The role of perioperative sedative anesthetics in preventing postoperative delirium: a systematic review and network-meta analysis including 6679 patients.

OBJECTIVE: Postoperative delirium is a common and debilitating complication that significantly affects patients and their families. The purpose of this study is to investigate whether there is an effective sedative that can prevent postoperative delirium while also examining the safety of using sedatives during the perioperative period. METHODS: The net-meta analysis was used to compare the incidence of postoperative delirium among four sedatives: sevoflurane, propofol, dexmedetomidine, and midazolam. Interventions were ranked according to their surface under the cumulative ranking curve (SUCRA). RESULTS: A total of 41 RCT studies involving 6679 patients were analyzed. Dexmedetomidine can effectively reduce the incidence of postoperative delirium than propofol (OR 0.47 95% CI 0.25-0.90), midazolam (OR 0.42 95% CI 0.17-1.00), normal saline (OR 0.42 95% CI 0.33-0.54) and sevoflurane (OR 0.39 95% CI 0.18-0.82). The saline group showed a significantly lower incidence of bradycardia compared to the group receiving dexmedetomidine (OR 0.55 95% CI 0.37-0.80). In cardiac surgery, midazolam (OR 3.34 95%CI 2.04-5.48) and normal saline (OR 2.27 95%CI 1.17-4.39) had a higher rate of postoperative delirium than dexmedetomidine, while in non-cardiac surgery, normal saline (OR 1.98 95%CI 1.44-2.71) was more susceptible to postoperative delirium than dexmedetomidine. CONCLUSION: Our analysis suggests that dexmedetomidine is an effective sedative in preventing postoperative delirium whether in cardiac surgery or non-cardiac surgery. The preventive effect of dexmedetomidine on postoperative delirium becomes more apparent with longer surgical and extubation times. However, it should be administered with caution as it was found to be associated with bradycardia.

Endovascular embolization of spontaneous massive hemorrhage of a facial plexiform neurofibroma: case report and literature review.

BACKGROUND: As a subtype of neurofibromatosis, the plexiform neurofibroma is a benign, autosomally inherited disorder and predisposed to tumour formation. However, life-threatening haemorrhage into facial plexiform neurofibroma is extremely rare. CASE INFORMATION: In the current study, we showed a facial plexiform neurofibroma case with massive haemorrhage in the cranio-maxillofacial region. An emergent selective angiography of the external carotid artery was performed to identify the offending artery, which was then selectively occluded by the combination of detachable coils and Onyx-34. Thus, the minimally invasive drainage surgery was successfully performed to evacuate the haematoma. CONCLUSION: We believe the endovascular embolization achieved its purpose by providing an initial salvage strategy for stopping active haemorrhage in plexiform neurofibroma, allowing surgeons to perform open surgery with lower complications rate.

[Blood pressure lowering efficacy of telmisartan and amlodipine taking on the morning or at bedtime: ABPM results].

OBJECTIVE: To observe the blood lowering effect of telmisartan and amlodipine taking on the morning or at bedtime in hypertensive patients. METHODS: A total of 108 individuals with hypertension (grade 2 or above) were randomized to receive telmisartan and amlodipine in one of the following four therapeutic schemes: Group A (26 cases): both medications taken on the morning; Group B (28 cases): both medication taken at bedtime; Group C (27 cases): telmisartan on the morning and amlodipine at bedtime; or Group D (27 cases): amlodipine on the morning and telmisartan at bedtime. ABPM was performed before and after 8 weeks treatment. RESULTS: BP was significantly reduced in 4 groups and the value of 24 hours SBP/DBP decline for each group after treatment was 29.94/16.32, 31.37/18.35, 29.49/17.30 and 25.80/15.51 mm Hg (1 mm Hg = 0.133 kPa) respectively (P < 0.05 vs. baseline). SI (smooth index) of 24 hours SBP/DBP was 1.79/1.34, 2.07/1.54, 1.70/1.43 and 1.55/1.32 respectively (P > 0.05). The night-time BP decline and the distributive difference of dipper, non-dipper, extreme dipper and reverse dipper pattern were similar among groups at both baseline and after various treatment regimens (all P > 0.05) . Morning blood pressure surge (MBPS) after treatment in group B declined more significantly than other groups (P < 0.05). CONCLUSION: Telmisartan/amlodipine administered either on the morning or at bedtime can effectively reduce blood pressure. The efficacy of BP lowering is independent of the drug taking time. There is a trend both in better BP lowering and less BP variability when two medications are administered at bedtime.

Introduction of a Novel, Continuous, Noninvasive Estimation of Intracranial Pressure and Cerebral Perfusion Pressure Based on Tympanic Membrane Temperature.

OBJECTIVE: Hydrocephalus is a common but potentially life-threatening condition. However, valve malfunction makes further diagnosis difficult. Thus, we tried to develop a noninvasive method to detect the hydrocephalus intracranial pressure (ICP) during routine follow-up. METHODS: In group I, the patient was recruited because a spinal tap test was necessary for either disease diagnosis or treatment. In group II, patients were diagnosed with high ICP hydrocephalus and received shunt surgery. The tympanic membrane temperatures (TMTs) were recorded and plotted against the spinal tap pressure (STP) and shunt valve pressures. RESULTS: All patients in group I showed an above-normal STP (from 180 to 400 mm H2O). The STP presents with an inverted U-shaped curve when it is plotted against TMT (R2 = 0.9). When the STP was 286.1 mm H2O, the TMT approached its peak value, which was 38.61°C (101.5°F). However, when ICP was in the normal range (50-200 mm H2O), the TMT correlated with ICP in a linear regression model (R2 = 0.69; P < 0.001). In addition, the cerebral perfusion pressure (CPP) was calculated and plotted against TMT. The TMT-CPP was also shown as a parabola (R2 = 0.74). Based on the TMT-ICP algorithm, we invented a noninvasive ICP monitor system, which performs in a manner comparable to the Codman ICP Transducer (R2 = 0.9; P < 0.01). CONCLUSIONS: Both Y-Jiang TMT-ICP and TMT-CPP algorithms are useful to monitor the shunt outcomes and identify potential shunt failure. More importantly, these algorithms open the possibility for the rational acquisition of ICP and CPP noninvasively.

Immiscible metallic melts in the deep Earth: clues from moissanite (SiC) in volcanic rocks.

The occurrence of moissanite (SiC), as xenocrysts in mantle-derived basaltic and kimberlitic rocks sheds light on the interplay between carbon, hydrogen and oxygen in the lithospheric and sublithospheric mantle. SiC is stable only at ƒO2 < ΔIW-6, while the lithospheric mantle and related melts commonly are considered to be much more oxidized. SiC grains from both basaltic volcanoclastic rocks and kimberlites contain metallic inclusions whose shapes suggest they were entrapped as melts. The inclusions consist of Si0 + Fe3Si7 ± FeSi2Ti ± CaSi2Al2 ± FeSi2Al3 ± CaSi2, and some of the phases show euhedral shapes toward Si0. Crystallographically-oriented cavities are common in SiC, suggesting the former presence of volatile phase(s), and the volatiles extracted from crushed SiC grains contain H2 + CH4 ± CO2 ± CO. Our observations suggest that SiC crystalized from metallic melts (Si-Fe-Ti-C ± Al ± Ca), with dissolved H2 + CH4 ± CO2 ± CO derived from the sublithospheric mantle and concentrated around interfaces such as the lithosphere-asthenosphere and crust-mantle boundaries. When mafic/ultramafic magmas are continuously fluxed with H2 + CH4 they can be progressively reduced, to a point where silicide melts become immiscible, and crystallize phases such as SiC. The occurrence of SiC in explosive volcanic rocks from different tectonic settings indicates that the delivery of H2 + CH4 from depth may commonly accompany explosive volcanism and modify the redox condition of some lithospheric mantle volumes. The heterogeneity of redox states further influences geochemical reactions such as melting and geophysical properties such as seismic velocity and the viscosity of mantle rocks.

[Experimental study on therapeutic efficacy of tetrandrine on lung injury induced by acute of paraquat poisoning].

OBJECTIVE: To investigate the antagonistic efficacy of tetrandrine (TET) on lung injury induced by acute paraquat poisoning. METHODS: Male Wistar rats were randomly divided into three groups (control group, non-treatment group and treatment group). The tetrandrine of 30 mg/kg was given by gastric lavage six hours after 32 rats were intraperitoneally injected with paraquat 15 mg/kg (treatment group). Then the same dose of tetrandrine was given once a day. Normal saline of the same volume was given by gastric lavage in another 32 rats intraperitoneally injected with paraquat 15 mg/kg (non-treatment group). Seven rats were intraperitoneally injected by normal saline as the control group. Levels of maleic dialdehyde (MDA), activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in plasma and the lung homogenate of three groups were determined at 3 d, 7 d, 14 d and 21 d after exposure to paraquat. Histological changes of the lungs were observed. RESULTS: The levels of MDA at 3 d both in plasma [(3.65 +/- 0.44) nmol/ml] and the lung homogenate [(9.54 +/- 0.92) nmol/mg pro] of the non-treatment group significantly increased compared with the control group (P < 0.01), the activities of GSH-Px and SOD in plasma at 3 d were significantly less than the control group (P < 0.05 or P < 0.01), the activities of GSH-Px (3 d, 7 d) and SOD (7 d, 14 d) in the lung homogenate were significantly less than the control group (P < 0.05). There were no significant difference in the levels of MDA both in plasma and the lung homogenate between the treatment group and the non-treatment group (P > 0.05). The SOD activities of treatment group on the third day was significantly increased compared with the non-treatment group (P < 0.01 or P < 0.05). Although the activities of GSH-Px in plasma and the lung homogenate of the treatment group on the third day were increased, there was no significantly difference compared with the non-treatment group (P > 0.05). The integral score of pulmonary fibrosis in the treatment group were significantly lower than in the non-treatment group (P < 0.01). CONCLUSION: TET has antagonistic effect against acute toxicity of paraquat through significant reduction of pulmonary fibrosis.

[Therapeutic efficacy of pralidoxime chloride on acute dichlorvos poisoning].

OBJECTIVE: To study the therapeutic efficacy and mechanism of oxime drug, pralidoxime chloride (PAM-Cl), on acute dichlorvos (DDV) poisoning. METHODS: The toxic signs and survival rate were recorded and ChE activity in blood was determined in treatment group with PAM-Cl and non-treatment group after DDV was given to rats and mice by gastrogavage; the therapeutic efficacy and reactivation of DDV-inhibited ChE by PAM-Cl were observed on the patients with acute DDV poisoning. RESULTS: (1) The alleviated and delayed toxic signs as well as higher survival rate were found in PAM-Cl treatment group compared with non-treatment group. (2) After the rats were exposed to DDV, the ChE activities of whole blood in different time within 24 h were statistically significantly higher in PAM-Cl treatment group than in non-treatment group (P < 0.05). (3) After PAM-Cl treatment, muscular fasciculation and other nicotinic signs in poisoned patients were disappeared and the inhibited blood ChE activities were gradually reactivated to normal level. CONCLUSION: PAM-Cl has therapeutic efficacy against acute toxicity of DDV through its reactivation of inhibited ChE.

[Therapeutic efficacy of N6-cyclopentyladenosine against acute dichlorvos poisoning].

OBJECTIVE: To study the therapeutic efficacy and mechanism of adenosine receptor agonist N(6)-cyclopentyladenosine (CPA) against acute dichlorvos poisoning. METHODS: Soon after a certain doses of dichlorvos were given to mice and rats by gastrogavage, physiological saline, CPA, atropine or pralidoxime chloride were administered to different groups. Toxic signs and survival rate were recorded and cholinesterase (ChE) activities and acetylcholine (ACh) concentrations in whole blood were determined in treatment group with CPA and non-treatment group after dichlorvos was given to rats by gastrogavage. RESULTS: (1) The alleviated and delayed appearance of toxic signs as well as obvious prolongation of survival time was observed in CPA treatment group compared with non-treatment group. (2) ChE activities in both treatment group with CPA [(0.49 +/- 0.05) U/ml] and non-treatment group [(0.52 +/- 0.04) U/ml] were significantly lower than that [(1.56 +/- 0.15) U/ml] of the control group (P < 0.01), but there was no significant difference between treatment group and non-treatment group (P > 0.05). (3) ACh concentration [(204.24 +/- 20.48) microg/ml] in whole blood of treatment group with CPA was significantly lower than that [(230.91 +/- 25.61) microg/ml] of non-treatment group (P < 0.05). CONCLUSION: CPA has therapeutic efficacy against acute dichlorvos poisoning, which is probably through the decrease in ACh concentration.

[Follow-up study on psychic and neuropathic delayed effects of acute organophosphorus pesticides poisoning].

OBJECTIVE: To study the delayed effect on neuropsychopathy and its related factors after acute organophosphorus pesticides poisoning (AOPP). METHODS: Two hundred and fifty-seven cases of AOPP in the observation period were chosen to follow-up 2 months later from the 4 county hospitals in Shandong Province where the incidence of organophosphorus pesticide poisoning is high. RESULTS: Nine cases of organophosphate induced delayed polyneuropathy (OPIDP) were found and the incidence rate was 3.5%. The occurrence of OPIDP were related to the need for emergent artificial respiration, and the degree of poisoning, and the kinds of organophosphorus pesticides (Ops). The positive rate of symptoms of peripheral nerves, central nerves and psychogeny except auditory and visual hallucination after poisoning was significantly higher than that before (P < 0.05). The patient's situation of health, economy and work became statistically worse (P < 0.05). CONCLUSION: We found some had delayed effects on neuropsychopathy after AOPP which could debase the patient's life quality. The control measure should be administered as early as possible.