Objective To explore the effect of combination application of preoperative carbohydrate loading and sequential enteral nutrition on the recovery of postoperative patients with stomach neoplasm.Methods Ninety-eight patients with stomach neoplasm were randomly divided into three groups.Those were Group A (preoperative fasting + sequential EN,n =33),group B (preoperative carbohydrate loading + postoperative TPN,n =33) and group C (preoperative carbohydrate loading + sequential EN,n =32).Insulin sensitivity (IS) ; Nutritional indicators including pre-albumin (PA) and transferrin (TRF) ; immunity parameters including IgG,IgM and IgA were measured in blood on the day before the operation,the 1st day,4th day and 8th day after the operation.Meanwhile,anal exhaust time after the operation,incidence of complications and postoperative hospitalizing time were also observed.Results The level of IS in group C at 4th day and 8th day after operation were 35.8 ± 3.2 and 36.1 ± 3.5,higher than those in A group and B group (A group:30.7 ±3.3,33.5 ±2.9;B group:33.7 ±3.1,34.0 ±2.2),and the differences were significant((F =20.88,7.28 ;P ＜0.05).At the 4th day after the operation,the levels of PA in group B and group C were (191 ± 11.6) mg/ and (193 ± 12.7) mg/L,significantly higher than those in group A ((176 ± 14.1) mg/L;F =17.15,P ＜ 0.01).At the 8th day after the operation,the levels of PA and TRF in group C were (221.3 ±30.81) mg/L and (86 ± 0.37) g/L,significantly higher than those in group A and group B (group A:(198.0 ± 30.6) mg/L,(1.60 ± ±0.33) g/L;group B:(202.0 ±28.6) mg/L,(1.61 ±0.34) g/L;F =5.42,5.83 ;P ＜0.01).At the 8th day after the operation,the levels of IgA,IgG and IgM in the group C were (2.74 ±0.69) g/L,(14.55 ±2.57) g/ L,(1.08 ± 0.33) g/L,significantly higher than that in group A and group B (group A:(2.30 ± 0.54) g/L,(12.71 ±2.94) g/L,(0.86 ±0.31) g/L;group B:(2.29 ±0.50) g/L,(12.06 ±3.33) g/L,(0.89 ±0.27)g/L;F =6.12,6.13,4.94;P ＜ 0.05).Conclusion The combination of preoperative carbohydrate loading and sequential enteral nutrition can reduce insulin resistance,improve postoperative nutritional status,improve the recovery of immune function and intestinal function,as well as reduce the incidence of postoperative complications.

Objective To investigate the production and mechanism of chemokine (C-C motif) ligand 5 (CCL5) by macrophages in U14 cervical cancer-bearing mice during infection. Methods The U14 cervical cancer cells were injected in C57BL/6 mice to induce tumor-bearing condition. Lipopolysaccharide (LPS) was injected into C57BL/6 mice to induce infection. The protein expression of CCL5 in the serum and the CCL5 mRNA expression in inflammatory cells were measured by ELISA and fluorescence quantitative-PCR in four groups. Macrophages were induced in the tumor conditioned medium (TCM) which extracted from mice serum. The protein expression levels of CCL5, prostaglandin E2 (PGE2) and cyclic adenosine monophosphate (cAMP) in the medium and CCL5, PGE2 and cAMP mRNA expression in the macrophages were detected in different groups. In order to determine whether the inhibition was related to PGE2, selective cyclooxygenase 2(COX-2) inhibitor NS398 was used to reverse this phenomenon and protein kinase A (PKA) inhibitor H89 demonstrated the mechanism through blocking cAMP/PKA signaling pathway. Results (1) The protein and mRNA level of CCL5 in tumor-bearing mice were respectively (151±35) pg/ml and 1.0, which were lower than those in the tumor-free mice (691 ± 85) pg/ml and 4.5 ± 0.8, there were significant difference between them (all P<0.05). The protein and mRNA level of PGE2 in tumor-bearing mice were (1 198±83) pg/ml and 5.8±0.8, which were higher than those in the tumor-free mice (187±25) pg/ml and 1.0, the difference were significant (all P<0.05). The protein and mRNA level of CCL5 in tumor-free+LPS mice were (4 049±141) pg/ml and 31.5±2.0, which were higher than those in the tumor-bearing+LPS mice (1 951±71) pg/ml and 12.1±2.8, the difference were also significant (P<0.05). The protein and mRNA level of PGE2 in tumor-free+LPS mice were (676±70) pg/ml and 3.4±0.4, which were lower than those in tumor-bearing+LPS mice (2 550±382) pg/ml and 11.6±0.9, the difference were also significant (all P<0.05). (2) Macrophages were cultured in vitro using TCM derived from mice. The protein and mRNA level of CCL5 in tumor-bearing mice TCM were respectively (1 626 ± 177) pg/ml and 28.6 ± 1.2, which were higher than those in the tumor-free mice TCM [(27 ± 3) pg/ml and 1.0], there were significant difference (P<0.05). The protein and mRNA level of PGE2 in tumor-bearing mice TCM were (790 ± 156) pg/ml and 1.7 ± 0.3, which were higher than those in the tumor-free mice TCM [(448 ± 115) pg/ml, 1.0], the difference were significant (all P<0.05). The protein and mRNA level of cAMP in tumor-bearing mice TCM were (164 ± 30) pg/ml and 1.6 ± 0.3, which weres higher than those in the tumor-free mice TCM [(118 ± 25) pg/ml,1.0], the difference were significant (all P<0.05). The protein and mRNA level of CCL5 in tumor-free + LPS mice TCM were (10 475 ± 742) pg/ml and 212.0 ± 5.7, which were higher than those in the tumor-bearing+LPS mice TCM [(6 375±530) pg/ml, 142.3±2.5], the difference were significant (all P<0.05). The protein and mRNA level of PGE2 in tumor-free+LPS mice TCM were (2 438±95) pg/ml and 4.3±0.7, which weres lower than those in the tumor-bearing + LPS mice TCM [(3 441 ± 163) pg/ml, 5.9 ± 0.3], the difference were significant (all P<0.05). The protein and mRNA level of cAMP in tumor-free+LPS mice TCM were (340 ± 13) pg/ml and 4.1 ± 0.4, which were lower than those in the tumor-bearing + LPS mice TCM [(542 ± 42) pg/ml, 5.4 ± 0.5], the difference were significant (all P<0.05). (3) Using COX-2 inhibitor NS398 in the tumor-bearing+LPS mice, the protein and mRNA level of CCL5, PGE2 and cAMP were (7 691±269) pg/ml and 159.0±8.9, (2 820±152) pg/ml and 4.9 ± 0.3, (465 ± 8) pg/ml and 4.3 ± 0.4, respectively, and there were significant difference (all P<0.05), compared to before treatment. Using PKA inhibitor H89 in the tumor-bearing+LPS mice, the protein and mRNA level of CCL5, PGE2 and cAMP were (8 375±520) pg/ml and 177.0±8.8, (2 650±35) pg/ml and 4.7 ± 0.4, (368 ± 13) pg/ml and 3.1 ± 0.7, respectively, and there were significant difference (all P<0.05), compared to before treatment. Conclusion TCM of U14 cells activated macrophages to release PGE2 could inhibit the expression of CCL5 levels by cAMP/PKA signaling pathway.

Objective:Eph receptors constitute the largest sub-family of receptor tyrosine kinases(RTKs) and have an important role in oncogenic transformation and tumor progression.This study aimed to analyze the aberrant expression of EphA1 gene in gastric cancer and its correlation with clinical parameters,so as to explore the significance of EphA1 in the etiology and progression in gastric cancer.Methods: Expression of EphA1 protein was determined using immunohistochemical staining in 60 gastric cancer patients.Correlation between EphA1 protein expression and clinical parameters was evaluated by statistics.Results: Over-expression was more commonly observed in more advanced patients(P=0.015) and in those with lymph nodes metastases(P=0.032).There was no correlation between EphA1 expression and other clinical parameters.Conclusion: EphA1 gene could promote the progression of gastric cancer.

ObjectiveTo evaluate the influence of electrotome on permanent and temporary cardiac pacemaker in laparoscopic cholecystectomy ( LC),and the application of cardiac pacemaker to the cases of cholecystolithiasis combined with bradyarrhythmia.MethodsClinical data of 215 patients with permanent or temporary cardiac pacemaker who underwent were studied for the preoperative and postoperative variation of pacemaker function,and for the influence of electricity coagulation during the operation on cardiac pacemaker function.ResultsLC was successfully completed in all 215 patients.The function of cardiac pacemaker was not obviously interfered during the operation,and the parameters of cardiac pacemaker did not remarkably change after the operation.ConclusionCardiac pacemaker is slightly interfered when electrotome and electrocoagulation were used in LC; LC is feasible and safe for patients with bradyarrhythmia by placement of cardiac pacemaker.

Lipoprotein a[Lp(a)]is a risk factor for cardiovascular disease.This paper summarizes the structure,anabolism and mechanism of action of Lp(a),and the relationship between Lp(a)and cardiovascular diseases,liver and kidney diseases,diabetes mellitus and other diseases.It focuses on the traditional lipid-low-ering regimen to reduce plasma Lp(a)level and the current popular novel therapies,such as mipomersen,pel-acarsen,olpasiran,and the interfering effect of related drugs on Lp(a)level and the degree of benefit on cardi-ovascular events.How to reduce plasma Lp(a)level and improve patient prognosis will be the key to future Lp(a)related research.

BACKGROUND:The type of graft selected during anterior cruciate ligament revision is considered one of the main factors affecting the postoperative outcome,but there are few reports on the comparison between different graft materials. OBJECTIVE:To explore the medium-to-long-term clinical efficacy after anterior cruciate ligament revision with autologous ligament,allogeneic ligament,and LARS artificial ligament. METHODS:A total of 67 patients with the first anterior cruciate ligament revision admitted to the Department of Joint and Sports Medicine,The Second Hospital of Tangshan from May 2011 to May 2020 were selected,including 41 males and 26 females,with a mean age of(45.83±7.39)years.They were divided into three groups according to different grafts used:autologous ligament group(n=24),allogeneic ligament group(n=22),and LARS artificial ligament group(n=21).Follow-up for more than 36 months after revision was performed to evaluate the effect of revision. RESULTS AND CONCLUSION:(1)International Knee Documentation Committee(IKDC)score,Lysholm knee score,and Tegner motor score 1 year after surgery and at the last follow-up in the three groups were higher than those before surgery(P<0.05).There were no significant differences in IKDC score,Lysholm knee score,and Tegner motor score among the three groups 1 year after surgery and the last follow-up(P>0.05).(2)The lateral differences of KT-1000 at 1 year after surgery and the last follow-up among the three groups were lower than those before surgery(P<0.05).The lateral difference of KT-1000 and the positive rate of the axial shift test in the last follow-up of the LARS artificial ligament group were higher than those in the autologous ligament group and allogeneic ligament group(P<0.05).(3)At the last follow-up,X-ray films showed no obvious enlargement of the reconstructed bone tunnel and no obvious failure of the graft fixation device.There was no obvious aggravation of osteoarthritis,but bone density decreased significantly in some elderly patients.(4)These findings suggest that anterior cruciate ligament revision with LARS artificial ligaments can obtain good initial stability,but with the extension of time,the stability of partial cases tends to decrease,even with reconstructed ligament failure.Both allogeneic and autogenous ligaments can obtain good clinical efficacy in anterior cruciate ligament revision.