Patients who have suffered an ischemic stroke with damage to the right insular cortex (IC) often develop post‐stroke cardiac complications. However, the pathophysiology and time course of these post‐stroke myocardial changes require further investigation which is complicated by a lack of pre‐clinical models. The purpose of this work is to assess the time course of post‐stroke cardiac fibrosis and inflammation in a rat model of selective insular ischemic stroke. IC ischemic stroke was induced in six‐month‐old Wistar rats via unilateral stereotaxic injection of endothelin‐1 into the right IC (n=6/surgical group). Control rats received a phosphate‐buffered saline (PBS) injection into the right IC (n=6/surgical group). To establish a time course of cardiac dysfunction, hearts were histologically examined at 6, 24 hours, 7, 14 and 28 days post‐stroke for fibrosis (Masson's Trichrome stain), inflammation (CD45+, myeloperoxidase, CD3+, CD45R, CD68+ immunostaining) and endothelial dysfunction (phosphorylated endothelial nitric oxide synthase (eNOS)). Areas of interest included the 4 heart chambers and pulmonary vein/left atrium border (PV‐LA border). Results from this study showed that focal IC ischemic stroke led to neutrophil infiltration at 6 hours, followed by T lymphocyte infiltration at 7 days at the PV‐LA border. Left atrial tissue experienced long‐term fibrosis at 28 days following focal IC stroke. Further, B lymphocyte infiltration was seen at 28 days post‐stroke in left ventricular tissue. These findings provide insight into the progression of post‐stroke cardiac changes and suggest that inflammation is a treatable target to prevent post‐stroke myocardial injury.Support or Funding InformationThis study is funded by the Kathleen & Dr Henry Barnett Research Chair in Stroke Research (Western University, London, Ontario, Canada), the Western University Medical and Health Sciences Research Board Seed Research Grant, and the Edward and Alma Saraydar Neurosciences Fund (London Health Sciences Foundation).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
High-quality hand therapy is critical to maximising functional capacity and optimising overall outcomes following hand injuries. Therapy delivery requires clear communication between surgeons and occupational therapists. At Sunnybrook Health Sciences Centre (SHSC), Canada’s largest tertiary care centre, suboptimal communication is a significant barrier to efficient hand therapy delivery in acute multisystem trauma patients. A baseline audit at SHSC found that 41% of hand therapy orders required clarification and 35% of patients waited over 24 hours before their order was fulfilled. In many cases, communication errors created unacceptably long delays that were suspected by surgeon stakeholders to impede patient outcomes. This highlighted an opportunity for investigation and system improvement.Using process mapping methodology, we outlined standard process involved in patient care and identified barriers to successful communication. We collaborated with key stakeholders to codesign a standardised template for care orders. We aimed to improve order clarity and consistency with the goal of reducing the incidence of clarification and delays.Postimplementation, the percentage of hand therapy orders requiring clarification was decreased to 24%. The number of patients waiting over 24 hours for therapy was also reduced; however, further investigation is required to verify this finding. In addition, essential order components were more consistently and comprehensively included. Next steps of this work include expanding the use of the order template outside of the multisystem trauma population and improving the communication of hand therapy at discharge from hospital.
Burn patients are at risk for hospital-acquired pressure injuries (HAPIs). An unexamined factor that may contribute to HAPI development is the effect of pressure from the operating table during surgery. The purpose of this study was to measure pressure on the buttocks and sacral area during burn surgery under general anesthesia (GA). Prospective study of consecutive adult burn patients admitted to an ABA-verified burn center who required surgery under GA between January 06, 2022 and December 08, 2022. We studied only cases that were supine, including those with both legs down (LD), one leg suspended (1LU), or both legs suspended (2LU). Interface pressures on the buttocks and sacral area were measured using a commercial sensor mat. Thousands of individual pressure measurements were integrated to show average and peak pressures over repetitive 10-minute intervals during the entire operation. Recordings were completed in 41 procedures among 28 patients (48.3 ± 16.9 years, % TBSA burn 19.2 ± 17.1, weight 80.2 ± 19.7 kg, BMI 26.7 ± 6.2). Both average pressure (Pave) and peak pressure (Ppeak) increased significantly with greater number of elevated legs (p < .001). During 2LU periods, Ppeak exceeded 100 mmHg for almost half the operative duration. Pave crept steadily upwards over time and had a positive relationship with weight, regardless of leg elevation. Prolonged moderate to high pressures are exerted on the sacral and buttock areas, especially with one or both legs suspended, during burn surgery. These novel observations suggest that pressure from the operating table could contribute to HAPI development.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.