Objective To explore the effectiveness,feasibility and suitability of the guideline for nasogastric tube feeding in adult patients.Methods Based on the Ottawa Model of Research Use as framework,we screened relevant evidence from guidelines,and developed new nasogastric tube feeding nursing procedure.Nursing knowledge,the rate of compliance to new procedure and the incidence of complications of nasogastric tube feeding were used to evaluate the clinical effects of the guideline.Results Nurses' knowledge increased significantly(P＜0.05).Nurses had a high degree of implementation of the new procedure,with the rate of over 85％.Compared with the control group,the rate of complications of nasogastric tube feeing in the experimental group was lower than that in the control group.Especially,the rates of reflux and aspiration were significantly lower(P＜0.05).Both rates of tube shedding and skin damage in the intervention group were decreased significantly(P＜0.05).Conclusion The nasal feeding nursing guideline in our clinical scenarios has its effectiveness,feasibility and suitability.

Objective To study the mechanism of liver fibrosis in rats caused by chronic exposure through drinking water containing sodium arsenite,to identify the differential proteins via proteomics technique.Methods Totally 40 healthy 8-week-old male Sprague Dawley (SD) rats of specific pathogen free (SPF) grade were randomly divided into 4 groups,which were control group (deionized water),0.68,1.36 and 2.73 mg/kg sodium arsenite (iAs3+) treated groups,respectively.The rats were fed with iAs-treated drinking water freely for 24 consecutive weeks.Twenty-four hour urine sample,blood and liver samples were collected.Hepatic fibrosis indices,specifically,type Ⅲ precollagen (PC Ⅲ),type Ⅳ collagen (Ⅳ-C),hyaluronic acid (HA) and laminin (LN) were detected by enzymelinked immunoassay (ELISA).Based on the isobaric tags for relative and absolute quantitation (iTRAQ) reagent 8-plex experiment,combined with 2DLC-MS/MS,the proteins in rats liver tissue of the medium dose group and the high dose group were compared with the those of control groups.Results ①The serum HA contents in the C (control) group,the L (low dose) group,the M (medium dose) group and the H (high dose) group were (198.51 ± 16.64),(218.39 ± 34.98),(261.72 ± 30.56) and (297.31 ± 35.72) ng/L;the serum PCⅢ contents in C,L,M and H groups were (15.32 ± 2.15),(16.78 ± 2.64),(19.51 ± 0.85) and (21.42 ± 1.63) μg/L;the serum LN contents in C,L,M and H groups were (734.57 ± 86.00),(792.65 ± 94.15),(916.83 ± 84.40) and (1 008.09 ± 64.17) μg/L;the serum Ⅳ-C contents in C,L,M and H groups were (52.34 ± 14.65),(59.72 ± 12.84),(74.38 ± 4.83) and (78.46 ± 4.30) μ.g/L,respectively.The differences in serological indices of liver fibrosis between-groups were statistically significant (F =21.136,19.957,22.007,14.288,all P ＜ 0.05).In multiple comparison of serum HA,PCⅢ and LN,there were no statistical significant differences between L group and C group.M and H groups were higher than L group and C group,significant statistical difference was found between H group and M group (all P ＜ 0.05).②Combining iTRAQ with 2DLC-MS/MS,based on the confidence threshold of protein (unused protScore) ＞ 1.3 and at least 1 matched peptides within the 95％ confidence interval,2 948 proteins were identified.Totally 2 162 proteins were detected in three groups compared with Venn diagram,after removing significant different proteins in C group,687 up-regulated proteins and 548 down-regulated proteins were identified in M group;633 up-regulated proteins and 519 downregulated were found in H group;the differences of protein expression between M and H groups were not statistically significant (P ＞ 0.05).③Up-regulated proteins related to the metabolism including AS3MT,MAT,SHMT,CHDH,CTH,CSAD and BHMT in M and H groups;of the two kinds of proteins of MTR,METK1 was up-regulated and F1LRB8 was down-regulated.Proteins associated with GSH including Gsta1,Gsta4,Gsta5,Gstt1,Gstt2,Gstk1,Gstp1,Gstm1,Gstm2,Gstm3,Gss,Gpx1,Gpx4,Esd,Hagh,Glo1,Mgst1 and B6DYQ5 which were all up-regulated.Proteins associated with liver fibrosis were Hic-5,Gss and six kinds of Tpm,and six kinds of Tpm subunits including two kinds of Tpm1,three kinds of Tpm2 and one kind of Tpm3 which were all up-regulated.Conclusions There is liver accumulation of arsenic after chronic arsenic exposure and resulting in liver fibrosis and decline of liver function.Expressions of AS3MT,MTR,MAT,SHMT,BHMT,CHDH,CTH and CSAD are up-regulated;arsenic meta bolism methionine cycle,folic acid cycle and sulfur transfer pathways are closely related.GSH plays an important role in arsenic metabolism and liver fibrosis,Hic-5,GSS and TPM may be associated with the occurrence of liver fibrosis.

OBJECTIVE:To explore optimization method and effect of clinical pharmacists on anticoagulants therapy plan for cancer patient with venous thromboembolism(VTE). METHODS:Clinical pharmacists participated in the whole process of antico-agulant therapy for one case of breast cancer complicated with VTE. Clinical pharmacists suggested patient to initially take low mo-lecular weight heparin sodium 0.6 ml,sc,qd;and then take Warfarin sodium tablet 3 mg,po,qd;initial plan and oral dosage form plan superimposed and alternated,and pharmaceutical care and medication education were also provided for the patient. RESULTS:Physicians adopted clinical pharmacist's suggestions,and the patient received anticoagulant therapy for 27 days and paclitaxel che-motherapy once. Coagulation function INR was 2.71;the patient didn't felt discomfort and then discharged from hospital. CON-CLUSIONS:The participation of clinical pharmacists in the optimization of individualized anticoagulant therapy and pharmaceutical care is able to promote rational drug use,prevent severe ADR in the clinic,guarantee the safety of drug use and improve medica-tion compliance.

Objective To observe the activation of rat hepatic stellate cells (HSC-T6) and the changes of methyltransferase (DNMT)1,DNMT3a mRNA expression with different doses of sodium arsenite stimulation.Methods HSC-T6 cells were exposed to a final concentration of 0 (control),5 (low dose),15 (medium dose) and 25 (high dose) μmol/L sodium arsenite in culture medium for 24,48 and 72 h,cells and cell culture supernatant were harvested.Enzyme-linked immunosorbent assay (ELISA) kit was used to measure fibrosis factors contents of type Ⅰ collagen (COL-1),type 11Ⅲ collagen (COL-3) and alpha smooth muscle actin (α-SMA) and quantitative real-time PCR was used to detect the expression levels of DNMT1 and DNMT3a mRNA.Results Different arsenic exposure time (24,48,72 h) had a significant effect on COL-1,COL-3 and α-SMA contents in HSC-T6 cells (F =249.574,328.493,3 157.436,all P ＜ 0.01);Different arsenic exposure content (low,medium,high dose groups) had a significant effect on COL-1,COL-3 and α-SMA contents in HSC-T6 cells (F =3 946.521,1 006.399,13 025.770,all P ＜ 0.01).After arsenic exposure for 24 and 48 h,the expression levels of DNMT1 mRNA in high dose group (4.33 ± 0.24,2.34 ± 0.43) were higher than those of control group (1.00 ± 0.00,1.00 ± 0.00,all P ＜ 0.05).At the same arsenic exposure levels (low,medium or high dose),the expression level of DNMT1 mRNA was declined with prolongation of sodium arsenite stimulation time (all P ＜ 0.05).After arsenic exposure for 48 and 72 h,the expression levels of DNMT3a mRNA in high dose group (2.23 ± 0.50,5.02 ± 0.23) were higher than those of control group (1.00 ± 0.00,1.00 ± 0.00,all P ＜ 0.05).The expression levels of DNMT3a mRNA in medium and high dose groups at 72 h (3.80 ± 0.14,5.02 ± 0.23) were higher than those of 24 h (3.03 ± 0.12,0.42 ± 0.15,all P ＜ 0.05).Conclusion HSC-T6 cells are obviously activated with pro-fibrotic effect;the expression levels of DNMT1 and DNMT3a mRNA are both up regulated in HSC-T6 cells after being exposed to sodium arsenite.

Asingleparticle-inductivelycoupledplasmamassspectrometric(SP-ICP-MS)methodwas established to detect the size distribution and number concentrations of silver nanoparticle ( AgNPs) in dilute aqueous solution. The optimal dwell time was 3 ms to reduce possibility of two or more particles entering into detector simultaneously. An iterative algorithm was applied to distinguish AgNPs as outliers from baseline and dissolved metal ion signal if the measured intensity was beyond five time standard deviation of whole data. Size distribution and number concentration of three commercial silver nanoparticle dispersions ( nominal diameters of 30, 50, 100 nm) were determined using SP-ICP-MS. The result of SP-ICP-MS is accurately similar to the transmission electron microscopy ( TEM) , indicating that SP-ICP-MS is able to size silver nanoparticles. The particle size detection limit is 25 nm and the limit of number concentration is 8 × 104 particles/L in dilute solution. Tap water added with silver nanoparticle was tested to obtain a similar size distribution and number concentration. This method is simple, fast and highly sensitive, which can be used to investigate risk assessment of silver nanoparticle in aqueous environment and monitor silver nanoparticle in drinking water.

Objective To evaluate the practicability of CHROMagar orientation medium combined with simple biochemical tests for identification of common oxidase-negtive gram-negative bacilli.Methods The CHROMagar orientation medium was used together with biochemical tests including indole test , ornithine decarboxylase test and lysine decarboxylase test for identification of common oxidase -negtive gram-negative bacilli.The sensitivity, specificity, likelihood ratio, Youden index and Kappa value of the diagnostic assays were evaluated .McNemar test was performed to evaluate facticity, accuracy and cost of the method in com-parison with the Vitek-2 system as reference method .Results The identification of oxidase-negtive gram-negative bacilli from 318 bacterial strains showed that the sensitivities and specificities of CHROMagar orien-tation mediumm in combination with simple biochemical tests to Serratia marcescens, Stenotrophomonas mal-tophilia and Acinetobacter baumannii reached 100%, and for Escherichia coli, Enterobacter aerogenes and Klebsiella pneumoiae were above 90%.The specificities for identification of Enterobacter cloacae, Klebsiella oxytoca, Citrobacter freundii and Proteus mirabilis were all above 90%, but the sensitivities were around 75%-90%.Kappa values of the assays were above 0.85, howerer, which was only 0.5947 for Citrobacter freundii.McNemar test showed that all P values were above 0.05, and cost of the assays was reduced by 90%.Conclusion CHROMagar orientation medium in combination with simple biochemical tests is a cost-effective assay for identification of common oxidase-negtive gram-negative bacilli .

ObjectiveTo evaluate the effect of alpha-lipoic acid (ALA) on cardiomyocyte apoptosis following renal ischemia-reperfusion injury(RIRI) in rats.MethodsThirty-six male SD rats weighing 250-280 g were randomly divided into 3 groups ( n =12 each): group sham operation (group S) ; group I/R and group I/R + ALA ( group L).The model of RIRI was produced by occlusion of renal artery and vein for 45 min followed by 24 h reperfusion,in group S the renal pedicles were exposed but not occluded.In group L ALA infusion (30 mg/kg) was given via tail vein at 20 mln before ischemia and at 20 min before reperfusion,while in group I/R the equal volume of solution (35％ polyethylene glycol + 60％ physiological saline + 5％ ethanol) was infused instead of ALA.The animals were saerificed at the end of 24 h of reperfusion,blood samples were taken for detecting concentrations of serum creatinine (Cr) and malondialdehyde (MDA).Then the hearts were immediately removed for determination of SOD activity,MDA content,cardiomyocyte apoptosis (flow cytometry) and Bcl-2/Bax ratio (immunohistology).ResultsSerum Cr concentration,serum and myocardium MDA levels and cardiomyocyte apoptosis were significantly increased after RIRI in groups I/R and L as compared with group S ( P ＜ 0.05).ALA treatment significantly decreased serum Cr concentration,serum and myocardium MDA levels,cardiomyocyte apoptosis and increased SOD activity and Bcl-2/Bax ratio ( P ＜ 0.05).ConclusionALA can attenuate myocardium injury by inhibiting cardiomyocyte apoptosis following RIRI in rats.

Objective To evaluate the capability of three tests used alone or in combination for identification of Staphylococcus aureus.Methods Identification of Staphylococcus aureus by the detection of spa gene with PCR and the Vitek-2 system were selected as the reference methods.Comparison of three phenotypic tests including DNase,mannitol fermentation and tube coagulase test was carried out to analyze the sensitivity,specificity,positive/negative predictive value,positive/negative likelihood ratio and Youden index.The consistency,cost and related indexes of the assays were analyzed between the combined phenotypic tests and the reference methods.Results In the present study,324 isolates of Staphylococci,including 293 Staphylococcus aureus and 31 non-Staphylococcus aureus,were collected.Single biochemical test could not identify Staphylococcus aureus efficiently.Comparison between the reference methods and the combined three biochemical tests by Kappa statistic analysis indicated that an overall Kappa value was 0.9441,and the algorithm of combined test was less costly.The sensitivity and specificity of this algorithm were 100％ and 90.3％,respectively.Conclusion The cost-effective algorithm of combined DNase,mannitol fermentation and tube coagulase test could efficiently distinguish Staphylococcus aureus from other Staphylococcus species.

Objective To compose and evaluate the measurement uncertainty of two kinds of chemiluminescence detection system using different methods.Methods The measurement uncertainty was composed by 4 different methods:(1) U 1％ was composed of within-run CV(CVw ％),between-run CV(CVB ％)and bias (CVBias ％);(2) U2％ was composed of CVB ％ and uncertainty of calibration (CVcal ％);(3) U3％ was composed of CVW％,CVs％ and CVcal％;(4) U4％ was composed of CVW％,CVB％,CVBias％ and CVcal％.The measurement uncertainty of Architect i2000SR system (Abbott,USA) and DXI800 system (Beckman,USA) was assessed.Pearson correlation analysis,Spearman correlation analysis,Paried t test and Mann-Whitney u test were performed to analyze the data.Results For Architect i2000SR system,U1％,U2％,U3％ and U4％ were significantly correlated (r=0.727-0.988,all P＜0.05),U3％ and U2％ were significantly different (t =6.88,P＜0.05),U4％ and U1％ were significantly different (t =6.21,P＜0.05).For DXI800 system,U1％,U2％,U3％ and U4％ were also significantly correlated (r =0.608-0.975,all P＜0.05),no significant difference was found between U3％ and U2％ (z=-1.33,P＞0.05),or between U4％ and U 1％ (z =-1.04,P＞ 0.05);the expanded measurement uncertainty was correlated with CVW％,CVB％,CVBias％(rs=0.653-0.912,all P＜0.05),but not with CVcal％(rs=0.548,P＞0.05).Conclusions For Architect i2000SR system,the fourth method is more proper to compose the measurement uncertainty (U4％).For DXI800 system,the first method is more appropriate (U1％).According to the contribution of different components to the measurement uncertainty,the measurement quality could be improved by reducing the imprecision and bias.

Objective To investigate the condition of nutrition in child with cerebral palsy (CP) and the effect of nutritional intervention. Methods 49 CP children and other 60 health children (controls) were measured their bodies, hemoglobin, serum trace elements, and bone mineral density (with ultrasonic), and the feeding behavior was also investigated. Results The incidence of malnutrition was 48.97%, in which 26.53% for low weight. The levels of serum iron and zinc were poor in the CP children, and the incidence of iron deficiency anemia was 34.67% in the CP children, different from the controls (P<0.05), while the incidence of low bone mineral density was 30.61%, not significantly different from the controls (P>0.05). Feeding problems were found in 44.9% of CP children. About 50% of malnutrition was corrected, especially the body weight after 4 months of Intervention, with anemia corrected in 88.2%, and bone mineral density recovered in 50%. Conclusion It is a problem for many CP children with malnutrition and nutritional disorders, and need nutrition intervention as the content of the rehabilitation.