Incidence and risk factors of postoperative delirium after pancreatic cancer surgery: a retrospective study.

PURPOSE: Postoperative delirium (POD) commonly occurs after major abdominal surgery and is associated with increased morbidity and mortality. There have been many studies on the relationship between POD and various surgeries, but research on POD after pancreatic cancer surgery is limited. The aim of this study was to identify the incidence and risk factors of POD after pancreatic cancer surgery. METHODS: The subjects of this retrospective analysis were 196 patients who were transferred for postoperative care after pancreatic cancer surgery, to a 12-bed critical care medicine ward at Shandong Provincial Hospital, affiliated with Shandong First Medical University, between January 2015 and December 2019. The patients were divided according to whether they suffered POD into a delirium group and a non-delirium group. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit and two independent medical practitioners analyzed all the data. Univariate and multiple logistic regression analyses were performed. RESULTS: The overall delirium incidence was 20.41%, which increased to 29.03% for patients aged ≥ 70 years. POD was associated with age, smoking, the American Society of Anesthesiologists classification, the Acute Physiology and Chronic Health Evaluation II score, and the TNM stage of the cancer. The variables concerning sex, drinking, hypertension, a history of cerebral disease, surgery type, operation time, amount of bleeding, and the intraoperative use of dexmedetomidine did not differ significantly between the two groups. There was no significant difference in the length of ICU stay, with the exclusion of long-term stay for complications, between the groups, but POD tended to prolong the postoperative hospital stay and increase the risk of mortality. There was also a gradual decline in the incidence of POD between 2015 and 2019, especially from 2015 to 2018, after preventive measures were implemented. CONCLUSION: POD is related to many risk factors and worthy of attention. Appropriate management can reduce its incidence or at least shorten its duration.

Study on Dynamic Progression and Risk Assessment of Metabolic Syndrome Based on Multi-State Markov Model.

Aim: Metabolic syndrome (MetS) coexists with the occurrence and even death of cardiovascular disease and diabetes mellitus. It is essential to study the factors in the dynamic progression of MetS in the interest of prevention and control. Purpose: The aim of this study was to analyze the dynamic progression of Mets and explore the potential factors influencing the progression or reversal of MetS. Patients and Methods: This study involved 5581 individuals from two waves of the China Health and Retirement Longitudinal Study: 2011 and 2015. A multistate Markov model containing 4 states (free of metabolic disorder (FMD), mild metabolic disorder (MMD), severe metabolic disorder (SMD) and MetS) was adopted to study the dynamic progression of MetS and its influencing factors. Results: After follow-up, a total of 2862 cases (50.28% of the total number) had disease state transition. The intensity of transition from MetS to SMD is the same as that from SMD to MMD, and is greater than that from MMD to Mets (0.06 vs 0.05). For the MetS state, a mean of 1/0.08=12.5 years was spent in the MetS state before recovery. The exercise, smoke, drink, BMI level, hyperuricemia had statistically significant effects on progression of MetS status (P<0.05). The obesity or overweight, little exercise, smoke, drink and hyperuricemia increased the risk of forward progression of MetS disease status. There were significant nonmodifiable (age, gender) and modifiable factors (exercise, drink, BMI level, or high HbA1c) associated with reversion of MetS state. Conclusion: The likelihood of progression from MMD to MetS is less likely than that of reversion from MetS to SMD and SMD to MMD. Old females were more resistant to recover from worse states than males. Prevention and intervention measures should be adopted early when MMD or SMD onset occurs.

[Degradation of OG with Peroxymonosulfate Activated by a MnFe2O4-graphene Hybrid].

The rG-MnFe2O4 was synthesized by hydrothermal method and characterized by transmission electron microscopy (TEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and Raman spectra. The rG-MnFe2O4 was used to activate peroxymonosulfate (PMS) to decolorize azo dyes, e.g., Orange G, and the effect of PMS dosage, rG-MnFe2O4 loadings, initial pH, and the concentration of Cl- were investigated. The results indicated that the degradation rate of OG was 100% within 27 min with 0.3 g ·L-1 of rG-MnFe2O4 and at a 40:1 of PMS:OG molar ratio. The decolorization efficiency of OG increased with increasing PMS concentration and increasing rG-MnFe2O4 dosage. The initial pH had a significant effect on OG degradation, and pH 5.00 was most favorable for its decolorization. In addition, the addition of Cl- accelerated the decolorization of OG, and the decolorization rate increased with increasing concentration of Cl-. The rG-MnFe2O4 also exhibited an excellent reusability, and its activation of PMS was still observed after five rounds of tests. From the analysis of UV-vis spectra and gas chromatography-mass spectrometry (GC/MS), the naphthalene ring and azo band were found to be destroyed, with p-nitrophenol and phthalic acid as the main degradation products. Finally, a TOC analysis indicated that a certain degree of OG mineralization was obtained in the rG-MnFe2O4/PMS system.

Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.

INTRODUCTION: The Surviving Sepsis Campaign guidelines recommend early goal-directed therapy (EGDT) for the resuscitation of patients with sepsis; however, the recent evidences quickly evolve and convey conflicting results. We performed a meta-analysis to evaluate the effect of EGDT on mortality in adults with severe sepsis and septic shock. METHODS: We searched electronic databases to identify randomized controlled trials that compared EGDT with usual care or lactate-guided therapy in adults with severe sepsis and septic shock. Predefined primary outcome was all-cause mortality at final follow-up. RESULTS: We included 13 trials enrolling 5268 patients. Compared with usual care, EGDT was associated with decreased mortality (risk ratio [RR]: 0.87, 95% CI: 0.77-0.98; 4664 patients, 8 trials; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] quality of evidence was moderate). Compared with lactate clearance-guided therapy, EGDT was associated with increased mortality (RR: 1.60, 95% CI: 1.24-2.06; 604 patients, 5 trials; GRADE quality of evidence was low). Patients assigned to EGDT received more intravenous fluid, red cell transfusion, vasopressor infusion, and dobutamine use within the first 6 hours than those assigned to usual care (all P values < .00001). CONCLUSION: Adults with severe sepsis and septic shock who received EGDT had a lower mortality than those given usual care, the benefit may mainly be attributed to treatments administered within the first 6 hours. However, the underlying mechanisms by which lactate clearance-guided therapy benefits these patients are yet to be investigated.