BackgroundPostoperative Delirium (POD) is the most common complication of elderly patients after surgery associated with increased postoperative morbidity, persistent care dependency and even mortality. Prevention of POD requires detection of patients at high risk prior to surgery. PROPDESC intends to provide an instrument for preoperative routine screening of patients' risk for POD.MethodsPROPDESC is a monocentric prospective observatory trial including 1000 patients older than 60 years from various disciplines of a university hospital planned for surgery of at least 60 min. To develop a score predicting the risk for POD, anesthesiological stratifications, laboratory values, medication and known risk factors as well as quality of life and cognitive performance are taken into account. POD assessment is performed daily on the first five days after the operation respectively the end of sedation in the intensive care units and normal wards. The score is evaluated from 600 data sets and subsequently validated internally. The most appropriate predictors are determined by a component-wise gradient boosting approach.DiscussionBased on retrospective investigations, etiology of POD is considered multifactorial. By a prospective analysis of various factors, PROPDESC intends to provide an applicable tool to predict the risk for POD from preoperative routine data and assessment of cognitive function. Objective is to establish an automatically generating score in preoperative routine to screen patients for increased risk of POD as starting point for POD reduction and management. Model compilation requires a high significance and enhancement within compound as well as regular availability of the selected predictors.Trial registrationDRKS, DRKS00015715. Registered 13 December 2018 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015715.

BACKGROUND: Acute mesenteric ischemia (AMI) is associated with a high mortality rate, yet diagnostic difficulties persist. Although many biomarkers have been investigated for diagnostic purposes, as well as imaging methods, a sufficiently specific and sensitive marker has not been identified. This research was designed to examine whether heparin-binding protein (HBP), which has a role in the early phase of inflammation, could be useful in the diagnosis of AMI. METHODS: Serum samples obtained from a previously performed rabbit model of AMI were used in the study. HBP, C-reactive protein (CRP) and interleukin 6 (IL-6) levels were measured in blood samples obtained at baseline and 1, 3, and 6 hours from subjects that were separated into 3 groups: control, sham, and ischemia. The change in each marker over time and comparisons of the groups were evaluated statistically. RESULTS: A significant difference was not detected at the first hour in any of the studied markers. At the third hour, the CRP and IL-6 levels in the ischemia group indicated a significant increase in comparison with the control and sham groups (p<0.001). The HBP values showed a significant increase at the sixth hour in the ischemia group in comparison with the others (p<0.001). CONCLUSION: The HBP level demonstrated a slower increase in a rabbit model of AMI compared with CRP and IL-6. However, it still has the potential to become an early diagnostic biomarker. Diagnostic sensitivity and specificity should be evaluated in further clinical trials.

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Amaç: Kronik obstrüktif akciğer hastalığı (KOAH)'nda hava yolu inflamasyonu, biyobelirteçler kullanılarak ölçülebilir. Bu çalışma, sistemik inflamasyonun biyobelirteçlerini kullanarak KOAH'ın heterojenliğini araştırmak için yapılmıştır.Gereç ve Yöntem: 19 KOAH'lı hastanın toraks bilgisayar tomografisi amfizem baskın ve kronik bronşit baskın olmasına göre değerlendirildi ve kan biyobelirteçleriyle karşılaştırıldı.Bulgular: Çalışma grubunun yaş ortalaması 72,1±8,0 yıldı. KOAH fenotipiyle kan biyobelirteçleri arasında bir fark saptanmazken, amfizem baskın ile kronik bronşit arasında, toraks anteroposterior (AP) ve transvers çap açısından istatistiksel olarak anlamlı fark saptanmıştır. AP çap/transvers çap oranı ile TNF-alfa arasında pozitif yönlü güçlü istatistiksel olarak anlamlı korelasyon saptandı. Sonuç: Yaygın kronik bronşitli hastalar ile yaygın pulmoner amfizemi olan hastalar arasında inflamatuar biyobelirteçler açısından anlamlı fark bulunmaması, bu iki klinik ve fonksiyonel fenotipin benzer inflamatuar bir paterne sahip olabileceğini düşündürmüştür. Sonuç olarak, KOAH'ın fenotipik ayrımı ya da tedaviye yanıtın değerlendirilmesi için biyobelirteçlerin kullanımına büyük bir ilgi vardır. Sonuçlarımızın, daha büyük klinik çalışmaların planlanmasında fayda sağlayacağını düşünüyoruz.