Objective:To investigate the effects of two different routes of nutrition support on the treatment of severe pneumonia in elderly patients.Methods:From January 2015 to January 2016,84 elderly patients with severe pneumonia in our hospital were randomly divided into two groups,42 patients in each group.The enteral nutrition (EN) group was treated with nasogastric feeding and another group was defined as combined treatment group.After 4 weeks of treatment,the nutritional status of two groups of patients was compared.The incidence of complications during treatment were documented.Results:After treatment,the hemoglobin was (111.34 ± 20.33) g/L,and the albumin was (23.33 ± 5.09) g/L in the EN group.The hemoglobin was (132.13 ±24.39) g/L,and the albumin was (35.43 ±9.12)g/L.There was significant difference between the two groups (P ＜ 0.05).The cure rates of the two groups were 92.86％ and 95.24％,respectively,and there was no significant difference (P ＞ 0.05).Conclusion:For elderly patients with severe pneumonia,the combination of enteral and parenteral nutrition is more likely to improve the nutritional index,and has a lower incidence of adverse events.

Objective To analyze acinetobacter Baumanii infections in ICU and explore the nursing strategies.Method The clinical data of 5310 ICU patients infected with acinetobacter Baumanii in our hospital were retrospectively analyzed.Results Among the 5310 patients in the ICU,26 were infected by acinetobacter baumanii with an incidence of 0.5%,with 46.2%patients contracted cerebral hemorrhage,38.5%intracerebral tumor,92.3%infection by multi-drug resistant bacteria and.All patients were managed with artificial ventilation and 84.6%patients were hospitalized in ICU for over 7 days.Conclusions The nursing strategies includes reasonable use of antibiotics,active treatment of primary diseases,rigid control of disinfection and isolation,attaching importance to hand hygiene and strict implementation of nursing practice,which are important for preventing and controling the infection of acinetobacter baumanii.

Objective To investigate the effects of different surgical modalities on primary anorectal malignant melanoma. Methods Clinical data of 60 primary anorectal malignant melanoma cases who were admitted between 1965 and 2007 were collected, summarized and analyzed. Multivariate analysis was performed using the COX proportional hazards regression method. Results Tumors located in the rectum in 50 cases, in the anal canal in 10 cases. The overall survival rates were not significantly different between the 23 cases who received tumor resection only and those 30 cases receiving postoperative adjuvant therapy (X2=0. 078, P>0.05). Among these 53 surgical cases of anorectal malignant melanoma, 37underwent abdominoperineal resection, 16 underwent wide local excisions, There was no significant difference of the survival rates between the two groups (X2=1.464,P>0.05). Risk factors analysis revealed that the depth of tumor invasion is a risk factor (P<0.05), the modality of treatment is a protective factor (P<0.05). Conclusions Surgical operation is the principal effective management for anorectal malignant melanoma, Wide local excision is the principal therapeutic choice for localized well-circumferential anorectal malignant melanomas.

Case teaching has evident characteristics compared with traditional theory teaching. This article expound the purpose,significance,teaching process and the noticeable problems of case teaching in medicaI ethics teaching.

Objective To investigate the expression of proinsulin, insulin, C-peptide in insulinoma and normal pancreas and their roles. Methods Thirty-eight cases of insulinoma and 20 cases of normal pancreas from Sep. 2006 to Dec. 2009 in our hospital were selected. Immunohistochemistry was used to determine the expression of proinsulin, insulin, C-peptide. Results Proinsulin, insulin, C-peptide was expressed in insulinoma and normal pancreas. Proinsulin, C-peptide were strongly expressed in 100%insulinoma, while they were weekly expressed in 55% ～60% normal pancreas; insulin was expressed as + + +in 79% insulinoma, while it was expressed as + + + + in 85% normal pancreas. Proinsulin, C-peptide positive cell accounted for 80% ～ 100% of 38 insulinoma, and insulin positive cell accounted for 50% ～ 70%,the proinsulin/insulin ratio ＞ 1 accounted for 78.9%; while the corresponding values were 20% ～ 80%, 60% ～90%, 10.0% in normal pancreas, and the difference was statistically significant ( P ＜ 0.05 ). Conclusions The proinsulin/insulin ratio ＞ 1 is 78.9% in insulinoma, and detection of proinsulin may help to diagnose insulinoma.

Objective To explore the relationship between the hepatic injury and the severity of the patients with non-gallstone severe acute pancreatitis,so as to provide some evidences in the treatment on the hepatic injury,to lower the systemic and local applications of SAP,as well as lower the morality of SAP.Methods Patients suffering from non-gallstone SAP were retrospectively analyzed.We statisticated the occurrence of multiple organ dysfunction syndrome.We adopted the occurrence of MODS of the patients as the indicatrix of prognosis and analyzed the results.Univariate analysis and multivariate logistic regression analysis were used to analyze the ralationship between the markers of heapatic injury and the prognosis of the patients suffered of non-gallstone SAP.Results The univariate logistic regression analysis of the relationship between hepatic dysfunction and the occur of MODS of non-gallstone SAP shows that there were correlation between the occur of MODS and AST,ALT,ALB,respectively.The multivariate logistic regression analysis shows that there were correlation between the occur of MODS and AST,ALT,ALB,respectively.Conclusion The study showed that the heighten of the serum consentration of AST,ALT,TB and the degrade of the serum consentration of Alb were the independent influencing factors of patients with non-gallstone SAP,respectively,and suggested the unfavourable prognosis of the patients.

Objective The article was to evaluate the efficacy of intra-articular tranexamic acid injection in reduction of blood loss and blood transfusion in total hip arthroplasty (THA). Methods 60 patients hospitalized from July 2011 to July 2013 were selected as research subjects , among whom 38 males and 22 females with 2-10 years'( an average of 6 years) duration of femoral head aseptic necrosis were treated with initial unilateral THA using the posterolateral approach .The patients were randomly divided into 2 groups:experimental group were treated with 100 mL intra-articular tranexamic acid injection after intraoperative suture of incision , control group received no topical tranexamic acid .Intraoperative blood loss , postoperative visible blood loss , blood transfusion , blood transfusion number , postoperative hemoglobin were taken as evaluation indexes to make comparison between the two groups . Results No significant differences were found in intraoperative blood loss between the two groups ( [ 200 ±60 ] mL vs [ 200 ±53 ] mL, P >0.05), but in comparison to control group, postoperation visible blood loss([140 ±45]mL vs [362 ±53]mL, P<0.05), blood transfusion([400 ±25]mL vs [750 ±50]mL, P<0.05) and blood transfusion number in group A were significantly decreased (P<0.05), and in terms of postoperative hemoglobin value ([95 ±15]g/L vs [81 ±12]g/L, P<0.05), experimental group was signifi-cantly higher than control group(P<0.05). Conclusion Topical tranexamic acid in total hip arthroplasty can significantly lower blood loss and blood transfusion in patients .

The common clinical subtypes of juvenile idiopathic arthritis (JIA) include systemic onset juvenile idiopathic arthritis (SOJIA), oligoarthritis/polyarthritis juvenile idiopathic arthritis and juvenile spondyloarthritis. Juvenile idiopathic arthritis has no specific diagnostic index, and needs to be differentiated from infectious diseases and malignant diseases. The onset of SOJIA is rapid, the disease progresses rapidly, and it is easy to be complicated with macrophage activation syndrome (MAS) which is life-threatening. The experience of pediatric rheumatologists in dealing with JIA is still insufficient, and the standardized diagnosis and treatment level of this disease needs to be further improved. Based on the experience and guidelines of diagnosis and treatment in China and abroad, we formulated this diagnosis and treatment standard, aiming at standardizing the diagnosis and treatment of the subtypes of JIA and MAS, so as to reduce the incidence of disability and serious complications and improve the prognosis.