Early prenatal exposure to air pollutants and congenital heart disease: a nested case-control study

BACKGROUND@#Congenital heart disease (CHD) is one of the most common congenital malformations in humans. Inconsistent results emerged in the existed studies on associations between air pollution and congenital heart disease. The purpose of this study was to evaluate the association of gestational exposure to air pollutants with congenital heart disease, and to explore the critical exposure windows for congenital heart disease.@*METHODS@#The nested case-control study collected birth records and the following health data in Tianjin Women and Children's Health Center, China. All of the cases of congenital heart disease from 2013 to 2015 were selected matching five healthy controls for each case. Inverse distance weighting was used to estimate individual exposure based on daily air pollution data. Furthermore, the conditional logistic regression with distributed lag non-linear model was performed to identify the association between gestational exposure to air pollution and congenital heart disease.@*RESULTS@#A total of 8,748 mother-infant pairs were entered into the analysis, of which 1,458 infants suffered from congenital heart disease. For each 10 µg/m3 increase of gestational exposure to PM2.5, the ORs (95% confidence interval, 95%CI) ranged from 1.008 (1.001-1.016) to 1.013 (1.001-1.024) during the 1st-2nd gestation weeks. Similar weak but increased risks of congenital heart disease were associated with O3 exposure during the 1st week and SO2 exposure during 6th-7th weeks in the first trimester, while no significant findings for other air pollutants.@*CONCLUSIONS@#This study highlighted that gestational exposure to PM2.5, O3, and SO2 had lag effects on congenital heart disease. Our results support potential benefits for pregnancy women to the mitigation of air pollution exposure in the early stage, especially when a critical exposure time window of air pollutants may precede heart development.

Clinical outcome and related risk factors of acute pancreatitis complicated with acute kidney injury / 中华胰腺病杂志

Objective:To investigate clinical outcome and the risk factors for death in acute pancreatitis (AP) patients complicated with acute kidney injury (AKI).Methods:The clinical data of 232 AP patients complicated with AKI admitted to the Center of Severe Pancreatitis of Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2016 to December 2020 were retrospectively analyzed. Patients were divided into survival group ( n=162) and death group ( n=70) based on the survival status. The two groups' clinical characteristics, biochemical indexes, and renal function indexes were compared. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors for death in AP patients complicated with AKI. Results:Sixteen patients(6.9%) among the 232 had AKI Ⅰ, 15(6.5%) had AKI Ⅱ, and 201(86.6%) had AKI Ⅲ. Forty-one patients (17.7%) became AKI with a disease course <7 days, 184 patients (79.3%) gradually progressed to acute kidney disease with a disease course of 7-90 days, and 7 patients (3.0%) eventually progressed to chronic kidney disease with a disease course >90 days. Renal replacement treatment (RRT) was administered in 179 patients (77.2%), lasting an average of 14 (7-25) days. 138 patients (59.5%) had their renal function recovered while they were hospitalized, including 9 patients (6.5%) who did so within 7 days, 69 patients (50.0%) within 30 days, and 127 patients (92.0%) within 90 days. The average recovery time was 16 (7-28) days. Seventy patients (30.2%) died during hospitalization, including 8(3.5%) within 7 days, 42(18.1%) within 30 days, and 68(29.3%) within 90 days. Univariate analysis revealed that the proportions of biliary etiology, neutrophil to lymphocyte ratio (NLR), serum cystatin C, sequential organ failure assessment(SOFA) score, AKI Ⅲ proportion, number of patients undergoing RRT, and duration of AKI were significantly higher in the death group compared to the survival group. The number of patients complicated by infected pancreatic necrosis (IPN) and having surgical intervention was also significantly greater than that in the survival group, while the proportion of patients whose renal function recovered was much lower than that in the survival group. The differences were all statistically significant (all P value <0.05). Multivariate logistic analysis showed that SOFA( OR=1.182, 95% CI 1.000-1.396, P=0.049), and IPN( OR=8.403, 95% CI 3.748-18.838, P<0.001) were independent risk factors for death. Conclusions:SOFA score and IPN at admission were independent risk factors for death in AP patients with AKI. Vigilance should be given as soon as possible to improve the outcome of patients through clinical intervention.

Effects of subclinical hypothyroidism during pregnancy treated with LT 4 on the growth and neuropsychology of offspring aged 0-36 months: A cohort study / 中华内分泌代谢杂志

Objective:To evaluate the effects of subclinical hypothyroidism during pregnancy treated with LT 4 on the growth and neuropsychology of offspring aged 0-36 months. Methods:A maternal-infant cohort was established in healthy singleton pregnant women aged 20-45 years without history of thyroid disease. Women developing subclinical hypothyroidism during pregnancy were treated with LT4. The weight, length, and head circumference of the offspring were recorded between 0 to 36 months after birth. Meanwhile, infant nutrition and family support were investigated. The Neuropsychological Development Questionnaire of 0-6 year old children was used to evaluate the neurodevelopment of offspring.Results:A total of 186 mother-infant pairs were included. All subjects were divided into the euthyroidism(ETH) group( n=136) and subclinical hypothyroidism(SHT) group( n=50) according to maternal thyroid function during pregnancy. The Z-scores(adjusted by months of age and gender) of weight, length, weight/length at birth, weight/length at 1 month, head circumference at 6 months, length at 8 months, weight/length at 24 months of SHT group were lower than those of the ETH group( P<0.05). Furthermore, the language competence of the SHT offspring at 12 months of age was also lower than that of the ETH group( P<0.05). Maternal subclinical hypothyroidism treated with LT 4 did not significantly affect preterm delivery, low birth weight, and developmental quotient <85, but reduced the risk of macrosomia(AOR 0.206, 95% CI 0.046-0.929, P=0.040). Conclusion:Although women with subclinical hypothyroidism received LT 4 treatment during pregnancy, the offspring still may suffer adverse effects on their growth and neural development.

Study of association between bile acid metabolites in early pregnancy and overweight / 中华内分泌代谢杂志

Objective:This study examined the associations between the levels of bile acids in early pregnancy and the occurrence of overweight.Methods:From 2010 to 2012, 22 302 pregnant women were recruited by Tianjin Women and Children′s Health Center to investigate gestational diabetes. Two hundred and forty-three women with gestational diabetes mellitus provided overnight fasting blood samples in the first trimester, and 243 counterparts without gestational diabetes mellitus matched on age were selected randomly to establish a nested case-control study. The association between bile acids and overweight were evaluated by binary logistic regression with data from 166 overweight pregnant women (body mass index≥24.0 kg/m 2) and 320 normal weight subjects (body mass index <24.0 kg/m 2). Results:Compared to non-overweight group, the level of primary unconjugated bile acids in overweight group was significantly higher. After adjustment of confounding factors, the OR of cholic acid (CA)>0.086 nmol/mL for overweight was 2.09 (95% CI 1.14-3.80, adjusted P=0.040), and OR of chenodeoxycholic acid (CDCA)>0.043 nmol/mL was 2.15 (95% CI 1.22-3.78, adjusted P=0.040) compared with the lower groups. However, the significant associations between the other bile acids and overweight were not detected. Stepwise selection was used to identify significant bile acid species in logistic regression. We found that only CA was independently associated with overweight, and the OR of CA>0.086 nmol/mL vs≤0.086 nmol/mL was 2.03 (95% CI 1.11-3.74, P=0.022). Conclusion:CA and CDCA in early pregnancy maybe associated with overweight, and CA might be independently associated with overweight.

Clinical characteristics and influencing factors for mortality of patients with intra-abdominal candidiasis: a multicenter retrospective study / 中华消化外科杂志

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

Research progress of coagulation dysfunction in coronavirus disease 2019 / 中华危重病急救医学

The coronavirus disease 2019 (COVID-19) has outbroken globally. As an acute infectious disease, COVID-19 has significant impacts on multiple organs and systems throughout the body. Among patients with COVID-19, especially severe and critical cases, a variety of potential risk factors for coagulation dysfunction exist. Furthermore, the coagulation dysfunction of COVID-19 patients was mainly characterized by elevated D-dimer levels. The coagulation dysfunction could directly affect the prognosis of COVID-19 patients and is a major cause of death in patients with severe COVID-19. In this article, the literatures on the basic clinical manifestations, clinical risk factor, mechanism of coagulation dysfunction and evaluation of coagulation function in COVID-19 were reviewed.

Research advances of hypertriglyceridemia acute pancreatitis / 中华检验医学杂志

In recent years,with the change of lifestyle in China, hypertriglyceridemia (HTG) has been the second leading cause of acute pancreatitis (AP). Recent studies have shown that HTG has long-lasting influences on AP onset (including recurrence), AP severity, as well as pancreatic regeneration. However, the underlying mechanisms of HTG-AP is still unclear, mainly focusing on free fatty acid, microcirculation disturbance, calcium overload, oxidative stress, gene polymorphism and so on. However, there is lack of effective intervention for the diagnosis and treatment of HTG-AP, which needs further study.

Stent assisted percutaneous endoscopic necrosectomy for treating infected pancreatic necrosis / 中华胰腺病杂志

Objective@#To investigate the feasibility and safety of stent-assisted percutaneous endoscopic necrosectomy (SAPEN) in the treatment of infected pancreatic necrosis (IPN).@*Methods@#The patients with severe acute pancreatitis (SAP) who received the treatment of SAPEN for IPN were sequentially included from January 2018 to September 2018 in the Eastern Theater General Hospital of People′s Liberation Army. The demographic and clinical data were analyzed. The mortality and incidence of major organ dysfunctions were used as the primary observation endpoints.@*Results@#A total of 40 IPN patients were enrolled including 27 men and 13 women. The percutaneous covered stent placement procedures were successful in all cases; the median number of SAPEN operations was 1 (range 1-3), and no operation-related complications occurred. 32 patients were successfully cured by SAPEN, and the treatment effective rate was 80.0%. 5 patients (12.5%) required further open surgery after SAPEN. 12 patients developed new important organ dysfunction and 6 patients eventually died.@*Conclusions@#SAPEN was an effective and feasible minimally invasive method for the treatment of IPN, but its technical advantages still need to be further validated in large scale studies.

Sharing database platform for acute pancreatitis / 中华胰腺病杂志

Acute pancreatitis ( AP ) is one of the common disorders of gastrointestinal system in clinical practice characterized by sudden onset, long course of disease, complex complications, severe conditions, heavy social and economic burden and the like. Recent years has seen a decreasing mortality due to the update and promotion of a series of therapeutic concepts. However, as the imbalance of comprehensive healthcare levels among different regions in China, substandard diagnosis and treatment of AP still exist, lowering the overall success rate of AP treatment. Moreover, the waste and miss of AP patients' data during the treatment period affect our original innovation in the field of AP research. Thus, after the accumulation of long-term exploration and practice, we integrated diverse data resources and established a single-disease database of AP by cooperating with computer and artificial intelligence ( AI) professionals, finished the deployment of hardware and network arrangement, generated a logical system of "business database→scientific database→sharing database", and built AP data sharing platform (www. ap-database. com), providing the fundamental functions including browse, search, upload and download ( with permissions) . We hope to share the abundant and free medical date with clinicians, computer or AI practitioners and attract communications and cooperation from different fields, which may deepen new values from current data mining and advance the research on AP.

Stent assisted percutaneous endoscopic necrosectomy for treating infected pancreatic necrosis / 中华胰腺病杂志

Objective To investigate the feasibility and safety of stent-assisted percutaneous endoscopic necrosectomy (SAPEN) in the treatment of infected pancreatic necrosis (IPN). Methods The patients with severe acute pancreatitis ( SAP) who received the treatment of SAPEN for IPN were sequentially included from January 2018 to September 2018 in the Eastern Theater General Hospital of People's Liberation Army. The demographic and clinical data were analyzed. The mortality and incidence of major organ dysfunctions were used as the primary observation endpoints. Results A total of 40 IPN patients were enrolled including 27 men and 13 women. The percutaneous covered stent placement procedures were successful in all cases;the median number of SAPEN operations was 1 ( range 1-3 ) , and no operation-related complications occurred. 32 patients were successfully cured by SAPEN, and the treatment effective rate was 80. 0％. 5 patients (12. 5％) required further open surgery after SAPEN. 12 patients developed new important organ dysfunction and 6 patients eventually died. Conclusions SAPEN was an effective and feasible minimally invasive method for the treatment of IPN, but its technical advantages still need to be further validated in large scale studies.

Effects of iodine nutrition during pregnancy and lactation on postpartum thyroid function in women with subclinical hypothyroidism / 中华内分泌代谢杂志

Objective To evaluate the effects of maternal iodine nutrition levels on postpartum thyroid function, and to provide clinical evidence for accurate iodine supplementation in women with subclinical hypothyroidism during pregnancy. Methods This study collected single-pregnant women who had no history of thyroid diseases before pregnancy in our city. Thyroid function and urinary iodine results were continuously recorded during pregnancy and lactation. All subjects were divided into subclinical hypothyroidism group and euthyroidism group according to their thyroid function during pregnancy. The relationship between urinary iodine levels during pregnancy and lactation with postpartum thyroid function were analyzed. Results A total of 148 maternal women were collected, including 41 cases of subclinical hypothyroidism group and 107 cases of euthyroidism group. The urinary iodine level in pregnant women was higher than that in lactation ( median 174.75 vs 149.89μg/L, P<0.05) . However, the iodine deficiency ratio(23.6％) during pregnancy was higher than that during lactation (5.4％). There were significant differences in the change of urinary iodine in each time interval during pregnancy and lactation ( P<0.05). A total of 56 maternal women developed postpartum thyroiditis ( PPT). The incidence of PPT in pregnant women with TPOAb-positive in early pregnancy was higher than that in TPOAb-negative patients (χ2=10.811, P=0.001) . The urinary iodine concentration in the 12-month postpartum period was lower in women with PPT than that in womenwithoutPPT(P<0.05).Coxregressionanalysisshowedthatiodinedeficiencyduringlactation(HR=3.870, 95％CI 1.595-9.392, P=0.003) and TPOAb positive in early pregnancy (HR=3.679, 95％ CI 1.466-9.233, P<0.05) increased the risk of PPT. Subgroup analysis also showed a similar risk increase of PPT in women with hypothyroidism during pregnancy (HR=8.318, 95％CI 2.383-29.029, P<0.05). However, this association was not found in euthyroidism group. Conclusion The urinary iodine level of women during pregnancy and lactation in our iodine suitable areas is within normal range, but attention should still be paid to the effect of iodine deficiency on breast-feeding women, especially among those with subclinical hypothyroidism.

Associations of urinary iodine and blood selenium levels with subclinical hypothyroidism and thyroid antibodies during the first half pregnancy in Tianjin women / 中华内分泌代谢杂志

Objective To investigate the associations of urinary iodine concentration ( UIC) and blood selenium levels with subclinical hypothyroidism and thyroid antibodies during the first half pregnancy in women. Methods A total of 239 pregnant women(7-20 weeks)were selected. The baseline data were collected, and serum TSH, FT4 , thyroid peroxidase antibody ( TPOAb), thyroglobulin antibody ( TgAb), blood selenium, and urinary iodine concentration(UIC) levels were measured. Results The median level of urinary iodine among 239 women was 156. 96 μg/ L. The distributions of pregnant women with iodine deficiency, iodine adequate, more-than-adequate or excessive iodine intake were 43. 9％ , 38. 9％ , 17. 2％ , respectively. The percentage of more-than-adequate and excessive iodine in women with subclinical hypothyroidism was higher than that in women with euthyroidism. The serum TSH level in women with UIC≥250 μg/ L was higher than those with 150≤UIC<250 μg/ L and UIC<150 μg/ L (P<0. 05). The serum TSH level in women with blood selenium<95 μg/ L was higher than those with selenium≥95μg/ L(P<0. 05). Logistic regression analysis showed that the risk of subclinical hypothyroidism in women with UIC≥250 μg/ L was increased by 3. 498 fold(95％ CI 1. 588-7. 704)as compared with those with 150≤UIC<250 μg/ L. The risk of subclinical hypothyroidism in women with blood selenium <80 μg/ L was increased by 2. 667 fold (95％ CI 1. 123-6. 331) compared with those with 90 ≤ selenium < 100 μg/ L. After adjusting for age, gestational weeks, residential district, TPOAb, TgAb, taking compound nutritional supplements, more-than-adequate and excessive iodine still increased the risk of subclinical hypothyroidism(OR= 3. 014, 95％ CI 1. 310-6. 938). Women with UIC≥250 μg/ L and blood selenium <95 μg/ L revealed the increased risk of subclinical hypothyroidism as compared to those with 150≤UIC<250 μg/ L and selenium≥95 μg/ L(OR=5. 429, 95％ CI 1. 929-15. 281). After adjusting for age, gestational weeks, residential district, TPOAb, TgAb, taking compound nutritional supplements, the fingdings still existed. Conclusion The nutrient condition of iodine and selenium of the pregnant women in Tianjin during the first half pregnancy should be noticed. The individualized supplement of iodine and selenium, if needed, should be performed to decrease the risk of subclinical hypothyroidism.

Effects of two-step approach combined with unprotected perineum method on the incidence of swallowing syndrome in neonates / 中华护理杂志

Objective To evaluate the effects of two-step approach combined with unprotected perineum method on the incidence uf neonatal swallowing syndrome.Methods A total of 360 patients were randomly divided into three groups:A,B and C,with 120 cases in each group.Group A was provided traditional midwifery approach:midwifery staff manually controlled the delivery rate of fetal head with hands,assisted to deliver fetal shoulders after fetal head was delivered,and quickly used hands to clean up the completely delivered newborn and routinely sucked mucus from mouth and nose using aurilave.Group B and C were provided two-step approach combined with unprotected perineum method:midwifery staff did not interfere delivery with hands,paused after the fetal head was delivered,delivered the fetal shoulders until next contraction.Group B was cleaned up respiratory tract like group A,group C was only provided surface cleaning or squeezing nose and mouth using hands.The incidence of neonatal swallowing syndrome and the number of vomiting were recorded within 24 hours after birth among three groups,and the differences among three groups were compared.Results The incidence of neonatal swallowing syndrome in group A was higher than those in groups B(x2=6.504,P=0.011)and C(x2=7.533,P=0.006);there was no significant difference between group A and B in neonatal swallowing syndrome(x2=0.042,P=0.837).There were significant differences in vomiting within 24 hours among three groups(F=10.185,P=0.006).There were significant differences in vomiting within 24 hours between group A and group B,and between group A and group C(P＜0.05);there was no significant difference between group B and group C(P＞0.05).Conclusion Inplementing the two-step approach combined with unprotected perineum method,the newborns can accomplish cleaning up respiratory tract naturally during natural delivery of fetal shoulders.

Effect of Xingnao Kaiqiao acupuncture on clinical efficacy of patients with mild cognitive impairment after stroke and its mechanism / 中国中西医结合急救杂志

Objective To observe the effect of Xingnao Kaiqiao acupuncture on the clinical efficacy of patients with mild cognitive impairment (MCI) after stroke and to explore its mechanism. Methods A prospective randomized controlled clinical trial method was conducted, 128 patients with MCI after stroke admitted to Department of Acupuncture and Moxibustion of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from September 2015 to May 2017 were enrolled, and they were divided into a control group and an observation group according to the random number table method, 64 cases in each group. The control group took 40 mg of nimodipine, 3 times a day; on the basis of the treatment in control group, the observation group was additionally given acupuncture therapy for arousing the brain and opening the orifices or resuscitation as the interference, the main acupoints applied were renzhong, neiguan (bilateral) and sanyinjiao (bilateral), the scalp points used were mainly baihui joining qianding (GV-21WHO), xinhui (GV-22WHO) joining qianting and benshen (GB-13WHO, bilateral), once a day, 5 times a week; the therapeutic course was 10 weeks in both groups. The differences in scores of Montreal cognitive assessment scale (MoCA), mini-mental state examination (MMSE), and in the levels of serum amyloid A (SAA) andβ-amyloid (Aβ) between the two groups before and 6 and 10 weeks after treatment were compared. Results With the prolongation of therapeutic time, the MoCA and MMSE scores of the two groups were increased significantly after treatment compared with those before treatment, the levels of SAA and Aβ were obviously lower than those before treatment, and the degrees of changes of the above indexes in the observation group were more marked than those in the control group, after treatment for 10 weeks, there were statistical significant differences in MoCA and MMSE scores between the observation and control groups (MoCA score: 25.32±2.54 vs. 22.67±3.17, MMSE score: 28.38±2.74 vs. 24.36±3.27), while after 6 weeks of treatment, the statistical significant differences in SAA and Aβlevels appeared between the two groups [SAA (μg/L): 74.52±25.64 vs. 103.36±27.53, Aβ (ng/L): 95.32±25.64 vs. 127.27±29.73, both P ＜ 0.05], and the situation persisted to 10 weeks after treatment [SAA (μg/L): 57.36±18.24 vs. 84.37±25.56, Aβ (ng/L): 55.47±21.36 vs. 92.74±23.57, both P ＜ 0.05]. Conclusion Resuscitation acupuncture possibly can inhibit the expression protein levels of serum SAA and Aβto improve the cognitive function of patients with MCI after stroke.

Continuous negative pressure irrigation and endoscopic debridement in treating patients with infected necrotizing pancreatitis / 中华胰腺病杂志

Objective To observe the clinical outcomes and safety of continuous negative pressure irrigation (NPI) and endoscopic necrosectomy(ED) for treating infected pancreatic necrosis(IPN). Methods A retrospective review of the data of 163 severe acute pancreatitis(SAP) patients with IPN who were treated by four-step drainage from January 2012 to December 2013 at the SAP therapy center of Nanjing General Hospital was performed. All patients were divided into 7 groups including PCD alone, PCD+NPI, PCD+NPI+ED, PCD+ON, PCD +NPI +ON, PCD +ED +ON and PCD +NPI +ED +ON group based on the drainage strategy of percutaneous catheter drainage(PCD),NPI, ED and open necrosectomy(ON), and the feasibility and safety were analyzed. Results All the patients underwent PCD therapy. Each patient underwent a median of 3 drainage procedures and the median total drainage duration was 11 days. No significant procedure-related complication was observed. Around 40% of the patients recovered after receiving PCD alone. Thirty-four patients(20.9%) underwent ON. The mean hospitalization duration was 38 days and the mean ICU stay was 19 days. There were 25 cases with new-onset organ functional failure,26 patients with sepsis,32 patients with gastric and intestinal fistula,34 patients with intra-abdominal bleeding,8 patients with portal vein thrombosis and 3 patients with gastric outlet obstruction. 28 patients(17.2%) died. Conclusions This four-step approach is effective in treating IPN when compared with other step-up strategies. NPI and ED could offer distinct clinical efficacy without adding no extra risk to patients.

Developing the PLA critical care medicine is critical for advancing the level of battle wound treatment in the new era / 解放军医学杂志

Critical care medicine is an emerging unique specialty developed from the later 20th century,since then,it has been enriched with theoretical and practical experiences and becomes the most active subject in the field of clinical medicine.Critical care medicine of the PLA has attained significant achievements in the treatment and research of severe trauma,sepsis,severe heat stroke,multiple organ failure and severe acute pancreatitis.Besides,it stands in the leading position in the organ function maintenance of critically ill patients,continuous hemofiltration and nutrition support in China.Furthermore,critical care medicine plays an important role in the rescue of critically ill patients,medical support and disaster relief.As the relationship between battle wound rescue system and critical care medicine has been increasingly close,transition in the form of war in the new period brings new tasks to battle wound treatment constantly.Combined with the characteristics of information-oriented war condition in the future,developing the PLA critical care medicine and advancing the level of battle wound treatment in the new period point out the direction for the future work of critical care medicine.

A new challenge to the diagnosis and treatment of sepsis: Persistent inflammation immuno-suppression catabolism syndrome / 医学研究生学报

The early mortality of sepsis patients has been largely decreased since the publication of the Surviving Sepsis Campaign guidelines.However, the poor long-term prognosis, high 3-year mortality, impaired mental and physical functions, and tremendous financial burden constitute a new challenge to the treatment of sepsis.Persistent inflammation immuno-suppression catabolism syndrome (PICS) is known to be a definite factor affecting the long-term prognosis of sepsis.This article presents a systematic review of the concept, pathogenesis and treatment strategies of PICS, hoping to provide a new approach to the diagnosis and management of sepsis.

Clinical analysis of persistent inflammation-immunosuppression-catabolism syndrome in patients with severe acute pancreatitis / 医学研究生学报

Objective Up to the present time, no reports are seen at home or abroad on the clinical characteristics of severe acute pancreatitis (SAP) with persistent inflammation-immunosuppression-catabolism syndrome (PICS), and few studies have been conducted on the risk factors for PICS.This article summarizes the clinical characteristics of PICS in SAP patients and presents a multivariate regression analysis of its risk factors.Methods This is a retrospective study on the clinical data about 214 cases of SAP treated for over 14 days in the Surgical Intensive Care Unit (SICU) from January 1, 2014 to December 31, 2015.According to the diagnostic criteria of PICS, we divided the SAP patients into a PICS group (n=149) and a non-PICS group (n=65).We compared the systemic and pancreatitis-specific complications and mortality rates in the SICU and at 12 months after discharge.We also performed a multivariate regression analysis on the risk factors of PICS.Results The incidence rates of biliary SAP and multiple-organ dysfunction syndrome (MODS) were significantly higher in the PICS (44.3% and 93.3%) than in the non-PICS group (29.2% and 55.4%) (P=0.038).The results of multivariate regression analysis showed that the risk factors for PICS included obesity (OR=2.3;95% CI: 1.0-5.2), biliary causes (OR=4.2;95% CI: 1.4-13.0), and MODS (OR=4.4;95% CI: 1.3-14.4).The survival rate at 12 months after discharge was remarkably lower in the PICS than in the non-PICS group (88.5% vs 98.2%, P=0.036).Conclusion The incidence rate of PICS is high in SAP patients.Obesity, biliary causes and MODS are independent risk factors for PICS.The complication of PICS may be an important indicator of the poor prognosis of SAP.

A survey of Vitamin D level and the rate of Vitamin D supplementation in infants and young children in Tianjin / 中华实用儿科临床杂志

Objective To investigate the Vitamin D levels of 3 030 infants and young children and the application rate of Vitamin D supplements.To evaluate the nutritional status of Vitamin D and to find out the problems in the application of Vitamin D supplements.Methods Enzyme linked inmmnosorbent assay was used to determine the level of 25-hydroxyvitamin D[25 (OH)D] in all the subjects.The subjects were divided into 4 groups according to their ages:≤6 months,＞ 6-12 months,＞ 12-24 months,＞ 24-36 months.The average levels of Vitamin D in different ages and seasons were compared.Three hundred and forty-one cases were randomly selected to undergo a parent questionnaire survey and a laboratory test including hemoglobin (Hb) and bone alkaline phosphatase (BALP).The association of 25 (OH)D level with feeding methods,gestational age,birth weight,Hb,and BALP were compared.Results The average level of 25 (OH) D was (60.2 ± 26.2) nmol/L with the minimum of 12.9 nmol/L and the maximum of 286.0 nmol/L.The total deficiency rate was 36.6％ (1 109/3 030 cases),and young children who were ＞ 24-36 months old had the lowest level of 25 (OH) D [(47.22 ± 21.93) nmol/L] (F =50.006,P ＜ 0.01).The levels of Vitamin D in autumn were(62.00 ± 27.42) nmol/L,which were significantly higher than those in other seasons (F =2.750,P ＜0.05).The levels of 25 (OH) D in preterm infants were (62.00 ± 27.42) nmol/L,which were significantly lower than those in full term infants (F =12.355,P ＜0.01).The application rate of Vitamin D supplements was 97.1％ (331/341 cases).Conclusions Although the application rate of Vitamin D supplementation in infants and young children is very high,there is still a certain proportion of Vitamin D deficiency.This may be because of the poor compliance of the supplementary process.Therefore,it is necessary to strengthen the publicity and education and improve the parental cognition and recognition.During pregnancy and age after birth,effective monitoring mechanism of Vitamin D levels and the application of Vitamin D supplements should be considered into the existing maternal and child health care system.

Ultrasonic features of acute acalculous cholecystitis developing at different stages of acute pancreatitis / 医学研究生学报

Objective Acute pancreatitis exhibits different clinical and ultrasonic features in patients complicated with acute acalculous cholecystitis ( AAC) at different stages .The aim of this study was to analyze the ultrasonic characteristics of acute pancreati-tis complicated with AAC at different stages . Methods We retrospectively analyzed the clinical data about 41 cases of acute pancrea-titis with moderate to severe AAC .According to whether AAC developed within or after 2 weeks of the onset of acute pancreatitis , we divided the patients into an early-stage group (n=18) and a late-stage group (n=23).We recorded the gallbladder size, gallbladder wall thickness , fluid around the gallbladder , biliary sludge deposition and the Murphy′s sign by ultrasonography , obtained AAC-related clinical and laboratory data concerning body temperature , Murphy′s sign, WBC count and C-reactive protein level , and analyzed the ultrasonic features of AAC at different stages in the acute pancreatitis patients. Results All the patients experienced a fever of >38.5℃, 38.89%with chills in the early onset group and 47.83%in the late onset group .Increases were observed in patients of the early-and late-stage groups in the WBC count ( 94.44%vs 82.61%) , the C-reactive protein level ( 100%vs 91.30%) , and the fluid volume around the gallbladder (94.44%vs 60.86%, P<0.05), but incidence rate of gallbladder wall thickening was significantly lower in the former than in the latter group (11.11%vs 78.26%, P<0.01). Conclusion AAC developing at different stages of acute pancreatitis has different ultrasonic features , with higher incidence rates of fluid around the gallbladder in the early stage and gallbladder wall thickening in the late stage.