Objective To carry out bacteriological analysis between re-used and disposable oxygen humidification devices. Methods Reused oxygen equipment and disposable oxygen moisture bottles from 6 randomly selected elderly wards were collected, patients who used oxygen will be randomized into 3 groups, group A used cold water as the oxygen humidification liquid, group B used distilled water as humidification liquid, group C used AQUAPAK disposable oxygen humidification devices, sample taking in group A and group B happened on every Monday and Thursday before the replacement of sample moisture bottles, sample was taken in group C after the use of disposable oxygen humidification devices, according to "hospital disinfection health standards" (GB5982-1995)sampling method of disinfection liquid sample was taken and sent to test in the disinfectant laboratory. Results Of 61 samples in group A bacteria cartier rate was 81.97%, bacteria carrier rate of 71 samples in group B was 47.89%, of 52 samples in group C the carrier rate was 0. The comparing of bacterial contamination rate of three kinds of oxygen moisture bottles after using was statistically significant. Take group A, B for comparison, the average severity level of bacteria in group A is higher than group B. In group A, the level of the Gram-negative bacteria as well as Gram-positive bacteria colonization was higher than group B. Conclusions Whether use of cold water or distilled water, oxygen humidification liquids have different degrees of pollution. Currently there is no general criteria and norms in the context of sterilization of oxygen humidification, for patients on long-term oxygen using, to choose disposable oxygen humidification device to reduce the incidence of hospital infections is recommended.

Objective To investigate the pattern of the cerebral white matter lesions in patients with mild and moderate Alzheimer's disease(AD)and healthy controls using proton magnetic resonance spectroscopy(~1H-MRS)and diffusion tensor imaging(DTI).Methods Twenty AD patients and Twenty healthy controls were recrnited.All subjects underwent clinical examination,neuropsychological assessment.The quantitative analysis of N-acetylaspartate(NAA),myoinositol(mI),Chotine(Cho)and Creatine(Cr)resonance signals in region of interests(ROIs)located in the paraventricular white matter region bilaterally were measured.Ratios of NAA/Cr,mI/Cr and Cho/Cr were calculated in two groups.In addition,conventional MRI and DTI scanning were received,fractional anisotropy(FA)and mean diffusivity(MD)values of white matter in the same regions were measured respectively.Results No significant difference between two groups were observed in NAA/Cr ratio(P＞0.05).A significantly increased mI/Cr and Cho/Cr were found in AD patients than in controls(P＜0.05).FA and MD values in AD patients were 0.470±0.082 and 0.771±0.099,and in controls were 0.539±0.068 and 0.691±0.064,respectively.FA value decreased significantly in AD patients(P＜0.05),M D value increased significantly in AD patients(P＜0.05).After controlling for age-related,partial correlation analysis revealed a negtive correlation between mI/Cr and FA value in the patients with AD(P＜0.05).No correlation between mI/Cr and MD was found(P＞0.05).Conclusion The results suggest that not only the gray matter is injured,but also the white matter is abnormal in AD patients.Combining ~1H-MRS with DTI alterations could provide the valuable informations about white matter lesions in AD patients.

BACKGROUND: Cerebrovascular disease often causes dysfunction of the brain nerve, and nerve cel apoptosis is the important factor of cerebral nerve dysfunction. The excessive expression of c-fos can block the transduction of intracelular signal so that producing some apoptosis-promoting factors, which involve in nerve cel apoptosis process after ischemia injury of brain. Bcl-2 is an inhibited factor. It might to be the key to treat ischemic cerebrovascular disease by inhibiting or reducing the apoptosis of nerve cels after ischemia injury. OBJECTIVE: To investigate the therapeutic effect and mechanism of the Total Flavone of Hawthorn Leaf on chronic cerebral ischemia rats. METHODS: A total of 72 healthy male Sprague-Dawley rats were randomly divided into sham surgery group, model group, Total Flavone of Hawthorn Leaf group and ginkgo leaf group. Permanent bilateral carotid artery ligation was used to prepare chronic cerebral ischemia model in the model group, Total Flavone of Hawthorn Leaf group and ginkgo leaf group. Total Flavone of Hawthorn Leaf group and ginkgo leaf group respectively received 140 mg/kg Total Flavone of Hawthorn Leaf and 12.3 mg/kg ginkgo leaf intragastricaly for 36 days from 36 days after model induction. Model group and sham surgery group received 3.5 mL/kg physiological saline intragastricaly. RESULTS AND CONCLUSION: Compared with the model group, the expression of c-fos protein significantly deceased in the Total Flavone of Hawthorn Leaf group (P < 0.01), Bcl-2 expression levels significantly increased (P < 0.01), and Ca2+ content decreased (P < 0.05). Moreover, no significant difference in above indexes was detected between Total Flavone of Hawthorn Leaf group and ginkgo leaf group (P> 0.05). These data indicated that the protective effect of Total Flavone of Hawthorn Leaf on chronic cerebral ischemia was associated with its inhibition of neuronal apoptosis. Its mechanism of anti-apoptosis might be associated with up-regulating expression of Bcl-2, down-regulating expression of c-fos and decreasing Ca2+ content in brain.

Objective? ?To?analyze?the?risk?factors?of?delirium?in?patients?in?cardiac?surgery?intensive?care?unit?(CSICU).? Methods? A?prospective?observational?study?was?performed.?Patients?admitted?to?CSICU?of?Fujian?Medical?University?Union?Hospital?from?March?to?August?in?2017?were?enrolled.?The?combination?of?the?Richmond?agitation?sedation?scale?(RASS)?and?the?ICU-confusion?assessment?method?(CAM-ICU)?were?used?to?evaluate?delirium.?The?patient?was?assessed?on?the?second?day?after?CSICU?admission,?twice?a?day,?the?evaluation?was?stopped,?and?the?follow-up??observation?was?terminated?after?the?patient?was?discharged?from?CSICU.?The?patients?were?divided?into?two?groups?according?to?whether?delirium?occurred?in?CSICU.?The?general?and?clinical?treatment?data?(including?condition,?operation,?anesthesia?and?CSICU?treatment)?of?the?two?groups?were?compared.?The?related?factors?of?delirium?were?identified?by?univariate?analysis?and?multifactor?Logistic?regression?analysis.? Results? A?total?of?318?cases?were?included?in?this?study.?Among?them,?93?cases?had?delirium?and?the?incidence?of?delirium?was?29.2%.?It?was?shown?by?univariate?analysis?that?age,?history?of?hypertension,?type?of?surgery,?surgical?procedure,?American?Society?of?Anesthesiologists?(ASA)?anesthesia?classification,?usage?of?propofol,?plasma?transfusion,?red?blood?cells,?platelet?transfusion,?blood?loss,?operative?time,?cardiopulmonary?bypass?(CPB)?time,?myocardial?block?time,?acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHEⅡ),?duration?of?mechanical?ventilation,?the?length?of?intensive?care?unit?(ICU)?stay,?postoperative?usage?of?diazepam,?midazolam,?fentanyl,?morphine,?chlorpromazine,?etc.?which?were?related?to?delirium,?and?occupation?? (on-the-job?or?self-employed),?medical?insurance?(city?or?provincial?medical?insurance),?education?(primary?to?junior?high?school,?high?school?or?above)?could?reduce?the?risk?of?delirium.?Colinearity?diagnosis?was?performed?on?variables?with?statistically?significant?differences,?and?variables?with?variance?expansion?factor?(VIF)?

Objective: To observe the efficacy and safety of Brucea javanica oil injection combined with S-1 in the treatment of elderly patients with advanced gastric cancer. Methods: The clinical data of 62 elderly patients with advanced gastric cancer who were admitted to Shanxi Provincial Cancer Hospital from May 2017 to May 2018 were retrospectively analyzed. Thirty-one patients in the control group treated with S-1 alone, and 31 patients in the observation group treated with S-1 combined with Brucea oil emulsion injection. The clinical efficacy, adverse reactions, immune function and quality of life of the two groups were compared. Results: The total effective rates of the observation group and the control group were 70.97% (22/31) and 48.39% (15/31), respectively, and the difference was statistically significant (χ ² = 11.889, P < 0.01). The incidence rates of gastrointestinal reaction and peripheral neurotoxicity in the observation group were 9.68% (3/31) and 3.23% (1/31), and the rates in the control group were 35.48% (11/31) and 25.81% (8/31), respectively, the differences between the two groups were statistically significant (both P < 0.05); the incidence rates of hepatotoxicity, nephrotoxicity and myelosuppression in the observation group were 3.23% (1/31), 3.23% (1/31), and 3.23% (1/31), and the rates in the control group were 22.58% (7/31), 16.13% (5/31), and 12.90% (4/31), respectively, and the differences between the two groups were not statistically significant (all P > 0.05). The Karnofsky scores of the observation group and the control group after treatment were (92±4) points and (86±3) points, respectively, and the difference was statistically significant (t = -2.075, P = 0.042). The serum levels of interleukin-2 (IL-2) and interferon-γ in the observation group after treatment were (38±4) ng/L and (51±4) ng/L, and the levels in the control group were (31±3) ng/L and (40±4) ng/L, respectively, and the differences were statistically significant (t values were -2.097 and -2.293, both P < 0.05), and the serum levels of IL-4, IL-6 and IL-10 in the observation group after treatment were (42±5) ng/L, (34±4) ng/L and (22±2) ng/L, and the levels in the control group were (59±6) ng/L, (50±5) ng/L and (30±3) ng/L, respectively, and the differences were statistically significant (t values were 2.109, 2.867 and 4.278, all P < 0.05). There was no statistical difference in the serum levels of tumor necrosis factor-α between the observation group and the control group after treatment (t = -0.922, P = 0.360). Conclusion Compared with monotherapy of S-1, the treatment of Brucea javanica oil emulsion injection combined with S-1 can improve the clinical efficacy, reduce the incidence of adverse reactions, enhance the immune function and effectively improve the quality of life of elderly patients with advanced gastric cancer.

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer′s protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.