Postoperative acute kidney injury after on-pump cardiac surgery in patients with connective tissue disease

ObjectivePatients with connective tissue disease have a poor prognosis after receiving cardiac surgery. This study described the clinical scenarios and investigated factors correlated with acute kidney injury (AKI) after on-pump cardiac surgery in patients with systemic lupus erythematosus (SLE) or vasculitis.MethodsPatients with SLE or vasculitis who underwent on-pump cardiac surgery from March 2002 to March 2022 were enrolled, while patients with preoperative renal dysfunction were excluded. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Uni- and multivariable analyses were performed to identify potential factors associated with postoperative AKI.ResultsAmong 123 patients enrolled, 39 (31.7%) developed AKI within seven days after receiving on-pump cardiac surgery. Four patients died in the hospital, resulting in an overall in-hospital mortality of 3.3%, and all deaths occurred in the AKI group. Patients in the AKI group also had longer ICU stays (median difference 3.0 day, 95% CI: 1.0–4.0, P < 0.001) and extubation time (median difference 1.0 days, 95% CI: 0–2.0, P < 0.001) than those in the non-AKI group. Multivariable logistic regression revealed that BMI over 24 kg/m2 (OR: 3.00, 95% CI: 1.24–7.28) and comorbid SLE (OR: 4.73, 95% CI: 1.73–12.93) were independently correlated with postoperative AKI.ConclusionFactors potentially correlated with AKI following on-pump cardiac surgery in patients with connective tissue disease were explored. Clinicians should pay more attention to preoperative evaluation and intraoperative management in patients with risk factors

Prediction models for chronic postsurgical pain in patients with breast cancer based on machine learning approaches

PurposeThis study aimed to develop prediction models for chronic postsurgical pain (CPSP) after breast cancer surgery using machine learning approaches and evaluate their performance.MethodsThe study was a secondary analysis based on a high-quality dataset from a randomized controlled trial (NCT00418457), including patients with primary breast cancer undergoing mastectomy. The primary outcome was CPSP at 12 months after surgery, defined as modified Brief Pain Inventory > 0. The dataset was randomly split into a training dataset (90%) and a testing dataset (10%). Variables were selected using recursive feature elimination combined with clinical experience, and potential predictors were then incorporated into three machine learning models, including random forest, gradient boosting decision tree and extreme gradient boosting models for outcome prediction, as well as logistic regression. The performances of these four models were tested and compared.Results1152 patients were finally included, of which 22.1% developed CPSP at 12 months after breast cancer surgery. The 6 leading predictors were higher numerical rating scale within 2 days after surgery, post-menopausal status, urban medical insurance, history of at least one operation, under fentanyl with sevoflurane general anesthesia, and received axillary lymph node dissection. Compared with the multivariable logistic regression model, machine learning models showed better specificity, positive likelihood ratio and positive predictive value, helping to identify high-risk patients more accurately and create opportunities for early clinical intervention.ConclusionsOur study developed prediction models for CPSP after breast cancer surgery based on machine learning approaches, which may help to identify high-risk patients and improve patients’ management after breast cancer

Benefits of high-dose intravenous immunoglobulin on mortality in patients with severe COVID-19: An updated systematic review and meta-analysis

BackgroundThe clinical benefits of high-dose intravenous immunoglobulin (IVIg) in treating COVID-19 remained controversial.MethodsWe systematically searched databases up to February 17, 2022, for studies examining the efficacy of IVIg compared to routine care. Meta-analyses were conducted using the random-effects model. Subgroup analysis, meta-regression, and trial series analysis w ere performed to explore heterogeneity and statistical significance.ResultsA total of 4,711 hospitalized COVID-19 patients (1,925 IVIg treated and 2786 control) were collected from 17 studies, including five randomized controlled trials (RCTs) and 12 cohort studies. The application of IVIg was not associated with all-cause mortality (RR= 0.89 [0.63, 1.26], P= 0.53; I2 = 75%), the length of hospital stays (MD= 0.29 [-3.40, 6.44] days, P= 0.88; I2 = 96%), the needs for mechanical ventilation (RR= 0.93 ([0.73, 1.19], P= 0.31; I2 = 56%), or the incidence of adverse events (RR= 1.15 [0.99, 1.33], P= 0.06; I2 = 20%). Subgroup analyses showed that overall mortality among patients with severe COVID-19 was reduced in the high-dose IVIg subgroup (RR= 0.33 [0.13, 0.86], P= 0.02, I2 = 68%; very low certainty).ConclusionsResults of this study suggest that severe hospitalized COVID-19 patients treated with high-dose IVIg would have a lower risk of death than patients with routine care.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021231040, identifier CRD42021231040

A protocol of Chinese expert consensuses for the management of health risk in the general public

IntroductionNon-communicable diseases (NCDs) represent the leading cause of mortality and disability worldwide. Robust evidence has demonstrated that modifiable lifestyle factors such as unhealthy diet, smoking, alcohol consumption and physical inactivity are the primary causes of NCDs. Although a series of guidelines for the management of NCDs have been published in China, these guidelines mainly focus on clinical practice targeting clinicians rather than the general population, and the evidence for NCD prevention based on modifiable lifestyle factors has been disorganized. Therefore, comprehensive and evidence-based guidance for the risk management of major NCDs for the general Chinese population is urgently needed. To achieve this overarching aim, we plan to develop a series of expert consensuses covering 15 major NCDs on health risk management for the general Chinese population. The objectives of these consensuses are (1) to identify and recommend suitable risk assessment methods for the Chinese population; and (2) to make recommendations for the prevention of major NCDs by integrating the current best evidence and experts’ opinions.Methods and analysisFor each expert consensus, we will establish a consensus working group comprising 40–50 members. Consensus questions will be formulated by integrating literature reviews, expert opinions, and an online survey. Systematic reviews will be considered as the primary evidence sources. We will conduct new systematic reviews if there are no eligible systematic reviews, the methodological quality is low, or the existing systematic reviews have been published for more than 3 years. We will evaluate the quality of evidence and make recommendations according to the GRADE approach. The consensuses will be reported according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT)

Protocol for the Development of the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China

Autoinflammatory diseases (AIDs) were defined over 20 years ago, and since then, 56 monogenic AIDs have been discovered. Due to the overlapping symptoms, AIDs are prone to misdiagnosis and mistreatment. Different AIDs are characterized by distinct genetic variants, and some AIDs have shown unique genetic characteristics in the Chinese population. Currently, there is no evidence-based guideline for the genetic diagnosis of AIDs in China. To further standardize the early recognition and precision diagnosis of AIDs, it is urgently needed to develop evidence-based clinical practice guidelines on the genetic diagnosis of AIDs to provide scientific guidance for the clinical management of AIDs. The Chinese Pharmacists Association Rare Diseases Medication Working Committee and the Subspecialty Group of Immunology from the Society of Pediatrics of the Chinese Medical Association have jointly launched a protocol for the development of the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, which was registered and written following WHO Handbook for Guideline Development with the help of nationwide multidisciplinary experts organized by the Department of Pediatrics, Peking Union Medical College Hospital. A formal document of the guidelines will be devised and published following the workflow of evidence-based guideline development. This paper introduces the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, including its background, significance, objectives, target population, guideline users, guideline working group members, and the workflow of guideline development

Effect of modified endotracheal intubation protocol combined with early oral intake on postoperative recovery quality in thyroid and parathyroid surgery at a tertiary hospital in China: a 2x2 factorial randomised controlled trial protocol

Introduction Early oral intake (EOI) is supposed to be safe and beneficial to patients’ recovery. However, the optimal timing of resuming oral intake has not been validated in thyroid and parathyroid surgery. On the other hand, a modified electromyography (EMG) endotracheal intubation protocol with real-time EMG monitoring during video laryngoscope/fibrescope-guided intubation was presented in 2022, which was regarded as an effective way to shorten the intubation time. We aimed to use Quality of Recovery-15 (QoR-15) questionnaire to compare the efficacy and safety of different EMG endotracheal intubation protocols combined with different postoperative oral intake strategy in thyroid and parathyroid surgery.Methods and analysis This prospective, single-centre, 2×2 factorial, randomised controlled trial will be conducted in the Peking Union Medical College Hospital (PUMCH), China. We plan to recruit 200 adult patients who will receive thyroid or parathyroid surgery under intraoperative nerve monitoring. Eligible patients will be randomly divided into two groups, which will receive either the modified intubation protocol (M group) or conventional intubation process (C group). After patients enter postanaesthesia care unit and Steward scores ≥4, they will be randomly divided into two groups again, which will receive early resumption of oral intake (E group) or delayed resumption of oral intake (D group). Patients will be followed up during hospitalisation and the QoR-15 questionnaire will be administered to compare the quality of recovery on the day before surgery (T0), the first day after surgery (T1) and the day of discharge (T2). The primary outcome is the QoR-15 scores at T1.Ethics and dissemination The study protocol has been approved by the Research Ethics Committee of Peking Union Medical College Hospital (IRB K-2501). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals.Trial registration number NCT05624463

Construction of prediction model for chronic postsurgical pain after video-assisted thoracoscopic surgery

Objective To construct a prognostic prediction model for chronic postsurgical pain after video-assisted thoracoscopic surgery and develop a risk evaluation tool. Methods As a single-center prospective study, the study enrolled 1 132 patients received video-assisted thoracoscopic surgery between November 2020 and May 2021 at Peking Union Medical College Hospital. Numeric rating scale was used to assess the severity of acute pain when they were discharged and chronic pain at 6 months after surgery. Patients were divided into two groups based on the presence or absence of chronic postsurgical pain. Multivariate Logistic regression was conducted to analyze the risk factors which were used to construct prediction model and draw nomogram for chronic postsurgical pain after video-assisted thoracoscopic surgery. Results 460 patients (40.6%) were reported chronic pain at 6 months after surgery. More women and more patients with coronary heart disease belonged to the group of chronic postsurgical pain. Patients reported higher scores of numeric rating scale when they were discharged and inclined to keep taking painkiller after discharge. However, there were fewer patients with incisions fewer than 3 or using nitrous oxide during surgery in the group of chronic postsurgical pain (P＜0.05). The outcome of multivariate Logistic regression showed that the history of coronary heart disease, not using nitrous oxide in surgery, incisions more than or equal to 3, and the score of numeric rating scale on discharge were independent risk factors for chronic postsurgical pain (P＜0.05). The area under the receiver operator characteristic curve of the prediction model was 0.734. Conclusions The prediction model is conducive to clinical management for chronic postsurgical pain after video-assisted thoracoscopic surgery

Pain Clinic in Tibet, China: A Single-Center Retrospective Study

Pain disease is a worldwide problem.The prevalence of chronic pain in developed and developing countries has been reported in some published research. However, little knowledge of situation of pain clinic in Tibet is known. Tibet Autonomous Region People’s Hospital established the first pain clinic in Tibet. This study collected and analyzed the data of medical records of pain clinic in Tibet Autonomous Region People’s Hospital from September 2017 to August 2018. The results showed that the total amounts of patients visiting pain clinic were very small, the most common pain diseases were postherpetic neuralgia and sciatica, and more female patients visited the pain clinic than male patients. All these results indicate that the hospital and government need to pay more attention to the development and promotion of pain medicine in Tibet to make Tibetans being accessed to high-quality pain clinic service

The effects of intermittent bolus paravertebral block on analgesia and recovery in open hepatectomy: a randomized, double-blinded, controlled study

Abstract Background We aimed to investigate the effects of intermittent bolus paravertebral block on analgesia and recovery in open hepatectomy. Methods Eighty 18–70 years old, American Society of Anesthesiologists level I-III patients scheduled for hepatectomy with a J-shaped subcostal incision were enrolled and randomized to receive either intermittent bolus paravertebral ropivacaine (0.5% loading, 0.2% infusion) or 0.9% saline infusion at 1:1 ratio (25 ml loading before surgery, 0.125 ml/kg/h bolus for postoperative 48 h). The primary outcome was set as postoperative 48 h cumulative intravenous morphine consumption recorded by a patient-controlled analgesic pump. Results Thirty-eight patients in each group completed the study. The cumulative morphine consumptions were lower in the paravertebral block than control group at postoperative 24 (difference -10.5 mg, 95%CI -16 mg to -6 mg, P < 0.001) and 48 (difference -12 mg, 95%CI -19.5 mg to -5 mg, P = 0.001) hours. The pain numerical rating scales at rest were lower in the paravertebral block than control group at postoperative 4 h (difference -2, 95%CI -3 to -1, P < 0.001). The active pain numerical rating scales were lower in the paravertebral block than control group at postoperative 12 h (difference -1, 95%CI -2 to 0, P = 0.005). Three months postoperatively, the paravertebral block group had lower rates of hypoesthesia (OR 0.28, 95%CI 0.11 to 0.75, P = 0.009) and numbness (OR 0.26, 95%CI 0.07 to 0.88, P = 0.024) than the control group. Conclusions Intermittent bolus paravertebral block provided an opioid-sparing effect and enhanced recovery both in hospital and after discharge in patients undergoing hepatectomy. Trial registration clinicaltrials.gov (NCT04304274), date: 11/03/2020