No abstract available.
Anesthetics, Local* ; Calcium* ; Hypothermia* ; Reperfusion Injury* ; Reperfusion*

Objective: : The purpose of this study was to evaluate the impact of time interval between index event and stenting on the periprocedural risk of stenting for symptomatic carotid stenosis and to determine the optimal timing of stenting. Methods: : This retrospective study included 491 (322 symptomatic [65.6%] and 169 asymptomatic [34.4%]) patients undergoing carotid stenting. The symptomatic patients were categorized into Day 0–3, 4–7, 8–10, 11–14, 15–21, and >21 groups according to the time interval between index event and stenting. Periprocedural (≤30 days) risk for clinical (any neurological deterioration) and radiological (new infarction on postprocedural diffusion-weighted imaging) events of stenting in each time interval versus asymptomatic stenosis was calculated with logistic regression analysis adjusted for confounders, and provided as odds ratio (OR) and 95% confidence interval (CI). Results: : Overall clinical event rate (4.3%) of stenting for symptomatic carotid stenosis was higher than that for asymptomatic stenosis (1.2%; OR, 3.979 [95% CI, 1.093–14.489]; p=0.036). Stenting in Day 0–3 (13.2%; OR, 10.997 [95% CI, 2.333–51.826]; p=0.002) and Day 4–7 (8.3%; OR, 6.775 [95% CI, 1.382–33.227]; p=0.018) was associated with high risk for clinical events. However, the clinical event rates in stenting after 7 days from index event (Day 8–10, 1.8%; Day 11–14, 2.5%; Day 15–21, 0%; Day >21, 2.9%) were not different from that in stenting for asymptomatic stenosis. Overall radiological event rate (55.6%) in symptomatic stenosis was also higher than that in asymptomatic stenosis (35.5%; OR, 2.274 [95% CI, 1.553–3.352]; p<0.001). The high risk for radiological events was maintained in all time intervals (Day 0–3 : 55.3%; OR, 2.224 [95% CI, 1.103–4.627]; p=0.026; Day 4–7 : 58.3%; OR, 2.543 [95% CI, 1.329–4.949]; p=0.005; Day 8–10 : 53.6%; OR, 2.096 [95% CI, 1.138–3.889]; p=0.018; Day 11–14 : 57.5%; OR, 2.458 [95% CI, 1.225–5.021];p=0.012; Day 15–21 : 55.6%; OR, 2.271 [95% CI, 1.099–4.764]; p=0.028; Day >21 : 54.8%; OR, 2.203 [95% CI, 1.342–3.641]; p=0.002). Conclusion : This study showed that as stenting was delayed, the periprocedural risk for clinical events decreased. The clinical event risk was high only in stenting within 7 days and comparable with that for asymptomatic stenosis in stenting after 7 days from index event, although the radiological event risk was not affected by stenting timing. Therefore, our results suggest that delayed stenting after 7 days from symptom onset is a safe strategy for symptomatic stenosis.

BACKGROUND: Early escharectomy has been shown to improve survival rates and treatment outcomes in major burn patients. However, its mechanism, especially in human immune systems, has not been fully elucidated. This observational study, focusing on cytokines, was conducted to assess changes in the levels of tumor necrosis factor alpha (TNF alpha) and interleukin-10 (IL-10) in major burn patients that underwent early tissue excision. METHODS: Seventeen ASA physical status II or III adults major burn patients, admitted to general surgery for burn wound care, were initially recruited. When early escharectomy was scheduled, a series of blood samples was obtained four times at 72 and 24 hours preop and at 24 and 72 hours postop. Changing levels of TNF alpha and IL-10 were measured by quantitative sandwich immnuoassay. RESULTS: Subjects suffered from 70% TBSA burns. Both cytokines demonstrated a significant tendency to increase in the blood during the study period. Although they temporarily decreased 24 hours after surgery, this effect did not last. CONCLUSIONS: Burn injury certainly increases cytokine response. Early escharectomy appears to decrease the pro and anti-inflammatory cytokines only temporarily. It did not seem to have any long term effect in the human immune system in major burn patients, probably due to the complex nature of the injury.
Adult ; Burns* ; Cytokines* ; Humans ; Immune System ; Interleukin-10 ; Observational Study ; Survival Rate ; Tumor Necrosis Factor-alpha ; Wounds and Injuries