Patients undergoing hepatobiliary surgery are very vulnerable to malnutrition while surgeons' knowledge on evidence-based guidelines in surgical nutrition remains poor. Efforts are therefore necessary to implement routine nutritional screening and nutritional support. Rea sonable measures in perioperative nutritional intervention ameliorate pre- and postoperative status of the patient and reduce surgical complications through regulation of immunity,adjustment of glucose concentration and maintenance of tissue and organ functions. Modern surgical achievements using fast- track surgery and minimally invasive surgery provide the opportunity to focus on early intestinal feeding to hepatobiliary surgery patients in the postoperative period.Perioperative nutrition support not only provides nutritional substrates but also modifies the composition of nutritional regimen by adding supernormal doses of specific substrates to improve surgical outcomes. As a consequence,the term “nutrition therapy” instead of “nutrition support” is more acceptable in this era of immunonutrition.

This paper reviews briefly the roles of these two ri sk factors in influenza epidemic, and the progress of the research on serologica l and molecular epidemiology of the influenza viruses antigenic mut ation.

OBJECTIVETo observe the life quality improvement of spastic hemiplegia of stroke treated with fire-needle.

METHODSSixty patients were randomly divided into a fire-needle group and a rehabilitation group, 30 cases in each one. In the two groups, the conventional treatment of neurology and rehabilitation strengthening limbs function were applied. In the fire-needle group, fire-needle was used at Jianyu (LI 15), Binao (LI 14), Quchi (LI 11), Yanglingquan (GB 34), Xuehai (SP 10) and Sanyinjiao (SP 6), etc. , once two days and continuously for 30 days (15 times). In the rehabilitation group, conventional rehabilitation exercises were given five times a week for 4 weeks (20 times). Before treatment, at the end of treating program and one month later after treatment, spasticity of upper and lower limbs was assessed by Ashworth scale and clinic spasticity index (CSI); limbs function was evaluated by Fugl-Meyer (FM) scale; life quality was estimated by patient-reported outcome (PRO). Clinical effects were compared between the two groups.

RESULTS(1) At the end of treating and one month later after treatment, the Ashworth scales were better than those before treatment in the two groups (P < 0.05, P < 0.01), and the scales of the fire-needle group were superior to those at the same time of the rehabilitation group (both P < 0.05). (2) At the end of treating and one month later after treatment, the CSIs were better than those be fore treatment in the fire-needle group (both P < 0.01), but not changed apparently in the rehabilitation group (both P > 0.05). And the indices of the fire-needle group were superior to those at the same time of the rehabilitation group (P < 0.05, P < 0.01). (3) The FM scales of upper and lower limbs at the end of treating and one month later after treatment were better than those before treatment in the two groups (all P 0.01), except the lower limbs at the end of treating in the rehabilitation group (P > 0.05). The FM scales of the fire-needle group were superior to those at the same time of the rehabilitation group (P < 0.05, P < 0.01). (4) At the end of treating and one month later after treatment, the PRO scales were better than those before treatment in the two groups (all P < 0.01), and the scales of the fire-needle group were superior to those at the same time of the rehabilitation group (P < 0.05, P < 0.01).

CONCLUSIONFire-needle can effectively relieve spastic hemiplegia of stroke, and improve limbs motor function and life quality. It is better than rehabilitation.

Acupuncture Therapy ; instrumentation ; methods ; Adult ; Aged ; Female ; Hemiplegia ; Humans ; Lower Extremity ; physiopathology ; Male ; Middle Aged ; Muscle Spasticity ; etiology ; physiopathology ; therapy ; Needles ; Quality of Life ; Stroke ; complications ; therapy ; Treatment Outcome ; Upper Extremity ; physiopathology

Objective The purpose of this report is to improve the recovery rate of diseases by integrating the advantages of mature treatment programs,with the method of diseases heterogeneity research.Methods Two programs (each program consist of effective group and invalid group) were took into investigation to study the characteristics of heterogeneity.If it showed that heterogeneous differences exist between the two effective groups,then we would treat the patients in different ways.Results The total effective rate of heterogeneous treatment was better than that of current optimal treatments.Conclusion Heterogeneous treatment could be applied to all diseases,either to TCM or to western medicine diseases.If the heterogeneous treatment can be popularized,it would improve the recovery rate of diseases surely.

Research of diseases' heterogeneity is a study method,which is based on the current ideas of single-program of clinical research,by means of searching the heterogeneous feature that corresponding to therapeutic schedule,optimizing and integrating the mature treatment programs,and aiming to improve diseases' recovery rate.Its characteristic is that it can integrate the advantages of current mature treatment programs,and make optimal effect.In this paper,we put forward the background,methods and ideas in the research of diseases' heterogeneity.

Septic shock induced by gram negative bacteria is the leading cause of inpatient mortality. Now there are two ways in endotoxin induced cellular response: the indirect way of cytokines and the direct way. The article reviewed mechanisms of the direct intracellular way induced by endotoxin.Paid special attentions to the development of transmembrane, intracellular and intranuclear signalling and looked ahead the application in clinic.

Objective: To investigate the effect and mechanism of liraglutide on vasodilatation of thoracic aortic ring in experimental rats.
Methods: The thoracic aortic rings were isolated from 32 male SD rats and divided into 2 groups: Without endothelium group and With intact endothelium group, n=16 in each group. The contractile force of vascular ring was detected and the effect of liraglutide (1×10-5 mol/L) on vasodilatation of norepinephrine (NE, 1×10-6 mol/L) pre-contracted ring was observed. The aortic ring in With intact endothelium group was further divided into 2 sub-groups:①the aortic ring was pre-treated by the inhibitor of nitric oxide synthase (NOS) (L-NAME at 10-4 mol/L),② the aortic ring was pre-treated by non-specific ATP-sensitive-potassium (KATP) channel (Glibenclamide at 10-5 mol/L), n=8 in each group. The impacts of liraglutide on those 2 sub-groups were studied.
Results: Liraglutide had no effect on isolated aortic ring at basic condition. Liraglutide at (10-5 mol/L) had vasodilatation effect in both Without endothelium and With intact endothelium groups, the effect was stronger in With intact endothelium group and the maximum vasodilatation reached 17%, P<0.05. In both pre-treated sub-groups, the effect of liraglutide on vasodilatation in sub-group①reached 4%, P<0.05, and the effect in sub-group②
reached 14%, P>0.05.
Conclusion: Liraglutide had obvious effect of vasodilatation on NE pre-contracted thoracic aortic ring in experimental rats, the mechanism might be related to NOS, while KATP channel could not block the vasodilatation effect of liraglutide.

There are two treatments of A and B for disease X,if B replaced A,some patients that effective originally may become invalid.That is,the new drugs can increase the efficiency but may keep the effective patients out of the crowd at the same time.In this paper,we put forward the method of cake segmentation based on the principle of diseases' heterogeneity,optimize and make up the effective programs at present.The treatment based on diseases' heterogeneity will replace the best medicines currently,and format new treatments.

Syndrome differentiation of prescription is a more practical,simple and effective method which is distinguished from syndrome differentiation with eight principals,syndrome differentiation of viscera and syndrome differentiation of Wei Qi Ying Xue.However,after the ages of classical prescriptions,most of the current prescriptions,even ones from many experienced herb doctors' experiences,were seldom to summarize the syndrome corresponding to the prescription so precisely and to obtain reliable effect like the classical prescriptions.In this paper,by the research of diseases heterogeneity,we hope to excavate the syndrome which can correspond to the prescriptions of Chinese herbs and to set up a lot of prescriptions that can combine prescription and syndrome perfectly just like the classical ones in order to guide clinical treatment more conveniently and effectively.

Objective To analyze the clinical characteristics of adult intussusception and improve its diagnostic and treatment levels.Methods Data of 80 cases of adult intussusception treated in the First Affiliated Hospital of China Mdeical Unuversity between January 2001 and December 2015 were reviewed retrospectively.Results 95％ patients had abdominal pain,34％ had bloody stool and 24％ had abdominal mass,8％ presented a triad of abdominal pain,bloody stool and abdominal mass.As confirmed by laparotomy 48％ were enteric intussusception,40％ were ileocolic intussusception,and 12％ colocolonic intussusception.The diagnosis rate of abdominal uhrasonography was 60％;CT established the diagnosis in 97％ cases.74％ underwent malignant or benign tumor resection,10％ underwent intestinal resection for inflammatory bowel disease.10％ were cured by simple reduction.4 cases received intussusception reduction and appendectomy.Conclusions Tumors were causes of adult intussusception in most case.CT is most accurate in diagnosis.Laparoscopy can be used for difficult diagnosis.