Objective To investigate the application of hypocaloric parenteral nutrition in postoperarive elderly patients with gastric cancer. Methods 59 elderly patients aged 60- 79 years with gastric cancer after operation were randomly assigned to receive 84 kJ · kg -1.d -1 hypocaloric parenteral nutrition (29 cases) and 126 kJ · kg-1 · d -1 standard-calorie parenteral nutrition (30cases),totally 6 d from postoperative 2 d. Complications, serum proteins, immune function,inflammation,blood glucose, liver function and recovery time of gastrointestinal function were observed during nutritional support. Results The postoperative complication rate were 37.9％(11/29) in hypocalorie group and 43.3 ％ (13/30) in standard calorie group ( P＞0.05),mainly pulmonary infection.There were no ditferences in levels of serum albumin,total protein and prealbumin between two groups at postoperative 3 d and 6 d (P＞0.05).Peripheral blood lymphocytes and T lymphocyte subsets CD3+,CD4+,CD4+/CD8- ratio were decreased after sugery,but CD8 1 values increased in two groups (P＞0.05).C reactive protein was increased significantly at postoperative 3 d compared with preoperation,and decreased at 6d than 3 d (P＞0.05).Blood glucose was decreased gradually at 3 and 6 d (P＞0.05).Postoperative liver function paraneters were elevated,no difference was found at 3 d (P＞0.05),and continued to rise at 6 d in standard calorie group than in hypocalorie group (P＜0.05). There was no difference in times of aerofluxus and cacation after operation between hypocalorie and standard calorie groups (P＞0.05). Conclusions Hypocaloric parenteral nutrition is a safe and effective method for nutrition support in postoperative elderly patients with gastric cancer.

Objective To study imageology anatomy concerned of sellar turica and explore its potential role on growth of pituitary adenomas. Methods According to classification of sinus sphenoidalis,103 normal imageology data of sellar turica region were analyzed, including 83 cases with entire saddle type sinus sphenoidalis and 20 cases anti-saddle type sinus sphenoidalis. Furthermore, the clinical data of 45 cases of pituitary adenomas with extension into sinus sphenoidalis were retrospectively studied. Results The relationship between sellar floor's shapes and sinus sphenoidals'types was that the larger the sinus sphenoidalis was, the deeper the floor was(98.8%). The relationship between sellar floor's shapes and the superior surface of hypophysis was that most of depressed sellar floors were companied with depressed superior surfaces of hypophysises(93.8%). The anteroposterior shapes of sellar turica in midsagittal can be divided into 4 types such as bag-type, kettle-type, tube-type, and sifter-type. 45 patients suffering from pituitary adenoms with extension into sinus sphenoidalis all had entire saddle type sinus sphenoidalis. Conclusions The imageology anatomy concerned of sellar turica could explain the phenomena of pituitary adenomas with extension toward sellar floor and sinus sphenoidalis. Referring to the literatures concerned, it indicated that the imageology anatomy was the key factor of affecting the growth of pituitary adenomas.

Aim To investigate the protective effects of polysaccharides from the rhizomorph of Armillaria mella(AMP-1) on alloxan injured INS-1 cells.Methods Graded concentrations of AMP-1(2,10,50,100,500,1 000 mg?L-1) were added into the culture medium of alloxan injured INS-1 cells.The survival rate was measured by MTT assay.The amount of glucose-stimulated insulin secretion in different concentrations of AMP-1 was determined by radioimmunoassay(RIA).SOD and NOS activity,NO,MDA and GSH production were assayed colorimetrically.Results AMP-1 could reduce oxidative injuries induced by alloxan in INS-1 cells.The survival rate of cells treated with AMP-1 increased significantly.In the presence of 5.6 mmol?L-1 or 16.7 mmol?L-1 glucose,AMP-1(50,100,500,1 000 mg?L-1)increased glucose-induced insulin secretion in INS-1 cells in a dose-dependent manner.NOS levels and the production of NO and MDA decreased significantly by AMP-1,while SOD levels and the production of GSH increased.Conclusions AMP-1 promoted glucose-induced insulin secretion in INS-1 cells by increasing the abilities of scavenging the free radicals induced by alloxan.

Objective To study the preventive effect of Omeprazole on post-endoscopic retrograde choledo-chopallcreatography(ERCP)-induced pancreatitis.Methods 126 patients were divided into two groups at random.One group received Omeprazole 20mg bid for two days.and the other group received placebo(Vitamine B).Blood was drawn in each group the day before,4 hours and 24 hours following ERCP for examination of amylase and hepa-torenal functions.Meanwhile Meanwhile the clinical manifestations of acute pancreatitis were also observed.Results Acute pancreatitis was clinically induced in 1.59% cases of placebo group,but none in the Omeprazole group.Hyperamy-lasemia occurred in 20.63%-7.93%in Omeprazole group at 4 hours and 24 hours after ERCP operation,while 30.16%.14.29%in placebo group;The incidence rate of acute pancreatitis following ERCP and hyperamylasemia 4 h after ERCP in omeprazole group were significantly lower than in placebo group(P<0.01,P<0.05).There were no significance differences in amylase 24 hours following ERCP between two groups(P>0.05).Concluslon Omeprazole can prevent the acute pancreatitis induced by ERCP to some extent.

Objective:To explore the prognostic factors of patients with Vibrio vulnificus sepsis. Methods:The clinical data of 67 patients with Vibrio vulnificus sepsis from January 2008 to December 2019 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. Univariate analysis was used to compare the differences in general information, clinical manifestations, admission laboratory indicators, antibiotics and surgery between the death group and the cured group. Then the factors with significant difference in univariate analysis were included in multivariate analysis, and the factors of prognosis were obtained. Results:Univariate analysis showed that there were significant difference in liver disease, admission with hypotension shock, multiple limb injuries; admission leukocytes, platelets, pH value, albumin, lactic acid, aspartate aminotransferase, creatinine, procalcitonin, creatine kinase, activated partial thromboplastin time, prothrombin time between the death group and the cured group (all P <0.05). Multivariate analysis showed that admission lactate ( OR=0.628, 95% CI: 0.461-0.855, P=0.003), albumin ( OR=1.330, 95% CI:1.062-1.667, P=0.013), creatine kinase ( OR=0.999, 95% CI: 0.998-1.000, P=0.016) and admission surgery time ( OR=0.118, 95% CI: 0.015-0.938, P=0.043) were risk factors of the prognosis. Patients with high lactate, creatine kinase and low albumin at admission indicate poor prognosis; patients with admission surgery time≤ 12 h have better prognosis. Conclusion:For the treatment of patients with Vibrio vulnificus sepsis, medical staff should dynamically evaluate these prognostic factors in the early stage, and early surgical treatment should be adopted to improve the prognosis of patients.

Objective To investigate the clinical manifestions, pathological features and diagnosing methods of Lafora disease. Methods The chnical and pathological features of 5 patients with Lafora disease who were diagnosed by axillary biopsies were systemically studied. The specimen were stained by HE, PAS and AB-PAS methods. Results Four of 5 cases had an onset during adolescence and 1 during adulthood. All cases presented with progressive generalized tonic-clonic seizure, myoclonus and dementia. Emotional disturbance, dysarthria and ataxia appeared in the early course of the disease. Lafora bodys were identified in myoepithelial cells and duct cells of both eccrine sweat glands and apecrine sweat glands in the biopsies of axillary skin. Conclusions Lafora disease could be confirmed by round and oval periodic acid-Schiff- positive inclusions in skin biopsy specimen combined with the proper clinical settings. Both axillary and other skins can be chosen as the sites of biopsy.

Objective To explore the expression of nestin and Ki-67 in malignant peripheral nerve sheath tumors (MPNST) and its significance in the differential diagnosis. Methods Immunohistochemical technique (SP) was used to detect the expression of nestin and Ki-67 in 42 cases of MPNST and 24 cases of benign peripheral nerve tumor.Results Total expression of nestin was found in 95.2 ％(40/42) of MPNST.Strong expression of nestin was detected more frequent in MPNST compared to benign peripheral nerve tumors [40.5 ％(17/42) versus 4.2 ％(1/24),x2 =8.403,P =0.004].Ki-67 labeling index in MPNST varied from 1％-70 ％.However,greater than 3 ％ labeling index of Ki-67 staining was observed in 64.3 ％(27 / 42) of MPNST while none of the 24 benign tumors had nuclear staining exceeding 3 ％. The higher Ki-67 labeling index showed significant differences between the two groups (x2 =23.518,P =0.000).Conclusion Nestin and Ki-67 are useful markers in distinguishing MPNST from benign tumors.

Objective To investigate the implementation of the system of older pregnant women prenatal ultrasound screening for the diagnosis and clinioal significance.Methods Clinical data from March 2004 to April 2009 a total of 10 630 cases of pregnant women receiving prenatal ultrasound examination of fetal malformation data,of which 712 cases of advanced maternal age( expected date of birth aged≥35 years) to implement the system of prenatal ultrasound screening and follow-up of all maternal age pregnancy outcome,the final post-natal diagnosis of fetal malformations in the standard,both young women screened as a control group for comparison to assess the value of prenatal ultrasound diagnosis.Results 712 cases of advanced maternal age,prenatal ultrasound diagnosis of fetal malformations in 32 cases,abnormalities occur in approximately 4.49％,single abnormal in 15 cases,complex deformity in 17 cases,missed 4 cases of malformation detection rate was 88.88％ (36/32).Control group,9918 cases of prenatal ultrasound diagnosis of fetal malformations 243 cases,2.45％ incidence of deformity (243/9 918 ).Conclusion Older pregnant women,prenatal ultrasound screening for malformations occur in approximately 4.49％,higher than the detection rate with screening younger women 2.45％,of older pregnant women according to the results of prenatal diagnostic screening could be effective in reducing the birth rate of deformed children and the rate of misdiagnosis.

Objective To investigate the effect of propofol on the brain injury in children undergoing open heart surgery under cardiopulmonary bypass (CPB).Methods Thirty children aged 4-10 yr undergoing repair of ventricular septal defect or atrial septal defect under CPB were randomly divided into 2 groups ( n = 15 each):control group (group C) and propofol group (group P). Anesthesia was induced with iv injection of sufentanil 1 μg/kg, propofol 2.5 mg/kg (midazolam 0.2 mg/kg in group C) and pipecuronium 0.1 mg/kg in group P. Anesthesia was maintained with iv infusion of 1％ propofol 6 mg·kg-1 ·h-1 (0.05％ midazolam 0.2 mg·kg-1 ·h-1 in group C) until the end of operation. Isoflurane ( 1％-2％ ) were inhaled during the operation in all patients. Sufentanil 1 μg/kg and pipecuronium 0. 1 mg/kg were injected intravenously after the start of CPB. A catheter was inserted into right internal jugular vein and advanced cephalad until jugular bulb for blood sampling before CPB, at 30 min of CPB, at the end of CPB, at 30 min after termination of CPB, at the end of operation, and at 24 h after termination of CPB to detect the plasma concentrations of 8-iso-PGF2 and S-100β by ELISA. Arterial and jugular bulb venous blood samples were collected for determination of SjvO2 before CPB, when naso-pharyngeal temperature was reduced to 30 ℃, when naso-pharyngeal temperature returned to 36 ℃ and at the end of CPB. Cerebral arterial venous oxygen content differences ( Da-jvO2 ) and cerebral oxygen extraction rate of oxygen ( CEO2 ) were calculated. Results Plasma concentrations of 8-iso-PGF2α and S-100β were significantly lower, SjvO2 was significantly higher, Da-jvO2 and CEO2 were significantly lower in group P than in group C (P ＜ 0.05＝. ConclusionPropofol can reduce the brain injury in children undergoing open heart surgery during CPB and the mechanism is related to decrease in cerebral oxygen metabolic rate and lipid peroxidation.