Objective: To identify the major chemical compounds in 78 batches of the exocarp of Juglans mandshurica from different origins by ultra performance liquid chromatography coupled with time-of-fight mass spectrometry (UFLC-Q-TOF/MS) and determine the major active chemical components. Methods: The separation was performed on Waters Acquity UPLC BEH C18 column (100 mm × 2.1 mm, 1.7 μm), with a mobile phase using water with 0.1% formic acid (A) and acetonitrile with 0.1% formic acid (B) for gradient elution; Q-TOF/MS and electrospray ion (ESI) source were applied for the analysis under the positive ion mode; One thousand ions were extracted through Markerview 1.2.1 software from 78 batches. And common ions (compounds) were selected according to the following principles: One ion can be detected in all samples, and the relative strength is greater than the e4. Then the formula of common ions were determined by accurate mass and isotopic abundance ratio from target screening function of Peakview 2.0/masterview1.0 software. Their structures were determined by analysis of MS/MS fragment or comparison with standard substances and references. Results: Thirty-one major chemical compounds including eleven naphthalene quinones, three diarylheptanoids, three flavonoids, eight triterpenes, and six other compounds were identified or inferred in the exocarp of J. mandshurica. Conclusion: UPLC-Q-TOF/MS method which develops a new strategy can identify the main chemical constituents from the exocarp of J. mandshurica rapidly and accurately, main chemical constituents can be used for the quality evaluation and efficacy material research.

OBJECTIVETo investigate the clinical effect of penile augmentation with superficial fascia retrocession.

METHODSThe first annular incision line was designed, reserving the inner plate 0.5 -0.8 cm. The second annular incision line was determined, according to the length of penile erection. The skin tissue between the double loops was stripped, reserving the superficial fascia and the superficial dorsal veins. Before the closure of two annual incision with no tension, the superficial fascia tissue was pushed proximally and fixed sectionally to augment penis.

RESULTSFrom Jun 2009 to Jun 2011, 60 patients with redundant prepuce or phimosis were treated with this method. During 3 to 12 months follow-up, the postoperative penile perimeter increased significantly. The glans were exposed and the prepuce looked smooth. The function of the penis maintained undamaged.

CONCLUSIONSThe penile augmentation with superficial fascia retrocession can make full use of autologous tissue to augment penis, meanwhile, redundant prepuce can be resected. It is very practical for clinical application.

Adolescent ; Adult ; Circumcision, Male ; methods ; Humans ; Male ; Middle Aged ; Penis ; surgery ; Subcutaneous Tissue ; surgery ; Transplantation, Autologous ; Young Adult

OBJECTIVETo assess the therapeutic effect, timing of administration, complication prevention and management of the double filtration plasmapheresis (DFP) in the treatment of refractory myasthenia gravis (MG).

METHODSThirty-one patients with refractory MG were treated with KM 8800 membrane plasmapheresis monitor. DFP was performed every 3 days and the exchanging liquid was composed of 50 ml of 20% albumen and 1000 ml plasma substitute. Physical examination for absolute clinical score and blood sample was collected for AchR-Ab determination early in the morning on days 0, 3, 7, 14 of DFP.

RESULTSWith a total effective rate of 91.9%, complete recovery, basic recovery, improvement, and response was achieved in 2, 4, 11, and 17 patients, respectively, whereas the other 3 failed to respond. Hypotension occurred twice in 2 cases and was corrected after symptomatic treatment.

CONCLUSIONDFP may effectively lower blood AchR-Ab level of with minimal complications, and can be valuable for treatment of refractory MG.

Adolescent ; Adult ; Autoantibodies ; blood ; Child ; Female ; Filtration ; Humans ; Male ; Middle Aged ; Myasthenia Gravis ; blood ; therapy ; Plasma Exchange ; methods ; Receptors, Cholinergic ; immunology ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the inhibitory effect of paeoniflorin (PAE) on TNF-α-induced TNF receptor type I (TNFR1)-mediated signaling pathway in mouse renal arterial endothelial cells (AECs) and to explore its underlying molecular mechanisms.

METHODSMouse AECs were cultured in vitro and then they were treated by different concentrations PAE or TNF-α for various time periods. Expression levels of intercellular cell adhesion molecule-1 (ICAM-1) were detected in the normal group (cultured by serum-free culture media), the TNF-α group (cultured by 2-h serum-free culture media plus 6-h TNF-α 30 ng/mL), the low dose PAE group (cultured by 2-h PAE 0.8 μmo/L plus 6-h TNF-α 30 ng/mL), the middle dose PAE group (cultured by 2-h PAE 8 μmol/L plus 6-h TNF-α 30 ng/mL), the high dose PAE group (cultured by 2-h PAE 80 μmol/L plus 6-h TNF-α 30 ng/mL) with Western blot analysis. Nuclear translocation of transcription factor NF-κB (NE-κB) was detected in the normal group (cultured by serum-free culture media), the TNF-α group (cultured by 2-h serum-free culture media plus 45-mm TNF-α 30 ng/mL), and the high dose PAE group (cultured by 2-h PAE 80 μmol/L plus 45-min TNF-α 30 ng/mL) by immunofluorescent staining. Expression levels of the phosphorylation of extracellular signal-regulated (protein) kinase (ph-ERK) and p38 (ph- p38) were detected in the normal group (cultured by serum-free culture media) and the high dose PAE group (2-h PAE 80 μmol/L culture) by Western blot. NF-κB inhibitor-α (IκBα) protein expressions were detected in the normal group (cultured by serum-free culture media), the TNF-α group (cultured by 2-h serum-free culture media plus 30-min TNF-α 30 ng/mL), the high dose PAE group (cultured by 2-h PAE 80 μmol/L plus 30-min TNF-α 30 ng/mL), the p38 inhibitor group (SB group, pretreatment with SB238025 25 μmol/L for 30 min, then treated by PAE 80 μmol/L for 2 h, and finally treated by TNF-α 30 ng/mL for 30 min), the ERK inhibitor group (PD group, treated by PD98059 50 μmol/L for 30 min, then treated by PAE 80 μmol/L for 2 h, and finally treated by TNF-α 30 ng/mL for 30 min) by Western blot.

RESULTSCompared with the normal group, ICAM-1 protein expression levels obviously increased (P < 0.01). Compared with the TNFα group, ICAM-1 protein expression levels were obviously inhibited in the high dose PAE group (P < 0.05). Protein expression levels of ph-p38 and ph-ERK were obviously higher in the hIgh dose PAE group (P < 0.05). Compared with the normal group, IκBα protein expression levels obviously decreased in the TNF-α group (P < 0.01). Compared with the TNFα group, TNF-α-induced IκBα degradation could be significantly inhibited in the high dose PAE group (P < 0.01); the inhibition of PAE on IκBα degradation could be significantly inhibited in the SB group (P < 0.05). NF-κB/p65 signal was mainly located in cytoplasm in the normal group. NF-κB/p65 was translocated from cytoplasm to nucleus after stimulated by 45 min TNF-α in the TNF-α group, while it could be significantly inhibited in the high dose PAE group.

CONCLUSIONSPAE inhibited TNF-α-induced expression of lCAM-1. Its action might be associated with inhibiting TNFR1/NF-κB signaling pathway. p38 participated and mediated these actions.

Animals ; Cells, Cultured ; Endothelial Cells ; cytology ; drug effects ; Glucosides ; pharmacology ; Intercellular Adhesion Molecule-1 ; metabolism ; Mice ; Monoterpenes ; pharmacology ; NF-kappa B ; metabolism ; Receptors, Tumor Necrosis Factor ; metabolism ; Signal Transduction ; drug effects ; Tumor Necrosis Factor-alpha ; pharmacology

Objective To observe the impact of the prophylactic cranial irradiation (PCI) and its different interventional times on the prognosis of patients with limited-stage small cell lung cancer (LSCLC) who received comprehensive therapy of complete response (CR). Methods A total of 184 LSCLC patients who received radiotherapy and chemotherapy based on comprehensive treatment were retrospectively analyzed. Patients were divided into two groups based on with or without PCI intervention. There were 50 patients (27.2%) in the PCI group and 134 patients (72.8%) in the non PCI group. The PCI group was subdivided into two groups, PCI1 group (n=20) and PCI2 group (n=30), according to whether patients completed 4 cycles of chemotherapy. Chemotherapy regimen, irradiation method and dose were identical for two groups. Results The brain metastasis rates were 14.0%and 30.6%for PCI group and non PCI group. There was significant difference in brain metastasis rate between the two groups (P<0.05). The median survival times were 25 months (95%CI:21.487-28.513) and 17 months (95%CI:15.175-18.825) for PCI group and non PCI group (P<0.05). The 1, 2 and 3-year survival rates were 54%, 36%, 15% and 37%, 18%, 13% for the two groups. There were no significant differences in brain metastasis rates between PCI1 group and PCI2 group (10.0% and 16.7%). There was no significant difference in median survival time between the two subgroups. Conclusion PCI can reduce the incidence of SCLC brain metastases, and prolong the overall survival time. However, different intervention times of PCI have no significant influence on the prognosis of LSCLC.

Objective To investigate the resistant mechanism of quinolones on multi-drug resistant Klebsiella caused pneumonia(MDR-KPN).Methods From August 2008 to May 2010,47 strains of MDR-KPN were collected from 6 hospitals in Hangzhou and Huzhou in Zhejiang province in China.Drug target genes to quinolones (gyrA,parC) and quinolone-resistance genes mediated by mobile genetic elements [qnrA,qnrB,qnrS,aac (6')-Ⅰ b-cr,qepA] were analyzed by PCR and verified by DNA sequencing.Results Positive results were found in 47 strains of MDR-KPN,43 strains (91.5％) of gyrA mutation,40 strains(85.1％) ofparC mutation,3 strains (6.4％) of qnrB2,1 strain (2.1％) ofqnrB 4,8 strains (17.0％) ofqnrS 1,5 strains (10.6％) of qnrS 4,2 strains (4.3％)of aac (6')-Ⅰ b-cr respectively.Moreover,5 novel variants of gyrA (GenBank accession number:JN811952,JN811953,JN811954,JN811955,JN811956),5 novel variants of parC (GenBank accession number:JN817432,JN817433,JN817434,JN817435,JN817436)were also identified.In addition,qnrS4 (GenBank accession number:JN836269) appeared to be the novel variants of qnrS.Conclusion Quinolone-resistance-determining region played a key role on the resistance to quinolones in this group of MDR-KPN,and quinolone-resistance genes mediated by mobile genetic elements [qnrB2,qnrB4,qnrS1,qnrS4,aac (6')-Ⅰ b-cr] showed positive in some parts of the strains.This was the first report on emergence of qnrS4 in the world.

OBJECTIVETo summarize the reasons for bile duct injury (BDI) after laparoscopic cholecystectomy (LC), and to determine the effect of multiple treatment after BDI.

METHODSA retrospective cohort study was performed. The medical records of 110 patients diagnosed with BDI after LC from October 1993 to November 2007, in ten large hospitals in Guangdong of China, were reviewed.

RESULTSAmong 110 patients with BDI, 58 cases (52.7%) were local patients, whereas 52 cases (47.3%) were transferred from outside hospitals. Reasons for BDI following LC were: (1) Lack of experience of the LC operator (48.2%); (2) LC performed during acute cholecystitis (20.0%); (3) The structure of Calot triangle was unclear (15.5%); (4) Variable anatomical position (11.8%); (5) Intra-operation bleeding (4.5%). The commonest sites of injury were the choledochus and common hepatic duct (76.4%). Following BDI, endoscopic stenting or operative repair was performed in 106 patients. The overall success rate was 95.3% (101/106), with a mortality rate was 0.9% (1/106). Cholangitis occurred in 3.8% (4/106) cases. Choledocho-enterostomy operation was performed in almost 60.0% (63/106) cases, and the success rate was 93.7% (59/63). Endoscopic stenting or operative repair was performed immediately following BDI in 23.6% (25/106) patients, the success rate was 100%; and within 30 days in 63.2% (67/106) patients. Eighty-eight out of 106 patients who underwent repair were successful following the first operative procedure.

CONCLUSIONSFactors such as an un-experienced operator and unclear anatomical position were causes of BDI following LC. Early operative repair should be regarded as the treatment of choice, in patients diagnosed with BDI. Early refer to an experienced hepatobiliary operator ensures a high success rate.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Ducts ; injuries ; surgery ; Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Humans ; Iatrogenic Disease ; Intraoperative Complications ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies

BACKGROUNDAvailable drug-eluting stents (DES) have achieved great success in reducing restenosis rates. Recently, investigators have demonstrated that the durable polymer carrier plays a significant role in DES-related hypersensitive reaction and delays vessel healing. TIVOLI stent is a novel sirolimus-eluting coronary stent with biodegradable coating containing sirolimus and polylactic-co-glycolic acid (PLGA) polymer. The present study sought to evaluate the effectiveness and safety of the TIVOLI biodegradable-polymer-based sirolimus-eluting stent in treating patients with coronary artery disease.

METHODSA prospective, multicenter clinical trial comparing TIVOLI biodegradable coated sirolimus-eluting stent with ENDEAVOR zotarolimus-eluting stent was conducted in 324 patients (TIVOLI group: 168 patients; ENDEAVOR group: 156 patients) at 12 centers in China to demonstrate the non-inferiority of in-stent late loss with TIVOLI stent compared to ENDEAVOR stent in subjects with a maximum of two de novo native coronary artery lesions (lesion length ≤ 40 mm, reference vessel diameter 2.25-4.00 mm). The primary end point was angiographic in-stent late loss at 8-month. The secondary end points were clinical outcomes at 2 years, including major adverse cardiac events (cardiac death, myocardial infarction, or target-lesion revascularization) and stent thrombosis.

RESULTSAngiographic late lumen loss at 8 months in the TIVOLI group was superior to the ENDEAVOR group (in-stent (0.25 ± 0.33) mm vs. (0.57 ± 0.55) mm, diff (95%CI) -0.23 (-0.32, -0.14), P < 0.0001; in-segment (0.25 ± 0.33) mm vs. (0.42 ± 0.55) mm, diff (95%CI) -0.13 (-0.23, -0.02), P = 0.0083). The rate of in-stent binary restenosis at 8 months was reduced from 8.6% in the ENDEAVOR group to 2.9% in the TIVOLI group (P = 0.0229). Compared to ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in target-lesion revascularization (4.2% vs. 9.6%, P = 0.0495) at 2 years. The two-year major adverse cardiac events (MACE) rate was lower for the TIVOLI group, but not significantly different (6.6% vs. 10.9%, P = 0.1630).

CONCLUSIONSTIVOLI was superior to ENDEAVOR stent with respect to late lumen loss at 8 months, and it yielded both lower rates of angiographic binary restenosis at 8 months and target lesion revascularization (TLR) at 2 years. The MACE rate at 2 years was comparable in both groups.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Artery Disease ; drug therapy ; therapy ; Drug-Eluting Stents ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Middle Aged ; Polymers ; chemistry ; Sirolimus ; analogs & derivatives ; therapeutic use ; Treatment Outcome

Objective To identify the epidemic characteristics and risk factors of an emerging infectious disease-severe fever with thrombocytopenia syndrome (SFTS) in Hubei province.Methods Active surveillance program on SFTS was set up in monitoring sites-hospitals,at the township level or above,in Suizhou,Huanggang and Wuhan from January to December,2010.Specific surveillance program on SFTS was launched across the province in hospitals above the county level.Cases that matched the definition of surveillance case were identified and reported to Centers for Disease Control and Prevention (CDCs).Cases were interviewed and their blood samples collected and detected using PCR and virus isolation.We also conducted serum antibody surveys among healthy population and livestock and surveillance on vector ticks in those high-epidemic areas.Results 188 cases that matched the definition of surveillance case and 21 deaths were reported in 11 cities,32 countries and 100 towns in 2010,with an incidence rate of 0.33/106.The fatality rate was 11.2％.Data showed that the patients were from hilly areas at the altitude elevated between 28-940 meters.The epidemic period was between April and December with the peak from May to September.The youngest case was an 11-year old,while the eldest was 81 with median age as 56-year old.95.3 ％ of the patients were farmers.All Patients did not have the history of traveling,two weeks before the onset of SFTS.93.6％ of the patients engaged in different kind of work which was associated with agriculture.52.8％ of the patients had been exposed to ticks.22.0％ of the patients had been bitten by ticks.Skin injury was found in 64.2％ of the patients.Samples from 129 cases (68.6％) were collected and detected,with 67.4％ of them (87 cases) showed positive by Real time-PCR for SFTS virus.An elevation in antibody titer by a factor of four or evidence of sero-conversion was observed in 11 patients; SFTS virus was isolated from 2 patients.The total antibody positive rates were 3.8％,55.0％ (6/11 ),36.7％ (2/3) and 80.0％ (4/5) respectively in healthy population,dogs,sheep and cows.Ticks from grass,cattle and sheep were detected positive by Real time-PCR.Conclusion Most cases of SFTS in Hubei were infected by SFTS virus,and cases of livestock were infected by SFTS virus.Ticks might serve as an important vector.Skin injury,exposure to tick bites seemed to be the risk factors.

The changes in effective components of Juglans mandshurica at different harvest periods were analyzed by UPLC-Q-TOF-MS/MS. Eighteen batch samples of J. mandshurica from six harvest periods were assessed by multivariate statistical analysis with Markerview software. The formula of different compounds were determined by accurate mass and isotopic abundance ratio from target screening function of Peakview 2.0/Masterview1.0 software. Then their structure were determined by analysis of MS/MS fragment or comparison with standard substances and references. Naphthoquinone are the major markers in samples of Juglans mandshurica from different harvest periods. Thirty-eight of naphthalenequinones were identified or inferred in J. mandshurica and contents decline gradually. UPLC-Q-TOF-MS method which develops a new strategy can identify and analyze chemical constituents from J. mandshurica rapidly and accurately, main chemical constituents can be used for quality evaluation and efficacy material research. The dynamic changes in the metabolite accumulation of J. mandshurica the basic data for harvesting medicinal plants at different times.