Capacity assessment is of significant priority for medical treatment and clinical research invol-ving mental disorder patients,as to protect an individual's fundamental rights.Clinical judgment of individual's ca-pacity to consent most focus on medical situation,well-designed capacity assessment instruments should be used to support experienced clinical judgment.Capacity to consent can be adequately captured by measuring the constructs of understanding,appreciation,reasoning and communicating /expressing a choice.A large number of instruments designed by foreign developers to assess capacity to consent need validation and implementation in China,the in-strument designed by Chinese researchers has not been widely agreed.Establishing an effective capacity assessment instrument with psychometric properties (validity and reliability),which considering the clinical practice and culture background in china would be a breakthrough in methodology.

A digital system for bioimpedance and electrical impedance tomography (EIT) measurement controlled by an ATmega16 microcontroller was constructed in our laboratory. There are eight digital electrodes using AD5933 to measure the impedance of the targets, and the data is transmitted to the computer wirelessly through nRF24L01. The structure of the system, circuit design, system testing, vitro measurements of animals' tissues and electrical impedance tomography are introduced specifically in this paper. The experimental results showed that the system relative error was 0.42%, and the signal noise ratio was 76.3 dB. The system not only can be used to measure the impedance by any two electrodes within the frequency of 1-100 kHz in a sweep scanning, but also can reconstruct the images of EIT. The animal experiments showed that the data was valid and plots were fitting with Cole-Cole theory. The testing verified the feasibility and effectiveness of the system. The images reconstructed of a salt-water tank are satisfactory and match with the actual distribution of the tank. The system improves the effectiveness of the front-end measuring signal and the stability of the system greatly.
Animals ; Electric Impedance ; Electrodes ; Tomography ; methods

Objective To compare the scores of amplitude-integrated electroencephalogram (aEEG) tracings between preterm infants who were smaller for gestational age (SGA) and those who were appropriate for gestation (AGA).Methods A total of 139 preterm infants were collected in the Neonatal Intensive Care Unit of the Affiliated Hospital of Guangdong Medical College during the period of Mar.2013 to Feb.2014.One hundred and fourteen patients met the inclusion criteria with gestational ages from 32 to 36 weeks at birth,including 54 SGA infants and 60 AGA infants.The aEEG recordings were obtained within 72 h after birth by using the NicoletOne monitor.Duration of each recording was at least 3 h.Five aspects of each tracing,such as continuity (Co),sleep-wake cycling (Cy),amplitude of the lower border (LB),bandwidth (B) and total maturation scores,were evaluated and compared between 2 groups by applying a aEEG scoring system.Results 1.As SGA infants,scores for Co,Cy,LB,B as well as total maturation scores were progressively increased with gestational age advancing(all P ＜ 0.05).As AGA infants,scores for Cy,B and total maturation scores progressively increased with advancing gestational age (all P ＜ 0.05),but there were no statistical differences between each gestational ages in Co,LB scores (all P ＞ 0.05).2.Linear regression analysis of SGA infants' gestational age to Co,Cy,LB,B and total maturation scores showed positively correlation,and the correlation coefficients were 0.438,0.597,0.385,0.606 and 0.608,respectively (all P ＜ 0.05).As AGA infants,a positive correlation between gestational age and Cy,B as well as total maturation scores were observed,and the correlation coefficients were 0.528,0.615 and 0.635,respectively (all P ＜ 0.05).3.At the same gestational age,both the B scores and total maturation scores in SGA group were lower than those in AGA group.Conclusions SGA and AGA,Co,Cy and total maturation scores can be used to evaluate the maturation of cerebral function.At the same gestational age,the scores of B and total maturation scores are lower in the SGA,and this might be associated with their delayed neuromotor development.

Objective To investigate the analgesic effects of parecoxib sodium combined with patient controlled epidural analgesia (PCEA) after orthopedic subarachnoid block anesthesia surgery.Methods Two hundred patients undergone orthopedic subarachnoid block anesthesia surgery were randomly and equally divided into two groups:Group P (treated intravenously with 40 mg parecoxib sodium combined with PCEA at the end of operation) and Group C ( treated intravenously with 0.5 g tramadol combined with PCEA at the end of operation).The visual analog scale (VAS) was performed at 6,12,24,48 and 72 hours postoperatively in two groups.Meanwhile,the press frequency of analgesic pump,effective frequency,side effects and satisfaction degree were recorded. Results The VAS sore of Group P was lower than that of Group C at 6,12,24,48 and 72 hours postoperatively ( P ＜ 0.05 ).Group P showed a less number in aspects of the press frequency of analgesic pump,effective frequency,and side effects at 12 and 24 hours,but a higher satisfactory degree,compared with Group C (P ＜0.05). Conclusion Combined use of parecoxib sodium and PCEA can exert a better analgesic effect and have a low incidence rate of side effects following orthopedic subarachnoid block anesthesia.

Objective To study the clinical characteristics of neonatal Serratia marcescens sepsis.Method A retrospective review of perinatal factors,clinical manifestations,laboratory findings,treatment and prognosis of Serratia marcescens sepsis in our unit from January 2012 to November 2017.Result A total of 21 cases of serratia marcescens sepsis were identified (diagnosed),all except one were prematurely born.Infection occurred on different days after birth,2 within 3 days,1 within 3 ～ 7 days and 9 in the second week,and the remainder,after 14 days.The clinical manifestations of neonatal Serratia marcescens sepsis were uncharacteristic,mainly manifested as gray pallor,lethargy,and recurrent apnea.Some infants had complications such as pulmonary hemorrhage,septic shock,necrotizing enterocolitis and scleroderma.Most infants had low white blood cell count,thrombocytopenia and high C-reactive protein at the onset of illness.All Serratia marcescens cases were sensitive to piperacillin/tazobactam,ceftazidime and meropenen.In total,17 cases had lumbar puncture,5 of them diagnosed with meningitis,with elevation of cerebrospinal fluid white blood cell count and protein,and 3 infants complicated with brain abscess.The duration of antibiotic therapy were 14 days or more depending on the clinical conditions.The overall mortality was 14.3％.Conclusion Serratia marcescens is an important opportunistic pathogen.It might cause serious infections in the premature infants including sepsis,brain abscess and meningitis.Regular neuro-imagings might be necessary for all sepsis infants.The infected and colonized neonates might be the hidden source of Serratia marcescens.The surveillance protocols,eradication of colonization,and strict adherence to hand disinfection/washing might help to prevent dissemination of invasive bacteria among premature infants.

ObjectiveTo observe the effects of inspiration, expiration, and the contraction of muscle groups outside the pelvis combined on Kegel exercise for contraction of pelvic floor muscles. MethodsFrom October, 2021 to February, 2022, 20 healthy female were invited to perform simple Kegel exercise, and Kegel exercise as inspiration or expiration, and/or with contraction of muscle group outside the pelvis (transverse abdominal muscle, hip adductors and hip extortors), while the maximum distance of bladder bottom up was measured with ultrasonography. ResultsCompared with traditional Kegel exercise, the maximum distance of bladder bottom up was more as expiration, as well as with contraction of transverse abdominal muscle (P < 0.05). ConclusionKegel exercise as expiration or with transverse abdominal muscle contraction is more effective on pelvic floor muscle training.

AIM: To compare the results calculated by population pharmacokinetic analysis tools Phoenix NLME, Monolix, R nlmixr package and CPhaMAS cloud platform with the gold standard sofeware NONMEM. METHODS: Fifty sparse sampling data sets based on a one-compartment model and fifty dense sampling data sets based on a two-compartment model were simulated, and the above five analysis tools were used to calculate the population typical value, individual variability and individual pharmacokinetic parameters. RESULTS: The population typical value and individual variability calculated by CPhaMAS and Phoenix NLME had the highest matching degree with NONMEM, followed by nlmixr. Monolix had the lowest matching degree, but Monolix and nlmixr might be more robust. The correspondence between clearance and distribution volume was better than the absorption rate constant. Except the absorption rate constant calculated by Monolix and intercompartmental clearance calculated by nlmixr, the correlation coefficients of individual pharmacokinetic parameters calculated by all analytical tools were greater than 0.99. CONCLUSION: The results calculated by the above four population pharmacokinetic analysis tools are highly correlated with that of NONMEM.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.