Reference ranges and influencing factors of thyroid function in preterm infants at 14 d after birth / 中华围产医学杂志

Objective:To investigate the reference ranges for thyroid function and its influencing factors in preterm infants at 14 d after birth.Methods:This retrospective study involved 514 preterm infants who met the inclusion criteria in Affiliated Hospital of Inner Mongolia Medical University from January 1, 2019 to December 31, 2021. They were divided into three group according to their gestational age [early premature group (26-31 +6 weeks, n=153), middle premature group (32-33 +6 weeks, n=129) and late premature group (34-36 +6 weeks, n=232)] or birth weight (BW) [<1 500 g group ( n=129), 1 500-2 000 g group ( n=120) and ≥2 000 g group ( n=265)]. Venous blood samples were collected from the infants at 14 d after birth and their thyroid function was determined by chemiluminescence immunoassay. The reference values of free triiodothyronine (FT 3), free thyroxine (FT 4) and thyroid stimulating hormone (TSH) were calculated based on the values of 95% confidence intervals ( CI) and expressed as percentiles in the range from P2.5 to P97.5. Mann-Whitney U test or Kruskal-Wallis H test was used to compare those thyroid hormone levels between groups. Spearman correlation analysis was used to study the correlation of gestational age or birth weight with FT 3, FT 4 and TSH levels. The factors influencing the levels of thyroid hormones were analyzed by multiple linear regression. Results:The reference ranges for FT 3, FT 4 and TSH were 1.53-3.72 pg/ml, 0.81-1.91 ng/dl and 1.32-7.80 μIU/ml in the early premature infants, 1.74-4.16 pg/ml, 0.90-2.82 ng/dl and 0.63-7.64 μIU/ml in middle prematures and 2.07-4.88 pg/ml, 1.09-2.27 ng/dl and 1.14-7.06 μIU/ml in late prematures. The reference ranges for the above three indexes were 1.53-4.06 pg/ml, 0.81-1.83 ng/dl and 1.14-7.84 μIU/ml in premature infants with BW<1 500 g, 1.67-3.98 pg/ml, 0.88-2.97 ng/dl and 0.94-7.64 μIU/ml in those whose BW between 1 500 g and 2 000 g and 1.91-4.75 pg/ml, 1.09-2.31 ng/dl and 1.14-6.32 μIU/ml in those whose BW≥2 000 g. Multiple linear regression showed that the level of FT 3 was positively correlated with gestational age ( β=0.119, P<0.05) and birth weight ( β=1.950×10 －4, P<0.05); that of FT 4 was positively correlated with gestational age only ( β=0.031, P<0.05); and TSH level was negatively correlated with birth weight ( β=－4.250×10 －4, P<0.05). Conclusions:Gestational age and birth weight are the factors influencing thyroid function in preterm infants at 14 d after birth. Evaluation of thyroid function with FT 4 and TSH should based on the references ranges of different gestational age and birth weight .

Effects of arsenic, selenium, lead and chromium in urine on blood pressure in people from arsenic exposure areas of Togtoh County, Inner Mongolia Autonomous Region / 中华地方病学杂志

Objective:To learn about the incidence of hypertension in residents of arsenic exposure areas of Togtoh County, Inner Mongolia Autonomous Region, and to analyze the influencing factors of hypertension.Methods:In Inner Mongolia Autonomous Region, Ciweigou of Togtoh County, a drinking water-type endemic arsenic poisoning area, and Lanjiayao of Horinger County, a non-arsenic poisoning area with similar living habits and economic conditions, permanent residents who had lived for ≥10 years were selected as the survey subjects. Totally 116 residents of Ciweigou (exposure group) and 68 residents of Lanjiayao (control group) were included in the survey. Blood pressure was measured and the contents of arsenic, selenium, lead and chromium in urine were detected, multivariate logistic regression was used to analyze the influencing factors of hypertension.Results:The detection rates of hypertension in exposure group and control group were 53.45% (62/116) and 70.59% (48/68), respectively, and the difference between the two groups was statistically significant (χ 2 = 5.33, P = 0.022). The contents of arsenic, selenium and chromium in urine of exposure group were higher than those of control group, and the content of lead in urine was lower than that of control group, and the differences were statistically significant ( Z = 13.04, 6.34, 11.28, - 9.91, P < 0.001). The results of multivariate logistic regression analysis showed that female, age ≥60 years old and high urinary arsenic content were the influencing factors of hypertension [odds ratio ( OR) = 2.074, 2.004, 0.424, 95% confidence interval ( CI): 1.113 - 3.866, 1.035 - 3.879, 0.219 - 0.820] in arsenic exposure areas. Conclusion:Female, age ≥60 years old and high urinary arsenic content are the influencing factors of hypertension in arsenic exposure areas of Togtoh County, Inner Mongolia Autonomous Region.

Application of PACS system in the standardized residency training of cardiovascular medicine / 中华医学教育探索杂志

Objective:To evaluate the effect of PACS system (picture archiving and communication system) in the standardized residency training of cardiovascular medicine.Methods:Fifty-nine residents taking the standardized residency training of cardiovascular medicine in Changhai Hospital from 2018 to 2019 were randomly divided into PACS teaching group ( n = 30) and traditional teaching group ( n = 29). The research group adopted the PACS system for the teaching of cardiovascular medicine, and the control group took the traditional teaching method. The teaching effect was evaluated by theoretical examination, imaging examination and questionnaire. SPSS 19.0 was used for t test and chi-square test. Results:The theoretical and film reading scores of the PACS teaching group were significantly higher than those of the control group [(87.70 ± 6.52) vs. (80.55 ± 8.63); (86.67 ± 6.33) vs. (77.48 ± 10.29), P < 0.05)]. The results of the questionnaire showed that PACS teaching method was helpful for residents to master cardiovascular knowledge, arouse their learning interest and improve their clinical thinking ability. The satisfaction with the teaching method in the PACS teaching group was significantly higher than that in the traditional teaching group [(9.22 ± 0.44) vs. (8.26 ± 0.72), P < 0.05]. Conclusion:The application of PACS system in the teaching of cardiovascular medicine can significantly improve the teaching effect of residents.

Simultaneous Determination of 7 Active Components in Mori Australis Cortex and Mori Cortex from Different Sources by HPLC / 中国药房

OBJECTIVE：To establish a meth od for the simultaneous determination of 7 active components in Mori Australis Cortex and Mori Cortex from different sources in Chongqing area ，so as to provide reference for improving the quality control standards of Mori Australis Cortex and Mori Cortex and comparing the equivalence of their quality. METHODS ：HPLC method was used to determine the contents of neochlorogenic acid ，mulberroside A ，chlorogenic acid ，astragalin，kaempferol，morusin and isoquercetin in 58 batches of Mori Australis Cortex and Mori Cortex. The chromatographic column was Diamonsil C 18 with mobile phase consisted of 0.1％ formic acid solution-acetonitrile （gradient elution ） at the flow rate of 1.0 mL/min. The detection wavelength was 280 nm，column temperature was 30 ℃，and the injection volume was 10 μL. Using SPSS 22.0 software， independent sample t-test，principal component analysis and cluster analysis were used to analyze the content difference of the above-mentioned 7 active components in Mori Australis Cortex and Mori Cortex. RESULTS ：There was a good linear relationship between the peak area and the concentration of the above 7 active components （r≥0.999 0）. The RSDs of precision ，stability（24 h），repeatability，durability and recovery were less than 3％. The average contents of neochlorogenic acid ，mulberroside A ， chlorogenic acid ， astragalin， kaempferol， morusin and 023-58576130。E-mail：1025473978@qq.com isoquercetin in Mori Australis Cortex were 0.304，22.462， 1.730，1.308，1.593，2.842 and 0.657 mg/g，respectively. Those of Mori Cortex were 0.305，22.995，2.486，2.438， 2.916，4.158 and 1.264 mg/g，respectively. The results of independent sample t-test showed that only the content of kaempferol in the above 7 active components of Mori Australis Cortex and Mori Cortex had significant difference （P＜0.05）. The results of principal component analysis and cluster analysis showed that there was no significant difference in the contents of above 7 active components between Mori Australis Cortex and Mori Cortex. CONCLUSIONS：The established HPLC method is simple ，sensitive and accurate ，which can provide a reference for improving the quality control standard of Mori Australis Cortex and Mori Cortex. Mori Australis Cortex and Mori Cortex have certain quality equivalence in main active components ，and the Mori Australis Cortex from M. australis and M. cathayana can be used as a substitute for the Mori Cortex.

Survey results of residents in a drinking water-borne endemic arsenism area in Togtoh County Inner Mongolia / 中华地方病学杂志

Objective:To investigate the prevalence of residents in a drinking water-borne endemic arsenism area in Togtoh County Inner Mongolia.Methods:In a drinking water-borne endemic arsenism area (Togtoh County of Inner Mongolia), eighty-five permanent residents (residence time ≥20 years) of Hedgehog Valley were selected as exposure group. In the same period, 58 people from a non-arsenism area (Lanjiayao of Helingeer County) were selected as the control group. The general situation of the respondents was investigated, and water arsenic, urine arsenic, blood glucose, blood lipids, blood pressure, liver function, renal function, electrocardiogram and abdominal B-ultrasound were analyzed in both groups. The exposure group was divided into the disease group and the non-disease group according to whether arsenic poisoning skin lesions occurred, and the general conditions and blood pressure changes in the two groups were analyzed.Results:In the exposure group and control group, there were no significant differences among the indicators such as sex, age, smoking, drinking and taking vitamin or calcium tablet ( P > 0.05). Arsenic concentration [Median (interquartile range)] in drinking water of the exposure group was 163.34 (35.34) μg/L, and in urine was 269.72 (152.54) μg/L. Arsenic concentration in drinking water of the control group was 2.96 (5.62) μg/L, and in urine was 24.21 (28.63) μg/L. There were no statistical differences in blood glucose, blood lipids between the exposure group and control group (χ 2 = 0.865, 0.886, P > 0.05); but liver function, renal function, sinus arrhythmia and fatty liver were significantly different statistically (χ 2 = 4.654, 4.355, 4.725, 12.423, P < 0.05); the detection rate of abnormal blood pressure in control group was higher than that of the exposure group (χ 2 = 16.289, P < 0.01). Skin lesions occurred in 24 patients (28.24%) in the exposure group and no skin lesions in 61 patients (71.76%). In disease group, 14 cases (58.33%, 14/24) smoked, the proportion of smoking was higher than that of cases in non-disease group(31.15%, 19/61, χ 2 = 5.360, P < 0.05); and the prevalence of hypertension (50.00%, 12/24) in cases of disease group was higher than that of cases in non-disease group (26.23%, 16/61, χ 2 = 4.406, P < 0.05). Conclusions:Long-term exposure to arsenic might injure liver function and renal function, and enhance the risk of arrhythmia and fatty liver. Smoking may be a risk factor for skin lesions in residents of drinking water-borne endemic arsenism area.

Simultaneous Determination of 4 Components in Huanshao Capsules by HPLC / 中国药房

OBJECTIVE：To estab lish a me thod for simultaneous determination of morroniside ，loganin，echinacoside and acteoside in Huanshao capsules. METHODS ：HPLC method was adopted. The determination was performed on Zhongpuhong RD-C18 column with mobile phase consisted of acetonitrile- 0.1％ formic acid solution （gradient elution ）at the flow rate of 1.0 mL/min. The detection wavelength was set at 240 nm （morroniside，loganin） and 330 nm （echinacoside，acteoside）. The column temperature was set at 35 ℃，and sample size was 10 μL. RESULTS：The linear range were 5.29-105.80 μg/mL for morroniside， 4.49-89.88 mg/L for loganin ，16.26-325.25 mg/L for echinacoside and 16.31-326.25 mg/L for acteoside ，r values were 0.999 9. RSDs of precision ，stability （24 h），reproducibility and durability tests were all lower than 2.0％ . The recoveries were 94.34％ -96.23％（RSD＝0.81％ ，n＝6），97.04％ -98.89％（RSD＝0.73％ ，n＝6），96.23％ -98.08％（RSD＝0.82％ ，n＝6）， 95.40％-98.47％（RSD＝1.23％，n＝6），respectively. The contents of above 4 components in 11 batches of Huanshao Capsules were 0.190-0.704，0.439-0.857，2.723-4.475 and 0.589-1.035 mg/g，respectively. CONCLUSIONS ：Established method is specific ， precise and can be used for content determination of 4 components in Huanshao capsules.

Changing trend regarding the burden on cerebrovascular diseases between 1990 and 2016 in China / 中华流行病学杂志

Objectives@#To analyze the status quo and trends on the burden of cerebrovascular diseases between 1990 and 2016 in China.@*Methods@#Morbidity mortality, years of life lost (YLL), years of lived with disability (YLD) and disability-adjusted life year (DALY) related to cerebrovascular diseases between 1990 and 2016, were collated and analyzed, according to the results of the Global Burden of Diseases Study 2016 (GBD 2016). Numbers on incidence and morbidity were used to assess the incidence of diseases, while the numbers of death and mortality were used to assess the death of diseases. Years of life lost due to premature death (YLL), years lost due to disability (YLD) and disability-adjusted life year (DALY) were used to assess the burden of diseases. Changing trend on the burden of cerebrovascular disease from 1990 to 2016 was also analyzed.@*Results@#In 2016 and 1990, the numbers of new cases/morbidity and the number of deaths/mortality on cerebrovascular diseases in the country showed an upward trend. Rates regarding YLL and DALY on cerebrovascular diseases remained stable from 1990 to 2016, however, the YLD rate showed a slow upward trend. The changing rate of DALY was mainly influenced by YLL. Both DALY and YLL crude rates in males showed a slow upward trend, with the highest DALY rate appearing in the ≥70 age group. Disease burden on males was heavier than that of the females and in the 50-60 age group, which taking the largest proportion. As for the composition in DALY, YLL appearing much larger than YLD and slowly increasing. Analysis on the subtypes of diseases, proportions of YLL and DALY in hemorrhagic stroke were greater than that in ischemic stroke while the proportion of YLD in ischemic stroke was in the opposite.@*Conclusions@#The burden of disease on cerebrovascular diseases remained heavy and the differences appeared in age, gender and subtypes of diseases. Our findings called for the adoption of measures including screening, intervention and rehabilitation to be taken on target populations, in order to reduce the burden on both individuals and the society.

Research progress in the heatstroke-induced myocardial injury / 中华危重病急救医学

Heat stroke is the most serious type of heat-related diseases, and the induced multiple organ dysfunction syndrome (MODS) is an important cause of death for heat stroke patients. The cardiovascular system is one of the important targets of heat injury. Studies have reported that heat stress can lead to myocardial inhibition, abnormal heart conduction and blood flow redistribution, thus changing the hemodynamic state, leading to obvious abnormalities in electrocardiogram, echocardiography, myocardial injury biological markers and hemodynamic indicators of patients with heat stroke. In this article, the pathophysiological and histological changes and clinical manifestations of heatstroke-induced myocardial injury are reviewed, aiming to provide references for further understanding and research of myocardial damage caused by hyperthermia.

Research progress in the heatstroke-induced myocardial injury / 中华危重病急救医学

Heat stroke is the most serious type of heat-related diseases, and the induced multiple organ dysfunction syndrome (MODS) is an important cause of death for heat stroke patients. The cardiovascular system is one of the important targets of heat injury. Studies have reported that heat stress can lead to myocardial inhibition, abnormal heart conduction and blood flow redistribution, thus changing the hemodynamic state, leading to obvious abnormalities in electrocardiogram, echocardiography, myocardial injury biological markers and hemodynamic indicators of patients with heat stroke. In this article, the pathophysiological and histological changes and clinical manifestations of heatstroke-induced myocardial injury are reviewed, aiming to provide references for further understanding and research of myocardial damage caused by hyperthermia.

Research progress in the heatstroke-induced myocardial injury / 中华危重病急救医学

Heat stroke is the most serious type of heat-related diseases, and the induced multiple organ dysfunction syndrome (MODS) is an important cause of death for heat stroke patients. The cardiovascular system is one of the important targets of heat injury. Studies have reported that heat stress can lead to myocardial inhibition, abnormal heart conduction and blood flow redistribution, thus changing the hemodynamic state, leading to obvious abnormalities in electrocardiogram, echocardiography, myocardial injury biological markers and hemodynamic indicators of patients with heat stroke. In this article, the pathophysiological and histological changes and clinical manifestations of heatstroke-induced myocardial injury are reviewed, aiming to provide references for further understanding and research of myocardial damage caused by hyperthermia.

A randomized controlled study of peramivir, oseltamivir and placebo in patients with mild influenza / 中华内科杂志

Objectives To evaluate the effectiveness and safety of peramivir trihydrate in patients with influenza.Methods This was a randomized,double-blind,double-dummy,placebo and positive control,multicenter clinical trial,comparing peramivir trihydrate with oseltamivir and placebo.The inclusive criteria were 15-70 years old,onset within 48 h,positive rapid influenza antigen test,and febrile(＞38℃) accompanied with at least two associated symptoms.The severe cases complicated with chronic pulmonary and cardiac diseases,malignancies,organ transplantation,hemodialysis,uncontrolled diabetes,immunocompromised status,pregnancy and coexistence of bacterium infections were excluded.All patients were randomized 2:2:1 to receive peramivir,oseltamivir and placebo respectively.The primary endpoint was the disease duration,the secondary endpoints included time to normal axillary temperature and normal living activities,viral response,and adverse effects.Results Following informed consent,133 patients were included in this study.Four patients were exclude due to missing medical records,not fitting inclusion or exclusion criteria and poor compliance.A total of 129 patients were finally analyzed,including 49 cases,54 cases and 26 cases in peramivir group,oseltamivir group and placebo group.The median disease duration were 96 (76,120)hours,105(90,124) hours,and 124 (104,172)hours in three groups respectively(P＞0.05).The time to normal axillary temperature,normal living activities and viral response were not significantly different in three groups(P＞0.05).Conclusion The value of antiviral therapy in patients with mild influenza needs to be further determined.

Advances in pre-hospital recognition and cooling treatment of exertional heat stroke / 中华危重病急救医学

Heat stroke (HS) is a life-threatening illness characterized by an altered level of consciousness with an elevated core body temperature 40 ℃, which may be further classified as exertional heat stroke (EHS) or classical heat stroke (CHS) according to the etiology of the condition. In recent years, the morbidity of EHS increases year by year. The severity and clinical outcome for an EHS casualty have a strong correlation with the area under the time and temperature curve for heat exposure. The early recognition and rapid cooling body core temperature ≤38.9 ℃ within 30 minutes of EHS results in the best clinical outcome and minimize severe multiple organ dysfunction and death for patients. Cold water immersion (CWI) is considered as an optimum cooling method for the reversal of hyperthermia in EHS. Some alternative modalities have also shown acceptable cooling rate, for example, the subjects immersed in a circulated water bath controlled below 20 ℃, tarp-assisted cooling with oscillation, body cooling unit, undressed, air-conditioned room, the whole body and large vessels placed ice packs, massaging the extremities; cold intravenous saline applied to dehydrated one. It is necessary to monitor body core temperature for hypothermia and/or recurrent hyperthermia, and to provide physical care for shivering, agitation, or concerns with the potential discomfort combativeness that may occur during cooling process. In this paper, pre-hospital recognition, care, monitoring and rapid cooling treatment measures of EHS have been reviewed to provide references for early identification of EHS and scientific, reasonable and effective cooling treatment.

Evaluation value of the quick sequential organ failure assessment score on prognosis of intensive care unit adult patients with infection: a 17-year observation study from the real world / 中华危重病急救医学

Objective To investigate the predictive value of quick sequential organ failure assessment (qSOFA) score on the prognosis of adult patients with infection in intensive care unit (ICU). Methods A retrospective analysis was conducted on the clinical data of the infected patients in the ICU of the 401st Hospital of the People's Liberation Army from August 1st, 2000 to December 31st, 2017. The clinical data included patients' gender, age, basic diseases, etc.; the worst values of vital signs and laboratory test results within 24 hours of admission were recorded, the scores of the qSOFA, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluationⅡ(APACHEⅡ) were calculated separately; the outcome of ICU was recorded. The predictive values of three scoring systems were evaluated by receiver operating characteristic curve (ROC). Results Excluding patients with incomplete clinical data, cancer and immunosuppressive patients, a total number of 1 059 patients were enrolled in this study, with 679 males and 380 females, the average age was 72.57±16.06, the ICU mortality was 35.32% (374/1 059). The ROC curve analysis showed that the areas under ROC curve (AUC) of APACHE Ⅱ, SOFA, qSOFA scores to predict the prognosis of infected patients were 0.713, 0.744 and 0.662, respectively. Although the AUC of qSOFA in predicting prognosis was significantly lower than that of other two scoring systems (both P < 0.05), but it still had some predictive ability. According to the Youden index, the best cut-off point for qSOFA was 2 to evaluate the prognosis of the infection, and the sensitivity was 71.65%, the specificity was 53.87%, the positive likelihood ratio was 1.55, the negative likelihood ratio was 0.53, the positive predictive value was 0.426, the negative predictive value was 0.799, and the accuracy was 59.62%. The mortality of the infected patients was increased with qSOFA score, and the mortality difference among patients with different qSOFA scores was statistically significant (χ2= 84.605, P = 0.000). The patients were divided into two groups according to the cut-off value of qSOFA, and the mortality in qSOFA score ≥2 group was higher than that in qSOFA score < 2 group [odds ratio (OR) = 2.767, 95% confidence interval (95%CI) = 2.116-3.617, P = 0.000]. Conclusions qSOFA, SOFA and APACHE Ⅱscores have the capability of predicting the outcome for the infected patients. qSOFA score is expected to be a quick and simple tool to judge the prognosis of ICU infection patients because of its advantages of quick acquisition.

Effect of early enteral nutrition on serum endotoxin and intestinal permeability in patients with severe acute pancreatitis / 中国基层医药

Objective To study the effect of early enteral nutrition ( EN ) on the serum endotoxin and intestinal permeability in patients with severe acute pancreatitis ( SAP ) .Methods Seventy patients with SAP were selected as study objects ,and they were divided into parenteral nutrition ( PN) group and EN group according to the random number table method ,with 35 cases in each group.The PN group was given PN intervention ,while the EN group was given EN intervention .The levels of serum endotoxin and the ratio of the excretion rates of urinary lactulose and mannitol excretion before and after 1 week and 2 weeks of intervention , and the levels of inflammatory factors before and after treatment were measured .Results Before intervention ,the levels of serum endotoxin and the ratio of the excretion rates of urinary lactulose and mannitol excretion had no statistically significant differences between the two groups (t=0.274,P=0.452;t=0.035,P=0.885).After 1 week and 2 weeks of intervention,the levels of serum endotoxin and the ratio of the excretion rates of urinary lactulose and mannitol excretion in the EN group were significantly lower than those in the PN group (t=9.024,10.761,P=0.000,0.000;t=6.935,8.358,P=0.000, 0.000).After treatment,the levels of TNF -α,IL-1β,IL-6 and IL-8 in the EN group were significantly lower than those in the PN group (t=12.674,10.318,9.754,8.307,P=0.000,0.000,0.000,0.002).Conclusion EN has significant influence on the serum endotoxin and intestinal permeability in patients with SAP ,and compared with PN,EN can promote the clearance of serum endotoxin ,reduce the permeability of intestinal mucosa ,and it is worth promoting.

Effect of different pharmaceutical care on medication compliance of elderly patients under the mode of medical care / 中国基层医药

Objective To analyze the effect of different pharmaceutical care on medication compliance of elderly patients under the mode of medical care .Methods 640 elderly patients in the nursing center for self -care were selected as the research subjects .The elderly patients were divided into study group and control group according to the pharmaceutical care model,320 cases in each group.The control group was given traditional pharmaceutical service mode,the study group was given comprehensive drug counseling ,medication guidance and drug related phar-macy services .The medication compliance and satisfaction of the two groups were observed .Results The compliance rate and total compliance rate of the study group were 96.25％,99.37％,respectively,which were significantly higher than 81.87％,94.37％of the control group (χ2 =33.94,13.21,all P<0.05).The satisfaction of the study group was significantly higher than that of the control group (χ2 =8.23,P<0.05).In the two groups,there were no statisti-cally significant differences between medication compliance and record of formal schooling ,age(χ2 =1.16,0.77,all P>0.05).Conclusion Under the mode of medical care ,high quality pharmaceutical care can effectively improve the medication compliance of elderly patients .

Preparation and application of cooling bag for heat stroke in wild field / 中华危重病急救医学

Cooling bag for heat stroke in wild field was invented in order to fulfill rapid cooling for heat stroke in field environment. The cooling bag is composed of the hood, the body cover (which is made up of the anterior portion, the linking, and the posterior portion), the fixed straps, the handles. The length is 200 cm, the regulative width is 60-70 cm, the folding volume is 26 cm× 20 cm× 9 cm, and the weight is 1.4 kg. There are a number of pockets for the cold sources in the hood and the body cover. Fixed straps are set in the upper, middle and lower of the bag. The handles are set in the hood and the body covers. Usage: put the activated cold sources in the pockets, then put off the patient's clothes, stretch his/her arms into the linking, zipper up and wrapped up by the fixed straps; the amount of cold sources can be adjusted or changed according to the temperature. The patient's temperature, blood pressure, intravenous infusion can be monitored during the cooling course. The handles in the hood and the body cover allow the patient to be easily moved and be transferred in rescue. The cooling bag for heat stroke in field has good cooling effect, and are reusable and easy to be carried, operate, monitor and move, with low cost, which make it popularization and application.

A study of outer membrane protein and molecular epidemiology of carbapenem-resistantAcinetobacter baumannii / 中华危重病急救医学

ObjectiveTo study the characteristics of the distribution and drug resistance ofAcinetobacter baumannii, and the epidemiology of the main strains among wards and hospitals, and to investigate the role of outer membrane protein in producing resistance against carbapenems.Methods 145Acinetobacter baumannii strains were collected from July 2013 to July 2014 from Huangdao Hospital Affiliated to Qingdao University and 401st Army Hospital. Antimicrobial susceptibility test was carried out with K-B disk diffusion method. Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) was used for DNA typing and test of homology. The carO gene of outer membrane protein was amplified by PCR, and the outer membrane proteins were extracted by ultrasonication and ultracentrifuge method from 30 randomly selected carbapenem-resistantAcinetobacter baumannii and 17 carbapenem-sensitive strains. Sodium dodecyl sulfate-polyacrylamide gel electropheresis (SDS-PAGE) was used to analyze the expressions of outer membrane proteins.Results 145Acinetobacter baumannii strains were generally resistant to 16 common antimicrobial agents, with the highest susceptibility rate of 79.3% for minocycline, followed by susceptibility rate of 40.7% for amikacin. There were 128 carbapenem-resistant strains (resistance rate of 88.3%), 137 multidrug-resistant strains and 126 extensively drug-resistant strains. The detection rates of carO gene were 97.7%(125/128)and 17.6%(3/17) in carbapenem-resistant and sensitive strains respectively. Around position of relative molecular mass 47 000, 16 of 17 sensitive isolates were expressed this protein, while 20 of 30 resistant ones were detected nothing or fade; 13 of 17 sensitive isolates were expressed around position of relative molecular mass 37 000 and 29 000 while 25 were detected nothing or fade around position of relative molecular mass 37 000 and 23 were detected nothing or fade around position of relative molecular mass 29 000 in 30 resistant ones. 145Acinetobacter baumannii were classified into 8 types based on ERIC-PCR electrophoresis patterns, and the major prevalence types were type A (71 strains) and type E (37 strains).Conclusions Drug resistance of clinically isolatedAcinetobacter baumannii is a serious problem in two hospitals; drug-resistant strains are spread and epidemic among wards and hospitals. The carO gene of outer membrane protein is widespread in carbapenem-resistantAcinetobacter baumannii. The loss or fading of outer membrane protein may play an important role inAcinetobacter baumannii resistance to carbapenems drugs.

N-terminal pro-B-type natriuretic peptide value for predition of mortality among critically ill patients in different age groups in intensive care unit / 中华危重病急救医学

Objective To investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoff value for the mortality in different age groups in critically ill patients.Methods A retrospective study was conducted.295 patients admitted to the intensive care unit (ICU) of 401st Hospital of PLA from January 2011 to October 2012 were divided into two groups according to age [group with age＜65 years old (n=105) and group with age≥ 65 years old (n =190)].The concentrations of serum NT-proBNP,hematocrit (HCT),procalcitonin (PCT),C-reactive protein (CRP),serum creatinine (SCr),estimated glomerular filtration rate (eGFR),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and probability of survival (PS) were recorded within 24 hours.The primary outcome was ICU mortality.Receiver operator characteristic curve (ROC curve) was used to evaluate the value of NT-proBNP for predicting the mortality.Results ① There were no significant differences in the length of stay in ICU,mechanical ventilation rate,the mortality,the incidence of cardiovascular disease,digestive disease,neurologic disease,and the number of patients having received operation,HCT,PCT and CRP between the two groups (all P＞0.05).The percentage of the male,the APACHE Ⅱ score,the percentage of respiratory disease,and NT-proBNP in group with age ≥ 65 years old were higher than those of the group with age ＜ 65 years old [the percentage of the male:51.6％ vs.33.0％,x2=9.093,P=0.003; APACHE Ⅱ score:22.94 ±8.10 vs.19.44 ±8.51,Z=-3.259,P=0.001; the percentage of respiratory disease:29.47％ vs.17.14％,x2=5.472,P=0.024; NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75) vs.2 882.00 (275.15,6 236.00),Z=-5.514,P=0.000]; PS,the percentage of patients having multiple injuries and other diseases and eGFR in group with age ≥65 years old were lower than those of the group with age ＜65 years old [PS:59.0 (31.5,79.0)％ vs.70.0 (40.0,84.0),Z=-3.431,P=0.001; the percentage of multiple injuries:0.53％ vs.17.14％,x2=30.987,P=0.000; the percentage of other disease:5.79％ vs.13.33％,x2=4.962,P=0.030; eGFR (ml·min-1· 1.73 m-2):81.07 (45.77,131.80) vs.95.54 (33.64,165.55),Z=-2.214,P=0.027].② The area under the ROC curve (AUC) [95％ confidence interval (95％ CI)] of NT-proBNP in patients with age＜65 years old was significantly higher than that of group with age≥65 years old and the entire group [0.825(0.738-0.892) vs.0.664 (0.592-0.731) and 0.725 (0.670-0.775),Z1 =-2.835,P1 =0.005; Z2=-1.995,P2=0.046].③ The sensitivity (76.]0％ vs.64.10％),specificity (82.35％ vs.67.12％),positive predictive value (90.0％ vs.75.8％),and negative predictive value (62.2％ vs.53.8％) with cutoff value of NT-proBNP (2 882 ng/L) in group with age ＜65 years old were significantly higher than those with NT-proBNP cutoff value (6 062 ng/L) in group with age ≥ 65 years old.Conclusion NT-proBNP cutoff value in different age groups for the prediction of mortahty in the critically ill patients maybe more objective and accurate.

A clinical observation on efficacy of nucha electrical acupuncture for treatment of patients with adult hypoxic ischemic encephalopathy / 中国中西医结合急救杂志

Objective To observe the clinical therapeutic effect of nucha electroacupuncture on patients with adult hypoxic ischemic encephalopathy(HIE)and to approach its mechanism. Methods After exclusion of cases with incomplete historical data from 80 adult HIE patients admitted in the Department of Critical Care Medicine of 401st Hospital of Jinan Military Region of PLA,finally 74 cases were randomly divided into a nucha electroacupuncture treatment group(38 cases)and a conventional therapy control group(36 cases)by random number table. The patients in the control group were treated with conventional medical therapies,including dehydration,intracranial pressure reduction,brain protection with head hypothermia,and so on. In nucha electroacupuncture group,based on the conventional treatment in the control group,additionally nucha electroacupuncture was performed for the patients. Before and after therapy,the changes of Glasgow coma scale score(GCS score)and Glasgow-Pittsburgh coma score (G-PCS score)in all the patients were assessed and compared between the two groups,and according to the standard criteria of GCS and G-PCS scores for evaluation of efficacy,the clinical therapeutic effective rates in the two groups were assessed. Results ①There were no statistically significant differences between the two groups in GCS score and G-PCS score before treatment(both P>0.05),after treatment,the GCS and G-PCS scores in nucha electrical acupuncture group were obviously higher than those before treatment(GCS score:6.22±2.66 vs. 4.33±1.35,G-PCS score:22.96±6.22 vs. 17.53±4.68,both P<0.05),and the GCS and G-PCS scores of nucha electroacupuncture group were markedly higher than those of control group after treatment(GCS score:6.22±2.66 vs. 5.17±3.01,G-PCS score:22.96±6.22 vs. 16.78±7.96,both P<0.05).②The total effective rate of nucha electroacupuncture group was significantly higher than that of control group when assessed by both the standard criteria of GCS score(73.7%vs. 50.0%,P<0.05)and G-PCS score(84.2%vs. 61.1%,P<0.05). Conclusion The nucha electroacupuncture has definite clinical therapeutic value in treatment of patients with adult HIE and it can improve their neurological function and outcome.

Clinical analysis of 17 cases of acne inversa / 中华皮肤科杂志

Objective To analyze the clinical characteristics and treatment of acne inversa.Methods Seventeen outpatients with acne inversa were collected in the Institute of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College from January l,2012 to December 31,2012.The general condition,clinical feature and treatment of these patients were retrospectively analyzed.Results All the patients were male with the age at onset being about 20 years and disease duration varying from 2 to 50 years.Characteristic clinical manifestations were recurrent tender inflammatory papules,nodules,abscesses,fistulae and sinus tracts in the neck,axillary fossa,groin,perineum and buttocks.Among these patients,10 had a family history and seven were sporadic with mild symptoms.Oral tretinoin combined with antibiotics were the main treatment,and surgical treatment was usually used for severe patients.Conclusions Acne inversa is mainly manifested as abscess,sinus and scars in areas bearing apocrine sweat glands,and therapeutic regimen should be selected according to the severity of lesions.