Objective To study the effect of early trace depth hydrolyzed protein formula and infant formula milk on very low birth weight (VLBW) infants of the gastrointestinal tolerance,growth and development,and provide scientific basis for early enteral feeding VLBW.Methods 126 premature infants with birth weight lower than 1 500 g were randomly divided into observation group (63 cases) and control group (63 cases).On the basis of routine treatment,the observation group was given early trace depth hydrolyzed protein formula,the control group was given early minimal preterm formula milk.We oberserved gastrointestinal tolerance,complications and growth monitoring of two groups.Results Period to regain their birth weight,up to full enteral feeding days of age,hospitalization days,discharge rate of extrauterine growth retardation,the incidence of feeding intolerance,the incidence of neonatal necrotizing enterocolitis,feeding dyspeptic diarrhea incidence in observation group were 12.81 d,25.76 d,37.95 d,23.8％,14.3％,6.3％,3.2％.The data in control group were 16.02 d,27.75 d,45.49 d,42.9％,30.2％,19％,12.7％ respectively.There was significant difference between two groups (P ＜ 0.05).Conclusion To carry out early trace depth hydrolysis protein can reduce the risk of the incidence of complications in VLBW infant which has good promotion on the recent growth and suitable for clinical use.

Objective To compare nasal intermittent positive pressure ventilation （NIPPV） with nasal continuous positive airway pressure (NCPAP) treatment of primary apenea of premature (AOP) effect,and provide a scientific basis for the AOP treatment.Methods Seventy-six cases of children with AOP were randomly divided into NIPPV group (40 cases) and NCPAP group (36 cases).Comparison of two groups changes of blood gas,curative effect,after treatment for invasive mechanical ventilation ratio,ventilation time,and so on.Results Blood gas analysis of two groups before treatment had no significant difference (P ＞ 0.05),1,12 h after treatment of blood gas analysis was statistically significant (P ＜ 0.05).The cure rate,effective rate and inefficiency in NIPPV group were significantly better than those in NCPAP group [82.5％ (33/40)vs.61.1％ (22/36),92.5％ (37/40) vs.80.6％ (29/36),7.5％ (3/40) vs.19.4％ (7/36)].Assisted ventilation time was significantly shorter in NCPAP group[(39.45 ± 6.99) h vs.(69.39 ± 20.51) h].The difference was statistically significant (P ＜ 0.05).Two groups of intraventricular hemorrhage,bronchial pulmonary hypoplasia,neonatal necrotizing enterocolitis incidence rate had no significant difference (P ＞0.05).In NIPPV group the incidence rate of premature infant retina disease and cererbral white matter softening around the ventricle was significantly lower than that in NCPAP group [2.5％ (1/40) vs.13.9％(5/36),2.5％(1/40) vs.11.1％(4/36)].The difference was statistically significant (P ＜ 0.05).Conclusion NIPPV in the treatment of recurrent apnea in premature infants curative effect and prognosis is better than NCPAP.

Objective To investigate the effect of nasal intermittent positive pressure ventilation(NIPPV) on the prognosis of infants with recurrent apenea of premature(AOP) for 12 months of correcting gestational age,thus to provide reference for the treatment of AOP.Methods The premature infants with recurrent AOP of the neonatal intensive care unit were divided into observation group and control group according to the random number table method.The observation group was treated with NIPPV,the control group was treated with nasal continuous positive airway pressure (NCPAP).All living premature infants were followed up for early intervention,hearing,visual acuity,physical and mental development after hospital discharge.Neonatal behavioral neurological assessment (NBNA) was given to the premature infants at the corrected gestational age of 40 weeks and 42 weeks,CDCC was used to test of the corrected gestational age of 1 year old,and the mental retardation,cerebral palsy,hearing impairment,severe deafness,blindness were assessed and compared.Results 123 cases were selected,including 2 cases were abandoned in the treatment,7 cases died(4 cases died during hospitalization,3 cases died after hospital discharge),5 cases were lost following up after hospital discharge,12 cases were treated with poor compliance,the actual research subjects were 97 cases,51 cases in NIPPV group,46 cases in NCPAP group.In NIPPV group,the NBNA score more than 35 points of 40 weeks and 42 weeks were in 38 cases(74.5％),47 cases(92.2％) respectively,which in NCPAP group were respectively in 28 cases(60.9％),37 cases (80.4％).There were statistically significant differences between the two groups (t =14.786,4.149,all P ＜ 0.05).In NIPPV group,MDI score ＜ 80 points,PDI score ＜ 80 points,mental retardation,cerebral palsy were respectively in 7 cases (13.7 ％),6 cases (11.8％),3 cases (5.9％),1 case (2.0％),which in NCPAP group were respectively in 15 cases(32.6％),14 cases(30.4％),8 cases(17.4％),5 cases(10.9％),there were statistically significant differences between the two groups (x2 =10.040,9.765,5.944,6.663,all P ＜ 0.05).In NIPPV group,the hearing impairment,very severe deafness,blindness were respectively in 2 cases (3.9％),0 cases (0.0％),0 cases(0.0％),which in NCPAP group were respectively in 7 cases(15.2％),2 cases(4.3％),2 cases (4.3％),there were statistically significant differences between the two groups (x2 =7.037,4.082,4.082,all P ＜0.05).Conclusion NIPPV in the treatment of premature infants with recurrent AOP has a certain improvement in prognosis.

Objective To study the incidence rate and risk factors of catheter-related infection (CRI) in preemie with peripherally inserted central catheter (PICC),in order to facilitate the implementation of control strategies and control infection.Methods Two hundred and fifty-eight PICC preemie of birth weight less than 2.5 kg,according to whether the incidence of CRI were divided into CRI group and non CRI group,two groups of gestational age,birth weight,PICC time,parenteral nutrition time and PICC parenteral nutrition time were statistically analyzed and compared different indwelling time of CRI incidence.Results Diagnosis of CRI in 24 cases,the occurrence rate of 9.3％ (24/258).There were significant differences in gestational age,birth weight,PICC time,parenteral nutrition time,PICC parenteral nutrition time between CRI group aad non CRI group (29.5 weeks vs.33.0 weeks,1.4 kg vs.1.8 kg,31.5 days vs.14.6 days,40.1 days vs.16.7 days,28.8 days vs.13.4 days,P ＜ 0.01 or ＜ 0.05).There was significant difference in incidence rate of CRI among different indwelling time (P ＜ 0.01).The risk factors of CRI including gestational age (P =0.007),birth weight (P=0.000),PICC time (P=0.001),parenteral nutrition time (P=0.035),PICC parenteral nutrition time (P =0.001).Multivariate Logistic regression analysis showed the greatest impact on the 3 factors were birth weight,parenteral nutrition time,gestational age.Conclusion Gestational age,birth weight,PICC time,parenteral nutrition time are the risk factors of CRI in preemie with PICC.

Objective To explore the necessities and clinical value of acute intestinal obstruction with com-puted tomography of whole abdomen in over 80 years old patients.Methods 50 patients with acute intestinal obstruc-tion were diagnosed in department of emergency surgery and underwent the abdominal CT examinations.The clinical data,CT and surgery pathology of all patients were compared and analyzed.Results All cases were verified by surgi-cal operation and pathological diagnosis,including colorectal cancer(n =21)and incarcerated abdominal external her-nia(n =21),appendicitis(n =2),adhesive intestinal obstruction(n =2),intestinal volvulus (n =2),and intestinal intussusception(n =1)and stercoral intestinal obstruction(n =1),12 cases were accompanied by bowel necrosis and perforation.12 patients were treated by laparoscope surgery,38 cases by open laparotomy,48 patients acquired good recovery,and 2 cases died from extensive bowel necrosis and multi -organ failure.Conclusion CT examination in whole abdomen could rapidly and accurately diagnose the cause of intestinal obstruction,evaluate complications and risks,so as to provide reasonable treatment choice and time,making patients acquired the effective effects as soon as possible,reducing the bad consequences.

Objective To investigate the imaging findings and key diagnostic points of Brunner’s gland adenoma on CT.Methods The CT imaging findings and pathological features of 9 cases of Brunner’s gland adenoma confirmed by pathology were retrospec-tively analyzed,including the lesions number,site,size,shape,margin,density and the enhancement pattern.Results Of the 9 ca-ses,1 case located in the antrum and 8 cases in the duodenaum [6 cases in the duodenal bulb (75%)and 2 in the papillary (25%)]. Of the 6 cases of duodenal lesions,3 were found at the anterior wall and 3 at the posterior wall.Except 1 case which complicated with enteritis and had an obscure margin,the other 8 cases were clear margined ,and were round or nodular in shape.The maximum size of tumors ranged 1 5-68 mm in diameters (mean 35.0 mm ± 1 6.2 mm).The density of tumors was homogeneous on CT scan without necrosis or hemorrhage.In the arterial phase after administration of contrast agent,the lesions were similar to the adjacent intestinal wall enhancement,and mucosal annular enhancement (halo sign)showed in 6 cases,and the dot-shape non-enhancement area within the lesion (black star sign)showed in 5 cases,and the thickening or tortuous enhanced blood vessel showed in 6 cases.In the venous phase,9 cases were progressive enhancement,and the “black star sign”or “the black line sign”showed more clearly in 5 cases.In the pathology,the lesions were polypoid-like,solid or cystic.Under the microscope,the hyperplasic Brunner’s glands were covered with normal duodenal mucosa and separated by bundles of smooth muscle cells with dilated duct,cyst,and adipose cells,1 case with atypical hyperplasia of the glandular epithelium and 1 case with ectopic pancreas.Conclusion There are some spe-cific CT imaging features in Brunner’s gland adenoma,which is of important clinical value in accurate preoperative diagnostic.

This study examined the effect of self-microemulsiflying drug delivery system (SMEDDS) containing Cremophor RH40 or Tween 80 at various dilutions on cytochrome P450 3A (CYP3A) enzymes in rat hepatocytes, with midazolam serving as a CYP3A substrate. The particle size and zeta potential of microemulsions were evaluated upon dilution with aqueous medium. In vitro release was detected by a dialysis method in reverse. The effects of SMEDDS at different dilutions and surfactants at different concentrations on the metabolism of MDZ were investigated in murine hepatocytes. The cytotoxicity of SMEDDS at different dilutions was measured by LDH release and MTT technique. The effects of SMEDDS on the CYP3A enzymes activity were determined by Western blotting. Our results showed that dilution had less effect on the particle size and zeta potential in the range from 1:25 to 1:500. The MDZ was completely released in 10 h. A significant decrease in the formation of 1'-OH-MDZ in rat hepatocytes was observed after treatment with both SMEDDS at dilutions ranging from 1:50 to 1:250 and Cremophor RH 40 or Tween 80 at concentrations ranging from 0.1% to 1% (w/v), with no cytotoxicity observed. A significant decrease in CYP3A protein expression was observed in cells by Western blotting in the presence of either Cremophor RH40 or Tween 80-based SMEDDS at the dilutions ranging from 1:50 to 1:250. This study suggested that the excipient inhibitor-based formulation is a potential protective platform for decreasing metabolism of sensitive drugs that are CYP3A substrates.

Objective To evaluate the diagnostic value of magnetic resonance imaging (MRI) in the diagnosis of soft tissue sarcoma. Methods Seventy-four soft tissue tumors patients having underwent plain and enhanced MRI scans were selected. A retrospective case-control study was conducted to compare the demographic and MRI characteristics between 32 cases of soft tissue sarcoma and 42 cases of benign soft tissue tumor. The examined MRI characteristics included lesion location, morphology, size, signal uniformity, intratumoral sign, sign outside the tumor and intensity pattern, et al. The MRI characteristics were compared between 2 groups. Results The 32 patients with soft tissue sarcoma included 7 cases with lipoblastoma, 5 cases with pleomorphic undifferentiated sarcoma, 5 cases with fibrosarcoma, 5 cases with synovial sarcoma 5 cases, 4 cases with dermatofibrosarcoma protuberant, 2 cases with low-grade fibromyxoid sarcoma, 2 cases with alveolar soft part sarcoma, 1 case with leiomyosarcoma, and 1 case with histiocytic sarcoma. The 42 patients with benign soft tissue tumor included 15 cases with neurilemmoma, 9 cases with angioma, 8 cases with neurofibroma, 6 cases with lipoma, and 4 cases with angiolipoma. After controlling for the potential confounding effects of sex and age, whether there was high signal on T2WI and whether the tumor boundary was clear can help for distinguishing soft tissue sarcoma and benign tumor. The occurrence of high signal on T2WI was a risk factor for soft tissue sarcomas ( OR=25.05, 95% CI 4.04 to 155.28), and tumors whose boundaries were less clear ( OR=18.84, 95% CI 2.98 to 118.99) and unclear ( OR=26.59, 95% CI 3.79 to 186.71) were more likely to be soft tissue sarcomas compared to those with clear boundaries. Conclusions The MRI characteristics of soft tissue sarcomas can be used for accurate diagnosis of the tumors before treatment.

This study examined the effect of self-microemulsiflying drug delivery system (SMEDDS) containing Cremophor RH40 or Tween 80 at various dilutions on cytochrome P450 3A (CYP3A) enzymes in rat hepatocytes, with midazolam serving as a CYP3A substrate. The particle size and zeta potential of microemulsions were evaluated upon dilution with aqueous medium. In vitro release was detected by a dialysis method in reverse. The effects of SMEDDS at different dilutions and surfactants at different concentrations on the metabolism of MDZ were investigated in murine hepatocytes. The cytotoxicity of SMEDDS at different dilutions was measured by LDH release and MTT technique. The effects of SMEDDS on the CYP3A enzymes activity were determined by Western blotting. Our results showed that dilution had less effect on the particle size and zeta potential in the range from 1:25 to 1:500. The MDZ was completely released in 10 h. A significant decrease in the formation of 1'-OH-MDZ in rat hepatocytes was observed after treatment with both SMEDDS at dilutions ranging from 1:50 to 1:250 and Cremophor RH 40 or Tween 80 at concentrations ranging from 0.1% to 1% (w/v), with no cytotoxicity observed. A significant decrease in CYP3A protein expression was observed in cells by Western blotting in the presence of either Cremophor RH40 or Tween 80-based SMEDDS at the dilutions ranging from 1:50 to 1:250. This study suggested that the excipient inhibitor-based formulation is a potential protective platform for decreasing metabolism of sensitive drugs that are CYP3A substrates.