Objective To study the feasibility and reliability of median nerve somatosensory evoked potential monitoring in neurosurgery around the brain stem. Methods in selected 43 patients SEP N20, waveforms were recorded after stimulation of left and right median nerves respectively. Anesthesia was maintained with intravenous anesthetics throughout the operation. As soon as N20 waveform changed significantly, the surgeon was informed and the operative procedure was modified whenever possible. Results SEP waveforms were almost stable during maintaining with total intravenous anesthesia (TIVA). Within 43 cases, SEP waveform of & patients significantly changed. In these cases, SEP of 5 patients returned to normal gradually and no further neurologic dysfunction happened postoperatively. The other 3 cases did not recover, and postoperative neurologic complications happened. There was no false-negative or false-positive result. The correlation between intraoperative SEP changes and postoperative neurologic alterations was significant statistically. Conclusions SEP recording is a reliable technique for intraoperative monitoring during neurosurgery around the brain stem. TIVA is helpful for SEP monitoring.

Objective To observe the preventing effect of optimal programs (improving turn over postures and elongating the turn over intervals)in preventing pressure sore occurrence in patients with acute stroke. Methods Acute stage stroke patients (time from on-set less than or equal to one week)were selected and divided randomly into 4 groups, one group adopted 2.0 hours turn over intervals as the routine group, others adopted 2.5 hours, 3.0 hours, 3.5 hours turn over intervals as the study groups. The incidence of pressure sores and complications were recorded. Results None of the groups (2.0 h, 2.5 h,3.0 h, 3.5 h)suffered from pressure sores. The incidence of complications including malnutrition, pulmonary infections and constipations was not increased in the study groups either. Conclusions Optimal turn over nursing programs including elongating turn over intervals to 2.5h, 3.0h, 3.5h and adopting 30 degree lateral posture can effectively prevent occurrence of pressure sores in acute stroke patients.

Objective: To study the effect of three different doses of propofol, midazolam and etomidate on short latency somatosensory evoked potential(SLSEP). Method:Ninety patients undergoing elective operation were randomly divided into 3 groups with 3 subgroups each,and propofol,midazolam,etomidate were administered by bolus injection at propofol 1.5,2,3mg/kg, midazolam 0.2,0.3,0.4mg/kg, etomidate 0.15,0.3,0.4mg/kg accordingly. SLSEP was recorded before,during and after injection. Result:Propofol did not significantly change the latencies of the subcortical N_(14),cortical N_(20) and central conduction time(CCT)N_(14)-N_(20),decreased the interwave amplitude N_(20)-P_(25)(P

Sodium glucose cotransporter 2 inhibitor (SGLT2i) emerged as a new hypoglycemic agent, which can inhibit glucose reabsorption and thus play a hypoglycemic role. Recent studies have shown that SGLT2i not only lowers blood glucose, but also has a protective effect on the cardiovascular system, which may benefit patients with heart failure.The specific mechanism of action is still not fully elucidated. This paper aims to summarize the latest research results of SGLT2i in the treatment of heart failure, and analyze the possible mechanisms for clinical guidance.

Objective The purpose of this research is to use modern statistical methods,to analyze the rules of cointment by Prof.Yang Zhimin treating yang deficiency and fatigue state patients,to increase the pertinence and to improve the clinical efficacy.Methods This paper analyzed 62 cases of Prof.Yang Zhimin in the treatment of the patients with yang deficiency and fatigue state from October 2010 to January 2013.The analyses were frequency analysis and association rules.Results Among the patients with yang-deficiency and fatigue,193 Chinese medicine were used.The monkshood was the highest frequency.Dampness-transforming medicine accounts for about 22.2％ in the top 36 frequency of medicine.Based on analyzing association rules,we found that the compatibility of medicine which were used more frequently came from Sini decoction,Danggui Sini decoction and Jinkui Shenqi pills,such as "monkshood and dried ginger","monkshood and roasted liquorice","dried ginger and roasted liquorice","monkshood and angelica","monkshood and comel","monkshood and prepared rehmannia root" and "monkshood and yam".Futhermore,we found two new core prescription.One was Qian Yang Dan combined with Sini decoction consist of "monkshood,roasted liquorice,dried ginger,fructus amomi".The other one was Tu Si Jian consist of "yam,semen cuscutae,angelica,roasted liquorice".Conclusions "Invigorating spleen and kidney","warming yang and dissipating dampness" and "hiding yang and Seeking Yang in Yin" are the habits and rules of the ointment medication by Prof.Yang Zhimin treatingyang deficiency and fatigue state patients.

Massive transfusion protocol (MTP) is a programmatic procedure for massive blood transfusions, which is an important means of patient blood management (PBM) for trauma and massive hemorrhage patients. MTP can be initiated in a variety of modes, including the McLaughlin, ABC and TASH scoring systems and the mode depending on the patient′s hemorheology. After MTP has been activated, blood components should be injected as soon as possible. Generally, red blood cells should be injected first, followed by plasma and platelets injected proportionally. MTP should be based on good damage control measures and good hemostatic treatment, and should try to avoid the waste of blood components.This article reviews the progress of research on MTP in the above aspects.

OBJECTIVE：To pre pare Glycyrrhetinic acid-modified docetaxel magnetic nanoparticles （GA-DTX-NGO/IONP- NPs），and to evaluate its physicochemical properties. METHODS ：Magnetic nano graphene oxide （NGO/IONP）was chosen as the anti-tumor drug carrier ，docetaxel（DTX）as the model drug and glycyrrhetinic acid （GA）as the target molecule. Firstly ，NGO/ IONP was synthesized by hydrothermal method and GA-CS was synthesized by amidation reaction. Fourier IR spectrometer ，DSC and vibration sample magnetic measuring instrument were used to characterize NGO/IONP and GA-CS. GA-DTX-NGO/IONP-NPs Huperzine A in the nicotinic acetylcholine receptor alleviates Aβ -induced 1-42 treatment of Alzheimer ’s disease and vascular dementia ：a neurotoxicity via downregulation of p 38 and JNK MAPK meta-analysis[J]. Evid Based Complement Alternat Med ， signaling pathways[J]. Neurochem Int ，2018. DOI ：10. 2014. DOI ：10.1155/2014/363985. 1016/j.neuint.2018.09.005. were prepared by the ion gelation method. TEM and particle size analyzer were used to observe and determine the morphology ， particle size and Zeta potential of GA-DTX-NGO/IONP-NPs ；the ultrafiltration-centrifugation method was used to determine encapsulation efficiency and drug loading amount ；the magnetic properties were investigated by investigating the state with or without external magnetic field ；the photothermal conversion test was carried out with laser irradiation of 808 nm. RESULTS ：NGO/ IONP and GA-CS were successfully synthesized ，and NGO/IONP exhibited superparamagnetism characteristics. GA-DTX-NGO/ IONP-NPs were spherical under TEM ，the particle size was （262.8±4.23）nm and the Zeta potential was （13.6±1.51）mV. The encapsulation rate and drug loading amount were （94.29±0.50）％ and（17.12±0.12）％，respectively. GA-DTX-NGO/IONP-NPs were black in appearance and evenly dispersed. Under the external magnetic field ，the magnetic nanoparticles could move directionally，showing good magnetic properties. GA-DTX-NGO/IONP-NPs showed a good concentration- and time-dependent photothermal conversion effect under 808 nm laser irradiation. CONCLUSIONS ：GA-DTX-NGO/IONP-NPs are successfully prepared. This study could provide some theoretical basis for the combined treatment of magnetic heating-chemotherapy for liver tumors.

OBJECTIVE： To establish UPLC fingerprint of Fortunella margarita， and to conduct its cluster analysis and principal component analysis. METHODS： UPLC method was adopted. The determination was performed on Waters Acquity UPLC BEH C18 column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid solution （gradient elution） at the flow rate of 0.3 mL/min. The detection wavelength was set at 330 nm， and sample size was 2 μL. Using fortunellin as reference， UPLC fingerprints of 8 batches of F. margarita were determined. The similarity of 8 batches of samples was evaluated by TCM Chromatographic Fingerprint Similarity Evaluation System（2012 edition） to confirm common peak. Cluster analysis and principal component analysis were performed by using SPSS 24.0 software. RESULTS： There were 24 common peaks in UPLC fingerprints of 8 batches of sample，the similarity of which was higher than 0.97. Cluster analysis showed that 8 batches of samples were clustered into 2 categories. S1， S2， S3， S4， S6， S7 and S8 were clustered into one category； S5 was clustered into the other category. By principal component analysis， the accumulative contribution rate of three main components was 81.366％. CONCLUSIONS： Established UPLC fingerprint， the results of cluster analysis and principal component analysis can provide reference for quality control of F. margarita.

Nuclear transporter importin-β1 is emerging as an attractive target by virtue of its prevalence in many cancers. However, the lack of druggable inhibitors restricts its therapeutic proof of concept. In the present work, we optimized a natural importin-β1 inhibitor DD1 to afford an improved analog DD1-Br with better tolerability (>25 folds) and oral bioavailability. DD1-Br inhibited the survival of castration-resistant prostate cancer (CRPC) cells with sub-nanomolar potency and completely prevented tumor growth in resistant CRPC models both in monotherapy (0.5 mg/kg) and in enzalutamide-combination therapy. Mechanistic study revealed that by targeting importin-β1, DD1-Br markedly inhibited the nuclear accumulation of multiple CRPC drivers, particularly AR-V7, a main contributor to enzalutamide resistance, leading to the integral suppression of downstream oncogenic signaling. This study provides a promising lead for CRPC and demonstrates the potential of overcoming drug resistance in advanced CRPC via targeting importin-β1.

OBJECTIVE： To optimize and improve the quality standard for Citrus reticulata formula granules. METHODS： Totally 13 batches of C. Reticulata formula granules from 4 different manufacturers were used as trial samples， and qualitative identification of hesperidin and nobiletin in the samples were carried out by TLC according to the method of 2015 edition of Chinese Pharmacopoeia （part Ⅳ）. The quantitative analysis of naringin， hesperidin， hesperetin， nobiletin and tangeretin in C. reticulatae formula granules were conducted by UPLC[The determination was performed on Waters Acquity UPLC BEH C18 column with mobile phase consisted of acetonitrile-0.2％ phosphoric acid aqueous solution （gradient elution）. The detection wavelength was set at 283 nm， and sample size was 3 μL]. RESULTS： The results of TLC showed that in the chromatograms of samples， same color spots were shown in the corresponding positions of the chromatogram of reference substance. The results of UPLC showed， that the linear range of naringin， hesperidin， hesperetin， nobiletin and tangeretin were 0.64-6.44， 15.78-157.80， 0.17-1.66， 2.08-20.85 and 2.04-20.43 μg/mL， respectively （all r≥0.999 2）； the limits of detection were 0.03， 0.33， 0.10， 0.20 and 0.06       μg/mL； the limits of quantitation were 0.07， 1.34， 0.20， 0.60 and 0.22 μg/mL. The average recoveries were 99.4％， 99.6％， 99.7％， 99.7％ and 99.7％ （n＝9）； RSDs of precision （n＝6）， stability （n＝7） and reproducibility （n＝6） tests were all≤2.03％； naringin was detected in only 3 batches of samples from one manufacturer （the content ranged from 0.067 3 to 0.069.6    mg/g）， while the other 4 components were detected in 13 batches of samples （the contents of them ranged 0.646 5-1.728 0，   0.102 6-0.290 5， 0.023 1-0.689 8， 0.018 2-0.270 7 mg/g）. CONCLUSIONS： In this study， the quality standard of C. reticulata formula granules was improved by qualitative and quantitative methods， and the contents of hesperidin， hesperetin， nobiletin and tangeretin were not less than 0.60， 0.10， 0.02 and 0.01 mg/g， respectively.