Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective:To explore the risk factors for atrial fibrillation in adult patients with critically severe burns after the first surgery.Methods:This study was a retrospective case series study. From January 1, 2018 to March 31, 2023, 211 adult patients with critically severe burns were admitted to the Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital and met the inclusion criteria, including 158 males and 53 females, aged 24-81 years. According to whether atrial fibrillation occurred after the first surgery, the patients were divided into postoperative atrial fibrillation (POAF) group (23 cases) and non-POAF group (188 cases). The following indexes of patients in POAF group were collected, including the onset time, duration, treatment method, and number of patients with more than once of atrial fibrillation after the first surgery. The following data of the two groups of patients were collected, including general data, such as gender, age, burn type, total burn area, full-thickness burn area, inhalation injury, underlying diseases, mechanical ventilation, and sepsis; electrolyte imbalance and blood index level before the first surgery; the first surgery-related information such as surgical length and surgical method; volume changes and vital signs during the first surgery, such as total volume of fluid infusion, total volume of blood transfusion, volume of blood loss, hypotension, and hypothermia; postoperative hypothermia; inflammatory index levels before the first surgery and on the first day after the first surgery, such as procalcitonin levels, white blood cell count, neutrophil count, lymphocyte count, platelet count, neutrophil to lymphocyte ratio (NLR), platelet count to lymphocyte ratio (PLR); mortality within 30 days of admission. The independent risk factors for occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery were screened.Results:The onset time of atrial fibrillation of patients in POAF group was 2 (2, 4) hours after the first surgery, and the duration of atrial fibrillation was 16 (6, 26) hours. Twenty-one patients were treated with intravenous injection of amiodarone, two patients were treated with cardiac electrical cardioversion, and atrial fibrillation of all patients converted to sinus rhythm after treatment. Three patients experienced atrial fibrillation more than once. The age was 59 (42, 70) years and the total burn area was 90% (70%, 94%) total body surface area (TBSA) in patients in POAF group, which were significantly higher than 48 (38, 56) years and 70% (60%, 83%) TBSA in non-POAF group (with Z values of -2.64 and -3.56, respectively, P<0.05). Compared with those in non-POAF group, the incidence rate of inhalation injury of patients in POAF group was significantly higher ( χ2=4.45, P<0.05), the total volumes of fluid infusion and blood transfusion during the first surgery were significantly increased (with Z values of -3.98 and -3.75, respectively, P<0.05), the incidence rates of hypothermia during the first surgery and hypothermia after the first surgery were significantly increased (with χ2 values of 8.24 and 18.72, respectively, P<0.05), the levels of procalcitonin before the first surgery and on the first day after the first surgery, as well as the NLR on the first day after the first surgery were significantly increased (with Z values of -3.03, -2.19, and -2.18, respectively, P<0.05), the lymphocyte count (with Z values of -2.07 and -2.60, respectively, P<0.05) and platelet count (with Z values of -3.35 and -3.58, respectively, P<0.05) were significantly reduced before the first surgery and on the first day after the first surgery, and the mortality rate within 30 days of admission was significantly higher ( χ2=4.03, P<0.05). There were no statistically significant differences in other indexes between the two groups of patients ( P>0.05). Multivariate logistic regression analysis showed that age, total burn area, and intraoperative hypothermia were independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery (with odds ratios of 1.08, 1.07, and 4.18, 95% confidence intervals of 1.03-1.12, 1.03-1.11, and 1.48-11.80, respectively, P<0.05). Conclusions:Age, total burn area, and intraoperative hypothermia are independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery. Patients with atrial fibrillation have an increased risk of death.

Objective:To investigate the clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns.Methods:A retrospective observational study was conducted. From May 2016 to September 2022, 17 patients with scar contracture deformities in the face and neck after extensive burns were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 13 males and 4 females, aged 23 to 55 years, with 3 patients having degree Ⅱ cervical contracture, 14 patients having degree Ⅲ cervical contracture, and 12 patients having facial scar contracture deformity. In the first stage, 34 rectangular skin and soft tissue expanders (hereinafter referred to as expanders) with rated capacity of 100-600 mL were inserted into the face, chest, shoulder, and abdomen, and then the normal saline was injected for expansion. In the second stage, the scar tissue was removed and the contracture was released to correct the deformity. Two expanded facial flaps were transplanted in local fashion, 17 expanded flaps were transplanted in pedicled fashion, and 15 expanded flaps were freely transplanted to repair the secondary wounds after release, with artery pressurization was performed in 7 flaps. Indocyanine green fluorescence imaging was used to evaluate the arterial blood perfusion and venous return of the flaps during transplantation. The incision area of 32 flaps except 2 facial flaps was 10 cm×8 cm-36 cm×16 cm. The wounds of 31 flap donor sites were closed by direct suture, and the wound of 1 flap donor site was repaired by autologous split-thickness scalp transplantation. The skin condition of inserted place, expansion time, and total amount of normal saline injection of expanders, complications of skin and soft tissue expansion surgery, and survival of flap after the second stage surgery were observed and recorded. The long-term face and neck reconstruction effect and recovery of flap donor area were followed up. At the last follow-up, the 5-level Likert scale was used to evaluate the efficacy satisfaction of patients.Results:Of the 34 expander inserted places in 17 patients, 22 places were superficial scar skin after deep partial-thickness burns, 8 places were superficial scar skin after multiple skin donations, and 4 places were normal skin. After 4 to 15 months of expansion, the total normal saline injection volume was 238 to 2 000 mL, with no complications occurred. After the second stage surgery, the distal part of 2 pedicled flaps was partially necrotic, and the necrotic wounds were healed after flap dressing and free transplantation of contralateral expanded triangular flaps, respectively; the other flaps survived completely. During 6 to 18 months of follow-up, except for 2 expanded paraumbilical flaps and 1 expanded groin flap, which were bloated and improved by flap thinning, the appearance and texture of the other flaps were good, and all the flap donor sites recovered well. At the last follow-up, the face and neck scar contracture deformities were significantly improved in all patients, and the satisfaction of curative effect of patient was very satisfactory in 8 patients and relatively satisfactory in 9 patients.Conclusions:The expanded flaps of chest, abdomen, and other parts, combined with local advance, pedicled, and free transplantation, can effectively reconstruct scar contracture deformities in the face and neck after extensive burns, restore the function of operative area and improve the appearance simultaneously, with high degree of patient satisfaction, which is worthy of promotion in clinic.

Objective: : This study aimed to investigate the changes and significance of microRNA155 levels in serum of patients with cerebral small vessel disease (CSVD). Methods: : Thirty patients with CSVD who met the inclusion criteria were selected and divided into eight patients with lacunar infarction (LI) group and 22 patients with multiple lacunar infarction (MLI) combined with white matter lesions (WML) group according to the results of head magnetic resonance imaging (MRI). Thirty samples from healthy volunteers without abnormalities after head MRI examination were selected as the control group. The levels of serum microRNA155 in each group were determined by real-time polymerase chain reaction, and the correlation between microRNA155 in the serum of patients with CSVD and the increase of imaging lesions was analyzed by Spearman correlation analysis. Results: : Compared with the control group, the serum microRNA155 level in the LI group, MLI combined with WML group increased, the difference was statistically significant (p<0.05); serum microRNA155 level was positively correlated with the increase of imaging lesions (p<0.05). Conclusion : The change of serum microRNA155 level in patients with CSVD may be one of its self-protection mechanisms, and the intensity of this self-protection mechanism is positively correlated with the number of CSVD lesions.

Objective:To explore the clinical effects of fiberoptic bronchoscopy airway lavage (FBAL) in the treatment of extremely severe burn patients with severe inhalation injury.Methods:From January 2015 to January 2019, 47 extremely severe burn patients with severe inhalation injury who were hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, meeting the inclusion criteria, were recruited in this retrospective cohort study. According to whether or not they were treated with FBAL, the patients were divided into fiberoptic bronchoscopy group (23 cases, 19 males and 4 females) and routine group (24 cases, 20 males and 4 females), with the age of (44±11) and (49±9) years, and the admission time of 4 (3, 4) h and 4 (3, 5) h respectively. The patients in routine group were given routine comprehensive treatment, and the patients in fiberoptic bronchoscopy group were treated with FBAL on the basis of routine comprehensive treatment. The pH value, arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), arterial oxygen saturation (SaO 2), oxygenation index, white blood cell count (WBC), neutrophils, blood lactic acid, and procalcitonin (PCT) at admission and on post injury day (PID) 3, 5, 7, and 10, the time of mechanical ventilation, the day of intensive care unit (ICU) stay, the incidence of complications and death within PID 28 were compared between the two study groups. The occurrences of bronchospasm and asphyxia of patients in fiberoptic bronchoscopy group were monitored. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, Bonferroni correction, chi-square test, and Fisher′s exact probability test. Results:(1) At admission, the values of pH, PaO 2, PaCO 2, SaO 2, and oxygenation index of patients in the two groups were similar ( Z=-0.118, -0.320, -0.362, -2.416, -0.234, P>0.05). On PID 3, 5, 7, and 10, the values of pH, PaO 2, SaO 2, and oxygenation index of patients in fiberoptic bronchoscopy group were significantly higher than those of routine group ( Z3 d=-4.711, -4.161, -5.525, -2.661; Z5 d=-3.489, -4.678, -5.875, -3.599; Z7 d=-5.104, -4.619, -5.876, -4.844; Z10 d=-4.026, -5.698, -5.877, -4.716; P<0.05 or P<0.01). The PaCO 2 values of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group ( Z=-2.895, -3.162, -3.407, -2.831, P<0.05 or P<0.01). (2) At admission and on PID 3, 5, and 7, the values of WBC, blood lactic acid, and PCT of patients in the two groups were similar ( Z=-0.830, -0.915, -0.458, -0.648, -1.714, -1.479; -0.330, -0.128, -1.766, -0.494, -1.396, -1.522, P>0.05). On PID 10, the values of WBC, blood lactic acid, and PCT of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group ( Z=-3.502, -2.630, -2.662, P<0.05 or P<0.01). At admission, the value of neutrophils of patients in fiberoptic bronchoscopy group was 0.887 (0.862, 0.912), which was similar to 0.887 (0.856, 0.897) in routine group ( Z=-0.404, P>0.05). On PID 3, 5, 7, and 10, the values of neutrophils of patients in fiberoptic bronchoscopy group were respectively 0.848 (0.802, 0.867), 0.831 (0.815, 0.849), 0.798 (0.771, 0.849), 0.796 (0.751, 0.869), which were significantly lower than those of routine group [0.882 (0.820, 0.906), 0.871 (0.835, 0.903), 0.845 (0.819, 0.905), 0.881 (0.819, 0.916), Z=-2.756, -2.810, -2.618, -3.033, P<0.05]. (3) The time of mechanical ventilation and the days of ICU stay of patients were shorter in fiberoptic bronchoscopy group than those in routine group ( Z=-2.199, t=2.368, P<0.05). Within PID 28, the number of patients with complications was significantly less in fiberoptic bronchoscopy group than in routine group ( χ2=5.436, P<0.05), while the incidence of death within PID 28 in fiberoptic bronchoscopy group was similar to that of routine group ( P>0.05). The airway lavage procedures of patients in fiberoptic bronchoscopy group went well with no bronchospasm or asphyxia occurred. Conclusions:FBAL is effective in treating extremely severe burn patients combined with severe inhalation injury. It can improve the oxygenation status of the lung, reduce the systemic inflammatory reaction of patients, shorten the time of mechanical ventilation and ICU stay, and reduce the incidence of complications.

Objective:To introduce the experience in treating burn patients with inhalation injury during the epidemic of coronavirus disease 2019 (COVID-19).Methods:Six burn patients combined with inhalation injury were hospitalized in Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from February 1 to March 1 in 2020 during the high-incidence period of COVID-19, including 4 males and 2 females, aged 21-63 years, admitted at 2-4 hours after burns, with total burn areas of 1%-20% total body surface area (TBSA) and full-thickness burn areas of 1%-12% TBSA. Among them, 1 case had severe inhalation injury, 2 cases had mild inhalation injury, and 3 cases had moderate inhalation injury. The body temperatures of the patients were normal at the time of admission, with no fever or cough in the past 2 weeks. At admission, chest CT of one patient showed double lower lobes and left upper lobes had multiple slices and slightly high-density shadow of nodules. Chest CT of two patients showed thickening of bilateral lung texture, and the chest CT of remaining patients were normal. After admission, 6 patients were given routine treatment, the medical staffs paid attention to the protection and screened for COVID-19 according to the diagnosis and treatment plan of COVID-19. On post injury day (PID) 1, 3, 6, and 9, vein blood of patients were collected for determination of white blood cell (WBC) count, neutrophil, lymphocyte absolute value, and level of procalcitonin (PCT). Nucleic acid of novel coronavirus was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction on PID 3 and 6. The temperatures of patients were recorded after admission. The results of chest CT within one week after injury and the prognosis of the patients were recorded. Measurement data distributed normally were expressed as ± s, and measurement data distributed abnormally were expressed as M( P25, P75). Results:(1) On PID 1, 3, 6, and 9, WBC counts of patients were respectively (19.8±3.8)×10 9/L, (17.2±3.4)×10 9/L, (13.3±3.1)×10 9/L, and (11.1±1.6)×10 9/L, neutrophils of patients were respectively 0.919±0.019, 0.899±0.011, 0.855±0.034, and 0.811±0.035, absolute values of lymphocytes of patients were respectively (0.65±0.18)×10 9/L, (0.65±0.24)×10 9/L, (0.91±0.34)×10 9/L, and (1.23±0.42)×10 9/L, and PCT values of patients were respectively 0.49 (0.36, 1.64), 0.39 (0.26, 0.73), 0.28 (0.18, 0.33), and 0.12 (0.11, 0.20) ng/mL. The values of WBC and neutrophils of patients were higher than the normal value, showing a downward trend. The absolute values of lymphocyte of patients returned to the normal value from PID 6. The PCT values of patients were higher than the normal value. (2) Nucleic acid test results of novel coronavirus of 6 patients were negative on PID 3 and 6. The temperatures of 6 patients ranged from 36.5 to 38.6 ℃. The typical imaging features of COVID-19 were not found in 6 patients within 1 week after injury by chest CT. After treatment for 14-32 days, 6 patients were cured and discharged. Conclusions:During COVID-19 pandemic, burn patients combined with inhalation injury should be treated under condition of good protection for doctors and nurses. Meanwhile, virus should be actively screened to reduce the risk of COVID-19 infection among doctors and patients.

Objective:To investigate the effect of fluid resuscitation guided by pulse contour cardiac output (PiCCO) monitoring technology on the organ function in extremely severe burn patients.Methods:From May 2015 to March 2019, 52 patients with extremely severe burn hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, meeting the inclusion criteria, were recruited to conduct a prospectively randomized control study. The patients were divided into PiCCO monitoring rehydration group (25 cases, 17 males and 8 females) and traditional rehydration group (27 cases, 20 males and 7 females) according to the random number table, with the ages of (47±9) and (49±8) years respectively. After admission, all the patients were rehydrated according to the rehydration formula of the Third Military Medical University during shock stage. In traditional rehydration group, fluid resuscitation of the patients was performed by monitoring the traditional shock indicators such as urine volume and central venous pressure, while PiCCO monitoring was performed in patients in PiCCO monitoring rehydration group, and the global end-diastolic volume index combined with the other relevant indicators of PiCCO monitoring were used to guide rehydration on the basis of the monitoring indicators of traditional rehydration group. The rehydration coefficients and urine volumes per kilogram of body weight per hour during the first and second 24 h post injury were compared between the two groups, which were compared with the corresponding rehydration scheme value of the Third Military Medical University (hereinafter referred to as the scheme value) at the same time. The total rehydration volumes within post injury hour (PIH) 8 and during the first and second 24 h post injury, the urine volumes per hour during the first and second 24 h post injury, and the levels of creatinine, urea nitrogen, lactate clearance rate, procalcitonin, creatine kinase isoenzyme (CK-MB) in blood and mean arterial pressure (MAP) on post injury day (PID) 1, 2, and 3 were measured. The incidence of complications, the application case number of mechanical ventilation, and the mechanical ventilation time within PID 28 were analyzed. Data were statistically analyzed with analysis of variance for repeated measurement, t test, Bonferroni correction, Mann-Whitney U test, chi-square test, and Fisher′s exact probability method test. Results:During the second 24 h post injury, the rehydration coefficient of patients in traditional rehydration group was significantly higher than the scheme value ( t=5.120, P<0.01). During the first and second 24 h post injury, the rehydration coefficients of patients in PiCCO monitoring rehydration group were significantly higher than the scheme values ( t=3.655, 10.894, P<0.01) and those in traditional rehydration group ( t=3.172, 2.363, P<0.05 or P<0.01). Within PIH 8, the total rehydration volumes of patients between the two groups were similar. During the first and second 24 h post injury, the total rehydration volumes of patients in PiCCO monitoring rehydration group were significantly higher than those in traditional rehydration group ( t=4.428, 3.665, P<0.01). During the first and second 24 h post injury, the urine volumes per kilogram of body weight per hour of patients in traditional rehydration group were significantly higher than the schema values ( t=4.293, 6.362, P<0.01), and the urine volumes per kilogram body weight per hour of patients in PiCCO monitoring rehydration group were significantly higher than the schema values ( t=6.461, 8.234, P<0.01). The urine volumes per kilogram of body weight per hour and urine volumes per hour of patients in PiCCO monitoring rehydration group during the second 24 h post injury were significantly higher than those in traditional rehydration group ( t=2.849, 3.644, P<0.05 or P<0.01). The creatinine levels of patients between the two groups on PID 1, 2, and 3 were similar. The urea nitrogen levels of patients in PiCCO monitoring rehydration group on PID 1, 2, and 3 were (6.8±1.5), (5.6±1.4), (4.4±1.4) mmol/L respectively, which were significantly lower than (8.6±1.8), (6.6±1.5), (5.5±1.4) mmol/L in traditional rehydration group ( t=3.817, 2.511, 2.903, P<0.05 or P<0.01). The lactate clearance rates of patients in PiCCO monitoring rehydration group on PID 1, 2, and 3 were significantly higher than those in traditional rehydration group ( t=2.516, 4.540, 3.130, P<0.05 or P<0.01). The procalcitonin levels of patients in PiCCO monitoring rehydration group on PID 2 and 3 were significantly lower than those in traditional rehydration group ( Z=-2.491, -2.903, P<0.05). The CK-MB level of patients in PiCCO monitoring rehydration group on PID 3 was (35±10) U/L, which was significantly lower than (51±16) U/L in traditional rehydration group ( t=4.556, P<0.01). The MAP levels of patients between the two groups on PID 1, 2, and 3 were similar. Within PID 28, the incidence of complications of patients in traditional rehydration group was significantly higher than that in PiCCO monitoring rehydration group ( χ2=4.995, P<0.05), and the application case number of mechanical ventilation and the mechanical ventilation time of patients between the two groups were similar. Conclusions:The use of PiCCO monitoring technology to guide the early fluid resuscitation of extremely severe burn patients is beneficial for accurate determination of the fluid volume required by the patients and reduction of organ injury caused by improper rehydration.

Objective: To establish a prediction model for infectious disease index（IDI）by autoregressive integrated moving average（ARIMA）,and to provide forcast of infectious diseases to the public. Methods: The data of the percentage of influenza-like illness（ILI）,the incidence rates of hand-foot-mouth disease（HFMD）and other infectious diarrhea（OID）from the 1st week of 2014 to the 14th week of 2018,and Breteau index（BI）from the 1st week of 2016 to the 14th week of 2018 were collected. ARIMA models were built to predict the risk indicators of ILI,HFMD,OID and BI. The weights of the four indicators were evaluated seasonally by the entropy weight method. Then the IDI was calculated and the data of ILI,HFMD, OID and BI from 15th to 19th week in 2018 was used for verification. Results: The forecast was in summer,so IDI=ROUND（0.33×risk index of ILI percentage +0.47×risk index of HFMD incidence +0.10×risk index of OID incidence+0.10×risk index of BI）. The predicted IDI would be 2（less safe）in the whole city and Xiangzhou District,and 1（safe）in Doumen District and Jinwan District. The consistency rates of IDI prediction was 97.50%,95.00%,97.50%,85.00% and 77.50% from 15th to 19th week in 2018,respectively. Conclusion It was feasible to use IDI for short-term risk prediction of infectious diseases.

Objective: To explore the guiding significance of pulse contour cardiac output (PiCCO) monitoring technology in the treatment of fluid replacement during shock stage of extensive burn in clinic. Methods: Sixty-five patients with extensive burn hospitalized in our unit from January 2014 to December 2018, conforming to the inclusion criteria, were recruited to conduct a prospective controlled research. According to the order of admission, 35 odd-numbered patients and 30 even-numbered patients were enrolled in routine rehydration group (25 males and 10 females) and PiCCO monitoring rehydration group (21 males and 9 females) respectively, with the age of (48±9) and (44±8) years respectively. All patients of the two groups were rehydrated according to the rehydration formula of the Third Military Medical University during shock stage. The rehydration speed was adjusted in routine rehydration group according to the general indexes of shock such as central venous pressure, mean arterial pressure, heart rate, respiratory rate, urine volume, and clinical symptoms of patients. PiCCO monitoring was performed in patients of PiCCO monitoring rehydration group, and the global end-diastolic volume index combined with the other relevant indicators of PiCCO were used to guide rehydration on the basis of the monitoring indicators of routine rehydration group. The heart rates and positive fluid balance volumes at post injury hour (PIH) 8, 16, 24, 32, 40, 48, 56, 64, and 72, the diuretic dosage at PIH 48 and 72, the total fluid replacement volumes, urine volumes, blood lactic acid, platelet count, and hematocrit at PIH 24, 48, and 72, the length of intensive care unit (ICU) stay, and the incidence of complications and death within 28 days after injury were compared between patients in the two groups. Data were processed with analysis of variance for repeated measurement, t test, Bonferroni correction, Mann-Whitney U test, chi-square test, and Fisher′s exact probability test. Results: The heart rates of patients in the two groups were similar at PIH 8, 16, 24, 32, 40, 48, and 56 (t=0.775, 1.388, 2.511, 2.203, 1.654, 2.303, 1.808, P>0.05), and the heart rates of patients in PiCCO monitoring rehydration group at PIH 64 and 72 were obviously lower than those of routine rehydration group (t=3.229, 3.357, P<0.05 or P<0.01). The positive fluid balance volumes of patients in the two groups were similar at PIH 8, 16, 40, and 56 (t=0.768, 1.670, 2.134, 2.791, P>0.05), and the positive fluid balance volumes of patients in PiCCO monitoring rehydration group at PIH 24, 32, 48, 64, and 72 were obviously less than those of routine rehydration group (t=3.364, 4.047, 2.930, 2.950, 2.976, P<0.05 or P<0.01). The amount of diuretics used by patients in the two groups was similar at PIH 48 and 72 (Z=-0.697, -1.239, P>0.05). The total fluid replacement volumes of patients in PiCCO monitoring rehydration group at PIH 24, 48, and 72 were (13 864±4 241), (9 532±2 272), and (8 480±2 180) mL, respectively, obviously more than those in routine rehydration group [(10 388±2 445), (8 095±1 720), and (7 059±1 297) mL, respectively, t=-3.970, -2.848, -3.137, P<0.05 or P<0.01]. The urine volumes of patients in the two groups at PIH 24 were close (t=-1.027, P>0.05). The urine volumes of patients in PiCCO monitoring rehydration group at PIH 48 and 72 were (3 051±702) and (3 202±624) mL respectively, obviously more than those in routine rehydration group [(2 401±588) and (2 582±624) mL respectively, t=-4.062, -4.001, P<0.01]. The levels of blood lactate acid of patients in PiCCO monitoring rehydration group at PIH 24, 48, and 72 were obviously lower than those in routine rehydration group (t=4.758, 6.101, 3.938, P<0.01). At PIH 24 and 48, the values of the platelet count of patients in PiCCO monitoring rehydration group were obviously higher than those in routine rehydration group (t=-2.853, -2.499, P<0.05), and the values of hematocrit of patients in PiCCO monitoring rehydration group were obviously lower than those in routine rehydration group (t=2.698, 4.167, P<0.05 or P<0.01). Both the platelet count and hematocrit of patients in the two groups were similar at PIH 72 (t=-1.363, 0.476, P>0.05). The length of ICU stay of patients in PiCCO monitoring rehydration group was obviously shorter than that of routine rehydration group (t=2.184, P<0.05). Within 28 days after injury, the incidence of complications of patients in routine rehydration group was obviously higher than that in PiCCO monitoring rehydration group (P<0.05), while the mortality rate of patients in routine rehydration group was similar to that in PiCCO monitoring rehydration group (P>0.05). Conclusions The application of PiCCO monitoring technology in monitoring fluid replacement in patients with extensive burn can quickly correct shock, reduce the occurrence of organ complications caused by improper fluid replacement, and shorten the length of ICU stay, which is of great significance in guiding the treatment of burn shock.