Objective To establish D-dimer normal reference range in pregnant and postpartum women in Zhejiang Han population.Methods Plasma samples were collected from 669 healthy pregnant women, 578 healthy postpartum women, 8 venous thrombosis or DIC patients and 80 healthy non-pregnant women in Women′s Hospital, School of Medicine, Zhejiang University from March 2009 to August 2010.According to different gestational week, postpartum days and delivery pattern, the healthy pregnant and postpartum women were stratified into 3 groups: (1) ≤13 weeks (n=120), 14-20 weeks (n=120), 21-27 weeks (n=145), 28-34 weeks (n=147), ≥35 weeks (n=137);(2) The first day after vaginal delivery (n=163), the second day after vaginal delivery (n=121);(3) The first day after cesarean sections (n=166), the second day after cesarean sections (n=128). These groups were further stratified based on age: ＜30 years old and ≥30 years old.All blood samples were drawn in citrate sodium anticoagulated blood.D-dimer concentration was determined by STA-R Evolution coagulation analyzer.Since D-dimer concentration showed non-normal distribution, the normal values (one-tailed) were established by using (P95) percentile method.The results of 8 patients were used to validate the established normal values.Results In the group of ＜30 years old, the D-dimer values[M(P25-P75)]in group of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks, ≥35 weeks and healthy non-pregnant women were 0.25(0.17-0.37), 0.51(0.38-0.75), 0.75(0.57-1.10), 1.14(0.80-1.48), 1.60(1.14-1.89) and 0.20(0.10-0.28) mg/L, respectively, which showed statistical difference(H=239.24, P＜0.05).In the group of ≥30 years old, the D-dimer values of the above different groups were 0.28(0.14-0.38), 0.50(0.36-0.65), 0.83(0.59-1.41), 0.93(0.68-1.37), 1.47(1.22-1.84) and 0.17(0.12-0.25) mg/L, respectively, which also showed statistical difference(H=127.75, P＜0.05).In the group of ＜30 years old, the D-dimer values were 2.45(1.51-3.77), 1.30(0.97-1.96), 2.68(1.52-3.74) and 1.55(1.10-2.10) on the first and second day after vaginal delivery and cesarean section, respectively, which showed statistical difference (H=64.85,P＜0.05).In the group of ≥30 years old, the corresponding values were 2.20(1.33-3.54), 1.33(1.02-2.14), 2.27(1.66-3.17) and 1.62(1.26-2.69), respectively, which also showed statistical difference(H=18.64, P＜0.05).D-dimer normal values were established based on different gestational week, postpartum days and delivery pattern.The normal values of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks and ≥35 weeks were ≤0.64 mg/L, ≤1.54 mg/L, ≤2.60 mg/L, ≤3.01 mg/L and ≤3.19 mg/L, respectively. The normal values of 1st day after vaginal delivery, 2nd day after vaginal delivery,1st day after cesarean sections and 2nd day after cesarean sections were ≤7.83 mg/L, ≤3.29 mg/L, ≤9.95 mg/L and ≤3.80 mg/L.All 8 patients showed positive results with the above normal values.Conclusion D-dimer normal values in pregnant and postpartum women in Zhejiang Han population are established, which can improve the application values of D-dimer in the pregnant and postpartum population.

Mild hypothermia significantly increases perioperative complications,such as adverse myocardial outcomes,coagulopathy,infection and delayed recovery.So it is important to maintain the core temperature above 36 ℃.Redistribution is the major cause of hypothermia during the first hour of intravertebral or general anesthesia.There are many methods to protect patients from hypothermia including passive insulation and active warming.Forced-air and electric heating pad are currently the most effective noninvasive choices.The contribution of intravenous fluids heating to patients' temperature is limited but it should be performed when large volume is required.

The paper has established an assessment system and a quantitative calculation method of the "implicit" environmental impact including environmental impact indicator, resources consumption indicator and energy consumption indicator. The quantitative calculation of the environmental impact indicator is based on the life cycle assessment system and the evaluation software BEES. The paper identifies normalization reference values and weights for 12 categories of the environmental impact. It also analyzes the environmental impact indicator in life cycle stages, raw materials, transportation, manufacturing, utilization, and end of life. A university refectory project is studied. The result has shown that human health, global warming and acidification are the first three environmental impacts in 12 categories. The environmental impact indicator per m2 of this project is 18.448×10-2 standard human equivalent weight. Moreover, 97.3 % of the total environmental impact occurs at the raw material stage, in which the most severe environmental impact is cancerous health effect; the global warming is the main impact at the transportation and manufacturing stages; the indoor air quality impact is at the usage stage.

Perioperative pain management play a critical role in rapid recovery and long term outcome in patient undergoing total knee arthroplasty.With the advancement of peripheral nerve block, technique such as femoral nerve block, sciatic nerve block, abductor canal block have play an important role in perioperative pain management.Local infiltration analgesia have also gained popularity.The ultimate goal of perioperative pain management is to ensure analgesia effect and maintain good motor function of lower extremity.We are still in searching of a safe, effective, analgesia without motor block.Currently multimodal analgesia seems to be the most favorable choice.

The incidence and proportion of right colon cancer is increasingly high in recent years with a relatively poor prognosis. Right hemicolectomy is the standard procedure for the treatment of right colon cancer. Recently, infrapyloric lymph node (No.206 nodes) dissection has become one of the hot topics of surgical treatment for right colon cancer. The incidence of infrapyloric lymph node metastasis is still unclear, and whether it belongs to the regional lymph node of the right colon cancer is controversial. There are few methods to judge and predict infrapyloric lymph node metastasis, and the accuracy of diagnosis is low. What's more, dissection of infrapyloric lymph node might increase the risk of complications and perioperative mortality, as well as lead to overtreatment. As a result, this series of problems and controversies result in the obscure of the clinical value of infrapyloric lymph node dissection. Therefore, there is urgent need to design more high-quality, multicenter and large-sample prospective randomized controlled trials to explore the standard of routine dissection of infrapyloric lymph node for right colon cancer. Based on research advances at home and abroad, the authors review the incidence of infrapyloric lymph node metastasis, methods for judgement of infrapyloric lymph node metastasis, inluencing factors for lymph node metastasis, value of lymph node dissection, and research of direction in the future.

Objective To explore the effect of different doses of irbesartan on osteopontin expression and fibrosis in diabetic rat kidney. Methods Sixty-three g-week old male Wistar rat were randomly divided into control group (Ctrl group,n=7),diabetes group (DM group,n=14),30 mg·kg-1d-1 hydralazine administrated group (DM+Hyd group,n=12),25 mg·kg-1·d-1 irbesartan administrated group (DM+Irb25 group,n=10),50 mg·kg-1 ·d-1 irbesartan administrated group(DM+Irb50 group,n=9) and 200 mg·kg-1·d-1 irbesartan administrated group (DM+Irb200 group,n=11).Four weeks after modeling,rats were administered with the corresponding dose of irbesartan.After 12 weeks,urinary albumin excretion rate (UAER),endogenous creatinine clearance rate (Ccr) were measured; morphology and collagen deposition in rat kidney were observed by PAS and Masson staining respectively; Ang Ⅱ content in kidney was measured by ELISA; renal tissue TGF-β1 and OPN mRNA expression were detected by real-time PCR. Results UAER and Ccr in the intervention groups of irbesartan were significantly decreased compared with DM group (P＜0.05).UAER and Ccr in DM+Irb200 group were significantly lower than those in DM+Irb25 group and DM + Irb50 group (P＜0.05).Glomerular hypertrophy,mesangial matrix expansion,tubular lesions and deposition of collagen fiber were siginficant in diabetic rats compared with Ctrl,and prevented after administration with different doses of irbesartan.Ang Ⅱ protein level and TGF-β1,OPN mRNA expression in renal tissue of diabetic rats were significantly higher than those in Ctrl group.Ang Ⅱ,TGF-β1,and OPN mRNA expression was significantly reduced after administration with different doses of irbesartan,and with the increase of irbesartan,the above indicators were decreased P＜0.05).Renal local Ang Ⅱ level was positively correlated with OPN mRNA expression (r=0.74,P＜0.01). Conclusion Irbesartan reduces renal TGF-β1,OPN mRNA expression by decreasing kidney local Ang Ⅱ in dose-dependent manner,and eventually reduces tubulointerstitial fibrosis,which plays a role in kidney protection.

Objective Analyse the influencing factors of early enteral nutrition support in patients of severe acute pancreatitis( SAP). Methods From April 2006 to August 2008, a total of 57 patients with SAP were analyzed in two aspects:the APACHE II scores, Ranson scores, Balthazar CT scores, and some frequent complications (shock, MODS, ACS, severe sepsis, paralytic ileus, etc.) were compared in two groups of A(≤5 d) and B( >5 d) according to the initial time of enteral nutrition:Hie initial timing of entend nutrition,the above scores and complications were also compared in two groups of nasojejunal feedingtube and jejunostomy feeding tube. Results The APACHE H scores, Ranson scores, Balthazar CT scores and the incidence of shock, MODS and ACS in group A were significant higher than those in group B; The APACHE II scores, Ranson scores and Balthazar CT scores in group of nasojejunal feeding tube were significant lower than those in group of jejunostomy feeding tube, and the initial time of enteral nutritionin nasojejunal feeding tube was significantly earlier. Conclusions Early enteral nutrition support in SAP is influenced by multiple factors, especially of pathogenetic severity, severe complications and feeding pathways.Homeostasis and intestines functions recover are the sign of enteral nutrition initiation, and to carry out enteral nutrition in ≤5 d after admission is feasible.The APACHE II scores may be helpful to guide the time of EN start.

Objective To evaluate the correlation between the elastic modulus of prostate and the degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) patients in order to build a new non-invasive diagnostic indicator for BOO.Methods From november 2011 to November 2012,a total of 34 BPH patients were enrolled in this prospective study.Clinical information of the patients including age,international prostate symptom score (IPSS) and quality of life (QOL) were collected.The morphological features of prostate including total prostate volume,transitaion zone volume and transition zone index were detected by transrectal ultrasound (US),and prostate elastic modulus was detected using shear wave sonoelastograhy.After US examination,urodynamic study was performed by the urologist and pressure-flow curves were used to determine the diagnosis and the degree of bladder outlet obstruction.The correlation of prostate elastic modulus and other features including clinical information,morphological features and urodynamic features with the degree of bladder outlet obstruction were evaluated.ROC curves were evaluated.The feature with the best diagnostic performance was obtained,the diagnostic values of which were calculated.Results 9 patients had no BOO,with the average prostate elastic modulus of (27.3±5.0) kPa; 12 patients had mild to moderate BOO,with the average prostate elastic modulus of (30.7±2.8) kPa; 13 patients had severe BOO,with the average prostate elastic modulus of (34.7±2.4) kPa.The prostate elastic modulus had higher correlation coefficient with the degree of bladder outlet obstruction than the other features (r =0.754,P=0.000).It also had the highest AUC of 0.853 (95％CI 0.720-0.986).At a cutoffof 31.65 kPa,the sensitivity,specificity and accuracy of the prostate elastic modulus for the diagnosis of BOO were 72％,90％and 81％ respectively.Conclusion The prostate elastic modulus is highly correlated with the degree of bladder outlet obstruction,which might serve as a novel,promising indicator to evaluate BOO in BPH patients.

Drug-induced liver injury(DILI) is one of the major causes of termination of drug development.The establishment of a high-throughput test system to predict potential clinical hepatotoxicity is a valuable approach in the pharmaceutical industry.The high-content imaging-based in vitro assays allow simultaneous detection of cellular multiple parameters in the system.The real-time monitoring of multiple signaling pathways can shed light on many mechanisms of cell injury,with high sensitivity and specificity.Many types of liver cell models have been applied to high-content screening(HCS) so far.This paper introduceds the HCS technology and reviews the data of hepatotoxicity obtained from HCS technology in recent years.At the same time,we discuss the application of this technology in exploring the mechanism of hepatotoxicity and the potential of HCS technology in studying DILI and mechanisms.

AIM: To investigate the effect of aminoguanidine (AG) on plasma and renal levels of angiogenesis Ⅱ (AngⅡ), and to identify the relationship of AGEs with AngⅡ in STZ-induced diabetic rats. METHODS: Wistar rats were randomly assigned to three groups. Diabetes was induced, rats were then received AG in treatment group. At the end of 12th week, urine albumin excretion rate (UAER) and calculate creatinine clearance (Ccr) were detected. Periodic acid-Schiff reagent was used to evaluate renal pathology. Plasma and renal AngⅡ were analyzed by radioimmunoassay and immunohistochemistry, respectively. RESULTS: AG treatment significantly prevented the increase in UAER (P<0.01), renal pathology (P<0.01), and level of renal AngⅡ (P<0.01). However, plasma concentration of AngⅡ was higher than that in diabetic rats without AG treatment (P<0.01). CONCLUSION: AG down-regulates renal Ang Ⅱ level, probably by reducing the formation of AGEs, which may be one of the renoprotective factors in diabetic nephropathy. More proofs are needed to identify the result that plasma AngⅡ concentration increases in DMA group.