Objective:To explore the role of process management for continuous periheral insulin infusion (CPII) for controlling hyperglycemia during enteral nutrition (EN) for critically ill patients.Methods:A total of 75 patients who received continuous EN treatment in the emergency intensive care unit (EICU) of Qinghai Red Cross Hospital from January 2023 to January 2024 were selected in this historical controlled trial study. Patients who were admitted before the implementation of process management for CPII were included in the historical control group ( n=35), and those who were admitted after the implementation were included in the observation group ( n=40). Both groups were treated with continuous EN infusion combined with micropump-based insulin therapy, with the target blood glucose being<10 mmol/L. The blood glucose values at 4 hours and 8 hours after treatment, the time to reach the target blood glucose and the dosage of insulin, the total amount of insulin at 24 hours, the amount of calories administered when reaching the target blood glucose, the frequency of blood glucose measurement, the incidence of hypoglycemia and hypokalemia, the amount of potassium supplemented for hypokalemia, the length of EICU stay, and the incidence of nosocomial infection were compared between these two groups. Results:The blood glucose levels of the observation group at 4 hours and 8 hours after CPII were significantly lower than those of the control group (both P<0.001), and the time for the observation group to reach the target blood glucose level was significantly shorter than that for the control group ( P<0.001). The total amount of insulin in the observation group when reaching the target blood glucose and the total amount of insulin used within 24 hours were significantly smaller than those in the control group (both P<0.05). The amount of calories administered to the observation group when reaching the target blood glucose level was significantly higher than that of the control group ( P=0.002). The number of blood glucose measurements within 24 hours after insulin initiation in the observation group was significantly larger than that in the control group ( P=0.042), but there was no statistically significant difference in the total number of monitoring during EICU stay ( P=0.561). The incidence rates of hypoglycemia and hypokalemia and the amount of potassium supplemented for hypokalemia in the observation group were significantly lower than those in the control group (all P<0.05). There was no statistically significant difference in the length of EICU stay and the incidence of nosocomial infection between the two groups (both P>0.05). Conclusions:Process management for CPII in critically ill patients promotes rapid glycemic control during enteral nutrition (EN), reduces hypoglycemia, hypokalemia, and nosocomial infections, and improves overall blood glucose stability. It is vital for controlling stress hyperglycemia during EN in critical illness, with excellent safety.

Objective:To explore the association between sublingual microcirculatory perfusion vessel proportion (PPV), high mobility group protein B1 (HMGB1), and sepsis-induced coagulopathy (SIC), and to identify early predictive markers for clinical intervention.Methods:A total of 66 septic patients admitted to the Respiratory Intensive Care Unit (RICU) between November 2021 and May 2024 were enrolled. Based on SIC diagnosis within 24 hours of admission, patients were categorized into SIC ( n=36) and non-SIC ( n=30) groups. Clinical parameters, including prothrombin time (PT), activated partial thromboplastin time (APTT), sublingual PPV, and serum HMGB1 levels (measured at 0 h and 6 h), were analyzed. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors. Results:Compared with the non-SIC group, the SIC group demonstrated significantly prolonged PT ( P<0.05) and APTT ( P<0.05), elevated 0 h lactate levels, and increased 6 h HMGB1. Spearman analysis revealed a positive correlation between 6 h PPV and platelet count ( P<0.05), while an inverse correlation was observed with 6 h PT ( P<0.05). Multivariate regression identified APTT, 6 h PPV, and 6 h HMGB1 as independent predictors of SIC. ROC analysis yielded AUC values of 0.732 for APTT, 0.802 for 6 h PPV, and 0.765 for 6 h HMGB1. The combination of 6 h PPV and HMGB1 further improved predictive accuracy (AUC=0.873). Conclusions:Prolonged APTT, decreased 6 h PPV, and elevated 6h HMGB1 are key indicators of SIC. Integrated assessment of these markers enhances early risk stratification in septic patients, facilitating timely clinical intervention.

Objective:To explore the role of process management for continuous periheral insulin infusion (CPII) for controlling hyperglycemia during enteral nutrition (EN) for critically ill patients.Methods:A total of 75 patients who received continuous EN treatment in the emergency intensive care unit (EICU) of Qinghai Red Cross Hospital from January 2023 to January 2024 were selected in this historical controlled trial study. Patients who were admitted before the implementation of process management for CPII were included in the historical control group ( n=35), and those who were admitted after the implementation were included in the observation group ( n=40). Both groups were treated with continuous EN infusion combined with micropump-based insulin therapy, with the target blood glucose being<10 mmol/L. The blood glucose values at 4 hours and 8 hours after treatment, the time to reach the target blood glucose and the dosage of insulin, the total amount of insulin at 24 hours, the amount of calories administered when reaching the target blood glucose, the frequency of blood glucose measurement, the incidence of hypoglycemia and hypokalemia, the amount of potassium supplemented for hypokalemia, the length of EICU stay, and the incidence of nosocomial infection were compared between these two groups. Results:The blood glucose levels of the observation group at 4 hours and 8 hours after CPII were significantly lower than those of the control group (both P<0.001), and the time for the observation group to reach the target blood glucose level was significantly shorter than that for the control group ( P<0.001). The total amount of insulin in the observation group when reaching the target blood glucose and the total amount of insulin used within 24 hours were significantly smaller than those in the control group (both P<0.05). The amount of calories administered to the observation group when reaching the target blood glucose level was significantly higher than that of the control group ( P=0.002). The number of blood glucose measurements within 24 hours after insulin initiation in the observation group was significantly larger than that in the control group ( P=0.042), but there was no statistically significant difference in the total number of monitoring during EICU stay ( P=0.561). The incidence rates of hypoglycemia and hypokalemia and the amount of potassium supplemented for hypokalemia in the observation group were significantly lower than those in the control group (all P<0.05). There was no statistically significant difference in the length of EICU stay and the incidence of nosocomial infection between the two groups (both P>0.05). Conclusions:Process management for CPII in critically ill patients promotes rapid glycemic control during enteral nutrition (EN), reduces hypoglycemia, hypokalemia, and nosocomial infections, and improves overall blood glucose stability. It is vital for controlling stress hyperglycemia during EN in critical illness, with excellent safety.

Clinically, it is challenging to differentiate Crohn's disease (CD) from abdominal actinomycosis due to their similar symptoms. However, cases of CD with secondary actinomycosis infection are rare. This article systematically reviews the diagnosis and treatment process of a patient with CD complicated by secondary actinomycosis infection at the Air Force Medical University Xijing Digestive Disease Hospital, to provide ideas and experience for future clinical diagnosis and treatment.

Clinically, it is challenging to differentiate Crohn's disease (CD) from abdominal actinomycosis due to their similar symptoms. However, cases of CD with secondary actinomycosis infection are rare. This article systematically reviews the diagnosis and treatment process of a patient with CD complicated by secondary actinomycosis infection at the Air Force Medical University Xijing Digestive Disease Hospital, to provide ideas and experience for future clinical diagnosis and treatment.

The purpose of clinical medications is to treat the disease, reduce patients′ symptoms and improve their condition. However, in recent years, paradoxical reactions that cause the opposite or aggravate the disease during clinical medication are not uncommon, and the gastrointestinal tract is one of the common organs involved in such events. This article reviews the events and potential mechanisms of inflammatory bowel disease induced or aggravated by drugs, so that clinicians can better understand such contradictory events and choose more appropriate treatment options for patients.

The purpose of clinical medications is to treat the disease, reduce patients′ symptoms and improve their condition. However, in recent years, paradoxical reactions that cause the opposite or aggravate the disease during clinical medication are not uncommon, and the gastrointestinal tract is one of the common organs involved in such events. This article reviews the events and potential mechanisms of inflammatory bowel disease induced or aggravated by drugs, so that clinicians can better understand such contradictory events and choose more appropriate treatment options for patients.

Background and Objectives: Psoriasis is a chronic inflammatory skin disease, which the mechanisms behind its initiation and development are related to many factors. DMSCs (dermal mesenchymal stem cells) represent an important member of the skin microenvironment and play an important role in the surrounding environment and in neighbouring cells, but they are also affected by the microenvironment. We studied the glucose metabolism of DMSCs in psoriasis patients and a control group to reveal the relationship among glucose metabolism, cell proliferation activity，and VEC (vascular endothelial cell) differentiation in vitro, we demonstrated the biological activity and molecular mechanisms of DMSCs in psoriasis. Methods: and Results: We found that the OCR of DMSCs in psoriatic lesions was higher than that in the control group, and mRNA of GLUT1 and HK2 were up-regulated compared with the control group. The proliferative activity of DMSCs in psoriasis was reduced at an early stage, and mRNA involved in proliferation, JUNB and FOS were expressed at lower levels than those in the control group. The number of blood vessels in psoriatic lesions was significantly higher than that in the control group (p＜0.05), which the mRNA of VEC differentiation, CXCL12, CXCR7, HEYL and RGS5 tended to be increased in psoriatic lesions compared to the control group, in addition to Notch3. Conclusions We speculated that DMSCs affected local psoriatic blood vessels through glucose metabolism, and the differentiation of VECs, which resulted in the pathophysiological process of psoriasis.

Objective:To discuss the assessment value of color Doppler ultrasonography on patients with diabetic kidney disease (DKD) treated by hyperbaric oxygen (HBO) therapy.Methods:A total of 64 DKD patients confirmed in the Affiliated Hospital of Qingdao University from October 2019 to October 2020 were divided into control group ( n=32) and HBO group ( n=32) using the random number table. The control group was given comprehensive treatments (conventional hypoglycemic and antihypertensive treatment, low-fat, low-salt, and low-sugar diet, and physical exercise), and the HBO group was given HBO based on the treatment in the control group. Color Doppler ultrasound examination was performed on each patient before and after treatment, and renal hemodynamic indicators such as peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) were recorded. After treatment, receiver operating characteristic (ROC) curves related to therapeutic effect were made based on the indicators of RI, PI, EDV, and PSV. Results:After treatment, the 24-hour urinary albumin excretion rate (UAER), blood urea nitrogen (BUN), EDV, PSV, RI, and PI in the control group and the HBO group were all improved compared with those before treatment, and all the above indicators in HBO group had greater improvement than those in the control group, with a statistically significant differences ( P<0.05). After treatment, the total effective rate of the HBO group (96.88%) was higher than that of the control group (75.01%), with a statistically significant difference ( P<0.05). According to the calculation, RI, PI, and EDV had some value for evaluating the efficacy of HBO on DKD patients, specifically, when the area under ROC of RI was 0.866, the cutoff value was 0.76, the sensitivity was 72.73%, and the specificity was 91.38%. Conclusion:The comprehensive treatments combined with HBO have a good effect on DKD. With the non-invasive and real-time advantages, color Doppler ultrasound can be adopted to monitor RI for assessing the efficacy of DKD treatment. When the RI cutoff value reaches 0.76, it has some value for evaluating the curative effect of DKD treatment.

Objective:To discuss the assessment value of color Doppler ultrasonography on patients with diabetic kidney disease (DKD) treated by hyperbaric oxygen (HBO) therapy.Methods:A total of 64 DKD patients confirmed in the Affiliated Hospital of Qingdao University from October 2019 to October 2020 were divided into control group ( n=32) and HBO group ( n=32) using the random number table. The control group was given comprehensive treatments (conventional hypoglycemic and antihypertensive treatment, low-fat, low-salt, and low-sugar diet, and physical exercise), and the HBO group was given HBO based on the treatment in the control group. Color Doppler ultrasound examination was performed on each patient before and after treatment, and renal hemodynamic indicators such as peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) were recorded. After treatment, receiver operating characteristic (ROC) curves related to therapeutic effect were made based on the indicators of RI, PI, EDV, and PSV. Results:After treatment, the 24-hour urinary albumin excretion rate (UAER), blood urea nitrogen (BUN), EDV, PSV, RI, and PI in the control group and the HBO group were all improved compared with those before treatment, and all the above indicators in HBO group had greater improvement than those in the control group, with a statistically significant differences ( P<0.05). After treatment, the total effective rate of the HBO group (96.88%) was higher than that of the control group (75.01%), with a statistically significant difference ( P<0.05). According to the calculation, RI, PI, and EDV had some value for evaluating the efficacy of HBO on DKD patients, specifically, when the area under ROC of RI was 0.866, the cutoff value was 0.76, the sensitivity was 72.73%, and the specificity was 91.38%. Conclusion:The comprehensive treatments combined with HBO have a good effect on DKD. With the non-invasive and real-time advantages, color Doppler ultrasound can be adopted to monitor RI for assessing the efficacy of DKD treatment. When the RI cutoff value reaches 0.76, it has some value for evaluating the curative effect of DKD treatment.