Delirium is an acute cognitive disorder caused by a variety of factors which lead to cerebral cortical dysfunction. At present the studies on the pathophysiology of delirium is still very few. But studies on serum biomarker of delirium can help to elucidate the pathophysiological mechanism of delirium, and the studies are significant for delirium diagnosis, severity classification and prediction of long-term outcome. This review examines three major groups of delirium related serum biomarkers: ① risk markers: those that are present or elevated prior to disease onset, including serum chemistries, genetic markers and so on; ② disease markers: those markers elevate with delirium onset and fall when delirium recovery, including acetylcholine and serum anticholinergic activity, serotonin, serum amino acids, and melatonin, interleukin, C-reactive protein; and ③ end products: those that rise in proportion to the consequences of disease, including S-100? and neuron specific enolase. The three markers mentioned above are helpful to further investigate the mechanism of delirium.
Objective To define risk factors of nosocomical pneumonia (NP) in elderly in-patients. Methods Two hundred elderly in-patients were selected in the Geriatric Department of West China Hospital from January 1999 to June 2002. Among them, 100 patients developed NP during their hospital days and the others didn’t have the episodes of NP at the same time. The following factors were analyzed: sex, age, multiple underline diseases and their severity, smoking, activity of daily life, conscious status, aspiration, nasogastrial intubations, antibiotics use and hospitalization. SPSS 10.0 was used for Logistic regression analysis to determine the factors significantly associated with the development of NP. Results The following factors were significantly associated with the development of NP in the logistic regression analysis: aspiration [OR 28.452, 95%CI (3.793 to 213.447)],multiple diseases [OR 17.157, 95%CI (2.734 to 107.651)], multiple antibiotics use [OR 6.396, 95%CI (1.861 to 21.980)], smoking [OR 1.774, 95%CI (1.211 to 2.600)] and prolonged hospitalization [OR 1.134, 95%CI (1.081 to 1.189)]. Conclusions Aspiration, multiple diseases, multiple antitiotics use, smoking and prolonged hospitalization are closely related to NP in elderly in-patients. Cautionary medical measures and shortening hospitalization were the key factors to decrease the incidence of NP for the patients in Geriatric Department.
ObjectivesTo systematically review the efficacy of intra-articular injection of sodium hyaluronate for kashin-beck disease. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CBM, VIP, WanFang Data, and CNKI were electronically searched from inception to January 2016 to collect randomized controlled trials (RCTs) about sodium hyaluronate in the treatment of kashin-beck disease. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 6 RCTs involving 1 276 patients were included. The result of metaanalysis suggested that the sodium hyaluronate group was significantly superior to the control group in clinical effect (OR=5.89, 95% CI 4.10 to 8.47, P < 0.000 01) and the Lequesne index (SMD=-1.66, 95% CI-2.14 to-1.13, P < 0.000 01). ConclusionIntra-articular injection of sodium hyaluronate is helpful in the improvement of kashin-beck disease in clinical effect and the Lequesne index. Due to the limited quality and quantity of the included studies, more high quality studies are need to verify the above conclusion.
Rheumatoid arthritis is a chronic inflammatory disorder. It is characterized by a chronic polyarthritis that primarily affects the peripheral joints and related periarticular tissues. To a patient with rheumatoid arthritis, we searched the evidence and indentified the best available therapy for him: ① Ibuprofen was used to relieve pain. ② Methopterin ivgtt qw and oral methopterin after the discharge for 12 months. ③ Oral omeprazole 20 mg/d to prevent peptic ulcear. ④ Administration with fish oil and physical exercises after discharge were recommended.
Objective To determine whether statins has some effects on the treatment of cardio-cerebral vascular diseases or hyperlipdemia increases bone mineral density （BMD）. Methods One hundred and sixty-two patients aged over 60 were identified in the outpatient-department of Geriatrics of West China Hospital from Jan. 1998 to Aug. 2003. Seventy cases were exposed to statins with follow-up for 5 years. BMD of the spine, femoral neck, femoral wards triangle and femoral trochanter was measured by dual-energy X-ray absorptiometry. The multiple regression analysis was used to exclude potential confounders, e.g. age, BMI, comorbidity,etc. Results Those elderly patients with a history of taking statins had higher BMD, such as femoral neck with t =-2. 466 （P =0. 015）, femoral wards triangle with t =-2. 483 （P = 0. 014 ）and femoral trochanter with t =-2. 743 （P =0. 007 ）than the control elderly at the end of follow-up. Conclusions It has been found that HMG-CoA reductase inhibitors （statins ） may prevent bone loss in elderly patients by increasing BMD. Further prospective studies of statins are needed to confirm these observatioris.
Objective To compare the effectiveness and safety of linezolid with vancomycin for the treatment of people with Gram-positive bacteraemia. Methods We electronically searched The Cochrane Library (Issue 1, 2009), MEDLINE, EMbase, Current Controlled Trials, The National Research Register, CBM disc and CNKI. We also handsearched some relevant journals. The search time was up to March 10, 2009. Randomized controlled trials of linezolid versus vancomycin for treatment of Gram-positive bacteraemia were included. Meta-analyses were performed for the results of homogeneous studies using the Cochrane Collaboration’s RevMan 5.0 software. Results A total of 8 randomized controlled trials involving 670 patients with Gram-positive bacteraemia were included. The results indicated that there was no significant difference between linezolid and vancomycin groups in treatment of Gram-positive bacteraemia [RR= 1.07, 95%CI (0.98,1.17), P= 0.15], MRSA bacteraemia [RR=1.22, 95%CI (0.97,1.53), P= 0.10] or catheter-related bacteraemia [RR= 1.01, 95%CI (0.86,1.19), P= 0.90]. There was no difference between groups in the total adverse effect (P=0.64). The rate of renal dysfunction was higher in vancomycin group (P=0.0003) and the rate of thrombopenia was higher in linezolid group (P=0.01). Conclusion Linezolid is associated with the outcomes that are not inferior to those of vancomycin in the patients with Gram-positive bacteraemia. More high-quality, large-scale randomized controlled trials exclusive for the bacteraemia are required.
ObjectiveTo analyze and reduce the defects in nursing records for blood transfusion by continuous quality improvement (CQI) method, in order to prevent blood transfusion related medical disputes. MethodsIn October 2014, CQI team was established to analyze the reason for transfusion record defects and make standardized process and quality monitoring forms for nursing record of blood transfusion. Six months after the implementation of CQI, 40 records were randomly selected before the CQI implementation (April to September 2014) and after the implementation (April to September 2015) for comparison and analysis. ResultAfter 6 months of implementation of CQI, nursing record defects of blood transfusion decreased significantly from 228 to 55 items. ConclusionUsing CQI method can effectively reduce nursing record defects of blood transfusion. CQI can also improve the quality of nursing records and prevent medical disputes caused by blood transfusion.
Objective To report evidence-based treatment for 2 case of Ⅱ B stage non-small cell lung cancer. Methods We searched systematic reviews and randomized controlled trials in The Cochrane Library (Issue 2, 2009), MEDLINE (PubMed, January 1970 to June 2009) and ACP Journal Club (1996 to June 2009), and evaluated the evidence. Results The best clinical evidence for Ⅰ and Ⅱ stage non-small cell lung cancer patients showed that in the patients with resectable nonsmall cell lung cancer, postoperative adjuvant radiotherapy and chemotherapy could not improve survival compared with surgery alone. We did not find evidence which indicated that preoperative chemotherapy improved survival in people with resectable non-small cell lung cancer. Conclusion In accordance with the wishes of the patient and family, they do not accept the radiotherapy and chemotherapy, but choose palliative and supportive therapy.