Objective To evaluate the clinical efficacy of early enteral nutrition combined with additional parenteral nutrition (EEN + PN) versus TPN (total parenteral nutrition) in patients after conventional pancreaticoduodenectomy (PD).Methods From January 2009 to January 2013, 340 consecutive patients who underwent conventional PD with Child's reconstruction at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled into this single-center retrospective comparative study.There were 87 patients in the EEN + PN group and 253 patients in the TPN group.The preoperative baseline characteristics,histopathological types, intraoperative parameters and postoperative outcomes were recorded and compared between the two groups.Results There were no significant differences in the preoperative general characteristics data, pathological patterns, and intraoperative details.There were significantly higher rates in delayed gastric emptying (DGE), morbidity (15.9％ vs 6.7％, P ＜ 0.05), and pneumonia (10.3％ vs 3.6％, P ＜ 0.05);significantly prolonged nasogastric tube removal time (5.6 ± 0.2 days vs 3.9 ± 0.1 days, P＜0.05), and increase in hospitalization expenses (65 397.0 ± 861.2) Yuan vs (50 663.9 ± 239.2) Yuan, P ＜ 0.05) in the EEN + PN group when compared with the TPN group.Conclusions EEN + PN after conventional PD was associated with increased rates of DGE and pneumonia, prolonged nasogastric tube removal time, longer EN duration and increase in hospitalization expenses.Hence, EEN should only be performed prudently and selectively.

Objective To determine the clinical significance of measuring the levels of 25-(OH) vitamin D3 [(25-(OH) D3)],immune globulins and serum alkaline phosphatase(AKP) in children with recurrent community-acquired pneumonia(CAP).Methods Serum samples were collected in children with recurrent CAP (recur-rent CAP group,n =38),first CAP (first CAP group,n =123),and age matched normal children (heath control group,n =39).The 25-(OH) D3 level,IgG,IgM,IgA and AKP levels were measured.Results The serum 25-(OH)D3 concentration of the recurrent CAP group was (47.87 ± 2.28)nmol/L,that of the first CAP group was (84.43 ± 4.12) nmol/L,and that of the heath control group was (91.2 ± 7.85) nmol/L,the differences among the three groups were statistically significant (t =3.716,8.881,all P ＜0.05).The differences of the serum IgA concen tration among the three groups had statistically significant differences (t =4.596,5.319,9.230,all P ＜ 0.05).But the serum IgG concentration among the three groups had no statistically significant differences(t =1.115,1.887,1.090,all P ＞ 0.05).The serum IgM concentration among the three groups had no statistically significant differences (t =0.804,0.942,0.918,all P ＞ 0.05).The serum AKP concentration among the three groups had no statistically signifi cant differences(t =0.277,0.661,0.866,all P ＞ 0.05).The serum 25-(OH) D3 levels in 161 cases of CAP patients were not correlated to any of the levels of IgM,IgG,IgA,or AKP.Conclusion The levels of 25-(OH) D3 and IgA are significantly lower in children with recurrent CAP,indicating that vitamin D deficiency may play a role in the pathogenesis of recurrent CAP.Prophylactic use of vitamin D supplementation may improve the immune function and reduce the development of recurrent CAP in children.

Objective To investigate the relationship and clinical significance between the concentration of 25-hydroxy vitamin D3 [25-(OH)D3 ]in the serum and community-acquired pneumonia(CAP)in infants.Methods The study recruited 98 infants.There were 68 cases of mild pneumonia and 30 cases of severe pneumonia.The con-centration of 25-(OH)D3 in serum,IgA and alkaline phosphatase(AKP)were measured.33 infants who accepted physical examination in the outpatient department were selected as control group at the same time.Results The serum 25-(OH)D3 concentration of severe pneumonia was (21.09 ±7.32)ng/mL,mild pneumonia was (25.77 ± 8.06)ng/mL and the control group was (37.13 ±6.94)ng/mL.The differences among the three groups had statisti-cally significant differences(t =9.18,3.72,5.34,all P <0.05).The differences of serum IgA concentration among the three groups had statistically significant differences (t =5.42,3.96,8.92,all P <0.05).But serum AKP concen-tration among the three groups had no statistically significant differences(t =0.86,0.58,0.47,all P >0.05).The prevalence of Vitamin D deficiency was 40.0%,which was higher than mild pneumonia patients(20.6%)and the healthy children(9.1%)(χ2 =8.43,17.55,all P <0.05).Conclusion The serum 25-(OH)D3 concentration and IgA of CAP patients were lower than healthy children,especially in severe pneumonia cases.The prevalence of Vita-min D deficiency was significantly higher than healthy children.There were no relevance between the serum concentra-tion of 25-(OH)D3 ,IgA and AKP.25-(OH)D3 plays an important role in the development of CAP.The low level of serum 25-(OH)D3 concentration may be one of the risk factors and has correlation to the severity of pneumonia.

Objective To explore the changes and significance of serum vitamin A levels in children with community acquired pneumonia. Methods A total of 80 children with community-acquired pneumonia (pneumonia group) were selected from October 2015 to March 2016 and were divided into Mycoplasma pneumoniae (MP) infection group, bacteria infection group, MP and bacteria mixed infection group (mixed infection group) according to different pathogens. Thirty healthy children in the same period were selected as the control group. The serum vitamin A concentration was detected by ultra-high-performance liquid chromatography-tandem mass spectrometry. Results The level of serum vitamin A was (0.567±0.163) μmol/L in pneumonia group, (0.578±0.162) μmol/L in MP infection group, (0.557±0.153) μmol/L in bacteria infection group and (0.554±0.186) μmol/L in mixed infection group, and all of them were lower than that in control group (0.759±0.160) μmol/L, and there were significant differences (P<0.05). There was no difference in serum vitamin A level among MP infection group, bacteria infection group and mixed infection group (P>0.05). There was a significant difference in the distribution of vitamin A deficiency between pneumonia group and control group ( P<0.001). The proportion of suspected subclinical vitamin A deficiency in control group was higher, while vitamin A deficiency and subclinical vitamin A deficiency in pneumonia group were higher. Conclusions The serum vitamin A level decreased in children with community-acquired pneumonia, But there was no significant differences in serum vitamin A levels among the children with pneumonia caused by different pathogens.