Objective:To systematically review and evaluate prediction models for aspiration risk in enteral nutrition patients, providing a reference for the development and application of future models.Methods:Literature related to prediction models for aspiration risk in enteral nutrition patients was searched in China National Knowledge Infrastructure, Wanfang Data, China Biology Medicine disc, Web of Science, Cochrane Library, Embase, and PubMed, with the search period covering from the inception of the databases to August 30, 2024. Two researchers independently conducted literature screening and data extraction, and the PROBAST tool was used to assess the risk of bias and applicability of the included studies.Results:A total of 18 studies were included, involving 24 prediction models, with sample sizes ranging from 103 to 512 and an event rate of 9.46% to 49.87%. The top six predictive variables reported most frequently were baseline age, history of aspiration, length of nasogastric tube insertion, nutritional risk, impaired consciousness, and Acute Physiology and Chronic Health Evaluation-Ⅱscore. The area under the receiver operating characteristic curve of the models ranged from 0.756 to 0.992. Twelve studies reported model calibration, six studies conducted internal validation only, one study conducted external validation only, and four studies performed both internal and external validation. The overall applicability of the 18 studies was good, but the risk of bias was high, mainly due to improper handling of continuous variables and missing data.Conclusions:The aspiration risk prediction models developed in various studies for enteral nutrition patients show good applicability but carry a high risk of bias. Future efforts should focus on further optimizing the model construction process, internal and external validation, and result analysis to provide more reliable and scientific tools for clinical aspiration risk assessment.

Objective:To systematically review and evaluate prediction models for aspiration risk in enteral nutrition patients, providing a reference for the development and application of future models.Methods:Literature related to prediction models for aspiration risk in enteral nutrition patients was searched in China National Knowledge Infrastructure, Wanfang Data, China Biology Medicine disc, Web of Science, Cochrane Library, Embase, and PubMed, with the search period covering from the inception of the databases to August 30, 2024. Two researchers independently conducted literature screening and data extraction, and the PROBAST tool was used to assess the risk of bias and applicability of the included studies.Results:A total of 18 studies were included, involving 24 prediction models, with sample sizes ranging from 103 to 512 and an event rate of 9.46% to 49.87%. The top six predictive variables reported most frequently were baseline age, history of aspiration, length of nasogastric tube insertion, nutritional risk, impaired consciousness, and Acute Physiology and Chronic Health Evaluation-Ⅱscore. The area under the receiver operating characteristic curve of the models ranged from 0.756 to 0.992. Twelve studies reported model calibration, six studies conducted internal validation only, one study conducted external validation only, and four studies performed both internal and external validation. The overall applicability of the 18 studies was good, but the risk of bias was high, mainly due to improper handling of continuous variables and missing data.Conclusions:The aspiration risk prediction models developed in various studies for enteral nutrition patients show good applicability but carry a high risk of bias. Future efforts should focus on further optimizing the model construction process, internal and external validation, and result analysis to provide more reliable and scientific tools for clinical aspiration risk assessment.

OBJECTIVE To study the toxicokinetics and tissue distribution characteristics of alpha-amanitin in rats.METHODS The tail venous blood was collected from SD rats before and 5,10,20,30 and 45 min,1,1.5,2.5,4 and 8 h after intraperitoneal injection of alpha-amanitin(1.5 mg·kg-1),and the concentration of alpha-amanitin in blood was determined by liquid chromatography-mass spectrometry(LC-MS/MS).DAS 2.0 software was used to analyze and plot the drug-time curve with toxicokinetic parame-ters.Based on the toxicokinetics results,18 SD rats were randomly divided into three groups.The rats were sacrificed,and left ventricular arterial(LVA)blood and 9 types of tissue samples involving the heart,liver,spleen,lung,kidney,whole brain,small intestine,stomach wall and testis were collected 15 min,40 min and 2.5 h after dosing,and the concentrations of alpha-amanitin were measured by LC-MS/MS to obtain the tissue distribution results of alpha-amanitin in SD rats.RESULTS Toxicokinetics studies revealed that the peak blood concentration(Cmax)was(633±121)μg·L-1,the elimination half-life(T1/2)was(0.72±0.37)h,and the peak time(Tmax)was(0.52±0.16)h.The total clearance rate(CLz)was(1.62±0.26)L·h·kg-1,the area under the curve(AUC0-t)was(946±183)μg·h·L-1,and the mean reten-tion time(MRT0-t)was(1.18±0.17)h.The apparent volume of distribution(Vz)was(1.65±0.86)L·kg-1.The results of tissue distribution study showed that alpha-amanitin was widely distributed in SD rats with the highest concentration in the kidney,followed by the lung,small intestines,stomach wall,LVA blood and liver,but was low in the heart,spleen,testicles and other tissues,and very low in the brain.Alpha-amanitin was absorbed and eliminated quickly,peaked at 40 min in each tissue,and the concen-tration was minimized after 2.5 h.CONCLUSION The absorption and elimination of alpha-amanitin by intraperitoneal injection are rapid in SD rats,and the blood concentration reaches the peak about 31 min after administration,but can not be detected 4 h later.Alpha-amanitin is mainly distributed in the kidney,followed by the tissues and metabolic organs with rich blood flow,such as the lung,small intestines,stomach wall,LVA blood and liver.The content of alpha-amanitin is low in the heart,spleen,testicles and other tissues,and very low in the brain.It is speculated that it may have toxic targeting effect on the kidney and low blood-brain barrier permeability.

Objective To study the effect of Ditan Decoction combined with aripiprazole and olanzapine in the treatment of schizophrenia and its influence on serum inflammatory factors chnage.Methods Seventy-seven patients with schizophrenia meeting the requirements visiting the outpatient department and hospitalized in Dazu District Hospital of Traditional Chinese Medicine and Dazu District Mental Health Center from July 2021 to March 2023 were selected as the study subjects and divided into the observation group(n=38)and control group(n=39).The control group was treated with aripiprazole and olanzapine,and the observation group was combined with Ditan Decoction on the basis of the control group.After 8 weeks of treatment,the TCM syndrome scores,Positive and Negative Syndrome Scale(PANSS)score,serum inflammatory factors(IL-6,IL-1β,IL-17)levels were compared between the two groups.Results The total effective rate was 97.37％in the observation group and 84.65％in the control group,and the difference was statistically signifi-cant(P＜0.05).The TCM syndrome score of each item and total scores after treatment in the observation group were lower than those in the control group(P＜0.05),the PANSS positive symptoms,negative symp-toms,general psychopathology and total scores in the observation group were lower than those in the control group(P＜0.05).The IL-17,IL-6 and IL-1β levels after treatment in observation group were lower than those in the control group(P＜0.05).Conclusion Ditan Decoction combined with aripiprazole and olanzapine has significant clinical efficacy in the treatment of schizophrenia,which could further reduce the symptom score of the patients and improve the serum inflammatory factors levels.The treatment is highly safe and worthy of clinical recommendation.

Objective To investigate the diagnostic value of detachable string magnetically controlled capsule endoscopy(ds-MCE)in patients with liver cirrhosis.Methods Patients with liver cirrhosis were screened for esophagogastroduodenoscopy(EGD)and ds-MCE examination to assess the accuracy of ds-MCE in identifying gastroesophageal varices,high-risk esophageal varices and portal hypertensive gastropathy using EGD as the gold standard,and evaluate the detection of portal hypertensive enteropathy and the comfort level of patients.Results From May 2021 to July 2022,a total of 53 patients with liver cirrhosis were successfully enrolled.With EGD as the gold standard,ds-MCE detected esophageal varices with 95.45％for sensitivity,100％for specificity and adjusted positive predictive value(PPV),95.65％for adjusted negative predictive value(NPV),and 0.877 for Kappa value(P＜0.001).For detection of gastric varices,ds-MCE had sensitivity,specificity,adjusted PPV,and adjusted NPV of 93.94％,90％,90.38％and 93.69％,and Kappa value of 0.839(P＜0.001).For detection of portal hypertension gastropathy,ds-MCE had sensitivity,specificity,adjusted PPV and adjusted NPV of 80％,90.70％,89.59％and 81.93％,and Kappa value of 0.657(P＜0.001).In differentiating high-risk esophageal varices,the sensitivity,specificity,adjusted PPV,and adjusted NPV were 76％,100％,100％and 77.43％,respectively;Kappa value was 0.770(P＜0.001).Of the patients with liver cirrhosis,26.0％(13/50)were diagnosed with portal hypertensive enteropathy.The main mucosal changes were edema,erythema,and vascular dysplasia.The ds-MCE comfort score of 3(2,4)was higher than that of the traditional EGD 1(0,3)(P＜0.000 1).Conclusion Compared with EGD,ds-MCE is an accurate,safe,feasible and comfortable method for detecting esophagogastric varices and portal hypertensive gastropathy in patients with liver cirrhosis.It is a potential alternative to EGD screening surveillance of gastroesophageal varices in patients with liver cirrhosis.

Acute pancreatitis is a common acute abdomen with a variety of causes and natural course.The incidence rate is increasing year by year.Some patients may develop severe acute pancreatitis,with serious complications and a high risk of death.Therefore,early prediction of the severity of the patient's condition and active treatment are beneficial to reduce the severity and mortality rate of patients and improve the prognosis of patients.In order to predict the severity of acute pancreatitis,many prediction methods have emerged in the clinic,including acute C-reactive protein,urea nitrogen,thyroid hormone,hematocrit,inflammatory factors,visceral fat area,pancreatic necrosis volume,APACHEⅡ,Ranson score,BISAP,EPIC,MCTSI,etc.This article summarizes the serological indicators,imaging methods and scoring systems that can be used to predict severe acute pancreatitis,focusing on their characteristics and limitations.

Objective　To accurately understand the current epidemic status and influencing factors of tuberculosis in Hainan Province, and to provide a scientific basis for preventing and controlling tuberculosis. Methods　In 2023, a two-stage unequal cluster random sampling method was employed to select 30 floating points in Hainan Province. Screening for tuberculosis was conducted through symptom investigation, etiological examination, and chest X-ray examination among permanent residents aged 15 years and above. The prevalence rate of active tuberculosis and etiologically positive tuberculosis was obtained and statistically analyzed after correction for the age and gender structure of the standard population. Results　In the 30 districts of the province, 35 221 individuals were targeted for screening, with an actual field investigation population of 33 778 and a detection rate of 95.9%. The prevalence rates for active pulmonary tuberculosis, smear-positive pulmonary tuberculosis, and etiologically positive pulmonary tuberculosis were 355/100 000, 63/100 000, and 96/100 000, respectively. Based on this estimation, there are 28 600 cases of active pulmonary tuberculosis, 5 099 cases of smear-positive pulmonary tuberculosis, and 7 772 cases of etiologically positive pulmonary among the population aged 15 and above in the province. The prevalence rate for active tuberculosis exhibited a fluctuating upward trend with increasing age. Except for the age group between ages 30 to <35 years old, the prevalence rate was higher in males than females across all other age groups. Smear-positive pulmonary tuberculosis patients were predominantly concentrated in the age range between ages <35 to <70; both male and female age groups displayed similar trends with three peaks in disease occurrence. The prevalence rates for active, smear-positive, and etiologically positive pulmonary TB among the Li ethnic population were 716/100 000, 121/100 000, and 205/100 000, respectively, which were higher than those in the Han and other ethnic minorities. In rural areas, the prevalence of active pulmonary tuberculosis was 435/100 000, 2.2 times higher than that in urban areas (197/100 000). However, the incidence rate for smear-positivity was slightly lower in rural areas compared to urban areas, while the prevalence of etiologically positive pulmonary TB remained consistent. Conclusions　The tuberculosis epidemic in Hainan Province is relatively severe, with certain areas experiencing serious outbreaks. Priority attention is needed for key populations, such as the Li ethnic group. The task of tuberculosis prevention and control is arduous.

Acute pancreatitis is a common acute abdomen with a variety of causes and natural course.The incidence rate is increasing year by year.Some patients may develop severe acute pancreatitis,with serious complications and a high risk of death.Therefore,early prediction of the severity of the patient's condition and active treatment are beneficial to reduce the severity and mortality rate of patients and improve the prognosis of patients.In order to predict the severity of acute pancreatitis,many prediction methods have emerged in the clinic,including acute C-reactive protein,urea nitrogen,thyroid hormone,hematocrit,inflammatory factors,visceral fat area,pancreatic necrosis volume,APACHEⅡ,Ranson score,BISAP,EPIC,MCTSI,etc.This article summarizes the serological indicators,imaging methods and scoring systems that can be used to predict severe acute pancreatitis,focusing on their characteristics and limitations.

BACKGROUND: Currently, the effect of the 2022 nationwide coronavirus disease 2019 (COVID-19) wave on the perioperative prognosis of surgical patients in China is unclear. Thus, we aimed to explore its influence on postoperative morbidity and mortality in surgical patients. METHODS: An ambispective cohort study was conducted at Xijing Hospital, China. We collected 10-day time-series data from December 29 until January 7 for the 2018-2022 period. The primary outcome was major postoperative complications (Clavien-Dindo class III-V). The association between COVID-19 exposure and postoperative prognosis was explored by comparing consecutive 5-year data at the population level and by comparing patients with and without COVID-19 exposure at the patient level. RESULTS: The entire cohort consisted of 3350 patients (age: 48.5 ± 19.2 years), including 1759 females (52.5%). Overall, 961 (28.7%) underwent emergency surgery, and 553 (16.5%) had COVID-19 exposure (from the 2022 cohort). At the population level, major postoperative complications occurred in 5.9% (42/707), 5.7% (53/935), 5.1% (46/901), 9.4% (11/117), and 22.0% (152/690) patients in the 2018-2022 cohorts, respectively. After adjusting for potential confounding factors, the 2022 cohort (80% patients with COVID-19 history) had a significantly higher postoperative major complication risk than did the 2018 cohort (adjusted risk difference [aRD], 14.9% (95% confidence interval [CI], 11.5-18.4%); adjusted odds ratio [aOR], 8.19 (95% CI, 5.24-12.81)). At the patient level, the incidence of major postoperative complications was significantly greater in patients with (24.6%, 136/553) than that in patients without COVID-19 history (6.0% [168/2797]; aRD, 17.8% [95% CI, 13.6-22.1%]; aOR, 7.89 [95% CI, 5.76-10.83]). Secondary outcomes of postoperative pulmonary complications were consistent with primary findings. These findings were verified through sensitivity analyses using time-series data projections and propensity score matching. CONCLUSION: Based on a single-center observation, patients with recent COVID-19 exposure were likely to have a high incidence of major postoperative complications. REGISTRATION NCT05677815 at https://clinicaltrials.gov/ .
Female ; Humans ; Adult ; Middle Aged ; Aged ; Cohort Studies ; COVID-19/complications* ; Pandemics ; Retrospective Studies ; Postoperative Complications/epidemiology*

OBJECTIVE: Reduce the number of false alarms and measurement time caused by movement interference by the sync waveform of the movement. METHODS: Vital signal monitoring system based on motion sensor was developed, which collected and processed the vital signals continuously, optimized the features and results of vital signals and transmitted the vital signal results and alarms to the interface. RESULTS: The system was tested in many departments, such as digestive department, cardiology department, internal medicine department, hepatobiliary surgery department and emergency department, and the total collection time was 1 940 h. The number of false electrocardiograph (ECG) alarms decreased by 82.8%, and the proportion of correct alarms increased by 28%. The average measurement time of non-invasive blood pressure (NIBP) decreased by 16.1 s. The total number of false respiratory rate measurement decreased by 71.9%. CONCLUSIONS False alarms and measurement failures can be avoided by the vital signal monitoring system based on accelerometer to reduce the alarm fatigue in clinic.
Humans ; Monitoring, Physiologic ; Electrocardiography ; Arrhythmias, Cardiac ; Blood Pressure ; Accelerometry ; Clinical Alarms