Nutritional evaluation and implementation of enteral nutrition in PICU / 中国小儿急救医学

Most critically ill children are in a state of severe stress and prone to malnutrition, which lead to a decline in the body′s resistance to disease and repair ability, thus aggravating the condition of children.After the initial support treatment of multiple organ functions, nutritional support should be considered as soon as possible to improve the metabolic status and supplement the metabolic needs of children, which can improve the nutritional status of children.Reasonable nutritional support treatment can not only improve nutritional status of the body, but also benefit the recovery and prognosis of the disease.Enteral nutrition is highly valued because it conforms to the gastrointestinal physiology and improves the mucosal barrier function of gastrointestinal tract.

FOXO1-miR-506 axis promotes chemosensitivity to temozolomide and suppresses invasiveness in glioblastoma through a feedback loop of FOXO1/miR-506/ETS1/FOXO1 / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

To explore the role of forkhead box protein O1 (FOXO1) in the progression of glioblastoma multiforme (GBM) and related drug resistance, we deciphered the roles of FOXO1 and miR-506 in proliferation, apoptosis, migration, invasion, autophagy, and temozolomide (TMZ) sensitivity in the U251 cell line using in vitro and in vivo experiments. Cell viability was tested by a cell counting kit-8 (CCK8) kit; migration and invasion were checked by the scratching assay; apoptosis was evaluated by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining and flow cytometry. The construction of plasmids and dual-luciferase reporter experiment were carried out to find the interaction site between FOXO1 and miR-506. Immunohistochemistry was done to check the protein level in tumors after the in vivo experiment. We found that the FOXO1-miR-506 axis suppresses GBM cell invasion and migration and promotes GBM chemosensitivity to TMZ, which was mediated by autophagy. FOXO1 upregulates miR-506 by binding to its promoter to enhance transcriptional activation. MiR-506 could downregulate E26 transformation-specific 1 (ETS1) expression by targeting its 3'-untranslated region (UTR). Interestingly, ETS1 promoted FOXO1 translocation from the nucleus to the cytosol and further suppressed the FOXO1-miR-506 axis in GBM cells. Consistently, both miR-506 inhibition and ETS1 overexpression could rescue FOXO1 overactivation-mediated TMZ chemosensitivity in mouse models. Our study demonstrated a negative feedback loop of FOXO1/miR-506/ETS1/FOXO1 in GBM in regulating invasiveness and chemosensitivity. Thus, the above axis might be a promising therapeutic target for GBM.

Correlation between ARID5B Gene SNP and MTX Resistance in Children with ALL / 中国实验血液学杂志

OBJECTIVE@#To investigate the correlation between single-nucleotide polymorphism (SNP) of ARID5B gene and resistance to methotrexate (MTX) in children with acute lymphoblastic leukemia (ALL).@*METHODS@#A total of 144 children with ALL who were treated in General Hospital of Ningxia Medical University from January 2015 to November 2021 were enrolled and divided into MTX resistant group and non-MTX resistant group, with 72 cases in each group. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) technology was used to measure the SNP of ARID5B gene in all children and analyze its correlation with MTX resistant.@*RESULTS@#There were no significant differences in the genotype and gene frequency of rs7923074, rs10821936, rs6479778, and rs2893881 between MTX resistant group and non-MTX resistant group (P>0.05). The frequency of C/C genotype in the MTX resistant group was significantly higher than that in the non-MTX resistant group, while the frequency of T/T genotype was opposite (P<0.05). The frequency of C allele in the MTX resistant group was significantly higher than that in the non-MTX resistant group, while the frequency of T allele was opposite (P<0.05). Multivariate logistic regression analysis showed that ARID5B gene rs4948488 TT genotype and T allele frequency were risk factors for MTX resistant in ALL children (P<0.05).@*CONCLUSION@#The SNP of ARID5B gene is associated with MTX resistant in ALL children.

Early warning value of laboratory parameters in patients with severe hemorrhagic fever with renal syndrome / 中华传染病杂志

Objective:To explore the early warning value of laboratory parameters in patients with severe hemorrhagic fever with renal syndrome (HFRS).Methods:The clinical data of 101 patients with HFRS hospitalized in the Department of Infectious Diseases of the First Hospital of Changsha from December 2013 to December 2020 were collected and analyzed. The differences of clinical routine laboratory parameters between mild and severe HFRS patients were compared and analyzed. The statistical methods including independent sample t test, rank sum test, chi-square test, Spearman rank correlation analysis, logistic regression analysis and receiver operator characteristic curve were used. Results:Among 101 patients with HFRS, 38 cases were in severe group and 63 cases in mild group. White blood cell count, aspartate aminotransferase (AST), prothrombin time (PT), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum creatinine, urea nitrogen and D-dimer in severe group were higher than those in mild group, while platelet count and albumin were lower than those in mild group, and the differences were all statistically significant ( t=8.61, Z=-3.76, t=4.19, Z=-2.84, Z=-7.23, t=4.98, t=4.64, t=36.02, Z=-5.49 and t=4.14, respectively; all P<0.050). Severe HFRS was positively correlated with white blood cell count, AST, PT, activated partial thromboplastin time (APTT), CK-MB, serum creatinine, urea nitrogen and D-dimer ( r=0.629, 0.376, 0.549, 0.471, 0.723, 0.500, 0.341 and 0.588, respectively; all P<0.001). White blood cell count, albumin, PT and CK-MB were independent influencing factors for the progression of severe HFRS (odds ratio ( OR)=0.922, 1.374, 0.730 and 0.938, respectively; all P<0.050). The area under curve (AUC) of white blood cell count, albumin, PT and CK-MB for the early warning prediction of severe HFRS were 0.869, 0.739, 0.785 and 0.931, respectively, with the optimal thresholds for prediction of 26.38×10 9/L, 26.05 g/L, 15.95 s and 35.5 U/L, respectively.And the AUC of the combined detection of the above laboratory parameters was 0.950, with the sensitivity of 87.3% and the specificity of 94.7%. Conclusions:White blood cell count, albumin, PT and CK-MB could be used as independent influencing factors for early warning of severe HFRS. Combined detection is more helpful for early warning of severe HFRS than single detection.

Trends in mortality of cardiovascular and cerebrovascular diseases and effects on life expectancy in Yuhang District from 2010 to 2020 / 预防医学

Objective @#To investigate the mortality of cardiovascular and cerebrovascular diseases and to examine the effects on life expectancy among residents in Yuhang District of Hangzhou City from 2010 to 2020, so as to provide insights into the management of cardiovascular and cerebrovascular diseases.@*Methods@#The mortality surveillance data of cardiovascular and cerebrovascular diseases of registered residents in Yuhang District from 2010 to 2020 were collected from Zhejiang All-cause Death Surveillance System. The crude mortality, standardized mortality, annual percent change ( APC ), Fulfillment index, life expectancy, cause-eliminated life expectancy and years of life lost, and the mortality of cardiovascular and cerebrovascular diseases and the impact on life expectancy were analyzed.@*Results@#A total of 21 761 deaths occurred due to cardiovascular and cerebrovascular diseases in Yuhang District from 2010 to 2020, and the annual average crude and standardized mortality rates of cardiovascular and cerebrovascular diseases were 206.14/105 and 129.62/105, respectively. The annual crude and standardized mortality of cardiovascular and cerebrovascular diseases both appeared a tendency towards a decline from 2010 to 2020, with APC of -3.63% and -5.45%, respectively ( P<0.05 ), and the Fulfillment index showed a tendency towards a reduction in residents at ages of 50 to 79 years ( P<0.05 ). The mean life expectancy and cause-eliminated life expectancy were 82.71 and 88.39 years in Yuhang District from 2010 to 2020, which both appeared a tendency towards a rise, both with APC of 0.50% ( P<0.05 ). The years of life lost were 5.02 to 6.47 years due to cardiovascular and cerebrovascular diseases, and the life loss rates were 6.00% to 7.73%.@*Conclusions@#The mortality of cardiovascular and cerebrovascular diseases appeared a tendency towards a decline decreased and the cause-eliminated life expectancy appeared a tendency towards a rise in Yuhang District from 2010 to 2020. Intensifying the management of cardiovascular and cerebrovascular diseases death may increase the life expectancy.

Clinical Characteristics and Prognosis of 76 Lung Adenocarcinoma Patients Harboring EGFR Mutations with Pleural Effusion at Initial Diagnosis: A Single-center Retrospective Study / 中国肺癌杂志

BACKGROUND@#Malignant pleural effusion is one of the common clinical manifestations of patients with lung adenocarcinoma. Patients with pleural effusion at the initial diagnosis of lung adenocarcinoma usually indicate poor prognosis. Epidermal growth factor receptor (EGFR) mutations mainly occur in patients with lung adenocarcinoma. Patients with different mutant subtypes have different prognosis. The clinical characteristics and prognostic factors of patients with EGFR mutated lung adenocarcinoma of different molecular subtypes combined with pleural effusion at initial diagnosis are still unclear. This study was designed to explore the clinical characteristics and prognostic factors of these patients in order to provide management recommendations for them.@*METHODS@#A retrospective analysis of the clinical characteristics, treatment, outcomes and progression-free survival (PFS) of first-line treatment in patients with EGFR mutated lung adenocarcinoma combined with pleural effusion at initial diagnosis admitted to Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital from January 2012 to June 2021 was performed. Pearson's chi-square test or Fisher's exact test were performed for comparison between groups. Kaplan-Meier method was performed for survival analysis and Cox proportional risk regression model was performed for multivariate analysis.@*RESULTS@#76 patients met the inclusion criteria in this study. The incidences of EGFR classical mutations 19del, 21L858R and non-classical mutations were 46.0%, 38.2% and 15.8%, respectively among these patients. There was no significant difference between the three mutations in terms of gender, age, presence of dyspnea at presentation, whether other distant metastases were combined, site of pleural effusion, volume of pleural effusion, presence of other combined effusions, tumor-node-metastasis (TNM) stage, presence of other gene mutations, and treatment of pleural effusion (P>0.05). In patients with EGFR classical mutations 19del or 21L858R or non-classical mutations subtype, the proportion of chemotherapy in first-line regimens were 17.1%, 20.7% and 58.3%, respectively (P=0.001); and first-line disease control rates were 94.3%, 75.9% and 50%, respectively (P=0.003); pleural effusion control rates were 94.3%, 79.3% and 66.7%, respectively (P=0.04); PFS were 287 d, 327 d and 55 d, respectively (P=0.001). Univariate analysis showed that EGFR mutation subtype, control of pleural effusion, first-line treatment agents, and first-line treatment efficacy were significantly associated with PFS (P<0.05). Cox multifactorial analysis showed that only EGFR mutation subtype and first-line treatment efficacy were independent prognostic factors for PFS (P<0.05).@*CONCLUSIONS@#PFS was significantly better for classical mutations than for non-classical mutations in patients with EGFR mutated lung adenocarcinoma combined with pleural effusion at initial diagnosis. Improving the efficacy of first-line therapy is the key to improve the prognosis of these patients.

Characteristics and Clinical Implication of UGT1A1 Heterozygous Mutation in Tumor / 中国肺癌杂志

BACKGROUND@#The literature recommends that reduced dosage of CPT-11 should be applied in patients with UGT1A1 homozygous mutations, but the impact of UGT1A1 heterozygous mutations on the adverse reactions of CPT-11 is still not fully clear.@*METHODS@#A total of 107 patients with UGT1A1 heterozygous mutation or wild-type, who were treated with CPT-11 from January 2018 to September 2021 in Peking University Third Hospital, were retrospectively enrolled. The adverse reaction spectra of patients with UGT1A1*6 and UGT1A1*28 mutations were analyzed. Adverse reactions were evaluated according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) 5.0. The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The genotypes of UGT1A1*6 and UGT1A1*28 were detected by digital fluorescence molecular hybridization.@*RESULTS@#There were 43 patients with UGT1A1*6 heterozygous mutation, 26 patients with UGT1A1*28 heterozygous mutation, 8 patients with UGT1A1*6 and UGT1A1*28 double heterozygous mutations, 61 patients with heterozygous mutation at any gene locus of UGT1A1*6 and UGT1A1*28. Logistic regression analysis showed that the presence or absence of vomiting (P=0.013) and mucositis (P=0.005) was significantly correlated with heterozygous mutation of UGT1A1*28, and the severity of vomiting (P<0.001) and neutropenia (P=0.021) were significantly correlated with heterozygous mutation of UGT1A1*6. In colorectal cancer, UGT1A1*6 was significantly correlated to diarrhea (P=0.005), and the other adverse reactions spectrum was similar to that of the whole patient cohort, and efficacy and prognosis were similar between patients with different genotypes and patients treated with reduced CPT-11 dosage or not.@*CONCLUSIONS@#In clinical use, heterozygous mutations of UGT1A1*6 and UGT1A1*28 are related to the risk and severity of vomiting, diarrhea, neutropenia and mucositis in patients with Pan-tumor and colorectal cancer post CPT-11 therpy. In colorectal cancer, UGT1A1*6 is significantly related to diarrhea post CPT-11 use, efficacy and prognosis is not affected by various genotypes or CPT-11 dosage reduction.

Value of liver/spleen stiffness combined with serum adenosine deaminase in predicting severe esophageal varices in patients with hepatitis B cirrhosis / 临床肝胆病杂志

ObjectiveTo investigate the value of liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) based on FibroTouch (FT) transient elastography combined with serum adenosine deaminase (ADA) in predicting severe esophageal varices (EV) in patients with hepatitis B cirrhosis. MethodsRelated clinical data were collected from 120 patients with hepatitis B cirrhosis who attended Department of Infectious Diseases, Changsha First Hospital, from December 2017 to June 2020. FT was used to measure LSM and SSM, and related examinations were performed, including electronic gastroscopy and serum levels of ADA, hemoglobin, albumin, alanine aminotransferase, and aspartate aminotransferase and platelet count. The serum liver fibrosis markers aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase/alanine aminotransferase ratio (AAR), and fibrosis-4 (FIB-4) were calculated. According to the severity of EV under gastroscopy, the subjects were divided into severe EV group with 58 patients and non-severe EV (without EV or with mild-to-moderate EV) group with 62 patients. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used to investigate the correlation of LSM, SSM, and ADA with severe EV. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of LSM, SSM, and ADA in the diagnosis of severe EV, and sensitivity and specificity were calculated. A multivariate binary logistic regression analysis was performed to calculate the area under the ROC curve (AUC) of the combined indicators, and the Z test was used for comparison of AUC. ResultsThere were significant differences in LSM, SSM, and ADA between the two groups (all P＜0.05). LSM, SSM, and ADA were positively correlated with severe EV, with a correlation coefficient of 0.686, 0.743, and 0.723, respectively (all P＜0.05). The optimal cut-off value was 22.35 kPa for LSM, 45.25 kPa for SSM, and 34.50 U/L for ADA in predicting severe EV, with an AUC of 0746, 0.802, and 0.791, respectively, a sensitivity of 82.8%, 75.9%, and 58.6%, respectively, and a specificity of 65.6%, 77.4%, and 90.2%, respectively. LSM+ADA, SSM+ADA, and LSM+SSM+ADA had an AUC of 0.826, 0.853, and 0.907, respectively, in predicting severe EV (all P＜0.05). ConclusionLiver/spleen stiffness combined with serum ADA has a good value in predicting severe EV, which can provide a preliminary diagnostic basis for severe EV in patients who refuse to undergo gastroscopy.

Role of T helper 17 cell/regulatory T cell imbalance in the progression of HBV-related liver diseases / 临床肝胆病杂志

Patients with chronic hepatitis B (CHB) often have immune-mediated liver injury, and it is considered that the interaction between viral infection and immune response is an important cause of disease progression. CHB can progress to liver fibrosis, liver cirrhosis, and even hepatocellular carcinoma (HCC). This article reviews the discovery of T helper 17 (Th17) cells and regulatory T (Treg) cells, describes their own features, and elaborates on their role and mechanism of action in maintaining the stability of the immune system. This article also analyzes the role of Th17/Treg cell imbalance in CHB, liver fibrosis, liver cirrhosis, and HCC and points out that Th17/Treg cell imbalance may promote the aggravation of HBV-related liver diseases.

What's new in trauma 2020 / 中华创伤杂志(英文版)

Throughout the past 2020, the pandemic COVID-19 has caused a big global shock, meanwhile it brought a great impact on the public health network. Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed. However, the trauma treatment of special population (geriatric patients and patients taking anticoagulant drugs) has received inadequate attention. Due to the high mortality following severe traumatic hemorrhage, hemostasis and trauma-induced coagulopathy are the important concerns in trauma treatment. Sepsis is another topic should not be ignored when we talking about trauma. COVID-19 itself is a special kind of sepsis, and it may even be called as serious systemic infection syndrome. Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma, or in intensive care and infection, etc. This article reviewed the research progress in areas including trauma emergency care, trauma bleeding and coagulation, geriatric trauma and basic research of trauma within 2020.

Annual review of Chinese Journal of Traumatology 2020 / 中华创伤杂志(英文版)

The year 2020 is an extremely unusual year. The world lost more than one million lives due to the attack of COVID-19. Economic production has been greatly reduced, and daily activities are largely restricted. Luckily the work of Chinese Journal of Traumatology (CJTEE) has not been adversely affected. 2020 is a harvest year for the journal, which (1) was included in the high-quality academic journals by China Association for Science and Technology; (2) cover of each issue is newly designed; (3) submission increased by about 60% with more countries and regions covered; (4) usage in the ScienceDirect database exceeded a million; (5) the CiteScore rises to more than 2.0 the first time. This study reviewed the articles published in the year 2020 by CJTEE.

Comparison of cognitive impairment in patients with intracranial artery severe stenosis or occlusion in anterior and posterior circulations / 中华行为医学与脑科学杂志

Objective:To investigate the impact of severe stenosis or occlusion of intracranial artery in anterior and posterior circulation on cognitive function in patients.Methods:Patients with Alberta stroke program early CT score(ASPECTS) and posterior circulation ASPECTS(pc-ASPECTS) of 10 were selected, and neuropsychological assessments were performed in 30 patients with intracranial artery severe stenosis or occlusion in anterior posterior circulation (anterior circulation group)and 23 patients with intracranial artery severe stenosis or occlusion in posterior circulation(posterior circulation group) and 53 control subjects using MMSE, MoCA and multidimensional psychological assessment system.Results:The scores of time orientation(control group: 5.00(5.00, 10.00), anterior circulation group: 5.00(5.00, 5.00), posterior circulation group: 5.00(5.00, 5.00)), attention (control group: 6.00(5.00, 6.00), anterior circulation group: 5.00(4.00, 6.00), posterior circulation group: 5.00(4.00, 6.00)) and word discrimination test (control group: 70.00(60.00, 82.00), anterior circulation group: 48.00(20.50, 67.50), posterior circulation group: 53.50(33.25, 75.25)) were significantly lower in patients of anterior circulation group and posterior circulation group than those of control group(all P<0.05); The scores of memory(control group: 3.00(2.00, 3.00), anterior circulation group: 2.00(1.00, 3.00), MMSE(control group: 29.00(28.00, 30.00), anterior circulation group: 28.00(26.75, 29.00)) and simple subtraction(control group: 72.00(53.50, 85.50), anterior circulation group: 53.50(37.00, 73.00)) were significantly lower in patients of anterior circulation group than those of control group(all P<0.05); The scores of visuospatial executive function(control group: 4.00(3.00, 5.00), posterior circulation group: 3.00(2.00, 4.00)) and digital sequence reasoning(control group: 74.50(51.50, 83.00), posterior circulation group: 42.00(28.00, 70.00)) were significantly lower in patients of posterior circulation group than those of control group(all P<0.05); The scores of spatial working memory test(control group: 77.50(51.75, 89.00), anterior circulation group: 56.50(34.00, 72.50), posterior circulation group: 31.00(18.50, 58.00))were significantly lower in patients of posterior circulation group than those of the other two groups(all P<0.05). Conclusion:Severe stenosis or occlusion of intracranial arteries in anterior and posterior circulation is associated with cognitive impairment in patients.Vascular lesions in different parts can lead to cognitive impairment in different aspects.

Covered Stenting Is an Effective Option for Traumatic Carotid Pseudoaneurysm with Promising Long-Term Outcome

Objective@#: Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes. @*Methods@#: Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra- and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Longterm outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography. @*Results@#: Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months. @*Conclusion@#: Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.

Comparison of clinical effect of two different Kirschner wire fixations after closed reduction on supracondylar fracture of humerus in children with GartlandⅡand Ⅲ / 中国骨伤

OBJECTIVE@#To compare clinical effect of Kirschner wire radial sector fixation and bilateral ulnar radial cross fixation in treating supracondylar fracture of humerus in children after closed reduction.@*METHODS@#From March 2017 to December 2018, 60 children with supracondylar fracture of humerus treated with closed reduction and Kirschner wire fixation were analyzed retrospectively, and divided into two groups according to different needling methods. Thirty patients in radial three needles fan fixation group (group A), including 19 males and 11 females, aged from 2 to 10 years old with an average of (5.00±2.10) years old, 21 patients were typeⅡ and 9 patients were typeⅢ according to Gartland classification. Thirty patients in cross fixationwith 3 needles on both ulnar and radial side group(group B), including 22 males and 8 females, aged from 1 to 9 years old with an average of(5.13±2.08) years old, 19 patients were typeⅡand 11 patients were typeⅢ. Healing time of fracture, postoperative complications, elbow flexion and extension activity, forearm rotation activity recovery, elbow carrying angle and angle loss after operation between two groups were observed and compared. Mayo Elbow function score at the final following up was used to evaluate clinical efficacy.@*RESULTS@#All patients were followed up, while there were no significant difference in follow-up time and fracture healing time between two groups (@*CONCLUSION@#Closed reduction and Kirschner wire at the early stage of fracture has advantages of less trauma, easy reduction, stable fixation, and early functional exercise. The risk of iatrogenic ulnar nerve injury caused by fan-shaped fixation of three radial needles is less than that of cross fixation of three radial needles.

From H1N1 to 2019-nCoV, what do we learn? / 中华创伤杂志(英文版)

The COVID-19 pandemic is still raging across the world. Everyday thousands of infected people lost their lives. What is worse, there is no specific medicine and we do not know when the end of the pandemic will come. The nearest global pandemic is the 1918 influenza, which caused about 50 million deaths and partly terminate the World War Ⅰ. We believe that no matter the virus H1N1 for the 1918 influenza or 2019-nCoV for COVID-19, they are essentially the same and the final cause of death is sepsis. The definition and diagnostic/management criteria of sepsis have been modified several times but the mortality rate has not been improved until date. Over decades, researchers focus either on the immunosuppression or on the excessive inflammatory response following trauma or body exposure to harmful stimuli. But the immune response is very complex with various regulating factors involved in, such as neurotransmitter, endocrine hormone, etc. Sepsis is not a kind of disease, instead a misbalance of the body following infection, trauma or other harmful stimulation. Therefore we should re-think sepsis comprehensively with the concept of systemic biology, i.e. inflammationomics.

The Effects and Management of Viral Pneumonia on Lung Cancer Patients / 中国肺癌杂志

The worldwide epidemic of three coronaviruses and one influenza virus in 21st century have seriously threatened human health. Infection with these viruses can cause respiratory symptoms. The patients with lung cancer are more susceptible to viral infection and have a worse prognosis due to the advanced age and the systemic immunosuppressive state caused by malignancy itself and the anticancer treatments. In addition, without sufficient clinical awareness, a missed diagnosis of viral pneumonia may occur due to the fever and respiratory symptoms caused by lung cancer and its secondary diseases. Furthermore, control measures against viral outbreaks may interfere with routine diagnosis and treatment of lung cancer patients. Therefore, scientific protection and individualized management of lung cancer patients are particularly important during virus epidemic prevention and control. Here, we systematically reviewed the epidemiological and clinical characteristics of viral pneumonia, its impact on patients with lung cancer and the differential diagnosis of lung cancer-related respiratory manifestations, aiming to provide guidance for the individual management of lung cancer patients during the prevention and control of viral pneumonia epidemic.

Interview of Rehabilitation Exercise for Breast Cancer Patients to Prevent Upper Limb Lymphedema / 中国康复理论与实践

Objective:To investigate the experience of rehabilitation exercise for the prevention of upper limb lymphedema in patients with breast cancer rehabilitation, to provide feasible and operative activities and exercise rehabilitation information for clinical health care personnel to guide exercise rehabilitation programs for breast cancer patients after discharge. Methods:From July, 2017 to June, 2018, individualized face-to-face in-depth interviews were performed in breast cancer rehabilitation patients who had been performing upper limb lymphedema exercise for more than three times a week. The content analysis was used to analyze the data. Results:Totally, 13 candidates for breast cancer rehabilitation were selected to provide experience, and their experience of breast cancer rehabilitation in preventing upper limb lymphedema were extracted, including the type, name, time, frequency and intensity of exercise, precautions, and detailed operational experience in sports rehabilitation. Conclusion:The exercise rehabilitation experience of breast cancer rehabilitation patients in preventing upper limb lymphedema have been drawn, which may enrich and refine the current behavior guidelines for breast cancer rehabilitation patients to prevent upper limb lymphedema, and help to deepen the prevention of breast cancer rehabilitation. The understanding of the actual situation of upper limb lymphedema provides a reference for preventive interventions for the development of lymphedema in medical staff.

Basis of the replacement of short peripheral intravenous catheters for clinical nurses: a qualitative study / 中国实用护理杂志

Objective@#To investigate the current status and influencing factors of basis of the replacement of short peripheral intravenous catheters for clinical nurses and explore the obstruction of the latest guide promoted in practice.@*Methods@#The qualitative research method was adopted, and semistructured interviews were used to interview 11 clinical nurses. Data were analyzed by the method of category analysis.@*Results@#Although the clinical nurses mainly used the national standards to do practical operation, they preferred to carry out catheter replacement according to clinical indications. The difference between the latest guide and the national standards was the main obstruction in the practical promotion of the latest guide.@*Conclusions@#The removal of short peripheral intravenous catheters according to clinical indications is more suitable for clinical practice. Further improving the standards of intravenous therapy in China has become a fundamental measure to solve the contradictions of work of clinical nurses, improve patients′ medical experience and save medical resources.

Meta-analysis and trial sequential analysis of modified Sangbaipi Decoction for treating acute exacerbation of chronic obstructive pulmonary disease / 中国中药杂志

The randomized controlled trials about modified Sangbaipi Decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) patients were collected from 7 databases( PubMed,CNKI,et al) from the establishment to December 5,2018. All the studies searched were strictly evaluated. Literatures were independently screened by two researchers according to the inclusion and exclusion criteria,and the methodological quality of included studies was evaluated. To systematically review the efficacy of modified Sangbaipi Decoction in treating AECOPD,the Meta-analysis and trial sequential analysis were conducted by using Stata/SE 14. 0 and TSA 0. 9. 5. 10 Beta,respectively. A total of 25 RCTs involving 1 784 patients were included. According to the results of Meta-analysis,compared with the control groups,the trial group had a higher clinical efficacy in AECOPD patients( RR =1. 18,95%CI[1. 13,1. 22],P = 0),improved pulmonary functions including forced expiratory volume in one second( FEV1,WMD =0. 44,95%CI[0. 01,0. 87],P = 0. 046),and the forced vital capacity( FVC,WMD = 0. 42,95%CI[0. 07,0. 22],P = 0),but no statistical significance in the percentage of forced expiratory volume in one second( FEV1%,P = 0. 067) and the first seconds breathing volume percentage of forced vital capacity( FEV1/FVC,P = 0. 238); it improved the arterial oxygen partial pressure( PaO2,SMD =0. 85,95%CI[0. 41,1. 30],P = 0) and decreased the arterial partial pressure of carbon dioxide( PaCO2,SMD =-0. 94,95% CI[-1. 70,-0. 18],P= 0. 016); and in terms of inflammatory markers,it improved the white blood cell count( WBC,WMD=-0. 94,95%CI[-1. 17,-0. 70],P = 0). The trial sequential analysis showed that the studies included with the improvement of clinical efficacy had passed the conventional and TSA threshold,so as to further confirm the evidence. According to the findings,in addition to conventional Western medicine treatment,modified Sangbaipi Decoction could improve the efficiency in treating acute exacerbation patients with chronic obstructive pulmonary disease,increase PaO2,and decrease PaCO2,with a high safety but no effect on pulmonary function. However,restricted by the low quality of studies included,this conclusion shall be further verified by more high-quality clinical trials.

Therapeutic effects on primary dysmenorrhea treated with moxibustion at Shenque (CV 8) and warm needling at Guanyuan (CV 4) and Sanyinjiao (SP 6) / 中国针灸

OBJECTIVE@#To explore the clinical effects on primary dysmenorrhea treated with moxibustion at Shenque (CV 8) and warm needling at Guanyuan (CV 4) and Sanyinjiao (SP 6).@*METHODS@#A total of 120 patients with primary dysmenorrhea were randomized into an observation group and a control group, 60 cases in each one. In the control group, the warm needling technique was used at Guanyuan (CV 4) and Sanyinjiao (SP 6). In the observation group, besides the same treatment as the control group, moxibustion was added at Shenque (CV 8). The treatment was given for 4 menstrual cycles consecutively. Before and after treatment, the score of the severity and the score of the total frequency in the retrospective scale of dysmenorrhea symptoms as well as the score of the visual analog scale (VAS) were recorded and compared in the patients between the two groups. Additionally, the safety of the two therapeutic methods was evaluated.@*RESULTS@#After treatment, the score of severity and the score of total frequency as well as VAS score of menstrual pain were all reduced as compared with those before treatment in the patients of the two groups (all 0.05).@*CONCLUSION@#The combined treatment of moxibustion at Shenque (CV 8) with the warm needling technique at Guanyuan (CV 4) and Sanyinjiao (SP 6) achieves the better clinical effects on primary dysmenorrhea as compared with the simple application of the warm needling technique at Guanyuan (CV 4) and Sanyinjiao (SP 6). This therapy is safety in clinical practice.