Objective To compare the efficacy and clinical value of early enteral immunonutrition (EIN) combined with glutamine with early standard formula enteral nutrition (EEN) in patients with severe acute pancreatitis(SAP).Methods Twenty-eight patients with SAP were divided into two groups by random number table.Both groups were fasted,given treatments of anti-infection,gastrointestinal decompression,acidoresistance,spasmolysis,pancreatic enzyme inhibition,reduce the burden on the pancreas insulin,water electrolyte balance and parenteral nutrition upon admission into hospital.Spiral nasointestinal tube was implemented within 72 hours of patients' admission.The 14 cases in the EEN group were given treatment of early standard enteral nutrition by nasojejunal tube.The 14 cases in the EIN group received early enteral immunonutrition (glutamine granules,0.2 g/(kg · d),at least three times oral administration by dissolving in enteral nutritious agent peptison with a small amount of warm water).During the treatment,the dose of glutamine granules was reduced gradually until withdrawal when the patients in the EIN group started normal diet.The changes were observed in patients in terms of APACHE Ⅱ,Ranson score,inflammatory markers,nutritional and immune indicators,while monitoring the first defecation time,ICU care unit stay,total hospital stay,total hospitalization costs,complication rate and mortality data.Results Patients of both groups tolerated early enteral nutrition treatment.Fourteen days after treatment,the value of the immune indicator IgG was significantly higher in the EIN group than in the EEN group((19.14 ± 2.03) g vs.(13.79 ± 3.29) g,P ＜0.05).The first defecation time,ICU care days,total hospital costs were significantly shorter or less in patients in the EIN group than in those in the EEN group (first defecation time:((4.29 ± 1.64) d vs.(5.36 ± 0.84)d,t =2.179 ; ICU care:(2.57 ± 0.85) d vs.(3.64 ± 1.60) d,t =2.213 ; total hospital costs:(343.6 ±35.9)thousand yuan vs.(438.6±94.3) thousand yuan,t =3.518; P ＜0.05).Conclusion It is feasible and safety to implement EIN treatment in patients with severe acute pancreatitis.EIN and EEN could significantly reduce the inflammatory response and improve the nutritional status of patients with severe acute pancreatitis.But EIN is better in improving immune function and the prognosis of patients with severe acute pancreatitis than the EEN.

BACKGROUND: Transfection is the most important beginning component of research about gene function. It is a problem to find a transfection agent with high efficiency and safety. Nanosized materials have high surface activity, are easy to be modified and easier to pass the biomembrane. Researchers are studying how to use nanosized materials as a transfection agent.OBJECTIVE: To study the transfection efficiency of different basic polymers with different molecular mass and degree of substitute, and to find the optimized transfection agent.DESIGN: Controlled study.SETTING: Institute of Genetic Engineering, Southern Medical University.METHODS: This study was performed in the Institute of Genetic Engineering, Southern Medical University from March 2006 to June 2007. Using the lipofectamine reagent as the positive control, we transfected siRNA (0.2 nmol/L), FITC-labeling targeting bcl-2, by nine nanometers (polylactic acid-polyglycolic acid, chitosan-poly-caprolactone, polyethyleneimin-macrogol) into leukemic cell K562 cultured without serum. Six hours post-transfection, 20% FBS serum was added. The cell proliferation was measured at 24, 48 and 72 hours by using the MTT method. After transfecting for 48 hours, the cells were collected to detect transfection ratio by using fluorescent microscopy, apoptosis ratio and expression of K562 and bcl-2 protein by flow cytometer (FCM). RESULTS: ① Fluorescence microscope detection showed there were significant differences of transfection efficiency between different materials (P < 0.05). Moreover there were statistical differences between different degrees of substitute, although they were the same material (P < 0.05). ② MTT method indicated the cell proliferation ratio was positively related to transfection ratio. ③ Flow cytometry results showed the suppression of expression of targeting gene and apoptosis ratio were positive correlated with transfection ratio. CONCLUSION:The nanometer poly-ethylene glycol combined with poly-ethylene imine (PEG-PEI), whose molecular mass is 1 800/2 000 and degree of substitute is 29%, has a high efficiency and low toxicity.

Objective To investigate the effect of detail management in ward drug administration.Methods Details management for ward drug management were applied,including the standardization of the drug storage,storage method,to carry out new knowledge learning,to strengthen the drug management,to set up the standardized nursing medication process identification and optimization measures.Results details management,the incidenues of drug mixed and delayed delivery were lower;the time of checking drug was significantly shorter(P<0?001).Conclusions The details management are the effective measures to ensure drug quality and safety.

Objective: To understand the clinical manifestation, imaging characteristics and outcomes of pulmonary malignant tumors in children. Method: We retrospectively collected information about seven cases of pulmonary malignant tumors in children in our hospital from Jan 2010 to Dec 2016. The information included clinical manifestation, imaging characteristics, pathologic results, and treatment. Result: (1) All the seven patients firstly visited pediatric internal medicine departments. Symptoms included cough (n=6), dyspnea (n=4), fever (n=2), anorexia (n=2), chest tightness (n=1), chest pain (n=1), lameness (n=1), abdominal distension and constipation (n=1). We did not find hemoptysis, wheezing or weight loss in those patients. Physical examinations revealed unilateral reduced breath sounds (n=5), moist rales and wheezes (n=1), and normal (n=1). Extrapulmonary signs included abdominal distension (n=2), left hip tenderness (n=1), and mass in left scrotum. We did not identify clubbing finger, anemic appearance, lymph node enlargement, or hepatosplenomegaly etc. (2) Laboratory examination results: complete blood count showed white blood cells in normal range except one case (17.44×10⁹/L). Neutrophil percentage ranged from 0.348 to 0.767. C reactive protein ranged between<1 and 162 mg/L. Hemoglobin was normal. Three out of four cases had abnormal blood tumor markers.(3) Imaging results showed multiple nodes (n=3), multiple cystic lesions in lungs (n=2) (both with pleuropulmonary blastoma), endobronchial soft tissue mass (n=1), pulmonary round-shaped mass (n=1), and mediastinal mass (n=1). Imaging results also found atelectasis (n=3), pneumonia (n=2), pneumothorax (n=2), longitudinal diaphragmatic hernia (n=2), pleural effusion (n=1), subcutaneous emphysema (n=1). (4) All the patients underwent tumor puncture biopsy or tumor resection. Pathology revealed the final diagnosis of pleuropulmonary blastoma (n=3), endodermal sinus tumors (n=2), squamous cell carcinoma of lung (n=1), and thyroid papillary carcinoma (n=1). All of them were malignant tumors. We followed up them. Two patients died (both with pleuropulmonary blastoma) after their parents refused any medical help. Two cases were lost to follow-up. Three patients survived (followed up for 19 months, 11 months and tow months, respectively). One case with thyroid papillary carcinoma pulmonary metastasis underwent right thyroid cancer radical plus left thyroid lobe resection plus modified selective central lymph node dissection, then iodine ¹³¹ treatment. One case with endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies, resection of left retroperitoneal tumor and left testicular tumor, and six additional chemotherapies. Another one case of endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies and was discharged. Conclusion Pulmonary malignant tumors are rare diseases in children. Clinical signs are often non-specific. For those with chest CT showing multiple cystic lesions, endobronchial soft tissue mass or multiple nodes, but no significant infection manifestation or no response to anti-infection therapy, pulmonary malignant tumors should be considered. Biopsy may be needed to confirm the final diagnosis.

{L-End}Objective To establish the construction of intelligent management system for equipment and supplies of medical rescue teams for provincial nuclear and radiation accidents, based on modern Internet+ Internet of Things. {L-End}Methods The current status and requirements of emergency equipment and supplies allocation and management of medical emergency teams for provincial nuclear and radiation accidents were analyzed. Utilizing technologies such as Internet of Things, low-power Bluetooth, and radio frequency identification, an intelligent management system for medical rescue teams, its equipment and supplies for provincial nuclear and radiation accidents was designed. {L-End}Results The intelligent management system for medical rescue teams, its equipment and supplies for nuclear and radiation accidents was able to perform the inventory warning, expiration date warning, maintenance alert, and warning for emergency personnel health status, based on dynamic management of rescue personnel, equipment and supplies. It provided an effective support for on-site commanders in making emergency decisions. {L-End}Conclusion The use of Internet+Internet of Things technology can achieve intelligent management for medical rescue teams and its equipment and supplies can effectively improve the level of personnel and equipment support for the rescue of nuclear and radiation accidents at the provincial level.

ObjectiveThree methods were applied to conduct occupational health risk assessment for the working positions exposed to silicon dusts in a sanitary ceramic manufacturing factory， and the evaluation results were compared to explore the applicability of different occupational health risk assessment methods. MethodsOne large sanitary ceramic product manufacturing enterprise in Songjiang District， Shanghai was selected to conduct occupational health risk assessment for the working positions exposed to silicon dusts， using occupational hazard risk index evaluation method， exposure ratio evaluation method， and International Council on Mining and Metals （ICMM） quantitative occupational health risk assessment method . The consistency of the evaluation results of the three methods was tested using weighted Kappa method. ResultsFourteen working positions exposed to silicon dusts were identified， and three positions had excessive dust concentration： composite forming position of phase 2 workshop （0.80 mg·m^-3）， addition forming position of phase 2 workshop （1.00 mg·m^-3）， and glazing position of 1F in phase 2 workshop （1.50 mg·m^-3）， with an excessive rate of 21.42%. The occupational hazard risk index evaluation method assessed 6 positions with no harm， 6 positions with mild harm， and 2 positions with moderate harm. The ICMM quantitative occupational health risk assessment method assessed 6 positions with potential risks， 2 positions with tolerable risks， and 6 positions with intolerable risks. The exposure ratio evaluation method assessed 8 positions with medium risk， 5 positions with high risk， and 1 position with extremely high risk. The consistency test results of the three evaluation methods were poor. The Kappa coefficient between the occupational hazard risk index evaluation method and the ICMM quantitative occupational health risk assessment method was 0.15. The Kappa coefficient between the occupational hazard risk index evaluation method and the exposure ratio evaluation method was -0.09. The Kappa coefficient between the ICMM quantitative occupational health risk assessment method and the exposure ratio evaluation method was 0.04. The RR values obtained by the three evaluation methods were significantly correlated： the correlation coefficients between RR_{ICMM quantitative assessment method} and RR_{exposure ratio evaluation method}， RR_{Occupational hazard risk index evaluation method} and RR_{ICMM quantitative assessment method}， RR_{Occupational hazard risk index evaluation method} and RR_{exposure ratio evaluation method} were 0.915， 0.604， and 0.594， respectively. The correlation between the assessment result level and C_TWA was strong. ConclusionThe occupational hazard risk index evaluation method is suitable for the working positions with low silicon dust exposure concentration， the ICMM quantitative occupational health risk assessment method and the exposure ratio evaluation method are suitable for the positions with high silicon dust exposure concentration， but all these three evaluation methods have limitations. It is more reasonable to use multiple methods at the same time in actual evaluation work.

The seventh article of Measures for the Ethical Review of Biomedical Research Involving Humans (2016) stipulated that medical and health institutions without an ethics committee shall not carry out biomedical research involving Humans. The Opinions on Strengthening the Governance of Ethics in Science and Technology, issued in March 2022, clearly stated that the institutions that do not meet the conditions for establishing a scientific and technological ethics (review) committee should entrust other institutions to conduct the review. The fourteenth article of Measures for Ethical Review of Life Science and Medical Research Involving Humans (2023) proposes that if an institution, which carries out life science and medical research involving humans, has not established an ethics committee or its ethics committee is not competent for ethics review, it can entrust a competent ethics committee or regional ethics committee in writing to carry out ethical review. Most medical institutions at or above the second level in China have set up ethics committees. While most universities and colleges, scientific research institutions, enterprises and grass-roots medical and health institutions have not set up ethics committees, which lack a working system to protect the safety and interests of the participants, and is difficult to conduct life sciences and medical research involving humans. At present, there is a need for some research institutions that do not have the conditions to establish ethics committees to entrust their projects of life science and medical research involving humans to other institutions for ethical review. The entrusted review is still in the exploratory stage, and there is no relevant specification. The hasty implementation of entrusted review may not achieve the goal of effectively protecting the safety and interests of the participants, and even cause legal disputes. Based on the thematic discussion, with reference to the relevant laws and regulations, departmental rules, ethical standards, and the experience of the ethics committees of some domestic institutions in implementing the entrusted review, the guideline was formulated for the reference of the current entrusted review to ensure the safety and interests of the participants.

The passing of ethical review is a necessary conditions and prerequisite for the development of life science and medical research involving humans. At present, some medical and health institutions have no or insufficient ethical review capabilities. The lack of ethical review ability has become a bottleneck restricting the development of life science and medical research involving humans. According to documents such as Opinions on Deepening the Reform of the Review and Approval System and Encouraging the Innovation of Pharmaceutical and Medical Devices, Opinions on Strengthening the Ethical Governance of Science and Technology, institutions can entrust competent institutional ethics review committees or regional ethics review committees in writing to conduct ethical review. Entrustment ethical review provides a viable solution for institutions that need to carry out life science and medical research involving humans but do not have an ethics (review) committee or the ethics (review) committee is not competent to review. To conduct the entrustment ethical review, the entrustment between the principal and the trustee is required. According to The Measures for Ethical Review of Life Sciences and Medical Research Involving Humans, if medical and health institutions and their ethical review committees do not accept the formal entrustment to provide the ethical review opinions for other institutions, the local health authorities at or above the county level will impose administrative penalties and sanctions on the relevant institutions and personnel in accordance with the law. Signing the entrustment ethical review contract, implementing legal compliance entrusted ethical review to protect the rights and interests of the trustee and the principal, and protect the research participants.