Investigation of simvastatin and its related substances was carried out using a reversed phase ultra performance liquid chromatography/tandem mass spectrometry method. The identification of impurities in simvastatin was performed with a triple-quadrupole mass spectrometer, with an electrospray ionization (ESI) source in the negative/positive ion mode. A total of 12 compounds were characterized in commercial samples, among which 2 impurities had never been reported. All the impurities were deduced based on the MS fragment pathways of simvastatin and the biosynthetic pathway of lovastatin. This work provides very useful information for quality control of simvastatin.

Objective:Acute retinal necrosis syndrome(ARNS) is a rare disease with high blinding rate.The surgery of vitrectomy,endolaser photocoagulation and silicone oil injection is considered an effective treatment of ARNS.The study investigated the effect of vitrectomy,endolaser photocoagulation and silicone oil injection treating ARNS.Methods:A consecutive 16 eyes of 16 patients with ARNS were treated with vitrectomy,endolaser photocoagulation and silicone oil injection.The 5 eyes without retinal detachment were photocoagulated from the posterior border of necrosis to the ora serrata.The 11 eyes with retinal detachment were treated with subtotal retinal photocoagulation,air/fluid exchange and silicone oil injection.The follow-up time were 6 months at least,16 months in average.Results:The final best-correcting visual acuity was counting fingers in 3 eyes(18.8%),0.02-0.3 in 7 eyes(43.8%),0.4-0.6 in 5 eyes(31.3%),0.7 in 1 eye(6.3%).The silicone oil was uneventfully removed in 14 patients(87.5%) from 3 to 12 months.No one had a recurrent retinal detachment.Conclusion:There is a favorable effect in ARNS with the treatment of vitrectomy,endolaser photocoagulation and silicone oil injection.

Objective: To assess therapeutic effect of alprostadil on improving myocardial microcirculatory disturbance and hemorheological disorder in patients with coronary heart disease (CHD).Methods: A total of 164 CHD patients treated in our hospital were selected.According to random number table method, they were randomly and equally divided into routine treatment group and alprostadil group (received alprostadil injection based on routine treatment group), both groups were treated for two weeks.Serum levels of nitric oxide (NO), vascular endothelial growth factor (VEGF), thromboxan β2 (TXβ2) and hemorheological indexes were measured and compared between two groups after treatment;TIMI grade and TIMI myocardial perfusion grading (TMPG) of CAG were compared between two groups after treatment.Results: Compared with routine treatment group after treatment, there were significant rise in serum levels of NO[(64.9±10.3) mmol/L vs.(98.8±13.2) mmol/L]and VEGF[(1.62±0.53) mg/L vs.(3.31±0.68) mg/L], and significant reduction in serum TXβ2 level[(180.4±22.8) pg/ml vs.(78.9±9.6) pg/ml], P<0.05 or<0.01;significant reductions in whole blood high shear viscosity[(5.84±0.72) mPa·s vs.(4.25±0.31) mPa·s], whole blood low shear viscosity[(8.42±0.93) mPa s vs.(5.31±0.68) mPa s], plasma viscosity[(2.73±0.34) mPa s vs.(1.61±0.29) mPa s], fibrinogen level[(4.09±0.55) g/L vs.(3.13±0.55) g/L], erythrocyte aggregation index[(3.85±0.47) vs.(2.24±0.31)]and maximum platelet aggregation rate[(67.4±5.3)% vs.(48.0±3.6)%]in alprostadil group, P<0.05 all.Among those patients undergoing second CAG, compared with routine treatment group, there were significant reductions in percentages of TIMI and TMPG grade II and grade III, and significant rise in percentages of TIMI and TMPG grade 0 and grade I in alprostadil group, P<0.05 or <0.01.Conclusion: Alprostadil can significantly improve myocardial microcirculatory disturbance and hemorheological disorder in patients with coronary heart disease, which is worth extending.

Digestive tract reconstruction is an important part of gastric carcinoma operation as well as tumor resection and lymph node dissection.Surgeons are seeking the optimal reconstruction method that reduces the occurrence of complications and maintains better quality of postoperative life extremely.Uncut Roux-en-Y anastomosis is a modified procedure in which an artificial jejunal occlusion is devised to avoid Roux stasis syndrome based on Billroth Ⅱ and Braun's anastomosis.Compared to the conventional Roux-en-Y anastomosis,the uncut Roux-en-Y anastomosis retains the advantage of preventing biliary and pancreatic secretions reflux,furthermore,it can decrease the symptoms associated with Roux stasis owing to the abnormal myoelectrical conduction of Roux limb.Because the early studies indicated that there was higher incidence of dehiscence or recanalization of the jejunal occlusion,the uncut Roux-en-Y anastomosis has not been widely applied.Since jejunal occlusion has been optimized recently,the uncut Roux-en-Y reconstruction may be an optional and appropriate method of digestive tract reconstruction after distal gastrectomy.

This paper will address the development of disaster psychology and its important contribution regarding its theoretical and practical frameworks as it applies to the psychological counseling for survivors suffering from the consequences of natural disasters.This paper will also analyze how the approach of disaster psychology can be applied to work with survivors suffering from natural disasters and to alleviate psychological challenges and its influential factors which affect these individuals.Several strategies have been discussed and proposed.In addition,relevant theoretical and integrated approaches for psychological intervention support and guidance,and rehabilitation have been established.

Children are in the stage of mental and behavior development and easily sufferd from physical and psychological barriers after disaster.This paper uses the theories and methods of the developmental psychology,disaster psychology and rehabilitation psychology to analyze the psychological and behavior barriers of the disaster survivors and to discuss the psychological intervention and rehabilitation approaches.

Objective To evaluate the clinical value of microvascular anastomotic devices in the reconstruction of lower extremity defects by free flap transfer.Methods A retrospective review of 42 consecutive patients who underwent lower extremity microvascular reconstruction performed from May 2013 to November 2013 by microvascular anastomotic devices was performed.Patient charts were reviewed for age,sex,etiology of defect,location of defect,flap type,anastomotic technique,complications and flap survival.Results No patients had an arterial or venous anastomosis revised.The vascular anastomosis patency rates was 100％ and the flap survival rate was 97.6％.Total complication rate (9.5％) was due to 1 partial flap loss,1 partial skin graft loss and 2 hematoma.There were no intraoperative or perioperative complications involving the use of a microvascular anastomotic device itself.Conclusion Microvascular anastomotic devices have effective vessel anastomoses in lower extremity microvascular reconstruction.Thus,it presents an ideal tool for lower extremity microsurgical reconstruction.

Objective To evaluate the feasibility of individual template assisting permanent interstitial brachytherapy for skull base region.Methods From August 2010 to June 2012,20 patients with recurrent malignancies of skull base region received 125I seed permanent implantation.Before implanting,all patients underwent CT scan,the data were stored in Dicom format and imported into brachytherapy treatment planning system (BTPS).The preplan were finished by BTPS.Then,the digital model based on virtual needle and skin CT slices was reconstructed by Mimics and Geomagic.According to the digital model,the individual template was made from medical light-cured resin using rapid forming machine.During implanting,needles were inserted under the individual template assistance and 125I seeds were implanted according to preplan.After implanting,implantation quality was evaluated by 2D and 3D CT images and BTPS.The needles and seed distribution were observed.The actual dose distribution of target volumes D90,V100 and V150 was calculated.The complications were recorded within 72 hours.Results Interstitial implantation of 20 patients were performed successfully and efficiently under the individual template assistance without serious complications.Because of containing the virtual needle positioning and face surface feature information at the same time,the individual template significantly improved precision of needle location and orientation.The actuarial median number of 125I seeds implanted was 70 (range,20-172),and actuarial median D90,V100 and V150 was 181.6 Gy (127.4-279.6 Gy),98.2％ (94.6％-100％),43.2％ (24.3％-52.2％),respectively.The seed distribution and dosimetric quality were well controlled.Conclusions The method of individual template assisting permanent interstitial brachytherapy for skull base region is feasible,which can improve the accuracy of needle position placement.

Investigation of simvastatin and its related substances was carried out using a reversed phase ultra performance liquid chromatography/tandem mass spectrometry method. The identification of impurities in simvastatin was performed with a triple-quadrupole mass spectrometer, with an electrospray ionization (ESI) source in the negative/positive ion mode. A total of 12 compounds were characterized in commercial samples, among which 2 impurities had never been reported. All the impurities were deduced based on the MS fragment pathways of simvastatin and the biosynthetic pathway of lovastatin. This work provides very useful information for quality control of simvastatin.
Chromatography, High Pressure Liquid ; Chromatography, Reverse-Phase ; Drug Contamination ; Hypolipidemic Agents ; chemistry ; Quality Control ; Simvastatin ; chemistry ; Spectrometry, Mass, Electrospray Ionization ; Tablets ; Tandem Mass Spectrometry

Objective To investigate the clinical characteristics of hemodialysis (HD) patients complicated with arteriosclerosis obliterans (ASO) of lower extremity,and to discuss the factors that influence the curative prognosis of percutaneous transluminal angioplasty (PTA).Methods The clinical data of 211 patients with ASO of lower extremity receiving HD or not receiving HD,who were admitted to authors' hospital during the period from January 2008 to October 2015,were retrospectively analyzed.PTA was successfully accomplished in all patients.Results The median follow-up time was 2.24 years.Theamputation-free survival of HD group was significantly lower than that of non-HD group (P＜0.000 1),and the postoperative artery patency rate of HD group was also obviously lower than that of non-HD group (P＜0.000 4).The factors influencing the survival rate without amputation of the two groups were different.The independent influence factor in HD group was diabetes mellitus,while in non-HD group the independent influence factors were Fontaine stage and hyperlipidemia.The infection mortality of HD group was 55.5％ (10/18),which was higher than 22.2％(6/26) of non-HD group,the difference was statistically significant (P＜0.05).Conclusion In treating ASO of lower extremity,the curative effect of PTA is poorer in HD patients than in non-HD patients,and the presence of diabetes mellitus may be an independent factor influencing prognosis.