Delirium is defined as an acute imbalance state in the higher nervous center.It is more of ten been an accompanied syndrome,or may be a complication associated with the diagnosis and treatment of cancer.Delirium occurs frequently in cancer patients,especially in terminal patients.No more attention was paid on it yet.Its clinical feature,diagnosis and treatment were described.

ObjectiveTo observe prophylactic effect and reliability of warfarin n preventing recurrant ischemic stroke.Methods168 patients identified as ischemic stroke admitted in Chaozhou Central Hospital from March 2001 to May 2004 were randomly divided into 2 groups,warfarin group and ticlopidine group (set as control).82 cases were in warfarin group,receiving warfarin 0.75~2.25mg/d orally.Prothrombin and international normalized radio (INR) were monitored,and INR was 1.5~2.0.86 cases were in ticlopidine group;they received 250mg/d ticlopidine orally.All patients were followed up every monty for 3 years,and recurrent ischemic stroke and drug side-effect were documented.ResultsThere were 8 cases (9.76%) of recurrence in warfarin group and 26 cases (30.02%) of recurrence in ticlopidine group.There was statistically significant difference between the two groups (P

Objective To observe the efficacy and safety of fluticasone propionate ointment in the treatment of psoriasis vulgaris. Methods A randomized comparative clinical observation was performed in 68 patients with pso-riasis vulgaris, they were divided into experimental group and control group. The experimental group of 34 cases was treated with fluticasone propionate ointment and the control group of 34 cases with kenacort-A ointment. The response was evaluated at 6 weeks. Results The total effective rate of the experimental group was 94.1% and 70.6% in the control group after 6 weeks. There was a significant difference between the two groups in treatment effective rate(P<0.01). Conclusion It is effective and safety for fluticasone propionate ointment in the treatment of psoriasis vulgar-is.

Objective To evaluate the feasibility and advantage of using withdrawable Sigma stent for the treatment of tracheo-esophageal fistular. Methods The stents were placed into trachea or/and esophagus by interventional or/and endoscopic technique. Results Esophageal cancerin 17 and benign disease in 2. Totally 38 stents were placed in 19 cases of patients (trachea 19, main bronchus 1, esophagus 18). Only one tracheal stent was placed in 2 cases. Two stents(one in trachea, another in esophagus) were placed in 15 cases ( 11 cases with 2 tubular type stent, 4 cases with one tubular and one bifurcated type stent). Three stents were placed in 2 cases. One stage placement of the stent in 35, withdrawed the stent and reinserted again in 3. All the patients have normal meal 2～4 days postoperatively. Only one patient had a little contrast in the trachea during X-ray exam but without symptoms, the fistulae completely sealed in 18 cases. Follow-up was fron 3 months to 3 year. 10 patients were still alive; the longest survival is 18 months. There were 9 deaths. The causes of death were pulmonary infection in 1, hemorrhage in 1, and systemic metastasis in 7 cases. Conclusion Sigma stent is can effectively treat tracheal or/and esophageal stenosis or fistular.

OBJECTIVETo explore the action mechanism of electroacupuncture (EA) at "Shenmen" (HT 7) and "Sanyinjiao" (SP 6) on insomnia.

METHODSThirty SD rats were randomly divided into a blank group, a model group and an EA group, 10 cases in each group. The insomnia model was made by immobilization method in the model group and EA group. After model establishment, rats in the blank group and model group were treated with fixation and no treatment was given. Rats in the EA group were treated with EA at "Shenmen" (HT 7) and "San-yinjiao" (SP 6) for 15 min, once a day for 4 days. After treatment, the level of daytime and nighttime activity, open-arm entry percentage and open-arm time percentage of elevated plus-maze test were measured; the content of noradrenaline (NE), dopamine (DA) and epinephrine (EPI) in plasma and NE, DA in thalamus and brainstem were detected by using euzymelinked immunosorbent assay method.

RESULTSCompared with the blank group, the daytime activity was increased and nighttime activity was reduced in the model group (both P<0. 05); the open-arm entry percentage and open-arm time percentage of elevated plus-maze test were both reduced in the model group (both P<0. 05); the contents of NE, DA, EPI in the plasma and NE, DA in thalamus and brainstem were increased in the model group (all P<0. 05). Compared with the model group, the daytime activity was reduced and nighttime activity was increased in the EA group (both P<0. 05); the open-arm entry percentage and open-arm time percentage of elevated plus-maze test were both increased in the EA group (both P<0. 05); the contents of NE, DA, EPI in the plasma and NE, DA in thalamus and brainstem were reduced in the EA group (all P< 0. 05).

CONCLUSIONElectroacupuncture at "Shenmen" (HT 7) and "Sanyinjiao" (SP 6) can restrain the over-activity of the sympathetic-adrenal medullary system to treat the insomnia.

Acupuncture Points ; Adrenal Medulla ; metabolism ; Animals ; Anxiety ; Disease Models, Animal ; Dopamine ; metabolism ; Electroacupuncture ; Female ; Humans ; Male ; Norepinephrine ; metabolism ; Rats ; Rats, Sprague-Dawley ; Sleep Initiation and Maintenance Disorders ; metabolism ; physiopathology ; psychology ; therapy ; Sympathetic Nervous System ; physiopathology

Objective To explore the neuroprotective effect of cyclosporine A against cerebral ischemia in a rat model of cerebral ischemia reperfusion. Methods Fifty-two adult male SD rats, weighted 250-280 gram, were randomly divided into three groups: the sham group (group A, n=6), PBS control group (group B, n=23) and cyclosporine A group (group C, n=23). Group C received hypodermic injection of cyclosporine A 10mg/kg daily after surgery and group B re?ceived equal volume of PBS instead. Modified Neurological Severity(mNss)scores were used to assess the neurological deficits at 3, 7, 14, 21 and 30 days following cerebral ischemia. The infarct volume were measured 3 days after reperfu?sion. The neurons, reactive microglia and astrocytes around the infract area were detected by immunofluorescence at 3 and 30 days after surgery. Results Modified Neurological Severity scores were significantly lower in group C than group B at the third(P=0.003),seventh (P=0.011),Fourteenth (P=0.000),twenty-first (P=0.003) and thirtieth (P=0.004) days after surgery. cyclosporine A reduced infarct volume, reactive microglia and astrocytes while increased survived neurons (P<0.001) in ischemic penumbra 3 and 30 days after reperfusion (all P<0.001). Conclusion Continuous injection of cyclosporine A not only protects neurons against ischemia damage but also improves neurological functional recovery af?ter acute stage of damage, possibly through reduction of reactive microglia cells and proliferation of astrocytes.

Objective To study the efficacy of intra-tumoral injection of different concentrations of ethanol for nude mice with implanted pancreatic cancer and provide evidence for choosing appropriate concentration of ethanol for clinical treatment of pancreatic cancer.Methods A subcutaneous xenograft mouse model of human pancreatic cancer SW1990 was established.Forty-eight nude mice with similar tumor size were randomly divided into 20％,40％,60％,80％,95％ ethanol injection groups and saline injection group.The longest (a) and the shortest diameters (b) of tumor of nude mice were measured.Tumor volume (TV),relative tumor volume (RTV) and the relative rate of tumor proliferation (T/C％) were calculated.Eight days later the nude mice were sacrificed.The tumor tissue was harvested for pathologic examinations.Results RTV in 20％ ethanol injection group was similar that of saline injection group (P =0.212).RTV in 40％,60％,80％ and 95％ ethanol injection groups were significantly lower than that in saline injection group (P ＜ 0.01).RTV was less than 1 and T/C％ was less than 30％ in 60％,80％ and 95％ ethanol injection groups.The values of RTV and T/C％ decreased with the increase of ethanol concentration.RTV in 80％ and 95％ ethanol injection groups were significantly lower than that of 60％ ethanol injection group (P =0.003 and P =0.009).RTV was similar in 80％ and 95％ ethanol injection groups (P =0.819).The pathologic examinations showed no tumor necrosis in saline injection group,while small amounts of necrosis in implanted pancreatic cancer was observed in 20％ and 40％ ethanol injection groups,while a large area of coagulation necrosis could be found in 60％,80％ and 95％ ethanol injection groups.Conclusions Intra-tumoral injection of 80％ ethanol is feasible therapy method for nude mice with human pancreatic cancer xenografts.

Objective:To evaluate the effects of periodontal flap surgery with the aid of microscope in the treatment of patients with chronic periodontitis(CP).Methods:30 patients with CP included in the study were randomly divided into 2 groups.Patients in the experiment group received periodontal flap surgery with the aid of microscope,while those in the control group received the routine flap surgery.The VAS pain scores were compared 1 ,3 and 7 days after surgery.The periodontal parameters were compared 3 and 6 months after surgery between 2 groups.Results:The VAS pain score in the experiment group was significantly lower than that in the control group 1 and 3 days (P =0.01 7 and 0.004)after surgery;the periodontal probing depth in the experiment group was significantly lower than that in the control group 3 and 6 months (P =0.01 0 and 0.047)after surgery.Conclusion:The periodontal probing depth,gin-gival recession and clinical attachment level can be improved and the pain can be reduced in the treatment of CP patients with the aid of microscope in the periodontal flap surgery.

Objective To establish the orthotopic human pancreatic cancer model in mice and study the method to detect the tumor growth. Methods Human pancreatic cancer cell lines SW1990 in logarithmic phase was made into cell suspension and in situ injected into the envelope of pancreatic tail of BALB/c nude mice. High-frequency endoscopy ultrasound was used to observe the growth of tumor mass and its imaging characteristics were studied. Results 20 nude mice were successfully implanted, and 1 died 25 h after implantation. 14 days after implantation, the tumor of pancreatic cancer on EUS was (8.09 ± 2.61) mm3, the tumor appeared as homogeneous hypoechoic mass with clear boundary, and envelope as well as sound halo was present, and the shape was regular; there was low speed circular vasculature signal in around 30% of tumor.The tumor size increased to (12.40 ± 3.51)mm3, and the shape of 70% tumor was irregular, and some appeared as lobulated, and the tumor appeared as heterogeneous hypoechoic mass, no necrosis or liquefaction was found 28 days after implantation. There was low speed circular vasculature signal in around 70% tumors.Conclusions The orthotopic pancreatic cancer model in nude mouse can be established by in situ injection and this method is relatively ideal because it is simple and effective. The high frequency probe of endoscopic ultrasonograph is a reliable method for monitoring implanted pancreatic cancer.

Objective To evaluate the efficacy and tolerability of EUS-guided intra-tumoral injection of E1B gene-deleted adenovirus (H101) combined with intravenous gemcitabine for unresectable pancreatic carcinomas. Methods Nineteen patients with advanced adenocarcinoma of the pancreas who were not resectable and never to anti-cancer treatment were enrolled in this study. Each patient underwent two sessions of EUS-guided H101 intra-tumoral injection in combination with gemcitabine (i. v. , 1000 mg/m2, d3, 10, 17). The tumor size before and after H101 intra-tumoral injection were recorded for efficacy assessment. The changes of pain score and KPS, adverse effects and complication rates, survival were estimated. Results The tumor size decreased in twelve patients by5.3% ~ 69.7% , but the difference was not statistically significant (P =0.275). All of nineteen patients completed two cycles of combination treatment. Among them, 3 (15. 8% ) achieved partial response, 10 (52.6% ) had stable disease, and none had complete response. The mean pain score after injection was significantly lower than that before injection (3.1 ±1.7 vs. 3.9±1.6, P = 0.004). KPS after injection was significantly increased more than that before injection [ (68.4 ± 12.1)% vs. (61.1 ±9.9)%, P =0.003)]. There was no complication associated with the procedure. Major adverse effects associated with H101 injection were fever and diarrhea. The survival time was 2.5 to 10 months. Nine patients were still alive. Conclusions EUS-guided E1B gene-deleted adenovirus intra-tumral injection in unresectable pancreatic carcinomas is feasible and well tolerated in combination with intravenous gemcitabine, which can improve the quality of life and decrease the pain score.