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OBJECTIVES Misdiagnosis of acute aortic syndrome (AAS) significantly increases mortality. Tenascin-C (TN-C) is an extracellular matrix glycoprotein related to cardiovascular injury. The elevation of TN-C in AAS and whether it can discriminate sudden-onset of acute chest pain in Chinese remains unclear. METHODS We measured the plasma concentration of TN-C by ELISA in a cohort of 376 patients with chest or back pain. Measures to discriminate AAS from acute coronary syndrome (ACS) were compared and calculated. RESULTS From October 2016 to September 2021, 376 undiagnosed patients with chest or back pain were enrolled. 166 of them were finally diagnosed as AAS, 100 were ACS and 110 without cardiovascular diseases (NCV). TN-C was significantly elevated in AAS at 18.18 ng/mL (IQR: 13.10--27.68) compared with 7.51 ng/mL (IQR: 5.67--11.38) in ACS (P < 0.001) and 3.68 ng/mL (IQR: 2.50--5.29) in NCV (P < 0.001). There was no significant difference in TN-C level among the subtypes of AAS. Of the 166 AAS patients, the peaked level of TN-C was at acute stage (P = 0.012), then a slight of decrease was observed at subacute stage. The area under receiver operating characteristic curve for AAS patients versus NCV was 0.979 (95% CI: 0.964-0.994) for TN-C. At a cutoff level of 11.474 ng/mL, TN-C has a sensitivity of 76.0%, specificity of 85.5%, accuracy of 82.0%, positive predictive value (PPV) of 76.0%, negative predictive value (NPV) of 85.5%. Diagnostic performance of TN-C was superior to D-dimer and hs-cTnT. CONCLUSIONS The concentration of serum TN-C in AAS patients was significantly higher than that in ACS patients and NCV. TN-C could be a new biomarker to distinguish AAS patients in the early stage after symptoms onset from other pain diseases. [ABSTRACT FROM AUTHOR]

Objectives: This study summarizes the epidemiological characteristics, species distribution, and drug sensitivity of clinical nontuberculous mycobacteria (NTM) isolates at the Public Health Clinical Center of Chengdu, China, from January 2017 to December 2022. Methods: We retrospectively analyzed data from patients with clinically isolated NTM strains. Chi-square analysis assessed the rate of Mycobacterium strain isolation over 6 years. Results: The number of samples tested for Mycobacterium tuberculosis (MTB) and/or NTM increased each year, while MTB detection decreased and NTM detection rose significantly each year (P=0.03). The average age of NTM patients was 51 ± 17.53 years, with a 14.1% HIV infection rate. The predominant isolates were Mycobacterium avium-intracellulare (MAC) and M. chelonae/M. abscessus, with 96.4% of cases being of Han ethnicity. Amikacin, moxifloxacin, and clarithromycin were effective against M. avium and M. intracellulare; linezolid, amikacin, and cefoxitin were effective against M. chelonae/M. abscessus. Over 90% of NTM cases originated from the respiratory tract. Conclusion: The NTM isolation rate in Southwest China has risen in recent years, primarily among elderly patients with a high HIV co-infection rate. The main NTM isolates were MAC and M. chelonae/M. abscessus. Amikacin, moxifloxacin, clarithromycin, and linezolid exhibited strong antibacterial activity against SGM, while amikacin and linezolid displayed relatively better antibacterial activity against RGM. The prevalence of NTM infection may be positively associated with regional economic development and health conditions. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is one of the most common diseases in China. The incidence of CRS in the Chinese urban population is between 5 and 15%. It is difficult to cure with traditional surgery. Endoscopic sinus surgery is the first choice for the treatment of CRS. Compared with developed countries, the development of the clinical pathway of endoscopic sinus surgery in China is still unclear.Objectives: The aim is to explore whether the clinical pathway of endonasal sinus surgery is better than the traditional one in the Chinese population.Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov, SinoMed, China National Knowledge Internet, Wanfang database of Chinese Journals, and VIP database of Chinese Journals. The last retrieval date was August 24, 2018. Review Manager 5.3 software was used for comprehensive quantification data analysis.Results: Fourteen papers involving 1,882 patients were included in this study. The results showed that compared with the traditional pathway, the clinical pathway can effectively shorten the average number of hospitalization days (mean difference, MD = -2.00, 95% CI: -2.50, -1.49). In total, 10 of the 14 papers, with a total of 1,500 patients, proved that the clinical pathway can effectively reduce the hospitalization costs of patients (standard mean difference, SMD = -3.15, 95% CI: -4.20, -2.10); 11 of the 14 papers, with a total of 1,488 patients, proved that the clinical pathway can effectively improve patients' knowledge of health (95% CI:1.03, 1.09); and 7 of the 14 papers, with a total of 810 patients, proved that the clinical pathway can effectively improve patient satisfaction (95% CI:1.10, 1.20).Conclusions: Our systematic review and meta-analysis support the use of the clinical pathway in patients with endoscopic sinus surgery in China. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between transportation accessibility and housing price in Tianjin, China. The transportation accessibility was measured by some indexes, such as Betweenness, Closeness and Straightness on the road network. The indexes and sample plots were transformed into the same dimension by means of Kernel Density Estimation. Based on the dimension, the correlationship between housing price and transportation accessibility was analyzed under the conditions of including or excluding some other important factors, such as construction year, distance from subway and education resources. Finally, an optimum proposal for the road network is given and the change feature of housing price is analyzed. Results indicate that housing price are highly correlated with transportation accessibility, which is more significant when excluding the other factors, and the optimization of road network will make different influences on transportation accessibility and the housing price increasing in terms of different indexes. If to plan residential quarters or adjust the housing price, the government should focus on Closeness and Straightness of the road network. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated the use of dexmedetomidine in patients with a high risk of postoperative nausea and vomiting (PONV) following gynaecological laparoscopic surgery.Objective: To investigate if the intra-operative use of dexmedetomidine could reduce the incidence of PONV in this patient population.Design: A randomised, double-blind, placebo-controlled trial.Setting: A tertiary hospital in Beijing, China.Patients: 130 adult patients scheduled for gynaecological laparoscopic surgery.Interventions: Patients in the dexmedetomidine group (Dex group, n = 65) received a loading dose of dexmedetomidine (0.5 μg kg over 10 min) before induction of anaesthesia, followed by a continuous infusion (0.1 μg kg h) until the end of surgery. Patients in the control group (Ctrl group, n = 65) received volume-matched normal saline. Propofol and remifentanil were used for induction and maintenance of anaesthesia. Intravenous patient-controlled analgesia with morphine was provided after surgery.Main Outcome Measures: The incidence of 24-h PONV.Results: The incidence of nausea within the first 2 postoperative hours was lower in the Dex group than in the Ctrl group [0% (0/65) vs. 9% (6/65), P = 0.037]. The overall incidence of PONV within the first 2 postoperative hours was slightly lower in the Dex group than in the Ctrl group, but the difference was not statistically significant [5% (3/65) vs. 14% (9/65), P = 0.069]. There was no significant difference between the two groups regarding the incidence of 24-h PONV.Conclusion: For adult patients undergoing gynaecological laparoscopic surgery, supplemental use of dexmedetomidine during general anaesthesia reduced the incidence of early postoperative nausea but not vomiting within the 24 h after surgery.Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-15006914. [ABSTRACT FROM AUTHOR]

Many non-communicable diseases (NCDs) are largely preventable via behaviour change and healthy lifestyle, which may be best established during childhood. This study sought insights into Chinese new immigrant mothers' perceptions about adult-onset NCDs prevention during childhood. Twenty-three semi-structured interviews were carried out with new immigrant mothers from mainland China who had at least one child aged 14 years or younger living in Hong Kong. Interviews were audio taped, transcribed and analysed using a Grounded Theory approach. The present study identified three major themes: perceived causes of adult NCDs, beliefs about NCDs prevention and everyday health information practices. Unhealthy lifestyle, contaminated food and environment pollution were perceived as the primary causes of adult NCDs. Less than half of the participants recognized that parents had responsibility for helping children establish healthy behaviours from an early age to prevent diseases in later life. Most participants expressed helplessness about chronic diseases prevention due to lack of knowledge of prevention, being perceived as beyond individual control. Many participants experienced barriers to seeking health information, the most common sources of health information being interpersonal conversation and television. Participants' everyday information practice was passive and generally lacked awareness regarding early prevention of adult-onset NCDs. Updated understanding of this issue has notable implications for future health promotion interventions. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common complication in elderly patients after surgery and associated with increased morbidity and mortality. Studies suggest that deep anesthesia and intense pain are important precipitating factors of postoperative delirium. Neuraxial block is frequently used in combination with general anesthesia for patients undergoing major thoracic and abdominal surgery. Compared with general anesthesia alone and postoperative intravenous analgesia, combined epidural-general anesthesia and postoperative epidural analgesia decreases the requirement of general anesthetics during surgery and provided better pain relief after surgery. However, whether combined epidural-general anesthesia plus epidural analgesia is superior to general anesthesia plus intravenous analgesia in decreasing the incidence of postoperative delirium remains unknown. Methods/design: This is a multicenter, open-label, randomized, parallel-controlled clinical trial. One thousand eight hundred elderly patients (age range 60-90 years) who are scheduled to undergo major thoracic or abdominal surgery are randomized to receive either general anesthesia plus postoperative intravenous analgesia or combined epidural-general anesthesia plus postoperative epidural analgesia. The primary outcome is the 7-day incidence of postoperative delirium. Secondary outcomes include the duration of postoperative delirium, the intensity of pain during the first three days after surgery, the 30-day incidences of postoperative non-delirium complications, the length of stay in hospital after surgery and 30-day all-cause mortality. Discussion: Results of the present study will provide information to guide clinical practice in choosing appropriate anesthesia-analgesia method for elderly patients undergoing major thoracic and abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Public health education increasingly emphasizes the link of personal lifestyle with cancer risk, which may result in unintended negative social effects such as triggering stigma and/or blame towards cancer patients when their illness is perceived to be caused by personal behaviours or disapproved lifestyles. Objectives: To explore nurses' blame attributions towards patients with different types of cancer and to identify associated factors. Design: Cross-sectional survey. Setting: A tertiary cancer-specialized hospital in Beijing. Participants: 317 Chinese oncology nurses working in the cancer hospital. Methods: Participant nurses completed a self-administrated anonymous questionnaire and rated how much they would blame someone with a diagnosis of breast cancer, cervical cancer, colon cancer, liver cancer, lung cancer, as well as leukaemia and obesity. Results: More than half of the oncology nurses (57.1%) attributed at least some blame to patients with leukaemia, following with breast cancer (67.5%), cervical cancer (79.2%), liver cancer (79.2%), and colon cancer (78.5%). Lung cancer patients attracted at least some blame by 82.0% of participating nurses. Attributions of blame for patients with lung, cervical, colon and liver cancer were most common among nurses with shorter working experience. Conclusions: This study demonstrated that a high proportion of Chinese nurses attributed at least some blame to patients with different cancers despite being working in a cancer-specialized hospital. Future education and support for nurses are essential to avoid negative attitudes and blame attributions to cancer patients in order to enhance the quality of care. [ABSTRACT FROM AUTHOR]

Background After more than 10 years without a case of wild poliovirus (WPV) in China, an outbreak occurred in 2011 in Xinjiang Uyghur Autonomous Region. Methods Acute flaccid paralysis (AFP) case surveillance was strengthened with epidemiological investigations and specimen collection and serological surveys were conducted among hospitalized patients. Results There were 21 WPV cases and 23 clinical compatible polio cases reported. WPV was isolated from 14 contacts of AFP cases and 13 in the healthy population. Incidence of WPV and clinical compatible polio cases were both highest among children <1 years, however, 24/44 (54.5%) polio cases were reported among adults aged 15-39 years. Conclusions High coverage of routine immunization should be maintained among children until WPV transmission is globally eradicated. Expansion of AFP case surveillance and use of serologic surveys to estimate population immunity should be conducted rapidly to guide preparedness and response planning for future WPV outbreaks. [ABSTRACT FROM AUTHOR]

Background: Several genetic factors underlying ischemic stroke have been identified. Variants of Neuropeptide Y (NPY), whose product plays diverse roles in modulating physiological functions, have been associated with an increased risk of ischemic stroke in South Korean individuals. Aims: We explored the association between a polymorphism in the NPY gene promoter at position -399 and the risk of ischemic stroke in Han Chinese. Study Design: Case-control study. Methods: The polymorphism -399T/C in the promoter of NPY was analysed in 500 patients with ischemic stroke and 500 healthy individuals by amplification and sequencing of this region. Non-conditional logistic regression was used to analyse association between genotypes and the risk of ischemic stroke. Results: Genotype and allele frequencies differed significantly between the ischemic stroke and control groups (P<0.05). Additionally, compared to stroke patients with the TT genotype, those with the CC genotype had a 1.7-times higher risk of ischemic stroke (OR=1.739, 95%CI=1.201-2.520, P=0.003), especially for those who were over 60 years old or male. Individuals with the TC genotype did not have an increased risk of ischemic stroke (P>0.05). Conclusion: The -399T/C polymorphism of the NPY gene is associated with ischemic stroke in Han Chinese individuals, and the CC genotype may be a risk factor for ischemic stroke. [ABSTRACT FROM AUTHOR]

Ling-zhi, a widely cultivated fungus in China, has a long history in traditional Chinese medicine. Although the name 'Ganoderma lucidum', a species originally described from England, has been applied to the fungus, their identities are not the same. This study aims to clarify the identity of this medicinally and economically important fungus. Specimens of Lingzhi from China (field collections and cultivated basidiomata of the Chinese 'G. lucidum'), G. lucidum from UK and other related Ganoderma species, were examined both morphologically and molecularly. High variability of basidioma morphology was found in the cultivated specimens of the Chinese 'G. lucidum', while some microscopic characters were more or less consistent, i.e. short clavate cutis elements, Bovista-type ligative hyphae and strongly echinulate basidiospores. These characters were also found in the holotype of G. sichuanense, a species originally described from Sichuan, China, and in recent collections made in the type locality of the species, which matched the diagnostic characters in the prologue. For comparison, specimens of closely related species, G. lucidum, G. multipileum, G. resinaceum, G. tropicum and G. weberianum, were also examined. DNA sequences were obtained from field collections, cultivated basidiomata and living strains of the Chinese 'G. lucidum', specimens from the type locality of G. sichuanense, and specimens of the closely related species studied. Three-gene combined analyses (ITS+IGS+rpb2) were performed and the results indicated that the Chinese 'G. lucidum' shared almost identical sequences with G. sichuanense. Based on both morphological and molecular data, the identity of the Chinese 'G. lucidum' (Ling-zhi) is considered conspecific with G. sichuanense. Detailed morphological descriptions and illustrations are provided in addition to discussion of nomenclature implications. [ABSTRACT FROM AUTHOR]

A legendary and very valuable medicinal fungus first known in China 2000 years ago is recognized in this study as a new species. The sanghuang mushroom (sanghuang) is a popular medicinal polypore used throughout China, Japan, and Korea. While its medicinal properties were recognized in an early Tang Dynasty herbal written in the 7th century, modern scientific research has only recently confirmed its highly effective antitumor properties. Although Japanese and Korean mycologists have adopted Phellinus linteus or P. baumii as the scientific name for sanghuang that belongs to the Inonotus baumii-I. linteus group in the Hymenochaetales (Basidiomycota), its species identity has not been satisfactorily answered. This study delimits the species of the I. baumii-I. linteus group including sanghuang, based on an analysis of morphological characteristics and nrDNA ITS sequences. Both morphological and molecular features were useful in separating different fungal species in this monophyletic group that are generally specialized with their host tree species. The true sanghuang is a new and previously undescribed species that grows solely on Morus in China, Japan, Korea, and Taiwan. It is now rare and endangered in the wild. Six related species of the I. baumii-I. linteus group distributed in Asia have evolved to specific host tree species: I. baumii on Syringa, I. lonicericola on Lonicera, I. lonicerinus comb. nov. on Lonicera, I. sanghuang on Morus, I. vaninii on Populus, and I. weigelae sp. nov. on Weigela; a key is provided to ease the determination of these taxa. [ABSTRACT FROM AUTHOR]

Objective: To derive age- and sex-specific reference values for waist circumference (WC) and waist-to-height ratio (WHtR) for Han Chinese children and adolescents and to establish the prevalence of excess central adiposity in our study population. Design: Cross-sectional study of schoolchildren attending randomly selected primary and secondary schools in south-west China in October 2003 and April 2004. Anthropometry was measured using standard procedures. The LMS method was used to construct smoothed WC and WHtR percentile curves. Overweight and obesity were defined by the International Obesity Task Force (IOTF) criteria and the Working Group on Obesity in Children. Excess central adiposity fat was defined by previously published WC cut-points and a WHtR ≥ 0·5. Setting: Primary and secondary schools in Chongqing, south-west China. SubjectsA total of 7326 (49·2 % boys) Han Chinese students at 5–17 years old. Results: On the basis of the IOTF criteria, 26·4 % of boys were overweight or obese compared with 16·4 % of girls (P < 0·001). WC cut-points identified 31 % of boys and 28 % of girls as having excess central adiposity, whereas using the WHtR criterion, 14·8 % of boys and 5·6 % of girls were identified. Young boys (5–12 years) had a significantly (P < 0·001) higher WHtR than girls.Conclusions: We have constructed WC and WHtR percentile curves for Han Chinese children and adolescents living in Chongqing. Our measurements were based on a student population with a relatively high rate of overweight and obesity. These data will provide a point of reference for future studies measuring the prevalence of overweight and obesity in China. [ABSTRACT FROM AUTHOR]

Zn, Cu, Cr and Pb concentrations of the sediment collected from three tidal flat sites of Yangtze estuary were investigated in October 2003. Results showed that the average concentrations of heavy metals in the sediments were two to three times to the environment background values of Yangtze estuary tidal flat sediment. The heavy metal concentrations in the sediments near the Bailonggang (BLG) and Laogang (LG) sewage outfalls were obviously higher than those of Chaoyang (CY) tidal flat where there are no sewage outfalls near the coast. And the concentrations of heavy metals in the surface sediments of LG tidal flat decreased with the increasing of the distance to the sewage outfalls. The heavy metal concentration profile in the sediment core changed with the depth, and generally reached maximum values at the depth of plant roots. The assessment results showed that the sediments of LG, BLG and CY tidal flat had been polluted by heavy metals in different level. The pollution degree of heavy metals in the sediments was as follows: Zn > Cu > Pb > Cr. The potential ecological risks of the four heavy metals in three tidal flat sites sediment were all at a middle level, and Cu and Pb made the main contributions. The adverse ecological effects caused by the four heavy metals did not occur frequently. [ABSTRACT FROM AUTHOR]

Field measurements of salinity, wind and river discharge and numerical simulations of hydrodynamics from 1978 to 1984 are used to investigate the dynamics of the buoyant plume off the Pearl River Estuary (PRE), China during summer. The studies have shown that there are four major horizontal buoyant plume types in summer: Offshore Bulge Spreading (Type I), West Alongshore Spreading (Type II), East Offshore Spreading (Type III), and Symmetrical Alongshore Spreading (Type IV). River mouth conditions, winds and ambient coastal currents have inter-influences to the transport processes of the buoyant plume. It is found that all of the four types are surface-advected plumes by analysing the vertical characteristic of the plumes, and the monthly variations of the river discharge affect the plume size dominantly. The correlation coefficient between the PRE plume size and the river discharge reaches 0.85 during the high river discharge season. A wind strength index has been introduced to examine the wind effect. It is confirmed that winds play a significant role in forming the plume morphology. The alongshore wind stress and the coastal currents determine the alongshore plume spreading. The impact of the ambient currents such as Dongsha Current and South China Sea (SCS) Warm Current on the plume off the shelf has also assessed. The present study has demonstrated that both the river discharge and wind conditions affect the plume evolution. [ABSTRACT FROM AUTHOR]

The ventricular septal defect (VSD) is the most common congenital heart defect and no candidate susceptibility gene has been identified. Endocardial cushion and outflow septal morphogenesis, malalignment of which induces VSD, have been suggested to be mediated by the vascular endothelial growth factor (VEGF). Three single-nucleotide polymorphism (SNP) variants in promoter and 5′-UTR region of the VEGF gene, C−2578A (rs699947), G−1154A (rs1570360) and G−634C (rs2010963), were reported to alter its expression. We assessed the association in a Chinese population between these SNPs and VSD using a double approach: case–control and TDT designs. Among the three SNPs, only −634C allele was less frequently present in 222 patients compared to 352 controls (odds ratio: 0.76, 95% CI: 0.59–0.97, X2=5.06, P=0.024, not significant after a Bonferroni correction). This was significantly less transmitted to VSD patients (trios: 142) (odds ratio: 0.39, 95% CI: 0.25–0.62, X2=8.11, df=1, P=0.004, corrected P=0.024). A similar result was observed for haplotype −2578C/−1154G/−634C allele in both studies (in TDT: X2=7.51, df=1, P=0.006, corrected P=0.048). All these associations for the first time demonstrated that –634C allele was in a significant protective association against VSD, suggesting that VEGF dysregulation was involved in the pathological processes of VSD.European Journal of Human Genetics (2007) 15, 1246–1251; doi:10.1038/sj.ejhg.5201890; published online 11 July 2007 [ABSTRACT FROM AUTHOR]

Water samples collected from early March 2001 to the end of April 2002 at the branch of Pearl River around the Guangzhou City were analyzed for its micro-polluted characteristics. The coagulation behavior of polyaluminum chlorides(PACls) was then examined focusing on the effect of primary water quality and speciation distribution. The results showed that PACIs exhibit better coagulation efficiency than alum in accordance with the different speciation. The turbidity removal property of PACIs is evidently better than alum at low dosage. While in neutral zone (about 6.5-7.5). the turbidity removal of PACIs decreases owing to the restabilization of particles at higher dosage. The organic matters in raw water exhibit marked influence on coagulation. In acidic zone, organic matters complex with polymer species and promote the formation of floes. With an increase in pH. the complexation of organics with polymer species gradually decreases, and the removal of organics mainly depends on adsorption. The effect evidently improved with the raise of B value. [ABSTRACT FROM AUTHOR]

To further understand the reasons Of the damage of reinforced concrete frame structures during Wenchuan earthquake, some typical damaged appearances of frame structures are summarized and the reasons of damage are analyzed according to the rules described in the Code for Seismic Design of Buildings, including the damages around the aseismic joint, damages due to uneven distribution of stiffness or strength along vertical direction, damages in the beams, columns and nodes of frame structures, damages of enclosed walls and stairs. Based on the analysis results, some methods to enhance the safety of frame structures are proposed. The research results can provide a reference for seismic design of frame building structures and revision of corresponding codes and regulations so that the frame structure can achieve the seismic protective objective of undamage for small earthquake, repairable damage for moderate earthquake and uncollapse for severe earthquake. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common and serious postoperative complication, especially in the elderly. Epidural anesthesia may reduce delirium by improving analgesia, reducing opioid consumption, and blunting stress response to surgery. This trial therefore tested the hypothesis that combined epidural-general anesthesia reduces the incidence of postoperative delirium in elderly patients recovering from major noncardiac surgery.Methods: Patients aged 60 to 90 yr scheduled for major noncardiac thoracic or abdominal surgeries expected to last 2 h or more were enrolled. Participants were randomized 1:1 to either combined epidural-general anesthesia with postoperative epidural analgesia or general anesthesia with postoperative intravenous analgesia. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the initial 7 postoperative days.Results: Between November 2011 and May 2015, 1,802 patients were randomized to combined epidural-general anesthesia (n = 901) or general anesthesia alone (n = 901). Among these, 1,720 patients (mean age, 70 yr; 35% women) completed the study and were included in the intention-to-treat analysis. Delirium was significantly less common in the combined epidural-general anesthesia group (15 [1.8%] of 857 patients) than in the general anesthesia group (43 [5.0%] of 863 patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number needed to treat 31). Intraoperative hypotension (systolic blood pressure less than 80 mmHg) was more common in patients assigned to epidural anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to 1.65; P < 0.001), and more epidural patients were given vasopressors (495 [58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P < 0.001).Conclusions: Older patients randomized to combined epidural-general anesthesia for major thoracic and abdominal surgeries had one third as much delirium but 50% more hypotension. Clinicians should consider combining epidural and general anesthesia in patients at risk of postoperative delirium, and avoiding the combination in patients at risk of hypotension.Editor’s Perspective: [ABSTRACT FROM AUTHOR]

Background: Delirium is a postoperative complication that occurs frequently in patients older than 65 years, and presages adverse outcomes. We investigated whether prophylactic low-dose dexmedetomidine, a highly selective α2 adrenoceptor agonist, could safely decrease the incidence of delirium in elderly patients after non-cardiac surgery.Methods: We did this randomised, double-blind, placebo-controlled trial in two tertiary-care hospitals in Beijing, China. We enrolled patients aged 65 years or older, who were admitted to intensive care units after non-cardiac surgery, with informed consent. We used a computer-generated randomisation sequence (in a 1:1 ratio) to randomly assign patients to receive either intravenous dexmedetomidine (0·1 μg/kg per h, from intensive care unit admission on the day of surgery until 0800 h on postoperative day 1), or placebo (intravenous normal saline). Participants, care providers, and investigators were all masked to group assignment. The primary endpoint was the incidence of delirium, assessed twice daily with the Confusion Assessment Method for intensive care units during the first 7 postoperative days. Analyses were done by intention-to-treat and safety populations. This study is registered with Chinese Clinical Trial Registry, www.chictr.org.cn, number ChiCTR-TRC-10000802.Findings: Between Aug 17, 2011, and Nov 20, 2013, of 2016 patients assessed, 700 were randomly assigned to receive either placebo (n=350) or dexmedetomidine (n=350). The incidence of postoperative delirium was significantly lower in the dexmedetomidine group (32 [9%] of 350 patients) than in the placebo group (79 [23%] of 350 patients; odds ratio [OR] 0·35, 95% CI 0·22-0·54; p<0·0001). Regarding safety, the incidence of hypertension was higher with placebo (62 [18%] of 350 patients) than with dexmedetomidine (34 [10%] of 350 patients; 0·50, 0·32-0·78; p=0·002). Tachycardia was also higher in patients given placebo (48 [14%] of 350 patients) than in patients given dexmedetomidine (23 [7%] of 350 patients; 0·44, 0·26-0·75; p=0·002). Occurrence of hypotension and bradycardia did not differ between groups.Interpretation: For patients aged over 65 years who are admitted to the intensive care unit after non-cardiac surgery, prophylactic low-dose dexmedetomidine significantly decreases the occurrence of delirium during the first 7 days after surgery. The therapy is safe.Funding: Braun Anaesthesia Scientific Research Fund and Wu Jieping Medical Foundation, Beijing, China. Study drugs were manufactured and supplied by Jiangsu Hengrui Medicine Co, Ltd, Jiangsu, China. [ABSTRACT FROM AUTHOR]