OBJECTIVE:To explore short-term efficacy and safety of early use of high-dose,medium-dose and low-dose ami-no acid in premature babies. METHODS:99 premature babies were selected and randomly divided into high-dose group,medi-um-dose group and low-dose group,with 33 cases in each group. 3 groups were given Amino acid injection,ivgtt,within 24 h af-ter birth,high-dose group was given 3 g/(kg·d),medium-dose group 2 g/(kg·d)and low-dose group 1 g/(kg·d);those dose in-creased by 0.5 g/(kg·d)day by day;predicted peak values of them were 3.5,3.5 and 3 g/(kg·d),respectively. Treatment courses of 3 groups lasted for 28 d. Health indexes,renal function indexes and blood indexes were observed in 3 groups. The occurrence of complications and ADR were recorded in 3 groups. RESULTS:2 cases withdrew from high-dose and low-dose groups. Hospital-ization stay,the time of body weight increasing to 2 500 g and the rate of body weight decreasing in high-dose group were signifi-cantly lower or shorter than in medium-dose and low-dose groups;the medium-dose group was significantly lower or shorter than the low-dose group,with statistical significance (P<0.05);the levels of creatinine,residual alkali,serum total bilirubin in high-dose group were significantly higher than medium-dose and low-dose groups,and the medium-dose group was significantly higher than the low-dose group,with statistical significance(P<0.05). The number of complications cases in high-dose group(11 cases)were significantly lower than in medium-dose group(20 cases)and low-dose group(26 cases),with statistical significance (P<0.05). No obvious ADR was found in 3 groups. CONCLUSIONS:High-dose of amino acid intravenous nutrition support in early stage can promote the recovery of nutrition state and healthy constitution in premature babies with good tolerance and safety.

Objective To apply the Isobaric tags for relative and absolute quantitation (iTRAQ) to identify proteins differentially in serums of gastric cancer (GC) patients, gastric mucosal intestinal metaplasia (IM) patients and normal control population. Methods The study included serum samples from GC group, IM group and normal control group with 45 cases each group,Proteins differentially regulated in serums were identified by the iTRAQ coupled with two-dimensional liquid chromatography/tandem mass spectrometry (2D-LC-MS/MS) technology. Results 10 540 unique peptides , of which correspond to a set of 199 proteins were identified , 23 proteins were over expressed and 14 proteins were underexpressed in GC and IM.Nine immune response proteins such as Lipopolysaccharide-binding protein,C-reactive protein and Ficolin-3 were found in the differential proteins, implying a close linkage between immune response and GC. Conclusions iTRAQ technology may help to identify novel serum markers for early diagnosis of GC.

Based on the construction experiences of our hospital, we in this paper introduce some problems met with in the central gas-supply, and meanwhile we have presented several solutions and preventive measures for the reference of other hospitals.
Delivery of Health Care ; organization & administration ; Equipment Safety ; Equipment and Supplies, Hospital ; Gases ; economics ; supply & distribution ; Maintenance ; Oxygen ; economics ; supply & distribution ; Oxygen Inhalation Therapy ; instrumentation

The distribution of neurotensin (NT) and neuropeptide Y (NPY) in the rat hypothalamic arcuate nucleus has been studied ultrastructurally by means of double labeling preembedding immunoelectron microscopic PAP technique. First, the NPY immunoreaction was demonstrated by chromogen DAB, and second, the NT immunoreaction was demonstrated by ammonium molybdate-TMB method. After being stabilized by DAB-cobalt chloride, the vibratome sections were processed for electron microscopic study. The results showed that in the arcuate nucleus the NPY immunoreactive products appeared as high electron-dense granular or flocculent materials deposited diffusely in the organelles and matrix of perikaryon, around the dendritic microtubules and axonic small clear vesicles. Whereas the NT immunoreactive products were dense needle- or mass-like deposits distributed dispersively in the perikaryon, dendrites and axon terminals. They can easily be distinguished although being intermingled together. The NPY-containing dendrites and axons formed synaptic connections with immuno-negative axon terminals, NT-containing somata and dendrites formed also synaptic conections with negative axon terminals. In addition, NPY-positive axon terminals formed symmetrical axodendritic synapses with NT-positive dendrites. The present results provided another new ultrastructural evidence for the peptidergic synaptic regulation of NT neurons in hypothalamus.

Using electron immunocytochemical method, the ultrastructural distribution and the synaptic connections of CCK-containing neurons in the paraventricular nucleus (PVN) of the rat were studied. The results showed that the CCK-like immunoreactive products located in farge granular vesicles, cytoplasmic matrix, at the periphery of small clear vesicles, rough endoplasmic reticulum and the membrane of mitochondria. The CCK-positive nerve cell bodies were large or small in size and distributed mainly in the medial part of the PVN, subependymal region and the vicinity of capillaries. Some of them as postsynaptic elements formed axosomatic synapses with CCK-negative axonal terminals. The CCK-positive dendrites and axons situated everywhere in the PVN. Some of them as postsynaptic elements formed axodendritic and axoaxonic synapses with CCK-negative structures. Some CCK-positive axonal endings surrounded the capillaries. Other CCK axonal terminals as presynaptic elements formed axosomatic, axondendritic and axo-axonic synapses with CCK-negative structures, respectively. In addition, we have first found that the CCK-positive dendrites penetrated ependyma and contacted directly with the cerebrospinal fluid in third ventricle, the CCK-positive axons traveled in the cavity of third ventricle near the ependyma. The above mentioned results suggested: (1) the soma, dendrite and axon of the CCK-containing neurons and CCK-negetive neurons in the PVN might form local neuronal circuit; (2) the neuron vessel circuit might be established between CCK-containing neurons and the blood vessels in the PVN; (3) the CSFcontacting neurons in the PVN may participate in forming brain-cerebrospinal fluid neurohumoral circuit and regulate functional activity of distal target area through the CSF pathway.

Objective: To investigate the experience of patients in the implementation of enhanced recovery after surgery (ERAS) strategy after radical gastrectomy and the factors affecting the treatment experience. Methods: A prospective cohort study was carried out. Patients who were diagnosed with gastric cancer by pathology and underwent radical gastrectomy at the Xijing Digestive Disease Hospital from December 2019 to December 2020 were consecutively enrolled. Those who received emergency surgery, residual gastric cancer surgery, preoperative neoadjuvant chemotherapy, non-curative tumor resection, intraperitoneal metastasis, or other malignant tumors were excluded. Patients' expectation and experience during implementation were investigated by questionnaires. The questionnaire included three main parts: patients' expectation for ERAS, patients' experience during the ERAS implementation, and patients' outcomes within 30 days after discharge. The items on the expectation and experience were ranked from 0 to 10 by patients, which indicated to be unsatisfied/unimportant and satisfied/important respectively. According to their attitudes towards the ERAS strategy, patients were divided into the support group and the reject group. Patients' expectation and experience of hospital stay, and the clinical outcomes within 30 days after discharge were compared between the two groups. Categorical data were reported as number with percentage and the quantitative data were reported as mean with standard deviation, or where appropriate, as the median with interquartile range (Q₁, Q₃). Categorical data were compared using the Chi-squared test or Fisher's exact test, where appropriate. For continuous data, Student's t test or Mann-Whitney U test were used. Complication was classified according to Clavien-Dindo classification. Results: Of the included 112 patients (88 males and 24 females), aged (57.8±10.0) years, 35 patients (31.3%) were in the support group and 77 (68.7%) in the reject group. Anxiety was detected in 56.2% (63/112) of the patients with score >8. The admission education during the ERAS implementation improved the patients' cognitions of the ERAS strategy [M(Q₁, Q₃) score: 8 (4, 10) vs. 2 (0, 5), Z=-7.130, P<0.001]. The expected hospital stay of patients was longer than the actual stay [7 (7, 10) days vs. 6 (6, 7) days, Z=-4.800, P<0.001]. During the ERAS implementation, patients had low score in early mobilization [3 (1, 6)] and early oral intake [5 (2.25, 8)]. Fifty-eight (51.8%) patients planned the ERAS implementation at home after discharge, while 32.1% (36/112) preferred to stay in hospital until they felt totally recovered. Compared with the reject group, the support group had shorter expected hospital stay [7 (6, 10) days vs. 10 (7, 15) days, Z=-2.607, P=0.009], and higher expected recovery-efficiency score [9 (8, 10) vs. 7(5, 9), Z=-3.078, P=0.002], lower expected less-pain score [8 (6, 10) vs. 6 (5, 9) days, Z=-1.996, P=0.046], expected faster recovery of physical strength score [8 (6, 10) vs. 6 (4, 9), Z=-2.200, P=0.028] and expected less drainage tube score [8 (8, 10) vs. 8 (5, 10), Z=-2.075, P=0.038]. Worrying about complications (49.1%) and self-recognition of not recovery (46.4%) were the major concerns when assessing the experience toward ERAS. During the follow-up, 105 patients received follow-up calls. There were 57.1% (60/105) of patients who experienced a variety of discomforts after discharge, including pain (28.6%), bloating (20.0%), nausea (12.4%), fatigue (7.6%), and fever (2.9%). Within 30 days after discharge, 6.7% (7/105) of patients developed Clavien-Dindo level I and II operation-associated complications, including poor wound healing, intestinal obstruction, intraperitoneal bleeding, and wound infection, all of which were cured by conservative treatment. There were no complications of level III or above in the whole group after surgery. Compared with the support group, more patients in the reject group reported that they had not yet achieved self-expected recovery when discharged [57.1% (44/77) vs. 22.9% (8/35), χ²=11.372, P<0.001], and expected to return to their daily lives [39.0% (30/77) vs. 8.6% (3/35), χ²=10.693, P<0.001], with statistically significant differences (all P<0.05). Only 52.4% (55/105) of patients returned home to continue rehabilitation, and the remaining patients chose to go to other hospitals to continue their hospitalization after discharge, with a median length of stay of 7 (7, 9) days. Compared with the reject group, the support group had a higher proportion of home rehabilitation [59.7% (12/33) vs. 36.4% (43/72), χ²=4.950, P=0.026], and shorter time of self-perceived postoperative full recovery [14 (10, 20) days vs. 15 (14, 20) days, Z=2.100, P=0.036], with statistically significant differences (all P<0.05). Conclusions: Although ERAS has promoted postoperative rehabilitation while ensuring surgical safety, it has not been unanimously recognized by patients. Adequate rehabilitation education, good analgesia, good physical recovery, and early removal of drainage tubes may improve the patient's experience of ERAS.
Enhanced Recovery After Surgery ; Female ; Gastrectomy ; Humans ; Length of Stay ; Male ; Pain ; Patient Outcome Assessment ; Postoperative Complications/surgery* ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms/surgery* ; Treatment Outcome

Objective To study the stress distribution on different length of pedicle screws under the physiological load by using the three dimensional finite element analysis. Method A three dimension model of the pedicle screw and L1 vertebral body were constructed with the model meshed on the basis of the finite element method. The feature dimension of pedicle screw in the model was set in a specified varied range. Under the physiological load, the stress on every model with different diameter sizes of pedicle screw was analyzed. ResultsThe stress on every bone model decreased with the increase of stress on screw under the axially pullout force as the length of screw ranged from 30mm to 50mm. And the maximum Equivalent Stress (EQV Stress) in the pedicle screw appeared in the central area of the pedicle screw, the maximum Equivalent Stress (EQV Stress) in the cortical bone appeared in both sides of contact surface, the maximum Equivalent Stress (EQV Stress) of the cancellous bone appeared in both sides of contact surface of the top of pedicle screw and cancellous bone. In a certain external load, with the 50mm length of screw, the load that transfers to the cortical bone and cancellous bone is reduced by 43.1% and 42.3%, respectively, while the maximum Equivalent Stress (EQV Stress) of screw was increased 38%. When L≥45mm, the variable stress on all models become stable. Conclusions While the length of screw is in range of 4.0　mm to 6.5　mm, 30～50 mm ,the increase of pedicle screw length could improve the distribution of axial pullout stress on the screws, cortical bone and cancellous bone. As long as the bone mass allowed, the length of pedicle screws should be not less than 45mm in clinical choice.

Objective To construct 3D finite element model of the thoracolumbar spinal cord, and study the mechanism of spinal cord injury caused by burst fracture through biomechanical experiments. Methods The compression simulation on burst fracture was performed using finite element technology, and the results were verified by comparing the tested models with the in vivo and in vitro experimental results. Results The strain distribution in white matter of the spinal cord was higher than that in grey matter at the initial stage of burst fracture. As the displacement of bony fragments increased, the strain distribution in grey matter increased subsequently. But when the displacement of bony fragments finally reached the maximum, the strain in white matter was higher than that in grey matter. Conclusions Traumatic severity of the spinal cord during burst fracture is dependent on the posterior encroachment, and the traumatic procedure order for ventral horn (motor function) or dorsal horn (sensory function) of cord tissue also plays an important role in the evaluation. In clinical practice, the patient’s condition can be evaluated more accurately by assessing severity of the spinal motor and sensory functions. Further understanding on strain distribution in the spinal cord during the injury may inspire new strategies for treating or preventing spinal cord injury.

Objective To investigate the changes of plantar pressure distributions in children with the unilateral developmental dysplasia of the hip (DDH) who underwent the Pemberton’s pericapsular osteotomy (PPO) at early age, so as to provide valuable references for clinical therapy and rehabilitation of such patients. Methods Eighteen child patients who underwent PPO before 4 year old were selected as the PPO group, while 18 healthy children at the same age with normal feet were selected as the control group. Footscan system was used to measure the plantar pressure of these subjects during walking. The parameters, i.e. contact area percentage of the total foot contact area (CA%), pressure-time integral (PTI) and contact time percentage of the stance time (CT%) in both PPO group and control group were compared to evaluate changes of the plantar pressures during walking. Results Compared with the sound limb in control group and the unaffected limb in PPO group, the affected limb in PPO group showed higher PTI in the 2nd to 5th toe zone and lower PTI in the medial heel zone. The affected limb in PPO group had a higher CA% in the 4th and 5th metatarsals than the unaffected limb in PPO group and the sound limb in control group, and a lower CA% in the 1st and 2nd metatarsals than the unaffected limb. Compared with the unaffected limb in PPO group and the sound limb in control group, CT% of the affected limb in PPO group increased in the forefoot push-off phase and decreased in the initial contact phase, and the total contact time of the affected limb was shorter than that of the unaffected limb in PPO group and the sound limb in control group. Conclusions There exist residual plantar pressure deviations during walking in DDH patients following PPO at early age, thus a longer period of intensive rehabilitation may be required to change the residual abnormality.

Objective To investigate the changes of plantar pressure distributions and risk of falling before and after the occurrence of neurogenic intermittent claudication (NIC) in patients with central lumbar spinal stenosis (LSS), so as to provide theoretical and data references for the application of plantar pressure analysis in judgment of walking abilities for LSS patients. Methods Twelve patients with LSS at the L4-5 segment were selected as the LSS group, while twelve healthy adults at the same age were selected as the control group. Footscansystem was used to measure plantar pressure of these subjects during walking. Contact area percentage of the total foot contact area (CA%), pressure-time integral (PTI), foot progression angle (FPA), contact time percentage of the stance time (CT%) and total stance time (CT) in both LSS group and control group were compared to evaluate changes of plantar pressures during walking．Results Before the occurrence of NIC, compared with the control group, the LSS group had lower CT% during the forefoot push-off phase (FFPOP) and higher CT% during the initial contact phase (ICP), the total CT and FPA also increased, and the PTI of the 1st-3rd metatarsals and the CA% of the 2nd and 3rd metatarsals were higher. After the NIC occurred, for LSS group, CT% during ICP and forefoot contact phase (FFCP) decreased, CT% during the foot flat phase (FFP) and FFPOP as well as total CT and FPA increased, the PTI and CA% increased in 1st-4th metatarsals. Moreover, the CA% also increased in toe zone, both the PTI and CA% decreased in heel zone. Conclusions In patients with central LSS during walking, the distribution of plantar pressure shifts forward, with abnormal phase of the stance time occurring. Such abnormality will be further aggravated by NIC, indicating a higher risk of falling.