Rational clinical nutrition support may slow down the progress from heart insufficiency to heart failure and improve the quality of life.This article summarizes advances in nutrition support in patients with heart insufficiency in terms of nutrition and metabolic characteristics, nutritional risk screening and nutrition status evaluation, nutrient recommendations, and clinical application of nutrition support.Moreover, nutrition and metabolic support in acute heart failure is also discussed.

Objective To investigate the clinical effects of trophic feeding in preterm infants. Methods 93 preterm infants with asphyxia, prenatal asphyxia or respiratory distress syndrome who could not receive routine feeding were enrolled in this study. These patients were randomly divided into the treatment group and the control group. The hospitalized days, the time of tolerating milk feeding, regaining the birth body weight and discontinuing intravenous infusion were compared between the two groups. Results Compared with the control group, the hospitalized days, the time of tolerating milk feeding, regaining the birth body weight and discontinuing intravenous infusion in the treatment group decreased by 4 76?1 81, 3 22?0 50, 2 71?0 95 and 2 68?1 09 days, respectively(P

Objective To analyze the distribution and antimicrobial resistance of pathogenic bacteria in urinary tract infection (UTI)so as to provide evidence for appropriate selection of antimicrobial agents in clinical practice. Methods From January 2001 to December 2008 in Shanghai Ruijin Hospital,4683 strains of pathogenic bacteria isolated from urine samples were detected by ATB system;drug susceptibility test was performed with disk diffusion method and pathogenic bacteria distribution and drug resistance was analyzed with WHO NET 5.3 software. Results Among 4683 strains of pathogenic bacteria,most was gramnegative bacilli,accounting for about 77.8%,of which predominant strain was Escherichia coli (68.7%,3217/4683).The predominant strain of gram-positive bacteria was Enterococcus faecalis,accounting for 10.0%(468/4683).Escherichia coli showed hish resistance rotes to ampicillin,piperacillin and compound snlfamethoxazole(SMZ-TMP),which were 76.6%,61.7%and 57.4%respectively,while a low resistance to imipenem,cefoperazone-sulbactam,piperacillin-tazobactam,Enterococcus faecalis showed high resistance rates to erythromycin,gentamicin and levofloxacin,which were 65.8%,43.2%and 31.1%respectively,and were most susceptive to vancomycin and teicoplanin, both with resistance rates of 0. The susceptibility rate of Enterobacteriaceae to imipenem was 100%. From 2006 to 2008, the detection rate of extend-spectrum β-lactamases ESBLs -producing Escherichia coil in outpatient increased year by year, from 28.7% to 43.3% (P＜0.05), whereas no significant change was found in inpatients. The detection rate of (ESBLs)-producing Escherichia coil in inpatients was significantly higher than that in outpatients (P＜0.05).The detection rate of ESBLs-producing Escherichia coil was 23.6%. The antimicrobial resistance rate in elderly patients was significantly higher than that in overall antimicrobial resistance rote (P＜0.05). Conclusions The predominant bacteria of UTI are still gram-negative bacteria, main of which is Escherichia col. Bacteria are resistant to a variety of antibiotics. Approximate selection of antibiotics in clinical practice should be made on the basis of susceptibility test results.

From August 6 to 8, 2010, the 23 rd "Nutritional risk, malnutrition, nutritional support, outcome, and cost-effective" workshop was held in Beijing. There were 30 participants from Beijing, Tianjin,Chongqing, Chengdu, Kunming, Guiyang, Guangzhou, Songyuan, Weifang, Guilin, Urumqi, Qingdao, Yueyang, and Qinhuangdao. The workshop has 2 sections. Section 1: Learn the published papers from ( 1 ) Jie B,Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition, 2010, (9); (2)Braga M, Gianotti L. Preoperative immunonutrition: cost-benefit analysis. JPEN J Parenter Enteral Nutr,2005, 29 ( 1 Suppl): S57-S61; and ( 3 ) Jiang ZM, Wilmore DW, Wang XR, et al. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br J Surg, 2010, 97 (6): 804-809. Section 2: Discuss two protocols for cohort study and for randomized clinical trial (RCT). The cohort study is to continue the investigations of the impact of nutritional support for inflammatory bowel disease (IBD) on outcome and cost/effectiveness, and the RCT protocol is to plan a new protocol about the impact of fish oil on postoperative outcome and cost/effectiveness. The second protocol also asked Professor Kondrup to join with as the co-principal investigator. At the pilot period, the fish oil study is an open RCT because the costs of nutrients need to be paid by patients himself (herself). To apply the support for nutrients is on the schedule. The 24th workshop will bo held on December 17-19, 2010 in Beijing.

Object To look for the proprietary constituent and the constituents with blood lipid regulating effect from the dried fruit of Crataegus pinnatifida Bge var major N E Br Methods Various column chromatographic techniques were employed for isolation and purification of the constituents UV, IR, EI MS, FAB MS, 1HNMR, 13 CNMR, HMBC, HMQC and 13 CGATE were used to identify the structure of the isolated constituents Results Six compounds were isolated from the fruit of C pinnatifida They were identified as 5, 7, 4′ trihydroxy flavone 8 C ? L rhamnopyranosyl (1→2) ? D glucopyranoside, i e vitexin rhamnoside (Ⅰ), hyperoside (Ⅱ), citric acid (Ⅲ), vitexin (Ⅳ), quercetin (Ⅴ), ursolic acid (Ⅵ) Conclusion Compound Ⅰ is a proprietary constituent in the fruit of C pinnalifida, which was obtained from this plant for the first time Compound Ⅱ is a main constituent with blood lipid reducing effect in flavonoids

Objective:To study the clinicopathologic characteristics and the prognostic factors of triple negative breast cancer,and to study the correlation between clinicopathologic features and EGFR expression.Methods:Clinical characteristics and prognosis of 200 breast cancer patients diagnosed between 1997 and 2004 were reviewed.The paraffin embedded tissues were selected and tissue microarray blocks were made.Immunohistochemical staining was used to evaluate the expression of ER,PR and HER2 for breast cancer molecular type.EGFR expression was evaluated to analyze its correlation with the clinical characteristics and prognosis.Results:Fourty-two cases(21%)of 200 were triple negative breast cancer(TNBC).There was no significant difference between TNBC and non-TNBC in clinicopathologic parameters such as age,tumor size,clinical stage,and lymph node status.However,there was significant difference in histological category and menostasis status between the two groups(P<0.05).Among TNBC,17 0f 42 died during the follow-up(the overall suivival rate was 59.52%),while 26 0f 158 non-TNBC died(the overall survival rate was 83.54%).EGFR was significantly overexpressed in TNBC(69.05%)and it was associated with lymph node status and histological category.Conclusion:Although the incidence of TNBC is low,it has a poorer prognosis than other subtypes.EGFR is highly expressed in TNBC and may serve as a prognostic index and an important therapatic target for breast cancer.

Objective To investigate the nutritional status,body composition,and energy metabolism of hepatocarcinoma patients undergoing surgical treatment and explore the relationships of the nutritional status with body composition and energy metabolism.Methods Totally 112 hospitalized hepatocarcinoma patients undergoing surgical treatment met the inclusion and exclusion criteria were enrolled as the intervention group,and another 100 patients with cholelithiasis during the the same period were enrolled as the control group.Their general clinical data including body mass index(BMI),arm circumference,grip,albumin,prealbumin,energy expenditure,and body composition were collected.The nutritional status was assessed by the scored patient-generated subjective global assessment(PG-SGA).The relationships of the nutritional status with body composition and between energy metabolism were analyzed.All the data were analysed by SPSS 16.0 software package.Results The arm circumference [(23.9±3.6)cm vs.(25.3±4.5)cm,t=2.57,P=0.014],hand grip[(31.7±6.0)kg vs.(39.2±7.6)kg,t=8.19,P<0.001],serum albumin[(32.5±4.7)g/L vs.(36.5±7.2)g/L,t=4.92,P=0.007] and prealbumin[(0.172±0.052)g/L vs.(0.263±0.077)g/L,t=10.3,P=0.004] of the intervention group were significantly lower than the control group.The total malnutrition rate of the intervention group was 37.5％(42 cases at levels B and C),and that of the control group was 14.4％(14 cases at levels B and C)(X2=19.73,P<0.001).The extracellular water significantly increased in the intervention group compared with that of the control group[(15.35±2.21)L vs.(13.51±2.73)L,t=5.54,P<0.001];however,the somatic cell mass [(27.54±4.42)kg vs.(29.03±4.38)kg,t=2.53,P=0.012],fat mass[(13.44±4.23)kg vs.(17.36±5.21)kg,t=6.18,P<0.001],and muscle mass[(43.11±6.27)kg vs.(48.17±7.13)kg,t=5.63,P<0.001] had significantly decreased compared with the control group.The measured value of rest energy expenditure(mREE)[(6 581.62±1 201.70)kJ/d vs.(6 290.73±1 071.68)kJ/d,t=1.98,P=0.042] of the intervention group was significantly higher than the control group(P=0.042),and the respiratory quotient(RQ)was also significantly higher(0.87±0.10 vs.0.85±0.06,t=2.72,P=0.027).The extracellular fluid(PG-SGA A vs.B P=0.035;A vs.C P<0.001;B vs.C P=0.042)were significantly increased,and the number of somatic cells(A vs.B P=0.015;A vs.C P=0.001;B vs.C P=0.022),fat(A vs.B P=0.026;A vs.C P=0.003;B vs.C P=0.022)and muscle mass(A vs.B P=0.029;A vs.C P=0.011;B vs.C P=0.036)were decreased with the deterioration of nutritional status,resting energy expenditure(A vs.B P=0.023;A vs.C P=0.002;B vs.C P=0.032),and RQ(A vs.C P=0.004;B vs.C P=0.012)were also increased with the deterioration of nutritional status,and there was significant difference among three groups.Conclusions The incidence of malnutrition is high in hepatocarcinoma patients undergoing surgical treatment.The patients can have lower lean body mass,more water retention,and higher energy metabolism,which may worsen along with the deterioration of nutritional status.

Objective To evaluate the short-term efficacy of total hip arthroplasty combined with subcutaneous osteotomy in the treatment of CroweⅣ hip dysplasia (DDH).Methods From March 2012 to March 2015,14 patients (16 hips) underwent total hip arthroplasty with femoral distraction osteotomy S-ROM femoral stem prosthesis.And we observed its recent efficacy.Results All patients underwent S-ROM prosthesis.The patients underwent transverse osteotomy of the femoral trochanter.The osteotomy length was 2.0-3.5 cm.The average follow-up time was 19 months.And no complications such as dislocation,vascular nerve injury,deep vein thrombosis and infection were observed during the follow-up.The average Harris scores improved from 42.3 preoperatively to 90.4 postoperatively at 9 months after the operation.The average lengths of preoperative limb shortening and postoperative limb shortening were 6.4 cm and 4.3 cm respectively.The X-ray films showed no dislocation of acetabulum and femoral prosthesis.Bone healing was achieved at 6 months after osteotomy.Conclusion This method could be a good choice for Crowe Ⅳ developmental dysplasia.The short-term efficacy is satisfactory.

Cancer cachexia is a multifactorial syndrome characterized by the continuous loss of skeletal muscle. The pathogenic mechanism of cancer cachexia remains unknown, and the effectiveness of routine nutritional therapy is limited. The mitochondrial disorder is demonstrated to play an important role in the mechanism of tumor-induced skeletal muscle atrophy, including alterations to the mitochondrial ultrastructure, biogenesis, dynamics, mitophagy, and functions. Interventions targeting mitochondrial alterations provide a potential solution to cancer cachexia and represent a new focus in this research field.

Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)in neoadjuvant chemotherapy(NAC) for triple negative breast cancer(TNBC)in the elderly.Methods A total of 16 elderly patients with TNBC admitted to hospital from October 2017 to June 2018 were selected,and they underwent ultrasound examination before treatment.Changes in lesion size and time intensity curve (TIC)parameters were compared against postoperative microscopic diagnoses,which were used as the gold standard,to evaluate the effect of NAC in elderly TNBC patients.Results Compared with pre-treatment imaging data,the sum of the diameters of target lesions was reduced by 38.0％ after NAC treatment[(7.29±1.62)cm vs.(4.52± 1.21)cm,t =2.313,P＜0.05],and TIC parameters showed that the peak intensity(PI)and the time to peak(TTP)and the slope of the ascending part of the curve,or Grad,were statistically different between pre and post-NAC treatment measurements[(-65.14± 3.75)dB vs.(57.67± 1.93)dB,(11.57±7.34)s vs.(5.35±0.83)s,(1.21±0.27) vs.(2.29± 0.45),t =3.512,2.271 and 2.727,P =0.003,0.049 and 0.026,respectively].When compared with microscopic examination results,CEUS TIC analysis for evaluating the efficacy of NAC showed an accuracy of 87.5％ (14/16),a sensitivity of 92.9％ (13/14),a specificity of 50.0％ (1/2),a positive predictive value of 81.3％ (13/16) and an inter-method kappa value of 0.429(x2=0.500,P=0.230).Using CEUS to evaluate the efficacy of NAC achieved an accuracy rate of 81.3％(13/16).Conclusions CEUS can effectively evaluate the efficacy of NAC in elderly patients with TNBC,and guide the clinician to develop an accurate,individualized treatment program benefiting the patients.