The risk of perioperative cardiac complications (PCCs) in patients living in high-altitude areas may increase with more adverse clinical outcomes due to the special geographical environment, which ...has not yet been studied. We aimed to determine the incidence and analyze risk factors for PCCs in adult patients undergoing major noncardiac surgery in the Tibet Autonomous Region.
This prospective cohort study enrolled resident patients from high-altitude areas receiving major noncardiac surgery in Tibet Autonomous Region People's Hospital in China. Perioperative clinical data were collected, and the patients were followed up until 30 days after surgery. The primary outcome was PCCs during the operation and within 30 days after the surgery. Logistic regression was used to build the prediction models for PCCs. A receiver operating characteristic (ROC) curve was used to evaluate the discrimination. A prognostic nomogram was constructed to generate a numerical probability of PCCs for patients undergoing noncardiac surgery in high-altitude areas.
Among the 196 patients living in high-altitude areas involved in this study, 33 (16.8%) suffered PCCs perioperatively and within 30 days after surgery. Eight clinical factors were identified in the prediction model, including older age (
= 0.028), extremely high altitude above 4,000 m (
= 0.442), preoperative metabolic equivalent (MET) < 4 (
= 0.153), history of angina within 6 months (
= 0.037), history of great vascular disease (
= 0.073), increased preoperative high sensitivity C-reactive protein (hs-CRP) (
= 0.072), intraoperative hypoxemia (
= 0.025) and operation time >3 h (
= 0.043). The area under the curve (AUC) was 0.766 (95% confidence interval: 0.785-0.697). The score calculated from the prognostic nomogram predicted the risk of PCCs in high-altitude areas.
The incidence of PCCs in resident patients living in high-altitude areas who underwent noncardiac surgery was high, and the risk factors included older age, high altitude above 4,000 m, preoperative MET < 4, history of angina within 6 months, history of great vascular disease, increased preoperative hs-CRP, intraoperative hypoxemia, and operation time >3 h. The prognostic nomogram of this study could help to assess the PCCs for patients in high-attitude areas undergoing noncardiac surgery.
ClinicalTrials.gov ID: NCT04819698.
Abstract
This study is designed to clarify the incidence of epidural morphine induced pruritus (EMIP) in Chinese Han and Tibetan parturients after cesarean section (CS) and to identify the correlated ...risk factors.
This is a prospective multicenter observational study. Follow-up evaluations were performed at 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours after morphine administration. The primary outcome was EMIP incidence. Other details were also recorded for risk factor screening.
Totally 284 parturients receiving CS were enrolled and 247 completed the study. The overall incidence of EMIP was 18.6% (46 in 247). The onset of pruritus was 5.6 ± 4.8 hours (mean ± SD) after morphine administration and the duration of pruritus was 14.0 ± 8.8 hours. Logistic regression models was built with 5 variables, history of allergy, serotonin receptor antagonist administration, I.V. fentanyl administration, epidural morphine volume and VAS pain score. Results of showed that 2 of the variables, history of allergy (
P
< .001) and serotonin receptor antagonist (
P
< .05), were significantly correlated with incidence of EMIP.
In conclusion, EMIP incidence in our study was 18.6%. Positive medical history of allergy and not using serotonin receptor antagonist were potential risk factors of EMIP development.
Trial registration:
ChiCTR-OPC-17012345
Pain disease is a worldwide problem.The prevalence of chronic pain in developed and developing countries has been reported in some published research. However, little knowledge of situation of pain ...clinic in Tibet is known. Tibet Autonomous Region People’s Hospital established the first pain clinic in Tibet. This study collected and analyzed the data of medical records of pain clinic in Tibet Autonomous Region People’s Hospital from September 2017 to August 2018. The results showed that the total amounts of patients visiting pain clinic were very small, the most common pain diseases were postherpetic neuralgia and sciatica, and more female patients visited the pain clinic than male patients. All these results indicate that the hospital and government need to pay more attention to the development and promotion of pain medicine in Tibet to make Tibetans being accessed to high-quality pain clinic service.
We report on the analysis of the 10-1000 TeV large-scale sidereal anisotropy of Galactic cosmic rays (GCRs) with the data collected by the Tibet Air Shower Array from 1995 October to 2010 February. ...In this analysis, we improve the energy estimate and extend the decl. range down to −30°. We find that the anisotropy maps above 100 TeV are distinct from that at a multi-TeV band. The so-called tail-in and loss-cone features identified at low energies get less significant, and a new component appears at ∼100 TeV. The spatial distribution of the GCR intensity with an excess (7.2 pre-trial, 5.2 post-trial) and a deficit (−5.8 pre-trial) are observed in the 300 TeV anisotropy map, in close agreement with IceCube's results at 400 TeV. Combining the Tibet results in the northern sky with IceCube's results in the southern sky, we establish a full-sky picture of the anisotropy in hundreds of TeV band. We further find that the amplitude of the first order anisotropy increases sharply above ∼100 TeV, indicating a new component of the anisotropy. All these results may shed new light on understanding the origin and propagation of GCRs.
ABSTRACT The events recorded by ARGO-YBJ in more than five years of data collection have been analyzed to determine the diffuse gamma-ray emission in the Galactic plane at Galactic longitudes 25° < l ...< 100° and Galactic latitudes . The energy range covered by this analysis, from ∼350 GeV to ∼2 TeV, allows the connection of the region explored by Fermi with the multi-TeV measurements carried out by Milagro. Our analysis has been focused on two selected regions of the Galactic plane, i.e., 40° < l < 100° and 65° < l < 85° (the Cygnus region), where Milagro observed an excess with respect to the predictions of current models. Great care has been taken in order to mask the most intense gamma-ray sources, including the TeV counterpart of the Cygnus cocoon recently identified by ARGO-YBJ, and to remove residual contributions. The ARGO-YBJ results do not show any excess at sub-TeV energies corresponding to the excess found by Milagro, and are consistent with the predictions of the Fermi model for the diffuse Galactic emission. From the measured energy distribution we derive spectral indices and the differential flux at 1 TeV of the diffuse gamma-ray emission in the sky regions investigated.
ABSTRACT This paper reports on the measurement of the large-scale anisotropy in the distribution of cosmic-ray arrival directions using the data collected by the air shower detector ARGO-YBJ from ...2008 January to 2009 December, during the minimum of solar activity between cycles 23 and 24. In this period, more than 2 × 1011 showers were recorded with energies between ∼1 and 30 TeV. The observed two-dimensional distribution of cosmic rays is characterized by two wide regions of excess and deficit, respectively, both of relative intensity ∼10−3 with respect to a uniform flux, superimposed on smaller size structures. The harmonic analysis shows that the large-scale cosmic-ray relative intensity as a function of R.A. can be described by the first and second terms of a Fouries series. The high event statistics allow the study of the energy dependence of the anistropy, showing that the amplitude increases with energy, with a maximum intensity at ∼10 TeV, and then decreases while the phase slowly shifts toward lower values of R.A. with increasing energy. The ARGO-YBJ data provide accurate observations over more than a decade of energy around this feature of the anisotropy spectrum.
The extended TeV gamma-ray source ARGO J2031+4157 (or MGRO J2031+41) is positionally consistent with the Cygnus Cocoon discovered by Fermi-LAT at GeV energies in the Cygnus superbubble. Reanalyzing ...the ARGO-YBJ data collected from 2007 November to 2013 January, the angular extension and energy spectrum of ARGO J2031+4157 are evaluated. After subtracting the contribution of the overlapping TeV sources, the ARGO-YBJ excess map is fitted with a two-dimensional Gaussian function in a square region of 10degrees x 10degrees, finding a source extension sigma sub(ext)= 1degrees.8 + or - 0degrees.5. The observed differential energy spectrum is dN/dE = (2.5 + or - 0.4) x 10 super(-11) (E/1 TeV) super(-2.6+ or -0.3) photons cm super(-2) s super(-1) TeV super(-1), in the energy range 0.2-10 TeV. The angular extension is consistent with that of the Cygnus Cocoon as measured by Fermi-LAT and the spectrum also shows a good connection with the one measured in the 1-100 GeV energy range. These features suggest to identify ARGO J2031+4157 as the counterpart of the Cygnus Cocoon at TeV energies. The Cygnus Cocoon, located in the star-forming region of Cygnus X, is interpreted as a cocoon of freshly accelerated cosmic rays related to the Cygnus superbubble. The spectral similarity with supernova remnants (SNRs) indicates that the particle acceleration inside a superbubble is similar to that in an SNR. The spectral measurements from 1 GeV to 10 TeV allows for the first time to determine the possible spectrum slope of the underlying particle distribution. A hadronic model is adopted to explain the spectral energy distribution.
This paper reports on the observation of the sidereal large-scale anisotropy of cosmic rays using data collected by the ARGO-YBJ experiment over 5 years (2008-2012). This analysis extends previous ...work limited to the period from 2008 January to 2009 December, near the minimum of solar activity between cycles 23 and 24. With the new data sample, the period of solar cycle 24 from near minimum to maximum is investigated. A new method is used to improve the energy reconstruction, allowing us to cover a much wider energy range, from 4 to 520 TeV. Below 100 TeV, the anisotropy is dominated by two wide regions, the so-called "tail-in" and "loss-cone" features. At higher energies, a dramatic change of the morphology is confirmed. The yearly time dependence of the anisotropy is investigated. Finally, no noticeable variation of cosmic-ray anisotropy with solar activity is observed for a median energy of 7 TeV.
ABSTRACT We report on the extensive multi-wavelength observations of the blazar Markarian 421 (Mrk 421) covering radio to γ-rays, during the 4.5 year period of ARGO-YBJ and Fermi common operation ...time, from 2008 August to 2013 February. These long-term observations, extending over an energy range of 18 orders of magnitude, provide a unique chance to study the variable emission of Mrk 421. In particular, due to the ARGO-YBJ and Fermi data, the entire energy range from 100 MeV to 10 TeV is covered without any gap. In the observation period, Mrk 421 showed both low- and high-activity states at all wavebands. The correlations among flux variations in different wavebands were analyzed. The X-ray flux is clearly correlated with the TeV γ-ray flux, while the GeV γ-rays only show a partial correlation with the TeV γ-rays. Radio and UV fluxes seem to be weakly or not correlated with the X-ray and γ-ray fluxes. Seven large flares, including five X-ray flares and two GeV γ-ray flares with variable durations (3-58 days), and one X-ray outburst phase were identified and used to investigate the variation of the spectral energy distribution with respect to a relative quiescent phase. During the outburst phase and the seven flaring episodes, the peak energy in X-rays is observed to increase from sub-keV to a few keV. The TeV γ-ray flux increases up to 0.9-7.2 times the flux of the Crab Nebula. The behavior of GeV γ-rays is found to vary depending on the flare, a feature that leads us to classify flares into three groups according to the GeV flux variation. Finally, the one-zone synchrotron self-Compton model was adopted to describe the emission spectra. Two out of three groups can be satisfactorily described using injected electrons with a power-law spectral index around 2.2, as expected from relativistic diffuse shock acceleration, whereas the remaining group requires a harder injected spectrum. The underlying physical mechanisms responsible for different groups may be related to the acceleration process or to the environment properties.
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