Identifying the preventive cellular mechanisms of memory decline after surgery

Memory and cognitive decline following surgery pose a major threat to the ageing population. Postoperative memory decline (POCD) has potentially devastating consequences due to its detrimental effects on quality of life and increased level of dependence. Acute neuroinflammatory changes after non-neurosurgical procedures have been linked to memory decline. Inflammation is the reflection of ongoing intracellular processes precipitated by stress following major insults such as surgery. I hypothesised that POCD is caused by an imbalance of cytoprotective mechanisms secondary to an inadequate physiological response to physiological stress. I set out to identify: 1) how memory is impaired in murine surgical models, using wild type and two genetically modified mouse lines, involving membrane danger receptors, purinergic receptor, ion gated channel 7 (P2X7) gene knockouts and the cytoplasmic chaperone heat shockprotein-72 (Hsp72), Hsp72 overexpressors, and 20 the effect of xenon anaesthesia and atorvastatin on memory decline following surgery. The inflammatory response was modelled by using multivariable analysis software (SIMCA) to identify a physiological signature, and the flow cytometry (FACS) technique of multiple cell-type responses within the hippocampus was optimised. The lack of P2X7 receptors could not prevent the development of POCD after tibial facture surgery under general anaesthesia. Over expression of Hsp72 proved to prevent POCD and its effect was associated with reduced microglia activation. Pretreatment with xenon and atorvastatin also prevented the development of POCD. In conclusion, SIMCA and FACS are potentially useful complementary methods for assessment of inflammation. P2X7 could not be proven to be involved in the development of POCD while the role of Hsp72 in POCD was proved and the prevention of POCD by using xenon through this mechanisms and atorvastatin by ameliorating the inflammatory response

A cohort study on detecting delirium using 4 ‘A’s Test in a London, UK, hospital

Delirium is a common neuropsychiatric disorder in hospitalised older adults. Often unrecognized, delirium is associated with increased morbidity and mortality, length of hospital stay, institutionalisation and costs to healthcare providers. The objective of this prospective cohort study was to detect the prevalence of delirium in a London (UK) hospital testing the feasibility and reliability of the 4 A's Test (4AT). Over a seven day period 174 inpatients were assessed by non-psychiatrically trained doctors using the 4AT and three widely adopted screening tools. The 4AT helped detect 21 (10.2%) delirious patients uncovering a delirium prevalence of 8.63 per 1000 hospital days. The 4AT showed a compatibility of 75% with other tools used. Changes in consciousness are often missed, but can be easily detected introducing a screening tool as the 4AT

Perioperative research into memory (PRiMe), part 2:Adult burns intensive care patients show altered structure and function of the default mode network

BACKGROUND: Long-term cognitive impairment (LTCI) is experienced by up to two thirds of patients discharged from burns intensive care units (BICUs), however little is known about its neurobiological basis. This study investigated if patients previously admitted to BICU showed structural and functional MRI changes of the Default Mode Network (DMN).METHODS: Fifteen patients previously admitted to BICU with a significant burns injury, and 15 matched volunteers, underwent structural and functional MRI scans. Functional connectivity, fractional anisotropy and cortical thickness of the main DMN subdivisions (anterior DMN (aDMN), posterior DMN (pDMN) and right (rTPJ) and left (lTPJ) temporo-parietal junctions) were compared between patients and volunteers, with differences correlated against cognitive performance.RESULTS: Functional connectivity between rTPJ and pDMN (t = 2.91, p = 0.011) and between rTPJ and lTPJ (t = 3.18, p = 0.008) was lower in patients compared to volunteers. Functional connectivity between rTPJ and pDMN correlated with cognitive performance (r 2 =0.33, p &lt; 0.001). Mean fractional anisotropy of rTPJ (t = 2.70, p = 0.008) and lTPJ (T = 2.39, p = 0.015) was lower in patients but there was no difference in cortical thickness. CONCLUSIONS: Patients previously admitted to BICU show structural and functional disruption of the DMN. Since functional changes correlate with cognitive performance, this should direct further research into intensive-care-related cognitive impairment.</p

Perioperative research into memory (PRiMe), part 2: Adult burns intensive care patients show altered structure and function of the default mode network

Background: Long-term cognitive impairment (LTCI) is experienced by up to two thirds of patients discharged from Burns Intensive Care Units (BICU), however little is known about its neurobiological basis. This study investigated if patients previously admitted to BICU showed structural and functional MRI changes of the Default Mode Network (DMN). Methods: Fifteen patients previously admitted to BICU with a significant burns injury, and 15 matched volunteers, underwent structural and functional MRI scans. Functional connectivity, fractional anisotropy and cortical thickness of the main DMN subdivisions (anterior DMN (aDMN), posterior DMN (pDMN) and right (rTPJ) and left (lTPJ) temporo-parietal junctions) were compared between patients and volunteers, with differences correlated against cognitive performance. Results: Functional connectivity between rTPJ and pDMN (t = 2.91, p = 0.011) and between rTPJ and lTPJ (t = 3.18, p = 0.008) was lower in patients compared to volunteers. Functional connectivity between rTPJ and pDMN correlated with cognitive performance (r2 =0.33, p < 0.001). Mean fractional anisotropy of rTPJ (t = 2.70, p = 0.008) and lTPJ (T = 2.39, p = 0.015) was lower in patients but there was no difference in cortical thickness. Conclusions: Patients previously admitted to BICU show structural and functional disruption of the DMN. Since functional changes correlate with cognitive performance, this should direct further research into intensive care related cognitive impairment

First report of Echinococcus vogeli in a paca in Misiones province, Argentina

Se presenta el primer hallazgo de Echinococcus vogeli en una paca (Cuniculus paca) del bosque tropical de Misiones, norte argentino. Se confirmó también la presencia de su único hospedador natural definitivo conocido, el perro silvestre (Speothos venaticus). Las hidátides poliquísticas, de 2-3 cm de diámetro, se encontraron solo en el hígado de una paca adulta. El rango promedio del largo de los ganchos y la proporción relativa hoja/ mango no mostraron diferencias significativas con respecto a lo ya afirmado para E. vogeli. Los ganchos de E. granulosus, medidos como comparación, fueron significativamente más pequeños (p < 0,0001). Estos resultados confirmaron la presencia de E. vogeli en Argentina. La probabilidad de encontrar equinococosis neotropical en el hombre refuerza la importancia de determinar la distribución de E. vogeli en la Argentina. La equinococosis causada por E. vogeli es muy agresiva y puede producir mortalidad hasta en un tercio de la población humana afectada.We report the first finding of Echinococcus vogeli in a paca, Cuniculus paca, in the tropical forest of Misiones, in the north of Argentina. The presence of the bush dog, Speothos venaticus, E. vogeli´s only natural definitive host, was also reported. The polycystic hydatids, 2 to 3 cm in diameter, were only found in the liver of an adult paca. The size range of the hooks and the relative proportion blade/handle did not show significant differences with respect to the ones reported for E. vogeli. The size of E. granulosus hooks, measured for comparison purposes, was significantly smaller (p < 0.0001). These results confirmed the presence of E. vogeli in Argentina. The probability of finding neotropical echinococcosis in humans reinforces the need to expand the search for E. vogeli in Argentina. Echinococcosis due to E. vogeli is very aggressive and may cause death in about a third of the human population affected.EEA Cerro AzulFil: Vizcaychipi, Katherina A.. Ciudad Autónoma de Buenos Aires. INEI-ANLIS «Dr. Carlos G. Malbrán»; ArgentinaFil: Helou, Marcia. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Cerro Azul; ArgentinaFil: Dematteo, Karen. University of Missouri. Department of Biology; Estados UnidosFil: Macchiaroli, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas . Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: Cucher, Marcela Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas . Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: Rosenzvit, Mara Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas . Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: D'Alessandro, Antonio. University of Tulane. Department Tropical Medicine; Estados Unido

A survey of the workload generated by older surgical patients referred to on-call medical registrars—SNAP-3

BackgroundOlder surgical patients who develop medical problems are commonly referred to medical teams, which can be proactive physician-led teams or through reactive referral to the on-call medical registrar.MethodsA cross-sectional survey of on-call medical registrars who received referrals from surgical teams was conducted in March–June 2022 at 140 NHS hospitals. It focused on the workload derived from referrals of older surgical patients to on-call medical registrars, excluding referrals to existing services such as perioperative medicine, orthogeriatric, or medical specialty teams. To minimise recall bias, completion of the survey was encouraged regardless of whether a registrar had received a referral. The aim of this survey was to estimate the unplanned, acute workload generated by older surgical patients requiring referral to on-call medical registrars. The survey also aimed to estimate the prevalence and nature of training in perioperative medicine amongst medical registrars.ResultsDuring an on-call shift, 41.3% (266/644) of medical registrars received at least one referral regarding an older surgical patient. The commonest indications were arrhythmia, acute respiratory problems, electrolyte abnormalities, suspected myocardial infarction, sepsis, and delirium. Three-quarters of registrars reported not receiving training in perioperative management of older patients.ConclusionsThe findings highlight the significant workload and training gaps faced by medical registrars in managing older surgical patients. Bridging the gap between national recommendations and local services may reduce demands on on-call registrars and improve care

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat