Health literacy levels and influencing factors among Uyghur residents in Moyu County, Xinjiang: a comparison between 2018 and 2020 / 中华健康管理学杂志

Objective:To analyze the health literacy level and influencing factors of Uyghur residents in Moyu County, Xinjiang between 2018 and 2020.Methods:A total of 5 211 and 5 207 Uyghur residents in Moyu County, Xinjiang were sampled using the multi-stage cluster method in 2018 and 2020, respectively. The health culture questionnaire for ethnic minority in Xinjiang was used. The survey included general demographic characteristics, overall health literacy levels, and the three aspects of health literacy levels (health knowledge and concepts, healthy lifestyles and behaviors, and health skills) and six dimensions (scientific health concept, health information literacy, infectious disease prevention and control literacy, chronic disease prevention literacy, safety and first aid literacy, and basic medical literacy). The influencing factors of residents′ health literacy in 2020 were analyzed using χ2 test and multivariate logistic regression. Results:In 2020, overall health literacy and its three aspects among Uyghur residents in Moyu County, Xinjiang were higher than in 2018 (overall 8.10% vs 5.07%, health knowledge and concepts 9.99% vs 7.60%, healthy lifestyle and behavior 6.88% vs 5.33%, health skills 40.12% vs 30.22%) (all P<0.05). In 2018, results for the six dimensions of health literacy were, from high to low, as follows: safety and first aid literacy (26.42%), basic medical literacy (14.14%), health information literacy (13.38%), scientific health concept (10.17%), infectious disease prevention and control literacy (8.96%), chronic disease prevention and treatment literacy (5.57%); In 2020, the results, from high to low, were: safety and first aid literacy (36.09%), basic medical literacy (24.08%), health information literacy (20.47%), infectious disease prevention and treatment literacy(15.19%), scientific health concept (13.85%), and chronic disease prevention and treatment literacy (10.10%). All values were higher than in 2018 (all P<0.05). Gender, age, education level, marital status, occupation, per capita monthly household income level, and area of residence influenced health literacy levels of local residents. Conclusions:The health literacy of Uyghur residents in Moyu County, Xinjiang improved from 2018 to 2020; however, the overall level remains low. Elderly people, people with low education levels, people with low incomes, business people & staff are the key groups requiring health education. Healthy lifestyle and behavior, chronic disease prevention and treatment literacy, scientific health concept, infectious disease prevention and control literacy are identified as areas necessitating health education and health promotion intervention.

Research on the teaching reform of internal medicine for graduate students in colleges and universities based on the concept of OBE / 中华医学教育探索杂志

Objective:To explore the teaching reform of internal medicine graduate students based on the concept of outcomes-based education (OBE).Methods:A total of 86 graduate students who studied in the Teaching and Research Section of Internal Medicine in the First Affiliated Hospital of Xinjiang Medical University from January 2019 to August 2020 were randomly divided into control group ( n=43) and observation group ( n=43). The control group adopted traditional teaching, and the observation group adopted the teaching based on the OBE concept. The evaluation of the academic performance of the two groups of graduate students and the recognition of the teaching mode by the graduate students were compared, and the improvement of the personal ability of the graduate students was evaluated. Meanwhile, the effect of teaching satisfaction and the improvement of learning ability of the graduate students was evaluated. SPSS 22.0 was used for t-test and Chi-square test. Results:The theoretical scores, general head and neck test scores, heart test scores, lung test scores, abdominal test scores, spinal and limb nervous system test scores, operation scores and total scores of graduate students in the observation group were higher than those in the control group ( P<0.05); students in the observation group believed that the teaching could improve their learning interest, improve the self-learning ability, improve communication and expression ability, improve teamwork ability, improve understanding and memory ability, improve internal medicine thinking ability, improve generalization ability, and improve clinical practice ability. All the above aspects were higher in observation group than control group ( P<0.05); the students in the observation group had 97.67% (42/43) recognition of teaching, which was higher than 83.72% (36/43) in the control group. Conclusion:Internal medicine teaching based on the concept of OBE can improve the academic performance and enhance the personal ability of graduate students, and the students are more satisfied with this teaching method.

Study on Different Conversion Strategies for Low-level Viremia in Chronic Hepatitis B / 胃肠病学

After receiving first-line antiviral drugs such as entecavir (ETV)，tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide fumarate (TAF) recommended by mainstream guidelines for at least one year，patients with chronic hepatitis B (CHB) have a 20% probability of presenting low-level viremia (LLV). CHB patients with LLV can cause virological and biochemical breakthrough，increasing the risk of drug resistance，cirrhosis，hepatocellular carcinoma，etc. Currently，there are three treatment strategies for LLV in CHB patients: one is to continue and maintain the original nucleos(t)ide analogues (NAs) monotherapy，the second is to change or add another NAsand the third is the combination of NAs with interferon (IFN). In recent years，more and more clinical studies have explored the different conversion therapies for LLV in CHB patients. This article reviewed the advances in study on different conversion strategies for LLV in CHB.

Correlation analysis between pulse pressure index, body mass index, and cerebral hemodynamics in 12 375 individuals undergoing physical examination in Urumqi / 中华健康管理学杂志

Objective:This study aimed to explore and analyze the correlation between pulse pressure index (PPI), body mass index (BMI), and cerebral hemodynamics and evaluate their significance in early screening for stroke.Methods:The subjects were selected from those who had completed the cerebral blood flow function test in the First Affiliated Hospital of Xinjiang Medical University from January to December 2018. First, basic information and disease history of the respondents were obtained through on-site questionnaire survey. Height, weight, and blood pressure were measured, and BMI, pulse pressure, PPI, and mean arterial pressure were calculated. Meanwhile, cerebral hemodynamic monitoring was completed. Individuals with cerebral hemodynamic indexes ≥75 were classified as normal cerebrovascular function group and those with cerebral hemodynamic indexes <75 as abnormal group. This study divided the PPI into three subgroups: high, medium, and low. According to the Chinese Adult Overweight and Obesity Prevention and Control Guidelines, the BMI was divided into too low, normal, overweight, and obese. The correlations of PPI and BMI with cerebral hemodynamics in different groups were calculated and compared.Results:A total of 12 375 subjects, aged (52.6±7.3) years, were included in the study, consisting of 7 275 men (58.79%) and 5 100 women (41.21%). There were 9 900 patients (80.00%) in the normal group and 2 475 patients (20.00%) in the abnormal group. The abnormal rate of cerebral hemodynamics was higher in the Han nationality； those with a history of hypertension, diabetes, and hyperlipidemia. Moreover, those with abnormal cerebral hemodynamic indicators had a higher BMI, systolic pressure, diastolic pressure, pulse pressure and PPI, mean arterial pressure was higher than the normal group (all P<0.001). In different PPI groups, the average blood flow, average velocity, maximum velocity, minimum velocity, and critical pressure level of the left and right sides showed a downward trend with the increase in PPI. Peripheral resistance, pulse wave velocity, characteristic impedance, dynamic resistance, and difference between diastolic and critical pressure all showed an upward trend with the increase in PPI. In different BMI groups, the average blood flow in the obese group on the left side was lower than that in the underweight, normal, and super recombination groups. The average blood flow in the obese group on the right side was lower than that in the normal and super recombination groups and higher than that in the subhypoxia group. The mean, maximum, and minimum velocities of the left and right sides decreased with the increase in BMI. The differences in peripheral resistance, pulse wave velocity, characteristic impedance, dynamic resistance, critical pressure level, diastolic blood pressure, and critical pressure showed an increasing trend with the increase in BMI, and the differences of the above indicators were statistically significant (all P <0.001).The results of unconditional multivariate logistic regression analysis showed that Han nationality, history of hypertension, history of diabetes, PPI, and BMI were the main risk factors for abnormal cerebral hemodynamics. The higher the PPI and BMI, the higher the risk of abnormal cerebral blood flow. Conclusion:The higher the PPI and BMI, the higher the possibility of abnormal cerebral hemodynamic indexes. Extremely high PPI and BMI should be paid greater attention.

Analysis of health literacy status and its influencing factors among Kazakh residents in Yili Prefecture, Xinjiang Uygur Autonomous Region / 中华健康管理学杂志

Objective:To investigate health literacy level and its influencing factors of 7, 945 Kazakh residents in Yili Prefecture, Xinjiang, China.Methods:Participants were enrolled from rural or urban Kazakh permanent residents aged 18 to 75 years living within the city and four counties of Yili Prefecture, Xinjiang, from April to November 2019. Stratified random sampling was adopted to divided the sites into five layers: Yining city, Gongliu County, Nilk County, Xinyuan County and Zhaosu County. According to the calculation of actual sample size, a total of 7, 945 subjects were selected. A health literacy questionnaire was used to determine the different demographic characteristics and health literacy status of Kazakh residents.Results:A total of 7, 945 cases, with mean age of (40.6±11.6) years, including 3, 391 males (42.68%) and 4, 554 females (57.32%) were studied. The total health literacy score was (45.8±17.2). In this study, we aimed to identify health literacy status of at least 424 cases(5.34%). The number of people with safety and first aid literacy was the largest, with a total of 2, 437 cases (30.67%). The number of people with health information access literacy and infectious disease prevention literacy was relatively small, with 860 (10.82%) and 866 cases (10.90%), respectively. Univariate analysis results showed that there were statistically significant differences (all P<0.05) in the scores of marital status, age, education level, personal monthly income, occupation, and household health literacy level. The results of multiple linear regression analysis showed that the main influencing factors of Kazakh residents′ health literacy were marital status, educational level, personal monthly income, occupation, and household registration. Conclusion:The health literacy of Kazakh residents in Yili prefecture, Xinjiang is at a low level, among which literacy in health information access and infectious disease prevention and control were the lowest. Ultimately, marital status, education level, personal monthly income, occupation, household registration, and other factors can have an impact on the level of health literacy.

Correlation analysis between pulse pressure index, body mass index, and cerebral hemodynamics in 12 375 individuals undergoing physical examination in Urumqi / 中华健康管理学杂志

Objective@#This study aimed to explore and analyze the correlation between pulse pressure index (PPI), body mass index (BMI), and cerebral hemodynamics and evaluate their significance in early screening for stroke.@*Methods@#The subjects were selected from those who had completed the cerebral blood flow function test in the First Affiliated Hospital of Xinjiang Medical University from January to December 2018. First, basic information and disease history of the respondents were obtained through on-site questionnaire survey. Height, weight, and blood pressure were measured, and BMI, pulse pressure, PPI, and mean arterial pressure were calculated. Meanwhile, cerebral hemodynamic monitoring was completed. Individuals with cerebral hemodynamic indexes ≥75 were classified as normal cerebrovascular function group and those with cerebral hemodynamic indexes <75 as abnormal group. This study divided the PPI into three subgroups: high, medium, and low. According to the Chinese Adult Overweight and Obesity Prevention and Control Guidelines, the BMI was divided into too low, normal, overweight, and obese. The correlations of PPI and BMI with cerebral hemodynamics in different groups were calculated and compared.@*Results@#A total of 12 375 subjects, aged (52.6±7.3) years, were included in the study, consisting of 7 275 men (58.79%) and 5 100 women (41.21%). There were 9 900 patients (80.00%) in the normal group and 2 475 patients (20.00%) in the abnormal group. The abnormal rate of cerebral hemodynamics was higher in the Han nationality； those with a history of hypertension, diabetes, and hyperlipidemia. Moreover, those with abnormal cerebral hemodynamic indicators had a higher BMI, systolic pressure, diastolic pressure, pulse pressure and PPI, mean arterial pressure was higher than the normal group (all P<0.001). In different PPI groups, the average blood flow, average velocity, maximum velocity, minimum velocity, and critical pressure level of the left and right sides showed a downward trend with the increase in PPI. Peripheral resistance, pulse wave velocity, characteristic impedance, dynamic resistance, and difference between diastolic and critical pressure all showed an upward trend with the increase in PPI. In different BMI groups, the average blood flow in the obese group on the left side was lower than that in the underweight, normal, and super recombination groups. The average blood flow in the obese group on the right side was lower than that in the normal and super recombination groups and higher than that in the subhypoxia group. The mean, maximum, and minimum velocities of the left and right sides decreased with the increase in BMI. The differences in peripheral resistance, pulse wave velocity, characteristic impedance, dynamic resistance, critical pressure level, diastolic blood pressure, and critical pressure showed an increasing trend with the increase in BMI, and the differences of the above indicators were statistically significant (all P <0.001).The results of unconditional multivariate logistic regression analysis showed that Han nationality, history of hypertension, history of diabetes, PPI, and BMI were the main risk factors for abnormal cerebral hemodynamics. The higher the PPI and BMI, the higher the risk of abnormal cerebral blood flow.@*Conclusion@#The higher the PPI and BMI, the higher the possibility of abnormal cerebral hemodynamic indexes. Extremely high PPI and BMI should be paid greater attention.

Evaluation on left ventricular volume and systolic function with three-dimensional echocardiographic automated algorithm in patients with coronary heart disease after percutaneous coronary intervention / 中国医学影像技术

Objective: To evaluate left ventricular systolic function in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) with three-dimensional echocardiographic automated algorithm (3DEA). Methods: Fifty patients with CHD were enrolled. Left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were measured before PCI and 1 month and 3 months after PCI by using 3DEA and two-dimensional biplane Simpson's (2DBP) methods. Results: LVEDV,LVESV and LVEF measured with 3DEA significantly correlated with those with 2DBP (r=0.92, 0.90, 0.84). Compared with measurements before PCI, LVEDV and LVESV measured with 3DEA and 2DBP methods decreased, while LVEF increased 1 month and 3 months after PCI (all P0.05). The time of 3DEA was short, and the reproducibility was higher than that of 2DBP (both P<0.05). Conclusion: 3DEA method is rapid and highly reproducible and highly correlated with 2DBP, therefore may be a useful technique in serially following patients with CHD and assessing responses to PCI.

Stratified outcomes of "Kidney Disease: Improving Global Outcomes" serum creatinine criteria in critical ill patients: a secondary analysis of a multicenter prospective study / 中华危重病急救医学

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

Prevalence of dyslipidemia and the risk factors analysis of 39 980 subjects in Urumqi / 中华健康管理学杂志

Objective To analyze the prevalence of dyslipidemia and the risk factors of 39 980 subjects in Urumqi and to explore the characteristics of dyslipidemia's risk factors. Methods The following parameters of the subjects were determined: total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), body mass index (BMI), waist circumference, systolic blood pressure, diastolic blood pressure, blood sugar, and uric acid. The prevalence of dyslipidemia of different gender or age and risk factors for dyslipidemia were analyzed. Results Dyslipidemia total detection rate was 55.15%, the rate in male (66.03%) was significantly higher than in women (41.72%) (χ2=2 360.034, P<0.001);and in the men the various types of dyslipidemia detection rate was higher than those in the female, the TC (χ2=66.860, P<0.001) and TG (χ2=2 756.572, P<0.001), LDL-C (χ2=258.636, P<0.001), HDL-C (χ2=2 714.685, P<0.001) were significantly higher in men than in women; the detection rate of dyslipidemiaincreased with age, and then decreased gradually in the age group 50-59 years after the peak, the (high total cholesterol (χ2=2 529.462, P<0.001), hypertriglyceridemia (χ2=1 389.313, P<0.001) high LDL-C (χ2=1 552.074, P<0.001), low HDL-C (χ2=97.279, P<0.001) of all age groups the dyslipidemia detection rate differences were statistically significant. Risk factors of dyslipidemia: Logistic regression analyses showed that male gender (OR=1.681;95%CI:1.337-1.928), age (OR=1.299;95%CI:1.270-1.330), high diastolic blood pressure (OR=1.248;95%CI:1.145-1.361), high waist circumference(OR=1.895;95%CI:1.638-1.956), high uric acid(OR=1.200;95%CI:1.094-1.317), high blood glucose(OR=1.366;95%CI:1.229-1.517), high TG(OR=4.043;95%CI:3.770-4.335), high LDL-C(OR=40.148;95%CI:37.341-43.166), low HDL-C ( OR=1.982;95%CI:1.432-2.511) were closely correlated with the high TC; male ( OR=1.956;95%CI:1.853-2.066), high age(OR=1.060;95%CI:1.040-1.080), high BMI(OR=2.097;95%CI:1.968-2.235), high diastolic blood pressure(OR=1.512;95%CI:1.411-1.620), high waist circumference(OR=1.397;95%CI:1.313-1.478), high uric acid(OR=2.146;95%CI:1.995-2.308), high blood glucose(OR=1.498;95%CI:1.375-1.631), high TC(OR=4.030;95%CI:3.821-4.250), low HDL-C(OR=4.003;95%CI:3.764-4.258) were closely correlated with the high TG. Conclusion The prevalence of dyslipidemia is high in Urumqi area. Improving prevention knowledge, attention to life style, regular physical examination, abnormal condition in time, are important to prevent and reduce the occurrence of vascular diseases.

The employment of acute gastrointestinal injury grading system in the strategy of diagnosis and treatment of severe acute pancreatitis in patients for guiding nutritional support / 中华急诊医学杂志

Objective To study the utility of acute gastrointestinal injury (AGI) grading system in the strategy of diagnosis and treatment of severe acute pancreatitis (SAP) in patients for the guidance of nutritional support.Methods Forty-five patients with SAP admitted to the ICU from January 2012 to December 2013 were enrolled for study.The diagnosis of SAP was made as per the 2013 Chinese guideline of dliagnosis and treatment of acute pancreatitis.The patients with aged ＜ 18 years,length of hospital stay ＜72 h,and those included in other experimental study were excluded.The patients were divided into two groups:AGI group (n =24) and control group (n =21).There were no statistically significant differences in age,gender,APACHE Ⅱ between two groups (P ＞ 0.05).The length of hospital stay,in-hospital mortality,the incidence of complications such as infection,the time of starting enteral nutrition (EN) and reaching caloric goal were compared between the two groups.The t test or Mann-Whitney U test was used for continuous variables and x2 test or Fisher exact test was used for categorical variables,and P ＜ 0.05 was considered statistically significant.Results (1) Between two groups,there were statistically significant differences in the time of starting EN (2.0 d vs.5.7 d,Z =-4.149,P ＜0.01) and reaching caloric goal (5.5 d vs.10.4 d,Z =-3.392,P =0.001).(2) Between two groups,there were statistically significant differences in the incidence of pneumonia (25％ vs.57.14％,P =0.028 1) and catheterrelated infection (0％ vs.23.81％,P =0.039 4).(3) Between two groups,there was no statistically significant difference in in-hospital mortality (16.67％ vs.33.33％,P =0.194 3).In addition,there was significant difference in length of hospital stay between two groups (23.13 ± 10.58) d vs.(31.10 ± 15.33) d,P =0.046.Conclusions The diagnosis and treatment strategy based on AGI grading system is associated with earlier initiation of EN and reaching caloric goal,and partly reduces the incidence of infections and shortens the length of hospital stay,in the meantime,provides guidance for the rationale of nutritional support in the patients with SAP.

Platelet-rich plasma with sodium hyaluronate in repair of rabbit knee osteoarthritis / 中国组织工程研究

BACKGROUND: Studies have shown that sodium hyaluronate inhibits cartilage damage in osteoarthritis and accelerates regeneration of cartilage cels, to stabilize and repair the articular cartilage. OBJECTIVE:To investigate the therapeutic effect of sodium-rich plasma combined with platelet-rich plasma (PRP) on rabbit knee osteoarthritis. METHODS:Forty New Zealand white rabbits were randomly divided into five groups, control group, combined group, sodium hyaluronate group, PRP group and model group, and then an osteoarthritis model of the right knee was made in each rabbit. After modeling, sodium hyaluronate+PRP, sodium hyaluronate, autologous PRP and normal saline were givenviathe knee joint cavity in the latter four groups, respectively, once a week for 5 weeks. The control group received no treatment, as normal controls. At 1 week after treatment, ELISA assay was used to detect serum interleukin-1, interleukin-6, tumor necrosis factor-α levels, and changes of the articular cartilage were observed under a light microscope. RESULTS AND CONCLUSION:Compared with the control group, the levels of interleukin-1, interleukin-6 and tumor necrosis factor-α were al increased in the other four groups (P < 0.01). Compared with the model group, the levels of interleukin-1, interleukin-6 and tumor necrosis factor-α were lowered significantly in the combined, sodium hyaluronate and PRP groups (P< 0.01 orP< 0.05), and the most significant decline was in the combined group. Articular cartilage damage was severest in the model group and mildest in the combined group. Experimental findings indicate that intra-articular injection of sodium hyaluronate+PRP can reduce inflammation and protect the articular cartilage in knee osteoarthritis, which is better than a single drug injection.

Predictive value of AGI grading system introduced into SOFA score in patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP.Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study.The criteria of exclusion were the age below 18 years old,pregnancy,or patients without consent to the treatment.A total of 63 patients with 37 males and 26 females aged (47 ± 15.3) years were included.The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score,the highest SOFA score and AGI grade within the first week,and the 28-day mortality rate were collected.Patients without AGI were defined as zero point,and AGI grade Ⅰ-Ⅳ were defined as 1-4 points.The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHE Ⅱ score,SOFA score,and SOFA + AGI score in predicting the prognosis of SAP.The areas under ROC curve (AUC) of the APACHE Ⅱ score,SOFA score,and SOFA + AGI score were compared with MedCalc software,and P value less than 0.01 was considered to be statistical significance.Results (1) The 28-day mortality of the 63 patients with SAP was 20.6％ (13/63),in which 50 patients in the survival group,13 patients in the death group.The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs.12.10 ± 3.74,P=0.0048),the SOFA scores were (14.77 ± 3.09 vs.9.24 ± 2.88,P ＜0.01),and the SOFA + AGI scores were (18.77 ±3.09 vs.10.74 ± 3.17,P＜0.01).(2) The AUC of APACHEⅡ score was0.748 ± 0.084 (95％ CI:0.622-0.849),the AUC of SOFA score was 0.902 ± 0.059 (95％ CI:0.801-0.962),and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95％ CI,0.882-0.994);There was no significant difference in AUC between APACHE Ⅱ score and SOFA score (P =0.10),and there was statistical significance between the AUC of APACHE Ⅱ score and that of SOFA + AGI score (P =0.013),and the difference in AUC between SOFA score and SOFA + AGI score was statistically significant (P =0.008).The Youden index and the positive likelihood ratio of SOFA + AGI score system were the greatest to be 0.863 and 15.38,respectively.Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it.

An analysis of relevant factors influencing the prognosis of post cardiac arrest syndrome / 中华危重病急救医学

ObjectiveTo investigate the relevant factors influencing the incidence and mortality of post cardiac arrest syndrome (PCAS), and to provide the basis of improvement of resuscitation rate.Methods A single center retrospective study of cardiopulmonary resuscitation (CPR) according to Utstein model was conducted. A clinical case report form was designed to collect clinical data. The clinical data of patients whose spontaneous circulation was restored (ROSC)> 24 hours in intensive care unit (ICU) of the First Hospital of Jilin University from January 2008 to June 2014 were collected and analyzed. The relevant risk factors of the incidence and mortality rate of PCAS were screened and analyzed by multivariate logistic regression analysis.Results① Successful CPR was achieved in 93 patients, of whom 83 patients were shown to have systemic inflammatory response syndrome (SIRS), and 75 patients suffered from PCAS (80.65%). Among them 49 died, and 18 patients who did not suffer from PCAS survived.② The age, gender, history of previous chronic disease, site of occurrence of cardiac arrest, type of rhythm when cardiac arrest occurred, and dosage of adrenaline showed no significant influence on the incidence of PCAS. The incidence of PCAS was elevated when defibrillation was done more than 3 times (χ2= 10.806,P= 0.001), SIRS occurred after ROSC (χ2= 46.687,P 5 minutes (χ2 = 4.190,P = 0.041), and ROSC time was longer than 10 minutes (χ2 = 20.042,P 10 minutes (χ2 = 36.451,P 2 mmol/L (χ2 = 28.926, P 15 (χ2 = 33.558,P< 0.001). Multivariate logistic regression analysis showed that the risk factors affecting the prognosis were ROSC time [odds ratio (OR) after adjustment = 36.643, 95% confidence interval (95%CI) = 2.382-563.767,P = 0.010], the number of organs with dysfunction (OR = 9.010, 95%CI = 1.140-71.199,P = 0.037), and APACHEⅡ score (OR = 10.001, 95%CI =1.336-74.893,P = 0.025).Conclusions ROSC time, the number of organs with dysfunction, and APACHEⅡ score were independent predictors of PCAS prognosis. Efforts should be given to shorten the rescue time, to shorten the time for restoring the spontaneous circulation, to prevent and treat SIRS after ROSC, and to protect the function of organs, in order to improve the prognosis of patients with PCAS.

Evaluation of clinical application of ESICM acute gastrointestinal injury grading system: a single-center observational study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In 2012, the working group on abdominal problems of the European Society of Intensive Care Medicine (ESICM) proposed a definition and also guidelines for the grading system and treatment of acute gastrointestinal injury (AGI). Until now, clinical reports on this topic have not been available, and the practicality of using the AGI grading system requires further validation in the clinic. Therefore, we conducted this study to evaluate the feasibility of utilizing the current AGI grading system in a clinical environment, and to provide evidence for its usefulness in assessing the severity and prognosis of critically ill patients with gastrointestinal dysfunction.</p><p><b>METHODS</b>A total of 133 patients were examined for the presence or absence of AGI, their scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and Lausanne Intestinal Failure Estimation (LIFE) test, and 28 days mortality. The presence and severity of AGI was based on guidelines provided by the ESICM. The patients were assigned to a NO-AGI group (n = 50) or an AGI group (n = 83). The AGI group was then further divided into three subgroups, consisting of AGI I (risk group, n = 38), AGI II (gastrointestinal dysfunction group, n = 33) and AGI III+AGI IV (gastrointestinal failure group, n = 12). These subgroups were then compared for differences in AGI indicators.</p><p><b>RESULTS</b>There were no statistically significant differences between the AGI group and the NO-AGI group in terms of age, gender, APACHE II score or LIFE score (P > 0.05); however, the two groups showed a significant difference in their respective rates of 28 days mortality (32.5% in the AGI group vs. 8.0% in the NO-AGI group (P < 0.05)). Patients in the three AGI subgroups showed significant differences in their 28 d mortality rates, APACHE II, and LIFE scores. AGI grading system showed strong positive correlations with APACHE II and LIFE scores (P < 0.05).</p><p><b>CONCLUSIONS</b>The current AGI grading system can be used to identify and evaluate gastrointestinal dysfunction in critically ill patients, and also to provide a preliminary assessment regarding the prognosis for patients with different grades of AGI.</p>

An application of arterial pressure-based cardiac output measurements in fluid management strategies of critically ill patients / 中华危重病急救医学

Objective To discuss the clinical significance of fluid management of severe patients according to arterial pressure-based cardiac output (APCO) monitoring volume responsiveness index.Methods A retrospective cohort study was conducted.The severe patients were selected from the intensive care unit (ICU) of the First Hospital of Jilin University from June 1st,2012 to December 31st,2013.The hemodynamic parameters were monitored by APCO,and the fluid resuscitation was managed by stroke volume variation (SVV) and passive leg-raising test (PLR) when the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥ 15,heart rate ＞ 100 bpm with the result that the preload and heart function could not be evaluated.The heart rate,SVV,lactic acid (Lac) and central venous pressure (CVP) and curative effect were recorded before and after carrying out fluid management strategy.The criteria of clinical effective was defined as heart rate decreased and (or) stroke volume (SV) increased ≥ 10％,accompanied by blood Lac and SVV decreased,other than,the cases did not meet above criteria were considered ineffective.Results Sixty-eight patients were enrolled in the study.① Before carrying out fluid management strategy:40 cases with CVP＞ 12 cmH2O (1 cmH2O=0.098 kPa),and 16 cases with 5-12 cmH2O,12 with ＜5 cmH2O.SVV＞13％ in 35 cases,SVV ＜ 13％ in 9 cases.PLR positive in 18 cases,and PLR negative in 6 cases.It was implicated that the patients with poor preload (SVV ＞ 13％ and PLR positive) accounted by 77.9％ (53/68).② There were 49 effective cases and 19 ineffective cases 4 hours after carrying out fluid management strategy,and the effective rate was 72.06％ (49/68).While there were 56 effective cases and 12 ineffective cases after 12 hours,and the total effective rate was 82.35％ (56/68).③ In effective group,heart rate,SVV,Lac after fluid management strategy were significantly lower than those before fluid management strategy [4 hours after fluid management strategy:heart rate (bpm) 112.45 ± 13.53 vs.129.55 ± 15.49,SVV (15.47 ± 6.32)％ vs.(21.20 ± 7.40)％,Lac (mmol/L) 4.16 ± 3.12 vs.6.21 ± 4.11 ; 12 hours after fluid management strategy:heart rate (bpm) 110.02 ± 13.92 vs.129.61 ± 14.93,SVV (14.61 ± 15.52)％ vs.(20.66 ± 7.40)％,Lac (mmol/L) 3.35 ± 2.26 vs.6.11 ± 4.02,P＜0.05 or P＜0.01],while there was no significant difference in those markers between before and after fluid management strategy in ineffective group [4 hours after fluid management strategy:heart rate (bpm) 119.53 ± 11.68 vs.125.79 ± 11.58,SVV (16.95 ±6.48)％ vs.(18.47 ±4.96)％,Lac (mmol/L) 5.55 ± 3.80 比 6.54 ± 3.72 ; 12 hours after fluid management strategy:heart rate (bpm) 115.92 ± 11.71 vs.123.40 ± 11.59,SVV (17.17 ± 6.09)％ vs.(19.42 ± 8.25)％,Lac (mmol/L) 6.33 ± 3.40 vs.7.21 ± 3.81,all P＞ 0.05].CVP only at 12 hours after fluid management strategy in effective group was significantly higher than that before fluid management strategy (cmH2O:12.88 ± 3.38 vs.11.27 ± 4.97,P＜0.05).Conclusion SVV monitored by APCO is a good indicator of volume responsiveness index,which can be used as an important reference combined with PLR for fluid management of severe patients.

The auxiliary effect of decoction of four-drug juice combined with glutamine on nutritional support in the elderly critical ill patients / 中国综合临床

Objective To explore the effect of decoction of four-drug juice plus glutamine on nutritional support in the elderly critically ill patients. Methods One hundred and twenty-four elderly critical ill patients in The First Hospital of Jilin University from May 2010 to May 2012 were randomly divided into treatment group(n = 62)and control group(n = 62). Patients in both two groups were given enteral nutrition(EN)plus parenteral nutrition(PN)after the hemodynamics became stable. In addition,patients in control group were given routine EN + PN,while in treatment group was given decoction o four-drug juice + EN plus glutamine + PN. Prealbumin (PA),serum total protein( TP),transferrin( TF)and serum albumin( ALB)were detected before and after treatment of nutritional support. The informations including recovery of bowel sounds,the occurrence of complications,antibiotic use time and the duration of ICU stay were recorded. Results There were no significant differences between two groups in terms of nutrition indices before treatment(P > 0. 05). After treatment,the contents of pre albumin,transferrin,total serum protein,serum albumin in treatment group were( 145. 24 ± 6. 72)g/ L,(1. 93 ± 0. 98)g/ L,(79. 86 ± 10. 38)g/ L,(54. 91 ± 2. 91)g/ L respectively,better than those in control groups((139. 24 ± 38. 76),(1. 68 ± 0. 33),(74. 73 ± 7. 31),(49. 87 ± 2. 61)g/ L),and the differences were statistically significant( t = 3. 610,2. 929,4. 360,6. 767;P < 0. 05). The incidence of stress ulcer and double infection in treatment group were 42%(26 / 62),37%(23 / 62),significantly lower than the control group(59%(37 / 62),53%(33 / 62)),and the differences were statistically significant( χ2 = 5. 186, 5. 271,P < 0. 05). Antibiotic use time and the duration of ICU stay in treatment group were(8. 82 ± 0. 71)d and(16. 14 ± 3. 01)d,and reaching full eternal nutrition time was(6. 90 ± 1. 01)d,decreased less than that in control group((10. 21 ± 1. 30),(20. 67 ± 2. 29),(13. 91 ± 1. 51)d)and the differences were statistically significant(t = 8. 892,7. 786,3. 609,P < 0. 05). The average recovery time of bowel sounds and first anal exhaust time average in treatment group were(26. 8 ± 3. 6)h,(25. 4 ± 3. 2)h,lower than that in control group ((38. 4 ± 4. 8)h,(37. 6 ± 4. 9)h)and the differences were statistically significant( t = 3. 551,2. 516,P< 0. 05). Conclusion The application of decoction of four-drug juice plus glutamine on nutritional support of the elderly critically ill patients can reduce complications,shorten the duration of ICU,recover the intestinal function as soon as possible. Meanwhile,patients can transit to full eternal nutrition as soon as possible,then the cost of therapy is reduced and rehabilitation is quickly.

Clinical analysis of a correlation between lactate clearance and prognosis in patients with multiple organ dysfunction syndrome following resuscitation / 中华急诊医学杂志

Objective To assess the relationship between lactate clearance and prognosis of patients with multiple organ dysfunction syndrome following resuscitation.Methods Data of 42 eligible patients with multiple organ dysfunction syndrome after resuscitation admitted from January 2009 to December 2011 were collected for retrospective analysis.The patients included were adult patients who survived more 24 hours after CPR for cardiac arrest with subsequent multi-organ failure.Exclusion criteria were traumatic heart arrest and the end-stage diseases.All the patients were divided into survival group and death group on the 3rd day and the 7th day after restoration of spontaneous circulation.The differences in the age,gender,mean arterial pressure,oxygenation index (PaO2/FiO2),APACHE Ⅱ score,white blood cell count (WBC),initial lactate level and 6h lactate clearance rate between the two groups were compared by using the Mann-Whitney U-tests and logistic regression analysis.Results Of 42 patients,the mean age was (59.57±14.68) years and mean APACHE Ⅱ score was (26.79 ±7.77),and 23 (54.8％) patients survived until the 3rd day and 14 (33.3％) patients survived to the 7th day after restoration of spontaneous circulation (ROSC).Univariate analysis showed that APACHE Ⅱ score in death group was significantly higher and 6 h lactate clearance was significantly lower than those in survival group (P ＜ 0.05) on the 3rd day and the 7th day after ROSC,and other biomarkers were not significantly different between the two groups.The results from logistic regression analysis showed that there were statistically significant difference in APACHE Ⅱ score (RR =2.143,P =0.028) and 6-h lactate clearance (RR =0.887,P =0.040) between survival group and death group on the 7th day after ROSC,although no significant differences in APACHE Ⅱ score and 6 h lactate clearance were found between the two groups on the 3rd day after ROSC.Conlusions Post-cardiac arrest patients with low lactate clearance in the early stage after ROSC have a poor prognosis.Lactate clearance may be an independent predictor of mortality in post-cardiac arrest patients in the recovery phase.

Effects of Shengmai Injection on multiple organ failure in post cardiopulmonary resuscitation rabbits / 中华急诊医学杂志

Objective To observe the effect of Shengmai Injection (a Chinese herbal medicine preparation) on the serum levels of TNF-α used as indicators of organ function in post cardiopulmonary resuscitation rabbits.Methods Rabbit cardiac arrest model was made with asphyxia by clamping the trachea of rabbit.A total of 30 rabbits were randomly (random number) divided into two groups,namely the normal saline group (n =15) and the Shengmai injection group (n =15).Rabbits in Shengmai injection group were injected with 2 ml/kg Shengmai Injection immediately at the beginning of cardiopulmonary resuscitation (CPR),and the same dose of Shengmai injection given 10 min after CPR.Rabbits in saline group were injected with the same volume of physiological saline instead at the same intervals as previous group.The rate of restoration of spontaneous circulation (ROSC) and survival rates at 6,12,24 and 48 h after ROSC were observed.The serum levels of TNF-α were measured by enzyme-linked immunosorbent assay (ELISA).Biochemical methods were used to detect myocardial MB-isoenzyme of creatine kinase (CK-MB),alanine aminotransferase (ALT),creatinine (Cr),glucose (Glu) and arterial partial pressure of oxygen (PaO2) before resuscitation and 12,24 and 48 h after ROSC simultaneously in the two groups.Results There was no statistically significant difference in the ROSC rate and survival rate after resuscitation between the two groups (P ＞ 0.05).Before asphyxia,there was no significant difference in the level of TNF-α found between the two groups (P ＞ 0.05),but at 12,24 and 48 h after ROSC,the levels of TNF-α in Shengmai group were much lower than those in Saline group (P ＜ 0.05).At 24 h after ROSC,the levels of serum CK-MB,ALT,and Cr in Shengmai group were much lower than those in Saline group (P ＜0.05).Furthermore,at 48 h after ROSC,the levels of CK-MB and ALT in Shengmai group were still lower than those in Saline group (P ＜ 0.05),but there was no significant difference in the level of Cr between the two groups (P ＞ 0.05).There was also no significant difference in the blood glucose and arterial partial pressure of oxygen between the two groups (P ＞ 0.05).Conclusions Shengmai Injection has significant inhibiting effect on the serum level of TNF-α in post cardiopulmonary resuscitation rabbits,and it also has more or less some degrees of protective effect on organ function of heart,liver and kidney in rabbits after ROSC.

Effect of shengmai injectio on restoration of spontaneous circulation and hemodynamics in the early stage of resuscitation in rabbit model of cardiac arrest / 中华急诊医学杂志

Objective To explore the effect of shengmai injection (a Chinese herb preparation made from radix astragali and radix rehmanniae) on restoration of spontaneous circulation (ROSC) and hemodynamics in the early stage of resuscitation (CPR) in animal models of cardiac arrest, providing adjuvant support to stabilize the circulation for the facilitation of follow-up study in the resuscitated animal. Method A total of 30 rabbits were randomly(random number) divided into two groups, shengmai group and saline group, ( n = 15 in each group).Asphyxia method was used to establish animal models of cardiac arrest. In the shengmai group, 2 mL/kg shengmai injection was given immediately just after initiation of CPR and the same dose of shengmai injectio was given once again 10 minutes after ROSC. In the saline group, saline was administered in the same volume and at the same given time instead of shengmai injectio. The duration of cardiac arrest of rabbits, and the lengths of time consumed for ROSC and for resume of spontaneous respiration after CPR as well as the rate of ROSC obtained and 6-hours survival rate after CPR were documented. The changes of hemodynamics including LVSP, + dp/dtmax,- dp/dtmax, LVEDP were recorded before asphyxia,just after the emergence of ROSC and 30 min,60 min, and 120 min after ROSC. Results There were no significant differences in duration of cardiac arrest, length of time consumed for the resume of spontaneous respiration, rate of ROSC obtained and 6-hours survival rate between two groups (P ＞ 0.05), but the ROSC emerged sooner in shengmai group. The LVSP, + dp/dtmax and- dp/dtmaxsignificantly lower 30 min, 60 min and 120 min after ROSC then those before asphyxia in both groups, but LVEDP increased after ROSC (P ＜0.05). At the corresponding intervals after ROSC, the values of LVSP, + dp/dtmaxand - dp/dtmax in the shengmai group were higher than those in the saline group, and the values of LVEDP in the shengmai group were lower than those in the saline group ( P ＜ 0. 05). Conclusions Shengmai injectio used in rabbits with cardiac arrest can shorten the time consumed for ROSC after CPR, improve cardiac diastolic and systolic function after R OSC, stabilizing the hemodynamics after resuscitation.

Clinical analysis of multiple organ dysfunction syndrome after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To enhance the cognition on the clinical features of post resuscitation multiple organ dysfunction syndrome (PR-MODS) in patients after cardiac arrest, and provide the basis for integrated control. Method Based on the retrospective analysis, the clinical data of 72 patients with cardiac arrest with restoration of spontaneous circulation (ROSC) in ICU were collected, including happening place of cardiac arrest, the type of rhythm first monitored after cardiac arrest, cause of cardiac arrest, incidence of SIRS and MODS, the position and number of organ dysfunction, success rate of CPR, the rate of survival to hospital discharge and cerebral performance categories(CPC) of discharged patients. Results ①In patients with ROSC after cardiac arrest, male to female ratio was 1.18:1,55 cases was happened in hospital and 17 cases was happened out of hospital, and the ratio was 3.24:1. ②The distribution of cardiac arrest place: ICU,emergency room and operating room were the major places of in-hospital cardiac arrest, adding up to 41 cases and accounting for 74.55% (41/55); the major places of outhospital cardiac arrest were on the way to hospital and in the ambulance, and accounting for 64.71% (11/ 17). ③According to the rhythm first monitored after cardiac arrest, there were 38 cases using shock and 32 cases using non-shock, the ratio was 1.12: 1. Cardiac arrest causes of cardiogenic and on-cardiogenic factors are 37 cases and 35 cases, a ratio of 1.06:1 .④All of the 72 cases, 16 cases died within 24 h, and 56 cases were successfully resuscitated, but 51 cases occurred SIRS after ROSC, 42 cases had combined MODS (42/56,75%), 27 cases(27/42,64.29%)died.The most involving organs in sequence were brain (38 cases, 90.48%), heart (35 cases,83.33%) and lung (28 cases, 66.67%). ⑤Among the 56 successfully resuscitated patients, MODS ( - ) group (14 cases) all survived, 15 cases in MODS ( + ) group (42 cases) survived, a total rate of survived to hospital discharge was 40.28%(29/72). All the MODS ( - ) group ( 14 cases) got CPC 1 point. In MODS ( + ) group, there were 7 cases getting CPC 1-2 point, 35 cases getting CPC 3-5 point. There were no significant difference between sex and age in the two groups (P > 0.05), while the comparison of CPC and survived to hospital discharge rate had statistically significance (P < 0.001). Conclusions The occurrence of SIRS in cardiac arrest patients with ROSC was common and there was high incidence of MODS subsequently. The heart and brain were the mostly involved dysfunctional organs. PR-MODS was an important factor influencing the prognosis of patients with cardiac arrest.