Quantitative NMR (qNMR) is a technology based on the principle of NMR. This technology does not need the references of the determined components, which supplies a solution for the problem of reference scarcity in the quantitative analysis of traditional Chinese medicines. Moreover, this technology has the advantages of easy operation, non-destructiveness for the determined sample, high accuracy and repeatability, in comparison with HPLC, LC-MS and GC-MS. NMR technology has achieved quantum leap in sensitivity and accuracy with the development of NMR hardware. In addition, the choice of appropriate experimental parameters of the pre-treatment and measurement procedure as well as the post-acquisition processing is also important for obtaining high-quality and reproducible NMR spectra. This review summarizes the principle of qHNMR, the various experimental parameters affecting the accuracy and the precision of qHNMR, such as signal to noise ratio, relaxation delay, pulse width, acquisition time, window function, phase correction and baseline correction, and their corresponding optimized methods. Moreover, the application of qHNMR in the fields of quantitation of single or multi-components of traditional Chinese medicines, the purity detection of references, and the quality analysis of foods has been discussed. In addition, the existing questions and the future application prospects of qNMR in natural product areas are also presented.

Objective To study the relationships between patients'personality traits,coping styles, perceived social support and the doctor?patient relationship,try to build the relationship model of patients’ psychological factors and the doctor?patient relationship,and to understand the patients psychological factors influence on the doctor?patient relationship,to provide a basis for improving the doctor?patient relationship. Methods The doctor patient relationship evaluation questionnaire, Eysenck personality questionnaire re?vised,short scale for Chinese( EPQ?RSC) ,simplified coping style questionnaire( SCSQ) and perceived social support scale( PSSS) were used to survey 400 outpatients,using SPSS 22.0 and AMOS 17.0 for data analysis. Results There was statistically significant difference in psychoticism between the high and low doctor?pa?tient relationship evaluation score groups( t=-4.537, P<0.01).There was statistically significant difference in positive coping,family support,friend support,other support and perceived social support between the high and low score groups(P<0.05).Psychoticism had a direct positive effect on doctor?patient relationship( r=0.228, P=0.000) ,and perceived social support had a direct negative effect on the doctor?patient relationship ( r=-0.256, P=0.000).Psychoticism,neuroticism,positive coping and negative coping styles could affect the doctor?patient relationship indirectly by perceived social support. Conclusion Patient personality can affect the doctor?patient relationship directly,meanwhile,it can affect the doctor?patient relationship indirectly by perceived social support,and coping styles can only affect the doctor?patient relationship indirectly by per?ceived social support.

Objective To evaluate the efficacy and safety of laparoscopic technique in the treatment of refractory adhesive intestinal obstruction. Methods In a retrospective matched?pair analysis, 68 patients of re?fractory adhesive intestinal obstruction whose relapsed more than 3 times were included in the research. All patients were treated with laparoscopic operation or continued follow?up observation after conservative treatment from Janu?ary 2011 to January 2016. The patients were divided into 2 groups, laparoscopic surgery (32 cases) and observation group (36 cases), to contrast the recurrence rate and safety of the two types of treatment. Results The recurrence rate of laparoscopic surgery group was significantly lower in the observation group (18.8%vs. 77.8%, P<0.05). Re?fractory adhesive intestinal obstruction is further divided into Mixed type, Patchy adhesion type and Cable Belt Com?pression type, in the laparoscopic surgery subgroup analysis, hybrid recurrence rate (66.7%, 4/6 cases) was signifi?cantly higher than that of patchy adhesion type (10.0%, 1/10 cases) and cord compression type (6.3%, 1/16 cases). Conclusion Laparoscopic operation is safe and feasible in the treatment of refractory adhesive intestinal obstruc?tion, and then it can effectively reduce the recurrence rate of refractory adhesive intestinal obstruction;the curative effect is closely related to the type of adhesion.

Objective To analyze the role of multislice spiral CT in the diagnosis of biliary com-plications following liver transplantation. Methods Forty-four patients with biliary complications re-ceived tri-phase contrast-enhancement CT examination and cholangiography (CP) within one week af-ter the CT scanning. Using the results of CP as the standard, we investigated the efficacy of multislice spiral CT for each kind of biliary complication. All the analyses for bile duct were based on the images on the late portal venous phase and the reconstruction of images performed with multiplan reformat,Results CP depicted biliary strictures involved in extrahepatic bile duct in 23 cases (including the common bile duct and common hepatic duct), left or right hepatic duct in 24 and intrahepatic bile duct in 27. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the CT examination were 91.3%, 83. 3% , 87. 8%, 87. 5% and 88. 2% for biliary stricture in extrahe-patic bile duct, 83. 3% , 88. 2%, 85. 4%, 90. 9% and 78. 9% for biliary stricture in left or right he-patic duct, 74.1%, 92.7%, 80.5%, 95.2% and 65.0%, for biliary stricture in intrahepatic bile duct, respectively. CT detected intrahepatic biloma in 4 cases and abscess in 2 but CP only detected biloma in 2 cases. The other 4 cases did not detected by CP because of severe biliary strictures which filled with biliary sludge. CP confirmed anastomotic bile leak in 3 cases. In these cases, CT only de-picted the fluid collection in hepatic hilum and abdominal cavity, none of the exact leak site could be detected. CP detected biliary sludge or stones in 33 cases. However, the sensitivity, specificity, accu-racy, positive predictive value and negative predictive value of the CT examination for biliary sludge or stones were 72.7%,100.0%,78.1%,100.0%and 47.6%,respectively.Meanwhile,in 1 patient with diffuse intrahepatic biliary strictures,active biliary bleeding was correctly detected by CT exami-nation and confirmed by hepatic arteriography.Conclusion Tri-phase contrast-enhancement CT exam-ination can be used as a general method for biliary complications after liver transplantation.Besides its benefits in biliary complications,it is of great value for depicting complications involved in hepatic pa-renchyma and acute biliary bleeding in the same examination.

Objective: To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation. Methods: From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺) in C group were measured at 8∶00 a. m.the next day. Results: The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P<0.05), while the levels of CD₄⁺ were lower than those in C group(all P<0.05). Compared with T0, the plasma NS and Cor decreased at T3 in M, P and D group (all P<0.05). The plasma Cor at T3 in P group was lower than that in M group[(475.77±49.69)μg/L vs.(502.33±60.92)μg/L](t=-26.57, P<0.05). The plasma NS and Cor at T3 in D group were lower than those in M group[(20.64±4.70)ng/L vs.(25.29±4.03)ng/L, (442.83±66.59)μg/L vs.(502.33±60.92)μg/L](t=-4.51, -59.50, all P<0.05), and were lower than those of P group[(20.64±4.70)ng/L vs.(23.60±4.49)ng/L, (442.83±66.59)μg/L vs.(475.77±49.69)μg/L](t=-2.96, -32.93, all P<0.05). Compared with T0, the level of CD₄⁺ decreased at T1, T2 and T3(except T3 in D group) in M, P and D group (all P<0.05), and the level of CD₈⁺ decreased at T1, T2 and T3 in M and P group (all P<0.05), but those in D group at T1, T2 and T3 were not significantly decreased(all P>0.05). The levels of CD₈⁺ at T2 and T3 in P and D groups were higher than that of M group (all P<0.05). The level of CD₄⁺/CD₈⁺ at T3 in D group were higher than that in M and P group[(1.46±0.30) vs.(1.26±0.33), (1.46±0.30) vs.(1.32±0.34)](t=0.21, 0.15, all P<0.05). Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation, and dexmedetomidine is better than propofol.

Objective:To establish the HPLC fingerprint of Centellae herba and determine the content of asiaticoside, madecassic acid and asiaticoside B simultaneously; To compare the quality differences of Centellae herba collected in different months. Methods:The chromatographic condition was a Shimadzu InertSustain C18 column (4.6 mm×250 mm, 5 μm) with a mobile phase consisting of acetonitrile and 2 mmol/L beta cyclodextrin in gradient elution at the flow rate of 0.8 ml/min. The detection wavelength was 204 nm, and the column temperature was 30 ℃. The different Centellae herba materials of collected in 2-12 months from Chenzhou were studied by the similarity evaluation combined with cluster analysis, principal component analysis and the three contents determination. Results:The HPLC fingerprint of Centellae herba was established and 9 common peaks were designated. The eleven samples were different, which can be aggregated into 4 categories and the quality of Centellae herba collected in July was the best. Conclusion:The established fingerprint and multi-components quantitative method are stable and reliable, which can provide a reference for the quality control and the utilization of Centellae herba resource.

The quality control of traditional Chinese medicine (TCM) preparations is a key issue related to their curative effect, safety and stability. The application of modern analytical means and the development of new disciplines improve the quality control of TCM preparations to some extent. For a long time, however, the quality control level of TCM preparations remains low and the quality standards exist in name only unable to effectively control drug quality and ensure therapeutic effect and safety. The essay makes a systematic analysis on possible factors impacting TCM preparations and current situation of quality control and discusses possible approaches and new methods for improving quality control of TCM preparations, in order to give an impetus to the quality control standards and the mode evolvement of TCM preparations and ensure safety, efficiency and quality controllability of TCM preparations.
Drugs, Chinese Herbal ; Medicine, Chinese Traditional ; methods ; Quality Control

Objective To explore the relationship between heart rate variability (HRV),heart rate turbulence (HRT) and blood pressure (BP) control in hypertensive patients.Methods Hypertensive patients with controlled BP group (n =50) and uncontrolled BP group (n =40) and control group non-hypertensive patients (n =52)were enrolled in this study in our hospital during June 2015 to June 2016.HRV and HRT as well as clinical characteristic of the three groups were analyzed.Results (1) Body mass index was significantly higher in the controlled BP group than in the control group.There was no statistical difference in proportions and categories of antihypertensive medication between the uncontrolled and controlled BP groups (P ＞ 0.05).(2) VLF,LF and TS were significantly lower in the uncontrolled BP group than the control group,and HF was significantly lower in the uncontrolled BP group than in the controlled BP group (P ＜ 0.05).(3) Results of muhiple logistic regression analysis showed that lower rMSSD,pNN50,VLF,LF,HF and TS were risk factors for BP control after adjusting for gender,age,EF value,creatinine,blood lipids,Beta-blockers and history of smoking,coronary heart disease and diabetes mellitus.(4) Spearman correlation analysis of the hypertensive patients showed that LF was negatively correlated with TO,and SDNN,SDANN,rMSSD,pNN50,VLF,LF,HF were positively correlated with TS.Conclusion The present results demonstrate that uncontrolled BP is associated with abnormal HRV and HRT,which suggested autonomous nervous imbalance was existed in uncontrolled hypertensive patients.

Objective To study the curative effect of enhanced external counterpulsation(EECP) on the ischemic symptoms,heart function and heart failure markers in the patients with ischemic heart failure.Methods One hundred and eithty patients with ischemic heart failure were divided into the external counterpulsation group and the control group.The treatment group received the EECP therapy.The angina curative effect and heart function(ultrasonic echocardiography,noninvasive hemodynamic monitoring,NYHA heart function grade) as well as heart failure markers changes after treatment were observed in the two groups.Results The effective rate of angina treatment in the counterpulsation group was higher than that in the control group,the difference was statistically significant (P＜0.01).The cardiac output (CO) and cardiac index (CI) in the counterpulsation group were significantly higher than those in the control group,the difference was statistically significant (P＜0.01);the stroke volume (SV),stroke volume index (SI),acceleration index (ACI) and velocity index (Ⅵ) in the counterpulsation group were higher than those in the control group,the difference was statistically significant (P＜0.05);the systemic circulation peripheral vascular resistance (SVR),systemic circulation peripheral vascular resistance index (SVRI) and systolic time rate (STR) in the counterpulsation group were lower than those in the control group,the difference was statistically significant (P＜0.05).There were no statistical difference between the two groups in left ventricular ejection fraction(EF),left ventricular end diastolic diameter(LVEDd) and thoracic cavity fluid volume(TFC) (P＞0.05);there was no statistical difference in NYHA heart function grade between the two groups before treatment.The NYHA heart function grade after treatment in the counterpulsation group was improved compared with that in the control group (P＜0.05).There was no statistical difference in NT-proBNP before treatment between the two groups.The NT-proBNP level after treatment in the counterpulsation group was significantly lower than that in the control group,the difference was statistically sinificant(P＜0.01).Conclusion External counterpulsation can be used for the treatment in the patients with ischemic heart failure,can alleviate the angina symptoms,improves the heart function and heart failure markers.

【Objective】 To investigate the availability and convenience of emergency blood transfusion in mainland China, and develop strategies for improvement. 【Methods】 The electronic questionnaire was self-made by the research team, and pushed to physicians and technicians related to emergency blood use and supply nationwide through the WeChat group of professional organizations such as the Chinese Medical Doctor Association′s Emergency Resuscitation and Disaster Medicine Professional Committee. The data was automatically aggregated by the internet survey platform named questionnaire star, and analyzed by statistics software SPSS 21.0. 【Results】 1) General information: A total of 3 151 questionnaires were collected, of which 85% (2 678 / 3 151), from 31 provinces, municipalities or autonomous regions in mainland China were valid, and 39%(1 044/2 678), 22%(577/2 678), 39%(1 057/2 678) were from the east, middle and west region, respectively; 78%(2 099/2 678) were from tertiary hospitals, and 22%(579/2 678) secondary hospitals and below; 60%(1 607/2 678), 16%(425/2 678), and 24%(646/2 678) were from Emergency Department(EM), Intensive Care Department (ICU) and other departments respectively. The respondents with senior position titles took up 34%(906/2 678) while those with intermediate and junior position titles took up 30% (798/2 678) and 36%(974/2 678) respectively. 2) Availability : 63%(1 680/2 678) of the respondents experienced untimely and insufficient blood supply at least once during June 2017 to May 2020, of which 75% (1 256/1 680) occurred in the past year. In the past half year, 51% (381/1 057) of respondents in the western region and 34% (713/2 099) in tertiary hospitals experienced more emergency blood shortages (P<0.05). The most prone to clinical blood supply shortage were red blood cells and whole blood, platelets and other plasma components, accounting for 43% (1151/2678), 42% (1125/2678) and 15% (402/2678), respectively. 48% (1 274/2 678) respondents believed that the insufficient blood supply for emergency use " has caused a significant adverse effect on the quality of rescue", and 40% (1 081/2 678) believed that it was " a potential medical safety threat" .3)Convenience: The waiting time for emergency blood transfusionwithin 0.5 h, 1 h and 2 h accounted for 28% (741/2 678), 71%(1 903/2 678) and 90% (2 547/2 678), respectively. The waiting time of emergency blood transfusion within 0.5 h accounted for 50% (286 / 577) in central region, which was significantly higher than that in eastern or western region (P < 0.05). 67% (889/2 678) of respondents experienced blood inventory depletion, of which 30%(792/2 678) had to wait for more than 8 hours for resuming blood supply. 80% (751/1 057) of the respondents in the western region experienced inventory depletion, significantly higher than that in the central region (P<0.05). 4)The influencing factors were mainly insufficient blood donation, growth of clinical demand in blood, blood waste due to expiration and clinical irrational use, accounted for 56% (1 485/2 678), 23% (619/2 678), 7% (183/2 678) and 6% (167/2 678) respectively. 60% (633/1 057) of the respondents in the western region considered insufficient blood donation as the influencing factors, statistically higher than that in the eastern and central regions (P<0.05).5)Suggestions for improvement included more voluntary blood donation, development of blood substitutes, standardization of clinical blood use and extension of blood storage shelf life, accounted for 49% (1 326/2 678), 24% (645/2 678), 19% (499/2 678), and 8% (208/2 678), respectively. 53% (561/1 057) of the respondents in the western region suggested strengthening voluntary blood donation (P<0.05), while 26% (268/1 044), 26% (152/577), 25% (553/2099) of respondents in the eastern, central region and tertiary hospitals respectively suggested strengthening the research and development of blood substitutes (P<0.05). 56% (504/906) of respondents with senior professional titles recommended strengthening voluntary blood donation, while 26% (453/1 772) and 0.9% (164/1 772) of those with intermediate and junior technical titles recommended research and development of blood substitutes and improvement of blood storage technology, respectively(P<0.05). 【Conclusion】 The whole blood reserve can not fully meet clinical emergency needs at present stage, especially in the western region and some tertiary hospitals,, showing the necessity to adopt comprehensive measures to further improve the availability and convenience of emergency blood transfusion, including strengthening voluntary blood donation, developing blood substitutes, prompting rational clinical blood use and improving blood storage technology.