Objective To evaluate the changes of β cell function in critically ill surgical patients and its re- lationship with prognosis.Methods 32 patients>16 years age with no history of diabetes who were admitted to sur- gical intensive care unit(SICU)were divided into two groups according to APACHE Ⅱ score.Blood sample Was taken on preoperative and postoprative 1st day for measures of fasting insulin(FINS)and fasting C peptide(FCP). The HOMA-β Was calculated.Results The level of FINS,FCP and HOMA-β were significantly decreased on first day after operation than preoperative in critical group.Compared with control group,The level of FINS.FCP and HO- MA-βwere significantly reduced on first day after operation-which had negative correlation with APACHE Ⅱ score, APACHE Ⅲ score and in charge days of ICU.Conclusion There is β cell dysfunction in critically ill Surgical pa- tients.β cell function in surgical critically ill patients is negatively correlated with APACHE Ⅱ SCOre-APACHE Ⅲ score and days of ICU.

According to the unique geographical conditions,climatic factors,human constitution,dietary custom,social environment and so on,the main etiology of exogenous cough in Lingnan areas is pathogenic dampness;and the main pathogenesis is phlegm-dampness internal retention and impaired and descending of lung.The syndrome of phlegm-dampness and syndrome of phlegm-heat are more common clinical types.We propose eliminating dampness and resolving phlegm,dispersing and descending lung qi as its main therapeutic methods.For chronic cough,it often have to take the therapeutic methods of strengthening spleen and nourishing lung.

Objective To explore the effects of folic acid and vitamin B12 supplement in maternal lactation on insulin resistance in fetal growth restriction (FGR) in rat offspring.Methods Eighteen Sprague-Dawley female rats and male rats were used.Pregnant rats were randomly divided into two groups at 12 days:normal-protein group (NP,n=6) and low-protein group (LP,n=12).The were 84 FGR newborn pups in LP group (93.3％,84/90).Forty-eight FGR newborn pups were randomly selected and divided into two groups (24 in each group):intervention group and non-intervention group.The intervention group was fed with high folate and vitamin B12 in the diet;and non-intervention group and NP group were fed normal diet.All of the newborn pups were weaned at 21 days after birth and then fed with normal diet.At days 21,60 and 120 d after birth,eight pups were randomly selected from each group and fasting plasma glucose (FPG),fasting insulin (FINS),blood diglyceride (TG) and cholesterol (TC) were measured.The insulin resistance index (IRI) and insulin sensitivity index (ISI) were calculated to evaluate insulin sensitivity.Variance and Student-Newman-Keuls tests were used for statistical analysis.Results (1) The incidence of FGR:Birth weight of LP offspring [(4.44±0.58) g] was significantly lower than that of NP ones [(7.03±0.56) g] (t=15.75,P ＜ 0.05).(2) FPG and FINS:at day 21 after birth,FPG of the non-intervention group,intervention group and NP group was (4.8±0.3),(4.8±0.4) and (4.6±0.3) mmol/L (F=0.57),respectively;FINS was (4.2± 0.2),(4.5 ±0.4) and (4.3 ±0.1) mU/L (F=0.31),respectively;and there was no significant difference among the three groups (both P ＞ 0.05).At day 60,FPG of the three groups was (7.5±0.4),(6.9± 1.0) and (5.5±0.6) mmol/L (F=17.14);FINS was (14.7± 1.9),(10.7± 1.0) and (9.2± 0.7) mU/L (F=38.34),respectively.At day 120,FPG was (8.9±0.9),(8.0±0.8) and (6.4±0.7) mmol/L (F=21.60);FINS was (56.3±2.8),(38.2±2.5) and (33.1 ±2.8) mU/L (F=164.46).FPG and FINS were highest in the non-intervention group,and lowest in NP group,with significant differences among the three groups of pups (all P ＜ 0.05).(3) IRI and ISI:at day 21,IRI of the non-intervention group,intervention group and the control group was 0.9±0.1,0.9±0.1 and 0.9±0.2 (F=0.49);ISI was-(3.0±0.7),-(3.0±0.1) and-(3.0±0.3) (F=0.69);and there was no significant difference among the three groups (both P ＞ 0.05).At day 60,IRI of the three groups was 4.9±0.8,3.3±0.3 and 2.2±0.3 (F=49.48);ISI was-(4.7±0.2),-(4.3±0.1) and-(3.9±0.1) (F=63.47).At day 120,IRI of the three groups was 22.4±3.1,13.6±2.0 and 9.3±0.9 (F=75.15);ISI was -(6.2 ± 0.1),-(5.7 ± 0.1) and-(5.3 ± 0.1) (F=104.42);and there were significant differences among the three groups (all P ＜ 0.05).(4) TC and TG:at day 21,TC of the non-intervention group,intervention group and the control group was (2.0±0.1),(2.0±0.1) and (2.0±0.1) mmol/L (F=0.10);TG was (0.75±0.1),(0.77±0.1) and (0.74±0.1) mmol/L (F=0.33);and there was no significant difference among the three groups (both P ＞ 0.05).At day 60,TC of the three groups was (2.3 ± 0.1),(2.2 ± 0.1) and (2.0± 0.2) mmol/L (F=8.34);TG was (1.5 ± 0.2),(1.2±0.1) and (1.0±0.2) mmol/L (F=17.93).At day 120,TC was (2.4±0.2),(2.2±0.1) and (2.1 ±0.1) mmol/L (F=6.12);TG was (1.7±0.5),(1.2±0.3) and (l.0±0.1) mmol/L (F=9.80).The TC and TG were highest in the non-intervention group and the lowest in the control group;and there were significant differences among the three groups (all P ＜ 0.05).Conclusion Supplementing folic acid and vitamin B12 in maternal lactation can improve in some extent insulin resistance in FGR rats,but not sufficient enough to completely repair glucose and lipid metabolism.

OBJECTIVE To analyze 28 cases in an outbreak of neonatal enterovirus nosocomial infection during summer of 2006.METHODS Demographic characteristics,clinical manifestations,laboratory data and outcome were analyzed to reveal the clinical severity.RESULTS The outbreak lasted more than one month and the nosocomial infection rate increased to 6.4%.There were 22 cases(78.6%) first presented with fever.Half of the patients were detected enterovirus from blood or cerebrospinal fluid by PCR.All of the 28 cases were diagnosed enterovirus infection based on the contact history,clinical signs and laboratory results.Among them,ten cases had viral meningitis.All patients discharged home after hospitalization with no sequelae.CONCLUSIONS Although this group of neonatal enterovirus infection developed viral meningitis,they had relatively mild illness with benign clinical course.Extreme vigilance is required in interrupting the spread of nosocomial enterovirus infections in neonatal units.This includes respect of strict hygiene measures and meticulous hand-washing.

As a new learning tool, mind mapping helps students master the learning content in a visual and radical way. This paper intro-duced the concept and method of making the mind map and analyzed the advantages of mind mapping in improving learning efficiency and its application in rehabilitation. It is pointed out that the use of mind mapping would help students to integrate new and old knowledge, to improve the ability to solve clinical problems, and to train innovative talents by stimulating students' divergent thinking. It is believed that the mind map has a broad application prospect in rehabilitation education in China.

Objective To investigate the relationships between low one-minute Apgar score and the prognosis of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI). Methods Altogether 50 EPI and ELBWI who had a low one-minute Apgar score ( ≤ 7) and were admitted to the Neonatal Intensive Care Unit (NICU) of Peking University Third Hospital from January 1,2010 to December 31, 2015 were enrolled in this study. All of them were divided into two groups according to their Apgar score: mild group (4-7) and severe group (0-3). Medical records of the subjects were reviewed and an at least 18 months follow up study was conducted. Conditions of all subjects during perinatal period and hospitalization were summarized. Outcomes and follow-up results were compared between the two groups by using Fisher exact test. Results (1) General information: Fifty infants were involved, among which 37 had a mild low Apgar score and 13 had a severe low Apgar score. The mean gestational age was (27.7±2.1) weeks and the mean birth weight was (884.4±174.3) grams. (2) Main complications (some infants with more than one complication): There were 42 cases of neonatal respiratory distress syndrome, 12 cases of pulmonary hemorrhage, 21 cases of bronchopulmonary dysplasia, 31 cases of patent ductus arteriosus, 36 cases of intraventricular hemorrhage, 22 cases of white matter damage and six cases of retinopathy of prematurity. (3) Outcomes: The survival rate was 48% (24/50) and the mortality rate was 52% (26/50). Among the 26 infants, five died despite treatment and 21 died within 72 hours after their parents giving up treatment. There were no significant differences in the survival rates, mortality rates and rates of abandon treatment between the two groups [43% (16/37) vs 8/13; 11%(4/37) vs 1/13; 46% (17/37) vs 4/13; Fisher exact test, all P>0.05]. (4) Follow-up results: Twenty-one infants were followed-up to at least 18 months of age, among which four were normal, 10 had growth retardation and recurrent respiratory tract infection and seven had motor development retardation. The incidence of motor development retardation in severe group was higher than that in mild group, and the difference between them was statistically significant (5/8 vs 2/13, Fisher exact test, P=0.046). Conclusions EPI or ELBWI with a low one-minute Apgar score have many nosocomial complications, resulting in high mortality and high incidence of motor development retardation.

Objective To investigate polymorphism in the promoter region of insulin-like growth factor-1(IGF-1) gene.Methods Five hundred and sixty-one neonates admitted to Peking University Third Hospital from June 1st,2010 to June 30th,2012 were recruited into the study.Gender,gestational age,birth weight and birth length were collected.Heel blood samples were collected on 3-5 days after birth.DNA was extracted to analyze the polymorphism in the promoter region of IGF-1 gene.Chi-square test,independent-sample t-test,analysis of variance and HardyWeinberg equilibrium were performed.Results Among the 561 neonates,413 were full term,and 148 were preterm; 92 were large for gestational age (LGA),433 were appropriate for gestional age (AGA),and 36 were small for gestional age (SGA).Seven different alleles and 23 genotypes in the promoter region of IGF-1 gene were identified in the population.The seven alleles were 188,190,192,194,196,198 and 200 bp respectively.The three most common genotypes were 190-192 bp,192-196 bp and 192-192 bp,whose frequencies were 23.2％ (130/561),15.0％ (84/561) and 12.8％(72/561).There were no significant differences of cytosine-adenosine (CA)19/CA19,CA19/CAno19and CAno19/CAno19 genotypes between full term and preterm infants [11.4％ (47/413) vs 16.9％(25/148),55.9％ (231/413) vs 50.7％ (75/148) and 32.7％ (135/413) vs 32.4％ (48/148)respectively,x2=2.96,1.21 and 0.00,all P＞0.05].There was no difference in the gestional age among infants with CA19/CA19,CA19/CAno19 and CAno19/CAno19 genotypes [(37.1±2.9),(37.6±3.1) and (37.4±3.1) weeks respectively,F=0.54,P=0.58].The frequency of CA19/CA19 in SGA neonates was higher than that in LGA and AGA neonates [25.0％ (9/36) vs 7.6％(7/92) and 12.9％ (56/433),x2 =7.01,P=0.03],but there were no differences in the frequency of CA19/CAno19 and CAno19/CAno19 among LGA,AGA and SGA neonates (CA19/CAno19:x2 =1.13,P=0.57; CAno19/CAno19:x2 =0.58,P=0.75).Conclusions Polymorphism exists in the promoter region of IGF-1 gene.The gestational age is not associated with the frequency of CA19 allele.

Objective To investigate the effect of preoperative nursing intervention in the prevention of postoperative retention of urine of patients after total knee arthroplasty. Methods 128patients underwent total knee arthroplasty were divided into the intervention group and the control group (64 cases in each group) by random number table.The patients in the control group received routine nursing care and the patients in the intervention group accepted preoperative nursing intervention 3 to 5 days before surgery. The incidence of post-operation urinary retention, catheterization, satisfaction degree and compliance of the patients were compared between the two groups. Results The incidence rate of post-operation urinary retention and catheterization of the patients was respectively 15.6%(10/64) and 7.8%(5/64) in the intervention group,lower than 34.4%(22/64) and 23.4%(15/64) in the control group. The difference was statistically significant (χ2=6.00, 5.93, respectively, P<0.05). The satisfaction degree and compliance of patients were respectively 95.3%(61/64) and 75.0%(48/64) in the intervention group, higher than 85.2%(52/64) and 31.3%(20/64) in the control group,the difference was statistically significant (χ2=6.12, 24.60,respectively, P < 0.05). Conclusions Preoperative nursing intervention have good effect in the prevention of postoperative retention of urine and improving satisfaction degree of patients underwent total knee arthroplasty.

Objective To examine the effectiveness of simulation newborn simulator in neona-tal resuscitation training for pediatric residents. Methods From June 2011 to June 2012, 11 residents working in neonatal ward of the Third Hospital of Peking University were enrolled into the study. Eval-uation on the residents was made before the training. Training of simulated teaching using simulation newborn simulator was conducted and evaluation was made after the training. SPSS 18.0 was used for statistical analysis. Comparison was made between pre- and post-training test by paired t test. P<0.05 was considered statistical significant. Questionnaire survey was conduct to acquire residents' feedback. Results A total of 11 participants completed the training and finished the questionnaire. The score of pre-training was 37.82±1.17 versus that of post-training 39.18±0.87(t=4.89, P<0.01). All residents were satisfied with the simulation-based training. Conclusion Simulation training can improve pedi-atric residents' knowledge and skills in neonatal resuscitation.

ObjectiveTo investigate the effect of intensive insulin therapy in critically ill elderly patients.MethodsElderly patients ( ≥ 65 years) admitted to the ICU of Beijing Tongren Hospital from June 2005 to December 2007 were divided into Group A ( glucose control target was 4.4-6.1mmol/L) and Group B ( glucose control target was 7.3-8.3mmol/L).Blood glucose level was controlled with a computer-assisted glucose control protocoL ResultsA total of 639 patients were enrolled,of which 280 were in Group A and 359 in Group B.The mean blood glucose level of the 2 groups was (6.07 ± 0.56) mmol/L and (7.52 ± 0.87 ) mmol/L respectively,both within the target ranges.The hyperglycemic index was (0.69±0.44) mmol/L in Group A and ( 1.60 ±0.73) mmol/L in Group B (P =0.000).No hypoglycemia adverse events occurred in either group.No significant differences were observed in the length of stay in ICU,duration of mechanical ventilation,hospitalization expenses,ICU mortality,and hospital mortality of the 2 groups.ConclusionMaintaining the blood glucose level of critically ill elderly patients at ≤8.3 mmol/L is safe and practical.