Objective To study TLC and HPLC fingerprint of Paeoniae Radix Alba;To provide reliable methods for its quality control and evaluation. Methods TLC was performed to detect paeoniflorin with CHCl3-EtOAc-methanol-formic acid (40∶5∶10∶0.2) as the developing solvent system. The HPLC chromatographic separation was performed on Kromasil C18 column (250 mm× 4.6 mm, 5μm, 12 nm). The mobile phase was a mixture of acetonitrile-0.05%phosphoric acid in gradient elution with flow rate of 1 mL/min. The detection wavelength was set at 254 nm, and the column temperature was 35 ℃. Results The TLC spots were clear. Fifteen common peaks including paeoniflorin (the ninth peak) in the HPLC profile were found in ten batches of samples of Paeoniae Radix Alba in different growing areas, the fingerprints of samples from Anhui Province and Zhejiang Province showed little difference. Conclusion Fingerprint of Paeoniae Radix Alba showed unique features, and can be used to control its quality.

Preliminary screening test and interfering test were used to study the bacterial endotoxin test (BET) for Shengmai Injection (SI). The results showed that there is no interference when the SI is diluted by 10 times and limulus reagent with a sensibility of 0.25EU/mL is used for BET.

Objective To investigate clinical value of procalcitonin (PCT ) in guiding treatment of infection in elderly patients with heart failure .Methods A total of 120 cases of elderly patients with heart failure and infection were divided into control group (50 cases) ,receiving conventional anti-infection treatment ,and observation group(70 cases) ,receiving adjusted anti-infection treat-ment based on serum PCT levels .Treatment efficiency ,cost of treatment ,hospitalization duration and other indicators were com -pared between the two groups .Results Effective rate of observation group was 78 .57% ,which was not significantly different with the 78 .00% of control group ( P > 0 .05) .Cost of treatment ,hospitalization duration ,application time of antibiotics ,antibacterial drug costs ,superinfection and mortality were significantly different between the two groups (P< 0 .05) .After treatment ,levels of e-rythrocyte sedimentation rate ,C-reaction protein ,white blood cells and neutrophil in the two groups were significantly improved (P< 0 .05) .After treatment ,C-reaction protein level of observation group was lower than control group (P < 0 .05) .Conclusion PCT based anti-infection treatment could help shorten the treatment time ,reducing treatment costs and improving outcomes ,and might be worthy of clinical application .

Objective To explore an optimal treatment and to study the prognosis related factors of breast cancer patients with local recurrence after mastectomy. Methods From 2002. 7 to 2005. 2, 477female patients with loco-regional recurrence of breast cancer treated in Tianjin Cancer Hospital were analyzed retrospectively. Results In 477 cases, recurrence within 1 year after mastectomy accounted for 26. 2% , recurrence within 2 years accounted for 61. 2%. There were 310 cases with metastasis after local recurrence was diagnosed, accounting for 65.0%. 5-year total survival rate after recurrence is 48.4%.Local control rates varied in subgroups with different recurrence site, clinical subtypes, radiotherapy fields,with or without radiotherapy, surgical resection or excisional biopsy ( P<0. 05 ). There was a statistical difference in distant metastasis rate and 5-year survival rate among subgroups which had different clinical stage of primary tumor, disease-free interval, clinical subtypes or treatment methods ( P<0. 05 ). Simplistic treatment option, late clinical stage of primary tumor and triple-negative breast cancer were the independent factors predicting poor prognosis for recurrent breast cancer ( P<0.05 ). Conclusions Multi-site recurrence and triple-negative breast cancer lead to a poor local control. Local expansion of radiotherapy combined with surgery improves the local control rate. Patients with late clinical stage of primary tumor,recurrence within 2 years, triple-negative breast cancer are likely to have distant metastasis when recurrence is diagnosed. Combined treatment program improves survival rate.

Objective To investigate the distribution and antimicrobial resistance of major pathogens causing bloodstream infection in a tertiary hospital,so as to guide the clinical rational use of antimicrobial agents.Methods Blood specimens from patients with suspected bloodstream infection in this hospital between January 2012 and January 2015 were cultured,identified and performed antimicrobial susceptibility testing,the major pathogens and antimi-crobial susceptibility testing results were analyzed statistically.Results A total of 1 658 strains of pathogens were isolated from 19 326 blood culture specimens,isolation rate was 8.58%,in which gram-negative bacilli,gram-posi-tive cocci,and fungi accounted for 58.57% (n=971 ),39.38% (n=653),and 2.05% (n=34)respectively,the major gram-negative bacillus,gram-positive coccus,and fungus were Escherichia coli ,coagulase-negative staphylo-cocci (CNS),and Candida albicans respectively.The isolated pathogens mainly distributed in departments of hema-tology,gastroenterology,and cardiovascular surgery.Detection rates of extended-spectrumβ-lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumoniae were 56.35% and 36.14% respectively,but were highly sen-sitive to cefoperazone/sulbactam and carbapenems (resistance rates <3%).The percentage of methicillin-resistant coagulase-negative staphylococcus (MRCNS ) and methicillin-resistant Staphylococcus aureus (MRSA ) were 78.60% and 32.28%respectively,but were highly sensitive to vancomycin and linezolid(resistance rates < 1 %). Conclusion Escherichia coli and CNS are predominant pathogens causing bloodstream infection in this hospital,antimicro-bial resistance rates are high;regular analysis on distribution and antimicrobial resistance of pathogens causing bloodstream infection is helpful for the prevention and control of infection caused by multidrug-resistant organisms.

Objective To explore the morbidity and risk factors of postoperative delirium in the patients undergoing coronary artery bypass grafting (CABG).Methods A total of 286 patients were continuously enrolled for CABG surgery from January to December 2013 in cardiac surgery ward in Beijing Anzhen Hospital.Delirium Rating Scale-Revised-98 was used as the diagnostic tool for the analysis of the morbidity and risk factors of postoperative delirium.Results (1) Delirium occurred in 24 patients of 286 patients and morbidity of postoperative delirium was 8.4％.Sixteen of 24 patients (66.7％) suffered from transient delirium (＜24 h).Eight of 24 patients (33.3％) suffered from continuous delirium (≥48 h).(2) The common clinical presentation of postoperative delirium included increased psychomotor activity, a disordered sleep-wake cycle and a reduced level of consciousness.(3) Univariate Logistic regression analysis results showed that delirium was associated with advanced age over 70 years old (OR =3.05, 95％ CI 2.55-72.94, P =0.023), previous cerebral infarction(OR =1.78, 95％ CI 1.07-2.96, P =0.026), previous brain heamorrhage (OR =1.99, 95 ％ CI 1.20-3.31, P =0.003), surgery time (OR =1.05, 95％ CI0.05-2.04, P =0.047), intensive care unit (ICU) staying time (OR =2.87, 95％ CI 1.43-5.72, P=0.003), use offentanyl (OR=2.78, 95％ CI 1.02-7.57, P=0.045).(4) The multiple Logistic stepwise regression analysis indicated that the perioperative risk factors of delirium included advanced age over 70 years old (OR =3.196, 95％ CI 1.574-6.488, P =0.001), cerebrovascular accident history(OR =2.610, 95％ CI 1.538-4.431, P =0.000) and ICU duration time(OR =1.480, 95 ％ CI 1.070-2.046, P =0.018).Conclusions The morbidity of postoperative delirium after CABG is 8.4％.Many predisposing and precipitating factors contribute to postoperative delirium.These factors include age ＞ 70 years, cerebral infarction and ICU staying time.Assessment and preventive strategies should be considered to reduce the incidence of delirium, particularly among those patients with high risks.

Objective To analyze the expression of serum anti M phospholipase A2 receptor (PLA2R)antibody in idiopathic membranous nephropathy (IMN),and to investigate its value in the diagnosis and evaluation of idiopathic membranous ne-phropathy.Methods One hundred and eighteen patients with biopsy-proved glomerular diseases were involved in this study, including 97 cases with IMN,21 cases with IgA nephropathy (IgAN)and 19 healthy people.ELISA was used to detect ser-um anti-PLA2R antibodies.Correlations of anti-PLA2R antibody level with laboratory parameters,including serum albumin, 24-hour urine protein of IMN patients were evaluated.Results The median of anti PLA2R antibody in IMN group,IgAN group and healthy group was 45.2(3.6~705.9)RU/ml,5.9(2.3~10.6)RU/ml and 1.2(0.6~9.3)RU/ml.The levels of serum anti PLA2R antibody in IMN group were higher than those in IgA nephropathy group and healthy control group.The difference was statistically significant (t=-5.027,-3.077;P=0.05).Among 97 cases with IMN,76 cases showed posi-tive anti-PLA2R antibodies (positive rate 78.35%).There was none patient showed positive anti-PLA2R antibody respec-tively in IgAN and healthy people.Furthermore,anti-PLA2R antibody level was negatively correlated with serum albumin (r=-0.453,P=0.000)and positively correlated with CREA,TC,ESR,24 hour urine protein (r=0.233,0.234,0.363, 0.586;P=0.004,0.217,0.021,0.000)in IMN patients.Conclusion Serum anti PLA2R antibody may be used as a IMN specific marker for the diagnosis of IMN,and it has important reference value for evaluating the severity of IMN.

Objective To valuate the effect of Ro20-1724 on ketamine-induced apoptosis in hippocampal neurons of neonatal rats.Methods Hippocampal neurons from newborn Sprague-Dawley rats were obtained and cultured in vitro.The primary hippocampal neurons were randomly divided into 4 groups (n =24 each) using a random number table:control group (group C),ketamine group (group K),solvent control group (group E),and Ro20-1724 group (R group).The neurons were incubated for 72 h in the normal culture medium in group C.The neurons were incubated for 72 h in the culture medium containing ketamine 150 μmol/L in group K.In E and R groups,after the neurons were incubated for 30 min in the culture medium containing ketamine 150 μmol/L,the culture medium was then replaced,0.01％ ethanol (final concentration) and 1 × 10-3 μmol/L Ro20-1724 (final concentration) were added to the culture medium,respectively,and the neurons were then incubated for 72 h.After 72 h incubation,the cell viability was detected by MTT assay,the cell apoptosis was detected by flow cytometry,the expression of Bcl-2 mRNA and Bax mRNA was determined by RT-PCR,and synaptophysin Ⅰ expression was detected by Western blot.The apoptosis rate was calculated.Results Compared with group C,the survival rate was significantly decreased,the apoptosis rate was increased,the expression of Bcl-2 mRNA and synaptophysin Ⅰ was down-regnlated,and Bax mRNA expression was up-regulated in K and E groups (P ＜ 0.05 or 0.01).Compared with group K,the survival rate was significantly increased,the apoptosis rate was decreased,the expression of Bcl-2 mRNA and synaptophysin Ⅰ was up-regulated,and Bax mRNA expression was downregulated in R group (P ＜ 0.05 or 0.01).Conclusion Ro20-1724 can inhibit ketamine-induced apoptosis in hippocampal neurons of neonatal rats and correction of Bcl-2/Bax imbalance is involved in the mechanism.

Objective To observe a new phosphodiesterase-4 inhibitor Ro 20-1724 on ketamine anesthesia-induced learning and memory impairment and cAMP/PKA-CREB-BDNF signal pathway in immature rats.Methods Twenty-four 21 day-old SD rats were randomly divided into 4 groups (n=6 each):control group (group C) ;ketamine group (group K) ;ketamine+Ro 20-1724 group(group K+Ro) and ketamine+vehicle (0.1％ ethanol) group (group K+E).Ketamine 70 mg/kg was injected intraperitoneally(IP) once a day for 7 consecutive days in groups K,K+Ro,and K+E.Ro 20-1724 0.5 mg/kg and equal volume of vehicle were injected IP at 30 min after IP ketamine each time respectively.Morris water maze was used to assess learning and memory ability after 2 days normal feeding,the escape latency and frequency of passing the platform were recorded.The animals were killed after water maze test and the cAMP,PKA,p-CREB,and BDNF protein expression in hippocampus were detected.Results Repetitive ketamine anesthesia significantly prolonged the escape latency (P＜0.01),decreased the frequency of passing the platform(P＜0.01),and down-regulated the expression of cAMP,PKA,p-CREB,and BDNF protein ((280±31) pmol/mg vs (210± 19) mol/mg,P＜0.01 ; 1.32±0.11 vs 1.13±0.12,P＜0.01 ; 2.61 ±0.22 vs 2.03 ± ±0.19,P＜0.01 ; 1.51 ±0.14 vs 1.16±0.10,P＜0.05) ; Compared with group K,Ro 20-172,significantly attenuated the escape latency time(P＜0.05,P＜0.01)and increased the frequency of passing the platform(P＜0.01),and ameliorated the expression of cAMP,PKA,p-CREB,and BDNF protein ((210± 19) pmoL/mg vs (240± 27) pmol/mg,P ＜0.05;1.13±0.12 vs 1.28±0.12,P＜0.05;2.03±0.19 vs 2.32±0.21,2.32±0.21;1.16±0.10 vs 1.37±0.11,P＜0.01).There was no difference between group K+Ro and group C,and between group K+E and group K(P＞0.05).Conclusion ketamine anesthesia-induced learning and memory impairment can be improved by Ro 20-1724,and cAMP/PKA-CREB-BDNF signal pathway in hippocampus participated in the changes.

Objective To evaluate the effects of Ro20?1724 on cognitive dysfunction induced by repetitive ketamine anesthesia in immature rats. Methods Thirty?two Sprague?Dawley rats of both sex, aged 21 days, weighing 45-55 g, were randomly divided into 4 groups ( n=8 each ) using a random number table: control group ( group C ) , ketamine group ( group K ) , ketamine+Ro20?1724 group ( group K+R) , and ketamine+anhydrous alcohol group ( group K+A) . In K, K+R and K+E groups, 70 mg∕kg ketamine was intraperitoneally injected once a day for 7 consecutive days. The equal volume of normal saline was given instead in group C. Two days after the rats were fed a common diet, 0.5 mg∕kg Ro20?1724 and the equal volume of anhydrous alcohol were injected in K+R and K+E groups, respectively, and the equal volume of normal saline was given instead in K and C groups, once a day for 7 consecutive days. Morris water maze test was used to test cognitive function, and the escape latency and frequency of crossing the original platform were recorded. The rats were sacrificed after the end of behavior tests, and hippocampi were removed to detect the content of brain?derived neurotrophic factor ( BDNF) in CA1 region using enzyme?linked immunosorbent assay. Results Compared with group C, the escape latency was significantly prolonged on 1st-4th days in K and K+E groups, the escape latency was prolonged on 3rd-4th days in K+R group, and the frequency of crossing the original platform and content of BDNF in CA1 region were decreased in K, K+R and K+E groups. Compared with K group, the escape latency was significantly shortened, and the frequency of crossing the original platform was increased on 3rd-4th days, and the content of BDNF in CA1 region was increased in K+R group, and no significant changes were found in the parameters mentioned above in K+E group. Conclusion Ro20?1724 can improve cognitive dysfunction induced by repetitive ketamine anesthesia in immature rats, and enhanced production of BDNF is involved in the mechanism.