Impact of delay extubation on the reintubation rate in patients after cervical spine surgery: a retrospective cohort study.

BACKGROUND: The incidence of cervical airway obstruction after cervical spine surgery (CSS) ranges from 1.2 to 14%, and some require reintubation. If not addressed promptly, the consequences can be fatal. This study investigated delayed extubation's effect on patients' reintubation rate after cervical spine surgery. METHODS: We performed a retrospective case-control analysis of cervical spine surgery from our ICU from January 2021 to October 2022. Demographic and preoperative characteristics, intraoperative data, and postoperative clinical outcomes were collected for all 94 patients. Univariable analysis and multivariable logistic regression were used to analyze postoperative unsuccessful extubation risk factors following cervical spine surgery. RESULTS: The patients in the early extubation (n = 73) and delayed extubation (n = 21) groups had similar demographic characteristics. No significant differences were found in the reintubation rate (0 vs. 6.8%, p = 0.584). However, the delayed extubation group had significantly more patients with 4 and more cervical fusion segments (42.9 vs. 15.1%, p = 0.013),more patients with an operative time greater than 4 h (33.3 vs. 6.8%, p = 0.004)and all patients involved C2-4 (78 vs. 100%, p = 0.019).Also, patients in the delayed extubation group had a longer duration of ICU stay (152.9 ± 197.1 h vs. 27.2 ± 45.4 h, p < 0.001) and longer duration of hospital stay (15.2 ± 6.9 days vs. 11.6 ± 4.1 days, p = 0.003). Univariate and multivariate analysis identified the presences of cervical spondylotic myelopathy (CSM) (OR 0.02, 95% CI 0-0.39, p = 0.009) and respiratory diseases (OR: 23.2, 95% CI 2.35-229.51, p = 0.007) as unfavorable prognostic factor for reintubation. CONCLUSIONS: Our analysis of patients with cervical spondylosis who received CSS indicated that delayed extubation was associated with the presence of respiratory diseases and CSM, longer operative time, more cervical fusion segments, and longer duration of ICU and hospital stays.

Comparative Venom Multiomics Reveal the Molecular Mechanisms Driving Adaptation to Diverse Predator-Prey Ecosystems in Closely Related Sea Snakes.

Predator-prey arms races are ideal models for studying the natural selection and adaptive evolution that drive the formation of biological diversity. For venomous snakes, venom is a key bridge linking snakes with their prey, but whether and how venom evolves under the selection of diet remains unclear. Here, we focused on two closely related sea snakes, Hydrophis cyanocinctus and Hydrophis curtus, which show significant differences in prey preferences. Data-independent acquisition (DIA)-based proteomic analysis revealed different degrees of homogeneity in the venom composition of the two snakes, which was consistent with the differential phylogenetic diversity of their prey. By investigating the sequences and structures of three-finger toxins (3FTx), a predominant toxin family in elapid venom, we identified significant differences between the two sea snakes in the binding activity of 3FTx to receptors from different prey populations, which could explain the trophic specialization of H. cyanocinctus. Furthermore, we performed integrated multiomic profiling of the transcriptomes, microRNAs (miRNAs), long noncoding RNAs (lncRNAs), and proteomes of the venom glands; constructed venom-related mRNA-miRNA-lncRNA networks; and identified a series of noncoding RNAs involved in the regulation of toxin gene expression in the two species. These findings are highly informative for elucidating the molecular basis and regulatory mechanisms that account for discrepant venom evolution in response to divergent diets in closely related snakes, providing valuable evidence for the study of coselection and coevolution in predator-prey ecosystems.

Impact of positive end-expiratory pressure on cerebral injury patients with hypoxemia.

BACKGROUND: Traumatic brain injury or intracranial hemorrhage patients with acute lung injury/acute respiratory distress syndrome need mechanical ventilation. The use of positive end-expiratory pressure (PEEP) in this situation remains controversial. This study explored the impact of PEEP on intracranial pressure (ICP), cerebral perfusion pressure (CPP), central venous pressure (CVP), and mean arterial pressure (MAP) in cerebral injury patients. METHODS: Nine cerebral injury patients with lung injury who needed mechanical ventilation and met the criteria for ICP monitoring were included in this study. Intraventricular catheters were positioned in 1 of the bilateral ventricles and connected to pressure transducers. Invasive arterial pressure and CVP were monitored continuously. Pressure control ventilation was applied during this clinical trial in a stepwise recruitment maneuver (RM) with 3 cm H2O intermittent increments and decrements of PEEP. RESULTS: A total of 28 RMs were completed in 9 patients. Mean values of MAP, CVP, ICP, and CPP 5 minutes after RMs showed no significant differences compared with baseline (P > 0.05). Correlation analysis of all the mean values of MAP, CVP, ICP, and CPP showed significant correlation between MAP and CPP, PEEP and CVP, PEEP and ICP, and PEEP and CPP with all P values less than 0.05. CONCLUSION: The impact of PEEP on blood pressure, ICP, and CPP varies greatly in cerebral injury patients. Mean arterial pressure and ICP monitoring is of benefit when using PEEP in cerebral injury patients with hypoxemia.

[Impact of age and gender on cardiac structure and function in normal Chinese population].

OBJECTIVE: To identify the impact of age and gender on cardiac structure and left ventricular function in normal Chinese by echocardiography. METHODS: Cardiac structure, valve flow velocity and cardiac function were measured by echocardiography in 15,692 healthy volunteers. Subjects were grouped by age at 5 years interval in population older than 5 years. Children under 5 years were divided into 3 age groups (< 1 years, 1 - 3 years, 4 - 5 years). Hierarchical cluster analyses were performed for ages, based on indexes of cardiac structure and function respectively. RESULTS: Six groups (< 1 years, 1 - 3 years, 4 - 5 years, 6 - 10 years, 11 - 20 years, > or = 21 years) were generated after the age hierarchical cluster analyses based on index of cardiac structure. Four groups (< or = 30 years, 31 - 50 years, 51 - 80 years, > or = 81 years) were generated based on spectral current flow. Six groups (< 1 years, 1 - 3 years, 4 - 5 years, 6 - 10 years, 11 - 15 years, > or = 16 years) were generated based on left ventricular systolic function and five groups (< or = 15 years, 16 - 30 years, 31 - 50 years, 51 - 80 years, > or = 81 years) were generated based on left ventricular diastolic function. Cardiac structure index were similar between male and female in age groups < or = 10 years and significantly lower in females than males in age groups > or = 11 years (P < 0.05). Valve flow velocity was similar between male and female in various age groups (P > 0.05). Left ventricular systolic function was similar between male and female in age groups < or = 10 years but was significantly higher in males than females in age groups > or = 11 years (all P < 0.05). Left ventricular diastolic function was similar between female and male in various age groups (P > 0.05) and equally decreased with aging in both female and male subjects. CONCLUSIONS: The cardiac development in Chinese population can be divided in 6 phases and becomes stable in subjects older than 21 years, left ventricular systolic function becomes stable in subjects older than 16 years and the left ventricular diastolic function declines physiologically with aging.

[The impact of positive end-expiratory pressure on cerebral perfusion pressure and hemodynamics in patients receiving lung recruitment maneuver].

OBJECTIVE: To explore the impact of lung recruitment maneuver (RM) on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and mean arterial pressure (MAP). METHODS: RM was performed and ICP, MAP, central venous pressure (CVP), saturation of arterial oxygen (SpO2) were monitored continuously in 6 severe cerebral injury patients combined with lung injury, who were indicated for mechanical ventilation and meeting the criteria for intracranial pressure monitoring. RM included pressure control ventilation with stepwise increase in positive end-expiratory pressure (PEEP). RESULTS: RM was performed for 22 times in 6 patients, among them two were moribund due to sharp drop of blood pressure and CPP. In the remaining 20 attempts, the mean values of MAP, CVP, ICP, CPP measured at each PEEP level showed no significant difference compared with baseline values (all P>0.05). MAP was significantly correlated with CPP (r=0.706, P=0.000). In the remaining RMs, a correlation between MAP and CPP accounted for 85% (17/20) of total RMs, that between PEEP and CVP accounted for 75% (15/20), that between PEEP and ICP accounted for 75% (15/20), and that between PEEP and CPP existed in 40% (8/20). In a total of 22 cases, there were 6 patterns of response of MAP to alteration in PEEP: MAP maintained relatively stable in 8 case, MAP decreased when PEEP increased and increased when PEEP decreased in 6 case; in 2 cases MAP elevated with increase in PEEP, and drop to baseline with decrease in PEEP, in 2 cases it fell with increase in PEEP but it did not rise with decrease in PEEP, in 2 cases it rose with increase in PEEP but remained at a high level with PEEP decreased to baseline, in 2 cases, MAP dropped abruptly with increase in PEEP resulting in termination of RM. In 11 cases, ICP increased with increase in PEEP and decreased with lowering of PEEP. ICP maintained stable in 6 cases, and ICP maintained at a high level and did not return to baseline after RM in 3 cases. CPP decreased with increase in PEEP and increased when PEEP decreased, and it returned to baseline when PEEP was back to baseline in 12 case. CPP kept constant in 6 case. In 2 cases, CPP remained at a low level, and it returned to baseline 10-20 minutes after PEEP was lowered to baseline. CONCLUSION: There is considerable individual difference in impact of RM on MAP, ICP and CPP in patients with cerebral. ICP monitoring is helpful to assure safety of RM in patients with cerebral injury complicated with lung injury.

[The analysis of 252 episodes of recruitment maneuver during mechanical ventilation in surgery intensive care unit].

OBJECTIVE: To analyze the clinical effects of recruitment maneuver and the impacts on blood pressure and oxygen saturation in patients with mechanical ventilation. METHODS: To analyze all related data from 252 episodes of recruitment maneuver of 46 patients admitted from July 2005 to February 2007. Recruitment maneuver method: the drive pressure constant was kept at 15 cm H(2)O (1 cm H(2)O=0.098 kPa) and the positive end-expiratory pressure (PEEP) level was increased gradually. RESULTS: Of the 252 episodes of recruitment maneuver, this procedure was effective in 91% of the patients, with pneumothorax and pneumo-mediastinum occurred in a patient with legionnaire pneumonia, and no improvement of oxygen saturation in one patient with patent foramen ovale. The value of effective PEEP used ranged from a minimum of 8 cm H(2)O to a maximum of 30 cm H(2)O and the duration of satisfactory oxygen saturation ranged from a minimum of 0.4 hour to a maximum of 368 hours. On average, each patient received 5.48 episodes of recruitment maneuver with one of the patients received 16 episodes of recruitment maneuver. Twenty-three out of the 46 patients (50%) had experienced an episode of hypoxemia. One hundred and one episodes of hypoxemia occurred in 252 recruitment maneuver (40%) and the minimum PEEP inducing hypoxemia is 8 cm H(2)O, and the maximum PEEP was 22 cm H(2)O, with an average value of 12.7 cm H(2)O. Twenty-five of the 46 patients (54%) had experienced transient hypotension with 93 episodes of hypoxemia in 252 episodes of recruitment maneuver (37%), and the minimum PEEP inducing hypotension was 6 cm H(2)O and the maximum PEEP was 23 cm H(2)O, with an average value of 13.9 cm H(2)O. CONCLUSION: Recruitment maneuver could effectively improve oxygenation while the value of PEEP used should be individualized according to clinical condition.