Clinical- and surgery-specific risk factors for post-operative sepsis: a systematic review and meta-analysis of over 30 million patients

Surgery Today - Post-operative sepsis is a severe complication of surgery, which often worsens the clinical outcomes. While several risk factors have been identified, the importance of others...     

Treatments of unilateral neglect: a review

OBJECTIVES: To review the existing literature on treatments of unilateral neglect, to synthesize findings, and to offer recommendations for future studies. DATA SOURCES: Computerized databases including MEDLINE and PsychINFO. STUDY SELECTION: All studies investigating treatment(s) of unilateral neglect. DATA EXTRACTION: Authors reviewed design and other methodologic issues. DATA SYNTHESIS: Unilateral neglect is a common consequence of right-hemisphere stroke. It is well recognized that the disorder is heterogeneous and has numerous subtypes. There have been numerous studies showing that arousal, hemispheric activation, and spatial attention treatments may all improve neglect, at least transiently. Despite these promising outcomes, little consensus exists as to whether 1 treatment is more efficacious than others, in part because cross-study differences in methodology render meta-analyses difficult, and in part because many studies fail to document duration of treatment effects or generalization to daily activities. One possibility is that these varied and diverse treatments may all be effective, reflecting redundancy in neural circuits devoted to attention and action in space, and consequent flexibility of the spatial processing system. It remains possible, however, that different subtypes of neglect may respond differentially to treatment of various sorts. Most existing studies of neglect have relied on very small populations of neglect patients, whose neglect is characterized only generally. CONCLUSION: Methodologic shortcomings hinder assessment of the efficacy of various types of neglect treatment. In the future, these shortcomings could be addressed with larger studies of well-characterized patients that evaluate duration of treatment effects and include functional measures. In addition, the role of overarching variables, such as reduced arousal, requires consideration. The ultimate goal of these studies might be the development of triaging strategies wherein neglect patients are assigned to treatments of most likely benefit on the basis of neuroanatomic and behavioral profiles.     

Behavioral assessment of unilateral neglect: study of the psychometric properties of the Catherine Bergego Scale

OBJECTIVE: To assess the psychometric properties of a scale for spatial neglect in everyday life. DESIGN: Validation study. SETTING: A neurologic rehabilitation unit in a university hospital. PARTICIPANTS: Eighty-three consecutive right-hemisphere stroke patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Catherine Bergego Scale (CBS) was used to assess neglect behavior and anosognosia. Its sensitivity was compared with that of 3 conventional tests. The inner structure of the scale was studied by principal component analysis. In addition, linearity, unidimensionality, and reliability of the scale were tested through Rasch analysis. RESULTS: Behavioral assessment correlated significantly to, but was more sensitive than, conventional tests. Anosognosia correlated significantly with neglect severity, although individual dissociations occurred. Factorial analysis disclosed a single underlying factor, explaining 65.8% of total variance. Rasch analysis also revealed that the 10 items defined a common, single ability continuum with widespread measurement range and quite regular item distribution, and showed a satisfactory reliability. CONCLUSION: Behavioral assessment proved to be more sensitive than conventional paper and pencil tasks. Both conventional statistics and Rasch analysis suggest that the CBS is reliable and valid, and that the 10 items define a homogeneous construct.     

Novel heteroleptic complexes of titanium(IV) derived from 2-hydroxyacetophenone: synthesis, characterization, antibacterial and molecular docking studies

A few new and versatile complexes of titanium(IV) derived from 2-hydroxyacetophenone of the types {[(Ap)Ti(OPr ⁱ )_2?n (L₂) _n ] (2a, 2e and 2f)}, {[(Ap)Ti(L₁OR)(L₂)] (2b–2d, 2g–2i)} have been synthesized by the reaction of the precursor [(Ap)Ti(OPr ⁱ )₂] with different 2-heteroaryl methyl ketone oximes and alkoxyalkanols in various molar ratios in refluxing toluene yielded mono nuclear heteroleptic derivatives, {where, n = 1–2, HAp = 2-hydroxyacetophenone, Pr ⁱ  = isopropyl, L₁ = O–CH₂–CH₂?, R = CH₃, C₂H₅, C₄H₉ and HL₂=HONC(Me)py-2, HONC(Me)fu-2}. All these newly synthesized complexes were characterized by elemental analysis, mass, UV, FT-IR and NMR (¹H, ¹³C) spectral studies. The mass spectra of the newly synthesized molecules indicate their monomeric state. Spectral studies suggest the bonding between metal and ligands in a tetra coordinated fashion. Thermogravimetric analyses indicate the multistep decomposition of complexes resulting TiO₂ as the end product at 600 °C. Antibacterial activities of these complexes were also exercised. Complex 2e is equipotent to the standard drug against Pseudomonas aeruginosa and Escherichia coli. A keen molecular docking study revealed lesser docking scores of some of these complexes than that of the standard drug gentamicin.     

Comparison of Current Recommended Regimens of Atropinization in Organophosphate Poisoning

Atropine is the mainstay of therapy in organophosphate (OP) toxicity, though research and consensus on dosing is lacking. In 2004, as reported by Eddleston et al. (J Toxicol Clin Toxicol 42(6):865-75, 2004), they noted variation in recommended regimens. We assessed revisions of original references, additional citations, and electronic sources to determine the current variability in atropine dosing recommendations. Updated editions of references from Eddleston et al.’s work, texts of Internal and Emergency Medicine, and electronic resources were reviewed for atropine dosing recommendations. For comparison, recommendations were assessed using the same mean dose (23.4 mg) and the highest dose (75 mg) of atropine as used in the original paper. Recommendations were also compared with the dosing regimen from the World Health Organization (WHO). Thirteen of the original recommendations were updated and 15 additional references were added giving a convenience sample of 28. Sufficient information to calculate time to targeted dose was provided by 24 of these samples. Compared to 2004, current recommendations have greatly increased the speed of atropinization with 13/24 able to reach the mean and high atropine dose within 30 min compared to 1/36 in 2004. In 2004, there were 13 regimens where the maximum time to reach 75 mg was over 18 h, whereas now, there are 2. While only one recommendation called for doubling the dose for faster escalation in 2004, 15 of the 24 current works include dose doubling. In 2004, Eddleston et al. called for an evidence-based guideline for the treatment of OP poisoning that could be disseminated worldwide. Many current recommendations can adequately treat patients within 1 h. While the WHO recommendations remain slow to treat patients with OP poisoning, other authorities are close to a consensus on rapid atropinization.     

Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?

Objective

To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management.

Methods

We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick’s classification.

Results

Before TMT, thrombus level was staged I for 1 (7 %), II for 10 (72 %) and III (21 %) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1–5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43 %) patients had a measurable decrease, 6 (43 %) had no change, and 2 (14 %) had an increase in the thrombus. One patient (7 %) had a downstage of thrombus level, 12 (85 %) had stable thrombi, and 1 (7 %) had an upstage. Regarding primary tumor, 7 (50 %), 5 (36 %) and 2 (14 %) patients had a decrease, stabilization and an increase in tumor size, respectively.

Conclusion

Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.     

Skeletal muscle fibrosis and stiffness increase after rotator cuff tendon injury and neuromuscular compromise in a rat model

Rotator cuff tears can cause irreversible changes (e.g., fibrosis) to the structure and function of the injured muscle(s). Fibrosis leads to increased muscle stiffness resulting in increased tension at the rotator cuff repair site. This tension influences repairability and healing potential in the clinical setting. However, the micro‐ and meso‐scale structural and molecular sources of these whole‐muscle mechanical changes are poorly understood. Here, single muscle fiber and fiber bundle passive mechanical testing was performed on rat supraspinatus and infraspinatus muscles with experimentally induced massive rotator cuff tears (Tenotomy) as well as massive tears with chemical denervation (Tenotomy + BTX) at 8 and 16 weeks post‐injury. Titin molecular weight, collagen content, and myosin heavy chain profiles were measured and correlated with mechanical variables. Single fiber stiffness was not different between controls and experimental groups. However, fiber bundle stiffness was significantly increased at 8 weeks in the Tenotomy + BTX group compared to Tenotomy or control groups. Many of the changes were resolved by 16 weeks. Only fiber bundle passive mechanics was weakly correlated with collagen content. These data suggest that tendon injury with concomitant neuromuscular compromise results in extra‐cellular matrix production and increases in stiffness of the muscle, potentially complicating subsequent attempts for surgical repair. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1111–1116, 2014.     

Fibrosis in Hepatitis C Patients Predicts Complications After Elective Total Joint Arthroplasty

Effects of Hepatitis C on total hip (THA) and total knee arthroplasty (TKA) outcomes are poorly understood. Seventy-two hepatitis C patients underwent 77 primary THA or TKA and were retrospectively identified, stratified by fibrosis and thrombocytopenia and compared to matched controls. Overall, Hepatitis C and control patients had similar outcomes. After TKA, fibrotic hepatitis C patients demonstrated a greater average hemoglobin drop than non-fibrotic hepatitis C patients (4.9 versus 3.8, P = 0.023), greater deep infection rate (21% versus 0%, P = 0.047), and rate of cellulitis (21% versus 0%, P = 0.047). Thrombocytopenia showed a trend toward greater infections. Prior to fibrosis, Hepatitis C patients appear to be at no increased risk of complication after joint arthroplasty. Evaluation of fibrosis may predict poor outcome in Hepatitis C patients.