Objective To investigate the feasibility,safety and effect of gasless laparoscopic surgery used in patients at the second trimester.MethodsFrom Aug.2006 to Aug.2008,the data of 10 cases at gestational 15 - 24 weeks complicated by ovary benign tumors ( the diameters more than 5 cm) undergoing gasless laparoscopic surgery were studied retrospectively.Operation time,bleeding loss,period of hospitalization,the status of fetus and newborn babies,and peri-operative or postoperative complications were observed.ResultsAll 10 cases were treated by gasless laparoscopic surgery,including 4 cases with mature teratoma,5 cases with epithelial tumors and 1 case with ovarian endometrioma.The mean time of surgery was (30 ± 5) minutes,the mean bleeding in the surgery was (30 ± 8) ml,the mean period of in hospitalization was ( 6 ± 2 ) days.The blood gas ( pH:7.42 ± 0.11,7.41 ± 0.18,7.42 ± 0.12 ),blood pressure [ mean arterial pressure (MAP):(90.4 ± 3.1 ),(90.6 ± 0.7 ),( 89.7 ± 0.8) mm Hg( 1 mm Hg =0.133 kPa) ] and heart rates [ ( 84.0 ± 1.6),( 84.3 ± 1.7 ),( 82.7 ± 1.1 ) bpm ] in all cases at pre,peri and postoperative time did not show statistical difference ( P all ＞ 0.05 ).The fetal hearts were all in the normal range preoperative,intraoperative and postoperative time (P ＞ 0.05 ).No perioperative and postoperative complications were observed.All the cases underwent term delivery.Fetal weight and Apgar score did not show abnormality.ConclusionGasless laparoscopic surgery at the second trimester is feasible and safe to mother and fetus.

Objective To investigate the safety and efficacy of rotational atherectomy in coronary artery calcification lesions used domestic drug eluting stent.Methods Clinical data of 14 patients with 20 coronary artery calcification lesions were analyzed. The success rates and follow-up results of rotational atherectomy in coronary artery calcification lesions used domestic drug eluting stent were analyzed.Results Procedural success was achieved in all patients.No main adverse cardiovascular events (including cardiac death, Q wave myocardial infarction and emergency coronary surgery) occurred during operation. 9 patients (64.3%) were checked by coronary angiography after 9 months, and no one was found with in-stent restenosis. Conclusion Rotational atherectomy in coronary artery calcification lesions used domestic drug eluting stent is effective and safe in the treatment of coronary artery calcification lesions, it can increase the success rate of percutaneous coronary intervention .

Objective To investigate the clinical treatment of infective endocarditis with vegetations in pregnant women and the outcomes of the gestation. Methods Nine cases of pregnant women diagnosed as infective endocarditis with vegetations in Beijing Anzhen Hospital, Capital Medical University from January 2001 to October 2015 were enrolled in retrospective analysis. Consultations were held by doctors from department of obstetrics, anesthesiology, cardiology, cardial surgery and extracorporeal circulation to decide the individualized treatment plan for the 9 cases of pregnant women after admissions. Clinical treatments including general treatment, anti-infection treatment, cardiac surgery, and termination of pregnancy surgery were completed through collaboration among related departments. The clinical characters, therapeutic regimens, maternal and neonatal outcomes of the 9 cases were analyzed. Results (1)Clinical characters: the ages of the 9 cases of pregnant women were from 25 to 36 years old. The onset gestational ages were from 19 to 36 weeks. Clinical symptoms: fever, cough, sputum and progressive anemia were the main symptoms. Patients had cyanosis of lips, could not lie on the back or even be orthopnea, when heart failure happened. Heart murmur was audible and splenomegaly was touched in physical examination. Blood cultures were positive. Basic heart disease types: 7 cases of congenital heart diseases included 2 cases of aortic insufficiency, 1 case of mitral insufficiency, 1 case of patent ductus arteriosus, 1 case of right ventricular outflow tract stenosis and 2 cases of ventricular septal defect.Two cases of rheumatic heart diseases included 1 case of mitral stenosis, 1 case of mitral stenosis after artificial disc changed and jammed. According to endocardial vegetations attached position there were 3 cases of mitral valve vegetations, 2 cases of pulmonary valve vegetations, 3 cases of aortic vegetations and 1 case of right ventricular outflow tract neoplasm. Preoperative heart function classification:1 case of levelⅡ, 3 cases of levelⅢ, 5 cases of levelⅣ.(2)Treatments:general treatment included oxygen uptake, rest in bed, cardiac strengthen and diuretic therapy, etc. Combined and adequate antibiotics were applied in anti-infection treatment according to drug sensitive test. Nine cases of pregnant women were all performed surgical treatment of heart diseases and removal of the endocardial vegetations. Caesarean sections were performed for 2 cases in second trimester and for 7 cases in last trimester. Cardiac surgery and caesarean section were operated in 6 cases at the same time among 22-34 weeks of pregnancy. Cardiac surgery were respectively operated in 2 cases 11 days and 32 days after the caesarean section at 33, 37 weeks of pregnancy. While Cardiac surgery was operated (at 26 weeks of pregnancy) before the caesarean section (at 37 weeks of pregnancy) in another 1 case. (3) Maternal and neonatal outcomes:7 cases of pregnant women were rescued successfully, while 2 cases of pregnant women were death. Postoperative heart function classification: 1 case of level Ⅰ, 2 cases of levelⅡ, 4 cases of levelⅢand 2 cases of levelⅥ. Neonatal survivals were 6 cases including 2case of full-term infants, 4 cases of preterm infants. Stillbirth or neonatal death were 3 cases, which included 2 cases performed caesarean section in second trimester and 1 case of very low weight infant who was given up treatment by family because of severe asphyxia. Followed up periods were from 1 to 7 years with an average time of (2.0 ± 1.6) years. Infants and young children grew and developed well during the period of follow up. Conclusions The risk is extremely high of pregnancy with infective endocarditis with vegetations. But there is still a way to save the maternal and neonatal life by using a multidisciplinary collaboration formulation and implementation of individualized treatment plan and selecting the appropriate time for heart surgery and the termination of pregnancy.

plus stented elephant trunk implantation (Bentall+Sun′s surgery), aortic root replacement (Bentall surgery), stent implantation, thoracic and abdominal aorta replacement. The aortic operation time of the 19 patients were 5 gestational weeks to 1 month after delivery. The relation between aortic operation and the termination of pregnancy: 4 patients underwent aorta surgery after termination of pregnancy, 9 patients had cesarean section and aorta surgery at the same time, 6 patients underwent aorta surgery before cesarean section. ②5 patients did not receive arota surgery, 2 patients of type A dissection and 1 patient of type B dissection died before the surgery;2 cases of type B dissection underwent conservative treatment. The termination time of pregnancy was 6-37 gestational weeks, with the average of (26 ± 10) weeks. (3)Maternal and fetal outcomes:20 patients survived after treatment (83%,20/24) and 4 patients died (17%,4/24). 10 cases were live births, including 4 full-term infants and 6 preterm premature infants. The birth weight of the neonates was 1 080-3 800 g, with the average of (2 302±764) g. Three of them were very low birth weight infants and 1 was low birth weight infant;3 neonates had mild asphyxia. The neonates were followed up for 0.5 to 10 years, with the average time of (1.4 ± 1.7) years. So far the infants′ development was good.Conclusions Pregnancy with aortic dissection is pernicious. Early identification, prompt diagnosis and prompt interventing of the vascular surgery are necessary to the safety of mother and fetus.

Objective:To improve the quality standard for Qingyuantiaozhi capsules. Methods:The main components of the prep-aration, such as Chrysanthemum, Anthraquinones, Hawthorn and Radix Rehmanniae Preparata, were identified by TLC qualitatively. The content of chlorogenic acid in chrysanthemum was determined by HPLC. A DIKMA Spursil C18(250 ×4.6 mm,5 μm)column was used with methanol-0. 2% phosphoric acid solution(9 ∶91) as the mobile phase. The flow rate was 1. 0 ml·min-1, the detection wavelength was set at 327 mn and the sample size was 20 μl. Results:The spots in TLC were clear without any interference. The cali-bration curve was linear within the range of 4. 425 2-30. 976 4μg·ml-1(r=0. 999 9) for chlorogenic acid. The average recovery was 101. 18% (RSD=1. 88%, n=6). Conclusion:The improved quality standard is specific, accurate and reproducible, which can be used for the quality control of Qingyuantiaozhi capsules.

Aspirin (AS) has been widely used globally for preventing incidence of cardio-cerebral ischemic disease for nearly 100 years.The people who takes AS for long term may reach several hun-dred million,but many persons were died from interned bleeding.We found salvianolic acids (salvianolic acid B 57％,salvianolic acid A 1％,rosmarinic acid,35％,SA)was much better than AS in preventing in-cidence of cardio-cerebral ischemic disease,and may avoid hemorrhage risk in clinical application.The research are summary briefly as follows: (1) both AS and AS have same anti-platelet aggregation ef-fect,but their mechanism is different.AS inhibited both TXA2 and PGI2,SA inhibited TXA2only;(2)For established thrombosis,SA could dissolved it, AS showed no effect. The thrombolytic mechanism of SA has been elucidated. (3) In SHRSP rats, the incidence of stroke and death rate in SA group was distinct less that of AS group;(4)In MCAO rats,SA and Sal B decreased stroke index and neural im-pairment. AS showed no such ability; (5) There is microcirculatory disturbance in cardio-cerebral isch-emic disease. SA could improve circulatory disturbance induced by LPS, adrenaline, ROS and I/r. there is no any paper reported AS could have beneficial effect on above mentioned microcirculatory dis-turbance models;(6)Hyperlipidemia is an independent risk factor for cardio-cerebral vascular disease. SA could significant hypolipidemic effect which is similar to that of statins(atovastin and simvastin)and ten times stronger than omega-3.AS has no inhibitory effect on hyperlipidemia.(7)Thereis overproduc-tion of ROS induced by ischemic/reperfusion in cardio-cererbal vascular disease.SA showed more ro-bust,anti-oxidant capacity than VitC,Vit E,melatonin,edalavone and resveratrol,etc.SA is one of the most powerful anti-oxidant in the world so far.(8)According to literatures,1/3 patients who take AS for long time will have hemorrhage, we found in normal rats and mice (coagulating and hemodynamics) SA had no apparent effect on coagulation system and this property of SA was confirmed in clinic trial with hundred thousand cases; (9) As well known, neurodegenerative disease are divided into acute and chronic neurodegenerative disease,and both have similar pathogenesis.We proved that SA could inhibit Aβ aggregation and fiber formation, inhibit tau hyperphosphorylation induced by OA and p25/CDK5,as well as increase neurogenesis and angiogenesis.More importantly,SA showed not only pre-ventive effect on cardio-cerebral vascular diseases. SA has been finished clinical trial phase I-IV for treatment of stroke.The therapeutic effect of SA is characterized by inducing multi-target effect and in-hibit pathogenesis of early,middle and late stage of stroke.SA as anti-stroke new drug was approved by the state food and drug administration of China in 2011.

Immobilized penicillin acylase was used for bioconversion of penicillin G into 6-APA in aqueous two-phase systems consisted of a light-sensitive polymer PNBC and a pH-sensitive polymer PADB.Partition coefficients of 6-APA was found to be:about 5.78,in the presence of 1% NaCl.Enzyme kinetic showed that reaction reached equilibrium at 7h or so.The 6-APA mole yields were 85.3%(pH 7.8,and 20 ℃) and this value was about 20%higher than control in reaction of single aqueous phase buffer.Partition coefficient of penicillin G(Na) washardly changeable,while partition coefficient of product,6-APA and phenylacetate acid was significantly changeable.Reason is due to Donnan effect of phase systems andhydrophobicity of products.The change of partition coefficients of products also affects bioconversion yield of products.In the aqueous two-phase systems,substrate,penicillin G,products 6-APA and phenylacetate acid are biased in top phase,while immobilized penicillin acylase is completely partitioned in bottom.Substrate,penicillin G enters into bottom phase,and it is catalyzed into 6-APA and phenylacetate acid,then the products enter into top phase.Finally,inhibition of substrate and products is removed to result in improvement of products yield.Moreover,immobilized enzymehashigher efficiency than immobilized cells and occupy smaller volume.Comparing with free enzyme,immobilized enzymehashigher stability,longer use life,completely partitioned in bottom phase and recycle.Bioconversion in two-phase systems using immobilized penicillin acylase showed outstanding advantage.The light-sensitive copolymer forming aqueous two-phase systems could be recovered by laser radiation at 488 nm or filtrated 450 nm light,while pH-sensitive polymer PADB could be recovered by isoelectric point(pH 4.1).The recovery of the two copolymers was 95%~99%.

Aim To establish a combined method ofβ-glucuronidase hydrolysis and LC-MS-MS analysis for the determination of scutellarein in human plasma, and investigate the pharmacokinetics of scutellarin prepara-tion in healthy male volunteers. Methods Plasma samples were prepared by enzymolysis with β-glucu-ronidase and protein precipitation with methanol. The analytes scutellarein and quercetin ( IS ) were separa-ted on an Agilent ZORBAX SB C18 column ( 2. 1 mm × 150 mm, 5 μm) with the mobile phases consisting of acetonitrile, methanol and water. Multiple reaction monitoring ( MRM) on MS was used to monitor precur-sor to produce ion transitions of m/z 285. 0→136. 8 for scutellarein and m/z 301. 1→120. 8 for IS. After method validation, this method was applied to deter-mine the plasma concentration of scutellarein in 12 male volunteers following single oral administration of 120 mg scutellarin preparation. Drug And Statistic soft-ware (1. 0) was used to process data and the pharma-cokinetic parameters were calculated. Results The assay was validated with linear range of 4 . 01-513. 38μg · L-1 for scutellarein. The intra- and inter-batch precisions ( RSD%) were within 7. 22%. The absolute recoveries were more than 84. 23%. The pharmacoki-netic parameters after a single dose were as follows:Cmax (μg · L-1 ): 159. 97 ± 58. 14; AUC(0-19) (μg · L-1·h):1151. 37 ±279. 80; AUC(0-∞)(μg·L-1· h):1194. 13 ± 264. 51; Tmax ( h):6. 33 ± 1. 67; T1/2 (h):2. 83 ± 0. 60. Conclusion The assay method is proved to be sensitive, accurate and convenient. It can be successfully applied to a pharmacokinetic study of scutellarin in healthy male volunteers.

Aim To establish a LC-MS/MS method for the determination of hydroxysafflor yellow A ( QA ) in human plasma. Methods After being added into 0. 2M ammonium acetate (1∶1,V/V), QA was extrac-ted using solid-phase extraction technique, and the eluent was directly injected into LC-MS/MS systems. Agilent ZORBAX SB C18 (3. 0 × 100 mm, 3. 5 μm) column and isocratic elution system composing of meth-anol and 0. 2 mM ammonium acetate (70 ∶ 30, V/V) provided chromatographic separation of QA and internal standard isorhamnetin-3-O-neohespeidoside ( SLS) fol-lowed by detection with mass spectrometry. The mass transition ion-pair was followed as m/z 611 . 131→490. 900 for QA and m/z 623. 032→298. 800 for SLS. Results The retention time of QA and SLS was 2. 7 min and 3. 9 min respectively, with no interference in human blank plasma. The proposed method showed good linearity over the concentration range of 8. 57 ~4185 μg·L-1 for QA with a correlation coefficient≥ 0 . 9949 . The lower limit of quantitation was 8. 570 μg ·L-1 . The intra-batch and inter-batch precision and accuracy were within 7%. The average matrix effect ranged from 115. 72% to 119. 06% with RSD less than 5%. The average extraction recovery ranged from 77. 75% to 80. 76% with RSD less than 5%. Stability of human samples after 4 h at room temperature, after the three freeze-thaw cycles and after 31 days at -70℃, and post-preparative stability of the processed sam-ples after 24 h was acceptable. Plasma samples with the concentration beyond the upper quantitation limit could be accurately determined after being diluted using 6. 25 times ( V/V ) of human blank plasma. Conclusion Our current LC-MS/MS method is sensitive, accurate and convenient, and is proved to be suitable for the sys-tematic study on clinical pharmacokinetics of QA.

Objective To analyze Holder pasteurization,temperature and duration of frozen,duration of continuous breast milk pumping and types of pumping tube on macronutrients and total energy in breast milk and the circadian variation of macronutrients and energy content of breast milk.Methods Two hundred and two breast milk samples were collected from healthy mothers of 188 infants who were hospitalized in Department of Pediatrics,Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University from April 2016 to December 2016.Fat,protein,carbohydrate and energy contents of the breast milk samples were detected both before and after various processes to analyze the influence of Holder pasteurization,frozen storage conditions (temperature and time),duration of continuous pumping and types of pumping tube and to observe the variations within a single day.Paired t-test,repeated-measures analysis of variance,one-way analysis of variance and LSD-t test were used for statistical analysis.Results The contents of fat,protein and energy in breast milk were significantly decreased [(3.69 ± 0.98) vs (4.22 ± 1.00) g/dl,t=9.405;(2.12 ± 0.34) vs (2.21 ± 0.34) g/dl,t=4.785;(69.77±9.35) vs (74.94±9.53) kcal/dl (1 kcal=4.184 kJ),t=9.470],while the carbohydrate content was increased [(6.66±0.17) vs (6.62±0.17) g/dl,t=-3.442] after Holder pasteurization comparing with those before (all P＜0.01).Breast milk frozen at =80 ℃ had higher protein content than that frozen at-20 ℃ (Ftemperature=4.990,Ptemperature=0.027).Breast milk stored at-20 ℃ for 7,15,30,60 and 90 days showed significantly decreased fat,protein and energy contents as compared with those in fresh breast milk,while the carbohydrate contents in the breast milk samples stored at-20 ℃ for 15,30 and 60 days were significantly increased and that kept for 90 days were lower than those at 30 and 60 days (LSD-t test,P＜0.05).Compared with fresh breast milk,breast milk stored at-80 ℃ showed significantly decreased fat,protein and energy contents at 60 d and 90 d,but increased carbohydrate content at 60 d (LSD-t test,P＜0.05).Compared with fresh breast milk,breast milk which was pumped at 1,2 or 3 h through gastric tube (size 6,8 or 10) or transfusion connecting pipe had lower fat content (LSD-t test,P＜0.05).Compared with fresh milk,breast milk had lower energy content on condition that it was pumped through gastric tube size 6 at 2 or 3 h or through gastric tube size 8 or 10 or transfusion connecting pipe at 1,2 or 3 h (LSD-t test,P＜0.05).Breast milk secreted from 12:01 to 15:00 had higher fat and energy contents [(5.16±0.93) g/dl and (86.96±9.35) kcal/dl] than that secreted from 00:01 to 03:00[(4.54±0.75) g/dl and (80.77±7.75) kcal/dl],from 03:01 to 06:00 [(4.61 ±0.75) g/dl and (81.44±7.69) kcal/dl] or from 21:01 to 24:00 [(4.71 ± 0.88) g/dl and (82.44± 8.82) kcal/dl].Moreover,breast milk secreted from 09:01 to 12:00 had higher fat and energy contents [(5.01 ± 0.94) g/dl and (85.31 ± 9.62) kcal/dl] than that secreted from 00:01 to 03:00,and that secreted from 09:01 to 12:00 had higher fat contents than that secreted from 03:01 to 06:00 (LSD-t test,P＜0.05).Conclusions Fresh breast milk is better than processed milk to meet the infantile need for growth and development.