scholarly journals Dynamic Change of Lymphocyte-to-Monocyte Is Associated With the Occurrence of POCD After Cardiovascular Surgery: A Prospective Observational Study

2021 ◽  
Vol 15 ◽  
Author(s):  
Qi Zhao ◽  
Rui Gao ◽  
Changliang Liu ◽  
Hai Chen ◽  
Xueying Zhang ◽  
...  

Objective: Postoperative cognitive dysfunction (POCD) is a common and severe complication of cardiovascular surgery. Lymphocyte-to-monocyte ratio (LMR) has been reported to be an independent predictor of lots of diseases associated with inflammation, but the association between the LMR and POCD is not clear. The present study aimed to investigate the potential value of LMR level to predict POCD in patients undergoing cardiovascular surgery.Methods: A prospective observational study was performed on the patients diagnosed with heart diseases undergoing cardiovascular surgeries with cardiopulmonary bypass. The leukocyte counts were measured by blood routine examination preoperatively. Then we calculated the LMR by dividing the lymphocyte count by the monocyte count. Neurocognitive functions were assessed 1 day before and 7 days after surgery. Perioperative factors were recorded to explore the relationship between LMR and POCD.Results: In total, 75 patients finished the whole study, while 34 patients developed POCD. The preoperative LMR level in the POCD group was higher than that in the non-POCD group. A cutoff value of 4.855 was identified to predict POCD occurrence according to ROC curve. The perioperative dynamic change of LMR level in the POCD group was higher than those in the non-POCD group. A cutoff value of 2.255 was identified to predict POCD occurrence according to ROC curve and the dynamic LMR change had similar varying trend with preoperative LMR level.Conclusions: The dynamic change of LMR level in the peripheral blood is associated with occurrence of POCD, and preoperative LMR level seems to be a prognostic biomarker of postoperative cognitive dysfunction in patients after cardiovascular surgery.

Gerontology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Yang Shen ◽  
Xianchen Li ◽  
Junyan Yao

Perioperative neurocognitive disorders (PNDs) refer to cognitive decline identified in the preoperative or postoperative period. It has been reported that the incidence of postoperative neurocognitive impairment after noncardiac surgery in patients older than 65 at 1 week was 25.8∼41.4%, and at 3 months 9.9∼12.7%. PNDs will last months or even develop to permanent dementia, leading to prolonged hospital stays, reduced quality of life, and increased mortality within 1 year. Despite the high incidence and poor prognosis of PNDs in the aged population, no effective clinical prediction model has been established to predict postoperative cognitive decline preoperatively. To develop a clinical prediction model for postoperative neurocognitive dysfunction, a prospective observational study (Clinical trial registration number: ChiCTR2000036304) will be performed in the Shanghai General Hospital during January 2021 to October 2022. A sample size of 675 patients aged &#x3e;65 years old, male or female, and scheduled for elective major noncardiac surgery will be recruited. A battery of neuropsychological tests will be used to test the cognitive function of patients at 1 week, 1 month, and 3 months postoperatively. We will evaluate the associations of PNDs with a bunch of candidate predictors including general characteristics of patients, blood biomarkers, indices associated with anesthesia and surgery, retinal nerve-fiber layer thickness, and frailty index to develop the clinical prediction model by using multiple logistic regression analysis and least absolute shrinkage and the selection operator (LASSO) method. The <i>k</i>-fold cross-validation method will be utilized to validate the clinical prediction model. In conclusion, this study was aimed to develop a clinical prediction model for postoperative cognitive dysfunction of old patients. It is anticipated that the knowledge gained from this study will facilitate clinical decision-making for anesthetists and surgeons managing the aged patients undergoing noncardiac surgery.


2012 ◽  
Vol 6 (1) ◽  
pp. 400-405 ◽  
Author(s):  
George Papadopoulos ◽  
Menelaos Karanikolas ◽  
Antonia Liarmakopoulou ◽  
George Papathanakos ◽  
Marianna Korre ◽  
...  

Aim: This study was conducted to examine perioperative cerebral oximetry changes in elderly patients undergoing hip fracture repair and evaluate the correlation between regional oxygen saturation (rSO2) values, postoperative cognitive dysfunction (POCD) and hospital stay. Materials and Methods: This prospective observational study included 69 patients. Data recorded included demographic information, rSO2 values from baseline until the second postoperative hour and Mini Mental State Examination (MMSE) scores preoperatively and on postoperative day 7. MMSE score ≤23 was considered evidence of cognitive dysfunction. Postoperative confusion or agitation, medications administered for postoperative agitation, and hospital length of stay were also recorded. Data were analyzed with Student’s t-test, Pearson’s correlation or multiple regression analysis as appropriate. Results: Patient age was 74±13 years. Baseline left sided rSO2 values were 60±10 and increased significantly after intubation. Baseline rSO2 L<50 and <45 was observed in 11.6% and 10.1% of patients respectively. Perioperative cerebral desaturation occurred in 40% of patients. MMSE score was 26.23 ± 2.77 before surgery and 25.94 ± 2.52 on postoperative day 7 (p=0.326). MMSE scores ≤ 23 were observed preoperatively in 6 and postoperatively in 9 patients. Patients with cognitive dysfunction had lower preoperative hematocrit, hemoglobin, SpO2 and rSO2 values at all times, compared to patients who did not. There was no correlation between rSO2 or POCD and hospital stay. Patients with baseline rSO2 <5 required more medications for postoperative agitation. Conclusion: Cognitive dysfunction occurs preoperatively and postoperatively in elderly patients with hip fractures, and is associated with low cerebral rSO2 values.


2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S59-S59
Author(s):  
Fabio Salvatore Macaluso ◽  
Maria Cappello ◽  
Anita Busacca ◽  
Walter Fries ◽  
Anna Viola ◽  
...  

Abstract Background and Aims There are few clinical data on Adalimumab (ADA) biosimilars in inflammatory bowel disease. Methods SPOSAB ABP 501 is a multicenter, observational, prospective study performed among the cohort of the Sicilian Network for Inflammatory Bowel Disease. All consecutive patients treated with ADA biosimilar ABP 501 from the introduction of the drug in Sicily (February 2019) to February 2020 (12 months) were enrolled to assess its safety and effectiveness. Patients were divided into 3 groups: group A, naïve to ADA and naïve to anti-TNFs; group B, naïve to ADA, previously exposed to anti-TNFs; group C: switched from ADA originator to ABP 501. Results 559 patients (median age 39 years; CD 88.0%, UC 12.0%) were included, with a follow-up time of 403.4 patient-years. Thirty-six SAEs occurred in 36 patients [(6.4% - incidence rate (IR): 8.9 per 100 person-years (PY)]. The IR of SAEs was higher among patients in group A compared with group C (17.4 vs. 4.8 per 100 PY; IR ratio=3.61; p&lt;0.001) and among patients in group B compared with group C (16.4 vs. 4.8 per 100 PY; IR ratio=3.42; p=0.041). Among ADA-naïve patients (group A+B), 188 (85.8%) had a clinical response after 12 weeks, including 165 (75.3%) who achieved steroid-free remission. Higher treatment persistence estimates were reported for patients in group C compared with group A and B (log-rank p&lt;0.001). Conclusions Safety and effectiveness of ABP 501 seem to be overall similar to those reported for ADA originator. Switching from originator to ABP 501 was safe and effective.


2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Tao Wang ◽  
Lei Zhong ◽  
Shiyi Yin ◽  
Tiancheng Bao ◽  
Jiezheng Yang ◽  
...  

Purpose. The present study highlighted the value of anterior segment optical coherence tomography (AS-OCT) for different types of corneal foreign bodies in humans. Methods. This study was a prospective observational study. The patients included were divided into two groups. If the patients were directly diagnosed based on eye injury history and slit-lamp examination, then they were assigned to Group A. Otherwise, the patients were assigned to Group B. We compared and described the characteristics of the corneal foreign body in both groups using AS-OCT. Results. From October 2017 to January 2020, 36 eyes of 36 patients (9 females and 27 males) with a mean age of 37.8 ± 11.7 years were included in the study. Patients in Group A were the majority and accounted for 72.2% (26/36). High signals on AS-OCT images were the main constituent and accounted for 92.3% (24/26) in Group A and 70.0% (7/10) in Group B. Most of the patients in Group A, 96.2% (25/26), had clear boundaries. A blurred boundary was observed in 70.0% (7/10) of the patients in Group B. The foreign bodies on AS-OCT images had key characteristics of a high signal followed by a central zone shadowing effect and a low signal followed by a marginal zone shadowing effect. Further, all of the lesions could be directly located in Group B, and 92.3% (24/26) of the patients in Group A did not have directly located lesions. Six representative cases are described in detail. Conclusions. AS-OCT is a valuable tool in the diagnosis and management of corneal foreign bodies, especially for unusual corneal foreign body.


2020 ◽  
Author(s):  
Yongpeng Zhou ◽  
Jun Huang ◽  
Zhongzhou Si ◽  
Sumei Luo ◽  
Qin Zhou ◽  
...  

Abstract Background Neurocognitive complications seriously affect long-term health-related quality of life in patients after liver transplantation, but what was it like during the transplant? There has been little related research,so it is very necessary to understand the changes in cognition during the perioperative period. Methods This observational study included patients with end-stage liver disease who are waiting for liver transplantation in our center. We performed the individual cognitive function investigation before and one week after successful surgery,then analyze the changes between them and further explore possible ones that cause perioperative cognitive dysfunction among several factors. Results From December 2018 to November 2019, there are 70 patients completed all the investgation. Compared with preoperative cognitive performance, 29 patients experienced deterioration, 14 patients showed significant improvement, and 27 patients remained unchanged. Multi-factor analysis results showed that, a mean arterial pressure <80 mmHg (p=0.035) during the reperfusion phase, sufentanil dosage <1.5 µg kg -1 (p=0.027), and blood transfusion volume >70 ml kg -1 (p=0.047) were closely related to early postoperative cognitive dysfunction. Conclusions The incidences of deterioration, maintenance, and improvement in cognitive function were 41.6%, 38.4%, and 20%, respectively. Massive blood transfusion, hypotension during the reperfusion phase, insufficient intra-operative analgesia, and lower anesthesia depth may be the independent pathogenic factors for deteriorated cognitive function.


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