Objective:To identify early potential risk factors for sepsis-associated liver injury and to provide a reference for early clinical identification and intervention.Methods:The clinical data of septic patients admitted to the intensive care unit (ICU) in the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from March 2020 to April 2023 were retrospectively analyzed. Patients with sepsis were categorized into the liver injury group and the non-liver injury group according to whether liver injury occurred or not, univariate and multivariate logistic regression analyses were used to explore the risk factors for SALI, receiver operating characteristic (ROC) curve analysis was used to assess its predictive effect for SALI, and performed subgroup analyses basing on the cut-off point.Results:Among 530 eligible patients, 403 patients were included. The incidence of liver injury was 39.45% in 159 cases with liver injury and 244 cases without liver injury. Multivariate logistic regression analysis showed that serum prealbumin, lactate and lactate dehydrogenase were independent risk factors for SALI. ROC curve analysis showed that all single indicators had some predictive value for SALI, the area under the curve was prealbumin (AUC: 0.752, 95% CI: 0.703-0.801), lactate (AUC: 0.679, 95% CI: 0.627-0.732), lactate dehydrogenase (AUC: 0.664, 95% CI: 0.611-0.718), respectively, The AUC for predicting SALI by lactate/prealbumin ratio (L/P) and lactate dehydrogenase/prealbumin ratio were 0.808 (95% CI: 0.766-0.850) and 0.795 (95% CI: 0.750-0.840), respectively, with the best efficacy of L/P in predicting SALI. Subgroup analyses showed that the incidence of liver injury was significantly higher in septic patients with L/P ≥0.23 than that in septic patients with L/P <0.23, at the same time, the acute physiology and chronic health evaluation II score, shock probability, and hospital mortality rate also increased accordingly, the differences were all statistically significant (all P < 0.001). Conclusions:L/P is early independent risk factor of SALI, for sepsis patients with L/P≥0.23 should be alerted to the development of liver injuryis.

Objective:To explore the implementation method of case teaching in pharmacology teaching according to the standards of golden course.Methods:The students from Batch 2017 clinical medical students in our university were selected as the research objects, and randomized into the control group ( n=121) and the case teaching group ( n=171). The control group used online learning and traditional lecture, and the case teaching group adopted the online teaching and case teaching methods. And the teaching effect was evaluated by questionnaire survey and final performance analysis. Results:Compared with control group, the case teaching group had better final performance ( P<0.01). The questionnaire survey showed that the case teaching improved the learning interest of students and also enhanced their application ability of the knowledge ( P<0.01 or P<0.05). Conclusion:Case teaching has achieved good teaching effect in pharmacology teaching.

Objective? To investigate the improving effect of nursing intervention based on Roy adaptation model on sleep condition of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods? A total of 118 patients with AECOPD admitted to Department of Respiratory Medicine, the First Affiliated Hospital of Zhengzhou University from July 2016 to May 2018 were selected by stratified sampling method. They were divided into observation group and control group according to random number table method, with 59 cases in each group. The control group was given conventional nursing care, while the observation group was given nursing intervention based on Roy adaptation model on the basis of the conventional nursing care. Before and after the intervention, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Social Support Rating Scale (SSRS), the Pittsburgh Sleep Quality Index (PSQI) were used to evaluate negative emotions, social support, sleep quality and quality of life of the patients. After the intervention, the nursing satisfaction of the two groups was compared. Results? After 2 weeks of intervention, the scores of SAS (26.33±4.72) and SDS (43.17±6.29) of the observation group were lower than those before intervention;the score of SSRS (34.21±6.95) was higher than that before intervention, and the observation group were all better than the control group, the differences were statistically significant (P＜ 0.05). After intervention, the PSQI scores of the observation group (5.01±1.27) and the control group (6.33±1.74) were statistically different (t=4.707, P＜0.05). The overall satisfaction of the patients in the observation group was 93.33% and that in the control group was 77.97%. There was a significant difference between the two groups (P＜ 0.05). Conclusions? Compared with conventional nursing, nursing intervention based on Roy adaptation model can better improve the negative emotions and social support of AECOPD patients, and improve sleep and nursing satisfaction.

Objective To explore the predictive value of early changes in platelet counts in the prognosis of severe pneumonia in aged patients.Methods This retrospective study included elderly patients with severe pneumonia,who were ≥65 years old and whose length of ICU stay ≥72 hours,admitted to the intensive care unit(ICU)of NO.2 People's Hospital of Changzhou from January 2014 to January 2017.They were divided into a survival group and a death group according to the 28-day outcome.General information and serum platelet levels at 0,24,36,and 72 hours after admission were collected.Receiver operating characteristic curve (ROC)was plotted according to platelet counts,changes in platelet counts and rates of change in platelet counts to evaluate their predictive value for 28-day prognosis.Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between different groups of patients,who were further divided according to platelet counts at 0 and 72 hours after admission to ICU,changes in platelet counts and rates of change in platelet counts at 72 hours after admission.Results (1)One hundred elderly patients with severe pneumonia were enrolled,among whom 41 cases were in the death group,thus with a mortality of 41.0％.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),sequential organ failure assessment (SOFA),C-reactive protein (CRP),and procalcitonin(PCT)in the death group were significantly higher than those in the survival group.2)Serum platelet levels showed a downward trend in both the death group and the survival group.The level of serum platelets at 72 hours after admission to ICU in the death group was significantly lower than that in the survival group(80.00 × 109/L vs.171.00 × 109/L,Z=5.786,P＜0.05);changes in platelet counts and rates of change in platelet counts in the death group were significantly higher than those in the survival group,especially at 72 hours after admission to ICU(/△PLT72:-79.00 × 109/L vs.-38.00 × 109/L,Z =4.938,P ＜0.05;△PLT 72％:43.6％ vs.-17.7％,Z=6.816,P＜0.05).(3)ROC curve analysis showed that platelet levels,changes in platelet counts,and rates of change in platelet counts could predict 28-day mortality in aged patients with severe pneumonia.The largest area under ROC curve was 0.902 when plotted with the rate of platelet counts at 72 hours after admission to ICU.Using the cut-off value of-36.14％ in the rate of change at 72 hours after admission to evaluate the predictive value in 28 day mortality,the sensitivity and specificity were 89.8％ and 75.6％,respectively.(4)Kaplan-Meier survival analysis showed that the 28 day survival rate was significantly higher and the length of survival was significantly greater when platelet counts at 0 and 72 hours after admission to ICU were higher than the cut-off value,and this also occurred in changes in platelet count and rates of change at 72 hours after admission to ICU.Conclusions Continuous decline in serum p[atelet levels indicates poor prognosis.When combined with platelet counts,changes in platelet counts and rates of change in platelet counts at 72 hours after admission to ICU,it may play an important role in assessing the prognosis of aged patients with severe pneumonia.

Aim To investigate the antitumor and antiangiogenic effects of combined low-dose cyclophosphamide(CTX)and recombined VEGF protein vaccine.Methods In this experiment,H22 hepatocellular carcinoma model was established in BALB/c mice.Mice were randomly divided into four groups: control group,CTX group(CTX),VEGF protein vaccine group(V2)and CTX plus V2 group(CTX+V2).The anti-tumor efficacy and antiangiogenic effect were investigated using a subcutaneous tumor model and an intradermal tumor model.Western blot and ELISAwere further adopted to detect the specific anti-VEGF antibody.Results CTX+V2 group displayed a lower tumor volume and tumor weight than either the single therapy group in the subcutaneous tumor model(P<005 vs V2,P<001 vs CTX).Meanwhile,CTX+V2 was more effective for antagonizing tumor-associated angiogenesis compared with either the single therapy(P<005 vs V2,P<001 vs CTX).After CTX+V2 immunization,high titer of anti-VEGF antibody was detected by ELISA and verified by Western blot.Conclusion The therapy of CTX combined with V2 has significant synergistic effect against H22 hepatocellular carcinoma.

Objective To study the auditory processing abilities of children with learning difficulty and deter-mine the proportion of the children with auditory processing disorder.Methods A single factor completely random-ized experimental design was used.Seventeen children with learning difficulties and 31 normal children from grade 2 to grade 4 in Beijing were induded in this study.The abilities of low-pass filtered speech,competing sentences,di-chotic digits and frequency patterns were tested through auditory processing disorder screening test software.Results There were significant differences in the abilities of listening sentences and digits in competitive environment and recognizing frequency patterns between children with learning difficulty and without.The auditory processing ability of children with learning difficulties was obviously poorer than normal children.The incidence of auditory processing disorder among the children with learning difficulties was 41.176%~58.824%.Conclusion The auditory process-ing ability in the competitive environment of children with learning difficulties was obviously poorer and they need in-tervention specifically.

Objective To explore the predictive value of dynamic serum phosphorus levels in the evaluation of prognosis in patients with sepsis. Methods A retrospective study was conducted. The septic patients admitted to intensive care unit (ICU) of the Second People's Hospital of Changzhou from January 2016 to June 2017 were enrolled, who were ≥18 years old and whose length of ICU stay > 72 hours. These patients were divided into survival group and death group according to 28-day outcome. The general information, the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score within 24 hours of ICU admission, the serum phosphorus at 1, 3, 5, 7 days after admission were collected. Receiver operating characteristic curve (ROC) was plotted according to the dynamic serum phosphorus levels and APACHE Ⅱ score for evaluating the predictive value of 28-day prognosis. Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between two groups of patients, who were divided according to the corresponding time of the serum phosphorus cut-off value. Results ① Eighty-five patients with sepsis were enrolled, among whom 25 cases were in the death group and the mortality was 29.4%. APACHE Ⅱ score in the death group was significantly higher than that in the survival group (22.28±3.98 vs. 16.05±5.44, P < 0.01), the rate of using vasoactive drugs was significantly higher than that in the survival group [64.0% (16/25) vs. 31.7% (19/60), P < 0.01], but there was no significant difference in the length of invasive mechanical ventilation and ICU stay between two groups.② The level of serum phosphorus was increased in survival group along with time of the treatment, and the death group showed a downward trend. The levels of serum phosphorus at 3, 5, 7 days after admission to ICU in death group were significantly lower than those in survival group (mmol/L: 0.90±0.24 vs. 1.05±0.19 at 3 days, 0.96±0.16 vs. 1.11±0.17 at 5 days, 0.83±0.19 vs. 1.21±0.14 at 7 days, all P < 0.01).③ROC curve analysis showed that APACHE Ⅱ score and serum phosphorus level on the 7th day could significantly predict 28-day mortality in patients with sepsis, and the areas under ROC curve (AUC) of them were 0.813 and 0.945 respectively (both P < 0.01). The AUC of serum phosphorus level on the 3rd day and 5th day were 0.692 and 0.745 respectively (both P < 0.01). Based on serum phosphorus cut-off value 1.01 mmol/L on the 7th day to evaluate the predictive value of 28-day mortality, the sensitivity was 91.7%, the specificity was 84.0%, the positive and negative likelihood ratios were 5.73 and 0.10 respectively. ④ Kaplan-Meier survival analysis showed that the 28-day survival rate was significantly higher and the length of survival was significantly longer if the serum phosphorus were higher than the cut-off value at different time points of ICU admission. The 28-day survival rate was significantly higher and the length of survival was significantly longer in the patients with serum phosphorus > 1.01 mmol/L than those serum phosphorus ≤ 1.01 mmol/L on the 7th day [28-day survival rate: 93.2% (55/59) vs. 22.7% (5/22), χ2= 49.697, P = 0.000; survival period (days): 27.1±3.6 vs. 19.8±7.8, t = 4.768, P =0.000]. Conclusion The continuous decline of serum phosphorus indicates poor prognosis, and the serum phosphorus level on the 7th day is one of the most important indicator to evaluate the prognosis of patients with sepsis.

Objective The study systematically reviewed the therapeutic effect of the Kidney-Nourishing therapy on aromatase inhibitor-associated bone loss (AIBL).Methods The databases CNKI, CBM, VIP, Medline and the Cochrane Library were searched. Cochrane collaboration's tool for assessing risk of bias was adopted to assess the quality of trials. The Revman 5.3 software was used for the analysis on the outcome index such as bone minernal density and the level of serum estradiol.Results Meta-analysis was conducted on 11 randomly controlled clinical trials. All 11 studies were concducted in China, and the quality of researches was low. Meta-analysis revealed that the decrement of bone mineral density in the group receiving kidney-nourishing herbs was significantly smaller than that in the control group(P<0.001), theMD was -0.070, 95%CI was (-0.087, -0.053), but there was no significant difference between two groups in the outcome of the serum estradiol level (P=0.159), theMD was -2.622, 95%CIwas(-6.273, 1.030).Conclusion Kidney- Nourishing herbs can delay the process of aromatase inhibitor-associated bone loss, but may not influence the serum estrogen level.

Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P<0.05) in both groups, and was lower in the prehabilitation group than in the control group before and six weeks after TKA (t>2.827, P<0.01). There was no significant difference in AROM of knee flexion when enrolling and before TKA in both groups (t<0.648, P>0.05), and it increased in the control group six weeks after TKA (t>3.555, P<0.01), and no increasement was found in the prehabilitation group (t<1.608, P>0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P<0.05). The muscle strength of trunk extention and flexion enhanced before TKA in the prehabilitation group (t>2.387, P<0.05), and no change was found in the control group (t<0.940, P>0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t<1.656, P>0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t<0.350, P>0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P<0.001), there was no significant difference in it between two groups six weeks after TKA (t=-0.497, P=0.622). The score of HSS-KS increased before TKA (t=-2.621, P=0.015) in the prehabilitation group, and no increasement was found in the control group (t=2.073, P=0.053), and they were higher in the prehabilitation group than in the control group before and six weeks after TKA (t>2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.

Objective To investigate the inpatients′satisfaction with the hospital environment,medical process,medical skills and service attitudes,in order to provide evidence for improving the hospital cultural construction and patients′satisfaction level.Methods According to the stratified sampling by the department,the study investigated 521 inpatients from a second-class hospital using questionnaire survey.Results Approximately 62.2% of the participants were satisfied with the “hardware”of the hospital culture and 66.8% were satisfied with the “software ” of the hospital culture.However,there were no statistical differences between these satisfactions (χ2 =0.046,P >0.05).Conclusions A considerable proportions of the participants are not satisfied with the current hospital culture.Thus,the hospitals should enhance their cultural construction and education,as well as improve the medical procedures and technical skills,in order to promote patients′rehabilitation and satisfaction level.