Objective:To preliminarily explore the synthesis of a quercetin derivative 3′,4′,5,7-four-(O-methoxy carbonyl meth-yl) quercetin and its pharmacological activities. Methods:Quercetin as the reactant and N,N-dimethyl-formamide ( DMF) as the sol-vent, the target product 3′,4′,5,7-four-(O-methoxy carbonyl methyl) quercetin was obtained by the slow addition of methyl chloroace-tate in the presence of anhydrous K2 CO3 to introduce ether bond at 3′,4′,5,7- bit. The structure was characterized by LC-MS, 1 H-NMR and element analysis. The nanoemulsion of the product was prepared using a film dispersion method, and with intraperitoneal in-jection, the effect on pituitrin-induced myocardial ischemia cardiovascular system in rats was observed. Results:3′,4′,5,7-Four-(O-methoxy carbonyl methyl) quercetin was successfully synthesized, and could be metastasized to a demethylation product containing dis-tal free carboxyl with increased polarity proved by metabolic tests in vitro. The results of electrocardiogram and animal experiments showed that the compound had improving effects on pituitrin-induced myocardial ischemia in rats. Conclusion: The nanoemulsion of 3′,4′,5,7-four-(O-methoxy carbonyl methyl) quercetin with intraperitoneal injection shows significant antagonism against pituitrin-in-duced myocardial ischemia in rats.

ObjectiveTo investigate the value of cold laser combined with choledochoscopy in the treatment of residual stones after biliary surgery. MethodsA retrospective analysis was performed for the clinical data of 79 patients with residual stones after biliary surgery who were admitted to Fuzhou General Hospital of Nanjing Military Area Command from January 2015 to June 2016. All the patients underwent cold laser combined with choledochoscopy at 6 weeks after surgery. The cure rate and complications were observed. ResultsAll the patients underwent successful lithotripsy, and the cure rate was 100%. Of all the patients, 68 did not experience any postoperative complication, 7 experienced abdominal distension, abdominal pain, and diarrhea, which achieved spontaneous remission after observation, and 4 experienced fear of cold and chill, which were improved after symptomatic treatment. No patients experienced serious complications, such as bile duct injury, biliary tract perforation, bile leakage, and hematobilia. ConclusionCold laser combined with choledochoscopy has a good effect, a high level of safety, and good repeatability in the treatment of residual stones after biliary surgery; therefore, it holds promise for clinical application.

High-quality development is the primary task of building a socialist modern country in an all-round way. Organ donation and transplantation in China are evolving from high-speed growth to high-quality development, which put forward new requirements for the safe, stable and healthy operation of Organ Procurement Organization (OPO). Safety is the foundation and prerequisite for achieving the goal of high-quality development. As an independent and comprehensive department, internal audit should create new achievements in the new era. The department should include OPO and organ donation into the scope of internal audit, shift the emphasis upon the overall development of organ donation. Besides, it should fully consider the actual situation in different places, conduct all-round, objective and fair evaluation, provide evaluation and consulting services for OPO to properly implement organ donation, and give full play to the supervision and prevention role of internal audit.

Objective To investigate the expression levels of basic leucine zipper and W2 domain 2 (BZW2) and isovaleryl-CoA dehydrogenase (IVD) in hepatocellular carcinoma (HCC) and evaluate their effect on clinical prognosis of liver transplant recipients with HCC. Methods Pathological specimens and clinical data of 87 liver transplant recipients with HCC were collected and retrospectively analyzed. The recurrence and metastasis of HCC after liver transplantation were assessed. Immunohistochemical staining was used to detect the expression levels of BZW2 and IVD. The relationship between BZW2, IVD and clinicopathological parameters of HCC and their effect on postoperative recurrence and clinical prognosis of the recipients was analyzed. Results Among 87 recipients, 31 cases recurred with a recurrence rate of 36%. HCC recurred at postoperative 2-49 months and the median recurrence time was postoperative 7 months. Immunohistochemical staining demonstrated that the positive expression rate of BZW2 in the HCC tissues was significantly higher than that in normal liver tissues (76% vs. 30%), and the positive expression rate of IVD was significantly lower compared with that in normal liver tissues (51% vs. 69%) (both P < 0.01). BZW2 expression was significantly correlated with tumor diameter and tumor capsule (both P < 0.05), whereas IVD expression was significantly associated with tumor diameter, alpha-fetoprotein (AFP) level, tumor, node and metastasis (TNM) staging and whether vascular invasion was found or not (all P < 0.05). In the high BZW2 expression group, the cumulative recurrence rate of HCC was significantly higher and the cumulative survival rate was significantly lower than those in the low BZW2 expression group. In the low IVD expression group, the cumulative recurrence rate of HCC was significantly higher and the cumulative survival rate was significantly lower compared with those in the high IVD expression group (all P < 0.05). Conclusions The expression level of BZW2 protein is up-regulated, whereas that of IVD protein is down-regulated in the HCC tissues. Moreover, the cumulative recurrence rate of HCC is relatively high and the cumulative survival rate is relatively low in liver transplant recipients with high BZW2 expression and low IVD expression.

Objective To explore the related factors of diarrhea onset in critically ill patients during early enteral nutrition (EEN). Methods Thirty Zhejiang Provincial Emergency Intensive Care Units (EICU) and ICU to implement EEN support for critically ill patients from July 2016 to August were enrolled, and the incidence of diarrhea within 1 week after EEN administration was observed. The patients were divided into a diarrhea group and a non-diarrhea group according to whether diarrhea occurred or not during EEN. The basic status data [sex, age, body mass index (BMI), albumin, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), nutritional risk screening (NRS2002), major disease diagnosis], and EN status (feeding route, infusion method, EN type, amount of EN on days 4 and 7), and clinical treatment (applying following treatments or not: mechanical ventilation and its duration, vasoactive drugs, gastrointestinal motility drugs, probiotics) and clinical outcomes (survival after discharge or not) were collected in two groups. Multivariate Logistic regression analysis was performed on the indexes with statistically significant differences obtained from the univariate analysis to screen out the relevant risk factors of occurrence of diarrhea in critically ill patients during EEN administration. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of each risk factor for occurrence of diarrhea in critically ill patients with EN therapy. Results Of the 510 critically ill patients who underwent EEN, 156 had diarrhea, 70.5% (110/156) had diarrhea within 4 days of EEN, most diarrhea lasts for 3 days and most frequency of diarrhea was 3-4 times a day. The univariate analysis showed that the age of patients in the diarrhea group was significantly higher than that in the non-diarrhea group (years:69.42±17.94 vs. 65.76±17.69), the mechanical ventilation time and ICU hospitalization time were significantly longer than those of non-diarrhea group [mechanical ventilation time (days): 8 (5, 14) vs. 8 (4, 9), ICU hospitalization time (days): 11.5 (8.0, 19.0) vs. 9.0 (6.0, 14.0)], the proportion of probiotics used and the proportion of feeding by nasal tube were significantly higher than those of non-diarrhea group [proportion of probiotics: 26.9% (42/156) vs. 14.4% (51/354), proportion of nasal tube feeding: [26.9% (42/156) vs. 14.4% (51/354)]. Multivariate Logistic regression analysis showed that the use of probiotics was a protective factor for diarrhea during EEN in critically ill patients [odds ratio (OR) = 0.447, 95% confidence interval (95%CI) = 0.273-0.730, P = 0.001]. ROC analysis showed that the area under the curve (AUC) of probiotics predicting diarrhea was 0.598 (95%CI = 0.554-0.640), P < 0.001, sensitivity was 35.9%, and because AUC was less than 0.7, the accuracy and sensitivity of predicting diarrhea with probiotics was considered to be relatively poor. Conclusion The incidence of diarrhea is high in EEN in critical illness patients and its occurrence is related to various factors. The addition of probiotics can reduce the incidence of diarrhea.

Donation after death is the most important ethical principle to carry out organ donation after citizens’ death. The newly-revised Regulations on Human Organ Donation and Transplantation does not define death, and avoids the key question of “whether to recognize brain death”. Certain legal risks or damages to the rights and interests of donors may exist in organ donation. Death is an inevitable part of human life. It is necessary to establish specific criteria, which is also the only approach, to define death in any era. Death criteria are established based on the view of death, and restricted by the development level of productive forces and other social factors. The determination of death criteria hugely varies between China and the West. To standardize organ donation and transplantation and promote high-quality development of organ donation, medical staff must adhere to the principle of pure motivation, take informed consents as the premise, respect the donors' and their close relatives' rights to choose their own death criteria, strictly follow the death judgment procedures and operating norms, and ensure the scientificity, accuracy and fairness of death determination.