The nutritional status of 162 patients with maintenance hemodialysis (MHD) was screened by Nutritional Risk Screening 2002 (NRS-2002) and assessed by Subjective Global Assessment (SGA) at the next day of admission.Among 150 MHD patients who met the study requirement,the nutritional risk was 29.3％ as screened with NRS-2002,and the rate of nutrition deficiency was 41.3％ with SGA assessment,there was no difference between two methods (x2 =18.155,P =0.109) ; According to BMI,the incidence of nutrition deficiencies,overweight and obesity in MHD patients was 13.3％,30.7％ and 29.3％.NRS-2002 and SGA are applicable to nutritional deficiencies assessment in MHD patients,but NRS-2002 is more comprehensive and feasible than SGA.

Objective To investigate the high risk factors for pneumonia-related bloodstream infection (BSI) caused by Acinetobacter baumannii (AB) in ventilated patients. Methods A retrospective observation was conducted. The data of invasive-ventilated patients underwent AB pneumonia admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2015 were enrolled. The patients were divided into non-AB-BSI group and AB-BSI group. The following factors were evaluated including gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at admission of intensive care unit (ICU), clinic pulmonary infection score (CPIS), underlying disease, neutropenia or agranulocytosis, hemoptysis, treatment of steroid or immunosuppressant in recent 3 months, central venous catheter (CVC), parenteral nutrition (PN), combined antibiotic therapy after the diagnose of AB pneumonia, duration of mechanical ventilation and the resistance of AB. The risk factors were analyzed by logistic regression analysis to confirm the independent high risk factors for the pneumonia-related BSI caused by AB in ventilated patients. Results 612 patients were enrolled, 561 patients in non-BSI group, and 51 in BSI group with 5-year BSI incidence of 8.3%. There was no significant difference in gender or age between the two groups. Compared with non-BSI group, the APACHE Ⅱ score (20.8±9.2 vs. 17.3±5.5) and CPIS (7.1±3.9 vs. 5.6±1.6) in BSI group were significantly increased (both P < 0.05). The patients with CPIS > 6 [80.4% (41/51) vs. 28.0% (157/561)], chronic obstructive pulmonary diseases [COPD, 86.3% (44/51) vs. 46.7% (262/561)], diabetes mellitus [DM, 25.5% (13/51) vs. 14.8% (83/561)] in BSI group were more than patients in non-BSI group, the incidence of heart failure [HF, 5.9% (3/51) vs. 23.5% (132/561)] was significantly decreased, and the incidence of hemoptysis [27.4% (14/51) vs. 3.4% (19/561)], therapy of steroid or immunosuppressant [19.6% (10/51) vs. 7.8% (44/561)] and duration of mechanical ventilation > 14 days [80.4% (41/51) vs. 48.5% (272/561)] were significant increased (all P < 0.05); no significant difference was found in other parameters between the two groups, including gender, age, other underlying diseases, neutropenia or agranulocytosis, CVC, PN, combined antibiotic therapy, and resistance of AB. It was showed by logistic regression analysis that CPIS > 6 [odds ratio (OR) = 2.513, 95% confidence interval (95%CI) = 1.400-20.439, P = 0.011], history of COPD (OR = 1.921, 95%CI = 0.068-5.603, P = 0.030), the treatment of steroid or immunosuppressant (OR = 2.012, 95%CI = 0.556-16.313, P = 0.021) and hemoptysis (OR = 1.866, 95%CI = 1.114-6.213, P = 0.037) were the independent risk factors for the pneumonia-related BSI caused by AB in ventilated patients. Conclusion CPIS > 6, history of COPD, the therapy of steroid or immunosuppressant and hemoptysis were the independent risk factors for the pneumonia-related BSI caused by AB in ventilated patients.

Female ; Fluoroscopy ; Humans ; Intubation, Intratracheal ; Male ; Middle Aged ; Tracheotomy ; methods

Objective To investigate the value of the application of fibrobronchoscopy in extubation for patients suffering from acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with low cough peak expiratory flow(CPEF). Methods A single-center prospective controlled study was conducted. The ventilated AECOPD patients who were cooperative at the time of extubation in Department of Critical Care Medicine of Guangzhou Institute of Respiratory Disease of Guangzhou Medical University from June 2009 to May 2014 were enrolled. All patients successfully passed the spontaneous breathing trial(SBT). Extubation was performed after determination of CPEF following energetic coughing. According to the CPEF,the patients were divided into CPEF≥60 L/min group (high CPEF group)and CPEF<60 L/min group(low CPEF group). After extubation,fibrobronchoscopic drainage was given to the patients in high CPEF group when necessary. Fibrobronchoscopic drainage was given to the patients in low CPEF group at least once a day,and the frequency of such treatment could be increased according to the patient's condition. If the patients did not require re-intubation within 48 hours,extubation was recorded as successful. The gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score before extubation,ventilation time,the time of intensive care unit(ICU)stay,the mortality in ICU,the rate of re-intubation,the ability to cough and the frequency of application of fibrobronchoscopy after extubation were recorded. Results A total of 102 patients with AECOPD were enrolled,58 patients in high CPEF group and 44 in low CPEF group. Compared with high CPEF group,the mean age in low CPEF group was older(years:74.3±15.2 vs. 69.5±11.4,t=2.164,P=0.041),the time of ICU stay was significantly longer(days:20.1±11.2 vs. 17.4±7.3,t=2.274,P=0.030), but there was no significant difference in gender〔male/female(cases):35/9 vs. 45/13,χ2=0.057,P=0.812〕, APACHEⅡscore(11.9±1.9 vs. 10.3±4.2,t=1.290,P=0.200),mechanical ventilation time(days:14.8±10.8 vs. 13.3±9.6,t=0.677,P=0.501)and the rate of re-intubation〔18.18%(8/44)vs. 12.07%(7/58),χ2=1.412, P=0.235〕between low CPEF group and high CPEF group. The cough strength of patients in high CPEF group was almost alwaysstrong(52 cases),and in the low CPEF group,most of them wasmoderate(14 cases)orweak(26 cases). The frequency of application of fibrobronchoscopy in low CPEF group was higher than that in high CPEF group(times:4.1±1.8 vs. 1.3±0.9,t=2.626,P=0.011). All patients underwent weaning successfully,and no death occurred. Conclusion The application of fibrobronchoscopy in the extubated AECOPD patients with low CPEF can reduce the rate of re-intubation,avoid the prolonged ventilation,but cannot reduce the time of ICU stay.

Objective_ To investigate the effect of resting heart rate on the progression to diabetes in impaired glucose regulation patients. Methods A total of 638 patients with impaired glucose regulation, from January 2011 to December 2012 in our endocrinology clinic, were selected for the study. According to the resting heart rate, patients were divided into four groups:<66 beat/min group, 66 to 69 beat/min group, 70 to 75 beat/min group, and>75 beat/min groups. All patients'baseline data were collected. The incidences of diabetes in different resting heart rate groups were compared, and the relationship between resting heart rate and the progression to diabetes was estimated using multiple regression analysis. Results In 704 patients with impaired glucose regulation, 636 patients have been completed 2 years follow-up, or reached the end of follow-up ( diagnosed as diabetes ) , the follow-up rate was 90. 34%. During two years follow-up, the incidence of diabetes of<66 beat/min group, 66 to 69 beat/min group, 70 to 75 beat/min group, and>75 beat/min group were 16. 2%, 19. 4%, 25. 0%, and 33. 0%, respectivlely. And the Cochran Armitage trend test showed that χ2 =11. 109, P=0. 001, the difference was statistically significant ( P<0. 05). According to blood glucose monitoring, the 636 patients with impaired glucose regulation were divided into impaired fasting glucose group, impaired glucose tolerance group and impaired fasting glucose combined with impaired glucose tolerance group:the Cochran Armitage trend test showed that, with the resting heart rate accelerating, the incidence of diabetes increased. The incidence of diabetes in impaired fasting glucose combined with impaired glucose tolerance group was higher than that of impaired fasting glucose group and impaired glucose tolerance group ( P=0. 062, 0. 113). The average resting heart rate in 68 impaired glucose regulation patients progressed to diabetes was (79.8±8.3)beat/min,andin568non-diabetescases,itwas(74.5±7.2)beat/min(t=-5.043,P<0.01). With the use of patients progressing to diabetes as the dependent variable, different resting heart rate group as independent variables, and resting heart rate<66 beat/min group as a reference, the logistic regression analysis showed that the risk of the progression to diabetes increased with the resting heart rate levels. Conclusion Higher resting heart rate is linked to higher risk of diabetes in patients with impaired glucose regulation.

Objective To investigate the value of N-terminal pro-B type natriuretic peptide (NT-proBNP) in predicting the outcome of spontaneous breathing trial (SBT) in ventilated elderly renal dysfunction patients. Methods The clinical data of patients who received mechanical ventilation in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2014 were analyzed retrospectively. AU the patients conformed to the following criteria: age > 65 years, endogenous creatinine clearance rate (CCr) < 60 mL·min-1·1.73 m-2, the duration of mechanical ventilation > 72 hours and undergone at least one SBT. The patients were assigned to a SBT success group and a SBT failure group according to the outcome of first SBT. The following factors were recorded: gender, age, the underlying disease [chronic obstructive pulmonary disease (COPD), heart failure (HF) and others], body mass index (BMI), serum pre-albumin (pre-ALB), and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, CCr and the concentration of the plasma NT-proBNP before SBT. Receiver operator characteristic curve (ROC) was plotted, and the predict value of NT-proBNP for the outcome of SBT in elder patients with kidney dysfunction was determined. Results A total of 58 patients with complete data were enrolled, with 41 cases in SBT success group, and 17 in SBT failure group. There were no significant differences in gender [male/female (cases): 26/15 vs. 13/4, χ2 = 0.930, P = 0.335], age (years: 70.2±7.4 vs. 74.6±10.1, t = 0.833, P = 0.339), the stratification of underlying diseases [COPD/HF/COPD+HF/others (cases): 15/9/13/4 vs. 7/3/5/2, χ2 = 0.242, P = 0.971], BMI (kg/m2: 25.2±11.3 vs. 27.4±6.43, t = 1.038, P = 0.221), pre-ALB (mg/L: 201.0±13.2 vs. 189.0±7.6, t = 0.688, P = 0.519), and APACHE Ⅱ score (12.2±3.2 vs. 13.5±6.3, t = 1.482, P = 0.147) and CCr (mL·min-1·1.73 m-2: 51.3±7.7 vs. 54.2±6.4, t = 0.711, P = 0.487) before SBT between SBT success group and SBT failure group. The concentration of plasma NT-proBNP in SBT failure group was significantly higher than that of the SBT success group (μg/L: 4.162±1.128 vs. 2.284±1.399, t = 4.905, P = 0.000). The area under ROC curve for plasma NT-proBNP in predicting successful SBT among elder patients with kidney dysfunction was 0.878, with 95% confidence interval (95%CI) 0.786 - 0.970. The cut-off method was used, and it was identified that the concentration of NT-proBNP < 3.350 μg/L as a predictor for successful SBT, with sensitivity of 82.4%, specificity of 87.8%, positive prediction value of 88.1% and negative predictive value of 76.5%. Conclusion The concentration of plasma NT-proBNP may increase in elderly kidney dysfunction patients undergoing ventilation, and NT-proBNP < 3.350 μg/L can serve as a good predictor for SBT success.

Objective To assess the sensitivity of indices of hip development in children with spastic diple-gia resulting from cerebral palsy. Methods X-ray images of the hips of 57 children with cerebral palsy ( the cere-bral palsy group) were checked, and the acetabular index ( AI), femur head migration percentage ( MP), center-edge angle and neck-shaft angle (NSA) were compared with those of normal children ( the control group, n = 30).Results The differences in MP and NSA between the two groups were significant. The prevalence of hip subluxation was 20.45% among the children with spastic diplegia who could not walk independently, and the prevalence was sig-nificantly greater in children 3 to 5 years old than among those under 3. Conclusion The MP can be used as a sen-sitive index to evaluate hip development. Age is a relevant factor affecting the hip development of children with cere-bral palsy.

Objective There is little research focusing on the expression and function of bradykinin 1 receptor ( B1R ) and bradykinin 2 receptor ( B2R) after cerebral ischemia/reperfusion on the basis of diabetes .The aim of this study was to compare the ex-pression difference and function change of B 1R and B2R in non-dia-betic and diabetic rats . Methods The cerebral ischemia/reperfu-sion model was established on 41 non-diabetic and type 2 diabetic rats, the weight and the biochemical index were measured on these two types of rats .8 non-diabetic rats and 8 diabetic rats were respec-
tively assigned to two groups according to random number tables:control group and I/R 24 h group, 4 in each group.Real-time PCR was performed to observe the expressions of two receptors at 24 h after reperfusion .Then, 33 non-diabetic rats and 33 diabetic rats were randomly divided into 4 groups respectively, including sham group (n=6), saline group (n=9), B1R antagonist group (n=9) and B2R antagonist group (n=9).At 24 hours after cerebral I/R, neurological deficiency was evaluated by neurological severity scores ( NSS);infarct volume was observed by TTC staining;cell apoptosis was determined by TUNEL staining;neuron degeneration was de-tected by Fluoro-Jade C staining. Results Glucoses of diabetics at 3, 7, 14 d after model establishment [(23.45 ±5.01), (23.71 ±4.87), (22.72 ±4.11) mmol/L] were obviously elevated compared with non-diabetics [(5.77 ±0.75), (6.05 ±0.69), (7.15 ±1.09) mmol/L];blood cholesterin [(4.59 ±3.43) mmol/L] and insulin [(67.26 ±12.02) pmol/L] at 14 d after model establishment were evidently incresaed in comparison to those in non-diabetics [(1.58 ±0.37) mmol/L, (25.34 ±4.88) pmol/L] (P<0.05), while no significant difference was found in the blood triglyceride of diabetics between them (P>0.05).Compared with non-diabetics, diabetics suffered from more apparent up-regulation of B1R mRNA (P<0.01) but relatively less B2R mRNA (P<0.05) at 24 h after I/R.NSS score, infarction volume, damaged and apoptotic cells in B2R antagonis-treated non-diabetic rats at 24 h after I/R conspicuously decreased compared with saline-treated non-daibetic rats.Those indicators in B1R antagonis-treated diabeics were strikingly lessened compared with saline-treated daibetics . Conclusion I/R induced distinct up-regulation of B2R mRNA in non-diabetics and inhibiton of B 2R effectively ameliorated the infarct volume and cell injury after I/R in non-diabetics; I/R induced more notable up-regulation of B1R mRNA in diabetics and B1R antagonist exerted neuroprotective effects instead of B 2R antagonist af-ter I/R in diabetics.

Objective To evaluate application effects of mind map in standardized training courses for the new nurses.Method 73 new nurses who graduated for 1-3 years were random divided into an experimental group (n=37) and a control group (n=36).Nursing department organized standardized training course for 73 new nurses for one year.The control group used conventional teaching methods,while the experimental group introduced mind mapping in teaching.Effects were evaluated after one year.Results The average scores of both theory and operation examination in experimental group were better than the control group,and there was significant difference between two groups (P=0.002,0.000).The score of critical thinking ability:the total score of experimental group was (303.89 ±23.81),higher than the total score of the control group (280.36 ± 17.22),and the total score and seven dimension score difference had statistical significance(P＜0.05,for all).Besides,the total score of selfstudy ability in the experimental group (126.54 ± 5.65),was higher than those in the control group (116.58-± 6.36),and the total score and four dimension score difference had statistical significance (P＜0.05).Conclusion Using mind mapping in the standardized training courses for nurses can arouse nurses' interest in learning,improve their critical thinking skills and autonomous self-study ability,and enhance the effectiveness of training.

Objective To investigate the effect of the modified spontaneous breathing trail (SBT) on the weaning procedure for elderly ventilated patients with chronic obstructive pulmonary disease (COPD). Methods Ventilated acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients ready for SBT from January 2013 to November 2014 were enrolled and were divided into 2-hour SBT (conventional SBT) group and 6-hour SBT (modified SBT) group randomly. The following factors were recorded and analyzed: age, gender, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)score before SBT, mechanical ventilation time before SBT, the oxygenation index before SBT, rapid shallow breathing index (RSBI), maximum inspiratory pressure (MIP), the outcome of SBT and weaning, the ICU mortality and the length of stay in ICU. Results Forty-one cases were enrolled with 20 cases in 2-hour SBT group and 21 cases in 6-hour SBT group. Patients′age, gender, APACHE Ⅱ score before SBT, mechanical ventilation time before SBT, the oxygenation index before SBT, RSBI and MIP indicated no significant difference in two groups (P > 0.05). There was a significantly higher SBT successful rate (90.0%) in 2-hour SBT group than that in 6-hour SBT group (57.1%)(P = 0.018), but patients passing SBT successfully in 2-hour SBT group showed a significant lower weaning successful rate (72.2%) than those in 6-hour SBT group (100.0%)(P = 0.046). No significant difference was found in ICU morality and the length of stay in ICU in two groups (P > 0.05). Conclusions For elderly ventilated COPD patients , a modified SBT may serve as a useful procedure to predict weaning outcome which will increase the ICU mortality and the time of stay in ICU.