Acute Normovolemic Hemodilution: Picking More Apples and Oranges

No abstract available

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Associations Between Impaired Cerebral Blood Flow Autoregulation, Cerebral Oxygenation, and Biomarkers of Brain Injury and Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery

BACKGROUND: Increasing evidence links postoperative cognitive dysfunction (POCD) to surgery and anesthesia. POCD is recognized as an important neuropsychological adverse outcome in surgical patients, particularly the elderly. This prospective cohort study aimed to investigate whether POCD is associated with impaired intraoperative cerebral autoregulation and oxygenation, and increased levels of biomarkers of brain injury. METHODS: Study subjects were patients ≥65 years of age scheduled for major noncardiac surgery. Cognitive function was assessed before and 1 week after surgery. POCD was diagnosed if a decline of >1 standard deviation of z-scores was present in ≥2 variables of the test battery. The incidence of POCD 1 week after surgery was modeled as a multivariable function of the index of autoregulation (MxA) and tissue oxygenation index (TOI), adjusting for baseline neuropsychological assessment battery (Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery [CERAD-NAB]) total score and the maximum C-reactive protein (CRP) concentration. The biomarkers of brain injury neuron-specific enolase and S100β protein, age, and level of education were included in secondary multivariable logistic regression analyses. RESULTS: Of the 82 patients who completed the study, 38 (46%) presented with POCD 1 week after surgery. In the multivariable regression analysis, higher intraoperative MxA (odds ratio [OR; 95% confidence interval (CI)], 1.39 [1.01–1.90] for an increase of 0.1 units, P = .08 after Bonferroni adjustment), signifying less effective autoregulation, was not associated with higher odds of POCD. The univariable logistic regression model for MxA yielded an association with POCD (OR [95% CI], 1.44 [1.06–1.95], P = .020). Tissue oxygenation index (1.12 [0.41–3.01] for an increase of 10%, P = 1.0 after Bonferroni adjustment) and baseline CERAD-NAB total score (0.80 [0.45–1.42] for an increase of 10 points, P = .45) did not affect the odds of POCD. POCD was associated with elevated CRP on postoperative day 2 (median [interquartile range]; 175 [81–294] vs 112 [62–142] mg/L, P = .033); however, the maximum CRP value (OR [95% CI], 1.35 [0.97–1.87] for a 2-fold increase, P = .07) had no distinct effect on POCD. CONCLUSIONS: Impairment of intraoperative cerebral blood flow autoregulation is not predictive of early POCD in elderly patients, although secondary analyses indicate that an association probably exists.

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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Should Practice Ever be Fully Based on Evidence and Science?

Evidence-based practice has become a buzz word these days, particularly in the healthcare system. One of the questions I would like to draw attention to is about evidence-based practice (EBP). It often compels me to ...

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Orale Schleimhautalteration – was ist die Ursache?

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Thermal behavior of Carrara marble after consolidation by ammonium phosphate, ammonium oxalate and ethyl silicate

Publication date: 15 April 2017
Source:Materials & Design, Volume 120
Author(s): Enrico Sassoni, Gabriela Graziani, Giovanni Ridolfi, Maria Chiara Bignozzi, Elisa Franzoni
The response to thermal variations is the primary cause of marble deterioration in ancient and modern buildings. In this study, the thermal behavior of Carrara marble after consolidation by an innovative hydroxyapatite-based treatment was investigated in comparison with ammonium oxalate and ethyl silicate. Samples were subjected to heating-cooling cycles up to 80°C. All the consolidating treatments were found to be fairly compatible, as in no case the residual strain after the thermal cycles was found to increase compared to the unweathered untreated marble. Anyway, the hydroxyapatite-treatment has the advantage of causing the highest increase in marble cohesion and the lowest residual strain, besides being more chromatically compatible and durable than the alternative commercial consolidants.

Graphical abstract

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Orale Schleimhautalteration – was ist die Ursache?

http://ift.tt/2lXftBh