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Objective To explore the related factors of diarrhea onset in critically ill patients during early enteral nutrition (EEN). Methods Thirty Zhejiang Provincial Emergency Intensive Care Units (EICU) and ICU to implement EEN support for critically ill patients from July 2016 to August were enrolled, and the incidence of diarrhea within 1 week after EEN administration was observed. The patients were divided into a diarrhea group and a non-diarrhea group according to whether diarrhea occurred or not during EEN. The basic status data [sex, age, body mass index (BMI), albumin, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), nutritional risk screening (NRS2002), major disease diagnosis], and EN status (feeding route, infusion method, EN type, amount of EN on days 4 and 7), and clinical treatment (applying following treatments or not: mechanical ventilation and its duration, vasoactive drugs, gastrointestinal motility drugs, probiotics) and clinical outcomes (survival after discharge or not) were collected in two groups. Multivariate Logistic regression analysis was performed on the indexes with statistically significant differences obtained from the univariate analysis to screen out the relevant risk factors of occurrence of diarrhea in critically ill patients during EEN administration. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of each risk factor for occurrence of diarrhea in critically ill patients with EN therapy. Results Of the 510 critically ill patients who underwent EEN, 156 had diarrhea, 70.5% (110/156) had diarrhea within 4 days of EEN, most diarrhea lasts for 3 days and most frequency of diarrhea was 3-4 times a day. The univariate analysis showed that the age of patients in the diarrhea group was significantly higher than that in the non-diarrhea group (years:69.42±17.94 vs. 65.76±17.69), the mechanical ventilation time and ICU hospitalization time were significantly longer than those of non-diarrhea group [mechanical ventilation time (days): 8 (5, 14) vs. 8 (4, 9), ICU hospitalization time (days): 11.5 (8.0, 19.0) vs. 9.0 (6.0, 14.0)], the proportion of probiotics used and the proportion of feeding by nasal tube were significantly higher than those of non-diarrhea group [proportion of probiotics: 26.9% (42/156) vs. 14.4% (51/354), proportion of nasal tube feeding: [26.9% (42/156) vs. 14.4% (51/354)]. Multivariate Logistic regression analysis showed that the use of probiotics was a protective factor for diarrhea during EEN in critically ill patients [odds ratio (OR) = 0.447, 95% confidence interval (95%CI) = 0.273-0.730, P = 0.001]. ROC analysis showed that the area under the curve (AUC) of probiotics predicting diarrhea was 0.598 (95%CI = 0.554-0.640), P < 0.001, sensitivity was 35.9%, and because AUC was less than 0.7, the accuracy and sensitivity of predicting diarrhea with probiotics was considered to be relatively poor. Conclusion The incidence of diarrhea is high in EEN in critical illness patients and its occurrence is related to various factors. The addition of probiotics can reduce the incidence of diarrhea.
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OBJECTIVE:To explore the clinical efficacy and safety of Yunkang granule combined with dydrogesterone in the treatment of early threatened abortion. METHODS:128 patients with early threatened abortion were randomly divided into single drug group and combined medication group,64 cases in each group. Single drug group received Dydrogesterone tablet with first dose of 40 mg,then 10 mg,q 12 h until vaginal bleeding;combined medication group additionally received 8 g Yunkang granule, tid,until symptoms disappeared. Human chorionic gonadotropin (HCG),clinical symptoms remission time and disappearance time,pregnancy/childbirth complications,pregnancy outcome and neonatal adverse outcome,and the incidence of adverse reac-tions in 2 groups were compared. RESULTS:After treatment,HCG in 2 groups significantly increased,and combined medication group was higher than single drug group,the differences were statistically significant(P0.05). The incidence of adverse reactions in combined medication group was 10.9%, which was significantly lower than single drug group (40.6%),the difference was statistically significant (P<0.05). CONCLU-SIONS:Both dydrogesterone alone and Yunkang granule combined with dydrogesterone show good efficacy in the treatment of ear-ly threatened abortion,but the remission time and disappearance time of clinical symptoms and adverse reactions in combined medi-cation group are less than that in single drug group.
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One of the main topics in population genetics is identification of adaptive selection among populations. For this purpose, population history should be correctly inferred to evaluate the effect of random drift and exclude it in selection identification. With the rapid progress in genomics in the past decade, vast genome-scale variations are available for population genetic analysis, which however requires more sophisticated models to infer species' demographic history and robust methods to detect local adaptation. Here we aim to review what have been achieved in the fields of demographic modeling and selection detection. We summarize their rationales, implementations, and some classical applications. We also propose that some widely-used methods can be improved in both theoretical and practical aspects in near future.