Different Effects of Volatile and Nonvolatile Anesthetic Agents on Long-Term Survival in an Experimental Model of Hemorrhagic Shock

Background: We investigated whether the cardioprotective, volatile gas anesthetic agent, isoflurane, could improve survival and organ function from hemorrhagic shock in an experimental rat model, compared to standard nonvolatile anesthetic agent ketamine/xylazine. Methods: Sprague Dawley rats (both genders) were randomized to receive either intraperitoneal ketamine/xylazine (K/X, 90 and 10 mg/kg; n = 12) or isoflurane (5% isoflurane induction and 2% maintenance in room air; n = 12) for anesthesia. Blood was withdrawn to maintain mean arterial blood pressure at 30 mm Hg for 1 hour, followed by 30 minutes of resuscitation with shed blood. Rats were allowed to recover and survive for 6 weeks. Results: During the shock phase, the total withdrawn blood volume (expressed as % of estimated total blood volume) to maintain a level of hypotension of 30 mm Hg was significantly higher in the isoflurane group (51.0% ± 1.5%) than in the K/X group (45.3% ± 1.8%; P = .023). Recovery of blood pressure during the resuscitation phase was significantly improved in the isoflurane group compared to the K/X group. The survival rate at 6 weeks was 1 (8.3%) of 12 in rats receiving K/X and 10 (83.3%) of 12 in rats receiving isoflurane ( P < .001). Histology performed at 6 weeks demonstrated brain infarction in the 1 surviving rat receiving K/X; no brain infarction occurred in the 10 surviving rats that received isoflurane. No infarction was detected in heart, lung, liver, or kidneys among the surviving rats. Conclusions: Isoflurane improved blood pressure response to resuscitation and resulted in significantly higher long-term survival rate.

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Abstract 187: Effects of Anesthetic Agents on the Hemodynamic Stabilization and Long Term Survival in an Experimental Model of Hemorrhagic Shock

Circulation ◽

10.1161/circ.138.suppl_2.187 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Wangde Dai ◽

Jianru Shi ◽

Juan Carreno ◽

Sharon Hale ◽

Robert A Kloner

Keyword(s):

Blood Pressure ◽

Survival Rate ◽

Blood Volume ◽

Brain Infarction ◽

Term Survival ◽

Long Term Survival ◽

Shed Blood ◽

Anesthetic Agents ◽

Isoflurane Group

Background: We investigated the cardiovascular responses to acute bleeding and shed blood restoration under different anesthetic agents, and their effects on long-term survival rate after hemorrhagic shock in rats, after our initial pilot study suggested differences between anesthetics. Methods: Sprague Dawley rats (both genders) were randomized to receive either intraperitoneal ketamine/xylazine (K/X, 90 mg/kg and 10 mg/kg; n=12), or isoflurane (5% isoflurane induction and 2% maintenance in room air; n=12) for anesthesia. Blood was withdrawn from the carotid artery to maintain mean arterial blood pressure (MBP) at 30 mm Hg for one hour, followed by 30 min of resuscitation with shed blood. Rats remained anesthetized for another 30 min before they were allowed to recovery and survive for 6 weeks. Hemodynamics were monitored during the surgical procedure. Results: During the shock phase, the total withdrawn blood volume (expressed as % of estimated total blood volume) to maintain MBP at 30 mmHg was significantly higher in the isoflurane group (51 ± 1.5 %) compared to the K/X group (45.3 ± 1.8 %; p=0.023). The diastolic internal dimension of the left ventricle, which indicated circulating intravascular blood volume, was significantly larger in the isoflurane group at the end of 1 hour of the shock phase (4.5 ± 0.2 mm compared to 3.5 ± 0.2 mm in K/X group; p=0.0003) and at 1 hour after initiation of shed blood reinfusion (6.3 ± 0.2 mm compared to 5.3 ± 0.3 in K/X group; p=0.014). Recovery of blood pressure during the resuscitation phase was significantly improved in the isoflurane group compared to the K/X group. The survival rate at 6 weeks was 1 of 12 (8.3%) in rats receiving K/X and 10 of 12 (83.3%) in rats receiving isoflurane (p < 0.001). Histology demonstrated brain infarction in the 1 surviving rat receiving K/X; no brain infarction in the 10 surviving rats that received isoflurane at 6 weeks. No infarction was detected in heart, lung, liver or kidneys in all surviving rats. Conclusions: These results suggest that isoflurane stabilizes the cardiovascular response to acute blood lose and benefits the perfusion of tissue, which resulted in significantly higher long term survival rate and improved blood pressure response to resuscitation, without end-organ infarction.

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Blockade of Pancreatic Digestive Proteases in Severe Hemorrhagic Shock Enhances Long‐term Survival Rate

The FASEB Journal ◽

10.1096/fasebj.23.1_supplement.594.13 ◽

2009 ◽

Vol 23 (S1) ◽

Author(s):

Frank A DeLano ◽

Geert W Schmid‐Schönbein

Keyword(s):

Survival Rate ◽

Hemorrhagic Shock ◽

Term Survival ◽

Long Term Survival ◽

Digestive Proteases

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Abstract 186: Remote Limb Ischemic Preconditioning Improves Short and Long Term Survival and Maintains Intravascular Blood Volume During Resuscitation of Hemorrhagic Shock

Circulation ◽

10.1161/circ.138.suppl_2.186 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Wangde Dai ◽

Jianru Shi ◽

Juan Carreno ◽

Sharon Hale ◽

Robert A Kloner

Keyword(s):

Blood Pressure ◽

Hemorrhagic Shock ◽

Blood Volume ◽

Ischemic Preconditioning ◽

Control Group ◽

Term Survival ◽

Shed Blood ◽

Short And Long Term ◽

And Control

Background: We further examined the protective effects of experimental bilateral lower limb remote ischemic preconditioning (RIPC) in rats undergoing experimental hemorrhagic shock. Methods: Sprague Dawley rats (both genders) were randomized into RIPC (n= 26) or control group (n= 27), and anesthetized with intraperitoneal ketamine/xylazine. RIPC was induced by 4 cycles of inflating small bilateral pressure cuffs to 200 mmHg around the femoral arteries for 5 minutes, followed by 5 minute deflation of the cuffs. Hemorrhagic shock was induced by withdrawing blood from the carotid artery. Target mean blood pressure of 30 mmHg was maintained for 30 minutes followed by reinfusion of shed blood within the next 30 min. Rats remained anesthetized for another 30 min before recovery; endpoints were survival at 72 hours and 6 weeks. Results: The % of estimated total blood volume withdrawn to maintain a level of 30 mmHg was similar in the RIPC group (41.7 ± 1.0 %) and control group (41.9 ± 1.0 %). Recovery of blood pressure during the early resuscitation phase was significantly improved in the RIPC group. The diastolic internal dimension of the left ventricle (echocardiogram), which indicates circulating intravascular blood volume, was significantly larger in the RIPC group at 1 hour after initiation of shed blood reinfusion (5.8 ± 0.1 mm) compared to 5.4 ± 0.1mm in the control group (p=0.04). Left ventricular fractional shortening was comparable between RIPC (50.9 ± 1.9 %) and control group (49.6 ± 1.8 %; p=0.64) at 1 hour after initiation of resuscitation. At 48 hours after shock, BUN was within normal range in the RIPC group (17.3 ± 1.2 mg/dl); but elevated in the control group (22.0 ± 1.7 mg/dl). At 72 hours after hemorrhagic shock injury, 6 of 27 (22.2 %) rats in the control group and 13 of 26 (50 %, p = 0.047) rats in the RIPC group survived. At 6 weeks, 5 of 27 (18.5 %) rats in the control group and 13 of 26 (50 %; p = 0.021) rats in the RIPC group survived. RIPC significantly increased survival rate at both 72 hours and 6 weeks. Conclusions: RIPC improved recovery of blood pressure and maintained more circulating intravascular blood volume in the early phase of resuscitation, improved BUN, and markedly and significantly improved short and long term survival in rats subjected to hemorrhagic shock.

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Abstract 216: Therapeutic Hypothermia Alone and in Combination With Preconditioning Improves Long Term Survival During Resuscitation of Hemorrhagic Shock

Circulation ◽

10.1161/circ.140.suppl_2.216 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Wangde Dai ◽

Jianru Shi ◽

Juan Carreno ◽

Robert A Kloner

Keyword(s):

Blood Pressure ◽

Hemorrhagic Shock ◽

Therapeutic Hypothermia ◽

Mean Blood Pressure ◽

Control Group ◽

Sprague Dawley ◽

Term Survival ◽

Long Term Survival ◽

Combination Study

Background: We investigated the effects of hypothermia treatment alone and in combination with experimental bilateral lower limb remote ischemic preconditioning (RIPC) in rats undergoing experimental hemorrhagic shock. Previously we showed that RIPC alone improved survival. Methods: In the hypothermia alone study, adult Sprague Dawley rats (both genders) were randomized to hypothermia (n=16) or control group (n=15); in a combination study, rats were randomized to hypothermia plus RIPC (n=11) or control group (n=10). Rats were anesthetized with intraperitoneal ketamine/xylazine. Therapeutic hypothermia (Thermosuit) was started at 5 minutes after mean blood pressure (MBP) reached 30 mmHg. Core temperature was maintained at ~ 32 °C until blood volume was fully restored. RIPC was induced by 4 cycles of inflating small bilateral pressure cuffs to 200 mmHg around the femoral arteries for 5 minutes, followed by 5 minute deflation of the cuffs prior to hemorrhagic shock. In the control group, body temperature was maintained at 37 °C during the procedure. Hemorrhagic shock was induced by withdrawing blood from the carotid artery. Target mean blood pressure of 30 mmHg was maintained for 30 minutes followed by reinfusion of shed blood within the next 30 min. Rats were allowed recovery and the primary endpoint was survival rate at 6 weeks. Results: In the setting of hypothermia alone, 4 of 15 (26.7 %) rats in the control group and 11 of 16 (68.8 %; p = 0.032) rats in the hypothermia group survived at 6 weeks. In the combination study, 1 of 10 (10 %) rats in the control group and 7 of 11 (63.6 %; p = 0.024) rats in the hypothermia plus RIPC group survived at 6 weeks. Kaplan Meier Survival Curves are shown in Fig1. Conclusions: Hypothermia alone and combination with RIPC significantly improved long term survival in rats subjected to hemorrhagic shock. Hypothermia and RIPC did not show survival rates greater than hypothermia alone.

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The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

Cancer Control ◽

10.1177/1073274821997430 ◽

2021 ◽

Vol 28 ◽

pp. 107327482199743

Author(s):

Ke Chen ◽

Xiao Wang ◽

Liu Yang ◽

Zheling Chen

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Survival Rate ◽

Meta Analysis ◽

Response Rates ◽

Control Group ◽

Term Survival ◽

Long Term Survival ◽

And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

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Long-term survival rate of teeth receiving multidisciplinary endodontic, periodontal and prosthodontic treatments

Journal of Oral Rehabilitation ◽

10.1111/joor.12136 ◽

2014 ◽

Vol 41 (3) ◽

pp. 236-242 ◽

Cited By ~ 6

Author(s):

A. S. Moghaddam ◽

G. Radafshar ◽

M. Taramsari ◽

F. Darabi

Keyword(s):

Survival Rate ◽

Term Survival ◽

Long Term Survival

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Octogenarian Patients with Colon Cancer – Postoperative Morbidity and Mortality are the Major Challenges

10.21203/rs.3.rs-911268/v1 ◽

2021 ◽

Author(s):

Øystein Høydahl ◽

Tom-Harald Edna ◽

Athanasios Xanthoulis ◽

Stian Lydersen ◽

Birger Henning Endreseth

Keyword(s):

Colon Cancer ◽

Survival Rate ◽

Emergency Surgery ◽

Relative Survival ◽

Curative Intent ◽

Term Survival ◽

Younger Patients ◽

Long Term Survival ◽

Over Time

Abstract Background Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. Methods All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 100-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.Results Among 239 octogenarian patients treated with major resections with curative intent, the 100-day mortality was 10.1%. Among 215 patients that survived the first 100 days, the five-year relative survival rate was 99.7%. The 100-day mortality of octogenarian patients was significantly shorter than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 100-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 100‑day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 100-day mortality was high, but after surviving 100 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 100-day mortality risk.

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