Objective To evaluate effects of steep meridian clear corneal incisions on corneal anterior surface and total astigmatism in phacoemulsification surgery . Methods Clinical data of 56 cases of phacoemulsification surgery with steep meridian clear corneal incisions from August to December 2015 were analyzed in this retrospective study .Corneal anterior surface and total astigmatism were measured with the Pentacam 3D anterior segment measurement and analysis system at the time before surgery and 1 month and 3 months after surgery .The polar coordinate analysis was used to evaluate effects of steep meridian incisions on corneal astigmatism . Results All the operations were accomplished successfully with smooth recovery .The corneal anterior surface and total astigmatism reduced significantly after 1 month and 3 months in astigmatic polar value AKP ( +0) (P<0.05), but no significant difference was found in AKP(+45) (P>0.05).No significant differences were detected between both corneal anterior surface and total astigmatism in AKP(+0) or AKP(+45) between 1 month and 3 months after surgery. Conclusion Steep meridian incision performed on the preoperative steeper meridian of keratometric astigmatism may reduce corneal total astigmatism .

Objective To investigate the diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 6 patients with injury in choledocho-pancreatico-duodenal junction who had been admitted to Beijing Hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of the 6 patients, 4 were diagnosed according to the intraoperative findings, cholangiography and fiber cholangioscopy. The 4 patients were cured after suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage. Two patients developed severe abdominal and retroperitoneal infection and other complications after operation, and were diagnosed by cholangiography and fiber cholangioscopy. Of the 2 patients, 1 was cured and 1 died after multiple drainage procedures and debridement. Conclusions Diagnosis and treatment in the early stage are crucial for the curative purpose. Cholangingraphy and fiber cholangioscopy are effective in the diagnosis of injury in choledocho-pancreatico-duodenal junction. The suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage should be chosen for patients who are diagnosed during primary operation. For patients with abdominal and retroperitoneal abscess and cellulitis, drainage and debridement should be performed, and biliopancreatic diversion and duodenal diverticularizatian are applied to patients when necessary.

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 investigate the changes of electrolyte metabolism in patients undergoing moderate elective abdominal operation,and explore its relationship with postoperative complications.Methods The clinical data of 1117 inpatients (age ≥ 18 years) who had undergone moderate elective abdominal operation in the Department of General Surgery of Beijing Hospital from January 1,2011 to December 31,2011 were retrospectively analyzed.They received postoperative fasting for ≥ 3 days,and the preoperative liver function and renal function were normal.The perioperative electrolyte changes and clinical outcomes were recorded.For patients with normal preoperative electrolytes but abnormal postoperative electrolytes,its potential correlations with the postoperative infections and total complications were analyzed.Results The rates of abnormal postoperative electrolytes were as follows:potassium,24.1％ ; sodium,6.4％ ; chloride,27.6％ ; calcium,61.7％ ; magnesium,16.3％ ; and phosphorus,71％.The vast majority of ion levels were below the normal levels.The total complication rate was 19.7％ and the postoperative infection rate was 17.19％.Univariate logistic regression analysis showed that the postoperative total and infective complications were significantly associated with the increased (P =0.007) or decreased (P =0.007) serum potassium,the decreased serum sodium (P =0.016),the decreased serum phosphorus (P =0.004),and the decreased magnesium (P =0.049).Conclusions Electrolyte decrease is common after moderate elective abdominal operations.There is a certain correlation between postoperative electrolyte decrease and postoperative complications.Therefore,attention should be paid to maintain electrolyte balance during the perioperative period.

Objective To investigate the nutritional status of elderly inpatients with benign orthopedic diseases and to assess its relationship with clinical outcomes.Methods Nutritional Risk Screening 2002 ( NRS 2002) was used to prospectively investigate undernutrition and nutritional risk in elderly patients hospitalized between April 1 and May 31, 2012 in Beijing Hospital for benign orthopedic diseases.Associations between nu-tritional status and clinical outcomes were analyzed.Results A total of 520 patients were included, with a mean age of (75 ±7.09) years.The mean body mass index (BMI) was (23.20 ±3.83) kg/m2, mean dominant-hand grip strength was (16.87 ±19.19) kg, mean mid-upper arm circumference was (25.62 ±3.81) cm, mean calf circumference was (31.92 ±4.02) cm.Compared with patients aged 65-79 years, patients≥80 years showed significantly lower hand grip strength [ (13.58 ±15.92) kg vs.(18.48 ±20.42) kg, P=0.004].All the pa-tients completed NRS 2002, which showed that 9.31%of the patients had undernutrition (BMI≤18.5 kg/m2), and 45.19%had nutritional risk (NRS 2002 score≥3).Compared with patients aged 65-79 years, patients≥80 years had significantly higher incidence of undernutrition (13.97% vs.7.21%, P=0.024) and nutritional risk (52.38%vs.41.76%, P=0.024), higher incidence of infectious complications in patients with nutritional risk (10.21%vs.5.26%, P=0.044), longer hospital stay [ (11.66 ±5.76) days vs.(10.42 ±4.37) days, P=0.016], and higher hospital expense [(20.28 ±1.811) thousand yuan vs.(16.39 ±1.362) thousand yuan, P=0.016].Conclusion Elderly patients hospitalized for benign orthopedic diseases have a high incidence of undernutrition and nutritional risk, which is associated with worse clinical outcomes.

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 rates of undernutrition and nutritional risks of surgical pa-tients with pancreatic tumors .Methods Totally 121 surgical patients with pancreatic tumors from Depart-ment of Surgery Beijing Hospital were enrolled in a prospective study during January 2014 to December 2015 . Patients were divided into two groups:the pancreatic cancer group ( n=90 ) and other pancreatic tumor group ( n=31 ) .Nutritional Risk Screening 2002 was used to assess the nutritional status .Other data including an-thropometric measure, body composition, blood biochemistry and clinical outcome were collected and ana-lyzed.Results Among 121 patients, the mean age was ( 61.9 ±13.6 ) years, the mean body mass index was ( 23.20 ±2.95) kg/m2 , the mean mid-upper circumference was ( 28.8 ±3.5 ) cm, the mean muscle weight was (44.6 ±7.4) kg, and the mean fat mass was (16.8 ±7.6) kg .There was no significantly differ-ence in anthropometric measurement results and body compositions between two groups ( all P>0.05 ) .In the pancreatic cancer group, albumin [ (39.0 ±4.7) g/L vs. (42.3 ±2.9) g/L, P<0.001], total protein [ (62.8 ±6.2) g/L vs.(66.3 ±2.9) g/L, P<0.001], and prealbumin [ (136.1 ±85.4) mg/L vs. (197.8 ±112.6 ) mg/L, P=0.011 ] were significantly lower than those in the other pancreatic tumor group and a higher fasting blood-glucose [ (6.45 ±2.47) mmol/L vs.(4.95 ±0.79) mmol/L, P<0.011] was found.Among all patients , the rates of undernutrition and nutritional risk were 4.1% and 78.5%, and the pancreatic cancer group had a higher rate of nutritional risk (91.1% vs.38.7%,χ2 =36.525, P<0.001). Conclusion In this prospective study , surgical patients with pancreatic cancer have a high incidence of nutri -tional risk, with low protein level and abnormal glucose metabolism .

ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1％ (81/269) ; more specifically,37.5％ (21/56) among geriatric patients ( ≥80 years) and 17.6％ (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3％ (103/269) ; more specifically,57.1％ (32/56) among the geriatric patients and 29.3％ (72/245) among the other age groups (P ＜0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3％,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.

ObjectiveTo explore the clinical outcome of the combined nutrition support for colorectal cancer patients.MethodsTwo research arms were obtained using a cohort sampling method.Ann A ( the study group): from 2009 to 2010,30 colorectal cancer patients were enrolled.They received nutritional risk screening (NRS) 2002 after admission.Nutritional risk was defined as NRS 2002 score ≥3 three days before operation.Patients with nutritional risk received enteral nutrition (EN) for bowel preparation without laxative drug and enema.After operation,they received EN combined with parenteral nutrition (PN) supports provided.Arm B (control group): 30 cases with historically confirmed colorectal cancer were enrolled from 2007 to 2008.They received routine bowel preparation (diet control,laxative drug,and enema) and PN supports after operation.Nutritional parameters,the rate of infectious complications,the rate of systemic inflammatory response syndrome,and the duration of hospital stay were analyzed.ResultsThere were no significant difference in body weight and plasma albumin between these two arms ( P ＞ 0.05 ). The incidence of systemic inflammatory response syndrome (13.3 ％ ),infectious complications (10.0％ ),and the duration of hospital stay [ (12.3 ± 6.5 ) d ] in arm A were significantly lowerthan those in arm B [33％,30％,and (15.0 ±7.2) d,respectively] (P =0.038,P =0.042,P =0.045).Conclusion For the colorectal cancer patients,nutritional risk screening on admission,bowel preparation with eneral nutrition before operation,and combined nutritional support after operation can improve the clinical outcome.

Objective To compare the benefits of the combined nutrition support with enteral nutrition (EN)and parenteral nutrition(PN)versus sole PN for elder patients after pancreaticoduodenectomy.Methods The clinical data of 48 consecutive elderly patients who underwent Whipple operations in Beijing Hospital were retrospectively analyzed.Patients were divided into PN+EN group(n=25)and sole PN group(n=23)according to the nutrition support modes.Demographic data as well as data on liver function,endotoxin levels,and post-operative complications were recorded.Mortality,length of hospital stay,and total costs of post-operative management were compared between two groups.Results Endotoxin level increased on the 1stpost-operative day(POD 1) in two groups,but there is not significant difference,and then gradually decreased in beth two groups;however,the decrease rate(compared with the POD 1 level)was significantly higher in PN+EN group than in PN group on POD 7 and 14(P<0.01).The levels of alanine transaminase,aspartate aminotransferase,total bilirubin,and direct bilirubin increased on POD 1 in both groups,but there is not significant difference,and then gradually decreased;however,the decrease rates(compared with the levels on POD 1)were also significantly higher in PN+EN group than in PN group(P<0.05)on POD 14.Infective complication rate in group PN+EN(2/25,8.0%)was significantly lower than that in group PN(6/23,26.0%)(P<0.05).Total complication rate,post-operative hospital stay,and total costs were similar between these both groups.Conclusions PN+EN can effectively reduce endotoxemia and post-operative infective complications and improve liver function without increasing costs.Therefore,it is feasible for elderly patients after pancreaticoduodenectomy.