British journal of anaesthesia最新文献

{"title":"RNA-binding protein SYNCRIP contributes to neuropathic pain through stabilising CCR2 expression in primary sensory neurones","authors":"Yang Zhang ,&nbsp;Bing Wang ,&nbsp;Xiaozhou Feng ,&nbsp;Huixing Wang ,&nbsp;Ju Gao ,&nbsp;Xu Li ,&nbsp;Xiaodong Huo ,&nbsp;Bushra Yasin ,&nbsp;Alex Bekker ,&nbsp;Huijuan Hu ,&nbsp;Yuan-Xiang Tao","doi":"10.1016/j.bja.2024.07.024","DOIUrl":"10.1016/j.bja.2024.07.024","url":null,"abstract":"<div><h3>Background</h3><div>Nerve injury-induced changes in gene expression in the dorsal root ganglion (DRG) contribute to the genesis of neuropathic pain. SYNCRIP, an RNA-binding protein, is critical for the stabilisation of gene expression. Whether SYNCRIP participates in nerve injury-induced alterations in DRG gene expression and nociceptive hypersensitivity is unknown.</div></div><div><h3>Methods</h3><div>The expression and distribution of SYNCRIP in mouse DRG after chronic constriction injury (CCI) of the unilateral sciatic nerve were assessed. Effect of microinjection of <em>Syncrip</em> small interfering RNA into the ipsilateral L3 and L4 DRGs on the CCI-induced upregulation of chemokine (C-C motif) receptor 2 (CCR2) and nociceptive hypersensitivity were examined. Additionally, effects of microinjection of adeno-associated virus 5 expressing full length <em>Syncrip</em> mRNA (AAV5-<em>Syncrip</em>) on basal DRG CCR2 expression and nociceptive thresholds were observed.</div></div><div><h3>Results</h3><div>SYNCRIP is expressed predominantly in DRG neurones, where it co-exists with CCR2. Levels of <em>Syncrip</em> mRNA and SYNCRIP protein in injured DRG increased time-dependently on days 3–14 after CCI. Blocking this increase through microinjection of <em>Syncrip</em> small interfering RNA into injured DRG attenuated CCI-induced upregulation of DRG CCR2 and development and maintenance of nociceptive hypersensitivities. Mimicking this increase through DRG microinjection of AAV5-<em>Syncrip</em> elevated CCR2 expression in microinjected DRGs, enhanced the responses to mechanical, heat, and cold stimuli, and induced ongoing pain in naive mice. Mechanistically, SYNCRIP bound to 3-UTR of <em>Ccr2</em> mRNA and stabilised its expression in DRG neurones.</div></div><div><h3>Conclusions</h3><div>SYNCRIP contributes to the induction and maintenance of neuropathic pain likely through stabilising expression of CCR2 in injured DRG. SYNCRIP may be a potential target for treating this disorder.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in hip fracture surgery in the United States from 2016 to 2021: patient characteristics, clinical management, and outcomes","authors":"Genewoo Hong ,&nbsp;Haoyan Zhong ,&nbsp;Alex Illescas ,&nbsp;Lisa Reisinger ,&nbsp;Crispiana Cozowicz ,&nbsp;Jashvant Poeran ,&nbsp;Jiabin Liu ,&nbsp;Stavros G. Memtsoudis","doi":"10.1016/j.bja.2024.07.022","DOIUrl":"10.1016/j.bja.2024.07.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Hip fractures are a serious health concern and a major contributor to healthcare resource utilisation. We aimed to investigate nationwide trends in the USA in patient characteristics and outcomes in patients after hip fracture repair surgery.</div></div><div><h3>Methods</h3><div>From the Premier Healthcare dataset, we extracted patient encounters for surgical hip fracture repair from 2016 to 2021. Patient characteristics, comorbidities, complications, and anaesthetic and surgical details were analysed. Cochran–Armitage trend tests and simple linear regression were used to determine trends.</div></div><div><h3>Results</h3><div>We included 347 086 hip fracture repair encounters. Notable trends included the following: median patient age declined from 82 yr [interquartile range: 73–88 yr] to 81 yr [interquartile range: 73–88 yr], (<em>P</em>-value=0.002), the proportion of female patients decreased from 68% to 66.2% (<em>P</em>-value=0.019); internal fixation was the most common intervention initially, but with a declining percentage from 49.9% to 43.8% (<em>P</em>-value &lt;0.001); in general, patients carried a greater comorbidity burden, with the proportion with three or more Elixhauser comorbidities increasing from 56.4% to 58.6% (<em>P</em>-value=0.006); general anaesthesia remained the most common anaesthetic technique, from 68.90% to 56.80% without a significant trend; per 1000 inpatient days, the most common complication remained acute renal failure; despite a higher comorbidity burden, no complication showed a statistically significant upward trend, and many showed downward trends.</div></div><div><h3>Conclusions</h3><div>Over the 6-yr period from 2016 to 2021, a majority of hip fracture repairs continued to be performed under general anaesthesia but with that percentage declining over time. Notable trends included a lower percentage of female patients, an increase in femoral neck fractures, a higher comorbidity burden among patients, and a decrease in complications.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided suprainguinal fascia iliaca compartment block and early postoperative analgesia after total hip arthroplasty. Comment on Br J Anaesth 2024; 133: 146-51.","authors":"Fu S Xue, Dan F Wang, Xiao C Zheng","doi":"10.1016/j.bja.2024.07.026","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.026","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving sustainability and mitigating the environmental impacts of anaesthesia and surgery: a narrative review.","authors":"Andrea J MacNeill, Chantelle Rizan, Jodi D Sherman","doi":"10.1016/j.bja.2024.05.042","DOIUrl":"https://doi.org/10.1016/j.bja.2024.05.042","url":null,"abstract":"<p><p>Climate change, environmental degradation, and biodiversity loss are adversely affecting human health and exacerbating existing inequities, intensifying pressures on already strained health systems. Paradoxically, healthcare is a high-polluting industry, responsible for 4.6% of global greenhouse gas emissions and a similar proportion of air pollutants. Perioperative services are among the most resource-intensive healthcare services and are responsible for some unique pollutants. Opportunities exist to mitigate pollution throughout the entire continuum of perioperative care, including those that occur upstream of the operating room in the process of patient selection and optimisation, delivery of anaesthesia and surgery, and the postoperative recovery period. Within a patient-centred, holistic approach, clinicians can advocate for healthy public policies that modify the determinants of surgical illness, can engage in shared decision-making to ensure appropriate clinical decisions, and can be stewards of healthcare resources. Innovation and collaboration are required to redesign clinical care pathways and processes, optimise logistical systems, and address facility emissions. The results will extend beyond the reduction of public health damages from healthcare pollution to the provision of higher value, higher quality, patient-centred care.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty and decisional regret after elective noncardiac surgery: a multicentre prospective cohort study","authors":"Yonathan Agung ,&nbsp;Emily Hladkowicz ,&nbsp;Laura Boland ,&nbsp;Husein Moloo ,&nbsp;Luke T. Lavallée ,&nbsp;Manoj M. Lalu ,&nbsp;Daniel I. McIsaac","doi":"10.1016/j.bja.2024.08.001","DOIUrl":"10.1016/j.bja.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is associated with morbidity and mortality after surgery. The association of frailty with decisional regret is poorly defined. Our objective was to estimate the association of preoperative frailty with decisional regret status in the year after surgery.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of a prospective, multicentre cohort study of patients aged ≥65 years who underwent elective noncardiac surgery. Decisional regret about having undergone surgery was ascertained at 30, 90, and 365 (primary time point) days after surgery using a 3-point ordinal scale. Bayesian ordinal logistic regression was used to estimate the association of frailty with decisional regret, adjusted for surgery type, age, sex, and mental health conditions. Subgroup and sensitivity analyses were conducted.</div></div><div><h3>Results</h3><div>We identified 669 patients; 293 (43.8%) lived with frailty. At 365 days after surgery, the unadjusted odds ratio (OR) associating frailty with greater decisional regret was 2.21 (95% credible interval [CrI] 0.98–5.09; <em>P</em>(OR&gt;1)=0.97), which was attenuated after confounder adjustment (adjusted OR 1.68, 95% CrI 0.84–3.36; <em>P</em>(OR&gt;1)=0.93). Similar results were estimated at 30 and 90 days. Additional adjustment for baseline comorbidities and disability score substantially altered the OR at 365 days (0.89, 95% CrI 0.37–2.12; <em>P</em>(OR&gt;1)=0.39). There was a high probability that surgery type was an effect modifier (non-orthopaedic: OR 1.90, 95% CrI 1.00–3.59; <em>P</em>(OR&gt;1)=0.98); orthopaedic: OR 0.87, 95% CrI 0.41–1.91; <em>P</em>(OR&gt;1)=0.36).</div></div><div><h3>Conclusions</h3><div>Among older surgical patients, there appears to be a complex association with frailty and decisional regret, with substantial heterogeneity based on assumed causal pathways and surgery type. Future studies are required to untangle the complex interplay between these factors.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teamwork matters: team situation awareness to build high-performing healthcare teams. Comment on Br J Anaesth 2024; 132: 771–8","authors":"Raymond Kelly,&nbsp;Aoife Lavelle","doi":"10.1016/j.bja.2024.07.023","DOIUrl":"10.1016/j.bja.2024.07.023","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative randomised controlled trials: to pilot or not to pilot?","authors":"Maura Marcucci ,&nbsp;Sandra Ofori","doi":"10.1016/j.bja.2024.07.017","DOIUrl":"10.1016/j.bja.2024.07.017","url":null,"abstract":"<div><p>The science of pilot trials is evolving, and understanding of their role in medical research is increasing. Perioperative randomised controlled trials often test interventions that are inherently multidisciplinary and complex; therefore, there might be compelling reasons to conduct pilot studies to assess feasibility and inform trial design. As pilot studies themselves require resources, investigators should not squander this opportunity; they should design them so that they properly address the sources of uncertainty regarding the success of the definitive trial.</p></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning and preoperative risk prediction: the machines are coming","authors":"Ben Shelley ,&nbsp;Martin Shaw","doi":"10.1016/j.bja.2024.07.015","DOIUrl":"10.1016/j.bja.2024.07.015","url":null,"abstract":"<div><div>Preoperative risk prediction is an important component of perioperative medicine. Machine learning is a powerful tool that could lead to increasingly complex risk prediction models with improved predictive performance. Careful consideration is required to guide the machine learning approach to ensure appropriate decisions are made with regard to what we are trying to predict, when we are trying to predict it, and what we seek to do with the results.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid overdose deaths are prominent in urban counties within the USA: an observational cross-sectional study","authors":"Amogh V. Patankar ,&nbsp;Rionna Octaviano ,&nbsp;Navneeth Gurachar ,&nbsp;Annabel W. Chen ,&nbsp;Alice Guan ,&nbsp;George A. Hung ,&nbsp;Nicholas Kikuta ,&nbsp;Armaan Jamal ,&nbsp;Malathi Srinivasan ,&nbsp;Adrian M. Bacong ,&nbsp;Robert J. Huang ,&nbsp;Gloria S. Kim ,&nbsp;Latha P. Palaniappan ,&nbsp;Eric R. Gross","doi":"10.1016/j.bja.2024.07.020","DOIUrl":"10.1016/j.bja.2024.07.020","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steady-state trumps accuracy: target-controlled infusion as a gain switch","authors":"Talmage D. Egan ,&nbsp;Charles F. Minto ,&nbsp;Thomas W. Schnider","doi":"10.1016/j.bja.2024.07.014","DOIUrl":"10.1016/j.bja.2024.07.014","url":null,"abstract":"<div><p>Target-controlled infusion (TCI) is a mature technology that enables the delivery of intravenous anaesthetics in the concentration domain. The accuracy of the pharmacologic models used by TCI systems is imperfect, especially regarding pharmacodynamic predictions. This shortcoming of TCI devices is not critical. That TCI systems produce steady-state effect-site concentrations at or near a specified target is a more important attribute than a high level of accuracy because anaesthesiologists titrate to a stable level of drug effect whatever the actual concentration is. In this sense, TCI functions as a ‘gain switch’. Achieving a steady state is more important than perfect accuracy.</p></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}