Objective To explore the methods of the nutritional support of children with severe sepsis.Methods The biochemical index,nutrition index,blood gas,blood routine and 24 hours urinary urea nitrogen of 198 children with severe sepsis were detected after hospitalization.Enteral nutrition,parenteral nutrition,or enteral and parenteral nutrition at the same time were selected for every children according to patients status.Children with parenteral nutrition were divided into glutamine (Gln) group and non-Gln group.Nutrition and metabolism indexes of survival and dead children were detected,including blood glucose,C-reactive protein,hemoglobin (Hb),pH,blood sodium,blood potassium,alanine transaminase,blood urea nitrogen,creatinine,blood lacticacid,lactate clearance rate,blood triglycerides,blood total cholesterol,serum pre-albumin (PA),retinal-binding protein (RBP),serum albumin (ALB) and 24 hours urinary urea nitrogen.The intake of calories were compared between survival and dead children before nutrition support (0 d),3 d and 7 d after nutrition support.Immunoglobulins of Gln group and non-Gln group were compared.Results The nutrition indexes of the survival group were higher than those of dead group [PA (130.0 ± 30.0) mg/L vs (50.8 ±20.5) mg/L,RBP(22.3 ±10.3) mg/L vs (15.7 ±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2) g/L,Hb(113.2 ±27.7) g/L vs (95.3 ±10.6) g/L,IgA(0.40 ±0.03) g/L vs (0.40 ±0.03) g/L,IgM(0.52 ±0.18) g/L vs (0.49 ±0.03) g/L] (P ＜0.05).The intake calories of survival group in 3 d and 7 d after nutrition support were (50.32 ±2.76) kcal/(kg·d) and (65.70 ±3.25) kcal/(kg·d),which were significantly higher than those of dead group [(32.54 ± 1.72) kcal/(kg·d) and (46.12 ± 1.08) kcal/(kg·d)).Among the survival children with parenteral nutrition,the levels of immunoglobulin in Gln group were higher than non-Gln group [IgG(4.93 ± 2.1) g/L vs (4.01 ± 1.03) g/L,IgA (0.31 ± 0.07) g/L vs (0.19 ±0.03) g/L,IgM(0.52 ±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05).Negative nitrogen balance was better in Gln group as(-2.5 ± 1.4) g/d than non-Gln group as (-5.3 ± 1.3) g/d(P ＜0.05).Conclusion Children with severe sepsis manifeste significantly increased metabolic rate and energy consumption,the protein decomposition utilization is greater than the synthetic with negative nitrogen balance.Children with more severe sepsis have lower metabolic indexes,nutrition indexes,and immunoglobulin.It is necessary for children with severe sepsis to use glutamine while having parenteral nutrition.

Objective To evaluate the curative effect of polyscope modular flexible ureteroscope combined with Holmium laser lithotrip-sy in the treatment of renal calculi. Methods 53 patients with renal calculi were performed CTU to detect the position of renal calculi before operation. The patients were treated with polyscope modular flexible ureteroscope combined with Holmium laser, and the double J tube were routinely indwelled 4 to 12 weeks after surgery. Results All the 52 patients has successfully completed the operation in the frist stage. The mean operative time was about 38 minutes. 6 patients were treated with flexible ureteroscope for second stage operation. One week after oper-ation, the review showed that there were residual calculi existed in 24 cases and there were 56 cases of post-operative infection, including 17 cases of sepsis or sepsis shock. Conclusion Polyscope modular flexible ureteroscope can be used for all kinds of kidney stones surgery and is characterized by safety and mild tissue injury. But we should pay more attention to the post-operative infection especially urosepsis.

Objective To summarise and analyze the clinical effecacy of endovascular treatment(internal holmium laser incision,bal-loon dilation,ureter dilator,rigid ureter dilation)for ureteral stricture.Methods The clinical data of 628 patients from January 2010 to Jan-uary 2015 in our hospital were analyzed.The relevant operation indicators,postoperative complications and recovery condition were recorded and analyzed.Results The operation time was 5.5 to 29 minutes,with average time of 16.5 minutes,no ureteral avulsion,ureteral fragmen-tation and massive haemorrhage happened.All patients were followed up for 6 to 36 months,591 cases(94.1%)were cured,29 cases (4.6%)of postoperative stricture recurrence received endovascular treatment again,8 patients(1.3%)conversion to open ureterolithotomy. Conclusion Endovascular treatment of ureteral stricture is diversified within holmium laser incision,it has the advantages of shorter opera-tion time,fewer complications,less trauma,repeatability and so on,which is an effective and safe treatment method.

Objective To investigate the strategy of cardiopulmonary resuscitation (CPR) after lung protective mechanical ventilation in critical children and follow-up study of the survivals 90 d after discharge.Methods Four hundred and eighty-nine cases of respiratory cardiac arrest which occurred for various reasons from January 2011 to June 2016 were analyzed in Pediatric Intensive Care Unit (PICU) in Guiyang Children's Hospital,in which mechanical ventilation was performed after CPR in 251 cases,death,or giving up treatment within 24 h in 83 cases,children surviving ＞ 24 h in 168 cases,118 cases were assigned into small tidal volume ventilation group,and 50 cases into conventional tidal volume ventilation group,and according to the tidal volume to adjust positive end expiratory pressure ventilation (PEEP),and the oxygen partial pressure [pa (O2)] and the oxygen index (OI),the change of the indexes of blood gas analysis,lactic acid clearance,and oxygenation were also observed.To observe the complications of mechanical ventilation,the situation of withdrawing machine as well as the outcome of the children.Follow-up was conducted for 90 d,including continuous respiratory symptoms,lung imaging examination after discharge and lung function,nervous system examination.Results (1) After mechanical ventilation treatment of 48 hours,compared with the levels of fractional inspired oxygen (FiO2) (0.42 ± 0.15 vs.0.43 ± 0.22),pa (O2) (8.25 ± 0.22 vs.8.27 ± 0.68),OI (5.33 ± 2.01 vs.6.59 ± 1.99) and lactic acid clearance(61.05 ± 1.87 vs.60.93 ± 2.71) between the routine tidal volume ventilation group and the lower tidal volume ventilation group,showing that the difference had no statistical significance (t =1.645,1.165,2.302,2.037,all P ＞ 0.05).(2) In small tidal volume group,the incidence of ventilator associated lung injury was significantly lower than that in the conventional tidal volume group,and the difference was statistically significant (x2 =5.873,P ＜ 0.05).(3) Comparing 2 groups of different tidal volume ventilation,the mortality of critical ill children had no statistically significant difference (x2 =1.063,P ＞ 0.05).(4) One hundred and twenty-seven cases of children survived and were discharged,and compared with their discharge,the follow-up of 62 cases after discharge for 30 d,90 d showed that all the children's lung function improved,tidal volume,inspiratory and expiratory time ratio(I/E),volume ratio of peak(VP/VE),time ratio of peak(TP/TE) and breathing rate(RR) were also improved,and there was significant difference (F =43.225,6.108,68.821,78.237,20.361,all P ＜ 0.05).(5) Neurological examination and children's brain function classification rating scale showed that some children had nerve dysfunction.Conclusions Small tidal volume ventilation in reducing the occurrence of ventilator associated lung injury is superior to the conventional tidal volume ventilation.To improve case fatality rate of the children with cardiac arrest resuscitation and oxygenation is not better than the conventional tidal volume group.Dynamic monitoring is helpful to adjust breathing mechanics indexes and parameters and ventilator.Through the follow-up most of the discharged children recovered well,but a few had recurrent respiratory infection and neurological sequelae.

Objective: To investigate the effect of pediatric early warning score(PEWS) on the evaluation of severity of emergency children admitted to pediatric intensive care unit(PICU). Methods: A total of 1 069 cases hospitalized through emergency room into PICU in Guiyang Children′s Hospital, from January to December in 2017 were analyzed, and the PEWS was recorded for the first time in emergency room and PICU, while receiver operating curve was used to analyze the efficacy of PEWS to diagnose the children, who were at risk of clinical deterioration and required transfer to the PICU, which included the sensitivity, specificity, Youden index.The diagnostic value of PEWS in asse-ssing the severity of disease in critically ill children was explored. Results: The 1 069 severe cases of PICU ranged from 1 month to 13 years and 8 months, and PEWS score was (4.6±0.8) scores in the emergency room, and (5.1±0.5) scores in the PICU, so there were significant differences of the PEWS score between the death group [(8.0±0.5) scores] and the survival group [(4.8±0.8) scores] in the emergency room and PICU(all P<0.05). The PEWS score of the respiratory, nervous, circulatory and digestive system groups in PICU was (5.8±0.5) scores, while other systemic diseases (blood, kidney, poisoning, and so on) PEWS score was(4.2±0.5) scores; which showed significant differences between 2 groups(t=4.60, P<0.05). In PICU, the score of PEWS was greater than or equal to 4.7, which was the demarcation point to distinguish the critical condition and predict the death risk of the patient. Conclusions PEWS is of great significance for assessing the children sent to PICU.Patients with mainly respiratory, circulatory, neurological, and digestive system diseases have higher PEWS scores.The PEWS score of other system diseases is significantly reduced.It is suggested that PEWS is not able to reflect the disease of such a system and needs to be taken seriously.

OBJECTIVETo investigate the feasibility and efficacy of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer.

METHODSClinical data of 19 cases who underwent the laparoscopic clockwise modularized lymphadenectomy for gastric cancer (clockwise group) from July 2016 to September 2016 were analyzed retrospectively. The clockwise modularized lymphadenectomy included the fixed operative order, detailed procedure and requirement of lymphadenectomy, which mainly reflected in assisting the exposure of operative field and dissection of lymph nodes through suspending the liver and banding the greater omentum, as well as proposing the requirements and attentions for the dissections of each station of lymph nodes to facilitate the quality control of lymphadenectomy. The operative time, intraoperative complications, intraoperative estimate blood loss, number of total harvested lymph nodes, morbidity and postoperative recovery, were compared with the data of another 19 cases who received traditional lymphadenectomy from January 2016 to June 2016 (control group).

RESULTSThe baseline data were comparable between two groups. All the patients were performed successfully by laparoscopy without conversion and intraoperative complications. The operative time, intraoperative estimated blood loss and number of total harvested lymph node were (278.4±29.9) min, (91.1±41.6) ml and 38.2±15.1 in clockwise group, and were (296.7±30.3) min, (102.2±32.2) ml and 37.0±12.3 in control group without significant differences (all P>0.05). However, the mean number of retrieved No.11p lymph nodes was 2.2±1.8 in clockwise group, which was significantly higher than that in control group (0.8±1.0) (P=0.013). Four patients in each group suffered from pulmonary infections, who were cured by conservative therapies. There was no anastomotic leakage, intraperitoneal hemorrhage, intraperitoneal infection or intestinal obstruction in each group.

CONCLUSIONThe clockwise modularized lymphadenectomy can contribute to the facilitation of the retraction and exposure, decrease of the surgical duration and intraoperative blood loss, and radicalization of lymph node dissection, especially for the lymph nodes dissection around the celiac trunk.

Blood Loss, Surgical ; prevention & control ; statistics & numerical data ; Convalescence ; Gastrectomy ; methods ; Humans ; Intraoperative Complications ; epidemiology ; Laparoscopy ; methods ; Lymph Node Excision ; methods ; statistics & numerical data ; Lymph Nodes ; surgery ; Operative Time ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

OBJECTIVE: To establish a mouse model bearing orthotopic temozolomide (TMZ)-resistant glioma that mimics the development of drug resistance in gliomas METHODS: Seventy-eight adult C57BL/6 mice were randomly divided into 6 groups ( RESULTS: The mouse models bearing TMZresistant glioma was successfully established. The cells from the high-dose induced group showed a significantly higher colony-forming rate than those from the high-dose control group ( CONCLUSIONS Progressive increase of TMZ doses in mice bearing orthotopic gliomas can effectively induce TMZ resistance of the gliomas.
Animals ; Antineoplastic Agents, Alkylating/pharmacology* ; Brain Neoplasms/drug therapy* ; Cell Line, Tumor ; Disease Models, Animal ; Drug Resistance, Neoplasm ; Glioma/drug therapy* ; Mice ; Mice, Inbred C57BL ; Temozolomide/therapeutic use*

This paper discussed the current education status on medical ethics and styles and the assessment condition in the examination of doctors' qualification， as well as the existing problems and potential solutions by reviewing domestic and foreign literature and summarizing the practice experience. Traditionally， medical ethics and styles have always been integrated into clinical medical practice in China. However， under the modern medical education system， it is challenged to integrate traditional education on medical ethics and styles with the rules of modern medical knowledge. By summarizing the education and assessment status of medical ethics and styles in the examination of doctors' qualification， it is found that the current examination is relatively poor in the evaluation content， and the way of evaluation is not diverse， with lack of curriculum of medical humanities. The solutions suggested are enriching relevant examination content， introducing more and comprehensive evaluation method， and establishing more medical humanities-related courses.

OBJECTIVETo establish the tissue response grading (TRG) system following neoadjuvant chemotherapy and to investigate its application in the gastric cancer patients who received neoadjuvant chemotherapy.

METHODSData of 30 cT3-4N0-3M0 gastric cancer cases who received neoadjuvant chemotherapy and operation from May 2017 to February 2018 at Department of Gastrointestinal Surgery, West China Hospital were analyzed retrospectively. The edema degree of gastrointestinal tract and perigastric tissues, intraoperative effusion, and fibrosis of tumor and lymph nodes bearing tissues which could be divided into 4 categories constituted the core parameters of the TRG system following neoadjuvant chemotherapy. Four categories of edema: grade 0, no obvious tissue edema; grade 1, slight tissue edema and swelling, no obvious effusion when dissecting the capsule of connective tissues; grade 2, moderate tissue edema and swelling, a few effusion when dissecting the capsule of connective tissues; grade 3, severe tissue edema and swelling with high tension on the capsule of connective tissues, tension blister could be observed in some patients, continuous effusion when dissecting the capsule of connective tissues. Four categories of intraoperative effusion: grade 0, no obvious effusion; grade 1, slight effusion and a few intraperitoneal exudation; grade 2, moderate effusion and continuous intraperitoneal exudation necessitating interrupted suction; grade 3, severe effusion and continuous intraperitoneal exudation necessitating constant suction. Four categories of fibrosis: grade 0, no fibrosis; grade 1, slight fibrosis with threadiness fibrous bands, clear dissecting space could be found between the fibrous tissues and adventitia/normal tissues; grade 2, moderate fibrosis with flaky fibrous tissues, the difficulty of tissue and lymph nodes dissection increased although dissecting space could be found between the fibrous tissues and adventitia/normal tissues; grade 3, severe fibrosis with hard and flaky fibrous membrane, the difficulty of tissue and lymph nodes dissection increased extremely and the fibrous tissues merges with adventitia/normal tissues without dissecting space. The relationships of TRG system with tumor response evaluation by computed tomography (CT), tumor regression score, surgical duration, number of retrieved lymph nodes, number of metastatic lymph nodes, number of enlarged lymph nodes seen in the preoperative CT scans as well as postoperative complications were analyzed using t test, χ² test and logistic regression model.

RESULTSNineteen male and 11 female patients with a mean age of(59.1±9.4) years were enrolled. There were 17 cases of grade 1, 12 cases of grade 2 and 1 case of grade 3 for tissue edema, while the corresponding number was 14, 15 and 1 for intraoperative effusion and 15, 14 and 1 for fibrosis respectively. There were no significant differences among the different degrees of tissue edema, intraoperative effusion and fibrosis in terms of the tumor response evaluation by CT and tumor regression score (all P>0.05). The results of logistics regression showed that tumor response evaluation by CT was related with the degree of tissue edema (P=0.012) and intraoperative effusion (P=0.007), rather than the degree of fibrosis (P=0.527). However, tumor regression score was not related with the degree of tissue edema(P=0.345), intraoperative effusion (P=0.159) and fibrosis (P=0.207). Surgical duration of one case with all grade 3 in tissue edema, intraoperative effusion and fibrosis was 408 minutes, which was longer than those with grade 1 and grade 2 patients [(295.9±40.1) minutes and (293.1±34.3) minutes, respectively]; the number of retrieved lymph nodes, metastatic lymph nodes, and enlarged lymph nodes seen in the preoperative CT scans of this case with all grade 3 were 25, 4 and 1, which were all less than those with grade 1 and grade 2 (42.3±11.9 and 38.5±18.2, 7.3±9.1 and 8.1±9.7, 1.8±1.6 and 2.3±1.3, respectively). There were no significant differences between grade 1 and grade 2 of tissue edema, intraoperative effusion and fibrosis in terms of surgical duration, retrieved lymph nodes, metastatic lymph nodes and enlarged lymph nodes seen in the preoperative CT scans(all P>0.05). Four patients suffered from pulmonary complications and 2 patients experienced slight lymphatic, and all leakage were cured by conservative therapies. There were no significant differences among the different grades of tissue edema, intraoperative effusion and fibrosis in terms of the operation-associated complications (all P>0.05).

CONCLUSIONThe tissue response grading system can assist the judgment of operation difficulty and reflect the effectiveness of neoadjuvant chemotherapy to some extent, which has the possibility of applications.

Aged ; China ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Neoadjuvant Therapy ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; surgery