Objective:To summarize the best evidence for nutrition management of sarcopenia in patients undergoing maintenance hemodialysis (MHD), to guide the development of nutrition management programs.Methods:Using the 6S evidence model, literature on nutrition management of sarcopenia in MHD patients was electronically retrieved from databases and websites including UpToDate, Guidelines International Network, Joanna Briggs Institute Evidence-Based Health Care Center Database, European Society for Clinical Nutrition and Metabolism, UK Kidney Association, PubMed, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period was from database establishment to July 30, 2024. After screening and quality assessment of the literature, evidence was extracted and summarized.Results:A total of 19 articles were included, comprising one clinical decision, six guidelines, five systematic reviews, five expert consensus, and two randomized controlled trials. Twenty-six pieces of evidence were summarized from six aspects of nutrition team establishment and counseling, nutritional screening and assessment, nutritional support, nutrient intake, nutritional monitoring, and health education.Conclusions:The evidence summary on nutrition management of sarcopenia in MHD patients provides a basis for implementing nutritional interventions. Evidence transformation and application should be conducted in accordance with patient preferences and the actual clinical context.

Objective:To summarize the best evidence for nutrition management of sarcopenia in patients undergoing maintenance hemodialysis (MHD), to guide the development of nutrition management programs.Methods:Using the 6S evidence model, literature on nutrition management of sarcopenia in MHD patients was electronically retrieved from databases and websites including UpToDate, Guidelines International Network, Joanna Briggs Institute Evidence-Based Health Care Center Database, European Society for Clinical Nutrition and Metabolism, UK Kidney Association, PubMed, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period was from database establishment to July 30, 2024. After screening and quality assessment of the literature, evidence was extracted and summarized.Results:A total of 19 articles were included, comprising one clinical decision, six guidelines, five systematic reviews, five expert consensus, and two randomized controlled trials. Twenty-six pieces of evidence were summarized from six aspects of nutrition team establishment and counseling, nutritional screening and assessment, nutritional support, nutrient intake, nutritional monitoring, and health education.Conclusions:The evidence summary on nutrition management of sarcopenia in MHD patients provides a basis for implementing nutritional interventions. Evidence transformation and application should be conducted in accordance with patient preferences and the actual clinical context.

[Objective]To explore the application and mechanism of dredging therapy in treating diabetes mellitus and cerebral infarction(DACI).[Methods]A method integrating theoretical literature review with modern mechanistic research was adopted to systematically organize the perspectives on the brain from ancient Chinese medical books and physicians,as well as their discussions on the etiology and pathogenesis of DACI.This process served to summarize the traditional Chinese medicine therapeutic system for treating DACI.Furthermore,by combining modern experimental and clinical research,the pharmacological mechanisms and pathways of action of representative formulas and medicinals belonging to the dredging therapy were analyzed.[Results]The brain is the mansion of the primordial spirit,with"replenishment"and"patency"serving as its physiological foundation.The pathogenesis of DACI primarily involves persistent consumptive thirst that leads to deficiency of both Qi and Yin,intermingled phlegm and blood stasis,and blockage of the brain collaterals.The dredging therapy is its fundamental treatment principle,mainly comprising the"tonifying and unblocking method"which boosts Qi,activates blood,nourishes Yin and unblocks collaterals;and the"purging and unblocking method"which purges the Fu-organs to drain heat and expel turbid stasis.Tonifying-unblocking formulas such as Buyang Huanwu Decoction and Dihuang Yinzi which can regulate glucose and lipid metabolism,inhibit inflammation,and promote vascular and neural repair.Purging-unblocking formulas such as Xinglou Chengqi Decoction and Huanglian Wendan Decoction which can improve gut microbiota,modulate the gut-brain axis and alleviate systemic inflammatory responses.[Conclusion]The dredging therapy emphasizes the therapeutic principle of"removing obstruction to restore free flow"and combines unblocking with tonification,which aligns with the physiological characteristics of the brain.It exerts significant therapeutic effects by multi-target regulation of the metabolic and inflammatory microenvironment,as well as the neurovascular micro-environment in DACI.Future research should focus on refining syndrome-based classification of the dredging therapy,elucidating the material basis of herbal medicine efficacy,and advancing integrated Chinese-western treatment models to promote its precise and individualized application.

[Objective]To explore the application and mechanism of dredging therapy in treating diabetes mellitus and cerebral infarction(DACI).[Methods]A method integrating theoretical literature review with modern mechanistic research was adopted to systematically organize the perspectives on the brain from ancient Chinese medical books and physicians,as well as their discussions on the etiology and pathogenesis of DACI.This process served to summarize the traditional Chinese medicine therapeutic system for treating DACI.Furthermore,by combining modern experimental and clinical research,the pharmacological mechanisms and pathways of action of representative formulas and medicinals belonging to the dredging therapy were analyzed.[Results]The brain is the mansion of the primordial spirit,with"replenishment"and"patency"serving as its physiological foundation.The pathogenesis of DACI primarily involves persistent consumptive thirst that leads to deficiency of both Qi and Yin,intermingled phlegm and blood stasis,and blockage of the brain collaterals.The dredging therapy is its fundamental treatment principle,mainly comprising the"tonifying and unblocking method"which boosts Qi,activates blood,nourishes Yin and unblocks collaterals;and the"purging and unblocking method"which purges the Fu-organs to drain heat and expel turbid stasis.Tonifying-unblocking formulas such as Buyang Huanwu Decoction and Dihuang Yinzi which can regulate glucose and lipid metabolism,inhibit inflammation,and promote vascular and neural repair.Purging-unblocking formulas such as Xinglou Chengqi Decoction and Huanglian Wendan Decoction which can improve gut microbiota,modulate the gut-brain axis and alleviate systemic inflammatory responses.[Conclusion]The dredging therapy emphasizes the therapeutic principle of"removing obstruction to restore free flow"and combines unblocking with tonification,which aligns with the physiological characteristics of the brain.It exerts significant therapeutic effects by multi-target regulation of the metabolic and inflammatory microenvironment,as well as the neurovascular micro-environment in DACI.Future research should focus on refining syndrome-based classification of the dredging therapy,elucidating the material basis of herbal medicine efficacy,and advancing integrated Chinese-western treatment models to promote its precise and individualized application.

Objective:To evaluate the efficacy of a modified continuous penetrating-suture pancreaticojejunostomy (PPJ), also known as a continuous PPJ with a U-shaped reinforcement of pancreatic section (U-PPJ), in patients with high risk of clinically relevant postoperative pancreatic fistula (CR-POPF).Methods:Clinical data of 33 patients with pancreatic tumors undergoing pancreatic surgery in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Wannan Medical College from August 2017 to December 2023 were collected, including 22 males and 11 females, aged (64.9±8.6) years old. According to the fashion of pancreaticojejunostomy, patients were divided into two groups: U-PPJ group ( n=11) and PPJ group ( n=22). The general data, incidence of CR-POPF, abdominal bleeding and other clinicopathological data were collected. Results:All patients underwent pancreatic surgery successfully and were discharged from the hospital uneventfully. Intraoperative blood loss in U-PPJ group was 200.00 (100.0, 200.0) ml, postoperative hospitalization was 13.0 (11.0, 18.0) d, and the drain removal time was 17.0 (12.0, 21.0) d, and no CR-POPF occurred. The intraoperative blood loss, postoperative hospitalization days, drain removal time, and incidence of postoperative biochemical leakage were comparable between the groups (all P>0.05). The incidence of CR-POPF in U-PPJ group was lower than that in PPJ group [0 vs. 22.7% (5/22), P<0.05]. Conclusion:U-PPJ is safe and effective in patients with pancreatic tumors and might reduce the incidence of CR-POPF.

Objective:To analyze the risk factors of clinically-relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) and penetrating pancreaticojejunostomy (PPJ).Methods:The clinical data of 108 patients who underwent PD and PPJ in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Wannan Medical College from January 2017 to October 2022 were analyzed retrospectively, including 65 males and 43 females, aged 65.5 (54.2, 72.0) years. The incidences of POPF, biliary fistula, abdominal bleeding and other related complications were reviewed. The related factors of CR-POPF were analyzed by univariate analysis, and the statistically significant factors were included in multivariate logistic regression analysis.Results:A total of 108 patients were successfully treated with PD, including laparoscopic PD in 76 cases (70.4%) and open PD in 32 cases (29.6%). PPJ was performed in PD, including the continuous fashion in 39 cases (36.1%), intermittent fashion in 49 cases (45.4%) and modified continuous fashion in 20 cases (18.5%). The operation time was 390.0 (314.0, 480.0) min, the intraoperative blood loss was 200.0 (100.0, 384.0) ml, the postoperative hospital stay was 12.0 (10.0, 15.0) d, and the incidence of POPF (grade B + C) was 11.1% (12/108). Body mass index, pancreatic CT value and pancreatic duct size were the significant factors of CR-POPF (all P<0.05). Multivariate logistic regression analysis showed that age ( OR=0.895, 95% CI: 0.822-0.975), pancreatic CT value ( OR=0.812, 95% CI: 0.698-0.946) and pancreatic duct size ( OR=0.457, 95% CI: 0.220-0.952) were risk factors of CR-POPF after PPJ (all P<0.05). Conclusion:PPJ is a safe method of pancreaticoenterostomy, and CR-POPF may be related to younger patients, lower pancreatic CT value and the smaller pancreatic duct size.

Objective To study the reasons for conversion to laparotomy in laparoscopic pancreaticoduodenectomy (LPD).Methods Of the 74 patients who underwent LPD in Yi Jishan Hospital,Wan Nan Medical College from May 2012 to Dec 2016,7 patients were converted to laparotomy.The clinical and operative data of the 7 patients were reviewed.Results There were 6 males and 1 female.The age ranged was 51 to 66 years.The pathologies included tumor of pancreatic head in 5 patients,chronic inflammation of pancreas in 1 patient and duodenum papilla cancer in 1 patient.The reasons for conversion were:uncontrollable bleeding in 4 patients with superior mesenteric vein injury in 1 patient,portal vein injury in 1 patient and first jejunal vein injury in 2 patients,respectively.The bleeding was controlled successfully after laparotomy in all the 4 patients.The conversion in the remaining 3 patients were due to difficulty in the operative procedures which resulted from severe adhesions between the tumor and the major vessels.There were 2 patients who had invasion of the SMV by tumor.They underwent vascular resection after laparotomy.The remaining patient had chronic inflammation and the lesion was resected successfully after careful dissection.Of the 7 patients,1 patient developed pancreatic fistula,1 patient developed delayed gastric emptying and 1 patient developed both bile leakage and delayed gastric emptying.They were all treated conservatively.There was no peri-operative death in the study.Conclusion Uncontrollable bleeding and severe adhesions between the lesion and major vessels were the major reasons in LPD for conversion to laparotomy.

A rapid, sensitive, label-free and separation-free analytical method for determination of melamine ( MA) was developed based on surface enhanced Raman scattering ( SERS ) effect of gold nanoparticles. Through tri-sodium citrate reduction method, gold nanoparticles with average diameter of 30 nm were obtained. The melamine detection platform was constructed after self-assembling 4-mercapto phenylboronic acid (4-MPBA) on the surface of gold nanoparticles through Au S covalent bond. When MA existed in solution, 4-MPBA functionalized gold nanoparticles would aggregate because of strong hydrogen bond interaction between MA and 4-MPBA. Moreover, following increase of the concentration of MA, gold nanoparticles would aggregate more intensively and form more hot spots. As a result, Raman signal of 4-MPBA and MA was enhanced greatly. The characteristic Raman peaks of 4-MPBA and MA respectively located at 1076 cm-1 and 715 cm-1 . Hence, the qualitative and quantitative detection for MA were realized based on the ratio value of I715 cm-1 to I1076 cm-1 . The linear range of MA detection was 0 . 1 μmol/L-1. 5 μmol/L. The limit of detection (LOD) reached 0. 02 μmol/L in terms of three times signal to noise.