Objective To explore the relationship between risk of stroke and calcaneal quantitative ultrasound(QUS)T score under-2. 5. Methods 5 847 subjects over the age of 40 from Yunyan District, Guiyang City were investigated with questionnaire, physical examination, blood lipids, other metabolic indexes and calcaneus bone density determination from May to October, 2011 by cluster sampling method and were followed up for 3 years. Subjects were divided into stroke group(99 subjects) and non-stroke group(5 748 subjects) according to the occurrence of stroke in the follow-up period. The relationship between risk of stroke and QUS T score under-2. 5 was analyzed. Results Compared to the non-stroke group, the number of subjects with T score under-2. 5 in calcaneal QUS was larger in the stroke group, the difference of which was statistically significant(P<0. 05). T score of bone density under-2. 5 in calcaneal QUS was found to be an independent risk factor for predicting stroke after adjusting for age, sex, and body mass index(HR=1. 467, 95%CI 0. 753-2. 855). The relationship between risk of stroke and T score under-2. 5 in calcaneal QUS remained unchanged after further adjust ment of smoking, diabetes, education, and hypertension(HR=1. 265, 95%CI 0. 647-2. 475). Conclusion The risk of stroke and T score of bone density under-2. 5 in calcaneal QUS was independently associated, and the latter is an independent risk factor for predicting stroke.

Objective To explore the related factors of diarrhea onset in critically ill patients during early enteral nutrition (EEN). Methods Thirty Zhejiang Provincial Emergency Intensive Care Units (EICU) and ICU to implement EEN support for critically ill patients from July 2016 to August were enrolled, and the incidence of diarrhea within 1 week after EEN administration was observed. The patients were divided into a diarrhea group and a non-diarrhea group according to whether diarrhea occurred or not during EEN. The basic status data [sex, age, body mass index (BMI), albumin, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), nutritional risk screening (NRS2002), major disease diagnosis], and EN status (feeding route, infusion method, EN type, amount of EN on days 4 and 7), and clinical treatment (applying following treatments or not: mechanical ventilation and its duration, vasoactive drugs, gastrointestinal motility drugs, probiotics) and clinical outcomes (survival after discharge or not) were collected in two groups. Multivariate Logistic regression analysis was performed on the indexes with statistically significant differences obtained from the univariate analysis to screen out the relevant risk factors of occurrence of diarrhea in critically ill patients during EEN administration. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of each risk factor for occurrence of diarrhea in critically ill patients with EN therapy. Results Of the 510 critically ill patients who underwent EEN, 156 had diarrhea, 70.5% (110/156) had diarrhea within 4 days of EEN, most diarrhea lasts for 3 days and most frequency of diarrhea was 3-4 times a day. The univariate analysis showed that the age of patients in the diarrhea group was significantly higher than that in the non-diarrhea group (years:69.42±17.94 vs. 65.76±17.69), the mechanical ventilation time and ICU hospitalization time were significantly longer than those of non-diarrhea group [mechanical ventilation time (days): 8 (5, 14) vs. 8 (4, 9), ICU hospitalization time (days): 11.5 (8.0, 19.0) vs. 9.0 (6.0, 14.0)], the proportion of probiotics used and the proportion of feeding by nasal tube were significantly higher than those of non-diarrhea group [proportion of probiotics: 26.9% (42/156) vs. 14.4% (51/354), proportion of nasal tube feeding: [26.9% (42/156) vs. 14.4% (51/354)]. Multivariate Logistic regression analysis showed that the use of probiotics was a protective factor for diarrhea during EEN in critically ill patients [odds ratio (OR) = 0.447, 95% confidence interval (95%CI) = 0.273-0.730, P = 0.001]. ROC analysis showed that the area under the curve (AUC) of probiotics predicting diarrhea was 0.598 (95%CI = 0.554-0.640), P < 0.001, sensitivity was 35.9%, and because AUC was less than 0.7, the accuracy and sensitivity of predicting diarrhea with probiotics was considered to be relatively poor. Conclusion The incidence of diarrhea is high in EEN in critical illness patients and its occurrence is related to various factors. The addition of probiotics can reduce the incidence of diarrhea.