Objective To explore the correlation between the glucose variability and the death of critically ill patients in neurology department.Methods Clinical characteristics of 231 patients admitted to neurointensive care unit (N-ICU) were analyzed retrospectively.The patients were divided into two groups:survival group(n =190)and death group (n =41).The baseline data,such as gender,age,mechanical ventilation,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were recorded.All data of blood glucose measured during hospitalization in N-ICU were collected.Standard deviation (SD),coefficient of variability (CV),maximum successive change and mean amplitude of glycemic excursions (MAGE) were used as glucose variability index.Logistic regression analysis was used to study the association between the glucose variability and the death.Receiver operating characteristic (ROC) curve was adopted to evaluate the application value of each glucose variability index on predicting mortality.Results Glucose variability,APACHE Ⅱ score (deleting the age component) and mechanical ventilation were significantly correlated with death (OR =4.959,1.444,5.472 ; 95％ CI 2.015 ～ 12.202,1.240 ～ 1.681,1.455 ～20.574;P =0.000,0.000,0.012).The predictive value was high and same when using SD and APACHE Ⅱ score (deleting the age component) as predictor (area under the ROC curve =0.910,0.957 ;Z =1.396,P =0.163).The application value of CV,maximum successive change and MAGE was moderate (area under the curve =0.847,0.856,0.872).Conclusion There is significant association between the glucose variability and the death of critically ill patients in neurology department.

Objective To explore the effect of amifostine combined with low-dose cyclosporine in treatment of refractory immune thrombocytopenia effect and related mechanisms.Methods 60 cases of refractory immune thrombocytopenia patients using parallel randomized controlled groups, divided into three groups, 20 cases in each group, amifostine group were treated with amifostine, cyclosporine group were treated with cyclosporine, amifostine+CSA group received amifostine+cyclosporine A treatment.The platelet count, platelet membrane glycoprotein antibody, lymphocyte subsets and bone marrow megakaryocyte count were observed and compared.Results After different treatment of three, six months, the level of platelet count of patients in three groups were compared with the group before treatment were significantly increased, and the treatment of platelet count level of amifostine group and cyclosporine group were significantly lower than that of amifostine +CSA group, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.The total efficacy of amifostine+CSA group was significantly higher than the other two groups, the difference was statistically significant ( P<0.05 ) , there was no significant difference between amifostine group and cyclosporine group.After the treatment, the platelet membrane glycoprotein GPIIb/IIIa antibody levels in three groups were significantly increased, and ring the detection level of amifostine+CSA group after treatment was significantly higher than the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the three groups of CD4 +, CD4 +/CD25 +and CD4 +/CD8 +levels were significantly increased, CD8 +decreased significantly, the difference was statistically significant (P<0.05).And the level of change after treatment with amifostine +cyclosporine group was significantly higher than that of the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the number of bone marrow megakaryocytes in the three groups was significantly lower than that before treatment , the level of count after treatment with amifostine +cyclosporine was significantly lower than that of the other two groups, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and cyclosporine group.The adverse reactions of amifostine group and amifostine+CSA group were significantly lower than that in cyclosporine group, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and amifostine+CSA group.Conclusion Amifostine combined with low dose of cyclosporine in treatment of refractory immune thrombocytopenia can play a synergistic effect, improve the therapeutic effect, and effectively reduce the dosage and adverse reactions.

Objective:To observe the effect of acupuncture on gastric motility, plasma motilin and serum gastrin in patients with diabetic gastroparesis (DGP) and evaluate its clinical efficacy.
Methods:A total of 100 eligible cases were randomly allocated into an acupuncture group (n=50) and a control group (n=50). Patients in the acupuncture group were treated by needling Zhongwan (CV 12), Zusanli (ST 36) and Neiguan (PC 6), whereas patients in the control group were treated with oral administration of Domperidone. The clinical efficacies of the two groups were compared; and changes in gastric motility, plasma motilin and serum gastrin in both groups were observed before and after treatment.
Results:After treatment, the symptom scores, gastric motility and contents of plasma motilin and serum gastrin were significantly improved in both groups (P<0.05). There were between-group statistically significant differences in symptom scores, gastric motility and levels of plasma motilin and serum gastrin after treatment (allP<0.05). The total effective rate was 96% in the treatment group, versus 78% in the control group, showing a statistically significant difference (P<0.05).
Conclusion:Acupuncture is effective for DGP and can reduce the levels of plasma motilin and serum gastrin.

Objective To explore the risk factors of hemorrhagic transformation (HT) following defibrase therapy in patients with acute cerebral infarction.Methods The clinical data of 245 patients with acute cerebral infarction,admitted to and treated with batroxobin in our hospital from March 2011 to May 2015,were summarized retrospectively.According to the intracranial hemorrhage under hospital CT scan or MRI,these patients were divided into HT group (n=18) and non-HT group (n=227).Influencing factors were analyzed by stepwise Logistic regression.The receiver operating characteristic (ROC) curve analysis on the independent risk factors was performed to obtain the optimum predictive value of HT following defibrase therapy.Results National Institutes of Health Stroke Scale (NIHSS) scores,sizes of cardioembolism,massive hemispheric infarction and cortical infarction,and fasting blood glucose level were statistically significant between HT and non-HT groups (P＜0.05).Logistic regression analysis demonstrated that NIHSS scores (OR=1.262,95％ CI=1.025-1.554,P=0.028) and size of cardioembolism (OR=3.949,95％CI=1.093-14.269,P=0.036) were independent predictors of HT following defibrase therapy in patients with acute cerebral infarction.The ROC curve showed that the optimal cutoffpoint of NIHSS scores to predict HT was 14.Conclusion Risk factors associated with HT following defibrase therapy in patients with acute cerebral infarction include high NIHSS scores and cardioembolism.