Objective To isolate and elucidate the structures of alkaloids in Huangyangning. Methods Alkaloids of Huangyangning were separated with preparative HPLC. The molecular structures were elucidated on the basis of chemical evidences and spectral analyses (UV, IR, MS, 1H-NMR, 13C-NMR, COSY, DEPT, HMQC, and HMBC). Results Cyclovirobuxine D is the major component in Huangyangning and cyclobuxine D and cyclovirobuxine C are the two related alkaloids. Conclusion It is demonstrated that all the Huangyangning alkaloids have the same structural frame with only minor differences in substitution through chromatographic and spectral analyses. Therefore, it is not easy to purify cyclovirobuxine D by using usual column, re-crystallization, or chemical approaches for the existence of the related alkaloids.

Objective To observe the effect of restrictive transfusion in colon cancer surgery in elderly patients on postoperative VAP (ventilator-associated pneumonia). Methods Forty cases of elderly patients with colon cancer intending to undertake surgery were randomly divided into restrictive transfusion group (group R) and standard transfusion group (group S) with 20 cases in each group. In group R, patients were administered one third of accumulative fluid loss in the first 60 minute, then the infusion rate were 4 mL/(kg·h) and central venous pressure was maintained at 5 ~ 7 cmH2O. In group S, rate of fluid administration = CVE + deficit +maintenance + loss + third space. Blood gas index including lactic acid and volumes of fluid administered, blood loss, urine volume and thoracic fluid count (TFC) were recorded in the operation. Clinical pulmonary infection score(CPIS) was recorded respectively before operation, 1 day, 3 day, 7 day after operation to evaluate the risk of VAP. Results Compare with those in group S, there were significantly less TFC and intraoperative volumes of fluid administration in group R. The CPIS was significant lower at day1, day3, day7 after operation in group R. There was no significant difference in MAP, HR, CO and urine volume between two groups. Conclusions In colon cancer surgery for elderly patients, restrictive transfusion can maintain hemodynamic stability, ensure the tissue oxygenation, reduce conjunction edema, shorten the recovery and hospital stay and reduce the incidence of VAP.

Objective To investigate the effects of rapid colloid and crystalloid infusions on the plasma concentration of propofol( Cp) during target-controlled infusion.Methods Thirty-six patients were randomly assigned to three interventions(12 patients per group).At least 30 min after the start of propofol infusion,the hydroxyethyl starch solution group(HES)received HES of 24 mL/(kg· h),on the former 20 min,the sodium acetate Ringer’s injection group(AR)received AR of 24 mL/(kg· h),while HES group and AR group of later 20 min and the control group of whole course received AR of 2 mL/(kg· h).The plasma concentrations of propofol were recorded per 2 min and a half.The cardiac outputting,blood volume and clearance of indocyanine green were measured by pulsed dye density analyzer,the effective hepatic blood flow( EHBF) were obtained.Results The varying of Cp with time showed a significant treatment factor(F[2,33] =14.14,P<0.001)and time factor(F[16,528] =10.37,P<0.001)and interaction between the above factors(F[32,528] =2.82,P <0.001) by ANOVA for repeated measurement;the difference of Cp among each group,Cp in HES group was significantly lower than AR group(5-40 min)or control group(10-40 min),with significant difference(P<0.05).The varying of EHBF with time showed a significant treatment factor(F[2,28] =3.68,P=0.038)and time factor(F[2,56] =5.37,P=0.007)and interaction between the above factors(F [4,56] =3.67,P=0.010);while there was no significant difference in other groups.Conclusion Rapid HES infusion increases the effective hepatic blood flow,resulting in a decrease of propofol concentration during target-controlled infusion.Rapid HES infusion should be used cautiously as it may decrease the depth of anesthesia.

Objective To investigate the efficacy of bilevel positive airway pressure mechanical ventilation (BiPAP) in the patients of acute organophosphorus pesticides poisoning (AOPP) with respiratory failure. Methods 44 AOPP patients with respiratort failure were randomly divided into experimental group (n = 22) and control group (n = 22). The routine trentment was given to both groups, additional BiPAP assisted ventilation was given to the treatment group. Blood gas,heart rate and respiratory rate were detected before and 2 h,24 h,48 h after treatment, and the rote of intubatinn,mortality,duration and cost of hospitalization were compared between two groups. Results Heart rate,PaO2 was significantly increased and PaCO2 decreased in BiPAP ventilation (P <0. 05). The mortality,intubatien rate and cost of hospitalization were significantly decreased in BiPAP treatment group (P < 0. 05). Conclusion The BiPAP ventilation is certainly effective to acute organophosphorus pesticides poisoning with respiratory failure. It could obviously improve the clinical symptoms and arterial blood gas analysis, and could reduce the mortaiity, rate of intubotion,cost of hospitalization of patients of acute organophosphoms pesticides poisoning with respiratory failure.

0.05).According to the HSS system,the mean score was 92.1(ranged from 76-97) one year after operation.No complication occurred,such as deep infection,necrosis of skin incision or loosening and breakage of internal fixators.[Conclusion]This modified posteromedial and posterolateral approaches could reduce the complications in incision successfully for the direct reduction and buttress fixation of articular fragments,as well as and soft tissue.

To study the related substances in nicergoline, electrospray positive ionization high resolution TOF/MS was used for the determination of the accurate mass and elemental composition of the related substances. Triple quadrupoles tandem MS/MS was employed for the determination of the fragmentations of the parent ions. 16 related substances were detected and identified to be eight synthetic by-products and eight degradation products, by using impurity references matching, product mass spectra fragmentations elucidation, and verified further according to synthetic processes and stress testing results. The results obtained are valuable for nicergoline manufacturing process control and quality assurance.
Chromatography, High Pressure Liquid ; Nicergoline ; chemical synthesis ; chemistry ; Quality Control ; Tandem Mass Spectrometry

To study the related substances in nicergoline, electrospray positive ionization high resolution TOF/MS was used for the determination of the accurate mass and elemental composition of the related substances. Triple quadrupoles tandem MS/MS was employed for the determination of the fragmentations of the parent ions. 16 related substances were detected and identified to be eight synthetic by-products and eight degradation products, by using impurity references matching, product mass spectra fragmentations elucidation, and verified further according to synthetic processes and stress testing results. The results obtained are valuable for nicergoline manufacturing process control and quality assurance.

Purpose To investigate the imaging characteristics and accuracy of diagnosing pilocytic astrocytoma (PA) with perfusion weighted imaging (PWI), diffusion weighted imaging (DWI), magnetic resonance sprectroscopy, susceptibility weighted imaging (SWI) and diffusion tensor imaging. Material and Methods MRI imaging of 11 patients with PA was retrospectively analyzed for functional imaging features. Results In 11 patients with PA, there were 9 mixed cystic and solid lesions, 1 case of cystic lesion and 1 case with solid lesion. Ten lesions showed mixed hypointensity on T1WI, and mixed hyperintensity on T2WI and FLAIR. One case was hypointense on T1WI, and hyperintense on T2WI and FLAIR. Prominent contrast enhancement was seen in the solid portion, capsular wall and mural nodules. On SWI 3 cases showed patchy low signal, 2 cases of dot-like low signal and 2 cases without low signal, with average intratumoral susceptibility signal intensity classification of 1.57. PWI findings were characterized by high perfusion with relative cerebral blood volume averaging 2.64±1.22. There was elevated choline component in the solid portion with significantly decreased NAA with average Cho/NAA ratio of 5.13±4.72 (1.46-15.26). Lactate peak was increased in 5 cases. On DWI there was limited diffusion in 1 case. 7 cases did not demonstrate limited diffusion with average relative apparent diffusion coefficient of 1.60±0.58. Conclusion Most MRI features of pilocystic astrocytoma are consistent with low grade glioma. There are characteristic functional imaging findings with higher perfusion than other gliomas. Functional MRI can evaluate tumor metabolism and prognosis.

Objective To learn the clinicians'attitude towards the “Drug and Medical Service Separation” reform in Beijing.Methods A number of pilot hospitals of “Drug and Medical Service Separation” reform in Beijing were pinpointed,for a random questionnaires survey among 800 clinicians,to learn their awareness,evaluation and attitudes to the reform.Results The clinicians were found with good awareness and understanding of the reform,with an awareness rate of 99.5％ ; 72.0％ of them hold that the pricing of “medical service charge” of the reform as reasonable; most of them believe that the reform plays a positive role in relieving the difficulties of seeing doctors and affordability of medical treatment; their approval rate for the reform pilot project is 97.3％; their satisfaction for the reform implementation is 90.8％,and their support for full implementation of the reform is 94.0％.Conclusion The clinicians from those pilot hospitals are sufficiently aware of and understand this policy,and are supportive of the pilot with useful suggestions.The recommended strengthened publicity and training,higher medical service charges,better pay for medical workers,improved incentive mechanism and evaluation mechanism,and better clinicians' satisfaction.

Objective: The bioactivity of four podophyllotoxin analogues were tested against 3rd instar larvae of Culex pipiens pallens and 5 h instar larvae of Pieris rapae L.Methods:WHO bioassay and leaf-dlpping method. Results: ①Deoxypodophyllotoxin and ?-apopicropodophyllotoxin exhibited toxicity(against) Culex pipiens pallens,and their LC_(50) were 0.001 48 and 0.001 68 g/L,respectively.②All the four podophyllotoxin analogues displayed inhibitory effect on the growth and development against Culex pipiens pallens,their pupation rates were delayed comparing with control.③Deoxypodophyllotoxin,?-apopicropodophyllotoxin and Podophyllotoxin exhibited toxicity against Pieris rapae L,the LC_(50) 96 h after treatment were 0.045 4?0.078 2 and 0.159 7 g/L,respectively.④All the four podophyllotoxin analogues showed antifeedant activity against Pieris rapae L,their AFC_(50)were 0.016 1,0.018 7,0.039 4 and(0.273 9) g /L,respectively.⑤All four podophyllotoxin analogues displayed inhibitory effect on the growth and development against Pieris rapae L,but the extent of each compound were very different. Conclusion: Based on the data obtained in this investigation,it is possible that the dissimilarity in the structure of the analogues leads to their different bioactivity.