Objective To investigate the correlation between acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation (MV).Methods A retrospective study was conducted. Eighty-nine senile severe pneumonia patients undergoing invasive MV admitted to intensive care unit (ICU) of Hunan Provincial People's Hospital from January 2015 to March 2017 were enrolled. APACHE Ⅱ scores were collected 24 hours before invasive MV. Consciousness assessment method-ICU (CAM-ICU) was used to diagnose delirium, and the patients were divided into delirium group and non-delirium group. The first delirium occurrence time, duration of MV and the length of ICU stay were recorded. The patients were divided into ≤15, 16-20, 21-25, 26-30, 31-35, 36-40 groups according to APACHEⅡ score, and the incidence of delirium in all groups were observed. The linear regression and Pearson correlation were used to analyze the correlation between APACHE Ⅱ scores and delirium probability. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive effect of APACHEⅡ score on delirium.Results Eighty-nine patients were enrolled in the final analysis, of which 35 had delirium, and 54 had no delirium, with delirium incidence of 39.33%, and the first delirium occurrence time of (1.85±1.30) days. The duration of MV and the length of ICU stay of delirium group were significantly higher than those of non-delirium group [duration of MV (days): 9.43±4.77 vs. 6.08±3.30, length of ICU stay (days): 14.60±6.59 vs. 9.69±4.61, bothP < 0.01]. The APACHE Ⅱ score in delirium group was significantly higher than that in non-delirium group (29.89±5.45 vs. 21.48±4.76,P < 0.01). With the increase in APACHE Ⅱ scores, the delirium incidence was gradually increased. Correlation analysis showed that there was a negative correlation between APACHE Ⅱ scores and first delirium occurrence time (r = -0.411,P = 0.014), and a significant linear positive correlation between APACHE Ⅱ scores and delirium incidence in all patients was found (r = 0.982, P = 0.000), which indicated the higher APACHE Ⅱ scores, the higher delirium incidences and the earlier first delirium occurrence time was. ROC curve analysis showed that the area under ROC curve (AUC) of APACHE Ⅱ scores on predicting delirium occurrence was 0.877, when the cut-off value of APACHE Ⅱ score was over 27, the sensitivity was 92.59%, the specificity was 71.43%, the positive predictive value was 83.33%, and the negative predictive value was 86.21%.Conclusions With the increase in APACHE Ⅱ score, the incidence of delirium was increased gradually in senile severe pneumonia patients receiving invasive MV. APACHE Ⅱ score played an important clinical value in evaluating the delirium probability of these patients

Eleven patients with small or comminuted displaced tibial avulsion fractures of posterior cruciate ligament admitted in the Department of Orthopaedics,Second Affiliated Hospital,Fujian Medical University between January 2003 and January 2008 were selected.With diameter of 4.0 mm,the length of 35 mm or 40 mm cancellous bone screw,and internal diameter of 4.0 mm spiked washer was implanted for fixation.For cases of large comminuted facture,two cancellous bone screws and spiked washer were used.Postoperatively,the limb was immobilizated in a cast plaster at a 30 degrees flexion for 2-4 weeks,followed by active exercise rehabilitation.All 11 patients were followed up with an average of 18 months(ranged 7 to 36 months).No electrolysis,corrosion reaction to metal material,or allergic response to the spiked washer were detected in patients.At 2 months,all patients achieved bony union,no fragment redisplacement,no knee laxity or instability was detected,and the affected knees regained full range of motion.The knee function was significantly improved.

Objective To investigate the protective effect of RLN revealed for RLN in high -risk thyroid surgery,and the clinical value of detecting nerve,thus to provide a reference for clinical treatment.Methods 132 patients of thyroid high -risk surgery were selected,according to whether to explode recurrent laryngeal nerve,they were divided into exposed group (80 cases)and non -exploded group(52 cases).The recurrent laryngeal nerve damage rate,clinical indicators of operation time were compared between the two groups.In the explode group,80 patients according to whether implementation of the nerve monitoring,were divided into the monitored group (36 cases)and non -monitored group(44 cases).The hours to find the nerve,recurrent laryngeal nerve injury rates and other indicators were compared.Results The operative time of the exploded group was (133.66 ±21.48)min,which was significantly longer than the non -exploded group,difference was statistically significant (t =3.994,P =0.025 ).The exposed group had similar incidence of hypocalcemia compared with the other groups,there was no statistically significant difference (P >0.05).The revealing recurrent laryngeal nerve injury rate of the exposed group was 2.50%,which was significantly lower than the non -exploded group,difference was statistically significant (χ2 =5.794,P =0.008).The recurrent laryngeal nerve positioning time of the monitoring group was (4.78 ±0.94)min,which was significantly shorter than the unmonitored group,difference was statistically significant (t =7.168,P =0.001).The recurrent laryngeal nerve injury rate of the monitoring group was 2.78%,showed no significant difference (χ2 =0.911,P =0.338).Conclusion In a high risk thyroid surgery,explode recurrent laryngeal nerve can reduce the rate of recurrent laryngeal nerve damage,nerve monitoring can effectively speed up the nerve localization time,but has no significant effect on reduce the rate of recurrent laryngeal nerve injury.

Objective: To investigate the effect of aqueous extract of Radix et Rhizome Rhodiolae on expressions of HIF-1?, HIF-1? and VEGF in human umbilical vein endothelial cells(HUVECs) exposed to hypoxia. Methods: The effect of different treatment time and concentrations of aqueous extract of Radix et Rhizome Rhodiolae on cellular proliferation were determined with XTT colorimetric assay. The mRNA and protein expressions of HIF-1?, HIF-1? and VEGF were analyzed respectively by quantitative real-time polymerase chain reaction with SYBR Green I and Western blot. Three groups were studied: normoxia control group, hypoxia control group, Radix et Rhizome Rhodiolae treatment group. Results: The optimal condition of Radix et Rhizome Rhodiolae treatment were 24h and 10?g/mL. The protein levels of HIF-1?, HIF-1? and VEGF were elevated by hypoxia (P

Evoked potentials can reflect the integrity of spinal sensory and motor conduction pathway.Evoked potential exami-nation not only provides relatively objective index for patients with spinal cord injury in preoperative diagnosis,intraoperative monitoring and prognosis judging,but also plays an irreplaceable role in evaluating animal models for spinal cord injury.This pa-per systematically reviews evoked potential in the clinical exami-nation of spinal cord injury and its application in evaluating ani-mal models.

Objective:To observe the effect of electroacupuncture at Baihui and Dazhui on cognitive function of vascular dementia rats and explore its possible mechanism. Methods:Male Sprague-Dawley rats were randomly divided into the sham operation group, model group and electroacupuncture group, with 10 rats in each group. Rats in the model group and the electroacupuncture group were made as vascular dementia models by carotid artery ligation of the two sides. After 2 weeks of modeling, the electroacupuncture group received electroacupuncture at Baihui and Dazhui for 4 weeks. Before and after the intervention, take the novel object recognition behavior test to detect the 1, 24 h new object preference coefficient; and use magnetic resonance spectroscopy to scan the levels of NAA/Cr and Cho/Cr neurometabolites in the hippocampus. q-PCR was used to detect the expression of caspase-3 and Bax in apoptotic cells. Immunohistochemistry was used to detect synapsin SYN expression. Results:Compared with the model group, the preference coefficient of new object of the electroacupuncture group at 1 h [(69.85 ± 11.26)% vs. (50.26 ± 8.85)%] and 24 h [(60.85 ± 11.86)% vs. (43.26 ± 10.25)%] significantly decreased ( P<0.01). The content of NAA/Cr (1.344 ± 0.149 vs. 0.892 ± 0.178) significantly increased ( P<0.01), and the content of Cho/Cr (0.661 ± 0.142 vs. 0.902 ± 0.178) in the hippocampus significantly decreased ( P<0.01). The expression of hippocampus caspase-3 (1.342 ± 0.041 vs. 2.437 ± 0.089), Bax (2.135 ± 0.083 vs. 4.358 ± 0.137) significantly decreased ( P<0.01), and the expression of SYN (0.577 ± 0.035 vs. 0.315 ± 0.025) significantly increased ( P<0.01). Conclusion:Electroacupuncture at Baihui and Dazhui can effectively improve the cognitive dysfunction of rats with vascular dementia, which may be related to the improvement of neuronal metabolites NAA, Cho content and inhibition of neuronal apoptosis and improvement of neuronal touch function.

The authors of this paper confirm the goal, factors and principles in arrangement of clinical practice, design a transplacement algorithm to solve the model, and after estimating the capacity to interns of affiliated hospital, make the schedule by that algorithm so as to relieve the relative short supply of good clinical education resourses.

Objective To summarize the clinical features of the pancreaticopleural fistula (PPF) in children in order to improve the understanding of PPF and to make early diagnosis and treatment of the disease.Methods Five cases of pediatric PPF in Beijing Children's Hospital Affiliated to Capital Medical University from December 2007 to March 2014 were studied by retrospective analysis.The clinical features, laboratory results, image characteristics, treatment and prognosis were reviewed.Results Five cases of PPF were diagnosed aged between 2 years to 10 years and 5 months old, history from more than 1 month to 6 months.The main symptoms were chest tightness (3 cases), chest pain (3 cases) , fever(3 cases) , wheeze (1 case) , dyspnea (1 case).Only 1 case was with abdominal pain and abdominal distension when he was admitted to hospital.All patients had massive pleural effusions, included right side (3 cases),left side(1 case) ,bilateral sides(1 case), 1 case complicated with massive ascites.Pleural fluid amylase of all the cases was significantly elevated (＞ 1 000 U/L) ,the highest was more than 50 000 U/L.Four cases had positive findings of pancreas by transabdominal ultrasound.Five cases had morphological changes in pancreas by magnetic resonance cholangiopancreatography (MRCP).Four cases had PPF and pancreatic pseudocysts respectively.Conservative treatment was given to 5 cases, but further 3 cases reveived stent insertion by endoscopic retrograde cholangiopanereatography, and 2 cases reveived surgical therapy.Conclusions PPF is rare in children, the main clinical feature is massive pleural effusion with respiratory symptoms.Pleural fluid amylase would be significantly elevated.The diagnosis of PPF generally relies on imaging, MRCP is considered the imaging study of choice for PPF due to its superiority in identifying a fistula in the pancreatic region and its noninvasiveness as compared to endoscopic retrograde cholangio pancreatography.Endoscopic and surgical therapy can be used if internal therapy is not satisfactory.

BACKGROUND:StageIorIIKummel’s diseaseisusualy suggested to be treated with percutaneous vertebroplasty (PVP) orpercutaneous kyphoplasty (PKP). Stage IIIKummel’s diseasewith neurologic deficit is treated with open decompression, cement-augmented combined with internalfixation. However, surgical options for stage IIIKummel’s diseasewithdural saccompression butwithnonervous symptoms arein disputeand rarely reported. OBJECTIVE:To investigatethesurgical options of Kummel’s disease with vertebral posterior walcolapse. METHODS:Fourteen patients with Kummel’s disease with vertebral posterior wal colapse wereenroled as experimental groupandtreated with PVP or PKP based on the degree of postural reduction.Another28 patients with osteoporotic vertebral fracture as control group were treated with PKP. Thenalpatients were folowed up to observe vertebralheight, Cobb angle, visual analog scale and the Oswestry disability index. RESULTS AND CONCLUSION:After folowed up for 10 to 42 months, therestoredvertebralheight, Cobb angle, visual analog scale and Oswestry disability index were significantly improved inthetwo groups (P<0.05). Thepostoperativevertebralheight intheexperimental group was significantly higher than thatinthe control group(P< 0.05).Butno significant differencesin Cobb angle, visual analog scalescoresand Oswestry disability indexwere found between thetwo groups after operation (P> 0.05). These data suggest that based on the degree of postural reduction, individualizedPVP or PKP for Kummel’s disease with vertebral posterior wal colapsecanattain satisfactoryoutcomes.

Objective To investigate the correlation of incident pneumonia and serum 25-hydroxyvitamin D[25(OH)D] levels in elderly patients with fragility hip fractures.Methods 132 patients with fragility hip fractures were divided into the pneumonia group [n=43,14 males and 29 females,aged 63-97 years,a mean age of (83.8±7.1) years] and the non-pneumonia group [n=89,28 males and 61 females,aged 60-93 years,a mean age of (77.1±8.1) years].Fasting venous blood samples were taken on the second day after admission.Serum 25 (OH)D levels were measured by radioimmunoassay.Results Vitamin D deficiency was found in 90.7％ of the patients in the pneumonia group,52.8％ in the non-pneumonia group (x2=24.953,P＜0.05).The age and smoking rate were higher in the pneumonia group than in the non-pneumonia group (t=4.661,P＜ 0.05;x2 =4.459,P=0.035).Logistic regression analysis showed that serum 25(OH)D levels,age and smoking were independent impact factors for pneumonia.When serum 25(OH)D levels were less than or equal to 20 g/L,the incidence of pneumonia was increased and the risk of pneumonia was 8.66 times higher than that for patients with normal 25 (OH)D levels.Conclusions The risk of pneumonia in patients with brittle hip fractures is correlated with age,smoking and the serum 25-hydroxyvitamin D level,with the latter as a major risk factor.Patients with brittle hip fractures should be supplemented with vitamin D as early as possible in order to reduce the risk of incident of pneumonia.