BackgroundPOD places a heavy burden on the healthcare system as the number of elderly people undergoing surgery is increasing annually because of the aging population. As a large country with a severely aging population, China's elderly population has reached 267 million. There has been no summary analysis of the pooled incidence of POD in the elderly Chinese population.MethodsSystematic search databases included PubMed, Web of Science, EMBASE, Cochrane Library Databases, China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), WanFang Database, and Chinese Science and Technology Periodicals (VIP). The retrieval time ranged from the database's establishment to February 8, 2023. The pooled incidence of delirium after non-cardiac surgery was calculated using a random effects model. Meta-regression, subgroup, and sensitivity analyses were used to explore the source of heterogeneity.ResultsA total of 52 studies met the inclusion criteria, involving 18,410 participants. The pooled incidence of delirium after non-cardiac surgery in the elderly Chinese population was 18.6% (95% CI: 16.4–20.8%). The meta-regression results revealed anesthesia method and year of publication as a source of heterogeneity. In the subgroup analysis, the gender subgroup revealed a POD incidence of 19.6% (95% CI: 16.9–22.3%) in males and 18.3% (95% CI: 15.7–20.9%) in females. The year of publication subgroup analysis revealed a POD incidence of 20.3% (95% CI: 17.4–23.3%) after 2018 and 14.6 (95% CI: 11.6–17.6%) in 2018 and before. In the subgroup of surgical types, the incidence of hip fracture surgery POD was 20.7% (95% CI: 17.6–24.3%), the incidence of non-cardiac surgery POD was 18.4% (95% CI: 11.8–25.1%), the incidence of orthopedic surgery POD was 16.6% (95% CI: 11.8–21.5%), the incidence of abdominal neoplasms surgery POD was 14.3% (95% CI: 7.6–21.1%); the incidence of abdominal surgery POD was 13.9% (95% CI: 6.4–21.4%). The anesthesia methods subgroup revealed a POD incidence of 21.5% (95% CI: 17.9–25.1%) for general anesthesia, 15.0% (95% CI: 10.6–19.3%) for intraspinal anesthesia, and 8.3% (95% CI: 10.6–19.3%) for regional anesthesia. The measurement tool subgroup revealed a POD incidence of 19.3% (95% CI: 16.7–21.9%) with CAM and 16.8% (95% CI: 12.6–21.0%) with DSM. The sample size subgroup revealed a POD incidence of 19.4% (95% CI: 16.8–22.1%) for patients ≤ 500 and 15.3% (95% CI: 11.0–19.7%) for patients > 500. The sensitivity analysis suggested that the pooled incidence of postoperative delirium in this study was stable.ConclusionOur systematic review of the incidence of delirium after non-cardiac surgery in elderly Chinese patients revealed a high incidence of postoperative delirium. Except for cardiac surgery, the incidence of postoperative delirium was higher for hip fracture surgery than for other types of surgery. However, this finding must be further explored in future large-sample studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023397883.
PurposeThe aim of this study was to investigate whether 11q loss of heterozygosity (LOH) aberration would impact the response of the primary tumor to neoadjuvant chemotherapy or to the degree of surgical resection in neuroblastoma (NB) patients with MYCN amplification.MethodsThe clinical data of 42 NB patients with MYCN amplification who were newly diagnosed and received treatments at our hospital from 2011 to 2020 were retrospectively analyzed. According to the results of the segmental chromosome aberration analysis, the patients enrolled were assigned to an 11qLOH positive group and an 11qLOH negative group.ResultsThere was no significant difference in the mean number of chemotherapy courses completed before surgery between the 11qLOH positive and 11qLOH negative groups (p = 0.242). Each of the 42 patients had metaiodobenzylguanidine (MIBG) scans both before and after neoadjuvant chemotherapy. The percentage of patients who had a clinical MIBG change in the 11qLOH positive group was lower than the percentage in the 11qLOH negative group (27.27 vs. 66.67%, p = 0.030). The 11qLOH negative group seemed to have a higher rate of surgical resection (≥90%); however, the difference between the two groups was not statistically significant (p = 0.088). Furthermore, the 11qLOH negative group did not show significantly superior event-free survival and overall survival rates compared with the 11qLOH positive group.ConclusionsThis study showed that patients with NB and MYCN amplification in combination with 11qLOH might be less likely to respond to neoadjuvant chemotherapy when compared with patients with NB and MYCN amplification without 11qLOH.
Background: To investigate whether protein induced by vitamin K antagonist-II (PIVKA-II) combined with alpha-fetoprotein (AFP) can improve the diagnostic and differential diagnostic accuracy of childhood hepatic tumors. Methods: A multi-center prospective observational study was performed at nine regional institutions around China from October 1, 2018, to September 30, 2020, 257 eligible patients were enrolled. Children with hepatic mass (Group T, n=144) were divided into hepatoblastoma group (Group THB, n=98) and hemangioendothelioma group (Group THE, n=46), children with extrahepatic abdominal mass (Group C, n=113). Peripheral blood was collected from each patient prior to surgery or chemotherapy. Receiver Operating Characteristics (ROC) curves and area under the curve (AUROC) were used to evaluate the diagnostic efficiency of PIVKA-II and the combined tumor markers with AFP. Results: The mean level of PIVKA-II and AFP were both significantly higher in Group T than Group C (P=0.001, P<0.001), in Group THB than Group THE (P=0.018, P=0.013). For the diagnosis of childhood hepatic tumors, AUROC of PIVKA-II (cut-off value 32.6 mAU/ml) and AFP (cut-off value 120ng/ml) was 0.867 vs. 0.857. The differential diagnostic value of PIVKA-II and AFP in hepatoblastoma from hemangioendothelioma were further assessed, AUROC of PIVKA-II (cut-off value 47.1mAU/ml) and AFP (cut-off value 560ng/ml) was 0.876 vs. 0.743. The combined markers showed higher AUROC (0.891, 0.895 respectively) than PIVKA-II or AFP alone. Conclusions: The serum level of PIVKA-II was significantly higher in children with hepatic tumors, especially those with malignant tumors. The combination of PIVKA-II with AFP further increased the diagnostic performance.Trial registration: Clinical Trials, NCT03645655. Registered 20 August 2018, https://www.clinicaltrials.gov/ct2/show/NCT03645655
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