Kerstin Kolodzie

Background: While periodontitis is well established as a risk factor for cardiovascular disease (CVD), the role of dental caries remains underexplored. Traditional measures such as number of carious lesions may not adequately capture the dynamic risk status of caries, potentially obscuring its association with systemic conditions. Caries Management by Risk Assessment (CAMBRA) offers a more comprehensive evaluation by incorporating biological, behavioral, and clinical factors. It is primarily designed as a clinical tool to estimate an individual’s future risk of developing caries and to guide preventive and management strategies. Additionally, pulpal inflammation may serve as a more direct indicator of active infection and systemic inflammatory burden. This cohort study aimed to assess the association between caries risk and CVD. It also examined whether pulpal inflammation was associated with CVD and described CAMBRA profiles according to CVD status. Methods: This retrospective cohort study included 39,837 patients from the BigMouth Dental Data Repository (January 2011 to December 2024). Baseline caries risk was evaluated as low, moderate, or high/extreme using the CAMBRA assessment form, and pulpal inflammation was identified using the Systematized Nomenclature of Dentistry Dental Diagnostic System (SNODDS). CVD was identified from the self-reported medical history form during follow-up. Baseline characteristics were summarized and compared across different caries risk levels. Adjusted logistic regression was performed to estimate the association between caries risk, pulpal inflammation and CVD. Missing values were imputed using a probability random forest with the ranger package. E-values were calculated for the point estimates and confidence interval limits to assess the robustness of the observed associations to unmeasured confounding. Results: Among 39,837 patients without CVD at baseline, 1,934 (4.9%) patients had newly recorded CVD during the follow-up period. Patients with moderate (adjusted OR = 2.27, 95% CI: 1.75 to 2.95) or high/extreme caries risk (adjusted OR = 2.32, 95% CI: 1.80 to 2.98) had significantly higher odds of newly recorded CVD compared to those at low risk. In contrast, pulpal inflammation was not associated with newly recorded CVD (adjusted OR = 1.06, 95% CI: 0.86 to 1.31). Patients with newly recorded CVD demonstrated a higher burden of oral disease indicators such as noncavitated approximal enamel lesions, cavitated lesions, and tooth extraction due to caries within three years. In addition, they also had fewer protective factors, such as lower exposure to fluoride and reduced use of antiseptic or antimicrobial rinse. Conclusions: Within the limitations of this cohort study, elevated caries risk was associated with higher odds of newly recorded CVD, whereas pulpal inflammation was not. Further prospective studies are needed to elucidate underlying mechanisms and evaluate potential causal pathways.

Background.: Hypotension during liver transplantation often requires vasopressor therapy. Acute kidney injury is a common complication after liver transplantation. Vasopressin acts as a portal flow modulator, may increase the glomerular filtration rate, and reduce the dose of catecholamines required. We hypothesized that intraoperative vasopressin use could be associated with reduced postoperative acute kidney injury. Methods.: This single-center retrospective cohort study included 1120 adult liver transplant recipients between June 2012 and November 2022. We assessed the association between intraoperative vasopressin use and postoperative severe acute kidney injury by using a propensity score-adjusted multivariable regression model. Results.: The incidence of severe postoperative acute kidney injury was 29.2%. The median age was 60 y, 64.9% of patients were males. Vasopressin was used in 34.0% of the cases. Patients receiving vasopressin had a higher Model for End-Stage Liver Disease-sodium score (24 versus 16, P < 0.001). The median [interquartile range] dose of catecholamine vasopressors was significantly higher in patients who received vasopressin (0.08 [0.05–0.12] versus 0.03 [0.01–0.05] µg·kg⁻¹·min⁻¹ norepinephrine equivalents, P < 0.001). We did not observe an association between the intraoperative use of vasopressin and severe acute kidney injury after liver transplantation (adjusted odds ratio: 1.29; 95% confidence interval: 0.92-1.80). Vasopressin use was not associated with a higher hazard of experiencing graft failure or related outcomes over time (hazard ratio = 1.17, P = 0.44). Conclusions.: In patients requiring high doses of intraoperative vasopressors during liver transplantation, vasopressin use was not associated with an increased risk of severe postoperative acute kidney injury or decreased graft survival.

Purpose of Review: This review summarizes the anesthetic considerations for amputation for orthopedic indications including trauma, malignancy, infection, or congenital anomalies. Much of the literature has previously focused on amputation for vascular disease. Recent Findings: Neuraxial anesthesia and peripheral nerve blocks are the most promising modalities to decrease perioperative pain, though it is unclear if they prevent long-term phantom limb pain (PLP). Treatments for PLP aim to disrupt the abnormal signaling along the peripheral and central pathways, including through medications, peripheral nerve stimulators, and surgical therapies. Summary: Perioperative management of orthopedic amputation patients should involve a multidisciplinary team that focuses on improved pain management, early rehabilitation, and improved patient satisfaction. Additional research is needed to determine the optimal regional anesthesia technique and evaluate its effect on perioperative outcomes.

Background: The post‐operative course after Liver Transplantation (LT) can be complicated by early allograft dysfunction (EAD), primary nonfunction (PNF) and death. A lactate concentration at the end of transplant of ≥5 mmol/L was recently proposed as a predictive marker of PNF, EAD, and mortality; this study aimed to validate these previous reports in a large single center cohort.Methods: This retrospective cohort study included adult liver transplant recipients who received grafts from deceased donors at our center between June 2012 and May 2021. Receiver operating characteristic (ROC) curves for the lactate concentration at the end of transplantation were computed to determine the AUC for PNF, EAD and mortality at 90 days.Results: In our cohort of 1137 cases, the AUCs for lactate to predict EAD, PNF and mortality were respectively .56 (95% confidence interval [CI]: .53–.60), .69 (95% CI: .52–.85), and .74 (95% CI: .63–.84).Conclusion: The clinical value of lactate concentration at the end of transplantation to predict PNF, EAD and mortality at 90 days was, at best, modest, as shown by the relatively low AUCs. Our findings cannot validate previous reports that the lactate level alone is a good predictor of poor outcomes after liver transplantation.

Background: Perioperative normal saline administration remains common practice during kidney transplantation. The authors hypothesized that the proportion of balanced crystalloids versus normal saline administered during the perioperative period would be associated with the likelihood of delayed graft function. Methods: The authors linked outcome data from a national transplant registry with institutional anesthesia records from 2005 to 2015. The cohort included adult living and deceased donor transplants, and recipients with or without need for dialysis before transplant. The primary exposure was the percent normal saline of the total amount of crystalloids administered perioperatively, categorized into a low (less than or equal to 30%), intermediate (greater than 30% but less than 80%), and high normal saline group (greater than or equal to 80%). The primary outcome was the incidence of delayed graft function, defined as the need for dialysis within 1 week of transplant. The authors adjusted for the following potential confounders and covariates: transplant year, total crystalloid volume, surgical duration, vasopressor infusions, and erythrocyte transfusions; recipient sex, age, body mass index, race, number of human leukocyte antigen mismatches, and dialysis vintage; and donor type, age, and sex. Results: The authors analyzed 2,515 records. The incidence of delayed graft function in the low, intermediate, and high normal saline group was 15.8% (61/385), 17.5% (113/646), and 21% (311/1,484), respectively. The adjusted odds ratio (95% CI) for delayed graft function was 1.24 (0.85 to 1.81) for the intermediate and 1.55 (1.09 to 2.19) for the high normal saline group compared with the low normal saline group. For deceased donor transplants, delayed graft function in the low, intermediate, and high normal saline group was 24% (54/225 [reference]), 28.6% (99/346; adjusted odds ratio, 1.28 [0.85 to 1.93]), and 30.8% (277/901; adjusted odds ratio, 1.52 [1.05 to 2.21]); and for living donor transplants, 4.4% (7/160 [reference]), 4.7% (14/300; adjusted odds ratio, 1.15 [0.42 to 3.10]), and 5.8% (34/583; adjusted odds ratio, 1.66 [0.65 to 4.25]), respectively. Conclusions: High percent normal saline administration is associated with delayed graft function in kidney transplant recipients. Editor’s Perspective: What We Already Know about This Topic: What This Article Tells Us That Is New:

[This corrects the article DOI: 10.1371/journal.pone.0245195.].

Background: This randomized study compared the efficacy and safety of extraplexus and intraplexus injection of local anesthetic for interscalene brachial plexus block. Methods: 208 ASA I-II patients scheduled for elective shoulder arthroscopy under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomly allocated to receive an injection of 25mL ropivacaine 0.5% either between C5-C6 nerve roots (intraplexus), or anterior and posterior to the brachial plexus into the plane between the perineural sheath and scalene muscles (extraplexus). The primary outcome was time to loss of shoulder abduction. Secondary outcomes included block duration, perioperative opioid consumption, pain scores, block performance time, number of needle passes, onset of sensory blockade, paresthesia, recovery room length of stay, patient satisfaction, incidence of Horner’s syndrome, dyspnea, hoarseness, and post-operative nausea and vomiting. Results: Time to loss of shoulder abduction was faster in the intraplexus group (log-rank p-value<0.0005; median [interquartile range]: 4 min [2–6] vs. 6 min [4–10]; p-value <0.0005). Although the intraplexus group required fewer needle passes (2 vs. 3, p<0.0005), it resulted in more transient paresthesia (35.9% vs. 14.5%, p = 0.0004) with no difference in any other secondary outcome. Conclusion: The intraplexus approach to the interscalene brachial plexus block results in a faster onset of motor block, as well as sensory block. Both intraplexus and extraplexus approaches to interscalene brachial plexus block provide effective analgesia. Given the increased incidence of paresthesia with an intraplexus approach, an extraplexus approach to interscalene brachial plexus block is likely a more appropriate choice.