The perioperative management of blood glucose has been controversial since clinical associations between hyperglycemia and adverse outcomes were fhrst reported.Many studies have demonstrated that hyperglycemia is a universal phenomenon in adults admitted to the ICU and it has been associated with increased morbidity and mortality,additionally,tight glycemic control with intensive insulin therapy in critically ill patients,including cardiac operation patients,significantly improves outcomes.But children's glycometabolism is different from adults',especially the ones who receive open-heart surgery with cardiopulmonary bypass for congenital heart disease,their internal enviroment chang a lot during pedoperative period,and whether hyperglycemia is associated with adverse outcomes after surgery and strict glycemic control is needed are still debatable in critically ill children.Although there are much dispute about perioperative management of glucose during openheart surgery in children,relevant researches are very limited,so further randomized controlled clinical trials are needed.

Objective To evaluate the effect between laparoscopic surgery and traditional laparotomy.Methods 70 cases of uterine fibrosis were divided into the laparoscopic surgery group(n=35)and traditional laparotomy group(n=35).Operative complications,operative time,blood loss and postoperative recovery of the situation were observed.Results Laparoscopoic surgery group time(63.0 ±32.0)min was significantly shorter than open surgery group time(86.0 ±29.0)min(t = 2.358 ,P ＜ 0.01);bleeding laparoscopic group(56.0 ±32.0)ml significantly less than the open group(97.0 ±52.0)ml(t =2.398,P ＜0.05);laparoscopic surgery than conventional open surgery foruterine fibroids after time activities get out of bed early,less abdominal pain,indwelling catheter time is short.As early as the exhaust,improve care and efficiency.Conclusion Nursing intervention of uterine fibroids had better effect of two surgical treatment methods.

Objective To explore the pathway of clinical nursing care to perioperative nursing care in the treatment of cancer of cervix.Methods 60 patients with cancer of cervix were randomly divided into experiment group(n = 30)and control group (n = 30).Patients were given nursing care in the light of pathway of clinical nursing care in the experiment group while routine nursing care was given in the control group,the occurrence of anxiety,the duration in bed,duration of hsopitalization and satisfaction of patients were compared.Results The score of anxiety rating scale ( SAS),after the intervention (36.58 + 6.50) points, significandy lower than before the intervention (42.73±5.42) points (t = 2.813, P < 0.05 ) ;the socre of self-rating depression scale(SDS),after the intervention (0.46±0.06) points,significantly lower than before the intervention (0.51 ±0.07) points(t =2.358,P <0.05) ;bed time of the experimental group (50.5±10.3) h,the number of hospitalization days (11.5±2.3 )d,satisfaction (96.8±3.2) % were lower than the control group[58.2±12.9)h,( 14.2±2.6)d,(86.5±7.5)% ,t =2.312,t =2.411 ,t = 2.489 ,P < 0.05].Conclusion It is effective to apply the pathway of clinical nursing care for perioperatire nursing care to increase quality of nursing care and satisfaction of patients in the treatment of cancer of cervix.

Objective To investigate the clinical outcome of large decompressive craniectomy in treatment of severe traumatic brain injury combined with herniation of brain.Methods A retrospective analysis was carried out to assess the clinical outcome of large decompressive craniectomy for 98 patients with severe traumatic brain injury combined with herniation of brain enrolled from Jan.2007 to Sep.2010.Results According to the Glasgow outcome scale,there were 27 patients ( GOS 5 points) with good recovery,23 ( GOS 4 points) with moderate deficit,28 (GOS 3 points) with severe deficit,6 (GOS 2 points) under persistent vegetative status and 14 (GOS1 points) deaths at the end of 6 month post injury.We observed a good prognosis rate (good recovery and moderate deficit) of 51％ and a poor prognosis of 49％.Conclusion Large decompressive craniectomy can significanty improve the outcome and reduce complications of patients with severe traumatic brain injury combined with herniation of brain.

Objective To explore the impact of diagnosis related groups (DRGs) payment and drug zero plus on the management of intensive care medicine department. Methods The clinical data of patients in one year from 2016 to 2017 admitted into the Department of ICU in Liuzhou Worker's Hospital concerning their numbers of discharged patients, transferred patients, bed utilization rate, number of bed turnover, average length of stay of discharged patients, cure and improvement rates, admission and discharge diagnostic coincidence rate, 3-day definite diagnosis rate, clinicopathological diagnosis coincidence rate, rescue success rate, total income, drug proportion, consumable proportion, DRGs payment and settlement data, etc were retrospectively analyzed to explore the dual challenges, DRGs payment and drug zero plus, facing the department and how to respond and deal with them. Results In 2016 and 2017, the total incomes of the department of critical care medicine in our hospital were 42.107 0 million yuan and 41.371 3 million yuan respectively, and the medical insurance incomes were 15.03 million yuan and 16.69 million yuan respectively;in 2016 and 2017, 2 693 patients and 2 922 patients were admitted and treated respectively; 595 patients and 577 patients were discharged respectively, with 2 071 patients and 2 334 patients transferred respectively; the balances of the department were 15.48 million yuan and 29.11 million yuan, respectively. From July to December 2017, the medical insurance DRGs payment data suggested that the proportion of loss of the department be 7.02%. Accelerating the Grade 6 electronic medical records and informationization construction, adopting the severe disease information solution program and fine quality control management in the department of critical care medicine can reduce the cost of manpower. Conclusion Our future development direction in the Department of Intensive Care Medicine includes the following aspects: Open source and reduce expenditure, strictly control the proportions of drugs and consumables, improve the balance of the department, and actively respond and deal with the medical insurance DRGs payment.

To determine the physicians′compliance of hour-1 bundle for sepsis. A management system of hour-1 bundle for sepsis was established. The clinical data of 286 sepsis patients were collected, who were classified into 3 months before the bundle (control group), 9 months during process (observation group) and 3 months after bundle (study group). The compliance of hour-1 bundle implementation was compared in three groups. The results showed that with the application and implementation of the management system, the compliance of hour-1 bundle for sepsis in the control group, observation group and study group was 58.3%(28/48), 69.1%(105/152) and 88.4%(76/86) respectively (χ 2=7.053, P=0.029). The 28 day mortality in sepsis patients was 41.7%(20/48), 34.9%(53/152) and 23.3%(20/86) respectively (χ 2=5.576, P=0.062).The management system of hour-1 bundle for sepsis can effectively improve the physicians′ compliance.

Systematic light chain (AL) amyloidosis is the most common forms of amyloidosis, which manifests as multiple organ system involvement, rapid progress, dire prognosis, difficult therapy and high mortality. Many patients may miss the optimal treatment as a result of not being diagnosed timely. Therefore, early diagnosis and assessment of involved extent of AL are clinical focuses. Related clinical studies have demonstrated that nuclear medicine imaging can be non-invasive in detecting amyloid deposits. It can not only early assess the extent and distribution of amyloid deposits in systemic AL amyloidosis, but also offer the indications for risk stratification, treatment response monitoring and prognosis assessment of the patients, especially for positron amyloidosis-specific tracers, which may have great prospects in the future. This review summarizes the application of nuclear medicine imaging in the systematic AL amyloidosis.

Objective·To investigate the relation between urinary excretion of protein-bound uremic toxins(PBUTs)and upper urinary tract calculus.Methods·Residents aged 18?80 years in the community of Haitou,Danzhou city in Hainan Province were recruited.Basic information and diet for the last 3 d of the subjects were recorded.Their fasting sera and 24-hour urine samples were collected,and they also underwent ultrasound examination of kidneys and ureters.The subjects with upper urinary calculi detected by ultrasound or a clear history of upper urinary calculi were selected as the calculus group,and the others as the non-calculus group.The biochemical indicators related to the formation of calculus in blood and urine were detected,and the levels of PBUTs,including indoxyl sufate(IS),indole-3-acetic acid(IAA),and p-cresol sulfate(PCS)in blood and urine,as well as oxalic acid and citric acid in urine were detected by high-performance liquid chromatography.The related factors of upper urinary tract calculus formation were analyzed by multivariate Logistic regression.The correlations of urine PBUTs with urine uric acid,oxalic acid,and citric acid were analyzed by Spearman correlation test.Results·A total of 117 participants were screened out with 54 people in the calculus group and 63 people in the non-calculus group.There were no significant differences between the two groups in terms of gender,age,serum indicators,and prevalence of complications such as hypertension,diabetes,and hyperuricemia/gout.The 24-hour urine pH,calcium,uric acid,and chlorine in the calculus group were significantly higher than those in the non-calculus group(all P<0.05),while IS was significantly lower than that in the non-calculus group(P<0.05).Multivariate Logistic regression analysis showed that urinary IS(OR=0.929,95%CI 0.875?0.986,P=0.016)was related to the calculus formation independently,in addition to urinary calcium.The Spearman correlation analysis results showed that the levels of IAA(r=0.420,P=0.000)and PCS(r=0.307,P=0.001)in 24-hour urine were positively correlated with oxalic acid,PCS was positively correlated with uric acid(r=0.297,P=0.002),and IS was positively correlated with citric acid(r=0.289,P=0.002).Conclusion·In the population,a decrease in urinary excretion of IS may be an independent risk factor for the formation of upper urinary tract calculus,and PBUTs levels are correlated with levels of uric acid,oxalic acid,and citric acid.

Ferroptosis is a novel form of programmed cell death that relies on the accumulation of intracellular iron ions,causing irreversible damage to cell membranes through extensive lipid peroxidation,ultimately leading to cell death.Ferroptosis is closely associated with various neurodegenerative diseases.The ferroptosis of glial cells can regulate neuronal death by inducing neuroinflammation and affecting oxidative stress,thereby exacerbating the progression of neu-rodegenerative diseases.This review summarizes how ferroptosis occurs in different types of glial cells and its impact on neurons,aiming to deeply understand the effects of glial cell ferroptosis on neurodegenerative diseases and explore the po-tential therapeutic applications of inhibiting this process in treatment.