中华烧伤与创面修复杂志

Analysis of epidemiological characteristics and treatment of wounds in pediatric patients with hematologic malignancies

Zhu Hai, Liu Ziyu, Guo Chunlai, Chen Kun

, Available online , doi: 10.3760/cma.j.cn501225-20250623-00278

Abstract [FullText HTML]

PDF

Abstract:
Objective To explore the epidemiological characteristics and treatment of wounds in pediatric patients with hematologic malignancies. Methods This study was a retrospective case series study. From January 2017 to December 2024, 20 and 12 pediatric patients with hematologic malignancies meeting the inclusion criteria were admitted to Beijing Children's Hospital of Capital Medical University and Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, respectively, yielding a total of 41 wounds. The following data were recorded, including gender, age, and type of hematologic malignancy of pediatric patients, wound etiology, location, time of onset, area, depth, presence of tumor invasion, concurrent infection, treatment modality, healing time, and whether the wound resulted in chemotherapy delay. According to the wound depth, the wounds were divided into superficial wound group (30 wounds) and deep wound group (11 wounds), and wound concurrent infection, presence of tumor invasion, treatment modality, healing time, and whether the wound resulted in chemotherapy delay were compared. According to the presence of tumor invasion, the wounds were divided into tumor-involved wound group (11 wounds) and ordinary wound group (30 wounds), and wound concurrent infection, depth, treatment modality, healing time, and whether the wound resulted in chemotherapy delay were compared. According to the treatment modality, the wounds were divided into surgical treatment group (23 wounds) and conservative treatment group (18 wounds), and wound depth, presence of tumor invasion, concurrent infection, healing time, and whether the wound resulted in chemotherapy delay were compared. Results Among the 32 pediatric patients, 19 were males and 13 were females, aged 2.0 to 12.5 years; 16 were diagnosed with non-Hodgkin lymphoma, 2 with acute myeloid leukemia, and 14 with acute lymphoblastic leukemia. Six wounds were iatrogenic and 35 wounds were non-iatrogenic. Nine, 9, 11, and 12 wounds involved the head, face and neck, trunk, extremities, and buttocks and perineum, respectively. Ten wounds appeared before chemotherapy, and 31 wounds appeared during chemotherapy. The wound area was 15.00 (4.00, 48.00) cm². Thirty wounds were superficial wounds, and 11 wounds were deep wounds. Eleven wounds showed tumor invasion, and 31 wounds had concurrent infection. Eighteen wounds received conservative treatment, and 23 wounds received surgical treatment. The wound healing time was 70.00 (38.50, 103.00) days. Twenty-seven wounds resulted in chemotherapy delay. There were no statistically significant differences between superficial wound group and deep wound group in concurrent wound infection, presence of tumor invasion, treatment modality, healing time, or whether the wound resulted in chemotherapy delay (P>0.05). The healing time of tumor-involved wound group was significantly longer than that in ordinary wound group (U=78.50, P<0.05). The percentages of concurrent infection and chemotherapy delay in surgical treatment group were significantly higher than that in conservative treatment group (P<0.05), with a significantly shorter healing time (U=112.00, P<0.05). Conclusions In pediatric patients with hematologic malignancies, wounds are mostly non-iatrogenic, with frequent concurrent infection and prolonged healing time. Because the presence of wounds frequently delays oncologic treatment, early identification and prompt treatment of wounds for which surgery is indicated are essential, and surgical treatment can accelerate wound healing.

Analysis of influencing factors of diabetic foot ulcer recurrence and construction of the Bayesian network model

Ma Hairong, Zheng Liran, Chen Jiageng, Xu Wenyan, Cui Xuecan, Wang Shuai, Chang Bai, Wang Meijun

, Available online , doi: 10.3760/cma.j.cn501225-20250805-00347

Abstract [FullText HTML]

PDF

Abstract:
Objective To explore the influencing factors of diabetic foot ulcer (DFU) recurrence, construct the Bayesian network model for predicting DFU recurrence, and investigate the interrelationships among these influencing factors and their effects on DFU recurrence. Methods This study was a retrospective cohort study. From April 2016 to April 2020, 1 656 hospitalized DFU patients who met the inclusion criteria were admitted to the Diabetic Podiatry Department of Tianjin Medical University Chu Hsien-I Memorial Hospital, including 1 127 males and 529 females, aged 18-80 years. According to DFU recurrence status within 5 years after discharge, the patients were divided into recurrence group (552 cases) and non-recurrence group (1 104 cases). The following indicators were compared between the two groups, including gender, duration of diabetes, retinopathy status, ulcer location, foot deformity, history of foot amputation, body mass index (BMI), systolic blood pressure, levels of D-dimer, fibrinogen, total cholesterol, and low-density lipoprotein (LDL) on the day of admission, level of glycated hemoglobin A1c (HbA1c) during hospitalization, hypoglycemic regimen, and use of aspirin and statins. A multivariate logistic regression model was used to identify independent risk factors for DFU recurrence. A restricted cubic spline model was applied to analyze the dose-response relationship between level of HbA1c during hospitalization and DFU recurrence after adjusting covariates. A Bayesian network model for predicting DFU recurrence was established to analyze the interrelationships among these influencing factors and their effects on DFU recurrence. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the Bayesian network model for DFU recurrence. Results There were statistically significant differences between the two groups of patients in gender, retinopathy status, ulcer location, foot deformity, history of foot amputation, hypoglycemic regimen, and use of aspirin and statins (with χ² values of 5.87, 6.14, 24.97, 159.63, 4.03, 39.07, 26.60, and 4.69, respectively, P<0.05), as well as duration of diabetes, BMI, systolic blood pressure, and levels of D-dimer, fibrinogen, total cholesterol, and LDL on the day of admission, and level of HbA1c during hospitalization (with Z values of -7.20, -6.14, -5.57, -2.24, -9.09, -2.08, -7.74, and -11.32, respectively, P<0.05). Multivariate logistic regression analysis showed that BMI, systolic blood pressure, levels of fibrinogen and LDL on the day of admission, level of HbA1c during hospitalization, duration of diabetes, ulcer location, foot deformity, hypoglycemic regimens of injecting insulin and oral hypoglycemic agents + injecting insulin, and use of aspirin were the independent risk factors for DFU recurrence (with OR values of 1.06, 1.01, 1.31, 1.47, 1.19, 1.04, 1.71, 6.59, 1.82, 1.60, and 1.85, respectively, 95%CI of 1.03-1.10, 1.01-1.02, 1.21-1.43, 1.29-1.68, 1.13-1.26, 1.03-1.06, 1.26-2.31, 4.67-9.38, 1.19-2.80, 1.18-2.16, and 1.45-2.38, respectively, P<0.05). Restricted cubic spline model showed a non-linear dose-response relationship between level of HbA1c ≥9.0% during hospitalization and DFU recurrence risk after adjusting covariates (χ²=15.01, P<0.05). The constructed Bayesian network model consisted of 10 nodes and 14 directed edges. The model demonstrated that ulcer location, use of aspirin, foot deformity, and levels of LDL and BMI on the day of admission were directly associated with DFU recurrence; foot deformity posed the greatest risk for DFU recurrence, followed by ulcer location and use of aspirin. The area under the ROC curve for the Bayesian network model was 0.74 (95%CI of 0.70-0.78). Conclusions The BMI, systolic blood pressure, levels of fibrinogen and LDL on the day of admission, level of HbA1c during hospitalization, duration of diabetes, ulcer location, foot deformity, hypoglycemic regimens, and use of aspirin were the independent risk factors for DFU recurrence. The ulcer location, use of aspirin, foot deformity, and levels of LDL and BMI on the day of admission were directly associated with DFU recurrence.

A prospective study on the dynamic changes of inflammatory and immune indicators after injury and their predictive value for 21-day mortality risk in patients with severe burns

Lou Jiaqi, Li Jiliang, Cui Shengyong, Huang Neng, Jin Guoying, Xu Sida, Yu Yaohua, Xu Pei, Jiang Jing, Pan Yanyan, Le Xin, Fan Youfen

, Available online , doi: 10.3760/cma.j.cn501225-20251121-00482

Abstract [FullText HTML]

PDF

Abstract:
Objective To investigate the dynamic changes of post-burn inflammatory and immune indicators in patients with severe burns and their predictive value for 21-day mortality risk. Methods This was a prospective cohort study. From January 2018 to December 2024, 760 patients with severe burns who met the inclusion criteria were admitted to the Department of Burns of Ningbo No. 2 Hospital. Based on the outcomes at 21 days post-burn, the patients were divided into death group (139 cases, 106 males and 33 females, aged 18-78 years) and survival group (621 cases, 467 males and 154 females, aged 18-78 years). Clinical data of patients in the two groups (such as sex, age, and burn index) were collected, and IL-6 and CD4⁺/CD8⁺ ratio were monitored on days 1, 3, 7, 14, and 21 post-burn. Meanwhile, the differences between IL-6 and CD4⁺/CD8⁺ ratio on day 7 post-burn and the corresponding values on day 1 post-burn were calculated, namely ΔIL-6 and Δ(CD4⁺/CD8⁺) ratio. The longitudinal trajectories of IL-6 and CD4⁺/CD8⁺ ratio post-burn were analyzed (n=760). A baseline Cox proportional hazards regression model (hereinafter referred to as the Cox model) was constructed to analyze the independent associations of age, sex, burn index, and IL-6 and CD4⁺/CD8⁺ ratio on day 1 post-burn with 21-day mortality risk (n=753). A dynamic Cox model was constructed to analyze the independent associations of age, sex, burn index and Δ(CD4⁺/CD8⁺) ratio with 21-day mortality risk (n=746). Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of IL-6 level on day 7 post-burn, ΔIL-6, Δ(CD4⁺/CD8⁺) ratio, and burn index for 21-day mortality risk, and the optimal cut-off value of Δ(CD4⁺/CD8⁺+) ratio was recorded. According to whether the Δ(CD4⁺/CD8⁺) ratio was higher than the cut-off value, patients were divided into increased group (363 males and 118 females, aged 18-78 years) and decreased group (207 males and 68 females, aged 18-78 years), and Kaplan-Meier survival curves were plotted for the two groups and compared. Time-dependent ROC analysis was used to compare the predictive abilities of the Cox models constructed based on IL-6 on day 7 post-burn, ΔIL-6, and Δ(CD4⁺/CD8⁺) ratio (with sample sizes of 760, 746, and 746, respectively), as well as the baseline Cox model and the dynamic Cox model, for mortality risk at 7, 14, and 20 days post-burn. Results Patients' IL-6 levels exhibited a downward trend over time post-burn (with an estimate of -4.52, a standard error of 0.10, t=-45.61, P<0.05), and IL-6 levels in death group were higher than those in survival group (with an estimate of 35.64, a standard error of 4.86, t=7.33, P<0.05); the longitudinal trajectories of IL-6 levels between survival group and death group were significantly different (with an estimate of -0.879, a standard error of 0.23, t=-3.78, P<0.05). Patients' CD4⁺/CD8⁺ ratio exhibited an upward trend over time post-burn (with an estimate of 0.02, a standard error of <0.01, t=21.48, P<0.05), and the CD4⁺/CD8⁺ ratio in death group was lower than that in survival group (with an estimate of -0.11, a standard error of 0.03, t=-4.04, P<0.05); the longitudinal trajectories of CD4⁺/CD8⁺ ratio between the two groups were significantly different (with an estimate of <0.01, a standard error of <0.01, t=3.64, P<0.05). The baseline Cox model showed that burn index was an independent predictor of 21-day mortality risk (P<0.05), while IL-6 and CD4⁺/CD8⁺ ratio on day 1 post-burn were potential independent predictors of 21-day mortality risk (with P values of 0.053 and 0.070, respectively). The dynamic Cox model showed that burn index was an independent predictor of 21-day mortality risk (P<0.05), while Δ(CD4⁺/CD8⁺) ratio was a potential independent predictor of 21-day mortality risk (P=0.058). The AUCs of IL-6 on day 7 post-burn, Δ(CD4⁺/CD8⁺) ratio, ΔIL-6, and burn index for predicting 21-day mortality risk were 0.66 (with a 95%CI of 0.61-0.70), 0.58 (with a 95%CI of 0.54-0.63), 0.55 (with a 95%CI of 0.50-0.61), and 0.62 (with a 95%CI of 0.57-0.68), respectively. The optimal cut-off value of Δ(CD4⁺/CD8⁺) ratio was -0.623. The 21-day survival rate of patients in increased group was lower than that in decreased group (χ²=26.20, P<0.05). The AUCs of the IL-6 Cox model on day 7 post-burn at 7, 14, and 20 days post-burn were 71.71% (with a 95%CI of 66.03%-77.39%), 61.38% (with a 95%CI of 55.42%-67.33%), and 61.38% (with a 95%CI of 55.42%-67.33%), respectively, all higher than those of the ΔIL-6 Cox model (59.38% (with a 95%CI of 50.62%-68.14%), 56.70% (with a 95%CI of 50.01%-63.38%), and 56.70% (with a 95%CI of 50.01%-63.38%)), the Δ(CD4⁺/CD8⁺) ratio Cox model (64.92% (with a 95%CI of 57.53%-72.31%), 57.19% (with a 95%CI of 50.65%-63.72%), and 57.19% (with a 95%CI of 50.65%-63.72%)), the baseline Cox model (70.02% (with a 95%CI of 63.39%-76.66%), 59.71% (with a 95%CI of 53.43%-66.00%), and 59.71% (with a 95%CI of 53.43%-66.00%)), and the dynamic Cox model (65.51% (with a 95%CI of 58.19%-72.83%), 57.12% (with a 95%CI of 50.58%-63.66%), and 57.12% (with a 95%CI of 50.58%-63.66%)). Conclusions In patients with severe burns, IL-6 and CD4⁺/CD8⁺ ratio exhibit dynamic changes post-burn; patients in the death group have stronger early inflammatory responses and more severe immunosuppression. IL-6 level on day 7 post-burn has certain predictive value for 21-day mortality.

Effect of the hand function assessment and training system on hand function rehabilitation in patients with burns

Lu Bo, Ma Xiaohong, Fu Qingqing, Zhou Yaqing, Heng Xue, Tan Jiangling

, Available online , doi: 10.3760/cma.j.cn501225-20250715-00306

Abstract [FullText HTML]

PDF

Abstract:
Objective To investigate the effect of the hand function assessment and training system on hand function rehabilitation in patients with burns. Methods This was a retrospective cohort study. From January 2021 to December 2024, 32 patients with hand burns who met the inclusion criteria were admitted to the Institute of Burn Research, the First Affiliated Hospital of Army Medical University (Third Military Medical University). According to the rehabilitation method, patients were divided into routine rehabilitation group (13 males and 3 females, aged (43±14) years) receiving routine rehabilitation training and system rehabilitation group (15 males and 1 female, aged (38±12) years) receiving additional training with the hand function assessment and training system on the basis of routine rehabilitation training, with 30 affected hands in each group. The total active motion (TAM) method was used to assess the range of motion of finger joints of affected hands before treatment and at 4 weeks after treatment, and the improvement degree of affected hands was recorded at 4 weeks after treatment. Before treatment and at 4 weeks after treatment, grip strength and pinch strength of affected hands were recorded; the severity of pain and pruritus of affected hands was scored using the Visual Analogue Scale; activities of daily living were assessed using the modified Barthel Index (MBI) and the Functional Independence Measure (FIM); and the scores of each dimension of the self-care subscale of FIM (eating, grooming, bathing, dressing upper body, dressing lower body, and toileting) were further recorded to reflect upper limb function. Results Within-group comparison showed that the total TAM of affected hands in routine rehabilitation group and system rehabilitation group at 4 weeks after treatment was (726±192)° and (709±242)°, respectively, both significantly higher than (633±208)° and (564±244)° before treatment (with t values of -7.25 and -7.65, respectively, P<0.05). At 4 weeks after treatment, the improvement degree of affected hands in system rehabilitation group was significantly better than that in routine rehabilitation group (RR=4.50, with a 95%CI value of 1.06–19.11, Z=-1.99, P<0.05). Within-group comparison showed that grip strength and pinch strength of affected hands in routine rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -6.90 and -6.61, respectively, P<0.05), and grip strength and pinch strength of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -11.89 and -14.98, respectively, P<0.05); between-group comparison showed that grip strength and pinch strength of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those in routine rehabilitation group (with t values of 3.07 and 2.97, respectively, P<0.05). Within-group comparison showed that compared with before treatment, the pruritus score of affected hands in routine rehabilitation group and the pain score of affected hands in system rehabilitation group were significantly increased at 4 weeks after treatment (with Z values of -2.31 and -2.17, respectively, P<0.05); between-group comparison showed that the pain score of affected hands in system rehabilitation group at 4 weeks after treatment was significantly higher than that in routine rehabilitation group (Z=-2.53, P<0.05). Within-group comparison showed that the MBI score and FIM score of affected hands in routine rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -3.62 and -3.72, respectively, P<0.05), and the MBI score and FIM score of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -3.83 and -4.29, respectively, P< 0.05); between-group comparison showed that the FIM score of affected hands in system rehabilitation group at 4 weeks after treatment was significantly higher than that in routine rehabilitation group (t=-1.02, P<0.05). Within-group comparison showed that the scores of eating, grooming, bathing, dressing upper body, dressing lower body, and toileting dimensions of the self-care subscale of FIM of affected hands in routine rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -5.57, -5.67, -5.44, -4.56, -3.71, and -4.03, respectively, P<0.05), and the scores of eating, grooming, bathing, dressing upper body, dressing lower body, and toileting dimensions of the self-care subscale of FIM of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -6.96, -9.52, -12.48, -4.68, -7.07, and -7.11, respectively, P<0.05); between-group comparison showed that the scores of bathing, dressing upper body, dressing lower body, and toileting dimensions of the self-care subscale of FIM of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those in routine rehabilitation group (with t values of -3.90, -2.89, -3.38, and -4.19, respectively, P<0.05). Conclusions The hand function assessment and training system can improve the range of motion of affected hand joints, increase grip strength and pinch strength, enhance activities of daily living, and improve upper limb function in patients with burns, thus providing assistance for hand function recovery in burn patients.

Efficacy of a thin ALTF designed based on an optimized perforator selection strategy for reconstructing skin soft tissue defects of the hand and foot in pediatric patients

Li Hai, Xiao Shun'e, Wei Zairong, Deng Chengliang, Wu Xiangkui, Wang Qi

, Available online , doi: 10.3760/cma.j.cn501225-20250603-00254

Abstract [FullText HTML]

PDF

Abstract:
Objective To investigate the efficacy of a thin anterolateral thigh flap (ALTF) designed based on an optimized perforator selection strategy for reconstructing skin soft tissue defects of the hand and foot in pediatric patients. Methods This was a retrospective observational study. From January 2018 to April 2025, 10 pediatric patients (8 boys and 2 girls; aged 2-14 years) with hand and foot skin and soft tissue defects meeting the inclusion criteria were admitted to the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. The wounds were located on the upper limb in 4 cases and on the foot in 6 cases. After thorough debridement, the soft tissue defects ranged from 5.0 cm×3.5 cm to 16.0 cm×9.0 cm. Preoperatively, the anterolateral thigh region was divided into zones Ⅰ-Ⅳ using the modified two-longitudinal and five-transverse method, and perforators in each zone were detected with a handheld Doppler. Based on the detection results, an optimized perforator selection strategy was formulated: under equivalent conditions, perforators in zones Ⅱ and Ⅲ were preferred; when a longer vascular pedicle or a thinner flap was required, perforators in zones Ⅲ and Ⅳ were preferred; and when an iliac bone graft, a bulkier tissue component, or septocutaneous perforators were required, perforators in zone Ⅰ were preferred. Intraoperatively, the ALTF was designed according to this strategy and the defect size, perforators were dissected at the superficial layer of the superficial fascia, and a thin ALTF was harvested. The flap size ranged from 5.0 cm×3.5 cm to 20.0 cm×6.0 cm. The flap artery and vein were anastomosed end-to-end or end-to-side to the recipient artery and vein, respectively, and the recipient-site wound was then closed. All donor-site wounds were closed with tension-reducing sutures. The distribution and selection of perforators in each zone of anterolateral thigh region were recorded, and the accuracy of preoperative perforator selection was recorded using intraoperative exploration findings as the gold standard. Postoperatively, flap survival was observed; complications such as vascular crisis and subflap fluid collection were recorded; The time to Kirschner wire removal was recorded for pediatric patients with concomitant fractures and for pediatric patients with scar contracture release. During follow-up, flap color, texture, elasticity, and appearance were evaluated, the need for secondary thinning and scar revision was recorded, and hand and foot function was assessed at the last follow-up using the Hand Function Evaluation Standard of the Hand Surgery Society of the Chinese Medical Association and the Maryland Foot Score, respectively. Results A total of 25 perforators were detected preoperatively in the anterolateral thigh region of 10 pediatric patients, including 5 in zone Ⅰ, 7 in zone Ⅱ, 9 in zone Ⅲ, and 4 in zone Ⅳ. Of these, 17 perforators were selected as the preferred ones, including 2 in zone Ⅰ, 6 in zone Ⅱ, 8 in zone Ⅲ, and 1 in zone Ⅳ, with 1-2 preferred perforators selected for each patient. The accuracy of preoperative localization of the preferred perforators was 16/17. At 1 month postoperatively, serous exudation occurred beneath the flap in one patient and healed after dressing changes and drainage; all the other flaps survived uneventfully without vascular crisis. Kirschner wires were removed within 3 months postoperatively in 2 pediatric patients with concomitant fractures and at 1 month postoperatively in 3 pediatric patients with scar contracture release. All patients were followed up for 6-60 months. The color and texture of the flaps were similar to those of the adjacent normal skin, with good elasticity, and none of the patients' family members requested secondary thinning. One child presented with obvious hypertrophic scar at the donor site at 3 months of follow-up, which was relieved after corresponding treatment; linear scars were left at the donor and recipient sites of the other patients. At the last follow-up, the hand wounds were rated as excellent in 3 cases and good in 1, and the foot wounds as excellent in 5 cases and good in 1. Conclusions An ALTF designed based on an optimized perforator selection strategy yields flaps with good postoperative appearance and texture for reconstructing soft tissue defects of the hand and foot in pediatric patients, and represents an effective option for pediatric hand and foot wound repair.

Opportunities and challenges for the discipline of burn and wound repair in the era of artificial intelligence

Wang Xingang, Liu Huan

, Available online , doi: 10.3760/cma.j.cn501225-20260809-00290

Abstract [FullText HTML]

PDF

Abstract:
Burns and chronic refractory wounds represent a major global public-health challenge. China faces substantial clinical demand for wound repair, and the development of a specialized discipline system for wound repair is advancing steadily. With its capabilities in image recognition, data analysis, and predictive modeling, artificial intelligence (AI) is comprehensively reshaping the diagnosis-and-treatment system for burns and wound repair and bringing new opportunities for disciplinary development. This paper systematically reviews multiple application scenarios and the latest advances of AI in the field of burns and wound repair. It also rationally analyzes the potential risks and challenges associated with current AI applications, and offers an outlook on AI-driven transformation of modern medicine from conventional diagnostic-therapeutic paradigms toward individualized and precision-oriented care.

Emphasizing the early diagnosis and intervention of malnutrition in burn patients

Peng Xi, Su Sen

, Available online , doi: 10.3760/cma.j.cn501225-20261008-00386

Abstract [FullText HTML]

PDF

Abstract:
Malnutrition is a common complication of severe burns and directly affects patient outcomes. Early diagnosis and intervention of malnutrition can significantly improve nutritional support effectiveness and clinical outcomes. Its use in practice remains controversial, and further work is needed to standardize clinical practice. This review examines advances in diagnosing malnutrition, diagnostic algorithms and strategies for malnutrition in burn patients, and early nutritional intervention methods. Drawing on the latest guidelines or consensus statements, and clinical experience, it focuses on key issues, including assessing skeletal muscle mass and function, setting nutritional targets, and strategies for parenteral and enteral nutrition. The recommendations aim to provide a referable clinical practice protocol to improve the efficacy of nutritional support and optimize patient outcomes.

Online First

Guidelines and Consensus>>

Notice>>