Association between anesthesia technique and complications after hip surgery in the elderly population

BACKGROUND Spinal anesthesia is superior to general anesthesia for postoperative recovery in older patients(≥65 age).However,evidence for this is lacking.AIM To evaluate the effect of anesthesia on postoperative complications in older patients undergoing hip surgery.METHODS This is a retrospective,propensity score-matched,cohort study.Patients≥65-years-old who underwent hip surgery at the Traditional Chinese Medicine of Guangdong Provincial Hospital in China from October 2016 to June 2020 were included.The operative methods were femoral fracture’s internal fixation and hip replacement.The orthopedic doctors in different hospitals of our group have varied requirements for patients’out-of-bed time after surgery.Therefore,spinal anesthesia or general anesthesia was selected according to the requirements of the orthopedic doctors.The primary outcome of this study was complications during the hospitalization of the postoperative patient.The length of hospital stay,postoperative blood transfusion,routine blood analysis,renal function,coagulation function,and inflammatory correlations were secondary outcomes.Propensity score matching(PSM)was performed utilizing logistic regression.RESULTS Among the 864 patients identified from the electronic medical record data database,we screened out those with incomplete medical record data.After PSM of the baseline values of the two groups of patients,data of 309 patients(206 patients in spinal anesthesia group and 103 patients in general anesthesia)were utilized in this study.67/309 patients had complications,including postoperative limb dysfunction,pulmonary infection,delirium,lower extremity venous thrombosis,and shock.The incidence of complications was not related to anesthesia methods(P>0.05),but the levels of D-Dimer(P=0.017),fibrinogen(P=0.005),and high-sensitivity C-reactive protein(hs CRP)(P=0.002)in the spinal anesthesia group were significantly higher than those in the general anesthesia group.CONCLUSION Anesthesia technology is not a risk factor for postoperative complications of hip surgery.The levels of D-Dimer and hs CRP were higher in the spinal anesthesia group.

Evaluation of the Safety and Immune Efficacy of Recombinant Human Respiratory Syncytial Virus Strain Long Live Attenuated Vaccine Candidates

Human respiratory syncytial virus(RSV)infection is the leading cause of lower respiratory tract illness(LRTI),and no vaccine against LRTI has proven to be safe and effective in infants.Our study assessed attenuated recombinant RSVs as vaccine candidates to prevent RSV infection in mice.The constructed recombinant plasmids harbored(5′to 3′)a T7 promoter,hammerhead ribozyme,RSV Long strain antigenomic cDNA with cold-passaged(cp)mutations or cp combined with temperature-sensitive attenuated mutations from the A2 strain(A2cpts)or further combined with SH gene deletion(A2cptsΔSH),HDV ribozyme(δ),and a T7 terminator.These vectors were subsequently co-transfected with four helper plasmids encoding N,P,L,and M2-1 viral proteins into BHK/T7-9 cells,and the recovered viruses were then passaged in Vero cells.The rescued recombinant RSVs(rRSVs)were named rRSV-Long/A2cp,rRSV-Long/A2cpts,and rRSV-Long/A2cptsΔSH,respectively,and stably passaged in vitro,without reversion to wild type(wt)at sites containing introduced mutations or deletion.Although rRSV-Long/A2cpts and rRSV-Long/A2cptsΔSH displayed temperature-sensitive(ts)phenotype in vitro and in vivo,all rRSVs were significantly attenuated in vivo.Furthermore,BALB/c mice immunized with rRSVs produced Th1-biased immune response,resisted wtRSV infection,and were free from enhanced respiratory disease.We showed that the combination ofΔSH with attenuation(att)mutations of cpts contributed to improving att phenotype,efficacy,and gene stability of rRSV.By successfully introducing att mutations and SH gene deletion into the RSV Long parent and producing three rRSV strains,we have laid an important foundation for the development of RSV live attenuated vaccines.