objective:To investigate the cause,pathogenesis,diagnosis and treatment of Wernicke encephalopathy(WE) after total parenteral nutrition(TPN). Methods:A retro spective study was conducted on 20 cases of clinical data about WE after long period of TPN. Results:WE usually occurred in the 2th～3th week of TPN support.18 cases of WE were treated with vitamin B_(1) in time,their symptoms disappeared and survived.2 patients died with misdiagnosis. Conclusion:Vitamin B_(1) is the key point to prevent and treat WE after long period of TPN.

Objective To evaluate the possibility of detection mutations of multiple genes in stool for secondary screening for colorectal cancer.Methods Tumor specimens and stool samples from 40 patients with colorectal cancer and 40 normal persons were examined for mutations of p53,K-ras and APC gene by polymerase chain reaction single strand conformation polymorphism(PCR-SSCP) and silver nitrate staining.Results ①The mutation rate of p53,K-ras and APC gene in the tissues and stools of colorectal cancer respectively were 57.50%,50.00%,60.00% and 42.86%,40.00%,51.43%,and no mutations were found in normal mucosa and stool.②The mutation ratioes between multiple gene and single gene had significant difference(P

OBJECTIVETo investigate the effect of delayed skin grafting combined traction in severe joint cicatricial contracture.

METHODSAt the first stage, the joint cicatricial contracture was released completely with protection of vessels, nerves and tendons. The wound was covered with allogenetic skin or biomaterials. After skin traction for 7-14 days, the joint could reach the extension position. Then the skin graft was performed on the wound. 25 cases were treated from Mar. 2000 to May. 2013.

RESULTSPrimary healing was achieved at the second stage in all the cases. The skin graft had a satisfactory color and elasticity. Joint function was normal. All the patients were followed up for 3 months to 11 years with no hypertrophic scar and contraction relapse, except for one case who didn' t have enough active exercise on shoulder joint.

CONCLUSIONDelayed skin grafting combined traction can effectively increase the skin graft survival rate and improve the joint function recovery.

Biocompatible Materials ; therapeutic use ; Cicatrix, Hypertrophic ; Combined Modality Therapy ; methods ; Contracture ; surgery ; Female ; Humans ; Male ; Recovery of Function ; Recurrence ; Skin Transplantation ; methods ; Tendons ; Traction ; methods ; Wound Healing

Objective: To evaluate the role of extracellular signal-regulated kinase (ERK) signaling pathway in intrathecal dexmedetomidine-induced reduction of spinal cord ischemia-reperfusion (I/R) injury in rats. Methods: Eighty clean-grade male Sprague-Dawley rats, aged 9-10 weeks, weighing 300-350 g, were divided into 4 groups (n=20 each) using a random number table method: sham operation group (group S), spinal cord I/R group (group I/R), dexmedetomidine group (group D), and dexmedetomidine plus ERK signaling pathway blocker PD98059 group (group P). Spinal cord ischemia was produced by cross-clamping of the abdominal aorta distal to the left renal artery for 25 min followed by reperfusion to establish the model of spinal cord I/R injury.Dexmedetomidine 1 μg/kg was intrathecally injected at 20 min before establishing the model in D and P groups, PD98059 2 mg/kg was given via the tail vein at the same time in group P, and the equal volume of normal saline was given instead in S and I/R groups.Five rats were selected at 6, 8, 10 and 12 h of reperfusion, and the modified Basso, Beattie, Bresnahan (BBB) scale was used to assess the hindlimb locomotor function.Five rats were sacrificed after assessing the locomotor function at 6 h of reperfusion, and the L_3-5 segments of the spinal cord were taken for determination of cell apoptosis (by TUNEL) and expression of phosphorylated ERK (p-ERK) (by Western blot). The apoptosis index was calculated. Results: Compared with group S, the BBB scores were significantly decreased at each time point of reperfusion, the apoptosis index was increased, and the expression of p-ERK was up-regulated in the other three groups (P<0.05). Compared with I/R group, the BBB scores were significantly increased at each time point of reperfusion, the apoptosis index was increased, and the expression of p-ERK was up-regulated in group D, and no significant change was found in the apoptosis index or p-ERK expression in group P (P>0.05). Compared with group D, the BBB scores were significantly decreased at each time point of reperfusion, the apoptosis index was increased, and the expression of p-ERK was down-regulated in group P (P<0.05). Conclusion The mechanism by which intrathecal dexmedetomidine reduces spinal cord I/R injury is related to activating ERK signaling pathway in rats.

Objective To investigate the clinical significance of nasointestinal tube placement in facilitating recovery after Roux-en-Y gastric bypass surgery.Methods The clinical data of patients with gastric neoplasms who underwent Roux-en-Y gastric bypass surgery were analyzed retrospectively.28 patients who had nasointestinal tube inserted were compared to 33 patients who didn't.Indicators for nutrition [body mass index (BMI),Nutrition Risk Screening 2002 (NRS 2002) score,serum total protein (TP),albumin (Alb) and prealbumin] and prognosis (bowel sound and anal exhaust or defecation time,anastomotic leakage rate,abdominal abscess or infection,incision infection or delayed healing,postoperative pulmonary infection rate,postoperative hospitalization time,unplanned reoperation or readmission rate) were analyzed.Results There was no statistically significant difference (all P＞0.05) between the two groups at baseline (sex,age,BMI,NRS 2002 score,operation time and blood loss during operation).The two groups had no statistically significant difference (all P＞0.05) in TP,Alb and prealbumin before the operation or at day 2 or day 6 after the operation.There were significant difference between the two groups in partial indicators for nutrition and prognosis:prealbumin at sixth days after operation (t =-2.05,P =0.045),bowel sound (t =7.71,P =0.000),anal exhaust or defecation time (t=4.52,P=0.000),postoperative hospitalization time (t=4.43,P=0.000),incision infection or delayed healing rate (x2 =4.78,P =0.029).No statistically significant difference (all P＞ 0.05) was found in anastomotic leakage rate,abdominal abscess or infection rate,postoperative pulmonary infection rate,and unplanned reoperation and readmission rate (x2=1.94,P=0.164).There was significant difference (Fisher,P =0.029) between patients aged 70 or above in the two groups in terms of postoperative pulmonary infection rate.Conclusions Enteral nutrition via nasointestinal tube after Roux-en-Y operation in patients with gastric neoplasms can promote protein synthesis,facilitate recovery of intestinal function,shorten hospitalization time and accelerate patient recovery.However,extra caution is needed in patients aged 70 or above,and early extubation should be considered based on the lung conditions of these patients.