Objective To investigate the effect of isochlorogenic acid B(ICAB)on CCl4-induced acute liver injury(ALI)in mice. Methods The animal model of CCl4-induced ALI in mice was established and then the protective effect of ICAB was evaluated using this model. Serum levels of alanine transaminase(ALT)and aspartate aminotransferase(AST),hepatic levels of malondialdehyde (MDA)and the activities of superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)were measured by spectrophotometric methods. Liver cell morphology was observed by hematoxylin and eosin staining method and the effects of ICAB on the protein expres-sion of nuclear factor erythroid-2-related factor 2(Nrf2),heme oxygenase-1(HO-1)and quinone oxidoreductase 1(NQO1)in mice he-patocyte were determined by Western blot method. Results ICAB(5,10 and 20 mg/kg)significantly protected against CCl4-induced liver injury by reducing the elevated levels of serum aminotransferases and hepatic MDA and remarkably restored the impaired antioxi-dants. Meanwhile,the histopathological changes were also attenuated in mice. In addition,ICAB could induce the protein expression of Nrf2 and promote its nuclear translocation,and further increase the protein expression of HO-1 and NQO1. Conclusion ICAB has protective effect against CCl4-induced ALI in mice,which is mainly due to its ability to promote the nuclear translocation of Nrf2 and decrease the oxidative stress.

Constipation has become a common clinical symptom in the elderly. Many factors can result in constipation, including diet,physiological aging, lack of exercise, inappropriate medication, psychological factors, perianal disease, and so on. If the individualized, targetedand comprehensive care interventions that consist of health education, psychological intervention, dietary intervention, medicationguide, functional exercise, passive attention to bowel training and abdominal massage etc. are done well, it can decrease the incidence ofconstipation, reduce a variety of complications and adverse effects caused by the constipation and improve the quality of life in the elderly.So it has important clinical significance.

Objective To investigate the efficacy of gelatin sponge particles(GSP)or polyvinyl alcohol particles (PVA) for hemoptysis secondary to bronchiectasis or pulmonary tuberculosis. Methods The clinical data on 271 patients with bronchiectasis- or tuberculosis-induced hemoptysis were retrospectively analyzed. The efficacy and rates of recurrence and complications were analyzed. Results A total 271 patients were included in this study, 176 of whom suffered from bronchiectasis and the rest 95 had tuberculosis. One-week cure rate was signifi-cantly higher in bronchiectasis group than in tuberculosis group(73.3%vs. 46.3%,P<0.05),and one-year recur-rence rate was significantly lower in bronchiectasis group(17.6%vs. 26.3%,P<0.05). One-year recurrence rate was slightly higher in patients receiving GSP than in those undergoing PVA(bronchiectasis group:22.2%vs. 10.3%, P<0.05;tuberculosis group:28.8%vs. 22.2%,P>0.05). No severe complications occurred. Conclusions In-terventional artery embolization therapy for hemoptysis secondary to bronchiectasis is better than tuberculosis-induced hemoptysis,and PVA is more effective than GSP. Recurrence of massive hemoptysis mostly occurrs within one month ,and most of the patients are complicated with blood supply and have a history of hemoptysis.

Objective To investigate the self‐management and cognitive situation of the patients with gestational diabetes melli‐tus (GDM) dietary and to discuss the influence of individualized diet intervention on patients .Methods Forty‐one pregnant women diagnosed with GDM were selected as the research objects .logistic regression analysis was used as well as questionnaire to evaluate the influence factors of comprehensive evaluation of the follow diet control ,detecting the 2 h plasma glucose(2 h PG) ,hemoglobin (HbAlc) ,total cholesterol (TC) ,three acyl glycerin (TG) change in value after individualized nutritional intervention ,which were compared with pre‐intervention index .Results (1)90 .2% of diet cognitive received diet educators ,26 .8% of the patients thought only diet and exercise therapy could effectively control blood sugar .Patients got 2 .4% correct overall about questions about food and 85 .4% patients followed diet .(2)Logistic regression analysis showed that the influencing factors of GDM patients following di‐et were age ,BMI ,cultural degree ,receiving diet education ,self monitoring of blood sugar ,regular review to the hospital regularly . (3) After the intervention(41 cases) ,the level of 2 h PG ,HbAlc ,TC ,TG of 38 cases were significantly lower than before ,and the difference was statistically significant (P<0 .01) .Conclusion Individualized diet intervention treatment in GDM patients shows obvious effect .

ObjectiveTo investigate the prevalence of nutritional risk and perioperative nutritional support status in the gastrointestinal cancer surgical patients.Methods Adult inpatients from the gastrointestinal cancer surgery department of our hospital were consecutively enrolled from May to September 2010.Nutritional Risk Screening 2002 ( NRS 2002) was performed at admission,and data of the nutritional support and complications during hospitalization were collected.The relationship between nutritional risk and postoperative complications was analyzed.ResultsA total of 195 patients were eligible.At admission,43.6％ (85/195) patients were at riskOf the patients at risk,totally 11.7％ (10/85) patients received preoperative nutritional support,and 100％ (85/85) patients received postoperative nutritional support; of the patients not at risk,no patients received preoperative nutritional support,and 84.5％ (93/110) patients received postoperative nutritional support.The overall rates of postoperative complications were 19.1％ ( 13/68 ) in the patients at risk while 7.1％ (9/127 )in the patients not at risk ( P =0.02).ConclusionsNutritional risk in gastrointestinal cancer surgical patients was high.The application of nutritional support was inappropriate in these patients.The nutritional risk is associated with higher postoperative complications.Dissemination of evidence-based guidelines should be enhanced.

Objective To evaluate the outcome of surgical treatment of tricuspid valve regurgitation after valve replacement.Methods Twenty one patients with tricuspid valve insufficiency after valve replacement were performed surgical treatment.Tricuspid valve-plasty was performed in 17 patients and tricuspid valve replacement was done in 4 patients.Three patients underwent edge-to-edge tricuspid valveplasty.DeVega procedure was performed in 5 patients.Cosgrove-Edward annuloplasty ring was used in 15 patients.Four patients' valve were replaced by SJM bileallet mechanical prostheses.Results There was 3 patients dead early after operation with a mortality of 14.3％(3/21).The causes of death including multiple organ failure,cardiac arrest and low cardiac output syndrome.The rate of early postoperative complications was 33.3％ (7/21),including pulmonary edema,arrhythmia,acute renal failure and low cardiac output syndrome.The patients were followed up 9-60 months.The rate of readmission was 23.8％ (5/21).Two patients went to hospital again for pleural effusion,1 patient for left ventricular dysfunction and 2 patients for right ventricular dysfunction.The other patients recovered well.Conclusions Surgical therapy is effective on severe tricuspid valve regurgitation after valve replacement.Preoperative aggressive treatment of heart failure,a reasonable grasp of surgical indications and timing of surgery,strict perioperative management are the keys to guarantee patients a smooth recovery.

Objective To investigate the endoscopic findings and treatment of gastrointestinal neu-roendocrine neoplasms.Methods Endoscopic manifestation and treatment were analyzed retrospectively in 72 patients who were diagnosed as having gastrointestinal neuroendocrine neoplasms by endoscopy and pathol-ogy from May 2011 to December 2014.Results In 72 patients of gastrointestinal NEN,rectum was most commonly involved (48 patients,66.7%),followed by the stomach (16 patients,22.2%),duodenum, esophagus and the ileocecal valve.There were certain features in rectal neuroendocrine neoplasms under endoscopy,mostly manifested by submucosal tumors.But gastric,esophageal,and small intestine NEN man-ifestations showed various forms,without specific typical features,and easy to be misdiagnosed.Some patients diagnosed as having NEN G1 or G2 underwent EMR,ESD or laparoscopy combined with endoscopy resection.Patients diagnosed as having NEN G2 or neuroendocrine carcinoma by pathology received surgical resection,chemotherapy or palliative treatment.All 50 patients underwent endoscopic treatment successful-ly.Perforation occurred in one duodenal bulbar G1 patient during ESD.No bleeding occurred during and after the operation.All patients after treatment were followed up for 15.6 +13.2 months on average with no recurrence or metastasis.Conclusion Manifestations of gastrointestinal neuroendocrine neoplasms vary under endoscopy.Some tumors that locate in mucosa or submucosa with diameter less than 1cm can be resec-ted through EMR or ESD.

OBJECTIVE:To provide reference for rational use of leucocyte increasing drugs in patients with lung cancer. METHODS:The application of drugs in lung cancer patients in 40 d each year were collected from 11 Zhejiang hospitals during 2009-2014,and then analyzed retrospectively in consumption sum,DDDs,DDC and department distribution,etc. RESULTS:The proportion of consumption sum of leucocyte increasing drugs in total consumption sum decreased generally in 11 Zhejiang hospital during 2009-2014,decreasing from 781 995.50 yuan in 2009(3.28%)to 626 792.80 yuan in 2014(1.53%). Top 3 departments in the list of consumption sum of leucocyte increasing drugs were oncology department(29.00%),radiotherapy department(27.08%) and respiratory medicine department(9.93%). Top 3 drugs in the list of consumption sum during 2009-2014 were recombinant hu-man granulocyte colony-stimulating factor,Coenzyme complex for injection and Leucogen tablets;top 3 drugs in the list of DDDs were Leucogen tablets,Berbamine tablet and recombinant human granulocyte colony-stimulating factor;Coenzyme complex for in-jection,recombinant human granulocyte colony-stimulating factor and human GM-CSF took the first three place in the list of DDC during 2009-2013,and Leucogen tablets were the top one in 2014. CONCLUSIONS:The application of leucocyte increasing drugs in lung cancer patients is decreasing year by year in 11 Zhejiang hospitals,and those with definite therapeutic efficacy and moder-ate price predominate clinical application predominate in the clinical practive.

Objective:To establish a new approach to synthesis of diethyl N-[4-[(2,4-diaminopyrido [3,2-d]pyrimidin-6-yl)methylamino]benzoyl]-L-glutamate.Methods:Target compound (5) was syn-thesized by the use of (2,4-dioxo-tetrahydropyridopyrimidin-6-yl) methyl acetate (1) as starting material via hydrolysis, chlorination, condensation with diethyl (p-aminobenzoyl)glutamate and aminolysis.Re-sults:A new approach to synthesis of diethyl N-[4-[(2,4-diaminopyrido[3,2-d]pyrimidin-6-yl)methyl-amino]benzoyl]-L-glutamatewas established .This synthetic route has hydrolysis reaction , chlorination, diethyl N-( p-aminobenzoyl )-L-glutamate condensation reaction and ammonolysis reaction .The total yield is 36.7%.The structures of those compounds have identified by 1 H nuclear magnetic resonance , 13 C nu-clear magnetic resonance and mass spectrometry .This synthetic route avoid the unstable brominated re-action product and improves the harsh condition of ammonolysis reaction .Conclusion:The new synthetic route has improved the reaction condition and the stability of the intermediate , and increased the extent of the derivative compounds , which has great significance to anti-folic acid of anti-tumor inhibitor synthesis .

Objective To explore the methodology of the preventing the absorption after autog-enous fat granule mammaplasty, and the main point of the operative methods.. Methods The clinical data were reviewed in 30 cases of patients with liposuction combined with fat-grafting injection for breast mammaplasty in the past four years. The tumescent technique was used in liposuction and the volume of fat tissue aspirated was between 500 ml and 3250 ml. Using appropriate way we prepared pure fat granules and then evenly injected into the layer beneath the pectoralis major muscle, submam-mary layer and subcutaneous layer of the breast, respectively. Results The effect of the method was satisfying because sucking area was significantly decreased. From six months to 10 months follow-up, grafts showed no obvious absorption. The breast looked symmetry. Conclusion Fat grafting injection is a practicable method for breast mammaplasty. The key point is to use appropriate way to get pure fat granule and to prevent infection. It deserves to be recommended.