Rotundine (1 micromol L(-1)) was incubated with a panel of rCYP enzymes (1A2, 2C9, 2C19, 2D6 and 3A4) in vitro. The remained parent drug in incubates was quantitatively analyzed by an Agilent LC-MS. CYP2C19, 3A4 and 2D6 were identified to be the isoenzymes involved in the metabolism of rotundine. The individual contributions of CYP2C19, 3A4 and 2D6 to the rotundine metabolism were assessed using the method of total normalized rate to be 31.46%, 60.37% and 8.17%, respectively. The metabolites of rotundine in incubates were screened with ESI-MS at selected ion mode, and were further identified using MS2 spectra and precise molecular mass obtained from an Agilent LC/Q-TOF-MSMS, as well as MS(n) spectra of LC-iTrap-MS(n). The predominant metabolic pathway of rotundine in rCYP incubates was O-demethylation. A total 5 metabolites were identified including 4 isomerides of mono demethylated rotundine and one di-demethylated metabolite. The results also showed that CYP2C19, 2D6 and 3A4 mediated O-demethylation of methoxyl groups at different positions of rotundine. Furthermore, the ESI-MS cleavage patterns of rotundine and its metabolites were explored by using LC/Q-TOF-MSMS and LC/iTrap-MS(n) techniques.

Adult ; Aged ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; epidemiology

Objective To study the efficacy of radical surgery for the invasion of chest wall by lung cancers and the different methods of chest wall reconstruction. Methods A retrospective analysis of clinical data was conducted in 27 cases of lung cancer with chest wall invasion in this hospital. 24 cases received lobectomy, 3 cases received pneumonectomy, and all cases received wall reconstruction. The size of chest wall defect after resection ranged from 6.5 cm × 5.4 cm × 5.0 cm to 15.5 cm × 12.5 cm ×10.0 cm. The number of rib resection for each patient ranged from 1 to 4. The reconstructive methods were as follows: using polyester fabric to reconstruct costal pleura, using plexiglass, stainless steel wire and grid-like titanium plate to reconstruct bone defect, and using nearby muscle flap and pedunculated muscle flap to reconstruct muscle defect. Results Pathologic diagnosis was non-small cell lung cancer,including 22 cases of squamous cell carcinomas and 5 adenocarcinomas. There were pulmonary infections in 6 cases, chest hemorrhage in 1 case and chest purulence in 1 case. One-year survival was 77. 9 %,3-yearsurvival was 58.3 %, and 5-year survival was 29. 1 %. Conclusion The lung cancer with chest wall invasion is advisable to make active use of radical surgery. The different methods and repair materials are chosen to reconstruct the chest wall defect, supplemented by comprehensive treatments.

Objective To evaluate the effect of awake tracheal intubation with intubating larynegeal mask airway (ILMA) on stress responses of hypertensive patients.Methods Sixty hypertensive patients,aged 45-64 yr,with body mass index of 20.3-27.5 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective abdominal surgery under general anesthesia,were divided into 2 groups (n=30 each) using a random number table:direct laryngoscope group (group D) and ILMA group (group I).At 3 min after topical anesthesia (T1),while epiglottis and glottis were exposed with direct laryngoscope in group D or during ILMA insertion in group I (T2),immediately after completion of intubation (T3),when the maximum change in hemodynamics after intubation appeared (at about 15 s after tracheal tubes were placed,T4),and at 5 min after completion of intubation (T5),mean arterial pressure (MAP) and heart rate (HR) were recorded,and blood samples were collected for determination of plasma epinephrine concentrations by radio-immunity method.Successful intubation at first attempt was recorded.Results Compared with the parameters at T1,the MAP,HR and plasma epinephrine concentrations were significantly increased at T2-4 in group D (P＜0.01),and no significant change was found in the parameters mentioned above at the other time point in group I (P＞0.05).Compared with group D,the MAP,HR and plasma epinephrine concentrations were significantly decreased at T2-4 (P＜0.01),and no significant change was found in the success rate of intubation at first attempt in group I (P＞0.05).Conclusion Awake tracheal intubation with ILMA does not induce strong stress responses and is helpful in avoiding the occurrence of cerebrovascular accidents,thus increasing the safty of awake tracheal intubation in hypertensive patients.

Objective To explore the relationship between resilience and coping style of cardiac valvular postoperative patients with cardiopulmonary bypass.Methods A total of 208 cardiac valvular postoperative patients with cardiopulmonary bypass were recruited from 4 cardiovascular surgery in Guangdong and were investigated with the self-designed questionnaire,Connor-Davidson Resilience Scale (CD-RISC),Medical Coping Modes Questionnaire (MCMQ).Results The average score of resilience in cardiac valvular postoperative patients with cardiopulmonary bypass was (55.38±10.63)points.The average score of tenacity,strength and optimism were (28.21 ±5.87)points,(18.21 ±4.02)and (8.96± 1.85)points respectively.The average score of coping style of confrontation,avoidance and acceptance-resignation were(18.13±3.38),(16.95±1.75)and (9.24±2.47)points respectively.All the sub-scores of the resilience were positively correlated with confrontation,and all the sub-scores of the resilience were negatively correlated with avoidance and acceptance-resignation.Conclusions There is a certain degree of correlation between resilience and copping style of cardiac valvular postoperative patients with cardiopulmonary bypass.Nurses should enhance resilience of the patients,guide the patients to adopt effective coping styles,to promote disease rehabilitation and improve the quality of life.

Objective To investigate the current status of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass and analyze its influential factor,and provide reference for effective intervention.Methods A total of 208 cardiac valvular surgery patients with cardiopulmonary bypass were recruited from 4 cardiovascular surgery in Guangdong and were investigated with the self-designed questionnaire,Mishel Uncertainty in Illness Scale (MUIS),Connor-Davidson Resilience Scale (CD-RISC),Medical Coping Modes Questionnaire (MCMQ),in the preoperative day and the day before discharge.The data were analyzed by single-factor and multiple-factor analysis.Results The average score of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass was 99.09±11.41,and 92.3％ of patients got a moderate uncertainty in illness level in the preoperative day.The average score of uncertainty in illness in the patients was 90.33± 10.32,and 91.8％ of patients got a moderate uncertainty in illness level in the day before discharge.Multiple linear regression indicated that,age,cardiac valvular disease types,number of cardiac valvular surgery,optimism and yield were the protective factors of uncertainty in illness level.Average monthly household income,self-improvement,scores of resilience and confront coping were the risk factors of uncertainty in illness level.Conclusion The level of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass is moderate.Age,average monthly household income,cardiac valvular disease types,number of cardiac valvular surgery,resilience and coping style are factors influencing uncertainty in illness level of patients.

Objective This study was performed to assess the clinical feasibility of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer.Methods Between March 2011 and May 2012,we retrospectively analyzed the data from 56 patients who underwent video-assisted mediastinoscopic lymphadenectomy(VAMLA).In patients receiving tumour resection subsequently,radicality of the previous mediastinoscopic dissection was controlled during thoracotomy.Results Mean operative time of video-assisted mediastinoscopic lymphadenectomy was(42.0 ± 13.5) min(range of 26-86 min).Mean number of resected lymph nodes was 12.4 ± 6.7 (range of 5-24).In video-assisted mediastinoscopic lymphadenectomy,the rates of lymph node dissection of stations 2,4,5,7,8 were 54.5％,92.7％,58.2％,100％,61.8％,respectively,there was no operative mortality and morbility.90.9％ patients achieved radical dissection.Conclusion Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure and provides more accurate staging of mediastinal node in lung cancer patients.It also plays an important role in minimal invasive surgery and neoadjuvant therapy.

The biotransformation, CYP reaction phenotyping, the impact of CYP inhibitors and enzyme kinetics of 3-cyanomethyl-4-methyl-DCK (CMDCK), a new anti-HIV preclinical candidate belonging to DCK analogs, were investigated in human intestinal microsomes and recombinant cytochrome P450 (CYP) enzymes. CMDCK (4 micromol L(-1)) was incubated with a panel of rCYP enzymes (CYP1A2, 2C9, 2C19, 2D6 and 3A4) in vitro. The remaining parent drug in incubates was quantitatively analyzed by a LC-MS method. CYP3A4 was identified as the principal CYP isoenzyme responsible for its metabolism in intestinal microsomes. The major metabolic pathway of CMDCK was oxidation and a number of oxidative metabolites were screened with LC-MS. The Km, Vmax, CLint and T1/2 of CMDCK obtained from human intestinal microsome were 45.6 micromol L(-1), 0.33 micromol L(-1) min(-1), 12.1 mL min(-1) kg(-1) and 25.7 min, respectively. Intestinal clearance of CMDCK was estimated from in vitro data to be 3.3 mL min(-1) kg(-1), and was almost equal to the intestinal blood flow rate (4.6 mL min(-1) kg(-1)). The selective CYP3A4 inhibitors, ketoconazole, troleandomycin and ritonavir demonstrated significant inhibitory effects on CMDCK intestinal metabolism, which suggested that co-administration of CMDCK with potent CYP3A inhibitors, such as ritonavir, might decrease its intestinal metabolic clearance and subsequently improve its bioavailability in body.

The acute phase of ischemic stroke patients are often treated with both Chinese patent medicine:and western medicine therapies in clinical practice. This research included 27,678 cases of the acute phase of ischemic stroke came from 14 3A level hospitals. We collected data from patients with ischemic stroke who used both Chinese patent medicine and western medicine and were hopitalized within 14 days from hospital information system (HIS). Constructing complex network of Chinese patent medicine and western medicine were found to show scale-free network. Hierarchical structure of the core algorithm was used to analyze the characteristics of combined core Chinese patent medicine and western medicine in admission condition of "acute", "critically", and "general" of ischemic stroke acute phase patient within one day, 2-3 days, 4-7 days and 8-14 days. We found that the core Chinese patent medicine mainly used for activate blood and resolve stasis medicine, and phlegm eliminating brain refreshing medicine in all kinds of patients, but the phlegm eliminating brain refreshing medicine were used to reduce with time elapsing. The core western medicine mainly used for anti-platelet medicine, improve circulation medicine, neuroprotective medicine, anticoagulants medicine and dehydration medicine. The dehydration medicine as the core western medicine for critically patients within 14 days, but the patients for general admission as core western medicine within 3 days. The neuroprotective medicine was used to decreases after 7 days in hospital. Combination of Chinese patent medicine and western medicine were mainly for neuroprotective medicine + activate blood and resolve stasis medicine, and anti-platelet medicine + activate blood and resolve stasis medicine, and improve circulation medicine + activate blood and resolve stasis medicine. The phlegm eliminating brain refreshing medicine was mainly combined with neuroprotective medicine by urgent and general admission condition patients, and it was more combined with dehydration medicine by critically admission condition patients. This research found that the dynamic characteristics for the combination of Chinese patent medicine and western medicine of acute phase of ischemic stroke patients by big data analytics and complex networks modeling, and provide basis for acute phase of ischemic stroke patients, it provide basis for ischemic stroke treatment strategy making.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Brain Ischemia ; drug therapy ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Stroke ; drug therapy

To assess whether the Shuxuening injection influences liver function, this paper analyzes the hospital information system (HIS) data from 20 national hospitals. The patients were divided two groups: patients (5 353 cases) using Shuxuening injection acted as the exposed group, then the patients (4 863 cases) not using Shuxuening injection acted as the unexposed group. Take the abnormal changes of alanine aminotransferase and aspartate aminotransferase indexes as the result. Control confounding factors by stratification analysis, classic logistic regression analysis, before logistic regression based on propensity score weighting method and logistic regression based on generalized boosted models (GBM) of propensity score weighted combination of covariate adjustment. Then, the study analyzes the effects of Shuxuening injection on liver function by observing the changes of the indexes. Analysis of the impact of parenterally administered Shuxuening on ALT shows that, before logistic regression based on propensity score, then the regression is -0.232 (P value is 0.017). However, after logistic regression based on propensity score method the regression became -0.150 (P value is 0.370). Whereas, analysis of the impact of parenterally administered Shuxuening on AST shows that, before logistic regression based on propensity score, then the regression is -0.034 (P value is 0.767). However, after logistic regression based on propensity score method the regression became -0.091(P value is 0.538). Thus, propensity score method can control a large number of confounding factors, making the results more close to the clinic. Hence, based on existing electronic medical data, this study didn't find that parenterally administered Shuexuening influences ALT and AST.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; Electronic Health Records ; Female ; Humans ; Injections ; Liver ; drug effects ; metabolism ; Logistic Models ; Male ; Middle Aged ; Young Adult