Objective: To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China. Methods: The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis. Results: Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ²=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ²=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ²=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg^-1·d^-1, 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient′s condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150). Conclusion The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.

BACKGROUND/AIMS: Several studies have demonstrated that sleep problems are associated with functional gastrointestinal disorders (FGIDs): irritable bowel syndrome (IBS), functional dyspepsia, etc, but the relationship between excessive daytime sleepiness (EDS) and FGIDs has not been systematically studied in the general population. This study aims to explore the relationship between EDS and specific types of FGIDs and the effect of the number of FGIDs on EDS. METHODS: A sample of 3600 individuals (aged 18–80 years) was selected from 5 regions in China using a randomized, stratified, multi-stage sampling method. EDS was measured by the Epworth Sleepiness Scale, while gastroesophageal reflux disease (GERD) and other FGIDs were assessed by Reflux Disease Questionnaire and the Rome II diagnostic criteria, respectively. RESULTS: The survey was completed by 2906 individuals (response rate: 80.72%), and 644 individuals (22.16%) had EDS. EDS was significantly associated with ulcer-like dyspepsia (OR, 2.50; 95% CI, 1.08–5.79), diarrhea-predominant IBS (OR, 2.00; 95% CI, 1.09–3.66), alternating IBS (OR, 2.32; 95% CI, 1.30–4.13), functional constipation (OR, 1.68; 95% CI, 1.20–2.35), and GERD (OR, 1.72; 95% CI, 1.08–2.72). Risk of EDS increased along with the increasing numbers of FGIDs: with 1 FGID (OR, 1.72; 95% CI, 1.37–2.15); with 2 FGIDs (OR, 2.43; 95% CI, 1.63–3.62); and with 3 or more FGIDs (OR, 3.26; 95% CI, 1.37–7.78). CONCLUSIONS: FGIDs, such as ulcer-like dyspepsia, diarrhea-predominant IBS, alternating IBS, functional constipation, and GERD, were significantly associated with EDS. Those who suffered from more kinds of FGIDs were more susceptible to EDS.
China* ; Constipation ; Disorders of Excessive Somnolence ; Dyspepsia ; Epidemiology ; Gastroesophageal Reflux ; Gastrointestinal Diseases* ; Irritable Bowel Syndrome ; Methods

Objective To study the effect of TLR4 activation with LPS on BMP9-induced osteogenic differentiation of immortalized mouse embryonic fibroblasts ( iMEFs).Methods The activation of TLR4/NF-κB signaling path-way was detected by ICC.iMEFs were treated with LPS,BAY11-7082,Adnovirus GFP and BMP9.The early osteo-genic differentiation capability of iMEFs was detected by ALP staining and quantitative assay .The later osteogenic differentiation capability was detected by alizarin red S staining .The expression of later osteogenic differentiation marker gene OCN and OPN were detected by PCR and Western blot .The change of p-Smad1/5/8 was detected by Western blot.The expression of Runx2 and Dlx5 were detected by PCR and Western blot .Results LPS can effec-tively stimulate TLR4/NF-κB signaling pathway .TLR4 activation inhibited BMP 9-induced osteogenic differentiation . BMP9-induced osteogenic differentiation related gene and Smad 1/5/8 signaling activation were inhibited by TLR4 activation .The inhibition effect was partly reversed by BAY 11-7082 ( P<0.05 ) .Conclusions TLR4 activation with LPS can inhibit BMP9-induced osteogenic differentiation of iMEFs cells via NF-κB signaling pathway .

The social and behavioral research in promoting human health and the impact on human social relations and structures has been confirmed .With the development of social and behavioral science , the importance of ethics review for the research is also increased .Despite its uniqueness , the basic principles of ethics in social and behavioral research are consistent with other biomedical studies .This paper introduces ethics review points of social and behavioral research from the research design , risk and benefits , informed consent , deception and debriefing , expedited review , exemption of ethics review, privacy and confidentiality .This paper also introduces the relevant experiences from Europe and America giving references for the domestic professionals .

From the point of view of ethics review work situation of our country, the existing capacity of our review of ethical problems in development are analyzed, a preliminary summary of the Chinese medicine ethics review ca-pacity development, systematically analyzes the Assessment Human Research Protection System of TCM and Chinese medicine clinical research ethics review platform evaluation work, and to improve the ethical review system to perfect supervision system, improve the medical ethics review standards and guidelines, carrying out the innovation and con-struction of ethical review professional knowledge training, to promote Chinese medicine ethics review certification and accreditation system construction work and Chinese medical ethics review of the clinical research objective, the practice of ethical review management of Chinese medicine are discussed.

Scientific review, time schedule of ethical review, standards of review, the compensation for injuries of subjects in clinical research and the relation between the ethical review and scientific integrity are common issues in ethical review of clinical research. This paper had an in-depth discussion on issues mentioned above. The interna-tional rules were referred and the personal suggestions were also provided for the reference in further discussion.

Objective To investigate and analysis the actuality and demands of scientific researchers in state clinical research facility of TCM, in order to provide evidences for policy making. Methods All the trainees taken part in the meeting for the training of clinical research method were assigned to answer the self-designed questionnaire. Results Of all these people, 47.58 percent people had senior professional title, 84.14 percent people had doctorate or master degree, 57.24 percent people had participated in project research at provincial or ministerial level as key personnel, 35.17 percent people had participated in a key disease research as directors, 65.52 percent people had taken methodology training of clinical research,30.34% of who trained by evidence-based medicine. The majority of these people had clear understanding in methodology of clinical research, who believed that evidence-based medicine and system evaluation are the most difficult subjects to understand and practice, hoping to learn more about the knowledge on statistics. Conclusion Clinical researchers of state clinical research facility of TCM had sound basis for scientific research, but relatively lacking of key disease research and systematic knowledge of scientific methodology, which needed to be enhanced.