Nowadays more and more evidences suggest that glycemic management of the patients in intensive care units needs to be individualized.We should pay more attention to the diabetes history in these patients besides the primary diseases.A brief literature review and a commentary about this topic were presented in this article.

Medicine, Chinese Traditional ; Translations

Objective To explore the incidence of nosocomial pulmonary infection in elderly patients with cerebral infarction and its prognosis.Methods Six hundred and sixty-nine patients with cerebral infarction were divided into elderly group (384 cases,≥75 years) and control group (285 cases,40-74 years).Logistic regression analysis was used to research the risk factors for pulmonary infection.According to in-hospital heart disease,neurological damage and hospital death,the prognosis of patients in elderly group was analyzed.Results The proportion of female patients,and patients with hypertension,atrial fibrillation and congetive heart disease in elderly group was significantly higher than that in control group,the incidence of patients with nosocomial pulmonary infection was significantly higher than that in control group,the proportion of patients with smoking and diabetes was lower than that in control group,there were significant differences (P ＜ 0.05 or ＜ 0.01).The proportion of patients with high cholesterol,ischemic heart disease,peripheral arterial disease between 2 groups had no significant difference (P ＞ 0.05).Logistic regression analysis showed that diabetes and smoking were independent risk factors for nosocomial pulmonary infection (P ＜ 0.05).The proportion of patients with the United States National Institutes of Health Stroke Scale(NIHSS) score 11-15 scores in elderly group was higher than that in control group[33.59％(129/384) vs.25.96％(74/285)],there was significant difference (P ＜ 0.05),but the proportion of patients with other NIHSS score had no significant difference (P ＞ 0.05).The proportion of patients with cardioembolism in elderly group was higher than that in control group (x2 =4.38,P ＜ 0.05),the proportion of patients with large artery atherosclerosis was lower than that in control group (x2 =4.57,P ＜ 0.05).The complication rate of in-hospital heart disease,the proportion of patients with severe nerve dysfunction (modified Rankin score ≥ 2 scores) and hospital mortality in elderly group was significantly higher than that in control group,there was significant difference (P ＜ 0.01).Conclusions Nosocomial pulmonary infection is more common in elderly patients with cerebral infarction,and prognosis may be even worse.Prevention and control of pulmonary infection is very important for elderly patients with cerebral infarction.

Megaureter was put forward firstly by Caulk in 1923.The common causes of children obstructive megeureter have been divided into congenital(congenital ureteral stricture,congenital lower segment ureteral valve,no performance of ureteral distal and ectopic ureter openings),and secondary (urethral valve disease,ureter cyst and polyp,neurogenic bladder and iatrogenic traumatic).Now commonly used surgical treatments has approved by bladder ureter bladder reimplantation,the bladder ureter bladder reimplantation,bladder disc ureteral reimplantation,etc.This paper summarizes the research progress of obstructive megaureter.

Based on the hospital information system, the hospital value-added service platform is constructed.The paper intro-duces the design scheme of the platform, its functional modules, the design of the database, the implementation of the platform and its application prospect, points out that the platform can not only serve as the channel for the information exchange between doctors and pa-tients but also offer such value-added services as health consultation and illness tracking other than regular services.

Arterial ischemic stroke (AIS) is an important cause of acquired brain injury in children,with a high morbidity and mortality.AIS in children differs from adult ischemic stroke in etiologies and risk factors.Recognition of AIS in children is challenging,and significant delays in diagnosis often occur.This article reviews the risk factors,diagnostic evaluation and treatment of AIS in children.

OBJECTIVE:To establish an LC-MS method for the determination of nimesulide in human plasma. METHODS:The separation was performed on Agilent Zorbox SB-Cl8 column,using acetonitrile-0.1% formic acid (65 ∶ 35) as the mobile phase at a flow rate of 1.0 mL?min-1. The column temperature was set at 35 ℃ and valsartan was served as internal standard. Positive electrospray ionization detection was applied to monitor m/z 309(nimesulide,[M+H]+)and m/z 436(valsartan,[M+H]+). RESULTS:The linear range of nimesulide was 5～50 ng?mL-1(r=0.998 9). The method recovery of nimesulide ranged from 87.1% to 92.9%. The intra-day and inter-day RSD were 3.1%～5.8%,6.4%～9.2%,respectively.CONCLUSION:The method is sensitive,simple,convenient,accurate and reproducible,and it is suitable for clinical plasma concentration monitoring and pharmacokinetics research of nimesulide.

Objective To evaluate the CT features of solitary inflammatory nodules of the lung. Methods CT features in twenty-three cases of solitary inflammatory nodules of the lung confirmed by operation or clinical were analyzed retrospectively. Spiral CT including plainscans and contrast enhanced scans was done in all patients. Thin-slice target scan and multiple plane reconstruction were used on the area of nodule. Different width and level of window were used to show the characteristic sign of the nodule.Results No calcification,satellite lesion,concentrated vessels and enlarged lymph nodes were found in or around all of the nodules. The size of these nodules were 10 mm?15 mm～30 mm?40 mm with round or irregular margin. Superficial lobular or spiculated margin was seen in only three nodules. Hyperemia and clouding appearance were found in 19 nodules and reflecting thickening pleura in 18 nodules. Unsteady edge enhancement were found in 18 nodules and no enhancement in 5 nodules. Effused change around the nodules could be seen perfectly when the level was about -400. MPR was the most accurate technique to show the relationship of nodule and pleura. Conclusion Solitary inflammatory nodules of the lung have obvious CT characterizes. By analyzing various CT manifestations comprehensively most nodules can be diagnosed correctly. Suitable width and level of window as well as MPR are helpful in showing the characterizes of the nodules.

Objective: To explore risk factors of percutaneous coronary intervention (PCI)-induced vagal reflex and its emergency treatment strategies.Methods: Clinical data of 214 patients undergoing successful PCI in our hospital were retrospectively analyzed.According to presence of vagal reflex or not, they were divided into vagal reflex group (n=56) and no vagal reflex group (n=158).Clinical features were compared between two groups.Logistic analysis was used to analyze related risk factors for PCI-induced vagal reflex, meanwhile, those patients with vagal reflex received emergency treatment and observation;and prevention and treatment plans were analyzed.Results: Single factor Logistic regression analysis indicated that age, diabetes mellitus, repeated puncture, indwelling sheath, previous PCI and hemostasis time by compression were risk factors for induced vagal reflex (OR=1.155~3.005, P<0.05 or <0.01).Multifactor Logistic analysis found that diabetes mellitus, indwelling sheath time and hemostasis time by compression were independent risk factors for induced vagal reflex (OR=1.846~2.998, P<0.05 all).Symptoms of those patients with vagal reflex were effectively controlled via rapid intravenous rehydration, blood volume expansion, intravenous injection of dopamine and atropine etc.Conclusion: Diabetes mellitus, indwelling sheath time and hemostasis time by compression are related factors for PCI-induced vagal reflex;high risk patients should be closely monitored, given standardized treatment rapidly.

High salt intake over four months caused high blood viscosity as well as hypertension in rats, reflected by the obvious increases of blood viscosity, plasma viscosity and hematocrit, and the decrease of erythrocyte sedimentation rate. With some vicious circle resulted from certain blood viscous factors in circulatory (especially in microcirculatory) system the high blood viscosity might relate to chronic sodium chloride toxicity and easily induce hypertension.