Risk Factors for Postoperative Cognitive Decline After Orthopedic Surgery in Elderly Chinese Patients: A Retrospective Cohort Study.

Purpose: We aimed to identify the risk factors for postoperative cognitive decline (POCD) by evaluating the outcomes from preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic interventions. Patients and Methods: Data used in the study were obtained from the Aged Patient Perioperative Longitudinal Evaluation-Multidisciplinary Trial (APPLE-MDT) cohort recruited from the Department of Orthopedics in Xuanwu Hospital, Capital Medical University between March, 2019 and June, 2022. All patients accepted preoperative CGA by the multidisciplinary team using 13 common scales across 15 domains reflecting the multi-organ functions. The variables included demographic data, scales in CGA, comorbidities, laboratory tests and intraoperative anesthetic data. Cognitive function was assessed by Montreal Cognitive Assessment scale within 48 hours after admission and after surgery. Dropping of ≥1 point between the preoperative and postoperative scale was defined as POCD. Results: We enrolled 119 patients. The median age was 80.00 years [IQR, 77.00, 82.00] and 68 patients (57.1%) were female. Forty-two patients (35.3%) developed POCD. Three cognitive domains including calculation (P = 0.046), recall (P = 0.047) and attention (P = 0.007) were significantly worsened after surgery. Univariate analysis showed that disability of instrumental activity of daily living, incidence rate of postoperative respiratory failure (PRF) ≥4.2%, STOP-Bang scale score, Caprini risk scale score and Sufentanil for maintenance of anesthesia were different between the POCD and non-POCD patients. In the multivariable logistic regression analysis, PRF ≥ 4.2% (odds ratio [OR] = 2.343; 95% confidence interval [CI]: 1.028-5.551; P = 0.046) and Sufentanil for maintenance of anesthesia (OR = 0.260; 95% CI: 0.057-0.859; P = 0.044) was independently associated with POCD as risk and protective factors, respectively. Conclusion: Our study suggests that POCD is frequent among older patients undergoing elective orthopedic surgery, in which decline of calculation, recall and attention was predominant. Preoperative comprehensive geriatric assessments are important to identify the high-risk individuals of POCD.

A New and Practical Model of Human-like Ascending Aorta Aneurysm in Rats.

INTRODUCTION: Ascending aortic aneurysm is a serious health risk. In order to study ascending aortic aneurysms, elastase and calcium ion treatment for aneurysm formation are mainly used, but their aneurysm formation time is long, the aneurysm formation rate is low. Thus, this study aimed to construct a rat model of ascending aorta aneurysm with a short modeling time and high aneurysm formation rate, which may mimic the pathological processes of human ascending aorta aneurysm. METHODS: Cushion needles with different pipe diameters (1.0, 1.2, 1.4 and 1.6 mm) were used to establish a human-like rat model of ascending aortic aneurysm by narrowing the ascending aorta of rats and increasing the force of blood flow on the vessel wall. The vascular diameters were evaluated using color Doppler ultrasonography after two weeks. The characteristics of ascending aortic aneurysm in rats were detected by Masson's trichrome staining, Verhoeff's Van Gieson staining and hematoxylin and eosin staining while RT-PCR were utilized to assess the total RNA of cytokine interleukin-1ß, interleukin 6, transforming growth factor-beta1 and metalloproteinase 2. RESULTS: Two weeks after surgery, the ultrasound images and the statistical analysis demonstrated that the diameter of the ascending aorta in rats increased more than 1.5 times, similar to that in humans, indicating the success of animal modeling of ascending aortic aneurysm. Moreover, the optimal constriction diameter of the ascending aortic aneurysm model is 1.4 mm by the statistical analysis of the rate of ascending aortic aneurysm and mortality rate in rats with different constriction diameters. CONCLUSIONS: The human-like ascending aortic aneurysm model developed in this study can be used for the studies of the pathological processes and mechanisms in ascending aortic aneurysm in a more clinically relevant fashion.

Recent Advances in Thallium Removal from Water Environment by Metal Oxide Material.

Thallium is widely used in industrial and agricultural development. However, there is still a lack of systematic understanding of its environmental hazards and related treatment methods or technologies. Here, we critically assess the environmental behavior of thallium in aqueous systems. In addition, we first discuss the benefits and limitations of the synthetic methods of metal oxide materials that may affect the practicality and scalability of TI removal from water. We then assess the feasibility of different metal oxide materials for TI removal from water by estimating the material properties and contaminant removal mechanisms of four metal oxides (Mn, Fe, Al, and Ti). Next, we discuss the environmental factors that may inhibit the practicality and scalability of Tl removal from water. We conclude by highlighting the materials and processes that could serve as more sustainable alternatives to TI removal with further research and development.

Firms' digitalization in manufacturing and the structure and direction of green innovation.

Green innovation will be one of the main drivers of future economic development. In the current wave of digital transformation, there is a paucity of literature that considers how corporate digital transformation affects green innovation and the characteristics of green innovation. Based on the data of China A-share listed manufacturing companies from 2007 to 2020, we find that digital transformation significantly improves corporate green innovation. This conclusion is robust to a series of robustness tests. The mechanism analysis finds that digital transformation promotes green innovation by increasing the investment of innovation resources and reducing the cost of debt. We further find that digital transformation significantly increases the number of citations of green patents, reflecting the pursuit of "quality" of green innovation by enterprises. At the same time, digital transformation is conducive to the simultaneous improvement of "source reduction" and "end-cleaning" green innovation, reflecting the combination of different pollution governance methods at the source and end of the enterprise. Finally, digital transformation can sustainably improve the level of green innovation. Our findings provide useful insights for promoting green technology innovation in emerging markets.

Comprehensive geriatric assessment for older orthopedic patients and analysis of risk factors for postoperative complications.

BACKGROUND: The comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool to reduce perioperative complications of geriatric patients, however there is no universally accepted standardization of CGA for orthopedic surgery. In this study, a novel CGA strategy was applied to evaluate the conditions of older patients undergoing orthopedic surgery from a broad view and to identify potential risk factors for postoperative complications. METHODS: A prospective cohort study was conducted from March 2019 to December 2020.The study enrolled patients (age > 75 years) for elective or confined orthopedic surgery. All patients were treated by a multidisciplinary team. A structured CGA was conducted to identify high-risk older patients and to facilitate coordinated multidisciplinary team care by a geriatric team. The basic patient characteristics, CGA results, postoperative complication and mortality rates were collected. Multivariate logistic regression analysis was used to identify risk factors for postoperative complications. RESULTS: A total of 214 patients with an age of 81.07 ± 4.78 (range, 75-100) years were prospectively enrolled in this study. In total, 66 (30.8%) complications were registered, including one death from myocardial infarction (mortality rate, 0.5%). Poor Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were accompanied by frailty, worse perioperative risk, pain, and nutritional status. Poor ADL was also associated with higher risks of falling, polypharmacy, and cardiac and respiration complications. Poor IADL was associated with a higher risk of cardiac and respiration complications. Higher stroke risk was accompanied by higher risks of cardiac complications, delirium, and hemorrhage. Worse American Society of Anesthesiologists (ASA) score was associated with worse ADL, IADL, frailty, and higher delirium risk. Multivariate logistic regression analysis showed that spinal fusion (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.65 to 0.83; p = 0.0214), blood loss(OR, 1.68; 95% CI, 1.31 to 2.01; p = 0.0168), ADL (severe dysfunction or worse) (OR, 1.45; 95% CI, 1.16 to 1.81; p = 0.0413), IADL (serious dependence) (OR, 1.08; 95% CI, 1.33 to 1.63; p = 0.0436), renal function (chronic kidney disease (CKD) ≥ stage 3a) (OR, 2.01; 95% CI, 1.54 to 2.55; p = 0.0133), and malnutrition(OR, 2.11; 95% CI, 1.74 to 2.56; p = 0.0101) were independent risk factors for postoperative complications. CONCLUSION: The CGA process reduces patient mortality and increases safety in older orthopedic surgery patients. Spinal fusion, blood loss, ADL (severe dysfunction or worse), IADL (serious dependence), renal function (CKD ≥ stage 3a) and nutrition mini nutritional assessment (MNA) (malnourished) were independent risk factors of postoperative complications following orthopaedic surgery in older patients.

Single-atom Ru loaded on layered double hydroxide catalyzes peroxymonosulfate for effective E. coli inactivation via a non-radical pathway: Efficiency and mechanism.

The Fenton-like processes are considered to be one of the most promising strategies for inactivating bacteria due to their capacity to produce reactive oxygen species (ROS). Herein, a catalytic system for efficient inactivation of Escherichia coli (E. coli) was developed by anchoring single-atom Ru on layered double hydroxides (LDH). The Ru/NiFe-LDH catalyst showed excellent performance in activating peroxymonosulfate (PMS) to inactivate E. coli. Under the combined action of the ultra-low concentrations of Ru/NiFe-LDH (40 mg/L) and PMS (5 mg/L), 7 log E. coli can be totally inactivated within 90 s. This was attributed to the combined effect of single-atom Ru adsorption to E. coli and the ROS produced in situ. Mechanism studies indicated that the 1O2 with electrophilic properties was the key active species responsible for the rapid inactivation of E. coli. The E. coli inactivation process suggested that the ROS produced first attacked the outer membrane of the cell, then the antioxidant enzymes in the cell were induced, the macromolecule substances were released and mineralized, eventually leading to irreversible cell death. This work firstly loads monoatomic Ru on LDH for bacterial inactivation, providing a feasible method for rapid inactivation of E. coli.

Assessment of the aggressiveness of rectal cancer using quantitative parameters derived from dual-energy computed tomography.

PURPOSE: To evaluate the value of quantitative parameters derived from dual-energy computed tomography (DECT) in assessing the aggressiveness of rectal cancer. MATERIALS AND METHODS: Seventy-eight patients with rectal cancers confirmed by pathology underwent contrasted DECT scans. The normalized iodine concentration (NIC) and normalized water concentration (NWC) of the tumor against artery and tumor sizes were measured. The quantitative parameters were compared and statistically analyzed between subgroups based on the following prognostic factors: pretreatment carcinoembryonic antigen (CEA) levels, mesorectal fascia (MRF) status, T stage (T1,2 and T3,4), N stage (N0 and N1,2), tumor differentiation grade (poor differentiation, poor-moderate differentiation, moderate differentiation, moderate-well differentiation, well differentiation), and extramural venous invasion. RESULTS: The differences of NIC values between MRF-free and MRF-invaded groups (P = 0.042), between T2 and T3-4 stage groups (P = 0.044), between N0 and N+ (N1, 2) groups (P = 0.036), between poor differentiation group and other differentiated groups (P < 0.05)were respectively significant. No significant differences of NIC values existed between CEA level or extramural venous invasion subgroups. For NWC values and tumor sizes, there were no significant differences between subgroups based on the prognostic factors above all. CONCLUSIONS: Higher NIC value is associated with a more aggressive tumor character. NIC value may have the potential to become an imaging biomarker of tumor aggressiveness.

Computed Tomography-Based Radiomic Features Could Potentially Predict Microsatellite Instability Status in Stage II Colorectal Cancer: A Preliminary Study.

RATIONALE AND OBJECTIVES: To investigate whether quantitative radiomics features extracted from computed tomography (CT) can predict microsatellite instability (MSI) status in an Asian cohort of patients with stage Ⅱ colorectal cancer (CRC). MATERIALS AND METHODS: This retrospective study was approved by our institutional review board, and the informed consent requirement was waived. From March 2016 to March 2018, 119 Chinese patients with pathologically confirmed stage Ⅱ CRC, available MSI status, and preoperative contrast-enhanced CT images were included in this study. Clinical and pathological information was obtained from the institutional database. The radiomics features were extracted from portal venous-phase CT images of segmented volumes of each entire primary tumor by using Matrix Laboratory (MATLAB), and radiomics signatures were generated using the least absolute shrinkage and selection operator logistic regression model. The minority group was balanced via synthetic minority over-sampling technique method. The association between the clinicopathologic characteristics and MSI status was assessed using Student's t test, Chi-square, or Fisher's exact test. The predictive efficacy of MSI status using radiomics features, clinical factors (including age, gender, CT-reported tumor location, differentiation degree of tumor, smoking history, hypertension history, family history of cancer, diabetes history, level of the Ki-67 expression, and laboratory analysis) and the combined models were evaluated, respectively. Predictive performance was evaluated by the area under receiver operating characteristic curve, accuracy, sensitivity, and specificity. RESULTS: MSI status was significantly associated with tumor location (p = 0.043); differentiation degree of tumor (p < 0.0001), hypertension history (p = 0.012), and the level of the Ki-67 expression (p = 0.015). Six radiomics features and 11 clinical characteristics were selected for predicting MSI status. The model that used the combination of clinical factors and radiomics features achieved the overall best performance than using either of the two features alone, yielding the area under the curve, sensitivity, and specificity of 0.752, 0.663, 0.841 for the combined model, 0.598, 0.371, 0.825 for clinical factors alone, and 0.688, 0.517, 0.858 for radiomics features alone, respectively. CONCLUSION: CT-based radiomic features of stage Ⅱ CRC are associated with MSI status. Combining analysis of clinical features and CT features could improve predictive efficacy and could potentially select the patients for individualized therapy noninvasively.

Correlations between the iodine concentrations from dual energy computed tomography and molecular markers Ki-67 and HIF-1α in rectal cancer: A preliminary study.

PURPOSE: To investigate whether dual energy computed tomography (CT) with iodine quantification is correlated with molecular markers Ki-67and hypoxia-inducible factor 1α (HIF-1α)in rectal cancer (RC). MATERIALS AND METHODS: Eighty patients (43 males and 37 females) diagnosed with rectal cancer got pelvic contrast-enhanced CT scan with dual energy computed tomography before any anticancer treatment. Analyse the normalized iodine concentration (NIC) values and CT values at each energy level (40-140 keV) from the virtual monochromatic image of the primary lesions. The postoperative specimens of all 80 patients underwent Ki-67 and HIF-1α immunohistochemistry staining. By SPSS17.0 software package, we analyzed the correlations of NIC values and CT values at each energy level (40-140 keV) with Ki-67 and HIF-1α expression. The receiver operating characteristic (ROC) curves of these dual energy computed tomography parameters were calculated and the diagnostic value were assessed. RESULTS: There was a weak positive correlation between NIC values and carcinoembryonic antigen level (r=0.246, P=0.028) in RC. Both the value and the level of Ki-67 expression were correlated positively with the NIC values (r=0.344, P=0.002 and r=0.248, P=0.026). HIF-1α expression was correlated positively with the NIC values of the RC (r=0.598, P<0.001). The best threshold values of NIC values in diagnosing the expression of HIF-1α was 0.5839. The sensitivity, 78%; specificity, 87%; PPV, 86%; NPV,79%;accuracy, 83%. CONCLUSION: The NIC values on dual energy computed tomography may be used as a measurement of hypoxia in RC and determining the ability of tumor invasion noninvasively.

Assessment of private economic benefits and positive environmental externalities of tea plantation in China.

Tea plantations are rapidly expanding in China and other countries in the tropical and subtropical zones, driven by relatively high private economic benefit. However, the impact of tea plantations on the regional environment, including ecosystem services and disservices are unclear. In this study, we developed an assessment framework for determining the private economic benefits and environmental externalities (the algebraic sum of the regulating services and disservices) of tea plantations in China. Our results showed that tea plantations provided private economic benefits of 5,652 yuan ha(-1) year(-1) (7.6 yuan = 1 USD in 2007) for tea farmers, plus positive environmental externalities of 6,054 yuan ha(-1) year(-1) for the society. The environmental externalities were calculated as the sum of the value of four regulating services, including carbon sequestration (392 yuan ha(-1) year(-1)); soil retention (72 yuan ha(-1) year(-1)); soil fertility protection (3,189 yuan ha(-1) year(-1)) and water conservation (2,685 yuan ha(-1) year(-1)), and three disservices, including CO2 emission (-39 yuan ha(-1) year(-1)), N2O emission (-137 yuan ha(-1) year(-1)) and nonpoint source pollution (-108 yuan ha(-1) year(-1)). Before the private optimal level, the positive environmental externalities can be maintained by private economic benefits; if a social optimal level is required, subsidies from government are necessary.