Objective: To establish a quantitative analysis of multi-components by single marker (QAMS) method for the determination of ten components in Xuefu Zhuyu Pills (XZP), which are paeoniflorin, ferulic acid, amygdalin, liquiritin, catalpol, β-ecdysone, hydroxysafflor yellow A, naringin, neohesperidin, and saikosaponin A, and to examine the feasibilities of the method for quality control of XZP. Methods: Using XZP as the research object, paeoniflorin was chosen as the internal reference substance by correction methods. The relative correlation factors (f) of ferulic acid, amygdalin, liquiritin, catalpol, β-ecdysone, hydroxysafflor yellow A, naringin, neohesperidin, and saikosaponin A to paeoniflorin were established. The contents of ten components in 16 batches of samples were determined by the external standard method and QAMS, and the measured values of the external standard method were compared with the calculated results of correction factor in order to test the accuracy of established method. The results were compared with the methods finally. Results: The f value of ferulic acid, amygdalin, liquiritin, catalpol, β-ecdysone, hydroxysafflor yellow A, naringin, neohesperidin, and saikosaponin A to paeoniflorin were 2.22, 1.73, 0.56, 3.55, 2.03, 2.31, 1.03, 1.68, and 1.13, respectively; There was no significant difference between the calculated value and the measured value of f by correction method. The contents of nine batches of catalpol, amygdalin, saikosaponin A, ferulic acid, naringin, neohesperidin, liquiritin, β-ecdysone, hydroxysafflor yellow A, and paeoniflorin were 0.47-0.72, 0.63-0.94, 0.37-0.74, 0.11-0.33, 1.15-1.37, 0.64-0.84, 1.47-1.88, 0.38-0.62, 0.17-0.34, and 1.16-1.48 mg/g, respectively. Conclusion: The QAMS method is feasible and credible, and could be used to determine and control the multiple components in XZP.

Objective: To develop a high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method for the simultaneous determination of eight components (puerarin, tanshinone IIA, stibene glucoside, paeoniflorin, ginsenoside Re, ginsenoside Rg1, calycosin-7-glucoside, and baicalin) in Shenwu Jiannao Capsules (SJC). Methods: Chromatographic column: YMC-Triart C18, mobile phase: methanol-water (including 0.2% formic acid), and gradient elution, flow rate: 0.6 mL/min, column temperature: 40℃. MS condition: electrospray ionization (ESI) and multiple reaction monitoring (MRM) were adopted, the detected peak areas of ion pairs were used for quantitative determination. Results: There was a good linearity between the absorption peak area and the concentration for puerarin, tanshinone IIA, stibene glucoside, paeoniflorin, ginsenoside Re, ginsenoside Rg1, calycosin-7- glucoside, and baicalin in the ranges of 20.31-20 310, 25.66-25 660, 20.45-20 450, 50.79-50 790, 50.57-50 570, 50.38-50 380, 10.32-10 320, and 25.74-25 740 ng/mL, respectively (r ≥ 0.999 0). The precision was good and RSD was less than 2.0%. The repeatability was good and RSD was less than 2.0%. The stability was good in 24 h. The average recoveries were ranged from 97.98% to 102.48% (RSD ≤ 1.6%). The contents of puerarin, tanshinone IIA, stibene glucoside, paeoniflorin, ginsenoside Re, ginsenoside Rg1, calycosin-7-glucoside, and baicalin in six batches of samples were in the ranges of 1.843-1.860, 1.618-1.629, 2.116-2.129, 2.537-2.547, 0.034-0.041, 0.048-0.055, 0.551-0.564, and 2.333-2.346 mg/g, respectively. Conclusion: The method is rapid, simple, repeatable, and can be used to determine the multi components in different batches of SJC simultaneously.

Objective To evaluate the effect of surgical management of primary venous reflux disease in lower extremity. Methods Literatures about the surgical management of venous reflux disease in lower extremity were collected and reviewed. Results In patients with primary venous reflux disease,comprehensive surgical management of concomitant superficial,deep and perforating veins might greatly improve the clinical effect.Conclusion Comprehensive surgical management will be the direction of surgical management of primary venous reflux disease in lower extremity.

Objective:　To explore the variant processes of c ell apoptosis and the inhibiting effect of moderate hypothermia on cell apoptosi s after diffuse brain injury. 　　Methods:　Models of diffuse brain injury were induced by the tra uma device reported by Marmarou.1 A total of 128 Wistar rats were divided into 4 groups: the uninjured group (Group A, n=8), the severely i njured group (Group B, n=60), the mildly injured group (Gr oup C, n=30) and the mild hypothermia group (Group D, n=30). In Group D, the severely injured rats were treated with moderate hypothermia to keep the rectal temperature at 32℃ (standard deviation for 0.1℃) for 6 hours. Then the morphosis, the characteristics and the qua ntity of apoptotic cells in the cerebral cortex and in the hippocampus regions a fter different severities of craniocerebral injuries were observed and compared under an electronic microscope, with terminal deoxynucleotidyl nick end labeling (TUNEL) in DNA fragmentation and with agarose gel electrophoresis. 　　Results:　TUNEL showed apoptotic cells increased according to t he injury severity, and they peaked at 48 hours after injury and then declined. In Group C, apoptosis was located in the CA2 and CA3 areas of the hippocampu s. And in Group B, apoptosis increased evidently, and located in the whole hippo campus and in the frontal and parietal cortex regions. The hypothermia-treated rats had some apoptotic cells, too. However, even at 24, 48 and 72 hours after i njury there were significantly fewer apoptotic cells in the cortex and in the hi ppocampus in Group D than that in the non-treated groups. Electron microscopy s howed that the apoptotic cells were round and shrunken in morphology and the nuc lei were round and condensed at 24 and 48 hours after injury. And the apoptosis at 48 hours was more severe than that at 24 hours. The hypothermia-treated rats had no apoptotic cells. Gel electrophoresis showed that characteristic DNA “la dders” were observed in the cortex and in the hippocampus at 48 hours after sev ere injury. But there was no DNA “ladder” at other time points in the severely injured group, in the mildly injured group and in the hypothermia-treated grou p. 　　Conclusions:　It suggests that apoptosis occurs after diffuse br ain injury and apoptotic cells increase with the injury severity. Moderate hypot hermia has a specific inhibiting effect on cell apoptosis after diffuse brain in jury in rats.

Brachiocephalic Trunk ; Fistula/surgery* ; Humans ; Trachea ; Tracheostomy

Objective: To investigate the related factors and treatments of delayed cerebrospinal fluid rhinorrhea (CFR) after invasive pituitary adenoma (IPA) surgery. Methods: One hundred and forty-two patients with IPA treated in Tianjin Huanhu Hospital from January 2014 to January 2019 were analyzed retrospectively, including 62 males and 80 females, aging from 38 to 67 years. The clinical data of patients before and after operation were collected. All patients with postoperative CFR underwent endoscopic CFR repair. During the operation, residual or recurrent pituitary adenomas were resected, the dura around the leak was enlarged and the necrotic tissue was removed. For those who still had fluid leakage after repair, the necrotic tissue was cleaned up, the leakage was filled and reinforced under endoscopy. Endoscopic rhinorrhea repair was performed if necessary. The cerebrospinal fluid leak was repaired with multi-layer materials. The related risk factors of delayed CFR after operation were analyzed. SPSS 19.0 software was used for statistical analysis. Results: Among the 142 patients in this group, 64 cases underwent total tumor resection and 78 cases underwent non-total tumor resection. They were followed up for 6 to 72 months. Thirty-one cases had delayed CFR, with an incidence of 21.83%, and occurred between 1 and 5 years postoperatively, with an average of 2.4 years. All 31 patients with delayed CFR underwent endoscopic CFR repair. The nasal endoscopy was rechecked at 2 weeks, 1 month, 3 months and 6 months after operation. Twenty-eight patients were repaired successfully after 1 operation, while 2 patients after 2 operations and 1 patient after 3 operations. These patients were followed up for 6 to 60 months, and no CFR occurred again. Univariate analysis showed that the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and operator experience were the risk factors of delayed CFR (all P<0.05). Multivariate analysis showed that the degree of tumor resection and recurrence were the highest independent risk factors for postoperative CFR, and tumor size, texture, postoperative radiotherapy and operator experience were the independent risk factors in this study. Conclusions: Delayed CFR after IPA is related to the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and the operator experience. It is necessary to completely remove the tumor under endoscope, to expand resection of the dura and necrotic tissue around the leak, to repair the defect with multi-layer materials, to follow-up closely and to repair timely after operation.
Adenoma/surgery* ; Adult ; Aged ; Cerebrospinal Fluid Leak ; Cerebrospinal Fluid Rhinorrhea/surgery* ; Female ; Humans ; Male ; Middle Aged ; Pituitary Neoplasms/surgery* ; Retrospective Studies

Objective: To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy. Methods: The total excision rate, postoperative complications and postoperative curative effect of 7 patients (4 males and 3 females, aging from 32 to 63 years old) who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed. All patients were followed up for 6 to 36 months. The postoperative MRI, clinical symptoms and recurrence were reviewed. Descriptive statistical methods were used for analysis. Results: Among the 7 patients, there were total resection (complete resection of cyst contents and capsule) in 4 patients, near-total resection (complete resection of cyst contents, incomplete resection of cyst capsule) in 1 patient, and subtotal resection (incomplete resection of cyst contents and capsule) in 2 patients. The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms. One case had postoperative cerebrospinal fluid rhinorrhea, which was cured after lumbar drainage and nasal iodoform gauge packing. Up to now, 7 patients (including patients with partial resection) had no recurrence. Conclusion: Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.
Adult ; Cholesteatoma ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Skull Base/surgery*

Objective: To analyze the activation of brain regions associated with olfactory in patients with mild cognitive impairment (MCI) by olfactory functional magnetic resonance imaging (fMRI). Methods: Twenty six patients with MCI were compared with twenty six controls in the dementia center of Tianjin HuanHu hospital in terms of olfactory function T&T testing, the differences between the activation of the whole brain and region of interest associated with olfactory (bilateral primary olfactory cortex(POC), bilateral hippocampus, bilateral orbital frontal gyrus) by olfactory stimulator using event correlation design for olfactory fMRI scanning. To analyze the correlation between the number of activator in POC and the threshold of olfactory discriminate as well as the severity of cognitive impairment.SPSS 19.0 software was used for the statistical analysis. Results: T&T olfactory testing revealed that MCI patients had higher scores than controls (3.57±1.29 (±s) vs 1.02±0.35, t=4.372, P<0.05). The activation range of whole brain in MCI patients was less than controls (pleasant odor (po) 147.36±21.45 vs 323.11±39.76, unpleasant odor (upo) 201.86±24.93 vs 447.73±57.22, t_po=4.241, t_upo=5.365, both P<0.05). The activation range of whole brain in inhaling unpleasant odor was more than pleasant odor in controls (447.73±57.22 vs 323.11±39.76, t=3.936, P<0.05). The number of activator in ROI_awo in MCI patients was less than controls (pleasant odor (po) 51.0[8.0, 109.0](M[P₂₅, P₇₅]) vs 135.0[21.0, 321.5], unpleasant odor (upo) 65.0[6.0, 158.0]vs 205.0[36.5, 491.0], Z_po=-2.199, Z_upo=-2.216, both P<0.05). The number of activator in POC in MCI patients was less than controls (pleasant odor (po) 19.0[4.0, 35.5]vs 46.0[9.0, 118.5], unpleasant odor (upo) 26.0[2.0, 51.0]vs 79.0[17.5, 189.0], Z_po=-1.898, Z_upo=-2.167, both P<0.05). The number of activator in POC was negatively correlated with olfactory discriminate threshold in MCI patients (r_po=-0.415, r_upo=-0.409, both P<0.05). The number of activator in POC was positively correlated with MoCA in MCI patients (r_po=0.289, r_upo=0.296, both P<0.05). Conclusion Olfactory fMRI can objectively assess the olfactory function in MCI, it is a imaging indicator with neuropsychological tests for detection in MCI, the number of activator in POC can reflect the severity of MCI.

OBJECTIVEThe study focus on the olfactory changes post upper respiratory infection, through observation of nasal mucosa and it's ultrastructural changes.

METHODSOlfactory test was performed by odor threshold and identification test (T&T olfactometry). The specimens of olfactory epithelium (OE) were obtained from 10 patients with anosmia or olfactory disorder post upper respiratory infection. All specimens were obtained under endoscope. Transmission electron microscope (TEM) was used to observe the ultrastructural changes of each group.

RESULTSUnder the TEM, the surface ultrastructure of the OE from patients showed following abnormal changes: (1) Normal epithelium structural characteristics maintained but clearance between cells appeared wider. (2) Olfactory vesicles reduced obviously, even if the olfactory vesicles existed, the olfactory cilia showed reduction. Some olfactory vesicles still existed, but the number of olfactory cilia reduced. Some olfactory vesicles changed their shape due to vacuolization. (3) Surface microvillus of the supporting cells disappeared. (4) The nuclei of supporting cell changed the shape or karyopyknosis, olfactory dendrites were shorter and wider than normal, and organelles reduced.

CONCLUSIONSThere is close relationship between ultrastructural changes and olfactory disorders post upper respiratory infection. Reduced olfactory vesicles, cilia and disappeared microvillus of the supporting cells are the main reasons for the patient's olfactory disorder.

Adult ; Common Cold ; complications ; Female ; Humans ; Male ; Microscopy, Electron, Transmission ; Middle Aged ; Olfaction Disorders ; etiology ; pathology ; Olfactory Mucosa ; ultrastructure

Objective: To establish HPLC coupled with wavelength switching and gradient elution method (HPLC-DVD) for simultaneous determination of ten main components (calycosin-7-glucoside, ruscogenin, amygdalin, ginsenoside Rb1, ginsenoside Re, ferulic acid, crocin I, salvianolic acid B, acetyl-11-keto-β-boswellic acid, and tanshinone IIA) in Shuangshenlong Capsule (SSLC). Methods: The chromatographic separation was achieved on Hypersil ODS C18 (150 mm × 4.0 mm, 3 μm) column with methanol- water (8∶2) T (A)-0.1% phosphoric acid solution (B) as mobile phases for gradient elution, at the flow rate of 0.6 mL/min; The detection wavelength was set at 260 nm for α-calycosin-7-glucoside, 280 nm for ruscogenin, 210 nm for amygdalin, 203 nm for ginsenoside Rb1 and ginsenoside Re, 320 nm for ferulic acid, 440 nm for crocin I, 286 nm for salvianolic acid B, 250 nm for acetyl-11-keto-β-boswellic acid, and 270 nm for tanshinone IIA. The volume of sample injection was 10 μL. Results :The ten active components were well separated and showed good linearity between mass concentration and peak area, such as calycosin-7-glucoside 3.88—69.86 mg/L (r = 0.999 2), ruscogenin 22.1—397.8 mg/L (r = 0.999 1), amygdalin 37.43—673.5 mg/L (r = 0.999 4), ginsenoside Rb1 45.15—812.72 mg/L (r = 0.999 6), ginsenoside Re 4.55—81.95 mg/L (r = 0.999 5), ferulic acid 3.06—55.15 mg/L (r = 0.999 4), crocin I 1.93—34.76 mg/L (r = 0.999 5), salvianolic acid B 15.68—282.15 mg/L (r = 0.999 6), acetyl-11-keto-β-boswellic acid 11.31—203.58 mg/L (r = 0.999 1), and tanshinone IIA 1.89—34.16 mg/L (r = 0.999 6). The precision was good, and RSD was not more than 1.27%. The repeatability was good, and RSD was not more than 1.28%. The stability was good in 8 h, and RSD was not more than 0.96%. The average recoveries and corresponding RSD values were 99.61% (1.21%), 100.11% (0.76%), 101.52% (0.62%), 101.22% (1.03%), 100.83% (1.14%), 98.94% (0.53%), 101.04% (1.09%), 100.05% (1.25%), 99.81% (0.68%), and 101.94% (1.31%), respectively. The contents of nine batches of calycosin-7-glucoside, ruscogenin, amygdalin, ginsenoside Rb1, ginsenoside Re, ferulic acid, crocin I, salvianolic acid B, acetyl-11-keto-β-boswellic acid, and tanshinone IIA were 0.142—0.158, 0.747—0.764, 1.578—1.619, 2.163—2.185, 0.235—0.251, 0.557—0.580, 0.105—0.122, 0.311—0.328, 0.605—0.624, 0.062—0.079 mg/capsule, respectively. Conclusion: HPLC coupled with wavelength switching and gradient elution method has been established for simultaneous determination of ten components in SSLC. The method is simple, quick, accurate, and it can be used for content determination and quality control of SSLC.