Correlation Between Anesthesia Methods and Adverse Short-Term Postoperative Outcomes Depending on Frailty: A Prospective Cohort Study.

Purpose: This study aims to investigate how the type of anesthesia used during major orthopedic surgery may impact adverse short-term postoperative outcomes depending on frailty. Methods: To conduct this investigation, we recruited individuals aged 65 years and older who underwent major orthopedic surgery between March 2022 and April 2023 at a single institution. We utilized the FRAIL scale to evaluate frailty. The primary focus was on occurrences of death or the inability to walk 60 days after the surgery. Secondary measures included death within 60 days; inability to walk without human assistance at 60 days; death or the inability to walk without human assistance at 30 days after surgery, the first time out of bed after surgery, postoperative blood transfusion, length of hospital stay, hospital costs, and the occurrence of surgical complications such as dislocation, periprosthetic fracture, infection, reoperation, wound complications/hematoma. Results: In a study of 387 old adult patients who had undergone major orthopedic surgery, 41.3% were found to be in a frail state. Among these patients, 262 had general anesthesia and 125 had neuraxial anesthesia. Multifactorial logistic regression analyses showed that anesthesia type was not linked to complications. Instead, frailty (OR 4.04, 95% CI 1.04 to 8.57, P< 0.001), age (OR 1.05, 95% CI 1.00-1.10, P= 0.017), and aCCI scores, age-adjusted Charlson Comorbidity Index, (OR 1.36, 95% CI 1.12 to 1.66, P= 0.002) were identified as independent risk factors for death or new walking disorders in these patients 60 days after surgery. After adjusting for frailty, anesthesia methods was not associated with the development of death or new walking disorders in these patients (P > 0.05). Conclusion: In different frail populations, neuraxial anesthesia is likely to be comparable to general anesthesia in terms of the incidence of short-term postoperative adverse outcomes.

[Analysis of immunophenotypic features of blasts in patients with myelodysplastic syndrome by flow cytometry and its diagnostic significance].

This study was purposed to analyse the characteristics of blast immunophenotype in patients with refractory anemia with excess blasts, type 1 (RAEB-1) and refractory anemia with excess blasts, type 2 (RAEB-2) by flow cytometry and investigate its diagnostic significance, as well as to compare the blast rate detected by FCM and bone marrow smear (BMS). FCM was used to count the blast rate and detect the expression of its antigens in 29 cases of MDS. The result indicated that: (1) The rate of the blasts detected by FCM and BMS was not statistically significant between patients with RAEB-1 and with RAEB-2 (P > 0.05); (2) Out of 13 patients with RAEB-1, the blasts of 10 cases, 12 cases, 8 cases, 11 cases, 11 cases, 3 cases, 7 cases, 0 case, 0 case, 3 cases and 2 cases patients had positive expressions of CD34, HLA-DR, CD117, CD33, CD13, CD15, CD11b, CD3, CD19, CD7 and CD56, separately. The blasts of 12 cases, 13 cases, 3 cases, 12 cases, 15 cases, 7 cases, 5 cases, 0 case, 1 case, 4 cases and 2 cases among 16 patients with RAEB-2 positively expressed CD34, HLA-DR, CD117, CD33, CD13, CD15, CD11b, CD3, CD19, CD7 and CD56, respectively. However, there was no significant difference in the expression of antigens in blasts of the bone marrow between the patients with RAEB-1 and with RAEB-2 (P > 0.05); (3) The positive expression for CD15 and CD11b in blasts was found in 10 cases and 12 cases, respectively; (4) The positive expression for CD19, CD7 and CD56 was observed in 1, 7 and 4 cases, respectively. None of the 29 cases of MDS was positive for CD3. It is concluded that FCM can reveal the characteristics of immunophenotypic abnormalities of the blasts in patients with MDS and provide the important information for diagnosis and differential diagnosis of MDS.

[Effects of glucocorticoids on the expression of GTIR and apoptosis of the CD4(+)CD25(+)CD127(dim/-) T cells in patients with systemic lupus erythematosus].

OBJECTIVE: To investigate the expression of glucocorticoid-induced tumor necrosis factor receptor (GITR) and apoptosis of CD4(+)CD25(+)CD127(dim/-) T cells of the patients with systemic lupus erythematosus (SLE),and to analyze its clinical value. METHODS: A total of 28 patients with a diagnosis of SLE according to the American College of Rheumatology (ACR) 1997 criteria were included in the study. The SLE patients were divided into active group (SLEDAI≥10) and inactive group (SLEDAI<10) according to the SLE disease activity index (SLEDAI). Active group included 15 patients and inactive group 13 patients. Clinical and laboratory data of the patients with SLE were recorded. In this study 12 normal volunteers without history of autoimmune diseases were also included. Peripheral blood CD4(+)CD25(+)CD127(dim/-) T cells were isolated by magnetic beads sorting. We classified them into two subgroups: the blank group and the therapeutic dose group (dexamethasone dose was 5×10(-2) mg/L and the peripheral blood CD4(+)CD25(+)CD127(dim/-) T cells with dexamethasone were cultured for 48 hours). The expressions of GITR and Annexin V were analyzed by flow cytometry before and after the culture. The correlations between GITR levels, apoptosis rates of these subsets and the clinic, laboratory parameters of SLE were analyzed. RESULTS: GITR levels and apoptosis rates in the patients with SLE were significantly higher than those in the normal control group (P=0.016; P=0.049). The expression levels of GITR on Treg cells between the blank group and the therapeutic dose group were found be of no significant difference in the patients with SLE (P>0.05), but in the normal group, the expression levels of GITR in the therapeutic dose group were higher than those in the blank group (P=0.034). After adding dexamethasone, the apoptosis rates of Treg cells were decreased in the patients with SLE, the difference was statistically significant (P=0.033); But in the normal control group, the apoptosis rate of Treg cells was higher in the therapeutic dose group than in the blank group (P=0.012). The expression levels of GITR on Treg cells were significantly positively correlated with SLEDAI, but were correlated negatively with the C3. CONCLUSION: The GITR is pathologically expressed on Treg cells in SLE, which may be used as an immunological index of SLE disease activity; Glucocorticoids may regulate immune abnormalities in patients with SLE by inhibiting the apoptosis of Treg cells.