Objective To determine the feasibility of using a special auditory intervention to detect intraoperative awareness in children under general anesthesia. Methods Thirty-four ASA Ⅰ or Ⅱ children aged 5-15 yr weighing 16-73 kg undergoing scoliosis were enrolled in this study.Intraoperative wake-up test was performed during operation.Two easily identified animal noises(60 dB,lasting 15 s)were played through head phones before induction of anesthesia and immediately after the intraoperative wake-up test. Children were interviewed on the 1st and 5th-7th days after surgery to assess their awareness of intraoperative wake-up test and special auditory intervention. Results Four children were excluded from the study because of restlessness during the intraoperative wake-up test or their refusal to be interviewed. From the remaining 30 children,4 children were suspected to be aware of intraooperative wake-up test. Awareness was comfirmed in 3 children and suspected in one child.The incidence of awareness of intraoperative wake-up test was 10%.But only one of them could tell the animal sound played during the wake-up test.All the patients in this study had explicit recall of the animal noises played before induction of anesthesia.Conclusion Special auditory intervention can not detect intraoperative awareness in children unnder general anesthesia.

BACKGROUND: The distal femur resection in total knee arthroplasty is commonly made using a fixed angle relative to an intramedullary rod. Does a fixed distal femur resection angle influence radiographic alignment in primary total knee arthroplasty? OBJECTIVE: To research the femoral mechanical-anatomical angle in Chinese and how it affects the femoral component angle and postoperative mechanical alignment for total knee arthroplasty. METHODS: Totally 109 cases (148 knees) underwent primary total knee arthroplasty. One surgeon used a fixed resection angle of 5° (group A; n=56 cases, 76 knees). The second surgeon adjusted the resection angle according to preoperative coronal alignment, using 5° for neutral/mild varus, 6° for more severe varus, 4° for mild valgus and 3° for severe valgus knees (group B; n=53 cases, 72 knees). Preoperative hip-knee-ankle angle, femoral mechanical-anatomical angle, postoperative hip-knee-ankle angle, femoral component angle and tibial component angle were measured from standing hip-knee-ankle angle radiographs. For postoperative hip-knee-ankle angle, 177°-183° were considered as neutral mechanical axis. For femoral and tibial component angles, the target results were 88°-92°.RESULTS AND CONCLUSION: (1) There was no statistically significant difference between groups in postoperative hip-knee-ankle angle (group A: (178.78±3.57)°, group B: (178.23±2.78)°; P=0.302) and good rate of hip-knee-ankle angle (group A: 62%, group B: 65%). (2) The mean femoral mechanical-anatomical angle was (6.70±1.34)°preoperatively. There was no significant difference in the good rate of hip-knee-ankle angle (hip-knee-ankle angle < 7°:69%; hip-knee-ankle angle ≥7°: 55%; P=0.108) postoperatively. There was a statistically significant difference about good rate of femoral component angle between different femoral mechanical-anatomical angle angles (femoral mechanical-anatomical angle < 7°: 76%; femoral mechanical-anatomical angle ≥7°: 39%; P < 0.01). (3) There was a statistically significant correlation between preoperative femoral mechanical-anatomical angle and postoperative hip-knee-ankle angle (r=?0.42, P < 0.01) and postoperative femoral component angle (r=?0.58, P < 0.01). (4) The mean femoral mechanical-anatomical angle was larger than foreign values. When the resection angle less than femoral mechanical-anatomical angle, the femoral component may tend to be varus which could affect the lower extremity mechanical alignment. For the larger femoral mechanical-anatomical angle, we advise to adjust the resection angle according to measured value preoperatively.

Objective To explore the relationship between serum uric acid and pulmonary hypertension (PH) in patients with systemic sclerosis (SSc). Methods The echocardiography, electrocardiogram, nailfold videocapillaroscopy and laboratory parameters of 62 patients with SSc were retrospectively analyzed . Patients were divided into two groups according to presence of PH . Statistical analysis was performed using SPSS 17 software . Results Compared to patients without PH , patients with PH had significantly higher serum uric acid levels ( P < 0 . 01 ) , systolic pulmonary arterial pressure ( P < 0 . 01 ) , abnormality of electrocardiogram (P < 0.01), abnormality of nailfold video capillaroscopy and lower serum albunin levels (P < 0.01). Systolic pulmonary arterial pressure had correlation with Serum UA ( r = 0 . 26 , P < 0 . 01 ) as well as serum ablumin (r = -0.28, P < 0.03). Moreover, the mean value of serum UA was significantly different in two ECG groups (P < 0.01) and two nailfold videocapillaroscopy groups (P < 0.01). At the cutoff level of 374 μmol/L, serum uric acid had reasonable accuracy for predicting the presence of PH in SSc patients ( sensitivity 66 . 7% and specificity 84 . 0%) . Conclusion The serum uric acid may be useful as a practicable marker for predict PH in patients with SSc .

Objective:To investigate the efficacy and safety of protein A immunoadsorption (PAIA) combined with rituximab (RTX) in highly sensitized patients who underwent haplo-hematopoietic stem cell transplantation (haplo-HSCT) .Methods:The clinical data of 56 highly sensitized patients treated with PAIA and RTX before haplo-HSCT at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematonosis Hospital between March 2021 and June 2023 were retrospectively analyzed. The number of human leukocyte antigen (HLA) antibody types and the mean fluorescence intensity (MFI), humoral immunity, adverse reactions during adsorption, and survival within 100 days before and after adsorption were measured.Results:After receiving the PAIA treatment, the median MFI of patients containing only HLA Ⅰ antibodies decreased from 7 859 (3 209-12 444) to 3 719 (0-8 275) ( P<0.001), and the median MFI of HLA Ⅰ+Ⅱ antibodies decreased from 5 476 (1 977-12 382) to 3 714 (0-11 074) ( P=0.035). The median MFI of patients with positive anti-donor-specific antibodies decreased from 8 779 (2 697-18 659) to 4 524 (0–15 989) ( P<0.001). The number of HLA-A, B, C, DR, and DQ antibodies in all patients decreased after the PAIA treatment, and the differences were statistically significant (A, B, C, DR: P<0.001, DQ: P<0.01). The humoral immune monitoring before and after the PAIA treatment showed a significant decrease in the number of IgG and complement C3 ( P<0.001 and P=0.002, respectively). Forty-four patients underwent HLA antibody monitoring after transplantation, and the overall MFI and number of antibody types decreased. However, five patients developed new antibodies with low MFI, and nine patients continued to have high MFI. The overall survival, disease-free survival, non-recurrent mortality, and cumulative recurrence rates at 100 days post-transplantation were 83.8%, 80.2%, 16.1%, and 4.5%, respectively. Conclusions:The combination of PAIA and RTX has a certain therapeutic effect and good safety in the desensitization treatment of highly sensitive patients before haplo-HSCT.