Objective To explore the effect of combination application of preoperative carbohydrate loading and sequential enteral nutrition on the recovery of postoperative patients with stomach neoplasm.Methods Ninety-eight patients with stomach neoplasm were randomly divided into three groups.Those were Group A (preoperative fasting + sequential EN,n =33),group B (preoperative carbohydrate loading + postoperative TPN,n =33) and group C (preoperative carbohydrate loading + sequential EN,n =32).Insulin sensitivity (IS) ; Nutritional indicators including pre-albumin (PA) and transferrin (TRF) ; immunity parameters including IgG,IgM and IgA were measured in blood on the day before the operation,the 1st day,4th day and 8th day after the operation.Meanwhile,anal exhaust time after the operation,incidence of complications and postoperative hospitalizing time were also observed.Results The level of IS in group C at 4th day and 8th day after operation were 35.8 ± 3.2 and 36.1 ± 3.5,higher than those in A group and B group (A group:30.7 ±3.3,33.5 ±2.9;B group:33.7 ±3.1,34.0 ±2.2),and the differences were significant((F =20.88,7.28 ;P ＜0.05).At the 4th day after the operation,the levels of PA in group B and group C were (191 ± 11.6) mg/ and (193 ± 12.7) mg/L,significantly higher than those in group A ((176 ± 14.1) mg/L;F =17.15,P ＜ 0.01).At the 8th day after the operation,the levels of PA and TRF in group C were (221.3 ±30.81) mg/L and (86 ± 0.37) g/L,significantly higher than those in group A and group B (group A:(198.0 ± 30.6) mg/L,(1.60 ± ±0.33) g/L;group B:(202.0 ±28.6) mg/L,(1.61 ±0.34) g/L;F =5.42,5.83 ;P ＜0.01).At the 8th day after the operation,the levels of IgA,IgG and IgM in the group C were (2.74 ±0.69) g/L,(14.55 ±2.57) g/ L,(1.08 ± 0.33) g/L,significantly higher than that in group A and group B (group A:(2.30 ± 0.54) g/L,(12.71 ±2.94) g/L,(0.86 ±0.31) g/L;group B:(2.29 ±0.50) g/L,(12.06 ±3.33) g/L,(0.89 ±0.27)g/L;F =6.12,6.13,4.94;P ＜ 0.05).Conclusion The combination of preoperative carbohydrate loading and sequential enteral nutrition can reduce insulin resistance,improve postoperative nutritional status,improve the recovery of immune function and intestinal function,as well as reduce the incidence of postoperative complications.

Objective To compare the effects of different dose aprotinin on cardiopulmonary bypass induced inflammation and myocardial injury Methods Eighteen adult patients undergoing cardiopulmonary bypass (CPB) were divided into three groups (n=6): control,low dose aprotinin and full dose aprotinin Plasma levels of tumor necrosis factor ?(TNF?), interleukin 6(IL 6), interleukin 10(IL 10), intercellular adhesion molecule 1(ICAM 1), troponin T(TnT) and neutrophil integrin cluster of differentiation 11b(CD11b) were measured at following points: before CPB(T1);1 h of CPB (T2) ;30 min after weaning from CPB (T3); 4 h after weaning from CPB (T4) ; and 24 h after weaning from CPB(T5) Results TNF?: the values in two aprotinin using groups were lower than the control levels at T2, T3 and T4 , furthermore, in full dose group was lower than in low dose group at T4 , and lower than two other groups at T5 (P

Objective To observe the changes of calcitonin gene related peptide (CGRP) in rat spinal motoneuron after upper motoneuron injury. Methods Thirty six adult male Wistar rats were selected. Spinal cord transection was made at the lower thoracic segment. The lumbar regions of spinal cord were removed immediately, 1, 2, 4, 7 and 14 days after surgery to be divided into dorsal and ventral sections. The content of CGRP in ventral section was detected using radioimmunoassay method.Results The level of CGRP in spinal motoneuron of the lumbar region was decreased significantly after transection of spinal cord, reached the lowest level on the 2nd day after surgery and then maintained at the low level.Conclusions The upper motoneuron injury can result in the decrease of CGRP content in spinal motoneuron.

Objective To determine the factors contributing to the development of deep vein thrombosis (DVT) in the lower extremity in patients after hip or knee arthroplasty and hip fracture internal fixation.Methods One hundred and forty-seven consecutive patients receiving hip or knee arthroplasty and hip fracture internal fixation from 2004 to 2005 were included in this study. Their age ranged from 33 to 92 years. Duplex color ultrasonic inspection was performed on veins of the bilateral lower extremities before operation and 2 weeks after operation for detection of DVT. The patients were divided into a DVT group and a DVT-free group based on the development of DVT after operation. Detailed perioperative clinical information about the patients, surgery and anesthesia was collected.Results Lower extremity DVT was found in 42.2% of the patients after operation, while the incidence of proximal DVT was 2.7%. Compared with the DVT-free group, the usage rate and dosage of ephedrine increased significantly, the duration of anesthesia was significantly longer, and the white blood cell count (WBC) on the 1st postoperative day and the highest WBC count were significantly higher in the DVT group(P＜0.05). Logistic regression analysis indicated that the above factors were closely related to DVT.Conclusion Duration of anesthesia ＞ 3 h, ephedrine administration and a marked increase in WBC count after operation are the risk factors for DVT in the lower extremities in patients after hip or knee arthroplasty and hip fracture internal fixation.

BACKGROUND: Selenium is one of necessary microelement of human body. It acts as the active center of selenium-contained enzyme with antioxidant function, which can clean up internal free radical, effectively catalyze harmful perhydride deoxidizing into innocuous hydroxyl compound,reinforce immunity of human body, prevent and cure cardio-cerebrovascular diseases and cancer.OBJECTIVE: To provide evidence for preventing and treating cardiocerebrovascular diseases via comparison of blood selenium content between patients and healthy persons.DESIGN: Case-control analysis.SETTING: Dalian Railway Medical School, Dalian Railway Hospital, Department of Applied Chemistry, Dalian Railway College.PARTICIPANTS: Totally 319 blood samples (169 males, 150 females)were collected from patients with cardio-cerebrovascular diseases from Dalian Railway Hospital from March 2000 to May 2001. Among them,there were 164 with hypertension, 97 with coronary atherosclerotic heart disease (CAHD), 41 with cardiac dysrhythmia and 17 with cerebral vascular accident. 300 healthy patients (159 males and 141 females) were in the healthy group.METHODS: The blood selenium content of patients with cardio-cerebrovascular diseases was detected with neopolarography.MAIN OUTCOME MEASURES: ①Total level of blood selenium of testees of the two groups. ②Comparison of level of blood selenium between males and females. ③Comparison of level of blood selenium of patients with different diseases.RESULTS: A total of 619 testees were involved in the result analysis. ①The total level of blood selenium of the patient group was lower than that of the healthy group [(114.0±52.5), (146.5±51.0) μg/L,P ＜ 0.001],which was only 76% of that of the healthy persons. ②Content of blood selenium of males and females was normal distribution. There was insignificant difference between males and females (P ＞ 0.10), but the level of blood selenium in females was slightly higher than that of males. ③The levels of blood selenium of patients with hypertension, CAHD, cardiac dysrhythmia were 82.7%, 68.6% and 66.0% of that of healthy persons, respectively, but the difference between males and females was insignificant(P ＞ 0.10). The level of blood selenium of patients with cerebrovascular accident (CVA) was the lowest, (84.4±28.9)μg/L, which was 57.6% of healthy persons.CONCLUSION: The content of blood selenium of patients with cardiocerebrovascular diseases is lower than that of healthy persons. Organic selenium and inorganic selenium should be supplemented moderately.

Objective To investigate the recent effect and safety of magnetic resonance guided focused ultrasound (MRgFUS) for treating uterine fibroids with a Meta analysis. Methods Such databases as Cochrane Library,PubMed,EMbase, CBM,CNKI,CQVIP and Wanfang were searched from their establishment. After thestudy selected, assessment and data extraction conducted by two reviewers independently, Meta-analysis were performed by using the Comprehensive Meta-analysis V2 software. The volume of non-perfusion ratio (NPVR), fibroid shrinkage, clinical symptom severity (SSS score) and adverse reactions were analyzed.Results Nighteen retrieved articles were included, with a total of 1 549 patients. The results of Meta-analysis showed that:(1)nonperfused volume ratio (NPVR),Mean=57.1%(95%CI 45.0% —69.2%).(2)Percentage of FBs shrinkage:mean=31.4% (95% CI 29.2% —33.6%).(3)Symptom severity score (SSS):baseline mean=51.00(95%CI 41.61—60.40),3 months mean=32.50 (95%CI 25.90—39.10),6 months mean=28.62(95%CI(23.57—33.66),12 months mean=24.46(95%CI 15.44—33.49), the average of the severity score of the patient symptoms had a tendency to reduce.(4)The degree of adverse reactions were mild and could relieve itself, there was fewer serious adverse reactions. Conclusions The current evidence indicates that MRgFUS in treatment of uterine fibroidsis reliable and safe. MRgFUS can significantly reduce the volume and the symptom severity score ofthe patients.

Inorganic layered materials with the open structure of low dimension and good biological compatibility and stability are considered as one of the most promising materials for immobilizing biomolecules, which can not only adjust the spacing of layers according to guest molecular size to prevent leakage of guest molecule, but also reduce the effects of surrounding elements on immobilized molecules significantly. Moreover, they can promote electron transfer between enzyme and the electrode. Therefore, the inorganic layered materials have great application potential in electrochemical sensors. This paper reviews the ways of immobilizing guest molecules of inorganic layered materials and the applications and development prospects of the different types of inorganic layered materials including cationic, anionic and nonionic inorganic layered materials in electrochemical sensor.

Modern information technology was used to establish the simulating interview question bank which includes the parts of medical history,physical examination,primary diagnosis,lab test, treatment,confirmed diagnosis and the final case abstract according to the clinical management process. Results of the application in gynecology and obstetrics teaching assessment among the medical probation showed that the simulating interview question bank had some advantages in assessing the student's ability of the knowledge comprehensive evaluation,self-thinking and synthetic analyzing. It could also make au-tomatic analysis after the examination and provide teaching feedback. This novel teaching assessment could be optimized and applied extensively.

[Objective]To study the association between the polymorphisms in the promoter region of Osteopontin(OPN)with hepatitis B virus(HBV)-related HCC.[Methods]A total of 225 cases diagnosed with hepatitis B virus(HBV)-related HCC and 200 age-matched patients with HBV infection without HCC were collected. Three polymorphisms(-156delG/G,-443T/C and-616T/G)in the Osteopontin promoter were genotyped using direct sequencing.[Results]The frequency of-156delG/delG genotype in the HCC group was higher than that of in the control group (P = 0.003). There was a significantly increased frequency of the allele-156delG(P<0.001)in HCC patients. Logistic regression analysis was performed to show an increase HCC risk associated with the delG variant genotype(OR1.64;95%CI 1.25~2.16). There were no differences between the groups in the genotype distributions and allele frequencies of SNP-443T/C and-616T/G.[Conclusion]Our findings suggest that allele-156delG in the Osteopontin promoter may be a marker for risk of HCC with HBV infection in Chinese Han population.

Objective To investigate de-escalation of empiric broad-spectrum antibiotics treatment for patients in intensive care unit (ICU).Methods Data of the patients discharged from ICU in the Second Affiliated Hospital of Zhejiang University from July 1 to December 31 of 2012 and from July 1 to December 31 of 2013 were retrospectively reviewed.Patients with initial use of empirical broad-spectrum antibiotics within 3 d after ICU admission were included in the study.Clinical data including status of infection,the initial empiric antimicrobial therapy,pathogens culture and adjustment of antibiotics in 5 days were analyzed.Results A total of 841 patients were discharged from ICU during the study periods and antibiotics were used in 786 (93.5％) patients.Among 786 patients,389 (49.5％) were treated empirically with broad-spectrum antibiotics,but only 269 (69.2％) had evidences of bacterial infections.Of the 389 patients with empiric antibiotics use,de-escalation of antibiotics was applied only in 6 (1.54％) patients within 5 days after the initiation of treatment.In 269 patients with evidence of infection,specimen sampling and culture were performed in 248 (92.2％) patients within 3 days,among which 165 samples were positive,and the clinical isolates were mainly multi-drug resistant gram negative bacilli and colonized bacteria in oropharyngeal cavity.De-escalation was applied only in 4 (1.49％,4/269) patients with evidences of bacterial infections.Conclusion Broad-spectrum antibiotics as initial empiric therapy is common for patients in ICU,however de-escalation of empiric therapy is rarely applied even in patients with positive results in pathogen isolation and culture.