Surgery - Journal Articleshttps://hdl.handle.net/10468/11602024-03-29T16:01:29Z2024-03-29T16:01:29Z261A cross-sectional survey of anaesthesia-related expectations amongst patients awaiting upper limb trauma surgeryIohom, GabriellaO'Donnell, Brian D.https://hdl.handle.net/10468/70702023-04-05T07:21:49Z2017-09-03T00:00:00Zdc.title: A cross-sectional survey of anaesthesia-related expectations amongst patients awaiting upper limb trauma surgery
dc.contributor.author: Iohom, Gabriella; O'Donnell, Brian D.
dc.description.abstract: Background and aims: Little is known regarding patients’ anaesthesia-related expectations when presenting for upper limb trauma surgery. Methods: We conducted a prospective cross-sectional survey exploring prior anaesthetic experience, anaesthesia-related knowledge, anaesthesia expectations, the preoperative visit and factors likely to influence anaesthesia choice. The survey was completed by 192 patients. Results: Anaesthetists were identified as doctors by 52%; 53% were unaware of their planned anaesthesia; 58% indicated likely acceptance of regional anaesthesia. Information regarding anaesthesia originated mostly from surgeons (65%); 93% had not seen an anaesthetist at the time of the survey. Most believed anaesthesia involved ‘going to sleep’ (82%) and 71% expected to receive general anaesthesia. The preoperative anaesthesia visit was rated as important by 65% of patients. 78% indicated that provision of information would increase the likelihood of accepting regional anaesthesia. Reducing postoperative pain and nausea would influence 80% in choosing a regional technique. Conclusion: A knowledge deficit exists regarding anaesthesia modalities for upper limb trauma surgery.
2017-09-03T00:00:00ZA descriptive study of the burden of animal-related trauma at Cork University HospitalSheehan, M.Deasy, Conorhttps://hdl.handle.net/10468/54342023-04-05T06:43:32Z2018-01-01T00:00:00Zdc.title: A descriptive study of the burden of animal-related trauma at Cork University Hospital
dc.contributor.author: Sheehan, M.; Deasy, Conor
dc.description.abstract: Farming is the most dangerous occupation in Ireland1 and the incidence of farm accidents is rising. This study examines major farm animal-related trauma treated at Cork University Hospital over a 5 year period. There were 54 patients admitted to Cork University Hospital (C.U.H.) with major farm animal-related trauma. The median age was 56 years, 85% were male and the median hospital length of stay was four days. Older patients had longer lengths of stay; 5.5 vs 4 days (p=0.026). Tibia/fibula fractures were the most common injuries (N=13, 24%); head injury occurred in six patients (11%). There were 32 (59%) patients who required surgery, the majority for orthopaedic injuries. There were nine patients (16.7%) admitted to the intensive care unit; their median ICU stay was four days. Injury prevention and treatment strategies require that the age profile, mechanism of injury and injury patterns of farmers sustaining animal-related trauma is recognised.
2018-01-01T00:00:00ZActivation of both TLR and NOD signaling confers host innate immunity-mediated protection against microbial infectionZhou, HuitingCoveney, Andrew P.Wu, MingHuang, JieBlankson, SiobhanZhao, HeO'Leary, D. PeterBai, ZhenjiangLi, YipingRedmond, H. PaulWang, Jiang HuaiWang, Jianhttps://hdl.handle.net/10468/80852023-04-05T07:22:03Z2019-01-14T00:00:00Zdc.title: Activation of both TLR and NOD signaling confers host innate immunity-mediated protection against microbial infection
dc.contributor.author: Zhou, Huiting; Coveney, Andrew P.; Wu, Ming; Huang, Jie; Blankson, Siobhan; Zhao, He; O'Leary, D. Peter; Bai, Zhenjiang; Li, Yiping; Redmond, H. Paul; Wang, Jiang Huai; Wang, Jian
dc.description.abstract: The detection of microbial pathogens relies on the recognition of highly conserved microbial structures by the membrane sensor Toll-like receptors (TLRs) and cytosolic sensor NOD-like receptors (NLRs). Upon detection, these sensors trigger innate immune responses to eradicate the invaded microbial pathogens. However, it is unclear whether TLR and NOD signaling are both critical for innate immunity to initiate inflammatory and antimicrobial responses against microbial infection. Here we report that activation of both TLR and NOD signaling resulted in an augmented inflammatory response and the crosstalk between TLR and NOD led to an amplified downstream NF-kB activation with increased nuclear transactivation of p65 at TNF-a and IL-6 promoters. Furthermore, co-stimulation of macrophages with TLR and NOD agonists maximized antimicrobial activity with accelerated phagosome maturation. Importantly, administration of both TLR and NOD agonists protected mice against polymicrobial sepsis-associated lethality with increased serum levels of inflammatory cytokines and accelerated bacterial clearance from the circulation and visceral organs. These results demonstrate that activation of both TLR and NOD signaling synergizes to induce efficient inflammatory and antimicrobial responses, thus conferring protection against microbial infection.
2019-01-14T00:00:00ZAssessment of plasma B7-H3 levels in pediatric patients with different degrees of surgical stressLi, YanYuan, QingHuang, JieLi, Yi PingPan, JianFeng, XingZhang, Xue GuangWang, Jiang HuaiWang, Jianhttps://hdl.handle.net/10468/41152023-04-05T07:21:52Z2016-07-26T00:00:00Zdc.title: Assessment of plasma B7-H3 levels in pediatric patients with different degrees of surgical stress
dc.contributor.author: Li, Yan; Yuan, Qing; Huang, Jie; Li, Yi Ping; Pan, Jian; Feng, Xing; Zhang, Xue Guang; Wang, Jiang Huai; Wang, Jian
dc.description.abstract: Background: Surgical stress initiates a series of host hormone, metabolism and immune responses, which predominantly affect the homeostatic mechanism of patients with major surgery. B7-H3 is a co-stimulatory molecule and has been shown to participate in both adaptive and innate immune responses. In this study we evaluated the clinical significance of plasma B7-H3 levels in pediatric patients with different types of operation and degrees of surgical stress. Methods: A total of 48 children received pediatric general and cardiac surgery were recruited into this study. Based on the surgical stress scoring, children were divided into moderate stress (n?=?14) and severe stress (n?=?34) groups. Plasma B7-H3 levels were assessed at selected time points: before surgery, immediately after surgery, at day 1, day 3, and day 7 after surgery. Correlations between plasma B7-H3 levels and surgical stress scores were also examined. Results: Plasma B7-H3 levels were significantly decreased in all 48 pediatric patients after surgery compared to the B7-H3 level before surgery (p?<?0.01). Children with general surgery showed significant decreases in plasma B7-H3 immediately after surgery, and at day 3 and day 7 after surgery (p?<?0.05, p?<?0.01), whereas children with cardiac surgery showed reduced plasma B7-H3 immediately after surgery and at day 3 after surgery (p?<?0.05). Plasma B7-H3 in cardiac surgery group was dropped much lower than that in general surgery group at day 1 (p?<?0.05) and day 3 (p?<?0.01) after surgery. Significantly reduced plasma B7-H3 was observed in the severe stress group, but not in the moderate stress group, immediately after surgery and at day 3 after surgery (p?<?0.05), and severe stress group had significantly lower plasma B7-H3 levels than moderate stress group at day 1, day 3, and day 7 after surgery (p?<?0.05). Furthermore, plasma B7-H3 levels at day 1 (p?=?0.01) and day 3 (p?=?0.025) after surgery correlated negatively with surgical stress scores. Conclusions: Plasma B7-H3 levels were decreased significantly in children subjected to pediatric general and cardiac surgery, which is closely associated with the severity of surgical stress. The negative correlation of plasma B7-H3 levels at day 1 and day 3 after surgery with surgical stress scoring implicates that the plasma B7-H3 level might be a useful biomarker for monitoring stress intensity during pediatric surgery.
2016-07-26T00:00:00ZB7-H3 augments inflammatory responses and exacerbates brain damage via amplifying NF-κB p65 and MAPK p38 activation during experimental pneumococcal meningitisChen, XuqinLi, YanBlankson, SiobhanLiu, MinHuang, DanpingRedmond, H. PaulHuang, JingWang, Jiang HuaiWang, Jianhttps://hdl.handle.net/10468/37492023-04-05T07:22:14Z2017-01-31T00:00:00Zdc.title: B7-H3 augments inflammatory responses and exacerbates brain damage via amplifying NF-κB p65 and MAPK p38 activation during experimental pneumococcal meningitis
dc.contributor.author: Chen, Xuqin; Li, Yan; Blankson, Siobhan; Liu, Min; Huang, Danping; Redmond, H. Paul; Huang, Jing; Wang, Jiang Huai; Wang, Jian
dc.description.abstract: The costimulatory protein B7-H3 has been shown to play a contributory role in the development and progression of experimental pneumococcal meningitis by augmentation of the innate immunity-associated inflammatory response via a TLR2-dependent manner. This study aimed to clarify the component(s) of TLR2-mediated signal transduction pathways responsible for B7-H3-augmented inflammatory response and subsequent brain damage during experimental pneumococcal meningitis. Administration of B7-H3 did not augment expression of TLR2 and other TLR2 upstream components, but led to an enhanced formation of MyD88-IRAK immunocomplex in the brain of S. pneumoniae-infected mice. Furthermore, B7-H3 substantially augmented S. pneumoniae-induced activation of TLR2 downstream NF-κB p65 and MAPK p38 pathways in the brain of S. pneumoniae-infected mice. Notably, blockage of NF-κB p65 and/or MAPK p38 with their specific inhibitors strongly attenuated B7-H3-amplified inflammatory response with significantly reduced proinflammatory cytokine and chemokine production, and markedly ameliorated B7-H3-exacerbated disruption of bloodbrain barrier and severity of disease status in S. pneumoniae-infected mice. These results indicate that targeting NF-κB p65 and/or MAPK p38 may represent a promising therapeutic option for amelioration of overwhelming inflammatory response-associated brain injury frequently observed during pneumococcal meningitis.
2017-01-31T00:00:00ZB7H3 ameliorates LPS-induced acute lung injury via attenuation of neutrophil migration and infiltrationLi, YanHuang, JieFoley, Niamh M.Xu, YunyunLi, Yi PingPan, JianRedmond, H. PaulWang, Jiang HuaiWang, Jianhttps://hdl.handle.net/10468/38532023-04-05T07:21:57Z2016-08-01T00:00:00Zdc.title: B7H3 ameliorates LPS-induced acute lung injury via attenuation of neutrophil migration and infiltration
dc.contributor.author: Li, Yan; Huang, Jie; Foley, Niamh M.; Xu, Yunyun; Li, Yi Ping; Pan, Jian; Redmond, H. Paul; Wang, Jiang Huai; Wang, Jian
dc.description.abstract: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are characterized by an excessive inflammatory response within the lungs and severely impaired gas exchange resulting from alveolar-capillary barrier disruption and pulmonary edema. The costimulatory protein B7H3 functions as both a costimulator and coinhibitor to regulate the adaptive and innate immune response, thus participating in the development of microbial sepsis and pneumococcal meningitis. However, it is unclear whether B7H3 exerts a beneficial or detrimental role during ALI. In the present study we examined the impact of B7H3 on pulmonary inflammatory response, polymorphonuclear neutrophil (PMN) influx, and lung tissue damage in a murine model of lipopolysaccharide (LPS)-induced direct ALI. Treatment with B7H3 protected mice against LPS-induced ALI, with significantly attenuated pulmonary PMN infiltration, decreased lung myeloperoxidase (MPO) activity, reduced bronchoalveolar lavage fluid (BALF) protein content, and ameliorated lung pathological changes. In addition, B7H3 significantly diminished LPS-stimulated PMN chemoattractant CXCL2 production by inhibiting NF-kappa B p65 phosphorylation, and substantially attenuated LPS-induced PMN chemotaxis and transendothelial migration by down-regulating CXCR2 and Mac-1 expression. These results demonstrate that B7H3 substantially ameliorates LPS-induced ALI and this protection afforded by B7H3 is predominantly associated with its inhibitory effect on pulmonary PMN migration and infiltration.
2016-08-01T00:00:00ZBRAFV600E mutation as a predictor of thyroid malignancy in indeterminate nodules: a systematic review and meta-analysisJinih, MarcelFoley, Niamh M.Osho, OlakunleHoulihan, LenaToor, Asad AliKhan, Jehan Z.Achackzai, Akbar A.Redmond, H. Paulhttps://hdl.handle.net/10468/35622023-04-05T07:21:46Z2016-11-22T00:00:00Zdc.title: BRAFV600E mutation as a predictor of thyroid malignancy in indeterminate nodules: a systematic review and meta-analysis
dc.contributor.author: Jinih, Marcel; Foley, Niamh M.; Osho, Olakunle; Houlihan, Lena; Toor, Asad Ali; Khan, Jehan Z.; Achackzai, Akbar A.; Redmond, H. Paul
dc.description.abstract: Background: Thyroid nodules are usually diagnosed using fine-needle aspiration (FNA). The sensitivity limitations of FNA result in 10–30% of nodules being classified as “indeterminate”. The BRAFV600E mutation is associated with papillary thyroid carcinoma (PTC). We conducted a systemic review and meta-analysis to evaluate the diagnostic utility of the BRAFV600E mutation in indeterminate nodules. Method: PUBMED and EMBASE were searched for studies testing for the BRAFV600E involving indeterminate nodules (Thy3a, Thy3f, Thy4) and containing information on final surgical histopathology. Thirty two studies involving 3150 indeterminate nodules were included in the analysis. Results: The overall sensitivity and specificity for BRAFV600E for the diagnosis of thyroid malignancy was 0.40 (95% CI: 0.32–0.48) and 1.00 (95% CI: 0.98–1.00) respectively. The diagnostic odds ratio (DOR) was 205.4 (95% CI: 40.1–1052). With a Fagan plot, the post-test probability of thyroid cancer, given a negative mutation was 6%, but this rose to 92% with a positive result. On subgroup analysis, for Thy3a nodules, the pooled sensitivity and specificity for thyroid malignancy was 0.21 (95% CI: 0.13–0.34) and 1.00 (95% CI: 0.98–1.00). For Thy3f nodules, the pooled sensitivity and specificity was 0.09 (95% CI: 0.03–0.20) and 1.00 (95% CI: 0.05–1.00) respectively. For Thy4 nodules, the corresponding sensitivity and specificity was 0.58 (95% CI: 0.5–0.64) and 0.99 (95% CI: 0.95–1.00) respectively. Conclusions: Despite a high specificity for thyroid cancer, BRAFV600E mutation has a low overall sensitivity and therefore has a limited diagnostic value as a single screening test.
2016-11-22T00:00:00ZCardiopulmonary bypass down-regulates NOD signaling and inflammatory response in children with congenital heart diseaseYang, QinghuaLiao, JianyiHuang, JieLi, Yi PingHuang, ShungenZhou, HuitingXie, YiPan, JianLi, YanhongWang, Jiang HuaiWang, Jianhttps://hdl.handle.net/10468/31712023-04-05T07:21:56Z2016-09-13T00:00:00Zdc.title: Cardiopulmonary bypass down-regulates NOD signaling and inflammatory response in children with congenital heart disease
dc.contributor.author: Yang, Qinghua; Liao, Jianyi; Huang, Jie; Li, Yi Ping; Huang, Shungen; Zhou, Huiting; Xie, Yi; Pan, Jian; Li, Yanhong; Wang, Jiang Huai; Wang, Jian
dc.description.abstract: In the present study, we aimed to examine the impact of cardiopulmonary bypass (CPB) on expression and function of NOD1 and NOD2 in children with congenital heart disease (CHD), in an attempt to clarify whether NOD1 and NOD2 signaling is involved in the modulation of host innate immunity against postoperative infection in pediatric CHD patients. Peripheral blood samples were collected from pediatric CHD patients at five different time points: before CPB, immediately after CPB, and 1, 3, and 7 days after CPB. Real-time PCR, Western blot, and ELISA were performed to measure the expression of NOD1 and NOD2, their downstream signaling pathways, and inflammatory cytokines at various time points. Proinflammatorycytokine IL-6 and TNF-α levels in response to stimulation with either the NOD1 agonist Tri-DAP or the NOD2 agonist MDP were significantly reduced after CPB compared with those before CPB, which is consistent with a suppressed inflammatory response postoperatively. The expression of phosphorylated RIP2 and activation of the downstream signaling pathways NF-κB p65 and MAPK p38 upon Tri-DAP or MDP stimulation in PBMCs were substantially inhibited after CPB. The mRNA level of NOD1 and protein levels of NOD1 and NOD2 were also markedly decreased after CPB. Our results demonstrated that NOD-mediated signaling pathways were substantially inhibited after CPB, which correlates with the suppressed inflammatory response and may account, at least in part, for the increased risk of postoperative infection in pediatric CHD patients.
2016-09-13T00:00:00ZClinical unity and community empowerment: the use of smartphone technology to empower community management of chronic venous ulcers through the support of a tertiary unitQuinn, Edel M.Corrigan, Mark A.O'Mullane, JohnMurphy, DavidLehane, Elaine Leahy-Warren, PatriciaCoffey, AliceMcCluskey, PatriciaRedmond, H. PaulFulton, Greg J.https://hdl.handle.net/10468/23572023-07-14T12:26:42Z2013-01-01T00:00:00Zdc.title: Clinical unity and community empowerment: the use of smartphone technology to empower community management of chronic venous ulcers through the support of a tertiary unit
dc.contributor.author: Quinn, Edel M.; Corrigan, Mark A.; O'Mullane, John; Murphy, David; Lehane, Elaine ; Leahy-Warren, Patricia; Coffey, Alice; McCluskey, Patricia; Redmond, H. Paul; Fulton, Greg J.
dc.description.abstract: Background: Chronic ulcers affect roughly 60,000 Irish people, at a total cost of €600,000,000, or €10,000 per patient annually. By virtue of their chronicity, these ulcers also contribute a significant burden to tertiary outpatient vascular clinics. Objective: We propose utilizing mobile phone technology to decentralise care from tertiary centres to the community, improving efficiency and patient satisfaction, while maintaining patient safety. Methods: Bespoke mobile software was developed for Apples iPhone 4 platform. This allowed for the remote collection of patient images prospectively and their transmission with clinical queries, from the primary healthcare team to the tertiary centre. Training and iPhones were provided to five public health nurses in geographically remote areas of the region. Data were uploaded securely and user end software was developed allowing the review and manipulation of images, along with two way communication between the teams. Establishing reliability, patients were reviewed clinically as well as remotely, and concordance analysed. Qualitative data were collected through focus group discussion. Results: From October to December 2011 eight patients (61-83 yrs, mean 75.3 yrs) with chronic venous ulceration and their five public health nurses were recruited. Data were transmitted using 3 G, Edge, GPRS and WiFi, at a mean speed of 69.03 kps. Concordance was 100% for wound bed assessment, 80% for skin integrity/colour and 60% for exudate assessment. Focus group analysis explored the concept, practicalities and future applications of the system. Conclusions: With an evolving national data network, the secure transmission of clinical images is a safe alternative to regular clinic appointments for patients with chronic venous ulceration. With further development, and packaged as a freely downloadable application, this has the potential to support the community care of chronic wounds.
2013-01-01T00:00:00ZCombination of electroporation delivered metabolic modulators with low-dose chemotherapy in osteosarcomaGill, Kheshwant S.Fernandes, PhilanaBird, BrianSoden, Declan M.Forde, Patrick F.https://hdl.handle.net/10468/69472023-04-05T07:22:13Z2018-01-01T00:00:00Zdc.title: Combination of electroporation delivered metabolic modulators with low-dose chemotherapy in osteosarcoma
dc.contributor.author: Gill, Kheshwant S.; Fernandes, Philana; Bird, Brian; Soden, Declan M.; Forde, Patrick F.
dc.description.abstract: Background: Osteosarcoma accounts for roughly 60% of all malignant bone tumors in children and young adults. The five-year survival rate for localized tumors after surgery and chemotherapy is approximately 70% whilst it drastically reduces to 15–30% in metastatic cases. Metabolic modulation is known to increase sensitivity of cancers to chemotherapy. A novel treatment strategy in Osteosarcoma is needed to battle this devastating malady. Results: Electroporation-delivered metabolic modulators were more effective in halting the cell cycle of Osteosarcoma cells and this negatively affects their ability to recover and proliferate, as shown in colony formation assays. Electroporation-delivered metabolic modulators increase the sensitivity of Osteosarcoma cells to chemotherapy and this combination reduces their survivability. Conclusion: This novel treatment approach highlights the efficacy of electroporation in the delivery of metabolic modulators in Osteosarcoma cells, and increased sensitivity to chemotherapy allowing for a lower dose to be therapeutic. Methods: Metabolic modulations of two Osteosarcoma cell lines were performed with clinically available modulators delivered using electroporation, and its combination with low-dose Cisplatin. The effects of Dicholoroacetic acid, 2-Deoxy-D-glucose and Metformin on cell cycle and recovery of Osteosarcoma cells were assessed. Their sensitivity to chemotherapy was also assessed when treated in combination with electroporation-delivered metabolic modulators.
2018-01-01T00:00:00Z