INTRODUCTION: Infected pancreatic necrosis (IPN) is an important complication of acute pancreatitis (AP). Absolute lymphocyte count (ALC) was reported to be associated with immunosuppression and the development of IPN. The aim of this study was to describe the trajectory of ALC during the early phase of AP and assess its association with IPN. METHODS: We retrospectively screened patients with AP admitted to our center between January 2016 and July 2019. The ALC levels for the first 7 days after admission were collected. Group-based trajectory modeling was performed to detect the trajectories. Cox proportional hazards regression model was adopted to identify potential risk factors of IPN. RESULTS: Overall, 292 patients were enrolled for analysis. A triple-group trajectory model was developed, assigning 116 patients to the low-level ALC group, 133 to the medium-level ALC group, and 43 to the high-level ALC group. There was no overall significant difference regarding the incidence of IPN among the 3 groups (P = 0.066). In pairwise comparison, patients in the low-level ALC group had significantly higher incidence of IPN than those in the high-level ALC group (hazard ratio: 3.50; 95% confidence interval: 1.22–10.00, P = 0.020). Length of hospital stay and intensive care unit stay differed significantly among patients with different trajectories (P = 0.042 and 0.033, respectively). DISCUSSION: Despite the fact that the trajectories of ALC is overall insignificant for the development of IPN, patients with persistent low ALC trajectories during the early phase of AP are more likely to develop IPN when compared with patients with high ALC trajectories.

Background: To analyze the online course efficiency of a combined mode of Massive Open Online Course (MOOC) micro-video and E-learning platform in Nanjing Medical University during the COVID-19 epidemic. Methods: We developed a new questionnaire to assess the efficiency of online teaching of medical statistics in Nanjing Medical University. This investigation enrolled students participating in the online course of medical statistics from January 2020 to June 2020. The “Questionnaire Star” electronic questionnaire collection system was used to collect data. Results: In total, 1050 of the 1210 (86.78%) students completed the questionnaire, including 971 (92.48%) juniors. To be specific, 57.33% of the students majored in clinical medicine, 15.14% in pharmacy, 10.38% in pediatrics, 8.00% in medical imageology, and 6.29% in basic medicine. As to the question "Are you satisfied with the current online teaching method?", 354 (32.77%) students responded with "Agree" and "Strongly Agree", and 1012 (96.47%) thought they needed to consolidate what they had learned after returning to school. Most students reported their "Difficulties in the learning process" by "Learning motivation" and "Personal inertia" (59.90% and 58.29%, respectively).Conclusions: The online course of medical statistics was favored by most students, suggesting its efficiency an efficient alternative to classroom study during the COVID-19 pandemic. Yet there were still some problems, such as inconvenient communication between teachers and students, poor mastery of key knowledge, which should be resolved in classroom teaching at school.

BackgroundThere is controversy over the optimal energy delivery in intensive care units (ICUs). In this study, we aimed to evaluate the association between different caloric adequacy assessed by a weight-based equation and short-term clinical outcomes in a cohort of critically ill patients.MethodsThis is a secondary analysis of a cluster-randomized controlled trial (N = 2,772). The energy requirement was estimated as 25 kcal/kg of body weight. The study subjects were divided into three groups according to their caloric adequacy as calculated by the mean energy delivered from days 3 to 7 of enrollment divided by the estimated energy requirements: (1) received < 70% of energy requirement (hypocaloric), (2) received 70–100% of energy requirement (normocaloric), and (3) received > 100% of energy requirement (hypercaloric). Cox proportional hazards models were used to analyze the association between caloric adequacy and 28-day mortality and time to discharge alive from the ICU.ResultsA total of 1,694 patients were included. Compared with normocaloric feeding, hypocaloric feeding significantly increased the risk of 28-day mortality (hazard ratio [HR] = 1.590, 95% confidence interval [CI]: 1.162–2.176, p = 0.004), while hypercaloric feeding did not. After controlling for potential confounders, the association remained valid (adjusted HR = 1.596, 95% CI: 1.150–2.215, p = 0.005). The caloric adequacy was not associated with time to discharge alive from the ICU in the unadjusted and the adjusted models.ConclusionEnergy delivery below 70% of the estimated energy requirement during days 3–7 of critical illness is associated with 28-day mortality.Clinical trial registration[https://www.isrctn.com/ISRCTN12233792], identifier [ISRCTN12233792].

Using the variational method, the two-dimensional Poisson equation is solved in the MOSFET device region including the gate oxide region, depletion region and buried oxide region (for a silicon-on-insulator [SOI] device). An analytical expression for the potential distribution together with a new natural gate length scale for the MOSFET is derived. The two-dimensional (2D) effects in front gate dielectric, back gate dielectric and silicon film can all be taken into account in this derivation. A comparison of the short channel effect for the uniform channel doping bulk MOSFET, intrinsic channel doping bulk MOSFET, SOI MOSFET and double-gated MOSFET is conducted using our model. The validity of electrical equivalent oxide thickness approximation is also investigated using this model. It is found that our model can be applied over a wide range of " I =" 0 with quite good accuracy. The results are verified by 2D numerical simulation using the 2D device simulator MEDICI.