Fluid Supplementation Research Articles

Real-time EEG-based detection of driving fatigue using a novel semi-dry electrode with self-replenishment of conductive fluid

A novel semi-dry electrode that can realize self-replenishment of conductive liquid is proposed in this study. Driving fatigue is detected by extracting the refined composite multiscale fluctuation dispersion entropy (RCMFDE) features in electroencephalogram (EEG) signals collected by this electrode. The results show that the new semi-dry electrode can automatically complete the conductive fluid supplement according to its own humidity conditions, which not only notably improves the effective working time, but also significantly reduces the skin impedance. By comparing with the classical entropy algorithms, the computational speed and the stability of the RCMFDE method are Substantially enhanced.

Small volume fluid resuscitation and supplementation with 20% albumin versus buffered crystalloids in adults with septic shock: A protocol for a randomised feasibility trial.

Fluid therapy is universally administered in the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin results in both lower fluid volumes and early cumulative fluid balance, and may reduce short-term mortality in patients with septic shock. In this single centre, open label, feasibility trial; patients with early septic shock will be randomly allocated either 20% albumin for resuscitation and daily supplementation, versus buffered crystalloids alone for all fluid therapy. The intervention period will last 7 days, with follow up points at ICU and hospital discharge, and 90 days after randomisation. Primary outcome measures including recruitment rate, intervention adherence, data completeness and safety will constitute objective evidence of feasibility, according to pre-specified thresholds. Secondary outcomes will include mortality and healthcare utilisation at 90 days, alongside other physiological and patient centred outcomes to inform the design of a future effectiveness trial. This study will rigorously test the feasibility of conducting a future trial to test both the clinical and cost-effectiveness of hyperoncotic albumin in patients with early septic shock.

The Influence of Oviductal and Uterine Fluid Supplementation on the In Vitro Development and Quality of Cloned Sheep Embryos.

Somatic cell nuclear transfer (SCNT) has great potential for the replication of high-commercial-value animals, threatened wild species for conservation purposes, and transgenic animals for biomedical purposes. However, SCNT has a low success rate due to intrinsic factors of the technique itself, which leads to low rates of embryonic development and epigenetic alterations in cloned embryos. The objective of this study was to evaluate the effect of OF-UF on the intracellular concentrations of ROS and GSH and the development of cloned and parthenogenetic Ovis aries embryos. The results do not show a beneficial effect on the development of parthenogenetic and cloned embryos at concentrations of 0.5% OF-UF. Furthermore, at 1% OF-UF, an adverse effect was observed in cloned embryos at the blastocyst stage and 2% OF and UF in parthenogenetic embryos during the first divisions. Decreases in ROS and GSH levels were observed in the parthenogenetic blastocysts treated with 1% OF-UF, but not in the clones, in which a higher concentration of GSH and a similar concentration of ROS were observed. No effect of OF-UF was observed on embryonic development and redox balance in sheep embryos cloned via handmade cloning.

Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review

Postural orthostatic tachycardia syndrome (POTS) is a chronic illness with unknown mortality and high morbidity, often diagnosed in the adolescent years. Published literature regarding POTS primarily focuses on the adult population, and guidance on treatment in pediatrics is sparse. The purpose of this clinical review is to evaluate the current literature on the management of POTS in pediatric patients. A search was conducted using the Cochrane database, Google Scholar, and PubMed. Studies were included if they evaluated the management of POTS, primarily in pediatric patients. Case reports and series were excluded. Eight published studies met the inclusion and exclusion criteria. To date, there are no US Food and Drug Administration-approved agents for the treatment of POTS. However, select pharmacological therapies have shown positive outcomes by addressing symptom origins, such as providing heart rate control, peripheral autonomic modulation, and targeting hypovolemia. Targeted pharmacological therapies studied in children and young adults include ivabradine, metoprolol, midodrine, pyridostigmine, intravenous crystalloid fluids, and fludrocortisone. Before adding pharmacotherapeutic interventions, non-pharmacologic interventions such as patient education, avoidance of symptom-triggering environments and medications, dietary fluid and sodium supplementation, exercise, and use of compression garments should be first attempted. Although the body of evidence for the management of POTS is expanding, additional research is needed to determine safe and efficacious dosing and establish clear guidelines for POTS in the pediatric population.

Milrinone in pediatric heart failure

Introduction. Heart failure is one of the most dangerous life-threatening conditions in children, requiring complex pathogenetically based treatment aimed at increasing cardiac output.The objective was to analyze publications devoted to assessing the effectiveness and safety of the use of milrinone in critical conditions in children.Materials and methods. The analysis included 60 publications from the PubMed and e-library abstract databases for the period from 2018 to 2023. The search was carried out using the keywords: milrinone, pediatric, neonate, heart failure, acute renal injury, and outcome. After the initial review of the abstracts, 18 articles were excluded from the analysis, if full text was not available or if they did not contain relevant information from a clinical perspective.Results. A significant part of the work is devoted to a comparative analysis of the therapeutic effects of milrinone and levosimendan in the early postoperative period after cardiac surgery in children, the authors of which in most cases believe that these drugs are comparable both in terms of treatment outcomes and side effects. At the same time, the results of a number of studies indicate significant advantages of milrinone, the use of which helps to reduce the level of lactate in the blood, is not accompanied by hypervolemia of the pulmonary circulation, helps to maintain optimal values of average blood pressure and reduce the duration of treatment in the ICU. On the other hand, there is evidence that the use of milrinone in the perioperative period may be associated with an increased need for additional fluid supplementation and an increase in the frequency of deaths after surgery in young children with complex congenital heart defects (CHD). Conclusion. Milrinone is the drug of choice for the treatment of acute heart failure in children with CHD in the early postoperative period and in newborns with persistent pulmonary hypertension.

Acute kidney injury caused by acute dimethyl oxalate poisoning: a case report

Dimethyl oxalate is one of the occupational toxic chemicals and causes strong renal toxicity. On May 16, 2023, a patient with acute dimethyl oxalate poisoning was admitted to Dingxi People's Hospital. The patient presented with nausea, vomiting, lumbar distension, weakness, poor appetite, anuria, and rapidly progressing acute kidney injury. Renal biopsy confirmed acute oxalate nephropathy. After symptomatic supportive treatments such as blood purification, anti-oxidative stress, glucocorticoid, fluid supplementation, alkalized urine, anti-infection, controlling blood pressure, calcium supplementation and anemia correction, the patient's symptoms disappeared, and the kidney function basically returned to normal. This case suggested that the etiology of patients with acute kidney injury must be clearly identified, and renal biopsy was an important examination method. For patients suffering from acute dimethyl oxalate poisoning, comprehensive treatment based on blood purification should be performed as soon as possible, aiming to improve the prognosis.

Effects of intraoperative fluid management on hemodynamics and tissue oxygenation according to the Pleth Variability Index in thoracic surgery.

The aim of this study was to compare the total fluid volume performed by noninvasive Pleth Variability Index in thoracic surgery patients in comparison to conventional fluid management. In this prospective randomized controlled study conducted between May 2019 and May 2020, 80 patients (68 males, 12 females; mean age: 58.5±6.7 years; range, 18 to 65 years) were divided into two groups: control (Group C) and the Pleth Variability Index (Group P). After performing routine anesthesia and Pleth Variability Index monitoring for all patients, fluids were given at a rate of 2 mL/kg/h with the standard anesthesia technique. Additional fluid supplementation was provided based on hemodynamic data in Group C. In Group P, 250 mL bolus crystalloid fluid was provided when Pleth Variability Index was >14%. Mean arterial pressure, heart rate, oxygen saturation, arterial blood gas, and blood biochemistry were recorded. Total fluid volumes and urinary output were also recorded. There was no significant difference between the groups in terms of total fluid volumes or urinary output. In the postoperative period, the oxygen saturation and mean arterial pressure of Group P were found to be higher than those of Group C. The postoperative creatinine and lactate values of Group P were lower than those of Group C. Although there was no significant difference in the total fluid given to the patients, fluid management by Pleth Variability Index monitoring had a positive effect on mean arterial pressure, oxygen saturation, lactate, and creatinine levels.

The impact of inhalation injury on fluid resuscitation in major burn patients: a 10-year multicenter retrospective study

BackgroundIt remains unclear whether additional fluid supplementation is necessary during the acute resuscitation period for patients with combined inhalational injury (INHI) under the guidance of the Third Military Medical University (TMMU) protocol.MethodsA 10-year multicenter, retrospective cohort study, involved patients with burns ≥ 50% total burn surface area (TBSA) was conducted. The effect of INHI, INHI severity, and tracheotomy on the fluid management in burn patients was assessed. Cumulative fluid administration, cumulative urine output, and cumulative fluid retention within 72 h were collected and systematically analyzed.ResultsA total of 108 patients were included in the analysis, 85 with concomitant INHI and 23 with thermal burn alone. There was no significant difference in total fluid administration during the 72-h post-burn between the INHI and non-INHI groups. Although no difference in the urine output and fluid retention was shown in the first 24 h, the INHI group had a significantly lower cumulative urine output and a higher cumulative fluid retention in the 48-h and 72-h post-burn (all p < 0.05). In addition, patients with severe INHI exhibited a significantly elevated incidence of complications (Pneumonia, 47.0% vs. 11.8%, p = 0.012), (AKI, 23.5% vs. 2.9%, p = 0.037). For patients with combined INHI, neither the severity of INHI nor the presence of a tracheotomy had any significant influence on fluid management during the acute resuscitation period.ConclusionsAdditional fluid administration may be unnecessary in major burn patients with INHI under the guidance of the TMMU protocol.

Comparison of efficacy of intraoperative intravenous 5% dextrose versus intravenous ringer lactate for prevention of postoperative nausea and vomiting in patients undergoing elective laparoscopic cholecystectomy.

Objective: To assess the effectiveness of intraoperative intravenous 5% dextrose in contrast to intravenous Ringer lactate for averting postoperative nausea and vomiting among individuals undergoing elective laparoscopic cholecystectomy at a Tertiary Care Hospital in Karachi. Study Design: Randomized Control Trial. Setting: Department of Anesthesia, Dow University of Health Sciences, Located at Civil Hospital in Karachi. Period: 25-09-20 to 25-03-21. Methods: Patient data was collected in a prospective manner following verbal consent. A total of 60 patients, meeting the diagnostic criteria, were incorporated in the study. A concise medical history was obtained, and demographic details were recorded in the performa. Data was all variables were collected and analysed using SPSS version 22. Results: This study encompassed a total of 60 patients. In the dextrose group, the mean age, duration of surgery, length of hospital stay, height, weight, and BMI were 48.21±6.24 years, 2.54±1.78 hours, 4±2.54 days, 147±4.21 cm, 71.7±7.25 kg, and 28.9±5.14 kg/m2, respectively. Conversely, in the ringer lactate group, these values were 49.48±8.41 years, 2.97±1.56 hours, 4±1.89 days, 158±5.28 cm, 78.7±9.87 kg, and 29.6±4.91 kg/m2. The efficacy for preventing postoperative nausea and vomiting was 80% for the dextrose group and 36.7% for the ringer lactate group in our study. Conclusion: Administering preoperative fluid supplementation with dextrose resulted in a reduced occurrence of postoperative nausea and vomiting (PONV) in comparison to ringer lactate.

Abstract B066: Elucidating the impact of ascites on high grade serous ovarian cancer through in vitro multi-model characterization

Abstract High grade serous ovarian cancer (HGSOC) is one of the most lethal gynecological neoplasia worldwide, due to late diagnosis, high relapse rate and drug resistance. At the time of the diagnosis, HGSOC patients frequently present ascites with intraperitoneal tumor dissemination. Metastasis occurs through the shedding of cells from the primary tumor and movement to the peritoneal cavity, with the generation of ascites, where cells can grow in the absence of adhesion and eventually adhere to distant tissues. In this context, malignant ascites acts as a source of soluble factors which provide a pro-inflammatory, immunosuppressive and tumour-promoting microenvironment for tumoral cells in the peritoneum, contributing to tumor progression. Thus, understanding the influence of ascitic factors on tumoral cells would allow to identify pathogenetic mechanisms associated to metastasis, cancer stemness and chemoresistance, and be crucial for target discovery and drugs development. Our approach is based on the use of 2D and 3D patient-derived in vitro culturing models obtained from ascites of HGSOC patients, cultured in parallel in the standard conditions and with the supplementation of ascitic fluid. Specifically, we compared freshly isolated ascites tumor cells (i.e. never put in culture), 2D primary cells and two types of 3D spheroids, as models that enrich for ovarian cancer stem cells (CSCs), namely bulk spheroids and single-cell Metastatic Ovarian Cancer Spheroids (sMOCS) (Velletri, Villa, Cilli, Barzaghi et al. 2021). First, we investigated the role of ascitic fluid in supporting the growth of our models, recreating the peculiar tumor microenvironment of peritoneal ascites: we showed an increase in proliferation rate, propagability, sphere forming efficiency and dimension in the presence of ascitic fluid. Also, we performed bulk RNAseq analysis showing that ascitic fluid supplementation allows to preserve the metabolic status of fresh samples, typically lost in standard culturing conditions. In parallel, 2D cells and 3D spheroids showed a model-specific effect of ascites’ supplementation. In 2D primary cells it caused the downregulation of genes involved in the biosynthesis of cholesterol and in inflammatory response, while in 3D spheroids it induced upregulation of pathways involved in proliferation and glycolysis, suggesting a phenotype specific for CSCs. Moreover, our data allowed the scoring of CSC-related genes, upregulated in our 3D models compared to fresh ascites and 2D cells, and ascites-dependent genes, as they are up/downregulated in 2D cells and/or spheroids in the presence of ascitic fluid. These results shed light on the specific effects of ascites acting as microenvironment on tumor cells, highlighting its relevance for in vitro patient-derived models to better capture tumor features and to improve culturing conditions. Also, they pave the way to the identification of new disease-relevant pathways and targets to be exploited for more refined care of patients. Citation Format: Bianca Barzaghi, Pietro Lo Riso, Marta Rosa Sallese, Carlo Emanuele Villa, Giulia Picco, Alessia Gatto, Ugo Cavallaro, Giuseppe Testa. Elucidating the impact of ascites on high grade serous ovarian cancer through in vitro multi-model characterization [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr B066.

Abstract A105: Untangling the effect of ascites in shaping high grade serous ovarian cancer progression

Abstract High Grade Serous Ovarian Cancer (HGSOC) is the eighth cause of cancer-related mortality worldwide. Progress in eradicating this disease has been hampered by several factors, including the uncertainty about its tissues of origin, late diagnosis coupled to early dissemination through accumulation of ascitic fluid and extensive inter-patient variability. While being histopathologically homogeneous, HGSOC is characterized by several layers of heterogeneity that require the development of ad hoc research strategies and to focus on specific scales in order to deconvolve HGSOC pathogenetic mechanisms. In this context, our lab has previously shown that HGSOC can be derived both from the distal tract of the fallopian tube (fallopian tube epithelium, FTE) and the ovarian surface epithelium (OSE), with a prognostic impact for the tissue of origin and origin-specific molecular phenotypes, including an immune-suppressive response in the more aggressive OSE-derived subtype (Lo Riso, Villa et al. 2020), pointing at the role of tumor microenvironment in shaping therapeutical response. Moreover, we have also shown the role of ascitic fluid in sustaining the generation of single cell-derived metastatic ovarian cancer spheroids (sMOCS), that enrich for cancer stem-like cells, and allowing to identify a consistent intra-patient variability in response to carboplatin treatment (Velletri, Villa, Cilli, Barzaghi et al. 2022). To understand the specific impact of the tumor microenvironment in shaping HGSOC complexity, here we show an experimental framework aimed at the identification of the downstream effect of ascites in shaping cellular and molecular features of HGSOC. Here we leverage a newly generated single cell transcriptomic atlas, encompassing 1.5 million cells from 79 patients derived from primary tumors, ascites and metastatic samples, to identify specific expression networks activated during the metastatization process. In parallel, we derive from bulk transcriptomic data the set of genes that are induced upon ascitic fluid supplementation in 2D and 3D in vitro models, that are coupled to model-specific phenotypes, including cell proliferation, stemness and invasiveness. These genes are then integrated in the single-cell derived metastasis-specific expression networks to identify the upstream regulators imputable to ascitic fluid exposure. The linked regulators and downstream effectors are then used to identify in the atlas cell populations whose expression landscape is directly affected by ascitic fluid. The identification of such cell populations will allow to highlight cell-to-cell interactions existing between i) different tumor subpopulations; ii) tumor and tumor-associated compartments, in both primary and metastatic samples, that can be ascribed to the presence of ascitic fluid. Moreover, the molecular characterization of these interacting populations will allow to identify novel targets, paving the way to the identification of novel therapeutical avenues for HGSOC patients. Citation Format: Pietro Lo Riso, Carlo Emanuele Villa, Bianca Barzaghi, Marta R. Sallese, Giulia Picco, Alessia Gatto, Ugo Cavallaro, Giuseppe Testa. Untangling the effect of ascites in shaping high grade serous ovarian cancer progression [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A105.

Rhabdomyolysis in a Burned Patient Stuck in a Well – a Case Report

Aim: Rhabdomyolysis is a rare clinical entity. Its manifestation might be acute or delayed, with an acute episode frequently accompanied by severe clinical signs, while delayed rhabdomyolysis presentation has a more benign progression. Case report: Here we report a case of a 70-year-old patient with combined rhabdomyolysis, brachial plexus injury, second-degree burn injuries and acute kidney injury with an unusual cause of injury and subsequent mild clinical course. Conclusion: Even with a benign clinical course, one must think of rhabdomyolysis in uncertain injury mechanisms or questionable circumstances, and prompt laboratory diagnosis and fluid supplementation should be undertaken.

Role of preoperative carbohydrate loading for prevention of perioperative ketoacidosis in elective cesarean delivery.

Starvation of long duration during third trimester of pregnancy is undesirable as it is associated with accelerated fasting leading to hypoglycemia, raised plasma free fatty acid (FFA) levels, and increased plasma/urinary ketones. Carbohydrate (CHO)-rich drinks given preoperatively may ameliorate these deleterious effects. The enhanced recovery after surgery (ERAS) guidelines for perioperative care recommend that oral CHO fluid supplementation 2 h before cesarean delivery may be offered to nondiabetic pregnant women. The aim of the study was to evaluate the role of preoperative oral CHO loading for the prevention of perioperative ketoacidosis in elective cesarean deliveries. One hundred and twenty American Society of Anesthesiologists (ASA) II/III parturients undergoing elective cesarean section under subarachnoid block (SAB) were divided into two groups of 60 each after they gave written informed consent. Group A parturients received 400 ml of filtered water 2 h before surgery. Group B parturients received 400 ml of nonparticulate CHO drink 2 h before surgery. The primary outcome was the incidence of ketonuria studied by the dipstick method. Secondary outcomes included hunger and thirst scores, anxiety score, dominant hand grip strength, and the quality of recovery score. The urine ketone levels were positive (+1) in 8.3% parturients in group A and 1.7% parturients in the CHO group (P value- 0.094). The hunger and thirst scores as well as the modified Beck's anxiety scores were significantly lower in the CHO group (P value- 0.002). Dominant hand grip strength was preserved in both the groups (P value- 0.827). The quality of recovery score was significantly improved in the CHO group (P value- 0.002). No serious adverse effects were noted in either group. Oral CHO drink is safe when administered 2 h before uncomplicated elective cesarean deliveries. It may have a positive influence on a wide range of perioperative markers of clinical outcome.

Excessive sodium supplementation but not fluid load is correlated with overall morbidity in extremely low birth weight infants.

Sodium homeostasis in extremely low birth weight (ELBW)infants is critical. While a lack of sodium delays growth, excessive supplementation increases morbidity. We performed a single-center retrospective study on sodium and fluid management during the first 2 weeks of live including all ELBW infants born between June 1, 2017 and May 31, 2019. Forty-seven patients (median GA 26 + 6 weeks, median BW 845 g) were included. Mean sodium intake was above the ESPGHAN recommendation, 4.58 mmol/kg/day during the first 2 days and 1.99 mmol/kg/day during the following period. Incidence of PDA, IVH, and ROP was directly associated with sodium intake (OR1.6, 1.3, and 1.4, respectively), but not with fluid supplementation. No association to BPD was found. The most important source for inadvertent sodium intake were 0.9% saline given by arterial lines. Sodium supplementation did not correlate directly with serum sodium levels, but a linear regression model combining sodium intake and fluid supplementation was able to predict serum sodium changes 24-48 h in advance (correlation coefficient of 0.294, p < 0.05). Sodium application substantially exceeded ESPGHAN recommendations in ELBW infants. An excess in sodium was associated with an overall increased morbidity, justifying increased efforts to identify inadvertent sodium sources in these patients with the aim to decrease sodium excess.

The Use of Intraosseous Infusion in the Early Resuscitation of Patients With Extremely Severe Burns.

According to research, shock, the most common complication of extremely severe burns, is also the leading cause of mortality among patients with such burns. The case fatality rate reaches 83.45% when the total burn area exceeds 90%. The American Heart Association in 2020 recommended the intraosseous (IO) access after the peripheral access and prior to the central venous access when venous cannulation is either difficult or delayed. The use and experience with intraosseous infusion in extremely severe burns are still limited. We report efficacy and safety results from 19 burn patients treated with IO infusion between June 2020 and December 2022. In these patients, the mean injury time of burns was 1.55 ± 1.10 hours, the mean burn surface area was 86.24% ± 11.33%, the mean catheterization time was 49.68 ± 10.11 seconds, and the mean emergency retention time was 2.75 ± 1.74 hours, the mean actual fluid supplement amount was 5,533.68 ± 3,077.19 mL, the mean hourly urine volume of the patient was 93.31 ± 60.94 mL, the mean emergency detention time was 4.16 ± 2.97 hours, and the mean duration of hospitalization was 34.50 ± 25.38 days. The results demonstrated a clinically meaningful improvement and higher response rate vs peripheral venous cannulation and an acceptable safety profile in those patients.

Normal saline for children with bronchiolitis: study protocol for a randomised controlled non-inferiority trial

IntroductionBronchiolitis is one of the most common reasons for hospital admissions in early childhood. As supportive treatment, some treatment guidelines suggest using nasal irrigation with normal saline (NS) to facilitate...

Use of an intravenous catheter to treat urinary distension in cases of feline lower urinary tract disease

Urolithiasis is a disease that commonly affects the urinary organs due to blockage of crystal stones in the urinary tract of male cats. A 3.5 year old male mixed breed domestic cat was examined at the Royal Purple Vet Clinic with complaints of a lack of appetite, fever, and vomiting. The results of the physical examination showed that the body temperature was 39.6°C, bladder distention occurred, and there was a pain response when palpated. Under emergency conditions, urinary distension was treated by insertion of an intravenous catheter (26G). Supporting examinations included urinalysis and microscopic examination of urine. Urinalysis results showed the presence of red blood cells, white blood cells, and protein in the urine. Meanwhile, the results of the microscopic examination showed that there were deposits of calcium oxalate crystal particles. The cat was diagnosed with urolithiasis with a Fausta prognosis. The treatment includes fluid therapy, antibiotics, anti-inflammatories, supplements, and herbal medicine. The cat experienced changes after being treated for four days, characterized by normal urination and no blood found in the urine

Fluid Supplementation Through Weakened Zonules via Side-Port Incision to Maintain Intraocular Pressure in High Myopic Eyes.

During phacoemulsification, the infusion pressure can cause the liquefied vitreous fluid to escape through the ciliary fiber interspace in highly myopic eyes, leading to reduced vitreous cavity pressure similar to vitrectomized eyes. This study assessed the probability of low intraocular pressure (IOP) in high myopic eyes with different axial length (AL) group undergoing cataract surgery, as well as the impact of balanced salt solution (BSS) supplementation and the optimal IOP value for such supplementation. The control group consisted of cataract eyes with normal AL (group 1: 22mm ≤ AL < 24.5mm), while cataract eyes with high axial myopia were categorized into three groups (group 2: 26mm ≤ AL < 28mm, group 3: 28mm ≤ AL < 30mm, group 4: AL ≥ 30mm). IOP was measured using the iCare pro tonometer intraoperatively. BSS supplementation was performed to raise IOP in cases of low IOP, before intraocular lens (IOL) implantation and before the end of surgery. The probability of low IOP was calculated, and the IOP before and after supplementation were compared. Ninety-five eyes were included. The total probability of low IOP in groups 2, 3, and 4 was 56.52, 62.50, and 70.83%, respectively, significantly higher than that in group 1 (16.67%). Similarly, the probability of low IOP before IOL implantation was significantly higher in groups 2, 3, 4 (43.48, 41.67, and 62.50%) compared to group 1 (4.17%, P < 0.05). The IOP before and after the first BSS supplementation in three high myopia groups were statistically significant (P < 0.05), increasing from 12.10mmHg (range, 6.0-24.9mmHg) to 16.60mmHg (range, 10.2-34.4mmHg). After the second BSS supplementation before the end of surgery, the IOP of high myopia groups increased from 12.60mmHg (range, 7.0-25.3mmHg) to 14.60mmHg (range, 9.8-25.3mmHg). The condition of highly myopic eyes seems more likely to develop low IOP during cataract surgery. There is an observed correlation: as AL increases, the total probability of low IOP rises. In patients with IOP < 9.5mmHg intraoperatively, fluid supplementation via a side-port incision can effectively raise IOP to about 16mmHg before IOL implantation and about 14mmHg after incision sealing, facilitating smoother IOL implantation and reducing the risk of postoperative low IOP. NCT, NCT05201677. Registered 23 November 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05201677 .

Benefits and harms of perioperative high fraction inspired oxygen for surgical site infection prevention: a protocol for a systematic review and meta-analysis of individual patient data of randomised controlled trials

IntroductionThe use of high fraction of inspired oxygen (FiO2) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Promising results of early randomised controlled trials (RCT) have been...

Characterization of changes in the intestinal microbiome following combination therapy with zinc preparation and conventional treatment for children with rotavirus enteritis.

Rotavirus (RV) is one of the most common pathogens causing diarrhea in infants and young children worldwide. Routinely, antiviral therapy, intestinal mucosa protection, and fluid supplementation are used in clinic, however this is not efficacious in some severe cases. Zinc supplementation has previously been shown to improve resolution of symptoms from infectious diarrhea. In this study differences in response rate, duration of hyperthermia, vomiting, and diarrhea, and the persistence time of cough and lung rales in groups were compared. 16SrDNA gene sequencing technology was used to analyze and compare changes in the intestinal microflora of children with RV enteritis who received the conventional treatment with or without the zinc preparation. In addition, the correlations between the differential bacterial species and the related inflammatory factors were determined. Conventional therapy combined with the zinc preparation significantly shortened the duration of hyperthermia, vomiting, and diarrhea compared with the conventional treatment alone. In addition, the time to symptom relief showed that the absorption time of cough and lung rales was significantly shorter in the combination treatment group than that in the conventional treatment group in the children with pneumonia. Further, compared with the conventional treatment, the combined treatment significantly increased the diversity and abundances of florae as compared with the conventional treatment. This combination therapy containing zinc preparation markedly increased the abundances of Faecalibacterium, Bacteroidales, Ruminoccoccoccus, and Lachnospiraceae at the genus level. The LEfSe analysis suggested that Clostridiumbolteae were most significantly altered after the combination therapy. In addition, a correlation analysis revealed significantly negative correlations between the inflammatory factors especially IL-6, TNF-a, CRP and some intestinal florae such as Bacteroides, Faecalibacterium, Blautia, Parabacteroides, Subdoligranulum, and Flavonifractor. Compared with the conventional therapy alone, the combined therapy with the zinc preparation significantly improves symptoms caused by RV. The combination therapy containing the zinc preparation significantly increases the diversity and abundances of some beneficial groups of bacteria. Further, The presence of these groups was further negatively correlated with relevant inflammatory factors. More importantly, this combination therapy containing the zinc preparation provides a reference for the clinical management of children with RV enteritis.