Browsing by Author "Sands, Laura P"

Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Perioperative cerebrospinal fluid and plasma inflammatory markers after orthopedic surgery.
    (J Neuroinflammation, 2016-08-30) Hirsch, Jan; Vacas, Susana; Terrando, Niccolo; Yuan, Miao; Sands, Laura P; Kramer, Joel; Bozic, Kevin; Maze, Mervyn M; Leung, Jacqueline M
    BACKGROUND: Postoperative delirium is prevalent in older patients and associated with worse outcomes. Recent data in animal studies demonstrate increases in inflammatory markers in plasma and cerebrospinal fluid (CSF) even after aseptic surgery, suggesting that inflammation of the central nervous system may be part of the pathogenesis of postoperative cognitive changes. We investigated the hypothesis that neuroinflammation was an important cause for postoperative delirium and cognitive dysfunction after major non-cardiac surgery. METHODS: After Institutional Review Board approval and informed consent, we recruited patients undergoing major knee surgery who received spinal anesthesia and femoral nerve block with intravenous sedation. All patients had an indwelling spinal catheter placed at the time of spinal anesthesia that was left in place for up to 24 h. Plasma and CSF samples were collected preoperatively and at 3, 6, and 18 h postoperatively. Cytokine levels were measured using ELISA and Luminex. Postoperative delirium was determined using the confusion assessment method, and cognitive dysfunction was measured using validated cognitive tests (word list, verbal fluency test, digit symbol test). RESULTS: Ten patients with complete datasets were included. One patient developed postoperative delirium, and six patients developed postoperative cognitive dysfunction. Postoperatively, at different time points, statistically significant changes compared to baseline were present in IL-5, IL-6, I-8, IL-10, monocyte chemotactic protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, IL-6/IL-10, and receptor for advanced glycation end products in plasma and in IFN-γ, IL-6, IL-8, IL-10, MCP-1, MIP-1α, MIP-1β, IL-8/IL-10, and TNF-α in CSF. CONCLUSIONS: Substantial pro- and anti-inflammatory activity in the central neural system after surgery was found. If confirmed by larger studies, persistent changes in cytokine levels may serve as biomarkers for novel clinical trials.
  • Thumbnail Image
    ItemOpen Access
    Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability.
    (J Gerontol A Biol Sci Med Sci, 2015-09) He, Shuang; Craig, Bruce A; Xu, Huiping; Covinsky, Kenneth E; Stallard, Eric; Thomas, Joseph; Hass, Zach; Sands, Laura P
    BACKGROUND: Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality. METHODS: A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information. RESULTS: Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p = .018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities. CONCLUSION: Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.