Purpose: Delirium is a common complication in postoperative critically ill patients. Although abnormal melatonin metabolism is thought to be one of the mechanisms of delirium, there have been few studies in which the association between alteration of perioperative plasma melatonin concentration and postoperative delirium was assessed. Materials:We conducted a prospective observational study to assess the association of perioperative alteration of plasma melatonin concentration with delirium in 40 postoperative patients who required intensive care for more than 48 hours. We diagnosed postoperative delirium using CAM-ICU and measured melatonin concentration 4 times (before the operation as the preoperative value, 1 hour after the operation, POD 1 and POD 2).Results: Postoperative delirium occurred in 13 (33%) of the patients. Although there was no significant difference in preoperative melatonin concentration, delta melatonin concentration at 1 hour after the operation was significantly lower in patients with delirium than in those without delirium (-1.1 vs. 0 pg/ml, p=0.036). After adjustment of relevant confounders, delta melatonin concentration was independently associated with risk of delirium (odds ratio; 0.50, p=0.047). Conclusions:Delta melatonin concentration at 1 hour after the operation has a significant independent association with risk of postoperative delirium.

Polyester fabrics were exposed to an atmospheric pressure plasma jet (APPJ) to improve their detergency performance. Surface characterization of the polyester fibers showed that wettability, surface free energy, and surface oxygen concentration increased after the APPJ treatment. The untreated and APPJ-treated polyester fabrics were soiled with carbon black, oleic acid, and stearic acid as model contaminants. The soiled fabric was washed together with the original fabric in the aqueous detergent solutions without and with mechanical action (shake or ultrasound). A washing test using a horizontal drum type washer in accordance with ISO 6330 was also performed to verify the efficiency of the APPJ treatment to polyester fabric in a domestic laundry. The soil removal from the fabric and redeposition onto the fabric were evaluated from the changes in the surface reflectance of the soiled and the original fabrics due to washing. As expected, the APPJ treatment was found to enhance soil removal and to prevent soil redeposition independent of detergent solution and mechanical action. When the polyester fabric after soiling was exposed to the APPJ, the increase in soil removal and the decrease in soil redeposition were remarkably observed compared with the APPJ exposure to polyester fabrics before soiling. Such detergency improvement by the APPJ was also observed for a cotton fabric soiled with stearic acid.

We assessed the safety and efficacy of application of an enteral nutrition (EN) protocol in postesophagectomy patients who required intensive care for more than 7 days. Methods: There was no EN protocol for 24 patients who underwent esophagectomy in 2006. The initiation and adjustment of feeding in those patients were decided by attending physicians once a day without any target goal of EN. An EN protocol was used in 27 patients in 2007. In those patients, EN was initiated on postoperative day 2 or 3, and the feeding dose was increased by 20 kcal/hr in the morning and evening toward 100% of basal energy expenditure (E100) calculated by Harris-Benedict formula. Results: The median durations to achieve EN administration of E100 was 3 days with the protocol, which was significantly shorter than the 6-day period for patients without the protocol (P < 0.001). There was no significant difference in the incidence of diarrhea and residual volumes between the two groups. The use of parenteral feeding was significantly less frequent in patients with the protocol than in patients without the protocol (0% vs. 16.7%, P = 0.03). Conclusions: Our simple EN protocol makes the duration to achieve the target goal of EN significantly shorter without any harmful side effects.