Objective To investigate the effects of different types of anesthesia on the incidence rates of low-er respiratory tract infections of elderly patients in orthopedic department.Methods Clinical data from 445 elderly patients in orthopedic department were collected and retrospectively analyzed.We also investigated the relationship be-tween the types of anesthesia and the lower respiratory tract infections.Results The incidence rates of lower respira-tory tract infections were 23.08%in 169 cases,12.14%in 173 cases,and 4.85%in 103 cases after general anesthe-sia with tracheal intubation,intraspinal anesthesia,and nerve blocking anesthesia,respectively.There was statistically significant difference in the infection rates among the three groups (χ2 =13.784,P=0.001).Conclusion Different ways of anesthesia is critically correlated with the incidence of the lower respiratory tract infections in elderly patients.

Objective To investigate the effectiveness of target intervention in preventing catheter -related bloodstream infection ( CRBSI ) .Methods The targeted monitoring was launched by changing venepuncture site , reinforcing instructions in aseptic insertion technique and hand hygiene supervision ,avoiding femoral access and remo-ving unnecessary catheters ,venous puncture implemented by high qualification anesthesiologist ,then the incidence of CRBSI before and after the project was compared .Results The incidence of CRBSI after the project decreased signif-icantly from 17.97%to 4.32%,the difference was statistically significant (χ2 =40.82,P<0.05).Chi-square test and logistic regression analysis showed that the incidence of infection was increased in patients with catheter for longer than 10 days (χ2 =4.33,P<0.05),the incidence of CRBSI was decreased in patients that central venous puncture implemented by high qualification anesthesiologist (χ2 =9.21,P<0.05),and patients received catheter indwelling into femoral vein had increased incidence of CRBS (χ2 =7.45,P<0.05).Conclusion Indwelling catheter time, unskilled operator ,catheter site are risk factors in patients with CRBSI .In response to these factors ,we should develop interventions to maximize establish a protective barrier , improve the quality of the medical operation , prevent the occurrence of CRBSI more efficiently .

Objective To investigate the effect of Tongqiao Yinao decoction ( TYD) on postoperative cogni-tive dysfunction in elderly patients and its underlying mechanisms .Methods 100 anesthetic patients for orthopedic surgery were randomly divided into the TYD-treated group and control group ,50 patients in each group .In TYD-trea-ted group,patients received 150mL TYD orally,twice daily for constitutive 15 days,beginning from the day of admis-sion in addition to conventional symptomatic and supportive treatment .While patients in control group received no TYD.Mini-mental state examination ( MMSE) was used to evaluate the patients′cognitive function before and after anesthesia.Meanwhile,blood samples of patients were also collected to test the expression levels of IL -6.Results There was no significant difference between the two groups before operation .However ,TYD-treated patients had signif-icantly lower incidence rate of POCD than the controls ( 20% in the control group , and 12% in the TYD-treated group;χ2 =4.332,P=0.037) 7 days after operation.The incidence rates of POCD in the TYD-treated group and control group were 30%and 38%1 day after operation ( P>0.05),28% and 20% 3 days after operation ( P>0.05),respectively.Compared with that before operation ,the blood levels of IL-6 in the two groups significantly increased 3 days after operation (control group,t=2.412,P=0.009;TYD-treated group,t=1.429,P=0.039).In contrast to the control group,the level of IL-6 in TYD-treated group declined to the baseline (the control group,t=0.851,P=0.049;TYD-treated group,P=0.404).Interestingly,compared with the controls,the TYD-treated patients had a significant lower level of IL-6 after operation (t=1.198,P=0.035).Furthermore,Pearson correlation analysis showed that change of IL-6 level in blood was negatively correlated with MMSE score (r=-0.782,P=0.022). Conclusion TYD can improve postoperative cognitive dysfunction in elderly patients ,presumably through decreasing the level of IL-6 in blood.

Objective:To differentiate the methamphetamine users according to the developmental stages of addictive behavior, and explore the characteristics of different stages in order to provid a theoretical reference for our clinical intervention.Methods:Take the male methamphetamine users in compulsory detoxification institute whom were admitted from September 2018 to December 2019 as research objects.All the objects were asked to complete clinical diagnosis, interview and questionnaire evaluation in one week.According to the developmental stages of addictive behavior, the subjects were divided into occasional use group ( n=51), regular use group ( n=95) and compulsive use group ( n=157).All subjects were evaluated using visual analogue scale(VAS), Barrett impulsiveness scale(BIS)and CogState scale.SPSS 20.0 software was used for statistical analysis, AVOVA or Kruskal-Wallis H test was used for group comparison.Multiple Logistic regression analysis was used to explore the factors associated with the development of addictive behavior. Results:(1)The compulsive use group had higher cumulative duration(24(8, 48), 12(4, 24), 22(10, 36)), average dose(6.6±3.8, 2.8±1.4, 4.5±3.4) and craving score(1(0, 5), 0(0, 1), 1(0, 3)) than the other two groups(all P<0.05).And individuals in compulsive use group had more previous heroin use experience(20.4%, 9.8%, 14.8%, P<0.05).The regular use group had more withdrawal times than the other two groups(1(1, 3), 1(0, 1), 1(1, 2), P<0.05).The total scores of Barrett impulsiveness scale(42.8±13.3, 34.5±13.6, 36.1±14.9) and the scores in all dimensions in the compulsive use group were significantly higher than those in the other two groups(motor impulsiveness: 37.5±15.8, 27.8±13.4, 29.2±17.8; attentional impulsiveness: 43.2±18.0, 39.4±17.0, 37.2±18.1; non-planning impulsiveness: 47.2±19.8, 38.8±18.7, 40.7±20.8; P<0.05) .In the compulsive use users, the ISL(16.50±4.87, 19.30±4.78, 18.33±4.91) and SEC(0.76±0.21, 0.89±0.22, 0.81±0.21) scores about cognitive assessment were significantly lower than other two groups(both P<0.05).(2)The results of multiple Logistic regression analysis showed that cumulative duration ( β=0.022, OR=1.022, 95% CI: 1.003-1.042), dosage( β=0.625, OR=1.869, 95% CI: 1.196-2.921), craving ( β=0.194, OR=1.214, 95% CI: 1.002-1.215), the total scores of Barrett impulse scale( β=0.036, OR=1.037, 95% CI: 1.013-1.061), scores of non-planning impulsiveness( β=0.040, OR=1.041, 95% CI: 1.004-1.038), scores of motor impulsiveness( β=0.033, OR=1.214, 95% CI: 1.001-1.068) were associated with the periodic grouping of addictions. Conclusions:Addictive behavior is a progressive process and methamphetamine users at different stages have different characteristics in substance use, impulsiveness and cognitive function.The development of addictive behavior is associated with the time, dosage and craving of substance use, as well as the personality impulsivity of users.And the compulsive users suffered more cognitive impairment than the other two groups. The methamphetamine users should be identified dynamically and targeted therapeutic intervention measures should be carried out to block the addictive process to achieve the goal of harm reduction.