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Objective:To investigate the current status of early nutritional support treatment in patients with severe acute pancreatitis complicated with intestinal fistula,and analyze the impact on the clinical outcomes of patients.Methods:Retrospective analysis was used to select the relevant data of 60 ICU admission patients with severe acute pancreatitis complicated with intestinal fistula of a tertiary hospital in Nanjing from May 2022 to May 2023,the statistics analysis of the patients'early nutritional support treatment were carried out,and explored the impact on clinical outcomes of patients.Results:A total of 45(75％)and 57(95％)patients started EN and PN treatment within 48 h of admission.The EEN calorie compliance rate after admission of 1 week was 44.2％.There was a difference in mechanical ventilation time and hospitalization expenses between the early enteral nutrition calorie group and non-compliance group,but no significant difference in the length of ICU stay(P＞0.005).Conclusion:The early enteral nutrition compliance rate of patients with severe acute pancreatitis combined with intestinal fistula is slightly lower.Compared with the early enteral nutrition non-compliance group,the enteral nutrition standard group has shorter mechanical ventilation time and lower total hospitalization costs,which can improve the clinical outcome of patients.

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<p><b>OBJECTIVE</b>This study is aimed to investigate oxidative stress status in chronic hepatitis C (CHC) patients.</p><p><b>METHODS</b>52 CHC patients were divided into two groups according to the serum level of alanine aminotransferase (ALT): group A (elevated ALT group) and group B (normal ALT group). 20 healthy controls were included in this study. Serum levels of xanthine oxidase (XOD), malondialdehyde (MDA), oxidizided glutathione (GSSG), glutathione (GSH), glutathione peroxidase (GSH-Px), glutathione S-transferase (GST), glutathione reductase (GR) and vitamin C (Vc) were determined by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>Serum levels of XOD, MDA, GST and GR increased in CHC patients compared with healthy controls. While, serum levels of GSH, GSH-Px and Vc decreased compared with healthy controls. Furthermore, serum levels of XOD, MDA, GSSG, GST and GR in group A were up-regulated compared with group B. Serum levels of GSH, GSH-Px and Vc in group A were down-regulated compared with group B. In CHC patients, serum ALT level positively correlated with serum levels of XOD, MDA, GSSG and GST, while, negatively correlated with serum levels of GSH, GSH-Px and Vc. Serum aspartate aminotransferase (AST) level positively correlated with serum levels of XOD, MDA, GSSG, GR and GST, while, negatively correlated with serum GSH-Px level in CHC patients. Serum gamma-glutamyl transpeptidase (GGT) level positively correlated with serum GR level and negatively correlated with serum GSH level in CHC patients. Serum alkaline phosphatase (AKP) level positively correlated with serum levels of MDA and GR in CHC patients. In CHC patients, serum XOD level was positively related with serum HCV RNA level.</p><p><b>CONCLUSION</b>Oxidative stress was increased in CHC patients. In CHC patients with elevated serum ALT level, oxidative stress usually became serious.</p>

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<p><b>OBJECTIVE</b>To estimate the correlations between functional MRI (fMRI) parameters and the severity of chronic liver lesions of hepatitis B patients.</p><p><b>METHODS</b>47 hepatitis B patients [6 with chronic hepatitis, 41 with cirrhosis (14 with Child-Pugh class A cirrhosis; 12 with class B cirrhosis; and 15 with class C cirrhosis)] and 10 normal volunteers, referred for measurements of apparent diffusion coefficient (ADC) values of the liver, perfusion imaging parameters, portal flow parameters and serum markers of hepatic fibrosis were included in the study. Diffusion-weighted imaging (DWI) with different b values and b value remainder was performed. Time to peak (TP), maximum slope of increase (MSI) and distribution volume (DV) were measured with dynamic contrast material-enhanced MR imaging. Portal velocity and portal flow with phase contrast (PC) were measured. The patients' serum hepatic fibrosis markers, including hyaluronic acid (HA), type-III-procollagen (PC III), laminin (LN) and type-IV-collagen (C IV), were measured and analyzed together with the fMRI results.</p><p><b>RESULTS</b>(1) The mean ADC3 in Child A, B, C cirrhosis patients was significantly lower than that in the controls (P < 0.05 in Child A, and P < 0.05 in Child B). (2) There was a significant increase of time to peak and a decrease of maximum slope of increase (P < 0.01) in the Child A, B, C patients than in the normal controls. (3) There was a significant decrease in portal velocity in cirrhotic patients as compared to that of the controls and chronic hepatitis patients (P < 0.01). (4) The mean HA in Child A, B, C cirrhosis patients was significantly higher than that in chronic hepatitis patients and in the controls (P < 0.01); The mean LN in Child A, B, C cirrhosis was also significantly higher than that in chronic hepatitis patients and in normal controls (P < 0.01); The mean PC III in Child A, B, C cirrhosis was significantly higher than that in the normal controls (P < 0.01).</p><p><b>CONCLUSION</b>fMRI parameters can reflect some changes of the livers, therefore fMRI parameters are of value in clinical diagnosis and treatment of chronic hepatitis B patients.</p>

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