Postoperative patients who underwent digestive tract reconstruction have a high risk of malnutrition and absorbing bar-rier. Enteral nutrition support can effectively maintain and improve the nutritional status of the human body, shorten hospital stay, and reduce complications. Therefore, the enteral approach is the preferred postoperative means of nutrition support. This article retrospec-tively summarizes the appropriate time to start enteral nutrition support therapy after digestive tract reconstruction, the proper selection of the mode of enteral nutrition support, the different enteral nutrition preparations, and the treatment of postoperative complications.

Objective To investigate the dynamic changes of mean platelet volume (MPV) and platelet distribution width (PDW),and to explore the role of MPV and PDW in the prognosis of patients with acute myocardial infarction (AMI).Methods This retrospective cohort study included 312 patients with AMI during 2012 to 2014 in The First Affiliated Hospital of Soochow University.Patients were divided into ST-elevation myocardial infarction (STEMI) group,non ST-elevation myocardial infarction group and low PDW group,high PDW group.Their clinical data and outcomes were analyzed.MPV and PDW were measured successively from admission to day-7 after AMI.The relationship between PDW,MPV and GRACE risk score was further investigated.Results In the STEMI group,the patients were younger (P =0.005),and with higher rates of hyperlipidemia and smoking (P ＜ 0.01).Patients in STEMI group had higher risk of death during hospitalization,compared to NSTEMI (P =0.014).In the high PDW group,the rates of congestion heart failure,cardiogenic shock and Killip ⅣV were higher (P ＜ 0.01;P =0.026;P ＜ 0.01).PDW was significantly associated with mortality of in-hospital,one-year mortality and the risk of re-infarction in one year (r =0.69,P ＜ 0.01;r =0.68,P ＜0.01;r =0.70,P ＜ 0.01).MPV was associated with one-year mortality (r =0.30,P =0.02).Conclusions PDW related to the severity of AMI could predict the risk of in-hospital mortality,one-year mortality and re-infarction.It was helpful to screen out the high-risk patients,so as to make more suitable treatment to improve the prognosis of patients.

Background and purpose:Liquid biopsy is a kind of blood, urine and other non-solid biologi-cal tissue sampling analysis, mainly for malignant tumor diagnosis, monitoring and predicting its prognosis. In this research, we optimized the extraction of miRNA in urine, established a standardized means of liquid biopsy, screened and verified the miRNA markers in patients with bladder cancer.Methods:From Jan. 2014 to Sept. 2015, we used miRNA microarray in six patients with bladder cancer and six healthy controls. Samples of 78 cases of bladder cancer and 23 healthy controls were tested by real-time fluorescent quantitative polymerase chain reaction (RTFQ-PCR) to verify the relationship between miRNA markers in liquid biopsy and clinical pathological parameters. The diagnostic value of miRNA markers was also analyzed and compared.Results:We screened 10 miRNAs differential expression in urine. Combined with previous literature, we selected 20 miRNAs to verify their expression levels in bladder cancers and healthy controls. miR-509-5p/miR-124 ratio in the urine was found higher in patients with bladder cancer than in healthy controls (P<0.0001). With the rise of miR-509-5p/miR-124 ratio in urine, tumor stage and grade were also increased (P=0.003). When the cutoff was set at 0.41, the diagnostic sensitivity and specificity of miR-509-5p/miR-124 ratio were 73.1% and 82.6%, respectively. The AUC of miR-509-5p/miR-124 ratio to detect bladder cancer was 0.864, higher than that of urinary exfoliated cells (P=0.0002).Conclusion:We optimized the extraction of miRNAs in urine,established a standardized liquid biopsy of miRNA markers. The miR-509-5p/miR-124 ratio could be an ideal diagnos-tic marker for bladder cancer.

OBJECTIVE:To investigate the effects of different diuretic regimens on related indicatora in hepatocellular carcino-ma patients after hepatic resection. METHODS:A total of 60 hepatocellular carcinoma patients undergoing hepatic resection were randomly divided into study group (30 cases) and control group (30 cases). After surgery,study group was given Spironolactone tablet 100 mg+Furosemide tablet 40 mg,qd,after breakfast;Control group was given Spironolactone tablet 100 mg orally,bid,af-ter breakfast and at 16:00+Furosemide tablet 20 mg,qd,after breakfast. Electrolyte,liver and renal function of 2 groups were re-checked every 3 days;diuretic regimen was adjusted according to body weight and volume of liquid intake and output. The effec-tiveness indexes of diuretic treatment were observed in 2 groups,such as the decrease of body weight,case number of effective di-uretic treatment,frequency of intravenous dieresis,frequency of hydroxyethl starch use,frequency of night arination,postoperative hospitalization stay,the time of ascites extinction;serum sodium,serum potassium,serum creatinine,blood urea nitrogen,serum al-bumin,ALT,AST,GGT,the occurrence of ADR were observed before and after treatment. RESULTS:The nocturnal micturition frequency of study group was significantly lower than that of control group,with statistical significance (P<0.05). There was no significant difference in the decrease of body weight,response rate of diuretic treatment,frequency of intravenous dieresis,frequen-cy of hydroxyethyl starch use,postoperative hospitalization stay or the time of ascites extinction between 2 groups(P>0.05). After treatment,the levels of serum sodium and serum albumin in 2 groups were decreased significantly,compared to before treatment;the levels of blood urea nitrogen,serum potassium and ALT,AST,GGT in 2 groups were significantly higher than before treat-ment,with statistical significance(P<0.05). There was no statistical significance in the levels of serum sodium,serum potassium, blood urea nitrogen,serum albumin or ALT,AST,GGT between 2 groups(P>0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Both two diuretic regimens can effectively avoid the occurrence of postoperative ascites formation and related complication in patients hepatocellular carcinoma after hepatic resection. The drug regi-mens of spironolactore 100 mg,qd+furosemide 40 mg,qd after breakfast can significantly reduce nocturnal micturition frequency and improve medication compliance.

Glycosylation is the key step of the synthesis of GM3 ,its reaction conditions are very harsh ,the stereoselec‐tivities are usually poor ,and the configuration of anomeric carbon is difficult to control .Whetherαglycosidic bond can be con‐structed efficiently in sialylation reactions is an important criteria used to evaluate the reaction quality .Studies of GM3 and de‐rivatives methods generally relates to following areas :the choice of the donor compounds and receptor compounds ,the control of stereoselectivity ,and the development of some new glycosidic reaction catalyst .In recent years ,important progress has been made in this research area .Now ,we predominately make a summary and review on the progress of methods for the synthesis of GM3 and derivatives .

Objective To investigate how the clinical pharmacists participate in the regime design and adjustment in the treatment of infectious disease and to show how clinical pharmacists to team with physicians for patient′s infection control by contributing their special knowledge .Method From August 2012 to April 2014 ,141 patients were consulted by the clinical pharmacists for the infectious diseases .The patient′s basic information ,ward distribution ,consultation purpose ,etiology of infections and adoption of the suggestions were analyzed .Results Among 141 consulted cases ,most patients belonged to the urology ,hepatobiliary surgery and neurosurgery department (accounted for 26 .95% ,21 .99% and 17 .73% respectively) .The top three consultation subjects are the use of ‘special use class’ antimicrobials ,regime adjustment and medication choice (ac-counted for 85 .82% ,74 .62% and 59 .57% ) .133 suggestions from clinical pharmacists were accepted ,1 was partially adopted and 7 were rejected (accounted for 94 .33% ,0 .71% and 4 .96% ) .Conclusion The clinical pharmacists play important roles in the treatment of infectious disease by providing the consultations to clinicians .With their special knowledge ,clinical pharma-cists can make a good contribution to ensure the safe and effective drug therapies .

OBJECTIVETo develop and evaluate a mouse model of nonalcoholic steatohepatitis (NASH) induced by a high-fat and high-fructose (HFHFr) diet.

METHODSSix-week-old C3H mice were randomly divided into groups for HFHFr diet experimental modeling, high fat-only (HF) diet controls, high fructose-only (HFr) diet controls, and standard chow (SC) diet controls. The standard HFHFr diet was modified so that it consisted of 76.5% standard chow, 12% lard, 1% cholesterol, 5% egg yolk powder, 5% whole milk powder, and 0.5% sodium cholate, along with 20% fructose drinking water. At the end of experimental weeks 4, 8, and 16, measurements were taken for the NASH-related parameters of body mass, serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lipid profile, and wet liver weight (upon sacrifice). In addition, histological changes in the liver were evaluated by hematoxylin-eosin (HE) and oil red O staining. The significance of differences between groups was assessed by statistical analysis, using the

METHODSof t-test, Wilcoxon rank sum test, x2 test, F test or Fisher's test as appropriate.

RESULTSAs compared to the mice in the SC group at the corresponding time points, the mice in the HFHFr and HF groups showed significantly higher body mass and wet liver weight, as well as more extensive and robust lipid disposition in hepatic tissues as evidenced by oil red O staining. However, HE staining indicated that the HFHFr and HF groups had different degrees of macrosteatosis accompanied with intralobular inflammatory foci, with the former showing more remarkable NASH-related histological changes. Analysis at the end of week 16 showed that about 80% of the mice in the HFHFr group had developed NASH [nonalcoholic fatty liver disease (NAFLD) activity score (NAS): less than 5]. The levels of low-and high-density lipoprotein (LDL and HDL) cholesterol, as well as the levels of ALT and AST, were increased from the end of week 4 to the end of week 8 for the HFHFr and HF groups. At the end of week 16, the two groups differed in the extent of increase in total cholesterol and LDL and HDL cholesterol, with only the HFHFr group showing statistically significant changes. Specifically, at the end of week 16, the HFHFr group showed ALT levels of 108.5 +/- 93.34 U/L (F=5.099, P =0.005 vs. HF group: 44.30 +/- 35.71 U/L, HFr group: 46.70 +/- 17.95 U/L, SC group: 24.70 +/- 6.57 U/L), AST levels of 316.30 +/- 208.98 U/L (F=6.654, P=0.001 vs. HF: 132.12 +/- 75.43 U/L, HFr: 143.30 +/- 38.53 U/L, SC: 122.60 +/- 12.76 U/L), total cholesterol levels of 5.18 +/- 0.58 mmol/L (F=72: 470, P =0.000 vs. HF: 3.94 +/- 0.75 mmol/L, HFr: 2.30 +/- 0.50 mmol/L, SC: 2.02 +/- 0.24 mmol/L), HDL cholesterol levels of 3.05 +/- 0.49 mmol/L (F=25.413, P =0.000 vs. HF: 2.65 +/- 0.54 mmol/L HFr: 1.77 +/- 0.47 mmol/L, SC: 1.58 +/- 0.16 mmol/L), LDL cholesterol levels of 1.11 +/- 0.23 mmol/L (F =83.297, P =0.000 vs. HF: 0.72 +/- 0.17 mmol/L, HFr: 0.27 +/- 0.04 mmol/L, SC: 0.20 +/- 0.05 mmol/ L).

CONCLUSIONThe present study suggests that a mouse model of NASH can be successfully induced by a 16-week modified HFHFr diet.

Objective To investigate the clinical value of preoperative nutritional support (PNS) therapy in the hepatectomy of patients with nutritional risk.Methods The prospective study was conducted.The clinical data of 133 patients with nutritional risk who were admitted to the Drum Tower Hospital Affiliated to Nanjing University Medical School from August 2012 to June 2016 were collected.All the patients undergoing PNS and traditional therapy were divided into the PNS group and the control group by random number table method,respectively.Observation indicators:(1) comparisons of laboratory indexes between groups;(2) comparisons of postoperative situations between groups;(3) comparisons of postoperative complications between groups.Measurement data with normal distribution were represented as-x±s.Comparisons between groups were evaluated with the independent-sample t test.Comparisons of count data were analyzed using the chi-square test,and repeated measures data were analyzed by the repeated measures ANOVA.Results All the 133 patients were screened for eligibility,including 68 in the PNS group and 65 in the control group.(1) Comparisons of laboratory indexes between groups:alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil),cholinesterase,albumin (Alb),prealbumin,transferrin and C-reactive protein (CRP) in the PNS group were respectively (36± 13) U/L,(29± 10) U/L,(18.5±2.4) mmol/L,(5 738± 1 824) U/L,(37.4±5.1) g/L,(155±48) mg/L,(2.2±0.5)g/L,(10±4) g/L at admission and (33 ± 9) U/L,(27 ± 8) U/L,(17.9± 1.8) mmol/L,(5 796± 2 016) U/L,(38.5 ± 4.7) g/L,(181 ± 40) mg/L,(2.4± 0.5) g/L,(8± 4) g/L before operation and (285±100)U/L,(218±93)U/L,(33.5±6.3)mmol/L,(4 847±1 044)U/L,(32.6±3.8)g/L,(105±34)mg/L,(1.3±0.4) g/L,(55±28) g/L at 1 day postoperatively and (149±84) U/L,(76±42) U/L,(22.7±4.9) mmol/L,(3 866±893) U/L,(34.2±2.4) g/L,(125±30) mg/L,(1.6±0.4) g/L,(51±34) g/L at 3 days postoperatively and (64±33) U/L,(44±18) U/L,(19.4±2.8) mmol/L,(4 257± 1 032) U/L,(37.0±2.1) g/L,(148±42) mg/L,(1.9±0.4)g/L,(16±11)g/L at 7 days postoperatively;ALT,AST,TBil,cholinesterase,Alb,prealbumin,transferrin and CRP in the control group were respectively (36± 15)U/L,(31± 12)U/L,(18.3±2.9)mmol/L,(5 762±1 693)U/L,(37.3±6.1)g/L,(162±51)mg/L,(2.3±0.5)g/L,(10±4)g/L at admission and (36±11)U/L,(30±11)U/L,(18.2±2.8)mmol/L,(5 789±1 673)U/L,(37.8±7.1)g/L,(166±57) mg/L,(2.3±0.6) g/L,(9±5) g/L before operation and (305±127) U/L,(246± 104) U/L,(34.2±7.8) mmol/L,(4 842±1 173)U/L,(32.0±4.1) g/L,(83±32) mg/L,(1.2±0.4) g/L,(61 ±31) g/L at 1 day postoperatively and (163±104)U/L,(82±62)U/L,(23.1±6.0)mmol/L,(3 672±937) U/L,(33.8±3.6) g/L,(106±30)mg/L,(1.4±0.4)g/L,(61±40)g/L at 3 days postoperatively and (77±48) U/L,(52±27) U/L,(20.2±3.5) mmol/L,(3 925±987) U/L,(36.6±2.8) g/L,(125±40) mg/L,(1.7±0.4) g/L,(22± 12) g/L at 7 days postoperatively,showing no statistically significant difference in changing trends of above indicators between groups (F =1.007,2.223,0.579,0.014,0.235,3.533,2.970,2.143,P＞0.05).Results of further analysis showed that there were statistically significant differences in the levels of ALT,AST and cholinesterase at 7 days postoperatively between groups (t=1.832,2.073,1.899,P＜0.05),and in the levels of prealbumin before operation and at 1,3 and 7 days postoperatively between groups (t =1.698,3.738,3.625,3.178,P＜0.05) and in the levels of transferrin and CRP at 3 and 7 days postoperatively between groups (t=2.917,2.709,1.667,2.990,P＜0.05).(2) Comparisons of postoperative situations between groups:time to initial exsufflation,time of initial defecation,infused volume of exogenous albumin and duration of postoperative hospital stay were respectively (46± 15)hours,(64±16)hours,(23±10)g,(9.2±2.6)days in the PNS group and (55±18)hours,(78±21)hours,(39±25)g,(11.7±5.3) days,with statistically significant differences in the above indicators between groups (t =2.830,4.157,5.044,3.497,P＜0.05).(3) Comparisons of postoperative complications between groups:23 and 33 patients in the PNS and control groups had postoperative complications,showing a statistically significant difference between groups (x2=3.915,P＜0.05).Eight and 17 patients in the PNS and control groups were respectively complicated with peritoneal effusion,with a statistically significant difference between groups (x2 =4.508,P＜ 0.05).Conclusion PNS therapy in the hepatectomy of patients with nutrition risk can effectively improve pre-and post-operative nutrition statuses,reduce liver damage,accelerate recoveries of liver and gastrointestinal functions,reduce complications,shorten duration of postoperative hospital stay and accelerate patients' recovery.

Objective To investigate the use of parenteral nutrition preparations in Jiangsu Province,and to provide reference for the standardized management of parenteral nutrition preparations.Methods 720 cases using parenteral nutrition preparations from January 2017 to June 2017 in the department of general surgery of 12 hospitals in Jiangsu province were selected.The rate of nutritional risk screening,the indications of parenteral nutrition,the way of infusion,the rationality and economy of the prescriptions were retrospectively evaluated.The calorie,amino acid content,non-protein calorie/nitrogen ratio,glycolipid ratio and cation concentration of the patients received total parenteral nutrition were calculated.Results The total costs of parenteral nutrition preparations of 720 cases were 1.614 1 millions,and 346 cases did not have the indications for parenteral nutrition.The results of prescription comment showed that only 16 patients were screened for nutritional risk by Nutritional Risk Screening 2002 tool at admission.544 cases were intravenous dripped with amino acid and fat emulsion from peripheral vein.In the 176 total parenteral nutrition prescriptions,there were 39 non-protein calorie/nitrogen ratio cases,15 glycolipid ratio cases,69 cation concentration cases,61 calorie cases and 32 amino acid content cases failing to comply with the recommendation of the guidelines.Only 31 total parenteral nutrition prescriptions were completely reasonable.Conclusion The costs of parenteral nutrition preparations used in hospitals of Jiangsu are high but the rate of rationality is low.Nutrition support team should be established to regulate the use of parenteral nutrition preparations and save medical resources.

Objective:To investigate the influencing factors for pancreatic endocrine and exocrine insufficiency after pancreaticoduodenectomy.Methods:The retrospective case-control study was conducted. The clinicopathological data of 168 patients who underwent pancreaticoduodenectomy in the Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2017 were collected. There were 96 males and 72 females, aged (64±13)years, with a range from 38 to 75 years. Of the 168 patients, 36 had pancreatic endocrine insufficiency while 8 had pancreatic exocrine insufficiency preoperatively. All patients underwent pancreaticoduodenectomy. Observation indications: (1) surgical situations and follow-up; (2) analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy; (3) analysis of influencing factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Follow-up using out-patient examination and telephone interview was performed to detect postoperative condition of blood glucose control, diet and nutrition, tumor recurrence and metastasis up to June 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Surgical situations and follow-up: all the 168 patients underwent pancreaticoduodenectomy successfully and recovered well after operation. All patients were followed up for 6 months. The level of fasting and postprandial blood glucose of the 168 patients after surgery were 7 mmol/L(range, 5-9 mmol/L) and 10 mmol/L(range, 7-14 mmol/L), respectively. The defecation frequency was (2.4±1.2)times per day. No tumor recurrence or metastasis occurred in either patient. One hundred and thirty-two of the 168 patients were included in the study excepting patients with pancreatic endocrine insufficiency before operation. At postoperative 6 months, 47 patients developed pancreatic endocrine insufficiency, with an incidence of 35.61%(47/132). One hundred and sixty of the 168 patients were included in the study excepting patients with pancreatic exocrine insufficiency before operation. At postoperative 6 months, 68 patients had pancreatic exocrine insufficiency, with an incidence rate of 42.50%(68/160). (2) Analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that gender, metabolic syndrome, chronic pancreatitis, excision point, and postoperative chemotherapy were the related factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy ( χ2=5.300, 6.270, 4.473, 4.392, 5.397, P<0.05). Results of multivariate analysis revealed that male and metabolic syndrome were independent risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy [ hazard ratio ( HR)=5.252, 5.364, 95% confidence interval ( CI): 1.362-6.382, 1.891-12.592, P<0.05)]. (3) Analysis of risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that body mass index (BMI), chronic pancreatitis, total bilirubin, excision point, postoperative pancreatic fistula as grade B or C, and pancreatic fibrosis were related factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( χ2=1.691, 4.910, 7.763, 5.605, 4.663, 7.700, P<0.05). Results of multivariate analysis showed that BMI<18.5 kg/m 2, chronic pancreatitis, total bilirubin ≥171 μmol/L were independent risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( HR=3.695, 5.231, 7.623, 95% CI: 1.232-7.324, 2.161-6.893, 1.562-5.235, P<0.05). Conclusions:Male and metabolic syndrome are risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. BMI<18.5 kg/m 2, chronic pancreatitis, and total bilirubin ≥171 μmol/L are risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy.