OBJECTIVE: To evaluate the safety and clinical therapeutic effect of in-line mechanical in-exsufflation to assist sputum clearance in patients with invasive mechanical ventilation. METHODS: A prospective observational study was conducted at the department of critical care medicine, the First Affiliated Hospital of Sun Yat-sen University from April 2022 to May 2023. Patients who were invasively ventilated and treated with in-line mechanical in-exsufflation to assist sputum clearance were enrolled. Baseline data were collected. Sputum viscosity, oxygenation index, parameters of ventilatory function and respiratory mechanics, clinical pulmonary infection score (CPIS) and vital signs before and after day 1, 2, 3, 5, 7 of use of the in-line mechanical in-exsufflation were assessed and recorded. Statistical analyses were performed by using generalized estimating equation (GEE). RESULTS: A total of 13 invasively ventilated patients using in-line mechanical in-exsufflation were included, all of whom were male and had respiratory failure, with the main cause being cervical spinal cord injury/high-level paraplegia (38.46%). Before the use of the in-line mechanical in-exsufflation, the proportion of patients with sputum viscosity of grade III was 38.46% (5/13) and decreased to 22.22% (2/9) 7 days after treatment with in-line mechanical in-exsufflation. With the prolonged use of the in-line mechanical in-exsufflation, the patients' CPIS scores tended to decrease significantly, with a mean decrease of 0.5 points per day (P < 0.01). Oxygenation improved significantly, with the oxygenation index (PaO₂/FiO₂) increasing by a mean of 23.3 mmHg (1 mmHg ≈ 0.133 kPa) per day and the arterial partial pressure of oxygen increasing by a mean of 12.6 mmHg per day (both P < 0.01). Compared to baseline, the respiratory mechanics of the patients improved significantly 7 days after in-line mechanical in-exsufflation use, with a significant increase in the compliance of respiratory system (Cst) [mL/cmH₂O (1 cmH₂O ≈ 0.098 kPa): 55.6 (50.0, 58.0) vs. 40.9 (37.5, 50.0), P < 0.01], and both the airway resistance and driving pressure (DP) were significantly decreased [airway resistance (cmH₂O×L^-1×s^-1): 9.6 (6.9, 10.5) vs. 12.0 (10.0, 13.0), DP (cmH₂O): 9.0 (9.0, 12.0) vs. 11.0 (10.0, 15.0), both P < 0.01]. At the same time, no new lung collapse was observed during the treatment period. No significant discomfort was reported by patients, and there were no substantial changes in heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure before and after the in-line mechanical in-exsufflation treatment. CONCLUSIONS The combined use of the in-line mechanical in-exsufflation to assist sputum clearance in patients on invasive mechanical ventilation can effectively improve sputum characteristics, oxygenation and respiratory mechanics. The in-line mechanical in-exsufflation was well tolerated by the patients, with no treatment-related adverse events, which demonstrated its effectiveness and safety.
Humans ; Prospective Studies ; Respiration, Artificial/methods* ; Respiratory Insufficiency/therapy* ; Sputum

Objective:To identify the serotype and genotype characteristics of the first cluster infection of Brucella in Nujiang Lisu Autonomous Prefecture of Yunnan Province. Methods:The information of seven suspected cluster brucellosis cases reported in Lanping County, Nujiang Lisu Autonomous Prefecture in April 2023 were collected, blood samples were collected, and the strains were isolated and cultured. Serological methods were employed for brucellosis diagnosis, bacterial species identification was performed using BCSP31-PCR and AMOS-PCR. Multilocus locus variable-number tandem repeat analysis (MLVA) was conducted for strain genotyping, followed by phylogenetic analysis comparing the strains with those from other regions of China.Results:All seven cases were diagnosed with brucellosis, they were all villagers from the same village and had daily contact with sheeps. Four suspected Brucella strains were isolated, identified as Brucella melitensis biotype by BCSP31-PCR and AMOS-PCR. The four isolated strains exhibited identical MLVA-16 genotype, with MLVA-8 genotype 42 and MLVA-11 genotype 180, belonging to the Eastern Mediterranean lineage. Compared with the MLVA-16 of the isolated strains from other regions of China, the four isolated strains formed an independent cluster. Conclusion:The first cluster infection of Brucella in Nujiang Lisu Autonomous Prefecture of Yunnan Province is caused by Brucella melitensis biotype, and the four isolated strains have showed unique MLVA genotype.

Schizophrenia,a severe mental illness characterized by high disability and chronicity,imposes a heavy disease burden on society and patients in China.Community-based management plays a crucial role in the long-term and comprehensive management of patients with schizophrenia.Through years of exploration,community-based management models—primarily focused on case management,assertive community treatment(ACT),and crisis intervention—have proven beneficial to the overall recovery of patients.However,notable differences exist in the implementation of these models between domestic and international practices.Given this context,we systematically analyze domestic and international research to examine the characteristics of different management models and the causes of the differences.Based on this analysis,we propose targeted recommendations for improving community-based management of schizophrenia in China.Regarding case management,a tiered approach should be adopted according to regional economic conditions and resource availability to optimize the efficiency of resource allocation.For ACT,we suggest developing a family-centered integrated intervention framework adapted to China's specific context.Finally,regarding crisis intervention,a collaborative family-community-police response mechanism should be established,complemented by enhanced professional training and streamlined referral procedures.We advocate enhancing resource allocation and theoretical research,along with broader involvement of all sectors of society,to jointly optimize the community-based management model for schizophrenia in China.

Objective:To identify the serotype and genotype characteristics of the first cluster infection of Brucella in Nujiang Lisu Autonomous Prefecture of Yunnan Province. Methods:The information of seven suspected cluster brucellosis cases reported in Lanping County, Nujiang Lisu Autonomous Prefecture in April 2023 were collected, blood samples were collected, and the strains were isolated and cultured. Serological methods were employed for brucellosis diagnosis, bacterial species identification was performed using BCSP31-PCR and AMOS-PCR. Multilocus locus variable-number tandem repeat analysis (MLVA) was conducted for strain genotyping, followed by phylogenetic analysis comparing the strains with those from other regions of China.Results:All seven cases were diagnosed with brucellosis, they were all villagers from the same village and had daily contact with sheeps. Four suspected Brucella strains were isolated, identified as Brucella melitensis biotype by BCSP31-PCR and AMOS-PCR. The four isolated strains exhibited identical MLVA-16 genotype, with MLVA-8 genotype 42 and MLVA-11 genotype 180, belonging to the Eastern Mediterranean lineage. Compared with the MLVA-16 of the isolated strains from other regions of China, the four isolated strains formed an independent cluster. Conclusion:The first cluster infection of Brucella in Nujiang Lisu Autonomous Prefecture of Yunnan Province is caused by Brucella melitensis biotype, and the four isolated strains have showed unique MLVA genotype.

Odontogenic maxillary sinusitis(OMS)is a subtype of maxillary sinusitis(MS).It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion.Due to the lack of unique clinical features,OMS is difficult to distinguish from other types of rhinosinusitis.Besides,the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis.Its current diagnosis and treatment are thus facing great difficulties.The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS.However,this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality.Based on systematically reviewed literature and practical experiences of expert members,our consensus focuses on characteristics,symptoms,classification and diagnosis of OMS,and further put forward multi-disciplinary treatment decisions for OMS,as well as the common treatment complications and relative managements.This consensus aims to increase attention to OMS,and optimize the clinical diagnosis and decision-making of OMS,which finally provides evidence-based options for OMS clinical management.

ObjectiveTo investigate the changes of intestinal microbiota in type 2 diabetic diarrhea （T2DD） patients with dampness-heat syndrome and spleen-kidney deficiency syndrome. MethodT2DD patients who were admitted to the Department of Endocrinology Ⅰ of the Affiliated Hospital of Shaanxi University of Chinese Medicine from March 2020 to May 2021 were selected， including 14 patients with type 2 diabetes mellitus （T2DM）， 12 T2DD patients with dampness-heat syndrome， and 13 T2DD patients with spleen-kidney deficiency syndrome. Twelve healthy subjects receiving medical examination were selected as control group. Their body mass index （BMI）， fasting plasma glucose （FPG）， 2 h postprandial blood glucose （2 h PBG） and glycosylated hemoglobin （HbA1c） were compared. Fecal samples were collected for DNA extraction to build a database. High-throughput 16S rDNA sequencing was used to compare the composition of intestinal microbiota and the differential bacteria among the four groups. ResultCompared with the conditions in control group， the levels of FPG， 2 h PBG and HbA1c in the other groups were increased （P<0.05）. Alpha diversity showed no significant difference in species richness， evenness and diversity of intestinal microbiota among the groups. Beta diversity indicated that intestinal microbiota tended to be consistent in each group， and there was no marked difference between groups. The top 5 phylum by relative abundance were Bacteroidetes，Proteobacteria， Firmicutes， Actinobacteria， and Fusobacteria， among which，Bacteroidetes， Proteobacteria and Firmicutes were dominant. Compared with the control group， the three diabetic groups had elevated relative abundance of Bacteroidetes while decreased relative abundance of Firmicutes. The relative abundance of Actinomycetes in spleen-kidney deficiency T2DD group was significantly higher than that in the other groups， and the relative abundance of Firmicutes and Fusobacteria in the dampness-heat T2DD group was significantly lower than that in the other groups. At the genus level， the top 10 bacteria by relative abundance were Phocaeicola， Bacteroides， Pseudescherichia， Prevotella， Bifidobacterium， Faecalibacterium， Fusobacterium， Roseburia， Citrobacter， and Cetobacterium. LEfSe analysis revealed that the relative abundance of Prevotella， Mediterraneibacter， Parabacteroides， and Fusicatenibacter in diabetic patients was remarkably higher than that in healthy patients. Bacteroides and Sutterella might be the characteristic microbiota of T2DD patients with dampness-heat syndrome， while Faecalibacterium， Limosilactobacillus， Eubacterium， Gemmiger， Enterocloster， Alistipes， Parasutterella and Oscillibacter might be the characteristic microbiota of T2DD patients with spleen-kidney deficiency syndrome. ConclusionBacteroides and Parasutterella might be the characteristic microbiota of T2DD patients with dampness-heat syndrome and spleen-kidney deficiency syndrome， respectively. This paper provided reference for studying the mechanism， diagnosis and treatment of modern traditional Chinese medicine for T2DD of dampness-heat type and spleen-kidney deficiency type.

Damp-heat syndrome is one of the common syndromes of various clinical diseases.Current studies have shown that intestinal flora is closely related to damp-heat syndrome,but the specific molecular biological mechanism related to intestinal flora and damp-heat syndrome is not yet clear.In this paper,the molecular biological mechanism of damp-heat syndrome is discussed from the perspective of intestinal flora related signaling pathways,so as to provide ideas for the essence of damp-heat syndrome and clinical diagnosis and treatment.

The Chinese Society of Critical Care Medicine (CSCCM) has developed the clinical practice guidelines of nutrition assessment and monitoring for patients in adult intensive care unit (ICU) of China. This guideline focuses on nutrition assessment and metabolic monitoring to achieve the optimal and individualized nutrition therapy for critical ill patients. This guideline was made by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough system review and summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and review by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on the currently available evidence and cover several key fields, including nutrition risk screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the PICO principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3 to 5 years.
Adult ; Humans ; China ; Critical Care ; Critical Illness/therapy* ; Intensive Care Units ; Nutrition Assessment ; Nutritional Support/methods*

Humans ; COVID-19 ; Consensus ; SARS-CoV-2 ; China

OBJECTIVE: To assess the association of C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene with autistic behavior and inheritance pattern of children patients. METHODS: Ninety three autism patients were selected as the study group, whilst 93 healthy children were selected as the control group. The C677T genotype of the MTHFR gene was determined, and the correlation between the genotype and the autistic behavior and inheritance pattern were investigated. RESULTS: MTHFR gene C677T locus revealed three genotypes CC, CT and TT. Compared with the control group, the study group had fewer CC genotype but more TT genotype (P<0.05). Individuals with the three genotypes showed a statistically significant difference in the frequencies of four problem behaviors (P<0.05). Regression analysis showed that at least one T allele encoding the degree of 1 and 2 for the 4 problem behaviors that were statistically different. MTHFR gene C677T genotype was associated with autism under the recessive inheritance model and allelic inheritance model (P<0.05). CONCLUSION The C677T polymorphism of the MTHFR gene is associated with autistic behaviors. Children with the TT genotype or T allele are at higher risk of developing autism, particularly direct gaze, complex limb movements, self-injurious behavior and hyperactivity 1 and 2 related with the degree of coding.
Autistic Disorder/genetics* ; Child ; Genetic Predisposition to Disease ; Genotype ; Humans ; Inheritance Patterns ; Methylenetetrahydrofolate Reductase (NADPH2)/genetics* ; Problem Behavior