Objective To investigate the effects of early parenteral feeding with glutamine on nitrogen balance and clinieal prognosis in Pationts with acute severe pancreatitis.Methods120 acute severe pancreatitis patients with Ranson scale≥3 were studied.Patients were randomized to receive either an early parenteral diet(control group,n=60) or the same formula with glutamine added(study group,n=60).The diets were isocaloric and isonitrogenous [35 kcal ? kg-1 ? day-1 and 1.5g of protein/(kg-1 ? d)].Main outcome measures were the APACHE-Ⅱ scale,incidence of infection,the length of stay in the intensive care unit and the number of days requiring mechanical ventilation,and monitor the nitrogen balance.ResultsThe two groups were homogeneous in gender,age,nutritional status and admission.There was no mortality during the study period.The two group have no statistic defference in nitrogen balance of 4.7 day.The median(range) number of infections per patient was significantly greater(P

Objective To evaluate the effect of minimal-invasive installed tube aspiration treatment of hypertensive intracerebral hematoma by rt-PA.Methods Total 71 patients of hypertensive intracerebral hematoma were divided randomly into 3 groups.Group A with 23 patients,which were performed stereotactically placed catheter into the hematoma,and drained consistently;Group B with 24 patients,which were instilled urokinase to liquefy after stereotactically placed catheter and drained the hematoma in 8-hour intervals repeating 3 times over 6 hours;Group C with 24 patients,which were instilled rt-PA to liquefy after stereotactically placed catheter and drained the hematoma in 8-hour intervals repeating 3 times over 6 hours.One week later,the result of head CT scan were compared.Results The volume of hamatoma in CT scan decreased in three groups after therapy.Compared between pre-therapy and post-treatment, difference was significant (P＜0.05),but Group C was the effectivest.Conclusion It was effective and safe that using minimal-invasive installed tube aspiration treatment of hypertensive intracerebral hematoma by rt-PA.

Objective To investigate the application and effect of aerobic exercise of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Methods Ninety-four hospitalized patients with COPD from June 2011 to June 2012 were enrolled.The clinical curative effect and safety of aerobic exercise of pulmonary rehabilitation in patients with COPD were observed and compared.Results After 3 months treatment,first second forced expiratory volume (FEV1) and forced vital capacity (FVC) were increased compared with those before treatment [(3.25 ± 0.49) L vs.(2.59 ± 0.55) L,(1.95 ± 0.41) L vs.(1.44 ± 0.48) L],and there were significant differences (P ＜ 0.05).There was no significant difference in FEV1/FVC before and after treatment (P ＞ 0.05).After 3 months treatment,arterial partial pressure of oxygen and arterial oxygen saturation were increased compared with those before treatment [(87.61 ± 8.56) mm Hg(1 mm Hg =0.133 kPa) vs.(63.88 ± 8.79) mm Hg,0.9648 ±0.0449 vs.0.7632 ± 0.0477],partial pressure of arterial carbon dioxide was decreased compared with that before treatment [(30.57 ± 9.47) mm Hg vs.(49.23 ± 9.54) mm Hg],and there were significant differences (P ＜ 0.05).There was no signifi.cant difference in blood pressure and heart rate before and after treatment (P＞ 0.05).No obvious adverse reactions were observed.Conclusions The aerobic exercise of pulmonary rehabilitation can improve significantly lung function.It is safe and rehable,and has less adverse reaction in patients with COPD.It is worthy of promotion and use.

Objective Aimed to clarify the molecular mechanism after subarachnoid hemorrhage （SAH） by investigating the expression of tight junction protein Claudin-5 and ZO-1 and the effects of SP600125 on them. Methods Seventy-five male Sprague Dawley rats （300 to 350 g） were randomly divided into sham,SAH,SAH ＋ DMSO （dimethyl sufoxide） solution,SAH ＋SP600125 （C-Jun N-terminal kinase inhibitor）10 mg/kg,and SAH ＋SP600125 30 mg/kg groups. The standard endovaseular perforation was performed to produce experimental SAH. The JNK inhibitor SP600125 was intraperitoneally administered at 1 hour before and 6 hours after SAH. Results At 24 hours after SAH,signs of microvessels injury were observed in brain cortex. Compared with the sham group,expression of Claudin-5 and ZO-1 was sig- nificantly decreased （P 〈 0.05 ）. JNK inhibitior SP600125 suppressed the decrease of Claudin-5 and ZO-1 expression, attenuated blood-brain barrier disruption in rats after SAH. Conclusions The blood-brain barrier disruption is an important mechanism of early brain injury after SAH. JNK inhibitor SP600125 improves neurological outcomes and provides neuropmtecfion against acute events after SAH such as bloodbrain barrier disruption and cell apoptosis.

Objective To evaluate the reliability of serum catecholamine concentrations in reflecting the depth of dexmedetomidine-based general anesthesia.Methods Forty patients,aged 30-45 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅱ,undergoing elective laparoscopic hysterectomy under general anesthesia,were divided into 2 groups (n =20 each) using a random number table:dexmedetomidine-based general anesthesia group (group Ⅰ) and general anesthesia group (group Ⅱ).Dexmedetomidine was intravenously infused as a loading bolus of 1 μg/kg over 10 min before induction of anesthesia,followed by an infusion of 0.5 μg · kg-1 · h-1 until 30 min before the end of operation in group Ⅰ.The equal volume of normal saline was given instead of dexmedetomidine in group Ⅱ.Anesthesia was induced with iv midazolam 0.05 mg/kg,propofol 1 mg/kg,cisatracurium 0.15 mg/kg and sufentanil 0.4 μg/kg.Anesthesia was maintained with iv infusion of remifentanil 0.1-0.3 μg · kg-1 · min 1,1％-2％ sevoflurane inhalation and intermittent iv boluses of cisatracurium.Before administration of dexmedetomidine,at the end of administration of the loading dose,at the end of intubation,at the end of skin incision,after establishment of pneumoperitoneum and at the end of operation (T0-5),venous blood samples were taken from the peripheral vein for determination of concentrations of epinephrine (E) and norepinephrine (NE) in serum (by enzyme-linked immunosorbent assay).Results Compared with group Ⅱ],the serum NE and E concentrations were significantly decreased at T1-4 in group Ⅰ (P＜0.05).Compared with the baseline at T0,the serum NE and E concentrations were significantly decreased at T1 in group Ⅰ,and increased at T2-4 in group Ⅱ (P＜0.05).Conclusion The serum catecholamine concentration produces poor reliability in reflecting the depth of dexmedetomidine-based general anesthesia,and thus it is not a suitable monitoring index.

OBJECTIVE To evaluate the value of central compartment neck dissection for cN0 papillary thyroid carcinoma.METHODS The clinical data of 46 cases with cN0 papillary thyroid carcinoma in our hospital from Jan.1999 to June 2004 were retrospectively studied.The level Ⅵ lymph nodes were removed during the operation.RESULTS In 46 cN0 cases,there were 11 cases(23.9 %) pathologically proved lymph nodes metastasis after operation.Four patients developed neck recurrence and underwent neck dissection.CONCLUSION It is necessary to probe the level Ⅵ lymph nodes during the operation for cN0 papillary thyroid carcinoma patients.

Objective To investigate the age-related pattern of normal skull bone marrow with 3. 0 T MR T1WI. Methods Cranial MR T1WI images which were defined to be normal were retrospectively reviewed in 360 cases. Patients with known diffuse bone marrow disease, focal lesions, history of radiation treatment or steroid therapy were excluded, while patients whose cranial MRI and follow-up visits were all normal were included in this study. All the subjects were divided into 7 groups according to the age: < 1, 1--2,3--5, 6--14, 15--29, 30--49, >50 years group. Mid- and para- sagittal T1WI images were used to be analyzed and the type of cranial bone marrow was classified according to the thickness of diploe and the pattern of the signal characteristics. Statistical analysis was conducted to reveal the relationship between the age and the type. Results The normal skull bone marrow could be divided into four types as follows: (1) Type- Ⅰ : 115 cases, 47 of which appeared type- Ⅰ a and the mean thickness was ( 1.24±0. 31 ) mm; 68 of which appeared type- Ⅰ b and the mean thickness was ( 1.76 ± 0. 37 ) mm. Type- Ⅱ : 57 cases and the mean thickness was (2.78 ±0.69) mm. Type-Ⅲ: 148 cases, 18 of which appeared type-Ⅲ a and the mean thickness was (2. 33±0. 65) mm; 88 of which appeared type-Ⅲ b and the mean thickness was (4. 01 ± 0. 86) mm; 42 of which appeared type-Ⅲ c and the mean thickness was (4. 31±0. 73) mm. Type-Ⅳ: 40 cases, 25 of which appeared type-Ⅳ a and the mean thickness was (5. 17 ± 1.02) mm; 15 of which appeared type-Ⅳ b and the mean thickness was (5.85±1.45) mm. (2) <1 year group: 40 cases, 20 of which appeared type- Ⅰ a, 20 type- Ⅰ b and the mean thickness of this group was ( 1.47 ± 0. 42 ) mm. 1-- 2 years group: 40 cases, 16 of which appeared type- Ⅰ a, 18 type- Ⅰ b, 6 type- Ⅱ and the mean thickness of this group was ( 1.68±0. 52) mm. 3--5 years group: 40 cases, 8 of which appeared type- Ⅰ a, 18 type-Ⅰb, 14 type-Ⅱ and the mean thickness of this group was (1.84±0.73) mm. 6--14 years group: 60 cases, 3 of which appeared type- Ⅰ a, 12 type- Ⅰ b, 27 type-Ⅱ , 12 type-Ⅲb, 6 type-Ⅲc, and the mean thickness of this group was (2.92±1. 00) mm. 15--29 years group: 60 cases, 7 of which appeared type-Ⅱ , 5 type-ma, 27 type-Ⅲb, 15 type-Ⅲc, 6 type-Ⅳa and the mean thickness of this group was (3.95 ± 0.97) mm. 30---49 years group: 60 cases, 3 of which appeared type-Ⅱ , 7 type-Ⅲa, 29 type-Ⅲb, 15 type-Ⅲc, 3 type-Ⅳa and 3 type-Ⅳb and the mean thickness of this group was (4. 30 ± 1.35) mm. ≥50 years group: 60 cases, 6 of which appeared type-Ⅲ a, 20 type-Ⅲb, 6 type-Ⅲc, 16 type-Ⅳa and 12 type-Ⅳb and the mean thickness of this group was (4.51 ± 1.40) mm. (3) There is a linear relationship between ages and types that is revealed by chi-square test (x2 = 266. 36, P < 0. 01 ). Conclusion There is characteristic in the distribution of normal skull bone marrow with age growing. And skull bone marrow transforms gradually from type- Ⅰ to Ⅳ with aging.

OBJECTIVETo investigate the relationship between tumor necrosis factor A-308 gene polymorphism and susceptibility of severe periodontitis in adults.

METHODSBuccal swabs from 65 adult patients with severe periodontitis and 96 periodontal healthy adult controls were obtained. DNA was extracted from each sample using Chelex-100 method, then PCR-RFLP was performed to determine the TNFA-308 genotype. Data were analyzed by statistics software.

RESULTSA significant difference of genotype distribution was found between the patients and controls. The percentage of 1/1 type of the patients was much higher (P < 0.001). Risk Analysis showed odds ratio for allele 1 was 4.64.

CONCLUSIONThis study suggested that TNFA-308 allele 1 maybe a marker of susceptibility to severe periodontitis.

Adult ; Genetic Predisposition to Disease ; HLA-DR4 Antigen ; genetics ; Humans ; Periodontitis ; genetics ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Tumor Necrosis Factor-alpha ; genetics

Objective To dynamically monitor the base excess(BE) in traumatic brain injury(TBI) patients within 3 d after admission,and to assess the impact of the early BE on prognosis.Methods Blood BE was monitored for 3 d in 56 TBI patients.Patients were classified into mild group(15 patients),moderate group (22 patients) and severe group (19 patients) according to the scores of Glasgow coma scale(GCS).Patients were classified into survival group(42 patients) and dead group(14 patients) according to prognosis.Patients were classified into high BE group (35 patients,BE≥-8 mmol/L) and low BE group (21 patients,BE ＜-8 mmol/L).The relations among BE,degree of injury and prognosis were analyzed.Results The level of BE in mild group,moderate group and severe group was increased after treatment for 1,2,3 d than that before treatment.The level of BE was consistent with the degree of injury [mild group:(-3.02 ± 0.21)mmol/L; moderate group:(-8.49 ± 1.44) mmol/L;severe group:(-9.64 ± 1.19) mmol/L].The level of BE in mild group and severe group had significant difference than that in moderate group (P＜ 0.01).The level of BE in dead group before treatment and after treatment for 1,2,3 d was significantly lower than that in survival group [(-11.97 ±2.13) mmol/L vs.(-6.29 ± 1.16) mmol/L,(-9.84 ± 1.33) mmol/L vs.(-4.89 ± 1.78)mmol/L,(-8.78 ± 2.01) mmol/L vs.(-3.61 ± 1.43) mmol/L,(-7.84 ± 1.42) mmol/L vs.(-3.10 ±0.98)mmol/L] (P ＜0.01).The scores of APACHE Ⅱ before treatment and fatality rate in low BE group were significantly higher than those in high BE group [(24.84 ± 3.68) scores vs.(16.27 ± 2.21) scores,52.4％ (11/21) vs.8.6％(3/35)] (P ＜ 0.01).The scores of GCS before treatment in low BE group was significantly higher than that in high BE group [(7.56 ± 3.09) scores vs.(10.51 ± 2.43) scores](P ＜ 0.01).Conclusion The level of early BE is a good factor on evaluating the condition and prognosis in TBI patients.

Objective To investigate the effects of down-regulation of Beclin 1, which is an autophagy regulatory molecule, expression induced by RNA interference on the proliferation and apoptosis in skin fibroblasts of naked mole rat. Methods The expression levels of Beclin 1 were detected after starvation or H2 O2 treatment.The fibroblasts were transi-ently transfected with specific siRNA targeting Beclin 1 and then screened by real-time PCR and Western blot.Cell prolifer-ation and apoptosis were determined using CCK-8 detection kit and flow cytometry ( FCM ) .The expressions of related genes were detected by Western blot.Results The expression of Beclin 1 gene at mRNA and protein levels was signifi-cantly lower in fibroblasts of the naked mole rat.Starvation and H2 O2 treatment induced changes of the Beclin 1 expression. Inhibition of Beclin 1 gene expression can inhibit cell proliferation and induce early and late apoptosis.The protein levels of p53, BAX, Bcl2, LC3B, p-AKT and mTOR were reduced after transient transfection with Beclin 1-siRNA.Conclusions The expression of Beclin 1 in fibroblasts of naked mole rat are changed in response to starvation or H2 O2 stimulation.Inhi-bition of Beclin 1 gene expression can inhibit cell proliferation and induce apoptosis.Therefore, Beclin1 gene may play a regulatory role in autophagy, proliferation and apoptosis in the skin fibroblasts of naked mole rat.