Development of a postoperative delirium risk scoring tool using data from the Australian and New Zealand Hip Fracture Registry: an analysis of 6672 patients 2017-2018

Background and purposeThis study aimed to determine the incidence, predictors of postoperative delirium and develop a post-surgery delirium risk scoring tool.Patients and MethodsA total of 6672 hip fracture patients with documented assessment for delirium were analyzed from the Australia and New Zealand Hip Fracture Registry between June 2017 and December 2018.Thirty-six variables for the prediction of delirium using univariate and multivariate logistic regression were assessed. The models were assessed for diagnostic accuracy using C-statistic and calibration using Hosmer-Lemeshow goodness-of-fit test. A Delirium Risk Score was developed based on the regression coefficients.ResultsDelirium developed in 2599/6672 (39.0%) hip fracture patients. Seven independent predictors of delirium were identified; age above 80 years (OR=1.6 CI 1.4-1.9; p=0.001), male (OR=1.3 CI 1.1-1.5; p=0.007), absent pre-operative cognitive assessment (OR=1.5 CI 1.3-1.9; p=0.001), impaired pre-operative cognitive state (OR=1.7 CI 1.3 -2.1; p=0.001), surgery delay (OR=1.7 CI 1.2-2.5; p=0.002) and mobilisation day 1 post-surgery (OR=1.9 CI 1.4-2.6; p=0.001). The C-statistics for the training and validation datasets were 0.74 and 0.75, respectively. Calibration was good (χ2=35.72 (9); p<0.001). The Delirium Risk Score for patients ranged from 0 to 42 in the validation data and when used alone as a risk predictor, had similar levels of diagnostic accuracy (C-statistic=0.742) indicating its potential for use as a stand-alone risk scoring tool.ConclusionWe have designed and validated a delirium risk score for predicting delirium following surgery for a hip fracture using seven predicting factors. This could assist clinicians in identifying high risk patients requiring higher levels of observation and post-surgical care.     

A chemiluminescence immunoassay for precise automatic quality control of glycoprotein in human rabies vaccine

Currently, quality control of glycoprotein in the human rabies vaccine is based on enzyme-linked immunosorbent assay (ELISA). However, ELISA does not match the needs of a modernised quality control system. For a long time, human rabies virus vaccine manufacturers have been devoted to seeking a detection platform that is sensitive, accurate, automatic, and feasible for practical applications. Therefore, our team invested major efforts into establishing a fully automated micromagnetic particle (MMP)-based chemiluminescence immunoassay (CLIA) platform. For vaccine quality control, MMP-coupled rabies virus glycoprotein monoclonal antibodies (S037) were used to capture the rabies virus. Another rabies virus glycoprotein antibody (S053) labelled with acridinium ester was added as a signal tracer. After pretreating the vaccine sample, the entire analysis was performed using a fully automated machine, which had a limited detection time (only 30 min) and eliminated manual error. Multiple experiments have identified the optimal conditions allowing valid and reliable assessment of vaccine potency. The CLIA platform has exhibited merits in terms of speed, robustness, high sensitivity (with a minimum detection value of 0.45 mIU/mL), considerable accuracy, and a wide linear range of detection (9.4–1200 mIU/mL). Furthermore, the results showed that the CLIA platform is consistent with the National Institutes of Health test and time-resolved fluorescent immunoassay (TRFIA) in quantitative analysis, and had a better analytic performance than TRFIA. Therefore, the CLIA platform presented here may be important for application in modern vaccine quality control.     

Protective effect of bromelain on corrosive burn in rats

IntroductionIn some cases, the tongue and oesophagus tissues are damaged by the corrosive burn. Surgical interventions may cause scar formation, and severe burns treatment methods are limited. This study aims to investigate bromelain, a phytotherapeutic product, on the corrosive burn as a non-surgical option and as an adjunctive therapy, insofar as the treatment of corrosive wounds is not limited only to the treatment of oxidative stress and inflammatory reactions.MethodsOn the tongues of Wistar albino rats, chemically produced oral ulcers were created by topical application of NaOH (40%) solution, and in the distal oesophagus same mixture was applied to produce a corrosive oesophageal burn. For a week, they were treated orally by bromelain (100 mg/kg/day) or saline solution. At the end of seven days, animals were decapitated to remove the tongue and oesophagus, and blood samples were collected to obtain serum. Myeloperoxidase (MPO) activity, malondialdehyde (MDA), glutathione (GSH), interleukin-1 beta (IL-1β) and tumour necrosis factor-alpha (TNF-α) concentrations were measured in serum, and luminol and lucigenin chemiluminescence (CL) were measured in tissue samples.ResultsMDA and CL values were significantly increased, and GSH levels in tissue significantly decreased due to the corrosive burns. Saline treated corrosive burn group measured higher in the serum cytokines in according to the control group.ConclusionsBromelain administration decreased oxidant and inflammatory parameters and increased antioxidant levels in NaOH-induced corrosive burns. Thus, we concluded that bromelain may protect the tongue and oesophagus tissues with its anti-inflammatory and antioxidant effects.     

骨碎补化学成分和生物活性研究进展＊

骨碎补是历代临床常用中药，具有疗伤止痛、补肾强骨、消风祛斑等功效。其主要含黄酮、苯丙素、三萜、酚酸及其苷等类化学成分，现代研究表明骨碎补具有抗骨质疏松、促进骨折愈合、促软骨再生、护牙健齿、保护肾功能、抗炎、防治中毒性耳聋、降血脂等多种生物活性，开发前景广阔。本文对近年来骨碎补的化学成分、药理作用及临床应用研究进行综述，以期为骨碎补的进一步深入系统的研究和开发利用提供依据。