Objective To compare the effect of parenteral nutrition and enteral nutrition with different start time on acute pancreatitic patients.Methods Randomized controlled trials comparing enteral and parenteral nutrition in acute pancreatitic patients published from January 1996 to January 2011 were searched in MEDLINE,EMBASE,Cochrane databases,Wanfang science library,and China National Knowledge Infrastructure.The information about study design,patient characteristics,and outcomes were extracted by two independent analysers before processed with RevMan 4.2 software.Results Altogether 14 trials were included.When started after 24 hours of admission,enteral nutrition,in comparison with total parenteral nutrition,resulted in a statistically significant reduction in the risks of infections (P =0.0004),surgical intervention (P =0.0200),organ failure (P =0.0400),and morality (P =0.0002) in acute pancreatitic patient.When started within 48 hours of admission,enteral nutrition,in comparison with total parenteral nutrition,resulted in a statistically significant reduction in the risks of infections (P =0.0000),surgical intervention (P =0.0001),organ failure (P =0.0006),and mortality (P =0.0300) in acute pancreatitic patients.Conclusions The time of the commencement of nutriton has an influence on the benefits of enteral nutrition.Enteral nutrition started between 24 hours and 48 hours of admission is more effective than within 24 hours or after 48 hours of admission.

OBJECTIVE To investigate the major pathogenic bacteria and drug resistance in the infantile septicemia and to provide laboratory evidence for clinical diagnosis and treatment. METHODS The venous blood plate was used. RESULTS Totally 328 isolated strains were assayed with French Bio-Merieux API System.Of them,203 strains of coagulase negative Staphylococcus(CNS),being 61.9%.115 strains(56.6%) were(S.epidermidis).45 strains(22.1%) were S.haemolyticus,and 43 strains(21.1%) were S.lugdunensis.The isolated rate of meticillin resistant coagulase negative Staphylococcus(MRCNS) was 35.5%.The drug test for MRCNS showed multiple drug-resistance. CONCLUSIONS MRCNS is the major pathogen in infantile septicemia.The detectable rate of MRCNS is high.Glycopeptide antibiotics are the first-choice drugs for MRCNS infection.

Objective: To evaluate the feasibility, technical characters and benefits of laparoscopic cholecystectomy (LC) in patients with cirrhotic portal hypertension(CPH). Methods:40 CPH patients, including 21 Child A class,26 Child B class and 3 Child C class were included. Data of the patients were collected and analyzed. Results: LC was successfully performed in 37 cases, and 3 patients were converted to open cholecystectomy (OC)for uncontrollled bleeding under laparoscopy and dense adhesion of Calot’s triangle. The convertion rate was 7.5%. The time of operation was (52.6? 15.2)min. The intraoperative blood loss was (75.5? 15.5)ml. The time to resume diet was (18.3?6.5)h. Seven postoperative complications occurred in 5 patients (13.2%). All patients discharged from hospital in (4.6?2.4) d after LC. Compared with LC in non cirrhotic patients, LC in patients with CPH has longer surgical time and hospital stay after operation, higher convertion rate and postoperative complication rate, more intraoperative blood loss. Conclusion: LC in patients with CPH has the advantages of minimal invasive surgery. It is feasible and relatively safe. But it has a higher convertion rate. Intraoperative blood loss is a prominent problem. The key step for a successful operation is to pay more attention to the perioperation managements and acquaint with the technical characters of this operation.

BACKGROUND: The different level of proteins regulating cell cycle and theircorrelation is the main criteria to differentiate the benign and malignant cellular proliferation.OBJECTIVE: To investigate the expression status of p21waf1 and p53 in lung cancer as well as proliferating cell nuclear antigen (PCNA)DESIGN:A case-control study.SETTING: Department of Respiratory Medicine, Renmin Hospital ,Wuhan UniversityPAITICIPANTS:This case-control study involved 135 patients who underwent lobectomy or fiberoptic bronchoscopy for primary lung cancer or benign chronic pulmonary diseases at Renmin Hospital of Wuhan University from October 1996 through May 1999. They were divided into two groups: lung cancer group (76 patients, including 56 men and 20 women,aged 18-74 years of age) and chronic pulmonary diseases group (59 cases,including 42 men and 17 women, aged 16-70 years of age).METHODS: Phosphate buffer solution replaced the first antibody as the negative control. Immunohistochemistry was performed using a modified streptavidin-biotinylated peroxidase technique according to the manufacturer's recommendations (Maxim Corporation). For p21waf1 staining, we used hydrated autoclaving as a pretreatment. Antigen retrieval was performed in a standard microwave unit for p53 staining. PCNA staining did not need The ratio of the positive cells indicated by yellowish brown nucleus due to staining was counted for 5 successive high-fold microscopic fields: when it was≥ 10%, it was taken as positive; when it was ＜10%, it was regarded as high-fold microscopic fields for the percentage of the positive cells indicated by yellowish brown nucleus due to staining in each field, and the average value of the five fields was taken as labeling index (LI) for proliferated nuclear antigens.MAIN OUTCOME MEASURES: The expression leyels of p21waf1, p53and PCNA in lung cancer.cancer were 75% (57/76) and 47%(36/76) respectively. The labeling index of PCNA in lung cancer group was significantly higher than that of the chronic pulmonary diseases group (0.44±0.32 vs 0.09±0.14, respectively).significantly higher than that of small cell lung cancer (0.51 ±0.33 vs in lung cancer tissues. In chronic pulmonary diseases group, the expression of p21waf1 and p53 showed a close relationship with PCNA.CONCLUSION: It was found that p21waf1 and p53 were obviously upregulated in lung cancer and the degree of cellular proliferation in lung cancer was rather high. The capacity of DNA damage repair in squamous lung cancer may be stronger than that in small cell lung cancer.

BACKGROUND: Therapist-assisted treadmill training is good gait training, but it consumes great physical strength of therapists, and requires many persons. Clinical application was limited. Robot-assisted treadmill training has been paid great attention. OBJECTIVE: To summarize the role of robot in recovery of walking after spinal cord injury (SCI) and its influence on muscle activation patterns and kinematic patterns.RESULTS AND CONCLUSION: Although there is currently no evidence that robot-assisted gait training improves walking function more than other locomotor training strategies. Several advantages of robotic devices are obvious for applications targeting gait rehabilitation. Robotic devices are passive in nature and focus primarily on repeated movements of the limbs via fixed kinematic trajectories. These types of training abolish the cycle-to-cycle variation in the kinematics and the sensorimotor pathways. They also cannot sensitively monitor important characteristics of the training as therapists do. Therapists need to know the robot devices, understand how to change parameters to continuously challenge the subjects, and are able to assess when the workload is inappropriate for the subject's abilities so that they can maximize voluntary locomotor performance during assisted stepping to augment the recovery of functional walking.

Objective To investigate the effect of robot-assisted walking therapy on gait of patients with incomplete spinal cord injury.Methods 10 patients with incomplete spinal cord injury accepted robot-assisted walking therapy with Lokomat for 12 weeks. The Lower Extremity Motor Scores (LEMS), step lenth (left and right), double support (left and right), single support (left and right), Symmetry Index (SI), overground gait speed, treadmill training speed, treadmill training distance and the amount of body-weight unload were recorded before,6 weeks and 12 weeks after training. Results All the patients finished the training. There was significant difference in all the indices among those were before, 6 weeks and 12 weeks after training (P<0.001). Conclusion Robot-assisted walking therapy with Lokomat facilitates to improve gait in patients with incomplete spinal cord injury.

Objective To track the effects of hyperbaric oxygen (HBO) therapy on neonatal rats with hypoxic-ischernic brain damage (HIBD).MethodsA total of 126 healthy,seven-day-old SD rats were used to model the HIBD and then randomly divided into seven groups of 18:a sham group,a hypoxic-ischemic (HI) group,a 6 h HBO group,a 24 h HBO group,a 48 h HBO group,a 72 h HBO group and a 1 week HBO group.One hour of HBO treatment at 2 atmospheres absolute pressure was administered once daily for a week to the rats in the latter 5groups,starting at 6,24,48,72 hours and 1 week post the HIBD modeling,while no HBO was administered to the sham and HI groups.The effects were assessed in terms of histological changes ( the neuron density and the percentage of neuron apoptosis in the CA1 region of the hippocampus) and nitric oxide (NO),malondialdehyde (MDA) and superoxygen dismustase (SOD) concentrations after 15 days.ResultsIn the 6 h HBO,24 h HBO,48 h HBO and 72 h HBO groups,average neuron density in the CA1 region was significantly higher than in the HI group.But in the 1 week HBO group the average density was not significantly different than in the HI group.In the 6 h HBO,24 h HBO,48 h HBO and 72 h HBO groups the average percentage of neuron cell apoptosis in the CA1 area of the hippocampus was significantly lower than in the HI group,but the 1 week HBO group again showed no significant difference.There were significant differences in average NO,MDA or SOD levels among the 6 h HBO,24 h HBO,48 h HBO,72 h HBO and HI groups,but the 1 week HBO group showed no significantly higher average levels than the HI group.ConclusionsThe optimal therapeutic window for using HBO to protect against HIBD is within the first week.The best effect can be obtained in the first 6 hours,but after 1 week HBO no longer has a significant effect.The earlier the HBO is administered,the better the effect obtained.

Objective: To explore the reasonable compatibility of anesthetics in painless small intestinal endoscopy by comparing the influence of different target plasma propofol concentrations combined with remifentanil on anesthesia effects and respiratory and circulatory functions.Methods: Two hundred patients requiring small intestinal endoscopy were randomly divided into 4 groups,Group Ⅰ given 1% propofol only,with the target plasma propofol concentration set at 4.5 ?g/ml,and Group Ⅱ,Ⅲ and Ⅳ receiving 30-second injection of remifentanil(0.3 ?g/kg) 1 min before target-controlled infusion(TCI) of propofol,with the target plasma propofol concentration set at 3.0,3.5 and 4.0 ?g/ml,respectively.The mean arterial pressure(MAP),heart rate(HR),pulse oxygenation(SpO2),induction time,awakening time,orientation recovery time and the incidence of patients' body motion were observed before anesthesia,at the vanishment of the eyelash reflex,while the small intestine endoscope passing through the Treitz ligament or ileoceal valve and after endoscopy.Results: Compared with baseline values,MAP and HR were significantly decreased in all groups when the eyelash reflex vanished,markedly increased in Group Ⅰ,although not so obvious in Groups Ⅱ and Ⅲ,when the small intestinal endoscope passed through the Treitz ligament or ileoceal valve,and greatly reduced at all time points in Group Ⅳ,with difficult entrance of the small intestine endoscope due to low tension of the intestinal cavity.Comparatively,the induction time was shorter and the awakening time and orientation recovery time were longer in Group Ⅰ,the total dose of propofol and the incidence of body motion notably decreased in Groups Ⅱand Ⅲ,and the incidence of respiratory depression obviously increased in Group Ⅳ.Conclusion: Propofol TCI combined with remifentanil can be used safely and effectively in painless small intestinal endoscopy.Target plasma propofol concentration(3.5 ?g/ml) in combination with remifentanil(0.3 ?g/kg) gives more efficient anesthesia,lower incidence of body motion and respiratory suppression and better recovery.Therefore,it is the suitable anesthetic compatibility in painless small intestinal endoscopy.

ObjectiveThe aim of this study is to analyze the etiology and status of bone age of children with short stat-ure.MethodsAnthropological and physical examination data were retrospectively collected and studied in 2132 children with short stature in the department of endocrinology between 2009 and 2014. Growth hormone (GH) levels were determined by ar-ginine-clonidine test. Bone age was determined by CHN scoring.ResultsAmong the 2132 patients, 1333 were males and 799 were females. Mean age is 9.03 ± 3.04 years old, mean bone age is 6.81 ± 3.05 years. Of them, 324 cases (15.2%) were diagnosed complete GH deifciency, 780 cases (36.59%) were partial GH deifciency, 27cases (1.27%) were multiple pituitary hormone de-ifciency, 13 cases (1.64%) were hypothyroidism, 893 cases (41.89%) were idiopathic short stature, 19 cases (0.89%) were small for gestational age (SGA), 40 cases (1.88%) were chromosomal disorders, etc. Signiifcant difference in age and bone age was found using t test (P<0.05). Signiifcant differences in Δage were found between etiological categories using ANOVA (P=0.000). Δage was signiifcantly and negatively associated with peak GH using Pearson's correlation.ConclusionsGH deifciency is the most common cause of short stature. Bone age of children with short stature is commonly delayed. Δage was signiifcantly and negatively associated with peak GH. Multiple pituitary hormone deifciency has a signiifcant effect on bone age. The etiology of patients with short stature cannot be determined just by bone age.