Objective To investigate the effect of early enteral nutrition on prognosis of severe acute pancreatitis (SAP) .Methods Fifty-eight patients with SAP were randomly divided into early enteral nutrition group (experimental group ,n=30) and total par-enteral nutrition(TPN) group(control group ,n=28) .The experimental group was feed by Nose-jejunum nutrition tube and the con-trol group were supported with TPN through central vena .Compared the differences in complication incidence rate ,infection rate , mortality rate ,length of hospital stay and costs between two groups .Results The incidence rate of complications ,infection rate , length of hospital stay and hospital costs in experimental group were lower than control group ,the difference was statistically sig-nificant(P<0 .05) .The mortality in experimental group was lower than control group ,but the difference was not statistically sig-nificant(P>0 .05) .Conclusion Early enteral nutrition support therapy can improve the nutritional status of patients with SAP ,re-duce the incidence of complications ,infection ,length of hospital stay and hospital costs .

Objective To investigate the effect of penehychdine hydrochloride (PHCD)on acute lung injury induced by acute severe acute pancreatitis and the expression of hypoxia inducible factor-1α(HIF-1α)in rats.Methods Forty healthy adult male SD rats were used and randomly divided into 3 groups, group S of sham operation,group ALI of pancreatitis-associated acute lung injury (PALI)and group P of PALI with PHCD.Rats of group ALI and group P were the model established of acute lung injury associated with SAP by retrograde injection of 4% sodium taurocholate into biliopancreatic duct.Rats of group P of acute lung injury with SAP were immediately given PHCD after SAP.Rats of group S and group ALI were injected the same amount of 0.9% sodium chloride solution.After modeling,the rats were sacri-ficed at 12 h.The wet/dry weight ratio (W/D)of lung tissue was calculated.Pathological changes of pan-creatic and lung tissues were scored.HIF-1α,IL-1β,IL-6 of lung tissues and serum amylase were detected by ELISA.The expression of TLR4,NF-κB p65 in lung tissue was detected by Western blot.Results Ex-tensive infiltration of neutrophils,alveolar hemorrhage and necrosis and fat necrosis with pancreatic tissue were observed in group PALI and group P.Pancreatic tissue injury score was significantly higher than that of group S (P <0.01).However,there was no statistically significant difference between the level of serum amylase in group P and group ALI.The W/D ratio of lung tissue in rats of group ALI and group P was sig-nificantly higher than those in group S (P <0.05).Compared with those of group ALI,the lung tissue pathological changes of group P were significantly improved,and the lung W/D value was significantly lower than that of group ALI (P <0.05).Compared with group S,the expression of TLR4,NF-κB p65,HIF-1αin lung tissue of group ALI and group P was significantly higher (P <0.01),and the expression of TLR4, NF-κB p65,HIF-1α,IL-1βand IL-6 in group P was significantly lower than that in group ALI (P <0.05).Conclusion PHCD could not alleviate the damage of pancreatic tissue of SAP.It suppressed the expression of HIF-1α,IL-1βand IL-6 and reduced the acute lung injury induced by SAP in rats,which might be depen-ded on suppressing the expression of inflammatory factors,such as HIF-1α.

Objective:To study the correlation between systemic immune inflammation index (SII) and prognosis of patients with hilar cholangiocarcinoma after surgical treatment.Methods:The clinical data of 181 patients with hilar cholangiocarcinoma treated by surgery at the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2016 were retrospectively analyzed. There were 119 men and 62 women, with an average age of 62.4 years. SII was calculated using preoperative routine blood tests. Receiver operating characteristic (ROC) curve was used to obtain the optimal cutoff value of SII. The Kaplan-Meier method was used to draw survival curves and survival rates were compared by log-rank test. The Cox proportional risk model was used to analyze single and multiple factors.Results:The SII area under the ROC curve in predicting postoperative survival was 0.749(95% CI: 0.641-0.858), the optimal threshold was 412.6. Using this threshold, patients were divided into the low SII group (SII≤412.6, n=80) and the high SII group (SII>412.6, n=101). The 1, 3, and 5-year cumulative survival rates of patients in the low SII group were 87.5%, 57.5%, and 26.3%, which were significantly better than those of the high SII group of 71.3%, 39.6%, and 9.9% respectively ( P<0.05). Multivariate analysis showed that SII>412.6 ( HR=2.887, 95% CI: 2.256-7.903, P<0.05) was an independent risk factor for overall survival of patients with hilar cholangiocarcinoma. Conclusion:Preoperative SII had predictive values for postoperative survival of patients with hilar cholangiocarcinoma, SII>412.6 was an independent risk factor for postoperative survival.

The treatment of hepatocellular carcinoma (HCC) has always been a hot spot of medical research worldwide. At present, surgical resection is the main therapy for HCC, supplemen-ted by interventional therapy, chemotherapy, radiotherapy, etc. Although the overall survival of HCC has been significantly improved in recent years, the overall effect is still unsatisfactory. New systemic therapeutic drugs are constantly emerging and applied to clinical practice, which bring new opportunities and challenges for the treatment of HCC. However, too many diagnosis and treatment topics bring obvious contradiction between the division system and the orderly and standardized HCC treatment. In the future, how to realize unified and standardized homogeneous diagnosis and treatment is the key problem to be solved urgently. The authors summarize the current status of diagnosis and treatment of HCC and propose the long-term management concept for HCC according to their own clinical experience and the current advances of the diagnosis and treatment at home and abroad, and carry out new practice and investigation on the patients with HCC by constructing a hepatobiliary multi-technical team.

ObjectiveTo screen out the mRNAs involved in the resistance of hepatoma cells to anlotinib using ceRNA microarray. MethodsHigh-dose shock combined with low-dose induction was used to culture hepatoma cells resistant to anlotinib, and CCK8 assay was used to verify the difference in the proliferation of drug-resistant hepatoma cells treated by anlotinib. The ceRNA microarray was used to screen out the differentially expressed genes between drug-resistant hepatoma cells and normal hepatoma cells, and real-time PCR was used to verify the differentially expressed genes detected by some microarrays. the independent samples t-test was used for comparison of continuous data between two groups, and the Kaplan-Meier method was used to analyze the overall survival of hepatoma cells samples, and the log-rank test was used to compare survival rates. Fisher’s exact test was used for chip screening. ResultsThere was a significant difference in gene expression between drug-resistant hepatoma cells and normal hepatoma cells, and 10 genes with the greatest difference were screened out for analysis by reducing the range. There were 4 genes associated with drug resistance and tumor growth, i.e., BIRC2, BIRC7, ABCC2, and MAPK8. There were significant reductions in the expression levels of BIRC2, ABCC2, and MAPK8 (P=0001 4, 0001 2, and 0.011 8), and there was a significant increase in the expression of BIRC7 (P＜0.001). The results of real-time PCR were consistent with those of microarray (t=10.74,32.65,18.34, and 2.80; P=0.000 4, 0.000 1, 0.000 1, and 0.044 8). The high expression of BIRC7 and the low expression of MAPK8 were associated with the significant reduction in survival time (P=0.022 0 and 0.005 6). ConclusionBIRC2, BIRC7, ABCC2, and MAPK8 are differentially expressed between anlotinib-resistant hepatoma cells and normal hepatoma cells and may be involved in the resistance of hepatoma cells to anlotinib.

Objective To explore the recurrent epidemiological characteristics of hand,foot and mouth disease (HFMD) among children aged <4 years to provide evidence for HFMD prevention and control. Methods Principles on historical cohort study were followed when analyzing data related to HFMD surveillance in Fujian province. All the research objects were restricted to patients aged<4,with HFMD and who were permanent residents in Fujian province. Characteristics of the study objects were extracted as potential factors when the patients first showed symptoms of HFMD. These factors might cause the recurrence of HFMD and were filtered by the logistic stepwise regression with SAS 9.0. Results A total of 82 949 children were included. Among them,2 612 had repetitiously suffered from HFMD (occupied 3.15%),including 2 510 who had the histories of suffering twice,98 suffering three times,3 suffering four times,and 1 even suffering five times. Comparing with the objects who had the first onset at the age of 3,also with the risk increased to 4.39 (95%CI:3.80-5.07)times,when compared to those who had the first onset at the age below 2. Again, the risk among children whose first onset was at the age of 2 had increased to 2.73 (95%CI:2.35-3.18)times. According to the current residents areas,the morbidities of patients under 6 years old were below 2%when the symptoms first started,but the risk of the objects whose morbidities were higher than 4%,had increased 2.15(95%CI:1.88-2.45) times. Again,risk of the objects whose morbidities were between 3%and 4%had increased to 2.10(95%CI:1.85-2.38)times. Among those whose specific morbidities were between 2% and 3%,the risk had increased to 1.65(95%CI:1.44-1.89) times. Comparing with the objects who never visited any maternal/child care settings when started the first onset,the risk among the ones who had been to the maternal/child care settings, had increased to 1.64(95%CI:1.51-1.78)times. Boys had the risk 1.34(95%CI:1.23-1.46)times increase than girls. The preponderant pathogen causing HFMD recurrence was EV71 (33/60). Recurrence might cause more severe symptoms or signs (8/2 612). Pathogens causing the initial infection and recurrence might both belonged to the same-EV71(3/6). Conclusion Recurrence of the disease were closely related to the opportunities of contacting the pathogens. Interventions should be imposed on patients in time as soon as the disease initiated,especially at the younger age.

Radical resection is the only measurement to cure patients of hepatobiliary and pancreatic tumors. The comprehensive application of endoscopy, interventional therapy, radiotherapy and systemic therapy can not only significantly improve the early diagnosis rate of the disease, and successfully transform some borderline resectable tumors into radical resectable states, but also reduce the recurrence rate of tumors after surgery, thus prolonging the survival time of patients. In recent years, the continuous emergence of new systemic therapeutic drugs has brought new opportunities for patients with hepatobiliary and pancreatic malignancies, but the number of doctors participating in diagnosis and treatment has also increased accordingly. Therefore, the contradiction between the division system based on treatment methods and the orderly and standardized treatment is becoming more and more prominent. According to the latest progress of hepatobiliary and pancreatic cancer research at home and abroad, and combined with our clinical experience, we proposed a long-term management concept based on hepatobiliary and pancreatic comprehensive multi-technical team. Based on this concept, we have carried out new thought and practice on the diagnosis and treatment of patients with hepatobiliary and pancreatic malignant tumors.

Objective To analyze the epidemiological characteristics and spatial distribution of human brucellosis in Fujian province during 2011-2016,and provide evidence for the prevention and control of the disease.Methods The surveillance data of human brucellosis in Fujian during 2011-2016 was analyzed with software R 3.3.1,ArcGIS 10.3.1,GeoDa 1.8.8 and SaTScan 9.4.3.Results During 2011-2016,a total of 319 human brucellosis cases were reported,the incidence increased year by year (F=11.838,P=0.026) with the annual incidence of 0.14/100 000.The male to female rate ratio of the incidence was 2.50 ∶ 1.Farmers and herdsmen accounted for 57.37％.The incidence was 0.40/100 000 in Zhangzhou and 0.32/100 000 in Nanping,which were higher than other areas.The number of affected counties (district) increased from 12 in 2011 to 28 in 2016,showing a significant increase (F=13.447,P=0.021).The Moran' s I of brucellosis in Fujian between January 2011 and December 2016 was 0.045,indicating the presence of a high value or low value clustering areas.Local spatial autocorrelation analysis showed that,high-high clustering area (hot spots) were distributed in Zhangpu,Longhai,Longwen,etc,while high-low clustering areas were distributed in Nan' an and Jiaocheng,etc.Temporal scanning showed that there were three clustering areas in areas with high incidence,the most possible clustering,occurring during January 1,2013-December 31,2015,covered 6 counties,including Yunxiao,Pinghe,Longhai,etc,and Zhangpu was the center,(RR =7.96,LLR=92.62,P＜0.001).Conclusions The epidemic of human brucellosis in Fujian is becoming serious,and has spread to general population and non-epidemic areas.It is necessary to strengthen the prevention and control of human brucellosis in areas at high risk.

OBJECTIVETo explore the recurrent epidemiological characteristics of hand, foot and mouth disease (HFMD) among children aged <4 years to provide evidence for HFMD prevention and control.

METHODSPrinciples on historical cohort study were followed when analyzing data related to HFMD surveillance in Fujian province. All the research objects were restricted to patients aged <4, with HFMD and who were permanent residents in Fujian province. Characteristics of the study objects were extracted as potential factors when the patients first showed symptoms of HFMD. These factors might cause the recurrence of HFMD and were filtered by the logistic stepwise regression with SAS 9.0.

RESULTSA total of 82 949 children were included. Among them, 2 612 had repetitiously suffered from HFMD(occupied 3.15%), including 2 510 who had the histories of suffering twice, 98 suffering three times, 3 suffering four times, and 1 even suffering five times. Comparing with the objects who had the first onset at the age of 3, also with the risk increased to 4.39 (95%CI:3.80-5.07) times, when compared to those who had the first onset at the age below 2. Again, the risk among children whose first onset was at the age of 2 had increased to 2.73 (95% CI: 2.35-3.18) times. According to the current residents areas, the morbidities of patients under 6 years old were below 2% when the symptoms first started, but the risk of the objects whose morbidities were higher than 4% , had increased 2.15(95% CI:1.88-2.45)times. Again, risk of the objects whose morbidities were between 3% and 4% had increased to 2.10 (95%CI:1.85-2.38) times. Among those whose specific morbidities were between 2% and 3% , the risk had increased to 1.65 (95% CI: 1.44-1.89) times. Comparing with the objects who never visited any maternal/child care settings when started the first onset, the risk among the ones who had been to the maternal/child care settings, had increased to 1.64 (95% CI:1.51-1.78) times. Boys had the risk 1.34 (95% CI:1.23-1.46)times increase than girls. The preponderant pathogen causing HFMD recurrence was EV71 (33/60). Recurrence might cause more severe symptoms or signs (8/2 612). Pathogens causing the initial infection and recurrence might both belonged to the same-EV71 (3/6).

CONCLUSIONRecurrence of the disease were closely related to the opportunities of contacting the pathogens. Interventions should be imposed on patients in time as soon as the disease initiated, especially at the younger age.

Child, Preschool ; China ; epidemiology ; Cohort Studies ; Epidemics ; Female ; Hand, Foot and Mouth Disease ; epidemiology ; Humans ; Infant ; Logistic Models ; Male ; Recurrence ; Risk Factors