Objective To retrieve,evaluate and synthesize the best evidence for nutritional management in patients with acute-on-chronic liver failure.Methods Evidence on nutritional management of patients with acute-on-chronic liver failure was systemically retrieved from the clinical decision support systems,guideline websites,professional association websites and databases,such as Cochrane Library,Joanna Briggs Institute,PubMed,Embase,CINAHL,Web of Science,VIP database,CNKI and CBM,including clinical decisions,guidelines,expert consensuses,evidence summaries and systematic reviews from inception to July 16,2024.Researchers trained in evidence-based nursing used authoritative tools to evaluate the methodological quality of the literature,and extracted and synthesized evidence according to the theme.Results A total of 13 articles were included,including 1 clinical decision,8 guidelines,and 4 expert consensuses.The best evidence included 26 pieces of evidence in 6 areas,namely the nutrition support team,nutritional assessment,energy and protein intake,oral nutrition support,enteral and parenteral nutrition support,and management of complications.Conclusion This study summarizes the best evidence for nutritional management in patients with acute-on-chronic liver failure,which can provide a basis for their standardized management.Medical staff should evaluate the availability of evidence from multiple perspectives when applying it.

Objective To retrieve,evaluate and synthesize the best evidence for nutritional management in patients with acute-on-chronic liver failure.Methods Evidence on nutritional management of patients with acute-on-chronic liver failure was systemically retrieved from the clinical decision support systems,guideline websites,professional association websites and databases,such as Cochrane Library,Joanna Briggs Institute,PubMed,Embase,CINAHL,Web of Science,VIP database,CNKI and CBM,including clinical decisions,guidelines,expert consensuses,evidence summaries and systematic reviews from inception to July 16,2024.Researchers trained in evidence-based nursing used authoritative tools to evaluate the methodological quality of the literature,and extracted and synthesized evidence according to the theme.Results A total of 13 articles were included,including 1 clinical decision,8 guidelines,and 4 expert consensuses.The best evidence included 26 pieces of evidence in 6 areas,namely the nutrition support team,nutritional assessment,energy and protein intake,oral nutrition support,enteral and parenteral nutrition support,and management of complications.Conclusion This study summarizes the best evidence for nutritional management in patients with acute-on-chronic liver failure,which can provide a basis for their standardized management.Medical staff should evaluate the availability of evidence from multiple perspectives when applying it.

Surgical operation is the main treatment of oral and maxillofacial tumors.Dysphagia is a common postoperative complication.Swal-lowing disorder can not only lead to mis-aspiration,malnutrition,aspiration pneumonia and other serious consequences,but also may cause psychological problems and social communication barriers,affecting the quality of life of the patients.At present,there is no systematic evalua-tion and rehabilitation management plan for the problem of swallowing disorder after oral and maxillofacial tumor surgery in China.Combining the characteristics of postoperative swallowing disorder in patients with oral and maxillofacial tumors,summarizing the clinical experience of ex-perts in the field of tumor and rehabilitation,reviewing and summarizing relevant literature at home and abroad,and through joint discussion and modification,a group of national experts reached this consensus including the core contents of the screening of swallowing disorders,the phased assessment of prognosis and complications,and the implementation plan of comprehensive management such as nutrition management,respiratory management,swallowing function recovery,psychology and nursing during rehabilitation treatment,in order to improve the evalua-tion and rehabilitation of swallowing disorder after oral and maxillofacial tumor surgery in clinic.

Objective:To analyze the diagnostic and prognostic value of routine bone marrow examination in patients with extranodal NK/T-cell lymphoma (ENKTCL) based on PET-CT staging.Methods:Clinical data of 186 patients who received bone marrow biopsy and bone marrow aspiration in Fujian Medical University Union Hospital from 2013 to 2021 were retrospectively analyzed. All patients were divided into bone marrow biopsy + bone marrow aspiration group ( n=186) and PET-CT + bone marrow biopsy group ( n=139). The sensitivity, specificity, positive and negative predictive values were compared between two groups. The data were analyzed and plotted. Survival analysis was performed using Kaplan-Meier method and log-rank test. Results:In the whole cohort, 45 patients were positive for bone marrow biopsy, and 30 of them were positive for bone marrow aspiration. A total of 141 patients who were negative for bone marrow biopsy also achieved negative results for bone marrow aspiration. A total of 139 patients completed PET-CT staging and bone marrow biopsy. And 30 patients were diagnosed with positive bone marrow by PET-CT, in which 22 of them were confirmed positive by bone marrow biopsy. Among 109 patients diagnosed with negative bone marrow by PET-CT, 5 of them were confirmed positive by bone marrow biopsy. All these cases were classified as stage Ⅳ due to distant metastases. PET-CT had a diagnostic sensitivity of 81.5%, a specificity of 92.9%, a positive predictive value of 73.3%, and a negative predictive value of 95.4%. Among early stage (Ⅰ-Ⅱ stage) patients diagnosed with PET-CT, all of them were negative for bone marrow biopsy (the negative predictive value was 100%). In stage Ⅳ patients ( n=55), the 1-year overall survival of patients with bone marrow involvement by bone marrow biopsy or PET-CT ( n=35) compared with their counterparts with the involvement of other organs ( n=20) was 28.7% vs.42.0% ( P=0.13), and 1-year progression free survival rates was 23.2% vs. 23.3% in ( P=0.94). Conclusions:Routine bone marrow biopsy does not change the original staging of patients with early stage ENKTCL based on PET-CT staging. Advanced stage patients with positive bone marrow biopsy tend to obtain worse prognosis, indicating that bone marrow biopsy still has certain value.

Objective:To compare the consistency and detection capability of seven 2019-nCoV nucleic acid detection kits, and provide reference for detection method selection of clinical laboratory and diagnosis of new coronavirus pneumonia.Methods:Two batches of pharyngeal swab samples were collected from tenpatients with confirmed infection of 2019-nCoV and 10 suspected patients with negative 2019-nCoV test results during January 29 to February 5, 2020 in Shenzhen Luohu People′s Hospital. Seven kinds of kits were labeled as ato g and used for nucleic acid detection respectively to evaluate the consistency of the test results of the clinical samples. A 2019-nCoV positive specimen was selected and diluted to 5-concentration gradient plates (Level-1 to 5) with RNase-free water. The positive detection rate and intra-batch repeatability of different brands of kits were compared.Results:The negative and positive coincidence rates of twenty clinical samples tested by six kinds of kits were 100%, and the positive and negative coincidence rate was 8/10 and 10/10 for the other kit, respectively. The results of intra-batch repeatability showed the CVs of viral loads tested by these seven kits were all less than 5%. In the concentration range of Level-1 to 3, the detection capability for open reading frame (ORF)1ab gene of Kit b,d and f was lower than Kit a,c,e and g, and the detection capability of kit e and g was the highest (14/15). The detection capability for N gene of Kit a (15/15) was higher than the other 5 kits. The comprehensive analysis of the detection capability for ORF1ab and N gene showedthat Kit d had the lowest detection capability (ORF1ab:40%,N:53%), and there was no significant difference in the detection capability of Kit a, b, c, e, and f.Conclusions:There was no significant difference in the accuracy and repeatability of the seven kits for positive samples with high viral loads, and the detection performance was good; but some kits had poor detection capability for weak positive samples. It is suggested that the weak positive samples should be rechecked by at least two manufacturers′ kits to ensure the accuracy of the results.

Objective To explore the change of postoperative pancreatic fistula (POPF) in modified pancreaticoenteric anastomosis in pancreaticoduodenectomy.Methods This paper retrospectively analyzed clinical data of 122 patients who suffered pancreaticoduodenectomy or enlarged pancreaticoduodenectomy from Apr.2008 to Sep.2017 in West China Hospital of Sichuan University.All surgeries were operated by a surgeon.30 patients from Apr.2008 to Dec.2010 were divided to control group,and 92 patients from Jan.2011 to Sep.2017 were the experimental group.Pancreatic duct-jejunum mucosa anastomosis was adopted in the two groups,but the method in experimental group was modified.Clinically relevant POPF was compared between the two groups.Results The rate of clinically relevant POPF was 0％ (0/92) in the experimental group,while it was 13.3(4/30) in the control group.Conclusion Modified technique for duct-to-mucosa pamcreaticojejunostomy can reduce the incidence of POPF.

Objective To compare the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and Quadrant minimally invasive system in treatment of lumbar disc herniation (LDH). Methods 59 single-level LDH patients were randomly divided into PTED group (n = 31) and Quadrant group (n = 28). Then compare the operative time, incision length, blood loss, length of hospital stay, and the return-to-work time between the two groups. In addition, visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and modified MacNab criteria were used for surgical efficacy evaluation. Results In PTED group, compared with Quadrant group, we observed, shorter incision length, less blood loss, shorter hospital stay, and shorter time of returning to work (P < 0.05), postoperative VAS, JOA and ODI scores had been improved in both groups (P < 0.05). The PTED group had lower VAS scores of lumbago at 3 days and 1, 3 months postoperatively (P < 0.05). As for postoperative JOA and ODI score, no notable difference was found between the two groups at each corresponding follow-up time point (P > 0.05). According to the improved MacNab criteria, there was no significant difference in excellent or good rate between the two groups (P > 0.05). Conclusion The clinical results of PTED and Quadrant minimally invasive system in treatment of lumbar disc herniation were satisfactory, and PTED were less traumatic method with rapid recovery.

Objective To investigate the clinical effect of the treatment of osteoporotic vertebral compression fractures in the elderly populationthrough different surgical approaches.Methods 98 cases with a single-level osteoporotic vertebral compression fracture in the elderly population were randomly divided into two groups from February 201 1 to June 2013.48 patients were performed by percutaneous vertebroplasty (PVP)through unipedicular approach and 50 patients through bipedicular approachs.The clinical data of patients were prospectively analyzed and the clinical efficacy were compared between two groups using VAS (visual analogue scale method)and ODI (Oswestry disability index)in preoperative,postoperative 1 day and 1 year postoperatively .The data of age, gender,injury to the patients with operation time,postoperative follow-up time,operation time,bone cement injection,bone cement leakage and other complications were observed.Cobb angle,vertebral compression ration were observed by imaging data.Results All the cases were followed-up.There was no statistical difference in preoperative clinical data between the two groups (P >0.05).In unilateral group (48 cases),the data of operation time,bone cement injection,bone cement leakage,Cobb angle improve,vertebral compression ration improve were (34.87±5.91)min,(6.20±0.66)mL,1 6 cases(33%),(10.1 9±2.12)%,(13.23°±1.58°)and adjacent vertebral fractures was 10 cases (20.9%).VAS score was respectively improved (4.05 ± 0.12 ),(5.42 ± 0.12 ) in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.40 ±0.1 1 )in postoperative 1 year than 1 day.ODI score was respectively improved (35.46 ± 1.89)%,(47.88 ±2.21 )% in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.42±0.24)% in postoperative 1 year than 1 day.In bilateral group (50 cases).The data of operation time,bone cement injection,bone cement leakage,Cobb angle improve, vertebral compression ration improve were (41.66±6.90)min,(4.88±0.52)mL,9 cases(18.0%),(10.48±1.43)%,(13.04°±2.03°)and adjacent vertebral fractures was 6 cases(12.0%).VAS score was respectively improved (4.06±0.1 1),(5.30±0.10)in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.34± 0.08)in postoperative 1 year than 1 day.ODI score was respectively improved (36.08±2.13)%,(47.54±1.97)%in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.26 ± 0.54)% in postoperative 1 year than 1 day.There was no obvious clinical problems after occurred leakage in two groups.there was statistical difference in cement injection,bone cement leakage and postoperative adjacent vertebral fractures after operation between the two groups.there was no statistical difference in Cobb angle improve,vertebral compression ration improve,VAS score and ODI score between the two groups.Conclusion Both approaches are effective in the treatment of osteoporotic vertebral compression fractures in the elderly population ,but there is advantage of decrease the incidence of bone cement leakage and postoperative adjacent vertebral fractures through bilateral approach.

OBJECTIVETo explore the myeloid-derived suppressor cell (MDSC) expression in the peripheral blood and lesions of 4NQO-induced tongue carcinoma in mouse.

METHODSThe established 4NQO mouse model was used to analyze the distribution of MDSC and T cell subsets in the peripheral blood by flow cytometry. The relations of MDSC with T cell subsets and CD4⁺/CD8⁺ changes were evaluated. The distribution of MDSC in the lesions of tongues was analyzed by immu- nohistochemistry, and the expression of arginase 1 (ARG-1) in tongue tissues was detected by real-time polymerase chain reaction.

RESULTSDuring tumor progression, a significant increase was observed in the frequency of MDSC in the peripheral blood of 4NQO treated mice (P < 0.01). The frequency of MDSC was positively correlated with systemic CD3⁺CD8+T cells but negatively correlated with the CD4⁺/CD8⁺ ratio. Squamous cell carcinomas were extensively infiltrated with MDSC, whereas dysplastic area and normal tongue mucosa had only sparse MDSC infiltration. The majority of MDSCs were located in the stroma, particularly along the tumor invasive front. Moreover, 4NQO-treated mice showed significantly higher ARG-1 mRNA levels in the tumor site (P<0.01).

CONCLUSIONMDSC may contribute to oral tumor progression and represents a potential target for immunotherapy of oral cancer.

4-Nitroquinoline-1-oxide ; Animals ; Arginase ; Cell Count ; Flow Cytometry ; Mice ; Models, Animal ; Myeloid-Derived Suppressor Cells ; immunology ; Real-Time Polymerase Chain Reaction ; T-Lymphocyte Subsets ; immunology ; Tongue Neoplasms ; immunology

Objective To investigate the result of local injection of growth differentiation factor-5 (GDF-5) and fibrin gel for treatment of lumbar disc injury in rabbits.Methods Lumbar puncture with a 20-gauge needle was performed at L3/4,L4/5,and L5/6 discs of 40 New Zealand white rabbits.After needle puncture,L3/4 discs were injected with GDF-5 and fibrin gel (compound group) ; L4/5 discs fibrin gel (fibrin gel group) ; L5/6 discs nothing (blank control group).Two weeks later,intervertebral disc degeneration in each group was observed via radiography,MRI and nucleus proteoglycan content detection and histological examination.Results At postoperative 2-,4-,8-,and 12-weeks,X-ray films revealed a gradual decrease in disc height index (DHI) among the three groups,but the decreasing velocity was lower in compound group than in other two groups (P ＜ 0.05).On MRI,the signal of intervebral discs among the three groups diminished progressively with time,but a relatively lower decreasing was observed in compound group (P ＜ 0.05).At postoperative 4-week,proteoglycan content of the nucleus pulposus was (6.3-± 0.4) in compound group,higher than (5.9-0.4) in blank control group and (5.8-± 0.3)in fibrin gel group (P ＜0.05).At postoperative 2-week,histological evaluation showed (5.28 ±0.41)points in compound group,lower than (7.54 ± 0.53) points in blank control group and (7.21 ± 0.44)points in fibrin gel group (P ＜ 0.05).Conclusion Local injection of GDF-5 and fibrin gel facilitates the restoration of the injured discs and delays further disc degeneration.