Nasal Feeding Research Articles

Nasal Feeding Tubes Are Associated with Fewer Adverse Events than Feeding via Ostomy in Hospitalized Patients Receiving Enteral Nutrition

BackgroundSurgical feeding ostomies (eg, gastrostomy) have become required by many nursing facilities for all patients receiving enteral nutrition, whether for short- or long-term use. These policies lack supportive evidence. Comparisons of adverse event rates between surgical and natural orifice tubes are few and lacking in the inpatient setting. Additionally, we hypothesize that adverse events related to feeding tubes are underreported. We sought to quantify adverse events to test the relative safety of surgical feeding ostomies and natural orifice (eg. nasogastric or orogastric) feeding tubes in hospitalized patients. MethodsThis was a prospective observational cohort study of enterally fed inpatients using semiweekly focused physical examination, scripted survey, and chart review. ResultsAll tube-fed patients admitted to a large, urban, academic hospital received semiweekly bedside evaluation and chart review over a 9-week period (n = 226 unique patients, mean 6.25 visits each, total 1118 observations). Demographics were comparable between 148 subjects with natural orifice and 113 subjects with surgical feeding tubes. A higher incidence of adverse events was observed with surgical tubes (3.34 vs 1.25 events per 100 subject days, P < .001). Only 50% of all adverse events were documented in the medical record. More patients with surgical tubes were discharged to skilled nursing facilities (58% vs 24%). ConclusionsSurgical feeding tubes are associated with significantly higher in-hospital adverse event rates when compared with natural orifice (nasal or oral) feeding tubes. Policies requiring surgical feeding ostomies should be reevaluated.

Determinants of nutritional status and outcome in adults with RCSE: a retrospective cohort study

BackgroundThis study aimed to investigate the association between nutritional characteristics in patients with refractory convulsive status epilepticus.MethodsWe retrospectively enrolled 73 patients with refractory convulsive status epilepticus over 18 years of age at the West China Hospital between January 2017 and May 2019. All patients met the 2016 International League Against Epilepsy diagnostic criteria for refractory convulsive status epilepticus. A logistic regression model was used to evaluate the association between malnutrition and refractory convulsive status epilepticus.ResultsOf the 73 patients with refractory convulsive status epilepticus, 33 (45.21 %) suffered from malnutrition during hospitalization, and duration of hospitalization in days (OR = 1.251; 95 % CI,–1.067–1.384; P = 0.007), nasal feeding (OR = 22.623; 95 % CI: 1.091-286.899; P = 0.013), and malnutrition on admission (OR = 30.760; 95 % CI: 1.064–89.797; P = 0.046) were significantly associated with malnutrition in patients with refractory convulsive status epilepticus.ConclusionsMalnutrition is a common complication during hospitalization in patients with refractory convulsive status epilepticus. The duration of hospitalization (days), nasal feeding, and malnutrition at admission are associated with malnutrition in patients with refractory convulsive status epilepticus. Further longitudinal studies are needed to identify the relationship between refractory convulsive status epilepticus and adverse outcomes.

Nursing Intervention and Effect Evaluation of Long-term Nasal Feeding for Bedridden Patients with Senile Dementia

Nursing Intervention and Effect Evaluation of Long-term Nasal Feeding for Bedridden Patients with Senile Dementia

Effect of Predictive Nursing on Complications of Senile Dementia Patients with Nasal Feeding

Effect of Predictive Nursing on Complications of Senile Dementia Patients with Nasal Feeding

Effect of Nursing Intervention on Prevention of Aspiration Pneumonia in Senile Dementia Patients with Nasal Feeding

Effect of Nursing Intervention on Prevention of Aspiration Pneumonia in Senile Dementia Patients with Nasal Feeding

Network Meta-analysis of oral or nasal feeding with Chinese patent medicine in treatment of hypertensive intracerebral hemorrhage

The effect of oral or nasal feeding with Chinese patent medicine on hypertensive intracerebral hemorrhage was systematically evaluated by using the method of network Meta-analysis. Four Chinese databases(CNKI, VIP, Wanfang, CBM), three English databases(Medline, EMbase, Cochrane Library) and ClinicalTrials.gov were retrieved through computers. According to the inclusion criteria and exclusion criteria, randomized controlled trials(RCTs) of Chinese patent medicine combined with Western medicine in the treatment of hypertensive intracerebral hemorrhage were screened out according to the inclusion criteria and exclusion criteria. The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies, and Stata 16.0 software was used to analyze the outcome indicators. A total of 3 888 literatures were retrieved, and 30 studies involving 6 kinds of Chinese patent medicines were finally included. The total sample size was 2 758 cases, including 1 401 cases in the treatment group and 1 357 cases in the control group. According to the results of network Meta-analysis,(1)in terms of improving the degree of nerve function defect, the order of Chinese patent medicines was conventional Western medicine combined with Xiaoyukang Capsules&gt;combined with Tongxinluo Capsules&gt;combined with Naoxuekang Oral Liquid&gt;combined with Naoxueshu Oral Liquid&gt;combined with Angong Niuhuang Pills&gt;conventional Western medicine;(2)in terms of reducing the amount of residual cerebral hematoma, the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid&gt;combined Xiaoyukang Capsules&gt;combined Naoxuekang Oral Liquid&gt;conventional Western medicine;(3)in terms of improving ability of daily living, the order of Chinese patent medicines was conventional Western medicine combined with Shenzhi Huoxue Capsules&gt;combined with Angong Niuhuang Pills&gt;combined with Naoxueshu Oral Liquid&gt;conventional Western medicine;(4)in terms of improving total effective rate, the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid&gt;combined with Xiaoyukang Capsules&gt;combined with Angong Niuhuang Pills=combined with Naoxuekang Oral Liquid&gt;combined Tongxinluo Capsules&gt;conventional Western medicine treatment. The results showed that in addition to conventional Western medicine therapy, the combined use with Chinese patent medicine can improve the clinical efficacy in the treatment of hypertensive intracerebral hemorrhage. However, due to the differences in the number and quality of various Chinese patent medicines included in the studies, and the lack of direct comparison of Chinese patent medicines, the ranking results still need to be verified by multi center, large-sample-size randomized double-blind trials in the future, so as to provide more reliable evidence support for clinical drug use.

Effects of radiotherapy in patients with nasopharyngeal carcinoma under continuous-discrete mixed mathematical model and comparison on the fungal and pathogen infection indexes before and after nutritional supplementation

The study aimed to explore the effects of radiotherapy on nasopharyngeal carcinoma (NPC) patients before and after nutritional supplementation, and the correlation between nutritional supplementation and infections, using continuous-discrete mixed mathematical model. Specifically, 398 NPC patients were selected based on information and health data. They all accepted radiation therapy, and enteral nutrition was provided through nasal feeding during the radiotherapy. Then, nutritional indicators, and infections were compared before and after nutritional supplementation. The results showed that, the radio-sensitivity coefficient and the age of tumor cells affected radiotherapy effects. After nutritional supplementation, the patient's Hemoglobin (Hb) was 139.26 ± 12.87 g/L, the serum albumin (ALB) was 45.65 ± 3.84 g/ L, the Lymphocyte (LYM) was 1.96 ± 0.68 (×109/L), and the Body Mass Index (BMI) was 26.12 ± 2.63 (kg/m2). Among them, Hb, LYM, and BMI were notably different from those before treatment (P < 0.05). After nutritional supplementation, the infection rates of Candida albicans, Candida tropicalis, Saccharomyces cerevisiae, Candida, and actinomycetes were reduced to 26.09%, 17.39%, 9.78%, 5.43%, and 1.09%, respectively, showing notable differences (P < 0.05); the infection rates of Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, pyogenic chain Coccus, Staphylococcus epidermidis, and Streptococcus viridans were reduced to 15.27%, 12.21%, 3.82%, 6.11%, 0.76%, and 0.76%, respectively, showing notable differences (P < 0.05). In conclusion, the continuous-discrete mixed mathematical model can simulate the effects of radiotherapy on NPC patients. Nutritional supplementation during radiotherapy can reduce the infection rates, thus improving the prognosis of NPC patients.

Clinical effects of intermittent oro-esophageal tube feeding combined with Xuanqiaoliyan decotion in stroke patients with dysphagia

To investigate the clinical effects of intermittent oro-esophageal tube feeding (IOE) combined with Xuanqiaoliyan decotion in stroke patients with dysphagia. A prospective study was conducted. Stroke patients with dysphagia admitted to Yidu Central Hospital Affiliated Hospital of Weifang Medical University from January 2018 to December 2019 were enrolled. According to the simple random sampling method, the patients were divided into control group and observation group, with 50 cases in each group. The control group was given routine swallowing function training, including low-frequency pulse electrical stimulation, swallowing function training and acupuncture treatment. The observation group was given IOE and Xuanqiaoliyan decoction (prescription composition: Rhizoma acori tatarinowii 15 g, Radix polygalae 10 g, Rhizoma gastrodiae 15 g, Arisaema cum bile 6 g, Rhizoma typhonii 6 g, Scorpio 6 g, Bombyx batryticatus 6 g, Perilla frutescens 10 g, Rhizoma pinelliae 10 g, Pericarpium citri reticulatae 10 g, Rhizoma zingiberis recens 3 tablets, decoction 200 mL, twice in the morning and evening by oral or nasal feeding) on the basis of the control group. Both groups were treated for 14 days. The standard swallowing function assessment (SSA) and water swallow test were used to evaluate the swallowing function before and after treatment. The time required for the improvement of swallowing function, total hospitalization time and the therapeutic effects were observed and the safety assessment was conducted. There were no significant differences in the gender, age, course of disease, and location and frequency of stroke between the two groups. After treatment, both the SSA scores in the two groups were decreased, and the grading of water swallow test was improved. The SSA scores in the observation group were significantly lower than that in the control group (19.8±1.8 vs. 23.2±3.2, P < 0.05), the recovery degree of water swallow test was higher than that in the control group [complete recovery (cases): 18 vs. 13, basic recovery (cases): 23 vs. 18, effective (cases): 9 vs. 19, χ2 = -2.107, P = 0.008]. The total effective rate of swallowing function in the observation group was higher than that in the control group (94.0% vs. 80.0%, Z = 4.684, P = 0.012), the time for improvement (days: 12.8±2.6 vs. 16.9±4.3, t = 11.628, P = 0.008)and total hospitalization time (days: 20.8±4.2 vs. 33.5±5.6, t = 10.924, P = 0.015) were shorter than those in the control group. In the observation group, there was 1 case of throat discomfort during the operation of IOE, and the symptoms disappeared after the operation; there was 1 case of mild elevation of alanine aminotransferase (ALT) and blood urea nitrogen (BUN) respectively, which returned to normal after the treatment. No adverse symptoms and damage to the liver and kidney were observed in the control group. IOE combined with Xuanqiaoliyan decotion could significantly improve the swallowing function of stroke patients with dysphagia, shorten the hospitalization time, and improve the curative effects and lifequality.

Effect of probiotics on the nutritional status of severe stroke patients with nasal feeding that receive enteral nutrition: A protocol for systematic review and meta-analysis of randomized controlled trials.

Background:Malnutrition is commonly observed after stroke and is closely associated with poor clinical outcomes. So, early nutrition support is particularly crucial for severe stroke patients. However, a significant number of critically ill patients are intolerant to enteral nutrition (EN). Probiotics have been widely used in malnutrition by various diseases and have a low incidence of enteral intolerance. So, we aim to elucidate the efficacy of probiotics in EN in improving the nutritional status and clinical prognosis of severe stroke patients with nasal feeding.Method:Embase, PubMed, Sinomed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, and Vip Journal Integration Platform were searched from inception to March 31, 2021. Randomized controlled trials that applied probiotics in patients with severe stroke were included. The data were extracted and the risk of bias was assessed independently by 2 evaluators.Results:Twenty-four studies comprising 2003 participants of randomized controlled trials were included. The result of pooled analyses showed that probiotics in EN were associated with better outcomes than EN alone on Glasgow Coma Scale score (mean difference [MD] = 1.03, 95% confidence intervals [CI]: 0.78–1.27; P < .00001), infection events (odds ratio [OR] = 0.25, 95% CI: 0.15–0.43; P < .00001), rate of intestinal flora dysbiosis (OR = 0.24, 95% CI: 0.12–0.48; P < .0001), gastrointestinal complications (OR = 0.25, 95% CI: 0.16–0.37, P < .00001), time to reach target nutrition (MD = −1.80, 95% CI: −2.42 to 1.18, P < .00001), prealbumin content (MD = 25.83, 95% CI: 13.68–37.99, P < .0001).Conclusion:Our results demonstrated that probiotics supplementation might be an effective intervention for improving the clinical prognosis in severe stroke patients with nasal feeding, but no significant effect on increasing muscle circumference.

Analysis of Pepsin Concentration and Influencing Factors in Saliva of Elderly Nasal Feeding Patients

Background Elderly patients receiving nasal feeding have weaker physiological function, and placement of a nasogastric tube weakens the natural barrier of the cardia-esophageal sphincter; therefore, the risk of gastroesophageal reflux (GER) is higher. Many studies have shown that pepsin is extremely sensitive in predicting GERD, so this study intends to investigate the level of pepsin in saliva of elderly patients with nasal feeding and analyze its influencing factors. Methods This was a cross-sectional study. Patients admitted to the Chinese PLA General Hospital from April 2018 to October 2018 who received nasal feeding were included. One ml of saliva was collected from each patient in while sitting during fasting in the morning and 1 hour after lunch for 3 consecutive days. Pepsin was quantified by enzyme-linked immunosorbent assay (ELISA). The patients were predivided into two groups (≥7.75μg/ml or <7.75μg/ml) based on the median pepsin. Baseline and clinical factors were compared. Results The mean age of the patients was 91.09 ± 4.91 years. There were statistical differences in diabetes and feeding methods between the two groups. There was a positive correlation between the morning and postprandial pepsin levels (r = 0.442, P < 0.001), and has no statistical difference (P = 0.175). Multivariate analysis showed that the risk factors for higher pepsin levels were diabetes (odds ratio (OR): 2.67; 95% CI: 1.225-5.819, P = 0.013) and nasal feeding methods (OR: 2.475; 95% CI: 1.183-5.180, P=0.016). Conclusions For patients undergoing nasal feeding who are older than 80 years, the fasting and 1-hour postprandial pepsin concentration were consistent. Diabetes and feeding methods are risk factors for high pepsin levels. For the elderly over 80 years old, age has no influence on pepsin concentration.

Research Progress of Nutritional Diet for the Disabled Elderly

With the rapid development of society, an aging society has already quietly arrived, and the accompanying elderly care service industry is also booming. Chinese medicated diets play a great role in the rehabilitation and health of the elderly. Therefore, the elderly are more sensitive to Chinese medicated diets. There is also an increasing demand for the elderly, especially the disabled elderly, whose physical functions are reduced, they are inconvenient to move, and have difficulty in taking food on their own. Therefore, they are prone to malnutrition, which leads to a series of complications. This article mainly uses qualitative research methods to study the current status of nutritional diets for disabled elderly people at home and abroad, especially bedridden elderly and nasal feeding elderly, and the nutritional value of traditional Chinese medicinal diets, in order to explore the important role of traditional Chinese medicinal diets in the nutritional diet of disabled elderly.

Endoluminal Cooling of the Esophagus during Percutaneous Thermal Ablation for Juxtaesophageal Liver Neoplasm: Two Cases

AbstractThermal injury to the surrounding hollow organs should be avoided during thermal ablation therapy. Although this type of injury is rare, severe complications, such as perforation or stricture, have been reported. Despite the development of various adjunctive thermoprotection techniques, there are a few reports of their use for protecting the esophagus during liver ablation therapy. Endoluminal irrigation is a well-known technique for protecting hollow organs, such as the biliary tract, renal pelvis, ureter, and rectum; however, it is used infrequently for avoiding thermal injury to the esophagus. There may be hesitation in treating juxtaesophageal liver tumors with conventional ultrasound-guided ablation because the location restricts the ultrasonic window due to the poor visibility. We successfully treated two consecutive cases of juxtaesophageal liver tumor with computed tomography-guided ablation by applying endoluminal irrigation and cooling via a 12-French nasal feeding tube placed in the lower esophagus.

Effect of combined WeChat video and comprehensive medical therapy on severe COVID‐19 with moderate Alzheimer's disease: A case report

ObjectiveWe present a case report of recovery from severe COVID ‐ 19 (novel coronavirus 2019) in a patient with cognitive decline (84‐year old, female), behavioral and psychiatric symptoms, hip arthroplasty, sacroiliac decubital necrosis, cachexia, after comprehensive therapy.BackgroundBecause of cognitive and behavioral disorders, patients with Alzheimer’s disease have poor coordination of treatment especially in an unfamiliar environment. Communicating with close family members through WeChat video can relieve patients' anxiety and other mental symptoms, leading to better cooperating with drug treatment and nasal feeding diet.MethodsPatient received 1 hour daily WeChat video communication with her son at isolation ward, including psychological comfort, care and positive words. The WeChat video communication were last for 4 weeks, during this time, the elderly patient was also treated with methylprednisolone (for 5 days), immunoglobulin (for 5 days), ulinastatin, thymus methoxide (for twice a week), acetylcysteine, antibiotics, low molecular weight heparin, probiotics, nutrition and other symptomatic support therapy.ResultsBefore WeChat video communication about 4 weeks, the patient refused medical treatment, consisting of extraction of infusion set and removal of gastric tube, which greatly affects the treatment of drugs and the nutritional intake of patients; and the state of the patient’s condition became even worse. However, after 4 weeks WeChat video communication, the patient showed a significant improvement in the Mini‐mental state examination scores from 8 to 12 (Education: illiterate) and in the Neuropsychiatric questionnaire scores from 35 to 10. Besides, after 4 weeks WeChat video communication and comprehensive therapy, the patient’s pneumonia improved significantly and the nucleic acid test turned negative.ConclusionsWeChat video communication may be a promising noninvasive approach for patients with Alzheimer’s Disease, which may help alleviate neuropsychiatric behavioral symptoms and can be more cooperative with medical workers.

From Best Evidence to Best Practice: Enteral Nutrition from Continuous Nasal Feeding in Stroke Patients.

BackgroundBest evidence regarding enteral nutrition from continuous nasal feeding in stroke patients is limited. The aim of this study was to explore the best evidence of continuous nasal feeding in stroke patients and translate the evidence into clinical practice.MethodsThis study utilized the standard procedures of the Joanna Briggs Institute (JBI) evidence-based nursing centers’ clinical evidence-practice application system. The baseline assessment of stroke patients in the neurology ward was conducted. A pre- and post-implementation audit approach was used in this study and adopted the Getting Research into Practice program. We analyzed the compliance of nurses with best practice and its impact on patients’ gastrointestinal function and complications, aspiration, aspiration pneumonia, nurses’ daily workload of nasal feeding, and the length of hospitalization before and after implementing the evidence-based strategies.ResultsAfter application of the evidence-based strategies, nurses’ compliance with best practice was improved. The incidence of patients’ gastrointestinal complications including vomit (χ2 = 5.195, P=0.023), palirrhea (χ2 = 4.216, P=0.039), diarrhea (χ2 = 4.514, P=0.042), constipation (χ2 = 5.535, P=0.035) and gastric retention (χ2 = 4.541, P=0.042) decreased significantly after the application of the best evidence. The working time of nurses undergoing nasal feeding decreased from 23.71 ±3.22 min to 7.73 ±1.14 min (P =0.000) and the length of patient’s hospitalization decreased from 35.63 ±4.45 days to 35.00 ±3.70 days (P=0.534). The rate of aspiration, aspiration pneumonia did not show a significant difference after implementation of the evidence-based strategies.ConclusionThe results revealed that the evidence-based practice of continuous nasal feeding in stroke patients is an effective method to improve nursing quality and reduce gastrointestinal complications, which was worthy of clinical application.

Nasal Feeding Tubes are Associated with Fewer Adverse Events than Feeding via Ostomy in Hospitalized Patients Receiving Enteral Nutrition

Background: Surgical feeding ostomies (SFO, e.g. gastrostomy) have replaced natural orifice feeding tubes (NOFT, e.g. nasogastric feeding tube) as the preferred route for long-term enteral nutrition. Reports of complication rates for SFO vary. Many hospitalized patients are required to accept SFO before hospital discharge due to skilled nursing facilities (SNFs) policy, and without supportive data. We compare adverse event rates between SFO and NOFT. Methods: A prospective cohort study of enterally fed inpatients using semiweekly focused physical exam, scripted survey, and chart review. Findings: Over the course of nine weeks, 226 unique patients were seen an average of 6.25 times each for a total of 1118 unique observations. Demographic data were comparable between subgroups. There were 148 subjects with NOFT and 113 subjects with SFO. 35 NOFT crossed over to SFO during the study. More NOFT than SFO observations took place in ICUs (p<0.001). SFO were associated with higher incidence of adverse events than NOFT (3.34 versus 1.25 events per 100 subject days, p<0.001). Overall there was a documentation rate of 50% of all adverse events, with no difference by feeding tube. More SFO patients were discharged to skilled nursing facilities than NOFT patients (58% versus 24%). Interpretation: Our study supports previous findings that SFO is associated with higher in-hospital adverse events rates than NOFT. Additionally, a substantial number of subjects with SFO were discharged to skilled nursing facilities. Surgical feeding ostomies have replaced natural orifice feeding tubes as the preferred route for long-term enteral nutrition. In the present study, we found that NOFT is associated with fewer and less serious adverse events when compared to SFO in patients receiving in-hospital enteral feeding. Our findings suggest SFO should be reevaluated as the preferred method for tube feeding in adults anticipated to require enteral nutrition on hospital discharge. Funding Statement: National Heart, Lung, and Blood Institute (Burgermaster—training grant T32 HL 7343‐37). Declaration of Interests: None declared. Ethics Approval Statement: Subjects and/or family members were told about the nature of the study and asked verbally for their willingness to participate. The study protocol was approved by the Columbia University Medical Center Institutional Review Board (IRB protocol number AAAM2257).

The impact of surgical treatment on the life quality of patients with locally advanced hypopharyngeal carcinoma

Objective: To explore the impact of surgical treatment on the life quality of patients with locally advanced hypopharyngeal carcinoma. Methods: A retrospective analysis of the clinical data of 21 patients with advanced hypopharyngeal carcinoma who underwent surgery at the Shenzhen Hospital of Chinese Academy of Medical Sciences Cancer Hospital from January 1, 2017 to December 31, 2019 was conducted. There were 3 patients with recurrence after radiotherapy and chemotherapy, 4 cases of postoperative recurrence, 3 cases of postoperative recurrence after radiotherapy and chemotherapy. Three cases were hypopharyngeal carcinoma with esophageal carcinoma and 8 cases were stage Ⅳ hypopharyngeal carcinoma. Among them, 3 cases were repaired by stomach, 4 cases by free jejunum, 2 case by great saphenous vein for internal carotid artery, 1 case by artificial blood vessel for internal carotid artery, 5 cases by transfer of pectoralis major musculocutaneous flap and 2 cases by transfer of submental island flap. The 21 patients were scored using the European Cancer Research and Treatment Organization's Quality of Life Head and Neck Tumor Special Scale (EORTC QLQ-H&N35) on the 3 months before and after surgery, and the changes in postoperative life quality were compared. Results: The preoperative life quality score of 21 patients was (56.86±7.95) points and life quality score of 3 months after operation was (50.93±7.91) points. The postoperative life quality was significantly improved (P<0.05). The improvement of the postoperative life quality of the patients mainly included the improvements of the head and neck pain, swallowing function, diet, taking analgesics and indwelling nasal feeding tubes. The preoperative scores were (7.58±1.56) points, (8.46±1.63) points, (7.94±0.43) points, (1.76±0.12) points and (1.86±0.28) points, respectively, while the scores of 3 months after operation were (5.02±1.23) points, (6.28±1.58) points, (6.34±0.36) points , (1.12±0.08) points and (1.24±0.18) points, the differences were statistically significant (all P<0.05). Conclusion: The flexible selection of flap repair for locally advanced hypopharyngeal carcinoma is still feasible, and surgery can improve the life quality of patients.

Imaging findings and clinical features of atypical retroperitoneal abscess caused by duodenal perforation: a case report and review of the literature

IntroductionA retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas.Case presentationA 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 109/L and a neutrophil absolute value of 18.81 109/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient’s body temperature gradually returned to normal, and his abdominal pain decreased.ConclusionsA retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.

Diagnosis and Management of Pediatric Nasal CSF Leaks and Encephaloceles

To describe the clinical presentation, diagnosis, and management of pediatric nasal encephaloceles. Encephaloceles and meningoencephaloceles are on the differential diagnosis for congenital midline nasal masses. These lesions are treated surgically to prevent craniofacial deformities and meningitis and to address symptoms such as a nasal obstruction, feeding difficulties, and cerebrospinal fluid (CSF) rhinorrhea. With the advent of endoscopic skull base approaches and instruments, surgical treatment of nasal encephaloceles have transitioned from large bicoronal external approaches to more minimally invasive endonasal endoscopic approaches. Endoscopic surgical approaches are safe in pediatric patients. Pediatric intranasal encephaloceles are more frequently managed endoscopically. However, due to the rarity of this condition, further multi-institutional research is needed to examine long-term outcomes for this surgical approach.

Clinical analysis and laboratory diagnosis of three cases with infantile botulism caused by Clostridium botulinum type B

Objective: To summarize the clinical characteristics and laboratory diagnostic methods of infant botulism caused by Clostridium botulinum type B. Methods: Clinical data of 3 infants with type B botulism who were admitted to Children's Hospital Affiliated to Capital Institute of Pediatrics from May to November 2018 were retrospectively analyzed. Botulinum toxin was detected in fecal samples or fecal enrichment solution of the patients, and Clostridium botulinum was cultured and isolated from fecal samples. Results: The age of onset of the patients (two boys and one girl) was 3, 3 and 8 months old, respectively. Two cases had the onset in May and one case had the onset in November. There were two cases with mixed feeding and one case with breast feeding. One case's family members engaged in meat processing. All of them were previously healthy. All the children presented with acute flaccid paralysis, cranial nerve involvement and difficult defecation. Two cases had secondary urinary tract infection. Electromyograms of two cases showed that action potential amplitude of the motor nerve were lower than those of their peers. After treatments including intravenous human immunoglobulin, respiratory tract management, urethral catheterization, nasal feeding, etc., three cases recovered completely 2 to 4 months later. Type B botulinum toxin was detected in the fecal diluent of one patient, and the TPGYT enrichment solution and cooked meet medium of the feces of 3 patients, respectively. Clostridium botulinum B was identified from the feces of 3 infants after culture, isolation and purification. Conclusions: Combined with typical clinical manifestations including acute flaccid paralysis, cranial nerve involvement symptoms and difficult defecation examination, infant botulism can be clinically diagnosed. The detection of fecal botulinum toxin and the culture and isolation of Clostridium botulinum are helpful for the diagnosis.

Enteral combined with parenteral nutrition improves clinical outcomes in patients with traumatic brain injury

ABSTRACT Objective: To investigate the effect of nutritional support on nutritional status and clinical outcomes of patients with traumatic brain injury (TBI). Methods: Sixty-one patients with TBI from the intensive care unit and neurosurgery of Xianyang Central Hospital from 2017 to 2019 were retrospectively included. General and clinical data of the study subjects were collected. The control group (n = 28) received parenteral nutrition alone, and the observation group (n = 33) received parenteral nutrition combined with enteral nutrition. The general conditions and biochemical indicators of both groups of patients were divided into two groups of ≤8 and ≥9 for stratified analysis to compare the nutritional support status and infection complications during hospitalization Occurrence, ICU length of stay, total length of stay, total cost of stay, and prognostic indicators of the patients were analyzed and compared. Results: There were no significant differences in biochemical indicators between both groups of patients when they were discharged. Among patients with GCS ≤8 points, the incidence of lung infection in the observer was significantly higher than that in the control group (P < 0.001), but the incidence of intracranial infection, stress ulcers, and diarrhea was not statistically different from that in the control group (P = 0.739). No significant differences were observed in hospitalization time and hospitalization costs between both groups (P = 0.306 and P = 0.079, respectively). The observation group was significantly better than the control group in GSC score and long-term quality of life score (P = 0.042 and P = 0.025, respectively). When GCS was ≥ 9 points, there was no statistical difference in the incidence of lung infections and intracranial infections between both groups of patients (P = 0.800 and P = 0.127, respectively). The observation group was significantly higher than the control group in terms of length of hospital stay, nasal feeding time and hospitalization costs (P < 0.001, P < 0.001 and P = 0.006, respectively). The observation group was significantly better than the control group in GSC score and long-term quality of life score (P = 0.001 and P = 0.015, respectively). There was no significant difference in the incidence of pulmonary infection and intracranial infection between both groups of patients (P = 0.800 and P = 0.127, respectively). Conclusion: Enteral nutrition combined with parenteral nutrition intervention has a positive effect on the clinical prognosis of TBI patients.