Perioperative management includes all the treatments during pre-, intra-, and post-operative periods. The enhanced recovery after surgery applies a series of evidence-based perioperative measures to accelerate patients' recovery by reducing both physical and mental stress caused by surgical operation. Compared with traditional perioperative management, it decreases the rate of complication and re-admission, and shortens the length of hospitalization without any impact on safety. The principle, strategy, and technique of enhanced recovery after surgery will be integrated into the perioperative management of all the patients in the future.
Humans ; Perioperative Care

Objective To investigate the relationship of BPH in patients with newly diagnosed type 2 diabetes mellitus with age,weight,blood glucose levels.Methods Totally 141 cases with type 2 diabetes and BPH in elderly patients were discussed.Glucose level,the international prostate symptom score (IPSS),prostate volume (PV) and maximum urinary flow rate (Qmax) were determined.Results The levels of IPSS(10.9±2.5 vs.16.4±3.0,P＜0.01; 10.9±2.5 vs.19.4±3.3,P＜0.05) and PV(43.3±7.7 vs.47.9±10.5,43.3±7.7 vs.48.1±8.6,both P＜0.05) were increased in age group of 70-79 years and age group ≥ 80,Qmax in age≥ 80 years was decreased (12.0±2.6 vs.8.5±1.4,P＜0.05) compared with age group of 60-69 years.In contrast to BMI ≤ 24 kg/m2 group,IPSS score,PV and HOMA-IR were increased in BMI ≥ 28 kg/m2 (9.8±3.4 vs.18.8±4.1,P＜0.01; 41.1±10.8 vs.49.1±11.4,1.87±1.1 vs.3.89±2.0,P＜ 0.05).IPSS and PV were higher (12.6±5.7 vs.16.9±4.2,42.9±9.7 vs.48.3±10.6,P＜0.05),Qmax was lower (11.7±1.9 vs.9.0±1.6,P＜0.05) in patients with HbA1c ≥7％ versus HbA1c＜7％.Conclusions Age,obesity,high blood glucose and insulin resistance can promote the progress of BPH in the elderly newly diagnosed type 2 diabetic patients.Therefore,control of weight,and lowering the glycosylated hemoglobin may inhibit the progress of BPH.

Objective: To investigate the nursing effect of clinical treatment combined with early rehabilitation nursing intervention in patients with heart failure. Methods: A total of 60 cases of patients with heart failure from January 2018 to May 2018 in Beijing Anzhen Hosipital, Capital Medical University were admitted. They were divided into control group (30 cases) and observation group (30 cases) by random digits table method. All patients in 2 groups were treated with clinical treatment, while those in control group were treated with conventional nursing and observation group combined with early rehabilitation nursing intervention. Echocardiogram, 6 min walking test (6MWT), body composition analyzer (measuring extracellular moisture ratio) and body mass index (BMI) was used to evaluate the changes of all indexes before and after nursing care in 2 groups. Results: Using the receiver operating characteristic curve(ROC) of extracellular moisture ratio to predict heart failure, the area under the curve (AUC) of patients with heart failure was predicted to be 0.737(P<0.01). Analysis of the correlation between the decrease of extracellular moisture ratio after treatment and the increase of walking distance after 6 minutes of treatment showed a positive correlation. With the decrease of extracellular water ratio after treatment, the 6MWT distance increased continuously after treatment (r=0.164, P=0.032). In the observation group, the 6 minute walking distance, extracellular water ratio, the added value of BMI, added value of 6 minute walking distance after treatment, after treatment of extracellular water reducing ratio, and BMI lower values were (438.76±89.16) m, (0.380±0.021)%, (24.74±3.13) kg/m², (129.20±18.62) m, 0.010±0.006, (2.71±0.89) kg/m², respectively. The control group were (356.40±85.28) m, (0.384±0.014)%, (25.93±2.68) kg/m², (60.25±8.43) m, 0.009±0.008, (1.37±0.85) kg/m². The differences between the two groups were statistically significant (t=1.726-15.739, P<0.05). Conclusions The extracellular moisture ratio indicates the degree of heart failure. Clinical treatment combined with early rehabilitation nursing intervention is superior to conventional nursing in patients with heart failure, which can significantly increase the patient′s 6MWT and reduce the patient′s BMI, which is worth popularizing and applying.

Objective To investigate the role of survivin in osteosarcoma metastasis. Methods Small interfering RNA (siRNA) was used to knockdown the expression of survivin and α5 integrin in the human osteosarcoma cell line MG63. Western blotting and immunostaining methods were used to assessed the effect of survivin knockdown on the expression of α5 integrin through flow cytometry and fluorescence microscopy detection. Meanwhile, the invasion and migration of transfected cells in Transwell and wound healing assays were probed, and the growth situation of these cells transplanted into nude mice was monitored. Results Knockdown of survivin expression could inhibit the invasion and migration of osteosarcoma MG64 cells in vitro and the expression of α5 integrin on osteosarcoma MG64 cell surface, suggesting that survivin can inhibit the invasion and migration of osteosarcoma cells through downregulation of α5 integrin. Anti-α5 integrin antibody could also markedly decrease the capability of invasion and migration of osteosarcoma MG64 cells. Additionally, knockdown of survivin expression could slow the growth of osteosarcoma MG63 cells transplanted into nude mice. Conclusions Survivin-directed anti-tumor strategies might be an effective method in the treatment of osteosarcoma.

OBJECTIVETo study the transport of glutamine and glucose, expression of their transporters and tissue morphology in intestinal hypoperfusion.

METHODSSprague-Dawley rats were randomized to receive 60 min of intestinal hypoperfusion (superior mesenteric artery clamp) or serve as normoxic controls (celiotomy only). At the same time, jejunal loops were randomized to receive in situ perfusion of mannitol,glucose,or glutamine.Intestinal brush border membrane vesicles (BBMV) were prepared by calcium precipitation. Sodium-dependent uptake of glucose and glutamine into BBMV were quantitated by rapid mixing and filtration. Histologic examination and immunohistochemistry were performed by pathologists blinded to the groups.

RESULTSWhen compared with the control group, tissue lactate concentration of the hypoperfused group increased significantly (4.9+/-0.3 vs 3.1+/-0.2), especially in the glucose perfused groups (P<0.01). Transport and transporters of glucose in brush border, but not glutamine, decreased during hypoperfusion [(76+/-10) pmol d mg(-1) d 10 s(-1) vs (290+/-13)pmol d mg(-1) d 10 s(-1)]. Tissue structural damage was most severe in glucose perfused groups during hypoperfusion.

CONCLUSIONTransport and expression of transporters of glucose and glutamine in enteral nutrition are differently regulated under conditions of trauma and stress.

Animals ; Enteral Nutrition ; Glucose ; metabolism ; Glutamine ; metabolism ; Intestine, Small ; blood supply ; metabolism ; pathology ; Ischemia ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley

Chronic radiation enteritis(CRE) is a common complication after pelvic radiotherapy, which severely affects patients' quality of life. Surgical treatment of CRE is challenging both for surgical skills and perioperative treatment strategy. Proper preoperative nutrition support therapy can reduce the morbidity of postoperative complication and the use of stoma, while postoperative nutrition support therapy can avoid the intestinal failure. Enteral nutrition should be the primary route of perioperative nutrition support therapy in CRE as possible. Pharmaconutrients aiming at intestinal commensal microbiota and its metabolites may play a role in the management of radiation enteritis.
Humans ; Intestines ; physiopathology ; Nutritional Support ; Postoperative Complications ; Quality of Life ; Radiation Injuries ; therapy

OBJECTIVETo investigate the potential molecular mechanism underlying down-regulation of albumin expression induced by lipopolysaccharide (LPS) in rat hepatocytes.

METHODSThe albumin mRNA expression and albumin protein levels in the supernatant were observed at 0, 2, 8, 12 and 24 hours after 1 micro g/ml LPS treatment. The albumin mRNA expression was determined by RT-PCR, and albumin protein levels were assayed with EIA in the supernatant of hepatocytes pretreated with specific inhibitors of extracellular signal-regulated kinase (PD98059) and p38 kinase (SB203580).

RESULTSThe albumin mRNA expression was reduced to 70% of baseline value, meanwhile, the albumin protein concentration in the supernatant was reduced by 50% compared with the controls after 24 hours of LPS treatment. Pretreatment with PD98059 and SB203580 did significantly inhibit the reduction of albumin by LPS at the given dose.

CONCLUSIONThe results indicate that LPS can induce the reduction of albumin synthesis by down-regulation of albumin mRNA expression at transcription level, and the process may be related to the signal transducation of extracellular signal-regulated kinase and p38 kinase.

Albumins ; genetics ; metabolism ; Animals ; Calcium-Calmodulin-Dependent Protein Kinases ; antagonists & inhibitors ; Dose-Response Relationship, Drug ; Down-Regulation ; Enzyme Inhibitors ; pharmacology ; Enzyme-Linked Immunosorbent Assay ; Flavonoids ; pharmacology ; Hepatocytes ; drug effects ; metabolism ; Imidazoles ; pharmacology ; Lipopolysaccharides ; toxicity ; Male ; Mitogen-Activated Protein Kinases ; antagonists & inhibitors ; Pyridines ; pharmacology ; RNA, Messenger ; genetics ; metabolism ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors ; p38 Mitogen-Activated Protein Kinases

OBJECTIVETo investigate the significance, effects and precautions of enteral nutritional support in patients with short bowel syndrome (SBS).

METHODSClinical data of 40 SBS patients who were maintained on enteral nutrition (EN) for more than 2 years were retrospectively summarized. The cost of EN and parenteral nutrition (PN), the PN-free duration, and the current nutritional status of these patients were analyzed.

RESULTSThe mean length of the remnant small bowel was (50.8 +/- 29.4) cm. All the patients currently lived on high-carbohydrate low-fat diet supplemented with EN (3284.0 +/- 1408.8) kJ/d, the cost was significantly lower than that of PN (P < 0.01). Mean PN-free duration was (29.1 +/- 9.2) months for these patients. The current defecation frequency and volume were (3.4 +/- 1.7) times/d and (720.2 +/- 350.3) ml/d, respectively. As for the patients' nutritional index, mean BMI, blood hemoglobin and serum albumin level were (17.8 +/- 3.2) kg/m(2), (113.3 +/- 14.8) g/L and (35.0 +/- 4.1) g/L, respectively.

CONCLUSIONSEnteral nutrition is a cost-effective method for maintaining the nutritional status in patients with short bowel syndrome, but proper management in clinical practice to avoid diarrhea or other complications should be ensured.

Adolescent ; Adult ; Enteral Nutrition ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Parenteral Nutrition ; Retrospective Studies ; Short Bowel Syndrome ; therapy ; Treatment Outcome

Aseptic loosening, ascribes to particle induced osteolysis, is the most common reason for total joint arthroplasty failure. Wear particles, liberated from the surface of prostheses, mediate the expression of inflammatory cytokines in macrophages and increase the osteoclastogenesis. However, it remains unclear how macrophages can recognize wear particles and be induced by wear particles. Recently, a number of studies have demonstrated that Toll like receptors and inflammasome may play a critical role in osteolysis. However, the mechanism of activation of Toll like receptors and the relationship between TLR pathway and downstream signaling pathways still remain unclear. It will be beneficial to understand the pathogenesis of aseptic loosening by exploring these mechanisms. This article highlights the role of Toll like receptors and inflammasome in aseptic loosening, which is helpful to the development of therapies that prevent wear particle induced aseptic loosening.

Patients with rotator cuff tears often have repeated irregular neck and shoulder pain, and all of them are aggravated at night. The patient is very painful and cannot suffer from lateral position. Most of them cannot or do not do the exercises such as stretching the elbow and bending the arm, which seriously affect sleep. Numerous studies have shown that in addition to inflammation, the two-way interaction to the circadian clock, the circadian clock also regulated many aspects of the immune system. And the mechanism of night pain caused by rotator cuff injury was related to factors such as inflammation of the acromion sac. This suggests that the night pain of rotator cuff tears may have a circadian rhythm. This article mainly reviews the mechanism of night pain caused by rotator cuff tears.