Objective To evaluate the influence of partial parenteral nutrition on serum osmotic pressure,blood glucose,(biochemistry),bilirubin metabolism,immune function,growth and development of premature infants.Methods Seventy premature infants were randomly divided into control group and study group.On the base of enteral feeding,study group were offered parenteral nutrition, while the control group were supplied 10% glucose, fluid and electrolytes. Simultaneously, relevant indices were measured in 2 groups.Results 1.There were no significant difference in serum osmotic pressure,blood glucose and biochemistry before and after parenteral nutrition. 2.There were no significant difference in emerging and lasting time of jaundice between 2 groups.3.Serum IgG,IgA,IgM,C_3,CD4 and CD4/CD8 in study group were significantly higher than those in control group. 4.In study group the time of hospitalization and birth-weight regain were significantly shorter than those in control group.Conclusions There is no significant influence on serum osmotic pressure,blood glucose, biochemistry and bilirubin metabolism during partial parenteral nutrition. Parenteral nutrition may help gain weight, shorten the time of hospitalization, and improve immunological function of neonates.

Objective To investigate the influence of hepatectomy combined with splenectomy on curative effect of primary hepatocellular carcinoma patients associated with hypersplenism.Methods Twenty three cases of primary hepatocellular carcinoma associated with hypersplenism were analyzed retrospectively and divided into hepatectomy combined with splenectomy group (n=10) and hepatectomy combined with ligation of splenic artery (n=13). Peripheral blood samples were collected 1 week before operation and 3 monthes after operation respectively. The levels of CD4, CD8, CD16, CD4/CD8, WBC and PLT in the blood were detected. Survival rate between the two groups was compared. Results There were not significant differences in the expressional levels of CD4, CD8, CD16, CD4/CD8,WBC and PLT before operation, bleeding quantity during the operation and rate of severe complications after operation in the two groups. The expressional levels of CD4, CD16, CD4/CD8, WBC and PLT of hepatectomy combined with splenectomy group were much higher in 3 months after operation than those in 1 week before operation and in hepatectomy combined with ligation of splenic artery group (P

Objective To explore the clinical manifestations of toxic epidermal necrolysis(TEN) and its rare pulmonary complications.Methods Clinical symptoms,treatment and prognosis of 1 child with TEN caused by carbamazepine were analyzed.Radiological images were reviewed to evaluate the manifestations and the outcome of chronic pulmonary complications associated with TEN.Results The patient had high fever shortly after a dosage increment of carbamazepine.A confluent erythematous exanthema developed rapidly into painful blistering with skin erosion,denudation and involvement of conjunctive and oropharyngeal mucosa.The diagnosis of TEN was made.The mucocutaneous damage was gradually recovered with steroid plus intravenous immunoglobulin for 3 weeks.However,the patient presented with respiratory failure in the recovery phase of TEN.The computer tomography revealed pulmonary bullae and pneumothorax in the right lung.Lung parenchyma was squeezed and pulmonary bullae ruptured with pneumothorax and atelectasis,which were absorbed gradually through thoracic drainages.The patient′s lung function and pulmonary bullae were partly improved during a 7-month follow-up.Conclusions TEN is a severe form of blistering skin di-sease which is characterized by an extensive loss of epidermis and mucous membrane.Chronic pulmonary complications may occur in recovery phase of TEN.Pulmonary bullae,which might be caused by mucous damage and respiratory obstruction,is a rare complication of TEN.

Objective To evaluate the efficacy of entecavir treatment on hepatitis B patients with acute-on-chronic liver failure. Methods Eighty-four hepatitis B patients with acute-on-chronic liver failure were treated with entecavir 0.5 mg daily and Other routine drugs. Another 99 hepatitis B patients with acute-on-chronic liver failure were treated with only routine drugs as control. The survival, liver functions, hepatitis B virus (HBV) DNA level, prothrombin time (PT) were observed. The survival rates of patients with early, middle or late stage of liver failure were analyzed. The comparison of rates were done using chi-square test. The numeration data were compared by t test. The survival rates were compared using Kaplan-Meier method. Results Among patients with early stage of acute-on-chronic liver failure, the survival rate in treatment group was 63.3% (31/49), which was significantly higher than that in control group (39.7%, 23/58) (χ2=5.923, P=0.015). Among patients with middle stage of acute-on-chronic liver failure, the surviral rate in treatment group was 63.0% (17/27), which was significantly higher than that in control group (35.1%, 13/37) (χ2=4.854, P=0.028). Among patients with late stage of acute-on-chronic liver failure, four out of eight cases survived in treatment group, while one out of four cases survived in control group. In patients with serum total hilirubin (TBil) level > 342 μmol/L, the survival rate was 56.0% in treatment group, which was significantly higher than that in control group (26.8%) (χ2=9.351,P=0.002). At week 4 of the treatment, the HBV DNA reduction in treatment group was 3. 95 lg copy/mL, which was higher than that in control group (1.78 lg copy/mL) (t=5.847, P=0.001). Conclusions Entecavir treatment could improve the survival rate of hepatitis B patients with early or middle stage of acute-on-chronic liver failure. And the further study with larger population is needed in patients with late stage of liver failure. In addition, entecavir therapy could also improve the survival rate of patients with TBil >342 μmol/L.

10.3969/j.issn.2095-4344.2013.24.021

Child ; Exostoses, Multiple Hereditary ; genetics ; Female ; Humans ; Mutation ; N-Acetylglucosaminyltransferases ; genetics ; Pedigree

Objective　To investigate the clinical feasibility of robotic-assisted laparoscopic radical cystectomy (RARC) by da Vinci surgical system and to summarize the operative technique and outcomes.Methods　From December 2007 to March 2012,22 patients (20 males and 2 females) with the bladder urothelial carcinomas were enrolled.Patient age was from 37 -72 years (rnean 62 years) ; the body mass index was 22.5 - 30.1 kg/m2 ( mean 26.1 kg/m2 ) ; and the American Society of Anesthesiologists score was 1 -2. All patients were diagnosed preoperatively with muscle -invasive or high-risk non-muscle-invasive bladder urothelial carcinomas in cystoscopic biopsy.There were no adjacent organ infiltration,pelvic lymph node involvement or dístant metastasis found on preoperative examinations.The clinical stage of all cases was under T2 N0 M0.Patients were under general anesthesia for RARC with urinary diversion.Extracorporeal urinary diversions (orthotopic ileal neobladder for 2 patients and ileal conduit urinary diversion for 13 patients)were performed on 15 patients and intracorporeal urinary diversions ( ileal conduit urinary diversion for 2 patientsand orthotopic ileal neobladder for 5 patients) were performed on 7 patients.　Results　All RARC procedure were completed on patients as planned.The operative time was 300 - 667 min ( mean 480 min)with estimated blood loss of 100 - 1200 ml (mean 550 ml),and the number of removed lymph nodes was 6 -25 (mean 15). All patients resumed ambulation on the 2nd to 3rd day postoperatively,and bowel function recovered on the 3rd or 4th day postoperatively.The length of hospital stay was 8 - 35 days ( mean 16 days).For patients underwent orthotopic ileal neobladder,the ileoureteral stents and the urethral catheter were removed 1 month after a cystogram confirming watertight healing.During the follow up of 4 -49 months (mean 32 months),2 patients had disease recurrence and 1 patient died of disease development and 2 patients had developed hydronephrosis.The other patients were with good urinary continence and normal renal functions.　Conclusions　RARC with urinary diversion are feasible and safe treatment option for bladder urothelial carcinoma.This technique will be more popular with more extensive surgical experiences and large randomized clinical trials.

Adenocarcinoma ; pathology ; Adenocarcinoma, Papillary ; pathology ; Aged, 80 and over ; Carcinoma, Renal Cell ; pathology ; Duodenal Neoplasms ; pathology ; Humans ; Kidney Neoplasms ; pathology ; Lung Neoplasms ; pathology ; Male ; Neoplasms, Multiple Primary ; pathology ; Sarcoma ; pathology ; Stomach Neoplasms ; pathology

Adenocarcinoma ; Adenoma ; Adult ; Cysts ; Female ; Humans ; Male ; Middle Aged ; Thyroid Neoplasms ; classification ; diagnosis ; pathology

ObjectiveTo investigate the association of phosphorylation of mammalian target protein of rapamycin (pmTOR) expression with glioma malignancy grades,and the correlation of pmTOR expression with Survivin and Ki-67,which represent tumor cell anti-apoptosis ability and reproductive activity.MethodsImmunohistochemistry EliVision method was employed to detect the expression of pmTOR,Survivin and Ki-67 in paraffin tissues from 87 patients with glioma (grade Ⅰ - Ⅱ 27 cases,grade Ⅲ24 cases and grade Ⅳ 36 cases).The association between positive expression rate,level of pmTOR and malignancy grades,and the correlation of its expression level with Survivin and Ki-67 were further evaluated.Results There was no significant difference in the positive expression rate of pmTOR among grade Ⅰ - Ⅱ(77.8％,21/27),grade Ⅲ(75.0％,18/24) and grade Ⅳ (72.2％,23/36) (P ＞ 0.05).However,the significant association between pmTOR expression level and malignancy grades was observed.The expression from 87 patients with glioma was significantly positively correlated with Survivin and Ki-67 expression level (r =0.858,P ＜ 0.01 ;r =0.708,P ＜ 0.01 ).ConclusionsThe expression level of pmTOR is associated with malignancy grades,tumor cell anti-apoptosis ability and reproductive activity.pmTOR may be served as a useful marker for predicting the biological behavior of glioma and a useful target for gene therapy.