Nutritional therapy is a core component of critically ill patient management,and the enteral route has become the preferred method due to its dual roles of nutrition and non-nutrition. The use of vasoactive medications makes enteral nutrition decisions more challenging for these patients. This review systematically examines the pathophysiological effects of vasoactive medications on gastrointestinal tract of critically ill patients,the current value and safety of enteral nutrition in this patient's population,summarizes the optimal strategies for implementing enteral nutrition in these patients for clinical reference.

Objective:To explore the clinical value of semi-ex vivo intestinal autotrans-plantation (IATx) for patients with mesenteric root regional tumors accompanied by vascular invasion.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 6 patients who underwent semi-ex vivo IATx in the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from September 2021 to December 2022 were collected. There were 4 males and 2 females, aged (47±21)years. Observation indicators: (1) surgical conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented by Mean± SD. Count data were represented by absolute numbers. Results:(1) Surgical conditions. All 6 patients completed semi-ex vivo IATx successfully. The operation time, warm ischemia time, cold ischemia time, volume of intraoperative blood transfusion were (10.2±2.1)hours, (2.3±1.6)minutes, (49.2±15.6)minutes, (707±263)mL. Of the 6 patients, 3 patients were intraoperatively perfused with cold UW solution, while the other 3 were not. (2) Postoperative conditions. Results of postoperative pathological examination of the 6 patients showed 4 cases of pancreatic ductal adenocarcinoma, 1 case of cholangiocarcinoma, and 1 case of mesenteric fibromatosis. All 6 cases had nega-tive surgical margins and the duration of postoperative hospital stay was (19±4)days. None of the patient had gastrointestinal bleeding or anastomotic leakage postoperatively, and the autotransplanted intestine functioned well. There was no perioperative death, and intravenous rehydration was not required after discharge. (3) Follow-up. All 6 patients were followed up for (12±5)months. Only 1 patient with mesenteric fibromatosis had recurrence in the 7th month postoperatively, while the remaining 5 patients showed no sign of recurrence or metastasis. There were 4 of 6 patients with chronic diarrhea. They were improved after oral loperamide, bifidobacterium and pancreatin capsules. All 6 patients survived.Conclusion:Semi-ex vivo IATx for the treatment of patients with mesenteric root regional tumors accompanied by vascular invasion is safe and feasible, which can achieve good short-term efficacy.

Objective:The purpose of quantitatively evaluating policies related to clinical specialties and exploring existing policy problems and paths to optimization is to provide a reference basis for the formulation and improvement of the policies.Methods:Text mining was conducted on the policies related to clinical specialties issued by the national and some provincial governments since the new medical reform in 2009.The PMC index model was used to construct a comprehensive evaluation system of policies containing 9 primary variables and 35 secondary variables.22 clinical specialty policies were selected for quantitative analysis.Results:Among the 22 clinical specialty policies,6 policies were good-type policies,14 were acceptable-type policies,2 were bad-type policies,and there were no excellent-type policies.The overall design of the policies related to clinical specialties is reasonable,but there is still room for improvement.Conclusion:The quality of China's clinical specialty policy text needs to be improved,and it is necessary to strengthen the top-level design,optimise the content of the objectives,focus on the balanced and sustainable development of the speciality,give full play to the role of demand-based policy tools,and enrich the incentives and constraints,in order to mobilise multi-principal participation in the construction of the clinical speciality enthusiasm.

Objective:To construct a health education program for enterostomy patients based on the guideline of Facilitating Client Centered Learning. Methods:From July to October 2022, based on the adaptability survey and literature research of the previous guidelines, the first draft of the health education program for enterostomy patients was formed. A total of 13 experts were selected using purposive sampling method, and two rounds of expert consultation were conducted through the Delphi method on the first draft of the program to build the final health education program for enterostomy patients. We calculated the authority, enthusiasm, coordination, and concentration of experts.Results:The health education program for enterostomy patients included 3 first-level indicators, 9 second-level indicators, and 31 third-level indicators. The effective response rates of the first and second rounds of consultation questionnaires were both 100.0%, and the authority coefficients of experts were both greater than 0.7. In the second round of consultation, the Kendal coordination coefficients of the importance of the first, second and third level indicators were 0.231, 0.154 and 0.182 ( P<0.05), and the Kendal coordination coefficients of the feasibility of the first, second and third level indicators were 0.216, 0.154 and 0.129 ( P<0.05), with coefficients of variation < 0.25. Conclusions:The health education program for enterostomy patients based on the guideline of Facilitating Client Centered Learning is practical and scientific, and can provide guidance for clinical practice.

This study aimed to propose an operational definition of late-onset hypogonadism (LOH) that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China. A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were measured and free testosterone (cFT) was calculated. The Aging Males' Symptoms (AMS) scale was used to evaluate the LOH symptoms. Finally, 5078 men were included in this analysis. The TT levels did not decrease with age (P = 0.59), and had no relationship with AMS symptoms (P = 0.87 for AMS total score, P = 0.74 for ≥ 3 sexual symptoms). The cFT levels decreased significantly with age (P < 0.01) and showed a negative association with the presence of ≥ 3 sexual symptoms (P = 0.03). The overall estimated prevalence of LOH was 7.8% (395/5078) if a cFT level <210 pmol l

OBJECTIVE: To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China. METHODS: According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017. RESULTS: A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66). CONCLUSIONS Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.
China ; Female ; Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies

Heavy metals and other harmful elements in traditional Chinese medicines inflict serious damage on public health. Therefore, risk assessment of Chinese raw materials has gained increasing attention. To date, few reports have been published on the health risk assessment of heavy metals and harmful elements in Chinese patent medicines. To gain a comprehensive understanding of heavy metals and other harmful elements in Chinese patent medicines and to establish proper limits, residual Pb, Cd, As, Hg, Cu and Cr in 15 054 samples of 295 drugs was analyzed with regard to distribution and variation between elements and dosage forms. In addition, in accord with procedures including hazard identification, hazard characterization, exposure assessment and risk characterization, basic procedures and specific parameters for risk assessment of heavy metals and harmful elements in Chinese patent medicines were clarified based on the health risk assessment of 14 787 samples and 276 drugs. A method and equation for establishing residual limits is proposed. The results show that content and target hazard quotients (THQs) of the investigated elements in all samples showed a skewed distribution approaching 0. Content of Pb, As, Cu, Hg, Cd or Cr in the samples exceeded 100 mg·kg^-1 and the content of Pb, As, or Cu in individual samples exceeded 1 000 mg·kg^-1. THQs of 586 samples and four drugs were above 1. We believe that the health risk of Hg, Pb and As in Chinese patent medicines with dosage forms of pill, capsule, tablet and powder, especially those in raw powder preparations, warrant concern.

Objective To investigate the effect of occipitocervical fusion in patients with craniovertebral junction deformity combined with atlantoaxial instability. Methods The clinical data of 59 patients with craniovertebral junction deformity combined with atlantoaxial instability from March 2013 to June 2017 were retrospectively analyzed. The patients were treated with occipitocervical fusion. The atlantoaxial distance (ADI), distance between the odontoid and Chamberlain line and cervicomedullary angle (CMA) were used to evaluate atlantoaxial dislocation, vertical displacement and spinal cord compression, and the Japan Orthopedic Association (JOA) score was used to evaluate the effect before operation and 7 days after operation. Results The operation time was 109 to 214 (148.5 ± 20.1) min, the transoperative bleeding was 55 to 210 (122.0 ± 16.7) ml, and no injury of spinal cord nerve and vertebral artery occurred during operation. The CMA and JOA score 7 d after operation were significantly higher than that before operation: (153.8 ± 5.4)° vs. (131.2 ± 7.1) ° and (12.7 ± 1.8) scores vs. (10.6 ± 1.4) scores, and the ADI and distance between the odontoid and Chamberlain line 7 d after operation were significantly lower than that before operation: (2.9 ± 0.7) mm vs. (8.3 ± 2.7) mm and (3.2 ± 1.4) mm vs. (8.2 ± 2.3) mm, and there were statistical difference (P＜0.05). One case (1.7%, 1/59) died of massive brainstem infarction 1 d after operation; 2 patients (3.4%, 2/59) had undergone a revision operation due to fusion failure 3 months after operation; other 56 patients in reduction, internal fixation and bone graft fusion. The patients were followed up for 6 to 38 (15.9 ± 7.2) months, and the symptom relief was in 56 cases. The rate of symptom relief was 94.9% (56/59). The JOA score at last follow-up was significantly higher than that before operation: (13.3 ± 1.8) scores vs. (10.6 ± 1.4) scores, and there was statistical difference (P＜0.05). Conclusions The occipitocervical fusion can effectively relieve spinal cord compression and atlantoaxial instability in patients with craniovertebral junction deformity combined with atlantoaxial instability.

Objective To compare the effects of different types of bone cement augmentation of pedicle screws on the prognosis of osteo -porotic thoracolumbar fractures in elderly patients.Methods From August 2013 to November 2016,184 elderly patients with osteoporotic thoracolumbar fractures in our hospital were selected as the research object,all the patients were randomly divided into observation group and control group,94 cases in each group.Two groups were treated with pedicle screw fixation,the control group received conventional pedicle screw combined with PMMA bone cement augmentation,and the observation group were treated by cannulated pedicle screws combined with PMMA bone cement augmentation,the prognosis of the two groups were recorded.Results All patients were successfully completed the oper-ation without serious complications occurred.There was no significant difference in operation time,intraoperative blood loss,the amount of sin-gle vertebral bone cement,hospitalization time between the two groups(P>0.05).The postoperative 1 month incidence rate of cerebrospinal fluid leakage,bone cement leakage,wound infection,loosening of internal fixation was 4.3% in the observation group,which was lower than 21.3%in the control group,the difference was significant(P<0.05).The postoperative 1 month of vertebral height in the observation group and the control group were respectively(4.53 ±1.11)mm and(5.09 ±1.42)mm that were lower than the preoperative(6.41 ±1.39)mm and(6.38 ±1.31)mm(P<0.05),meanwhile the vertebral height at postoperative 1 month of the observation group was lower than that of the control group,the differences were significant(P<0.05).There were 0 case of Frankle grade A,0 case of grade B,10 cases of grade C, 18 cases of grade D,66 cases of grade E in the observation group at postoperative 1 month,and there were 6 cases,14 cases,20 cases,20 ca-ses and 34 cases of corresponding Frankle grade in the control group,the observation group was significantly better than the control group,the differences were significant(P<0.05).Conclusion The application of cannulated pedicle screw combined with PMMA bone cement in the osteoporotic thoracolumbar fractures does not increase the difficulty of operation,and it can reduce the complications and reduce vertebral height,which is conducive to the recovery of nerve function.

OBJECTIVETo analyze the clinical effects of percutaneous endoscopic technique via three different approaches for highly migrated lumbar disc herniation.

METHODSThe clinical data of 68 patients underwent percutaneous endoscopic technique from June 2011 to June 2014 were retrospectively analyzed. There were 43 males and 25 females, aged from 11 to 77 years old with an average of (42.29±15.92) years. The patients were divided into three groups according to different operative approaches, of them, 45 cases were by transforaminal approach (group A), 15 cases by translaminar approach (group B), and 8 cases by transpedicular approach (group C). There was 1 case in level L₂,₃, 12 cases in L₃,₄, 36 cases in L₄,₅, 19 cases in L₅S₁. The herniated disc was migrated superiorly in 23 patients, inferiorly in 45 patients. MRI were available to confirm migrated disc pre-and post-operatively. Operation time, loss blood volume, intraoperative and postoperative complications, time of back to work (postoperative recovery time) were recorded. Preoperative and postoperative VAS were used to evaluate low back pain and sciatica and JOA and MacNab criteria were used to evaluate functional recovery.

RESULTSAll the operations were successful and all the patients were followed up from 12 to 40 months with an average of (18.0±15.9) months. Seven patients(3 cases in group A, 3 cases in group B, 1 case in group C) complicated with transient paraesthesia (hyperalgesia or hypesthesia), and the symptoms relieved after symptomatic treatment with neurotrophic medicine, at final follow-up, no symptoms were left. One case in group B complicated with dura mater tearing during operation and it was untreated, there was no resulted complications such as headache and sinus tract of skin. In group A, B, C, the mean VAS score of sciatica improved from preoperative 6.93±1.34, 6.33±1.23, 6.13±1.73 to 0.80±0.87, 0.73±0.70, 0.38±0.52 at final follow-up; and JOA score improved from preoperative 9.09±2.62, 9.80±2.31, 10.50±2.93 to 26.82±1.53, 25.93±1.58, 26.50±1.51 at final follow-up, respectively(<0.05). There was no significant difference among three groups(>0.05). There was no significant difference in loss blood volume, postoperative recovery time among three groups. But operation time of group B was shorter than other two groups. According to MacNab criterion to assess the clinical effects, 42 cases got excellent results, 21 good, 5 fair.

CONCLUSIONSPercutaneous endoscopic technique is a safe and effective method for surgical treatment of highly migrated herniation. The decision of operative approach should be made by characters of anatomy. By tanspedicular approach the lesion could be found directly. However, it depends on good skill and equipment.