From basic research to clinical practice: The impact of laminar airflow filters on surgical site infection in vascular surgery.

BACKGROUND: Laminar airflow filters have been suggested as a potential preventive factor for surgical site infections, given their ability to reduce the airborne microbiological load. However, their role is still unclear, and evidence regarding vascular surgery patients is scarce. Our aim was to assess the impact of laminar-airflow filters on surgical site infections. METHODS: This single-centre retrospective cohort study was conducted with vascular surgery patients who underwent arterial vascular intervention through a groin incision between July 2018 and July 2019 (turbulent airflow cohort) and July 2020 and July 2021 (laminar airflow cohort). Data were prospectively collected from electronic medical files. We estimated the cumulative incidence of surgical site infections and its 95% confident interval (95%CI). A propensity score matching analysis was performed. RESULTS: We included 200 patients, 78 in the turbulent airflow cohort and 122 in the laminar airflow cohort. The cumulative incidence was 15.4% (12/78; 95%CI: 9.0-25.0%) in the turbulent-airflow cohort and 14.8% (18/122; 95%CI: 9.5 -22.1%) in the laminar-airflow cohort (p-value: 1.00). The propensity score matching yielded a cumulative incidence of surgical site infection of 13.9% (10/72) with turbulent airflow and 12.5% (9/72) with laminar airflow (p-value: 1.00). Risk factors associated with infection were chronic kidney disease (OR 2.70; 95%CI: 1.14-6.21) and a greater body mass index (OR 1.47; 95%CI: 1.01-2.14). CONCLUSION: Laminar airflow filters were associated with a non-significant reduction of surgical site infections. Further research is needed to determine its usefulness and cost-effectiveness. Surgical site infection incidence was associated with chronic kidney disease and a greater body mass index. Hence, efforts should be made to optimize the body mass index before surgery and prevent chronic kidney disease in patients with known arterial disease.

Are iodophor-impregnated drapes associated with lower intraoperative contamination compared to no adhesive drape?: A protocol for systematic review and meta analysis.

BACKGROUND: Surgical site infection (SSI) is one of the most frightening complications after surgery. Adhesive drapes (AD) are widely used as an infection prevention tool. They can be non-impregnated or iodophor-impregnated, although non-impregnated are less used as they might be related to higher number of infections. One of the most common ways to study their efficacy is by analyzing the intraoperative contamination, which is a useful primary endpoint as it does not need follow-up and it has been strongly associated with infections. Therefore, we believe a systematic review (SR) and meta-analysis is needed to determine which is the literature available about this topic and to explore their results. METHODS: All randomized controlled trials (RCT) published since 1984 through to January 15, 2023 will be included. Non-human and experimental studies will be excluded. We will only include studies written in English. We will conduct searches in the following electronic databases: MEDLINE (via PubMed), SCOPUS and Web Of Science. The protocol of the SR was registered in PROSPERO under the number CRD42023391651 and was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol guidelines. DISCUSSION: The evidence regarding the benefits of using iodophor-impregnated adhesive drapes (IIAD) is scarce. Therefore, this SR and meta-analysis is required to determine if they are related with a lower intraoperative contamination incidence, compared to no AD.

Lessons learned in aortoenteric fistula repair: a multidisciplinary team approach and diagnostic-therapeutic algorithm matter.

Aortoenteric fistula (AEF) is a low-prevalence, life-threatening condition regardless of treatment, with a 30-50% postoperative (≤60 days) mortality. This study aimed to estimate our postoperative cumulative mortality incidence and assess the feasibility of the diagnostic-therapeutic algorithm used in our clinical practice. We performed a retrospective cohort study of patients treated for AEF at a fully-equipped tertiary healthcare center between January 2008 and December 2020.

Groin surgical site infection incidence in vascular surgery with intradermal suture versus metallic stapling skin closure: A study protocol for a pragmatic open-label parallel-group randomized clinical trial (VASC-INF trial).

BACKGROUND: Surgical site infection is 1 of the most frightening complications in vascular surgery due to its high morbimortality. The use of intradermal sutures for skin closure might be associated with a reduction in infections incidence. However, the data available in the literature is scarce and primarily built on low-evidence studies. To our knowledge, no multicenter clinical trial has been published to assess if the intradermal suture is associated with a lower surgical site infection incidence than metallic staples in patients who will undergo revascularization surgery requiring a femoral approach. METHODS: VASC-INF is a pragmatic, multicenter, multistate (Spain, Italy, and Greece), randomized, open-label, clinical trial assessing the surgical site infection incidence in patients undergoing revascularization surgery requiring a femoral approach. Patients will be randomized on a 1:1 ratio to intradermal suture closure (experimental group) or to metallic staples closure (control group).The primary outcome is the number (percentage) of patients with surgical site infection (superficial and/or deep) associated with a femoral approach up to 28 (±2) days after surgery. Among the secondary outcomes are the number (percentage) of patients with other surgical wound complications; the number (percentage) of patients with surgical site infections who develop sepsis; type of antibiotic therapy used; type of microorganisms' species isolated and to describe the surgical site infection risk factors. DISCUSSION: Intradermal suture closure may be beneficial in patients undergoing revascularization surgery requiring a femoral approach. Our working hypothesis is that intradermal suture closure reduces the incidence of surgical site infection respect to metallic staples closure.

Acute administration of inorganic nitrate reduces VO(2peak) in endurance athletes.

PURPOSE: Humans can reduce inorganic nitrate (NO(3)(-)) to nitrite (NO(2)(-)), nitric oxide (NO), and other bioactive nitrogen oxides. The purpose of this study was to test the hypothesis that a single dose of inorganic nitrate before exercise might enhance the tolerance of endurance athletes to high intensity exercise. METHODS: Eleven cyclists (age = 34.3 ± 4.8 yr, VO(2peak) = 65.1 ± 6.2 mL·kg(-1)·min(-1)) participated in this randomized, double-blind, crossover study. Subjects received dietary supplementation with nitrate (NaNO(3) 10 mg·kg(-1) of body mass) or a placebo (NaCl) 3 h before exercise. They then performed a cycle ergometer test that consisted of four 6-min submaximal workloads, corresponding to 2.0, 2.5, 3.0, and 3.5 W·kg(-1) of body mass, interspersed with 3 min of passive recovery. After a 5-min recovery period, subjects performed one incremental exercise test until exhaustion. RESULTS: Plasma nitrate and nitrite were significantly higher (P < 0.05) 3 h after supplementation (nitrate = 250 ± 80 µM, nitrite = 2313 ± 157 nM) than after the placebo (nitrate = 29 ± 8 µM, nitrite = 1998 ± 206 nM) at resting conditions. Nitrate supplementation significantly reduced VO(2peak)(nitrate = 4.64 ± 0.35 L·min(-1), placebo = 4.82 ± 0.33 L·min(-1), P = 0.010) and the ratio between VO(2) and power at maximal intensity (nitrate = 11.2 ± 1.1 mL·min(-1)·W(-1), placebo = 11.8 ± 1.1 mL·min(-1)·W(-1), P = 0.031). This reduction of VO(2) occurred without changes in the time to exhaustion (nitrate = 416 ± 32 s, placebo = 409 ± 27 s) or in the maximal power (nitrate = 416 ± 29 W, placebo = 410 ± 28 W). CONCLUSIONS: A single oral dose of inorganic nitrate acutely reduces VO(2peak)without compromising the maximal exercise performance.

[Endovascular management of a left subclavian artery lesion following thoracoplasty for bronchopleural fistula and empyema secondary to aspergillus fumigatus]. / Manejo endovascular de lesión de arteria subclavia izquierda tras toracoplastia por fístula broncopleural y empiema secundario a Aspergillus fumigatus.

Massive and/or recurrent hemoptysis is a clear indication for surgical treatment of pleuropulmonary aspergilloma, despite the incidence of postoperative morbidity and mortality. Thoracoplasty has been widely used for 20 years and is still indicated in these cases, following lobectomy, even though the procedure is not free of complications. We report the case of a patient who required thoracoplasty to treat a pleuropulmonary aspergilloma invading the chest wall. Subsequent placement of an aortic stent-graft was required due to tearing of the left subclavian artery.

Manejo endovascular de lesión de arteria subclavia izquierda tras toracoplastia por fístula broncopleural y empiema secundario a Aspergillus fumigatus / Endovascular management of a left subclavian artery lesion following thoracoplasty for bronchopleural fistula and empyema secondary to Aspergillus fumigatus

La hemoptisis masiva y/o repetitiva es una indicación clara de tratamiento quirúrgico del aspergiloma pleuropulmonar, a pesar de la morbimortalidad posquirúrgica existente. La toracoplastia, muy utilizada hace 2 décadas, todavía tiene su indicación aquí, tras lobectomía, aunque no está exenta de complicaciones. Presentamos un caso de aspergiloma pleuropulmonar con invasión de pared torácica que requirió toracoplastia y posteriormente técnicas endovasculares aórticas por desgarro de la arteria subclavia izquierda

Massive and/or recurrent hemoptysis is a clear indication for surgical treatment of pleuropulmonary aspergilloma, despite the incidence of postoperative morbidity and mortality. Thoracoplasty has been widely used for 20 years and is still indicated in these cases, following lobectomy, even though the procedure is not free of complications. We report the case of a patient who required thoracoplasty to treat a pleuropulmonary aspergilloma invading the chest wall. Subsequent placement of an aortic stent-graft was required due to tearing of the left subclavian artery

Overexpression of hypoxia/inflammatory markers in atherosclerotic carotid plaques.

Hypoxia, angiogenesis and inflammation leads to plaque progression and remodelling and may significantly contribute towards plaque rupture and subsequent cerebrovascular events. Our aim was to study, markers of hypoxia and inflammation previously identified by microarray analysis, in atherosclerotic carotid arteries with low to moderate stenosis. We hoped to describe different cellular populations expressing the studied markers. The location of selected inflammatory molecules obtained as vascular transplants from organ donors were analysed by immunohistochemistry with monoclonal and polyclonal antibodies. Paraffin-embedded sections were cut and probed with antibodies recognizing active B and T-lymphocytes (CD30), hypoxia-inducible factor-1alpha, endoglin (CD105), Interleukin-6 and C-reactive protein. We observed a notable overexpression of HIF-1alpha in inflammatory and hypoxic areas of carotid arteries in all types of lesions from type II-V taken from the patients with carotid stenosis less than 50%. This suggests that HIF-1alpha may have a putative role in atherosclerosis progression and angiogenesis. Dynamic changes in the non-occluding plaques may explain some of the clinical events in patients with low to moderate carotid stenosis.

Expresión de la proteína C reactiva en placas ateroscleróticas de carótida / Expression of C-reactive protein in atherosclerotic carotid plaques

Introducción. La proteína C-reactiva (PCR) es un marcador de inflamación y de pronóstico de la enfermedad cardiovascular. Además, esta proteína parece realizar funciones mediadoras de esta enfermedad, dado sus múltiples efectos proaterogénicos y su presencia en las lesiones ateroscleróticas. Material y métodos. En este estudio, se analizó la expresión de la PCR, mediante la reacción en cadena de la polimerasa a tiempo real, en las lesiones avanzadas de carótida obtenidas mediante endarterectomía. Además, mediante inmunohistoquímica, se analizó la expresión de esta proteína en estas lesiones ateroscleróticas avanzadas y en muestras de arteria carótida que se encontraban en diferentes estadios de progresión. Resultados. Los valores de ácido ribonucleico mensajero de PCR fueron significativamente más elevados en las lesiones ulceradas no complicadas, comparado con las lesiones ulceradas complicadas (p = 0,001) y fibrosas (p = 0,01). Mediante inmuno-histoquímica, se observó marcaje para PCR en las lesiones más avanzadas, principalmente en las células inflamatorias infiltradas y en vasos de nueva formación. En cambio, en lesiones más tempranas y en las arterias carótidas sanas no se encontró tinción para la PCR. Conclusión. La expresión de la PCR en las lesiones ateroscleróticas de carótida se induce en estadios medios y avanzados de la progresión, y puede estar implicada en la inflamación y la neovascularización que aparece en estos estadios, lo que conlleva riesgo de complicaciones hemorrágicas (AU)

Background. C-reactive protein (CRP) is an inflammatory and powerful marker of future vascular events. Recently, it has been proposed as a mediator molecule of atherosclerotic disease due to its multiple proatherogenic effects and its presence in atherosclerotic plaques. Material and methods. CRP expression was analyzed by real time polymerase chain reaction (PCR) in advanced carotid plaques. Furthermore, protein expression was analyzed by immunohistochemistry in carotid atherosclerotic lesions obtained by endarterectomy and in carotid samples in different phases of progression. Results. Analysis by real time PCR showed significantly higher levels of CRP in ulcerated non-complicated lesions as compared to complicated ulcerated lesions (p = 0.001) or fibrous lesions (p = 0.01). An immunohistochemistry assay for CRP showed that in advanced lesions, mainly infiltrated inflammatory cells and new vessels were stained. In contrast, no CRP staining was observed in early lesions and carotid artery controls. Conclusion. CRP expression in carotid atherosclerotic lesions is induced in moderated and advanced stages of plaque progression, suggesting a possible role of this molecule in inflammation and neovascularization and triggering atherothrombotic complications (AU)

Endogenous expression of C-reactive protein is increased in active (ulcerated noncomplicated) human carotid artery plaques.

BACKGROUND AND PURPOSE: There is growing evidence suggesting that C-reactive protein (CRP) is an effecter molecule able to induce and promote atherothrombosis. The presence of CRP in atherosclerotic plaques may reflect local production or infiltration from circulating CRP increased in general inflammatory responses. Our aim was to analyze the presence of CRP in human advanced carotid artery plaques with differential anatomo-pathological characteristics and to assess local expression of CRP and other proinflammatory genes in these lesions. METHODS: Human carotid artery specimens from 38 patients undergoing scheduled endarterectomy were classified into 3 groups: ulcerated (noncomplicated) (UNC, n=19), fibrous (F, n=12) and ulcerated (complicated/hemorrhagic) plaques (UC, n=7). The presence of CRP was evaluated by immunohistochemistry, and plasma samples were screened for circulating high-sensitivity C-reactive protein. TaqMan Low-density Arrays were used for study of genes related to inflammation (CRP, interleukin-6, macrophage colony-stimulating factor-1, monocyte chemotactic protein-1, cyclooxygenase-2). RESULTS: CRP mRNA levels were predominantly detected in UNC-high risk plaques but not in UC (P=0.001). UNC also exhibit the highest expression levels of other genes involved in the inflammatory responses: cyclooxygenase-2 (P<0.005 versus F and versus UC), IL-6 (P<0.005 versus F and versus UC) and monocyte chemoattractant protein-1 (P<0.01 versus F and versus UC). Plaque CRP mRNA levels correlated with immunohistochemical findings but were independent of plasma high-sensitivity CRP. In UNC plaques endothelial cells and inflammatory cells were strongly positive for CRP around areas of newly formed microvessels. CONCLUSIONS: In human high-risk carotid artery plaques (UNC) CRP expression reflects an active proinflammatory stage. Local synthesis of CRP could be involved in plaque neovascularization and increased risk of hemorrhagic transformation.