Enhanced recovery after surgery (ERAS) has developed continuously in China for 10 years,including optimizing step by step the perioperative analgesia regimens and goal-oriented fluid therapy.The ERAS principle has been accepted and expanded extensively in the surgery field,meanwhile,ERAS for perioperative care have been proved valueble in shortening hospital stay,reducing complications,improving organ function,reducing surgical stress reaction,accelerating recovery and increasing survival rate.ERAS is in the ascendant,and promotes development of multidisciplinary training and education program,supples of high-quality research evidences and translational clinical applications seem to be the direction of ERAS.And therefore,the content that this paper talks about is of great significance to deepen the research and understanding of ERAS.

Cancer cachexia patients have severely metabolic disorders. The release of tumor specific cachectic factors and increased synthesis of cytokines will lead to reinforced catabolism、decreased anabolism and increased energy expenditure of the patients. Progressive depletion of host reserves of adipose tissue and protein will lead to decreasing organs function ,and ultimately the failure of the patients.By increasing understanding of the mechanisms involved in cancer cachexia process,the application of mechanism based anticachectic agents will make great improvements in the therapy of cancer cachexia.

Objective To investigate effect of double end-to-side neuroanastomosis for bilateral obsolete proper digital nerve injuries.Methods From November 2000 to October 2009,40 patients with bilateral obsolete proper digital nerve injuries were admitted to our center.Fifteen patients underwent double end-to-side neuroanastomosis.During operation,the injured digital nerve was excised,then bilateral distal ends and proximal ends were sutured,respectively; consequently,the distal and proximal nerve bows were formed.A cutaneous antebrachii lateralis nerve was freed and obtained from the homolateral forearm,then divided equally to 2 parts which were used to bridge the 2 nerve bows.Thirteen patients underwent single end-to-side neuroanastomosis,while other 12 patients underwent end-to-end neuroanastomosis.Results Thirty one patients were successfully followed up for 6 to 8 months.In double end-to-side neuroanastomosis group,12 patients were successfully followed up; anaesthesia and pain of the injured fingers disappeared completely; finger pulp was plump with good flexibility; the average result of sensation measurement was S(4.21 ±1.97),which was significantly higher than those of the other 2 groups; the average result of two point discrimination was 5.4±0.9 mm which was significantly lower than those of the other 2 groups.In single end-to-side neuroanastomosis group,10 patients were successfully followed up; anaesthesia relieved and spontaneous pain disappeared completely,but there was still tenderness; the average result of sensation measurement was S(1.57±0.72); the average result of two point discrimination was 7.2±1.2 mm.In end-to-end neuroanastomosis group,9 patients were successfully followed up; anaesthesia and pain relieved; the average result of sensation measurement was S(3.19± 1.04); the average result of two point discrimination was 7.68±0.8 mm; there were significant differences in results of sensation measurement and two point discrimination between the latter two groups.Conclusion The double end-to-side neuroanastomosis is a valuable method for repairing bilateral obsolete proper digital nerve injuries.

Objective: To investigate the effect of Bortezomib (an inhibitor of proteasome) on IL-6 synthesis and cachexia in colon 26 tumor bearing mice. Methods: Murine colon 26 adenocarcinoma cells were inoculated subcutaneously in male BALB/c mice to induce cachexia. Saline and three doses of Bortezomib (0.1, 0.5 and 1.0 mg/kg) were given intraperitoneally on day 6, 9, 12 and 15 after tumor inoculation and mice were sacrificed on day 16. Body weight, food intake and tumor volume were monitored daily. Serum levels of IL-6 and IL-10, tumor tissue levels of IL-6 and activity of NF-κB in tumor tissues were investigated in all animals. Results: By day 16, saline treated tumor-bearing mice showed significant body weight and carcass weight changes (P<0.01), gastrocnemius muscle wasting and epididymal fat depletion (P<0.01). Furthermore, Tumor-bearing caused a significant increase of IL-6 and IL-10 (P<0.01) in serum and IL-6 in tumor tissues. Administration of Bortezomib attenuated the wasting of carcass weight, gastrocnemius muscle and epididymal fat. Bortezomib dose dependently inhibited the NF-κB activation and IL-6 synthesis of the tumor cells, and the maximal inhibition was observed at the dose of 1.0 mg/kg (P<0.01). Bortezomib 0.5 mg/kg significantly inhibited the increase of serum IL-6 (P<0.01). Bortezomib showed significant anti-tumor effect, and tumor growth was significantly inhibited by Bortezomib with 0.5 and 1.0 mg/kg (P<0.01). Conclusion: Bortezomib can inhibit NF-κB activation, tissue wasting and cancer cachexia.

Objective To explore the diagnosis criterion of acute and chronic radiation oral mucositis induced by ionazition correctly. Methods 40 patients who were given radiotherapy because of head-neck cancer and 40 patients who were irradiated in the whole body for hematogenic stem cell transplant pretreatment were observed and analyzed. They were diagnosed by symptom and sign. Results 28 patients who were given radiotherapy were found acute oral mucous membrane change when cumulate radiation dose attained 30 Gy. The incidence of acute radiation oral mucositis was 70 percent. 20 TBI patients were found oral ulcer in 7 to 8 Gy radiation dose. The incidence of oral ulce was 50 percent. Conclusion The advance limit of irradiated dose for acute and chronic radiation oral mucositis are 20～30 Gy and 50～60 Gy.

Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery.The ERAS programs aim to reduce traumatic stress and postoperative complications,improve full recovery of patients or combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care.The international working group assembled by the ERAS Society composed the 2014 Consensus guidelines for enhanced recovery after gastrectomy Enhanced Recovery After Surgery (ERAS(@)) Society recommendations in July 2014.This guideline is designed for optimal perioperative care for patients undergoing gastrectomy.This paper presented the understanding of hot issues of the guidelines in order to provide the clinical evidence of evidence-based medicine for the surgical field in China.

Objective To compare the sensitivity and specificity of neutrophil CD64 and C-reactive protein( CRP) in the diagnosis of bacterial infection by Meta-analysis. Methods A computerized literature search of PubMed,Embase and Science Citation Index Expanded was conducted to retrieve studies related to evaluating the diagnosis value both of neutrophil CD64 and CRP in bacterial infectious diseases before January 2015. The methodological quality of each included study was assessed. The method of statistical analysis was dichotomous Meta- analysis using STATA 12. 0 software. Results Ultimately we included a total of 10 studies with 1 057 specimens in neutrophil CD64 group and 1 063 specimens in CRP group. Neutrophil CD64 compared with CRP in the sensitivity,OR=1. 755,95%CI(1. 041,2. 958),P=0. 035,while in the specifici-ty,OR=0. 620,95% CI(0. 442,0. 870),P=0. 006. Conclusion In the diagnosis of bacterial infectious dis-eases,neutrophil CD64 is better than CRP in the sensitivity,but,CRP is better than neutrophil CD64 in the specificity.

Gastrointestinal tumor patients are characterized by malnutrition resulting from various elements. So it is necessary to analyze,assess, and treat malnutrition of patients with gastrointestinal tumor. Nutrition support is an indispensable step in tumor therapy.

Objectives: Early postoperative inflammatory ileus(EPII) is a special type of ileus. For its special pathophysiological and clinical characters, EPII is hard to be treated.The combination therapy including total parenteral nutrition(TPN), enteral nutrition(EN), somatostatin and cortin has been used to treat EPII. Methods: From May 2001 to December 2001, 10 EPII patients were treated and the changes of clinical symptoms, serum total protein, albumin, prealbumin and the curative effect were observed. Results: All patients were cured without operation. Two days after treatment, the gastric juice was reduced from (1 377.5?856.8)ml to (484.0?396.3)ml ( P = 0.037 ) but the serum total protein, albumin and prealbumin had no changes. The clinical symptoms subsided quickly. Average TPN time was 21 days and EN time was 9 days. The average time in hospital was 32 days. Conclusions:The combination therapy can obviously alleviate the clinical symptoms, maintain the nutritional status and promote the recovery of intestinal function in EPII patient.

The progressive loss of skeletal muscle protein observed in cancer cachexia may have a negative impact on both the quality of life and the survival time of patients. In recent years, accumulating evidences suggest that the ATP ubiquitin proteasome pathway may be crucial in muscle cachexia. The review is mainly about the role of the ATP ubiquitin proteasome pathway in the degration of skeletal muscle protein during cancer cachexia.