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Background: Post-operative cognitive dysfunction (POCD) is a decline of cognitive status that commonly occurs after surgery in elderly patients. Whether DNA methylation is associated with the development of POCD remains unclear., Methods: Subjects (N = 124) older than 65 years-of-age undergoing hip replacement surgery were enrolled. A battery of neuropsychiatric tests was used to examine the perioperative cognitive function of the patients. Early POCD was analyzed using the reliable change index (RCI), and subjects were diagnosed with POCD if RCI < -1.96. Peripheral leukocyte DNA was isolated, and DNA methylation was measured via 5-methylcytosine (mC) using Elisa., Results: Twenty-four patients (19.4%) developed early POCD. There was no difference in baseline 5-mC levels by POCD status. The 5-mC levels significantly decreased on day 7 after surgery in patients who developed early POCD (P = .004), but did not change in non-POCD patients. Moreover, post-operative 5-mC levels were significantly lower in POCD patients than those in non-POCD patients (P = .003). Bivariate logistic models adjusted for age, gender, BMI, duration of anesthesia, and education level clearly demonstrated an independent association between post-operative 5-mC level and early POCD., Conclusions: Post-operative global hypomethylation of leukocyte DNA was associated with the development of early POCD., Trial Registration: ClinicalTrial, NCT02965235. Registered 16 November 2016, https://www.clinicaltrials.gov/ct2/results?term=NCT02965235&rank=1#rowId0., (© 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background: Remifentanil, an ultra-short-acting opioid, is widely used for pain control during surgery. However, regular dose (RD) remifentanil exacerbates postoperative pain in a dose-dependent manner. Recent studies suggest that high-dose (HD) remifentanil offers sustained analgesia in experimental studies. We thus hypothesized that intraoperative administration of high-dose remifentanil may attenuate postoperative pain., Methods: In this prospective, randomized, double blind, controlled clinical study, sixty patients undergoing thyroidectomy (18-60 years-of-age) received an intraoperative infusion of 0.2 (RD group) or 1.2 μg kg(-1) min(-1) (HD group) remifentanil during thyroidectomy. A visual analogue scale (VAS) was used to measure pain intensity. Mechanical pain threshold on the forearm was assessed using von Frey filaments before surgery (baseline), 2 h postoperatively and 18-24 h postoperatively. The primary outcome was to compare the difference of VAS score at different time points after operation and morphine consumption 24 h postoperatively between RD and HD groups. The second outcome was to compare the difference of mechanical pain thresholds in the forearm postoperatively between RD and the HD groups., Results: VAS scores were lower 30 min postoperatively in the HD group (1.29 ± 1.67, 95% CI 0.64-1.94) compared with the RD group (2.21 ± 1.67, 95% CI 1.57-2.84) (t = 3.427, p = 0.0043, RD group vs. HD group). Postoperative morphine consumption was much lower in the HD group compared with the RD group (1.27 ± 1.88 mg vs. 0.35 ± 1.25 mg, p = 0.033). In both groups, mechanical pain threshold was decreased 18-24 h postoperatively (2.93 ± 0.209 Ln(g) vs. 3.454 ± 2.072 Ln(g), p = 0.032 in RD group; 2.910 ± 0.196 Ln(g) vs. 3.621 ± 0.198 Ln(g), p = 0.006 in HD group, 18-24 h postoperatively vs baseline)., Conclusions: Intraoperative administration of high-dose remifentanil decreased VAS scores and morphine consumption postoperatively. Thus, modulation of intraoperative opiates may be a simple and effective method of postoperative pain management., Trial Registration: This trial is registered in ClinicalTrials.gov, with the Name: Effect of Higher Doses of Remifentanil on Postoperative Pain in Patients Undergoing Thyroidectomy, and ID number: NCT01761149.

Objective: To analyze the incidence and cause of complications during and after interventional therapy for congenital heart disease (CHD)., Methods: From April 1986 to April 2009, 388 out of 6029 patients with CHD developed complications during and post interventional therapy, another 5 patients died post procedure, clinical data from these 393 patients were retrospectively analyzed. The patients with severe functional insufficiency requiring intervention or surgery during and after interventional therapy were classified as severe complications., Results: The overall complication rate was 6.44% [7.69% post atrial septal defect occlusion, 4.20% post patent ductus arteriosus (PDA) occlusion, 1.31% post percutaneous balloon pulmonary valvuloplasty, 14.94% post ventricular septal defect occlusion, 3.13% post percutaneous closure of aortopulmonary collaterals, 30.95% post catheter embolotherapy of pulmonary arteriovenous malformations, 12.50% post transcatheter closure of coronary artery fistulae, 20.00% post transcatheter closure of ruptured sinus of Valsava aneurysm, 66.67% post percutaneous balloon aortic valvuloplasty]. The severe complication rate was 0.65%(39/6029). The procedure-related mortality rate was 0.08% (5/6029), 0.26% (2/761) post percutaneous balloon pulmonary valvuloplasty, 0.05% (1/2070) post PDA occlusion, 9.10% (1/11) post balloon atrial septostomy, 33.33% (1/3) post percutaneous balloon aortic valvuloplasty. Emergency Cardiovascular surgery rate was 0.22% (13/6029). Selective surgery was required in 0.13% (8/6029) of patients post procedure. Two patients (0.03%) received permanent pacemaker implantation., Conclusions: The severe complications and mortality rate of interventional therapy for CHD are relative low. Post procedure follow-up is needed fro monitoring possible procedure-related complications.

Objective: To study the incidence and risk factors of intraocular pressure (IOP) elevation in patients who underwent vitreoretinal surgery., Methods: Data for 422 patients (446 eyes) who underwent vitreoretinal surgery from June 2005 to June 2007 were retrospectively analyzed. IOP was measured before surgery and on day 1, 2, 3, 7-14 after surgery with Goldmann applanation tonometer. Ocular hypertension was defined as IOP 25 mmHg or more. All factors were analyzed for association with Ocular hypertension., Results: 232 of the 422 patients were female. 190 were male. The IOP was elevated significantly in 185 eyes (41%) after surgery within 2 weeks. Among them the IOP occurred mostly in day 1 (152 eyes, 82%). The rate of IOP elevation with intraocular tamponade of C3F8 or silicone oil was 53% or 55%, the difference being not statistically significant (P>0.05). The incidence of high IOP in C3F8 injection group and silicone oil injection group were statistically higher than simple pars plana vitrectomy group (P<0.01). The risk factors of ocular hypertension include C3F8 injection (chi2=37.82, P<0.01), silicone oil injection (chi2=27.84, P<0.01), lentectomy (chi2=8.98, P<0.01), scatter endolaser (chi2=7.41, P<0.01), diabetes (chi2=12.12, P<0.01) and increasing patient age (chi2=7.07, P<0.01)., Conclusion: IOP elevation was a common complication of vitreoretinal surgery. The risk factors of ocular hypertension include C3F8 injection, silicone oil injection, lentectomy, scatter endolaser, diabetes and increasing patient age.

Objective: To study the clinical features of silicone oil dependent eyes., Method: Retrospective observational case series. Twenty four silicone oil dependent eyes collected from the Peking Union Medical College from Jan.2000 to Dec.2006 were studied. The pathogeny, surgical process and prognosis were analyzed., Results: There were 5.9% silicone oil dependent eyes in eyes underwent vitrectomy and silicone oil tamponade. Silicone oil tamponade was performed again in 17 eyes because of severe proliferative vitreoretinopathy (PVR) or repeated vitreous hemorrhage after silicone oil removal and C3F8 tamponade. Silicone oil replacement was performed in 3 eyes because of severe PVR. Continually low intraocular pressure occurred after silicone oil removal in 4 eyes with 360 degree peripheral retinotomy. Thirteen of 24 patients had visual acuities of finger counting to 0.1, 9 had hand movement, one had light perception and one had no light perception., Conclusions: The incidence of silicone oil dependent eye is approximately 5.9%. This is often seen in the patients with severe or repeated PVR, or 360 degree peripheral retinotomy. The visual prognosis is poor in most cases.