Objective To investigate the clinical effect of treating melasma by catgut embedding combined with thunder-fire moxibustion and acupuncture.Methods Between September 2011 to December 2012,82 cases of melasma patients in Acupuncture Department of Tongren Hospital were randomly recruited into test group (42 cases) and control group (40 cases).Test group was treated by catgut embedding combined with thunder-fire moxibustion and other 40 cases of control group were treated by common acupuncture.Then therapy effects were observed 8 weeks after treatments.Results In test group,general efficient rate of 42 cases was 97.6％,cure rate was 23.8％;in control group,general efficient rate of 40 cases was 72.5％,and cure rate was 15％.By statistical analysis,the effect of the test group was obviously higher than that of the control group (P＜0.05).Conclusions The treatment of melasma by catgut embedding combined with thunder fire moxibustion achieves more effective outcomes than common acupuncture.

Objective To evaluate the valRe of Geneva score,plasma D-dimer lUmitel,lower extremity compressive ultrasonography and transthoracic echocardiography,as well a8 their combination,in diagnosis for suspected pulmonary thmmboernbolism(PTE)and its exclusion.Methods In total,139 confirmed FrrE patients were enrolled in the study,with 50 patients with suspected PTE at admission but excluding PTE after testing as controls,Geneva scores and plasma level of D-dimer were determined,and deep vein uhrasonography in the lower extremity and transthoracic echocardiography were performed for all the confirmed cases of PTE and controls.Diagnostic values were evaluated with each teat index alone or in combination,to confirm or exclude PTE.Results FrrE could be diagnosed by hish Geneva score,with a positive likelihoed ratio more than 10 and it could not be excluded by a negative likelihood ratio more than 0.1 with Latex semi.quantitative method and quantitative methed Latex method P,rE could be excluded by a multi-tests in parallel with negative likelihoed ratio less than 0.1.High Geneva scores,in combination with ultrasonography of the lower extremity and transthoracic echoeardiography in combination with Youden index greater than 0.6 could indicate PTE.Sensitivity and specificity of P1'E diagnosis could be improved by multi-tests in parallel or in series.Conclusions Geneva SCOre is more objective indicator and hish score has diagnostic value for PTE.PTE could be excluded reliably by negative result of multi-diagnostic tests in paralleL Misdiagnosis and under-diagnosis for PTE can be reduced by Geneva score,blood D-dimer level,lower extremity compressive ultrasonogaphy and transthoracic echocardiography,as well as their combination,in parallel in hospitals without ECT or spiral CT.

OBJECTIVE:To shorten the time of admixture of temporary medical order in PIVAS,and to guarantee the timely treatment of patients. METHODS:Through the definition,measurement,analysis,improvement and control ie. five steps of six sigma method,the consumed time of each link of temporary medical order admixture in PIVAS was analyzed in our hospital during Mar. 9th-22nd in 2015 (before improvement);key points were found out,and relevant measures were formulated and improved;the consumed time of each link of temporary medical order admixture in PIVAS was collected again during Jul. 27th-Aug. 9th in 2015 in order to evaluate improvement effects. RESULTS:It was quality key point that total length of temporary medical order ad-mixture which included injection sequence,label checking,preparation,package rechecking,drug distribution and so on,was con-trolled within 120 min;through formulating and implementing various measures as improving information system,adjusting prepa-ration sequence and shunting staff posts flexibly,the total time of first 3 batches of temporary order admixture were 120,98 and 77 min after improvement,shortening by about 30,50 and 55 min respectively,compared with before improvement (P<0.05). CONCLUSIONS:The six sigma method has shortened the time of temporary order medical admixture in our hospital. The formulat-ed measures are effective and feasible.

Objective To evaluate spectral CT imaging in characterizing the pathological type and the differentiation of gastric cancer.Methods Ninety-one patients diagnosed of gastric cancer were retrospectively analyzed.Patients were all underwent triple-phase enhanced scan using single source dualenergy CT on gemstone spectral imaging(GSI) mode.Three types of images were reconstructed for analysis:the water concentration (WC),iodine concentration (IC),and normalized iodine concentration (NIC).The patients were divided into groups of mucinous carcinoma (MUC),including mucinous adenocarcinoma and signet ring cell carcinoma,and non-mucinous gastric carcinoma (non-MUC).Independent-samples t test was used for statistical analysis.Results There were 24 patients of MUC and 67 patients of non-MUC.The IC and NIC of the non-MUC were significantly higher than the MUC in vein phase (VP) and in parenchymal phase (PP) [(21.33 ±6.31) × 100 vs (16.94 ±6.13) × 100 μg/ml,0.55 ±0.17 vs 0.42 ±0.14 in VP,and(20.65 ±5.49) × 100 vs (18.07 ±4.51) × 100 μg/ml,0.72 ±0.20 vs 0.57 ±0.12 in PP,respectively t =-2.948,-3.362,-2.261,-4.326,P ＜0.05].The IC and NIC of the signet ring cell carcinoma were statistically higher than those of the mucinous adenocarcinoma [(19.36 ± 4.75) × 100 vs (12.10 ±5.92) ×100μg/ml,0.49 ± 0.09 vs0.28±0.11 in VP,and (19.88±3.28) ×100 vs (14.45±4.62) ×100 μg/ml,0.63 ±0.08 vs 0.47 ±0.11 in PP,respectively t =3.253,5.180,3.339,3.850,P ＜0.01].For the poorly differentiated and well /moderately differentiated adenocarcinoma,the IC and NIC of the former were higher than those of the latter in VP and PP [(23.48 ±6.49) × 100 vs (18.98 ±5.26) × 100 μg/ml,0.61±0.16vs0.48±0.15 in VP,and (22.95±5.51) ×100 vs (18.28±4.47) ×100 μg/ml,0.81 ± 0.21 vs 0.63 ± 0.15 in PP,respectively t =3.098,3.249,3.766,4.117,P ＜ 0.01].The between-group differences of WC,IC and NIC in artery phase were no significant (P ＞ 0.05).Conclusions Different pathological types could determine different IC.The spectral CT imaging may be helpful for characterizing the pathological type of gastric cancer.

Objective To explore the effects of manumycin on U937 cells and its mechanisms.Methods Apoptosis was detected by flow cytometry using annexin V and propidium iodide (PI) after treatment with manumycin (2 μmol/L) for different time.The reactive oxygen species (ROS) was detected by flow cytometry using Reactive Oxygen Species Assay Kit.The expressions of PI3K,P-Akt and Akt were detected by Western blotting.Results Compared with the 0 h treatment,manumycin treatment resulted in apoptosis (P ＜ 0.05) and ROS generation (P ＜ 0.05) gradually in U937 cell lines.Furthermore,manumycin also inhibited the activation of phosphatidylinositol-3 kinase (PI3K)/Akt pathway.Moreover,NAC could decrease manumycin-induced ROS generation and inhibit the effects of manumycin on the PI3K/Akt pathway and protect U937 cells from apoptosis induced by manumycin.Conclusion Manumycin induces apoptosis in U937 human leukemia cells through the regulation of the PI3K/Akt pathway and ROS production plays a critical role in the progress.

AIM　To isolate and identify the active constituents of Erigeron brevisapus (Vant.) Hand. -Mazz. METHODS　The chemical constituents were isolated by silica gel column chromatography and two new compounds were obtained. Their structures were elucidated by IR, MS, 1HNMR, 13CNMR, DEPT and 2DNMR. The injury of BCMEC (bovine cerebral microvascular endothelial cell) was determined by lactic dehydrogenase (LDH), the ability of the drugs anti-oxidation and scavenging oxidation of free radical was measured by colorimetric method. RESULTS　Two new compounds have been identified as 1-O-methyl-3, 5-O-dicaffeoyl quinic acid methyl ester (III) and 5-O-caffeoyl quinic acid butyl ester (IV). CONCLUSION Compounds III and IV are new compounds. Compound III can protect BCMEC injury by LPC.

Objective To evaluate the effect of cisplatin on analgesia with morphine in rats with incisional pain.Methods Forty-two adult male Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 6 groups (n =7 each) using a random number table:normal saline group (group C),normal saline + Pglycoprotein inhibitor LY335979 group (group CL),normal saline + morphine group (group CM),cisplatin group (group S),cisplatin + morphine group (group SM) and cisplatin + morphine + LY335979 group (group SML).Cisplatin 2 mg/kg was injected intraperitoneally once every two days for 5 times in S,SM and SML groups,while the equal volume of normal saline was injected intraperitoneally in C,CL and CM groups.At 2 days after the end of administration,the incisional pain models were established.At 10 min after establishing the model,normal saline 2 ml was injected subcutaneously in C and S groups; LY335979 20 mg/kg was injected via the caudal vein and normal saline 2 ml was injected subcutaneously in group CL; morphine 2 mg/kg was injected subcutaneously in CM and SM groups; LY335979 20 mg/kg was injected via the caudal vein and morphine 2 mg/kg was injected subcutaneously in group SML.Cumulative pain score was used to evaluate analgesia.Results Compared with group C,cumulative pain scores were significantly decreased in group CM,and no significant change was found in cumulative pain scores in CL and S groups.Compared with group CM,cumulative pain scores were significantly increased in group SM,and no significant change was found in cumulative pain scores in group SML.Cumulative pain scores were significantly lower in group SML than in group SM.Conclusion Cisplatin can weaken analgesia induced by morphine in rats with incisional pain through enhancing P-glycoprotein function in the blood-brain barrier.

Objective To observe the change of the serum trough concentration and its pharmacokinetics of vancomycin in patients with severe acute pancreatitis (SAP), and to analyze the factors influencing vancomycin concentration. Methods A retrospective analysis was conducted. Steady-state trough concentrations of vancomycin from patients (18-80 years old) with SAP concomitantly with G+ infection admitted to Intensive Care Unit (ICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2010 to December 2016 were enrolled. According to the usage time of vancomycin, the patients with SAP were divided into early group (onset within 21 days), middle group (onset between 21-28 days) and late group (onset over 28 days). The gender, age, body weight, clinical diagnosis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score, renal function, and the pharmacokinetic parameters were recorded. Influencing factors of vancomycin was analyzed by multiple linear regression and stepwise regression. Results Fifty-eight patients were enrolled who contained 134 times trough concentrations of vancomycin. There were 41 patients enrolled and 61 times of trough concentrations in the early group, 24 patients enrolled and 33 times of trough concentrations in the middle group, and 28 patients enrolled and 40 times of trough concentrations in the late group. There was no significant difference in gender, age, body weight, serum creatinine, creatinine clearance (CCr), albumin, APACHE Ⅱ score among the three groups. There was significantly difference in the duration from the onset time to vancomycin administration between early, middle groups and late group (days:15.9±3.2, 23.3±2.2 vs. 35.0±6.7, both P < 0.05). The positive liquid balance in early group was lower than that of late group (mL: 1565.2±3132.1 vs. 3675.1±3411.5, P < 0.01), while it was increased in the middle group as compared with that of late group (mL: 5078.7±3892.4 vs. 3675.1±3411.5, P < 0.05). The average daily dose of vancomycin in the early, middle and late groups were (14.7±5.0), (15.0±2.8), (17.0±4.2) mg/kg, respectively, and there was no significant difference (P > 0.05). Compared with the standard concentration (15 mg/L) of vancomycin, the serum trough concentration of vancomycin was significantly reduced in SAP patients [(7.5±4.3) mg/L, P < 0.01]. Apparent volume of distribution (Vd) was (72.4±15.4) L, and clearance rate (CL) was (9.0±2.8) L/h. According to the Bayesian, the serum trough concentration of vancomycin was significantly reduced in early group and middle group compared with late group (mg/L: 5.0±2.1, 7.3±2.5 vs. 11.5±5.1, both P < 0.01), CL was significantly increased (L/h: 10.5±3.0, 8.1±1.9 vs. 7.4±1.9, both P < 0.05), and Vd was significantly increased in early group compared with late group (L: 73.7±15.5 vs. 71.0±12.6, P < 0.05). It was shown by multiple linear regression analysis that there was strong relationship between serum trough concentration and the serum creatinine, CCr, average daily dose and the starting time of vancomycin treatment (r value were 0.449, -0.318, 0.373, 0.763, respectively, all P < 0.05). Conclusions The serum trough concentration of vancomycin was significantly reduced in SAP patients. And the earlier usage of vancomycin, the lower of the trough concentration is. Therefore, higher dosage regimen was needed to ensure the clinical effect, and reduce the bacterial resistance.

Objective To evaluate the serum trough concentration and the pharmacokinetics/pharmacodynamics (PK/PD)of vancomycin in patients with severe acute pancreatitis (SAP), and analyze the effect of vancomycin continuous infusion for optimizing the characteristics of its PK/PD.Methods The inhospital patients with SAP received vancomycin treatment and admitted to emergency intensive care unit (EICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to December 2016 were enrolled. Steady-state trough concentrations of vancomycin from patients were collected retrospectively. The SAP patients were divided into augmented renal clearance (ARC) and non-ARC groups, as well as systemic inflammatory response syndrome (SIRS) and non-SIRS groups according to the patients with or without symptom above. Adjustments of increased dosage or 24-hour continuous infusion or increase vancomycin dose were made for patients if the steady-state trough concentrations fell below the target level. Steady state trough concentration for vancomycin intermittent infusion or steady state concentration for vancomycin continuous infusion was determined by the fluorescence polarization immunoassay method. PK parameters of vancomycin were calculated using the Bayesian estimator and the area under the serum drug concentration-time curve (AUCc-t), the minimum inhibitory concentration (MIC) and AUCc-t/MIC was recorded and calculated.Results The steady state trough concentration or steady state concentration from 61 patients with SAP were collected with mean steady state trough concentration of vancomycin of (7.7±4.4) mg/L, which was significantly lower than standard concentration (15 mg/L,P < 0.001). Apparent volume of distribution (Vd) and clearance of vancomycin was (1.06±0.26) L/kg and (8.9±2.8) L/h. The serum steady state trough concentration of vancomycin in ARC group (n = 33) was significantly lower than that in non-ARC group (n = 28; mg/L: 6.7±3.5 vs. 8.2±4.1, P < 0.01), clearance was significantly increased (L/h: 9.8±2.9 vs. 7.7±2.2,P < 0.01). Compared with non-SIRS group (n = 31), the serum steady state trough concentration of vancomycin in SIRS group (n= 30) was significantly lowered (mg/L: 6.1±3.2 vs. 13.0±4.2,P < 0.01), and clearance was significantly increased (L/h: 9.4±2.0 vs. 7.1±2.1,P < 0.05). Compared with the only increasing vancomycin dose group (n = 29), vancomycin continuous infusion for 24 hours (n = 21) could significantly reduce daily dosage (mg/kg: 13.6±3.9 vs. 19.1±3.5,P < 0.01), increase the serum trough concentration (mg/L: 18.1±7.0 vs. 12.6±5.3,P < 0.01), and improve the AUCc-t/MIC.Conclusions The serum trough concentration of vancomycin was significantly reduced in SAP patients with ARC. The more serious of the SIRS is, the lower the vancomycin trough concentration is. Vancomycin 24-hour continuous infusion could optimize the PK/PD parameters, decrease the daily dose, increase the clinical effect, and reduce the bacterial resistance.

Objective To investigate the metabolic changes and the metabolites distribution of different hippocampal regions (head,body and tail)in patients with Alzheimer’s disease (AD)using 1 H-MRS for early diagnosis.Methods The hippocampal multivoxel 1H-MRS at 3.0 T was scanned in 30 patients with AD and other 30 normal cognitive elders (NC)as contrast.The data obtained were processed at a workstation.The hippocampus was divided into 3 parts (head,body and tail),and the ratios of N-acetylaspartate (NAA)/creatine (Cr),myoinositol (MI)/Cr and MI/NAA were calculated respectively.The metabolite ratios and distribution changes were compared between group AD and NC.Results Compared with the group NC,the NAA/Cr in group AD in bilateral hippocampal body and tail was decreased,whereas the MI/Cr and MI/NAA in bilateral body and tail,MI/NAA in left head were opposite (P<0.01).In group NC,the NAA/Cr was gradually decreased from the bilateral hippocampal heads to tails (P<0.01),however,the MI/NAA was opposite (P<0.01).No distribution differences in every metabolic ratios of bilateral hippocam-pus were found in AD group (P>0.05).Conclusion Metabolic changes and disappearance of the normal distribution in different hippocampal regions detected by 1 H-MRS provide helpful clues for early diagnosis of the AD.