OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

Objective:To explore the effect of setting up an internal-cross disciplinary team (ICDT) in the intensive care unit (ICU) on a new model of overall treatment for patients with chronic critical illness (CCI).Methods:A 60-year-old male patient with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to ICU in the Second Affiliated Hospital of Fujian Medical University was introduced. The role of ICDT composed of physicians, nurses, respiratory therapists, physiotherapists, clinical dietitians and patients' family members in ventilator withdrawal and super-early rehabilitation was analyzed in this case.Results:The patient was diagnosed as AECOPD, type Ⅱ aspiration penumonia respiratory failure, septic shock. The ICDT in ICU carried out early rehabilitation treatment for the patient on the basis of traditional infection control and supportive treatment. Under the care of the ICDT, peripheral blood white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), arterial partial pressure of carbon dioxide (PaCO 2), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), right excursion of diaphragm, sputum viscosity, tidal volume (VT) and respiratory rate (RR) were improved. Subsequently, the ventilator mode was gradually changed and the ventilator parameters were down-regulated. The ventilator was successfully weaned on the 10th day of treatment. After weaning, the patient's bedside pulmonary function indicators improved, and he was transferred out of ICU on the 15th day of treatment and discharged on the 20th day. The mental state of the patients was good and the quality of life was greatly improved in CCI outpatient follow-up. Conclusions:ICDT cooperation is very important for monitoring and treatment of CCI patients, which is beneficial to the super-early rehabilitation and prognosis improvement of critically ill patients.

Objective:To explore any changes with age in the center of plantar pressure among normal people after walking.Methods:Fifty healthy subjects were divided into a young group and an elderly group, each of 25. Gait descriptors were collected for each subject using a model AL-600 gait and balance training and evaluation apparatus. The gait descriptors were the center of pressure displacement (COPD), and the COPD in the medial-lateral (COPD-X) and anterior-posterior (COPD-Y) directions before and after 10 and 15 minutes of walking.Results:The average COPD, COPD-X and COPD-Y of the elderly group increased after both 10 and 15 minutes of walking, but among the young group increases were observed only after 15 minutes. The average COPD, COPD-X and COPD-Y of the elderly group were always significantly larger than the young group′s averages.Conclusions:Gait stability among the elderly decreases after as little as 10 minutes of walking, but among the young decreases are observed only after 15 minutes.

Objective:To document the blood indexes of middle-aged and elderly intracerebral hemorrhage (ICH) patients complicated with deep vein thrombosis (DVT).Methods:A retrospective analysis was conducted of 77 hospitalized ICH patients using venous color Doppler ultrasonography within 3 days of admission. According to the results, they were divided into a DVT group (18 cases) and a non-DVT group (59 cases). The blood routine, biochemistry, coagulation, and D-dimer examinations were conducted on the 2nd day after admission. T-tests and rank sum tests tested the significance of any differences between the groups in average white blood cell counts, neutrophil percentages, platelets, albumin, globulin, fasting blood glucose, urea nitrogen, creatinine, uric acid, electrolytes, fibrinogen or D-dimer.Results:The average levels of albumin, uric acid and calcium in the DVT group were significantly lower than in the non-DVT group. The average levels of fasting blood glucose and D-dimer were significantly higher.Conclusions:Decreased serum uric acid, calcium and albumin levels, together with increased fasting blood glucose and D-dimer are related to the occurrence of DVT in ICH patients. To reduce the risk of DVT it is important to maintain normal levels of serum uric acid, calcium and albumin and to limit D-dimer and fasting blood glucose.

Objective:To observe factors influencing the risk of urinary tract infection (UTI) after cerebral hemorrhage (ICH).Methods:A total of 77 ICH patients undergoing rehabilitation between August 2015 and August 2017 were studied. Among them, 24 were diagnosed with a UTI according to clinical manifestations and urine routine tests and urine culture. They formed the UTI group. The other 53 were the non-UTI group. Complete clinical evaluations were available for all 77, and those data were used to identify risk factors for UTI using univariate and multivariate logistic regression analysis.Results:The univariate analysis showed that age, side of paralysis, consciousness dysfunction, Brunnstrom staging of the lower extremity, tracheotomy, indwelling catheter, lung infection, white blood cell count, neutrophil percentage, serum natrium, uric acid, D-dimer level and fibrinogen were all significant predictors of UTI. The multivariate analysis identified age, right side hemiplegia and D-dimer level as useful predictors.Conclusions:Advanced age and a high D-dimer level are independent risk factors for UTI after ICH, while hemiplegia on the right side is a protective factor.

Objective:To observe risk factors for lung infection (LI) after cerebral hemorrhage (ICH).Methods:A total of 118 patients with ICH were retrospectively analyzed. Among them, 63 were diagnosed with an LI according to clinical manifestations and X-ray or CT on admission. They were selected into an LI group, while the rest formed the non-LI group. Gender, age, duration of disease, side of paralysis, position and type of ICH, complications, cognitive disorders, consciousness, dysphagia, motor function, and serum levels of albumin, sodium, potassium, calcium and magnesium were recorded on the second day after admission. The risk factors for LI were analyzed using univariate and multivariate logistic regression analysis.Results:Age, duration of disease, side of paralysis, position and type of ICH, tracheotomy, urinary tract infection, cognitive impairment, dysphagia, motor function, and serum levels of albumin, sodium, calcium, and magnesium were all significant predictors of LI after an ICH. Multivariate logistic regression analysis showed that right side hemiplegia, bilateral paralysis, subarachnoid hemorrhage, urinary tract infection, and serum magnesium are all significant predictors.Conclusions:Right or bilateral paralysis, subarachnoid hemorrhage and urinary tract infection are independent risk factors for LI after an ICH. High serum magnesium within the normal range can reduce the incidence of LI.

Objective:To explore the factors related to cognitive dysfunction after traumatic brain injury.Methods:A total of 55 patients with traumatic brain injury were analyzed retrospectively. The clinical information about the patients, including age, gender, paralyzed side, course of the disease, type of injury, degree of injury, treatment, speech function (grades of Boston aphasia severity), swallowing function (7-level evaluation method), limb motor function (Brunnstrom stages of the upper limb, hand and lower limb), complications (tracheotomy, lung infection, urinary tract infection, pressure sores, electrolyte imbalance and hypoproteinemia), whether the patient received rehabilitation therapy, and D-dimer and coagulation examination results were recorded. Univariate analysis and ordered multi-class logistic regression analysis were conducted to screen the related factors using Rancho Los Amigos cognitive function grades as the dependent variable.Results:The results of the univariate analysis showed that consciousness, aphasia severity, swallowing ability, Brunnstrom stages, having received a tracheotomy, urinary tract infection, hypoproteinemia, fibrinogen and D-dimer all significantly predicted Rancho Los Amigos cognitive function grades. The logistic regression analysis showed that disordered consciousness, aphasia severity, Brunnstrom stage of the upper limbs, and urinary tract infection were significant predictors.Conclusions:Disordered consciousness, aphasia severity, Brunnstrom stage of the upper limbs, and urinary tract infection are factors related to cognitive dysfunction after traumatic brain injury.

Objective: To explore the predictive value of the timed "up and go" test on falling of inpatients with stroke, providing objective reference for clinical fall risk evaluation. Methods: A total of 62 stroke in patients who were treated in the department of Neurology of the Second Affiliated Hospital of Shantou University Medical College from January 2018 to June 2018 were selected by the convenience sampling method. The timed "up and go" test was used to record the walking function of stroke inpatients. An ROC curve was used to analyze the efficacy in predicting falls of stroke inpatients. Results: The TUGT has demonstrated intraclass correlation coefficient (ICC) value of 0.963 (95%CI 0.938-0.978), and Cronbach alpha coefficient value of 0.983.The difference of the TUGT time between recurrent-fall stroke inpatients [15.69 (13.30, 19.87) seconds] and the patients without a history of falling [12.45 (10.08, 16.26) seconds] was statistically significant (Z=-2.585, P<0.05). Meanwhile, the difference of the TUGT time between male stroke inpatients [13.12 (10.23, 15.35) seconds] and female stroke inpatients [17.09 (12.98, 19.87) seconds] was also statistically significant (Z=-2.297, P<0.05). The TUGT time was significantly (P<0.05) positively correlated both with the fall history (rs=0.331) and gender (rs=0.294) in stroke inpatients. The result of ROC curve showed that the optimal TUGT cut-off point for predicting the fall of male stroke patients was 13.12 seconds with 0.696 for AUC, 78.6% for sensitivity and 68.2% for specificity (P<0.05).While the optimal TUGT cut-off point for predicting the fall of female stroke inpatients was 13.68 seconds with 0.691 for AUC, 73.3% for sensitivity and 65.6% for specificity (P<0.05). Conclusions Although TUGT has good feasibility in stroke inpatients, its predictive value for future falls of stroke inpatients is medium. The assessment and prediction of fall risk should be considered carefully by medical workers so as to reduce the occurrence of falls in stroke inpatients.

Objective To observe any effect of pulmonary rehabilitation in preventing ventilator-associated pneumonia (VAP) among patients receiving invasive mechanical ventilation (MV). Methods A total of 117 a-dults who had be receiving mechanical ventilation for at least 48 hours were randomly divided into an observation group and a control group. Both groups were given routine drug treatment and nursing, but the observation group al-so received comprehensive and individualized pulmonary rehabilitation interventions including airway clearance, respiration training, electrical stimulation of the sacral nerve, lung expansion and early mobilization. The main indi-cators were the incidence of VAP, mortality, MV duration, ICU stay time, and total hospital stay. Results At the end of the treatment the average clinical pulmonary infection score, the acute physiology and chronic health e-valuation Ⅱ score, SpO2 level and oxygenation index of the observation group were all significantly better than those of the control group. The incidence of VAP within one month after leaving the ICU was 47. 5％ in the observation group and the mortality rate was 44.1％, both significantly lower than in the control group. The average MV dura-tion, total hospitalization time and the ICU stay of the observation group were also significantly shorter than those of the control group. Conclusion Early and comprehensive pulmonary rehabilitation can prevent VAP and shorten the length of hospital stays, ICU stays and time on a mechanical ventilator, improving patients' survival chances and prognoses.

Objective To explore the risk factors for deep vein thrombosis (DVT) of the lower extremity among patients hospitalized after a cerebral hemorrhage. Methods A total of 230 patients with cerebral hemorrhage admitted between August 2015 to August 2017 were retrospectively analyzed. At admission, each was were given a coagulogram, D-dimer and color Doppler ultrasound of the lower extremity. The patients were divided into a DVT group (31 cases) and a non-DVT group (199 cases) according to the color Doppler ultrasound results. The following clinical information was recorded: sex, age, disease course, paralysis side, consciousness, tracheotomy, complications (pulmonary infection, urinary tract infections and pressure sores), foreign matter implanting, history of venous catheterization, heart rate over 100 beats/ min or not, rehabilitation intervention after the onset, muscle tension in the lower extremity, activity and swelling on the paralysis side, and the serum levels of D-dimer and fibrinogen. Univariate and multivariate logistic regression was applied in search of useful risk factors. Results The univariate analysis showed that age, gender, disease course, tracheotomy, urinary tract infections, pressure sores, foreign matter implanting, and swelling and muscle tension in the lower extremity were all associated with the occurrence of DVT among these cerebral hemorrhage patients. According to the results of the multivariate logistic regression analysis, swelling and muscle tension in the lower extremity were related with the occurrence of DVT for those patients. Conclusion Swelling and muscle tension in a lower extremity are independent risk factors for the occurrence of DVT after a cerebral hemorrhage.__