Injectable lipid emulsions have been routinely used in patients since 1960s as a nutritional supplement for patients requiring parenteral nutrition. In recent years, lipid injectable emulsions have been extensively studied as a kind of novel drug carrier, also the quality problems of the lipid emulsion attract more and more attentions gradually. Large diameter tail of injectable lipid emulsions as a significant quality control indicator should pay more attention. Regarding to the defect of detecting large diameter tail of lipid injectable emulsions in our country, the purpose of this article is to summarize the techniques of detecting large diameter tail, illustrate the impacts of large lipid droplet on the quality of lipid injectable emulsions, emphasize the importance of detecting large diameter tail in lipid emulsions and provide guidance for researching and developing lipid emulsions in domestic market.

Objective To analyze the efficacy and prognosis of different antiviral agents on compensated hepatitis B cirrhosis.Methods Eight hundred and sixty-five cases of Hepatitis B patients with compensated cirrhosis were randomly divided into five groups:A group(n =143,subcutaneous injection interferon 3 million U every other day for 48 weeks),B group(n =171,orally treatment with lamivudine 100 mg/d for 48weeks),C group(n =137,orally treatment with adefovir 10 mg/d for 48 weeks),D group(n =83,oral treatment with entecavir O.5 mg/d,for 48 weeks) and E group(n =331,treated with general hepatoprotective drugs).Clinical symptoms and signs,changes in liver function were observed and prothrombin time activity degrees (PTA),quantitative HBV-DNA,HBeAg seroconversion and HBeAg/HBeAb conversion situation were detected.Results There were significant differences on HBeAg seroconversion between A group and other four groups after treated for48 weeks(31.5％ vs 13.5％,22.6％,18.1％,5.7％,x2 =58.56,P ＜0.01) and at the end of follow up (33.1％ vs 14.2％,23.3 ％,23.6％,6.4％,x2 =52.87,P ＜ 0.01).Patients' condition in A,B,C,D groups progressed slowly,and their incidence rates of decompensate cirrhosis were significantly lower than that in group E(x2 =122.41,P ＜ 0.01).The incidence rate of liver cancer in group A was significantly lower than that in B,C,D,E groups (x2 =19.61,P ＜ 0.01).Conclusion Antiviral therapy of interferon and nucleoside drugs can slow the progression of compensated Hepatitis B cirrhosis and reduce the incidence rates of decompensate cirrhosis.And interferon can significantly reduce the incidence rate of liver cancer.

Objective To investigate the perioperative risk of deep vein thrombosis (DVT) in patients with hepatic cirrhosis that underwent total hip arthroplasty (THA), and to evaluate the safety and feasibility of individualized anti-coagulation treatment.Methods There were 25 patients complicating hepatic cirrhosis that underwent THA (from Jan.to Dec.2014), including 17 males and 8 females, aged 57.9t9.2 years.The primary causes of THA were avascular necrosis of the femoral head (eighteen cases) and osteoarthritis of the hip (seven cases).Low molecular weight heparin (LMWH) was applied for anti-coagulation treatment.Parameters of hepatic function and coagulation function of THA cases (randomized thirty cases, from Jan.2008 to Dec.2008) without hepatic cirrhosis were used as reference for monitoring.For the cases of massive blood loss or upper gastrointestinal hemorrhage, a LMWH administration pause and an administration of fresh frozen plasma and clotting factors were performed in order to maintain a hemorrage/coagulation balance.The clinical outcome of the hip joint was evaluated and complications were treated.A subsequent follow-up was also carried out after perioperative period.Results All cases received successful surgeries and followed up.The follow-up duration was 34± 15.7 months.The preoperative Harris hip score was 32.4± 10.2 points, while the most recent follow-up score was 82.9±6.1 points, which was statistically significant.Dislocation, periprosthetic fracture and periprosthetic infection were absent.All cases received individualized anti-coagulation treatments during peripoerative period.A hemorrage/coagulation balance was achieved.The dynamic parameter curves did not present excessive deviation from reference.One case encountered intermuscular hematoma of the lower limbs 48 hours postoperatively, which was solved by a LMWH pause and administration of fresh frozen plasma and clotting factors.One case suffered upper gastrointestinal hemorrhage five days postoperatively, which was controlled by a LMWH pause and the administration of somatostatin and proton pump inhibitor.Jaundic got worse in one case three days postoperatively but got relieved after treatment.Overt blood loss was 686t141.8 ml.Perioperative death, hepatic failure, hepatic encephalopath, hepatorenal syndrome were absent.No DVT was observed.Conclusion There are risks of DVT in patients of hepatic cirrhosis.Individualized anti-coagulation treatment is needed during perioperative period of THA.

Objective To investigate the prevalence of uveitis associated with axial spondyloarthritis (ax-SpA), and analyze the features of patients with ax-SpA accompanying uveitis. Methods Two hundred and eighteen patients with ax-SpA were recruited. The differences in demographic factors, clinical features, the use of drugs and the quality of life were compared between uveitis group and non-uveitis group by using t-tests andχ2 tests. Results The prevalence of uveitis associated with ax-SpA was 24.3%. Uveitis group had longer disease duration [(156±140) month] compared to the non-uveitis group [(84±98) month] (t=-3.473, P=0.001), longer duration from disease onset to diagnosis [(90±105) month] compared to non-uveitis group [(47±65) month (t=-2.818, P=0.006), longer duration from first visit to diagnosis [(67±97) month] compared to non-uveitis group [(34 ±55) month] (t=-2.366, P=0.021). Patients with uveitis had higher rate of positive HLA-B27 (97.7%) compared to non-uveitis group (74.2%) (t=5.822, P=0.016), higher score of bath ankylosing spondylitis metrology index (BASMI) (3.3±2.0) compared to non-uveitis group (2.4±1.9) (t=-3.141, P=0.002), higher usage rate of biological agent (64.2%) compared to non-uveitis group (t=4.907, P=0.027). Conclusion In patients with acute anterior uveitis, the history should be carefully collected and HLA-B27 should be examined in order to make early diagnosis and treatment of ax-SpA, reducing uveitis flares and functional impairment.

Objective To investigate cognitive function and behavior characteristics in the childhood onset schizo?phrenia patients with or without obsessive-compulsive symptoms. Methods One hundred forty-nine schizophrenia chil?dren were recruited and 72 healthy children served as children control group. According to the Schedule for Affective Dis?orders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), the patients were fur?ther divided into two groups, the children with obsessive-compulsive disorder group (70 cases) and the children without obsessive-compulsive disorder group (79 cases). All the children were retrospectively surveyed and the Achenbach’s Child Behavior Check-list (CBCL) was used to assess their social competence and behavioral characteristics at the age from 6-year-old to 10-year-old. The cognitive function was estimated with WISC, STROOP color and word test, trail making test, visal spatial memory test and maze test. Results Compare to the control group, the CBCL factor scores of behavior problems were higher (P<0.01), social ability factor scores were lower (P<0.05) and all factor scores in the cog?nitive function tests were lower (P<0.05) in the two patients groups. Compare to the patients without obsessive-compul?sive symptoms, the CBCL factor scores of the school situation (P<0.01), splitting force (P<0.01), and physical complaints (P<0.01) were significantly higher and the scores were significantly lower in the test of common sense (P<0.01), wood (P<0.01), STROOP (P<0.01) and BVMT-R (P<0.01) in those with obsessive-compulsive symptoms. Correlation analysis showed that social competence total scores were positively correlated with similarity in the patients with obsessive-com?pulsive symptoms (r=0.31, P<0.01);while behavior problems total scores were negatively correlated with wood (r=-0.31, P<0.01) and patchwork (r=-0.32, P<0.01) in the patients without obsessive-compulsive symptoms. Conclusion The schizophrenia children with obsessive-compulsive symptoms have more behavioral problems in pre-symptom period and their cognitive dysfunction are more severe following onset of the disease. Cognitive function is related to behavioral prob?lems and social competence in the schizophrenia children with or without obsessive-compulsive symptoms .

Objective To assess the effect of altitude hypoxia on the elderly patients with coronary artery disease (CAD). Methods Three subject groups were surveyed during their train trip on the highest railroad--the Qinghai-Tibet Railway: 22 elderly individuals with documented CAD, 20 healthy elderly controls, and 20 healthy young controls, all of whom from Beijing near the sea level (76 m). Survey questions addressed clinical features of their healthy conditions and aspects of their coronary disease. The baseline study was performed at Xining at an altitude of 2261 m, and then during acute exposure to altitudes of 2808 m, 4768m, 5072 m and 4257 m by train for 24 hours. Resting pulse rate, blood pressure, oxygen saturation, electrocardiograph (ECG), and cardiac work estimated by the heart rate-blood pressure double product were obtained five times in each subject at different altitudes. Results On arrival to altitudes between 4768 m and 5072 m, the older passengers, especially those with preexisting coronary disease, had higher HR, higher BP, and lower SaO2, as well as more frequent abnormalities on ECG, as compared to the younger healthy subjects. As compared with the healthy elderly controls, incomplete right bundle branch block, left ventricular hypertrophy, and ST segment depression were more frequently seen in the elderly coronary patients (P<0.01). Cardiac work in group 1 was increased by 13% 12 hours after arrival to altitudes between 2808 m and 5072 m. Oxygen saturation decreased significantly with the altitude increasing by train ascent but improved after inhalation of oxygen. Most of the older subjects tolerated their sojourn at high altitude well except one who developed angina repeatedly with a significant ST segment depression. Conclusions Coronary events and ECG signs of myocardial ischemia are rare in elderly individuals with CAD who travel from sea level to moderate altitudes of 1500m to 2800 m. Patients with CAD who are well compensated at sea level generally tolerate this moderate altitude well. However, it would be prudent for patients with CAD going to altitude above 3000 m. The patients should consult their physician before undertaking a trip to such altitude.

AIM: To explore the effect of atorvastatin on the expression of α-SMA and TGF-β1 in the adventi-tia of ApoE-/-mice with atherosclerosis, and to investigate the underlying mechanism of atorvastatin therapy.METHODS:Male ApoE-/-mice (n =40) at 6-weeks of age were used to establish the atherosclerosis model by feeding with high fat diet. The mice were randomly divided into model group and atorvastatin group.In atorvastatin group, the mice were lavaged with atorvastatin at dose of 20 mg? kg-1? d-1 .The mice in model group were given normal saline.C57BL/6 mice of the same age served as control group, feeding with ordinary food.The mice were respectively sacrificed at the time points of 10 and 15 weeks after feeding with different diets.The ascending aorta was removed for serial sectioning.Some sections were per-formed with Movat staining in order to observe the morphological changes of the tissues, and to measure the relative athero-sclerotic plaque area and the thickness of the adventitia.Some sections were stained with Sirius red to identify the collagen synthesis.Immunohistochemistry assay was prepared to observe the expression of α-SMA and TGF-β1 in the adventitia at different time points.The expression of TGF-β1 at mRNA and protein levels in the thoracoabdominal aorta was measured by RT-qPCR and Western blot.RESULTS: Compared with model group, the formation of plaque in atorvastatin group signifi-cantly descended.Meanwhile the adventitial thickness and collagen synthesis also decreased.The results of immunohisto-
chemical staining showed that compared with 10 weeks-model group, α-SMA and TGF-β1 in 15 weeks-model group was in-creased.The expression of α-SMA and TGF-β1 in atorvastatin group decreased significantly compared with model group. The expression of TGF-β1 at mRNA and protein levels in model group were higher than those in control group.They de-creased in atorvastatin group compared with model group.Compared with 10 weeks-model group, the mRNA and protein of TGF-β1 in 15 weeks-model group were increased.CONCLUSION: Atorvastatin modulates adventitial fibroblast phenotype differentiation by suppressing expression of TGF-β1 and intervenes atherosclerotic development in ApoE.

Objective:To explore the application value of chronic disease trajectory-based nursing in the management of COPD patients outside the hospital.Methods:From January 2018 to December 2019, convenience sampling was used to select 226 discharged COPD patients from the First Affiliated Hospital of Zhengzhou University. The patients were divided into the control group and the research group with the random number table method, each with 113 cases. The control group carried out routine out-of-hospital health management, and the research group carried out out-of-hospital chronic disease trajectory model-based nursing, and the interventions all lasted for 3 months. The Exercise of Self-care Agency Scale (ESCA) was used to evaluate the self-management ability of the two groups, and the Dyspnea, Degree of Airflow Obstruction, Smoking Status, the number of Exacerbation (DOSE) index was used to evaluate the disease control effect of the two groups.Results:After intervention, the ESCA score of the research group was (114.45±3.26) , which was higher than (99.92±6.56) of the control group, and the difference was statistically significant ( t=20.666, P<0.001) . After intervention, the DOSE index of the research group was (2.28±0.08) , which was lower than (2.72±0.09) of the control group, and the difference was statistically significant ( t=34.692, P<0.001) . Conclusions:The chronic disease trajectory model-based nursing can improve the self-management ability of COPD patients outside the hospital and control their condition.

With the in-depth research on pressure injury, pressure injury-related pain has gradually attracted attention, but its definition is not uniform yet, and there is a lack of targeted assessment tools. This research systematically searches the Chinese and English literature related to pressure injury-related pain published from 1995 to 2019, and uses Rodgers' evolutionary concept analysis method to systematically analyze the concept, and clarify its defining attributes, causes and consequences. This research also puts forward the attributes of pressure injury-related pain, clarifies related concepts such as chronic wound-related pain and wound-related pain, as well as the concept with typical cases, so as to provide a reference for the management of pressure-related pain.

Objective To compare the categorical agreement between drug susceptibility testing(DST)and whole genome sequencing(WGS)for the detection of drug resistance in Mycobacterium tuberculosis(MTB),and to explore the characteristics of WGS for MTB drug resistance detection.Methods A total of 71 MTB clinical isolates retained in West China Hospital of Sichuan University from 2018 to 2020 were included in this study.The MTB strains were tested for resistance to 14 anti-tuberculosis drugs,including Isoniazid(INH),Rifampicin(RIF),Rifabutin(RFB),Ethambutol(EMB),Streptomycin(SM),Moxifloxacin(MFX),Ofloxacin(OFX),Levofloxacin(LFX),Amikacin(AMK),Kanamycin(KAN),Capreomycin(CPM),Para-aminosalicylic acid(PAS),Ethionamide(ETH)and Clofazimine(CLO),using both DST(colorimetric redox indicator meth-od)and WGS methods.Kappa test was performed to analyze the results of drug resistance detection for both methods.Results Based on DST and WGS methods to detect anti-tuberculosis drug resistance in seventy-one MTB clinical isolates,the results showed that the agreement rate of RIF,RFB,SM,MFX,OFX and LFX ex-ceeded 90.00％,and the kappa values were all greater than 0.80,with near perfect agreement;The agreement rates of INH and EMB were 84.51％and 81.69％,and Kappa values were 0.68 and 0.54,respectively,with fair agreement.No more than two drug resistant MTB strains of AMK and KAN were detected by both meth-ods,and the resistance rate was less than 3.00％.The agreement rates of CPM,ETH,PAS,and CLO ranged from 61.97％to 91.55％,and the Kappa values were less than 0.40,with slight or fair agreement.Conclusion There are differences in the ability of WGS to detect resistance to various anti-tuberculosis drugs,and it is more effective in detecting resistance to six anti-tuberculosis drugs,including RIF,RFB,SM,MFX,OFX and LFX,while there are still certain differences in detecting resistance to other anti-tuberculosis drugs compared with DST.It is necessary to further clarify the detailed resistance mechanisms of relevant anti-tu-berculosis drugs and to explore the standardization of WGS for drug resistance detection.