Objective To explore the clinical efficacy of Toutongning capsule combined with nimodipine in the treatment of 76 patients with primary vascular headache.Methods 76 patients with primary vascular headache were selected as the research subjects.According to the different surgery,the patients were randomly divided into control group (n =38) and observation group (n =38).The control group was given compound Danshen injection,while the observation group was given Toutongning capsule combined with nimodipine.The efficacy,the peak systolic velocity(Vs) and pulsatility index(PI) of each vessel,the time of stopping pain,recurrence rate and adverse reaction were compared between the two groups.Results The total effective rate of the observation group was 94.74％,which was higher than 84.21％ of the control group,the difference was statistically significant (x2 =4.785,P ＜ 0.05).The MCA,ACA,BA,VA value of Vs and PI,the time of stopping pain and recurrence rate in the observation group were better than those in the control group (t =5.385,6.834,7.407,6.651,4.032,5.716,6.203,5.016,4.785,x2 =5.473,all P ＜ 0.05).There were no significant differences between the two groups in PCA value of Vs and PI and adverse reaction(t =0.283,0.037,x2 =0.314,all P ＜ 0.05).Conclusion Toutongning capsule combined with nimodipine in the treatment of primary vascular headache has high application value and significant effect,and it can promote cerebral circulation,blood flow,time of stopping pain and recurrence rate,so it is worthy of clinical popularization and application.

Objective To explore the effect of Xingnaojing injection on cognitive function recovery in patients with acute cerebral infarction. Methods 100 patients with cerebral infarction who were hospitalized from November 2015 to October 2016 were selected and randomly divided into experimental group and control group, with 50 cases in each group.The patients in the control group were treated with routine treatment of cerebral infarction, including treatment of blood circulation, intravenous drip of mannitol to reduce intracranial pressure, subcutaneous injection of low molecular weight heparin sodium anticoagulant, control of blood pressure and blood glucose to appropriate level, and prevention of venous thrombosis.On the basis of the control group, the experimental group received Xingnaojing injection treatment , according to moderate moderation dose and drip rate.We adjusted the dosage and the drop rate according to the illness.The cognitive function was assessed by using Montreal Cognitive Assessment Scale ( MoCA) and minimum mental state examination (MMSE) at admission and after one month of treatment.Results At one month after treatment, the MoCA score of the experimental group and the control group was (27.44 ±2.97), (25.08 ±0.54) respectively, which was higher than that before treatment, but the experimental group was significantly higher than the control group, the difference was statistically significant ( P<0.05 ) .The MMSE scores of the experimental group and the control group were (21.06 ±1.43), (20.29 ±1.16) respectively, the score did not changed compared with before treatment, and the difference was not statistically significant.Conclusion Xingnaojing injection can improve cognitive impairment in patients with acute cerebral infarction, MoCA is better than MMSE in assessmenting the cerebral infarction patients cognitive situation.

Objective: To investigate the value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension (PAH). Methods: In this prospective study, 51 patients with PAH diagnosed by right heart catheterization in east hospital and south hospital of Renji hospital affiliated to school of medicine of Shanghai Jiaotong University from September 2015 to July 2017 were enrolled as PAH group from July to November 2017. Meanwhile, 26 healthy volunteers with age and sex matched with pulmonary hypertension patients were recruited as control group. The patients were aged (45.8±15.5) years old in PAH group, and there were 6 males and 45 females. The healthy volunteers were aged (45.4±14.6) years old in control group, and there were 4 males and 22 females. Two-dimensional and four-dimensional echocardiographic images were obtained to measure the structure and function of the right heart. The myocardial strain of each ventricle and atrium was measured by sparkle tracking. The patients in PAH group were followed up from July 2017 to August 2018 to observe the endpoint events including all-cause death, re-hospitalization, and clinical deterioration. Results: There were significant differences in two-dimensional echocardiographic parameters(including tricuspid annular plane systolic excursion (TAPSE), right ventricular area change fraction (FAC), and right ventricular systolic pressure (RVSP)), speckle tracking parameters (including global longitudinal systolic peak strain of left ventricle (LVGLS), global longitudinal systolic peak strain of right ventricle (RVGLS),left atrial reservoir function(LASr), left atrial conduit function (LASc), left atrial pump function (LASp), right atrial reservoir function (RASr), right atrial conduit function (RASc), and right atrial pump function (RASp)), and four-dimensional echocardiographic parameters(including right ventricular end diastolic volume (RVEDV) , right ventricular end systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular freewall longitudinal strain(RVLSf), interventricular septum longitudinal strain(IVSLS), right ventricular ejection fraction(RVEF)) between control group and PAH group (all P<0.01 or 0.05).Spearman correlation analysis showed that RVEF was correlated with 6-minute walking distance (r=0.540, P<0.001), B-type natriuretic peptide (r=-0.545,P<0.001), New York Heart Association (NYHA) cardiac function classification(r=-0.583, P<0.001), TAPSE(r=0.595, P<0.001), LVGLS (r=-0.461, P=0.001) ,LASc (r=0.453, P=0.002) ,RASc (r=0.532, P<0.001) ,RVESV (r=-0.418, P=0.004) , RVSV (r=0.351, P=0.017) , and IVSLS (r=-0.450, P=0.002) . Pearson correlation analysis also showed that RVEF was correlated with FAC(r=0.579, P<0.001),RVSP (r=-0.442, P=0.002) ,RVGLS (r=-0.521, P<0.001) , LASr (r=0.483, P=0.001) , RASr (r=0.617, P<0.001) , RASp (r=0.513, P<0.001) , and RVLSf (r=-0.592, P<0.001) .After a follow-up of (10.4±2.7) months, there were 4 all-cause deaths, 5 re-hospitalizations and 5 clinical deterioration. Multivariate Cox regression analysis showed that increased RVEF was independent protective factor for end-point events in PAH patients (HR=0.702, P=0.043), and increased RVSP was independent risk factor for end-point events in PAH patients (HR=1.083, P=0.017). The receiver operating characteristic (ROC) curve showed that RVEF and RVSP could be used to predict the end-point events in PAH patients. The area under the curve (AUC) was 0.835(P=0.001) and 0.820(P=0.001), respectively. Conclusions RVEF measured by four-dimensional echocardiography is correlated with right ventricular function parameters measured by two-dimensional echocardiography and can be used to estimate the prognosis of PAH patients. The right atrial and left atrial function assessed by speckle tracking can also reflect the right ventricular function to a certain extent.

Objective:To investigate the normal range of exhaled nitric oxide in healthy children aged 6-18 in Jinan.Methods:The healthy school children aged 6-18 in Jinan from October 11 to 26, 2017 were selected for questionnaire survey, physical examination and exhaled nitric oxide test.The levels of mouth exhaled nitric oxide at the flow rate of 50 mL/s (FeNO 50) and mouth exhaled nitric oxide at the flow rate of 200 mL/s(FeNO 200), alveolar nitric oxide (CaNO), and nasal exhaled nitric oxide at the flow rate of 10 mL/s(FnNO 10) were measured by the electroche-mical method.The distributions of FeNO 50, FeNO 200, CaNO and FnNO 10 were analyzed, and their correlations with gender, age, height and body mass index (BMI) were discussed by the multiple linear regression model. Results:A total of 772 healthy children were enrolled in this study, including 364 males and 408 females, with a median age of 12.1(11.8-12.3) years old, a median height of 154.8(153.6-156.0) cm, and a median BMI of 20.3 (20.0-20.6) kg/m 2. The measured values of FeNO 50, FeNO 200, CaNO and FnNO 10 fluctuated in the range of 3.0-168.0 ppb, 2.0-44.0 ppb, 0.5-44.2 ppb and 0-1 253.0 ppb, respectively.FeNO 50, FeNO 200 and CaNO values showed skewed a distribution, and their 95% upper limits were 35.0 ppb, 13.3 ppb and 8.5 ppb, respectively.The geometric mean(95% CI) of FeNO 50 in males (95% CI)[14.6 (13.7-15.5) ppb] was significantly higher than that in females [13.3(12.7-14.0) ppb], and the difference was statistically significant ( Z=1.470, P=0.027). The multiple linear regression results suggested that, FeNO 50 was positively correlated with age and height ( β=0.023, 0.007, respectively, all P<0.05), and negatively correlated with BMI ( β=-0.016, P<0.05). The geometric mean (95% CI) of FeNO 200in males[7.1 (6.8-7.4) ppb] was significantly higher than that in females[6.4 (6.1-6.6) ppb], and the difference was statistically significant( Z=1.747, P=0.004). The multiple linear regression results suggested that, FeNO 200 was positively correlated with height ( β=0.005) and negatively correlated with gender(female β=-1.126) (all P<0.05). There was no significant difference between male and female in CaNO, which had no correlation with gender, age, height and BMI (all P>0.05). FnNO 10 showed a normal distribution, with a mean value of 456.2 ppb, 95% CI of 29.3-863.4 ppb.The geometric mean (95% CI) of FnNO 10 in males [408.7 (377.1-443.0) ppb] was significantly higher than that in females [368.8 (339.0-401.3) ppb], and the difference was statistically significant ( Z=1.722, P=0.005). The multiple linear regression results indicated that FnNO 10 was related to gender ( β=-36.098, P<0.05), and not correlated with age, height and BMI (all P>0.05). Conclusions:The normal ranges of FeNO 50, FeNO 200, CaNO and FnNO 10 in healthy children aged 6-18 in Jinan are 3.0-35.0 ppb, 2.0-13.3 ppb, 0.5~8.5 ppb and 29.3-863.4 ppb, respectively.FeNO 50 is correlated with age, height and BMI.FeNO 200 is correlated with gender and height.CaNO and FnNO 10 are not correlated with age, height or BMI.

In order to improve transformation efficiency of phytosterols into 9α-hydroxylation of 4-androstene-3,17-dione (9α-OH-AD) by Mycobacterium sp. LY-1, we studied the strains breeding using atmospheric and room temperature plasma (ARTP) technology and optimized their conversion process. A high production strain named C33 with a good genetic stability was selected and the product molar yield reached to 15.5%, 34.8% higher than that of original strain with 15 g/L phytosterols. Furthermore, the fermentation medium was optimized through the design of orthogonal experiment. Besides, oil-water bidirectional transformation system was set up to improve the 9α-OH-AD molar yield of mutant strain C33. With adding 12 mL soybean oil to each 1 g phytosterols, the molar yield of 9α-OH-AD reached 47.0%, which increased twice than that of control (15.5%).