Inguinal hernia repair in an elderly patient with moderate aortic stenosis under sole epidural anesthesia: A case report.

Key Clinical Message: In resource limited settings, epidural anesthesia can be a safe option for elderly patients with aortic stenosis for lower abdominal surgeries as the hemodynamic changes are known to be less as compared to spinal or general anesthesia. Abstract: Spinal or general anesthesia in an elderly patient with aortic stenosis is always a challenge for anesthesiologists. It is even more challenging in a resource limited setting. The marked hemodynamic changes associated with either spinal or general anesthesia increase the morbidity and mortality. We present a case of right inguinal hernia in a 71-year-old patient with hypertension, bradycardia, and moderate aortic stenosis planned for open mesh repair under sole epidural anesthesia.

Recurrent pancreatitis secondary to hypertriglyceridemia: A case report and case review.

Key Clinical Message: Managing acute pancreatitis secondary to hypertriglyceridemia in pregnancy is challenging. The use of intravenous insulin along with lipid lowering drugs can be an option in settings where plasmapharesis and gene therapy are unavailable. Abstract: Acute pancreatitis secondary to hypertriglyceridemia is rare but various studies have highlighted it as the third most common cause following gallstones and alcohol consumption. Managing acute pancreatitis is always challenging; even more challenging during pregnancy. We present a case of a 31-year- old female with a history of recurrent pancreatitis secondary to hypertriglyceridemia with a current episode of acute pancreatitis at 21 weeks of gestation.

Ultrasound-guided femoral and sciatic nerve block as an option for below-knee amputation in an elderly patient: A case report.

Peripheral nerve blocks can be a very safe option in elderlypatients with multiple comorbidities where spinal or general anesthesia may be associated with increased risks. We present a 67 years male taking antiplatelet drugs with deranged coagulation profile with bilateral pneumonia with diabetic foot with wet gangrene planned for emergency below knee amputation under ultrasound guided femoral and sciatic nerve block.

Elevated Level of Serum C-reactive Protein Predicts Postoperative Delirium among Patients Receiving Cervical or Lumbar Surgery.

OBJECTIVE: To explore the relationship between elevated serum C-reactive protein (CRP) level and postoperative delirium (POD). METHODS: 206 patients scheduled to receive cervical or lumbar vertebra surgery under general anesthesia for more than 2 hours in a single medical center were observed and analyzed. Patients' serum CRP, delirious status (using the confusion assessment method (CAM)), and delirious score (using the memorial delirium assessment scale (MDAS)) were examined before surgery and 1-2 days after surgery. The association of a serum CRP elevation value from before to after surgery (D-CRP) with delirium occurrence within 2 days after surgery was assessed with a binary logistic regression model, while the association of D-CRP with the postoperative delirious score was assessed with a linear regression model. The effect of D-CRP on predicting delirium occurrence was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: D-CRP was significantly positively associated with postoperative delirium occurrence (OR = 1.047, 95%CI = 1.013, 1.082), and D-CRP was also significantly linearly associated with the postoperative delirious score (ß = 0.014, 95%CI = 0.006, 0.023). AUC of ROC was 0.711 (P = 0.014), suggesting that D-CRP had moderate efficacy on predicting postoperative delirium occurrence (P < 0.05). CONCLUSIONS: Elevated serum CRP after surgery may be a risk factor for and a predictor of postoperative delirium.

COPB2 is up-regulated in breast cancer and plays a vital role in the metastasis via N-cadherin and Vimentin.

Breast cancer (BC) is a common malignant tumour for the adult female and its relative incidence has increased continuously in recent years. The primary molecular mechanisms of breast tumourigenesis remain unclear. With the sequencing technology, we found that coatomer protein complex subunit beta 2 (COPB2) gene is overexpressed in breast cancer tissues. However, the biological function of COPB2 in BC has yet to be determined. This current research demonstrates, significant up-regulation of COPB2 in tissues of breast cancer while comparing the adjacent normal tissue both invalidated cohort and TCGA cohort. Up-regulated expression of COPB2 was correlated with lymph node metastasis (LNM) and oestrogen receptor (ER) in the TCGA cohort and a high level of COPB2 was associated with age and lymph node metastasis in the validated cohort. Besides, logistic analysis illustrated in BC patient COPB2 expression, tumour size, age, ER and disease stage were independent high-risk factors of LNM. Loss of function experiments revealed that down-regulation of COPB2 could inhibit capacities of proliferation and cell invasion in MDA-MB-231 and BT-549 cell lines. Moreover, underexpression of COPB2 could decrease the EMT-related protein N-cadherin and vimentin which may lead to cell invasion. This current research provides new shreds of evidence that COPB2 overexpression shows significant character in the progression of breast cancer. To best of our knowledge, our findings indicated that COPB2 was vital oncogene which was associated with breast cancer.