Systematic review of clinical evidence on postoperative delirium: literature search of original studies based on validated diagnostic scales.

BACKGROUND: Postoperative delirium is a serious complication that can occur within the 5th postoperative day. In 2017, the European Society of Anesthesiologists delivered dedicated guidelines that reported the need for routine monitoring using validated scales. OBJECTIVE: Aim of this systematic review is to identify clinical studies related to postoperative delirium that included postoperative monitoring with validated scales. DESIGN: Systematic review METHODS: Searched keywords included the following terms: postoperative, postsurgical, post anesthesia, anesthesia recovery, delirium, and confusion. Two researchers independently screened retrieved studies using a data extraction form. RESULTS: Literature search led to retrieve 6475 hits; of these, 260 studies (5.6% of the retrieved), published between 1987 and 2021, included in their methods a diagnostic workup with the use of a postoperative delirium validated scale and monitored patients for more than 24 h, therefore are qualified to be included in the present systematic review. CONCLUSION: In conclusion, available clinical literature on postoperative delirium relies on a limited number of studies, that included a validated diagnostic workup based on validated scales, extracted from a large series of studies that used inconsistent diagnostic criteria. In order to extract indications based on reliable evidence-based criteria, these are the studies that should be selectively considered. The analysis of these studies can also serve to design future projects and to test clinical hypothesis with a more standardized methodological approach.

Detection of IgG3 antibodies specific to the human immunodeficiency virus type 1 (HIV-1) p24 protein as marker for recently acquired infection.

Reducing the risk of human immunodeficiency virus type 1 (HIV-1) transmission is still a public health priority. The development of effective control strategies relies on the quantification of the effects of prophylactic and therapeutic measures in disease incidence. Although several assays can be used to estimate HIV incidence, these estimates are limited by the poor performance of these assays in distinguishing recent from long-standing infections. To address such limitation, we have developed an assay to titrate p24-specific IgG3 antibodies as a marker of recent infection. The assay is based on a recombinant p24 protein capable to detect total IgG antibodies in sera using a liquid micro array and enzyme-linked immunosorbent assay. Subsequently, the assay was optimised to detect and titrate anti-p24 IgG3 responses in a panel of sequential specimens from seroconverters over 24 months. The kinetics of p24-specific IgG3 titres revealed a transient peak in the 4 to 5-month period after seroconversion. It was followed by a sharp decline, allowing infections with less than 6 months to be distinguished from older ones. The developed assay exhibited a mean duration of recent infection of 144 days and a false-recent rate of ca. 14%. Our findings show that HIV-1 p24-specific IgG3 titres can be used as a tool to evaluate HIV incidence in serosurveys and to monitor the efficacy of vaccines and other transmission control strategies.

Electrospinning induced surface activation (EISA) of highly porous PMMA microfiber mats for HIV diagnosis.

This work presents an Electrospray Induced Surface Activation (EISA) method generalization for electrospinning. It allows an easy way to produce surface functionalized microfiber mats for infectious disease diagnostic purposes. We present the details of both the production and characterization of surface functionalized highly porous poly methyl methacrylate (PMMA) microfiber mats produced using dry (DS) and wet substrate (WS) configurations. The characterization was performed using high-resolution scanning electron microscopy (HRSEM), Size Exclusion Chromatography (SEC), X-ray photoelectron spectroscopy (XPS) and biological essays attaching both the recombinant auto-fluorescent green fluorescent protein (GFP) and the anti-human Ig protein containing a fluorescent reporter R-phycoerythrin (AbPE). The final biological application assay was performed by positively detecting HIV contaminated human samples.

Molecular epidemiology of hepatitis C virus infection in an area of hyperendemicity in southern Italy: a population-based study.

In a cohort of subjects from Italy, anti-hepatitis C virus (HCV) and HCV RNA [HCV(+) subgroup] prevalences were 24.6 and 79.6%, respectively. HCV types 1b and 2a/c accounted for 95% of infections. Adjusted alanine aminotransferase levels were higher in males than in females and in RNA-positive subjects than in RNA-negative subjects regardless of HCV type. Genotype distribution was unrelated to demographic variables.

Protein kinase C modulator effects on parathyroid hormone-induced intracellular calcium and morphologic changes in UMR 106-H5 osteoblastic cells.

The effects of parathyroid hormone (PTH) on 1,4,5-inositol triphosphate (1,4,5-IP3) and intracellular free calcium (Cai2+) in osteoblasts are variable, whereas adenylate cyclase activity is consistently stimulated. Cyclic AMP is considered a mediator in the contractile effects of PTH on osteoblasts, but the regulation and role of Cai2+ remains unclear. Recent studies indicate that protein kinase C (PKC) inhibits PTH-stimulated Cai2+ increases in osteoblastic cells. Therefore, the objectives of this study were to determine the effects of PKC modulators and PTH on UMR 106-H5 rat osteoblastic cell morphology, and the relationship between cell shape and PTH-induced Cai2+ changes. In suspended cells loaded with the calcium indicator dye fura-2, pretreatment with PKC inhibitors calphostin C (100 nM x 1 h) and H-7 (30 microM x 18 h) potentiated the effects of 1 microgram/ml bPTH (1-84) on Cai2+ (83% increase over basal) by 1.4- and 1.65-fold, respectively. In comparison, PTH (10 ng-1 micrograms/ml) was without significant effect on adherent cell Cai2+ as measured by single-cell image analysis, although another in vitro bone resorbing agent, thrombin (10 U/ml), produced an acute 3-fold increase in the ratio (R) of emission (approximately lambda 510 nm) detected and optimized at lambda 348/374 nm (i.e., Ca-bound dye/free dye) in control cells. Phase-contrast microscopy revealed PKC inhibitor-treated cells changed from a spread configuration to a stellate form with retracting processes or cell rounding and a collapse of actin stress fibers. Within 1 h of PTH addition, PKC inhibitor-treated cells continually became extended/respread up to 3 h with an associated increase in actin stress fibers that was preceded by an acute 1.6-fold Cai2+ increase. In contrast, control or PKC activator-treated cells (phorbol 12,13-dibutyrate or 12-O-tetradecanoylphorbol-13-acetate; TPA) contracted/retracted within 5 min in response to PTH. A role for Cai2+ in PTH-induced cell spreading was further indicated by a contractile response to PTH when PKC-inhibitor-treated cells were loaded with the intracellular calcium chelator dimethyl BAPTA (3 microM x 30 min). PTH-induced Cai2+ increases in adherent PKC inhibitor-treated cells were also associated with a 1.8-fold 1,4,5-IP3 increase as measured by mass assay. The data suggest PKC contributes to UMR 106-H5 cell morphology and selectively regulates signal pathways activated by PTH to promote either cell contraction (cAMP) or extension (1,4,5-IP3/Cai2+).

Profilin forms tetramers that bind to G-actin.

Profilin binds to G-actin and affects polymerization. However, regulation of profilin function is generally unknown and controversy exists regarding profilin effects on actin polymerization. Because protein-protein interactions are implicated in many cellular responses, human platelet profilin self-association and actin inter-action was examined. Silver stained SDS-PAGE of poly-l-proline/sepharose 4B column purified profilin revealed the presence of profilin (14.8 kD) and extraneous higher bands (primarily 30 kD and 58.5 kD). Re-electrophoretic analysis of gel electroelution purified profilin yielded predominantly 14.8 kD and 58.5 kD proteins. Rabbit IgG antibodies made against gel electroelution-purified profilin recognized all profilin sizes on immunoblots. Capillary electrophoresis of profilin in solution produced a single peak that resolved into three distinct peaks upon addition of reducing agent or high salt conditions. Further, G-actin did not bind to 14.8 kD profilin on immunoblot overlay assays, but surprisingly bound only to 58.5 kD profilin. The data indicate that monomeric profilin forms tetramers which are the relevant high affinity actin-binding form.

E-cadherins identified in osteoblastic cells: effects of parathyroid hormone and extracellular calcium on localization.

The presence and regulation of cadherin localization in osteoblastic cells were examined. Monoclonal antibody (ECCD-1) that interferes with E-cadherin function prevented cell adhesion in UMR 106-H5 rat osteosarcoma cells and non-tumorigenic mouse calvarial MC3T3-E1 cells, whereas CCL39 fibroblast adhesion was not affected. Immunofluorescent antibodies (ECCD-2 and polyclonal L-CAMP P1) revealed cadherins are localized along the osteoblastic cell-cell boundaries. Exposure of UMR 106-H5 cells to bovine parathyroid hormone (1-84) (PTH; 10 ng/ml x 1 hr) or low calcium medium (1.0-0.025 mM) produced cellular retraction accompanied by intense immunofluorescence for cadherins throughout cells with a corresponding loss of punctate localization at remaining cell-cell adhesion points. Western immunoblot analysis indicated 108 kd and 115 kd cadherins are present, with a smaller 29.5 kd band that became predominantly associated with the cytosolic fraction of cells treated with parathyroid hormone or lowered calcium. The results demonstrate E-like cadherins are present in osteoblastic cells and implicate a regulatory role for parathyroid hormone and calcium in cadherin function and localization.

Modification of the complement induced by PGE2 and gonadotropins.

The Complement is one of the major effectors of the humoral aspecific immune system building up a defence mechanism of the organism. As it is known that some hormonal substances like gonadotropin (hCG) and some hormone-like substances (PGE2) influence the entire immunitary system, we wanted to see if they had specific action on the Complement. The measurement of CH50 was carried out using Mayer's method, derived by Ferrazzi and modified by us. Fractions C3 and C4 were measured by means of immunochemistry using Beckman nephelometer. The treatment with hCG (1,000 U + 10 Lf tetanus toxoid) caused an increase in the CH50 and in the fraction C3, while the fraction C4 was not modified. The treatment with PGE2 (0.25 microgram/rat/die) caused a higher increase of CH50 and C3 fraction. It seems possible to acknowledge C3 involvement in the variation of the Complement's haemolytic activity and this could confirm the intervention of the "alternative pathway". The notable increase in the activity of the Complement induced by hCG and PGE2 could indicate an alternative mechanism of activation of the aspecific humoral immunity in the defence of the organism in all those physio-pathological situations where these substances cause a state of depression of cellular mediated activity.

Fetal antigens as tumor growth enhancing factors in Yoshida's tumor rats.

Malignant neoplastic cells have been shown to have some antigenic features identical to those of embryonic cells. Since several antigens are likely to be shared by both embryonic cells and neoplastic tissue, we tried to understand the meaning of the appearance of such antigens and the type of effect that the immunization with embryonic antigens would have on the survival of Yoshida's tumor rats. Wistar rats were immunized with fetal antigens by fetal cells (1.5 x 10(6)) suspended in 0.5 ml of Hanks solution plus an equal volume of Freund adjuvant, were injected in hind footpads, i.p. and i.m., respectively, for active immunization. Rabbit antigen sera were used for passive immunization. All animals presented ascites and tumor growth. Animals immunized by means of fetal cell antigens showed a mean survival rate after neoplastic transplant of 14 days. Animals that received rabbit immune serum showed a mean survival rate after neoplastic transplant of 17 days. The immunization by means of fetal antigens elicited a scanty effect on the survival of Yoshida's tumor transplanted rats. It can be concluded that antibodies, which are able to cross react with neoplastic cells, do not have cytotoxic effect and do not interfere with the survival of the neoplastic transplanted animals. Therefore, fetal antigens are likely able to carry out an immunosuppressive action. The fact that they appear on neoplastic cells could be seen as a metabolic modification effect or as a growth enhancing factor.

[Pre-, intra- and postoperative somatosensory evoked potentials in cervical vertebral and spinal cord injuries]. / Potenziali evocati somatosensoriali pre-, intra- e postoperatori nei traumi vertebro-midollari cervicali.

Somatosensory Evoked Potentials (SEPs) to upper limb nerves stimulation, are able to detect cervical medullary dysfunction in case of cervical spine trauma. We have monitored cervical spinal cord functionality in 13 subjects with severe cervical spine trauma. In most of subjects, a prolonged P11onset-P13onset interval was found. Postoperatory a reduced P11onset-P13onset interval well correlates with clinical improving of medullary function. Intraoperatory, a transitory impairment of spinal cord function was found during medullary distraction and vertebral body fusion.

Properties and sidedness of 5'-nucleotidase in rat red cell ghosts.

The occurrence of a Mg++-activated 5'-AMPase activity in rat ghosts is demonstrated. This activity is inhibited by the alpha, beta-methyleneadenosine 5'-diphosphate, a specific inhibitor of 5'-nucleotidase. The enzyme has an apparent Km of approximately 90 microM, and is located on the exterior side of the plasma membrane.

Influence of age on 5'-nucleotidase in plasma membranes isolated from rat liver.

Studies were carried out to determine the kinetic properties of 5'-nucleotidase from liver plasma membranes in rats of different ages; four groups were examined, namely rats 25 +/- 2, 60 +/- 5, 230 +/- 15 and 525 +/- 20 days old. The 5'-nucleotidase showed minimum Vmax values in young rats; differences in this kinetic parameter were not detected among the other groups. However, the Km values increased during growth and development, declined in young animals and increased again in the middle-aged. Arrhenius plots of the 5'-nucleotidase activity showed a single break at aroung 22 degrees C in developing the middle-aged animals; the break temperature decreased to 17 degrees C in the rats 230 +/- 15 days old. The pH-Vmax and pH-Km curves showed a maximum at pH 7.6 at all ages. Lipid analysis of membrane preparations was carried out. Phospholipid composition did not change markedly with age. The cholesterol level decreased between 25 +/- 2 and 60 +/- 5 days. The degree of saturation of fatty acids seemed to increase in the same period, but reached the lowest value in the young rats. The results indicate that either sphingomyelin or other phospholipids do not affect the isothermal kinetics of 5'-nucleotidase during development and aging. Furthermore, phospholipid polar groups as well as the cholesterol and fatty acids of the bulk lipid phase modulate the membrane fluidity in the same way at different ages. Finally, the modifications of the Km with age cannot be correlated with changes in the surface charge.

[Influence of thyroid condition on 5'-nucleotidase activity of the plasma membrane in the rat liver]. / Influenza dello stato tiroideo sull'attivita' 5'-nucleotidasica della membrana plasmatica nel fegato di ratto.

The effect of thyroid hormones on the Kinetic properties of plasmatic membrane 5'-nucleotidase in rat liver is studied. The Vmax and Km which increased significatively a week after thyroidectomy were reported to the normal values by the chronic administration of T3. The decrease in Vmax and Km observed five weeks after thyroid ablation may be attributed to secondary effects occurring with time.

[Influence of age on the 5'-nucleotidase activity of the plasma membrane of rat liver: note II]. / Influenza dell'eta' sull'attivita' della 5'-nucleotidasi associata alla membrana plasmatica di fegato di ratto: nota II.

The effect of age on the kinetic properties of the plasma membrane 5'-nucleotidase in liver cells is studied. Vmax and Km and the discontinuity temperature are lower in the 230 +/- 15 days old rats. It appears that lipids do not affect the isotermic kinetic of the enzyme, while the decrease in the discontinuity temperature in the 230 +/- 15 days old animals might be related to the higher percent of insaturated fatty acids.

[Influence of the age on 5'-nucleotidase activity associated with the rat liver plasma membrane]. / Influenza dell'età sull'attività della 5'-nucleotidasi associata alla membrana plasmatica da fegato di ratto.

The influence of age on the isothermic and temperature-induced kinetics of the plasma membrane 5'-nucleotidase was studied in rat liver. The apparent Km values increased with age, while the Vmax, the temperature discontinuity and the Ex above and below the max break were unaffected.