Identification of independent risk factors for intraoperative gastroesophageal reflux in adult patients undergoing general anesthesia

BACKGROUND Gastroesophageal reflux(GER)affects up to 20%of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation.GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being.However,the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear.AIM To explore independent risk factors for the incidence and extent of GER during general anesthesia induction.METHODS A retrospective study was conducted,and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University.This study recruited a total of 601 adult patients undergoing general anesthesia,and the characteristics of patients and the incidence or extent of GER were recorded.The potential risk factors for the incidence of GER were explored using multivariate logistic regression,and the risk factors for the extent of GER were evaluated using multivariate linear regression.RESULTS The current study included 601 adult patients,82 patients with GER and 519 patients without GER.Overall,we noted significant differences between GER and non-GER for pharyngitis,history of GER,other digestive tract diseases,history of asthma,and the use of sufentanil(P<0.05),while no significant differences between groups were observed for sex,age,type of surgery,operative time,body mass index,intraoperative blood loss,smoking status,alcohol intake,hypertension,diabetes mellitus,psychiatric history,history of respiratory infection,history of surgery,the use of lidocaine,palliative strategies,propofol,or rocuronium bromide,state anxiety inventory,trait anxiety inventory,and selfrating depression scale(P>0.05).The results of multivariate logistic regression indicated that female sex[odds ratio(OR):2.702;95%confidence interval(CI):1.144-6.378;P=0.023],increased age(OR:1.031;95%CI:1.008-1.056;P=0.009),pharyngitis(OR:31.388;95%CI:15.709-62.715;P<0.001),and history of GER(OR:11.925;95%CI:4.184-33.989;P<0.001)were associated with an increased risk of GER,whereas the use of propofol could protect against the risk of GER(OR:0.942;95%CI:0.892-0.994;P=0.031).Finally,age(P=0.004),operative time(P<0.001),pharyngitis(P<0.001),history of GER(P=0.024),and hypertension(P=0.017)were significantly associated with GER time.CONCLUSION This study identified the risk factors for GER in patients undergoing general anesthesia including female sex,increased age,pharyngitis,and history of GER.

Using intra-operative GeneSearchTM Breast Lymph Node Assay to detect breast cancer metastases in sentinel lymph nodes： results from a single institute in China

Background Sentinel lymph node （SLN） biopsy has become a common procedure for early breast cancer patients. The GeneSearchTM Breast Lymph Node （BLN） Assay is a real-time RT-PCR assay for the detecting nodal metastases larger than 0.2 mm. China Breast Cancer Clinical Study Group （CBCSG）-001a is a prospective multi-center clinical trial that was conducted to validate the GeneSearchTM BLN Assay in China.