Objective To compare sensitivity and specificity of the acute physiology,age,and chronic health evaluation system Ⅱ (APACHE Ⅱ),the acute physiology,age,and chronic health evaluation system Ⅲ (APACHE Ⅲ) system in predicting prognosis after cardiac operation.Methods A prospective study of 1 180 consecutive patients entering in a single cardiac postoperative intensive care unit of Anzhen hospital was assigned between November 2013 to January 2014.APACHE Ⅱ and APACHE Ⅲscore was calculated daily at least three days or until death,then compared the calibration and discrimination of the two different system using Hosmer-Lemeshow goodness-of-fit and receiver operating characteristic(ROC) curve.Results In discrimination analysis,ROC value of the first day after operation was(APACHE Ⅱ 0.699 、APACHE Ⅲ 0.734),ROC of the maximum(APACHE Ⅱ 0.836,APACHE Ⅲ 0.862),ROC of the maximum during the first 3 days(APACHE Ⅱ 0.814、APACHE Ⅲ 0.855),ROC of the change between the third day and the first day(APACHE Ⅱ 0.524 、APACHE Ⅲ 0.549).In calibration analysis,we compared the x2 value and overall corrected percentage of the first day value,the maximum value,the maximum value during the first 3 days,the change value between the third day and the first day of the three different system.x2 value of APACHE Ⅱ was(15.688,10.132,8.061,42.253),x2 value ofAPACHE Ⅲ was(13.608,11.196,19.310,47.576).Conclusion APACHE Ⅲ was better than APACHE Ⅱ in prediction of death risk after cardiac surgery.

OBJECTIVE To investigate the clinical distribution and antibiotics resistance of Pseudomonas aeruginosa nosocomial infection after open-heart operation.METHODS The clinical data of 393 patients with nosocomial infection from Jan 2004 to Dec 2007 were analyzed retrospectively.RESULTS There were 57 infected cases caused by P.aeruginosa,and accounted for 14.5% of all infections during period.All infected patients had serious original heart diseases,and received broad-spectrum antibiotic therapy previously.Forty-two patients developed postoperative cardiorespiratory function failure,and 28 patients needed circulatory support.Thirty-six patients prolonged mechanical ventilation time for over 1 week.Results of susceptibility test showed that ciprofloxacin,levofloxacin and piperacillin/tazobactam were the most active antibiotics,followed by tobramycin,netilmicin,gentamicin,meropenem and imipenem/cilastatin.P.aeruginosa presented high resistance to ceftazidime and cefoperazone/sulbactam.CONCLUSIONS P.aeruginosa is one of the most common pathogenic bacteria after open-heart operations in our hospital and presented multidrug resistance.Rational use of antibiotics is important to reduce drug resistant strains.

Objective Metabolic syndrome ( MS), a disorder involving multiple metabolic abnormalities such obesity,hypertension, diabetes or abnormal glucose tolerance and dyslipidemia, has been observed in many patients receiving coronary artery bypass procedures. In this study we try to examine the perioperative effects of metabolic syndrome on the off-pump coronary artery bypass (OPCABG). Methods A prospective study was conducted in 1060 consecutive OPCABG patients who were admited to Beijing Anzhen Hospital from July 2009 to March 2010. The patients were grouped as MS group and non-MS group according to the diagnostic criteria for Chinese metabolic syndrome. The outcomes such as mortality, atrial fibrillation,stroke, staying in ICU for more than three days, use of IABP, ECMO, dialysis, multiple organ dysfunction score ( MOOS) ,postoperative score for cardiac surgery (PSCS), PaO2/FiO2 , heart rate x central venous pressure/mean artery pressure(pressure-adjusted heart rate, PAHR) ,renal and liver function, platelets, and the dosage of vasoactive agents were analyzed and compared between the two groups by x2 test or t test. Results Three hundred and eighty-nine cases were diagnosed with MS among 1060 cases with OPCABG. In the MS group, 17 cases stayed in ICU for more than 3 days, 2 cases died, 76 had atrial fibrillation, 3 had stroke, 18 cases were treated with intra-aortic balloon counterpulsation (IABP). In the non-MS group, 47 cases stayed in ICU for more than 3 days, 12 cases died, 148 had atrial fibrillation, 3 had stroke, 48 cases were treated withIABP, 3 cases received ECMO and 4 cases received dialysis. No significant difference between MS group and non-MS group was identified in the aspects of mortality, atrial fibrillation, stroke, duration of more than three days in ICU, the use of IABP,ECMO, dialysis after OPACBG based on the x2 test(P＞0.05). However, on the operative days, the MODS and PSCS in MS group were significantly higher than that in non-MS group (P ＜ 0.05). MODS 2. 57 ± 1. 62 in MS group vs. 2. 15 ± 1.65 in non-MS group, PSCS 4.27 ±2.15 in MS group vs. 3.92 ±2.29 in non-MS group. PaO2/FiO2 in MS group was significantly lower than that in non-MS group (249.23 ± 110.99 vs. 283. 33 ± 114. 35), P ＜ 0. 01. PAHR in MS group was significantly higher than that in non-MS group (9.98 ±3.54 vs. 9.23 ±3. 88), P ＜0.05. On the first postoperative days, the MODS in MS group was also significantly higher than that in non-MS group (3.05 ±1.64 vs. 2.82 ± 1.72), P＜0.05. PaO2/FiO2 in MS group was significantly lower than that in non-MS group (277.11 ±122.99 vs.318.47 ±143.84), P＜0.05. Conclusion MS was not a predictor for death, atrial fibrillation, stroke, duration of more than three days in 1CU, the use of IABP, ECMO, dialysis after OPACBG. However, MS had a temporary adverse effect on the respiratory and circulatory systems on the operative day and the first postoperative day after OPCABG.

OBJECTIVE To investigate the risk factors and treatment of nosocomial pulmonary fungal infection after open heart surgery.METHODS A total of 11040 consecutive patients who underwent open heart surgery were retrospectively studied from Jan 2004 to Dec 2006.And the clinical data of 324 patients with microbiologically documented nosocomial infection were analyzed.RESULTS There were 61 infected cases caused by fungi,accounted for 18.8% of all infections during the same period.Sixteen patients died.All infected patients had serious original heart diseases,and received previously glucocorticoids and broad-spectrum antibiotic therapy.The number of senile and pediatric patients was 28.Forty three patients developed postcardiotomy cardiorespiratory and renal function failures,and circulatory assist was established in 22 patients.Thirty six patients prolonged mechanical ventilation time for over one weeks.Thirty four patients developed hyperglycosemia.Candida albicans was the predominant pathogen(39 strains,63.9%),followed by C.glabrata(15 strains,24.6%).Results of susceptibility test showed that fluconazole,itraconazole and flucytosine presented highly antimicrobial activity.CONCLUSIONS Developments of nosocomial pulmonary fungal infection is closely associated with the severity of preoperative underlying heart diseases,prolonged mechanical ventilation and longer period of broad-spectrum antibiotic therapy.

Objetctive To summarize the associated complications with circulatory support device,and provide reference for chnical practice.Method A total of 8306 consecutive patients who underwent open heart surgery,in Department of Post-operation Intensive Care Unit of the Cardiac Surgery,Anzhen Hospital,Capital Medical University,was retrospectively studied from January 2005 to February 2007.And the clinical data of 246 patients including 63 female and 183 male patients with mean age 56.7±14.2 years supported with various circulatory support devices for perioperative cardiorespiratory function failure in ICU were analyzed.Left ventricular assist device (LVAD) was used in 3 patients by the cannulation of the left alritan and ascending aorta.The extracorporeal membrane oxygenation(ECMO) was established in 48 patients for postoperative cardiorespiratory function failure.The vencarterial bypass was established by cannulation of the right atrium in 41 patients and femoral artery and of venovenons in 2 patients,and of the right atrium and ascending aorta in 5 cases,lntra-aortic balloon pumping(I-ABP)was performed via the femoral artery either percutaneonsly by the Seldinger technique in 195 patients.The cardiac operations included coronary artery bypass grafting (n=170),coronary artery bypass grafting with romoldingof left ventricle (n = 22),coronary artery bypass grafting with valvular operation (n=10),valvular operation (n=27),heart transplantation(n=8),correction of congenital heart defects(n=6),aortic operations(n=2).The duration of circulatory support ranged from 4 to 451 hours.Correlative complications of 3 kinds of circulatory support device were compared and repair of ventricular septal perforation in the wake of acute myocardial infarction (n=1).Results Seventy-eight (31.7%) patients died.Seventy-one(28.9% ) patients devdoped various complications including infection(n=27),renal failure required renal rephcement therapy (n=27),re-exploration for bleeding(n=24),haemolysis(n=6),limb ischemia(n=15),neurological complications(n=6),oxygenator failure(n=7) Conchusions The improvement of management to reduce complications may result in improved outcomes of patients supported with circulatory support devices.

National Teaching Contests of young teachers from medical colleges in China has been held for several years. Experiences obtained from participating and observing the contest have shown that the teaching ability and quality of young teachers have been dramatically improved over these years. But there are a few problems worthy of attention. First, up-to-date progress in scientific research should be intro-duced to the class in proper way. Applying the scientific material mechanically or overgeneralizing individual findings should be avoided in this process. Secondly, the teachers should strengthen the cultivation of criti-cal thinking and dialectical way of thinking, to enable students to use critical thinking, the integrated point of view to analyze and solve the problem. Thirdly, teaching should also focus on humanistic education, and through the infiltration of human content in the classroom, imperceptibly affect students. Finally, young teachers can give full play to their advantages of rapid learning and to use internet as a platform for the reform of teaching methods to promote the interaction between teachers and students, enriching their class-room.

Objective: To identify Euryales Semen and its closely related species using the ITS2 barcode. Method:The total genomic DNAs were extracted from twenty samples of Euryales Semen and its closely related species. The ITS2 regions of the samples were amplified and bidirectional sequenced. Obtained sequences were submitted to the GenBank with Sequin 12.3. ITS2 sequences of 102 samples belonging to thirty species were downloaded from GenBank. The 122 ITS2 sequences were aligned and the genetic distances were analyzed with MEGA 5.1. Identification analyses were performed using BLAST1 and nearest distance methods, and were presented intuitively by constructing neighbor-joining (NJ) tree. Result: The length of ITS2 region of Euryales Semen was 214 bp, which was only one haplotype. There was significant divergence of the ITS2 regions among the samples. The NJ tree showed that Euryales Semen could be obviously differed from its closely related species, which had good 408 monophyly. Conclusion: ITS2 regions as a DNA barcode can stably and accurately distinguish Euryales Semen from its closely related species and also provide a new technique to ensure clinical safety in utilization of tradi-tional Chinese medicines. The new exploration could broaden the application of DNA barcoding technology in identification of Traditional Chinese Medicine.

Objective To investigate the effect of body mass index on early postoperative clinical outcomes following off-pump coronary artery bypass grafting. Methods A total of 1062 patients that received OPCABG in Beijing Anzhen Hospital were recorded continuously from January 2015 to May 2015. The patients were divided into normal weight group(n=360), overweight group(n=527) and obesity group(n=175) according to their body mass index. The following outcomes in the ear-ly postoperative period were compared among the three groups: hospital mortality, atrial fibrillation and intra aortic balloon counter pulsation usage, multiple organ failure score system, postoperative score for cardiac surgery, sequential organ failure assessment score, respiratory index, and pressure-adjusted heart rate. Results The lowest mortality rate was observed in the overweight group(0.6％) in comparison with the normal weight group(2.2％) and obesity group(1.1％)(P<0.01). The lowest rate of atrial fibrillation was observed in the obesity group(20. 1％) in comparison with the normal weight group (22.1％) and overweight group(20. 7％)(P <0. 01). The IABP usage rate was the highest in the normal weight group (8. 1％), followed by the overweight group(6. 0％) and the obesity group(2. 9％)(P<0. 01). On the operation day and the first day after operation, the MODS, SOFA and PSCS scores of the obese group were significantly higher than those of the nor-mal weight group(P <0. 01). PaO2/FiO2 in the obese group was significantly lower than that in the normal weight group (P<0. 01). PAHR in the obese group was significantly higher than that in the normal weight group(P<0. 01). Conclusion High BMI groups were associated with lower rates of mortality, atrial fibrillation, and IABP utilization. The lowest mortality rate was observed in the overweight group.

Objective:To investigate and analyze the influencing factors of teachers' teaching input status on teaching effect satisfaction in medical colleges.Methods:A total of 782 teachers of basic medicine and clinical medicine in a local medical college in Hebei Province were selected by multi-stage stratified random sampling method. The (mean ± standard deviation) was used to describe the status quo of teachers' teaching input, and the t- or F-test was used for inter-group comparison. The influence of teaching input on teaching satisfaction was analyzed by multiple linear regression. Results:The teaching input of medical college teachers was affected by different demographic characteristics, among which the teaching time input was affected by gender, age, professional title, teaching age, educational background and category (all P<0.05), the emotional input was affected by age,professional title,teaching age,educational background and category (all P<0.05), and the teaching ability development input was affected by age, professional title, teaching age and category (all P<0.05). There was a correlation between the population characteristics of teachers and the teaching input and the satisfaction of teaching effect, and the teaching age of teachers is negatively correlated with the satisfaction of teaching effect ( β=-0.057, P<0.05). There were positive correlations between teaching satisfaction and teaching effect (all P<0.05), including the number of lesson preparation hours, the number of weekly teaching hours, the degree of teaching attention, the degree of medical teaching research balance, the learning and expansion of teaching skills, and the difference of teaching observation reflecting teaching input. The teaching input of basic medicine teachers was significantly higher than that of clinical teachers (all P<0.05). Conclusion:It is suggested that medical colleges and clinical teaching bases should pay attention to the construction of teacher echelon, optimization of policies and measures to balance the relationship between medical education and research, construction of the support system of teachers' teaching work input to improve teachers' professional efficacy, and the building of a professional development community of teachers integrating basic medical teachers and clinical teachers to improve the training quality of medical students.

Objective:To construct the core competence evaluation index system of general practice residents by the Delphi method.Methods:After the literature review of home and abroad and group discussion, the core competence evaluation index system of general practice residents in the outpatient environment was preliminarily developed. On this basis, the index system was determined through two rounds of expert consultation. Excel 2015 and SPSS 26.0 were used for data entry and statistical analysis.Results:The active coefficients of the two rounds of expert consultation were 95.0% (19/20) and 100.0% (19/19) respectively, and the degree of authority of the two rounds of expert consultation was 0.86. An index system consisting of 6 first-level indicators and 28 second-level indicators was determined. The 6 first-level indicators were medical services/patient care, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, interpersonal communication, and communication skills.Conclusion:This study has constructed a complete and highly reliable core competence evaluation index system of general practice residents based on the outpatient environment, which can provide reference for the cultivation of the outpatient reception ability of general practice residents in the future.