EP.WE.629The effect of different anaesthetic agents in postsurgical inflammatory response in thoracic surgery: a systematic review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Julian Aquilina ◽  
Georgios Geropoulos ◽  
Ioannis Loufopoulos ◽  
Anaya Gupte ◽  
Sofoklis Mitsos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Inflammatory Response ◽  
Thoracic Surgery ◽  
Cellular Response ◽  
Interferon Γ ◽  
Anaesthetic Agents ◽  
Systemic Inflammatory Reaction ◽  
Immunological Effects ◽  
Immune Changes ◽  
The Impact

Abstract Aims Post-operative systemic inflammatory reaction is part of the stress response caused by major thoracic surgery. Different anaesthetic agents used affect different immunological phenomena. This systematic review evaluates the impact of anaesthetic agents on the immunological profile and the associated clinical significance. Methods A systematic review of MEDLINE, EMBASE and Cohrane databases to explore how different anaesthetic agents affect post-operative inflammatory response. Results A total of nine studies were included in our analysis. Peri-operative use of dexmedetomidine, propofol, sevoflurane, isoflurane, ropivacaine, sufentanil, naloxone and clonidine were compared, based on their effect on the systemic release of inflammatory markers. Variance on the levels of the circulating inflammatory molecules such as interleukins, interferon-γ, tumor necrosis factor a and on the cellular response including natural killer, CD4 and CD8 T cells, were observed among different anaesthetic agents. Conclusions Inflammation improves immunity and regenerative cell recruitment, however excessive responses can lead to delayed wound healing, organ dysfunction and increased morbidity and mortality. There is still uncertainty regarding the role of immune changes on clinical outcomes of patients undergoing thoracic surgery, and more research is needed to explore other immunological effects related to anaesthetic agents.

scholarly journals Relationship between nutritional status and the systemic inflammatory response: micronutrients

2018 ◽  
Vol 78 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Donald C. McMillan ◽  
Donogh Maguire ◽  
Dinesh Talwar
Keyword(s):  
Systematic Review ◽  
Inflammatory Response ◽  
Nutritional Status ◽  
Systemic Inflammatory Response ◽  
The Body ◽  
Acute Injury ◽  
Chronic Injury ◽  
Micronutrient Status ◽  
The Impact ◽  
Present Systematic Review

Micronutrients such as trace elements and vitamins are important as enzyme cofactors in the metabolism of all cells in the body and therefore key to determining nutritional status. The present systematic review examined the evidence of the impact of the systemic inflammatory response on plasma micronutrient status in acute (surgical) and chronic tissue injury. A literature review using targeted subject headings was carried out. Plasma C-reactive protein was used to classify minor (<10 mg/l), moderate (11–80 mg/l) and major (>80 mg/l) inflammation. The literature search produced 2344 publications and plasma vitamin D, zinc and carotenoids were most commonly studied and plasma vitamins K, B2and B6were least studied. In acute injury thirteen studies (all prospective) and in chronic injury twenty-four studies (largely retrospective) were included in the review. There was consistent evidence that most common measured micronutrients in the plasma (zinc, selenium, vitamins A, D, E, K, B2, B6, B12, C, lutein, lycopene, α- and β-carotene) were significantly lowered from minor to moderate to major inflammation. The results of the present systematic review indicate that most plasma micronutrients fall as part of the systemic inflammatory response irrespective of acute or chronic injury. Therefore, in the presence of a systemic inflammation, plasma micronutrient concentrations should be interpreted with caution. There are a number of methods applied to adjust plasma micronutrient concentrations to avoid misdiagnosis of deficiency. Alternatively, intracellular measurements appear to obviate the need for such plasma adjustment to assess micronutrient status.

scholarly journals Clostridium Collagenase Impact on Zone of Stasis Stabilization and Transition to Healthy Tissue in Burns

2021 ◽  
Vol 22 (16) ◽  
pp. 8643
Author(s):  
Rosanne E. Frederick ◽  
Robert Bearden ◽  
Aleksa Jovanovic ◽  
Nasreen Jacobson ◽  
Rajiv Sood ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Cellular Response ◽  
Burn Injury ◽  
Macrophage Polarization ◽  
Clinical Results ◽  
Burn Wounds ◽  
Inflammatory Microenvironment ◽  
Collagenase Treatment ◽  
Dermal Collagen ◽  
The Impact

Clostridium collagenase has provided superior clinical results in achieving digestion of immediate and accumulating devitalized collagen tissue. Recent studies suggest that debridement via Clostridium collagenase modulates a cellular response to foster an anti-inflammatory microenvironment milieu, allowing for a more coordinated healing response. In an effort to better understand its role in burn wounds, we evaluated Clostridium collagenase’s ability to effectively minimize burn progression using the classic burn comb model in pigs. Following burn injury, wounds were treated with Clostridium collagenase or control vehicle daily and biopsied at various time points. Biopsies were evaluated for factors associated with progressing necrosis as well as inflammatory response associated with treatment. Data presented herein showed that Clostridium collagenase treatment prevented destruction of dermal collagen. Additionally, treatment with collagenase reduced necrosis (HMGB1) and apoptosis (CC3a) early in burn injuries, allowing for increased infiltration of cells and protecting tissue from conversion. Furthermore, early epidermal separation and epidermal loss with a clearly defined basement membrane was observed in the treated wounds. We also show that collagenase treatment provided an early and improved inflammatory response followed by faster resolution in neutrophils. In assessing the inflammatory response, collagenase-treated wounds exhibited significantly greater neutrophil influx at day 1, with macrophage recruitment throughout days 2 and 4. In further evaluation, macrophage polarization to MHC II and vascular network maintenance were significantly increased in collagenase-treated wounds, indicative of a pro-resolving macrophage environment. Taken together, these data validate the impact of clostridial collagenases in the pathophysiology of burn wounds and that they complement patient outcomes in the clinical scenario.

Systematic review methodology for development: An example from microfinance

2018 ◽  
Vol 43 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Carina Van Rooyen ◽  
Ruth Stewart ◽  
Thea De Wet
Keyword(s):  
Systematic Review ◽  
International Development ◽  
Health Sector ◽  
Evidence Based ◽  
Systematic Review Methodology ◽  
Development Interventions ◽  
The Us ◽  
Sub Saharan ◽  
The Impact ◽  
Evidence Based Decision Making

Big international development donors such as the UK’s Department for International Development and USAID have recently started using systematic review as a methodology to assess the effectiveness of various development interventions to help them decide what is the ‘best’ intervention to spend money on. Such an approach to evidence-based decision-making has long been practiced in the health sector in the US, UK, and elsewhere but it is relatively new in the development field. In this article we use the case of a systematic review of the impact of microfinance on the poor in sub-Saharan African to indicate how systematic review as a methodology can be used to assess the impact of specific development interventions.

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