Objective To investigate the effects of early parenteral feeding with glutamine on nitrogen balance and clinieal prognosis in Pationts with acute severe pancreatitis.Methods120 acute severe pancreatitis patients with Ranson scale≥3 were studied.Patients were randomized to receive either an early parenteral diet(control group,n=60) or the same formula with glutamine added(study group,n=60).The diets were isocaloric and isonitrogenous [35 kcal ? kg-1 ? day-1 and 1.5g of protein/(kg-1 ? d)].Main outcome measures were the APACHE-Ⅱ scale,incidence of infection,the length of stay in the intensive care unit and the number of days requiring mechanical ventilation,and monitor the nitrogen balance.ResultsThe two groups were homogeneous in gender,age,nutritional status and admission.There was no mortality during the study period.The two group have no statistic defference in nitrogen balance of 4.7 day.The median(range) number of infections per patient was significantly greater(P

Objective To study the effect of combination mode of blood purification on insulin resistance in MODS patients and discuss the best mode of blood purification to improve insulin resistance in MODS patients.Methods A total of 60 MODS pa-tients were selected and randomly divided into control group(single mode of blood purification)and treatment group(combination mode of blood purification),each group of 30 cases.Blood glucose (BG),glucose standard deviation (BGSD),coefficient of variation of blood glucose (BGCV),regular insulin dosage (Ins),fasting insulin (FINS),insulin resistance index (HOMA-IR),HbA1c,C-re-active protein (CRP)was observed before and after treatment.Results BG,HbA1c,FINS,CRP,HOMA-IR,Ins of experimental group was lower than that of control group (P <0.05).After treatment,BG,FINS,CRP,HOMA-IR,Ins was declined in experi-mental group (P <0.05).After treatment,HbA1c was not changed in experimental group (P >0.05 ).Conclusion Combination mode blood purification may be more effective to insulin resistance in MODS patients.

OBJECTIVE:To prepare multivesicular liposomes-sodium polymannuronate microspheres(MVLs-Alg)for protein drugs and to study the physico-chemical property and elementary stability of MVLs-Alg.METHODS:MVLs and Alg were used as matrix and BSA as a model protein drug,MVLs-Alg microspheres were prepared by interior/gelatin method.The relationship between MVLs and Alg was analyzed by differential thermal analysis and the effect of temperature(4,25,40 ℃)on entrapment efficiency and peroxide value of phospholipid in base material was investigated.RESULTS:The MVLs-Alg microspheres were spherical.Analyzed by DTA,it was considered that physical adsorption between MVLs and Alg was potentially existed.Storing for 90 days at 4,25,and 40 ℃ respectively,the encapsulation efficiency of the MVLs-Alg microsphereswere were 85.36%,63.75%,and 50.49%,respectively.The peroxide value of phospholipid increased increasingly,but not significant as compared with MVLs.CONCLUSIONS:The stability of MVLs-Alg microspheres was heightened compared with that of MVLs and which can be used for the delivery of protein drugs.

Objective:To develop a mental status scale in non psychiatric settings (MSSNS) and to test its reliability and validity.Methods:Based on the common negative emotions in non psychiatric settings confirmed by nursing specialists and international scales, the MSSNS was constructed with psychological testing and statistical techniques. The reliability and validity were examined with 1 010 patients in non psychiatric settings.Results: The MSSNS consisted of 38 items. The reliability coefficients were 0.932 9 for internal consistence(Cronbach ?) and 0.894 0 for split half. Using the principle component analysis with varimax rotation, we got 4 factors: anxiety, depression, anger and loneliness. The correlation between MSSNS and related factors of HAD were 0.652 and 0.533 respectively. Conclusion: With its good reliability and validity, MSSNS is an ideal rating scale for total and convenient rating of patients' mental status in non psychiatric settings.

Objective To discuss the current status of application of the four kinds of clinical decision‐making method (mode recognition method ,hypothesis deductive method ,event‐driven method and applying regulation method ) in the clinical practice of the emergency resident doctors and to understand their mastery situation of the clinical decision‐making methods and the influencing factors .Methods One thousand and thirty‐five patients collected by 207 resident doctors (5 cases were randomly collected from the patients diagnosed and treated by each resident doctor ) were divided into 3 groups according to different year systems .The clinical decision‐making methods ,diagnosis accuracy of different clinical decision‐making methods and the influencing factors of decision‐making methods were compared among different grades .Results The difference in the decision‐making methods among different year systems had statistical significance (P<0 .05);furthermore ,the difference in the diagnostic accuracy among different decision‐making methods had statistical significance (P< 0 .05) ,the differences in the defensive behaviors and different decision‐making methods were statistically significant (P<0 .05) ,the multi‐classification Logistic regression of different decision‐making methods showed that the differences in the different residency year system ,residency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree had statistical significance (P< 0 .05) .Conclusion The most commonly used decision‐making method by the resident doctors is the applying regulation method .The residency year system ,resi‐dency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree are the influencing factors of application of the clinical decision‐making methods in the clinical practice of the emergency medicine spe‐cialty .

Objective:To investigate the expression of GDNF mRNA on proximal end of sciatic nerve and T 12 L 1 spinal cord after sciatic nerve was cut in rats. Methods:The sciatic nerve of proximal end and spinal cord paralleling T 12 L 1 nerve root was taken respectively before and after sciatic nerve were severed. The level of GDNF mRNA on proximal end of sciatic nerve and spinal cord was observed and compared before and after sciatic nerve cut. Semi quantitative RT PCR method with ? actin as an inner consult was used to detect the expression of GDNF mRNA. Results:GDNF mRNA expression decreased by 10% 24 h after sciatic nerve was cut, 38% 7 d later, 45% 14 d and 52% 28 d in proximal end, while it decreased by 20%, 68%,80% and 85% on 1, 7, 14 and 28 d respectively in the spinal cord. Conclusion:The reduction of GDNF mRNA level on proximal end and homologous segmental spinal cord may be caused by losing the support of GDNF mRNA from the target tissue after sciatic nerve cut. This study provides a foundation for foreign GDNF to be used in treating SCI.

Objective To compare the curative results of three different therapies for earlyintermediate stage primary liver cancer. Methods The data of 428 patients with early-intermediate stage primary liver cancer treated with one of three curative therapies from April 2004 to July 2010 in our center were analyzed retrospectively. The patients were divided non-randomly into three groups: group A liver-cancer resection (n = 231), group B radio-frequency ablation (RFA) (n = 63), and group C liver transplantation (n=134). The 1-, 3-, 5-year accululative survival and recurrence rate in each group were compared. Results The accumulative 1-, 3-, 5-year survival rates were 93.3%, 71.9%, 57.2% for group A; 86.7%, 46.5%, 38.8% for group B; 95.7%, 78.3%, 72.1% for group C,respectively. The 1-, 3-, 5-year recurrence rates were 30. 3% , 49. 7%, 68. 6% for group A; 39. 3% , 58. 7% , 79. 3% for group B; 7. 0% , 12. 1% , 12. 1% for group C,respectively. There was a highly significant difference between groups A, B and C in the survival rates and the recurrence rates. The 5-year survival rate was significantly higher for group C than group A and group B (P<0. 01, P<0. 001), and the recurrence rate of 1, 3, 5-years were significantly lower for group C than for group A and B (P<0. 001). Conclusion Liver transplantation was the most effective therapy for the early-intermediate stage primary liver cancer.

Inflammation and lung function decline are the main pathophysiological features of chronic obstructive pulmonary disease (COPD). Acupuncture can improve lung function in patients with COPD, but the underlying mechanisms are not well understood. Orexins (OXs), which are found in peripheral plasma, are neuropeptides that regulate respiration and their levels are related to COPD. Therefore, we hypothesized that acupuncture might alter OXs, reduce lung inflammation and improve lung function in COPD.

Objective To evaluate the effect of the Parasep? feces centrifuge tube method on detecting schistosome eggs. Methods A total of 803 residents aged from 6-65 years were selected in 2 schistosomiasis endemic villages Jiangling Coun-ty Hubei Province and their stool samples were collected and detected parallelly by the Kato-Katz technique nylon silk egg hatching method and Parasep? feces centrifuge tube method at the same time. Results Among the 803 people 15 cases were found of schistosome egg positive and the positive rate was 1.87%. The positive rates of the Kato-Katz technique nylon silk egg hatching method and Parasep? feces centrifuge tube method were 0.75% 1.49% and 1.12% respectively. The schistosome eggs got with the Parasep? feces centrifuge tube method were clear and easy to identify. Conclusion In low endemic areas of schistosomiasis the Parasep? feces centrifuge tube method can be used as schistosomiasis japonica etiology diagnosis method.

Objective To evaluate the influence of hepatitis B surface antigen positive or antihepatitis B core positive donors on HBV allograft re-infection or de novo hepatitis B and recipients and grafts survival after liver transplantation.Methods Between June 2004 and December 2011,510 liver transplants were performed at our department while 387 patients were followed up.Among them,9 patients received hepatitis B surface antigen positive grafts,50 patients received anti-hepatitis B core positive grafts,and 328 patients received HBV marks negative grafts.The rate of HBV allograft reinfection or de novo hepatitis B and accumulative recipients as well as grafts survival were compared.Results All recipients with hepatitis B surface antigen positive donors remained hepatitis B surface antigen carriers after operation.HBV allograft re-infection occurred in one recipient of anti-hepatitis B core positive donor group. Five recipients with HBV marks negative donors appeared hepatitis B surface antigen positive,including two cases of Lamivudine resistance leading to HBV allograft reinfection and three cases of de novo hepatitis B from non-related diseases. The 1-,3-,5-year accumulative survival rate in anti-hepatitis B core positive grafts group,hepatitis B surface antigen positive grafts group and HBV marks negative grafts group was 100％,86％,43％; 87％,79％,57％; and 87％,80％,79％,respectively (Log-rank =1.287,P =0.525).And the 1-,3-,5-year accumulative grafts survival rate in these three groups was 100％,86％,43％; 85％,77％,56％;and 86％,79％,77％,respectively (Log rank=1.288,P =0.525).During the follow-up period,no graft loss or death was found to be related to the HBV allograft re-infection or de novo hepatitis B.Conclusion Liver grafts from anti-hepatitis B core positive donors do not increase the risk of graft loss or recipient death due to HBV allograft re-infection or de novo hepatitis B under effective antiviral therapy.Hepatitis B surface antigen positive donors are feasible to save lives or prolong life in emergency situation.