The incidence of acute gastrointestinal injury (AGI) in critically ill patients is high and significantly affects their clinical prognosis. Currently,there have been numerous studies in both western and Chinese medicine specialties on the diagnosis,prevention,and treatment of AGI,including investigations into high-risk factors prone to AGI,biomarkers for diagnosing AGI,scoring methods for evaluating gastrointestinal function in western medicine,syndrome differentiation in Chinese medicine,and treatment and prevention approaches of AGI in both western and Chinese medicine. To further standardize the strategies for the prevention and treatment of AGI in critically ill patients through the integration of Chinese and western medicine,this consensus convened experts in critical care medicine,evidence-based medicine,and methodology in the field of integrative Chinese and western medicine within the country to formulate the Chinese expert consensus on integrative Chinese and western medicine for the prevention and treatment of acute gastrointestinal injury in critically ill patients. This consensus is based on the PICO (patient,intervention,comparison,and outcome) principle and adopts the grading of recommendations,assessment,development and evaluation (GRADE) standard. It takes a problem-oriented approach from the perspective of the integration of Chinese and western medicine,this consensus summarizes the evidence-based medical evidence and puts forward recommendations on the definition,diagnosis,treatment and prevention of AGI to provide professional suggestions for the standardized implementation of the prevention and treatment of AGI in critically ill patients through integrative Chinese and western medicine.

The incidence of acute gastrointestinal injury (AGI) in critically ill patients is high and significantly affects their clinical prognosis. Currently,there have been numerous studies in both western and Chinese medicine specialties on the diagnosis,prevention,and treatment of AGI,including investigations into high-risk factors prone to AGI,biomarkers for diagnosing AGI,scoring methods for evaluating gastrointestinal function in western medicine,syndrome differentiation in Chinese medicine,and treatment and prevention approaches of AGI in both western and Chinese medicine. To further standardize the strategies for the prevention and treatment of AGI in critically ill patients through the integration of Chinese and western medicine,this consensus convened experts in critical care medicine,evidence-based medicine,and methodology in the field of integrative Chinese and western medicine within the country to formulate the Chinese expert consensus on integrative Chinese and western medicine for the prevention and treatment of acute gastrointestinal injury in critically ill patients. This consensus is based on the PICO (patient,intervention,comparison,and outcome) principle and adopts the grading of recommendations,assessment,development and evaluation (GRADE) standard. It takes a problem-oriented approach from the perspective of the integration of Chinese and western medicine,this consensus summarizes the evidence-based medical evidence and puts forward recommendations on the definition,diagnosis,treatment and prevention of AGI to provide professional suggestions for the standardized implementation of the prevention and treatment of AGI in critically ill patients through integrative Chinese and western medicine.

Objective:To evaluate the therapeutic effect of electroacupuncture on acute gastrointestinal injury (AGI) in patients with severe traumatic brain injury (sTBI).Methods:A prospective randomized controlled trial was conducted. 126 consecutively hospitalized patients with AGI after sTBI admitted to intensive care unit (ICU) of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2018 to December 2019 were enrolled. The patients were divided into observation group and control group by random number table. All the patients of two groups were given conventional treatment of western medicine for consecutive 7 days, including the treatments of primary diseases, indwelling nasogastric tube to extract gastric contents every 6 hours to determine gastric residual volume (GRV). When vital signs were basically stable, enteral nutrition (EN) was implemented and EN feeding amount and speed were adjusted according to GRV. On the basis of conventional western medicine treatment, the observation group was treated with electroacupuncture at Zusanli, Tianshu, Shangjuxu, Xiajuxu and Zhongwan, once in the morning and once in the evening, 30 minutes each time. The gastrointestinal function parameters including intra-abdominal pressure (IAP), serum diamine oxidase (DAO) and gastrointestinal failure (GIF) scores were observed before treatment and at day 3 and day 7 of treatment. The incidence of ICU hospital-acquired pneumonia (HAP-ICU), duration of mechanical ventilation (MV), length of ICU stay, 28-day mortality and adverse reactions of electroacupuncture were also observed in the two groups. Kaplan-Meier method was used for 28-day survival analysis.Results:During the 7-day treatment and observation, 26 cases of 126 patients withdrew from the study, and 100 cases were actually enrolled, 50 cases in the observation group and 50 cases in the control group. IAP and DAO at day 3 of treatment in both groups were significantly lower than those before treatment [control group: IAP (cmH 2O, 1 cmH 2O = 0.098 kPa) was 13.75±2.76 vs. 18.11±3.97, DAO (U/L) was 129.88±24.81 vs. 158.01±22.64; observation group: IAP (cmH 2O) was 13.56±2.19 vs. 18.50±3.54, DAO (U/L) was 129.11±29.32 vs. 159.36±28.65; all P < 0.01]. The gastrointestinal function parameters of the two groups improved gradually with the extension of treatment time, and the IAP, DAO and GIF scores at day 7 of treatment in the observation group were significantly lower than those in the control group [IAP (cmH 2O): 11.28±3.61 vs. 12.68±3.23, DAO (U/L): 49.69±17.56 vs. 57.27±20.15, GIF score: 2.02±0.74 vs. 2.40±0.70, all P < 0.05). The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group [duration of MV (days): 15.72±4.60 vs. 18.08±4.54, length of ICU stay (days): 16.76±4.68 vs. 19.26±5.42, both P < 0.05], and the incidence of ICU-HAP and 28-day mortality were significantly lowered (12.0% vs. 30.0%, 22.0% vs. 32.0%, both P < 0.05). Survival analysis showed that the 28-day cumulative survival rate in the observation group was significantly higher than that in the control group (86.4% vs. 76.1%; Log-Rank test: χ 2 = 37.954, P < 0.001). The patients in the observation group had no significant adverse reaction of electroacupuncture treatment. Conclusion:Electroacupuncture at corresponding acupoints can effectively improve gastrointestinal function in patients with AGI after sTBI, which is beneficial to shortening the length of ICU stay, promoting the recovery of the patients, and reducing the 28-day mortality.

Objective To discuss the influence of Tanshinone ⅡA on the tight junction protein of intestinal mucosal epithelial cells in rat severe septic models. Methods Seventy-five Sprague-Dawley (SD) rats were randomly divided into sham operation group, model group and Tanshinone ⅡA injection high (20 mg/kg), medium (10 mg/kg) and low (5 mg/kg) dose groups, each group 15 rats. Sepsis rat models were established by cecal ligation and puncture (CLP) method, in sham operation group, only switched abdominal surgery was performed without CLP. In Tanshinone ⅡA injection groups, different doses of Tanshinone ⅡA were injected intraperitoneally after modeling for 10 minutes and 6 hours; in sham operation and model groups, equal volume of normal saline was injected intraperitoneally at the same times as above. After operation, 3 L/kg of normal saline was injected into the caudal vein in all rats for fluid resuscitation.Twelve hours after operation, the rats were killed, the abdominal lymph nodes, liver, spleen and kidney tissues were taken for bacterial culture and calculating the rate of bacterial translocation; under microscope, the histopathological changes of ileum mucosal tissues were examined and Chiu scoring was carried out; TdT-mediated dUTP nick end labeling (TUNEL) was applied to detect the ileum mucosal epithelial cell apoptosis and calculating the index (AI);fluorescence immunoassay and Western Blot methods were used to measure the contents and protein expression levels of tight junction protein, junctional adhesion molecule-1 (JAM), Claudin-1, Zonula occludens-1 (ZO-1), Occludin, c-Fos and Tryptase. Results ① In bacterial cultures of abdominal lymph node, liver, spleen and kidney, the positive rate of mesenteric lymph node was the highest, followed by liver and spleen, mainly Escherichia coli, Proteus mirabilis, etc. The highest positive rate of bacterial culture was in model group (38.8%), followed by low dose of Tanshinone ⅡA injection group (35.0%), and the lowest was 16.6% in high dose Tanshinone ⅡA injection group, the differences being statistically significant in comparisons between any pair of groups (all P < 0.05). ② Pathological examination showed that the pathological changes of ileum mucosa were obvious and the Chiu score (4.17±0.98 vs. 0) and AI (11.70±2.87 vs. 2.17±0.80) in model group were significantly higher than those in sham group (all P < 0.05); with the increase of dosage of Tanshinone ⅡA injection, the pathological changes of rat ileum mucosa were improved gradually, the Chiu score and AI were decreased gradually, and the degrees of decrease in high dose Tanshinone ⅡA group were more significant than those in model group (Chiu score: 1.12±0.79 vs. 4.17±0.98, AI: 3.65±1.98 vs. 11.70±2.87, both P < 0.05).③ Immunofluorescence staining showed that the positive staining of protein JAM, ZO-1 and c-Fos were all green in color, Claudin-1, Occludin and Tryptase were all red in color, the localizations of all of them were in the cytoplasm, the protein expression of JAM, Claudin-1, ZO-1, Occludin from strong to weak in turn were Sham group, high, medium, low dose Tanshinone ⅡA group and model group, the expression of c-Fos, Tryptase from strong to weak in turn were model group, low, medium, high dose Tanshinone ⅡA group and Sham group. ④ Western Blot showed that the expressions of ileum tissue JAM, Claudin-1, ZO-1 and Occludin in model group were all significantly lower than those of the sham group, while the expressions of c-Fos, Tryptase were obviously higher than those of the sham group, with the increase of dosage of Tanshinone ⅡA, the expressions of JAM, Claudin-1, ZO-1 and Occludin were increased gradually and the protein expressions of c-Fos and Tryptase were gradually decreased, and the changes in high dosage group of Tanshinone ⅡA were more significant than those in low and moderate groups [JAM (gray value): 25.39±1.82 vs. 12.41±1.34, 19.45±1.66, Claudin-1 (gray value): 28.44±1.56 vs.17.26±1.46, 21.23±1.34, ZO-1 (gray value): 28.84±1.59 vs. 16.45±1.21, 24.22±1.46, Occludin (gray value): 25.49±1.63 vs. 13.34±1.45, 19.45±1.37, c-Fos (gray value):15.76±1.36 vs. 27.84±1.36, 21.22±1.73, Tryptase (gray value): 14.44±1.41 vs. 28.14±1.38, 22.32±1.57], all the above comparisons of different dosage groups were statistically significant (all P < 0.05). Conclusion Tanshinone ⅡA injection may improve intestinal wall structure and reduce bacterial translocation by improving the intestinal mucosal tight junction protein in sepsis model rats, and this effect is positively correlated to Tanshinone ⅡA dosage.

Objective To observe the influences of uncoupling protein 2 (UCP-2) rs660339 variants transfection on cell proliferation and apoptosis of human umbilical vein endothelial cell (HUVEC). Methods Two UCP-2 green fluorescent protein (GFP) lentivirus constructs were created with the rs660339 locus carried C or T (UCP-2C or UCP-2T), respectively. HUVEC were cultured after lentiviral infection of UCP-2C or UCP-2T. The expression of UCP-2C or UCP-2T was detected with real time polymerase chain reaction. Cell proliferation and cell apoptosis were compared among negative control (NC) group, UCP-2T group and UCP-2C group using CCK-8 cell viability and flow cytometry. Western blot and immunostaining were employed to examine the expression of Bcl-2 gene. Results The lentivirus constructs were successfully created.>80%of the transfected cells were found to express GFP under fluorescent microscope. The mRNA levels of UCP-2 gene were significantly increased (F=29.183, P=0.001) in the UCP-2T group and UCP-2C group. The CCK-8 assay revealed that on day two (F=15.970, P=0.004), day three (F=16.738, P=0.004), day four (F=5.414, P=0.045) post-infection, UCP-2T and UCP-2C group showed significantly greater proliferation than the NC cells. The apoptotic rate in the UCP-2T and UCP-2C group was significantly lower than NC group (F=277.138, P=0.000), and the apoptotic rate of UCP-2T was significantly lower than that of UCP-2C (P=0.003). The protein levels of Bcl-2 in the UCP-2T and UCP-2C group were significantly greater than that in the NC group (F=425.679, P=0.000), and the Bcl-2 expression of UCP-2T was greater than that of UCP-2C (P=0.002). The Bcl-2 density in the UCP-2T and UCP-2C group were greater than that in the NC group (F=11.827, P=0.008), while there was no difference between UCP-2T and UCP-2C group (P=0.404). Conclusion The variants of UCP-2 rs660339 may influence HUVEC proliferation and apoptosis, and UCP-2T showed a stronger effect of inhibiting apoptosis than UCP-2C.

BACKGROUND:Maxilary posterior tooth defects can be repaired using the dental implant. However, implantation accuracy is not ensured by traditional plaster models used as implant template, which leads to the incidence of complications,andaffectsthe repair effects.
OBJECTIVE:To study application effects of surgical guide plates designed using the computer aided design (CAD)/computer aided manufacturing (CAM) technology for the repair of maxilary posterior tooth defects.
METHODS:Implant treatment was performed in 30 patients with maxilary posterior tooth defects. Surgical guide plate was made using the CAD/CAM technology after CT scan of the jaw bone. The repair was conducted with guideplateassistant. The deviation between the virtual and actual implant position was measured after implantation. The clinical repair effects and periodontal tissues were observed during the 12-month folow-up.
RESULTS AND CONCLUSION:Thirty-sixCAD/CAM surgical guide plates in 30 patients werestabilized after implantation. Thirty-six implants were emplaced precisely with the assist of the surgical guide plates. There was no any problem during the process of implantation. The deviation of the head between the virtual and actual implant position was very smal, which did not affect the accuracy of implant placement. Before and 6 and 12 months after the repair, gingival crevicular fluid, tumor necrosis factor-α, and sulcus bleeding index were not obviously changed in the patients. Our results suggest that the implant head deviation and angle deviation appearduring the repair process of maxilary posterior tooth defects using CAD/CAM surgical guide for dental implants;however, the implantation accuracy is not affected. The repair effect is ideal and periodontal tissue is in good status after implantation.

BACKGROUND:Targis/composite fiber is a new type of non-metalic repair material that has good hardness and strength, but it is rarely reported on its application in the repair of young permanent tooth defects.
OBJECTIVE:To investigate the clinical effect of Targis/composite fiber in repairing young permanent tooth defects.
METHODS:Sixty cases of young permanent teeth defects 10-17 years of age were enroled, including 27 males and 33 females. Al cases were subjected to Targis/composite fiber repairing. After 36 months of folow-up, alkaline phosphatase level, probing depth, gingival sulcus bleeding index, tooth mobility, plaque index, gingival crevicular fluid volume and aspartate aminotransferase level in patients were detected; the integrity and edge of dental prosthesis and the color matching.
RESULTS AND CONCLUSION:After 36 months, the alkaline phosphatase level in the patients had no significant changes (P> 0.05), but the probing depth, gingival sulcus bleeding index, tooth mobility, plaque index, gingival crevicular fluid volume and aspartate aminot ransferase level were decreased significantly compared with those before repair (P< 0.05). Additionaly, there were two cases of incomplete dental prosthesis, six of color mismatching, andtwo of unsealed prosthesis edge. These findings indicate that the Targis/composite fiber for repairing young permanent tooth defects has good histocom patibility maintains periodontal health in good condition, is a kind of ideal repair materials.

BACKGROUND:Dental implantation in maxilary esthetic zone is difficult to achieve desired outcomes.
OBJECTIVE:To observe the feasibility of digital rapid prototyping implant template for anterior implantation.
METHODS: Eighty patients scheduled to receive anterior implant treatment were enroled. According to the wishes of patients, they were divided into two groups, with 40 cases in each group, and were given routine implant treatment (control group) and digital rapid prototyping template-aided dental restoration (observation group). After implantation, the X-axis, Y-axis and Z-axis errors of the two groups were measured, and the patients were folowed up for 12 months.
RESULTS AND CONCLUSION:After implantation, the errors of X, Y and Z axes in the observation group was significantly lower than those in the control group (P< 0.05); at 24 hours after implantation, patients in the two groups showed good appearance of the anterior tooth with no dental prosthesis loosing. Imaging examinations in the two groups showed no obvious bone resorption. These findings indicate that the aid therapy using digital rapid prototyping can obtain satisfactory therapeutic effect on anterior tooth restoration in the maxilary esthetic zone and precisely localize the dental implantation site.

Objective To investigate the risk factors of prognosis of gram-positive bacteria associated nosocomial bloodstream infections,and to investigate the drug resistance of the strains.Methods A total of 132 patients with gram-positive bacteria associated nosocomial bloodstream infections were collected from the First Affiliated Hospital of Zhejiang Chinese Medicine University during January 2010 and December 2012.Clinical data including demographic characteristics,underlying diseases,risk factors and use of antibacterial agents were retrospectively analyzed.According to 28-day prognosis,patients were divided into survival group (n =97) and death group (n =35).Binary logistic regression was used to identify the risk factors of 28-day fatality.Results Among 132 patients,49 (37.12％) were infected with coagulase-negative Staphylococcus,46 (34.85％) were infected with Staphylococcus aureus,37 (28.03％)were infected with Enterococcus.The rates of methicillin resistant coagulase negative Staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) were 77.55％ (38/49) and 54.35％ (25/46),respectively.The rate of linezolid resistant coagulase negative Staphylococci was 8.16％ (4/49) ; Four out of 37 strains (10.81％) of Enterococcus were both resistant to vancomycin and linezolid.Binary logistic regression showed that septic shock (OR =34.344,95％ CI:6.539-180.389,P =0.000),deep venous catheterization (OR =13.411,95％ CI:1.877-95.832,P =0.010),no catheter removal after infection (OR =8.759,95％ CI:2.197-34.911,P =0.002),parenteral nutrition (OR =3.684,95％ CI:1.072-12.663,P =0.038),inappropriate antibacterial therapy in early stage (OR =12.951,95％ CI:2.075-80.836,P =0.006) and Enterococcus associated bloodstream infections (OR =4.227,95％ CI:1.090-16.394,P =0.037) were independent risk factors of 28-day fatality in patients with gram-positive bacteria associated nosocomial bloodstream infections.Conclusions The predominant pathogens are coagulase-negative Staphylococcus,Staphylococcus aureus and Enterococcus in gram-positive bacteria associated nosocomial bloodstream infections.Patients with septic shock,deep venous catheterization,no catheter removal after infection,parenteral nutrition,inappropriate antibacterial therapy in early stage and Enterococcus associated bloodstream infections are likely to have high fatality rate.

[Objective] To investigate the effects of Naoyi'an (NYA) on the expression of ICAM-1 in the brain of rats with experimental intracerebral hemorrhage.[Methods] The rats model of intracerebral hemorrhage was prepared by type Ⅶ collagenase injected into globus pallidus under stereotaxic apparatus.Then,the expression of ICAM-1 with or without intervention with NYA was determined in the brain of these animals respectively by in situ hybridization and western blot technique.[Results] Among the modeling animals,the expression of ICAM-1 was increased after the operation.In contrast,the expression of ICAM-1 was significantly down-regulated in the rats treated by NYA(P