BackgroundPostoperative delirium (POD) is a common and critical complication after cardiac surgery. However, the relationship between POD and postoperative physical frailty and the effect of both on long-term clinical outcomes have not been fully explored.ObjectiveWe aimed to examine the associations among POD, postoperative frailty, and major adverse cardiac events (MACE).DesignThis was a prospective cohort study.MethodsWe studied 329 consecutive patients undergoing elective cardiac surgery. The intensive care delirium screening checklist was used to assess POD. Postoperative frailty was defined by handgrip strength and walking speed. Patients were subsequently followed-up to detect MACE.ResultsPOD was present in 13.2%, while the incidence of postoperative frailty was 27.0%. POD was independently associated with development of postoperative frailty (adjusted odds ratio = 2.98). During follow-up, MACE occurred in 14.1% of all participants. On multivariate Cox proportional hazard analysis, POD (adjusted hazard ratio (HR) = 3.36), postoperative frailty (HR = 2.21), postoperative complications (HR = 1.54), and left ventricular ejection fraction (HR = 0.95) were independently associated with increased risk of MACE.LimitationsIt is a single-center study with a risk of bias. We did not investigate follow up cognitive function.ConclusionsPOD was a predictor of postoperative frailty after cardiac surgery. Both postoperative frailty and POD were associated with the incidence of MACE, while POD was the stronger predictor of MACE. Thus, POD and frailty play critical roles in the risk stratification of patients undergoing cardiac surgery.

Preoperative nutritional status as assessed by the GNRI could reflect perioperative physical function. Preoperative poor nutritional status may be an independent predictor of the retardation of postoperative rehabilitation in patients undergoing elective cardiac surgery.

Poor exercise capacity was found to be an independent predictor of POD following elective cardiac surgery. This finding suggests the importance of preoperative functional evaluation in the prevention and management of POD in cardiac surgery patients.

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Background: Sleep in preschool children is an important factor for their health and active lives. The lack of adequate sleep in preschool children is a serious public problem in Japan. The relationship between health literacy (HL) and health status is well recognized. The purpose of this study was to investigate the association between the sleep duration of preschool children and the HL of their parents. Methods: In the present study, participants were preschool children (3–6 years) and their parents. We assessed the HL of the parents with the 14-item Health Literacy Scale (HLS-14) questionnaire. Sleep duration of the children was reported by their parents. We divided parents into two groups according to HLS-14 score and analyzed children’s sleeping time separately. Results: Data from 279 parents and their children were ultimately analyzed. The high HL group comprised 210 families (75.3%) and the low HL group comprised 69 families (24.7%). Average children’s sleep duration was significantly longer in the high HL group (9.5 ± 0.9 h) than in the low HL group (9.1 ± 1.1 h) (p = 0.013). A positive correlation was found in the low HL group between parents’ HL and their children’s sleeping times (p < 0.01, r = 0.32) but the difference was not significant in the high HL group (p = 0.98, r = −0.0009). Conclusion: The HL of parents appears to affect their children’s sleep duration, suggesting that parental HL may be an appropriate target for interventions aiming to lengthen children’s sleeping time.

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Purpose We describe the initial assessment of the peripheral quantitative CT (pQCT) imaging capabilities of a cone-beam CT (CBCT) scanner dedicated to musculoskeletal extremity imaging. The aim is to accurately measure and quantify bone and joint morphology using information automatically acquired with each CBCT scan, thereby reducing the need for a separate pQCT exam. Methods A prototype CBCT scanner providing isotropic, sub-millimeter spatial resolution and soft-tissue contrast resolution comparable or superior to standard multi-detector CT (MDCT) has been developed for extremity imaging, including the capability for weight-bearing exams and multi-mode (radiography, fluoroscopy, and volumetric) imaging. Assessment of pQCT performance included measurement of bone mineral density (BMD), morphometric parameters of subchondral bone architecture, and joint space analysis. Measurements employed phantoms, cadavers, and patients from an ongoing pilot study imaged with the CBCT prototype (at various acquisition, calibration, and reconstruction techniques) in comparison to MDCT (using pQCT protocols for analysis of BMD) and micro-CT (for analysis of subchondral morphometry). Results The CBCT extremity scanner yielded BMD measurement within ±2–3% error in both phantom studies and cadaver extremity specimens. Subchondral bone architecture (bone volume fraction, trabecular thickness, degree of anisotropy, and structure model index) exhibited good correlation with gold standard micro-CT (error ~5%), surpassing the conventional limitations of spatial resolution in clinical MDCT scanners. Joint space analysis demonstrated the potential for sensitive 3D joint space mapping beyond that of qualitative radiographic scores in application to non-weight-bearing versus weight-bearing lower extremities and assessment of phalangeal joint space integrity in the upper extremities. Conclusion The CBCT extremity scanner demonstrated promising initial results in accurate pQCT analysis from images acquired with each CBCT scan. Future studies will include improved x-ray scatter correction and image reconstruction techniques to further improve accuracy and to correlate pQCT metrics with known pathology.