To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective To investigate the expressions of transforming growth factor β1 (TGF-β1) and brain natrium peptide (BNP) in patients with diastolic heart failure (DHF),and to explore the correlation between plasma levels of TGF-β1,BNP and TGF-β1/BNP with parameter of diastolic function,diastolic dysfunction and New York Heart Association (NYHA) classification of cardiac function.Methods Hospitalized patients with DHF from October 2016 to November 2017 in Beijing Chaoyang Hospital were selected as subjects.At the same time,the age-and gender-matched non-heart failure hospitalized patients were selected as the control.The diastolic function index (E/e') was measured using cardiac ultrasound spectral Doppler and tissue Doppler methods.The diastolic dysfunction classification was evaluated according to the American Society of Echocardiography guidelines.Cardiac function was evaluated with NYHA classification.The levels of plasma TGF-β1 and BNP were measured with method of enzyme linked immunosorbent assay (ELISA).The correlation between the indicators was analyzed and the receiver operating characteristic (ROC) curve was drawn.Results A total of 186 patients were enrolled,including 114 patients as DHF group [54 males and 60 females,mean age (70.75 ± 11.45) years old] and 72 cases as control group [41 males and 31 females,mean age (68.74 ± 10.86) years old].The levels of TGF-β1 [(77.68 ± 42.31) ng/L] and BNP [(1 153.84 ± 564.96) ng/L] in patients with DHF were significantly higher than those of the control group [(18.76 ± 13.70),(264.07 ± 179.43) ng/L,t =15.62,13.77,P ＜ 0.01].Pearson correlation analysis showed that level of plasma TGF-β1 had a significant liner correlation with index E/e' (r =0.582,P ＜ 0.01),level of plasma BNP had a low-degree liner correlation with index E/e' (r =0.261,P ＜ 0.01),and TGF-β1/BNP had no correlation with index E/e' (r =0.081,P ＞ 0.05).Spearman correlation analysis showed that the levels of TGF-β1 and BNP were significantly correlated with diastolic dysfunction grading (r =0.473,0.417,P ＜ 0.01),while TGF-β1/BNP had no correlation with diastolic dysfunction grading (r =0.062,P ＞ 0.05).Plasma TGF-β1 and BNP had low-degree correlation with NYHA classification of heart failure (r =0.309,0.326,P ＜ 0.01),TGF-β1/BNP had no correlation with NYHA classification of heart failure (r =0.011,P ＞ 0.05).Logistic analysis showed that both plasma TGF-β1 and BNP were independent predictors of DHF (OR =1.264,2.283,P ＜ 0.05 or ＜ 0.01).The area under ROC curve (AUC) of BNP for prediction of DHF was 0.937 ± 0.064,and TGF-β1 was 0.597 ± 0.042.AUC areas of BNP and TGF-β1 were significantly different (P ＜ 0.01).Conclusions The expressions of plasma TGF-β1 and BNP in patients with DHF are higher than those without DHF.The levels of plasma TGF-β1 and BNP are significantly correlated with index E/e',diastolic dysfunction grading and NYHA classification.Both elevated BNP and TGF-β1 levels are independent predictors of DHF.Both plasma BNP and TGF-β1 have auxiliary diagnostic value on DHF and the diagnostic value of plasma BNP is greater than plasma TGF-β1.

Objective To evaluate the safety and efficiency of the unibody bifurcate endografts in treating aortoiliac occlusive disease. Methods We performed a retrospective review of patients with aortoiliac occlusive disease who underwent endovascular revascularization with unibody bifurcated endografts. Data of demography, operative details, and outcomes were collected. Results From March 2016 to December 2017, 7 patients (6 males and 1 female) were treated using this endovascular technique. Technical success was achieved in all patients and there were no procedure related complications. The aortoiliac reconstructions remained patent within the median follow up of 11.0 (range 6.3-21.3) months, and all the patients clinically were improved an average of 1.71 Rutherford categories. Conclusions Endovascular repairment using an unibody bifurcated endograft for aortoiliac occlusive disease is feasible and effective, and has excellent short and midterm patency; however, the long?term patency need to be consequently observed.

Objective To study the application value of dynamic monitoring of blood pressure in the prevention and treatment of elderly hypertension. Methods 519 hypertensive patients from December 2017 to December 2018 were monitored with ambulatory blood pressure monitoring, and were divided into the elderly group (≥60 years old, 264 cases) and the control group (<60 years old, 255 cases). The results of ambulatory blood pressure monitoring in two groups were analyzed, which inclued the circadian rhythm of blood pressure, blood pressure, pulse pressure, coefficient of variation of blood pressure, blood pressure load value, average heart rate and morning blood pressure surge. Results The incidence of abnormal circadian rhythm of ambulatory blood pressure in the elderly group was 76.5%. Compared with the control group, there were differences in the indexes of diastolic blood pressure (DBP), diastolic blood pressure load value (DBPLV), pulse pressure (PP), 24 h average heart rate (24 hAHR), systolic blood pressure coefficient of variation (SBPCV), 24 h diastolic blood pressure coefficient of variation (24 h DBPCV) and morning diastolic blood pressure surge (MDBPS) between the two groups(all P<0.05). There were differences in 24 h systolic blood pressure (24hSBP), night systolic blood pressure (nSBP), night diastolic blood pressure (nDBP), night pulse pressure (nPP), day systolic blood pressure load value (dSBPLV), ninght systolic blood pressure load value (nSBPLV), 24 h SBPCV, 24 h dDBPCV and other indicators among different blood pressure types in the elderly group (all P<0.05). Conclusion Ambulatory blood pressure monitoring indicators have important guiding value for the prevention and treatment of elderly hypertension.

Objective :To analyze therapeutic effect of different dose of simvastatin on hypertension complicated hy‐perlipidemia and its safety .Methods :A total of 90 patients with hypertension complicated hyperlipidemia treated in our hospital were randomly and equally divided into simvastatin routine dose group (20mg／d simvastatin) and high dose group (40mg／d simvastatin) ,both groups were treated for six months .Therapeutic effect ,levels of blood pressure (BP) and blood lipids before and after treatment ,and incidence of adverse reactions were compared between two groups .Results :Compared with routine dose group after treatment , there were significant rise in total effective rates of hypertension (75.56% vs.93.33%) and hyperlipidemia (71.11% vs.95.56%) in high dose group ,P＝0.020 ,0.002 ;Compared with routine dose group after treatment ,there were significant reductions in levels of serum TC [ (5.68 ± 0.68) mmol／L vs. (4.07 ± 0.62) mmol／L] ,TG [(1.89 ± 0.37) mmol／L vs.(1.03 ± 0.31) mmol／L] ,LDL‐C [ (3.59 ± 0.74) mmol／L vs. (2.12 ± 0.69) mmol／L] and blood pressure [ (134.84 ± 11.92)／(90.96 ± 8.79) mmHg vs.(120.09 ± 11.43)／(81.78 ± 8.57) mmHg] ,and significant rise in serum HDL‐C level [ (1.28 ± 0.41) mmol／L vs.(1.48 ± 0.46) mmol／L] in high dose group , P＜0.05 or ＜0.01. There was no significant difference in incidence rate of adverse reactions between two groups (P＝0.535).Conclusion :High dose simvastatin possesses more significant therapeutic effect on hypertension compli‐cated hyperlipidemia .It can significantly reduce BP and blood lipids with good safety .

The research and clinical application of pulmonary function testing in children in China has a history of more than 50 years, which started in the 1960s and developed rapidly during the past two decades.Chinese scholars have explored the normal reference values, standard of bronchodilation test and applications in the diagnosis and treatment of diseases of different pulmonary function tests in children, especially infants, and developed a series of guidelines to standardize the operations, reports and applications.In the past decade, the applications have been fully promoted, and quality control have been continuously improved through standardized training.At present, pulmonary function tests have become an important method in the diagnosis and treatment of respiratory diseases in children.

Objective: To explore the effectiveness and safety of ultrasound-guided radiofrequency ablation (RFA) in treatment of thyroid benign nodules. Methods: We analyze 573 patients with thyroid benign nodules from June 2014 to September 2017 treated by RFA at Department Ⅱof Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University. Among these patients, there were 75 males and 498 females, with a median age of 45 years old. All patients were diagnosed as thyroid benign nodules by ultrasound-guided fine needle aspiration biopsy before RFA. A total of 750 benign tumors were treated. To evaluate the thyroid function of the patients before RFA and 3 months after it, and to observe the changes of thyroid benign nodules by ultrasound at 3, 6, 12 months after RFA. The paired t-test was used to compare the measurement data with normal distribution, and Wilcoxon's signed rank test was used to compare the measurement data with non-normal distribution. To calculate the volume change and reduction rate of thyroid benign nodules. Results: RFA was successfully completed in all patients, the volume reduction rate was 67%(48%, 83%) in the 3rd month after RFA, in the 6th month was 81%(67%, 91%), in the 12th month was 89%(80%, 95%). Eighteen patients felt pain during RFA, but the pain was alleviated after stopping ablation. Three patients′ tone decreased, but recovered in a week. Hoarseness occurred in 6 patients and recovered in 3 months. Three patients had neck hemorrhage, which was managed with simple compression of the neck. Conclusions RFA is an effective and safe treatment for thyroid benign nodules and has obvious advantages such as less invasiveness, having no influence in thyroid functions. It is clinically prospective for application.

In the research of artificial joint biomechanics, it is a common method in the world to evaluate the biomechanical properties of the implanted fixtures through experiments . The domestic research started late, and the corresponding testing software were lacking. There is still no special software. In this paper, an integrated software test system was designed and built based on the existing hardware system, including:hardware control, data collection, data save, data processing and display. It can directly show the 3D motion trajectory and the angle curve of joints. The system can accurately measure the relative motion angle value, external torque value, and inter pressure value of each joint. It has some reference significance for the development of the artificial joints' evaluation system.

Objective To investigate the metabolomics characteristic of neuromyelities optica spectrum disorder (NMOSD) in plasma and cerebrospinal fluid.Methods Ultra high performance liquid chromatography-mass spectrometry (UHPLC-MS) was used to identify plasma metabolites in 16 patients with NMOSD and 8 healthy controls.At the same time,the identification of metabolites in cerebrospinal fluid of 8 NMOSD patients and 5 healthy controls was completed.Differential metabolites screening and metabolomic pathway analysis were performed by diversified data analysis methods.Results Compared with healthy control group,the content of 8 substances such as Cis.8.11.14.Eicosatrienoic acid in the plasma of NMOSD patients was increased.The content of 8 substances such as L-glutamine acid were decreased.There was no significant difference in the metabolites between Aquaporin 4 (AQP-4) antibody positive and negative NMOSD plasma.The content of 6 substances such as 3-hydroxybutyric acid in cerebrospinal fluid of patients with NMOSD was reduced.Conclusions The distribution of metabolites in plasma between NMOSD patients and healthy controls was significantly different.There was no significant difference in metabolites between AQP-4 antibody positive and negative NMOSD plasma.There are some differences in metabolites between cerebrospinal fluid of NMOSD patients and healthy controls.A variety of amino acid abnormalities,sphingomyelin dysfunction,energy metabolism and mitochondrial dysfunction were involved in the pathogenesis of NMOSD.

AIM To prepare Scutellariae Radix total flavonoids-loaded liposomes and to evaluate their in vitro anti-tumor activity.METHODS Liposomes were prepared by reverse evaporating method.Taking phospholipid concentration,ratio of phospholipid to cholesterol,ratio of organic phase to aqueous phase and total flavonoids concentration as influencing factors,together with encapsulation efficiency as an evaluation index,Box-Behnken design was applied to optimizing the preparation,after which MTT was employed to detect the obtained liposomes' inhibitory effect on human hepatocellular carcinoma cells HepG2.RESULTS The optimal conditions were determined to be 30 mg/mL for phospholipid concentration,3 ∶ 1 for ratio of phospholipid to cholesterol,2 ∶ 1 for ratio of organic phase to aqueous phase,and 5 mg/mL for total flavonoids concentration.The obtained round and uniform liposomes demonstrated an average particle size of (160.7 ± 12.0) nm,Zeta potential of (-41.4 ±2.3) mV,encapsulation efficiency of (86.19 ±0.44)％,drug loading of (5.32 ± 0.04)％,and accumulative release rate of (80.77 ± 2.53) ％ at 24 h.Compared with total flavonoids,liposomes exhibited stronger inhibitory effect on HepG2 cells with the IC50 of 48.853 μg/mL at 48 h in a time-and dose-dependent manner.CONCLUSION Scutellariae Radix total flavonoids-loaded liposomes stored at low temperature (4 ℃) display sustained-release effect and in vitro anti-tumor activity.