Analysis of Intraoperative Variables Responsible for the Increase in Lactic Acid in Patients Undergoing Debulking Surgery.

Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI (ρ = 0.532; p-value < 0.001) and duration of surgery (ρ = 0.518; p-value < 0.001). Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L.

Evaluation of the relationship between lactacidemia and postoperative complications after surgery for peritoneal carcinomatosis.

BACKGROUND: Cytoreductive surgery was developed as a treatment for peritoneal carcinomatosis. However, this surgery is associated with important complications. The present study aimed to assess the relationship between lactacidemia and the rate of associated complications during the immediate postoperative period in the intensive care unit (ICU) in patients undergoing cytoreductive surgery. METHODS: This was a retrospective observational study. A total of 57 patients underwent cytoreductive surgery. All patients were admitted to the ICU immediately after the surgery. Data on lactic acid levels at the time of admission and discharge from the ICU were collected. Postsurgical complications that occurred during the ICU stay were recorded according to failure-to-rescue analysis and their severity stratified according to the Clavien-Dindo classification. RESULTS: The lactic acid levels at admission to the ICU were significantly higher in patients who developed complications, with an almost tripled unadjusted relative risk (2.9, 95% CI: 1.6, 5.3), than in those who did not develop complications for the lactacidemia threshold established in the cumulative sum curve graphs. After adjustment for confounding effects, the relative risk became even higher (3.1, 95% CI: 1.8, 3.6). Lactic acid levels were still significantly higher in this group at the time of discharge from the ICU. CONCLUSIONS: Serum lactate level is a risk factor for postoperative complications in patients undergoing cytoreductive surgery for peritoneal carcinomatosis. This study suggests that the risk of developing severe complications almost triples with a lactic acid level of 2.5 mmol/L or higher at the time of admission in the ICU.

Can human movement analysis contribute to usability understanding?

Nowadays human-machine interfaces are evaluated using different methodologies. These methodologies rarely consider the human movements involved in the interaction, and if so, the movements are considered in a simplistic manner. Another often neglected aspect is the relationship between the learning process and the use of the interface. Traditional approaches of cognitive modeling consider learning as just one continuous process. However there is some current evidence of concurrent processes on different time scales. This paper aims to answer, with experimental measurements, if learning actually implies a set of concurrent processes, if those processes are related to the coordinative aspects of hand movement, and how this can vary between young adult and elderly users. Two different interfaces, a washing machine and a domotic system, were analyzed with 23 and 20 people, respectively, classified as men or women and elderly (over 55) or adult (between 40 and 50). The results of the study provide support for the existence of different concurrent processes in learning, previously demonstrated for motor tasks. Moreover, the learning process is actually associated with changes in movement patterns. Finally, the results show that the progression of the learning process depends on age, although elderly people are equally capable of learning to use technological systems as young adults.

Kinematics of the trunk in sitting posture: an analysis based on the instantaneous axis of rotation.

This paper presents a new approach for analysing trunk kinematics in sitting posture based on the characterisation of thorax and pelvis motion by means of ranges of motion and instantaneous axes of rotation (IAR). These variables are estimated from videophotogrammetric data. An experiment was carried out in order to analyse three motions associated with the flexion-extension movement: the absolute motions of the pelvis and thorax and the relative motion between the thorax and pelvis. The results obtained suggest a sequential activation of lumbar vertebrae in the flexion-extension motion. On the other hand, the location of the pelvis IAR shows that the movement of the pelvis on the seat is not just a rolling motion but a rolling with some level of sliding. Finally, the location of the IAR in the thorax-pelvis relative motion shows a mismatch between the trunk IAR and the backrest axis of rotation in several office chairs. The proposed technique provides a new approach for the kinematic analysis of sitting posture. The results can be applied to the improvement of biomechanical models of seated posture as well as to define some design criteria of work seats based on the fit between the trunk and backrest movements.

Objective firmness, average pressure and subjective perception in mattresses for the elderly.

For elderly people, the desirable situation of living independently means facing everyday tasks and risks alone [Monk et al., 2006. Towards a practical framework for managing the risks of selecting technology to support independent living. Appl. Ergon. 37, 599-606]. One such task is buying a mattress through the same channels as younger people. Quite short trials (if any) in the store are usually the only basis for choice. Despite the long-term effects a mattress may have on the user, acceptance or rejection largely depends on this extremely short trial experience. This paper aims to cover the salient mechanical aspects of comfort and usability (rolling, getting up). The results should help manufacturers to know if the long-term benefits of their products are perceived in the short term by senior citizen customers. Four mattresses for the elderly chosen from a sample of 17 available on the Spanish market were compared in pairs for short-term effects (1 min pressure with both hands, 1 min sitting, 1 min lying on back, and 1 min lying on side), simulating a store purchasing trial by a group of young and elderly people in terms of differences between perceived firmness, usability (ease of movement) and comfort. The results of these comparisons were correlated to differences in objective properties such as pressure distribution and objective firmness. No differences in perception were found between young and old users. Only two of the four test methods for perceiving mattress firmness were necessary to explain the majority of variance: pressing the surface of the mattress with a part of the body (both hands or buttocks), and contact using the entire body (lying on back or side). A number of significant relationships were found, with the following of note: increments in 'objective firmness' (estimated from test load/deflection) correlate positively to increments in 'perceived firmness'; increments in 'average pressure' (measured using a mannequin) correlate positively to increments (within certain limits) in 'perceived firmness'; increments in 'objective firmness' and in 'average pressure' are associated with increments in 'overall comfort' and with reductions in 'difficulty in rolling". Finally, it was found that people with a higher body mass index tend to be (weak correlation) more sensitive to changes in 'objective firmness'.