ABSTRACT
BACKGROUND: One possible area of intervention to prevent postoperative delirium (PD) is intraoperative blood pressure management. However, the relationship between intraoperative blood pressure and PD is unclear. A secondary analysis of a RCT study examining the PD risk over the range of absolute intraoperative mean arterial blood pressure (MAP) readings and the corresponding relative changes from preoperative baseline level was performed to determine the role of MAP on PD. METHODS: Nonparametric locally weighted quadratic polynomial smoothing (LOESS) regression explored the pattern of PD risk at postoperative day 2 as a function of mean surgery MAP (msMAP) and percent change of msMAP from baseline in 103 elderly hip fracture patients. Segment-linear logistic regression models were then constructed to determine the odds ratios (OR) of PD over the observed range of these msMAP measures, adjusting for potential confounds. RESULTS: Twenty-three patients (22%) developed PD on day 2. LOESS regression revealed a j-shaped association between absolute levels of msMAP and PD risk. When msMAP was ≥80 mmHg, higher msMAP imparted greater PD risk (OR = 2.28 per 10 mmHg msMAP increase; 95% CI: 1.11-4.70), while higher msMAP was associated with lower PD risk (OR = 0.19 per 10 mmHg increase; CI: 0.05-0.76) if msMAP was <80 mmHg. There was no statistically significant relationship between PD risk and average percent change from baseline in these msMAP measures. CONCLUSION: In elderly hip fracture patients, both very high and very low levels of msMAP were associated with significantly increased risk of PD.
Subject(s)
Blood Pressure , Delirium/etiology , Hip Fractures/blood , Hip Fractures/complications , Postoperative Complications , Age Factors , Aged , Aged, 80 and over , Delirium/diagnosis , Female , Hip Fractures/surgery , Humans , Intraoperative Period , Male , Risk FactorsABSTRACT
BACKGROUND: HIV-infected patients are on the increase in Japan, and anti-HIV therapy improved their prognosis. It is expected that the number of operations in HIV patients will increase. METHODS: We surveyed the prevalence of HIV 30,188 patients operated at International Medical Center of Japan, a major, HIV/AIDS hospital, from 2001 to 2007. RESULTS: The number of HIV-positive cases was 389 in 7 years, and the prevalence of HIV seropositivity was 1.3% in total, 1.0% in scheduled, and 2.0% in emergent cases. The prevalence of male (2.0%) was higher than female (0.7%) patients and the prevalence was highest (9.2%) in male patients in their 30's. They were parallel with the HIV occurrence trend of Japan. The prevalence was the highest (2.4%) in the division of general surgery, as well as in obstetric and gynecology. The number of major surgery in HIV patients has been increasing. CONCLUSIONS: We assume that the perioperative management in each hospital has become more important. The annual trend of the number of the operations performed in HIV-positive patients at our hospital did not show annual changes.
Subject(s)
HIV Infections/epidemiology , Hospitals, Public/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Age Factors , CD4 Lymphocyte Count , Female , HIV Infections/diagnosis , Humans , Japan/epidemiology , Male , Mass Screening , Prevalence , Sex Factors , Time FactorsABSTRACT
An effective protein expression system was constructed in Escherichia coli using the promoter of the tyrosine phenol-lyase (tpl) gene of Erwinia herbicola. This system involves a mutant form of the TyrR protein with an enhanced ability to activate tpl and the TutB protein with an ability to transport L-tyrosine (an inducer of Tpl). The highest expression level obtained for this system was more than twice that obtained for the tac system, although it was lower than the level obtained for the T7 system, as revealed with the lac-reporter assay and SDS-polyacrylamide gel electrophoresis.
