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.

Patent legal system is a part of civil law,while protection system for the varieties of traditional Chinese medicines is involved in the market regulation law.Both of them emphasize on different aspects compiementarily in protecting traditional Chinese medicine (TCM) with advantages and disadvantages.To meet the requirements of the development of TCM in the new era,protection scope of the protection system for varieties of traditional Chinese medicines should be promoted,examination system and elimination mechanisms should be improved through the inheritance and innovation of TCM,which may be conducive to protect rights and interests of TCM enterprises and improve the quality of varieties of traditional Chinese medicines.

Acute lung injury(ALI)/acute respiratory distress syndrome(ARDS)is one of the most common clinical critical illnesses in ICU.The basic pathological features of this disease are uncontrolled inflammation, destruction of the alveolar-capillary barrier and diffuse alveolar and interstitial edema.In severe cases, patients may develop significant pulmonary fibrosis.Based on the pathological changes, repairing damaged alveolar-capillary membrane and reducing fibrosis seem to be the key to the treatments of ALI/ARDS.Vascular endothelial growth factor(VEGF) is known to be the main regulator of endothelial cell proliferation and differentiation.Previous studies have suggested that VEGF plays an important role in the inflammatory reactions and pathological manifestations of ALI/ARDS, but the results are complex.This review mainly focused on the expression changes of VEGF in ALI/ ARDS and the effects and mechanisms of regulating VEGF signaling.

Objective To systematically evaluate the effects of the different postoperative exercise programs on the rehabilitation (such as shoulder range of motion,the incidence of the lymphedema and postoperative complications) of breast cancer patients.Methods The relevant randomized controlled trials which were retrieved from January 2008 to October 2013 were searched in the databases of the Pubmed,Embase,Ovid,Cochrane Library,China Biomedical Literature Database (CBM),China National Knowledge Infrastructure (CNKI),Wanfang Data,VIP.Two reviewers independently screened the literature according to the inclusive and exclusive criteria,extracted the data,and assessed the quality.The RevMan 5.2 software was used for Meta-analysis.Results Finally 10 randomized controlled trial involving 1 110 patients were included.The Metaanalysis showed that progressive exercise program compared to usual exercise obviously modified the shoulder anteflexion [MD =33.04 (26.85-39.23) and 28.05 (21.81-34.30)],abduction [MD =31.06 (8.17-53.95) and 31.39(24.96-37.82)],extorsion [MD=18.47(13.44-23.50) and 16.02(8.35-23.68)] 1 month and 3 months after surgery (P＜ 0.05),extension 1 month after surgery,adduction 3 months after surgery.It also decreased the incidence of the lymphedema.Conclusions It gives us some evidence that the progressive exercise program can promote the rehabilitation of the postoperative breast cancer patients.

Objective To observe the ventilation effect of I-gel laryngeal mask in endoscopic thyroid surgery under general anesthesia. Methods A total of 60 cases of endoscopic thyroid surgery under general anesthesia, were randomly di?vided into 3 groups (n=20):the group that patients used endotracheal intubation (Group Q);the group that patients employed Supreme laryngeal mask (Group S);the group that patients wore I-gel laryngeal mask (Group I). Success rate of insertion, du?ration of insertion, endotracheal pressure of Group S and Group I worerecored, and fiberoptic bronchoscopy was performed in Group S and I to evaluate the position of laryngeal mask. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen satura?tion (SpO2) at time points of before insertion (T0), 1 min after insertion (T1), 3 min after insertion (T2), before the establishment of CO2 operating space (T3), 30 min after the establishment of CO2 operating space (T4), 10 min after the resection of speci?mens (T5), 1 min before removal of laryngeal mask (T6) and 1 min after the removal of laryngeal mask (T7) were recorded and the end-tidal carbon dioxide pressure [ p(CO2) ]and peak airway pressure (Ppeak) form T1 to T5. were also recorded. Occur?rence of nausea and vomiting, sore throat and other adverse reactions after removal of laryngeal mask were also noted. Re?sults The successful rate of insertion was not significant different among all three groups. Compared with Group Q, inser?tion time was significantly shorter in Group I and S (P<0.05). Endotracheal pressure and fiberoptic bronchoscopy score are not statistically different between Group S and I. Compared with Group Q, MAP and HR in T1, T6 and T7 were significantly lower in Group S and I (P<0.05). SpO2,p(CO2) and Ppeak show no statistical difference between three groups. Compared with Group S and Q, the occurrence of sore throat, painful swallowing and bleeding which is indicated by the appearance of blood in laryngeal were all significantly lower in Group I (P<0.05). Conclusion Both I-gel laryngeal mask and Supreme laryngeal mask can be used safely and effectively in airway management of endoscopic thyroid surgery patients while I-gel laryngeal mask is less hurting and more comfortable than Supreme laryngeal mask.

Objective To explore the related factors of the influence of persistent pulmonary hypertension( PPH) after neonatal resuscitation. Methods Tow hundred and fifty?six cases asphyxia patients who were treated in the Maternal and Child Care Service Center of Shangluo from March 2012 to March 2015 were retrospectively analyzed. One hundred and thirty?six newborns asphyxia of persistent pulmonary hypertension were selected as the observation group. One hundred and twenty newborns asphyxia without persistent pulmonary hypertension were selected as the control group. Medical records of children of two groups were retrospectively analyzed. Apgar scores of all observed objects. Before resuscitation blood pressure, blood glucose, body temperature,blood pH value of children in the two groups were recorded. Results In admission, the systolic blood pressure,diastolic blood pressure,body temperature,blood sugar,blood pH value in the observation group ((49. 27±8. 08) mmHg,(22. 25±5. 17) mmHg,(34. 40±0. 41)℃,(2. 78±0. 65) mmol/L,(7. 11±0. 79)) were lower than that in the control group((51. 23±4. 17) mmHg,(23. 87±2. 18) mmHg,(36. 80±0. 85)℃, (3. 55±0. 33) mmol/L,(7. 33±0. 17)),the differences were statistically significant(t=2. 480,3. 334,28. 169, 12. 155,3. 166;P<0. 05) . Hypoglycemia,hypothermia,low systolic blood pressure,low diastolic blood pressure were identified as the impact factors that can cause neonatal resuscitation after persistent pulmonary hypertension ( OR=3. 660,1. 930,8. 903,4. 543;95%CI=1. 061-12. 631,1. 399-2. 661,1. 166-67. 962,1. 636-12. 613;P<0. 05). Conclusion Hypoglycemia,hypothermia,low systolic blood pressure and low diastolic blood pressure are impact factors can cause neonatal resuscitation after persistent pulmonary hypertension.

Objective To evaluate the value of detecting chlorophyll related genes of plankton in the diagnosis of drowning. MethodsEighteen rabbits were divided randomly into three groups: death by drowning (n=10), postmortem submersion (n=6) and control (n=2). The heart blood, lung, liver, kidney and brain tissues were taken from every rabbit. After isolated plankton from tissues with percoll and extracted their DNA, the chlorophyll-related genes, including EG (EG1 and EG2) and SK (SK1 and SK2), were detected using PCR technique. Meanwhile, diatom test was also performed from lung and liver tissues by nitric acid digestion method. ResultsFor the drowning group, the specific amplification products for EG1 were detected from 9 samples in heart blood, 10 samples in lung, 9 samples in liver, 7 samples in kidney and 8 samples in brain. The products for EG2 were detected from 8 samples, 10 samples, 7 samples, 5 samples and 7 samples accordingly. There were a small number of positives in heart blood, lung and kidney with SK1 and SK2 (≤2). For the postmortem submersion group, only one case was positive from heart blood and lung tissue respectively for EG1. No amplified product was detected for EG1 and EG2 in various tissues in control group, and also no product was detected for SK1and SK2 in other groups. In addition, diatoms were detected from 9 lung and 3 liver tissues in drowning group with the nitric acid digestion, and only one sample of lung was positive in the postmortem submersion group. ConclusionThe detection rate of the chlorophyll-related gene EG with PCR method was higher than that of diatom with nitric acid digestion method in drowning victims, and it can be used as a potentially useful tool for diagnosing drowning.

90 min, isoflurane concentration was increased or a bolus dose of fentanyl (25-50 ?g) was given i.v.. The BIS values before and during anesthesia and at extubation, emergence time, extubation time, the time between the end of operation and Aldrete anesthesia recovery score≥9, MMSE score and isoflurane consumption were recorded and compared between the two groups. Results The total amount of isoflurane consumed was 34% lower in BIS group than in control group. The average BIS values were higher and end-tidal isoflurane concentration was lower in BIS group than in control group. The time from the end of surgery to eye-opening, to extubation and Aldrete score≥9 were significantly shorter in BIS group than in control group. The MMSE score was significantly decreased at 1 h after operation as compared to the baseline score before induction of anesthesia while in control group MMSE score was still significantly decreased at 2 h after operation. Conclusion Titration of isoflurane using BIS monitoring can reduce the dose of isoflurane during operation and contribute to faster recovery from anesthesia in elderly patients undergoing intra-abdominal surgery.

Objective To explore the relationship between Lp (a)level and age,gender in Nanjing area.Methods 8 442 ser-um specimens from examination individuals were collected in the First Affiliated Hospital of Nanjing Medical University in 2014.Lp (a)was measured by immune turbidimetry method.All the subjects were divided into six groups:15~29,30~44, 45~59,60~69,70~79 and ≥80 years old.SPSS21.0 software was used to carry out statistics.Results The Lp(a)level in female [134±197 mg/L (M±QR,the same below)]was higher than that in male significantly (U =8 355 137,P <0.001). LP (a)levels from people of different sex correlated with the age weakly (r =0.154,P <0.001),and increased with age groups.Lp(a)of six groups in male were 106.5± 151.0,119.0± 170.0,128.0± 179.0,159.0±206.0,145.0±200.0 and 162.0± 190.0 mg/L respectively.The difference was statistically significant between between 1 and 2 groups,2 and 3 groups,3 and 4 groups,theU value were 645 152.5,1 006 572.0,197 595.0 respectively;P all<0.05.The difference was not statistically significant between 4 and 5 groups,5 and 6 groups,3 and 4 groups,theU value were 59 127.0 and 15 959.5 respectively,P >0.05.Lp(a)of six groups in female were 128.0 ± 194.0,128.0 ± 187.0,139.0 ± 207.0,157.0 ± 228.0, 173.5±227.0 and 150.0±201.0 mg/L.The difference was statistically significant between 2 and 3 groups,theU value was 641 147,P =0.006,respectively.The difference was not statistically significant between 1 and 2 groups,3 and 4 groups,4 and 5 groups,5 and 6 groups,theU value were 783 676,92 442.5,16 069.5 and 3 038,respectively;P all>0.05.Conclusion Lp (a)level in healthy population in Nanjing area is related to gender and age groups,it is necessary to establish different reference ranges.

Objective To study the protective effect of hepatocyte growth factor(HGF) on grafted mucous membrane of transplanted small bowel.Methods Total small bowel transplantation was made in inbred Wistar (RT1 k) rats heterotopically,either total parenteral nutrition (control group, n =10) or hepatocyte growth factor supplemented TPN (HGF group, n =10) was given to the recipients from the 2nd day to the 10th day postoperatively. Morphological parameters of the transplanted intestinal mucosa, such as mucosal villous height, villous width, crypt depth, mucosal thickness and villous surface area were observed. Variation of ultrastructure of transplanted epithelial cells was observed. Composition of mucosal protein and DNA content were tested. Results Comparison between HGF group and the control group were as follows. Mucosal villous height (298.79?22.31) ?m vs (176.45? 14.62) ?m, P =0.001, villous width (107.46? 12.34) ?m vs (74.20?16.85) ?m, P =0.004, crypt depth (104.56?11.17) ?m vs (74.45?8.34) ?m, P =0.000 5, mucosal thickness (409.53?35.83) ?m vs (259.38?24.65) ?m, P =0.003, and villous surface area (0.101? 0.011) mm 2 vs (0.041?0.005) mm 2, P =0.001 were found significantly increased in HGF group compared with control group, there were no obvious difference decrease as compared to pretransplant parameters.Mucosal protein composition was higher in HGF group than that in control group (89.65? 9.28) mg/g wet wt vs (53.73? 11.45) mg/g wet wt, P =0.012, baseline (92.64?10.52) mg/g wet wt, nearly equal to baseline; DNA composition was also high in HGF group (0.89?0.09) mg/g wet wt vs (0.51?0.06) mg/g wet wt, P =0.008, baseline (0.91? 0.09) mg/g wet wt. Nearly normal ultrastructure of the graft was maintained in HGF group, atrophied microvilli and broken mitochondrial crista were observed in control group.Conclusion Hepatocyte growth factor can improve mucosal structure, preserve enterocyte ultrastructure of isograft after small bowel transplantation in rat.