Objective To observe the effectiveness of early enteral nutrition (EEN) in managing ICU mechanically ventilated patients.Methods Totally 47 patients who had been ventilated for more than one week were randomly divided into EEN group and control group.The EEN group was supplied with enteral nutrition (EN) 12-24 hours after ICU admission,whereas the control group received EN 72 hours-5 days later.The function of intestinal mucosal barrier was evaluated by the reabsorb concentration of disaccharides lactulose/mannitol (L/M).In addition,the body mass index (BMI),body temperature,urine L/M ratio,serum albumin,pre-albumin,and ventilation days were recorded or calculated.Results On the seventh day,the L/M ratio was (0.036 ±0.004) in the EEN group,which was significantly lower than that (0.108 ±0.020) in the control group (t =2.746,P ＜0.01) ; the average body temperature was significantly lower in the EEN group than in the control group [(38.25 ± 1.20) ℃ vs (38.92 ± 1.40) ℃ ; t =2.683,P ＜ 0.05)] ; the incidences of adverse reactions such as constipation and diarrhea were significantly lower in the EEN group [16.7％ (4/23) vs 27.3％ (6/22),P＜0.05].The weaning rate within 2 weeks also favoured the EEN group [90％ (18/20) vs 80％ (16/20),P ＜ 0.05].Compared with the control group,the nutritional status of serum albumin and pre-albumin also showed a favourbale trends in the EEN group.Conclusions EEN can improve intestinal mucosal barrier and increase the weaning possibility in patients with mechanical ventilation.

ObjectiveWe evaluate our experience of previously blocking both pulmonary artery and veins in true video assisted thoracic surgery (VATS) for the treatment of non-small-cell lung carcinoma ( NSCLC ).MethodsSix patients undergoing lobectomy with previously blocking both pulmonary artery and veins in the VATS in our institution between December 2007 and June 2011 were reviewed.ResultsIn our series,six patients required previously blocking both pulmonary artery and veins in the VATS,The mean occlusion time of PA and PV was (42.0 ± 8.6 ) min and ( 39.3 ± 8.2 ) min,respectively.Four patients required partial PA reconstruction.The mean repair time of the PA was (21.25 ±9.91 ) min.No complications attributable to the technique or mortality were seen.There were no local recurrences on the pulmonary artery.ConclusionIt is feasible and safe that the technology of previously blocking of the pulmonary artery and veins was applied in VATS.This technique can reduce the risk of intraoperative bleeding and the chance of converting to open thoracotomy,and extend the inclusion criteria of VATS lobectomy.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

OBJECTIVETo explore the regulation and clinical significance of intestinal dripping of Jianpi Tongli (JPTL) Chinese herbs on levels of serum cytokines, such as interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R) and interleukin-12 (IL-12) in treating patients with gastric cancer (GC) at early post-operational stage.

METHODSSixty patients with GC were randomly divided into two groups, i. e. the studied group (n = 30), treated with JPTL Chinese herbs, and the control group (n = 30) treated with normal saline. The medication was started from the 1st day after operation by intestinal dripping daily, 7 days as one course. Levels of IL-2, sIL-2R and IL-12 were observed before and after operation.

RESULTSSignificant difference was seen on the 7th day post-operation between the studied and the control group, mainly in aspects of obvious increase of IL-2 and decrease of sIL-2R (P <0.05), no significant difference in IL-12 was found (P >0.05) though there was certain improvement. Compared with pre-operation of the same group, significant difference was found in the studied group in the increased IL-2 and IL-12 and decreased sIL-2R on the 7th day post-operation, while no significant difference in these indexes was found in the control group (P >0.05), though certain improvement was shown.

CONCLUSIONEarly intestinal dripping of JPTL Chinese herbs to post-operational patients with GC could improve their immune function, which was of important significance in early preventing the severe complications, improving the prognosis, and elevating the survival rate.

Adenocarcinoma ; blood ; drug therapy ; surgery ; Adult ; Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Interleukin-12 ; blood ; Interleukin-2 ; blood ; Intestine, Small ; Intubation, Gastrointestinal ; Male ; Middle Aged ; Phytotherapy ; Postoperative Period ; Receptors, Interleukin-2 ; blood ; Stomach Neoplasms ; blood ; drug therapy ; surgery

Objective:To explore the clinical efficacy of kidney transplantation(KT)from senile living-related donors aged over 70 years.Methods:Between 2017 and 2019, perioperative and follow-up data from 18 pairs of donors and recipients were retrospectively reviewed.Results:Operations of all 18 pairs of recipients and donors were conducted successfully without serious perioperative complications.No delayed graft function occurred.There was 1 episode(5.6%)of acute rejection.The mean level of serum creatinine(SCr)at Day 3 post-KT and at discharge was(155.7±63.5)and(97.6±28.7)μmol/L.The median follow-up period was 37.5 months.All 18 donors survived with normal renal function.And no proteinuria or kidney donation related hospitalization events occurred.SCr was(84.4±15.0)μmol/L at the last follow-up and there was no statistical significance as compared with SCr level at discharge( P=0.610). No recipient mortality or graft loss occurred.Levels of SCr were(92.1±18.3), (95.5±21.9)and(100.1±21.2)μmol/L at Month 12/24 and the last follow-up.No statistical difference existed in posttransplant SCr level at these follow-up timepoints( P=0.507). Posttransplant proteinuria occurred in 3 recipients(16.7%). In 8 donors, donated kidney glomerular filtration rate(GFR)was lower than 40 ml/(min·1.73m 2). No statistical difference existed in posttransplant SCr level between this group and higher GFR group( P>0.05). Conclusions:After thorough preoperative assessments, satisfactory short-term outcomes may be achieved for KT from living-related donors aged over 70 years.The long-term outcome should be further explored.

ObjectiveTo explore the application value of event-related potential P300 in the evaluation of cognitive dysfunction in patients with traumatic brain injury. MethodsFrom January to September 2021， a total of 36 patients with traumatic brain injury who were conservatively treated in the Neurosurgery Department of the Third Hospital of Mianyang and met the diagnostic criteria were selected as the experimental group. And 36 participants were recruited from the family members and carers of other patients in the hospital as the control group. Oddball paradigm was used to measure the event-related potential P300. Montreal Cognitive Assessment （MoCA） and Mini-Mental State Examination （MMSE） were used to assess the cognitive function of the subjects. The latency and amplitude of P300， MoCA and MMSE scores were compared between two groups. The detection rates of P300 latency， MoCA and MMSE on cognitive dysfunction in patients with traumatic brain injury were compared. ResultsMoCA and MMSE scores in experimental group were lower than those in control group ［（18.08±4.29） vs. （27.36±1.20）， （22.53±3.54） vs. （28.11±1.09）， t=-12.510， -9.041， P<0.05］. The latency of P300 in experimental group was higher than that in control group ［（406.08±26.95）ms vs. （367.08±22.50）ms， t=6.665， P<0.05］， and the amplitude was lower than that in control group ［（7.76±0.90）μV vs.（9.87±0.99）μV， t=-9.459， P<0.05］. In experimental group， the positive detective rate of P300 latency and MoCA on cognitive dysfunction were higher than that in MMSE （χ²=5.675， 7.604， P<0.05）. ConclusionEvent-related potential P300 can be used as an objective clinical indicator for evaluating cognitive dysfunction in patients with traumatic brain injury.