Protective effect of intranasal insulin on postoperative cognitive dysfunction in elderly patients with metabolic syndrome undergoing noncardiac surgery: a randomized clinical trial.

BACKGROUND: Insulin plays a crucial and multifactorial role in cognitive activity, with insulin resistance appearing in neurodegenerative and metabolic diseases. Insulin resistance contributes to the pathobiology of postoperative cognitive dysfunction (POCD) in experimental models, which can be rescued by intranasal insulin administration. AIMS: To test the effect of intranasal insulin on the incidence of POCD in elderly patients with metabolic syndrome. METHODS: The study was designed as a randomized, double-blind, placebo-controlled clinical trial. 116 elderly participants were randomly assigned to receive either 40 IU insulin (n = 58) or placebo (n = 58) for 7 days. The primary outcome was the incidence of POCD at 7 days and 3 months after surgery. Secondary outcomes included the degree of peripheral insulin resistance postoperatively, changes in peripheral inflammation levels and the safety of interventions. RESULTS: The results showed that POCD occurred in the insulin group on the 7th postoperative day in 11 (20.8%) patients, which was fewer than the 23 (45.1%) patients in the placebo group (P = 0.008). The insulin group indicated better cognitive functional performance on language and memory test than the placebo group (P < 0.05). Mean peripheral plasma concentration of TNF-α (P < 0.05) and CRP (P < 0.001) in the insulin group was significantly declined compared with the placebo group on D3 and D7. CONCLUSIONS: Intranasal insulin administration reduced the incidence of POCD and alleviated peripheral inflammatory levels in elderly patients with metabolic syndrome. TRIAL REGISTRY: Chinese Clinical Trial Registry (ChiCTR1800015502).

Prediction model of recovery time after gynecological robotic surgical procedures / 中国医师杂志

Objective:In order to accurately evaluate the postoperative rehabilitation of gynecological robotic surgery, a prediction model for evaluating postanesthesia care unit (PACU) extubation time and hospital stay in gynecological robotic surgery was established.Methods:The clinical data of gynecological patients who underwent robotic surgery in Xiangya Third Hospital of Central South University from October 2015 to May 2017 were retrospectively analyzed, and the data were screened to evaluate the postoperative recovery of patients from two aspects: PACU extubation time and postoperative hospital stay. Binary logistic regression was used to screen out the factors affecting PACU extubation time and postoperative hospital stay, and the prediction model was preliminarily established and verified.Results:Finally, there were 456 patients and 30 variables analyzed in the binary logistics regression. According to these variables, the prediction model of the postoperative recovery evaluation after gynecological robotic surgical procedures was established. Among them, age, intraoperative amount of atracurium and midazolam were independent risk factors affecting PACU extubation time (all P<0.05). American Society of Anesthesiologists (ASA) grade, intraoperative amount of midazolam, intraoperative bleeding and operation time were independent risk factors affecting postoperative hospital stay (all P<0.05). All models passed Hosmer lemeshow test (all P>0.05); The areas under the receiver operating characteristic curve (ROC) were 0.647 and 0.806, respectively. Conclusions:The prediction model of PACU extubation time and the postoperative hospitalization time has been established.

Dynamic observation on changes of chest imaging in pneumoconiosis patients in tin smelting workers / 中国职业医学

OBJECTIVE: To observe the changes of chest imaging and prognosis in pneumoconiosis patients in tin smelting workers. METHODS: Ten pneumoconiosis patients working with tin smelting were examined by chest X-ray,computed tomography( CT) photography and dynamic observation on pulmonary imaging to analyze their characteristics and prognosis. RESULTS: There were mild clinical manifestations and no tuberculosis in these 10 cases of tin smelting pneumoconiosis patients. There was no obvious change on the pulmonary ventilation function change. The high k V X-ray chest observation results showed that the circular shadow was the primary small shadow of the two lungs,that were mostly distributed in the medium and upper lung zones of both lungs. In most cases,we found lung texture distortion,deformation or increase,blurred,hilar shadow increased thickening,lymph node calcification,individualized eggshell. There was no pleural changes and emphysema changes. There was no significant change found in 5-10 years of dynamic observation except for 1 case of increased small shadow. The chest CT examination in 2011 showed 2-5 mm nodular shadows. Among them,we found 7 cases of small nodules from the upper lobe evenly distributed to the middle of the lobe,the lower back lobe of the lungs,lower basal ganglia lesions decreased,lesions were diffuse distribution of the whole lung,and the small nodules in 3 cases. Interval lobular thickening at varying degrees were found in 5 cases,lobular central or apoptotic pulmonary emphysema were found in 4 cases,and 1 case of pulmonary bullae formation was found. The results of chest CT examination in 2016 showed 2 cases of diffuse pulmonary nodules,3 cases of thickening of lobular septum and 2 cases of pulmonary emphysema compared with the CT result in 2011. CONCLUSION: There was no obvious lung small shadow absorption found in tin smelting pneumoconiosis patients after 5 to 10 years of X-ray dynamic observation,and progress of lesions could be seen. CT examination is helpful for follow-up observation in tin smelting pneumoconiosis.

Survey and study on vitamin D level in healthy adults Fuling district of Chongqing / 重庆医学

Objective To explore the nutritional status of vitamin D among healthy adults lived in Fuling district of Chongqing .Methods A total of 718 healthy adults aged 23-90 years old undergoing the physical examination in the physical ex‐amination center of our hospital from March 2012 to December 2013 were selected and divided into the 23-44 years old group and the ≥45 years old group .The tandem mass spectrometer was adopted to detect the level of serum 25(OH) vitamin D for evaluating the nutritional status of vitamin D .Results The proportions of lack ,insufficiency ,normal and excess of vitamin D in the 23 -44 years old group were 80 .79% ,19 .21% ,0% and 0% respectively ;which in the ≥45 years old group were 77 .91% ,18 .20% ,3 . 89% and 0% respectively .The average level of serum 25(OH) vitamin D in 23-44 years old group was lower than that in the ≥45 years old group ,the difference was statistically significant (P=0 .002 ,t=1 .98) .In these two groups ,the difference in serum 25 (OH) vitamin D level between males and females had no statistical significance (P>0 .05) .Conclusion The healthy adults in Ful‐ing district are lack of vitamin D in different degrees .