Objective:To explore the characteristics of Traditional Chinese Medicine (TCM) syndromes in sepsis patients with different blood urea nitrogen (BUN) levels.Methods:From January 2017 to December 2018, 252 sepsis patients, who were admitted in the Department of Intensive Care Unit of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine) and met the inclusion criteria, were divided into lower level group (BUN<9.25 mmol/L) and higher level group (BUN≥9.25 mmol/L) according to BUN levels. The baseline data, complications, infection sites and other data were collected. TCM syndromes were judged according to the four diagnostic information of TCM and BUN levels. Variables with P<0.2 in univariate analysis were introduced as candidate variables, and the correlation between TCM syndrome elements and BUN was analyzed by multivariate logistic regression. Results:The comparison of TCM syndromes showed that the proportion of blood stasis syndrome in higher level group was significantly higher than that of the lower level group [74.60% (94/126) vs. 53.17% (67/126), P<0.01)], and the proportion of toxic heat syndrome in the higher level group was significantly lower than that of the lower level group [52.38% (66/126) vs. 65.87% (83/126), P=0.029]. The comparison of TCM deficiency syndromes showed that the proportion of qi deficiency syndrome and yang deficiency syndrome in the higher level group was significantly higher than that of the lower level group [67.46% (85/126) vs. 45.24% (57/126), P<0.01; 11.90% (15/126) vs. 3.97% (5/126), P=0.032, respectively]. Logistic regression analysis showed that the higher blood urea nitrogen level was correlated with the increased incidence of qi deficiency syndrome ( OR=3.425, 95% CI: 1.934-6.068, P<0.01), yang deficiency syndrome ( OR=3.460, 95% CI: 1.160-10.325, P=0.026) and kidney deficiency syndrome ( OR=2.212, 95% CI: 1.173-4.173, P=0.014) in sepsis patients. Conclusion:Sepsis patients with higher blood urea nitrogen level have a higher proportion of blood stasis syndrome, qi deficiency syndrome and yang deficiency syndrome and may be related to the increased incidence of qi deficiency syndrome, yang deficiency syndrome and kidney deficiency syndrome.

Background: Enteral nutrition is an essential component for treatment of severe acute pancreatitis (SAP), yet there is no consensus on whether glutamine should be added in the enteral nutrition. Aims: To systematically evaluate the effect of glutamine-supplemented enteral nutrition on the condition and prognosis of SAP. Methods: Randomized controlled trials (RCT) on the effect of glutamine-supplemented enteral nutrition in the treatment of SAP were retrieved from CNKI, Wanfang, VIP, SinoMed, The Cochrane Library, PubMed, Embase and Web of Science from the date of database foundation to June 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the quality was evaluated and data were extracted. RevMan 5.2 software was used to conduct meta-analysis. Results: A total of 18 RCT involving 1 119 patients were included. Meta-analysis showed that glutamine-supplemented enteral nutrition could decrease APACHEⅡ score (MD=-2.20, 95% CI: -2.70-1.71, P<0.000 01), CRP (SMD=-1.20, 95% CI: -1.37-1.02, P<0.000 1), IL-6 (SMD=-2.09, 95% CI: -2.31-1.87, P<0.000 01), TNF-α (SMD=-2.61, 95% CI: -2.82-2.39, P<0.000 01) when compared with conventional enteral nutrition, and could shorten the hospital stay (MD=-4.84, 95% CI: -8.08-1.60, P=0.003). However, no significant differences in the incidence of complications (RR=0.84, 95% CI: 0.66-1.06, P=0.15) and mortality (RR=0.88, 95% CI: 0.51-1.51, P=0.64) were found between the two groups. Conclusions: Glutamine-supplemented enteral nutrition can reduce the inflammation level and improve the severity of SAP, but it has no effect on the incidence of complications and mortality.

Objective:To establish the acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) classification system, and to examine the reliability and evaluate the effect of clinical application.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 293 patients with osteoporotic thoracolumbar fracture(OTLF) admitted to Honghui Hospital from January 2016 to December 2018. There were 514 males and 779 females, aged 57-90 years [(71.4±6.3)years]. The T value of bone mass density was -5.0--2.5 SD [(-3.1±-0.4)SD]. According to the clinical symptoms a and fracture morphology, OTLF was divided into 4 types, namely type I(I occult fracture), type II(compressed fracture), type III (burst fracture) and type IV(unstable fracture). The type II was subdivided into three subtypes (type IIA, IIB, IIC), and the Type III into two subtypes (type IIIA, IIIB). of all patients, 75 patients (5.8%) were with type I, 500 (38.7%) with type II A, 134 (10.4%) with type IIB, 97 (7.5%) with type IIC, 442 (34.2%) with type IIIA, 27(2.1%) with type IIIB and 18 (1.4%) with type IV. After testing the validity of the classification, different treatment methods were utilized according to the classification, including percutaneous vertebroplasty (PVP) for Type I, PVP after postural reduction for Type II, percutaneous kyphoplasty (PKP) for Type IIIA, posterior reduction and decompression, bone graft fusion and bone cement-augmented screw fixation for Type IIIB, and posterior reduction, bone graft fusion and bone cement-augmented screw fixation for Type IV. The visual analog score (VAS), Oswestry disability index (ODI), Frankel grade of spinal cord injury, local Cobb Angle, and vertebral body angle (vertebral body angle) were recorded in all patients and in each type of patients before surgery, at 1 month after surgery and at the last follow-up. The neurological function recovery and complications were also recorded.Results:The patients were followed up for 24-43 months [(29.9±5.1)months]. A total of 3 000 assessments in two rounds were conducted by three observers. The overall κ value of inter-observer credibility was 0.83, and the overall κ value of intra-observer credibility was 0.88. The VAS and ODI of all patients were (5.8±0.7)points and 72.5±6.6 before surgery, (1.8±0.6)points and 25.0±6.3 at 1 month after surgery, and (1.5±0.6)points and 19.5±6.2 at the last follow-up, respectively (all P<0.05). The Cobb angle and vertebral body angle of all patients were (13.0±9.1)° and (8.0±4.6)° before surgery, (7.9±5.2)° and (4.6±2.9)° at 1 month after surgery, and (9.1±6.0)° and (5.8±3.0)° at the last follow-up, respectively (all P<0.05). At the last follow-up, VAS, ODI, Cobb Angle and VBA of each type of patients were significantly improved compared with those before surgery (all P<0.05). The spinal cord compression symptoms were found 1 patient with type IV and 5 patients with type IIIB preoperatively. At the last follow-up, neurological function improved from grade C to grade E in 1 patient and from grade D to grade E in 5 patients ( P<0.05). The lower limb radiation pain or numbness in 3 patients with type IV and 22 patients with type III preoperatively were fully recovered after surgical treatment at the last follow-up except for three patients. Conclusions:The ASOTLF classification is established and has high consistency and reliability. The classification-oriented treatment strategy has achieved a relatively satisfactory effect, indicating that the classification has a certain guiding significance for treatment of OTLF.