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.

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 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

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 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 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 prevalence and the relative factors of the overweight and the obese in a population of Gansu Province pre-pregnancy women.and the effects of pre-pregnancy maternal body mass index (BMI) on gestational weight gain and pregnant outcome.Methods We conducted a populationbased birth cohort study in Gansu Province Maternity and Child Health Care Hospital from February,2010 to December,2011.Single live term birth women who have complete anthropometry were enrolled this study.They were categorized into four BMI groups according to World Health Organization's BMI recommendations for Asian populations.We explored the prevalence and the relative factors of the overweight and the obese,and the effects of pre-pregnancy maternal body mass index on gestational weight gain and birth outcomes by Chi-square test,analysis of variance.Results A total of 6 400 cases included in this study.The BMI range is from 13.3 to 38.1,the average BMI is (20.6 ±2.7).Among 6 400 cases,636 cases(9.9％) and 416 cases (6.5％) were overweight and obese.The average age (unit:years) is increase gradually in low weight group (27.8±3.8),normal group (29.1 ±4.3),overweight group (30.3 ±4.7) and obese group (30.6±4.6),the difference was statistically significant (F=77.490,P＜0.01).The result prompt that the median BMI increased with the increasing of maternal age (r=0.18,P＜0.01).The BMI of multiparous women (21.22 ±2.63) is higher than nulliparous women (20.43 ± 2.64),the difference was statistically significant (t=-9.630,P＜0.01).The BMI has negatively correlated with education level and economic income level (r=-0.06,P＜0.01; r=-0.04,P=0.036).With the increase of BMI,the weight gain of early (13 weeks) pregnancy (F=8.892,P＜ 0.01) and the total weight gain during whole pregnancy (F=21.700,P＜ 0.01) gradually reduced in four groups.The neonatal birth weight in overweight group is largest,in turn higher than obesity group,normal group and low weight group,the difference was statistically significant (F=11.261,P＜0.01).With increasing BMI,the incidence of pre eclampsia (x2=85.758,P＜0.05),gestational diabetes mellitus (x2=58.913,P＜0.05),postpartum hemorrhage (x2=13.501,P＜0.05),neonatal hypoglycemia (x2=6.563,P＜0.05) and neonatal pulmonary hyaline membrane (x2=9.579,P＜0.05) was increased.The incidence of caesarean section (x2=125.442,P＜0.05),macrosomia (x2=62.963,P＜0.05) and birth defects (x2=9.087,P＜0.05) also increased.The incidence of abnormal umbilical cord in overweight group is highest,in turn higher than normal group,low weight group,and the obesity group (x2=15.82g,P=0.001).The incidence of neonatal electrolyte disorder in obesity group was higher than low weight group,normal group,and the overweight group (x2=12.092,P=0.007).The incidence of preterm birth in overweight group is highest,in turn higher than obesity group,normal group and the low weight group (x2=7.865,P=0.049).Compared with the normal group,the risk of caesarean section (OR=l.700,95％ CI:1.325-2.181),pre-eclampsia (OR=2.436,95％ CI:1.578-3.761),gestational diabetes (OR=3.182,95％ CI:1.049-9.653) and abnormal umbilical cord (OR=2.252,95％ CI:1.267-4.004) in overweight group was increased.the risk of pre eclampsia (OR=2.585,95％ CI:1.020-6.914),macrosomia (OR=2.484,95％ CI:1.017 6.070),neonatal electrolyte disorder (OR=4.430,95％ CI:1.290-t5.217) in obesity group was increased.Conclusions The median BMI before pregnancy increased with increasing maternal age,parity,but decreased with education level and income level.The weight gain of early (13 weeks) pregnancy and the total weight gain during whole pregnancy decreased with increasing BMI.Overweight and obesity before pregnancy increased the risk the caesarean section,preeclampsia,gestational diabetes,macrosomia and neonatal electrolyte disorder.

Objective To investigate the possible effect of ginsenoside Rg1 and oligo Aβ1-42 on PKA/CREB pathway.Methods The damage was induced by oligomeric Aβ1-42 in primary cortical neuron.Neurons were incubated with or without glutamate,or incubated in Aβ,or pre-incubated in Rg1 and then co-incubated in Aβ.The proteins of p-CREB,t-CREB,PKA Ⅱ α and BDNF were detected by Western blot.Results After the treatment with Oligo Aβ1-42 for 2 h,the p-CREB/t-CREB level induced by glutamate was obviously lower (P＜ 0.001).However,in neurons pre incubatedwith 2.5,5.0,10.0 μmol/L of ginsenoside Rg1 and then co-incubated with 5μmol/L of oligo Aβ1-42,the p-CREB/t-CREB induced by glutamate was significantly increased as compared with that of Aβ1-42 group (P＜0.05).Upon Aβ1-42 exposure for 2 h,cortical neurons showed a statistically significant increase in PKA Ⅱ α as compared to the control group (P ＜ 0.001).Pre-treatmentwith varying doses of ginsenoside Rg1 (2.5,5,10μmol/L) showed a decrease in PKA Ⅱ α as compared to neurons treated with Aβ1-42 alone for 2 h (P＜0.001).Furthermore,BDNF level significantly increased in Rgl-pretreated cells as compared to cells treated with Aβ1-42 alone for 24h (P＜0.05).Conclusions Ginsenoside Rg1 attenuates the oligo Aβ142 inhibition of PKA/CREB pathway.

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.