Effect of volatile and total intravenous anesthesia on syndecan-1 shedding after minimally invasive gastrectomy: a randomized trial

AbstractThis study aimed to compare the effects of volatile anesthesia and total intravenous anesthesia (TIVA) on syndecan-1 shedding in patients with gastric cancer undergoing minimally invasive gastrectomy. Patients were randomly assigned to either the Volatile (n = 68) or the TIVA (n = 68) group. Anesthesia was maintained with sevoflurane/remifentanil or propofol/remifentanil in the Volatile and TIVA groups, respectively. Serum syndecan-1 was evaluated at pre-operation, end of operation, and postoperative day (POD) 1. Inflammatory markers including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), were also measured at pre-operation, end of operation, and POD 1, 2, 3, and 5. The TIVA group showed significantly lower levels of syndecan-1 at the end of the operation compared to the Volatile group; however, no difference was seen between the groups at POD 1. The WBC count and NLR were significantly lower in the TIVA group at the end of the operation than the Volatile group, but there were no differences between the groups at POD 1, 2, 3, and 5. CRP levels were similar between the groups at all time points. In conclusion, despite TIVA being superior to volatile anesthesia in protecting endothelial glycocalyx during the operation, both did not prevent postoperative syndecan-1 shedding after gastrectomy.Clinical trial registration number: NCT04183296 (ClinicalTrial.gov, 03/12/2019).

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The Effect of Total Intravenous Anesthesia and Volatile Anesthesia on Shedding of the Endothelial Glycocalyx in Patients Undergoing Laparoscopic or Robotic Assisted Gastrectomy

Case Medical Research ◽

10.31525/ct1-nct04183296 ◽

2019 ◽

Author(s):

Keyword(s):

Total Intravenous Anesthesia ◽

Endothelial Glycocalyx ◽

Intravenous Anesthesia ◽

Robotic Assisted ◽

Volatile Anesthesia

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Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis

Journal of Orthopaedic Surgery ◽

10.1177/2309499020968296 ◽

2020 ◽

Vol 29 (1) ◽

pp. 230949902096829

Author(s):

Christina van Gerven ◽

Kevin Eid ◽

Tobias Krüger ◽

Michael Fell ◽

Daniel Kendoff ◽

...

Keyword(s):

Antibiotic Treatment ◽

Serum Levels ◽

Blood Chemistry ◽

Nonoperative Treatment ◽

C Reactive Protein ◽

Disc Disease ◽

Reactive Protein ◽

Postoperative Serum ◽

Wbc Count ◽

And Control

Purpose: C-reactive protein (CRP) and white blood cell (WBC) count are routine blood chemistry parameters in monitoring infection. Little is known about the natural history of their serum levels in conservative and operative spondylodiscitis treatment. Methods: Pre- and postoperative serum levels of CRP and WBC count in 145 patients with spondylodiscitis were retrospectively assessed. One hundred and four patients were treated by debridement, spondylodesis, and an antibiotic regime, 41 only with a brace and antibiotics. The results of the surgical group were compared to 156 patients fused for degenerative disc disease (DDD). Results: Surgery had a significant effect on peak postoperative CRP levels. In surgically managed patients, CRP peaked at 2–3 days after surgery (spondylodiscitis: pre-OP: 90 mg/dl vs. post-OP days 2–3: 146 mg/dl; DDD: 9 mg/dl vs. 141 mg/dl; p < 0.001), followed by a sharp decline. Although values were higher for spondylodiscitis patients, dynamics of CRP values were similar in both groups. Nonoperative treatment showed a slower decline. Surgically managed spondylodiscitis showed a higher success rate in identifying bacteria. Specific antibiotic treatment led to a more predictable decline of CRP values. WBC did not show an interpretable profile. Conclusion: CRP is a predictable serum parameter in patients with spondylodiscitis. WBC count is unspecific. Initial CRP increase after surgery is of little value in monitoring infection. A preoperative CRP value, and control once during the first 3 days after surgery is sufficient. Closer monitoring should then be continued. Should a decline not be observed, therapy needs to be scrutinized, antibiotic treatment reassessed, and concomitant infection contemplated.

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Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00074-y ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Ademola Olusegun Talabi ◽

Tewogbade Adeoye Adedeji ◽

Oludayo Adedapo Sowande ◽

Olusanya Adejuyigbe

Keyword(s):

Acute Appendicitis ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

C Reactive Protein ◽

Blood Cell Count ◽

Alvarado Score ◽

Reactive Protein ◽

Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

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The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

Acute Medicine Journal ◽

10.52964/amja.0655 ◽

2017 ◽

Vol 16 (2) ◽

pp. 52-59

Author(s):

Sotirios Kakavas ◽

◽

Aggeliki Papanikolaou ◽

Evangelos Balis ◽

Evgenios Metaxas ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Increased Risk ◽

Preliminary Study ◽

Wbc Count ◽

A Prospective Study ◽

Acute Pe

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death. These findings require further prospective validation.

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Abstract 35: Common Variants in the CRP Promoter are Associated with a High C-reactive Protein Level in Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.35 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Jae-Jung Kim ◽

Sin Weon Yun ◽

Jeong Jin Yu ◽

Kyung Lim Yoon ◽

Kyung-Yil Lee ◽

...

Keyword(s):

Kawasaki Disease ◽

Phenotypic Variation ◽

Genome Wide Association Study ◽

Replication Study ◽

Common Variants ◽

C Reactive Protein ◽

Reactive Protein ◽

A Genome ◽

Wbc Count ◽

Stage 1

Kawasaki disease (KD) is an acute self-limiting form of vasculitis that afflicts infants and children and manifests as fever and signs of mucocutaneous inflammation. Children with KD show various laboratory inflammatory abnormalities, such as elevations in their white blood cell (WBC) count, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR). We here performed a genome-wide association study (GWAS) of 178 KD patients to identify the genetic loci that influence 10 important KD laboratory markers: WBC count, neutrophil count, platelet count, CRP, ESR, hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, and total protein. A total of 165 loci passed our arbitrary stage 1 threshold for replication ( p < 1 * 10 -5 ). Of these, only 2 SNPs (rs12068753 and rs4786091) demonstrated a significant association with the CRP level in replication study of 473 KD patients ( p < 0.05). The SNP located at the CRP locus (rs12068753) demonstrated the most significant association with CRP in KD patients (beta = 4.73 and p = 1.20 * 10 -6 according to the stage 1 GWAS; beta = 3.65 and p = 1.35 * 10 -8 according to the replication study; beta = 3.97 and p = 1.11 * 10 -13 according to combined analysis) and explained 8.1% of the phenotypic variation observed. However, this SNP did not demonstrate any significant association with CRP in the general population (beta = 0.37 and p = 0.1732) and only explained 0.1% of the phenotypic variation in this instance. Furthermore, rs12068753 did not affect the development of coronary artery lesions or intravenous immunoglobulin resistance in KD patients. These results indicate that common variants in the CRP promoter can play an important role in the CRP levels in KD.

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The influence of propofol-based total intravenous anesthesia on postoperative outcomes in end-stage renal disease patients: A retrospective observation study

PLoS ONE ◽

10.1371/journal.pone.0254014 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254014

Author(s):

Ho Bum Cho ◽

Mun Gyu Kim ◽

Sun Young Park ◽

Sanghoon Song ◽

Youn Sil Jang ◽

...

Keyword(s):

Chloride Concentration ◽

Postoperative Outcome ◽

Total Intravenous Anesthesia ◽

Cardiac Events ◽

Observation Study ◽

Intravenous Anesthesia ◽

Volatile Anesthesia ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background To determine whether the anesthetic method of propofol total intravenous anesthesia (TIVA) is associated with postoperative outcome in ESRD patients, we evaluated the incidence of postoperative major adverse cardiac events (MACE), comparing propofol TIVA versus anesthesia with volatile anesthesia in ESRD patients. Methods Retrospectively, we identified cases with ESRD patients who underwent surgery under general anesthesia. Patients were divided into those who received only volatile anesthesia (volatile group) and those who received only propofol TIVA (TIVA group). The incidence of MACE and potential confounding variables were compared separately in a univariate logistic model and subsequently by multivariate logistic regression. Results Among the 2576 cases in ESRD patients, 1374 were in the TIVA group and 1202 were in the volatile group. The multivariate analysis included 12 factors, including the anesthesia method, of which five factors were significant. Factors that were associated with a significantly lower MACE risk included preoperative chloride concentration (OR: 0.96; 95% CI, 0.92–0.99), baseline SBP (OR: 0.98; 95% CI, 0.98–0.99), and propofol TIVA (OR: 0.37; 95% CI, 0.22–0.60). Conclusions We inferred that the anesthetic method associated with the postoperative outcome in patients with ESRD.

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Acute phase proteins in bitches subjected to conventional and minimally invasive ovariohysterectomy

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-5132 ◽

2018 ◽

Vol 38 (11) ◽

pp. 2124-2128 ◽

Cited By ~ 1

Author(s):

Elizabeth M.S. Schmidt ◽

Camila P. Rubio ◽

Funmilola Thomas ◽

João C.P. Ferreira ◽

David P. Eckersall

Keyword(s):

Minimally Invasive ◽

Acute Phase ◽

Acute Phase Proteins ◽

C Reactive Protein ◽

Reactive Protein ◽

Serum Haptoglobin ◽

Hemoglobin Binding ◽

Mixed Breed ◽

Significant Difference ◽

Haptoglobin Concentration

ABSTRACT: The aim of this study was to evaluate and to compare the possible inflammatory changes by screening acute phase proteins concentrations in healthy bitches subjected to ovariohysterectomy. Minimally invasive and conventional (laparotomy) ovariohysterectomies were performed in 17 client-owned adult female mixed breed dogs. Nine animals were subjected to minimally invasive and eight animals to conventional ovariohysterectomy. Blood samples were taken before surgery, 24, 48 hours, and seven days postoperatively. Serum C-reactive concentration was determined by a commercial ELISA kit and serum haptoglobin concentration was measured via hemoglobin binding assay, both previously validated for use in dogs. As the data did not meet the normal distribution criteria, the nonparametric Kruskall-Wallis was performed to compare quantitative variables between groups. One-way ANOVA and the Friedman test were used for multiple comparisons between time points, with a P<0.05 considered significant. C-reactive protein concentration was significantly different (P<0.0001) at 24 hours postoperatively between groups. There was no significant difference in haptoglobin concentration between groups. C-reactive protein and haptoglobin concentrations were significantly different at 24 and 48 hours postoperatively for minimally invasive and conventional ovariohisterectomies. These findings provided an overview of the short-term inflammatory effects produced by minimally invasive and conventional ovariohysterectomies.

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O181 SERUM C-REACTIVE PROTEIN CAN BE AN EARLY PREDICTOR OF LENGHT OF HOSPITAL STAY AFTER MINIMALLY INVASIVE OESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doz092.181 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Gabriele Corsi ◽

Krashna Patel ◽

Omar Abbassi ◽

Zobia Gudkalli ◽

David O’Hara ◽

...

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Hospital Stay ◽

Acute Phase Protein ◽

C Reactive Protein ◽

Operative Morbidity ◽

Reactive Protein ◽

Operative Recovery ◽

Minimally Invasive Oesophagectomy ◽

Overall Mortality

Abstract Aim Oesophagectomy is associated with a significant number of potential complications affecting the lenght of the post-operative recovery. Serum C-reactive protein (CRP) is an acute phase protein which has been linked to early detection of post-operative complications, including but not limited to anastomotic leak. The aim of this retrospective study was to investigate the value of CRP elevation in the early post-operative days as a predictor of lenght of Hospital stay after minimally invasive oesophagectomy for cancer. Background and Methods The study group included 88 patients undergoing minimally invasive oesophagectomy for cancer from September 2017 to April 2019. CRP values on post-operative day 1,3,5 and 7 were retrieved and correlated to overall lenght of stay. Post-operative morbidity and mortality were also recorded. Results The approach was fully minimally invasive in 65 patients (74%) and hybrid in the remaining 23 (26%). The median length of stay was 11 days (IQR, 6-105 days) with overall mortality of 3.4% (n=3). Gastro-intestinal complications occurred in 15 patients (17%). The overall surgical or endoscopic re-intervention rate was 13.6% (n=12). The median CRP value was 54.8, 167, 143 and 134 mg/L, respectively on day 1,3,5 and 7. There was a positive correlation between CRP and length of stay on day 1, 3 and 7. A cut-off value of 167 mg/L on day 3 appeared to be a significant predictor of increased lenght of stay (12.8 vs 23.3 days, p=0.008). Conclusion CRP levels above 167mg/L on post-operative day 3 were associated with a prolonged lenght of hospital stay in our group of patients. Elevated CRP in the early post-operative period could represent a useful tool to predict lenght of stay after minimally invasive oesophagectomy.

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Serum C - Reactive Protein, White Cell Counts and Neutrophil Percentage are Predictors For Distal Ureteric Calculus Expulsion Rate: A Prospective Study

Journal of Nobel Medical College ◽

10.3126/jonmc.v8i1.24479 ◽

2019 ◽

Vol 8 (1) ◽

pp. 58-62

Author(s):

Ram Sagar Shah ◽

Kaushal Sigdel

Keyword(s):

Cell Count ◽

White Cell Count ◽

White Cell ◽

C Reactive Protein ◽

Expulsion Rate ◽

Reactive Protein ◽

Ureteric Calculus ◽

Cell Counts ◽

Neutrophil Percentage ◽

Wbc Count

Background: To determine the relationship between expulsion rate of distal ureteric calculus less than orequal to 10mm in size and C reactive protein (CRP) level, white cell count and neutrophil percentage. Materials and Methods: A total of 186 patients with distal ureteric calculus of ≤10mm were evaluated for stone expulsion rate and its correlation with serum CRP, white cell count and neutrophil percentage. All patients received tablet Tamsulosin 0.4mg for 4 weeks or till the expulsion of stone. Patients were called weekly till 4 weeks, or early if there was history of stone expulsion. Patients were divided in two groups according to normal and elevated CRP levels, white cell count and neutrophil percent age at baseline for statistical analysis. Results: The patients had an average age of 35.6 } 13.9 years. 52.2% were male. Ratio of right to left was1.58:1. Majority of the patients with distal ureteric calculus ≤ 10mm passed their stone (74.7 %) with medical expulsion therapy. Expulsion of stone less than 5mm was statistically significant (p0.017). Patients with normal neutrophil percentage and normal CRP level had higher stone expulsion rate than elevated neutrophil or CRP (85.2% vs. 40.9, 91.8% vs. 30.8% respectively).In patients with normal white cell count, 86.4% passed their stone while in elevated white cellcount group 39.1% passed their stone. Conclusion: This study showed patients with distal ureteric calculus of ≤10mmwith normal CRP level and normal neutrophil count had higher expulsion rate while WBC count showed no statistically significant association.

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