Objective To evaluate the clinical efficacy of hypocaloric enteral nutrition in patients with acute severe traumatic brain injury (TBI).Methods A total of 100 patients with severe TBI [Glasgow Coma Scale (GCS) 3-8 points] were enrolled and randomly divided into hypocaloric enteral nutrition group (hypocaloric group, 41.86-62.79 kJ · kg-1 · d-1) and traditional caloric enteral nutrition group (traditional caloric group, 104.65-125.58 kJ · kg-1 · d-1) ,50 patients per group.The enteral nutrition was given at 24-72 hours postoperatively.The changes of total serum protein (TP), serum-albumin (ALB), plasma hemoglobin (Hb), fasting blood glucose (Glu) and major gastrointestinal tract complications were observed and compared at 7 and 14 days after enteral nutrition support.Results Levels of TP, ALB and Hb were lowered in both groups at 7 and 14 days after nutritional support but showed no statistical difference (P ＞ 0.05).Glu was (6.37 ± 1.02) mmol/L in hypocaloric calorie group, significantly lower than (7.35 ± 1.70) mmol/L in traditional caloric group at day 7 after nutritional support (P ＜ 0.05).At 7 and 14 days after nutrition support, nausea, regurgitation, vomiting and complication incidence showed no significant difference between hypocaloric calorie group and traditional caloric group after nutritional support (P ＞ 0.05), but abdominal distension, diarrhea and stomach retention rate in hypocaloric group were significantly lower than those in traditional caloric group (P ＜ 0.05).Conclusion Hypocaloric enteral nutrition can significantly reduce the stress hyperglycemia, abdominal distention, diarrhea, gastric retention and other gastrointestinal symptoms in patients with acute severe TBI.

Objective To summarize the perioperative clinical care experience of parenteral and enteral nutrition supports in post-hepatectomy patients.Methods The clinical data of 146 consecutive post-hepatectomy patients in Beijing Hospital were collected and analyzed.For these patients,nutritional risk screening (NRS) 2002 was performed after admission,enteral nutrition support was provided before operation,and enteral and parenteral nutrition supports were provided after operation.Nutritional parameters,clinical outcomes,and nursing methods were evaluated.Results Among these 146 patients,91 patients had≥3 NRS2000 scores,and the remaining 55 patients scored ＜ 3.A total of 118 patients were administrated with enteral and pareteral nutrition;the average enferal nutrition time was 9.6 days,and the average pareteral nutrition time was 5.4 days.The average onset time of passage of gas by anus afar operation was (70.7±17.1) hours.Three patients died,15 patients suffered from infections after operation,and 13 patients experienced other complications.The median hospital stay was 25.5 days.Conclusions Post-hepatectomy patients need take nutritional risk screening after admission and receive appropriate nutritional supports in the perioperative period.It is equally important to strengthen clinical nursing for nutrition support.

Objective To investigate the history, current situation and ecological environment of Chongqing wild and cultivated Fritillaria taipaiensis resources; To provide references for protection and industrial development of Fritillaria taipaiensis resources. Methods Data query, on-the-spot investigation and follow-up survey were used in the study. Results Chongqing Fritillaria taipaiensis was in the medical records since 1843. Now 5 counties have wild Fritillaria taipaiensis resources and 6 districts have cultivated Fritillaria taipaiensis resources, with 6 typical ecological types. Conclusion Chongqing wild Fritillaria taipaiensis resources are wide distributed and with long history of medical usage. Chongqing is the original producing area of Fritillaria taipaiensis, which has been destroyed by human factors. Fritillaria taipaiensis resources in several districts have become extinct, however, the cultivated Fritillaria taipaiensis resources is developing rapidly.

Objective To evaluate the postoperative pain induced by various therapeutic catheters after abdominal surgery.Methods A prospective study was conducted in patients selected based on the inclusion criteria.The general condition of the patients was recorded,and nutritional risk screening was performed.The indwelling of therapeutic catheters after abdominal surgery were recorded,including urinary catheter,nasogastric tube,peritoneal drainage tube,common bile duct drainage tube,wound drainage tube,central venous catheter and peripherally inserted central catheter.The pain caused by each type of catheters was evaluated using visual analog scale at 24,48 and 72 hours after tube/catheter insertion.Results A total of 157 patients were selected,including 70 males and 87 females,aged (60.5 ± 12.5) years,with a body mass index of (23.8 ± 3.2) kg/m2,and a total nutritional risk rate of 42％.According to visual analog scale scores,the degrees of pain due to the therapeutic catheters,in descending order,were as follows:4.9 ± 1.7 for nasogastric tube,3.6 ± 0.9 for wound drainage tube,3.0 ±0.9 for urinary catheter,2.6 ±0.9 for central venous catheter,2.4 ± 1.0 for peritoneal drainage tube,1.9 ± 0.7 for common bile duct drainage tube,and 1.8 ± 0.8 for peripherally inserted central catheter.The catheter-induced pain accounted for (44.9 ± 14.1)％ of the total pain during the hospital stay.Conclusions Nasogastric tube,wound drainage tube and urinary catheter can increase the pain of patients.It is therefore recommended to remove the indwelling tubes as early as possible if only the removal does not harm the outcome of the patient.

Objective:The occurrence of numerous tumors, particularly classical Hodgkin's lymphoma (CHL), is related with Ep-stein-Barr virus (EBV) infection. However, the incidence of CHL and its association with EBV varies significantly with ethnicity, geo-graphic location, sex, and age. This study investigated the association of EBV infection with CHL in Northern Chinese Han population. Methods:EBV-encoded small RNA (EBER) was detected in 136 cases of CHL through in situ hybridization. Results:A total of 37 cas-es were EBER positive (28%). The mixed cellularity (MC) subtype had the highest positive EBER rate of 49%(23/47;P<0.001), fol-lowed by lymphocyte-rich subtype with 30%(3/10), nodular sclerosis (NS) subtype with 14%(10/73), and 1ymphocyte depletion with 0%(0/2). Our study identified a single age distribution in the third decade. Moreover, NS subtype showed an evident single peak in the third decade. However, MC subtype had a lower peak in the fifth decade. The incidence of EBER showed a bimodal age distribution with two peaks in the first and fifth decades (21.6%and 24.3%, respectively). Conclusion:CHL in Northern Chinese Han population was associated with EBV infection, particularly the MC subtype.

Objective To discuss the semilateral supine position for retroperitoneoscopic adrenalectomy. Methods From Jan. 2006 to Dec. 2008, 36 patients (20 males and 16 females with mean age of 43 years) underwent retroperitoneoscopic adrenalectomy in 60° -70° semilateral supine position. There were adrenal cortex adenomas in 18 cases, pheochromocytoma in 6 cases, adrenal cysts in 3 cases, myelolipoma in 2 cases, gangliocytoma in 1 case, lymphangioma in 1 case, metastatic tumor in 1 case and corticohyporplasia in 4 cases. The mean diameter of the tumors was 2.6 cm( 0.5 - 7.7 cm ). The tumors were superior to the renal pole in 5 cases, anteromedial in 10 cases and superomedial in 17 cases. The three ports that were usually used in lateral position and were placed anteriorly to create retroperitoneal place: the first port was placed 2 -4 cm superior to the iliac crest along the anterior axillary line, the other two were placed just below the costal margin along the midaxillary line and at the same level along the midclavicular line, and dissected along the anterior surface of kidney to its superomedial aspect, so as to avoid the hampering of the kidney in the exposing of the diseased adrenal gland. Results The procedure was completed successfully in all of the cases with the operating time of 37 - 145 min ( mean 69 min) and intraoperative blood loss of 30 - 100 ml (mean 48 ml). Six cases had rupture of peritoneum, which were sutured and the procedure was continued to completion. The postoperative hospital stay was 3 -8 d (mean 5 d ). Thirty-five patients were available for follow-up of 3 - 28 months ( mean 14 months). The case of metastatic tumor died of the primary diseases in the 12th month postoperatively. No other complication was found. Conclusion With this alternative position and ports' location, the procedure of retroperitoneoscopic adrenalectomy could be easier and safer than the conventional position.

Objective:To synthesize 177Lu-prostate-specific membrane antigen (PSMA)-617 with domestic 177Lu (made in China), and explore its optimal labeling condition, biodistribution, stability, and safety. Methods:177Lu-PSMA-617 was prepared with domestic 177Lu by a manual method. The optimal labeling condition, radiochemical purity, stability ( in vivo and in vitro), lipid-water partition coefficient, and plasma protein binding rate were determined. The uptake rate of 177Lu-PSMA-617 was evaluated by using 22RV1 cells. Biodistribution and SPECT/CT imaging were performed on normal mice with imported 177Lu-PSMA-617 as control group. The blood routine test was performed to evaluate the safety. Results:The best labeling result of domestic 177Lu-PSMA-617 can be obtained under the following conditions: pH=4.5, 100 ℃ for 30 min. And the radiochemical purity was ≥99%. The product was stable in vivo and in vitro, with the radiochemical purity >95% in 72 h. The plasma protein binding rate was (35.3±5.3)%, the lipid-water partition coefficient was -2.27±0.06, and the specific uptake rate of domestic 177Lu-PSMA-617 by 22RV1 cells reached the highest in 1 h ((7.58±0.84)%), which was slightly lower than the imported 177Lu-PSMA-617 ((7.86±0.96)%), but there was no significant difference between them ( t=-0.439, P>0.05). The distribution and SPECT/CT imaging of normal mice showed that domestic and imported 177Lu-PSMA-617 in blood were cleared quite fast, and both of them were excreted mainly through the kidneys. No obvious adverse reactions were found in the toxicity test of domestic and imported 177Lu-PSMA-617. There was no obvious abnormality in blood routine and liver and kidney metabolism. Conclusion:The domestic 177Lu-PSMA-617 has many advantages, such as qualified quality control, good biological properties and safety, which support its potential application value in diagnosis of prostatic neoplasms.

Purpose: Microtubule-associated protein 1 light chain 3B (LC3B) serves as a key component of autophagy,which is associated with the progression of carcinoma. Yet, it is still unclear whetherLC3B is also an independent risk factor for intrahepatic cholangiocarcinoma (ICC). We aimto explore the predictive value of LC3B on prognosis of ICC, and to establish a novel andavailable nomogram to predict relapse-free survival (RFS) and overall survival (OS) for thesepatients after curative-intent hepatectomy. Materials and Methods: From August 2004 to March 2017, 105 ICC patients were eligibly enrolled in the ThirdAffiliated Hospital of Sun Yat-sen University. Preoperative clinical information of enrolledpatients was collected. Expression LC3B in the ICC specimen was detected by immunohistochemistry. Results: The 5-year RFS and OS in this cohort were 15.7% and 29.6%, respectively. On multivariateCox regression analysis, independent risk factors for 5-year OS were cancer antigen 125,microvascular invasion, LC3B expression and lymph node metastasis. Except for the above4 factors, neutrophil/lymphocyte ratio and tumor differentiation were independent factorsfor 5-year RFS. The area under the curve of nomograms for OS and RFS were 0.820 and0.747, respectively. Conclusion The nomograms based on LC3B can be considered as effective models to predict postoperativesurvival for ICC patients.

OBJECTIVETo explore the molecular mechanism in the formation of unstable plaques.

METHODSThe cDNA microarray E-MTAB-2055 was downloaded from ArrayExpress database to screen the differentially expressed genes in 24 ruptured plaques against 24 stable plaques. Functional enrichment analysis was conducted to define the biological processes and pathways involved in disease progression. The protein-protein interaction network was constructed to identify the risk modules with close interactions. Five pairs of carotid specimens were used to validate 3 differentially expressed genes of the risk modules by real-time PCR.

RESULTSA total of 439 genes showed differential expression in our analysis, including 232 up-regulated and 207 down-regulated genes according to the data filter criteria. Immune-related biological processes and pathways were greatly enriched. The protein-protein interaction network and module analysis suggested that TYROBP, VCL and CXCR4 might play critical roles in the development of unstable plaques, and differential expressions of CXCR4 and TYROBP in carotid plaques were confirmed by real-time PCR.

CONCLUSIONOur study shows the differential gene expression profile, potential biological processes and signaling pathways involved in the process of plaque rupture. TYROBP may be a new candidate disease gene in the pathogenesis of unstable plaques.

Adaptor Proteins, Signal Transducing ; genetics ; Disease Progression ; Down-Regulation ; Gene Expression Profiling ; Humans ; Membrane Proteins ; genetics ; Oligonucleotide Array Sequence Analysis ; Plaque, Atherosclerotic ; genetics ; Protein Interaction Maps ; Real-Time Polymerase Chain Reaction ; Receptors, CXCR4 ; genetics ; Transcriptome ; Up-Regulation ; Vinculin ; genetics

Objective To understand HIV incidence in community residents and epidemiological characteristics of newly detected HIV infection cases in Dali,Yunnan province.Methods A cohort study was conducted among 146720 community residents who were tested to be HIV negative during 2010-2011,they were followed-up from June 1,2014 to May 31,2015.Results A total of 136356 community residents received follow up (92.9％).The follow-up time was 0.23-5.40 years (medium:3.43 years),cumulatively 459675 person years,and 78 people were found to be HIV positive.The incidence rate of HIV infection was 0.170/1000 person years.The incidence rate was 0.037/1000 person years in age group 15-29 years,0.288/1000 person years in age group 30-44 years,0.210/1000 person years in age group 45-59 years,0.204/1000 person years in age ≥60 years;0.213/1 000 person years in males,0.130/1000 person years in females;0.248/1000 person years inHan ethnic group,0.149/1000 person years in Minorities;0.194/1000 in people with education level ≤junior middle school,0.046/1000 person years in people with education level ＞ junior middle school;0.070/1000 person years in the unmarried,0.194/1000 person years in the married and 0.425/1000person years in the divorced/widowed.Cox proportional hazards regression analysis showed that being male (HR=l.731),aged 30-44 years (HR=13.158),aged 45-59 years (HR=10.329),aged ≥60years (HR=8.291),unmarried (HR=3.162) and divorced/widowed (HR=2.689) were the risk factors for HIV infection,while the education level ＞ junior middle school (HR=0.132) was the protective factor for HIV infection.Conclusions By medium 3.43 years follow up,the cohort study showed that incidence rate HIV infection was 0.170/1000 person years in the community residents in Dali.Male,middle aged and old people,people with low education level,the unmarried and the divorced/widowed had relatively higher risk to be infected with HIV,Close attention should be paid to the prevention and control of AIDS in these populations.