Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes.

BACKGROUND: Enhanced recovery after surgery advocates that consuming carbohydrates two hours before anesthesia is beneficial to the patient's recovery. Patients with diabetes are prone to delayed gastric emptying. Different guidelines for preoperative carbohydrate consumption in patients with diabetes remain controversial due to concerns about the risk of regurgitation, aspiration and hyperglycemia. Ultrasonic gastric volume (GV) assessment and blood glucose monitoring can comprehensively evaluate the safety and feasibility of preoperative carbohydrate intake in type 2 diabetes (T2D) patients. AIM: To evaluate the impact of preoperative carbohydrate loading on GV before anesthesia induction in T2D patients. METHODS: Patients with T2D receiving surgery under general anesthesia from December 2019 to December 2020 were included. A total of 78 patients were randomly allocated to 4 groups receiving 0, 100, 200, or 300 mL of carbohydrate loading 2 h before anesthesia induction. Gastric volume per unit weight (GV/W), Perlas grade, changes in blood glucose level, and risk of reflux and aspiration were evaluated before anesthesia induction. RESULTS: No significant difference was found in GV/W among the groups before anesthesia induction (P > 0.05). The number of patients with Perlas grade II and GV/W > 1.5 mL/kg did not differ among the groups (P > 0.05). Blood glucose level increased by > 2 mmol/L in patients receiving 300 mL carbohydrate drink, which was significantly higher than that in groups 1 and 2 (P < 0.05). CONCLUSION: Preoperative carbohydrate loading < 300 mL 2 h before induction of anesthesia in patients with T2D did not affect GV or increase the risk of reflux and aspiration. Blood glucose levels did not change significantly with preoperative carbohydrate loading of < 200 mL. However, 300 mL carbohydrate loading may increase blood glucose levels in patients with T2D before induction of anesthesia.

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study.

Background: The diverse manifestations of tuberculosis (TB) in chronic kidney disease (CKD) patients can cause difficulty in diagnosis, delayed treatment, even death. Therefore, this study investigated the clinical characteristics and the risk factors for mortality in CKD patients with TB. Methods: This retrospective study included 167 patients diagnosed with active TB at two tertiary medical centers in Chongqing within six years. Clinical characteristics and outcomes of anti-TB treatment in patients with and without CKD were collected, and the predictive mortality values of variables were analyzed. Results: Of the 167 patients, 66.7% (44/66) hemodialysis (HD), 41.1% (21/51) pre-HD, and 32.0% (16/50) non-CKD patients had extrapulmonary TB. The pleura and lymph node were the common sites in CKD patients. Clinical presentations of cough and hemoptysis in CKD patients were less common than those in non-CKD patients, 13.7% (16/117) of CKD patients even not having any clinical symptoms. The positive rates of tuberculin skin test, TB-polymerase chain reaction and acid-fast bacilli in sputum in HD patients were lower than those in pre-HD and non-CKD patients (p<0.05). CKD patients were more prone to gastrointestinal and neurological side effects during anti-TB treatment. The mortality rates of non-CKD, pre-HD and HD patients was 6.1%, 31.9% and 37.3%, respectively. Multivariate Cox analysis revealed that age≥40 years (HR: 5.871; p=0.019), hypoalbuminemia (HR:2.879; p=0.004), CKD stage 4-5 (HR:4.719; p=0.018) and HD (HR:6.13; p=0.005) were associated with mortality. Discussion: CKD patients with TB have atypical clinical manifestations and high mortality. Age, hypoalbuminemia, CKD stage 4-5, and HD were independent predictors of mortality.

Effect of Ultrasound-Guided Fascia Iliac Compartment Block with Nalbuphine and Ropivacaine on Preoperative Pain in Older Patients with Hip Fractures: A Multicenter, Triple-Blinded, Randomized, Controlled Trial.

INTRODUCTION: Pain management for older patients with hip fractures is challenging. This study aimed to investigate the effect of ultrasound-guided fascia iliac compartment block (UGFICB) using different doses of nalbuphine in combination with ropivacaine on preoperative analgesia in older patients with hip fractures. METHODS: In this multicenter randomized controlled trial, 280 elderly patients with hip fracture were randomly allocated into four UGFICB groups (n = 70 in each group): a ropivacaine group (30 mL 0.1% ropivacaine + 0.9% normal saline) and three ropivacaine plus nalbuphine groups (5, 10, and 20 mg nalbuphine, respectively). The primary outcomes were the duration of analgesia at rest and on passive movement. Secondary outcomes included sensory block area, side effects, and vital signs. The doses of rescue analgesia with parecoxib sodium were also analyzed. RESULTS: The addition of nalbuphine dose-dependently increased the duration of analgesia at rest and on passive movement (P < 0.05) and expanded the area of sensory block (P < 0.05). Compared with the ropivacaine group, the pain scores at rest and on movement at 6 and 8 h after the block were lower in three ropivacaine plus nalbuphine groups (P < 0.05), without between-group differences at 2, 4, and 12 h. The four groups had comparable side effects (nausea and vomiting) and vital signs (P > 0.05). CONCLUSIONS: UGFICB with 5, 10, and 20 mg nalbuphine added to ropivacaine prolonged the analgesia duration, increased sensory block area, reduced pain, and decreased the doses of rescue parecoxib sodium for older patients after hip fracture, without obvious side effects. Among these three doses, nalbuphine 20 mg in combination with ropivacaine provided the longest duration of analgesia and the largest sensory block area. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2000029934).

Analgesia and stress attenuation of ultrasound-guided modified pectoral nerve block type-II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: A prospective parallel randomized double-blind controlled clinical trial.

WHAT IS KNOWN AND OBJECTIVE: A previous randomized clinical trial concluded that an optimal concentration of 0.3% ropivacaine could provide satisfactory analgesia for breast cancer patients undergoing modified radical mastectomy. We wondered if a smaller volume (30 ml vs. 40 ml) of 0.3% ropivacaine could still provide adequate analgesia in an ultrasound-guided PECS II block in modified radical mastectomy. METHODS: We performed a prospective parallel randomized double-blind controlled clinical trial. Eligible patients were assigned to either the P30 or P40 group (30 or 40 ml of 0.3% ropivacaine, respectively). The skin area of hypoesthesia, anaesthetic plane determined with ultrasound, pain visual analogue scale (VAS), anaesthetic dosages, and complications were recorded. Serum levels of interleukin-1ß and interleukin-6 were measured postoperatively. RESULTS AND DISCUSSION: A total of 40 patients completed the trials, with 20 patients in each group. Although the skin area of hypoesthesia and the anaesthetic planes were significantly larger in the P40 group compared with the P30 group (p < 0.05), the VAS, analgesic and opioid doses, serum cytokine levels, anaesthetic toxicity, and complications had no significant differences between the two groups. WHAT IS NEW AND CONCLUSION: Compared with 40 ml, 30 ml of 0.3% ropivacaine could provide adequate analgesia and reduce surgical stress in patients undergoing modified radical mastectomy for breast cancer.

PTPN12 Affects Nasopharyngeal Carcinoma Cell Proliferation and Migration Through Regulating EGFR.

OBJECTIVE: Nasopharyngeal carcinoma (NPC) shows the leading morbidity in otorhinolaryngological malignant tumor. It is a common malignancy in China with obvious reginal distribution. NPC is a polygenic disease that is affected by numerous factors. Protein tyrosine phosphatase nonreceptor type 12 (PTPN12) regulates multiple tumor proliferation and development, including breast cancer and colon cancer. However, the role of PTPN12 in NPC occurrence and development has not been elucidated. PATIENTS AND METHODS: NPC cell line CNE2 was cultured in vitro and divided into three groups, including control, empty plasmid, and PTPN12 groups. PTPN12 mRNA and protein expressions were tested by real-time polymerase chain reaction and Western blot. CNE2 cell proliferation was detected by MTT assay. Cell migration was determined by wound healing assay. Cell apoptosis was evaluated by caspase 3 activity detection. Epidermal growth factor receptor (EGFR) expression was assessed by Western blot. RESULTS: PTPN12 plasmid transfection increased PTPN12 mRNA and protein expressions, suppressed cell proliferation and migration, reduced EGFR level, and enhanced caspase 3 activity compared with control and empty plasmid groups (p < 0.05). CONCLUSIONS: PTPN12 regulates NPC proliferation and migration through negative regulating EGFR. It could be treated as a molecular target for NPC diagnosis and prognosis analysis.

[Application of gastric pharyngeal anastomosis assisted by laparoscope and a report of 4 cases].

OBJECTIVE: To explore the clinical application of gastric pharyngeal anastomosis assisted by laparoscope. METHOD: Apply laparoscope in the gastric pharyngeal anastomosis for 4 cases of advanced hypopharyngeal carcinoma and cervical esophageal carcinoma patients. RESULT: Gastric pharyngeal anastomosis assisted by laparoscope were successfully completed in all 4 patients, all patients avoided thoracotomy or laparotomy, one patient occurred pharyngeal fistula, and died six months later. One patient had cervical lymph node metastasis a year and a half later, without treatment again because of economicissue. The remaining two patients were still alive, one patient had survived 3 years and a half after operation, the other had survived 2 years and a half after operation. CONCLUSION: Gastric pharyngeal anastomosis assisted by laparoscope is feasible. It can reduce the operation wound, improve the safety of operation and patients' life quality.

[Small partial laryngectomy without tracheotomy for T1-2 stage glottic carcinoma].

OBJECTIVE: To investigate the feasibility and clinical characteristics of small partial laryngectomy without tracheotomy for T1-2 stage glottic carcinoma. METHOD: Forty-five patients with laryngeal squamaous cell carcinoma in T1-2 stage received small partial laryngectomy without tracheotomy. RESULT: All patients were primarily healed and were hospitalized for an average of 11.5 days post-operatively. In all patients, the function of respiration and the reflection of cough were normal, and laryngeal obstruction did not happen. The only postoperative complication was subcutaneous emphysema noted in 29 patients. Among them, subcutaneous emphysema extincted after 4-6 days in 26 patiens, only 3 patiens suffered from delayed healing because the subcutaneous emphysema extincted after 2 weeks. Mild subcutaneous emphysema did not affect the function of respiration and deglutition, healing of wound, and psychology of patients. All patients had been followed-up for 1-13 years. Only 2 patients died of tumor recurrence or metastasis. The function of respiration and deglutition were normal in the living patients, and no implanting metastasis on surface of trachea were found. CONCLUSION: The theoretical foundation of small partial laryngectomy without tracheotomy for T1-2 stage glottic carcinoma has been well established. This surgical technique is feasible, safe and effective. It can significantly improve clinical outcome of T1-2 stage glottic carcinoma with minimal invasiveness. Furthermore, it can obviously abate the surgical, physiological and psychological trauma on patients.

[Laryngeal function preservation in the surgical treatment of cervical esophageal carcinoma].

OBJECTIVE: To study the indication and the methods of hypopharyngeal and esophageal reconstruction in the surgical treatment of cervical esophageal carcinoma with laryngeal function preservation. To explore the reasons of err inhaling after gastric-pharyngeal anastomosis and its prevention and treatment. METHOD: Clinical data of nine patients who underwent surgical treatment of cervical esophageal carcinoma with laryngeal function preservation from 1998 to 2006 were analyzed retrospectively. The patients without preoperative hoarseness included two cases of pure cervical esophageal carcinoma, six cases of cervical esophageal carcinoma involved hypopharynx and one cases of cervical-thoracic esophageal poly primary malignant carcinoma. Eight patients were carried out total laryngeal function preservation and one patient was carried out partial laryngeal function preservation. The methods of hypopharyngeal and cervical esophageal reconstruction included gastric-pharyngeal anastomosis (seven patients), free forearm flap (one patient) and pectoralis major myocutaneous flap (one patient). RESULT: Good laryngeal function in four patients, moderate laryngeal function in two patients and bad laryngeal function in three patients. Everyone in seven patients underwent gastric-pharyngeal anastomosis had a very degree of gastric countercurrent, temporalitive disappearance of cough reflex and err inhaling, five of them laryngeal paralysis. The higher anastomosis gob, the heavier err inhaling. One patient with free forearm flap died of lethal haemorrhage. One patient with pectoralis major myocutaneous flap occurred anastomosis gob stricture. CONCLUSION: Patients with pure cervical esophageal carcinoma and cervical esophageal carcinoma involved hypopharynx less than 1 cm from the entrance of esophagus are feasible to undergo total laryngeal function preservation operation, while elder patients with cervical esophageal carcinoma involved hypopharynx more than 1 cm from the entrance of esophagus are feasible to undergo partial laryngeal function preservation operation or no laryngeal function preservation operation instead of total laryngeal function preservation operation. Err inhaling is nearly relevant to the disorder of deglutition function of the pharynx-esophagus and err inhaling prevention function of the larynx.

[Comparison and improvement in the methods of establishing animals model of experimental chronic sinusitis in rabbits].

OBJECTIVE: To compare and improve the methods of establishing animal model of experimental chronic sinusitis in rabbits . METHODS: Sixty-six New Zealand white rabbits were divided into seven groups: control group, sham-operation group I, sham-operation group II, bacteria inoculation group, ostia-blocked group, ostia-blocked and bacteria inoculation group, incomplete ostium blocked and set-cotton group. The animals were examined by the methods of histology and bacteriology after 42 days. RESULTS: The positive rate of chronic inflammation in ostium blocked group was 80%, inoculated staphylococcus group was 100%, incomplete ostium blocked and set-cotton group was 100%, and the other groups were 0%. All infected sinuses displayed signs of moderate or severe chronic inflammation. The cultivated bacteria were mainly opportunistic pathogens. The probability of having abscess in maxillary sinus was high in ostia-blocked and bacteria inoculation group. CONCLUSIONS: The method of incomplete ostium blockage and set cotton can establish stable chronic sinusitis model, it is a simple and perfect method.

[Comprehensive evaluation of the middle ear function in children with secretory otitis media after tympanotomy tube insertion].

OBJECTIVE: To study the method on comprehensive evaluation of the middle ear function in children with secretory otitis media (SOM) after tympanotomy tube insertion. METHOD: Ear canal volume (ECV), pure tone audiometry and distortion product otoacoustic emission(DPOAE) were carried out in 31 children(43 ears) with SOM before and 1 month after tube insertion,in the meantime Eustachian tube function was recorded. The tympanotomy tube was observed under microscope. RESULT: After one month of tube insertion, the hearing level was improved in 39 ears with an ECV > 2.0 ml. In addition,the detection rate and amplitude of DPOAE were significantly increased in these 39 ears. No case of the function of Eustachian tube was complete recovered. CONCLUSION: ECV, pure tone audiometry, DPOAE and inflation-deflation test are significantly clinical worth for comprehensive evaluation of the middle ear function in children with SOM after tympanotomy tube insertion.

[Extraluminal foreign body originated from pharynx and esophagus (24 cases report)].

OBJECTIVE: To summarize the symptoms, various diagnostic procedures, and therapy of extraluminal foreign body originated from pharynx and esophagus (EFBOPE). METHOD: Twenty-four patients with EFBOPE were retrospectively reviewed. RESULT: Twenty-two cases were removed surgically, 1 case was spontaneous expulsion, 1 case died. CONCLUSION: EFBOPE is seldom seen in the clinical, diagnosis of EFBOPE should be considered whenever haematemesis or haemorrhage, inflammation or abscess in parapharyngeal space outside of pharynx and esophagus are presented after ingesting foreign body. Radiography and computed tomography are main diagnostic tools. Surgical treatment is the only effective method for EFBOPE and must be performed in time.

[Tinnitus with normal hearing and evoked otoacoustic emissions].

OBJECTIVE: To investigate the objective methods for tinnitus exploration by analysing the cochlear activity in tinnitus patients with normal hearing. METHOD: The 50 cases (50 ears) of unilateral tinnitus with normal hearing (the plastic group 1), 24 cases (46 ears) of bilateral tinnitus with normal hearing(the plastic group 2) and the 34 persons (68 ears) of normal hearing without tinnitus (control group) were measured by evoked otoacoustic emissions (TEOAE and DPOAE). All the tinnitus patients were also tested by the subjective tinnitus frequency and analysed with appropriate characteristic in TEOAE and DPOAE audiogram. RESULT: (1) The passing rate of TEOAE was 64.0% in the tinnitus group 1, 91.3% in the group 2, and 100% in the control group (group 1 P < 0.01, group 2 P >0.05 ). (2) The passing rate of DPOAE was 100% in three groups. But comparing to the control group, the amplitudes of DPOAE at the limited frequency ranges (3.125 kHz and 8.837 kHz) of the tinnitus group 1 was significant decreased ( P <0.05). (3) The subjective tinnitus frequencies were 0.25 approximately 8.00 kHz. The decreases in amplitudes and absent within the tinnitus frequencies were observed in TEOAE and DPOAE audiogram. CONCLUSION: Some patients of normal hearing with tinnitus have had early harmness of outer hair cell in cochlear. Evoked otoacoustic emissions is one of worthy methods to evaluated objectively the tinnitus. TEOAE is more susceptible to harmness in cochlear than DPOAE. DPOAE is superior to the analysis of tinnitus frequencies.

[Diagnosis and treatment of juvenile recurrent laryngeal papillomatosis].

OBJECTIVE: To evaluate some perplexing problems in the diagnosis and treatment of juvenil recurrent laryngeal papillomatosis (JRLP) and the relationship between juvenile onset recurrent respiratory papillomatosis(JORRP) and infantile laryngeal condyloma accuminatum (ILCA). METHODS: A group of 44 cases with JRLP were analyzed retrospectively from March, 1994 to March, 2002 in the light of literature review. RESULTS: The average age of first visit was 1.6 years. Average 5.3 operations had been performed per patient. There was an interval of average 2.4 months between two surgical excisions. Of 233 operations, the total incidence rate of all the complications was 3.9%. At present, the laryngeal lesion of 18 cases have withered away for over 1 year. 11 cases have being followed up. 10 cases have lost follow-up and 5 cases have died (11.4%). Combined laryngeal lesion excision with tracheotomy aiming at prolonging operative interval or Chinese traditional medicine has received more satisfactory effect than other therapies. There is an extensive similarity between JORRP and ILCA. CONCLUSIONS: To demondrate further whether JORRP and ILCA are the same identical disease has important significance in both theoretical study and clinic practice. The treatment for JRLP is still difficult. The tracheotomy for laryngeal obstruction resulted from the laryngeal lesion of JRLP should be avoided as far as possible. Combined laryngeal lesion excision with tracheotomy aiming at prolonging opertive interval or Chinese traditional medicine shows optimistic prospect.