Acute Ischemic Stroke at High Altitudes in China: Early Onset and Severe Manifestations

The detailed characteristics of strokes at high altitudes in diverse nations have not been extensively studied. We retrospectively enrolled 892 cases of first-ever acute ischemic strokes at altitudes of 20, 2550, and 4200 m in China (697 cases from Penglai, 122 cases from Huzhu, and 73 cases from Yushu). Clinical data and brain images were analyzed. Ischemic strokes at high altitudes were characterized by younger ages (69.14 ± 11.10 vs. 64.44 ± 11.50 vs. 64.45 ± 14.03, p &lt; 0.001) and larger infract volumes (8436.37 ± 29,615.07 mm3 vs. 17,213.16 ± 47,044.74 mm3 vs. 42,459 ± 84,529.83 mm3, p &lt; 0.001). The atherosclerotic factors at high altitude, including diabetes mellitus (28.8% vs. 17.2% vs. 9.6%, p &lt; 0.001), coronary heart disease (14.3% vs. 1.6% vs. 4.1%, p &lt; 0.001), and hyperlipidemia (20.2% vs. 17.2% vs. 8.2%, p = 0.031), were significantly fewer than those in plain areas. Polycythemia and hemoglobin levels (138.22 ± 18.04 g/L vs. 172.87 ± 31.57 g/L vs. 171.81 ± 29.55 g/L, p &lt; 0.001), diastolic pressure (89.98 ± 12.99 mmHg vs. 93.07 ± 17.79 mmHg vs. 95.44 ± 17.86 mmHg, p = 0.016), the percentage of hyperhomocysteinemia (13.6% in Penglai vs. 41.8% in Huzhu, p &lt; 0.001), and the percentage of smoking (33.1% in Penglai vs. 50.0% in Huzhu, p = 0.023) were significantly elevated at high altitudes. We concluded that ischemic stroke occurred earlier and more severely in the Chinese plateau. While the atherosclerotic factors were not prominent, the primary prevention of strokes at high altitudes should emphasize anticoagulation, reducing diastolic pressure, adopting a healthy diet, and smoking cessation.</jats:p

Prevalence and risk factors for perioperative complications of CKD patients undergoing elective hip surgery

Abstract Purpose Chronic kidney disease (CKD) is known to increase morbidity and mortality after orthopedic surgery. The purpose of this study is to investigate how CKD affects perioperative complications in hip surgery patients. Material and methods From 2013 to 2016, a total of 230 patients (30 patients with CKD and 200 without CKD) undergoing hip surgery were enrolled in this study. Preoperative, intraoperative, and postoperative data was collected and analyzed between CKD and non-CKD patients. Logistic regression was used to evaluate the independent risk factor for postoperative complications. Results There were significant differences in the number of people with hypertension (90.0% vs 27.3%, P < 0.001), diabetes (33.3% vs 8.7%, P = 0.01), coronary heart disease (20.0% vs 2.0%, P = 0.001), smoking habits (56.7% vs 22.7%, P = 0.016), anemia (90.0% vs 19.3%, P < 0.001), and low hemoglobin levels (94.1 ± 19.7 vs 121.3 ± 18.8, P < 0.001) between CKD and non-CKD patients before surgery. Receiving a blood transfusion was significantly more common in CKD patients (50% vs 28.5%, P = 0.018). Postoperatively, significant differences were detected in the average number of patients who transferred to the ICU (73.3% vs 19.3%, P < 0.001). Furthermore, differences were found in the quantity of hemoglobin (92.5 ± 16.8 vs 107.5 ± 18.3, P < 0.001) and albumin (32.4 ± 4.1 vs 34.9 ± 5.5, P = 0.02) measured between CKD and non-CKD patients. Logistic regression analysis indicated that diabetes, alcohol, and anemia were all independent risk factors for obtaining a blood transfusion, while age, CKD, and osteoporosis were all independent risk factors for ICU transfers. Conclusion Compared with non-CKD patients, CKD patients were accompanied with more cardiac diseases preoperatively. In addition, CKD patients were more likely to receive a blood transfusion and transfer to the ICU after hip surgery. Preoperative anemia should be restored sufficiently to decrease the incidence of blood transfusions