AIM To develop an HPLC method for the simultaneous content determination of berberine hydrochloride,jatrorrhizine hydrochloride,palmatine hydrochloride,kaempferol,luteolin and apigenin in Qingre Zhili Pills (Berberidis Radix and Portulacae Herba).METHODS The analysis of methanol extract of this drug was performed on a 35 ℃ thermostatic Agilent TC-C18 column (4.6 mm × 250 mm,5 μm),with the mobile phase comprising of acetonitrile-0.02％ potassium dihydrogen phosphate flowing at 0.9 mL/min in a gradient elution manner,and the detection wavelengths were set at 265 nm and 360 nm.RESULTS Six constituents showed good linear relationships within their own ranges (r≥0.999 3),whose average recoveries were 97.16％-99.90％ with the RSDs of 0.62％-1.48％.CONCLUSION This simple method can be used for the rapid quality control of Qingre Zhili Pills.

Objective To explore the efficacy of sulfasalazine for treatment for epilepsy induced by gliomas .Methods The patients with epilepsy caused by gliomas in neurosurgery department were recruited from March 2006 to December 2013 .Epilepsy was controlled with sulfasalazine .The efficacy of sulfasalazine for treatment for epilepsy induced by glioma were analyzed to calcu-late the 50% response rate ,75% response rate and seizure-free rate .Meanwhile the outcomes scores of therapy of sulfasalazine for varieties types of epilepsy were evaluated ,according to the end result of scoring criteria in epileptic seizures .Results A total of 31 patients were controlled with sulfasalazine .The average reduction rate of seizure frequency per month was 54 .32% ,61 .71% , 75 .74% after three months of treatment .The differences of average reduction rate of seizure frequency before and after the treat -ment have an evident statistic significance (P< 0 .01) .The 50% response rate ,75% response rate and seizure-free rate per month af-ter treatment with sulfasalazine have significant higher than those before treatment (F= 20 .007 ,P< 0 .01) .After 3 month of thera-py ,four different types of epilepsy was 100 .00% ,100 .00% ,84 .62% and 75 .00% in improvement rate added complete control rate .Those have no statistical difference(P> 0 .05) .Conclusion Sulfasalazine can effectively control seizures ,and both effective va-rious types of epileptic .

Objective To summarzie the experiences of kidney transplantation from rhabdomyolysis.Methods The surgical procedures and treatment protocols of the kidney transplantation in 3 cases from DD donors who suffered from anuria due to rhabdomyolysis were retrospectively analyzed.Results Three recipients were donated by two donors.When the blood of kidneys is washed out,the color of the kidneys was brown,and when the kidneys restored the blood perfusion,the transplanted kidneys were dark brown.All of these 3 cases had delayed renal function,and 2 recipients who received the kidneys from the same donor secreted the urine 3 weeks after surgery.The creatinine gradually decreased,and they discharged when the renal function was normal.The urine volume in the another recipient was 3000 ml or more per day in the first two days,gradually decreased from the third day,until anuria.We conducted an exploration of the transplanted kidney due to the area of transplantation uplift.We found that the kidney was bright red during the operation,the hematoma was removed and hemostasis was done,the urine volume gradually increased from one week after surgery,and the creatinine levels gradually decreased.After two months the creatinine levels were 103μmol/L.Conclusion For the patients with rhabdomyolysis,their kidneys can be transplanted after active preservation,evaluation of the donor kidney function and blood flow,and the short-term outcome is satisfactory.

Objective To analyze the reasons and outcomes of the unplanned re-operation in renal transplant recipients during perioperative period,and to summarize the corresponding strategies.Methods From January 2014 to September 2017,the clinical data of 20 cases of kidney transplantation which had a total of 22 unplanned re-operations were retrospectively analyzed.All patients were given quadruple immunosuppression with antibody induction and tacrolimus (TAC) and mycophenolate mofetil (MMF) plus prednisone (Pred).We analyzed the reasons,occurrence time,effect of re-operation and the renal function,as well as survival rate of all graft and recipient.The delayed graft function (DGF),acute rejection (AR) and incidence of pulmonary infection were monitored as well.Results Up to September 2017,during the follow-up of 1-36 months,the overall rate of unplanned re-operation was 4.6％,and 2 patients underwent 3 operations.For the reasons of re-operation,there were 18 cases of bleeding (13 cases of blood oozing from the wound surface,3 cases of renal parenchyma rupture because of rejection,and 2 cases of rupture of renal artery infection),2 cases of renal artery thrombosis and 2 cases of the repair of leakage of urine.Two operations were performed within 1 days for 9 cases,2-5 days for 5 cases,6-10 days for 3 cases,above 10 days for 45 cases.There was no deaths during the perioperative period.One patient died of rupture of exiliac aneurysm 3 months after the operation.One patient died of cerebral hemorrhage 6 months postoperation.The death censored graft survival rate was 72.2％ (13/18) and the incidence of DGF was 55 ％.Conclusion The major reason of unplanned re-operation for renal transplantation is associated with bleeding of various causes.And the incidence of DGF is high.If the secondary operation was performed with the correct decision,the kidney allograft recovers well.

Objective:To summarize the clinical experiences of managing patients with novel coronavirus(2019-nCoV) infection after kidney transplantation.Methods:Clinical data were retrospectively analyzed for two patients with 2019-nCoV infection after renal transplantation in January 2020. Case 1 was a 48-year-old male with CMV pneumonia secondary to 2019-nCoV infection at 4 months post-transplantation. CT imaging showed multiple patchy ground-glass opacities of both lungs. Case 2 was a 59-year-old male who screened positive for 2019-nCoV nucleic acid due to fever at 9 days post-transplantation and he showed no clinical manifestations of pneumonia. After a definite diagnosis, case 1 was transferred to a designated hospital for isolation. Treatment regimens: cefoperazone sulbactam sodium plus linezolid for anti-infection, gamma globulin for enhancing immunity, methylprednisolone for controlling inflammatory responses and antiviral regimens of arbidol tablets plus lopina-velitonavir tablets. Case 2 was isolated in a single room. The treatment plan included cefoperazone sulbactam sodium for anti-infection, gamma globulin for enhancing immunity, arbidol for antiviral therapy and other symptomatic measures.Results:During a follow-up period of 3 weeks, case 1 recovered with renal dysfunction, nucleic acid test of nasopharyngeal swab turned negative and pulmonary imaging improved. Case 2 showed no obvious clinical symptoms and nucleic acid test of nasopharyngeal swab turned negative thrice.Conclusions:Renal transplant recipients should take precautions to avoid exposure to high-risk environments. A definite diagnosis should be made on the basis of clinical manifestations and results of nucleic acid test and pulmonary imaging. Currently there is no effective antiviral agent and symptomatic treatment is a major option.

Objective: To explore the diagnosis and treatment of BKV nephropathy after renal transplantation. Methods: A total of 62 patients with progressive creatinine elevation were routinely examined by blood and urine BKV-DNA. And 21 patients with positive results underwent graft biopsies for confirming a diagnosis. Results: Among 21 cases of BKV infection, 20 cases received leflunomide in replacing mycophenolate mofetil (MMF) and a lower dose of tacrolimus. One case with urine (-) & blood (+ ) received sirolimus in replacing tacrolimus and a lower dose of MMF. Among 11 cases with urine (+ ) and blood (-), urinary BKV-DNA turned negative & creatinine decreased markedly (n=4), urinary BKV-DNA load decreased & creatinine stablized (n=4), death from pulmonary infection with hepatic & renal failure (n=1), urine BKV-DNA load decreased & creatine increased (n=1), BKV–DNA load was not re-examined in 1 case of acute rejection and hydronephrosis with elevated creatine; Among 9 cases with urine (+ ) & blood (+ ), blood BKV-DNA turned negative with urinary BKV-DNA load & creatine decreased (n=6), blood BKV-DNA load decreased & creatine stablized (n=2) and no re-examination with a stable level of creatine (n=1); One case with urine (-) & blood (+ ) was not timely treated and ultimately leading to graft loss after an onset of acute rejection. Conclusions BKV nephropathy may be effectively treated by decreasing immunosuppressive intensity. However, clinicians should stay on a high alert for acute rejection due to an excessive reduction of immunosuppressive agents.

Objective To explore the protective effect of Mn (Ⅲl)tetrakis (4-benzoic acid) porphyrin (MnTBAP) on rats after intracerebral hemorrhage (ICH) and its mechanism.Methods Sixty-six adult SD rats were randomized into sham-operated group,control group and experimental group (n=22).Rats in the latter two groups were performed stereotactic injection of autologous tail arterial blood to induce ICH models;the rats in the experimental group were given 2 μL MnTBAP (100 μg/μL) by intracerebroventricular injection 30 min after ICH,while the rats in the control group were given normal saline of same volume.The expressions of 4-hydroxynonenonal (4-HNE,a marker of lipid peroxidation),3-nitrotyrosine (3-NT,a reliable marker of protein nitration),8-hydroxy-2'-deoxyguanosine (8-OHdG,a marker of DNA oxidative damage),Zonula occludens-1 (ZO-1,a kind of tight junction protein) and myeloperoxidase (MPO,a marker of neutrophil) in the perihematomal brain tissues 24 h after ICH were detected by immunofluorescence;protein expressions of ZO-1 and matrix metalloproteinase-9 (MMP-9) were detected by Western blotting 24 h after ICH;brain water content and modified neurological severity (mNSS) scores were measured 24 and 72 h after ICH.Results As compared with those in the control group,3-NT (264.53±83.99vs413.22±89.16),4-HNE (245.64±73.10vs 391.41±51.43),8-OHdG (221.53±68.25 vs 332.32±94.93),MPO (296.14±66.34 vs 431.59±102.68) and MMP-9 (0.75±0.07 vs 0.96±0.04) expressions in perihematomal brains of experimental group were significantly decreased,while the expressions of ZO-1 (0.74±0.05 vs 0.56±0.06) were significantly increased (P＜0.05).The mNSS scores (9.33±1.37 vs 11.33±1.51;6.17±0.98 vs 9.50±1.38) and brain water contents in the experimental group were significantly lower as compared with those in the control group 24 and 72 h after ICH (80.41％±0.69％ vs 82.48％±0.94％;79.78％±0.65％ vs 81.57％±0.82％) (P＜0.05).Conclusion MnTBAP could protect injured brain tissues by alleviating oxidative and nitrative stress,decreasing neutrophils invasion and MMP-9 activation at early stage of ICH;meanwhile,MnTBAP could relieve the blood-brain barrier disruption and neurological deficit following ICH.

Purpose: The aim of this meta-analysis was to evaluate the efficacy and safety of imidafenacin for overactive bladder (OAB) induced by benign prostatic hyperplasia (BPH) in men receiving alpha-blocker monotherapy. Methods: We performed a systematic research of the PubMed, Embase, and Cochrane Library databases, and searched for studies about alpha-blocker with or without imidafenacin treatment for OAB in patients with BPH. We also investigated the original references of the included texts. Results: Four randomized controlled trials including 779 participants with BPH (389 in the alpha-blocker+imidafenacin group and 390 in the alpha-blocker only group) were studied. The main efficacy endpoint was the Overactive Bladder Symptom Score, which showed a mean difference of -1.88 (95% confidence interval, -2.32 to -1.44; P<0.00001), suggesting that alpha-blocker and imidafenacin treatment was effective in treating men with OAB. As other primary efficacy end points, the International Prostate Symptom Score (IPSS) total score (P=0.47), the IPSS storage symptom score (P=0.07), the IPSS voiding symptom score (P=0.60), and the IPSS quality of life score (P=0.18) indicated that 2 methods had no significant differences in treating men with OAB. In terms of safety, which was assessed using postvoid residual volume (P=0.05) and maximum flow rate (P=0.53), the analysis suggested that combination treatment was very well tolerated. Conclusions This study suggested that imidafenacin plus alpha-blocker was an efficacious and safe treatment for OAB symptoms in BPH patients.

Purpose: Transcutaneous electrical neural stimulation (TENS), as a non-invasive modality, has been clinically used as an alternative treatment for children with overactive bladder (OAB). We conducted a pooled analysis to explore the effect of TENS on OAB. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline was followed in this study. The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases, as well as the reference lists of the retrieved studies, were used to find trials relevant for assessing the use of TENS to treat OAB. Results: Of the 246 records identified, 8 publications were analyzed in our study. Our analysis found that TENS resulted in a greater decrease of wet days/wk, daily voiding frequency, daily incontinence episodes, and daily number of voids than was observed in the control group. Furthermore, TENS-treated patients showed similar visual analogue scale (VAS) scores to patients in the control group, demonstrating that the application of TENS did not increase patients’ discomfort and pain. TENS had a relative advantage in the number of partial responses, but no clear differences were found in frequency of no response or a full response compared to the control group. In urodynamic testing, TENS led to obvious improvements in average voided volume and maximum voided volume in children with OAB. Conclusions TENS had a remarkable effect on the improvement of urodynamic indexes and objective OAB symptoms without a significant increase in VAS scores for children with OAB.