OBJECTIVE:To investigate the number of insoluble particle in total parenteral nutrition(TPN)solutions and to pro-vide reference for clinical application. METHODS:6 kinds of commonly used TPN prescriptions were selected. After prepared ac-cording to sterile operation procedure,TPN at 25℃was investigated at 0,1,4,8 and 24 h in terms of appearance,pH value,os-motic pressure and the numbers of insoluble particles. RESULTS:The appearance and pH value of TPN had no significant change within 24 h after preparation,and osmotic pressures were all lower than 900 mOsm/L. Study results showed that the numbers of in-soluble particles quickly increased,and ≥10 μm and ≥25 μm insoluble particles exceeded the limitation of Chinese Pharmacopoe-ia after Lipid-soluble vitamin for injection were injected into TPN. Medium/long chain fat emulsion injection,water-soluble vita-min,electrolytes and trace elements also increased the numbers of insoluble particles. CONCLUSIONS:Medium/long chain fat emulsion injection,lipid-soluble/water-soluble vitamin,vitamin C,electrolytes and trace elements have certain influence on the number of insoluble particle of TPN. To analyze the reason for the forming of insoluble particles has great meaning both for improv-ing the TPN quality and reducing the harm of particles for patients.

Objective:To explore the clinical significance of the combined detection of Clara cell secretory protein 16 (CC16) and soluble receptor for advanced glycation end product (sRAGE) in the diagnosis and prognosis of acute respiratory distress syndrome (ARDS).Methods:100 ARDS patients admitted to the intensive care unit (ICU) of Chu Hsien-I Memorial Hospital of Tianjin Medical University from July 2019 to September 2020 were enrolled as the ARDS group, and 100 non-ARDS patients admitted to the ICU during the same period were enrolled as the control group. The general information, vital signs, blood gas analysis, serum CC16 and sRAGE levels, duration of mechanical ventilation, length of ICU stay and prognosis during hospitalization were collected. The receiver operating characteristic (ROC) curve was drawn and the area under ROC curve (AUC) was calculated to evaluate the clinical value of CC16 and sRAGE lonely or combination in the diagnosis and prognosis of ARDS.Results:The duration of mechanical ventilation in the ARDS group was significantly longer than that in the non-ARDS group (days: 15.44±3.04 vs. 12.61±3.73, P < 0.01), and the hospitalization mortality was higher (38.0% vs. 9.0%, P < 0.01), but there was no significant difference in gender, age, body mass index (BMI), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score or the length of ICU stay between the two groups. There were 62 ARDS patients survived and 38 ARDS patients died during hospitalization. The APACHEⅡ score of the death group was significantly higher than that of the survival group (23.55±2.83 vs. 19.40±4.10, P < 0.01), but there was no significant difference in age, BMI, oxygenation index, mean arterial pressure, duration of mechanical ventilation or the length of ICU stay between the two groups. The serum levels of CC16 and sRAGE in the ARDS group were significantly higher than those in the non-ARDS group [CC16 (mg/L): 38.78±14.70 vs. 21.87±2.45, sRAGE (pg/L): 2 470.95±288.70 vs. 2 013.22±131.15, both P < 0.01]; and the serum levels of CC16 and sRAGE of ARDS patients in the death group were significantly higher than those in the survival group [CC16 (mg/L): 42.02±10.81 vs. 30.52±9.47, sRAGE (pg/L): 2 638.34±324.07 vs. 2 279.91±163.70, both P < 0.01]. ROC curve showed that the AUC of CC16 and sRAGE in the diagnosis of ARDS alone were 0.859 [95% confidence interval (95% CI) was 0.808-0.911] and 0.821 (95% CI was 0.762-0.879), and the best cut-off values were 25.76 mg/L and 2 203.00 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.932 (95% CI was 0.900-0.965) with the sensitivity of 89.0% and the specificity of 87.6%. The AUC of CC16 and sRAGE in predicting the death of patients with ARDS during hospitalization were 0.747 (95% CI was 0.651-0.843) and 0.819 (95% CI was 0.737-0.902), and the best cut-off values were 32.95 mg/L and 2 554.50 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.900 (95% CI was 0.828-0.972) with the sensitivity of 88.7% and the specificity of 84.5%. Conclusions:Serum CC16 and sRAGE have clinical value for the diagnosis and prognosis of ARDS. The combined detection of them is superior to individual detection for early prediction of ARDS and prognosis.

Objective To investigate the expression of multidrug resistance protein 1 (MDR1) and brain and acute leukemia cytoplasm (BAALC) genes and its relationship with prognosis in patients with newly diagnosed acute myeloid leukemia (AML).Methods A total of 100 adults with newly diagnosed AML were enrolled in the study.All patients were treated with anthracyclines induced chemotherapy combined with cytarabine.The expression levels of MDR1 and BAALC genes were detected,and the relationships with the clinical characteristics of patients with AML,genetic type,therapeutic effect and prognosis were analyzed.Results There was no significant differences in white blood cells,hemoglobin and platelet between patients with high and low expression of MDR1 gene and BAALC gene (P>0.05).There were significant differences in the expression level of MDR1 gene between patients with different chromosome risk stratification (P<0.05) but there was no significant difference in the expression level of BAALC gene (P>0.05).After chemotherapy intervention,CR of patients with high expression of MDR1 gene was significantly lower than patients with low expression of MDR1 gene (60.78% vs.87.76%)(P<0.05),CR of patients with high expression of BAALC gene was slightly lower than patients with low expression of MDR1 gene (67.31% vs 81.25%)(P>0.05).Comparison of median overall survival (OS) and overall survival (OS) in patients with high and low expression of MDR1 gene.The difference was statistically significant (P<0.05).Comparison of median overall survival (OS) and overall survival (OS) in patients with high and low expression of BAALC gene.There was no significant difference(P>0.05).Conclusion Compared with the expression of BAALC gene,the value of expression of MDR1 gene is higher in evaluating the curative effect in patients with newly diagnosed AML.Combined detection of MDR1 and BAALC genes can improve the accuracy in predicting the prognosis of patients.

Objective:To investigate ?-catenin expression during check pouch carcinogenesis in golden hamster.Methods:Expression of ?-catenin was examined with immunohistochemical SABC method in 23 cases of check normal buccal epithelium of golden hamster,22 of hyperplasitic epithelium,22 of dysplastic epithelium,29 of squamous cell carcinoma.Results:Normal buccal epithelium showed strong pericellular staining in the basal,suprabasal and prickle cell layers.Positive rates(%) of ?-catenin in normal buccal epithelium,hyperplastic epithelium,dysplastic epithelium and squamous cell carcinoma were 100,100,77.3 and 41.4 respectively.Conclusion: The decreased expression of ?-catenin may be related to the carcinogenesis of golden hamster check pouch.

Herpes simplex virus type 1 (HSV-1), as a pathogen usually leading to herpes labialis, has been found to cause more cases of genital herpes and be associated with the occurrence of neurological diseases such as Alzheimer′s disease (AD). AD is a chronic and progressive degenerative disease of the central nervous system, the pathogenesis of which has not been fully elucidated, and currently there is a lack of drugs that can effectively treat the disease. The hypothesis that HSV-1 infection is involved in the pathogenesis of AD has been discussed for a long time, but there is no definite evidence to prove it. This article briefly reviewed the research progress in the pathogenesis of AD caused by HSV-1.

Objective To investigate the clinical value of Color Doppler Ultrasound in diagnosis of lymph node diseases. Methods We observed the ultrasound features of the 93 cases of swelled lymph nodes with Color Doppler ultrasound. The ultrasound features included pseudokidney sign, assessment on blood flow distribution, the Doppler resistive Index (RI), maximal flow rate (Vmax),the longitudinal axis compared to the diameter of a node (L/D ratio) . Results Out of 93 cases of clinically confirmed swelled lymph nodes,the concordance rate of Color Doppler Ultrasound was 86%and 88%in diagnosis of malignant lymph node disease and benign lymph node disease, respectively. 4 cases of lymph tuberculosis were misdiagnosed as lymphoma due to the similar ultrasound characteristics found in malignant lymph group,the rate of misdiagnosis was 8%. In the cases of proliferative lymph node diseases with Pseudokidney sign, 93% of the blood flow distribution was classified as grade 0-I. 90% of lymphadenitis were found with Pseudokidney sign,and 95%of those cases with blood flow distribution was classified as grade II-III. Malignant lymph diseases had no Pseudokidney sign, and 86%of blood flow distribution grade was as III. There was statistically significant difference in the L/D ratio and RI between benign lymph group and malignant lymph group (P<0.01) . There was statistically significant difference in Vmax between lymphoproliferative group and other groups (P<0.01) . Conclusions Pathological characteristics on different lymph node disease determin the ultrasound characteristics. Combined clinical data based on Pseudokidney sign, Blood Flow Distribution, RI value,Vmax value and L/D ratio can enhance the accuracy of various lymph node disease diagnosis.

Objective To investigate the effects of different concentrations of propofol on the apoptosis in hippocampal neurons in neonatal rats in vitro.Methods Primary hippocampal neurons were prepared from newborn Sprague-Dawley rats (aged 7 days) and cultured for 7 days.The neurons were randomly divided into 7 groups (n =8 each):control group (group C),propofol 4,8 and 12 μg/ml groups (groups P1-3),and fat emulsion 4,8and 12 μg/ml groups (groups F1-3).The cells were cultured for 24 h in the culture medium containing propofol 4,8 and 12μg/ml in groups P1-3,respectively.The cells were cultured for 24 h in the culture medium containing fat emulsion 4,8 and 12 μg/ml in groups F1 3,respectively.The cell morphology was examined by microscopy after 24 h culture.The expression of caspase-3 (by immuno-histochemistry) and neuronal apoptosis were detected.The neuronal apoptosis rate was calculated.Results Compared with group C,the neuronal apoptosis rate and caspase3 expression were significantly increased in groups P1-3 (P ＜ 0.05 or 0.01).The neuronal apoptosis rat and caspase-3 expression were increased in a concentration-dependent manner in groups P1-3 (P ＜ 0.05).The neuronal apoptosis rate and caspase-3 expression were significantly lower in groups F1-3 than in groups P1-3 (P ＜ 0.05).There was no significant difference in the neuronal apoptosis rate and caspase-3 expression between groups F1-3 (P ＞ 0.05).The damage to neurons was induced in groups P1-3 and most severe in group P3.Conclusion Propofol can promote the apoptosis in hippocampal neurons in neonatal rats in vitro in a concentration-dependent manner.

Objective To explore the consistency between preoperative clinical TNM stage and postoperative pathological TNM stage of gastric cancer and look for the underlying reason.Methods Sixty-four patients of gastric cancer with complete clinical data from December 2010 to December 2011 in Gansu Provincial Hospital were enrolled into this study.All cases were performed postoperative pathological TNM staging according to the TNM stage criteria of gastric cancer from JGCA(the 14th edition,2010),and the results were compared with preoperative TNM staging,then we studied the consistency of T staging,N staging and M staging using SPSS 18.0.Results The Kappa value from T staging of preoperative and postoperative was 0.729,showing a good consistency.The N stage' s consistency was lower,Kappa value being only 0.216.For M staging,Kappa value 0.743,having a good consistency.Conclusions According to the General Rules for Gastric Cancer Treatment,a accurate TNM staging and individual treatment plan can be made for gastric cancer patients in clinic.But the overestimate and underestimate still existed,especially in N staging.Therefore,making a accurate judgment for N staging according to all kinds of preoperative clinical data and images is the key to improvement of preoperative TNM staging accuracy and treatment.

Objective To summarize the experience of nursing cancer patients with anal fistula treated with blood stem cells transplantation (BSCT). Method 8 critical cancer patients with anal fistula treated with BSCT from August 2013 to November 2014 were intervened by nursing measures such as prevention of constipation and diarrhea , protecting the anus from infection and health education . Results Two patients of them contracted with mild crissum infection , 1 moderate , 0 severe . With the pertinent nursing intervention , no serious complications occurred . The hospital stay was 20~30 d , with an average of ( 24 . 75 ± 2 . 30 ) . Conclusion The nursing measures including preventing constipation and diarrhea, keeping the anus from infection and health education can be effective in avoiding anal fistula infection and its related complications and reducing patients′pain , which are worth clinical promotion .

BACKGROUND:Interbody fusion is widely used in spine surgeries. Failed fusion may cause many complications, so it is very important to evaluate fusion before surgery. Imaging methods are commonly used to evaluate fusion, including X ray, CT and MRI. Above methods have their own specific methods and characteristics, which cause their differences in sensibility and specificity. OBJECTIVE:To review the research progress of imaging methods in interbody fusion. METHODS:The English key words were“lambar fusion, cervical fusion, interbody fusion, evaluation method”in the PubMed database. The literatures with detailed description of interbody fusion were selected for further review, including comparative study on a variety of evaluation methods of imaging means. RESULTS AND CONCLUSION:According to the inclusion criteria and exclusion criteria, a total of 40 papers were included. X-ray and CT are the most commonly used methods, while CT is more reliable. MRI, bone scan and other methods cannot correctly and directly evaluate spinal fusion. Overal judgment of symptoms, signs and different kinds of image data are more reasonable fusion evaluation strategies.