BACKGROUND: Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery. METHODS: This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO 2 ) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO 2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO 2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression. The secondary outcome was the correlation between SmtO 2 in the forearm and that in the thigh. RESULTS: We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO 2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P  = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P  = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center. CONCLUSION: Muscular tissue desaturation, defined as a baseline SmtO 2 < 80% in the forearm, may be associated with an increased risk of POP. TRIAL REGISTRATION No. ChiCTR-ROC-17012627.
Humans ; Cohort Studies ; Pneumonia/epidemiology* ; Postoperative Complications/epidemiology* ; Oxygen ; Muscles ; Lung Neoplasms/surgery*

BACKGROUND: Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery. METHODS: This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge. RESULTS: A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders. CONCLUSIONS: In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED. REGISTRATION Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).
Humans ; Aged ; Body Temperature ; Emergence Delirium ; Hypothermia ; Postoperative Complications/epidemiology* ; Prospective Studies

We report two women with massive hemoptysis during late pregnancy, who gave birth to two live neonates by cesarean section under a rigid bronchoscopy-guided high-frequency jet ventilation combined with general anesthesia at 33 and 28 gestational weeks, respectively. Bronchoscopy- guided hemostasis was achieved during the operation. Postoperative bronchial arteriography and bronchial artery embolization confirmed the diagnosis of pulmonary vascular malformations. During the 12-month follow-up, no relapse of hemoptysis was observed and the two babies were healthy.

Objective: To evaluate the relationship between modified Frailty Index (mFI) and development of delirium after artificial joint replacement in elderly patients. Methods: Elderly patients (aged ≥60 yr) who scheduled for elective hip or knee replacement, were enrolled.Preoperative frailty was assessed using the mFI scale.All the patients received surgery under combined spinal-epidural anesthesia.Primary outcome was the incidence of delirium within 5 days after operation, and delirium was assessed by Confusion Assessment Method or Confusion Assessment Method-Intensive Care Unit.The patients were divided into delirium group and non-delirium group according to whether delirium occurred or not. Results: A total of 620 patients were included in the study, the mFI was 0.09 (0.18), and the incidence of delirium within 5 days after surgery was 8.5%.The results of multivariate logistic regression analyses showed that increase in age (OR 1.068, 95% CI 1.018-1.120, P=0.007), higher postoperative consumption of morphine (OR 1.089, 95% CI 1.051-1.128, P<0.01) and higher mFI (OR 2.465, 95% CI 1.636-3.714, P<0.01) were the independent risk factors for postoperative delirium. Conclusion Higher mFI is the independent risk factor for delirium after artificial joint replacement in elderly patients.

Objective To evaluate the relationship between modified Frailty Index(mFI)and de-velopment of delirium after artificial joint replacement in elderly patients.Methods Elderly patients(aged≥60 yr)who scheduled for elective hip or knee replacement,were enrolled.Preoperative frailty was assessed using the mFI scale.All the patients received surgery under combined spinal-epidural anesthesia.Primary outcome was the incidence of delirium within 5 days after operation,and delirium was assessed by Confusion Assessment Method or Confusion Assessment Method-Intensive Care Unit.The patients were di-vided into delirium group and non-delirium group according to whether delirium occurred or not.Results A total of 620 patients were included in the study,the mFI was 0.09(0.18),and the incidence of delirium within 5 days after surgery was 8.5％.The results of multivariate logistic regression analyses showed that in-crease in age(OR 1.068,95％CI 1.018-1.120,P＝0.007),higher postoperative consumption of mor-phine(OR 1.089,95％CI 1.051-1.128,P＜0.01)and higher mFI(OR 2.465,95％CI 1.636-3.714,P＜0.01)were the independent risk factors for postoperative delirium.Conclusion Higher mFI is the independent risk factor for delirium after artificial joint replacement in elderly patients.

Objective: To establish the information solution for the classification and assessment of specimen quality based on the assembly line. Methods: Before the samples entered into the assembly line, they were took pictures and screened by the image results. For the suspected samples, serum index was detected. Then, the classification criteria of specimen quality were set, and the alarm thresholds of serum indices for each item suitable for our laboratory were established. The results of serum indices were compiled into the corresponding text descriptions and automatically written into the notes of the result reports. The pictures of blood collection tubes were stored in the laboratory information management system (LIMS) and could be accessed at any time for verification. The samples intercepted by the automatic review were further reviewed by manual. Results: The intra-assay coefficients of variation (CV) of serum indices for haemolysis (H), lipaemia (L) and icterus (I) were 0.6%, 0.7% and 1.3%, respectively, indicating that the precision was good. Among 657 770 samples detected by the assembly line, 11.9% of samples were screened out before they entered the assembly line. The detection of serum indices of these samples demonstrated that the samples with haemolysis, lipaemia and icterus accounted for 1.6%, 1.2% and 0.3% of the total samples, respectively. According to the results of the interference experiment, the alarm threshold of hemolytic serum index was set in 11 items, and those of lipaemia and icterus were set in 1 item. Conclusion By establishing the information solution of specimen quality based on the assembly line, the real-time classification prompting of specimen quality is realized, and the missed detection is avoided, which is helpful to reduce the pre-analysis errors caused by serum quality and simplify the laboratory workflow.

Objective To evaluate the effect of early postoperative delirium on outcomes in elderly patients undergoing joint replacement.Methods Elderly patients,aged ≥ 60 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective hip or knee joint replacement,were divided into delirium group and non-delirium group according to whether the patients developed postoperative delirium.The case-matching criteria was set up with difference in age less than 5 yr and difference in Charlson comorbidity index less than 2 and with a ratio of 1 ∶ 4 for match.The development of complications was recorded within 28 days after operation.Complications happened after delirium was recorded in delirium group.Results There were 53 cases in delirium group and 212 cases in non-delirium group.There was no significant difference in preoperative baseline data or intraoperative variables between two groups (P ＞0.05).Compared with non-delirium group,the total incidence of postoperative complications was significantly increased,the incidence of postoperative cognitive dysfunction,cardiovascular complications,pulmonary complications and deep venous thrombosis was increased,and the length of hospitalization was prolonged in delirium group (P＜0.05).Conclusion Early postoperative delirium is not helpful for outcomes in elderly patients undergoing joint replacement.

Objective To evaluate the effect of early postoperative delirium on prognosis in the pa-tients undergoing coronary artery bypass graft in a nested case control study. Methods A total of 308 pa-tients scheduled for elective coronary artery bypass graft were divided into delirium group or non-delirium group according to whether early postoperative delirium occurred. Type of surgery (on-pump or off-pump) and difference of EuroSCORE between two cases ≤2 were considered as criteria, and patients in two groups were matched with a ratio of 1 : 1. The development of complications was observed within 28 days after op-eration. The development of complications developed after delirium was recorded in delirium group. Results The incidence of delirium was 46. 4％. The total incidence of complications, postoperative cardiac insuf-ficiency and incidence of arrhythmia were significantly higher in delirium group than in non-delirium group (P<0. 05). Conclusion Early postoperative delirium is not helpful for the prognosis in the patients under-going coronary artery bypass graft.

Objective The objectives of this study were to investigate the clinical significance of CD39,CD73,double positive subgroups for CD39 and CD73,and other lymphocytes with clinicopathological parameters in the microenvironment of colorectal cancer.Methods Tumor infiltrating lymphocyte(TIL)was collected from 24 patients with colorectal cancer after radical resection.The expression of CD39+,CD73+ or CD39+ with CD73+ in T cells were measured by flow cytometry.The association between these subgroups and clinicopathologic parameters was analyzed.Results The CD73+ and CD39+ with CD73+ subgroups were associated with lymph node metastasis and poor degree of differentiation,and this mechanism was closely related to tumor-associated inflammation.Conclusion CD39+ with CD73+ colorectal tumor infiltration Treg has a more unique biological activity than other Treg group.This study provides a new idea and theoretical basis for predicting the prognosis of colorectal cancer.

Objective To explore the effect of the posterior condylar offset (PCO) on clinical results after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis.Methods Clinical and radiographic materials of 107 consecutive female patients (107 knees),who had undergone primary TKAs for end-stage osteoarthritis was prospectively analyzed.All operations were performed by using the same operative technique.Based on the corrected PCO change,all cases were divided into two groups:66 knees in which the corrected PCO change ≥0 mm (aged 48-73 years,with an average of 61.4 years) and 41 knees in which the corrected PCO change ＜ 0 mm (aged 52-75 years,with an average of 62.2 years).One-year postoperatively,clinical and radiographic variables from the two groups were compared by independent t-test.The associations between the corrected PCO changes and the improvements of clinical variables in all patients were analyzed by Pearson linear correlation.Results The corrected PCO change was 2.49±1.71 mm in the PCO change ≥0 mm group and-1.28±1.41 mm in the PCO change ＜ 0 mm group.One-year postoperatively,the Knee Society scores,the Western Ontario and McMaster Universities Osteoarthritis Index,non-weight-bearing active and passive range of knee flexion,flexion contracture,and their improvements had no statistical differences between the two groups.The corrected PCO change was not significantly correlated with the improvement of any clinical variable.While the PCO change ≥0 mm group (130.40°± 11.63°) demonstrated greater flexion than the PCO change ＜ 0 mm group (123.80°±13.12°) during active weight-bearing one year after TKA,which was significantly different between the two groups (t=2.11,P=0.0401).Conclusion Restoration of PCO plays an important role in the optimization of active knee flexion during weight-bearing conditions after posterior-stabilized TKA,while it had no benefit to non-weight-bearing knee flexion and any other clinical result.