Objective To establish a method used for determination of Aconitine and Hypaconitine and Mesaconitine in blood by LC/MS/MS.Methods Extraction of blood sample was conducted by use of 1% thirdchloroactic acid and acetonitrile liquid,and the electrospray fog ionic source,and positive ion MRM scan were employed.Result The linearity correlation coefficients(r)was≥0.992 2.The limit of quantification (LOQ S/N=5) was 2.0 ng/ml for Aconitine,0.5 ng/ml for Hypaconitine,and 0.5 ng/ml for Mesaconitine.The recovery of appended contrast in blank blood sample ranged from 91.25% to 103.1% with coefficient of variation (CV,n=6) less than 10.93%.Conclusion The method of LC/MS/MS is sensitive and reliable,and the sample handling is quick and simple,which was suitable for determination of the Aconitine and Hypaconitine and Mesaconitine in blood sample.

The effect of RNA interference-mediated adiponectin gene silence on glucose-lipid metabolism in apolipoprotein E gene knock-out(ApoE~(-/-)) mice was studied. The plasma adiponectin level in ApoE~(-/-) mice with high-fat diet and adiponectin short hairpin RNA (shRNA) adenovirus injection (ADI group) was significantly lower than that in ApoE~(-/-)mice with high-fat diet(HF group), normal-chow(NF group)and naked adenovirus injection (GF, both P<0.01). Fasting blood glucose, fasting plasma insulin, free fatty acids, total cholesterol, triglycerides, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and body weight were significandy elevated in three high-fat diet groups compared with in NF group, (P<0.01). However, fasting plasma insulin, free fatty acids, total cholesterol, triglycerides, LDL-C, and HDL-C in ADI group were significantly higher than those in HF and GF groups(P<0.01 or P<0. 05). A typical clinical phenotype of glucose-lipid metabolism and insulin resistance in ApoE~(-/-) mice can be induced by high-fat feeding and adiponecting gene silencing.

Objective To investigate the relationship of circulating zinc-α2-glycoprotein (ZAG) as well as adiponectin with adiposity and insulin resistance in humans.Methods Serum ZAG and adiponectin levels were determined by ELISA in 285 subjects with normal glucose tolerance (NGT),impaired glucose tolerance (IGT),and newly diagnosed cases with type 2 diabetes mellitus(T2DM).The relationships between circulating ZAG and insulin resistance or metabolic parameters were also explored.Results Circulating ZAG and adiponectin levels were all lower in T2 DM and IGT subjects than those in control subjects [ZAG:(37.14 ± 13.25 and 48.84 ± 18.74 vs 59.36 ± 16.20) mg/L,P＜0.05 or P＜0.01 ; adiponectin:(27.79 ± 11.23 and 33.00 ± 9.42 vs 41.81 ± 13.68) μg/L,P＜0.01].Circulating ZAG was correlated positively with high density lipoprotein-cholesterol and adiponectin (all P＜0.01),and inversely with body mass index,waist-hip ratio,FAT％,diastolic blood pressure,triglyceride,fasting blood glucose,fasting insulin,HbA1C,and homeostasis model assessment for insulin resistance(HOMA-IR,P＜0.05 or P＜0.01).By multivariate analysis,ZAG levels were independently associated with body mass index,HOMA-IR,diastolic blood pressure,and adiponectin (P＜0.05 or P＜0.01).Conclusions ZAG levels,associated with fat,insulin sensitivity,and adiponectin expression,are likely to play an important role in insulin resistance and energy homeostasis in humans.

Objective To evaluate the effect of electrical stimulation of the pelvic floor muscles combined with bladder training on urinary dysfunctionafter incomplete spinal cord injury.Methods Sixty-two incomplete spinal cord injury patients who had received an operation between November 2009 and December 2014 were enrolled and divided randomly into a control group (n=32) and a treatment group (n =30).Both groups were treated with conventional intermittent catheterization,while the treatment group was additionally given electrical stimulation of the pelvic floor muscles combined with bladder training.The residual urine volume was recorded before and after the treatment.Uurodynamic examinations were conducted,and the rate of successful catheter extraction and of urinary tract infection on the 15th and 30th day of treatment,were recorded and analyzed.Results All of the patients were followed-up for an average of 18.5 months.Significant improvement was observed in the residual urine volume,the maximum or average urinary flow rate,and the detrusor pressure at peak flow of both groups.However,at the end of follow-up the treatment group recorded significantly better results on all these measures than the control group.The successful catheter extraction rate of the treatment group (96.7％) was significantly higher than that of the control group and their average number of catheterization days was significantly fewer.The urinary tract infection rates on the 15th and 30th day of treatment were 16.7％ and 6.7％ in the treatment group,significantly lower than in the control group.Conclusions Electrical stimulation of the pelvic floor combined with bladder training significantly improves urination function after an operation for incomplete spinal cord injury,decreases the days of catheterization and lowers the rate of urinary tract infection.Such combined therapy is worth promoting in clinical practice.

Objective To investigate the method and effectiveness of the digital artery series and parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger Methods Between September 2008 and July 2012,the finger artery series retrograde island flaps tiled in the repair of finger degloving injury in 13 cases,repair of adjacent finger tip degloving injury in 11 cases; 8 cases of degloved injuries of the fingertip were tiled with the digital artery parallel island flap from ulnaris middle finger and radialis ring finger of arteria digitalis communis pedicled which were from the same palm side.The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm-7.2 cm ×5.5 cm,gutted flap minimum ranged from 1.1 cm × 1.0cm-1.5 cm × 1.3cm,and the maximum ranged from 3.0 cm × 2.2 cm-5.5 cm × 4.5 cm.The donor sites were repaired with the intermediate split thickness free skin grafts and performed with pressure dressing.Results The group of 32 cases,in 1 case the flap vasospasm occurred in operation of free process,the symptoms disappeared after local application of papaverine and hot compress ; 1 case of flap occurred disturbance of blood circulation after operation because of tight suturing for pedicle,the symptoms relieved after removing the stitches at intervals; 2 cases blisters appeared after operation,disappeared after a week.All skin flaps were survived,incision and skin graft donor sites healed by first intention.Twenty patients were followed-up from 6 to 12 months after operation.All flaps presented the satisfactory appearance and texture,recovered protective feeling.At last follow-up,the two-point discrimination was 7 to 10mm,and the flexion and extension function of wounded fingers recovered to normal.According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association,there were excellent in 19 cases,good in 10 cases,and moderate in 3 cases.No significant loss to the donor shape and function.Conclusion The surgery by adopted the digital artery series or parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger,not only has the advantages of simpleness,safety and reliability,but also can satisfy the patients who aren't willing to accept or because of physical reasons can't accept the treatment of abdominal skin tube or nail flap from hallux toe,which performs in both high-end and low level hospitals,and deserves of general application.

Objective To evaluate the surgical methods and clinical effects of the reconstruction of soft tissue defect in distal thumbwith dorsal thumb neurocutaneous vascular flap.Methods From January,2014 to December,2016,32 patients with soft tissue defects of distal thumb were repaired with dorsal thumb neurocutaneous vascular flaps,including left thumbs in 11 cases and right thumbs in 21 cases.They were including 7 cases of nail bed defects,9 cases of pulp defects under nails,16 cases ofthe defects of tips or stump of fingers;skin and soft tissue defects range of 1.5 cm×1.0 cm-3.5 cm×3.2 cm;Flap cutting areas range of 2.0 cm×l.5 cm-4.0 cm×3.5 cm.If the donor areas could be sutured directly,be sutured;if they could not,be covered with intermediate split thickness skin grafts.All patients were followed up when they were reviewed in outpatient department,and to be evaluated the shape,texture,sensation,flexion and extension function,and donor site of the flaps.Results One case of flaps blood circulation disordereddue to tight suture,and eased after the removal of part of the sutures;One case of flaps atrophied,and the phalangette was exposed after 3 months,so we removed the end part of bone and the wound was closed;other flaps were survived,with primary wound healing.In the total 32 patients,they were followed up range of 3 to 36 months,with an average of 12 months.Eighteen cases were followed up at least 6 months,which were 4 of the 7 cases of nail bed defects,5 of the 9 cases of pulp defects under nail and 9 of the 16 cases of the defects of tip or stump of fingers.The appearances and textures of flaps were good,protective sensations were restored,and skin flap two-point discriminationswere 8-10 mm.According to the Trial Standard for Evaluation of Upper Limb Function of Chinese Society of Hand Surgery,it was excellent in 11 cases,good in 17 cases and moderate in 4 cases,with the excellent and good rate of 87.5％.Conclusion It has advantages of simple operation,low risk,high success rate and satisfactory curative effects of the use of dorsal thumb neurocutaneous vascular flap for repair of distal thumb defect of skin and soft tissue.It is not only suitable for the hospital with good technical and equipment,but also suitable for the primary hospital.

Objective To find out the present situation and influence factor in core capabilities of nurses that with blood purification skills in 18 hospitals, and offer reference frame for training. Methods The questionnaires were used to investigate, theresults underwent analysis. Results Among three parts of core capabilities, total score of N1-2 made the highest,the mean score was 236.75,N3 score made the lowest,the mean score was 168.00. The percent of pass in every hierarchy didn't passed 50%. Using the multiple regression to analyze the factor,N1-1 was the work experience in department of nephrology;N3 was the training time of blood purification. Conclusions Percent of pass in core capabilities of nurses of blood purification is in a low level,every hospital should follow the principle of recruitment,and regulate the training of nurses in blood purification.

Objective To evaluate the association of apM1 gene single nucleotide polymorphisms (SNP) with type 2 diabetes mellitus in Chinese population. Methods Odds ratios (OR) of apM1 gene SNP distribution were analyzed. The Meta-analysis software (RevMan 4.3.1) was employed for summarizing the studies,calculating the pooled OR and its 95% CI and testing the overall effects. Egger's test and fail-safe number for P=0.05 (Nfs<,0.05>) were performed for evaluating the publication bias. The sensitivity analysis by different effect models and sample sizes were employed for the reliability of Meta-analysis. Results Nine literatures were obtained, apM1 gene SNP45 showed remarkable heterogeneity among the studies (P<0.10). Sub-group analysis revealed that the discrepancy based on southern Chinese individuals was the main source of the total heterogeneity.The distribution frequencies of apM1 gene SNP45G, SNP45GG, SNP276G and SNP276GG were significantly higher in Chinese type 2 diabetes mellitus group than those in NGT group (P<0.05). Their pooled OR and 95% C/were 1.50[1.12,2.02], 2.15[1.53, 3.02],1.23[1.03, 1.46] and 1.26[1.00,1.59], respectively (all P<0.05). The distribution of apM1 gene SNP45TG and SNP276GT between type 2 diabetes mellitus and normal glucose tolerance group revealed no difference among these studies. The results of publication bias diagnostics and sensitivity analysis accounted for the reliability and stability of this Meta-analysis. Conclusion apM1 gene SNPs are strongly associated with type 2 diabetes mellitus in Chinese population. SNP45G and SNP276G seem to be risk factors for type 2 diabetes mellitus.

Objective To find out the present situation and influence factor in core capabilities of nurses of blood purification, and offer reference frame for evaluation, selection, authentication and engagement of nursing post. Methods Core capability training module for nurses of blood purification was selected as theoretical basis for rough draft of evaluation index system establishment. The selected index underwent expert consultation with Delphi method. Results Four hierarchy were confirmed after 3 rounds of consultation (N1-1,N 1-2, N2, N3). Each hierarchy had three evaluation indexes, knowledge, technology and clinical practice. Number of grade one evaluation indexes of each hierarchy was 5,5,4; 5,5, 4;5,5,5; 5,5,1. Number of grade two evaluation indexes was 20,20,24;20,20,20;25,25,48;23,24,14.Only N1- 1,N1-2 and N2 had grade three evaluation indexes, 16, 5, 13 respectively. Conclusions Preliminary establishment of core capability evaluation index system can basically evaluate capability of nurses of blood purification.