INTRODUCTION: The primary objective of this guideline is to establish evidence-based recommendations for the clinical use of parenteral nutrition (PN) in adult patients within the acute hospital setting in Singapore. METHOD: An expert workgroup, consisting of healthcare practitioners actively involved in clinical nutrition support across all public health institutions, systematically evaluated existing evidence and addressed clinical questions relating to PN therapy. RESULTS: This clinical practice guideline developed 30 recommendations for PN therapy, which cover these key aspects related to PN use: indications, patient assess-ment, titration and formulation of PN bags, access routes and devices, and monitoring and management of PN-related complications. CONCLUSION This guideline provides recommendations to ensure appropriate and safe clinical practice of PN therapy in adult patients within the acute hospital setting.
Humans ; Singapore ; Parenteral Nutrition/adverse effects* ; Adult

Background Previous studies found that high temperature and heatwave increase the risk of traffic injuries. The complex road conditions in Yunnan Province result in frequent traffic accidents. However, there is limited evidence on the correlation between heatwave and traffic injuries in Yunnan Province. Objective To assess the association between heatwave events and traffic injuries, to estimate its disease burden, and to identify relevant sensitive groups. Methods We collected data on traffic injury cases and concurrent meteorological information from four surveillance sites in Yunnan Province, China: Dali, Lufeng, Zhaoyang, and Qilin from May to September each year from 2015 to 2023. Traffic injury cases refer to patients who visited the outpatient or emergency departments of local surveillance hospitals for the first time due to traffic injuries. Meteorological data were derived from the fifth generation atmosphericreanalysis dataset of the global climate provided by the European Centre for Medium-Range Weather Forecasts. A time-stratified case-crossover design combined with distributed lag non-linear model was used to analyze the association between short-term exposure to heatwave and traffic injuries. We also conducted subgroup analyses by sex, age, occupation, injury cause, activity at the time of injury occurrence, and severity of injury. Results A total of 34764 traffic injury surveillance cases were included in the analysis. The risk of traffic injuries occurred during heatwave was 1.13 times (95%CI: 1.07, 1.20) greater than those occurred during non-heatwave, and 2.64% (95%CI: 1.49%, 3.73%) of traffic injuries were attributed to heatwave exposure throughout the study period. The results of stratified analysis showed greater impacts of heatwave on the risk of traffic injuries in female [odds ratio (OR)=1.17, attributable fraction (AF)=3.23%], people aged 15-64 years (OR=1.13, AF=2.68%), farmers/workers (OR=1.22, AF=4.07%), people with non-motor vehicle traffic injuries (OR=1.17, AF=3.24%), people who were driving or riding when injuries occurred (OR=1.12, AF=2.43%), and people with minor injuries (OR=1.18, AF=3.49%) ( P<0.05). Longer duration [excess risk (ER)=0.99%] and greater intensity (ER=4.12%) of heatwave had greater impacts on the risk of traffic injuries (P<0.05). Conclusion Heatwave events are associated with an increased risk of traffic injuries. Female, people aged 15-64, farmers/workers, people with non-motor vehicle traffic injuries, those injured while driving/riding a vehicle, and people with minor injuries are particularly vulnerable. The findings suggest that targeted mitigation and adaptation measures should be taken to address the risk of traffic injuries associated with extreme climate events.

Through the dismantlement,analysis,and sorting of the method of clearing collaterals and nourishing yin in the differentiation of syndromes in Wenbing Tiaobian written by WU Tang,a renowned physician of the Qing Dynasty.This article concluded that WU Tang's clinical application of clearing collaterals can be divided into clearing the qi collateral heat,clearing the blood collateral stasis,and clearing collateral stagnant heat.The yin-nourishing method specifically includes the sweet-cold fluid-restoring,sour-sweet yin-generating,sweet-bitter yin qi-nourishing,sweet-moistening fluid-preserving,heat-clearing fluid-protecting,and emergency purgative yin-preserving methods.Our team explored the application of this approach in tumor treatment based on the academic perspective of"strengthening healthy qi to treat cancer"and in combination with the"clearing collaterals and nourishing yin"method.It proposes that within the relationship between"strengthening healthy qi to treat cancer"and the"clearing collaterals and nourishing yin"method,"nourishing yin to strengthen healthy qi"often serves as the foundation of tumor treatment,whereas"clearing collaterals to eliminate pathogens"acts as an auxiliary measure.This paper summarizes our team's clinical experience and evidence in further treating cancerous diseases based on this theory,citing examples such as Qinghao Biejia Decoction,Xijiao Dihuang Decoction,Zhibai Dihuang Pill,our team's empirical formulas,and the specialized use of medications for cancerous diseases.The further application of this method in cancer diseases can be expanded to improve the clinical effect by summarizing the theory of"strengthening healthy qi to treat cancer"and improving the understanding of clearing collaterals and nourishing yin.

Through the dismantlement,analysis,and sorting of the method of clearing collaterals and nourishing yin in the differentiation of syndromes in Wenbing Tiaobian written by WU Tang,a renowned physician of the Qing Dynasty.This article concluded that WU Tang's clinical application of clearing collaterals can be divided into clearing the qi collateral heat,clearing the blood collateral stasis,and clearing collateral stagnant heat.The yin-nourishing method specifically includes the sweet-cold fluid-restoring,sour-sweet yin-generating,sweet-bitter yin qi-nourishing,sweet-moistening fluid-preserving,heat-clearing fluid-protecting,and emergency purgative yin-preserving methods.Our team explored the application of this approach in tumor treatment based on the academic perspective of"strengthening healthy qi to treat cancer"and in combination with the"clearing collaterals and nourishing yin"method.It proposes that within the relationship between"strengthening healthy qi to treat cancer"and the"clearing collaterals and nourishing yin"method,"nourishing yin to strengthen healthy qi"often serves as the foundation of tumor treatment,whereas"clearing collaterals to eliminate pathogens"acts as an auxiliary measure.This paper summarizes our team's clinical experience and evidence in further treating cancerous diseases based on this theory,citing examples such as Qinghao Biejia Decoction,Xijiao Dihuang Decoction,Zhibai Dihuang Pill,our team's empirical formulas,and the specialized use of medications for cancerous diseases.The further application of this method in cancer diseases can be expanded to improve the clinical effect by summarizing the theory of"strengthening healthy qi to treat cancer"and improving the understanding of clearing collaterals and nourishing yin.

Objective:To investigate the effectiveness and prognosis of using improved domestic neonatal ureteral stents (referred to as improved double-J stents) for thoraco-amniotic shunting (TAS) in treating fetal chylothorax.Methods:A retrospective analysis was conducted on the clinical data of 21 cases of fetal chylothorax treated with TAS using improved double-J stents at Nanjing Drum Tower Hospital, Nanjing University Medical School from April 1, 2018, to September 30, 2023. Surgical complications and perinatal outcomes were summarized, and the development of surviving infants in five domains (communication, gross motor, fine motor, problem-solving, and personal-social) was assessed using the Ages and Stages Questionnaires-Third Edition (ASQ-3). Descriptive statistical analysis was used. Results:(1) The median gestational age at prenatal diagnosis was 28.7 weeks (27.3-30.4 weeks), with 85.7% (18/21) of cases complicated by fetal hydrops, 90.5% (19/21) by polyhydramnios, and 85.7% (18/21) by bilateral pleural effusion. (2) The median gestational age at the first TAS was 30.9 weeks (29.7-32.7 weeks). Of the 21 cases, 10 required repeat stent placement due to dislodgement or blockage, with a total of 49 stent placements. The dislodgement rate within 7 days was 24.5% (12/49), and the blockage rate was 16.3% (8/49). The rate of premature rupture of membranes within one week post-stent placement was 9.5% (2/21), with an overall preterm premature rupture of membranes rate of 28.6% (6/21). The median interval from the first TAS to delivery was 30.0 d (19.8-40.0 d). Of the 21 cases, three opted for selective termination of pregnancy; the remaining 18 cases resulted in live births, with a median gestational age at delivery of 35.6 weeks (34.1-37.1 weeks), and three neonatal deaths. The overall neonatal survival rate was 15/18. Surviving infants were followed up to a median age of 30 months (7-48 months), with 13 showing normal development and two scoring below the ASQ-3 threshold.Conclusion:The improved double-J stent can be used for TAS in the treatment of fetal chylothorax, with generally favorable outcomes.

Objective The aim of this study was to analyze the incidence and mortality of gastric cancer in tumor registration areas of Yunnan province in 2020,as well as the changing trends from 2012 to 2020,and provide suggestion for the prevention and treatment of gastric cancer in Yunnan province.Methods The incidence and death cases of gastric cancer in tumor registration areas of Yunnan province from 2012 to 2020 were collected and complied.After the quality control,the data was included in 89 monitoring points in 2020.Excel 2016 and SPSS 18.0 software were used to calculate the crude incidence,crude mortality,age-standardized inci-dence rate by World standard population(ASIRW),age-standardized mortality rate by World standard population(ASMRW),cumula-tive rate and other indicators of gastric cancer in Yunnan province in 2020.Joinpoint 4.8.0.1 software was used to calculate the annu-al percentage change(APC)and 95%CI of the ASIRW and ASMRW of gastric cancer from 2012 to 2020,and analyze the trend of change.Results In 2020,the crude incidence and ASIRW of gastric cancer in Yunnan province were 11.59/100,000 and 7.60/100,000,respectively.Males(14.90/100,000 and 10.25/100,000)were higher than those in females(8.10/100,000 and 5.04/100,000).In 2020,the crude mortality and ASMRW of gastric cancer in the Yunnan in 2020 were 9.06/100,000 and 5.82/100,000,respectively.Males(11.51/100,000 and 7.89/100,000)were higher than those in females(6.48/100,000 and 3.82/100,000).The crude incidence and mortality of gastric cancer in Yunnan province increased with age.They were at a low level before the age of 45 years old,and then increased rapidly.The 80-84 age group reached the peak(64.12/100,000 and 72.67/100,000),respectively.The APC for ASIRW and ASMRW of gastric cancer in Yunnan province from 2012 to 2020 were-0.35%and 0.22%,re-spectively,there were no significant difference in the trend of change(P>0.05).Conclusion ASIRW and ASMRW of gastric cancer of Yunnan province in 2020 are higher for men than women.The trend of ASIRW and ASMRW maintained stable from 2012 to 2020,and the males and middle-aged elderly people over 45 years old in Yunnan province are the key population for gastric cancer preven-tion and control.

Objective The aim of this study was to analyze the incidence and mortality of gastric cancer in tumor registration areas of Yunnan province in 2020,as well as the changing trends from 2012 to 2020,and provide suggestion for the prevention and treatment of gastric cancer in Yunnan province.Methods The incidence and death cases of gastric cancer in tumor registration areas of Yunnan province from 2012 to 2020 were collected and complied.After the quality control,the data was included in 89 monitoring points in 2020.Excel 2016 and SPSS 18.0 software were used to calculate the crude incidence,crude mortality,age-standardized inci-dence rate by World standard population(ASIRW),age-standardized mortality rate by World standard population(ASMRW),cumula-tive rate and other indicators of gastric cancer in Yunnan province in 2020.Joinpoint 4.8.0.1 software was used to calculate the annu-al percentage change(APC)and 95%CI of the ASIRW and ASMRW of gastric cancer from 2012 to 2020,and analyze the trend of change.Results In 2020,the crude incidence and ASIRW of gastric cancer in Yunnan province were 11.59/100,000 and 7.60/100,000,respectively.Males(14.90/100,000 and 10.25/100,000)were higher than those in females(8.10/100,000 and 5.04/100,000).In 2020,the crude mortality and ASMRW of gastric cancer in the Yunnan in 2020 were 9.06/100,000 and 5.82/100,000,respectively.Males(11.51/100,000 and 7.89/100,000)were higher than those in females(6.48/100,000 and 3.82/100,000).The crude incidence and mortality of gastric cancer in Yunnan province increased with age.They were at a low level before the age of 45 years old,and then increased rapidly.The 80-84 age group reached the peak(64.12/100,000 and 72.67/100,000),respectively.The APC for ASIRW and ASMRW of gastric cancer in Yunnan province from 2012 to 2020 were-0.35%and 0.22%,re-spectively,there were no significant difference in the trend of change(P>0.05).Conclusion ASIRW and ASMRW of gastric cancer of Yunnan province in 2020 are higher for men than women.The trend of ASIRW and ASMRW maintained stable from 2012 to 2020,and the males and middle-aged elderly people over 45 years old in Yunnan province are the key population for gastric cancer preven-tion and control.

Objective:To systematically assess the efficacy and safety of acupuncture therapy for essential hypertension.Methods:A computerized literature search of the Chinese National Knowledge Infrastructure(CNKI),Chongqing VIP Database(CQVIP),Wanfang Academic Journal Full-text Database(Wanfang),China Biology Medicine Disc(CBM),PubMed,Excerpta Medica Database(EMBASE),and Cochrane Library was conducted to retrieve randomized controlled clinical trials on acupuncture as the main intervention for the treatment of essential hypertension published from the inception of the database to 30 January 2021.The risk-of-bias assessment was carried out for each included study according to the Cochrane Handbook.Data analysis was performed using Review Manager 5.4.1 and Stata 15.0.Results:After the screening,46 randomized controlled trials involving a total of 3 859 subjects were included.Primary outcomes included changes in the diastolic blood pressure after intervention[eight studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group[mean difference(MD)=1.45,95%confidence interval(CI)(0.48,2.43),P=0.004,fixed effects model;I2=39%]and changes in the systolic blood pressure after intervention{11 studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group[MD=8.60,95%CI(7.12,10.07),P<0.00001,fixed effects model;I2=26%]}.The secondary outcome was antihypertensive efficacy,12 studies of acupuncture monotherapy group[risk ratio(RR)=1.20,95%CI(1.12,1.28),P<0.00001,fixed effects model;I2=36%]and 15 studies of acupuncture combined with antihypertensive drug group[RR=1.27,95%CI(1.20,1.34),P<0.00001,fixed effects model;I2=6%]showed better results than the antihypertensive drug monotherapy group in antihypertensive efficacy.In terms of the adverse events,four studies showed that the acupuncture monotherapy group had fewer adverse events than the antihypertensive drug monotherapy group[RR=0.10,95%CI(0.04,0.25),P<0.00001,fixed effects model;I2=0%].Conclusion:Acupuncture combined with antihypertensive drugs is superior to antihypertensive drugs alone in reducing blood pressure,and acupuncture therapy is effective and safe for the treatment of essential hypertension with fewer side effects.However,there is still a lack of high-quality multicenter randomized double-blinded controlled trials in this field.Rigorous large-sample clinical trials are needed to validate these findings.

Objective: To investigate the proteomic characteristics of overweight/obesity and related abnormal glucose and lipid metabolism caused by phlegm-dampness retention to identify related biomarkers. Methods: Seventy-one subjects were enrolled in the study. We assessed blood glucose, blood lipids, body mass index (BMI), and phlegm-dampness pattern, which was confirmed by a traditional Chinese med-icine clinician. Of the participants, we included healthy participants with normal weight (NW, n =23), overweight/obese participants with normal metabolism (ONM, n = 19), overweight/obese participants with pre-diabetes (OPD, n = 12), and overweight/obese participants with marginally-elevated blood lipids (OML, n = 17). Among them, the ONM, OPD, and OML groups were diagnosed with phlegm-dampness pattern. The data-independent acquisition (DIA) method was first used to analyze the plasma protein expression of each group, and the relevant differential proteins of each group were screened. The co-expressed proteins were evaluated by Venn analysis. The pathway analyses of the differential proteins were analyzed using Ingenuity Pathway Analysis (IPA) software. Parallel reaction monitoring (PRM) was used to verify the differential and common proteins in each group. Results: After comparing ONM, OPD, and OML groups with NW group, we identified the differentially expressed proteins (DEPs). Next, we determined the DEPs among OPD, OML, and ONM groups. Using Venn analysis of the DEPs in each group, 24 co-expressed proteins were screened. Two co-expressed proteins were verified by PRM. IPA analysis showed that pathways including LXR/RXR activation, acute phase response signaling, and FXR/RXR activation were common to all three groups of phlegm-damp overweight/obesity participants. However, the activation or inhibition of these pathways was different among the three groups. Conclusion: Participants with overweight/obesity have similar proteomic characteristics, though each type shows specific proteomic characteristics. Two co-expressed proteins, VTN and ORM1, are potential biomarkers for glucose and lipid metabolism diseases with overweight/obesity caused by phlegm-dampness retention.

Objective: To observe the clinical effect and syndrome scores improvements of herbal cake-partitioned moxibustion (HPM) and ginger-partitioned moxibustion (GPM) in treating ulcerative colitis (UC). Methods:A total of 65 eligible cases were randomly divided into a HPM group (n=32) and a GPM group (n=33) according to their visiting order. Bilateral Tianshu (ST 25) and Dachangshu (BL 25) were selected for the HPM or the GPM treatment once daily, 12 d as a treatment course with a 3-day interval, 6 courses in all. The clinical effect, syndrome scale and Mayo scale were evaluated and compared between the two groups. Results:Of the 65 cases enrolled, 2 cases dropped out in the HPM group and 3 cases dropped out in the GPM group, 30 cases of each group finished the treatment courses. The total effective rate is 93.3% in HPM group and 86.7% in the GPM group, there was no statistically significant difference in the total effective rate between the two groups (P>0.05); there were statistically significant differences between the two groups in score evaluation of lasting time of abdominal pain and frequency of diarrhea, HPM is prior to GPM (P=0.032,P=0.044). There are no statistical significant differences between the two groups in scores evaluation of general symptom, three main symptoms, quality of life (QOL), frequency and severity of abdominal pain, times, and pattern of diarrhea (allP>0.05). There was a statistical significant difference in the improvement of Mayo score between the two groups, and HPM was superior to GPM (P=0.048). Conclusion:HPM and GPM are both promising ways to treat UC, and the total effect is quite similar. HPM is superior to GPM in the improvement of lasting time of abdominal pain and frequency of diarrhea, and also the Mayo score.