OBJECTIVETo perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation.

METHODSThe electronic databases of PubMed, Springerlink, the Chinese Biomedical Database (CBM), the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms: nutritional support, enteral nutrition, parenteral nutrition, hepatic/liver surgery, liver cirrhosis, cancer, hepatectomy, and liver transplantation. The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration. The meta-analysis was conducted using RevMan software, version 5.2.

RESULTSA total of 11 relevant RCTs, representing 510 patients, were included in the meta-analysis. Compared to patients in the control (normal nutrition) group, the patients in the BCAA group experienced an effective improvement in hepatic function, as evidenced by significant decreases in total bilirubin (by 0.07 mumol/L; 95% confidence interval (CI): -0.18 to 0.05, P more than 0.05]. In addition, the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) = 0.07; 95% CI: 0.06, 0.24, P less than 0.05) and alanine aminotransferase (WMD = +5.61; 95% CI: -8.63 to 19.86, P more than 0.05] but neither of the changes reached the threshold of a statistically significant improvement. The BCAA group did however show significantly lower complication rate after operation (65%, 95% CI: 0.48, 0.87, P less than 0.01] and mean duration of hospital stay (4.61 days; 95% CI: -6.61, -2.61, P less than 0.01].

CONCLUSIONBCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation, thereby helping to reduce the complication risk, duration of hospital stay, and financial burden. BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.

Amino Acids, Branched-Chain ; therapeutic use ; Hepatectomy ; methods ; Humans ; Intraoperative Period ; Liver ; physiology ; surgery ; Liver Transplantation ; methods ; Nutritional Support ; methods ; Randomized Controlled Trials as Topic

Objective To observe the effect of Botulinum toxin type A (BTX-A) injection on spastic hamstring in the children with cerebral palsy. Methods 39 cerebral palsy children with spastic hamstring were divided into control group (n=20) and experimental group (n= 19). The control group accepted physical therapy, while the experimental group accepted BTX-A injection in affected hamstring in addition.They were assessed with modified Ashworth Scale (MAS), Gross Motor Fucntion Measure (GMFM-88) and flexion angle of knee joints before and after treatment. Results The scores of MAS and GMFM-88, and flexion angle of knee joints improved significantly 6 weeks after treatment in the experimental group (P<0.05), and improved more than that in the control group (P<0.05). Only the score of GMFM-88 improved significantly in the control group (P<0.05). Conclusion BTX-A injection can relieve hamstring spasticity in children with cerebral palsy, which may be helpful to correct abnormal gait and improve the motor function.

This paper introduced a system for rehabilitation residency training, including the object, courses, assessment, and the structure.

Objective To observe the effect of Botulinum toxin-A (BTX-A) injection on spastic iliopsoas in the children with cerebral palsy. Methods July 2006 to August 2012, 37 cerebral palsy children with spastic iliopsoas were treated. The age ranged from 3 to 15 years.The control group (n=20) was treated by physical therapy. The experimental group (n=17) accepted BTX-A injection in addition. The dose of BTX-A block was identified with the weight of the child and the modified Ashworth Scale (MAS). The dose of injection ranged from 15 IU to 45 IU, average (31.2±13.9) IU. Results There was no significant difference between 2 groups in age, weight, MAS score, Gross Motor Function Measure (GMFM) score and extension angle of hip joints before treatment (P>0.05). In both groups, the MAS score decreased,GMFM score and extension angle of hip joints increased after 8 weeks. In the control group, the GMFM score improved significantly (P<0.05). In the experimental group, MAS score, GMFM score and extension angle of hip joints changed significantly after treatment. There was significant difference between 2 groups in MAS score, GMFM score and extension angle of hip joints after treatment (P<0.05). Conclusion The BTX-A injection can relieve iliopsoas spasticity on the children with cerebral palsy efficiently.

Objective To investigate the effect of conductive education applied in water exercise on cerebral palsy. Methods 58 children with cerebral palsy who could accept conductive education were divided into observation group (n=29) and control group (n=29) randomly. All the children accepted routine rehabilitation, and the observation group accepted water exercise in the model of conductive education. They were assessed with muscular strength, muscular tension (modified Ashworth Scale) and the Gross Motor Function Measure (GMFM) before and after training. Results The score of GMFM improved more in the observation group than in the control group (P<0.05), as well as the incidence of improvement of muscle tension (released 1 grade or more, 75.9% vs. 44.8%, P<0.05) and muscle strength (increased 1 grade or more, 82.8% vs. 58.6%, P<0.05). Conclusion Water exercise with the conductive education model can improve the gross motor function and muscle strength, release the spasticity in children with cerebral palsy.

Objective To compare the advantages and disadvantages of botulinum toxin A (BTX-A) and phenol block in the treatment of spasticity in children with cerebral palsy. Methods Four hundred and twenty children with spastic cerebral palsy were divided into an experimental group (375 cases) and a control group (45 cases).The children were aged from 1 to 22 years ( average age 6 years).The children in the experimental group were treated with BTX-A block at a dosage of 55 to 350 IU (average 130.5 IU).The children in the control group were treated with a 5％ phenol solution block at a dosage of 0.5 to 4.6 ml ( average 2.2 ml).Children of both groups were given systematic functional rehabilitation training. All the children were evaluated with a physician rating scale (PRS) and the modified Ashworth scale (MAS) before and after the blocking.Effectiveness rates,effectiveness durations and side effects rates were calculated. Results Before treatment there was no significant difference in terms of motor disorder or spasticity between the 2 groups.After treatment,spasticity had been significantly reduced in both groups.The effectiveness rate was 98.4％ in the experimental group and 95.6％ in the control group,a difference which was not significant.The average effectiveness duration was ( 24.9 ± 5.76 ) weeks in the experimental group and ( 69.2 ± 13.76) weeks in the control group,significantly longer.The side effects rate was 5.33 ％ in the experimental group and 15.56％ in the control group,also a significant difference. Conclusion BTX-A could be more widely used because of its safety and credibility.

Objective To investigate the long-term efficacy of Botulinum toxin type A (BTX-A) on spasticity in cerebral palsy, and theeffect of rehabilitation on it. Methods 230 children with spastic cerebral palsy were treated with BTX-A block. The dose of BTX-A wasidentified with the weight of the children and the Modified Ashworth Scale (MAS). They were divided into group A who exercised morethan 2 h/d, and group B who exercised less than 2 h/d or not. They were assessed with Gross Motor Function Measure (GMFM) 1 year aftertreatment. Results There was no significant difference between group A and B with ages, weight, MAS, GMFM before block (P>0.05), norwith BTX-A effect time (P>0.05). The GMFM improved significantly in both group A and B 1 year after block (P<0.05), and it improvedmore in group A than group B (P<0.01). Conclusion The long-term efficacy of BTX-A block is positive. The rehabilitation training afterblock can help children to improve their gross motor function.

Objective To evaluate the validity of Community Extremity Disability Assessment Schedule (CEDA) in community rehabilitation. Methods 313 patients with hemiplegia after stroke were divided into rehabilitation group and control group. The rehabilitation group received community-based rehabilitation (CBR) for 3 months, and was assessed with Community Extremity Disability Assessment Schedule before and 1 month, 2 months and 3 months after rehabilitation respectively. And it was compared with Fugl-Meyer Assessment (FMA). The control group received the same evaluation only. Results The scores of CEDA and FMA improved more in the rehabilitation group than in the control group 2 months after rehabilitation (P<0.01). The score of CEDA positively correlated with the FMA (r=0.643, P<0.01). Conclusion CEDA can be used to evaluate the efficacy of community rehabilitation.

Objective To investigate the effects of locomotor training on improving locomotor function after spinal cord injury(SCI)and the mechanism of spinal cord plasticity.Methods A model of complete thoracic cord transection was established using 84 adult female rats divided into sham,SCI and treadmill training(BWSTT) groups.The hind limb locomotor function of all the rats was evaluated.The fluorescence intensities due to (EphA4),vesicular glutamate transporter 2(VGluT2)and EphA4/VGluT2 double-positive neurons in the ventromedial area of the anterior horn of the lumbar COrd were detected using immunofluorescence double labeling and laser confocal microscopy.Results The rats in the BWSTT group showed better functional recovery in their hind limbs than those in the SCI group.BWSTT was correlated with markedly increased EphA4.VGIuT2 and EphA4/VGluT2 intensities in the ventromedial area.Conclusion BWSTT improves hind limb locomotor function in rats with thoracic cord transections by elevating the expression of EphA4/VGluT2,promoting neuronal plasticity in the lumbar anterior horn.

OBJECTIVE To understand the pathogens and their drugs resistance in general surgery department and provide rational suggestion of antibiotics use for clinic treatment.METHODS A total of 158 cases with nosocomial infection among the general surgery department inpatients from Jun 2006 to Oct 2008 were retrospectively analyzed and summarized.RESULTS The common nosocomial infection sites were the lower respiratory tract,gastrointestinal tract,urinary tract and surgical sites.The G-bacilli of nosocomial infections in turn were Escherichia coli(18.02%),Acinetobacter baumannii(11.26%),Pseudomonas aeruginosa(7.66%),and Klebsiella pneumoniae(4.50%).The main G+cocci were Staphylococcus aureus(21.62%),Enterococcus faecium(5.86%)and E.faecalis(3.15%)in turn.In G-bacilli,the sensitivity to imipenem was the highest from 58.82% to 100.00%.The sensitivity to amikacin were more than 70.00% except A.baumannii,and to sulbactam/cefoperazone were more than 50.00% except Pseudomonas aeruginosa.In G+ cocci,the sensitivity to vancomycin of S.aureus and E.faecium was 100.00% and 84.62%.CONCLUSIONS Investigating the pathogens and their drug resistance in general surgery department is very important to prevent and control nosocomial infections.