To investigate the clinical significance of procalcitonin(PCT), N-terminal precursor natriuretic peptide (NT-pro-BNP), lactic acid(Lac)in sepsis patients of ICU and the value of prognosis evaluation of them.

Total 70 cases of sepsis patients were collected in the Department of Critical Care Medicine of our hospital between April 2016 and April 2018(observation group); at the same time 30 cases of healthy physical examination were enrolled(control group). Venous blood was extracted from sepsis patients to detect PCT, NT-pro-BNP and LAC when they entered ICU, and fasting venous blood was extracted from the control group to detect PCT, NT-pro-BNP and LAC, and the differences between the two groups were compared. The observation group was divided into survival group and death group. The differences of PCT, NT-pro-BNP and LAC were compared between the two groups. Spearman test was used for correlation analysis of PCT, NT-pro-BNP and LAC in patients with survival and mortality. ROC curve was used to evaluate the value of PCT, NT-pro-BNP and LAC in the prognosis of sepsis patients.

PCT, NT-pro-BNP and LAC in the observation group were (23.00±27.60)ng/L, (7 665.50±8 084.83)ng/L and (4.59±3.47)mg/L, respectively, higher than the control group (P<0.05). PCT, NT-pro-BNP and LAC were (45.65±30.64)ng/L, (9 950.21±7 118.21)ng/L and (6.79±3.00)mg/L respectively in the death group, higher than that in the survival group (P<0.05). Spearman correlation analysis showed that PCT, NT-pro-BNP and LAC were negatively correlated with the survival outcome of patients, with r being -0.597, -0.323 and -0.505, respectively (P<0.05). The ROC curve showed that the cutoff value of PCT was 12.25 ng/L, the sensitivity was 0.998, and the specificity was 0.698; the cutoff value of NT-pro-BNP was 2 372.50 ng/L, the sensitivity was 0.963, and the specificity was 0.488; the cutoff value of LAC was 2.8 mg/L, the sensitivity was 0.999, and the specificity was 0.628.

PCT, NT-pro-BNP and LAC in sepsis patients are significantly increased, and combined detection of PCT, nt-pro-bnp and LAC have a certain value in prognostic evaluation of sepsis patients.

To develop the risk assessment scale of loss of inpatients, to provide an adaptive tool scale for assessing the risk of loss of inpatients, and to verify the reliability and validity of the scale.

By consulting literature, consulting experts, qualitative interviews and Delphi method, the risk assessment scale of inpatient loss was prepared, and 105 inpatients who met the standards in 2019 were selected by random sampling method, and the risk assessment scale of inpatient loss was used to investigate the patients.

Finally, the lost risk assessment scale for inpatients was developed, which included six dimensions, including past history, support system, state of consciousness, cognitive function, high-risk diseases, and influencing drugs, with a total of 16 items, The Cronbach α coefficient of the six dimensions was 0.783-0.879, and the validity (CVI) was 0.870-1.000.

The overall reliability and validity of the risk assessment scale are relatively high, which has certain evaluation value for the risk of inpatient misorientation.

To explore the application and effect of "problem oriented" shift change mode in emergency department.

A retrospective control study was carried out on 304 cases of bedside shift events in the Emergency Department of Mentougou District Hospital, Beijing from June to November 2019, including 155 males and 149 females, aged 20-84 years with an average of (50.13±5.12) years. There were 77 cases of nervous system diseases, 58 cases of digestive diseases, 55 cases of respiratory diseases, 78 cases of cardiovascular diseases and 36 cases of trauma. Between the common bedside shift mode and the "problem oriented" bedside shift mode, the difference of patients’ condition control, patients’/family members’ satisfaction, nurses’ satisfaction and the incidence of adverse events was compared.

After adopting the "problem oriented" bedside shift mode, the nurses’ mastery of patients’ condition [(50.46±6.99) score (38.98±4.76) score], patients’ and family members’ satisfaction [(52.64±2.13) score (40.77±3.26) score], nurses’ satisfaction [(54.16±2.35) score (44.22±2.12) score] were improved, and the incidence of nursing adverse events was reduced [0.16%]. The difference was statistically significant (P < 0.05).

Compared with the common bedside shift, the degree of mastery of patients’ condition, the satisfaction of patients/family members and the satisfaction of the nurses who take over the shift are improved, and the incidence of nursing adverse events is reduced.

To investigate the effect of humerus intramedullary nailing for the treatment of elderly patients with proximal humerus fractures.

A retrospective study of 60 elderly patients with proximal humeral fractures admitted to the Department of Orthopaedics, Jiaozhou People’s Hospital, Shandong Province from July 2016 to February 2018 were enrolled in this study, including 27 males and 33 females, aged 60-84(68.96±3.41)years, average fracture time (1.81±0.33) weeks. According to the random number table method, the patients were divided into control group (using locking plate method) and observation group (receiving intramedullary nail fixation). The surgical time, intraoperative blood loss, fracture healing time/shoulder joint mobility, constant score, and postoperative complications were compared between the two groups.Hemorheological parameters were detected and compared between the two groups of patients before and after treatment.

The operation time, intraoperative blood loss and fracture healing time of the observation group were all lower than that of the control group(P<0.05). The number of external rotations of the observation group was higher than that of the control group(P<0.05). There were no significant differences in the evaluation of other shoulder function and the constant score between the two groups(P>0.05). There was no significant difference in blood rheology between the two groups before operation(P>0.05). There were different degrees of reduction in the plasma viscosity, whole blood viscosity and fibrinogen level after treatment of the observation group were lower than those of the control group(P<0.05). In the control group, 1 case of incision infection, 4 cases of delayed fracture healing and 3 cases of venous thrombosis, the total incidence was 24%. Observation group, 1 case of incision infection, 1 case of delayed fracture healing and 1 case of venous thrombus, the total incidence was 10%.

The humerus intramedullary nailing has a better effect on the proximal humerus fractures, and this surgical method takes less time and has less bleeding, and the postoperative hemorheology index changes are normal, which may shorten bone healing time and improve prognosis.

To evaluate the prognostic value of serum microRNA-130a combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score for predicting death in septic patients with thrombocytopenia.

This nested case-control study was performed from July 2017 to July 2019. A total of 52 septic patients with thrombocytopenia who were diagnosed in the Affiliated Hospital of Jiangsu University were included. There were 30 males and 22 females. The age ranged from 33 to 79 years, with an average age of (62.81 ± 11.48) years. The age rangedAPACHE Ⅱ score were recorded. Plasma samples of all patients within 24 h after admission were collected and stored at -20℃ for later use. The definite diagnosis of sepsis in hospital was defined as the starting point for participating, and death was defined as the end point for terminating participation. Patients who died during the study period were defined as the death group. Meanwhile, the age, sex, onset time, primary infection site and other basic information of the children were used as matching conditions, and the non-dead children were randomly selected from the same cohort as the control group in 1: 1. Differences of serum microRNA-130a expression and APACHE Ⅱ score in two groups were compared. Pearson correlation analysis was used to analyze the correlation between the serum miR-130a expression and APACHE Ⅱ score in septic patients with thrombocytopenia. Receiver operator characteristic (ROC) curve analysis was used to analyze the value of microRNA-130a and APACHE Ⅱ score in predicting the death of septic patients with thrombocytopenia.

According to the design, a total of 42 septic patients with thrombocytopenia (21 in the death group and 21 in the control group) were selected as the final participants. Baseline data were comparable between the two groups. Compared with the control group, the expression of microRNA-130a [(0.95±0.15) vs. (0.80±0.29)] was significantly lower, and the APACHE Ⅱ score [(19.38±3.63) vs. (22.52±4.70)] was significantly higher in the death group (P<0.05). The correlation analysis showed that the expression of serum miR-130a was negatively correlated with APACHE Ⅱ score (r=-0.750, P<0.05) in death septic patients with thrombocytopenia. ROC curve analysis indicated that the prognostic value of microRNA-130a combined with APACHE Ⅱ score [(the area under the ROC curve (AUC) =0.71, 95% confidence interval (95% CI): 0.54~0.89)] was of higher than the single microRNA-130a [(AUC=0.688, 95%CI: 0.52 ~ 0.86)], and APACHE Ⅱ score [(AUC=0.694, 95%CI: 0.53 ~ 0.86)].

Decreased serum microRNA-130a expression level is closely associated with mortality of septic patients with thrombocytopenia; microRNA-130a combination with APACHE Ⅱ score has a good predictive value for the death of septic patients with thrombocytopenia.

To investigate the clinical effect of endo-venous radiofrequency ablation combined with foam sclerotherapy in the treatment of great saphenous vein of varicose of the lower limbs.

The clinical data of 520 patients with primary saphenous varices admitted to Xuzhou Central Hospital from June 2016 to December 2018 were retrospectively analyzed, including 300 males and 220 females, aged 30-80 years with an average age of (60 ± 2) years. The study group included 260 patients(320 limbs) who underwent endo-venous radiofrequency ablation combined with foam sclerotherapy and compared them with 260 patients with saphenous varices who underwent conventional surgery. The operation time, intraoperative blood loss, postoperative activity out of bed days, hospitalization time, and the incidence of postoperative pain, saphenous nerve injury, wound infection, deep vein thrombosis, and hematoma were compared between the two groups. The postoperative quality of life, the closure of the saphenous vein in the 6th and 12th months after surgery, and the recurrence rate within 1 year were compared by follow-up.

The operation time between the study group and the control group was (30.0±3.6) min vs. (60.4±5.9) min, intraoperative blood loss was (20.3±4.6) mL vs. (80.0±3.2) mL, postoperative activity out of bed days was (1.0±0.3)h vs.(6.3±2.0)h, hospitalization time was (2.0±0.8)d vs.(7.5±1.2)d, postoperative pain score was (3.2±0.3) vs.(5.4±1.2), saphenous nerve injury was 0 (0/260) vs. 2.3% (6/260), wound infection was 0 (0/260) vs. 3.0% (8/260), deep vein thrombosis rate was 0 (0/260) vs. 1.9% (5/260), the incidence of thigh hematoma was 0 (0/260) vs. 6.9% (18/260), and the quality of life score was (56.78±3.21) vs. (42.23±2.81); the difference between the two groups was statistically significant (P<0.05). The follow-up results showed that there were 3 cases and 5 cases of partial saphenous vein in the study group at 6 months and 12 months after operation, but in the control group, the recanalization rates of saphenous vein at 6 months and 12 months were 1.5% (4/260) and 1.9% (5/260), respectively. There was no significant difference in the recurrence rate of varicose veins between the two groups (P>0.05).

Radiofrequency ablation combined with foam sclerotherapy has a positive effect on primary saphenous vein varices, and it has good short-term and long-term effects, which can provide a better model for daytime surgery.

To investigate the clinical significance of preoperative neutrophil/lymphocyte ratio (NLR) in evaluating the prognosis of patients with acute cholangitis complicated with choledocholithiasis.

From January 2016 to June 2019, 60 patients with acute cholelithitis complicated with choledocholithiasis were treated in the Department of General Surgery of Wujin people's Hospital affiliated to Jiangsu University, were selected as subjects for retrospective study, including 27 males and 33 females, aged 46-88 years with an average age of (67.93±11.46) years. Preoperative NLR<5.435 patients were treated as low NLR group (31 patients), NLR tientsed as subjects for r(29 patients), white blood cell count, C-reactive protein, glutamic oxaloacetic transaminase and glutamyl transaminase levels were compared between the two groups, and the levels of leukocyte count, C-reactive protein, glutamic oxaloacetic transaminase and glutamyl transaminase in the two groups were analyzed by total hospitalization days, postoperative hospitalization days, total hospitalization expenses, etc.

The levels of leukocyte count [(6.28±1.66)×10⁹/L vs (10.59±3.55)×10⁹/L, P<0.05 ], C-reactive protein [(57.63±47.68)ug/mL vs (81.38±38.25)ug/mL, P<0.05 ], glutamic oxaloacetic transaminase [(96.17±71.25)U/L vs (281.90±438.30)U/L , P<0.05] and glutamyl transaminase [(297.57±255.97)U/L vs (509.70±462.06)U/L, P<0.05] in low NLR group were significantly lower than those in the high NLR group (P<0.05). The total hospitalization days [(13.34±4.55)days vs (15.49±3.94)days, P<0.05], postoperative hospitalization days [(10.07±2.80)days vs (11.6±3.41)days, P<0.05] and total hospitalization expenses [(26 984.78±4 316.30)CNY vs (30 875.35=±4 305.50) CNY, P<0.05] in the low NLR group were significantly lower than those in the high NLR group (P<0. 05).

The NLR value of peripheral blood in patients with acute cholangitis with cholelithiasis is positively correlated with the degree of inflammatory infection, suggesting that NLR is consistent with the actual severity of the patient and has a prognosis for surgical treatment.

To investigate the relationship between the expression of neuron specific enolase (NSE) in serum and the severity and prognosis of patients with brain injury caused by different causes.

A retrospective analysis of 38 patients admitted to our intensive care unit from June 2018 to June 2019 was performed, including 28 males and 10 females, aged 25-87 years with an average age of (53.9 ± 13.3) years.The patients who met the admission criteria were GCS scores. The patients were divided into three groups according to the GCS score: mild and intermediate group (group A), severe group (group B) and very severe group (group C). There were 10 cases in group A (GCS 9-15 points), 14 cases in group B (GCS 6-8 points), and 14 cases in group C (GCS 3 to 5 points). The above grouped patients were scored APACHE II respectively. Serum NSE levels were detected.

The serum NSE levels of all patients with craniocerebral injury were higher than those of the moderately severe group and the mild group (P<0.05). The higher the NSE level, the higher the APACHE II score and the higher the mortality rate.

The expression of neuron-specific enolase can be used as a laboratory index to evaluate the degree of craniocerebral injury and is negatively correlated with the prognosis of patients.

To explore the clinical effect of kangfuxin fluid combined with pantoprazole and thrombin in the treatment of peptic ulcer complicated with bleeding.

A retrospective study was conducted on 114 patients with peptic ulcer complicated with bleeding admitted to the Department of Gastroenterology, People’s Hospital of Jiaozhou City, Shandong Province from September 2014 to February 2016. Patients in control group (57 cases) received conventional clinical treatment, and patients in the study group (57 cases) received conventional treatment on the basis of convalescent fluid combined with pantoprazole and thrombin, and the ulcer treatment effect, hemostatic effect, abdominal pain disappearance time and drug side effects were compared between the two groups.

The total effective rate of ulcer healing in the study group was 98.25%, lower than that in the control group (P<0.05). The total effective rate of hemostasis in the study group was 98.25% lower than that in the control group (85.96%) (P< 0.05). The disappearance time of abdominal pain in the study group was shorter than that in the control group (P<0.05). The total adverse reaction rate (3.51%) in the study group was the same as that in the control group (1.75%) (P>0.05).

The clinical effect of kangfuxin liquid combined with pantoprazole and thrombin in the treatment of peptic ulcer complicated with bleeding is remarkable. The ulcer healing of patients is favorable, with good hemostatic effect and low recurrence rate and the symptoms of patients are improved; the toxic and side effects of the therapy are lower, and the safety is higher, and therefore it can be promoted clinically.

To assess the safety and efficiency of such diagnostic strategy of aortic dissection score combined D-dimer for acute aortic syndromes (AAS).

In a multicenter prospective observational study involving 3 hospitals from 2014 to 2017, 3330 patients were analyzed. Among them, 2132 were males and 1198 were females, aged from 50 to 72 years, with an average age of (52.68±4.9) years. The tool for PPA was the aortic dissection detection risk score (ADD-RS) per current guidelines. DD was considered negative (DD-) if >0.5 cu/mL. Final case adjudication was based on conclusive diagnostic imaging, autopsy, surgery or on 14-day follow-up. The outcomes were the failure rate and efficiency of a diagnostic strategy ruling-out AAS in patients with ADD-RS=0/DD^- or ADD-RS≤D/DD^-.

766 (23%) patients had ADD-RS=0, 1732 (52%) patients had ADD-RS=1, and 832 (25%) had ADD-RS>1. 434 (13%) patients had AAS. A positive DD test result had an overall sensitivity of 95.2% (95% CI 92.7-97%) and a specificity of 62% (95% CI 60.3-64.1%) for diagnosis of AAS; 17 patients with AAS had DD^-. Within 529 patients with ADD-RS=0/DD^-, 2 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.1-1.9%) and efficiency of 15.3% (95% CI 14.6-17.2%) for the ADD-RS=0/DD^- strategy. Within 1 663 patients with ADD-RS ≤s/DD^-, 6 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.2-1.1%) and efficiency of 51.2% (95% CI 48.1-53.6%) for the ADD-RS≤f/DD^- strategy.

Integration of ADD-RS (both =0 or ≤o)with DD may be considered to standardize diagnostic rule-out of AAS.

The aim of the study was to demonstrate that TCD and APACHE II scores can be used as predictors of the neurologic outcome after abdominal cardiopulmonary resuscitation.

A retrospective study was performed in a total of 66 cardiac arrest patients with abdominal cardiopulmonary resuscitation in Zhengzhou People’s Hospital and Sanmenxia center hospital were selected. There were 34 males and 32 females, whose age ranged from 19 years old to 80 years old with the mean age of 50.91±14.50 years. According to the Glasgow-Pittsburgh cerebral performance categories, the patients were divided into favorable prognosis group with the CPC1~2(n=29)and unfavorable prognosis group with the CPC3~5 (n=37). Two groups of patients’CBF by TCD and APACHEⅡ scores were compared in 24 hours after successful abdominal cardiopulmonary resuscitation. The date was analyzed and receiver operating characteristic curves were made.

CBF of favorable prognosis group was higher than that of unfavorable prognosis group[(6.23±1.88)vs(4.88±1.15), P<0.05], and APACHEⅡ scores was lower than that of unfavorable prognosis group[(15.31±5.37)vs(25.05±7.94), P<0.05]. CBF had negative correlation with APACHEⅡ scores(R=-0.692, P<0.01). ROC curves for unfavorable prognosis patients revealed an area under the curve of 0.722 for CBF, and 0.844 for APACHEⅡ scores.

The increasing CBF and decreasing APACHEⅡ scores were observed in patients with good outcome in brain function. So CBF and APACHEⅡ scores can be used as predictors of the brain function after abdominal cardiopulmonary resuscitation.

To investigate the safety and efficacy of completely uni-portal thoracoscopic lobectomy(Uni-portal VATS)and the indications of this procedure.

The clinical data of 86 consecutive patients (52 men, 34 women, median age 56.2±10.5 years, range from 32 to 82 years) underwent Uni-portal VATS in the People’s Hospital of Bao An of shen zhen city from Aug. 2015 to Aug. 2017 were retrospectively analyzed. All candidates were either peripheral pulmonary nodules suspected of lung cancer (81 pts) or benign lesions (5 pts) localized within single lobe who needed to receive lobectomy. The lobectomy was completed through uni-portal incisions in the intercostal space. Anatomic lobectomies were carried out in all cases and systemic lymph node dissection was performed in malignancies. This group consisted of lobectomies of right upper lobe (n=21), right middle lobe (n=6), right lower lobe (n=18), left upper lobe (n=19), and left lower lobe (n=22).

All procedures were successfully completed except for 2 conversions to thoracotomy. Postoperative diagnosis were primary lung cancer (n=80), metastasis of clear cell carcinoma from kidney (n=1), and, benign lesions (n=5). 2 patients had mild complications, atelectasis, needed temperately mechanical ventilation. All were treated conservatively without re-operation. No operative mortality or serious complications occurred in this group. The operative duration was 116.2±64.8 min (range from 84 to 210 minutes). The blood loss was 310±460 mL (range from 60 to 770 mL), and two cases needed blood transfusion. Chest drainage time was 5.8±4.2 days. Postoperative hospital stay was 8.5±4.0 days. Followed-up time was for 1 to 24 months, metastasis happened in two patients with primary lung cancer 20 and 4 months separately after operation.

Uni-portal VATS is a safe and feasible surgical procedure with minimal invasiveness. The advocated indications include selected peripheral typed early stage lung cancer and benign pulmonary lesions which need lobectomy.

To evaluate safety and clinical effects of Irinotecan (CPT-11) plus ciplatin (DPP) on treatments of advanced gastric cancer patients for whom first-line treatment failed.

A total of 60 patients with advanced gastric cancer were enrolled from June 2012 to June 2014 based on the inclusion and exclusion criteria. There were 41 males and 19 females, aged from 18 to 65 years with an average age of (48.91±5.77) years. The patients were randomly divided into two groups including CPT-11(180 mg/m²)treatment group and CPT-11(180 mg/m²)+ DDP(25 mg/m²) group. After CPT-11 and CPT-11+ DPP treatments, clinical evaluation was performed by the detection of tumor markers, recent efficacy and long-term efficacy. Adverse events were also analyzed in this study.

Compared with CPT-11 regimen, CPT-11+ DDP regimen had more effective in progression-free-sur (PFS) and the level of CA199 [(220.18±59.93) mg/L vs (154.12±23.77) mg/L], CEA [(31.24±6.15) mg/L vs (15.29±3.84) mg/L] and CA242 [(50.17±5.86) mg/L vs (36.46±6.44) mg/L] were significantly lower (P<0.05). Butthere were no significantly differences in response rate (RR), disease control rate (DCR) and overall survival (OS). The occurrence rates of the adverse effects grade 3-4 events were leukopenia [18.33%(11/60)], anemia [8.33%(5/60)] and vomiting [5%(3/60)] in all regimens. The incidence rate of diarrhea of CPT-11+ DDP regimen was less than that of CPT-11 [46.67%(14/30) vs 16.67%(5/30), P<0.05]. And, CPT-11+ DPP regimen had more fatigue [76.67%(29/30) vs 70.00%(21/30), P<0.05] and vomiting [70.00%(21/30) vs 26.67%(8/30), P<0.05].

CPT-11+ DPP treatments significantly improve the patient’s PFS and reduce the expression of tumor markers and the incidence of diarrhea, but increase the incidence of vomiting and fatigue.

To investigate the value of IMEWS method in assessing the condition of trauma patients in pre-hospital accident scene.

A retrospective analysis of 2 243 cases of road traffic injuries with pre-hospital treatment in emergency department of Zhenjiang Emergency Center in Zhenjiang City, Jiangsu Province was conducted and evaluated by TIEWS scoring method. Of the 2 243 patients, 1 239 were male (55.2%) and 1 004 (44.8%) were women, ranging in age from 18 to 97 years with a mean age of (47.3±11.2) years. Among all the patients, the patients in the age group of 31-40 years old were the most (642 cases) (28.6%), followed by the patients aged 41-50 years (576 cases) (25.7%). The limb injury patients were 1 336 cases (59.6%) and the traumatic brain injury (TBI) patients were 1 021 cases (45.5%).1 683 cases (75.0%) had IMEWS score <6, 472 cases (21.0% ) had IMEWS score ≥6 and <12 , only 88 cases (3.9%) had IMEWS score ≥12 points. By a different scores corresponding to the patient's whereabouts after hospitalization and the prognosis of illness, we draw its relationship with the disease.

The number of patients receiving IMEWS score <6 was significantly less than that of ICU patients receiving IMEWS scores 6-11 and ≥12 (P<0.01) and the number of deaths was also significantly less than that (P<0.01). There was no significant difference in the male/female ratio, improved KTS score and number of different age among three groups (P>0.05). Patients with IMEWS score <6 had no difference between patients with different age groups and those with IMEWS scores of 6 to 11, and those with ≥12 scores (P>0.05).

IMEWS method can be used to determine the severity of illness in patients with traumatic injury and has the ability to identifypotentially critically ill patients.