Objective To investigate the correlations of risk factors of age,delirium-inducing factors,dementia,delirium severity,and disease severity with the prognosis of elderly patients with delirium.Methods A total of 112 patients aged 70 years and older with initial onset of delirium during hospital stay were enrolled in this study.They were hospitalized in Dalian Municipal Central Hospital from Jan.2013 to Dec.2015.The severity of delirium was evaluated by delirium rating scalerevised-98(DRS-R-98).The acute physiology and chronic health enquiry(APACHE-Ⅱ)score and the sequential organ failure assessment(SOFA)score were recorded within 48 h after delirium onset.After periods of hospitalization of Jan.2013 to Dec.2015,patients were followed up until 31 Dec 2017.Correlations of age,delirium-inducing factors and dementia with survival time and long-term viability after delirium onset were statistically analyzed.Results Age,delirium-inducing factors,cognitive impairment,duration of cognitive impairment,type of dementia,and delirium severity had no correlations with the lifetime and long-term viability in patients with delirium.While,APACHE Ⅱ score for assessment of severity degree of delirium(P ＜0.001,r =-0.390) and SOFA score(P ＜0.001,r=-0.638)were negatively correlated with the lifetime in patients with delirium.SOFA score (P =0.004) and delirium recurrence (P ＜ 0.001) were significantly correlated with the long-term viability in patients with delirium.Conclusions The severity and recurrence of delirium are strongly correlated with the lifetime and quality of life in patients with delirium.Compared with APACHE Ⅱ score,SOFA score may have a more important clinical application value in predicting the prognosis of patients with delirium.

Objective To analyze the epidemiological characteristics of an outbreak caused by human brucellosis in a farm in Yantai City,to explore the causes and transmission routes,and to provide evidence for prevention and control of brucellosis in Yantai City.Methods In 2014,an on-site investigation was conducted in a farm where brucellosis occurred in Yantai City,and case searches were conducted on exposed populations in the farm.According to the investigation questionnaire on epidemiology of brucellosis in Shandong Province,general information,clinical manifestation and high-risk behavior exposure information of the cases were collected;blood samples were collected and tested by tiger red plate agglutination test (RBPT) and tube agglutination test (SAT).Brucellosis was diagnosed according to the "Diagnostic Criteria for Brucellosis" (WS 269-2007).Results The first case was male,58 years old,farm worker.A total of 38 suspected cases were found.Eleven patients with positive RBPT and SAT≥1:100 (++) were confirmed cases.The confirmed cases were all male,with a median age of 52 years,ranging from 40 to 60 years old;5 farm workers and 6 construction workers;the onset time was mainly in June and July,a total of 7 cases;clinical manifestations mainly included excessive sweating,muscle and joint pain,fatigue,testicular swelling,etc.Of the 147 sheep in the farm,47 were positive by laboratory tests,accounting for 31.97％,which were the main sources of infection.High-risk exposures for farm workers included hand-delivered births (5 cases) and breeding for livestock (1 case);high-risk exposures for construction workers included entry and exit of sheep houses (6 cases) and handling of supplies in sheep houses (6 cases).Conclusions The epidemic is caused by direct contact with Brucella-infected sheep or caused by respiratory contact with brucellosis contaminated environment.It is necessary to strengthen the health education for prevention and control of the disease in key populations and improve the awareness of the disease.

Objective To explore the efficacy of hematopoietic stem cell transplantation (HSCT) for 5 patients with Ph-like acute lymphoblastic leukemia (ALL).Methods Fluorescent in situ hybridization (FISH) was performed for detecting the rearrangement of susceptibility genes.Combined therapy of chemotherapy and ruxolitinib were applied,followed by HSCT.Those failing to achieve complete remission (CR) received an infusion of chimeric antigen T-cells (CAR-T),followed by HSCT once CR was achieved.Four patients accept allogenic HSCT while another auto HSCT.Results Three of them achieved CR after chemotherapy and ruxolitinib.The remaining 2 patients got CR after CAR-T.Four patients remained in CR after HSCT.Early relapse occurred in 1 patient after HSCT.Conclusions Combined therapy of chemotherapy,ruxolitinib and CAR-T are necessary for Phlike ALL patients.HSCT after an initial CR improve patient prognosis.

Objective To investigate the effect of pressure ulcer risk warning system in the pressure ulcer management in patients undergoing thoracolumbar fracture surgery.Methods A retrospective case control study was performed to analyze the clinical data of 120 patients with thoracolumbar fracture who underwent posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery at People's Hospital of Henan Province from October 2016 to September 2018.There were 76 males and 44 females,aged 45-80 years [(59.2 ± 7.2) years].A total of 60 patients received treatment and care under the pressure ulcer early warning system (early warning group),while 60 patients were given assessment form for pressure ulcer management (control group).The time of filling in the assessment form,the implementation score of pressure ulcer prevention measures,the incidence of pressure ulcer,visual analogue pain score (VAS) and patient satisfaction were compared between the two groups.Results In the control group and early warning group,the time of filling in the form was (121.5 ± 9.0) minutes and (11.3 ± 2.0) minutes (P ＜ 0.01),the implementation score of pressure ulcer prevention measures was (85.9 ± 3.8) points and (96.0 ± 2.2)points (P ＜ 0.01),and the pressure ulcer incidence was 25％ (15 patients) and 3％ (two patients),respectively (P ＜0.01).In the control group,the preoperative VAS was (7.3 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (3.7 ± 1.1) points,(3.2 ± 0.9) points,(2.4 ± 1.0) points,(2.3 ± 0.8) points,respectively.In the early warning group,the preoperative VAS was (7.4 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (2.9 ± 0.7) points,(2.4 ± 0.7) points,(1.8 ± 0.7) points,(1.6 ± 0.8) points,respectively.There was no significant difference in preoperative VAS between the two groups (P ＞ 0.05),while significant differences were found between the postoperative VAS (P ＜ 0.01).The satisfaction score in the control group was (94.6 ± 1.4) points,while that of the early warning group was (98.3 ± 1.1) points (P ＜ 0.01).Conclusion For patients undergoing posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery,the pressure ulcer risk warning system is convenient and reduces the incidence of pressure ulcer,thus alleviating patients'pain and improving patients' satisfaction.

Objective ToquantitativelystudythecorrelationbetweenT2mappingvalueofthesupraspinatuswithfattydegenerationand supraspinatustendontear.Methods From MarchtoSeptemberin2016,patientswithsupraspinatustendontearinourhospitalwere enrolled.TheT2mappingvalueofthesupraspinatuswasmeasured.Accordingtothesupraspinatustendontearclassification,patients weredividedintogroupA,BandC.ThecorrelationwasanalyzedbetweenT2mappingvalueandsupraspinatustendontear.Results 45patientswereenrolled,including30malesand15females,aged15－85years,withanaverageageof(45.4±16.6)years.Among the45shoulderjoints,12jointswereingroupA withnotendontear,14jointswereingroupBwithincompletetomoderatetear,and 19jointswereingroupCwithmosttofulllayertear.TheT2mappingvaluesofsupraspinatusingroupA,BandCwere46.0±7.0,51.5± 10.6and65.0±8.4,respectively.TheT2mappingvalueincreased withtheseverityofthesupraspinatustendontear (P＜0.001), whichwaspositivelycorrelated.Conclusion ThemeasurementofT2mappingisareliable methodforquantitativelyevaluatingthe fattydegenerationinthesupraspinatus.ThatthehigherT2mappingvalue,thehigherfatcontentinthesupraspinatusmuscle,suggests thetearofsupraspinatustendonismoreserious.T2mappingisanotheroptionalmethodforclinicaldiagnosisandprognosisevaluation oftherotatorcufftear.

Objective: To investigate the effects of interferon inducible protein 16 (IFI16), a cytosolic DNA sensor, on the expression of human T-cell leukemia virus type 1 (HTLV-1) proteins and pro-inflammatory cytokines in adult HTLV-1-positive T cells. Methods: IFI16 expression in different HTLV-1-positive T cell lines was detected by immunoblot assay. Specific siRNA targeting the IFI16 gene was constructed and the gene silencing efficiency was detected by immunoblot assay. Expression of HTLV-1 Tax protein at mRNA and protein levels was respectively detected by real-time PCR and immunoblot assay after knocking down the expression of IFI16 in HTLV-1-positive T cells with siRNA. Expression of interferon (IFN)-α, IFN-γ, tumor necrosis factor (TNF)-α, Tax and Env were detected by real-time PCR. Results: Compared with the HTLV-1-negative T cell line Jurkat, IFI16 expression was enhanced in the HTLV-1-positive T cell lines MT2, MT4 and C8166. Tax expression was increased, while that of IFN-α, IFN-γ and TNF-α was decreased in MT2 and MT4 cells after silencing the expression of IFI16 with siRNA. Conclusions IFI16 expression was increased in HTLV-1-positive MT2 and MT4 cells. Meanwhile, IFI16 promoted the production of interferon and pro-inflammatory cytokines and inhibited the expression of HTLV-1 proteins.

Objective: Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a recently recognized high-risk T lymphoblastic leukemia subgroup. The optimal therapeutic approaches to adult patients with ETP-ALL are poorly characterized. In this study, we explore the efficacy and outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for ETP-ALL. Methods: The clinical data of 23 patients with ETP-ALL receiving allo-HSCT from 2010 to 2018 were retrospectively analyzed. Patients with ETP-ALL were diagnosed based on the characteristic immunophenotypes. Second-generation sequencing was done in all patients. As to the donors, 12 patients had haploidentical donors (Haplo-HSCT) , 7 HLA-matched sibling donors (Sib-HSCT) and 4 HLA-matched unrelated donors (URD-HSCT) . Before transplantation, 19 patients achieved complete remission (CR) and 4 patients without. Results: The main clinical features of ETP-ALL included high white blood cell counts in 5 patients, splenomegaly in 14, lymphadenopathy in 19, and thymus masses in 5. According to cytogenetic and molecular characteristics, 11 patients had gene mutations related to myeloid tumors, and 7 with high risk Karyotype. After first induction regimen, 14/23 patients achieved CR. 5 patients reached CR after more than 2 cycles of chemotherapy, while another 4 patients did not reach CR. After allo-HSCT, 22 patients were successfully implanted. The median time of granulocyte and platelet reconstitution was +12 and +19 days. One patient died of transplant-related infection at +14 days. The estimated 18-month overall survival (OS) and relapse-free survival (RFS) rates were (55.0±14.4) % and (48.1±14.7) % respectively. Transplant-related mortality was 4.3%. The median OS in patients achieving CR before transplantation was 20 months, however, that in patients without CR was only 13 months. OS and RFS between haplo-HSCT and sib-HSCT were comparable (P=0.460 and 0.420 respectively) . Conclusions Allo-HSCT is an effective therapy in some patients with ETP-ALL. Salvage HSCT cannot overcome the poor outcome. Haplo-HSCT and sib-HSCT in ETP-ALL patients have the similar clinical outcome.

With the birth rate and survival rate of premature infants significantly increased, the risk of premature infant-related complications after discharge also gradually increased. Due to the parents′ lack of care experience to take care of premature infants, premature infants are prone to high re-admission rate, family pressure and burden. Therefore, strengthening transitional care, promoting the safe transition of premature infants from neonatal intensive care unit to home, and promoting the growth and development of premature infants are of great significance to improve the quality of life of premature infants. Transitional nursing of premature infants abroad has been carried out for nearly 30 years, while domestic research is still in its infancy and has not been carried out in a wide range of research and application. Therefore, this article summarized the concept, significance and nursing mode of premature infant transitional care, so as to provide reference for medical personnel to carry out premature infant transitional care.

Objective: To investigate the features of plaques of saphenous venous graft (SVG) with virtual histology intravascular ultrasound (VH-IVUS) in patients underwent coronary artery bypass graft surgery. Methods: From March 2016 to March 2018, a total of 45 patients ((64.4±7.9) years old, 88.9% male (40 cases)) with ischemic symptoms after coronary artery bypass graft surgery and with coronary artery angiography evidenced SVG stenosis greater than or equal to 50%, who received percutaneous coronary intervention in Tianjin chest hospital were continuously included in this study, and the clinical data were retrospectively analyzed. VH-IVUS was performed before PCI to analyze plaque composition. The patients were divided into no smoking group (21 cases) and smoking group (24 cases), no diabetes group (30 cases) and diabetes group (15 cases), normal very low density lipoprotein cholesterin (VLDL-C) group (24 cases) and elevated VLDL-C group (21 cases), stable angina pectoris group (5 cases) and acute coronary syndrome group (40 cases), plaque burden (PB) < 70% group (11 cases) and PB ≥ 70% group (34 cases), without thin-cap fibroatheroma group (35 cases) and thin-cap fibroatheroma group (10 cases), and plaque features were compared between different groups. Results: The graft age was (8.9±3.7) years.The stenosis degree of SVG lesions was 90 (90, 98) %. The minimum lumen diameter was 1.6 (1.5, 1.8) mm. The vessel cross-sectional area was (12.1±4.0) mm². The plaque area was 8.6 (5.7,12.0) mm². The minimum lumen area was 2.5 (2.1,3.3) mm². The plaque burden was (75.3±8.3)%. The fibrotic tissue (FI) ratio was (65.1±10.1)%, fibrofatty plaque (FF) ratio was 13.8 (5.4,25.3) %, necrotic core tissue (NC) ratio was 12.0 (5.4,24.0)%, and dense calcium tissue (DC) ratio was1.0 (0.2,3.8)% in SVG lesions. There were no significant differences in SVG plaque area, FI area,FF area,NC area,and DC area between no smoking group and smoking group, no diabetes group and diabetes group, and normal VLDL-C group and elevated VLDL-C group. SVG plaque volume was significantly higher in acute coronary syndrome group than in stable angina pectoris group (262.2 (148.5,401.2) mm³ vs. 93.1 (50.6,155.9) mm³,P=0.006), and plaque area (10.1 (6.6,13.3) mm² vs. 5.0 (3.6,6.9) mm², P<0.001), FI area(4.8 (3.2,6.8) mm² vs. 2.8 (1.9,3.0) mm², P<0.001),and FF area (1.15 (0.60, 2.07) mm² vs. 0.30 (0.10,0.90) mm², P=0.009) were significantly larger in PB ≥ 70% group than in PB < 70% group.The NC area (1.75(0.40,2.78) mm² vs. 0.60 (0.20,1.30) mm², P=0.030) and DC area (0.35 (0.10,0.50) mm² vs. 0.00 (0.00,0.10) mm², P=0.006) were significantly larger in thin-cap fibroatheroma group than that in without thin-cap fibroatheroma group. Spearman correlation analysis showed that the plaque area of SVG lesion was positively correlated with FF area (r=0.64, P<0.001) and NC area (r=0.43, P=0.003). PB was positively correlated with FF area (r=0.50, P<0.001) and NC area (r=0.33, P=0.028). Graft age was positively correlated with FF area (r=0.30, P=0.047). Conclusions The main components of SVG plaque are fibrotic tissue, conversely, calcified tissue is rare in patients with SVG stenosis after coronary artery bypass graft surgery. Fibrofatty tissue is increased in the plaque in patients with PB ≥ 70%. The necrotic component is also increased in patients with thin-cap fibroatheroma. The fibrofatty component increases and the plaque tends to be unstable in proportion with increaing age of the graft in this patient cohort.

Objective: To establish a liquid chromatography tandem mass spectrometry method to determine the cortisol in saliva. Methods: Take 0.5 ml saliva sample into a 2 ml centrifuge tube, add excess sodium chloride and 1ml acetonitrile to it, then vortex for 3 min, centrifuge for 10 min at 15 000 r/min, and take 800 μl of the upper layer to another centrifuge tube. Finally, the sample was concentrated by a vacuum concentrator and brought to 200 μl with the initial mobile phase. Then, the sample was analyzed by liquid chromatography tandem mass spectrometry. The target compound was quantified by external standard curve method. Results: The linear range of the method was 0.02-5.00 ng/ml, r=0.999 9, the method limit of the detection was 0.002 ng/ml, the method limit of quantitative was 0.02 ng/ml, and the spiked recoveries were 89.60%-98.60%. The intra-assay precision was 1.90%-3.30%, and the inter-assay precision was 4.20%-9.00%; samples could be stored at -20 °C for at least 14 days. The determination of cortisol could not be interfered by other endogenous substances in the sample. Conclusion The method is simple in pretreatment, high sensitivity, good reproducibility and good recovery, and it is suitable for the quantitative analysis of cortisol in saliva for normal and occupationally stressed populations.