Goal-directed fluid therapy in gastrointestinal cancer surgery:A prospective randomized study

Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included.Patients were randomized into 2 groups that received liberal fluid therapy(the LFT group,n=45)and goal-directed fluid therapy(the GDFT group,n=45).Patients’Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity(CR-POSSUM)physiological score,Charlson Comorbidity Index(CCI),perioperative vasopressor and inotrope use,postoperative AKIN classification,postoperative intensive care unit(ICU)hospitalization,hospital stay,and 30-day mortality were recorded.Results:The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group(P<0.05).CR-POSSUM physiological score and CCI were significantly higher in the GDFT group(P<0.05).Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group(P<0.05),postoperative acute kidney injury development was not affected.Postoperative mortality was determined to be similar in both groups(P>0.05).Conclusion:Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery,and it can prevent perioperative fluid overload,and the postoperative results are comparable in the two groups.     

Effects of Crataegus microphylla on Vascular Dysfunction in Streptozotocin‐induced Diabetic Rats

Vascular dysfunction plays a key role in the pathogenesis of diabetic vascular disease. In this study, we aimed to investigate whether chronic in vivo treatment of Crataegus microphylla (CM) extract in diabetic rats induced with streptozotocin (STZ, intraperitoneal, 65 mg/kg) preserves vascular function and to evaluate whether the reduction of inducible nitric oxide synthase (iNOS), proinflammatory cytokines, and lipid peroxidation mediates its mechanisms of action. Starting at 4 weeks of diabetes, CM extract (100 mg/kg) was administrated to diabetic rats for 4 weeks. In aortic rings, relaxation to acetylcholine and vasoreactivity to noradrenaline were impaired, whereas aortic iNOS expression and plasma tumor necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6), total nitrite–nitrate, and malondialdehite levels were increased in diabetic rats compared with controls. Chronic CM treatment significantly corrected all the above abnormalities in diabetic rats. In comparison, pretreatment of the aorta of diabetic rats with N‐[3(aminomethyl) benzyl]‐acetamidine, dihydrochloride (10^–5 M), a selective inhibitor of iNOS, produced a similar recovery in vascular reactivity. These results suggest that chronic in vivo treatment of CM preserves endothelium‐dependent relaxation and vascular contraction in STZ‐induced diabetes, possibly by reducing iNOS expression in the aorta and by decreasing plasma levels of TNF‐α and IL‐6 and by preventing lipid peroxidation. Copyright © 2012 John Wiley & Sons, Ltd.     

Plasma visfatin levels in preeclamptic and normal pregnancies

Objective  

Increasing evidences support the participation of adipokines in the pathogenesis of preeclampsia (PE). Visfatin is a novel adipokine secreted by fat tissue and macrophages and is involved in the regulation of glucose homeostasis. Our aim is to investigate visfatin levels in women with PE, women with the third trimester of normal pregnancy and healthy non-pregnant women.     

Immediate breastfeeding and skin-to-skin contact during cesarean section decreases maternal oxidative stress,a prospective randomized case-controlled study

Objective: Immediate skin-to-skin contact (ISSC) and early breastfeeding are recommended for the wellbeing of the neonate. In this study, we aimed to evaluate the effect of ISSC and early breastfeeding on maternal oxidative stress and postoperative pain.

Methods: A total of 90 patients were randomized into two groups based on the timing of skin-to-skin contact and breastfeeding. Group 1 (n?=?45) was provided ISSC and breastfeeding in the operating room during the cesarean section (C/S). Group 2 (n?=?45) breastfed their babies 1?h after the C/S. As markers of oxidative stress, maternal serum levels of total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress indices (OSI) were evaluated. Maternal oxytocin levels and the relation between these parameters and postoperative pain were also evaluated.

Results: The postoperative TAS levels were significantly higher, whereas TOS and OSI levels were lower in Group 1 than Group 2. Negative correlations between oxytocin level and postoperative TOS and OSI were observed, as was a positive correlation between oxytocin level and postoperative TAS.

Conclusions: The effect of ISSC and early breastfeeding on mothers was documented for the first time in this study. Our results demonstrated ISSC and early breastfeeding during C/S reduce maternal oxidative stress.     

Role of endometrial power Doppler ultrasound using the international endometrial tumor analysis group classification in predicting intrauterine pathology

Purpose

To assess the contribution of the terms and definitions recently described by international endometrial tumor analysis (IETA) group when evaluating endometrial lesions on power Doppler imaging.

Methods

Patients requiring endometrial sampling were examined prospectively by transvaginal B-mode and power Doppler sonography (PDS) the day before scheduled diagnostic procedure. Sonographic features were classified using IETA group classification. These were compared with the final histopathological diagnosis.

Results

Ninety-seven patients were included in the study. The histopathological diagnoses were as follows: endometrial polyp: 39 cases (40.2 %), endometrial hyperplasia: 9 cases (9.3 %), submucous myoma: 10 cases (10.3 %), endometrium cancer: 7 cases (7.2 %), non-specific findings: 32 cases (33 %). The sensitivity, specificity and positive and negative predictive values for single dominant or branching single dominant vessel pattern in diagnosing endometrial polyps were 66.67, 98.28, 96.3 and 81.43 %; for multiple vessels with focal origin pattern in diagnosing endometrial cancer, they were 42.86, 91.11, 27.27 and 95.35 %; for multifocal origin at the myometrial–endometrial junction in diagnosing other non-specific endometria, they were 81.25, 89.23, 78.79 and 90.62 %; for scattered vessel pattern in diagnosing endometrial hyperplasia, they were 88.89, 88.64, 44.4 and 98.73 % and for circular flow pattern in diagnosing submucosal fibroids, they were 80, 100, 100 and 97.75 %, respectively. The color score of the endometrium was not statistically different among different endometrial pathologies (P value >0.05).

Conclusion

The nomenclature described by IETA group for power Doppler assessment of the endometrium is clinically valuable and reasonable. Using this terminology, it will be easier to compare results of different studies on endometrial Doppler sonography in the future.