Objective Analyze the current narrative medical research in China. Method The data came from China National Knowledge Infrastructure, China Science Periodical Database, VIP Web.The key word was narrative medicine. The search started in January 2010 and ended in June 2021.A total of 487 articles were included. Keyword cluster analysis, timeline analysis and highlight word analysis were also carried out by CiteSpace software. Result The number of published literatures rising since 2010 with the most obvious increase just after 2018. The authors and research institutions are still concentrated in the humanities or traditional Chinese medicine research institutes of universities.Narrative medicine research is still focused on traditional Chinese medicine, empathy, humanistic care and relationships between doctor and patient. Parallel medical records have been the main research method of narrative medicine since 2010. Conclusion The research of narrative medicine focuses on traditional Chinese medicine, humanistic care.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

目的 探讨急性颅脑疾病患者早期心功能参数的分布状况以及其对预后的影响.方法 本研究回顾性调查了2009年1月～2014年12月共71位由于急性颅脑疾病而收住北京大学首钢医院重症医学科(ICU)患者的病历资料,所有研究对象于发病6 h内置入PICCO导管监测心功能等血流动力学参数.收集研究对象年龄、性别、APACHEⅡ评分、格拉斯哥(GCS)评分、转归等一般资料,以及颅脑疾病的类别、高血压病、冠心病、心功能不全等临床诊断资料;应用PULSION PiCCO plus容量监测仪测定心功能参数包括心功能指数(CFI)、全心射血分数(GEF)、左心室收缩力指数(dPmax)、心指数(CI)和每搏量指数(SVI).根据患者28天转归情况将患者分为死亡组和存活组.分析急性颅脑疾病患者在发病早期各心功能参数的分布情况.结果 死亡组和存活组2组GCS评分存在显著性差异P<0.05(P=0.02).对2组发病后每天心功能进行分析,结果显示发病后第2天、第3天、第4天和第7天dPmax水平有显著性差异(P分别为0.012、0.016、0.025和0.029),死亡组均高于存活组;同时第3天CI水平和第7天SVI水平有显著差异(P分别为0.013和0.015)死亡组均低于存活组.进一步相关分析显示PICCO测得的心功能参数之间有着较好的相关性,但dPmax与GEF(r=0.02,P=0.750)和SVI(r=-0.02,P=0.622)之间无相关性,同时除了CI与GCS评分(r=-0.07,P=0.133)无相关性外,其余各心功能参数均与GCS评分有较好的相关性,其中CFI和dPmax与GCS评分呈负相关关系.而偏相关分析显示,无论总体患者还是存活组与死亡组患者,其心功能变化与发病天数均无相关性.进一步的生存分析显示第2天CFI、第3天CFI、第2天dPmax、第3天dPmax和第1天的CI对28天生存情况有影响(P分别为0.038、0.019、0.035、0.020和0.019),CFI、CI降低的患者生存率明显降低,以及dPmax正常的患者生存率明显降低.结论 急性颅脑疾病患者发病后,心功能状态会有所变化,并且与28天存活率有关.

Objective:To analyze the treatment and prognosis of advanced age inpatients in Medical Department with lower limbs deep venous thrombosis(DVT).Methods:This was a retrospective study of elderly medical inpatients with DVT, including 58 males(54.7%)and 48 females(45.3%), aged from 80 to 99 years old, in Geriatric Medicine of Peking University Third Hospital from March 2016 to March 2019.There were 91 patients(85.9%)with DVT alone and 15 patients(15.2%)with pulmonary embolism.The clinical data of patients were analyzed, and treatment and prognosis within half a year after discharge were followed-up.Results:A total of 106 elderly medical patients were included, the ratio of male to female was 1.2∶1.0, the age range was 80-99 years old, the median age was 86 years old.Of a total of 106 DVT patients, forty-five cases(42.5%)developed symptoms, sixty-one cases(57.6%)were asymptomatic.Twenty-eight cases(26.4%)involved the proximal lower limb deep veins(popliteal veins and above), seventy-eight cases(73.6%)only involved distal deep veins.Except for advanced age, other DVT risk factors included sixty cases(56.6%)of lung infection, 58 cases(54.7%)being bedridden(>3 d), 50 cases(47.2%)of type 2 diabetes, 46 cases(43.4%)of cerebral infarction, 37 cases(34.9%)of heart failure, and 28 cases(26.4%)of active malignancies, etc.Of a total of 106 DVT patients, 80 cases(75.5%)had high risk of venous thrombosis score, and 68 cases(64.2%)had high risk of bleeding.74 cases received anticoagulant treatment, the rate of anticoagulant treatment was 69.8%.Compared with anticoagulant patients, non-anticoagulant group showed that renal insufficiency, being bedridden, heart failure, cerebral infarction prevalence, and all-cause mortality were increased( P<0.05 or P<0.01).The rate of high risk of bleeding was significantly higher in the non-anticoagulation group than in the anticoagulation group( P<0.01).The pulmonary embolism rate, proximal deep vein involvement rate and their improvement rate when timely rechecking were significantly higher in anticoagulation group than in non-anticoagulation group( P<0.05 or P<0.01, respectively).In the anticoagulation group, 26 patients received short term low-molecular heparin(LMH)treatment during hospitalization, 48 patients(45.3%)were prescribed oral anticoagulants at the time of discharge.Anticoagulation treatment rate is 31.1%(33 cases)at 3 months and 24.5%(26 cases)at 6 months.Non-fatal bleeding occurred in 4 patients in anticoagulation group, but there was no significant difference between the two groups( P>0.05). Conclusions:Great attention should be paid to the risk factors such as lung infection, being bedridden, cerebral infarction, and malignant tumor in the elderly medical inpatients.The rate of high risk of bleeding was high in elderly inpatients, and the rate of regular anticoagulant treatment is low.The risk versus benefit of anticoagulant therapy should be comprehensively evaluated, and individualized therapy should be given.

目的:依据JCI标准对外周化疗患者进行静脉管理,降低静脉炎的发生率,促进外周化疗患者的安全.方法:选取2018年8月～2019年4月于本院放疗病房外周化疗的患者为实验组,制定外周化疗患者静脉炎的预防和处理标准,促进标准落实,加强对患者和家属静脉炎相关知识的宣教,同时进行电话随访跟踪式健康教育.记录每月静脉炎发生情况,并进行原因分析,不断完善静脉炎预防和处理标准.结果:2018年8月～2019年4月共1858人次,发生静脉炎3例,发生率为0.16％,较2018年1月～7月下降62.8％.结论:基于JCI标准

目的 观察老年反杓型血压节律者中,日间血压控制是否达标的影响因素、用药选择以及对心脏重构的影响.方法 连续入选2016年1月至2019年1月在我院老年内科住院的年龄≥65岁的高血压患者,通过24小时动态血压监测(24 h ABPM)筛选出反杓型血压节律患者共300例,根据日间手测血压结果是否达标分为达标组148例和未达标组152例.比较2组患者的特征及药物使用的差异,通过超声心动图方法比较血压控制是否达标对心脏结构和功能的影响.结果 2组日间手测血压比较,未达标组收缩压更高,而舒张压差异无统计学意义;ABPM结果显示,2组间除舒张压外,不同时段的平均收缩压和平均脉压之间差异均有统计学意义(均P<0.05).2组患者中,年龄、性别、冠心病、外周血管疾病、肾功能不全共患病率、血脂水平之间差异均无统计学意义(均P>0.05);糖尿病共患病率、体重指数(BMI)、氮末端脑钠肽(NT-pro-BNP)水平在血压未达标组中明显高于达标组,差异均有统计学意义(均P<0.05).药物治疗方面,绝大多数患者(272例,90.67％)为联合用药,钙离子拮抗剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)以及α受体拮抗剂的应用比例差异均无统计学意义,而噻嗪类利尿剂和β受体阻滞剂的应用,在日间血压达标组较未达标组明显增多.应用超声心动图评估心脏结构功能,2组患者的左心室射血分数(LVEF)之间差异无统计学意义;室间隔厚度、左心室重量指数(left ventricular mass index,LVMI)、左心房内径、E/e'值在血压未达标组均高于达标组(均P<0.05).结论 在老年反杓型节律高血压患者中,噻嗪类利尿剂及β受体阻滞剂的应用更有利于血压降至目标值.血压控制未达标患者的NT-pro-BNP水平升高,且室间隔厚度、LVMI、左心房内径和E/e'值均明显升高,显示即使同为反杓型血压节律患者中,血压控制未达目标值对心脏重构的影响更加显著.

Objective:To investigate the clinical significance of extravascular lung water index (EVLWI) in patients with acute cerebral disease in ICU.Methods:This study retrospectively investigated the medical records of 71 patients with acute cerebral disease in ICU of Peking University Shougang Hospital from January 2009 to December 2014. All the patients underwent PICCO catheter placement to monitor hemodynamic parameters within six hours. The general information including age, sex, APACHE II score, Glasgow score, and outcome was collected. The clinical diagnostic data such as the type of cerebral disease, hypertension, coronary heart disease, and heart failure were also collected. EVLWI was measured with a PULSION PICCO plus monitor. All patients were divided into either a death group or a survival group according to 28-day outcome and EVLWI was compared between the two groups.Results:There was a significant difference in Glasgow score between the two groups (P=0.02). There was a higher EVLWI in the death group on the 3rd and 5th day after the onset of the disease (P=0.024 and 0.010, respectively), and the death group also had a higher percentage of patients with EVLWI elevation on the 5th and 7th day (P=0.047 and 0.028, respectively). Correlation analysis showed that EVLWI and the percentage of patients with EVLWI elevation were positively correlated with the number of days of onset (r=0.14, P=0.005; r=0.991, P=0.000), and EVLWI was also positively correlated with the number of days of onset in the death group (r=0.337, P=0.000), but not in the survival group (r=0.039, P=0.587). In both groups, the proportion of patients with increased EVLWI was positively correlated with the number of days of onset (r=0.862, P=0.013; r=0.938, P=0.001). Further survival analysis showed that on the 5th and 7th day, EVLWI had an effect on the survival rate of the patients (P=0.038 and 0.011), and the survival rate of the patients with increased EVLWI was decreased significantly.Conclusion:After the onset of acute craniocerebral disease, EVLWI is related to the course of disease and the survival of patients.

目的:比较营养风险筛查2002(Nutrition risk screening 2002,NRS 2002)和患者参与主观整体评估量表(Patient generated-subjective global assessment,PG-SGA)在恶性肿瘤同步放化疗患者中应用差异,为临床提供更优方案.方法:采用方便抽样,选以恶性肿瘤同步放化疗患者,同时应用两者评估营养状况,并比较.结果:NRS 2002评定57例患者(38.0％)存在营养风险,PG-SGA评定105例(70.0％)存在营养不良.秩和检验分别比较两者各条目得分,得分主要来源于营养状态和疾病代谢相关因素(P<0.001).以PG-SGA评定营养不良(≥4分)为标准,NRS 2002 Kappa值=0.37(P<0.001).以PG-SGA评定重度营养不良(≥9分)为标准,NRS 2002 Kappa值=0.59(P<0.001).两者分组结果χ2检验显示差异来自非重度营养不良/风险组(PG-SGA:<9分,NRS 2002:<3分)(P<0.001).以PG-SGA评定营养不良(≥4分)或NRS 2002筛查存在营养风险(≥3分)患者为标准,NRS 2002 ROC曲线下面积0.873(95％CI:0.817～0.928)(P<0.001);PG-SGA 0.995(95％CI:0.986～1.00)(P<0.001).结论:PG-SGA评定阳性率比NRS 2002高,两者评定差异来自非重度营养/风险组.临床上应以阻止或减缓下降甚至增加患者体重为目标来制定营养干预措施.医护人员应按要求定期使用NRS 2002筛查患者营养状况,结果阳性则使用PG-SGA评定,及时进行营养干预.

Objective To evaluate the effects and mechanisms of glucose-insulin-potassium (GIK) on post-procedural myocardial injury (PMI) after percutaneous coronary intervention (PCI).Methods A total of 200 non-diabetic patients with documented coronary heart disease (CHD) were divided into the Group GIK and Group G,with 100 patients in each group.Patients in Group G were given intravenous infusion of glucose solution 2 hours before PCI.As compared,patients in Group GIK were given GIK.Results Both post-procedural creatine phosphokinase isoenzyme MB (CK-MB;62.1 ± 47.8 vs.48.8 ± 52.6 U/L,P =0.007) and cTnI (0.68 ± 0.83 vs.0.19 ± 0.24 ng/mL,P ＜ 0.001) in Group GIK were significantly higher than those in Group G.In Group G,9.0％ and 4.0％ of patients had post-procedural increases in CK-MB 1-3 times and ＞ 3 times,which were significantly lower than those in Group GIK (14.0％ and 7.0％,respectively;all P values ＜ 0.01);13.0％ and 7.0％ of patients had post-procedural increases in cTnI 1-3 times and ＞ 3 times,which were also significantly lower than those in Group GIK (21.0％ and 13.0％,respectively;all P ＜ 0.001).Pre-procedural (10.2 ± 4.5 vs.5.1 ± 6.3,P ＜ 0.001) and post-procedural rapid blood glucose (RBG) levels (8.9 ± 3.9 vs.5.3 ± 5.6,P ＜ 0.001) in Group G were higher than those in Group GIK.In adjusted logistic models,usage of GIK (compared with glucose solution) remained significantly and independently associated with higher risk of post-procedural increases in both CK-MB and cTnI levels ＞ 3 times.Furthermore,pre-procedural RBG levels ＜ 5.0mmol/L were significantly associated with higher risk of post-procedural increases in both CK-MB and cTnI levels.Conclusions In non-diabetic patients with CHD,the administration of GIK may increase the risk of PMI due to hypoglycemia induced by GIK.

目的 研究稳定性冠心病合并非瓣膜性心房颤动的高龄患者抗栓治疗的现状.方法 回顾性分析自2016年10月至2019年10月在北京大学第三医院老年内科住院治疗的稳定性冠心病合并非瓣膜性心房颤动患者的临床资料.对患者基本信息、结局等进行描述性分析.根据患者是否接受抗凝或抗血小板治疗将其分为接受抗凝或抗血小板治疗组(n=236)与未接受抗凝或抗血小板治疗组(n=18),再将接受抗凝或抗血小板治疗的患者根据治疗方案分为单药抗血小板治疗(SAPT)组(n=138)、口服抗凝药物治疗(OAC)组(n=60)及抗凝联合单药抗血小板治疗(OAC+SAPT)组(n=38).根据患者是否接受抗凝治疗将其分为抗凝组(n=98)与未抗凝组(n=156).探讨患者不同抗栓方案与其治疗结局的相关性.结果 本研究共纳入254例患者,平均年龄(84.94±5.89)岁,CHADS2评分、CHA2DS2-VASc评分、HAS-BLED评分分别为(3.54±1.38)分、(5.61±1.57)分、(3.08±0.89)分.所有入组患者中死亡40例(15.7％),栓塞56例(22.0％),出血54例(21.3％).接受抗凝或抗血小板治疗组患者的死亡事件、栓塞事件的发生率均低于未接受抗凝或抗血小板治疗组,差异有统计学意义(P<0.05).抗凝组死亡事件、栓塞事件的发生率均低于未抗凝组,差异有统计学意义(P<0.05).OAC+SAPT组与SAPT组患者死亡事件发生率比较,差异有统计学意义(P<0.05);而OAC+SAPT组与OAC组患者死亡事件发生率比较,差异无统计学意义(P>0.05);OAC+SAPT组栓塞事件发生率低于SAPT组、OAC组,差异有统计学意义(P<0.05).结论 高龄稳定性冠心病合并非瓣膜性房颤患者接受抗凝治疗的比例较低,抗凝药物应用仍不充分,抗血小板单药治疗与患者死亡及栓塞的不良结局可能相关.

With the aging in China getting seriously, the elderly population surged in these years. Therefore, the development of geriatric education can't meet the demand of the aging society. Using the full-text database (CNKI) and Wanfang database from 1988 to 2019, the total 280 articles related to geriatric education as the research object were included. Citespace software was approached to establish the knowledge mapping and visualization analysis. It was found that papers with the theme of geriatric education got faster increases in these years. Limited by the professional discipline setting in medical colleges and universities in China, the geriatric education research still has not formed the trend of collectivization and specialization. At the same time, humanistic education, narrative medicine and interprofessional education are complementary to geriatrics education.

目的 观察新型冠状病毒肺炎(简称新冠肺炎)疫情期间医院感染管理措施的应用效果.方法 ?选择2019年全年(1月1日至12月31日)和2020年1月21日至3月15日在北京大学国际医院重症监护病房(ICU)住院的患者作为研究对象.以2019年全年(1月1日至12月31日)收治的1?267例次患者为对照,并与2019年第一季度(1月1日至3月31日)收治的273例次及2020年1月21日至3月15日收治的57例次患者进行比较.2020年1月21日至3月15日本院实行疫情期间感染控制措施,包括严把入口关;在科患者予单间病房,均检测体温和血常规,新入科患者安置在隔离病区,与原有患者相隔至少1个以上房间,减少探视;工作人员实行弹性工作制,减少聚集;严格病区消毒和个人防护等.观察疫情前后ICU器械相关感染及手卫生依从性的变化.结果 疫情期间本院未收治新冠肺炎确诊及疑似病例.2020年1月21日至3月15日疫情期间本院ICU每日在科患者数(例:7.22±2.02比13.05±3.26、14.92±3.43)和每日新入住患者数〔例:0(0,2)比3(1,5)、3(1,5)〕均较2019年全年和2019年第一季度明显减少(均P<0.05),中心静脉导管使用率较2019年?全年和2019年第一季度明显降低〔19.40％(77/397)比39.86％(1?898/4?762)、44.08％(592/1?343),均P<0.05〕,?导尿管使用率较2019年全年和2019年第一季度明显升高〔99.50％(395/397)比93.37％(1?254/1?343)、96.56％(4?598/4?762),P<0.05〕.2019年全年、2019年第一季度、2020年疫情期间中心静脉导管相关血流感染(CLABSI)千日发生率〔1.05(2/1?898)、0(0/592)、0(0/77)例/千导管日〕、呼吸机使用率〔53.09％(2?528/4?762)、56.14％(754/1?343)、54.41％(216/397)〕、呼吸机相关性肺炎(VAP)千日发生率〔5.14(13/2?528)、3.98(3/754)、?0(0/216)例/千通气日〕、导尿管相关泌尿系感染(GAUTI)千日发生率〔1.09(5/4?598)、1.59(2/1?254)、5.06(2/395)例/千导管日〕比较差异均无统计学意义(均P>0.05).2019年全年和2020年1月21日至3月15日疫情期间手卫生依从率比较差异亦无统计学意义〔91.26％(2?505/2?745)比90.91％(400/440),P>0.05〕.结论 ?疫情期间采取的一系列措施,在有效防控新冠肺炎的同时保证了常规医院感染管理工作的质量.

目的:确定冠状动脉CT血管成像(CCTA)最佳重建期相,优化采集时间窗.评价优化采集时间窗对图像质量及辐射剂量的影响.方法:400例受检者(A组)行全心动周期(0～100％ RR间期)采集时间窗冠状动脉CT血管成像,确定最佳重建期相.优化采集时间窗设置为最佳重建期相的95％置信区间,即平均值±标准差×2.比较优化采集时间窗扫描模式(B组,400例)与全期相扫描模式(A组)的心率、信噪比、图像质量主观评分及辐射剂量,并进行统计学分析.结果:心率＜61 bpm者纳入低心率组(A1、B1);心率介于61～75 bpm者纳入中心率组(A2、B2);心率＞75 bpm者纳入高心率组(A3、B3).A1组最佳重建期相(76±3)％RR间期(95％置信区间70％～82％).A2组最佳重建期相(44±3)％及(76±3)％ RR间期(95％置信区间:38％～50％及70％～82％).A3组最佳重建期相(48±5)％RR间期(95％置信区间38％～58％).A、B两组的心率[A组为(70.54±13.06) bpm,B组为(70.38±13.05) bpm)]、图像质量主观评分[A组为(1.52±0.65)分,B组为(1.51±0.63)分]、信噪比(A组为15.76±3.70,B组15.66±4.59)差异均无统计学意义(P值均＞0.05).A1组[(36.73±14.39) mGy]与B1组[(7.13±2.53) mGy]、A2组[(27.57±11.69) mGy]与B2组[(12.13±3.39) mGy]、A3组[(25.55±10.33) mGy]与B3组[(7.74±3.13) mGy]之间的容积CT剂量指数(CTDIvol]差异均有统计学意义(P值均＜0.05).对于低、中、高心率受检者,优化采集时间窗扫描模式与全心动周期扫描模式相比,辐射剂量分别降低了81％0、56％、70％.结论:慢心率者冠脉最佳成像时间位于舒张中末期,高心率者位于收缩末期;中心率者位于收缩末期或舒张中末期.优化采集时间窗,可以在保证图像质量的前提下缩短曝光时间从而降低辐射剂量.

[目的]应用营养风险筛查2002(NRS 2002)和病人主观整体评估(PG-SGA)调查肿瘤放疗病人的营养状况,描述其放疗期间营养风险和营养状况变化,并对两种营养评价工具的效果进行研究,为进一步开展营养风险调查和营养支持提供依据.[方法]方便选取符合条件的病人,在入院48 h内分别采用两种工具进行调查,记录最近时点的客观营养指标及放疗次数等.[结果]共有163例病人入组,根据NRS 2002评分,有营养风险占33.7％;根据PG-SGA评价营养不良占79.8％,其中重度营养不良占31.3％.NRS 2002评分在放疗5～7周(T3)与放疗1～2周(T1)、3～4周(T2)之间比较差异均有统计学意义(P<0.05);而PG-SGA评分仅在放疗5～7周与放疗1～2周间比较差异有统计学意义(P<0.05).[结论]放疗病人营养风险和营养不良发生率较高.N RS 2002能更早地反映放疗中病人营养状况的变化,推荐应用NRS 2002监测放疗病人营养状况的变化;PG-SGA量表可与之结合,避免遗漏营养不良的病人,以便更好地指导临床营养治疗.

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Objective:To evaluate the short-term effect of pulse indicator continuous cardiac output (PiCCO)-guided fluid management in patients with severe pneumonia and heart failure (HF) and the risk factors for 28-day mortality.Methods:We retrospectively analyzed the data from 121 patients with severe pneumonia and HF in Peking University Shougang Hospital from January 2013 to January 2015.Fifty-seven patients who received PiCCO-guided fluid management served as PiCCO group,and 64 patients who received central venous pressure-guided fluid management as the control group.Results:The fluid intake during the first 12 h in PiCCO group was significantly more than that in the control group (P ＜ 0.05).However,within 24-48 and 48-72 h,fluid intake volume was similar between two groups (P ＞ 0.05).Additionally,APACHE Ⅱ and SOFA scores in the PiCCO group were significantly lower than those in the control group (P ＜ 0.05).Logistic regression analysis demonstrated that age,SOFA,APACHE Ⅱ scores and ventilation duration were independent risk factors for 28-day mortality.ROC curve showed that age ≥67 years old,SOFA ≥6,APACHE Ⅱ[≥23 and ventilation duration ≥7 days were the thresholds.Conclusion:PiCCO could accurately guide fluid management in patients with severe pneumonia and HF,with shorter duration of mechanical ventilation and ICU stay days,though 28-day mortality was similar between two groups.Age,APACHE Ⅱ score,SOFA score and ventilation duration were independent risk factors for 28-day mortality.

Objective To explore the prevalence of nutritional risk, undernutrition and application of nutritional support in cancer patients during chemoradiotherapy. Methods A total of 80 were enrolled from March 2010 to February 2011 .Nutritional risk screening(NRS 2002) was performed on first 48 hours incharge and the discharged day, Nutritional support was evaluated on the discharged day too. Results Overall prevalence of nutritional risk and undernutrition on first 48 hours incharge was 38.75% , 23.75% respectively, the prevalence of nutritional risk and undernutrition on the discharged day was 81.25%,40%respectively. Totally 20 patients with NRS≥3 were received nutritional support. Grade 3 or higher myelosuppression occurrence were 29%(9/31), 26.5%(13/49) among patients with NRS≥3 and NRS<3 respectively . Grade 4 anemia and thrombocytopenia only occurred in patients with NRS≥3. Conclusions A large proportion of cancer patients is at nutritional risk or undernutrition during chemoradiotherapy .The application of nutrition support is inappropriate. Assessing the nutrition risk dynamically, and carrying out effective nutrition support are the key points to prevent chemoradiotherapy patients from undernutrition.

目的 探讨老年冠心病患者,应用简易营养评价精简法(MNA-SF)进行营养评估的可行性和价值,并评价营养状态对住院日等治疗相关指标的影响.方法 采用前瞻性研究,随机入选住院的老年冠心病患者86例,根据MNA-SF评分分为营养正常组45例及营养不良组41例.研究对象又根据是否合并糖尿病分为糖尿病组38例,非糖尿病组48例.同时获取血脂、尿酸、蛋白等实验室检查结果,比较MNA-SF评分对营养评估的一致性.并以MNA-SF评分作为营养状态的量化指标,观察其与住院日的相关性.结果 与营养正常组比较,营养不良组跌倒风险、住院天数明显升高[(11.14±6.31)分vs (7.91±4.68)分,P＜0.05;(17.49±7.01)d vs (12.93±4.37)d,P＜0.05],白蛋白和MNA-SF评分明显降低[(37.57±5.11)g/L vs (40.01±3.79)g/L,P＜0.05;(9.07±2.05)分vs (12.87±1.04)分,P＜0.01].糖尿病组与非糖尿病组跌倒风险和住院日比较,差异无统计学意义(P＞0.05).多重线性回归分析显示,MNA-SF评分与住院日呈负相关(r=-0.614,P=0.000),回归方程为:住院日=36.459-0.614×MNA-SF评分.结论 老年冠心病患者中,白蛋白水平降低是营养不良的表现之一.营养不良会增加跌倒的风险,并且导致住院日明显延长.

Background: Mitochondrial biogenesis is crucial for the maintenance of mitochondrial function and cellular homeostasis. C1q/tumor necrosis factor-related protein-3 (CTRP3) is an adipokine that owns multiple functions on metabolic and cardiovascular diseases. However, whether CTRP3 affects mitochondrial biogenesis in cardiomyocytes remains unknown. Methods: Neonatal rat ventricular myocytes were cultured and treated with globular CTRP3 (gCTRP3). The expression of mitochondrial biogenesis related genes was measured by real-time PCR and western blot analysis. Mitochondrial morphology was assessed by a transmission electron microscope. ATP content, oxygen consumption rate (OCR), and sirtuin1 activity were measured with commercial kits. Results: gCTRP3 increased the expression of peroxisome proliferators activated receptor-gamma co-activator-1 alpha (PGC-1 alpha), nuclear respiratory factor 1 (NRF-1), NRF-2, mitochondrial transcription factor A (TFAM), cytochrome B, and oxidative phosphorylation complexes III and V, and increased mitochondrial cristae components and OCR. Additionally, gCTRP3 enhanced mitochondrial DNA copy number and ATP content, while the induction was inhibited by knockdown of PGC-1 alpha. via small interfering RNA. gCTRP3 increased phosphorylation of AMP-activated protein kinase (AMPK), whereas adenine 9-beta-D-arabinofuranoside (AraA), an AMPK inhibitor, attenuated gCTRP3-mediated induction of NRF-1, TFAM, and complexes III and V. gCTRP3 increased both the expression and activity of sirtuin1, whereas inhibition of sirtuin1 by EX-527 attenuated gCTRP3-induced responses. Meanwhile, gCTRP3-mediated activation of sirtuin1 was attenuated by AraA. Moreover, gCTRP3 restored the reduction of sirtuin1, PGC-1 alpha, NRF-1, complex III and ATP content induced by hypoxia-reoxygenation injury. Conclusion: CTRP3 promotes mitochondrial biogenesis in cardiomyocytes via AMPK/PGC-1 alpha pathway. General significance: CTRP3 is an endogenous modulator for mitochondrial biogenesis, and may protect cardiomyocytes by ameliorating mitochondrial dysfunction. (C) 2016 Elsevier B.V. All rights reserved.