The preoperative salivary cortisol AM/PM ratio was significantly associated with the presence of early POCD. This biomarker may have potential utility for screening patients for an increased risk and also for further elucidating the etiology of POCD.

BackgroundThere may be great individual variability in the hemodynamic effects of this dexmedetomidine. For this reason, the dose must be carefully adjusted to achieve the desired clinical effect. Whether a loading dose of dexmedetomidine produces hemodynamic side effects during the anesthesia maintenance is unknown. The aim of this study was to compare the effects of a loading dose of dexmedetomidine combined with propofol or sevoflurane on hemodynamics during anesthesia maintenance.MethodsEighty-four patients who were scheduled for general surgery under balanced general anesthesia were randomly allocated into 4 groups (n = 21): the propofol and dexmedetomidine group, the sevoflurane and dexmedetomidine group, the propofol and normal saline group, or the sevoflurane and normal saline group. The hemodynamic indexes at the time of just before, 5 min after and the end of study drug infusion (dexmedetomidine or normal saline) were recorded. The incidence rates of increasing blood pressure at the end of study drug infusion (greater than 20% compared to baseline or before study drug infusion) were evaluated.ResultsMean arterial pressure increased significantly (P < 0.01) only in the propofol and dexmedetomidine group after intravenous dexmedetomidine compared administration. 80% of cases with propofol and dexmedetomidine had increased mean arterial blood pressure compared to only 5% of cases in the sevoflurane and dexmedetomidine group (P < 0.05). Heart rates in the propofol and dexmedetomidine and the sevoflurane and dexmedetomidine groups decreased significantly after dexmedetomidine infusion (P < 0.01).ConclusionsIntraoperative administration of a loading dose of dexmedetomidine combined with propofol in anesthesia maintenance proceeded a significant increase in blood pressure. In contrast, it combines with sevoflurane didn’t produce increased blood pressure. Meanwhile it is not unexpected that dexmedetomidine combined with propofol or sevofurance decreased heart rate, due to the known side effects of DEX. Therefore, dexmedetomidine should be used cautiously during the entire intravenous anesthesia maintenance period, especially during maintenance with propofol.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-17010423, registered on 13 January 2017.

Background Homocysteine, folate, and vitamin B12 involved in 1-carbon metabolism are associated with cognitive disorders. We sought to investigate the relationships between these factors and delayed neurocognitive recovery (dNCR) after non-cardiac surgery. Methods This was a prospective observational study of patients (n = 175) who were ≥ 60 years of age undergoing non-cardiac surgery. Patients were evaluated preoperatively and for 1 week postoperatively by using neuropsychological tests and were divided into dNCR or non-dNCR groups according to a Z-score ≤ − 1.96 on at least two of the tests. The relationship between the occurrence of dNCR and preoperative levels of homocysteine, folate, and vitamin B12 was analyzed. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with dNCR. Results Delayed neurocognitive recovery was observed in 36 of 175 patients (20.6%; 95% confidence interval [CI], 14.5–26.6%) 1 week postoperatively. Patients who developed dNCR had significantly higher median [interquartile range (IQR)] homocysteine concentrations (12.8 [10.9,14.4] μmol/L vs 10.6 [8.6,14.7] μmol/L; P = 0.02) and lower folate concentrations (5.3 [4.2,7.3] ng/mL vs 6.9 [5.3,9.5] ng/mL; P = 0.01) than those without dNCR. Compared to the lowest tertile, the highest homocysteine tertile predicted dNCR onset (odds ratio [OR], 3.9; 95% CI, 1. 3 to 11.6; P = 0.02), even after adjusting for age, sex, education, and baseline Mini Mental State Examination. Conclusions Elderly patients with high homocysteine levels who underwent general anesthesia for non-cardiac surgery have an increased risk of dNCR. This knowledge could potentially assist in the development of preventative and/or therapeutic measures. Trial registration NCT03084393 (https://www.clinicaltrials.gov)

BackgroundCor triloculare biventriculare accounts for approximately 0.31% of cases of congenital heart disease (CHD). Moreover, people with cor triloculare biventriculare always have shorter life spans, and cases of gestation are rare. There have been various related reports of cor triloculare biventriculare in recent years.Case presentationWe described an emergency cesarean section of a 30-year-old, 38-weeks-pregnant woman suffering from cardiac insufficiency and fetal distress. Combined spinal-epidural anesthesia was performed safely, and a male baby was smoothly delivered 10 min after the procedure without any adverse outcome on the mother or newborn. After surgery, we advised that the patient submit to an echocardiogram examination, which revealed the congenital heart disease cor triloculare biventriculare.ConclusionsCombined spinal-epidural anesthesia was administered to a patient with cor triloculare biventricularethis with good effect, ensuring the patient’s safety and meeting the need for emergency surgery.

Modal test is one of the basic works of studying on dynamic characteristics of aircraft. The ideal state is to make the specimen in the "free-free" state when doing modal test. In actual, specimen is supported by an elastic supporting system, the stiffness, added mass and supporting position of the supporting system will affect the rigid-body modal frequency of the system directly. In this paper, we took a certain aerospace products as an example and used ANSA, NASTRAN software, studied on the influence of stiffness, added mass and supporting position of the supporting system on modal test results, and put forward the design method of modal test supporting system.

Background: Postsurgical cognitive decline is a common complaint among older adults. While the mechanisms that contribute to this outcome are incompletely understood, leukocyte telomere length (LTL) can be measured as a form of a biological clock associated with individual lifespan. As such, LTL offers potential utility as an aging-associated biomarker that can be used to evaluate delayed neurocognitive recovery (dNCR) and related conditions. Methods: For this study, 196 adults over 60 years of age scheduled to undergo major non-cardiac surgical procedures underwent neuropsychological testing pre-one day and the post-one week following surgery. The finding of dNCR was based on a measured Z-score ≤ -1.96 on two or more separate tests. The frequency of dNCR was presented as the primary outcome of the study. Secondly, we evaluated the association between dNCR and preoperative LTL. Results: Overall, 20.4% [40/196; 95% confidence interval (CI), 14.7-26.1%] of patients exhibited dNCR at 1-week post-surgery. Longer LTL was identified as a predictor for the onset of early cognitive impairment resulting in post-operative cognitive decline [odds ratio (OR), 14.82; 95% CI, 4.01-54.84; P < 0.001], following adjustment of age (OR, 12.33; 95% CI, 3.29-46.24; P< 0.001). The dNCR incidence based on LTL values of these patients, the area under the receiver operating characteristic (ROC) curve was 0.79 (95% CI, 0.722-0.859; P <0.001). At an optimal cut-off value of 0.959, LTL values offered respective specificity and sensitivity values of 64.7% and 87.5%. Conclusions: The incidence of dNCR was substantially correlated with the longer LTL. This biomarker may help identify patients at higher risk and clarify the etiology of dNCR.

Abstract. airplane oil pressure reservoirs are major fuel supplying parts of airplanes to have flight maneuvers. Since they are always working under alternating loadings, they are prone to produce fatigue fractures. Therefore, they will undergo vibration endurance tests in general. And the fixed-frequency vibration endurance test is commonly used in engineering. This paper has established a finite element model for the vibration test system, taken into consideration the influence of liquid fuel and introduced the fluid-solid coupling method to conduct harmonic response analysis on different excitation conditions with MSC.Nastran, thus obtaining the stress distribution under different loading conditions. Moreover, the results have been compared with the test results to verify correctness of the method, thus providing references for the improvement in structural design.

The aircraft electronic devices are mainly composed of plate type, the structures with so many electronic components are complex. Most electronic components are standard parts. Reliability analysis of aircraft electronic equipment is mainly focused on the circuit of electronic equipment and components and so on. However, the investigation about reliability of electronic equipment structure research is seldom. This article introduces the principle and method of structural reliability of aircraft electronic equipment. Taking the computer box of air data processing for a type of aircraft as an example, reliability analysis process is described based on Monte Carlo Method. the result of calculating the strength and stiffness reliability of the box are 99.9746% and 99.9833% respectively, while the experimental reliability are 99.9986% and 99.9918%. The good consistency between simulation and experiment results indicates that the analysis method is reasonable and effective.