OBJECTIVE:To establish the method for simultaneous determination of gallic acid,rosmarinic acid,liquiritin and ammonium glycyrrhetate in Regan saibisitan granules. METHODS:RP-HPLC method was adopted. The determination was per-formed on Waters RP-C18 column with mobile phase consisted of acetonitrile-0.2% phosphoric acid (gradient elution) at the flow rate of 1.0 mL/min. The detection wavelengths were 210 nm(gallic acid,rosmarinic acid and liquiritin),230 nm(ammonium glyc-yrrhetate). The column temperature was 28 ℃,and sample size was 20 μL. RESULTS:The linear ranges were 0.2744-7.546 μg for gallic acid(r=0.9998),0.1870-5.143 μg for rosmarinic acid(r=0.9996),0.1300-3.575 μg for liquiritin(r=0.9999)and 0.2540-6.985μg for ammonium glycyrrhetate(r=0.9998),respectively. The LOQ were 2.67,1.36,1.09 and 2.11 ng,respective-ly. The LOD were 1.03,0.62,0.87 and 0.91 ng,respectively. RSDs of precision,stability and repeatability tests were all less than 2.0%. The average recoveries were 97.26%-101.00%(RSD=1.1%,n=9),97.66%-101.80%(RSD=1.3%,n=9),97.45%-101.70%(RSD=1.4%,n=9),97.74%-101.70%(RSD=1.4%,n=9). CONCLUSIONS:The method is simple,accurate and reproducible, and can be applied for simultaneous determination of gallic acid,rosmarinic acid,liquiritin and ammonium glycyrrhetate in Regan saibisitan granules.

Objective To explore the executive function in patients with mild traumatic brain injury (mTBI). Methods The evaluation of executive function was conducted in 63 mTBI patients in 1 week, 1, 3 and 6 month after injury and 60 health controls. The executive function was evaluated using Trail Making Test (TMTA), Hopkins Verbal Learning Test-revised (HVLT-R), Brief Visuospatial Memory Test-revised (BVMT-R), Stroop Color Word Tes and Con-tinuous Performance Test (CPT). Results There were significant differences between mTBI patients and controls in TM-TA, HVLT-R, BVMT-R, Stroop Color Word Test and CPT a week following TBI (P<0.05). There were a significant in-crease in scores of TMTA and a significant decrease in HVLT-R, BVMT-R, stroop and CPT-IP at 1, 3 and 6 month compared with 1 week following TBI (P<0.05). There were a significant decrease in TMTA and a significant increase in BVMT-R and stroop 1 month compared with 1 week following TBI (P<0.05). There were a significant increase in stroop, BVMT-R and CPT-IP at 3 month compared with 1 month following TBI (P<0.05). There was a significant increase in stroop and CPT-IP at 6 month compared with 3 month following TBI (P<0.05). Conclusions Patients with mTBI have executive function impairment. The recovery times of different executive function are different in patients with mTBI.

Objective To systematically evaluate the comprehensive effect of subglottic secretion drainage (SSD) on patients with mechanical ventilation (MV) in intensive care unit (ICU). Methods The randomized controlled clinical trials (RCTs) comparing SSD (intervention group) versus non-SSD (control group) in adult patients with MV in ICU was collected through the databases such as the PubMed database of the National Library of Medicine, CNKI, Wanfang database and the Chinese journal of science and technology database (VIP). The subjects were ICU patients with MV, and the retrieval time ranged from January 2006 to December 2016. Two reviewers independently screened the studies according to the inclusive and exclusive criteria, extracted the data, and assessed the quality. Then RevMan 5.3 software was used for Meta-analysis. Sensitivity analysis was performed using Stata 11.0 software. Funnel plot was used to analyze publication bias. Results In the 1004 documents obtained from preliminary screening, a total of 13 studies involving 2052 patients were enrolled after excluding duplicated documents and literature did not meet the inclusion criteria, with 1021 patients in intervention group, and 1031 in control group. Meta-analysis showed that compared with control group, the application of SSD in patients with MV could contribute to the reduction of the incidence of ventilator-associated pneumonia [VAP; risk ratio (RR) = 0.54, 95% confidence interval (95% CI) = 0.46-0.64, P < 0.00001], the duration of MV [mean difference (MD) = -3.29, 95%CI = -4.53 to -2.05, P < 0.00001] and length of hospital stay (MD = -4.27, 95% CI = -7.36 to -1.18, P = 0.007) were shortened, while there was no significant difference in ICU or hospital mortality rate between the intervention group and control group (RR = 0.89, 95%CI = 0.73-1.09, P = 0.25). The sensitivity analysis for studies enrolled in Meta-analysis of MV duration showed that individual research results were stable through step remove of the included literatures and combined calculation of the remaining literature value, suggesting that individual research results were stable, and would not have a significant impact on the overall results. The results of the funnel analysis showed that there was a symmetry in the inclusion studies, and no significant publication bias was found. Conclusions SSD did have effect in reducing the incidence of VAP, shortening the duration of MV and length of hospital stay, while there was no significant effect on reducing mortality rate. Effective use of SSD is an important measure to prevent VAP. It is necessary to objectively evaluate the clinical effect of SSD.

OBJECTIVE:To provide reference for the optimization of automatic system in outpatient pharmacy of the hospital. METHODS:Based on PDCA(Plan,Do,Check and Action)cycle management,the modules for adding and dispensing drugs of the automatic system in the outpatient pharmacy were optimized and the work records and quality indexes before (July-September in 2013) and after (May-July in 2014) the optimization were compared. RESULTS:By the optimization of the software system, hardware equipment and staff training,the error rate of adding drugs was reduced by 95%,daily box number of added drugs was increased by 30.9%,monthly box number of drugs damaged by the machine was decreased by 80%,the error rate of dropping drugs was decreased by 96.6%,and the frequency of machine fault was decreased by 87.5%,compared with before. CONCLU-SIONS:By PDCA cycle management,the work efficiency of automatic outpatient pharmacy can be improved,and the errors of prescription dispensing are reduced.

BACKGROUNDNovel influenza A viruses of avian-origin may be the precursors of pandemic strains. This descriptive study aims to introduce a novel avian-origin influenza A (H10N8) virus which can infect humans and cause severe diseases.

METHODSCollecting clinical data of three cases of human infection with a novel reassortment avian influenza A (H10N8) virus in Nanchang, Jiangxi Province, China.

RESULTSThree cases of human infection with a new reassortment avian influenza A(H10N8) virus were described, of which two were fatal cases, and one was severe case. These cases presented with severe pneumonia that progressed to acute respiratory distress syndrome (ARDS) and intractable respiratory failure.

CONCLUSIONThis novel reassortment avian influenza A (H10N8) virus in China resulted in fatal human infections, and should be added to concerns in clinical practice.

Aged ; Antiviral Agents ; therapeutic use ; Female ; Fluoroquinolones ; therapeutic use ; Humans ; Imipenem ; therapeutic use ; Influenza A Virus, H10N8 Subtype ; drug effects ; pathogenicity ; Influenza, Human ; complications ; diagnosis ; drug therapy ; Male ; Middle Aged ; Oseltamivir ; therapeutic use

Objective To investigate correlation between demyelination and caspase-12 expression alteration after compressed spinal cord injury (CSCI) so as to discuss mechanism of demyelinating lesion after CSCI.Methods Seventy-five adult SD rats were randomly divided into five groups,ie,normal group,control group,compression 1 d,3 d and 7 d groups,with 15 rats per group.Models of spinal cord compression were established with a self-made device.Ultrastructure of the demyelinated nerve fibers was observed by electronic microscope and oligodendrocyte apoptosis was detected by TUNEL staining and double labeling immunofluorescence.Immunoblotting was used to defect caspase-12 that was related to cell apoptosis.Results Demyelination of nerve fiber occurred after CSCI and was aggravated with time.Apoptosis of oligodendrocytes was found after CSCI,and showed significant difference between compression 7 d group and normal group (P ＜ 0.05).Caspase-12 was also upregulated with extension of compression time.Conclusion Caspase-12 mediating oligodendrocyte apoptosis is one of the mechanisms of nerve fiber demyelination after CSCI.

Objective To investigate the role of demyelination and the alteration of chondrotin sulfate proteoglycan (CSPG,NG2) expression after compression injury of the spinal cord (CSCI).Methods Seventy-five adult Sprague-Dawley rats were randomly divided into a normal group,a sham-operation group,a CSCI 1 day group,a CSCI 3 day group,and a CSCI 7 day group.There were 15 rats in each group.The injuries in the CSCI groups were inflicted using a technique devised in our laboratory.Basso-Beattie-Bresnahan (BBB) neurological function assessment was used to assess the rats' motor function,osmic acid staining and transmission electronic microscopy (TEM)were used to observe any pathological changes of myelinated nerve fibers in the white matter at 1,3 and 7 days after CSCI.The amount of myelinated nerve fibers in the posterior funiculus of the spinal cord and the ratio of myelin sheath thickness to axon diameter (the G-ratio) were calculated.Any alteration in NG2 expression was observed by Western blotting.Results The average neurological function assessment scores in the CSCI groups were (1.23 ±0.45),(0.65 ± 0.35) and (0.00 ± 0.00) respectively.Compared with the normal group (21.00 ± 0.00) and the sham operation group (21.00 ± 0.00),the differences were all statistically significant.The rats' motor function deteriorated gradually with time after the CSCI.Osmic acid staining showed that the white matter was intact in the normal and sham groups.After being compressed the myelinated nerve fibers became swollen,degenerated and broke down.The amount of myelinated nerve fibers in the normal group,the sham operation group and the three CSCI groups was (2771 ± 108),(2675 ± 199),(2403 ± 161),(1708 ± 70) and (8 10 ± 95) respectively.The amount of myelinated nerve fibers decreased in the CSCI groups and reached a minimum on the 7th day.The difference was statistically significant.The TEM quantity analysis showed that the G-ratios in the normal,sham operation,and CSCI 1 day,3 day and7 day groups were (18.10±0.4),(17.70±1.0),(6.69 ±0.8),(5.73 ±0.4) and (4.95 ±0.5) respectively.Compared with the normal and sham operation groups,the G-ratios in the 3 CSCI groups were lower and reached their minimum on the 7th day after injury.The difference was statistically significant.TEM observation showed that the axons and myelin sheaths were intact in the normal and sham groups.After CSCI the axons became swollen and cell organelles in the axoplasm degenerated and decreased.The layers of myelin sheath shrank,folded and even wrinkled,which had an onion-like appearance.The oligodendrocytes exhibited chromatin condensation.Macrophages showed infiltration.Western blotting showed that the expression of NG2 in the CSCI groups reached a maximum on the 1st day after injury and then decreased with time.The expression of NG2 in the CSCI groups was higher than in the normal and sham groups,and the difference was statistically significant.Conclusion Demyelination occurs after CSCI-the amount of myelinated nerve fibers decreases and neurological deficits increase with time.The expression of NG2 was associated with changes in the myelin sheaths after CSCI and contributed to recovery of the myelin sheath through proliferation and differentiation to oligodendrocytes and perhaps other kinds of cells.

Objective To observe the effects of electro-acupuncture on the expression and inhibition of DNA binding protein 2 (Id2) and myelin basic protein (MBP),and to explore the mechanism of remyelinization after compressive spinal cord injury (CSCI) in rats.Methods Fifty-four SD rats were randomly divided into a control group and a treatment group,and each was further subdivided into 3 time point subgroups:3,7 and 14 days.There were 9 rats in each subgroup.The CSCI models were made with a self-designed method.The acupuncture points Jiaji (EX-B2),bilateral Zusanli (ST36) and Taixi (KI3) were selected for treatment.Electro-acupuncture (continuous wave,2 Hz,1.5 V)was applied to the bilateral Zusanli (ST36) and Taixi (KI3) points.The control group received the injury but no treatment.The changes in the ultrastucture of the nerve fibers＇ white matter were de-termined by transmission electron microscopy (TEM).The alterations in the expression of MBP and Id2 were observed by double labeled immunofluorescence and Western blotting on the 3rd,7th and 14th day after the injury.Results TEM showed that the myelin sheaths in the control group had degenerated,swollen,and even broken down after CSCI.Changes to the myelin sheaths in the treatment group were milder than those in the control group.The immunofluorescence results showed the amount of Id2-immunoreactive oligodendrocytes in the control group to be (20 ±2) on the 3rd day after CSCI,becoming (16 ± 1) on the 14th day.The differences among the 3 control subgroups were not statistically significant.The amount of Id2-immunoreactive oligodendrocytes in the treatment group was (13 ± 1) on the 3rd day,reaching a minimum the 14th day.The differences among the 3 treatment groups were statistically significant.The differences compared with the control group at the same time points were also statistically significant.Western blotting showed that the expression of Id2 in the contrast and treatment groups was (1.12 ±0.12) and (0.67 ±0.01) respectively on the 3rd day after CSCI,and both decreased with time.The expression of Id2 in both groups reached their minima ((0.86 ±0.02) and (0.25 ±0.01) respectively) on the 14th day.The difference between the treatment groups and the contrast group was statistically significant at each time point.The expression of MBP in the contrast and treatment groups at day 3 was (0.44 ± 0.02) and (0.67 ± 0.04) respectively,and these increased with time.The expression of MBP in both groups peaked at the 14th day (at (0.95 ± 0.04) and (1.74 ± 0.09) respectively).These differences were again statistically significant.Conclusion Electro-acupuncture can regulate the expression of Id2 and MBP after CSCI.The down-regulation of Id2 which controls MBP negatively and the up-regulation of MBP may contribute to remyelination in the injured spinal cord.

Objective To investigate the clinical efficacy of purging fu-organs traditional Chinese medicine (TCM)therapy for treatment of patients with severe pneumonia and sthenia-heat. Methods According to random number table method,71 patients with sthenia-heat of severe pneumonia were divided into a treatment group (35 cases)and a control group(36 cases). Conventional basic treatment was given to both groups,and additionally, small chengqi decoction was applied nasogastrically for the therapy in treatment group for 2 weeks. The clinical pulmonary infection score(CPIS),Marshall score,integration score of TCM syndromes and the mortalities in 28 days and 60 days were used to compare the clinical efficacy of the two groups. Results With the prolongation of treatment,the CPIS,Marshall score and integration score of syndromes in the two groups were gradually decreased. In treatment group,CPIS and Marshall scores were lower than those of control group on the 4th day ,and there were statistically significant differences(CPIS score:5.8±1.7 vs. 6.8±1.9,Marshall score:5.3±2.3 vs. 6.6±2.7,both P<0.05);the above 2 scores in treatment group were also lower than those of control group on the 7th and 14th day after treatment(7th day CPIS score:5.3±1.5 vs. 5.6±1.4,Marshall score:5.1±1.9 vs. 5.7±1.8;14th day CPIS score:3.9±1.7 vs. 4.4±2.3,Marshall score:4.2±1.9 vs. 4.9±2.5),but there were no statistically significant differences(all P>0.05). In addition,the integration scores of syndromes were significantly decreased on the 4th, 7th and 14th day in the treatment group significantly lower than those in the control group(4th day:7.6±2.3 vs. 10.6±2.7,7th day:7.4±2.5 vs. 9.2±2.1,14th day:6.1±1.9 vs. 8.3±2.4,all P<0.05). However,there were no statistically significant differences in mortality rates in 28 days and 60 days respectively between control group and treatment group(28 days:16.7% vs. 11.4%,60 days:25.0% vs. 20.3%,both P>0.05). Conclusion Purging fu-organs therapy not only can decrease the CPIS and Marshall scores of patients with sthenia-heat of severe pneumonia,but also can improve their syndromes.

This paper proposed the idea of building the applied anatomical experiment and research platform for surgical postgraduates with professional degree,establishing double-tutorial system and applying applied anatomical teaching in basis course learning,clinical skill training and research capacity cultivating after analyzing the reasons of poor applied anatomical background of surgical postgraduates with professional degree.These ideas were intended to improve the cultivation quality.