OBJECTIVETo establish a method for rapid determination of organic fluorides in the air of a fluorine chemical plant using portable gas chromatography-mass spectrometer (GC-MS).

METHODSStandard samples of monochlorodifluoromethane, tetrafluoroethylene, and hexafluoropropylene of different concentrations were prepared by static volumetric method with high-purity nitrogen as the diluent gas. The samples were injected into the GC-MS by a hand-held probe. Retention time and characteristic ion were used for qualitative analysis, and the area of selected ion peak was used for quantitative analysis. The standard curves were then created for quantitative determination of the three organic fluorides.

RESULTSThe linear ranges for monochlorodifluoromethane, tetrafluoroethylene, and hexafluoropropylene by the method were 0.39-7.72, 0.45-8.84, and 0.61-12.20 mg/m3, respectively, the average recovery rates for the three concentrations were 102.8%, 96.0%, and 106.5%, respectively, and the average deviations were 2.1%, 5.1%, and 2.4%, respectively.

CONCLUSIONThe portable GC-MS can be used for the simultaneous qualitative and quantitative analysis of monochlorodifluoromethane, tetrafluoroethylene, and hexafluoropropylene in the workplace air, and the method is simple, fast, and accurate.

Air Pollutants, Occupational ; analysis ; Chlorofluorocarbons, Methane ; analysis ; Fluorides ; analysis ; Fluorocarbons ; analysis ; Gas Chromatography-Mass Spectrometry ; Workplace

Objective:The chemiluminescence immunoassay for AngiotensinⅠ ( AngⅠ ) was developed by the competition method. The renin activity was calculated by the determination of Ang Ⅰ. Methods: AngⅠ antigen was labeled with biotin and fluorescein labeled AngⅠantibody,and anti fluorescein antibody was used to coated with the microporous plate . Results:The standard range of the method was 100-7 800 pg/ml. The assay sensitivity was 24. 3 pg/ml. The intra- and inter-assay coefficients of variance were 5. 6%-8. 7% and 6. 8%-10. 4% respectively. Analytical recovery was 95. 4%-105. 3%. The correlation coefficients between measured and expected values were 0. 999 after serial diluted. Compared with radioimmunoassay kit,the correlative equation was y=0. 95x+235. 70,correlation coefficient was 0. 973. Coated microporous plate and biotin labeled Ang Ⅰ antigen,and fluorescein labeled Ang Ⅰantibody at 37℃ for a week with good stability. Conclusion: The results of the method were in accord with the basic requirements of immunoassay.

Objective To compare the effect of pedicles screw fixation through entry point of the “人" shape crest and traditional entry point (Weinstein method). Methods Ninety-two patients of lumbar spine disorders were treated by pedicles screw fixation combined with bone grafting through posterior approach. The screws were placed through the traditional entry point among 45 patients (group A, transverse process method, 186 screws), the others were through entry point of the “人" shape crest (group B, “人" shape crest method, 196 screws). The condition of accuracy of screw placement, operation time, bleeding amount and injury were compared. Results All patients accepted the examination of X-ray and CT scan after operation. The rate of screw bad placement was 6.5% in group A and 2.0% in group B, the incidence of injury of nerve and blood vessel was 8.9% in group A and 2.1% in group B. The accuracy of screw placement, operational time and bleeding amount in group B were significantly better than those in group A (P

It is helpful to improve continuing education of TCM through learning American CME. The author described the strength and characteristic of American CME from the organization structure, the project organizer, the Physician's credit system and the trend of CME programs in the future. Discuss how to improve continuing education of TCM from changing the idea of sponsor, diversifying the ways of training and to build effect of evaluation mechanism.

Objective:To observe the safety of intravitreal injection of triamcinolone acetonide (TA) combined with partial anterior pars plana vitrectomy (PPV) for cataract with severe vitreous hemorrhage.Methods:A retrospective case-control study. A total of 60 patients (60 eyes) with cataract and severe vitreous hemorrhage were included from June 2017 to June 2019 in Xi’an People’s Hospital (Xi’an Fourth Hospital). There were 32 males (32 eyes) and 28 females (28 eyes), with a mean age of 64.8 years. The eyes were randomly divided into intravitreal injection TA group (TA group) and non-TA injection group (control group), with 30 eyes in each group. Before phacoemulsification, 0.05-0.10 ml TA was injected into the vitreous cavity in the TA group and the vitreous besides the vitrectomy channel was removed. The eyes of the control group underwent conventional cataract phacoemulsification combined with PPV. The follow-up time after surgery was ≥6 months. The rate of success continuous circular capsulorhexis, posterior capsule rupture, and intraocular lens (IOL) implantation in the capsular bag were compared between the two groups. The statistical data were compared with χ2 test. Results:For all eyes in the TA group, after intravitreal injection of TA combined with partial anterior PPV, the white reflection of the fundus can clearly show the anterior and posterior capsule of the lens. Continuous circular capsulorhexis was completed, the posterior capsule was not broken, and the IOL was successfully implanted inside the capsular bag. Among the 30 eyes of the control group, 4 eyes did not complete continuous circular capsulorhexis. Radial tear occurred during capsulorhexis, and capsulorhexis was used to complete capsulorhexis. In 5 eyes with posterior capsule rupture, the posterior capsule occurred in 3 eyes during phacoemulsification, and injecting the lens cortex caused posterior capsule repture in 2 eyes; the IOL was implanted in the ciliary sulcus and the capsular bag in 4 and 1 eyes, respectively. Whether the consecutive capsulorhexis was successful ( χ2=4.286), whether the posterior capsule was ruptured ( χ2=5.455), whether the IOL was implanted in the capsular bag ( χ2=4.286), the differences in the number of eyes between the two groups were statistically significant ( P= 0.038, 0.020, 0.038). At the last follow-up, no special complications occurred. Conclusions:Intravitreal injection of TA combined with partial anterior PPV can improve the visibility of the anterior and posterior lens capsule and lens nucleus during phacoemulsification in patients with cataract and severe vitreous hemorrhage. The surgical success rate is high, the complications are few, and the safety is good.

Objective To study the clinical efficacy of external fixator and combined screwing at iliac crests and pubic symphysis for the treatment of unstable pelvic fractures.Methods From January 2013 to February 2014,12 cases of unstable pelvic fracture were treated at our department.They were 8 men and 4 women,from 32 to 57 years of age (average,42.5 years).Seven cases were caused by a traffic accident,and 5 by falling from a height.By Tile classification,8 cases were type B (including type B1 in 3 cases,type B2 in 3 and type B3 in 2),and 4 cases type C1.Associated injury included shock in 7 cases,bladder injury in one,limb long bone fracture in 6,joint injury in 3,and thoracic and lumbar injury in 4.The interval from injury to operation averaged 4 days,ranging from 12 hours to 7 days.The type B fractures were treated with an external fixator and combined screwing at iliac crests and pubic symphysis while the type C1 fractures with internal fixation with percutaneous S1 sacroiliac screws in addition to what was used for the type B fractures.Results The 12 patients were followed up for 5 to 12 months(average,9 months).No one died in this group.The fractures healed after 8 to 13 weeks (average,11.3 weeks).All the patients recovered normal walking.Superficial infection at the pin hole occurred in 7 cases,but there was no deep infection.Screw loosening was observed in only one case,and no reduction loss,injury to nerves or urinary canal was observed.According to the Majeed criteria,the efficacy was evaluated as excellent in 10 cases,good in one,and moderate in one.Conclusion External fixator and combined screwing at iliac crests and pubic symphysis can restore the stability of anterior pelvic ring,leading to good clinical outcomes.

An improved everted gut sac method was applied to the study of prescription compatibility effect on the major components in Danshen extracts. With the separation and detection by HPLC-ECD, 5 major peaks could be detected in intestinal absorbed solution after prescription administration. Following the identification by HPLC-MS/MS, peak 2, 3, 4, and 5 were rosmaric acid, lithospermic acid, salvianolic acid B, and salvianolic acid A, respectively, which also confirmed with reference standards of those components. Through paralleling substance identification, peak 2, 3, 4, and 5 could be found as the major components in Danshen extracts, except Salvianolic acid E which is undetectable in intestinal solution. The contents of peak 2, 3, and 4 did not show difference before and after compatible prescription administrated, where the peak 5 had a significant increase in the same process. Those results revealed that peak 5, salvianolic acid A, might lead to an increasing pharmacological effect after prescription compatibility.

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An LC-MS method was established for the identification of the related substances in rivaroxaban. HPLC separation was carried out on an Inert Sustain C18 column(250 mm×4. 6 mm, 5 μm)with linear gradient elution using a mobile phase consisting of 0. 2% formic acid acetonitrile and 0. 2% formic acid aqueous solution. Rivaroxaban and its related substances could be completely separated under the established HPLC conditions. The structures of the related substances were identified by electrospray positive ESI high resolution TOF/MS and MS/MS spectra determination and elucidation, and further verified through reference substances. Fifteen related substances were detected and identified to be three related substances of starting materials, four synthetic by-products and ten degradation products. The established method is useful for the identification of the related substances in rivaroxaban. The results obtained are valuable for its manufacturing control and quality assurance.

Objective To systematically evaluate the safety and feasibility of enhanced recovery after surgery (ERAS) in perioperative management of pancreatectomy.Methods Literatures were researched using CNKI,Wanfang database,VIP database,PubMed,Cochrane Library,Embase from January 1990 to March 2018 with the key words including "快速康复外科,加速康复外科,胰腺切除术,胰十二指肠切除术,惠普而术,ERAS,enhanced recovery,fast track,pancreatic surgery,pancreatectomy,Whipple,pancreatoduodenectomy,pancreatoduodenal resection".The cohort study about ERAS in elective pancreatic surgery or pancreaticoduodenectomy were received and enrolled.The patients using ERAS in perioperative management and using traditional perioperative management were respectively allocated into the ERAS group and control group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odds ratio (OR) and 95％ confidence interval (CI).Weighted Mean Difference (WMD) was used as a consolidated statistics for measurement data that were measured using the same tool,and standardized mean difference (SMD) was used as a consolidated statistics for measurement data that were measured using the different tools.The heterogeneity of the studied was analyzed using the I2 test.Results Nineteen retrospective cohort studies were enrolled in the Meta analysis,and total sample size was 3 699 patients,including 1 823 in the ERAS group and 1 876 in the control group.The results of Meta analysis showed that there were statistically significant differences in the time of postoperative nasogastric tube removal,time for postoperative solid diet intake,time of postoperative defecation recovery,incidence of postoperative overall complications,incidence of postoperative delayed gastric emptying,incidence of postoperative intra-abdominal infection,duration of postoperative hospital stay and hospital expenses between ERAS group and control group (WMD=-1.70,-3.61,-0.86,OR =0.65,0.60,0.70,WMD=-4.64,SMD=-0.48,95％CI:-2.97--0.42,-4.70--2.53,-1.01--0.71,0.52-0.81,0.45-0.80,0.54-0.91,-5.91--3.38,-0.77--0.18,P ＜ 0.05).There was no statistically significant difference in the operation time,volume of intraoperative blood loss,incidence of postoperative pancreatic fistula,incidence of postoperative wound infection,readmission rate,reoperation rate and mortality between ERAS group and control group (WMD=-9.73,-14.39,OR=0.85,0.72,1.05,0.81,0.74,95％CI:-34.24-14.78,-116.96-88.17,0.72-1.01,0.46-1.14,0.83-1.32,0.58-1.13,0.53-1.02,P＞0.05).The results of subgroup analysis showed that heterogeneity of data was from eastern and western countries.Conclusion ERAS in the perioperative management of pancreatectomy is safe and feasible,it can also promote postoperative recovery of patients and reduce incidence of complications and financial burden.