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Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients

World Journal of Orthopedics 2024年第8期15卷 773-782页

作者： Peter C Brennan Stephanie M Peterson Thomas J O'Byrne Mariana L Laporta Cody C Wyles Paul J Jannetto Garvan C Kane Maria Vassilaki Hilal Maradit Kremers Department of Orthopedic Surgery Mayo ClinicRochesterMN 55905United States Department of Quantitative Health Sciences Mayo ClinicRochesterMN 55905United States Department of anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Department of Laboratory Medicine and Pathology Mayo ClinicRochesterMN 55905United States Department of Cardiovascular Diseases Mayo ClinicRochesterMN 55905United States

BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)*** To determine the association of commonly used implant metals with echocardiographic measures in TJA *** The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium *** underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal *** and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac *** titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some *** studies are warranted to better understand the systemic effects of metals in TJA patients.

关键词： Total joint arthroplasty Metal-on-metal Cardiotoxicity Heart failure Echocardiography Cobalt

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Inhaled volatile anesthetics in the intensive care unit

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World Journal of Critical Care Medicine 2024年第1期13卷 28-39页

作者： Erin D Wieruszewski Mariam ElSaban Patrick M Wieruszewski Nathan J Smischney Department of Pharmacy Mayo ClinicRochesterMN 55905United States anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Department of anesthesiology&Perioperative Medicine Mayo ClinicRochesterMN 55905United States

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th ***,a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres,finding diverse applications in intensive care *** the dynamic landscape of intensive care,volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements,managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus,conditions of high sedative requirements including burns,high opioid or alcohol use and neurological conditions such as status *** anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry,providing intensivists with multiple options to tailor ***,their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy,mitigating risks associated with conventional sedation *** the amounting enthusiasm for the use of these therapies,barriers to widespread utilization include expanding equipment availability,staff familiarity and training of safe *** article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology,administration considerations in intensive care settings,complication considerations,and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

关键词： Anesthesia Critical care Mechanical ventilation Sedation Volatile anesthetics Sedative

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Continuous ward monitoring and intensive postoperative management

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Chinese Medical Journal 2024年第6期137卷 631-632页

作者： Kai Li Jiayi Wang Daniel I.Sessler Department of anesthesiology China-Japan Union HospitalJilin UniversityChangchunJilin 130031China Outcomes Research Consortium ClevelandOhio 44195USA Department of anesthesiology Shanghai Ninth People’s HospitalShanghai JiaoTong University School of MedicineShanghai 201999China Department of Outcomes Research Cleveland ClinicClevelandOhio 44195USA

When patients having major surgery reach the post-anaesthesia care unit,families naturally assume that they have survived the most dangerous part of the perioperative *** assumption is *** in the 30 days after surgery is 140 times higher than intraoperative mortality.^([1,2])In fact,if the month after surgery were considered a disease,it would be the world’s third leading cause of death.^([3])

关键词： assume dangerous wrong

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Prediction of Th17/Treg cell balance on length of stay in intensive care units of patients with sepsis

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Journal of Intensive Medicine 2024年第2期4卷 240-246页

作者： Yu Wu Guosheng Wu Minyu Li Yongqing Chang Miao Yu Yan Meng Xiaojian Wan Department of Intensive Care Medicine Changhai HospitalNaval Medical UniversityShanghaiChina Department of anesthesiology Bethune International Peace HospitalShijiazhuangHebeiChina Department of Burns Changhai HospitalNaval Medical UniversityShanghaiChina Department of Special Needs clinic Changhai HospitalNaval Medical UniversityShanghaiChina

Background Prolonged length of stay(LOS)of sepsis can drain a hospital's material and human *** study investigated the correlations between T helper type 17(Th17)and regulatory T(Treg)balance with LOS in *** A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai,China,from January to October *** patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines,procalcitonin,subtypes,and biomarkers of T cells in the peripheral blood were *** analyzed the correlation between these and *** Sixty septic patients were classified into two groups according to whether their intensive care unit(ICU)stay exceeded 14 *** patients with LOS≥14 days were older([72.6±7.5]years vs.[63.3±10.4]years,P=0.015)and had higher Sequential Organ Failure Assessment(SOFA)(median[interquartile range]:6.5[5.0–11.0]vs.4.0[3.0–6.0],P=0.001)and higher Acute Physiology and Chronic Health Evaluation(APACHE)II scores(16.0[13.0–21.0]vs.8.5[7.0–14.0],P=0.001).There was no difference in other demographic characteristics and cytokines,interleukin-6,tumor necrosis factor-α,and interleukin-10 between the two *** Th17/Treg ratio of sepsis with LOS<14 days was considerably lower(0.48[0.38–0.56]vs.0.69[0.51–0.98],P=0.001).For patients with LOS≥14 days,the area under the receiver operating characteristic curve for the Th17/Treg ratio was *** improved to 0.840 and 0.850 when combined with the SOFA and APACHE II scores,*** The Th17/Treg ratio was proportional to septic severity and can be used as a potential predictor of ICU stay in sepsis,presenting a new option for ICU practitioners to better care for patients with sepsis.

关键词： Sepsis Th17/Treg Length of stay Intensive care units

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高分子囊泡领域面临的挑战和未来研究方向

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Science China Materials 2024年第1期67卷 18-30页

作者：石隽秋孙青梅王文立李畅尹海洋李浩澜滕润鑫范震朱云卿杜建忠 Department of Gynaecology and Obstetrics Shanghai Key Laboratory of Anesthesiology and Brain Functional ModulationClinical Research Center for Anesthesiology and Perioperative MedicineTranslational Research Institute of Brain and Brain-Like IntelligenceShanghai Fourth People’s HospitalSchool of MedicineTongji UniversityShanghai 200434China Department of Polymeric Materials School of Materials Science and EngineeringTongji UniversityShanghai 201804China

作为细胞中的主要运输系统,天然囊泡在物质的定点输运过程中具有至关重要的作用.高分子囊泡是与之结构相似的一种人工囊泡,具有优异的膜稳定性和胶体稳定性、高药物负载率、低膜穿透性、优异的可修饰性和长循环时间等优势,在生物医用领... 详细信息

作为细胞中的主要运输系统,天然囊泡在物质的定点输运过程中具有至关重要的作用.高分子囊泡是与之结构相似的一种人工囊泡,具有优异的膜稳定性和胶体稳定性、高药物负载率、低膜穿透性、优异的可修饰性和长循环时间等优势,在生物医用领域具有广泛的应用前景.然而,目前该领域尚面临一系列重要挑战,如合成和制备方法较为复杂、生物相容性较难预测、功能和递送途径有限等,限制了其临床转化之路.本文从囊泡的构建模块合成、自组装技术和潜在的生物医学应用等角度,提出了设计和制备下一代高分子囊泡需要解决的五个关键科学问题,指出了未来面临的重要挑战和发展方向,例如简化设计和合成过程,优化和规范自组装过程,拓展潜在的应用前景.

关键词：生物医学应用胶体稳定性自组装技术运输系统膜稳定性输运过程穿透性高分子

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Obstructive sleep apnea-hypopnea syndrome immunological relationship

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World Journal of clinical Cases 2024年第27期12卷 6011-6014页

作者： Mahmoud Ali Alaa Ramadan Salim Surani Department of Medicine Al-Azhar UniversityDamietta 11651Egypt Department of Medicine South Valley UniversityQena 83523Egypt Department of Medicine and Pharmacology Texas A&M UniversityCollege StationTX 77843United States Department of anesthesiology Mayo ClinicRochesterMN 55905United States

Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a complex disorder cha-racterized by symptoms resulting from intermittent hypoxia and hypopnea,with research indicating a crucial role of immune system dysregulation and genetic variations in its pathogenesis.A recent Zhao et al study utilizes Mendelian ran-domization analysis to explore the causal relationship between immune cell characteristics and *** study identifies specific lymphocyte subsets as-sociated with OSAHS,providing valuable insights into the disease's pathophy-siology and potential targets for therapeutic *** findings underscore the significance of genetic and immunological factors in sleep disorders,offering a fresh perspective on OSAHS's *** to existing literature,Zhao et al's study stands out for its focus on genetic markers and specific immune responses associated with OSAHS,expanding upon previous research primarily centered on systemic *** conclusion,the study represents a signi-ficant advancement in the field,shedding light on the causal role of immune cells in OSAHS and paving the way for future research and targeted treatments.

关键词： Obstructive sleep apnea Mendelian randomization Lymphocyte charac-teristics Immunology Obstructive sleep apnea-hypopnea syndrome

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Safety of teplizumab in patients with high-risk for diabetes mellitus type 1:A systematic review

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World Journal of Diabetes 2024年第8期15卷 1793-1801页

作者： Venkata Buddhavarapu Gagandeep Dhillon Harpreet Grewal Pranjal Sharma Rahul Kashyap Salim Surani Department of Medicine Banner Baywood Medical CenterBanner HealthMesaAZ 85206United States Department of Medicine UM Baltimore Washington Medical CenterGlen BurnieMD 21061United States Department of Radiology Ascension Sacred Heart HospitalPensacolaFL 32504United States Department of Medicine Northeast Ohio Medical CenterRootstownOH 44272United States Department of Research Wellspan HealthYorkPA 17403United States anesthesiology Mayo ClinicRochesterMN 55905United States Department of Medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States

BACKGROUND The incidence of diabetes mellitus type 1(DM1)has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status.A new anti-CD4 antibody,Teplizumab,has been shown to delay the progression of DM1 and is the only medication approved for this ***,more information is needed about the safety profile of this *** To identify the odds ratios(OR)of systems-based adverse effects for Teplizumab when compared to *** An extensive systematic review was conducted from the inception of the medication until December 31,*** clinical trials and studies that evaluated Teplizumab vs placebo were included in the initial *** study protocol was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guidelines and was registered in PROSPERO(ID:CRD42024496169).Crude OR were generated using RevMan Software version *** After screening and review,5 studies were selected to determine the risk of adverse effects of teplizumab compared to placebo.A total of 561 patients were included in the study *** adverse effects and system-based adverse effects were studied and *** determined that patients receiving Teplizumab had a higher risk of developing gastrointestinal(GI)(OR=1.60,95%CI:1.01-2.52,P=0.04),dermatological(OR=6.33,95%CI:4.05-9.88,P<0.00001)and hematological adverse effects(OR=19.03,95%CI:11.09-32.66,P<0.00001).These patients were also significantly likely to have active Epstein-Barr Virus infection(OR=3.16,95%CI:1.51-6.64,P<0.002).While our data showed that patients receiving Teplizumab did have a higher incidence of total adverse effects vs placebo,this finding did not reach statistical significance(OR=2.25,95%CI:0.80-6.29,P=0.12).CONCLUSION Our systematic review suggests that Teplizumab patients are at risk for significant adverse effects,primarily related to GI,dermatological,and hematolog

关键词： Teplizumab Diabetes mellitus type 1 Adverse effects Monoclonal antibody Systematic review

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Hyperlactatemia in patients with non-acetaminophen-related acute liver failure

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World Journal of Gastroenterology 2006年第12期12卷 1949-1953页

作者： Pilar Taurá Graciela Martinez-Palli Julia Martinez-Ocon Joan Beltran Gerard Sanchez-Etayo Jaume Balust Teresa Anglada Antoni Mas Juan-Carlos Garcia-Valdecasas Department of anesthesiology Hospital ClinicBarcelonaSpain Department of Hepatology Hospital ClinicBarcelonaSpain Department of Surgery Hospital ClinicBarcelonaSpain

AIM： To characterize hyperlactatemia in patients with non-acetaminophen acute liver failure （ALF） in an attempt to clarify the mechanisms implicated and the role as a prognosis factor. METHODS： In the setting of liver transplantation, 63 consecutive patients with non-acetaminophen acute liver failure were studied in relation to tissue oxygenation, hemodynamic and metabolic parameters. Before and after transplantation, the number of infected patients and outcome were registered. RESULTS： Acute ALF showed higher levels of lactate than subacute ALF （5.4 ± 1 mmol/L versus 2.2 ± 0.6 mmol/L, P= 0.01）. Oxygenation parameters were within the normal range. Lactate levels showed good correlation with respiratory quotient （r=0.759, P〈 0.005）, mean glucose administration （r= 0.664, P= 0.01） and encephalopathy （r= 0.698, P= 0.02）, but not with splanchnic arteriovenous difference in PCO2, pH and the presence of infection （P=0.1）. Portal vein lactate was higher （P〈0.05） than arterial and mixed venous lactate, suggesting its production of hyperlactatemia in the intestine and spleen. The presence of infection was an independent predictor of survival. CONCLUSION： Hyperlactatemia is not a prognosis factor due to byproduct of the overall acceleration in glycolysis.

关键词： Hyperlactatemia Non-acetaminophen acuteliver failure Splanchnic hypoperfusion Acute liverfailure

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clinical challenges of glycemic control in the intensive care unit:A narrative review

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World Journal of clinical Cases 2022年第31期10卷 11260-11272页

作者： Roshni Sreedharan Adriana Martini Gyan Das Nida Aftab Sandeep Khanna Kurt Ruetzler anesthesiology Institute Cleveland ClinicClevelandOH 44195United States

Glucose control in patient admitted to the intensive care unit has been a topic of much debate over the past 20 *** harmful effects of uncontrolled hyperglycemia and hypoglycemia in critically ill patients is well *** a large clinical trial in 2001 demonstrated significant mortality and morbidity benefits with tight glucose control in this patient population,the results could not be replicated by other ***“Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation”trial in 2009 established that tight glucose control was not only of no benefit,but in fact harmful due to the significant risk of *** current guidelines suggest a moderate approach with the initiation of intravenous insulin therapy in critically ill patients when the blood glucose level is above 180 mg/*** most important factor that underpins glycemic management in intensive care unit patients is the consequent prevention of *** glucose monitoring strategies and insulin protocols need to be implemented in order to achieve this goal.

关键词： Diabetes management Intensive care unit anesthesiology

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Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

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World Journal of Diabetes 2021年第8期12卷 1255-1266页

作者： Ursula Galway Praveen Chahar Marc T Schmidt Jorge A Araujo-Duran Jeevan Shivakumar Alparslan Turan Kurt Ruetzler Department of General anesthesiology Anesthesiology InstituteCleveland ClinicClevelandOH 44195United States Department of Intensive Care and Resuscitation Anesthesiology InstituteCleveland ClinicClevelandOH 44195United States Department of Outcomes Research Anesthesiology InstituteCleveland ClinicClevelandOH 44195United States

Prediabetes and diabetes are important disease processes which have several perioperative *** one third of the United States population is considered to have *** prevalence in surgical patients is even *** is due to the associated micro and macrovascular complications of diabetes that result in the need for subsequent surgical procedures.A careful preoperative evaluation of diabetic patients and patients at risk for prediabetes is essential to reduce perioperative mortality and *** preoperative evaluation involves an optimization of preoperative *** also includes optimization of antidiabetic medication regimens,as the avoidance of unintentional hypoglycemic and hyperglycemic episodes during the perioperative period is *** focus of the perioperative management is to ensure euglycemia and thus improve postoperative ***,prolonged preoperative fasting should be avoided and close monitoring of blood glucose should be initiated and continued throughout *** can be accomplished with either analysis in blood gas samples,venous phlebotomy or point-of-care *** capillary and arterial whole blood glucose do not meet standard guidelines for glucose testing,they can still be used to guide insulin dosing in the operating *** glycemic control goals may vary slightly in different protocols but overall the guidelines suggest a glucose range in the operating room should be between 140 mg/dL to 180 mg/*** hyperglycemia is detected in the operating room,blood glucose management may be initiated with subcutaneous rapid-acting insulin,with intravenous infusion or boluses of regular *** and electrolyte management are other perioperative *** diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state are the two most serious acute metabolic complications of diabetes that must be recognized early and treated.

关键词： Diabetes mellitus Perioperative management Insulin Hyperglycaemia Anaesthesia Surgery

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