In a recent study, we reported that interleukin (IL)-4 had a protective role against acetaminophen (APAP)-induced liver injury (AILI), although the mechanism of protection was unclear. Here, we carried out more detailed investigations and have shown that one way IL-4 may control the severity of AILI is by regulating glutathione (GSH) synthesis. In the present studies, the protective role of IL-4 in AILI was established definitively by showing that C57BL/6J mice made deficient in IL-4 genetically (IL-4−/−) or by depletion with an antibody, were more susceptible to AILI than mice not depleted of IL-4. The increased susceptibility of IL-4−/− mice was not due to elevated levels of hepatic APAP-protein adducts, but was associated with a prolonged reduction in hepatic GSH that was attributed to decreased gene expression of γ-glutamylcysteine ligase (γ-GCL). Moreover, administration of recombinant IL-4 to IL-4−/− mice post-acetaminophen treatment diminished the severity of liver injury and increased γ-GCL and GSH levels. We also report that the prolonged reduction of GSH in APAP-treated IL-4−/− mice appeared to contribute towards increased liver injury by causing a sustained activation of c-Jun-N-terminal kinase (JNK), since levels of phosphorylated JNK remained significantly higher in the IL-4−/− mice up to 24 hours after APAP treatment Conclusion Overall these results show for the first time that IL-4 has a role in regulating the synthesis of GSH in the liver under conditions of cellular stress. This mechanism appears to be responsible at least in part for the protective role of IL-4 against AILI in mice and may have a similar role not only in AILI in humans, but also in pathologies of the liver caused by other drugs and etiologies.

Our study is the first diverse analysis of unplanned postoperative ICU admissions in the literature across multiple specialties and practice models. We found an association of advanced age, higher ASA PS class, and duration of procedure with unplanned ICU admission after surgery. Surgical specialties and procedures with the most unplanned ICU admissions could be areas for quality improvement and clinical pathways in the future.

Pulmonary complications post-hematopoietic stem cell transplantation (HSCT) such as diffuse alveolar hemorrhage (DAH) can occur in 2%-14% of HSCT patients with a mortality greater than 80%. [1][2][3][4] It is described as a syndrome of acute respiratory failure characterized by diffuse bilateral infiltrates and progressive hemorrhage and manifests as bleeding in the alveolar space due to injury to the alveolar-capillary basement membrane. 4,5 Clinical symptoms include cough, hypoxemia, and fever. [1][2][3][4] Imaging findings, either by x-ray or

Background Patient involvement in surgical decisions is formalized in the informed consent process, which should reflect that the patient understands their diagnosis, planned procedure, and the associated risks and benefits before consenting to treatment. If high-quality shared decision making has occurred, the treatment chosen should best match the goals and preferences of the patient. Little information currently exists that analyzes factors associated with decisional quality in surgery. Identifying patient factors correlated with specific deficits in preoperative decision making is essential for improvement of the shared decision-making process. This study aims to identify patient characteristics and coping strategies associated with the presence of knowledge deficits regarding their diagnosis and procedure so that interventions can be targeted to these vulnerable groups. Methods Approximately 882 preoperative patients were assessed regarding understanding of their diagnosis and procedure. Sociodemographic and decision-making variables were evaluated using validated measures. Univariate analysis and logistic regression models assessed factors associated with lower decisional quality. Results Approximately 136 (15%) of 882 patients had deficits in knowledge of diagnosis and/or procedure. Older patients were more likely to demonstrate these deficits (P = 0.0002). Using multivariate analysis, independent predictors of knowledge deficits included patients who identified themselves as Black, Asian, or other race (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.19–5.85; and OR, 1.88; 95% CI, 1.00–3.55, respectively); were older (OR, 1.02; 95% CI, 1.01–1.04); and used denial as a coping strategy (OR, 2.61; 95% CI, 1.29–5.28). The use of acceptance as a coping strategy negatively predicted knowledge deficits (OR, 0.55; 95% CI, 0.36–0.84). Conclusions Specific patient factors and coping strategies are associated with deficiencies in decisional quality. Identifying vulnerable groups at risk for these issues can help target methodologies and resources to ensure high-quality surgical decision making.

The objective of this retrospective analysis was to describe the development and implementation of an anesthesiologist-led multidisciplinary committee to evaluate high-risk surgical patients in order to improve surgical appropriateness. The study was conducted in an anesthesia preoperative evaluation clinic at an academic comprehensive cancer center. One hundred sixty-seven high-risk surgical patients with cancer-related diagnoses were evaluated and discussed at a High-Risk Committee (HRC) meeting to determine surgical appropriateness and optimize perioperative care. The HRC is an anesthesiologist-led model for multidisciplinary review of high-risk patients developed at Roswell Park Comprehensive Cancer Center. The group of high-risk patients in which surgery was not performed had, on average, a greater percentage of hypertension, smoking history, dyspnea, heart failure, chronic obstructive pulmonary disease, diabetes, renal failure, and sleep apnea than the group in whom surgery was performed. Only one of 107 high-risk patients who had surgery died within the first 30 days after surgery. A smaller percentage of patients died in the group that had surgery versus the group in which surgery was canceled. For all patients discussed by the HRC, the mortality was less than 2% within the first 30 days after the HRC.

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We present a rare case of acute postoperative sialadenitis or "anesthesia mumps" necessitating emergent intubation in a 16-year-old girl after biopsy of a brainstem mass under general anesthesia. Postoperative computed tomography of the brain demonstrated extensive right-sided facial swelling, parotid gland enlargement, and pharyngeal edema extending to the parapharyngeal space, soft palate, and uvula with significant narrowing of the airway. To our knowledge, this entity has not been previously described in the radiologic literature.

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