Surgical nutrition therapy is a novel course for undergraduates who are major in food hygiene and nutrition.In this study,the purpose,content,model and specific teaching approaches of the course were discussed,and the essentials of clinical practice for surgical nutrition therapy were pointed out.We hope that our experience would be helpful for the development of the course.

Objective To analyze the MRI data of misdiagnosed and missed diagnosed of breast lesions and their histopathological features.Methods Data from 241 breast lesions within 121 patients were recruited in this study.The data included MRI images,uhrasounds and X-ray images were retrospectively interpreted by two radiologist and each lesion was assessed according to the BI-RADS classification.The pathologic features of miss or error diagnosed lesions on MRI were analyzed.Results In 241 breast lesions (malignance 120,bcnign 121),4 lcsions were miss diagnosed on MRI.Thcy were 2 intraductal papillomatosis and 2 fibroadenoma.All was benign.Twenty three lesions were misdiagnosed on MRI.Sixteen were overestimation,including 3 chronic inflammations,3 sclerosing adenosis,2 fibroadenoma,4 fibrocystic changes with or without atypical ductal hyperplasia (ADH),2 intraductal papilloma,1 infiltration of pectoralis major muscle and 1 axillary lymphnode metastasis.Meanwhile,there were 7 lesions were underestimation.These lesions included 2 invasive ductal carcinomas,1 mucinous adenocarcinoma,2 DCIS and 1 blunt duct adenosis with ADH and focal cancerous,1 inflammatory breast cancer underwent chemotherapy.The sensitivity and specificity and accuracy of breast MRI were 95.83 ％ (115/120),72.73 ％ (88/121),84.23 ％ (203/241),respectively.MRI findings had no difference with respect to mammogram or ultrasound was 75.10 ％ (181/241).Conclusion MRI misdiagnosis and missed often occurs in smaller breast lesions,morphologic and hemodynamic malignant manifestation atypical,especially intraductal lesions.MRI diagnosis should be combined with physical examination,X-ray mammogram and ultrasound to improve diagnostic accuracy and reduce missed diagnosis.

Objective To study the protective effect of(-)clausenamide on the damage of PC12 cells induced by serum deprivation and to explore its related mechanism. Methods The cell viability was detected by MTT assay and morphological observation. The effect of(-)clausenamide on the PC12 cell apoptosis was analyzed by flow cytometry. Then western blotting and confocal microscope was used for the further study of effect of(-)clausenamide on the protein expression of GSK-3?,Bax and Bcl-2. Results(-)Clausenamide remarkably increased PC12 cell survival rate through inhibiting the PC12 cell apoptosis induced by serum deprivation at the concentration of 1 or 10 ? mol/L(P

ObjectiveTo evaluate the uncertainty for the determination of ethanol in human blood by auto-headspace gas chromatography (HS-GC) with internal standard curve method.Methods Each source of uncertainty, arising from the procedure of testing, was analyzed and conifrmed according to the guidelines of the uncertainty in measurement . After each uncertainty component was quantized, the combined standard uncertainty and the expanded uncertainty of the result were calculated.Results The relative uncertainty brought from the measurement repeatability, standard solution of the ethanol, the sample of blood, internal standard solution of the tert-butyl alcohol, the calibration cure, gas chromatography were 3.4%,0.71%,0.61%,0.41%,1.1% and 1.3% respectively; the relative expanded uncertainty of ethanol in blood was 3.9%.Conclusion The measurement uncertainty of the concentration of ethanol was came primarily from the measurement repeatability of sample, HS-GC and standard curve of ethanol.

Objective To evaluate the effects on the mineral bone disorder using different calcium concentration citrate-based dialysate in maintenance hemodialysis (MHD) patients.To compare the concentrations of intact parathyroid hormone(PTH) with biointact PTH(1-84) in these patients.Methods Citrate dialysate with different calcium concentration (DCa 1.75,DCa 1.5,DCa 1.25 mmol/L)were used in turn in 15 stable MHD patients each week.Serum tCa and iCa were measured by automatic biochemistry analyzer.The concentrations of iPTH and bio-iPTH were compared.Results (1) The patients treated with DCa 1.75 citrate dialysate had increased serum iCa and tCa after dialysis,and PTH did not change significantly as compared to those findings before the dialysis.With the DCa 1.5 citrate dialysate,serum iCa and tCa were kept stable and PTH level was increased.With DCa 1.25 citrate dialysate,serum iCa and tCa decreased significantly and PTH decreased.(2)iPTH and bioPTH had excellent correlations.Variation of bio-iPTH was more correlated with the changes of calcium than iPTH.Conclusions Serum levels of iPTH,tCa and iCa can be kept stable in MHD patients treated with DCa 1.75 ～ 1.5 citrate dialysate.Bio-iPTH is a more sensitive marker for mineral bone disease than iPTH.

Objective To compare the effects of different administration routes and dosages of tropisetron on cisplatin-induced kaolin intake in rats.Methods Ninety-six healthy adult male Wistar SPF rats were randomly divided into 8 groups(n =12 each):intrathecal (IT) control group (group TC) and 3 tropisetron groups receiving IT tropisetron 10,20 and 30 μg,the volume of each group was 30 μl (group T10,T20,T30),intravenous(Ⅳ) control group (group IC) and 3 tropisetron groups receiving Ⅳ tropisetron 0.3,0.5 and 0.7 mg/kg respectively (group I0.3,I0.5,I0.7).In group TC and IC,normal saline 30 μl and 0.5 ml were injected IT and Ⅳ,respectively.All rats received cisplatin 3mg/kg by intraperitoneal injection at the time point of thirty minutes after administration,each rat weight,the daily food and kaolin intakes were detected at the time point of 48 hours after cisplatin administration.Results Compared with group Tc,each rat weight loss,the kaolin intakes were significantly decreased (P ＜ 0.05),and food intake dose was significantly increased in group T20 (P ＜ 0.05).Compared with group IC,each rat weight loss,the kaolin intakes were significantly decreased (P ＜ 0.05),and food intake dose was significantly increased in group I0.5 and I0.7 (P ＜0.05).There was no significant difference between group I0.5,I0.7 and group T20.Conclusions The kaolin intakes and the rat weight loss can be decreased by IT tropisetron,and the food take dose was increased meanwhile,and IT tropisetron 20 μg has equivalent efficacy to IV tropisetron 0.5 or 0.7 mg/kg.IT could be the new administration route of tropisetron.

Objective:Recent studies have shown that in contrast to decrease in distal gastric adenocarcinoma (DGA), incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased noticeably in numerous counties. However, the reasons remain unclear. This study evaluated the possible differences in the expression of KLF4, SP1, and Cyclin D1 in AEG and DGA, and explored the potential carcinogenesis of AEG. Methods:Immunohistochemistry was performed on paraffin-embedded tissues to evaluate the pu-tative differences in the expressions of KLF4, SP1, and Cyclin D1 at protein level between AEG (n=58) and DGA (n=47). The patholog-ical significance of these markers between the two groups was also compared and analyzed. Results:The percentage of positive KLF4 expression was significantly lower in DGA than in AEG (P<0.05). Lower KLF4 expression was found both in well-or moderately dif-ferentiated cases and in poorly differentiated cases with DGA compared with their AEG counterparts (P<0.05). However, positive stain-ing for SP1 was significantly higher in DGA (P<0.05). No significant difference was found in the expression of Cyclin D1 between the two groups. Further analysis showed that in DGA, the positive expression of KLF4, SP1, and Cyclin D1 were significantly correlated with lymph node metastasis. In AEG, only Cyclin D1 expression was correlated with lymph node metastasis (P<0.05). No correlation was found among the expression of KLF4, SP1, and Cyclin D1 in AEG. In DGA, KLF4 was inversely correlated with SP1 and Cyclin D1 (r=-0.334 and r=-0.341, respectively, P<0.05), and SP1 was positively correlated with Cyclin D1 expression (r=0.340, P<0.05).Conclusion:Different expression patterns and clinicopathological significance of KLF4, SP1, and Cyclin D1 were observed between AEG and DGA, suggesting the putative difference in the carcinogenesis and progression of AEG and DGA.

Objective To explore the related risk factors of cerebral hemorrhage complicated with stress ulcer (SU). Methods The clinical data of 1 185 patients with cerebral hemorrhage admitted to Department of Emergency Medicine of Nanjing General Hospital from March 2006 to March 2014 were retrospectively analyzed. Patients were divided into two groups according to whether patients complicated with SU or not. Data was collected within 8 hours after admission in two groups including gender,age,amount of bleeding,the bleeding site (basal ganglia,thalamus, brainstem,brain lobe,ventricle,subarachnoid,and cerebellum),disturbance of consciousness,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,systolic blood pressure(SBP),history of hypertension,and history of cerebral hemorrhage. The statistically significant risk factors found using univariate analysis was selected and was analyzed to find independent risk factors with multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve)was plotted to analyze the independent risk factors and evaluate their power of test. Results 1 185 patients with cerebral hemorrhage were enrolled in the study,293 cases occurred SU,accounting for 24.7%,and 892 cases without SU,which accounted for 75.3%. As shown by univariate analysis,risk factors for cerebral hemorrhage complicated with SU included age,amount of bleeding,the bleeding site,disturbance of consciousness,APACHEⅡscore,SBP. As to the site of bleeding,brain,thalamus,brainstem hemorrhage complicated with SU were higher proportion,45.3%(43/95),39.1%(63/161),36.9%(48/130),which were significantly higher than those of the lobes of the brain 〔26.2% (33/126)〕,cerebellum 〔18.8% (15/80)〕,basal ganglia〔16.1%(78/485)〕,arachnoid the inferior vena cava 〔12.0% (13/108)〕. Multivariate logistic regression analysis showed that amount of bleeding 〔odds ratio (OR)=3.305,P=0.001,95%confidence interval (95%CI)2.213-48.634〕,the bleeding site (OR=1.762,P=0.008,95%CI 0.123-2.743),SBP (OR=1.223,P=0.034,95%CI 0.245-2.812) were independent risk factors of cerebral hemorrhage complicated with SU. The area under the ROC curve (AUC)of amount of bleeding and SBP were 0.846 and 0.597,suggesting that amount of bleeding has moderate diagnostic value and SBP has low diagnostic value. Conclusions Cerebral hemorrhage patients with large amount of bleeding,the bleeding site in the ventricle,thalamus or brainstem,high SBP are of great risk. We should lower blood pressure and give preventive treatment for SU as soon as possible.

Objective To assess the risk factors of postphlebitic syndrome(PS)after deep vein thrombosis of the lower extremities. Method In this study,102 DVT patients managed by conservative therapy were recruited.Data including age,sex,etiopathogenesis,anticoagulation,pathogenesis, elasticstocking therapy,degree of lower extremity exercise,INR,WBC,PT%and FIB were analyzed by single factor analysis and COX analysis. Result PS developed in 67.60%cases,single factor analysis shows:sex(P=0.025),anticoagulation(P=0.000),elastic-stocking therapy(P=0.000),degree of lower extremity exercises(P=0.000),INR(P=0.033),WBC(P=0.012),PT%(P=0.000),FIB(P=0.002)are related to the occurrence of PS.COX regression shows that anticoagulation(P=0.011),the degree of lower extremity exercise(P=0.019),elastic-stocking therapy(P=0.000)are related to PS.Age (P=0.299),etiopathogenisis(P=0.838)and pathogenesis(P=0.2 17)are not statistically PS related.Conclusion DVT is a multi-factors related disease.Multivariant analysis revealed that elastic-stocking (P=0.000),anticoagulation(P=0.011)and the degree of lower extremity exercises(P=0.019)are related to the development of PS.

Objective To observe the effect of early multidisciplinary rehabilitation therapy on stroke patients.Methods 80 cases of acute stroke were randomly divided into the rehabilitation group (n=40) and control group (n=40). All patients of two groups were treated with routine treatment, and those of the rehabilitation group were added with early multidisciplinary rehabilitation therapy. The degrees of clinical neural function defect, motor function and activities of daily living (ADL) of all patients in two groups were assessed by the clinical neural function defect assessment (NIHSS), Fugl-Meyer Assessment (FMA) and Barthel Index (BI) before and one month after treatment.Results The scores of NIHSS, FMA and BI of patients in two groups were not different before treatment ( P>0.05). After treatment, the scores of patients of the rehabilitation group were significantly higher than that of the control group ( P<0.01).Conclusion Early multidisciplinary rehabilitation therapy can improve the neural function, ADL and raise the quality of life of post stoke patients.