Zhonghua yi xue za zhi
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Zhonghua yi xue za zhi · Nov 2020
[Effect of posterior lumbar fusion on the degeneration of adjacent segments using cortical bone trajectory screw fixation].
Objective: To compare the degenerative changes of adjacent segments after posterior lumbar fusion surgery using cortical bone trajectory (CBT) screws and pedicle screws (PS) in lumbar spinal degenerative disease. Methods: According to certain inclusion and exclusion criteria, prospective non-randomized study on cases of the single-segment lumbar spinal fusion surgery using cortical bone trajectory screws fixation and pedicle screws fixation in Beijing Chao-Yang Hospital from January 2015 to February 2016 was performed. The intervertebral space height (ISH), foramen height (FH), foramen width (FW), cephalad adjacent segment (CAS) and intervertebral disc degeneration grades at MRI scans were measured before surgery and during follow-up. ⋯ During follow-up, 4 cases (12.1%) of R-ASD and no S-ASD were found in the CBT group, while 12 cases (33.3%) of R-ASD appeared in the PS group, which was significantly higher than that in the CBT group (χ(2)=4.35, P=0.04). According to MRI, the adjacent discs of PS group had significantly more severe degeneration at the last follow-up than the CBT group (Z=-2.14, P=0.03). Conclusions: Compared with the PS fixation fusion, the CBT screw fixation can effectively reduce the occurrence of adjacent segment degeneration.
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Zhonghua yi xue za zhi · Nov 2020
[Stress, anxiety, depression and insomnia in adults outside Hubei province during the COVID-19 pandemic].
Objective: To investigate the severity of stress, anxiety, depression and insomnia during the novel coronavirus disease (COVID-19) pandemic in adults outside Hubei Province, China. Methods: An online survey of psychological and sleep by using Questionnaire Star program from 5th to 19th February 2020 was conducted. The Impact of Event Scale-Revised was used to assess COVID-19 outbreak-related stress symptoms. ⋯ Conclusion: The COVID-19 outbreak resulted in related stress response and widespread increase in anxiety, depression, and insomnia outside Hubei Province, China in the general population. The aggravation of anxiety, depression and insomnia is associated with stress levels. Our data demonstrate that the widespread psychological and insomnia problems in the general population need to be addressed at the early phase of the pandemic.
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Zhonghua yi xue za zhi · Nov 2020
[Acute kidney injury diagnosed by elevated serum creatinine increases mortality in ICU patients following non-cardiac surgery].
Objective: To analyze whether acute kidney injury (AKI) patients diagnosed by elevated serum creatinine had a higher risk of in-hospital mortality following non-cardiac surgery compared with those diagnosed by oliguria alone according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Methods: This was a secondary analysis of a previous retrospective cohort study. A total of 729 consecutive adult patients with high risk of AKI admitted to the intensive care unit (ICU) of Peking University First Hospital after non-cardiac surgery were enrolled in the previous study from July 2017 to June 2018. ⋯ Multivariate logistic regression analysis revealed that AKI-Scr (OR=20.286, 95%CI: 2.544-161.797, P=0.004) and preoperative hypoproteinemia (OR=4.897, 95%CI: 1.240-19.329, P=0.023) were independent risk factors for in-hospital mortality in postoperative AKI patients. Conclusions: AKI patients diagnosed by increased serum creatinine had a higher risk of in-hospital mortality following non-cardiac surgery, accompanied by several worsen short-term outcomes and higher total medical costs, compared with those diagnosed by oliguria alone according to the KDIGO criteria. More attention should be paid to AKI patients diagnosed by elevated serum creatinine, to improve the prognosis.
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Zhonghua yi xue za zhi · Nov 2020
[The value of intraoperative cerebral oxygen saturation in predicting postoperative neurocognitive dysfunction in elderly patients with mild cognitive impairment].
Objective: To evaluate the value of intraoperative cerebral oxygen saturation in predicting postoperative neurocognitive dysfunction (PND) in elderly patients with mild cognitive impairment. Methods: A total of 210 cases of lumbar decompression, bone grafting and fusion surgery under general anesthesia were collected in the Third Central Hospital of Tianjin from June, 2019 to January, 2020, either sex, aged 65-75 year, BMI 19.5-32.5 kg/m(2), ASA physical status Ⅱ or Ⅲ, preoperative comorbidities with mild cognitive impairment. MoCA and MMSE were used to evaluate the cognitive function of patients 1 day before the operation, 7 days and 3 monthes after operation. ⋯ Compared with the non-PND group, MoCA and MMSE scores 7 days after surgery in the PND group were reduced (t=2.630, 3.108, all P<0.05). The critical value of intraoperative SctO(2max)% was 13.74%, the area under the curve of PND was predicted to be 0.907 (95%CI: 0.819-0.995), sensitivity and specificity were 88.9% and 88.5%, respectively. Conclusion: SctO(2max)%>13.74% can be used as an indicator to predict PND occurrence in elderly patients with mild cognitive impairment during lumbar surgery.