Evaluation and treatment of altered mental status patients in the emergency department:Life in the fast lane

BACKGROUND:Altered mental status(AMS) is a very common emergency case,but the exact etiology of many AMS patients is unknown.Patients often manifest vague symptoms,thus,AMS diagnosis and treatment are highly challenging for emergency physicians.The aim of this study is to provide a framework for the assessment of AMS patients.This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS:This is a prospective cohort observational study.We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24months(June 2009 to June 2011).Demographic characteristics,clinical manifestations,assessment approaches,causative factors,emergency treatments and outcomes were collected prospectively.RESULTS:In 1934 patients with AMS recruited,accounting for 0.93%of all emergency department(ED) patients,1 026(53.1%) were male,and 908(46.9%) female.Their average age was 51.95±15.71 years.Etiologic factors were neurological(n=641;35.0%),pharmacological and toxicological(n=421;23.0%),systemic and organic(n=266;14.5%),infectious(n=167;9.1%),endocrine/metabolic(n=145;7.9%),psychiatric(n=71;3.9%),traumatic(n=38;2.1%),and gynecologic and obstetric(n=35;1.9%).Total mortality rate was 8.1%(n=156).The death rate was higher in elderly patients(≥60) than in younger patients(10.8%vs.6.9%,P=0.003).CONCLUSIONS:Patients with AMS pose a challenge for ED physicians.The most frequently encountered diagnostic categories causing AMS were primary CNS disorders,intoxication,organ system dysfunction,and endocrine/metabolic diseases.AMS has a high fatality rate in the ED.AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects.Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.

simultaneous determination of vitexin-2"-O-glucoside,vitexin-2"-O-rhamnoside,rutin,vitexin,and hyperoside by HPLC

A simple,precise,and rapid high-performance liquid chromatographic method was developed and validated for the simultaneous determination of vitexin-2 00-O-glucoside,vitexin-2 00-O-rhamnoside,rutin,vitexin,and hyperoside.The HPLC separation was performed using a Shim-pack VP-ODS C 18 column(250 mm 4.6 mm i.d.,5 mm) with the isocratic mobile phase consisting of tetrahydrofuran/acetonitrile/0.05% phosphoric acid solution(20:3:77,v/v/v),and the flow rate was set at 1.0 mL/min.UV detection was carried out at a wavelength of 360 nm and the whole analysis took 25 min.The method was linear in the range of 4.12-206.00 mg/mL for vitexin-2 00-O-glucoside,4.05-202.50 mg/mL for vitexin-2 00-Orhamnoside,1.64-82.00 mg/mL for rutin,1.74-87.00 mg/mL for vitexin,and 1.41-70.60 mg/mL for hyperoside with the correlation coefficient for each analyte more than 0.998.The limit of detection(LOD) and limit of quantitation(LOQ) were 0.6 and 2 ng for vitexin-2 00-O-glucoside,0.6 and 2 ng for vitexin-2 00-O-rhamnoside,0.3 and 1 ng for rutin,1 and 3 ng for vitexin,and 0.5 and 2 ng for hyperoside,respectively.Intra-and inter-day precision and accuracy(RSD) were less than 3%.The developed HPLC method was successfully applied to the analysis of five flavonoids in hawthorn leaves,hawthorn fruits,and the preparations containing hawthorn leaves or fruits.

Cronkhite-Canada syndrome:Report of six cases and review of literature

Cronkhite-Canada syndrome(CCS)is a rare nonfamilial polyposis syndrome characterized by epithelial disturbances in the gastrointestinal tract and skin.The aim of this study was to investigate the clinical features and potential therapies for CCS.Six patients with CCS admitted from December 1992 to July 2008 to Peking Union Medical College Hospital were evaluated.All patients had clinical manifestation of nonhereditary gastrointestinal polyposis with diarrhea,skin hyperpigmentation,alopecia,and nail dystrophy.Fecal occult blood was positive in all six cases.Serum hemoglobin,potassium,calcium and protein were below the normal range in two cases.Anti-Saccharomyces cerevisiae and antinuclear antibodies were present in three cases.Multiple polyps were found in all patients by gastroscopy and colonoscopy,with only one in the esophagus.Histologically,there were hyperplastic polyps in five cases,tubular adenoma in three,and juvenile polyp in one with chronic inflammation and mucosal edema.Comprehensive treatment led by corticosteroids can result in partial remission of clinical symptoms,and longterm follow-up is necessary.

Association between maternal gestational diabetes and allergic diseases in offspring:a birth cohort study

Background Previous studies have linked gestational diabetes(GDM)with allergies in offspring.However,the effect of specific glucose metabolism metrics was not well characterized,and the role of polyunsaturated fatty acids(PUFAs),a modifier of metabolism and the immune system,was understudied.We aimed to investigate the association between maternal GDM and allergic diseases in children and the interaction between glucose metabolism and PUFAs on allergic outcomes.Methods This prospective cohort study included 706 mother–child dyads from Guangzhou,China.Maternal GDM was diagnosed via a 75-g oral glucose tolerance test(OGTT),and dietary PUFAs were assessed using a validated food frequency questionnaire.Allergic disease diagnoses and the age of onset were obtained from medical records of children within three years old.Results Approximately 19.4%of women had GDM,and 51.3%of children had any allergic diseases.GDM was positively associated with any allergic diseases(hazard ratio[HR]1.40;95%confidence interval(CI)1.05–1.88)and eczema(HR 1.44;95%CI 1.02–1.97).A unit increase in OGTT after two hours(OGTT-2 h)glucose was associated with an 11%(95%CI 2%–21%)higher risk of any allergic diseases and a 17%(95%CI 1–36%)higher risk of food allergy.The positive associations between OGTT-2 h glucose and any allergic diseases were strengthened with decreased dietary a-linolenic acid(ALA)and increased n-6 PUFAs,linoleic acid(LA),LA/ALA ratio,and n-6/n-3 PUFA ratio.Conclusions Maternal GDM was adversely associated with early-life allergic diseases,especially eczema.We were the first to identify OGTT-2 h glucose to be more sensitive in inducing allergy risk and that dietary PUFAs might modify the associations.

费米超流体的类振荡膨胀（英文）

在强相互作用的费米气体的研究中,原子团的膨胀动力学过程的测量是获取强相互作用费米气体性质的重要手段之一.由于制备的原子团原子数少(~10~5)和温度高(~0.1T_F),此前的研究工作中强相互作用费米气体的膨胀过程通常仅能维持几毫秒.因此,本文首先制备出了大原子数(5×10~6)和极低温度(0.06(1)T_F)的费米超流.结合特殊的磁场设计,作者成功地观测到了长达30ms的费米超流体的类振荡膨胀过程.同时,作者测量了费米超流体的指数型状态方程,得到了准震荡频率与相互作用、温度的关系.该实验结果和方法将促进对费米超流诸多有趣现象的研究,如椭圆流、正常-超流相变和super-Efimov效应等.

Construction of Metallacycle-Linked Heteroarm Star Polymers via Orthogonal Post-Assembly Polymerization and Their Intriguing Self-Assembly into Large-Area and Regular Nanocubes

of main observation and conclusion In recent years,synthesis of hybrid heteroarm star polymer with precisely defined arms has evolved to be one of the most attractive topics within polymer chemistry.In this study,we present the successful synthesis of metallacycle-linked heteroarm star polymers(HASPs)composed of crystalline poly(e-caprolactone)(PCL)and polyacrylate(poly(N-isopropylacrylamide)(PNIPAM)segments via combination of ring-opening polymerization(ROP)and reversible addition-fragmentation chain transfer(RAFT)controlled radical polymerization.Firstly,a hexagonal metallacycle containing three hydroxy groups and three chain transfer agent moieties at the alternative vertexes was designed and synthesized based on the general principle of coordination-driven self-assembly.Subsequently,upon combination of two orthogonal post-assembly polymerizations,a new family of HASPs containing a well-defined hexagonal metallacycle with precisely controlled position of polymer arms was facilely prepared.Interestingly,the obtained HASPs could spontaneously self-assemble into large-area and regular cubic nanoparticles in tetrahydrofuran(THF)/methanol(MeOH)mixed solvents under specific conditions as confirmed by scanning electron microscopy(SEM)and atomic force microscopy(AFM).This study provides a simple route to the controllable preparation of HASPs,and opens up a new way for further study on self-assembly of different HASPs systems.