Association between perioperative self-reported sleep disturbances and delirium risk in elderly patients following total joint arthroplasty: a cohort study.

Perioperative sleep disturbance may increase delirium risk. However, the role of perioperative sleep disturbance in delirium following total joint arthroplasty remains unclear. This prospective cohort study aimed to observe the delirium risk in patients with sleep disturbances. After excluding pre-existing sleep disturbances, older patients scheduled for total joint arthroplasty from July 17, 2022, to January 12, 2023, were recruited. Preoperative sleep disturbance or postoperative sleep disturbance was defined as a Chinese version of the Richards-Campbell Sleep Questionnaire (RCSQ) score of <50 during hospitalisation. A cut-off score of 25 was used to classify the severity of sleep disturbance. The primary outcome was the incidence of postoperative delirium. In all, 11.6% of cohort patients (34/294) developed delirium. After multivariate analysis, a preoperative Day 1 RCSQ score of ≤25 (odds ratio [OR] 3.62, 95% confidence interval [CI] 1.19-10.92; p = 0.02), occurrence of sleep disturbances (OR 2.76, 95% CI 1.19-6.38; p = 0.02) and RCSQ score of ≤25(OR 2.91, 95% CI 1.33-6.37; p = 0.007) postoperatively were strong independent predictors of delirium. After sensitivity analysis for daily delirium, a postoperative Day 1 RCSQ score of ≤25 (OR 9.27, 95% CI 2.72-36.15; p < 0.001) was associated with a greater risk of delirium on postoperative Day 1, with a reasonable discriminative area under the curve of 0.730. We concluded that postoperative but not preoperative sleep disturbances may be an independent factor for delirium risk. Sleep disturbance on the first night after surgery was a good predictor of subsequent delirium, no matter the nature of self-reported sleep disturbance.

Improving Photocatalytic Water Treatment through Nanocrystal Engineering: Mesoporous Nanosheet-Assembled 3D BiOCl Hierarchical Nanostructures That Induce Unprecedented Large Vacancies.

Vacancy control can significantly enhance the performance of photocatalytic semiconductors for water purification. However, little is known about the mechanisms and approaches that could generate stable large vacancies. Here, we report a new mechanism to induce vacancy formation on nanocrystals for enhanced photocatalytic activity: the introduction of mesopores. We synthesized two nanosheet-assembled hierarchical 3D BiOCl mesoporous nanostructures with similar morphology and exposed facets but different nanosheet thickness. Positron annihilation analysis detected unprecedentedly large VBi‴ VO•• VBi‴ VO•• VBi‴ vacancy associates (as well as VBi‴ VO•• VBi‴) on BiOCl assembled from 3-6 nm nanosheets but only VBi‴ VO•• VBi‴ vacancy associates on BiOCl assembled from thicker (10-20 nm) nanosheets. Comparison of vacancy properties with 2D ultrathin 2.7 nm nanosheets (with VBi‴ VO•• VBi‴ and VBi‴) indicates that nanosheet thinness alone cannot explain the formation of such large atom vacancies. On the basis of density functional theory computations of formation energy of isolated Bi vacancy, we show that mesopores facilitate the formation of large vacancies to counterbalance thermodynamic instability caused by incompletely coordinated Bi and O atoms along the mesopore perimeters. We corroborate that the extraordinarily large VBi‴ VO•• VBi‴ VO•• VBi‴ vacancy associates facilitate photoexcitation of electrons and prevent the recombination of electron-hole pairs, which significantly enhances photocatalytic activity. This is demonstrated by the rapid mineralization of bisphenol A (10-5 M) with low photocatalyst loading (1 g L-1), as well as enhanced bacterial disinfection. Improved electron-hole separation is also corroborated by enhanced photocatalytic reduction of nitrate.

Synthesis of a novel adamantyl nitroxide derivative with potent anti-hepatoma activity in vitro and in vivo.

In this study, a novel adamantyl nitroxide derivative was synthesized and its antitumor activities in vitro and in vivo were investigated. The adamantyl nitroxide derivative 4 displayed a potent anticancer activity against all the tested human hepatoma cells, especially with IC50 of 68.1 µM in Bel-7404 cells, compared to the positive control 5-FU (IC50=607.7 µM). The significant inhibition of cell growth was also observed in xenograft mouse model, with low toxicity. Compound 4 suppressed the cell migration and invasion, induced the G2/M phase arrest. Further mechanistic studies revealed that compound 4 induced cell death, which was accompanied with damaging mitochondria, increasing the generation of intracellular reactive oxygen species, cleavages of caspase-9 and caspase-3, as well as activations of Bax and Bcl-2. These results confirmed that adamantyl nitroxide derivative exhibited selective antitumor activities via mitochondrial apoptosis pathway in Bel-7404 cells, and would be a potential anticancer agent for liver cancer.