Objective To develop the method for simultaneous identification and quantification of morphine,6-monoactylmorphine,codeine,heroin,ketamine,3,4-Methylenedioxyamphetamine (MDA),3,4-methylenedioxymethamphetamine (MDMA),amphetamine and methylamphetamine in human plasma.Methods UPLC-MS/MS was adopted to analyze plasma with protein precipitated using 10％ trichloroacetic acid.Plasma samples were separated on ACQUITY UPLC HSS C18 column with aqueous solution (0.01％ formic acid)-methanol (0.01％ formic acid) as the mobile phase,and at a flow rate of 0.3 mL·min-1.The multiple reaction monitoring (MRM) mode was performed combined with the positive ion mode for quantification in four sections.Results The retention time,the characteristic fragment ions,and the relative abundance ratio of the molecular ion peak could be used to identify these nine compounds sensitively.The liner calibration curve of morphine,codeine,heroin,ketamine,6-monoacetylmorphine,MDA,MDMA,amphetamine and methamphetamine were obtained in the concentration range of 5.00×10-3～5.00 (r=0.9934),1.00× 10-2～ 10.00 (r=0.9905),1.00× 10-2～ 10.00 (r=0.9929),2.50× 10-3 ～2.50 (r=0.9960),5.00× 10-3 ～ 5.00 (r=0.9925),5.00× 10-4 ～ 5.00 (r=0.9910),5.00× 10-4 ～ 5.00 (r=0.9924),5.00× 10-4 ～ 5.00 (r=0.9920) and 5.00×10-4～5.00 μg·mL-1 (r=0.9900) respectively.The lowest detection limit was 1.00,1.00,1.00,0.50,0.50,0.10,0.10,0.10 and 0.10 ng· mL-1 respectively.The relative standard deviation (RSD) of the inter-day and intra-day were less than 18％.The relative recovery was more than 60％,and the RSD were less than 15％.Conclusion The method is accurate,sensitive and suitable for identification and quantification of 9 drugs of opiates,ketamine and amphetamines in human plasma.

Objective A morphometric study was carried out on GABAergic neurons and astrocytes in primary auditory cortex of 4 young cats (1-3 years old, 20-2.5 kg) and 4 old cats (10-13-year-old, 3-3.5 kg), in order to explore the age-related changes and the probably physical effects underlying these changes. Methods The same regions of the primary auditory cortex (AI) were comparatively studied. Nissl staining and immunohistochemical methods were applied to explore the differences of GABAergic neurons and astrocytes(specifically labeled by GFAP as a mark as antibody) in the primary auditory cortex(Al) between young and old cats. Serial cross-sections from two age groups were stained with Nissl for layer structure observation and demonstration of neurons; Adjacent sections were stained with anti_GABA immunohistochemistry for localizing and characterizing GABAergic and with anti-GFAP for astrocytes in AI. Results The diameter, density and number of GABAergic neurons in Al of old cats declined significantly compared with the counterpart in young cats, especially in layers Ⅱ,Ⅲ of AI; but the change in GFAP-IR cells was reversed: old cats showed clearly larger number and stronger staining of GFAP-IR cells than that in young cats. The GFAP-IR cell bodies and dendrites swelled obviously in old cats, especially in layer Ⅰ of AI and in white matter. Conclusion The result presented a direct morphological evidence for weakness of GABAergic intracortical inhibition, which is considered to be a possible mechanism for age-related acoustic function decline. The enhanced function of astrocytes may play an important role in decreasing the GABA content in AI of the old individuals.

On the basis of systematicly reviewing the developmental history of acupuncture and moxibustion and profoundly understanding its academic connotations,the authors of the present article make a summary and analysis on the key factors influencing the development of acupuncturology. These key factors are 1) the emergence of "microacupuncture needle regulating-Qi" and the establishement of their corresponding theory system,2) a large number of practitioners who inherited the learnings of acupuncturology generations by generations,and abundant medical classical works which recorded the valuable academic thoughts and clinical experience of the predecesors,3) the application of acupuncture charts and manikins,and 4) modernizing changes of acupuncture learnings after introduction of western medicine to China. Just under the influence of these key factors,the acupuncture medicine separates itself from the level of the simple experience medicine,and has formed a set of special theory system and developed into a mature subject.

Objective To investigate the clinical value of multiband mucosectomy (MBM) for the treatment of early esophageal cancer and precancerous lesions.Methods The clinical data of 43 patients with early esophageal cancer or precancerous lesions (including 13 cases of early esophageal cancer and 30 cases of precancerous lesion) who were admitted to the Tengzhou Central People's Hospital from January 2010 to January 2011 were retrospectively analyzed.A total of 51 lesions were confirmed by preoperative endoscopy and mucosal biopsy,and then were treated by MBM.Results A total of 52 MBM procedures were carried out,and 180 lesions were resected.The sizes of the lesions ranged from 10 mm × 8 mm to 25 mm × 23 mm,and the mean operation time was (37 ± 5)minutes.The complete resection rate was 92.2％ (47/51).The submucosal layer of 1 patient was invaded by squamous cell carcinoma postoperatively,and the patient was treated by operation;1 patient wth squamous epithelium carcinoma was treated by radiotherapy at 2 weeks after MBM ; the other 2 lesions were treated by argon plasma coagulation (APC).Four lesions with bleeding were detected during 52 MBM procedures,and no esophageal perforation was detected during MBM.Early complications consisted of delayed bleeding (1 patient,cured by APC) and slight esophageal stenosis (1 patient,recovered at postoperative month 6).The accurate rate of pathological examinations was 51.0％ (26/51).Forty-three patients were followed up for 1 year,3 patients with tumor recurrence were treated by MBM or APC.No death occurred during the followup.Conclusion MBM is a safe and effective technique for the treatment of early esophageal cancer and precancerous lesions.

Objective: To explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA). Methods: Patients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups ( n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups ( P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups. Results: The total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A ( P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B ( P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups ( P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B ( P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups ( P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups ( χ2=1.721, P=0.550). Conclusion: For intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.

Objective:To assess the prognostic value of modified Charlson comorbidity index (mCCI) combined with serum albumin for long-term prognosis in peritoneal dialysis (PD) patients.Methods:From January 1, 2007 to June 30, 2015, patients who started PD in Nanjing Drum Tower Hospital were enrolled in this retrospective cohort study. Clinical data including gender, age, underlying diseases, laboratory examination and prognosis were collected. The mCCI at the beginning of PD was calculated. Whether the duration of PD exceeded 5 years was used as an indicator to evaluate the prognosis. The patients were divided into≥5 years group and<5 years group according to the duration of PD, and the data were compared between the two groups. Cox regression model was constructed to analyze the influencing factors of all-cause death in PD patients. Multivariate logistic regression model and receiver operating characteristic (ROC) curve were used to analyze the predictive value of mCCI and serum albumin levels on whether patients could maintain long-term PD.Results:Of the 183 patients included [males 106(57.9%), females 77(42.1%); (53.35±16.50) years old; 162 cases (88.5%) with hypertension, 55 cases (30.1%) with diabetes], 97 cases had PD duration for ≥5 years and 86 cases less than 5 years. The overall 5-year technical survival rate was 65.1%. At the beginning of PD, compared with the dialysis age≥5 years group, the patients in the dialysis age less than 5 years group had older age, higher mCCI, lower serum albumin level, and higher C-reactive protein (CRP) level (all P<0.05), but there were no significant differences in gender, education level, electrolyte, mean arterial pressure, high densitv lipoprotein (HDL), low-density lipoprotein (LDL) and PD adequacy index between the two groups (all P>0.05). Multivariate logistic regression analysis showed that increased age ( OR=1.022, 95% CI 1.000-1.043, P=0.046), increased mCCI ( OR=1.620, 95% CI 1.300-2.018, P<0.001) and decreased serum albumin ( OR=0.807, 95% CI 0.730-0.893, P<0.001) were independent predictors for the duration of PD<5 years. ROC curve analysis showed that the area under ROC curves ( AUC) of mCCI, serum albumin level and combined prediction probability of the two for the duration of PD<5 years were 0.647(95% CI 0.568-0.727), 0.655(95% CI 0.577-0.734), and 0.767(95% CI 0.700-0.835), respectively, indicating that the accuracy of combined parameters to predict survival outcome was higher than that of any single parameter. Multivariate Cox analysis showed that increased age ( HR=1.073, 95% CI 1.046-1.100, P<0.001), increased mCCI ( HR=1.198, 95% CI 1.044-1.375, P=0.010) and decreased serum albumin ( HR=0.904, 95% CI 0.843-0.969, P=0.004) were independent influencing factors for all-cause death in PD patients. Conclusions:Old age, high mCCI and low serum albumin level are influencing factors for dialysis age<5 years and all-cause death in PD patients. mCCI combined with serum albumin level can improve the accuracy of predicting the long-term dialysis in PD patients.

Two patients with typical Gitelman syndrome were diagnosed by gene and their clinical data and endocrine and metabolic status were evaluated.The etiology,clinical manifestation,laboratory findings,genetic diagnosis,and treatment for Gitelman syndrome were reviewed.

In order to realize the sustained education concept in clinical medical English teaching,several measures were taken in the first clinical medical college of Nanjing University of Traditional Chinese Medicine,such as training the teaching staff,using original textbooks and redesigning the curriculum.Particularly the tutorial system was introduced to the education frame.The teaching and research section of clinical medical English explored the new teaching routes for postgraduates in traditional Chinese medicine university.

Portal vein thrombosis refers to thrombotic lesions in the portal vein and is caused by various etiologies. Its clinical manifestations vary with location, extension, degree of vascular occlusion, and formation time, and severe thrombosis may cause gastrointestinal congestion and necrosis, liver insufficiency, esophagogastric variceal bleeding, and portal hypertensive biliary disease and even threatens patients’ life. Color Doppler ultrasound and contrast-enhanced abdominal computed tomography/magnetic resonance imaging are important auxiliary examinations for the diagnosis of portal vein thrombosis and play a vital role in early diagnosis and treatment, severity evaluation, and guidance for targeted treatment of this disease. Therapies of portal vein thrombosis depend on its severity and mainly target portal vein thrombosis and its complications. Surgical treatment should be performed for patients with intestinal congestion and necrosis, portal hypertension with esophagogastric variceal bleeding, splenomegaly, hypersplenism, portal hypertensive biliary disease, and end-stage liver disease. This article reviews the advances in the etiology, clinical manifestations, diagnosis, and surgical treatment of portal vein thrombosis.

Objective:To explore the causes of the maintenance of smoking behaviors in male patient with chronic schizophrenia.Methods:Totally 188 male,smoking patients with chronic schizophrenia,meeting with the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-IV),above 5-year course of disease,taken a steady dosage of antipsychotics for 3 months,and 61 healthy smoking men were collected according to the voluntary principles.The psychopathologic symptoms and the dependence of cigarette of all patients were as-
sessed with the Positive and Negative Syndrome Scale (PANSS)and the Fagerstrom Test for Nicotine Dependence (FTND),the Russell's Smoking Motivation Questionnaire (SMQ)was used to investigate the causes for maintai-ning behaviors of smoking in patients and healthy controls respectively.Results:The sedative item scores of SMQ were lower in patient group than in the controls [3 (0,9)vs.6 (0,9),P <0.001],and other scores of subscales had no significant difference compared with control.Heavy dependence happened in patient group slightly less than health controls (2.7%vs.8.2%,P <0.05).The total scores of FTND were positively correlated with the doses of antipsychotics (chlorpromazine equivalent)(r =0.22,P <0.01).The scores of total (β=0.22),automatic (β=0.27)and sedative (β=0.37)items in patient group were less than controls (Ps <0.001)by multi-factors step-wise Linear regression analysis.Conclusion:Compared with general smokers,lower need for sedation,less heavy dependence and motivation in smoking patients might be correlated with the strict management for inpatients smok-ing,social-psychological factors and culture background in China.