Citations

ABSTRACT The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell‐released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV‐associated functional activities. Finally, a checklist is provided with summaries of key points.

Abstract Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative neurological status of the patient. However, there is paucity of information regarding factors responsible for continuation of MV in these patients. This study was carried out to identify the indications and risk factors for elective ventilation after intracranial tumour surgery. Materials and Methods: A prospective observational study was carried out on consecutive adult patients who underwent elective craniotomy for tumour excision, and postoperatively required MV. Data on anaesthesia technique, duration of anaesthesia and surgery, blood loss and transfusion and volume of fluids infused were noted. Intraoperative complications like tight brain, massive blood loss, brainstem handling, cranial nerve handling, haemodynamic instability, cardiac arrhythmias, venous air embolism, electrolyte abnormality and hypothermia were also recorded. Statistical analysis was done using Strata 9.0 software. Categorical data was analysed using Chi-square test or Fisher's exact test and continuous data by Student's t-test. Results: A total of 709 patients enrolled for the study over a period of one year out of which 347 patients (48.9%) required continuation of MV during the postoperative period. The mean duration of MV was 29.7 ± 39.7 hrs. The most common causes for postoperative MV were ‘not responding to commands’ (43.2%), and neurosurgeon's advice (41.8%). The mean ICU and hospital stays were 92.2 ± 134.0 hrs and 13.8 ± 16.5 days, respectively. 47.6% of patients who required postoperative MV on neurosurgeon's advice developed complications whereas it was 33.2% for those ventilated other reasons (P < 0.05). Glasgow outcome scale (GOS) at discharge was poor in 12.4%. On multivariate analysis, intraoperative blood transfusion, tracheostomy and duration of ventilation more than 48 hrs were the independent risk factors associated with poor outcome. Conclusions: Although the neurosurgeon's advice for elective ventilation should not be ignored, but prolonged and avoidable MV may exacerbate the postoperative morbidities apart from increasing the cost of treatment. Hence, a complete understanding of intraoperative events, cerebral physiology and various factors influencing it during the perioperative period may not be overemphasised.