Objective:To investigate the effects of sleep quality on cognitive function in elderly patients undergoing hemodialysis.Methods:In this cross-sectional study, the cognitive function in hemodialysis patients was evaluated by Montreal Cognitive Assessment(MoCA)and the sleep quality was accessed by Pittsburgh sleep quality index(PSQI). The related indexes of cognitive function were compared and the relationship between cognitive function and sleep quality was analyzed by using multiple binary Logistic regression method.Results:A total of 121 elderly hemodialysis patients aged 67.4±7.2 years with cognitive impairment of 76 cases(62.8%)were included in the study.Numbers(%)of cases with very good, good, general and poor sleep quality were 33(27.3%), 39(32.2%), 14(11.6%)and 35(28.9%), respectively.The proportion of patients with pretty good sleep quality was lower in cognitive impairment group than in normal cognitive group(13/76 or 17.1% vs.20/45 or 44.4%, P<0.001). The proportion of patients with poor sleep quality was higher in cognitive impairment group than in normal cognitive group(29/76 or 38.2% vs.6/45 or 13.3%, P<0.05). Multiple binary Logistic regression analysis showed that age( OR: 1.128, 95% CI: 1.083-1.175, P<0.001), a education level( OR: 0.353, 95% CI: 0.151-0.556, P<0.05), hypertension( OR: 2.508, 95% CI: 1.189-5.291, P<0.05), diabetes( OR: 1.913, 95% CI: 1.045-3.502, P<0.05), stroke( OR: 4.044, 95% CI: 1.439-11.365, P<0.05), dialysis age( OR: 1.016, 95% CI: 1.010-1.023, P<0.001), KT/V( OR: 0.025, 95% CI: 0.005-0.122, P<0.001)and parathormon(iPTH)( OR: 1.002, 95% CI: 1.000-1.003, P<0.05)were associated with cognitive impairment.After adjusting for above factors, sleep quality was also correlated with cognitive impairment( OR: 1.180, 95% CI: 1.108-1.258, P<0.001), showing that the risk of cognitive impairment increased by 1.18 times with every one point increase in PSQI scores. Conclusions:Cognitive impairment is associated with age, education level, hypertension, diabetes, stroke, dialysis age, KT/V and iPTH in elderly hemodialysis patient, and sleep quality is also an independent risk factor for cognitive impairment.

Objective:To study the concentrations of fine particulate matters and ultrafine particles and influenced factors during winter in an area of Beijing .Methods:Real-time monitoring of particles ’ mass and number concentrations were conducted in an area of Beijing from February 7th to 27th , 2013.At the same time, the meteorological data were also collected from the Beijing meteorological website .Differences of the particles ’ mass and number concentrations during different periods were analyzed using Mann -Whitney U test.Meanwhile, the influenced factors were also analyzed .Results: The mean concentra-tions of fine particulate matters and ultrafine particles were ( 157.2 ±142.8 ) μg/m3 and (25 018 ± 9 309) particles/cm3, respectively.The particles’ number and mass concentrations in haze days were 1.27 times and 2.91 times higher than those in non-haze days, respectively.The mass concentrations of fine particulate matters in the self-monitoring site were higher than those in the nearest central monitoring sites, and the hourly-average concentrations of particles were significantly consistent with those at the commuter times.Meanwhile, the setting off of fireworks/firecrackers during the Spring Festival could lead to short-term increases of the particles ’ number and mass concentrations .When the wind speed was low and the related humidity was high , the concentrations of particulate matters were relatively high , and the mass concentrations of fine particulate matters were lagged about 1-2 d.Conclusion: The level of the particulate matters in this area was high .Heavy traffic , setting off of fireworks/firecrackers and meteoro-logical factors may be some of the main factors affecting the concentrations of the particulate matters in this area.Among those factors, the effect of setting off of fireworks/firecrackers didn’t last long and the effect of the meteorological factors had a hysteresis effect .

Objective To evaluate the association between hypersensitive C reactive protein (hs-CRP) and the incidence of acute kidney injury in subarachnoid hemorrhage(SAH) patients.Methods It retrospectively recruited 213 cases of computerized tomography validated SAH patients from the neurology ICU from Beijing Tiantan Hospital between January 2012 and January 2015.The average age was (56.29±11.95) years old,and the patients were divided into AKI and non-AKI groups according to Kidney Disease: Improving Global Outcomes (KDIGO) diagnosis standards, Clinical features of AKI and Non-AKI patients including serum levels of hs-CRP were compared and multi-logistic regression was applied to find the risk factors concerning with the incidence of AKI.Receiver operating characteristics (ROC) curve was also plotted to evaluate the diagnostic value of hs-CRP towards the incidence of AKI.Results A total of 25 (11.74%) patients developed AKI.Average age of the SAH patients in both AKI and non-AKI groups were (63.60±12.21) years old vs.(55.31±11.60) years old(t=-3.33, P<0.05).The ratios of diabetics were were 28.00% vs.11.17% (χ2=5.47,P<0.05) and the ratio of proteinuria were 80.00% vs.34.57%, respectively (χ2=3.83, P<0.05).The median of serum creatinie were 63.72(51.45, 79.72)μmol/L vs.53.21(45.27, 65.62)μmol/L (P<0.05), and serum hs-CRP were (14.12±5.03)mg/L vs.(10.23±6.76)mg/L (P<0.05), and the ratios of antibiotics application were 84.00% vs.43.08% (P<0.05 for all).Multi-logistic regression analysis showed that serum hs-CRP was an independent risk factors for AKI after age, serum creatinine at admission were adjusted.[OR (95% CI) was 3.33(1.13, 9.85),P<0.05 for all].The area under curve of ROC was 0.69 (P<0.05), and the cut-off point of serum hs-CRP under the maximum Youden index was 13.85 mg/L.Conclusion Serum hs-CRP is an independent risk factor of theincidence of AKI in SAH patients, the significantly increase of serum hs-CRP might be an important predictor of the incidence of AKI in SAH patients.

OBJECTIVE:To observe the clinical efficacy and safety of vitamin C with large dose combined with diphosphate in the treatment of myocardial injury after neonatal asphyxia and the effects on creatine kinase isoenzyme (CK-MB) level. METH-ODS:Totally 76 children with myocardial injury after neonatal asphyxia were randomly divided into control group and observation group. Control group was given routine treatment,including oxygen inhalation,sedation,cardiotonic,Danshen injection and ener-gy mixture,etc. Based on the treatment of control group,the observation group was added diphosphate 100-150 mg/(kg·d),iv infu-sion,qd;and vitamin C 250 mg/(kg·d)adding into 10%glucose injection 20 ml,iv infusion,qd. 10 d was a course. The clinical ef-ficacy,cardiac troponin T(cTnI),CK-MB level and incidence of adverse reactions before and after treatment were observed. RE-SULTS:The total effective rate in observation group was significantly higher than control group,with significant difference(P<0.05). After treatment,the cTnI and CK-MB level in 2 groups were significantly lower than before,and observation group was low-er than control group,with significant differences (P<0.05). There were no adverse reactions in 2 groups during the treatment. CONCLUSIONS:Based on the routine treatment,Vitamin C with large dose combined with diphosphate has good efficacy in the treatment of myocardial injury after neonatal asphyxia and can effectively reduce the CK-MB level,with good safety.

With the continuous improvement of treatment ability in intensive care unit (ICU), many critically ill and complex patients have survived due to the development of technology. However, most of them suffer from the psychological and physiological problems of post-intensive care syndrome (PICS). Therefore, the early identification and prevention of PICS is particularly critical. We should understand the pathophysiological mechanism of PICS, strictly implement ABCDEFG bundle management measures [including airway management (A), breath (B), reasonable analgesia and sedation treatment (C), prevention of delirium (D), early rehabilitation (E), family engagement (F), good communication (G)] during ICU hospitalization, and pay attention to reasonable nutritional support, optimizing blood glucose management, providing positive psychological intervention and support to patients through family members' encouragement and accompanying, ICU diary and other forms, following up the health status of patients transferred out/discharged from ICU, providing multi-disciplinary and professional continuing medical services, finding the entry point and timing of traditional Chinese medicine intervention, and giving full play to the advantages of integrated traditional Chinese and Western medicine treatment, which can improve the quality of life of patients. This article reviews the pathophysiological mechanism, risk factors, prevention and management measures, traditional Chinese medicine syndrome differentiation and treatment of PICS, in order to improve the early identification, diagnosis and treatment of critical patients with PICS, and improve the prognosis of patients.

Objective: To evaluate and compare cardiac structure and function pre- and post-percutaneous interventional treatment of pulmonary hypertension (PH) using echocardiography. Methods: Eight female patients received percutaneous interventional treatment in our hospital were enrolled. All of them were suffered moderate to severe PH. Echocardiographic parameters included: right ventricular diameter (RVD), left ventricular diameter (LVD), right atrial diameter (RAD), left atrial diameter (LAD), main pulmonary arterial diameter (DMPA), left ventricular eccentric index (EI), left ventricular ejection fraction (LVEF), right ventricular systolic pressure (RVSP), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tissue Doppler-derived tricuspid lateral annular systolic velocity (s′), right ventricular index of myocardial performance (RIMP) and right ventricular free wall longitudinal strain (RVLS_FW). The median time for follow-up after interventional treatment was 98 d. Results: ①In our study, 8 patients had no significant serious complications, and only one patient had mild intimal avulsion during stenting. ②RVSP and RVD/LVD increased significantly before intervention in patients with PH (P<0.05). After interventional treatment, RVSP (P<0.01) and RVD/LVD decreased significantly (P<0.05). ③The result of follow-up showed that RVFAC, RIMP, s′and RVLS_FW improved significantly(P<0.05). Conclusions Echocardiography could evaluate the recent effect of interventional treatment and illustrates that the interventional treatment for pulmonary artery stenosis is effective and safe.

To investigate effects of l% l-acetylforskoin (l-aF) suspension eye-drops administeredtopically on intraocular pressure (IOP) in rabbits and men, and observe the loca l irritation of the drug． l% l-aF suspension eye-drops was prepared and was instilled into one of e yes while the corresponding vehicle into the contralateral eye as control． IOP was measured b y pneumatonometer before and after administration． l%1-aF suspension eye-drops s ig nificantly reduced IOP in rabbits reaching the maximum reduction of 2.2 mmHg and lasting a t least 3 hours． But it didnt show significant effects in men． There was little local irritati on neither in rabbits nor in men． l% l-aF suspension eye-drops significantly reduced IOP in normal rabbit s, but not in men． No local irritation was observed in rabbits and in men．

Objective · To improve the surgical procedure of correcting upper eyelid retraction.Methods · Patients suffering upper eyelid retraction of 2-5 mm caused by thyroid-associated ophthalmopathy were treated with modified levator lengthening technique in Shanghai Ninth People's Hospital (Shanghai Jiao Tong University School of Medicine,China) from July 2013 to December 2014.Results· Of the 34 patients underwent the modified levator lengthening surgery for upper eyelid retraction correction,there were 7 males and 27 females.After 6 months,upper eyelid retraction got fully resolved in 25 cases and partly improved in 9 cases.The palpebral fissure height demonstrated an average decrease of 3.7 mm (P=0.000).Patient's ocular discomfort such as photophobia and tearing were either cured or improved.Conclusion · Modified levator lengthening surgery can effectively correct upper eyelid retraction,improve the patient's appearance and cure their ocular discomfort.

Objective:To explore the related risk factors of aortic arch calcification (AoAC) and the relationship between AoAC and long-term outcome in maintenance hemodialysis patients.Methods:The patients who underwent hemodialysis in the Blood Purification Center of Beijing Shijitan Hospital Affiliated to Capital Medical University from March to June 2015 were recruited. Calcification of the aortic arch was estimated with plain chest radiology. The patients were divided into AoAC group and no-AoAC group. Multivariate binary logistic regression was used to analyze the influencing factors of AoAC. Kaplan-Meier analysis and Cox regression model were used to examine the association between AoAC and adverse prognostic events (all-cause death and cardiovascular events).Results:There were 157 hemodialysis patients included in this study, with age of (62.63±15.05) years (30-90 years old) and 85 males (54.14%). The median follow-up time was 54(20, 54) months. There were 99 cases (63.06%) in AoAC group and 58 cases (36.94%) in no-AoAC group. The age, proportion of diabetes history, serum corrected calcium and triglyceride levels in AoAC group were higher than those in no-AoAC group (all P<0.05), while the proportion of using active vitamin D, serum albumin and intact parathyroid hormone level were lower than those in no-AoAC group (all P<0.05). Multivariate logistic regression analysis showed that older age ( OR=1.109, 95% CI 1.067-1.152, P<0.001), diabetes ( OR=4.110, 95% CI 1.551-10.890, P=0.004), longer dialysis duration ( OR=1.026, 95% CI 1.010-1.043, P=0.001), higher systolic pressure ( OR=1.039, 95% CI 1.012-1.067, P=0.005) and higher triglycerides levels ( OR=1.932, 95% CI 1.148-3.125, P=0.013) were the independent risk factors of AoAC, and higher hemoglobin was a protective factor ( OR=0.967, 95% CI 0.938-0.998, P=0.035) of AoAC. Sixty-three cases (63.64%) died, and 78 cases (78.79%) had cardiovascular events in AoAC group. Fourteen cases (24.14%) died, and 12 cases (20.69%) had cardiovascular events in no-AoAC group. Kaplan-Meier analysis showed higher incidence rate of all-cause death (Log-rank χ2=22.499, P<0.001) and cardiovascular events (Log-rank χ2=50.797, P<0.001) in patients with AoAC. Multivariate Cox regression analysis showed AoAC was the independent risk factor of all-cause death ( HR=2.003, 95% CI 1.039-3.859, P=0.038) and cardiovascular events ( HR=5.642, 95% CI 3.003-10.600, P<0.001). Conclusions:Older age, diabetes mellitus, longer dialysis duration, hypertension, higher triglyceride levels and lower hemoglobin are significantly associated with AoAC. AoAC is the independent risk factor of all-cause death and cardiovascular events in maintenance hemodialysis patients.

Cerebral white matter hyperintensity(WMH)is a type of ischemic alteration that appears as speckled or patchy areas around the ventricles and in the centrocentral area of the semiovals.This alteration can be caused by various factors and indicates a change in the composition of the white matter in the brain.It suggests an alteration in the water content of the hydrophobic white matter fiber bundles.WMH is commonly used as an imaging marker for cerebral small vessel disease.Previous studies have shown that WMH is highly correlated with cognitive impairment.Large-scale longitudinal studies,both population-based and hospital-based,have confirmed the correlation between WMH and clinical symptoms and demonstrated a causal relationship between large-scale WMH and dementia.Adequate differential diagnosis,evaluation,and management are crucial for patients,especially those with early cognitive impairment.Novel imaging techniques may detect subtle impairments before they become visible on an MRI.The purpose of this review is to offer a comprehensive overview of the relationship between WMH and cognitive function.