Intraoperative Blood Pressure Lability Acts as a Key Mediator in the Impacts of Goal-Directed Fluid Therapy on Postoperative Complications in Patients Undergoing Major Spine Surgery / 中国医学科学杂志(英文版)

Objective Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator. Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates. Results Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was -0.18 (95% CI: -0.28, -0.07; P < 0.01). The average causal mediation effect was -0.08 (95% CI: -0.15, -0.04; P < 0.01). The average direct effect was -0.09 (95% CI: -0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI: 18.3%, 140.0%). Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.

Standard Process for Palliative Sedation in Peking Union Medical College Hospital / 中国医学科学院学报

End-stage patients experience unbearable pain because of refractory symptoms.Palliative sedation is a form of palliative care which relieves patients' agony by lowering their consciousness.Standard palliative sedation can help patients die with dignity.It is distinct from euthanasia and does not alter the survival of patients.Sufficient palliative care is the premise of palliative sedation.Repeated and detailed clinical evaluation,as well as multidisciplinary involvement,is necessary for the standardized implementation of palliative sedation.Here,we proposed the standard process and specifications of palliative sedation in Peking Union Medical College Hospital.Furthermore,we reported a case of palliative sedation for an advanced cancer patient with refractory delirium and living pain to demonstrate its application in clinical practice.

Detection of Gene Abnormalities in 43 Cases of Chronic Lymphocytic Leukemia by Fluorescence in Situ Hybridization / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the value of fluorescence in situ hybridization (FISH) in diagnosis and prognosis evaluation of chronic lymphocytic leukemia (CLL).</p><p><b>METHODS</b>R banding technique was used for karyotype analysis in 43 cases of CLL, and fluorescence in situ hybridization（FISH） technique was used for analysis of 5 genes in 43 cases of CLL, including D13S25, RB1,ATM, P53 and CEP 12 .</p><p><b>RESULTS</b>The detection rate of chromosome abnormality was 9.3％ for the 43 cases. The chromosome karyotype abnormality was involoved in the number abnormality and the structural abnormality, including No. 2, 6, 14, and sex chromosome. The patients with normal chromosome karyotype were more common（79.1％）. At the same time, mitotic figure in 5 CLL patients did not observed. The positive rate of FISH detection was 55.8％(24/43). Among which, D13S25 deletion was the highest and reached to 37.2％, followed by RB1 deletion（20.9％）, CEP 12 amplification（16.3％）, ATM deletion（9.3％） and P53 deletion（7.0％）. In 24 FISH-positive cases, 20 cases displayed the normal chromosome karyotype, and in 3 cases the mitotic figure was absent. There was only one case of abnormal chromosome, which was not involved in the positive gene tested by FISH.</p><p><b>CONCLUSION</b>FISH is an important means of CLL genetic detection, which can greatly raise the detection rate of cytogenetics abnormalities in CLL, but the probe quantity is limited, so it is necessary to use FISH technology combined with chromosome karyotype analysis so as to improve the detection rate of abnormal cytogenetics, and provide the basis for the clinical diagnosis and prognosis of CLL.</p>

Chemoradiotherapy vs pure chemotherapy for local progressive gastric cancer following D2 lymph node dissection: A comparison of effectiveness / 第二军医大学学报

Objective To compare the thcrapcutic effects and adverse reaction of concurrent chemoradiotherapy with pure chemotherapy for local progressive gastric cancer following D2 lymph node dissection. Methods Seventy-nine patients with progressive gastric cancer who underwent RO gastric resection and D2 lymph node dissection were randomly divided into two groups. After radical gastrectomy, the experimental group (n = 40) received radiotherapy concurrent with capecitabine chemotherapy, and then followed by 4 cycles of XELOX chemotherapy; however, the control group (n = 39) only received 6 cyclcs of XELOX chemotherapy. The local recurrence rates, 3-year disease-free survival rates, 3-year ovcrall survival rates and adverse reactions were evaluated after the treatment. Resulte The local recurrence rate in the experimental group was significantly lower than that of the control group (40. 0%[16/40] vs 64. 1% [25/39],P=0. 032). The 3-year disease-free survival rates and 3-year overall survival rates of the experimental group were higher than those in the control group, but with no significant difference (P> 0. 05). The 3 year overall survival rate of patients with positive lymph node was significantly higher in the experimental group than in the control group (45. 2% [14/31] vs 18. 5% [5/27], P=0. 049), with their median disease-free survival (mDFS)periods being 26 months and 19 months, respectively (P = 0. 024). The incidences of hematological and gastrointestinal toxicities in the experimental group were higher than those in the control group. Concllision Concurrent chemoradiotherapy and chemotherapy can greatly reducc local recurrence after curative resection and D2 lymph node dissection in gastric cancer patients. In patients with lymph node positive gastric cancer, postoperative concurrent chemoradiotherapy may improve their survival. The main adverse reactions of the concurrent treatment are hematological and gastrointestinal toxicities.

Simultaneous determination of six ingredients in Huoxiang Zhengqi oral liquid by UPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To develop a UPLC method for the simultaneous determination of liquiritin, narirutin, hesperidin, ammonium glycyrrhetate, honokiol and magnolol in Huoxiang Zhengqi oral liquid.</p><p><b>METHOD</b>A Zorbax Eclipse C18 column was used with the mobile phase of acetonitrile and 0. 05% phosphate acid by gradient elution at the detection wavelength of 220 nm. The flow rate was 0.42 mL x min(-1) and the column temperature was 30 degrees C.</p><p><b>RESULT</b>The calibration curves were linear in the ranges of 0.001 7-0.034, 0.003 4-0.068, 0.006 4-0.128, 0.012 8-0.256, 0.003 2-0.064, 0.006 4-0.128 microg, respectively. The average recoveries were 103.3%, 98.39%, 98.29%, 102.1%, 98.45%, 102.2% with RSDs of 2.1%,1.0%, 0.50%, 2.3%, 0.9%, 2.0%, respectively.</p><p><b>CONCLUSION</b>The UPLC method was simple, rapid and accurate, it could be used for quality control of Huoxiang Zhengqi oral liquid.</p>