The prognostic validity of delirium severity as measured by Delirium Observation Screening Scale (DOS scale) on adverse outcomes.

OBJECTIVE: To investigate whether an assessment of delirium severity at diagnosis using the Delirium Observation Screening Scale (DOS scale) predicts adverse outcomes in hospital and on discharge. METHODS: A prospective cohort study was conducted on a convenience sample of patients admitted to an acute geriatric ward with delirium over an eight-month period. DOS scale was administered to the patients within 48 h of delirium diagnosis to measure delirium severity. Univariate logistic regression analysis was performed to evaluate the correlation between DOS scale and adverse outcomes. RESULTS: Fifty-nine patients were included in the study. There was a moderate correlation between increasing DOS scores and duration of delirium (r = 0.46, p < 0.001), as well as increasing DOS scores and decline in mobility on discharge (r = 0.35, p = 0.007). There was a weak correlation between increasing DOS scores and functional decline as measured by change in Katz Index from admission to discharge (r = -0.27, p = 0.04). No statistically significant correlations were found between DOS scores and in-hospital mortality, inpatient complication rates or discharge to higher level of care. CONCLUSION: Delirium severity as measured by DOS scale may be useful in predicting delirium duration and decline in mobility and function on discharge. Further research with larger sample sizes is needed to establish if this finding can be replicated and whether delirium severity predicts additional adverse outcomes. Measuring delirium severity at diagnosis may be useful for communicating prognostic information to family members and setting expectations and treatment goals.

A CMOS Temperature Sensor with a Smart Calibrated Inaccuracy of ±0.11 (3σ).

This paper presents a BJT-based smart CMOS temperature sensor. The analog front-end circuit contains a bias circuit and a bipolar core; the data conversion interface features an incremental delta-sigma analog-to-digital converter. The circuit utilizes the chopping, correlated double sampling, and dynamic element matching techniques to mitigate the effects of process bias and nonideal device characteristics on measurement accuracy. Furthermore, based on the principle of charge conservation, the dynamic range utilization of the ADC increases. We propose a neural network that uses a multilayer convolutional perceptron to calibrate the sensor output results. Using the algorithm, the sensor achieves an inaccuracy of ±0.11 °C (3σ), exceeding the accuracy of ±0.23 °C (3σ) achieved without calibration. We implement the sensor in a 0.18 µm CMOS process, occupying an area of 0.42 mm2. It achieves a resolution of 0.01 °C and has a conversion time of 24 ms.

Noncontact Conjunctiva: A Better Mitomycin C Application Site for Trabeculectomy.

INTRODUCTION: Bleb scarring is the most important complication of trabeculectomy. Changing the application position of mitomycin C (MMC) during trabeculectomy might affect the surgery outcome. Our aim is to compare the effectiveness and safety of intraocular pressure (IOP) lowering in two different application sites of mitomycin in trabeculectomy. METHODS: This retrospective trial compared the surgical outcomes of 177 eyes that underwent trabeculectomy with adjunctive mitomycin C. In 70 eyes, an MMC-soaked sponge was applied under the scleral flap without touching Tenon's capsule. In 107 eyes, an MMC-soaked sponge was applied under the scleral flap covered by Tenon's capsule. Outcome measures were the IOP, best-corrected visual acuity (BCVA), success rates, and incidence of complications. RESULTS: Within both groups, a highly significant IOP reduction was seen during follow-up. The effectiveness in reducing IOP and the change in best-corrected visual acuity (BCVA) were similar between the two groups. Thin-walled blebs and postoperative hypotony were seen more often when MMC-soaked sponges were applied under the scleral flap covered by Tenon's capsule (P = 0.008 and P = 0.012, respectively). There was no significant difference in BCVA or other complications in either group. CONCLUSION: Since the effectiveness of IOP reduction was similar between both groups and with a low incidence of thin-walled blebs and hypotony, the subscleral application without touching Tenon's capsule seems to be the safer application site of MMC during trabeculectomy.

SNS alleviates depression-like behaviors in CUMS mice by regluating dendritic spines via NCOA4-mediated ferritinophagy.

ETHNOPHARMACOLOGICAL RELEVANCE: Depression is one of the most common mood disturbances worldwide. The Si-ni-san formula (SNS) is a famous classic Traditional Chinese Medicine (TCM) widely used to treat depression for thousands of years in clinics. However, the mechanism underlying the therapeutic effect of SNS in improving depression-like behaviors following chronic unpredictable mild stress (CUMS) remains unknown. AIM OF THE STUDY: This study aimed to investigate whether SNS alleviates depression-like behaviors in CUMS mice by regulating dendritic spines via NCOA4-mediated ferritinophagy in vitro and in vivo. STUDY DESIGN AND METHODS: In vivo, mice were exposed to CUMS for 42 days, and SNS (4.9, 9.8, 19.6 g/kg/d), fluoxetine (10 mg/kg/d), 3-methyladenine (3-MA) (30 mg/kg/d), rapamycin(1 mg/kg/d), and deferoxamine (DFO) (200 mg/kg/d) were conducted once daily during the last 3 weeks of the CUMS procedure. In vitro, a depressive model was established by culture of SH-SY5Y cells with corticosterone, followed by treatment with different concentrations of freeze-dried SNS (0.001, 0.01, 0.1 mg/mL) and rapamycin (10 nM), NCOA4-overexpression, Si-NCOA4. After the behavioral test (open-field test (OFT), sucrose preference test (SPT), forced swimming test (FST) and tail suspension test (TST), dendritic spines, GluR2 protein expression, iron concentration, and ferritinophagy-related protein levels (P62, FTH, NCOA4, LC3-II/LC3-I) were tested in vitro and in vivo using immunohistochemistry, golgi staining, immunofluorescence, and Western blot assays. Finally, HEK-293T cells were transfected by si-NCOA4 or GluR2-and NCOA4-overexpression plasmid and treated with corticosterone(100 µM), freeze-dried SNS(0.01 mg/mL), rapamycin(25 nM), and 3-MA(5 mM). The binding amount of GluR2, NCOA4, and LC3 was assessed by the co-immunoprecipitation (CO-IP) assay. RESULTS: 3-MA, SNS, and DFO promoted depressive-like behaviors in CUMS mice during OFT, SPT, FST and TST, improved the amount of the total, thin, mushroom spine density and enhanced GluR2 protein expression in the hippocampus. Meanwhile, treatment with SNS decreased iron concentrations and inhibited NCOA4-mediated ferritinophagy activation in vitro and in vivo. Importantly, 3-MA and SNS could prevent the binding of GluR2, NCOA4 and LC3 in corticosterone-treated HEK-293T, and rapamycin reversed this phenomenon after treatment with SNS. CONCLUSION: SNS alleviates depression-like behaviors in CUMS mice by regulating dendritic spines via NCOA4-mediated ferritinophagy.

Evaluation of the learning curve of laser peripheral iridectomy: the 20th case reaches the turning point.

AIM: To explore the learning curve for ophthalmologists at the start of laser peripheral iridectomy (LPI) training. METHODS: The learning curve of 4 doctor groups without previous LPI experience was studied. Three main parameters of LPI were reviewed: total energy, argon energy and neodymium-doped yttrium aluminum garnet (Nd:YAG) energy. Procedures were evaluated in cohorts of 20 cases to identify the turning points of the three variables. RESULTS: There was no significant difference in terms of age or eye among the 4 doctor groups. There were stable trends on the learning curve for the Doctor A and C groups regarding total energy and argon energy. In addition, the turning points on the learning curve were determined after the 20th procedure for the Doctor B and D groups regarding total energy and argon energy. Moreover, the Nd:YAG energy was relatively stable since the first procedure. CONCLUSION: It requires approximately 20 procedures for a beginner to reach a turning point on the learning curve regarding LPI. It can serve as a point of reference or guideline for training beginners to perform LPI.

Characteristics of the Ciliary Body in Healthy Chinese Subjects Evaluated by Radial and Transverse Imaging of Ultrasound Biometric Microscopy.

Background: The imaging and analysis of the ciliary body (CB) are valuable in many potential clinical applications. This study aims to demonstrate the anatomy characteristics of CB using radial and transverse imaging of ultrasound biometric microscopy (UBM) in healthy Chinese subjects, and to explore the determining factors. Methods: Fifty-four eyes of 30 healthy Chinese subjects were evaluated. Clinical data, including age, body mass index (BMI), intraocular pressure (IOP), axial length (AL), and lens thickness (LT), were collected. Radial and transverse UBM measurements of the ciliary body were performed. Anterior chamber depth (ACD), ciliary sulcus diameter (CSD), ciliary process length (CPL), ciliary process density (CPD), ciliary process area (CPA), ciliary muscle area (CMA), ciliary body area (CBA), ciliary body thickness (CBT0, CBT1, and CBTmax), anterior placement of ciliary body (APCB), and trabecular-ciliary angle (TCA) of four (superior, nasal, inferior, and temporal) quadrants were measured. Results: The average CPL was 0.513 ± 0.074 mm, and the average CPA was 0.890 ± 0.141 mm2. CPL and CPA tended to be longer and larger in the superior quadrant (p < 0.001) than in the other three quadrants. Average CPL was significantly correlated with AL (r = 0.535, p < 0.001), ACD (r = 0.511, p < 0.001), and LT (r = −0.512, p < 0.001). Intraclass correlation coefficient (ICC) scores were high for CPL (0.979), CPD (0.992), CPA (0.966), CMA (0.963), and CBA (0.951). Conclusions: In healthy Chinese subjects, CPL was greatest in the superior quadrant, followed by the inferior, temporal, and nasal quadrants, and CPA was largest in the superior quadrant, followed by the tempdoral, inferior, and nasal quadrants. Transverse UBM images can be used to measure the anatomy of the ciliary process with relatively good repeatability and reliability.

Electrosynthesis of (hetero)aryl nitriles from α-imino-oxy acids via oxidative decarboxylation/N-O cleavage.

A new method for the synthesis of (hetero)aryl nitriles via iminyl radicals has been developed through the electrochemical oxidative decarboxylation of α-imino-oxy acids. This protocol provides an efficient approach to nitriles with a broad range of functional-group tolerance under ambient conditions and can be applied for one-pot gram-scale synthesis.

Predictive Equation for Angle Opening Distance at 750 µm After Laser Peripheral Iridotomy in Primary Angle Closure Suspects.

Aim: The aim of this study was to investigate the changes in anterior segment parameters as assessed by ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) and to propose a prediction equation for the width of the angle after LPI. Design: This was a prospective study. Participants: The participants included 100 subjects with primary angle closure suspect (PACS). Methods: Anterior segment UBM parameters were measured, whereas AOD750 was chosen to indicate the width of the angle associated with gonioscopic angle closure, as found in a prior study. Main Outcome Measures: Angle parameters, iris parameters, anterior chamber parameters and ciliary body parameters. Results: All angle parameters increased after LPI, including the mean angle opening distance at 750 µm (AOD750), mean angle opening distance at 500 µm from the scleral spur (AOD500), mean angle opening distance at 750 µm from the scleral spur (AOD750), and mean angle recess area at 750 µm from the scleral spur (ARA750). Among iris parameters and ciliary body parameters, the iris thickness at 2,000 µm (IT2000), iris curvature (IC), and trabecular-ciliary process distance (ICPD) were reduced after LPI. The final equation consisted of four parameters: anterior chamber depth (ACD), iris thickness at 750 µm from the scleral spur (IT750), AOD750, and lens vault (LV). This equation explained 42.7% of the variability in the angle opening indicator AOD750 after LPI, whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached the highest a maximum of 68.6%. Conclusions: There was an increase in angle opening and iris flattening after LPI. An equation involving four angle parameters was constructed, this equation which could explained 42.7% of the variability in the angle opening indicator AOD750 after LPI whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached a maximum of 68.6%.

Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015.

Periviable infants (PIs) born at 22-25 weeks gestational age (wGA) have a variable survival rate (49.7-86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010-2015; Epoch-II, 2016-2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170-5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.

Frequent detection of anticoagulant rodenticides in raptors sampled in Taiwan reflects government rodent control policy.

Anticoagulant rodenticides (ARs) are known to cause extensive secondary exposure in top predators in Europe and North America, but there remains a paucity of data in Asia. In this study, we collected 221 liver samples from 21 raptor species in Taiwan between 2010 and 2018. Most birds were recovered from rescue organizations, but some free-ranging individuals were obtained from bird-strike prevention measures at airports. ARs were detected in 10 species and more than half of the total samples. Common rodent-eating Black-winged Kites (Elanus caeruleus) had the highest prevalence (89.2%) and highest average sum concentration (0.211 ±â€¯0.219 mg/kg), which was similar between free-ranging birds at airports and injured birds from rescue organizations. Scavenging Black Kites (Milvus migrans) and snake-eating Crested Serpent-eagles (Spilornis cheela) had the second highest prevalence or sum concentration, respectively. Seven different AR compounds were detected, of which brodifacoum was the most common and had the highest average concentration, followed by flocoumafen and bromadiolone. The frequency of occurrence in the three most numerous species (Black-winged Kite, Crested Goshawk [Accipiter trivirgatus], and Collared Scops-owl [Otus lettia]) was significantly higher in autumn than summer, which is consistent with the timing of the Taiwanese government's supply of free ARs to farmers. Regional differences in the detection of individual compounds also tended to reflect differences in human population density and use patterns (in agriculture or urban-dominated environments). Clinical poisoning was confirmed in Black Kites with sum concentrations as low as 0.026 mg/kg; however, further study of interspecific differences in AR sensitivity and potential population effects are needed. In addition, continued monitoring remains important given the Taiwanese government has modified their farmland rodent control policy to gradually reduce free AR supplies since 2015.

Frailty and anesthesia - risks during and post-surgery.

Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.

The Effects of Rainfall, Temperature, and Wind on a Community of Montane Birds in Shei-Pa National Park, Taiwan.

Bruno A. Walther, Jane Ren-Jen Chen, Hui-Shan Lin, and Yuan-Hsun Sun (2017) Montane birds are regularly exposed to extreme weather variations. Taiwan's subtropical montane avifauna (which contains many endemic species) is regularly exposed to large weather fluctuations. From 2010 to 2013, we conducted monthly censuses to study the influence of monthly weather variations on species richness and bird density of a montane bird community (> 3000 m a. s. l.) in Shei-Pa National Park. Censuses were conducted along a trail which traverses four distinct habitats with increasing altitude: bush forest ecotone, post- re grassland, conifer forest, and rocky bushland. The highly variable weather corresponded with large fluctuations in the bird community. We found that lower temperatures had a negative effect on species richness and bird density, and this effect was strongest in the highest elevation habitat, the rocky bushland. Rainfall was positively correlated with bird density, but only explained 15% of the variation, while the effects of wind speed were inconsistent and small. This is the first study to demonstrate such weather effects in Taiwan and probably East Asia. We brie y discuss adaptations to harsh weather conditions in birds which could become a promising future research field for montane birds in Taiwan.

Frailty and post-operative outcomes in older surgical patients: a systematic review.

BACKGROUND: As the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The aim of this review was to examine the impact of frailty on adverse outcomes in the 'older old' and 'oldest old' surgical patients. METHODS: A systematic review was undertaken. Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical populations with a mean age of 75 and older. Articles were excluded if they were in non-English languages or if frailty was measured using a single marker only. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument. RESULTS: Twenty-three studies were selected for the review and they were assessed as medium to high quality. The mean age ranged from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty. CONCLUSION: There was strong evidence that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay. Frailty assessment may be a valuable tool in peri-operative assessment. It is possible that different frailty tools are best suited for different acuity and type of surgical patients. The association between frailty and return to pre-morbid function, discharge destination, and quality of life after surgery warrants further research.

Screening in delirium: A pilot study of two screening tools, the Simple Query for Easy Evaluation of Consciousness and Simple Question in Delirium.

AIM: Delirium is poorly recognised and inadequately treated in medical settings. This research aimed to determine the psychometric properties of a newly developed tool, SQeeC against another emergent instrument, SQiD, in the screening of delirium. METHODS: The SQeeC was administered to 100 patients and SQiD administered to their informants in the general medical wards of a General Hospital. Data were compared with the reference standard geriatric consultant assessment of delirium. RESULTS: Compared with the reference standard, the SQeeC was found to have a sensitivity of 83% (95% CI 52-98%) and a specificity of 81% (95% CI 72-89%) with a negative predictive value of 97% (95% CI 90-100%) while the SQiD was found to have a sensitivity of 77% (95% CI 56-91%), a specificity of 51% (95% CI 37-64%) and a negative predictive value of 83% (95% CI 66-93%). CONCLUSION: The SQeeC and SQiD are simple and time efficient screening tools with encouraging psychometric properties.