In the clinical practice,critically ill patients are in great risk of delirium because of the impact of psychological,surroundings,illness,and medications,with the incidence rate as high as 45％-87％.Delirium could result in bad prognosis and clinical consequences of cognitive function in late stage.Dexmedetomidine (DEX) is a novel and highly selective 2-adrenoceptor agonist.It offers beneficial pharmacological properties and has been widely used in intensive care unit (ICU).In order to provide scientific and effective references for clinical practice,this paper reviewed the development of DEX intervention for the prevention of delirium in ICU both in China and abroad refereed to the pharmacological characteristics and the efficiency in clinic and the influence factors ofthe efficiency;and also discussed the possible mechanisms,such as modulating the neurotransmitters,and attenuating stress response and inflammation.

Objective To investigate the relativity for weight of macrosomia predicted by ultrasound and clinical measurements . Methods 1 037 subjects who were delivered in May to November 2012 ,in Chongqing Health Center for Women and Children ,were collected and analyzed satistically .The parameters for the comparisons included maternal abdominal circumference (MAC) ,fundal height(FH) ,and fetal diameters measured by ultrasonic imaging such as biparietal diameter (BPD) ,head circumference(HC) ,femur length(FL) ,and abdominal circumference(AC) .The coincidence was calculated with real weights and compared with clinical predic-tions .Results When FH+ MAC 134 cm ,the accuracy of preliminary screening for macrosomia is the highest ,the area under the ROC curve is 0 .895 .Combining with the abdominal circumference(AC) by prenatal ultrasound ,the highest prediction rate of mac-rosomia is 75 .2% .when Fetal AC≥37 cm ,macrosomia incidence rate took 91 .7% .Conclusion Pregnant women with FH+MAC<134 cm ,whose incidence of Macrosomia is low .While if the FH+MAC≥134 cm ,combining with the prenatal ultrasound whose fetal AC>36 cm ,especially ≥37 cm ,the possibility of macrosomia is very high .

SUMMARY Regenerationofbonetissue,aswellasothertissues,requiresinvolvementandinteraction of cells,scaffolds and relevant growth factors,among which growth factors play a crucial role in maintai-ning the stability of microenvironment.Nel-like-type 1 molecule (NELL-1 ),a novel growth factor in tis-sue engineering,has been studied intensively in recent years.Researches mainly covered gene and pro-tein structure and their expression profiling,biological function,molecular mechanisms and disease rele-vance.NELL-1 expressed in embryonic tissue is essential for growth and development of bone tissue. NELL-1 presents excellent abilities of inducing bone and cartilage regeneration,especially with high spe-cificity to chondrocyte lineage.Compared with classic osteogenic growth factor bone morphogenetic pro-tein 2 (BMP-2),the process of osteogenesis interacted with NELL-1 exhibits stronger specificity,higher bone density and fewerside effects.Furthermore,a recent study shows synergistic effects of NELL-1 and BMP-2.NELL-1 enhances the osteogenic reaction induced by BMP-2 of cells and notably declines in-flammation response caused by BMP-2.This review evaluates the current research progress of the function and application of NELL-1 by the systematic method of evidence-based medicine.

BACKGROUND:Industrialization of new-born bovine serum and abundant resource of bovine lendon enable industrialization of medical collagen sponge.OBJECTIVE:To prepare collagen sponge with new-born bovine tendons by inoculating Veto cells,primary embryo skin cell of Tianzhu White Yak and lamb testicle cell of Minxian black fur sheep of the tissue scaffold of collagen sponge.and observe the biocompatibility of collagen sponge with three different cells.DESIGN,TIME AND SETTING:Repetitive measurement was performed at the Key Laboratory of State Nationalities Afrairs Committee,College of Life Sciences and Engineering,Northwest University for Nationalities from February to May 2006.MATERIALS:Tendons of new-born bovine within 24 hours were digested by glacial acetic acid and pepsinum firstly and then salting-out,dialysis and vacum freeze drying were performed to prepare collagen sponge.f2 passage of embryo skin cells of Tianzhu Whit Yak and f2 passage of lamb testicle cells of Minxian black fur sheep were prepared by out laboratory;Vero cells were provided by Union Medical University.METHODS:In a 6-hole plate,the Vero cell,embryo skin cells of Tianzhu White Yak and lamb testicle cells of Minxian Black Fur Sheep were inoculated into the collagen sponge pretreated by ultraviolet and sterilized by ozone.and incubated in 5%CO2 at 37℃.In addition,cells only inoculated ia a culture plate served as control. MAIN OUTCOME MEASURES:Inverted phase contrast microscope was used to observe cell growth condition in the collagen sponge and 6-hole plate at 5,12,24 and 72 hours.In addition,Coomassie brilliant blue as well as HE staining were conducted at 11 days after culture to identify the culture.RESULTS:Five hours after inoculation,cell adherence and expansion was observed at the bottom of culture plate.and some of the cells showed division.On the surface of collagen sponge.a round cell arrangement was observed.After inoculation of 48-72 hours,monolayer was found at the bottom of the plate.On the 11th day of culture.Coomassie brilliant blue and HE staining of three kinds of cells showed there were lager amount of cells well grew in the holes of collagen sponge,and the collagen sponge turned to be eminent,transparent and tenacious.CONCLUSION:The collagen sponge made from new-born bovine tendons exhibit good biocompatibility with three kinds of cells from different animals and tissues,and can be served as culture seaffoId of skin cells,tenal ceils.and testicle cells.

OBJECTIVE:To establish the HPLC characteristic chromatogram of pheretima,and compare the differences of the main ingredient contents of Guangdong pheretima and Shanghai pheretima and the chromatogram differences among pheretima and 3 other animal drugs. METHODS:Pheretima HPLC characteristic chromatogram method was adopted to determine the characteris-tic chromatograms of 16 Guangdong pheretima,8 Shanghai pheretima,3 eupolyphaga,3 hirudo and 3 catharsius. Similarity evalua-tion and t test were used to analyze the differences of chromatogram data of 5 animal drugs. RESULTS:The established HPLC char-acteristic chromatogram method firstly identified 11 common characteristic peaks,including 6 nucleosides,4 nucleobase and 1 ami-no acid;and it could be used for the identification of pheretima from eupolyphaga,hirudo and catharsius;the differences of main ingredient contents in the characteristic chromatogram of Guangdong pheretima and Shanghai pheretima were firstly studied. The contents of xanthine and adenosine in Guangdong pheretima were higher than Shanghai pheretima,while the contents of uridine, guanosine and 2′-deoxy guanosine in Shanghai pheretima were higher than Guangdong pheretima. A new index S,calculated by these 5 constituents,was successfully applied to distinguish the 2 kinds of pheretima. CONCLUSIONS:The characteristic chro-matogram can be used for the identification of pheretima,and can provide reference for the pharmacodynamic differences study of Guangdong pheretima and Shanghai pheretima.

Objective To observe the role of α7 nicotinic acetylcholine receptor (α7nAChR) in the protection against delirium by the use of dexmedetomidine (DEX) in endotoxin derived delirium and its mechanism. Methods 100 male adult C57BL/6 mice were randomly divided into normal saline control group (NS group), DEX control group, lipopolysaccharide (LPS) induced endotoxemia model group (LPS group), DEX protection group (DEX+LPS group), and α-bungarotoxin antagonism group (α-BGT+DEX+LPS group), with 20 mice in each group. A model of endotoxemia was reproduced by intraperitoneal injection of LPS 20 mg/kg, and the mice in NS group and DEX control group were given equivalent sterile normal saline. The mice in DEX control group, DEX+LPS group, and α-BGT+DEX+LPS group were intraperitoneally injected with DEX 40 μg/kg 15 minutes before LPS injection. The mice in α-BGT+DEX+LPS group were intraperitoneally injected with α7nAChR inhibitor α-BGT 1 μg/kg 15 minutes before DEX injection. The mice in NS group were given equivalent sterile normal saline. Ten mice in each group were assigned for open field test before and 24 hours after model reproduction, and the mice were then sacrificed to obtain the specimens. The levels of tumor necrosis factor-α (TNF-α) and neuron-specific enolase (NSE) in serum were determined by enzyme-linked immune sorbent assay (ELISA). Western Blot method was used to determine the expression of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in hippocampus. Another 10 mice were subjected to new object recognition test to observe the total exploration time during training period and preference index at 3 hours and 24 hours after LPS challenge. Results There were no significant differences in all parameters between NS group and DEX control group. ① It was shown by the open field test results that there were no significant differences in all parameters of open field test before model reproduction among all the groups. Twenty-four hours after model reproduction, when compared with NS group, the mice in LPS group showed that they had the ability of cognition of new environment, but learning and memory abilities were lowered, and tension was increased. DEX could significantly attenuate the degree of delirium, however, the protection of DEX from the delirious syndrome was antagonized partly by α-BGT. ② The new object recognition test results showed that compared with NS group, the ability of exploring new object was decreased in LPS group. DEX could significantly improve the exploration ability. However, DEX failed to control the delirious syndrome in α-BGT+DEX+LPS group. ③ The results of ELISA showed that the levels of TNF-α and NSE in serum were significantly increased in LPS groups as compared with that in NS group, and the levels of TNF-α and NSE were significantly decreased in DEX+LPS group. However, α-BGT could antagonise the protective effect of DEX [TNF-α (ng/L) in NS, LPS, DEX+LPS and α-BGT+DEX+LPS groups was 23.72±3.13, 808.78±87.86, 192.96±31.47, 829.99±80.98, respectively, and NSE (μg/L) was 8.70±0.74, 25.90±3.03, 18.10±2.14, and 23.12±2.21, respectively, all P < 0.01]. ④ The results of Western Blot showed that compared with NS group, the protein expression of ChAT in LPS group was significantly declined, and the protein expression of AChE was significantly increased. DEX could reverse the expressions of ChAT and AChT, however, α-BGT could reverse the protective effect of DEX [ChAT (gray value) in NS, LPS, DEX+LPS and α-BGT+DEX+LPS groups was 1.536±0.150, 0.381±0.138, 0.914±0.173, 0.628±0.088, respectively, and AChE (gray value) was 0.382±0.201, 1.843±0.325, 0.898±0.155, and 1.470±0.220, respectively, P < 0.05 or P<0.01]. Conclusions Delirium syndrome may occur in mice with endotoxemia. DEX could attenuate endotoxemia-associated delirium syndrome through transforming central neurotransmitter, and its mechanism maybe related with α7nAChR.

Objective To explore the clinical and neuroimaging features of a frontotemporal dementia with parkinsonism linked to chromosome 17 ( FTDP-17 ) pedigree caused by mutation of microtubule-associated protein tau ( MAPT) gene.Methods The proband and one patient from a FTDP-17 pedigree were assessed through standardized clinical evaluation , neuropsychology assessment , video-electroencephalogrom ,MRI, genetic sequencing , as well as 18 F fludeoxyglucose ( FDG) SPECT for brain metabolism and 11 C 2β-carbomethoxy-3β-( 4-fluoro ) tropane ( CFT ) PET for dopamine transporter ( DAT ) distribution, respectively.Results A FTDP pedigree with 15 patients (6 still alive) was recruited to this study.The proband and one affected patient were genotyped and confirmed as MAPT c .1788T>G mutation. Parkinsonism was the first symptom for both two patients . Personality, speech changes and dementia accompanied with brain atrophy were developed at the later stage in one patient .The 18 F FDG SPECT studies illustrated asymmetric hypometabolism of the temporal , frontal lobes and basal ganglia in two patients . Regarding to the 11 C CFT PET, one affected patient showed asymmetric decreased uptake of tracer in basal ganglia regions.Conclusions FTDP-17 can display a confusingly broad clinical phenotype , with the parkinsonism as the first symptom . Brain glucose metabolism and DAT distribution could be potential biomarkers in early diagnosis of FTDP-17.

Objective :The study discussed the relationship between the cell differentiation and its func-tion differentiation of enamel organ durrng the development of enamel ,explained the meaning of shape andfunction of SA and RA in the mature enameloblasts. Methods:The rats were fixed with pouring hearts ,em-bed with Epon and GMA resin,made semi-thin slice ,stained with toluidine blue and histochemistry, thenwe observed the changes of histomorphology and the law of distribution of enamel. Results:The develop-memt of tooth germ of rat incisor could be divided into proliferation stage, difference stage and maturestage. Enameloblasts expressed special periodic changes in mature stage :SA legion and RA legion present-ed altermately. Histochemical study indicated that most of amelogenin stayed in enamel matrix and othersdiffused to dentin, dental tube and odontoblast layer. Conclusion: (1) The proliferation stage, differencestage and mature stage of tooth of development of enamel organ in rat were similar to the bud stage ,capstage and bell stage of human being. There was a relationship between the RA legion in mature enam-eloblast and mineral substance pouring into them. RA legion was presented because water and protein lost.)That amelogenin spread into dentin could promote the odontoblast differentiation and induce dentin calci-fication.

ObjectiveTo investigate the effect and gender differences of experimental moderate pain on attentional bias towards pain-related words.MethodsWith the tourniquet around the left upper limb,32 healthy college students were asked to perform two dot-probe tasks including five kinds of pain-related words,one task with the tourniquet deflating and the other task with the tourniquet inflating to 200 mm Hg pressure.The reaction time (RT) and the error rate of recognition task were recorded.The pain intensity and distress were recorded too.Results ( 1 ) Compared with no pain condition ( RT of affective and social-threat words were (507 ± 78 ) ms,(504 ±89 )ms respectively),the react time was shorter in female in the condition of tourniquet pain,particularly for affective and social-threat words (the RT were (464 ± 79 )ms,(465 ± 72 )ms respectively,F ( 1,4) =19.157,P ＜0.01 ),but not in male.( 2 ) In condition of no pain,the reaction time of male ( (456 ± 59) ms ) was shorter than that of female (504 ± 79ms).However,in the condition of pain,the significant main effect was not found.ConclusionThe reacting time of female was shorter in condition of moderate tourniquet pain,which imply that female showed significant attentional bias towards affective and social-threat words.

Community nurses are the main forces of community heaLth service, whose skiLL LeveLs directLy affects the performance of traditionaL Chinese medicine (TCM) nursing. This articLe reviews the research reLated to TCM nursing training in community nurses and proposes countermeasures accordingLy in order to provide a reference for TCM nursing training in community nurses.