Objective To compare the effects of desflurane inhalation anesthesia versus propofol total intravenous anesthesia on postoperative recovery quality in patients undergoing endoscopic transnasal pituitary adenoma resection,and to provide evidence-based recommendations for optimizing anesthetic management in this surgical population.Methods This single-center,prospective,randomized controlled trial enrolled 112 patients scheduled for endoscopic transnasal pituitary adenoma resection,who were randomly assigned to either the desflurane group(n=56)or the propofol group(n=56).The desflurane group received desflurane[0.7-1.0 minimum alveolar concentration(MAC)]combined with remifentanil for anesthesia maintenance,whereas the propofol group received propofol(4-6 mg·kg-1·h-1)with remifentanil.The primary outcome was defined as the time from discontinuation of anesthetics to achieving an Aldrete score of 9.Secondary outcomes included emergence time,extubation time,and incidences of postoperative agitation and vomiting.Results Patients receiving desflurane achieved an Aldrete score of 9 significantly faster than those in the propofol group(13.0 min vs 16.5 min,P=0.003).Similarly,both emergence time(14.0 min vs 16.5 min,P=0.009)and extubation time(13.0 min vs 16.5 min,P=0.003)were significantly shorter in the desflurane group.However,the desflurane group had higher incidences of postoperative agitation(17.9%vs 3.6%,P=0.015)and vomiting(19.6%vs 5.4%,P=0.022).No significant difference was observed in severe agitation rates or 24 h postoperative recovery quality[Quality of Recovery-15(QoR-15)scores]between groups.Conclusion Desflurane anesthesia significantly accelerates postoperative recovery in patients undergoing endoscopic transnasal pituitary adenoma resection,however,it may increase risks of mild agitation and vomiting.In clinical applications,it is necessary to balance recovery benefits against potential adverse effects,and take targeted prophylactic measures.

Objective To compare the effects of desflurane inhalation anesthesia versus propofol total intravenous anesthesia on postoperative recovery quality in patients undergoing endoscopic transnasal pituitary adenoma resection,and to provide evidence-based recommendations for optimizing anesthetic management in this surgical population.Methods This single-center,prospective,randomized controlled trial enrolled 112 patients scheduled for endoscopic transnasal pituitary adenoma resection,who were randomly assigned to either the desflurane group(n=56)or the propofol group(n=56).The desflurane group received desflurane[0.7-1.0 minimum alveolar concentration(MAC)]combined with remifentanil for anesthesia maintenance,whereas the propofol group received propofol(4-6 mg·kg-1·h-1)with remifentanil.The primary outcome was defined as the time from discontinuation of anesthetics to achieving an Aldrete score of 9.Secondary outcomes included emergence time,extubation time,and incidences of postoperative agitation and vomiting.Results Patients receiving desflurane achieved an Aldrete score of 9 significantly faster than those in the propofol group(13.0 min vs 16.5 min,P=0.003).Similarly,both emergence time(14.0 min vs 16.5 min,P=0.009)and extubation time(13.0 min vs 16.5 min,P=0.003)were significantly shorter in the desflurane group.However,the desflurane group had higher incidences of postoperative agitation(17.9%vs 3.6%,P=0.015)and vomiting(19.6%vs 5.4%,P=0.022).No significant difference was observed in severe agitation rates or 24 h postoperative recovery quality[Quality of Recovery-15(QoR-15)scores]between groups.Conclusion Desflurane anesthesia significantly accelerates postoperative recovery in patients undergoing endoscopic transnasal pituitary adenoma resection,however,it may increase risks of mild agitation and vomiting.In clinical applications,it is necessary to balance recovery benefits against potential adverse effects,and take targeted prophylactic measures.

OBJECTIVES: Patients with heart failure with reduced ejection fraction (HFrEF) often require diuretics during hospitalization to alleviate fluid retention and improve prognosis. However, the diuretic efficacy and renal impact of dapagliflozin in this population remain unclear. This study aims to investigate the effects of dapagliflozin on diuresis and renal function in hospitalized patients with HFrEF. METHODS: This retrospective analysis included clinical data from 200 hospitalized HFrEF patients treated at Xiangya Hospital of Central South University between January 2021 and September 2022. Patients were divided into 2 groups based on whether they received dapagliflozin: a standard treatment group (n=120) and a dapagliflozin treatment group (n=80). The following were compared between the 2 groups during hospitalization: The 24-hour average difference of liquid intake and output during the first 5 days, urine output, cumulative urine output, diuretic efficiency, estimated glomerular filtration rate (eGFR), N-terminal pro B-type natriuretic peptide (NT-proBNP), hospitalization costs, drug costs, and cost-effectiveness ratio (C/E). RESULTS: 1) Primary outcome: The 24-hour average difference of liquid intake and output during the first 5 days was significantly higher in the dapagliflozin treatment group than in the standard treatment group (P<0.05). 2) Secondary outcomes: The 24-hour average urine volume, cumulative urine volume and diuretic efficiency in the first 5 days of dapagliflozin treatment group were higher than those in the standard treatment group, and the differences were statistically significant (all P<0.05). Among patients with impaired renal function on admission [eGFR between 45 and 90 mL/(min·1.73 m²)], the change in eGFR after treatment was significantly smaller in the dapagliflozin treatment group (P<0.05). For patients with normal renal function on admission [eGFR >90 mL/(min·1.73 m²)], the difference in eGFR changes between 2 groups was not significant (P>0.05). NT-proBNP decreased more in the dapagliflozin treatment group than in the standard treatment group during hospitalization (P<0.05). 3) Other indicators: The length of hospital stay was longer in the dapagliflozin treatment group. However, discharge systolic blood pressure, drug costs, and hospitalization costs were all higher in the standard group, though differences were not statistically significant (all P>0.05). The C/E was more favorable in the dapagliflozin treatment group (425.36 vs. 476.67). CONCLUSIONS In hospitalized patients with chronic HFrEF, dapagliflozin treatment increased 24-hour average difference of liquid intake and output and total urine output, reduced NT-proBNP levels, and showed a milder decline in eGFR in those with pre-existing renal impairment. Discharge blood pressure, drug costs, and hospital stay were not significantly affected. While standard therapy may offer better short-term clinical benefits, dapagliflozin demonstrated a superior short-term cost-effectiveness profile.
Humans ; Benzhydryl Compounds/pharmacology* ; Glucosides/pharmacology* ; Retrospective Studies ; Male ; Female ; Heart Failure/physiopathology* ; Hospitalization ; Middle Aged ; Aged ; Glomerular Filtration Rate/drug effects* ; Diuretics/therapeutic use* ; Kidney/drug effects* ; Natriuretic Peptide, Brain/blood* ; Stroke Volume ; Peptide Fragments/blood* ; Diuresis/drug effects*

Objecave To develop a sensitive and specific LC-MS/MS method for determination of testolactone in human urine.Methods A C_(18 )column(2.1×50mm,3.5μm) was used.The mobile phase Was a mixture of acetonitrile and the buffer solution(ammonium acetate-water solution adjusted with formic acid to pH 3.5)at a flow rate of 0.5ml/min.A mass spectrometer equipped with electrospray ionization source was used as a detector and operated in the positive mode.In multiple reaction monitoring(MRM)mode,the ion transitions of m/z 301→121 and m/z 301→25 was used to qualify and quantify the testolactone,respectively.Results Chromatograms showed no endogenous interfering peaks with the urine blank sample.Each analysis was completed within 7min The calibration wag linear in the concentration range within 0.1～50μg/ml.The intra-batch and inter-batch RSD were less than 10%.The recovery rate of the extraction was about 60%.Conclusions The method is proved to meet the requirements of WADA and be suitable for routine screening.