Objective To study whether the protective effects of fenofibrate on insulin resistance in mice of nonal-coholic fatty liver disease(NAFLD) are related to endoplasmic reticulum stress (ERS). Methods Male C57BL/6 mice were fed with high-calorie and high-cholesterol diet ( HCD) to induce a model of NAFLD, then one of those two groups from HCD was treated with fenofibrate 40 mg/( kg · d ) for 2 weeks ( HCF ) . Glucose tolerance test (GTT) and insulin tolerance test (ITT) were used to analyze the improvement on insulin resistance. The serum levels of triglyceride ( TG) , total cholesterol ( TC) , high density lipoprotein-cholesterol ( HDL-C) , low density lip-oprotein-cholesterol ( LDL-C) , alanine aminotransferase ( ALT) and aspartic transaminase ( AST) were detected. The pathological changes of livers were detected with HE and Oil Red O staining, the mRNA and protein expression of peroxisome proliferator-activated receptorα( PPARα) , glucose regulated protein 78 ( GRP78 ) and transcription factors GADD153 ( CHOP) were detected with real-time quantification PCR and Western blot analysis respectively. Results Compared with the SCD mice, the HCD mice showed significant insulin resistance, higher serum levels of TG, TC and LDL-C (P<0. 01, P<0. 05), lower serum level of HDL-C (P<0. 01), micro-and macrovesicular steatosis, ballooned hepatocytes and infiltration of inflammatory cells were observed in the liver, the expressions of PPARα and GRP78 at mRNA and protein levels were decreased (P<0. 05), however, the expressions of CHOP at mRNA and protein levels were increased ( P<0 . 05 ) . Fenofibrate intervention significantly improved insulin resist-ance and decreased the serum level of TG ( P<0. 05 ) . Fenofibrate also alleviated hepatic steatosis and inflammato-ry infiltration, and increased the mRNA and protein expressions of PPARα and GRP78, decreased the mRNA and protein expression of CHOP ( P<0 . 05 ) . Conclusion Fenofibrate significantly improves insulin resistance and de-creases the serum level of TG in NAFLD mice, which may be related to activating PPARα and relieving ERS.

Objective To discuss the etiology,clinical features,diagnosis and treatment of congenital pleural effusion in fetuses and neonates in order to improve the understanding of this disease. Methods Six neonate cases with congenital pleural effusion were retrospectively analyzed in neonates who were admitted to the Department of Neonatolo-gy of the First Affiliated Hospital of Zhengzhou University after birth and the etiology,clinical features,diagnosis and re-lated treatment were analyzed based on literature review. Results Among 6 patients with congenital pleural effusion, chylothorax was found in 3 cases,one of whom had chylothorax,chylous abdominal,21 trisomy syndrome and congenital hypothyroidism,and the etiology of the other 3 cases were unknown. Diagnosis mainly was depended on imaging and la-boratory tests. The number of nucleated cells of hydrothorax or ascites were(1 588 - 13 057)× 106 / L,mainly lympho-cytes. Protein qualitative was( + - + + + ),the chylothorax qualitative test was positive in 3 cases. The liver function showed that the total protein and albumin were decreased in varyig degrees. Conservative or surgical treatment was taken according to the situation of the patients. Among 6 patients,3 cases were cured after treatment,the others gave up treat-ment finally. Conclusions The etiology of congenital pleural effusion was different,and often associated with chromo-somal abnormalities or other malformations,ultrasonography was the main method to diagnose congenital pleural effusion and the patients should be dynamically observed or treated during the antepartum or intrapartum period. If the neonates are found to have pleural effusion in prenatal period early diagnosis and treatment is a best choice.

Objective To investigate the possibility of urethroplasty with a free graft of colic mucosa for the treatment of complex anterior urethral stricture of long length. Methods Six dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colic mucosa. All the dogs were sacrificed 12 weeks after the procedure for histological examination of urethra.Besides, a patient with complex anterior urethral stricture was treated by urethroplasty with the use of a colic mucosal graft.Retrograde urethrography,urethroscopy and uroflowmetry were carried out 3 months after operation. Results Histological examination revealed that all the grafted colic mucosa have survived in the urethra of the experimental dogs and some of the glandular epithe lium has been transformed into urethelium. Clinically,the patient voided well after removal of the urethral stent.Neither necrosis of the neourethral mucosa nor stenosis at the anastomosis sites has been observed on urethroscopy. Retrograde urethrogram demonstrated a wide urethral caliber with no significant graft sacculation. Uroflowmetry examination showed the maximum flow rate was 30 ml/s. Conclusions Colic mucosa graft urethroplasty is an effective one stage procedure for the treatment of complex anterior urethral stricture. The technique is useful for urethral reconstruction when local or preputial skin and buccal or bladder mucosa are not available.

Objective To evaluate bulbourethral sling procedure in the treatment of post prostatectomy incontinence. Methods 5 patients with post prostatectomy incontinence underwent the bulbourethral sling procedure.Preoperatively 1 patient was completely incontinent and 4 patients required a mean of 3.5 pads per day.The mean duration of incontinence was 4.5 years. A sling tension of a mean of 500 g was used to correct incontinence. Results 4 patients have been completely dry,whereas postoperative difficulty in voiding occurred in the other patient and was corrected by subsequent transurethral bladder neck revision resulting in free passage of urine and continence. Conclusions The bulbourethral sling procedure is an effective means in the treatment of post prostatectomy incontinence.

Objective To evaluate the selection of different procedures for the treatment of complex anterior urethral stricture and the key to successful operation. Methods 78 patients with complex anterior urethral strictures underwent different procedures of urethroplasty.Of them various mucosa urethral reconstruction were adopted in 40 cases,one-stage pedicle flaps urethroplasty in 26 and two-stage urethroplasty of Johanson procedure in 12. Results The patients were followed up for 6 to 36 months (mean 16.5 months).67 patients voided well and complications developed in 11. Of the 11 cases urethrocutaneous fistula occurred in 1,meatal stenosis in 2 and penile chordee in 1 for mucosal urethroplasty;urethrocutaneous fistula occurred in 2 and 1 of them was accompanied by hair bearing neourethra,urethral re-stricture in 3 for pedicle flaps urethroplasty;penile chordee developed in 2 and 1 of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure. Conclusions Selection of different procedures for treatment of complex anterior urethral strictures depends on stricture length,location and severity.Penile pedicle flap urethroplasty is an effective method for those with urethral stricture 10 cm,especially in those whose bladder mucosa is not available.

Objective To evaluate the feasibility and efficiency of endoluminal catheter-based ultrasonography on diagnosis of upper urinary tract diseases. Methods From January 1997 to December 2006,the clinical data of upper urinary tract of 68 cases who examined by endoluminal uhrasonography with a 10 MHz miniature ultrasound transducer and a 8 F outer catheter were reviewed.There were 30 males and 38 females aged 17-81 years with an average of 58 years.The renal pelvis and its surrounding structures were examined in 48 cases and the ureter and its surrounding structures were examined in 20 cases.The total of 73 sides had experienced by this technique.The accuracy of diagnosis with endoluminal catheter-based ultrasonography was evaluated by the pathology and clinical follow-up. Results The total success rate of the ultrasound probe introduced into ureter was 91%in 68 cases.In the pelvis group it was 96%(46/48)and the ureter group 80%(16/20).In renal pelvis abnomalities,the detectable rate of abnormal by ultrasonography was 89%(41/46).The total detectable rate in ultrasound probe group was significantly higher than that in other equipment groups(P＜0.01).The detectable rate of ultrasonography on ureter disease was 75%(12/16). Conclusion Endoluminal catheter-based ultrasonography is an effective,safe technique for the diagnosis of diseases in the upper urinary tract.

Objective To study the influences of fenofibrate on oxidative stress and endoplasmic reticulum stress in livers of hyperlipidemic rats. Methods Male SD rats were fed with high-fat diet for 12 weeks to induce a model of hyperlipidemia, then divided into control group, high-fat diet group with another four-week high-fat diet and fenofibrate group, in which rats were treated with fenofibrate [100 mg / (kg·d)] for 4 weeks. Then improvement of insulin resistance was detected in rats with GTT and ITT experiment. The serum levels of glucose (GLU), fasting insulin (FINS),triglyceride (TG) and total cholesterol (TC) were detected. The pathological changes of livers were detected with Oil Red O staining. The oxidative stress indices such as T-SOD, Mn-SOD, GSH and T-AOC were detected with liver homogenate. The expression of GRP78 was detected with real-time quantification RT-PCR and Western blot analysis respectively. Results Compared with rats with high-fat-diet, rats after fenofibrate treatment showed obviously improved insulin resistance, lower serum level of TG, TC and FINS (P < 0.05), decreased number and size of lipid droplets in liver tissue sections. T-SOD level in liver homogenate was significantly increased (P < 0.05), while GSH and T-AOC levels increased but had no obvious differences when compared with control group (P > 0.05). The expression of GRP78 at mRNA and protein levels were increased significantly after fenofibrate treatment (P < 0.05). Conclusions Fenofibrate has significant effects on improving insulin resistance and lipid regulation, which might be related to decreased oxidative stress and subsequent endoplasmic reticulum stress.

Objective To explore the traits of improved polyacrylamide gel electrophoresis (PAGE)-ethidium bromide(EB) staining in the detection of genotype polymorphisms.Methods The methods of PAGE-silver staining,agarose gel electrophoresis (AGE)-EB staining and improved PAGE-EB staining in polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) were used to detect the μ-opioid receptor (OPRM1) A118G genotypes in case group (n =167) infants with intracranial hemorrhage (ICH),and control group(n =163) infants without ICH,to conduct a case study analysis.And the application traits of three methods were compared.Results Genotypes of OPRM1 A118G were GG (169 bp),AG (193 bp,169 bp),AA (193 bp).Both the electrophoresis methods of PAGE-silver staining and PAGE-EB could be used to detect the genotypes of OPRM1 A118G clearly in this study.There was no statistically significant difference between the resolutions of DNA fragments (P =0.884).The first method,which had 13 experiment steps,consuming 4-5 hours,involving 12 kinds of chemical reagents,and the pictures were taken with the camera,was complex,with difficult operation,more time consuming; Compared with the first method,the secondmethod was simple,which had 6 test procedures,consuming 2 hours with 8 reagents,and the pictures were taken by using an automatic gel imager.AGE-EB could not be used to detect genotypes of OPRM1 A118G.Conclusions The method of improved PAGE-EB has the advantages of fast,easy operation,and high resolution,which is worthy of wider application.

OBJCETIVE:To investigate the role of clinical pharmacists in medication reconciliation. METHODS:Totally 200 inpatients admitted or transferred to nephrology department of our hospital during Aug.-Oct. 2015 were selected. Within 48 h after admission,1-year medication history were collected by reviewing electronic medical records,consultation,querying self-prepared drugs and medical history;and then medication reconciliation was conducted by clinical pharmacists. RESULTS:Among drug lists collected by clinical pharmacists,there were 987 kinds of drugs,but only 9.63%(95 kinds) drugs were recorded in the medical records. There were 5 cases of ADR in total,and only 40.00% of them (2 cases) were recorded in the medical records. Among 200 patients,medication reconciliation was needed in 45 cases with reconciliation rate of 22.50%. Among 492 medical orders of 200 patients,medication errors were found in 103 medical orders;the number of medication errors per case was (2.3 ± 1.8), mainly including wrong dose,repeated medication,wrong solvent,drug interactions;the potential risk degree was mainly degree 1 (53 orders,51.46%). Among 103 medication reconciliation orders,main plans were drug withdrawal (78 cases,75.73%), followed by drug change(17 cases,16.50%)and drug supplement(8 cases,7.77%). A total of 90 reconciled medical orders were adopted by physicians,with success rate of 87.38%. CONCLUSIONS:Compared with physicians,clinical pharmacists can obtain more detailed and accurate drug list. It can reduce medication error and guarantee the safety of drug use to maximum extent that clinical pharmacists conduct medication reconciliation.

Objective To explore the microsurgical experience of supra- and infra-tentorial meningioma of the posterior petrous bone.Methods Clinical data of 21 patients who had undergone microsurgical treatment were retrospectively reviewed.Results All patients underwent surgical treatment via a suboccipital retrosigmoid approach,and hyperostosis of the petrous bone and infiltrated cerebellar tentorium were resected intraoperatively.Tumor resection was categorized as Grade Ⅰ in 16 patients,Grade Ⅱ in 5 patients,according to the Simpson classification system.The main postoperative complications included slight facial paresis and hearing function deterioration.The mean follow-up time was 3.2 years.All patients resumed normal daily activity and no tumor recurrence happened.Conclusions Total resection for supra- and infra-tentorial meningioma of the posterior petrous bone can be achieved with an excellent prognosis by use of microsurgical technique.