Many studies have shown that diabetes mellitus is associated with vascular cognitive impairment (including vascular dementia),mild cognitive impairment,and Alzheimer's disease.Its pathophysiological mechanism is very complex,involving in vascular mechanisms and including non-vascular mechanisms of hyperglycemia,hypoglycemia,and insulin resistance.

Objective To explore the incidence and risk factors for postoperative delirium patients over 60 years undergoing total knee arthroplasty.Methods Three hundred and sixty-nine patients (73 males,296 females,aged over 60 years,ASA Ⅰ or Ⅱ) undergoing unilateral total knee arthroplasty were chosen.Before induction of anesthesia,femoral nerve block by nerve stimulator was performed for all patients,25 ml of 0.4% ropivacaine was injected to the continuous femoral nerve catheter for postoperative analgesia,all patients received intravenous-inhalation anesthesia during the operative.The confusion assessment method-intensive care unit (CAM-ICU) was used twice a day to evaluate whether the postoperative delirium had happened for patients within 3 days after operation,and record the case of complication besides postoperative delirium.To analysis the perioperative indicators depend on whether the postoperative delirium had happened for patients,then to screen out the probable risk factors for postoperative delirium,which include the kind of intravenous anesthesia drugs during operation,gender,age group,level of education;preoperative hypertension,coronary heart disease,arrhythmia,stroke,respiratory disease,diabetes,abnormal renal function and the ASA grade;the bleeding and blood transfusion volume during operative and the total amount of blood transfusion;degree of postoperative pain and whether used pethidine after operative.Put all observed factors to be analyzed by the Logistic regression model.Results Sixty-two patients (16.8%) had delirium within 3 days after operation.The results of multi-factor Logistic regression analysis indicates that the patients` increasing age (OR=2.116,P=0.035),low level of education (OR=0.091,P<0.001),preoperative chronic obstructive pulmonary diseases (COPD) (OR=12.500,P=0.002),high ASA grade (OR=22.333,P=0.005),increasing total amount of blood transfusion (OR=4.500,P<0.001) and postoperative used pethidine(OR=22.372,P=0.001) were the independent risk factors for postoperative delirium.Conclusion The patients` age,level of education,preoperative COPD,high ASA grade,increasing total amount of blood transfusion and postoperative used pethidine are the independent risk factors for postoperative delirium.

It was the honor to participate in the exchange program between University of Malta and Soochow University focusing on Dementia care;gerontology and elderly rehabilitation care from September 2016 to January 2017. During those 5 months, as a nursing graduate student, the experience which made me a deeply impression is the point of view ofperson-centred carefrom the medical care I′ve seen in Malta. This essay combined with the exchange experience through clinical observation and practice at hospitals in Malta, is going to highlight the point of view of person-centred care. That can reflect on some shortages of domestic in the medical care environment in China, hoping for a morehumane, moreperson-centred, andperson in heartmedical care environment.

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.

Based on the analysis on the present status and importance of medical humanity education for inter-national medical students during the clinical internship, this paper discussed the importance of strengthening medi-cal students′humanistic education during the clinical internship and proposed ways to promote the humanity educa-tion:optimizing the setting of humanity education curriculum and adhering to the humanity education throughout the whole process of clinical internship;improving the clinical supervisors′humanity quality and ensuring the quality of humanity education;holding the orientation of evaluation and adding the humanity quality as one of the evaluation indicators; establishing hospital atmosphere with humanity spirit and highlighting environmental education effect;building theuniversity-intern hospital two-grade platform of humanity education and standardizing the relevant systems.

Objective To observe the changes of circumpapillary retinal nerve fiber layer (CP-RNFL)thickness and optic disk parameters in retinitis pigmentosa (RP) eyes.Methods Prospective clinical case-control study.A total of 25 patients (42 eyes) with RP were in the RP group,and 42 age matched healthy subjects (84 eyes) in the control group.All subjects underwent optical coherence tomography (OCT) examination,in which 37 eyes with 3D optic disk scanning and 5 eyes with circle optic disk scanning.The parameters included average thickness of entire CP-RNFL,thickness of nasal,superior,temporal and inferior quadrant of CP-RNFL,disc area,disc cup area,rim area,cup/disc (C/D) area ratio,C/D horizontal diameter ratio,C/D vertical diameter ratio,disc cup volume and disc rim volume.Results The average thickness and the thickness of temporal and nasal quadrants of CP-RNFL in RP group were significantly thicker than the control group (t=2.27,3.73,6.44;P=0.027,0.00,0.00),while the thickness of inferior and superior areas were the same as control group(t=-1.49,-1.19;P=0.14,0.24).The disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio,C/D vertical diameter ratio,disc cup volume in RP group were significantly bigger than control group (P＜0.05),while rim area and rim volume were not significant differences (t=1.75,0.40;P=0.08,0.59).Conclusion In comparison with the healthy subjects,the average thickness and temporal and nasal areas of CP-RNFL in RP eyes were thicker,and the disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio,C/D vertical diameter ratio,disc cup volume in RP eyes were bigger.

Objective To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and macular retina after acute primary angle closure.Methods Prospective clinical case-control study.A total of 26 patients (30 eyes) with acute primary angleclosure glaucoma (APACG) were in the APACG group,whose intraocular pressure were control after a single episode acute primary angle closure;30 age-and sex-matched healthy subjects (30 eyes) in the control group.All subjects underwent three dimensional optical coherence tomography (3D-OCT) examination with 3D optic disk scanning or circle optic disk scanning and 6 mm× 6 mm macular scanning.The parameters included average thickness of entire CP-RNFL,thickness of nasal,superior,temporal and inferior quadrant of CP-RNFL,disc area,disc cup area,rim area,cup/disc (C/D) area ratio,C/D horizontal diameter ratio and C/D vertical diameter ratio.The foveal retinal thickness,center retinal thickness (≤ 1 mm from the fovea),4 quadrants of macular inner-ring (＞ 1 mm but ≤3 mm from the fovea) retinal thickness,4 quadrants of macular outer-ring (＞3 mm but ≤6 mm from the fovea) retinal thickness,average thickness of macular retinal thickness and macular volume were measured and analyzed.Results The disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group (t=3.22,4.12,3.90,3.00,3.23;P＜0.05),rim area was smaller than the control group (t=-2.63,P＜0.05).The average thickness (t=-6.68) and the thickness of superior (t =-5.90),temporal (t =-11.64) and inferior (t =-5.06) quadrants of CP-RNFL,center retinal thickness (t=-2.50),4 quadrants of macular inner-ring retinal thickness (t=-4.91,-4.88,-2.83,-3.59),nasal (t=-2.13) and superior (t=-2.49) quadrants of macular outerring retinal thickness as well as average thickness of macular retinal thickness (t=-2.65) were significantly thinner than the control group (P＜0.05),and the macular volume (t=-2.69) was significantly smaller than the control group (P＜0.05).There was no statistically difference at nasal CP-RNFL (t=-0.11),foveal retinal thickness (t=-0.59),temporal (t=-0.67) and inferior (t=-1.02) quadrants of macular outer-ring retinal thickness between two groups (P＞0.05).Conclusions In comparison with the healthy subjects,the disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio,C/D vertical diameter ratio in APACG eyes were bigger,while rim area was smaller;the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL,fovea,temporal and inferior quadrants of macular outer-ring retinal.

Objective To develop a simple high-resolution melting ( HRM) analysis method for differentiation of Pc and P2 variants in class 1 integron.Methods DNA fragments containing Pc and P2 variants were amplified from plasmids pACW ( PcW ) and pACWP2 ( PcW-P2 ) respectively , then these purified PCR products and P 2 promoters were analyed full-length amplicon by HRM .Eight DNA fragments containing different Pc promoters were amplified and site-specific mutated from plasmids pACS ( PcS ) , pACH2 ( PcH2 ) , pACH1 ( PcH1 ) , pACW ( PcW ) , genomic DNA of Klebsiellar pneumonia HS07-68 (PcWTGN-10)and HS05-1792(PcH2TGN-10)respectively.The purified PCR products and eight Pc variants were characterized by HRM analyses of an unlabeled probe and full-length amplicon.This assay was applied to the differentiate Pc and P2 variants in 109 class 1 integrons from 95 urine clinical Escherichia coli isolates in Huashan Hospital during 2004 -2007.The differentiation results were compared with that determined by direct sequencing .Results P2 promoter with a significant higher melting temperature ( Tm ) can be identified by HRM analysis clearly .P2 promoters were identified in 2 class 1 integrons and consistent with direct sequencing results .Eight Pc variants were classified into three groups: PcS, PcSTGN-10 , PcW, PcWTGN-10, PcH1, PcH1TGN-10.Using direct HRM analysis.PcH2, PcH2TGN-10 were classified into four groups:PcS, PcH1, PcH2, PcW, PcSTGN-10 , PcH1TGN-10 , PcH2TGN-10 , PcWTGN-10 according to the melting curves of the unlabeled probe .Combined the HRM analyses of the whole amplicon and unlabeled probe , the eight Pc variants can be differentiated from each other .Five different Pc variants, PcS, PcW, PcH1, PcH2TGN-10 and PcWTGN-10 , were identified and consistent with direct sequencing results .Conclusions This developed a simple Pc and P 2 variants differentiation method via simultaneous HRM analyses of an unlabeled probe and full-length amplicon .This method is cost-effective and accurate , could be used in differentiation of Pc and P2 variants of class 1 integrons in clinical isolates .

Hair ; Hair Follicle ; Humans ; Neoplasms ; diagnosis

Objective We observed influence of different handgrip exercise on the changes of blood flow velocity and blood vessel diameter of basilic vein before and after the PICC placement and discuss the best model for handgrip exercise.Methods 60 patients with PICC were chosen and divided into group A,B and C with 20 patients in each groups.Group A received routine guidance on unarmed handgrip exercise,group B used electronic handgrip,the frequency was 25 times/min,the time period was 2 min with 4 times a day,once every 4 hours,group C adopted the same model as that of group B and 6 times a day,once every 3 hours.The venous blood flow velocity and blood vessel diameter was measured by pulsed Doppler ultrasound one hour before the PICC placement and one hour,1 day,3 days,7 days,10 days,14 days,21 days after placement.Results The venous blood flow velocity before and after PICC placement had statistically significant differences at different time points (F=2.934,P ＜ 0.05).The effect of group B and C was better than that of the group A and group C showed the best effect.The blood vessel diameter before and after PICC placement had significant differences at different time points(F=3.940,P ＜ 0.05).There was significant differences in the blood vessel diameter 1h before and 1h after PICC placement.Conclusions Handgrip exercise can effectively promote the upper limb venous blood flow velocity in patients with PICC,but shows little effect on the blood vessel diameter.Using the electronic hand grip in weak tap position,25 times/min,2 min every time,and 6 times a day (once every 3 hours),can obviously promote the upper limb venous blood flow velocity.