Introduction: The effect of perioperative omega-3 fatty acids for liver surgery remained controversial. We conducted a systematic review and meta-analysis to explore the influence of omega-3 fatty acids versus placebo in patients undergoing liver surgery. Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020, and included randomized controlled trials (RCTs) assessing the effect of omega-3 fatty acids versus placebo for liver surgery. This meta-analysis was performed using the random-effect model. Results: Five RCTs were included in the meta-analysis. Overall, compared with control group for liver surgery, omega-3 fatty acids were associated with substantially reduced incidence of infection (odd ratio [OR]=0.56; 95% confidence interval [CI] =0.34–0.91; P = .02), but revealed no remarkable influence on complications (OR = 0.60; 95% CI = 0.29–1.24; P = .17), mortality (OR = 0.76; 95% CI = 0.06–9.37; P = .83), liver failure (OR = 0.72; 95% CI = 0.10 to 5.00; P = 0.74), biliary leakage (OR=1.24; 95% CI = 0.41 to 3.76; P = .70), bleeding (OR = 1.76; 95% CI = 0.63–4.95; P = .28), or ileus (OR = 0.39; 95% CI = 0.07–2.05; P = .27). Conclusion: Perioperative omega-3 fatty acids may be beneficial to reduce the incidence of infection after liver surgery.
Background Atrial septal shunt devices might improve hospitalizations and also prognosis in heart failure with increased pulmonary pressures due to left heart diseases. In recent years, atrial shunt devices have been used for the treatment of chronic heart failure, but there remains a lack of clinical experience. This study aimed to analyse the therapeutic effect of a novel type of atrial shunt on chronic heart failure. Methods and results From May 2020 to September 2020, six patients who were diagnosed with chronic heart failure and completed percutaneous D‐shant atrium shunt device implantation in the Department of Cardiovascular Surgery, Union Hospital, were retrospectively included. The shunt location was evaluated by echocardiography and digital subtraction angiography. Heart function was evaluated by New York Heart Association functional class. Echocardiography was used to measure the diameter of the new chamber and ventricle, and to evaluate the degree of mitral and tricuspid regurgitation. Before operation and 6 months after operation, left atrial end‐diastolic volume, right atrial end‐diastolic volume, left ventricular end‐diastolic volume, and right ventricular end‐diastolic volume were measured by magnetic resonance imaging. Left ventricular ejection fractions and right ventricular ejection fractions were calculated. Haemodynamic indexes of right heart catheterization and clinical cardiac function indexes were collected and compared before and 6 months after shunt implantation. All six patients completed percutaneous shunt device implantation. Echocardiography and digital subtraction angiography showed that the shunt device was correctly positioned and unobstructed in all patients. Echocardiography revealed that the left ventricular diameter decreased significantly from 6.40 ± 0.57 mm to 5.03 ± 0.73 mm (P < 0.05). There was an obvious decrease in mitral regurgitation. Magnetic resonance imaging showed a reduction in the volume of the left ventricle (182.00 ± 27.02 mL vs. 125.75 ± 16.11 mL, P < 0.05). Cardiac catheter examination showed the mean left atrium pressure or pulmonary capillary wedge pressure decreased postoperatively (31.83 ± 11.55 vs. 18.00 ± 5.51 mmHg, P < 0.05). There was also obvious improvement in clinical indicators of cardiac function at 6 months after implantation. Conclusions This novel D‐shant atrium shunt device revealed maintained good function, no dislodgement and no paradoxical emboli. After implantation, functional mitral regurgitation in all patients with heart failure with reduced ejection fraction improved.
Intra-abdominal hypertension (IAH) can damage multiple organ systems, but the explicit impact on the adrenal gland is unclear. To evaluate the effects of intra-abdominal pressure (IAP) on the secretory function of the adrenal glands, we established canine models of IAH. By comparing morphology; hemodynamics; plasma cortisol, aldosterone, epinephrine, and norepinephrine concentrations; and the expression of IL-1, IL-6, and TNF-α in adrenal gland tissue from these dogs, we found that hemodynamic instability occurred after IAH and that IAH increased the plasma cortisol, aldosterone, epinephrine, and norepinephrine concentrations. Higher IAPs resulted in more significant changes, and the above indicators gradually returned to normal 2 h after decompression. Compared with the sham-operated group, IAH significantly increased IL-1, IL-6, and TNF-α levels in adrenal tissue, with larger increases in the presence of higher IAPs. However, the concentrations of these markers remained higher than those in the sham-operated group despite their decrease after 2 h of decompression. Histopathological examination revealed congestion, red blood cell exudation, and neutrophil infiltration in the adrenal glands when IAP was elevated; these conditions became more significant with more severe IAH. These results suggest that the secretion of adrenal hormones and adrenal gland inflammation are positively correlated with IAP and that abdominal decompression effectively corrects adrenal gland function.
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