The aim of nutritional support is to maintain the metabolic function of cells, organs and the whole body, and also to reduce the total energy consumption, finally promotes the patients to recover. Infectious patients are often in the status of high catabolism and negative nitrogen balance. It is necessary for such patients to receive nutritional support, however, the performance is difficult because of the high catabolism status and disorder of physiological function. What is more, inappropriate performance may lead to even worse outcome. Accordingly, the current clinical researches focus on how to improve the effects of nutritional support in infectious patients. Several aspects on this issue including the time, route, dose, metabolic intervention and immune modulation are discussed.

Objective To discuss the value of high frequency ultrasound in assessment the changes of knee,ankle and elbow joints with haemophiliac arthropathy in children.Methods Eighty joints of 42 haemophiliac patients were enrolled in this study.Sixty two joints of 29 patients were examined by X-ray at the same time.The correlation of ultrasonography and X-ray on bone aspects were compared.Results Among 80 joints of 42 haemophilic patients,soft tissue swelling was showed in 12 joints,synovial hypertrophy was in 48 joints,the thickness range of synovial membrane was from 2.01 to 11.12 mm [(4.71± 2.26)mm],increased blood flow was in 40 joints,effusion in 53 joints,haemosiderin was in 33 joints,bone erosion was in 36 joints,subchondral cyst formation was in 20 joints,cartilage damage or disappear was in 31 joints.Ultrasonograthy showed bone erosion in 29 joints,subchondral cyst formation was in 16 joints,cartilage damage was in 24 joints.X-ray showed bone erosion in 23 joints,subchondral cyst was in 16 joints,narrowing joint space was in 20 joints.There was high correlation between the osteochondral domain of the ultrasonography and X ray:Kappa value were 0.803,0.832,0.790 respectively(P ＜0.05).Conclusions Ultrasonography is sensitive to detect the signs of enrolled joints in hemophiliac patients.It is an important method on diagnosis for hemophiliac arthrophv.

Objective:In order to provide policy-makers with basis and reference for improving the operational efficiency of county general public hospitals, this paper studies the changes in overall efficiency, technical efficiency and scale efficiency of 40 county general public hospitals in Fujian province from 2009 to 2014 , as well as how the to-tal factor productivity changes over the time. Methods: After collecting the relevant data of hospital operations from 2009 to 2014, this paper uses CCR, BBC, Malmquist model and other data envelopment analysis (DEA) methods to analyze the data. Results:The vast majority of those 40 county general public hospitals are in decreasing state. The total factor productivity of 40 hospitals from 2009 to 2014 is 1. 019. There are 21 hospitals (52. 5%) that slightly im-proved their productivity, of which 3 hospitals increased their productivity mainly due to technological progress, 3 hospitals due to efficiency increase, and the rest 15 hospitals due to the effect of both technological progress and effi-ciency increase. Conclusions:The operational efficiency of county general public hospitals in Fujian province is gen-erally insufficient, and there are significant differences between operating efficiency of different regions. The efficien-cy of hospitals in mountainous areas had increased, but the efficiency of hospitals in coastal areas had decreased. Therefore, in order to increase investment in county general public hospitals, the government should take differential policy and pay attention to the reasonable control of hospital size, as well as to strengthen the connotation building and attach importance to improving medical service technologies.

Objective To investigate the quantitative analysis of tissue diffusion of real-time elastography(RTE) in chronic renal allograft injury(CRAI) and the relationship between RTE and the level of serum creatinine(Cr).Methods Sixty-nine cases of allograft renal transplantation patients were detected by conventional ultrasound and RTE.According to the time after operation and Cr,they were divided into three groups:group A (in three months after operation and normal Cr,25 cases),group B (more than three months after operation and normal Cr,23 cases),and group C (more than three months after operation and high Cr,21 cases).The results were compared and analyzed.Results ①Contrast between group A and group B,there were differences on Cr and average ralative strain value(MEAN),area ratio of low-strain region (％ AREA),complexity (COMP),skewness (SKEW),(P ＜ 0.05).② In group B,there was correlation between Cr and ％AREA,MEAN,SKEW (r =0.682,P ＜0.05; r =0.628,P ＜0.05; r =-0.481,P ＜0.05).③To make ROC curve,MEAN has higher sensitivity (90.9％),COMP has higher specificity and accuracy (68.0％,81.8％).④ To apply the third result in group C,4 or 5 cases in 21 were abnormal.Conclusions There is a good correlation between the quantitative analysis of tissue diffusion and the level of serum creatinine.RTE can indirectly reflect CRAI,and it is a new method of ultrasonic to evaluate renal allograft function.

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of postoperative complications after pancreas transplantation.Methods Eighty-six post pancreastransplantation patients were examined by CEUS to observe the perfusion of contrast agent,plot timeintensity curve (TIC),and compare to the results of enhanced CT,MRI and pathology.Results Eleven cases of thrombosis,13 cases of rejection and 13 cases of pancreatitis were observed among 86 patients.Result from CEUS showed that:① Distribution of normal pancreatic grafts vascular and parenchyma was even,TIC follows positive skewed distribution.②Thrombosis:there was no perfusion in the embolic vessels and no enhancement or low uneven enhancement in the parenchyma.③ Rejection:perfusion of the parenchyma was slow,peak value was decreased,rising and falling slope of the TIC was reduced with blunt peak.④Pancreatitis:perfusion of the parenchyma was uneven,the regional low enhanced area was visible,clear of the contrast agent was relatively slow,rising slope of TIC was reduced and the peak value was decreased.Conclusions CEUS can monitor the perfusion of the pancreatic grafts vascular and parenchyma,and get useful perfusion parameters.It has been proven as an effective method to definitely diagnose postoperative complications after pancreas transplantation.

BACKGROUND:Volar locking plate is the domin Pedicle screw placement for spinal fractures with X-ray and CT assistant can optimize the accuracy of screw placement.Additionally,X-ray is cheap,repetitive and can reduce radiation injury,but has not been confirmed.OBJECTIVE:To evaluate the effect and imaging evaluation of X-ray in pedicle screw placement for spinal fractures.METHODS:Twenty patients with spinal fractures at T1-8 levels in our hospital from November 2014 to December 2016 were enrolled.The needles were placed along the pedicle axis at the middle of the pedicle,vertebral posterior and vertebral anterior,and its position was recorded by C-arm X-ray,100 pedicle screws were placed under C-arm X-ray,and then evaluated by CT to analyze the application effect of X-ray.RESULTS AND CONCLUSION:The screw length between the actual placement at T1,T2,T3,T4,T5,T6,T7,T8 screw length under C-arm X-ray and virtual ones had no significant differences (P ＞ 0.05),suggesting that X-ray can optimize the accuracy of screw placement.A total of 100 screws were placed,94 screws were excellent,which were placed into the vertebral body completely,and the direction and depth were in accordance with the requirements.Six screws were good,some screws slightly worn out,but the cortical bone was less,and none was poor.No accident of pedicle violations was found.To conclude,C-arm X-ray-assisted screw placement for spinal fractures exhibits ideal outcomes.

It's a hard but imperative research subject for postgraduate to study medical English in TCM colleges.For more than 3 years,Nanjing University of TCM has obtained good effect in such a field and their practices include adopting original edition of textbooks,selecting medical professionals who are good at English as teachers rather than English teachers who have some medical knowledge.Our teaching methodology is continuous,large volume fast reading.

Objective To explore the changes in expression of Klotho, an aging-suppression protein, and neutrophil gelatinase associated lipocalin ( NGAL) and their relationship with rat mesangial cells ( RMCs) cultured with high glucose in vitro, and to explore the role played by Toll-like receptor-4 (TLR4) / nuclear factor-kB(NF-kB) p65 pathways in this process. Methods Three NGAL-siRNA sequences were designed and synthesized. The effective sequence in subsequent experiments was chosen. RMCs were preincubated with pyrrolidinedithiocarbamate (PDTC)or exogenously added Klotho prior to high glucose treatment. Realtime PCR was used to analyze Klotho, TLR4, NGAL mRNA expressions. Western blot was used to observe Klotho, TLR4,NF-kB p65, NGAL,fibronectin (FN), and connective tissue growth factor ( CTGF) protein expression. ELISA assay was used to detect monocyte chemoattractant protein-1 ( MCP-1) and CXCL5 secretions. Results High glucose suppressed Klotho expression significantly(P<0. 05) and activated TLR4 / NF-kB p65 pathway. Meanwhile,the levels of NGAL,FN,CTGF, MCP-1, and CXCL5 were highly expressed ( P < 0. 01). NGAL gene silencing obviously down-regulated the increased expressions of FN, CTGF, MCP-1, and CXCL5 ( P < 0. 01). After PDTC treatment the overexpression of NGAL protein was markedly lowered(P<0. 01). In addition, Klotho treatment significantly inhibited the activity of TLR4 /NF-kB p65 pathways and down-regulated the expressions of NGAL, FN, CTGF, MCP-1 and CXCL5 stimulated by high glucose(P<0. 01). Conclusion Klotho inhibits the activity of TLR4 / NF-kB p65 pathways and thus inhibits NGAL expression in RMCs cultured with high glucose in vitro. And then it suppresses the expressions of FN, CTGF, MCP-1, and CXCL5. This provides a new basis to illustrate the protection mechanism of the anti-aging protein Klotho in diabetic nephropathy, and may provide new ideas and therapeutic targets for prevention and treatment.

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis and grading of acute rejection of the transplanted pancreas after simultaneous pancreas-kidney transplantation.Methods Seventy cases pancreas grafts underwent gray scale ultrasound,color Doppler flow imaging(CDFI) and CEUS examination,the contrast agent perfusion processes were observed,and the parameters of time intensity curves(time-intensity curve,TIC) were calculated.The CEUS results were compared with the pathological findings.Results Twenty-one cases were acute rejection in 70 cases,of which 10 cases were mild,8 cases were moderate and 3 cases were severe;and 49 cases were non-rejection.①Gray scale and CDFI ultrasound:The pancreatic grafts of acute rejection were edema and enlarged,the parenchyma echo were decreased.The artery resistance index(RI) were significant different between acute rejection group and non-rejection group (0.77 ± 0.05 vs 0.74 ± 0.10,P ＜0.05),but there were no significant differences between mild,moderate and severe group (P ＞0.05).②CEUS:TIC curves showed a significantly longer time to reach peak [TTP,(21.7 ± 4.3)s vs (13.0 ± 2.9) s,P ＜0.01] and significantly reduced peakintensity(PI,18.8 ± 7.9 vs 29.6 ± 2.4,P ＜0.05).There was no significant difference between the mild and moderate groups (P ＞0.05) but statistically difference was found when the severe group compared with the other two groups (P ＜0.05).Conclusions CEUS can be used to observe the perfusion of the vascular and parenchyma of the pancreas,the results also can be quantitative analyzed.It is an effective method for the diagnosis of pancreas acute rejection of simultaneous pancreas-kidney transplantation.

Objective To investigate the clinical,imaging,pathological and molecular biological features of mitochondrial encephalomyopathy with lactic acidosis and stroke -like episodes(MELAS)in children.Methods The clinical,imaging,pathological and molecular biological features of 1 2 children with MELAS diagnosed through muscle biopsy or gene sequencing in the Fifth Affiliated Hospital of Zhengzhou University from January 201 1 to December 201 5 were retrospectively analyzed.Results (1 )Clinical features:the main manifestations included headache and vomiting in 1 1 cases,epileptic seizures in 9 cases,short stature in 8 cases,hairy in 7 cases,intolerance fatigue in 7 cases,cogni-tive decline in 7 cases,visual disturbance in 6 cases,hearing disturbance in 6 cases,and 5 cases had positive family history.In addition,7 cases had the serum lactic acid level increase in a rest for 1 0 min after exercise.(2)Imaging fea-tures:4 cases showed bilateral basal ganglia calcification symmetry in 8 patients who underwent head CT scan.The most frequently involved parts of the lesion were occipital in 1 0 cases,temporal in 9 cases and parietal lobe in 7 cases in stroke -like episodes.The lesions were lamellar necrosis.The abnormal areas by MRI showed low signal intensity on T1 weighted imaging,high signal intensity on T2 weighted imaging and fluid attenuated inversion recovery,high or equal signal intensity on diffusion weighted imaging,high or low signal intensity on apparent diffusion coefficient;the lactate peak significantly increased on magnetic resonance spectroscopy.The distribution was not in accordance with the control region of the cerebral vessels.Dynamic observation revealed that the lesions were reversible and migratory.(3)Myo-pathological features:muscle biopsy was performed in all children,and ragged -red fibers were found in 1 0 cases by im-proved Gomori staining,strongly succinate dehydrogenase -reactive were found in 9 cases,and the lipid droplets slight-ly increased in 8 cases by oil red O staining.Besides,the crystalline inclusion bodies in mitochondria were arranged in a parking lotpattern in 9 cases by electromicroscope.(4)Molecular biological characteristics:the mitochondrial gene mutations were analyzed in peripheral blood of 9 children and their parents,including 8 cases with A3243G muta-tion and 1 case with G13513A mutation.Five mothers had the same A3243G mutation site in 8 cases.Conclusions Children with MELAS have complex and varied clinical manifestations and certain characteristic of neuroimaging.More-over,muscle pathology and gene sequencing have important diagnostic value.Fully understanding the clinical,muscle pathology,imaging and molecular biological characteristics of children with MELAS can be helpful to the early diagnosis and treatment,also reduce misdiagnosis.