Effect of regional anesthesia on the postoperative delirium: A systematic review and meta-analysis of randomized controlled trials

ObjectivePostoperative delirium (POD) starts in the recovery room and occurs up to 5 days after surgery. However, the POD guidelines issued by the European Society of Anesthesiology (ESA) suggest that the effect of regional anesthesia on POD is controversial. This meta-analysis aims to investigate whether perioperative regional anesthesia reduced the incidence of POD.MethodsStandard Published randomized controlled trails (RCTs) were searched from bibliographic databases to identify all evidence that reported regional anesthesia assessing incident delirium following diverse surgeries. The primary outcome was the incidence of POD, and the secondary outcomes were POD scores, pain scores, and emergence time. The relative risk (RR) for dichotomous outcomes and the weighted or standardized mean difference (WMD, SMD) for continuous outcomes were estimated using a random-effects model.ResultsTwenty RCTs with 2110 randomized participants undergoing different surgeries were included. Meta-analysis showed that regional anesthesia was associated with less POD incidence compared to general anesthesia (total intravenous anesthesia (TIVA) or inhalation anesthesia) (relative risk (RR) = 0.62, 95% confidence interval (CI) = 0.45–0.85)). Subgroup analysis showed that the decrease in POD incidence was associated with a nerve block (0.46, 95% CI = 0.32–0.67) and regional-combined-general anesthesia (0.42, 95% CI = 0.29–0.60). Regional anesthesia significantly reduced POD incidence in the recovery room after pediatric surgeries (0.41, 95% CI = 0.29–0.56). Regional anesthesia also reduced the POD score (SMD −0.93, 95% CI = −1.55 to −0.31) and pain score (SMD −0.95, 95% CI = −1.72 to −0.81). There was no significant difference in emergence time between regional anesthesia and general anesthesia (WMD −1.40, 95% CI = −3.83 to 6.63).ConclusionsThere was a significant correlation between regional anesthesia and the decrease in POD incidence, POD score, and pain score

A high-resolution study of particle export in the southern South China Sea based on Th-234 : U-238 disequilibrium

During a spring intermonsoon cruise in 2004, depth profiles of total and particulate Th-234 in the upper 100 m were collected at 36 stations in the southern South China Sea (SCS), covering a surface area of similar to 1.0 x 10(6) km(2). Thorium-234 was sampled by using a modified small-volume MnO2 co-precipitation technique, which allows mapping the Th-234 distribution with a high spatial resolution. A stratified structure of Th-234/U-238 disequilibria was generally observed in the upper 100 m water column, suggesting that the euphotic zone of the southern SCS in this season can be separated into two layers: an upper layer with low export production rates and a lower layer with high export production rates. At the same time, we observed extensive zones of Th-234 excess within the euphotic layer, which is possibly due to intense remineralization of particulate matter. Particulate organic carbon (POC) export was estimated from a three-dimensional steady state model of Th-234 fluxes combined with measurements of the POC/Th-234 ratio on suspended particles. The POC export for this region varied from a low of -10.7 +/- 1.5 mmolC m(-2) d(-1) to a high of 12.6 +/- 1.1 mmolC m(-2) d(-1), with an average of 3.8 +/- 4.0 mmolC m(-2) d(-1). A negative flux of POC export is interpreted as the result of lateral input of particulate matter from nearby waters. Regional patterns in POC export show enhanced fluxes along the western and southern boundaries of the study region, and a "tongue'' of low export extending northwestward from similar to 7 degrees N 116 degrees E to similar to 10 degrees N 111 degrees E. This geographic distribution is consistent with the overall surface circulation pattern of the southern SCS in this season

Triptolide Inhibits the Proliferation of Prostate Cancer Cells and Down-Regulates SUMO-Specific Protease 1 Expression

Recently, traditional Chinese medicine and medicinal herbs have attracted more attentions worldwide for its anti-tumor efficacy. Celastrol and Triptolide, two active components extracted from the Chinese herb Tripterygium wilfordii Hook F (known as Lei Gong Teng or Thunder of God Vine), have shown anti-tumor effects. Celastrol was identified as a natural 26 s proteasome inhibitor which promotes cell apoptosis and inhibits tumor growth. The effect and mechanism of Triptolide on prostate cancer (PCa) is not well studied. Here we demonstrated that Triptolide, more potent than Celastrol, inhibited cell growth and induced cell death in LNCaP and PC-3 cell lines. Triptolide also significantly inhibited the xenografted PC-3 tumor growth in nude mice. Moreover, Triptolide induced PCa cell apoptosis through caspases activation and PARP cleavage. Unbalance between SUMOylation and deSUMOylation was reported to play an important role in PCa progression. SUMO-specific protease 1 (SENP1) was thought to be a potential marker and therapeutical target of PCa. Importantly, we observed that Triptolide down-regulated SENP1 expression in both mRNA and protein levels in dose-dependent and time-dependent manners, resulting in an enhanced cellular SUMOylation in PCa cells. Meanwhile, Triptolide decreased AR and c-Jun expression at similar manners, and suppressed AR and c-Jun transcription activity. Furthermore, knockdown or ectopic SENP1, c-Jun and AR expression in PCa cells inhibited the Triptolide anti-PCa effects. Taken together, our data suggest that Triptolide is a natural compound with potential therapeutic value for PCa. Its anti-tumor activity may be attributed to mechanisms involving down-regulation of SENP1 that restores SUMOylation and deSUMOyaltion balance and negative regulation of AR and c-Jun expression that inhibits the AR and c-Jun mediated transcription in PCa

Fine-Structural Morphology of the Mouthparts of the Polyphagous Invasive Planthopper, <i>Ricania speculum</i> (Walker) (Hemiptera: Fulgoromorpha: Ricaniidae)

Mouthparts are the crucial sensory and feeding organs associated with food detection and feeding in insects. The Asian ricaniid planthopper Ricania speculum (Walker), recently introduced into Europe, can cause severe economic damage by sucking the phloem sap of tea, camphor, citrus, black locust and other plants using piercing-sucking mouthparts. To facilitate comprehensive understanding of feeding mechanisms in the Ricaniidae, the fine structure of the mouthparts of Ricania speculum was observed by scanning electron microscopy for the first time. The mouthparts are tubular, consist of a cone-shaped labrum, with a wrinkled epidermis and without sensilla; the tubular labium is divided into three segments: a slender stylet fascicle consisting of two mandibular stylets with four ridged processes and a row of longitudinal striations on the distal part of the outer surface; and two maxillary stylets with a smooth and sharp distal part, interlocked to form a larger food canal and a smaller salivary canal. On the labium, 15 kinds of sensilla of different functions were recognized. Two rows of short sensilla basiconica (SB I) are symmetrically distributed along the labial groove on the first segment. Two pairs of long sensilla basiconica (SB II) (proprioceptors) are on both sides of the labial groove at the junction of the second and third segments. A placoid, flattened sensillum (SPF) is symmetrically located laterally on the proximal end of the last segment and several flattened sensilla campaniformia (SFC) were visible on the ventral side on the second and third segments. The distribution of four types (I–IV) of sensilla cheatica of different lengths on the dorsal surface of the labium is significantly denser than on the lateral and ventral surfaces. The labial apex is divided into dorsal and ventral sensory fields, mainly including uniporous long peg sensilla (I), as well as smaller peg sensilla (II) and nonporous peg sensilla (PGSN) on each dorsal field. These nonporous sensilla basiconica (BSN I and III) occur on the ventral sensory fields and are constant in number and distribution. The nonporous sensilla basiconica (BSN II) are symmetrically arranged near the opening of the stylet fascicle similarly to two oval multiporous plate sensilla (OPSM). The sensilla arrangement is slightly different from that observed in previously studied Fulgoromorpha using scanning electron micrographs, which may reflect differences in feeding preference or behavior

How do subjective mortality beliefs affect the value of social security and the optimal claiming ages?

Abstract Households that postpone claiming Social Security benefits are, in effect, making additional purchases of the Social Security annuity and acquiring valuable longevity insurance. This paper investigates the impact of plausible variations of subjective mortality beliefs on the value of delayed claiming and the optimal claiming ages of retired workers. Using the Health and Retirement Study data, we show that older individuals could, on average, predict their life expectancy correctly; however, the average variance of age of death calculated from subjective mortality tables is 6.2%–14.4% lower than that from cohort life tables. Using numerical optimization techniques, we further show that, theoretically, older households place a lower value on delaying claiming when they have greater confidence in their ability to forecast their age of death. But the magnitude of this effect is not large enough to change their optimal claiming ages, unless they hold extreme subjective mortality beliefs. As a result, we conclude that subjective mortality beliefs alone cannot explain the prevalence of early claiming behaviors

Node Centrality Comparison between Bus Line and Passenger Flow Networks in Beijing

In recent decades, complex network theory has become one of the most important approaches for exploring the structure and dynamics of traffic networks. Most studies mainly focus on the static topology features of the traffic networks, and there are also increasing literature focusing on passenger flow networks. However, not much work has been completed on comparing the static networks with dynamic flow networks from the perspective of supply and demand. Therefore, this study aimed to apply the complex network approach to explore the spatial relationship between bus line organization and bus flows in Beijing. Based on the bus route data and the passenger flow data obtained from the Beijing smart bus card, this study investigated the spatial characteristics of the bus line network and the temporal bus flow networks, and presented a comparison analysis on the spatial relationship between them by using the node centrality indices, namely degree centrality, betweenness centrality and closeness centrality. The results show that the overall spatial patterns of node centralities between the bus line network and the bus flow network were similar, while there were also some differences. For weekdays, the correlation between them is higher, as calculated by the degree of centrality. For weekends, the two networks have a greater correlation measured by degree centrality and betweenness centrality. The highest coefficients of correlation between the line network and traffic network appear in the morning peak, which implies that the congestion issues during the morning peak hours might receive the highest priority in Beijing’s bus-line network planning. Our study can provide implications for policymakers to improve the public urban transport network, and thus enhance residents’ happiness

Study on High energy efficiency photovoltaic facility agricultural system in tropical area of China

The photovoltaic facility agriculture is developing rapidly in recent years, but there are many problems brought out, even in some important demonstration projects, due to the lack of standards. In order to solve some of these problems, we set up a photovoltaic facilities agricultural system in Guilinyang University City, Haikou, China and make an in-depth study on the photovoltaic facility agricultural system and its related problems. In this paper we disclose some of the experimental results. We plant corianders under two kinds of solar cell panels and general double glass assembly already sold on the market. Experiments showed that the square format cell panels are much better than row type, and the next one is general double glass assembly sold on the market, the last is the case without any shelter. 30 days after planting, the height of coriander plants are 50mm, 30mm, 23mm and 20mm correspondingly. The two typical solar cell panels have gaps between cells, and can save much more energy and improve power generation efficiency, we arrange the panels at optimum tilted angle, and design the system as open structure to save more energy. The photovoltaic facilities agricultural system we set up in Guilinyang University City can achieve much high solar energy efficiency than others and has broad application prospects

Study on High energy efficiency photovoltaic facility agricultural system in tropical area of China

The photovoltaic facility agriculture is developing rapidly in recent years, but there are many problems brought out, even in some important demonstration projects, due to the lack of standards. In order to solve some of these problems, we set up a photovoltaic facilities agricultural system in Guilinyang University City, Haikou, China and make an in-depth study on the photovoltaic facility agricultural system and its related problems. In this paper we disclose some of the experimental results. We plant corianders under two kinds of solar cell panels and general double glass assembly already sold on the market. Experiments showed that the square format cell panels are much better than row type, and the next one is general double glass assembly sold on the market, the last is the case without any shelter. 30 days after planting, the height of coriander plants are 50mm, 30mm, 23mm and 20mm correspondingly. The two typical solar cell panels have gaps between cells, and can save much more energy and improve power generation efficiency, we arrange the panels at optimum tilted angle, and design the system as open structure to save more energy. The photovoltaic facilities agricultural system we set up in Guilinyang University City can achieve much high solar energy efficiency than others and has broad application prospects

Thermodynamics Study on the Separation Process of Cresols from Hexane via Deep Eutectic Solvent Formation

Phenolic compounds could be separated through their formation of deep eutectic solvent (DES). This process was different from normal liquid liquid extraction and was more efficient and environmental. In this work, the thermodynamic process of this kind of separation was studied. Ternary liquid liquid equilibrium data were systematically measured at atmospheric pressure and temperatures from 303.15 to 313.15 K. The experimental data were regressed by NRTL and UNIQUAC models, and the validated results revealed that NRTL model were more consistent with experimental data. The above mentioned parameters could be used to predict ternary mixture interactions and then applied in subsequent design and optimization of the separation process of corresponding systems. This extraction process was further optimized using Aspen Plus with NRTL as thermodynamic model. The simulation results were in good agreement with the experimental outcomes.</p