Comparison of restrictive fluid therapy with goal-directed fluid therapy for postoperative delirium in patients undergoing spine surgery: a randomized controlled trial.

BACKGROUND: Postoperative delirium (POD) is a common phenomenon after spinal surgery. Intraoperative fluid management may affect POD. The aim of this study was to compare the effects of restrictive fluid therapy (RF) with those of goal-directed fluid therapy (GDT) on POD. METHODS: A total of 195 patients aged ≥ 50 years who underwent spinal surgery were randomly divided into two groups: the RF group and the GDT group. In group RF, a bolus of lactated Ringer's solution was administered at a dose of 5 mL·kg-1 before the induction of anesthesia, followed by a dose of 5 mL·kg-1·h-1 until the end of surgery. For patients in the GDT group, in addition to the initial administration of lactated Ringer's solution at 5 mL·kg-1, the subsequent fluid therapy was adjusted by using a continuous noninvasive arterial pressure (CNAP) monitoring system to maintain pulse pressure variation (PPV) ≤ 14%. The primary endpoint was the incidence of POD, assessed once daily with the Confusion Assessment Method-Chinese Reversion (CAM-CR) scale at 1-3 days postoperatively. The secondary endpoints were intraoperative fluid infusion volume, urine volume, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), regional cerebral oxygen saturation (rSO2) value, lactic acid value, and visual analog scale (VAS) pain score at 1-3 days after surgery. Moreover, postoperative complications and the length of hospital stay were recorded. RESULTS: The incidence of POD was lower in the GDT group than in the RF group (12.4% vs 4.1%; P = 0.035) in the first 3 days after spine surgery. Compared to group RF, group GDT exhibited a significantly increased volume of intraoperative lactated Ringer's solution [1500 (interquartile range: 1128 to 1775) mL vs 1000 (interquartile range: 765 to 1300) mL, P < 0.001] and urine volume [398 (interquartile range: 288 to 600) mL vs 300 (interquartile range: 200 to 530) mL, P = 0.012]. Intraoperative MAP, CI and rSO2 values were higher in the GDT group than in the RF group (P < 0.05). Moreover, the length of hospital stay [17.0 (14 to 20) days versus 14.5 (13 to 17.0) days, P = 0.001] was shorter in the GDT group than in the RF group. CONCLUSIONS: GDT reduced the incidence of POD in middle- and old-aged patients undergoing spinal surgery possibly by stabilizing perioperative hemodynamic and improving the supply and demand of oxygen. TRIAL REGISTRATION: ChiCTR2000032603 ; Registered on May 3, 2020.

Microarray analysis of differential gene expression profile in peripheral blood cells of patients with human essential hypertension.

The polygenic nature of essential hypertension and its dependence on environmental factors pose a challenge for biomedical research. We hypothesized that the analysis of gene expression profiles from peripheral blood cells would distinguish patients with hypertension from normotensives. In order to test this, total RNA from peripheral blood cells was isolated. RNA was reversed-transcribed and labeled and gene expression analyzed using significance Analysis Microarrays (Stanford University, CA, USA). Briefly, Significance Analysis Microarrays (SAM) thresholding identified 31 up-regulated and 18 down-regulated genes with fold changes of ≥2 or ≤0.5 and q-value≤5% in expression. Statistically significantly gene ontology (GO) function and biological process differentially expressed in essential hypertension were MHC class II receptor activity and immune response respectively. Biological pathway analysis identified several related pathways which are associated with immune/inflammatory responses. Quantitative Real-Time RT-PCR results were consistent with the microarray results. The levels of C-reactive protein were higher in hypertensive patients than normotensives and inflammation-related genes were increased as well. In conclusion, genes enriched for "immune/inflammatory responses" may be associated with essential hypertension. In addition, there is a correlation between systemic inflammation and hypertension. It is anticipated that these findings may provide accurate and efficient strategies for prevention, diagnosis and control of this disorder.

[Mass screening prostate cancer and clinical comparison].

OBJECTIVE: To investigate the clinical value of the mass screening by analyzing the features of prostate cancer between mass screening patients and clinical patients. METHODS: From January 2000 to January 2008, 441 cases of prostate cancer (including 122 patients from clinical diagnosis and 319 patients from mass screening 23 183 men who were more than 50 years old) were analyzed from age, digital rectal examination (DRE), serum prostate specific antigen (PSA) levels and range, the Gleason's score and grade, clinical staging and therapy. RESULTS: 42.0% of mass screening patients were inspected by DRE, it was lower than that (79.5%) in the clinical patients. The percent of patients with serum PSA levels of less than 10.0 microg/L in mass screening group was higher than in clinical group, while the percent of patients with serum PSA levels of more than 20.0 microg/L in mass screening group was lower than in clinical group. The percent of moderately differentiated degree of prostate cancer in mass screening group was higher than in clinical group, but it was on the contrary for poorly differentiated degree of prostate cancer. The percent of T1-2 prostate cancers in mass screening group was 56.1%, which was higher than 25.4% in clinical group. While, the percent of T3-4 tumors in mass screening group was lower than in clinical group. The percent of men undergoing radical prostatectomy in mass screening group was 18.2%, which was higher than 9.8% in clinical group. The percent of men of locally advanced and far metastasis in mass screening group was 26.0%, while was lower than 46.0% in clinical group. CONCLUSION: General investigation for prostate cancer is benefit to find asymptomatic cancer of early stage.

[Diagnosis and treatment of non-specific granulomatous prostatitis: a report of 32 cases].

OBJECTIVE: To discuss the diagnosis and treatment of non-specific granulomatous prostatitis (NSGP). METHODS: Thirty-two cases of NSGP were diagnosed by puncture biopsy under transrectal ultrasound (TRUS) and treated with antibiotics and other medicines from September, 2000 to May, 2006. RESULTS: Pathomorphologically, NSGP was basically characterized by granuloma with vessels or grand alveoli in the center. The mean follow-up was 24 months. Urination irritation and obstruction were improved. Q(max) was increased to 15.0-24.0 ml/s, and in 3 cases of urinary retention, to 12.0, 14.5 and 16.5 ml/s, respectively. Digital rectal examination (DRE) indicated a reduced size and softened texture of the prostate induration. PSA was decreased to 1.3-11.5 microg/L. Four cases experienced relapse but were cured after retreated. No prostate cancer was observed. CONCLUSION: NSGP can be definitely diagnosed by puncture biopsy under TRUS and effectively relieved by antibiotics with the alpha-receptor blocker. In case of serious obstruction complicated by urinary retention, transurethral electrotomy can be considered.

[Transrectal ultrasound: an applicable diagnostic approach to chronic prostatitis].

OBJECTIVE: To assess the application value of transrectal ultrasound (TRUS) in the diagnosis of chronic prostatitis. METHODS: TRUS and examination of prostatic secretion (EPS) were used in the diagnosis of 3 500 cases of chronic prostatitis from September, 2000 to May, 2006. RESULTS: Lower resonance of the inner gland, low-level echo, uneven echo light spots, incomplete outlines and unsmooth borderlines were found in 2279 cases (65.1%), and the enlarged prostate in 1 084 cases (31.0%), with clear integrated amicula and enhanced echogenic spots at the juncture of the external and inner gland. No obvious changes were noted in 137 cases (4.0%), and in another 391 cases (11.2%) were detected alteration of the acoustic image of cystospermitis and blurred margins and uneven echoes of the seminal vesicle. The WBC count in EPS was < 10/HP in 132 cases (3.8%), 10-19/HP in 2 156 cases (61.6%) and > or =20/HP in 1212 cases (34.6%). CONCLUSION: TRUS, as a diagnostic means for chronic prostatitis, can be easily performed and causes little pain and therefore is readily accepted by patients. Combined with EPS, TRUS can provide more definite diagnostic evidence, and for those who are afraid of pain and reject EPS, it is a desirable alternative in the diagnosis of chronic prostatitis.