Objective To explore the correlation of metabolic disorder of newly diagnosed type 2 metabolism(T2DM) and nonalcoholic fatty liver disease (NAFLD).Methods A total of 117 patients with newly diagnosed T2DM in Beijing Ditan Hospital Affiliated to Capital Medical University from June 2014 to June 2015 were enrolled.Patients were divided into two groups:T2DM with NAFLD of 57 cases and T2DM without NAFLD of 60 cases.Body mass index (BMI),waist circumference (WC),liver and kidney function,serum lipid,glycosylated hemoglobin A1c (HbA1c),fasting glucose,fasting insulin and C-peptide (FCP) were detected.The insulin resistance and β-cell function were assessed by homeostasis model assessment insulin resistance (HOMA-IR) and HOMA-β.Results The incidence of NAFLD in T2DM patients was 51％ (that was,60 cases of T2DM patients with NAFLD),compared with 2TDM group,the metabolic index of T2DM without NAFLD was significantly increased (blood triglyceride (TG):(2.58 + 1.8) mmol/1 vs.(1.22 + 0.4) mmol/l,fasting blood glucose:(11.5+6.1) mmol/l vs.(9.2+4.3) mmol/l,serum uric acid:(465.3+65) umol/l vs.(325.3+72) umoL/l;P =0.03,0.03,0.02);HOMA-IR was more serious ((4.9 ± 2.8) vs.(3.8 ± 2.7);P =0.03);insulin β-cell function was compensatory more obvious ((49.2 ± 27) vs.(29.5 ± 18);P =0.02);prevalence rate of obesity,hypertension and diabetic ketoacidosis (DKD),diabetic retinopathy (DR),diabetic peripheral neuropathy(DPN) were significantly increased(P＜0.05).Logistic regression analysis showed that,smoking(OR=1.405,95％CI:1.262-1.567),male(OR=1.037,95％CI:1.015-1.063),BMI(OR=1.113,95％CI:1.278-2.531),WC (OR =1.624,95％ CI:1.162-1.761) and TG (OR =1.823,95％ CI:1.2822.563) were risk factors of NAFLD (P ＜ 0.05).Conclusion T2DM patients with NAFLD have severer insulin resistance than those without NAFLD.The β-cell function of those patients is compensatory increased.NAFLD prevalence rate significantly increase in patients with obesity,especially in male diabetic patients who smoking.

Objective To translate the English version of the Nursing Profession Self-Efficacy Scale into Chinese,and to test the reliability and validity of the Chinese version. Methods The reliability and validity of the Chinese version of scale was tested among 480 nurses from Tianjin First Central Hospital. Results The revised Chinese version of the Nursing Professional Self-Efficacy Scale contained 19 entries, the Cronbach′s α coefficient was 0.95, the test-retest reliability was 0.91. Conclusions The revised Chinese version of the Nursing Profession Self-Efficacy Scale has acceptable reliability and validity. It can be used to measure the Nursing Profession Self-Efficacy among nurses in China.

Objective To evaluate the clinical value of OLGA (Operative Link on Gastritis Assessment) system in pathological assessment of gastric mucosa from Chinese patients.Methods Endoscopic and pathological data of patients,who underwent the endoscopic examination of upper gastrointestinal tract from 2007 to 2012,were analyzed.Using the Sydney protocol,we graded atrophy and staged the Helicobacter pylori infection status in gastric biopsies from 108 patients with dyspepsia.We applied the OLGA system to assess the relationship between OLGA staging and grading and dysplasia/cancer,and the relationship between OLGA grading and Helicobacter pylori infection.Results Two cases of early gastric adenocarcinoma were detected at stage Ⅱ and Ⅳ,respectively.The detection rates of precancerous lesions (including intestinal metaplasia and dysplasia) in cases clustered in stages Ⅲ-Ⅳ were significantly higher than those in stages 0-Ⅱ (intestinal metaplasia:100.0％ VS 65.3％,P ＜0.001 ;dysplasia:77.8％ VS 13.9％,P ＜0.001,respectively),and there were significant differences between OLGA staging and the degree of dysplasia (r =0.671,P ＜0.001).In the subjects at stage 0-Ⅱ,we observed only 10 cases (13.9％) of mild dysplasia.The difference in rate of Helicobacter pylori infection was significant at different OLGA grade (P ＜ 0.001),and the correlation between OLGA grading and infection degree of Helicobacter pylori was significant (r =0.586,P ＜ 0.001).Conclusion Precancerous lesions and gastric adenocarcinoma tend to be discovered in patients clustered at high-risk (Ⅲ-Ⅳ) OLGA stages.OLGA staging of dysplasia can effectively differentiate the risks of gastric cancer.The OLGA grading system is consistently associated with the Helicobacter pylori infection.

Objective To systematically evaluate the effects of prone position ventilation on newborn with respiratory distress syndrome.Methods We searched databases including PubMed,EMBASE,Cochrane Library,Web of Science,CBM,CNKI,Wanfang and VIP.We included all randomized controlled trials and randomized crossover trials of neonatal respiratory distress syndrome.Studies were selected according to inclusion and exclusion criteria,extracting data and assessing quality.Then RevMan 5.3 software was used to analyze the data.Results Ten studies included seven randomized controlled trials and three randomized crossover trials,and 500 patients were included.The results of meta-analysis showed that in prone position ventilation group SaO2[MD=2.41,95％CI(0.87,3.95),P=0.002],PaO2[MD=5.20,95％CI(3.04,7.36),P＜0.001],Pa2//FiO2[MD=24.40,95％CI(8.35,40.44),P=0.003],the risk of pneumothorax [RR =0.10,95％ CI (0.01,0.76),P=0.03] and intracranial hemorrhage [RR =0.41,95％ CI (0.20,0.83),P=0.01]and duration of mechanical ventilation [MD=-23.22,95％CI(-38.30,-8.14),P=0.003] compared with supine positiongroup had significantly statistical difference;however there was no significant difference in ventilator-associated pneumonia[RR=0.72,95％CI(0.48,1.09),P=0.12] between two groups.Conclusion Prone position ventilation is effective to improve SaO2,PaO2 and PaO2/FiO2,shorten duration of mechanical ventilation and reduce the risk of pneumothorax and intracranial hemorrhage in newborn with respiratory distress syndrome.While it could not effectively reduce incidence of ventilator-associated pneumonia.Due to the limitations of the quality of studies included,multi-centered randomized controlled trials with large sample size are needed in the future to evaluate the effects of prone position ventilation on neonatal respiratory distress syndrome.

Objective To investigate the potential mechanism for symptoms related to epigastric discomfort in patients without Helicobacter pylori (H.pylori) infection.Methods Patients who underwent gastric endoscopy and conformed H.pylori negative by histologic examination were enrolled.Among them,232 adult patients were collected between August 2006 and November 2006 and 31 children were collected between September 2005 and August 2009.All patients showed no apparent abnormality by endoscopic examination.The endoscopic biopsy was examined with HE or Warthin-Starry staining.Results In adult group,arteriole obstruction was found in 16 (8.8%) cases and focal haemorrhage in 82 (45.6%) cases.Both were existed in 82 (45.6%) cases.The histopathologic findings showed that arteriole obstruction in transition zone (65.2 %,P = 0.159) was common,whereas the focal haemorrhage in gastric fundus and corpus (65.6%,P=0.001) was in predominance.The symptom of heartburn was less in patients with arteriole obstruction and/or focal haemorrhage in comparison with those without these changes (x2 =8.564,P=0.003).In adolescent group,arteriole obstruction and/or focal haemorrhage accounted for 96.8% (30/31).Conclusion Gastric mucosa ischemic resulted from arteriole obstruction are commonly seen in both adult and adolescent patients,which is an important reason for epigastric discomfort in H.pylori negative patients.

Objective To investigate the mortality risk factors of nosocomial infection patients in intensive care unit (ICU), and to guide clinicians to take effective control measures. Methods A retrospectively cohort study was conducted. The relevant information of patients with nosocomial infection treated in ICU of Hengshui Harrison International Peace Hospital Affiliated to Hebei Medical University from June 2009 to December 2015 was analyzed. The patients who admitted to ICU again, with length of ICU stay less than 48 hours, without first etiology of screening within 48 hours of ICU admission, or without complete pathogenic information were excluded. The gender, age, diagnosis, length of ICU stay, invasive operation, nutritional status, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, distribution and drug resistance of the pathogens, and procalcitonin (PCT) levels at 7 days after nosocomial infection were recorded. The risk factors leading to death in patients with nosocomial infection were analyzed by logistic regression, and the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of all risk factors on the outcome of patients with nosocomial infection. Results In 864 enrolled patients with male of 54.75% and mean age of (63.50±15.80) years, 732 (84.72%) patients survived and 132 (15.28%) died. Compared with survivors, the non-survivors had higher age (years: 65.47±15.32 vs. 58.15±13.27), incidence of urgent trachea intubation (32.58% vs. 22.81%), deep venous catheterization (83.33% vs. 63.25%), and multiple drug-resistant infection (65.91% vs. 33.20%), longer length of ICU stay (days: 13.56±4.29 vs. 10.29±4.32) and duration of coma (days: 7.36±2.46 vs. 5.48±2.14), lower albumin (g/L: 23.64±8.47 vs. 26.36±12.84), higher APACHEⅡ score (19.28±5.16 vs. 17.56±5.62), SOFA score (8.55±1.34 vs. 6.43±2.65), and PCT (μg/L: 3.06±1.36 vs. 2.53±0.87, all P < 0.05). There was no significant difference in gender and urinary tract catheterization between survivors and non-survivors (both P > 0.05). The low respiratory tract was the most common site of infection followed by urinary tract and bloodstream in both groups. It was shown by logistic regression analysis that prolonged ICU stay [odds ratio (OR) = 2.039, 95% confidence interval (95%CI) = 1.231-3.473, P = 0.002], APACHEⅡ score (OR = 1.683, 95%CI= 1.002-9.376, P = 0.000), SOFA score (OR = 2.060, 95%CI = 1.208 -14.309, P = 0.041), PCT (OR = 2.090, 95%CI = 1.706-13.098, P = 0.004), and multi-drug resistant pathogens infection (OR = 5.245, 95%CI = 2.213-35.098, P = 0.027) were independent risk factors for ICU mortality in patients with nosocomial infection. The area under ROC curve (AUC) of length of ICU stay, APACHEⅡ score, SOFA score, and PCT level for predicting death of nosocomial infection patients was 0.854, 0.738, 0.786, and 0.849, respectively, the best cut-off value was 16.50 days, 22.45, 6.37 and 3.38 μg/L, respectively, the sensitivity was 83.6%, 90.0%, 81.1%, and 89.6%, and the specificity was 70.3%, 75.6%, 71.3%, and 85.4%, respectively. Conclusions Prol onged ICU stay, nosocomial infection with secondary sepsis and multiple organ dysfunction syndrome were the leading causes of death for nosocomial infection patients in ICU. Prolonged ICU stay, APACHE Ⅱ score, SOFA score, and PCT level could effectively predict death risks for nosocomial infection patients.

Objective Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagen band with an inflammatory infiltrate in the mucosa.This report describes the first case of collagenous gastritis occurring in a young Chinese woman and reviews the literatures.Methods The patient underwent the gastroscopy screening, and the biopsy specimens were treated with HE staining, Masson staining, Congo red staining and Warthin-Starry staining.Patients' clinical data was discussed and followed up.Results A twenty-year-old girl had intermittent epigastric pain for 4 years, abdominal distention, hiccup and weight loss for two months.The gastric endoscopy revealed diffuse white nodular appearance of the mucosa in angular incisure and antrum.Pathologic examination of the gastric biopsies from the antrum and angular showed a subepithelial collagen deposition with moderate infiltrates of lymphoplasma cells and eosinophils of the lamina propria.The collagen band measured up to 120.3 μm (mean 43.8 μm).Prednisone 20 mg/d for 4 weeks led to clinical remission and weight gain.Conclusion There are about 40 cases in literatures to date, and the cause and pathogenesis of collagenous gastritis remain unknown.According to the clinical and pathological characteristics, the patient in this article is the subtype of collagenous gastritis that occurring in children and young adults.Specific therapy has not been established, the gluten-free diet and glucocorticosteroid may be helpful to relieve symptoms in collagenous gastritis patients.

Objective To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. Methods A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group,with 16 cases in each group. Beside the treatment for primary disease,the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons,and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. Results Compared with control group,the time from diagnosis to operation(minutes:8.00±1.36 vs. 23.06±3.83,t=14.790,P=0.000)and the operation time were significantly shortened(days:5.37±1.02 vs. 7.31±1.70,t=7.286,P=0.000),the frequency of drainage tube replacement(times:0.18±0.40 vs. 3.87±1.14,t=12.128,P=0.000)and the times of repeated chest radiography(times:1.12±0.34 vs. 2.93±0.77,t=8.589,P=0.000)in observation group were significantly reduced,the length of hospital day was significantly shortened(days:8.30±1.37 vs. 24.56±5.62,t=17.289, P=0.000),the rates of dislocation of drainage tube(0 vs. 3 cases),obstruction of the tube(0 vs. 5 cases),and subcutaneous emphysema(3 vs. 16 cases)were reduced obviously,but there was no difference in incidence of incision infection(1 vs. 3 cases)and infection of thoracic cavity(0 vs. 2 cases). Conclusions The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure,and its effect is positive.

Objective To evaluate the clinical curative effect of ulinastatin combined with CRRT in the treatment of multiple organ dysfunction syndrome(MODS).Methods Sixty eight patients with MODS who were admitted to ICU from July 2013 to July 2015 were randomly divided into three groups:control group,CRRT group,combined group;Patients' APACHE Ⅱ,SOFA scores level of inflammatory markers were recorded before treatment and after treatment of 72 hours and 7 days.The mortality of the three groups in ICU were compared.Results After 72 hours and a week of treatment,the level of IL-10,IL-6,TNF-α,WBC、PCT、CRP in CRRT group and combined group were significantly better than that of control group(P＜0.05),and combined group were significantly better than that of CRRT group.Compared with the control group,the oxygen index,lactic acid,ALT significantly im proved in CRRT group and combined group were better than control group,after 72 hours and a week of treatment(P＜0.05),and the cornbined group was the most obvious.After a week of treatment,the mortality rate of CRRT group and combined group was significantly better than the control group (P＜0.05),while there was no statistical differences between CRRT group and combined group(P＞0.05).Conclusion Ulinastatin combined with CRRT is an effective method for the treatment of MODS.

Objective To translate the English version of Type 2 Diabetes Stigma Assessment Scale(DSAS-2) into Chinese,and to test the reliability and validity of the Chinese version of DSAS-2. Methods The DSAS-2 was translated and adapted according to Chinese culture following the translation and back-retranslation procedure.The reliability and validity of the Chinese version of DSAS-2 was tested among 294 patients with type 2 diabetes. Results The Chinese version of DSAS-2 included three subscales: Treated Differently (6 items), Blame and Judgment (7 items), and Self-stigma (6 items) and contained a total of 19 items.The Cronbach α coefficient of the Chinese version of DSAS-2 was 0.879,the Cronbach α coefficient of three factors was 0.832,0.815 and 0.844,respectively;the test-retest reliability was 0.835. The content validity index was 0.916. The scores of DSAS-2 correlated with the scores of Rosenberg Self-esteem Scale, Patient Health Questionnaire 8- Item Scale and Generalized Anxiety Disorder 7-Item Scale (r =-0.452, 0.443, 0.412, P<0.01). Three factors were extracted by exploratory factor analysis and could explain 55.75% of the total variance. Conclusions The Chinese version of DSAS-2 has acceptable reliability and validity,which can be used to evaluate stigma among patients with type 2 diabetes in China.