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Abstract Introduction: Propofol is a widely used anesthetic and its dose is closely related to aging. Telomere length (TL) is a unique heritable trait, and emerging as a biomarker of aging, health and disease. Telomerase RNA component (TERC) plays an important role in maintaining TL. We proposed a hypothesis that propofol dose in general anesthesia can be predicted by measuring TL before operation, which greatly reduced the risk of anesthesia, especially the elderly. Methods: The association between the propofol dose in anesthesia induction and: TL in the DNA of peripheral blood leukocytes; body weight; sex; difference of the Bispectral Index (BIS) before and after anesthesia induction in patients was evaluated by multivariable linear regression analyses. The mutation at the 5'end or 3'end of TERC was detected. We recruited 100 patients of elective surgery. Results: We found that propofol dose in anesthesia induction was clearly correlated significantly with TL (r = 0.78, p < 0.001), body weight (r = 0.84, p = 0.004), sex (r = 0.83, p= 0.84, p = 0.004), sex (r = 0.83, p = 0.004), and difference of BIS before and after anesthesia induction (r = 0.85, p = 0.029). By comparing the absolute values of standardized regression coefficients (0.58, 0.21, 0.19, and 0.12) of the four variables, it can be seen that TL contributes the most to the propofol dose in anesthesia induction. However, the mutation at the 5' end or 3' end of TERC was not found. Conclusions: These findings provide preliminary evidence that the propofol dose in anesthesia induction was clearly correlated with genetically determined TL. TL may be a promising predictor of the propofol dose, which is beneficial to improve the safety of anesthesia and reduce perioperative complications.
Subject(s)
Humans , Aged , Propofol/pharmacology , Body Weight , DNA , Telomere , Anesthetics, Intravenous/pharmacology , Electroencephalography , Anesthesia, General , LeukocytesABSTRACT
Objective To study the effect of different collateral circulation on the neurological function and clinical outcome in acute ischemic stroke patients with intravenous thrombolysis, and explore the relationship of the sub item of National Institute of Health stroke scale (NIHSS) with collateral circulation status. Methods From December 2016 to April 2019, 73 consecutive patients with severe stenosis and occlusion of middle cerebral artery (Ml segment) who underwent intravenous thrombolysis at the Department of Neurology, The First Affiliated Hospital of Xinxiang Medical College were retrospectively recruited. The target patients were selected according to CT angiography (CTA) - CT perfusion (CTP) and the collateral circulation status was evaluated before intravenous thrombolysis. The patients were divided into the good collateral circulation group and the poor collateral circulation group. Clinical data were collected and the NIHSS score was used to assess the neurological deficit. The modified Ranking scale (mRS) was used to assess the prognosis of 90 days after onset. The clinical data of the two groups were compared to investigate the relationship between collateral circulation status and NIHSS score sub-items at admission by univariate and multivariate Logistic regression analysis. Also, the relationship between collateral circulation before thrombolysis and clinical outcome after thrombolysis was studied (The primary outcome: mRS score 0 -1 at 90 d; the secondary outcomes: early neurological function significant improvement [NIHSS score 0-1 at 72 h after treatment, or 8 points lower than baseline NIHSS score] and mRS score 0-2 at 90 d after onset; the safety outcome: cerebral hemorrhagic transformation and death 90 days after onset). Results Among the 73 patients, 43 patients were in the good collateral circulation group and 30 patients were in the poor collateral circulation group. The NIHSS scores at admission and 72 hours after treatment in the good collateral circulation group were lower than those in the poor collateral circulation group(2.00 [1.00, 5.00] score vs. 7.00[3.75, 10. 00]score, 1. 00[0. 00, 3. 00]score vs. 5. 00[1. 75, 6. 25]score, respectively; all P <0. 01). Single factor Logistic regression analysis showed that, the scores of facial paralysis, upper limb movement, lower limb movement, dysarthria in the poor collateral circulation group were more than those in the good collateral circulation group(OR and 95%CI, 5.058[2. 249 -11. 372], 1.465[1. 024-2. 094], 1. 633[1. 069 -2. 495], 2. 669 [1. 072 -6. 647], all P < 0. 05). For the primary outcome, 67.4% (29/43) of patients with good collateral circulation and 40. 0% (12/30) of patients with poor collateral circulation had a mRS score of 0-1 (OR, 1.686, 95% CI 1. 068 -3. 105, P = 0. 020). For the secondary outcomes, early neurological improvement was achieved in 53. 5% (23/43) of patients with good collateral circulation and 20.0% (6/30) in patients with poor collateral circulation (OR, 2. 672, 95% CI 1. 241 -5. 765, P = 0.004); the mRS score 0-2 was obtained in 86.0% (37/43) of patients with good collateral circulation and 63. 3% (19/30) of patients with poor collateral circulation (OR, 1. 359, 95% CI 1. 009-1.830, P = 0.024). For the safety outcome, 2 patients in the good collateral circulation group and 7 patients in the poor collateral circulation group had hemorrhagic transformation (OR, 0. 199, 95% CI 0. 044 - 0. 894, P = 0.043); there was no significant difference in mortality risk between the two groups (OR, 0. 698, 95% CI 0. 104 -4. 682, P = 1. 000). Conclusions For acute ischemic stroke patients with middle cerebral artery severe stenosis and occlusion, good collateral circulation is associated with mild clinical symptoms. The increased scores of the facial paralysis, upper limb movement, lower limb movement, dysarthria in NIHSS score sub-item could reflect the poor collateral circulation. Good collateral circulation is conducive to early improvement of neurological function and favorable prognosis in patients with intravenous thrombolysis. It may reduce the risk of hemorrhagic transformation but not the risk of death.
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@#Objective To investigate the effect of artificial colloid on coagulation function in pediatric patients weighing less than 5 kg with congenital heart disease during cardiopulmonary bypass in congenital heart disease surgery by using artificial colloid instead of human serum albumin. Methods A total of 65 pediatric patients with weight less than 5 kg who underwent congenital heart disease surgery in our hospital from September 2016 to December 2017 were included in the study. They were randomly divided into two groups: an artificial colloid group (the experimental group, n=33) and a human serum albumin combined artificial colloid group (the control group, n=32). Perioperative hemoglobin concentration (Hb), blood products and hemostatic drugs used, postoperative coagulation function index and pleural fluid volume 24 hours after surgery were monitored. Results There was no significant difference in perioperative Hb and chest tube drainage between the two groups. The platelet utilization rate in the experimental group was significantly lower than that in the control group (P<0.05). No significant difference was found in the dosage of other blood products and hemostatic drugs between the two groups during the perioperative period. There was no significant difference in coagulation parameters between the two groups before and after surgery (P>0.05). Conclusion The use of artificial colloid as colloid priming solution during cardiopulmonary bypass has no adverse effect on coagulation function in pediatric patients weighting less than 5 kg with congenital heart disease.
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Objective: We conducted a cohort study to investigate the association of three common SNPs of vascular endothelial growth factors [VEGF] gene [+1612G/A, -634C/G and +936G/C] with clinical outcome of osteosarcoma in a Chinese population
Methods: A prospective study was conducted. Genotyping analyses of VEGF -2578C/A, +1612G/A, -634C/G and +936G/C were conducted using polymerase chain reaction-restriction fragment length of polymorphism. Multivariate Cox proportional hazards models were used to calculate hazard ratio [HR] and 95% Cl of effect of each genotype of VEGF+1612G/A, -634C/G and +936G/C on PFS and osteosarcoma of osteosarcoma
Results: The good response rate was 52.29%, and 116 [68.7%] died during the follow-up period
Patients carrying the +936 CC genotype and C allele showed a significantly more response to chemotherapy than those carrying the wild-type genotype. In the Cox proportional hazards model, patients carrying the VEGF -634 T allele was associated with a significantly decreased risk of PFS and Osteosarcoma [OS]
Patients carrying the +936 CC genotype and C allele were associated with a significantly decreased risk of presenting progressive disease or death from osteosarcoma when compared with those carrying the wild-type genotype. However, we observed no significant association between the VEGF -2578C/Aand +1612A/G polymorphisms and PFS and Osteosarcoma [OS] in gastric cancer patients
Conclusions: We found that VEGF -634G/C and +936T/C polymorphisms may affect the prognosis of osteosarcoma patients. These finding may be useful for predicting the clinical outcome of patients with Osteosarcoma [OS]
Further studies are greatly needed to confirm the clinical significance of these results
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<p><b>OBJECTIVE</b>To survey the occurrence of childhood sexual abuses (CSA) among adult students and analyze the correlation between the sexual abuses and the results of Symptom Check-List-90 (SCL-90) test.</p><p><b>METHODS</b>Questionnaire survey of 1307 adult students (701 female students, 606 male students) in a college about their personal experience on childhood sexual abuses. The surveys were conducted anonymously. And SCL-90 test was carried out at the same time.</p><p><b>RESULTS</b>A total of 1307 students were surveyed. 18.67% of them (female students, 155, 22.11%; male students, 89, 14.69%) experienced non-physical contact sexual abuses and/or physical contact sexual abuses before the age of 18 years, among whom 124 students (female students, 81, 11.55%; male students, 44, 7.26%) experienced physical contact sexual abuses, including 35 (26 female; 9 male) who suffered attempted genital or anal sexual intercourse and 11 (8 female and 3 male) were forced for genital or anal sexual intercourse; 13.70% (female 15.66%; male 11.44%) said they experienced sexual abuses before the age of 16 years. Of the boys, experienced sexual abuse 54.7% from age 12 to age 16 years. And among the girls sexual abuses tended to increase with their growth (results of tendency test: chi(2) = 33.5, P < 0.001). The abusers were mostly males; only a small percentage of them used violence; for most female students who experienced non-physical contact sexual abuses, the abusers were strangers (78.7%), while 71.3% of physical contact abuses were from acquaintances, 12.5% of them were teachers, 17.5% were neighbors and 21.3% were relatives. Of the male victims, 89.9% said they knew the abusers before the abuses happened, 14.6% (13 out of 89) of them were teachers, and neighbors constituted another 21.3% (19 out of 89). Students who experienced childhood sexual abuses got higher scores than the students who didn't have such experience in the nine basic symptom factors of SCL-90 and higher than normal model of national young group notably.</p><p><b>CONCLUSION</b>Childhood sexual abuse among students is not rare. The female students' incidence was obviously higher than that among the male students (chi(2) = 11.8, P = 0.001). About half of the abusers were the victims' close relatives, neighbors and teachers who live or study together with them. Personal experience of childhood sexual abuses may be one of the important factors influencing the victims' results of SCL-90 test.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Age Factors , Chi-Square Distribution , Child Abuse, Sexual , China , Epidemiology , Incidence , Sex Factors , Students , Surveys and Questionnaires , UniversitiesABSTRACT
OBJECTIVE To analyze risk factors in order to provide scientific gist in diagnosis and treatment of central venous catheter related sepsis(CRS) in patients with total parenteral nutrition(TPN). METHODS To make comparison of the 57 cases of CRS with 423 cases of non-CRS during 1998-2002.First,monovariable chi-square test and then non-condition Logistic regression analysis of the markedly different factors in SPSS10.0 were conducted. RESULTS The major risk factors might be infectious disease,duration of central venous catheter in,location of catheter, type of catheter and material of catheter,and serum protein
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The currently unfavorable physician - patient relationship has lead to a total loss of interests from multiple sides of hospitals,patients,medical staff,medical education and the society,which specifies in the wellbeing loss of patients and the whole population.The social stability has also been affected.The health care reform should aim to minimize the conflicts between doctors and patients,thus the above mentioned losses will be diminished and a harmonious physician - patient relationship will be built up and the win - win pattern of benefits between doctors and patients will also be realized.Multiple efforts from the government,society,hospitals,medical staff,and patients are all needed to achieve such a goal.