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 The diagnosis and treatment of renal angiomyolipoma were studied. Methods A total of 72 cases of renal angiomyolipoma encountered and treated from Jan. 1983 to Dec. 1999 were reviewed. Results Of the 72 cases, 13 were misdiagnosed preoperatively.The positive diagnosis rate of ultrasonography was 73.6%(53/72) and that of CT 81.9%(59/72).10 cases( 13.9 %) had been misdiagnosed preoperatively with the combined use of ultrasonography and CT.Tumors smaller than 4 cm had a significantly higher misdiagnosis rate( P

Objective To investigate the changes of the serum level of IL-6 and IL-10 as well as their significance after coronary artery stent implantation. Methods The study involved 30 patients who underwent coronary artery stent implantation. Blood stamples were taken from the femoral arteries before and 24h after successful coronary stenting. Serum concentration of interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured and complications as well as the occurance of restenosis were observed after the procedure. Results The concentration of IL-6 in femoral aterial blood was significantly higher after 24 hours of stent-implantation (214.6?118.0 ng/L vs 175.8?81.8 ng/L, P 0.05, and the ratio of IL-6/IL-10 increased (3.2?1.9 vs 2.3?1.0, P

AIM: To establish the quality standard for Jieeryin Effervescent Tablets (Fructus Cnidii, Folium Artemisiae Argyi, Radix Sophorae Flavescentis, Cortex Phellodendri, etc.). METHODS: Radix Sophorae Flavescentis、Cortex Phellodendri、Radix Scutellariae and Fructus Gardeniae in Jieeryin Effervescent Tablets were identified by TLC. The content of geniposide was determined by HPLC. RESULTS: The average recovery was 99% and relative standard deviation was 1.6%. CONCLUSION: The precision and reproducibility of the method are good. The method can be used for quality control of Jieeryin Effervescent Tablets.

Objective To evaluate the detection competence of HbA2 and HbF in Guangxi medical laboratories.Methods The external quality assessment(EQA) of HbA2 and HbF was conducted twice a year and five samples was detected each time during 2012 to 2016.The laboratories participated in EQA completed the samples' detection and submitted the detection results at specified time according to the requirements of EQA.The distribution of each detection system,the qualification rate of each laboratory,the variation degrees of each detection system and each detection method,and the variations of results for different levels of quality control(QC) materials during 5 years were analyzed based on the returned results.Results The application of high performance liquid chromatography (HPLC) and capillary electrophoresis(CE) increased year by year and their usage rates in 2016 reached up to 46.1％ (82/178) and 18.0％ (32/178),respectively.The qualification rates of HbA2 and HbF increased from 51.5％ (34/66) and 60.6％ (40/66) in 2012 to 93.3％ (166/178) and 92.1％ (164/178) in 2016,respectively.The average coefficient of variation(CV) of each detection system decreased year by year.There were good CVs for the results of high,medium and low levels of HbA2 QC materials detected by the Bio-Rad Variant Ⅱ and Sebia CAPILLARYS 2 systems,and they were less than 6.0％.HPLC and CE could quantitatively detect the HbA2 and HbF levels,and their total detection competence was superior to that of agarose gel electrophoresis.Conclusion EQA can assess the abihty of one laboratory detecting HbA2 and HbF,and quantitatively analyze the levels of HbA2 and HbF,which may provide the quality assurance and data support for the screening and prevention of thalassemia.

Objective To explore the pathological basic of some common characteristic of papillary microcarcinoma of thyroid in ultrasound. Methods Totally 117 thyroid papillary microcarcinomas that were completed all thyroid ultrasound examinations before the surgical excisions were collected. Shape, border, internal echogenicity, halo, posterior echogenicity and calciifcation were observed in ultrasound. While the degree of inifltration of the tumor, the tumor’s internal structure as well as calciifcation was observed in pathology. Results IIrregular shape (87.18%, 102/117), unclear border (80.34%, 94/117), hypoechoic (90.60%, 106/117) and microcalciifcations (65.81%, 77/117) were recognized by ultrasound while the main pathological features were invasive growth (93.16%, 109/117), cell components internally (46.15%, 54/117) and calciifcation (56.41%, 66/117). Of the 109 neoplasms which were invasive growth in pathology, 102 (93.58%) nodules presented irregular shape in ultrasound while 91 (77.78%) presented unclear border. All of the 8 neoplasms which were not invasive growth in pathology showed regular shape in ultrasound. Thirteen nodules showed halos in ultrasound, and 8 of them showed visible ifbrous capsule surrounding the mass. Whatever the tumor’s internal structure was, most nodules presented hypoechoic. And the hyperechoic nodules were all found cell components internally. Of the 66 neoplasms which were found calciifcation by microscope, 35 (53.03%) nodules showed calciifcation in ultrasound and 31 (46.97%) did not. And of the 51 neoplasms in which calciifcation were not found by microscope, 42 (82.35%) nodules showed calciifcation in ultrasound and 9 (17.65%%) did not. Conclusions There is no doubt that all the performances of papillary microcarcinoma in ultrasound have bases in pathology. It is helpful to the judgment of a thyroid nodule if we could understand the correlation of performances in ultrasound and pathology.

Objective To understand the effect of astragalus on insulin resistance and plasma amylin levels in newly diagnosed type 2 diabetic patients.Methods 88 patients of newly diagnosed type 2 diabetes were randomly divided into three groups:Group A (lifestyle intervention group) contained 30 patients,Group B (metformin treatment group) also contained 30 Patients,and Group C (astragalus and metformin treatment group) contained 28 Patients.Patients in group A were intervened with the control of diet,blood pressure and lipids level; patients in group B were additionally treated with metformin on the basis of group A; patients in group C were additionally treated with metformin and astragalus on the basis of group A.The course for both treatments were 8 weeks.Various clinical and biochemical parameters were detected before and after the treatment in all three groups and enzyme-linked immunosorbent assay was adopted for the detection of plasma amylin.Results Fasting blood glucose levels were significantly decreased after treataent in the three groups (t=-2.696、-4.029、-3.995,P＜0.05) ; insulin resistance index reduced in group B and group C (t=-2.599、-3.813,P＜0.05),the difference between group C and group B was statistically significant (t=-2.334,P＜0.05) ;treatments of group B and group C could improve the beta cell function index (t=2.303、2.384,P＜0.05),and they also could increase the plasma amylin level (t=2.341、3.045,P＜0.05).Conclusion Astragalus and metformin can improve insulin resistance index and increase plasma amylin levels in newly diagnosed type 2 diabetic patients.

Objective To explore the gender differences in patients with primary hyperparathyroidism (PHPT) concurrent with upper urinary tract stone.Methods The clinical data of 40 PHPT concurrent with upper urinary tract stone cases treated from January 1997 to December 2013 were analyzed retrospectively.There were 21 males and 19 females,with an mean age of 51 years (26-77 years).All patients underwent operation for PHPT,with preoperative parathyroid hormone (PTH) level of (38.42± 30.11)pmol/L.The PTH level in female patients was significantly higher than that in male patients (29.37± 17.64pmol/L versus 48.47±40.55 pmol/L,P=0.04).Serum biochemical variables were monitored,and 21 cases had 24 h-urinalysis.Results Postoperative pathology confirmed 36 cases of parathyroid adenoma and 4cases of parathyroid hyperplasia.Hypercalcemia and hypophosphatemia were improved with no significant gender difference (both P＞0.05).But in 21 cases of 24 h-urinalysis,urinary calcium and phosphorus in males were significantly higher than those in females (8.26±2.60 mmol/24 h versus 6.08± 1.59 mmol/24 h,P=0.03; 7.03±1.44 mmol/24 h versus 5.42±1.25 mmol/24 h,P=0.01).Conclusion In patients with PHPT concurrent with urolithiasis,male patients may be more associated with hypercalciuria.

Objective To understand the effect of astragalus on serum levels of advanced glycation end products (AGEs),soluble receptor for advanced glycation end products (sRAGE) in newly diagnosed patients with type 2 diabetes.Methods 60 patients of newly diagnosed type 2 diabetes were randomly divided into control group (28 patients) and treatment group (28 patients),the control group was given control of blood glucose,blood pressure,lipids and other necessary treatment,and the treatment group was additionally treated with astmgalus granule based on the control group.The course for both treatments is 12 weeks.Various clinical and biochemical parameters were tested before and after treatment in both groups with enzyme-linked immunosorbent assay for the detection of serum AGEs,sRAGE levels.Results ① Glycosylated hemoglobin (HbA1c) in the control group after treatment (7.28± 0.83)％ was significantly decreased than before treatment (9.57±1.14) ％,the difference was statistically significant (t＝5.75,P＜0.05); glycerin three greases (TG) in the control group after the treatment (1.45± 0.39)mmol/L decreased significantly compared with those before treatment (1.92± 1.01)mmol/L,the difference was statistically significant(t＝2.79,P＜0.05); ② HbA1c (7.16± 0.88) ％ in the treatment group after treatment was significantly decreased than before treatment (9.29± 1.62)％,the difference was statistically significant (t＝6.08,P＜0.05) ; TG (1.53 ± 0.41) mmol/L in the treatment group after treatment was significantly decreased compared with those before treatment (2.11 ± 0.79)mmol/L,the difference was statistically significant (t ＝ 2.40,P ＜ 0.05) ; the levels of serum sRAGE (20.38 ± 8.01) ng/ml in the treatment group after treatment increased obviously compared with those before treatment (15.10 ± 9.22)ng/ml,the difference was statistically significant (t＝-2.29,P＜0.05); ③ The level of serum sRAGE (20.38 ± 8.01) ng/ml in the treatment group after treatment increased obviously than the levels of serum sRAGE (15.13 ± 9.27)ng/ml in the control group after treatment,the difference was statistically significant (t＝-1.17,P＜0.05).Conclusion Astragali can increase serum sRAGE expression in newly diagnosed type 2 diabetic patients.

Objective To investigate the antibiotic resistance of extended-spectrum β-lactamases (ESBLs)-producing bacteria,and the risk factors for patients with hospital-acquired lower respiratory tract infections caused by these bacteria.Methods The clinical data of 80 cases of hospital-acquired lower respiratory tract infections caused by ESBLs + bacteria in the People's Hospital of Qingtian in Zhejiang Province from July 2008 to December 2011 were collected; and 160 cases of nosocomial infection caused by ESBLs- bacteria were randomly selected as controls.Univariate analysis and multivariate logistic regression were used to analyze the risk factors for ESBLs + bacteria infection.The resistance of sixteen antibiotics was detected by K-B method.Results Univariate analysis revealed that the risk factors for nosocomial lower respirator tract infection caused by ESBLs+ bacteria were hospitalization ≥ 10 d,readmission to hospital,oxygen inhalation,invasive operations,using antacid ＞ 7 d,using glucocorticoids ＞ 7 d,using immunosuppressant ＞ 7 d,using third-generation cephalosporins,using fluoroquinolone antibacterials,and the combined use of antibiotics≥3 d.Multivariate logistic regression analysis identified five independent risk faetors:oxygen inhalation (OR =8.613,95％ CI:1.870-39.659),invasive operations (OR =5.900,95％CI:1.885-18.467),using third-generation cephalosporins (OR =7.465,95％ CI:2.364-23.578),using fluoroquinolone antibacterials (OR =4.481,95％ CI:1.197-16.781) and combined use of antibiotics≥3 d (OR =5.346,95％ CI:1.717-16.643).ESBLs + Escherichia coli and Klebsiella pneumoniae strains were sensitive to imipenem,meropenem,cefoperazone /sulbactam and piperacillin/tazobactam (with the resistance rates lower than 30.00％),but were highly resistant to most β-lactam,aminoglycoside,fluoroquinolone and sulfonamide antibacterials.Conclusion ESBLs + isolates were highly resistant to most antibacterials,and hospital-acquired lower respiratory tract infections with ESBLs+ bacteria are mainly related with invasive operations and the use of antibiotics.