Objective To observe the effect of low molecular weight heparin in the treatment of patients with intrahepatic cholestasis pregnancy(ICP)and regulation of cytokines.Methods 124 patients with ICP were randomly divided into observation group and control group.The control group was treated with SAMe +UDCA therapy,the con-trol group was added low molecular weight heparin.All patients were treated for 10 days.Alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bile acid (TBA),tumor necrosis factor alpha (TNF -α)and IL-18 were observed before and after treatment.Results After treatment,ALT,AST and TBA levels were lower in the two groups(t=64.48,110.14,45.75,40.76,62.54,24.67,all P=0.000),which of the observation group were higher(t=62.42,49.42,23.03,all P=0.000).After treatment,the TNF-αand IL-18 levels were lower in the two groups(t=13.14,25.07,all P=0.000),the TNF-αlevel in the observation group was lower than the control group(t=4.91,P=0.000).After treatment,the incidence rates of neonatal meconium,neonatal asphyxia of the observation group were significantly lower than those of the control group(7.14%vs.20.69%,χ2 =4.33,P=0.037;8.93% vs.24.14%,χ2 =4.75,P=0.029).The incidence rate of fetal and maternal hemorrhage between the two groups had no statistically significant differences (1.79% vs.1.72%,χ2 =0.00,P=0.980;5.17% vs.3.57%,χ2 =0.17,P=0.680).Conclusion The effect of low molecular weight heparin in the treatment of patients with intrahepatic cholestasis of pregnancy is exact,it can reduce the biochemical markers and inflammatory cytokine expression and improve perinatal outcome,which deserves to promote in the clinical treatment application.

[Objective] To observe NGF on cultured human retinal vascular endothelial cells (HRCEC) proliferation. [Methods] The MTT assay was used to analyze the impact of culture HRCEC on different factors (NGF concentration groups, NGF + K252a concentration groups, bFGF group, bFGF + K252a groups, the normal culture medium groups) in normal and hypoxic condition. [Results] With the increase of NGF concentration (20,50,100 ng/mL), HRCEC significantly increased (normal condition: 0.254±0.033,0.696±0.029, 1.136±0.051; hypoxic condition: 0.422±0.036, 0.798±0.044, 1.376±0.052, P< 0.05). Compared NGF + K252a group with the same concentration of NGF (100 ng/ml) group, HRCEC reduced (P<0.05), with increasing the concentration of K252a (50,100,200 nmol/L), the trend of HRCEC decreasing is become more significant (normal condition:0.864±0.067, 0.496±0.025, 0.202±0.078; hypoxic condition:K252a 1.042±0.047,0.700±0.065, 0.401±0.078, P<0.05). [Conclusion] NGF can promote the proliferation of HRCEC, the effect could be specifically blocked by TrkA inhibitor K252a.

Objective In a new hospital,the construction of the ethics committee is also gradually evolving.This article aims to describe the current status of the ethics committee,analyze and summarize identified problems in the operation of the ethics committee,to propose a solution for better construction of ethics committee.At the same time,it can also provide certain reference for the new establishment of Ethics Committee of other institutions.Methods This paper analyzes the construction and current situation of operation of the ethics committee in detail.Results The ethics committee is running well,but there are still some problems such as management mode to be further optimized and ethical review system to be further strengthened.Conclusions The construction and capacity building of the EC is a continuing effort.On-going improvement of identified problems plays significant role in better construction of the ethics committee.

Objective To explore the role of transvertebral transposition of the spinal cord in the treatment of the pa?tients suffering from angular kyphoscoliosis with neurologic deficit. Methods Twelve patients with at least 1 year follow?up, in?cluding 5 females and 7 males, suffering from neurologic deficit secondary to angular kyphoscoliosis underwent transvertebral transposition of the spinal cord and posterior correction from January 2005 to June 2013 were retrospectively analyzed. The initial age averaged 21±14 years. The etiologies of deformity were congenital kyphoscoliosis in 9 patients, idiopathic kyphoscoliosis in 3 patients. Preoperative spinal cord function graded by Frankel criteria was 3 cases of grade C and 9 of grade D. The initial major curve was 79.4°±16.2° with a global kyphosis of 68.3°±25.0°. The change of distance between spinal cord and canal on the convex side at the apex was measured on MR images to evaluate the efficacy of transposition;in addition, Cobb angle on coronal and sagit?tal plane was evaluated before surgery, on discharge and at the last follow?up. Results All patients were followed up for 2 years on average (1-5 years). The post operation spinal function evaluated by Frankel criteria were as follow:with grade C of 1 case, grade D of 4 cases and grade E of 7 (7 cases changed one grade, 1 case changed two grades, 4 cases did not change obvious). At the last follow?up, all the cases got obvious recovery of spinal function, with 1 case of grade C and 11 of grade D (10 cases changed one grade, 2 cases changed two grades). The distance between spinal cord and canal on the convex side at the apex changed from 11.9±6.4 mm to 9.8±6.9 mm. After surgery, the major curve improved to 39.3°±15.1° with 50.3%±20.5%correction rate, and the mean loss of correction was 6.1%±7.5%. The mean kyphosis was 41.3°±16.6°, demonstrating a 39.0%±13.0%correction rate im?mediately after operation, and showing 3.1%±4.2%correction loss at the final follow?up. No neurologic complications or no death occurred intra?and post?operatively. No screw or rod fracture, instrumentation loosening and pseudarthrosis were found during fol?low?up. Conclusion Transvertebral transposition of the spinal cord and posterior correction is a useful procedure for the recovery of neurologic deficit secondary to angular kyphoscoliosis, with good results of deformity correction.

Narrative medicine emphasizes the cultivation of narrative ability,providing an important pathway to promote clinical discipline teaching and guide the transformation of medical students into the role of doctors.Based on the theory of narrative medicine,the Warm Medicine course is designed with a two-layer advanced practical teaching system covering the entire life cycle of"birth,aging,illness,and death".It can train the ability of medical students to absorb,interpret,and respond to patients'stories and difficulties in actual medical scenarios.Taking the"birth"theme practice as an example,the paper presentes the specific implementation and development of the course.The practical teaching of the"birth"theme enhanced students'understanding of medical themes and their perception of the essence of life,as well as promoting the establishment of the subjectivity of doctor-patient relationships and the formation of medical students'holistic medical diagnosis and treatment thinking.

Objective:To investigate the Chinese anesthesiologist′s proficiency, training experience and needs of flexible bronchoscope-guided awake flexible bronchoscopy intubation (AFBI) using a questionnaire method.Methods:The cluster sampling was used, and self-designed questionnaires that addressed 54 questions in 5 categories were distributed through WeChat and online platforms. The survey took one month, and the answers were automatically recorded by the WeChat server.Results:A total of 1 250 anesthesiologists participated in the survey in 30 provinces of China, 9 of them were not anesthesiologists, and 1 241 (99.28%) questionnaires were validated. In the valid questionnaires, 52.70% (654) of the anesthesiologists were from tertiary hospitals, and 74.78% (928) of the anesthesiologists were attending physicians or above, only 7.57% (94) of the anesthesiologists had sufficient confidence in AFBI. Twenty-five point two two percent (313) of the anesthesiologists preferred fiberoptic intubation as the first tool when dealing with the anticipated difficult airway. Forty-eight point one one percent (597) of the anesthesiologists had implemented AFBI. Among them, 80.74% (482) had experienced unsuccessful AFBI practices. Eight hundred and ninety-four anesthesiologists had received AFBI training, and the most common AFBI training strategy was theoretical lectures. In addition, the degree of satisfaction regarding the theoretical lectures quality, technical training, clinical practice relativity and non-technical skills training was 21.47% (192), 14.32% (128), 12.3% (110) and 17.90% (160), respectively. The degree of satisfaction with all the 4 training elements mentioned above was 7.27% (65).Conclusions:The awareness and practice of Chinese anesthesiologists in terms of clinical application of AFBI to treat difficult airways need to be strengthened at present, and the lack of high-quality AFBI training may be the key.

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

BACKGROUND: Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients. METHODS: We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis. RESULTS: The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064-3.493, P  = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115-10.707, P  = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233-3.456, P  = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108-18.228, P  = 0.001) in the ICU patients. CONCLUSIONS FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.
Critical Illness ; Enteral Nutrition/adverse effects* ; Humans ; Infant, Newborn ; Intensive Care Units ; Prevalence ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Vomiting/etiology*