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Background Delirium is common in elderly patients after surgery and is associated with poor outcomes. This study aimed to investigate the impact of intraoperative dexmedetomidine on the incidence of delirium in elderly patients undergoing major surgery. Methods This was a randomized double-blind placebo-controlled trial. Elderly patients (aged 60 years or more) scheduled to undergo major non-cardiac surgery were randomized into two groups. Patients in the intervention group received a loading dose of dexmedetomidine 0·6 μg/kg 10 min before induction of anaesthesia followed by a continuous infusion (0·5 μg per kg per h) until 1 h before the end of surgery. Patients in the control group received volume-matched normal saline in the same schedule. The primary outcome was the incidence of delirium during the first 5 days after surgery. Delirium was assessed with the Confusion Assessment Method (CAM) for non-ventilated patients and CAM for the Intensive Care Unit for ventilated patients. Results In total, 309 patients who received dexmedetomidine and 310 control patients were included in the intention-to-treat analysis. The incidence of delirium within 5 days of surgery was lower with dexmedetomidine treatment: 5·5 per cent (17 of 309) versus 10·3 per cent (32 of 310) in the control group (relative risk (RR) 0·53, 95 per cent c.i. 0·30 to 0·94; P = 0·026). The overall incidence of complications at 30 days was also lower after dexmedetomidine (19·4 per cent (60 of 309) versus 26·1 per cent (81 of 310) for controls; RR 0·74, 0·55 to 0·99, P = 0·047). Conclusion Intraoperative dexmedetomidine halved the risk of delirium in the elderly after major non-cardiac surgery. Registration number: ChiCTR-IPR-15007654 (www.chictr.org.cn).

Transgenic Bacillus thuringiensis (Bt) crops are increasingly significant in pest control, but resistance development of target pests is a major issue in the sustainable deployment of Bt crops. The fitness cost of resistance in target pests is regarded as one of the main factors delaying resistance when adopting the refuge strategy. In this study, we compared the life-history traits of three independent sets of Helicoverpa armigera (Hübner, 1809) adults, of each there were a susceptible population and a Cry1Ac-resistant population derived by selection from it. Confirming to the previous studies, resistant individuals exhibited fewer progeny, less fecundity, lower egg hatching rate, and longer adult longevity. And poor fecundity in resistant strains was associated with the decline of the mature follicular amount, the ovarian weight ratio, and the length of the longest ovarian tubule. Interestingly, the juvenile hormone (JH) level appeared higher in resistant strains relative to susceptible strains. Application of methoprene (JH analogue) in vivo was effective in reducing fecundity and hatchability with the up-regulation of detected JH titer. These results suggested that resistance against Bt toxin reduced the reproductive capacity of H. armigera, and JH level is affected in the tradeoff between reproductive capacity and Bt resistance.

Currently published studies on the relationship between hormonal and reproductive factors and esophageal cancer (EC) risk in women have yielded contradictory findings. For a better understanding of this relationship, we first performed this meta-analysis by pooling all available publications. Sixteen independent studies were retrieved after a comprehensive search in PubMed and Embase databases. The pooled relative risks (RRs) with 95% confidence intervals (95% CIs) were calculated. The pooled RRs implicated that hormone replacement therapy was negatively associated with the risk of EC (RR = 0.72, 95% CI 0.60-0.86, P < 0.001) and esophageal squamous cell carcinoma (RR = 0.68, 95% CI 0.48-0.97, P = 0.031). Menopausal women were at an increased risk of EC (RR = 1.47, 95% CI 1.07-2.03, P = 0.018), particularly esophageal squamous cell carcinoma (RR = 1.66, 95% CI 1.12-2.48, P = 0.012). Additionally, decreased risk of EC (RR = 0.79, 95% CI 0.68-0.92, P = 0.003) and esophageal adenocarcinoma (RR = 0.66, 95% CI 0.53-0.82, P < 0.001) was demonstrated among women with breast-feeding history. Moreover, such associations were more significant among Caucasians, but not Asians. Our study suggests that menopause is an independent risk factor for EC, while hormone replacement therapy and breast-feeding history play a protective role against EC, particularly among Caucasians. All results are consistent with the hypothesis that effects of estrogen may lower the risk of EC in women.