ObjectiveTo investigate the influence of the midazolam sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients in intensive care unit (ICU).Methods A single-center prospective randomized controlled trial was conducted. 140 consecutive critically ill patients admitted to ICU of Peking University People's Hospital, undergoing mechanical ventilation longer than 24 hours, with the need of sedation, from February 2014 to January 2015 were enrolled. They were randomly divided into two groups by computer generated random numbers table, eachn = 70. The patients in observation group received midazolam 1μg·kg-1·min-1 for sedation, and 1 mg/mL remifentanil for analgesia with 0.05 mg/kg intravenous bolus, then continuous infusion of 0.02-0.10 mg·kg-1·h-1. The patients in control group received midazolam for sedation only. The data were recorded as follows: the main indices for observation included the occurrence of delirium and its duration; the second item for observation was consumption of drug for sedation, followed by the mean arterial pressure (MAP) before and after sedation, the time of wake-up, duration of mechanical ventilation, the length of ICU stay, and 28-day fatality rate. The 28-day survival was analyzed by Kaplan-Meier survival curve.Results The dosage of remifentanil used in observation group was (98.6±24.9) mg/d, the dosage of midazolam was significantly lower than that of the control group (mg/d: 160.6±33.3 vs. 178.9±43.4, t = 2.829,P = 0.005), the incidence of delirium was obviously lower than that of the control group [22.9% (16/70) vs. 57.1% (40/70),χ2 = 15.700,P< 0.001], and the time of delirium was slightly shorter than that of the control group (hours: 162.9±78.0 vs. 194.8±117.3,t = 0.947,P = 0.348). Among the patients with delirium, the dosage of dexmedetomidine used in observation group was significantly less than that of the control group (mg/d: 0.54±0.11 vs. 0.64±0.14,t = 2.112,P = 0.041). The MAP before sedation was similar as the MAP after sedation in both groups, and there was no significant difference between observation group and control group [mmHg (1 mmHg = 0.133 kPa), before treatment: 84.7±16.2 vs. 89.5±37.7, after treatment: 82.3±10.7 vs. 80.8±13.9, bothP> 0.05]. There was no significant difference in the time of waking-up between observation group and control group (hours: 2.3±0.9 vs. 2.4±0.8,t = 0.487,P = 0.627). The duration of mechanical ventilation (hours: 143.4±138.3 vs. 163.9±158.9, t = 0.812,P = 0.418), the length of ICU stay (days: 8.8±7.7 vs. 10.0±7.8,t = 0.917,P = 0.361) and 28-day fatality rate [11.4% (8/70) vs. 20.0% (14/70),χ2 = 1.941,P = 0.245] in observation group were slightly lower than those of the control group without significant difference. Kaplan-Meier survival curve showed that the cumulative 28-day survival rate in observation group was slightly higher than that of control group (χ2 = 1.647,P = 0.199). ConclusionAnalgesia based on sedation may reduce the occurrence of delirium and its severity, furthermore, even if delirium occurs, it may be less severe.

Objective To evaluate the effects of aerobic combined strength and balance exercise on cognitive function and satisfaction in patients with cognitive impairment no dementia. Methods Four hundred and twenty patients with cognitive impairment no dementia were divided into control group (200 cases) and experimental group (220 cases) by random digits table method. The control group received general health education and rehabilitation training. The experimental group received aerobic combined strength and balance exercise. The patients were assessed with Montreal Cognitive Assessment (MoCA) to evaluate their cognition before training, as well as after training. And the patients′satisfaction with the questionnaire was evaluated. Results The total scores of MoCA, scores of name, attention, language, memory and directionafter training were (23.47 ±2.38), (2.77 ±0.42), (5.09 ±0.86), (2.50 ±0.65), (3.42 ±0.68), (5.03 ± 0.10) points in the experimental group, and (21.20±2.55), (2.31±0.76), (4.71±1.10), (2.35±0.70), (2.23±0.81), (4.48±0.96) points in the control group, and there were significant differences, P<0.05. There were no significant differences in the space and abstract thinking between experimental group and control group:(3.61±0.91) points vs. (3.45±1.09) points, (1.83±0.76 ) points vs. (1.72±0.52) points, P>0.05. The scores of satisfaction in the experimental group was significantly higher than that in the control group:(49.33 ±1.57) points vs. ( 48.20 ±2.14) points, P<0.01. Conclusion The application of aerobic combined strength and balance exercise could improve the cognitive function and patients′satisfaction.

Objective To test the reliability and validity of the Chinese version of Quality-of-Life Questionnaire for Mechanically Ventilated Patients (QOL-MV). Methods The English version of QOL-MV was revised and translated into Chinese version. The reliability and validity of the Chinese version of QOL-MV was tested in 120 mechanically ventilated patients. Results The Cronbachαcoefficient of the Chinese QOL-MV was 0.904. The item-level content validity index of Chinese QOL-MV were 0.86-1.00 and the scale-level content validity index of Chinese QOL-MV was 0.92. Two factors were extracted by factor analysis and the cumulated variance was 80.18%. The dimensional factor loading of each item was greater than 0.565. The correlation coefficient between the score of Chinese QOL-MV and the Euroqol Group′s 5-domain 3 Level Questionnaire (EQ-5D) and Richards Campbell Sleep Questionnaire (RCSQ) was 0.947 and 0.561 respectively (P<0.01). Conclusions The Chinese version of QOL-MV has been proved to be reliable and valid.It can be used to measure the quality-of-life for mechanically ventilated patients.

Head ; pathology ; Head and Neck Neoplasms ; diagnosis ; Humans ; Neck ; pathology ; Sarcoma, Alveolar Soft Part ; diagnosis

OBJECTIVE:To establish a method for the content determination of total flavonoids in Morus alba. METHODS:UV-visible spectrophometry was performed with Al(NO2)3-NaNO2-NaOH color-test at the wavelength of 510 nm with the reference of rutin. RESULTS:The linear range of rutin was 0.031 2-0.156 mg/ml(r=0.999 9);RSDs of precision,stability and reproduc-ibility tests were lower than 2%;recovery was 95.7%-101.0%(RSD=2.1%,n=6). CONCLUSIONS:The method is simple,sta-ble and reproducible,and can be used for the content determination of total flavonoids in M. alba.

Objective To observe the factors affecting inadequate ST-segment resolution in patients with acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention (PCI). Methods The patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI were enrolled for study. According to the ratio of ST-segment resolution, 186 cases were divided into inadequate ST-segment resolution group (54 cases) and relatively adequate ST-segment resolution (132 cases). Clinical data of two groups were compared. The single factor and multiple Logistic regression analysis were performed to determine the factors influencing inadequate ST-segment resolution. Results Pre-infarction angina was protective factor of inadequate ST-segment resolution after emergency PCI (OR=0.361, 95%CI 0.131-0.994, P<0.05). Anterior myocardial infarction, attack-to-balloon time, Killip classification and white blood cell counts were risk factors of inadequate ST-segment resolution (OR=2.389, 95%CI 1.194-4.781;OR=1.655, 95% CI 1.082-2.532; OR=1.319, 95% CI 1.026-1.695; OR=1.184, 95% CI 1.004-1.396, P<0.05). Conclusions Patients with pre-infarction angina could reduce the risk of inadequate ST-segment resolution after PCI. Patients with anterior myocardial infarction,long attack-to-balloon time, Killip classification≥2 and high blood cell counts could increase the risk of inadequate ST-segment resolution, and earlier and more active clinical intervention should be taken.

Objective To clone human autoimmune antigen SSA/Ro60 and to purify its expression to provide the material basis for the assisted diagnosis of human autoimmune diseases .Methods The SSA/Ro60 gene was cloned by RT‐PCR and directionally inserted into expression vector pPICZ .The recombinant plasmid was transformed into Pichia SMD1168 .The obtained recombinant protein was identified by SDS‐PAGE and Western blotting .Results The amplified full‐length sequence was about 1 .5 kb in size . The pPICZ‐SSA positive clone produced a 60 × 103 recombinant protein which had natural immunogenicity of human autoimmune antigen SSA/Ro60 by SDS‐PAGE and Western blot .Conclusion Human autoimmune antigen SSA/Ro60 is successfully cloned and expressed ,which lays a foundation for diagnosing autoimmune diseases .

Objective To assess whether FICE or IC is more effective at detecting colonic diseases.Method We searched PubMed, CINAHL, CQVIP and the Cochrane Library databases for relevant papers published between January 2008 and August 2013 using the following keywords: lfexible spectral imaging color enhancement, indigo carmine, colonoscope, colonic lesions, colon tumor and chromoendoscopy. We included eight articles, and all data were subdivided for analysis.Results We used odds ratios (OR^s) with 95 % conifdence intervals (CIs) to assess correlations between the detection methods and detection rates. The detection rates did not signiifcantly differ between FICE and IC for colonic tumor lesions (OR^ = 0.90, 95 % CI: 0.76~1.08,P = 0.255), non-tumor lesions (OR^ = 1.09, 95 % CI: 0.92~1.30,P = 0.302), adenomas (OR^ = 0.87, 95 % CI: 0.72~1.07,P = 0.188), non-neoplastic polyps (OR^ = 0.84, 95 % CI: 0.67~1.06,P = 0.146), lfat lesions (OR^ = 0.87, 95 % CI: 0.71~1.08,P = 0.203), protruded lesions (OR^= 1.23, 95 % CI: 0.93 ~ 1.64,P = 0.153), right colon lesions (OR^ = 0.83, 95 % CI: 0.60 ~ 1.14,P =0.251), transverse colon lesions (OR^ = 0.71, 95 % CI: 0.48~1.05,P = 0.086), or left colon lesions (OR^ = 1.35, 95 % CI: 1.01 ~ 1.80,P = 0.045).Conclusions There were no signiifcant differences in the rate of colonic lesion detection between FICE and IC except the left colon. Therefore, providers should choose a suitable inspection method based on the resources of the hospital.

Cholesteatoma ; diagnosis ; pathology ; Humans ; Petrous Bone ; pathology

Objective To explore the dose-effect,time-effect and safety of alteplase in the treatment of acute cerebral infarction.Methods One hundred and ten patients with acute cerebral infarction were selected,among whom 50 patients whose time window ≤3.0 h were divided into group A and group B by random digits table method with 25 cases each,and 60 patients whose time window 3.1-4.5 h were divided into group C and group D by random digits table method with 30 cases each.The patients in group A and group C received alteplase 0.6 mg/kg (maximum dose 60 mg) intravenous thrombolysis;the patients in group B and group D received alteplase 0.9 mg/kg (maximum dose 90 mg) intravenous thrombolysis.The national institutes of health stroke scale (NIHSS) scores before treatment and 1 h,24 h,7 d,30 d and 90 d after treatment were observed in the 4 groups.The therapeutic effect,complication incidence and fatality rate were compared.The prognosis was estimated by modified Rankin scale (mRS) score 90 d after treatment.Results The NIHSS scores 1 h,24 h,7 d,30 d and 90 d after treatment were significantly lower than those before treatment in the 4 groups,and there were statistical differences (P ＜ 0.05).The NIHSS score decreased significantly with time.There were no statistical differences in NIHSS score between group A and group B,group C and group D.There were no statistical differences in complication incidence and fatality rate 90 d aftcr treatment in group A and group D compared with group B and group C (P＞ 0.05).The rate of eusemia in group A was 76.00％ (19/25),in group B was 64.00％ (16/25),in group C was 43.33％ (13/30),and in group D was 53.33％ (16/30).And there were no statistical differences between group A and group B (x2 =0.620,P ＞0.05),and between group C and group D (x2 =0.069,P＞ 0.05).Conclusions The low dose alteplase is also effective and safe to acute cerebral infarction patients at time window ≤ 3 h.It is also effective and safe to acute cerebral infarction patients at time window 3.0-4.5 h at standard dose.