Objectives In the early stage of sepsis, identifying high-risk paediatric patients with a poor prognosis and providing timely and adequate treatment are critical. This study aimed to evaluate the effect of average body temperature within 24 hours of admission on the short-term prognosis of paediatric patients with sepsis.Design A retrospective cohort study.Setting A single-centre, tertiary care hospital in China, containing patient data from 2010 to 2018.Participants 1144 patients with sepsis were included.Intervention None.Primary and secondary outcome measures The main outcome measure was in-hospital mortality, which was defined as death from any cause during hospitalisation. The secondary outcome was the length of hospital stay.Results The LOWESS method showed a roughly ‘U’-shaped relationship between body temperature on the first day and in-hospital mortality. Multivariate logistic regression showed that severe hypothermia (OR 14.72, 95% CI 4.84 to 44.75), mild hypothermia (OR 3.71, 95% CI 1.26 to 10.90), mild hyperthermia (OR 3.41, 95% CI 1.17 to 9.90) and severe hyperthermia (OR 5.15, 95% CI 1.84 to 14.43) were independent risk factors for in-hospital mortality. Compared with other variables, the Wald χ2 value of temperature on the first day minus the degree of freedom was the highest.Conclusions Whether hypothermic or hyperthermic, the more abnormal the temperature on the first day is, the higher the risk of in-hospital death in children with sepsis.

目的:了解公费医学生自主学习能力及其影响因素.方法:采取普查的方法调查济宁医学院2017-2020级公费医学生,并采用大学生自主学习量表进行问卷调查.结果:公费医学生动机分量表均分为(3.53±0.63),策略分量表均分为(3.41±0.70).多元逐步回归分析结果显示,学习目标与方法、自主学习时间(小时/天)等因素影响公费医学生的学习动机.学习目标与方法、使用手机时间(小时/天)影响其学习策略.结论:公费医学生的自主学习能力稍高于中等水平.高校应加强公费医学生的专业思想教育,增强学生对服务基层医疗卫生事业的认同感,建立由学生主导、学生动手的高效自主学习课堂,从而提高其自主学习能力.

Diabetic retinopathy is one of the most common diabetes complications and the leading cause of blindness in the working-age population worldwide. Diabetic retinopathy can cause progressive retinal damage, eventually leading to the vision loss and lowering the patient′s quality of life.In the past, diabetic retinopathy was considered to be only a vascular disease. However, it is now widely believed that diabetic retinopathy is a neurovascular disease with neurodegeneration occurring prior to the appearance of the microvascular lesions. Although diabetic retinopathy has been extensively studied, its complex pathogenesis has not been fully elucidated, and this review focuses on the possible pathogenesis of neurodegeneration in diabetic retinopathy as well as potential treatments.

BackgroundThe fulfillment of contractual obligations by rural-oriented tuition-waived medical students (RTMSs) to work in rural medical institutions after graduation directly impacts the improvement of rural health quality. This study aimed to not only quantitatively measure the direct impact of honesty-credit, specialty identity, and career identity on willingness to fulfill the contract of RTMSs but also to quantify the intermediary role of specialty identity and career identity between honesty-credit and willingness to fulfill the contract. The research results provided recommendations for the rural-oriented tuition-waived medical education (RTME) program to achieve its goal of training rural primary healthcare personnel.MethodsFrom March to May 2022, 1162 RTMSs were selected as the research objects. The honesty-credit, specialty identity, career identity, and willingness to fulfill the contract were quantitated using a self-completed questionnaire. Pearson's correlation analysis and structural equation modeling were used for statistical analysis and mediating effect evaluation.ResultsA total of 455 (42.3%) RTMSs had high willingness to fulfill the contract, and honesty-credit had a significant direct positive effect on willingness (β = 0.198, P < 0.001), specialty identity (β = 0.653, P < 0.001), and career identity (β = 0.180, P < 0.001). In the intermediary path between honesty-credit and willingness, career identity [95% confidence interval (CI): 0.007–0.051] had significant mediating effects. Career identity (95% CI: 0.030–0.149) also had significant mediating effects between specialty identity and willingness, and specialty identity (95% CI: 0.465–0.760) had significant mediating effects between honesty-credit and career identity. These results strongly confirmed that honesty-credit, specialty identity, and career identity are early and powerful predictors of the willingness to fulfill the contract of RTMSs.ConclusionThe honesty-credit of RTMSs can predict their willingness to fulfill the contract early, significantly and positively. For the students who fail to pass the credit assessment for many times and have a strong tendency to default, their training qualifications should be canceled in time, so that students who are truly willing to serve rural areas can enter the project, and finally achieve the policy goal of “strengthening the rural primary medical and health system”.

Objective:To explore the diagnostic features of idiopathic multicentric Castleman disease.Methods:The clinical data of a patient with idiopathic multicentric Castleman disease admitted to the emergency department of the Affiliated Hospital of Jining Medical University on June 26, 2020 was retrospectively analyzed, and relevant literatures were reviewed.Results:The patient was a 31-year-old young female who was admitted to the hospital for " fever for 1 week" , accompanied by fatigue, cough, and abdominal distension. Physical examination showed multiple lymph node enlargement, low breath sounds in both lower lungs, and dull percussion note. Chest CT showed a large amount of pleural effusion, and anti-infective treatment was not effective.Human herpesvirus-8 (HHV-8) DNA quantitative detection was in the normal range, and human immunodeficiency virus (HIV) negative. The pathological examination of the left cervical lymph node biopsy showed reactive hyperplasia of lymphatic tissue, and the morphology showed the hyaline vascular change of Castleman′s disease. The patient was diagnosed with idiopathic polycentric Castleman′s disease.Conclusion:Early improvement of HHV-8 DNA quantitative detection, immunological indicators, bone marrow biopsy and lymph node pathological examination are helpful for early diagnosis and typing of Castleman′s disease.

Globally, 1 in 11 adults has diabetes, and the threat of diabetes to the human body is mainly its serious, sometimes life-threatening complications. Ceramide is a sphingolipid substance that plays a key role in the regulation of signal transduction pathways, which is mainly synthesized by three pathways: de novo synthesis pathway, sphingomyelin hydrolysis/degradation pathway and recovery/remediation pathway. Ceramide has been linked to the development of diabetes by inducing β cell apoptosis, insulin resistance, and inhibiting insulin gene expression. Some species or ceramide proportions of ceramide may serve as biomarkers of diabetes risk, and understanding the role of ceramides in diabetes and its complications is critical for treatment planning.This review discusses the relationship and mechanism of ceramides in the progression of diabetes and its complications, with a focus on the mechanisms of correlation between ceramides and diabetic retinopathy, diabetic nephropathy, diabetic cardiovascular disease, and diabetic neuropathy, as well as some potential and emerging treatment strategies.

多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是一种常见的内分泌紊乱综合征,常因稀发排卵或无排卵而导致不孕,发病率逐渐升高,严重影响患者的生活质量.孙冰教授从事临床多年,擅长中西医结合治疗PCOS不孕,强调本病与肾虚密切相关,常伴有肝郁脾虚和痰瘀阻滞,运用调周法结合辨证论治,以中药为主,攻补兼施,调经、助孕、安胎步步跟进,为治疗该病提供了宝贵思路.

目前,儿童营养不足的情况在我国农村和贫困山区仍较常见,常因蛋白质与锌、铁等微量元素摄入不足,出现生长发育迟缓、低体重、贫血等现象.生长激素(GH)/胰岛素样生长因子-1(IGF-l)轴是促进儿童和青少年生长发育的主要调控因素.本文主要总结了儿童和青少年营养不足对GH/IGF-1轴的影响,以及在评估GH/IGF-1轴时考虑儿童营养状况的重要性.

Gastric cancer is one of the most common malignant tumors in China, and its pathogenesis is complex. At present, there is no good method for the diagnosis and treatment of gastric cancer. However, studies have shown that microRNA (miRNA) has abnormal expression in gastric cancer, which participates in the regulation of gastric cancer related genes, and has an impact on the occurrence, development, diagnosis and treatment of gastric cancer. This paper aims to review the relationship between miRNA and the diagnosis and treatment of gastric cancer, as well as the drug resistance in the treatment, so as to lay the foundation for the follow-up research and clinical diagnosis and treatment.

目的 探讨矮小症儿童和青少年血尿酸(UA)与丙氨酸转氨酶(ALT)的相关性.方法 本研究纳入了山东省生长发育疾病随访研究队列中诊断为矮小症的685例患者,收集其基线临床资料,横断面分析矮小症儿童和青少年UA与ALT的相关性.结果 单因素分析显示UA与ALT呈正相关(P<0.05);校正了混杂因素以后,通过平滑曲线拟合发现UA与ALT呈曲线关系,UA的拐点为6.47mg/dl,当UA<6.47mg/dl时,UA每增加1mg/dl,ALT降低0.04U/L(95％CI:-0.69～0.76;P=0.924);当UA≥6.47mg/dl时,UA每增加1mg/dl,ALT增加3.62U/L(95％CI:0.85～6.40;P=0.011).结论 在矮小症儿童和青少年中,UA水平与ALT的水平存在曲线关系.

贫血在2型糖尿病(T2DM)患者中普遍存在,多项研究表明贫血是糖尿病肾病(DN)、糖尿病视网膜病变(DR)等微血管并发症的危险因素.其可通过诱导缺氧、氧化应激、内皮功能失调等机制参与T2DM患者微血管病变的发生、发展.本文主要探讨贫血与T2DM患者微血管病变的致病关系,研究通过纠正贫血改善T2DM患者微血管并发症预后的可行性.

Objective:To investigate the correlation between serum bilirubin level and the risk of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus of different sexes.Methods:A total of 1 304 patients with type 2 diabetes mellitus were included in this study. The clinical data were collected and fundus examination was performed. According to the results of fundus examination, the patients were divided into DR group and Non-DR (NDR) group. The correlation between the levels of serum total bilirubin, direct bilirubin, indirect bilirubin, and the occurrence of DR was analyzed.Results:The levels of total bilirubin, direct bilirubin, and indirect bilirubin in DR group were significantly lower than those in NDR group. Univariate analysis showed that the levels of total bilirubin and indirect bilirubin were negatively correlated with the occurrence of DR ( P<0.01). There was no significant correlation between the level of direct bilirubin and the occurrence of DR. Smooth curve fitting showed that there was a U-shaped relationship between the levels of total bilirubin and indirect bilirubin and the risk of DR in women, while a negative correlation between total bilirubin, indirect bilirubin and the risk of DR in men. The results of multiple regression analysis showed that in men total bilirubin increased by 1 μmol/L, the risk of DR decreased by 8% ( OR=0.92, 95% CI 0.88-0.98, P<0.01). Indirect bilirubin increased by 1 μmol/L, and the risk of DR decreased by 9% ( OR=0.91, 95% CI 0.84-0.96, P<0.01). In women, when total bilirubin<12.8 μmol/L, for every 1 μmol/L increase in total bilirubin, the risk of DR decreased by 17%( OR=0.83, 95% CI 0.72-0.95, P<0.01); When total bilirubin≥12.8 umol/L, for every 1 μmol/L increase in total bilirubin, the risk of DR increased by 10%( OR=1.10, 95% CI 1.01-1.20, P<0.05); When indirect bilirubin<9.8 μmol/L, for every 1 μmol/L increase in indirect bilirubin, the risk of DR decreased by 20%( OR=0.80, 95% CI 0.68-0.94, P<0.01); When indirect bilirubin≥9.8 μmol/L, for every 1 μmol/L increase in indirect bilirubin, the risk of DR increased by 13%( OR=1.13, 95% CI 1.01-1.25, P<0.05). Conclusion:This study shows that there is a U-shaped relationship between the levels of total bilirubin and indirect bilirubin and the risk of DR in female patients with type 2 diabetes mellitus, and there is a negative correlation between total bilirubin, indirect bilirubin and the risk of DR in male patients. However, there was no significant correlation between direct bilirubin and DR risk.

Polycystic ovary syndrome (PCOS) is of multiple etiological factors and clinical manifestations characterized with abnormal endocrine and metabolism.PCOS is a common cause of infertility in women of childbearing age.Professor Sunbing is a national outstanding TCM clinical talents, and is a famous Chinese medicine specialist in Shandong Province.She is good at treating infertility, especially the infertility caused by PCOS.Based on long-term clinical experience, she created her own systems of principle-method-recipe-medicines for differentiation and treatment of PCOS.This paper summarized the academic thought and clinical experience of Professor Sunbing in infertility caused by PCOS.

微血管病变是糖尿病的特异性并发症,主要可累及视网膜、肾、神经等组织器官,严重影响患者生存质量,并可导致高致残率及高病死率.总胆红素是临床上常用的一种简单、方便的指标,由于其抗氧化和抗炎作用,近年来许多研究表明其与2型糖尿病微血管并发症的发生发展密切相关.本文主要对血清总胆红素水平与2型糖尿病微血管并发症关系的研究进展作一综述.

目的 探究基于云班课的PBL教学模式在《中医内科学》临床见习中的教学效果.方法 将我校2015、2014级中西医临床医学专业本科见习学生分为实验组和对照组,在脾胃病见习中分别采用云班课-PBL教学法、PBL教学法,比较调查问卷、学习成绩、教师评价.结果 与PBL教学法相比,云班课PBL教学法在提高学习兴趣及积极性、知识的运用能力和临床思维能力、团队协作能力及促进师生与生生间交流、提高学习成绩等方面效果更好,学生更喜欢云班课-PBL教学法,具有显著差异(P＜0.05).结论 基于云班课的PBL教学法可以提高临床见习教学效果,值得应用和推广.

Objective The aim of this study was to evaluate the relationship between hemoglobin ( Hb ) levels and diabetic retinopathy( DR) risk in Chinese patients with type 2 diabetes mellitus( T2DM) . Methods A total of 629 patients who were hospitalized and diagnosed as T2DM were enrolled in the study. The clinical data were collected;All participants underwent an ophthalmic examination, including fundus photographs. They were divided into DR and non-diabetic retinopathy( NDR) groups based on the results of fundus examination. Anemia was defined according to Chinese anemia criteria. The analyses were performed to evaluate the relationships between Hb levels and DR risks. Results The patients with DR had lower hemoglobin levels and a higher prevalence of anemia compared to those without DR. A univariate analysis displayed a significant negative correlation between Hb levels and the rates of DR( P<0.01) . In multivariate linear regression, a 29％ decrease in DR risk was found with a 1 g/dl increase in Hb level(OR=0.713, 95％CI 0.598-0.850, P<0.01). Presence of anemia increased the risk of DR with OR=4.123(95％CI 1.793-9.478, P<0.01) times compared to those who did not have anemia. Conclusion The study indicates a negatire relationship letween Hb levels and DR risk, and a higher Hb levels may reduce the development of DR in T2DM.

Objective To investigate the risk factors for postsurgical hypopituitarism in patients with pituitary adenomas.Methods We retrospectively reviewed the clinical records of 439 pituitary adenoma patients undergoing surgical treatment in the Affiliated Hospital of Jining Medical University from 2005 to 2015.The review included gender,age,tumor diameter,tumor classification,recurrence or not,tumor invasion,pituitary apoplexy,surgical approaches,total tumor resection or not,presurgical hypopituitarism,and tumor recurrence.The risk factors for postsurgical hypopituitarism were analyzed.Results The 439 pituitary adenoma patients included 17 cases of microadenoma cases,356 of macroadenoma and 66 of giant adenoma.Threshold effect analysis showed that the threshold value of tumor diameter was 22 mm.Multivariate Logistic regression analysis revealed that tumor diameter >22 mm〔OR=1.23,95%CI(1.15,1.31)〕,and development of presurgical hypopituitarism〔OR=3.91,95%CI(1.64,9.09)〕 were risk factors for postsurgical hypopituitarism(P<0.001). Conclusion Tumor diameter and presurgical hypopituitarism are independent risk factors for postsurgical hypopituitarism.

二十世纪80年代中期,前苏联学者N.Berkman通过研究发现,人体除了健康状态和疾病状态之外,还存在着一种非健康非疾病的中间状态,称为第三状态即诱病状态.所谓第三状态,我国学者称之为“亚健康状态(SUB-HEALTHYSTATE)”.与健康人相比,亚健康人群的工作、学习效率降低.常见的临床表现有:身体易疲劳,头昏沉、失眠健忘,自汗,易感冒;在心理方面,表现为情绪低落、精神萎靡、记忆力减退、焦虑烦躁、神经质,甚至出现冷漠、孤独、轻率等.这种状态的显现,表示已出现了与某些疾病相关的高危倾向,潜伏着发展成为某一类病理损害的极大可能,或已启动了向某些病理改变的态势.

目的:观察痛泻要方加减治疗肝郁脾虚型溃疡性结肠炎的临床疗效以及其对T细胞Th1/Th2、Th17/Treg介导的炎性细胞因子平衡的影响.方法:筛选符合肝郁脾虚证型的溃疡性结肠炎入院及门诊患者62例,随机分为对照组和治疗组.对照组采用柳氮磺胺吡啶片进行常规治疗,治疗组在常规方案的基础上采用痛泻要方加减进行治疗.2周为1个疗程,连续干预2个疗程.治疗前后对患者临床症状和疗效进行评价,采集患者外周血通过ELISA方法检测血清IL-4、IL-10、IL-17和IFN-γ的含量.之后计算每个样本治疗前后IFN-γ/IL-4和IL-17/IL-10的比值.结果:在治疗有效率方面,对照组为41.94％,治疗组的有效率为67.74％,组间比较差异具有统计学意义(P＜0.01).与治疗前相比,两组治疗后临床症状积分均呈现降低趋势,差异都具有统计学意义,与对照组治疗后相比,治疗组治疗后临床症状积分降低趋势更明显,差异具有统计学意义(P＜0.01).与治疗前相比,两组治疗后IL-4和IL-10的含量升高明显,IL-17和IFN-γ的含量降低,差异均具有统计学意义(P＜0.01).比值分析发现,治疗后两组IFN-γ/IL-4和IL-17/IL-10的比值均呈现降低趋势,与对照组治疗后相比,治疗组降低趋势明显,差异具有统计学意义(P＜0.05).结论:痛泻要方联合常规西医治疗能够明显缓解肝郁脾虚型溃疡性结肠炎的临床症状,机制与其能够促使Th1/Th2、Th17/Treg介导的炎性平衡朝炎性抑制方向转化相关.

Objective To study the effect of blood glucose levels and insulin response state in rats with focal cerebral ischemia/reperfusion(I/R)in brain injury.Methods Male SD rats were randomly divided into focal cerebral I/R models of physiological saline control group(Control),high,middle and low dose rosiglitazone(RSG)drug preconditioning(4,2,1 mg·kg-1·d-1)and sham groups,8 rats in each group.All the rats except for those in the sham group were suffered from the middle cerebral artery embolism ischemia 2 h/reperfusion 22 h(MCAO).Fasting plasma glucose(FPG),blood lipid,serum insulin levels,insulin sensitivity index(IAI)were measured.The effect of RSG on the volume of cerebral infarction and the neurological deficits score of rats were observed.Results There was relation between IAI and infarct volume or neurological function score.RSG reduced infarct volume after ischemia and improved neurological function,at the same time it could increase insulin sensitivity,reduce high blood glucose after stroke in dose-dependent manner.Conclusions High glucose and insulin resistance could aggravate the focal cerebral I/R injury of brain,and insulin resistance is more durable.RSG has neuroprotective effects on cerebral I/R injury,simply reducing blood sugar is not enough,the improvement insulin resistance is more important.