scholarly journals Intraoperative Dexmedetomidine in Peripheral or Emergency Neurologic Surgeries of Patients With Mild-to-Moderate Traumatic Brain Injuries: A Retrospective Cohort Study

Dose-Response ◽  
2020 ◽  
Vol 18 (2) ◽  
pp. 155932582092011
Author(s):  
Qin Ding ◽  
Xianhe Zhang ◽  
Peng Chen
Keyword(s):  
Superoxide Dismutase ◽  
Cohort Study ◽  
Animal Models ◽  
Normal Saline ◽  
Retrospective Cohort ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Blood Biomarkers ◽  
Level Of Evidence ◽  
Antioxidant Effects

Background: Although animal models have demonstrated dexmedetomidine (DEX) as neuroprotective in craniocerebral and subarachnoid injuries, but its role in humans remains to be elucidated. The objectives of the study were to compare plasma brain-derived neurotrophic factor (BDNF), cytokine, and superoxide dismutase levels of patients between those who received intraoperative DEX and those who received intraoperative normal saline (NSE) during peripheral or emergency neurologic surgeries. Methods: Intra- and postoperative data of blood biomarkers and surgical outcomes of patients who underwent peripheral or emergency neurologic surgeries with mild-to-moderate traumatic brain injuries were analyzed retrospectively. Patients received intraoperative DEX group (n = 109) or NSE group (n = 116). Results: At 15 minutes after intubation and before the operation, in the DEX group, plasma BDNF concentration decreased but remained much higher than the NSE group ( P < .0001, q = 15.82). After 24 hours of surgeries, levels of cytokine were higher in the NSE group than the DEX group ( P < .05 for all). Dexmedetomidine increased malondialdehyde ( P < .0001) and superoxide dismutase ( P < .0001) levels in DEX group. Conclusions: Intraoperative infusion of DEX may have a neuroprotective, anti-inflammatory, and antioxidant effects during peripheral or emergency neurologic surgeries. Level of Evidence: III.

scholarly journals Intraoperative Dexmedetomidine Versus Midazolam in Patients Undergoing Peripheral Surgery With Mild Traumatic Brain Injuries: A Retrospective Cohort Analysis

Dose-Response ◽  
2020 ◽  
Vol 18 (2) ◽  
pp. 155932582091634
Author(s):  
Jing Peng ◽  
Fujuan He ◽  
Chenguang Qin ◽  
Yuanyuan Que ◽  
Rui Fan ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Cohort Analysis ◽  
Traumatic Brain Injuries ◽  
Level Of Evidence ◽  
Group 4 ◽  
Retrospective Cohort Analysis ◽  
Mild Traumatic Brain Injuries ◽  
Postoperative Morphine ◽  
Antioxidant Effects ◽  
Morphine Equivalent

Background: The intra- and postoperative effects of dexmedetomidine are not completely consistent and midazolam/fentanyl is most widely used in peripheral surgeries. The objectives of the study were to evaluate the sedative, analgesic, hemodynamic, anti-inflammatory, and antioxidant effects of dexmedetomidine against midazolam in patients undergoing peripheral surgeries with mild traumatic brain injuries. Methods: Medical records of patients who underwent peripheral surgeries with mild traumatic brain injury were included in the analysis. Patients received intraoperative midazolam (MDZ cohort, n = 225) or dexmedetomidine (DEX cohort, n = 231). Pre-, intra-, and postoperative characteristics of patients were collected and analyzed. Results: After administration of anesthesia, up to 40 minutes, patients of the MDZ group had lower modified observer’s assessment of alertness/sedation score than those of the DEX group ( P = .041), but after 40 minutes, patients of the MDZ group had a higher score than those of the DEX group throughout surgeries ( P = 0.048). The DEX group has less requirements of postoperative morphine/equivalent doses than the MDZ group (4 ± 1 vs 5 ± 1, P < .0001, q = 18.451). Conclusions: Intraoperative DEX offers better sedation, postoperative analgesia, and clinical recovery for peripheral surgeries and suppresses inflammatory response. Level of Evidence: III.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

scholarly journals The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hao Li ◽  
Rui Li ◽  
L. L. Li ◽  
Wei Chai ◽  
Chi Xu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Periprosthetic Joint Infection ◽  
Retrospective Cohort Study ◽  
Persistent Infection ◽  
Retrospective Cohort ◽  
Joint Infection ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Coagulation Profile ◽  
Significant Difference

Abstract Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

The Change of Coagulation Profile in Two-staged Arthroplasty for Periprosthetic Joint Infection Patients：A Retrospective Cohort Study

2021 ◽  
Author(s):  
Hao Li ◽  
Rui Li ◽  
Liangliang Li ◽  
Chi Xu ◽  
Wei Chai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Periprosthetic Joint Infection ◽  
Retrospective Cohort Study ◽  
Persistent Infection ◽  
Retrospective Cohort ◽  
Joint Infection ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Coagulation Profile ◽  
Significant Difference

Abstract Aims：Periprosthetic joint infection (PJI) a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate 1) the change of coagulation profile in two-staged arthroplasty patients 2) the relationship between coagulation profile and the outcomes of reimplantation. Method: Between 2011 January and 2018 December, a total of 202 PJI patients who were performed with two-staged arthroplasty were included in this study initially. They were followed up at least 2 years and corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points 1) preresection and 2) preimplantation. Then, the difference of coagulation profile between preresection and preimplantation was evaluated. Besides, receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of coagulation profile and the change of coagulation profile for predicting persistent infection before reimplantation. Results: The levels of APTT, INR, platelet count, PT, TT and plasma fibrinogen before spacer implantation were significantly higher than that before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95%CI:(0.511,0.823) and 0.667 (95%CI: (0.526,0.808)), respectively.Conclusion: The coagulation profile before preresection is different from that before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of Evidence: level III, diagnostic study

Mild traumatic brain injuries with minor intracranial hemorrhage: Can they Be safely managed in the community? – A cohort study

2020 ◽  
Vol 76 ◽  
pp. 88-92 ◽  
Author(s):  
Sanjay Gupta ◽  
Haytham M.A. Kaafarani ◽  
Peter J. Fagenholz ◽  
Myriam Tabrizi ◽  
Martin Rosenthal ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intracranial Hemorrhage ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Mild Traumatic Brain Injuries

scholarly journals Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: a multicentre cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (3) ◽  
pp. e014472 ◽  
Author(s):  
Amélie Boutin ◽  
Lynne Moore ◽  
François Lauzier ◽  
Michaël Chassé ◽  
Shane English ◽  
...  
Keyword(s):  
Cohort Study ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Multicentre Cohort Study ◽  
Health Centres ◽  
Multicentre Cohort

Does Proximal Row Carpectomy Improve Union in Wrist Arthrodesis? A Retrospective Cohort Study

2021 ◽  
Author(s):  
John J. Bartoletta ◽  
Dana Rioux-Forker ◽  
Raahil S. Patel ◽  
Katharine M. Hinchcliff ◽  
Alexander Y. Shin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Plate Fixation ◽  
Proximal Row Carpectomy ◽  
Level Of Evidence ◽  
Wrist Arthrodesis ◽  
Hardware Failure ◽  
Therapeutic Study

Abstract Background Some surgeons advocate for concomitant proximal row carpectomy (PRC) with total wrist arthrodesis (TWA), though there are limited data to support or oppose this view. Questions/Purposes Does concomitant PRC improve rates of union, revision, hardware loosening, hardware failure, and hardware removal in TWA? Patients and Methods A retrospective cohort study of patients who underwent TWA with and without concomitant PRC between January 2008 and December 2018 was undertaken. Patients were included if they underwent TWA using a dorsal spanning plate. Patients were excluded if they underwent partial wrist arthrodesis, revision TWA, or TWA with nondorsal spanning plate fixation. Results A total of 183 wrists in 180 patients were included in the study, 96 (52.5%) in the TWA only and 87 (47.5%) in the TWA + PRC groups. Median clinical and radiographic follow-up was 18.0 months (3.0–133.0 months) in the TWA + PRC group and 18.5 months (2.0–126.0 months) in the TWA only group (p = 0.907). No difference in nonunion (TWA + PRC: 13/87 [14.9%], TWA only: 18/96 [18.8%], odds ratio: 0.76, p = 0.494), revision (TWA + PRC: 5/87 [5.75%], TWA only: 8/96 [8.33%], hazard ratio [HR]: 0.73, p = 0.586), loosening (TWA + PRC: 4/87 [4.60%], TWA only: 6/96 [6.25%], HR: 0.74, p = 0.646), failure (TWA + PRC: 5/87 [5.75%], TWA only: 4/96 [4.17%], HR: 1.55, p = 0.530), and removal (TWA + PRC: 12/87 [13.8%], TWA only: 16/96 [16.7%], HR: 0.84, p = 0.634) were identified. Conclusion Concomitant PRC might not improve rates of union or diminish complications in patient undergoing TWA. The role of PRC and the rationale for its use in TWA need to be individualized and discussed with patients prior to surgery. Level of Evidence This is a Level IV, therapeutic study.

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