Objective To systematically retrieve and integrate the best evidence of enteral and parenteral nutrition support in adult patients with severe bums.Methods 2 nursing master students who had studied evidence-based nursing systematically searched the clinical decisions,recommended practices,guidelines,expert consensuses,systematic reviews,evidence summaries and other evidences on enteral and parenteral nutrition support for adult patients with severe bums in domestic and foreign guideline networks,relevant institutional websites and databases.The retrieval time was from the establishment of the databases to April 2023.2 researchers who had obtained master's degrees and undergone systematic evidence-based training in Fudan University used the appraisal of guidelines for research and evaluation n and JBI critical appraisal tools to evaluate the methodological quality,and extracted and summarized the evidence according to the theme.Results A total of 28 articles were included,including l clinical decision,9 guidelines,3 expert consensuses,9 systematic reviews,and 6 evidence summaries.A total of 20 pieces of evidence were summarized from 6 aspects:nutritional risk screening and assessment,energy requirement calculation,timing and route of nutritional support,nutrient intake,nutritional support monitoring and effect evaluation.Conclusion The best evidence of enteral and parenteral nutrition support for adult patients with severe burns summarized in this study is more comprehensive and scientific.It is suggested that in clinical application,targeted screening should be carried out according to the promotion and hindering factors of evidence,so as to scientifically carry out nutritional support for adult patients with severe burns.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

This paper reported a case of severe COVID-19 in the recovery stage with acute lymphoblastic leukemia treated by integrated traditional Chinese and western medicine， with the intention of shedding light on the clinical diagnosis and treatment of similar conditions. The patient， who had acute lymphoblastic leukemia， developed COVID-19 infection during the bone marrow suppression period after chemotherapy. Treatment with western medicine was mainly anti-infection， symptomatic management， and supportive care. During the recovery stage， considering the patient's chemotherapy history and disease progression， the overall syndrome was identified as deficiency of both qi and yin and binding of phlegm and blood. Based on the “state-target” combined treatment strategy， herbal prescriptions were selected and modified to address the “deficiency state”， “disease target”， and “symptom target”. In addition to western medicine， the patient was administered with Shengmai Powder （生脉散） and Compound Zhebei Granules （复方浙贝颗粒） in its modifications to boost qi， nourish yin， and reinforce healthy qi， nourish and cool the blood， ultimately achieving satisfactory therapeutic effects.

Objective:To explore the effect of stabilizing muscle training on cervical function and quality of life in continuous nursing care of patients with cervical spondylosis.Methods:From June 2018 to June 2019, a total of 98 patients with cervical spondylosis in the First Affiliated Hospital of Zhengzhou University were selected by convenience sampling method, and divided into control group and observation group by random number table method. In the course of treatment and follow-up, 15 cases were lost in the two groups, and 42 cases were included in the control group and 41 in the observation group. The control group was given routine continuous nursing after discharge, and the observation group was given stabilizing muscle training on the basis of routine continuous nursing. The scores of Japanese Orthopedic Association (JOA) and Neck Disability Index were compared before intervention, 3 months after intervention and 6 months after intervention between the two groups. The scores of Short Form 36 Health Survey Questionnaire (SF-36) were compared after intervention between the two groups.Results:The results of repeated measurement ANOVA of JOA score and NDI score before intervention, 3 months and 6 months after intervention showed that there were interaction, inter group and time effects, and the differences were statistically significant ( P<0.01) . After the intervention, the scores of SF-36 in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:In the continuous nursing of patients with cervical spondylosis, the application of stabilizing muscle training is more conducive to relieve muscle tension, improve symptoms, and improve the quality of life of patients.

AIM: To investigate the role of autophagy in the apoptosis of human pulmonary artery endothelial cells (HPAECs) induced by cigarette smoke extract (CSE).METHODS: HPAECs were cultured routinely.HPAECs were treated with CSE at different concentrations, and the cell viability was detected by MTT assay.HPAECs were divided into control group, CSE group, 3-methyladenine (3-MA) group and 3-MA+CSE group.The autophagy was observed under fluorescence microscope with monodansylcadaverine (MDC) staining.Annexin V/propidium iodide staining and Hoechst 33342 staining were employed to detect apoptosis.In addition, the protein levels of LC3, beclin-1 and cleaved caspase-3 were determined by Western blot.RESULTS: MDC staining showed the increased production of autophagic vacuoles was observed in CSE group.The results of Western blot showed that the expression levels of autophagy-related proteins LC3 and beclin-1 were increased, while 3-MA pretreatment inhibited the expression of these proteins and the production of autophagic vacuoles.Observation with Annexin V/propidium iodide staining and Hoechst 33342 staining showed that the apoptotic rate in CSE group was significantly higher than that in control group, and pretreatment with 3-MA induced further increase in the cell apoptosis.The protein level of cleaved caspase-3 in CSE group was significantly higher than that in control group (P<0.05), and 3-MA+CSE treatment induced the further increase in the protein level of cleaved caspase-3.CONCLUSION: CSE induces autophagy and apoptosis in the HPAECs.Inhibition of autophagy promotes the apoptosis induced by CSE in HPAECs, which can be achieved through activation of caspase-3.

Objective To study the relationship between the positive expression of human leukocyte antigen B27 (HLA-B27) in different age groups and genders in Uygur and Han nationality in Xinjiang,and explore the clinical value of HLA-B27 in different ethnic groups.Methods From January 2013 to November 2016,1 416 cases of Uygur and Han patients with positive expression of HLA-B27 were detected by flow cytometry.There were 369 cases of Uygur and 1 047 cases of Han.Results Independent samples t-test showed that the positive expression of HLA-B27 in Uygur and Han population was statistically significant (165.22±8.262 vs 163.99±8.113,t=2.479,P=0.013).In male,there was a significant difference in the positive expression of HLA-B27 between Uygur and Han population (165.40 ± 8.237 vs 163.99 ± 8.164,t =2.187,P =0.029).In the age of 41～60 years old and ＞60 years old,the positive expression of HLA-B27 in Uygur was higher than that in Han nationality (166.18 ± 7.650 vs 164.53 ± 8.018,t =2.215,P =0.027;171.63 ± 8.134 vs 167.40 ± 9.469,t =2.126,P=0.035).There was no significant difference in the positive expression of HLA-B27 between Uygur and Han nationality in women,as well as in the age of 20 years and 21～40 years (t=-0.029～1.257,all P＞0.05).Conclusion The investigation showed that the positive expression of HLA-B27 in Uygur was higher than that in Han nationality.The content of HLA-B27 positive expression has racial difference.

Background and objective Fast track surgery (FTS) can accelerate rehabilitation and reduce postop-erative hospital stay. It has been effectively applied to several surgical diseases. However, the safety and effectiveness of FTS for patients with lung cancer in China is unclear. hTismeta-analysis aimed to evaluate the effect of FTS undergoing lung cancer surgery in China.Methods Using home and abroad databases to search all documents required. hTe deadline of retrieval was January 31, 2016. hTen the studies were screened according to the inclusion and exclusion criteria. Data were analyzed by RevMan 5.3 sotfware.Results 8 randomized controlled trials (RCTs) and 5 clinical controlled trials (CCTs) with 1,241 pa-tients were eligible for analysis. Compared with control group, FTS group can signiifcantly shorten postoperative hospital time (MD=-3.61, 95%CI: -5.05--2.16,P<0.000,01) and chest tube duration (MD=-2.62, 95%CI: -3.07-2.17,P<0.000,01), reduce incidence of postoperative complications (OR=0.30, 95%CI: 0.19-0.47,P<0.000,01) and hospitalization costs (MD=-0.92, 95%CI: -1.19--0.65,P<0.000,01).Conclusion FTS can safely and effectively accelerate the recovery of patients with lung can-cer in China, it exhibits important clinical values.

Objective To explore the way of contrast-enhanced ultrasound(CEUS)and quantitative analysis technology to assess testicular microvascular ischemia-reperfusion inj ury.Methods Twenty-four healthy adult rabbits were randomly divided into the control group and the microvascular mild,moderate, serve ischemic inj ury group (group Ⅰ,including group Ⅰ1 ,Ⅰ2 ,Ⅰ3 ).The spermatic cord of the control group were threaded but not ligated.The group Ⅰ1 ,Ⅰ2 ,Ⅰ3 were reperfused 2 h after 2 h,4 h,6 h complete testicular ischemia respectively.The ultrasound contrast angiographic parameters of each group were analyzed by the quantitative analysis techniques,including peak intensity(PI),time to peak(TP),slope,mean transmit time(MTT),DT/2 and area.The levels of plasma vWF,NO and ET-1 were tested after the CEUS. The pathological changes of the ipsilateral testicular were observed by the HE and immunohistochemical staining.Statistical analysis was performed by SPSS 13.0 software.Results Preoperativeiy,each parameter of the experimental group and the control group showed no statistical significance (P > 0.05 ). Postoperatively,the PI,slope,area of the group Ⅰ1 increased significantly,while the TP,MTT were prolonged(P <0.05).Contrast time-intensity curve was significantly higher peak and retrusion.The groupⅠ2's PI,slope,area increased further,DT/2 was significantly prolonged,but TP significantly reduced (P <0.05).The contrast curve significantly increased,forward and decreased slowly.The contrast curves of the group Ⅰ3 was approximate a straight line.The vWF,NO,ET-1 levels of each experimental group were significantly higher than those in control group (P <0.05),among them,the levels of group Ⅰ2 were the highest (P <0.05 ).With the aggravation of ischemia,the testicular capillaries expansion,erythrocyte sedimentation,leakage,infiltration of inflammatory cells,MMP-9 expression in vascular basement membrane gradually increased.Conclusions The CEUS and quantitative analysis techniques can effectively evaluate testicular microvascular inj ury.

Objective:To analyse the salivary cortisol changes in patients with temporomandibular disorders(TMD)after electrical stimulation,and the relationship between cortisol and pain catastrophizing.Methods:1 1 TMD and 1 1 healthy subjects were evoked by electrical stimulation.The saliva samples were collested before test,50 s and 1 00 s of stimulation after test seperately.Salivary cortisol was analysed by ELISA kit.The pain catastrophizing scale(PCS)was answered by all the subjects before stimulation.Data were statis-tically analysed.Results:The salivary cortisol concentration in TMD patients was higher than that in the controls(P <0.05).After stimulation,it showed a downward trend.No interaction between time and groups.The total scores of PCS including three indexes(ru-mination,magnification,helpless)were positively correlated with salivary cortisol concentration.Conclusion:The unpredictable stress causes high level of cortisol.which is related to pain catastrophizing.

Objective To investigate the sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and to decrease misdiagnosis rate. Methods Thirty-one patients with 35 FV-PTCs and 66 patients with 75 conventional PTCs (C-PTCs) were enrolled in this study. The sonographic features were reviewed retrospectively between the two groups with universally accepted standards. Results The sonographic features of 35 FV-PTCs included irregular shapes (6/35), anteroposterior to transverse diameter ratio A/T > 1 (7/35), spiculated margins (25/35), marked hypoechogenicity (0/35), hypoechogenicity (18/35), isoechogenicity (16/35), no calcification (15/35), microcalcifications (11/35), macrocalcification (9/35), color Doppler lfow patternⅠ(20/35), color Doppler lfow patternⅡ(10/35), color Doppler lfow patternⅢ(5/35). Irregular shapes, A/T>1, spiculated margins, marked hypoechogenicity, microcalciifcations, and color type Ⅱ were rarer in FV-PTCs than in C-PTCs, while isoechogenicity, no calciifcation, macrocalciifcation, and color type Ⅲwere more frequent in FV-PTCs than in C-PTCs. The differences of the above features were statistically significant [χ2=4.276, P=0.039; χ2=8.125, P=0.004; P=0.009 (Fisher′ s exact test); χ2=8.548, P=0.003;χ2=4.898, P=0.027,χ2=7.796, P=0.005;χ2=5.462, P=0.019;P=0.001 (Fisher′s exact test)] . During the preoperative ultrasonography, 20 of 35 FV-PTCs were diagnosed as malignancy, and others were misdiagnosed as benign nodules (misdiagnosis rate was 43%). The lymphatic metastasis rate of FV-PTCs was 29%(9/31), significantly lower than C-PTCs [62%(41/66),χ2=9.246, P=0.002]. In terms of the sonographic features of metastatic lymph nodes, there was no marked difference between FV-PTCs and C-PTCs. Conclusions Some FV-PTCs are lack of malignant features, and tend to be misdiagnosed frequently when coexisting with benign thyroid nodules. Observing the echogenicity, color lfow characteristics and other features of each thyroid nodule and cervical lymph node with multiple views may decrease the misdiagnosis rate.