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.

Seventy eight children with Henoch-Schonlein syndrome (HSP) admitted in our hospital from October 2013 to April 2015 were enrolled in this study,and 30 healthy children were also enrolled as controls.The serum S-100 protein levels were measured with enzyme-linked immunosorbent assay (ELISA)in two groups;and electroencephalogram (EEG) examination was performed in HSP patients.The serum S-100 protein level of HSP group (0.206 ± 0.101) μg/L was significantly higher than that in the normal control group [(0.060 ±0.042) μg/L,P ＜ 0.001];and the serum S-100 protein levels in patients with kidney type (0.284 ±0.099) μg/L and mixed type [(0.284 ±0.043) μg/L,P ＜0.01] were higher than those in patients with skin type (0.151 ±0.098) μg/L,gastrointestinal type (0.138 ±0.036) μg/L and joint type [(0.117 ± 0.065) μg/L,P ＜ 0.001].Abnormal EEG findings were detected in 52 cases (66.7％),however,no clinical manifestations of nervous system were found in those patients.Serum S-100 protein levels were higher in patients with abnormal EEG than those with normal EEG [(0.223 ± 0.099) μg/L vs.(0.173 ± 0.096) μg/L,P ＜ 0.05].The results suggest that the serum S-100 protein is associated with HSP disease severity,and children with HSP may have subclinical neurological damage.

Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) for elder patients (age more than or equal to 80 years).Methods Data of 464 patients (age ≥ 80 years) who underwent ERCP procedures from June 2008 to June 2014 in the First Affiliated Hospital of Nanchang University were compared with those of patients less than or equal to 60 years old,randomly chosen at 1∶4,for comorbidity,feature of disease distribution,intraoperative situation and postoperative complications of ERCP.Results The comorbidity rates of coronary heart disease,hypertension,chronic pulmonary disease and type 2 diabetes in observation group were significantly higher than those in the control group(P＜0.05),but there was no significant difference between two groups regarding to the comorbidity rate of arrhythmia(P =0.111).The main feature of disease distribution in two groups was choledocholithiasis,but the rate of malignant tumor in observation group was higher than that in the control group(P＜0.05).The success rate of ERCP showed no significant difference in two groups (98.92％ VS 99.35％,P=0.358).There was no significant difference between the two groups in the complication rates of acute pancreatitis (4.96％ VS 3.18％,P =0.064),infection (0.43％ VS 0.54％,P =1.000) and hemorrhage (1.08％ VS 0.59％,P=0.259).However the rate of perforation in observation group was lower than that in the control group (0.43％ VS 0.05％,P =0.043).Conclusion ERCP is safe and effective for elder patients.

Objective To evaluate the safety of anesthesia endoscopic retrograde cholangio pancreatography (ERCP) under general anesthesia.Methods From January 1st,2008 to June 30th,2016,patients underwent ERCP under general anesthesia were enrolled as anesthesia group and from January 1st,2005 to December 31st,2007,patients accepted ERCP without anesthesia were enrolled as control group.Chi-square test was performed to analyze disease composition,conditions during operation,success rate of operation and complications in these two groups.Results A total of 14 724 patients with ERCP under general anesthesia and 2 102 patients received ERCP without anesthesia were enrolled.In 14 724 patients with ERCP under general anesthesia,1 799 cases had malignant biliary and pancreatic diseases and 12 925 cases with biliary and pancreatic diseases.During the operation,transient hypoxemia occurred in 441 cases (3.00％) and relieved by increasing oxygen flow,lower anesthetic dose or lifting lower jaw.The success rate of ERCP in the anesthesia group (98.41 ％,14 490/14 724) was higher than that in the control group (97.34％,2 046/2 102),and the difference was statistically significant (x2 =11.500,P=0.001).The incidence rate of post-ERCP pancreatitis in the anesthesia group was 2.35％ (346/14 724),which was lower than that in the control group (3.85％,81/2 102),and the difference was statistically significant (x2 =16.813,P＜0.01).Conclusion ERCP under general anesthesia is safe,which could increase the success rate of operation and reduce the incidence rate of post-ERCP pancreatitis.

Objective To explore the normal values for two-dimension solid state high resolution anorectal manometry (HRAM) in healthy adult volunteers.Methods The healthy adult volunteers were recruited by advertisement and underwent solid state HRAM in the left lateral position.Anorectal pressures and rectal sensation were recorded and analyzed.Results (1) A total of 126 Chinese healthy adult volunteers (male:50 cases (39.7％);age:(37.5 ± 14.2) years old) were recruited in this study.(2)Mean anal resting pressure (MERP) was (71.8 ± 17.3) mmHg (1 mmHg =0.133 kPa).Maximum anal resting pressure (MARP) was (79.3 ± 17.8) mmHg,Maximum anal squeeze pressure (MSP) was (178.7 ± 52.8) mmHg.Anal high pressure zone (HPZ) length was (3.4 ± 0.6) cm.During simulated evacuation,residual anal pressure (RAP) was (63.8 ±20.5) mmHg,and anal relaxation rate (ARR) was (37.0 ± 11.5) ％.Rectal threshold volume for first sensation (FST),desire to defecate (DDT),urgency to defecate (UDT) and maximum discomfort (MDT) was (47.4 ±10.0) ml,(84.5 ±18.2) ml,(125.8 ± 28.5) ml,and (175.5 ±36.1) ml,respectively.(3) Compared with female subjects,male subjects had higher MSP [(211.0 ± 50.7) mmHg vs (157.5 ± 42.5) mmHg],RAP [(71.6 ± 18.1) mmHg vs (58.8 ± 20.5) mmHg]and rectal MDT[(187.0 ±36.4) mmHg vs (168.0 ±34.1)mmHg],but lower ARR [(32.1 ±8.0)％ vs (40.2 ±12.3)％],all P＜0.01.(4) MERP,MARP,MSP and rectal MDT were higher in young group (≤ 40 years old),all P ＜ 0.05.Conclusions These observations provide normal values for two-dimension solid state HRAM,which have significant difference between genders and different age groups.

Objective To evaluate the safety and efficiency of domestic snare applied during retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions.Methods A total of 27 patients who underwent retrograde PCI for CTO and used domestic snare during the procedure were enrolled in our study from March 2012 to November 2016.Clinical data, angiographic characteristics and PCI details were collected.Clinical data, characteristics of CTO lesion, effect of the domestic snare and snaring time were retrospectively analyzed.Special complications related to the domestic snare and major adverse cardiovascular events (MACE) were also documented.Results Domestic snare was used in all the procedures, which included facillitating the micro-catheter to pass through the CTO lesions in 6 patients and assisting the RG3/rotational guide-wire externalization in all the 27 patients.Mean snaring time was 3.5±5.4 minutes.Stents were successfully implanted in 26 patients except in 1 patient who failed to receive stent implantation for severe coronary calcification.No complications including coronary dissection, fracture of guide-wire and unreleased snare happened during the procedures and no MACE occurred during hospitalization.Conclusions Domestic snare facilitates retrograde micro-catheter crossing CTO lesions and retrograde guide-wire entering the guiding catheter and externalization.It is a simple, safe and efficient method.

Objective:To explore the reasons of the proximal migration of pancreatic stents and the endoscopic management.Methods:From April 2007 to January 2015, of all 967 patients with biliopancreatic diseases implanted with pancreatic duct plastic stents at the First Affiliated Hospital of Nanchang University, proximal migration occurred in 10 cases. Migrated rates and endoscopic retrieval methods of pancreatic straight stents and single pigtail stents were compared.Results:Pancreatic straight stents showed a higher migration rate than those single pigtail ones [3.23% (7/217) VS 0.40% (3/750)]. For 3 migrated single pigtail pancreatic stents: 2 were directly removed with biopsy forceps. Another failed in retrieval, and the same stent then was implanted. There was no discomfort after the operation. For 7 migrated pancreatic straight stents: 2 were pulled out of duodenum papilla incision under wire-guided balloon and basket. Five others were pulled out of papilla under wire-guided balloon, and then the stents were removed by a snare.Conclusion:Pancreatic straight stents are more likely to migrate compared with single pigtail stents. Migrated pancreatic straight stents can be removed with wire-guided balloon or basket and snare, while migrated single pigtail stents can be directly retrieved with biopsy forceps.