Objective To evaluate the association of gastrointestinal failure(GIF)with ICU hospital days,mechanical ventilation days and mortality,to identify its risk factors.Methods A retrospective analysis of patients (n=1836)admired to ICU and EICU during the years from 2003 to 2007 was performed to evaluate the association between GIF and their length of stay,mechanical ventilation days and mortality.The ability of APACHE Ⅱ,SOFA and age in predicting the incidence rate of GIF was identified.Results GIF was significantly related to higher mortality,as well as prolonged length of ICU stay and mechanical ventilation respectively.Age,APACHE Ⅱ and SOFA scores at admission were identified as the risk factors for the development of GIF.Condusion GIF should be considered a relevant clinical predictor of mcreased mortality and prolonged ICU stay and mechanical ventilation.Age,APACHE Ⅱ and SOFA scores are sensitive risk factors for the development of GIF.

Objective:To test the psychometric properties of the super brief-pathological narcissism inventory(SB-PNI) in Chinese college students.Methods:A total of 541 college students were recruited through convenient sampling method.All subjects were measured by SB-PNI, fear of missing out scale(FOMOs), Interpersonal Communication Scale and Social Interaction Scale.SPSS 25.0 was used for item analysis, criterion related validity analysis and Cronbach α coefficient. Mplus 7.4 software was used for structural validity analysis.Results:Through the construct validity analysis, it was found that the Bi-factor model was well fitted.SB-PNI presented a better Bi-factor structure(χ 2/ df=2.03, CFI =0.96, TLI=0.94, RMSEA=0.04, SRMR=0.04), namely a general factor and two local factors (grandiose narcissism and vulnerable narcissism). The score of SB-PNI was positively correlated with grandiose narcissism, vulnerable narcissism, interpersonal communication, social interaction and fear of missing out ( r=0.13-0.85, all P<0.01). The Cronbach's α coefficients of SB-PNI degreed from 0.74 to 0.81.The composite reliability of SB-PNI degreed from 0.75 to 0.84.The retest reliability of SB-PNI degreed from 0.75 to 0.85.The homogeneity reliability of SB-PNI was 0.64. Conclusion:The Chinese version of the SB-PNI has good validity and reliability among Chinese college students.

Objective:To explore the role of the multidimensional therapy in postpartum rehabilitation. Method:150 patients meeting the inclusion criteria were randomly divided into the control group and the exper-imental group.The control group received routine postpartum rehabilitation education and guidance,while the experimental group received the postpartum rehabilitation multidimensional therapy(PRMT)on this basis.The postpartum weight retention,posture change,body fat distribution,pelvic floor muscle surface voltage,inter-recti distance(IRD)and the scores of incontinence quality of life questionnaire(I-QOL),pelvic floor impact questionnaire short form(PFIQ-7)and Edinburgh postnatal depression scale(EPDS)were respectively mea-sured to observe the effect of intervention.Satisfaction with the PRMT was investigated by self-made question-naire before and after intervention. Result:The body weight(BW),waist circumference(WC),body mass index(BMI)and waist-hip ratio(WHR)of the experimental group were significantly reduced after 40 days intervention(P＜0.01),and the BMI,WC and WHR were significantly lower than those in the control group(P＜0.01);the percentage body fat(PBF),body fat mass(BFM),visceral fat area(VFA)and fat mass index(FMI)were significantly reduced(P＜0.01)in the experimental group,PBF,BFM and FMI were significantly lower than those in the control group(P＜0.05);the pelvic floor type Ⅰ and type Ⅱ muscle fiber voltage,assessment total score,I-QOL score were significantly increased(P＜0.01)and PFIQ-7 score were significantly decreased(P＜0.01)in the experimen-tal group,and the pelvic floor type Ⅰ and type Ⅱ muscle fiber voltage,assessment total score and I-QOL score were significantly higher than those in control group(P＜0.05).The IRD of parturients in the resting and flexion state of experimental groups was significantly reduced,with significant difference compared with before intervention(P＜0.05 or P＜0.01).In addition,the IRD of the upper umbilical margin and the lower um-bilical margin at resting state and the lower umbilical margin at flexion state were significantly lower than those in the control group(P＜0.05).After intervention,the EPDS in the experimental group were significantly decreased(P＜0.01),and the improvement were significantly better than the control group(P＜0.05).The 57 parturients in the experimental group completed the satisfaction questionnaire,about 80％of them were satis-fied with the PRMT process and considered that the PRMT improved their willingness to have a second or third child. Conclusion:PRMT was effective in improving the postpartum weight retention,posture change,body fat dis-tribution,pelvic floor function injury,diastasis recti abdominis(DRA)and postpartum psychological depression.

Objective To explore the factors that contribute to the anxiety and depression in obstructive sleep apnea hypopnea syndrome (OSAHS) patients in terms of excessive daytime sleepiness (EDS) and sleep quality.Methods A total of 196 OSAHS patients,including 103 severe patients and 93 mild-moderate patients,were enrolled.Polysomnography was carried on at the sleep center of the First Hospital of China Medical University between May 2013 and November 2015.According to the Epworth sleepiness scale (ESS) and the subject daytime sleepiness symptom,all patients were divided into EDS group and non-EDS group.The patients' general information and subjective symptoms were recorded.Emotional states were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS).Sleep quality was evaluated with Pittsburgh sleep quality index (PSQI).The anxiety and depression related factors were studied by regression analysis.Results (1) In severe OSAHS group,the patients with EDS showed higher PSQI(6.22± 2.57 vs.4.05± 3.72,P＜0.01) and oxygen desaturation index(ODI)[(57.70±17.53) events/h vs.(48.23 ± 22.01)events/h,P＜0.05] when compared with those without EDS.(2) In both severe and mild-moderate OSAHS groups,the patients with EDS presented higher SAS scores (severe:33.86±7.60 vs.28.95 ± 4.71,mild-moderate:37.46± 10.68 vs.33.40± 11.07,P＜0.05)and SDS scores(severe:32.81 ± 8.36 vs.28.90±4.53,mild-moderate:36.98± 12.77 vs.31.70±10.94,P＜0.05)when compared with those without EDS.(3) The multiple regression analysis showed that the SAS scores were related to ESS,PSQI,insomnia and nasal obstruction (R2=0.356,P＜0.05),and the SDS scores were related to ESS,PSQI and insomnia(R2=0.344,P＜0.05).Conclusions The anxiety and depression of OSAHS patients are closely related to the severity of EDS and sleep quality.Both severe and mild-moderate OSAHS patients with EDS have worse anxiety and depression scores.

Objective: To investigate the curative effect of hairy cell leukemia by clatabine. Methods: The clinical data of 24 patients with hairy cell leukemia treated by cladribine from November 2006 to October 2017 were analyzed retrospectively, then the curative effect and adverse drug reaction were analyzed. Results: ① A total of 24 patients including 22 male and 2 female, and the median age was 49.5 years (range 33 to 76) at diagnosis. There were 20 patients with of splenomegaly (4 patients with mild splenomegaly, 4 moderate splenomegaly, and 12 massive splenomegaly), 3 patients with enlargement of lymph nodes, and 1 patients who had undergone splenectomy. Five patients were pancytopenia, 15 were cytopenia in 2 lineages, and 4 patients were cytopenia only in one lineage. The median ratio of HCL cells detected by flow cytometry in bone marrow was 21.79% (0.69%-68.96%). BRAF mutation was detected in 15 patients by first generation or next generation sequencing technology. ② Among 24 patients, 20 were treated with cladribine alone (one course in 19 patients, 2 courses in 1 patient), and 4 patients were treated with cladribine combined with rituximab (one course in 3 patients, 2 courses in 1 patient). Excepting 5 patients whose follow-up time was not reaching 6 months, 19 patients were evaluated for efficacy in 6-12 months after treatment: 9 patients obtained CR, 9 obtained unconfirmed CR (Cru), the other 1 obtained PR, the CR/CRu rate was 94.7%, the overall response rate (ORR) was 100.0%. ③ All the 24 patients appeared 2-4 grade hematological adverse reactions after cladribine treatment, which were mainly grade 3/4 neutropenia (66.67%) and grade 3/4 thrombocytopenia (29.2%). All the adverse reactions were controlled or recovered spontaneously. ④ After the median follow-up time of 15 (3-133) months, no progression, recurrence or death occurred in the patients. Both median OS and PFS were not reached. Conclusion This study suggests that treatment of HCL with cladribine has high response rate, controllable adverse reactions and the good prognosis.

Objective: To explore the prognostic factors in newly diagnosed multiple myeloma (NDMM) patients with 1q21 amplification/gain treated with bortezomib-based regimens followed by autologous hematopoietic stem cell transplantation (ASCT) . Methods: We retrospectively assayed 35 NDMM patients with 1q21 amplification/gain who received bortezomib-based chemotherapy followed by ASCT and maintenance therapy between January 2008 and August 2015. Results: ①The median age of 35 patients were 49(33-63)years old. Ratio of male to female was 22∶13. Monosomy1q21 amplification/gain was only seen in 3(8.6%) patients, the other 32 patients were with additional cytogenetic abnormalities including 13q14 deletion, t(11,14), t(4,14), t(14,16), 17p deletion and complex karyotype aberrations. ②The complete remission (CR) rate was 57.0% (20/35), the very good partial remission(VGPR) rate was 37.1%(13/35) and the partial remission (PR) rate was 5.7%(2/35) after ASCT. At a median follow-up of 24 (8-85) months, 3-year estimated progression free survival (PFS) and overall survival (OS) rate were (66.5±9.7)% and (69.6±9.9)%, respectively. ③As 13 patients with high-risk cytogenetic abnormalities, the median PFS and OS time was 26 and 28 months. The 3-year estimated PFS and OS was (28.0±15.9)% and (36.5±16.4)%, respectively. Another 22 patients without other high-risk cytogenetic abnormalities, the median PFS and OS time was 54 months and not reached. The 3-year estimated PFS and OS was (71.5±12.7)% and (92.3±7.4)% in this group, respectively. The presence of additional other high-risk cytogenetic abnormalities resulted in significantly shortened PFS (χ²=5.404, P=0.020) and OS (χ²=7.596, P=0.006) compared with no high-risk cytogenetic patients. Conclusion NDMM patients with isolated1q21 amplification/gain were rarely and usually had additional other cytogenetic abnormalities. The outcomes in this group treated with bortezomib-based chemotherapy followed by ASCT and maintenance therapy were satisfied, additional other high-risk cytogenetic abnormalities made PFS and OS further shortened.

Objective: To investigate the clinical status of lymphoid tissue neoplasms patients with bacteria bloodstream infections, bacteriology and drug susceptibility results, and provide the basis for rational clinical anti-infection option. Methods: A retrospectively analysis of clinical data and bacterial susceptibility test results of patients with bacteria bloodstream infections from September 2010 to December 2014 was conducted. Results: A total of 134 cases including 107 patients with bloodstream infections were enrolled. 84 cases were male, 50 cases were female, the median age was 31 (12-71) years old. 112 cases were agranulocytosis, and 106 cases were severe agranulocytosis (ANC<0.1×10⁹/L) . 27 cases underwent hematopoietic stem cell transplantation, 100 cases received chemotherapy[33 cases with VD (I) CP±L (vincristine+daunorubicin/idarubicin + cyclophosphamide + prednison±asparaginasum) induction chemotherapy, 41 cases with intensive chemotherapy of Hyper-CVAD/MA or MA (mitoxantrone+cytarabine) , 26 cases with other chemotherapy regimens], and 7 cases were infected without chemotherapy. 10 patients discharged from hospital owing to treatment abandoning, 120 cases were cured through anti-infective therapy, 2 patients died of bacteria bloodstream infections, 1 patient died of sudden cardiac, and 1 patient died of GVHD after allogenic hematopoietic stem cell transplantation. A total of 144 strains were isolated, including 108 strains (75.0%) of Gram-negative bacteria and 36 strains (25.0%) of Gram-positive cocci. The susceptibility of Gram-negative bacteria to the carbapenems was 98.00%, and the adjustment treatment rate of carbapenems was 3.0%. The susceptibility of Gram-negative bacteria to the other antibiotics was 60.30%, and the adjustment treatment rate was 90.5%. The susceptibility of Grampositive cocci to the carbapenems was 49.3%, and to glycopeptides and linezolid was 100.0%. Comparing all patients’empirical use of antimicrobial agents with the drugs susceptibility results of blood cultures, 80.1% of the patients’initial drug selection was sensitive. Conclusion The lymphoid neoplasms patients experienced bacteria bloodstream infections most often after receiving the chemotherapy regimens of treating acute lymphoblastic leukemia. The majority type of bacteria was Gram-negative bacteria. Drug susceptibility test showed that susceptibility of Gram-negative bacteria to the carbapenems was the highest, and the treatment adjustment rate was obviously lower. The susceptibility of Gram-positive cocci to glycopeptides and linezolid was high, and which could be applied to the patients with Gram-positive cocci sepsis on basis of susceptibility results in general.

Objective To investigate the effects of chronic intermittent hypoxia on somatotropic axis hormone levels in rats.Methods Mature male Wistar rats were exposed to air or intermittent hypoxia randomly.The serum levels of growth hormone-releasing hormone (GHRH),growth hormone (GH) and somatostatin (SS) were measured before exposure,at the 4th,8th,and 12th week after exposure.Different hormone levels in two groups were compared and analyzed.Results Compared with the control group,GHRH levels in chronic intermittent hypoxic group showed a significant decline at the 4th week [(732.77± 46.99)pg/ml vs.(893.59±40.00) pg/ml,P＜0.05],while SS levels at the 8th week [(30.71 ±2.27) pg/ml vs.(44.69±3.36) pg/ml,P＜0.05] and GH levels at the 12th week [(1.20±0.29) ng/ml vs.(2.06±0.13) ng/ml,P＜0.05]were similarly reduced.As the duration of intermittent hypoxia was prolonged,the GHRH levels did not decrease further [4th week (732.77±46.99) pg/ml vs.8th week (607.54± 131.61) pg/ml vs.12th week (730.05±40.63) pg/ml,P＞0.05].However,the serum SS levels decreased further from the 8th week to the 12th week [(30.71±2.27) pg/ml vs.(24.41±4.06) pg/ml,P＜0.05].Conclusion Chronic intermittent hypoxia might inhibit the function of somatotropic axis.Hypothalamic hormones are the earlyonesto be influenced,thereafter the entire axis.

BACKGROUND:Changes in skeletal muscle mass have been indicated in studies addressing the effects of low-frequency pulsed magnetic fields on the structure and morphology of the skeletal muscle,but no relevant studies have been conducted on the morphologic changes that occur after chronic exposure to the low-frequency pulsed magnetic field. OBJECTIVE:To observe the effects of chronic exposure to low-frequency pulsed magnetic fields on the maximal voluntary contraction and morphologic indicators of the quadriceps muscle of the leg,thereby providing a reference of muscle morphologic changes for the use of this technique as a strategy for muscle function improvement. METHODS:Seventy healthy subjects were recruited and randomly divided into a test group that received magnetic field stimulation and a control group that underwent sham treatment,with 35 subjects in each group,and the total duration of the trial was 4 weeks.The test group underwent low-frequency pulsed magnetic stimulation for 15 minutes every 48 hours,while the control group underwent sham treatment,with the same intervention interval and duration as the test group.After 4 weeks of intervention,changes in the maximum voluntary contraction value of the quadriceps muscle in different groups were observed,and B-mode ultrasonography was utilized as a means of assessment to observe changes in muscle thickness,muscle cross-sectional area,and pinnation angle indexes. RESULTS AND CONCLUSION:After 4 weeks of chronic exposure to low-frequency pulsed magnetic fields,68 subjects completed the test.The maximum voluntary contraction value of the quadriceps muscle in the test group increased significantly(P=0.000),and the increment was significantly higher than that of the control group(P=0.008).Three indexes related to muscle morphology in the test group were significantly higher than the pre-test values(P=0.000),while in the control group,muscle thickness showed a significant reduction(P=0.020),there was no significant change in the pinnation angle,but a significant increase in the cross-sectional area(P=0.000).Intergroup comparisons revealed that the three indicators related to muscle morphology,including muscle thickness(P=0.012),pinnation angle(P=0.003),and cross-sectional area(P=0.049),were significantly higher in the test group than in the control group.The above data confirmed that the maximum voluntary contraction of the quadriceps muscle was significantly increased in healthy adults after 4 weeks of chronic exposure to the low-frequency pulsed magnetic field,and significant increases in the three muscle morphometric indices of muscle thickness,cross-sectional area,and pinnation angle were observed in the test group,providing a basis of muscle tissue morphology for the use of this technique as an exercise alternative and medical treatment strategy for muscle improvement.

Sleep is essential for the maintenance of human normal functions.Nowadays,the occurrence of active sleep deprivation(ASD)or passive sleep depriva-tion(PSD)is becoming more and more common due to the inability of the body adapting to the rapid changes in the internal and external environment.SD is not only an action,a brief process or a result,but also a directly or indirectly sustained state,which is associated to sleep time,circadian rhythm or sleep quality.SD can lead to numerous adverse effects on the body,such as sleep-related acute and chronic diseases.Long-term SD increases the risk of neurological and cardiovascular dis-eases as well as immune system dysfunction.In addi-tion,SD may affect the reproductive health of the body,giving rise to a series of potential fertility problems.In recent years,the correlation research and mechanism between SD and the related diseases have become a focus of scholars' attention.Numerous lines of evidence suggest that pathological sleep,such as insomnia and sleep apnea syndrome,is associated with impaired repro-ductive function.Disruptions in the circadian rhythm can also lead to impaired hypothalamic-pituitary-gonadal(HPG)axis function and thereby interfere with the repro-ductive process.Our research team has demonstrated that SD significantly affects the fertility of male and female rats and has adverse effects on reproduction.By new generation sequencing(NGS)and RT-PCR verifica-tion,we have identified differently expressed genes that are involved in mediating the effect of SD on fertility.However,the mechanisms and biological macromolecules regulated by SD are worthy of being further explored.This paper provides a brief review of SD research and then focuses on the adverse impact of SD on fertility,conducting a literature review to sort out the ideas and pro-vide references for research in this field.