Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes

BACKGROUND Enhanced recovery after surgery advocates that consuming carbohydrates two hours before anesthesia is beneficial to the patient’s recovery.Patients with diabetes are prone to delayed gastric emptying.Different guidelines for preoperative carbohydrate consumption in patients with diabetes remain controversial due to concerns about the risk of regurgitation,aspiration and hyperglycemia.Ultrasonic gastric volume(GV)assessment and blood glucose monitoring can comprehensively evaluate the safety and feasibility of preoperative carbohydrate intake in type 2 diabetes(T2 D)patients.AIM To evaluate the impact of preoperative carbohydrate loading on GV before anesthesia induction in T2 D patients.METHODS Patients with T2 D receiving surgery under general anesthesia from December 2019 to December 2020 were included.A total of 78 patients were randomly allocated to 4 groups receiving 0,100,200,or 300 m L of carbohydrate loading 2 h before anesthesia induction.Gastric volume per unit weight(GV/W),Perlas grade,changes in blood glucose level,and risk of reflux and aspiration were evaluated before anesthesia induction.RESULTS No significant difference was found in GV/W among the groups before anesthesia induction(P>0.05).The number of patients with Perlas grade II and GV/W>1.5 m L/kg did not differ among the groups(P>0.05).Blood glucose level increased by>2 mmol/L in patients receiving 300 m L carbohydrate drink,which was significantly higher than that in groups 1 and 2(P<0.05).CONCLUSION Preoperative carbohydrate loading<300 m L 2 h before induction of anesthesia in patients with T2 D did not affect GV or increase the risk of reflux and aspiration.Blood glucose levels did not change significantly with preoperative carbohydrate loading of<200 m L.However,300 m L carbohydrate loading may increase blood glucose levels in patients with T2 D before induction of anesthesia.

The comparative efficacy of ezetimibe added to atorvastatin 10 mg versus uptitration to atorvastatin 40 mg in subgroups of patients aged 65 to 74 years or greater than or equal to 75 years

Background Coronary heart disease （CHD） risk increases with age; yet lipid-lowering therapies are significantly under-utilized in patients 〉 65 years. The objective was to evaluate the safety and efficacy of lipid-lowering therapies in older patients treated with atorvastatin 10 nag ＋ ezetimibe 10 mg （EZ/Atorva） vs. increasing the atorvastatin dose to 40 mg, Methods Patients 〉 65 years with atherosclerotic vascular disease （LDL-C ≥1.81 mmol/L） or at high risk for coronary heart disease （LDL-C 〉 2.59 mmol/L） were randomized to EZ/Atorva for 12 wk vs. uptitration to atorvastatin 20 nag for 6 wk followed by atorvastatin 40 nag for 6 wk. The percent change in LDL-C and other lipid parameters and percent patients achieving prespecified LDL-C levels were assessed after 12 wk. Results EZ/Atorva produced greater reductions in most lipid parameters vs. uptitration of atorvastatin in patients 〉 75 years （n = 228）, generally consistent with patients 65-74 years （n = 812）. More patients achieved LDL-C targets with combination therapy vs. monotherapy in both age groups at 6 wk and in patients 〉 75 years at 12 wk. At 12 wk, more patients 〉 75 years achieved LDL-C targets with monotherapy vs. combination therapy. EZ/Atorva produced more favorable improvements in most lipids vs. doubling or quadrupling the atorvastatin dose in patients 〉 75 years, generally consistent with the findings in patients 65-74 years. Conclusions Our results extended previous findings demonstrating that ezetimibe added to a statin provided a generally well-tolerated therapeutic option for improving the lipid profile in patients 65 to 74 years and 〉 75 years of age.

A review of thickness-induced evolutions of microstructure and superconducting performance of REBa2Cu3O7-δ coated conductor

The research and development of high temperature superconducting （HTS） films, especially ReBa2Cu3- O7-δ （REBCO or RE123; RE=Y, Gd, or other rare earths） yttrium-based coated conductors, has generated widespread interest for the potential applications of the second generation superconducting films. In view of commercialization, however, the maximum superconducting currents for coated conductors should be increased further. Unfortunately, it has been frequently observed that the average critical current density Jc decreases with an increase in film thickness. The thickness effect is still a hurdle for largescale production, especially in pulsed laser deposition and metal organic deposition processes. An engineering current of more than 1 000 A/cm is desired owing to the high cost of 2G superconducting materials. The present work attempts to review the evolution of various issues subject to the thickness effect, including the microstructure, epitaxial texture, surface roughness, pinning force, oxygen deficiency, residual stress, copper-rich layers, and segregation of elements. Furthermore, recent progress in enhancing the performance of superconductors especially in terms of critical current density is illustrated, such as the use of heavy doping. Further understanding of the thickness effect is extremely important for large-scale commercial development of the second generation high temperature superconductors.