OBJECTIVETo evaluate incidence of postoperative delirium after hip surgery in elderly patients by meta-analysis.

METHODSFrom January 1, 2014 to December 31, 2013, clinical literatures about postoperative delirium after hip surgery in elderly patients,were searched from the Pubmed. Literature extract table were formed according to inclusion and exclusion criteria. Stata-12.0 was applied for Meta-analysis. P was used to test heterogeneity of study, random-effect model was performed when I2 > 50%. Subgroup analysis was used according to stage of age, assessment scale of delirium and statistical area of literature. Begg test was used to test publication bias.

RESULTSTwenty-one literatures were included. Incidence of postoperative delirium after hip surgery in elderly patients by weighted and combination was 17% [95% CI (16%, 18%)]. Incidence of postoperative delirium after optional hip surgery was decreased more than emergency operation in included 5 literatures [OR = 0.32, 95% CI (0.22, 0.45)]. Incidence of postoperative delirium in patients less than 80 years old was 21% [95% CI (19%, 23%)], while 21% [95% CI (19%, 24%)] in patients more than 80 years old. Incidence of postoperative delirium in CAM evaluation scale was 23% [95% CI (21%, 26%)], while 19% [95% CI (17%, 21%)] in other evaluation scales. Incidence of postoperative delirium in Asian area was 17% [95% CI (15%, 20%)], while 23% [95% CI (21%, 25%)] in European and American area. There was no publication bias tested by Begg test (P < 0.05).

CONCLUSIONIncidence of postoperative delirium after hip surgery in elderly patients increases higher, especially in emergency operation. A standardizing research method is benefit for evaluate incidence of postoperative delirium after hip surgery in elderly patients, decreasing heterogeneity and publication bias.

Aged ; Delirium ; epidemiology ; Hip Fractures ; surgery ; Humans ; Incidence ; Postoperative Complications ; epidemiology ; Publication Bias

ObjectiveTo investigate the anatomical changes and dose variation of rectum during radiotherapy in patients with cervical cancer.Methods Ten patients with cervical cancer underwent intensity-modulated radiotherapy using online cone beam computed tomography (CBCT) before each fraction.Rectum was contoured on each CBCT and projected onto the planning CT to analyze the changes of the rectal volume and position.The rectal volume receiving ≥ 45 Gy ( V45 ) was evaluated accordingly.Results227 CBCT images in 10 patients were collected.The rectal volume changed from ( 35.0 ± 7.3)cm3 to (97.7±14.7) cm3.The shift of rectal center was (0.14 ±0.06) cm in left and right direction,(0.24±0.10) cm in anterior and posterior direction,and (0.55±0.28) cm in superior and inferior direction.The V45 of rectum varied from (9.19±2.46)％ to (60.54 ±11.67)％.In7 of the 10 patients,rectal volume and V45 of the rectum had significant positive correlation (r =0.582 - 0.743,all P ＜ 0.01 ).Among the 227 images,the V45 of rectum was ≤50％ in 68 images (30.0％ ).ConclusionsSignificant changes in rectal volume and position occurred during fractionated radiotherapy in patients with cervical cancer,which resuhs in variations in the dose rectum received.For most patients,rectal volume and the V45of rectum had significant positive correlation.

Objective To study the effect and related mechanism of celecoxib on tumor necrosis factorrelated apoptosis-inducing ligand(TRAIL) induced apoptosis of medullary thyroid cancer TT cell line.Methods MTT assay was used to measure the growth inhibition induced by TRAIL and celecoxib alone and their combination.TT cell cycle distribution was analyzed by flowcytometry.Hochest33258 staining and DNA ladder was used to detect the apoptosis of drug combination on TT cells.Western blot was used detect the protein change of cyclin A,Cdk2,caspase-8,c-FLIP,and RIP.Results ①MTT showed the growth inhibition ratio of TT cell intervened by the combination of TRAIL and celecoxib was 47.53％ ± 1.34％,which was much higher than that intervened by TRAIL(7.75 ％ ± 3.84％)and celecoxib alone.The differences had statistical significance (t test,F =5.234,P ＜0.01);②PI detection found the cells' number in G0/G1 phase in celecoxib group and combination group were increased compared to that in control group and TRAIL group(F =242.694,P ＜ 0.01);③Western blot indicated the expression of Cyclin A and Cdk2 were down regulated,there was no statistic significance;④ The apoptosis morph in nuclus was detected by Hochest33258 staining and showed the karyopycnosis and muclear fragmentation were increased in combination group with the apoptosis rate 24.23％ ± 2.91％,which was much higher than that in TRAIL(5.86％ ± 1.41％) and celecoxib(20％ ± 1.24％) (t test,F =1.824,P ＜0.01),the difference has statistic significance;⑤Western blot illustrated the active schizolysis of casplase-8 was higher and the expression of c-FLIP and RIP was down regulated in combination group.Conclusion celecoxib plays a positive effect on TRAIL-reduced apoptosis of medullary thyroid cancer TT cell line,which may due to the cell cycle arrest at G0/G1 phase,down-regulation of c-FLIP and RIP and subsequent activation of caspase-8.

Objective:To investigate the inhibitory effects of halofuginone on radiation-induced pulmonary injury and to explore the therapeutic mechanism of this drug. Methods:A total of 72 healthy female C57BL/6 mice were randomized into 4 groups, namely, control, irradiation, halofuginone, and irradiation plus halofuginone groups, with 18 mice in each group. No treatment was performed in the control group. In the halofuginone group, the halofuginone lavage was conducted once a day, with a continuous course treatment for a month or until sacrifice of the mice. In the therapeutic alliance group, the treatment mode was the same as that in the halofuginone group. Then, a 6MV-X ray single fraction irradiation was performed after the completion of a 15-day intragastric administration. At 24 h, 1 week, 2 weeks, 4 weeks, 12 weeks, and 20 weeks after the irradiation, 3 mice from each group were randomly sacrificed, and total lung tissues were harvested. The lung was dissected to prepare pathological sections. The sections were stained with hematoxylin and eosin staining (H&E) to explore morphologic changes. The protein and mRNA expression levels of TGF-β1 were analyzed by a combi-nation of immunohistochemistry and polymerase chain reaction. The level of hydroxyproline was also measured. Results: The out-comes of H&E staining showed that halofuginone markedly ameliorated the acute pulmonary inflammation and fibrosis induced by irra-diation. The combination group had a lower level of hydroxyproline than the irradiation group, with statistically significant differences at 20 weeks after irradiation (P=0.037). The protein and mRNA expression levels of TGF-β1 were higher in the irradiation and combi-nation groups than in the control group and (or) halofuginone group at different time points (P<0.05). The combination group had lower TGF-β1 protein expression than the irradiation group at different time points, with statistically significant differences at 2, 4, 12, and 20 weeks after the irradiation (P<0.05). Meanwhile, TGF-β1 mRNA level was lower in the combination group than in the irradiation group only at 4 and 12 weeks after the irradiation (P<0.05). Conclusion:Halofuginone can ameliorate the irradiation-induced lung inflamma-tion and fibrosis probably by inhibiting the radiation-induced TGF-β1 expression. Therefore, halofugione is expected to be a therapeu-tic drug for preventing irradiation injury of the lung.

Objective • To explore the clinical value of the ratio of low attenuation areas (LAA%) and lung volume calculated according to chest CT in evaluating the severity of spirometric abnormality. Methods • The patients who underwent chest CT scan and lung function test at the same time from January 2010 to July 2014 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively enrolled. LAA% and lung volume were calculated by Myrian software. The correlation analysis was performed between post-bronchodiation forced expiratory volume in 1 second (FEV1) or its percentage of predicted value (FEV1%pred) and LAA% or lung volume. Multi-variable models for post-bronchodiation FEV1 and FEV1%pred were developed based on LAA%, lung volume, gender, height, and weight. The ROC curves were depicted and the diagnostic values of LAA%, lung volume, and models were compared. The cut points were chosen according to Younden indexes and specificity. Results • A total of 1 150 patients were included in summarization group. LAA% was negatively correlated with post-bronchodiation FEV1 and FEV1%pred. Lung volume was positively correlated with post-bronchodiation FEV1. The regression models of post-bronchodiation FEV1 and FEV1%pred were FEV1=-2.700+0.111×lung volume-0.216×ln (LAA%+0.1)-0.025×age+0.154×gender+0.034×height and FEV1%pred=65.582+4.014×lung volume-7.508×ln (LAA%+0.1)-10.264×gender, respectively. The regression model performed better than LAA% and lung volume in estimating the degree of post-bronchodiation FEV1 decrease. LAA% and the regression model performed better than lung volume in estimating the degree of post-bronchodiation FEV1%pred decrease. The sensitivity was 75.6% and the specificity was 90.6% in estimating post-bronchodiation FEV1%pred<35% by using LAA%>1.61% as the criteria. The sensitivity was 58.9% and the specificity was 81.4% in estimating post-bronchodiation FEV1<1 L by using the value of regression model<1.76. Conclusion • The regression models of post-bronchodiation FEV1 and FEV1%pred were obtained based on lung volume and LAA% on chest CT. LAA% and lung volume can roughly estimate the severity of spirometric abnormality.

Objective To investigate bladder anatomical changes and dose variation in patients with cervical cancer.Methods We analyzed 20 patients,undergoing external beam radiotherapy scanning cone beam CT(CBCT)before each fraction.Bladder was contoured on each CBCT,was projected onto the planning CT and assesses anatomical changes and dose variation.Results A total 451 CBCT images,for 20 patients were collected for analysis,show more change in bladder volume and position.In 15 cases bladder volume and V45 had no significant correlation(r=0.225 -0.473,all P>0.05),4 cases shows negative correlation(r=-0.564,P<0.05;r=-0.597,P<0.01;r=-0.942,P<0.01;r=-0.816,P<0.01),1 case shows positive correlation(r=0.662,P<0.01).Have more than the criteria(V45≤50%)number is 64/451(14.2%)in whole treatment.Conclusions For most patients by filling adequacy bladder,bladder dose variation is acceptable:CTV lager for individual patients should be closely observed its regression,implementation of the offline or online calibration.

Objective: Doubled blepharoplasty, which has a various types, is one of the commonest plastic surgery procedures. Incision method has a long-standing result but linear scars can be seen when eyes are closed. So it is necessary to improve this surgerical procedure. The aim of this report is to propose a novel palpebral margin incision technique which avoids scars in the upper eyelid. Methods: 15 patients undertook blepharoplasty with palpebral margin incision technique. All the patients in this study were healthy with no other serious diseases. The double-eyelid crease was formed after the operation.The aesthetic results were evaluated based on their satisfaction. Results: All of the patients were satisfied with aesthetic results, and no significant complications occurred. And No obvious regression of the double fold took place. Conclusions This new method provides an effective way to achieve eyelid reconstruction without obvious scar in the upper eyelid which is of very important clinical significance and makes cosmetic surgery process take a step forward.

Cocrystal separation technology is a technology that utilizes coformers to selectively form cocrystals with target compounds and separate them from mixed systems. Our study used puerarin (PUE), daidzein (DDZ), and genistein (GEN) as model drugs, which have similar structures and are the main isoflavones in Pueraria lobata root. The separation and purification processes in the modern traditional Chinese medicine (TCM) of these three components use conventional column chromatography, recrystallization, and other technologies, which have the issues of lengthy separation cycles, high solvent consumption, and inefficient preparation. Different with existing separation technology, our team used the early-found cocrystal separation method to design a step-by-step extraction and separation experiment of GEN-PUE-DDZ ternary mixture. Caffeine and L-proline were added to the mixed system in turn, GEN-caffeine cocrystal and PUE-proline cocrystal were prepared by suspension method. The cocrystals precipitated out of the solution. The purities of the GEN-caffeine cocrystal and the PUE-proline cocrystal could achieve 93% (the purity of GEN) and 99% (the purity of PUE). Besides, the purity of DDZ could also be increased by 6.76 times. This study proposed a simple operating, low cost and wide application range separation method different from the traditional separation method and realized the separation of structurally similar chemical components in TCM, laying a foundation for the application of cocrystal technology in the separation and refining of TCM.

Due to the fact that the articular cartilage of children's joints has not yet been fully ossified, visualizing the adjacent anatomical structures during the clinical diagnosis and treatment of joint diseases and injuries in children is a challenging issue. Arthrography is an efficient, convenient, and minimally invasive technique, and is particularly crucial for the visualization of children's hip joints. Currently, arthrography technology is widely employed during surgeries for developmental dysplasia of the hip (DDH), and in recent years, numerous studies have concentrated on the efficacy of joint angiography, exploring its assessment and predictive roles during and after the operation. We review the overview of hip joint arthrography techniques, such as the concept of arthrography, the selection of access routes for hip joint arthrography, the process of hip joint arthrography, the dosage and operation of contrast agents, and the adverse reactions of contrast agents; the use of hip joint arthrography to evaluate the quality of closed reduction; the use of hip joint arthrography to predict the future development and outcome of the acetabulum after closed reduction; the use of hip joint arthrography in the study of open reduction or osteotomy; the use of hip joint arthrography to observe the morphology of soft tissues in the hip joint; the use of hip joint arthrography in combination with nuclear magnetic resonance to observe the anatomical structure of the acetabular labrum. Summarizing the research results of arthrography for evaluating the corresponding indicators of the hip joint helps improve the matching between the femoral head and the acetabulum and the accuracy of evaluating the quality of reduction, uncovers identifying factors such as labrum varus that hinder concentric reduction, enhances the ability to predict the development and outcome of the acetabulum, and has significant guiding significance for the precise selection of the timing of surgical intervention for early and residual deformities in children with DDH. Exploring the application of arthrography technology in evaluating the quality of closed reduction in DDH and predicting the development of the acetabulum after reduction is expected to provide meaningful references for orthopedic surgeons in the current clinical diagnosis, treatment, and research of DDH.

Objective To investigate the protective effects of intra-peritoneal fluid resuscitation on small intestinal mucosa in rats with hemorrhagic shock. Method Fifty Sprague-Dawley (SD) rats were randomly (random number) divided into five groups, namely sham operation group (group I ), hemorrhagic shock group (group Ⅱ ), intra-venous fluid resuscitation group (group Ⅲ ) . intravenous fluid resuscitation plus intra-peritoneal saline resuscitation (group Ⅳ ) and intravenous fluid resuscitation plus intra-peritoneal PD-2 solution resuscitation group (group Ⅴ ). The rats of 5 groups were processed with cannulations of right common carotid artery, right femoral vein and left femoral artery with systemic heparinization. The rat models of hemorrhagic shock were established with modified Wigger' s method by which the blood exsanguinated from left femoral artery. The rats of group Ⅲ were resuscitated with shed blood plus twice equal volume of Ringer's solution after modeling of hemorrhagic shock.The rats of group Ⅳ and group Ⅴ were administered intra-peritoneally with 30 mL saline and 30 mL of 2.5% PD-2 solution, respectively as adjuncts to those used in the group Ⅲ . The specimens of blood and small intestine of rats of all groups were collected 60-120 minutes after modeling and resuscitation. The activity of plasma diamine oxidase (DAO) was determined with chromatometry, the level of plasma D-lactic acid (D-LA) with spectorophotometry and the level of plasma lipopolysaccharide (LPS) with nephelometry. The histopathological and ultrastructure changes of small intestine tissue of rats were observed under light microscope and electronic microscope. Results There were remarkable differences in activity of DAO, and the levels of D-LA and IPS in rats between those ingroup Ⅱ and group I (P <0.01), and between those in group V and groups Ⅱ , Ⅲ or Ⅳ (P <0.05 or P < 0.01) The pathomorphology and ultra-structure of small intestine tissues were severely damaged in group Ⅱ compared with those in group Ⅰ , and those markedly lessened in group V compared with groups Ⅱ , Ⅲ and Ⅳ . Conclusions Intraperitoneal fluid resuscitation with PD-2 solution can significantly protect the integrity of intestinal mucosa and the normal permeability of intestinal wall, and blunts the histopathological changes, and restrains bacterial translocation from gut and reduces the level of plasma endotoxin.