Nutritional support therapy is one of the extremely important treatment methods for patients in the intensive care unit. Timely and effective nutritional support regimens can improve patients' immune function, reduce complications, and optimize clinical outcomes. Energy expenditure is influenced by multiple factors, including patients' baseline characteristics (such as physical condition, gender, age) and dynamic changes in indicators (such as body temperature, nutritional support regimens, and therapeutic interventions). The currently recognized "gold standard" for accurately assessing energy metabolism in clinical practice is the indirect calorimetry system, also known as the metabolic cart. This device monitors carbon dioxide production and oxygen consumption in real time and uses specific algorithms to estimate the metabolic proportions of the three major nutrients (carbohydrates, fats, and proteins) in energy expenditure. An appropriate nutrient ratio helps maintain the balance between supply and demand in the body's nutritional metabolism. In the management of critically ill patients, the application of the metabolic cart enables personalized nutritional therapy, avoiding over- or under-supply of energy and optimizing the use of medical resources. Furthermore, with real-time, quantitative data support from the energy metabolism monitoring system, clinicians can develop more precise nutritional intervention strategies, thereby improving patient prognosis. This article provides a systematic review of the technical features of the metabolic cart and its application value in various critical care scenarios, aiming to offer a reference for indirect calorimetry in clinical practice.
Humans ; Critical Illness/therapy* ; Nutritional Support ; Energy Metabolism ; Calorimetry, Indirect

To investigate the strain composition and drug resistance characteristics of G +(Gram positive cocci) cocci causing bloodstream infections in the People′s Hospital of Inner Mongolia Autonomous Region in recent years and provide a basis for the empirical and rational use of drugs for the prevention and treatment of bloodstream infections caused by G +cocci. The strain composition and drug-resistant characteristics of G +cocci isolated from positive blood culture specimens sent to various departments of the Inner Mongolia Autonomous Region People′s Hospital from January 2015 to December 2022 were retrospectively analyzed, and the higher detection rates of Staphylococcus hominis and Staphylococcus epidermidis, Enterococcus faecium and Enterococcus faecalis, and methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) were examined. MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) were comparatively analyzed for resistance. The resistance data were analyzed by Whonet 5.6 statistical software, the significance of difference was analyzed by SPSS 22.0 software, and the resistance rate was compared by χ2 test. The results showed that 1 209 strains of G +cocci, in terms of the composition ratio, from high to low, were mainly human staphylococci (32.5%,393/1 209), Staphylococcus epidermidis (27.8%, 336/1 209), Staphylococcus aureus (14.9%,180/1 209) and Enterococcus faecalis (10.6%, 128/1 209). Among them, the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) (42.8%, 77/180) was lower than that of methicillin-resistant coagulase-negative staphylococcus (MRCNS) (71.5%, 608/850); and among enterococci, the detection rate of Enterococcus faecalis (71.5%, 128/179) was much higher than that of Enterococcus faecalis (28.5%, 51/179). For drug resistance, the resistance rate to five commonly used antimicrobial drugs, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin and tetracycline, was higher in Staphylococcus hominis than in Staphylococcus epidermidis ( χ2=7.152-64.080, P<0.05); however, for the aminoglycoside antimicrobial drug gentamicin, the rate of resistance in Staphylococcus humanus was lower than in Staphylococcus epidermidis, and the difference was statistically significant ( χ2=11.895, P<0.05); no strains resistant to linezolid and vancomycin were found in both. Comparison of the resistance rates to seven antimicrobial drugs, gentamicin, rifampicin, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin and tetracycline, was significantly higher in MRSA than in MSSA ( χ2=6.169-56.941, P<0.05); however, the resistance rate to cotrimoxazole, MRSA (15.6%, 12/77) was significantly lower than that of MSSA (35.3%, 36/102), and the difference was statistically significant ( χ2=5.155, P<0.05); MRSA and MSSA resistant to linezolid and vancomycin were not found. The resistance rate of Enterococcus faecalis to penicillin G and ampicillin was much higher than that of Enterococcus faecalis, and the difference was statistically significant ( χ2=22.965, P<0.05), and vancomycin-resistant enterococci (VRE) were not found. In conclusion, for staphylococci, except for individual antibiotics, S.hominis and MRSA were more resistant to most antimicrobial drugs than S. epidermidis and MSSA, showing a multidrug-resistant pattern. For enterococci, except for penicillin G and ampicillin resistance rate, Enterococcus faecalis is much higher than Enterococcus faecalis, the rest of the antimicrobial drugs did not see a significant difference, in addition to vancomycin-resistant enterococci were not detected. Clinicians should pay great attention to the monitoring data of multidrug-resistant G +cocci isolated from blood cultures to provide a basis for empirical and rational use of drugs in the clinic, to effectively prevent and reduce the incidence of bloodstream infections caused by G +cocci.

To investigate the strain composition and drug resistance characteristics of G +(Gram positive cocci) cocci causing bloodstream infections in the People′s Hospital of Inner Mongolia Autonomous Region in recent years and provide a basis for the empirical and rational use of drugs for the prevention and treatment of bloodstream infections caused by G +cocci. The strain composition and drug-resistant characteristics of G +cocci isolated from positive blood culture specimens sent to various departments of the Inner Mongolia Autonomous Region People′s Hospital from January 2015 to December 2022 were retrospectively analyzed, and the higher detection rates of Staphylococcus hominis and Staphylococcus epidermidis, Enterococcus faecium and Enterococcus faecalis, and methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) were examined. MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) were comparatively analyzed for resistance. The resistance data were analyzed by Whonet 5.6 statistical software, the significance of difference was analyzed by SPSS 22.0 software, and the resistance rate was compared by χ2 test. The results showed that 1 209 strains of G +cocci, in terms of the composition ratio, from high to low, were mainly human staphylococci (32.5%,393/1 209), Staphylococcus epidermidis (27.8%, 336/1 209), Staphylococcus aureus (14.9%,180/1 209) and Enterococcus faecalis (10.6%, 128/1 209). Among them, the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) (42.8%, 77/180) was lower than that of methicillin-resistant coagulase-negative staphylococcus (MRCNS) (71.5%, 608/850); and among enterococci, the detection rate of Enterococcus faecalis (71.5%, 128/179) was much higher than that of Enterococcus faecalis (28.5%, 51/179). For drug resistance, the resistance rate to five commonly used antimicrobial drugs, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin and tetracycline, was higher in Staphylococcus hominis than in Staphylococcus epidermidis ( χ2=7.152-64.080, P<0.05); however, for the aminoglycoside antimicrobial drug gentamicin, the rate of resistance in Staphylococcus humanus was lower than in Staphylococcus epidermidis, and the difference was statistically significant ( χ2=11.895, P<0.05); no strains resistant to linezolid and vancomycin were found in both. Comparison of the resistance rates to seven antimicrobial drugs, gentamicin, rifampicin, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin and tetracycline, was significantly higher in MRSA than in MSSA ( χ2=6.169-56.941, P<0.05); however, the resistance rate to cotrimoxazole, MRSA (15.6%, 12/77) was significantly lower than that of MSSA (35.3%, 36/102), and the difference was statistically significant ( χ2=5.155, P<0.05); MRSA and MSSA resistant to linezolid and vancomycin were not found. The resistance rate of Enterococcus faecalis to penicillin G and ampicillin was much higher than that of Enterococcus faecalis, and the difference was statistically significant ( χ2=22.965, P<0.05), and vancomycin-resistant enterococci (VRE) were not found. In conclusion, for staphylococci, except for individual antibiotics, S.hominis and MRSA were more resistant to most antimicrobial drugs than S. epidermidis and MSSA, showing a multidrug-resistant pattern. For enterococci, except for penicillin G and ampicillin resistance rate, Enterococcus faecalis is much higher than Enterococcus faecalis, the rest of the antimicrobial drugs did not see a significant difference, in addition to vancomycin-resistant enterococci were not detected. Clinicians should pay great attention to the monitoring data of multidrug-resistant G +cocci isolated from blood cultures to provide a basis for empirical and rational use of drugs in the clinic, to effectively prevent and reduce the incidence of bloodstream infections caused by G +cocci.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To observe the therapeutic effect of laparoscopic sleeve gastrectomy (LSG) in treating patients with obesity and polycystic ovary syndrome (PCOS). Methods In this retrospective analysis, clinical materials of 60 patients with obesity and PCOS by LSG were analyzed, and postoperative improvements of PCOS symptoms were observed. Results A total of 60 patients had a preoperative mean body mass index (BMI) of (39.4±5.4) kg/m² and an average age of (26.3±6.1) years old, and all of them successfully completed LSG. After follow-up of 12 to 18 months, 50 cases (83.3%) had normalized menstrual cycles, with an average recovery time of (4.5 ±2.2) months after surgery, and 7 cases had natural pregnancy after surgery. Before surgery, ultrasound results in 35 patients indicated polycystic ovarian morphology (PCOM), and 29 cases (82.9%) regained normal ovarian status with an average recovery duration of (6.3±2.8) months. Complicated hyperandrogenemia was observed in 31 patients, and 29 cases (93.5%) exhibited normalization of testosterone levels within 18 months after surgery. At 18 months after surgery, the BMI was (26.47±4.70) kg/m², the average weight loss was (32.4±7.4) %. Conclusion LSG is a safe and effective treatment for obese PCOS.

Abstract: Objective To observe the phenotypic characteristics of 3 wild-type plague phages under different experimental environments, providing scientific evidence for the identification of phage biological characteristics and the study of their interaction with host bacteria in the future. Methods The sensitivity of 3 wild-type plague phages were detected by using liquid culture method, emisolid medium method and micro-liquid culture method based on OmniLog TM microbial identification system. Results The growth result based on LB liquid medium showed that the growth of plague phage 476 for 20-24 hours at both 28 ℃ and 37 ℃was better than that of plague phages 087 and 072204 at 37 ℃, and the growth of plague phages 087 was better than that of plague phages 072204 at 37 ℃. With the attenuated plague bacterium EV76 as the host bacterium, phage 476 was able to form visible plaque on double-layer agar medium for 20-20 hours at both 28 ℃ and 37 ℃, phages 087 and 072204 were only able to form opaque plaque on double-layer agar medium for 20-24 hours at 37 ℃. The growth results based on OmniLogTM system showed that when plague phage was lysed in EV76 strain at 33 ℃, the first row appeared as a straight line with a peak of no more than 100 in the 96-well microplate curve chart. As the phage quantity decreased, the dilution plate appeared with growth curve similar to EV76 strain in turn, and the color of tetrazolium dyes in the experimental wells gradually deepened as the phage number decreased and the host bacteria number increased. Therefore, it indicates that phage 476 was sensitively at both 28 ℃ and 37 ℃, while phage 087 and 072204 were temperature-dependent only at 37 ℃ to attenuated plague bacterium EV76. Conclusions The lysing ability of 3 wild-type plague phages are temperature-dependent, and the growth results are consistent under the three experimental conditions.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

ObjectiveTo evaluate the methodological quality of traditional Chinese medicine （TCM） diagnosis and treatment guidelines/consensus of constipation with Appraisal of Guidelines for Research and Evaluation Ⅱ （AGREE Ⅱ）tool， and to study the attention situation of the included Chinese patent medicines in China's National Reimbursement Drug List in the guidelines/consensus. MethodThe data of CNKI，VIP，Wanfang Data，SinoMed，PubMed and Cochrane from the inception of the databases to October 2021 were searched to collect the TCM diagnosis and treatment guidelines/consensus of constipation. Then，the diagnosis and treatment standards and recommended Chinese patent medicines were extracted. Two researchers assessed the methodological quality of the guidelines/consensus with AGREE Ⅱ tool independently. The quality of reports was evaluated by Reporting Items for practice Guidelines in HealThcare （RIGHT） Statement. The recommended Chinese patent medicines in the guidelines/consensus were compared with those in the National Reimbursement Drug List. ResultEleven consensus and 2 guidelines were included，involving 794 experts. The scores of AGREE II were clarity of presentation（59.0%），scope and purpose（44.0%），stakeholder involvement（23.1%），rigor of development （12.1%），applicability （11.1%），and editorial independence （8.3%） from high to low. Five articles were recommended at B level（recommended after revision） and 8 articles were at C level （not recommended）. The average scores of RIGHT Statement were as follows：basic information （93.59%），background （57.69%），evidence （18.46%），recommendations （20.88%），review and quality assurance （19.23%），funding，declaration and management of interests （0.00%）， and other information （0.00%）. The included guidelines/consensus recommended a total of 27 Chinese patent medicines，among which 20 were included in the National Reimbursement Drug List，with 4 species of Class A and 16 species of Class B， accounting for 74.1% of all recommended Chinese patent medicines. Ten purgative Chinese patent medicines in the National Reimbursement Drug List were recommended by the guidelines/consensus，accounting for 50% of all purgative drugs， and 8 were not recommended. There were prescriptions for purgation， for promoting digestion and removing food stagnation， for clearing heat and purging fire，and for warming the middle and dissipating cold，Tibetan medicine and Mongolian medicine. ConclusionBy the AGREE Ⅱ assessment，the methodological quality of the TCM diagnosis and treatment guidelines/consensus of constipation included in this study needed to be improved in the future. The report quality evaluated with RIGHT Statement was low. Most drugs included in the National Reimbursement Drug List were paid attention in the TCM diagnosis and treatment guidelines/consensus of constipation. Moreover，the drugs included in the National Reimbursement Drug List could basically fulfill the clinical needs reflexed from the guidelines/consensus recommendations. However， the reasons of some drugs failing to be included in the National Reimbursement Drug List needed to be studied in the future.

Objective:To investigate the effects of rapamycin on the autophagy activation of M2 macrophages and the radiosensitivity in colorectal cancer xenograft.Methods:THP-1 cells were induced into Type-Ⅱ macrophages with PMA and/or IL-4. Rapamycin and Bafilomycin A1 were uesd to activate and suppress autophagy of M2 macrophage, respectively. Colorectal cancer LoVo cells were inoculated on BALB/c-nu/nu nude mice. After the xenograft tumor size approached to 10 mm in diameter, the nude mice were divided into the following groups randomly: M2 macrophage autophagy inactive group and active group, autophagy downregulation of the activated group, and nontreatment control group. The tumors in mice were irradiated with 8 Gy X-rays in two fractions, and the radiosensitivity of colorectal cancer xenograft in each group was analyzed.Results:The expression levels of M2 macrophage markers Arg-1 and CCL-22 were significantly higher than those in M0 macrophage. The tumor weight, volume [(1.93±0.05)g, (2.14±0.06)cm 3] and micro-vessel density (36.37±1.04) in M2 autophagy inactive group were higher than those in control group [(1.35±0.05)g, (1.77±0.02)cm 3, 25.69±1.34] ( t=20.07, 14.56, 10.92, P < 0.05). After activation of M2 autophagy, the tumor weight, volume and micro-vessel density were significantly decreased to (0.89±0.03)g, (1.24±0.01)cm 3, and 13.60±1.52 ( t=44.37, 40.32, 21.43, P < 0.05). After down-regulation of M2 autophagy with bafilomycin A1, the tumor weight, volume and micro-vessel density were increased to (1.02±0.07)g, (1.37±0.02)cm 3, and 21.06±1.41 ( t=4.67, 13.79, 6.23, P < 0.05). Autophagy inaction suppressed the expression of Livin and Survivin in tumor ( t=2.64, 7.90, P < 0.05), and the activation of M2 autophagy further down-regulated the expression of Livin, Survivin ( t=5.43, 9.39, P < 0.05). The expression levels of Livin and Survivin were increased after the treatment with bafilomycin A1 ( t=2.80, 3.17, P<0.05). Conclusions:M2 macrophagy promoted the growth of colorectal cancer xenograft by inducing the formation of micro-vessels in the tumor, which is one of the mechanisms of tumor-associated macrophages participating in the radiotherapy resistance of colorectal cancer. Activation of M2 autophagy by rapamycin inhibited the ability of M2 macrophagy in promoting tumor growth, and induced apoptosis of colorectal cancer cells after radiotherapy by down-regulating the expression of anti-apoptotic genes Livin and Survivin, thus increased the radiosensitivity of colorectal cancer.

Objective:To investigate the current status of perceived vulnerability of parents of children with type 1 diabetes mellitus (T1DM) and to conduct a path analysis of its influencing factors, in order to provide a reference for reducing the level of perceived vulnerability of parents of children with T1DM.Methods:This study was a cross-sectional study. Using the convenient sampling method, a total of 500 parents of children with T1DM who were treated in 4 hospitals in Henan Province from January 2019 to May 2020 were selected as the research objects. The survey was conducted using the General Information Questionnaire, Child Vulnerability Scale (CVS) , Perceived Social Support Scale (PSSS) , General Self-Efficacy Scale (GSES) and Parenting Stress Index-Short Form (PSI-SF) . Structural equation modeling was used to analyze the influencing factors of parental perceived vulnerability in children with T1DM. A total of 500 questionnaires were distributed and 489 valid questionnaires were recovered, with an effective recovery rate of 97.8%.Results:Scores of CVS, PSSS, PSI-SF and GSES of 489 parents of children with T1DM were respectively (6.40±2.17) , (60.47±2.17) , (87.16±7.87) and (24.85±1.42) . The structural equation model showed that social support, self-efficacy and parenting stress had direct effects on the perceived vulnerability of children's parents, while education level and per capita monthly income had direct and indirect effects on the perceived vulnerability of children's parents through self-efficacy and parenting stress. The course of disease and parental age had indirect effects on parental vulnerability perception through social support and parenting stress ( P<0.05) . Conclusions:Parents of children with T1DM have a high level of perceived vulnerability, which is affected by factors such as social support, self-efficacy, parenting pressure, educational level and per capita monthly income. It is suggested that medical staff should carry out disease awareness education for parents of children, pay attention to their psychological change, improve the level of self-efficacy, encourage them to obtain more social support, reduce the burden of care and take timely multi-faceted interventions to reduce their perceived vulnerability.