Objectives: To observe the clinical effects of nutritional support with protein diet in patients with moderate and severe burns. Methods: 50 cases were randomly divided into treatment group(25 cases) and control group(25 cases). The control group was treated with routine and nutritional support. The treatment group was given additionally with protein diet (80g/d,consisting of Gln 4g and protein 66g). Either oral admistration or tube feeling was chosen according to patient condition. The treatment lasted 21 days. Results: There was no significant difference between the two groups on the levels of Alb、PA、TF and TLC before the management. The level of Alb in the treatment group was obviously changed after the management. The levels of PA、 TF and TLC in the treatment group were increased significantly and had significant differences between the two groups(P

Objective: To observe the effect of peptisorb on the result of intestinal preparation,the change of correlated nutritional index,the fuction of intestine and the immune function after operation in perioperative colorectal cancer patients.Methods: Sixty patients were randomly allocated into two groups. The trial group (n=30) received peptisorb 3days before and 7days after operation. Control group (n=30) received coloclysis treatment.The the level of Alb, globulin,the number of IgG, IgA,IgM, CD3+,CD4+/ CD8+ ,the station of intestinal mucosa and intestine cleaning during operation, nutritional state after operation, immune function, infcetious complications, length of stay were detected.Results: There were no significant difference in the station of intestinal mucosa and intestine cleaning. The index of nutritional and immune in two groups were descend, but the trail group was better(P＜0.01). The number of IgG,IgA, IgM, CD3+ in the trail group were significantly higher than the control group(P＜0.01),the rate of postoperative infectious complications in the trail group was lower than the control group.The trail group aslo showed shorter average length of stay after surgery than the control(P＜0.01).Conclusion: The peptisorb can ameliorate the host immune function and improve clinical outcome,which is a good nutrition support pathway to perioperative colorectal cance patinets.

Objectives:To learn about the attitudes toward the "Global Minimum Essential Requirements(GMER) in medical education" between Chinese doctors and graduates from the same medical university and to offer reference for spreading GMER in China.Methods: To investigate the subbjects using a questionnaire describing the related abilities of GMER.Description,rank test,multivariate analysis of variance and factor analysis are applied in data analysis.Results: In general,there are different attitudes toward GMER between doctors and graduates.13 of 23 items have statistical significance in scores between groups.The proportion of person considering every item as important or very important among doctors is higher than that among graduates.There is statistical significance between groups on the transformed score in 7 domains of GMER.The domain of topmost score is "clinical skills",and of the lowermost one is "community health & health system".Conclusions: Doctors and graduates both accept GMER.They both pay attention to occupational skills,but ignore the public health.Doctors think much of basic knowledge,while graduates are short of the cognition on "Information Management".

Objective To report one stage treatment of chronic tibial defection in children. Methods 19 children with chronic tibial defection were treated in our department when their infection was at the stage of latency. First their focuses of infection were cleared away. Next a piece of fibula with vessel pedicles whose length was equal to that of the tibial defect was taken as the support to restore the length of the tibia. Then the external fixators were applied and a mixture of antibiotic and Lebone powder was used to fill the defect. Results In 15 cases the incision healed at one stage, slight infection occurred in 4 cases whose incisions healed after treatment of 3 to 4 weeks. Follow-ups of 0.5 to 1.5 years showed that no infection occurred again, bone defects healed well and limb function was satisfactory. Conclusion To treat chronic tibial defection in children at one stage, combined therapy should be applied. Grafting of fibula with vessel pedicles and Lebone under external fixators is a good one, because it can shorten the treatment time at no cost of satisfactory effects.

Patients were divided into normal control, liver fibrosis and liver cirrhosis groups. The patients with cirrhosis were categorized according to the Child Pugh classification into Child A,Child B and Child C groups. The waveforms of the right hepatic vein were examined with ultrasonography. HV(hepatic vein)0 waveforms were found in all the control subjects, 70.8% in those with fibrosis and 40.7% in those with cirrhosis. HV1 were found in 16.7% of those with fibrosis and 17.8% of those with cirrhosis. HV2 were found in 12.5% of those with fibrosis and 41.5% of those with cirrhosis. Statistical analysis showed that HV2 waveforms were significantly more often in patients with cirrhosis than in those with fibrosis. HV2 waveforms in the right hepatic vein are suggestive of liver cirrhosis.

Objective To detect the levels of retinol binding protein(RBP)and adiponectin during the second trimester in the serum of women in normal pregnancy and women who subsequently develop gestational diabetes mellitus(GDM )and to evaluate their role in predicting GDM .Methods A case‐control study was performed to detect and compare the levels of RBP and adiponec‐tin between women who subsequently develop GDM (n= 88)and normal control from 16 to 20 pregnancy weeks (n= 88) . Results Maternal serum RBP levels and the RBP/adiponectin ratio were significantly higher in GDM women than that in normal controls(P<0 .01) .The levels of maternal serum adiponectin were significantly lower in GDM women than that in normal controls (P<0 .01) .The levels of RBP≥30 .45 mg/L ,adiponectin≤9 .93 mg/L and the ratio of RBP/adiponetin≥3 .18 as early markers for predicating development of GDM ,their sensitivities were 63 .6% ,80 .7% and 81 .8% ,and specificities were 75 .0% ,65 .1% and 79 .7% ,respectively .Conclusion The combination of RBP and adiponetin as early marker for predicating development of GDM from 16 to 20 pregnancy weeks was more valuable than single use of them .

Background and purpose:Hepatocellular carcinoma(HCC) is one of the most common malignancies in the world,It has a poor prognosis due to its rapid infiltrating growth and complicating liver cirrhosis.Surgical resection is considered the best curative option,the 5-year survival rate could reach 50%,especially in the patients with lesions less than 5 cm in diameter and good residual liver function.However curative surgery is feasible for only about 20% of patients.Transcatheter arterial chemoembolization(TACE) has been demonstrated that its short-term curative effect is better than the other nonsurgical treatments.However,it has not provided any survival benefit.Many studies have been done to improve the overall therapeutic effects of HCC with multi-modality approaches.The purpose of our trial was to evaluate the effects of TACE combined with 3-dimensional conformal radiation therapy(3-DCRT) for primary hepatic carcinoma.Methods:90 patients with primary hepatic carcinoma were randomly divided into two groups :45 were treated with 3-DCRT plus TACE and the others were treated with TACE alone.For TACE,80-120 mg cisplatin and 1 000 mg 5-Fluorouracil or 30 mg hydroxycamptothecine)were perfused into the hepatic arteries,then 50-100 mg adriamycin(or epirubicin) or 16 mg mitomycin C and iodized oil 10-30 ml were given to embolize the hepatic arteries,and followed by 1-2 mm gel form particles.TACE of 1-3 sessions was given to both groups.For the combined group,3-DCRT was given by 6MV X-ray.The patients with planned target volume(PTV) lesser than 512 cm~(3) received a total dose of 45-56 Gy,4.5-7 Gy per fraction,and the patients with PTV larger than 512 cm~(3) received a total dose of 45-56 Gy,2.5-4.5 Gy per fraction,5 times every week.Results:The response rates (CR+PR)of 3-DCRT plus TACE group and TACE alone group were 91.1% and 60%,respectively(?~(2)=11.79,P

Objective To investigate the effect of valproic acid (VPA) on NKG2D-ligand expression in ARK,OPM2 human myeloma cell lines and their sensitization to natural killer (NK) cell-mediated Killing.Methods Different concentrations of VPA from 0-5.0 mmol/L were used to treat ARK,OPM2 cells respectively,then the cell viabilities were tested by flow cytometry (FCM).Real-time quantitative-PCR and FCM were used to detect the changes in mRNA,protein levels of NKG2D-ligand respectively in the two cell lines treated with 1 mmol/L VPA for 48 hours.The calcein-release-assay (CARE-LASS) was carried out to detect cytotoxic changes of NK cells against mydoma cells after VPA treatment.Results VPA induced the expression of MICA/B,ULBP2 (P ＜ 0.05) and in turn enhanced the NK cytotoxicity on myeloma cells.The enhancing effect of VPA was blocked by NK cells pretreated with anti-NKG2D mAb (P ＜ 0.05).The primary mechanism of NK cell killing of myeloma cells was perforin/granzyme-mediated.Conclusion VPA can induce the expression of MICA/B,ULBP2 in ARK,OPM2 cells,thereby enhancing the cytotoxicity against myeloma cells,which implies a new mechanism of anticancer approach and may be a new approach in myeloma immunotherapy.

ObjectiveTo make ultrasound anatomy teaching samples of odynopoeia fetus heart with complex abnormity consistent with echocardiographic view,and utilize them in echo teaching.MethodsTen odynopoeia foetus hearts were cutted comparing to different echocardiographic imaging respectively.Results Dissections of fetus heart were obtained including 5 cases of single cardiac ventricle(2 case with interruption of aortic arch),4 cases of double outlet of right ventricular,and 1 case of hypoplastic left heart syndrome with serious coarctation of the aorta.The apical long axis view,the three blood vessel view,as well as the long axis view of the aortic arch were typical views of ultrasound diagnosis and teaching.ConclusionsIt is profit to raise and accurate rate of fetus echocardiography diagnosis by studying dissection of fetus heart anatomic structure with complex abnormity,which would make ultrasound imaging visualization.

Objective To explore the diagnostic value of magnetization transfer imaging (MTI) and DWI for detecting intestinal wall property of crohn's disease (CD). Methods Forty four patients with CD were prospectively enrolled in the study, and MR enterography (MRE), MTI and DWI were performed. According to MRE findings, patients were divided into three subgroups:acute inflammatory group, chronic fibrotic group and combined inflammatory with fibrotic group. Intestinal wall T2WI signal, magnetization transmisson rate (MTR) and ADC value were measured on MRE, MRI and DWI imagings, respectively. The differences of MTR and ADC among the three groups were analyzed by one-way ANOVA;the differences of T2WI scores were analysed by Kruskal Wallis;the differences of MTR and ADC values between normal and pathological intestinal wall were analyzed by paired t test;ROC curve were used to evaluate the CD fibrosis and inflammation diagnostic efficiency of MTI ana DWI based on MRE signs. Results Among the 44 cases, 11 cases were in the acute inflammatory group, 18 cases were in the chronic fibrotic group and other 15 cases were in the combination group. The T2WI score, MTR and ADC among the three groups showed significant differences (all P<0.01).The mean MTR and ADC of pathological intestinal wall of the 44 cases were (40.77±6.05)%and (1.04±0.18)× 10-3mm2/s, and the adjacent normal bowel were (21.75±4.17)%and (1.97 ± 0.23) × 10- 3mm2/s, respectively. Moreover, the difference of the above values showed significant differences (t=19.12,-21.80 respectively, all P<0.01). There was a negative correlation between MTR and T2WI score (r=-0.71,P<0.01). While ADC value was positively correlated with T2WI score (r=0.80, P<0.01). Using ROC curve analysis to differentiate the CD fibrosis from acute inflammation, the area under the curve (AUC) of MTR and ADC were 0.97 and 0.96 ,respectively. Conclusions Both MTI and DWI can be used to assess the properties of intestinal wall, which has the same diagnostic efficacy to identify the acute inflammation and fibrosis.