OBJECTIVE:To improve the safety and effectiveness of total parenteral nutrition(TPN),and to provide reference for clinical rational use. METHODS:1400 TPN prescriptions in PIVAS from Jan. to Jun. 2013 were analyzed statistically in re-spects of rationality and stability. RESULTS:Among 1400 TPN prescriptions,there were 433 prescriptions of unreasonable glu-cose-lipid ratio(30.93%),782 prescriptions of unreasonable hot-nitrogen ratio(55.86%),443 prescriptions of unreasonable liquid amount(31.64%),1 261 prescriptions of unreasonable total calorie(90.07%)and 383 prescriptions of unreasonable treatment du-ration (27.36%). CONCLUSIONS:TPN prescription design is reasonable,but there are still some problems as low calorie,too high or too low hot nitrogen ratio,improper electrolyte dosage,improper duration of nutrition support. Clinicians should accurately assess the nutritional status of patients to design the prescriptions rationally and improve clinical safety and effectiveness of TPN. Pharmacists should further ensure the reasonableness of the prescription by prescription checking.

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BACKGROUND:Traditional studies on foot and ankle biomechanics have limitation. Ankle joint was complicated and had big range of motion, so it is difficult to establish finite element models and to analyze the type of fracture.
OBJECTIVE: To construct the finite element models of distal tibial fractures and analyze the stability.
METHODS: CT data of ankle were colected from a normal male volunteer and the three-dimensional reconstruction of volunteer was made by Mimics software, and the effectiveness was verified. The ratio of different joint involvement and height of fracture block were assumed with Solidwork software, and finite element models of distal tibial fractures were established. Fracture stability was analyzed by ANSYS software using finite element method.
RESULTS AND CONCLUSION:The distal tibia fracture model was consistent with the relevant literature data, and finite element analysis could be further conducted. The ratio of articular surface involved was positively associated with fragment height and fracture displacement, and negatively associated with fracture stability. These results indicate that the three-dimensional finite element models of distal tibial fractures were successfuly established. Fracture stability was associated with the ratio of articular surface involved and fragment height.

Objective To analyze the genotype of varicella-zoster virus (VZV) strains isolated from patients with chickenpox or zoster and to differentiate them from Oka vaccine strain by molecular analysis. Methods In the present study, single nucleotide polymorphisms(SNP) based VZV genotypes were analyzed in 19 VZV isolates using the polymerase chain reaction and restriction fragment length polymorphisms analysis of DNA fragments of the open reading frames 38, 54, 62, and the 1t5 repeat region. Results The genotypes of 19 VZV isolates including two different groups with 52.7% of Pst Ⅰ+ Bgl Ⅰ+ R5A and 47.3% of Pst Ⅰ+ Bgl Ⅰ+ R5B, which is very different from those found in North America, Europe and Japan. All the Chinese isolates are wild-type strains with ORF62 Sma Ⅰ-. No Oka vaccine strains were revealed among the isolates. Conclusion Chinese VZV strains reported in this study showed different molecular characteristics from those circulating in Europe, North America and Japan. The SNPs in ORF62 and ORF38 may be used to distinguish VZV wild-type strains and vaccine strain in clinical isolates in China.

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.

Objective To study the feasibility of using fractional flow reserve (FFR) to guide whether to perform coronary revascularization of non-culprit moderate stenosis in patients with unstable angina and estimate their clinical prognosis. Methods This study enrolled unstable angina patients with multivessel disease. First successful stenting of the culprit artery, then the other non-culprit moderate coronary stenosis were randomized into PCI guided by angiography or guided by FFR measurements. Death from any cause, nonfatal myocardial infarction, unplanned hospitalization leading to urgent revascularization and clinical manifestations with angina were followed during the first year. Results 71 patients were included, among them 35 patiens were randomly assigned to angiography-guided PCI and 36 patients to FFR-guided PCI. In FFR-guided PCI group, FFR was successfully measured in all of non-culprit moderate coronary stenosis. In 23 stenosis, the FFR was greater than 0.80, and stents were not placed in these stenosis. In 13 stenosis with FFR<0.8, stent were inplant and FFR was raised≥0.95 after stenting. The percentage of patients who had a primary end-point event was higher in the angiography-guided PCI group than the FFR-guided PCI group (P<0.05). Neither the rate of mortelity from any cause nor the rate of non-fatal myocardial infarction had significant difference between the 2 groups. Related to the target vessels rates of nonfatal myocardial infarction (5.6%vs. 28.6%) and target lesion revascularization (5.6%vs. 31.4%) were statistically different (P<0.01 and P<0.05, respectively). Conclusions In patients with unstable angina, it is safe to use FFR values to guide decisions on the revascularization of angiographically moderate non-culprit stenosis. Routine measurement of FFR in addition to angiographic guidance, as compared with PCI guided by angiography alone, results in a significant reduction in major adverse events at 1 year, particularly in urgent revascularization, and clinical manifestations with angina get better.

Cubic and conductive teaching pattern is based on standardized operation process of microbiological specimens. It uses multi-dimensional teaching methods including tests, question guid-ance, discussion, lectures, measurements and scientific researches to lead the undergraduate students to master the standardized inspection process and to train talents with good gifts and abilities in prac-tical application. The teaching pattern helps the trainees complete training in basic experiment skills, analysis and problem solving skills, scientific thinking and working methods. Then the corresponding practical quantification evaluation criteria has been established according to the standardized inspec-tion process to assess the interns' level of grasping various vocational skills and comprehensive appli-cation in the inspection process. This pattern reflects the teaching philosophy of modern laboratory medicine and can scientifically and objectively assess the talent cultivation quality and teaching quality. Since its implementation, these trainees have improved their overall vocational abilities, and made a good preparation for their practical work after school. Besides, it has enhanced the teaching level of microbiology laboratory practice and has been highly valued by interns. It is hoped that this practical experience will be a useful attempt to promote medical education development of modern laboratory medicine.

The improvement of the electroosmotic pump properties and the effects of the bi-directional electrostacking system on the pre-concentration factor were investigated.A portable electrokinetic flow analysis system with electroosmotic driving and bi-directional electrostacking unit was introduced.The improved system with graphite furnace atomic absorption spectrometry was employed to separate,pre-concentrate and determine Cr(Ⅵ) and Cd(Ⅱ)in mineral water.The detection limit of Cr(Ⅵ)and Cd(Ⅱ)was 9 ng/L and 10 ng/L(3б of blank,n=11),respectively.Their recoveries of 200ng/L Cr(Ⅵ) and 100ng/L Cd(Ⅱ) added to samples were(105～107)±2% and (104～106)±2%(n=3).

Objective To evaluate the clinical significance of prenatal ultrasonography in diagnosis of retroaortic left innominate vein ( LINV ) . Methods Thirty fetus with retroaortic LINV were involved , including 17 cases of isolated retroaortic LINV and 13 cases of complicated retroaortic LINV . Three-vessel and trachea ( 3VT ) view was focused in the routine second trimester ultrasound screening to observe whether LINV existing or not . And then the transducer was rotated to the fetal sagittal view to assess the relationship between LINV and aortic arch and the convergence of left subclavian vein and left internal jugular vein into the LINV . Results The characteristic feature of retroaortic LINV was the LINV converge into right superior vena cava ( SVC) under the aortic arch ,not above the aortic arch . The most important plane to detect the retroaortic LINV was the 3VT view ,which revealed the abnormal vein lying to the left of pulmonary artery . The abnormal vein then could be traced and revealed its connection with the right SVC beneath the aortic arch on the transverse plane inferior to the 3VT view and on the fetal sagittal plane . Conclusions The whole course of retroaortic LINV can be revealed by ultrasound prenatally ,which can not only account for the abnormal vein to the left of pulmonary artery on 3VT view ,but also play an important role in surgery decision and future cardiac intervention treatment .

Objective To study the characteristics of ? cell function change and to explore the predictive value of glutamic acid decarboxylase (GAD)-Ab and other factors for ? cell function in the patients with latent autoimmune diabetes of adults (LADA). Methods Sixteen LADA patients (positive GAD-Ab) and 24 type 2 diabetic patients (negative GAD-Ab) were followed-up at 0, 6th, 12th, 30th, 36th, 42th and 48th months respectively. Their fasting and postprandial 2h C-peptide and glycemic control were measured. GAD-Ab was determined by radioimmunoprecipitation assay and C-peptide by RIA. Results Decreased fasting C peptide (FCP) levels (Month 30, 36, 42, 48 compared with Month 0, P