Objective:To prepare morphine sulfate sustained-release suppositories and determine the content by HPLC. Methods:An Eclipse XDB-C18 (150 mm × 4. 6 mm,5 μm) chromatographic column was used, methanol-heptane sulfonic acid sodium acetate solu-tion(2. 02 g sodium heptanesulfonate was dissolved in appropriate amount of water and 5ml glacial acetic acid was added, and then water was added to 1000 ml, shaken up) (50 ∶50) was used as the mobile phase, the flow rate was 1. 0 ml·min-1 , the detection wavelength was 233 nm, the column temperature was 25℃ and the sample size was 10μl. Results:The average content of morphine in 3 batches of samples was 99. 9%, the linear range of 4. 18-86. 60μg·ml-1 was good (r=0. 999 3), and the average recovery was 100. 6% (RSD=1. 58%, n=9). Conclusion:The method is sensitive, rapid and accurate, and suitable for the quality control of morphine sulfate sus-tained-release suppositories.

Objective To evaluate denervation changes [fibrillation potentials (fib) and positive sharp waves (psw)] in thoracic paraspinal muscles as diagnostic aids in amyotrophic lateral sclerosis (ALS). Methods The fib and psw of thoracic paraspinal muscles,the motor unit potential of sternocleidomastoid muscle were detected in 50 patients who had been identified as having ALS.Age and sex-matched,30 normal subjects and 30 patients who suffered radicular disease in cervical or lumbosacral region were also detected in thoracic paraspinal muscles for finding fib and psw serving as controls. Results In ALS group,a vast of fib and psw were found in thoracic paraspinal muscles in 41 of 50 ALS patients (82%),they were not found with sternocleidomastoid muscle,but the motor unit potential of this muscle was shown having long-duration and high-amplitude in 48 of 50 ALS patients (96%),which were coincided with the chronic neurogenic changes.6 of 50 patients had denervation changes of tongue muscles,3 of them found fib and psw.2 of 30 patients who suffered from radicular diseases were found with a few of fib and psw changes in thoracic paraspinal muscles.None of these symptoms were found in normal subjects.Conclusion A vast of fib and psw in thoracic paraspinal muscles should represent a sensitive tool for diagnosis of ALS.

Objective To retrospectively analyze clinical manifestations of autonomic nervous system (ANS) and skin sympathetic response (SSR) in Lambert-Eaton myasthenic syndrome (LEMS).Methods Fifty-three LEMS patients' medical records were reviewed and information regarding clinical symptoms and signs of ANS and SSR testing results were collected.Results ( 1 ) The most common initial symptom of LEMS was weakness of lower extremities ( n =41 ) and the most common symptom of ANS dysfunction was constipation ( n =25 ) and dry-mouth ( n =23),which could be occurred before the onset of the legs (n =7).(2) In symptoms of ANS,cardiovascular system dysfunction was found in 4 patients include one of ingone of bradycardia,one of postural hypotension and 2 of tachycardia- Secretory glands dysfunction was found in 34 patients:23 dry-mouth,6 dry-eyes,and 8 patients sweating dysfunctions.Twenty-eight patients complained of alimentary dysfunction including constipation and diarrhea.Bladder dysfunction was found in 2 patients,who complained of urinary incontinence.Seven male patients complained of sexual dysfunction.Abnormal skin scratch test was found in 17 patients.(3) SSR was performed in 33 patients and 18 found abnormal.Conclusions ANS manifestations are common and prominent in LEMS patients.SSR abnormality is also common in LEMS.More electrophysiology tests are needed in LEMS patients.

Objective To explore the correlation between diffuse neurogenic changes on electromyography and diagnosis of amyotrophic lateral sclerosis (ALS).Methods Retrospective study was performed based on database of motor neuron disorders collected from January,2002 to December,2008.The category of disease with diffuse neurogenic changes at the first examination was summarized.The electromyography (EMG) manifestation in ALS patients at the first examination and the results after follow-up were reviewed.The factors affecting EMG manifestation in ALS were analyzed with binary Logistic regression.Results In 298 patients with diffuse neurogenic changes on EMG,192 cases (64.4％ ) were diagnosed of ALS,36 ( 12.1％ ) progressive muscular atrophy,13 (4.4％ ) Kennedy' s disease,10 (3.4％)Hirayama disease,9 ( 3.0％ ) cervical spondylosis combined with lumbar spondylosis,6 ( 1.3％ ) spinal muscular disease,5 ( 1.7％ ) multifocal motor neuropathy,5 ( 1.7％ ) ALS-plus disease,4 ( 1.3％ )myopathy,3( 1.0％ ) hereditary motor neuropathy,3 ( 1.0％ ) axonal motor neuropathy,2(0.7％ ) postpolio syndrome,and 10 (3.4％) with no definite diagnosis.In total 213 patients who were diagnosed with ALS after follow-up,at their first examinations,8 (3.8％) had neurogenic changes in two regions and 13(6.1％ ) had neurogenic changes in one region,and they all developed to diffuse neurogenic changes after follow-up for 3 to 24 months.Logistic regression analysis showed that the EMG change at first examination was not related to duration from onset,symptom location at onset,age at onset and gender.Conclusion Diffuse neurogenic changes on EMG can present in many disease including ALS.Neurogenie changes in one or two regions on EMG can be the manifestation of ALS at early stage.

Objective To explore the impact of childbirth on women external anal sphincter electromyography by analysis of motor unit potentials parameters of external anal sphincter electromyography of healthy women volunteers with different childbirth experiences.Methods Twenty-eight healthy volunteers with different childbirth experiences were recruited in this study.Among them , 7 had a history of cesarean and 21 had experienced 1-3 uncomplicated vaginal deliveries ( 12 women had experienced 1, 6 had experienced 2, and 3 had experienced 3).Another 9 nulliparous healthy volunteers were recruited as control group.Among all subjects who completed the examination , parameters of motor unit potentials ( duration, amplitude, area, mean number of turns and mean phases ) of bilateral external anal sphincter were obtained for statistical analysis.Results There were no significant differences in any of the parameters of motor unit potentials between the nulliparous group and the cesarean group , while parameters of durations (10.5 ms vs 9.0 ms, t=-2.506, P=0.019) and mean phases (4.0 vs 3.6, t =-2.707, P=0.012) of vaginal delivery group were significantly higher than that of cesarean group and parameter of durations ( 10.5 ms vs 8.9 ms, t =-3.025, P =0.005 ) of vaginal delivery group was significantly higher than that of the nulliparous group;With increasing numbers of vaginal deliveries , only the parameter of mean turns showed statistically significant differences , although there was a slight trend of larger and more complex motor unit potentials.Compared with subjects without vaginal delivery experience ( including nulliparous group and the cesarean group ) , the parameters of durations and mean phases of subjects with vaginal delivery experience were statistically higher; Nevertheless , parameter of bilateral duration of the motor unit potential preferred asymmetric.Conclusions Childbirth experience has an explicit impact on the parameters of the external anal sphincter motor unit potentials , which is considered to be strongly correlated with the vaginal delivery process rather than the pregnancy procession itself.In addition , the impact is mostly from the first vaginal delivery experience.The characters of asymmetry of motor unit potential parameters imply the possibility of mechanical damage and decrease blood perfusion of tissues during delivery procession.

Objective To retrospectively analyzed the current application of warfarin in hospitalized patients with non-valvular atrial fibrillationand ( NVAF), explore the key role of clinical pharmacists in warfarin medication. Methods A retrospective survey of anticoagulant therapy for 179 hospitalized patients with non-valvular atrial fibrillation in Renming Hospotal of Wuhan University from January to December 2013 was retrived,including the usage of warfarin for NVAF and new-onset atrial fibrillation,dosage,international normalized ratio(INR),hemorrhage event and so on.The simple factor like the age,complicated chronic diseases and previous cerebrovascular events on the use of warfarin was explored. Results The total response rate to anticoagulants was 85.6% for patients with high risk of stroke(27.3% with warfarin and 58.3% with antiplatelet therapy),who are recommended to use warfarin,patient were treated with anti-thrombotic therapy.The total of 19.1% of the patients with new-onset atrial fibrillation used warfarin as therapy.The whole monitoring rate of INR was 89.8%,and the good control rate was 11.9%. Univariate analysis showed that some high risk factors such as age and high blood pressure affected the usage of warfarin. Conclusion The anti-thrombotic therapy for NVAF patients in the hospital is good,but usage of warfarin for those with new-onset atrial fibrillation is low,which couldn't reach the INR standard. More attention should be taken by the clinic pharmacists in effective managing the use of anticoagulant to build a safe,economic and effective medication system for warfarin application.

Objective To investigate the clinical features and causes of micturition and defecation dysfunction in motor neuron disease (MND) patients.Methods The micturition and defecation function was evaluated by a questionnaire covering storage and voiding of urine and feces respectively in 50 MND patients.The clinical features and external anal sphincter electromyography (EAS-EMG) were analyzed to explore the causes of micturition and defecation dysfunction in MND patients.Results Micturition and defecation dysfunction was detected in 9 of 50 (18.0％) MND patients.The main types of micturition and defecation dysfunction were constipation (4/9),urinary frequency,urgency with or without incontinence,fecal urgency (4/9),powerlessness for micturition and defecation (2/9),hesitancy for micturition (1/9).EAS-EMG was normal in 9 MND patients accompanied with micturition and defecation dysfunction.Conclusions MND patients accompanied with micturition and defecation dysfunction were not very rare.Constipation,urgency and powerlessness were the main types of micturition and defecation dysfunction and they were not related to the function of external anal sphincter.Gastrointestinal dysfunction from abnormal autonomic nerve involvement,muscle weakness and the resulted reduced activity,severe upper motor neuron damage and respiratory muscle weakness may be the main causes of micturition and defecation dysfunction in MND patients.

Objective To assess the utility of single fiber electromyography (SFEMG) in the differential diagnosis of amyotrophic lateral sclerosis (ALS) and cervical spondylotic radiculopathy and myelopathy. Methods SFEMG was performed in extensor digitorum communis muscles (EDC) of 3 groups of patients, including 61 ALS patients with findings of cervical spendylosis on MRI, 59 ALS patients with normal MRI of cervical spine, and 55 patients with cervical spendylotic radiculopathy and myelopathy. The parameters of SFEMG between different groups were compared. Results The mean jitter was (81.2± 25.9), (91.6 ± 32. 4) and (40. 9 ± 11.8) μ in ALS patients with finding of cervical spondylosis on MRI, ALS patients with normal MRI of cervical spine, and patients with cervical spondylosis respectively. M50 of the percentage of jitter >55 μs was 73%, 80% and 5% in the 3 groups respectively. M50 of the percentage of block was 10%, 20% and 0 in the 3 groups respectively. Fiber density was 2.9±0.5, 2.9±0.6 and 2. 4 ± 0. 6 in the 3 groups respectively. There was no significant difference in those parameters of SFEMG between the ALS with findings of cervical spondysosis and those with normal MRI. There was significant difference in those parameters of SFEMG between the patients with ALS (the mean jitter: (86. 3± 29. 6) μs; M50 of the percentage of jitter > 55 μs: 80% ; M50 of the percentage of block: 14% ; fiber density: 2. 9±0. 5) and those with cervical spondylosis (t = 14.49, Z = 8.96, 7. 68,t = 5. 83, all P = 0. 000). In 18 patients with ALS, conventional EMG studies showed active and chronic denervation in only 1 region at the first visit. SFEMG was performed in EDC which had normal Medical Research Council Scale and EMG. SFEMG showed increased fiber density in 16 patients, increased jitter in 13 patients and impulse block in 6 patients. Conclusion SFEMG shows significantly increased jitter and block in ALS whether there is MRI findings of cervical spondysosis or not, which can help to differentiate ALS from cervical spondysotic radiculopathy and myelopathy.

Objective To investigate whether the polymorphism of rs10260404 in DPP6 gene in Chinese Han origin is associated with sporadic amyotrophic lateral sclerosis (SALS). Methods The genomic DNA was extracted from the leukocytes of whole blood samples in 58 Chinese Han patients with SALS and 52 healthy controls. The asymmetric PCR was processed in the presence of an unlabeled probe that contained the rs10260404 locus. The product was genotyped on light scanner and some was confirmed with sequencing. Results Two single nucleotide polymorphism, rs10260404 that was reportedly consistently strongly associated with susceptibility to SALS in different populations of European and American ancestry, rs10260404 were genotyped, but not strongly associated with ALS in Chinese patients(SALS:C:12.94%,T:87.06%;health controls:C:10.58%,T:89.43%;χ2=0.29,OR=1.256,95%CI 0.549-2.872, P>0.05). Conclusion The rs10260404 is not associated with ALS susceptibility in Chinese people.

Objective To assess the diagnostic value of single fiber electromyography(SFEMG)in amyotrophic lateral sclerosis(ALS).Methotis SFEMG was performed in extensor digitorum communis muscles(EDC)of 165 patients with AIS and 145 patients with other neurogenetic disorders.Grade scale of the medical research council(MRC)in EDC was assessed simultaneously.The patients were divided into four groups according to the MRC scale(MRC＞4 us MRC≤4)and different disease (AIS vs other neurogenetic disorders).The parameters of SFEMG between different groups were compared.Results When the strength of EDC was normal(MRC＞4),the mean jitter was(66.1±20.1)μs in ALS and (38.0±9.2)μs in other neurogenic disorders(t=9.05,P＜0.01),median of the percentage of jitter＞ 55μs was 55%in AIS and 0 in other neurogenic disorders(Z=-7.81.P＜0.01).median of the percentage of block was 6.7%in AIS and 0 in other neurogenic disorders(Z=-6.93,P＜0.01).There was significant difference in those parameters of SFEMG between the two groups.When the strength of EDC was abnormal(MRC≤4),the mean jitter was(93.5±31.2)μs in ALS and(52.8±25.9)μs in other neurogenic disorders(t=9.37,P＜0.01),median of the percentage of jitter＞55 μs was 86%in ALS and 20%in other neurogenic disorders(Z=-8.46,P＜0.01),median of the percentage of block was 20%in ALS and 0 in other neurogenic disorders(Z=-7.25,P＜0.01).There was significant difference in those parameters of SFEMG between the two groups.When SFEMG was performed in EDC with normal muscle strength,the sensitivity and specificity of mean jitter＞55μs for diagnosis of ALS were 70.2%and 92.7% respectively.Conclusions When SFEMG is studied for diagnosis of ALS,it is recommended to perform in muscles with normal strength.The mean jitter,the percentage of jitter＞55μ s and block are of great importance in differentiating ALS from other neurogenic disorders.