INTRODUCTION: The primary objective of this guideline is to establish evidence-based recommendations for the clinical use of parenteral nutrition (PN) in adult patients within the acute hospital setting in Singapore. METHOD: An expert workgroup, consisting of healthcare practitioners actively involved in clinical nutrition support across all public health institutions, systematically evaluated existing evidence and addressed clinical questions relating to PN therapy. RESULTS: This clinical practice guideline developed 30 recommendations for PN therapy, which cover these key aspects related to PN use: indications, patient assess-ment, titration and formulation of PN bags, access routes and devices, and monitoring and management of PN-related complications. CONCLUSION This guideline provides recommendations to ensure appropriate and safe clinical practice of PN therapy in adult patients within the acute hospital setting.
Humans ; Singapore ; Parenteral Nutrition/adverse effects* ; Adult

Objective: To investigate the efficacy and safety of Rivaroxaban for elderly patients with thrombotic diseases. Methods: This was a retrospective study.A total of 301 elderly patients taking Rivaroxaban from October 2012 to November 2017 at the Second Medical Center of the Chinese PLA General Hospital were consecutively selected.The ages ranged from 60 to 102 years, with an average age of(86.5±8.4)years.Anticoagulation regimens were developed based on comprehensive evaluation of indications, creatinine clearance, ischemia and bleeding risk.Patients were divided into a Rivaroxaban 2.5-5.0 mg/d group(n=72), a 10.0 mg/d group(n=205), and a 15.0-20.0 mg/d group(n=24). Hepatic function, renal function, and coagulation indexes were measured before and after the administration of Rivaroxaban.Fatal bleeding, cardiovascular deaths, all-cause deaths, non-fatal bleeding and thromboembolic events were recorded during the follow-up period. Results: The average dose of Rivaroxaban was(9.3±3.0)mg/d, and the minimum dose was 2.5 mg/d.The average follow-up time was(14.9± 13.9)months and the longest follow-up time was 48 months.One patient had intracranial bleeding.Twenty patients(6.6%)died with a cumulative incidence of 25.2%, three(1.0%)died of cardiac events, and 55.0% died of pneumonia and multiple organ failure.Forty patients(13.3%)had non-fatal hemorrhagic events with a cumulative incidence of 42.4%.Seven patients(2.3%)had thromboembolic events with a cumulative incidence of 16.0%, including 2 cases of non-fatal myocardial infarction, 3 cases of cerebral infarction and 2 cases of deep vein thrombosis.After treatment, levels of prothrombin time and fibrinogen significantly increased while levels of D-dimer significantly deceased(P<0.05). Conclusions Compared with previous reports, low-dose Rivaroxaban is safe and effective for elderly patients with thrombotic diseases.However, the risk of bleeding and ischemia should be comprehensively evaluated, and appropriate doses of Rivaroxaban should be selected individually.

Radiation-induced brain injury (RBI) is the most serious complication of head and neck tumor after radiotherapy. The pathogenesis of RBI is complicated, and the clinical course is irreversible, while no effective treatment available. The activation of glial cells is one of the main theories of RBI, and the prevention and treatment of RBI by targeting glial cells is the focus of current research. As a post-transcriptional regulatory factor, microRNA (miRNA) has been confirmed to be involved in regulatingglial cell radiosensitivity, inflammation type transformation, autophagy, exosomatic, long non-coding RNA (lncRNA), circular RNA (circRNA) and other related pathways, thereby mediating the occurrence and development of cascade reaction of inflammatory injury and neurological function repair of central nervous system (CNS) disease. Therefore, the establishment of miRNA - glial regulatory network may provide a new strategy for the prevention and treatment of RBI.

Objective To compare the effect of immediate implantation and delayed implantation on the surrounding tissue.Methods The clinical data of 98 cases of anterior teeth with single implant repair were analyzed retrospectively,and they were divided into study group (n =50) and control group (n =48) according to the method of implantation.The patients in the study group were implanted in the tooth socket immediately after the minimally invasive tooth extraction,and the patients in the control group were implanted after 12-16 weeks of minimally invasive extraction.All the two groups were repaired in coronal at 6 months after implantation.The success rate of implant,implant bone resorption,periodontal probing depth,gingival bleeding index,plaque index and red aesthetic score were compared between the two groups.Results The success rate was 100％ in the two groups after 12 months,the difference was not statistically significant(P ＞ 0.05).The implant surrounding bone absorption in the study group was lower than that in the control group,the differences were statistically significant (t =2.132,2.241,2.421,all P ＜ 0.05).At the end of 3 and 6 months,the depth of probing in the study group were significantly lower than those in the control group (t =2.019,2.307,all P ＜ 0.05),and the red aesthetic score in the study group was significantly higher than that in the control group,the differences were statistically significant [(7.97 ± 1.12) points vs.(6.82 ± 1.03) points,(8.65 ± 1.14) points vs.(7.42 ± 1.07) points,t =2.012,2.137,all P ＜ 0.05].The modified sulcus bleeding index and plaque index had no statistically significant differences between the two groups (all P ＞ 0.05).Conclusion The clinical effect of immediate implant restoration of anterior teeth is better than delayed implantation.

Hemangioma ; pathology ; Hemangiosarcoma ; pathology ; Humans