[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure...[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(CSTJ)were systematically searched for relevant literature published prior to February 27,2025.Literature screening and data extraction were conducted by two independent researchers in accordance with predetermined inclusion and exclusion criteria.The primary observation indicator was the incidence of POD across various treatment populations.The risk ratio for the primary outcome was calculated using the Mantel-Haenszel method.The secondary outcomes included the adverse effects associated with insulin treatment,which encompassed the glycemic variability indices,the incidence of nasal irritation symptoms following administration,hypoglycemic reactions,and insulin allergic reactions.The study protocol was registered on PROSPERO(CRD420250607492)before data extraction.[Results]A total of five randomized controlled trials involving 357 patients were included in the analysis.In the adult population undergoing surgical procedures,the administration of insulin via nasal delivery was found to significantly reduce the incidence of POD[RR=0.35,95%CI(0.23-0.53),P<0.001].The results of the subgroup analysis indicated that there were notable differences in the effectiveness of various doses of insulin administered nasally in preventing POD.Specifically,both the 20 U dose group[RR=0.45,95%CI:(0.29,0.70),P<0.001]and the 30 U dose group[RR=0.01,95%CI:(0.03,0.42),P<0.001]showed a significantly lower incidence of POD compared to the control group,with statistically significant conclusions.Conversely,the 40 U dose group[RR=0.47,95%CI:(0.17,1.34),P=0.16]yielded no statistically significant difference.Furthermore,the efficacy in preventing POD was found to be greater in the 30 U dose group compared to the 20 U dose group.Additionally,two cases of hypoglycemic reactions and increased nasal irritation symptom scores were reported in the 40 U dose group across the entire study population(P<0.05),suggesting potential adverse risks associated with this dosage.[Conclusions]The nasal administration of insulin significantly decreases the incidence of POD at a specific dosage,with optimal efficacy and high safety observed at a dosage of 30 U.展开更多
目的:探讨外阴肌上皮瘤样肿瘤(myoepithelioma-like tumors of the vulvar region, MELTVR)的临床病理学特征、分子特征、诊断及鉴别诊断。方法:回顾性分析我院1例发生于左侧腹股沟MELTVR临床病理学资料,并进行相关文献复习。结果:患者...目的:探讨外阴肌上皮瘤样肿瘤(myoepithelioma-like tumors of the vulvar region, MELTVR)的临床病理学特征、分子特征、诊断及鉴别诊断。方法:回顾性分析我院1例发生于左侧腹股沟MELTVR临床病理学资料,并进行相关文献复习。结果:患者女,35岁,以“左侧腹股沟肿物2次手术后再发1个月”为主诉入院。镜检示:肿瘤呈弥漫实性分布,其内可见大小不等的滤泡样结构及片状坏死。肿瘤细胞呈上皮样或梭形,间质可见多量小血管增生,呈圆形或分枝状,部分区域可见肿瘤细胞围血管生长、呈“假菊形团”样结构。高倍镜下,胞质嗜酸、局灶胞质透亮,核染色质不均匀、略呈泡状,可见一到数个小核仁,核分裂象易见(>20/10 HPF)。肿瘤位于皮下脂肪组织,可见一层纤细的纤维组织与周围组织分隔,局灶可见脂肪组织浸润。免疫表型:ER、EMA和Vimentin弥漫阳性,INI1阴性。FISH结果显示:EWSR1基因无断裂。结论:MELTVR是一种罕见的发生于女性外阴区的间叶源性肿瘤。它具有多变的组织学模式。与以往文献不同的是该病例未见明确的黏液样区域,正确认识该疾病有助于避免误诊和漏诊。展开更多
文摘[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(CSTJ)were systematically searched for relevant literature published prior to February 27,2025.Literature screening and data extraction were conducted by two independent researchers in accordance with predetermined inclusion and exclusion criteria.The primary observation indicator was the incidence of POD across various treatment populations.The risk ratio for the primary outcome was calculated using the Mantel-Haenszel method.The secondary outcomes included the adverse effects associated with insulin treatment,which encompassed the glycemic variability indices,the incidence of nasal irritation symptoms following administration,hypoglycemic reactions,and insulin allergic reactions.The study protocol was registered on PROSPERO(CRD420250607492)before data extraction.[Results]A total of five randomized controlled trials involving 357 patients were included in the analysis.In the adult population undergoing surgical procedures,the administration of insulin via nasal delivery was found to significantly reduce the incidence of POD[RR=0.35,95%CI(0.23-0.53),P<0.001].The results of the subgroup analysis indicated that there were notable differences in the effectiveness of various doses of insulin administered nasally in preventing POD.Specifically,both the 20 U dose group[RR=0.45,95%CI:(0.29,0.70),P<0.001]and the 30 U dose group[RR=0.01,95%CI:(0.03,0.42),P<0.001]showed a significantly lower incidence of POD compared to the control group,with statistically significant conclusions.Conversely,the 40 U dose group[RR=0.47,95%CI:(0.17,1.34),P=0.16]yielded no statistically significant difference.Furthermore,the efficacy in preventing POD was found to be greater in the 30 U dose group compared to the 20 U dose group.Additionally,two cases of hypoglycemic reactions and increased nasal irritation symptom scores were reported in the 40 U dose group across the entire study population(P<0.05),suggesting potential adverse risks associated with this dosage.[Conclusions]The nasal administration of insulin significantly decreases the incidence of POD at a specific dosage,with optimal efficacy and high safety observed at a dosage of 30 U.
文摘目的:探讨外阴肌上皮瘤样肿瘤(myoepithelioma-like tumors of the vulvar region, MELTVR)的临床病理学特征、分子特征、诊断及鉴别诊断。方法:回顾性分析我院1例发生于左侧腹股沟MELTVR临床病理学资料,并进行相关文献复习。结果:患者女,35岁,以“左侧腹股沟肿物2次手术后再发1个月”为主诉入院。镜检示:肿瘤呈弥漫实性分布,其内可见大小不等的滤泡样结构及片状坏死。肿瘤细胞呈上皮样或梭形,间质可见多量小血管增生,呈圆形或分枝状,部分区域可见肿瘤细胞围血管生长、呈“假菊形团”样结构。高倍镜下,胞质嗜酸、局灶胞质透亮,核染色质不均匀、略呈泡状,可见一到数个小核仁,核分裂象易见(>20/10 HPF)。肿瘤位于皮下脂肪组织,可见一层纤细的纤维组织与周围组织分隔,局灶可见脂肪组织浸润。免疫表型:ER、EMA和Vimentin弥漫阳性,INI1阴性。FISH结果显示:EWSR1基因无断裂。结论:MELTVR是一种罕见的发生于女性外阴区的间叶源性肿瘤。它具有多变的组织学模式。与以往文献不同的是该病例未见明确的黏液样区域,正确认识该疾病有助于避免误诊和漏诊。
