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The concept that brief manipulation(s) could protect an organ or tissue from subsequent ischemic injury was first put forth by Bob Jennings of Duke University. In the ensuing 35 years, ischemic preconditioning has been shown in preclinical studies to protect all commonly transplanted organs from myriad pathophysiologic insults; however, the translation of this phenomenon into clinical practice has not been smooth. Nonetheless, under controlled scenarios where there is a high probability of an ischemic event, various human preconditioning trials have demonstrated benefit with respect to improved organ function and reduced morbidity and mortality. Volatile anesthetics (VAs) have been shown to directly precondition or indirectly enhance ischemic preconditioning of a variety of different organs. The importance of preconditioning and its implications during general anesthesia and specifically during surgery are still controversial.

Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). With recent advancements in the field of transplantation, especially with an expanded donor pool and postoperative care, kidney transplants are now viewed as relatively straightforward surgeries. More than 23,000 kidney transplants were done in the United States in 2019, yet there still remains major unmet need for more organs. As of June 20, 2020, there were more than 93,000 patients on the waiting list to receive a kidney transplant. Thus, optimum anesthetic management is an integral part of patient and graft survival. The majority of transplanted kidneys are procured from deceased donors following death by neurological criteria (DNC). Therefore, due to the unpredictable and emergent nature of the surgery, in addition to routine preoperative evaluation, unique considerations need to be addressed. This chapter reviews the major considerations for pre-, intra-, and postoperative care of kidney transplantation.

Background: Exposure to toxic materials predisposes the lungs to infectious agents and inflammatory responses. The present study was performed on patients with anthracosis caused by exposure to fossil fuels in previous years, and histopathological features of airways’ normal-appearing tissue were compared with histopathological features of anthracotic plaques in these patients. Methods: Bronchoscopic evaluations were performed on bakery workers who were directly in contact with fossil fuels. Samples were taken from anthracotic plaques (Group A) or seemingly intact tissues at their periphery (Group B). Pathological evaluations were done after hematoxylin and eosin staining. Then, microbiological cultures were performed for the diagnosis of Mycobacterium tuberculosis. Data obtained from bronchoscopy, pathology, and cultures were compared between anthracotic and normal-appearing peripheral tissues using chi-square and analysis of variances (ANOVA) at a 95% confidence level. Results: Sixty-eight patients were diagnosed with anthracotic plaques. The mean ± SD of the patients’ age was 72.12 ± 13.74 years. Females comprised 58.8% of the sample, and 85.3% of the patients were Iranian. The frequency rates of disseminated plaques and obstructive types were 86.8% and 48.5%, respectively. Ten patients (14.70%) were diagnosed with tuberculosis, and 4.41% (3 of 68) had granuloma, which was detectable only in samples gathered from Group A. Fibrosis was more common in Group A (10.3%, p = 0.03), and most of the evaluated samples in both groups exhibited inflammatory features. Conclusion: Inflammatory changes and tissue damage can be seen in anthracotic plaques and the surrounding normal-appearing tissue, even after removing the triggering factors. So, it is suggested to take a biopsy from seemingly intact tissue at the periphery of the anthracotic plaque when a biopsy is needed in a patient with anthracosis to reduce the risk of bleeding. Besides, medical treatment should be done to control inflammation.

Background The purpose of this study was to determine the prevalence of musculoskeletal complaints, rheumatologic diseases, and disability among the Zoroastrian population in Iran. Methods The city of Yazd, in central Iran was selected for this study, with the highest population of Zoroastrians in Iran. Subjects were selected by cluster sampling of 9 neighborhoods populated with Zoroastrians. Subjects ≥15 years old were interviewed by trained interviewers in their houses. The validated Farsi translation of Community Oriented Program for the Control of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) was used for this study. Subjects with musculoskeletal complaints (pain, stiffness and/or swelling) were examined by a rheumatologist. Laboratory tests and radiographic exams were performed when deemed necessary. Results Two-thousand subjects were interviewed during a 12-month period, of which 956 were male, and 1044 were female. The mean age was 41.1 ± 18.3 years (95%CI: 40.3–41.9). 36.9% of the subjects had university-level education. In the 7 days prior to the interview, 27.6% of the subjects had musculoskeletal complaints, with the knee, dorsolumbar spine, and shoulder being the most common sites of complaints. The most common rheumatologic diagnoses were osteoarthritis (21.5%) and low back pain (10.3%). Rheumatoid arthritis was diagnosed in 1.2% of the subjects. Conclusions The epidemiology of musculoskeletal complaints and rheumatologic disorders was inconsistent with previous COPCORD studies in Iran, with a lower prevalence of musculoskeletal complaints in general, lower rates of Behçet and lupus, and a higher prevalence of rheumatoid arthritis. The findings of this study can be for development of better prevention, screening, and treatment programs for the vulnerable population of Zoroastrians in Iran.

Background Intra-abdominal adhesion is one of the most important complications of abdominopelvic surgery. It increases morbidity and mortality for patients. Although laparoscopy is the gold standard of adhesion diagnosis, it can cause visceral damage during the operation. Therefore, surgeons prefer to use non-invasive methods for planning the operation. We designed this study to evaluate transabdominal ultrasonography ( TAU) accuracy for diagnosing Intra-abdominal Adhesions Material & methods This double-blinded cohort study was conducted on 47 patients with previous laparotomy who undergo another surgery. Spontaneous visceral slide (SVS) and induced visceral slide (IVS) were measured during TAU. Results The mean age and BMI of 47 patients were 43.21±10.3 and 27.545±5.76. The majority of the patients were female (76%). Mean SVS and IVS in patients with intra-abdominal adhesion were 8.73±1.60 and 44.84±11.60. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TAU in intra-abdominal diagnosis were 83.33%, 51.72%, 51.72%, 83.33%, 63.83%. Conclusions Although TAU is an appropriate method for detecting the intra-abdominal adhesion, it isn't good enough for diagnosing free adhesion area. We recommended further researches with greater sample size and other non-invasive techniques., Highlights • Evaluation of accuracy, sensitivity, specificity, PPV, NPV for adhesion diagnosis. • There are not a lot of studies on ultrasonography accuracy before. • It’s an only double-blinded cohort study. • Our study refers to high sensitivity and NPV for diagnosing the adhesion.

Background: Impaired kidney function is frequently observed in heart surgery patients following cardio-pulmonary bypass. Previous studies by our group have linked acute reductions in nitric oxide bioactivity, specifically declines in the main regulator of tissue blood flow S-nitrosohemoglobin (SNO-Hb), to reductions in kidney oxygenation and blood flow and subsequent renal impairment. For the current study, we hypothesized that components of the bypass procedure (viz. transfusion and red blood cell trauma) would reduce circulating SNO-Hb levels with the magnitude of this reduction correlating with markers of kidney function and patient outcome. Methods: After obtaining written informed consent, blood samples were obtained before and during bypass and on post-operative day (POD) 1. In addition to quantifying SNO-Hb samples were analyzed for change in kidney function (estimated glomerular filtration rate; eGFR), and plasma erythropoietin (EPO) concentration. Status and outcome data were secured from the patients’ medical record. Results: In the patients studied to date (n=30), there was a significant decline in SNO-Hb concentration by POD 1, the level of which inversely correlated with ICU stay (R=-0.32). In addition, there was a direct correlation between SNO-Hb and eGFR on PODs 1 & 2 (R=0.48 and 0.30, respectively), i.e. lower SNO-Hb tracked with reductions in kidney function. Consistent with a presumed reduction in kidney oxygenation, we observed a significant rise in plasma EPO levels when coming off pump that were sustained into POD 1. Furthermore, the rise in EPO was inversely correlated with both SNO-Hb (R=-0.53) and eGFR (R=-0.55). Conclusion: CPB decreases SNO-Hb and is associated with kidney dysfunction and worse patient outcome (e.g. increased ICU stay). While the mechanism for this decline remains to be determined, the results suggest that therapies directed at maintaining or increasing NO bioactivity could improve outcome in adult cardiac surgery patients.

Disruption of microvascular blood flow is a common cause of tissue hypoxia in disease, yet no therapies are available that directly target the microvasculature to improve tissue oxygenation. Red blood cells (RBCs) autoregulate blood flow through S-nitroso-hemoglobin (SNO-Hb)-mediated export of nitric oxide (NO) bioactivity. We therefore tested the idea that pharmacological enhancement of RBCs using the S-nitrosylating agent ethyl nitrite (ENO) may provide a novel approach to improve tissue oxygenation. Serial ENO dosing was carried out in sheep (1–400 ppm) and humans (1–100 ppm) at normoxia and at reduced fraction of inspired oxygen (FiO(2)). ENO increased RBC SNO-Hb levels, corrected hypoxia-induced deficits in tissue oxygenation, and improved measures of oxygen utilization in both species. No adverse effects or safety concerns were identified. Inasmuch as impaired oxygenation is a major cause of morbidity and mortality, ENO may have widespread therapeutic utility, providing a first-in-class agent targeting the microvasculature.