Objective The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients.Methods According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU). Then these patients were observed by domestic multifunctional detector for electroencephalographic (EEG) variables such as brain lateralization, brain introvert, brain activity, brain energy consumption, focus inward, focus outward, cerebral inhibition, fatigue, sleep severity, sedation index, pain index, anxiety index, fidgety index, stress index and the cerebral blood flow (CBF) index which was named of perfusion index. Other variables including indexes of ICU blood gas analysis, which was consisted of variables of blood gas analysis, routine blood test and biochemistry, previous history and prognostic outcome was recorded. Binary logistic regression was used for multivariate analysis.Results Forty-three postoperative patients, who needed intensive care, were included. Eighteen were in delirium group and twenty-five in control group. Excluding the trauma, variables like gender, age, temperature, heart rate, respiratory rate, mean arterial pressure, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, organ failure, dementia and emergency surgery didn't show any statistical significance between two groups. The trauma in delirious patients increased obviously compared with the control group (33.3% vs. 4.0%,P = 0.031). Except for the brain activity [122.47 (88.62, 154.21) vs. 89.40 (86.27, 115.97),P = 0.034], there were no statistical differences in any other EEG and CBF variables. In ICU blood gas analysis, only pH value (7.43±0.42 vs. 7.47±0.31,P =0.003), chloride concentration [Cl- (mmol/L): 114.66±4.32 vs. 111.90±3.08,P = 0.019], magnesium concentration [Mg2+ (mmol/L): 0.60±0.10 vs. 0.54±0.06,P = 0.035] and blood osmolality [mmol/L: 290.10 (284.15, 306.35) vs. 282.70 (280.20, 286.75),P = 0.014] were statistically significant. Compared with control group, the prognostic variables in delirium group such as duration of mechanical ventilation [days: 125.0 (49.0, 293.0) vs. 149.5 (32.0, 251.3)], length of stay in ICU [days: 216.5 (50.5, 360.8) vs. 190.0 (72.0, 330.5)] and mortality rate (22.2% vs. 24.0%) didn't appear to be statistically significant either (allP > 0.05). It was shown by multivariate logistic regression analysis that pH [odds ratio (OR) = 1.446, 95% confidence interval (95%CI) = 1.116-1.875,P = 0.005] and Cl- (OR= 0.708, 95%CI =0.531-0.945,P = 0.019) were potential risk factors of delirium.Conclusions The brain activity of HXD_Ⅰ may contribute to the clinical diagnose of delirium, but it still remained to be proved further. The pH and Cl- are potential risk factors of delirium.

Objective To investigate the effect of propofol on C-fos expression and glutamate concentration in rat cerebral cortex induced by ketamine. Methods Twenty-eight male Wistar rats weighing 260-280 g were randomly divided into four groups of seven animals: group 1 received normal saline intraperitoneally (ip) (group NS); group 2 received NS + ketamine 100mg?kg-1 ip (group K); group 3 received propofol 100 mg?kg-1 + ketamine 100mg?kg-1 ip (group PK); group 4 received diazepam 10mg?kg-1 + ketamine 100 mg?kg-1 ip (group DK). The interval between the two intraperitoneal injections was 5 min in each group. The animals were decapitated 30 min after ip injection. C-fos mRNA expression was detected by RT-PCR method and fos protein expression by immuno-histochemical technique. Another forty Wistar rats were randomly divided into 4 groups of 10 animals as was described above. Two hours after ip injection, five animals in each group were decapitated for microscopic examination and the other five animals for determination of water and glutamate content of cerebral cortex.Results C-fos mRNA expression increased at 30 min after intraperitoneal ketamine. Ketamine induced significant increase in Fos protein expression, and glutamate and water content in cerebral cortex 2 h after ip injection. Propofol and diazepam inhibited the increases induced by ketamine ( P

In this study nine cases of thallium poisoning in a series of homicidal poisoning were analyzed in order to provide more information concerning thallium poisoning. It was found that the most common clinical feature of thallium poisoning was peripheral neuropathy and paraesthesia was more common than amyasthenia. Understanding of these clinical characteristics of thallium poisoning was helpful to early identification and differential diagnosis. Since the early administration of Prussian Blue, as a specific antidote for thallium poisoning, can substantially improve the prognosis, it is of great importance to establish a correct and early diagnosis.

The aim of this study was to investigate the effects of nifedipine on stress responses to tracheal intubation. Thirty adult patients, ASA Ⅰ to Ⅱ, scheduled for elective surgery, were randomly assigned to receiving intravenous infusion of normal saline 30ml (group Ⅰ). fentanyl 5?g/kg (group Ⅱ) or nifedipine 40 ?g/kg(group Ⅲ), respectively. After intravenous thiopental, valium and atracurium. the tracheal intubation was performed. SP, DP, HR and RPP were determined before administration, immediately before and after intubation. 1, 3 and 5 min following intubation separately, and the venous blood samples were taken at correspondingly later 5 times to measure plasma concentrations of endotheline(EF), atrial natriuretic polypeptide (ANP), TXB_2 and 6-keto-PGF_1 ? by radioimmunoassay individually. Following intubation. MAP went up in group Ⅰ and transiently in group Ⅱ and Ⅲ, HR in creased by 36.6% and 33.3% in group Ⅰ and Ⅲ and remained stable in group Ⅱ, RPP rose in group Ⅰ and rept statistically unchanged in group Ⅱ and Ⅲ, ET level stayed constant in all three groups, levels of ANP and TXB_2 ascended in group Ⅰ, transiently in group Ⅱ and did not vary in group Ⅲ, 6-keto-PGF_1? level were raised in group Ⅱ, transiently in group Ⅲ and did not change in group Ⅰ, and TXB_2/6-keto-PGF_1? ratio(T/K) shoot up in group Ⅰ and reduced in group Ⅱ and Ⅲ. As compared with those in group Ⅰ, before intubation, ANP level increased in group Ⅱ and Ⅲ. 6-keto-PGF_1? level decreased and T/K rose in group Ⅲ; after intubation, levels of ANP and 6-keto-PGF_1 ? went up in group F, transiently in group Ⅲ, and TXB_2 and T/K values went down in group Ⅱ and Ⅲ. It is suggested that prophylactic intravenous nifedipine may effectively depress the cardiovascular and hormone responses to tracheal intubation, but can not take complete place of fentanyl for this procedure.

Objective To evaluate the effect of medical hygiene wipes on disinfecting object surface and compliance to use in an intensive care unit (ICU).Methods 30 beds in the ICU at a hospital were randomly selected and divided into three groups:A,B and C,each group had 10 beds.Group A were only provided hygiene wipes,group B used towel soaked in chlorine-containing disinfectant (disinfected towel),group C were provided both medical hygiene wipes and disinfected towel for selected use.Compliance to different disinfection methods,and disinfectant efficacy on object surface were compared.Results The rate of compliance to disinfection in group A was higher than group B (78.78% vs 42.12%,χ2 =68.56,P <0.05);except medical disposal trolley and ventilator,compliance to disinfection of the other object surface in group A were all higher than group B (all P <0.05).Except ventilator, adenosis triphosphate (ATP)values before and after disinfection of object surface in group A and B were both significantly different (both P <0.05 ),disinfectant efficacy of group A was superior to group B.Group C used medical hygiene wipes more than disinfected towel ([836 times,91 .57%]vs [77 times,8.43%]).Nurses spent (20.15+ 3.00 )minutes on preparing disinfectant every day,and (15.02 ± 2.00 )minutes on washing used disinfected towel,while hygiene wipes could be used immediately,discarded after use,and was timesaving. Conclusion Use of medical hygiene wipes is convenient,rapid,and without irritating odor,it also improves disinfection effect on object surface and ICU health care workers’compliance to disinfection.

Total flavones of hippophase rhamnoides (TFH) inhibited the contraction of isolated rabbit aortic preparations induced by KCl, CaCl_2 and noradrenaline (NE), shifted the dose-response curvesto the right and depressed the maximal response. PD_2' values were 5.79, 5.75 and 5.81 respectively. TFH could also reduce Ca~(2+) -dependent contraction in rabbit aortic preparations. These results suggest that relaxation of vascular smooth muscles caused by TFH may be due to TFH natagonistic effect on transmembrane Ca~(2+) channels.

Objective To monitor right heart hemodynamic changes of patients with lung cancer during and after the procedures of pneumonectomy and discuss the effect of pneumonectomy on right heart function and risk of postoperation morbidities. Method 16 patients with lung cancer were randomly selected and the clinical database was queried and Swan-Ganz catheter was applied awake from jugular vein to pulmonary artery ,measuring mean arterial pressure(MAP) ,heart rate(HR) ,central venous pressure(CVP) ,mean pulmonary artery pressure (MPAP),mean pulmonary capllary wedge pressure(MPCWP) ,and eardiaoc output(CO) and calculating cardiac index (CI),left ventricular-stroke work index (LVSWI), right ventricular stroke work index (RVSWI) , and stroke volume index(SVI) instantaneously before anaesthesia, after anaesthesia with single lung ventilation, after pulmonary artery and pulmonary vein occlusion and supine chest dosed during the procedure of pneumonectomy. Pre-and post-operative complications were recored. Results Cardiovascular complications occurred in 6 patients(37.5%) postoperatively. There were no operative or perioperative deaths. MPAP increased significantly after the procedure of pneumonectomy compared with that of preoperation, and MPAP > 26 mm Hg was in 4 patients who got cardiovascular complications postoperatively with morbidity of 100% ,which was "significantly higher than the morbidity of 16.7% (2/12) when MPAP < 25 mm Hg. Conclusion Pneumonectomy has significant effects on right heart hemodynemic changes and as MPAP increases postoperatively, the risk of cardiovascular complications becomes higher.

OBJECTIVE To evaluate the curative effects of surgery combined with early radiotherapy and local injection of hormonal anti-scarring drugs in the treatment of keloid in head and neck region. METHODS 35 patients with keloid were treated with surgery(completely excised and sutured directly or treated with local skin flap).Radiotherapy was applied within 24 hours after operation.A total dose of 20 Gy was administered in ten fractions of 2 Gy every day. Patients who had recurrences were treated with local injection of hormonal anti-scarring drugs.RESULTS After operation,all the wounds were healed by first intention.After 1-4 year follow-up,25 cases(71.43%) were cured without relapse;10 cases(28.57%) showed partial remission.The rate of therapeutic effect was 100%.CONCLUSION Surgical removal combined with local radiation and local injection of hormonal anti-scarring drugs are one of the effective methods in treatment with keloid in head and neck region.

Objective The aim of this study was to investigate the accuracy and reliability of linear measurements using cone beam computed tomography(CBCT) system and to provide theoretical application of CBCT in oral implantation. Methods Ten experimental models of different toothless mandibles mixed with 10% of barium sulfate were used in this study. All these mandible models were marked with gutta-percha markers to standardize the plane of the transverse cross-sections and path of measurements. The mandible models were imaged using Mayer SS-X9010D CBCT device. Measurements were taken with DCT Viewer software and compared with measurements recorded directly in the mandible models using vernier caliper. A paired sample t-test was performed to compare difference between CBCT measurement and vernier caliper measurement. Less than 0.05 were considered statistically significant. Results The differences of vertical lines between CBCT and vernier caliper were (-0.089 5±0.220 0) mm in anterior teeth area and (-0.083 0±0.190 0) mm in posterior teeth area. The differences of vertical lines between CBCT and vernier caliper were (-0.052 0 ± 0.140 0) mm in anterior teeth area and (-0.084 7 ± 0.320 0) mm in posterior teeth area. The corresponding t values were-1.784,-1.981,-1.621 and-1.684, respectively. All the P values were greater than 0.05. There was no significant difference between CBCT measurement and vernier caliper measurement. Conclusions CBCT is auseful tool to provide good accuracy and precision of linear measurement in dental implants.