ABSTRACT
Objective To retrospectively analyze the effects of anesthesia mode on the perioperative period and postoperative outcome in patients with traumatic fractures. Methods A total of 699 patients with traumatic shoulder fractures and hip fractures, admitted in the Fourth Medical Center of PLA General Hospital from Mar. 2016 to Aug. 2018, were divided into general anesthesia (GA) group (n=331) and regional block anesthesia (RA) group (n=368) according to different anesthesia mode. The preoperative basic conditions, change rates of intra-operative mean arterial pressure (MAP) and heart rate (HR), amount of blood loss and transfusion, and postoperative outcome were recorded for analyzing whether different anesthesia methods affected the outcome of fracture patients in the real world. Results There was no significant difference in the preoperative comorbidity between the two groups (P>0.05); Compared with the GA group, patients in RA group were older (P0.05), but age analysis indicated that, regardless of the mode of anesthesia, the incidence of postoperative complications increases with age (P<0.05). Compared with GA, patients older than 80 years reduced the incidence of postoperative complications significantly when they chose RA, and the difference was statistically significant (P=0.039). Meanwhile, compared with GA group, patients in RA group was lower and shorter in preoperative time, operative time, length of stay and cost in hospital, showing statistical difference (P<0.05). Conclusions Although there was no significant difference in postoperative outcomes of patients with overall fractures under different anesthesia modes, postoperative complications will increase with age. The advantages of regional block anesthesia are mainly reflected in fracture patients ≥80 years.
ABSTRACT
<p><b>BACKGROUND</b>Mutations of transthyretin (TTR) cause the most common type of autosomal-dominant hereditary systemic amyloidosis, which occurs worldwide. To date, more and more mutations in the TTR gene have been reported. Some variations in the clinical presentation are often observed in patients with the same mutation or the patients in the same family. The purpose of this study was to find out the clinicopathologic and genetic features of Chinese patients with hereditary TTR amyloidosis.</p><p><b>METHODS</b>Clinical and necessary examination materials were collected from nine patients of eight families with hereditary TTR amyloidosis at Peking University First Hospital from January 2007 to November 2014. Sural nerve biopsies were taken for eight patients and skin biopsies were taken in the calf/upper arm for two patients, for light and electron microscopy examination. The TTR genes from the nine patients were analyzed.</p><p><b>RESULTS</b>The onset age varied from 23 to 68 years. The main manifestations were paresthesia, proximal and/or distal weakness, autonomic dysfunction, cardiomyopathy, vitreous opacity, hearing loss, and glossohypertrophia. Nerve biopsy demonstrated severe loss of myelinated fibers in seven cases and amyloid deposits in three. One patient had skin amyloid deposits which were revealed from electron microscopic examination. Genetic analysis showed six kinds of mutations of TTR gene, including Val30Met, Phe33Leu, Ala36Pro, Val30Ala, Phe33Val, and Glu42Gly in exon 2.</p><p><b>CONCLUSIONS</b>Since the pathological examinations of sural nerve were negative for amyloid deposition in most patients, the screening for TTR mutations should be performed in all the adult patients, who are clinically suspected with hereditary TTR amyloidosis.</p>