[The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors].

Objective: To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors. Methods: A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern. Results: For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02). Conclusions: The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.

[Predictive value of white blood cell, procalcitonin and high-sensitivity C-reactive protein for the bloodstream infection in the super-elderly critically-ill patients].

Objective: To investigate the ability of white blood cell (WBC), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the super-elderly patients with bloodstream infection. Methods: It was a retrospective study. A total of 77 patients (≥85 years) admitted to the ICU of Peking Union Medical College Hospital from June, 2016 to December, 2017 were enrolled. The patients included 67 males and 10 females, with an age of 85-105 years and the average age was (92±5) years. According to the results of blood culture, patients were divided into positive blood culture group (n=50) and negative blood culture group (n=27). The data which obeyed normal distribution were compared with single sample t test between the two groups. Results: There was no significant difference in WBC level between the positive blood culture group and the negative blood culture group[12.4(7.8, 36.6)×10(9)/L vs 10.7(8.5, 18.7)×10(9)/L, U=0.109, P=0.124]. Compared to the positive blood culture group, the PCT level [2.6(0.8, 7.4)µg/L vs 1.5(0.6, 5.3)µg/L, U=3.015, P=0.004] and hs-CRP level [119(62, 220) mg/vs 54 (24, 80) mg/L, U=7.791, P<0.001] were significantly higher in the negative blood culture group. The ROC analysis showed that the area under the curves (AUC) of WBC, PCT and hs-CRP was 0.704(95%CI: 0.586-0.822, P<0.01), 0.896(95%CI: 0.829-0.964, P<0.01) and 0.864(95%CI: 0.778-0.949, P<0.01), respectively. The best cutoff value of PCT for discrimination of positive blood culture was 0.44 µg/L, which resulted in a sensitivity of 70.0% and a specificity of 92.6%. The best cutoff value of hs-CRP was 50.35 mg/L, which resulted in a sensitivity of 62.0% and a specificity of 88.9%. Conclusion: Compared to WBC, both PCT and hs-CRP have a better ability to predict bloodstream infection in the Super-elderly patients.

Folate intake and pancreatic cancer risk: an overall and dose-response meta-analysis.

OBJECTIVE: Inconsistent findings of association between supplemental folate consumption and pancreatic cancer risk have been observed in the literature. This study aims to summarize the relationship between folate intake and risk of pancreatic cancer. STUDY DESIGN: Pertinent studies published before November 2011 were identified by searching PubMed and Embase and by reviewing the reference lists of retrieved articles. The summary relative risks were estimated by the random effects model. A linear regression analysis of the natural logarithm of the relative risk (RR) was carried out to assess a possible dose-response relationship between folate intake and pancreatic cancer risk. RESULTS: Ten studies on dietary and supplemental folate intake and pancreatic cancer (4 case-control and 6 cohort studies) were included in the meta-analysis. The pooled RRs of pancreatic cancer for the highest vs lowest categories of dietary folate intake and supplemental folate intake were 0.66 (95% CI: 0.49-0.88) and 1.08 (95% CI, 0.82-1.41), respectively. The dose-response meta-analysis indicated that a 100 µg/day increment in dietary folate intake conferred a RR of 0.93 (95% CI: 0.90-0.97). These findings support the hypothesis that dietary folate may play a protective role in carcinogenesis of pancreatic cancer.