Emergence delirium (ED) is a complex of perceptual disturbances and psychomotor agitation that occurs most commonly in preschool-aged children in the early postanesthetic period.Although these events are often short lived,they increase the risk of self-injury,require additional nursing staff and can increase medical care costs,all of which are causes for concern.A variety of anesthesia-,surgery-,patient-,and adjunct medication-related factors have been suggested to play a potential role in the development of such an event.The risk of ED is lowest when propofol is used as a single-agent anesthetic compared with sevoflurane-based anesthetics.Adjunctive agents can be rated in the following order of most effective to least effective interventions:dexmedetomidine,fentanyl,ketamine,clonidine.This review summarizes the factors that may predict ED and provides an intervention algorithm to guide effective prevention and treatment.

Objective To study the applied value of invasive arterial blood pressure monitoring in the diagnose and treatment of coronary artery intervention. Methods The dynamic changes of ECG, the non-invasive blood pressure, the invasive arterial blood pressure monitoring and the clinical performance were ob-served in 163 patients in the process of coronary artery intervention (CAI). Then the invasive arterial blood pressure change and the non-invasive blood pressure change were compared. Results The change rates of invasive arterial blood pressure were higher than that of non-invasive arterial blood pressure. The difference of both changes had statistical significance. The invasive blood pressure decreased and wave forms changed in 26 cases. These reflected sensitively the patients' condition and the issues in the process of CAI. Conclusions To strengthen the invasive arterial blood pressure monitoring can improve the success rate of CAI more effec-tively and reduce the complication.

Objective To observe the effect of grape seed Procyanidins on platelet aggregation and experimental thrombosis in rats.Methods 50 Experimental thrombosis male SD rats of clean grade,weighing 250～300 g,were randomly divided into five groups,normal saline(control)group,aspirin(ASP)group(60 mg/kg),and procyanidins 1 00 mg/kg,200 mg/kg,400 mg/kg group,10 in each.50 experimental thrombosis male Kunming mice of clean grade,weighing 18～20 g,were also randomly divided into five groups,normal saline(control)group,aspirin group(84 mg/kg)and Procyanidins 140 mg/kg,280 mg/kg,560 mg/kg group,10 in each.Intragastric administration was performed in these experimental animals.The effects of Procyanidins were observed on rat platelet aggregation induced by ADP,COL and AA.Experimental rat's thrombosis was induced by method of"arterio-venous"shunt and the death rate within 15 min was determined with collagen plus adrenaline induced thrombus model in mice,aspirin as a positive control.Results Procyanidins in the middle and high-dose group can inhibit ADP,COL,AA-induced platelet aggregation and experimental thrombosis obviously.Conclusion Procyanidins can inhibit experimental thrombosis and have anti-platelet aggregation effect.

Nonsteroidal anti inflammatory drugs (NSAIDs) are among the most commonly used drugs in the world, but their use is limited because of their propensity to cause many severe adverse reactions. Cyclooxygenase 2 (COX 2) not only take part in inflammatory reaction, but also exert various physiological functions. Selective COX 2 inhibitors still have a series of adverse reactions. COX 3, a new COX cloned and expressed recently, can be inhibited selectively by acetaminophen and do not relate to inflammation. A hypothesis about COX family is assumed and seven isoforms are supposed in this article.

Chinese patent medicines have unique advantages in treatment of diabetes. This article provides a comprehensive review of the classification, analysis and evaluation of the post-marketed Chinese patent medicines for diabetes and proposes that pure TCM preparations and Chinese/western compound preparations should be considered differently in regards to their clinical uses. TCM symptom-complex differentiation is the common guideline for rational use of both pure TCM preparations Chinese/western compound preparations. Moreover, the Chinese/western compound preparations should be used in accordance to the indications of the western medicine contained and strictly under the physician's instruction. Education and training of rational medication usage, basic and clinical study on post-marketed medicines are important measures to control and reduce medication risk.

100 were found in 8,7 and 9 patients respectively.(3)The positive rate in detection of insulinoma by ultrasonography,CT scan and intraoperative palpation was 30%,60% and 100% respectively.Conclusion Typical symptoms and laboratory examinations are main evidence in diagnosis of insulinoma.Intraoperative ultrasound and palpation are more useful for localization diagnosis of insulinoma.Operations should be considered in patients with typical clinical characteristic and negative imageology.

This paper analyzes the concept of hospital financial information management and the current situation.From the perspective of public hospital reform, we proposed the hospital should fulfill the information-based budget management and salary management, construct hospital information-based cost control flowsheet, build message conducting and transferring program, that budget should be achieved as soon as possible, information technology should be applied in hospital management, and build a complex financial information management team as soon as possible.

Objective To investigate the relevant risk factors for,clinical manifestation and treatment responses of symmetric acral keratoderma in 9 patients.Methods Clinical data were collected from 9 outpatients with symmetric acral keratoderma.Skin lesions were photographed,tissue specimens were obtained from the lesions and subjected to fungal and histopathological examinations.The patients were given topical treatment.Results There were 8 males and 1 female in these patients with an average age of 28.2 years and age at onset of 24.6 years.The disease duration varied from 2 months to 16 years.The lesions were predominantly distributed on the dorsum of both hands and wrists symmetrically and circularly.Ankles were the third popular site involved.Generally,the lesions were aggravated in summer,spontaneously cured in winter.Most of the patients had a history of occupational contact with plastics or rubber.Some patients suffered from ichthyosis vulgaris.Microscopic examination for fungal element was negative.Histopathology revealed epidermal hyperkeratosis,acanthosis and mild papillomatosis.The urea and Vitamin E cream mixed with clobetasol propionate cream at a ratio of 1 ∶ 1 proved to be effective.Conclusions Ichthyosis vulgaris may be a risk factor for symmetric acral keratoderma.The whitening of lesions after short exposure to water may be a kind of physical phenomenon with the involvement of water and air.Topical steroids may serve as the first-line treatment choice for symmetric acral keratoderma.

Objective To explore the influence of pomegranate juice on cognitive behavior of chroniccerebral hypoperfusion in rats and its mechanism.Methods 48 healthy male Wistar rats were selected and randomly divided into 3 groups, sham operation group (SO), permanent bilateral persistence commancarotid artery occlusion or two-vesselocclusion (2VO) group, pomegranate juice group.Chronic cerebral hypoperfusion model was prepared in rats by permanent bilateral common carotid artery ligation.Given the intervention after operation 1 weeks, before the 2 groups were given by sugar water intragastric ( every 100 mL syrup containing 25 g,sucrose 2 g, fructose glucose 2 g) with pomegranate juice, pomegranate juice group ( polyphenol content of 2.4-4.8 mg/mL) were given by gavage,2 mL/d, a total of 7 weeks.8 th weeks after surgery, cognitive behavior ability of 3 groups was tested by space exploration target quadrant swimming time after an interval of 1day;CA1 region of 8-hydroxy deoxyguanosine (8-OHdG), 4-hydroxyl nonenal ( 4-HNE ) expression of 3 groups in cortex and hippocampus detected by immunohistochemical method; observed whether it could improve the chronic cerebral hypoperfusion in rats learning, memory ability, or had antioxidative stress injury.Results On the 4th day and 5th day, the time of rats in SO to find the platform and the shortest time, group 2VO for the longest time, compared with statistical significance between the three groups (P<0.01); the 3 groups of rats in the target quadrant emergence time in sham operation group, the longest (10.05+1.688)s, 2VO group has the shortest time (6.343 ±1.220) s, and there was statistical significance (P<0.05).The integral optical density of positive cells in 3 groups of rats cortex and hippocampal CA1 region of 4HNE, the value of the 8-OHdG IOD is the lowest in the sham operation group, 2VO group was the highest, with statistical significance.Pomegranate juice intervention, cortex of rats and hippocampal CA1 region of 8-OHdG, 4-HNE decreased significantly ( P <0.05).Conclusion Chronic cerebral hypoperfusion may cause oxidative stress injury, pomegranate juice can improve the low irrigation learning and memory ability of rats with chronic cerebral, decrease 8-OHdG and 4-HNE expression may play a protective function through antioxidative stress pathway.

Objective To explore neuroprotective effect of escitalopram oxalate on cerebral ischemia reperfusion in injury rats and its possible mechanism,thus provide experimental evidence for the use of the drug in the clinical treatment of ischemic cerebrovascular disease.Methods 160 male rats of SD were selected and randomly divided into three groups:sham operation group(Sham group),negative control group(NS group),intervention group(CIT group,for 14 days and 21 days).Focal middle cerebral artery occlusion model(MCAO)of rats were constructed.Neurological deficit of rats in each group were evaluated by modified neurological severity score(mNSS)scale.Microvessel diameter,density,and total area of each group angiogenesis in cerebral ischemic area were observed by Laser cofocal technology after 14 days and 21 days at different time points;the plasma concentrations of VEGF were detected by ELASA,and expression levels of VEGF were detected by immunohistochemical assay and Western blot in each group,to explore its possible mechanism of molecular biology.Results After modeling,neurological deficit of intervention group for 14 days and 21 days were improved significantly.The indicators were as follows:scores of mNSS in NS group(6.57 ±1.13)was significantly higher than(4.39 ±0.92)in intervention group for 14 days(P<0.05);scores of mNSS in intervention group(3.23 ±0.55)for 21 days was significantly lower than(4.14 ±0.74)in intervention group for 14 days(P<0.01).Confocal 3D imaging results after 14 days showed:microvascular total area was significantly lager which illustrated that the effect of drug intervention for 14 days started to work over time.Plasma concentrations and expression levels of VEGF in intervention group for 14 days and 21 days were higher than those in Sham group,NS group.VEGF protein expression of cerebral ischemia tissues in intervention group for 21 days were higher than that of 14 days(P<0.01).Conclusion Escitalopram oxalate could significantly reduce cerebral ischemia and reperfusion in rats nerve injury and improve neurological function,which has a neuroprotective effect,the effect of drug intervention gradually increases over time,and the possible mechanism of which is related to angiogenesis mediated by VEGF.