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Objective:To evaluate and summarize the best evidence of energy and protein intake targets and calculation in adult critically ill patients, and to provide evidence-based basis for critical nutrition management.Methods:Evidence related to energy and protein intake targets and calculation of adult critically ill patients, including guideline, expert consensus, systematic review and evidence summary, were systematically searched in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Library, UpToDate, BMJ Best Practice, Joanna Briggs Institute (JBI), Web of Science, SinoMed, Medive, China National Knowledge Infrastructure, Wanfang database, VIP database, Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), Registered Nurses Association of Ontario (RNAO), and Society of Critical Care Medicine (SCCM) from January 2012 to June 2022. Two researchers independently evaluated the quality of the included literatures using the JBI Evidence-based Health Care Center evaluation tool and the Appraisal of Clinical Practice Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ), extracted and summarized the best evidence for the nutritional intake goal and calculation of adult critically ill patients, and described the evidence.Results:A total of 18 literatures were included, including 5 clinical guidelines, 8 expert consensus, 3 systematic reviews and 2 evidence summaries. After literature quality evaluation, 18 articles were all enrolled. The evidence was summarized from the four aspects, including energy target calculation method, dose body weight, energy and protein intake target, and calculation method, 24 pieces of the best evidence were finally formed.Conclusions:The best evidence of energy and protein intake targets and calculation for critically ill patients was summarized based on evidence-based. Clinical medical staff can choose indirect calorimetry to calculate energy goals when equipment is available. Patient's height, body weight should be recorded accurately, dose body weight can be determined by body mass index (BMI). Meanwhile, blood urea nitrogen (BUN) loss, fat-free body weight, simple formulas and other methods should be used to continuously evaluate and adjust protein intake targets, to achieve the purpose of optimizing intensive nutrition support.
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OBJECTIVES@#Low dose computed tomography (LDCT) is the best method for early diagnosis of lung cancer. Even though it has been widely used in clinic, the selection of screening objects and the management scheme of pulmonary nodules are still not unified among research institutions. This study aims to evaluate the effect of LDCT in detection effect and follow-up process for pulmonary nodules in asymptomatic participants.@*METHODS@#A total of 1 600 asymptomatic participants (37 to 82 years old), who came from Yantian District People's Hospital, Southern University of Science and Technology, received LDCT. The lung nodules were categorized into positive nodules and semi-positive nodules, and according to the density of positive nodules they were categorized into 4 types: solid nodules (SN), partial solid nodules (pSN), pure ground glass nodules (pGGN), and pleural nodules (PN). The number, detection rate, imaging findings, follow-up change of lung nodules, and the postoperative pathological results of positive nodules were recorded and analyzed.@*RESULTS@#Lung nodules were found in 221 cases by LDCT. The total detection rate of lung nodule was 13.8% (221/1 600), and the detection rate in positive nodules was 4.9% (79/1 600). The detected nodules were mainly single (173 cases), solid (133 cases) and semi-positive nodules (142 cases). Most of nodules (177 cases) had no change in the follow-up process. The enlargement and/or increased density of nodules (5 cases) were lung cancer. Pathological results were obtained in 10 cases, 8 cases were malignant (1 small cell lung cancer and 7 adenocarcinomas), 2 cases were benign (cryptococcal infection and alveolar epithelial dysplasia). The detection rate of lung cancer was 0.5% (8/1 600), and the proportion of early lung cancer was 75% (6/8).@*CONCLUSIONS@#LDCT screening can identify and increase the detection rate in the early lung cancer, which is an effective screening method. It is safe and feasible to take regular follow-up and re-examination for nodules with diameter less than 5 mm. When the size and or density of nodule increases, it indicates the malignant prognosis of the nodule and timely clinical intervention is needed.
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Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Adenocarcinoma , Early Detection of Cancer/methods , Lung Neoplasms/pathology , Mass Screening/methods , Tomography, X-Ray Computed/methodsABSTRACT
OBJECTIVE： To study the improvement effects of Shenshao yiqi yangxue granule on experimental aplastic anemia （AA） in mice and the preventive and therapeutic effects of it on myelosuppressive in mice. METHODS： Totally 72 mice were randomly divided into blank group （normal saline）， model group （normal saline）， positive control group （Yixuesheng capsule， 0.625 g/kg in content）， Shenshao yiqi yangxue granule low-dose， medium-dose and high-dose groups （1.26， 7.56， 15.12 g/kg by crude drug）， with 12 mice in each group. Except for blank group， other groups were given 60Co-γ irradiation combined with intraperitoneal injection of CTX to induce AA model. After modeling， they were given relevant medicine intragastrically once a day， for consecutive 7 d. After 6 days of administration， the mice were placed on a treadmill for exhaustion test， and the exhaustion distance and exhaustion time were measured. After 7 days of administration， the changes of peripheral blood （the number of RBC， WBC， PLT and content of HGB） were determined of mice in each group. The percentage of reticulocyte （Ret） was measured after blood smear， and the number of bone marrow nucleated cells （BMNC） was determined after bone marrow smear. Another 90 mice were collected， grouped and given relevant medicine as above， with 15 mice in each group. They were relevant medicine intragastrically once a day， for consecutive 12 d. After 3 days of administration， except for blank group， other groups were given 5-fluorouracil intraperitoneally to induce the bone marrow suppression model at the beginning of medication. After medication， peripheral hemogram， Ret and the number of BMNC were determined in each group. RESULTS： Compared with blank group， the exhaustion distance and exhaustion time of AA model group were significantly decreased （P＜0.01）， while the number of RBC， WBC， PLT and content of HGB， Ret and the number of BMNC were decreased significantly （P＜0.05 or P＜0.01）. Compared with model group， the exhaustion distance and exhaustion time of positive control group and Shenshao yiqi yangxue granule medium-dose and high-dose groups were increased significantly （P＜0.05 or P＜0.01）； the peripheral hemogram indicators， Ret and the number of BMNC were increased significantly in positive control group and Shenshao yiqi yangxue granule high-dose group， and Ret of Shenshao yiqi yangxue granule medium-dose group was increased significantly （P＜0.05 or P＜0.01）. In bone marrow suppression model， compared with blank group， the number of WBC， RBC and PLT， Ret， the number of BMNC were decreased significantly in model group （P＜0.05 or P＜0.01）. Compared with model group， the number of WBC， RBC and PLT， Ret and the number of BMNC in peripheral blood were increased significantly in positive control group and Shenshao yiqi yangxue granule high-dose group， and the number of RBC， Ret and the number of BMNC were increased significantly in Shenshao yiqi yangxue granule medium-dose group （P＜0.05 or P＜0.01）. CONCLUSIONS： Shenshao yiqi yangxue granule has certain improvement effects on AA in mice， and can prevent and treat myelosuppression in mice.
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Objective Trauma-induced coagulopathy (TIC)is an acute coagulopathy in which coagulation,fibrinolysis,and anticoagulant pathways are activated after trauma due to massive hemorrhage and tissue damage.TIC is caused by hypothermia,acidosis,blood dilution,hyperfusion,tissue injury,etc.To diagnose TIC,we mainly rely on traditional coagulation function analysis and thrombelastogram (TEG).At present,the key to treat TIC is quick hemostasis.The basic treatment procedure includes transfusion of packed red blood cells and fresh frozen plasma by appropriate proportion,and timely infusion of platelets and coagulant material so as to stabilize blood pressure and reconstruct the blood coagulation mechanism.In this paper,we reviewed recent advances in the pathophysiological and treatment of TIC in order to provide references for further research in related fields.
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Objective: To determine the antibody titer in the serum of allergic rabbits after the injection of 1, 3-di-caffeoylquinic acid contained in Shuanghuanglian injection.Methods: The complete antigen was prepared by incubating the suspected small molecular hapten 1, 3-di-caffeoylquinic acid contained in Shuanghuanglian injection with the serum from the normal rabbits.The specific antibody was obtained in the immunized rabbits.The antibody titers of antiserum were measured by ELISA kits.Indirect competitive ELISA was used to determine serological specificity, and the obtained data was used to plot the inhibition curves.The content of IgE antibody in the antiserum of rabbits was detected by rabbit immunoglobulin E (IgE) ELISA kits.Results: The antibody titer (A) of 1,3-di-caffeoylquinic acid was 2 times higher than that of the negative control, which indicated its potential allergenicity.The regression equation was I=0.170 6 lg C + 0.317 5 , which was with the correlation coefficient of r=0.985 4 , the detection limit of IC 10 =57.40 μg·ml-1 and the half inhibitory concentration of IC 50 =8.732 0 mg·ml-1.Furthermore, the exogenous IgE antibody was produced in the rabbits.Conclusion: The results indicated that the hapten substance 1,3-di-caffeoylquinic acid in Shuanghuanglian injection was allergenic under the present experimental conditions.
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The design of research protocol and quality control are the key to ensure the quality of clinical trial. A randomized clinical trial regarding the effects of medication combined with acupuncture on live birth rate in polycystic ovary syndrome (PCOS), which was initially designed as a comparative effectiveness research, then added with an acupuncture control group and finally became a factorial analysis, is taken as an example to explain the protocol design and optimization process, demonstrating the high level of methodology design and international recognization. By a series of measurements, such as unified purchase of acupuncture equipment, multiple trainings and assessments for acupuncturists' knowledge and operation standardization, in-site supervision of local center experts, the standard operation of acupuncture could be ensured and the credibility and scientificity of research results could be improved.
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Objective To explore the related factors of diabetes insipidus and disorders of sodium and water after surgery of sellar region tumor,and to find nursing strategy and improve the prognosis of sellar region tumors.Methods In this study,we retrospectively reviewed 150 cases of sellar region tumor from January 2005 to January 2011 in our department,including 67 cases of pituitary adenoma,53 cases of meningioma,30 cases of craniopharyngiona.Approaches were depended on the size and growing pattern of the tumors.Related factors of postoperative diabetes insipidus and disorders of sodium and water were analyzed.Results Large tumor size,the pathology of tumor,preoperative endocrine dysfunction,preoperative visual field and vision disorders and surgery approach were related to such complications.Conclusions Finding the related factors of these complications in patients and adopting care measures play an important role in improving the prognosis of sellar region tumors.
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The article discussed the necessity of strengthening continuous medical education in general hospitals,and puts forward that to establish high quality medical staff that can keep up with time,take the challenges and promote the innovation and the development of hospital,We must attach importance to strengthening and continuing medical education,and at the same time,improving and perfecting the education system is also very important.