Objective To analyze the prefrontal electroencephalogram characteristics of patients with emergence delirium(ED)after hip or knee arthroplasty.Methods Sixty-four patients undergoing elective hip or knee arthroplasty were selected,12 males and 52 females,aged≥60 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅱ or Ⅲ.The confusion assessment method-intensive care unit(CAM-ICU)and the Richmond agitation-sedation scale(RASS)were used to determine the occurrence of ED dur-ing postoperative anesthesia.The patients were divided into two groups according to whether delirium oc-curred during emergence from anesthesia:the emergence delirium group(ED group)and the non-emergence delirium group(non-ED group).The patients'raw EEG data during the emergence phase were recorded by the EEG monitor,and the data from before(5-10 minutes after discontinuation of the drug)and after emergence(15-20 minutes after removal of the laryngeal mask)were intercepted and spectrally analyzed.Results Twenty-eight patients(44％)developed ED.EEG changes during emergence from anes-thesia were consistent in both groups:the spectral edge frequency(SEF)was increased,the β and y wave power was increased,and the peak α wave frequency was decreased.Compared with the pre-emergence state,the θ and α wave power were significantly lower and the peak α wave power was significantly lower in the non-ED group during full awakening(P＜0.05),and the difference between the α wave power and the peak α wave power was not statistically significant in the ED group during full awakening.Sample entropy and alignment entropy of patients in the ED group before emergence and in full awakening were significantly higher than those in the non-ED group(P＜0.05).Conclusion The θ wave power,α wave power,and peak α wave power were significantly lower during emergence from anaesthesia in patients with no delirium.In patients who developed ED,there was no significant change in α wave power or peak α wave power dur-ing emergence from anesthesia,but there was an increase in sample entropy and alignment entropy.

Objective To explore the role and mechanism of periostin(POSTN)in the proliferation of pulmonary artery smooth muscle cell(PASMC)in hypoxia-induced pulmonary hypertension(HPH).Methods The primary PASMC from male rats were ex-posed to hypoxic environment to simulate HPH.The cells were divided into normoxia group,hypoxia group,hypoxia+control adenovirus transfected group(hypoxia+Ad-shNC group),hypoxia+POSTN silenced adenovirus transfected group(hypoxia+Ad-shPOSTN group),POSTN group,POSTN+U0126 group.α-smooth muscle actin(α-SMA)was used to evaluate the purity of PASMC,CCK-8 assay was performed to detect cell viability,and Western blot was utilized to detect the protein expression level of POSTN,proliferating cell nuclear antigen(PCNA),bone morphogenetic protein type Ⅱ receptor(BMPR2),phosphorylated extracellular signal-regulated ki-nase 1/2(p-ERK1/2),and extracellular signal-regulated kinase 1/2(ERK1/2)in PASMC.Results Compared with the normoxia group,hypoxia promoted the proliferation of PASMC and the expression level of POSTN protein,while inhibited the expression level of BMPR2 protein.Down-regulation of POSTN expression could inhibit hypoxia-induced proliferation of PASMC and restore BMPR2 pro-tein expression level.In addition,POSTN significantly increased the protein expression ratio of p-ERK1/2 or ERK1/2,and the prolifer-ation of PASMC,which could be blocked by U0126.Conclusion In the pathological mechanism of HPH,POSTN promotes the prolifera-tion of PASMC,and its potential mechanism may be related to the regulation of BMPR2 expression and activation of ERK1/2 signaling pathway.

Objective To explore the role of intestinal sympathetic nerve in the improvement of obesity-related hypertension(OH)by carotid baroreceptor stimulation(CBS).Methods Twenty male SD rats were randomly divided into four groups:normal control(C-sham)group,OH-sham group,OH-CBS group and OH-6-OHDA-sham group,with 5 rats in each group.The OH model was in-duced by feeding with high-fat diet and 10％fructose water for 4 weeks.All rats were implanted with CBS stimulator at the end of the 4th week.The OH-CBS group received electrical stimulation,while the OH-sham,C-sham and OH-6-OHDA-sham groups received no stimulation.The OH-6-OHDA-sham group was intraperitoneally injected with 6-OHDA at the 6th week.Blood pressure and body weight of all rats were measured weekly.After 12 weeks,the weight of visceral fat was recorded,and serum glucose and lipid metabolism indexes were detected.Immunofluorescence staining was used to detect tyrosine hydroxylase(TH),mucin-2(MUC2),and zonula oc-cludens-1(ZO-1)in the ileum.Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)was used to detect MUC2,ZO-1 and interleukin-22(IL-22).Results Compared with the C-sham group,the OH-sham group had significant in-creases in blood pressure,the intestinal TH was overexpressed in OH-sham group(P＜0.05),blood pressure,body weight,visceral fat content,serum low-density lipoprotein,glucose,free fatty acid,triglyceride,and total cholesterol were significantly increased(P＜0.05),and serum high-density lipoprotein,IL-22,MUC2,and ZO-1 were decreased(P＜0.05).The TH overexpression was sig-nificantly reduced,the blood pressure,body weight,visceral fat content,serum low-density lipoprotein,glucose,free fatty acid,triglyc-eride,total cholesterol of OH rats were significantly decreased,the expression of serum high-density lipoprotein,IL-22,MUC2 and ZO-1 were also increased in OH-CBS group and OH-6-OHDA-sham group under high-fat and high-sugar feeding.Conclusion Intestinal sympathetic nerve plays an important role in the improvement of OH by CBS.

Objective : To explore the frontal EEG characteristics of elderly patients with postoperative delirium (POD) after spinal surgery under conscious and general anesthesia． Methods : he inclusion criteria were patients aged≥65 years who underwent elective spinal surgery．POD was evaluated using The Confusion Assessment Method ( CAM) 1－7 days after surgery．Patients were divided into two groups based on whether POD occurred : Postoperative Delirium Group (POD group) and Non Postoperative Delirium Group (Non POD group) ．The raw EEG data of two groups of patients in the EEG monitoring instrument were extracted，and the data of two time periods of wakefulness and anesthesia were intercepted for spectral analysis．The EEG data that did not meet the requirements were excluded，and ultimately 80 patients were included，including 32 in the POD group and 48 in the Non-POD group. Results : Compared with the Non-POD group，patients in the POD group were found to be under anesthesia the power of θ、α、β waves (5 －18 Hz) significantly decreased，the peak α frequency of the wave was slower (P = 0. 038) ，the peak power of α (P＜0. 001) and the total power were lower (P＜0. 001) ．Comparing the EEG chan- ges between two groups from wakefulness to anesthesia，the study found that the increase of α power in POD group was not significant． Conclusion The characteristic electroencephalograms associated with POD in elderly patients during the perioperative period can help anesthesiologists to identify high-risk patients with POD in the early .

Objective To investigate the effect of Shenxiong glucose injection on platelet reactivity during aspirin treatment in patients with acute ischemic stroke.Methods A total of 263 patients with acute ischemic stroke admitted to 12 hospitals from January 2014 to December 2016 were enrolled prospectively.They were randomly divided into aspirin group and aspirin + Shenxiong glucose injection group.The changes of platelet maximum aggregation rate induced by 4 platelet aggregating agents (arachidonic acid,adenosine diphosphate,collagen and platelet activating factor) were detected before and after the treatment.Results There were no significant differences in the demographic data and baseline clinical characteristics between the aspirin group (n =132) and the Shenxiong glucose injection + aspirin group (n =131).At baseline,the maximum aggregation rate of platelet induced by arachidonic acid and platelet activating factor in Shenxiong glucose injection + aspirin group was significantly higher than that in the aspirin group (all P ＜0.05).On the 6th day after treatment,the maximum aggregation rate of platelets induced by the 4 aggregating agents in the Shenxiong glucose injection + aspirin group was significantly lower than that in the aspirin group (all P ＜ 0.001).Conclusion Shenxiong glucose injection had a significant inhibitory effect on platelet reactivity during aspkin treatment in patients with acute ischemic stroke.

Objective To evaluate the changes in the status of macrophages during the non-ventilated lung injury in the patients undergoing long-time one-lung ventilation (OLV).Methods Thirty patients of both sexes,aged 35-64 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective pulmonary lobectomy for lung cancer,were divided into 2 groups (n=15 each) according to the time of OLV:short-time OLV group (＜30 min,group S) and long-time OLV group (＞2 h,group L).Anesthesia was routinely induced and maintained.Normal lung tissues around the cancer tissues from the lobe of the lung excised were obtained for microscopic examination of pathologic changes which were scored.The activated macrophages (CD68 positive),polarized M1 macrophages (CD86 positive) and polarized M2 macrophages (CD206 positive) in lung tissues were detected using immunofluorescence.The ratio of CD86 positive cells to CD206 positive cells was calculated.Results Compared with group S,lung injury scores on the non-ventilated side were significantly increased,the number of CD68,CD86 and CD206 positive cells in lung tissues was increased,and the ratio of CD86 positive cells to CD206 positive cells was increased in group L (P＜0.05).Conclusion Long-time OLV (＞2 h) can result in increased number of activated macrophages,especially the polarized M1 macrophages,which may be one of the mechanisms underlying lung injury on the non-ventilated side.

Objective To evaluate the causation and management of complications caused by enteral nutrition (EN)after stomach cancer surgery.Methods The clinical data of 195 gastric cancer patients which used EN after surgery were analyzed retrospectively from September 2002 to April 2008 in our hospital.Results Among the 195 patients,29(14.87%)developed abdominal distention,17(8.71%)diarrhoea,Six(3.07%)metabolic complica tions,three anastomotie leakage,1 patient with colon perforation.Conclusion These complications caused by EN after stomach cancer surgery associated with the stress of surgery,the speed and concentration of nutrition infusion, patients'metabolic conditions and other related factors.

OBJECTIVE:To explore the general patterns and characteristics of the adverse drug reactions(ADR)induced by acyclovir.METHODS:52 acyclovir-induced ADR reports(60 cases)published in China Hospital Knowledge Database from 1994 to 2006 was analyzed statistically.RESULTS:The ADR induced by acyclovir were more often occurred in patietns aged from 31 to 60,with 41.67% appearing within 10～60 min after drug use.The clinical presentation was complex and diverse,which involved different systems and organs,predominantly the lesion of renal function.CONCLUSION:Clinician and pharmacists should attach great importance to Acyclovir-induced ADR in clinical practice and stick to rational drug use.