Surgery
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Predicting refractory coagulopathy early in resuscitation of injured patients may decrease a leading cause of preventable death. We hypothesized that clot strength (G) measured by point-of-care rapid thrombelastography (r-TEG) on arrival in the emergency department can predict massive transfusion (MT) and coagulation-related mortality (MT-death). ⋯ These data suggest that the point-of-care TEG parameter clot strength (G) provides consistent, independent prediction of MT and MT-death early in the resuscitation of injured patients.
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Carotid endarterectomy (CEA) reduces the risk of stroke in selected patients with symptomatic and asymptomatic carotid disease, but its beneficial influence on cognitive performance in the elderly remains debatable. This prospective study sought to determine early and long-term neurocognitive outcomes after CEA for severe unilateral carotid artery stenosis. ⋯ Our study showed that only elderly symptomatic patients with severe carotid lesions had a significant improvement in cognitive performance scores after CEA, although the benefit was considered clinically not significant. This suggests that CEA does not diminish neurocognitive functions, but it might provide some protection against cognitive decline in the elderly.
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Acute kidney injury secondary to renal ischemia and reperfusion injury is widely prevalent. Ghrelin, which is a stomach-derived peptide, has been shown to be anti-inflammatory. The purpose of this study was to examine whether human ghrelin has any beneficial effects after renal ischemia and reperfusion injury, and if so, whether ghrelin's action in renal ischemia and reperfusion injury is mediated by the vagus nerve. ⋯ Human ghrelin treatment in renal ischemia and reperfusion injured rats attenuated systemic and kidney-specific inflammatory responses. The protection of human ghrelin in renal ischemia and reperfusion injury was mediated by the vagus nerve. These data suggest that ghrelin can be developed as a novel treatment for patients with acute kidney injury induced by renal ischemia and reperfusion injury.
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Although the function of visceral fat has gradually become clear, the effects of its resection on insulin resistance and glucose metabolism are still unknown. This study aimed to clarify the effects of visceral fat resection and gastric banding in an obese diabetic rat model. ⋯ In diabetic fatty rats, the surgical removal of visceral fat effected some improvement in insulin resistance and glucose metabolism. Because the effect was relatively minimal compared with that of gastric banding, visceral fat resection combined with gastric banding did not appear to exert additional effects on insulin resistance and glucose metabolism compared with gastric banding alone.