Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs

398 Rifaximin Displays a Protective Activity in Experimental Enteropathy Induced by Indomethacin in Rats

Introduction. Nonsteroidal anti-inflammatory drugs, besides exerting detrimental effects on the upper digestive tract, can also damage the small and large intestine. Although the underlying mechanisms remain unclear, there is evidence that enteric bacteria play a pivotal role. On this basis, the present study examined the entero-protective effects of rifaximin, a poorly absorbed antibiotic with a broad spectrum of antibacterial activity, in a rat model of indomethacin (IND)-induced enteropathy. Methods. Enteropathy was induced in 40-weekold male rats by intragastric (i.g.) IND administration (1.5 mg/kg BID) for 14 days. A delayed-release formulation of rifaximin (REIR, 50 mg/kg BID, i.g.) was administered 1 hour before IND. Subgroups of rats treated with IND or REIR+IND also received omeprazole (OME, 0.7 mg/kg OD, i.g.), as inhibitor of gastric acid secretion. At the end of treatments, blood samples were collected to evaluate hemoglobin (Hb) concentration (as an index of digestive bleeding). Small intestine was excised and processed for: 1) histological assessment of intestinal damage (percentage length of lesions over the total length examined); 2) assay of tissue myeloperoxidase (MPO) levels, as an index of neutrophil infiltration; 3) assay of tissue malondialdehyde (MDA) concentration, as an index of lipid peroxidation. Results. Rats treated with IND displayed a 13.3% mortality rate, while in groups treated with REIR+IND or OME+IND the mortality rate was lower (8.3% and 6.7%, respectively). No deaths were observed in controls or animals treated with OME+REIR+IND. IND treatment significantly decreased Hb levels (by 28%). While OME did not affect the Hb decrease, it was significantly lessened in rats treated with REIR+IND or OME+REIR+IND. IND treatment was associated with the occurrence of lesions in the jejunum and ileum. In both intestinal regions of rats treated with REIR+IND or OME+REIR+IND the percentage of lesions was significantly lower, as compared with rats receiving IND alone. The severity of lesions elicited by IND was reduced by co-treatment with OME in the jejunum, but not in the ileum. MPO and MDA levels in jejunum and ileum from IND-treated rats were significantly increased, as compared with controls. While OME was unable to affect these parameters, in rats treated with REIR+IND or OME+REIR+IND, MPO and MDA levels were not significantly different from those observed in controls. Results obtained are summarized in the enclosed Table. Conclusion. REIR treatment significantly prevents IND-induced intestinal damage, this entero-protective effect being associated with a decrease in tissue inflammation, oxidative stress and digestive bleeding. Administration of OME does not appear to affect the parameters related to intestinal damage, with few minor exceptions

Small bowel protection against NSAID-injury in rats: Effect of rifaximin, a poorly absorbed, GI targeted, antibiotic

Nonsteroidal anti-inflammatory drugs, besides exerting detrimental effects on the upper digestive tract, can also damage the small and large intestine. Although the underlying mechanisms remain unclear, there is evidence that enteric bacteria play a pivotal role. The present study examined the enteroprotective effects of a delayed-release formulation of rifaximin-EIR (R-EIR, 50mg/kg BID, i.g.), a poorly absorbed antibiotic with a broad spectrum of antibacterial activity, in a rat model of enteropathy induced by indomethacin (IND, 1.5mg/kg BID for 14 days) administration. R-EIR was administered starting 7 days before or in concomitance with IND administration. At the end of treatments, blood samples were collected to evaluate hemoglobin (Hb) concentration (as an index of digestive bleeding). Small intestine was processed for: (1) histological assessment of intestinal damage (percentage length of lesions over the total length examined); (2) assay of tissue myeloperoxidase (MPO) and TNF levels, as markers of inflammation; (3) assay of tissue malondialdehyde (MDA) and protein carbonyl concentrations, as an index of lipid and protein peroxidation, respectively; (4) evaluation of the major bacterial phyla. IND significantly decreased Hb levels, this effect being significantly blunted by R-EIR. IND also induced the occurrence of lesions in the jejunum and ileum. In both intestinal regions, R-EIR significantly reduced the percentage of lesions, as compared with rats receiving IND alone. Either the markers of inflammation and tissue peroxidation were significantly increased in jejunum and ileum from IND-treated rats. However, in rats treated with R-EIR, these parameters were not significantly different from those observed in controls. R-EIR was also able to counterbalance the increase in Proteobacteria and Firmicutes abundance induced by INDO. To summarize, R-EIR treatment significantly prevents IND-induced intestinal damage, this enteroprotective effect being associated with a decrease in tissue inflammation, oxidative stress and digestive bleeding as well as reversal of NSAID-induced alterations in bacterial population

Accuracy of Preoperative Lung Ultrasound Score for the prediction of Major Adverse Cardiac Events in elderly patients undergoing HIP Surgery under Spinal Anesthesia: the LUSHIP multicenter observational prospective study

Background and objective: We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA). Methods: Prospective, observational multicenter study of 11 Italian hospitals on patients aged >65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy. Results: A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 vs. 4.97 ± 4.90 (p < 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (p < 0.001), MICA scores (p = 0.001) and ASA classes (p < 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55-9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, p < 0.001. Conclusions: The preoperative LUS score, with its high negative predictive value, could improve patients' risk stratification when used alone or add further value to the RCRI score. Registration: Registered at clinicaltrials.gov as NCT04074876