Delirium is a common disorder in aged people.Although it is in poor prognosis,delirium still has been under-recognized and inappropriately evaluated and treated.The clinical aspects of delirium on epidemiology,diagnosis,risk and precipitating factors,prevention and treatment were introduced in this paper.

Comprehensive geriatric assessment (CGA) conducts comprehensive assessment of many aspects of health and well-being of an older patient including medical,functional,nutritional,psychiatric and behavioral issues and needs as well as family and social support.CGA is typically conducted by a multidisciplinary team led by a geriatrician.Based on the CGA findings,appropriate recommendations are provided to the patient and family.This paper introduces the CGA concept and its content,targeted population,and implementation methods.It will also describe clinical studies focusing on the effectiveness and utility of CGA.

Chronic cough in children is one of the most frequent reasons for consultation in clinic. The high cough sensitivity in most patients with chronic cough is difficult for treatment. Capsaicin,as the most com-monly used material for the test of cough sensitivity,is widely used in clinic. Capsaicin provocation test is more mature in foreign country,while in our country there is a few scholars applying it with the adult who suffered chronic cough,but few with children. This article reviews the process,chemical structure,nerve conduction,clini-cal operation,influence factors and safety of capsaicin provocation test.

Objective To study the effect of non-invasive low frequency nerve and muscle stimulator on labor analgesia. Methods Four hundred primigravida in our hospital were randomized into the control and observation group in equal number:The deliveries of the former group were accompanied with full-process Doula and those of the latter with Doula-assisted analgesia besides Doula accompany.The two groups were compared in terms of analgesic effect,labor progress,delivery method,post-partum hemorrhage and neonatal conditions. Results The observation group was significantly better than the control group in terms of analgesic effect,active phase,total labor and spontaneous delivery(all P<0.05).There was no significant difference between them in occurrence of neonatal asphyxia and hemorrhage 2h after labor(both P>0.05). Conclusion Doula-assisted analgesia plus Doula accompany for the full labor process is effective for alleviating labor pains,accelerating labor process and spontaneous delivery.

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33 cases were treated by spotted—moxibustionwith Zhuang medicated threads,the effective rate be-ing 84.6～85.0%.The longterm effect was also satis-factory.This therapy can also markedly raised the in-filtration pressure of nocturnal urination.There wasno obvious relation between the therapeutic effect andsyndrome typing.

Objective To analyze the clinical characteristics and prognosis of the overlap syndrome of dementia,depression and delirium coexistence in two or three of them (the 2D's or 3D's) in elderly patients,in order to raise awareness.Methods Clinical data of 16 patients aged ＞65 years diagnosed with the 2D's or 3D's admitted to Peking Union Medical College Hospital from 2010 to 2014 were analyzed and relevant literatures were reviewed.Results Patients with the 2D's or 3D' s accounted for 10％ of the elderly demented patients and 3％ of the elderly depressive patients.16 patients [11 females and 5 males,median age 82 years and mean age (80±6) years] were enrolled,with 7 cases of dementia with depression,6 cases of delirium superimposed on dementia,2 cases of the 3D's,and 1 case of coexisting depression and incident delirium.The Charlson comorbidity index of the 16 patients was (3.0± 1.5).(4.0± 1.6) kinds of geriatric syndromes were found,and the most common were falls (62％),sleep disorders (56％),frailty (50％),polypharmacy (43 ％),and malnutrition (37％).Disability was identified in 14 (88％) patients on admission.Delirium was observed in 9 patients (56 ％),with 7 cases of hyperactive delirium and 2 cases of hypoactive delirium.Coexisting underlying dementia was identified after episodes of delirium in 6 cases.16 patients all received corresponding intervention during hospitalization period.During a mean follow-up period of (15±13) months,62 ％ of the patients had more impaired physical function (ADL score reduction≥ 1),and 43％ of the patients had more impaired cognitive function (MMSE score reduction≥3).Two patients were transferred to long-term care facilities and one patient died during follow-up.The readmission rate was 50％ within 1 year after discharge.Conclusions The domestic report of overlap syndrome of dementia,depression and delirium is rare.Patients with the coexistence of the 2D's or 3D's are more commonly combined with geriatric syndromes,which results in further cognitive and physical function impairment with a higher re-admission rate.We should pay attention to the follow-up in elderly patients with delirium for screening dementia.

AIM:To explore the role of sphingosine 1-phosphate (S1P) in the dysfunction of vascular endo-thelial cells exposed to high glucose.METHODS: In human aortic endothelial cells cultured under high-glucose ( 22 mmol/L glucose) medium, nitric oxide ( NO) level, polymorphonuclear neutrophil-endothelial cell adhesion rate, protein level of intercellular adhesion molecule-1 ( ICAM-1) , migration of endothelial cells and Akt/endothelial nitric oxide syn-thase ( eNOS) pathway activation were observed after S1P, sphingosine kinase-1 inhibitor and/or Akt inhibitor treatments. RESULTS:S1P decreased NO level, increased polymorphonuclear neutrophil adhesive rate, enhanced ICAM-1 protein level, and inhibited migration of endothelial cells and activation of Akt/eNOS pathway in endothelial cells cultured under high-glucose condition.Sphingosine kinase-1 inhibitor, which reduced S1P content, significantly improved the above endo-thelial cell function indexes and restored the activation of Akt/eNOS pathway.CONCLUSION: S1P promoted high glu-cose-induced dysfunction of endothelial cells probably by inhibiting the activation of Akt/eNOS signal pathway.Targeting S1P is expected to become one of potential treatment strategies to reduce endothelial cell dysfunction.

Objective To explore the effect of calories supplement or protein supplement on the skeletal muscle in the elderly.Methods The ambulatory elderly (≥65 yrs) with reduced handgrip strength and/or gait speed were enrolled,who did not suffer from any neurological or arthritic disease impairing mobility,or any severe pulmonary or heart disease,or chronic kidney failure.The subjects were recruited with their written informed consent from clinical practices in five hospitals in China.The subjects were randomized to control group(n=26),nutrition supplementation (Nutren 400 kcal/ d) group (n=27) or protein supplementation(Biopro Protein 20 g/d) group (n=21).All the subjects were given healthy lifestyle education.The physical performances i.e.gait speed and handgrip strength were measured at baseline and at 2 and 3 months of followed up.Lean soft tissue mass (muscle mass) was measured by BIA at baseline and at 3 months of follow-up.Results A total of 74 subjects completed the trial,including 26 in controls,27 in Nutren,and 21 in protein group.At the end of the trial,the changes from baseline in appendicular muscle mass were-490.0 g (95％CI:-801.9--245.5,P=0.001)in control group,90.0 g (95％CI:-346.8--442.0,P=0.241) in Nutren group,and 290.0 g (95％CI:-746.6-20.1,P=0.007) in protein group.There were no significant difference in above indices among the three groups (P=0.051),except between Nutren group and control group (P=0.020).The handgrip strength and gait speed in the three groups were improved obviously as compared with those at baseline,but not statistically significant between different groups.Conclusions Caloric supplementation group may have greater effect in maintaining muscle mass than the protein supplement group in the elderly.Both the caloric supplement and the protein supplement produce no additional effect on muscular function as compared with healthy lifestyle education.

Objective To explore the way to evaluate hemodynamics of posterior circulation distal ischemia with PWI. Methods Thirty-two patients with vertebral basilar artery severe stenosis were reviewed and compared with thirty normal persons. Information and data of PWI and MRA were collected and analyzed. Following parameters were observed, index of vascular stenosis, collateral vessels, cerebral blood flow (rCBF), cerebral blood volume (rCBV), and mean transit time (rMTT). Results All the patients had at least one vertebral basilar artery with more than 70% stenosis. There were 17 cases with severe vertebral artery stenosis , 20 cases with severe basal artery stenosis , 8 cases with severe superior cerebellar artery stenosis , 17 cases with posterior cerebral artery stenosis , 22 cases with after the traffic artery open , 11 cases with soft meningeal arteries show and 12 cases with small artery show. The ratio of ROI with frontal white matter was lower than the rCBF and rCBV in the country group. MTT value was extended and P value of the parameters in both groups was less than 0.05, reflecting the statistical difference. Conclusions PWI combined with MRA can effectively evaluate the posterior circulation distal ischemia area and tissue perfusion , as well as the hemodynamic status of ischemia area.