Early Enteral Nutrition and Sepsis-Associated Acute Kidney Injury: A Propensity Score Matched Cohort Study Based on the MIMIC-III Database

Purpose@#We aimed to analyze the optimal timing of enteral nutrition (EN) in the treatment of sepsis and its effect on sepsis-associated acute kidney injury (SA-AKI.) Materials and Methods: The MIMIC-III database was employed to identify patients with sepsis who had received EN. With AKI as the primary outcome variable, receiver operating characteristic (ROC) curves were utilized to calculate the optimal cut-off time of early EN (EEN). Propensity score matching (PSM) was employed to control confounding effects. Logistic regressions and propensity score-based inverse probability of treatment weighting were utilized to assess the robustness of our findings. Comparisons within the EEN group were performed. @*Results@#2364 patients were included in our study. With 53 hours after intensive care units (ICU) admission as the cut-off time of EEN according to the ROC curve, 1212 patients were assigned to the EEN group and the other 1152 to the delayed EN group. The risk of SA-AKI was reduced in the EEN group (odds ratio 0.319, 95% confidence interval 0.245–0.413, p<0.001). The EEN patients received fewer volumes (mL) of intravenous fluid (IVF) during their ICU stay (3750 mL vs. 5513.23 mL, p<0.001). The mediating effect of IVF was significant (p<0.001 for the average causal mediation effect). No significant differences were found within the EEN group (0–48 hours vs. 48–53 hours), except that patients initiating EN within 48 hours spent fewer days in ICU and hospital. @*Conclusion@#EEN is associated with decreased risk of SA-AKI, and this beneficial effect may be proportionally mediated by IVF volume.

Arthroscopic one-stage reconstruction of anterior and posterior cruciate ligaments with LARS artificial ligaments / 中华创伤骨科杂志

Objective To evaluate the efficacy of arthroscopic one-stage reconstruction of anterior and posterior cruciate ligaments with LARS artificial ligaments. Methods From October 2009 to December 2011, 8 patients with combined injury to anterior and posterior cruciate ligaments received arthroscopic one-stage reconstruction with LARS artificial ligaments. They were 7 men and one woman, aged from 26 to 52 years ( average, 35. 3 years ) . The time from injury to operation ranged from 17 to 21 days, averaging 19 days. Pre-operative and intraoperative inspections showed complete tear of both anterior and posterior cruciate ligaments. Inter national Knee Documentation Committee ( IKDC ) scoring was used at 6 months postoperation to grade the knee movement of the patients; Lysholm scoring was used at final follow-ups to evaluate the knee function. Results The operating time for this series ranged from 85 to 102 minutes ( average, 93 minutes ) . All the patients were followed up for 6 to 24 months ( average, 12 months ) . Wound infection at upper tibia occurred in one patient, which responded to debridement and screwing 4 weeks after operation. All the patients got rid of instability of the knee joint, and gained normal knee extension and fine functional recovery. At final follow-ups, the range of motion of the knee ranged from 100° to 125° ( average, 108. 4°) . Follow-ups revealed no breakage or loosening of the ligaments. By the IKDC scoring, of the 8 patients who had been graded all as D before opera-tion, one was improved into A and 7 into B. The Lysholm scores at final follow-ups averaged 86. 1+4. 8, sig-nificantly higher than the postoperative value ( 18. 7+3. 1 ) ( P < 0. 05 ) . Conclusion Arthroscopic one-stage reconstruction of anterior and posterior cruciate ligaments with LARS artificial ligaments can restore the stability of knee joint and obtain satisfactory short-term results.

Open, multicenter, phase Ⅳ clinical trial of Shenbei Guchang capsules in treatment of diarrhea type irritable bowel syndrome / 中国中药杂志

To evaluate the safety and effectiveness of Shenbei Guchang capsules in treatment of diarrhea type irritable bowel syndrome (yang deficiency of spleen and kidney) under widely used conditions, an open, multicenter, controlled, phase Ⅳ clinical trial was conducted in the drug clinical trial centers of 16 domestic hospitals. 2 123 patients from June 10, 2011 to November 29, 2012 were enrolled in the trial. Drug clinical trial was approved by Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital Ethics Committee before implementation. Before the start of trial, subjects were selected according to the research scheme and inclusion criteria, then they would step into the 14 d study after signing Informed Consent Form. All subjects were treated according to the research scheme, evaluated the conditions and filled in CFR sheet, to provide the evaluation data and information on safety and efficacy of Shenbei Guchang capsules. Shenbei Guchang capsules were used to treat diarrhea type irritable bowel syndrome in widely used conditions (2 123 cases), and 2 029 cases of them entered FAS set, cure+markedly effective in 1 921 cases, with a comprehensive curative effect rate of 94.68%; 2 010 cases of them entered PPS set, cure+markedly effective in 1 906 cases, with a comprehensive curative effect rate of 94.83%. The primary symptoms of IBS were abdominal pain and diarrhea. After treatment, both abdominal pain and diarrhea were improved, with significant differences (P<0.000 1). There were significant differences in traditional Chinese medicine symptom scores on both post-treatment day 7 and day 14 as compared with the conditions before treatment (P<0.000 1). 35 cases of adverse events occurred during the trial with an incidence of 1.65%, including 12 cases of drug-related adverse events (adverse reaction) with an incidence of 0.57%, mainly manifested as nausea, abdominal distension and dry mouth, most of which would be spontaneously relieved without any measures. No serious adverse events occurred. The commercially available Shenbei Guchang capsules are proved safe and effective for the treatment of diarrhea type irritable bowel syndrome (yang deficiency of spleen and kidney) under widely used conditions (2 123 cases), and can be continued for clinical promotion and application.

Inhibitory effects of SRT1720 on the apoptosis of rabbit chondrocytes by activating SIRT1 via p53/bax and NF-κB/PGC-1α pathways / 华中科技大学学报（医学）（英德文版）

SRT1720, a new discovered drug, was reported to activate silent information regulator 1 (SIRT1) and inhibit the chondrocyte apoptosis. However, the underlying mechanism remains elusive. In the present study, the chondrocytes were extracted from the cartilage tissues of New Zealand white rabbits, cultured in the presence of sodium nitroprusside (SNP) (2.5 mmol/L) and divided into five groups: 1, 5, 10, and 20 μmol/L SRT1720 groups and blank control group (0 μmol/L SRT1720). MTT assay was used to detect the chondrocyte viability and proliferation, and DAPI staining and flow cytometry to measure the chondrocyte apoptosis. The expression levels of SIRT1, p53, NF-κB/p65, Bax, and peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC-1α) were detected by Western blotting and the expression levels of SIRT1, type II collagen, and aggrecan mRNA by RT-PCR. The results showed that in the SRT1720-treated groups, the nuclei of chondrocytes were morphologically intact and had uniform chromatin. In the blank control group, nuclear rupture into debris was observed in chondrocytes. With the SRT1720 concentration increasing, the chondrocyte viability increased, the apoptosis rate decreased, the protein expression levels of SIRT1 and PGC-1α and the mRNA expression levels of type II collagen and aggrecan increased ({ptP}<0.05), and the expression levels of p53, NF-κB and bax decreased (P<0.05). It was suggested that SRT1720 inhibits chondrocyte apoptosis by activating the expression of SIRT1 via p53/bax and NF-κB/PGC-1α pathways.

Multiple supernumerary teeth associated with bone protuberance: a case report / 华西口腔医学杂志

Supernumerary tooth is a frequent phenomenon in clinic, but the simultaneous occurrence of many supernumerary teeth and protuberance of jaw bones is rare. A case of 5 supernumerary teeth in oral and multiple protuberances of jaw bones was reported and the relevant literatures were reviewed.

EARLY TREATMENT FOR THE FRACTURE OF MAXILLOFACIAL BONE COMBINED WITH CEREBRAL INJURY / 解放军医学杂志

To assess early treatment for fracture of the maxillofacial bone complicated by cerebral injury, 120 patients were retrospectively reviewed. The change in GCS, the incidence of stress ulceration, nosocomial pneumonia and the injury of liver or kidney were determined 1 week after fixation of the fracture of the maxillofacial bone at different stages. There was no significant influence of the time of the operation on the severity of brain injury and the incidence of the complications. It is our assertion that the bone fracture could be fixed at an earlier stage, and RIMF is a kind of satisfactory fixation method.