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.

Antibody bridging keratinocyte/mononuclear leucocyte adhesion(ABKMA), an experimental model in vitro for psoriasis, has been used in the investigation of cytokine network changes. ABKMA was formed by using normal human epidermal cells incubated with IgG of patients with psoriasis, and then mononuclear leucocytes(ML) of patients with psoriasis were added. Interleukin 2 and interleukin 6 in culture supernate were estimated by ABC amplified ELISA. The results indicated that the synthesis and secretion of interleukin 2 and interleukin 6 were higher than normal IgG and serum free medium controls. Immunohistochemistry staining was used to demonstrate the cell surface interleukin 2 receptor ? chain (IL2R?). The expression of IL2R? +ML/ML and IL2R? +ML/adhesion ML was 4.6% and 40.4% respectively. Both these data were higher than corresponding controls.

OBJECTIVE:To understand the utilization of antihypertensives in our hospital.METHODS:150medical records of the patients who had received antihypertensives and were discharged in June,2002were collected.The kind,utiliza?tion and combined use of antihypertensives were analysed.RESULTS:The first4places of drugs used in order of number of case were angiotensin converting enzyme inhibitors,?-receptor blocking agents,diuretics and calcium antagonists.The first3places of DDDs of antihypertensives were Betaloc,Benazepril and Fosinopril.DUI≤1.Most patients received a single agent or combination of two or three agents.CONCLUSION:The study shows that complications are frequent and so is the combined use of drugs,and the use of drugs is basically rational.

OBJECTIVE:To study the antithrombotic effect of orientoside.METHODS:The effects of prophylactic oriento_side on the clotting time in vitro and the systemic clots dissolution of mice,the plasma prothrombin time(PT),the kaolin partial thromboplastin time(KPTT),the thrombin time(TT),and the platelet aggregation induced by ADP and the euglobulin lysis time (ELT)in rabbits were studied.RESULTS:As compared with the normal saline group,orientoside(1,2,and 4mg/kg)signi_ficantly prolonged the clotting time of mice in vitro,yet which had no significant influence on the systemic clots dissolution of mice;while orientoside(0.625,1.25 and 2.5 mg/kg)significantly prolonged the PT,KPTT and TT of rabbits,and significantly inhibited platelet aggregation of rabbits induced by ADP,yet which had no significant influence on the ELT of the rabbits.CONCLUSION:Orientoside can significantly inhibit the formation of thrombus.

Objective To study the washing methods for the piping instruments of laparoscope and prevention form biological membrane .Methods 300 pieces of the piping instruments of laparoscope select from the center of sterilization supply were random classified into 3 groups(100 pieces in each group) according to washing methods :washing by hand(group A) ,full-automation wash-ing machine(group B) and Tri-band pressurized ultrasonic washing machine(group C) .Comparing the cleanliness and ATP detec-tion fluorescence value on different methods .Results Cleanliness of group A was 85% ,ATP fluorescence detection rate was 27% ;Cleanliness of group B was 82% ,ATP fluorescence detection positive rate was 31% ;Cleanliness of group C was 99% ,ATP fluores-cence detection positive rate was 5% .The test data of group C was significantly compare with the data of group A and B . Conclusion The washing method of using tri-band pressurized ultrasonic washing machine can effectively improve laparoscopic tube cavity equipment cleaning effect and prevent form biological membrane .

Objective To understand the main pathogenic bacteria distribution and drug susceptibility in the common bile duct calculi with infection ,so as to provide the basis for rational use of antimicrobial agents .Methods Data′s of 296 cases of bile specimens treated from January 2011 to December 2013 were retrospectively surveyed and drug resistance of bacteria culture results were analyzed .Results Among all the 296 cases ,there were 199 cases of pathogenic bacteria in bile specimens ,the positive rate was 67 .23% ;among them ,there were 21 cases of two kinds of bacteria ,a total of 220 strains of pathogenic bacteria were detected ,and among them there were 158 strains of gram negative bacteria ,accounting for 71 .82% ;there were 46 strains of gram positive bacte‐ria ,accounting for 20 .91% ;there were 16 strains of fungi ,accounting for 7 .27% ;the lowest resistance of gram negative bacilli lies in amikacin ,followed by tazobactam ,aztreonam ,three to four generations of cephalosporins and quinolone .Gram negative bacilli has the highest drug resistance to pseudomonas aeruginosa and e .coli ,and it has a drug resistant rate higher than 50 .00% to most anti‐microbial drugs .Gram positive cocci has 0 drug resistance rate to add ring element ,has a drug resistance rate lower than 30 .00% to vancomycin and rina thiazole amine ,and has highest drug resistance rate (70 .00% -100 .00% ) to erythromycin ,clindamycin and chlorine lincomycin .Conclusion Among all the 296 cases of common bile duct calculi bile with biliary tract infection ,the main path‐ogenic bacteria were e .coli ,klebsiella pneumoniae ,eosinophilic malt narrow and excrement enterococcus bacterium ;and the drug re‐sistance to penicillin is highest .

Objective · To investigate the expression of androgen receptor (AR) in human breast cancer and its prognostic significance. Methods · A total of 183 female patients with breast cancer were selected. The expression of AR in breast cancer tissues was detected by immunohistochemical staining. The relationship of AR expression with the clinicopathological characteristics was analyzed. Survival analysis of AR gene expression by an online database (Kmplot) was also performed. Results · The positive rate of AR expression was 47.5% and was significantly higher in grade 1 and grade 2 group than that in grade 3 group (57.6% vs 25.0%, P<0.05). Breast cancer patients with estrogen receptor, progesterone receptor and P53 positive expression had significantly increased AR levels (P<0.05). AR expression were significantly higher in patients with luminal type as compared withthose in patients with human epidermal growth factor receptor-2 (HER2) positive and patients with triple negative breast cancer (51.7% vs 31.6%,P<0.05). Kaplan-Meier curves identified that AR gene expression was positively correlated with relapse-free survival, overall survival and distant metastasis-free survivalof breast cancer patients (P<0.05). Conclusion · The breast cancer patients with AR positive expression have a better prognosis, which suggests that inhibitors of AR pathway may be a treatment option for breast cancer.

Objective Our previous research demonstrated that trkA and p75 receptors of nerve growth factor(β-NGF) are expressed in human pterygium fibroblasts(HPF), and trkA is expressed only in conjunctiva. The purpose of present study was to investigate the effects of β-NGF on proliferation of HPF and analyse the pathogenesis mechanism of pterygium. Methods The HPF specimen was obtained from Union Hospital of Tongji Medical College, Huazhong University of Science and Technology during the surgery. Explant culture technique was used for the primary culture of HPF tissue. The cells of confluenting 80% were collected and digested using 0. 25% tripsin + 0. 02% EDTA (1:1) and the third to fifth generation of cells were utilized in the experiment. Different concentrations of β-NGF was added in medium. Cultured cells were identified using vimentin, keratin and α-SMA. MTT was used to determine the proliferation of HPF after addition of β-NGF. The expression of trkA and p75 in HPF was detected by immumofluorescence method. Cell proliferation also was semi-quantitatively analyzed by detect of expressions of PCNA protein and mRNA in HPF using Western blot and RT-PCR. Results Cultured HPF cells showed the positive responses for vimentin, α-SMA, trkA and p75 but absent reaction for keratin. MTT revealed that the OD value of HPF cells was gradually enhanced with the increase of β-NGF concentration in 12, 24, 48, 72 and 96 hours after β-NGF action with the maximum stimulation at 48 hours. The expression of PCNA protein and mRNA in HPF was significantly different among various concentrations of β-NGF groups(F_(protein) = 24. 980, P = 0. 000; F_(mRNA) = 64. 490, P = 0. 000) and increased from 5 ng/mL β-NGF group through 50 ng/mL β-NGF group in comparison with 0 and 1 ng/mL β-NGF group (P ＜ 0. 05) . Conclusion The findings demonstrate the potential proliferative effect of β-NGF binding to trkA and p75 on HPF.

Objective To investigate the value of MR intravoxel incoherent motion (IVIM)imaging and dynamic susceptibility contrast-enhanced(DSC)perfusion imaging in astrocytoma grading.Methods 22 patients with high grade astrocytoma and 28 patients with low grade astrocytoma underwent conventional MRI and IVIM,DSC scanning before operation.Parameters of IVIM included standard diffusion coefficient(ADCstandard ),slow diffusion coefficient(D),fast diffusion coefficient(D? ),fractional perfusion-related volume (f)values,and parameters of DSC included relative blood volume(rCBV),relative blood flow(rCBF)values of tumor solid part were measured quantitatively.The values between the two groups were compared by two samples t-test.By using ROC curve to evaluate the diagnostic efficacy of using IVIM and DSC alone or jointly.Results The ADCstandard ,D,rCBV,rCBF values of tumor solid part had significant differences between the groups(P<0.01).The D? and f values were no significant differences (P=0.130,P=0.379).The area under the ROC curve of the values showed that ADCstandard (0.823),D(0.854),rCBV(0.858),rCBF(0.871),D+rCBV(0.952),D+rCBF(0.953).Conclusion The D,rCBV,rCBF values are helpful to determine the grade of astrocytomas.The use of IVIM in combination with DSC may improve the diagnostic accuracy of astrocytoma grading.

group A by turns. (3) The concentrations of plasma endothelin-1 (ET-1) and angiotensin converting enzyme (ACE) were significantly higher in group B than that in group A. However, the ET-1 and ACE were significantly lower in group C than those in group B. (4) The ET-1 and ACE had a significant positive correlation with R/L+S, mPAP and PI, respectively. The multivariate linear regression analysis revealed that ET-1 and ACE were major factor affecting PI. CONCLUSION: The pulmonary vascular and myocardial structural remodeling are one of the pathogenesis accompanied with excessive cell proliferation in hypoxic pulmonary hypertension (PH). Cilazapril effectively prevents and treats the hypoxic PH by inhibiting cell proliferation and structural remodeling of pulmonary circulation, as induced by ET-1 and ACE.