Background
Delirium is common in elderly patients after surgery and is associated with poor outcomes. This study aimed to investigate the impact of intraoperative dexmedetomidine on the incidence of ...delirium in elderly patients undergoing major surgery.
Methods
This was a randomized double‐blind placebo‐controlled trial. Elderly patients (aged 60 years or more) scheduled to undergo major non‐cardiac surgery were randomized into two groups. Patients in the intervention group received a loading dose of dexmedetomidine 0·6 μg/kg 10 min before induction of anaesthesia followed by a continuous infusion (0·5 μg per kg per h) until 1 h before the end of surgery. Patients in the control group received volume‐matched normal saline in the same schedule. The primary outcome was the incidence of delirium during the first 5 days after surgery. Delirium was assessed with the Confusion Assessment Method (CAM) for non‐ventilated patients and CAM for the Intensive Care Unit for ventilated patients.
Results
In total, 309 patients who received dexmedetomidine and 310 control patients were included in the intention‐to‐treat analysis. The incidence of delirium within 5 days of surgery was lower with dexmedetomidine treatment: 5·5 per cent (17 of 309) versus 10·3 per cent (32 of 310) in the control group (relative risk (RR) 0·53, 95 per cent c.i. 0·30 to 0·94; P = 0·026). The overall incidence of complications at 30 days was also lower after dexmedetomidine (19·4 per cent (60 of 309) versus 26·1 per cent (81 of 310) for controls; RR 0·74, 0·55 to 0·99, P = 0·047).
Conclusion
Intraoperative dexmedetomidine halved the risk of delirium in the elderly after major non‐cardiac surgery. Registration number: ChiCTR‐IPR‐15007654 (
www.chictr.org.cn).
Antecedentes
El delirio después de la cirugía es frecuente en los pacientes de edad avanzada y se asocia con malos resultados. El objetivo de este estudio fue investigar el impacto de la administración intraoperatoria de dexmedetomidina en la incidencia de delirio en pacientes mayores sometidos a operaciones de cirugía mayor.
Métodos
Se trataba de un ensayo aleatorizado, doble ciego y controlado con placebo. Un total de 620 pacientes mayores (60 años o más) fueron programados para ser sometidos a intervenciones (no cardiacas) de cirugía mayor y se aleatorizaron a dos grupos. Los pacientes en el grupo de intervención recibieron una dosis de carga de dexmedetomidina (0,6 μg/kg, 10 minutos antes de la inducción anestésica) seguida de una infusión continua (0,5 μg/kg/h) hasta 1 h antes de la finalización de la cirugía. Los pacientes del grupo control recibieron el mismo volumen de suero salino siguiendo la misma pauta. El resultado principal era la incidencia de delirio durante los primeros 5 días postoperatorios. Para la valoración del delirio se utilizó el método para la evaluación de la confusión (Confusion Assessment Method, CAM) en pacientes no intubados y el CAM‐UCI para los pacientes intubados.
Resultados
En total, 309 pacientes que recibieron dexmedetomidina y 310 del grupo control se incluyeron en el análisis por intención de tratar. La incidencia de delirio durante los primeros 5 días tras la cirugía fue inferior en presencia de tratamiento con dexmedetomidina que en ausencia del mismo: 5,5% (17/309) versus 10,3% (32/310); riesgo relativo (RR) 0,53, i.c. del 95% 0,30‐0,94, P = 0,026. La incidencia global de complicaciones a los 30 días excluyendo el delirio también fue inferior en presencia que en ausencia de tratamiento con dexmedetomidina (19,4% (60/309) versus 26,1% (81/301), RR 0,74, i.c. del 95% 0,55‐0,99, P = 0,047).
Conclusión
La administración intraoperatoria de dexmedetomidina reduce la presencia de delirio en los pacientes mayores tras cirugía mayor no cardiaca.
In this RCT, intraoperative infusion of dexmedetomidine was found to reduce the rate of postoperative delirium and surgery‐related complications. The shortcomings of previous studies, such as study design and sample size, were amended, providing more robust evidence for clinical practice.
Halved the rate of delirium
Aims
We have developed a new diagnostic technique, termed loop‐mediated isothermal amplification coupled with lateral flow biosensor (LAMP‐LFB), which has been successfully applied to the detection ...of Aspergillus fumigatus.
Material and Methods
A set of six LAMP primers was designed according to the A. fumigatus‐specific anxC4 gene, which specifically recognized eight different regions of the target sequence. The LFB was employed for reporting the A. fumigatus‐LAMP results, and the visual readouts were obtained within 2 min. The strains of A. fumigatus species and non‐A. fumigatus species were used to test the assay's sensitivity and examine the analytical specificity of the target assay. Optimal LAMP conditions were 66°C for 50 min. The limit of detection is 100 fg. No cross‐reactions were obtained, and the specificity of LAMP‐LFB assay was 100%. The whole process of the assay, including 20 min of DNA preparation, 50 min of constant temperature amplification, and 2 min of detection by the sensor strip, took a total of 72 min (less than 75 min). Among 89 sputum specimens for clinical evaluation, 10 (11·23%) samples were A. fumigatus‐positive by LAMP‐LFB and traditional culture method, 9 (10·11%) samples were A. fumigatus‐positive by PCR method. Compared with culture method, the diagnostic accuracy of LAMP‐LFB method was 100%.
Conclusions
The novel LAMP‐LFB detection technology established in the current research is a rapid and reliable detection tool for A. fumigatus.
Significance and Impact of the Study
This novel LAMP‐LFB assay can quickly, specifically and sensitively detect A. fumigatus, thereby speeding up the detection process and increasing the detection rate. In addition, it can also be used as a new molecular method for detection of A. fumigatus in clinical and laboratory areas.
Adeno-associated virus (AAV) vectors are showing promise in gene therapy trials and have proven to be extremely efficient biological tools in basic neuroscience research. One major limitation to ...their widespread use in the neuroscience laboratory is the cost, labor, skill and time-intense purification process of AAV. We have recently shown that AAV can associate with exosomes (exo-AAV) when the vector is isolated from conditioned media of producer cells, and the exo-AAV is more resistant to neutralizing anti-AAV antibodies compared with standard AAV. Here, we demonstrate that simple pelleting of exo-AAV from media via ultracentrifugation results in high-titer vector preparations capable of efficient transduction of central nervous system (CNS) cells after systemic injection in mice. We observed that exo-AAV is more efficient at gene delivery to the brain at low vector doses relative to conventional AAV, even when derived from a serotype that does not normally efficiently cross the blood-brain barrier. Similar cell types were transduced by exo-AAV and conventionally purified vector. Importantly, no cellular toxicity was noted in exo-AAV-transduced cells. We demonstrated the utility and robustness of exo-AAV-mediated gene delivery by detecting direct GFP fluorescence after systemic injection, allowing three-dimensional reconstruction of transduced Purkinje cells in the cerebellum using ex vivo serial two-photon tomography. The ease of isolation combined with the high efficiency of transgene expression in the CNS, may enable the widespread use of exo-AAV as a neuroscience research tool. Furthermore, the ability of exo-AAV to evade neutralizing antibodies while still transducing CNS after peripheral delivery is clinically relevant.
•A comprehensive review on the properties of Cu6Sn5 is provided.•Crystal structure, mechanical properties and solidification behaviour are covered.•The review provides a rational basis for future ...scientific progress in Pb-free solders.
As the most common of the intermetallic compounds (IMCs) formed between Sn-based solders and Cu substrates during the packaging of integrated circuits (ICs), Cu6Sn5 is frequently involved in the fabrication of solder joints and plays an important role in the integrity of electronic devices. This is especially true for recently developed micro-bumps in 3-dimensional (3D) high-density integrated circuits (ICs), in which the volume fraction of Cu6Sn5 is significantly higher than in conventional ball grid array (BGA) or through hole pin (THP) arrangements. Recently, with the use of advanced characterization techniques, significant progress has been made in the understanding of Cu6Sn5 intermetallics in terms of their crystal structure, solidification behaviour, role in interface reactions, thermal expansion and mechanical properties. This improved understanding is of fundamental importance for the production of next generation electronic devices, however there is no existing comprehensive summary of this research available. Here, we provide a review on the properties of Cu6Sn5 with a focus on: (1) identification of crystal structure and possible phase transformations of Cu6Sn5 in real solder joints; (2) formation of Cu6Sn5 during solidification of commonly used Pb-free alloys and its influence on the final microstructure; (3) the formation and growth texture of interfacial Cu6Sn5; (4) thermal expansion and mechanical properties of Cu6Sn5 and the relationship between crystal structure and temperature. The effects of selected alloying elements that have remarkable influences on the above properties are also discussed. The aim of this paper is to identify the key factors that affect the properties of this important IMC and the relationship between these properties and the integrity of solder joints under various conditions.
A 5vol%SiC/AA2024 nanocomposite was prepared by a powder metallurgy routine involving high energy ball milling (HEBM), spark plasma sintering (SPS) and hot extrusion. The microstructures and ...mechanical properties of the 5vol%SiC/AA2024 nanocomposite samples prepared using different HEBM and SPS times were investigated in detail. It was found that increasing the milling time from 12 to 24 h caused refinement of Al grains and better dispersion of SiC nanoparticles, leading to a significantly increase of hardness and strength. Increasing the SPS time from 5 to 10 min helped to improve the quality of interparticle bonding, and resulted in grain growth and consequently the formation of a bimodal microstructure which is beneficial for the improvement of ductility. Optimized tensile mechanical properties were achieved in a 5vol%SiC/AA2024 nanocomposite with ball milling time of 24 h and SPS time of 10 min, with its yield strength, ultimate tensile strength and elongation to fracture being 463 MPa, 626 MPa and 4.4%, respectively. Based on the analysis of the contributions of different strengthening mechanisms to the strength, nanoparticle strengthening and grain boundary strengthening made the majority of the contributions to the improved strength of the 5vol%SiC/AA2024 nanocomposite.
•Optimized tensile mechanical properties were achieved in a 5vol%SiC/AA2024 nanocomposite.•Increasing ball milling time caused refinement of matrix and precipitates with better dispersion of SiC nanoparticles.•Increasing SPS time resulted in grain coarsening, bimodal microstructure, high quality of inter-particle bonding level.•Nanoparticle strengthening and grain boundary strengthening make the major contributions to the yield strength.
Previous studies have demonstrated that type 1 diabetes mellitus (T1DM) could be triggered by an early childhood infection. Whether maternal infection during pregnancy is associated with T1DM in ...offspring is unknown. Therefore, we aimed to study the association using a systematic review and meta-analysis. Eighteen studies including 4304 cases and 25 846 participants were enrolled in this meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were synthesised using random-effects models. Subgroup analyses and sensitivity analyses were conducted to assess the robustness of associations. Overall, the pooled analysis yielded a statistically significant association between maternal infection during pregnancy and childhood T1DM (OR 1.31, 95% CI 1.07-1.62). Furthermore, six studies that tested maternal enterovirus infection showed a pooled OR of 1.54 (95% CI 1.05-2.27). Heterogeneity from different studies was evident (I2 = 70.1%, P < 0.001) and was mainly attributable to the different study designs, ascertaining methods and sample size among different studies. This study provides evidence for an association between maternal infection during pregnancy and childhood T1DM.
Microbial diversity of pit mud (PM) plays a significant role in Baijiu's flavour. Here we explored the microbial community structures and aroma substances of Wenwang Winery with high‐throughput ...sequencing coupling with headspace solid‐phase microextraction‐gas chromatography‐mass spectrometry. We discovered that the odorant was mainly derived from 14 aroma compounds because of their OAVs ≥ 1 (OAV, the ratio of substance concentration to aroma threshold; s, on behalf of the plural), such as ethyl hexanoate (2438), ethyl octanoate (975), caproic acid (52) and etc. Moreover we also revealed that Lactobacillaceae (97·08%) was the mainly bacterial microbial community in 2‐year‐old PM, companied by the primarily fungi including Aspergillaceae (55·45%), Unclassified Ascomycota (11·13%) and Dipodascaceae (5·72%). Compared with the 2‐year‐old PM, bacterial floras in 20‐year‐old PM and 30‐year‐old PM were more abundant (i.e. Dysgonomonadaceae, Clostridium and Synerggstaceas), while no fungi were detected. Besides, the physicochemical analysis showed that the content of Lactobacillaceae was inversely associated with moisture, pH and ammonia nitrogen. By further Spearman's correlation coefficient analysis, we verified that the content of Lactobacillaceae was positively correlated with ethyl hexanoate, while negatively correlated with ethyl octanoate and caproic acid. Meanwhile, ethyl octanoate and caproic acid were positively correlated with most flora including Ruminococcaceae, Dysgonomonadaceae and Clostridiacea, which were related to physicochemical indexes. This work demonstrates promise for adjusting the physicochemical indexes of PM to affect the micro‐organisms and aroma, which may provide a reference for the production of high‐quality Baijiu.
Significance and Impact of the Study: Pit mud is a determining factor in the aroma of Baijiu. This study analysed the aroma substances, microbial composition and physicochemical indexes of pit mud in different years. So as to reveal the effects of physicochemical indexes on microbial communities and flavour substances. The results may provide a basis for studying the physicochemical indexes, community structure and flavour of Wenwang pits, offering a reference for optimizing the aroma and flavour of Baijiu.
CoCrFeNi and CoCrFeNiAl0.3 high entropy alloys reinforced with in-situ oxide nanoparticles have been successfully fabricated by mechanical milling in combination with hot pressing and hot extrusion. ...The as-fabricated CoCrFeNi samples exhibited an ultrafine grained microstructure with in-situ Cr2O3 oxide nanoparticles formed during hot pressing and extrusion process and distributed both on grain boundaries and in grain interiors. Increasing extrusion temperature from 1000 to 1100 °C caused a significantly increase of grain size from 700 nm to 2.5 μm owing to recrystallization and growth of the recrystallized grains, as well as the coarsening of Cr2O3 nanoparticles with their mean size increasing from 57 to 140 nm. When adding Al elements, finer Al2O3 nanoparticles (mean size: 30 nm) formed in the CoCrFeNiAl0.3 high entropy alloy, leading to refinement of the grains (mean size: 504 nm) due to their pinning effect on grain boundary immigration. After T6 heat treatment, the CoCrFeNiAl0.3 high entropy alloy demonstrated improved mechanical properties with yield strength of 1335 MPa, ultimate tensile strength of 1346 MPa and an elongation to fracture of 7.9%. With quantitative analysis based on the current models, it was concluded that grain boundary strengthening and Orowan strengthening acted as the dominant strengthening mechanisms.
Effective diagnostic methods for detecting latent tuberculosis infection (LTBI) are important for its eradication. A number of studies have evaluated the use of interferon-γ-induced protein 10 ...(IP-10), which is elevated after tuberculosis infection, as a biomarker for LTBI, but conclusive results regarding its effectiveness have not been reported.
Our objective was to assess the diagnostic value of IP-10 for LTBI.
We searched the PubMed, Embase, the Cochrane Library and Web of Science databases to find eligible studies.
We included cohort, case–control and cross-sectional studies that evaluated IP-10 in LTBI participants in comparison with tuberculin skin tests (TST) and interferon-γ release assays (IGRA).
Individuals with LTBI and uninfected participants.
IP-10 (index test) compared with TST and IGRA (reference standard) for diagnosing LTBI.
PubMed, Embase, the Cochrane Library, and Web of Science databases were searched up to June 2018. A hierarchical summary receiver operating characteristic (HSROC) model was used to evaluate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and HSROC curve for the diagnostic efficiency of IP-10.
Twelve studies including 1023 participants and 1122 samples were included. The overall pooled sensitivity was 0.85 (95% CI 0.80–0.88), specificity was 0.89 (95% CI 0.84–0.92), PLR was 7.55 (95% CI 5.20–10.97), NLR was 0.17 (95% CI 0.13–0.22) and DOR was 44.23 (95% CI 28.86–67.79), indicating a high accuracy for diagnosing LTBI. Based on a meta-regression analysis, high-burden countries, study design, IP-10 method, reference standard and the IP-10 cut-off could not explain the heterogeneity (p >0.05).
Our results suggested that IP-10 is a promising biomarker for the diagnosis of LTBI.
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