ORCID Profile
0000-0002-1846-4423
Current Organisation
University Hospital Cologne
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Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.JOCA.2005.03.007
Abstract: The purpose of the study was to validate a Gradient Peak Method (GPM) by evaluating its accuracy and consistency at different magnetic field strengths. The GPM using magnetic resonance imaging (MRI) was previously proposed to quantitatively assess the morphology of focal cartilage lesions, and its feasibility was demonstrated. GPM quantifies the morphologic properties of cartilage lesions based on their three-dimensional geometry. Twenty-two conical and cylindrical lesions were surgically created on fresh porcine knees, and the results obtained by GPM were compared with manually measured lesion dimensions. Another 15 focal lesions of various shapes were created and scanned, and the quantification results were compared at 1.5 Tesla and 3 Tesla. Additionally, cartilage lesions in three patients were scanned, quantified by GPM, and compared with arthroscopic visualization and measurements. The average absolute errors of GPM (depth: < or =0.4mm diameter: < or =1.4mm) were within twice the in-plane resolution in depth estimates and within the slice thickness in diameter estimates. Analysis also suggested that the quantifications of GPM using 1.5 Tesla and 3 Tesla data were not statistically different. Moreover, the GPM results were shown to be consistent with the lesion measurements obtained arthroscopically. The GPM using MRI provides estimates of lesion thickness, depth, diameter, and area. With this validation, the method can be potentially used as an auxiliary tool to help radiologists and physicians assess cartilage lesions quantitatively and monitor disease progression.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.ATHORACSUR.2012.03.035
Abstract: Brachial artery reactivity testing (BART)--a surrogate test of microvascular function--predicts cardiac risk in the nonsurgical population and associates it with adverse outcome after vascular surgery. This pilot study investigated BART-derived variables, including flow-mediated dilation (FMD), in preoperative risk stratification for major thoracic surgery. After institutional review board approval, BART was performed in 63 patients before major thoracic surgery. Ultrasonography recorded two-dimensional images and Doppler flow signals of the brachial artery preoperatively at baseline and after induced reactive hyperemia. Variables derived using BART were correlated with preoperative risk factors, established risk scores, and postoperative complications. The median preoperative FMD value in patients without postoperative complications was 11.5%. This value was used to delineate all patients into two groups: low (FMD < 11.5%) and high (FMD ≥ 11.5%) FMD cohorts. Patients in the low FMD group experienced more postoperative complications: 54% versus 30% had one or more adverse postoperative event, and 11% versus 0% had three or more adverse postoperative events (p < 0.001), respectively. The low FMD group required longer intensive care unit (3.9 ± 2.0 days versus 0.9 ± 0.3 days p = 0.015) and hospital (14.0 ± 3.3 days versus 6.8 ± 0.6 days p = 0.007) stays. This cutoff point for FMD accurately predicted 71% of the patients with adverse postoperative events, achieving 71.4% (95% confidence interval, 54.7 to 88.2) sensitivity and 48.6% (95% confidence interval, 32.0 to 65.1) specificity. Using BART, preoperative microvascular dysfunction can be identified in patients at increased risk for postoperative complications. These data suggest that larger observational studies and studies exploring preoperative optimization strategies aimed at improving microvascular function are warranted.
Publisher: Springer Science and Business Media LLC
Date: 12-08-2011
DOI: 10.1007/S00101-011-1931-Y
Abstract: The rate of Caesarean sections in Germany continues to rise. The change in anesthetic technique of choice from general to spinal anesthesia began later than in other countries and at the last survey in 2002 was not widely established. The literature on the anesthetic management of Caesarean sections contains many controversies, for ex le fluid preload before performing spinal anesthesia and the vasopressor of choice. Other issues have received relatively little attention, such as the level of experience of anesthesiologists working autonomously on the labour ward or the timing of antibiotic prophylaxis. The aim of the current survey was to provide an updated overview of anesthetic management of Caesarean sections in Germany. A questionnaire was sent out to 709 departments of anesthesiology serving obstetric units in Germany. The questionnaire concerned various aspects of anesthetic management of Caesarean sections. A total of 360 questionnaires (50.8%) were returned of which 346 were complete and could be analyzed, accounting for 330,000 births and 90,000 Caesarean sections per year. The predominant anesthetic method used for Caesarean sections was spinal anesthesia (90.8%) using hyperbaric bupivacaine and in approximately one third of the hospitals surveyed without administering intrathecal opioids. Approximately 12% of the departments surveyed used traumatic Quincke needles. In 86.2% the vasopressor of choice was caffedrine/theodrenaline. Nitrous oxide was used in only 19.2% of departments surveyed when general anesthesia is performed. An antibiotic drug was administered in only 11% of hospitals before cord cl ing. In 43.1% no neonatologist was available to treat unexpected critically ill newborns. In 32.1% of departments surveyed residents with less than 2 years experience worked autonomously on the labour ward. Currently the predominant anesthetic technique of choice in Germany is spinal anaesthesia and at a much higher rate than in 2002. In addition 12% of departments use traumatic Quincke needles which are associated with a higher incidence of postpuncture headache. Nitrous oxide is no longer frequently used in Germany. Finally, the administration of an antibiotic before cord cl ing has been shown to lead to lower rates of endometritis and postoperative wound infection without detrimental effects on the newborn. This is practiced in only a small minority of departments across Germany.
Publisher: Elsevier BV
Date: 03-2020
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1053/J.JVCA.2015.03.014
Abstract: The authors hypothesized that, compared with conventional ultrasound (CUS), the use of a novel navigated ultrasound (NUS) technology would increase success rates and decrease performance times of vascular access procedures in a gel phantom model. A prospective, randomized, crossover study. A university Hospital. Participants were 44 anesthesiologists with varying clinical experience. Anesthesiologists performed in-plane and out-of-plane vascular access procedures using both NUS and CUS for needle visualization in a gel phantom model. Procedure time was measured from needle insertion to verbalization of final needle positioning by the participants, and successful needle placement into the simulated vessel was verified by aspiration of simulated blood. By employing ultrasound navigation capabilities in addition to real-time ultrasound imaging during in-plane/long-axis vascular access procedures, median procedure time showed a nonsignificant decrease (7.5 seconds v 13.0 seconds p = 0.028), and the observed increase in procedure success rate (90.9% v 100% p = 0.125) did not reach statistical significance. For out-of-plane/short-axis vascular access procedures, a significant reduction in median procedure time (5.0 seconds v 11.5 seconds p<0.001) and a significant increase in procedure success rate (75% v 100% p<0.001) were achieved by using navigation technology combined with real-time ultrasound. NUS technology improved the performance times and success rates of vascular access procedures conducted by anesthesiologists in a gel phantom model.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
DOI: 10.1007/S10877-015-9810-8
Abstract: Hyper or hypoventilation may have serious clinical consequences in critically ill patients and should be generally avoided, especially in neurosurgical patients. Therefore, monitoring of carbon dioxide partial pressure by intermittent arterial blood gas analysis (PaCO
Publisher: Elsevier BV
Date: 03-2013
Publisher: Elsevier BV
Date: 09-2022
Publisher: Springer Science and Business Media LLC
Date: 26-05-2022
DOI: 10.1186/S13741-022-00246-3
Abstract: Preoperative risk stratification is used to derive an optimal treatment plan for patients requiring cancer surgery. Patients with reversible risk factors are candidates for prehabilitation programmes. This pilot study explores the impact of preoperative covariates of comorbid disease (Charlson Co-morbidity Index), preoperative serum biomarkers, and traditional cardiopulmonary exercise testing (CPET)-derived parameters of functional capacity on postoperative outcomes after major colorectal cancer surgery. Consecutive patients who underwent CPET prior to colorectal cancer surgery over a 2-year period were identified and a minimum of 2-year postoperative follow-up was performed. Postoperative assessment included: Clavien-Dindo complication score, Comprehensive Complication Index, Days at Home within 90 days (DAH-90) after surgery, and overall survival. The Charlson Co-morbidity Index did not discriminate postoperative complications, or overall survival. In contrast, low preoperative haemoglobin, low albumin, or high neutrophil count were associated with postoperative complications and reduced overall survival. CPET-derived parameters predictive of postoperative complications, DAH-90, and reduced overall survival included measures of VCO 2 kinetics at anaerobic threshold (AT), peakVO 2 (corrected to body surface area), and VO 2 kinetics during the post-exercise recovery phase. Inflammatory parameters and CO 2 kinetics added significant predictive value to peakVO 2 within bi-variable models for postoperative complications and overall survival ( P 0.0001). Consideration of modifiable ‘triple low’ preoperative risk (anaemia, malnutrition, deconditioning) factors and inflammation will improve surgical risk prediction and guide prehabilitation. Gas exchange parameters that focus on VCO 2 kinetics at AT and correcting peakVO 2 to body surface area (rather than absolute weight) may improve CPET-derived preoperative risk assessment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: Georg Thieme Verlag KG
Date: 03-12-2018
DOI: 10.1055/A-0741-7001
Abstract: Positive effects of exercise on cancer prevention and progression have been proposed to be mediated by stimulating natural killer (NK) cells. Because NK cell receptors are regulated by epigenetic modifications, we investigated whether acute aerobic exercise and training change promoter DNA methylation and gene expression of the activating KIR2DS4 and the inhibiting KIR3DL1 gene. Sixteen healthy women (50–60 years) performed a graded exercise test (GXT) and were randomized into either a passive control group or an intervention group performing a four-week endurance exercise intervention. Blood s les (pre-, post-GXT and post-training) were used for isolation of DNA/RNA of NK cells to assess DNA promoter methylation by targeted deep- licon sequencing and gene expression by qRT-PCR. Potential changes in NK cell subsets were determined by flow cytometry. Acute and chronic exercise did not provoke significant alterations of NK cell proportions. Promoter methylation decreased and gene expression increased for KIR2DS4 after acute exercise. A high gene expression correlated with a low methylation of CpGs that were altered by acute exercise. Chronic exercise resulted in a minor decrease of DNA methylation and did not alter gene expression. Acute exercise provokes epigenetic modifications, affecting the balance between the activating KIR2DS4 and the inhibiting KIR3DL1, with potential benefits on NK cell function.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-09-2022
DOI: 10.1097/ACO.0000000000001188
Abstract: The purpose of this narrative review is to give an overview about the effects of multimodal prehabilitation and current existing and prospectively planned studies. The potential efficacy of exercise in the context of prehabilitation ranges from preoperatively improving patients’ functional capacity to inducing cellular mechanisms that affect organ perfusion via endothelial regeneration, anti-inflammatory processes and tumour defense. Current studies show that prehabilitation is capable of reducing certain postoperative complications and length of hospital stay in certain patient populations. These findings are based on small to mid-size trials with large heterogeneity, lacking generalizability and evidence that prehabilitation has positive effects on long term survival. The concept of prehabilitation contains the features, namely preoperative exercise, nutritional intervention and psychological support. Preoperative exercise holds potential molecular effects that can be utilized in the perioperative period in order to improve patients’ postoperative outcome. Future multimodal prehabilitation trials must specifically clarify the clinical impact of this concept on patients’ quality of life after major cancer surgery and cancer-specific survival.
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/837130
Abstract: Background . Perioperative vascular function has been widely studied using noninvasive techniques that measure reactive hyperemia as a surrogate marker of vascular function. However, studies are limited to a static setting with patients tested at rest. We hypothesized that exercise would increase reactive hyperemia as measured by digital thermal monitoring (DTM) in association to patients' cardiometabolic risk. Methods . Thirty patients (58 ± 9 years) scheduled for noncardiac surgery were studied prospectively. Preoperatively, temperature rebound (TR) following upper arm cuff occlusion was measured before and 10 minutes after exercise. Data are presented as means ± SD. Statistical analysis utilized ANOVA and Fisher’s exact test, with P values .05 regarded as significant. Results . Following exercise, TR-derived parameters increased significantly (absolute: 0.53 ± 0.95 versus 0.04 ± 0.42 ∘ C, P=0.04 , and % change: 1.78 ± 3.29 versus 0.14 ± 1.27 %, P=0.03 ). All patients with preoperative cardiac risk factors had a change in TR (after/before exercise, ΔTR) with values falling in the lower two tertiles of the study population ( Δ TR 1.1 %). Conclusion . Exercise increased the reactive hyperemic response to ischemia. This dynamic response was blunted in patients with cardiac risk factors. The usability of this short-term effect for the preoperative assessment of endothelial function warrants further study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 21-06-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: MDPI AG
Date: 19-05-2019
Abstract: Natural Killer (NK-) cells reveal a keen reaction to acute bouts of exercise, including changes of epigenetic modifications. So far, exercise-induced alterations in NK-cell DNA-methylation were shown for single genes only. Studies analyzing genome-wide DNA-methylation have used conglomerates like peripheral blood mononuclear cells (PBMCs) rather than specific subsets of immune cells. Therefore, the aim of this pilot-study was to generate first insights into the influence of a single bout of exercise on genome-wide DNA-methylation in isolated NK-cells to open the field for such analyses. Five healthy women performed an incremental step test and blood s les were taken before and after exercise. DNA was isolated from magnet bead sorted NK-cells and further analyzed for global DNA-methylation using the Infinium MethylationEPIC BeadChip. DNA-methylation was changed at 33 targets after acute exercise. These targets were annotated to 25 genes. Of the targets, 19 showed decreased and 14 increased methylation. The 25 genes with altered DNA-methylation have different roles in cell regulation and differ in their molecular functions. These data give new insights in the exercise induced regulation of NK-cells. By using isolated NK-cells, exercise induced differences in DNA-methylation could be shown. Whether or not these changes lead to functional adaptions needs to be elucidated.
Publisher: Springer Science and Business Media LLC
Date: 15-07-2021
DOI: 10.1186/S12871-021-01400-Y
Abstract: In the recent years, an increasing number of patients with multiple comorbidities (e.g. coronary artery disease, diabetes, hypertension) presents to the operating room. The clinical risk factors are accompanied by underlying vascular-endothelial dysfunction, which impairs microcirculation and may predispose to end-organ dysfunction and impaired postoperative outcome. Whether preoperative endothelial dysfunction identifies patients at risk of postoperative complications remains unclear. In this prospective observational study, we tested the hypothesis that impaired flow-mediated dilation (FMD), a non-invasive surrogate marker of endothelial function, correlates with Days at Home within 30 days after surgery (DAH30). DAH30 is a patient-centric metric that captures postoperative complications and importantly also hospital re-admissions. Seventy-one patients scheduled for major abdominal surgery were enrolled. FMD was performed pre-operatively prior to major abdominal surgery and patients were dichotomised at a threshold value of 10%. FMD was then correlated with DAH30 (primary endpoint) and postoperative complications (secondary endpoints). DAH30 did not differ between patients with reduced FMD and normal FMD (14 (4) (median (IQR)) vs. 15 (8), P = 0.8). Similary, no differences between both groups were found for CCI (normal FMD: 21 (30) (median (IQR)), reduced FMD: 26 (38), P = 0.4) or frequency of major complications (normal FMD: 7 (19%) (n (%)), reduced FMD: 12 (35%), P = 0.12). The regression analyses revealed that FMD in combination with ASA status and surgery duration had no additional significant predictive effect for DAH30, CCI or Clavien-Dindo score. FMD does not add predictive value with regards to DAH30, CCI or Clavien-Dindo score within our study cohort of patients undergoing abdominal surgery. The study was registered in the German Clinical Trials Register ( DRKS00005472 ), prospectively registered on 25/11/2013.
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000458704
Abstract: b i Objectives: /i /b We evaluated end-tidal CO sub /sub (etCO sub /sub ), which has been proposed to assess acute hemodynamic changes, to guide percutaneous edge-to-edge mitral valve repair (PMVR) with the MitraClip system. b i Methods: /i /b Thirty-nine patients (aged 78 ± 14 years) undergoing PMVR for moderate-to-severe mitral regurgitation (MR) of primary and secondary etiology were included. General anesthesia was maintained with sevoflurane and constant ventilation parameters to ensure stable etCO sub /sub tension. MR grade was determined semiquantitatively by transesophageal echocardiography by 2 experienced operators blinded to etCO sub /sub measurements. etCO sub /sub levels were measured 3, 5, 10, and 15 min after final MitraClip placement. b i Results: /i /b Overall, etCO sub /sub increased from 32.2 ± 1.7 before to 35.4 ± 3.0, 34.6 ± 2.6, and 34.2 ± 2.4 mm Hg 3, 5, and 10 min after implantation. A significant correlation was noted between the echocardiographic reduction in MR grade and the increase in etCO sub /sub . ANOVA for repeated measures confirmed a significant increase in etCO sub /sub after clip implantation (corrected i F /i = 20.0 i /i 0.001) and revealed a significantly greater increase in etCO sub /sub in patients with MR reduction ≥2 grades as compared to lesser MR reductions ( i F /i = 6.47 i /i = 0.015). Blood pressure changes did not correlate with the degree of MR reduction. b i Conclusions: /i /b We observed a close correlation between the reduction in MR grade during PMVR and etCO sub /sub , which might evolve as a useful parameter to complement treatment guidance during PMVR.
Publisher: American Association for Cancer Research (AACR)
Date: 14-05-2014
DOI: 10.1158/0008-5472.CAN-13-2044
Abstract: Circulating endothelial cells (CEC) are derived from multiple sources, including bone marrow (circulating endothelial progenitors CEP), and established vasculature (mature CEC). Although CECs have shown promise as a biomarker for patients with cancer, their utility has been limited, in part, by the lack of specificity for tumor vasculature and the different nonmalignant causes that can impact CEC. Tumor endothelial markers (TEM) are antigens enriched in tumor versus nonmalignant endothelia. We hypothesized that TEMs may be detectable on CEC and that these circulating TEM+ endothelial cells (CTEC) may be a more specific marker for cancer and tumor response than standard CEC. We found that tumor-bearing mice had a relative increase in numbers of circulating CTEC, specifically with increased levels of TEM7 and TEM8 expression. Following treatment with various vascular-targeting agents, we observed a decrease in CTEC that correlated with the reductions in tumor growth. We extended these findings to human clinical s les and observed that CTECs were present in patients with esophageal cancer and non–small cell lung cancer (N = 40), and their levels decreased after surgical resection. These results demonstrate that CTECs are detectable in preclinical cancer models and patients with cancer. Furthermore, they suggest that CTECs offer a novel cancer-associated marker that may be useful as a blood-based surrogate for assessing the presence of tumor vasculature and antiangiogenic drug activity. Cancer Res 74(10) 2731–41. ©2014 AACR.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2007
DOI: 10.1007/S00423-007-0174-5
Abstract: Clinically, the immunosuppressive drug sirolimus, used in organ transplantation, appears to impair wound healing. Little is known about the mechanisms of action. We investigated the effect of sirolimus on wound healing, and we analyzed the expression of stimulating mediators of angiogenesis (VEGF, vascular endothelial growth factor) and collagen synthesis (nitric oxide) in wounds. Groups of ten rats underwent dorsal skin incision, and polyvinyl alcohol sponges were implanted subcutaneously. Beginning at the day of wounding, rats were treated with 0.5, 2.0, or 5.0 mg sirolimus/kg/day. Animals were killed 10 days later to determine wound breaking strength and reparative collagen deposition. Expression of VEGF and nitric oxide was studied in wounds. Splenic lymphocyte proliferative activity was significantly decreased by sirolimus (p < 0.05). Sirolimus levels in wound fluid were found to be approximately two- to fivefold higher than blood levels (p < 0.01). Sirolimus (2.0 and 5.0 mg kg(-1) day(-1)) reduced wound breaking strength (p < 0.01) and wound collagen deposition (p < 0.05). This was paralleled by decreased expression of VEGF and nitric oxide in wounds. Experimentally, our data show that sirolimus impairs wound healing, and this is reflected by diminished expression of VEGF and nitric oxide in the wound.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.JCMS.2019.11.007
Abstract: The aim of this study was to evaluate the impact of extubation time on postoperative complications in patients undergoing bimaxillary orthognathic surgery. We therefore retrospectively compared the effect of early extubating (EE) in the operating room versus delayed extubating (LE) on the intensive care unit (ICU) regarding postoperative complications and length of ICU/hospital stay (LOICUS/LOHS). Furthermore, we analyzed the influence of the PAS change on postoperative complications. The clinical data of 117 patients were retrospective analyzed regarding postoperative complications using Clavian-Dindo Classification. Volumetric calculations of the pre- and postoperative PAS were conducted using ITK-SNAP software. The Fisher's exact test was performed to evaluate the significance of differences between categorical variables. Continuous variables were analyzed using the Mann-Whitney U-Test or the Kruskal-Wallis one-way analysis of variance. Regression analysis was used estimating predictors for postoperative complications. EE led to significant shortening of LOICUS (p < 0.001) and LOHS (p = 0.023). In total, we recorded 38 complications (minor n = 30 major n = 8) within the hospital stay. Complication rates were without significant differences with respect to the postoperative ventilation strategy. Large changes in PAS volume led to an increase in the major complication rates (p = 0.031). Increase or decrease of PAS was independent from postoperative complication rates (p = 1.000). Higher body mass index (p = 0.04) and a higher ASA PS score (p = 0.016) were associated with increased major complication rates. Early extubation after surgery is a safe procedure and is associated with a reduced LOICUS and LOHS. Complications seem to occur more frequently in marked changes of the PAS and should be considered in perioperative risk stratification.
Publisher: SAGE Publications
Date: 03-2010
Abstract: Although perioperative macrovascular events (eg, myocardial infarction, stroke) are readily evident, their absolute incidence remains relatively low. In contrast, microvascular dysfunction and its role in perioperative morbidity is not easily measured. Microvascular dysfunction is likely to have a greater impact on noncardiovascular complications (eg, wound healing and end-organ failure), through impaired perfusion, than that which is readily appreciated. Inflammation and oxidative stress, such as that induced by surgical trauma, disrupts endothelial homeostasis thereby decreasing the bioavailability of nitric oxide. This predisposes blood vessels to vasoconstriction, inflammation, leukocyte adhesion, thrombosis—factors that contribute to perioperative cardiovascular events at both macrovascular and microvascular level. Current clinical strategies applicable to the perioperative setting that improve microvascular health include preoperative exercise therapy, pharmacologic interventions (eg, statins, newer β-blockers) and attempts to stimulate mobilization and homing of bone marrow—derived endothelial progenitor cells. Many of these strategies are still in their infancy and large prospective trials that investigate the impact of these therapeutic options on postoperative outcome are eagerly awaited.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.BJA.2018.03.024
Abstract: The biological perturbation associated with psychological and surgical stress is implicated in cancer recurrence. Preclinical evidence suggests that beta-blockers can be protective against cancer progression. We undertook a meta-analysis of epidemiological and perioperative clinical studies to investigate the association between beta-blocker use and cancer recurrence (CR), disease-free survival (DFS), and overall survival (OS). Databases were searched until September 2017, reported hazard ratios (HRs) pooled, and 95% confidence intervals (CIs) calculated. Comparative studies examining the effect of beta-blockers (selective and non-selective) on cancer outcomes were included. The Newcastle Ottawa Scale was used to assess methodological quality and bias. Of the 27 included studies, nine evaluated the incidental use of non-selective beta-blockers, and ten were perioperative studies. Beta-blocker use had no effect on CR. Within subgroups of cancer, melanoma was associated with improved DFS (HR 0.03, 95% CI 0.01-0.17) and OS (HR 0.04, 95% CI 0.00-0.38), while endometrial cancer had an associated reduction in DFS (HR 1.40, 95% CI 1.10-1.80) and OS (HR 1.50, 95% CI 1.12-2.00). There was also reduced OS seen with head and neck and prostate cancer. Non-selective beta-blocker use was associated with improved DFS and OS in ovarian cancer, improved DFS in melanoma, but reduced OS in lung cancer. Perioperative studies showed similar variable effects across cancer types, albeit from a limited data pool. Beta-blocker use had no evident effect on CR. The beneficial effect of beta-blockers on DFS and OS in the epidemiological or perioperative setting remains variable, tumour-specific, and of low-level evidence at present.
Publisher: Springer Science and Business Media LLC
Date: 04-03-2019
DOI: 10.1007/S12630-019-01330-X
Abstract: Cancer-related mortality, a leading cause of death worldwide, is often the result of metastatic disease recurrence. Anesthetic techniques have varying effects on innate and cellular immunity, activation of adrenergic-inflammatory pathways, and activation of cancer-promoting cellular signaling pathways these effects may translate into an influence of anesthetic technique on long-term cancer outcomes. To further analyze the effects of propofol (intravenous) and volatile (inhalational gas) anesthesia on cancer recurrence and survival, we undertook a systematic review with meta-analysis. Databases were searched up to 14 November 2018. Comparative studies examining the effect of inhalational volatile anesthesia and propofol-based total intravenous anesthesia (TIVA) on cancer outcomes were included. The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Reported hazard ratios (HRs) were pooled and 95% confidence intervals (CIs) calculated. Ten studies were included six studies examined the effect of anesthetic agent type on recurrence-free survival following breast, esophageal, and non-small cell lung cancer (n = 7,866). The use of TIVA was associated with improved recurrence-free survival in all cancer types (pooled HR, 0.78 95% CI, 0.65 to 0.94 P < 0.01). Eight studies (n = 18,778) explored the effect of anesthetic agent type on overall survival, with TIVA use associated with improved overall survival (pooled HR, 0.76 95% CI, 0.63 to 0.92 P < 0.01). This meta-analysis suggests that propofol-TIVA use may be associated with improved recurrence-free survival and overall survival in patients having cancer surgery. This is especially evident where major cancer surgery was undertaken. Nevertheless, given the inherent limitations of studies included in this meta-analysis these findings necessitate prospective randomized trials to guide clinical practice. PROSPERO (CRD42018081478) registered 8 October, 2018.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2009
Publisher: Japan Atherosclerosis Society
Date: 2013
DOI: 10.5551/JAT.15255
Abstract: The inflammatory response following tissue injury after major surgery is known to affect endothelial function and vascular reactivity. In this study we evaluated the utility of bedside Digital Thermal Monitoring (DTM) as a surrogate for evaluating vascular function in the postoperative period. Ischemia-induced reactive hyperemia variables were measured in sixty patients scheduled for major thoracic surgery using DTM (VENDYS 5000BC Endothelix, Inc., Houston, TX, USA) at baseline and at 24, 48, 72 hours, and day 5 postoperatively. Furthermore, baseline DTM variables (TR, aTR and AUCTR) and postoperative kinetics of these variables were compared among patients with and without preoperative chemo-radiation and cardiovascular risk factors. There were no significant differences in the DTM parameters measured at baseline and on each of the studied postoperative days. Compared to the baseline, the lowest measures of all variables were observed 24 hrs postoperatively and the highest measures of all variables were observed at 72 hrs. Patients with abdominal obesity and smoking had lower DTM values than the rest of the study group. In our study, DTM as measured by the VENDYS 5000BC DTM system (Endothelix, Inc.) did not reveal significant changes in ischemia-induced reactive hyperemia (vascular reactivity) between the baseline and after surgery in the postoperative period. Patients with certain cardiovascular risk factors (abdominal obesity, smoking) had a significant lower DTM signal. Whether this novel non-invasive technique is able to serve as a perioperative diagnostic tool for patients in a clinical setting warrants further study.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
DOI: 10.1097/EJA.0000000000001177
Abstract: Despite intensive research, cardiac arrest remains a leading cause of death. It is of paramount importance to undertake every possible effort to increase the overall quality of cardiopulmonary resuscitation (CPR) and improve patient outcome. CPR initiated by a bystander is one of the key factors in survival of such an incident. Telephone-assisted CPR (T-CPR) has proved to be an effective measure in improving layperson resuscitation. We hypothesised that adding video-telephony to the emergency call (video-CPR, V-CPR) enhances the quality of layperson resuscitation. This randomised controlled simulation trial was performed from July to August 2018. Laypersons were randomly assigned to video-assisted (V-CPR), telephone-assisted (T-CPR) or control (unassisted CPR) groups. Participants were instructed to perform first aid on a mannequin during a simulated cardiac arrest. This study was conducted in the Skills Lab of the University Hospital of Cologne. One hundred and fifty healthy adult volunteers. The participants received a smartphone to call emergency services, with Emergency Eye video-call in V-CPR group, and normal telephone functionality in the other groups. T-CPR and V-CPR groups received standardised CPR assistance via phone. Our primary endpoint was resuscitation quality, quantified by compression frequency and depth, and correct hand position. Mean compression frequency of V-CPR group was 106.4 ± 11.7 min, T-CPR group 98.9 ± 12.3 min (NS), unassisted group 71.6 ± 32.3 min ( P 0.001). Mean compression depth was 55.4 ± 12.3 mm in V-CPR, 52.1 ± 13.3 mm in T-CPR ( P 0.001) and 52.9 ± 15.5 mm in unassisted ( P 0.001). Total percentage of correct chest compressions was significantly higher ( P 0.001) in V-CPR (82.6%), than T-CPR (75.4%) and unassisted (77.3%) groups. V-CPR was shown to be superior to unassisted CPR, and was comparable to T-CPR. However, V-CPR leads to a significantly better hand position compared with the other study groups. V-CPR assistance resulted in volunteers performing chest compressions with more accurate compression depth. Despite reaching statistical significance, this may be of little clinical relevance. ClinicalTrials.gov (Identifier: NCT03527771)
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1093/BJA/AEU135
Publisher: Springer Science and Business Media LLC
Date: 16-06-2022
DOI: 10.1007/S00402-022-04494-2
Abstract: Application of tranexamic acid (TXA) in spine surgery is very frequent even without signs of hyperfibrinolysis, although its beneficial blood-saving effects are offset by harmful adverse events such as thromboembolic incidents. Thus, we investigated whether in relatively less invasive spinal procedures such as one-level posterior spinal fusion, omission of TXA affects the requirement for blood transfusions. We conducted a retrospective propensity score-matched noninferiority study with 212 patients who underwent one-level posterior spine fusion and who were stratified according to whether they received TXA intraoperatively at our tertiary care center. The primary endpoint was the volume of transfused packed red cells. Testing for noninferiority or equivalence was performed by two one-sided testing procedure (TOST) with a priori defined noninferiority margins ( $$\\delta$$ δ ). After propensity score matching a total of five patients (11.6%) treated with TXA were transfused compared with five patients (11.6%) who did not receive TXA. The majority of patients (51.2%) had a risk-increasing condition. The risk difference (no TXA–TXA) of intraoperative transfusion was − 4.7% (CI 90% − 13.62 to 4.32%), and omitting TXA was noninferior ( $$\\delta$$ δ = $$\\pm$$ ± 10%). The mean intergroup difference in transfused volume (no TXA–TXA) was − 23.26 ml intraoperatively (CI 90% − 69.34 to 22.83 ml) and − 46.51 ml overall (CI 90% − 181.12 to 88.1 ml), respectively, suggesting equivalence of TXA omission ( $$\\delta$$ δ = $$\\pm$$ ± 300 ml). The hemoglobin decline between both groups was also equivalent (with $$\\delta$$ δ = $$\\pm$$ ± 1 g/dl) both on the first postoperative day ( $$\\Delta \\Delta$$ Δ Δ Hb = 0.02 g/dl, CI 90% − 0.53 to 0.56 g/dl) and at discharge ( $$\\Delta \\Delta$$ Δ Δ Hb = − 0.29 g/dl, CI 90% − 0.89 to 0.31 g/dl). We demonstrated that requirement of transfusion is rare among one-level fusion surgery and the omission of TXA is noninferior with regard to blood transfusion in high-risk patients undergoing this procedure. Therefore, the prophylactic use of TXA cannot be recommended here, suggesting to focus on alternative blood conservation strategies, if necessary.
Location: United States of America
Location: No location found
No related grants have been discovered for Robert Schier.