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Morbidity and Mortality during Anaesthesia in Patients with versus without Diabetes: Single-Centre Cohort Study

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Open Journal of Anesthesiology 2024年第3期14卷 93-107页

作者： Noelly Mukuna Wilfrid Mbombo Joseph Nsiala Aliocha Nkodila Alphonse Mosolo Freddy Mbuyi jonathan Kukila Paul Kambala Rémy Kashala Chris Nsitwavibidila Patrick Kobo Dan Kankonde gracias Likinda Jean Claude Mubenga Khazi Anga Lionel Diyamona Berthe Barhayiga Department of Anaesthesia and Intensive Care Kinshasa University Clinics University of Kinshasa Kinshasa DRC Department of Anaesthesia and Intensive Care Monkole Hospital Kinshasa DRC Protestant University of Congo Kinshasa DRC Laboratory Department Monkole Hospital Kinshasa DRC Department of Clinical Biology Kinshasa University Clinics University of Kinshasa Kinshasa DRC Surgical Department Monkole Hospital Kinshasa DRC Department of Internal Medicine Monkole Hospital Kinshasa DRC

Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.

关键词： Anaesthesia Diabetes Morbidity Mortality Perioperative

石英纳米通道单磷脂囊泡的电阻-脉冲分析方法（英文）

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电化学 2017年第2期23卷 207-216页

作者： jonathan T.cox 张波美国华盛顿大学化学系西雅图华盛顿981951700

本文报告了用于检测单囊泡及其粒径分析的石英纳米通道电阻-脉冲分析方法.采用圆柱形石英纳米通道可检测粒径为100~300 nm的单磷脂囊泡和直径为170~400 nm的聚苯乙烯纳米颗粒.单囊泡和纳米颗粒的迁移可通过检测各自产生的方波电流脉冲信... 详细信息

本文报告了用于检测单囊泡及其粒径分析的石英纳米通道电阻-脉冲分析方法.采用圆柱形石英纳米通道可检测粒径为100~300 nm的单磷脂囊泡和直径为170~400 nm的聚苯乙烯纳米颗粒.单囊泡和纳米颗粒的迁移可通过检测各自产生的方波电流脉冲信号,并由此确定颗粒尺寸.结果表明,采用石英纳米通道电阻-脉冲分析方法得到的颗粒/囊泡粒径与采用动态光散射法和扫描电子显微法得到的结果完全一致.这种基于电子的分析方法具有快速简单的特点,所用的自制微传感器廉价耐用.石英通道的应用还可与其它分析方法如电流分析法和荧光显微法联用,以获得生物囊泡及人工囊泡更完全的信息.

关键词：电阻-脉冲分析方法石英纳米通道单囊泡聚苯乙烯纳米颗粒

Risk assessment of venous thromboembolism in inflammatory bowel disease by inherited risk in a population-based incident cohort

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World Journal of gastroenterology 2023年第39期29卷 5494-5502页

作者： Andrew S Rifkin Zhuqing Shi Jun Wei Siqun Lilly Zheng Brian T Helfand jonathan S Cordova Vincent F Biank Alfonso J Tafur Omar Khan Jianfeng Xu Program for Personalized Cancer Care NorthShore University HealthSystemEvanstonIL 60201United States Department of Surgery NorthShore University HealthSystemEvanstonIL 60201United States Pritzker School of Medicine University of ChicagoChicagoIL 60637United States Department of Pediatrics NorthShore University HealthSystemEvanstonIL 60201United States Cardiovascular Institute NorthShore University HealthSystemEvanstonIL 60201United States Department of Medicine NorthShore University HealthSystemEvanstonIL 60201United States

Inflammatory bowel disease(IBD),including Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory disease of the digestive tract with increasing prevalence *** venous thromboembolism(VTE)is a major complication in IBD patients,it is often underappreciated with limited tools for risk *** To estimate the proportion of VTE among IBD patients and assess genetic risk factors(monogenic and polygenic)for *** Incident VTE was followed for 8465 IBD patients in the UK Biobank(UKB).The associations of VTE with F5 factor V leiden(FVL)mutation,F2 g20210A prothrombin gene mutation(PgM),and polygenic score(PgS003332)were tested using cox hazards regression analysis,adjusting for age at IBD diagnosis,gender,and genetic background(top 10 principal components).The performance of genetic risk factors for discriminating VTE diagnosis was estimated using the area under the receiver operating characteristic curve(AUC).RESULTS The overall proportion of incident VTE was 4.70%in IBD patients and was similar for CD(4.46%),UC(4.49%),and unclassified(6.42%),and comparable to that of cancer patients(4.66%)who are well-known at increased risk for *** carriers of F5/F2 had a significantly increased risk for VTE compared to non-mutation carriers,hazard ratio(HR)was 1.94,95%confidence interval(CI):*** contrast,patients with the top PgS decile had a considerably higher risk for VTE compared to those with intermediate scores(middle 8 deciles),HR was 2.06(95%CI:1.57-2.71).The AUC for differentiating VTE diagnosis was 0.64(95%CI:0.61-0.67),0.68(95%CI:0.66-0.71),and 0.69(95%CI:0.66-0.71),respectively,for F5/F2 mutation carriers,PgS,and *** Similar to cancer patients,VTE complications are common in IBD *** provides more informative risk information than F5/F2 mutations(FVL and PgM)for personalized thromboprophylaxis.

关键词： Inflammatory bowel disease Venous thromboembolism Polygenic score Factor V leiden Prothrombin gene mutation

The role of mechanotransduction versus hypoxia during simulated orthodontic compressive strain——an in vitro study of human periodontal ligament fibroblasts

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International Journal of Oral Science 2019年第4期11卷 315-324页

作者： Niklas Ullrich Agnes Schroder jonathan Jantsch gerrit Spanier Peter Proff Christian Kirschneck University Medical Centre of Regensburg Franz-Josef-Strauβ-Allee 11D-93053 RegensburgGermany Department of Orthodontics University Medical Centre of RegensburgFranz-Josef-Strauβ-Allee 11D-93053 RegensburgGermany Department of Medical Microbiology and Hygiene University Medical Centre of RegensburgFranz-Josef-Strauβ-Allee 11D-93053 RegensburgGermany Department of Cranio-Maxillo-Facial Surgery University Medical Centre of RegensburgFranz-Josef-Strauβ-Allee 11D-93053 RegensburgGermany

During orthodontic tooth movement(OTM)mechanical forces trigger pseudo-inflammatory,osteoclastogenic and remodelling processes in the periodontal ligament(PDL)that are mediated by PDL fibroblasts via the expression of various signalling *** far,it is unknown whether these processes are mainly induced by mechanical cellular deformation(mechanotransduction)or by concomitant hypoxic conditions via the compression of periodontal blood *** primary PDL fibroblasts were randomly seeded in conventional six-well cell culture plates with O2-impermeable polystyrene membranes and in special plates with gas-permeable membranes(Lumox?,Sarstedt),enabling the experimental separation of mechanotransducive and hypoxic effects that occur concomitantly during *** simulate physiological orthodontic compressive forces,PDL fibroblasts were stimulated mechanically at 2 g·cm?2 for 48 h after 24 h of *** quantified the cell viability by MTT assay,gene expression by quantitative real-time polymerase chain reaction(RT-qPCR)and protein expression by western blot/enzyme-linked immunosorbent assays(ELISA).In addition,PDL-fibroblast-mediated osteoclastogenesis(TRAP+cells)was measured in a 72-h coculture with RAW264.7 *** expression of HIF-1α,cox-2,PgE2,VEgF,COL1A2,collagen and ALPL,and the RANKL/OPg ratios at the mRNA/protein levels during PDL-fibroblast-mediated osteoclastogenesis were significantly elevated by mechanical loading irrespective of the oxygen supply,whereas hypoxic conditions had no significant additional *** cellular–molecular mediation of OTM by PDL fibroblasts via the expression of various signalling molecules is expected to be predominantly controlled by the application of force(mechanotransduction),whereas hypoxic effects seem to play only a minor *** the context of OTM,the hypoxic marker HIF-1αdoes not appear to be primarily stabilized by a reduced O2 supply but is rather stabilised mechanically.

关键词： RAW264.7 periodontal mec

Control of modifiable risk factors and major adverse cardiovascular events in people with peripheral artery disease and diabetes

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World Journal of Diabetes 2021年第6期12卷 883-892页

作者： jonathan golledge Aaron Drovandi Sophie Rowbotham Ramesh Velu Frank Quigley Jason Jenkins Queensland Research Centre for Peripheral Vascular Disease College of Medicine and DentistryJames Cook UniversityTownsville 4811QueenslandAustralia Department of Vascular and Endovascular Surgery Townsville University HospitalTownsville 4811QueenslandAustralia Department of Vascular Surgery Mater HospitalTownsville 4811QueenslandAustralia Department of Vascular Surgery The Royal Brisbane and Women's HospitalBrisbane 4000QueenslandAustralia

BACKgROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with *** To examine the association between the control of modifiable risk factors,estimated by the novel PAD-medical score,and the incidence of MACE in people with PAD and *** Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and *** of reversible risk factors was assessed by a new composite measure,the PAD-medical *** score takes into account the control of low-density lipoprotein cholesterol,blood pressure,blood glucose,smoking and prescription of an *** were followed to record incidence of myocardial infarction,stroke and cardiovascular death(MACE).The association of PAD-medical score with MACE was assessed using cox proportional hazard analyses adjusting for age,sex and prior history of ischemic heart disease and *** Between 2002 and 2020,a total of 424 participants with carotid artery disease(n=63),aortic or peripheral aneurysm(n=121)or lower limb ischemia(n=240)were prospectively recruited,and followed for a median duration(inter-quartile range)of 2.0(0.2–4.4)*** 33(7.8%)participants had the optimal PAD-medical score of five,with 318(75%)scoring at least three out of *** were 89(21.0%)participants that had at least one MACE during the follow-up period.A one-unit higher PAD-medical score was associated with lower risk of MACE(HR=0.79,95%CI:0.63-0.98)after adjusting for other risk *** The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.

关键词： Peripheral artery disease Diabetes Major cardiovascular events Medical management Prospective study Clinical practice

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage:Retrospective cohort study

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World Journal of Clinical Cases 2023年第17期11卷 4003-4018页

作者： Alana Zulian Terres Rafael Sartori Balbinot Ana Laura Facco Muscope Morgana Luisa Longen Bruna Schena Bruna Teston Cini gilberto Luis Rost Jr Juline Isabel Leichtweis Balensiefer Louise Zanotto Eberhardt Raul Angelo Balbinot Silvana Sartori Balbinot jonathan Soldera Clinical gastroenterology Universidade de Caxias do SulCaxias do Sul 95020-002Brazil School of Medicine Universidade de Caxias do SulCaxias do Sul 95020-002Brazil Department of gastroenterology University of South WalesCardiff CF371DLUnited Kingdom

BACKgROUND Acute esophageal variceal hemorrhage(AEVH)is a common complication of cirrhosis and might precipitate multi-organ failure,causing acute-on-chronic liver failure(ACLF).AIM To analyze if the presence and grading of ACLF as defined by European Society for the Study of the Liver-Chronic Liver Failure(EASL-CLIF)is able to predict mortality in cirrhotic patients presenting *** Retrospective cohort study executed in Hospital geral de Caxias do *** from medical records from 2010 to 2016 were obtained by searching the hospital electronic database for patients who received *** records were reviewed in order to determine the diagnosis of cirrhosis and AEVH,including 97 ***-Meier survival analysis was used for univariate analysis and a stepwise approach to the cox regression for multivariate *** All-cause mortality for AEVH patients was 36%,40.2%and 49.4%for 30-,90-and 365-day,*** prevalence of ACLF was 41.3%.Of these,35%grade 1,50%grade 2 and 15%grade *** multivariate analysis,the non-use of non-selective beta-blockers,presence and higher grading of ACLF and higher Model for End-Stage Liver Disease scores were independently associated with higher mortality for 30-day with the addition of higher Child-Pugh scores for 90-day *** Presence and grading of ACLF according to the EASL-CLIF criteria was independently associated with higher 30-and 90-day mortality in cirrhotic patients admitted due to AEVH.

关键词： gastrointestinal hemorrhage Prognosis Esophageal and gastric varices Liver cirrhosis Acuteon-chronic liver failure Organ dysfunction scores

Real-world treatment attrition rates in advanced esophagogastric cancer

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World Journal of gastroenterology 2020年第39期26卷 6027-6036页

作者： Erica S Tsang Howard J Lim Daniel J Renouf Janine M Davies jonathan M Loree Sharlene gill Department of Medicine BC CancerVancouver V5Z 4E6Canada Division of Medical Oncology University of British ColumbiaVancouver V5Z 4E6Canada

BACKgROUND Over the last decade,multiple agents have demonstrated efficacy for advanced esophagogastric cancer(EgC).Despite the availability of later lines of therapy,there remains limited real-world data about the treatment attrition rates between lines of *** To characterize the use and attrition rates between lines of therapy for patients with advanced *** We identified patients who received at least one cycle of chemotherapy for advanced EgC between July 1,2017 and July 31,2018 across six regional centers in British Columbia(BC),***,treatment,and outcomes data were *** Of 245 patients who received at least one line of therapy,median age was 66 years(IQR 58.2-72.3)and 186(76%)were male,Eastern Cooperative Oncology group(ECOg)performance status 0/1(80%),gastric vs gEJ(36%vs 64%).Histologies included adenocarcinoma(78%),squamous cell carcinoma(8%),and signet ring(14%),with 31%HER2 positive.72%presented with de novo disease,and 25%had received previous *** was a high level of treatment attrition,with patients receiving only one line of therapy n=122,50%),two lines n=83,34%),three lines n=34,14%),and four lines n=6,2%).Kaplan-Meier analysis demonstrated improved survival with increasing lines of therapy(median overall survival 7.7 vs 16.6 vs 22.8 vs 40.4 mo,Pcox regression,improved survival was associated with better baseline ECOg and increased lines of therapy(Pghlight the unmet need for more efficacious early-line treatment options for patients with advanced EgC.

关键词： Esophagogastric cancer gastric cancer Treatment attrition Systemic therapy Treatment outcomes Real-world evidence

Fast Track gynaecologic Surgery in the Overweight and Obese Patient

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International Journal of Clinical Medicine 2010年第2期1卷 64-69页

作者： jonathan Carter Shannon Philp Vivek Arora 不详

Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIgO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had cox II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.

关键词： Fast Track Surgery Obese Overweight

A 5-Year Review of gynaecological Oncology Patients Managed by a Fast Track Surgery Program

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International Journal of Clinical Medicine 2014年第1期5卷 36-41页

作者： jonathan Carter Shannon Philp Rachel O’Connell Sydney Cancer Centre Royal Prince Alfred Hospital Sydney Australia The University of Sydney Sydney Australia NHMRC Clinical Trials Centre Sydney Australia Sydney gynaecological Oncology group Sydney Australia Sydney Cancer Centre Royal Prince Alfred Hospital Sydney Australia The University of Sydney Sydney Australia

Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates gery, age, performance status, malignant vs benign pathology, the use of cox-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of cox-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of cox-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph no

关键词： Fast Track Surgery Enhanced Recovery Optimized Recovery