Objective:To summarize the evidence on preventing and managing feeding intolerance (FI) in ICU patients with enteral nutrition, providing a basis for clinical practice.Methods:Clinical practice guidelines, systematic reviews, evidence summaries, expert consensus, and randomized controlled trials related to the prevention and management of FI in ICU patients with enteral nutrition were systematically searched in Chinese and English databases, guideline websites, and professional association websites. The search period was from January 1, 2013, to March 29, 2023. Two researchers conducted quality evaluation, evidence extraction, and summarization of the included literature.Results:A total of 25 articles were included, including five clinical practice guidelines, three evidence summaries, 11 systematic reviews, one expert consensus, and five randomized controlled trials. Thirty-seven pieces of evidence were summarized from four aspects risk assessment, preventive measures, intervention measures, and evaluation.Conclusions:This study summarizes the best evidence for FI prevention and management in ICU patients with enteral nutrition. It is recommended that medical and nursing staff apply evidence based on clinical situations and patient preferences.

SWOT-PEST model was used to analyze the internal advantages and disadvantages,external,opportunities and challenges of tertiary public pediatric hospitals.Based on stakeholder theory,through the literature review method,policy analysis method,combined with the actual work,and summarize its main role and demands.Put forward the development strategy of three-level public pediatric specialty hospital.Through the analysis of interest demands of stakeholders of tertiary public pediat-ric specialty hospitals,the overall development is good at present,but there are still problems that need to be solved urgently.From the perspective of internal and external stakeholders,the optimization strategy involving multiple levels,multiple angles and multiple subjects is proposed to promote the comprehensive development of tertiary public pediatric specialty hospitals.

Objective:To explore the diagnostic value of serum C-C chemokine ligand 5 (CCL5) in assessing the degree of liver fibrosis in patients with metabolic-associated fatty liver disease (MAFLD).Methods:71 MAFLD patients who visited the Department of Integrated Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, and underwent liver biopsy histopathology examinations between October 2021 and June 2023 were selected for diagnostic testing. Simultaneously, 71 healthy subjects who underwent physical examinations at the physical examination center of the hospital were selected as the control group. Serum CCL5 levels were detected using an enzyme-linked immunosorbent assay (ELISA). Routine blood tests, liver and kidney function tests, and other tests were conducted to analyze the expression level of CCL5 and its correlation with the above indicators. The aspartate aminotransferase/platelet ratio index (APRI) and fibrosis 4 index (FIB-4) were calculated. SPSS 26.0 software was used for statistical analysis. The area under the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of CCL5 for the degree of liver fibrosis in MAFLD. The combined diagnostic efficacy of APRI and FIB-4 was further analyzed for the degree of liver fibrosis in MAFLD.Results:The expression level of serum CCL5 gradually increased with the increase in liver fibrosis stage in patients with MAFLD, and the difference was statistically significant ( P<0.05). The AUC value of serum CCL5 for diagnosing significant liver fibrosis in MAFLD patients was 0.775, with a sensitivity of 65.7%, a specificity of 80.6%, and an optimal cutoff value of 49.845 ng/ml. The CCL5 and FIB-4 combination had the highest diagnostic value for significant liver fibrosis in patients with MAFLD, with an AUC of 0.802, a sensitivity of 91.4%, and a specificity of 61.1%. Conclusion:CCL5 has a high diagnostic value for significant liver fibrosis in MAFLD patients. Therefore, it is expected to become a non-invasive diagnostic marker for assessing the degree of liver fibrosis in MAFLD patients.

From the perspectives of traditional Chinese medicine （TCM） information knowledge base and assisted decision-making knowledge base， the construction status， quality evaluation status and existing problems of current TCM knowledge bases have been sorted out. And based on the quality evaluation strategies and dimensions of know-ledge bases in other disciplines， the evaluation indexes for TCM knowledge base is discussed， and the evaluation framework is initially formed， providing ideas for the improvement of the TCM knowledge base evaluation system. In terms of the evaluation indexes， there are basic evaluation dimensions which include data sources， data collection， and data application. The specific evaluation dimension of the information-based knowledge base is data quality， while that of the assisted decision-making knowledge base is data matching. Except for the data application dimension which counts the valid data items in the database for calculation， other indexes are scored based on the qualitative evaluation of "yes"， "no" or "unknown". The basic evaluation score and the specific evaluation score are added to obtain the total score. The knowledge base is graded according to the score， and the results are presented in the form of grade plus number.

Consumptive thirst is widely discussed in Huangdi Neijing and it is classified as a"strange disease"in Suwen·Strange Diseases Treatise,which reflects the intractable nature of consumptive thirst.This paper explores and analyzes consumptive thirst based on the core concept in Huangdi Neijing.First,this paper approaches the subject through the use of image thinking method from Huangdi Neijing,recognizing that consumptive thirst can lead to changes in the internal climate of the human body.Then,guided by the theories of essence and qi,yin and yang,and the five elements in Huangdi Neijing,it deconstructs and analyzes the causes of these changes and the laws of qi transformation.It points out that the changing climate of consumptive thirst is characterized by"heat symptoms".The main cause of"heat symptoms"is spleen deficiency and excessive dampness,and its qi transformation law is the heat transformation of Shaoyin.The intractable nature of consumptive thirst is mainly reflected in the uncontrolled"heat symptoms"caused by the imbalance of the five elements.Based on the understanding of the heat symptoms of consumptive thirst,this paper proposes a treatment strategy for preventing the disease by resolving dampness and regulating the spleen,harmonizing kidney qi to prevent progression,and balancing yin and yang to treat chronic and recalcitrant conditions.The aim is to provide a reference for optimizing the treatment of consumptive thirst.

Objective To evaluate the efficacy and safety of CT-guided 125I seeds implantation for the treatment of abdominal wall incision metastasis of gastrointestinal malignancies.Methods The clinical data of 17 patients with abdominal wall incision metastasis of gastrointestinal malignancies(17 lesions in total),who received CT guided 125I seeds implantation at the Third Affiliated Hospital of Soochow University of China between January 2011 and December 2021,were collected.The treatment planning system was used to make preoperative planning for CT-guided 125I seeds implantation.Follow-up visit was performed once every 3 months to assess the local control rate,treatment-related adverse effects,and degree of pain relief.Results Successful CT-guided 125I seeds implantation was accomplished for the 17 lesions of gastrointestinal malignant tumor incision metastasis.A total of 372 125I seeds were implanted with an average of 21.9 seeds per lesion.The average prescription dose was 100 Gy per lesion.The average survival time was 9.8 months.CT scan performed at 3 months after first-time implantation showed that among the 17 lesions complete remission was obtained in 3,partial remission in 6,stable disease in 7 and progression in one,with a local control rate of 94.1％.The postoperative 6-month and 12-month local objective remission rates were 63.6％and 33.3％respectively,disease control rates were 100％and 50％respectively.Before treatment 8 patients had local pain,and 3 months after treatment pain relief was observed in 6 patients,and in 2 patients the NRS pain score was decreased by ≥ 2 points.No serious postoperative complications occurred.Conclusion For the treatment of abdominal wall incision metastasis of gastrointestinal metastasis,CT-guided 125I seeds implantation is clinically safe and effective.(J Intervent Radiol,2024,33:655-658)

Objective:To establish a method for determintation of chlorogenic acid and linarin in Yejuhua granules by HPLC.Methods:We applied HPLC methods. The Kromasil 100-5 C18 column (250 mm×4.6 mm,5 μm) was used, the mobile phase was acetonitrile-0.4%H 3PO 4 solution (gradient elution), the flow rate was 1.0 ml/min, the dection wavelenghth was 334 nm and the column temperture was 32 ℃. Results:Chlorogenic acid and buddleoside had good linearity in the ranges of 0.30-1.50 μg ( r2=0.999 1) and 0.12-0.62 μg ( r2=0.999 8), respectively. The average recoveries were 99.70% and 96.67%, with RSD<2%, respectively. Conclusion:The method is simple, rapid, reliable, efficient, and can be used for determination of chlorogenic acid and buddleoside in Yejuhua Granules.

Objective:To investigate the impacts of stroke volume variation (SVV)-guided goal-directed fluid therapy on intraoperative signs, intestinal barrier function and prognosis in patients undergoing laparoscopic radical rectal cancer surgery.Methods:A total of 90 patients who underwent laparoscopic radical resection for rectal cancer in Peking University International Hospital from May 2020 to May 2022 were prospectively selected as subjects, and divided into SVV group (45 cases) and traditional infusion group (45 cases) by random number table method. The SVV group was given SVV-guided goal-directed fluid therapy, and the traditional infusion group was given central venous pressure (CVP)-guided goal-directed fluid therapy. The operation-related indicators (urine volume, crystalloid volume, colloid volume, total fluid volume, blood loss and operation time), intraoperative signs indicators[heart rate (HR), CVP, mean arterial pressure (MAP)], intestinal barrier function indicators [diamine oxidase (DAO), D-lactic acid], inflammatory factor levels [interleukin-10 (IL-10), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and the incidence of complications were compared between the two groups.Results:There was no significant difference in the urine volume, blood loss and operation time between the two groups (all P>0.05), while the crystalloid volume, colloid volume and total fluid volume in the SVV group were greatly lower than those in the traditional infusion group (all P<0.05). There was no significant difference in HR between the two groups at different time points ( P>0.05). Compared with T 0, CVP at T 1 in the two groups was significantly decreased (all P<0.05), and increased at T 2 and T 3 compared with T 1 (all P<0.05). There was no significant difference in MAP at different time points in the SVV group (all P>0.05). The MAP at T 1, T 2 and T 3 in the traditional infusion group was significantly lower than that at T 0 (all P<0.05), and the MAP at T 1, T 2 and T 3 in the SVV group was significantly higher than that in the traditional infusion group (all P<0.05). Compared with T 0, DAO and D-lactic acid levels were significantly increased at T 1, T 3, T 4 and T 5 in the two groups (all P<0.05), and DAO and D-lactic acid levels at T 1, T 3, T 4 and T 5 in the SVV group were significantly lower than those in the traditional infusion group (all P<0.05). Compared with T 0, serum IL-10 level in the two groups was significantly decreased at T 4 ( P<0.05), and serum IL-6 and TNF-α levels were significantly increased at T 4 (all P<0.05). The serum levels of IL-10, IL-6 and TNF-α in the SVV group at T 4 were significantly different from those in the traditional infusion group (all P<0.05). Compared with T 4, the serum levels of IL-10 at T 5 were significantly increased (all P<0.05), while the levels of IL-6 and TNF-α were significantly decreased (all P<0.05), but there was no statistical significance between the two groups (all P>0.05). The incidence of postoperative infection, anastomotic fistula, vomiting and nausea in SVV group (13.33%) was significantly lower than that in traditional infusion group (35.33%) ( P<0.05). Conclusions:SVV-guided goal-directed fluid therapy for patients undergoing laparoscopic radical rectal cancer can effectively stabilize intraoperative vital signs, reduce inflammation, improve intestinal barrier function, and improve prognosis.

OBJECTIVE: To study the chemical constituents of the EtOAc extract of Armillaria gallica 012m. METHODS: The chemical constituents of the EtOAc extract of A. gallica 012m were isolated and purified by various column chromatography and their structures were elucidated on the basis of the 1D and 2D NMR spectroscopic and HRESIMS data. Cytotoxicity of all isolates against A549, HCT-116, M231 and W256 human tumor cells was determined by the MTT method. RESULTS: A new sesquiterpene aryl ester, armimelleolide C ( 1), and eight known ones including armillarivin ( 2), melleolide F ( 3), 6'-chloromelleolide F ( 4), melleolide ( 5), melleolide K ( 6), melledonol ( 7), 13-hydroxydihydromelleolide ( 8), and armillane ( 9), were isolated from the EtOAc extract of A. gallica 012m. All isolates showed potential cytotoxic activities against at least one of the human cancer cell lines with IC₅₀ values ranging from (3.17 ± 0.54) to (17.57 ± 0.47) μmol/L. Compound 1 showed significant inhibitory activity against M231 with an IC₅₀ value of (7.54 ± 0.24) μmol/L compared with paclitaxel as the positive control. Compounds 2, 3, and 7, 9 showed obvious inhibitory activity against HCT-116 and were better than that of the positive control. CONCLUSION The chemical constituents including a new sesquiterpene aryl ester armimelleolide C ( 1) from the EtOAc extract of A. gallica 012m have a variety of structures and potential antitumor activities.

Abstract: Objective　To investigate the antimicrobial activity of omadacycline (OMC) against clinical Streptococcus agalactiae (GBS) isolates, as well as its relationship with biofilm formation, resistance genes and virulence genes. Methods　A total of 136 strains of Streptococcus agalactiae isolated from Shenzhen Nanshan People's Hospital between 2015 to 2020. The minimum inhibitory concentration (MIC) of OMC against Streptococcus agalactiae was determined by broth microdilution. Crystal violet staining was used to detect the biofilm formation ability of GBS. Resistance genes (tetM, tetO, tetK, ermB, OptrA) and virulence genes (cpsⅢ, bca, fbsA, cpsA, scpB) were investigated by polymerase chain reaction (PCR). Results　Among the 136 clinical isolates of GBS, 20 strains (14.7%) were resistant to OMC, 64 (47.1%) were intermediate, and 52 (38.2%) were sensitive. Fifty-seven strains (41.9%) were biofilm-positive, 20 of which (35.1%) were sensitive to OMC. Seventy-nine strains (58.1%) were biofilm-negative, 32 of which (40.5%) were susceptible to OMC. There was a statistically significant difference in the sensitivity rates between the two groups of strains (χ2=63.062, P<0.001), but there was no significant difference in the sensitivity of OMC among the biofilm-positive strains (Fisher's exact test, P=0.824). The resistance rates of tetM, tetO, ermB and OptrA positive strains were higher than those of negative strains, while tetK was opposite. The presence of tetM (Z=0.815, P=0.415), tetO (Z=0.151, P=0.88), tetK (Z=0.567, P=0.571), ermB (Z=1.198, P=0.231) resistance genes in Streptococcus agalactiae had no significant impact on the sensitivity of OMC. However, the presence of the OptrA resistance gene showed a statistically significant effect on the sensitivity of OMC (Z=2.913, P=0.004). The virulence factors cpsⅢ, bca, fbsA, cpsA and scpB were all detected at a rate higher than 50%. The presence of the virulence genes cpsⅢ (Z=0.222, P=0.824), bca (Z=0.141, P=0.888), fbsA (Z=0.813, P=0.416), and cpsA (Z=1.615, P=0.106) in Streptococcus agalactiae had no significant impact on the sensitivity of OMC. However, there was a significant inter-group difference in the scpB virulence gene (Z=2.844, P=0.004), but the rank mean values and resistance rates of scpB-positive strains were lower than those of the negative strains. Conclusions　The formation of biofilm in Streptococcus agalactiae reduces its sensitivity to OMC, but there was no significant difference in the sensitivity to OMC among the biofilm-positive strains. The presence of resistance genes tetM, tetO, tetK, ermB, and virulence genes cpsⅢ, bca, fbsA, cpsA, scpB in Streptococcus agalactiae is not associated with OMC resistance, but the presence of the resistance gene OptrA is correlated with OMC resistance..