The Journal of surgical research
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Thrombelastography (TEG) is a viscoelastic hemostatic assay. We have observed that end-stage renal disease (ESRD) and trauma-induced coagulopathy (TIC) produce distinctive TEG tracings. We hypothesized that rigorously definable TEG patterns could discriminate between healthy controls and patients with ESRD and TIC. ⋯ ESRD and TIC demonstrate distinct TEG patterns. The coagulopathy of ESRD is typified by a prolonged enzymatic phase of clot formation, with normal-to-elevated final clot strength. Conversely, TIC is typified by prolonged clot formation and weakened clot strength. Our taxonomic categorization constitutes a rigorous system for the algorithmic interpretation of TEG based on cluster analysis. This will form the basis for clinical decision support software for viscoelastic hemostatic assays.
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Release of neutrophil extracellular traps (NETs) has been identified as an important aspect of innate immunity. We examined whether sepsis had any influence on ex vivo generation of NETs by neutrophils. ⋯ The ex vivo generation of NETs is downregulated in neutrophils isolated from patients with sepsis. However, it is unclear whether in vivo NET formation is also impaired during sepsis, so further investigation is necessary.
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Postoperative fatigue (POF) is an important complication that is commonly observed postoperatively and is also one of the most serious obstacles to postoperative convalescence. However, the risk factors for POF have not been fully addressed, and there is no effective method to predict POF. The aim of the present study was to investigate the risk factors for POF and to explore prediction of the degree of POF. ⋯ Old age, nutritional risk screening 2002 score ≥ 3 and gastrectomy were risk factors for POF in patients undergoing elective gastrointestinal surgery. POF was reduced in laparoscopic-assisted surgery. Consideration of these factors could be important for the prevention and treatment of POF.
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Extracorporeal shock wave application (ESWA) has the potential to qualify as an adjuvant therapy option for soft tissue disorders such as chronic wounds. As of today, little is known about its exact mechanism of action. For a better understanding of the pathophysiology, we investigated the effect of ESWA on microcirculation and leukocyte-endothelial interaction. ⋯ ESWA has a significant and immediate impact on microcirculation with endothelial integrity loss and increase of adherent leukocytes as part of a proinflammatory process. Although a dilation of venules was caused, arterioles primarily show a constriction. The study shows alterations in microcirculation that could help understand the mechanism of action in the future.
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Randomized Controlled Trial
Effects of dexmedetomidine on patients undergoing radical gastrectomy.
Surgical stress may cause immunosuppression especially in patients who have surgery for primary tumor removed. This study aimed to explore the effects of dexmedetomidine on immune and inflammatory response in patients undergoing radical gastrectomy. ⋯ Dexmedetomidine has been shown to reduce surgical stresses and maintain Th1/Th2 balance. It has been shown to reduce inflammatory responses and exerts immunoprotective effect.