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.

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 .

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 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 liver surgical site infection related influencing factors were discussed.Methods Retrospective analysis the clinical data of A total of 1 187 patients with liver and gallbladder surgery,using SPSS12.0 software for statistical analysis of data.Results A total of 1 187 cases of liver and gallbladder surgery patients and 63 cases of surgical site infection occurred,the in-fection rate of 5.31%,including incision shallow tissue 51 cases,8 incision deep tissue,organ lacuna in 4 cases,accounted for 80.95%,12.70% and 6.35% respectively.Isolated pathogenic bacteria distribution and composition ratios were as follow,15 strains of gram-negative bacteria(55.56%),12 gram positive bacteria strains(44.44%),including gram-negative bacteria in e.coli, gram-positive bacterium with staphylococcus aureus detection most(25.93% and 14.81% respectively),not isolated fungus;Age, presence of diabetes mellitus,drainage time,postoperative complications,operation time and open operation for independent risk fac-tors for surgical site infection (P <0.05).Conclusion Liver and gallbladder surgery in patients with surgical site infection is asso-ciated with a variety of factors,should strengthen the preoperative patients with postoperative condition evaluation,improve the lev-el of operation at the same time,thereby reducing surgical site infection.

Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO).Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study.Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female.The average age was (51.25 ± 12.24) years and the course was 5-17 days.All patients were given best corrected visual acuity (BCVA),intraocular pressure,slit lamp with preset lens,fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination.The patients were divided into conbercept and laser group (group Ⅰ),laser group (group Ⅱ) and conbercept group (group Ⅲ),with 30 eyes in each group.The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072,0.286;P=0.930,0.752).Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg),and macular grid pattern photocoagulation 3 days later.Group Ⅱ patients were given macular grid pattern photocoagulation.Times of injection between group Ⅰ and Ⅲ,laser energy between group Ⅰ and Ⅱ,changes of BCVA and CMT among 3 groups at 1 week,1 month,3 months and 6 months after treatment were compared.Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20 ± 0.41) and (2.23 ± 1.04) times respectively,and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections.The difference of injection times between two groups was significant (P＜0.001).Patients in group Ⅱ had received photocoagulation (1.43 ±0.63) times,9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation.The average laser energy was (96.05 ±2.34) μV in group Ⅰ and (117.41 ±6.85) μV in group Ⅱ,the difference was statistical significant (P=0.003).BCVA improved in all three groups at last follow-up.However,the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607,-4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=-0.802,P=0.429).The mean CMT reduced in all three groups after treating for 1 week and 1 month,comparing that before treatment (t=-11.855,-10.620,-10.254;P＜0.001).There was no statistical difference of CMT between group Ⅰ and Ⅲ at each follow up (t=0.404,1.723,-1.819,-1.755;P=0.689,0.096,0.079,0.900).CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=-4.621,-3.230;P＜0.001,0.003).The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month,but the difference was not statistically significant (t=1.995,P=0.056).All patients had no treatment-related complications,such as endophthalmitis,rubeosis iridis and retinal detachment.Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO.Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.

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.

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.