Objectives:To identify the risk factors associated with delirium in intensive care unit (ICU) hospitalization of sepsis patients and construct a clinical prediction model to to provide a reference for the prevention and control of delirium in sepsis patients.Methods:Data were collected of sepsis patients admitted in the Intensive Care Unit in the Second Affiliated Hospital of Soochow University from September 2020 to August 2022.The patients were divided into delirium group and non-delirium group according to whether delirium occurred or not. Comparing of the differences in general and clinical data between the two groups, the independent risk factors for delirium were screened by backward stepwise regression method, and the delirium risk prediction model was constructed and evaluated. An independent risk factor analysis for delirium was conducted using a backward stepwise regression approach to identify significant predictors. A delirium risk prediction model was constructed based on the identified risk factors, followed by a comprehensive evaluation of the model's performance.Results:A total of 381 sepsis patients were included in the study, 114 patients (29.9%) developed delirium during the ICU hospitalization. Univariate analysis revealed statistically significant differences ( P< 0.05) between the delirium and non-delirium groups for several factors including age ≥ 65 years, blood transfusion, use of midazolam, use of adrenaline, APACHEⅡ score>15, SOFA score>4, metabolic acidosis, urea>7.1 mmol/L, coagulation disorders, lactate levels, and platelet count. Multivariate analysis identified age ≥ 65 years, use of midazolam, APACHEⅡ score>15, metabolic acidosis, urea>7.1 mmol/L, and coagulation disorders as independent risk factors for delirium in sepsis patients during ICU hospitalization.The predictive model was evaluated with an area under the ROC curve of 0.813, a non-significant Hosmer-Lemeshow goodness-of-fit test ( P=0.957>0.05), and a Brier score of 0.149 (<0.25), indicating good predictive performance and calibration. Clinical decision and impact curves demonstrated the model's favorable clinical applicability. Conclusions:The occurrence of delirium in ICU sepsis patients closely associate with six factors: age ≥ 65 years, use of midazolam, APACHEⅡ score>15, metabolic acidosis, urea>7.1 mmol/L, and coagulation disorders. This sepsis delirium prediction model has good clinical predictive ability and clinical applicability.

This article investigated an occupational chemical poisoning incident that occurred in a certain place in Guangdong Province in September 2020, detected the air at the scene, and analyzed the clinical data of the poisoned patients. The peripheral blood methanol concentrations of the three patients were 307.76 mg/L, 354.80 mg/L and 454.14 mg/L when they were admitted to the hospital. The raw and auxiliary materials were analyzed for volatile organic components. Methyl acetate was detected in the finished glue, synthetic resin and compound machine post glue in the glue room, and the relative percentages were 23.05%, 32.79% and 31.68%, respectively. Through comprehensive analysis, it was judged that this incident was an acute occupational methyl acetate poisoning incident, and 3 workers were poisoned.

This article investigated an occupational chemical poisoning incident that occurred in a certain place in Guangdong Province in September 2020, detected the air at the scene, and analyzed the clinical data of the poisoned patients. The peripheral blood methanol concentrations of the three patients were 307.76 mg/L, 354.80 mg/L and 454.14 mg/L when they were admitted to the hospital. The raw and auxiliary materials were analyzed for volatile organic components. Methyl acetate was detected in the finished glue, synthetic resin and compound machine post glue in the glue room, and the relative percentages were 23.05%, 32.79% and 31.68%, respectively. Through comprehensive analysis, it was judged that this incident was an acute occupational methyl acetate poisoning incident, and 3 workers were poisoned.

Objective To explore the diagnostic value of serum lipoprotein(a)[Lp(a)]in cerebral infarction by a model of Logistic regression and receiver operating characteristic(ROC)curve.Methods A total of 316 patients with cerebral thrombosis from Foshan Hospital Affiliated to Southern Medical University were col-lected.According to the diagnostic criteria,the patients were divided into cerebral thrombosis group(196 ca-ses)and non-cerebral thrombosis group(120 cases).All the subjects were tested for Lp(a)by immune turbi-dimetry.To evaluate the diagnostic value of Lp(a)by applying logistic regression model,drawing ROC curves and calculating the area under the curve(AUC).Results The P25,P50,P75of Lp(a)in cerebral thrombosis group and non-cerebral thrombosis group were 97.23,238.22,430.01 and 29.80,92.27,233.86,the average rank were 185.42 and 114.52,the differences in the two groups were significant(P<0.05).Logistic regres-sion showed that the correlation between Lp(a)level and cerebral thrombosis was positive,the partial regres-sion coefficient(B)was 0.005,Wald value was 31.295.It suggested that when the levels of Lp(a)was higher the risk of cerebral thrombosis increased.The most valuable diagnosis level was 305.80 mg/L.And the area under the ROC curve(AUC)was 0.724,which has moderate diagnostic efficacy.Diagnostic specificity was 91.7%,misdiagnosis rate was 8.3%,negative predictive value was 48.7%,sensitivity was 40.8%,omission rate was 59.2%,positive predictive value was 88.9%.Conclusion The level of serum Lp(a)has high diag-nostic specificity for the diagnosis of cerebral thrombosis.

Objective To investigate the application value of urine microalbumin (mALB) ,retinol binding protein(RBP) and cys-tatin C(CysC) and their combined detection in early diagnosis of type 2 diabetic nephropathy(DN) .Methods Ninety-two inpatients with DN (DN group) and 90 people undergoing the physical examination(control group) in our hospital from June 2014 to Decem-ber 2015 were collected .Urine mALB ,RBP and CysC were detected in all subjects and detection results were analyzed statistically . Results The levels of urine mALB ,RBP and CysC in the DN group were significantly higher than those in the control group ,the differences all had statistical significance (P< 0 .05) .Among 3 indicators ,the positive rate of urine mALB for detecting DN was highest (94 .57% ) ,while which of 3-index combined detection was 97 .83% ,and significantly higher than that of single detection , the difference was statistically significant(P<0 .05) .The sensitivity ,specificity ,positive predictive value ,negative predictive value and Youden index of 3-index combined detection were all higher than those of single index .The ROC curve showed that AUC of u-rine mALB for diagnosing DN was 0 .732 ,the diagnostic cut-off value was 43 .58 mg/L ,AUC of urine RBP was 0 .685 ,the diagnos-tic cut-off value was 1 .47 mg/mL ,AUC of urine CysC was 0 .701 ,the diagnostic cut-off value was 1 .42 mg/L ,while AUC of com-bined detection was 0 .928 .Conclusion Urine mALB ,RBP and CysC are better indexes reflecting renal injury .Their combined de-tection will increase the positive rate ,sensitivity and specificity for diagnosing DN .So monitoring the levels of urine mALB ,RBP and CysC has an important significance to diagnosing the occurrence and development of DN early renal injury and prevention ,treat-ment and delaying progress of DN .

Objective To explore preliminarily the effects of preoperative depression condition in patients with breast cancer on the efficacy of intravenous analgesia with dezocine and the serum level of 5 hydroxytryptamine.Methods Sixty patients with breast cancer were assessed with Hamilton depression scale (HAMD).The total patients were divided into three groups according to HAMD scores,including normal group (26 cases),suspicious group (22 cases),and depression group (12 cases).The postoperative analgesia was facilitated with patients intravenous control analgesia with dezocine and the postoperative pain was assessed by visual analogue scale (VAS) at 2 hours,12 hours,and 24 hours.Yhe serum concentration of 5 hydroxytryptamine was measured by enzyme-linked immunosorbent assays before anesthesia,2 hours after surgery beginning,and 24 hours after surgery.Results The postoperative VAS at 12 hours and 24 hours in suspicious group and in depression group were higher than those in normal group (P ＜ 0.05).There was no statistical difference between depression and suspicious groups (P ＞ 0.05).The serum concentrations of 5 hydroxytryptamine in three groups increased obviously at 2 hours after surgery beginning (P＜0.05),and then decreased at 24 hours postoperation.The serum concentrations of 5 hydroxytryptamine in suspicious group and depression group at three measurement point were significantly lower than those in normal group (P ＜0.05).The serum concentrations of 5 hydroxytryptamine in depression group at three measurement point were significantly lower than those in suspicious group (P ＜ 0.05).Conclusions Under this preliminary study condition,the preoperative severity of the depression in patients with breast cancer may affect the analgesia effect of patients intravenous control analgesia with dezocine and maybe have some relationships with serum levels of 5 hydroxytryptamine.

OBJECTIVETo summarize the techniques and evaluate the therapeutic effect of posterior fixation and fusion in the treatment of Os odontoideum complicated by atlantoaxial dislocation.

METHODSFrom March, 2007 to October, 2010, 10 patients with Os odontoideum (including 6 male and 4 female patients aged from 20 to 65 years, mean 39.8 years) were treated in our hospital. Before and after the operation, the patients underwent X ray, CT and MRI examinations to measure and evaluate the degree of dislocation and neural compression. After preoperative traction for 1-2 weeks, all the 10 patients showed deductible atlantoaxial dislocation. Through a posterior approach, Atlantoaxial pedicle screws fixation were performed in 9 cases, and C2/3 pedicle-Occiput screw fixation was performed in 1 case. All the patients wore cervical collars as external support for 3 months after the operation.

RESULTSThe mean operative time was 3 h in these patients with a mean intraoperative blood loss of 420 ml. The symptoms were relieved after the surgery in all the patients, who showed no neck pain or neurological defects. The patients were followed up for 6 to 52 months (mean 22 months), and bony fusion was observed in all the 10 cases within 6 to 8 months without such complications as internal fixation failure or redislocation of the atlas.

CONCLUSIONPatients with Os odontoideum complicated by atlantoaxial dislocation should undergo surgical stabilization to avoid severe neurological injury. Pedicle screw instrument in the atlas allows restoration of the spinal stability, short-segment fusion, and maximal preservation of the mobility of the neck.

Adult ; Aged ; Atlanto-Axial Joint ; injuries ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; complications ; surgery ; Joint Loose Bodies ; complications ; surgery ; Male ; Middle Aged ; Odontoid Process ; pathology ; Spinal Fusion ; methods ; Treatment Outcome ; Young Adult

Objective To study the effects of rehabilitation training combined with the transplantation of bone marrow mesenchymal stem cells-derived neural stem cells (BMSC-D-NSCs) on the expression of Nogo-A and NgR protein in rats after spinal cord injury (SCI).Methods The spinal cords of eighty Sprague-Dawley rats were injured using a modified Allen′s impactor (H = 25 mm) at T10. The injured rats were randomly divided into a combination therapy group which was given rehabilitation training and cell transplants, a cell graft group, a rehabilitation training group and a control group. At the 7th day post SCI, BMSC-D-NSCs were transplanted into the injured spinal cords of the rats in the combination therapy and cell graft groups. Hindlimb movement was assessed using the BassoBeattie-Bresnahan (BBB) scale every week, and protein was extracted from the injured spinal cord tissue for Nogo-A and NgR determination by Western blotting at the 1st, 3rd and 7th day after cell transplantation.Results The average BBB score of the rats in the combination therapy group was significantly higher than that of the other groups from 2 weeks post transplantation. The scores in the rehabilitation training group were significantly higher than in the control group from the 5th week post transplantation. Western blotting showed high expression of Nogo-A and NgR protein 24 h post surgery, but these declined with time. For Nogo-A there was a significant difference among the groups at all three time points. In the combination therapy group the expression declined to a minimum by the 7th day. For NgR protein there was no significant difference between the 1st and 3rd day in any group.Conclusions Rehabilitation training combined with BMSC-D-NSC transplantation can have a synergistic effect on functional recovery from SCI. It can down regulate the expression of Nogo-A and NgR protein.

OBJECTIVETo investigate the gene expression of two kinds of constitutive nitric oxide synthase (cNOS): neuronal NOS (nNOS) and endothelial NOS (eNOS) in injured spinal cord tissue.

METHODSThirty-six adult Sprague-Dawley rats were divided randomly into six groups: the normal group and the injury groups (2, 6, 12, 24, 48 h after injury, respectively). A compression injury model of the spinal cord wa s ma de and gene expression of nNOS and eNOS were examined by reverse transcription polymerase chain reaction (RT-PCR).

RESULTSThe gene expression of nNOS and eNOS was detected in the normal group and they were up-regulated quickly after injury, reaching the maximum at 6 h. There was no difference between gene expression of nNOS and eNO S in the normal group, but in each injury group the gene expression of eNOS was much higher than that of nNOS.

CONCLUSIONSExpression of constitutive NOS (cNOS) in spinal co rd tissue was up-regulated after injury mainly in the early stage. cNOS as a wh ole offers protection in spinal cord injury, but different cNOS may play different roles.

Animals ; Gene Expression ; Nitric Oxide Synthase ; genetics ; Nitric Oxide Synthase Type II ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Spinal Cord Injuries ; enzymology ; genetics ; Up-Regulation

Objective:To study the reliability and validity of schizophrenia quality of life scale (SQLS)in China.Method:Eighty-eight patients with schizophrenia were assessed with the SQLS.Results:The Cronbach's alpha were in 0.58-0.93.The split-half reliability coefficient were in 0.91-0.94.The test-retest reliability coefficient were in 0.57-0.76.The content validity and construct validity reached psychometrically acceptable level.Conclusion:The SQLS is a simple and reliable scale.