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

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.

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 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 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: 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.

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.

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.

OBJECTIVETo determine the serum level and mRNA expression of type-1/type-2 cytokines of T lymphocytes in spleens of rats after thermal injury and to investigate the effects of escharectomy during burn shock stage on IFN-gamma and IL-4.

METHODSOne hundred and sixty male Wistar rats were randomized into four groups. In group A, animals were not subjected to escharectomy. In groups B, C and D, escharectomy and skin allograft were performed at 8, 24, 96 hours postburn (PB) respectively. At 4, 12, 24, 48, 96, 120 and 168 hours PB, animals were killed and blood and spleens samples were harvested. ELISA was applied to determine the concentration of IFN-gamma and IL-4 in serum. The expression pattern of IFN-gamma and IL-4 were observed at mRNA level in T lymphocytes isolated from spleen by RT-PCR.

RESULTSThe serum level of IFN-gamma and IL-4 rose rapidly and significantly after scald injury, expression of IFN-gamma and IL-4 mRNA in rats' T lymphocyte were also up-regulated spontaneously. The serum level of IFN-gamma and its mRNA expression began to rise within 4 hours PB, peaking at 24 hours PB. Whereas IL-4 and its mRNA expression showed a persistent elevation. Thereby leading to a dominant tendency of Th2 cytokine response on 7 d PB. In group A all above parameters revealed most obvious changes compared with controls, then ranked in group D, B and C.

CONCLUSIONEscharectomy during burn shock stage is helpful to decrease the harmful over expression of Th2-type lymphocyte after severe thermal injury.

Animals ; Burns ; metabolism ; surgery ; Enzyme-Linked Immunosorbent Assay ; Interferon-gamma ; genetics ; metabolism ; Interleukin-4 ; genetics ; metabolism ; Male ; RNA, Messenger ; metabolism ; Rats ; Rats, Wistar ; Reverse Transcriptase Polymerase Chain Reaction ; Shock, Traumatic ; metabolism ; surgery ; Spleen ; cytology ; T-Lymphocytes ; metabolism ; Time Factors

RNA interference (RNAi) is a promising technology in development of specific antiviral therapy, but the quantitative detection of small interfering RNA (siRNA) expressed in vivo is the main challenge to assess its antiviral effect. In order to detect the siRNA molecules (siN1 and SiN2) particularly expressed in cells to inhibit the replication of classical swine fever virus (CSFV), serial specific stem-loop primers were designed and synthesized. Two of them (SLP-N1-6 and SLP-N2-8) were selected by screening in cross combination and successfully used in establishment of an optimal stem-loop RT-qPCR, which showed high specificity and sensitivity in detection of anti-CSFV siRNA expressed in PK-15 cells. The method was capable of detecting 10(2) to 10(8) copies of siRNA molecule with good parallel relationship (R(sq) = 0.999) and high amplification efficiency (Eff. = 98.2%). Therefore, the established stem-loop RT-qPCR can be used as an ideal tool in quantitative assessment of the anti-CSFV effects of RNAi in combination with detection of viral antigens using indirect immunofluorescent assay and TCID50, providing a novel technique for evaluating the antiviral effects of the siRNA expressed in anti-CSFV transgenic pigs to be established in future.
Animals ; Cell Line ; Classical swine fever virus ; genetics ; isolation & purification ; metabolism ; RNA Interference ; RNA, Small Interfering ; analysis ; genetics ; metabolism ; RNA, Viral ; genetics ; Real-Time Polymerase Chain Reaction ; methods ; Swine ; Transfection ; Viral Nonstructural Proteins ; genetics ; metabolism ; Virus Replication