The Impact of Incident Postoperative Delirium on Survival of Elderly Patients After Surgery for Hip Fracture Repair.

BACKGROUND: The impact of delirium on survival of elderly patients remains undetermined with conflicting results from clinical studies and meta-analysis. In this study, we assessed the relationship between long-term mortality and incident postoperative delirium in elderly patients undergoing hip fracture repair. METHODS: Patients ≥65 years old who were not delirious before undergoing hip fracture repair were included in a database maintained prospectively from March 1999 to July 2009. All participating patients underwent delirium assessment on the second postoperative day by using the confusion assessment method. Survival of the participants was determined as of October 2012. RESULTS: In 459 patients, the mean (SD) period of evaluation from surgery until death or study closure was 4.1 (3.5) years with patients followed for as long as 13.6 years. Preoperative cognitive impairment was present in 120 patients (26.1%), and delirium on the second postoperative day was observed in 151 (32.9%) of these patients. Although univariate analysis demonstrated a strong association between incident postoperative delirium and survival, this relationship did not persist in a multivariate model. Survival was a function of age at the time of surgery (P < 0.001), illness severity as determined by the ASA physical status score (P < 0.001), and duration of admission to the intensive care unit after surgery (P < 0.001). Incorporation of incident postoperative delirium did not meaningfully (P = 0.22) enhance the final survival model. In such a model, the hazard ratio (95% confidence interval) for incident postoperative delirium was 1.25 (0.92-1.48). CONCLUSIONS: Incident postoperative delirium was not significantly associated with decreased survival in elderly patients undergoing hip fracture repair.

Intranasal Deposition of Accuspray™ Aerosol in Anatomically Correct Models of 2-, 5-, and 12-Year-Old Children.

BACKGROUND: To our knowledge, quantification of intranasal deposition of aerosol generated by Accuspray(™) (AS) in children has never been published. We hypothesized that deposition would vary significantly with age and with placement of the device within, or outside, of the nostril. METHODS: We tested these hypotheses in anatomically-correct physical models based on CT scans of 2-, 5-, and 12-year-old children with normal, intranasal airways. Models included a removable anterior nose (AN) with exterior facial features and interior nasal vestibule and nasal valve area and a main nasal airway (MNA), subdivided into upper (superior turbinates and olfactory area), middle (middle turbinates), and lower (inferior turbinates and nasopharynx) thirds. Aerosol was generated from distilled water admixed with (99m)technetium pertechnetate and administered during static airflow by AS inserted inside the right nostril (eight runs/model), or outside the right nostril (six runs/model). Mean aerosol Dv(50) ± standard deviation was 67.8 ± 24.7 µm. Deposition was quantified by 2D gamma scintigraphy and expressed as percentage of the emitted dose. RESULTS: When placed inside the nostril, mean (± standard deviation) deposition within the MNA was significantly less in the 2-year-old, compared to the 5- and 12-year-old, averaging 46.8 ± 33.8% (AN:55.4 ± 29.9%), 75.4 ± 26.7% (AN:23.3 ± 13.6%), and 72.1 ± 18.5% (AN:25.8 ± 18.5%), respectively (p<0.05). When placed outside the nostril, MNA was significantly less in the 2- and 5-year-old compared to the 12-year-old, with 1.4 ± 2.5% (AN:69.7 ± 40.7%), 7.4 ± 9.0% (AN:77.8 ± 32.8%), and 21.1 ± 29.1% (AN:29.2 ± 19.3%), respectively (p<0.05). Deposition in the MNA of all age models was highest when AS was placed inside the nostril (p<0.05). Deposition in the lower third was significantly increased for the 5- and 12-year-old and in the middle third of the 5-year-old when AS was placed inside the nostril. CONCLUSIONS: These results indicate that age and device placement play important roles in terms of intranasal deposition, when administering aerosol with Accuspray(™) to children.

Feasibility study to quantify the auditory and social environment of older adults using a digital language processor.

OBJECTIVE: To investigate the feasibility of using a digital language processor (DLP) to objectively quantify the auditory and social environment of older adults. DESIGN: Thirty-seven participants aged 64 to 91 years residing in a retirement community were asked to wear a DLP to record their auditory and language environment during 1 waking day. Recordings were analyzed with specialized software to derive quantitative estimates such as the number of spoken words heard and percentage of time spent around meaningful speech versus television/radio. RESULTS: Adequate DLP recordings that began before 10 AM and lasted for 10 hours or greater were collected from 24 participants. The mean duration of recording was 13 hours and 13 minutes, and individuals spent a mean of 26.7% (range, 4%-58%) of their waking day near a television or other electronic sounds. The projected mean word count over a maximum of 16 hours was 33,141 with nearly a 14-fold range between the lowest and highest observed values (range, 5120-77,882). CONCLUSIONS: High-quality objective data on the auditory environment of older adults can be feasibly measured with the DLP. Findings from this study may guide future studies investigating auditory and language outcomes in older adults.

Weight gain after adenotonsillectomy is more common in young children.

OBJECTIVE: Adenotonsillectomy (TA), performed for obstructive sleep apnea (OSA) or recurrent tonsillitis (RT), has been associated with weight gain after surgery. The objective of this study was to look at a large population of children undergoing TA and the demographic factors that contribute to postoperative weight gain. STUDY DESIGN: Case series with retrospective chart review. SETTING: Tertiary, urban academic care center. SUBJECTS AND METHODS: Children undergoing TA at an academic center between 2008 and 2011 were included in this study. Demographic data (age, gender, race), OSA disease severity, preoperative and 3- to 6-month postoperative normalized body mass index (BMI; z-scores), and changes in z-scores were compared. RESULTS: Complete weight data after TA were available for 115 children, 85 of whom underwent surgery for OSA. Mean age (7.2 ± 4.3 vs 7.3 ± 4.4 years, P = .955) and gender distribution (38% female vs 50% male; P = .323) were similar for the OSA and RT groups. However, children with OSA were more likely to be black (60% vs 33%) than RT patients (P = .026). Overall, the preoperative BMI z-score increased from 0.98 ± 1.50 to 1.21 ± 1.25 (P = .0009) with no difference by surgical indication (P = .58). Multiple linear regression analysis demonstrated that only age was significantly, and negatively, associated with changes in BMI z-scores (P = .015). CONCLUSIONS: Similar to previous studies, children had weight gain after TA. In this analysis, younger age (≤ 6 years) was a significant predictor of postoperative weight gain. Future research should prospectively evaluate the association between weight gain and demographic factors in children undergoing TA, with special attention to the relationship with age.

Suprabasin is hypomethylated and associated with metastasis in salivary adenoid cystic carcinoma.

BACKGROUND: Salivary gland adenoid cystic carcinoma (ACC) is a rare cancer, accounting for only 1% of all head and neck malignancies. ACC is well known for perineural invasion and distant metastasis, but its underlying molecular mechanisms of carcinogenesis are still unclear. PRINCIPAL FINDINGS: Here, we show that a novel oncogenic candidate, suprabasin (SBSN), plays important roles in maintaining the anchorage-independent and anchorage-dependent cell proliferation in ACC by using SBSN shRNA stably transfected ACC cell line clones. SBSN is also important in maintaining the invasive/metastatic capability in ACC by Matrigel invasion assay. More interestingly, SBSN transcription is significantly upregulated by DNA demethylation induced by 5-aza-2'-deoxycytidine plus trichostatin A treatment and the DNA methylation levels of the SBSN CpG island located in the second intron were validated to be significantly hypomethylated in primary ACC samples versus normal salivary gland tissues. CONCLUSIONS/SIGNIFICANCE: Taken together, these results support SBSN as novel oncogene candidate in ACC, and the methylation changes could be a promising biomarker for ACC.