Emphasizing nutritional risk in surgical patients and implementing comprehensive nutritional management / 中华普通外科杂志

Over the past 60 years, clinical nutrition has evolved into a key technology for saving the lives of patients with intestinal failure or complex diseases. However, the 21st century has seen issues with adverse outcomes due to a lack of timely and effective nutritional screening and intervention. Despite the benefits of minimally invasive surgery, nutritional risks or adverse outcomes still exceed 50% in gastrointestinal surgery. The study explores the importance of comprehensive nutritional management for surgical patients, beginning with a reevaluation of their nutritional risks and malnutrition, especially in the context of increasing chronic diseases like cancer, elderly comorbidities, and inflammatory bowel disease. It emphasizes the importance of clinical nutrition guidelines and consensus in surgical practice validated by various studies. The article then details the comprehensive nutritional management of surgical patients, including the importance of nutritional risk screening, assessment, diagnosis, and nutritional support treatment, especially during the early and recovery phases of major gastrointestinal surgery. The aim is to enhance the awareness of surgeons and healthcare workers about nutritional management to improve patients' clinical outcomes and quality of life.

Analysis of risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer / 中华消化外科杂志

Objective:To investigate the risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 196 patients who underwent laparos-copy-assisted radical gastrectomy at Peking Union Medical College Hospital from March 2016 to March 2019 were collected. There were 144 males and 52 females, aged (61±10)years. Observation indicators: (1) early complications after laparoscopy-assisted radical gastrectomy and treatment; (2) analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy.Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( P25,P75). Count data were represented as absolute numbers. Univariate analysis was conducted using the t test, Mann-Whitney U test or chi-square test. Multivariate analysis was conducted using the Logistic regressional model. Results:(1) Early complications after laparoscopy-assisted radical gastrectomy and treatment: 51 of 196 patients had early postoperative complications, including 7 cases of grade Ⅰ according to Clavien-Dindo classi-fication system, 32 cases of grade Ⅱ, 9 cases of grade Ⅲa, 3 cases of grade Ⅲb. There was no grade Ⅳ or Ⅴ complication. There were 25 cases with abdominal complications, 7 cases with thoracic complications, 3 cases with internal/catheter related complications and 16 cases with other unclassified complications. All patients with complications were improved after symptomatic and supportive treatments. (2) Analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy: results of univariate analysis showed that the lymphocyte count, neutrophil-to-lymphocyte ratio, radiotherapy, operation time, volume of intraoperative blood loss, T stage, lymph node metastasis were related factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( Z=?2.048, χ2=6.385, 4.168, 8.068, 6.336, 12.497, 7.522, P<0.05). Results of multivariate analysis showed that the neutrophil/lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis were independent risk factors for early complica-tions after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( odds ratio=2.279, 2.245, 2.226, 95% confidence interval as 1.149-4.519, 1.116-4.517, 1.125-4.402, P<0.05). Conclusions:The abdominal complications are the most common early complications after laparoscopy-assisted radical gastrectomy. The neutrophil-to-lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis are independent risk factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer.

Changes in platelet related parameters in obese patients after sleeve gastrectomy / 中华内科杂志

To compare changes in platelet related parameters in obese patients before and after sleeve gastrectomy (SG), we retrospectively analyzed the clinical data of 31 obese patients who underwent SG in Peking Union Medical College Hospital from December 2012 to September 2020. Results showed that compared with those before surgery, platelet count (PLT) decreased significantly at 2-12 weeks of follow-up ( P=0.009), while platelet distribution width (PDW), mean platelet volume (MPV), and large platelet ratio (P-LCR) increased significantly at the same periods of follow-up after operation ( P<0.001). However, the levels of PDW, MPV, and P-LCR began to decrease at 16-55 weeks when compared with those at 2-12 weeks of follow-up ( P<0.01). PLT was positively correlated with white blood cells and neutrophils at 2-12 weeks of follow-up and positively correlated with high sensitivity C-reactive protein at 16-55 weeks of follow-up after operation ( P<0.05).

Distribution of na?ve T cell and memory T cell subsets in peripheral blood of non-small cell lung cancer patients / 国际肿瘤学杂志

Objective:To investigate the distribution of na?ve T cell and memory T cell subsets in the peripheral blood of non-small cell lung cancer (NSCLC) patients.Methods:A total of 25 NSCLC patients from the Oncology Department of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June to December 2018 were included in the study, and 20 healthy volunteers in the same period were used as controls. Flow cytometry was used to analyze the na?ve T cell and memory T cell subsets in peripheral blood. The results were analyzed by SPSS 16.0.Results:The percentage and absolute number of na?ve T cell/stem-like central memory T cells (T N/SCM) in NSCLC patients declined compared to the control group [(7.71±1.11)% vs. (15.84±2.00)%, t=3.685, P=0.001; (8.38±1.23)×10 7/L vs. (3.40±0.43)×10 8/L, t=6.130, P<0.001]. The percentage and absolute number of central memory T cells (T CM) in NSCLC patients declined compared to the control group [(6.62±1.16)% vs. (17.88±0.83)%, t=7.641, P<0.001; (7.98±1.78)×10 7/L vs. (3.40±0.31)×10 8/L, t=9.028, P<0.001]. The absolute number of CD8 + T CM in NSCLC patients declined compared to the control group [(5.19±1.04)×10 6/L vs. (1.49±0.15)×10 7/L, t=5.561, P<0.001]. The percentage of effector memory T cells (T EM) in NSCLC patients increased compared to the control group [(38.27±2.01)% vs. (17.37±1.06)%, t=8.776, P<0.001]. The percentage and absolute number of CD8 + T EM in NSCLC patients increased compared to the control group [(13.93±1.55)% vs. (4.65±0.52)%, t=5.310, P<0.001; (1.48±0.14)×10 8/L vs. (9.97±1.14)×10 7/L, t=2.584, P=0.014]. The percentage of effector memory T cells re-expressing CD45RA (T EMRA) in NSCLC patients increased compared to the control group [(17.33±1.86)% vs. (8.48±1.01)%, t=3.989, P<0.001]. The percentage and absolute number of CD8 + T CM in stage Ⅰ-Ⅱ patients declined compared to stage Ⅲ-Ⅳ patients [(0.33±0.06)% vs. (0.89±0.34)%, t=2.600, P=0.020; (3.99±0.84)×10 6/L vs. (9.03±3.07)×10 6/L, t=2.270, P=0.040]. There were no statistically significant differences in the na?ve T cells and memory T cell subsets of NSCLC patients with different pathological types. Conclusion:In NSCLC patients, the na?ve/memory T cell subsets are changed compared with the healthy volunteers. The T N/SCM and T CM those with the characteristics of differentiation ability and long-term survival are reduced, and those of the stage Ⅰ-Ⅱ patients are reduced significantly. T EM and T EMRA with immunological effect are increased significantly.

Clinical study of preoperative enteral nutrition on malignant digestive tumors patients with nutritional risk / 国际外科学杂志

Objective To assess the effect of preoperative enteral nutrition on malignant digestive tumors patients with nutritional risk.Methods A prospective clinical study was conducted on 73 malignant digestive tumors patients who were admitted in Department of General Surgery,Peking Union Medical College Hospital from January to June in 2015.Seventy-three patients were screened preoperatively by NRS 2002 and then divided into two groups:enteral nutrition group (n =31) and control group (n =42).Patients in enteral nutrition group were given oral or tube feeding elemental diet for 7-10 days before operation.Patients in control group ate normally.Both patients were given intravenous nutritional support postoperatively.The data of body weight,body mass index,blood total protein,albumin,pre-albumin and incidence of postoperative complications were compared on admission and before operation.Measured data were expressed as (x) ± s.The t-test was used to compare the indexes between groups.The paired t-test was used for comparison between admission and before surgery;the count data were expressed as frequency and percentage (％),comparison between groups use Chi-square test or Fisher's exact probability method.Results The nutritional status including body weight,body mass index,blood total protein,albumin and pre-albumin were significantly improved pre-operatively in enteral nutrition group (P ＜ 0.05),and postoperative complications including wound dehiscence,pneumonia and anatomotic leakage in enteral group were 9.68％,6.45％ and 3.23％ separately,which were less than that in control group (14.4％,11.9％ and 7.14％),however,the result was not significantly different (P ＞ 0.05).Conclusion Pre-operative enteral nutrition is safe and efficacy,which is helpful for malignant digestive tumors patients with nutritional risk.

The progression of parenteral and enteral nutrition based on new guidelines / 中华外科杂志

As people are getting a better understanding of organism′s metabolism and the concept of disease treatment is being continuously updated, parenteral and enteral nutrition become an inter discipline subject that serves for the clinic and involves a number of disciplines. Just in the past five years, related guidelines at home and abroad have been published as much as more than 40. In order to better serve the clinical decision making, this text attempts to give a carding and interpretation from the three aspects of nutrition screening and assessment, the implementing of nutritional intervention and the progress of special nutrition support. It is observed that the standard clinical nutrition diagnosis and treatment process has been formed consensus. But in the practical application, there are still many details need to confirm and further study.

Effect of sleeve gastrectomyon intestinal barrier of obesity rats fed with high-fat diet / 基础医学与临床

Objective To investigate the effect of sleeve gastrectomy on the intestinal barrier of obesity rats fed with high-fat diet.Methods Thirty obesity rats fed with high-fat diet were randomly divided into three groups including common diet group (CD,n=10),sham operation group (SO,n=10) and sleeve gastrectomy group (SG,n=10).The lactulose/mannitol ratios (L/M) in 24-hour urine and endotoxin in portal vein were evaluated four weeks after surgery.The levels of tight junction proteins including claudin-1 and occludin in intestinal mucosa were analyzed by western blot.Results The body weight of SG group was significantly decreased than those of CD group (P<0.001) and SO group (P<0.001) four weeks after surgery.The L/M ratio in 24-hour urine of SG group was significantly lower than those of CD group (P<0.001) and SO group (P<0.01).The endotoxin level in portal vein of SG group was significantly lower than those of CD group (P<0.01) and SO group (P<0.05).The claudin-1 level in intestinal mucosa of SG group was significantly higher than those of CD group (P<0.001) and SO group (P<0.01) four weeks after surgery.The occludin level in intestinal mucosa of SG group was significantly higherthan those of CD group (P<0.001) and SO group (P<0.001).Conclusions Sleeve gastrectomy can reduce body weight,L/M ratio in 24-hour urine and endotoxin level in portal vein of obesity rat fed with high-fat diet and increase the levels of claudin-1 and occludin in intestinal mucosa.

The role of teaching feedback in improvingthe quality of eight-year program clinical medical students' surgery courses / 基础医学与临床

Feedback for teaching refers to the mutual transmission and interaction of various information between teaching and learning in teaching process,and is an inevitable result and objective existence of teaching in which teachers and students participate.Effective feedback for teaching is characterized by timely,comprehensive and authentic.Teachers can continuously modify teaching per formance through the feedback of students;the feedback of teaching by students is reflected in examination performance,which really reflects the idea that teaching benefits teachers as well as students.Clinical comprehensive course of eight-year program students is an important bridge between basic medicine and clinical medicine,and the foundation of teaching clinical medicine.Feedback for teaching was applied in students of academic year 2011 from the Department of Surgery of Clinical College in Pekjing Union Medical College,and teaching approach was adjusted in time,contributing to good teaching effectiveness.

Literature Analysis of Vitamins Utilization in Parenteral Nutrition Prescription in China during 2006-2015 / 中国药房

OBJECTIVE:To investigate the application of vitamins in parenteral nutrition (PN) prescription,and to provide reference for rational use of vitamins in PN. METHODS:Usingparenteral nutritionintravenous nutritionprescription analy-sisrational drug useanalysis of medical orderas keywords,the literatures about the rationality analysis of PN prescriptions were retrieved from CNKI and Wanfang database during 2006-2015,and the utilization of vitamin included in literatures were ana-lyzed and summarized. RESULTS:A total of 34 literatures were included. There were 158874 prescriptions,among which vitamin was used in 145400 prescriptions (91.52%). 12 or 13 kinds of vitamin were used in 73508 prescriptions (46.27%);over-dose drug use was found in 53388 prescriptions(33.60%),and vitamin was not completely added into 18504 prescriptions(11.65%);no vitamin was added into 1663 prescriptions (1.05%). The proportion of the prescriptions including 12 or 13 kinds of vitamin was the highest in northern China (52.00%). 12 or 13 kinds of vitamin were added into the prescriptions and the author believed that the proportion of excessive use of vitamin,incomplete addition of water-soluble vitamin and fat-soluble vitamin in class three grade A hospitals were all lower than hospitals below class three grade A. The prescriptions including 12 or 13 kinds of necessary vi-tamin were adopted in oncology department(97.72%),internal medicine department(86.62%),intensive care unit(77.99%)and surgery department(52.83%). CONCLUSIONS:The standardized use of vitamin PN prescriptions occupies low proportion in Chi-na. It is necessary to enhance the conception that multiple recommended vitamins should be added into PN.

Analysis of the lymphocyte subsets of 508 cases of cancer patients / 国际肿瘤学杂志

Objective To study the characteristics of peripheral blood lymphocyte subsets in patients with lung cancer,gastric cancer and breast cancer.Methods Five hundred and eight patients with cancer from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine (256 cases with lung cancer,152 cases with gastric cancer,100 cases with breast cancer),and 50 healthy volunteers were collected.Two ml peripheral blood were obtained from these cases.The distribution of lymphocyte subsets in peripheral blood was measured by flow cytometry in these cases.The data were analyzed using SPSS 16.0 software.Results The number of lymphocytes of cancer patients was decreased,the healthy volunteers was 5125,breast cancer patient was 3642,gastric cancer patient was 3178,lung cancer patient was 2895.The case of outliers of lymphocyte subsets classified based on the three kinds of cancer was 218 (85.2％,lung cancer),133 (87.5％,gastric cancer),88 (88.0％,breast cancer).The case of outliers of T-lymphocyte subsets classified based on the three kinds of cancer was 83 (32.4％,lung cancer),32 (32.0％,breast cancer),44 (28.9％,gastric cancer).The case of outliers of CD4 +/CD8 + classified based on the three kinds of cancer was 185 (72.3％,lung cancer),108 (71.1％,gastric cancer),84 (84.0％,breast cancer).The case of outliers of natural killer-lymphocyte subsets classified based on the three kinds of cancer was 32 (12.5％,lung cancer),22 (14.5％,gastric cancer),16 (16.0％,breast cancer).The case of outliers of B-lymphocyte subsets classified based on the three kinds of cancer was 38 (14.8％,lung cancer),52 (34.2％,gastric cancer),12 (12.0％,breast cancer).Compared to healthy subjects,the CD19+％ of patients with lung cancer was decreased (12.8 ± 5.0 vs.11.5 ± 5.7,t =3.006,P =0.003);the CD4 + ％ of patients with gastric cancer was decreased (39.2 ±7.7 vs.35.3 ± 7.6,t =2.315,P =0.023);the CD19 + ％ of patients with gastric cancer was decreased (12.8 ± 5.0 vs.8.9 ± 4.2,t =3.302,P =0.010);the CD8 + ％ of patients with breast cancer was increased (24.0 ± 8.1 vs.29.1 ± 13.0,t =2.019,P =0.047).Conclusion The number of lymphocytes in cancer patients is decreased,the abnormal rates of lymphocyte subsets in the three kinds of cancer patients are higher than those in healthy volunteers,the lymphocyte subsets of different kinds of cancers perform different characteristics.

Iodine intake and thyroid disease / 中华地方病学杂志

Iodine is a micronutrient that is essential for the production of thyroid hormones.Either iodine deficiency or excess will not only affect the synthesis and secretion of thyroid hormone but also be related to the occurrence and development of thyroid diseases.Iodine deficiency can cause endemic goiter,cretinism,hypothyroidism and thyroid cancer;high incidence of hyperthyroidism,hypothyroidism,autoimmune thyroid disease,goiter,and thyroid cancer are associated with excessive iodine intake.It is essential to assess iodine nutritional status for the populations,particularly those with thyroid diseases.

Clinical pathological features and prognosis analysis of gastrointestinal stromal tumor: a series of 558 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate and analysis the clinical and pathological characteristic of gastrointestinal stromal tumor (GIST) patients, and to clarify the factors that effect on prognosis.</p><p><b>METHODS</b>The clinical and pathological features and follow-up of GIST patients who received surgery in Peking Union Medical College Hospital from May 2002 to December 2013 were analyzed retrospectively. The prognosis was evaluated by univariate and multivariate analysis. Kaplan-Meier unvariate analysis and Log-rank test were used to compare the survival rates. Multivariate factors for survival were analyzed by Cox proportional hazards regression model.</p><p><b>RESULTS</b>A total of 558 GIST patients were collected, including 284 males and 272 females. The high incidence was in the elderly and age of 50 to 70 years. Most of the primary tumors are located in stomach (303 cases), followed by the small intestine (118 cases). Surgical procedures included R0 resection in 517 cases, R1 resection in 4 cases, R2 or palliative resection in 37 cases. The recurrence risk was very low in 102 cases, low in 156 cases, moderate in 67 cases and high in 233 cases. Of all the patients, 495 cases completed the follow-up, the follow-up rate was 88.7%. Five year survival rate was 87.4%. Patients who took targeted therapy with moderate and high risk of recurrence had a better prognosis compared with not taking the drug. Univariate analysis revealed that the factors impacting the prognosis were age, tumor size, tumor site and mitotic count. Multivariate analysis showed that tumor size (P=0.01, RR=1.562, 95% CI: 1.452 to 15.664), location (P=0.01, RR=1.552, 95% CI:1.324 to 12.225), mitotic figures (P<0.01, RR=1.415, 95% CI: 2.126 to 7.968) and tumor rupture (P=0.01, RR=1.578, 95% CI: 1.543 to 15.892) were independent prognostic factors.</p><p><b>CONCLUSION</b>R0 resection combined with targeted therapy is the best treatment of GIST. Tumor size, location, mitosis count and tumor rupture are independent prognostic factors of GIST patients.</p>

Body composition measurement methods and their clinical application / 中华临床营养杂志

Body composition measurement could significantly facilitate evaluating the content of various body components,getting information about the health status and assessing the diagnosis,treatment,test,and prognosis of several diseases.Human health will be seriously affected by the imbalance of body composition.Body composition measurement methods are generally divided into local measurement methods and general measurement methods.The former ones include skinfold thickness measurement,ultrasonic measurement,computed tomography and nuclear magnetic resonance measurement;while the latter ones include anthropometry,underwater weighing measurement,air displacement measurement,biological resistance measurement,near infrared absorption measurement,dual-energy X-ray absorptiometry measurement,isotope dilution measurement,potassium isotope measurement and three-dimensional body scanning measurement,etc.This article reviews a variety of body composition measurement methods and their clinical application.

Preoperative oral carbohydrate alleviates postoperative insulin resistance and inflammatory reaction / 中华内分泌外科杂志

Objective To observe the effect of preoperative oral administration of carbohydrate on blood glucose,insulin resistance(IR) and inflammatory reaction after gastrointestinal operation.Methods 48 patients receiving gastrointestinal operation were randomly divided into the study group(n =23)and the control group(n =25).Patients in the study group were orally given 25％ glucose solution 300 ml 3 hours before operation.Before anesthesia induction,gastric contents were aspirated through nasogastric tube to examine its volume and pH.Serum high sensitivity C-reactive protein(hsCRP),fasting blood glucose,insulin level and homeostasis model assessment-insulin resistance(HOMA-IR) were detected before operation and on the first morning after operation between the two groups.Results No anesthesia or operation related complications occurred in either groups.Patients had similar gastric contents volume and the PH value of gastric contents.There was no significant difference in serum hsCRP,fasting blood glucose and HOMA-IR between the two groups before operation.But on the first day,fasting blood glucose,HOMA-IR and hsCRP were significantly lower in the study group than in the control group(6.51 ±1.15 vs 7.49 ±0.57 mmol/L,P =0.038;4.34 ± 1.60 vs 6.09 ±2.81,P =0.043;40.45 ± 27.02 vs 80.02 ± 38.98 mg/L,P =0.03).Conclusion Preoperative oral administration of carbohydrate can obviously lower the postoperative blood glucose level and insulin resistance and alleviate postoperative inflammatory reaction.

Correlation analysis between prognostic nutritional index and clinicopathological features and long-term prognosis of resectable gastric cancer / 中华普通外科杂志

Objective To investigate the correlation between the prognostic nutritional index (PNI) and clinicopathological features and long-term prognosis of gastric cancer patients after radical gastrectomy.Methods The clinical data of 135 gastric cancer patients who underwent radical gastrectomy in this hospital from 2002 to 2006 was analyzed retrospectively.The PNI value was calculated by serum albumin (g/L) + 5 x lymphocyte count (× 109/L).The receiver operating characteristic (ROC) curve and Youden index was used to determine the cutoff value of the PNI.Survival curves were described by the Kaplan-Meier method and compared by the Log-rank test.The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.Result The mean PNI value was 47.3 ± 5.9.The mean values of the PNI in age (t =2.909,P =0.004),tumor size (t =2.227,P =0.028),tumor depth (t =3.314,P =0.001),negative lymph node (t =2.381,P =0.019),negative lymphovascular invasion (t =2.781,P =0.006) were significantly higher than those in patients without such factors.When the PNI was 47,the Youden index was maximal,with a sensitivity of 70％ and specificity of 63％.The mean age in high PNI group was significantly lower than that in low PNI group (x2 =6.443,P =0.011).Tumor infiltration depth in high PNI group was less than in low PNI group (x2 =7.394,P =0.007).The proportion of lymphovascular invasion in high PNI group was significantly lower than in low PNI group (x2 =4.540,P =0.033).The overall survival rate in high PNI group was higher than in low PNI group (P =0.002).The univariate and multivariate analyses showed that tumor location (OR,2.144 ; 95 ％ CI 1.239-3.712 ; P =0.006),lymph node metastasis (OR,4.887 ; 95 ％ CI 1.856-12.866 ; P =0.001),lymphovascular invasion (OR,1.842 ; 95％ CI 1.078-3.145 ; P =0.025) and the PNI value (OR,2.282 ; 95 ％ CI 1.344-3.874 ; P =0.002) were independent factors for predicting overall survival rate.Conclusions The PNI value is a simple and useful tool to predict the prognosis of patients with gastric cancer.

Advance in Drug Development for Alzheimer's Disease Targeted Microtuble Associated Protein Tau (review) / 中国康复理论与实践

Alzheimer's disease (AD) is the general neurodegenerative disease in the elderly. Alterations of microtubule associated pro-tein tau are closely related to the onset and progression of AD. The role of tau protein in the development of AD has been a focus in the cur-rent study of AD, with an emphasis on the identification of compounds that inhibit tau protein phosphorylation and aggregate, and accelerate tau protein depolymerization. The current research status of tau protein as target of AD preventive and therapeutic drug was also reviewed.

Clinical Study on Treatment of Senile Constipation with Combination of Acupuncture and Chinese Medicine / 世界科学技术-中医药现代化

This study was aimed to explore the clinical effect of San-Jiao (SJ) acupuncture combined with Chinese medicine and Cisapride tablets in the treatment of senile constipation. A total of 118 patients were selected according to the inclusion criteria. According to the visiting sequence, patients were randomly divided into the acupuncture with Chinese medicine group of 60 cases and drug group of 58 cases. In the acupuncture with Chinese medicine group, SJ acupuncture was combined with Huang-Di (HD) powder in the treatment. In the drug group, Cisapride tablets were applied. Both groups were treated for 20 times. The scale was used in the comprehensive evaluation of integral effect evaluation of main symptoms, psychological evaluation before and after the treatment. The results showed that there was significant difference on the integral before and after treatment in both groups (P< 0.01). The posttreatment integral showed that the acupuncture with Chinese medicine group was better than the drug group (P<0.01). There was no significant difference on total effective rate between two groups. However, comparison on good improvement rate showed that the acupuncture with Chinese medicine group was better than the drug group (χ2 =28.25, P < 0.01). It was concluded that the acupuncture with Chinese medicine group had better effect on the im-provement of clinical symptom integral, psychological integral, and comprehensive effect evaluation. SJ acupuncture combined with HD powder was a safe treatment method with good effect.

Risk factors of reoperation in patients with Crohn's disease recurrence / 中华消化外科杂志

Objective To investigate the risk factors of reoperation in patients with Crohn's disease recurrence.Methods The clinical data of 108 patients with Crohn's disease who were admitted to the Peking Union Medical College Hospital from March 2004 to September 2013 were retrospectively analyzed.Of the 108 patients,82 received single operation and 26 received reoperation.Twenty-five factors which might influence the reoperation were analyzed,which were gender,age,blood type,preoperative levels of white blood cells,neutrophils,lymphocytes hemoglobin,albumin,prealbumin,high sensitive-C reactive protein (hs-CRP),anti-saccharomyces cerevisiae antibody (ASCA),anti-neutrophil cytoplasmic antibody (ANCA),location and type of the lesions,extraintestinal manifestation,perianal lesions,history of smoking,appendectomy,course of the disease before the first operation,pre-operative administration of immunosuppressants,body mass index (BMI) before the first operation,onodera prognostic nutrition index (OPNI),enteral nutrition,emergent operation,complications after the first operation.The univariate analysis was done using the chi-square test or Fisher exact probability,and the multivariate analysis was done using the Logistic regression model.Results The results of univariate analysis showed that the level of preoperative prealbumin,hs-CRP,location and type of the lesion,the history of smoking,preoperative administration of immunosuppressants,enteral nutrition before the first operation were the risk factors of reoperation in patients with Crohn's disease (x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P ＜ 0.05).The results of multivariate analysis showed that the lesion located at the ileocolon,administration of immunosuppressants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal/d before the first operation were the independent risk factors of reoperation (OR =1.908,3.535,5.489,95％ confidence interval:1.035-3.518,1.087-11.494,1.816-16.590,P＜0.05).Conclusions Patients with lesions located at the ileocolon,administration of immunosuppresants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal before the first operation have higher risk of Crohn's disease recurrence and reoperation.

Advance in Drug Development for Alzheimer's Disease Targeted Microtuble Associated Protein Tau (review) / 中国康复理论与实践

@#Alzheimer's disease (AD) is the general neurodegenerative disease in the elderly. Alterations of microtubule associated protein tau are closely related to the onset and progression of AD. The role of tau protein in the development of AD has been a focus in the current study of AD, with an emphasis on the identification of compounds that inhibit tau protein phosphorylation and aggregate, and accelerate tau protein depolymerization. The current research status of tau protein as target of AD preventive and therapeutic drug was also reviewed.

A study on the effect of QCC in enhancing the specimens sending rate of stool/urine from cancer patients / 中国现代医生

Objective To investigate the improvement by QCC on sending rate of stool /urine from cancer patients. Methods We carried out a process named "the neat ring" quality circles. In the process we tried to enhance the pa-tients’ specimen sending rate of stool/urine by quality control. We internalized inpatients who were hospitalized in our department in a certain month before and after QCC had been implemented, analyzed their stool /urine sending rate on the third day after their admission and the day when they left the hospital. Results The stool sending rate on corre-sponding dates increased from 33.33% and 62.86% to 74.04% and 96.15%,as to urine, the sending rate augmented from 38.89%and 64.81%to 95.45%and 100%respectively. All differences were statically significant(P<0.01). Con-clusion The specimen sending rate of stool /urine from cancer inpatients were substantially enhanced through the im-plement of QCC.