Parenteral nutrition associated cholestasis (PNAC) mainly occurs in children. Currently identified risk factors include premature infants, lack of enteral feeding, repeated infections, and toxicity or nutrient deficiency of parenteral nutrition solution. Recent studies have shown that nuclear receptor-mediated bile acid transporter may be the key site of PNAC pathogenesis, in which some cytokines play important roles. New anti-cholestatic therapy based on the regulation of expression of these molecules may prevent end-stage liver disease caused by PNAC.

Objective:To establish a preoperative forecasting model for the nature of duodenal papillary tumors and to discuss its main predictors.Methods:A case-control study was conducted;the case group included patients with malignant duodenal papillary tumors and the control group included patients with benign duodenal papillary tumors.All the patients were from Changhai Hospital. Data of patients,including the demographic characteristics,clinical symptoms during onset,laboratory findings,and radiological data, were collected by face-to-face interviews or by reviewing the medical history.Chi-square,t-test or ANOVA were employed to performed univariate analysis.All factors with P values less than or equal to 0.25 in the univariate analysis were used as independent variables for multivariate analysis,and a Logistic regression forecasting model for the nature of duodenal papillary tumors was established.Results: Totally 199 patients with pathologically-confirmed duodenal papillary tumors were included in the present study,with 166 in the case group and 33 in the control group.Multivariate analysis showed that hemoglobin(Hb),total bilirubin(Tbil),direct bilirubin(Dbil), aspartate transferase(AST),alkaline phosphatase(AKP),gamma glutamyl transpeptidase(GGT),and carcinoembryonic antigen(CEA) were independent predictors for nature of duodenal papillary tumors,with their odds ratios(95% confidence interval)being 0.981 (0.959,1.003),0.867(0.794,0.948),1.207(1.075,1.355),1.028(1.008,1.048),0.996(0.992,1.000),1.002(1.000,1.004),and 0.974(0.953,0.994),respectively.Conclusion:The Logistic regression model,which takes into consideration of Hb,Tbil,Dbil,AST, AKP,GGT,and CEA,can be used to predict the nature of duodenal papillary tumors,and its clinical value need to be further studied.

AIM: To provide application and identification basis for methanol-extratis of Fructus aurantii by constructing the HPLC-FP. METHODS: The C_(18) column was used with a mobile phase of(A)(0.095%) phosphoric acid acetonitrile-(B)(0.095%) phosphoric acid gradient elution.The flow rate was(1.0) mL/min.The wavelength of detecter was set at 330 nm.Naringin was reference standard. RESULTS: By cluster analysis,the eighteen kinds of Fructus aurantii samples were classified as four clusters: the superior in producing area,the ordinary in producing area,the ordinary and the inferior.By similarity calculation,the similarity of the superior in producing area and the ordinary in producing area were(0.9)～(1.0),and the ordinary and the inferior were less than(0.9). CONCLUSION: The HPLC-FP of Fructus aurantii has been established.The method can be used to identify and evaluate the quality of Fructus aurantii.

Objective To assess the effect of thoracoscopic surgery under laryngeal mask anesthesia and explore the nursing strategies. Methods Thirty-five patients from April to December in 2014 undergoing video-assisted thoracoscopic surgery (VATS) were given intubation anesthesia and another thirty-five ones undergoing the same surgery in 2015 received laryngeal mask anesthesia. The two groups were compared in terms of surgery conditions, surgery complication and ambulation time. Results No significant differences were found in surgery time or blood loss between two groups (P>0.05). The postoperative waking time in the mask anesthesia group was significantly shorter than that of the intubation anesthesia group (P<0.05), and ambulation time was significantly shortened (P<0.05). The rates of throat discomfort, hoarseness and gastrointestinal reactions were significantly lower. Conclusions Laryngeal mask anesthesia used in small thoracoscopic surgery for airway management is safe and feasible. Combined with training in respiration and limb function, better analgesia and nursing, it can keep away complications related to intubation anesthesia, shorten hospital stay and accelerate postoperative rehabilitation.

OBJECTIVEThe changes of pain threshold and expression of 5-hydroxytryptamine(5-HT) and c-Fos in spinal dorsal horn of rats were observed after targetedly damaged the cerebraspinal fluid-contacting nucleus (CSF-contacting nucleus) to provide experimental evidence for the mechanism of regulating pain CSF-contacting nucleus involved in.

METHODSMale adult SD rats were divided into control, sham, choleratoxin subunit B conjugated with horse-radish peroxidase (CB-HRP)and damage groups randomly. The pain threshold using mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were recorded and analyzed. Immunofluorescence method was used to observe the expression of 5-HT and c-Fos in spinal dorsal horn.

RESULTSCompared with the control, sham and CB-HRP groups, the MWT and TWL of the damage group were significantly increased (P < 0.05). The results of immunofluorescence showed that 5-HT was detected in neurons of CSF-contacting nucleus. In the damage group, the number of neurons of CSF-contacting nucleus reduced gradually, and no survived neurons were observed at the 10th day. Meanwhile, both the expression of 5-HT and c-Fos in spinal dorsal horn increased gradually, and negatively correlated with the change of pain threshold.

CONCLUSIONThe method of targeted damaging CSF-contacting nucleus by cholera toxin subnit B conjugated with saporin(CB-SAP) is scientific and reliable, and it results in the changes of pain threshold and expression of 5-HT and c-Fos in spinal dorsal horn of rats. This study suggests that CSF-contacting nucleus participate in the regulation of pain, moreover, 5-HT and c-Fos play important roles in this regulation.

Animals ; Cerebrospinal Fluid ; Male ; Pain ; metabolism ; surgery ; Proto-Oncogene Proteins c-fos ; metabolism ; Rats ; Rats, Sprague-Dawley ; Serotonin ; metabolism ; Spinal Cord Dorsal Horn ; metabolism

To investigate the relationship of the expressions of matrix metalloproteinases(MMPs) and tissue inhibitor of metalloproteinase (TIMP) with metastasis and prognosis in colorectal cancer. Using S P immunohistochemistry method to detect the expressions of MMPs and TIMP in 41 cases of colorectal cancer. The expression levels were analyzed quantitatively by computer image analysis system. The results showed that the expression of MMP 2,MMp 9 and TIMP 1 was higher than those in normal epithelial mucosa. In the cases with metastasis to lymph node, the expressions of MMP 2 and MMP 9 TIMP 1 were significantly higher than that of cases without metastasis.The high expressions of the three factors are closely correlated with the progression and poor prognosis of colorectal cancer. It suggested that expressions of MMPs and TIMP are closely related with metastasis and prognosis in colorectal cancer.

Objective The epidemiology of Acinetobacter baumannii isolates from bloodstream infections,their antibiotic resistance profiles and virulence-associated factors were studied.Methods A total of 90 isolates from 17 hospitals were collected from the patients with bloodstream infections during July 2013 and July 2014.Vitek-2 Compact system was used for identification of the strains and antibiotic susceptibility testing.The epidemiology was studied by pulsed-field gelectrophoresis(PFGE).Drug-resistant genes and associated virulence genes were amplified by PCR.Results According to antimicrobial susceptibility testing,75 isolates are multi-drug resistant Acinetobacter baumannii.PFGE results showed that 75 multi-drug resistant Acinetobacter baumannii isolates belonged to eight clone types(A to H),with the A (n=51)and B (n=14)clone being the dominant PFGE clone types.Different clone isolates spread in different hospitals.Most of the hospitals were given priority to with clone A.Clone A only maintaining high sensitive rate to cefoperazone/sulbactam、amikacin and tigecycline.Virulence gene abaI,cusE,ompA,bap,bfms detection rates are 93.3% (84/90),92.2% (83/90),100.0% (90/90),84.4% (76/90),92.2% (83/90),respectively.There were 7 mucoid isolates,which are all multi-drug resistant Acinetobacter baumannii,all belong to clone B and all associated virulence genes can be detected.Conclusions The dominant clone type of multi-drug resistant Acinetobacter baumannii from bloodstream infections is clone A.The abaI-,bap-and bfms-positive strains are associated with a higher incidence of antibiotic resistance in most types of antimicrobials.The acquisition of mucous type may indicate the emergence of virulent strains,which should be paid attention to during clinical treatment.

ObjectiveTo investigate the clinical efficacy of heat-sensitivepoint Yaoyangguan(GV3)moxibustion for sciatica and preliminarily explore the mechanism of its action.MethodOne hundred and twelve sciatica patients were randomly allocated to heat-sensitive point Yaoyangguan moxibustion (observation), non-heat-sensitive point Yaoyangguan suspended moxibustion (control) and medication groups. The observation group received heat-sensitive point Yaoyangguan moxibustion; the control group, non-heat-sensitive point Yaoyangguan suspended moxibustion; the medication group, oral administration of Yaobitong capsules. The clinical symptoms were scored, the Pain Rating Index (PRI), the Visual Analogue Scale (VAS) and the Present Pain Intensity (PPI) scores were counted and serum IL-8 content was measured in the three groups beforeand after 15 days of treatment.ResultAfter 15 days of treatment, all the three treatments had a certain therapeutic effect on sciatica. The therapeutic effect was bestin the observation group (P<0.05). The PRI, VAS and PPI scores and serum IL-8 contentdecreased in all the three groups compared with before treatment (P<0.05) and were lower in the observation group than in the control and medication groups (P<0.05). There was no statistically significant difference between the control and medication groups (P>0.05).ConclusionHeat-sensitive point Yaoyangguan moxibustion has a better therapeutic effect than non-heat-sensitive point Yaoyangguan suspended moxibustion and oral administration of Yaobitong capsules. This method is an ideal treatment for sciatica. The mechanism may be related to a posttreatment decrease in inflammatory factors in the diseased region.

The pathogenesis of chronic obstructive pulmonary disease is the dysfunction of qi-blood-body fluid.By the analysis of the pathogenesis of different stages of COPD,qi deficiency,phlegm,blood stasis is the key to COPD.According to the pathogenesis of syndrome differentiation,a good curative effect can be achieved by the selection of different treatment methods like tonifying qi,eliminating phlegm and removing blood stasis.

[Objective] To research the sedative effect of intranasal dexmedetomidine and sufentanil for pediatric sedation for stomatological operation of outpatient department.[Methods] 60 children undergoing stomatological operation of outpatient department,age 3 ～ 7 years,weighing 10 ～ 32 kg,of ASA physical status Ⅰ ～ Ⅱ,were divided into the three groups (n =20) randomly using a random number table:group dexmedetomidine and sufentanil (group DS),group dexmetomidine (group D),group sufentanil (group S).Recorded the children's behavior using the Ohio State University behavior rating score (OSUBRS),the University of Michigan Sedation Score (UMSS),SBP,HR and side-effects when entry,during and leave operation and in post-anesthesia care unit,side-effects,the satisfaction of stomatological doctors and parents.[Results] The OSUBRS of group DS when entry,during operation were lower than group D (P ＜ 0.01).The UMSS of group DS were higher than group D and group S when entry and during operation (P ＜ 0.05).The success rate of group DS was higher than group D and group S (P ＜ 0.01).There was no different of mean percentage change in systolic blood pressure and heart rate from baseline between group DS and group D (P ＞ 0.05).There were no instances of respiratory depression,hypotension and bradycadia.[Conclusion] Intranasal dexmedetomidine and sufentanil provides satisfactory pediatric sedation for stomatological operation of outpatient department without side effects such as respiratory depression,bradycadia and hypotension.