Chinese Medical Sciences Journal最新文献

{"title":"Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU: A User-Centered Design for Rapid Prototyping","authors":"","doi":"10.24920/004326","DOIUrl":"10.24920/004326","url":null,"abstract":"<div><h3>Objective</h3><p>Renal replacement therapy (RRT) is increasingly adopted for critically ill patients diagnosed with acute kidney injury, but the optimal time for initiation remains unclear and prognosis is uncertain, leading to medical complexity, ethical conflicts, and decision dilemmas in intensive care unit (ICU) settings. This study aimed to develop a decision aid (DA) for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.</p></div><div><h3>Methods</h3><p>Development of DA employed a systematic process with user-centered design (UCD) principle, which included: (i) competitive analysis: searched, screened, and assessed the existing DAs to gather insights for design strategies, developmental techniques, and functionalities; (ii) user needs assessment: interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs; (iii) evidence syntheses: integrate latest clinical evidence and pertinent information to inform the content development of DA.</p></div><div><h3>Results</h3><p>The competitive analysis included 16 relevant DAs, from which we derived valuable insights using existing resources. User decision needs were explored among a cohort of 15 family surrogates, revealing four thematic issues in decision-making, including stuck into dilemmas, sense of uncertainty, limited capacity, and delayed decision confirmation. A total of 27 articles were included for evidence syntheses. Relevant decision-making knowledge on disease and treatment, as delineated in the literature sourced from decision support system or clinical guidelines, were formatted as the foundational knowledge base. Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT, possible outcomes, and reasons to choose. The DA was drafted into a web-based phototype using the elements of UCD. This platform could guide users in their preparation of decision-making through a sequential four-step process: identifying treatment options, weighing the benefits and risks, clarifying personal preferences and values, and formulating a schedule for formal shared decision-making with clinicians.</p></div><div><h3>Conclusions</h3><p>We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting. Future studies are needed to evaluate its usability, feasibility, and clinical effects of this intervention.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 2","pages":"Pages 91-101"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Chinese Multi-Specialty Delphi Consensus to Optimize RAASi Usage and Hyperkalaemia Management in Patients with Chronic Kidney Disease and Heart Failure","authors":"","doi":"10.24920/004327","DOIUrl":"10.24920/004327","url":null,"abstract":"<div><h3>Objective</h3><p>Variations are present in common clinical practices regarding best practice in managing hyperkalaemia (HK), there is therefore a need to establish a multi-specialty approach to optimal rennin-angiotension-aldosterone system inhibitors (RAASi) usage and HK management in patients with chronic kidney disease (CKD) &amp; heart failure (HF). This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.</p></div><div><h3>Methods</h3><p>A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique. The group then created a list of 41 statements for a consensus questionnaire, which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China. Consensus was assessed using a modified Delphi technique, with agreement defined as “strong” (≥75% and &lt;90%) and “very strong” (≥90%). The steering group, data collection, and analysis were aided by an independent facilitator.</p></div><div><h3>Results</h3><p>A total of 150 responses from 21 provinces across China were recruited in the survey. Respondents were comprised of an even split (<em>n</em>=75, 50%) between cardiologists and nephrologists. All 41 statements achieved the 75% consensus agreement threshold, of which 27 statements attained very strong consensus (≥90% agreement) and 14 attained strong consensus (agreement between 75% and 90%).</p></div><div><h3>Conclusion</h3><p>Based on the agreement levels from respondents, the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 2","pages":"Pages 79-90"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Suggestions of Ethical Review on Clinical Research Involving Brain-Computer Interfaces","authors":"","doi":"10.24920/004377","DOIUrl":"10.24920/004377","url":null,"abstract":"<div><p>Brain-computer interface (BCI) technology is rapidly advancing in medical research and application. As an emerging biomedical engineering technology, it has garnered significant attention in the clinical research of brain disease diagnosis and treatment, neurological rehabilitation, and mental health. However, BCI also raises several challenges and ethical concerns in clinical research. In this article, the authors investigate and discuss three aspects of BCI in medicine and healthcare: the state of international ethical governance, multidimensional ethical challenges pertaining to BCI in clinical research, and suggestive concerns for ethical review. Despite the great potential of frontier BCI research and development in the field of medical care, the ethical challenges induced by itself and the complexities of clinical research and brain function have put forward new special fields for ethics in BCI. To ensure “responsible innovation” in BCI research in healthcare and medicine, the creation of an ethical global governance framework and system, along with special guidelines for cutting-edge BCI research in medicine, is suggested.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 2","pages":"Pages 131-139"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Dataset on Population Activity Patterns in Typical Regions of North China","authors":"Yi-Sen Yang ,&nbsp;Sheng-Yu Liu ,&nbsp;Ya-Yuan Mei ,&nbsp;Quan Zhou ,&nbsp;Mei-Duo Zhao ,&nbsp;Qun Xu ,&nbsp;Si-Zhu Wu","doi":"10.24920/004324","DOIUrl":"10.24920/004324","url":null,"abstract":"<div><p>This data article describes the “Typical Regional Activity Patterns” (TRAP) dataset, which is based on the Tackling Key Problems in Air Pollution Control Program. In order to explore the interaction between air pollution and physical activity, we collected activity patterns of 9,221 residents with different occupations and lifestyles for three consecutive days in typical regions (Jinan and Baoding) where air pollutant concentrations were higher than those in neighboring areas. The TRAP dataset consists of two aspects of information: demographic indicators (personal information, occupation, personal habits, and living situation) and physical activity pattern data (activity location and intensity); additionally, the exposure measures of physical activity patterns are included, which data users can match to various endpoints for their specific purpose. This dataset provides evidence for exploring the attributes of activity patterns of residents in northern China and for interdisciplinary researchers to develop strategies and measures for health education and health promotion.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 1","pages":"Pages 69-73"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Positions Alter Hemodynamics and Respiration in Healthy Adults: A Systematic Review and Meta-Analysis","authors":"Ruchada Sriamad,&nbsp;Sirinut Chaiduang,&nbsp;Thaniya Klinsophon,&nbsp;Premtip Thaveeratitham","doi":"10.24920/004281","DOIUrl":"10.24920/004281","url":null,"abstract":"<div><h3>Objective</h3><p>Different body positions can exert both positive and negative physiological effects on hemodynamics and respiration. This study aims to conduct a literature review and examine hemodynamic and respiratory alterations to different body positions.</p></div><div><h3>Methods</h3><p>The study protocol was registered with the International Prospective Registry of Systematic Reviews (register no. CRD42021291464). Two independent reviewers evaluated the methodological quality of all included studies using the Down and Black checklist, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The overall effects of different body positions were reported from random effects meta-analysis.</p></div><div><h3>Results</h3><p>Three studies with low risk of bias and ten with high risk of bias met the eligibility criteria. The supine resulted in the highest cardiac output compared to the 70 deg head-up tilt, sitting, and standing positions (very low- to moderate-quality evidences) and the lowest systemic vascular resistance compared to the 70 deg head-up tilt and standing positions (moderate-quality evidence). Additionally, the supine was associated with the highest total respiratory resistance compared to the 70 deg head-up tilt, left lateral, and standing positions (very low-to moderate-quality evidence) and higher alveolar ventilation than the prone (low-quality evidence).</p></div><div><h3>Conclusions</h3><p>The supine position has the most positive association with hemodynamic variables, resulting in the highest cardiac output and the lowest systemic vascular resistance. The upright positions (70 deg head-up tilt and standing positions) has the most positive association with the respiratory variables, resulting in the lowest total respiratory resistance.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 1","pages":"Pages 29-45"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective Effect of Dihydromyricetin Against ExerciseInduced Muscle Damage and Its Mechanism","authors":"Ying Wu ,&nbsp;Da-Wei Wang ,&nbsp;Jun Li ,&nbsp;Xian-Jie Xu ,&nbsp;Zhi-Dan Gao ,&nbsp;Hong-Yan Li ,&nbsp;Yong Zhang ,&nbsp;Peng Liu","doi":"10.24920/004272","DOIUrl":"10.24920/004272","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the protective effect of dihydromyricetin (DHM) against exercise-induced muscle damage (EIMD) in mice and its potential mechanism.</p></div><div><h3>Methods</h3><p>Adult male C57BL/6J mice were randomly divided into control group (CG), exercise group (EG), and exercise + 100 mg/kg weight •d DHM (DHM) group. The intervention lasted for four weeks, during which the animals in the EG and DHM groups were subjected to exercise training for 1 h per day. The day after the training, a 90-min treadmill exercise (slope: 0 and speed: 18 m/min) was conducted in both EG and DHM groups. Samples of blood and gastrocnemius muscles were harvested from the three groups 24 h after the exercise, followed by the measurement of serum creatine kinase (CK) and lactate dehydrogenase (LDH) activities, total superoxide dismutase (T-SOD) activity, malondialdehyde (MDA), and skeletal muscle mitochondrial enzyme complex I and II activities. Histological changes in the skeletal muscle were observed by transmission electron microscopy, and the protein expressions of mitochondrial function-related pathways were detected by Western blotting.</p></div><div><h3>Results</h3><p>Skeletal muscle morphological changes and mitochondrial damage were alleviated in the DHM group compared to those in the EG. The activities of EIMD markers CK and LDH and the level of lipid peroxidation were notably repressed and the serum T-SOD activity was enhanced after DHM intervention. Western blotting demonstrated that the expressions of sirtuin type 3 (SIRT3), estrogen-related receptor alpha, and peroxisome proliferator-activated receptor-gamma coactivator-1 alpha in the skeletal muscle of mice increased after the DHM intervention.</p></div><div><h3>Conclusion</h3><p>DHM can relieve EIMD in mice, possibly by promoting the recovery of the mitochondrial structure and function in the skeletal muscle of mice after high-intensity exercise <em>via</em> the activation of the SIRT3 signaling pathway.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 1","pages":"Pages 46-53"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data-lndependent Acquisition-Based Quantitative Proteomic Analysis Reveals Potential Salivary Biomarkers of Primary Sjogren's Syndrome","authors":"Yi-Chao Tian ,&nbsp;Chun-Lan Guo ,&nbsp;Zhen Li ,&nbsp;Xin You ,&nbsp;Xiao-Yan Liu ,&nbsp;Jin-Mei Su ,&nbsp;Si-Jia Zhao ,&nbsp;Yue Mu ,&nbsp;Wei Sun ,&nbsp;Qian Li","doi":"10.24920/004338","DOIUrl":"https://doi.org/10.24920/004338","url":null,"abstract":"<div><h3>Objective</h3><p>As primary Sjogren's syndrome (pSS) primarily affects the salivary glands, saliva can serve as an indicator of the glands’ pathophysiology and the disease's status. This study aims to illustrate the salivary proteomic profiles of pSS patients and identify potential candidate biomarkers for diagnosis.</p></div><div><h3>Methods</h3><p>The discovery set contained 49 samples (24 from pSS and 25 from age- and gender-matched healthy controls [HCs]) and the validation set included 25 samples (12 from pSS and 13 from HCs). Totally 36 pSS patients and 38 HCs were centrally randomized into the discovery set or to the validation set at a 2:1 ratio. Unstimulated whole saliva samples from pSS patients and HCs were analyzed using a data-independent acquisition (DIA) strategy on a 2D LC–HRMS/MS platform to reveal differential proteins. The crucial proteins were verified using DIA analysis and annotated using gene ontology (GO) and International Pharmaceutical Abstracts (IPA) analysis. A prediction model for SS was established using random forests.</p></div><div><h3>Results</h3><p>A total of 1,963 proteins were discovered, and 136 proteins exhibited differential representation in pSS patients. The bioinformatic research indicated that these proteins were primarily linked to immunological functions, metabolism, and inflammation. A panel of 19 protein biomarkers was identified by ranking order based on <em>P</em>-value and random forest algorichm, and was validated as the predictive biomarkers exhibiting good performance with area under the curve (AUC) of 0.817 for discovery set and 0.882 for validation set.</p></div><div><h3>Conclusions</h3><p>The candidate protein panel discovered may aid in pSS diagnosis. Salivary proteomic analysis is a promising non-invasive method for prognostic evaluation and early and precise treatments for pSS patients. DIA offers the best time efficiency and data dependability and may be a suitable option for future research on the salivary proteome.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 1","pages":"Pages 19-28"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140631244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of GPRC5A-Regulated ABCB1 Expression on Lung Adenocarcinoma Proliferation","authors":"Yun Li ,&nbsp;Wen-Wen Cui ,&nbsp;Zhong-Fa Yang ,&nbsp;Wen-Hao Liu ,&nbsp;Mao-Wang Bian ,&nbsp;Jiong Deng ,&nbsp;Tong Wang","doi":"10.24920/004216","DOIUrl":"10.24920/004216","url":null,"abstract":"<div><h3>Objective</h3><p>Aberrant expression of ATP binding cassette subfamily B member 1 (<em>ABCB1</em>) plays a key role in several cancers. However, influence of G protein coupled receptor family C group 5 type A (GPRCSA)-regulated <em>ABCB1</em> expression on lung adenocarcinoma proliferation remains unclear. Therefore, this study investigated the effect of <em>GPRC5A</em> regulated <em>ABCB1</em> expression on the proliferation of lung adenocarcinoma.</p></div><div><h3>Methods</h3><p><em>ABCBI</em> expressions in lung adenocarcinoma cell lines, human lung adenocarcinoma tissues, and tracheal epithelial cells and lung tissues of <em>GPRC5A</em> knockout mice and wild-type mice were analyzed with RT-PCR, Western blot, or immunohistochemical analysis. Cell counting kit-8 assay was performed to analyze the sensitivity of tracheal epithelial cells from <em>GPRC5A</em> knockout mice to chemotherapeutic agents. Subcutaneous tumor formation assay was performed to confirm whether down-regulation of <em>ABCBI</em> could inhibit the proliferation of lung adenocarcinoma <em>in vivo.</em> To verify the potential regulatory relationship between GPRCS A and ABCB1, immunofluorescence and immunoprecipitation assays were performed.</p></div><div><h3>Results</h3><p>ABCB1 expression was up-regulated in lung adenocarcinoma cell lines and human lung adenocarcinoma tissues. ABCBI expression in the tracheal epithelial cells and lung tissues of <em>GPRC5A</em> deficient mice was higher than that in the wild type mice. Tracheal epithelial cells of <em>GPRC5A</em> knockout mice were much more sensitive to tariquidar and doxorubicin than those of <em>GPRC5A</em> wild type mice. Accordingly, 28 days after injection of the transplanted cells, the volume and weight of lung tumor in <em>ABCBI</em> knockout cell-transplanted GPRCS A^-/C57BL/6 mice were significantly smaller than those in wild type cell-transplanted mice (P = 0.0043, P = 0.0060). Furthermore, immunofluorescence and immunoprecipitation assays showed that GPRC5A regulated ABCBI expression by direct binding.</p></div><div><h3>Conclusion</h3><p>GPRC5A reduces lung adenocarcinoma proliferation <em>via</em> inhibiting <em>ABCBI</em> expression. The pathway by which GPRC5A regulates <em>ABCBI</em> expression needs to be investigated.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 1","pages":"Pages 9-18"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atopic Dermatitis Associated Retinal Detachment and Retinal Vasculitis: A Case Report","authors":"Shi-Yu Cheng ,&nbsp;Zao-Wen Wang ,&nbsp;Rong-Ping Dai","doi":"10.24920/004321","DOIUrl":"10.24920/004321","url":null,"abstract":"<div><p>Atopic dermatitis is usually associated with various ocular complications. We report a 21-year-old Chinese male who presented to our ophthalmology clinic with bilateral retinal detachment and cataracts. The patient had a clear medical history of atopic dermatitis, which had been diagnosed eight years earlier and had been treated with loratadine and pimecrolimus. Cataract surgery was performed for both eyes, combined with scleral buckling for the right eye and pars plana vitrectomy for the left eye. During postoperative follow-up, fundus fluorescein angiography showed retinal vasculitis in both eyes and macular edema in the left eye, which coincided with an exacerbation of atopic dermatitis. Macular edema improved after four months of regular dupilumab treatment in the dermatology department. The ocular condition remained stable three years postoperatively.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 1","pages":"Pages 74-78"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Dexmedetomidine on Intraoperative Hemodynamics and Blood Loss in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis","authors":"Mei Wang ,&nbsp;Jian-Xiang Che ,&nbsp;Lei Chen ,&nbsp;Ting-Ting Song ,&nbsp;Jin-Tao Qu","doi":"10.24920/004294","DOIUrl":"10.24920/004294","url":null,"abstract":"<div><h3>Objective</h3><p>Dexmedetomidine (Dex) is a highly selective α2 adrenoceptor agonist that reduces blood pressure and heart rate. However, its ability to provide stable hemodynamics and a clinically significant reduction in blood loss in spine surgery is still a matter of debate. This study aimed to investigate the effects of Dex on intraoperative hemodynamics and blood loss in patients undergoing spine surgery.</p></div><div><h3>Methods</h3><p>The Web of Science, MEDLINE, EMBASE, and the Cochrane Library were searched up to February 2023 for randomized controlled trials (RCTs) including patients undergoing spine surgeries under general anaesthesia and comparing Dex and saline. A fixed- or random-effect model was used depending on heterogeneity. Results Twenty-one RCTs, including 1388 patients, were identified. Dex added the overall risk of intraoperative hypotension (odds ratio [OR]: 2.11; 95% confidence interval [<em>CI</em>]: 1.24 – 3.58; <em>P</em>=0.006) and bradycardia (OR: 2.48; 95%<em>CI</em>: 1.57 – 3.93; <em>P</em>=0.0001). The use of a loading dose of Dex led to significantly increased risks of intraoperative hypotension (OR: 2.00; 95%<em>CI</em>: 1.06 – 3.79; <em>P</em>=0.03) and bradycardia (OR: 2.28; 95%<em>CI</em>: 1.42 3.66; <em>P</em>=0.0007). For patients receiving total intravenous anesthesia, there was an increased risk of hypotension (OR: 2.90; 95%<em>CI</em>: 1.24 – 6.82; P=0.01) and bradycardia (OR: 2.66; 95%<em>CI</em>: 1.53 - 4.61; <em>P</em>=0. 0005). For patients in the inhalation anesthesia group, only an increased risk of bradycardia (OR: 4.95; 95%<em>CI</em>: 1.41 – 17.37; P=0.01) was observed. No significant increase in the risk of hypotension and bradycardia was found in the combined intravenous-inhalation anesthesia group. The incidence of severe hypotension (OR: 2.57; 95%<em>CI</em>: 1.05 – 6.32; <em>P</em>=0.04), but not mild hypotension, was increased. Both mild (OR: 2.55; 95%<em>CI</em>: 1.06 – 6.15; <em>P</em>=0.04) and severe (OR: 2.45; 95%<em>CI</em>: 1.43 – 4.20; <em>P</em>=0.001) bradycardia were associated with a higher risk. The overall analyses did not reveal significant reduction in intraoperative blood loss. However, a significant decrease in blood loss was observed in total inhalation anesthesia subgroup (mean difference [MD]: –82.97; 95%<em>CI</em>: -109.04––56.90; <em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Dex increases the risks of intraoperative hypotension and bradycardia in major spine surgery. The administration of a loading dose of Dex and the utilization of various anesthesia maintenance methods may potentially impact hemodynamic stability and intraoperative blood loss.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"39 1","pages":"Pages 54-68"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}