Objective:To investigate the clinical efficacy, safety and tolerance of different enteral nutritional therapy in the treatment of moderately severe acute pancreatitis (MSAP).Methods:From January 2018 to January 2019, 65 patients with MSAP who were hospitalized in Beijing Chao-Yang Hospital, Capital Medical University were prospectively enrolled. According to random number table, the patients were divided into the nasogastric tube enteral nutrition (NGEN) group (35 cases) and the nasojejunal tube enteral nutrition (NJEN) group (30 cases). All the patients received enteral nutrition solution through continuously pumping at a constant speed for 24 h. The two groups were compared in the relief time of abdominal pain, time from admission to receiving enteral nutrition treatment, time to resume oral feeding, computed tomography severity index (CTSI) score 1 week after enteral nutrition, nutrition status, infection parameters, hospitalization time, hospitalization expenses and complications. Independent sample t test and rank sum test of two independent samples were used for statistical analysis. Results:There were no significant differences in age, gender, body mass index (BMI), CTSI score and Ranson score at admission, relief time of abdominal pain, time from admission to receiving enteral nutrition treatment, time to resume oral feeding, CTSI score one week after enteral nutrition or hospitalization time between NGEN group and NJEN group (all P>0.05), and there was no death in both groups. The cost of hospitalization, catheterization time, cost of catheterization of NGEN group were all lower than those of NJEN group ((40.0±10.0) thousand yuan vs. (40.4±9.0) thousand yuan; 2.00 min (1.50 min, 2.50 min) vs. 11.50 min (9.50 min, 12.75 min); 135.42 yuan (135.42 yuan, 135.42 yuan) vs. 1 313.30 yuan (1231.20 yuan, 1 823.72 yuan)), and the differences were statistically significant ( t=2.342, Z=6.737 and 7.687, all P<0.01). The albumin levels of MSAP patients of the NGEN group at admission and 1 week after enteral nutrition were both higher than those of NJEN group ((43.5±5.1) g/L vs. (41.0±4.0) g/L, (42.1±4.1) g/L vs. (39.5±4.4) g/L), and the differences were statistically significant ( t=2.135 and 2.486, P=0.04 and 0.02), however there was no statistically significant difference in the decrease of albumin level between the two groups ( P>0.05). There were no statistically significant differences in the incidence of nutrition-related complications (abdominal distension, diarrhea, gastric retention and lumen obstruction) or the incidence of severe complications (transient organ failure and pancreatic necrosis complicated with infection) between NGEN group and NJEN group (all P>0.05). Conclusions:The efficacy and safety of NGEN are equivalent to NJEN in MSAP. Moreover, it can reduce the medical expenses of patients, and it is convenient to carry out in primary hospitals because of its easy operation.

Objective:The study aims to explore the abnormal characteristics in cerebral cortex among children with different subtypes of attention deficit hyperactivity disorder (ADHD).Methods:Four hundred and twelve samples were obtained from the Healthy Brain Network project of American Child Mind Institute. There were 288 children with ADHD (all subjects: age,M=10.03,SD=3.11; 151 of ADHD-C, 20 of ADHD-H, and 117 of ADHD-I) and 124 healthy controls (age,M=9.98,SD=2.98). Using FreeSurfer software, we processed the brain structure images and obtained the cortical volume, cortical thickness and surface area for each subject. Analysis of Variance (ANOVA) and post hoc comparison analyses were conducted.Results:ANOVA analysis showed significant differences of the cortical volume located in the left superior parietal gyrus ( Z=5.94) and superior temporal gyrus ( Z=5.49) among the 3 subtypes of ADHD children and the healthy controls (Monte Carlo, P<0.05). Compared with the healthy controls, ADHD-H group exhibited an increased cortical volume in the left superior parietal gyrus ( Z=6.79), while the ADHD-I group had a decreased volume in the left superior temporal gyrus ( Z=-5.12) and lateral occipital cortex ( Z=-6.40). ADHD-C group also had a decreased volume in the left lateral occipital cortex ( Z=-3.37). Among 3 subtypes of ADHD patients, both ADHD-I and ADHD-C groups had a smaller volume in the left superior parietal gyrus than that of the ADHD-H group (ADHD-I: Z=-7.33,MNI coordinate:x=-26.8,y=-60.6,z=45.4; ADHD-C: Z=-7.14,MNI coordinate:x=-26.6,y=-60.2,z=45.4). Additionally, there was no statistical difference in cortical volume between the ADHD-I and ADHD-C group (Monte Carlo, P>0.05). Subsequent supplementary analyses showed that the sample size and age had no significant effect on the above results. Moreover, analysis of cortical thickness and the surface area showed that the abnormality of the cortical volume in different ADHD subtypes was mainly determined by the surface area of the cerebral cortex. Conclusion:Cortical measures in the superior parietal gyrus might be the crucial features that distinguishes the different subtypes of ADHD. These results enable us to further explore the neurodevelopmental mechanism of ADHD and guide the precise and specific clinical treatment.

Objective:The study aims to explore the abnormal characteristics in cerebral cortex among children with different subtypes of attention deficit hyperactivity disorder (ADHD).Methods:Four hundred and twelve samples were obtained from the Healthy Brain Network project of American Child Mind Institute. There were 288 children with ADHD (all subjects: age,M=10.03,SD=3.11; 151 of ADHD-C, 20 of ADHD-H, and 117 of ADHD-I) and 124 healthy controls (age,M=9.98,SD=2.98). Using FreeSurfer software, we processed the brain structure images and obtained the cortical volume, cortical thickness and surface area for each subject. Analysis of Variance (ANOVA) and post hoc comparison analyses were conducted.Results:ANOVA analysis showed significant differences of the cortical volume located in the left superior parietal gyrus ( Z=5.94) and superior temporal gyrus ( Z=5.49) among the 3 subtypes of ADHD children and the healthy controls (Monte Carlo, P<0.05). Compared with the healthy controls, ADHD-H group exhibited an increased cortical volume in the left superior parietal gyrus ( Z=6.79), while the ADHD-I group had a decreased volume in the left superior temporal gyrus ( Z=-5.12) and lateral occipital cortex ( Z=-6.40). ADHD-C group also had a decreased volume in the left lateral occipital cortex ( Z=-3.37). Among 3 subtypes of ADHD patients, both ADHD-I and ADHD-C groups had a smaller volume in the left superior parietal gyrus than that of the ADHD-H group (ADHD-I: Z=-7.33,MNI coordinate:x=-26.8,y=-60.6,z=45.4; ADHD-C: Z=-7.14,MNI coordinate:x=-26.6,y=-60.2,z=45.4). Additionally, there was no statistical difference in cortical volume between the ADHD-I and ADHD-C group (Monte Carlo, P>0.05). Subsequent supplementary analyses showed that the sample size and age had no significant effect on the above results. Moreover, analysis of cortical thickness and the surface area showed that the abnormality of the cortical volume in different ADHD subtypes was mainly determined by the surface area of the cerebral cortex. Conclusion:Cortical measures in the superior parietal gyrus might be the crucial features that distinguishes the different subtypes of ADHD. These results enable us to further explore the neurodevelopmental mechanism of ADHD and guide the precise and specific clinical treatment.

Objective: To study and analyze the risk factors of deep Venous Thrombosis of Lower limbs in patients with Orthopaedic bed rest. Methods: 273 cases of patients with bed rest who were treated by Orthopaedic operation from November 2015 to March 2016 and from November 2016 to March 2017 in our hospital were.collected and divided into 2 groups according to whether there were deep venous thrombosis after operation, and A group had 232 patients who did not have deep venous thrombosis of lower limbs after Operation. B Group had 41 patients who had deep venous thrombosis of lower limbs after Operation. The two groups of patients were treated with orthopedic treatment, the researchers recorded the basic data of two groups of patients, and analyzed the risk factors of lower extremity deep venous thrombosis in patients with orthopedic Bed rest. Results: In group B, patient ratio of age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m², with chronic diseases, bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500 μgP/L, operating time over 4 h were 54.10% (23/41), 58.54% (24/41), 75.61% (31/41), 60.98% (25/41), 58.50% (24/41), 63.41% (26 /41), 48.78% (20/41), respectively.In group A, patient ratio of age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m², with chronic diseases, bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500ugP/L, operating time over 4 h were 24.14%(56/232), 23.28% (54/232), 13.36% (31/232), 23.28% (54/232), 21.12% (49/232), 10.78% (25/232), 9.91% (23/232), respectively, The difference between the two groups was statistically significant (χ²=3.602~11.623, all P < 0.05); Related risk factors for deep venous thrombosis in lower limbs logistic regression analysis showed that age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m², with chronic diseases, bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500 μg/L, operating time over 4 h were the related risk factors for deep venous thrombosis in patients with bed rest after operation. Conclusion the risk factors for deep venous thrombosis of lower limbs in the elderly patients with bed rest after orthopedic operation are mainly age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m², with chronic diseases (such as hypertension, diabetes, etc.), bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500 μg/L, operating time over 4 h, nursing staff should carry out nursing intervention according to the risk factors related to deep venous thrombosis of lower limbs to avoid the formation of deep vein thrombosis of lower limbs as far as possible.

Objective To investigate nurses' scientific research competency and training demand in Chinese tertiary hospital.Methods It was a multi-stage large-scale survey.A total of 27 335 nurses from 22 provinces/autonomous regions/municipalities were recruited to complete the self-designed questionnaire,including demographic data(7 items),scientific research competency(objective index of 4 items,and subjective index of 6 subscales with 40 items),and training demand evaluation(6 subscales with 16 items).Results There were 1 130(4.14％) nurses who had managed or were managing the research projects as principal investigators(PIs),2 147(7.85％)nurses who had attended or were attending research programs,1 463(5.35％) nurses had published papers,and 557(2.04％) nurses obtained patents.The self-evaluated competency score was 25.00 (12.50,37.50)(rangedfrom 0 to 100)and training demand score was 53.13(37.50,75.00)(ranged from 0 to 100).Conclusion The nurses' scientific research competency should be improved and they had strong training demands.In order to improve nurses' research competency and quality,nursing administrators should pay more attention to post-graduate training focusing on research competency.

Objective To study the psychological experience of the primary caregivers of patients with lower extremity deep vein thrombosis in Department of Neurosurgery, and to provide the basis for the establishment of nursing intervention measures under the cultural background of China. Methods By using qualitative phenomenological research method, 13 caregivers of patients with lower extremity deep vein thrombosis in Department of Neurosurgery were semi structured interviewed from May to October in 2017, and data were analyzed by using Colaizzi method. Results In the end, 4 themes were generated. They were psychological response at the beginning of diagnosis, the pressure in the process of care, changes in social adaptation ability and coexistence of difficulties and hopes. Conclusions The mood of caregivers is directly related to the physical and mental health of patients with lower extremity deep vein thrombosis. When interviewing patients, medical staff should give more knowledge of disease and psychological counseling to their caregivers to reduce the uncertainty of disease, release the burden of primary caregivers and ultimately promote them recovery.

Objective To explore the effects of signaling pathways inducing activation of DC-SIGN promoter on the activity of HIV-1 5'LTR.Methods The sequences of DC-SIGN promoter and HIV-1 5'LTR were amplified by PCR and then cloned into pGL-3/Basic plasmid to constructluciferase reporter plasmids for DC-SIGN promoter and HIV-1 5'LTR.Differentiated THP-1 cells stimulated by PMA (phorbol myristate acetate) were used as the in vitro model of DCs.The activaties of DC-SIGN promoter and HIV-1 5'LTR induced by IL-4 in differentiated THP-1 cells were studied using luciferase reporter plasmids.The signaling pathways were identified by using specific inhibitors.Results IL-4 induced signaling pathways could increase the activities of HIV-1 5'LTR and DC-SIGN promoter for more than two times in THP-1 cells transfected with luciferase reporter plasmids.However,the activity of HIV-1 5'LTR was weaker than that of DCSIGN promoter.ERK/JAK-STAT/NF-κB signal pathway blockers could inhibit the luciferase activity driven by DC-SIGN promoter,of which ERKI/2 blocker showed the strongest inhibitory effect that almost completely blocked IL-4 induction.NF-κB blocker had a significant inhibitory effect on HIV-1 5'LTR activity at a rate of 52.32％,followed by the ERK blocker at a rate of 43.31％.Conclusion This study suggested that IL-4-induced signaling pathways mediate the activation of DC-SIGN promoter and HIV-1 5'LTR through NFκB and ERK.

ObjectiveTo discuss the clinical diagnosis and treatment of multiple endocrine neoplasia ( MEN ) 2A, and report the mutation of the RET proto-oncogene in a pedigree of three patients with MEN 2A.MethodsBilateral adrenalectomy was performed on two of the three patients with hypertension and bilateral adrenal-conserving adrenal pheochromocytoma resection was performed on the other patient. All three patients were treated by total thyroidectomy and neck lymphadenectomy. Twelve family members were recruited to the study. Peripheral blood was collected and total genomic DNA was prepared for polymerase chain reaction (PCR). PCR products of exon 10 and exon 11 of the RET proto-oncogene were purified and a direct DNA sequence analysis was performed.ResultsThe pathological diagnosis of the specimens was bilateral adrenal pheochromocytoma and medullary thyroid carcinoma in all the three patients. There was no tumor recurrence or distant metastasis after 1.5 - 5 years of follow-up. A missense mutation of TGC (Cys)to CGC (Arg) at codon 634 in exon 11 of the RET proto-oncogene was detected in all three patients. Genetic screening identified two mutation carriers in the other members of this pedigree.ConclusionGenetic mutation screening and surgical intervention may be helpful to the members of high-risk families.