Objectives To determine the influence of total parenteral nutrition(TPN)and partial parenteral nutrition(PPN)on gut hormones in preterm infant.Methods The levels of gastin,motilin and vasoaetive intestinal polypoptide of 31 TPN and 33 PPN preterm infants were measured by RIA at ages of 1,3,7,and 10 days.Results On 7th and 10th day,three gut hormones were all significantly higher in preterm infant of PPN than those in preterm infant of TPN(P

Residents(medical specialists)programmed education is an important aspect to fulfill the post-graduated medical education. It can remedy the clinical practice of young doctors,which ac-cords with the trend of international medical education .This article is to give advice for the resi-dents (medical specialists)programmed education according to the work and existing problems in our hospital.

OBJECTIVETo investigate the distribution of apolipoprotein E (apo E) polymorphism in Chinese Dehong Dai and Kunming Han ethnic groups.

METHODSAfter the process of extracting genomic DNA from 171 Chinese Dehong Dai and 71 Chinese Kunming Han subjects, the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to amplify the fourth exon of apoE, which contains site 112 and 158 in amino acid sequence, and the apoE polymorphism was detected.

RESULTSThe genotyping frequencies of apolipoproteinE epsilon 2/2, epsilon 2/3, epsilon 2/4, epsilon3/3, epsilon3/4, epsilon4/4 in Dehong Dai were 0.006, 0.111, 0.006, 0.789, 0.088 and 0.000 respectively, while the genotyping frequencies of apoE epsilon2/2, epsilon2/3, epsilon2/4, epsilon3/3, epsilon3/4, epsilon4/4 in Kunming Han were 0.000, 0.169, 0.014, 0.718, 0.099, 0.000, respectively (P>0.05). The allelic frequencies of apoE epsilon2, epsilon3 and4 in Dehong Dai were 0.064, 0.889, 0.047 respectively, while the allelic frequencies of apoE epsilon2, epsilon3 and epsilon4 in Kunming Han were 0.092, 0.852, 0.056, respectively (P>0.05).

CONCLUSIONThe results revealed that either the frequency of genotype or that of allele of apoE gene polymorphism showed statistical difference between the ethnic populations. Compared with the data from other nationalities in China, the frequency of epsilon2 allele in Dehong Dai was significantly lower than that in Zhuang nationality (P<0.01); the frequency of epsilon3 allele in Dehong Dai was significantly higher than that in Chaoxian, Hui, Mongolian,Zhuang nationalities (P<0.05) and Uygur nationality (P<0.01); the frequency of epsilon4 allele in Dehong Dai was significantly lower than that in Olunchun nationality (P<0.05) and Uygur, Owenk nationalities (P<0.01). By comparison with the data from the populations of other races, the distribution of apoE gene polymorphism in Dehong Dai population is similar to that in Japanese population (P>0.05), but different from those in Singapore,European and American populations.

Adult ; Aged ; Aged, 80 and over ; Apolipoproteins E ; genetics ; China ; Ethnic Groups ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Genetic ; genetics

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective: To evaluate the clinical application effects of an iliac-crest-preserving iliac wing bone graft harvesting technique and the bone regenerative ability of the donor site after harvesting. Methods: From January 2016 to June 2017, a series of 39 patients including 28 men and 11 women aged between 16 and 59 y (35±13 y in average) were prospectively collected to treat bone defects using the iliac-crest-preserving iliac wing bone graft harvesting technique. The patient cohort included 38 ipsilateral and 1 bilateral bone harvests taken from 15 femoral fracture non-unions, 8 tibial fracture non-unions, 11 femoral head necroses (hip preserving surgery), 1 tuberculosis deriving hip arthritis with bone defect (total hip arthroplasty), 2 hip prosthesis loosenings (revision), and 2 proximal femoral benign tumors. All patients were treated through comprehensive surgeries containing autologous iliac bone grafting. The surgical time, blood loss, bone graft volume, 24 h post-operative visual analogue scale (VSA) at the iliac surgical site, complications, and bone regeneration of the donor site were documented and evaluated. Results: In the 39 patients (40 sides), the average surgical time was 25±4 min, average blood loss was 79±23 ml, average bone graft volume was 27±6 cm³. The average 24 h post-operative VAS at the iliac surgical site was 1.8±0.7 points. The VSA at the 6 week later and thereafter were 0 in all patients. The iliac incisions in 38 patients (39 sides) were healed uneventfully. However, seroma at the iliac surgical site emerged in 1 patient at the 6th post-operative day in the manner of serous exudation and was treated successfully with non-operative measures. None infections and lateral femoral cutaneous nerve injuries took place. Iatrogenic non-displaced iliac crest fractures happened in the very first 2 patients when taking the crest as a pivot to pry up the graft, which united without special cure at the 3 month post-operative. This complication was completely avoided when shifting the pivot to the anterior pillar containing the anterior iliac spines. None pelvic fractures and heterotopic ossifications took place. Post-operative radiographical examinations revealed that the bone defects at the donor site shrank through bone regeneration, that mamillary or canine-tooth-shaped bone formation occurred in some of the cases, and that none complete bone regeneration took place to eliminate the bone defect at the donor. There were 12 patients in whom pre- and post-operative computed tomographic scans necessitated by the disease were prescribed, which facilitated the measuring of the bone defect at the donor site. The measurement of 13 sides revealed that the bone defects were decreased more or less: the average immediate post-operative bone defect was 25.7±6.5 cm², the average 12 month post-operative bone defect was 12.7±5.3 cm². Conclusion The iliac wing bone graft harvesting technique suggested here is safe and less invasive, in the premise of preserving the iliac crest and retaining the figure of the surgical site, it can harvest a large amount of iliac wing bone graft and reserve the bone regenerative ability of the donor site

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.