Objective To explore the effectiveness of early enteral nutrition (EN) support and growth hormone (GH) treatment in critically ill patients.Methods Seventy critically ill patients were randomly divided into early EN support group and early EN support plus GH treatment group.The nutrition intakes were isonitrogenic and isocalorie in these two groups.Body weight,blood biochemistry,nutritional statues,and lactulose/mannitol levels were measured or analyzed before and after nutrition support.Immunologic functions were analyzed after ten days.Nitrogen balance was measured daily.Results The changes of body weight,albumin level,and transferrin level were more obvious in the EN + GH group than those in the EN group without significant difference (P ＞0.05).The changes of prealbumin and fibronectin in the EN + GH group were significantly higher than those in the EN group (P ＜ 0.05).The level of IgA in the EN + GH group was significantly lower than that in the EN group,while the levels of CD4 and NK in the EN + GH group was significandy higher than those in the EN group (P ＜0.05).The gut barrier function in the EN + GH group was superior to that in the EN group during nutrition support (P ＜0.05).Nitrogen balance was positive in the EN + GH group and negative in the EN group (P ＜ 0.05).Conclusions Early EN can improve the nutritional status and reduce complications in critically ill patients.GH treatment may strengthen the immune function and remarkably decrease the disability and mortality in critically ill patients.

College education plays a significant role in cultivating the innovative talents in the national education system.It is an important way to make a person innovative By carrying out the education reform of scientific research among undergraduates.Much to my honor,I,having participated in all the process of the project application and experimental research supported by the funds,the project application of undergraduate scientific research,WHU,2006.I,attempt to make an argument about significance and superiority of the medical undergraduates taking part in the scientific research.Moreover,I would like to put forward some principles for those who are about to participate in this similar kind of activity.

Objective To study retrospectively X -ray manifestations of pulmonary injury due to acute ammonia intoxica. Methods Chest X-ray manifestations of 37 cases of pulmonary injury due to acute ammonia intoxica were analyzed, and one-year follow-up was performed. Results Early pulmonary injuries included lung marking increase, lobular, interstitial emphesema and pulmonary edema, and the symptoms at late stage consisted of CB, pulmonary interstitial fibrosis and bullae. Conclusion Pulmonary injury due to acute ammonia intoxica is irreversible.

Objective To discuss the CT manifestations of renal leiomyosarcoma. Methods 9 cases of renal leiomyosarcoma proved by pathology were analyzed retrospectively. Results CT imaging showed homogeneous hyperattenuation in two cases. Heterogeneous in density with necrosis inside was observed on the CT scan in six cases. After contrast medium administration heterogeneous enhancement with cystic and necrotic areas could be revealed in all cases on both CT scan. Conclusion Large renal mass with intra-tumor necrosis,cystic and hemorrhagic change is the characteristic manifestations of renal leiomyosarcoma. But differential diagnosis from renal carcinoma by CT clinical setting is difficult before surgery, and final diagnosis should depend on pathology examination.

Objective To measure the diameter of optic nerve sheath by ultrasonography to evaluate the change of intracranial pressure(ICP)in prone position ventilation,and to provide basis for prone position ventilation in patients with increased intracranial pressure (ICH). Methods A total of 58 patients with mechanical ventilation were treated with prospective clinical study from 2016.05.01 to 2017.05.01. The patients were treated with different PEEP and different positions(supine position and prone position),and detected optic nerve sheath diameter(ONSD)behind 3 mm of eye 3 mm by bedside ultrasound. The cause inducing increase of ICP was studied through the changes of ONSD and the data was analyzed by the paired t test. Results Prone position had a significant effect on patients with increased intracranial pressure. PEEP had a significant effect on MAP,Ppeak, Pplat,but had no effect on increased intracranial pressure. Conclusions Prone position ventilation significantly affect the ONSD. Therefore ,it weighs the pros and cons when patients with intracranial hypertension were received prone position ventilation.

Objective:To investigate the effect of pulmonary vascular dysfunction in the prognosis of patients with acute lung injury (ALI).Methods:Patients with ALI who underwent pulmonary artery catheterization in the department of critical care medicine of Wuhan NO.1 Hospital from June 2017 to June 2019 were enrolled. The general information, clinical and hemodynamic indexes [central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), pulmonary artery systolic pressure (sPAP), pulmonary artery diastolic pressure (dPAP), mean pulmonary artery pressure (mPAP), cardiac index (CI)], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, arterial blood gas parameters [pH, partial pressure of oxygen (PO 2), partial pressure of carbon dioxide (PCO 2), oxygenation index (PaO 2/FiO 2)], whether there was shock or not; ventilator parameters [platform pressure (Plat), positive end-expiratory pressure (PEEP)], etc. were recorded. Pulmonary artery oxygen saturation, pulmonary vascular function indexes [transpulmonary potential gradient (TPG) and pulmonary vascular resistance index (PVRi)] were calculated. The relationship between TPG, PVRi and mechanical ventilation time, the length of intensive care unit (ICU) stay, cardiovascular days and 60-day mortality were analyzed in patients with different prognosis of 60-day and whether the TPG increased (≥12 mmHg was defined as elevated TPG, 1 mmHg = 0.133 kPa). Results:A total of 65 patients were included in the study, including 30 males and 35 females; aged (48.9±15.2) years old. Forty-eight cases survived in 60-days, 17 died, and the 60-day mortality was 26.2%. At the baseline, there were no significant differences in cardiopulmonary function measurements, such as CVP, sPAP, dPAP, PAWP, CI, etc. between the two groups of patients with different prognosis. The APACHEⅡ score, shock ratio, TPG and PVRi of the death group were significant higher than those of the survival group [APACHEⅡ: 34±9 vs. 28±11, shock: 52.9% vs. 25.0%, TPG (mmHg): 16.2±1.9 vs. 14.6±2.1, PVRi (kPa·s·L -1): 31.8±4.2 vs. 29.7±3.5, all P < 0.05]. The 60-day mortality of 47 patients with TPG ≥ 12 mmHg was significantly higher than that of 18 patients with TPG < 12 mmHg (34.0% vs. 5.6%), and the mechanical ventilation time and the length of ICU stay were also significantly longer (days: 17±9 vs. 11±8, 16±5 vs. 12±5), and the cardiovascular days also increased significantly (days: 23±7 vs. 18±6), and the differences were statistically significant (all P < 0.05). Pearson correlation analysis showed that PVRi was significantly correlated with mechanical ventilation time, the length of ICU stay and cardiovascular days ( r1 = 0.317, P1 = 0.030; r2 = 0.277, P2 = 0.005; r3 = 0.285, P3 = 0.002). In the individual multivariate Logistic regression model, the highest PVRi was an independent risk factor for the 60-day mortality [odds ratio ( OR) = 30.5, 95% confidence interval was 20.4-43.1, P = 0.023]. Conclusion:Pulmonary vascular dysfunction is common in ALI patients and is independently associated with adverse outcomes.

Objective: To analyze the application and significance of three-dimensional (3D) printing in the surgical simulation and plan-ning for pelvic malignant tumors before the actual surgery, surgical resection, and postoperative resection effect analysis. Methods: A retrospective analysis was performed for 20 cases of primary pelvic malignant tumors in 11 male and 9 female patients with a mean age of 39.1 years (range, 14-60 years) who were admitted to Xinjiang University of Medical Science and Technology between January 2014 and January 2018. The tumors included osteosarcoma in 7 patients, chondrosarcoma in 12, and Ewing's sarcoma in one. Accord-ing to the Enneking pelvic classification, 10 cases involved the pelvicⅡarea; 6, the pelvicⅢarea; 6, the pelvicⅠandⅡareas; and 8, the pelvic I andⅣareas. According to whether or not a 3D-printed osteotomy guide plate was used, the cases were divided into a 3D-printed guide plate group and a conventional group, with 10 cases in each group. Operation time, blood loss volume, function score, and linear distance deviation were compared between the two groups. Results: The operation was completed successfully with com-plete excision in 20 patients. The operation time in the 3D-printed guide plate group (4.4～1.4 h) was not statistically significantly dif-ferent from that in the control group (4.5～1.4 h; P=0.83). No significant difference in intraoperative blood loss volume was found be-tween the 3D-printed guide plate (1,980～1,158 mL) and control (2,785～1,784 mL; P=0.16) groups. The postoperative Musculoskele-tal Tumor Society score (20.4～0.98) in the 3D-printed guide plate group showed no significant difference from that in the convention-al group (20.2～1.29; P=0.78). The mean linear difference between the 3D-printed guide plate group (3.8～1.9 cm) and the conven-tional group (8.7～1.0) was statistically significant (P=0.001). Conclusions: The 3D-printed group was not significantly different from the conventional group in terms of operation time, blood loss volume, and function score but had better surgical resection accuracy than the conventional group.

ObjectiveTo investigate the correlation between systemic immune-inflammation index (SII) and prognosis in patients with hepatic alveolar echinococcosis. MethodsA retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgery for hepatic alveolar echinococcosis, and SII was calculated. The chi-square test was used for comparison of categorical data between two groups, and a Spearman correlation analysis was performed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of SII; the Kaplan-Meier method was used to plot survival curves and analyze overall survival time in the two groups, and the log-rank test was used for comparison of survival rates between the two groups; univariate and multivariate Cox regression analyses were used to identify the influencing factors for the prognosis of patients with hepatic alveolar echinococcosis. ResultsThe Spearman correlation analysis showed that SII was positively correlated with the postoperative fatality rate of patients with hepatic alveolar echinococcosis (r=0.267, P＜0.001). The ROC curve showed that the optimal cut-off value of SII before surgery was 758.92, and based on this, 242 patients with hepatic alveolar echinococcosis were divided into low SII (SII ≤758.92) group with 126 patients and high SII (SII ＞758.92) group with 116 patients. The low SII group had 1-, 3-, and 5-year survival rates of 98.20%, 88.47%, and 6610%, respectively, and the high SII group had 1-, 3-, and 5-year survival rates of 90.80%, 53.05%, and 27.40%, respectively. The low SII group had a cumulative survival rate of ＞50% and a mean survival time of 55.584 months (95% confidence interval［CI］: 53550-57.617), while the high SII group had a cumulative survival rate of ＜50%, a mean survival time of 39.384 months (95% CI: 35.070-43.698), and a median survival time of 43 months (95% CI: 34.694-51.306). The low SII group had a significantly better survival rate than the high SII group, and there was a significant difference in overall survival rate between the two groups (χ2=46.979, P＜005). The univariate analysis showed that SII ＞758.92 (hazard ratio ［HR］=5.907, 95% CI: 3.386-10.306, P=0.001) was an influencing factor for the overall survival time of patients with hepatic alveolar echinococcosis, and the multivariate Cox regression analysis showed that preoperative peripheral blood SII (HR=3.507, 95% CI: 1.911-6.435, P=0.001) was an independent risk factor for the overall survival rate of patients with hepatic alveolar echinococcosis. ConclusionPreoperative SII level is clearly correlated with the prognosis of patients with hepatic alveolar echinococcosis and can thus be used as a clinical indicator to evaluate the prognosis of patients. The higher the peripheral blood SII before surgery, the worse the prognosis of patients.

BACKGROUNDThe presence of intracellular organisms (ICOs) in polymorphonuclear leukocytes obtained from bronchoalveolar lavage fluid (BALF) is a possible method for rapid diagnosis of ventilator-associated pneumonia (VAP). However, the validity of this diagnostic method remains controversial and the diagnostic thresholds reported by investigators were different. Our objective was to evaluate the accuracy of quantification of ICOs in BALF for the diagnosis of VAP, and to detect the best cutoff percentage of PMNs containing ICOs (PIC) in the microscopic examination of BALF for the diagnosis of VAP.

METHODSThis was a prospective multi-center study conducted in 4 ICUs in Wuhan, China, which involved 181 patients suspected of first episode of VAP. BALF was obtained from all enrolled patients. The BALF samples underwent quantitative culture, cytological and bacteriological analysis to detect the culture results, PIC values and the morphological features of microorganisms. Definite diagnosis of VAP was based on pre-set criteria. The receiver-operating characteristic curve was used to detect the best cutoff point for PIC to diagnose VAP, and the diagnostic accuracy was calculated. Moreover, quantitative culture and Gram's stain of BALF were adopted to diagnose VAP, and their diagnostic accuracy was evaluated as well.

RESULTSThere were 102 patients definitely diagnosed with VAP (VAP group), and 60 patients definitely diagnosed without VAP (no VAP group). We found that ICOs were present in 96.08% (98 out of 102) of VAP patients and 20.00% (12 out of 60) of no VAP patients. The PICs were significantly higher ((9.53 ± 6.65)% vs. (0.52 ± 1.33)%, P < 0.01) in VAP group. In our study, the best cutoff point for PIC to diagnose VAP was 1.5%,which had a sensitivity of 94.12%, a specificity of 88.33%, a positive predictive value (PPV) of 93.20% and a negative predictive value (NPV) of 89.83%.The area under the receiveroperating characteristic curve was 0.956 (95% confidence interval,0.925-0.986; P < 0.01). When the positive quantitative culture results of BALF were used to diagnose VAP, the sensitivity, specificity, PPV and NPV were 65.69%, 95.00%, 95.71% and 61.96%, respectively. Whereas they were 70.59%, 76.67%, 83.72% and 60.53%, respectively, when the positive Gram's stain results of BALF were used to diagnose VAP. The concordance between the results of Gram's stain and quantitative cultures was poor, only 32.10% (52 out of 162) was totally right, and 17.28% (28 out of 162) was partially right.

CONCLUSIONSPIC>1.5% has good diagnostic performance in the microscopic examination of BALF for the diagnosis of VAP. However, Gram's stain is not reliable for the early application of antibiotic therapy, due to the poor bacteriological predictive value.

Aged ; Bronchoalveolar Lavage Fluid ; microbiology ; Female ; Humans ; Male ; Middle Aged ; Pneumonia, Ventilator-Associated ; diagnosis ; Prospective Studies

This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) in patients with severe/critical coronavirus disease 2019 (COVID-19). In this retrospective study, data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20, 2020. All patients were divided into an exposed group (CHM users) and a control group (non-users). After propensity score matching in a 1:1 ratio, 156 CHM users were matched by propensity score to 156 non-users. No significant differences in seven baseline clinical variables were found between the two groups of patients. All-cause mortality was reported in 13 CHM users who died and 36 non-users who died. After multivariate adjustment, the mortality risk of CHM users was reduced by 82.2% (odds ratio 0.178, 95% CI 0.076-0.418; P < 0.001) compared with the non-users. Secondly, age (odds ratio 1.053, 95% CI 1.023-1.084; P < 0.001) and the proportion of severe/critical patients (odds ratio 0.063, 95% CI 0.028-0.143; P < 0.001) were the risk factors of mortality. These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.
Age Factors ; Aged ; COVID-19/therapy* ; China ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Survival Rate