Chinese Medical Sciences Journal最新文献

{"title":"Accuracy of Mean Value of Central Venous Pressure from Monitor Digital Display: Influence of Amplitude of Central Venous Pressure during Respiration","authors":"Meng-Ru Xu ,&nbsp;Wang-Lin Liu ,&nbsp;Huai-Wu He ,&nbsp;Xiao-Li Lai ,&nbsp;Mei-Ling Zhao ,&nbsp;Da-Wei Liu ,&nbsp;Yun Long","doi":"10.24920/004158","DOIUrl":"10.24920/004158","url":null,"abstract":"<div><h3>Background</h3><p>A simple measurement of central venous pressure (CVP)-mean by the digital monitor display has become increasingly popular. However, the agreement between CVP-mean and CVP-end (a standard method of CVP measurement by analyzing the waveform at end-expiration) is not well determined. This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude (ΔCVP= CVPmax – CVPmin) during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end.</p></div><div><h3>Methods</h3><p>In total, 291 patients were included in the study. CVP-mean and CVP-end were obtained simultaneously from each patient. CVP measurement difference (| CVP-mean – CVP-end |) was defined as the difference between CVP-mean and CVP-end. The ΔCVP was calculated as the difference between the peak (CVPmax) and the nadir value (CVPmin) during the respiratory cycle, which was automatically recorded on the monitor screen. Subjects with | CVP-mean – CVP-end | ≥ 2 mmHg were divided into the inconsistent group, while subjects with | CVP-mean – CVP-end | &lt; 2 mmHg were divided into the consistent group.</p></div><div><h3>Results</h3><p>ΔCVP was significantly higher in the inconsistent group [7.17(2.77) <em>vs</em>.5.24(2.18), <em>p</em>&lt;0.001] than that in the consistent group. There was a significantly positive relationship between ΔCVP and | CVP-mean – CVP-end | (<em>r</em>=0.283, <em>p</em> &lt;0.0001). Bland-Altman plot showed the bias was -0.61 mmHg with a wide 95% limit of agreement (–3.34, 2.10) of CVP-end and CVP-mean. The area under the receiver operating characteristic curves (AUC) of ΔCVP for predicting | CVP-mean – CVP-end | ≥ 2 mmHg was 0.709. With a high diagnostic specificity, using ΔCVP&lt;3 to detect | CVP-mean – CVP-end | lower than 2mmHg (consistent measurement) resulted in a sensitivity of 22.37% and a specificity of 93.06%. Using ΔCVP&gt;8 to detect | CVP-mean – CVP-end | &gt;8 mmHg (inconsistent measurement) resulted in a sensitivity of 31.94% and a specificity of 91.32%.</p></div><div><h3>Conclusions</h3><p>Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios. ΔCVP during the respiratory period is related to the variation of the two CVP methods. A high ΔCVP indicates a poor agreement between these two methods, whereas a low ΔCVP indicates a good agreement between these two methods.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 2","pages":"Pages 117-124"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860033","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":"Association Between Constipation and a Reduction in Lower Limb Muscle Strength in Preoperative Patients with Thoracic Spinal Tumors","authors":"Yong Liu,&nbsp;Si-Yuan Yao,&nbsp;Xi Zhou,&nbsp;Shu-Zhong Liu,&nbsp;Yan-Yan Bian","doi":"10.24920/004154","DOIUrl":"10.24920/004154","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs.</p></div><div><h3>Methods</h3><p>A single-center, retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021. The study involved a review of electronic medical records and radiographs and the collection of clinical data. The differences in clinical manifestations between patients with constipation and those without constipation were analyzed. Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.</p></div><div><h3>Results</h3><p>A total of 227 patients were enrolled, including 131 patients with constipation and 96 without constipation. The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery (83.2% <em>vs.</em> 17.7%, <em>χ</em>² <em>=</em> 99.035, <em>p</em> &lt; 0.001). Constipation (<em>OR =</em> 9.522, 95%<em>CI</em>: 4.150-21.849, <em>p</em> &lt; 0.001) and urinary retention (<em>OR =</em> 14.490, 95%<em>CI</em>: 4.543–46.213, <em>p</em> &lt; 0.001) were independent risk factors for muscle strength decline in the lower limbs.</p></div><div><h3>Conclusions</h3><p>The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness. Moreover, the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 2","pages":"Pages 109-116"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9851475","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":"Dupilumab for Treatment of Food-Dependent, Exercise-Induced Anaphylaxis: Report of One Case","authors":"Li-Ping Zhu ,&nbsp;Rui Tang ,&nbsp;Qing Wang,&nbsp;Hong Li","doi":"10.24920/004208","DOIUrl":"10.24920/004208","url":null,"abstract":"<div><p>Food-dependent, exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening disorder that often occurs with exercise, and patients typically have eaten a specific food within hours before disease onset. This disease is exceedingly rare, with a prevalence of 0.02%. No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly. Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years. As the anaphylactic symptoms had not been controlled after traditional treatments, the patient was given subcutaneous injection of dupilumab seven times within 33 weeks. During dupilumab treatments, the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis. Thus, dupilumab may improve the allergic reactions in FDEIA patients.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 2","pages":"Pages 159-162"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9858131","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":"Primary Ovarian Small Cell Carcinoma of Pulmonary Type: Analysis of 6 Cases and Review of 31 Cases in the Literatures","authors":"Xu Chen ,&nbsp;Hong-Ling Liu ,&nbsp;Jin-Sui Wang ,&nbsp;Feng-Hui Zhao","doi":"10.24920/004183","DOIUrl":"10.24920/004183","url":null,"abstract":"<div><h3>Objective</h3><p>Primary ovarian small cell carcinoma of pulmonary type (SCCOPT) is a rare ovarian tumor with a poor prognosis. The platinum-based chemotherapy is the standard treatment. However, there is little research on the clinical characteristics of SCCOPT and the potential benefits of other treatments due to its low incidence. The study aims to investigate clinicopathological characteristics and treatment of SCCOPT.</p></div><div><h3>Methods</h3><p>We summarized the clinical, imaging, laboratorical and pathological characteristics of 37 SCCOPT cases, in which 6 cases were admitted to the Gansu Provincial Hospital from the year of 2008 to 2022 and 31 cases reported in 17 English and 3 Chinese literatures.</p></div><div><h3>Results</h3><p>The median age of the studied SCCOPT cases (<em>n</em>=37) was 56.00 (range, 22–80) years. Almost 80% of them had a stage III or IV tumor. All patients underwent an operation and postoperative chemotherapy. Nevertheless, all cases had a poor prognosis, with a median overall survival time of 12 months. Immunohistochemically, the SCCOPT of all patients showed positive expressions of epithelial markers, such as CD56 and sex-determining region of Y chromosome-related high-mobility-group box 2 (SOX-2), and negative expressions of estrogen receptor, progesterone receptor, vimentin, Leu-7, and somatostatin receptor 2. The tumor of above 80% cases expressed synaptophysin. Only a few cases expressed neuron-specific enolase, chromogranin A, and thyroid transcription factor-1.</p></div><div><h3>Conclusions</h3><p>SCCOPT had a poor prognosis. SOX-2 could be a biomarker to be used to diagnose SCCOPT.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 2","pages":"Pages 130-137"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9852028","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":"Central Granular Cell Odontogenic Tumor: A Literature Review of Cases Reported in the Last 71 Years with a New Case Report","authors":"Fatemeh Mashhadiabbas ,&nbsp;Sanaz GholamiToghchi ,&nbsp;Roohollah Safarpour","doi":"10.24920/004159","DOIUrl":"10.24920/004159","url":null,"abstract":"<div><p>Central granular cell odontogenic tumors (CGCOTs) are rare, benign, slowly growing odontogenic neoplasms. Due to their uncertain histogenesis, CGCOTs are still not included as a distinct entity in the WHO classification (2017) of odontogenic tumors. We report a case of CGCOT involving the right side of maxillary anterior region of a 39-year-old white female. Immunohistochemical staining showed that granular cells positively expressed CD68 and vimentin, and negatively expressed S-100 protein. Meanwhile, we searched PubMed, Google Scholar, and Scopus databases to summary the clinico-pathological features of 51 reported cases of CGCOT. The results showed that the granular cells of 28.6% cases were immunopositive for vimentin and CD68, and odontogenic epithelial cells were positive immunoreactivity for cytokeratin. These findings reinforced the mesenchymal origin of granular cells and the odontogenic nature of epithelium islands.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 2","pages":"Pages 138-146"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9914356","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":"Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study","authors":"Bei Wu ,&nbsp;Wan-Qing Song ,&nbsp;Jin-Qian Dong ,&nbsp;Hong-Li Yue ,&nbsp;Yu Lu ,&nbsp;Yun Yu ,&nbsp;Shu-Yu Hao ,&nbsp;Bai-Yun Liu ,&nbsp;Wei-Hua Cui","doi":"10.24920/004188","DOIUrl":"10.24920/004188","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury (TBI) patients in the early postoperative stage.</p></div><div><h3>Methods</h3><p>We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy. Generalized additive mixed model (GAMM) was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale (GCS) on postoperative days 1,3, and 7. Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale (GOS) at discharge.</p></div><div><h3>Results</h3><p>A total of 340 TBI patients were enrolled in this study. There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group, and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group. It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients (<em>β</em> = 0.75, 95%<em>CI</em>: –0.55 to 2.05, <em>p</em> = 0.260). However, elevation in GCS from baseline was 1.73 points (95%<em>CI</em>: –2.81 to –0.66, <em>p</em> = 0.002) less in the sevoflurane group than that in the propofol group on postoperative day 1, 2.03 points (95%<em>CI</em>: –3.14 to –0.91, <em>p &lt;</em> 0.001) less on day 3, and 1.31 points (95%<em>CI</em>: –2.43 to –0.19, <em>p</em> = 0.022) less on day 7. The risk of unfavorable GOS (GOS 1,2, and 3) at discharge was higher in the sevoflurane group (<em>OR</em> = 4.93, 95%<em>CI</em>: 1.05 to 23.03, <em>p</em> = 0.043). No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.</p></div><div><h3>Conclusions</h3><p>Compared to propofol, sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy. This difference was not detected in TBI patients undergoing decompressive craniectomy.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 2","pages":"Pages 97-108"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9844548","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":"Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction","authors":"Ya-Nan Zhao ,&nbsp;Jia-Ning Cui ,&nbsp;Xing-Hua Zhang ,&nbsp;Jin-Feng Li ,&nbsp;Shi-Min Chen ,&nbsp;Xiu-Zheng Yue ,&nbsp;Tao Li","doi":"10.24920/004120","DOIUrl":"10.24920/004120","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the impact of microvascular obstruction (MVO) on the global and regional myocardial function by cardiac magnetic resonance feature-tracking (CMR-FT) in ST-segment-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention.</p></div><div><h3>Methods</h3><p>Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1 - 7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, patients were divided into groups with MVO and without MVO. The infarct zone, adjacent zone, and remote zone were determined based on a myocardial 16-segment model. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) of the global left ventricle (LV) and the infarct, adjacent, and remote zones were measured by CMR-FT from cine images and compared between patients with and without MVO using independent-samples <em>t</em>-test. Logistic regression analysis was used to assess the association of MVO with the impaired LV function.</p></div><div><h3>Results</h3><p>A total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled. MVO was detected in 37.58% (59/157) of STEMI patients, and the mean size of MVO was 3.00 ±3.76 mL. Compared with patients without MVO (<em>n</em> = 98), the MVO group had significantly reduced LV global RS (<em>t</em> = −4.30, <em>P</em> &lt; 0.001), global CS (<em>t</em> = 4.99, <em>P</em> &lt; 0.001), and global LS (<em>t</em> = 3.51, <em>P</em> = 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (<em>t</em> = −3.38, <em>P</em> = 0.001; <em>t</em> = 2.64, <em>P</em> = 0.01; respectively) and the infarct size was significantly larger (<em>t</em> = 8.37, <em>P</em> &lt; 0.001) than that of patients without MVO. The presence of LV MVO [<em>OR</em> = 4.10, 95%<em>CI</em>: 2.05 – 8.19, <em>P</em> &lt; 0.001) and its size [<em>OR</em> = 1.38, 95% <em>CI</em>: 1.10–1.72, <em>P</em>=0.01], along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis, while only heart rate (<em>OR</em>=1.08, 95%<em>CI</em>: 1.03 – 1.13, <em>P</em>=0.001) and LV infarct size (<em>OR</em>=1.10, 95%<em>CI</em>: 1.03 - 1.16, <em>P</em>=0.003) were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.</p></div><div><h3>Conclusion</h3><p>The infarct size was larger in STEMI patients with MVO, and MVO deteriorates the global and regional LV myocardial function.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 1","pages":"Pages 11-19"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9319368","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":"Panscleritis After Blunt Ocular Trauma in A Child with Epididymitis","authors":"Yi-Nan Liu ,&nbsp;Yi-Ning Guo ,&nbsp;Yi-Fan Song ,&nbsp;Yan-Jie Tian ,&nbsp;Xue-Min Li","doi":"10.24920/004150","DOIUrl":"10.24920/004150","url":null,"abstract":"<div><p>We reported an 8-year-old boy with panscleritis in left eye and right epididymitis after falling on the ground. Etiologic diagnosis played a key role in this case. Systemic examinations ruled out systemic autoimmune diseases, tumors, and infections as the cause of scleritis and suggested that the disease was caused by a local delayed-type hypersensitivity (DTH) induced by ocular trauma and was non-infectious. Still, the right epididymitis was infectious. Both conditions were treated successfully using steroids and antibiotics, respectively. Thus, early etiologic diagnosis and reasonable treatment are crucial to prevent visual loss.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 1","pages":"Pages 57-61"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9311108","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":"Analysis of Significant Genes and Pathways in Esophageal Cancer Based on Gene Expression Omnibus Database","authors":"An-Yi Song ,&nbsp;Lan Mu ,&nbsp;Xiao-Yong Dai ,&nbsp;Li-Jun Wang ,&nbsp;Lai-Qiang Huang","doi":"10.24920/004148","DOIUrl":"10.24920/004148","url":null,"abstract":"<div><h3>Objective</h3><p>To screen antigen targets for immunotherapy by analyzing over-expressed genes, and to identify significant pathways and molecular mechanisms in esophageal cancer by using bioinformatic methods such as enrichment analysis, protein-protein interaction (PPI) network, and survival analysis based on the Gene Expression Omnibus (GEO) database.</p></div><div><h3>Methods</h3><p>By screening with highly expressed genes, we mainly analyzed proteins MUC13 and EPCAM with transmembrane domain and antigen epitope from TMHMM and IEDB websites. Significant genes and pathways associated with the pathogenesis of esophageal cancer were identified using enrichment analysis, PPI network, and survival analysis. Several software and platforms including Prism 8, R language, Cytoscape, DAVID, STRING, and GEPIA platform were used in the search and/or figure creation.</p></div><div><h3>Results</h3><p>Genes <em>MUC13</em> and <em>EPCAM</em> were over-expressed with several antigen epitopes in esophageal squamous cell carcinoma (ESCC) tissue. Enrichment analysis revealed that the process of keratinization was focused and a series of genes were related with the development of esophageal cancer. Four genes including <em>ALDH3A1, C2, SLC6A1,</em> and <em>ZBTB7C</em> were screened with significant <em>P</em> value of survival curve.</p></div><div><h3>Conclusions</h3><p>Genes <em>MUC13</em> and <em>EPCAM</em> may be promising antigen targets or biomarkers for esophageal cancer. Keratinization may greatly impact the pathogenesis of esophageal cancer. Genes <em>ALDH3A1, C2, SLC6A1,</em> and <em>ZBTB7C</em> may play important roles in the development of esophageal cancer.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 1","pages":"Pages 20-28"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9321891","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 Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis","authors":"Li-Juan Tian ,&nbsp;Yun-Tai Yao ,&nbsp;Su Yuan ,&nbsp;Zheng Dai","doi":"10.24920/004088","DOIUrl":"10.24920/004088","url":null,"abstract":"<div><h3>Objective</h3><p>Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.</p></div><div><h3>Methods</h3><p>PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September, 2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.</p></div><div><h3>Results</h3><p>A total of 12 RCTs with 833 elderly patients (dexmedetomidine group, 546 patients; control group, 287 patients) were included. There was no significant increase in perioperative heart rate (HR), mean arterial pressure (MAP), and diastolic blood pressure (DBP) in the dexmedetomidine group before and during the operation. In addition, the variations of hemodynamic indexes including HR, MAP, SBP (systolic blood pressure), and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = −0.87, 95% <em>CI</em>: −1.13 to −0.62; MAP: SMD = −1.12, 95% <em>CI</em>: −1.60 to −0.63; SBP: SMD = −1.27, 95% <em>CI</em>: −2.26 to −0.27; DBP: SMD = −0.96, 95% <em>CI</em>: −1.33 to −0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion, the patient's heart rate declined in a time-dependent way.</p></div><div><h3>Conclusion</h3><p>Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However, further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.</p></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 1","pages":"Pages 1-10"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9318327","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}