5366 research outputs found
Sort by
In vitro endothelial hyperpermeability occurs early following traumatic hemorrhagic shock.
No full textBACKGROUND
Endothelial hyperpermeability is suggested to play a role in the development of microcirculatory perfusion disturbances and organ failure following hemorrhagic shock, but evidence is limited.
OBJECTIVE
To study the effect of plasma from traumatic hemorrhagic shock patients on in vitro endothelial barrier function.
METHODS
Plasma from traumatic hemorrhagic shock patients was obtained at the emergency department (ED), the intensive care unit (ICU), 24 h after ICU admission and from controls (n = 8). Sublingual microcirculatory perfusion was measured using incident dark field videomicroscopy at matching time points. Using electric cell-substrate impedance sensing, the effects of plasma exposure on in vitro endothelial barrier function of human endothelial cells were assessed.
RESULTS
Plasma from traumatic hemorrhagic shock patients collected at ED admission induced a 19% loss of in vitro endothelial resistance compared to plasma from controls (p 0.99). Interestingly, in vitro endothelial resistance showed a positive association with in vivo microcirculatory perfusion (r = 0.56, p < 0.01).
CONCLUSIONS
Plasma from traumatic hemorrhagic shock patients obtained following ED admission, but not at later stages, induced in vitro endothelial hyperpermeability. This coincided with in vivo microcirculatory perfusion disturbances
Weight loss during medical weight management does not predict weight loss after bariatric surgery: a retrospective cohort study.
No full textBACKGROUND
Many bariatric surgical centers mandate achieving weight loss targets through medical weight management (MWM) programs before offering bariatric surgery, but the evidence for this is unclear.
OBJECTIVES
To examine the relationship between weight changes during (1) MWM, and (2) preoperative low-energy-diet (LED), and weight changes at 12 and 24 months after surgery.
SETTING
Multicenter community- and acute-based MWM services referring to one regional bariatric center, United Kingdom.
METHODS
A retrospective cohort study of patients who attended MWM and then underwent a primary laparoscopic bariatric procedure (adjustable gastric banding [LAGB], or Roux-en-Y gastric bypass [RYGB]) in a single bariatric center in the United Kingdom between 2013 and 2015. Data were collected from patient electronic records.
RESULTS
Two hundred eight patients were included (LAGB n = 128, RYGB n = 80). Anthropometric data were available for 94.7% and 88.0% of participants at 12 and 24 months, respectively. There was no relationship between weight loss during MWM and after surgery at either 12 or 24 months. Weight loss during the preoperative LED predicted greater weight loss after LAGB (β = .251, P = .006) and less weight loss after RYGB (β = -.390, P = .003) at 24 months, after adjusting for age, sex, ethnicity, baseline weight, and LED duration.
CONCLUSIONS
Weight loss in MWM does not predict greater weight loss outcomes up to 24 months after LAGB or RYGB. Greater weight loss during the preoperative LED predicted greater weight loss after LAGB and less weight loss after RYGB. Our results suggest that patients should not be denied bariatric surgery because of not achieving weight loss in MWM. Weight loss responses to preoperative LEDs as a predictor of postsurgical weight loss requires further investigation
What did the European Liver Transplant Registry bring to liver transplantation?
No full textSince its foundation in 1985, the European Liver Transplant Registry has evolved to become an important tool to monitor the liver transplantation activity in Europe. The vast amount of data collected on 169 473 liver transplantations performed in 153 238 recipients has also resulted in scientific publications. Without doubt, several of these have influenced the daily practice of liver transplantation. This paper gives an overview of the development, the functioning, and the scientific activity of the European Liver Transplant Registry during more than three decades. Indeed, it can be said that the registry helped to advance the practice of liver transplantation not only in Europe but also worldwide
Nicotinamide Adenine Dinucleotide Metabolome Is Functionally Depressed in Patients Undergoing Liver Transplantation for Alcohol-Related Liver Disease.
No full textNicotinamide adenine dinucleotide (NAD) and related coenzymes play critical roles in liver function. Although hepatic alcohol metabolism depresses NAD, current understanding of the NAD metabolome in alcohol-related liver disease (ArLD) is based on animal models. We used human liver samples to quantify the NAD metabolome in ArLD with samples obtained at the time of liver transplantation or resection at University Hospitals Birmingham National Health Service Foundation Trust. The severity of steatohepatitis in liver from patients with ArLD was assessed with standard liver function tests and histology. NAD-targeted quantitative metabolomic analysis of liver tissue was performed by liquid chromatography-tandem mass spectrometry. Seventy-two human liver specimens were analyzed, including 43 with ArLD. The NAD metabolome differed significantly between different types of liver disease (two-way analysis of variance [ANOVA], = 0.001). ArLD liver tissue showed markedly depressed concentrations of NAD (432 μM vs. 616 μM in normal liver) and precursor molecules nicotinic acid and nicotinamide riboside. There was a significant overall difference in the NAD metabolome between ArLD samples with and without steatohepatitis (two-way ANOVA, = 0.018). After correcting for multiple comparisons, a significant difference for individual components of the metabolome was observed for the concentration of NAD (mean, 462 μM vs. 322 μM; < 0.01 in nonsevere vs. severe alcoholic steatohepatitis, respectively). NAD concentration was inversely related to serum bilirubin concentration ( = -0.127; = 0.04) and positively correlated with myeloperoxidase activity ( = 0.31; = 0.003). The concentration of NAD and its precursor molecules are significantly reduced in ArLD and are associated with disease activity. : Liver samples from people with ArLD show depressed NAD and precursor levels as well as depressed myeloperoxidase activity
Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsions: a minimum 2-year follow-up study.
No full textThis study reports the arthroscopic ligament-specific repair of the triangular fibrocartilage complex (TFCC) that anatomically restores both the volar and dorsal radioulnar ligaments into their individual foveal footprints. Twenty-five patients underwent arthroscopic ligament-specific repair with clinical and radiological diagnoses of TFCC foveal avulsions. The mean age was 28 years (range 14-47) and the mean follow-up was 31 months (range 24-47). Following arthroscopic assessment, 20 patients underwent double limb radioulnar ligament repairs and five had single limb repairs. At final follow-up, there were significant improvements in wrist flexion-extension, forearm pronation-supination and grip strength. There were also significant improvements in pain and patient-reported outcomes as assessed by the patient-rated wrist evaluation, Disabilities of the Arm, Shoulder and Hand score and modified Mayo wrist scores. Arthroscopic ligament-specific repair of the TFCC does not require specialist dedicated equipment or consumables and offers a viable method of treating these injuries. IV
Urine metabolomic phenotyping for detection of adrenocortical carcinoma: still a long way to go - Authors' reply.
No full textSuspected food allergy in adults: mapping 208 open food challenges with allergy tests and risk stratification.
No full textEmotional Resilience and Bariatric Surgical Teams: a Priority in the Pandemic.
No full textThe infection control measures implemented as a result of COVID-19 led to a postponement of bariatric surgical procedures across many countries worldwide. Many bariatric surgical teams were in essence left without a profession, with many redeployed to other areas of clinical care and were not able to provide the levels of patient support given before COVID-19. As the pandemic continues, some restrictions have been lifted, with staff adjusting to new ways of working, incorporating challenging working conditions and dealing with continuing levels of stress. This article explores the concept of emotional labour, defined as 'inducing or suppressing feelings in order to perform one's work', and its application to multidisciplinary teams working within bariatric surgery, to offer insight into the mental health issues that may be affecting healthcare professionals working in this discipline
Outcomes of Cochlear Implantation in Patients with Superficial Siderosis: A Systematic Review and Narrative Synthesis.
No full textThis study aimed to establish outcomes following cochlear implantation (CI) in patients with superficial siderosis (SS). MEDLINE, Embase, Web of Science, Cochrane, and ClinicalTrials.gov databases were searched for this systematic review. No limits were placed on the language or the year of publication. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of a total of 46 studies, 19 studies met the inclusion criteria reporting outcomes in 38 patients. Of the 44 implants, 23 implants (52.27%) had good hearing outcomes at the last follow-up, 9 (20.45%) were initially beneficial for the patient, but then the performance deteriorated (4 of which were re-implanted), and 12 (27.27%) were not beneficial for the patient. All studies were classified as grade 4 studies using the Oxford Centre for Evidence-Based Medicine (OCEBM) grading system, being retrospective in nature and consisting of case reports and noncontrolled case series with a small number of patients. Of the 44 implants, 32 (72.73%) showed improved hearing outcomes following CI for SS at some point in time, of which 23 (52.2%) implants showed sustained benefit at the last follow-up (average follow-up time was 21.97 months). It is difficult to predict the longevity of benefit owing to the progressive nature of the disease or the patients in whom it may be beneficial, as the preoperative investigations inadequately predict benefit. Preimplantation and postimplantation counseling with the patient and their family regarding the potential limited benefit and eventual parallel decline with the neurological disease are crucial, along with thorough clinical investigations