Objective To discuss the influence of different ways of low-dose corticosteroids infusion on hemodynamics, changes in blood glucose level and prognosis in patients with refractory septic shock. Methods A prospective single-blind randomized controlled trial was conducted. Refractory septic shock patients admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from April 1st, 2013 to October 31st, 2014 were enrolled for the study. The patients were divided into control group and research group by random number table. Besides conventional treatment for septic shock, patients in control group were given 200 mg/d hydrocortisone intravenous infusion lasting for 2 hours, while those of research group were given 8.33 mg/h hydrocortisone per hour with an intravenous pump. Treatment lasted for 5 continuous days for both groups. The changes in heart rate ( HR ), mean arterial pressure ( MAP ), central venous pressure ( CVP ) and arterial blood lactic acid in both groups were observed at the time of enroldment and 6 hours, 24 hours, 48 hours, and 5 days after the treatment. With a dynamic blood glucose monitor, mean blood glucose ( MBG ) level, largest amplitude of glycemic excursions ( LAGE ), glucose variability ( GV ), and the ratio of hyperglycaemia time were recorded. The duration of shock, length of intensive care unit ( ICU ) stay, total length of hospital stay, and 28-day mortality of both groups were recorded. Results Seventy-nine septic shock patients were assigned to the treatment, with 41 in control group, and 38 in research group. Compared with control group, 6-hour MAP in research group was obviously lowered [ mmHg ( 1 mmHg=0.133 kPa ):66.31±4.38 vs. 68.58±4.86, t=1.062, P=0.033 ], but there were no significant differences in HR, MAP, CVP, lactic acid clearance and norepinephrine ( NE ) utilization rates at other time points between two groups. No significant difference in MBG was found between research group and control group ( mmol/L:8.69±2.14 vs. 9.95±3.87, t=1.771, P=0.080 ), but LAGE, GV, the ratio of hyperglycemia time in research group were significantly lower than those of the control group [ LAGE ( mmol/L ): 17.18±8.97 vs. 22.71±11.80, t = 2.331, P = 0.022; GV ( mmol/L ): 2.57±1.05 vs. 3.16±1.37, t=2.136, P=0.036;the ratio of hyperglycemia time:( 43.1±11.7 )%vs. ( 49.4±15.3 )%, t=2.044, P=0.044 ]. There was no statistical difference in the following features between research group and control group, such as the duration of shock ( days:3.47±0.98 vs. 3.61±1.07, t=0.605, P=0.547 ), length of ICU stay ( days:8.74±3.12 vs. 9.97±3.37, t = 1.543, P = 0.120 ), total length of hospital stay ( days: 18.34±9.27 vs. 19.58±9.83, t = 0.576, P = 0.566 ) and 28-day mortality rate ( 23.68%vs. 26.83%,χ2=0.103, P=0.748 ). Conclusions Compared with slow intravenous infusion, a continuous intravenous supplementation of small amount of hydrocortisone to patients with refractory septic shock could stabilize blood glucose levels and maintain metabolic balance efficiently. However, in both groups there was no significant difference in the efficiency in stabilizing hemodynamics, shortening shock duration, reducing ICU or hospital days and decreasing 28-day mortality.

Objective To explore the influence of different positive end-expiratory pressure (PEEP) levels on cerebral blood flow (CBF) and cerebrovascular autoregulation in patients with acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.Moderate or severe ARDS patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st,2013 to October 1st,2013 were enrolled.The changes in hemodynamics,respiratory mechanics and gas exchange under different levels of PEEP were observed.CBF velocity of middle cerebral artery (MCA) was measured using transcranial Doppler (TCD),and breath-holding index (BHI) was also calculated.Results 35 patients with ARDS were included.The oxygenation index (OI),peak inspiratory pressure (PIP),plat pressure (Pplat) and central venous pressure (CVP) were markedly elevated [OI (mmHg,1 mmHg=0.133 kPa):324.7± 117.2 vs.173.4± 95.8,t=5.913,P=0.000; PIP (cmH2O):34.7 ± 9.1 vs.26.1 ± 7.9,t=4.222,P=0.000; Pplat (cmH2O):30.5 ± 8.4 vs.22.2 ± 7.1,t=4.465,P=0.000; CVP (mmHg):12.1 ± 3.5 vs.8.8 ± 2.2,t=4.723,P=0.000] when PEEP was increased from (6.4 ± 1.0) cmH2O to (14.5-± 2.0) cmH2O (1 cmH2O=0.098 kPa).But no significant difference in the heart rate (beats/min:85.5 ± 19.1 vs.82.7 ± 17.3,t=0.643,P=0.523),mean arterial pressure (mmHg:73.5 ± 12.4 vs.76.4 ± 15.1,t=0.878,P=0.383) and CBF velocity of MCA [peak systohc flow velocity (Vmax,cm/s):91.26 ± 17.57 vs.96.64 ± 18.71,t=1.240,P=0.219; diastolic flow velocity (Vmin,cm/s) 31.54 ±7.71 vs.33.87 ±8.53,t=1.199,P=0.235; mean velocity (Vmean,cm/s) 51.19 ± 12.05 vs.54.27 ± 13.36,t=1.013,P=0.315] was found.18 patients with BHI＜0.1 at baseline demonstrated that cerebral vasomotor reactivity was poor.BHI was slightly decreased with increase in PEEP (0.78 ± 0.16 vs.0.86 ± 0.19,t=1.905,P=0.061).Conclusions Some of moderate or severe ARDS patients without central nervous system disease have independent of preexisting cerebral autoregulation impairment.However,independent of preexisting cerebral autoregulation may not further be impaired when a high PEEP was chosen.

Objective To investigate the relationship between the serum homocysteine(Hcy) level and heart rate variability in elderly patients with metabolic syndrome.Methods Retrospective analysis of 162 elderly patients with metabolic syndrome aged 60 and above was conducted in our hospital from January 2013 to August 2016.And the level of serum homocysteine and other biochemical indicators were measured.The 162 cases were divided into three groups of 42 cases in Hcy normal group(Hcy,5-15 μmol/L),70 cases in Hcy mildly high group(Hcy,16-30 μmol/L),50 cases in Hcy moderately high group (Hcy,31 ～ 100 μmol/L).Simultaneously 24-hour rhythm in ambulatory heart rate variability spectrum was used to detect HRV.And the relationship between heart rate variability(HRV) and Hcy levels were analyzed.Results Normal RR interval standand deviation (SDNN),5 min mean heart rate standard deviation (SDANN),Edinburg index (PNN50),root mean square value of adjacent RR interval difference(RMMSD)were all lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜0.05).Low-frequency(LF) and highfrequency(HF)were lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group(P ＜ 0.05).Sympathetic-vagal balance indicators (LF/HF) were higher in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜ 0.05).The HRV indexes were lower in Hcy high groups than in the Hcy normal group.Hcy was negatively correlated with SDANN,RMSSD,LF,HF,and LF/HF at night(r=-0.578、-0.651、-0.531、-0.662、-0.729,all P ＜ 0.01).Conclusions The elevated homocysteine level and metabolic syndromecombined with decreased HRV in the elderly patients suggest that cardiac autonomic nervous system might be injuried.Enhancing the detection of HRV and homocysteine level in elderly patients with MS is clinically useful for early detection of autonomic neuropathy.

OBJECTIVE: To find out some evidence that may indicate the theory of voice pitch of the five tones being correlated with the five zang viscera in Huangdi Neijing, which was lost 2 000 years. METHODS: Eight-four healthy females were divided into younger group (<34 years old) and older group (> or =34 years old) according to their ages. The pronunciations of these females were examined by sono-frequency analysis facility. RESULTS: The frequency of Jiao tone was much higher than those of the other tones in both groups (P<0.01) and the frequency of Jiao tone increased as aging. The frequency of Zhi tone in the younger group was higher than that in the older group (P<0.05). CONCLUSION: The results of higher frequency of Jiao tone in females is in accordance with the theory put forward by Ye Gui (a famous doctor in Qing Dynasty of China) that the liver is the congenital base of female life. In traditional Chinese medicine, Jiao tone is correlated with the liver, and Zhi tone is correlated with the heart. The high frequency of Zhi tone in younger females implies that regulating the Small Intestine Meridian of Hand-Taiyang and Heart Meridian of Hand-Shaoyin may be beneficial to the health maintenance of younger female.

Objective To investigate the relationship between serum homocysteine (Hcy) level and heart rate variability (HRV) in patients with acute cerebral infarction.Methods A retrospective study was conducted in 76 elderly patients with acute cerebral infarction in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016,and the patients were monitored by 24 hours electrocardiogram within three months.According to age and Hcy level,the patients were divided into three groups:normal Hcy low age group (5-15μmol/L,60-80 years old),high Hcy low age group (＞ 15μmol/L,60-80 years old),high Hcy high age group (＞15μmol/L,≥80 years old).The correlation between Hcy and HRV was analyzed.Results The standard deviation of the normal-to-normal RR intervals (SDNN),the mean standard deviation of 5-minute RR intervals means (SDANN),the root mean square of successive differences in RR intervals (RMSSD),adjacent RR intervals greater than 50 ms (PNN50) in the high Hcy low age group were (108.75 ±34.18)ms,(97.63 ±31.34) ms,(22.04 ±6.97) ms,(3.78 ± 4.07) ％,respectively,which in the high Hcy high age group were (81.43 ± 27.68) ms,(71.46 ±25.45) ms,(23.82 ± 7.59) ms,(3.95 ± 3.56) ％,respectively,which were significantly lower than those in the normal Hey low agc group[(127.21 ± 22.21) ms,(114.75 ± 23.55) ms,(29.17 ± 9.71) ms,(7.68 ± 6.17) ％](t =2.219,2.140,2.920,2.585,t =6.502,6.328,2.227,2.722,all P ＜ 0.05).The levels of SDNN and SDANN in the high Hcy low age group were lower than those in the high Hcy low age group (t =3.185,3.322,all P ＜ 0.05).The low frequency (LF) and high frequency (HF) values in the high Hcy low age group were (11.86 ± 5.39) ms,(8.47 ± 3.25) ms,respectively,which in the high Hcy high age group were (9.29 ± 4.98) ms,(71.46 ± 25.45) ms,respectively,which were lower than those in the normal Hcy low age group[(15.15 ±4.56) ms,(11.36 ±4.36) ms] (t =2.281,2.612,t =4.392,2.900,all P ＜ 0.05).The LF/HF value of high Hcy high age group (1.09 ± 0.3) was lower than (1.42 ± 0.36) in normal Hcy low age group and (1.41 ± 0.40) in the high Hcy low age group (t =3.569,3.339,all P ＜ 0.05).Logistic regression analysis showed that SDNN,SDANN,RMSSD,nocturnal HF and nocturnal LF/HF were correlated with hyperhomocysteinemia (r =-0.037,-0.132,-0.087,-0.468,-3.746,all P ＜ 0.05).Conclusion Hyperhomocysteinemia with acute cerebral infarction in elderly patients is more likely to have cardiac autonomic nerve dysfunction.And clinically we should strengthen HRV detection of elderly patients with acute cerebral infarction and hyperhomocysteinemia.

Objective To investigate the protective effects of vascular endothelial growth factor-165 (VEGF165) transfected the endothelial progenitor cells (EPCs) mediated by lentivirus on acute lung injury (ALI) in rats. Methods The mononuclear cells from the male Sprague-Dawley (SD) rats were isolated and cultured to get the EPCs for study. The lentivirus vector carrying the human VEGF165 gene was constructed. According to the random number table method, 90 male SD rats were divided into ALI model group, phosphate buffer solution (PBS) group, EPCs treatment group, none transfected EPCs treatment group and VEGF165 transfected EPCs treatment group, and the rats in each group were subdivided into 4, 12 and 48 hours subgroups, with 6 rats in each subgroup. The rat model of ALI was reproduced by intravenous injection of oleic acid (0.15 μL/g). Then each treatment group was given PBS, EPCs, none transfected EPCs and VEGF165 transfected EPCs respectively with the same volume of 0.2 mL. For the groups with cells, about 1×106cells were contained. Abdominal aortic blood and lung tissue were harvested at 4, 12 and 48 hours. Arterial blood gas analysis was performed. The lung wet/dry weight ratio (W/D) was calculated. The expressions of induced nitric oxide synthase (iNOS), endothelin-1 (ET-1) and VEGF165 were determined by enzyme-linked immunosorbent assay (ELISA). After dyed with hematoxylin-eosin (HE), the lung tissue pathology was observed and the lung injury score was performed. Results Compared with the ALI model group, the arterial partial pressure of oxygen (PaO2) in EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups was significantly increased from 4 hours, and lung W/D, expressions of iNOS and ET-1 were significantly decreased, and VEGF165 expression was significantly increased. Compared with the EPCs treatment group, the increase in PaO2, the decrease in lung W/D and expressions of iNOS and ET-1, and the increase in VEGF165 expression in VEGF165 transfected EPCs treatment group were more significant [4 hours: PaO2(mmHg, 1 mmHg = 0.133 kPa) was 82.84±10.69 vs. 72.34±9.36, lung W/D ratio was 4.83±0.23 vs. 5.55±0.37, iNOS (ng/mg) was 8.77±1.10 vs. 14.84±1.34, ET-1 (ng/mg) was 103.41±5.66 vs. 153.08±5.12, VEGF165 (ng/mg) was 130.56±12.16 vs. 83.03±5.95; 12 hours: PaO2(mmHg) was 91.67±6.81 vs. 78.5±8.81, lung W/D ratio was 4.44±0.35 vs. 5.32±0.25, iNOS (ng/mg) was 7.23±0.24 vs. 14.04±1.18, ET-1 (ng/mg) was 91.98±3.52 vs. 125.99±7.55, VEGF165 (ng/mg) was 164.49±5.71 vs. 96.61±6.12]; individual parameters reached valley value or peak value at 48 hours [lung W/D ratio was 4.26±0.30 vs. 4.89±0.15, iNOS (ng/mg) was 5.79±0.85 vs. 12.72±1.10, ET-1 (ng/mg) was 74.53±7.10 vs. 108.33±5.84, VEGF165 (ng/mg) was 237.43±10.79 vs. 134.24±11.99, all P < 0.05]. Over time, lung tissue injury in each group was gradually increased, and the lung injury score was gradually increased. The lung injury score at 48 hours in the EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups were lower than that in the ALI model group. Compared with the EPCs treatment group, the VEGF165 transfected EPCs treatment group had a lower score at 48 hours (8.50±1.05 vs. 10.50±1.05, P < 0.05). Conclusion The transplantation of EPCs which were transfected with VEGF165 mediated by lentivirus could obviously improve the oxygen pressure, reduce the lung water seepage, decrease the iNOS and ET-1 expressions in lung tissue, and had obvious protective effects on ALI.

Objective:To evaluate the effect of airway driving pressure (ΔP) guided sedation strategy on the prognosis of patients with mechanical ventilation.Methods:Patients who needed invasive mechanical ventilation and admitted to the department of intensive care unit (ICU) of Jiangxi Provincial People's Hospital from January 2017 to December 2018 were enrolled. The patients were divided into study group and control group according to the random number table. After informed consent of patients or their families, both groups received routine treatment in ICU. The control group was treated with light sedation strategy, the Richmond agitation sedation score (RASS) was performed every 4 hours, and the target was RASS > -3. ΔP in the study group was measured once a day, and the sedative target of patients with low driving pressure (ΔP ≤ 14 cmH 2O, 1 cmH 2O = 0.098 kPa) was RASS > -3, while the patients with high driving pressure (ΔP > 14 cmH 2O) was RASS ≤ -3. The evaluation was conducted at 28 days after admission to ICU, and the patients were followed up to 60 days. The main outcome was days without mechanical ventilation in 28 days. The secondary outcomes were the rate of extubation, discharge outcome, incidence of ventilator associated pneumonia (VAP) and delirium, and 60-day survival rate. Results:A total of 60 patients with respiratory failure due to various reasons were recruited, 30 in each group. There was no significant difference in gender, age, primary disease, severity of disease or ΔP between the two groups. The days without mechanical ventilation within 28 days in the study group were significantly more than that in the control group [days: 20 (0, 23) vs. 12 (0, 16), P = 0.018], and the incidences of VAP (3.3% vs. 16.7%, P = 0.045) and delirium (0% vs. 10.0%, P = 0.038) were significantly lower than that in the control group. There were no significant differences in the rate of extubation (73.3% vs. 66.7%, P = 0.273), discharge outcome [improvement (cases): 24 vs. 21, unhealed (cases): 2 vs. 5, deaths (cases): 4 vs. 4, P = 0.506] and 60-day survival rate (83.3% vs. 76.7%, P = 0.519) between the study group and control group. Conclusion:Compared with light sedation strategy, ΔP directed sedation strategy can effectively shorten the duration of mechanical ventilation and reduce the incidence of VAP and delirium in the ICU patients.

To investigate the effect of multiple factors, including breast-feeding and modes of birth, on gastrointestinal (GI) symptoms of children with autism spectrum disorder (ASD). Methods This was a cross-sectional study. A total of 92 children, aged 2 to 10 years, with a diagnosis of ASD by DSM-5 criteria, along with 84 age-matched typical developing (TD) children as control, were enrolled in this study. The six-item gastrointestinal symptom index (6-GSI) was used for symptomatic survey. The self-made questionnaires were used to collect information on dietary preferences, sleep problems and breast-feeding. Results Constipation from 6-GSI was higher in ASD group than in TD group (P＜0.01). Stratified analysis revealed that total GI symptom scores (P=0.030), fecal odor (P=0.028) and abdominal pain (P=0.022) were higher in ASD children born by c-section than ASD children born vaginally whereas only abdominal pain was higher in TD children born by C-section than TD children born vaginally (P=0.016). ASD children with pick eating had higher scores in diarrhea (P=0.048) and abdominal pain (P=0.013) than those without. ASD children with sleep disorders had higher scores in constipation (P=0.008), diarrhea (P=0.020) and fecal odor (P=0.027) than those without. There was also a significant difference in constipation from 6-GSI between mainly breast-fed children and mainly formula-fed children among all subjects (P=0.026). Conclusion ASD children have more severe constipation than TD children. ASD children with pick eating or with sleep disorders tend to have more GI symptoms, including diarrhea, fecal odor, and abdominal pain, while breastfeeding can alleviate these symptoms.

Objective:To explore the effect of narrative medicine course on the empathy ability and comprehensive ability training of residents in the standardized residency training in municipal hospitals.Methods:A narrative medicine group was set up in a municipal hospital, and a anarrative medical course of 2 months of narrative theory teaching and 4 months of clinical practice education was carried out among 42 residents. The Chinese version of the Interpersonal Response Index Scale (IRI-C) was used to measure the empathy ability at 4 time points (before intervention, 2 months after theory education, 2 months after practice, and 4 months after practice). The effect of narrative medicine courses was evaluated through the satisfaction questionnaire survey, parallel medical record writing and the first-time pass rate of Medical Practitioner Qualification Examination. SPSS 25.0 was used to analyze the variance of one-way repeated measurement.Results:The empathy ability of 42 residents was significantly improved. The empathy score after 2 months after practice was higher than that before intervention and after the theoretical course ( P < 0.05), while the empathy score after 4 months of practice was higher than that before intervention and after the theoretical course ( P < 0.05). The most popular theoretical teaching forms among residents were interactive theoretical teaching (64.29%, 27/42), video viewing (59.52%, 25/42), and situational simulation (52.38%, 22/42). The comprehensive abilities of parallel medical record writing and podium performance among residents were improved. Passing the Medical Practitioner Qualification Examination is a necessary condition for passing the residency training program. The first-time pass rate of the Qualification Examination for the residents was 72.00% (18/25), which was higher than that of the residents who were not recruited during the same period (64.71%, 11/17). Conclusion:Carrying out narrative medicine education is helpful to improve the empathy ability and comprehensive ability of training residents in municipal hospitals.

【Objective】 To explore the reasons for wrong connection between anticoagulant and normal saline solution during apheresis platelet donation, as well as the preventive measures, so as to ensure the safety of apheresis platelet donors. 【Methods】 Manual checking in the first phase (December 2008 to September 2016) was compared with double checking (manual checking plus information system) in the second phase (October 2016 to October 2020) via bilateral testing using Fisher's Exact Test to study pre-post-improvement differences. 【Results】 The incidence of solution connection errors during apheresis platelet donation in the first phase was 1.02/10 000, and the error incidence between Amicus and Trima + Mcs^®+ blood cell separator was statistically significant (P<0.05). The total incidence of errors between the first and second phases was not statistically significant (P>0.05). After the performance of double checking in the second phase, no wrong connection of anticoagulant and saline solution occurred. 【Conclusion】 The double checking method assisted by manual and information system can effectively prevent the wrong connection between anticoagulant and normal saline solution.