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[PMID]: 25138203
[Au] Autor:Chapman DG; Irvin CG; Kaminsky DA; Forgione PM; Bates JH; Dixon AE
[Ad] Address:Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA.
[Ti] Title:Influence of distinct asthma phenotypes on lung function following weight loss in the obese.
[So] Source:Respirology;19(8):1170-7, 2014 Nov.
[Is] ISSN:1440-1843
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:BACKGROUND AND OBJECTIVE: There appears to be two distinct clinical phenotypes of obese patients with asthma-those with early-onset asthma and high serum IgE (TH 2-high), and those with late-onset asthma and low serum IgE (TH 2-low). The aim of the present study was to determine in the two phenotypes of obese asthma the effect of weight loss on small airway function. METHODS: TH 2-low (n = 8) and TH 2-high (n = 5) obese asthmatics underwent methacholine challenge before and 12 months following bariatric surgery. Dose-response slopes as measures of sensitivity to airway closure and narrowing were measured as maximum % fall forced vital capacity (FVC) and forced expiratory volume in 1 s/FVC, respectively, divided by dose. Resting airway mechanics were measured by forced oscillation technique. RESULTS: Weight loss reduced sensitivity to airway closure in TH 2-low but not TH 2-high obese asthmatics (pre-post mean change ± 95% confidence interval: 1.8 ± 0.8 doubling doses vs -0.3 ± 1.7 doubling doses, P = 0.04). However, there was no effect of weight loss on the sensitivity to airway narrowing in either group (P = 0.8, TH 2-low: 0.8 ± 1.0 doubling doses, TH 2-high: -1.1 ± 2.5 doubling doses). In contrast, respiratory resistance (20 Hz) improved in TH 2-high but not in TH 2-low obese asthmatics (pre-post change median interquartile range: 1.5 (1.3-2.8) cmH2 O/L/s vs 0.6 (-1.8-0.8) cmH2 O/L/s, P = 0.03). CONCLUSIONS: TH 2-low obese asthmatics appear to be characterized by increased small airway responsiveness and abnormalities in resting airway function that may persist following weight loss. However, this was not the case for TH 2-high obese asthmatics, highlighting the complex interplay between IgE status and asthma pathophysiology in obesity.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1111/resp.12368

  2 / 1408730 MEDLINE  
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[PMID]: 24748474
[Au] Autor:Miller GD; Norris A; Fernandez A
[Ad] Address:Department of Health and Exercise Science, Wake Forest University, Box 7868 Reynolda Station, Winston-Salem, NC, 27109, USA, millergd@wfu.edu.
[Ti] Title:Changes in Nutrients and Food Groups Intake Following Laparoscopic Roux-en-Y Gastric Bypass (RYGB).
[So] Source:Obes Surg;24(11):1926-32, 2014 Nov.
[Is] ISSN:1708-0428
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Serial changes in dietary intake, including specific food groups and nutrients during the first year following Roux-en-Y gastric bypass (RYGB) are of interest due to surgically induced alterations in meal size, food intolerances present after surgery, and potential nutrient deficiencies. To help improve the nutritional health of surgical patients, this study's purpose was to examine changes in macro- and micronutrients, food groups, and selected foods during 12 months of follow-up in post-RYGB individuals. METHODS: RYGB patients (n = 17) completed 4-day food records at baseline (prior to surgery) and then at 3 weeks, 3 months, 6 months, and 12 months after surgery. Mean daily intake was determined at each time for energy intake, macro- and micronutrients, food groups, and selected foods in targeted food groups. RESULTS: A dramatic decrease in mean (±SEM) daily energy intake occurred-2,150 ± 165 kcal at baseline vs. 649 ± 40 kcal at 3 weeks; energy intake continually increased to a high of 1,307 ± 129 kcal by 12 months. More than 50 % of patients had low intake of vitamins D, E, C, folate, and calcium, magnesium, and potassium at 12 months. Servings from vegetables, grains, fats, and sweetened beverages were lower, whereas, meats, dairy, fruits, and sweets showed only small, transient changes following surgery. CONCLUSIONS: The reduction in energy intake following RYGB is from selected food groups and not solely a reduction in portion sizes across the diet. The lower intake of micronutrients indicates potential risk for deficiencies unless supplements are used. These findings can help in the clinical management of surgical patients to improve nutritional health.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s11695-014-1259-1

  3 / 1408730 MEDLINE  
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[PMID]: 24735935
[Au] Autor:Wang HH; Abern MR; Cost NG; Chu DI; Ross SS; Wiener JS; Routh JC
[Ad] Address:Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina....
[Ti] Title:Use of Nephron Sparing Surgery and Impact on Survival in Children with Wilms Tumor: A SEER Analysis.
[So] Source:J Urol;192(4):1196-202, 2014 Oct.
[Is] ISSN:1527-3792
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Nephron sparing surgery is the standard of care for many adults with renal tumors and has been described in some children with Wilms tumor. However, beyond case series the data concerning nephron sparing surgery application and outcomes in patients with Wilms tumor are scarce. We examined nephron sparing surgery outcomes and factors associated with its application in children with Wilms tumor. MATERIALS AND METHODS: We retrospectively reviewed the 1998 to 2010 SEER database. We identified patients 18 years old or younger with Wilms tumor. Clinical, demographic and socioeconomic data were abstracted, and statistical analysis was performed using multivariate logistic regression (predicting use of nephron sparing surgery limited to unilateral tumors smaller than 15 cm) and Cox regression (predicting overall survival) models. RESULTS: We identified 876 boys and 956 girls with Wilms tumor (mean ± SD age 3.3 ± 2.9 years). Of these patients 114 (6.2%) underwent nephron sparing surgery (unilateral Wilms tumor in 74 and bilateral in 37). Median followup was 7.1 years. Regarding procedure choice, nephron sparing surgery was associated with unknown lymph node status (Nx vs N0, p <0.001) and smaller tumor size (p <0.001). Regarding survival, only age (HR 1.09, p = 0.002), race (HR 2.48, p = 0.002), stage (HR 2.99, p <0.001) and lymph node status (HR 2.17, p = 0.001) predicted decreased overall survival. Survival was not significantly different between children undergoing nephron sparing surgery and radical nephrectomy (HR 0.79, p = 0.58). CONCLUSIONS: In children with Wilms tumor included in the SEER database nephron sparing surgery has been infrequently performed. Nephron sparing surgery application is associated with smaller, bilateral tumors and with omission of lymphadenectomy. However, there are no evident differences in application of nephron sparing surgery based on demographic or socioeconomic factors. Despite lymph node under staging, overall survival is similar between patients undergoing nephron sparing surgery and radical nephrectomy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

  4 / 1408730 MEDLINE  
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[PMID]: 25081365
[Au] Autor:Ji Y; Fish PM; Strawn TL; Lohman AW; Wu J; Szalai AJ; Fay WP
[Ad] Address:Department of Medicine and Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO, USA.
[Ti] Title:C-reactive protein induces expression of tissue factor and plasminogen activator inhibitor-1 and promotes fibrin accumulation in vein grafts.
[So] Source:J Thromb Haemost;12(10):1667-77, 2014 Oct.
[Is] ISSN:1538-7836
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: C-reactive protein (CRP) promotes tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1) expression in vitro, and an elevated plasma CRP concentration is associated with an increased risk of vein graft (VG) thrombosis after coronary artery bypass surgery. However, little is known about the effects of CRP on VG TF and PAI-1 expression in vivo, or on VG thrombosis. OBJECTIVES: We studied transgenic (Tg) mice expressing human CRP in a VG model to explore in vivo cause-and-effect relationships between CRP and TF, PAI-1, and VG thrombosis. METHODS: Vein segments from wild-type (WT) and CRP-Tg donors were transplanted into carotid arteries of WT and CRP-Tg recipients. VGs were analyzed 1-4 weeks later. RESULTS: Human CRP accumulated in VGs during the first 4 weeks after surgery, but appeared to originate exclusively from systemic sources, rather than local production. Human CRP significantly increased TF gene expression, protein concentration and activity in VGs. Human CRP also increased PAI-1 concentrations in VGs, although only in vascular endothelial cells. Human CRP stimulated macrophage migration, invasion into VGs, and TF expression. Fibrin deposition was significantly greater in VGs of CRP-Tg mice than in WT controls. CONCLUSIONS: CRP accumulates in VGs early after surgery, originating from systemic sources rather than local synthesis. Human CRP promotes TF and PAI-1 expression in VGs, although with different expression patterns. Human CRP stimulates macrophage invasion and fibrin deposition within VGs. These results suggest that CRP induces pathologic changes in VGs that contribute to early VG occlusion.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1111/jth.12680

  5 / 1408730 MEDLINE  
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[PMID]: 24535482
[Au] Autor:Wang L; Bauer M; Curry R; Larsson A; Sessler DI; Eisenach JC
[Ad] Address:The Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
[Ti] Title:Intrathecal ketorolac does not improve acute or chronic pain after hip arthroplasty: a randomized controlled trial.
[So] Source:J Anesth;28(5):790-3, 2014 Oct.
[Is] ISSN:1438-8359
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:Hypersensitivity to mechanical stimuli following surgery has been reported in patients who subsequently develop chronic pain after surgery. In animals, peripheral injury increases prostaglandin production in the spinal cord, and spinal cyclooxygenase inhibitors reduce hypersensitivity after injury. We therefore tested the hypothesis that spinal ketorolac reduces hypersensitivity and acute and chronic pain after hip arthroplasty ( www.clinicaltrials.gov NCT 00621530). Sixty-two patients undergoing total hip arthroplasty with spinal anesthesia were randomized to receive 13.5 mg hyperbaric bupivacaine with spinal saline or 13.5 mg hyperbaric bupivacaine with 2 mg preservative-free ketorolac. The primary outcome was area of hypersensitivity surrounding the wound 48 h after surgery, but this only occurred in 4 patients, precluding assessment of this outcome. The groups did not differ in acute pain, acute opioid use, or pain incidence or severity at 2 and 6 months after surgery. There were no serious adverse events. Our results suggest that a single spinal dose of ketorolac does not substantially reduce acute surgical pain and is thus unlikely to reduce the risk of persistent incisional pain.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00540-014-1798-6

  6 / 1408730 MEDLINE  
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[PMID]: 25291982
[Au] Autor:Nitsche U; Müller TC; Späth C; Cresswell L; Wilhelm D; Friess H; Michalski CW; Kleeff J
[Ti] Title:The evidence based dilemma of intraperitoneal drainage for pancreatic resection - a systematic review and meta-analysis.
[So] Source:BMC Surg;14(1):76, 2014.
[Is] ISSN:1471-2482
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Routine placement of intraperitoneal drains has been shown to be ineffective or potentially harmful in various abdominal surgical procedures. Studies assessing risks and benefits of abdominal drains for pancreatic resections have demonstrated inconsistent results. We thus performed a systematic review of the literature and meta-analyzed outcomes of pancreatic resections with and without intraoperative placement of drains. METHODS: A database search according to the PRISMA guidelines was performed for studies on pancreatic resection with and without intraperitoneal drainage. The subgroup 'pancreaticoduodenectomy' was analyzed separately. The quality of studies was assessed using the MINORS and STROBE criteria. Pooled estimates of morbidity, mortality and length of hospital stay were calculated using random effects models. RESULTS: Only two randomized trials were identified. Their results were contradictory. We thus included six further, retrospective studies in the meta-analysis. However, with I2 = 68% for any kind of complication, the estimate of inter-study heterogeneity was high. While overall morbidity after any kind of pancreatic resection was lower without drains (p = 0.04), there was no significant difference in mortality rates. In contrast, pooled estimates of outcomes after pancreaticoduodenectomy demonstrated no differences in morbidity (p = 0.40) but increased rates of intraabdominal abscesses (p = 0.04) and mortality (p = 0.04) without intraperitoneal drainage. CONCLUSION: Although drains are associated with slightly increased morbidity for pancreatic resections, routine omission of drains cannot be advocated, especially after pancreaticoduodenectomy. While selective drainage seems reasonable, further efforts to generate more reliable data are questionable because of the current studies and the presumed small differences in outcomes. TRIAL REGISTRATION: Systematic review registration number CRD42014007497.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1186/1471-2482-14-76

  7 / 1408730 MEDLINE  
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[PMID]: 25298918
[Au] Autor:Ng HY; Ng WH; King NK
[Ad] Address:Department of Neurosurgery, Changi General Hospital, 2 Simei Street 3, Singapore.
[Ti] Title:Value of routine early post-operative computed tomography in determining short-term functional outcome after drainage of chronic subdural hematoma: An evaluation of residual volume.
[So] Source:Surg Neurol Int;5:136, 2014.
[Is] ISSN:2229-5097
[Cp] Country of publication:India
[La] Language:eng
[Ab] Abstract:BACKGROUND: Computed tomography (CT) scans are widely used in managing chronic subdural hematoma (CSDH). Factors that determine early post-operative volume have not been examined. The value of routine early post-operative residual volume have not been evaluated. Our study aims to compare pre-operative and early post-operative CT findings to determine the factors affecting residual hematoma and evaluate if early post-operative CT scans are useful in the management of CSDH. METHODS: Forty-three patients who underwent burr hole drainage of unilateral CSDH from August 2006 to January 2013 and had routine post-operative CT scans within 48 hours of surgery were selected. Data regarding age, sex, neurological deficit, Glasgow Coma Scale (GCS), pre-existing medical conditions, use of antiplatelets or anticoagulation, operative time, usage of drains, and number of burr holes were obtained. The pre-operative CSDH volume, CSDH density, and midline shift were measured. Residual volume was calculated from early post-operative CT scans. Clinical outcome was evaluated with Glasgow Outcome Scale (GOS) at the time of discharge. Statistical analysis was performed to look for correlation between the pre-operative factors and residual volume, and the residual volume and GOS. RESULTS: Pre-operative volume was found to correlate significantly with post-operative residual volume. There was no significant correlation between all other pre-operative factors and residual volume. There was also no correlation between residual volume and GOS at discharge. CONCLUSION: Routine post-operative CT brain for burr hole drainage of CSDH may be unnecessary in view of the good predictive value of pre-operative volume, and also because it is not predictive of the clinical outcome.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Cu] Class update date: 141011
[Lr] Last revision date:141011
[Da] Date of entry for processing:141009
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.4103/2152-7806.141299

  8 / 1408730 MEDLINE  
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[PMID]: 25298917
[Au] Autor:Kobayashi S; Ishikawa T; Tanabe J; Moroi J; Suzuki A
[Ad] Address:Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan....
[Ti] Title:Quantitative cerebral perfusion assessment using microscope-integrated analysis of intraoperative indocyanine green fluorescence angiography versus positron emission tomography in superficial temporal artery to middle cerebral artery anastomosis.
[So] Source:Surg Neurol Int;5:135, 2014.
[Is] ISSN:2229-5097
[Cp] Country of publication:India
[La] Language:eng
[Ab] Abstract:BACKGROUND: Intraoperative qualitative indocyanine green (ICG) angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS) after STA-MCA anastomosis. METHODS: Ten patients undergoing STA-MCA anastomosis due to unilateral major cerebral artery occlusive disease were included. Ten patients with normal cerebral perfusion served as controls. The ICG transit curve from six regions of interest (ROIs) on the cortex, corresponding to ROIs on positron emission tomography (PET) study, was recorded. Maximum intensity (IMAX), cerebral blood flow index (CBFi), rise time (RT), and time to peak (TTP) were evaluated. RESULTS: RT/TTP, but not IMAX or CBFi, could differentiate between control and study subjects. RT/TTP correlated (|r| = 0.534-0.807; P < 0.01) with mean transit time (MTT)/MTT ratio in the ipsilateral to contralateral hemisphere by PET study. Bland-Altman analysis showed a wide limit of agreement between RT and MTT and between TTP and MTT. The ratio of RT before and after bypass procedures was significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.60 ± 0.032 and 0.80 ± 0.056, respectively; P = 0.017). The ratio of TTP was also significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.64 ± 0.081 and 0.85 ± 0.095, respectively; P = 0.017). CONCLUSIONS: Time-dependent intraoperative parameters from the ICG transit curve provide quantitative information regarding cerebral circulation time with quality and utility comparable to information obtained by PET. These parameters may help predict the occurrence of postoperative HPS.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Cu] Class update date: 141011
[Lr] Last revision date:141011
[Da] Date of entry for processing:141009
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.4103/2152-7806.140705

  9 / 1408730 MEDLINE  
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[PMID]: 25298784
[Au] Autor:Ziran NM; Smith WR
[Ad] Address:Hip & Pelvis Institute, 2001 Santa Monica Blvd, Suite 760, 90404 Santa Monica, California USA.
[Ti] Title:The 'Ziran' wrap: reconstruction of critical-sized long bone defects using a fascial autograft and reamer-irrigator-aspirator autograft.
[So] Source:Patient Saf Surg;8(1):40, 2014.
[Is] ISSN:1754-9493
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Reconstruction of critical-size bony defects remains a challenge to surgeons despite recent technological advances. Current treatments include distraction osteogenesis, cancellous autograft, induced membranes (Masquelet procedure), polymeric membranes, and titanium-mesh cages filled with bone graft. In this article, the authors presents two cases in which critical-sized defects were reconstructed using a meshed fascial autograft encasing reamer-irrigator-aspirator (RIA) autograft and cancellous allograft. This article will discuss the clinical outcomes of the technique, comparison to other current techniques, and technical insight into the potential biological mechanism.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Cu] Class update date: 141011
[Lr] Last revision date:141011
[Da] Date of entry for processing:141009
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1186/s13037-014-0040-7

  10 / 1408730 MEDLINE  
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[PMID]: 25295519
[Au] Autor:Han S; Ko JS; Jin SM; Park HW; Kim JM; Joh JW; Kim G; Choi SJ
[Ad] Address:Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea....
[Ti] Title:Intraoperative Hyperglycemia during Liver Resection: Predictors and Association with the Extent of Hepatocytes Injury.
[So] Source:PLoS One;9(10):e109120, 2014.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Patients undergoing liver resection are at risk for intraoperative hyperglycemia and acute hyperglycemia is known to induce hepatocytes injury. Thus, we aimed to evaluate whether intraoperative hyperglycemia during liver resection is associated with the extent of hepatic injury. METHODS: This 1 year retrospective observation consecutively enrolled 85 patients undergoing liver resection for hepatocellular carcinoma. Blood glucose concentrations were measured at predetermined time points including every start/end of intermittent hepatic inflow occlusion (IHIO) via arterial blood analysis. Postoperative transaminase concentrations were used as surrogate parameters indicating the extent of surgery-related acute hepatocytes injury. RESULTS: Thirty (35.5%) patients developed hyperglycemia (blood glucose > 180 mg/dl) during surgery. Prolonged (≥ 3 rounds) IHIO (odds ratio [OR] 7.34, P = 0.004) was determined as a risk factors for hyperglycemia as well as cirrhosis (OR 4.07, P = 0.022), lower prothrombin time (OR 0.01, P = 0.025), and greater total cholesterol level (OR 1.04, P = 0.003). Hyperglycemia was independently associated with perioperative increase in transaminase concentrations (aspartate transaminase, ß 105.1, standard error 41.7, P = 0.014; alanine transaminase, ß 81.6, standard error 38.1, P = 0.035). Of note, blood glucose > 160 or 140 mg/dl was not associated with postoperative transaminase concentrations. CONCLUSIONS: Hyperglycemia during liver resection might be associated with the extent of hepatocytes injury. It would be rational to maintain blood glucose concentration < 180 mg/dl throughout the surgery in consideration of parenchymal disease, coagulation status, lipid profile, and the cumulative hepatic ischemia in patients undergoing liver resection for hepatocellular carcinoma.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1410
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1371/journal.pone.0109120


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