[Risk factors for hypothermia in patients undergoing general anesthesia in the postanesthesia care unit].

Objective: To investigate the incidence of hypothermia and its risk factors in patients after general anesthesia in the post anesthesia recovery unit (PACU). Methods: A total of 10 341 patients after general anesthesia in the PACU of Peking University People's Hospital from January to December 2019 were retrospectively reviewed. According to whether hypothermia occurred in the PACU, the patients were divided into hypothermia group and non-hypothermia group. After propensity score matching based on age and gender, 336 cases in hypothermia group and 336 cases in non-hypothermia group were finally included. The clinical characteristics of the two groups were compared, and the potential risk factors of hypothermia in the PACU were analyzed by multivariate logistic regression model. Results: The incidence of hypothermia in PACU was 3.3% (339/10 341). The age of hypothermia group was (54.1±17.1) years, with 156 males and 180 females; the age of non-hypothermia group was (53.1±16.0) years, with 156 males and 180 females. There was no statistically significant difference in age, gender, American Society of Anesthesiologists (ASA) classification and operation type between the two groups (all P>0.05). Compared with the non-hypothermia group, the body mass index (BMI) [(22.8±3.5) kg/m2 vs (24.7±4.2) kg/m2] and baseline body temperature [(36.3±0.5)℃ vs (36.5±0.5)℃] were lower, and anesthesia time [(4.4±1.6) h vs (3.2±1.5) h] and operation time [(3.1±1.4) h vs (2.1±1.3) h] were longer in hypothermia group. The amount of intraoperative bleeding, blood transfusion and intravenous fluid was larger in hypothermia group (all P<0.001). Multivariate logistic regression analysis showed that larger amount of blood loss (L) (OR=5.361, 95%CI: 2.863-10.037, P<0.001), prone position operation (OR=3.653, 95%CI: 2.104-6.342, P<0.001), longer anesthesia time (h) (OR=1.421, 95%CI: 1.227-1.646, P<0.001), and general anesthesia combined with regional nerve block (OR=1.708, 95%CI: 1.026-2.843, P=0.039) were independent risk factors of hypothermia in the PACU, and higher BMI (OR=0.849, 95%CI: 0.801-0.900, P<0.001) was an independent protective factor. Conclusions: The incidence of hypothermia in patients after general anesthesia in the PACU remains relatively high. Therefore, more attention should be paid to identify high-risk patients, and active preventive measures should be taken for the risk factors of hypothermia.

The expression of p53, mgmt and egfr in brain glioma and clinical significance.

In order to discuss the expression of P53, MGMT (O6-methylguanine-DNA methyltransferase) and EGFR (epidermal growth factor receptor) in brain glioma and their clinical significance, this paper collected clinical features of 40 patients. We observed the expression of P53, MGMT and EGFR in samples using immuohisto-chemistry assay and analyzed their interaction, as well as their relationship to brain glioma. It was found that among 40 cases of brain glioma samples, cases with positive P53 expression accounted for 47.5%, and its expression in high-grade brain glioma was higher than in low-grade brain glioma (P less than 0.05); cases with positive MGMT expression accounted for 37.5%;, and its expression in high-grade glioma and low-grade brain glioma had no statistical significance (P>0.05); cases with positive EGFR expression accounted for 55%, and its expression in high-grade brain glioma was higher than in low-grade brain glioma (P less than 0.05); the expression of P53, MGMT and EGFT were not correlated to age, gender or size of tumor; P53 expression was negatively correlated to MGMT expression (P < 0.05) but positively correlated to EGFR expression (P < 0.05) demonstration that P53, EGFR and MGMT play important roles in the occurrence and development of brain glioma.

Comparative analysis of protein expression in differentiated thyroid tumours: a multicentre study.

This study compared clinical features and protein expression profiles in differentiated thyroid tumours to identify protein markers with the potential for indicating malignancy status. Tissue microarrays were constructed using 119 thyroid tumour samples (45 papillary carcinomas, 26 follicular carcinomas, 48 adenomas). Generally, there was overexpression of proliferating cell nuclear antigen (PCNA), p53, matrix metalloproteinase (MMP)-7, Hector Battifora mesothelial-1 (HBME-1), MMP-2, pituitary tumour-transforming gene (PTTG) and human telomerase reverse transcriptase (hTERT) in malignant thyroid carcinomas, and overexpression of fragile histidine triad (FHIT), p16 and E-cadherin in thyroid adenomas. Multiple factor binary logistic regression analysis indicated that MMP-2, HBME-1, p16 and FHIT were independently related to differentiated thyroid tumours. Receiver-operating characteristics for these four factors showed HBME-1 as best for diagnostic accuracy. Sensitivity and specificity were enhanced using an HBME-1 and p16 cluster. HBME-1 expression was not significantly different for papillary and follicular carcinomas, whereas p16 expression was significantly specific.

Cytologic and histologic review of atypical glandular cells (AGC) detected during cervical cytology screening.

This article is to determine the clinical significance and underlying pathology among patients with atypical glandular cells (AGC) identified during cervical Papanicolau (Pap) smear screening. AGC slides were searched from 51,412 computerized files of the cytology laboratory of Mackay Memorial Hospital during a 29-month period. The results of clinical evaluations were reviewed and an experienced gynecologic cytopathologist who was not involved in the original cytologic diagnosis and was not aware of the clinical results of the follow-up examinations rechecked all AGC slides. We used the z score to determine whether different results were achieved after the gynecologic cytopathologist rechecked the slides. We further analyzed all slides with different cytologic diagnoses and compared results with the histologic diagnoses. Forty-nine cases were initially identified as AGC. Among these, 29 were reviewed and identified as AGC again, and the result of biopsies revealed that they were all chronic cervicitis, ie, negative for malignancy or premalignancy. The other 20 cases were reviewed and diagnosed as non-AGC. Among the results of cytologic examinations, seven had inflammation, two had atypical squamous cells of undetermined significance (ASC-US), ten had high-grade cervical intraepithelial neoplasia (CIN), and one had adenocarcinoma. The results of histologic diagnosis included eight cases with normal tissue, two with CIN grade 1, eight with high-grade CIN, one with microinvasive squamous cell carcinoma, and one with adenocarcinoma. Histologic results revealed 20.4%1 (10/49) and 50% 1(10/20) at initial cytologic diagnosis of AGC and expert-reviewed non-AGC, respectively, which were finally at least high-grade CIN. According to the gynecologic cytopathologist's diagnosis, 59.2%1 (29/49) of cases would have eliminated unnecessary histologically diagnostic procedures. In conclusion, clinicians should be careful about the significance of the cytologic diagnosis of AGC, because there may actually be an underlying pathology, which can be identified by a pathologist who is an expert in gynecologic cytopathology. The interobserver variation in diagnosing AGC favors specialized training in gynecologic cytopathology. In addition, prompt diagnostic interventions, including colposcopy, endocervical curettage, and/or endometrial biopsy, should be performed after confirmation of the diagnosis of non-AGC by an experienced gynecologic cytopathologist.

Carbohydrate utilization and digestibility by tilapia, Oreochromis niloticus x O. aureus, are affected by chromic oxide inclusion in the diet.

A 12-wk feeding trial was conducted to study the influence of chromic oxide (Cr2O3) on carbohydrate utilization and digestibility by tilapia, Oreochromis niloticus x O. aureus. Two levels of chromic oxide (0.5 and 2%) were each incorporated into diets containing glucose or starch. Chromic oxide was added at 0 or 8 wk. The diets were fed to triplicate groups of fish weighing 1.11 +/- 0.05 g. Fish fed the starch diet had greater (P < 0.05) weight gain, feed efficiency ratio, protein efficiency ratio, protein deposition and digestibility of protein, lipid, carbohydrate and dry matter than fish fed the glucose diet irrespective of the time and level of chromic oxide supplementation. Fish fed the glucose diet with 0.5% chromic oxide had higher weight gain, feed efficiency ratio, protein efficiency ratio and protein deposition than fish fed the glucose diet with 2% chromic oxide. The ingredient digestibility estimated using 0.5% chromic oxide as the marker was greater than that estimated with 2% chromic oxide. Higher phosphofructokinase and lower glucose-6-phosphatase activity was found in fish fed the starch diet than in fish fed the glucose diet regardless of the time and level of chromic oxide inclusion. Fish fed the glucose diet with 0.5% chromic oxide had higher phosphofructokinase activity and lower tissue chromium concentration than fish fed the glucose diet with 2% chromic oxide irrespective of chromic oxide inclusion time. These data suggest that the level of chromic oxide in the diet alters glucose utilization by tilapia and affects nutrient digestibility by tilapia. The time of chromic oxide inclusion had no effect on carbohydrate utilization and digestibility.

Minimizing emergence phenomena: subdissociative dosage of ketamine in balanced surgical anesthesia.

Three hundred twelve patients, ranging in age from 14 to 89 years and undergoing various major and minor surgical procedures, were anesthetized by oxygen, nitrous oxide, and ketamine in sequence. Anesthesia was induced with thiopental (5.8 mg./kg.). The first 212 patients received an initial dose of ketamine of 1.6 mg./kg. lean body mass; 100 other patients, an initial (subdissociative) dose of ketamine of 0.4 mg./kg. body weight. Subsequent doses of ketamine, one-half the initial dose, were given 20 to 40 minutes apart, as needed. Postoperative subjective reactions were limited to slight confusion on emergence, with some disorientation to time, and occurred in 10 patients (5 percent) in the first group and 4 (4 percent) in the latter group. No psychotomimetic reactions were noted in either group. The latter group unanimously found the anesthetic technic acceptable for future use.