Showing papers by "Comac published in 2024"
TL;DR: Routine use of lidocaine infusions for perioperative analgesia and CPSP prevention is not supported in this population of women and moderate-quality evidence is provided that perioperative lidocaine infusion does not reduce CPSP in patients undergoing breast cancer surgery.
Abstract: Breast cancer is the most common cancer among women and tumour resection carries a high prevalence of chronic persistent postsurgical pain (CPSP). Perioperative i.v. lidocaine infusion has been proposed as protective against CPSP; however, evidence of its benefits is conflicting. This review evaluates the effectiveness of perioperative lidocaine infusions for breast cancer surgery.Randomised trials comparing perioperative lidocaine infusions with parenteral analgesia in breast cancer surgery patients were sought. The two co-primary outcomes were the odds of CPSP at 3 and 6 months after operation. Secondary outcomes included rest pain at 1, 6, 12, and 24 h; analgesic consumption at 0-24 and 25-48 h; quality of recovery; opioid-related side-effects; and lidocaine infusion side-effects. Hartung-Knapp-Sidik-Jonkman (HKSJ) random effects modelling was used.Thirteen trials (1039 patients; lidocaine: 518, control: 521) were included. Compared with control, perioperative lidocaine infusion did not decrease the odds of developing CPSP at 3 and 6 months. Lidocaine infusion improved postoperative pain at 1 h by a mean difference (95% confidence interval) of -0.65 cm (-0.73 to -0.57 cm) (P<0.0001); however, this difference was not clinically important (1.1 cm threshold). Similarly, lidocaine infusion reduced oral morphine consumption by 7.06 mg (-13.19 to -0.93) (P=0.029) over the first 24 h only; however, this difference was not clinically important (30 mg threshold). The groups were not different for any of the remaining outcomes.Our results provide moderate-quality evidence that perioperative lidocaine infusion does not reduce CPSP in patients undergoing breast cancer surgery. Routine use of lidocaine infusions for perioperative analgesia and CPSP prevention is not supported in this population.PROSPERO CRD42023420888.
TL;DR: This systematic review of 22 publications on vasoplegic syndrome during heart transplantation found a 28.72% incidence, associated with male sex, higher BMI, and pre-HT device usage, and linked to increased postoperative complications and mortality.
Abstract: Vasoplegic syndrome (VS) is a common occurrence during heart transplantation (HT). It currently lacks a uniform definition between transplant centers, and its pathophysiology and treatment remain enigmatic. This systematic review summarizes the available published clinical data regarding VS during HT.We searched databases for all published reports on VS during HT. Data collected included the incidence of VS in the HT population, patient and intraoperative characteristics, and postoperative outcomes.Twenty-two publications were included in this review. The prevalence of VS during HT was 28.72% (95% confidence interval: 27.37%, 30.10%). Factors associated with VS included male sex, higher body mass index, hypothyroidism, pre-HT left ventricular assist device or venoarterial extracorporeal membrane oxygenation (VA-ECMO), pre-HT calcium channel blocker or amiodarone usage, longer cardiopulmonary bypass time, and higher blood product transfusion requirement. Patients who developed VS were more likely to require postoperative VA-ECMO support, renal replacement therapy, reoperation for bleeding, longer mechanical ventilation, and a greater 30-day and 1-year mortality.The results of our systematic review are an initial step for providing clinicians with data that can help identify high-risk patients and avenues for potential risk mitigation. Establishing guidelines that officially define VS will aid in the precise diagnosis of these patients during HT and guide treatment. Future studies of treatment strategies for refractory VS are needed in this high-risk patient population.
TL;DR: A novel PFOV model accurately characterizes the stress relaxation behavior of unidirectional prepreg with fewer parameters, improving physical interpretability and capturing intricate behaviors.
Abstract: In the hot-stamp molding and hot diaphragm forming processes of composites, pressure significantly influences shaping quality. This study establishes a novel parallel fractional-order viscoelastic (PFOV) model with two Scott-Blair elements, achieving remarkable accuracy (R2 = 0.99) with fewer parameters. Unlike traditional models, it incorporates the force history of prepreg, providing a more precise representation of its mechanical response. Comparative analysis against established models underscores its superior ability to capture intricate stress relaxation behaviors. Notably, the model’s reduced parameters enhance its physical interpretability, offering a significant advantage in simulating and predicting prepreg material compression behavior for diverse manufacturing processes.