Objective To select the best condition of preparation process for the water-extraction and alcohol-precipitation method of Radix astragali in “Leifengguan” granules. Methods The effective compound astragaloside IV of Radix astragali was determined with the methods of TLC-scanning. The preparation process was screened with orthogonal design [L9(34)] and single factor analysis. Results The best condition of preparation process for water-extraction of Radix astragali was A3B2C2 that the drug materials were decocted for 3 times with 8 times amount of water, each time for 1 hour. After the solution was concentrated to proportion as 1 g/mL (drug materials/solution), alcohol was added to the solution to 60% alcohol. Conclusions The optimized preparation process was found to be stable with a good reproducibility.

Objective To explore the safety of enteral nutrition(EN)support in non-blood circulation disorders of elderly patients with intestinal obstruction.Methods A total of 40 patients (22 men and 18 women aged 62-84 years)with intestinal obstruction were enrolled in this study.Ileus tubes were rapidly placed in these patients with the assistance of endoscopy and X-ray.Afterwards patients were equally randomized into parenteral nutrition(PN)and EN(PN+EN)group and PN only group.The clinical outcomes and complications were recorded and compared.Results The average time for catheter placement was(24.83 4±7.95)minutes.Abdominal pain were relieved within 1-2 hours in26 pafienta(65.0%)and within 48 hours in 11 patients(27.5%).In the PN+EN group,EN was provided(25.25±8.17)hours after catheter placement,and most patients could tolerate EN.Laboratory findings were not significantly different at admission between two groups.The mean prealbumin leveh were below than normal level at admission but returned normal after one week,which were significantly different inside each group(P<0.05)but were not significantly different between these two groups.The triglyceride leveh were higher than the normal level at admission but returned normal after treatment;however,the difference between the two groups was not significant.The laboratories tests were also not significantly different between two groups one week after admission.Conclusion EN support is safe for elderly patients with intestinal obstruction after effective gastrointestinal decompression.

Objective To evaluate the operative techniques and the methods of the renal function protection in laparoscopic nephron sparing surgery for the treatment of renal tumors.Methods Thirty-six renal tumor patients accepted transperitoneal laparoscopic partial nephrectomy at the 70 degree lateral decubitus position.There were 17 tumors in the upper pole,13 in the lower pole and 6 in the center of kindey.The mean tumor diameter was 2.6 cm(from 0.8 to 4.0 cm).Peke forceps were used to clamp the renal artery and achieve warm ischemia.Cold scissors was used to resect tumors and Hem-o-lok was used to clamp and control the artery bleeding in surgical bed instead of ligature when suturing the kidney parenchyma.Ulinastatin was used to prevent and relieve the ischemical reperfusion injury.The operative time,estimated blood loss,warm ischemia time,intraoperative and postoperative complications and the operative efficacy were recorded.Results All operations were completed successfully,no case was converted to open surgery.The mean operative time was 128 min(95 to 186 min),mean estimated blood loss was 130 ml (40 to 600 ml),mean warm ischemia time was 21 min(16to 28 min).There was no hemorrhage and urinary leakage after surgery.The post-operative renal function was normal in all the cases.The histopathological examination showed that 36 cases were renal cell carcinoma including 31 pT1a,cases and 5 pT1b cases.There was no positive surgical margin.The mean follow-up time was 16 months (from 6 to 30 months).There was no recurrence and metastasis found and renal function was normal in all cases during the follow-up.Conclusions Laparoscopic nephron sparing surgery for renal tumors is a safe and feasible treatment option.This procedure can resect tumor safely and preserve renal function efficiently.The use of Hem-o-lok instead of ligature can significantly reduce the operative time.Ulinastatin can help reducing the ischemical reperfusion injury and thus preserve renal function.

Objective To investigate the detection rate of malnutrition among post-stroke patients in community hospitals and unravel the relevant factors that precipitate malnutrition after stroke. Methods Based on 438 post-stroke patients who were admitted in community hospitals, we examined the demographic characteristics, the nutritional indices and the possible malnutrition related factors through a cross-sectional study.Results The detection rate of malnutrition among post-stroke patients was 52.7%. Group comparison through multivariate logistic regression analysis showed that there was a higher malnutrition detection rate in the post-stroke patients with multiple stroke attacks (three stroke attackes and above, OR = 11.00,95%CI 1. 14-106.34), higher NIHSS scores (group with NIHSS≥15, OR=7.09, 95% CI 2.90-17.36) , higher modified Rankin scales (group mRS 4-5, OR = 15. 77,95% CI 6.61-37.59) (trend test P<0.0001) .The risk of malnutrition was also correlated with the post-stroke depression, poorer family care, no early-stage rehabilitation, history of malignant tumors and severe alcoholism. Conclusions There is a high detection rate of malnutrition among post-stroke patients in community hospitals. There are many factors related to malnutrition among post-stroke patients in the community. More attention to controllable influencing factors would improve the prognosis of post-stroke patients.

Objective To establish a high-performance liquid chromatography (HPLC) method with diode array detection to simultaneously determine carbamazepine,phenytoin,and phenobarbital in serum.Methods Extraction solvent (800μl ethylene acetate) and sample (0.2 ml) was mixed,extracted for 2 min,and centrifuged (3500 r/min,4 minutes).A volume (600 μl) of extract liquor was volatilized to dryness in water bath with the volatilization temperature 75 ℃,then was redissolved with 1.0 ml mobile phase.Analysis conditions was column temperature 30°,mobile phase (methanol∶ water =40∶60),and detection wavelength of 254 nm.Three metabolites were effectively separated.Results Under the optimized condition,calibration curves of three metabolites were linear in the ranges of (1.52 ～ 120 mg/L) and the correlation coefficients were not less than 0.999.The detection limits (S/N =3) were in the range of 0.4 ～ 1.5 mg/L.The spiked recoveries were in the range of 91.3％ ～ 111％ with relative standard deviations (RSD) less than 5％.Conclusions The optimal pretreatment condition for the sample was established.The chromatographic separation and the detection condition were optimized.The method was sensitive and accurate,and could meet the need of monitoring serum drug concentration.

Objective To demonstrate the efficacy and safety of Hangzhou tacrolimus capsule(Saishi Tac capsule, Hangzhou Zhongmei Huadong Pharmaceutical Co. Ltd, China) in Chinese kidney transplant recipients. Methods Multicenter, randomized open-labeled, prospective controlled clinical trial was performed in de novo Chinese kidney transplant recipients. According to including and excluding criterions, 65 kidney recipients from 9 transplant centers were enrolled. The mean age of recipients was (36.53 ± 5.71 ) years, and 8 received living donor transplantion. The time of cold ischemia and warm ischemia was (4.08 ± 5.43) h and (3.90 ± 2.15) min respectively. The number of mismatched HLA was (2.1 ± 0.8). The recipients accepted Saishi Tac capsule + mycophenolate steroid 60 days, followed by 5-10 μg/L until the terminal observation time point (12 weeks after transplantation). The efficacy and safety were estimated during the period. The primary efficacy endpoint of the study was the incidence of biopsy-confirmed acute rejection. Graft survival and renal function (evaluated by serum creatinine) were the secondary endpoints. Safety was assessed by monitoring laboratory parameters and adverse events reported over the course of the study, such as infection, hepatic damage, hypertension, hyperlipema, diabetes mellitus and other adverse affairs.Results The dose of Tac at 1 st, 2nd, 4th and 8th week postoperation was (6.54 ± 1.69), (6.39 ±1.45),(6.73± 1.25), (6.25 ± 1.02) and (6.03 ± 1.16) mg, corresponding values to the C0 were (8.24±2.09),(9.39± 1.35),(9.93± 1.87),(7.23± 1.16) and (6.43± 1.26) μg/L. During 12weeks of follow-up, the incidence of biopsy-confirmed acute rejection was 12.3% (8/65), among which 6 cases were reversed by implosive therapy. The survival rate of graft kidney was 96.9% (63/65). The incidence of hypertension and hepatic damage was both 7.7% and morbidity of lung infection was 7.6%. There were 3 patients (4.6%) complicated with hyperlipema and diabetes mellitus respectively. Conclusion During the first 3 months of treatment Saishi Tac capsule was safe and effective to Chinese kidney transplant recipients.

Chronic obstructive pulmonary disease(COPD)is a common respiratory system dis-ease,with high incidence rate and mortality.So far,the pathogenesis of COPD has not been clearly determined.Microinflammatory state refers to the growth and reproduction of certain pathogens in the body due to bacteria,viruses and fungi infections,which causes inflammatory response of local tissues and the whole body,it is manifested by a slight and continuous increase of inflammatory marker pro-teins and inflammatory cytokines in systemic circulation.This article reviewed the literature on micro-inflammatory state and COPD.It is concluded that microinflammatory state will lead to the imbalance of proinflammatory and anti-inflammatory mechanisms,which can cause ischemic and hypoxic destruc-tion and injury of lung tissue cells,and further aggravate lung injury.The common inflammatory fac-tors such as C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin(IL)in microinflammatory state are closely related to the severity of COPD,which may promote disease pro-gression,continuously affect lung function,arterial blood gas and nutritional status of patients.

Chronic obstructive pulmonary disease(COPD)is a common respiratory system dis-ease,with high incidence rate and mortality.So far,the pathogenesis of COPD has not been clearly determined.Microinflammatory state refers to the growth and reproduction of certain pathogens in the body due to bacteria,viruses and fungi infections,which causes inflammatory response of local tissues and the whole body,it is manifested by a slight and continuous increase of inflammatory marker pro-teins and inflammatory cytokines in systemic circulation.This article reviewed the literature on micro-inflammatory state and COPD.It is concluded that microinflammatory state will lead to the imbalance of proinflammatory and anti-inflammatory mechanisms,which can cause ischemic and hypoxic destruc-tion and injury of lung tissue cells,and further aggravate lung injury.The common inflammatory fac-tors such as C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin(IL)in microinflammatory state are closely related to the severity of COPD,which may promote disease pro-gression,continuously affect lung function,arterial blood gas and nutritional status of patients.

Chronic obstructive pulmonary disease (COPD) is characterized by progressive and incomplete reversible airflow limitation, and COPD is mainly caused by small airway lesions and seriously endangers human health due to its high incidence rate and mortality rate. At present, the occurrence of COPD can be effectively prevented by detecting the characteristics of small airway lesions, so the study of small airway lesions has positive significance in the prevention and early intervention of COPD. This paper reviews the research progress on characteristics, detection methods and diagnosis and treatment methods of small airway lesions in COPD, so as to provide a theoretical basis for clinical research.

Objective To study the impact of individualized birth process management on birth outcomes of low-risk parturient unipara .Methods 729 parturient women were divided into the experimental group ( n=503 ) and the control group ( n=226 ) .The free position during labor was used in the control group . In the experimental group , individualized labor movements and pre-delivery positions were provided to improve the birth outcome .The incidence of emergency cesarean section and use of obstetric forceps were compared between groups .Results A total of 468 parturient women in the experimental group were in spontaneous labor , with an incidence of 93.04%;198 parturient women in the control group were in spontaneous labor , with an incidence of 87.6%.The use of obstetric forceps in the experimental group was 1.59%, which was lower than 3.98%in the control group .Twenty-six parturient women in the experimental group went through emergency cesarean section , with an incidence of 5.17%; nineteen parturient women in the control group went through emergency cesarean section , with an incidence of 8.41%.The difference was significant between groups (χ2 =6.97 ,P<0.05 ) .The most frequent labor position in the experimental group was semireclining position , with an incidence of 90.46%.The least use labor position was kneeling-squatting position , with an incidence of 4.57%.Conclusions The Individualized birth process management can significantly decrease the rate of emergent cesarean and forceps delivery .