# Protective Treatments against Endothelial Glycos
## 3 Results
### Outcomes and Results  
When analysing the included articles of our systematic review, the focus was on (1) the comparison between control and intervention groups to reduce levels of EG degradation in surgery; (2) correlations between glycocalyx degradation and an inflammatory response; and (3) correlation between glycocalyx degradation and extravasation. For each study, we assessed biomarkers for glycocalyx degradation (syntecan-1, and those that measured HS), as well as those that measured inflammatory markers and capillary leakage. Four studies investigated the protective treatments against degradation of the EG in CPB [22; 23; 25; 27]. Only 2 studies [25; 27] showed a significant lowering of plasma syndecan-1, which in both cases occurred during surgery. The [PERSON] [25] study, which investigated the effects of diazoxide, found similar changes in hyaluron (\(p<0.04\) and \(p<0.04\) respectively). The [PERSON] study [22] investigated the effects of hydrocortisone. There were no significant differences in plasma syndecan-1 levels between intervention and control groups. However, they did establish significant lowering of HS levels intra-operatively. The [PERSON] study [23] differed from the other clinical trials by comparing two interventions; hydroxyl starch (HES) vs. crystalloid. It has also differed from the other studies as patients had undergone off-pump CPB, which is of clinical significance as studies have shown differences in plasma syndecan-1 and plasma heparan sulphate concentrations between surgeries [29]. Following infusion of 20 mL/kg of the study fluids, median syndecan-1 levels were higher in the HES group than the crystalloid group ([79.7 (46.6-176.6) vs. 62.7 (30.1-103)]). However, overall peri-operative changes in syndecan-1 were not significantly different between the groups. Of the 4 selected articles, the [PERSON] study [22] was the only to investigate the inflammatory response in addition to glycocalyx degradation. There was significant lowering of CRP levels on days 1, 2 and 3 post-operatively in the hydrocortisone group (\(p\) is 0.014, 0.012 and 0.022 respectively). Interleukin-6 (IL-6) was significantly lower in the intervention group to the control group (\(p<0.05\)). One study [27] used urinary trypsin inhibitor (UTI) to treat EG degradation in video-assisted thoracoscopy (VATS) lobectomy. There were no significant differences in baseline values of syndecan-1, HS, HGB and serum albumin levels in the control and UTI group. However, syndecan-1 levels were elevated at T1 in the control group (3.77 \(\pm\) 3.15 versus 4.28 \(\pm\) 3.30, \(p\) = 0.022), whereas the UTI group showed no significant increase at T1 (3.98 \(\pm\) 3.04 versus 4.24 \(\pm\) 3.12, \(p\) = 0.160). There were no obvious changes in HS levels between groups. One study looked into the effects of pre-operative methylprednisolone treatment in total knee arthroplasty [24]. Syndecan-1 concentrations remained stable in the control group with a statistically significant drop from baseline to 24-h post-operative (14.1 \(\pm\) 1.4 versus 12.4 \(\pm\) 12.4, \(p\) = 0.001). Vascular endothelial growth factor (VEGF) increased in both groups with only a transient increase in the methylprednisolone group (T0\(>\)T6: 42.4 (2.5) to 54.8 (4.1), \(p\) = 0.008 versus 37.7 (2.5) to 47.7 (4.9), \(p\) = 0.019). Soluble thrombomodulin (sTE) increased in both groups but only transiently in the methylprednisolone group (T0\(>\)T6: 5.0 (0.2) to 5.4 (0.3), \(p\) = 0.008 versus 5.0 (0.2) to 5.2 (0.4), \(p\) = 0.022). CRP increased in both groups but less so in the methylprednisolone group (T0\(>\)T24: 4.5 (1.1) to 36.6 (3.6) versus 6.9 (2.2) to 74.4 (5.0)). Overall, effects of methylprednisolone were more pronounced at higher base values in sTM, sE-Selectin and VEGF (\(p\) =0.012, \(p\) = 0.009 and \(p\) < 0.001, respectively) but this was not the case for syndecan-1. One study looked into the effects of ringer's lactate (a form of fluid therapy) to prevent EG degradation in abdominal hysterectomy [26].