Objective To evaluate the effects of applying clinical pathway in clinic teaching of kidney diseases. Methods Data of average in-hospital days,costs,percentage of antibiotic drugs, improvement rate and satisfaction of patients who received the clinic pathway in nephrology depart-ment from January 2010 to December 2012 were used to evaluate the quality of clinical pathway and were compared with those of patients not received clinic pathway in 2009. Teaching effects of eight-year clinic medical students whose scores were provided by internal medical teaching section were al-so analyzed. Questionnaire of hospital quality was adopted to assess satisfaction of patients,nurses and doctors and the results were compared with those of 2009 students. All data were analyzed by SPSS 13.0 software. Chi-square test was used for enumeration data and results were expressed as percentage while t test was used for measurement data and results were expressed as (x±s),with P<0.05 stand-ing for statistically significant differences. Results After applying clinical pathway,average in-hos-pital days were reduced from 10.7 d in 2009 to 8.7 d in 2012,percentage of medical drugs were de-creased from 86.6% in 2009 to 33.4% in 2012 and percentage of antibiotic drug were reduced from 79.1%to 23.0%. Average in-hospital days and costs of IgA nephropathy and lupus nephritis were de-creased. Satisfaction of patients was increased from 94.1% to 99.0% and scores of students were in-creased from (81.0 ±2.5)points to (89.5 ±2.8)points. Conclusions Application of clinical path-way in clinic medical teaching should be encouraged. It can enhance the teaching quality and is help-ful for culturing inno-vative clinic thinking of medical students and cultivate practical medical talents.

Objective To evaluate the ultrasound guidance method in central venous catheterization (CVC) via the axillary vein.Methods Totally 1369 CVC patients in our center from November 2010 to October 2012 were enrolled in this study.They were randomly divided into two groups based on their different procedures:ultrasound group (n =687):the central veins were assessed using ultrasound,and catheters were placed via axillary vein with ultrasound guidance ; and control group (n =682):CVC was performed using the anatomical landmark method.The operation time,one-attempt success rate,complications,and malposition rate were compared between these two groups.Results The ultrasound group had significantly shorter operation duration than the control group [(7.8± 2.2) min vs (8.4 ± 1.7) min,P =0.000],higher one-attempt success rate [(96.0％ (659/687) vs 81.7％ (557/682),P =0.000],and lower complications and malposition rate [0.6％ (4/687) vs3.7％ (25/682),P=0.000; 0.6％ (4/687) vs2.1％ (14/682),P=0.017,respectively].Conclusions Compared with the conventional landmark method via subclavical vein,ultrasound-guided CVC via axillary vein method can effectively increase success rate,decrease operation duration,attempts of puncture,and complication rate,and avoid catheter malposition.Therefore,the ultrasound method can improve the safety and accuracy of the CVC procedure and deserves wider clinical application.

ObjectiveTo monitor the early blood lactic acid concentration of patients with severe trauma who have been experienced routine surgery or damage control surgery,and explore the influence of surgical methods for the early lactate clearance rate.MethodsSelected 40 patients with severe trauma,they were divided into two groups with 20 cases each in accordance with the adopted operation mode,reference group by damage control surgery,and control group by routine surgery.Recorded acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) in patients after admission,blood lactic acid concentration at 6 h after admission and admission,calculated the early lactate clearance rate.ResultsIn reference group,blood lactic acid concentration at 6 h after admission was significantly lower than that in control group[ (3.5 ± 1.1 )mmol/L vs.(4.2 ± 1.4) mmol/L,P＜ 0.05 ],early lactate clearance rate was higher than that in control group [ (24.6 ± 6.3 )％ vs.( 11.4 ± 5.3 )％,P＜ 0.05 ].Conclusions Damage control surgery in patients with severe trauma in favour of the early removal of lactic acid,maintaining the homeostasis of the organism,is the key to improve the achievement ratio of treatment with severe trauma.

Objective To purify and rejuvenate the plant of Curcama kwangsiensis,improve the transplantation survival rate of cultivars,and make the convenience of storagement and management for the cultivars production.Methods The rhizome plantlet formation of C.kwangsiensis was induced by regulating both of macro-element and sucrose concentration in the MS culture medium.Results Both of them were very important influence factors on the rhizome plantlet formation of C.kwangsiensis.Media 1/2 MS and 6% sucrose were adaptable to the rhizome plantlet formation of C.kwangsiensis,had the best effects on the formation rate of the rhizome plantlet,diameter and direct transplanting rate of the rhizome plantlet.Both plantlet and root system development were stronger.Conclusion In the present research,it is successful in inducing the rhizome plantlet formation of C.kwangsiensis.

BACKGROUND:Procolagen type 1 N-terminal propeptide (P1NP) and β-colagen special sequence(β-CrossLaps) are two bone metabolic markers that are closely related to osteoporosis. Combined detection of bone metabolic markers and bone mineral density is of clinical significance for the diagnosis of osteoporosis. Bone metabolic markers are ideal indicators to predict fractures, which can compensate for the lack of bone density test. OBJECTIVE:To introduce the application of bone metabolic markers in the monitoring of drug efficacy on the treatment of osteoporosis as wel as in the prediction of fracture risks in recent 20 years and to explore the clinical values of P1NP and β-CrossLaps to assess the therapeutic efficacy on osteoporosis and risks for osteoporotic fractures. METHODS:A computer-based search of CNKI and SCI databases were performed for relevant articles published from 2000 to 2014 using the keywords of “serum bone metabolic markers; osteoporosis; bone mineral density” in Chinese and English, respectively. Finaly, 44 articles meeting the inclusive criteria were reviewed. RESULTS AND CONCLUSION:This paper analyzes the source and detection mechanisms of P1NPand β-CrossLaps and then compares their advantages in the therapeutic effect assessment of osteoporosis. Serum bone metabolic markers cannot only reflect the dynamic changes of bone metabolism, but also have earlier changes than the bone mineral density. Both P1NPand β-CrossLaps are very important for assessing the early diagnosis of osteoporosis as wel as anti-osteoporosis drug efficacy.

Objective To investigate the effects of interaction between human umbilical vein endothelial cells (HUVECs) which were infected with dengue virus type 2 (DENV-2) and CD4+T cells on the expression of ICAM-1 (intercellular adhesion molecule 1),VCAM-1 (vascular cell adhesion molecule 1),IL-10 and TGF-β1 at mRNA level for further understanding the immunological mechanism of DENV infection.Methods HUVECs were treated with CYM-5442,a selective agonist for sphingosine-1-phosphate receptor 1 (S1P1),for 24 hours and then infected with 103 TCID50 (50% tissue culture infective dose) of DENV-2 before co-culturing with CD4+T cells.Changes in the expression of NS1 (DENV-2 nonstructural protein),SPHK1 (sphingosine kinase 1,phosphorylating sphingosine to S1P),ICAM-1,VCAM-1,IL-10 and TGF-β1 at mRNA level were detected by real-time PCR after 4,8,12,24,48 and 72 hours of co-culturing.Results There was a certain timeliness in the expression of NS1 at mRNA level after infecting HUVECs with DENV-2 and the expression reached a peak at 24 h.Treating HUVECs with or without CYM-5442 had no significant influence on the expression of DENV-2 NS1 at mRNA level.The expression of SPHK1 at mRNA level was significantly increased after treating HUVECs with CYM-5442 and DENV-2 (P<0.05).Compared with DENV-2-infected or untreated HUVECs,Co-culturing DENV-2-infected HUVECs with CD4+T cells increased the expression of ICAM-1 and VCAM-1 in HUVECs at mRNA level (P<0.01) as well as the expression of IL-10 in CD4+T cells at mRNA level (P<0.05),but had no significant influence on the expression of TGF-β1 in CD4+T cells at mRNA level.Conclusion This study shows that DENV-2 can replicate and proliferate in HUVECs,but CD4+T cells inhibit the replication and proliferation.CD4+T cells play an important role in promoting the expression of VCAM-1 and ICAM-1 in DENV-2-infected HUVECs at mRNA level,activating HUVECs and increasing inflammation,which may be associated with increased vascular permeability induced by DENV-2 infection.Co-culturing CD4+T cells with DENV-2-infected HUVECs promotes the expression of IL-10 in CD4+T cells at mRNA level,but has no significant effect on TGF-β1.

Objective To evaluate multi-slice CT (MSCT) features and pathological basis of lung cancer containing thin-walled airspace. Methods Thirty?five cases of pathologically confirmed lung cancer containing thin-walled airspace were retrospectively analysed with regard to clinical data, pathological types and MSCT features between 2012 and 2015.There were 35 cases(25 adenocarcinoma, 9 squamous carcinoma, 1 spindle cell tumor) in total. MSCT features were compared between the lesions with or without solid component .Fisher exact test was used for the statistical analysis. For dynamic follow-up CT scans, the lesion dynamic change was evaluated .Correlations between the pathological section and CT images of the 11 cases were analysed. Results These features accounted for more than 60% of all MSCT signs in 35 cases, including round shape in 28 cases(80.0%),lobulation in 32 cases(91.4%),multiple cysts in 27 cases(77.1%), irregular inner wall in 33 cases(94.3%)and septum in airspace in 31 cases(88.6%). Shape, spiculation, bronchus cut-off, blood vessel and bronchus passing through the airspace, and ground-glass opacity were significantly different between the lesions with or without solid component(P<0.05).The frequency of spiculation(11 cases) and bronchus cut-off(12 cases) in mixed solid lesions was higher than that in lesions without solid component(1 case, respectively).The frequency of irregular shape(6 cases),blood vessel passing through the airspace(12 cases),ground-glass opacity(13 cases)and bronchus passing through the airspace(7 cases) in lesions without solid were higher than that in solid mixed lesions(1, 1, 5, 3 cases respectively).The pathological basis of the formation of thin-walled airspace was obvious central necrosis in solid lesions and emphysematous change due to the tumor cells diffused along the inner airspace wall and the alveolar wall destruction.Five lesions were with progressive wall thickening and increased size of the airspace,and two lesions were with decreased size of the airspace and enlarged nodules in followed CT.One case of lung cancer with thin-walled airspace evolved from ground glass nodule. Conclusions The CT manifestation of lung cancer containing thin-walled airspace was characteristic.The pathological basis of the thin-walled airspace was various.

Objective Comparing obturator nerve reflex in different anesthesia,to investigate the incidence of obturator nerve reflex in transurethral resection of bladder tumor.Methods A total of 160 patients with lateral wall of bladder tumors were included,who required a TURBT,were randomly divided into four groups:general anesthesia group (group G),combined spinal-epidural anesthesia group (group C),combined spinal-epidural anesthesia compounding intravenous anesthesia group (group V),combined spinal-epidural anesthesia compounding obturator nerve block group (group O),n =40 in each group.The incidence of obturator nerve reflex was recorded.Results Incidence of obturator nerve reflex in group O (7.5％) was lower than in group C (32.5％,P=0.005) and group V (40.0％,P=0.001).There was no significant difference between group G (5.0％) and group O (P =0.644).Conclusion Both combined spinal-epidural anesthesia with obturator nerve block and general anesthesia can effectively prevent obturator nerve reflex.

Objective To investigate the current knowledge and execution status of venous thromboembolism (VTE) prevention and management among critical care practitioners in cancer hospitals in China. Methods A self-designed electronic questionnaire was used to survey the registered medical members from the Critical Care Medicine Society of China Anti-Cancer Association (CACA), 409 practitioners participated in the survey with validated questionnaires. The respondents were divided into physician group (n = 142) and nurse group (n = 267) according to the occupation. The practitioners' basic knowledge situation of VTE prevention, the daily practice of VTE prophylaxis, and the prevention of anti-coagulation situation in patients undergoing tumor surgery and non-surgery treatment were analyzed. Results Respondents from 24 Departments of Critical Care Medicine of Cancer Hospitals in 17 provinces and 4 municipalities across China participated in the survey, accounting for 29.0% of the total registered members of the Critical Care Medicine Society of CACA. ① Practitioners' current basic knowledge and attitude of VTE prevention:45.8% (11/24) of the hospitals involved in the survey had established VTE quality control system; 66.5% (272/409) of the respondents very concerned about VTE; the proportion of respondents very concerned about VTE [83.8% (119/142) vs. 57.3% (153/267)] and proportion of respondents who thought that VTE had a significant effect on prognosis [84.5% (120/142) vs. 74.9% (200/267)] in physician group were significantly higher than those in nurse group (both P < 0.05); a similar proportion of the respondents in physician and nurse groups suggested energetic prevention of VTE should be carried out [70.4% (100/142) vs. 69.3% (185/267), P > 0.05]. ② Daily practice of VTE prevention: compared with American College of Chest Physicians (ACCP) and National Comprehensive Cancer Network (NCCN) guidelines, the proportion of the respondents who were familiar with the VTE guidelines from the Chinese society of clinical oncology (CSCO) was significantly higher [61.4% (251/409) vs. 38.9% (159/409), 38.1% (156/409)]; 99.0% (405/409) of the respondents believed guidelines were necessary for the VTE prevention and management of critically ill cancer patients, meanwhile 60.6% (248/409) suggested the implementation of the current guidelines needed to be adjusted according to the clinical practical situation; 85.1% (348/409) of the respondents performed regular VTE risk assessment in clinical practice; 81.9% (335/409) implemented VTE prevention strategy based on difference in risk stratification results; 66.7% (273/409) of the respondents selected Caprini score recommended by the guidelines for VTE risk assessment. ③ VTE prophylaxis for critically ill cancer patients: for postoperative cancer patients, 78.5% (321/409) of the respondents implemented both mechanical prophylaxis and anticoagulants for prevention of VTE, 66.3% (271/409) respondents discontinued the mechanical prophylaxis and 54.0% (221/409) discontinued prophylactic anticoagulation once the patients were ambulatory; for patients with critical cancer illness under medical treatment, only 9.5% (39/409) of the respondents routinely implemented prophylactic anticoagulation, while the majority of respondents 82.4% (337/409) implemented prophylactic anticoagulation based on a comprehensive risk assessment for bleeding; 61.1% (250/409) discontinued mechanical prophylaxis and 42.3% (173/409) discontinued prophylactic anticoagulation once the patients were ambulatory. Conclusions The results of this nation-wide survey reveal the current knowledge and practice status of the VTE prevention and management among critical care practitioners in China, indicating that VTE prophylactic anti-coagulation practice for critically ill cancer patients is still suboptimal. The present guidelines are not directing to the VTE preventive works for such patients, resulting in that the VTE preventive strategy remains largely based on experiences of medical workers rather than scientific evidence from clinical trials. Establishing and improving expert consensus or guidelines for critical cancer patients are beneficial and of great importance to elevate the level of standardizing prevention and management of VTE in China.

Objective:To investigate the incidence and related risk factors of refeeding syndrome (RFS) in patients with severe stroke.Methods:Patients with severe stroke admitted to the Department of Neurology, the First Affiliated Hospital of Soochow University underwent nutritional treatment again after fasting between December 2017 and October 2022 were included retrospectively. The incidence of RFS in patients with severe stroke was summarized. Multivariate logistic regression models were used to analyze the independent risk factors for RFS. A restricted cubic spline model was used to explore the dose-response relationship between relevant indicators and RFS. Results:A total of 188 patients were included, including 108 males and 80 females, with a median age of 72 years (interquartile range, 63-77 years); 185 patients (98.4%) had ischemic stroke and 3 (1.6%) had cerebral hemorrhage; 59 (31.4%) received enteral nutrition, 36 (19.1%) received gastrointestinal decompression, 30 (16.0%) received mechanical ventilation; and 60 patients (31.9%) developed RFS. Multivariate logistic regression analysis showed that serum creatinine (odds ratio [ OR] 1.011, 95% confidence interval [ CI] 1.001-1.020; P=0.025), serum potassium ( OR 8.349, 95% CI 3.025-23.039; P<0.001), serum phosphorus ( OR 46.578, 95% CI 6.444-336.661; P<0.001) and diabetes ( OR 2.173, 95% CI 1.087-4.345; P=0.028) were the independent risk factors for the occurrence of RFS. The restricted cubic spline model analysis showed that there was a non-linear relationship between serum creatinine and RFS, and the increased risk of RFS showed an "S" shape with the increase of serum creatinine. When serum creatinine exceeded 70.68 μmoI/L, the risk of RFS continued to increase. There was no non-linear relationship between serum phosphorus and serum potassium and RFS. Conclusions:Serum creatinine, serum phosphorus, serum potassium and diabetes are the independent risk factors for RFS in patients with severe stroke. These risk factors should be utilized to identify the high-risk patients with RFS early and the targeted measures should be taken as soon as possible.