Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Developing tumor-specific drug delivery systems with minimized off-target cargo leakage remains an enduring challenge. In this study, inspired from the natural cryptobiosis explored by certain organisms and stimuli-responsive polyphenol‒metal coordination chemistry, doxorubicin (DOX)-conjugated gelatin nanoparticles with protective shells formed by complex of tannic acid and Fe

Objective To investigate the demographic characteristics, clinical features, diagnosis and treatment of patients with gout in China.Methods Clinical data of 6 814 patients with gout from 100 hospitals in 27 provinces, municipalities or autonomous regions in China were collected and analyzed. Results (1)The ratio of male to female in patients with gout was 14.7:1.The mean age of onset was(48.8 ± 15.1)years old.Mean serum urate level was(526.7 ± 132.3)μmol/L.Patients'education background was of U-shaped distribution; (2) Hypertension was the most common comorbidity [15.8%(1 079/6 814)], then overweight or obesity[51.9%(3 536/6 814)];(3)Alcohol and high-purine food intake were dominant triggering factors in men. The diagnosis of gout was made after onset in majority of patients with cardinal symptom arthralgia.Most patients had the disease less than 5 years,and the longer the course,the more flares in the previous year of entry;(4)Febuxostat was the mostly used urate-lowering medication.20.7%(1 412/6 814), 10.8%(739/6 814) and 3.9%(265/6 814) of patients were followed up in 4 weeks, 12 weeks and 24 weeks after registration,and 18.9%(267/1 412),29.1%(215/739)and 38.1%(101/265)of them reached the control target of serum urate levels,respectively.After treatment,patients'liver function was not affected,but serum creatinine levels decreased significantly. Conclusions The proportion of gout patients who reach target serum urate level is very low.Further steps including education and survey need to be carried on.

OBJECTIVETo discuss the influence of setup errors on the accuracy of pelvic cancer in IGRT, analysis setup errors and determine the CTV-to-PTV margins.

METHODS60 pelvic cancer patients treated with Varian 23IX, all of them were performed by CBCT before and after-correction three times in the first week and after that once a week. Then, to measure the setup errors at X(left-right), Y(superior-inferior), Z(anterior-posterior) axis and E(coronal), F(sagittal), G(axial) rotation directions.

RESULTS530 scans obtained in all, the setup errors in X, Y, Z, E, F, G were (-0.52 ± 4.18) mm, (0.73 ± 4.86) mm, (-0.36 ± 3.62) mm, (0.14 ± 1.20)degrees, (0.13 ± 1.34)degrees, (0.21 ± 1.73)degrees respectively and were much lower after correction at X, Y, Z axis, besides, CTV-to-PTV margins decrease a lot.

CONCLUSIONThe accuracy of radiotherapy can be highly increased with the use of IGRT in pelvic cancer.

BACKGROUND:A large number of clinical trials have found that the number of bone marrow stem cels at the femoral neck and proximal femur in patients with osteonecrosis of the femoral head is significantly reduced, accompanied by decreased activity, which causes a significant decrease in osteogenic capacity that the necrotic bone cannot be effectively repaired after absorption, leading to the colapse of the femoral head. OBJECTIVE:To probe into the early clinical efficacy of autologous peripheral blood mononuclear cel transplantation with porous core decompression for treatment of avascular necrosis of the femoral head. METHODS:Forty-five patients with avascular necrosis of the femoral head (49 hips) were enroled in this study, and underwent autologous peripheral blood mononuclear cel transplantation with porous core decompression. After treatment, pain scores, Harris hip score, scores on the satisfaction of patients were evaluated, as wel as X-ray, CT and MRI examinations. RESULTS AND CONCLUSION:Al the patients received a folow-up visit of 11-14 months, averagely (12.5±0.6) months. During the folow-up, there were no complications and serious adverse reactions. Postoperative pain scores and Harris scores were both improved significantly compared with preoperative ones (P < 0.05). At 12 months after treatment, the excelent satisfaction rate was up to 92%. Patient’s MRI low signal region accounting for a percentage of the volume of the femoral head was decreased from (40.1±7.34)% preoperatively to (20.23±5.4)% at 6 months postoperatively, and there was a significant difference (P < 0.05). These findings indicate that autologous peripheral blood mononuclear cel transplantation with porous core decompression for treatment of avascular necrosis of the femoral head has significantly clinical effects at early stage, which can obviously reduce joint pain, improve and restore hip joint function, and delay progression of disease.

Objective To discuss the influence of setup errors on the accuracy of pelvic cancer in IGRT, analysis setup errors and determine the CTV-to-PTV margins. Methods 60 pelvic cancer patients treated with Varian 23IX, al of them were performed by CBCT before and after-correction three times in the first week and after that once a week. Then, to measure the setup errors at X(left-right), Y(superior-inferior), Z(anterior-posterior) axis and E(coronal), F(sagittal), G(axial) rotation directions. Results 530 scans obtained in al , the setup errors in X, Y, Z, E, F, G were (-0.52±4.18) mm, (0.73±4.86) mm, (-0.36±3.62)mm, (0.14±1.20)o, (0.13±1.34)o, (0.21±1.73)o respectively and were much lower after correction at X, Y, Z axis, besides, CTV-to-PTV margins decrease a lot. Conclusion The accuracy of radiotherapy can be highly increased with the use of IGRT in pelvic cancer.

Objective To determine plasma soluble HLA-G (sHLA-G) levels in patients with systemic lupus erythematosus (SLE),and to analyze its association with the possibility of organs or systems involvement in lupus patients.Methods Plasma samples were collected from 96 SLE patients and 74 healthy controls,and sHLA-G levels were determined by enzyme-linked immunosorbent assay.The sHLA-G levels in SLE patients and healthy controls were compared with students't-test.The difiefence of clinical and seroimmunological data among the SLE patients was assessed by chi-square test or students't-test.A value of P<0.05 was considered to be significant.Results Plasma concentration of sHLA-G was significanto higher in SLE patients than that in healthy controls[(230±192)U/ml vs(118±38)U/ml,P=0.0001].No relationship between plasma sHLA-G levels and SLE disease activity index(SLEDAI)was found(r=0.157,P=0.141).However,the patients with increased levels of sHLA-G had more severe disease activity (11±5 vs 8±5,P=0.027) and more central nervous system (CNS) involvement (24.2% vs 4.8%,P=0.007) in comparison with patients with normal plasma levels of sHLA-G.Conclusion The increased production sHLA-G,paralleled with more severe disease activity and higher CNS involvement,indicates that sHLA-G may play an important role in the pathogenesis of SLE.

Objective To study clinical characteristics in patients of systemic lupus erythematosus (SLE)with cardiac involvement and to assess relevant risk factors contributed to it.Methods Totally,239 patients of SLE were evaluated by cardiogram,echocardiogram and serologic examinations,and those with cardiac involvement were compared to those without it by clinical and laboratory data.Results There were 114 of 239(47.7%)SEE patients with cardiac abnormalities,of whom only 31(27.2%)had cardiac symptoms,including 44 cases(38.6%)with hydropericardium,32(28.1%)with myocardial damage,14 (12.3%)with cardiac valvular lesions,19(16.7%)with cardiac block,and 13 with other cardiac damages.No significant difference in age,gender,course of disease,SLE activity index(SEEDAI)scores,serum levels of auto-antibodies and complement(C3),and so on,were found between 114 SLE patients with cardiac abnormalities and 64 without it,who were:randomly selected from 125 patients of SEE without cardiac damage.But,patients of SLE complicated with pericarditis or myocardial lesions had higher SLEDAI scores and lower serum level of C3 than those without cardiac lesions(both P＜0.05),and relatively longer course of disease was found in those with valvular heart disease.Conclusions Cardiac damage was common in patients with SLE,but most of whom were asymptomatic,and only those with severe and active illness tended to develop pericarditis and myocardial damage and those with longer course were liable to have valvular heart disease.

Objective To determine the level of monocyte chemoattractant protein-1 (MCP-1) in patients with systemic lupus erythematosus (SLE) and to assess its relationship with disease activity and organ damage. Methods The plasma levels of MCP-I were measured by enzyme linked immunosorbent assay (ELISA) in 95 patients with SLE and 21 healthy controls. Disease activity in SLE patients was assessed using the SLE Disease Activity Index (SLEDAI). Results Plasma level of MCP-1 was significantly elevated in SLE patients than in healthy controls [(849±289) pg/ml vs (426±266) pg/ml, P<0.01]. Moreover, level of MCP-1 was significantly higher in SLE patients with lupus nephritis (LN) than in patients without LN (P<0.01), andin SLE patients with neuropsychiatric symptoms than in patients without neuropsychiatric involvement (P< 0.01). In addition, significant correlation between plasma MCP-I levels and the SLEDAI was observed (r= 0.3699, P<0.01), and this relationship was not influenced by the treatment with glucocorticoid and cyclophosphamide. Conclusion MCP-I may play an important role in the pathogenesis of SLE, including renal and neuropsychiatric involvement. MCP-I is also a serologic marker of disease activity in patients with SLE, and its measurement in SLE patients may be useful for the evaluation of disease activity.

0.05).However,the patients with increased levels of sHLA-G had higher incidence of central nervous system involvement(P=0.007) and more severe disease activity(P=0.027) in comparison with patients with normal plasma sHLA-G levels.Finally,the expression of plasma sHLA-G was not influenced by the treatment with glucocorticoids,immunosuppressive agents or antimalarials.Conclusion The increased production of sHLA-G indicates that sHLA-G may play an important role in the pathogenesis of SLE.The expression of sHLA-G may be associated with disease activity and severity of lupus patients,but be independence of HLA-G 14bp ins/del polymorphism and drug treatment.