The safety and efficacy of balanced crystalloid vs. normal saline in non-cardiac surgeries - A systematic review and meta-analysis.

OBJECTIVE: Balanced crystalloid and normal saline are routinely used in clinical anesthesia, but their safety and efficacy in non-cardiac surgeries are still unclear. MATERIALS AND METHODS: PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI, from January 1980 to March 2023, were searched. Studies comparing balanced crystalloid (BC) with normal saline (NS) during non-cardiac surgeries were included. The primary outcomes were clinical outcomes (acidosis, renal insufficiency, and mortality), and the secondary outcomes were pH value, Na+, Cl- and creatinine levels, and vasopressor requirement. RESULTS: Forty-three RCTs were included in this meta-analysis. Low evidence revealed that the development of acidosis was lower in the BC group than in the NS group (OR: 0.05, 95% CI: 0.01-0.43, I2=80.8%, p=0.00), and no between-group difference exists in renal insufficiency and mortality. At the end of surgery and on postoperative day 1 (POD 1), the pH value was higher, and the levels of Na+ and Cl- were lower in the BC group. No between-group difference exists in creatinine level and vasopressor requirement. CONCLUSIONS: Perioperative balanced crystalloids can maintain the stability of acid-base and electrolyte balance and reduce acidosis compared with saline, but they cannot reduce postoperative renal insufficiency and mortality.

[Effect of equal temperature bladder irrigation in patients with transurethral resection of prostate: A meta-analysis].

OBJECTIVE: To evaluate the effect of equal temperature bladder irrigation on bladder spasm, postoperative bleeding, vital signs and discomfort of chills in patients of transurethral resection of prostate using meta-analysis. METHODS: Several electronic databases included Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine (CBM) were searched systematically for published randomized controlled trial about equal temperature bladder irrigation in patients with transurethral resection of prostate before November 20, 2019. Two reviewers selected independently the literature in the light of the inclusion and exclusion criteria, assessed the risk of bias by quality assessment and extracted data which were consisted of clinical efficacy indexes, such as incidence of bladder spasm, severity of bladder spasm, incidence of tube plugging, amount of bladder flushing fluid, time of bladder flushing, heart rate, systolic pressure, diastolic pressure, and incidence of chills. Data were pooled using fixed-effects model or random-effects model, and the summary effect measure was calculated by risk ratio (RR) or mean difference (MD) and 95% confidence interval (95%CI). Meta-analysis was performed by Review Manager 5.3 Software. RESULTS: In the study, 13 randomized controlled trails met the requirement with a total of 2 033 patients of transurethral resection of prostate were included, of whom 1 015 were carried out with equal temperature bladder irrigation and 1 018 with room temperature bladder irrigation. The results of meta-analysis showed that incidence of bladder spasm [RR=0.51, 95%CI (0.45, 0.57), P < 0.001], severity of bladder spasm [MD=-1.61, 95%CI (-2.00, -1.23), P < 0.001], incidence of urinary blockage [RR=0.29, 95%CI (0.19, 0.44), P < 0.001], dosage of bladder irrigation [MD=-6.75, 95%CI (-7.33, -6.17), P < 0.001], time of bladder rinse [MD=-7.60, 95%CI (-11.91, -3.29), P < 0.001], heart rate [MD=-13.68, 95%CI (-15.19, -12.17), P < 0.001], systolic pressure [MD=-29.26, 95%CI (-31.92, -26.59), P < 0.001], diastolic pressure [MD=-29.36, 95%CI (-31.75, -26.98), P < 0.001], incidence of chills and discomfort [MD=0.37, 95%CI (0.31, 0.44), P < 0.001] in equal temperature group of the patients with transurethral resection of prostate had significantly statistical difference compared with room temperature group. CONCLUSION: Based on current available evidence, equal temperature bladder irrigation reduced the incidence of bladder spasm and urinary blockage, relieved bladder spasm, reduced dosage and time of bladder irrigation, and hardly affected normal vital signs and increased the patient' s comfort.

A systematic review of risk factors for postinduction hypotension in surgical patients undergoing general anesthesia.

OBJECTIVE: Clinical evidence has proved that postinduction hypotension (PIH) is very prevalent in surgical patients undergoing general anesthesia, and commonly develops within 20 min after the induction of general anesthesia. However, the risk factors for PIH are not clear till now, therefore, a systematic review of current evidence was conducted. MATERIALS AND METHODS: PubMed, Embase, Cochrane library, and Web of Science were searched for articles published in English up to June 2021. The following search items were used: postinduction, postintubation, propofol induction, anesthesia induction, general anesthesia induction, hypotension, risk factor, general anesthesia, surgery. The articles were screened using the inclusion and exclusion criteria, and the data from included studies were extracted and analyzed. RESULTS: Twelve studies were included. Seven studies reported the association between age and PIH, and six showed age was a risk factor. Five or three studies reported the association between mean arterial pressure (MAP) and PIH or between systolic blood pressure (SBP) and PIH, but the results were conflicting. Results from two studies regarding gender and PIH were conflicting. Two studies reported that weight was negatively correlated with PIH. Low baseline blood volume, emergency operation, long-term intake of the angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) were risk factors for PIH. One study showed that ASA III-V, propofol induction, and increasing fentanyl dosage were risk factors for PIH. CONCLUSIONS: Aging, ASA III-V, emergency operation, low baseline blood volume, long-term intake of ACEI/ARB, propofol induction, and increasing fentanyl dosage are potential risk factors for PIH, while body weight gain is a protective factor. Based on the current evidence, it is difficult to determine whether baseline blood pressure or gender is associated with the development of PIH.

A large common-source outbreak of norovirus gastroenteritis in a hotel in Singapore, 2012.

An outbreak of gastroenteritis affected 453 attendees (attack rate 28·5%) of six separate events held at a hotel in Singapore. Active case detection, case-control studies, hygiene inspections and microbial analysis of food, environmental and stool samples were conducted to determine the aetiology of the outbreak and the modes of transmission. The only commonality was the food, crockery and cutlery provided and/or handled by the hotel's Chinese banquet kitchen. Stool specimens from 34 cases and 15 food handlers were positive for norovirus genogroup II. The putative index case was one of eight norovirus-positive food handlers who had worked while they were symptomatic. Several food samples and remnants tested positive for Escherichia coli or high faecal coliforms, aerobic plate counts and/or total coliforms, indicating poor food hygiene. This large common-source outbreak of norovirus gastroenteritis was caused by the consumption of contaminated food and/or contact with contaminated crockery or cutlery provided or handled by the hotel's Chinese banquet kitchen.

Physiological evaluation of the responses of Larix olgensis families to drought stress and proteomic analysis of the superior family.

The conifer Larix olgensis has been analyzed to delineate physiological and proteomic changes that occur under drought stress. Studies of the deleterious effects of drought in the larch families have mainly focused on photosynthesis. In the present study, when the intensity of drought was increased, plant height was inhibited as both POD and MDA levels increased, which indicates oxidative stress. Two-dimensional gel electrophoresis analysis detected 23 significantly differentially expressed proteins, of which 18 were analyzed by peptide mass fingerprinting by using MALDI-TOF/TOF. Eight spots were found to be up-regulated, while the other 10 spots were down-regulated during drought stress. The proteins that were induced by drought treatment have been implicated in the physiological changes that occurred. These results could provide additional information that could lead to a better understanding of the molecular basis of drought-sensitivity in larch plants.