Objective To examine the association between caregiver burden and comorbidity in elderly patients with cognitive impairment.Methods The study was conducted in 212 patients at the Memory Clinic and the Departments of Geriatrics and Neurology of Fuxing Hospital from September 2014 to September 2016.Recruited patients were assigned into a dementia group and a non-dementia group according to their cognitive status and were examined using mini mental state examination (MMSE),auditory verbal learning test (AVLT),activity of daily living (ADL),neuropsychiatric inventory(NPI),and Charlson comorbidity index(CCI).Their caregivers were surveyed with Zarit burden inventory (ZBI).Results The ZBI score was significantly correlated with patients' age,gender,CCI,MMSE,NPI,and ADL.The ZBI score was higher in male patients(21.21 ± 11.24)than in female patients(18.33±10.38).Age(r=0.10,P＜0.001),NPI(r=0.32,P＜0.001),ADL(r=0.29,P ＜0.001),and CCI(r =0.38,P ＜0.001) were positively correlated with caregiver burden,while MMSE(r =-0.28,P ＜ 0.001) was negatively correlated with it.Multiple linear regression model analysis indicated that MMSE,NPI,ADL,and CCI were influencing factors for caregiver burden.When CCI was stratified into CCIno dementia and CCIdementi8,influencing factors for caregiver burden were identified as MMSE,NPI,ADL,and CCIdementia.Conclusions Cognitive deterioration,decrease in ADL,and neuropsychiatric symptoms in elderly patients are the major causes of increased caregiver burden.Besides,the number and severity of comorbidity are independent factors for caregiver burden.

Objective Investigation of the significance for applying the percentage of neutrophils, neutrophil to lymphocyte ratio combined with contrast enhanced ultrasonography in the diagnose of coronary artery disease through examining the percentage of neutrophils, neutrophil to lymphocyte ratio on peripheral blood. Methods 130 patients with acute coronary syndrome (ACS group) , 90 patients with stable angina (SAP group) and 50 nonCAD patients (control group were observed. The neutrophils counts of all the patients were detected and Neut％, NLR were calculated; all the patients were asked to examine enhanced carotid contrast echocardiography. The plaque enhancement (DE) , and luminal enhancement ratio (Ratio) were recorded. The differences in neut％, NLR and CEUS were compared among the three groups. The Pearson correlation analysis was used to analyze the correlation between Ratio and Neut％, NLR. Multivariate logistic regression analysis was used to evaluate the predictive value of Neut％, NLR and CEUS for ACS. Results (1) The value of Neut％, NLR of the peripheral blood, DE, and Ratio in both ACS group and SAP group were higher than those in control group, and the value of ACS group was higher than that in SAP group (P < 0.05 or P < 0.01); (2) The analysis of Linear correlation showed that the ratio of CEUS in ACS patients was positively correlated with Neut％ (r = 0.422, P = 0.001) and NLR (r = 0.407, P = 0.001). (3) The ROC results showed that circulating Neut％, NLR and DE, Ratio play a significant role in the diagnose of unstable plague in CAD patients; (4) Multivariate logistic regression analysis showed that Neut％, NLR, DE, Ratio were independent indicators of the ACS patients (P< 0.05 or P < 0.01).Conclusions Contrast enhanced carotid examination combined with leukocyte analysis on peripheral blood were useful to detect plaque instability and inflammatory response in CAD patients, and it also provide lots of objective evidence for predicting and intervening unstable plaque in CAD patients.

Objective To investigate the predicting value of Notch1 levels expressed in peripheral blood mononuclear cell (PBMC) for coronary artery calcification.Methods 300 consecutive patients with coronary artery disease (CAD) who hospitalizing in the department of cardiology in Guangzhou first people's hospital from January 2016 to June 2017 were enrolled.All Patients received 320-slice multi-detector row computed tomography scanning and coronary artery calcium sore(CCS)were measured.Patients were divided into three groups:control group (CCS =0),Low CCS group (CCS ＜97.6) and high CCS group (CCS ≥97.6) according to the mean value of CCS (CCS =97.6).Notch1 expressed in PBMC,serum interlekin-6 (IL-6) and high sensitivity C reactive protein (hs-CRP)of patients were examined and compared among three groups.Results The levels of Notch1 in PBMC and serum IL-6,hs-CRP of patients in high CCS group were significant higher than the other two groups [Notch1:7.02 ± 0.86 vs 6.32 ± 0.78 vs 5.49 ± 0.71;IL-6:(133.66 ± 10.18) μg/L vs (127.49 ± 10.79) μg/L vs (111.62 ± 9.87) μg/L;hs-CRP:(3.98 ± 1.02) mg/L vs (3.11 ±0.95)mg/L vs (2.56 ±0.76)mg/L] (P ＜0.05).The Spearman correlation analysis showed that the levels of Notch1 in PBMC were positive correlated with the levels of serum IL-6 and hs-CRP in enrolled patients with coronary calcification (P ＜ 0.05).Multivariate logistic regression analysis showed that the levels of Notch1 in PBMC and serum IL-6 were two strong independent risk factors for severity of coronary calcification in patients with CAD (P ＜ 0.05).Conclusions Notch1 expression in PBMC of patients with CAD was valuable to predicate the severity of coronary calcification.That the Notch1 signal path regulating the inflammation conditions in patients may be one of the most important mechanisms in the formation and progress of coronary calcification.

Objective To investigate the knowledge and recognition of middle aged and elderly cognitive normal people in clock drawing test (CDT) and determine the items of CDT.Methods Two hundred and sixty four middle aged and elderly cognitive normal people from community were involved in the cross-sectional study.The questionnaire was comprised of 26 items scoring in CDT in literature.Each item was rated by subjects as complete agreement, partial agreement or disagreement.Pearson correlation analysis was used to analyze the related items of age and education degree.Results There were 5 items significantly related with age and education.Twelve items enjoyed complete agreement of more than 50％ and disagreement lower than 20％.The new scoring system was composed of 12 items, including the 12 complete agreement items excepted one which was significantly related to age and education, and one item that was proved to be sensitive to cognitive impairment.Conclusion The new scoring system with 12 items for CDT may be suitable in screening cognitive impairment with high identity, and further investigation about the validity and reliability should be conducted.

【Objective】 To investigate the clinical application of self-developed magnetic anchoring device for assisting thoracoscopic pulmonary resection. 【Methods】 Eleven patients underwent thoracoscopic pulmonary assisted with resection magnetic anchoring technique at the Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, from March to May 2019. Their clinical data were retrospectively analyzed. The operation time, blood loss, blood transfusion volume, postoperative hospital stay, and postoperative complications were recorded. 【Results】 There were seven male and four female patients, with the average age of (51.6±13.9) years (range from 22 to 69 years). Three single-port and eight single-utility-port thoracoscopic surgeries were performed. Magnetic instruments provided good surgical field exposure in all operations. Among 11 surgeries, one was converted to thoracotomy and one to three-hole surgery due to enlargement and adhesion of hilar lymph nodes. The operation time was (107.8±63.1) minutes (range of 27-182 minutes). The blood loss was 50 (10-50)mL (range of 5-1 000 mL). No blood transfusion was needed during the operation. The postoperative hospital stay was (5.0±1.8) days (range of 3-9 days). No postoperative complications occurred in all the patients. 【Conclusion】 Magnetic anchor technique can effectively alleviate the "chopstick effect" in thoracoscopic surgery. Magnetic anchor technique is safe and feasible in assisting thoracoscopic pulmonary resection.