Triglyceride-glucose index predicts postoperative delirium in elderly patients with type 2 diabetes mellitus: a retrospective cohort study.

BACKGROUND: Postoperative delirium (POD) is more prevalent among elderly patients with type 2 diabetes mellitus (T2DM). Insulin resistance (IR) can be assessed using the triglyceride-glucose (TyG) index, a novel biomarker. This study aims to investigate the predictive potential of the TyG index for POD in elderly patients with T2DM. MATERIALS AND METHODS: Elderly patients (≥ 65) with T2DM who underwent non-neurosurgery and non-cardiac surgery were enrolled. Univariate and multivariate logistic regression analyses were conducted to assess the association between the TyG index and POD. Additionally, subgroup analyses were performed to compare the sex-specific differences in the predictive ability of the TyG index for POD. RESULTS: A total of 4566 patients were included in this retrospective cohort. The receiver operating characteristic (ROC) curve analysis determined the optimal cut-off value for the TyG index to be 8.678. In the univariate model, a TyG index > 8.678 exhibited an odds ratio (OR) of 1.668 (95% CI: 1.210-2.324, P = 0.002) for predicting POD. In the multivariate regression models, the ORs were 1.590 (95% CI: 1.133-2.252, P < 0.008), 1.661 (95% CI: 1.199-2.325, P < 0.003), and 1.603 (95% CI: 1.137-2.283, P = 0.008) for different models. Subgroup analyses demonstrated that the predictive ability of the TyG index was more pronounced in females compared to males. CONCLUSION: The TyG index shows promise as a novel biomarker for predicting the occurrence of POD in elderly surgical patients with T2DM.

Association of sleep quality on the night of operative day with postoperative delirium in elderly patients: A prospective cohort study.

BACKGROUND: Sleep disturbances in the peri-operative period have been associated with adverse outcomes, including postoperative delirium (POD). However, research on sleep quality during the immediate postoperative period is limited. OBJECTIVES: This study aimed to investigate the association between sleep quality on the night of the operative day assessed using the Sleep Quality Numeric Rating Scale (SQ-NRS), and the incidence of POD in a large cohort of surgical patients. DESIGN: A prospective cohort study. SETTING: A tertiary hospital in China. PATIENTS: This study enrolled patients aged 65 years or older undergoing elective surgery under general anaesthesia. The participants were categorised into the sleep disturbance and no sleep disturbance groups according to their operative night SQ-NRS. MAIN OUTCOME MEASURES: The primary outcome was delirium incidence, whereas the secondary outcomes included acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively. RESULTS: In total, 3072 patients were included in the analysis of this study. Among them, 791 (25.72%) experienced sleep disturbances on the night of operative day. Patients in the sleep disturbance group had a significantly higher risk of developing POD (adjusted OR 1.43, 95% CI 1.11 to 1.82, P  = 0.005). Subgroup analysis revealed that age 65-75 years; male sex; ASA III and IV; haemoglobin more than 12 g l -1 ; intra-operative hypotension; surgical duration more than 120 min; and education 9 years or less were significantly associated with POD. No interaction was observed between the subgroups. No significant differences were observed in the secondary outcomes, such as acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively. CONCLUSIONS: The poor subjective sleep quality on the night of operative day was independently associated with increased POD risk, especially in certain subpopulations. Optimising peri-operative sleep may reduce POD. Further research should investigate potential mechanisms and causal relationships. TRIAL REGISTRY: chictr.org.cn: ChiCTR1900028545.

TET1 is a Diagnostic and Prognostic Biomarker Associated with Immune Infiltration in Papillary Thyroid Cancer.

To investigate the function of ten-eleven translocation 1 (TET1) and its underlying mechanism in papillary thyroid cancer (PTC). Using the RNA-Seq data based on GDC TCGA, we analyzed the gene expression pattern of TET1 in PTC. Immunohistochemistry was carried out to assess the TET1 protein level. Then, its diagnostic and prognostic functions were determined by various bioinformatics approaches. Enrichment analysis was performed to explore the potential pathways in which TET1 is mainly involved. Finally, the immune cell infiltration analysis was conducted and the association of TET1 mRNA expression with the expression levels of immune checkpoints, tumor mutation burden (TMB) score, microsatellite instability (MSI) score, and cancer stem cells (CSC) score was examined. TET1 expression was lower in PTC tissues compared with that in normal tissues (P < 0.01). Besides, TET1 had a certain value in diagnosing PTC, and low-TET1 mRNA expression led to favorable disease-specific survival (DSS) (P < 0.01). The enrichment analysis revealed autoimmune thyroid disease and cytokine-cytokine receptor interaction were the consistent pathways in which TET1 participated. TET1 was negatively correlated with the Stromal score and Immune score. The different proportions of immune cell subtypes were observed between high- and low-TET1 expression groups. Interestingly, TET1 mRNA expression was inversely related to the expression levels of immune checkpoints, and TMB, MSI, and CSC scores. TET1 might be a robust diagnostic and prognostic biomarker for PTC. TET1 affected the DSS of PTC patients possibly through the regulation of immune-related pathways and tumor immunity.

Risk factors prediction of 6-month mortality after noncardiac surgery of older patients in China: a multicentre retrospective cohort study.

BACKGROUND: Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large datasets can assist patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after noncardiac surgery using the clinical data from 11 894 older patients in China. MATERIALS AND METHODS: A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. The authors retrospectively included 11 894 patients (aged ≥65 years) who underwent noncardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality. RESULTS: The authors predicted 12 preoperative risk factors associated with 6-month mortality in older patients after noncardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By using a random forest model, the authors constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97). CONCLUSION: The authors identified 12 preoperative risk factors associated with 6-month mortality in noncardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.

Individualised positive end-expiratory pressure titrated intra-operatively by electrical impedance tomography optimises pulmonary mechanics and reduces postoperative atelectasis: A randomised controlled trial.

BACKGROUND: A protective intra-operative lung ventilation strategy has been widely recommended for laparoscopic surgery. However, there is no consensus regarding the optimal level of positive end-expiratory pressure (PEEP) and its effects during pneumoperitoneum. Electrical impedance tomography (EIT) has recently been introduced as a bedside tool to monitor lung ventilation in real-time. OBJECTIVE: We hypothesised that individually titrated EIT-PEEP adjusted to the surgical intervention would improve respiratory mechanics during and after surgery. DESIGN: Randomised controlled trial. SETTING: First Medical Centre of Chinese PLA General Hospital, Beijing. PATIENTS: Seventy-five patients undergoing robotic-assisted laparoscopic hepatobiliary and pancreatic surgery under general anaesthesia. INTERVENTIONS: Patients were randomly assigned 2 : 1 to individualised EIT-titrated PEEP (PEEPEIT; n = 50) or traditional PEEP 5 cmH2O (PEEP5 cmH2O; n = 25). The PEEPEIT group received individually titrated EIT-PEEP during pneumoperitoneum. The PEEP5 cmH2O group received PEEP of 5 cmH2O during pneumoperitoneum. MAIN OUTCOME MEASURES: The primary outcome was respiratory system compliance during laparoscopic surgery. Secondary outcomes were individualised PEEP levels, oxygenation, respiratory and haemodynamic status, and occurrence of postoperative pulmonary complications (PPCs) within 7 days. RESULTS: Compared with PEEP5 cmH2O, patients who received PEEPEIT had higher respiratory system compliance (mean values during surgery of 44.3 ±â€Š11.3 vs. 31.9 ±â€Š6.6, ml cmH2O-1; P < 0.001), lower driving pressure (11.5 ±â€Š2.1 vs. 14.0 ±â€Š2.4 cmH2O; P < 0.001), better oxygenation (mean PaO2/FiO2 427.5 ±â€Š28.6 vs. 366.8 ±â€Š36.4; P = 0.003), and less postoperative atelectasis (19.4 ±â€Š1.6 vs. 46.3 ±â€Š14.8 g of lung tissue mass; P = 0.003). Haemodynamic values did not differ significantly between the groups. No adverse effects were observed during surgery. CONCLUSION: Individualised PEEP by EIT may improve intra-operative pulmonary mechanics and oxygenation without impairing haemodynamic stability, and decrease postoperative atelectasis. TRIAL REGISTRATION: Chinese Clinical Trial Registry (www.chictr.org.cn) identifier: ChiCTR2100045166.

Mental health changes in elderly patients undergoing non-cardiac surgery during the COVID-19 pandemic in China.

BACKGROUND: The COVID-19 pandemic has a heavy impact on the mental health of elderly surgical patients worldwide. In particular, the elderly patients faced considerable psychological stress due to various environmental and medical factors during the outbreak. This study aims to examine changes in mental health trends among non-cardiac surgical patients aged 65 and above in China during the COVID-19 pandemic. METHODS: This multi-center, convenient sampling, longitudinal observational study was conducted from April 1, 2020 to April 30, 2022. Primary outcome was the prevalence of postoperative depression. Secondary outcome was the prevalence of postoperative anxiety. Follow-up was conducted separately at 7 days and 30 days after surgery. Depression symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9) scale. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (GAD-7) scale, with scores of ≥5 defining positive depression or anxiety symptoms. Multivariate logistic regression analysis was used to investigate risk factors of mental health status in more elderly patients undergoing non-cardiac surgery. RESULTS: A total of 4639 patients were included, of whom 2279 (46.0 %) were male, 752 (15.2 %) were over the age of 75, and 4346 (93.7 %) were married. The monthly prevalence trends demonstrated that compared to the outbreak period, a significant reduction in the prevalence of depression and anxiety symptoms in elderly patients who underwent surgery during the post-pandemic period. In post-pandemic period, a statistically significant decrease in the prevalence of all severity depression and anxiety patients was noted at the 7-day follow-up, but no significant decrease was observed for severe depression and anxiety in the 30-day follow-up. In COVID-19 low-risk area, a significant overall decrease in prevalence of mental health was observed during the post-pandemic period compared to the outbreak period, including 7-day depression, 7-day anxiety, 30-day depression, and 30-day anxiety (all with P < 0.001). Female and patients with ≥2 comorbidities appeared to be more susceptible to postoperative depression and anxiety during the pandemic. LIMITATION: The absence of data from the early days of the COVID-19 outbreak. CONCLUSIONS: This study analyzed the prevalence of depression and anxiety in elderly non-cardiac patients during and after the COVID-19 pandemic, focusing on dimensions such as severity, risk-areas, gender, and comorbidity. Our findings revealed a significant decrease in the prevalence of depression and anxiety in elderly surgery patients during the post-pandemic period.

HIF1A overexpression predicts the high lymph node metastasis risk and indicates a poor prognosis in papillary thyroid cancer.

Objective: To investigate the value of Hypoxia-inducible factor 1 A (HIF1A) in predicting lymph node metastasis (LNM) stage and clinical outcomes of papillary thyroid cancer (PTC) patients. Materials and methods: The HIF1A gene expression analysis in PTC was performed by bioinformatics approaches followed by evaluating its protein level using immunohistochemistry analysis. The role of HIF1A in predicting the LNM stage was evaluated by logistic regression analysis, nomogram construction, and receiver operating characteristic (ROC) analysis. We performed survival analyses to determine its prognostic value. Enrichment analysis was conducted, and immune cell infiltration and stromal content were evaluated to examine the underlying mechanism of HIF1A in PTC. Results: HIF1A transcription and protein levels were significantly high in PTC tissue (P < 0.05). Its overexpression predicted high LNM risk and unfavorable prognosis for PTC patients (P < 0.05). Cox regression analysis revealed HIF1A as an independent prognostic biomarker for the disease-free interval (DFI) (P < 0.01). In addition, HIF1A was positively related to tumor-suppressive immunity but was negatively correlated with anti-tumor immunity. HIF1A upregulation was also associated with increased stromal content. Conclusions: HIF1A overexpression is an independent predictor for worse DFI in PTC. The HIF1A expression may affect the prognosis of PTC patients through immune- and stroma-related pathways. Our study provides new insight into the role of HIF1A in PTC biology and clinical management.

Cancerous inhibitor of protein phosphatase 2A enhances chemoresistance of gastric cancer cells to oxaliplatin.

BACKGROUND: Cancerous inhibitor of protein phosphatase 2A (CIP2A) is a newly discovered oncogene. It is an active cell proliferation regulatory factor that inhibits tumor apoptosis in gastric cancer (GC) cells. CIP2A is functionally related to chemoresistance in various types of tumors according to recent studies. The underlying mechanism, however, is unknown. Further, the primary treatment regimen for GC is oxaliplatin-based chemotherapy. Nonetheless, it often fails due to chemoresistance of GC cells to oxaliplatin. AIM: The goal of this study was to examine CIP2A expression and its association with oxaliplatin resistance in human GC cells. METHODS: Immunohistochemistry was used to examine CIP2A expression in GC tissues and adjacent normal tissues. CIP2A expression in GC cell lines was reduced using small interfering RNA. After confirming the silencing efficiency, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide tetrazolium and flow cytometry assays were used to evaluate cell proliferation and apoptosis caused by oxaliplatin treatment. Further, the key genes and protein changes were verified using real-time quantitative reverse transcription PCR and Western blotting, respectively, before and after intervention. For bioinformatics analysis, we used the R software and Bioconductor project. For statistical analysis, we used GraphPad Prism 6.0 and the Statistical Package for the Social Sciences software version 20.0 (IBM, Armonk, United States). RESULTS: A high level of CIP2A expression was associated with tumor size, T stage, lymph node metastasis, Tumor Node Metastasis stage, and a poor prognosis. Further, CIP2A expression was higher in GC cells than in normal human gastric epithelial cells. Using small interfering RNA against CIP2A, we discovered that CIP2A knockdown inhibited cell proliferation and significantly increased GC cell sensitivity to oxaliplatin. Moreover, CIP2A knockdown enhanced oxaliplatin-induced apoptosis in GC cells. Hence, high CIP2A levels in GC may be a factor in chemoresistance to oxaliplatin. In human GC cells, CIP2A regulated protein kinase B phosphorylation, and chemical inhibition of the protein kinase B signaling pathway was significantly associated with increased sensitivity to oxaliplatin. Therefore, the protein kinase B signaling pathway was correlated with CIP2A-enhanced chemoresistance of human GC cells to oxaliplatin. CONCLUSION: CIP2A expression could be a novel therapeutic strategy for chemoresistance in GC.

Redescription of two species and a new distribution record for China of the genus MelanogryllusChopard, 1961 and a report of one new species of the genus Velarifictorus Randell, 1964 (Orthoptera: Gryllidae; Gryllinae).

Dark body color is very common among crickets, and this article discusses four species of black field crickets with distinct distributions. There are three species of the genus Melanogryllus Chopard, 1961 and one species of the genus Velarifictorus Randell, 1964. Of them, Melanogryllus chopardi Bey-Bienko, 1968 was discovered in Southwest Xizang, on the border between China and Nepal; Melanogryllus desertus (Pallas, 1771) was primarily found in arid regions of northwestern China; Melanogryllus bilineatus Yang & Yang, 1994 was often collected from the Southeast China coastal region; and the last species, Velarifictorus yuanilandrevus sp. nov., is a new species that was collected in Yunnan, a province in Southwest China. In addition, the new species could be distinguished from the others by its black body coloration and the absence of yellow stripes on the head. Here, we describe these species in detail, with photographs of the genitalia, and provide a distribution map for them and keys for Chinese Melanogryllus species.

Description of one new species of the genus Gymnogryllus (Orthoptera, Gryllidae, Gryllinae) from Cameroon with a key for African species.

During a Gryllidae survey in the Southern Cameroonian Plateau, one new species of the genus Gymnogryllus (Orthoptera, Gryllidae, Gryllinae) was discovered and described, namely Gymnogryllus bilongi Um Nyobe & Kekeunou sp. nov. This finding extends the number of species known of this genus in Cameroon at two and proposes a key for African species.

Pteronemobius yuani Ma & Wang sp. nov. and Metiochodes tianfuensis Ma, Yuan & Gu sp. nov., new species of Trigonidiidae from China (Orthoptera: Trigonidiidae; Trigonidiinae).

The article describes two new species of Trigonidiidae Saussure, 1874, namely Pteronemobius yuani Ma & Wang sp. nov. and Metiochodes tianfuensis Ma, Yuan & Gu sp. nov. The former belongs to Pteronemobius Jacobson, 1904, and is similar to Pteronemobius gifuensis (Shiraki, 1911) but has a long and narrow epiphallic median lobe, and the outer posterior tibia is armed with three dorsal spurs; while the latter belongs to Metiochodes Chopard, 1932, which is similar to Metiochodes flavescens Chopard, 1932, but the epiphallic median lobe is concave. Here, we describe and illustrate these new species.

Ultrastructural observation of digestive tract and the adaptative characteristics of dietary habits for ground-dwelling and omnivorous insects.

The digestive tract of insects from mouth to anus is the crop, proventriculus, gastric caecum, midgut, ileum, colon and rectum, and the Malpighian tubules attached to the ileum belong to the excretory organs. As the main organs for digesting food and absorbing nutrients, the structure of the insect digestive tract is inevitably adapted to feeding habits. Among the Orthoptera, the digestive tracts of phytophagous locusts and carnivorous katydids have been studied for their adaptations to their food habits, while the adaptations of the digestive tracts of omnivorous insects have been less studied. In order to systematically study the adaptations of the digestive tracts of ground-nesting omnivorous insects to their feeding habits, this study was carried out with Loxoblemmus taicoun Saussure, 1877, Teleogryllus emma (Ohmachi & Matsuura, 1951), and Velarifictorus micado (Saussure, 1877). Through the use of a scanning electron microscope (SEM) and a VHX digital microscope, the digestive tract structures of these three most widespread and common omnivorous crickets in China were examined in order to better understand how omnivorous insects digestive tract structures differ from those of specialists. When we compared the morphological features of these crickets digestive tracts to those of phytophagous and carnivorous insects, we discovered six adaptive traits of omnivorous insects, including: (1) they have a shorter foregut and longer midgut and hindgut; (2) they have a well-developed muscular intestinal wall; (3) the spines in the inner wall of their crop are uniformly arranged and less chitinized; (4) the proventriculus is sclerotized and spherical, and the inner wall is accompanied by ossified large teeth; (5) they have well-developed cilia at the base of the crop and at the base of the ossified denticles; (6) they have only two lobulated gastric caeca. The study summarizes six characteristics of the digestive tract of omnivorous crickets that are compatible with their food habits, providing evidence and clues for further research on the relationship between the digestive tract and food habits in Orthoptera.

Redescription of both Goniogryllus bistriatus Wu & Wang, 1992 and Callogryllus yunnanus Wu & Zheng, 1992 (Orthoptera: Gryllidae, Gryllinae).

Goniogryllus bistriatus Wu & Wang, 1992 was described at the end of the last century, based on the female holotype, and there have been no further studies or reports related to this species since then. Callogryllus yunnanus Wu & Zheng, 1992 also has a similar situation. Although the holotype is a male, its external genitalia have been lost. These issues pose obstacles to subsequent taxonomic research. Recently, we have successively discovered these two species in Huize County, Yunnan Province, China. To address the aforementioned taxonomic problems, this article describes the male specimens of the G. bistriatus and redescribes the female; meanwhile, since the original description of C. yunnanus lacked male genital characteristics, and we have also conducted a complete redescription of this species based on the new specimen.

A new genus and a new species of Trigonidiidae (Orthoptera: Grylloidea) from north Myanmar amber.

We present the description of a new genus and new species of Trigonidiidae, Qiongqi crinalis gen. et sp. nov., found in amber deposits at Noije Bum, near Tanai in the Hukawng Valley of northern Myanmar. Its lateralized eyes, short clypeus, exposed mandible, and extremely dense setae entirely covering the body, provides us with new knowledge on the morphology of Trigonidiidae. Additionally, a key to species of fossil Trigonidiidae in amber was provided.

Polionemobius gyirongensis sp. nov. from Tibet, China, and the identification of the species Polionemobius ebony Wu & Ma, 2022 and its close relative (Orthoptera: Trigonidiidae; Nemobiinae).

A new species, Polionemobius gyirongensis Ma & Wang, sp. nov., is reported from Tibet, China. Its appearance is similar to that of Polionemobius yunnanus Liu & Shi, 2014, with a small-sized body and oval notch on both sides of the pronotum. Description and illustrations for the new species are provided here. At the same time, we compared Polionemobius ebony Wu & Ma, 2022 and Pteronemobius nigriscens (Shiraki, 1911) and determined that they are different species.

Redescription of two species of Capillogryllus Xie, Zheng & Liang, 2003, with a new species from China (Orthoptera: Gryllidae; Gryllinae).

The species with a strongly pubescent body with the genus name Capillogryllus by Xie, Zheng, and Liang in 2003 are reviewed. Capillogryllus has presently two species, Capillogryllus exilipalpis Xie & Zheng, 2003 (type specimen is a female), and Capillogryllus dolabripalpis Xie & Zheng, 2003 (type species), both of which are only known from China at this time. In Gyirong County, Tibet, we discovered a new species of this genus that is distinct from the two species mentioned above. Here, three species of Capillogryllus are described and illustrated.

A morphological study of the ovipositor of the genus Capillogryllus Xie, Zheng & Liang, 2003 with a new species of the genus from China (Orthoptera: Gryllidae; Gryllinae).

The genus Capillogryllus includes three species, Capillogryllus dolabripalpis Xie & Zheng, 2003, Capillogryllus exilipalpis Xie & Zheng, 2003, Capillogryllus spinae Wu & Ma, 2023. Recently, we found a new species of this genus in Yadong County, Xizang Autonomous Region, and described it here. In addition, we found that the ovipositor varies greatly within this taxon, so we compare and characterize their ovipositor and discuss the feasibility of using the ovipositor alone to identify them. We also provide two keys based on the genitalia of males and females.

Ornebius exserolimbus Wang & Ma, sp. nov., a new species of Ornebius (Orthoptera: Mogoplistidae; Mogoplistinae) from China.

The Mogoplistidae genus Ornebius contains eight species groups and 124 species worldwide, with 14 species recorded from China. Here, we find a new species belonging to the species group alii Bhowmik, 1970 from Yunnan Province, China. The new species, Ornebius exserolimbus sp. nov., is distinct by bearing a protrusion on the anterior margin of the pronotum. This feature was first discovered in scale crickets and it might be related to some special locomotion function of crickets. Besides describing and illustrating the new species, we provide keys for Chinese Ornebius species in this article.