Measuring serum and drainage fluid interleukin-6 and tumor necrosis factor-α levels for early detection of infectious complications after minimally invasive surgery for gastric cancer

Itami T., Kurokawa Y., Yoshioka R., et al. Measuring serum and drainage fluid interleukin-6 and tumor necrosis factor-α levels for early detection of infectious complications after minimally invasive surgery for gastric cancer. European Journal of Surgical Oncology 50, 108564 (2024); https://doi.org/10.1016/j.ejso.2024.108564.Objective: Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) are inflammatory cytokines produced in response to biological invasion or infection. Their levels are elevated in the blood and locally. We examined whether measuring IL-6 and TNF-α levels in serum or drainage fluid on postoperative day (POD) 1 could detect infectious complications after minimally invasive surgery for gastric cancer. Methods: This cohort study included 205 consecutive patients who underwent laparoscopic or robot-assisted gastrectomy for gastric cancer between November 2020 and July 2023. We measured serum and drainage fluid IL-6 and TNF-α levels on POD 1 after gastrectomy. Receiver operating characteristic (ROC) curves were created to compare the diagnostic values of each cytokine and serum C-reactive protein levels for detecting postoperative infectious complications. Results: IL-6 and TNF-α levels in the serum or drainage fluid were significantly higher in patients with an infectious complication. In addition, drainage fluid IL-6 levels were significantly different in patients with versus without intra-abdominal abscess. In the ROC curve analysis, serum and drainage fluid IL-6 had the highest AUC values for any infectious complication and intra-abdominal abscess, respectively. POD 1 serum IL-6 level above 47 pg/mL could detect any infectious complication with sensitivity of 74.1 % and specificity of 71.8 %. POD 1 drainage fluid IL-6 level above 14,750 pg/mL had 100 % sensitivity for detecting intra-abdominal abscess with specificity of 56.0 %. Conclusions: Measurement of IL-6 levels in blood and drainage fluid on POD 1 is valuable for early detection of postoperative infectious complications or intra-abdominal abscess after gastric cancer surgery

The relation between subjective symptom and circulation during orthostatic stress using a tilt table

起立負荷時における気分不良の有無と体循環,脳循環との関係について検討することを目的とし,電動チルト台を用いて起立負荷を行った.対象者は20代の自律神経疾患を有さない健常女性12名とし,起立負荷によって気分不良を示さなかった群を正常群とし,示した群を気分不良群とした.電動tilt tableを0°→ 30°→ 45°→ 60°→ 0°と変化させ,各段階を約3分ずつ保持した.その際,平均動脈血圧(MBP),心拍出量,心拍数,1回拍出量,総末梢血管抵抗,腓腹筋内側頭部のTotal Hb,中大脳動脈の平均血流速度(FV)と末梢血管抵抗(PI)を測定し,気分不良尺度を10段階評価でもって記録した.その結果,正常群は起立負荷に伴いFVは低下を示したが,MBP,PIに著変はなく,気分不良群はMBPの上昇に対してPIは減少し,FVはほぼ変化はみられなかった.一般的にめまいなどの気分不良症状は脳血流量の減少により生じるとされていたが,今回の結果では気分不良には脳血流量の増加による脳細動脈へのストレスなどが考えられた.This study aimed at considering the relation between subjective symptoms and the circulation of healthy women during orthostatic stress using a tilt table. From 12 healthy women in there twenties who don't have autonomic nervous disorders, two groups were formed: 1) a normal group which didn't feel ill during orthostatic stress, and 2) a FI group which feel ill during orthostatic stress. An electric tilt table was changed from 0°→30°→45°→60°→0°, and each stage was held for about 3 minutes. Mean artery blood pressure (MBP), cardiac output, heart rate, stroke volume, total peripheral resistance and total hemoglobin at the part of interior gastrocnemius (Total Hb), flow velocity (FV) and peripheral resistance (PI) of the middle cerebral artery (MCA) were measured. The scale of poor feeling was also recorded by10 stage evaluations. Consequently, although the normal group showed an FV fall with orthostatic stress,there were no significant changes in MBP and PI. In the FI group, PI decreased but FV didn't show muchchange with the rise of MBP. According to this result, the stress to the arteriola caused not by a fall but anincrease in the cerebral blood flows etc. seems thus to have been the source of the feeling

慢性閉塞性肺疾患における呼吸リハビリテーションの重要性と現状 <総説>

慢性閉塞性肺疾患(chronic obstructive pulmonary disease : COPD)はタバコ煙などに含まれる有害物質を長期に吸入することにより生じる炎症性肺疾患であり,気流閉塞と動的肺過膨張による労作時呼吸困難を特徴とする.中等症以上のCOPDが呼吸リハビリテーションの適応となる.特に運動療法は呼吸困難を軽減し運動耐容能やquality of life(QOL)を改善し,薬物療法への上乗せの改善効果を有する.呼吸リハビリテーションを広く普及させ,包括的に行うためには,多職種の連携および教育が重要である