Relationship between postoperative delirium and preoperative frailty in elderly patients undergoing spinal surgery / 中华麻醉学杂志

Objective:To evaluate the relationship between postoperative delirium(POD) and preoperative frailty in elderly patients undergoing spinal surgery.Methods:Two hundred and twenty patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ-Ⅳ, undergoing elective posterior lumbar decompression, bone grafting and internal fixation under general anesthesia, were selected. Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale on 1 day before surgery. POD was assessed twice a day within 3 days by Confusion Assessment Method. Patients were divided into POD group and non-POD group according to whether POD occurred within 3 days after surgery. Multivariate logistic regression analysis was used to identify the risk factors for POD in elderly patients undergoing spinal surgery, and the value of preoperative frailty in predicting POD was analyzed using the receiver operating characteristic curve.Results:A total of 190 patients were finally enrolled, among which 55 patients presented with frailty before surgery, and the incidence was 29.0%. Forty-six patients developed POD, and the incidence was 24.2%. Multivariate logistic regression analysis showed that aging ( OR=1.15, 95% confidence interval [ CI] 1.03-1.29, P=0.017), preoperative frailty ( OR=2.35, 95% CI 1.24-4.43, P=0.009), increase in surgical segments ( OR=4.14, 95% CI 1.71-10.05, P=0.002) and increase in postoperative 24-h pain VAS score ( OR=1.38, 95% CI 1.07-1.78, P=0.013) were independent risk factors for POD in elderly patients undergoing spinal surgery. The area under receiver operating characteristic curve of preoperative frailty in predicting POD was 0.702 (95% CI 0.608-0.796, P<0.001). Conclusions:Preoperative frailty is an independent risk factor for POD in elderly patients undergoing spinal surgery. Preoperative frailty can predict the occurrence of POD in elderly patients undergoing spinal surgery to some extent.

Clinical and genetic analysis of a child with maternal uniparental disomy of chromosome 20 / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical and genetic characteristics of a boy with isolated maternal uniparental disomy of chromosome 20 [UPD(20)mat].@*METHODS@#A child who was admitted to the Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology on April 8,2021. was selected as the study subject. Phenotypic and endocrinological findings of the child were retrospectively analyzed. Whole exome sequencing (WES) and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) were carried out for detecting the UPD sequences and copy number variations. Both of his parents were verified by Sanger sequencing. Relevant literature was systematically reviewed.@*RESULTS@#The child, a 3-year-and-8-month-old boy born to a 41-year-old mother by Cesarean delivery at 36+2 gestational weeks due to oligohydramia, had a birth weight of 2 300 g and length of 46 cm. He was admitted to the NICU for feeding difficulties which had persisted despite of clinical management. At the age of 3.75, he had a height of 92.5 cm (< 3rd percentile; 25th ~ 50th percentile at 2.5 years) and a weight of 10.8 kg (< 3rd percentile; 50th percentile at 15 months). He had also presented with growth retardation, short stature, attention deficit and hyperactivity disorder (ADHD), mild mental retardation, and speech and language development disorders. He had simian creases in both hands but no additional dysmorphic signs, and his motor development was normal. Serum insulin, thyroid-stimulating hormone, and insulin growth factor binding protein 3 levels were within the normal ranges, though insulin growth factor-1 (IGF-1) was slightly decreased. Since that time he had continuously used atomoxetine hydrochloride capsules to control his ADHD. WES and MS-MLPA revealed the existence of UPD (20)mat.@*CONCLUSION@#The UPD(20)mat syndrome is characterized by feeding difficulties, growth retardation and short stature. The child in our case has been accompanied by ADHD and speech and language development disorders, which required long-term treatment. For women with advanced maternal age and suggestive phenotypes, genetic testing and counseling should be conducted.

Anesthesia methods for patients undergoing orthopeadic surgery in the epidemic period of COVID-19 / 中华创伤骨科杂志

Objective:To compare the anesthesia methods for patients undergoing orthopaedic surgery between the epidemic period of COVID-19 in 2020 and the same period in 2019.Methods:A retrospective study was conducted of the patients who had undergone orthopedic surgery at The Trauma Emergency Center, The Third Hospital of Hebei Medical University in the epidemic period of COVID-19 from 20 January through 1 March in 2020 and from 4 February through 14 March in 2019 (the same lunar period). Their anesthesia methods were analyzed.The patients in the 2 periods were divided into a group of ≥65 years old and a group of <65 years old.The anesthesia methods and anesthetic operation time were compared between the total cohorts and 2 age groups in the 2 periods.Results:A total of 285 orthopedic operations were completed in the epidemic period in 2020, a decrease by 63.7% than the 784 operations in the same period in 2019; the proportion of elderly fracture patients ≥65 years old in 2020 [29.5%(84/285)] was significantly higher than that [18.1%(142/784)] in 2019. The proportion of non-airway management anesthesia in the epidemic period in 2020 [56.5% (161/285)] was significantly higher than that in the same period in 2019 [38.3%(300/784)]; there was a significant difference in the proportion of non-airway management anesthesia for elderly patients ≥65 years old between the 2 periods [41.6%(59/142) versus 71.4%(60/84)] ( P<0.05). The proportions of intraspinal anesthesia[36.5% (104/285)] and intravenous/+peripheral nerve block anesthesia[4.9%(14/285)] in 2020 were significantly higher than those in 2019 [25.5%(200/784) and 0.3%(2/784)] ( P<0.05); the proportion of laryngeal mask/+peripheral nerve block anesthesia in 2020 [27.7%(79/285)] was significantly lower than that in 2019 [48.9% (383/784)] ( P<0.05). In the group of ≥65 years old, the proportions of intraspinal anesthesia [48.8% (41/84)] and intravenous/+peripheral nerve block anesthesia [10.7%(9/84)]in 2020 were significantly higher than those in 2019 [29.6%(42/142) and 0] ( P<0.05), but the proportion of laryngeal mask/+peripheral nerve block anesthesia in 2020 [21.4% (18/84)] was significantly lower than that in 2019 [47.9%(68/142)] ( P<0.05). Compared with the operation time for intraspinal anesthesia (6.2 min ± 0.4 min) and for intubation/+block anesthesia (7.4 min ± 0.4 min) in 2019, the operation time in 2020 (12.6 min ± 0.4 min and 13.2 min ± 0.3 min, respectively) was significantly increased ( P< 0.05). Conclusions:The anesthesia methods for patients undergoing orthopaedic surgery in the epidemic period in 2020 were featured by non-airway management like peripheral nerve block anesthesia, intraspinal anesthesia, and laryngeal mask/+peripheral nerve block anesthesia because they might have helped to reduce the postoperative complications in respiratory system.The anesthetic operation time in the epidemic period in 2020 was increased than in the same period in 2019.

Agreement between regional cerebral oxygen saturation and jugular bulb venous oxygen saturation during one-lung ventilation in elderly patients / 中华麻醉学杂志

Objective To evaluate the agreement between regional cerebral oxygen saturation (rSO2) and jugular bulb venous oxygen saturation (SjvO2) during one-lung ventilation (OLV) in elderly patients.Methods Twenty-two patients of both sexes,aged 65-76 yr,with body mass index of 21-32 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing open pulmonary lobectomy or radical resection of esophageal cancer with combined intravenous-inhalational anesthesia,were selected.Immediately after beginning of two-lung ventilation (T0),at stable two-lung ventilation in the lateral position (T1),at 5,25 and 45 min of OLV in the lateral position (T2-4) and at the end of OLV in the lateral position (T5),blood samples were collected from the jugular bulb for blood gas analysis,and SjvO2 was recorded,rSO2 was also recorded at the time points mentioned above.Bland-Altman analysis was used to evaluate the agreement.Results SjvO2 was significantly lower at T0-5 than rSO2 (P＜0.05).rSO2 and SjvO2 were gradually decreased at T1-5 (P＜0.05).The results of Bland-Altman analysis showed that the difference between rSO2 more than 95％ and SjvO2 was within the range of 95％ limits of agreement,and the absolute value of the maximum difference was 20.8％.Conclusion There is a good agreement between rSO2 and SjvO2 during OLV in elderly patients,and SjvO2 can be recommended as an alternative to rSO2 clinically.

Evaluation of the Correlation of Four System for Testing HIV-1 Genotype Drug Resistance / 沈阳医学院学报

Objective:To compare the correlation of four drug-resistance interpretation system including HIVDB, ANRS, REGA and HIV GRADE for testing HIV-1 genotype drug resistance. Methods:Trendy subtypes and restructuring model of HIV-1 including B’,CRF01_AE and CRF07_BC were selected,each genotype was 200 series,600 samples were analyzed by four drug?resistance interpretation system, the results were divided into three levels including resistance (R), possible drug?resistance (I) and susceptible (S). Results:Four drug?resistance interpretation system had a high correlation in genotypic drug?resistance consequence (rs>0.57, P<0.01), CRF07_BC had the highest correlation, followed by subtype B, CRF01_AE was slightly lower.Conclusion:Four drug?resistance interpretation system has a high correlation in analyzing antiviral drug resistance for major epidemic of HIV in China.