Objective

To investigate the clinical characteristics and prognosis of patients with diabetic ketoacidosis （DKA） combined with acute pancreatitis （AP），and to explore their predictive value for DKA combined with AP.

Methods

A total of 63 patients with DKA who were admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Zunyi Medical University from January 2017 to April 2023 were enrolled.According to whether AP was combined，they were divided into a DKA group （40 cases） and a DKA + AP group （23 cases），and the clinical data and prognostic characteristics of the two groups were compared.Multivariate logistic regression analysis was used to evaluate the risk factors of DKA combined with AP； the receiver operating characteristic （ROC） curve was used to analyze their predictive value for DKA combined with AP and the area under the curve （AUC） was compared.

Results

There were statistically significant differences in diabetes diagnosis，C-reactive protein，triglyceride，serum potassium （K ⁺），serum chloride （Cl ^-），non-invasive ventilator use，total hospitalization cost，and all-cause readmission within 3 months between the two groups （all P ＜0.05）.Compared with the DKA group，the DKA + AP group had more patients with unknown previous diabetes mellitus and fewer patients with type 1 diabetes （both P ＜0.017）.Multivariate logistic regression analysis showed that K⁺ ［odds ratio （OR）=0.134，95% confidence interval （CI）（0.028，0.645），P = 0.012］ was a protective factor for DKA combined with AP，while triglyceride was a risk factor ［OR=1.918，95%CI （1.229，2.994），P=0.004］.ROC analysis showed that the AUC of K⁺ was 0.697 ［95%CI （0.559，0.835），P=0.010］，the sensitivity was 0.739，the specificity was 0.650，and the cut-off value was 3.880 mmol/L.The AUC of triglyceride was 0.878 ［95%CI （0.786，0.970），P ＜0.001］，the sensitivity was 0.957，the specificity was 0.675，and the cut-off value was 1.940 mmol / L.The AUC of triglyceride for predicting DKA combined with AP was higher than that of K⁺ （Z=1.964，P=0.049）.

Conclusions

Patients with an unknown history of diabetes mellitus are more likely to have AP when DKA occurs.High triglycerides are risk factors for DKA combined with AP and thus have some value in predicting the concurrent AP in patients with DKA.

Objective

To investigate the incidence of enteral nutrition feeding intolerance（FI） in elderly critically ill patients，analyze its risk factors，and construct and validate a risk prediction nomogram.

Methods

Data of elderly critically ill patients admitted to the ICU of Jiangyin Clinical Medical College Affiliated to Jiangsu University between January and December 2023 were collected.Patients were divided into modeling and validation datasets.Univariate analysis and binary logistic regression were used to build the risk prediction model.The receiver operating characteristic （ROC） curve was employed to assess the model fit and determine the cut-off value.Sensitivity and specificity of the validation dataset were calculated.The R software "rms" package was applied to convert the prediction model formula into a nomogram.

Results

The modeling dataset included 316 patients，with an FI incidence of 42.4% （134/316）.Among those FI patients，88.8% （119 /134） occurred FI within 1-5 days after initiating enteral nutrition.Binary logistic regression identified age ［odds ratio （OR） = 1.107，95%confidence interval （CI） （1.073，1.141），P ＜0.001］，acute physiology and chronic health evaluation（APACHE） II ［OR = 1.056，95%CI （1.025，1.089），P ＜0.001］，albumin ［OR = 0.921，95%CI（0.874，0.971），P=0.002］，and high positive end-expiratory pressure （PEEP） ［OR = 3.366，95%CI（1.752，6.466），P ＜0.001］ as independent risk factors for FI during enteral nutrition in elderly critically ill patients.The prediction model formula was as follows： Z = -6.692 + 0.102 × age +0.055×APACHE II score-0.082×albumin+1.214×high PEEP （0，1）.Internal validation showed an area under the curve （AUC） of 0.884，sensitivity of 92.0%，and specificity of 54.4%.External validation yielded an AUC of 0.757，sensitivity of 78.1%，and specificity of 75.6%.

Conclusions

The incidence of FI in elderly critically ill patients is high.The constructed nomogram demonstrates strong predictive performance for FI，aiding clinicians in risk assessment and prognosis improvement during enteral nutrition.

目的

观察信息化全院血糖管理模式在合并糖尿病的骨科围手术期患者中的应用效果。

方法

选取2022年3月至2023年2月入住嵊州市人民医院骨科的208 例合并糖尿病的围手术期患者为对照组，采用常规会诊血糖管理模式及科室自我管理模式；选取2023年3月至2024年2月入住骨科的205 例合并糖尿病的围手术期患者作为试验组，采用基于全院血糖管理模式。比较两组患者的低血糖及高血糖发生率、糖化血红蛋白检测率、血糖达标率以及出院时餐前餐后血糖平均值的差异。

结果

与对照组比较，试验组患者高血糖发生率[（53±22）% vs.（38±21）%，t = 6.946，P<0.001]下降，糖化血红蛋白检测率[38.0%（79/208）vs. 58.0%（119/205），χ²=16.660，P<0.001]和血糖达标率[（46±21）% vs.（61±20）%，t = 7.227，P<0.001]均增高，出院空腹血糖[9.32（7.88，11.41）mmol/L vs. 7.90（6.90，9.10）mmol/L，Z=5.470，P<0.001]及出院餐后血糖[10.75（8.60，12.88）mmol/L vs. 9.20（7.60，10.85）mmol/L，Z=5.029，P<0.001]均降低。

结论

基于信息化全院血糖管理模式可有效改善骨科围手术期患者血糖控制情况，值得推广应用。

目的

探讨早期监测白细胞介素35（IL-35）、肝素结合蛋白（HBP）对脓毒症相关急性肾损伤（SA-AKI）的预测价值。

方法

收集2023年6月至2024年12月期间在南京医科大学附属苏州医院重症医学科收治的符合Sepsis 3.0 诊断标准的96 例脓毒症患者，对患者HBP、IL-35 以及白细胞计数（WBC）、C 反应蛋白（CRP）、降钙素原（PCT）等临床常用炎症指标进行早期监测，根据改善全球肾脏病预后组织标准将96 例脓毒症患者分为对照组（48 例）及SA-AKI 组（48 例），分析比较两组患者的基本临床资料以及预后情况。应用受试者工作特征（ROC）曲线分析IL-35、HBP 及IL-35 联合HBP 对SA-AKI 的预测价值。

结果

96 例脓毒症患者中有48 例患者（50.00%）发生SA-AKI。SA-AKI 组患者入院时血清IL-35、HBP、WBC 水平均明显高于对照组（P均＜0.05）。Spearman 相关性分析显示，IL-35 水平与HBP、PCT、WBC、CRP 均呈正相关（r=0.211、0.293、0.384、0.262，P= 0.039、0.004、＜0.001、0.010）。入院时IL-35[比值比（OR）=1.005，95%置信区间（CI）（1.000，1.010），P= 0.047]、HBP[OR=1.014，95%CI（1.001，1.027），P= 0.037]为脓毒症患者发生SA-AKI 的危险因素。ROC 曲线分析结果表明，IL-35、HBP 均对脓毒症患者发生SA-AKI 具有一定预测价值。IL-35、HBP 及两指标联合的ROC 曲线下面积（AUC）分别为0.707 [95%CI（0.603，0.812），敏感度为60.40%，特异度为79.20%，P ＜0.001]，0.781[95%CI（0.679，0.883），敏感度为89.60%，特异度为68.80%，P ＜0.001]，0.730[95%CI（0.629，0.831），敏感度为68.80%，特异度为72.90%，P ＜0.001]。

结论

IL-35、HBP 及两指标联合均对脓毒症患者发生SA-AKI 有一定的预测价值。

Objective

To explore the optimization and effectiveness of emergency medicine course teaching for international students in China.

Methods

The data of regular performance, final examination papers and total evaluation scores of the emergency medicine course for international students majoring in clinical medicine at the School of Medicine of Zhejiang University from 2014 to 2024 were collected. The differences in the total evaluation scores of international students in different genders and places of origin were analyzed.

Results

The total evaluation scores of female students were better than those of male students [87.00 (82.00,91.00) vs. 86.00 (80.00, 90.00), Z=2.072, P=0.038]. There was a statistically significant difference in the total evaluation scores among different continents (H = 9.498,P = 0.049). Moreover, the total evaluation scores of Asian international students were much better than those of African students [87.00 (82.00, 91.00) vs. 84.00 (79.00, 90.00), P < 0.05].

Conclusions

The teaching of emergency medicine course for international students in China needs to be optimized. Differences in students' gender and places of origin have certain influences on academic performance.

Objective

To investigate the efficacy of hematopoietic stem cell transplantation （HSCT） in the treatment of acute leukemia and to analyze the factors affecting its recurrence.

Methods

A total of 172 acute leukemia patients admitted to the Hebei Yanda Ludaopei Hospital from August 2020 to August 2022 were selected as study subjects.According to different treatment methods，they were divided into an observation group and a control group，each with 86 cases.The observation group was treated with autologous hematopoietic stem cell transplantation （auto-HSCT），and the control group was treated with allogeneic hematopoietic stem cell transplantation （allo-HSCT）.The clinical data，therapeutic effect and recurrence rate of the two groups were compared.Patients were followed up for 1 year and divided into a recurrence group （38 cases） and a non-recurrence group （134 cases）according to their recurrence status.A generalized estimating equation （GEE） model was used to analyze the factors affecting the recurrence of patients.Then a prediction model was established and verified based on the influencing factors.

Results

The remission rate of the observation group was significantly higher than that of the control group ［96.51%（83 / 86） vs.88.37% （76/86），χ²=4.077，P=0.043］，while the recurrence rate was lower ［13.95% （12/86） vs.30.23% （26/86），χ²=6.621，P=0.010］.Through GEE model analysis，it was found that gender（male），age ＞45 years old，lymphocyte count ≤3 × 10⁹/ L，white blood cell count ＞40 × 10⁹/ L，platelet count ≤200×10⁹/L，monocyte count ＞3 × 10⁸/kg，CD34⁺ cell count ＞3 × 10⁶/kg and type of acute leukemia （acute lymphoblastic leukemia） were risk factors for recurrence of acute leukemia （all P ＜0.05）.The regression equation was as follows： P = 1 /［1 + exp （0.835 + male ×1.032+age ＞45 years old×0.921+lymphocyte count ≤3×10⁹/L×1.103+white blood cell count ＞40×10⁹/L×0.503+platelet count ≤200×10⁹/L×0.883+monocyte count ＞3 ×10⁸/kg×0.868+CD34⁺ cell count ＞3 × 10⁶ / kg × 0.799 + acute lymphoblastic leukemia × 1.013）］； the predicted model agreement rate was 82.56%.

Conclusions

HSCT is effective in the treatment of acute leukemia.Compared with allo-HSCT，auto-HSCT has higher remission rate and lower recurrence rate.Relapse is affected by many factors，and the prediction model can provide clinical decision support.

Objective

To analyze the influence of respiratory rate-oxygenation (ROX) index combined with chest CT on respiratory treatment decisions in patients with acute hypoxic respiratory failure (AHRF) related to corona virus disease 2019 infection (COVID-19).

Methods

A total of 62 adult patients with COVID-19-related AHRF who initiated high-flow nasal cannula oxygen therapy (HFNC) after the failure of conventional oxygen therapy in the Minda Hospital of Hubei Minzu University were retrospectively included from March 2020 to March 2024. The indications for mechanical ventilation (MV) were judged by attending physicians of the patients.All patients underwent CT examinations immediately after admission. The proportion of lung infiltration volume (LIV) was calculated through chest CT image analysis using 3D Slicer software. The clinical characteristics of all patients were recorded and the ROX index was calculated approximately 6 hours after admission. Multivariate logistic regression analysis was used to evaluate risk factors for the need of MV in patients with COVID-19-related AHRF. The area under the curve (AUC) and cutoff value of the ROX index and/or LIV for predicting the MV required by patients were analyzed using a receiver operating characteristic (ROC) curve.

Results

According to whether they received MV or not, 62 patients with COVID-19-related AHRF were divided into a HFNC group (35 cases) and a MV group (27 cases). At admission,the hemoglobin, creatinine, lactic dehydrogenase and LIV of patients in the MV group were significantly higher than those in the HFNC group, while the ROX index was significantly lower,and the time from the onset of the disease to admission and the time from the onset of the disease to the initiation of HFNC were significantly shorter (all P ＜0.05). Multivariate logistic regression analysis showed that the ROX index ≤6.55 [odds ratio (OR)=0.141, 95% confidence interval (CI) (0.023, 0.885),P = 0.037] and LIV ＞ 33.45% [OR = 40.012, 95%CI (4.833,331.273), P=0.001] were independent risk factors for MV treatment in patients with COVID-19-related AHRF. ROC curve analysis showed that the combination of ROX index and LIV had ideal efficacy in predicting the need for MV treatment in patients with COVID-19-related AHRF(AUC: 0.939; sensitivity: 92.59%; specificity: 82.86%). According to the prognosis at 28 days,62 patients with COVID-19-related AHRF were divided into a death group (6 cases) and a survival group (56 cases). After analysis, the ROX index of AHRF patients in the death group was significantly lower than that in the survival group [3.80 (3.00, 4.70) vs. 7.05 (5.40, 8.65),Z=3.549, P ＜0.001], while LIV was significantly higher [46.75% (44.20, 65.90)% vs. 32.90%(25.20, 37.45)%, Z=3.786, P ＜0.001].

Conclusion

The LIV combined with ROX index shown by chest CT can provide support and guidance for physicians in the decision-making of respiratory management (HFNC or MV) in patients with COVID-19-related AHRF.

Objective

To investigate the application effect of the goal-oriented advanced teaching method in emergency endotracheal intubation skills training.

Methods

A total of 64 standardized training residents who trained in the Department of Emergency Medicine, Zhongda Hospital, Southeast University from March 2023 to March 2024 were recruited as the research objects. Participants were randomly assigned to a control group (32 cases) and an advanced group (32 cases) based on the random number table method. Participants in the control group and advanced group received traditional clinical training and goal-oriented advanced training for tracheal intubation, respectively. After the training, all of resident doctors were assessed by theoretical test and clinical skill operations, while feedback on the teaching process was obtained through questionnaires. Besides, the training effect of resident doctors of emergency, critical care and anesthesiology in clinical practice was evaluated after 6-mouth follow-up.

Results

After the training, the total assessment scores of both the advanced group[(90.8±3.6) vs. (76.8±8.7), t=8.371, P<0.001] and the control group [(87.6 ±5.3) vs. (77.1 ±10.9),t = 4.891,P = 0.007] were significantly improved compared to those before the training.Moreover, the total assessment scores [(90.8 ± 3.6) vs. (87.6 ± 5.3),t = 2.889,P = 0.006], skill assessment scores [(55.7 ± 2.8) vs. (53.6 ± 3.7),t = 2.559,P = 0.013], and clinical thinking assessment scores [(17.8±1.6) vs. (16.1±2.0),t=3.815, P<0.001] of the advanced group after the training were all higher than those of the control group. The questionnaire survey showed that the advanced group had significantly improved scores in knowledge acceptance [(9.1 ± 0.8)vs. (7.7±1.1), t=5.719, P < 0.001], learning initiative [(8.9 ± 0.9) vs. (7.7 ± 1.4),t = 4.221, P <0.001], clinical thinking ability [(8.5 ± 1.2) vs. (7.0 ± 1.2) ,t = 5.172, P < 0.001], emergency response ability [(9.1 ± 1.0) vs. (7.2 ± 1.3),t = 6.309, P < 0.001], and training satisfaction [(9.1 ±0.9) vs. (7.7 ± 1.3),t = 5.111, P < 0.001] as compared with the control group. In clinical practice, there was no statistically significant difference in the success rate of the first tracheal intubation of residents of emergency, critical care, and anesthesiology between the advanced group and the control groups (10 / 11 vs. 6 / 9, χ²= 1.727,P = 0.189).

Conclusion

The goaloriented advanced teaching could enhance the efficacy of endotracheal intubation training for emergency resident physicians, by establishing explicit stage-specific objectives.

Objective

To investigate the metabolic alterations of human placental mesenchymal stem cell (hPMSC) therapy on Crohn's disease model mice based on fecal metabolomics, and to screen biomarkers related to efficacy evaluation.

Methods

A total of 25 SAMP1 / Yit mice with spontaneous chronic ileitis were used as Crohn's disease models and divided into a treatment group (n= 15) and a disease group (n = 10). Additionally, 10 AKR /J mice were used as healthy controls. Mice in the treatment group were injected intraperitoneally with hPMSC, and mice in the disease group and the healthy control group were injected intraperitoneally with an equal volume of phosphate buffered saline at the same time points. On the 0th, 3rd, 7th, and 14th days after treatment, fecal samples of mice in the three groups were obtained, and chemical isotope labeling liquid chromatography-mass spectrometry (CIL LC-MS) was used for metabolomic analysis.

Results

The fecal metabolomic analysis based on CIL LC-MS detected 3 504 mass spectral peak pairs, of which 77.77% could be positively or putatively identified. Partial least squares-discriminant analysis (PLS-DA) was performed according to the mass spectrometry data of the metabolites, and it was found that the metabolic disorders of Crohn's disease mice were restored to a certain extent after treatment. Statistical analysis of the metabolite abundance of mice in each group found that a total of 35 metabolites had significant changes between the disease group and the healthy control group, and between the treatment group and the disease group (P < 0.05, fold change > 1.2). Through stepwise optimization of biomarker combinations, five biomarkers with the best classification performance and biological significance were finally determined by the orthogonal partial least squares-discriminant analysis(OPLS-DA) and machine learning model based on logistic regression algorithm, namely 5-Hydroxyindolepyruvate, p-Synephrine, Isomer 1 of 4-(2-Aminophenyl)-2,4-dioxobutanoic acid, LMetanephrine, and Threonylproline. The combination of these biomarkers achieved an area under the receiver operating characteristic curve of 0.920 with an accuracy of 87.0%.

Conclusion

Five metabolites identified through CIL LC-MS-based fecal metabolomic analysis can serve as a biomarker panel to assess the efficacy of hPMSC in the treatment of Crohn's disease with high accuracy.