Objective To compare the influence of early parenteral nutrition and enteral nutrition on the nutrition,immune,and liver function state of patients with total gastrectomy.Methods A total of 90patients with total gastrectomy in our hospital from July 2010 to October 2012 were selected as research objects,and were randomly divided into group A (early parenteral nutrition group,n =45)and group B(early enteral nutrition group,n =45).The nutrition state indexes,immune state indexes,and liver function indexes of two groups before the intervention and at 3th and 10th day after the intervention were compared.Results The nutrition state indexes[3rd d:TP (68.35 ±3.02)g/L,A (38.94 ±4.69)g/L,PAB (273.54 ±29.68) mg/L,TRF (2.14 ±0.29) g/L,Hb (129.84 ±7.92) g/L;10th d:TP (72.59 ± 3.52)g/L,A (42.31 ±5.49)g/L,PAB (305.57 ±30.95)mg/L,TRF (2.78 ±0.31)g/L,Hb (135.87 ±8.95) g/L],immune state indexes [3rd d:IgA (0.94 ± 0.10) g/L,IgG (9.24 ± 0.63) g/L,IgM (1.51 ±0.14) g/L,RBC-C3bR (10.54 ± 0.52) ％,RBC-ICR (12.21 ± 1.41) ％ ; 10th d:IgA (1.23 ± 0.15) g/L,IgG (10.98 ±0.72)g/L,IgM (1.71 ±0.18) g/L,RBC-C3bR (13.74 ±0.69)％,RBC-ICR (9.27 ±1.05)％],and liver function indexes[3rd d:ALT (32.59 ±3.56)U/L,AST (33.95 ±4.03) U/L,TBIL(12.07± 1.38)μmol/L,GGT (24.03 ±2.59) U/L;10th d:ALT (22.93 ±3.18) U/L,AST (24.84 ±3.29) U/L,TBIL (10.50 ± 0.96) μmol/L,GGT (20.70 ± 2.49) U/L] in group B at 3rd and 10th day after the interventiont were all better than those in group A [3rd d:TP (64.59 ± 2.83)g/L,A (35.53 ±4.37)g/L,PAB (224.96 ±25.50)mg/L,TRF(1.63 ±0.20)g/L,Hb (121.03 ±7.18)g/L,IgA (0.68±0.07)g/L,IgG (7.32 ±0.51)g/L,IgM (1.12 ±0.10)g/L,RBC-C3bR (8.13 ±0.40)％,RBC-ICR (14.59 ±1.54)％,ALT (40.26 ±4.13)U/L,AST (40.95 ±4.26)U/L,TBIL (16.37 ± 1.75)μmol/L,GGT (31.45 ±2.97) U/L;10th d:TP (66.96 ±2.97) g/L,A (36.01 ±4.43) g/L,PAB (241.35 ±26.63) mg/L,TRF (1.86 ± 0.24) g/L,Hb (127.69 ± 7.73) g/L,IgA (0.81 ± 0.08) g/L,IgG (8.54 ±0.55) g/L,IgM (1.28 ± 0.12) g/L,RBC-C3bR (8.52 ± 0.46) ％,RBC-ICR (13.07 ± 1.46) ％,ALT(31.52 ± 3.84) U/L,AST (33.54 ± 3.90) U/L,TBIL (13.21 ± 1.41) μmol/L,GGT (25.39 ± 2.65) U/L],and these indexes in group B at 10th day after the intervention were all significantly better than those at 3rd day after the intervention (all P ＜ 0.05).Conclusions The early enteral nutrition palys an active role in improving the nutrition,immune,and liver function state of patients with total gastrectomy,and it provides the necessary premise for the postoperative rehabilitation of patients.

Objective To explore the application value of D-dimmer(DD),hs-CRP and homocysteine(Hcy) in postoperative condition monitoring in the patients with femoral neck fracture.Methods Forty cases of femoral neck fracture treated in our hospital were selected as the observation group and 40 patients with other fractures were selected as the control group.The observation group were given the surgical treatment,while the control group adopted the corresponding measures for conducting intervention according to the fracture situation.The DD,hs-CRP and Hcy levels were detected in the two groups.Then the detection results were compared between the two groups.Results The various indexes before treatment in the observation group were slightly higher than those in the control group without statistical difference(P>0.05).The levels of various indicators at postoperative 24,48 h in the observation group were significantly elevated,moreover the increase range at postoperative 24 h in the observation group was maximal,which was significantly higher than that in the control group(P<0.05).The positive rates of hs CRP,Hcy and DD in the observation group were 75.00%,77.50% and 60.00% respectively,while which in the control group were 0.00%,2.50% and 0.00%,the observation group was significantly higher than the control group (P<0.05).Conclusion Hs CRP,Hcy and DD can be used as the important indicators of condition monitoring for femoral neck fracture.

Objective: To explore early diagnostic and resent prognostic assessment value of serum levels of ischemia-modified albumin (IMA) and cardiac troponin I (cTnI) for acute coronary syndrome (ACS).Methods: A total of 175 ACS patients were selected, including 73 cases with unstable angina pectoris (UAP), 61 cases with non-ST elevation myocardial infarction (NSTEMI) and 41 cases with ST elevation myocardial infarction (STEMI).According to chest pain-to-visit time, ACS patients were divided into <3h group (n=112) and 3~6h group (n=63);another 40 healthy subjects were selected simultaneously as healthy control group.Serum IMA and cTnI levels were compared among above groups and between patients suffering from major adverse cardiovascular events (MACE) within 30d or not in <3h group.Risk factors for MACE in <3h patients within 30d were screened.Results: Compared with healthy control group and UAP group, there were significant rise in serum levels of IMA[(16.78±4.25) μg/L, (35.16±8.32) μg/L vs.(49.76±9.29) μg/L, (52.07±11.34) μg/L], cTnI[(0.17±0.06) ng/ml, (0.15±0.06) ng/ml vs.(7.65±1.29) ng/ml, (8.83±1.40) ng/ml]in NSTEMI group and STEMI group, and IMA level in STEMI group was significantly higher than that of NSTEMI group, that of UAP group was significantly higher than that of healthy control group (P<0.05 or <0.01);serum IMA level of <3h group was significantly higher than those of 3~6h group and healthy control group, and cTnI level of <3h group was significantly lower than that of 3~6h group (P<0.01 all);serum levels of cTnI and IMA in patients suffering from MACE in <3h group were significantly higher than those of patients without MACE (P<0.01 both);multi-factor Logistic regression analysis indicated that elevated serum IMA level was an independent risk factor for MACE within 30d in ACS patients[OR=2.757,95%CI(2.084~4.705), P=0.001].Conclusion: The levels of cTnI and IMA significantly rise in ACS patients.IMA level possesses early diagnosis and recent prognosis evaluation value.

Objective:To establish a performance validation method for mNGS applied in BALF samples.Method:Hela cells were used as a representative of host cells, and simulated BALF samples were prepared by adding different concentrations of Hela cells, seven species of isolated pathogens (including Streptococcus pneumonia, Hemophilus influenza, Klebsiella pneumonia, Candida albicans, Cryptococcus neoformans, Aspergillus fumigatus, and Adenovirus), and interfering substances to sterile normal saline. Clinical BALF samples were collected simultaneously, and the results of mNGS were evaluated using traditional detection methods as a reference. The limit of detection (LOD), precision, anti-interference ability, stability, and accuracy of mNGS were determined. Results:In the simulated samples, the LOD of Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Candida albicans, Cryptococcus neoformans, Aspergillus fumigatus, and Adenovirus were 150, 262, 102, 67, 96, 83 CFU/ml, and 439 copies/ml, respectively. The repeatability of the detection results for all pathogens of simulated positive BALF samples was 100%. The anti-interference test showed that the higher the concentration of human DNA, the fewer pathogen sequences detected by mNGS. Escherichia coli and Shigella sonnei were used to evaluate the ability of mNGS to distinguish closely related species. The results showed that the system could stably distinguish Escherichia coli and Shigella sonnei when the concentration of Shigella sonnei was 4, 000 CFU/ml. The stability test results showed that there was no significant change in the number of pathogen sequences detected whether after 1 to 3 freeze-thaw cycles or storage at 4 ℃, -20 ℃, or -80 ℃ for 36 h. Compared with traditional detection methods, the accuracy of 17 clinical samples was 82.4%(14/17). Continuous evaluation of clinical BALF samples simultaneously tested by mNGS and traditional methods at Tongji Hospital from October 25, 2021, to September 14, 2022, showed that the accuracy of mNGS compared to bacterial culture, fungal culture, mycobacterial culture, Mycobacterium tuberculosis culture, and conventional PCR techniques was 67.5%(472/699), 81.5%(570/699), 92.3%(335/363), 96.4%(350/363), and 86.8%(132/152), respectively. Compared with conventional PCR techniques, the accuracy of mNGS for detecting Pneumocystis jirovecii, Adenovirus, and Mycoplasma pneumoniae was 89.4%(84/94), 93.3%(56/60), and 87.1%(61/70), respectively. Conclusion:By preparing simulated BALF samples and using traditional detection methods as a reference, the performance characteristics of mNGS in detecting BALF samples can be preliminarily evaluated.