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 ...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 24 months （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）.CONCLUSION： 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.展开更多
A new improved two-step method in fabricating Tl_(2)Ba_(2)CaCu_(2)O_(8)(Tl-2212)thin films is presented in this paper.In the first process of dc magnetron sputtering,the thallium content in the precursor film is large...A new improved two-step method in fabricating Tl_(2)Ba_(2)CaCu_(2)O_(8)(Tl-2212)thin films is presented in this paper.In the first process of dc magnetron sputtering,the thallium content in the precursor film is largely increased by adjusting the ratio of thallium in the sputtering targets.After the second annealing process in the absence of additional thallium pellets or powder source,high-quality Tl-2212 thin films can be obtained.The proper content of thallium in the precursor film provides a relatively stable atmosphere to guarantee the growth of Tl-2212 film.This method avoids the repeated production of the thallium pellets in the post-annealing process,the repeatability and controllability of the experiment are greatly improved.X-ray diffraction(XRD)scans show that all of the sharp peaks of the sample films can be assigned to the(00 l)peaks of Tl-2212 phase.The highest superconducting critical temperature(T_(c))of the films is 105 K and the critical current density(J_(c))can achieve 1.93 MA/cm^(2) in zero magnetic field at 77 K for a 600 nm film.展开更多
MOST cases of encephalitis are caused by viruses but a few have an immunological basis, such as paraneoplastic encephalitis, with specific antibodies identified. One recently characterized encephalitis caused by antib...MOST cases of encephalitis are caused by viruses but a few have an immunological basis, such as paraneoplastic encephalitis, with specific antibodies identified. One recently characterized encephalitis caused by antibodies is anti-N- methyl-D-aspartate （NMDA） receptor encephalitis. It is a form of paraneoplastic limbic encephalitis associated with ovarian teratoma and has recently been described.The NMDA receptor mediates excitatory neurotransmission. It is important for synaptic plasticity, and thus for higher function such as learning and memory. This disorder results in prominent psychiatric symptoms followed by a rapid decline of the level of consciousness, central hypoventilation, seizures, involuntary movements and dysautonomia.展开更多
The rocking curve of Tl-2212 thin films in Fig.2 of our original paper[1]should be replaced with the following new one.Accordingly,in the fifth paragraph of Section 3 of the original paper,the statement“The full widt...The rocking curve of Tl-2212 thin films in Fig.2 of our original paper[1]should be replaced with the following new one.Accordingly,in the fifth paragraph of Section 3 of the original paper,the statement“The full width at half maximum(FWHM)of the(0012)peak of the Tl-2212 phase is about 0.24°”should be“The full width at half maximum(FWHM)of the(0012)peak of the Tl-2212 phase is about 0.42°”.展开更多
文摘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 24 months （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）.CONCLUSION： 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.
基金Project supported by the National Natural Science Foundation of China(Grant No.51002081)the Fundamental Research Funds for the Central Universities,Chinathe Research Program of Application Foundation and Advanced Technology of Tianjin,China(Grant No.15JCQNJC01300)
文摘A new improved two-step method in fabricating Tl_(2)Ba_(2)CaCu_(2)O_(8)(Tl-2212)thin films is presented in this paper.In the first process of dc magnetron sputtering,the thallium content in the precursor film is largely increased by adjusting the ratio of thallium in the sputtering targets.After the second annealing process in the absence of additional thallium pellets or powder source,high-quality Tl-2212 thin films can be obtained.The proper content of thallium in the precursor film provides a relatively stable atmosphere to guarantee the growth of Tl-2212 film.This method avoids the repeated production of the thallium pellets in the post-annealing process,the repeatability and controllability of the experiment are greatly improved.X-ray diffraction(XRD)scans show that all of the sharp peaks of the sample films can be assigned to the(00 l)peaks of Tl-2212 phase.The highest superconducting critical temperature(T_(c))of the films is 105 K and the critical current density(J_(c))can achieve 1.93 MA/cm^(2) in zero magnetic field at 77 K for a 600 nm film.
文摘MOST cases of encephalitis are caused by viruses but a few have an immunological basis, such as paraneoplastic encephalitis, with specific antibodies identified. One recently characterized encephalitis caused by antibodies is anti-N- methyl-D-aspartate （NMDA） receptor encephalitis. It is a form of paraneoplastic limbic encephalitis associated with ovarian teratoma and has recently been described.The NMDA receptor mediates excitatory neurotransmission. It is important for synaptic plasticity, and thus for higher function such as learning and memory. This disorder results in prominent psychiatric symptoms followed by a rapid decline of the level of consciousness, central hypoventilation, seizures, involuntary movements and dysautonomia.
文摘The rocking curve of Tl-2212 thin films in Fig.2 of our original paper[1]should be replaced with the following new one.Accordingly,in the fifth paragraph of Section 3 of the original paper,the statement“The full width at half maximum(FWHM)of the(0012)peak of the Tl-2212 phase is about 0.24°”should be“The full width at half maximum(FWHM)of the(0012)peak of the Tl-2212 phase is about 0.42°”.
