ABSTRACT
Objective To evaluate carotid sinus block (CAS) in preventing the low hemodynamic state in the perioperative period of carotid artery stenting (CAS).Method A prospective single-center randomized controlled study was conducted on 172 patients with internal carotid artery stenosis receiving CAS from May 2015 to May 2018.Patients were randomly divided into group A treated with local anesthesia of the carotid artery sinus of the trouble side under the guidance of ultrasound preoperatively and group B without local block anesthesia.The carotid artery stenosis rate,the maximum intraoperative reduction of blood pressure and heart rate,the use of atropine and vasopressor were monitored and compared between the two groups.Results There were no significant differences between the two groups in preoperative general data,degree of stenosis,plaque nature,degree of residual stenosis (P ＞ 0.05).The maximum reduction of intraoperative blood pressure and heart rate in group A was significantly lower than that in group B,and the number and dose of intraoperative atropine were smaller than those in group B (P ＜ 0.05).The number of postoperative patients with low hemodynamic status in group A and the time period of vasopressor use were significantly less than those in group B (P ＜ 0.05).Conclusion Preoperative carotid sinus block anesthesia is safe and effective in preventing low hemodynamic status in perioperative period of CAS.
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Objective To evaluate the performance of automated blood cell analysis parameters for differential diagnosis of myelodysplastic syndromes (MDS) and aplastic anemia (AA).Methods Data of automatic blood cell analysis parameters at diagnosis of confirmed patients with MDS and AA from December 2002 to February 2011 in Peking University Shenzhen Hospital were retrospectively reviewed.Results 33 cases of MDS and 36 cases of AA were recruited in this study.Based on the evaluable data,mean corpuscular hemoglobin concentration (MCHC) (328.58 ± 17.24 g/L vs 342.47±18.75 g/L,n=33/36) was significantly lower (P=0.002 1),while monocyte percentage (MONO％) (11.48±9.99 vs 6.94±2.50,n=32/34),platelet distribution width (PDW％) (13.51±4.24 vs 10.62±3.68,n=20/22) and platelet hematocrit (PCT％)(0.11 ±0.10 vs 0.04±0.07,n=11/15) were markedly higer (all P＜0.05) in patients with MDS than that of AA.No significantly differences for other blood cell analysis parameters were seen between patients with MDS and AA.Under the condition of best cut-off value,areas under the ROC curve of MCHC,MONO％,PDW and PCT were 0.706 (95％ confidence interval:0.584～0.809),0.666 (0.540～0.778),0.668 (0.506～0.805) and 0.745 (0.538～0.894) respectively.MONO％ and MCHC had high specificities (97.06％ and 88.89％) and positive predictive values (93.3％ and 80.0％) for differential diagnosis of MDS from AA.Conclusion MONO％ and MCHC may be used as simple indicators for differential diagnosis of MDS and AA.
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<p><b>OBJECTIVE</b>To establish the median of serum markers for second trimester screening in Qingdao region and to assess the influence of median correction on the performance of screening.</p><p><b>METHODS</b>Maternal serum alpha-fetoproteins (AFP), human chorionic gonadotrophin, free beta subunit (β -HCG) and unconjugated oestriol (uE3) were assayed for prenatal screening of 18 188 singleton pregnancies at 15-20(+ 6) weeks gestation from January 2009 to July 2010. The median of serum markers was calculated based on above results and applied for risk estimation in screening for fetal aneuploidy from August 2010 to March 2011. The screening performance, specified in terms of detection rates (DRs), false positive rates (FPRs) and odds of being affected given a positive result (OAPR) were compared between the two groups. The risks of 45 affected pregnancies detected during the study were estimated with both Caucasian and corrected medians.</p><p><b>RESULTS</b>The average level of AFP in local pregnancies was similar to that of the Caucasian population, whilst β -HCG and uE3 were respectively 11% and 33% higher than those of Caucasians. The multiple of median (MoM) value was between 0.94 and 1.02 for the dataset based on the corrected median. At a cut-off of l in 270, FPR has decreased from 5.2% to 4.9%, and DR of Down syndrome has increased from 60% to 69.2%, and OAPR has increased from 1:79 to 1:59 when evaluating risk based on the corrected median. For the 45 affected pregnancies, three Down syndrome pregnancies could be missed because their risk estimates were lower than the cut-off level based on Caucasian median.</p><p><b>CONCLUSION</b>It is useful to establish and apply population and laboratory-specific medians in order to improve the performance of prenatal screening and diagnosis.</p>