A predictive scoring system for postoperative delirium in the elderly patients with intertrochanteric fracture.

OBJECTIVE: To establish a scoring system to predict the postoperative delirium in elderly patients with intertrochanteric fracture. MATERIALS AND METHODS: We retrospectively reviewed 159 elderly patients with a diagnosis of intertrochanteric fracture and underwent closed reduction and intramedullary nail fixation, and then divided them into two groups including the delirium group (23 cases) or non-delirium group (136 cases) in our hospital from January 2017 to December 2019. The following clinical characteristics were recorded and analyzed: age, gender, fracture classification, body mass index (BMI), history of diabetes mellitus, history of stroke, preoperative albumin, preoperative hemoglobin (Hb), preoperative arterial partial pressure of oxygen (PaO2), time between admission and surgery, lower limb thrombosis, American Society of Anesthesiologists (ASA) grade, operative time, operative blood loss, and intraoperative blood transfusion. The prevalence of these clinical characteristics in delirium group was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated. RESULTS: The predictive scoring system was based on five clinical characteristics confirmed as significant predictors of postoperative delirium, namely, age > 75 years, history of stroke, preoperative Hb ≤ 100 g/L, preoperative PaO2 ≤ 60 mmHg, and time between admission to surgery > 3 days. Delirium group showed a significant higher score than non-delirium (6.26 vs. 2.29, P < 0.001), and the optimal cut-off value for the scoring system was 4 points. The sensitivity and specificity of the scoring system for predicting postoperative delirium were 82.61% and 81.62% in derivation set, respectively, and 72.71% and 75.00% in validation set. CONCLUSION: The predictive scoring system confirmed with achieve satisfactory sensitivity and specificity in predicting postoperative delirium in the elderly with intertrochanteric fracture. The risk of postoperative delirium in patients with the score of 5 to 11 is high, while the score of 0 to 4 is low.

Development and in vitro characterization of drug delivery system of rifapentine for osteoarticular tuberculosis.

The study was to develop and evaluate the rifapentine-loaded poly(lactic acid-co-glycolic acid) (PLGA) microspheres (RPMs) for the treatment of osteoarticular tuberculosis to avoid critical side effects caused by oral regimens of antibiotics or intravenous antibiotics. The RPMs were spherical with rough surfaces, and elevated amounts of rifapentine in the formulation markedly increased the particle size and drug loading, while decreased the size distribution and entrapment efficiency. The highest drug loading and encapsulation efficiency of RPMs were 23.93%±3.93% and 88.49%±8.49%, respectively. After the initial rapid drug release, the release rate gradually decreased, and approximately 80% of the encapsulated rifapentine was released after 30 days of incubation. Moreover, RPMs could effectively inhibit the growth of Staphylococcus aureus. With increasing rifapentine content, the inhibition zones were continuously enlarged while the minimal inhibitory concentration values decreased. These results suggested that RPMs were bioactive and controlled release delivery systems for the treatment of osteoarticular tuberculosis.

[Low-dose lipopolysaccharide mediated up-regulation of Nrf2 attenuates inflammatory response in rats with spinal cord injury].

OBJECTIVE: To explore the neuroprotective effects of preconditioning with low-dose lipopolysaccharide (LPS) in rats after spinal cord injury and its possible mechanism. METHODS: Forty-eight female SD rats were randomly divided into four groups as follows: empty virus (EV), LPS combined with empty virus (LPS-EV), nuclear factor erythroid 2-related factor 2 (Nrf2) interference virus (NIV), and LPS combined with Nrf2 interference virus (LPS-NIV) (n=12 per group). The model of traumatic spinal cord injury (TSCI) was established by the modified Allen's method. Hind limb motor function of the rats was assessed by the Basso, Beattie and Bresnahan (BBB) score 3 days after the operation. The injured spinal cord tissues were harvested after the operation. The pathological changes of spinal cord were observed by HE staining. The Nissl body and neuron survival index were assessed by Nissl staining. The expressions of Nrf2, NF-κB and associated pro-inflammatory cytokines (IL-1ß, TNF-α) were detected by immunohistochemical staining and Western blotting. RESULTS: NIV group showed descended Nrf2 protein expression and ascended NF-κB, IL-1ß, TNF-α protein levels compared with EV group, and no significant difference from LPS-NIV group. The Nrf2 protein expression of LPS-EV group increased significantly compared with EV group and LPS-NIV group, and NF-κB, TNF-α and IL-1ß protein expression decreased significantly at the same time. Compared with those of EV group and LPS-NIV group, the neuron survival index of LPS-EV group was improved. The morphological change of LPS-EV group was also obviously alleviated. The BBB score had no statistical significance among these groups. CONCLUSION: Low-dose LPS preconditioning had neuroprotective effects on spinal cord injury. This protective effect was mediated by activating the Nrf2 to down-regulate expressions of NF-κB and pro-inflammatory cytokines and alleviate inflammatory response.

Physicochemical and biological properties of a novel injectable polyurethane system for root canal filling.

A root canal sealer with antibacterial activity can be efficacious in preventing reinfection that results from residual microorganisms and/or the leakage of microorganisms. In the present study, a series of injectable, self-curing polyurethane (PU)-based antibacterial sealers with different concentrations of silver phosphate (Ag3PO4) were fabricated. Subsequently, their physicochemical properties, antibacterial abilities, and preliminary cytocompatibilities were evaluated. The results indicated that the fabricated PU-based sealers can achieve a high conversion rate in a short amount of time. More than 95% of the isocyanate group of PU sealers with 3 wt% (PU3) and 5 wt% (PU5) concentrations of Ag3PO4 were included in the curing reaction after 7 hours. With the exception of those for film thickness for PU5, the results of setting time, film thickness, and solubility were able to meet the requirements of the International Organization for Standardization. The antibacterial tests showed that PU3 and PU5 exhibit stronger antimicrobial effects than that achieved with 1 wt% Ag3PO4 (PU1) and AH Plus (positive control) against Streptococcus mutans. The cytocompatibility evaluation revealed that the PU1 and PU3 sealers possess good cytocompatibility and low cytotoxicity. These results demonstrate that the PU3 sealer offers good physicochemical and antimicrobial properties along with cytocompatibility, which may hold great application potential in the field of root canal fillings.