scholarly journals Effect of preoperative carbohydrate intake on inflammatory factors and clinical outcomes in elderly patients undergoing radical prostatectomy: a single-center, double-blind randomized controlled trial

2020 ◽  
Author(s):  
Zhen Hu ◽  
Ji Liu ◽  
Wenchao Ma ◽  
Fen Wang
Keyword(s):  
Placebo Group ◽  
Radical Prostatectomy ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Operation Time ◽  
Inflammatory Factors ◽  
Blocking Group ◽  
Open Radical Prostatectomy ◽  
Water Blocking ◽  
First Time

Abstract BACKGROUND To investigate the advantages of Carbohydrate (CHO) in inflammatory factors, comfort and clinical outcomes in elderly patients with open radical prostatectomy. METHODS Patients of ≥ 65 years old with radical prostatectomy who underwent open radical prostatectomy were randomized to the CHO group, placebo group, and conventional water-blocking group. Patients in the CHO group and placebo group received oral CHO, 800 ml of placebo water before surgery,and oral CHO and placebo water 400 ml 2 to 3 hours before surgery; the water-free group did not drink any liquid. The main test indicators are inflammatory factors, comfort and clinical outcomes. RESULTS 28 patients in the CHO group, 30 in the placebo group, and 32 in the conventional water-blocking group were included in the study. The three groups matched well in age, body mass index, the grade of (American Society of Anesthesiologists)ASA, operation time, blood loss, and fluid volume.CHO reduces IL-6 of Day1 and Day7 (P = 0.009, 0.005, respectively), IL-8 (P = 0.005) of Day1, Day1, Day 3, and Day 7 TNF (P = 0.001, 0.006, 0.003 respectively) compared with the water-stopping group ; placebo water reduced Day 1 and Day 7 TNF (P = 0.005, 0.038, respectively), Day 1of IL-8 (P = 0.045). CHO reduced Day3 of TNF (P = 0.026) compared to placebo. In the CHO group and the placebo group, the morning thirst scores (0.68, 1.26, respectively) and starvation (0.24, 0.47, respectively)were decreased. The first time to leave bed in the conventional water-blocking group (39.21 (15–93) h) was much later than in the CHO group (28.57 (10–100) h) and the placebo group (28.71 (12–70) h). Conclusion Compared with routine water ban, preoperative CHO and placebo water can reduce the levels of IL-6, IL-8 and TNF in elderly patients undergoing radical prostatectomy, which can improve the patient's preoperative comfort and shorten the patient's first time to leave bed. Compared with placebo water, CHO has no significant advantage in improving inflammatory factors and clinical outcomes.

scholarly journals Effect of preoperative carbohydrate intake on inflammatory factors and clinical outcomes in elderly patients undergoing radical prostatectomy: a single-center, double-blind randomized controlled trial

2020 ◽  
Author(s):  
Zhen Hu ◽  
Ji Liu ◽  
Wenchao Ma ◽  
Fen Wang
Keyword(s):  
Radical Prostatectomy ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Inflammatory Markers ◽  
Controlled Trial ◽  
Operation Time ◽  
Inflammatory Factors ◽  
Water Group ◽  
First Time

Abstract BACKGROUND: To investigate the advantages of Carbohydrate (CHO) in inflammatory markers, comfort and clinical outcomes in elderly patients undergoing open radical prostatectomy.METHODS: Patients of ≥65 years old with radical prostatectomy who underwent open radical prostatectomy were randomized to the CHO group, water group, and fasted group. Patients in the CHO group and water group received oral CHO, 800 ml of placebo water before surgery, and oral CHO and placebo water 400 ml 2 to 3 hours before surgery; the fasted group did not drink any liquid. The main outcomes are inflammatory markers. The secondary outcomes are cellular immunity, comfort, the index of grip strength of body mass and clinical outcomes.RESULTS: A total of 90 patients were included in current study (i.e., CHO group, n=28; water group, n=30; fasted group, n=32). The three groups matched well in age, body mass index, the grade of (American Society of Anesthesiologists) ASA, operation time, blood loss, and fluid volume. CHO reduces IL-6 of Day1 and Day7 (P = 0.009, 0.005, respectively), IL-8 (P=0.005) of Day1, Day1, Day 3, and Day 7 TNF (P = 0.001, 0.006, 0.003 respectively) compared with the fasted group ; placebo water reduced Day 1 and Day 7 TNF (P = 0.005, 0.038, respectively), Day 1of IL-8 (P = 0.045). CHO reduced Day3 of TNF (P=0.026) compared to placebo water. In the CHO group and the water group, the morning thirst scores (0.68, 1.26, respectively) and starvation (0.24, 0.47, respectively) were decreased. The first time to leave bed in the fasted group (39.21 (15-93) h) was much later than in the CHO group (28.57 (10-100) h) and the water group (28.71 (12-70) h).Conclusion: Compared with routine water ban, preoperative CHO and placebo water can reduce the levels of IL-6, IL-8 and TNF in elderly patients undergoing radical prostatectomy, which can improve the patient's preoperative comfort and shorten the patient's first time to leave bed. Compared with placebo water, CHO has no significant advantage in improving inflammatory markers and clinical outcomes.

scholarly journals Effects of Preoperative Carbohydrate Intake on Inflammatory Markers and Clinical Outcomes in Elderly Patients Undergoing Radical Prostatectomy: A Single-Centre, Double-Blind Randomised Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhen Hu ◽  
Ji Liu ◽  
Fen Wang
Keyword(s):  
Drinking Water ◽  
Placebo Group ◽  
Radical Prostatectomy ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Inflammatory Markers ◽  
Controlled Trial ◽  
Double Blind ◽  
Clinical Trial Registration ◽  
Open Radical Prostatectomy

Background: This study aimed to analyse the effects of carbohydrate (CHO) intake on inflammatory markers, comfort, and clinical outcomes in elderly patients undergoing open radical prostatectomy.Methods: Patients aged ≥65 years who underwent open radical prostatectomy were randomly divided into CHO, drinking water, and fasting groups. A total of 90 patients were enrolled in this study (CHO group, n = 28; placebo group, n = 30 and fasting group, n = 32). Patients in the CHO group were given 800 and 400 ml of carbohydrates 8 and 2–3 h before surgery, respectively. Patients in the placebo group were given 800 and 400 ml of water 8 and 2–3 h before surgery, respectively. Patients in the fasting group did not consume any liquids. The main result is levels of inflammation markers. Secondary results included cellular immunity, comfort, body weight, grip index, and clinical results.Results: Compared with the fasting group, the CHO group exhibited a decrease in interleukin 6 (IL-6) levels on days 1 and 7 (75.47 and 7.06 pg/mL, respectively), IL-8 levels on day 1 (274.61 pg/mL) and tumour necrosis factor (TNF) levels on days 1, 3, and 7 (11.16, 9.55, and 9.67 pg/mL, respectively). The placebo group exhibited a decrease in IL-8 (390.26 pg/mL) and TNF levels (13.99 pg/mL) on day 1. Compared with the placebo group, the CHO group exhibited a decrease in IL-6 levels on day 1 and TNF levels on day 3. In the CHO and placebo groups, the thirst and hunger scores decreased on the morning of surgery.Conclusion: Preoperative CHO and drinking water are associated with decreased levels of IL-6, IL-8, and TNF. CHO and water can also reduce thirst and hunger scores. Therefore, we recommend that patients without contraindications should be given 200–400 ml of fluid 2–3 h before surgery, preferably CHO.Clinical Trial Registration:http://www.chictr.org.cn/edit.aspx?pid=21783&htm=4; ChiCTR-INR-17012867.

da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs

2015 ◽  
Vol 96 (3) ◽  
pp. 287-294 ◽  
Author(s):  
Christina Niklas ◽  
Matthias Saar ◽  
Britta Berg ◽  
Katrin Steiner ◽  
Martin Janssen ◽  
...  
Keyword(s):  
Health Insurance ◽  
Radical Prostatectomy ◽  
Clinical Outcomes ◽  
Open Surgery ◽  
Research Database ◽  
Robotic Assisted ◽  
Open Radical Prostatectomy ◽  
Insurance Costs ◽  
Study Results ◽  
Robotic Assisted Radical Prostatectomy

Purpose: To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. Methods: Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study. Results: Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676). Conclusions: The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.

A New Ceramic Interspinous Process Spacer for Lumbar Spinal Canal Stenosis

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS108-ONS114 ◽  
Author(s):  
Shunsuke Yano ◽  
Kazutoshi Hida ◽  
Toshitaka Seki ◽  
Takeshi Aoyama ◽  
Minoru Akino ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Visual Analog Scale ◽  
Operation Time ◽  
Magnetic Resonance Images ◽  
Disc Height ◽  
Analog Scale ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis

Abstract Objective: Because surgery in elderly patients should be minimally invasive, interspinous process distraction has been widely used in this group to treat lumbar canal stenosis. We developed a new interspinous process distraction spacer composed of hydroxyapatite ceramic. In this work, we demonstrate the usefulness of this novel device. Methods: Since 2003, we operated on 19 elderly patients with lumbar canal stenosis, including 14 men and five women. Their mean age was 70.1 years. We compared the intervertebral angle, posterior disc height, and interspinous process distance on midsagittal magnetic resonance images obtained before and after the surgery. We also assessed clinical outcomes by using the Visual Analog Scale and the Zurich Claudication Questionnaire. Results: The average operation time per level was 44.7 minutes. Postoperatively, there were significant changes in the angle (from 12.5 to 8.6 degrees, P &lt; 0.0001), the posterior disc height (from 10.6 to 13.1 mm, P &lt; 0.0001), and the interspinous process distance (from 9.7 to 14.1 mm, P &lt; 0.0001). The clinical outcomes, which we assessed by using the Visual Analog Scale and the Zurich Claudication Questionnaire, were considered satisfactory. (Visual Analog Scale, from 6.88 to 3.00; Zurich Claudication Questionnaire, symptom severity domain from 2.94 to 1.92, physical function from 2.51 to 1.73.) Conclusion: Our ceramic spacer is useful in the treatment of elderly patients with lumbar canal stenosis. Treatment comprises an easy surgical procedure and produces no metal artifact on radiological evaluations, such as magnetic resonance imaging and computed tomographic scans.

Alanine Aminotransferase Predicts Outcomes in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 89-95
Author(s):  
Jianfeng Zheng ◽  
Rui Xu ◽  
Zongduo Guo ◽  
Xiaochuan Sun
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Laboratory Data ◽  
Cardiac Complications ◽  
World Population ◽  
Systemic Complications ◽  
Poor Outcome ◽  
Poor Outcomes

Objective: With the aging of the world population, the number of elderly patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) is gradually growing. We aim to investigate the potential association between plasma ALT level and clinical complications of elderly aSAH patients, and explore its predictive value for clinical outcomes of elderly aSAH patients. Methods: Between January 2013 and March 2018, 152 elderly aSAH patients were analyzed in this study. Clinical information, imaging findings and laboratory data were reviewed. According to the Glasgow Outcome Scale (GOS), clinical outcomes at 3 months were classified into favorable outcomes (GOS 4-5) and poor outcomes (GOS 1-3). Logistic regression analysis was used to assess the indicators associated with poor outcomes, and receiver curves (ROC) and corresponding area under the curve (AUC) were used to detect the accuracy of the indicator. Results: A total of 48 (31.6 %) elderly patients with aSAH had poor outcome at 3 months. In addition to ICH, IVH, Hunt-Hess 4 or 5 Grade and Modified Fisher 3 or 4 Grade, plasma ALT level was also strongly associated with poor outcome of elderly aSAH patients. After adjusting for other covariates, plasma ALT level remained independently associated with pulmonary infection (OR 1.05; 95% CI 1.00–1.09; P = 0.018), cardiac complications (OR 1.05; 95% CI 1.01–1.08; P = 0.014) and urinary infection (OR 1.04; 95% CI 1.00–1.08; P = 0.032). Besides, plasma ALT level had a predictive ability in the occurrence of systemic complications (AUC 0.676; 95% CI: 0.586– 0.766; P<0.001) and poor outcome (AUC 0.689; 95% CI: 0.605–0.773; P<0.001) in elderly aSAH patients. Conclusion: Plasma ALT level of elderly patients with aSAH was significantly associated with systemic complications, and had additional clinical value in predicting outcomes. Given that plasma ALT levels on admission could help to identify high-risk elderly patients with aSAH, these findings are of clinical relevance.

scholarly journals The Impact of Intra-Operative Cell Salvage During Open Radical Prostatectomy

2019 ◽  
Vol 45 (11) ◽  
pp. 2215
Author(s):  
Ned Kinnear ◽  
Bridget Heijkoop ◽  
Lina Hua ◽  
Derek Hennessey ◽  
Daniel Spernat
Keyword(s):  
Radical Prostatectomy ◽  
Cell Salvage ◽  
Open Radical Prostatectomy ◽  
The Impact

scholarly journals Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

scholarly journals Extraperitoneal Robotic Laparo-Endoscopic Single-Site Plus1-Port Radical Prostatectomy Using the da Vinci Single-Site Platform

2021 ◽  
Vol 10 (8) ◽  
pp. 1563
Author(s):  
Ching-Chia Li ◽  
Tsu-Ming Chien ◽  
Ming-Ru Lee ◽  
Hsiang-Ying Lee ◽  
Hung-Lung Ke ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Da Vinci ◽  
Specific Antigen ◽  
Operation Time ◽  
Setup Time ◽  
Single Site ◽  
University Hospital ◽  
Da Vinci Surgical System ◽  
Free Survival ◽  
The Aesthetic

Currently, over 80% of radical prostatectomies have been performed with the da Vinci Surgical System. In order to improve the aesthetic outlook and decrease the morbidity of the operation, the new da Vinci Single Port (SP) system was developed in 2018. However, one major problem is the SP system is still not available in most countries. We aim to present our initial experience and show the safety and feasibility of the single-site robotic-assisted radical prostatectomy (LESS-RP) using the da Vinci Single-Site platform. From June 2017 to January 2020, 120 patients with localized prostate cancer (stage T1–T3b) at Kaohsiung Medical University Hospital were included in this study. We describe our technique and report our initial results of LESS-RP using the da Vinci Si robotic system. Preoperative, intraoperative and postoperative patient variables were recorded. Prostate-specific antigen (PSA)-free survival was also analyzed. A total of 120 patients were enrolled in the study. The median age of patients was 68 years (IQR 63–71), with a median body mass index of 25 kg/m2 (IQR 23–27). The median PSA value before operation was 10.7 ng/mL (IQR 7.9–21.1). The median setup time for creat-ing the extraperitoneal space and ports document was 25 min (IQR 18–34). The median robotic console time and operation time were 135 min (IQR 110–161) and 225 min (IQR 197–274), respectively. Median blood loss was 365 mL (IQR 200–600). There were 11 (9.2%) patients who experienced complications (Clavien–Dindo classification Gr II). The me-dian catheter duration was 8 days (IQR 7–9), with a median of 10 days (IQR 7–11) of hospital stay. The PSA free-survival rate was 86% at a median 19 months (IQR 6–28) of follow up. Robotic radical prostatectomy using the da Vinci Single-Site platform system is safe and feasible, with acceptable outcomes.

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