ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1％ (81/269) ; more specifically,37.5％ (21/56) among geriatric patients ( ≥80 years) and 17.6％ (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3％ (103/269) ; more specifically,57.1％ (32/56) among the geriatric patients and 29.3％ (72/245) among the other age groups (P ＜0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3％,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.

Objective To explore the effects of L-carnitine on the plasma lipid profile and liver function in elderly patients receiving total parenteral nutrition after abdominal operations.Methods In this prospective blinded randomized controlled trial,24 eligible elderly patients were given 6-day total parenteral nutrition.They were further equally divided into L-carnitine group(administered with L-carnitine 50 mg/kg)and control group(without L-carnitine).The changes of lipid profile and liver function and the clinical outcomes were recorded and compared.Results The plasma triglyeride levels were lower in L-carnitine group than in control group on the 4th and 7th post-operative day,but there were not significant difference(P>0.05);There was a significant difference between the two groups in the change of the 4th post-operative day and pre-operative day(P<0.05).However,the liver function indicators were not significantly different between these two groups.Conclusion Administration of L-carnitine during total parenteral nutrition can improve the triglyeride metabolism in elderly patients after abdominal operations and may benefit the recovery of liver function.

AIM: To explore the therapeutic strategies of heat-clearing and detoxifying (HCDT) and Yin-invigorating and fluid-supplementing (YIFS), the method of Chinese medicine, on the high density lipoprotein (HDL) and alkaline phosphatase (ALP) molecules, which are associated with endotoxin-degradation. METHODS: The animal model of endotoxemia was established by the injection of E. Coli lipopolysaccharides through rabbits ear vein. The endotoxemic rabbits were treated respectively with two representative herbal preparations of therapeutic principles against febrile diseases: HCDT or YIFS preparations. The serum levels of interleukin-1 (IL-1), tumor necrosis factor ? (TNF-?) and HDL, the ALP activity, the expression of ALP mRNA in liver and kidney tissues were observed. RESULTS: The serum levels of IL-1 and TNF-? in HCDT group were significantly decreased, while the serum ALP activity and the expression of ALP mRNA in liver and kidney tissues were obviously increased, as compared with those in model group. Meanwhile, the serum levels of IL-1 and TNF-? in YIFS group were significantly reduced, and its plasma HDL level was elevated. CONCLUSIONS: Both the herbal preparations, HCDT and YIFS, have the scavenging effects on the overproduction of inflammatory cytokines such as IL-1 and TNF-? induced by endotoxin, but their effects on the endotoxin-degrading molecules might be different. HCDT principally increases ALP activity and enhances ALP expression in liver and kidney tissues, while YIFS might preferably facilitate the elevation of plasma HDL level.

Objective To evaluate the clinical significance of implanting an inferior vena cava filter to prevent pulmonary embolism.Methods Reviewed the causality of 180 cases,which was undertaken the ultrasound examination,patients were diagnosed as the deep vein thrombosis,male patients were 128 cases, female patients were 52 cases,median age was 65 years old,all received the transfemora] implantation of inferior vena cava filter implantation.Results All the operations were successfully conducted,filters were placed into inferior vena cava at 1-3 cm inferior of renal vein,without hematoma in the puncture position and thrombosis.One hundred and forty-nine cases (82.8%) were followed up at 1,6,12 months respectively, 55 cases(30.6%)were followed up more than 36 months, no filter drift,deformation and inferior vena perforation complications was observed.There was no fatal pulmonary embolism occurred for all the cases,the inferior vena unobstructed rate was 95.6%.Conclusion Vena cava filter is an effective and safe method which can prevent and cure pulmonary embolism.

Objective To evaluate the muscle mass in elderly patients with inguinal hernia using CT scan.Methods 30 male (age 70-90 years) hospitalized patients scheduled to receive surgery for inguinal hernia were selected into study group, 10 male health volunteers (40-50 years) were involved in adult control group, and 10 men of the same age as the study receiving annual physical examination were enrolled as elderly control group.General information were recorded;CT scanning of the stomach muscles and thigh muscles were conducted, and the muscle area was calculated using a special software.Results The index of grip strength in the study group was significantly lower than the adult control group [(36.44 ± 14.15) kg vs.(77.30 ± 22.69) kg, P =0.001], the calf circumference in the study group was significantly less than the adult control group [(25.18 ±2.31) cm vs.(27.62 ±2.33) cm, P =0.006].There was no significant difference in L3 abdominal area, subcutaneous fat area, abdominal fat area, and vertical spinal muscular volume between the study group and the adult control group;while the L3 abdominal muscle area and vertical spinal muscular mass was significantly less in the study group than in the adult control group [(12 094.23 ± 1 970.30) mm2 vs.(17462.00±1 600.58) mm2, P=0.001;(1 642.60±266.90) mm2 vs.(2 003.50±350.91) mm2,P =0.007].L3 skeletal muscle index of the study group was 50.64 ±7.52 and 66.7％ (20/30) of the study group had sarcopenia (≤52.4％).The CT findings of abdominal muscle of the study group were not significantly different from those of the elderly control group.The thigh muscle mass in the study group was significantly less than that in the control group (P =0.001), but there was no significant inter-group difference in thigh fat and femur areas (P ＞ 0.05).Conclusion The muscle mass and strength in elderly patients with inguinal hernia are significantly lower than those of adult controls, for which CT scan can be applied for assessment.

ObjectiveTo evaluate the hemostatic effect of human thrombin in surgery.Methods A prospective, randomized, controlled and multicenter study was designed to evaluate the hemostatic effect of human thrombin on abdominal operation incision (96 cases) and liver wound (40 cases). Human thrombin was insufflated topically in study group, with 0 9% NS as control. Results The average hemostatic time of abdominal incision in study group was (104?70) s, hemorrhagic volume per square unit was (0 4?0 3)g/cm 2, in liver wound the average hemostatic time was (106?78) s, the hemorrhagic volume per square unit was (1 0?0 7) g/cm 2, the difference was all statistically significant ( P

The data collected from 34 type 2 diabetic patients receiving intensive insulin therapy for six years showed that the yearly mean HbA1C was less than 7.0％,and none of the patients showed severe hypoglycemia,occurrence or evident progression of retinopathy or nephropathy,and the islet β cell function gained improvement.The DQOL score,used to evaluate the quality of patients' life had no significant change during the observation ( P ＞0.05 ).It is satisfactory and safe to maintain long-term glycemic control with prolonged intensive insulin therapy in patients with type 2 diabetes,and that such therapy does not induce untoward influence on the quality of diabetic patients life.

Objective To evaluate the effects of a carbohydrate-electrolyte solution on serum glucose, pancreas islet function and inflammatory response in elderly patients after abdominal operation.Methods It was a prospective, randomized, double-blinded and controlled trial. Totally 40 elderly patients after abdominal operation who met the defined criteria were enrolled. The subjects in study group were administered with 1000 ml carbohydrate-electrolyte solution intravenously in consecutive three days since 1st or 2nd postoperative day. Control group was administered with 1000 ml of 10% glucose on the same method. The changes of serum glucose, insulin, C-peptide and inflammatory response cytokine (IL-6, TNF-α, CRP) were detected before and after injection.Systemic inflammatory response syndrome (SIRS) was observed.Results All the 40 patients completed the study according to the study protocol. The incremental rate of serum glucose was significantly lower in study group than in control group on the 2nd and 3rd day after administration [(4.40±2.58) mmol/L vs. (14.97±3.44) mmol/L, t=2.984, P=0.008; (2.70± 1.55) mmol/L vs. (8.11± 2.60) mmol/L, t= 5.659, P= 0.000]. The changes of insulin and C-peptide of two group were similar before and after operation. The levels of IL-6 and TNF-α were significantly lower in study group than in control group on the 3rd day after administration[IL-6: (21.76±10.40) ng/Lvs. (50.17±35.24) ng/L, t=-2.447, P=0.034; TNF-α:(23.92±14.89) ng/L vs. (51.48±42.81) ng/L, t=-2.268, P=0.043]. In study group, 6 cases experienced SIRS and 4 cases had infective complications, but in control group the numbers were 8 and 6 respectively.Conclusions Appropriate application of carbohydrate-electrolyte solution intravenously has relatively mild effects on serum glucose and inflammatory response cytokine in elderly patients after abdominal operation, it decreases incidence of SIRS and maybe decrease infective complications.

BACKGROUND:Several reports have demonstrated that metabolic disorders and physiopathologic changes accompany with urinary diversion.But these metabolic disorders caused by bladder reconstruction using intestinal tract are related to type and length of intestinal canal.OBJECTIVE:To investigate the histological change of reservoir mucosa and to assess effects on metabolic state in patients with a Roux-y sigmoid neobladder.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Urinary Surgery,the 184 Hospital of Chinese PLA between June 2000 and November 2008.PARTICIPANTS:The experimental group comprised 33 bladder carcinoma patients,21 males and 12 females,averaging 64 years of age.The control group consisted of 25 subjects who had no sigmoid colon diseases confirmed by gastroenterological endoscopy.METHODS:Patients with bladder carcinoma received radical cystectomy and bladder reconstruction using Roux-y sigmoid neobladder which controlled urination with anal sphincter.Prior to and after neobladder drainage tube removal,serum levels of electrolyte,creatinine,and urea nitrogen were detected.Before and 36 months after surgery,reservoir mucosa from 13 patients with bladder carcinoma was pathologically examined.For the control group,the thickness of sigmoid colon mucosa and the numbers of intestinal glands were determined.MAIN OUTCOME MEASURES:Electrolyte,renal function,acid-base balance,mucosal layer thickness,numbers of intestinal glands prior to and after surgery,as well as prior to and after drainage tube extraction.RESULTS:After surgery,electrolyte,creatinine,and urea nitrogen were all normal in 30 patients.There was no significant difference in serum electrolyte,creatinine,and urea nitrogen between prior to and after surgery.Mild acid poisoning was found in 3 patients.Microscopic observation results revealed that sigmoid colon mucosa in the control group did not change significantly after surgery,and it basically kept the normal tissue structure;in the experimental group,sigmoid colon mucosa that was(577.6±169.4)μm prior to surgery was thinned(412.5±114.7)μm(P＜0.05),intestinal glands were loosely arranged,interstitial substance became less,and the number of intestinal glands per high-fold visual field that was(26.4±3.5)/high-fold visual field prior to surgery was decreased(15.2±2.7)/high-fold visual field(P＜0.05),after surgery.In addition,intestinal villus in the neobladder was gradually atrophied,and no enterocyte proliferation and malignant changes were found after surgery.CONCLUSION:After Roux-y sigmoid neobladder application,colon mucosa was gradually thinned,intestinal glands were loosely arranged,interstitial substance became less,the number of glands per high-fold visual field was decreased,and body metabolism produced no changes.

Objective To analyze the current status and influencing factors of occupational burnout among medical staff in Dongguan City. Methods A total of 1 007 medical staff from eight hospitals in Dongguan City were selected as the study subjects using the stratified sampling method. The Maslach Burnout Inventory-Human Service Survey and Moral Injury Symptom Scale (Healthcare Professionals Edition) were used to assess occupational burnout and moral injury among these study subjects. Binary logistic regression analysis was conducted to identify the influencing factors of occupational burnout. Results The detection rate of occupational burnout among the medical staff was 46.2%, and the detection rate of moral injury was 48.1%. The result of binary logistic regression analysis showed that after controlling for confounding factors such as age, marriage status, educational level, religious belief, professional title, and hospital characteristics, male medical staff had a higher risk of occupational burnout than female staff (P<0.01). Medical staff with ≤10 years of work experience had a higher risk of occupational burnout than those with >10 years of work experience(P<0.01). Additionally, medical staff with moral injury had a higher risk of occupational burnout than those without moral injury (P<0.01). Conclusion Occupational burnout is relatively common among medical staff in Dongguan City and is influenced by factors such as gender, working years, moral injury, and others.