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 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.

AIM: To study the effect of chronic hypoxic hypercapnia on gene expression of thromboxane synthase and prostacyclin synthase in pulmonary arterioles. METHODS: Sprague-Dawley rats were randomly divided into two groups: control group and hypoxic hypercapnic group. TXS mRNA and PGI 2-S mRNA were observed in pulmonary arterioles by in situ hybridization. RESULTS:mPAP, weight ratio of right ventricle (RV) to left ventricle plus septum(LV+S), contents of TXB 2 and 6-keto-PGF1 ? in plasma and lung and TXS mRNA in pulmonary arterioles were much higher in rats of hypoxic hypercapnic group than those of control group. Differences of PGI 2-S mRNA in pulmonary arterioles were not significant in two groups. Light microscopy showed hypertrophy of vessel smooth muscle cells and vessel cavity straitness were found in hypoxic hypercapnic group. CONCLUSION: Changes of gene expressions of thromboxane synthase and prostacyclin synthase and imbalance of TXA 2/PGI 2 may play an important role in hypoxic hypercapnic pulmonary hypertension.

Objective To evaluate the efficacy of thoracic paravertebral block for preemptive analgesia in the patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCAB).Methods Sixty patients of both sexes,aged 54-75 yr,weighing 55-82 kg,of American Society of Anesthesiologists physical Ⅱ or Ⅲ,with New York Heart Association Ⅰ-Ⅲ,scheduled for elective MIDCAB,were randomly divided into 2 groups (n =30 each) by using a random number table:control group (group C) and thoracic paravertebral block group (group P).Thoracic paravertebral block was performed under the guidance of a nerve stimulator in group P.A paravertebral catheter was placed at T4,5 interspace,a test dose of 0.5％ ropivacacine 5 ml was injected through the catheter,and 5 min later a bolus dose of 0.5％ ropivacacine 15 ml was injected.Anesthesia was induced with intravenous etomidate,midazolam,fentanyl and vecuronium.All the patients were intubated with a double-lumen endobronchial tube and mechanically ventilated,and end-tidal pressure of carbon dioxide was maintained at 30-40 mmHg.Anesthesia was maintained with intravenous injection of fentanyl and vecuronium,intravenous infusion of propofol,and inhalation of sevoflurane.Bispectral index value was maintained at 40-60.When systolic blood pressure ＞ 160 mmHg,fentanyl 0.1 mg was injected intravenously.Both groups started to receive patient-controlled intravenous analgesia (PCIA) after extubation until 48 h after operation.PCIA solution contained morphine in 100 ml of normal saline.The PCIA pump was set up with a 2 mg bolus dose,a 10 min lockout interval and background infusion at a rate of 0.5 mg/h.Visual analogue scale was maintained ≤ 4.When visual analogue scale＞4,morphine 4 mg was injected intravenously as rescue analgesic.The consumption of intraoperative fentanyl was recorded.The consumption of morphine and requirement for rescue analgesics were recorded within 24 and 48 h after operation.The adverse reactions such as somnolence,nausea and vomiting,respiratory depression,pruritus,and atelectasis were recorded within 48 h after operation.The extubation time after operation,length of time in intensive care unit,and recovery time after operation were recorded.At 24 and 48 h after operation,pulmonary function was detected,the forced vital capacity (FVC) expressed as a percentage of the predicted value (FVC％),and forced expiratory volume in 1 second (FEV1)expressed as a percentage of the predicted value (FEV1 ％) were recorded,and the ratio of FEV1/FVC was calculated.Blood gas analysis was performed,and arterial oxygen partial pressure and partial pressure of arterial carbon dioxide were recorded at 24 and 48 h after operation.Results Compared with group C,the intraoperative consumption of fentanyl and consumption of morphine within 24 and 48 h after operation were significantly reduced,the extubation time and length of time in intensive care unit were shortened,FVC％ and FEV1％ were increased at 24 and 48 h after operation,the partial pressure of arterial carbon dioxide and incidence of somnolence were decreased (P＜0.05),and no significant change was found in the FEV1 / FVC,arterial oxygen partial pressure,requirement for rescue analgesics and recovery time after operation in group P (P＞0.05).Conclusion Thoracic paravertebral block analgesia can provide good preempive analgesia in the patients undergoing MIDCAB.