Objective:To evaluate the early predictive value of serum procalcitonin (PCT) , C-reactive protein (CRP) , and white blood cell count (WBC) levels for pancreatic fistula after pancreaticoduodenectomy (PD) .Methods:Data of 93 patients undergoing PD in Department of Pancreatic Surgery at the First Affiliated Hospital of Xinjiang Medical University from Jan. 2017 to Nov. 2019 were retrospectively analyzed. The general information of patients before surgery and postoperative pancreatic fistula were recorded. The levels of serum PCT, CRP, and WBC before surgery and 1st, 3rd, and 5th days after operation were recorded. Patients were divided into pancreatic fistula group (63 cases) and non-pancreatic fistula group (30 cases) . The preoperative data were compared between the two groups. Box plot and the receiver operating characteristic curve (ROC) were drawn. The area under the ROC curve (AUC) was calculated. The sensitivity and specificity of PCT, CRP, and WBC levels in predicting pancreatic fistula alone and jointly were calculated.Results:There were no statistically significant differences in the age, gender, presence or absence of diabetes, total bilirubin, preoperative albumin, surgical time, or intraoperative bleeding in the general information of the pancreatic fistula group and the non-pancreatic fistula group. The difference in index (BMI) was statistically significant. The value of PCT, CRP, and WBC before operation and the value of PCT on the first day after operation were not statistically significant between the two groups ( P=0.424, 0.819, 0.484, and 0.072, respectively) . The PCT values on the 3rd and 5th days after surgery, the values of CRP and WBC on the 1st, 3rd, and 5th days after surgery were all statistically significant (all P values were<0.05) . The area under the ROC curve was jointly predicted by the three at the 3rd and 5th days after operation (AUC=0.792, 0.812) , and the sensitivity (62.9%, 71.4%) and specificity (83.3%, 80%) were better than the three alone. Conclusion:PCT, CRP, and WBC values on the 1st, 3rd, and 5th days after surgery alone have certain limitations in predicting pancreatic fistula, and the combined prediction of the three is more valuable.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Non-neonatal tetanus remains a serious public health problem, although neonatal tetanus has been eliminated in China since 2012. Non-neonatal tetanus is a potential fatal disease. In the absence of medical intervention, the mortality rate of severe cases is almost 100%. Even with vigorous treatment, the mortality rate remains 30%-50% globally. These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China, in order to improve medical quality and safety. These specifications introduce the etiology, epidemiology, pathogenesis, clinical manifestations and laboratory tests, diagnosis, differential diagnosis, grading and treatment of non-neonatal tetanus.

Tetanus consists of neonatal tetanus and non-neonatal tetanus.Non-neonatal tetanus remains a serious public health problem,although neonatal tetanus has been eliminated in China since 2012.Non-neonatal tetanus is a potential fatal disease.In the absence of medical intervention,the mortality rate of severe cases is almost 100％.Even with vigorous treatment,the mortality rate is still 30％-50％ globally.These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China,in order to improve medical quality and safety.These specifications introduce the etiology,epidemiology,pathogenesis,clinical manifestations and laboratory tests,diagnosis,differential diagnosis,grading and treatment of non-neonatal tetanus.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Although neonatal tetanus in China has been eliminated since 2012, non-neonatal tetanus remains a serious public health problem. Non-neonatal tetanus is a potential fatal disease, and the mortality rate of severe cases is almost 100% in the absence of medical intervention. Even with vigorous treatment, the mortality rate is still 30~50% globally. In order to standardize the diagnosis and treatment of non-neonatal tetanus in China, this specification is hereby formulated. This standard includes etiology, epidemiology, pathogenesis, clinical manifestations, laboratory tests, diagnosis, differential diagnosis, classification, grading and treatment of non-neonatal tetanus.

Objective? To?compare?the?efficacy?and?safety?of?conservative?and?conventional?oxygen?therapy?in?critically?ill?patients.? Methods? Relevant?literature?and?randomized?controlled?trials?(RCTs)?about?the?effect?of?conservative?oxygen?therapy?and?conventional?oxygen?therapy?on?the?prognosis?of?intensive?care?unit?(ICU)?critically?ill?patients?was?searched?from?CNKI,?VIP,?Wanfang?Data,?Chinese?Clinical?Trial?Registry,?PubMed,?Embase,?the?Cochrane?Library,?and?ClinicalTrials.gov?by?using?the?keywords?"critically?ill?patients,?conservative?oxygen?therapy,?liberal?oxygen?therapy,?conventional?oxygen?therapy,?mortality"?until?October?30th?in?2018.?The?main?outcome?indicators?were?short-term?mortality?(28-day?mortality?or?ICU?mortality);?secondary?indicators?were?90-day?mortality,?duration?of?mechanical?ventilation,?the?length?of?ICU?stay,?total?hospitalization?time,?new?infection?rate?in?ICU?and?incidence?of?new?organ?dysfunction?in?ICU.?In?the?conservative?oxygen?therapy?group,?the?aim?of?pulse?oxygen?saturation?(SpO2)?was?0.90-0.92?or?the?arterial?partial?oxygen?pressure?(PaO2)?was?70-100?mmHg?(1?mmHg?=?0.133?kPa),?while?in?conventional?oxygen?therapy?group?SpO2?>?0.96?or?PaO2?>?150?mmHg.?Literature?search,?quality?evaluation?and?data?extraction?was?conducted?independently?by?the?two?authors.?The?quality?of?these?study?was?evaluated?using?Cochrane?risk?deviation?assessment?tool,?and?the?relevant?data?were?analyzed?using?RevMan?5.3?software.? Results? Four?studies?were?included?in?the?analysis,?these?studies?were?assessed?as?moderate?to?high?quality?studies.?A?total?of?1?076?patients?were?enrolled,?with?539?in??the?conservative?oxygen?therapy?group?and?537?in?the?conventional?oxygen?therapy?group.?Compared?with?conventional? oxygen?therapy?group,?short-term?mortality?[odds?ratio?(OR)?=?0.66,?95%?confidence?interval?(95%CI)?=?0.50-0.87,?P?=?0.003]?and?the?incidence?of?new?organ?dysfunction?in?ICU?(OR?=?0.64,?95%CI?=?0.41-0.99,?P?=?0.04)?were?significantly?decreased?in?conservative?oxygen?therapy?group,?duration?of?mechanical?ventilation?was?significantly?prolonged?[standardized?mean?difference?(SMD)?=?17.17,?95%CI?=?7.14-27.21, P?=?0.000?8].?But?there?was?no?significantly?difference?in?90-day?mortality?(OR?=?0.83,?95%CI?=?0.59-1.17,?P?=?0.28),?new?infection?rate?in?ICU?(OR?=?0.90,??95%CI?=?0.66-1.21,?P?=?0.47),?the?length?of?ICU?stay?(SMD?=?-0.22,?95%CI?=?-1.02-0.59,?P?=?0.60)?and?total?hospitalization?time?(SMD?=?1.44,?95%CI?=?-1.43-4.31,?P?=?0.32)?between?the?two?groups.? Conclusion? Compared?with?conventional?oxygen?therapy,?conservative?oxygen?therapy?can?reduce?short-term?mortality?and?the?incidence?of?organ?dysfunction?in?critically?ill?patients,?but?cannot?decrease?the?length?of?ICU?stay?and?total?hospitalization?time.

Objective To understand the situations of departments of intensive care units (ICUs) of different level hospitals in Guizhou Province, and to provide directions and evidences for improving quality control in critical care medicine.Methods A county-level hospital and a provincial-level hospital's comprehensive ICU in Guizhou Province were selected to record and analyze and compare the structural indicators, patient admission and transfer, disease distribution, ventilator associated pneumonia (VAP), intravascular catheter related blood stream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) of the two hospitals' comprehensive ICU in 2017.Results The ICU of the People's Hospital of Suiyang County (county hospital) was found in 2012, and the ICU of the Affiliated Hospital of Guizhou Medical University (provincial hospital) was found in 1994. Until 2017, there were 10 and 46 beds, 6 (all of them hold bachelor's degree) and 18 physicians (6 of them hold PhD, 5 of them hold master's degree, 7 of them hold bachelor's degree), 17 (4 of them hold bachelor's degree, 13 of them hold college degree or graduated from secondary school) and 69 nurses (2 of them hold master's degree, 53 of them hold bachelor's degree, 14 of them hold college degree or graduated from secondary school) in the two ICUs respectively, there were significant differences in the education background of the physicians and nurses between the two ICUs (bothP < 0.01). During 2017, 471 cases were admitted to the ICU of the county hospital while 1633 cases were admitted to the ICU of the provincial hospital. Compared with the ICU of the provincial hospital, the ratio of the patients with acute physiology and chronic health evaluationⅡ(APACHE Ⅱ) ≥ 15 at admission was lower (74.8％ vs. 85.1％,P < 0.01), the ratio of direct admission was higher (30.8％ vs. 17.4％,P < 0.01), the ratio of the patients admitted to the ICU more than once was lower (0.8％ vs. 5.0％,P < 0.01), the ratio of the patients whose the length of ICU stay less than 24 hours was higher (51.6％ vs. 13.7％,P < 0.01), the ratio of the patients whose the length of ICU stay more than 28 days was lower (1.1％ vs. 2.9％, P < 0.05), the ratio of the patients discharged against-advice (25.5％ vs. 20.5％,P < 0.05) was higher, the ratio of the patients transferred to other hospitals was higher (5.1％ vs. 0.3％,P < 0.05), and the ICU mortality was lower (4.0％ vs. 13.9％,P < 0.01) in the ICU of the county hospital. The top three kinds of diseases treated in the ICU of the county hospital were brain injury (27.4％), trauma (19.1％) and toxication (6.8％); while in the ICU of the provincial hospital were brain injury (18.6％), sepsis (16.2％) and severe acute pancreatitis (4.8％). In addition, the incidences of VAP, CRBSI and CAUTI in the ICU of the county hospital were 10.0/1000 ventilator days, 1.4/1000 catheter days, 0.5/1000 catheter days; while in the ICU of the provincial hospital were 5.8/1000 ventilator days, 2.0/1000 catheter days, 3.7/1000 catheter days, respectively.Conclusions There are short of physicians and nurses in the ICU of the provincial and county hospitals in Guizhou Province, and the educational level of the medical staff in the ICU of the county hospital is relatively low. Moreover, there were significant differences in the admissions and treatments and the outcomes of the critically ill patients between the two ICUs. The characteristics of the ICUs of county hospitals should be fully considered when the quality control of critical care medicine and continuing medical education are done.

Objective To analyze the anticoagulation in patients with atrial fibrillation.Methods A retrospective analysis of anticoagulant therapy situation in 926 patients with atrial fibrillation was conducted,in order to sum up experience and improve the understanding of atrial fibrillation.Results In 926 patients with atrial fibrillation,there were no anticoagulant therapy in 675 patients,accounting for 72.89%,while only 251 cases received the treatment of anticoagulation,accounting for 27.11%.Only 66 patients aged>75 years were treated with anticoagulant therapy,accounting for 33.17%.The patients with coronary heart disease,in 17.60% and with anticoagulation treatment,the patients with diabetes in 28.37% and received anticoagulation therapy,28.32% patients with anticoagulation therapy in patients with hypertension,30.77% patients with cardiac insufficiency with anticoagulant therapy.Choice of treatment of aged>75,hypertension,coronary heart disease,clinical treatment strategies and patients were the main factors that affected the use of warfarin,but only>75 years of age,coronary heart disease,choice of treatment factors with statistical significance of three factors(OR=7.02,12.73,4.79,all P<0.05).675 cases without anticoagulant therapy in 101 patients with non warfarin treatment indications without the use of warfarin anticoagulation treatment,accounted for 14.96%.In addition,there were 574 AF patients with warfarin treatment indications and treatment with warfarin,analysis of its causes:63 cases had anticoagulant contraindications,172 cases for the doctor too much about bleeding complications,440 patients were not in accordance with the requirements of the detection of INR.Conclusion The positive effect of warfarin in prevention of ischemic stroke,but in basic hospital application of warfarin anticoagulation in patients with severe AF deficiency,should raise the awareness of risk of grassroots medical staff and patients of atrial fibrillation complicating embolism,do a good job of educating patients,to reduce the incidence of embolic events in patients with atrial fibrillation.

OBJECTIVETo observe the clinical efficacy differences between modified lateral position and prone position in patients treated with electroacupuncture (EA) for lumbar herniated disc (LHD).

METHODSSeventy-six patients with LHD were randomly divided into a lateral position group and a prone position group, 38 cases in each one. The acupoint selection and treatment method were identical in the two groups except the position. Mingmen (GV 4), Yaoyangguan (GV 3), Dachangshu (BL 25), Xiaochangshu (BL 27), Zhibian (BL 54) and Huantiao (GB 30) were selected. EA was given three times a week, ten times were taken as one course and totally 20 times were given. The visual analogue scale (VAS) and Japanese orthopaedic association (JOA) scale were taken as efficacy criteria, which were evaluated before and after treatment as well as one month after treatment.

RESULTSAfter treatment, VAS and JOA were significantly improved in the two groups (lateral position group:JOA 10.60±2.60 vs 18.92±3.87, VAS 8.13±0.99 vs 2.34±0.81; prone position group:JOA 10.94±2.06 vs 17.02±3.96, VAS 8.02±1.05 vs 2.86±0.96, all<0.01); the VAS and JOA in the lateral position group were higher than those in the prone position group (both<0.05). One month after treatment, VAS and JOA were significantly improved in the two groups (all<0.01), which was more significant in the lateral position group (both<0.05).

CONCLUSIONSThe treatment position could influence the efficacy of EA for LHD, and lateral position pre-sents certain advantages to prone position group.

Objective To explore the application effects of the structured intervention model on the protective restriction in psychiatric inpatients.Methods The study investigated 91 8 psychiatric inpatients hospitalized from January 201 3 to December 201 4.The participants were randomly divided into the intervention group (n =469 )and the control group (n =449 ).The patients of intervention group received protective restriction based on the structured intervention model.A standard risk assessment was applied before and after the restriction.The patients of control group received the routine protective restriction.The protection rate, protection duration,and day-night protection time were compared between the two groups.Results The protection rate was 1 5.4% (71 /469)for the intervention group,which was lower than the rate of 20.49%(92 /449)for the control group (P <0.05 ).The difference of day-night protection was also statistically significant between the two arms (P <0.05).Conclusions The application of structured intervention model on the clinical practice can effectively reduce the protection rate and protection duration in psychiatric inpatients.

BACKGROUND:Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE: To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION: Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95%CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95%CI: 1.94-12.09,P< 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.