Objective To identify the risk factors for early postoperative cognitive dysfunction (POCD) in the elderly patients undergoing spinal surgery.Methods One hundred and fifty ASA Ⅱ or Ⅲ patients,aged ≥65 yr,undergoing elective spinal surgery under general anesthesia,were studied.Venous blood samples were taken at 1 day before operation and 7 days after operation to determine the concentration of serum S-100B protein.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation and 7 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The patients were divided into POCD group and non-POCD group.Age,body weight,sex,education,type of operations,complications,preoperative TCM syndrome type,MMSE score at 1 day before operation and 7 days after operation,duration of operation,emergence time,and intraoperative blood loss,cardiovascular events,and amount of fluid infused per hour were recorded.The risk factors for POCD were analyzed using multivariate logistic regression analysis.Results Thirty-eight patients developed early POCD (25.3％).The resuhs of logistic regression analysis showed that age ≥ 70 yr,elementary education or below,duration of operation ≥5 b,and the number of hypotension occurred during operation≥3 were the risk factors for early POCD.Conclusion Age≥70 yr,elementary education or below,duration of operation ≥ 5 h,and the number of hypotension occurred during operation ≥ 3 are the risk factors for early POCD in the elderly patients undergoing spinal surgery.

Objective To confirm whether community management of hypertension could improve blood pressure control in Chongqing.Methods Cluster sampling method was used to select 5283 adults from 20 community healthcare centers in Chongqing.Matched t test was used to analyze the changes of blood pressure before and after the intervention.x2 test analysis was performed to compare the rate of normal blood pressure.Results The average age of 5283 participants was (60.5 ± 11.0) years old.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly decreased after intervention (total population:t values were 16.98 and 13.80,respectively; male:t values were 12.58 and 10.66,respectively; female:t values were 11.60 and 9.10,respectively; all P ＜ 0.05).The most significant decrease in SBP was found in 50-59 y age group (t =15.29,P ＜0.05),followed by 40-49 y age group (t =9.22,P ＜0.05).The control rate of hypertension was increased by 5.3％ after 1 year's intervention (x2 =134.5,P＜0.05),except for 60-69 y age group and ≥70 y age group (x2 values were 2.5 and 1.7,respectively ; both P ＞ 0.05).Conclusion Our results show that standardized management of hypertension in communities can decrease the level of blood pressure and increase the control rate of hypertension.

Objective To explore cost of standard operation procedure of primary public healthcare services.Methods Standard operation procedure of primary public healthcare services was put forward according to national basic public healthcare service standards (2011 edition) in 2012.Random sampling method was used to choose participants from two community sanitary service centers,two township heahhcare centers and one maternity and child heahhcare hospital.Service standard operation procedure was used to measure human cost and supportive cost of public healthcare services.Results Management of 10 thousand patients who had different diseases needed various numbers of medical staff (MS),such as health profile needed 3.4 MS,hypertension management needed 10.8 MS,diabetes management needed 10.6 MS,elderly people care needed 9.2 MS,child care needed 4.6 MS,maternal care needed 24.3 MS,psychosis management needed 13.3 MS,and planned immunity for children needed 4.6 MS.Besides,the people whole covered service projects need 2.4 MS per 100 thousand people.The research showed that managing 1 sample of different kind people needed different human cost,such as health profile needed 22.67 yuan,hypertension management needed 72.69 yuan,planned immunity for children needed 30.68 yuan,diabetes management needed 71.34 yuan,old people management needed 61.50 yuan,child care needed 30.88 yuan,maternal care needed 157.15 yuan,psychosis management needed 74.25 yuan.Besides,the people whole covered service projects needed 124.9 thousand yuan per 100 thousand people.Conclusion For primary public healthcare service project,it should be critical to modify manning regulation and labor costs.

Objective To explore the value of B-type natriuretic peptide (BNP) predicting cardiac events after noncardiac surgery in the aged patients. Methods The level of BNP， the score of Goldman analysis and the cardiac risk grade of ACC/AHA guideline were analyzed in 274 aged patients for cardiac outcome after noncardiac surgery. Results Preoperative BNP concentration>100 pg/ml，score of Goldman≥13，and the high or moderate risk grade by ACC/AHA guideline were related with cardiac events. There was no significant difference in the index such as sensitivity，specificity, accuracy，positive predictive value and negative predictive value for cardiac events between BNP level and cardiac risk grade. Compared with the score of Goldman, BNP was more sensitive （100% vs 55.6%）and negatively predictive （100% vs 96.3%） for cardiac events. Conclusion The risk of cardiac events after noncardiac surgery could be predicted with the level of BNP before operation in the aged patient.

OBJECTIVETo investigate the prognosis-related factors and treatment strategy of primary parotid squamous cell carcinoma.

METHODSForty-nine primary parotid squamous cell carcinoma treated from 1970 to 2005 were retrospectively analyzed. The follow up data were analyzed by SPSS 13.0 software.

RESULTSIntegrated follow up data were obtained from 44 patients with a median follow up time of 38 months (5 - 215 months). Recurrence or distant metastasis of the carcinoma occurred in 21 patients, including 13 local recurrence in parotid or neck and 8 distant metastasis. Local recurrence was the main reason of treatment failure. The 3-year and 5-year survival rate and disease-free survival rate was 52%, 27% and 34%, 16%. Kaplan-Meier and log-rank analysis indicated that age, tumor size, distant metastasis, postoperative radiotherapy, facial nerve dysfunction, neck dissection, skin invasion, and surgical margins were prognosis-related factors. Cox analysis showed that age, facial nerve dysfunction, distant metastasis and surgical margins were the important factors that influenced the prognosis.

CONCLUSIONSPrimary parotid gland squamous cell carcinoma is an uncommon tumor, surgery and postoperative radiotherapy are the optimal treatment, which can improve the prognosis of the patients and decrease recurrence of the tumor.

Aged ; Carcinoma, Squamous Cell ; pathology ; secondary ; therapy ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Neck Dissection ; Neoplasm Recurrence, Local ; Parotid Gland ; Parotid Neoplasms ; pathology ; therapy ; Prognosis ; Rare Diseases ; pathology ; therapy ; Retrospective Studies ; Survival Rate ; Treatment Failure ; Tumor Burden

Adult ; Dermatologic Surgical Procedures ; Drainage ; methods ; Humans ; Male ; Osteomyelitis ; therapy ; Skin ; injuries ; Thigh ; surgery

OBJECTIVESTo explore the roles of CD14 and TLR4 in severe hepatitis B induced by endotoxin.

METHODSThe levels of mCD14 on PBMCs from 30 cases of severe hepatitis B, 20 cases of chronic hepatitis B and 20 cases of healthy controls were detected by flow cytometry. The expressions of CD14 mRNA and TLR4 mRNA in PBMCs from these patients were also detected by RT-PCR. Meanwhile, the concentration of plasma endotoxin was detected by limulus amebocyte lysate test and the levels of TNF alpha, IL-1, IL-6 in serum were detected by ELISA.

RESULTSThe levels of mCD14 on PBMCs in severe hepatitis B, chronic hepatitis B and control were 74.2+/-12.3, 63.6+/-11.8 and 60.3+/-7.2 respectively. There was a significant difference among severe hepatitis B,chronic hepatitis B and healthy controls (both of P less than 0.01). The expressions of CD14 mRNA and TLR4 mRNA (2.92+/-0.67 and 1.86+/-0.45) were also upregulated, compared with that in chronic hepatitis B patients (1.34+/-0.51, 0.93+/-0.18) and healthy group (0.92+/-0.58, 0.73+/-0.16) (P less than 0.01). Similarly, the concentration of plasma endotoxin was much higher in severe hepatitis B (1.87+/-1.61) than that in chronic hepatitis B patients (0.11+/-0.11) and that in healthy group (0.03+/-0.03) (P less than 0.01). As a result, the inflammation cytokines, such as TNF alpha, IL-1 and IL-6 (19.78+/-9.21, 0.96+/-0.16, 68.34+/-48.30) also increased significantly in severe hepatitis B, which were remarkably higher than those in chronic hepatitis B patients (7.26+/-6.52, 0.19+/-0.02 and 19.28+/-4.65) and healthy group (4.15+/-4.06, 0.15+/-0.01 and 12.01+/-3.88) (P less than 0.01). Furthermore, correlation analysis showed there was positive correlation among the level of mCD14, the expression of CD14 mRNA/TLR4 mRNA, the concentration of endotoxin and the levels of inflammation cytokines in severe hepatitis B (r1 = 0.865, r2 = 0.415, r3 = 0.524, all of P less than 0.05).

CONCLUSIONEndotoxin is an important factor in the aggravation of hepatitis B. Meanwhile, mCD14, CD14 mRNA and TLR4 mRNA are remarkably upregulated during the endotoxin stimulation. The inflammation cytokines (TNF alpha, IL-1 and IL-6) are also elevated, which may finally result in the aggravation of the hepatitis B. Therefore, CD14, TLR4 and inflammation cytokines play important roles in pathogenesis of severe hepatitis B induced by endotoxin.

Adult ; Case-Control Studies ; Endotoxins ; Female ; Hepatitis B, Chronic ; etiology ; metabolism ; Humans ; Interleukin-1 ; metabolism ; Interleukin-6 ; metabolism ; Lipopolysaccharide Receptors ; metabolism ; Male ; Middle Aged ; Toll-Like Receptor 4 ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism ; Young Adult

0.05.Conclusions The UF effectively removed BUN in sheep with low flow VV-ECMO.The application of UF didn't cause blood shunt in ECMO.The low flow VV-ECMO effectively eliminated carbon dioxide and rerformed oxygenation.

Objective To explore the self-face recognition and its relationship to empathy in patients with schizophrenia.Methods Sixty-two schizophrenic patients and fifty -four healthy subjects were assessed with the self-face recognition task (SFRT) and the interpersonal reactivity index-C (IRI-C).Results The SFRT reaction time in the patients group( (2188 ± 1138) ms) was significantly longer than that in the control group( ( 1152 ± 326) ms) (P ＜ 0.01 ) ;the accuracy in the patients group ( (80 ± 16) ％ ) was significantly lower than that in the control group ( (88 ± 6) ％ ) (P ＜ 0.01 ).The IRI-C total scores,the subscores in perspective taking,the subscores in fantasy and empathic concern of IRI-C were significantly lower in the patients group(respectively(44.82 ± 10.50),(8.98 ± 3.56),( 11.87 ± 4.38 ),( 14.73 ± 4.00) ) than those in the control group ( respectively (49.85 ± 10.28),( 10.78 ± 3.86),( 14.98 ± 6.12),( 17.39 ± 4.56) ) ; the subscore in personal distress of IRI-C in the patients group(9.37 ± 5.12) was significantly higher than those in the control group(6.52 ± 3.89) ( P＜ 0.01 ).There was significant positive correlation between the accuracy for self-face recognition in SFRT and the subscore in fantasy of IRI-C ( r =0.322,P ＜ 0.05 ),the reaction time of SFRT had significantly positive correlation with the subscore in personal distress.Conclusion Schizophren patients have general impairments of self-face recognition and empathic abilities,and the self-face recognition is related to the empathic abilities.

OBJECTIVESTo investigate the clinical effect of sequential therapeutic intervention Yupei Qisun [compensating for weakness by invigorating Kidney (Shen) and Spleen (Pi) in advance] in Chinese medicine (CM) and hysteroscopic endometrial mechanical stimulation on the treatment of infertile patients with repeated implantation failure (RIF); and to study the differences in patients' endometrial thickness and type on the day of embryo transfer, serum hormone levels on embryo transfer day and clinical pregnancy outcomes.

METHODSIn the clinical study, 168 frozen-thawed embryo transfer (FET) cycles for couples with RIF conforming to the research protocol were randomly divided into three groups: a CM group with 56 cycles (CM combined with FET), a hysteroscopy group with 55 cycles (hysteroscopic endometrial mechanical stimulation), and a control group with 57 cycles (conventional FET). Differences in endometrial thickness on the embryo transfer day, levels of serum estradiol (E2) and progesterone (P) on the embryo transfer day, the E2/P ratio on the embryo transfer day, biochemical and clinical pregnancy rates, implantation rate, abnormal pregnancy rate and other indices were compared among the three groups.

RESULTSEndometrial thickness, E2 and P levels, and the E2/P ratio on embryo transfer day and other factors had no significant differences among groups. The biochemical pregnancy, clinical pregnancy, and implantation rates of the CM and hysteroscopy groups were significantly higher than the control group (P<0.05), and there were no significant differences between these two groups. The abnormal pregnancy rate had no significant difference among the three groups.

CONCLUSIONSSequential therapy of Yupei Qisun could significantly improve the clinical outcomes of rif-fet cycles, being equivalent to hysteroscopic endometrial mechanical stimulation, and provided a reliable method to treat such infertile couples.

Abortion, Habitual ; therapy ; Adult ; Embryo Implantation ; Embryo Loss ; therapy ; Embryo Transfer ; Endometrium ; pathology ; physiopathology ; Female ; Humans ; Hysteroscopy ; Infertility, Female ; pathology ; therapy ; Medicine, Chinese Traditional ; methods ; Physical Stimulation ; methods ; Pregnancy ; Retreatment ; statistics & numerical data