High-risk Surgery Research Articles

The effect of dexmedetomidine on acute kidney injury after elective major abdominal surgery : a retrospective single-center propensity score matched study

BackgroundMajor abdominal surgery is a kind of high-risk surgery type for postoperative acute kidney injury (AKI) among non-cardiac surgeries. Despite dexmedetomidine exerts significant renal protective effects in cardiac surgeries and animal studies, whether it is associated with a lower incidence of AKI in major abdominal surgeries remains unclear.MethodsFrom January 2019 to July 2021, patients undergoing elective major abdominal surgery in West China Hospital were enrolled. Participants were divided into two groups based on exposure to continuous intravenous dexmedetomidine: the Dex group (exposed) and the Control group (not exposed). The primary outcome was the incidence of AKI in the postoperative 7 days. Secondary outcomes included intraopertive average urine output, renal function on the first day after surgery, incidence of postoperative dialysis, postoperative intensive care unit (ICU) admission, in-hospital mortality, length of hospital stay, incidence of intraoperative hypotension and bradycardia, and intraoperative use of inotropes and vasopressors. Propensity score matching (PSM), based on participants’ baseline and intraoperative characteristics, was performed to minimize potential bias. Furthermore, a subgroup analysis was conducted based on the infusion rate and the use of a loading dose to explore the effects of different methods of dexmedetomidine administration on AKI. The subgroups included: loading dose, non-loading dose, low-infusion rate (infusion rate ≤ 0.4 µg/kg/h), and high-infusion rate (infusion rate > 0.4 µg/kg/h).ResultsAfter PSM with a ratio of 1:1, a total of 8836 patients were successfully matched. Dexmedetomidine administration had no association with the incidence of postoperative AKI, serum creatinine (Scr) level on the first postoperative day, incidence of postoperative dialysis, postoperative ICU admission, in-hospital mortality, length of hospital stay, intraoperative hypotension, or the use of inotropes and vasopressors, but had association with increased intraoperative average urine output (122.95 (76.80, 189.27) vs. 104.65 (67.04, 161.07) ml/h, P < 0.001), higher value of estimated glomerular filtration rate (eGFR) (97.33 ± 15.95 vs. 96.13 ± 16.35 ml/min/1.73m2, P < 0.001) on the first day after surgery and a higher incidence of intraoperative bradycardia (37.0% vs. 30.6%; P < 0.001). In the loading dose subgroup, dexmedetomidine use was significantly associated with a reduced incidence of postoperative AKI (odds ratio (OR): 0.44, 95% confidence interval (CI): 0.23–0.76, P = 0.006).The association between dexmedetomidine and postoperative AKI was absent in subgroups of high or low infusion rate and no loading dose use.ConclusionIn this single-center retrospective propensity-matched study, we did not detect a significant overall difference in post-operative AKI rates between patients treated with or without dexmedetomidine during major abdominal surgery. However, though additional prospective data are needed, our study found that administering dexmedetomidine with a loading dose may be associated with lower rates of AKI, potentially indicating a renoprotective effect of loading-dose dexmedetomidine in this setting.

Implantation of a sutureless aortic valve into the ring of a mechanical valve: an extreme solution for extreme cases.

Reoperations due to dysfunction of artificial mechanical aortic valves represent a complex and high-risk surgical procedure, particularly for elderly patients. In this report, we present a case of an 81-year-old female patient where, due to structural degeneration of the mechanical valve, an emergency surgical procedure was indicated. After the removal of the valve leaflets, a sutureless aortic valve was implanted within the mechanical ring. In our case, we demonstrate that such an approach is a safe alternative for high-risk patients, who cannot undergo percutaneous procedures. By reducing the duration of cardiopulmonary bypass and aortic clamping, the surgical outcomes and complication rates can be significantly improved.

Amniotic fluid-derived stem cells: potential factories of natural and mimetic strategies for congenital malformations

Background:Mesenchymal stem cells (MSCs) derived from gestational tissues offer a promising avenue for prenatal intervention in congenital malformations although their application is hampered by concerns related to cellular plasticity and the need for invasive, high-risk surgical procedures. Here, we present naturally occurring exosomes (EXOs) isolated from amniotic fluid-derived MSCs (AF-MSCs) and their mimetic analogs (MIMs) as viable, reproducible, and stable alternatives. These nanovesicles present a minimally invasive therapeutic option, addressing the limitations of MSC-based treatments while retaining therapeutic efficacy.Methods:MIMs were generated from AF-MSCs by combining sequential filtration steps through filter membranes with different porosity and size exclusion chromatography columns. A physicochemical, structural, and molecular comparison was conducted with exosomes (EXOs) released from the same batch of cells. Additionally, their distribution patterns in female mice were evaluated following in vivo administration, along with an assessment of their safety profile throughout gestation in a mouse strain predisposed to neural tube defects (NTDs). The possibility to exploit both formulations as mRNA-therapeutics was explored by evaluating cell uptake in two different cell types(fibroblasts, and macrophages) and mRNA functionality overtime in an in vitro experimental setting as well as in an ex vivo, whole embryo culture using pregnant C57BL6 dams.Results:Molecular and physiochemical characterization showed no differences between EXOs and MIMs, with MIMs determining a threefold greater yield. Biodistribution patterns following intraperitoneal administration were comparable between the two particle types, with the uterus being among targeted organs. No toxic effects were observed in the dams during gestation, nor were there any malformations or significant differences in the number of viable versus dead fetuses detected. MIMs delivered a more intense and prolonged expression of mRNA encoding for green fluorescent protein in macrophages and fibroblasts. An ex-vivo whole embryo culture demonstrated that MIMs mainly accumulate at the level of the yolk sac, while EXOs reach the embryo.Conclusions:The present data confirms the potential application of EXOs and MIMs as suitable tools for prevention and treatment of NTDs and proposes MIMs as prospective vehicles to prevent congenital malformations caused by in utero exposure to drugs.

A profile of the impella 5.5 for the clinical management of cardiogenic shock and a review of the current indications for use and future directions

ABSTRACT Introduction The Impella 5.5 device is a surgically inserted, trans-valvular, microaxial flow device capable of providing 5.5 L/min of continuous, antegrade flow from the left ventricle (LV) to the aorta. The ability of the Impella 5.5 to fully pressure and volume unload the dysfunctional LV while allowing for mobilization and rehabilitation has rapidly expanded use. Clinical use scenarios include escalation of support for acute myocardial infarction cardiogenic shock (AMICS), transition from extracorporeal membrane oxygenation to mobile support, bridge to transplantation or durable MCS in acute decompensated heart failure, or perioperative use in post-cardiotomy cardiogenic shock (PCCS). Areas Covered This review provides a profile of the Impella 5.5 device, summarizes current literature surrounding clinical applications, reviews active and upcoming clinical trials, and projects future applications for the device in an expert review. Expert Opinion The development of the Impella 5.5 has allowed for monitoring of left heart recovery, optimizing right ventricular function, and rehabilitating patients to meet bridging endpoints. The 2018 heart transplant allocation system modifications have expanded use of temporary mechanical circulatory support (tMCS) on the transplant waitlist, increasing the number of patients transplanted on support. With increased safety and durability, an expanding frontier is used in perioperative support for PCCS in high-risk cardiac surgery.

Preservation of the superior laryngeal nerve without neuromonitoring during thyroid surgery

Recently, Intraoperative neurophysiological monitoring (IONM) has enabled the prevention of nerve injury, reducing the incidence of complications associated with nerve injury even in high-risk surgeries. However, reliance on IONM is not feasible in all situations. Therefore, surgeons have the necessity and obligation to master the techniques for identifying and preserving nerves without the aid of neurophysiological monitoring. Therefore, it aims to introduce the course and variations of the superior laryngeal nerve, as well as methods for identifying and preserving the external branch of the superior laryngeal nerve during thyroid surgery without the use of intraoperative neurophysiological monitoring.

Prognostic value of preoperative echocardiography in predicting myocardial injury after open abdominal aortic surgery.

Abdominal aortic aneurysms (AAAs) and peripheral arterial and aortic diseases (PAAD) are associated with increased risk of myocardial injury after noncardiac surgery (MINS). To evaluate whether preoperative transthoracic echocardiography (TTE) abnormalities are linked to MINS in patients undergoing open vascular surgeries involving the abdominal aorta due to AAA and / or PAAD. This is a retrospective cohort that analyzed consecutive patients who underwent open abdominal aortic surgery due to infrarenal AAA and / or aortoiliac occlusive disease in a single tertiary center. In each patient, TTE was performed within 1-3 months before the surgery and at least two postoperative high-sensitive troponins were measured (on the first and the second postoperative day) as per the standard of care at the participating center. The study group comprised 336 patients. The median age was 67 years, and 82.7% of patients were male. MINS was diagnosed in 122 (36.3%) patients. Multivariable analysis revealed that myocardial hypokinesis compared to normal contractility was associated with a higher risk of MINS (OR 3.23, 95% CI 1.30 to 8.03). A similar association was not found for left ventricular ejection fraction (OR 1.08, 95% CI 0.78 to 1.48), left ventricular septum hypertrophy (OR 1.58, 95% CI 0.91 to 2.75), increased left atrium surface (OR 0.95, 95% CI 0.54 to 1.70) and mitral insufficiency (OR 0.89, 95% CI 0.50 to 1.58). Our study suggests that routine preoperative TTE may have a low but possible value in the prediction of MINS among patients undergoing high-risk vascular surgery.

Effect of desflurane, sevoflurane or propofol on the incidence of postoperative delirium in older adults undergoing moderate- to high-risk major non-cardiac surgery: study protocol for a prospective, randomised, observer-blinded, clinical trial (RAPID-II trial)

IntroductionThe effect of different anaesthetics on the incidence of postoperative delirium is still not entirely clear. Therefore, we will evaluate the effect of desflurane versus sevoflurane versus propofol for the...

Corporate Risk Disclosure Practice and Financial Performance of Listed Industrial Goods Firms in Nigeria

In recent years, corporate risk disclosure has gained increasing attention in corporate governance discourse due to its potential impact on financial performance. The need for transparency in reporting risks has become more critical, particularly in the industrial goods sector, which is often characterized by high operational and financial risks. This study examined the influence of corporate risk disclosure on the financial performance of listed industrial goods firms in Nigeria, a sector known for high levels of operational and financial risk. It specifically assessed how financial and operational risk disclosures affect financial performance. This study employed expo-facto research design. The study population consisted of 13 industrial goods firms listed on the Nigerian Exchange Group (NGX) as of 31st December 2023. Census sampling was applied to include the entire population. Data were collected from annual reports and corporate governance disclosures were analysed with descriptive statistics and feasible generalised least squares regression analysis. The findings found that while financial risk disclosure positively and significantly influences financial performance, operational risk disclosure has a negative but significant effect. These outcomes suggest that financial transparency boosts investor trust and confidence, enhancing financial performance, whereas disclosing operational risks may reduce investor confidence due to concerns about operational stability and profitability. This study concluded that corporate risk disclosure demonstrated a significant role in influencing financial outcomes, yet its effect varies based on the type of risk disclosed. In line with empirical findings of this study, it was recommended that firms should balance transparency with discretion by selectively disclosing operational risks that have been mitigated or managed, reducing the potential for investor concerns over operational vulnerabilities.

Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis

IntroductionOliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria. MethodsThis was a retrospective cohort conducted in four intensive care units (ICUs) across two private Brazilian hospitals, analyzing patients admitted after intermediate and high-risk surgeries between January 1, 2018 and December 31, 2022. Results1476 patients were included in the final analysis. Overall, 656 (44,5 %) were males, and the median age was 61,7 years. Oliguria was identified in 508 (34,4 %) patients within the first 24 h after surgery. Vasopressor requirement at admission, non-elective procedures, male sex and baseline serum creatinine were higher among oliguric patients. Among oliguric patients, age and basal serum creatine were higher among those who experienced AKI. Although only 12,4 % of oliguric patients developed AKI according to serum creatinine criterion, this incidence was significantly higher than in non-oliguric group (3,6 %), RR 3.42, IC 95 % 2.3–5.1 (p < 0.01). AKI recovery, RRT, ICU and hospital free days, and mortality were similar between the groups. ConclusionsPostoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.

Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey – a qualitative analysis

BackgroundEnd-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family...

BN SO07 - Percutaneous cholecystostomy in patients with severe acute calculous cholecystitis. What next? An analysis of 102 cases

Abstract Background Percutaneous cholecystostomy (PC) can be a life-saving treatment for patients presenting with fulminant acute calculous cholecystitis (ACC). In the case of those who make a good recovery and are fit for surgery, PC is often advocated. However, in those who are higher risk for surgery, there is currently no strong consensus regarding further management. The aim of this study was to evaluate the long-term outcomes of PC and interval LC versus PC alone in patients with ACC. Method We conducted a single-centre retrospective case-control evaluation of the outcomes of patients who have undergone a PC due to severe ACC, comparing those who have gone on to have an interval LC versus those who had PC only. The primary outcomes were the rate of readmissions with recurrent biliary disease and late mortality. Results While the rate of readmissions did not differ between groups (p= 0.583), in the surgical cohort most recurrent gallstone events occurred before LC. ASA score &amp;gt;2 and Tokyo grade 3 were significant positive predictors of all-cause mortality (95% CI 1.6 to 12.6, OR 4.5, p=0.004, and 95% CI 1.2 to 12.2, OR 3.8, p=0.027, respectively). Surgery was found to be a negative predictor of mortality (95% CI 0.04 to 0.5, OR 0.2, p=0.003). Conclusion Those who do not go on to have their gallbladder removed after PC, face significantly worse outcomes. Every effort should be made to optimise these patients to facilitate operative management.

Abstract 4136274: A Case of Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) Complicated by a Ventricular Septal Defect (VSD)

Case: A 69-year-old woman with a history of hypertension and tobacco use disorder presented with acute chest pain. The patient was found to have classic anterior ST elevation myocardial infarction (STEMI) pattern on electrocardiogram (ECG) with high-sensitivity troponin of 12,772 ng/L and was taken emergently to the catheterization laboratory. Coronary angiography showed tortuous coronary vessels though without evidence of obstructive coronary artery disease, plaque rupture, ulceration, dissection, or vasospasm. Transthoracic echocardiogram showed an apical ventricular septal defect (VSD) with normal left ventricular systolic function of 60%. Cardiac computed tomography (CT), confirmed a discrete apical VSD that was 7.93 mm in diameter and multiple small VSDs distally in the septum. Right heart catheterization revealed severe left-to-right shunting with a ratio of pulmonary blood flow to systemic blood flow (Qp:Qs) of 2.8. Early surgical repair of the apical VSD was pursued despite known high operative risk given the hemodynamic significance of the shunt. The patient developed ongoing hemodynamic instability from cardiogenic shock with inability to ween from intra-aortic balloon pump (IABP). Unfortunately, because of the location of the residual VSDs and elevated panel-reactive antibody testing of 98%, the patient was deemed to not be a candidate for percutaneous closure or heart transplantation, respectively. Discussion: An acquired ventricular septal defect (VSD) is a rare and catastrophic complication of myocardial infarction, typically with a culprit obstructive coronary artery lesion identified on coronary angiography. Acquired VSDs in myocardial infarction with nonobstructive coronary arteries (MINOCA) is an even more rare phenomenon. Possible causes include low flow, inflammation, intimal disruption, or vasospasm of coronary arteries. Our case highlights that MINOCA can present with life-threatening complications similar to obstructive STEMI. The timing of intervention and treatment approach of acquired VSDs remains an area of debate. The life-threatening effects of VSDs make it critical to manage in a multidisciplinary manner involving advanced imagers, interventional cardiologists, cardiothoracic surgeons, and heart failure specialists. This case emphasizes the importance of maintaining a high index of suspicion for abnormal coronary anatomy, even in patients with MINOCA, and prompt interdisciplinary decision making to reduce mortality.

Abstract 4138717: Infective Root Aortitis: Medical Therapy Alone or Medical Therapy and Surgery?

Clinical presentation: A 75-year-old male with previous 3 vessel CABG and bioprosthetic aortic valve (BAV) surgical replacement in 2013 was admitted with severe sepsis from diabetic foot ulcer complicated with Group A Streptococcus bacteremia and infective root aortitis. Imaging Findings: Initial technically limited transthoracic echocardiogram was followed by a transesophageal echocardiogram (TEE) that demonstrated a well seated BAV with mildly thickened leaflets but no vegetations, mild intra-valvular regurgitation, and 9 mm end-diastolic soft tissue echoreflectant thickening of the posterior aortic root (AoR) extending up 3 cm from the aortic annulus to the ascending aorta (Fig 1A,B). There were no signs of perivalvular abscess formation. Initial FDG PET-CT demonstrated heterogenous hypermetabolic activity at the annulus of the BAV (Fig 1C) and AoR (Fig 1D) consistent with aortitis. Decision-making: In the absence of guidelines for the management of these patients, a multidisciplinary team including cardiology, cardiothoracic surgery, and infectious disease opted for a conservative medical therapy instead of high-risk surgery. Patient then underwent left foot first digit amputation to achieve infectious source control. Upon completion of 4 out of 6 weeks of intravenous ceftriaxone 2 grams daily, repeat TEE showed improved AoR thickening to 6 mm (Fig 1E,F), no AoR abscess, and unchanged BAV structure and function. Repeat FDG PET-CT at the same time of TEE demonstrated persistent but improved hypermetabolic activity of the BAV annulus and AoR. After 10 weeks of IV antibiotics, repeat FDG PET-CT showed further decrease in metabolic activity on both areas. However, an Indium-111 labeled leukocyte scan showed no activity at the BAV annulus and root (Fig 1G) and therefore indicated healed AoR aortitis, which was further supported by significant decrease of ESR and CRP initial values of 126 mm/hr and 122.7 mg/L to 11 mm/hr and 3 mg/L, respectively. Patient is currently clinically stable 8 months later. Conclusion: This case illustrates that a conservative management of infective AoR aortitis with an extended course of intravenous antibiotics is a reasonable alternative to high-risk re-do valve and root surgery.

Postoperative outcomes among Northern versus Southern Ontario patients undergoing common intermediate- to high-risk elective surgeries: a population-based cohort study.

Northern Ontario residents experience multiple health disparities compared with those in Southern Ontario. It is unknown whether this leads to differences in surgical outcomes. We sought to compare postoperative outcomes of patients from Northern and Southern Ontario. We conducted a retrospective population-based cohort study using linked administrative health care data to identify all adult patients undergoing selected elective intermediate- to high-risk noncardiac surgeries in Ontario, Canada between 2009 and 2022. The primary outcome was 30-day mortality following surgery. The secondary outcomes were number of days alive at home, hospital length of stay, total health care system costs, discharge disposition, and readmissions. We used regression models to estimate the adjusted association between the exposure and outcomes. This study identified 562,115 patients, including 41,191 (7.3%) from Northern Ontario. We did not find strong evidence that mortality rates were higher for Northern vs Southern Ontario residents (adjusted odds ratio, 1.04; 95% confidence interval [CI], 0.85 to 1.27). Health system costs were lower for Northern Ontario residents at 30days [adjusted ratio of mean (RoM), 0.92; 95% CI, 0.89 to 0.96] and at 365days (adjusted RoM, 0.93; 95% CI, 0.90 to 0.96). Hospital length of stay was longer for Northern Ontario residents (adjusted RoM, 1.06; 95% CI, 1.01 to 1.11). The number of days alive at home and rate of readmission were not statistically different between the two groups. Northern Ontario residency was not associated with increased odds of mortality after intermediate- to high-risk elective noncardiac surgery. Overall, we found no clinically meaningful differences in postoperative outcomes between patients from Northern and Southern Ontario.

Enterprise digital transformation and employee treatment: Evidence from China

Enterprise digital transformation can reshape corporate internal governance models, but it may also influence the workforce in the firms. This study explores the impact of enterprise digital transformation on employee treatment. We find that, enterprise digital transformation significantly promotes better employee treatment. Mechanism analysis reveals that the improvement of internal control and labor income share are potential pathways. Furthermore, the positive correlation between digital transformation and employee treatment is more pronounced in non-state-owned enterprises, technology-oriented firms, and firms with higher operational risk. Moreover, the results suggest that enterprise digital transformation can further enhance corporate value by improving employee treatment. The research suggests that the improvement of digital transformation can be an effective factor for the firms to enhance labor relations.

Relationship between sST2 and NT-proBNP levels and postoperative atrial fibrillation in patients having non-cardiac surgery.

We explored the link between sST2 and NT-proBNP levels and postoperative atrial fibrillation (POAF) incidence in non-cardiac surgery patients in this study. The research involved 302 participants over 40 years old who underwent medium and/or high-risk non-cardiac surgeries. These patients were divided into two groups: those who developed POAF and those who did not. The study cohort consisted of a total of 302 patients, with 14 (4.6%) experiencing POAF. POAF was more common in patients with previous heart failure, a high Left Atrial Volume Index (LAVI), and elevated ASA and RCRI scores (all P<0.05). LAVI, sST2, NT-proBNP, and RCRI scores were found to be independent predictors of POAF in patients undergoing non-cardiac surgeries (all P<0.05). The area under the curve (AUC) for sST2 and NT-proBNP in predicting POAF was 0.707 (95% CI 0.544-0.869; P=0.009) and 0.727 (95% CI 0.598-0.857; P=0.004), respectively. Combined elevation of sST2 and NT-proBNP increased the likelihood of developing POAF by approximately 8.5 times (OR: 8.65, CI 95% 1.06-35.3, P=0.044). sST2 and NT-proBNP are valuable predictors of POAF in patients undergoing non-cardiac surgery. Identifying these predictors can help in recognizing high-risk patient groups for POAF.

Comparison of Complications and Mid-term Results for Patients who Underwent Open Radical Prostatectomy for High-Risk and Oligometastatic Prostate Cancer: A Cross-Sectional Study from a Tertiary Reference Center.

This study aimed to evaluate perioperative complications and oncologic results for high-risk and oligometastatic prostate cancer patients. The data of patients who underwent surgery for prostate cancer in the authors' clinic between January 2012 and March 2022 were analyzed retrospectively. According to D'amico classification, 28 patients with high-risk prostate cancer and 23 patients in the oligometastatic stage were included in the study. The patients were divided into two groups: group 1 (high-risk prostate cancers) and group 2 (oligometastatic cancer). Demographic characteristics, oncologic data, pathologic data, and complications of the patients were recorded. The mean age of the patients was 67.84 years (range, 52-79 years). The average follow-up period was 45.48 months for group 1 and 46.36 months for group 2 (p = 0.84). The mean hemoglobin decrease was 1.53 g/dL in group 1 and 0.69 g/dL in group 2 (p = 0.046). Five patients(17.8%) in group 1 had biochemical recurrence at 14.55 months, whereas three patients (13%) in group 2 had biochemical recurrence at 9.87 months (p = 0.646). According to Clavien-Dindo classification, major complications developed in 7.2% of the group 1 patients and in 8.6% of the group 2 patients. Surgical margin positivity was detected in 6 group 1 patients (21.4%) and 12 group 2 patients (52.2%) (p = 0.023). During the follow-up period, four patients died. Only one of the patients died of cancer. The authors think that oligometastatic and high-risk prostate cancer surgeries do not differ significantly in terms of complications.

Comparison of pulse pressure and stroke volume variations measured by three monitors in high-risk surgical patients

IntroductionDynamic indices of fluid responsiveness (FR) such as pulse pressure variation (PPV) and stroke volume variation (SVV) differ among hemodynamic monitors, which use proprietary algorithms, and vary even over a short period of time. We aimed to compare the baseline values, fluctuation and predictive value for FR of PPV and SVV measured by three minimally invasive monitors. Patients and methodsTwenty patients undergoing high-risk abdominal surgery were included and 45 fluid challenges were analysed. The patients were simultaneously monitored using Carescape B650, LiDCO Rapid and FloTrac/Vigileo system. Cardiac output (CO), PPV and SVV were recorded before and after the fluid challenge of 500ml of balanced crystalloid solution. An increase in CO ≥ 15 % defined fluid responders. Concurrently recorded arterial waveform was used for offline calculation of PPV. ResultsMean baseline values of the indices ranged between 8.6% and 13.4%. LiDCO showed higher fluctuation of indices compared to the other monitors. Area under the receiver operating characteristic curve (AUROC) ranged from 0.71 to 0.76 with optimal cut-off value between 7.5% and 13.9%. AUROC increased for all indices when FR was defined as an increase in stroke volume. Furthermore, a decrease in PPV or SVV after fluid challenge (ΔPPV, ΔSVV) proved a better marker of FR (AUROC 0.82 – 0.93) than baseline values with a uniform threshold of approximately -3%. ConclusionsAlthough a significant range of baselines variations and optimal cut-off values was observed, the predictive value of PPV and SVV from all the monitors was only moderate and comparable. Nevertheless, ΔPPV and ΔSVV appear to be a reliable and device-independent markers of FR.

What Is the Best Experimental Model for Developing Novel Therapeutics in Peripheral Artery Disease?

More than 200 million people worldwide have peripheral artery disease (PAD). PAD affects the quality of life and is associated with significant morbidity and mortality. Standard treatment for severe cases of PAD is surgical or endovascular revascularization. However, up to 30% of patients are not candidates for open or endovascular procedures, due to high operative risk or unfavorable vascular involvement. Furthermore, revascularization procedures may be insufficient to adequately improve microvascular tissue perfusion, wound healing, or limb salvage. Accordingly, regardless of advances in treatment modalities, outcomes of patients with PAD have remained unfavorable. Therefore, new medical therapeutic approaches are much needed. Small animal models are indispensable tools for the understanding of PAD physiopathology and the development of novel medical therapies. Development of animal models that more closely mimic the pathophysiology (with occlusive atherothrombosis and chronic development of limb ischemia) can incorporate the cardiovascular risk factors associated with this disease state, and focus on more clinically relevant outcomes is critical. In practice, this means using both animals that develop atherosclerosis and methods for the application of gradual arterial occlusion to induce hind limb ischemia. Doing so will likely help identify novel targets for intervention and overcome some principal challenges confronted by previous clinical trials. While various rodent models are discussed, the optimal animal model is yet to be defined.

An extensive review of pre-operative nursing care for high-risk obstetric surgeries

Healthcare professionals have particular difficulties while performing high-risk obstetric procedures, such as hysterectomies for excessive bleeding, cesarean sections in complex pregnancies, and surgery for ectopic pregnancies. In order to guarantee the safety and wellbeing of the mother and the fetus, perioperative nursing is essential. The purpose of this review is to highlight important nurse interventions, possible side effects, and evidence-based procedures that enhance surgical outcomes in high-risk obstetric situations. The results highlight the significance of important nurse interventions, thorough patient evaluations, and multidisciplinary cooperation throughout the perioperative phase.