Background: Chronic HBV infection has a continuous effect on blood sugar and blood phospholipid metabolism.Metabolic syndrome (MS) and insulin resistance (IR) are the main risk factor leading to diabetes and cardiovascular disease. At present, the relationship between chronic HBV infection and MS was still controversial. Objective: To explore the correlation between hepatitis B virus (HBV) infection status, level of surface antigen-antibody and phospholipid metabolism, insulin resistance (IR). Methods: A retrospective analysis was performed on the clinical data of 423 patients who underwent hepatitis B markers test in the hospital from January 2017 to June 2019. Among them, there were 95 cases with positive hepatitis B surface antigen (HBsAg) in the HBV infection positive group and 328 cases with negative HBsAg in the HBV infection negative group. The serum phospholipid fatty acid maps and IR related indexes were compared between the two groups. The correlation between the level of HBsAg antibody and phospholipid fatty acid maps, IR related indexes were analyzed by Spearman analysis. Results: The levels of saturated fatty acid (SFA) and u-6/u-3 polyunsaturated fatty acid (PUFA) in the HBV infection positive group were higher than those in the HBV infection negative group, while n-6PUFA, n-3PUFA, PUFA, and PUFA/SFA were all lower than those in HBV infection negative group (P<0.05). The levels of fasting blood glucose (FBG) and insulin resistance index (HOMA-IR) in the HBV infection positive group were higher than those in the HBV infection negative group, while fasting insulin (FINS) and islet sensitivity index (ISI) were lower than those in HBV infection negative group (P<0.05). Spearman correlation analysis showed that HBeAg level was positively correlated with SFA, n-6/n-3 PUFA, FBG and HOMA-IR (r=0.381, 0.369, 0.516, 0.453, P<0.001), while negatively correlated with n-3 PUFA, n-6 PUFA, PUFA, PUFA/SFA, FINS and ISI (r=-0.322, -0.306, -0.467, -0.482, -0.465, -0.356, P<0.001). Conclusion: HBV infection may cause changes in the composition of serum phospholipid fatty acid and IR.
A giant retrosternal goiter can lead to compression of vital organs in the mediastinum with high risk of acute cardiorespiratory decompensation. Additionally, patients with acromegaly are prone to developing severe airway obstruction and ventilation difficulties during anesthetic induction, leading to hypoxia and an increased partial pressure of carbon dioxide. Therefore, more comprehensive airway management strategies are needed. We herein describe a 57-year-old man with acromegaly and severe tracheal obstruction caused by a giant retrosternal goiter. He presented with a 1-week history of progressive dyspnea and was scheduled to undergo right lobe thyroidectomy and retrosternal goiter thyroidectomy. We created a comprehensive emergency plan for a difficult airway, including regional and topical anesthesia for awake endotracheal intubation, sevoflurane inhalation, small doses of midazolam and sufentanil to increase tolerance, self-made extended-length tracheostomy, video laryngoscope-assisted fiber-optic bronchoscopy, extracorporeal membrane oxygenation, and surgical tracheostomy. Importantly, tetracaine was inhaled through an atomizer, and a laryngotracheal topical anesthesia applicator was used to spray the larynx with 1% tetracaine to reduce stimulation during intubation. The giant goiter was successfully removed through the cervical approach. A carefully designed airway management strategy and close communication among a multidisciplinary operation team are the basis of perioperative anesthetic management for these patients.
Obstetrical brachial plexus palsy (OBPP) is caused by traction of the brachial plexus during delivery. The incidence of OBPP was once reported to be 2.9 per 1,000 live births, and the incidence of persisting OBPP was 0.46 per 1,000 [1] . Although most patients with OBPP recover spontaneously in the first 2 months, up to 35% are left with varying degrees of shoulder weakness, contracture, or joint deformity [2] . Even after neuro-reconstructive surgery, children with incomplete recovery often have abnormal motor performance [3] . The upper trunk of the brachial plexus (C5 and C6) is most commonly affected in OBPP [3,4] . Paresis of the deltoid, supraspinatus, infraspinatus, and teres minor, which are innervated by the upper trunk, results in poor performance of the shoulder abduction/external rotation. The relatively unaffected or better recovered internal rotators can lead to adduction/internal rotation contracture of the shoulder due to the muscular imbalance. Besides, the internal rotators are often overactive while the patients flex, abduct, or externally rotate their shoulders. The phenomenon of this overactivation is called abnormal co-contraction, which is something like unilateral synkinesis after facial palsy that can be treated by botulinum neurotoxin [5] . On physical examination, the muscle tightness of the lattisimus dorsi and teres major can often be palpated. Active range of flexion and abduction are limited. The patients perform movements of arm elevation usually with elbow flexion, scapular wing protruding outward, and trunk extension. The complex movements such as handto-mouth and hand-on-neck are hard to accomplish. Co-contractions can be identified by physical examination and further confirmed by the electromyography (EMG) study. Abnormal co-contractions of the internal rotators impair the active range of motion of shoulder abduction/external rotation, impede the rehabilitation of the affected arm, and cause the functional loss of daily life activities such as putting food into the mouth, dressing, high reaching, and caring of hair. ABSTRACTObstetrical brachial plexus palsy (OBPP) is caused by traction of the brachial plexus during delivery. The incidence of OBPP was once reported to be 2.9 per 1000 live births, and the incidence of persisting OBPP was 0.46 per 1000. Although most patients with OBPP recover spontaneously in the first 2 months, up to 35% are left with varying degrees of shoulder weakness, contracture, or joint deformity. Even after neuro-reconstructive surgery, children with incomplete recovery often have abnormal motor performance.
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