Feeding interruption related to airway procedures is a crucial factor contributing to enteral feeding disruption in critically ill patients,and it represents a significant cause of inadequate enteral nutrition delivery.Prolonged or repeated interruptions exacerbate the insufficiency of enteral nutrition,impede patient recovery,and increase the risk of adverse complications.The absence of clear guidelines and standardized protocols has led to variations in clinical practices regarding feeding interruption during airway procedures.This article provides an overview of the clinical importance and current practices associated with feeding interruption during airway procedures in critically ill patients.Additionally,potential avenues for future research are proposed with the aim of enhancing standardization,safety,and efficacy in feeding interruption practices linked to airway procedures for critically ill patients.

Objective To construct a deep learning-based artificial intelligence model to automatically quantify left ventricular ejection fraction (LVEF) using static views of echocardiography. Methods The study included data of 1, 902 adults with left ventricular multi-slice echocardiographic views at end-systole and end-diastole. The collected dataset was divided into development set (1, 610 cases, with 1, 252 cases for model training and 358 cases for parameter adjustment), internal test set (177 cases for internal validation), and external test set (115 cases for external validation and generalization testing). The model achieved left ventricular segmentation and automatic quantification of LVEF through precise identification of the left ventricular endocardial boundary and inspection of key points. The Dice coefficient was employed to evaluate the performance of the left ventricular segmentation model, while the Pearson correlation coefficient and the intraclass correlation coefficient were used to assess the correlation and consistency between the automatically measured LVEF and the reference standard. Results The left ventricular segmentation model performed well, with Dice coefficients ≥ 0.90 for both the internal and external independent test sets; the agreement between the automatically measured LVEF and the cardiologists' manual measurements was moderate, with Pearson correlation coefficients ranging from 0.46 to 0.71 and intragroup correlation analysis agreements from 0.39 to 0.57 for the internal test set; and Pearson correlation coefficients for the independent external test set were 0.26 to 0.54 and intra-group correlation analysis agreement of 0.23 to 0.50. Conclusion In this study, a left ventricular segmentation model with better performance is constructed, and initial application of the model for automatic quantification of LVEF for two-dimensional echocardiography has general performance, which requires further optimisation of the algorithm to improve the model generalisation.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

In this cross-sectional study, consecutive Chinese Han ethnic inpatients in the Division of Cardiology, the First Affiliated Hospital of Soochow University from January 1, 2010 to December 31, 2013 were included. According to the exclusion criteria, 9 587 patients [1 604 with type 2 diabetes mellitus (T2DM) and 7 983 without T2DM]were obtained for final analysis. Logistic regression model was used to analyze the association of ApoB/A-1 ratio with T2DM and the possible interactions between ApoB/A-1 ratio and other risk factors. The results showed that the distribution of ApoB/A-1 ratio was positively skewed in Chinese Han ethic population. The median of ApoB/A-1 ratio of female was lower than that of male (0.68 vs 0.73,P<0.01). In all groups, the proportion of T2DM was increased with the raised ApoB/A-1 ratio. By the stratification analyses of sex, age, coronary artery disease, and the use of statins, ApoB/A-1 ratio was still correlated with T2DM. There existed significant interactions between ApoB/A-1 ratio and the smoking status or creatinine in T2DM.

Objective To explore the clinical results of the arthroscopic acromioplasty in the rotator cuff repair.Methods Sixty-five patients (42 males and 23 females) to receive suture bridge repair under the arthroscopy between May 2012 and May 2014 were selected and randomly divided into an experimental group and a control group.The experimental group was given suture bridge repair with acromioplasty,while the control group underwent the suture bridge repair without acromioplasty.The time of operation was recorded.The range of motion (ROM) of the shoulder,the UCLA shoulder scoring system (ULCA) score,American orthopedic surgeon scoring system (ASES) score,the visual analogue scale (VAS) score and Constant score were observed 3 and 12 months after the operation.Results There were no significant differences in age,sex and the affected side between the two groups.Significant differences were found between the two groups in the duration of the operation (t=-18.5,P＜0.05).There were no significant differences in the ROM and the ULCA,ASES,VAS and constant scores of the shoulder 3 and 12 months after the operation.Conclusion No significant differences were found in the ROM and the shoulder function scoring between giving acromioplasty under the arthroscopy or not.However,the operation time of undergoing acromioplasty under the arthroscopy was longer.

Objective To investigate the status quo of ICU nurses′ working environment and its impact on their turnover intention.Methods A total of 388 nurses from 8 different intensive care units in a class Ⅲ grade A in Sichuan province were surveyed by the general information questionnaire, the practice environment scale of the nursing work index (PES-NWI) and the turnover intention sScale in September 2016. The correlation analysis and multivariate regression analysis were used to explore the effect of nursing work environment on turnover intention. Results The average PES-NWI score was (97.38±13.89). The domain of "nursing foundations for quality of care" had the highest score, whereas the score of the "staffing and resource adequacy" was the lowest. Different age, health condition, working years, ICU working years, working title, the numbers of night shift, and social support might affect the ICU nurses′ perception of working environment. The average score of turnover intention among the participants was (14.67±3.46). There was up to 71.4%(277/388)of nurses reported a high intention of turnover. There was a negative correlation between the nurses′ perception of working environment and their turnover intention (r=-0.319,P<0.01). Nursing work environment is one of the influencing factors of turnover intention, which can explain 10.2% of the variance.Conclusions Corresponding management strategies such as the modification of human and material resources can be adopted by nursing decision-makers to improve the nursing working environment, thus to minimize the likelihood of nurse turnover.

ObjectiveTo examine the effect of Xuebijing Injection on the number of T lymphocytes and Toll-like receptors as adjuvant therapy of severe abdominal infections.MethodsA total of 78 patients with severe abdominal infection who were hospitalized in the intensive care unit were divided into control group and treatment group. The patients in control group received conventional therapy alone, while the patients in treatment group received Xuebijing Injection (50 mL twice daily for 2 weeks) in addition to conventional therapy. Blood sample was drawn before and after 2-week treatment to determine T lymphocytes. The peripheral blood mononuclear cells were separated to determine the expression of Toll-like receptors (TLR) 2 and TLR4. The Acute Physiology and Chronic Health Evaluation (APACHE) II score and gastrointestinal function score were recorded before and after treatment.ResultsThe levels of CD3+, CD4+ and CD4+/CD8+ of peripheral blood in the Xuebijing-treated patients were signiifcantly higher than those in control group (P<0.01), but the levels of CD8+ was signiifcantly lower than that in control group (P<0.01). The levels of TLR2 and TLR4 mRNA of the peripheral blood mononuclear cells in the treatment group were signiifcantly lower than those in control group (P<0.01). The APACHE II score and gastrointestinal function score in treatment group were signiifcantly lower than those in control group (P<0.01).ConclusionXuebijing Injection as adjuvant therapy of severe abdominal infection can improve the number of T lymphocytes, and reduce the expression of Toll-like receptors.

Objective To observe the clinical effect of headless compression Screw (HCS)under arthroscope in the treat-ment of patella fracture.Methods Nineteen patients of patella transverse fractures were selected,all of them were treated with HCS fixation under arthroscope,reviewed and followed-up after surgery.Results X-ray examination after surgery of 3 -5 weeks found that the fracture lines blurred or disappeared,and the patella articular surface was smooth without displacement.The healing time of fracture was 8 weeks on average after operation;There was no statistical difference in the range of the knee joint in the af-fected side in (135.42±5.82)°and the contralateral side in (139.38±6.55)°(P >0.05);The knee Lysholm score of the last follow-up was 86-100 points[(93.7±4.14)points],which was significantly higher than the preoperative score of 65.7 (P <0.05);There was no fracture displacement in the period of followed-up,drop of internal fixator,fracture and other complications.Conclusion HCS fixation under arthroscope in treatment of patella fracture is effective.The joint function recovered quickly with less complica-tion.It could be one of the effective methods for the treatment of patella transverse fracture.

BACKGROUND:To reduce the amount of bleeding and the amount of hemoglobin after total knee replacement has been a key project in the clinical research in the division of bone and joint. Currently, ice therapy has been widely used in the clinic for tissue sweling and pain due to various physical and chemical factors. OBJECTIVE:To investigate the risk factors of postoperative hemoglobin after total knee replacement and discuss the effects of ice intervention. METHODS: 240 patients with osteoarthritis based on the random draw principles were equaly divided into the treatment group and the control group. The general information, disease status, diagnosis and treatment and prognosis of the two groups were investigated. Al patients were actively subjected to artificial total knee replacement. On the basis of the treatment in the control group, the treatment group received ice intervention at 2 hours after replacement for 7 consecutive days. RESULTS AND CONCLUSION:The postoperative hemoglobin decrease occurred in 34 patients, with the incidence of 14.2% among 240 patients at 7 days after replacement. Multivariate logistic regression analysis results showed that age, no ice treatment, body mass index were the main risk factors for hemoglobin decrease after total knee replacement (P < 0.05). Compared with the control group, the postoperative hemoglobin values of the treatment group were significantly higher (P < 0.05). Hemoglobin decrease values, total blood loss, blood transfusion rate, blood transfusion amount, and pain score at 3 and 7 days after replacement were significantly lower in the treatment group than in the control group (P < 0.05). The knee function excelent and good rate was 96.7% in the treatment group, and 95.8% in the control group, which showed no significant difference (P > 0.05). Results verify that clinical application of total knee replacement facilitated the knee recovery in patients with osteoarthritis, but hemoglobin decrease and bleeding existed. Active ice intervention can reduce the risk and relieve postoperative pain.

Objective To investigate the dynamic changes ofprocalcitonin (PCT) within 72 h of acute stroke without infection and explore the value of PCT in diagnosis of bacterial infection in the early stage of acute stroke.Methods Forty-one patients with acute stroke within 24 hours of symptom onset,admitted to our hospital from July 2012 to January 2013,were enrolled in our study.The concentrations of PCT and C-reactive protein (CRP) in the serum were measured,respectively,at 24,48 and 72 h after symptom onset.At each time point,the PCT and CRP values were compared with the upper value of normal ranges of PCT and CRP,respectively.Results The median (quartiles) PCT concentrations at 24,48 and 72 h after stroke onset were,respectively,(0.050 [0.040,0.080]) ng/mL,(0.060 [0.036,0.095]) ng/mL and [0.051 (0.040,0.079)] ng/mL,which were significantly different as compared with that of the upper value of normal range (0.05 ng/mL,P＜0.05).The median (quartiles) CRP concentrations at 24 and 48 h after stroke onset were,respectively,[3.200 (1.100,5.000)] mg/L and [4.300(1.700,9.900)] mg/L,showing no significant difference with the upper value of normal range (5.0 mg/L,P＞0.05); however,the mean CRP concentration at 72 after stroke onset was [5.300 (2.500,15.550) mg/L],enjoying significant difference as compared with the upper value of normal range (P＜0.05).Most of the patients (22 patients,53.67％) had a peak level of PCT at 24 h,while most of them (26,63.41％) had a peak level of CRP at 72 h.The concentration of PCT increased within 24 h after symptom onset,but declined in the following 72 h; in contrast,the concentration of CRP continuously increased in the first 72 h of symptom onset.Conclusions PCT concentrations may increase in the first 72 h after acute stroke,therefore,when using PCT in diagnosis of bacterial infection in the early stage of acute stroke,the influence of elevating PCT concentrations by stroke itself should be considered.But PCT usually reaches its peak level earlier than CRP and returns to normal range faster than CRP,which may be more valuable than CRP in diagnosis of bacterial infection in the early stage of acute stroke.