外科营养学是在现代外科学基础上发展起来的一门新兴学科。自上世纪60年代Dudrick提出的肠外营养(PN)治疗在临床实施后，应用逐渐广泛，挽救了大量肠道功能衰竭和危重患者的生命。我国的外科营养学虽起步晚于国外，整体水平还有待提高，但通过众多临床医师和科研人员的不断努力业已呈现出一派欣欣向荣的景象……
Objective To study the application of pressure regulated volume control ventilation in respiratory support after liver transplantation. MethodsTwenty patients underwent liver transplantation were randomly averagely divided into two groups: pressure regulated vlume control ventilation (PRVCV) group and volume control (VC) group. The parameters of respiratory mechanics, hemodynamics and blood gas analysis of patients in two groups were compared, such as oxygen delivery (DO2), oxygen consumption (VO2), oxygen incepation ratio (O2ER), arteriovenous oxygen content difference (C(a-v)O2), cardiac output (CO), mean arterial pressure (mABP), mean pulmonary arterial pressure (mPAP), alveolar-arterial PO2 difference 〔P(A-a)O2〕, gas exchange index (PaO2/FiO2)， ratio of shunted blood to total perfusion (Qs/Qt), peak inspiratory pressure (PIP) and mean airway pressure (mAP). Results The P(A-a)O2 and Qs/Qt were significantly decreased in PRVCV group than those in VC group 〔P(A-a)O2: (101.42±28.07) mm Hg vs. (136.76±39.13) mm Hg; Qs/Qt: (1.78±0.86)% vs. (3.28±0.99)%〕, P＜0.05, P＜0.05， while the C(a-v)O2 and O2ER were significantly increased 〔C(a-v)O2: (20.70±10.41) mm Hg vs. (12.83±2.49) mm Hg; O2ER: (16.34±9.79)% vs. (9.37±1.83)%〕, P＜0.05, P＜0.01. There was no difference in the hemodynamics and airway pressure parameters between PRVCV group and VC group. Conclusion PRVCV mode could be a more suitable mechanical ventilation pattern to patients after liver transplantation.
Objective To retrospectively analyze the epidemiology, clinical characteristics and causes of misdiagnosis of Juvenile myoclonic epilepsy (JME) in Xinjiang Uygur Autonomous Region, so as to provide basis for improving the diagnosis and treatment of JME. Methods 979 patients with epilepsy in Xinjiang Uygur Autonomous Region were analyzed retrospectively. There.were515males and 464females,average.age(18.66+8.31)years,.The epidemiological characteristics of JME were analyzed. The clinical characteristics, EEG, treatment effect and prognosis of patients diagnosed with JME were analyzed. The causes of misdiagnosis, missed diagnosis and delayed treatment were analyzed. Results The proportion of JME in 979 patients with epilepsy was 1.4%, a total of 14 cases. The median age of onset was (15+5.83) years, the median time from onset to treatment was 3 years, and the median time from onset to diagnosis was 6 years. All patients showed myoclonic seizures, 13 cases were complicated with generalized tonic clonic seizures, and 4 cases were accompanied by absence seizures. EEG findings include normal background activity, 3-6 Hz generalized spikes or frontal dominant multiple spikes at the beginning of arousal. seven patients were treated with levetiracetam, and the other seven patients were treated with lamotrigine and / or sodium valproate. Incomplete collection of medical history and failure to describe the medical history in detail are the main reasons for delaying diagnosis. Conclusion Juvenile myoclonic epilepsy is an treatable disease, but it is easy to be misdiagnosed. The rate of misdiagnosis and missed diagnosis of JME in Xinjiang is higher, and the delay of diagnosis and treatment is longer. The inquiry of more detailed and demonstrative medical history is of great significance to improve the diagnostic accuracy.
ObjectiveTo investigate the effect of Lactobacillus plantarum (LP) on the intestinal barrier function under inflammation. MethodsInterleukin-10 knockout (IL-10－/－) mice were used as the model of inflammatory bowel disease. IL-10－/－ and wild type (WT) mice received the LP or Ringer solutions for 4 weeks. Colitis was assessed by histological score and clinical manifestation was observed. The gut paracellular permeability was measured by Ussing chamber. The concentrations of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were detected by the ELISA method. The expressions and distributions of tight junction proteins were determined by Western blot and immunofluorescence, respectively. ResultsCompared with the WT group, the diarrhea, rectal prolapse, and weight loss were obvious (Plt;0.01), the concentrations of TNF-α and IFN-γ significantly increased (Plt;0.01), the infiltration of numerous inflammatory cells, even transmural ulcers, and crypt abscess were observed, the ultrastructure of tight junction was damaged, the mannitol permeability significantly increased (Plt;0.001) and transepithelial resistance (TER) significantly decreased (Plt;0.001), and the expressions of tight junction proteins (ZO-1, occludin, and claudin-1) significantly decreased (Plt;0.01) in the IL-10－/－ group. Compared with the IL-10－/－ group, the clinical and pathological manifestations of colitis significantly improved (Plt;0.01), the ultrastructural damage of tight junction was prevented, the mannitol permeability significantly decreased (Plt;0.001) and the TER significantly increased (Plt;0.001), the concentrations of TNF-α and IFN-γ significantly decreased (Plt;0.01), and the expressions of tight junction proteins (ZO-1, occludin, and claudin-1) significantly increased (Plt;0.01) in the IL-10－/－+LP group. ConclusionTreatment with LP ameliorates colonic epithelial barrier dysfunction by promoting the expressions of tight junctional proteins in IL-10－/－ mice.
ObjectivesTo systematically review the efficacy and safety of Orlistat for obese patients with cardiovascular risk including hyperlipidemia, hypertension, diabetes and prediabetes.MethodsSinomed, CNKI, WanFang Data, PubMed, EMbase, The Cochrane Library and ClinicalTrails.gov databases were electronically searched to collect randomized controlled trials (RCTs) of Orlistat for obese patients with cardiovascular risk such as hyperlipemia, diabetes, prediabetes and hypertension from inception to Jan 7th, 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using Stata 14.0 software.ResultsA total of 28 RCTs were included. The results of meta-analysis showed that, compared with placebo, Orlistat could significantly reduce the weight (MD=–2.85, 95%CI –3.47 to –2.24, P=0.000), waist (MD=–2.45, 95%CI –3.07 to –1.83, P=0.000) and BMI (MD=–1.29, 95%CI –2.08 to –0.49, P=0.002) of patients. Orlistat could also control the blood pressure, blood glucose and other cardiovascular risk factors well. Compared with the blank control, Orlistat could improve the waist and parts of cardiovascular risk factors (P<0.05). The incidence of adverse events of Orlistat was slightly higher than that of placebo, but most could be self-healing.ConclusionsCurrent evidence shows that compared with placebo and blank control, Orlistat is effective for improving both weight loss and some cardiovascular risk factors. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo compare the clinical therapeutic efficacy of radiofrequency ablation (RFA) and external beam radiation (XRT) in the treatment of early hepatocellular carcinoma (HCC). MethodsThe early HCC patients were collected in the SEER (Surveillance, Epidemiology, and End Results) database, from 2010 to 2015, according to the established inclusion and exclusion criteria. The patients were assigned into an XRT group and a RFA group according to according treatment plans. The propensity score matching (PSM) was performed at a ratio of 1∶4 based on age, gender, race, alpha-fetoprotein (AFP), cirrhosis, and tumor diameter. The overall survival of the patients of the two groups was compared, and the risk factors affecting the long-term prognosis for the early HCC patients were analyzed. ResultsA total of 2 861 early HCC patients were collected, including 2 513 in the RAF group and 348 in the XRT group. After PSM, a total of 1 582 patients were enrolled, including 343 in the XRT group and 1 239 in the RFA group. After PSM, the proportion of tumor with larger diameter (>5 cm) in the XRT group was still higher than that in the RAF group (P<0.001), but there were no statistically significant differences in the other clinical pathological characteristics between them (P>0.05). The Kaplan-Meier survival curves of the RFA group was better than that of the XRT group (HR=1.65, P<0.001); The stratified analysis based on the tumor diameter revealed that the survival curves of the RFA group were superior to those of the XRT group in the HCC patients with tumor diameters <3 cm, 3–5 cm, and >5 cm (<3 cm: HR=1.79, P<0.001; 3–5 cm: HR=1.50, P<0.001; >5 cm: HR=1.67, P=0.003). The results of the multivariate Cox regression model analysis showed that the older age (≥65 years), higher AFP level (≥400 μg/L), larger tumor diameter (≥3 cm), and later AJCC stage (stage Ⅱ) were the risk factors for overall survival in the early HCC patients (RR>1, P<0.05), while XRT treatment was a risk factor for shortening overall survival in the HCC patients (HR(95%CI)=1.62(1.41, 1.86)=1.61, P<0.001). ConclusionThe data analysis results from the SEER database suggest that the long-term overall survival of RFA treatment is superior to XRT treatment for patients with AJCC stage Ⅰ or Ⅱ.