Background Postoperative delirium is one of the most common complications in the older surgical population,but its pathogenesis and biomarkers are largely undetermined.Retinal layer thickness has been demonstrated to ...Background Postoperative delirium is one of the most common complications in the older surgical population,but its pathogenesis and biomarkers are largely undetermined.Retinal layer thickness has been demonstrated to be associated with cognitive function in mild cognitive impairment and patients with Alzheimer’s disease.However,relatively little is known about possible retinal layer thickness among patients with postoperative delirium.Aims We aimed to investigate the relationship between retinal layer thickness and postoperative delirium in this cross-sectional study.Methods The participants(≥65 years old)having elective surgery under general anaesthesia were screened via medical records from Shanghai 10th People’s Hospital.Preoperative macular thickness and peripapillary retinal nerve fibre layer(RNFL)thickness were measured using optical coherence tomography(OCT).The Confusion Assessment Method(CAM)algorithm and CAM-Severity(CAM-S)were used to assess the incidence and severity of postoperative delirium on the first,second and third days after surgery.Results Among 169 participants(mean(standard deviation(SD)71.15(4.36)years),40(24%)developed postoperative delirium.Notably,individuals who developed postoperative delirium exhibited thicker preoperative macular thickness in the right eye compared with those who did not(mean(SD)283.35(27.97)µm vs 273.84(20.14)µm,p=0.013).Furthermore,the thicker preoperative macular thickness of the right eye was associated with a higher incidence of postoperative delirium(adjusted odds ratio 1.593,95%confidence interval(CI)1.093 to 2.322,p=0.015)and greater severity(adjusted mean difference(β)=0.256,95%CI 0.037 to 0.476,p=0.022)after adjustment for age,sex and Mini-Mental State Examination(MMSE)scores.However,such a difference or association did not appear in the left macular or bilateral peripapillary RNFL thicknesses.Conclusions Current findings demonstrated that preoperative macular thickness might serve as a potential non-invasive marker for the vulnerability of developing postoperative delirium in older surgical patients.Further large-scale validation studies should be performed to confirm these results.展开更多
Objective The inhalation anesthetic isoflurane has been shown to induce mitochondrial dysfunction and caspase activation, which may lead to learning and memory impairment. Ginsenoside Rgl is reported to be neuroprotec...Objective The inhalation anesthetic isoflurane has been shown to induce mitochondrial dysfunction and caspase activation, which may lead to learning and memory impairment. Ginsenoside Rgl is reported to be neuroprotective. We therefore set out to determine whether ginsenoside Rgl can attenuate isoflurane-induced caspase activation via inhibiting mitochondrial dysfunction. Methods We investigated the effects of ginsenoside Rgl at concentrations of 12.5, 25, and 50 μmol/L and pretreatment times of 12 h and 24 h on isoflurane-induced caspase-3 activation in H4 naive and stably transfected H4 human neuroglioma cells that express full-length human amyloid precursor protein （APP） （H4-APP cells）. For mitochondrial dysfunction, we assessed mitochondrial permeability transition pore （mPTP） and adenosine-5＇-triphosphate （ATP） levels. We employed Western blot analysis, chemiluminescence, and flowcytometry. Results Here we show that pretreatment with 50 μmol/L ginsenoside Rgl for 12 h attenuated isoflurane-induced caspase-3 activation and mitochondrial dysfunction in H4-APP cells, while pretreatment with 25 and 50 μmol/L ginsenoside Rgl for 24 h attenuated isoflurane-induced caspase-3 activation and mitochondrial dysfunction in both H4 naive and H4-APP cells. Conclusion These data suggest that ginsenoside Rgl may ameliorate isoflurane-induced caspase-3 activation by inhibiting mitochondrial dysfunction. Pending further studies, these findings might recommend the use of ginsenoside Rgl in preventing and treating isoflurane-induced neurotoxicity.展开更多
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure are performed with increasing frequency to treat patients with diffused peritoneal carcinomatosis. These procedures have showed to increase...Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure are performed with increasing frequency to treat patients with diffused peritoneal carcinomatosis. These procedures have showed to increase life expectancy in what was previously considered a "terminal condition". Anyway patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. Despite the need of an advanced organ monitoring and support all these derangements seem to be mild and short-lived when timely addressed, at least in the majority of patients. Intensive care physicians are involved in providing surveillance and organ support till the patient is effectively weaned after the operation. Moreover, the anesthesiologist as perioperative physician is involved in pain control, metabolic and nutritional support of this cohort of patients. This task can be challenging considering that part of the patients are already on a long list of pain control medication after previous surgery or chemotherapy. A malnourished state is common too and it is secondary to diffi cult feeding, wasting syndrome from the tumor and massive ascites. The last issue the anesthesiologists need to be aware of is the impact over the quality of life(Qo L) of this procedure. The patient's underlying pathology is unlikely to be defi nitively cured so no treatment is an acceptable choice. The possibility to withhold the treatments must be part of the consultation process like the discussion about the Qo L in the immediate, as well as in the long-term, after the operation. Careful monitoring and treatment of every aspect that can impact the Qo L must be taken and the efforts to be poured into an effective preservation of the Qo L must be doubled when compared with a patient scheduled for major abdominal surgery.展开更多
Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives...Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.展开更多
Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabrie...Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.展开更多
目的探讨国内外全身麻醉患者苏醒期躁动(EA)的研究现状与前沿趋势,为深入开展EA研究提供参考。方法计算机检索中国知网、万方数据、维普资讯、Web of Science核心合集数据库、PubMed及Scopus数据库自建库至2024年3月发表的EA有关研究文...目的探讨国内外全身麻醉患者苏醒期躁动(EA)的研究现状与前沿趋势,为深入开展EA研究提供参考。方法计算机检索中国知网、万方数据、维普资讯、Web of Science核心合集数据库、PubMed及Scopus数据库自建库至2024年3月发表的EA有关研究文献,运用CiteSpace 6.2.R3可视化分析软件绘制关键词的相关图谱并分析该领域发文趋势及主要作者。结果分别纳入中文、英文文献752篇、755篇。经分析可知,金约西、李军、柴小青与闵苏并列位居中文数据库发文之首,中国学者张野在英文数据库中发文量位居第一;EA领域中英文数据库最高频关键词分别为“右美托咪定”“emergence agitation”;出现最早且持续时间最长的突现词分别为“麻醉”“preschool child”;突现强度最高的关键词分别为“地佐辛”“emergence delirium”;研究时间跨度最长的中英文聚类标签分别为“丙泊酚”“psychomotor agitation”。结论国内外EA领域整体研究态势趋于一致,研究热点主要聚焦于EA的重点关注人群、影响因素以及预防与干预管理等方面。未来建议研究者持续拓展并深入EA领域的关键问题,优化特殊人群陪护政策,在全面探究围手术期EA危险因素的基础上,系统构建集束化EA预防与干预方案,以期形成科学可行的EA防治体系,进一步推动EA领域研究与实践的融合与发展。展开更多
基金supported by grants from National Natural Science Foundation of China(81720108012,82001118)Ministry of Science and Technology of China(2021ZD0202003)+1 种基金Shanghai‘Rising Stars of Medical Talents’Youth Development Program(SHWSRS(2023)-62)Henry K.Beecher Professorship from Harvard University。
文摘Background Postoperative delirium is one of the most common complications in the older surgical population,but its pathogenesis and biomarkers are largely undetermined.Retinal layer thickness has been demonstrated to be associated with cognitive function in mild cognitive impairment and patients with Alzheimer’s disease.However,relatively little is known about possible retinal layer thickness among patients with postoperative delirium.Aims We aimed to investigate the relationship between retinal layer thickness and postoperative delirium in this cross-sectional study.Methods The participants(≥65 years old)having elective surgery under general anaesthesia were screened via medical records from Shanghai 10th People’s Hospital.Preoperative macular thickness and peripapillary retinal nerve fibre layer(RNFL)thickness were measured using optical coherence tomography(OCT).The Confusion Assessment Method(CAM)algorithm and CAM-Severity(CAM-S)were used to assess the incidence and severity of postoperative delirium on the first,second and third days after surgery.Results Among 169 participants(mean(standard deviation(SD)71.15(4.36)years),40(24%)developed postoperative delirium.Notably,individuals who developed postoperative delirium exhibited thicker preoperative macular thickness in the right eye compared with those who did not(mean(SD)283.35(27.97)µm vs 273.84(20.14)µm,p=0.013).Furthermore,the thicker preoperative macular thickness of the right eye was associated with a higher incidence of postoperative delirium(adjusted odds ratio 1.593,95%confidence interval(CI)1.093 to 2.322,p=0.015)and greater severity(adjusted mean difference(β)=0.256,95%CI 0.037 to 0.476,p=0.022)after adjustment for age,sex and Mini-Mental State Examination(MMSE)scores.However,such a difference or association did not appear in the left macular or bilateral peripapillary RNFL thicknesses.Conclusions Current findings demonstrated that preoperative macular thickness might serve as a potential non-invasive marker for the vulnerability of developing postoperative delirium in older surgical patients.Further large-scale validation studies should be performed to confirm these results.
基金supported by 2013 Beijing NOVA Program(Z131107000413044)
文摘Objective The inhalation anesthetic isoflurane has been shown to induce mitochondrial dysfunction and caspase activation, which may lead to learning and memory impairment. Ginsenoside Rgl is reported to be neuroprotective. We therefore set out to determine whether ginsenoside Rgl can attenuate isoflurane-induced caspase activation via inhibiting mitochondrial dysfunction. Methods We investigated the effects of ginsenoside Rgl at concentrations of 12.5, 25, and 50 μmol/L and pretreatment times of 12 h and 24 h on isoflurane-induced caspase-3 activation in H4 naive and stably transfected H4 human neuroglioma cells that express full-length human amyloid precursor protein （APP） （H4-APP cells）. For mitochondrial dysfunction, we assessed mitochondrial permeability transition pore （mPTP） and adenosine-5＇-triphosphate （ATP） levels. We employed Western blot analysis, chemiluminescence, and flowcytometry. Results Here we show that pretreatment with 50 μmol/L ginsenoside Rgl for 12 h attenuated isoflurane-induced caspase-3 activation and mitochondrial dysfunction in H4-APP cells, while pretreatment with 25 and 50 μmol/L ginsenoside Rgl for 24 h attenuated isoflurane-induced caspase-3 activation and mitochondrial dysfunction in both H4 naive and H4-APP cells. Conclusion These data suggest that ginsenoside Rgl may ameliorate isoflurane-induced caspase-3 activation by inhibiting mitochondrial dysfunction. Pending further studies, these findings might recommend the use of ginsenoside Rgl in preventing and treating isoflurane-induced neurotoxicity.
文摘Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure are performed with increasing frequency to treat patients with diffused peritoneal carcinomatosis. These procedures have showed to increase life expectancy in what was previously considered a "terminal condition". Anyway patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. Despite the need of an advanced organ monitoring and support all these derangements seem to be mild and short-lived when timely addressed, at least in the majority of patients. Intensive care physicians are involved in providing surveillance and organ support till the patient is effectively weaned after the operation. Moreover, the anesthesiologist as perioperative physician is involved in pain control, metabolic and nutritional support of this cohort of patients. This task can be challenging considering that part of the patients are already on a long list of pain control medication after previous surgery or chemotherapy. A malnourished state is common too and it is secondary to diffi cult feeding, wasting syndrome from the tumor and massive ascites. The last issue the anesthesiologists need to be aware of is the impact over the quality of life(Qo L) of this procedure. The patient's underlying pathology is unlikely to be defi nitively cured so no treatment is an acceptable choice. The possibility to withhold the treatments must be part of the consultation process like the discussion about the Qo L in the immediate, as well as in the long-term, after the operation. Careful monitoring and treatment of every aspect that can impact the Qo L must be taken and the efforts to be poured into an effective preservation of the Qo L must be doubled when compared with a patient scheduled for major abdominal surgery.
文摘Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.
文摘Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.
