Mini Bypass and Proinflammatory Leukocyte Activation: A Randomized Controlled Trial

Nguyen, Bao; Fiorentino, Francesca; Reeves, Barnaby C; Baig, Kamran; Athanasiou, Thanos; Anderson, Jon R.; Haskard, Dorian O.; Angelini, Gianni; Evans, Paul C.

doi:10.1016/j.athoracsur.2015.09.029

Cited by 18 publications

(11 citation statements)

References 19 publications

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“…In addition, monocytes could activate T and B lymphocytes and further produce cytokines such as IL-12 and TNF-α to stimulate the immune response [ 17 ]. However, either overstimulation or immunosuppression of monocytes caused by surgical procedure and/or other external factors could disrupt the immune system [ 18 , 19 ]. Previous studies have shown an elevated preoperative monocyte count to be a poor prognostic factor in esophageal squamous cell carcinoma, mantle cell lymphoma, follicular lymphoma, and classical Hodgkin lymphoma, respectively [ 6 , 7 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

High postoperative monocyte indicates inferior Clinicopathological characteristics and worse prognosis in lung adenocarcinoma or squamous cell carcinoma after lobectomy

Hai

Chen

et al. 2018

BMC Cancer

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BackgroundPeripheral monocyte count is an assessable parameter. Recently, evidence suggested an elevated preoperative monocyte counts predicting poor prognosis in malignancies. The aim of this study was to determine the prognostic effect of early postoperative blood monocyte count in patients with lung adenocarcinoma or squamous cell carcinoma following lobectomy.MethodsWe retrospectively reviewed patients with operated lung adenocarcinoma or squamous cell carcinoma from 2006 to 2011 in Western China Lung Cancer database. Univariate analysis on disease-free survival (DFS) and overall survival (OS) was performed using the Kaplan-Meier and log-rank tests, and multivariate analysis was conducted using the Cox proportional hazards regression model.ResultsThere were 433 patients enrolled in our analysis. High postoperative elevated monocyte was associated with male gender (P < 0.001), positive smoking history (P = 0.005), and higher N stage (P = 0.002) and higher tumor stage (P = 0.026). Two-tailed log-rank test indicated patients with an early postoperative elevated monocyte count predicted a poor DFS and OS overall (P < 0.001, P < 0.001, respectively) as well as in subgroup analysis, and further presented as a promising independent prognostic factor for both DFS and OS (HR = 2.991, 95%CI: 2.243–3.988, P < 0.001; HR = 2.705, 95%CI: 1.977–3.700, P < 0.001, respectively) on multivariate analysis. However, no significance was detected for preoperative monocyte in multivariate analysis.ConclusionsElevated early postoperative peripheral monocyte count was an independent prognostic factor of poor prognosis and inferior clinicopathological features for patients with operable lung adenocarcinoma or squamous cell carcinoma by lobectomy.

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Section: Discussionmentioning

confidence: 99%

High postoperative monocyte indicates inferior Clinicopathological characteristics and worse prognosis in lung adenocarcinoma or squamous cell carcinoma after lobectomy

Hai

Chen

et al. 2018

BMC Cancer

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“…This is supported also by the study by Halonen et al [19] in which the incidence of postoperative AF was significantly lower in patients treated with intravenous metoprolol as compared to metoprolol by mouth. Evolution of the cardiopulmonary bypass has emerged new techniques such as MECC to reduce the inflammatory response follow cardiac surgery [21][22][23]. Reducing the surface area of the circuit and removing the blood-air interface potentially offers several benefits compared to CECC including reduced hemodilution, postbypass coagulopathy, and inflammatory response [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…New techniques, such as miniaturized ECC (MECC), have been developed to reduce blood-air and blood-artificial material contact and, thus, inflammatory response compared to conventional ECC (CECC) [21][22][23]. In addition, an increasing number of CABG procedures are performed without any ECC (OPCAB) aiming to less surgical trauma and even less inflammatory reaction than with CECC or MECC [24,25].…”

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confidence: 99%

How do different extracorporeal circulation systems affect metoprolol bioavailability in coronary artery bypass surgery patients

Kokki

Maaroos

Ellam

et al. 2018

Eur J Clin Pharmacol

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Purpose Cardiac surgery and conventional extracorporeal circulation (CECC) impair the bioavailability of drugs administered by mouth. It is not known whether miniaturized ECC (MECC) or off-pump surgery (OPCAB) affect the bioavailability in similar manner. We evaluated the metoprolol bioavailability in patients undergoing CABG surgery with CECC, MECC, or having OPCAB. Methods Thirty patients, ten in each group, aged 44-79 years, scheduled for CABG surgery were administered 50 mg metoprolol by mouth on the preoperative day at 8-10 a.m. and 8 p.m., 2 h before surgery, and thereafter daily at 8 a.m. and 8 p.m. Blood samples were collected up to 12 h after the morning dose on the preoperative day and on first and third postoperative days. Metoprolol concentration in plasma was analyzed using liquid chromatography-mass spectrometry. Results The absorption of metoprolol was markedly reduced on the first postoperative day in all three groups, but recovered to the preoperative level on the third postoperative day. The geometric means (90% confidence interval) of AUC 0-12 on the first and third postoperative days versus the preoperative day were 44 (26-74)% and 109 (86-139)% in the CECC-group, 28 (16-50)% and 79 (59-105)% in the MECC-group, and 26 (12-56)% and 96 (77-119)% in the OPCAB-group, respectively. Two patients in the CECC-group and two in the MECC-group developed atrial fibrillation (AF). The bioavailability and the drug concentrations of metoprolol in patients developing AF did not differ from those who remained in sinus rhythm. Conclusion The bioavailability of metoprolol by mouth was markedly reduced in the early phase after CABG with no difference between the CECC-, MECC-, and OPCAB-groups.

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“…However, either overstimulation or immunosuppression of monocytes caused by surgical procedure and/or other external factors could disrupt the immune system (18,19). Previous studies have found an elevated preoperative monocyte count tumor-associated macrophages (TAMs), which further promote those invading leukocytes to bring out potentials of angiogenesis, motility, and invasion (25,26).…”

Section: Discussionmentioning

confidence: 99%

High Postoperative Monocyte Indicated Inferior Clinicopathological Characteristics and Worse Prognosis in Lung Adenocarcinoma or Squamous Cell Carcinoma after Lobectomy

Hai

Chen

et al. 2018

Preprint

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1 3 Background: Peripheral monocyte count is an assessable parameter. Recently, evidence 1 4 However, no significance was detected for preoperative monocyte in multivariate analysis. 3 1 Conclusions: Elevated early postoperative peripheral monocyte count was an independent 3 2 prognostic factor of poor prognosis and inferior clinicopathological features for patients with 3 3 operable lung adenocarcinoma or squamous cell carcinoma by lobectomy. 3 4

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Mini Bypass and Proinflammatory Leukocyte Activation: A Randomized Controlled Trial

Abstract: Both p38-MAPK activation and ROS were attenuated with the use of mCPB compared with cCPB, providing a potential mechanism for reduced inflammation in association with CPB miniaturization.

Cited by 18 publications

References 19 publications

High postoperative monocyte indicates inferior Clinicopathological characteristics and worse prognosis in lung adenocarcinoma or squamous cell carcinoma after lobectomy

High postoperative monocyte indicates inferior Clinicopathological characteristics and worse prognosis in lung adenocarcinoma or squamous cell carcinoma after lobectomy

How do different extracorporeal circulation systems affect metoprolol bioavailability in coronary artery bypass surgery patients

High Postoperative Monocyte Indicated Inferior Clinicopathological Characteristics and Worse Prognosis in Lung Adenocarcinoma or Squamous Cell Carcinoma after Lobectomy

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