Glutamine is rich conditionally essential amino acid in the body,widely found in intestinal epithelial cells,lymphocytes,neutrophils,macrophages and other fast-proliferating cells in the intracellular fluid,and is one of the energy necessary for proliferation and differentiation of these cells.Alanyl glutamine (Ala-Gln) has overcome low glutamine of water-soluble,heat resistance bad,after intravenous infusion can quickly decompose into free amino acids and glutamine,effectively providing glutamine and glutamine.This paper collected and summarized the clinical application and research progress of Ala-Gln,so as to provide evidence for the safety and efficacy of the drug.

Objective To investigate the application effects of modified laparoscopic totally extraperitoneal prostheic in the treatment of inguinal hernia.Methods 100 patients with inguinal hernia were selected,and they were divided into control group (50 cases) and observation group (50 cases) according to the digital table.The control group was treated with opening totally extraperitonea prosthetic,the observation group was treated with modified laparoscopic totally extraperitoneal prostheic.The operation time,hospital stay,leaving bed time,visual analogue scale (VAS score),adverse reaction and recurrence between the two groups were compared.Results The operation time between the two groups had no significant difference (P ＜ 0.05).The leaving bed time,hospital stay and VAS score of the observation group were (13.54 ± 3.81) h,(5.04 ± 1.24) d,(3.46 ± 0.75) points,repectively,which of the control group were (25.76 ± 4.35) h,(8.39 ± 1.65) d,(7.19 ± 1.27) points,repectively,the differences were statistically significant(t =14.943,11.477,17.882,all P ＜ 0.05).There was no statistically significant difference in the incidence of scrotal effusion,hematoma and wound infection between the two groups (all P ＞ 0.05).The incidence rates of chronic pain(2.00％ vs.16.00％) and adverse reactions(10.00％ vs.30.00％) in the observation group were lower than those in the control group,the differences were statistically significant (x2 =5.983,6.250,all P ＜ 0.05).After 6 months' follow-up,2 cases(4.00％) occurred recurrence in the observation gToup,3 cases(6.00％) occurred recurrence in the control group,the recurrence rate between the two groups had no statistically significant difference (x2 =0.211,P ＞ 0.05).Conclusion Modified laparoscopic totally extraperitoneal prostheic can effectively relieve the postoperative pain degree and improve the adverse reaction rate,and with fast recovery.

Objective To compare the analgesic effect and motor function of epidural analgesia and continuous adductor canal block in the elderly patients with internal malleolus fracture,in order to provide a reference for the choice of postoperative analgesia.Methods A total of 80 patients aged 65-74 years were enrolled in this study.They were randomly divided into adductor canal block group (T group,n =40) and epidural block group (C group,n =40) by computer random software.The T group underwent laryngeal mask intubation with general anesthesia + ultrasound guided transnasal saphenous nerve block.The C group underwent epidural anesthesia.The systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were measured before anesthesia (T0),10 minutes after anesthesia (T1),30 minutes after operation (T2),before leaving OR (T3).Visual analogue (VAS) was recorded immediately before leaving OR,2h,6h,12h,24h and 48h after operation.The incidence of complications such as hypotension,ephedrine use,postoperative urinary retention and other anesthesia-related complications were also recorded.Results The SBP and DBP were significantly higher in the T group at T1,T2 and T3 than those in group C (t =5.069,3.087,3.019,5.659,2.744,2.254,all P ＜ O.05).The HR was lower in the T group at T1 and T2 than those in the C group (t =4.138,3.797,all P ＜ 0.05).There were no statistically significant differences in VAS between the two groups at 2h,6h,12h,24h and 48h postoperatively (all P ＞ 0.05).The incidence of intraoperative hypotension (7 cases),ephedrine use (6 cases) and postoperative urina-ry retention (12 cases) were significantly higher in the C group than those in the T group (0 cases,O cases,1 cases,x2 =11.11,P ＜0.05).Conclusion Compared with epidural anesthesia,ultrasound-guided adductor canal block anesthesia can maintain hemodynamics stability in elderly patients with internal malleolus fracture,it can provide the same analgesic effect as epidural analgesia,and has no effect on the motor function of the contra lateral limbs and can reduce the risk of postoperative complications.

Objective To investigate the expression mechanism and significane of helper T cells in children with aplastic anemia(AA).Methods 53 children of AA were divided into heavy AA group(SAA group,21 cases),light AA group(MAA group,i7 cases),AA remission group (CR group,15 cases) by the disease,the other taken the non-aplastic anemia blood platelet disorders caused by reduced or anemia in children (AL group) of 16 cases,20 healthy children were selected as the NC group.The peripheral blood CD4+,CD4+ CD225+,CD4+ CD25+ CD127low,CD4+ IFN-γ(Thl cells),CD4+ IL-4 + (Th2 cells) in each group were detected by flow cytometry.ELISA test was used to detect peripheral blood levels of transforming growth factor-β (TGF-β),interferon-γ (IFN-γ) and interleukin-4 (IL-4).Results The peripheral blood CD4+,CD4+ CD25+,CD4+ CD25+ CD127low,TGF-beta 1 levels in the SAA group were (26.59 ± 4.37) ％,(3.44 ± 0.29) ％,(3.13 ± 1.16) ％,(14.59 ± 3.10) ng/mL,respectively,which in the MAA group were (32.67 ± 3.19) ％,(5.42 ± 0.28) ％,(4.29 ± 1.21) ％,(22.98 ± 3.38) ng/mL,respectively,which in the CR group were (33.13 ±3.24)％,(5.23 ±0.26)％,(4.36 ± 1.33)％,(23.19 ± 3.91) ng/mL,respectively,which in the AL group were (37.98 ± 4.01)％,(6.89 ± 0.28)％,(4.99 ± 1.42)％,(34.46 ± 5.23) ng/mL,respectively,which in the NC group were (38.66 ± 3.41) ％,(7.01 ± 0.38) ％,(5.10 ± 1.52) ％,(35.17 ±5.i4) ng/mL,respectively,the differences among the four groups were statistically significant(F =23.72,25.49,15.24,24.52,all P ＜ 0.05).Peripheral blood Th1,Th2 and Th1/Th2 levels in the SAA group were (13.04 ± 3.01)％,(3.44 ±0.29)％,(1.99 ± 1.17),respectively,which in the MAA group were (11.01 ±2.89)％,(6.28 ±2.99)％,(1.75 ± 0.97),respectively,which in the CR group were (10.38 ± 3.27)％,(6.41 ± 3.18)％,(1.62 ±1.03),respectively,which in the AL group were (8.033 ±.42) ％,(6.35 ± 3.08) ％,(1.26 ± 1.11),respectively,which in the NC group were (8.41 ± 3.84) ％,(6.23 ± 3.44) ％,(1.34 ± 1.12),the differences among the four groups were statistically significant (F =35.92,42.43,22.24,all P ＜ 0.05).Peripheral blood IFN-gamma and IL-4levels in SAA group were (13.04 ± 2.58) pg/mL,(17.22 ± 3.88) pg/mL,respectively,which in MAA group were (10.11 ± 2.22) pg/mL,(17.24 ± 4.21) pg/mL,respectively,which in the CR group were (9.88 ± 2.16) pg/mL,(17.01 ±4.00)pg/mL,respectively,which in the AL group were (8.01 ± 1.68)pg/mL,(16.63 ± 3.58)pg/mL,respectively,which in the NC group were (38.66 ± 3.41) pg/mL,(16.743 ±.81) pg/mL,the differences among the four groups were statistically significant (F =24.17,3.39,all P ＜ 0.05).Conclusion Treg cells decreased,the inhibition extent of TGF-β1 on Th1 cells and IFN-γsecretion decreased,which leading to Th1/Th2 shifted to Th1,leading to hematopoietic marrow failure may be one of the pathogenesis of children sufferred from AA.

Objective To explore the effect of psychological nursing intervention on the compliance of pain medication in ederly patients with malignant tumor.Methods Retrospective analysis of 92 elderly patients with malignant tumors was conducted.All patients were treated with standardized drugs according to the three-step analgesic principle.The patients were randomly divided into two groups,the control group was given routine nursing intervention,and the observation group was given psychological nursing intervention on the basis of the control group.The improvement of pain response,depression and anxiety,the treatment compliance and nursing satisfaction of two groups before and after treatment were compared.Results The pain relief rate of the observation group was 89.36％,which was significantly higher than 64.44％ of the control group (Z =-3.534,P ＜ 0.05).The total remission rate of the observation group was significantly higher than that of the control group (x2 =4.058,P ＜ 0.05).The depression score of the observation group [(17.52 ± 4.06) points] was significantly lower than (23.35 ± 3.24) points of the control group (t =7.592,P ＜ 0.05).The anxiety score of the observation group [(17.52 ± 4.06) points] was significantly lower than (18.05 ± 4.02) points of the control group (t =7.622,P ＜ 0.05).The compliance of the observation group witb analgesic drugs was better than that of the control group (Z =-6.994,P ＜ 0.05).The nursing satisfaction of the observation group was 87.23％,which was significantly higher than 75.56％ of the control group (Z =-2.764,P ＜ 0.05).Conclusion Psychological nursing intervention can effectively improve the pain response,anxiety and depression of elderly patients with malignant tumor,thus to improve the compliance and safety of the treatment and the care of nursing staff.

Objective To investigate the effect of Bushen Huoxue Huatan decoction on blood lipid and homocysteine (Hcy) levels of patients with carotid artery stenosis.Methods 120 cases of carotid artery stenosis were selected.The different syndromes of patients were analyzed by weight coefficient,including phlegm turbidity,blood stasis,yin deficiency and qi deficiency syndrome.Phlegm traditional Chinese medicine was used to treat the patients.Serum lipids and Hcy levels before and after treatment were measured with enzyme conversion method and enzyme repeat method.Results After weight coefficient analysis,90.0％ (108/120) of patients were phlegm turbidity syndrome,82.5 ％ (99/120) were blood stasis,yin deficiency was 67.5 ％ (81/120) and qi deficiency syndrome was 51.67％ (62/120).Before treatment,the Hcy,TC,TG and HDL levels of patients with phlegm turbidity,blood stasis,yin deficiency and qi deficiency syndrome were increased.After treatment,the Hcy,TC,TG and HDL levels of patients with phlegm turbidity were (10.38 ± 0.12) μmol/L,(7.23 ± 0.91) mmol/L,(11.03 ± 0.13) mmol/L,(7.30 ±0.84) mmol/L,respectively,which of patients with blood stasis were (6.39 ± 0.22) μ mol/L,(16.37 ± 0.21) μmol/L,(6.45 ±0.20) mmol/L and (3.21 ±0.62)mmol/L,respectively,which of patients with yin deficiency were (16.37 ± 0.21) mmol/L,(10.22 ± 0.88) mmol/L,(15.89 ± 0.19) mmol/L,(10.67 ± 0.65) mmol/L,respectively,which of patients with qi deficiency were (10.25 ± 0.14) mmol/L,(8.20 ± 0.73) mmol/L,(9.98 ± 0.11) mmol/L,(8.43 ± 0.34) mmol/L,respectively.After treatment,the levels of Hcy,TC,TG and HDL were significantly improved,and the differences were statistically significant(F =46.774,12.310,49.486,59.406,all P ＜ 0.05).Conclusion Bushen Huoxue Huatan decoction is effective in the treatment of carotid artery stenosis,which can significantly improve the levels of Hcy,TC,TG and HDL,and it is of great value.

Objective To investigate the influence of rosuvastatin combined with noninvasive positive pressure ventilation on pulmonary ventilation function,SGRQ score and laboratory parameters of patients with AECOPD.Methods 110 patients with AECOPD were chosen and they were randomly divided into two groups according to the digital table,each group in 55cases.The control group received noninvasive positive pressure ventilation,and the observation group received rosuvastatin on the basis of the control group.The number of acute exacerbation and re-hospitalization,pulmonary ventilation function,SGRQ score,6MWT,the levels of IL-8,CRP,alanine aminotransferase,triacylglycerol and total cholesterol before and after treatment of the two groups were compared.Results The number of acute exacerbation and re-hospitalization of the observation group were significantly lower than those of the control group(t =3.19,2.84,all P ＜ 0.05).The levels of FEV1 and FEV1/FVC after treatment of both two groups were significantly higher than before treatment(t =2.88,3.14,2.90,3.42,all P ＜0.05).The levels of FEV1 and FEV1/FVC after treatment of the observation group were significantly higher than those of the control group (t =2.38,2.61,all P ＜0.05).The SGRQ scores and 6MWT after treatment of both two groups were significantly better than those before treatment(t =2.59,2.51,2.84,3.17,all P ＜ 0.05).The SGRQ scores and 6MWT after treatment of observation group were significantly better than those of the control group (t =2.59,2.51,all P ＜ 0.05).The levels of the IL-8,CRP,alanine aminotransferase,triacylglycerol and total cholesterol after treatment of both two groups were significantly lower than those before treatment (t =2.78,2.50,2.94,3.07,4'.26,3.89,3.02.3.67,all P ＜0.05).The levels of IL-8,CRP,alanine aminotransferase,triacylglycerol and total cholesterol after treatment of the observation group were significantly lower than those of the control group (t =2.64,2.33,2.81,3.15,all P ＜ 0.05).Conclusion Rosuvastatin combined with noninvasive positive pressure ventilation in the treatment of patients with AECOPD can efficiently promote lung function recovery,higher quality of life and exercise endurance,improve the laboratory indicators and is help to avoid the acute attack and re-hospitalization for long-term.

Objective To evaluate the clinical effect of E-max press ceramic onlay restoration of endodontically treated posterior teeth.Methods 36 endodontically treated posterior teeth were restored with E-max press ceramic onlay.After 6 and 12 months,the patients were recalled.The teeth with restoration were assessed by using the modified USPHS criteria including secondary caries,gingivitis,tooth fracture,marginal discoloration,marginal integrity criteria and restoration fracture/debond,etc.Results 100％ of the restorations displayed good results,92％ of the restorations did not have gingival inflammation and food impaction.Conclusion Ceramic orlay made by E-max press is an effective restoration for endodontically treated posterior teeth.

Objective To investigate the influence of probiotics assisted with routine antibiotic regimens on the short-term clinical efficacy,mucosal barrier function and inflammatory response of patients with bacterial peritonitis secondary to liver cirrhosis.Methods 60 patients with bacterial peritonitis secondary to liver cirrhosis were chosen,and they were randomly divided into two groups according to the digital table,each group in 30 cases.The control group received routine antibiotic regimens alone,and the observation group were given probiotics on the basis of the control group.The short-term clinical efficacy,the levels of DAO,D-Lac and ET before and after treatment of the two groups were compared.Results The short-term effective rates of the control group and observation group were 70.00％,96.67％,respectively.The short-term effective rate of the observation group was significantly higher than that of control group(x2 =9.14,P ＜0.05).After treatment,the levels of DAO of the control group and observation group were (4.33 ± 0.79) U/mL,(2.19 ± 0.47) U/mL,respectively.The levels of D-Lac of the control group and observation group after treatment were (15.88 ± 1.95) U/mL,(8.57 ± 1.03) U/mL,respectively.The levels of DAO and D-Lac of the observation group after treatment were significantly lower than those of the control group and before treatment(t =2.78,3.06;3.44,3.78,3.61,4.10,all P ＜ 0.05).The levels of ET of the control group and observation group after treatment were (0.09 ± 0.02) EU/mL,(0.04 ± 0.01) EU/mL,respectively.The level of ET of the observation group after treatment was significantly lower than that of the control group and before treatment(t =2.49,3.01,3.46,all P ＜ 0.05).Conclusion Probiotics assisted with routine antibiotic regimens in the treatment of patients with bacterial peritonitis secondary to liver cirrhosis can effectively relieve the symptoms and signs,improve the mucosal barrier function and is helpful to reduce the inflammatory response.

Objective To investigate the clinical effects of calcium dobesilate combined with insulin in the treatment of elderly patients with diabetic nephropathy in early stage.Methods 100 elderly patients with diabetic nephropathy in early stage were chosen,and they were randomly divided into two groups according to the digital table,each group in 50cases.The control group were given benazepril alone,and the observation group were given benazepril combined with calcium dobesilate on the basis of intensive insulin intervention.The levels of FPG,2hPG,Scr,BUN,mAlb,β2-MG,Cys-C and hs-CRP and QOL-C30 scores before and after treatment of the two groups were compared.Results There were no statistically significant differences in the levels of FPG,2hPG after treatment between the two groups(all P ＞0.05).Before treatment,the levels of Scr,BUN,mAlb and β2-MG of the control group were (81.16 ± 18.92) mmol/L,(5.63 ± 1.15) mmol/L,(105.71 ± 21.77) mg/24h,(543.46 ± 74.70) μg/L,respectively,which of the observation group were (81.59 ± 19.04) mmol/L,(5.58 ± 1.13) mmol/L,(106.33 ± 2 L 82) mg/24h,(548.20 ± 75.37) μg/L,respectively.After treatment,the levels of Scr,BUN,mAlb and β2-MG of the control group were (78.35 ± 14.35) mmol/L,(5.17 ± 0.97) mmol/L,(69.84 ± 14.24) mg/24h,(395.56 ±42.38) μg/L,respectively,which of the observation group were (73.10 ± 10.74) mmol/L,(4.63 ± 0.71) mmol/L,(52.92 ± 10.52) mg/24h,(337.89 ± 25.04) μg/L,respectively.The levels of Scr,BUN,mAlb and 32-MG after treatment of the observation group were significantly lower than those of the control group and before treatment (t =2.45,2.66,2.18.2.40;2.82,3.10,2.58.3.34;2.61,3.20;2.66.3.05;all P ＜ 0.05).Before treatment,the levels of Cys-C and hs-CRP of the control group were (1.82 ± 0.67) mg/L,(22.73 ± 6.54) mg/L,respectively,which of the observation group were (1.87 ± 0.70) mg/L,(1.17 ± 0.27) mg/L,respectively.After treatment,the levels of Cys -C and hs-CRP of the control group were (1.59 ± O.50) mg/L,(19.35 ± 5.60) mg,/L,respectively,which of the observation group were (22.58 ± 6.50) mg/L,(15.88 ± 4.03) mg/L,respectively.The levels of Cys-C and hs-CRP after treatment of the observation group were significantly lower than those of the control group and before treatment (t =2.32,2.67;2.85,3.19,2.66,3.02;all P ＜ 0.05).The QOL-C30 scores of the control group before and after treatment were (52.65 ± 7.70) points,(68.29 ± 9.84) points,respectively.The QOL-C30 scores of the observation group before and after treatment were (53.22 ± 7.78)points,(80.53 ± 12.10)points,respectively.The QOL-C30 scores of the observation group after treatment were significantly higher than those of the control group and before treatment (t =2.38,2.78,3.15,all P ＜ 0.05).Conclusion Bigeminy drug regimen assisted with intensive insulin intervention in the treatment of elderly patients with diabetic nephropathy in early stage can efficiently protect renal function,reduce the levels of inflammatory cytokines and is helpful to improve the quality of life.