Objective:To determinate the concentration of Cisatracurium in the plasma of an rabbit via a proposed HPLC method. Methods:A C18 column was used,the mobile phase was made up of 50mmol/L dipotassium hydrogen phosphate(pH=3.0) and acetonitrile(50∶50),and examination and emission wavelengths are 200nm and 320nm,respectively. Results:the linear range was 25~2 000ng/ml,the limit of detection(LOD) is 25ng/ml, the intra- and inter-precisions(RSD) were lower than2.56% and 3.68%,respectively. Besides,the recovery of extraction was 85.2%~86.1%(n=5) and the recovery of addition was 93.4%~98.8%. Conclusion:The proposed method proved to be accurate and repetitive.

OBJECTIVE:To determine the contents of betahistine hydrochloride and the related substances by HPLC.METHODS:The chromatographic separation was performed on Eclipse XDB-C18 column with column temperature at 25 ℃.The mobile phase consisted of water(sodium heptanesulfonate+10 mL triethylamine+810 mL water,with the pH adjusted to 3.0 with phosphoric acid) and methanol(82:18) at a flow rate of 0.8 mL?min-1.The detection wavelength was 261 nm and the sample size was 50 ?L.RESULTS:The linear range of betahistine hydrochloride was 10～80 ?g?mL-1(r=0.999 3).The lowest detection limit was 2.84 ?g?mL-1 and the lowest quantitative limit was 3.01 ?g?mL-1.The average recovery was 99.8%(RSD=0.3%).The average content for the related substances in 3 batches of samples was 0.13%.CONCLUSION:The method is simple,rapid,accurate and reliable,and suitable for the quality control of betahistine hydrochloride.

Objective To explore the feasibility and reasonable of low-dose scan on abdominal angiography in 64-slice spiral helical CT. Methods Phantom test: at 120 KV and from 200 mAs to 30 mAs at an interval of 10 mAs in each image acquisition, it was measured standard deviation (SD) of CT number, high contrast resolution and low contrast resolution, and then analyzed the relationship between the three parameters and the mAs values. Three mAs values were chosen to undertake clinical analysis.Clinical analysis: 90 randomly selected objects with abdominal angiography were divided into three groups,scanning with above three mAs values.Measurement of the SD value at the plain scan images was performed and the enhanced low-dose scan images were used post-processing with three-dimensional volume reconstruction (VR). The VR images were classified into three grades (excellent, moderate, bad) with the blind evaluation of three CT radiologists. The quality-correlation analysis was used between the standard deviation (SD) values of plain scan image and abdominal angiography VR image. Results According to the quality-correlation analysis between the standard deviation (SD) value of plain scan image and abdominal angiography VR image, the area under curve in receiver-operated characteristic (ROC) analysis was 0.921, 0.906 and 0.893 in each three group, respectively. Conclusions The low-dose scan of abdominal angiography is feasible. 80mAs can ensure better image quality. The enhanced scan probably can use 60mAs when the SD value is less than 5.78 in the plain scan; but when the SD value of plain scan is greater than 11.8, the enhanced scan is used best 100 mAs or higher.

Objective To compare the clinical characteristics,and outcomes of patients with heart failure with different left ventricular ejection fractions (LVEF).Methods A total of 1 182 hospitalized patients with heart failure (HF) were enrolled and retrospectively studied in the present study.The patients were stratified by LVEF as reduced (HFrEF,LVEF ＜ 40％,n =313),mid-range (HFmrEF,40％ ≤ LVEF ＜50％,n =287) and preserved (HFpEF,LVEF≥50％,n =582) ejection fraction groups.Among the 1 182 cases,941 of them (81.3％,84.9％,and 84.0％ inHFrEF,HFmrEF and HFpEF groups,respectively) were followed up for an median duration of 27.3 months.Results (1) Among the study patients,26.5％ were in HFrEF,24.3％ in HFmrEF,and 49.2％ in HFpEF groups.(2) Ischemic heart disease with HFmrEF was more frequent than that in patients with HFrEF.The average age,percentage of female subjects,systolic blood pressure,uric acid,N terminal B-type natriuretic peptide precursor (NT-proBNP),hemoglobin,and the incidence of hypertensive heart disease,anemia,atrial fibrillation in patients with HFmrEF were higher than those in patients with HFrEF,but lower than those in patients with HFpEF (all P ＜0.01).(3) The all-cause cumulative mortality was 10.8％ at 1 year,20.6％ at 2 years and 35.9％ at 5 years.No difference was observed in the all-cause cumulative mortality at 1 year,2 years,5 years among the three groups (all P ＞ 0.05).Conclusions The HFmrEF patients,as a new and distinct group,were with many intermediate characteristics compared with HFrEF and HFpEF subjects.However,the all-cause mortality was not significantly differeut among HF patients with different LVEF.

Objective: To explore the relationship between serum levels of immunoglobulin E (IgE) and calciifc aortic valve disease (CAVD) in relevant patients.
Methods: A total of 394 patients were enrolled in our study. Based on echocardiography presentation, the patients were divided into 2 groups: CAVD group,n=169 and Non-CAVD group,n=225. Serum levels of IgE were examined by chemiluminescence method. The IgE levels were compared between 2 groups and the relationship between serum IgE level and CAVD was analyzed.
Results: Serum levels of IgE in CAVD group was significantly higher than Non-CAVD group 113.30 IU/ml vs 63.76 IU/ml (P<0.05); multivariate logistic regression analysis conifrmed above difference (P<0.05) and it also indicated that the alteration of surum IgE level is obviously related to CAVD occurrence.
Conclusion: Serum IgE level is obviously increased in CAVD patients. IgE is an independent biochemical indicator of CAVD, it may play the important role in CAVD pathogenesis.

OBJECTIVETo investigate the changes of myocardial energy expenditure in patients with heart failure following myocardial infarction after treatment with different doses of perindopril.

METHODSSixty-three patients with heart failure after myocardial infarction were treated with perindopril for 12 months at the doses of 4 mg (group N) and 8 mg (group H). Doppler imaging was used to measure the structural and systolic functional parameters before and after the treatment, and the circumferential end-systolic wall stress (cESS) and myocardial energy expenditure (MEE) were calculated. The biochemical indicators including serum creatinine and plasma NT-proBNP were detected before and after the treatment.

RESULTSThe two groups had similar measurements before treatment. After 12 months of perindopril treatment, the patients in group N showed higher LA, LV, RA, RV, LVIDs, AD, cESS, lgNT-proBNP, and MEE with lower LVFS and LVEF than those in group H. Compared to those before treatment, LVFS and LVEF were increased and LA, LV, RA, RV, AD, LVIDs, LVMI, lgNT-proBNP and MEEm lowered after the 12-month treatment in group H. Significant changes were also found in the measured parameters except for PWTs, LVET, LVSV and LVFS in group N after the treatment. Bivariate analysis showed a significant positive correlation between MEE and lgNT-proBNP (r=0.513, P<0.01).

CONCLUSIONA 12-month treatment with perindopril can suppress myocardial remodeling, improve left ventricular systolic function, and lower NT-proBNP and myocardial energy expenditure in patients with heart failure after myocardial infarction, and a higher dose can produce better results.

Aged ; Energy Metabolism ; Female ; Heart Failure ; drug therapy ; etiology ; metabolism ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; drug therapy ; Myocardium ; metabolism ; Perindopril ; administration & dosage ; therapeutic use ; Treatment Outcome ; Ventricular Function, Left ; Ventricular Remodeling

Objective:To investigate the anatomical safety and feasibility ofposterior occipitocervical fixation with atlan-tooccipital-clivus screw.Methods:Data of 60 patients who treated in the spinal department of our hospital with upper cervical computed tomographic scans from February 2017 to November 2019 were retrospectively collected. Occipitocervical infection, injury, tumor and deformity were excluded. The Mimics software was used to reconstruct the occiput, atlas and measure the anatomical parameters, including the height and width of the anterior edge of the clivus, the height and width of the middle part of the clivus, the thinnest distance of the soft tissue in front of the clivus, the anteroposterior diameter, transverse diameter, the angle of inside tilting in coronary plane of the occipital condyle, the distance from the hypoglossal canal to the atlantooccipital articular surface, the anteroposterior diameter and transverse diameter of the superior joint of atlas, the height of the lateral mass, and the height and transverse diameter of the inferior articular process of the superior atlas joint. The three-dimensional digital modeling was performed and the screw diameter of 3.5mm was simulated. 3-Matic software were used to measure the screw placement parameters, including the inside tilting angle in coronary plane of screw, and the angle of upper tilting in sagittal plane and length of screw. The atlanto-occipital junction was exposed at the rear of 8 cadavers. According to the above parameters, the titanium alloy screws with a diameter of 3.5 mm were transferred from the inferior articular process and posterior arch of the atlas to the clivus through the atlantooccipital. Finally, the screw path was cut along the nail path with a pendulum saw, and the track of the screw was observed to confirm the safety and effectiveness of the screw.Results:The leading edge height and width of male clivus was 16.8±2.5 mm and 20.1±3.1 mm. The middle part of the clivus was 9.7±2.3 mm and 22.4±3.7 mm. The thinnest soft tissue in front of the clivus was 5.8±1.48 mm. The anteroposterior diameter of the occipital condyle was 19.1±1.9 mm, the transverse diameter was 12.6±2.0 mm, the inside tilting angle was 33.7°±4.5°, and the vertical distance from the lowest point of the neural tube to the articular surface of the occipital condyle was 9.6±1.1 mm. The height of the lateral mass of atlas was 12.9±2.4 mm, the anteroposterior diameter of the upper joint of atlas was 21.7±1.9 mm, and the transverse diameter was 11.7±1.4 mm. The width of the inferior facet was 14.9±1.4 mm and the height of the inferior facet was 5.7±0.85 mm. The distance from the screw entry point to the vertical line of the lateral mass migration midpoint was 2.5±0.6 mm; The distance from the screw entry point to the horizontal line of the midpoint was 2.3±0.7 mm.The inside titling angle of screw was 18.4°±1.6°, the upper tilting angle was 55.6°±3.1°, the length of the screw track was 53.0±2.8 mm, the adjustment range of upper tilting angle was 15.0±2.8 mm, the adjustment range of inside tilting angle was 10.4±2.4 mm. The anatomical parameters of females were slightly smaller than those of males, and the difference was statistically significant, but there was no significant difference between left and right parameters. The screws of 8 specimens could be inserted safely and effectively.Conclusion:Atlan-tooccipital-clivus screw can be implanted without damaging the nerve and vascular structure, and it can be used as a choice for occipitocervical fixation.

Objective:To investigate the safety of posterior atlantoaxial transarticular screw combined with atlas pedicle screw fixation in Chinese.Methods:CT data of upper cervical spine in 48 patients were collected from Ningbo No.6 Hospital, including 26 males and 22 females aged 26-58 years [(37.3±13.5)years]. All CT data was transformed into 3D dimensional model and inserted with virtual screws by Mimics 19.0. Firstly, the vertical plane P 1 and the horizontal plane P 2 of the atlas were built in those atlantoaxial models, secondly the atlantoaxial transarticular screw S 0 was inserted by Margel method, and it's insertion point was located at 3 mm lateral and 2 mm cephalad in the C 2 inferior articular process. Finally, four atlas pedicle screws were inserted at the midline of atlas lateral mass. The four screws are inserted as follows. S 1: the screw was tangent to the lateral side of the S 0 or the medial of the atlas pedicle. S 2: the screw was tangent to the lateral wall of the atlas pedicle. S 3: the screw was tangent to the upper wall of the atlas pedicle. S 4: the screw was tangent to the inferior wall of the atlas pedicle. The angles between S 1, S 2 and P 1 as the camber angle, and the angle between S 3, S 4 and P 2 as the gantry angle were measured. Then the safety range of camber angle and gantry angle were calculated, and the screw length of S 1, S 2, S 3 and S 4 was measured. In all models, the camber angle and gantry angle of the screws were adjusted an interval of 2°, the number of successful cases was calculated and the success rate of insertion was calculated. Results:All 3D models were inserted successfully. The minimum value, maximum value and safety range of the camber angle of atlas pedicle screws were (-6.7±5.2)°, (10.4± 4.3)°, (17.1±3.7)°, respectively; and of the gantry angle were (-0.5±3.5)°, (11.0±5.8)°, (11.5±4.9)°, respectively. The length of screw placement was S 1: (31.1±2.4)mm, S 2: (28.3±2.5)mm, S 3: (29.2±3.8)mm, S 4: (29.6±3.0)mm, respectively ( P<0.05). When the camber angle was from -1°to 5°, the success rate of screw placement was 87.5%; when inserting with 2° camber angle, the success rate was 100%; when the gantry angle was 5°, the success rate was 93.8%. Conclusion:The posterior atlantoaxial transarticular screw combined with atlas pedicle screw can achieve satisfy insertion length and success rate.

Objective: To compare the clinical efficacy of posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft or iliac bone graft for atlantoaxial instability. Methods: A retrospective case-control study was conducted to analyze the clinical data of 56 patients with atlantoaxial instability admitted to the Sixth Hospital of Ningbo from September 2014 to October 2016. There were 35 males and 21 females, with the age range from 9 to 59 years [(50.3±3.2)years]. A total of 26 patients were treated with posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft (complex group), while 30 patients were treated with iliac bone graft (ilium group). Patients showed different degrees of neck pain and limited neck activity preoperatively. X-ray films and three-dimensional CT examination of the cervical spine were taken before and after operation for evaluating the atlantoaxial reduction, bone graft fusion and internal fixation. The operation time, intraoperative bleeding, bone fusion time, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, atlantodental interval (ADI) and axial symptoms were compared between the two groups, and the complications were recorded. Results: Both groups were followed up for 24-30 months, with an average of 27.4 months. In the complex group and the ilium group, the operation time was (2.21±0.25)hours and (2.72±0.26)hours (P<0.01); the intraoperative blood loss was (227.3±45.4)ml and (277.7±43.4)ml, respectively (P<0.05); the bone fusion time was (6.9±0.5)months and (8.1±1.8)months (P>0.05), respectively. In the complex group, the VAS was (5.45±0.69)points before operation, (2.64±0.51)points at the follow-up one month after operation, (0.91±0.7)points at the follow-up 12 months after operation, and (0.45±0.16)points at the follow-up 24 months after operation; and in the ilium group, the VAS was (5.18±0.75)points, (2.45±0.52)points, (1.27±0.19)points and (0.41±0.18)points correspondingly. In terms of VAS, there were significant differences before and after operation within each group (P<0.01), while there were no significant differences between the two groups at different time points (P>0.05). In the complex group, the JOA score was (10.82±0.35)points before operation, (12.73±0.65)points at the follow-up one month after operation, (15.18±0.61)points at the follow-up 12 months after operation, and (15.64±0.15)points at the follow-up 24 months after operation; and in the ilium group, the JOA score was (10.73±1.19)points, (13.01±0.63)points, (14.73±0.91)points and (15.55±0.51)points correspondingly. In terms of JOA score, there were significant differences between before and after operation within each group (P<0.01), while there were no significant differences between the two groups at different time points (P>0.05). In the complex group, the ADI was (2.28±0.59)mm before operation, (1.83±0.56)mm at the follow-up one month after operation, (1.71±0.56)mm at the follow-up 12 months after operation, and (1.59±0.67)mm at the follow-up 24 months after operation; and in the ilium group, the ADI was (2.23±0.60)mm, (1.80±0.18)mm, (1.67±0.69)mm and (1.62±0.53)mm correspondingly. In terms of ADI, there were significant differences between before and after operation within each group (P<0.01), while there were no significant differences between the two groups at different time points (P>0.05). The axial symptom scores were graded as excellent in 23 patients and good in three patients of the complex group while excellent in 21 patients and good in nine patients in the ilium group (P>0.05). There were no patients with spinal nerve injury caused by pedicle screw placement after operation. One patient in the ilium group had incision errhysis and recovered after dressing change, and other patients had no incision infection. Conclusions For atlantoaxial instability, posterior atlantoaxial screw-rod fixation combined with spinous process muscle-vessel complex bone graft or autogenous iliac bone graft can both achieve satisfactory clinical results. The spinous process-muscle-vascellum complex graft has less operation time and intraoperative bleeding than the autogenous iliac bone graft, which can be a feasible alternative operation.

Objective: To investigate the prognostic value of N-terminal B-type natriuretic peptide (NT-proBNP) on all-cause mortality in heart failure patients with preserved ejection fraction (HFpEF) at real world scenarios. Methods: Patients who met the diagnostic criteria of HFpEF in the China National Heart Failure Registration Study (CN-HF) were divided into death and survival groups. The demographic data, physical examination, results of the first echocardiography, laboratory results at admission, complications, drug use and clinical outcomes were obtained from CN-HF. The univariate Cox proportional hazard model was used to screen the variates that might predict prognosis, and then the covariates with statistical significance were included in the multivariate Cox regression model to analyze the predictive value of baseline NT-proBNP on all-cause death. Spearman correlation analysis was used to evaluate the relationship between NT-proBNP and estimated glomerular filtration rate (eGFR), so as to further explore the predictive value of the interaction between renal dysfunction and NT-proBNP on death. Since NT-proBNP did not obey the binary normal distribution, it was expressed by the natural logarithm of NT-proBNP (LnNT-proBNP). Results: A total of 1 846 HFpEF patients were enrolled in this study, with an average age of 71.5 years, 1 017 males(55.1%), median NT-proBNP 860 ng/L, and median eGFR 73.9 ml·min^-1·1.73m^-2. After a median follow-up of 34 months, 213 (11.5%) patients died. Patients in the death group were older, with higher NYHA classification Ⅲ-Ⅳ ratio, longer hospital stay, higher serum potassium and NT-proBNP level, prevalence of complications of diabetes mellitus, arrhythmia and atrial fibrillation, use of angiotensin receptor antagonist(ARB), mineralocorticoid receptor antagonists (MRA), diuretic and digoxin was significantly higher in death group than in survival group. Body mass index (BMI), diastolic blood pressure, left ventricular ejection fraction (LVEF), hemoglobin, serum cholesterol(TC), serum triglycerides (TG) and eGFR, and use of angiotensin converting enzyme inhibitors (ACEI), statins and aspirin were lower in death group than in survival group. Univariate Cox regression analysis showed that NT-proBNP was a predictor of all-cause death in HFpEF patients (HR=2.522, 95%CI 2.040-3.119, P<0.001). Multivariate Cox regression analysis showed that the elevated NT-proBNP remains as the independent predictor of all-cause death in patients with HFpEF (HR=1.230, 95%CI 1.049-1.442, P=0.011) after adjusting for age, BMI, diastolic blood pressure, LVEF, hemoglobin, serum potassium, serum sodium, TC, serum high-density lipoprotein cholesterol (HDL-C), TG, eGFR, atrial fibrillation, as well as the treatment of ACEI/ARB, MRA, diuretics and digoxin. Spearman correlation analysis showed that LnNT-proBNP was negatively correlated with eGFR (r=-0.361, P<0.001), but there was no interaction between NT-proBNP and renal dysfunction in predicting death in HFpEF patients (P>0.05). Conclusion The elevated level of NT-proBNP at admission is an independent predictor of all-cause mortality in HFpEF patients.