Objective To investigate the application effect of a bedside ultrasound-guided intestinal cleaning program in patients with severe acute pancreatitis.Methods A total of 51 patients with severe acute pancreatitis admitted to the ICU of a tertiary A hospital in Shandong from March to September 2023 were selected by convenience sampling method,and they were divided into an experimental group and a control group according to random number table method.The experimental group was given the bedside ultrasound-guided intestinal cleaning program,and the control group was given the routine intestinal cleaning program.Acute gastrointestinal injury ultrasonography score,the incidence of grade Ⅲ acute gastrointestinal injury and intra-abdominal pressure were compared between the 2 groups before intervention,on the 3rd and 5th day.Results There was an interaction effect between time and group in the comparison of acute gastrointestinal injury ultrasonography scores in the 2 groups(F=7.478,P<0.001);simple effect analysis showed that acute gastrointestinal injury ultrasonography scores in the experimental group were lower than those in control group on the 3rd and 5th day,with statistically significant differences(P<0.05).The incidence of grade Ⅲ acute gastrointestinal injury in the experimental group(23%)was lower than that in the control group(60%),with statistically significant differences(P<0.05).The intra-abdominal pressure had an interaction effect between the 2 groups(F=47.128,P<0.001);simple effect analysis showed that the intra-abdominal pressure in the experimental group was lower than that in the control group on the 3rd and 5th day,with statistically significant differences(P<0.05).Conclusion The bedside ultrasound-guided intestinal cleaning program can improve acute gastrointestinal injury and reduce intra-abdominal hypertension in patients with severe acute pancreatitis.

Objective:To explore the diagnosis and clinical characteristics of congenital meningocele combined with type 1 neurofibromatosis (NF1).Methods:Clinical data of a child with congenital meningoencephalocele complicated with NF1 diagnosed and treated by the Hunan Provincial Brain Hospital on July 12, 2021 were collected, and relevant literature was reviewed.Results:Patient, female, 9 years old, with milk coffee stains on the skin of the trunk and limbs, mostly with a length greater than 1.5 cm; A three-dimensional CT scan of the skull showed a skull defect in the left temporal occipital region (approximately 7.5 cm×6.7 cm) and below the right posterior occipital tuberosity (approximately 3 cm×3 cm). The patient′s clinical whole exome sequencing detected one pathogenic mutation (NF1: p. Arg681Ter), and underwent lumbar cistern drainage, cyst resection, occipital cistern ostomy, and titanium mesh repair and shaping surgery. The pathological result showed proliferation of arachnoid and fibrous tissue, and good postoperative recovery.Conclusions:Congenital meningoencephalocele combined with NF1 is extremely rare, and early surgery has more advantages than disadvantages. The use of titanium mesh with sliding groove can alleviate the limitation on skull growth to a certain extent. NF1 has diverse clinical manifestations and different onset ages, and should be followed up by a multidisciplinary team for a long time.

As the search for effective treatments for COVID-19 continues, the high mortality rate among critically ill patients in Intensive Care Units (ICU) presents a profound challenge. This study explores the potential benefits of traditional Chinese medicine (TCM) as a supplementary treatment for severe COVID-19. A total of 110 critically ill COVID-19 patients at the Intensive Care Unit (ICU) of Vulcan Hill Hospital between Feb., 2020, and April, 2020 (Wuhan, China) participated in this observational study. All patients received standard supportive care protocols, with a subset of 81 also receiving TCM as an adjunct treatment. Clinical characteristics during the treatment period and the clinical outcome of each patient were closely monitored and analysed. Our findings indicated that the TCM group exhibited a significantly lower mortality rate compared with the non-TCM group (16 of 81 vs 24 of 29; 0.3 vs 2.3 person/month). In the adjusted Cox proportional hazards models, TCM treatment was associated with improved survival odds (P < 0.001). Furthermore, the analysis also revealed that TCM treatment could partially mitigate inflammatory responses, as evidenced by the reduced levels of proinflammatory cytokines, and contribute to the recovery of multiple organic functions, thereby potentially increasing the survival rate of critically ill COVID-19 patients.
Humans ; COVID-19 ; Medicine, Chinese Traditional ; SARS-CoV-2 ; Critical Illness ; Treatment Outcome

objective:This paper summarizes the nursing care of a case of severe acute pancreatitis complicated with intra-abdominal hypertension by ultrasonic-guided enema.Methods:One patient with severe acute pancreatitis internal high pressure from February 28, 2021 in Shandong Provincial Hospital Affiliated to Shandong First Medical University setting indiidualized enema scheme, advantage of the characteristics of ultrasonic visualization, before and after the enema examine case of intestinal cleaning and waste water accumulation, enema, positioning enemator catheter and cutting-edge position, ensure the accuracy of the enema, normal irrigation using configuration at the same time, the relaxation anal sphincter and so on, to observe the therapeutic effects enema.Results:After careful treatment and nursing, the patient achieved satisfactory results of exhaust and defecation, enema, abdominal distention improved, intra-abdominal pressure returned to normal, 10 days later, the condition was stable and transferred to the general ward.Conclusions:For the nursing of patients with severe acute pancreatitis complicated with intra-abdominal hypertension, it is particularly important to reduce intra-abdominal pressure by enema. Nurses should make reasonable use of new technology to implement individualized enema nursing, promote the excretion of stool, reduce intra-abdominal pressure, and facilitate the early recovery of the disease.

Objective: To investigate the current status of the ten-year implementation of the World Health Organization (WHO) surgical safety checklist (SSC) in China. Methods: A questionnaire was designed based on the three phases described by the checklist — the period before induction of anaesthesia, the period before skin incision, and the period before patient leaves operating room, taking into account some hotspots and disputes.The questionnaire was sent to the members of the Chinese-based online New Youth Anesthesia Forum through the WeChat platform.Answers were completed by mobile phones or desktop computers.Each WeChat ID number allowed only one answer for each individual participant. Results: A total of 3 943 members red the questionnaire invitation, of which 2 121 members completed the questionnaire with an overall completion rate of 53.79%.For checks completed before induction of anesthesia, the percentage of members who routinely practiced checks before induction of anesthesia was 93.35%, the percentage of members who completed each and every element of the checklist was 60.16%, and the percentage of members who selected the element of the checklist the surgeon was not involved in the check was 14.05%.For checks practiced before skin incision, the percentage of members who routinely completed checks before skin incision was 78.22%, the percentage of members who completed each and every element of the checklist was 51.91%, and the percentage of members who selected the element of the checklist surgeons and anesthesiologists routinely stated their own professional key information was 18.24% and 18.81%, respectively.For checks practiced before the patient leaved the operating room, the percentage of members who routinely completed checks before removing the patient from the operating room was 64.26%, and the percentage of members who completed each and every element of the checklist was 44.18%.The percentage of members who was really serious about practicing the checklist was 56.20%.The percentage of members who believed that surgeons should participated in checks practiced before induction of anesthesia was 81.47%.If the member himself or a member of his family needed a surgery, the percentage of members who hoped to implement the checklist was 98.35%.The percentage of members who believed that practicing WHO SSC could reduce the complications of surgery and improve the anesthetic safety of patients was 94.34%. Conclusion The implementing rate of checks practiced before induction of anesthesia is high, while the implementing rates of checks completed before skin incision and before patient leaves operating room are sequentially reduced in China.Although there are some problems with the implementation of WHO SSC, most respondents believe that implementing SSC can improve the anesthetic safety of patients undergoing surgery.

BACKGROUND: Exosomes are nano-scale vesicles that can be secreted by almost all types of cells in the body, which can participate in multiple cell signaling pathways by transporting signal molecules, such as proteins, lipids and miRNAs to perform intercellular communication, immune responses, and antigen presentation. Therefore, exosomes have a great value in the clinical diagnosis and treatment of diseases. Of the cell types known to produce exosomes, mesenchymal stem cells are currently the most prolific producer closely related to the occurrence and development of neurodegenerative diseases. OBJECTIVE: To review the origin and biological characteristics of mesenchymal stem cell-derived exosomes, the isolation and identification methods of exosomes, and the progress of mesenchymal stem cell-derived exosomes in the treatment of neurodegenerative diseases. METHODS: The literature search was performed in PubMed and CNKI databases, and the keywords were "mesenchymal stem cells; exosomes; MSC-exosomes; neurodegenerative diseases" in Chinese and English, respectively. RESULTS AND CONCLUSION: A total of 61 eligible literatures were enrolled. Mesenchymal stem cell-derived exosomes have low immunogenicity and long-circulating half-life and can carry small molecular substances across the blood-brain barrier, which can promote nerve cell growth and neuronal differentiation. Mesenchymal stem cell-derived exosomes help damaged nervous system function and enhance vascular neurogenesis, which is becoming an emerging treatment for neurodegenerative diseases.

BACKGROUND:During fracture healing, in addition to the need for appropriate biomechanical environment, the role of cytokines is also increasingly attracted attention.
OBJECTIVE:To study the effect of nerve growth factor and alpha-lipoic acid on fracture healing in rat models of femoral fracture.
METHODS:Sprague-Dawley rat models of femoral fracture were established. Seventy-two rats were randomly divided into three groups. In the control group, rats were intramuscularly injected with physiological saline. In the nerve growth factor group, rats were intramuscularly injected with nerve growth factor 200 ng/kg, once a day. In the combined therapy group, rats were intramuscularly injected with nerve growth factor 200 ng/kg and oral y taken alpha-lipoic acid 25 mg/kg, once a day. At 1, 2 and 3 weeks after administration, bony cal us volume was measured. Enzyme linked immunosorbent assay was used to measure serum bone morphogenetic protein-2 levels. Western blot assay was utilized to detect bone morphogenetic protein-2 protein expression at the broken end of fracture. Semi-quantitative RT-PCR was applied to examine vascular endothelial growth factor mRNA expression.
RESULTS AND CONCLUSION:(1) At 1 week after administration, no significant difference in bony cal us volume was detected among the three groups. Serum bone morphogenetic protein-2 level, bone morphogenetic protein-2 protein expression, and vascular endothelial growth factor mRNA expression were significantly higher in the nerve growth factor group and combined therapy group compared with the control group (P<0.05), but no significant difference was found between the two groups. (2) At 2 weeks after administration, the amount of cal us, serum bone morphogenetic protein-2 levels, bone morphogenetic protein-2 protein expression, and vascular endothelial growth factor mRNA levels were significantly higher in the nerve growth factor group and combined therapy group compared with the control group (P<0.05). Above expression levels were higher in the combined therapy group than in the nerve growth factor group (P<0.05). (3) At 3 weeks after administration, serum bone morphogenetic protein-2 levels, bone morphogenetic protein-2 protein expression, and vascular endothelial growth factor mRNA levels were significantly decreased in the nerve growth factor group. However, above expression levels were stil high in the combined therapy group, and significantly higher than in the nerve growth factor group (P<0.05). (4) These results indicate that nerve growth factor combined with alpha-lipoic acid had better effects on the fracture healing compared with the nerve growth factor alone.

OBJECTIVETo observe the effect of intrapartum and postpartum factors on abnormal neurological findings in the extremely preterm infants.

METHODClinical data of 62 premature infants (33 of male, 29 of female) were retrospectively analyzed. None of the premature infants had birth defect; their gestational ages were all less than 28 weeks (23(+ 6)-27(+ 6) weeks). They were hospitalized within 12 hours after birth in the neonatal intensive care unit (NICU) of BAYI Children's Hospital from November 2010 to June 2013. The blood gas, birth condition, complications, the mechanical ventilation and the ultrasonic encephalography were recorded. The 62 cases were divided into 2 groups, alive group and died group. Meanwhile, all cases of survial were divided into brain injuries group and normal brain group. Data were analyzed with t-test, Chi square test and Spearman correlation analysis.

RESULTFifty-six cases were alive, and 6 cases died (3 were during the treatment and 3 were after parents gave up). The average birth weight of brain injuries group was (954 ± 182) g; and that of the normal brain group was (1 071 ± 136) g. There were significant differences between the two groups in gender (χ(2) = 4.314, P = 0.038), gestational age (χ(2) = 11.622, P = 0.001), birth weight (t = 2.728, P = 0.009), which had significant correlation with neurological outcomes. The Spearman correlative coefficients were -0.278, 0.456 and 0.364 respectively. And P values were 0.038, 0.000 and 0.006. The rates of multiple pregnancy, lung hemorrhage and surgical operation in brain injuries group were 45%(9/20), 55%(11/20), 40%(8/20), which were significantly higher than those in normal brain group, 3%(1/36), 17%(6/36), 11%(4/36)(χ(2) = 12.800, 8.936, 4.773, P all < 0.05). These three factors were the high risk factors for adverse neurological outcomes, the odds ratios were 28.64, 6.11 and 5.33 respectively. There was no significant difference in delivery mode, amniotic fluid, maternal infection, asphyxia, necrotizing enterocolitis, patent ductus arteriosus, sepsis, mechanical ventilation, inhaled nitric oxide therapy, blood glucose, blood gas analysis, doses of dopamine between brain injuries group and normal brain group. The birth weight in alive group was (1 029 ± 163) g, which was significantly higher than those in died group (870 ± 144)g (r=0.29, P=0.022). There was no significant difference in other factors between alive group and died group(P all>0.05).

CONCLUSIONGender, gestational age and birth weight may have relation with the neurological outcomes of extremely preterm infants. Multiple pregnancy, pulmonary hemorrhage and surgical operation are the risk factors of brain injuries. Birth weight is related to the survival of extremely preterm infants.

Birth Weight ; Brain Injuries ; physiopathology ; Female ; Gestational Age ; Humans ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature, Diseases ; Lung ; pathology ; Male ; Pregnancy ; Pregnancy, Multiple ; Retrospective Studies ; Risk Factors

BACKGROUND:After arthroscopic knee surgery, deep vein thrombosis easily occurs. Currently, there were no specific clinical manifestations in deep vein thrombosis, so a fast, convenient and reliable risk assessment tool was needed to evaluate the clinical high-risk groups for prevention and intervention. The effectiveness of Caprini Risk Assessment Scale used in thrombosis risk assessment has been confirmed by a large number of researches, but the current domestic research is less.
OBJECTIVE:To verify the validity of Caprini risk assessment scale in evaluations of high deep venous thrombosis risk patients among knee arthroscopy patients, and to explore effective strategies for prevention of deep vein thrombosis in patients undergoing knee arthroscopic surgery.
METHODS: A case-control study design was used to colect 49 deep vein thrombosis patients admitted to the Department of Orthopedics, Renhe Hospital of Three Gorges University from January 2008 to June 2015 as case group, and randomly selected 98 patients admitted during the same period of non-deep vein thrombosis patients as control group. Caprini risk assessment scale was used to assess risk assessment and risk grading of deep venous thrombosis, and to explore the correlation between risk classification and risk of deep vein thrombosis.
RESULTS AND CONCLUSION: (1) Basic conditions comparison: application time of tourniquet, the proportion of smoking patients, and proportion of deep venous thrombosis and (or) the history of pulmonary thromboembolism were higher in the case group than in the control group (P < 0.05). (2) Caprini score was significantly higher in the case group than in the control group (P < 0.001). In the case group, the proportion of very high risk patients (53%) was highest, folowed by high risk (25%), totaly 78%. In the control group, the proportion of high risk patients (32%) was highest, folowed by low risk (29%). Significant differences in above risk degree analysis were identified between the two groups (P< 0.001). (3) Deep venous thrombosis and (or) the history of pulmonary thromboembolism was positively correlated with Caprini score in the case and control groups (P < 0.05). Caprini score was positively associated with application time of tourniquet in the case group (P< 0.05). (4) Logistic regression analysis of Caprini risk classification and the risk of deep vein thrombosis: with increased caprini risk classification, the risk of deep vein thrombosis increased significantly. The risk of deep venous thrombosis in patients with high risk and very high risk was 2.130 and 11.786 times of patients with low risk, respectively. (5) These results indicate that Caprini risk assessment model can effectively assess the risk of deep vein thrombosis among patients receiving knee arthroscopy.

OBJECTIVETo evaluate the efficacy and safety of tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) after failure of nucleoside-analogues (NAs).

METHODSA total of 30 CHB patients who had been previously treated with NAs and had subsequently completed a 48-week course of TDF were retrospectively investigated. Patients' data of HBV DNA level (log10 copies/ml) and rate of undetectable HBV DNA at treatment weeks 0 (baseline), 4, 12, 24, 36 and 48 were collected for evaluation. The lower limit of HBV DNA detection was 100 IU/ml. The serum alanine aminotransferase (ALT) normalization rate, hepatitis B e antigen (HBeAg) seroconversion rate, viral breakthrough (VBT) rate, viral response (VR) rate, and adverse events were determined upon treatment completion. Statistical analyses were carried out using the Student's t-test, the x² test or the Kaplan-Meier method.

RESULTSOver the 48-week treatment period, HBV DNA levels declined significantly from baseline (week 4:(2.11 ± 0.38) log10 IU/ml, t =5.582; week 12:(0.93 ± 0.31) log10 IU/ ml, t =9.303; week 24:(0.75 ± 0.20) log10 IU/ml, t =3.123; week 36:(0.16 ± 0.19) log10 IU/ml, t =10.759; week 48:(0.14 ± 0.25) log10 IU/ml, t =12.202) (all P less than 0.01). However, the rates of HBV DNA reduction and of cumulative reduction were comparable at weeks 24, 36 and 48 (all P more than 0.05). The most robust decline in HBV DNA levels was observed at week 4 ((2.11 ± 0.38) log10 IU/ml) and the highest cumulative HBV DNA reduction was observed at week 24 ((3.79 ± 0.37) log10 IU/ml). The rate of undetectable HBV DNA at week 4 (26.7%) was significantly lower than that at weeks 24 (87.5%, P less than 0.01), 36 (80.0%, P=0.007), and 48 (88.9%, P=0.001). The median time to achieving undetectable HBV DNA was 10.4 weeks (range:3.43-34.0 weeks). At week 48, the rates of VR, HBeAg seroconversion, and VBT were 88.9% ,6.7%, and 0% respectively. During treatment, the levels of creatine kinase were more than two times the upper limit normal in 9.2% of the patients, and were comparable at each time point examined (all P more than 0.05). All patients showed a normal level of serum creatinine throughout the treatment period.

CONCLUSIONFor CHB patients with non-response to NAs, TDF can suppress HBV DNA replication very quickly and achieve a high rate of ALT normalization with a low rate of adverse events.

Adenine ; administration & dosage ; analogs & derivatives ; therapeutic use ; Adult ; Antiviral Agents ; administration & dosage ; therapeutic use ; DNA, Viral ; blood ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; drug therapy ; Humans ; Male ; Middle Aged ; Organophosphonates ; administration & dosage ; therapeutic use ; Retrospective Studies ; Tenofovir ; Young Adult