Objective To explore the prognostic role of nutritional benefit assessment (NUTRIC score), nutritional risk screening 2002 (NRS 2002), traditional nutritional laboratory indicators albumin (ALB) and prealbumin (PA) in critically ill patients. Methods A historical-prospective cohort study was conducted. The data of 427 patients admitted to Department of Critical Care Medicine of the Affiliated Hospital of Guizhou Medical University from February 2014 to October 2014 were retrospectively analyzed, and thereafter a follow-up of 275 critically ill patients from November 2014 to April 2015 prospectively enrolled was performed. 261 patients were enrolled finally. Patients were divided into death group and survival group according to 28-day and 90-day outcome, the baseline data, acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, NRS 2002, NUTRIC score, ALB and PA were compared between the two groups. Logistic regression analysis was used to find risk factors for 28-day and 90-day prognosis. Results ① NRS 2002 score of all the 261 patients were greater than or equal to 3 with 100% nutritional risk. The patients in NUTRIC score 5-9 group had lower ALB and PA, higher NRS 2002 score, longer mechanical ventilation time and length of intensive care unit (ICU) stay, which indicated they were more serious. ② Twenty eight-day mortality was 20.7% (54 died from 261). Compared with survival group, the patients in death group had higher APACHE Ⅱ, SOFA, and NUTRIC scores [29.00 (22.75, 34.25) vs. 24.00 (20.00, 28.00), 10.0 (8.0, 13.0) vs. 9.0 (7.0, 11.0), 6.37±1.84 vs. 5.59±1.64, all P < 0.01], and longer days from hospital to ICU admission and mechanical ventilation time in ICU [1.5 (0, 9.2) days vs. 0 (0, 4.0) days, 6.0 (4.0, 11.0) days vs. 4.2 (2.5, 7.8) days, both P < 0.05]. It was revealed by logistic regression analysis that APACHE Ⅱ score [odds ratio (OR) = 1.089, 95% confidence interval (95%CI) = 1.039-1.141, P = 0.000] and days from hospital to ICU admission (OR = 1.042, 95%CI = 1.014-1.071, P = 0.003) were the independent risk factors for 28-day death in critically ill patients. ③ Ninety-day mortality was 42.5% (111 died from 261). Compared with the survival group, the death group patients were older with higher APACHE Ⅱ, SOFA, NRS 2002, and NUTRIC scores [age (years): 64.44±18.11 vs. 54.25±19.66, APACHE Ⅱ: 27.00 (23.00, 31.00) vs. 23.00 (20.00, 27.00), SOFA: 10.0 (8.0, 12.0) vs. 9.0 (7.0, 11.0), NRS 2002: 5.08±1.47 vs. 4.67±1.41, NUTRIC: 6.32±1.58 vs. 5.33±1.68], ALB was significantly reduced [g/L: 27.70 (23.05, 32.00) vs. 30.73 (26.90, 34.20)], and mechanical ventilation time in ICU was extended obviously [days: 5.7 (3.6, 11.0) vs. 3.9 (2.4, 7.0), all P < 0.05]. It was revealed by logistic regression analysis that old age (OR = 1.019, 95%CI = 1.002-1.037, P = 0.029) and NUTRIC score (OR = 1.211, 95%CI = 0.983-1.491, P = 0.072) were the independent risk factors for 90-day death probability, and ALB probability was the protect factor for 90-day death (OR = 0.954, 95%CI = 0.916-0.994, P = 0.024). Conclusion It was NUTRIC score but not NRS 2002, ALB and PA predicted 90-day mortality in critically ill patients.

To foster interdisciplinary talents with the highly fusion of clinical skills and the capacity for scientific research, a preliminary exploration of teaching for the cultivation of scientific innovation ability was carried out for clinical postgraduate students. In the cultivation of clinical post-graduate students' innovation consciousness and innovative spirit, we focused on the transformation of attaching more importance to the clinical skills than to the capacity for scientific research to establish the foundation of the competitive compound talents. Then in the early stage of medical project writing, basic knowledge learning and exchange, we stressed clinical postgraduate students' solid grasp of basic knowledge of medical science to consolidate the way of enhancing the scientific research ability. Furthermore , under the guidance of the second research supervisors allocated by the department , we strengthened the clinical postgraduate students' writing of scientific research project bid and pro-fessional paper to promote the organic combination of the clinical practice and scientific research innovation and enhance their scientific research ability.

BACKGROUND: The morbidity of diabetes mellitus increased recently.There are few reports about the pulmonary function status of the patients with diabetes mellitus.OBJECTIVE: To comparably observe the difference of the pulmonary function status between patients with diabetes mellitus and normal persons,and to probe into the relationship between the course of disease of diabetes mellitus and the functional change of pulmonary function.DESIGN: Case controlled observation SETTING: Renmin Hospital, Wuhan University PARTICIPANTS: Totally 90 patients with diabetes mellitus hospitalized in the Renmin Hospital, Wuhan University between January 2000 and De cember 2003 were recruited. All the patients participated in the experiment voluntarily. Totally 20 cases were of insulin dependent diabetes mellitns (IDDM) and 70 cases were of non-insulin dependent diabetes mellitus (NIDDM). Another 90 cases were divided into 2 groups with the boundary line of 10 years: group with disease course ＜10 years (n=40) and group with disease course ＞10 years (n=50). And 30 normal persons with healthy pulmonary function was set as healthy control group, all the testees were voluntary participants in the experiment.METHODS: Pulmonary function index of the participants of each group was measured: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1%), peak expiratory flow rate(PEFR)maximal voluntary ventilation (MVV) and comparison was performed between them.Comparison of the pulmonary function status of the patients between different levels of diabetes mellitus.pulmonary function between different groups : Compared with health control group, VC , FVC and MVV of the patients with diabetes mellitus was significantly decreased (t=1.999-2.301, P ＜ 0.05).There was no significant difference in the VC, FVC and MVV between patients with monary function between patients with different diabetes mellitus: the pulmonary function status in the group with disease course ＞10 years was improved less than that in the group with disease course ＜10 years [ VC (L):2.62±0.65 vs 3.25±1.25;FVC(L): 2.40±0.52 vs 3.21±0.98;FEV1%:75.31±2.31 vs 80.63±5.56;PEFR (L/s):4.33±0.68 vs 5.98±1.02;MVV (L/s): 76.22±6.98 vs 89.21±5.69 (t=2.012-2.350, P ＜ 0.05)].CONCLUSION: Pulmonary function of the patients with diabetes mellitus has reduced tendency compared with the normal persons, and the pulmonary function of the patients with long course of disease decreases significantly. More attention should be paid to diabetes patients' pulmonary function changes.

Objective:To observe the effect of old RBCs transfusion on cognitive function in rats and the improvement effect of mi -nocycline.Methods: Male SD rats at the age of 6 months were randomly divided into 4 groups.The RBCs were obtained from male rats by centrifuging the total blood and stored at 4℃.The rats of fresh RBCs group (group F) were transfused with the RBCs stored for 1 day.The rats of old RBCs group (group O) were transfused with the RBCs stored for 7 days.The rats of treatment group (group T) received 40 mg· kg-1 minocycline with intraperitoneal injection before the transfusion .The rats of the control group ( group C) were transfused with the normal saline .The brain levels of IL-1βand IL-6 were determined with Quantikine ELISA kits in 24 hours after the blood transfusion (n=6).The rats were subjected to Barnes maze tests after 1 week of the blood transfusion (n=10).Results:The brain levels of IL-1βand IL-6 in group O were higher than those in group C and F (P<0.05), which were lower in group T than those in group O(P<0.05).The rats of group O spent longer time finding the target box than those of group C and F in the Barnes maze (P<0.05), and the time was shorter in group T than that in group O (P<0.05).Conclusion: Old RBCs transfusion plays a role in neuro-inflammation and induces cognitive dysfunction in rats , which may be improved by minocycline .

Objective To investigate the effects of narrow-band ultraviolet B (NB-UVB) therapy on the levels of plasmin and CC chemokine ligand 20 (CCL20) in peripheral blood of patients with psoriasis vulgaris.Methods A total of 60 patients with psoriasis vulgaris in progressive stage were treated with NB-UVB radiation thrice a week for 8 weeks.Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of plasmin and CCL20 in the peripheral blood of the patients before and after the treatment,as well as in the peripheral blood of 50 healthy controls.Results After the treatment,psoriasis area and severity index (PASI) scores in patients were significantly decreased compared with those before the treatment (2.54 ± 1.64 vs.10.26 ± 3.14,t =17.40,P ＜ 0.05),and the response rate was up to 87％ (52/60).Before the treatment,levels of plasmin and CCL20 were both significantly higher in the patient group than in the control group (plasmin:180.07 ± 40.62 μg/L vs.76.30 ± 26.92 μg/L,t =15.45,P ＜ 0.05;CCL20:422.41 ± 129.87 pg/L vs.205.33 ± 49.89 pg/L,t =11.15,P ＜ 0.05).After the treatment,levels of plasmin (148.22 ± 40.05 μg/L) and CCL20 (329.67 ± 100.73 pg/L) in patients were significantly decreased compared with those before the treatment (t =4.97,6.44,P ＜ 0.05),but still significantly higher than those in controls (t =10.82,7.95,P ＜ 0.05).Before the treatment,the level of plasmin was positively correlated with the level of CCL20 in peripheral blood of the patients (r =0.57,P ＜ 0.05),and the levels of plasmin and CCL20 were both positively correlated with the PASI score (r =0.49,0.62,respectively,both P ＜ 0.05).Conclusion NB-UVB radiation may exert a therapeutic effect on psoriasis vulgaris by reducing levels of plasmin and CCL20 in peripheral blood of patients.

Objective To observe the clinical features of atrial fibrillation (AF) patients, and to explore the correlation between the routine detection index and the new-onset AF and to find out risk factors for new AF in critically ill patients. Methods A prospective observational study was conducted. The patients with AF admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from March 2016 to June 2017 were enrolled. The patients were divided into new-onset AF group and past-existed AF group according to their past history of AF (including persistent AF, paroxysmal AF or permanent AF). In addition, patients in ICU without history of AF and new-onset AF were selected as the control group (no AF group). The general epidemiological characteristics of patients in three groups, and the blood biochemical, coagulation and other related indicators at the time of AF occurred (new-onset AF group) or 48 hours after ICU admission (AF group and no AF group) were analyzed; the difference of laboratory indexes between patients in new-onset AF group with AF within 48 hours before occurred and patients in no AF group within 48 hours after admission to ICU was compared. The relationship between each index and new-onset AF were analyzed. Pearson or Spearman rank correlation was used for analysis. Risk factors of new-onset AF were analyzed by Logistic regression analysis. Results 1 673 patients were admitted to ICU, including 179 cases of AF (10.70%), and 106 males and 73 females, with an average age of (71.73±23.22) years. There was 75 new-onset AF (morbidity 4.48%), and had a 28-day mortality of 45.33% (34/75). There were differences in age, previous heart disease and heart failure (HF) among new-onset AF group (n = 75), past-existed AF group (n = 104) and no AF group (n = 75). Compared with other two groups, renal insufficiency rates, troponin, serum sodium, calcium and procalcitonin levels were higher, mechanical ventilation time and the length of ICU stay were significantly prolonged, ICU and hospitalization costs were higher in new-onset AF group. Compared with no AF group, new-onset AF patients with the higher percentage of septic shock, the accumulation of vascular contraction drugs within 24 hours after AF usage were higher, and used more anti-arrhythmic drugs, has higher brain natriuretic peptide (pro-BNP), serum creatinine, blood lactic acid levels, and lower albumin, oxygenation index, and serum potassium levels, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and 28-day mortality were higher. Correlation analysis showed that age, APACHE Ⅱ score, septic shock, HF, cardiovascular disease, renal insufficiency were positively correlated with new-onset AF (r values were 0.393, 0.270, 0.386, 0.251, 0.194, 0.170;P values were 0.000, 0.001, 0.000, 0.002, 0.017, 0.037, respectively). The age [odds ratio (OR) = 0.962, P = 0.046], basic oxygenation index (OR = 1.005, P = 0.028) and serum potassium levels (OR = 1.638, P = 0.022) were the risk factors for new-onset AF. Conclusions Critical patients with a high incidence of AF, new-onset AF significantly prolong the length of ICU stay; age, APACHE Ⅱ score, septic shock, cardiovascular disease, and renal insufficiency are related to new-onset AF; age, basic oxygenation index and serum potassium levels are risk factors for new-onset AF.

Objective:To analyze the clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation.Methods:Clinical data of patients with septic shock due to gastrointestinal perforation admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2019 were analyzed retrospectively. The general information; procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) scores during the first 24 hours in intensive care unit (ICU); results of ascites culture during the first 72 hours in ICU; the maximum dosage and total time of norepinephrine (NE) in ICU; mechanical ventilation time, the length of ICU stay, occurrence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT) and 28-day mortality were collected. The patients were divided into upper gastrointestinal tract group (stomach and duodenum) and lower gastrointestinal tract group (jejunum, ileum, appendix, colon and rectum), with a boundary of Treitz. The clinical features between the two groups were compared.Results:There were 33 patients in the upper gastrointestinal tract group and 30 patients in the lower gastrointestinal tract group. There was no significant difference in gender and age between the two groups. The main pathogens in the ascites cultures in the upper gastrointestinal tract group were Candida albicans (45.5%), Enterococcus faecalis (18.2%) and Escherichia coli (18.2%). Escherichia coli (46.2%) and Enterococcus faecalis (30.8%) were the main pathogens in the lower gastrointestinal tract group. There were significant differences in PCT, the length of ICU stay, mechanical ventilation time, the maximum dosage and total time of NE between the upper gastrointestinal tract group and lower gastrointestinal tract group [PCT (μg/L): 17.69 (3.83, 26.62) vs. 32.82 (4.21, 100.00), the length of ICU stay (hours): 149.0 (102.5, 302.0) vs. 115.5 (30.8, 214.5), mechanical ventilation time (hours): 106.0 (41.5, 183.0) vs. 57.5 (25.0, 122.3), the maximum dosage of NE (μg·kg -1·min -1): 1.2 (0.5, 2.0) vs. 0.7 (0.5, 1.2), the total time of NE (hours): 72.0 (21.0, 145.0) vs. 26.5 (18.0, 80.5), all P < 0.05], while there was no statistically differences in APACHEⅡ or SOFA scores [APACHEⅡ: 30.0 (24.5, 35.0) vs. 28.0 (25.0, 33.5), SOFA: 10.67±4.14 vs. 9.50±3.33, both P > 0.05]. Compared with the lower gastrointestinal tract group, patients in the upper gastrointestinal tract group were more likely to have AKI (78.8% vs. 53.3%, P < 0.05) and require CRRT (39.4% vs. 16.7%, P < 0.05), but there was no significant difference in the 28-day mortality (39.4% vs. 43.3%, P > 0.05). Conclusions:The clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation are not the same. Patients with septic shock caused by upper gastrointestinal perforation are more likely to suffer from fungal infection, with more severe shock, more likely to have AKI and require CRRT, and significantly longer mechanical ventilation and the length of ICU stay. While patients with septic shock caused by lower gastrointestinal perforation showed higher PCT.

Whether the localized flow acceleration occurs in the resting stenotic left anterior descending coronary artery was explored and its value for detection of coronary stenosis estimated.Blood flow in the left anterior descending coronary arteries in 45 patients was detected by transthoracic color Doppler echocardiograph and multipoint pulse Doppler spectrums were recorded in the same segment. The ratio of the maximal peak diastolic velocity to the minimal peak diastolic velocity was calculated. The ratio ≥1.5 was the cutoff value for the presence of localized acceleration flow.There were 23 patients with localized acceleration flow examined by echocardiography. Twenty of them were found to have luminal diameter stenosis (60 %- 98 %) in the left anterior descending coronary arteries by coronary angiography and 3 patients were normal. There were 22 patients without localized acceleration flow examined by echocardiography. Eighteen of them had no or ＜60% stenosis. Four patients had serious stenosis (≥95 %) or occluded segments in the left anterior descending coronary arteries on coronary angiography. The ratio of the maximal peak diastolic velocity to the minimal peak diastolic velocity was significantly higher in patients with left anterior descending coronary artery stenosis than that in those without stenosis (1.9±0.3 vs 1.3±0.2, P＜0.01) and it correlated significantly with left anterior descending coronary artery stenosis (r=0.77, P＜0.01). The specificity by using the ratio≥1.5 for stenosis detection was 85.7 % (18/21), and the sensitivity was 83.3 % (20/24). This study demonstrated that local blood flow velocity was increased in the resting stenotic left anterior descending coronary artery. Transthoracic color Doppler echocardiography is a reliable noninvasive method to detect localized acceleration flow in the left anterior descending coronary artery stenosis and it is useful in the noninvasive diagnosis of stenosis in the left anterior descending coronary artery.

Objective:To evaluate the effect of continuing health management on type 2 diabetes mellitus based on WeChat platform by Meta-analysis.Methods:Clinical randomized controlled trials connected with WeChat continuing health management for type 2 diabetes was searched by database including China Knowledge Network, Wanfang, Weipu, PubMed, Elsevier Science Direct, CINAHL, Web of Science, Cochrane Library. Cochrane bias risk assessment tool was used for evaluating the methodological quality of the included literatures. Meta-analysis of the data extracted from the included literature was performed by RevMan5.2 statistical software to assess heterogeneity of the outcome indicators and extract value of mean difference ( MD) and odds ratio ( OR). Results:A total of 1 133 patients with type 2 diabetes from 9 researches were enrolled in the study. The results showed that the WeChat continuing health management group had statistically significant differences in levels of fasting blood glucose ( MD value was -0.98, 95% CI -1.14 - -0.83, P<0.01), postprandial blood glucose ( MD value was -1.27, 95% CI -1.56 - -0.97, P<0.01), glycated hemoglobin ( MD value was -0.69, 95% CI -0.82 - -0.56, P<0.01), total cholesterol ( MD value was -0.54, 95% CI -0.65 - -0.44, P<0.01), triglyceride ( MD value was -0.50,95% CI -0.67 - -0.32, P<0.01) and low-density lipoprotein ( MD value was -0.52, 95% CI -0.74 - -0.30, P<0.01) compared with the control group. Conclusions:WeChat continuing health management intervention can effectively control the blood sugar and blood lipid levels of patients with type 2 diabetes mellitus and improve their self-management ability. For the deficiencies of little included references, the result still required a large-sample and high-quality randomized controlled trials to enhance accuracy.

CDIO is a new education model composed of Conceive, Design, Implement and Operate modules. In order to meet the needs of social development, this paper discusses the construction of the training system of applied innovative talents in ophthalmology of integrated traditional Chinese and western medicine guided by CDIO concept. Combing with practice, this paper puts forward teaching reform strategies from such five aspects as teaching purpose, curriculum system, construction of the teaching team, evaluation system, and practice effect, providing a new thought for the cultivation of applied innovative talents in ophthalmology.