[Analysis of risk factors for postoperative gastrointestinal disorders in patients undergoing thoracolumbar fusion]

Objective: To analyze the risk factors for patients' postoperative gastrointestinal disorders (POGD) after surgery of thoracolumbar fusion. Methods: This retrospective study was based on clinical data of 434 patients who underwent thoracolumbar fusion from January 2021 to December 2021 in Nanjing Drum Tower Hospital.According to the occurrence of POGD, the patients were divided into POGD group(n=70) and non-POGD group(n=364). The clinical data of the two groups were compared, and the risk factors of POGD were discussed by binary logistic regression. Results: There were 23 males and 47 females in POGD group, with an average age of (60±6) years, and 133 males and 231 females in the non-POGD group, with an average age of (62±7) years. There were significant differences in operation duration, blood loss, intraoperative spinal decompression, intraoperative hypotension, white blood cell count 24 h postoperatively, C-reactive protein 24 h postoperatively, and postoperative hospitalization days between the two groups (P<0.05). Binary logistic regression analysis showed that intraoperative decompression (OR=2.368, 95%CI: 1.365-4.106, P=0.002), blood loss≥10.9 ml/kg (OR=2.115, 95%CI: 1.166-3.835, P=0.014), white blood cell count 24 h postoperatively≥15.2×109/L (OR=3.580, 95%CI: 1.773-7.226, P<0.001), and intraoperative hypotension (OR=2.019, 95%CI: 1.080-3.773, P=0.028) were risk factors for POGD in patients after thoracolumbar fusion. Use of dexamethasone was a protective factor (OR=0.408, 95%CI:0.218-0.762, P=0.005). Conclusion: Intraoperative decompression, blood loss≥10.9 ml/kg, white blood cell count 24 h postoperatively≥15.2×109/L and intraoperative hypotension are risk factors for POGD after thoracolumbar fusion, and dexamethasone is a protective factor.

[The predictive values of platelet mitochondrial mass and quantity during the perioperative period in elderly patients on the occurrence of postoperative delirium]

Objective: To investigate the changes of platelet mitochondrial mass and quantity during perioperative period in elderly patients, and assess their predictive values on the occurrence of postoperative delirium (POD). Methods: In this prospective study, 162 elderly patients scheduled for abdominal surgery under general anesthesia were enrolled from November 2021 to January 2022 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. Among them, 20 patients [10 males, 10 females, aged (71.4±6.8) years] developed POD within 3 days after surgery (POD group), and another 20 patients[12 males, 8 females, aged (67.7±5.3) years] who did not develope POD were selected as controls (control group) using propensity score matching method. Blood samples were collected preoperatively, at the end of surgery and on the first postoperative day. Platelets were extracted and mitochondrial mass was detected with flow cytometry. Transmission electron microscopy was used to determine mitochondrial quantity. The receiver operating characteristic (ROC) curve was drawn to analyze the value of mitochondrial mass and quantity in predicting the occurrence of POD. Results: The mean fluorescence intensities of platelet mitochondrial mass were 193±46, 236±61, 264±53 preoperatively, at the end of surgery and on the first postoperative day in the POD group, respectively. The corresponding values were 209±61, 191±67 and 201±56 in the control group. The platelet mitochondrial mass of patients in the POD group was significantly increased on the first postoperative day compared to preoperative levels (P<0.001). In contrast, there was no significant difference in the control group (P=0.410). Patients in the POD group had higher platelet mitochondrial mass than patients in the control group on the first postoperative day(P=0.002). Meanwhile, platelets from patients in the POD group showed significantly higher number of mitochondria than platelets from patients in the control group [3 (2, 4) vs 2 (1, 2), P<0.001]. According to the ROC curve of platelet on the first postoperative day, at a mitochondrial mass cut-off value of>275.35, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 55%, 90% and 0.800 (95%CI: 0.666-0.934, P<0.001). At a mitochondrial quantity cut-off value of>2, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 53%, 78% and 0.680 (95%CI: 0.584-0.776, P<0.001). Conclusions: Patients who developed POD show higher platelet mitochondrial mass after surgery compared to preoperative levels. The mitochondrial mass of platelets on the first postoperative day has good predictive value on the occurrence of POD.

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

[Effects of surgical procedures and general anesthesia exposure within 2 hours in early childhood on neurodevelopmental outcomes in school-age]

Objective: To observe the effect of surgical procedures and general anesthesia exposure (<2 h) in early childhood on neurodevelopmental outcomes in school-age. Methods: A total of 147 children aged 6-12 years old, who received surgery under general anesthesia (<2 h) at the age of 0-2 years in Children's Hospital of Nanjing Medical Universityfrom June 2009 to December 2012 were retrospectively enrolled in this study (from June 2018 to December 2021) as exposure group, including 76 males and 71 females, with a mean age of (8.8±1.6) years. All the cases were divided into single-exposure group (n=65) and multiple-exposure group (≥2 times, n=82) according to different times of anesthesia exposure. According to the cohort of exposure group, 160 healthy children of the same age with no history of surgery under general anesthesia were recruited from the community from June 2018 to December 2021 as the control group, including 87 males and 73 females, and aged (8.6±1.9) years. A variety of standardized neurological tests including Wechsler intelligence scale for children fourth edition (WSC-Ⅳ), integrated visual and auditory continuous performance test (IVA-CPT), Swanson Nolan and Pelham, version Ⅳ (SNAP-Ⅳ), children sensory integration capacity development rating scale (CSIC), and social living ability scale were performed in all subjects by a child health specialist who failed to know the details. The primary outcome was the full-scale IQ (FSIQ) in WISC-Ⅳ, and the secondary outcomes were IVA-CPT, SNAP-Ⅳ, CSIC, and social living ability scale. Results: The FSIQ of single-exposure, multiple-exposure and control groups was 105.4±14.1, 100.9±10.2 and 103.6±13.5, respectively, with no statistically significant difference (F=2.37, P=0.095). The FSIQ of different first age exposure groups (aged 0-6 months, 7-12 months and 1-2 years) was 99.8±10.2, 104.5±10.5 and 104.4±14.5, respectively, with no statistically significant difference (F=2.39, P=0.095). The FSIQ of different exposure duration groups (0-59 min, 60-119 min and control group) was 102.8±11.3, 103.0±13.7 and 103.6±13.5, respectively, with no statistically significant difference (F=0.13, P=0.882). As for the secondary outcomes, the scores of visual persistence quotient in single-exposure, multiple-exposure and control groups were 94.8±10.5, 94.0±10.9 and 100.6±17.7, with a statistically significant difference (F=6.96, P=0.001). In terms of locomotion in social living ability scale, the score of the three groups was 10.0±0.2, 10.2±0.6 and 10.4±0.7, respectively, with a statistically significant difference (F=10.61, P<0.001), but all were within the standard range. Conclusions: The surgical procedures and general anesthesia exposure within 2 hours in early childhood has no effect on the overall FSIQ in school age, but has a slight impacts on the visual persistence quotient of IVA-CPT and the locomotion score of social living ability scale.

Temporal retinal thinning might be an early diagnostic indicator in male pediatric X-linked Alport syndrome

AIM

To evaluate temporal retinal thinning changes in retinal layers using spectral-domain optical coherence tomography (SD-OCT) in pediatric X-linked Alport syndrome (XLAS) patients.

METHODS

A retrospective case-control study. SD-OCT scans of pediatric patients diagnosed with XLAS and age- and sex-matched healthy control participants were reviewed. Automated segmentation of SD-OCT scans was induced to analyze the retinal thickness (RT) of different layers. The temporal thinning index (TTI) was calculated for each layer and compared between the patients and the control group.

RESULTS

Forty-three pediatric XLAS patients and 60 healthy controls were included. Temporal retinal thinning was present in 33 patients (76.74%), while 28 patients (65.11%) had severe pathological temporal retinal thinning and 5 patients (11.63%) had moderate thinning. The temporal inner sector RT (P<0.0001), the temporal outer sector RT (P<0.0001), and the nasal outer sector RT (P=0.0211) were significantly thinner in the XLAS male patients. The TTI of the total retina was significantly higher in the XLAS group than in the control group (P<0.0001). The TTI of the inner retina layers (P<0.0001), ganglion cell layer (P<0.0001), inner plexiform layer (P<0.0001), inner nuclear layer (P<0.0001), and outer nuclear layer (P<0.0001) were significantly higher in the XLAS group. The central RT of the XLAS group was significantly thinner than that of the control group (P<0.0001).

CONCLUSION

Temporal retinal thinning appears early in XLAS patients, especially in male patients. The thinning is mainly caused by structural abnormalities of the inner retina. This suggests that temporal retinal thinning could be helpful for the early diagnosis and follow-up of XLAS with noninvasive SD-OCT examination.

[Risk factors of massive introperative blood loss in posterior spinal fusion for adolescent idiopathic scoliosis]

Objective: To investigate the risk factors and prognostic impact of massive introperative blood loss in posterior spinal fusion (PSF) surgery for adolescent idiopathic scoliosis (AIS). Methods: Clinical data were collected of 1 896 AIS patients who underwent PSF surgery under general anesthesia in Drum Tower Hospital Affiliated to Nanjing University Medical School from November 2010 to October 2019 and retrospectively analyzed. According to the volume of intraoperative blood loss, the patients were divided into the massive introperative blood loss group [estimated blood loss (EBL)/estimated blood volume (EBV)≥30%] and the non-massive introperative blood loss group (EBL/EBV<30%). The perioperative parameters between the two groups were compared, single factor analysis and multivariate logistic regression analysis was performed to identify independent risk factors related to massive introperative blood loss in PSF surgery. Results: A total of 1 896 AIS patients who underwent PSF surgery were included in the study. There were 298 males and 1 598 females, with an age of (14.5±1.7) years. Among them, 633 (33%) experienced massive intraoperative blood loss. The factors significantly related to the massive blood loss during PSF surgery in this study are: sex, body mass index(BMI), preoperative blood platelet count (PLT), prothrombin time, international normalized ratio(INR), preoperative Cobb angle, duration of operation, the number of fused levels, the number of screws, thoracoplasty, intraoperative use of tranexamic acid and dexmedetomidine; The independent factors included duration of operation longer than 4 hours(OR=4.311,P<0.001), the number of fused levels to be more than 10(OR=4.044,P<0.001), thoracoplasty (OR=2.174,P=0.019), BMI lower than 18.1 kg/m²(OR=2.094,P<0.001), preoperative PLT less than 186.5×10⁹/L(OR=1.480,P=0.009), preoperative INR larger than 1 (OR=1.531,P=0.003) and preoperative Cobb angle larger than 53°(OR=1.306,P=0.036) ;Intraoperative use of tranexamic acid (OR=0.770, P=0.047) and dexmedetomidine (OR=0.653, P=0.008) are protective factors for massive intraoperative blood loss. In addition, in the massive intraoperative blood loss group, length of postoperative hospital stay (P<0.001), volume of postoperative incision drainage (P<0.001), postoperative allogeneic blood transfusion rate (22.7% vs 14.3%, P<0.001), incidence of postoperative hypoalbuminemia (90.3% vs 80.7%, P<0.001) and the number of rescue opioid analgesic requirements after surgery (P=0.006) were significantly higher than those in the non-massive introperative blood loss group. Conclusions: Longer operation duration, higher number of fusion levels, lower BMI, lower preoperative PLT, higher INR, larger preoperative Cobb angle and intraoperative thoraplasty are independent risk factors for massive intraoperative blood loss in AIS patients undergoing PSF surgery. Intraoperative use of tranexamic acid and dexmedetomidine can reduce the risk of massive blood loss in PSF surgery. Massive intraoperative blood loss significantly affects the patient's prognosis.

[Risk factors associated with massive drainage after posterior spinal orthopaedic surgery for adolescent scoliosis]

Objective: To identify risk factors that influence the massive drainage after posterior spinal orthopaedic surgery for adolescent scoliosis. Methods: A total of 1 461 patients from 11 to 18 years old diagnosed with adolescent scoliosis who underwent first posterior spinal orthopaedic surgery in affiliated Drum Tower Hospital, Medical School of Nanjing University between November 2010 and October 2015 were retrospectively reviewed. Patients were categorized on the basis of massive or normal drainage, with the boundary 30(th) percentile of drainage/estimated blood volume. Preoperative factors including age, gender, body mass index(BMI), ASA physical status, diagnostic type of scoliosis, main Cobb angle, laboratory tests, intraoperative factors including the number of fusion level and screws, tranexamic acid used or not, use of osteotomy and thoracoplasty, use of cell salvage technology, duration of operation, the volume of urine output, blood loss, fluid therapy and transfusion, postoperative factors including the length of hospital stay, number of transfusion, the volume of drainage, time of drain were collected. Univariate and multivariate analyses were used to determine risk factors which were independently associated with massive drainage. Results: The average drainage was (856.3±333.4)ml. 479(32.8%) patients had massive drainage(drainage≥30% of drainage/estimated blood volume). Multivariate analysis identified risk factors of massive drainage: BMI<17.63 kg/m(2), odds ratio(OR)=2.90, preoperative platelet count<190×10(9)/L (OR=1.67), preoperative main Cobb angle≥55 degrees(OR=1.66), number of fusion levels≥11(OR=2.33), number of screws≥15(OR=1.73), use of osteotomy(OR=1.54), intraoperative volume of crystalloids≥35.63 ml/kg(OR=1.40), intraoperative volume of colloids≥28.92 ml/kg(OR=1.82), intraoperative volume of transfusion≥19.55 ml/kg(OR=1.72), while the use of tranexamic acid(OR=0.26) was the only protective factor. Conclusion: BMI<17.63 kg/m(2,) preoperative platelet count<190×10(9)/L, preoperative main Cobb angle≥55 degrees, number of fusion levels≥11, number of screws≥15, use of osteotomy, intraoperative volume of crystalloids≥35.63 ml/kg, intraoperative volume of colloids≥28.92 ml/kg, intraoperative volume of transfusion≥19.55 ml/kg were risk factors associated with massive drainage after posterior spinal orthopaedic surgery for adolescent scoliosis, while the use of tranexamic acid could decrease the possibility of massive drainage.

[Epidemiological study on the association between oral contraceptive and female hyperlipemia and hypertension]

This paper analyzed the mean of serum lipid and blood pressure, prevalence rates and risks of hyperlipemia and hypertension in 999 healthy rural women who had been taking Chinese No. 1 contraceptive pill for 5-25 years. Data was compared with those in 1 065 control subjects wearing IUDs in a series of cohort studies. The results showed that the level of serum triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL) and hypertriglyceridemia prevalence rate after long-term administration of contraceptive pill were significantly higher than that in control subjects (P < 0.01), which hypercholesterolemia prevalence rate did not increase significantly. The mean of systolic pressure and diastolic pressure in taking-pill group were 6.57 mmHg and 3.24 mmHg (lmmH = 0.133322kPa) respectively, higher than that of control group, but still maintained in the normal range. The prevalence rates of systolic hypertension and diastolic hypertension were higher than that of control group (P < 0.01). The results of multiple regression analysis suggested that long-term administration of Chinese No. 1 contraceptive pill had no marked influence on female hyperlipemia and hypertension after dispelling the effects caused by confounding factors.

[Study on correlation of valvular function of deep vein and clinical symptoms]

The material consists of 291 cases (299 limbs) in which all limbs have varicosity of superficial vein. Routine conventional venographic examinations were performed. Valsalva's test was adauted to observe the valvular function of the deep vein. The statistics showed close corelationship between valvular functional state and clinic manifestations (P < 0.005). In maintenance of the normal function of the vein in lower extremities, the valvular function of femoral vein together with that of the popliteal vein is better than each alone. The valvular function of the femoral vein is more efficient than that of popliteal vein.

[Phlebographic observations on the morphology and function of the femoral vein and its valves]

The morphology and function of the femoral vein and its valves in normal and abnormal groups were analysed and compared in 334 cases (414 lower limbs) by ascending and descending phlebography. The diagnostic criteria were established in the normal and abnormal femoral vein and its valves using statistical analysis. Three types of the femoral valvular incompetence were proposed and the value of ascending and descending phlebography in the diagnosis of femoral valves was discussed.