The Montreal Cognitive Assessment (MoCA) scale is a rating scale for rapid screening of mild cognitive impairment.In recent years,with the deepening of clinical research,the application scope of MoCA has been gradually expanded to the assessment of cognitive impairment-related diseases.This article reviews the clinical advances in research on MoCA in early screening of vascular cognitive impairment-no dementia

Objective: To evaluate the feasibility and advantages or disadvantages of patient-controlled sedation (PCS) compared with doctor-controlled sedation (DCS) during epidural anesthesia. Method: Forty patients were divided at random into two groups with 20 patients in each group. Patients in group I were administered by themselves a mixture of propofol (20mg) and fentanyl (10?g) in increments using a Graseby PCA infuser (lockout period 1 min) to achieve sedation; patients in group Ⅱ received propofol 3.6mg?kg~(-1)?h~(-1) and fentanyl 1.8?g~(-1)?kg~(-1)?h~(-1)contin uously intravenously by the anesthesiologist to achieve intra-operative sedation. Sedation scale, satisfaction and cooperation degrees were measured. Cognition was also evaluated using abbreviated Mini Mental Status Examination. Result: The drug total dose used in DCS group was higher than that in group PCS (P

Objective\ To introduce the clinical application of the osteocutaneous flap pedicled with the lateral superior genicular artery or the lateral most superior genicular artery in reconstruction of defect of the soft tissue, bone or compound tissue defect on the hand or distal of the forearm.Methods\ The origin course distribution and an astomosis of the lateral superior genicular artery and the lateral most superior genicular artery were observed on the lower limbs of 30 adult cadavers perfused with pink plastics. The osteocutaneous flap based on the lateral superior genicular artery or the lateral most superior genicular artery were designed according to anatomic study. Results\ One cutaneneous flap, 1 osteo flap and 3 osteocutaneous flaps pedicled with lateral superior genicular artery were used; the area of the cutaneous or osteo flap were 7.5 cm?5.0 cm-14.5 cm?6.5 cm and 5.0 cm?1.5 cm?1.2 cm-6.5 cm?2.0 cm?1.6 cm respectively; all the flap and osteocutaneous flap survived. Bone union occurred 3-5 months after the operation. Conclusion\ The lateral supragenual osteocutaneous flap can be used to reconstruct the defect of soft tissue, bone or compound tissue defect on the hand and distal of the forearm.

Objective To evaluate the dynamic change of the antithrombase and fibrinolytic function in the critical patients.Methods Eighty-seven patients hospitalized in ICU were studied. According to the clinical manifestation, all patients were divided into systemic inflammatory response syndrome (SIRS) group ( n = 68) and non-SIRS group ( n = 19), or multiple organ dysfunction syndrome (MODS) group ( n = 37) and non-MODS group (n = 50) respectively. Thirty-one healthy volunteers were selected for control in the same period. The intravenous blood samples were taken 1,3 and 5 days after ICU admission to measure platelet,count (PLT) , and the plasma levels of antithrombase activity (AT: A), plasminogen activity (PLG: A), fibrinogen (FIB) and D-dimer (D-D) concentrations.Results AT: A, PLG: A and PLT were lower and FIB and D-D levels higher in all patients than control levels (P

Objective To study the pathogenesis mechanism of hepatitis C vires (HCV) core protein (CORE), the subcellular localization of different truncated genotype 1b HCV CORE was observed. Methods HepG2 cells were transiently transfected with the enhanced green fluorescence protein (EGFP-CORE) recombinant plasmids, which expresses EGFP and COREs from three different genotype lb HCV strains and different truncated COREs from one HCV strain. The localizations of different truncated COREs was analyzed by the laser scanning confocal microscope and fluorescence microscope. Results N terminal 1-172 an of different HCV strains of genotype 1b expressed mainly in cytoplasm. Among the different truncated COREs, the longer of the CORE containing N terminal, the more expressed in cytoplasm. The N terminal 1-58 aa mainly expressed in nucleus. CORE of 59-126 aa and 127-172 aa expressed both in cytoplasm and nucleus. Conclusion The different localizations of different truncated COREs might have some relationships with their functions in pathogenesis.

AIM: To observe the changes of inflammatory factors and blood coagulatory factors and effects of antithrombin Ⅲ (ATⅢ) on activated inflammatory factors and blood coagulatory factors in rats with hemorrhagic shock. METHODS: The rat model of hemorrhagic shock was set up. 40 SD rats were randomized into four groups: sham operation, shock, routine dose ATⅢ and high dose ATⅢ groups, each group was composed of 10 SD rats. Shock group was administered common resuscitation fluid, routine dose ATⅢ group was administered ATⅢ 20 U/kg, high dose ATⅢ group was administered ATⅢ 100 U/kg everyday for successive three days. Plasma NF-?B, 6-Keto-prostaglandinF1?, E-selectin, sICAM-1, thrombin-ATⅢ complexes, thrombinogen fragment F1+2 (PF F1+2), D-dimer and TMD levels were detected. RESULTS: Plasma NF-?B, sICAM-1, E -selectin levels were significantly lower in high dose ATⅢ group than those in shock group and routine dose ATⅢ group (P

OBJECTIVETo observe the effect of transcutaneous acupoint electric stimulation on the postoperative nausea and vomiting (PONV) and explore its mechanism.

METHODSNinety cases of elective cesarean section of I to II grade in American Society of Anesthesiologists (ASA) were collected and randomized into a transcutaneous acupoint electric stimulation group (group A), a sham-acupoint group (group B) and a blank control group (group C), 30 cases in each one. In the group A, 30 min before operation, the transcutaneous electric stimulation was applied to bilateral Neiguan (PC 6) and Zusanli (ST 36). The stimulation lasted during operation and 1 h after operation. In the group B, the same electric stimulation was given at the sites 3 cm lateral to the medial sides of Neiguan (PC 6) and Zusanli (ST 36). In the group C, the electric plaster was attached to bilateral Neiguan (PC 6) and Zusanli (ST 36), without any electric stimulation. The lumbar epidural combined anesthesia and the postoperative analgesia were same in each group. The mean arterial pressure (MAP), heart rate (HR) , oxygen saturation of blood (SpO2) and the VAS (visual analogue scale) score of nausea and vomiting were recorded before acupoint stimulation (T0), at skin incision (T1), fetal delivery (T2), abdominal exploration (T3) and 1 h after operation (T4) as well as bleeding and application of oxytocin, ephedrine and atropine during operation separately. The changes of plasma 5-hydroxytryptamine (5-HT) concentration were observed at T0 and 30 min after electric stimulation.

RESULTSThe differences were not significant in MAP, HP and SpO2 at each time point of the three groups (all P> 0.05). The differences were not significant in bleeding and application of oxytocin, ephedrine and atropine during operation (all P > 0.05). The scores of nausea and vomiting in the group A during T1 to T4 were lower than those in the group B and group C (all P < 0.05). In the group A, 30 min after transcutaneous acupoint electric stimulation, plasma 5-HT concentration was lower than those in the group B and group C (both P < 0.01).

CONCLUSIONThe transcutaneous acupoint electric stimulation apparently relieves nausea and vomiting during and after cesarean section and the mechanism is relevant with the decrease of plasma 5-HT concentration.

Acupuncture Points ; Adult ; Cesarean Section ; adverse effects ; Electric Stimulation ; Female ; Humans ; Postoperative Nausea and Vomiting ; blood ; etiology ; therapy ; Pregnancy ; Serotonin ; blood ; Young Adult

Objective:To compare the efficacy of different concentrations of ropivacaine for interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery under general anesthesia.Methods:Ninety American Society of Anesthesiologists physical statusⅠor Ⅱ patients (NYHA classⅠorⅡ) of both sexes, aged 18-64 yr, with body mass index of 18.0-26.9 kg/m 2, undergoing elective arthroscopic shoulder surgery were selected, and were divided into 3 groups ( n=30 each) using a random number table method: 0.25% ropivacaine group (group A), 0.375% ropivacaine group (group B) and 0.5% ropivacaine group (group C). Interscalene brachial plexus block was performed with 0.25%, 0.375% and 0.5% ropivacaine 20 ml in A, B and C groups, respectively.Before operation (T 0) and at 30 min (T 1), 4 h (T 2), 6 h (T 3), 8 h (T 4), 10 h (T 5) and 12 h (T 6) after administration, the diaphragmatic mobility was measured and recorded using M-mode ultrasound and forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured using portable spirometer.The occurrence of phrenic paralysis was recorded at T 1-6.The duration of sensory and motor block was recorded.When visual analogue scale score>3 within 24 h after operation, flurbiprofen axetil 50 mg was injected intravenously for analgesia and the consumption was recorded.The adverse reactions such as cardiovascular events, local anesthetic intoxication, Horner syndrome, pneumothorax, and nausea and vomiting within 24 h after administration were recorded. Results:Compared with group A, the diaphragmatic mobility was significantly decreased during quiet breathing at T 1-3 and was decreased during deep breathing at T 2-5, and the diaphragmatic paralysis rate was increased during quiet and deep breathing at T 2-3 in group B, diaphragmatic mobility was decreased during quiet and deep breathing at T 1-6, diaphragmatic paralysis rate was increased during quiet and deep breathing at T 1-4, FEV 1% and FVC% were decreased at T 1 and FVC% was decreased at T 2 in group C, and the duration of sensory and motor block was prolonged in B and C groups ( P<0.05 or 0.01). Compared with group B, the diaphragmatic mobility was significantly decreased during quiet breathing at T 4-6 and was decreased during deep breathing at T 1-6, the diaphragmatic paralysis rate during quiet breathing was increased at T 2-4 ( P<0.05) was increased during deep breathing at T 3-4, and FEV 1 % and FVC % at T 1 were decreased in group C ( P<0.05). There was no significant difference in the postoperative requirement for flurbiprofen axetil and the incidence of adverse reactions within 24 h after administration among the 3 groups ( P>0.05). Conclusion:0.25% ropivacaine 20ml provides better efficacy when used for interscalene brachial plexus block in the patients undergoing arthroscopic shoulder surgery.

Objective To evaluate the long-term func ti onal outcome of the Gustilo-typeⅢB andⅢC open fractures of the tibia treate d with limb-salvage.Methods Twenty-onepatients,including16cases of Gustil o-tapeⅢB and5cases of ⅢC open fractures of the tibia,were repaired by30f ree vascularized tis-sue flap transfer from1990to1999.The soft tissue and bone defect of 13cases Gustilo-typeⅢB open frac-tures of the tibia wer e repaired simultaneously with osseous-cutaneous flap or musculo-cutaneous-o sseous flap transplantation,the soft tissue defect in3cases of open fractures of the tibia were covered with cutaneous flap or musculo-cu taneous flap at first setting,and the tibia defect or non-union were repaired with vascu lari zed osseous flap at the second.The posterior tibia vessels were reconstructed in all of 5cases of Gustilo-typeⅢC group,in3cases of which posterior tib ial nerve were repaired simultaneously,and emergency cutaneous flap or musculo-cutaneous flap transfer were performed in2cases,delayed vascularized flap tr ansplantation were performed in another3cases.The salvageable limb function w as assessed according to the punos sev en-scale score criteria which includin g freedom of pain,activities of daily life,range of motion,residual deform ity,ra-diographic changes,muscle strength and sensation.Results Twnety-twov ascularized tissue flaps were trans-ferred at first setting in21patients,1 9vascularized tissue flap survived,and other3vascularized tis sue flap failed .The survival rate was86.4%.The average duration from the injury to the f irst vascu larized tis sue flap transplatation was84days.The soft tissue defe ct was completely re paired after the second setting and the fracture or defect was united finally;the average number of procedure for the Gustilo-typeⅢB was4and10for the Gustilo-typeⅢC tibial fractures with an average period fr om injury to bony union of 210and640days in typeⅢB and typeⅢC respective ly.After an average58months of follow-up,ranging from17to129months, 10case obtained excellent and good re sults(62.5%),4cases fair(25 .0%),2cases poor (12.5%)in Gustilo-typeⅢB tibia open fracture.Th ere were no one with excellent,good and fair results,5cases poor (100%) in Gustilo-typeⅢC.Conclusion Theamputation below the knee should be consid-e red for the Gustilo-typeⅢC open fractures of the tibia,especially along wit h the severe injury of the ankle or the dis ruption of poste rior tibial ner ve or the obvious limb shortening.The Gustilo-typeⅢB open frac-tures of t he tibia should deserve reconstruction with the technique of microsurgery,and the functional recov-ery of the salvageable limb was satisfactory.

Objective To investigate the risk factors of thrombopenia(TP)in septic patients complicated with acute kidney injury (AKI).Methods Two hundred and sixty five septic patients complicated with AKI admitted in Intensive Care Unit ICU of Zhejiang Provincial People''s Hospital during January 2012 and December 2016 were enrolled in the study.The clinical data, results of laboratory tests, Acute Physiology and Chronic Health Evaluation (APACHEII) scores, Sequential Organ Failure Assessment (SOFA) scores, therapeutic intervention, and 28-day mortality were documented.Among 265 patients, TP occurred within 7 days in 112 cases (TP group) and did not occur in 153 cases (non-TP group).Multivariable Logistic regression analysis was performed to analyze the risk factors of TP.Results The 28-day mortality rate in TP group was higher in TP group than that in non-TP group (47.3% vs.33.3%, χ2=5.307,P<0.05).Univariate analysis showed that age, C-reactive protein (CRP), procalcitonin (PCT) and APACHEII score, SOFA score, continuous renal replacement therapy (CRRT), heparin anticoagulation, shock, usage of linezolid and bloodstream infections were associated with TP in septic patients with AKI(all P<0.05).Multivariable Logistic regression analysis showed that age≥65 (OR=4.53, 95%CI 1.23-9.24,P<0.05), CRRT(OR=5.24,95%CI 2.14-14.56,P<0.01), heparin anticoagulation(OR=4.56,95%CI 2.13-8.46,P<0.01), usage of linezolid(OR=2.35,95%CI 1.25-5.24,P<0.01), shock(OR=2.15,95%CI 1.03-4.96,P<0.01)and bloodstream infections(OR=4.26,95%CI 1.36-12.48,P<0.01)were independent risk factors for septic patients with TP.Conclusion For septic patients with AKI having these risk factors, the platelet counts should be closely monitored, and intervention measures should be given to reduce the occurrence of TP.