Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma.Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed.All the 48 patients underwent radical resection for hilar cholangiocarcinoma,including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group).The serologic indices and liver function were detected regularly after operation.Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb ＜ 30 g/L.The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7,including the serologic indices and liver function,the exhaust time,the volume of Alb infusion,the complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and the duration of hospital stay.The patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as x ± s,comparison between groups and count data were analyzed using the t test and chi-squared test,respectively.Results Patients in the 2 groups were cured successfully and discharged,and no patient died perioperatively.Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected.The level of the GGT was (108 ± 73) U/L in the EEN group,which was significantly lower than (225 ± 121) U/L in the TPN group at postoperative day 3 (t =4.041,P ＜ 0.05).The level of the GGT was (142 ± 86) U/L in the EEN group,which was no significantly different from (183 ± 107)U/L in the TPN group at postoperative day 7 (t =1.477,P ＞ 0.05).The postoperative time to anal exsufflation and the duration of hospital stay were (73 ± 18) hours and (15 ± 4) days in the EEN group,which were significantly different from (97 ± 21) hours and (18 ± 4) days in the TPN group,and the volume of Alb infusion was (44 ± 29)g in the EEN group,which was significantly lower than (101 ± 92) g in the TPN group (t =4.295,2.615,2.916,P ＜ 0.05).All the 48 patients were followed up for 1 to 71 months (mediantime,10 months),no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective,it could accelerate the recovery of enteral function,shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb,which is helpful for the fast recovery of patients.

AIM: To observe the inhibitory effect of recombinant human endostatin (rhES) on plaque angio-genesis, and to explore the regulatory mechanism of Dll4 /Notch pathway in the anti-angiogenic effect of rhES.METH-ODS: Male Wistar rats were randomized into 3 groups: normal control group (N group), atherosclerotic model group (AS group), and rhES treated group (AS +rhES group).The rats in N group were fed a normal diet, while the remaining 2 groups were established to atherosclerotic rat model via high-cholesterol diet, intraperitoneal injection of vitamin D3 and aor-tic balloon injury.The rats in AS +rhES group received intraperitoneal injection of rhES.The blood total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), interleukin-1 (IL-1) and troponin I (TnI) were measured.The atherosclerotic abdominal aortas were taken for pathological observation.Immu-nohistochemical staining was used to measure the density of neovessels in the plaques, which were marked by CD31.The protein levels of Dll4 and Notch1 in the aortas were analyzed by Western blot.RESULTS: The levels of blood TC, TG, LDL-C, CRP and IL-1 in AS group and AS +rhES group were much higher than those in N group (P <0.05), and no sta-tistical difference between AS group and AS +rhES group was observed.The expression of CD31 in AS group was the high-est among all groups.Compared with AS group, the density of neovessels in the plaques of AS +rhES group decreased sig-nificantly (P <0.05).The protein expression of Dll4 and Notch1 in AS group was lower than that in N group (P <0.05). Compared with AS group, the protein expression of Dll4 and Notch1 increased significantly (P <0.05).CONCLUSION:rhES has the ability to inhibit plaque angiogenesis in rats.The activation of Dll4 /Notch pathway may be the mechanism of rhES in inhibiting plaque angiogenesis.

OBJECTIVETo find an effective operative procedure against reflux after esophagogastric anastomosis with mucosal valve.

METHODSFour hundred and sixty-four patients with esophageal or cardiac cancer were randomly divided into three groups according to anastomosis modes. Group A underwent esophagogastric anastomosis with mucosal valve (175 cases), group B with mechanical stapler (151 cases) and group C one layer anastomosis with handcraft suture (138 cases). The gastroesophageal reflux index (GERI) was examined by isotope,and 24 h esophageal pH was also monitored. The esophageal motor function was compared among three groups.

RESULTSThe reflux rates were 0, 33.3%, and 6.7% in group A, B, C respectively. The esophageal motor function and the 24 h esophageal pH monitoring indicated that the various indexes were approaching to the normal level in group A, but the various indexes in group B and C were significantly different from the normal values (P< 0.05).

CONCLUSIONThe esophagogastric anastomosis with mucosal valve has better antireflux effect and can prevent the reflux esophagitis after esophageal or cardiac cancer eradication.

Adult ; Aged ; Anastomosis, Surgical ; methods ; Esophageal Neoplasms ; therapy ; Esophagus ; surgery ; Female ; Gastroesophageal Reflux ; prevention & control ; Heart Neoplasms ; therapy ; Humans ; Male ; Middle Aged ; Mucous Membrane ; surgery ; Stomach ; surgery

OBJECTIVETo investigate the relationship between eye injury and laser in-situ keratomileusis (LASIK) surgery in military personnel.

METHODSThis retrospective study collected the data from 27 evacuation hospitals of Chinese army. All medical records of eye injuries in military personnel admitted to the 27 hospitals between January 2006 and December 2010 were reviewed. Patients'detailed information was analyzed, including the injury time, place, type, cause, as well as examination, treatment and outcome.

RESULTSThere were 72 eye-injured patients who had been treated by LASIK before. The incidence was rising year by year. Among them, 69 patients were diagnosed with mechanical ocular injury and 3 with non-mechanical ocular injury; 29 patients had traumatic flap-related complications and 21 patients need surgery. There was statistical difference when compared with those having no refractive surgery history. Visual acuity recovered well at discharge.

CONCLUSIONThere is a high risk of potential traumatic flap problems after LASIK and it is not recommended in army service.

Humans ; Keratomileusis, Laser In Situ ; Military Personnel ; Myopia ; Retrospective Studies ; Surgical Flaps ; Visual Acuity

OBJECTIVETo investigate the epidemiological characteristics of eye injuries sustained by military personnel in Chinese army.

METHODSEleven military evacuation hospitals located in different regions were selected for this study. We reviewed all the medical records of eye injuries sustained by military personnel between January 2005 and December 2009. Patients'information was collected. All data were put into database and analyzed statistically.

RESULTSTotally there were 415 inpatients with eye injuries (442 eyes) and their mean age was 24.40 years. Eye injury accounts for 13.51% of all eye diseases in this study. From 2006 to 2009, the number of eye injury increased gradually. Among them, 175 (42.17%) were injured in leisure time, and 145 (34.94%) in working time. Twenty-two (5.30%) patients had an eye surgery or history of eye disease before injury. In all, 246 patients (59.28%) were sent to evacuation hospital within 24 hours and 64 (56.64%) underwent surgeries in 24 hours after injury. There were 389 patients (93.73%) hospitalized for 1 time. Visual acuities of 187 eyes (42.31%) were grade 1 (larger than or equal to 20/40) after injury. When discharge, 349 eyes (78.96%) obtained a visual acuity of grade 1.

CONCLUSIONEye injury has a very frequent incidence in Chinese army and much more attention should be paid to prevent it.

China ; epidemiology ; Eye Injuries ; epidemiology ; Humans ; Incidence ; Military Personnel ; Visual Acuity

OBJECTIVEConsidering the difficulty in classifying some cases with eye trauma by Birmingham Eye Trauma Terminology (BETT) in our epidemiological study, we introduce a new classification for epidemiological study of mechanical eye injuries based on BETT.

METHODSA retrospective investigation was carried out in 31 hospitals from January 2005 to December 2010. All medical records of inpatients with eye injuries were reviewed. A total of 10 718 patients (11 227 eyes) were diagnosed as mechanical eye injuries. All mechanical eye injuries were tried to be classified using BETT. While some eye injuries were difficult to categorize. We recorded the injury type and case number. A new classification based on BETT was also used for the same project.

RESULTSOf 10 718 patients (11 227 eyes) with mechanical eye injuries, the following cases cannot be classified by BETT: 1 488 patients (1 559 eyes) with merely orbital or ocular adnexa injury, 1 961 (2 054) globe injuries associated with orbital or ocular adnexa injury, 271 (284) ocular surface foreign body (OSFB) or ocular wall foreign body (OWFB), 77 (89) contusion, 9 (11) lamellar laceration associated with OSFB or OWFB, 29 (30) rupture associated with OSFB, OWFB or intraocular foreign body and 60 (62) lace- ration associated with OSFB or OWFB. While according to our new classification, all eye injuries can be categorized without any difficulty.

CONCLUSIONDifficulty in classifying some eye injuries in epidemiological study by BETT brings some trouble to our study, which can be solved by our new eye injury classification to some extent. It is hoped that other ophthalmologists present better ones to make the classification more perfect.

Adolescent ; Eye Injuries ; classification ; epidemiology ; Humans ; Retrospective Studies ; Young Adult

Objective We aimed to assess the association between urinary bisphenol A(BPA)concentrations and gestational age in pregnant women. Methods A total of 248 pregnant women were recruited from a maternal and child care hospital in Shanghai. A questionnaire survey was completed to collect socio-demographic information and spot urine samples were collected during pregnancy. Gas chromatography-tandem mass spectrometry(GC-MS/MS)was used to measure BPA concentrations in urine samples. Linear relationship between urinary BPA level and gestational age was assessed by using generalized additive models. Multivariate regression model was used to evaluate associations of prenatal BPA exposure with gestational age. Results BPA was detected in all the urine samples. Median value and geometric mean of urinary BPA levels were 0.85 μg/L and 1.21 μg/L, respectively. Linear relationship between urinary BPA concentration and gestational weeks was confirmed(non-linear P > 0.05). Positive association between urinary BPA level and gestational age was indicated(regression coefficient, β = 0.19;95%CI:0.04-0.35;P = 0.016). However, it was only observed in girls, stratified by sex of newborns(β = 0.18;95%CI:0.03-0.34;P = 0.020). After stratification by trimester, no significant association was found in the second or the third trimesters. Conclusion Pregnant women are extensively exposed to BPA. Urinary BPA exposure during pregnancy may extend gestational age, especially in girls.

Immune mediated suppression of hematopoiesis has been considered as one of the most important mechanisms leading to pancytopenia in myelodysplastic syndromes. This research was aimed at evaluating immune state of the MDS patients, analyzing the peripheral blood T cell subsets and CD3zeta chain expression and searching the possible reasons of hematopoietic disorders in 11 cases of MDS. Peripheral blood mononuclear cells were collected from 11 patients whose diagnosis was confirmed according to the new WHO diagnostic criteria. Flow cytometry was used for the counts of IFNgamma(+)CD4(+) cell (Th1), IL4(+)CD4(+) cell (Th2), IFNgamma(+)CD8(+) cell (Tc1), and IL4(+)CD8(+) cell (Tc2), and for the analysis of expression of CD3zeta chain in T cell subsets. The results showed that CD8(+) cells increased significantly in MDS patients; there was no significant difference between Th1/Th2, Tc1/Tc2 ratios of T cell subsets and normal control; CD3zeta chain, the functional protein in the signal transduction pathway of T cell, was over expressed in the CD8(+) cell. In conclusion, research indicates that abnormal changes of T cell subgroups exist in peripheral blood of MDS patients. Enhancement of CD8(+) cells and over-expression of CD3zeta chain are important features, which suggest that CD8(+) cells play the most critical role in the pathologic process as compared with other T cell subsets. The over active immunity mediated by T cell subset may be one of the major mechanisms resulting in cytopenia in MDS.
Aged ; Aged, 80 and over ; CD3 Complex ; biosynthesis ; CD8-Positive T-Lymphocytes ; immunology ; metabolism ; pathology ; Female ; Flow Cytometry ; Humans ; Lymphocyte Count ; Male ; Myelodysplastic Syndromes ; immunology ; metabolism ; pathology ; T-Lymphocyte Subsets ; immunology ; metabolism ; pathology

OBJECTIVETo explore the suitable temperature index to establish temperature-mortality model.

METHODSThe mortality and meteorological information of Guangzhou between year 2006 and 2010 were collected to explore the association between sendible temperature, heat index and deaths by adopting distributed lag non-linear model to fit the daily maximum, mean and minimum temperature with and without humidity. Q-Q plots based on the standardized residuals of each model were used to qualitatively access the goodness of fitting. The minimum Akaike information criterion (AIC) and residual sum of squares (RSS) value were used to explore the most suitable temperature index for model establishment, and to further analyze the fittest temperature index for different diseases, ages and cold and hot effect.

RESULTSGuangzhou features a subtropical monsoon climate, with an annual average temperature at 22.9°C and daily average relative humidity of 71%. The standardized residuals of all models followed normal distribution. For all death, death from circulation system diseases, the 65-84 years old aging groups and cold effect models, the daily average temperature fit better, whose AIC (RSS) values were the smallest as 11 537 (1897), 9527 (1928), 10 595 (2018) and 11 523 (1899), respectively. However, for death from respiratory system disease, groups aging under 65 years old or over 85 years old and hot effect models, the daily average sendible temperature fit better, whose AIC (RSS) values were the smallest as 8265(1854), 675 (1739), 8550 (1871) and 11 687 (1938), respectively. In comparison with the model controlling both temperature and relative humidity, different diseases, aging groups and cold and hot effect models fitted by sendible temperature index showed smaller AIC (RSS) values. The relative risk (RR) value of the cold effect lagging 0 - 3 days fitting by daily maximal temperature was < 1, and the RR value of it fitting by daily minimum temperature was > 1.04. The RR value of the hot effect lagging 0 - 1 days fitting by daily maximal temperature was < 1.16, and the RR values of it fitting by daily minimum temperature and daily average temperature were > 1.16.

CONCLUSIONThere were no best temperature indicators for different diseases, ages and cold and hot effect. The model using sendible temperature index better fit the model including relative humidity as a covariable.

Aged ; Aged, 80 and over ; Climate ; Humans ; Mortality ; Nonlinear Dynamics ; Risk Factors ; Temperature

China ; epidemiology ; Female ; Gastrointestinal Neoplasms ; mortality ; Humans ; Male