Objective:To evaluate the value of preoperative quantitative quadriceps muscle ultrasound measures in predicting postoperative delirium (POD) in elderly patients undergoing gastrointestinal surgery.Methods:This was a prospective study. A total of 277 elderly patients of both sexes, aged 65-88 yr, with American Society of Anesthesiologists Physical Status classification ≤ Ⅳ and body mass index of≤30 kg/m 2, undergoing elective gastrointestinal surgery with general anesthesia at the Northern Jiangsu People′s Hospital from March to December 2023, were included in the study. The quadriceps femoris thickness and echo intensity were measured using ultrasound before induction of anesthesia. Delirium was assessed using the Confusion Assessment Method score at 1-7 days after operation. The patients were divided into 2 groups based on the occurrence of POD: POD group and non-POD group. Factors with statistically significant differences between groups were included in the logistic regression analysis to identify the independent risk factors for POD, and then a visual risk Nomogram prediction model for POD risk factors was developed based on this analysis in elderly patients undergoing gastrointestinal surgery. The receiver operating characteristic curve was plotted, and the area under the receiver operating characteristic curve (AUC) and 95% confidence interval ( CI) were used to evaluate the predictive value of each independent risk factor and Nomogram prediction model for POD. The Youden Index was used to determine the critical value for predicting POD, and the sensitivity and specificity were calculated. Results:The results of logistic regression analysis revealed that age, preoperative Mini-Mental State Examination scores, quadriceps femoris thickness and echo intensity of quadriceps femoris were independent risk factors for POD in elderly patients undergoing gastrointestinal surgery ( P<0.05). The AUC of preoperative quadriceps femoris thickness was 0.695 (95% CI 0.614-0.746), the critical value 2.465 cm, the sensitivity 73.7% and the specificity 78.2%. The AUC of preoperative quadriceps femoris echo intensity was 0.717 (95% CI 0.662-0.773), the critical value 59.985, the sensitivity 81.9% and the specificity 48.5%. Conclusions:Preoperative ultrasound measurement of quadriceps femoris thickness and echo intensity is an independent risk factor for POD and has some predictive value for POD in elderly patients undergoing gastrointestinal surgery.

Objective:To assess the value of preoperative salivary cortisol morning/night secretion ratio (AM/PM ratio) in predicting acute postoperative pain in patients.Methods:This was a prospective cohort study. A total of 120 patients, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with body mass index of 18-28 kg/m 2, undergoing elective single-port laparoscopic hysterectomy from January to October 2023 in Subei People′s Hospital of Jiangsu Province, were selected, and their anxiety and depression status was evaluated by using the Hospital Anxiety and Depression Mood Measurement Scale (HADS) before surgery. Saliva samples were collected in the morning and evening 1 day before operation, and the cortisol concentration was determined by enzyme-linked immunosorbent assay. The ratio of morning cortisol concentration to night cortisol concentration before operation was calculated (cortisol AM/PM ratio). The patients were divided into two groups according to the highest numerical rating scale (NRS) score within 48 h after surgery: no or mild pain group with the highest NRS score ≤3 and moderate to severe pain group with the highest NRS score ≥ 4. Multivariate logistic regression was used to identify the risk factors of moderate to severe acute pain after surgery, and the receiver operating characteristic curve was plotted to evaluate the predictive value. Results:Multivariate logistic regression analysis showed that age, preoperative HADS anxiety score, preoperative HADS depression score and preoperative cortisol AM/PM ratio were independent risk factors for moderate to severe acute pain after surgery ( P<0.05). The results of the receiver operating characteristic curve showed that the area under the curve of preoperative cortisol AM/PM ratio in predicting moderate to severe acute postoperative pain was 0.803 (95% confidence interval 0.708-0.898, P<0.001), the optimal cut-off value was 3.46, the sensitivity was 71.1%, and the specificity was 87.7%. Conclusions:Preoperative salivary cortisol morning/night secretion ratio can predict the occurrence of acute postoperative pain in patients.

Objective:To evaluate the effect of individualized positive end-expiratory pressure (PEEP) titration based on open-lung strategy on the intraoperative thoracic fluid content (TFC) in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy (TULIP).Methods:Eighty-six American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, patients, aged 65-80 yr, with body mass index of 18-28 kg/m 2, scheduled for elective TULIP, were divided into 2 groups ( n=43 each) by the random number table method: fixed PEEP group (group C) and individualized PEEP titration group (group P). PEEP was set at 4 cmH 2O after routine mechanical ventilation in group C. Patients underwent pulmonary recruitment maneuvers combined with individualized PEEP titration during surgery in group P. TFC was measured using a non-invasive cardiac output monitor at 5 min after tracheal intubation (T 0), 30 min after PEEP titration and ventilation (T 1), 5 min before surgery (T 2), and 5 min before leaving the recovery room (T 3). Cardiac output, oxygenation index and stroke volume index were recorded from T 0-T 2, arterial blood gas analysis was simultaneously performed to record peak airway pressure and dynamic lung compliance, and oxygenation index was calculated. The duration of postanesthesia care unit stay, pulmonary complications within 7 days after surgery, and length of hospital stay were also recorded. Results:Eighty-three patients were finally included, with 42 in group C and 41 in group P. Compared with group C, TFC was significantly decreased at T 1-T 3, cardiac index, cardiac output and stroke volume index were decreased at T 1, dynamic lung compliance, PaO 2 and oxygenation index were increased at T 1 and T 2, PaCO 2 was decreased, the incidence of postoperative pulmonary complications was reduced, and the duration of postanesthesia care unit stay and postoperative length of hospital stay were shortened in group P ( P<0.05). Conclusions:Individualized PEEP titration based on open-lung strategy can effectively decrease TFC and improve intraoperative oxygenation and prognosis in elderly patients undergoing TULIP.

OBJECTIVES: This study aimed to observe the clinical and immune response characteristics of vaccinated persons infected with the delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Yangzhou, China. METHODS: We extracted the medical data of 129 patients with delta-variant infection who were admitted to Northern Jiangsu People's Hospital (Yangzhou, China) between August and September, 2021. The patients were grouped according to the number of vaccine doses received into an unvaccinated group: a one-dose group and a two-dose group. The vaccine used was SARS-CoV-2-inactivated vaccine developed by Sinovac. We retrospectively analyzed the patients' epidemiological, clinical, laboratory, and imaging data. RESULTS: Almost all patients with delta-variant infection in Yangzhou were elderly, and patients with severe/critical illness were over 70 years of age. The rates of severe/critical illness (P=0.006), fever (P=0.025), and dyspnea (P=0.045) were lower in the two-dose group than in the unvaccinated group. Compared to the unvaccinated group, the two-dose group showed significantly higher lymphocyte counts and significantly lower levels of C-reactive protein (CRP), interleukin-6 (IL-6), and D-dimer during hospitalization and a significantly higher positive rate of immunoglobulin G (IgG) antibodies at admission (all P<0.05). The cumulative probabilities of hospital discharge and negative virus conversion were also higher in the two-dose group than in the unvaccinated group (P<0.05). CONCLUSIONS Two doses of the SARS-CoV-2-inactivated vaccine were highly effective at limiting symptomatic disease and reducing immune response, while a single dose did not seem to be effective.
Aged ; Aged, 80 and over ; Humans ; COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; Critical Illness ; Immunity ; Retrospective Studies ; SARS-CoV-2 ; Vaccines, Inactivated/adverse effects* ; Viral Vaccines/adverse effects*

The main lysosomal protease cathepsin D (cathD) is essential for maintaining tissue homeostasis via its degradative function, and its loss leads to ceroid accumulation in the mammalian nervous system, which results in progressive neurodegeneration. Increasing evidence implies non-proteolytic roles of cathD in regulating various biological processes such as apoptosis, cell proliferation, and migration. Along these lines, we here showed that cathD is required for modulating dendritic architecture in the nervous system independent of its traditional degradative function. Upon cathD depletion, class I and class III arborization (da) neurons in Drosophila larvae exhibited aberrant dendritic morphology, including over-branching, aberrant turning, and elongation defects. Re-introduction of wild-type cathD or its proteolytically-inactive mutant dramatically abolished these morphological defects. Moreover, cathD knockdown also led to dendritic defects in the adult mushroom bodies, suggesting that cathD-mediated processes are required in both the peripheral and central nervous systems. Taken together, our results demonstrate a critical role of cathD in shaping dendritic architecture independent of its proteolytic function.

Objective: To evaluate the role of microRNA-125b (miR-125b) on ventilator-induced lung injury (VILI) in mice. Methods: Forty healthy male C57BL/6 male mice, weighing 25-30 g, aged 2-3 months, were divided into 4 groups (n=10 each) using a random number table method: sham operation group (group Sham), group VILI, VILI plus miR-125b negative control group (group VILI+ NC), and VILI plus miR-125b overexpression group (group VILI+ miR-125b agomir). In VILI+ NC and VILI+ miR-125b agomir groups, miR-125b negative control and miR-125b agomir transfection complex 50 μl were intratracheally instilled, respectively, and 48 h later VILI model was established.The animals were mechanically ventilated for 4 h with high tidal volume (40 ml/kg) to induce VILI.Blood samples were obtained from the femoral artery at 4 h of mechanical ventilation for detection of PaO₂, then animals were sacrificed, lungs were removed for determination of wet to dry weight ratio (W/D ratio) and for examination of pathological changes (with a light microscope), and lung injury was scored.In VILI+ NC and VILI+ miR-125b agomir groups, bronchoalveolar lavage fluid (BALF) was collected to measure the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay.The cell apoptosis of lung tissues was measured using TUNEL, apoptosis index was calculated, the caspase-3 expression was detected by Western blot, and the miR-125b expression was detected by real-time polymerase chain reaction. Results: Compared with Sham group, PaO₂ was significantly decreased, and W/D ratio and lung injury score were increased in VILI, VILI+ NC and VILI+ miR-125b agomir groups, and the expression of miR-125b was down-regulated in VILI and VILI+ NC groups (P<0.05). Compared with VILI group, PaO₂ was significantly increased, W/D ratio and lung injury score were decreased, the expression of miR-125b was up-regulated (P<0.05), the pathological changes of lung tissues were significantly attenuated in group VILI+ miR-125b agomir, and no significant change was found in the parameters mentioned above in group VILI+ NC (P<0.05). Compared with group VILI+ NC, the concentrations of TNF-α and IL-6 in BALF and apoptotic index were significantly decreased, and the expression of caspase-3 was down regulated in group VILI+ miR-125b agomir (P<0.05). Conclusion MiR-125b is involved in the endogenous protective mechanism of VILI in mice.

Objective To identify the risk factors for postoperative fatigue syndrome(POFS)in outpatients with painless gastroscopy.Methods The outpatients received painless gastroscopy from October 2016 to February 2017 in our hospital were included in this study.The possible factors related to POFS were summarized by reviewing the relevant literature.The questionnaires were completed by the methods such as preoperative interview,intraoperative recording,and telephone follow-up.POFS occurrence,score and outcomes were evaluated.The patients were divided into POFS group(groupⅠ)and non-POFS group(groupⅡ)according to whether POFS occurred.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors.Results Two hundred and forty-six patients completed this study.Sixty-nine cases developed POFS,and the incidence was 28.0％,the initial fatigue score was(5.2±2.4),and the duration of POFS was 3(9)h.The mean con-sumption of propofol(according to anesthesia time,mg/min)was an independent risk factor for POFS.Conclusion The mean consumption of propofol is an independent risk factor for POFS in outpatients with painless gastroscopy.

Objective: To identify the risk factors for postoperative fatigue syndrome (POFS) in outpatients with painless gastroscopy. Methods: The outpatients received painless gastroscopy from October 2016 to February 2017 in our hospital were included in this study.The possible factors related to POFS were summarized by reviewing the relevant literature.The questionnaires were completed by the methods such as preoperative interview, intraoperative recording, and telephone follow-up.POFS occurrence, score and outcomes were evaluated.The patients were divided into POFS group (groupⅠ) and non-POFS group (groupⅡ) according to whether POFS occurred.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors. Results: Two hundred and forty-six patients completed this study.Sixty-nine cases developed POFS, and the incidence was 28.0%, the initial fatigue score was (5.2±2.4), and the duration of POFS was 3(9) h. The mean consumption of propofol (according to anesthesia time, mg/min) was an independent risk factor for POFS. Conclusion The mean consumption of propofol is an independent risk factor for POFS in outpatients with painless gastroscopy.

Objective To investigate the effect of different serum sodium levels on heart function and prognosis in very elderly patients with heart failure. Methods Totally 152 elderly patients(aged ≥ 85 years)with hyponatremia were enrolled.Based on the serum sodium level ,they were divided into mild(125 mmol/L ≤ Na+ < 135 mmol/L) ,moderate(125 mmol/L ≤ Na+ < 135 mmol/L) ,and severe hyponatremia(Na+ < 115 mmol/L)groups ,and 76 patients with normal blood sodium level(Na+ ≥ 135 mmol/L)were selected as control group. The general data ,levels of serum creatinine and N-terminal pro-brain natriuretic peptide (NTproBNP)and prognosis were compared among the above groups. Results Compared with the control group ,patients with severe hyponatremia were much older ,with more diuretics administration ,higher level of serum creatinine , lowerlevelofeGFRandleftventricularejectionfractions[(38.1±3.9)％ vs.(45.2±9.7)％ ].There were higher incidences of coronary atherosclerotic heart disease [72.4％ (n=21)vs. 56.6％ (n=43)] ,diabetes[41.4％ (n=12)vs. 23.7％ (n=18)] ,chronic renal insufficiency [22.6％ (n=8)vs. 11.8％ (n=9)] ,stroke[20.6％ (n=6)vs. 9.2％ (n=7)]in patients with severe hyponatremia compared with other groups. The severe hyponatremia group showed significantly higher levels of NTproBNP [(4823. 9 ± 588. 1 )ng/L v s. (1124. 4 ± 349. 1 )ng/L ,(1836. 2 ± 369. 3 )ng/L ,(2894. 1 ± 687. 3 )ng/L ]and higher rates of mortality [27.6％ (n=8) vs.5.3％ (n=4) ,7.6％ (n=6) ,13.6％ (n=6)]as compared to the control group ,mild and moderate hyponatremia groups. Furthermore ,length of stay in hospital were markedly longer in patients with severe hyponatremia than those with mild and moderate hyponatremia[(11.1 ± 7.1)d vs. (19.6 ± 5.7)d ,(16.1 ± 4.2)d] . Conclusions Hyponatremia is a common type of electrolyte disorder in very elderly patients with heart failure ,and severe hyponatremia may predictand increased risk of death.

Objective To assess the accuracy and feasibility of respirophasic variation in carotid artery blood flow peak velocity (△Vpeak-CA) as predictors of fluid responsiveness in laparoscopic surgery.Methods Fifty-five patients undergoing laparoscopic surgeries,29 males and 26 females,aged 45-75 years,ASA physical status Ⅰ-Ⅲ,with body mass index 20-24 kg/m2,were enrolled.When intra-abdominal pressure was steady at the level of 13-15 mm Hg,6％ hydroxyethylstarch (HES 130/0.4) 500 ml was infused at the speed of 7 ml/kg within 20 minutes.After volume expansion,subjects were classified as responders (group R,n =32) if cardiac index increased (△CI) was≥ 15％ and no responders (group NR,n =23) as △CI＜15％.The receiver operating characteristic curve (ROC) curve for △Vpeak-CA in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under curve (AUC) and 95 ％ confidence interval (CI) was calculated.Cardiac index (CI),△Vpeak-CA and stroke volume variation (SW) were independently recorded at 5 minutes after induction (T1),5 minutes after intra-abdominal pressure were stable at the level of 13-15 mm Hg (T2) and 5 minutes after volume expansion (T3).Results △Vpeak-CA is highly negatively correlated with CI (r=-0.843,P＜0.001).The results of ROC curve analysis showed,△Vpeak-CA threshold discriminated between responders and non-responders with a sensitivity of 81.3％ and a specificity of 91.3％,and the AUC was 0.884 (95％ CI 0.793-0.975).Conclusion △Vpeak-CA seems to be a highly feasible and reliable predictor for fluid responsiveness in laparoscopic surgery patients.