Objective: To evaluate the effect of glucocorticoid on the treatment of acute cerebral stroke. Methods: Seventy-six patients with acute cerebral infarction were randomly divided into two treatment groups which included the group of intravenous infusion with dexamethasone 10 mg, Xuesaitong 0.4 g, and sodium citicoline 0.5 g Qd,and the group without dexamethasone treatment. Results: The infarction area enlarged on CT scan and the deficits of neural function accelerated in dexamethasone group. There was no change on CT scan and no neural function deterioration in patients without dexamethasone treatment. Conclusion:Side effect is obtained with the early use of dexamethasone for the treatment of acute ischemic cerebral stroke.

Objective To investigate the possible risk factors for the progression of abdominal aortic calcification (AAC) in MHD patients.Methods Total of 170 patients on MHD between June 2014 and October 2014 in the dialysis center of the Second Hospital of Tianjin Medical University were included prospectively.Lateral lumbar radiography were applied to evaluate patients' AAC score (AACs) at baseline and after two-years of follow-up respectively.According to the change of AACs,the patients were divided into rapid AAC progression group and non-rapid AAC progression group.Multivariable Logistic regression models were used to determine the risk factors for the progression of AAC in MHD patients.Results At baseline,the presence of AAC (AACs≥1) was 43.5％(74/170).The mean follow-up duration was 27.6(24.7,28.0) months.AACs were available in 111 patients,and the presence of AAC was 78.4％(87/111).During the follow up,36 patients developed new AAC;rapid AAC progression was seen in 54 patients,and non-rapid AAC progression was seen in 57 patients.Multivariate Logistic regression analysis demonstrated that hyperphosphatemia (OR=4.373,95％ CI 1.562-7.246,P=0.005) and high density lipoprotein (HDL) (OR=0.031,95％CI 0.003-0.338,P=0.004) were independent risk factors for AAC progression in MHD patients.Conclusions Hyperphosphatemia and low HDL may promote the progression of AAC.Well-controlled serum phosphate and lipid metabolism may slow the progression of vascular calcification,reducing cardiovascular morbidity and mortality.

Objective:To explore the risk factors of severe acute kidney injury (AKI) in septic patients, and to establish an hour-specific prediction model.Methods:Based on the information of septic patients in the Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ) database, general information, comorbidities, vital signs, severity scoring system, laboratory indicators, invasive operations and medication use were recorded. The enrolled patients were randomized into a training set and a validation set according to a ratio of 7∶3. AKI was diagnosed according to the guidelines of Kidney Disease: Improving Global Outcome (KDIGO). Based on Lasso regression and Cox regression, the risk factors of severe AKI (AKI stage 2 and stage 3) in septic patients were analyzed and hour-specific prediction model were established. Consistency index (C-index), area under the receiver operator characteristic curve (AUC) and calibration curve were used to assess the predictive efficacy of the model.Results:A total of 20 551 septic patients were enrolled, including 14 385 patients in the training set and 6 166 patients in the validation set. Multivariate Cox regression analysis showed that atrial fibrillation [hazard ratio ( HR) = 1.266, 95% confidence interval (95% CI) was 1.150-1.393], heart failure ( HR = 1.348, 95% CI was 1.217-1.493), respiratory failure ( HR = 1.565, 95% CI was 1.428-1.715), heart rate ( HR = 1.004, 95% CI was 1.002-1.007), mean arterial pressure ( HR = 1.245, 95% CI was 1.126-1.377), lactic acid ( HR = 1.051, 95% CI was 1.025-1.077), simplified acute physiology score Ⅱ (SAPSⅡ, HR = 1.019, 95% CI was 1.016-1.023), serum creatinine ( HR = 1.171, 95% CI was 1.127-1.216), anion gap ( HR = 1.024, 95% CI was 1.010-1.038), serum potassium ( HR = 1.155, 95% CI was 1.079-1.236), white blood cell count ( HR = 1.006, 95% CI was 1.003-1.009) and furosemide use ( HR = 0.414, 95% CI was 0.368-0.467) were independently associated with severe AKI in septic patients (all P < 0.01). The above predictors were applied to construct an hour-specific prediction model for the occurrence of severe AKI in septic patients. The C-index of the prediction model was 0.723 and 0.735 in the training and validation sets, respectively. The AUC for the occurrence of severe AKI at 12, 24, and 48 hours were 0.795 (95% CI was 0.782-0.808), 0.792 (95% CI was 0.780-0.805), and 0.775 (95% CI was 0.762-0.788) in the training set, and the AUC were 0.803 (95% CI was 0.784-0.823), 0.791 (95% CI was 0.772-0.810), and 0.773 (95% CI was 0.752-0.793) in the validation set, respectively. The calibration curves of the two cohorts were in good agreement. Conclusion:The hour-specific prediction model effectively identifies high-risk septic patients for developing severe AKI within 48 hours, aiding clinicians in stratifying patients for early therapeutic interventions to improve outcomes.