Association between anesthesia technique and complications after hip surgery in the elderly population.

BACKGROUND: Spinal anesthesia is superior to general anesthesia for postoperative recovery in older patients (≥ 65 age). However, evidence for this is lacking. AIM: To evaluate the effect of anesthesia on postoperative complications in older patients undergoing hip surgery. METHODS: This is a retrospective, propensity score-matched, cohort study. Patients ≥ 65-years-old who underwent hip surgery at the Traditional Chinese Medicine of Guangdong Provincial Hospital in China from October 2016 to June 2020 were included. The operative methods were femoral fracture's internal fixation and hip replacement. The orthopedic doctors in different hospitals of our group have varied requirements for patients' out-of-bed time after surgery. Therefore, spinal anesthesia or general anesthesia was selected according to the requirements of the orthopedic doctors. The primary outcome of this study was complications during the hospitalization of the postoperative patient. The length of hospital stay, postoperative blood transfusion, routine blood analysis, renal function, coagulation function, and inflammatory correlations were secondary outcomes. Propensity score matching (PSM) was performed utilizing logistic regression. RESULTS: Among the 864 patients identified from the electronic medical record data database, we screened out those with incomplete medical record data. After PSM of the baseline values of the two groups of patients, data of 309 patients (206 patients in spinal anesthesia group and 103 patients in general anesthesia) were utilized in this study. 67/309 patients had complications, including postoperative limb dysfunction, pulmonary infection, delirium, lower extremity venous thrombosis, and shock. The incidence of complications was not related to anesthesia methods (P > 0.05), but the levels of D-Dimer (P = 0.017), fibrinogen (P = 0.005), and high-sensitivity C-reactive protein (hsCRP) (P = 0.002) in the spinal anesthesia group were significantly higher than those in the general anesthesia group. CONCLUSION: Anesthesia technology is not a risk factor for postoperative complications of hip surgery. The levels of D-Dimer and hsCRP were higher in the spinal anesthesia group.

Effect of electrically stimulating acupoint, Zusanli (ST 36), on patient's recovery after laparoscopic colorectal cancer resection: a randomized controlled trial.

OBJECTIVE: To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on enhanced recovery after surgery (ERAS) in laparoscopic colorectal cancer resection and its clinical significance. METHODS: Sixty-four patients undergoing laparoscopic colorectal resection were randomly divided into two groups, the control group (group A) and the TEAS group (group B). Patients in the TEAS group received electroacupuncture stimulation of bilateral Zusanli (ST 36) at 30 min before anesthesia to the end of surgery. The patients in the control group were not given the stimulation. Perioperative anesthesia management of the two groups were performed according to the ERAS guidelines, and postoperative patient-controlled intravenous analgesia (PCIA) was used. The amount of remifentanil used in the two groups was observed and recorded, and the visual analogue scale (VAS) of the 4, 12, 24 and 48 h after surgery in the two groups was recorded. Moreover, postoperative anal exhaust time, postoperative feeding time, postoperative first ambulation time and postoperative hospital stay length were compared between the two groups. RESULTS: Compared with group A, the VAS score of group B decreased significantly at 48 h after operation (P < 0.05). The postoperative anal exhaust time in group B was significantly shorter than that of group A (P < 0.05). There was no significant difference between the two groups with regards to remifentanil consumption, postoperative feeding time, postoperative first ambulation time and postoperative hospital stay (all P > 0.05). CONCLUSION: TEAS can promote the recovery of postoperative gastrointestinal function and reduce the pain intensity 48 h after surgery, thus satisfying the need of early postoperative analgesia.

[TIE's flying acupuncture for acute cerebral infarction hemiplegia: a randomized controlled trial].

OBJECTIVE: To compare the efficacy difference between TIE 's flying acupuncture combined with conventional treatment and conventional treatment alone on acute cerebral infarction hemiplegia. METHODS: A total of 120 patients were randomly divided into an observation group and a control group, 60 cases in each one. The control group was treated with conventional treatment, including anti-platelet aggregation, lipid-lowering, formula of traditional Chinese medicine which could promote circulation and remove stasis, neurotrophic medication and symptomatic treatment; mannitol was used for cerebral infarction with large area or increased intracranial pressure. Based on the conventional treatment applied in the control group, the observation group was treated with flying acupuncture at the affected Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), Waiguan (TE 5), Hegu (LI 4), Huantiao (GB 30), Biguan (ST 31), Futu (ST 32), Zusanli (ST 36), etc. The treatment was given once a day, six days per week, for totally 2 weeks. The simplified Fugl-Meyer score, National Institute of Health Stroke Scale (NIHSS) and ADL-Bathel index (BI) score were evaluated before and after treatment in the two groups. RESULTS: After the treatment, the simplified Fugl-Meyer and BI were significantly increased in both groups (all P<0.05), which was significantly higher in the observation group (both P<0.05); after the treatment, the NIHSS was significantly lowered in both groups (both P<0.05), which was significantly lower in the observation group (P<0.05). CONCLUSION: TIE 's flying acupuncture combined with conventional treatment were effective for acute cerebral infarction hemiplegia, which have better efficacy than conventional treatment on improving motor function, neurological deficit and daily living ability, and the pain is mild.

Membrane potential-dependent uptake of 18F-triphenylphosphonium--a new voltage sensor as an imaging agent for detecting burn-induced apoptosis.

BACKGROUND: Mitochondrial dysfunction has been closely related to many pathologic processes, such as cellular apoptosis. Alterations in organelle membrane potential are associated with mitochondrial dysfunction. A fluorine-18 labeled phosphonium compound: (18)F-triphenylphosphonium ((18)F-TPP) was prepared to determine its potential use as a mitochondria-targeting radiopharmaceutical to evaluate cellular apoptosis. METHODS: Studies were conducted in both ex vivo cell lines and in vivo using a burned animal model. Uptake of (18)F-TPP was assessed in PC-3 cells by gamma counting under the following conditions: graded levels of extracellular potassium concentrations, incubation with carbonyl cyanide m-chlorophenylhydrazone and staurosporine. Apoptosis was studied in a burn animal model using terminal deoxynucleotidyl transferase dUTP nick end labeling staining and simultaneous assessment of (18)F-TPP uptake by biodistribution. RESULTS: We found that stepwise membrane depolarization by potassium (K) resulted in a linear decrease in (18)F-TPP uptake, with a slope of 0.62 ± 0.08 and a correlation coefficient of 0.936 ± 0.11. Gradually increased concentrations of m-chlorophenylhydrazone lead to decreased uptake of (18)F-TPP. Staurosporine significantly decreased the uptake of (18)F-TPP in PC-3 cells from 14.2 ± 3.8% to 5.6 ± 1.3% (P < 0.001). Burn-induced significant apoptosis (sham: 4.4 ± 1.8% versus burn: 24.6 ± 6.7 %; P < 0.005) and a reduced uptake of tracer in the spleens of burn-injured animals as compared with sham burn controls (burn: 1.13 ± 0.24% versus sham: 3.28 ± 0.67%; P < 0.005). Biodistribution studies demonstrated that burn-induced significant reduction in (18)F-TPP uptake in spleen, heart, lung, and liver, which were associated with significantly increased apoptosis. CONCLUSIONS: (18)F-TPP is a promising new voltage sensor for detecting mitochondrial dysfunction and apoptosis in various tissues.