Uremic pruritus (UP) is a common complication in patients with end-stage renal disease, which seriously reduces the quality of life of patients. Compared with the internal treatment of TCM, the external treatment of TCM for UP is simpler and more effective, and can avoid the first pass effect caused by oral drugs and may cause liver and kidney damage. The treatment methods mainly include external washing of TCM, medicated bath, fumigation, wet compress, enema, scraping, acupuncture, auricular point sticking, acupoint application, acupoint iontophoresis, autologous blood acupoint injection and so on. At present, most studies are based on the conventional treatment of Western medicine, and the addition of external treatment of TCM can improve the efficacy, and has certain advantages in improving itching symptoms, inflammatory indicators, sleep quality, anxiety and depression. Some studies have selected parathyroid hormone, blood phosphorus, CRP, IL-6, histamine, SCr, BUN, β2-microglobulin and other indicators to evaluate the efficacy. The results suggest that external treatment of TCM can improve the micro-inflammatory state of patients and protect renal function, but further mechanism research is needed. The existing research has the following problems: the clinical efficacy evaluation scale is not uniform, and it is difficult to compare and summarize horizontally; the relief of pruritus symptoms is based on the scale evaluation, which is subjective; the course of treatment is short, and the long-term efficacy and safety can not be evaluated; some studies do not specify the patients' syndrome type, which is difficult to reflect the advantages of TCM syndrome differentiation and treatment, and needed to be improved in the future.

Diabetic foot(DF),a primary chronic complication of diabetes mellitus,contributes to a major disability and mortality in diabetic patients.DF is diagnosed mainly depending not only on clinical manifestations,signs,and related inspection,but also on recently emerging diagnostic means:biological markers.Inflammatory biomarkers are preferably used for its superiority in DF early diagnosis.In recently years,thanks to advancements of biological technologies,biomarkers such as procalcitonin(PCT),C-reactive protein(CRP),interleukins(ILs),and tumor necrosis factor-alpha(TNF-α)have been comprehensively used in DF diagnosis.Moreover,biomarkers of genomics,proteomics,metabolomics,and metagenomics have been employed as well.In this review,we aim to com-prehensively review the role of serum biomarkers in DF diagnosis and risk stratification,elaborating on the current research status in applying serum biomarkers for DF prevention,diagnosis,and prognosis assessment.

Objective: To compare bioelectrical impedance analysis (BIA) and dual energy X ray absorptiometry (DXA) for measuring body mineral content (BMC) of children and adolescents, and to provide a basis for BIA to accurately measure BMC in children and adolescents. Methods: By using the convenience sampling method, among 1 469 children and adolescents aged 7-17 were recruited in Guangzhou from April to May 2019, the BMC was measured by DXA and BIA. The intraclass correlation coefficient ( ICC ) and Bland Altman analysis were used to evaluate the agreement between BIA and DXA. Bland Altman analysis was performed on log transformed data. The BMC was categorized into age and specific tertiles, and the agreement between methods was evaluated based on the kappa coefficients. Treating the BMC with DXA as the dependent variable, a prediction model was constructed for correcting the BIA measure. Results: The ICC s were 0.93 and 0.94 for boys and girls, respectively. In Bland Altman analysis, the limits of agreements for the BIA to DXA ratio were wide in boys and girls, ranging from 0.27-0.76 and 0.17-0.72, respectively. The kappa coefficients for categorized BMC levels were 0.57 and 0.45 for boys and girls, respectively, showing a fair to good degree of agreement. When sub grouped by BMI, the kappa coefficients for all BMI groups of boys and overweight girls were all >0.75 , with an excellent agreement. The prediction models for boys and girls were as follows: BMC DXA =-0.51+0.44× BMC BIA + 0.06× Age +0.02× BMI ; and BMC DXA =-0.55+0.43× BMC BIA +0.06× Age +0.02× BMI , respectively. The R 2 for models of boys and girls were 0.87 and 0.87, respectively. Conclusion The agreement between BIA and DXA was poor for measuring BMC, but acceptable when evaluating the categorized BMC levels, suggesting the BIA may be applied in assessment of the BMC levels when compared to the age and gender specific population. Additionally, the prediction model for correcting BMC by BIA fis well to the measurement by DXA.

Objective:To investigate the changes of biomarkers in peritoneal dialysis patients' peritoneal drainage fluid and their relationship with the peritoneal small molecule solute transport rate (PSTR).Methods:Seventy newly-tubed peritoneal dialysis patients from the Peritoneal Dialysis Center of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from September 29, 2014 to April 26, 2018 were selected. The levels of biomarkers plasminogen activator inhibitor-1 (PAI-1), matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) in the peritoneal dialysis priming fluid were measured at different time points and 4 h dialysate/blood muscle (D/P) creatinine values at 2 years of follow-up, and the correlation between biomarkers in the extracted peritoneal fluid and 4 h D/P creatinine was examined.Results:Longitudinal studies showed an increase in PAI-1 ( P<0.001) and VEGF ( P=0.04) with increasing duration of peritoneal dialysis. PSTR levels at baseline and after 2 years of follow-up were significantly correlated with PAI-1, MMP-2, and VEGF levels at baseline. PSTR at 2 years was also correlated with MMP-2 levels at 6 months and PAI-1 levels at baseline. Conclusions:The biomarkers PAI-1, MMP-2, and VEGF in peritoneal dialysis drainage fluid are positively correlated with PSTR in peritoneal dialysis patients during the 2-year period.

Objective:To analyze the current status of body composition and development patterns of children and adolescents aged 6-17 years in Guangzhou.Methods:This was a cross-sectional study involving 8 169 school students from 3 elementary schools and 3 middle schools in Guangzhou from March to December 2019.The fat-free mass (FFM) and fat mass (FM) were measured by the bioelectrical impedance analysis.The fat-free mass index (FFMI) and fat mass index (FMI) were calculated via the height standardization. T test was used to compare quantitative variables between groups.The growth pattern of body composition was described using the Hattori chart. Results:A total of 4 431 boys (54.24%) and 3 738 girls (45.76%) were involved in this study.FFM and FM both increased with age between boys and girls.Except for boys aged 11 years, FFM in boys were significantly higher than that in girls with the same age (all P<0.05). In the age of 7-10 years, FM in boys were significantly higher than that in girls with the same age, while it was significantly higher in girls aged 12 years and older than that of boys at the same age (all P<0.05). The Hattori chart showed that the difference in body composition between genders occurred after 11 years old.In contrast to girls, increases in the weight and body mass index (BMI) in boys were mainly attributed to the FFM development. Conclusions:The development of FFM and FM in children and adolescents varies with age, accompanied with the gender-specific features.FFM in boys is higher than that of girls at the same age.The weight gain in boys is mainly attributed to the development of fat-free tissues, and thus the utility of BMI may lead to the overestimation of obesity.

Objective:Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence.Methods:Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS.Results:A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ 2=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ 2=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ 2=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ 2=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ 2=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ 2=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ 2=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions:For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

Objective:Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence.Methods:Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS.Results:A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ 2=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ 2=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ 2=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ 2=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ 2=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ 2=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ 2=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions:For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

Objective To study the influence of combined spinal-epidural anesthesia on perioperative coagulation function,RAAS activity and postoperative analgesia effect in parturients with cesarean section.Methods One hundred and eighteen parturients of cesarean section in our hospital from June 2013 to January 2016 were collected and divided into the observation group and control group according to the random number table method,59 cases in each group.The observation group received the combined spinal-epidural anesthesia and the control group received epidural anesthesia.The coagulation function indicators on preoperative 1 d (T0),at 10 min before operation end(T1) and postoperative 6 h (T2) were detected by adopting the automatic blood coagulation analyzer,the renin angiotensin aldosterone system (RAAS) function indices were detectd by radioimmunoassay.The pain indicators at postoperative 6 h(T2),12 h (T3) were detected by the pain threshold test instrument.Results The levels of prothrombin time(PT),activated partial thromboplastin time (APTT) and thrombin time (TT) at T1 and T2 in the observation group were significantly higher than those in the control group,while the PTA level was lower than that in the control group(P<0.05);serum RAAS indices such as (renin),angiotensin Ⅱ(ANG II) aldosterone(ALD) in the observation group were lower than those in the control group(P<0.05).The VAS score at T2,T3 in the observation group was lower than that in the control group,while the pain threshold and pain tolerance threshold levels in the observation group were higher than those in the control group(P<0.05).Conclusion Combined spinal-epidural anesthesia can reduce the blood coagulation and RAAS activation caused by cesarean section trauma,and the effect of postoperative analgesia is more significant.

Objective To determine the EC50 of dexmedetomidine hydrochloride ( DEX) which causes disappearance of explicit memory by process dissociation procedure (PDP). Methods Forty patients those who had senior middle school or higher educational background undergoing lower extremity surgery with grade ASA Ⅰ or Ⅱ, without hearing impairment, dysphasia,nervous system disorders,and having no drugs in the treatment of the central nervous system were included.PDP was applied to establish study table and record, and calculate performance of explicit memory and implicit memory. Memory performance was statistically compared with 0, 0 memory was considered to be statistically significant and disappearance, respectively.Sequential method was used for determination.According to explicit memory disappearance or not,target concentration of the next patient was adjusted (increase or decrease).DEX target concentration of the first patient was set to 4 ng?mL-1,and the ratio of target concentration between the adjacent patients was 1.2.If the explicit memory of the former patient disappeared,the target concentration of the next patient was decreased by 1 concentration gradient;if the explicit memory of the former patient did not disappear,the target concentration of the next patient was increased by 1 concentration gradient, and so forth. All the 40 patients were determined.The median effective dose (D1) and 95% confidence interval (CI) of DEX were calculated. Results The ED50 of DEX causing explicit memory disappearance was 5.23 ng?mL-1,and the 95% CI was 4.07-6.39 ng?mL-1. Conclusion In clinical,target concentration of dexmedetomidine hydrochloride 5.23 ng?mL-1 levels for sedation,can cause half of patients’ explicit memory disappear,so as to avoid intraoperative awareness.

Objective To investigate the risk factors of mental disorders of patients treated in intensive care unit(ICU).Methods Collected from January 2013 to December 2014 ICU stay eligible cases,and analyzed the past history (hypertension,intemperance),previous surgery,mechanical ventilation,date of ICU admission,quality of care, APACHE II score,electrolyte disorder,LVEF,sleep disturbance,PCT,oxygenation index,drug use situation (midazo-lam,opioids)and the clinical care unit the incidence of mental disorders in relationship.Results 568 patients (male 345 cases,female 223 cases),mental disorders group of 157 patients,the clinical incidence rate of 27.6% overall;568 patients were in the sex ratio of 1.55:1,mental disorders group of 157 patients(96 males,61 females),male to female ratio 1.57:1,mean age was (65.5 ±11.2)years;no mental disorders group (249 males,162 females),male to female ratio 1.30:1,mean age was (48.8 ±14.3)years.Logistic regression analysis revealed that coronary heart disease,hypotension,alcohol abuse,surgery,mechanical ventilation,ICU admission time,quality of care,APACHE II score,electrolyte imbalance,ejection fraction,sleep disorders,procalcitonin,oxygenation index,use of midazolam or opioids were among the risk factors of ICU mental disorders.Mechanical ventilation,quality of care,hypotension,alco-hol abuse,and use of midazolam were independent risk factors for ICU mental disorders (all P <0.05).Conclusion ICU inpatients with past history of hypertension and intemperance,use of mechanical ventilation and midazolam should be closely monitored and evaluated,early psycho -psychiatric screening,and take effective measures in time;high -quality care can reduce the incidence of mental disorders in ICU patients significantly.