Objective:To investigate the relationship among happiness, resilience, optimistic intelligence quotient and perceived social support in patients with advanced gynecological cancer.Methods:A total of 269 patients with advanced gynecological cancer from January 2018 to January 2019 in three top three hospitals in Shanghai were selected as subjects by convenient sampling.The basic information questionnaire, Memorial University of New-foundland scale of happiness, Connor-Davidson Resilience Scale simplified Chinese version, Optimistic Intelligence Quotient Questionnaire and Perceived Social Support Scale were used to investigate.Results:The score of happiness was (32.45±6.37), the score of resilience was (30.64±8.78),the score of optimistic intelligence quotient was (62.74±12.49) and the score of perceived social support was (68.14±4.25) in patients with advanced gynecological cancer. Linear regression equation analysis showed that happiness and optimistic intelligence quotient × happiness had significant predictive effect on resilience ( β values were 0.547, 0.016, P < 0.05), optimistic intelligence quotient had no significant predictive effect on resilience ( P>0.05), and optimistic intelligence quotient, happiness, resilience, optimistic intelligence quotient×happiness had significant predictive effect on perceived social support ( β values were 0.015-0.251, P<0.01). Happiness could regulate the direct path and the first half of the mediating effect of resilience between perceived social support and optimistic intelligence quotient. According to Johnson-Neyman's analysis, the boundary value of the moderating effect of happiness between optimistic intelligence quotient and resilience was 26.19, and the boundary value of the moderating effect of happiness between optimistic intelligence quotient and perceived social support was 22.08. Conclusions:There is a positive correlation between optimistic intelligence quotient and perceived social support in patients with advanced gynecological cancer. Resilience can play a significant mediating role between optimistic intelligence quotient and perceived social support under the regulation of happiness, which can provide corresponding psychological intervention for patients with advanced gynecological cancer.

Objective The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients.Methods According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU). Then these patients were observed by domestic multifunctional detector for electroencephalographic (EEG) variables such as brain lateralization, brain introvert, brain activity, brain energy consumption, focus inward, focus outward, cerebral inhibition, fatigue, sleep severity, sedation index, pain index, anxiety index, fidgety index, stress index and the cerebral blood flow (CBF) index which was named of perfusion index. Other variables including indexes of ICU blood gas analysis, which was consisted of variables of blood gas analysis, routine blood test and biochemistry, previous history and prognostic outcome was recorded. Binary logistic regression was used for multivariate analysis.Results Forty-three postoperative patients, who needed intensive care, were included. Eighteen were in delirium group and twenty-five in control group. Excluding the trauma, variables like gender, age, temperature, heart rate, respiratory rate, mean arterial pressure, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, organ failure, dementia and emergency surgery didn't show any statistical significance between two groups. The trauma in delirious patients increased obviously compared with the control group (33.3% vs. 4.0%,P = 0.031). Except for the brain activity [122.47 (88.62, 154.21) vs. 89.40 (86.27, 115.97),P = 0.034], there were no statistical differences in any other EEG and CBF variables. In ICU blood gas analysis, only pH value (7.43±0.42 vs. 7.47±0.31,P =0.003), chloride concentration [Cl- (mmol/L): 114.66±4.32 vs. 111.90±3.08,P = 0.019], magnesium concentration [Mg2+ (mmol/L): 0.60±0.10 vs. 0.54±0.06,P = 0.035] and blood osmolality [mmol/L: 290.10 (284.15, 306.35) vs. 282.70 (280.20, 286.75),P = 0.014] were statistically significant. Compared with control group, the prognostic variables in delirium group such as duration of mechanical ventilation [days: 125.0 (49.0, 293.0) vs. 149.5 (32.0, 251.3)], length of stay in ICU [days: 216.5 (50.5, 360.8) vs. 190.0 (72.0, 330.5)] and mortality rate (22.2% vs. 24.0%) didn't appear to be statistically significant either (allP > 0.05). It was shown by multivariate logistic regression analysis that pH [odds ratio (OR) = 1.446, 95% confidence interval (95%CI) = 1.116-1.875,P = 0.005] and Cl- (OR= 0.708, 95%CI =0.531-0.945,P = 0.019) were potential risk factors of delirium.Conclusions The brain activity of HXD_Ⅰ may contribute to the clinical diagnose of delirium, but it still remained to be proved further. The pH and Cl- are potential risk factors of delirium.

At present, there are still problems in medical postgraduate education in our country such as backward concept, disconnected basic research and clinical transformation, as well as imper-fect cultivation system and evaluation system. Translational medicine conception has been generally accepted and practiced, and provides a new thinking for medical postgraduate education. As a result, medical postgraduate education should reform education model to resolve the disconnection between basic research and clinical application, build a multidisciplinary intersection translational medicine research guidance team, create a strong translational medicine research atmosphere, and the quantita-tive evaluation system and peer evaluation system of scientific research achievements, thus strengthen-ing medical graduate students' concept of translational medicine and their scientific research ability, to provide the necessary talent base to solve the major problems in medical science.

Objective To investigate the influence of hydroxyethyl starch solution on exogenous coagulation and active protein C (APC) in the patients with septic shock.Methods A single-center prospective study was conducted.Eighty-four consecutive patients with septic shock admitted to intensive care unit (ICU) of Peking University People's Hospital from November 2009 to October 2014 were enrolled.The patients were randomized into two study groups by random digits table:Ringer lactate solution group (RL group,n =40) and hydroxyethyl starch group (HES group,n =44),and Ringer lactate solution or hydroxyethl starch 130/0.4 was used for resuscitation respectively.Peripheral blood was collected at four time points:before resuscitation,6,12,and 24 hours after resuscitation.The prothrombin time (PT),tissue factor (TF),tissue factor pathway inhibitor (TFPI) and APC were determined,and the length of ICU stay and the mortality were recorded.Results There were no significant differences in PT,TF,TFPI,and APC before and after resuscitation in RL group.No change in PT was found after resuscitation in HES group,and no significant difference was found as compared with RL group.TF after resuscitation in HES group was decreased gradually,and the level at the 24 hours after resuscitation was significantly lower than that before resuscitation (U/L:15.80±7.32 vs.31.40±2.75,P ＜ 0.05); but there was no significant difference at all time points when compared with that of RL group (all P ＞ 0.05).TFPI at 12 hours and 24 hours after resuscitation in HES group was increased when compared with before resuscitation (μg/L:1.32±0.22,1.14±0.09 vs.0.63±0.54).TFPI in HES group was significantly higher than that in RL group (μg/L:0.84 ± 0.69,0.95 ± 0.30),but there was no significant differences between two groups (both P ＞ 0.05).APC after resuscitation in HES group was decreased gradually,which was significantly lower than that in RL group at 6,12,24 hours after resuscitation (mg/L:3.38±3.00 vs.5.98±4.12,3.31 ± 1.94 vs.5.33 ± 3.71,3.42 ± 2.64 vs.7.53 ± 4.67,P ＜ 0.05 or P ＜ 0.01).The length of ICU stay in HES group was significantly shorter than that in RL group (days:12.50 ± 8.83 vs.17.10± 16.60,t =9.037,P ＜ 0.001),but there was no significant difference in mortality between HES group and RL group [40.9％ (18/44) vs.60.0％ (24/40),x 2=2.339,P =0.126].Conclusions Both RL and hydroxyethyl starch fluid resuscitation did not affect the PT of the patients.The use of hydroxyethyl starch probably inhibits excessive activation of the exogenous coagulation and hyper-coagulation in the early stage of sepsis,and inhibits activation of protein C as well.

Idiopathic pulmonary fibrosis(IPF), as one of the chronic and complex diseases, is with high incidence and mortality rate. It is also a difficult to treat disease in modern medicine. Traditional Chinese medicine (TCM) syndrome differentiation and treatment embodies characteristics and advantages. In recent years, the collateral disease theory guiding the prevention and treatment of the chronic and complex diseases has become a hot point and frontier in medical research, and achieved certain effects. This article is to summary the structures and functions of pulmonary collaterals based on the collateral disease theory. Combined with clinical manifestations of IPF, we put forward Fei-Re Luo-Y u as the fundamental role in the pathogenesis of IPF in its acute phase to lay the theoretical foundation to the further exploration of syndrome prevention and differentiation on IPF in its acute exacerbation.

Objective To compare the value of ultrasound International Ovarian of Tumor Analysis (IOTA) simple rules and gynecologic imaging reporting and data system (GI-RADS) ultrasonographie stratification in the diagnosis of adnexal masses.Methods A total of 463 patients with adnexal masses were classified according to IOTA simple rules by senior doctor.The benign and malignant masses were enrolled in the study.Then the masses were judged according to GI-RADS classification and IOTA simple rules by senior and junior doctors.And junior doctorn in diagnosis of adnexal masses with IOTA was group A1,senior doctor in diagnosis of adnexal masses with IOTA was group B1,junior doctor in diagnosis of adnexal masses with GI-RADS was A2,senior doctor in diagnosis of adnexal masses with GI-RADS was B2.The efficacy of the two methods were compared.Results Among the 463 cases,there were 411 cases (411/463,88.77％) of benign mass and malignant mass by IOTA and 52 cases (52/463,11.23 ％) of uncertain mass.The specificity,positive predictive value,diagnostic accuracy had statistical differences between groups A2 and B2,A1 and A2 (all P＜0.05),and sensitivity and negative predictive value had no statistical differences (all P＞0.05).Diagnostic efficacy index had no statistial signifi cance between group A1 and B1,B1 and B2 (all P＞0.05).Conclusion The diagnostic efficacy of IOTA simple rules and GI-RADS is high and similar in diagnosis of benign and malignant adnexal masse.IOTA simple rules do not depend on experience,but they are not suitable for the diagnosis of all adnexal masses.

Sepsis is a high-risk factor for the death of critical patients. High density lipoprotein (HDL) are the major protective serum proteins, and the serum levels of HDL are closely related to the severity of sepsis. The anti-inflammatory and anti-oxidation properties of HDL, may be able to play an important role in the innate immune response. Thereby it may reduce the damage of septic shock and multiple organ dysfunction syndrome (MODS) in animals or human beings, and improve the prognosis. In order to unveil the metabolism of HDL in septic patients and its effects on both progression and prognosis of sepsis, this review not only focuses on the composition and structure of HDL, but also analyzes its pivotal role in inflammatory immune response and anti-oxidation.

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 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.

18F-2-fluro-D-deoxy-glucose (18F-FDG) is used by positron emission tomography/computed tomography (PET/CT) examination as an imaging agent,by observing the uptake of the agent of the lesion to determine its metabolism,and make a diagnosis.It can provide anatomical and functional at the same time,not only qualitative but also position and can significantly improve the accuracy of diagnosis.Currently PET/CT has been widely used in the clinical aspects of the differential diagnosis of benign and malignant tumors,prognostic assessment and so on.The property of pleural effusion is important to the treatment and prognosis of the disease.