Objective To study the influencing factors of postoperative cognitive dysfunction ( POCD) in elderly patients after knee joint replacement. Methods 165 cases of elderly patients undergo-ing knee replacement surgery were recruited in the study. According to whether there was POCD,the patients were divided into POCD group (35 cases) and non POCD group (130 cases).The gender,age,educational level,medical history,physical exercise,operation mode( cruciate-retaining total knee arthroplasty and poste-rior stabilized total knee arthroplasty) ,operation time,blood loss,preoperative depression score and postoper-ative pain score were recorded and compared.The logistic multiveariate regression analysis was conducted to analyze the risk factors of POCD in elderly patients with knee replacement. Results (1)There were statis-tically significant differences in the total score of MoCA, visual space and executive function,naming and de-laying recall between non-POCD group and POCD group after the operation ( Z=-5. 327, P=0. 000;Z=-3.140, P=0.002;Z=-2.910, P=0.004;Z=-3.333, P=0.001). (2)The results of logistic multiveariate regression analysis showed the age>70 years old ( OR=3.708,95%CI =1.037-13.261, P<0.05) ,hyperten-sion ( OR=5.250,95%CI =1.787-15.423, P<0.05),diabetes ( OR=6.560,95%CI =1.418-30.345, P<0.05) ,preoperative depression ( OR=4.648,95%CI =1.290-16.744, P<0.05) and postoperative pain score>4 ( OR=3.149,95%CI=1.072~9.251, P<0.05) were risk factors of POCD,and physical exercise ( OR=4.330,95%CI =1.294-14.488, P<0.05) and CR-TKA( OR=0.187,95%CI =0.045-0.781, P<0.05) were the protective factors of POCD. Conclusion The overall level of cognitive function in elderly patients after knee replacement surgery is low. The advanced age,hypertension,diabetes,lack of physical exercise,choice of operation method,postoperative pain and preoperative depression are important influence factors of POCD.

OBJECTIVE:To investigate the effects and safety of Xingnaojing injection combined with butylphthalide on neuro-logical function,cognitive function,coagulation function and living activity. METHODS:A total of 106 patients with middle cere-bral artery infarction in Wuhan University People's Hospital during Jun. 2014-Dec. 2015 were divided into control group and obser-vation group according to random number table,with 53 cases in each group. Besides routine symptomatic treatment,control group was given Butylphthalide soft capsules 0.2 g,po,tid. Observation group was additionally given Xingnaojing injection 20 mL added into 0.9% Sodium chloride injection 250 mL,ivgtt,qd. Both groups were treated for 14 d. The neurological function score (NI-HSS,NFDS),cognitive function score (MoCA,MMSE),coagulation function indexes (PT,APTT,FIB),BI score were ob-served in 2 groups before and after treatment. The occurrence of secondary remote damage and ADR were recorded. RESULTS:Eight patients withdrew from the study,including 3 patients of control group and 5 of observation group. Before treatment,there was no statistical significance in neurological function scores(NIHSS,NFDS),cognitive function scores(MoCA,MMSE),coag-ulation function indexes or BI scores between 2 groups (P>0.05). After treatment,NIHSS,NFDS scores and FIB of 2 groups were decreased significantly compared to before treatment,and the observation group was significantly lower than the control group,with statistical significance (P<0.05). MoCA,MMSE,BI scores in 2 groups were increased significantly,and PT and APTT in 2 groups were prolonged significantly,and the observation group was significantly higher or longer than the control group, with statistical significance (P<0.05). The incidence of secondary remote damage in observation group (11.3%) was significantly lower than control group (41.5%),with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:For middle cerebral artery infarction,the application of Xingnaojing injection combined with butylphthalide can reduce the risk of remote damage,promote the recovery of neurological function and cognitive func-tion,and improve coagulation function and living activity with good safety.

Objective To investigate the effect and safety of topical tranexamic acid (TXA) plus cocktail analgesic for reducing blood loss during total knee arthroplasty (TKA).Methods A prospective case control study was made on 60 patients scheduled to undergo TKA because of knee injuries between August 2015 to June 2016.There were 13 males and 47 females,with the mean age of 65.5 years (range,51-80 years).Traumatic arthritis occurred in 44 patients and degenerative arthritis in 16 patients.The patients were assigned to separate cocktail analgesic group (Group A,n =30) and topical TXA plus cocktail analgesic group(Group B,n =30),according to the random number table.Patients in Group A received multiple-point intra-articular cocktail analgesic injection before implantation of the prosthesis in TKA.While patients in Group B received multiple-point intra-articular TXA plus cocktail analgesic injection before implantation of the prosthesis.Between-group differences were compared with respect to intraoperative blood loss,hemoglobin change (Hb),haematocrit (Hct),postoperative drainage,total blood loss,hidden blood loss,blood transfusion rate,Hospital for Special Surgery (HSS) score,incidence of deep venous thrombosis (DVT) and other complications.Results All patients were followed up for 3 months.Perioperative Hb reduction in Group B was 18.5 (13.0,26.0) g/L,less than 23.0 (21.0,35.5) g/L in Group A (P ＜ 0.05).Hct was reduced by 5.6 (4.1,7.8) ％ in Group B,while 7.2 (6.1,10.7) ％ in Group A (P ＜ 0.05).Postoperative drainage volume,total blood loss and occult blood loss in Group B were 105.0(60.0,223.8) ml,596.0(426.1,795.3) ml,422.3 (228.9,624.0) ml respectively,decreased compared to Group A [162.5 (118.8,245.0) ml,788.3 (583.0,1 082.4) ml,603.2 (435.2,884.7)ml respectively] (P ＜0.05).There were no significant differences in intraoperative blood loss,blood transfusion rate,HSS score and DVT incidence between the two groups (P ＞0.05).Conclusion Topical TXA plus cocktail analgesic can reduce blood loss during perioperative period in TKA,without increasing the risk of DVT.

OBJECTIVE:To explore the risk factors of adverse reaction of cefazolin drugs by Logistic model. METHODS:Re-lated information was collected from the information system of our hospital,and SPSS 19.0 software was conducted for statistical analysis. RESULTS:Totally 855 patients were enrolled,30 of which had adverse reactions(3.51%). According to the results of Logistic analysis,intravenous administration with the concentration of ≥20 mg/ml (OR=7.857,95% CI:1.566-39.431,P=0.003) was the risk factor of adverse reaction of cefazolin drugs when single dose was above 2 g (OR=13.75,95% CI:2.423-78.028,P<0.001)at 0:00-8:00(OR=2.340,95% CI:1.043-5.253,P=0.034). CONCLUSIONS:Adverse reaction of ce-fazolin drugs might be dose-related type. The drug adverse reaction predictive thresholds are single dose above >1.75 g with ad-ministration time of 0:00-9:05 and concentration of above 7 mg/ml. According to the predictive thresholds,the risk of patients with adverse reaction can be predicted to promote safe and effective use of cefazolin.

Objective To explore whether albumin corrected anion gap (ACAG) is associated with long-term mortality of sepsis patients.Methods Adult patients with a diagnosis of sepsis within the first 24 hours (from December 2013 to December 2014) admitted to the intensive care unit (ICU) were included via the Sepsis database of West China Hospital Sichuan University. To record their long-term survival, patients were followed up by telephone interview one year after enrollment. ACAG was calculated according to the anion gap (AG) level within the first 24 hours admitted to ICU, and patients were divided into normal ACAG group (ACAG 12-20 mmol/L) and high ACAG group (ACAG > 20 mmol/L), and clinical characteristics and 1-year mortality were compared between groups. Patients were also divided into survivors and non-survivors according to the 1-year survival outcome, and multivariate logistic regression analysis was conducted to find independent risk factors for long-term mortality of sepsis patients.Results A total of 296 sepsis patients were enrolled in the study, with 191 (64.5%) in the high ACAG group and 105 (35.5%) in the normal ACAG group. There were no significant differences in age, gender, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), Charlson cormobidity index (CCI) and other background variables between groups. Compared with the normal ACAG group, patients who suffered from multiple organ dysfunction syndrome (MODS) in the high ACAG group were more prone to develop renal and gastrointestinal injury (43.5% vs. 25.7%, 52.9% vs. 33.3%, respectively), had significantly higher serum creatinine [SCr (μmol/L): 89.0 (61.0, 148.0) vs. 67.1 (48.0, 86.0)], greater need for continuous renal replacement therapy (CRRT, 16.8% vs. 6.7%), and significantly shorter length of ICU stay and hospital stay [days: 11 (5, 22) vs. 16 (18, 31), 21 (14, 39) vs. 28 (20, 47)], with statistically significant differences (allP < 0.05). It was shown by Kaplan-Meier survival analysis that 1-year cumulative survival for the high ACAG group was significantly lower than that of the normal ACAG group (55.0% vs. 67.7%,P = 0.046). It was shown by multivariate logistic regression that ACAG [odds ratio (OR) = 1.201, 95% confidence interval (95%CI) = 1.115-1.293,P = 0.000], APACHE Ⅱ (OR = 1.053, 95%CI = 1.011-1.098, P = 0.014), the incidence of septic shock (OR = 2.203, 95%CI = 1.245-3.898,P = 0.007), fungus infection (OR = 3.107, 95%CI = 1.702-5.674,P = 0.000), acute renal failure (OR = 2.729, 95%CI = 1.134-6.567,P = 0.025) and complicated with malignancy (OR = 2.929, 95%CI = 1.395-6.148,P = 0.005) were independent risk factors contributing to increased 1-year mortality among sepsis patients.Conclusion ACAG was an independent risk factor for 1-year mortality of sepsis patients.

Objective To investigate the effects of Epimedium ,Astragalus ,Radix Puerariae on DMT1 expression in the cere‐bral cortex of APPswe/PS1ΔE9 double transgenic mice model of AD .Methods A total of 60 specific‐pathogen‐free male APPswe/PS1ΔE9 double transgenic mice aged 6 months were equally and randomly assigned to model ,Epimedium ,Astragalus ,Radix puerari‐ae ,compound and DFO groups .An additional 10 6‐month‐old C57BL/6J mice served as negative control group .Using immunohisto‐chemistry and molecular biology methods to investigate the effects of a compound combining the effective components of Epimedi‐um ,Astragalus ,Radix puerariae on DMT1 expression in the cerebral cortex of APPswe/PS1ΔE9 double transgenic mice model of AD . Results Immunohistochemical staining results revealed that DM T 1 positive cell did not show in negative control group .DM T1 ex‐pression was higher in model group compared with the negative control group .DMT1 expression was lower in the compound and deferoxamine groups than in the model group .No significant difference was detected in DM T 1 expression between deferoxamine and compound groups .RT‐PCR ,Western blot and immunohistochemical staining results showed no significant difference .Conclusion These compounds can downregulate DMT1 expression and inhibit iron overload in the cerebral cortex of mice with Alzheimer′s dis‐ease ,reduce iron overload induced impairment of the central nervous system .

Objective Toanalyzetheclinicalcharacteristicsandtreatmentoutcomesofspinalfilum terminalevascularmalformation.Methods Theclinicaldataof6patientswithfilumterminalevascular malformation diagnosed and treated from January 2008 to December. 2013 were analyzed retrospectively. The definition of filum terminale vascular malformation is anterior/posterior spinal artery feeding arteriovenous fistula or arteriovenous malformation and located below conus medullaris,and does not complicate with spinal vascular lesions in the other part. The Aminoff & Logue score and MRI of spinal cord function were performedatoneyearaftermicroneurosurgeryand/orendovascularembolization.Results Allpatients were males. Their clinical presentations were the weakness of both lower extremities and sphincter disturbance. The mean course of disease was 17. 1 ± 5. 2 months. The pathological type of the 6 patients were all arteriovenous fistulas. The feeding arteries included lumbar artery,internal iliac artery,and median sacral artery. Two of the 6 patients underwent Onyx glue embolization,3 were treated with microneurosurgery,and 1 was treated with embolization in combination with microneurosurgery. They were all achieved anatomic cure. The Aminoff & Logue scores were improved after 1 year (3. 8 ± 1. 9 scores before procedure,2. 8 ± 2. 0 scores after procedure),there was no significant difference (P >0. 05). The myodynamia scores were improved in 3 patients,2 did not change,1 got worse. The urinary and bowel functions were improved in 2 patients,and4didnotchange.Conclusion Filumterminalevascularmalformationisararevascular malformation of spinal cord. Both embolization and surgical treatment can achieve anatomic cure. Although the spinal cord function can be only partially restored,but continuous deterioration can be prevented.

Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair, and evaluate the value of real-time three-dimensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation of valveplasty ring. A 4-0 Goretex sutures was used for reconstruction of artificial chordae. Realtime three-dimensional transesophageal echocardiography was performed in all the patients during the preoperative, intraoperatire, and postoperative periods. The length of the chordae tendineae under the A1 section of the anterior leaflet and the P1 section of the posterior leaflet were measured and considered the normal length of chordae tendineae by real-time three-dimensional transesophageal echocardiography preoperatively. These pre-determined normal chordal lengths helped intraoperatively to approximate the length of the artificial chordae used and postoperatively to gauge the success of the procedures. The same values were used again postoperatively to gauge the success of intervention. Full flexible valveplasty rings were used in all the patients.Results There was no operative death. The mean cardiopulmonary bypass (CPB) and aortic cross clamp time were ( 142. 0 ±31.2 ) min and (98.0 ± 22.5 ) min, respectively. One patient' s intraoperative echocardiography upon termination of CPB showed persistent severe mitral regurgitation and was converted to mitral valve replacement. This patient was not included in the study group. The mean number of artificial chordae per patient was (2.0 ± 1.5 ) , range from 1 to 3. The mean preoperatively measured normal chordal length was ( 21.0 ± 2.5 ) mm, and the mean postoperative artificial chordal length was ( 20.0 ± 2.2 )mm. The difference was not significant. The follow-up interval was from 3 to 30 months and the follow-up rate was 98%. During the follow-up period, there was no late death. Trace mitral regurgitation (MR) was detected in 15 patients, mild and moderate MR were detected in 1 for each. No severe MR was detected. The freedom from reoperation was 100% during follow-up.There were no documented artificial chordae ruptures. Conclusion Conclusion Artificial chordal replacement with Gore-tex suture in mitral valve repair in this group of patients with mitral valve prolapse appears to have satisfactory early and mid-term results. Real-time three-dimensional transesophageal echocardiography plays a critical role in this technique. Real-time threedimensional transesophageal echocardiography can exactly predict the length of artificial chordae, which is helpful to improve the outcomes of mitral valve repair. However, longer term follow-up and larger series are required to validate our findings.

Objective To investigate the effect of endovascular treatment of vertebral basilar artery dissecting aneurysms. Methods The clinical data of 40 patients with vertebral basilar artery dissecting aneurysm admitted to Beijing Xuanwu Hospital and Haidian hospital,Capital Medical University from August 2013 to September 2014 were analyzed retrospectively. Their clinical symptoms and imaging were followed up. According to the treatment methods,they were divided into either a stent-assisted coil emboliza-tion group (group A;n = 34)or a parent artery occlusion (group B;n = 6),and according to the clinical symptoms and imaging followed-up,the efficacy was assessed at 1 year after procedure. Results The patients were followed up for 1 year after procedure,29 patients (85. 3%)were improved in group A, 1 (2.9%)was stable,and 4 (11. 8%)deteriorated. All the 4 deteriorated patients died of cerebral infarction complications (at 1 week to 6 months after procedure). The 6 patients in group B were improved compared with before procedure. No intracranial hemorrhage and ischemic events occurred. Conclusion Using the stent-assisted coil embolization technique and the parent artery occlusion technique for the treatment of the vertebral basilar artery dissecting aneurysms are relatively safe and effective.

0.05 ). The average enhancement rate of LV endocardial border was 96.6 %. The myocardial contrast agent perfusions of left ventricular walls were clearly visualized in 30 patients. CONCLUSION: Clinical application of intravenous left heart contrast echocardiagraphy with perfluoropropane-albumin microsphere is feasibility and effective.