Efficacy and safety of endoscopic retrograde cholangiopancreatography in the very elderly by using a combination of intravenous midazolam, ketamine and pethidine

Aim The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. Methods In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged >= 80 years (Group A) and 173 patients (193 procedures) were aged <= 65 years (Group B). We analyzed the prospectively collected data of patient- and procedure-related variables. Results The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). Conclusions ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int center dot center dot; center dot center dot: center dot center dot-center dot center dot Geriatr Gerontol Int 2021; center dot center dot: center dot center dot-center dot center dot.WOS:0006873533000012-s2.0-85113207943PubMed: 3442703

Szerokość rozkładu objętości płytek i płytkokryt: nowe biomarkery zawału serca z uniesieniem odcinka ST u młodych pacjentów

Background: Platelets play a central role in myocardial infarction, and platelet activity can be evaluated with platelet indices, including platelet distribution width (PDW) and plateletcrit (PCT). These indices have been demonstrated as markers of prothrombotic state in cardiovascular diseases. Aim: Therefore, we aimed to investigate, the usefulness of these biomarkers in ST-elevation myocardial infarction (STEMI) in young patients. Methods: This cross-sectional study consisted of 565 subjects who were classified into three groups: group 1 (168 young patients with STEMI), group 2 (173 non-young patients with STEMI), and group 3 (224 age-matched controls with angiographically normal coronary arteries). Male patients aged under 45 years and female patients aged under 55 years were defined as young STEMI. Results: In group 1, PDW and PCT (17.2 ± 0.67, 0.249 ± 0.05, respectively) were significantly higher than the other groups (group 2, 16.4 ± 0.56, 0.231 ± 0.04; group 3, 15.1 ± 0.63, 0.227 ± 0.04). PDW and PCT had moderate negative correlation (r = –0.305, r = –0.330, respectively) with age and moderate positive correlation with peak creatine kinase MB (r = 0.259, r = 0.320, respectively). At multivariate analysis, adjusted for other factors, 1 fL increase in PDW levels was 13.5% more likely to be associated with young STEMI, and similarly, a 1% increase in PCT levels was 18.9% more likely associated with young STEMI. Conclusions: Platelet distribution width and plateletcrit levels seem to be independent markers of STEMI in young patients and may reflect prothrombotic state in this specific population.Wstęp: Płytki krwi odgrywają podstawową rolę w zawale serca, a ich aktywność można ocenić na podstawie wskaźników płytkowych, takich jak wskaźnik rozpiętości rozkładu objętości płytek (PDW) i płytkokryt (PCT). Wykazano, że wskaźniki te są markerami stanu prozakrzepowego w chorobach sercowo-naczyniowych. Cel: Celem pracy było zbadanie użyteczności tych wskaźników w zawale serca z uniesieniem odcinka ST (STEMI) u młodych pacjentów. Metody: W tym przekrojowym badaniu uczestniczyło 565 osób, które podzielono na trzy grupy: grupa 1 — 168 młodych pacjentów ze STEMI, grupa 2 — 173 starszych chorych ze STEMI i grupa 3 — 224 dopasowanych pod względem wieku osób z prawidłowym obrazem tętnic wieńcowych w koronarografii (grupa kontrolna). Za młodych pacjentów ze STEMI uznawano mężczyzn w wieku poniżej 45 lat i kobiety poniżej 55 lat. Wyniki: W grupie 1 wartości PDW i PCT (odpowiednio 17,2 ± 0,67; 0,249 ± 0,05) były istotnie wyższe niż w innych grupach (odpowiednio grupa 2: 16,4 ± 0,56; 0,231 ± 0,04; grupa 3: 15,1 ± 0,63; 0,227 ± 0,04). Wskaźniki PDW i PCT wykazywały umiarkowanie silną ujemną korelację (odpowiednio r = –0,305 i r = –0,330) z wiekiem i umiarkowanie silną dodatnią korelację z maksymalnym stężeniem frakcji MB kinazy kreatynowej (odpowiednio r = 0,259; r = 0,320). W analizie wieloczynnikowej, po skorygowaniu względem innych zmiennych, wykazano, że zwiększenie o 1 fl wartości PDW wiązało się z większym o 13,5% prawdopodobieństwem zawału w młodym wieku. Podobnie przy 1-procentowym wzroście wartości PCT prawdopodobieństwo STEMI u młodych osób zwiększało się o 18,9%. Wnioski: Wskaźniki PDW i PCT są niezależnymi markerami STEMI u młodych osób i mogą być wyznacznikiem stanu prozakrzepowego w tej szczególnej populacji pacjentów.

Magnetic Field Distributions inside Magnetically Driven Nanofluids for Thermal Management of CPUs

Herein a magnetic actuation strategy is proposed to manipulate magnetic nanofluids in CPU thermal management applications. The proposed concept consists of a multi-circular microchannel unit and a rotating permanent magnet. A set of numerical simulations have been carried out to evaluate the influences of (i) magnet diameter, (ii) distance between the magnet and the microchannel, and (iii) shape of the magnet on magnetic flux densities (MFD) inside microchannels with Fe3O4 magnetic nanofluid. The results indicated that the MFD on the magnetic nanofluid significantly varies along with the radial position within the microchannel

Efficacy of Epinephrine Injection in Preventing Post-ERCP Pancreatitis

Background: Rectal indomethacin or a topical spray of epinephrine to the papilla of Vater has each shown efficacy alone in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We supposed that a submucosal epinephrine injection would be more effective and longer acting than a topical epinephrine spray and therefore would further reduce the incidence of PEP. Patients and Methods: A retrospective analysis was conducted of 412 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2017 and December 2019. These patients were divided into 2 groups: the indomethacin group and the indomethacin plus the submucosal epinephrine injection group. The incidence rates and severity of PEP, post-ERCP hyperamylasemia, other outcomes, and any other adverse events were compared between the groups. Results: Baseline demographic and clinical characteristics and procedure-related parameters were similar between the 2 groups. The incidence of PEP was 0.4% in the epinephrine group compared with 5.1% in the indomethacin group (P <0.001). Post-ERCP hyperamylasemia occurred in 24.6% of patients in the indomethacin group, whereas 7.6% of patients in the epinephrine group developed this condition; the difference was significant (P <0.001). Postsphincterotomy bleeding occurred in 5 patients, all of whom were in the indomethacin group (P < 0.001). Other adverse events, including arrhythmias, acute coronary events, stroke, or hypertension were not significantly different between the 2 groups. Conclusion: Addition of a submucosal epinephrine injection in conjunction with rectal indomethacin significantly reduced the incidence of PEP, post-ERCP hyperamylasemia, and post-sphincterotomy bleeding.WOS:0006477597000162-s2.0-8510368338

Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease

Background. Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease. Methods. This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality. Results. During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 +/- 1.6 g/dL vs. 13.7 +/- 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 +/- 8.4 years vs. 68.6 +/- 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 +/- 85.6 and 126.8 +/- 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis. Conclusion. In our study, higher PLR was associated with increased all-cause mortality

Exogenous ATP administration prevents ischemia/reperfusion-induced oxidative stress and tissue injury by modulation of hypoxanthine metabolic pathway in rat ovary

Gul, Mehmet Ali/0000-0002-5849-0116; Cetin, Nihal/0000-0003-3233-8009; Gul, Mehmet Ali/0000-0002-5849-0116; AKSOY, Ayse Nur/0000-0002-3793-9797WOS: 000339538600020In this study, xanthine oxidase (XO), malondialdehyde (MDA), myeloperoxidase (MPO) and glutathione (GSH) levels in the ovarian tissues of rats during the development of ischemia and postischemia-induced reperfusion were investigated, and the effect of ATP on ischemia-reperfusion (I/R) damage was biochemically and histopathologically examined. the results of the biochemical analyses demonstrated that ATP significantly reduced the level of XO and MDA and increased the amount of GSH in both ischemia and I/R-applied ovarian tissue at the doses administered. Furthermore, ATP significantly suppressed the increase in MPO activity that occurred following the application of post ischemia reperfusion in the ovarian tissue. the biochemical results obtained in the present study coincide with the histological findings. the severity of the pathological findings, such as dilatation, congestion, haemorrhage, oedema and polymorphonuclear nuclear leukocytes (PMNLs), increased in parallel with the increase observed in the products of XO metabolism. in conclusion, exogenously applied ATP prevented I/R damage by reducing the formation of XO in ischemic ovarian tissue