306 research outputs found
ERAS in Cardiac Surgery: Wishful Thinking or Reality
Enhanced recovery after cardiac surgery (ERACS) is a multi-disciplinary approach to improve patient outcomes and reduce complications following cardiac surgery. The aim of ERACS protocol is to optimize pre-operative preparation, reduce surgical trauma, and minimize post-operative stress.The protocol has been shown to improve patient outcomes, including shorter hospital stays, lower rates of complications, and faster return to normal activities. It is important to note that ERACS is a multi-disciplinary approach, and requires close collaboration between surgeons, anaesthesiologists, nurses, and other healthcare professionals to ensure successful implementation. Anaesthesiologists play a crucial role in the ERACS protocol, as they are responsible for the management of the patient’s anaesthesia and pain management during and after surgery. In this paper provide an overview of the ERACS protocol from the perspective of an anaesthesiologist
Cytosorb® haemoadsorption: a potential game changer for patients needing myocardial surgical revascularisation
Cytosorb, an extracorporeal blood purification system, utilises the principles of haemoadsorption to remove low molecular weight substances from the blood, including multiple cytokines such as interleukin (IL)-1b, IL-6, IL-8, and tumour necrosis factor-α, and anti-platelet drugs aiming to improve clinical outcomes. Given the prominent role of pro-inflammatory cytokines in various inflammatory states, Cytosorb has seen growing application as a therapeutic immunomodulator including surgery. This review focuses on the effects of the use of Cytosorb in patients undergoing coronary artery bypass grafting (CABG) and the indications of removal of cytokines and anti-platelet agents such as ticagrelor. The evidence supports the feasibility and safety profile of Cytosorb, with no device-related adverse events reported in all studies. Initial studies suggest significant potential for Cytosorb in urgent or emergency CABG surgery to remove anti-platelet medication with promising benefits on clinical outcomes including fewer blood product transfusions, decreased length of intensive care unit stay, and lower re-sternotomy rates. Furthermore, a cost saving analysis indicated that intraoperative removal of ticagrelor with Cytosorb would be cost effective in the setting of emergency cardiac surgery. However, the evidence remains inconclusive when Cytosorb is used in elective CABG surgery for cytokine removal. Definite high quality clinical trials for both indications for Cytosorb in CABG surgery are needed to clarify if there is a clinically significant benefit in clinical outcomes. There is substantial trial activity for the application of Cytosorb in higher risk cardiac surgery to establish the place of Cytosorb in future treatment pathways in cardiac surgery
A sertéságazat helyzetének bemutatása (jövedelmezőség, hatékonyság)
Jelen tanulmányban a sertĂ©ságazat piaci helyzetĂ©t Ă©s jövedelemtermelĹ‘ kĂ©pessĂ©gĂ©t vizsgáltuk, ehhez kapcsolĂłdĂłan jártuk körbe az ágazatot. Az ágazati körkĂ©p után a sertĂ©startás jövedelemtermelĹ‘ kĂ©pessĂ©gĂ©nek bemutatására egy „jĂł szĂnvonalĂş termelĂ©si gyakorlatot” kĂvántunk modellezni. Az EredmĂ©nyek között bemutatásra kerĂĽlt, hogy mi jellemzi a naturális ráfordĂtásokat, a termelĂ©si költsĂ©geket, valamint ezek szerkezetĂ©t Ă©s összetĂ©telĂ©t. MegállapĂtásra kerĂĽlt, hogy a sertĂ©shĂşs előállĂtás összes költsĂ©gĂ©nek körĂĽlbelĂĽl kĂ©tharmadát a takarmányozási költsĂ©gek teszik ki, Ăgy itt a költsĂ©ghatĂ©konyság javĂtása alapvetĹ‘ gazdasági cĂ©l. A termelĂ©s legfĹ‘bb nehĂ©zsĂ©ge a folyamatosan változĂł felvásárlási ár, amely alapvetĹ‘en meghatározza, hogy az adott vállalkozás nyeresĂ©get vagy vesztesĂ©get realizál. Az adatokbĂłl levezettĂĽk, hogy adott körĂĽlmĂ©nyek között hogyan alakulna egy virtuális ĂĽzem árbevĂ©tele, Ă©s megállapĂtásra kerĂĽlt, hogy a jelenlegi piaci árak mellett támogatás nĂ©lkĂĽl nem lehet a sertĂ©ságazatban jövedelmet elĂ©rni, a virtuális ĂĽzem kizárĂłlag az ágazati támogatásnak köszönhetĹ‘en tudott nyeresĂ©get realizálni. VĂ©gezetĂĽl kereszttábla elemzĂ©sekkel szemlĂ©ltettĂĽk, hogyan befolyásolja a termelĂ©s hatĂ©konyságát Ă©s gazdaságosságát a takarmány ára Ă©s a hĂzĂł Ă©rtĂ©kesĂtĂ©si ára, illetve a takarmány ára Ă©s a takarmányozási egyĂĽtthatĂł. Azt a megállapĂtást tehetjĂĽk, hogy a virtuális ĂĽzemĂĽnk nehĂ©z helyzetben van, ugyanis ha a fajlagos takarmányhasznosĂtás minimálisan emelkedik (cp), vagy a takarmányárak növekednek (cp), mindkĂ©t esetben vesztesĂ©get realizál az ĂĽzem kĂĽlön-kĂĽlön is. A jelenlegi takarmányárak mellett Ă©rdemes fontolĂłra venni, hogy milyen kompromisszumot kötĂĽnk azzal kapcsolatban, hogy teljes mĂ©rtĂ©kben az adott genetika igĂ©nyeit kĂvánjuk kielĂ©gĂteni, ezzel akár magas szĂnvonalĂş takarmányhasznosulási Ă©s jĂł hĂşsminĹ‘sĂ©gi mutatĂłkat elĂ©rve, vagy olcsĂłbb takarmányokat etetĂĽnk, amely a naturális mutatĂłkat ronthatja, azonban költsĂ©ghatĂ©konyságban kedvezĹ‘bb szintet tudunk elĂ©rni
Volatile organic compound profiling to explore primary graft dysfunction after lung transplantation
Primary graft dysfunction (PGD) is a major determinant of morbidity and mortality following lung transplantation. Delineating basic mechanisms and molecular signatures of PGD remain a fundamental challenge. This pilot study examines if the pulmonary volatile organic compound (VOC) spectrum relate to PGD and postoperative outcomes. The VOC profiles of 58 bronchoalveolar lavage fluid (BALF) and blind bronchial aspirate samples from 35 transplant patients were extracted using solid-phase-microextraction and analyzed with comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry. The support vector machine algorithm was used to identify VOCs that could differentiate patients with severe from lower grade PGD. Using 20 statistically significant VOCs from the sample headspace collected immediately after transplantation (\u3c 6 h), severe PGD was differentiable from low PGD with an AUROC of 0.90 and an accuracy of 0.83 on test set samples. The model was somewhat effective for later time points with an AUROC of 0.80. Three major chemical classes in the model were dominated by alkylated hydrocarbons, linear hydrocarbons, and aldehydes in severe PGD samples. These VOCs may have important clinical and mechanistic implications, therefore large-scale study and potential translation to breath analysis is recommended
The role of interleukin-1β as a predictive biomarker and potential therapeutic target during clinical ex vivo lung perfusion
BACKGROUND: Extended criteria donor lungs deemed unsuitable for immediate transplantation can be reconditioned using ex vivo lung perfusion (EVLP). Objective identification of which donor lungs can be successfully reconditioned and will function well post-operatively has not been established. This study assessed the predictive value of markers of inflammation and tissue injury in donor lungs undergoing EVLP as part of the DEVELOP-UK study. METHODS: Longitudinal samples of perfusate, bronchoalveolar lavage, and tissue from 42 human donor lungs undergoing clinical EVLP assessments were analyzed for markers of inflammation and tissue injury. Levels were compared according to EVLP success and post-transplant outcomes. Neutrophil adhesion to human pulmonary microvascular endothelial cells (HPMECs) conditioned with perfusates from EVLP assessments was investigated on a microfluidic platform. RESULTS: The most effective markers to differentiate between in-hospital survival and non-survival post-transplant were perfusate interleukin (IL)-1β (area under the curve = 1.00, p = 0.002) and tumor necrosis factor-α (area under the curve = 0.95, p = 0.006) after 30 minutes of EVLP. IL-1β levels in perfusate correlated with upregulation of intracellular adhesion molecule-1 in donor lung vasculature (R(2) = 0.68, p < 0.001) and to a lesser degree upregulation of intracellular adhesion molecule-1 (R(2) = 0.30, p = 0.001) and E-selectin (R(2) = 0.29, p = 0.001) in conditioned HPMECs and neutrophil adhesion to conditioned HPMECs (R(2) = 0.33, p < 0.001). Neutralization of IL-1β in perfusate effectively inhibited neutrophil adhesion to conditioned HPMECs (91% reduction, p = 0.002). CONCLUSIONS: Donor lungs develop a detectable and discriminatory pro-inflammatory signature in perfusate during EVLP. Blocking the IL-1β pathway during EVLP may reduce endothelial activation and subsequent neutrophil adhesion on reperfusion; this requires further investigation in vivo
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