Pre-Operative Hyponatremia in a High Dependency Cardiovascular Surgical Center of a Tertiary Health Facility in Nigeria: Risk Factors, Prevalence, Clinical Correlates and Treatment Outcome. A Retrospective Cohort Study

Introduction: Hyponatremia is the commonest electrolyte derangement seen in medical and surgical wards and in high dependency treatment units. It is associated with prolonged hospital stay, high economic burden and increased morbidity and mortality. Hyponatremia is well reported in medical and surgical conditions but literature is scanty concerning its relationship with treatment outcome in patients managed in high dependency heart and vascular surgical centers. Objectives: To determine the prevalence, determinants, clinical correlates and outcome of pre-operative hyponatremia. Methods: Retrospective study involving patients that had surgery (cardiac and vascular) between January 2015 and December 2019. Data were obtained from patients’ case files, perioperative and intensive unit charts. All participants with preoperative hyponatremia had their serum sodium corrected to ≥135 mmol before surgical incision and those with hypernatremia had their sodium corrected to <145 mmol. The socio-demographic, clinical, laboratory findings were entered. Statistical analysis was done using student’s t-test and Chi square. Results: Of the 305 participants (186 males and 119 females), pre-operative hyponatremia was found in 30.8% and normonatremia in 59.7%. Pre-operative hyponatremia was more common in advance age, overweight, those presenting for open heart and other major surgeries and those with background chronic heart failure and chronic liver disease. Participants with pre-operative hyponatremia had shortened and also prolonged hospital stay and higher risk of death than with normonatremia. Conclusion: Pre-operative hyponatremia is common in high dependency surgical unit particularly in the elderly, those with comorbidities and those presenting for major heart surgeries. It impacts negatively on the morbidity and mortality as it could shorten hospital stay through death, and could prolong hospital stay with increased health burden on patients, their care givers and the general population. The impact of this finding across different races needs further evaluation.

Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion

Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients have acute superior mesenteric artery(SMA)occlusion,and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization,and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia,and to perform bowel resections.The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization.This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion.Explorative laparotomy needs to be performed first.Curative treatment is based upon intestinal revascularization followed by bowel resection.If no vascular imaging has been carried out,SMA angiography is performed.In case of embolic occlusion of the SMA,open embolectomy is performed followed by angiography.In case of thrombotic occlusion,the occlusive lesion can be recanalized retrograde from an exposed SMA,the guidewire snared from either the femoral or brachial artery,and stented with standard devices from these access sites.Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy,leaving definitive bowel reconstructions to a planned second look laparotomy,according to the principles of damage control surgery.Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon,and a hybrid revascularization approach is of utmost importance to improve outcomes.

Identification of Annexin A1 protein expression in human gastric adenocarcinoma using proteomics and tissue microarray

AIM:To study the differential expression of Annexin A1(ANXA1)protein in human gastric adenocarcinoma.This study was also designed to analyze the relationship between ANXA1 expression and the clinicopathological parameters of gastric carcinoma.METHODS:Purified gastric adenocarcinoma cells(GAC)and normal gastric epithelial cells(NGEC)were obtained from 15 patients with gastric cancer by laser capture microdissection.All of the peptide specimens were labeled as18O/16O after trypsin digestion.Differential protein expressions were quantitatively identified between GAC and NGEC by nanoliter-reverse-phase liquid chromatography-mass/mass spectrometry(nanoRPLC-MS/MS).The expressions of ANXA1 in GAC and NGEC were verified by western blot analysis.The tissue microarray containing the expressed ANXA1 in 75 pairs of gastric carcinoma and paracarcinoma specimens was detected by immunohistochemistry(IHC).The relationship between ANXA1 expression and clinicopathological parametes of gastric carcinoma was analyzed.RESULTS:A total of 78 differential proteins were identified.Western blotting revealed that ANXA1 expression was significantly upregulated in GAC(2.17/1,P<0.01).IHC results showed the correlations between ANXA1protein expression and the clinicopathological parameters,including invasive depth(T stage),lymph node metastasis(N stage),distant metastasis(M stage)and tumour-lymph node metastasis stage(P<0.01).However,the correlations between ANXA1 protein expression and the remaining clinicopathological parameters,including sex,age,histological differentiation and the size of tumour were not found(P>0.05).CONCLUSION:The upregulated ANXA1 expression may be associated with carcinogenesis,progression,invasion and metastasis of GAC.This protein could be considered as a biomarker of clinical prognostic prediction and targeted therapy of GAC.

Aggressive restenosis after percutaneous intervention in two coronary loci in a patient with human immunodeficiency virus infection

A 54-year-old black African woman, 22 years human immunodeficiency virus(HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibitors. Viral load and CD4 count were stable. Angiography revealed a right coronary artery lesion, which was treated with everolimus eluting stent. She also underwent balloon angioplasty to the first diagonal. She re-presented on three different occasions and technically successful coronary intervention was performed. The patient has reported satisfactory compliance with dual anti platelet therapy throughout. She was successfully treated with surgical revascularisation. The patient did not experience any clinical recurrence on follow up. This case demonstrates exceptionally aggressive multifocal and recurrent instent restenosis in a patient treated for HIV infection, raising the possibility of an association with HIV infection or potentially components of retro viral therapy.

Improved experimental model of hepatic cystic hydatid disease resembling natural infection route with stable growing dynamics and immune reaction

AIM To investigate a safer way to set up the disease model of cystic echinococcosis without contamination risk and develop a novel experimental murine model of hepatic cystic echinococcosis. METHODS C57 B/6 mice were injected with human protoscolices of three different concentrations via the portal vein. The mice were followed for 10 mo by ultrasound,gross anatomy,and pathological and immunological examinations. The protoscolex migration in the portal vein,hydatid cyst growth,host immune reaction,and hepatic histopathology were examined periodically.RESULTS The infection rates in the mice in the high,medium,and low concentration groups were 90%,100%,and 63.6%,respectively. The protoscolices migrated in the portal vein with blood flow,settled in the liver,and developed into orthotopic hepatic hydatid cysts,resembling the natural infection route and course.CONCLUSION We have established an improved experimental model of hepatic cystic echinococcosis with low biohazard risk but stable growing dynamics and immune reaction. It is especially useful for new anti-parasite medication trials against hydatid disease.

Transcervical access,reversal of flow and mesh-covered stents:New options in the armamentarium of carotid artery stenting

In the last 25 years, the very existence of carotid artery stenting(CAS) has been threatened on a number of occasions. The initial disappointing results that even lead to the discontinuation of an early randomized controlled trial have improved considerably with time. Novel devices, advanced stent and equipment technology, alternative types of access and several types of filters/emboli protecting devices have been reported to reduce stroke/death rates during/after CAS and improve CAS outcomes. The present review will provide a description of the various technology advances in the field that aim to reduce stroke and death rates associated with CAS. Transcervical access, reversal of flow and mesh-covered stents are currently the most promising tools in the armamentarium of CAS.

Aortic valve replacement reduces mortality in moderate aortic stenosis:a systematic review and meta-analysis

BACKGROUND With the introduction of transcatheter aortic valve replacement and an evolving understanding of the natural progression and history of aortic stenosis,the potential for earlier intervention in appropriate patients is promising;however,the benefit of aortic valve replacement in moderate aortic stenosis remains unclear.METHODS Pubmed,Embase,and the Cochrane Library databases were searched up until 30th of December 2021 using keywords including moderate aortic stenosis and aortic valve replacement.Studies reporting all-cause mortality and outcomes in early aortic valve replacement(AVR)compared to conservative management in patients with moderate aortic stenosis were included.Hazard ratios were generated using random-effects meta-analysis to determine effect estimates.RESULTS 3470 publications were screened with title and abstract review,which left 169 articles for full-text review.Of these studies,7 met inclusion criteria and were included,totalling 4,827 patients.All studies treated AVR as a time-dependent co-variable in cox-regression multivariate analysis of all-cause mortality.Intervention with surgical or transcatheter AVR was associated with a 45% decreased risk of all-cause mortality(HR=0.55[0.42-0.68],I2=51.5%,P<0.001).All studies were representative of the overall cohort with appropriate sample sizes,with no evidence of publication,detection,or information biases in any of the studies.CONCLUSION In this systematic review and meta-analysis,we report a 45% reduction in all-cause mortality in patients with moderate aortic stenosis who were treated with early aortic valve replacement compared to a strategy of conservative management.Randomised control trials are awaited to determine the utility of AVR in moderate aortic stenosis.

Intrabiliary rupture of hepatic hydatid cysts： results of 10 years＇ experience

Intrabiliary rupture （IBR）is the most common and potentially fatal complication of Hepatic cysticechinococcosis （HCE） Early diagnosis and treatment of IBR is very important, since mortality is high when obstruction of the biliary ducts occurs, leading to ascending cholangitis and septicemia.

Activation of Anti-tumor Immune Response by Ablation of HCC with Nanosecond Pulsed Electric Field

Locoregional therapy is playing an increasingly important role in the non-surgical management of hepatocellular carcinoma(HCC).The novel technique of non-thermal electric ablation by nanosecond pulsed electric field has been recognized as a potential locoregional methodology for indicated HCC.This manuscript explores the most recent studies to indicate its unique anti-tumor immune response.The possible immune mechanism,termed as nano-pulse stimulation,was also analyzed.

Effect of coronary artery dynamics on the wall shear stress vector field topological skeleton in fluid–structure interaction analyses

In this paper,we investigate the impact of coronary artery dynamics on the wall shear stress(WSS)vector field topology by comparing fluid–structure interaction(FSI)and computational fluid dynamics(CFD)techniques.As one of the most common causes of death globally,coronary artery disease(CAD)is a significant economic burden;however,novel approaches are still needed to improve our ability to predict its progression.FSI can include the unique dynamical factors present in the coronary vasculature.To investigate the impact of these dynamical factors,we study an idealized artery model with sequential stenosis.The transient simulations made use of the hyperelastic artery and lipid constitutive equations,non‐Newtonian blood viscosity,and the characteristic out‐of‐phase pressure and velocity distribution of the left anterior descending coronary artery.We compare changes to established metrics of time‐averaged WSS(TAWSS)and the oscillatory shear index(OSI)to changes in the emerging WSS divergence,calculated here in a modified version to handle the deforming mesh of FSI simulations.Results suggest that the motion of the artery can impact downstream patterns in both divergence and OSI.WSS magnitude is also decreased by up to 57%due to motion in some regions.WSS divergence patterns varied most significantly between simulations over the systolic period,the time of the largest displacements.This investigation highlights that coronary dynamics could impact markers of potential CAD progression and warrants further detailed investigations in more diverse geometries and patient cases.