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OBJECTIVE To provide a reference for the implementation and high-quality development of hospital medication reconciliation. METHODS A semi-structured questionnaire was designed to investigate the implementation of drug reconciliation services in medical institutions before and after the release of 5 standards such as Standard for Medication Reconciliation Services in Medical Institutions(“standards” for short,in 2021 and 2022). Descriptive statistical analysis was conducted on the survey results. RESULTS After the promulgation of the standards, the medication reconciliation service rate of all types of medical institutions increased from 15.10% (434/2 874) in 2021 to 27.84%(363/1 304) in 2022. In 2022, in the 363 medical institutions providing drug reconciliation services, the median number of pharmacists involved in drug reconciliation was 6. The participation rate of pharmacists in standardized training for drug reconciliation services was 75.00%, among which the participation rate of third-class hospitals was higher, reaching 85.71%. The main stages covered by medication reconciliation services included patient admission, transfer between departments, and discharge. The main problems found in the service included repeated medication (252, 69.42%), inappropriate usage and dosage (228, 62.81%), drug interactions and adverse reactions (218, E-mail:cputianxin@163.com 60.06%). Only 69 institutions (19.01%) had a separate electronic information recording system, while 48 institutions 58516003。E-mail:zhenjiancun@vip.163.com (13.22%) had established comprehensive quality management and evaluation improvement systems. In terms of value embodiment, 141 institutions (38.84%) did not provide any form of compensation to relevant pharmacists. “Closely linked to enhancing patient satisfaction and improving services” was the most significant experience influencing medication reconciliation work(192, 52.89%), while “the shortage of talent which meet the relevant requirements” stands as the primary challenge faced by medical institutions at all levels(238, 65.56%). CONCLUSIONS The release of the standards has effectively improved the development rate of medication reconciliation in national medical institutions. However, there is still room for improvement in various aspects, including the allocation of personnel for medication reconciliation services, service content, information management, and the construction of quality control and evaluation systems.
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Objective To analyze the problems and solutions in the diagnosis of a patient with occupational radiogenic neoplasms. Methods The dose conversion method was selected in dose estimation. Personal dose equivalent, skin absorbed dose, and reported detection data were converted into red bone marrow absorbed dose. The upper 95% confidence limit of the probability of causation (PC 95%) was calculated. Results The PC 95% of cancer due to radiation in the worker was 66.38%, which suggested occupational radiogenic neoplasms. Personal dose data were missing in dose estimation. The current dose estimation standard lacked bedside radiography and CT operation type, and the dose conversion formula was not perfect. Conclusion In the judgment of occupational radiogenic neoplasms, the estimated dose showed uncertainty. There is an urgent need to formulate and promulgate dose estimation standards that are operational and in line with the current development of radiological diagnosis and treatment technology and equipment.
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Methylmalonic acidemia(MMA) is one of the common diseases in hereditary organic acid metabolism disorder. The disorder is mainly treated by using vitamin B12 which comes in various forms.The use of the methylcobalamin and adenosylcobalamin in China cannot meet the needs of children with MMA. Parenteral use of hydroxocobalamin of high concentration has significant advantages in the treatment of MMA. But, the accessibility to hydroxocobalamin is challenging now.Through the supervision and adjustment of hydroxocobalamin, we explored the strategy of using the drugs. Meanwhile, we are considering the oral use of the hydroxocobalamin as supplement to treatment. Solving the challenges of the hydrococobalamin is helpful to meet the treatment of MMA and to provide a new possibility for the use of medication for rare diseases. The improvement in policy and supervision measures will facilitate the development, involvement, and production of hydroxocobalamin, so that the patients will have a good chance of access to the treatment.
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OBJECTIVE@#Acute liver failure (ALF) is characterized by severe liver dysfunction, rapid progression and high mortality and is difficult to treat. Studies have found that sulforaphane (SFN), a nuclear factor E2-related factor 2 (NRF2) agonist, has anti-inflammatory, antioxidant and anticancer effects, and has certain protective effects on neurodegenerative diseases, cancer and liver fibrosis. This paper aimed to explore the protective effect of SFN in ALF and it possible mechanisms of action.@*METHODS@#Lipopolysaccharide and D-galactosamine were used to induce liver injury in vitro and in vivo. NRF2 agonist SFN and histone deacetylase 6 (HDAC6) inhibitor ACY1215 were used to observe the protective effect and possible mechanisms of SFN in ALF, respectively. Cell viability, lactate dehydrogenase (LDH), Fe2+, glutathione (GSH) and malondialdehyde (MDA) were detected. The expression of HDAC6, NRF2, glutathione peroxidase 4 (GPX4), acyl-CoA synthetase long-chain family member 4 (ACSL4) and solute carrier family 7 member 11 (SLC7A11) were detected by Western blotting and immunofluorescence.@*RESULTS@#Our results show that NRF2 was activated by SFN. LDH, Fe2+, MDA and ACSL4 were downregulated, while GSH, GPX4 and SLC7A11 were upregulated by SFN in vitro and in vivo, indicating the inhibitory effect of SFN on ferroptosis. Additionally, HDAC6 expression was decreased in the SFN group, indicating that SFN could downregulate the expression of HDAC6 in ALF. After using the HDAC6 inhibitor, ACY1215, SFN further reduced HDAC6 expression and inhibited ferroptosis, indicating that SFN may inhibit ferroptosis by regulating HDAC6 activity.@*CONCLUSION@#SFN has a protective effect on ALF, and the mechanism may include reduction of ferroptosis through the regulation of HDAC6. Please cite this article as: Zhang YQ, Shi CX, Zhang DM, Zhang LY, Wang LW, Gong ZJ. Sulforaphane, an NRF2 agonist, alleviates ferroptosis in acute liver failure by regulating HDAC6 activity. J Integr Med. 2023; 21(5): 464-473.
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Humans , Ferroptosis , NF-E2-Related Factor 2/genetics , Liver Failure, Acute/drug therapy , Isothiocyanates/pharmacology , Glutathione , Histone Deacetylase 6ABSTRACT
Objective:To investigate the effect of high concentration electrolyte on fat emulsion stability in multi-chambered bag parenteral nutrition, and to protect clinical drug safety.Methods:Multi-chambered bag parenteral nutrition with the same composition containing high concentration electrolyte were used, except for that water-soluble vitamins, fat-soluble vitamins, sodium glycerophosphate and trace elements were supplemented in the experimental group only. The appearance, pH, osmolality and average particle size were examined at 0, 12, 24, 36, 48, 60, 72, and 168 hours after preparation under room temperature.Results:There was no flocculation or oil-water separation in both groups. The pH value was 5.73 to 5.83 for the experimental group, while that was 5.52 to 5.57 for the control group ( P<0.001). For both groups, the comparison between 0 and 168 hours showed significant differences ( P<0.001). The osmolality was significantly different between the experimental group (1 076-1 117 mOsmol/kg) and the control group (1 072-1 104 mOsmol/kg, P=0.012), but showed no statistical significant difference across examined time points within each group ( P>0.05). The average particle size was 296.1 to 310.9 nm for the experimental group, and 296.6 to 334.9 nm for the control group, showing no statistical significant difference ( P=0.096). The particle size showed no profound changes over time in both groups ( P>0.05). Conclusions:The average particle size of fat emulsion in multi-chambered bag parenteral nutrition were basically stable over 168 hours after preparation under room temperature. The addition of water-soluble vitamins, fat-soluble vitamins, sodium glycerophosphate and trace elements had no significant impact on the stability of fat emulsion.
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Objective To assess the psychological status of staff at the centers for disease control and prevention(CDC) in Sichuan during the outbreak of coronavirus disease 2019(COVID-19) and explore the influencing factors. Methods The staff at Sichuan provincial,municipal,and county(district)-level CDC were selected by convenience sampling.Their basic information,work status,training status,work difficulties,and support from the work group were collected from the self-filled questionnaires online.The Generalized Anxiety Disorder Scale and the 9-question Patient Health Questionnaire were respectively employed to measure the anxiety and depression of the staff.The stepwise Logistic regression was carried out to analyze the influencing factors of anxiety and depression in CDC staff. Results Among the 653 staff,58.35% and 50.06% presented anxiety and depression,respectively.The regression results showed that age(OR=0.95,95%CI=0.92-0.97) and mental support from the work group(OR=0.61,95%CI=0.45-0.82) were the protective factors while physical fatigue(OR=1.82,95%CI=1.20-2.74),work pressure(OR=1.61,95%CI=1.21-2.12),and insufficient protective equipment(OR=1.92,95%CI=1.06-3.49) were the risk factors for depression of CDC staff.Age(OR=0.97,95%CI=0.94-0.99),length of sleep per day(OR=0.74,95%CI=0.56-0.96),and participation in technical training(OR=0.33,95%CI=0.12-0.95) were the protective factors while mental fatigue(OR=1.68,95%CI=1.18-2.41),work pressure(OR=2.94,95%CI=2.08-4.17),and unclear incentive system for overtime(OR=1.99,95%CI=1.23-3.23) were the risk factors for the anxiety of CDC staff. Conclusion The anxiety and depression status of CDC staff during the COVID-19 outbreak were worrying,which were mainly affected by age,sleep,supply of protective equipment,incentive system,fatigue,and work pressure.
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Humans , Anxiety/epidemiology , COVID-19 , China/epidemiology , Cross-Sectional Studies , Disease Outbreaks , SARS-CoV-2 , Surveys and Questionnaires , United StatesABSTRACT
Objective:To observe the efficacy of sintilimab combined with apatinib in the treatment of advanced non-small cell lung cancer (NSCLC).Methods:Eighty-two patients with advanced NSCLC who were admitted to Nantong Cancer Hospital from October 2019 to September 2020 were selected for a prospective controlled study. They were divided into control group (treated with apatinib) and combination group (treated with sintilimab + apatinib) using the random number table method, with 41 cases in each group. The short-term clinical efficacy, tumor markers [neuron specific enolase (NSE), cytokeratin 19 fragment antigen (CYFRA21-1)], adverse reactions during treatment and survival were compared between the two groups.Results:The objective remission rate and clinical control rate in the combination group were higher than those in the control group [41.46% (17/41) vs. 19.51% (8/41), 85.37% (35/41) vs. 58.54% (24/41)], and the differences were statistically significant ( χ2 values were 4.66 and 7.31, both P < 0.05). The levels of NSE and CYFRA21-1 in the combination group were lower than those in the control group after treatment [(19.04±2.54) ng/ml vs. (21.35±3.11) ng/ml, (4.58±1.02) μg/L vs. (6.07±1.84) μg/L], and the differences were statistically significant ( t values were 3.68 and 4.54, both P < 0.001). There were no statistical differences in the incidence rates of gastrointestinal reaction, bone marrow depression, fatigue, and liver and kidney function damage between the combination group and the control group during treatment (all P > 0.05). The survival rate of the combination group was higher than that of the control group (71.79% vs. 47.50%), and the difference was statistically significant ( χ2 = 4.84, P = 0.028). Conclusions:Sintilimab combined with apatinib may improve clinical efficacy, reduce tumor marker levels, and improve short-term survival rate of advanced NSCLC patients.
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OBJECTIVE:To provide reference for summarize the management and clinical use levels of biosimilar products . METHODS:Related policies and regulations about approval and application of biosimilar products were retrieved from domestic and foreign supervision departments and WHO. The biosimilar products were described from multi-dimensional aspects of whole life cycle of drugs ,generic name and prescription ,indication extrapolation ,clinical drug exchange ,pharmacovigilance,medical insurance payment system ,education and training. RESULTS & CONCLUSIONS :Biosimilar products refer to therapeutic biological products which are similar to the reference drugs which have been approved for marketing in terms of quality ,safety and effectiveness. In R&D ,production,circulation,use and supervision links,the management of biosimilar products has its own characteristics in different countries/areas/organization. In the R&D stage ,biosimilar products do not need to independently verify their safety and effectiveness ,but only step by step use analytical methods to gradually clarify their high similarity with reference drugs in terms of structure and function. The name of biosimilar products in China is the same as that of the original drugs ,and the general name was used in prescription. For FDA to approve the indication extrapolation of biosimilar products ,it needs to be based on the data and information at the time of application ,the safety and effectiveness information of reference drugs ,and the consideration of relevant scientific elements of indications. It needs to be evaluated and used conditionally under supervision. The standard of FDA approval is strict,that is to say ,the approval standard of realizing interchangeability is higher than that of biological similarity which has no such concept in China. The enterprise community ,regulatory agencies ,academic institutions and hospital drug rooms need to communicate and exchange ,and further strengthen post market risk control and safety monitoring. China’s medical insurance department should establish an appropriate payment system and encourage the use of biosimilar products through the payment system. Meclical workers should learn the characteristics of biosimilar products so that they can make good use of biosimilar products in practice on the basis of understanding their technical evaluation.
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Objective:To establish a predictive equation for the osmolarity of parenteral nutritional prescription in China.Methods:From July 2019 to September 2019, 2 480 individualized samples of 328 different parenteral nutritional prescriptions (adult) of Peking Union Medical College Hospital were collected, and the osmolarity of parenteral nutritional solution samples was determined by a freezing point reduction method. Pearson χ2 test and a multiple linear regression analysis were utilized to establish a prediction equation for the osmolality of parenteral nutritional solution. Results:The average osmolarity of parenteral nutritional prescription was (1 164.20 ± 252.59) mOsm/kg, and the best fitting equation was (9.66A+ 7.88G+ 3.52F+ 36.4Na+ 27.55K+ 3.38P+ 7.46W-250)/V.Conclusion:The osmolarity is determined accurately and effectively by the fitting equation, which provide a benefit reference for the formulation, review and selection of clinical parenteral nutrition prescription especially in China.
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Objective: To study the glycosides from the 70% ethanol extract of Lonicera macranthoides. Methods: The compounds were isolated and purified by column chromatography of HP-20 macroporous resin, silica gel, ODS, Sephadex LH-20, and semi-preparative RP-HPLC. Their structures were elucidated by physicochemical properties and spectral analyses. Results: Eight compounds were isolated and identified as 7,3’,4’-trimethoxylquercetin-3-O-α-L-arabinadosyl-(1→6)-O-β-D-glucopyranoside (1), 7,3’,4’-trimethoxylquercetin-3-O-rutoside (2), quercetin-3-O-β-D-glucopyranoside (3), (2E,6S)-8-[α-L-arabinopyranosyl-(1″→6’)- β-D-glucopyranosyl]-2,6-dimethyloct-2-eno-1,2″-lactone (4), kankanoside E (5), betulalbuside A (6), shomaside F (7), and amarantholidoside V (8), respectively. Conclusion: Compound 1 is a new compound named methoxylquercetinside, while compounds 5-8 are isolated from the genus of Lonicera for the first time.
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The flower buds of Lonicera macranthoides (Shan Yin-Hua), represent an important traditional Chinese medicine and food ingredient. A phytochemical investigation of the 70% EtOH extract of the flower buds of L. macranthoides resulted in the isolation of 12 triterpenoids (1-12), including two new ursane-type nortriterpenes, 2α, 24-dihydroxy-23-nor-ursolic acid (1) and 2α, 4α-dihydroxy-23-nor-ursolic acid (2). Their structures were established by multiple spectroscopic methods and comparison with literature data. All isolated compounds were evaluated for their anti-inflammatory effects in LPS-activated RAW264.7 cells. Compounds 1 and 2 exhibited inhibitory effects on iNOS at the concentration of 30 μmol·L.
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Animals , Mice , Anti-Inflammatory Agents , Chemistry , Pharmacology , Drugs, Chinese Herbal , Chemistry , Enzyme Inhibitors , Chemistry , Pharmacology , Ethanol , Chemistry , Flowers , Chemistry , Lonicera , Chemistry , Macrophages , Metabolism , Molecular Structure , Nitric Oxide , Metabolism , Nitric Oxide Synthase Type II , Plant Extracts , Chemistry , Plants, Edible , Chemistry , Triterpenes , Chemistry , PharmacologyABSTRACT
To identify the metabolites of Danshensu in plasma and urine in rats by using UHPLC-LTQ-Orbitrap method. After oral gavage of Danshensu CMC-Na suspension in SD rats, urine and plasma samples were collected and processed by solid phase extraction. ACQUITY UPLC BEH C₁₈ column (2.1 mm×100 mm, 1.7 μm) was utilized, with 0.1% formic acid (A)-acetonitrile (B) solution as the mobile phase for gradient elution. Negative electrospray ion mode based data-acquisition method was established to collect the mass spectrometry data of biological samples. As a result, Danshensu and 21 Danshensu Ⅰ phase and Ⅱ phase metabolites were finally identified according to the accurate mass measurements, mass fragmentation behaviors and comparing with the reference standards. The main metabolic pathways included dehydration, methylation, glucuronide conjugation, sulfate conjugation and their composite reactions. Consequently, our study expounded metabolites of Danshensu in rats based on UHPLC-LTQ-Orbitrap method and provided a reference for further researches on therapeutic material basis and mechanism of Danshensu.
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Animals , Rats , Chromatography, High Pressure Liquid , Lactates , Blood , Metabolism , Urine , Mass Spectrometry , Rats, Sprague-DawleyABSTRACT
OBJECTIVE:To investigate the protection role and mechanisms of salidroside (SALD) on acetaminophen (APAP)-induced liver injury model mice. METHODS:60 mice were randomly divided into normal group(normal saline),model group (normal saline),positive group (acetylcysteine,150 mg/kg),SALD low-dose,medium-dose and high-dose groups (100, 200,300 mg/kg),with 10 mice in each group. Except for normal group,other groups were given APAP 500 mg/kg intragastrically to induce liver injury model. 1 h before modeling,mice were given relevant medicine intrgastrically for consecutive 5 d. After medication,the serum contents of ALT,AST,ALP and LDH were determined,and the pathohistological changes of the liver tissue were observed by HE staining. The protein expressions of Keap1 (in tranuclear), Nrf2 (in tranuclear), HO-1 (in tracytoplasm),NQO1 (in tracytoplasm) and GCLC (in tracytoplasm) in liver tissue were determined by Western blot assay. RESULTS:Compared with normal group, serum contents of ALT, AST, ALP and LDH in model group were increased significantly(P<0.01). The liver lobuli hepatis disorder and difficult to recognize,liver cell eosinophilic necrosis and other lesions were found in liver tissue. The protein expressions of Nrf2,Keap1,HO-1 and GCLC in liver tissue were decreased significantly (P<0.05). Compared with model group,above indexes of all groups were improved significantly (P<0.05 or P<0.01),except that the decrease of LDH content in serum of mice in SALD low-dose group and the expression improvement of Nrf2 and Keap1 in liver tissue were not significant in positive group. The expression of NQO1 protein in liver tissue of mice was increased significantly in administration groups (P<0.05 or P<0.01);pathohistological exchange of liver tissue in mice was improved in adminstration groups to different extent. CONCLUSIONS:SALD can protect APAP-induced liver injury;the mechanism of which may be associated with promoting Keap1,Nrf2 into the of nucleu and strengthening the protein expression HO-1,NQO1,GCLC in liver tissue.
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Components and compounding of parenteral nutrition solutions were different in different hospitals and different parts of China.In order to raise awareness,reduce improper compounding and improve patient safety,Pharmacy Cooperative Group of Chinese Society for Parenteral and Enteral Nutrition composed the Consensus for Parenteral Nutrition Solutions Compounding,providing evidence for standardization in this field.
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OBJECTIVE:To provide reference for the selection and management of compound drugs. METHODS:The variet-ies and frequency of compound drugs recorded in the national drug reimbursement list and drug reimbursement list supplementary varieties in provinces (regions and municipalities) were statistically analyzed,and Spearman test method was used to conduct the correlation analysis for the variety and local economic development level. RESULTS:There were totally 126 varieties of compound drugs recorded in the national drug reimbursement list,covering 19 categories. The varieties of compound drugs in class B supple-mentary drug lists of 28 provinces (regions and municipalities) ranged from 19 to 50;for the supplementary lists of compound drugs in 24 provinces(regions and municipalities),the varieties ranged from 12 to 117. Almost 50% of the compound drugs were recorded in only 1 province(region and municipality),and most compound drugs recorded 1-4 time(s)in provinces(regions and municipalities). There was no significant relationship between the varieties number of supplementary compound drugs and the per capita GDP in a province(region and municipality)(P>0.05,r=-0.180). CONCLUSIONS:The supplementary variety of com-pound drugs in a region has little relationship with the local economic development level. The work progress of recoding the com-pound drugs varies a lot,with large differences in number and high dispersion. It is necessary to clarify the definition of compound drug at a national level,develop unified management policies,standardize the selection criteria for compound drugs and guarantee the clinical medication requirements of patients.
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Objective:Based on annual reports on state assets,public hospitals could enhance the level of lean management about assets.Methods:The comparative analysis method was used to summarize the connection and difference between the annual report and the inventory report of the state assets in administrative institutions.On this basis,it analyzed the difficulties of public hospitals in the preparation of annual reports on state assets.Results:Through the top-level design of asset management,optimizing the process of whole life cycle management and innovating asset management tools,the public hospital not only to solve the difficulties of preparing the annual report on state assets,but also to enhance the level of lean management about assets.Conclusion:Based on the annual reports on state assets,public hospitals should change the traditional management mode of assets,improve the quality and application level of information,boost the lean management of assets,and speed up the establishment of modern hospital management system.
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OBJECTIVE:To provide reference for the selection and management of compound drugs. METHODS:The variet-ies and frequency of compound drugs recorded in the national drug reimbursement list and drug reimbursement list supplementary varieties in provinces (regions and municipalities) were statistically analyzed,and Spearman test method was used to conduct the correlation analysis for the variety and local economic development level. RESULTS:There were totally 126 varieties of compound drugs recorded in the national drug reimbursement list,covering 19 categories. The varieties of compound drugs in class B supple-mentary drug lists of 28 provinces (regions and municipalities) ranged from 19 to 50;for the supplementary lists of compound drugs in 24 provinces(regions and municipalities),the varieties ranged from 12 to 117. Almost 50% of the compound drugs were recorded in only 1 province(region and municipality),and most compound drugs recorded 1-4 time(s)in provinces(regions and municipalities). There was no significant relationship between the varieties number of supplementary compound drugs and the per capita GDP in a province(region and municipality)(P>0.05,r=-0.180). CONCLUSIONS:The supplementary variety of com-pound drugs in a region has little relationship with the local economic development level. The work progress of recoding the com-pound drugs varies a lot,with large differences in number and high dispersion. It is necessary to clarify the definition of compound drug at a national level,develop unified management policies,standardize the selection criteria for compound drugs and guarantee the clinical medication requirements of patients.
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OBJECTIVE:To investigate the occurrence of ADR induced by Shuxuening injection in Beijing area,and to pro-vide reference for rational drug use in clinic. METHODS:ADR induced by Shuxuening injection in Beijing area during 2003-2013 was classified statistically in respects of population,organs/systems involved in ADR,clinical manifestations,occurrence time, drug combination and prognosis. RESULTS:Of 1648 ADR cases,the incidence of ADR in the elderly patients was higher than young patients,and that of female patients (60.92%) was higher than that of male patients (39.14%). Multiple organs/systems were involved in Shuxuening injection-induced ADR,and top 3 were nervous system (422 cases,21.33%),skin and its appen-dants (411 cases,20.78%) and others (305 cases,15.42%). Clinical manifestations were skin rash,itching,dizziness and ner-vousness,palpitation,arrhythmia,etc. ADR mostly occurred within 5-30 min after medication. In ADR reports,there were a vari-ety of drugs combined with Shuxuening injection. Shuxuening injection combined with Alprostadil injection was most common(61 cases,accounting for 23.46% of drug combination). Among 1648 ADR cases,there were 622 cured cases and 1039 cases im-proved,4 cases were not improved,3 cases had sequelae and 1 case died. CONCLUSIONS:Clinical application of Shuxuening in-jection should strictly follow the indications of drug package inserts;differentiation of symptoms and signs is based on specific dos-age,solvent,route of administration,etc. It is necessary to strengthen the prescription check,and strengthen the observation after medication especially for the elderly and other special groups so as to reduce and avoid ADR.
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Objective Long-chain triacylglycerol (LCT) by three producers,each mixed with the same medium-chain triacylglycerol (MCT),were compared with the brand MCT/LCT in causing focal necrosis of hepatocytes in beagle dogs (a bioequivalence evaluation).Methods 21 beagle dogs (male,0.7-1.5 years old,10-15 kg) were used in this study.According to the sources of the LCT,the animals were divided into Group A (LCT made in China),Group B (LCT made in Japan),Group C (LCT made in Germany),and the control group (the brand 10% MCT/LCT).Central venous port was placed via the lumber vein of the animals under general anesthesia.After 2 weeks of rehabilitation,MCT/LCT was administered through this port for 28 days at 9 g/ (kg · d) [while the routine dose used clinically was 1 g/ (kg · d)].The laboratory indexes and the pathomorphism of the liver and kidney were studied single blindly.Results Laboratory tests,including liver and kidney function,blood coagulation function and lipid metabolism,did not identify differences among emulsions with different sources of LCT.Liver biopsy at day 28 showed no focal necrosis in Group C and the control group;there was minor damage in Group B;and Group A had obvious liver necrosis.and the pathological findings of other organs are similar.No significant difference was observed in biopsies of other organs.Conclusions Emulsions with different sources of LCT varied in their damage to the liver.Generics with LCT of higher quality were equivalent to the brand MCT/LCT in terms of safety.