Objective To compare the effectiveness of nose jejunal tube (NJT) and nasogastric tube (NGT) in providing early enteral nutrition for patients with severe craniocerebral injury. Methods Forty patients with severe craniocerebral injury and required early enteral nutrition were equally and randomly divided into NJT group and NGT group based on the tube type. The biochemical indicators, gastrointestinal tract tolerance, and complications were compared between these two groups. Results Serum albumin, blood glucose, and lymphocyte count were not significantly different between these two groups before and immediately after nutritional support (all P ＞0. 05). However, 14 days after nutritional support, the blood sugar level significantly decreased compared with the baseline levels in the NJT group (P =0. 0001). The incidences of reflux (P = 0. 001) and abdominal distension (P =0.011) were significantly lower in NJT group than in NGT group. Conclusion NJT is superior to NGT in providing early enteral nutrition for patients with severe craniocerebral injury.

Objective To analyze the effect of bifrontal decompressive craniectomy on patients with refractory diffusing of brain swelling after severe traumatic brain injury.Methods The clinical data of 68 patients with refractory diffusing of brain swelling after severe traumatic brain injury were analyzed retrospectively.Thirty-five patients were performed with bifrontal decompressive craniectomy as observed group,continued intracranial pressure monitoring after surgery.Thirty-three patients were treated conservatively to reduce intracranial pressure as control group,continued intracranial pressure monitoring.The Glasgow outcome scale after discharge 6 months were assessed.The efficacy,the incidence of complications were observed in observed group.Results The admission intracranial pressure in observed group was significantly higher than that after surgery [(35.9 ±6.9) mmHg (1 mmHg =0.133 kPa) vs.(17.5 ±5.2) mmHg,P ＜0.05].The admission intracranial pressure in control group was (34.2 ± 8.6) mmHg,after admission 10.5 h was (32.0 ±4.8) mmHg (P ＜0.05),difference was no statistically significant (P＞ 0.05).The intracranial pressure after admission 10.5 h in control group was significantly higher than that in observed group after surgery (P ＜0.05).Two cases of subdural effusion,1 case of postoperative hydrocephalus in observed group.The better prognosis rate in observed group was significantly higher than that in control group [45.7％ (16/35) vs.18.2％ (6/33),P ＜ 0.05].Conclusions Bifrontal decompressive craniectomy is a suitable measure to decrease the intracranial pressure in the patients with refractory diffusing of brain swelling.If carried out early,it could provide better outcome for these patients.

Panax notoginseng (BurK.) F.H.Chen is a traditional Chinese medicinal material with a time-honored history of cultivation.There are a series of problems,such as high pesticide residues,serious disease and pest,and continuous cropping obstacles in the process of the cultivation of notoginseng.Pollution-free cultivation is an effective strategy for the sustainable development of notoginseng industry.We herein summarized three points of the pollution-free cultivation of notoginseng in this review.The standard of lands suitable for the cultivation of notoginseng was established on the basis of the analysis of medicinal plants around global producing areas.The integrated measures of soil improvement were put forward by cfficient rotation and soil disinfection with new varieties breeding combined with the management of water,light and fertilization,and the safe and low-toxic methods of disease and pest control.Additionally,the mode of wild tending should be carried out when the marker-assisted breeding of new varieties was developed,and the platform of comprehensive disease and pest control was founded.Above-mentioned points can effectively perfect and optimize the pollution-free cultivation of notoginseng and promote sustainable development of notoginseng industry.

OBJECTIVE: To summarize the classification, property of skull repair material and the processing of related complications in the application of repairing and remodeling the skull.METHODS: The PubMed database (http://www.ncbi.nlm.nih.gov/PubMed) and CNKI Database (www.cnki.net/index.htm) was searched by the first author using key words of "codubix, synmesh, and bone cement" both in English and Chinese. Articles whose content is related to the types, property, biocompatibility and its application effect of skull repairing materials were selected. In the same field, the articles published by authoritative journals or different races were preferred. The repetitive or obsolete literatures were excluded. After that 26 documents were included in this paper.RESULTS: The bone cement exhibited good histocompatibility, however, it is difficult to be absorbed, thus, it only be used for repairing part of skull defects. The study found that titanium had good biocompatibility and could combine with the skull. Its application had a promising prospect, but there are many inadequacies. With the continuous deepening of bio-engineering, bone tissue engineering, and cartilage tissue engineering, it will provide a broader perspective for the study of skull repair materials.CONCLUSION: There are many kinds of materials for skull repairing, and this paper only introduces some of the widely used ones. Actually, the selection of repairing materials should consider the pathogenetic condition, economic condition, local equipment and technical levels. If possible, titanium mesh and titanium screw are preferred, which is characterized by easy operation, few complication and beautiful appearance: When using autogenous bone or bone cements, if related complications can be reduced and handled effectively, the results will be satisfactory.

Objective To investigate the prevalence of complication and related risk factors in Uygur patients with type 2 diabetes mellitus (T2DM).Methods Total 1 507 Uygur patients aged above 20 with T2DM were recruited in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to October 2015.Clinical characteristics,biochemical parameters and related complications were analyzed in different age groups of patients.Multivariate logistic regression was performed to determine associated factors for diabetic complications.Results Among 1 507 cases,there were 61.3％ male patients (n=924),37.4％ (n=564) with diabetes duration ≥5 years,12.5％ (n=189) with HbA1c＞10％,31.5％ (n=475) with hypertension,28.8％ (n=434) with smoking history and 37.4％ (n=564) patients without antidiabetic drug treatment.The average body mass index (BMI) of patients was (27.4±5.2)kg/m2 with a obesity rate of 43.0％ (648/1 507),and 65.0％ (980/1 507) had physical exercise＜150 min/week.The prevalence of diabetic complication was 70.6％(1 064/1 507),in which 28.7％,19.2％ and 22.7％ cases had 1,2 and 3 or more complications,respectively.The proportion of patients with coronary heart disease,stroke/transient ischemic attack and large artery atherosclerosis was 32.4％,10.4％ and 35.8％,respectively.The proportion of patients with diabetic retinopathy,nephropathy and neuropathy were 23.4％,6.5％ and 35.8％,respectively.Patients aged ≥60 years had highest prevalence of large artery atherosclerosis (38.2％,163/427) and diabetic retinopathy (27.2％,116/427);patients in age group 50-59 years had highest prevalence of diabetic neuropathy (40.3％,207/514).Multivariate logistic regression analysis showed that HbA1c＞10％ (OR=2.74,95％CI:1.40-5.34),obesity (OR=1.54,95％CI:1.07-2.21),systolic pressure≥140 mmHg (1 mmHg=0.133 kPa) (OR=1.42,95％CI:1.01-1.99),diastolic pressure≥90 mmHg (OR=0.37,95％CI:0.21-0.67),smoking (OR=1.53,95％CI:1.09-2.15) and physical aetivity＜150 min/week (OR=1.42,95％CI:1.07-1.89) were the risk factors of diabetic complications.Conclusion Uygur patients with type 2 diabetes in Xinjiang show a relatively high prevalence of complications.Poor glycemic control,obesity,hypertension,smoking and physical inactivity may contribute to development of complications,while well-controlled blood glucose and hypertension and quitting smoking and increasing physical activity may reduce diabetic complications.

Objective:To investigate the effect of hyperuricemia on acute kidney injury in sepsis patients.Methods:It is a retrospective cohort study of 459 adult sepsis patients who were admitted to the Department of Intensive Care Unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from March 2014 to June 2019, and the Second Affiliated Hospital of Guangxi Medical University from January 2017 to June 2019. The patients were divided into the hyperuricemia group and the non-hyperuricemia group according to the first serum uric acid level within 24 h after ICU admission, and the incidence of AKI within 7 days after ICU admission was compared between the two groups. The effect of hyperuricemia on sepsis-associated AKI was analyzed by univariate analysis and binary logistic regression analysis.Results:Among the 459 sepsis patients, 81 patients (17.6%) had hyperuricemia, and 127 patients (27.7%) had AKI. The incidence of AKI in the hyperuricemia group and the non-hyperuricemia group were 60.5% (49/81) and 20.6% (78/378), respectively, which showed significantly statistical difference ( χ2=52.954, P<0.01). After adjusting for gender, associated diseases (diabetes, coronary heart disease), sequential organ failure score (SOFA) on the day of ICU admission, the use of diuretics within one week before and after ICU admission, invasive mechanical ventilation, basal renal function, lactic acid, and procalcitonin, binary logistic regression analysis showed that hyperuricemia was an independent risk factor for AKI in sepsis patients ( OR=5.091, 95% CI: 2.768-9.362, P<0.01); For every 1 mg/dL increase in serum uric acid in sepsis patients, the risk of developing AKI increased by 28.4% ( OR=1.284, 95% CI: 1.165-1.414, P<0.01). Conclusions:AKI is a common complication in sepsis patients admitted to ICU, and hyperuricemia is an independent risk factor for AKI in sepsis patients.

Objective:To explore the effect of serum lactic acid (Lac) level on acute kidney injury (AKI) in patients with sepsis and whether Lac level affects the in-hospital mortality of patients with sepsis-associated AKI.Methods:A retrospective cohort study was conducted. Clinical data of patients with sepsis admitted to the internal intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from March 2014 to June 2019 and the ICU of the Second Affiliated Hospital of Guangxi Medical University from January 2017 to June 2020 were collected. According to the first quartile of Lac within 24 hours of admission to ICU, the patients were divided into Lac ≤ 1.4 mmol/L group (group Q1), Lac 1.5-2.4 mmol/L group (group Q2), Lac 2.5-4.0 mmol/L group (group Q3), and Lac ≥ 4.1 mmol/L group (group Q4). The incidence of sepsis-associated AKI after admission to ICU and hospital mortality were compared among four groups. The effect of elevated Lac on the incidence and mortality of sepsis-associated AKI was investigated by binary Logistic regression analysis. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of Lac on the incidence and mortality of sepsis-associated AKI, and the cut-off value was obtained to analyze the incidence and death risk of sepsis-associated AKI at different Lac levels. Results:A total of 655 sepsis patients were enrolled, of which 330 patients (50.4%) developed AKI and 325 patients (49.6%) did not. Among 330 patients with sepsis-associated AKI, 134 (40.6%) died and 196 (59.4%) survived. With the increase of Lac level, the incidence of sepsis-associated AKI increased gradually (34.5%, 41.0%, 58.4%, 66.3%, respectively, in group Q1- Q4), meanwhile, the in-hospital mortality also increased gradually (23.4%, 29.2%, 33.1%, 43.4%, respectively, in group Q1- Q4), the differences were statistically significant (both P < 0.01). Compared with the non-AKI group, the Lac level in the AKI group was significantly increased [mmol/L: 3.08 (1.84, 5.70) vs. 1.91 (1.20, 3.10), P < 0.01]. After adjustment for factors such as gender (male), site of infection (abdominal cavity), vasoactive drugs, basal mechanical ventilation, mean arterial pressure (MAP), basal renal insufficiency, uric acid, procalcitonin (PCT), platelet count (PLT), basal serum creatinine (SCr) and basal estimated glomerular filtration rate (eGFR), and other influencing factors, multivariate Logistic regression analysis showed that elevated Lac was an independent risk factor for sepsis-associated AKI [odds ratio ( OR) = 1.096, 95% confidence interval (95% CI) was 1.022-1.175, P = 0.010]. Compared with the survival group, the Lac level in the death group was significantly increased [mmol/L: 3.55 (2.00, 6.76) vs. 3.00 (1.70, 4.50), P < 0.01]. After adjusting for age, diabetes, vasoactive drugs, basal eGFR, and other factors, multivariate Logistic regression analysis suggested that increased Lac was an independent risk factor for in-hospital mortality in sepsis-associated AKI patients ( OR = 1.074, 95% CI was 1.004-1.149, P = 0.037). ROC curve analysis showed that the area under the ROC curve (AUC) of Lac for predicting the incidence and mortality of sepsis-associated AKI was 0.653 (95% CI was 0.611-0.694) and 0.593 (95% CI was 0.530-0.656, both P < 0.01), respectively, and the cut-off values were 2.75 mmol/L (sensitivity was 57.8%, specificity was 69.2%) and 5.95 mmol/L (sensitivity was 56.7%, specificity was 83.7%). When the Lac ≥ 2.75 mmol/L, the risk of sepsis-associated AKI was 2.772 times higher than that of < 2.75 mmol/L ( OR = 2.772, 95% CI was 1.754-4.380, P < 0.001). When the Lac ≥ 5.95 mmol/L, the patients with sepsis-associated AKI had a 2.511 times higher risk of in-hospital death than those with Lac < 5.95 mmol/L ( OR = 2.511, 95% CI was 1.378-4.574, P = 0.003). Conclusions:Elevated Lac level is an independent risk factor for the incidence and mortality of sepsis-associated AKI. When Lac ≥ 2.75 mmol/L, the risk of AKI in patients with sepsis increased by 1.772 times; when Lac ≥ 5.95 mmol/L, the risk of in-hospital death in patients with sepsis related AKI increased by 1.511 times.