Plasma metabolomic profiling of hypertrophic cardiomyopathy patients before and after surgical myectomy suggests postoperative improvement in metabolic function

Background Hypertrophic cardiomyopathy (HCM) is a common inherited heart disorder complicated by left ventricle outflow tract (LVOT) obstruction, which can be treated with surgical myectomy. To date, no reliable biomarkers for LVOT obstruction exist. We hypothesized that metabolomic biomarkers for LVOT obstruction may be detectable in plasma from HCM patients. Methods We conducted metabolomic profiling on plasma samples of 18 HCM patients before and after surgical myectomy, using a commercially available metabolomics platform. Results We found that 215 metabolites were altered in the postoperative state (p-value < 0.05). 12 of these metabolites were notably significant after adjusting for multiple comparisons (q-value < 0.05), including bilirubin, PFOS, PFOA, 3,5-dichloro-2,6-dihydroxybenzoic acid, 2-hydroxylaurate, trigonelline and 6 unidentified compounds, which support improved organ metabolic function and increased lean soft tissue mass. Conclusions These findings suggest improved organ metabolic function after surgical relief of LVOT obstruction in HCM and further underscore the beneficial systemic effects of surgical myectomy.

Study of peculiarities of intra- and postoperative state of the interface «intraocular lens - posterior capsule» in phacoemulsification of senile cataract

Presence of full contact of interface «intraocular lens (IOL) – posterior capsule (PC)» ensures the transparency of the latter in the early period after phacoemulsification (PE) of senile cataract (SC). The main reasons for absence of full contact of IOL with PC are: the presence of residuals of viscoelastic (VE) in the capsular bag, uneven tension of the capsule by the haptic elements of the IOL, and the incommensurability of the size of the IOL with the capsule. Purpose. To study the features of the intra- and postoperative state of interface «IOL – PC» during PE SC. Material and methods. Dynamic observation of 42 patients (42 eyes), who operated on immature senile cataracts, was carried out. All operations were performed using OPMI LUMERA 700 surgical microscope (Carl Zeiss Meditec AG, Jena, Germany) with integrated intra-operative OCT, state of interface «IOL – PC» was examined. 2 hours after and on the 1st day after the operation state of interface «IOL – PC» was studied in all eyes by OCT on Optovue RTVue-100 (Optovue, Inc., US) with module for anterior segment examining to protocols «Cornea Line» and «Cornea Cross Line». Results. During the operation, the presence of contact between IOL and PC was observed only in 9 eyes (21.4%). 2 hours after surgery, 40 eyes (95.2%) had absence of contact between lens and capsule. On the 1st day after surgery, the optimal interface between IOL and PC was observed in 32 eyes (76.2%). Conclusion. Studies have shown that state of interface «IOL – PC» on the 1st day does not depend on its characteristics revealed intraoperative and 2 hours after the operation. The main reason for absence of contact between IOL and PC is residues of VE, and the using «impulse-irrigation» technique allows completely removing VE from the central zone of the capsule in all cases. Key words: cataract, phacoemulsification, intraocular lens, lens capsule, viscoelastic, interface «IOL – PC».

Plasma Metabolomic Profiling of Hypertrophic Cardiomyopathy Patients Before and After Surgical Myectomy Suggests Postoperative Improvement in Liver and Kidney Function

Hypertrophic cardiomyopathy (HCM) is a common inherited heart disorder complicated by left ventricle outflow tract (LVOT) obstruction, which can be treated with surgical myectomy. To date, no reliable biomarkers for LVOT obstruction exist. To determine whether metabolomic biomarkers for obstruction can be identified, we conducted metabolomic profiling on plasma samples of 18 HCM patients before and after undergoing surgical myectomy to measure changes in the plasma metabolome in the postoperative state. Plasma was collected approximately 4 weeks before surgery at the preoperative visit and approximately 3 months after the surgery at the postoperative visit. We found that 215 metabolites were altered in the postoperative state (p-value &amp;lt; 0.05). Identified metabolites that were significantly reduced post-myectomy included metabolites of heme, such as bilirubin, and phenylacetylglutamine, a biomarker of urea cycle disorders, which suggests that liver and kidney function are improved in the postoperative state. Markers of arginine metabolism such as homoarginine and dimethylarginine are also decreased in the postoperative state, suggestive of reduction in nitric oxide production, inflammation and heart failure after surgery. 3-hydroxybutyrate (BHBA) was also decreased, suggesting possible increased fatty acid utilization and a return to normal heart function. 12 of these metabolites were notably significant after adjusting for multiple comparisons (q-value &amp;lt; 0.05), including bilirubin, PFOS, PFOA, 3,5-dichloro-2,6-dihydroxybenzoic acid, 2-hydroxylaurate, trigonelline and 6 unidentified compounds, which support improved kidney and liver function and increased lean soft tissue mass. These findings suggest improved organ metabolic function after surgical relief of LVOT obstruction in HCM and further underscore the beneficial systemic effects of surgical myectomy.

Hypocaloric Peripheral Parenteral Nutrition Administered in Intestinal Reconnection Postoperative Patients with 3–5 Days Oral Fasting Indicated: A Case Report

Postoperative patients of intestinal reconnection in Morelia, Mexico, are usually in for 3–5 days of oral fast, which increases protein catabolism in the patient, thus lengthening their hospital stay and increasing the risk of developing metabolic comorbidities. Hypocaloric peripheral parenteral nutrition (HPPN) reduces proteolysis and improves inflammatory markers in these patients. The aim of this case report is to determine whether or not peripheral parenteral nutrition (PPN) improves inflammation, lessening the postoperative risk. A 62-year-old female patient and her cancer diagnosis and intestinal reconnection surgery are discussed. PPN is not commonly used in this type of patients due to the short duration of the fast, although its use is common before surgery. However, postoperative use can be beneficial as well, and given the delicate postoperative state these patients are in, it is worth it (at least in these cases) to give them all the strength and tools available for a better recovery. PPN in the case discussed herein improved the patient’s inflammatory marker levels in a shorter period.

Risk Factors For Severity Of Thrombocytopenia In Full Term Infants: A Single Center Study

Background: Neonatal thrombocytopenia (NT) (platelet count <150 x 109/L) is a common finding in the neonatal intensive care unit (NICU). The main aim of this study was to assess the prevalence, rick factors, and outcomes of severe NT in full term (FT) infants.Methods: During the study period, all FT infants who met the inclusion criteria for NT on two occasions were included. Maternal data, such as maternal age, weight, gestational age, mode of delivery, and history of systemic diseases, including diabetes mellitus, pre-eclampsia, systemic lupus erythematosus, and immune thrombocytopenic purpura, were recorded. Furthermore, neonatal data, such as gender, neonatal weight, causes/duration of admission, types of respiratory support used, complete blood count measurements, and outcomes for neonates admitted to the NICU, were recorded.Results: In total, 55 FT infants with NT met the inclusion criteria, and 29 (52.73%) cases had severe NT. The most common cause of NT was neonatal sepsis (20 cases, 36.35%), followed by a postoperative state (5 cases, 9.09%). Moreover, in cases of positive blood cultures, the most commonly isolated organism was Escherichia coli (6 cases, 10.90%), followed by Klebsiella (5 cases, 9.09%). Cases of severe NT needed more platelet transfusions (P=0.001) and had higher rates of mortality (P=0.001) when compared to cases of mild/moderate NT associated with signs of bleeding and pulmonary/intraventricular hemorrhage (IVH) (P=0.001).Conclusion: Thrombocytopenia is a frequent challenge between neonatologists. The most common causes of NT in FT infants were neonatal sepsis, followed by postoperative state. Furthermore, when severe NT compared to mild/moderate NT, associated with signs of bleeding and pulmonary/IVH, needed more platelet transfusions, and had increased mortality. Further research is needed to explain which of these complications related to severity of thrombocytopenia or were associated with the bad general condition of these patients due to their original disease.

Risk factors for severity of thrombocytopenia in full term infants: a single center study

Background: Neonatal thrombocytopenia (NT) (platelet count <150 x 109/L) is a common finding in the neonatal intensive care unit (NICU). The main aim of this study was to assess the prevalence, rick factors, and outcomes of severe NT in full term (FT) infants.Methods: During the study period, all FT infants who met the inclusion criteria for NT on two occasions were included. Maternal data, such as maternal age, weight, gestational age, mode of delivery, and history of systemic diseases, including diabetes mellitus, pre-eclampsia, systemic lupus erythematosus, and immune thrombocytopenic purpura, were recorded. Furthermore, neonatal data, such as gender, neonatal weight, causes/duration of admission, types of respiratory support used, complete blood count measurements, and outcomes for neonates admitted to the NICU, were recorded.Results: In total, 55 FT infants with NT met the inclusion criteria, and 29 (52.73%) cases had severe NT. The most common cause of NT was neonatal sepsis (20 cases, 36.35%), followed by a postoperative state (5 cases, 9.09%). Moreover, in cases of positive blood cultures, the most commonly isolated organism was Escherichia coli (6 cases, 10.90%), followed by Klebsiella (5 cases, 9.09%). Cases of severe NT needed more platelet transfusions (P=0.001) and had higher rates of mortality (P=0.001) when compared to cases of mild/moderate NT associated with signs of bleeding and pulmonary/intraventricular hemorrhage (IVH) (P=0.001).Conclusion: Severe NT occurred in 52.73% of cases. The most common cause of NT was neonatal sepsis, followed by a postoperative state. Furthermore, severe NT, when compared to mild/moderate NT associated with signs of bleeding and pulmonary/IVH, needed more platelet transfusions and had increased mortality.

Risk Factors For Severity Of Thrombocytopenia In Full Term Infants: A Single Center Study

Background Neonatal thrombocytopenia (NT) is a common finding in the neonatal intensive care unit (NICU). The main aim of this study was to assess the prevalence, rick factors and outcomes of severe NT in full term (FT) infants. Method: During the study period, all FT infants who met the inclusion criteria for NT on two occasions were included. Maternal data such as maternal age, weight, gestational age, mode of delivery, and history of systemic diseases were recorded. Furthermore, neonatal data such as gender, neonatal weight, causes/duration of admission, types of respiratory support used, blood count and outcomes for neonates admitted to the NICU were recorded. Results In total, 55 FT infants with NT met the inclusion criteria. In all, 29 (52.73%) cases had severe NT. The most common cause of NT was neonatal sepsis (20 cases, 37.03%), followed by a postoperative state (5 cases, 9.25%). Moreover, in cases of positive blood cultures, the most commonly isolated organism was Escherichia coli (6 cases, 10.90%), followed by Klebsiella (5 cases, 9.09%). Cases of severe NT, when compared to cases of mild/moderate NT associated with signs of bleeding and pulmonary/intraventricular hemorrhage (IVH) (P = 0.001), needed more platelet transfusions (P = 0.001) and had higher rates of mortality (P = 0.001). Conclusion Severe NT occurred in 52.73% of cases. The most common cause of NT was neonatal sepsis, followed by a postoperative state. Furthermore, severe NT, when compared to mild/moderate NT associated with signs of bleeding and pulmonary/IVH, needed more platelet transfusions and had increased mortality.

Hypocaloric Peripheral Parenteral Nutrition Administered in Intestinal Reconnection Postoperative Patients with 3–5 Days Oral Fasting Indicated: A Case Report

Postoperative patients of intestinal reconnection in Morelia, Mexico, are usually in for 3–5 days of oral fast, which increases protein catabolism in the patient, thus lengthening their hospital stay and increasing the risk of developing metabolic comorbidities. Hypocaloric peripheral parenteral nutrition (HPPN) reduces proteolysis and improves inflammatory markers in these patients. The aim of this case report is to determine whether or not peripheral parenteral nutrition (PPN) improves inflammation, lessening the postoperative risk. A 62-year-old female patient and her cancer diagnosis and intestinal reconnection surgery are discussed. PPN is not commonly used in this type of patients due to the short duration of the fast, although its use is common before surgery. However, postoperative use can be beneficial as well, and given the delicate postoperative state these patients are in, it is worth it (at least in these cases) to give them all the strength and tools available for a better recovery. PPN in the case discussed herein improved the patient’s inflammatory marker levels in a shorter period.