molecular mechanisms of lung cancer are still unclear. Investigation of immune cell infiltration (ICI) and the hub gene will facilitate the identification of specific biomarkers. : Key modules of ICI and immune cell-associated differential genes, as well as ICI profiles, were identified using lung cancer microarray data from the single sample gene set enrichment analysis (ssGSEA) and weighted gene co-expression network analysis (WGCNA) in the gene expression omnibus (GEO) database. Protein-protein interaction networks were used to identify hub genes. The receiver operating characteristic (ROC) curve was used to assess the diagnostic significance of the hub genes, and survival analysis was performed using gene expression profiling interactive analysis (GEPIA). : Significant changes in ICI were found in lung cancer tissues versus adjacent normal tissues. WGCNA results showed the highest correlation of yellow and blue modules with ICI. Protein-protein interaction networks identified four hub genes, namely CENPF, AURKA, PBK, and CCNB1. The lung adenocarcinoma patients in the low hub gene expression group showed higher overall survival and longer median survival than the high expression group. They were associated with a decreased risk of lung cancer in patients, indicating their potential role as cancer suppressor genes and potential targets for future therapeutic development. : CENPF, AURKA, PBK, and CCNB1 show great potential as biomarkers and immunotherapeutic targets specific to lung cancer. Lung cancer patients' prognoses are often foreseen using matched prognostic models, and genes CENPF, AURKA, PBK, and CCNB1 in lung cancer may serve as therapeutic targets, which require further investigations.
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Basic Operative Tactics for Pulmonary Echinococcosis in the Era of Endostaplers and Energy Devices.
Medicina (Kaunas)2023 Mar;59(3):. doi: 543.
Bakinowska Estera, Kostopanagiotou Konstantinos, Wojty? Ma?gorzata Edyta, Kie?bowski Kajetan, Ptaszy?ski Konrad, Gaji? Darko, Ruszel Nikola, Wójcik Janusz, Grodzki Tomasz, Tomos Periklis,
Abstract
Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed.
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