ObjectiveTo investigate the risk factors for post-acute pancreatitis diabetes mellitus （PPDM-A） in patients with acute pancreatitis （AP）， to construct a nomogram prediction model， and to provide a reference for the development of individualized treatment regimens. MethodsA total of 351 patients with AP who were admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from June 2021 to January 2025 were prospectively enrolled， and they were randomly divided into modeling group with 246 patients and validation group with 105 patients at a ratio of 7∶3. According to the presence or absence of PPDM-A in the patients with AP， the modeling group was further divided into PPDM-A group with 86 patients and non-PPDM-A group with 160 patients. Clinical data were collected from all patients. The least absolute shrinkage and selection operator （LASSO） regression analysis was used to determine independent variables， and a Logistic regression analysis was used to investigate the influencing factors for PPDM-A. R software was used to construct a nomogram model. The receiver operating characteristic curve was used to assess the discriminatory ability of the model， and the Hosmer-Lemeshow test was used to test the model fitting degree， and the calibration curve was used to evaluate the model consistency； and decision curve analysis （DCA） was used to assess its clinical application value. The independent-samples t test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. ResultsAmong the 246 patients， 86 developed PPDM-A， resulting in an incidence rate of 34.96%. There were significant differences between the PPDM-A group and the non-PPDM-A group in the proportion of patients with an age of ≥60 years （65.12% vs 40.62%， P<0.05）， male sex （75.58% vs 55.63%， P<0.05）， a body mass index （BMI） of ≥24 kg/m² （63.95% vs 37.50%， P<0.05）， alcoholic AP （56.98% vs 36.87%， P<0.05）， moderate-to-severe AP （54.65% vs 35.00%， P<0.05）， or a computed tomography severity index （CTSI） score of ≥4 points （48.84% vs 28.75%， P<0.05）， as well as significant differences in the levels of blood calcium （1.46±0.35 mmol/L vs 1.89±0.37 mmol/L， P<0.05） and random blood glucose （Glu） （17.68±4.12 mmol/L vs 11.68±4.27 mmol/L， P<0.05）. The LASSO regression analysis obtained 8 independent variables. The Logistic regression analysis showed that age， sex， BMI， alcoholic AP， moderate-to-severe AP， CTSI score， and Glu were risk factors for PPDM-A （all P<0.05）， while blood calcium was a protective factor （P<0.05）. The model had an area under the ROC curve （AUC） of 0.932 （95% confidence interval ［CI］： 0.903 — 0.962） in the modeling group， and the Hosmer-Lemeshow goodness-of-fit test yielded χ²=7.346 （P=0.728）， the accuracy of model fitting was good； the calibration curve showed that the predicted probability was consistent with the actual probability， indicating that the consistency was good. The model had an AUC of 0.835 （95%CI： 0.753 — 0.917） in the validation group， and the Hosmer-Lemeshow goodness-of-fit test yielded χ²=7.014 （P=0.711）， the accuracy of model fitting was good； the calibration curve showed that the predicted probability was consistent with the actual probability， indicating that the consistency was good. The DCA results of the modeling group showed that the model exhibited a high clinical value in evaluating PPDM-A when the threshold probability was 0.13 — 0.94. ConclusionAge， sex， BMI， alcoholic AP， moderate-to-severe AP， blood calcium， CTSI score， and Glu are influencing factors for PPDM-A. The nomogram model constructed based on the above influencing factors shows good performance in predicting the risk of PPDM-A and can thus provide a reference for developing prevention strategies for PPDM-A in clinical practice.

Objective:To observe the effects of early energy intake and early enteral nutrition on prognosis of patients during extracorporeal membrane oxygenation (ECMO).Methods:Patients who received ECMO treatment in the emergency intensive care unit (EICU) of the Jiangsu Provincial Hospital (First Affiliated Hospital of Nanjing Medical University) from January 2021 to June 2022 were selected as subjects to summarize the early energy intake of ECMO patients. Logistic regression analysis and restricted cubic spline (RCS) analysis were used to determine the relationship between early energy intake and prognosis of ECMO patients. According to the results of RCS analysis, the patients were divided into energy-deficient group and energy-sufficient group. And according to whether early enteral nutrition (EEN) was initiated, the patients were divided into EEN group and non-EEN group. The differences of clinical outcomes between energy-deficient group and energy-sufficient group, EEN group and non-EEN group were compared.Results:There was no significant difference in age, sex, BMI, primary disease and ECMO pattern between energy-deficient group and energy-sufficient group, EEN group and non-EEN group. The ECMO conversion time (days) and hospitalization time (days) in the energy-deficient group were significantly lower than those in the energy-sufficient group, and the survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group [43.2% (19/44) vs. 66.0% (31/47), P=0.029]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group, and the risk of death was 2.595 times higher than that in the energy-sufficient group. The conversion time (days), hospital stay (days) and average daily energy intake [kcal/(kg·d)] in the EEN group were higher than those in the non-EEN group ( P<0.05), and the survival rate in the non-EEN group was significantly higher than that in the non-EEN group [66.1% (41/62) vs. 31.0% (9/29), P<0.002]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the non-EEN group was significantly lower than that in the EEN group, and the risk of death was 2.981 times higher than that in the EEN group ( P<0.001). Conclusions:The energy intake of patients with ECMO above 16.94 kcal/ (kg·d) is a protective factor for prognosis. EEN helps to increase early energy intake and improve prognosis in patients during ECMO.

Objective:To explore the application value of case-based learning (CBL) and problem-based learning (PBL) dual-track teaching mode in the standardized resident training in laboratory medicine.Methods:The students of Grade 2017 and Grade 2018, who underwent standardized resident training of laboratory medicine in the Second Affiliated Hospital of Wenzhou Medical University from September 2017 to June 2021, were selected in this study. Seven students of Grade 2017 were served as the traditional lecture teaching group (traditional teaching group), and 12 students of Grade 2018 were assigned to the CBL-PBL dual-track teaching mode group (CBL-PBL group). Students of the two groups received 22 months of laboratory specialty training, and underwent one admission theory assessment,two mid-term theory assessments, annual professional level test, final theory assessment, final practical skills assessment as well as questionnaire survey. The questionnaire was distributed and finished anonymously after the final assessment. Survey indicators included ability assessment on solving clinical problem, assessment on the theoretical knowledge, computer operation skill, preparation time before teaching, teaching method satisfaction degree and clinical recognition. The results were divided into 5 categories: extremely agree, agree, general, disagree and extremely disagree, respectively (ranked as 5, 4, 3, 2, and 1). The Cronbach′s α coefficient was used to analyze the reliability of the questionnaire.Results:The mid-term theory assessment, annual professional level test and assessment results of clinical outcome interpretation were significantly higher in CBL-PBL dual-track teaching mode group than those in traditional lecture teaching group (all P<0.05). The performance after standardized resident training was significantly higher in the CBL-PBL group than in the traditional teaching group ( P<0.05). The Cronbach′s α coefficient of questionnaire reliability analysis was 0.938. Parameters assessment results including improved clinical problem-solving skills, computer operation skill, the ability to analyze and solve problems, the ability of innovation and adaptation, the learning interest, the ability of autonomous learning, teaching method satisfaction and conventional application to clinical recognition scores were all significantly better in the CBL-PBL group than those in the traditional teaching group (all P<0.05). Conclusion:The application of CBL-PBL dual-track teaching mode for the standardized resident training in laboratory medicine can effectively improve the assessment results and performance of students undergoing standardized resident training, and help to cultivate high quality medical laboratory professionals.

Objective To investigate the inoculum effect of fosfomycin on enterococci,in comparison with penicillin,rifampin,vancomycin and teicoplanin.Methods A total of 91 strains of enterococci were obtained from the patients hospitalized in The First Affiliated Hospital of China Medical University from January 2010 to January 2012.There was no repeated strain.The 91 strains consisted of 44 Enterococcus faecalis and 47 Enterococcus faecium strains.Agar dilution method was used to measure the minimum inhibitory concentrations (MIC) of the five antibiotics against the 91 enterococci strains under standard low inoculation concentration (1 × 105 colony-forming units [cfu]/mL) and high inoculation concentration (1 × 107 cfu/mL).Results For all tested strains,MIC of fosfomycin fluctuated between 16-64 tμg/mL in high and low inoculated concentrations.Among the tested strains,both Enterococcus faecalis and Enterococcus faecium had the highest drug-sensitive rate (100.0％) and the lowest drugresistance rate (0) to fosfomycin.With the increase of the inoculation concentration,MIC of the five antibiotics increased less than 8 times,which indicated that there was no inoculation effect.Conclusion Fosfomycin shows high drug-sensitivity against enterococci without inoculum effect in vitro,and it is recommended for the treatment of enterococci-infected patients.

Objective To explore the perioperative nursing of elderly patients undergoing esophageal hiatal hernia repair with laparoscope. Method Twenty elderly patients undergoing esophageal hiatal hernia repair with laparoscope were managed with holistic nursing and the key nursing points were summarized. Results After operations, 3 of them contracted with dysphagia, 5 with weakened gastrointestinal motility, 6 with pulmonary infections, 3 with dyspnea and 1 with thrombus in the deep veins of lower extremities. All the 20 patients got recovered successfully after pertinent treatments. 3 months follow-ups showed the clinical symptoms disappeared and barium meal showed no relapse of hernias. Conclusion Strengthened perioperative nursing of operations on esophageal hiatal hernia is beneficial for postoperative recovery and reduction of postoperative complications.

Objective To explore the clinical features,risk factors and the sensitivity to antibiotics of lower respiratory tract acinetobacterial infection.Methods The clinical data,results of sputum bacterial culture and drug sensitivity of the 72 cases with lower respiratory tract acinetobacterial infection were netrospectively reviewed.Results 53 cases(73.6%)were elder than 60 years old,69 cases(95.8%)had basic diseases,and 59 cases(81.9%)were nosocomial infection.Risk factors included basic diseases,lower immune function,all kinds of invasive operations,aerosol inhalation,unreasonable usage of antibiotics.Drug sensitivity test showed that the drugs which sensitive to acinetobacter was upper than 50% included Imipenen,Levofloxacin,Cefooerazone/sulbactum and Amikacin.Conclusion The patients who sufferred from lower respiratory tract acinetobacterial infection usually are elder than 60 years old,and have basic diseases.Most of this kind of infection is nosocomial infection.Because of severe clinical symptom and high drug resistant rate,the prognosis is poor.Reasonable selection of sensitive antibiotics is important.

Objective To discuss the clinical characteristics of thalamic hemorrhage,the correlative risk factor and the factors influencing prognosis.Method The clinical datas of 74 cases of thalamic hemorrhage and CT examination results were analyzed to find out the relationship between the clinical characteristics and the prognosis.Results The old age and hypertension were the main causes of thalamic hemorrhage.The mortality of thalamic hemorrhage that rupturing into ventricle was higher than that not rupturing into ventricle.Conclusions The old age and hypertension are the main causes of thalamic hemorrhage.The clinical manifestation of thalamic hemorrhage is variety.The prognosis is related weith age,blood pressure and the present of rupturing into ventricle.

Objective To explore the etiology of pulmonary atelectasis and explore the value of fiberoptic bronchoscope in the diagnosis and treatment of pulmonary atelectasis.Methods 192 cases of pulmonary atelectasis confirmed by thoracic X-ray and CT were examined and treated under fiberoptic bronchoscope.Results The final cause of 192 cases pulmonary atelectasis was lung cancer in 122 cases,chronic inflammation in 35 cases,tuberculosis in 24 cases,foreign body in 3 cases,blood clot obstruction in 3 cases,no clear causes in 5 cases;97.4% of pulmonary atelectasis were diagnosed.The treatment of pulmonary atelectasis caused by tumor obstruction was ineffective under fiberoptic bronchoscope;Then for others,atelectasis of patients was re-expanded completely in 65.7% after treatment one week under fiberoptic bronchoscope,re-expanded partially in 27.1% and the effective rate was 92.8%.Conclusion The rate of etiologic diagnosis of pulmonary atelectasis under fiberoptic bronchoscope is high;The main causes of pulmonary atelectasis are lung cancer,chronic inflammation and tuberculosis.The pulmonary atelectasis with no clear cause should be examined with fiberoptic bronchoscope.The treatment under fiberoptic bronchscope is effective for non-tumor atelectasis.