Factors associated with post-operative delirium in hip fracture patients: what should we care.

BACKGROUND: The postoperative delirium is a common yet serious complication in elderly patients with hip fracture. We aimed to evaluate the potential risk factors of delirium in patients with hip fracture, to provide reliable evidence to the clinical management of hip fracture. METHODS: This study was a retrospective design. Elderly patients who underwent hip fracture surgery in our hospital from June 1, 2019 to December 30, 2020 were selected. The characteristics and treatment data of delirium and no delirium patients were collected and compared. Multivariate logistic regression analysis was performed to analyze the influencing factors affecting postoperative delirium in elderly patients with hip fracture. RESULTS: A total of 245 patients with hip fracture were included, the incidence of postoperative delirium in patients with hip fracture was 13.06%. There were significant differences in the age, BMI, history of delirium, estimated blood loss and duration of surgery (all p < 0.05). There were significant differences in the albumin and TSH between delirium and no delirium group (all p < 0.05), Logistics analyses indicated that age ≥ 75 years (OR 3.112, 95% CI 1.527-5.742), BMI ≥ 24 kg/m2 (OR 2.127, 95% CI 1.144-3.598), history of delirium (OR 1.754, 95% CI 1.173-2.347), estimated blood loss ≥ 400 mL (OR 1.698, 95% CI 1.427-1.946), duration of surgery ≥ 120 min (OR 2.138, 95% CI 1.126-3.085), preoperative albumin ≤ 40 g/L (OR 1.845, 95% CI 1.102-2.835) and TSH ≤ 2 mU/L (OR 2.226, 95% CI 1.329-4.011) were the independent risk factors of postoperative delirium in patients with hip fracture(all p < 0.05). CONCLUSIONS: Postoperative delirium is very common in elderly patients with hip fracture, and it is associated with many risk factors, clinical preventions targeted on those risk factors are needed to reduce the postoperative delirium.

MicroRNA let-7i-3p affects osteoblast differentiation in ankylosing spondylitis via targeting PDK1.

Ankylosing spondylitis (AS) is a chronic autoimmune disease in which let-7i has been studied to involved. But, whether let-7i-3p could regulate osteoblast differentiation in AS remains unclear. This research targeted to decipher the impact of let-7i-3p on AS progression by modulating pyruvate dehydrogenase kinase 1 (PDK1). The bone mineral density of femur and lumbar vertebra and the maximum loading and bending elastic modulus of tibia, tumor necrosis factor-α (TNF-α), matrix metalloproteinase (MMP)-3, osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) in serum of AS mice, the pathological condition of synovial tissue were determined via let-7i-3p inhibitor and OE-PDK1 in animal experiment. Also, the cell viability and ALP activity were measured by let-7i-3p inhibitor and OE-PDK1 in cell experiments. let-7i-3p and PDK1 expression were detected. Let-7i-3p raised and PDK1 declined in AS mice. Depleted let-7i-3p and restored PDK1 increased bone mineral density and maximum loading and bending elastic modulus of tibia, reduced TNF-α, MMP-3 and RANKL contents, attenuated the pathological condition of synovial tissue and raised OPG content in AS mice. In cell experiments, up-regulating PDK1 and down-regulating let-7i-3p enhanced cell viability and ALP activity in AS mice. Low expression of let-7i-3p could enhance osteoblast differentiation in AS by up-regulating PDK1.Abbreviations: AS: Ankylosing spondylitis; PDK1: pyruvate dehydrogenase kinase 1; TNF-α: tumor necrosis factor-α MMP: matrix metalloproteinase; OPG: osteoprotegerin; RANKL: receptor activator of nuclear factor-κB ligand; miRNAs: MicroRNAs; BMD: bone mineral density; PFA: paraformaldehyde; NC: negative control; OE: overexpression; HE: Hematoxylin-eosin; PBS: phosphate-buffered saline; EDTA: ethylene diamine tetraacetic acid; DMEM: Dulbecco's Modified Eagle Medium; RT-qPCR: Reverse transcription quantitative polymerase chain reaction; GAPDH: glyceraldehyde phosphate dehydrogenase; UTR: untranslated region; WT: wild type; MUT: mutant type.

Clinical Efficacy and Rehabilitation of Microscopic "Over the Top" for Bilateral Decompression in Degenerative Lumbar Stenosis: A Retrospective Study.

BACKGROUND: Recently, "over the top" (also called ULBD; microscopic unilateral laminotomy for bilateral decompression) is a less invasive technique for symptomatic degenerative lumbar spinal stenosis (LSS), and this minimally invasive surgical technique has demonstrated favorable therapeutic outcomes. However, the risk of postoperative complications remains controversial. OBJECTIVE: This study is aimed at determining the clinical efficacy and complication and rehabilitation of the microscopic "over the top" for degenerative LSS in geriatric patients. Study Design. This was a retrospective study. Setting. All data were obtained from the People's Hospital of a University. METHODS: A retrospective analysis of 39 consecutive elderly patients treated for LSS by microscopic "over the top" between January 2016 and January 2018 was performed. A postoperative rehabilitation program for geriatric patients with restricted weight-bearing was instituted after the microscopic "over the top" treatment. Estimated blood loss, duration of operation, length of hospitalization, and total complications were also evaluated. The CT and MRI examinations of the lumbar spine were collected to evaluate the completeness of the nerve decompression. Clinical data were assessed at 6 months and 12 months after operation utilizing the visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short-Form Health Survey (SF-36). Preoperative comorbidities, complications, and revision surgery were also recorded. RESULTS: We enrolled a total of 39 degenerative LSS patients (27 male and 12 female patients, mean age of 75.8 ± 9.2 years). Twenty patients had one-level of degenerative LSS; thirteen patients had two-level of LSS; six patients had three-level of LSS. The average follow-up time in our study was 14.6 ± 7.8 months (range, 6-24 months). The overall complication rate was 10.2% (4/39), and the reoperation rates at one year were 2.5% (1/39). VAS back and leg pain score at 6 months were decreased to 1.8 ± 0.7 and 1.4 ± 0.6, respectively, and remained at 1.9 ± 0.3 and 1.2 ± 0.2 at 12 months, respectively. ODI scores improved significantly from 32.26 ± 6.82 to 11.44 ± 2.50 at 6 months and 10.56 ± 2.29 at 12 months. 36-Item Short-Form Health Survey scores revealed a significant improvement throughout follow-up. Postoperative complications included dural tear (n = 2), neurologic deficit (n = 1), and reoperation (n = 1). No infections or hematomas were reported. Limitation. Multicenter research is recommended to confirm our results and investigate the factors related to clinical and radiographic results. CONCLUSIONS: Microscopic "over the top" technique is a safe, effective option in the therapy of degenerative LSS and obtained satisfactory functional outcomes when coupled with aggressive rehabilitation, with a long recurrence-free recovery.

Effects of leptin on femoral fracture in rats.

In this study, our objective was to evaluate effects of leptin on fracture healing in rats. Seventy two male Sprague-Dawley (SD) rats were randomized into 3 groups. Standardized femoral fractures were created in all the rats. Group A was treated with 1 mL normal saline (NS), group B with 0.3 µg/kg leptin in 1 mL NS, and group C with 0.5 µg/kg leptin in 1 mL NS for 2 weeks intraperitoneally. Each group was divided into three subgroups including 8 rats for evaluation at 2, 4 and 8 weeks. Radiological evaluation showed that callus formation of group B and C was all significantly higher than group A at 8 weeks (P=0.04 and P=0.013, respectively). There was no statistically significant difference in fracture healing between group B and group C at 8 weeks (P=0.197). Histological evaluation revealed fracture healing of group B and C was better than group A at 4 weeks (P=0.01 and P=0.002, respectively) and 8 weeks (P=0.008 and P=0.003, respectively). Micro-computed tomography (Micro-CT) analysis demonstrated that greater amounts of bony callus and evidence of bone fusion were observed in group B and C at 4 weeks (P=0.02 and P=0.04, respectively) and 8 weeks (P=0.005 and P=0.001, respectively) compared to group A. Group C also had better fracture healing than group B at 8 weeks (P=0.01). In conclusion, leptin has a positive effect on rat femoral fracture healing.

The effect of 10-hydroxycamptothecine in preventing fibroblast proliferation and epidural scar adhesion after laminectomy in rats.

Little is known about the influence of 10-hydroxycamptothecin (HCPT) on fibroblast proliferation and pathological changes in epidural scar tissue after laminectomy. Here we illustrated the effect of HCPT on fibroblast proliferation and epidural scar adhesion after laminectomy in rats. In the present study, seventy-two rats underwent laminectomies at Lumbar-1 level, then HCPT in various concentrations (0.1, 0.05, and 0.01 mg/ml) or saline (9 mg/ml) were applied to the laminectomy sites. Four weeks later the rats were killed and the epidural adhesion was evaluated. The area of epidural scar tissue and the number of fibroblasts were also determined. The degree of epidural adhesion was classified according to Rydell standard. The results showed that no or little epidural adhesions were seen in the laminectomy sites treated with 0.1 mg/ml HCPT. The Rydell classification, the area of epidural scar tissue and the number of fibroblasts in 0.1 mg/ml HCPT group were significantly less than those of 0.05 mg/ml HCPT group, 0.01 mg/ml HCPT group and saline group. Moderate epidural adhesions were noted in the laminectomy sites of 0.05 mg/ml HCPT group. The Rydell classification, the area of scar tissue and the number of fibroblasts were less than those of 0.01 mg/ml HCPT group and saline group. However, dense epidural adhesions were found in 0.01 mg/ml HCPT group and saline group. The Rydell classification, the area of scar tissue and the number of fibroblasts showed no significant difference compared with those of saline group. In conclusion, topical application of 0.1 mg/ml HCPT could effectively prevent fibroblast proliferation and reduce epidural adhesion after laminectomy in rats.

Electrochemical identification of the property of peripheral nerve fiber based on a biocompatible polymer film via in situ incorporating gold nanoparticles.

We report a simple electrochemical method for the identification of properties of peripheral nerve fibers, based on the detection of a neurotransmitter enzyme, acetylcholinesterase (AChE). A poly(diallydimethylammonium) (PDDA) adulterated poly(dimethylsiloxane) (PDMS) film is spin-coated on the surface of gold electrodes. Gold nanoparticles (AuNPs) are in situ synthesized on the polymer film, which act as "electron antennae" between the film and the electrode surface and also provide a biocompatible interface. This PDMS-PDDA/AuNPs film shows different adsorption sites to choline oxidase (ChO) and AChE; after incubation with ChO, the polymer-gold nanocomposite film also shows excellent adsorption ability to AChE. Moreover the adsorption sites of AChE would not be blocked by bovine serum albumin (BSA) which provides a good platform for the quantitative amperometric determination of AChE via the oxidation of the enzymatically generated H 2O 2 in the bienzyme system in the presence of acetylcholine. The detection limit is down to 1.0 unit/mL. The polymer-gold nanocomposite film shows excellent anti-interference ability to the coexistent electroactive substances such as ascorbic acid. Thus it was applied to determine AChE in peripheral nerve fibers homogenates and identify the motor and sensory fibers for the first time. Compared with histochemical staining methods, the electrochemical technique shows good accurate rate and faster response, which has good potential for a clinical application.

A comparison of the effectiveness of mitomycin C and 5-fluorouracil in the prevention of peridural adhesion after laminectomy.

OBJECT: The effectiveness of the topical application of mitomycin C (MMC) or 5-fluorouracil (5FU) in preventing peridural adhesion after laminectomy was compared in this study. METHODS: Laminectomies were performed at L-1 in 30 rats. Cotton pads soaked with 0.1 mg/ml MMC, 25 mg/ml 5FU, or 9 mg/ml saline (control) were applied to the operative sites. To evaluate neurological deficits pre- and postoperatively, somatosensory evoked potentials were monitored and the Basso-Beattie-Bresnahan locomotion test was performed. Four weeks postlaminectomy the rats were killed, and peridural scar adhesion was evaluated histologically. The level of hydroxyproline, the area of peridural scar tissue, and the number of fibroblasts were determined. The degree of peridural adhesion was classified according to the Rydell standard. RESULTS: No obvious adhesion formed in the rats in the MMC group, but severe peridural adhesions were found in those in the 5FU and control groups. The content of hydroxyproline, the area of peridural scar tissue, and the number of fibroblasts in the MMC group were significantly lower than those in the 5FU and control groups. CONCLUSIONS: The topical application of MMC rather than 5FU may be a successful method of preventing postlaminectomy peridural adhesions.