Objective To establish the HPLC determination method of chlorogenic acid for developing the quality standard of Yinqiao Jiedu Oral Liquid.Methods HPLC method was performed on an E.Merck LiChrospher 100RP-18 column(250 mm? 4 mm,5 ? m).The mobile phase consisted of acetonitrle and o.4 % phosphoric acid(10:100).The flow rate was 1.0 mL/min,column temperature was 30 ℃,and the detection wavelength was 327 nm.Results Chlorogenic acid was linear at the range of 0.12～ 0.63 ? g(r=0.999 6),the average recovery was 96.68 %,and RSD was 1.56 % .Conclusion This method is accurate,reliable,reproducible,and can provide evidence for the quality control of Yinqiao Jiedu Oral Liquid.

Objective To summarise the clinical characteristics and surgical treatment experience of primary cardiac tumours treated by tumorectomy under extracorporeal circulation .Methods The clinical data of 352 patients with primary cardiac tumors in our hospital from January 1980 to December 2015,who received surgical treatment of tumorectomy under extracorporeal circulation were retrospectively ana -lyzed.Results Among the 352 cases in all, there were 338 cases (96%) of benign tumor, including 309 cases (87.8%) of myxoma and 14 cases (4.0%) of malignant tumor.There were 4 cases of perioperative death, and all the 4 cases were malignant tumor.Conclusion Myxoma is the most common primary cardiac tumor ,and the best solution for the cardiac benign tumor is surgery .However , the effect of sur-gical operation on malignant cardiac tumors was poor .

Objective The aim of this study was to explore the inhibitory effect of alcohol extracts of Narcissus bulb on melanogenesis in zebrafish embryos.Methods Zebrafish embryos were exposed to different concentrations of alcohol extracts of Narcissus (0, 50, 100, 200, and 500 μg/mL), and then the formation of melanin was observed.Furthermore, we measured the enzyme activity of tyrosinase (TYR), which plays a pivotal role in melanogenesis.Meanwhile, the spatial and temporal pattern of melanin-specific marker genes were detected.Arbutin (Ar) was used as a positive control in all these experiments.Results The treatment of alcohol extracts of Narcissus bulb inhibited melanogenesis in the zebrafish embryos in a dose-dependent manner.Furthermore, the mRNA expression levels of melanin-related genes such as tyrosinase (TYR), silver (SILV) and Mitfa were significantly reduced after treatment with different concentrations of Narcissus extracts by in-situ and semi-quantitative PCR.Finally, the enzyme activity of tyrosinase was also gradually decreased with increasing concentrations of the alcohol extracts.Conclusions Narcissus alcohol extracts can effectively inhibit the production of melanin in zebrafish embryos.This study provides potential evidence and approaches for the screening of natural whitening compounds using zebrafish models.

ObjectiveTo evaluate the effect of rehabilitation nursing in the peri-operative period of the first-stage combined anterior-posterior approach surgery in the sacral tumor resection.Methods15 patients with sacral tumor received psychological intervention, gastrointestinal preparation, exercises of perineum sphincter contraction and relaxation training before the operation. Changes of patients' vital signs and nerve function were observed after the operation, and rehabilitation training and instruction were performed.ResultsAll cases were followed up for 2～37 months. Except one case died of tumor transfered to lung, all of other cases had a satisfactory curative effect in the near future, and their local symptom released and the functions of urination and defecation were kept well.ConclusionRehabilitation nursing in the peri-operative period plays an important role in surgical treatment of sacral tumor. It affects the rehabilitation and function restitution obviously and can reduce the occurrence of complication effectively.

Objective: To evaluate the efifcacy of modiifed extended Morrow procedure on hypertrophic obstructive cardiomyopathy (HOCM) in adolescent patients. Methods: We retrospectively studied 29 consecutive HOCM patients at the age≤21 years who received modiifed extended Morrow procedure in our hospital from 2011 to 2015 for their clinical conditions to assess surgical efifcacy. Echocardiography was performed to compare left atrial size, left ventricular end diastolic diameter, left ventricular ejection fraction, left ventricular outlfow tract peak pressure, ventricular septal thickness, mitral systolic anterior motion and mitral regurgitation grade before and after operation. Moreover, pre-operative and post-operative plasma NT-proBNP levels were determined. Cardiac function was evaluated by New York Heart Association functional class. Results: There were 17 (58.6%) patients received isolated modiifed extended Morrow procedure and 12 patients had concomitant operation including 8 (27.6%) with coronary artery bypass grafting. Compared with pre-operation, the post-operative thickness of ventricular septum decreased from (24.6 ± 6.8) mm to (16.9 ± 7.1) mm, left ventricular outlfow tract gradient decreased from (68.8 ± 15.7) mmHg to (10.7 ± 4.2) mmHg, bothP<0.001; mitral regurgitation degree reduced from (1.7 ± 1.3) to (0.2 ± 0.4),P<0.01; NYHA classification improved from (3.4 ± 0.8) to (1.4 ± 0.5),P<0.01; plasma level of NT-proBNP reduced from (1957.6 ± 392.5) ng/ml to (458.7 ± 161.0) ng/ml,P<0.01. There was no peri-operative death, the survival rates at 12, 24 and 36 months post-operation were 100%, 86.7% and 86.7% respectively. Conclusion: Modiifed extended Morrow procedure has been a safe and effective method for treating adolescent HOCM patients, adequate exposure is the key point to assure surgical efifcacy.

Objective To study the feasibility and safety of trial of labor after cesarean section (TOLAC). Methods Retrospective analysis of five medical center of Guangdong province from January 2011 to December 2015 hospitalized delivery information, compare the same scar TOLAC (research group) with the scar pregnancy (control group) pregnancy outcomes, to study the feasibility and safety of TOLAC. Results (1)During 2011-2015, total delivery 95 600 cases in five medical center, 13 824 cases of thme with uterine scar pregnancy, including 12 027 cases elective repeat cesarean section and 1 797 cases (13.00%, 1 797/13 824) with scar uterus vaginal trial of labor. Among 1 308 cases of vaginal delivery,the success for trial of labor rate was 72.79% (1 308/1 797). From 2011 to 2015, there were increased rate of pregnancy after cesarean section, which were respectively 10.71%, 13.28%, 14.45%, 15.54%and 16.98%. The will of vaginal birth were rising and the rate were respectively 11.85%, 12.25%, 13.49%, 13.82%and 12.93%. (2) There were 489(27.21%,489/1 797) cases of scar uterus maternal emergency cesarean section in the trial of labor, reason for“social factors”require for cesarean delivery have 68 cases, the percentage was 13.91% (68/489), compared with control group (7.18%, 206/2 869), the difference was statistically significant difference (χ2=27.356,P=0.000). Doctors diagnosed as“aura uterine rupture”in the labor was 11.86% (58/489), compared with that in control group (1.43%, 41/2 869), the differences were statistically significant difference (χ2=1 578.223,P=0.000). (3) The incidence of uterine rupture of the research group(0.74%,9/1 211)was significantly higher than that of control group (0.01%,2/31 200;χ2>2 000,P=0.000). The incidence of postpartum hemorrhage in research group was 6.94% (84/1 211), compared with that in the control group (3.05%, 951/31 200), there was statistically significant difference (χ2=16.328,P=0.000). While, there were no statistical significancefor the labor time limit,birth rate of severe asphyxia and neonatal birth weight average differences between two groups (P>0.05). Conclusions The rate of pregnancy after cesarean section is increasing year by year, and the will of vaginal birth is increasing, while it still are generally low. TOLAC is safe and feasible, but also significantly higher risk, strictly labor monitoring and can proceed fast cesarean delivery in delivery room is an important guarantee of safe delivery.

Objectives: To evaluate the predictor and risk factor of left ventricular (LV) free wall reverse remodeling in patients with obstructive hypertrophic cardiomyopathy (HCM) after modiifed Morrow procedure by three-layer speckle tracking of echocardiography.
Methods: Our investigation included 2 groups: HCM group, n=60 patients who had successful modified Morrow procedure in our hospital from 2014-06 to 2014-12, there were 41 (68.3%) male with the average age of (39.1 ± 15.2) years. Control group, n=40 healthy subjects. Three-layer speckle tracking echocardiography was conducted to analyze pre-and post-operative LV free wall three-layer myocardium (endocardial, mid, and epicardial layers) changes at longitudinal strain (LS) and circumferential strain (CS). Clinical and echocardiography information were collected at pre-and (6-24) months post-operation. The impact factors for LV free wall reverse remodeling was identiifed by liner regression analysis and the segment’s thickness≥15mm was deifned as the hypertrophic LV free segment.
Results: In HCM group, compared with pre-operative condition, the post-operative thickness of LV free wall including anterior, anterolateral and inferolateral were reduced;while both post-operative LS and CS elevated (-13.8 ± 4.8)%vs (-17.0 ± 5.2)%and (-23.7 ± 3.8)%vs (-25.4 ± 3.7)%, P<0.05. LV mass index by echocardiography was larger than LV mass index by surgical resection (13.5 ± 30.9) g/m2 vs (3.4 ± 2.0) g/m2, P<0.05. Liner regression analysis indicated that the number of pre-operative hypertrophic segments (r=-0.680, P<0.001) and age (r=0.638, P<0.001) were the independent impact factors for post-operative LS;△left ventricular outlfow tract (LVOT) gradient (r=0.386, P=0.005) was the independent impact factor for post-operative CS.
Conclusion:①After modiifed Morrow procedure, LVOT obstruction disappeared which leaded LV free wall reverse remodeling in HCM patients, ②three-layer myocardium of LV free wall all had reverse remodeling, ③better improved LVOT gradient were with less number of hypertrophic segments;the elder patients usually had the better post-operative reverse remodeling.

We applied literature review and the Delphi method to develop technical operation of manual lactation technique. The databases and websites were systematically searched, such as UpToDate, the Cochrane Library, CNKI, VIP, Wanfang, and SinoMed. The evidence related to the technique was evaluated by Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ), and A Measure Tool to Assess Systematic Reviews 2 (AMSTAR 2). the included evidence was classified and summarized to form the preliminary draft of the technical operation specification. A total of 26 experts were selected to evaluate the draft, and some recommendations were deleted and modified according to the screening criteria and expert opinions, resulting in the final technical specifications for manual lactation technique applicable to health care professionals. The study included 4 guidelines, 5 expert consensus articles, 2 clinical decisions, and 3 systematic reviews, and the overall quality of the evidence was fair. A total of 26 questionnaires were collected in each of 2 rounds of expert consultation, with a 100% return rate and an overall authority coefficient of 0.91. The technical practice specification was formed in 11 aspects, including assessment content, indications, contraindications, operation methods, adverse events, and treatment methods, with a total of 50 recommendations. The technical operation specification is comprehensive, and the recommendations are clearly expressed, which is in line with the real clinical situation and can provide effective reference for the clinical practice of this technique.

Objective:To explore the effect of medical care, elderly care and nursing management mode on self-care ability and blood pressure management in elderly patients with hypertension.Methods:From July 2018 to June 2019, 164 elderly patients with hypertension admitted into the outpatient department of the ZhejiangHospital were selected as the study objects by convenience sampling method, and randomly divided into the control group and the experimental group, 82 cases in each group. Routine hypertension management mode was given in the control group and medical care, elderly care and nursing management mode was given in the experimental group for 6 months. The Exercise of Self-Care Agency Scale (ESCA) scores and blood pressure control of the two groups were compared before and after intervention.Results:The ESCA total score and self-concept, self-care responsibility, self-care skills, and health knowledge scores of the experimental group were higher than those before intervention [(123.3±17.2) vs. (88.3±10.4) points, (26.8±3.7) vs. (20.6±3.0) points, (22.3±4.2) vs. (16.6±2.1) points, (29.3±4.1) vs. (17.6±2.4) points, (44.9±5.4) vs. (33.5±4.5) points], and higher than those of the control group [(90.0±10.2) points, (21.2±3.2) points, (16.1±2.1) points, (18.2±2.5) points, (34.5±4.2) points] (all P<0.05). The systolic blood pressure and diastolic blood pressure of the two groups after the intervention were lower than those before the intervention [control group: (142.5±7.8) vs. (161.6±8.5) mmHg (1 mmHg=0.133 kPa), (91.3±6.2) vs. (98.6±10.2) mmHg, experimental group: (132.2±8.5) vs. (160.6±8.1) mmHg, (84.2±7.4) vs. (98.1±10.3) mmHg], and the experimental group was lower than the control group (all P<0.05). The blood pressure control rate of patients in the experimental group was 88.8%, which was higher than the control group of 48.6% ( P<0.05). The satisfaction rate of quality of life in the experimental group was higher than that in the control group (28.8% vs. 18.1%), and the dissatisfaction rate was lower than in the control group (18.8% vs. 34.7%) ( P<0.05). Conclusion:The medical care, elderly care and nursing management mode can effectively improve the self-care ability and blood pressure management ability of elderly patients with hypertension.

Objective:To investigate the appropriate method of labor induction in the second trimester for complete placenta previa patients.Methods:The labor induction outcomes of 85 cases with complete placenta previa in the second trimester were retrospectively analyzed. Twenty patients in group A were treated with cesarean section, 30 patients in group B were treated with ethacridine and mifepristone combined with uterine artery embolization (UAE), and 35 patients in group C were induced by using ethacridine and mifepristone. The clinical features and induction outcomes of three groups were compared.Results:The total duration of labor in group B [(28.7±30.1) hours] was significantly longer than that of group C [(24.3±21.9) hours; P<0.05]. The total amount of blood loss during induction and labor in group B [(302±271) ml] was significantly lower than those of group C [(393±523) ml] and group A [(626±487) ml; P<0.05]. The incidence of fever in group B (13%, 4/30) was significantly higher than those of group C (11%, 4/35) and group A (10%, 2/20; P<0.05). In group C, 13 patients (37%, 13/35) underwent emergency UAE, and 2 patients (6%, 2/35) underwent emergency cesarean section. As to average hemoglobin level and blood transfusion rate, there were no difference among the three groups (all P>0.05). Conclusion:Prophylactic UAE combined with drug induction in patients with complete placenta previa in the second trimester could significantly reduce the amount of bleeding during induction and reduce the risk of emergency procedures.