Academic Inspection is not only an important part of clinical teaching,but also a vital tache of improvement for medical treatment quality.Unlike internal medicine and surgery,acdemic inspection of ICU has its own characteristics.PBL teaching method on acdemic inspection of attending doctor in ICU is explored in this article.

Objective To explore the safety and clinical efficacy of central venous infusions of concentrated potassium chloride corrects hypokalemia by micro-pump in intensive care unit(ICU). Methods The data was analyzed retrospectively on 78 patients with hypokahmia in ICU. They were randomly divided into 2 groups: general group (39 cases) with potassium concentration 40 mmol/L and the rate 10-20 mmol/h,concentrated potassium group(39 cases) with potassium concentration 100-300 mmol/L and the rate 40-200 retool/h, calculating the whole potassium dosage respectively, examining the initial potassium concentration, urine volume per hour, the mean time to aimed potassium concentration and side effect.Results The initial potassium concentration and the whole potassium dosage were no significant difference between the two groups [(2.9 ± 0.2), (3.0 ± 0.2) mmol/L and (85.2 ± 8.7), (92.3 ± 7.6) mmol, respectively](P >0.05). It took longer time reaching the aimed potassium concentration in general group than that in concentrated potassium group [(17.25 ± 4.49) hours and (5.67 ± 0.75) hours, respectively] (P < 0.01).There were no comphcations such as hyperkalemia, fatal arrhythmia and phlebitis. Five patients were bloating in general group. Condusions Under meticulous monitoring, it is effective and relative safely to correct hypokahmia by central venous infusions of concentrated potassium chloride using micro- pump in ICU. The therapy is of clinical value in treating hypokalemia patients.

Objective To investigate the application effect of early postoperative activity on postoperative rehabilitation of patients with liver cancer undergoing liver resection.Methods A total of 100 liver cancer patients, having undergone liver resection in Hunan Provincial People's Hospital from January 2015 to May 2016, were divided according to random number table into observation group, with 52 cases and control group, with 48 cases. Patients in the control group were treated by conventional postoperative activity program, while patients in the observation group received early postoperative activity program. Recovery time of bowel sound, time to get out of bed, the first time of flatus, of defecation, and postoperative complications of the two groups were compared. The activity of daily living scale (ADL) was used to compare self-care ability of patients in the two groups.Results In the observation group, recovery time of bowel sound was (55.26±2.63) h, time to get out of bed was (64.43±3.37) h, the first time of flatus was (73.78±3.10) h, and the first time of defecation was (123.43±6.46) h, all shorter than that in the control group (t=4.81, 3.16, 3.57, 2.59;P<0.05); there was no significant difference in incidence of postoperative complications between the two groups (x2=2.53, P>0.05); it was shown in variance analysis of repeated measures that before and after the intervention, at different time points, ADL differences of all the patients were statistically significant (FTime=1598.85,P<0.05), ADL differences between the two groups were statistically significant (FInter-group=40.01,P<0.05), and interaction existed among measurement and intervention (FInteraction=21.62,P<0.05).Conclusions Early postoperative activity was safe and effective to patients having undergone open hepatic resection, which can accelerate recovery of gastrointestinal function and help patients recover their self-care ability.

Objective To study the effect of parecoxib sodium on tumor microenvironment in patients undergoing laparoscopic radical resection of rectal cancer.Methods Sixty patients undergoing laparoscopic surgery for radical rectal cancer resection were randomized into test group and control group(n=30).The patients in test control group received intravenous injections of 40 mg parecoxib sodium at the time of anesthesia induction,immediately after and at 12 h after the surgery,and those in the control group were injected with an equal volume of physiological saline at the same time points.Plasma levels of IL-6,TNF-α,and CXCL8 of the patients were measured using ELISA,and expressions of CXCL8,CXCR1,and CXCR2 in the peripheral blood mononuclear cells(PBMCs)were detected with Western blotting.Postoperative VAS scores and gastrointestinal reactions and disease regression at 6 months after the operation were recorded.Results Compared with the control patients,the patients in the test group showed significantly reduced plasma levels of IL-6,TNF-α,and CXCL8(P<0.05)and milder elevations of CXCL8,CXCR1,and CXCR2 proteins in PBMCs(P<0.05)with significantly lower VAS scores at 12 h and 24 h after the operation(P<0.05)and lower postoperative incidence of adverse gastrointestinal reactions(P<0.05).At 6 months after the operation,the number of patients with metastasis or tumor recurrence was significantly smaller in the test group than in the control group(P>0.05).Conclusion Parecoxib sodium can improve the inflammatory microenvironment to promote patient recovery after laparoscopic radical resection of rectal cancer possibly through a mechanism that down-regulates CXCL8-CXCR1/2 expressions in the PBMCs.

Objective To compare the adverse reaction′s incidence of oxaliplatin with three different injection ways , to explore the most appropriate infusion .Methods A total of 90 patients were randomly divided into 3 groups averagely: peripheral vein ( PV ) group, central venous catheterization ( CVC ) group and peripherally inserted central catheter ( PICC) group.The occurrence rate and degree of adverse reaction were compared among groups including peripheral neuritis , blood system , digestive system toxicity .Results The occurrence rates of peripheral neuritis were 37.50%, 21.43%, 10.00% in the PV group, CVC group and PICC group, and the difference was statistically significant (χ2 =6.628,P<0.05).The occurrence rates of toxic action of blood system and digestive system were respectively 53.13%, 53.57%, 50.00%and 78.13%, 92.86%, 73.33%in the PV group, CVC group and PICC group with no statistical difference (χ2 =0.090, 3.892,respectively;P>0.05).Conclusions The best method of oxaliplatin infusion among these three ways is PICC, followed by CVC, and PV is not recommended.

Objective To study the effect of parecoxib sodium on tumor microenvironment in patients undergoing laparoscopic radical resection of rectal cancer.Methods Sixty patients undergoing laparoscopic surgery for radical rectal cancer resection were randomized into test group and control group(n=30).The patients in test control group received intravenous injections of 40 mg parecoxib sodium at the time of anesthesia induction,immediately after and at 12 h after the surgery,and those in the control group were injected with an equal volume of physiological saline at the same time points.Plasma levels of IL-6,TNF-α,and CXCL8 of the patients were measured using ELISA,and expressions of CXCL8,CXCR1,and CXCR2 in the peripheral blood mononuclear cells(PBMCs)were detected with Western blotting.Postoperative VAS scores and gastrointestinal reactions and disease regression at 6 months after the operation were recorded.Results Compared with the control patients,the patients in the test group showed significantly reduced plasma levels of IL-6,TNF-α,and CXCL8(P<0.05)and milder elevations of CXCL8,CXCR1,and CXCR2 proteins in PBMCs(P<0.05)with significantly lower VAS scores at 12 h and 24 h after the operation(P<0.05)and lower postoperative incidence of adverse gastrointestinal reactions(P<0.05).At 6 months after the operation,the number of patients with metastasis or tumor recurrence was significantly smaller in the test group than in the control group(P>0.05).Conclusion Parecoxib sodium can improve the inflammatory microenvironment to promote patient recovery after laparoscopic radical resection of rectal cancer possibly through a mechanism that down-regulates CXCL8-CXCR1/2 expressions in the PBMCs.

Objective:By analyzing factors associated with lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years old, a nomogram model for lower urinary tract symptoms was constructed to assist the clinical development of targeted interventions to reduce the incidence of lower urinary tract symptoms in this population.Methods:In the cross-sectional study, 798 middle-aged and elderly women aged 55-65 years receiving physical examination in the Health Management Center of Third Xiangya Hospital from November 2013 to December 2020 were selected as research participants.Univariate regression analysis was used to compare differences in the basic data related to lower urinary tract symptoms in the population.Multivariate Logistic regression analysis was used to identify related influencing factors, and a nomogram model for lower urinary tract symptoms in the population was established.Results:Among 798 middle-aged and elderly women surveyed, the prevalence of lower urinary tract symptoms was 81.08 %(647 cases), and the rate of urinary tract infections was 21.48 %(139 cases). Variables with statistical significance in univariate regression analysis were included in multivariate Logistic regression analysis.The results showed that body mass index, vaginal delivery, strength of pelvic floor type Ⅱ fiber muscle, pelvic and abdominal coordination and mental health were independent influencing factors for lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years( OR=1.099, 2.681, 0.895, 0.658, 1.057, P=0.010, 0.030, 0.040, 0.010, 0.038). The monogram model based on the five risk prediction indexes produced a consistency index(C-index)of 0.651 and a diagnostic sensitivity and specificity of 66.9% and 58.9%, respectively.The correction curve showed that the predicted results of the model were essentially the same as the actual probability of condition. Conclusions:In this study, the independent influencing factors for lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years were screened by univariate regression and multivariate Logistic regression analysis and a nomogram model for risk prediction of the population was constructed, was proved to have a good ability for accurately and effectively predicting the risk of lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years, and will assist clinicians to screen for high-risk patients, formulate targeted interventions, and reduce the incidence of lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years.

Objective To establish a mouse model of pregnancy pain-depression comorbidity induced by chronic unpredictable stress(CUS),complete Freund's adjuvant(CFA),and formalin,and to systematically evaluate the associated phenotypes and preliminarily explore the pathological basis of the comorbidity.Methods Eight-week-old C57BL/6J female mice were randomly strarified divided into a control group(no intervention before pregnancy)and a CUS model group(CUS intervention before pregnancy)based on sucrose preference test(SPT)data.After completing the CUS treatment,female and male mice were paired and mated.Pain was induced by injecting 50％CFA and 5％formalin in the right hind foot during pregnancy to create a model of pregnancy pain-depression comorbidity.The experiment was divided into 8 subgroups:control-blank group,CUS-blank group,control-CFA group,CUS-CFA group,control-formalin group,CUS-formalin group,control-CFA+formalin group,and CUS-CFA+formalin group,with 10 mice in each group.The mice in each group were subject to behavioral tests,including the SPT,forced swimming test,tail suspension test,and open field test before and after CUS intervention,during pregnancy,and after delivery.Pain sensitivity changes were measured using mechanical allodynia and thermal hyperalgesia tests.Mice were then euthanized.Levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in hippocampus,as well as cortisol and adrenocorticotropic hormone(ACTH)in serum,were detected by enzyme-linked immunosorbent assay(ELISA).Results Compared with the control-blank group,the CUS-blank group showed a significant depression-like behavior with reduced pain threshold(P＜0.001).The control-CFA+formalin group showed a decrease in pain threshold after both CFA injection and formalin injection(P＜0.01).Compared with the control-blank and control-formalin groups,the pain threshold was significantly lower in the CUS-formalin group(P＜0.01),with a sequential decrease among the three.Compared with the control-blank and control-CFA groups,the pain threshold was significantly lower in the CUS-CFA group(P＜0.001),with a sequential decrease among the three.Compared with the control-blank and control-CFA+formalin groups,the mechanical pain threshold of mice in the CUS-CFA+formalin group was significantly lower(P＜0.001)and the thermal radiation tolerance time was shorter(P＜0.01),both with sequential decreases among the three.Compared with the control-CFA+formalin and the CUS-blank groups,the CUS-CFA+formalin group had a significantly lower percentage of sucrose preference(P＜0.001),longer immobility time during the forced swimming test(P＜0.001)and tail suspension test(P＜0.001),reduced central exploration time in the open field test(P＜0.001),reduced total exploration distance(P＜0.001),and reduced percentage of distance traveled for central exploration(P＜0.001).Compared with the control-CFA+formalin and CUS-blank groups,the serum cortisol and ACTH levels of the CUS-CFA+formalin group were significantly higher(P＜0.01),and the levels of IL-6 and TNF-α in the hippocampus were higher(P＜0.05).Conclusion The combination of CUS+CFA+formalin injections is an ideal method for establishing a C57BL/6J mouse model of pregnancy pain-depression comorbidity.The behavioral changes in model mice may be attributed to the regulation of inflammatory response in hippocampus and hormone levels in the hypothalamic-pituitary-adrenal(HPA)axis.