Objective To identify the influence of early postoperative delirium on long-term morbidity ,mortality and quality of life(QoL) .Methods 261 patients admitting to SICU after noncardiac surgery were prospectively included .The clinical data were collected .Delirium was diagnosed clinically by Confusion Assessment Method-Intensive Care Unit(CAM-ICU) .The patients were followed 2 years after the surgery and the quality of life was assessed by three scales .Results The incidence of early PD was 21 .8% .Multivariate logistic regression analysis showed that increasing age ,shorter educational time ,preoperative diabetes melli-tus ,high ASA grades and high APACHE II score on SICU admission were the independent predictors for early PD .The cumulative survival in 24 months was 66 .5% in patients without delirium and 57 .3% in patients with delirium ,there was no statistical differ-ence between two groups(P=0 .187) .Multivariable Cox model showed that male patients ,tumor stage ≥3 and high ASA grades were the independent predictors for postoperative death .The long-term QoL in delirious patients were significant poorer than that in non-delirious patients in mainly four domains :physical function ,role-physical ,social function and cognitive function .Conclusion Early postoperative delirium significantly deteriorate the long-term quality of life in severe patient after noncardiac surgery in mainly four domains :physical function ,role-physical ,social function and cognitive function .

Single nueleotide polymorphisms (SNPs) are the most common genetic variants in human genome.Candidate gene,genome-wide association studies (GWASs) and exome sequencing which base on SNPs have made a great progress in identifying cancer susceptibility.The development and application of high resolutions in SNPs has played an important role in clarifying the mechanism,prevention,diagnosis and targeted therapy in cancers.

Audiology ; methods ; Hearing Tests ; methods ; Humans ; Time Factors

Objective To investigate the relationship between genetic polymorphism of methylenetetrahydrofolate reductase (MTHFR) and the risk of acute lymphocytic leukemia (ALL). Methods Eighty-three patients with ALL and a cohort of 83 matched healthy objects were included, and DNA was extracted from their peripheral blood. PCR-RFLP was used to determine the genotypes of MTHFR C677T and A1298C. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using unconditional logistic regression model. Results It was found that the frequency of the MTHFR C677T TT genotype among patients was significantly different from that among control objects (P=0.008). The MTHFR C677T TT genotype had an increased risk of ALL compared with that of 677CC genotype (OR=3.229, 95%CI: 1.328-7.847, P=0.01). No significant association between the MTHFR C677T CT genotype or A1298C polymorphism and the risk of leukemia. Conclusion The present findings suggest that 677C→T polymorphism in MTHFR may be a genetic susceptibility factor for acute lymphocytic leukemia.

Objective To evaluate the pulmonary protection of dexmedetomidine during one-lung ventilation in patients undergoing radical operation for lung cancer.Methods Thirty patients of both sexes,aged 40-70 yr,weighing 50-80 kg,of ASA physical status Ⅰ-Ⅲ,scheduled for elective radical operation for lung cancer,were randomized into 2 groups (n =15 each):dexmedetomidine group (group D) and control group (group C).Before induction of anesthesia,a loading dose of dexmedetomidine 1.0 μg/kg was infused over 10 min,followed by continuous infusion of dexmedetomidine at a rate of 0.6 μg· kg-1 · h-1 until the chest was closed in group D,while the equal volume of normal saline was given in group C.Immediately after induction of anesthesia,at 30 and 60 min of one-lung ventilation,and at the end of operation,arterial blood samples were collected for determination of the serum concentrations of TNF-α,IL-6 and IL-8,and for blood gas analysis.Oxygenation index was calculated.Results Compared with group C,the serum concentrations of TNF-α,IL-6 and IL-8 were significantly decreased,and oxygenation index was increased in group D.Conclusion Dexmedetomidine can mitigate inflammatory responses during one-lung ventilation and improve pulmonary function,thus providing pulmonary protection in patients undergoing radical operation for lung cancer.

Objective To investigate the efficacy comparison of endovascular therapy and simple medical therapy for symptomatic intracranial artery stenosis. Methods A total of 145 patients with intracranial artery stenosis were analyzed retrospectively. They were divided into either an endovascular therapy group (n=72) or a medical therapy group (n=73). They were treated with endovascular therapy (gateway balloon,wingspan stents,Apollo stents) or medical therapy (aspirin 100 mg/d,clopidogrel 75mg/d, and atorvastatin 20-40 mg/d) according the willingness of the patients or their family members. The incidences of stroke and transient ischemic attack ( TIA ) , and restenosis rate ( stenosis rate >50% as a standard) during 1-,3-,6-,9-,and 12-month follow-up periods were observed and compared. Results On the basis of medical therapy,the patients of the endovascular therapy group were successfully stented. The success rate of stenting was 98. 6% (70/71). Seven patients had complications in the endovascular therapy group (9.9%),2 of them complicated with hemorrhage(one of was died),drinking cough,hoarseness, dizziness,headache,and excitement were one case in each, the other patients were cured and discharged with active medical treatment, and they did not have serious sequelae. At 12 months after treatment, the stroke recurrence rate of the endovascular therapy group was 8. 4% (n=6,both were TIA),and that of the medical therapy group was 26. 0% (84. 2% was minor stroke). There was significant difference (χ2 =7. 752,P<0. 01);at 12 months after treatment,the incidences of restenosis and aggravated stenosis were 5. 6% (n=4) and 6. 8% (n=5) respectively. There was no significant difference (χ2 =0. 091,P>0. 05). Conclusion Compared with the medical therapy,the efficacy of endovascular therapy for symptomatic intra-cranial arterial stenosis is more significant. The improvement of clinical prognosis is superior to medical therapy.

OBJECTIVE: The present study was aimed to assess the ability of tone recognition performance for postlingually deafed cochlear implanted adults using no-duration tone test materials. METHOD: Sixteen cochlear implanted users have used their devices at least six months. Ten monosyllabic syllables were selected, and combined with four lexical tones which were made up of 40 tone tokens. Then, these original words were recorded using one adult male and one adult female native Beijing Mandarin speaker. The speakers were asked to record these 40 monosyllabic words multiple times, and the 80 tokens in which the durations of four tones in each monosyllabic word were within 5 ms precision were chosen as the original tone tokens. The subjects were asked to perform a four alternative forced-choice study and select the tone they had heard. RESULT: The mean score of lexical tone perception tasks for 16 cochlear implanted users is (70.7 ± 22.0)%, and Tone 4 was the easiest to perceive, while Tone 2 was the hardest for cochlear implanted subjects to perceive. Tone 1 was more often misperceived as Tone 2 relative to other tones. Tone 2 was more often misperceived as Tone 1 and 3. Tone 3 was more often misperceived as Tone 2. The tone perception performance was positively correlated with duration of hearing aid use. CONCLUSION Duration cues may impact on the ability of tone recognition performance for cochlear implant subjects, especially for tone 3. Due to the limited ability for cochlear implant subjects on pitch perception, tone l and tone 2, and tone 2 and tone 3 are most often confused with each other without duration cues. The experience of hearing aid use may benefit for postlingual deafness cochlear implant recipients on tone perception performance.
Adult ; Asian Continental Ancestry Group ; Cochlear Implantation ; Cochlear Implants ; Female ; Hearing ; Hearing Aids ; Humans ; Language ; Male ; Pitch Perception ; Speech Perception ; Tongue

Objective To assess the efficiency of total laminectomy and transpedicular screw placement techniques and a thoroughly decompression with a three column fixation device on the early cervical spine cord injury.Methods 27 patients were operated successfully with total cervical laminectomy through transpedicular screw techniques.Precise measurements of all cervical spines were made by postoperative CT scan of pedicle dimensions,angulation,and offset relative to the lateral mass boundaries.And meanwhile,cortical integrity and neurovascular injury were then assessed by obtaining postoperative computed tomography scans of each patient.Results Using manual techniques,220 pedicles were instrumented and all the cases were followed up between three to twenty-four months.The postoperative gradations were obviously better than the preoperative evaluation.Regardless of the technique used,the vertebral artery was the structure most likely to be injured.Conclusion Insufficient correlation between different surgeons' assessments of surface landmarks attests to the inadequacy of screw insertion techniques in the cervical spine based on such specific topographic.At the early stage of cervical spinal cord injury,using total laminonectomy decompression through cervical screws techniques to reconstruct spinal alignment could improve the prognosis of patients.

BACKGROUND:Tripterygium hypoglaucum(Levl.)Hutch (THH) has been accurately confirmed a good clinical therapeutic effect for rheumatoid arthritis(RA).However.functionaI mechanism of THH remains unclearly.OBJECTIVE:To investigate the effect of THH on proliferation and apoptosis of macrophage-like synoviocytes and fibroblast-like synoviocytes from patients with RA and to explore its dose-effect relation.DESIGN.TIME AND SETTING:In vitro cytology grouping controlled observation was performed in the Center Laboratory of the First Clinical College of Shantou University and the Laboratory for Cellular Biology of Southern MedicaI University from August 2003 to June 2007.MATERIALS:Synovium was obtained from 6 patients with RA and 3 normaI synovial samples.All samples sourced from patients admitted in Department of Orthopaedics.the First Clinical College of Shantou University and in Spinal and Joint Surgery of Nanfang Hospital.The water extracts of THH contained 0.667 g/mL crude drug.METHODS:Synovial cells were isolated by digesting synovial tissue with collagenase.CD68+and CD68-synoviocytes were sorted from synovial cells by Dynabeads(magnetic celI sorting)from the 2~(nd)-4~(th) passages of synoviocyes.After 72 hours incubation,all groups of isolated synoviocytes were cultured in culture medium containing the flnaI concentrations of 0 mL/L,5 mL/L,1 0 mL/L and 20 mL/L of THH for 24 and 48 hours,respectively,and the common culture medium was sewed as the control. MAIN OUTCOME MEASURES:The morphology of synoviocytes were observed by inverted phase contrast microscope and studied by scanning electron microscopy(SEM).In vitro cell growth was assessed by the MTT assay,and synoviocytes apoptosis was evaluated using temlinaI deoxynucleotidyl transferase biotin-dUTP nick end labeling(TUNEL)assay and a flow cytometry.RESULTS:CD68~+ synoviocytes were appeared macrophage-like and CD68~- synoviocytes were exhibited fibroblast-like.After incubated with THH,some synoviocytes presented the volume of cells deflated,progressively destruction of cell membrane,microvillus or pseudopodium tended to be decreased even disappeared,and apoptosis bodies appeared.When incubated with 2% THH,proliferation inhibiUon and inducing apoptosis could be observed;it showed that THH had the cytotoxic effect on synoviocytes.The effect of proliferation inhibition and inducing apoptosis on CD68-and CD68+synoviocytes from RA patients was more significantly than that from normal arthritis (P<0.01).When incubated with 1%THH.proliferation inhibition and inducing apoptosis on synoviocytes from RA patients also could be found(P<0.01),but not found on normal synoviocytes(P>0.05).Compared with the negative controI group.proliferation inhibition was no significant difference On all groups with the low dose (≤5 mL/L) of THH(P>0.05).Furthermore,the effect of proliferation inhibition and inducing apoptosis on synoviocytes decreased in a dose-dependent and time-dependent manner.The inhibition rate of synoviocytes also could be found positively correlated with apoptosis rate aftat treatment of THH(r=0.497,P<0.01).CONCLUSlON:THH have cytotoxic effect on rheumatoid synoviocytes and normal synoviocytes.it can inhibit macrophage-like synoviocytes and fibroblast-like synoviocytes from RA on proliferation and induce them to apoptosis.In the some contraction of THH.proliferation Inhibition and inducing apoptosis can be occur on synoviocytes from RA but not on normal synoviocytes.

Objective To explore the clinical significance and the dynamic changes of serum anti-inflam-mation factor interleukin-10(IL-10)and inflammatory factor interleukin-8(IL-8)in cerebral infarction.Methods The serum levels of IL-10 and IL-8 in 30 patients were measured by double-antibody sandwich enzyme-linked inunu-nosorbent assay(ELISA)on days 1.3,7 and 14 respectively after infarction.Results The serum levels of IL-10 and IL-8 were higher in patients than those in control group on days 1,3 and 7(P<0.05).Conclusion IL-10 and IL-8 are involved in the pathophysiology of acute cerebral infarction.