Objective To investigate the impact of early enteral nutrition on the nutritional status and complications of patients with advanced esophageal carcinomas.Methods Sixty-five patients with advanced esophageal carcinomas were randomly divided into the enteral nutrition group group (n =33) and the control group (n =32).The two groups were given enteral nutrition support and normal nasogastric feeding diet respectively in 24-72 h after hospitalization.The two groups were tested with nutrition indicators:body Mass Index (BMI)/brachial triceps skinfold thickness/upper arm circumference measurement,fasting blood glucose/serum total protein/albumin/cholesterol/triglyceride and the liver function (alanine aminotransferase (ALT)/aspartate aminotransferase(AST)/total bilirubin (TBiL)),and were observed the incidences of complications with liver/intestinal and infection diseases.Results After one month's treatment,compared with the control group,there was significant statistical difference between the two group in patients' nutritional status (BMI index:(22.1 ±4.5) kg/m2 vs.(19.2±4.3) kg/m2; skinfold thickness:(6.2 ±0.4) mm vs.(5.1 ±0.4)mm ; upper arm circumference:(22.8 ± 3.0) cm vs.(20.4 ± 3.2) cm ; serum total protein:(49.2 ± 10.1) g/L vs.(45.1 ± 9.9) g/L; Albumin:(35.5 ± 5.8) g/L vs.(30.6 ± 6.1) g/L; Cholesterol:(5.0 ± 0.6) mmol/L)vs.(4.3 ± 0.7) mmol/L)),the liver function(ALT:(36.0 ± 4.7) U/L vs.(61.5 ± 9.9) U/L; AST:(29.6 ±6.7) U/Lvs.(88.9±10.6) U/L;TBiL:(17.7±3.8) μmol/Lvs.(31.6 ±9.4) μmol/L) (t=2.624,2.036,2.220,2.256,4.155,2.207,2.349,2.476,2.280 respectively,P ＜ 0.05 for all),and the incidence of diarrhea (12％ (4/33) vs.34％ (11/32)) and infection (15％ (5/33) vs.41％ (13/32)) (x2 =2.501,2.193 respectively;P ＜0.05).No statistical difference was observed between the two groups on the levels of serum glucose and triglycerides,and the incidences of complications like bloating/constipation/reflux (P ＞ 0.05).Conclusion The early enteral nutrition could improve the nutritional status of patients with advanced esophageal carcinomas effectively,and reduce the incidence of liver injury,diarrhea and infection.

Objective To evaluate the effect of the department teaching management by using attending physician responsibility system. Methods Eight teachers were scored using the teaching management quantitative scoring standard before and after the implementation ofattending physician responsibility system. Score data of 12 months before the implementation ofattending physician respon-sibility system was defined as the control group, while the score data of 12 months after the implemen-tation ofattending physician responsibility system was defined as the study group. Groups were compared by using the paired t-test and P<0.05 means the difference has statistics significance. Results Com-pared with the control group , there was significant statistical difference between the two groups in teaching lectures, teaching rounds, case discussions, medical recordsquality, departmental rotation examination and the total score ( P<0 . 05 ) . No statistical difference was observed between the two groups on teaching score(P>0.05). Compared with the control group, there was significant statistical difference between the two groups in the senior grade and intermediate grade (P<0.05). Conclusion The attending physician responsibility systemfor teaching management is an effective way to improve the teaching management level.

Purpose Papillary thyroid microcarcinoma (PTMC) is difficult to diagnose its nature before surgery, thus results in misdiagnosis. This paper aims to determine the best diagnostic cutoff value using anteroposterior and transverse diameter ratio (A/L) and longitudinal and transverse diameter ration (L/T) in PTMC. Materials and Methods The CT data of 154 pathology proven benign and malignant thyroid nodules ≤ 1.0 cm in diameter in 78 cases were reviewed, including 75 PTMC in 47 patients and 79 benign nodule in 31 patients. The anteroposterior and transverse diameter ratio (A/T) on axial view, A/L on sagittal view, and L/T on coronal view were measured and calculated. A non-parametric method was used to draw the receiver operating curve of A/T, A/L and L/T. The mean and standard deviation of CT diameters in benign and malignant nodules were calculated. The area under the curve, sensitivity, specificity and diagnostic accuracy, positive predictive value and negative predictive value were determined. CT manifestations of small benign and malignant thyroid nodules were also analyzed. Results The A/T and A/L ratio were significantly larger for PTMC than benign nodules (P<0.01), while L/T diameters were significantly smaller than the benign nodules (P<0.01). The area under ROC was 0.8841, 0.7676 and 0.4052 for A/T, A/L and L/T respectively. The best diagnostic cutoff value of A/T and A/L were 1.05 and 1.0. With A/T ≥ 1.05, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 88.00%, 84.81%, 86.36%, 84.62% and 88.12%, respectively. With A/L ≥ 1.0, the sensitivity, specificity, accuracy, positive predictive value and negative predictive values were 66.67%, 82.28%, 74.68%, 78.13% and 72.22%, respectively. CT characteristics of PTMC included superficial location, oval low density, blurry boundary, microcalcification and progressive enhancement with accuracy of 71.43%, 50.00%, 79.22%, 68.83% and 90.91%, respectively. Conclusion The cutoff values of A/T ≥ 1.05 and A/L ≥ 1.0 can be used to diagnose PTMC with high accuracy.

Objective: To build up rabbit models of hepatic cirrhosis in through common bile duct partial ligation (CBDPL). Methods: Male New Zealand rabbits were subjected to CBDPL to induce hepatic cirrhosis. The liver biopsies were performed during the surgery and after sacrifice to evaluate hepatic fibrosis. The serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), total protein (TP) and albumin (ALB) were determined at week 0, 1, 2, 4 and 11 following the occlusion. Results: There were two kinds of morphological and histological manifestations after CBDPL, the one was inconspicuous hepatic fibrosis coexisted with sacculation-like bile ductal dilation and muddy stone; the other is remarkable hepatic fibrosis and cirrhosis along with uneven bile ductal dilation. The serum levels of ALT, AST, TBIL and DBIL were significantly higher after one week of operation. The levels of ALT, AST, TP and ALB decreased after two-week of operation, and the levels of TBIL and DBIL were returned to the normal level after two-week of operation. Conclusion: The animal models of hepatic cirrhosis can be built up through CBDPL in rabbits.

Objective:To investigate the clinical application value of peripheral blood metagenomic next-generation sequencing (mNGS) test for patients with hematological diseases accompanied by fever.Methods:The blood mNGS results and clinical data of inpatients with hematological diseases accompanied by fever treated in the Hematology Department of Tianjin Medical University General Hospital in March 2020 to June 2021were retrospectively analyzed. A total of 90 patients with 98 cases of specimens were included. The pathogen distribution characteristics and mNGS test performance were analyzed.Results:The positive rate of peripheral blood mNGS was significantly higher than that of traditional examination (68.37% vs 37.76%, P<0.001) and blood culture (68.37% vs 9.18%, P<0.001) . Viral, bacterial, and fungal infections accounted for 38.81%, 14.93%, and 2.99% in patients with single-pathogen infections, respectively. Polymicrobial infections accounted for 43.28%, in which viral and bacterial coinfections were the most common type (25.37%) . There were 55 virus-positive cases (82.09%) , 30 bacteria-positive cases (44.78%) , and 14 fungus-positive cases (20.90%) . The clinical approval rate of peripheral blood mNGS was 64.63% (63/98) . The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of peripheral blood mNGS were 75.68%, 36.07%, 41.79%, and 70.97%, respectively, and the overall consistency rate with traditional examination was 51.02%. Of the 22 pulmonary infection cases with no detectable pathogens by conventional tests, the pathogens were identified by peripheral blood mNGS in 14 cases, 10 of which were clinically approved. Conclusion:The positive rate of peripheral blood mNGS was significantly higher than that of blood culture and traditional laboratory examination. Peripheral blood mNGS had a high clinical recognition rate, sensitivity, and NPV in the detection of pathogens in patients with hematological diseases accompanied by fever.