Objective To determine the risk factors for post-operative delirium(POD)and post-operative cognitive dysfunction(POCD)in patients undergoing spine surgery.Methods One hundred and twenty ASA Ⅰ-Ⅲ of both sexes aged 50-76 yr undergoing elective spine surgery under general anesthesia were studied.POD was assessed by Delirium Rating Scale revised 98 at 2 days after operation and the patients were assigned into POD and nonPOD group.Cognitive function was assessed by Mini-Mental State Examination(MMSE)at 1 day before and 3 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The palients were assigned into POCD and nonPOCD group.Executive function and depression were assessed by stroop interference test and Beck Depression Inventory(BDI)at 1 day before operation.Age,sex,education,alcohol consumption per week,a history of psychiatric disease,ASA physical status,Charlson comorbidity score,type of anesthesia,anticholinergic drug administration and VAS score at 1 day after operation were recorded.If there was signifirant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select risk factor for incidence of POD and POC).Results Eleven patients developed POD(9.2％)and 30 patients developed POCD(25.0％).Logistic regression model showed that lower Stroop-CW,higher BDI score,higher Charlson comorbidity score and a history of psychiatric disease were risk factors for POD,while lower Stroop-CW,higher BDI score,higher Charlson comorbidity score and higher alcohol consumption per week were risk factors for POCD.Conclusion Preoperative executive dysfunction,depression and greater preoperative comorbidity are risk factors for both POD and POCD.A history of psychiatric disease is a risk factor for POD and higher alcohol consumption is a risk factor for POCD in patients undergoing spine surgery.

Objective To investigate the effects of melatonin on choline acetyltransferase (ChAT) in rat hippocampus after isoflurane anesthesia. Methods Sixty male SD rats weighing 390 - 440 g were randomized into 5 groups (n = 12 each): control group (group C), 1% isoflurane group (group Ⅰ), 1% isoflurane + melatonin group (group IM) , 2% isoflurane group (group J) and 2% isoflurane + melatonin group (group JM) . In IM and JM groups, melatonin 10 mg/kg was administered intraperitoneally once a day for 7 consecutive days, while equal volume of normal saline was given intraperitoneally instead of melatonin in C, I and J groups. Groups Ⅰ and IM inhaled 1% isoflurane and groups J and JM 2% isoflurane for 4 h on 7th day. All the rats underwent Morris water maze test on the day after anesthesia for assessment of learning and memory ability (escape latency and probe time) . The training test was performed 4 times a day for S days. Six rats randomly selected from each group were sacrificed the end of the test. The blood samples were collected for detection of plasma melatonin level by ELISA.The brain tissues were removed for determination of the expression and activity of ChAT in hippocampus by Western blot or colorimetric assay. The left rats were selected and sacrificed for determination of the number of ChAT positive neurons in hippocampal CA1 region and entate gyrus by immunofluorescence. Results The plasma melatonin level and expression and activity of ChAT were significantly lower in group I than in group C ( P ＜ 0.01) . The escape latency was significantly longer, the probe time was significantly shorter, and the plasma melatonin level and expression and activity of ChAT were significantly lower in group J than in group C ( P ＜ 0.05 or 0.01) . The escape latency was significantly shorter, the probe time was significantly longer, and the plasma melatonin level and expression and activity of ChAT were significantly higher in group IM than in group Ⅰ ( P ＜ 0.05 or 0.01). The escape latency was significantly shorter and the plasma melatonin level and ChAT activity were significantly higher in group JM than in group J ( P ＜ 0.05 or 0.01) . The results of immunofluorescent staining showed that the number of ChAT positive neurons in hippocampal CA1 region and dentate gyrus wag consistent with the changes in the measured ChAT expression. Conclusion Melatonin can reduce isoflurane-mediated inhibition of ChAT expression and activity and thus improve spatial memory impaired by isoflurane anesthesia in rats.

Objective To estimate the association between the risk of high birth weight(HBW) and maternal environmental and behavioral factors exposure during pregnancy in rural areas. Methods Data were collected from the surveillance system of birth population and adverse pregnancy outcome in Pingding County, Shanxi Province during 2007 and 2012, where we followed up 204 controls with normal birth weight, 125 cases with HBW≥4 200 g and 171 cases with HBW 4 000-4 200 g. Case control study was performed to explore the potential risk factors of HBW. Results The total number of births was 18 749, including 1 177 cases of high birth weight, with an incidence rate of 6.28% between 2007 and 2012. Concerning the case control study on HBW<4 200 g, after adjusting parental reproductive age and parity, the risk of HBW was 3.10(95% CI：1.67-5.76)times higher among women with gestational weeks ≥42 than that of women with gestational weeks < 42. The risk of HBW in boys was 2.30(95% CI：1.46-3.63)times higher than that in girls. No significant association was observed between maternal BMI before pregnancy and the risk of HBW；Regarding the case control study on HBW≥4200 g, after adjusting maternal reproductive age and parity, the risk of HBW was 3.01(95% CI:1.49-6.08) times higher among women with gestational weeks≥42 than that of those with gestational weeks <42. The risk of HBW was 1.91(95% CI:1.15-3.16)times higher among women with pre-pregnancy BMI≥24 than that of those with pre-pregnancy BMI< 24. The risk of HBW was 2.59(95% CI:1.06-6.32)times higher in women who ate soybean products ≥4 times a week than that of those who ate soybean products less than once a week. Conclusion It would be of public health significance to reduce the risk of high birth weight, which can be reduced by managing pre-pregnancy BMI, diet during pregnancy and controlling gestational week.

Adolescent ; Adult ; Bleomycin ; therapeutic use ; Child ; Child, Preschool ; Female ; Hemangioma ; drug therapy ; Humans ; Laryngeal Neoplasms ; drug therapy ; Male ; Middle Aged ; Pharyngeal Neoplasms ; drug therapy ; Young Adult

BACKGROUNDWith economic growth and urbanization there have been significant changes in the life style and diet of urban residents in large cities of China, which is experiencing a rapid increase in the prevalence of diabetes. While high prevalence of diabetes has been reported, little is known of the long-term effects of diabetes in such a large population. The aim of this study was to estimate the morbidity rate of diabetic peripheral neuropathy (DPN) in a Chinese urban diabetic population with more than 10 years' disease duration, and evaluate the relevant risk factors. The clinical manifestation of DPN and pain status was also assessed.

METHODSFive hundred and sixty-five diabetes patients were recruited into the study. Symptoms and examination helped diagnose neuropathy. The clinical manifestation of DPN was assessed with a visual analog pain score (VAS). Diabetic complication status was determined from medical records. Serum lipids and lipoproteins, glycosylated hemoglobin (HbA1c), and the urinary albumin excretion rate were measured.

RESULTSThe morbidity rate of DPN was 46.6%. HbA1c, hyperlipidemia, and retinopathy were significantly associated with neuropathy, and these risk factors were correlated with other diabetic micro and/or macrovascular complications. The average VAS pain score of the DPN patients was 4.12 ± 2.07. Severe and moderate pain was experienced by 11.4% and 40.5% respectively of DPN patients. About 3.7% of diabetic subjects had lower limb ulcer or amputation.

CONCLUSIONSThe morbidity rate of DPN for diabetic patients with > 10 years duration is very high compared to the range reported for other populations in the world. The risk factors for DPN include HbA1c, hyperlipidemia, and retinopathy. In long-standing diabetic patients, DPN was not associated with diabetic duration, and half of the DPN patients experienced considerable daily suffering.

Aged ; China ; Diabetic Neuropathies ; epidemiology ; metabolism ; physiopathology ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hyperlipidemias ; epidemiology ; metabolism ; physiopathology ; Male ; Middle Aged ; Pain ; etiology ; Risk Factors ; Urban Population

OBJECTIVETo investigate the status of enterovirus (EV) infection in children with acute lower respiratory tract infection (ALRTI).

METHODSA total of 404 samples (with odd numbers) of nasopharyngeal aspirates were collected from the children who were hospitalized in the Children's Medical Center, Hunan Provincial People's Hospital due to ALRTI between September 2007 and April 2008. The conserved sequence in the 5'-noncoding region of EV was used to design the primer, and nested RT-PCR was performed to detect EV in the samples.

RESULTSOf the 404 samples, 19 (4.7%) were EV-positive, and mostly taken from children under 3 years of age (95%); there was no significant difference in the detection rate between male and female children. Of the EV-positive children, 13 (68%) were clinically diagnosed with bronchial pneumonia, and 6 (32%) with bronchiolitis; 90% of them showed symptoms of fever, 84% had a cough, 63% had asthma, and 63% had complications mainly including diarrhea (6 cases), granulocytopenia (4 cases), and acute respiratory distress syndrome (2 cases). In addition, 26% of the EV-positive children had leukocyte disorder, more than half had liver dysfunction, and a few had myocardial involvement.

CONCLUSIONSEV is a pathogen that should not be neglected in children with ALRTI. For these children, close attention should be paid to the epidemiological status and clinical features of EV infection, and blood routine examination, liver function test and myocardial enzyme assay should be carried out periodically to improve prognosis.

Acute Disease ; Child ; Child, Preschool ; Enterovirus Infections ; epidemiology ; Female ; Humans ; Infant ; Male ; Nasopharynx ; virology ; Respiratory Tract Infections ; virology

OBJECTIVE: To explore the clinical features and genetic basis for a patient with hereditary hypophosphatemic rickets with hypercalciuria(HHRH). METHODS: Clinical data of the patient was collected. The patient was subjected to whole exome capture and next generation sequencing (NGS). Suspected variants were verified by Sanger sequencing. RESULTS: The patient presented with hypophosphatemic rickets, short stature, hypercalciuria, and renal stones. NGS showed that he has carried compound heterozygous variants of the SLC34A3 gene, namely c.532_533delCA(p.Q178Vfs*6) and c.894_925+69del(splicing). His parents were asymptomatic heterozygous carriers of one of the variants. Based on ACMG guidelines, both variants were classified as pathogenic. CONCLUSION The compound heterozygous variants c.532_533delCA (p.Q178Vfs*6) and c.894_925+69del(splicing) of the SLC34A3 gene probably underlie the disease in this child. Above finding has enriched the variant spectrum for HHRH. Based on the results, prenatal diagnosis may be provided for the family.

BACKGROUNDIt is well recognized that meteorological factors have important infuences on the onset and development of many kinds of diseases. The present study was undertaken to investigate the effects of the meteorological elements on admission rates of cerebral infarction patients with hypertensive nephropathy at Changchun city, Jilin Province, northeast China.

METHODSA total of 763 medical records of inpatients from nine hospitals at Changchun city, during a period from April 6 to April 17 in 2010, were reviewed. These patients were admitted to hospitals due to the occurrence of cerebral infarction. The hypertensive nephropathy was evidenced with certain diagnosis of essential hypertension and hypertension-related kidney injuries. The cerebral infarction was diagnosed according to the World Health Organization (Stroke) standard. All the meteorological data were from practical monitoring records in Jilin Province Meteorological Observatory. The relationships between the epidemiological prevalence of cerebral infarction and meteorological variables were analyzed using the time series models of statistics.

RESULTSCompared with admission rates before the violent change in meteorological status (April 6 to April 17, 2010), the number of admission patients suffering from cerebral infarction remarkably peaked on April 12. Such an increase was highly correlated with heavy precipitation, elevation of daily average relative humidity, and reduction of average daily air temperature. With the betterment of the meteorological conditions on April 17, the admission rates of cerebral infarction patients dropped to the same level as the dates before snowing (April 6 to April 11).

CONCLUSIONSThe meteorological changes are highly associated with the occurrence of cerebral infarction in patients with hypertensive renal injury in northeast China. This study also suggested that an intensive medical interference for those patients with hypertension-induced organ injuries is very necessary in preventing the occurrence of cerebral infarction with hypertensive nephropathy when there is a violent change in meteorological condition.

Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; China ; Female ; Hospitalization ; statistics & numerical data ; Humans ; Hypertension, Renal ; Male ; Meteorological Concepts ; Middle Aged ; Nephritis ; Patient Admission ; statistics & numerical data

Objective: To explore the mechanism of herbal cake-partitioned moxibustion in Crohn disease (CD) treatment by observing the effect of herbal cake-partitioned moxibustion on protein expressions of colonic M2 macrophage marker CD206, AMP-activated protein kinase (AMPK) and tuberous sclerosis complex (TSC) 2. Methods: Twenty-six specific pathogen free male rats were randomly divided into a normal group, a model group and a herbal cake-partitioned moxibustion group. The CD model was prepared by enema with the mixture of 5％ (W/V) 2,4,6- trinitrobenzene sulfonic acid (TNBS) and 50％ ethanol at 2:1 (volume ratio). After the model was successfully prepared, rats in the herbal cake-partitioned moxibustion group received herbal cake-partitioned moxibustion at Qihai (CV 6) and bilateral Tianshu (ST 25). Hematoxylin-eosin (HE) staining was used to observe the histopathological changes of rat colon; immunohistochemical technique was used to detect the expression of colonic CD206 protein; Western blot, immunofluorescence, and real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) technologies were used to detect the protein and mRNA expressions of colonic AMPK and TSC2. Results: Compared with the normal group, rats in the model group showed damaged colonic mucosa, missing of the epithelial layer, thickened submucosa, vascular proliferation, massive infiltration of monocytes and lymphocytes, and cracked ulcers that reached the muscle layer. Rats in the herbal cake-partitioned moxibustion group showed reduced intestinal inflammation and healing intestinal epithelium ulcers. Compared with the normal group, rat colonic CD206 protein expression, and the protein and mRNA expressions of colonic AMPK and TSC2 were decreased in the model group (all P<0.01); compared with the model group, rat colonic CD206 protein expression was increased (P<0.01), as well as the protein and mRNA expressions of AMPK and TSC2 in the herbal cake-partitioned moxibustion (all P<0.05). Conclusion: Herbal cake-partitioned moxibustion can reduce intestinal inflammation in CD rats, increase colonic CD206 protein expression, and up-regulate the protein and mRNA expressions of colonic AMPK and TSC2.

OBJECTIVEIn order to understand the epidemiological and virologic characteristics of coronavirus HKU1 infection in hospitalized children with acute respiratory tract infection (ARTI) in Changsha.

METHODS1165 nasopharyngeal aspirates (NPA) specimens were collected from hospitalized children with ARTI between September 2007 and August 2008 in Changsha. Specimens were screened for pol gene of coronavirus HKU1 by polymerase chain reaction. All positive amplification products were confirmed by sequencing and compared with those in GenBank.

RESULTSCoronavirus HKU1 were detected in 12 patients (1.03%) out of the 1165 children. The patients were from 8 days to 3 years. The most common clinical diagnosis was bronchopneumonia(83.33%). Similarity of coronavirus HKU1 with those published in the GenBank at nucleotide levels was 98.18% - 100%.

CONCLUSIONCoronavirus HKU1 may be important pathogens in children with acute lower respiratory tract infection. Coronavirus HKU1 infections are common in children under 3 years old. There is no significant difference in the infectious rate between the boys and the girls. The peak of its prevalence is in spring and winter. A single genetic lineage of Coronavirus HKU1 was revealed in human subjects in Changsha.

Acute Disease ; Child, Hospitalized ; Child, Preschool ; China ; Coronavirus ; classification ; genetics ; isolation & purification ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Phylogeny ; Polymerase Chain Reaction ; Respiratory Tract Infections ; virology