Daily Test Research Articles

Early Detection of Amyloid-Related Changes in Memory among Cognitively Unimpaired Older Adults with Daily Digital Testing.

This study was undertaken to determine whether assessing learning over days reveals Alzheimer disease (AD) biomarker-related declines in memory consolidation that are otherwise undetectable with single time point assessments. Thirty-six (21.9%) cognitively unimpaired older adults (aged 60-91 years) were classified with elevated β-amyloid (Aβ+) and 128 (78%) were Aβ- using positron emission tomography with 11C Pittsburgh compound B. Participants completed the multiday Boston Remote Assessment for Neurocognitive Health (BRANCH) for 12 min/day on personal devices (ie, smartphones, laptops), which captures the trajectory of daily learning of the same content on 3 repeated tests (Digit Signs, Groceries-Prices, Face-Name). Learning is computed as a composite of accuracy across all 3 measures. Participants also completed standard in-clinic cognitive tests as part of the Preclinical Alzheimer's Cognitive Composite (PACC-5), with 123 participants undergoing PACC-5 follow-up after 1.07 (standard deviation = 0.25) years. At the cross-section, there were no statistically significant differences in performance between Aβ+/- participants on any standard in-clinic cognitive tests (eg, PACC-5) or on day 1 of multiday BRANCH. Aβ+ participants exhibited diminished 7-day learning curves on multiday BRANCH after 4 days of testing relative to Aβ- participants (Cohen d = 0.49, 95% confidence interval = 0.10-0.87). Diminished learning curves were associated with greater annual PACC-5 decline (r = 0.54, p < 0.001). Very early Aβ-related memory declines can be revealed by assessing learning over days, suggesting that failures in memory consolidation predate other conventional amnestic deficits in AD. Repeated digital memory assessments, increasingly feasible and uniquely able to assess memory consolidation over short time periods, have the potential to be transformative for detecting the earliest cognitive changes in preclinical AD. ANN NEUROL 2024;95:507-517.

Memantine inhibits cortical spreading depolarization and improves neurovascular function following repetitive traumatic brain injury

Cortical spreading depolarization (CSD) is a promising target for neuroprotective therapy in traumatic brain injury (TBI). We explored the effect of NMDA receptor antagonism on electrically triggered CSDs in healthy and brain-injured animals. Rats received either one moderate or four daily repetitive mild closed head impacts (rmTBI). Ninety-three animals underwent craniectomy with electrocorticographic (ECoG) and local blood flow monitoring. In brain-injured animals, ketamine or memantine inhibited CSDs in 44 to 88% and 50 to 67% of cases, respectively. Near-DC/AC-ECoG amplitude was reduced by 44 to 75% and 52 to 67%, and duration by 39 to 87% and 61 to 78%, respectively. Daily memantine significantly reduced spreading depression and oligemia following CSD. Animals ( N = 31) were randomized to either memantine (10 mg/kg) or saline with daily neurobehavioral testing. Memantine-treated animals had higher neurological scores. We demonstrate that memantine improved neurovascular function following CSD in sham and brain-injured animals. Memantine also prevented neurological decline in a blinded, preclinical randomized rmTBI trial.

Visual identification of silver ornament by the structural color based on Mie scattering of ZnO spheres

Structural colors originated from Mie scattering of dielectric spheres can be regulated by the coupling effect between them and substrates. Here a rapid visual identification method of silver ornaments was proposed by the coupling effect of ZnO spheres with them. Both simulation and experimental results proved that, by coupling with different metal substrates, the Mie resonance scattering peaks of ZnO spheres with dimeter of 700 nm showed different degrees of redshift, which lead to different structural color appeared when ZnO spheres deposited on different metal surfaces with a similar appearance. A red structural color was displayed on the surface of the real silver ornament and a yellow-green structural color was shown on the surface of the cupronickel ornament. This method is quite simple and low-cost because it only needs to spray the dispersion of ZnO spheres on the ornament surface. Due to the mild chemical properties of the ZnO, covering and erasing ZnO spheres on the surface of silver would not corrode the silver ornament. Finally, an atomizer method was used for portable and daily testing. This work opens new perspectives on the visual identification of silver.

Analisis Butir Soal Ulangan Harian Semester Gasal Menggunakan Google Formulir di SMA Ipiems Surabaya

This research aims to (1) determine the quality of the daily test items for the even semester of class The sample for this research was students of class X Merdeka 5 at SMA Ipiems Surabaya with 33 students as respondents. This research instrument includes multiple choice questions and answer keys resulting from students' work, then tabulated analysis, validity, reliability, difficulty of questions, and differentiability of question items using the help of Microsoft Excel software. The results of this research show that of the 20 multiple choice questions, 21 students completed the multiple choice questions with a reliability value of r11 0.611, rtable level 1% 0.424, 1% reliable category, and the item difficulty index obtained was a value of 11 items in the medium category, 9 questions in the easy category, and 0 questions in the difficult category.

Initiative to reduce unnecessary routine daily testing of complete blood counts across 11 safety net hospitals.

National societies recommend against performing routine daily laboratory testing without a specific indication. Unnecessary testing can lead to patient harm, such as hospital-acquired anemia. The objective of this study was to reduce repeat complete blood counts (CBCs) after initial testing. This was a quality improvement initiative implemented across 11 safety net hospitals in New York City. A best practice advisory (BPA) was implemented that asked the user to remove a CBC if the last 2 CBCs within 72 hours had normal white blood cell and platelet counts and unchanged hemoglobin levels. The outcome measure was the rate of CBCs per 1000 patient days preintervention (January 8, 2020, to December 22, 2020) to postintervention (December 23, 2020, to December 7, 2021). The process measure was the acceptance rate of the BPA, defined as the number of times the repeat CBC order was removed through the BPA divided by the total number of times the BPA triggered. Across 11 hospitals, repeat CBC testing decreased by 12.3% (73.05 to 64.04 per 1000 patient days, P < .001). Six of the 11 hospitals exhibited statistically significant decreases, ranging from a 10% to 48.9% decrease of repeat CBCs. The overall BPA action rate was 20.0% (24,029 of 119,944 repeat CBCs). This low-effort, electronic health record-based intervention can effectively reduce unnecessary laboratory testing.

Operational and Performance Experience with uMI550 Digital PET-CT during Routine Quality Control Procedures.

Introduction The quality control (QC) procedures for positron emission tomography (PET) scanners are covered by National Electrical Manufacturers Association and International Electrotechnical Commission. QC must be carried out at regular intervals according to the specifications of the scanner manufacturer. Daily and weekly QC plays a valuable role in monitoring positron emission tomography (PET) scanner performance changes. This study shares operational and performance experience of QC procedures that do not require a radioactive Ge-68 source to perform daily QC and experience with fluorodeoxyglucose F18 ( 18 F-FDG) as a substitute for germanium-68/sodium-22 (Ge-68/Na-22) source for weekly QC. Method This study was performed on an uMI550 digital positron emission tomography-computed tomography (PET-CT) scanner. In this scanner daily QC checks system temperature and humidity, system count rate, data link status, and voltage. QC was performed at the console control, the position of the scanner table was in the home position pulled out from the gantry, and the room was closed during the quick QC. Weekly full QC check items include look-up table drift, energy drift, time-of-flight status, C-map status, temperature and humidity, and voltage. Weekly full QC was performed with a 18 F-FDG source in a rod phantom source. Results Over 200 daily QC tests without a radioactive source Ge-68 phantom and 50 full weekly QC tests using a 18 F-FDG rod phantom were performed with this scanner according to the manufacturer's instructions and a test report was generated. No daily QC errors or warnings were observed during this period. Conclusion The new approach for the daily PET QC does not expose operators to radiation. This translates into commercial and operational merits with consistent performance and results. Implications for Practice Reduction in radiation exposure to operating staff during QC procedure in PET-CT scanner.

Cognitive dynamics in healthy aging and mild cognitive impairment

AbstractBackgroundIn observational and clinical intervention studies of Alzheimer disease (AD), cognition is typically assessed in an extended, “single‐shot” testing session to measure mean‐level changes in performance over time. However, this strategy ignores day‐to‐day fluctuations in cognition that may occur due to mood, stress or fatigue. It is possible that the overall magnitude of daily variability in cognition is a more sensitive endpoint than traditional metrics of cognitive change. Previous research has suggested that attention and personality traits are important predictors of AD, yet it is unknown how scores on these outcomes fluctuate over short intervals. The aim of this project was to evaluate the extent to which scores on attention, personality and mood and fatigue vary across 3 weeks of daily testing and whether cognitive variability increases in early‐stage AD.MethodA total of 66 younger adults (YAs), 52 cognitively healthy older adults (OAs), and 37 individuals with cognitive impairment (CIs) completed 21 daily assessments of attention, personality, and mood. Cognitive impairment was determined as a rating of 0.5 on the Clinical Dementia Rating scale or a score of less than 11 on the mini Montreal Cognitive Assessment. Group differences in mean performance and variability were assessed using Bayesian mixed effects location scale models.ResultAdherence was high with an average of 20.1, 19.7 and 19.2 daily sessions (out of 21 possible) completed for YAs, OAs and CIs, respectively. YAs reported overall lower mood compared to the OAs. No other mean comparisons were significant. In terms of daily variability, YAs had greater fluctuations in reported fatigue, conscientiousness and neuroticism compared to healthy OAs. Finally, both YAs and CIs had greater variability in attention relative to OAs. These differences persisted after accounting for global cognition.ConclusionHealthy aging (OAs compared to YAs) results in greater stability in personality ratings. In contrast, pathological aging (CIs compared to OAs) results in greater variability in attention scores with no detectable changes on mean performance. We argue that cognitive variability provides unique insight to cognitive changes that occur in healthy aging and early‐stage AD and should continue to be explored as primary outcomes.

ANALYSIS OF STUDENTS' MATHEMATICS LEARNING OUTCOMES IN THE TOPIC OF MATRICES, SPECIFICALLY DETERMINANTS AND MATRIX INVERSES, BASED ON BLOOM'S TAXONOMY

This study is to classify daily mathematics tests on matrix subject with determinant and matrix inverse as sub-material and describe the mathematics learning outcomes of students in class XI MIPA 3 at SMAN 5 Pekanbaru for the 2022/2023 academic year based on the cognitive domain of Bloom's Taxonomy. The research method used was a descriptive method with a qualitative approach. The subject of this research is the answer sheets for the daily mathematic test on matrix subject of the students in class XI MIPA 3. Based on the results of research, the percentage of item classification was 60% for the cognitive level of understanding (C2) and 40% for the cognitive level of application (C3). The results of learning mathematics for class XI MIPA 3 students has been reached the level of applied cognitive ability (C3), with the following average percentages: cognitive understanding level (C2) of 82.43% and applied cognitive level (C3) of 48.65%.

PENERAPAN MEDIA PEMBELAJARAN KOMIK STRIP UNTUK MENINGKATKAN MOTIVASI DAN HASIL BELAJAR MATA PELAJARAN IPS TERPADU PESERTA DIDIK KELAS IXC MTs SHOLIHIYYAH KALITENGAH

Fun learning will arouse students' motivation, because students will not feel bored and will actually feel interested in learning activities. Motivation has a significant role in determining the outcome of the learning process. Comic strip learning media in education can be applied in integrated social studies learning on the subject of socio-cultural change because comic strips can provide an interesting and funny atmosphere so that students feel happy and more enthusiastic in carrying out teaching and learning activities. student learning outcomes with the application of the Comic Strip learning media on integrated social studies subjects on the material of Socio-Cultural Change. The results show that after learning by applying comic strip media the motivation of students has increased compared to when they have not used comic strip media and based on daily test analysis, the average value of students shows an increase. Before the application of comic strip media in learning the average value achieved was 78.98 while after the application of comic strip media it increased by 6.77% to 84.30.

Utility of Vizient Clinical Data Base as a benchmarking tool for laboratory stewardship programs

Abstract Establishing an effective laboratory stewardship program across healthcare systems to improve patient care has been of growing interest. Despite general guidelines from various organizations, clear definitions for these laboratory-based quality measures, and associated benchmarks, are still lacking. Hence, we utilized Vizient® Clinical Data Base (CDB) as a tool to benchmark our institution against U.S. News and World Reports’ Honor Roll (USNW) healthcare organizations 2021-2022. We focused on inpatient laboratory testing with specific targets including mean laboratory resource units used per patient per day to obtain an overview of our institution’s overall performance, daily basic metabolic panel and CBC test ordering patterns across various service lines, and C-reactive protein (CRP) to erythrocyte sedimentation rate (ESR) order ratios compared to USNW hospitals. As one of the five institutions with the highest mean laboratory resource units used per case per day (12.7) from January 1, 2021-January 31, 2022, we investigated this further to identify tests driving this result. Of all the laboratory tests ordered, blood gas was identified at the 99th percentile compared to peers. Stratifying by service, we found cardiac surgery (17%), general medicine (15%), pulmonary/critical care (11%), neonatology (10%) and transplant (9%) services at our institution were the major contributors to blood gas orders. Investigating daily laboratory test orders (BMP, CBC) showed that our institution was at the 46th and 71st percentile overall, respectively. Further CBC analysis showed that general medicine (28%) and oncology (11%) services were the major contributors for the test volume and highest total resource units used per quarter in 2021. Assessing CRP to ESR ratio depicted that our institution’s ratio of 2.2 was lower compared to USNW hospitals’ average of 2.9, meaning ESR is likely overutilized. In conclusion, Vizient CDB can be used as a resource for benchmarking laboratory utilization patterns. It can be helpful in developing road maps and prioritizing interventions for lab stewardship programs. This study identified a general overuse of laboratory resources at the hospital compared to peers, and identified some intervention targets including blood gas testing and ESR.

Prediction of ovulation: new insight into an old challenge

Ultrasound monitoring and hormonal blood testing are considered by many as an accurate method to predict ovulation time. However, uniform and validated algorithms for predicting ovulation have yet to be defined. Daily hormonal tests and transvaginal ultrasounds were recorded to develop an algorithm for ovulation prediction. The rupture of the leading ovarian follicle was a marker for ovulation day. The model was validated retrospectively on natural cycles frozen embryo transfer cycles with documented ovulation. Circulating levels of LH or its relative variation failed, by themselves, to reliably predict ovulation. Any decrease in estrogen was 100% associated with ovulation emergence the same day or the next day. Progesterone levels > 2 nmol/L had low specificity to predict ovulation the next day (62.7%), yet its sensitivity was high (91.5%). A model for ovulation prediction, combining the three hormone levels and ultrasound was created with an accuracy of 95% to 100% depending on the combination of the hormone levels. Model validation showed correct ovulation prediction in 97% of these cycles. We present an accurate ovulation prediction algorithm. The algorithm is simple and user-friendly so both reproductive endocrinologists and general practitioners can use it to benefit their patients.

THE EFFECT OF GENDER CHARACTERISTICS AND MATHEMATICS HABITS OF MIND ON STUDENTS' MATHEMATICS LEARNING OUTCOMES IN KENDARI

This study aims to describe gender characteristics, describe Mathematics Habits of Mind, and determine the effect of gender characteristics and Mathematics Habits of Mind on mathematics learning outcomes. This study method uses a quantitative approach with the type of ex-post facto research. The gender characteristics questionnaire was adapted from the Bem Sex Role Inventory by Sandra L. Bem (1977), and the Mathematics Habits of Mind questionnaire was modified by Costa and Kallick (2008). While the results of learning mathematics are taken from the teacher's documentation of the results of students' daily tests. Based on the results of the research data analysis, it was found that 1) There were ten students with Feminine Gender, there were 34 students with Masculine Gender, there were 26 students with Androgyny Gender, and there 35 students with Undifferentiated Gender; 2) Mathematics Habits of Mind of students who are in the High category by 1.9% of students; 55.2% are in the Medium category, and 42.9% are in a Low category; 3) There is an effect of gender characteristics and Mathematics Habits of Mind on students' mathematics learning outcomes

IMPLEMENTASI MODEL PEMBELAJARAN PROBLEM BASED LEARNING (PBL) KURIKULUM 2013 UNTUK MENINGKATKAN HASIL BELAJAR DAN AKTIVITAS SISWA PADA MATERI SISTEM PERSAMAAN LINIER DUA VARIABEL KELAS VIII.8 SMP NEGERI 21 BATAM

The purpose of this study is to improve student learning outcomes and activities in the implementation of the 2013 curriculum Problem Based Learning (PBL) Learning Model in grade VIII.8. The author conducted research at SMP Negeri 21 Batam grade VIII.8 Mathematics subject for the 2020/2021 academic year. This Classroom Action Research uses qualitative Descriptive Techniques in two learning cycles through observation and tests of the ability to solve SPLDV problems Mastery of the Two Variable Linear Equation System material in grade VIII.8 SMP Negeri 21 Batam shows an increase, this can be shown by the average daily test results, but in cycle 1 (before using the PBL model) which is 63 and 69 and after using the PBL model to 70 in the cycle, While in cycle 2 it becomes 78. Based on the study of theory and frame of mind proposed by researchers, as well as the results of research conducted on grade VIII.8 students, it can be concluded that the Problem Base Learning (PBL) Learning Model can improve learning outcomes and student activeness in class during learning. Based on observations, student activities in implementing the PBL learning model have increased, namely the good category. In the initial data of activity observations of 50% sufficient quality, in cycle 1 it rose to 54% sufficient quality, and for cycle 2 it increased but not significantly by 67%.

Determinants of differences in RT-PCR testing rates among Southeast Asian countries during the first six months of the COVID-19 pandemic.

A positive correlation has been demonstrated between gross domestic product (GDP) per capita and COVID-19 tests per 1000 people. Although frequently used as an indicator of economic performance, GDP per capita does not directly reflect income distribution inequalities and imposed health costs. In this longitudinal ecological study, we aimed to determine if, besides GDP per capita, indicators relating to governance, public health measures enforcement, and health and research investment explain differences in RT-PCR testing rates among countries in Southeast Asia (SEA) during the first six months of the COVID-19 pandemic. Using open-access COVID-19 panel data, we estimated the effect of various indicators (GDP per capita, health expenditure per capita, number of researchers per one million population, corruption perceptions index, stringency index, regional authority index) on daily COVID-19 testing by performing fixed-effects negative binomial regression. After accounting for all indicators, the number of daily confirmed COVID-19 cases, and population density, the model provided a 2019 GDP per capita coefficient of 0.0046330 (95% CI: 0.0040171, 0.0052488; p <0.001), indicating that a rise in 2019 GDP per capita by 100 international dollars is associated with a 46.33% increase in the number of daily tests performed. Additionally, all indicators were significantly associated with the daily number of RT-PCR testing on multivariable analysis. In conclusion, we identified different country-level indicators significantly associated with differences in COVID-19 testing rates among SEA countries. Due to the study's ecological design, we caution on applying our results to the individual level given potential for systematic differences between the included countries. Additional investigation is likewise needed to understand how government expenditure on healthcare may have impacted COVID-19 testing capacity during the initial stages of the pandemic.

Time Series Homogenization with ACMANT: Comparative Testing of Two Recent Versions in Large-Size Synthetic Temperature Datasets

Homogenization of climatic time series aims to remove non-climatic biases which come from the technical changes in climate observations. The method comparison tests of the Spanish MULTITEST project (2015–2017) showed that ACMANT was likely the most accurate homogenization method available at that time, although the tested ACMANTv4 version gave suboptimal results when the test data included synchronous breaks for several time series. The technique of combined time series comparison was introduced to ACMANTv5 to better treat this specific problem. Recently performed tests confirm that ACMANTv5 adequately treats synchronous inhomogeneities, but the accuracy has slightly worsened in some other cases. The results for a known daily temperature test dataset for four U.S. regions show that the residual errors after homogenization may be larger with ACMANTv5 than with ACMANTv4. Further tests were performed to learn more about the efficiencies of ACMANTv4 and ACMANTv5 and to find solutions for the problems occurring with the new version. Planned changes in ACMANTv5 are presented in the paper along with related test results. The overall results indicate that the combined time series comparison can be kept in ACMANT, but smaller networks should be generated in the automatic networking process of the method. To improve further the homogenization methods and to obtain more reliable and more solid knowledge about their accuracies, more synthetic test datasets mimicking the true spatio-temporal structures of real climatic data are needed.

A Feasibility Study on a Portable Vision Device for Patients with Stroke and Brain Tumours

ABSTRACT This prospective, single-centre cohort study aimed to evaluate the impact of a portable vision reading device, OrCam Read, on vision-related quality-of-life and independent functional status in patients with low vision due to stroke or brain tumours. Six patients with poor visual acuity or visual field defects due to a stroke or a brain tumour were enrolled at a U.S. Ophthalmology Department. Participants were trained to use OrCam Read and given a loaner device for the 1 month duration of the study. Various assessments, including daily function tests, the National Eye Institute Visual Function Questionnaire-25, and the 10-item neuro-ophthalmic supplement, were administered at the first and last visits. Patients’ experience with the device was evaluated with weekly telephone and end-of-study satisfaction surveys. The main outcome measures were the patient satisfaction with OrCam and the mean assessment scores between enrolment and final visits. The intervention with OrCam significantly improved patients’ ability to complete daily tasks and participants reported good satisfaction with the device. The results also show non-significant improvement with distant activities, dependency, and role difficulties. Our findings demonstrate the feasibility of studying vision-related quality-of-life using a portable vision device in this patient population and pave the way for a larger study to validate the results of this study.

Implementation and expansion of laboratory capacity for molecular diagnostics in response to COVID-19 and preparedness for other emerging infectious diseases in the Islamic Emirate of Afghanistan.

Afghanistan experienced various outbreaks before and during the Covid-19 pandemic, including dengue, Crimean Congo hemorrhagic fever (CCHF), measles, and acute watery diarrhea (AWD). Diagnostic and surveillance support was limited, with only the Central Public Health Laboratory equipped to handle outbreak responses. This article highlights initiatives taken to improve diagnostic capabilities for COVID-19 and other outbreaks of public health concern encountered during the pandemic. The World Health Organization (WHO) Afghanistan Country Office collaborated with the WHO Eastern Mediterranean Regional Office (EMRO), Central Public Health Laboratory (CPHL), and National Influenza Center (NIC) to enhance COVID-19 diagnostic capacity at national and subnational facilities. To alleviate pressure on CPHL, a state-of-the-art laboratory was established at the National Infectious Disease Hospital (NIDH) in Kabul in 2021-2022, while WHO EMRO facilitated the regionalization of testing to subnational facilities for dengue, CCHF, and AWD in 2022-2023. COVID-19 testing capacity expanded nationwide to 34 Biosafety Level II labs, improving diagnosis time. Daily testing rose from 1000 in 2020 to 9200 in 2023, with 848,799 cumulative tests. NIDH identified 229 CCHF cases and 45 cases nationally. Dengue and CCHF testing, decentralized to Nangarhar and Kandahar labs, identified 338 dengue and 18 CCHF cases. AWD testing shifted to NIDH and five subnational facilities (Kandahar, Paktia, Balkh, Herat, and Nangarhar labs), while measles testing also decentralized to nine subnational facilities. Afghanistan implemented a remarkable, multisectoral response to priority pathogens. The nation now possesses diagnostic expertise at national and subnational levels, supported by genomic surveillance. Future efforts should concentrate on expanding and sustaining this capacity to enhance public health responses.

Implementation of Islamic Religious Education Learning Evaluation Through Daily Tests on Students' Learning Motivation UPTD SMP Negeri 4 Parepare

This research aims to determine the implementation of learning evaluations for Islamic religious education through daily tests at UPTD SMP Negeri 4 Parepare and to find out students' learning motivation after implementing learning evaluations for Islamic religious education through daily tests at UPTD SMP Negeri 4 Parepare. The type of research used was field research conducted at UPTD SMP Negeri 4 Parepare, using a qualitative research approach, there were two data sources used, namely primary data sources including students and Islamic religious education teaching staff and secondary data sources including documentation results and various literature in the form of books, journals, articles related to research, the research instruments used are the researchers themselves, observation guidelines, interview guidelines and documentation guidelines, data collection techniques used are observation, interviews and documentation. The data analysis techniques used are data reduction, data presentation and data collection and drawing conclusions. The research results showed that: 1) The implementation of learning evaluation for students' Islamic religious education through daily tests has gone well. 2) Students' learning motivation after implementing learning evaluations through daily tests tends to increas

Analysis of Multiple‐choice Propositions in Secondary School English Tests

Multiple choice questions are a common question type used in current secondary school English tests. Multiple choice questions can test students' completion of multiple learning tasks such as vocabulary, grammar, and listening. Multiple choice questions have the advantages of effectively testing students' learning ability, wide coverage, convenient and efficient use, etc., and occupy an important position in daily secondary school English tests. To this end, this study will analyze the proposition system of multiple‐choice questions in the current secondary school English test, make use of the strengths and avoid the weaknesses, and provide design principles and recommendation for the proposition system.

Dynamics of lipoperoxidation and amino acid spectrum in patients with delirium after intramedullary osteosynthesis with ropivocaine epidural anesthesia

Introduction The pathogenesis of postoperative delirium, its causes, and factors contributing to its development remain a subject of debate. We consider it promising to study the dynamics of lipoperoxidation, cortisol levels and amino acid metabolism in patients with postoperative delirium. Such studies will reveal diagnostic and prognostic markers.The aim was to identify differences in the dynamics of lipoperoxidation, amino acid balance and cortisol levels in patients with and without delirium.Materials and methods A total of 41 patients who underwent surgery for a femoral fracture under epidural anaesthesia were included in the study. All patients underwent a daily test, the Confused Consciousness Assessment Method. If it was positive, delirium was diagnosed; thus, two groups were identified: with postoperative delirium (n = 12) and without delirium (n = 29).Results In the preoperative delirium group, there was a relative lack of glucocorticosteroids as measured by reduced cortisol levels (pU &lt; 0.01) and inhibition of lipid peroxidation as reduced Schiff bases (pU = 0.01). There were no significant differences in amino acid metabolism of the major amino acid pools. The intraoperative period in both groups had similar characteristics and no significant differences. In the postoperative period inhibition of lipoperoxidation in the delirium group changed into its greater activation, which was revealed by increased levels of ketodienes and conjugated trienes in isopropanol phase (pU &lt; 0.01). There was also an increase in the aromatic pool (pU &lt; 0.01) due to an increase in large neutral amino acids (phenialanine, pU = 0.0, tryptophan, pU = 0.02, tyrosine, pU &lt; 0.01) and a decrease in the aliphatic pool (pU &lt; 0.01). Cortisol levels remained significantly lower in the delirium group (pU &lt; 0.01).Discussion The preoperative decrease in the studied indices in the delirium group may indicate initial reductive stress. In the postoperative period, patients with and without delirium differ in their metabolic activity with respect to lipoperoxidation and amino acid metabolism, and cortisol levels remain significantly lower in the delirium group.Conclusion The development of delirium is facilitated by initial reductive stress and a tolerant adaptation strategy.