Preoperative Hematocrit Levels and Postoperative Mortality in Patients Undergoing Craniotomy for Brain Tumors

BACKGROUND: Abnormal hematocrit values, including anemia and polycythemia, are common in patients undergoing craniotomy, but the extent to which preoperative anemia or polycythemia independently increases the risk of mortality is unclear. This retrospective cohort study aimed to examine the association between preoperative anemia and polycythemia and postoperative mortality in patients who underwent craniotomy for brain tumor resection. METHODS: We retrospectively analyzed data from 12,170 patients diagnosed with a brain tumor who underwent cranial surgery at West China Hospital between January 2011 and March 2021. The preoperative hematocrit value was defined as the last hematocrit value within 7 days before the operation, and patients were grouped according to the severity of their anemia or polycythemia. We assessed the primary outcome of 30-day postoperative mortality using logistic regression analysis adjusted for potential confounding factors. RESULTS: Multivariable logistic regression analysis reported that the 30-day mortality risk was raised with increasing severity of both anemia and polycythemia. Odds ratios for mild, moderate, and severe anemia were 1.12 (95% CI: 0.79-1.60), 1.66 (95% CI: 1.06-2.58), and 2.24 (95% CI: 0.99-5.06), respectively. Odds ratios for mild, moderate, and severe polycythemia were 1.40 (95% CI: 0.95-2.07), 2.81 (95% CI: 1.32-5.99), and 14.32 (95% CI: 3.84-53.44), respectively. CONCLUSIONS: This study demonstrated that moderate to severe anemia and polycythemia are independently associated with increased postoperative mortality in patients undergoing craniotomy for brain tumor resection. These findings underscore the importance of identifying and managing abnormal hematocrit values before craniotomy surgery

Association of Anemia With Mortality in Young Adult Patients With Intracerebral Hemorrhage

This study aimed to examine the association of hemoglobin concentration with a 90-day mortality of young adult patients with ICH in a large retrospective cohort. A retrospective observational study was conducted between December 2013 and June 2019 in two tertiary academic medical centers in China. We defined patients with hemoglobin concentration \u3c 80 g/L as severe anemia and 80-120/130 g/L as mild to moderate anemia. We also defined patients with hemoglobin concentration \u3e 160 g/L as high hemoglobin. Associations of hemoglobin and outcomes were evaluated in multivariable regression analyses. The primary outcome was mortality at 90 days. We identified 4098 patients with ICH who met the inclusion criteria. After adjusting primary confounding variables, the 90-day mortality rate was significantly higher in young patients with severe anemia (OR, 39.65; 95% CI 15.42-101.97), moderate anemia (OR, 2.49; 95% CI 1.24-5.00), mild anemia (OR, 1.89; 95% CI 1.20-2.98), and high hemoglobin (OR, 2.03; 95% CI 1.26-3.26) group than in young patients of the normal group. The younger age was associated with a higher risk of death from anemia in patients with ICH (P for interaction = 0.01). In young adult patients with ICH, hemoglobin concentration was associated with 90-day mortality, and even mild to moderate anemia correlated with higher mortality. We also found that in ICH patients with anemia, younger age was associated with higher risk

Association Between Intraoperative Steroid and Postoperative Mortality in Patients Undergoing Craniotomy for Brain Tumor

BACKGROUND: Despite the widespread use of intraoperative steroids in various neurological surgeries to reduce cerebral edema and other adverse symptoms, there is sparse evidence in the literature for the optimal and safe usage of intraoperative steroid administration in patients undergoing craniotomy for brain tumors. We aimed to investigate the effects of intraoperative steroid administration on postoperative 30-day mortality in patients undergoing craniotomy for brain tumors. METHODS: Adult patients who underwent craniotomy for brain tumors between January 2011 to January 2020 were included at West China Hospital, Sichuan University in this retrospective cohort study. Stratified analysis based on the type of brain tumor was conducted to explore the potential interaction. RESULTS: This study included 8,663 patients undergoing craniotomy for brain tumors. In patients with benign brain tumors, intraoperative administration of steroids was associated with a higher risk of postoperative 30-day mortality (adjusted OR 1.98, 95% CI 1.09-3.57). However, in patients with malignant brain tumors, no significant association was found between intraoperative steroid administration and postoperative 30-day mortality (adjusted OR 0.86, 95% CI 0.55-1.35). Additionally, administration of intraoperative steroids was not associated with acute kidney injury (adjusted OR 1.11, 95% CI 0.71-1.73), pneumonia (adjusted OR 0.89, 95% CI 0.74-1.07), surgical site infection (adjusted OR 0.78, 95% CI 0.50-1.22) within 30 days, and stress hyperglycemia (adjusted OR 1.05, 95% CI 0.81-1.38) within 24 h after craniotomy for brain tumor. CONCLUSION: In patients undergoing craniotomy for benign brain tumors, intraoperative steroids were associated with 30-day mortality, but this association was not significant in patients with malignant brain tumors

Secular trends of hypertension prevalence based on 2017 ACC/AHA and 2018 Chinese hypertension guidelines: Results from CHNS data (1991‐2015)

Abstract This study aimed to assess the impact of the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and the 2018 Chinese hypertension guidelines on the different secular trends for hypertension prevalence. A total of 82 665 eligible individuals aged ≥20 years were selected from nine cross‐sectional study periods (1991‐2015) from the China Health and Nutrition Survey (CHNS). Over the 24‐year period, the long‐term trend for the prevalence of the 2017 ACC/AHA‐defined age‐adjusted hypertension showed an increase from 32.2% (95% confidence interval (CI): 31.0%‐33.3%) in 1991 to 60.0% (95% CI: 58.6%‐61.3%) in 2015 (Ptrend < 0.001). According to the 2018 Chinese guideline for hypertension, the weighted hypertension prevalence increased from 10.0% (95% CI: 9.4%‐10.5%) in 1991 to 28.7% (95% CI: 27.9%‐29.6%) in 2015 (Ptrend < 0.001). However, slopes of increasing prevalence of hypertension were significantly greater according to the 2017 ACC/AHA guideline than that based on Joint National Committee (JNC 7) report (β = 1.00% vs β = 0.67% per year, respectively, P = 0.041). Based on the 2017 ACC/AHA definition, the prevalence of stage 1 hypertension and elevated blood pressure significantly increase from 22.3% and 6.9% in 1991 to 31.2% and 10.1% in 2015 (all P < 0.05), respectively. The secular trend for the prevalence of hypertension according to the 2017 ACC/AHA guideline showed a greater rate of increase compared with the prevalence based on the 2018 Chinese hypertension guidelines. Public health initiatives should focus on the current status of hypertension in China because of the possible high prevalence of hypertension and concomitant vascular risks

Reaction Behavior of Kaolinite in Sulfur-Bearing Sodium Aluminate Solution under the Simulated Bayer Process

Over a billion tons of high-sulfur bauxite has not been utilized effectively currently in China, because the pyrite existing in the bauxite poses a range of hazards during the Bayer process. A novel idea was proposed to remove sulfur by the silicon-containing minerals in bauxite reacting with sulfur species in sodium aluminate solution to form sulfur-bearing desilication products (SDSP) for discharge with the red mud in the Bayer process. This study investigated the reaction behavior between kaolinite and different sulfur-containing ions under the simulated Bayer process conditions, elucidating the desulfurization rate variation and formation mechanism of SDSPs. The thermodynamic calculations suggest that the reaction between kaolinite and sulfur-bearing sodium aluminate solution to form SDSPs can occur spontaneously. The experimental results demonstrated that various SDSPs can be produced through the reaction of kaolinite and sulfur-containing ions in sodium aluminate solution during the simulated Bayer process, resulting in various desulfurization efficiencies, while the desulfurization process will not result in additional alkali consumption. Increasing the kaolinite dosage, extending the reaction time, and elevating the reaction temperature all contribute positively to enhancing desulfurization efficiency. Kaolinite reacted with S2O32− in sodium aluminate solution to generate Na8Al6Si6O24S2O3·2H2O, achieving a desulfurization rate exceeding 90% under optimized conditions. Under the simulated Bayer digestion process conditions at elevated temperature, the desulfurization rates of kaolinite ranked in ascending order as S2− SO32−  SO42− S2O32−. Kaolinite reacted with SO42− and S2O32− to form cancrinite type SDSPs, and a superior desulfurization rate can be achieved. This work can provide a theoretical foundation and technological support for the efficient utilization of high-sulfur bauxite by the Bayer process

Rerupture outcome of conservative versus open repair versus minimally invasive repair of acute Achilles tendon ruptures: A systematic review and meta-analysis.

ObjectiveTo compare the rerupture rate after conservative treatment, open repair, and minimally invasive surgery management of acute Achilles tendon ruptures.DesignSystematic review and network meta-analysis.Data sourcesWe searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to August 2022.MethodsRandomised controlled trials involving different treatments for Achilles tendon rupture were included. The primary outcome was rerupture. Bayesian network meta-analysis with random effects was used to assess pooled relative risks (RRs) and 95% confidence intervals. We evaluated the heterogeneity and publication bias.ResultsThirteen trials with 1465 patients were included. In direct comparison, there was no difference between open repair and minimally invasive surgery for rerupture rate (RR, 0.72, 95% CI 0.10-4.4; I2 = 0%; Table 2). Compared to the conservative treatment, the RR was 0.27 (95% CI 0.10-0.62, I2 = 0%) for open repair and 0.14 (95% CI 0.01-0.88, I2 = 0%) for minimally invasive surgery. The network meta-analysis had obtained the similar results as the direct comparison.ConclusionBoth open repair and minimally invasive surgery were associated with a significant reduction in rerupture rate compared with conservative management, but no difference in rerupture rate was found comparing open repair and minimally invasive surgery

Elevated lactate dehydrogenase predicts pneumonia in spontaneous intracerebral hemorrhage

Background: Although a variety of risk factors for pneumonia after spontaneous intracerebral hemorrhage have been established, an objective and easily obtainable predictor is still needed. Lactate dehydrogenase is a nonspecific inflammatory biomarker. In this study, we aimed to assess the association between lactate dehydrogenase and pneumonia in spontaneous intracerebral hemorrhage patients. Methods: Our study was a retrospective, multicenter cohort study, undertaken in 7562 patients diagnosed with spontaneous intracerebral hemorrhage from 3 hospitals. All serum Lactate dehydrogenase was collected within 7 days from admission and divided into four groups as quartile(Q). We conducted a multivariable logistic regression analysis to assess the association of Lactate dehydrogenase with pneumonia. Results: Among a total of 7562 patients, 2971 (39.3%) patients were diagnosed with pneumonia. All grades of elevated lactate dehydrogenase were associated with increased raw and risk-adjusted risk of pneumonia. Multiple logistic regression analysis showed odds ratios for Q2-Q4 compared with Q1 were 1.21 (95% CI, 1.04–1.42), 1.64(95% CI, 1.41–1.92), and 1.92 (95% CI, 1.63–2.25) respectively. The odds ratio after adjustment was 4.42 (95% CI, 2.94–6.64) when lactate dehydrogenase was a continuous variable after log-transformed. Conclusions: Elevated lactate dehydrogenase is significantly associated with an increase in the odds of pneumonia and has a predictive value for severe pneumonia in patients with pneumonia. Lactate dehydrogenase may be used to predict pneumonia events in spontaneous intracerebral hemorrhage patients as a laboratory marker

Radiation-Hardened and Flexible Pb(Zr_0.53Ti_0.47)O₃ Piezoelectric Sensor for Structural Health Monitoring

Piezoelectric sensors are excellent damage detectors that can be applied to structural health monitoring (SHM). SHM for complex structures of aerospace vehicles working in harsh conditions is frequently required, posing challenging requirements for a sensor’s flexibility, radiation hardness, and high-temperature tolerance. Here, we fabricate a flexible and lightweight Pb(Zr0.53Ti0.47)O3 piezoelectric film on flexible KMg3(AlSi3O10)F2 substrate via van der Waals (vdW) heteroepitaxy, endowing it with robust ferroelectric and piezoelectric properties under low energy-high flux protons (LE-HFPs) radiation (1015 p/cm2). More importantly, the Pb(Zr0.53Ti0.47)O3 film sensor maintains highly stable damage monitoring sensitivity on an aluminum plate under harsh conditions of LE-HFPs radiation (1015 p/cm2, flat structure), high temperature (175 °C, flat structure), and mechanical fatigue (bending 105 cycles under a radius of 5 mm, curved structure). All these superior qualities are suggested to result from the outstanding film crystal quality due to vdW epitaxy. The flexible and lightweight Pb(Zr0.53Ti0.47)O3 film sensor demonstrated in this work provides an ideal candidate for real-time SHM of aerospace vehicles with flat and complex curve-like structures working in harsh aerospace environments