To study the related substances in nicergoline, electrospray positive ionization high resolution TOF/MS was used for the determination of the accurate mass and elemental composition of the related substances. Triple quadrupoles tandem MS/MS was employed for the determination of the fragmentations of the parent ions. 16 related substances were detected and identified to be eight synthetic by-products and eight degradation products, by using impurity references matching, product mass spectra fragmentations elucidation, and verified further according to synthetic processes and stress testing results. The results obtained are valuable for nicergoline manufacturing process control and quality assurance.
Chromatography, High Pressure Liquid ; Nicergoline ; chemical synthesis ; chemistry ; Quality Control ; Tandem Mass Spectrometry

Objective To assess the feasibility and safety of transradial puncture route for digital subtraction angiography (DSA)in young patients with ischemic cerebrovascular disease. Methods One hundred young patients with cerebrovascular disease who underwent whole brain angiography at the Department of Neurology,the 81 st Hospital of PLA were enrolled. They were divided into either a radial group (n =50)or a femoral group (n = 50)using a computer random number method. The time of puncture,success rate of puncture,success rate of selective angiography,exposure time,and incidence of complications were compared and analyzed. Results (1)The puncture time of the radial group was significantly longer than that of the femoral group,they were 3. 00 ± 0. 50 min and 1. 50 ± 0. 25 min respectively. There was significant difference (t = 18. 97,P < 0. 05). There were no significant differences in the success rate of puncture (98% vs. 100%),success rate of selective angiography (100% vs. 100%),and exposure time (5. 3 ± 2. 2 vs. 4. 8 ± 1. 7 min)between the two groups (all P > 0. 05). (2)The incidence of complications of the radial group (4%,n = 2)was significantly 1ower than that of the femoral group (18%,n = 9 ). There was significant difference between the two groups (χ2 = 5. 01,P < 0. 05 ). Conclusion Transradial route puncture for whole brain DSA in young patients with cerebrovascular disease is safely and feasible.

Objective To study the early clinical outcome of patients undergone minimally invasive direct coronary bypass(MIDCAB) surgery,and the mid-term patency of left internal mammary artery(LIMA)-left anterior descending(LAD) anastomosis.Methods From Jannuary 2007 to May 2014,47 cases underwent MIDCAB surgery in our department,with 35 males and 12 females,aged 48-76 years,with the average of (62.9 ± 8.1) years old.Types of LAD lesions were as followed:1 case was ostial total obstruction,28 severe stenosis at proximal segment,10 long and severe stenosis,3 calcified lesion with severe stenosis,5 myocardial bridge.All patients had symptomatic angina,typical myocardial ischemia could be detected by electrocardiogram for all patients with myocardial bridge.Comorbidities included:hypertension 38 cases,27 diabetes mellitus,3 COPD and 3 chronic kidney disease.Results All surgery went well without transfer to mid-sternotomy.LIMA harvest time was 38-53 minutes,mean LIMA flow rate was(22 ± 6) ml/min after anastomosis.Surgery duration was 117-143 minutes,blood loss was less than 100 ml for each operation.No blood transfusion was required.Tracheal intubation time was 4-16 hours,ICU stay time was 22-45 hours,hospital stay time was 6-10 days.There was no peri-operative death,either no myocardial infarction or cerebral vessel accident.During follow-up,all LIMA-LAD appeared to be patent by coronary CT angiography.Conclusion High patency rate of LIMA-LAD anastomosis could also be obtained during MIDCAB surgery.It was reserved as a safe and effective surgery for well-selected patients.

To study the related substances in nicergoline, electrospray positive ionization high resolution TOF/MS was used for the determination of the accurate mass and elemental composition of the related substances. Triple quadrupoles tandem MS/MS was employed for the determination of the fragmentations of the parent ions. 16 related substances were detected and identified to be eight synthetic by-products and eight degradation products, by using impurity references matching, product mass spectra fragmentations elucidation, and verified further according to synthetic processes and stress testing results. The results obtained are valuable for nicergoline manufacturing process control and quality assurance.

Objective To explore the change of function and expression of hematopoietic lineage cell specific protein-1 (HS1) and phosphorylated HS1 (p-HIS) and factors devoting to HS1 phosphorylation in platelet with sepsis.Methods Plasma with rich platelet was collected from 150 sepsis patients and 50 healthy subjects, and comparison of platelets adhesion and aggregation were detected by micro-pore method and platelet aggregation instrument.Meanwhile the ATP concentrations of washed platelet of two groups were detected by the kit to compare release reaction.And then total HS1 (t-HIS) and p-HS1 of platelet from two groups were compared by using western blot.Afterwards the specific inhibitors of Src and Syk were used to verify the HS1 activation regulated by Src and Syk in LPS-induced cell model.Results The significant differences were present between healthy subjects and sepsis patients in platelet counts, platelet distribution width (PDW) and mean platelet volume (MPV) (P ＜ 0.01).The data showed the sepsis patients had greater ability than healthy subjects in adhesion, aggregation and release reaction.Meanwhile the platelets of sepsis patients had higher concentration of t-HS1 and p-HS1 than healthy subjects, and the specific inhibitors of Src and Syk , PP2 and piceatannol, inhibited the increase in p-HS1 in LPS-induced cell model.Conclusions Function of platelet is closely related to HS1 in sepsis and it will be a target for sepsis therapy.

Objective To investigate the impact of sputum suction under laryngoscope in stroke patients on the occurrence and prognosis of ischemic stroke-associated pneumonia (SAP).Methods A total of 127 cases with acute ischemic stroke (AIS) with Glasgow Coma Scale 6-12 scores,non-artificial airway and need for intensive care were enrolled.According to the suction practice,the cases were divided into laryngoscope euthyphoria group (practice group,PG,n =59),and conventional oral or nasal sputum suction group (control group,CG,n =68).The PG was perspectively studied,while the CG were analyzed retrospectively.All patients were cared with the Guidelines for the management of adult with hospitalacquired ventilator-associated and healthcare-associated pneumonia set by American Thoracic Society/Infectious Diseases Society of America in 2005 and the Guidelines for the early management of patients with acute ischemic stroke set by American Heart Association/American Stroke Association in 2013 including patting on the back of patients in prone position routinely in order to facilitating expectoration,phlegm elimination with physical vibration and apophlegmatic agent application during their stay in ICU.Incidences of SAP and 28-day mortality were calculated.Levels of inflammatory markers (white blood cell,WBC;highsensitive C-reaction protein;procalcitonin,PCT) in serum were detected.Adverse events related to laryngoscopy were documented.Results There were no significant differences in incidences of SAP and 28-day mortality between PG and CG groups (32.20％ vs.41.18％,P ＞ 0.05;47.37％ vs.53.57,P ＞ 0.05,respectively).However,there was statistically significant difference (P ＜ 0.05) in the ICU stay length and inflammatory markers,and the sputum suction process in PG did decrease the incidence of artificial airway establishment and mechanical ventilation (18.64％ vs.35.29％,P ＜ 0.05),and the laryngoscope euthyphoria method was proved to be a protective factor (HR =0.515;95％ CI 0.281-0.057,P =0.038).WBC and PCT were lower in PG group than in CG group (P ＜ 0.05).Conclusion Sputum suction under laryngoscope can reduce the probability of artificial airway establishment and invasive ventilator employment in patients with AIS,shortening ICU stay length and down-regulating levels of WBC and PCT.

To investigate the relationships among plasma secreted frizzled-related protein ( sfrp) 5 level and body fat parameters, glucolipid metabolism, insulin resistance index, and inflammation. 89 subjects with normal glucose tolerance(NGT) and 87 patients with type 2 diabetes mellitus (T2DM) were enrolled and each group was divided into no-obese and obese subgroups. Obesity was defined as body mass index ( BMI)≥25 kg/m2 according to the World Health Organization -Western Pacific Region diagnostic criteria ( 2000 ) . Body fat parameters were measured and BMI, waist-hip ratio were evaluated, meanwhile, the levels of blood glucose-lipid parameters and fasting insulin were also determined. Insulin resistance index ( IR) was assessed by homeostasis model assessment ( HOMA) . The concentrations of plasma sfrp5 and interleukin 6 were detected by enzyme-linked immunosorbent assay. Plasma sfrp5 level in T2DM group was significantly lower than that in NGT group [(8. 35±3. 38 vs 11. 35±3. 69)ng/ml, P<0. 01]. The levels of plasma sfrp5 in subjects with obesity were also lower than those in subjects with no-obesity in both NGT and T2DM groups [(9. 46±2. 70 vs 13. 12±3. 62)ng/ml and(6. 70±2. 34 vs 10. 12±3. 45) ng/ml, both P<0. 01]. Plasma concentrations of sfrp5 in T2DM-obese group were significantly lower than that in NGT-obese group(P<0. 01). Correlation analysis showed that plasma sfrp5 levels were negatively correlated with waist-hip ratio, HbA1C, fasting insulin, triglycerides, waist circumference, fasting plasma glucose, interleukin 6, natural logarithm of HOMA-IR [ln(HOMA-IR)], and BMI(P<0. 01 or P<0. 05). Multiple linear regression showed that ln(HOMA-IR), BMI, triglycerides were independent related factors in influencing the levels of plasma sfrp5 (r2=0. 216, 0. 177, 0. 113, all P<0. 05). Plasma sfrp5 levels were decreased in obesity and T2DM subjects and were correlated with body fat disposition, glucose-lipid metabolism, insulin resistance and inflammation. Lack of sfrp5 may contribute to the pathophysiology of obesity and T2DM.

Objective To investigate the prevalence and epidemiologic characteristics of metabolic syndrome (MS) in adults aged over 35 years in Chongqing.Methods Randomly selected adults were studied by means of multi-stage sampling.A cross-sectional study was conducted in Chongqing with a representative sample of 5 384 Chinese adults aged over 35 years.After an overnight fasting,participants underwent an oral glucose tolerance test,fasting and 2-hour plasma glucose,blood lipid profile as well as height,body weight,blood pressure were measured.In this survey,the prevalence of MS was analyzed according to the diagnostic criteria of International Diabetes Federation in 2005.Results The crude prevalence of MS was 20.28％,and the standardized prevalence was 18.72％ after age was adjusted.Compared to male population,female participants showed a higher prevalence (25.55％ vs 12.90％,P＜0.01).The prevalence of MS was higher in urban residents than in rural (26.65％ vs 16.94％,P＜0.01).The prevalence of MS increased with age,along with the highest prevalence in the group aged over 65 years.The incidences of central obesity,high triglyceridemia,hyperglycemia,hypertension,and low highdensity lipoprotein-cholesterol were 30.11％,26.17％,43.93％,54.03％,and 27.23％,respectively.There were at least 83.06％ subjects who possessed more than 1 risk factor.The most common combination of four components of MS were central obesity,high triglyceridemia,hyperglycemia,and hypertension.Conclusion There is a high prevalence of MS in adult residents in Chongqing.MS is increasingly becoming a noteworthy health problem requiring urgent attention for its prevention and treatment.

Objective To analyze the cause of puncturing failure in ultrasonography guided minimal-invasive percutaneous nephrolithotomy (MPCNL). Methods A retrospective analysis involved total 612 patients with upper urinary tract lithialisis treated with MPCNL from May 2005 to May 2010.382 cases were acupunctured by traditional G18 puncturing instrument (group A),and the other 230 cases were performed by the improved ARROW Raulerson blue syringe (group B).The average renal pelvis range was 24 mm vs.21 mm before operation,and largest diameter of renal calculi was 3.7 cm vs.3.8 cm (P ＞ 0.05).Success rate and time cost as well as therapeutic effect were compared between the 2 groups. Results There were 29 cases of puncturing failure in group A (totally 382 cases) while only 2 in group B (totally 230 cases).The successful rate of establishment of working channel was significantly higher in group B (P ＜ 0.05).Average time of puncture procedure was 5.1 min and 4.8 min respectively (P ＞ 0.05).There was no puncturing-related severe complication in any group.The unsuccessful cases in the group A and related causes were:5 cases for obesity,13 cases for puncture needle slipping,9 cases for channel dropout,and 2 cases for needle route dropout.However,only 2 cases failed in group B,the accurate position of calculi was at upper and lower calyx.One case was over-weighted,another was because of pathway-loss during the calculi elimination processs.And the one-off puncture successful rate of A and B group was 92.4％ vs.99.1％,and the one-off puncture successful rate was significantly higher in group B. Conclusions Overobesity of patients is an important cause of puncturing failure for sonographically MPCNL.The establishment of working-channel with ARROW Raulerson blue syringe could be feasible and the success rate was significantly higher.