Toxic heavy metals (THMs) are contaminants commonly found in the environment. Although a large number of studies have demonstrated their damage to the biological functions of the human being, their potential associations with the risk of developing schizophrenia remain controversial. In this study, we investigated the associations between four THMs (chromium (Cr), cadmium (Cd), lead (Pb) and arsenic (As)) in serum and the risk of schizophrenia. In total, 95 patients with schizophrenia (cases) and 95 normal subjects (controls) were recruited from Hebei Province, China. The serum concentrations of the 4 THMs were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). A higher concentration of Pb was found significantly associated with an elevated risk of schizophrenia (OR = 3.146; 95%CI: 1.238–7.994, p = 0.016), while significant association for the other three THMs were not observed. Besides, significant correlations were found between the metabolic biomarkers and the concentrations of Pb and As, respectively. In order to further characterize the association between these THMs and schizophrenia with greater statistical power, we conducted meta-analysis by including 538 cases and 1040 controls from the current study and 5 available datasets published from 2002 to 2018. Using a random-effect model, Cr was significantly associated with schizophrenia (SMD = 0.3246; 95%CI: 0.0166–0.6326, p < 0.01). Overall, this study suggested that higher levels of Pb and Cr may be one of the factors associated with an elevated risk of schizophrenia.

Study objective: To assess the association of intraoperative hypotension with long-term survivals in older patients after major noncardiac surgery mainly for cancer. Design: A secondary analysis of databases from three randomized trials with long-term follow-up. Setting: The underlying trials were conducted in 17 tertiary hospitals in China. Patients: Patients aged 60 to 90 years who underwent major noncardiac thoracic or abdominal surgeries (≥ 2 h) in a single center were included in this analysis. Exposures: Restricted cubic spline models were employed to determine the lowest mean arterial pressure (MAP) threshold that was potentially harmful for long-term survivals. Patients were arbitrarily divided into three groups according to the cumulative duration or area under the MAP threshold. The association between intraoperative hypotension exposure and long-term survivals were analyzed with the Cox proportional hazard regression models. Measurements: Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals. Main results: A total of 2664 patients (mean age 69.0 years, 34.9% female sex, 92.5% cancer surgery) were included in the final analysis. MAP < 60 mmHg was adopted as the threshold of intraoperative hypotension. Patients were divided into three groups according to duration under MAP < 60 mmHg ( 10 min) or area under MAP <60 mmHg (< 1 mmHg⋅min, 1–30 mmHg⋅min, and > 30 mmHg⋅min). After adjusting confounders, duration under MAP < 60 mmHg for > 10 min was associated with a shortened overall survival when compared with the < 1 min patients (adjusted hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.09 to 1.57, P = 0.004); area under MAP < 60 mmHg for > 30 mmHg⋅min was associated with a shortened overall survival when compared with the < 1 mmHg⋅min patients (adjusted HR 1.40, 95% CI 1.16 to 1.68, P < 0.001). Similar associations exist between duration under MAP < 60 mmHg for > 10 min or area under MAP < 60 mmHg for > 30 mmHg⋅min and recurrence-free or event-free survivals. Conclusions: In older patients who underwent major noncardiac surgery mainly for cancer, intraoperative hypotension was associated with worse overall, recurrence-free, and event-free survivals.

Handover of anesthesia care is often required in busy clinical settings. Herein, we investigated whether intraoperative anesthesia handover was associated with an increased risk of major adverse cardiovascular events (MACEs) after thoracic surgery. A retrospective cohort study. A tertiary hospital. Adult patients who underwent elective thoracic surgery. A complete handover of intraoperative anesthesia care was defined when the outgoing anesthesiologist transferred patient care to the incoming anesthesiologist and no longer returned. Our primary endpoint was a composite of MACEs, including acute myocardial infarction, new-onset congestive heart failure, non-fatal cardiac arrest, and cardiac death, that occurred within 7 days after surgery. The impact of complete anesthesia handover on postoperative MACEs was analyzed using propensity score matching. Of 6962 patients (mean age 59.7 years; 57.4 % female) included in the analysis, 2319 (33.3 %) surgeries were conducted with anesthesia handover whereas 4643 (66.7 %) were conducted without. After propensity score matching, 2165 (50.0 %) surgeries were conducted with anesthesia handover whereas the other half were conducted without. Patients with anesthesia handover developed more MACEs when compared with those without (10.4 % [225/2165] vs. 8.4 % [181/2165]; relative risk 1.24, 95 % CI 1.03 to 1.50, P = 0.022). Specifically, myocardial infarction was more common in patients with anesthesia handover than in those without (9.2 % [199/2165] vs. 7.4 % [160/2165]; relative risk 1.24, 95 % CI 1.02 to 1.52, P = 0.032). For adult patients undergoing thoracic surgery, a complete handover of intraoperative anesthesia care was associated with an increased risk of MACEs after surgery.

Objective: To test the hypothesis that peripheral nerve block (PNB) use might be associated with improved perioperative outcomes after major surgery. Background: PNB has been used to improve postoperative analgesia. Methods: This was a retrospective cohort study with propensity score matching. We included patients aged ≥65 years who underwent major (≥2 hours) non-cardiac thoracic and abdominal surgery under general anesthesia. Data were analyzed according to whether patients received PNB or not during anesthesia. Our primary outcome was the length of hospital stay; secondary outcomes included occurrence of major complications in hospital after surgery. Results: A total of 1915 patients were included in the full cohort, of whom 1316 received PNB and 599 did not; 1174 patients remained in the cohort after matching, with 587 in each group. Length of hospital stay after surgery was shorter in patients who received PNB than in those who did not [7 days (5–9) with PNB vs 7 days (5–11) without PNB: hazard ratio: 1.15, 95% CI: 1.02–1.29, P = 0.012]. When compared with patients who did not receive PNB, those who received PNB developed fewer major complications during hospital stay (relative risk: 0.41, 95% CI: 0.30–0.58, P < 0.001). Patients with PNB required less supplemental analgesia within 72 h (relative risk: 0.70, 95% CI: 0.59–0.84, P < 0.001). Conclusions: The use of PNB was associated with shortened length of hospital stay and reduced major complications in older patients after major non-cardiac thoracic and abdominal surgery, possibly due to improved analgesia.