Objective To explore the effects of postoperative self-controlled analgesic pump containing esketamine(ESK)on psychological status and early cognitive function of elderly patients after radical surgery for colorectal cancer(CRC).Methods The data of elderly patients after radical CRC surgery in Jianyang People's Hospital were retrospectively collected from January 2021 to January 2024,and were divided into the control group[only using sufentanil(FEN)]and the combined group(FEN combined with ESK)according to the different medications in the self-controlled analgesic pump.The pain levels[visual analog scale(VAS)and the number of presses of the self-controlled analgesic pump],psychological state[90-item symptom self-assessment scale(SCL-90)],and early cognitive function[Montreal Cognitive Assessment Scale(MoCA)]before and after treatment were compared between the two groups.Adverse reactions during the use of self-controlled analgesic pumps were observed and recorded in both groups to assess the safety.Results A total of 86 patients were included in the study,with 45 in the control group and 41 in the combined group.At 1 h before the surgery,there was no statistically significant difference in the VAS scores,dimensional mental status scores and MoCA scores between the two groups(P＞0.05).At 1 h(T2),12 h(T3),24 h(T4)and 72 h(T5)after the surgery,the VAS scores of the combined group were significantly lower than those of the control group(all P＜0.05)and the times of using the analgesic pump in the combined group were significantly lower than those in the control group(P＜0.05).After 72 h of using analgesic pumps,the psychological state scores of patients in both groups in terms of somatization scores,obsessive-compulsive symptom scores,and interpersonal relationship scores decreased significantly compared with the pre-treatment period,and the score of combined group was lower than that of the control group(P＜0.05).During the use of analgesic pumps,the MoCA scores of patients in both groups showed a decreasing and then a increasing trend(P＜0.05),and the MoCA scores of the combined group were significantly higher than those of the control group at T4 and T5(P＜0.05).In terms of the safety,the difference in the incidence of gastrointestinal symptoms,arrhythmia,vertigo and drowsiness between the two groups was not statistically significant(P＞0.05).Conclusion ESK postoperative self-control analgesic pump can effectively relieve the pain level,psychological state and early cognitive function of elderly patients after radical CRC surgery,and the safety is good.

Background Long-term occupational polycyclic aromatic hydrocarbons (PAHs) exposure is an important risk factor for cognitive impairment. At the same time, it can also cause a decrease of brain-derived neurotrophic factor (BDNF). However, it is not clear whether BDNF plays a key role in the cognitive impairment of workers caused by occupational PAHs exposure. Objective To analyze the correlation between the levels of PAHs in the plasma of coke oven workers and cognitive impairment, and to explore the possible mediating effect of plasma BDNF level on the relationship between PAHs and cognitive impairment. Methods A cross-sectional survey was carried out to select 138 pairs of workers from a coking plant (exposure group) and an energy plant (control group) in a large enterprise in Taiyuan, and the matching variables included age, education level and smoking status. The basic data of the workers were collected by questionnaire. The cognitive function of the workers was assessed by the Montreal Cognitive Assessment (MoCA) scale. Fasting elbow venous blood was collected, the plasma concentrations of 16 PAHs were determined by high performance gas chromatography-mass spectrometry (GC-MS), and the plasma concentration of BDNF was detected by enzyme-linked immunosorbent assay (ELISA). Multiple linear regression model was used to analyze the relationship between 12 PAHs levels in plasma and MoCA scores, and Bootstrap method was used to analyze the mediating effect of BDNF in the relationship between these two indicators. Results The average (\begin{document}$\bar x \pm s $\end{document}) age of workers in the two groups was (48.46±5.04) years, the length of service was (21.45±9.78) years, and 58.7% of the participants reported their education level at secondary vocational school, high school, and above. The median level (25th and 75th percentiles) [M(P₂₅, P₇₅)] of plasma Σ₁₂PAHs concentration of workers in the exposure group [20.937 (9.454, 38.387) μg·L⁻¹] was significantly higher than that of the control group [9.997 (4.952, 23.770)μg·L⁻¹] and the MoCA score (22.82±2.38) of the exposure group was significantly lower than that of the control group (24.60±5.67) (P<0.05). The plasma BDNF showed no significant difference between the exposure group [(29.99±9.80) μg·L⁻¹] and the control group [(31.48±9.09) μg·L⁻¹](P>0.05). Taking plasma PAHs as independent variable and MoCA score as dependent variable, after adjusting selected covariates, the results of multiple linear regression model showed that the MoCA score changed by −0.020 (95%CI: −0.035 - −0.005) for every 1 μg·L⁻¹ increase of plasma Σ₁₂PAHs. Low (<P₃₃), medium ( P₃₃~P₆₆) and high (>P₆₆) dummy variables were set according to the intertertile boundaries (8.31, 23.76) μg·L⁻¹ of the plasma level of Σ₁₂PAH of the workers. The change of MoCA score in the high concentration group versus the low concentration group was −1.167 (95%CI: −1.866 - −0.467). The MoCA score changed by 0.066 (95%CI: 0.012 - 0.119) for each 1 μg·L⁻¹ increase in plasma BDNF level. The results of dichotomous logistic regression analysis showed that the risk of cognitive impairment in the high concentration group was 2.635 (95% CI: 1.085 - 6.398) times higher than that in the low concentration group. The results of mediating effect analysis showed that plasma BDNF level was an intermediate variable between PAHs and cognitive impairment, and 45.50% of PAHs-induced cognitive impairment risk was mediated by reduced BDNF level. Conclusion The level of plasma PAHs in coke oven workers is negatively correlated with MoCA score, and PAHs may mediate cognitive impairment by reducing plasma BDNF level.

OBJECTIVE To summarize the clinical characteristics,diagnositic and therapeutic strategies of severe cytomegaloviral (CMV) pneumonia after kidney transplantation. METHODS To analyze retrospectively pertinent clinical information of 6 cases of severe cytomegaloviral pneumonia after kidney transplantation, including developing process of disease, clinical manifestation of pre-and post-hospitalization ,various assistant examination,therapeutic procedures and prognosis. RESULTS 6 cases had similar characters of episode as follows:CMV pneumonia occurred after 1～3 months after kidney transplantation. Major clinical symptoms included fever, coughing,few sputum without obvious manifestation of breathholding.Peripheral white blood cell was normal or less than normal range, serum CMVpp65 was finally positive during hospital stay. Radiological image of the lung presented inflammatory infiltration and obvious interstitial lesion after 7～10 days of fever, which went worse rapidly. Renal function descended with deterioration of pulmonary infection. All of patients had been treated with multiple antibiotics,glucocorticoid and mechanical ventilation, Etiological diagnosis of the 3th～6th cases were earlier than 1th～2th cases , the 3th～6th cases who finally survived were treated with longer and higher doses of antivirus and glucocorticoid, than 1th～2th cases who died of refractory hypoxemia and acute renal failure during hospital stay. CONCLUSIONS Severe cytomegaloviral pneumonia had similar clinical characteristics of episode. early diagnosis of etiology,continuous application of antivirus and glucocorticoid were crucial for Severe cytomegaloviral pneumonia after kidney transplantation.

Objective: To study the relation between hyperglycemia and mechanical ventilatory time, the days in the intensive care unit,infection rate,mortality . Methods: 572 patients' blood glucose levels in the morning were measured,and divided into two groups by the level of 7.78 mmol/L.The mechanical ventilatory time, days in the intensive care unit,infection rate and mortality were compared between two groups. Results: The mechanical time,stay in ICU and infection rate in the group with blood glucose level below 7.78 mmol/L were significantly less than in the group with blood glucose level above 7.78 mmol/L(P

0.05). Serum IL-10 and IL-10/TNF? ratio in the dead were significantly higher than that in the survivors( P 0.05). Conclusions The septic patients with high serum IL-10 or IL-10/TNF? ratio fared with poor prognosis.