Risk factors for death and their predictive value on diabetic kidney disease patients in intensive care unit based on MIMIC-Ⅲ database / 中华危重病急救医学

Objective:To analyze the influencing factors of prognosis of patients with diabetic kidney disease (DKD) in intensive care unit (ICU), and analyze their predictive value.Methods:Based on the inpatient information of more than 50 000 patients from June 2001 to October 2012 in the latest version of American Intensive Care Medical Information Database (MIMIC-Ⅲ v1.4), the data of DKD patients were screened out, including gender, age, body weight, comorbidities [hypertension, coronary heart disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD)], sequential organ failure assessment (SOFA) score, the length of ICU stay, the incidence of mechanical ventilation, vasoactive drugs and renal replacement therapy during the ICU hospitalization, complications of other diseases [ventilator-associated pneumonia (VAP), urinary tract infection (UTI), diabetic ketoacidosis (DKA), acute myocardial infarction (AKI)] and prognosis of ICU. At the same time, the blood routine and biochemical data of the first 24 hours in ICU and the extremum values during the ICU hospitalization were collected. Multivariate Logistic regression analysis was used to screen the prognostic factors of DKD patients in ICU, and receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of death risk factors.Results:416 DKD patients were screened out, 20 patients were excluded due to data missing, and finally 396 patients were enrolled, including 220 survival patients and 176 dead patients. Compared with the survival group, the patients in the death group were older (years old: 57.13±13.04 vs. 52.61±14.15), with lower rates of hypertension and CKD (11.4% vs. 23.6%, 26.7% vs. 41.4%), higher SOFA scores and baseline values of blood urea nitrogen (BUN), serum creatinine (SCr) and blood K + [SOFA score: 5.86±2.79 vs. 4.49±2.56, BUN (mmol/L): 18.4±10.0 vs. 14.8±9.0, SCr (μmol/L): 387.2±382.8 vs. 284.6±244.9, K + (mmol/L): 4.64±0.99 vs. 4.33±0.86], and longer ICU stay [days: 2.65 (1.48, 5.21) vs. 2.00 (1.00, 4.00)], and the differences were statistically significant (all P < 0.01). Further analysis of laboratory tests extremum values during ICU hospitalization showed that the maximum (max) and minimum (min) values of white blood cell (WBC), BUN and SCr, and K +max in the death group were significantly higher than those in the survival group [WBC max (×10 9/L): 17.3±10.3 vs. 14.5±7.3, WBC min (×10 9/L): 7.9±4.1 vs. 6.7±2.7, BUN max (mmol/L): 23.8±10.4 vs. 18.8±10.2, BUN min (mmol/L): 11.0±6.6 vs. 9.3±6.6, SCr max (μmol/L): 459.7±392.5 vs. 350.1±294.4, SCr min (μmol/L): 246.6±180.3 vs. 206.9±195.4, K +max (mmol/L): 5.35±0.93 vs. 5.09±0.99], and the minimum values of hemoglobin (Hb min) and glucose (Glu min) were significantly lower than those in the survival group [Hb min (g/L): 87.4±14.5 vs. 90.6±16.5, Glu min (mmol/L): 4.0±1.7 vs. 4.6±2.0], and the differences were statistically significant (all P < 0.05). The incidences of mechanical ventilation and vasoactive drugs during ICU hospitalization in the death group were significantly higher than those in the survival group (37.5% vs. 24.1%, 32.4% vs. 20.0%, both P < 0.01), and the incidences of UTI and AMI in the death group were significantly higher than those in the survival group (29.5% vs. 19.1%, 8.5% vs. 3.6%, both P < 0.05). Multivariate Logistic regression analysis showed that age [odds ratio ( OR) = 1.019, 95% confidence interval (95% CI) was 1.003-1.036, P = 0.023], SOFA score ( OR = 1.142, 95% CI was 1.105-1.246, P = 0.003), WBC min ( OR = 1.134, 95% CI was 1.054-1.221, P = 0.001) and BUN max ( OR = 1.010, 95% CI was 1.002-1.018, P = 0.018) were risk factors of death of DKD patients in ICU. ROC curve analysis showed that the area under ROC curve (AUC) of combination of risks factors of death was 0.706, the sensitivity was 61.6%, and the specificity was 73.2%. Conclusions:In order to prevent DKD patients from getting worse in ICU, we should pay close attention to the blood biochemical indexes, especially the renal function indexes, and give timely treatment. At the same time, we should actively prevent the occurrence of complications such as infection and cardiovascular disease.

Integration of judicial expertise into basic medicaleducation improves the growing up of excellent medical doctors / 基础医学与临床

Through the addition of discussion course associated with judicial expertise during the pre medical education, integration of true and typical forensic pathological cases into basic medical theory and experimental education, further addition of optional course of forensic medicine,and guiding the medical students applying the scientifically training projects about forensic pathology, students may improve their learning interesting and clinical thought, and are made early warning and increase the abilities of preventing and dealing with the suddenly medical tangles in the future, at the same time, the medical teachers also increase their professional levels and teaching qualities.These benefit the growing up of high quality medical doctors, decrease and even prevent the happening of medical tangles.

Regulative effect of Xuanbai Chengqi Decoction on TNF-α and IL-1β in patients with acute respiratory distress syndrome and its mechanical indexes / 实用医学杂志

Objective To study the effects of Xuanbaichengqi decoction on the regulation of inflammatory factors TNF-α and IL-1 β in patients with acute respiratory distress syndrome (ARDS) and its mechanism.Methods 60 patients with ARDS who had been hospitalized from January 2016 to August 2016 were randonly selected and then assigned to a control group (30 patients) and a study group (30 patients).Both groups received routine therapies and mechanical ventilation,and the study group received additional Xuanbaichengqi decoction.Levels of TNF-o,IL-1β and IL-10,and peak inspiratory pressure (PIP),plateau airway pressure (Pplat),PVC,forced vital capacity (FVC),forced expiratory volume in one second (FEV 1),and oxygenation index (PaO2/FiO2) were detected before and after treatment.Results Levels of TNF-α and IL-1βwere significantly lower in the study group than in the control group (P ＜ 0.05).IL-10 level was significantly higher in the study group than in the control group (P ＜ 0.05).And the improvement in PIP and Pplat was also significant in the study group (P ＜ 0.05).Less adverse reactions occurred in the study group.Conclusions Xuanbaichengqi decoction can improve the indexes for respiratory mechanics and pulmonary function in patients on mechanical ventilation and reduce the inflammatory response,having a significant effect.

The application of combined teaching method of case-based learning and W2H2 thinking-type learning in the comparative morphology experiment teaching / 基础医学与临床

The combined teaching method of case-based learning and W2 H2 thinking-type learning was used in the comparative morphology experiment teaching.The teaching method can further strengthen the reform of the compar-ative morphology experiment teaching, and improve the quality of practice teaching.

THE EXPRESSION OF CONNEXIN 43 IN HUMAN CARDIAC CONDUCTION SYSTEM / 解剖学报

Objective To study the expression of connexin 43 in human cardiac conduction system(CCS) and heart. Methods The distribution of CX43 was studied immunohistochemically using of SABC method with antibody CX43. Results Smaller amounts of CX43 can be seen in the nodal myocytes at the periphery of sinoaterial and atrioventricular node whereas in the myocytes at the center of nodes were negative. In the Purkinje fibers, abundant expression of CX43 was found, and in atrial and ventricular myocardium contained abundant amounts of CX43, especially in the intercatalated disk.Conclusion The expression of connexin 43 varies greatly in specific regions of the human heart with different conduction properties. These differences may play a role in regulating electric impulse of cardiac conduction.

A STUDY OF MICROVASCULAR SUPPLY OF MEDIAL ARM FLAP / 解剖学报

Thirty two upper limbs of 16 adult fresh cadavers were studied.Suspension ofbarium sulfate in red latex were injected prior to medial arm flap dissection.Thearm flaps were observed and measured under the magnifying spectacles(3X),and X-ray photographs were taken.The main results obtained are summarized as follows:1.In 30 specimens,there are 386 branches arising from the brachial artery——pure cutaneous branches(67,17.36?1.93%),pure muscular and myocutaneous branches(186,48.182?2.54%)and mixed branches(133,34.46?2.42%).2.The brachial profundal artery arises from the brachial artery about 2 to 3cm.below the lower margin of pectoralis major.The caliber of the artery is 2.22?0.14mm.It supplies the triceps brachii and the skin of medial and dorsal surfaceof the upper part of arm.3.The superior ulnar collateral artery arises from the brachial artery about 6cm,below the lower margin of the pectoralis major.The caliber of the artery is1.71?0.08mm.It supplies the long and medial head of Triceps Brachii and the skinof middle and lower part of arm.It is a main artery of medial arm flap.4.The inferior ulnar collateral artery arises from the brachial artery about 18cm,below the lower margin of pectoralis major.The caliber of the artery is 1.50?0.07mm.5.The myocutaneous artery of biceps brachii arises from the brachial arteryabout 8cm,below the lower margin of pectoralis major.The caliber of the artery is1.63?0.13mm.It gives off a larger cutaneous artery.6.An abundance of anastomoses is formed by these cutaneous arteries and arich network of arteries may be seen.The caliber of some of the cutaneous arteries isabove 1mm.7.The venous drainage consisted of venae comitants.The medial arm flap is generally thin,soft and non-hair-bearing,the caliberand length of the pedicles of the arteries are large enough for microsurgical vasoanas-tomosis.It is a suitable donor site for free transfer of skin flap and the optimaldimension is 8?20cm.