Objective:To establish rules for medical order review in parenteral nutrition, assist pharmacists in the efficient real-time pre-review of parenteral nutrition medical orders, and promote the standardized use of parenteral nutrition.Methods:Professional clinical nutrition pharmacists, prescription reviewing pharmacists, clinicians, and nutritionists jointly contributed to the formulation of custom prescription review rules for parenteral nutrition. Utilizing the prescription review system of our hospital, pharmacists reviewed and intervened parenteral nutrition medical orders in real time.Result:After the implementation of review rules, all of the medical orders for parenteral nutrition have been pre-reviewed in our hospital, and the related indicators that are out of normal range and the cases of single bottle infusion show significant reduction in frequency.Conclusion:The formulation and implementation of specific prescription review rules for parenteral nutrition can effectively assist pharmacists in real-time review of parenteral nutrition medical orders, and can solve the problems of inappropriate medical orders and single-bottle infusion.

Objective:To explore the predictive factors of renal replacement therapy (RRT) in extracorporeal membrane oxygenation (ECMO) patients.Methods:The clinical data of 68 ECMO patients treated at Emergence Department of Jiangsu Provincial Hospital from January 2015 to December 2018 were retrospectively analyzed. Vasoactive-inotropic score (VIS) was used to assess the usage of vasoactive-inotropic drugs on day 1, 2 and 3 of ECMO (24 h VIS, 48 h VIS, and 72 h VIS). According to received RRT or not, patients were divided into the RRT group and non-RRT group. Age, gender, weight, VIS, presence of cardiac arrest before ECMO, ECMO mode, and ECMO treatment time were compared. Logistic regression analysis was used to identify predictive factors for RRT in ECMO patients.Results:Of the enrolled patients, 73.5% of ECMO patients received RRT. The mean age, 24 h VIS, ECMO failure and mortality of the RRT group were significantly higher than those of the non-RRT group ( P <0.05). The use of RRT was 87.8% in elderly ECMO patients (> cutoff age of 38.5 years). According to the cutoff value of 24 h VIS (33.75), ECMO patients were divided into the high VIS group and low VIS group. The rates of RRT and mortality were both exceeded 90% in the high VIS group, which was significantly higher than that of the low VIS group ( P <0.05). Logistic regression analysis showed that age ( OR=1.223) and 24 h VIS ( OR=1.033) were predictive factors of RRT in ECMO patients ( P <0.05). Conclusions:Age and 24 h VIS show the predictive value for RRT in ECMO patients.

At present, we are fighting against the outbreak of novel coronavirus pneumonia (NCP) in China. For the purposes of diagnosis and treatment of NCP patients, Hangzhou Xixi Hospital, as a designated hospital, make available the wards quickly, initiated the management system of public health emergencies, and established a "tolerate admission- strict discharge" patients management program. Meanwhile, the hospital has established an emergency supply and coordinated distribution mechanism for medical protection materials, and a full-system and multi-model training system, ensuring smooth progress of the diagnosis and treatment work.

At present, we are fighting against the outbreak of COVID-19 in China.For the purposes of diagnosis and treatment of these patients, Hangzhou Xixi Hospital, as a designated hospital, made available the wards quickly, initiated the management system of public health emergencies, and established a " tolerate admission-strict discharge" patients management program. Meanwhile, the hospital has established an emergency supply and coordinated distribution mechanism for medical protection materials, and a full-system and multi-model training system, ensuring smooth progress of the diagnosis and treatment work.

We conducted a detailed analysis of different hypothermic circulatory arrest techniques, from its evolution, application on aortic arch surgery and research, focusing on the application and advantages and disadvantage, which provides some guide for the future discussion on the optimal temperature of hypothermic circulatory arrest.

Objective To evaluate the efficacy of patient-controlled brachial plexus block with different concentrations of dexmedetomidine mixed with ropivacaine for analgesia after elbow joint surgery.Methods One hundred patients of both sexes,aged 18-64 yr,weighing 45-75 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elbow joint surgedyy,were divided into 4 groups (n =25 each) using a random number table method:different concentrations of dexmedetomidine mixed with ropivacaine groups (DR1-3 groups) and ropivacaine group (group R).An analgesia pump was connected at the end of surgery and patient-controlled brachial plexus block was performed.The patient-controlled analgesia (PCA) solution contained 0.5 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR1,0.75 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR2,1 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR3 and 0.3％ ropivacaine in group R.All the drugs were diluted to 400 ml in normal saline in each group.The PCA pump was set up to deliver 3 ml bolus dose with a 20-min lockout interval and background infusion at 5 ml/h.Parecoxib 0.6 mg/kg was intravenously injected as a rescue analgesic.The visual analogue scale (VAS) scores at rest and during movement (voluntary and continuous passive movement) were recorded at the end of surgery and 12,24,36,48 and 72 h after surgery.The number of successfully delivered doses,the number of attempt and postoperative consumption of parecoxib were recorded.The elbow flexion angle during voluntary and continuous passive movement was recorded.The development of motor block and drug-related adverse reactions was also recorded.Results There was no significant difference in VAS scores at rest at each time point among the four groups (P＞0.05).Compared with group R,the VAS scores during movement,the number of attempts,the number of successfully delivered doses and parecoxib consumption were significantly increased in DR1 and DR2 groups,the elbow flexion angle during voluntary and continuous passive mnovement was significantly decreased in group DR1,the elbow flexion angle during continuous passive movement was significantly decreased in group DR2,and the elbow flexion angle during voluntary movement was significantly increased (P＜0.05),and no significant change was found in the other parameters in group DR3 (P＞0.05).Compared with group DR1,the VAS scores during movement were significantly decreased,the number of attempts,the number of successfully delivered doses and parecoxib consumption were decreased,and the elbow flexion angle during voluntary and continuous passive movement was increased in DR2 and DR3 groups (P＜0.05).Compared with group DR2,the VAS scores during movement were significantly decreased,the number of attempts,the number of successfully delivered doses and parecoxib consumption were decreased,and the elbow flexion angle during voluntary and continuous passive movement was increased in group DR3 (P＜0.05).No motor block was found in DR1,DR2,and DR3 groups,and the incidence of motor block was significantly higher in group R than in the other three groups (P＜0.05).The hemodynamics was stable and no drug-related adverse reactions were found in the perioperative period in the four groups.Conclusion Patient-controlled brachial plexus block with dexmedetomidine 1 μg/ml mixed with 0.2％ ropivacaine can provide satisfactory analgesia and is helpful in improving prognosis for the patients undergoing elbow joint surgery.

Aim To observe the neuroprotective effect of different doses of propofol on ischemic fetal rat brain.Methods Eighteen healthy pregnant SD rats were randomly allocated into the following six groups with three rats in each.Group S: sham operation group, Group IR: ischemia/reperfusion group, Group P1~P3: different doses of propofol groups, Group B: bicuculline group.In group S and group IR, 1 ml saline solution was administered via caudal vein.In group P1~P3, 10, 30, 50 mg·kg-1 of propofol was administered via caudal vein respectively.In group B, when 50 mg·kg-1 propfol was administered via caudal vein, 5 mg·kg-1 bicuculline was injected intraperitoneally at the same time.Bilateral uterine ovarian arteries were clamped for 11 mins to make intrauterine distress model of the fetal rats.The brains of fetal rats were removed after 3 days of reperfusion.Brain sections(5 μm thick) were mounted and stained with Hematoxylin and eosin(HE).The profile of the hippocampus CA1 was evaluated under a light microscope and neuronal Lesion-index(LI) was calculated.MDA content of fetal rat brain was detected by thiobarbituric acid reaction method to determine the lipid peroxidation degree of brain.Results LI was (7.2±0.9) and MDA was (3.86±0.20) μmol·g-1 in group S.LI was 71.9±2.8 and the content of MDA was (9.10±0.45) μmol·g-1 in group IR, which increased significantly compared with those in group S(P<0.01).LI was (40.8±2.6), (21.4±1.4), (20.1±1.3) and the content of MDA was (7.32±0.41), (5.65±0.27), (5.44±0.28) μmol·g-1 in propofol groups, which decreased significantly compared with those in group IR(P<0.05).LI and the content of MDA was (51.2±2.3), (7.54±0.31) μmol·g-1 in group B,respectively, reversing partly the neuroprotevtive effect of propofl.Conclusion Propofol could protect the neurons in hippocampus CA1 region of fetal rat against intrauterine distress by reducing the concentration of MDA in the brain.

Objective To compare the distribution situation of human papillomavirus(HPV)infective genotypes in normal cells and atypical squamous cells of undetermined significance(ASC-US)in uterine cervix and its clinical significance.Methods The pol-ymerase chain reaction(PCR)combined with the gene-chips technology were adopted to detect 23 kinds of HPV genotype from 1 000 cases of normal cells specimens and 229 cases of ASC-US specimens.Results 106 cases of HPV-positive infection were de-tected from 1 000 cases of normal cells with the total HPV infection rate of 10.60%(106/1 000),in which the single genotype in-fection rate was 9.30%(93/1 000)and the multiple genotypes infection rate was 1.30%(13/1 000);116 cases of HPV-positive in-fection were detected from 229 cases of cervial ASC-US specimens with the total HPV positive rate was 50.66% (116/229 ),in which the single genotype infection rate was 34.06%(78/229)and the multiple genotypes infection rate was 16.59%(38/229).The total HPV positive rates,single and multiple genotype infection had statistically significantly differences between the two groups(P<0.05).Conclusion The HPV types 16,18,33,42,43,52,58 are the predominant genotypes in normal cervical cells and ASC-US. PCR combined with the gene-chip technology can be used in the HPV genotype detect in cervical cells,conduces to perform the fur-ther distribution management on ASC-US and has the important significance to prevention and control of cervical cancer.

Background and purpose: Colorectal cancer (CRC) is the most frequently occurring primary malignant tumor. Chemotherapy can reduce the risk of local and distant relapse. Therefore, it is very important to ifnd new biomarkers that can predict chemoresistant and help in treatment decisions. Methods:In this study, we examined the expression levels of 1 200 human miRNAs in 6 CRC tissues, using miRNA proifling assay arrays. A validation study was done to corroborate a subset of the results, including expression levels of miR-4299, miR-196b, miR-324-5p, miR-455-3p and miR-939, by analyzing 100 specimens of stageⅣcolorectal adenocarcinoma (not respond and respond to the chemotherapy) to quantitative real-time PCR. We modeled the relationship between the expression levels of these miRNAs and the survival rate of 100 CRC patients by Kaplan-Meier method. Results:Expression proifles in CRCs suggested that 5 miRNAs were candidate markers associated with the chemoresistance of colorectal cancer. We found that miR-4299 and-196b had signiifcant diagnostic value for chemoresistance CRC. miR-4299 yielded an AUC (the areas under the ROC curve) of 0.784 and miR-196b yielded an AUC of 0.647 in discriminating CRC from controls. Combined ROC analysis using these 2 miRNAs revealed an elevated AUC of 0.848 with 67.9%sensitivity and 90.9%speciifcity in discriminating chemoresistance CRC. The low level of miR-4299 expression and the high level of-196b expression are signiifcantly correlated with the good survival of CRC patients. Conclusion:These data suggest that miR-4299 and-196b have strong potential as novel biomarkers for chemoresistant detection of colorectal cancer.

Objectives To study the correlation between social emotion and temperament in infants and toddlers. Me-thods The Brief Infant-Toddler Social and Emotional Assessment (BITSEA) and Toddler Temperament Questionnaire (TTQ) were used to evaluate the social emotional problems and temperament of 657 infants and toddlers 1 to 3 years old. Results The temperament dimensions were correlated with behavior and competence factors. The infants and toddlers in dififcult type group had more behavior problems or deifcits/delays in competence than those in easy type group (χ2=26.49, 10.48, P<0.01). Conclu-sions Infants and toddlers with negative temperament traits have more behavior problems and weaker social emotional compe-tences. The temperament should be considered in dealing with emotional problems.