Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.

OBJECTIVE： To discuss the selectivity of enatiomers of clinically used asymmetric drugs.METHODS： To exsamplify this issue in respect to pharmacokinetic characteristics,pharmacodynamic properties and clinical application of asymmetric drugs.RESULTS ＆ CONCLUSION： The enatiomers of asymmetric drugs assume complex pharmacokinetic and pharmacodynamic characteristics.Thorough study of enatiomers of asymmetric drugs will exert great influence on rational use of asymmetric drugs.

BACKGROUND: With the development of China, quality of life (QOL) is getting more and more attention, however, there are few studies on QOL, especially in Mainland China.OBJECTIVE: To observe the situation of combinative application of Functional Independence Measure (FIM) and QOL assessment in rehabilitation clinical practice.DESIGN: Case analysis.SETTING: Zhongshan Hospital of Fudan University.PARTICIPANTS: Totally 83 rehabilitation patients selected from Shanghai Zhongshan Hospital from January to December 2003,consenting to take part in the study, were divided into 4 groups: bone & joint rehabilitation(n=42), stroke rehabilitation (n=17), internal medicine (n=15), and cancer rehabilitation (n=9).METHODS: Every patient carried out functional independence assessment and quality of life measurement within 24 hours of admission. FIM was adopted for functional independence assessment which included 13 items of motor (ranged from 13 to 91 points) and 5 items of cognition (ranged from 5to 35 points), and FAQ for quality of life included making telephone call,self-care economy, shopping, using vehicle, housework, jobs, entertainment,etc. with 100 in total. The author performed all the assessment.MAIN OUTCOME MEASURES: Every patient carried out FIM and FAQ assessment after admission and discharge.RESULTS: All data of totally 83 patients entered the final analysis. [1]The average age and length of hospital stay in stroke group were higher than those in other groups (P ＜ 0.01). [2] FIM motor and cognitive scores in stroke group were higher at discharge than those at admission (5.276,3.624;6.200,5.941,P ＜ 0.01), but scores of functional activity were lower at discharge than those at admission (1.253, 1.547, P ＜ 0.01). [3]In bone joint group, the FIM cognitive scores were coincidence in general, while motor scores were higher at discharge than those at admission (6.220,5.388, P ＜ 0.01), but scores of functional activity were lower at discharge than those at admission (0.610, 0.912, P ＜ 0.01). [4] Only scores of functional activity in tumor group were lower at discharge than those at admission (0.722, 0.989, P ＜ 0.05). [5] All items in internal medicine group were coincidence in general (P ＞ 0.05).CONCLUSION: FAQ is more sensitive than FIM in rehabilitation practice, but cannot replace FIM, and should be used with FIM.

Objective To explore the reasonable nursing interventions of advanced schistosomiasis patients. Methods The medical records of 52 advanced schistosomiasis patients hospitalized from 2008 to 2013 were collected,and the nursing interven-tions were summarized. Results The 52 cases of advanced schistosomiasis included 38 men and 14 women,with a mean age of 65.8 years(57-75 years). Totally 53.8%of the subjects were schistosome positive by IHA test,67.3%positive by ELISA,and 21.2%positive of HBsAg. There were 13 cases of ascites type,34 cases of megalosplenia type,and 5 cases of dwarfism type of ad-vanced schistosomiasis. Following the therapy together with nursing interventions,73.1%achieved clinical cure,23.1%achieved stable,and 3.8%achieved improvement. The major nursing interventions involved basic nursing,diet nursing,treatment nursing, physiological nursing and surgical nursing. Conclusion The scientific and reasonable nursing interventions can improve the ther-apeutic efficacy and prognosis in advanced schistosomiasis patients,as well as improve their quality of life.

ObjectiveTo explore the characteristics of traditional Chinese medicine (TCM) syndrome differentiation in chronic complications of type 2 diabetes mellitus (DM).Methods124 patients with chronic complications of type 2 DM were scored by 5 grades according as the severities of their symptoms. There were 5 kinds of patterns such as deficiency of Qi, deficiency of Yin, deficiency of Yang, blood stasis and retention of phlegm and fluid by which the TCM syndrome differentiation was generalized.ResultsThe sequence of TCM patterns was deficiency of Yin, blood stasis, deficiency of Qi, deficiency of Yang and retention of phlegm and fluid, and the syndrome of the two formers were greater than 50%. The proportion of unity of deficient and excessive pattern was 80.5%. Three larger syndrome types were deficiency of both Yin and Yang combined with blood stasis (17.7%), Qi-Yin deficiency with blood stasis ( 16.9 %) and Yin deficiency with blood stasis (16.9%). There was a statistically significant difference in TCM syndromes which were divided into different groups by course of diseases (P<0.05). At onset of DM, the typical symptoms were less observed in the group whose course of disease was less than 5 years, and only 39.1% of patients had the typical symptoms. But at the same time, the prevalences of hypertension and hyperlipidemia were higher in this group than in the others, respectively 63.0% and 87.0%.ConclusionThe primary syndrome is unity of deficient and excessive pattern in chronic complications of type 2 DM and deficiency of Qi and blood stasis are the commonest patterns in course of DM.

Objective Clarify the effect of neutrophil extracellular traps (NETs) on endothelial cell injury, and investigate whether the heparin can exert a protective effect on endothelial cells by reducing the endothelial cell injury induced by NETs.Methods Neutrophils (PMN) were obtained from healthy human peripheral blood by Percoll-Histopaque density gradient centrifugation, and was stimulated with phorbol ester (PMA) to induce NETs. The qualitative and quantitative analysis of NETs was detected by immunofluorescence staining combined with fluorescence detector. The NETs were used to induce human umbilical vein endothelial cells (HUVEC)in vitro. Recombinant DNA hydrolytic enzymes (rhDNase) and heparin intervention were added respectively. The activity of HUVEC was measured by methyl thiazolyl tetrazolium (MTT) method after 6 hours.Results PMA can stimulate PMN to produce NETs. Immunofluorescence staining showed the formation of reticular formation around the PMN. The concentration of cell-free DNA in the supernatant of PMN stimulated by PMA was significant increased compared with the control group through the detection of PicoGreen fluorescent labeling instrument (2 hours: 119.62±14.83 vs. 24.27±0.67, 4 hours: 146.67±21.24 vs. 28.35±2.98, bothP < 0.05). Application of NETs to stimulate the HUVEC, cell damage was dose dependent and inhibition rate increased gradually. The endothelial cell inhibition induced by NETs can be antagonized after adding rhDNase [10μg/L NETs: (8.65±0.51)% vs. (10.99±0.35)%, 20μg/L NETs:(14.85±0.43)% vs. (16.85±0.49)%, 30μg/L NETs: (26.06±3.51)% vs. (27.54±0.62)%, allP < 0.05]. Heparin with different concentrations were added into the experimental group (0.01, 0.1, 1, 10 kU/L). We found that the endothelial cell inhibition rate decreased compared with control group [10μg/L NETs: (8.96±0.70)%, (5.32±1.36)%, (0.70±0.30)%, (0.75±0.20)% vs. (10.99±0.35)%; 20μg/L NETs: (15.57±0.62)%, (13.28±0.65)%, (6.91±0.15)%, (5.86±0.17)% vs. (16.85±0.49)%; 30μg/L NETs: (30.49±0.74)%, (29.41±1.41)%, (23.45±0.75)%, (21.72±1.52)% vs. (27.54±0.62)%, allP < 0.05].Conclusions NETs can induce endothelial cell injury, and the injury degree was increased with the concentration of NETs. Heparin can reduce endothelial cell injury induced by NETs, which may be a potential mechanism for the protective effect of heparin on sepsis.

Objective To assess health-related quality of life and the mood disorder in adults with epilepsy,and to evaluate factors contributing to the quality of life.Methods Quality of life was measured by the Quality of Life in Epilepsy Inventory(QOLIE-31)and the World Health Organization Quality of Life Assessment-Bref(WHOQOL-BREF).Psychotic conditions were evaluated by Self-rating Depressive Scale (SDS)and Self-rating Anxious Seale(SAS).The multivariate analysis was used to assess the determinant factors.Results The study included 141 epilepsy patients in the teat group and 59 sex,age,and education matched normal controls. WHOQOL-BREF scores in the physical and psychological aspects were significantly lower in epilepsy patients(12.7 ±1.8 and 12.4±1.9,respectively)than those in the normal controls(15.1 ±2.3 and 13.9 ±1.9,respectively,t value were 11.75 and 8.625.both P<0.05).The survey reported that 57.4 % of the epilepsy patients suffered with depression.and 39.7 % anxiety.The patients with both anxiety and depression scored lower in all aspects in QOLIE survey except medical effect.Multivariate analysis showed that factors that effect the overall quality of life in order were anxiety.depression and disease duration.Conclusion Our results support that complications of anxiety and depression and long disease duration are key factors affecting the quality of life in epilepsy patients.

Objective To summarize the clinical experience of the temporal arachnoid cysts in children with cysto-peritoneal shunt.Methods The clinical data of 16 patients from June 2009 to August 2012 of children with the temporal arachnoid cysts taken by cysto-peritoneal shunt were analyzed retrospectively .The surgical procedure and prognosis were also analyzed .Results Sixteen ca-ses of follow-up from 2 to 30 months after surgery showed 5 cases of preoperative symptoms disappeared .After surgery of 6 months, the head computed tomography (CT) showed 4 cysts disappeared (25.0%), 12 cysts shrink (75.0%), reduced >50%in 9 cases, and reduced <50%in 3 cases.After surgery of 12 months, 12 cases of cysts shrink head CT showed 7 cysts disappeared , reduced>50%in 4 cases, and reduced <50%in 1 cases.1 case after surgery of 2 months with head CT showed the cysts shrink and had left frontal subdural effusion;Two years later the cranial CT scan showed the cysts disappeared and the left frontal subdural effusion absorption . No serious complications and infections were observed .Conclusions Cysto-peritoneal shunt might be a safe and effective method to treat intracranial temporal arachnoid cysts in children and had good prognosis .

ObjectiveTo investigate the expression of CXCR4 and CD133mRNA in primary lesion of primary gastric adenocarcinoma and the relation with clinicopathological features,and to explore the correlation of CXCR4 and CD133.MethodsThe primary lesion of primary gastric adenocarcinoma and normal tissues adjacent to gastric cancer were obtained from 50 patients.The diction of CXCR4 and CD133 protein expression was detected by the immunohistochemical staining,and the relative gray scale values of CXCR4 and CD133mRNA by semi-quantitative RT-PCR (Fisher' s exact probability method).Their relationship with clinicopathological features was also investigated ( Spearman relation analysis).ResultsThe positive rates of CXCR4 and CD133 protein in gastric cancers were 76.0％ and 66.0％ respectively,which were significantly higher than that in normal tissues adjacent to gastric cancer ( 16.0％ and 10％ ; P =0.000,P =0.000).The increment of relative gray scale values of CXCR4mRNA was associated with the larger tumor diameter,the later TNM stage and the occurrence of lymphatic metastasis( P ＜ 0.05 ).And the larger diameter of tumor,the later TNM stage were associated with the higher relative gray scale values of CD133mRNA (P ＜0.05).The levels of the relative gray scale values of CXCR4 mRNA and CD133mRNA were positively related(r =0.453,P ＜ 0.01 ).ConclusionsThe higher expression of CXCR4 and CD133mRNA correlateswith tumour diameter,TNM stage and lymphatic vessel invasion. The relative gray scale values of CD133mRNA increase with the increment of the relative gray scale values of CXCR4.

BACKGROUND: Pathological change of synovium in rheumatoid arthritis (RA) has the characteristic of tumor-like growth, it appears thickening of the synovium tissue and the formatiom of pannus, which generate periarticular erosion and destruction. Multiplicate cell factors and growth factors participate in the development course of tumor-like lesion of synovium, and the tumor necrosis factor-α(TNF-α) and vascular endothelial growth factor(VEGF)play important roles in the development of RA and the formation of pannus.OBJECTIVE: To observe the contents of plasma TNF-α of collagen-induced arthritis and the expression change of VEGF of synovium at different time point, and investigate the effect and correlation of TNF-α and VEGF in the pathogenesis of RA.DESIGN: Randomized grouping experiment taking animals as subjects.SETTING: Institute integrated traditional and western medicine of Xiangya Hospital of Central South University.MATERIALS: The experiment was finished from July to November 2003 in the laboratory of institute integrated traditional and western medicine.Forty SD rats aged 45-50 days were selected, the rats were randomly divided into the normal control group (n=10) and collagen-induced arthritis model group(n=30).METHODS: 10 mg Cattle collagen type Ⅱ and 5 ml full Freund adjuvant were grinded together, 100 μL of which were intradermally injected at the root of tails of rats, collagen-induced arthritis model of rats were re-immunized with the above-mentioned methòd and dosage after 21 days. The accumulated points of arthritis index was evaluated based on degree and extent of flare and the condition of tumefaction and deformation, the higher the accumulated points of arthritis index were, the more serious the arthritis symptom was. The blood was obtained by decapitation after 25 days in normal control group, and in the collagen-induced arthritis model group the blood was obtained by decapitation 25,30,35,40,45 days after immunization (model establishing), the contents of plasma TNF-α of collagen-induced arthritis rats at different time point was detected by radio-immune assay, the level of expression of VEGF in synovium tissue were detected with immunohistochemical method simultaneously, the correlation of invasion time and the neovascularization of synovium. The accumulated points of arthritis index . TNF-α and VEGF was observed. The correlation of TNF-α and VEGF was analyzed with the linear correlation analysis, the correlation of the accumulated points of arthritis index and TNF-α. VEGF was analyzed with the rank correlation analysis.MAIN OUTCOME MEASURES: The correlation of invasion time of collagen-induced arthritis with the accumulated points of arthritis index, with the plasma content of TNF-α and the expression of VEGF, the correlation analysis of the plasma content of TNF-α of collagen- induced arthritis rats with the expression of VEGF in synovium.RESULTS: Forty rats attended the experiment, all of them entered the final analysis. the neovascularization of synovium was increased, synovium was thickening, the accumulated points of arthritis index was gradually increased, and the contents of TNF-α and level of VEGF were increased accordingly with the process of the invasion time of the collagen-induced arthritis rats; Its accumulated points of arthritis index had the positive correlation with the level of expression of VEGF (r=0.535 ,P ＜ 0.05)and had the correlated increasing tendency with the contents of TNF-α, but there was no significant difference(r=0.371 ,P ＞ 0.05 ). the plasma contents of TNF-α had the positive correlation with the level of expressions of VEGF (r=0.893,P ＜ 0.01 ).CONCLUSION: The TNF-α and VEGF have an important effect on the inflammatory reaction of RA and Cytokine network of neovascularization of synovium, they are possibly mutually influenced and promoted and have the effect of mediating the malignant network circulation; They are the key factors among multiplicate ones which mediate the generation and development of RA, bone erosion and Mutilation.