Objective:To investigate the utilization of total parenteral nutrition ( TPN) in a hospital to provide reference for the clinical rational drug use. Methods:The utilization and trend of TPN in the surgical inpatients during August 2012 to July 2013 in the hospital were analyzed statistically. Results:Totally 116 patients received TPN with 1 013 times, and the patients with gastrointestinal malignant tumor accounted for 48. 3%. The average use day was (8. 7 ± 3. 2) d and the total energy was within the range of 900-1 500 kcal. The number of prescription with glycolipid ratio below 1 was 878 (86. 7%), that with hot nitrogen ratio of 100-150 was 689 (68. 0%), that with monovalent cation concentration below 150 mmol·L-1 was 1 008 (99. 5%), that with divalent cation concentra-tion below 5 mmol·L-1 was 879 (86. 8%), that with glutamine was 765 (75. 5%) and that with sugar and insulin ratio (g:u) be-low 3 was 42 (4. 1%). Conclusion:The maln problem in the TPN application in the hospital is that glycolipid ratio in the majority of prescriptions is low, and irrational hot nitrogen ratio, excessive cation concentration and insulin dosage appeared in the minority of pre-scriptions. Clinicians should strengthen the learning of parenteral nutrition knowledge and clinical pharmacists should actively perform reasonable intervention in the TPN prescriptions to promote the reasonable TNP therapy and improve the therapeutic effect.

Objective To discuss the relationship between diabetic macular edema(DME) and visual field defects and evaluatethe therapeutic effect of micro-pulse laser.Methods A total of 117 patients (149 eyes) with diabetic retinopathy(DR) were enrolled in this study and divided into two groups according to early treatment diabetic retinopathy study(ETDRS) DME diagnostic criteria:DME group(n=50,70 eyes) and N-DME group(n=67,79 eyes).Healthy subjects(n=40,80 eyes)were selected as NC group in thisstudy.The clinical data and biochemical index were collectedand visual fields were examined in all the subjects.Then the DME group was further divided into two subgroups:micro-pulse laser subgroup(35 eyes) and conventional laser subgroup(35 eyes).The vision recovery after treatment was evaluated on different time points.Results Diabetes duration,FPG,HbA1c and HOMA-IR were significantly higher in DME group than in N-DME group (P<0.05).RF value was less than 15% in each group,suggestingreliable test results.The levels of MD index[(7.81±0.75) vs (4.32±0.67) vs (1.14±0.22) dB],LV[(20.17±4.85) vs (15.34±3.19) vs (4.72±1.11) dB] and sLV[(10.71±1.37) vs (7.22±1.12) vs (2.35±0.41) dB] were significantly higher in DME group and N-DME group than in NC group,and those in DME group were higher than in N-DME group(P<0.01).After three month's treatment,the levels of MD index,LV and sLV were lower in micro-pulse laser subgroup than in conventional laser subgroup(P<0.05).There were no statistically significant difference in MD index,LV and sLV in conventional laser subgroup on different time points(P>0.05).Multiple logistic regression analysis showed that DM duration,FPG,HbA1c and HOMA-IR were riskfactors for DME(all P<0.01).Conclusion Patients with DME have severe vision loss.Micro-pulse laser therapy is helpful invision recovery,while conventional laser therapy have no obvious effect on it.Longer duration of DM,higher level of FPG,HbA1c,and IR severity may increase the risk of DME.

Infertility has become a global problem affecting human reproductive health.As an important treatment for infertility, assisted reproductive technology has made great progress over the past few decades.Rapid development has also taken place in medical devices for human assisted reproductive technology.It is imperative to establish the risk management and safety evaluation system of these products.In 2016, the industry standard YY/T 1434-2016 Human in vitro Assisted Reproductive Technology With Medical Equipment in vitro Mouse Embryo Test was officially released.In this paper, the key notes and elements of this in vitro mouse embryo test are briefly reviewed.

Objective To explore the ability of advanced oxidation protein products (AOPP)in predicting the progression of diabetic retinopathy (DR)in patients with type 2 diabetes mellitus (T2DM). Methods 363 T2DM patients were enrolled in this prospective cohort study. According to the quartile points of baseline AOPP level,patients were divided into four groups (Q1,Q2,Q3 and Q4 ). The progression rate of DR was calculated according to the changes of non-mydriatic fundus photography after a 5-year follow-up. Results With the increase of baseline AOPP level,the rate of progression of DR increased (19.51% vs 28.42% vs 37.36% vs 47.37%,P <0.01). Logistic regression analysis showed that baseline level of AOPP was an independent risk factor for the progression of DR (OR=1.833,95%CI:1.573~1.982,P<0.05).Area under the curve of AOPP in predicting DR is 0.883 (95% CI:0.842~0.924)with the sensitivity 86.1% and specificity 91.9%. Conclusion AOPP may be one of the biomarkers for the prediction of type 2 diabetic retinopathy progression.

Objective To study the expression of Gli1 protein and vascular endothelial growth factor (VEGF)-C in papillary thyroid carcinoma and their relationship with cervical lymph node metastasis.Methods The expression of Gli1 protein and VEGF-C were investigated by immunohistochemical EnVision method in 67 cases of papillary thyroid carcinoma and 32 cases of nodular goiter pathological specimen tissues.Nascent microvascular and micro-lymphatic of all pathological speimen tissues were examined by immunohistochemical monoclonal antibody CD34 and D2-40 staining assay respectively,and the microvascular density (MVD) and micro-lymphatic vessel density (MLVD) were calculated.The relationship between the positive expression of Gli1 protein and MVD,between the positive expression of VEGF-C and MLVD,and their relationship with cervical lymph node metastasis were analyzed.Results The positive rates of Gli1 protein,VEGF-C and MVD,MLVD were significantly higher in papillary thyroid carcinoma than those in nodular goiter [67.16％(45/67) vs.43.75％(14/32),70.15％(47/67) vs.31.25％(10/32),23.14 ± 2.06 vs.2.14 ± 0.31,13.36 ± 1.32 vs.3.53 ± 0.65,P ＜ 0.05].The positive expression of Gli1 protein was related to the patient' s age and the tumor size (P ＜ 0.05),while the positive expression of VEGF-C was not related to the patient' s age and the tumor size (P ＞ 0.05).The positive expression of Gli1 protein and VEGFC were significantly higher in TNM stage Ⅲ-Ⅳ of papillary thyroid carcinoma than those in TNM stage Ⅰ-Ⅱ (P ＜ 0.01) and also was significantly higher with cervical lymph node metastasis than without cervical lymph node metastasis (P ＜ 0.01).MVD and MLVD were significantly higher with cervical lymph node metastasis than without cervical lymph node metastasis (P ＜ 0.05).The positive expression of Gli1 protein was positively correlated with MVD (r =0.784,P＜ 0.01),the positive expression of VEGF-C was positively correlated with MLVD (r =0.529,P ＜ 0.01),the positive expression of Gli 1 protein was positively correlated with the positive expression of VEGF-C (r =0.586,P ＜0.01).Conclusions Gli1 protein which may participate in the formation of nascent microvascular is abnormally activated by the Hedgehog signaling pathway to express,VEGF-C which may be participate in the formation of nascent micro-lymphatic is mediated and started by the MAPK signaling pathways to express.Expressions of Gli1 protein is positively correlated with expressions of VEGF-C,therefore the Hedgehog signaling pathway may be associated with the MAPK signal pathway.Suppressing nascent microvascular and micro-lymphatic may become new target to blockingup papillary thyroid carcinoma cervical lymph node metastasis.

Objective To assess the effect of aspirin for the chemoprevention of colorectal adenomas by meta analysis of the published literature.Methods Cochrane strategy in combination with manual search was used to identify previously published randomized controlled trials by searching PubMed,EMBase,Cochrane Library,China Journal Full-text Database(CNKI),Chinese Scientific Journal Full-text Database (CSJD) and Chinese Biomedical Literature Database (CBM).Results Six randomized controlled trials involving a total of 2 858 patients were studied.Of the six trials,two trials were performed in China,four trials were in the Europe and the United States.Some sufficient evidence were found to support that aspirin could prevent of colorectal adenomas compared with placebo group ( P =0.003,RR =0.66,95％ CI:0.50-0.86).No adaquate evidence supported the role of aspirin in the prevention of development of colorectal cancer ( P =0.29,RR =0.65,95％ CI:0.30-1.44).High-dose aspirin ( P =0.10,RR =0.85,95％ CI:0.71-1.30 ) and low-dose aspirin could prevent colorectal adenomas compared with placebo group( P =0.02,RR =0.57,95％ CI:0.36-0.90),and a dose-dependent associtation was found.The risk of stroke was higher in any dose of aspirin compared with placebo group ( P =0.04),and the risks of adverse events had no significant differences in all groups.Conclusion Aspirin might prevent the development of colorectal adenomas in individuals,but could not prevent the colorectal cancer.

Objective To investigate the effect of insulin-like growth factor binding protein-related protein 1 ( IGFBPrP1 ) in the formation and development of hepatic fibrosis. Methods Hepatic fibrosis model of mice was made by intraperitoneal injecting with thioacetamide, then the mice were sacrificed four, five and six weeks later (10 mice were sacrificed at each time point, model groups). Mice in the control groups were treated by normal saline (6 mice were sacrificed at each time point). Collagen accumulation in liver tissues was detected by Masson stain. Distribution and dynamic expressions of IGFBPrP1, alpha-smooth muscle actin ( α-SMA ),Collagen Ⅰ , fibronectin ( FN), TGF-β1 and Smad3 in different groups were detected by immunohistochemistry.The expressions of IGFBPrP1, α-SMA and Smad3 were detected by Western blot. All data were analyzed using the analysis of variance (ANOVA), Pearson rank correlation coefficient. Results The expressions of IGFBPrP1 in the liver tissues were increased from 0.21 ±0.03 to 5.03 ±0.09, α-SMA from 0. 11 ±0.04 to 10.09 ±0. 18,Collagen Ⅰ from 0.22 ±0.01 to 11.01 ±0. 16, FN from 0.31 ±0.09 to 19.81 ±1.62, TGF-β1 from 0.49 ±0.02 to 5.97 ± 0. 19, and Smad3 from 0.22 ± 0.03 to 2.03 ± 0.07. Compared with the control groups, the expressions of IGFBPrP1, α-SMA, Collagen Ⅰ , FN, TGF-β1 and Smad3 in the model groups were significantly increased as time passed by ( F = 783. 141,998. 200,886. 715,935. 242, 931. 241,697. 118, P < 0. 05 ). During the formation of hepatic fibrosis, the expression of IGFBPrP1 was positively correlated with the expressions of α-SMA,Collagen Ⅰ , FN, TGF-β1 and Smad3 ( r = 0. 906, 0. 927, 0. 988, 0. 947, 0. 977, P < 0.05 ). The results of Western blot showed that the protein expression of IGFBPrP1 was increased from 0. 23 ± 0.01 to 0.92 ± 0.07,α-SMA from 0.36 ± 0. 02 to 1.39 ± 0.03, FN from 0.03 ± 0.00 to 0.12 ± 0.02, and Smad3 from 0.09 ± 0. 01 to 0.56 ±0.04. The protein expressions of IGFBPrP1, α-SMA, FN and Smad3 were significantly increased in the model groups when compared with the control groups (F =57. 316, 201. 214, 103. 871, 72. 966, P <0.05).During the formation of hepatic fibrosis. IGFBPrP1 was positively correlated with the expressions of α-SMA, FN and Smad3 (r = 0. 982, 0. 924, 0. 965, P < 0.05 ). Conclusions The expression of IGFBPrP1 increases as the aggravation of the fibrosis. IGFBPrP1 promotes the formation and development of hepatic fibrosis by activating hepatic stellate cells, accelerating the synthesis and secretion of Collagen Ⅰ and FN which are the principal components of extracellular matrix, and affecting the TGF-β1/Smad3 pathway.

Objective To evaluate left ventricular (LV) remodeling and function after acute myocardial infarction (MI) in rats using speckle tracking imaging (STI). Methods The left anterior descending coronary was ligated to induce MI in twenty normal rats. One day after creation of MI, fifty survivals based on the diagnostic criteria of MI were divided into 4 groups as follows:pre-infarction, 1 day,4weeks,and 8 weeks after MI. Echocardiography was performed to evaluate the changes of left ventricularfunction in rats. M-mode and two-dimensional cross-sectional echocardiography data were acquired at the papillary muscle level and digitally stored for further analysis. Circumferential strain rate(SRcir) and radial strain rate(SRrad) indexes were measured by STI software for each animal. Results One day after MI,indexes of SRcir and SRrad in anterior and lateral segments were significantly decreased (P ＜0.01, for both). Four weeks after MI,compared with baseline,SRrad and SRcir were decreased in all segments ( P ＜0.01). Eight weeks after MI, however, SRrad and SRcir showed no significant difference compared with 4weeks group. Conclusions STI can correctly identify LV dysfunction in rats and can be used for serial assessment of cardiac remodeling in rats models.

Objective To analyze the MRI features of chordoid meningioma (CM),and to compare with other meningiomas. Methods Clinical and MRI features of 7 patients with CM confirmed by pathology were analyzed retrospectively.Featrues of every MRI sequence were investigated qualitatively.Meanwhile normalized signal ratios of each sequence were analyzed furtherly,including normalized T1 weighted image intensity ratios (NT1 ),normalized T2 weighted image intensity ratios(NT2 ),normalized ADC ratios (NADC)and normalized T1 WI contast enhancement intensity ratios (NCE).Fisher ’s exact test and Dunnett T 3 test were employed to analyze the difference of CM and nonchordoid meningiomas (34 cases of WHO grade Ⅰ meningioma,1 6 cases of nonchordoid WHO grade Ⅱ meningioma,and 5 case of WHO grade Ⅲ meningioma).Results The CM showed hyperintensity on T2 WI and meanwhile other nonchordoid meningiomas demonstrated isointensity,hypointensity or slight hyperintensity on T2 WI.Evaluations of DWI revealed variable signal intensities of CM.But all 7 cases had no obvious restricted diffusion,and increased signal was seen on the ADC map in each patient.The solid parts of CM enhanced markedly after contrast agent injection.Quantitative indicators NT2 , NADC and NCE of CM were higher than other meningiomas(P <0.01),but NT1 showed no statistic difference between CM and other meningiomas (P =0.889).Whether there was cyst,necrosis,orflow void sign on T2 WI,and no matter with or without perifocal edema,dural tail sign and a broader base among meningiomas had no significance in differentiating CM and other meningiomas.Conclusion CM has typical MRI features.The tumors show hyperintensity on T2 WI,especially have no obvious restricted diffusion and enhance markedly after contrast.The measurement of NT2 ,NADC and NCE enables reliable preoperative prediction of the atypical histopathologic diagnosis.

Objective To examine the effectiveness of self-efficacy training on fluid intake in maintenance hemodialysis patients.Methods Fifty-four hemodialysis patients participated in the study.The intervention was based on Bandura's self-efficacy theory.The outcome measure was self-efficacy for managing chronic disease,the mean interdialysis weight gain,dialysis-related complications and patient satisfaction.Data were collected at baseline and 3 months after the intervention.Results The mean score of selfefficacy,the mean interdialysis weight gain,dialysis-related complications and patient satisfaction after the intervention were all statistically significant compared with those bcfore the intervention.Conclusions The study supports the effectiveness of the self-efficacy training in improving the fluid intake compliance in maintenance hemodialysis patients.So it is worth being popularized in clinic.