Predictive value of six critical illness scores for 28-day death risk in comprehensive and specialized intensive care unit patients based on MIMIC-Ⅳ database / 中华危重病急救医学

Objective:To explore the basic characteristics of various types of intensive care unit (ICU) patients and the predictive value of six common disease severity scores in critically ill patients on the first day on the 28-day death risk.Methods:The general information, disease severity scores [acute physiology score Ⅲ (APSⅢ), Oxford acute disease severity (OASIS) score, Logistic organ dysfunction score (LODS), simplified acute physiology score Ⅱ (SAPSⅡ), systemic inflammatory response syndrome (SIRS) score and sequential organ failure assessment (SOFA) score], prognosis and other indicators of critically ill patients admitted from 2008 to 2019 were extracted from Medical Information Mart for Intensive Care-Ⅳ 2.0 (MIMIC-Ⅳ 2.0). The receiver operator characteristic curve (ROC curve) of six critical illness scores for 28-day death risk of patients in various ICU, and the area under the ROC curve (AUC) was calculated, the optimal Youden index was used to determine the cut-off value, and the AUC of various ICU was verified by Delong method.Results:A total of 53 150 critically ill patients were enrolled, with medical ICU (MICU) accounted for the most (19.25%, n = 10 233), followed by cardiac vascular ICU (CVICU) with 17.78% ( n = 9 450), and neurological ICU (NICU) accounted for the least (6.25%, n = 3 320). The patients in coronary care unit (CCU) were the oldest [years old: 71.79 (60.27, 82.33)]. The length of ICU stay in NICU was the longest [days: 2.84 (1.51, 5.49)] and accounted for the highest proportion of total length of hospital stay [63.51% (34.61%, 97.07%)]. The patients in comprehensive ICU had the shortest length of ICU stay [days: 1.75 (0.99, 3.05)]. The patients in CVICU had the lowest proportion of length of ICU stay to total length of hospital stay [27.69% (18.68%, 45.18%)]. The six scores within the first day of ICU admission in NICU patients were lower than those in the other ICU, while APSⅢ, LODS, OASIS, and SOFA scores in MICU patients were higher than those in the other ICU. SAPⅡ and SIRS scores were both the highest in CVICU, respectively. In terms of prognosis, MICU patients had the highest 28-day mortality (14.14%, 1 447/10 233), while CVICU patients had the lowest (2.88%, 272/9 450). ROC curve analysis of the predictive value of each score on the 28-day death risk of various ICU patients showed that, the predictive value of APSⅢ, LODS, and SAPSⅡ in comprehensive ICU were higher [AUC and 95% confidence interval (95% CI) were 0.84 (0.83-0.85), 0.82 (0.81-0.84), and 0.83 (0.82-0.84), respectively]. The predictive value of OASIS, LODS, and SAPSⅡ in surgical ICU (SICU) were higher [AUC and 95% CI were 0.80 (0.79-0.82), 0.79 (0.78-0.81), and 0.79 (0.77-0.80), respectively]. The predictive value of APSⅢ and SAPSⅡ in MICU were higher [AUC and 95% CI were 0.84 (0.82-0.85) and 0.82 (0.81-0.83), respectively]. The predictive value of APSⅢ and SAPSⅡ in CCU were higher [AUC and 95% CI were 0.86 (0.85-0.88) and 0.85 (0.83-0.86), respectively]. The predictive value of LODS and SAPSⅡ in trauma ICU (TICU) were higher [AUC and 95% CI were 0.83 (0.82-0.83) and 0.83 (0.82-0.84), respectively]. The predictive value of OASIS and SAPSⅡ in NICU were higher [AUC and 95% CI were 0.83 (0.80-0.85) and 0.81 (0.78-0.83), respectively]. The predictive value of APSⅢ, LODS, and SAPSⅡ in CVICU were higher [AUC and 95% CI were 0.84 (0.83-0.85), 0.81 (0.80-0.82), and 0.78 (0.77-0.78), respectively]. Conclusions:For the patients in comprehensive ICU, MICU, CCU, and CVICU, APSⅢ or SAPSⅡ can be applied for predicting 28-day death risk. For the patients in SICU and NICU, OASIS or SAPSⅡ can be applied to predict 28-day death risk. For the patients in TICU, SAPSⅡ or LODS can be applied for predicting 28-day death risk. For CVICU patients, APSⅢ or LODS can be applied to predict 28-day death risk.

Detection of antibodies against SARS-CoV-2 as a serologic marker of infection in patients with COVID-19 / 中国输血杂志

【Objective】 To investigate the diagnostic value of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) specific antibodies IgM and IgG on coronavirus disease 2019 (COVID-19). 【Methods】 1) The test results of SARS-CoV-2 IgM/IgG antibodies and nucleic acid(NAT), which were tested by colloidal gold test and fluorescent quantitative PCR respectively, were collected from 145 febrile outpatients during early March, 2020, named Fever group, in which retrospective analysis and paired chi-square test were performed. 2) 612 cases of SARS-CoV-2 IgM/IgG antibodies test results, which were done on March 5, 2020, were collected. They were named COVID-19 group (Our hospital was provisionally assigned as a specialized hospital for COVID-19, and 1500 COVID-19 patients admitted to our hospital from February 12, 2020 to March 18, 2020). The SARS-CoV-2 IgM/IgG antibodies and NAT were respectively tested on the 30th and the 60th day after the date of discharge. The clinical application values of the antibodies was clarified by statistical analysis. 【Results】 1) In the fever group, the positive rate of SARS-CoV-2 IgM, IgG and IgM+ IgG antibodies were 26.21% (38/145), 54.48% (79/145) and 26.21% (38/145), respectively(P<0.01), and the positive rate of NAT was 4.14% (6/145), which was lower than that of antibody (P<0.01). One (1/145, 0.69%) positive NAT was implicated in initially negative IgM and IgG antibodies samples. 2) In the COVID-19 group, the positive rate of IgM antibody was low (5%) and IgG antibody was high (65%) during 2~14 days after infection, and stably increased during the 15~56 days [IgM 47.68%(277/581) vs IgG 94.15% (547/581) ], then both decreased after 57 days. The positive rates of IgM antibody and IgG antibody were 45.8% (280/612) and 93.1% (570/612) in 612 patients during hospitalization. 15 patients′ data after dischange were not collected as they were later transferred to Huoshenshan Hospital for treatment. The coronavirus NAT results of the rest 597 COVID-19 patients, tested on the 30th and 60th days after the date of discharge, were negative, and the positive rates of IgG antibody and IgM antibody were still ≥80% and ≥40% respectively at the second month after discharge. 【Conclusion】 IgM, IgG antibody against SARS-CoV-2 can be well detected by Colloidal gold method(Innovita), whose positive rate is higher than that of NAT. IgG antibody is produced earlier than IgM, and it keeps high positive rate and persists for a long time. The combination of colloidal gold antibody test and NAT can improve the diagnose rate of COVID-19 and the exclusion of suspected cases.

An evaluation of the effect of health education on iodine deficiency disorders in Jilin Province in 2019 / 中华地方病学杂志

Objective:To understand the awareness status about prevention and treatment of iodine deficiency disorders (IDD) in the target population in Jilin Province, and to evaluate the effect of IDD health education.Methods:In 2019, 10 counties (cities, districts) were selected as project counties in iodine deficiency area of Jilin Province, to carry out the health education activities of IDD prevention and treatment. And 3 townships (towns) were selected from each project county, and school health education were carried out among students of grade 4-6 in central primary schools in each township (town); 3 villages were selected from each township (town) to carry out community health education. Before and after health education intervention, 30 students from one class of grade 5 from each central primary school and 15 housewives in the place where the school was located were selected to conduct a questionnaire survey of IDD prevention and treatment knowledge in each township (town). The awareness rate of IDD prevention and treatment knowledge and intervention effect were evaluated.Results:A total of 900 primary school students and 460 housewives were investigated in the baseline survey, the awareness rates of IDD prevention and treatment knowledge were 68.30% (1 844/2 700) and 80.14% (1 106/1 380). After the health education intervention, 905 primary school students and 459 housewives were investigated, and the awareness rate of IDD prevention and treatment knowledge was 95.95% (2 605/2 715) and 96.22% (1 325/1 377), respectively. Compared with that before the intervention, there was an increase of 27.65 and 16.08 percentage points, respectively, the differences were statistically significant (χ 2=706.239, 170.904, P < 0.01). Conclusion:After carrying out of health education, the awareness rates of IDD prevention and treatment knowledge of primary school students and housewives in iodine deficiency area of Jilin Province are significantly increased and health education has achieved good results; IDD health education should be continuously strengthened.

Study on change rule of coagulation related indexes in patients with acute cerebral infarction / 国际检验医学杂志

Objective To research the change rule of indexes of thromboelastography (TEG) ,conventional coagulation test and platelet(PLT) count in the patients with acute cerebral infarction .Methods Eighty-two patients with acute cerebral infarction were selected as the disease group and divided into the mild group (35 cases) ,moderate group (30 cases ) and severe group (17 cases ) according to the disease severity .Other 42 healthy subjects undergoing the physical examination were collected as the control group .The TEG indexes (R ,K ,A ,MA) ,conventional coagulation test (PT ,APTT ,FIB) and PLT count were measured .Then the cor-relation analysis was performed .Results Compared with the control group ,R and K in the disease group , mild ,moderate and severe groups the different disease group were decreased ,while A ,MA and FIB were in-creased ,the differences were statistically significant (P<0 .05);K ,A and APTT had statistical difference be-tween the severe group and moderate group(P<0 .05);R was positively correlated with PT ,APTT and PLT (r=0 .606 ,0 .303 ,0 .179 ,P<0 .05);K was positively correlated with PT and negatively correlated with FIB (r=0 .217 ,-0 .212 ,P< 0 .05);A was negatively correlated with PT and positively correlated with FIB (r= -0 .259 ,0 .228 ,P<0 .05);MA was positively correlated with FIB and PLT (r=0 .297 ,0 .165 ,P<0 .05) . Conclusion The blood in the patients with acute cerebral infarction is in hypercoagulable state .Compared with the conventional coagulation test ,TEG can earlier reflect the body′s coagulation function abnormalities and has a certain help for judging the severity of the disease .TEG has a certain correlation with conventional coagulation test indexes and PLT .

The changes of fresh frozen plasma parameters after its off from the cold chain / 中国输血杂志

Objective To discuss the changes of the quality of the fresh frozen plasma,which leaved refrigerator and it was out of the cold chain.Method The fresh frozen plasma was placed at the room temperature,in six different periods,that is 0,0.5,2,4 h,8,and 12 hours.The prothrombin time,activated partial thrombin live enzymes time,fibrinogen and factor FⅤ,factor FⅧ,antithrombin(AT) and protein C were tested on each point.Results In the fourth group and the fifth group,the FⅧ,AT,and protein C were statistically lower compared with the controls (P＜0.05).But there were no obvious changes of APTT,PT,INR,Fbg and FⅤwhen placed at room temperature for 12 hours.Conclusion After the fresh frozen plasma placed at room temperature for more than 8 hours,the FⅧ ∶ C,AT and protein C were significantly lower compared with the control group.But they have no obvious changes of APTT,PT,INR,Fbg and F Ⅴ when placed at room temperature for 12 hours.

Comparative study of different gastrointestinal motility drugs on capsule endoscopy / 中国医师进修杂志

Objective To compare the effect of different gastrointestinal motility drugs on capsule endoscopy. Methods Seventy-one patients with suspected small bowel disease were randomly divided into metoclopramide group (24 patients), mosapride group(25 patients) and control group (22 group). The patients in metoclopramide group swallowed capsule endoscopy immediately after intramuscularly injecting 10 mg metoclopramide, the patients in mosapride group swallowed capsule endoscopy 15 min after taking 5 mg mosapride, and the patients in control group did not take any of the gastrointestinal motility drugs. Three groups had the same bowel preparation before checking. The finishing rate of small bowel examinations, stomach and small intestinal transit time, intestinal cleanliness and the detection rates of lesions in three groups were compared. Results The total small bowel examination finishing rate was 94.4%(67/71). The small bowel examination finishing rate in metoclopramide group, mosapride group, and control group was 95.8%(23/24), 96.0%(24/25), and 90.9% (20/22), and there was no significant difference(P>0.05). The stomach transit time in metoclopramide group, mosapride group and control group was(27.5 ± 20.7), (28.1 ± 20.9) and (52.3 ± 33.5) min. The stomach transit time in metoclopramide group and mosapride group had no significant difference (P>0.05), but it was significantly lower than that in control group (P0.05). The image class scores in metoclopramide group, mosapride group and control group was (2.5 ± 0.4), (2.7 ± 0.4) and (1.7 ± 0.3) scores.The scores in metoclopramide group and mosapride group had no significant difference (P>0.05), but they were significantly higher than that in control group (P0.05), but it was significantly higher than that in control group (P<0.05). Conclusions The use of gastrointestinal motility drugs before capsule endoscopy can improve the quality of inspection, and metoclopramide and mosapride shows no significant difference.

Risk factors analysis on sepsis complicated with hepatic insufficiency in elder patients / 中国医师进修杂志

Objective To explore the risk factors of sepsis complicated with hepatic insufficiency in elder patients.Methods With retrospective case-control study method,according to whether or not complicated with hepatic insufficiency,a total of 384 elder sepsis patients were divided into case group (91 patients) and control group(293 patients),then single factor analysis and multiple factors Logistic regression methods were used to screen the risk factors.Results Single factor analysis identified 6 kinds of significant variables,including age(P =0.000),history of alcohol(P =0.006),chronic diseases(P =0.001),arterial blood lactate level (P =0.035),mechanical ventilation (P =0.009) and acute physiology and chronic health evaluation Ⅲ score (APACHE-Ⅲ) scores(P =0.004).Multiple factors Logistic regression analysis showed that age,history of alcohol,chronic diseases,arterial blood lactate level,mechanical ventilation,APACHE-Ⅲ scores were correlated with sepsis complicated hepatic insuffciency in elder patients (P ＜ 0.01 or ＜ 0.05).Conclusion The risk factors which closely relate to sepsis complicated with hepatic insufficiency in elder patients are age,history of alcohol,chronic diseases,arterial blood lactate level,mechanical ventilation,APACHE-Ⅲ scores.

A survey on the iodine nutrition status and thyroid function in rural population of Jilin province / 中华内分泌代谢杂志

One hundred children aged 8-10 years and 100 adults aged 18-45 from their families in three townships Baoshan,Mingcheng,and Yantongshan of Panshi city,Jilin province were selected in April 2009. In addition,50 pregnant or lactating women,and their 50 infants aged 0-2 years were selected.The median level of iodine in salt at household was 30.2 mg/kg and that of drinking water was 2.8 μg/L.The median levels of urine iodine in school age chidren ( 196.5 μg/L),during pregnancy( 198.5 μag/L),lactation( 224.9 μg/L),and in infants (209.0 μg/L) all were optimal according to World Health Organization criteria.Only the median urine iodine in adults ( 269.0 μg/L) was more than adequate.The prevalence of goiter evaluated by B-ultrasound was 1.8％ in 8-10year-old children.The incidences of various thyroid dysfunctions were low in these residents,such as subclinical hyperthyroidism ( 2.1％ ),subclinical hypothyroidism ( 1.5％ ),and hyperthyroidism ( 1.2％ ). Subclinical hypothyroidism occurred mostly in adults (2.7％),pregnant women ( 1.7％ ),and lactating women ( 1.8％ ) ; and subclinical hyperthyroidism occurred mostly in 8-10 years old school chidren (4.5％) and lactating women (3.6％).These results show that the current iodized salt content has no harmful effect on thyroid function of rural residents in Jilin province.

Analysis on relevant factors of hyperthyroidism complicating hyperthyroid heart disease / 中国基层医药

Objective To investigate the relevant factors of hyperthyroidism complicating hyperthyroid heart disease.Method Among 48 cases,those factors including age,course of disease,condition and regular treatment were analyzed with Logistic multiple factor reg-ression analysis.Result The hyperthyroid heart disases was related with age,course of disease,condition and whether to treat regularly.Conclusions There are many factors to lead to hyperthroidism complicating hyperthyroid heart disease.It should be paid attention to in those patients with elder,longer course of disease,serious condition and no regular treatment.

A community population-based epidemiologic study of chronic constipation in Guangdong province / 中华消化杂志

Objective To investigate prevalence of chronic constipation in Guangdong province and its impact on health-related quality of life (HRQOL). Methods A questionnaire survey was conducted among permanent inhabitants aged 18-80 years in Guangdong province by randomizing clustered sampling under stratification of urban and suburban areas. The impact of symptoms on HRQOL was evaluated using a well-standardized measure, the SF-36. Results A total of 3931 residents (male 1795, female 2136) were investigated. Mean age among the responders was (42.7?14.1) years old. The prevalence of chronic constipation in Guangdong province is 4.0% according to RomeⅡcriteria. The age-and gender-specific standardized constipation rates after gender and age adjustment was 3.6%. The prevalence was increasing with age. A body mass index

Combination of penetrating keratoplasty, cataract extraction and intraocular lenses implantation / 眼科新进展

Objective　To observe the therapeutic effect of combination of penetrating keratoplasty, cataract extraction and intraocular lenses implantation.Methods　Penetrating keratoplasty was performed simultaneously with cataract extraction and intraocular lenses implantation on 134 cases. Results　One hundred and twenty cases were recorded after following up for 0.5～12 years. Ninety-nine cases (82.5%)of the corneas remained clear. Twenty-one cases (17.5%)of the corneas failed.Ninety-two cases (76.7%)achieved a better visual acuity postoperatively.Eighty-nine eyes(74.2%)were not blind any longer. Conclusion　The combination of penetrating keratoplasty, cataract extraction and intraocular lenses implantation offers advantages of rapid and better rehabilitation of visual acuity with low complication rate.

Erosive esophagitis detected by endoscopy in Guangdong province / 中华消化内镜杂志

Objective To investigate the endoscopic prevalence of erosive esophagitis (EE) among 13 hospitals in Guangdong province of China. Methods Retrospectively reviewed all the cases (63459 cases) that received oesophagogastrodeuodenoscopy in 13 main hospitals in Guangdong province of China in 2003. Los Angeles criteria for classification of erosive esophagitis were employed as the basis of analysis. Results One thousand two hundreds and sixty-three patients (age range 3-90yr, mean 50. 2 ?17. 1 ) were found to have EE. The overall prevalence of EE was 1. 99% (1263/63459). The prevalence of EE in A, B, C, and D grade were 0. 94% , 0. 69% , 0. 21% and 0. 14% respectively. Age correlated positively on endoscopic grading of EE (F=22. 932, P