Objective To establish HPLC method for fast, effective, simultaneous determination of Vancomycin and Norvancomycin in serum. Methods The separation was achieved on the Hypersil ODS2(250 mm ×4.6 mm,5μm)with methanol-acetonitrile-a mixture of potassium phosphate (9.5:2.5:88) as the mobile phase.The flow rate was 1.0 mL/min.The UV detecting wavelength was 280 nm.The temperature of the column was 35 ℃. Vancomycin and Norvancomycin were used as the internal standard for each other .Results Vancomycin and Norvancomycin blood concentration were in well linearity in the range of 1.25-100μg/mL,R2 =0.9996.The average method recovery rate of three concentrations were 96.88%,99.50%,105.01%respectively, the average method recovery rate of three concentrations were 94.40%,103.90,103.81%respectively, the intra-day and inter-day RSD were less than 5%.Conclusion The HPLC method is proved to be simple,sensitive, accurate and precise in which little blood sample is taken, thus it is suitable for the therapeutic drug monitoring(TDM) and pharmacokinetic study of Vancomycin and Norvancomycin.

Objective:To introduce the use of fluoxetine in neurologic disease,especially in epilepsy.Method:We used fluoxetine as a supplement antiepileptic drug in 25 patients who couldnt be controlled yet by routine antiepileptics. A long term follow-up with these cases was carried out.Results:Most patients got better outcome.Conclusion:Fluoxetine would be an important supplement antiepileptic drug and have value for further clinical and experimental research.

BACKGROUND: Critical incidents are natural and man-made disasters arising suddenly, which are beyond the ability of the individuals to resist or control. In the situation of stress, individuals feel stuck, and are unable to control the situation.OBJECTIVE: To confirm the assessment model of stress response to critical events and the interventional effect of social support, general self-efficacy and coping efficacy.DESIGN: A randomized sampling, questionnaire-based investigation.PARTICIPANTS: We selected 1016 college students of 17 provinces or cities including Beijing, Guangzhou, Hefei, Jilin, Jiangsu, Jiangxi , Liaoning, Sichuan, Inner Mongolia, Shandong , Shanghai, Hebei, Tianjin,Wuhan, Zhejiang , Chongqing and so on as subjects. Totally 708 college students selected from the above regions received the same survey one year later.METHODS: Depression and anxiety state of the subjects were investigated with Center for Epidemiological Studies Depression Scale (CESD)and Anxiety Inventory (SAS) during SARS. Social support condition was investigated with Social Support Rating Scale, authorized by Xiao Shuiyuan. Related items were amended considering used among college students. The subscale was integrated into 3 subscales including group-support, friend-support and social support utilization. One year later, stress response to SARS was investigated again with self-made coping efficacy scale, self-esteem scale and self-efficacy scale and SARS Stress Response Questionnaire, which included 13 items measuring the students in three aspects: cognitive evaluation to SARS epidemic, such as "I believe human beings can conquer SARS in the end"; panic to SARS, like "worrying about SARS sweats me and makes me feel shiver sometimes"; and defense response to SARS, as "In order to prevent SARS, I have to wear respirator in the public". As far as cognitive, panic emotion and defense behaviors were concerned. The coping efficacy developed by the author covered 18items, such as "I'm afraid that I can not deal with things", "I have enough confidence to conquer any difficulty", and namely as friability, confidence and intelligence.RESULTS: ① The two investigated results were compared through assessment of covariation. There was a significant difference in cognitive condition, panic emotion and defense behavior; that was to say, the stress response to SARS had been obviously relieved . ② Social support and SARS stress response model x2=8.654,df=4,P=0.07;criterion fit index NFI= 1, RFI =0.997 and IFI =1, RMSEA=0.034. ③self-efficacy confirmative factor analysis showed the following: x2=0.536,df=2,P=0.765;x2/df=0.268, NFI=1, RFI=1, IFI=1 and CFI=1, RMSEA=0.000. ④The discriminating and convergent validity of coping efficacy questionnaire was as follows. The coefficient was 0.633 with general efficacy questionnaire, 0.530 with self-respect (SES), 0.481 with CESD, 0.387 with anxiety (SAS), and -0.003 with living events. ⑤ A structural equation model about general self-efficacy, coping efficacy and SARS stress response was established: x2 =2.722 df=3, P=0.437; NFI=1, RFI=0.999,IFI=1, CFI=1, RMSEA=0.068. The model fitted well. According to the data, coping efficacy affected SARS stress response negatively (the coefficient was -0.59)CONCLUSION: ① The three-dimensional assessment model assessed the stress response to critical incidents including cognitive adjustment, emotional response and behavioral tendency. The three-dimensional model stood the test while assessing SARS stress response. Compared with the assessment of emotional disorders, such as depression and anxiety, the model was more sensitive. ②Social support played a vital role in the stress response to critical incidents as a buffer or a regulator. It showed more influence on emotional disorders than on SARS stress response. ③Coping efficacy was a measurable intervening variable, which deserves more attention to in the stress response to critical incidents. Compared with general self-efficacy, coping efficacy had a greater intervening effect on SARS stress response.

Objective To value of economic with emergency endoscopy in the diagnosis and treatment of massive upper gastrointestinal hemorrhage. Methods I00 patients with upper gastrointestinal hemorrhage were ran-domly divided into emergency endoscopy group (group A) 48 cases and non emergency endoscopy group (group B) 52 cases. Then the correct diagnosis rates, rebleeding rates, complication rates, mean hospitalization days, the en-doscopy costs, the blood transfusion costs, the drugs costs and the total hospitalization costs of two groups were evalu-ated and the cost effect ratio (C/E) was calculated. Results Thecorrect diagnosis rates in A group (100. 0%) were higher than the B group(90. 2%)(x2 =4.01,P <0. 05) ;The endoscopy costs of group A (714. 78±263.54) yuan were higher than the group B (383.57 ±251.72) yuan(t = 2. 778, P < 0. 01) ; Rebleeding A group (6. 7%) were sig-nificantly lower than B group(26. 8%) (x2 = 4. 13 ,P < 0. 05) ; The total hospitalization costs in group A (2785.76 ± 353.26) yuan were lower than group B (3527. 76 ± 555.62) yuan (t = 2. 898, P < 0. 01) ; The C/E of group A (2785.76) yuan per patient were lower than the group B(3527.76) yuan per patient (t = 2. 239 ,P < 0. 01). Con-dusion Emergency endoscopy is economical in the diagnosis and treatment of massive upper gastrointestinal hereof-rhea.

Objective To analyze the relationship between the varicosity of esophagus and portal hypertensive gastropathy(PHC) in patients with upper gastrointestinal hemorrhage of hepatocirrhosis. Methods The damage degree of esophageal varicosity was divided into four grades and the PHG were divided into three groups according to the McCormack standards by emergency gastric endoscopy. Results Among 200 patients with upper gastrointestinal hemorrhage,100 cases(50. 0%) were caused by esophageal varicosity explosion and 44 cases(22. 2% ) were induced by PHG,38 cases (19. 0%) were due to gastric ulcer, 18 cases (9. 0%) were duo to other causes. Comparison between etiology and liver function of A-class(except for other reasons group) were significantly different(X2 =4. 23 ,X2 =4. 15 ,X2 =4. 18,X2 =4. 07,P＜0. 05 ;X2 =6. 83 ,X2 =7. 01 ,P＜0. 01 ) ;The portal vein diameter＞1.5cm bleeding incidence(32. 5% ) were significantly higher than the diameter＜1. 1cm bleeding incidence( 12. 5% ) (X2 =4. 73 ,P ＜0. 05 ) ;The degree of PHG in severe esophageal varices (55. 6% ) were significantly higher than the mild esophageal varices( 11.1% )( X2 = 7.73, P＜0. 01 ). The correlation between PHG degree and esophagus varicosity were positive related(r=0.455,X2 = 4.01,P＜0.05). Conclusion The esophageal varicosity explosion and PHG are two major factors to cause hepatocirrhosis complicated with upper gastrointestinal hemorrhagein. The more severe the damage degree of esophageal varicosity is,the higher incidence and the more severe the PHG will be.

Objective To analyze the value of serum calcitonin level to determine the illness severity of the elderly patients with severe pneumonia within six hours after admission and to dynamically observe the predictive value of serum PCT level change rate in different time points on the prognosis of the patients.Methods A total of one hundred and twenty olderly patients with severe pneumonia were enrolled.Within six hours after admission,the serum PCT level was detected by enzyme linked fluorescence analysis.Acute physiology and chronic health score (APACHEⅡ)were used to assess the severity of the disease.The correlation between serum PCT and APACHEⅡ score was analyzed by Pearson correlation coefficient.The receiver operating characteristic curve (ROC curve)showed the value of serum PCT level for the prognosis.Serum PCT levels were respectively monitored on the 1st,2nd,3rd and 5th day. Based on the prognosis outcome on twenty -first day after admission,the patients were divided into survival group and death group.The changes of serum PCT level in two groups were compared and the rate of change of serum PCT was also compared and the value of the clinical mortality of twenty -first day was assessed.Results Within six hours after admission,the level of serum PCT was positively correlated with APACHE Ⅱ score (r =0.768,P <0.05).The receiver operating characteristic curve (ROC curve)showed that the level of serum PCT was low for the predictive value on the prognosis of the patients,and the area under the curve was 0.502(t =0.915,P =0.153).All patients, there were ninty -four cases in the survival group and twenty -six cases of death group.Dynamic observation of serum PCT levels in the survival group showed a trend of gradual decline with time prolong,the level of PCT change rate was more than or equal to 50 percent within 72 hours.The level of serum PCT change rate in death group showed a gradual upward or downward trend and the change rate of PCT in seventy -two hours was less than 50%.The ROC curve showed that the rate of change of serum PCT level in seventy -two hours was better in predicting the mortality of patients on the twenty -first day,and the area under the ROC curve was 0.892(t =3.895,P =0.001).Conclusion Dynamic monitoring of serum PCT levels can be helped to assessment the prognosis of patients with sepsis and also predict the severity of the illness.The level of serum calcitonin can reflect the severity of severe pneumonia in elderly patients within six hours after admission,but can not accurately determine the prognosis of patients with severe pneu-monia.Dynamic monitoring of changes in serum calcitonin level is helpful to judge the prognosis of the elderly patients with severe pneumonia and the predictive value of serum calcitonin level change rate is higher in seventy -two hours after admission.

Xi Jinping,Secretary General has recently called on scientists mastering knowledge and proving in practice,to write papers in the motherland and in the realization of modernization.Up to the beginning of this century,ancestors and predecessors in Keshan disease prevention and control have made great achievements,including therapeutic methods,prevention of Keshan disease by supplementing selenium and compiling health standards,and these achievements have played an important technical supporting role in effectively controlling the epidemic of Keshan disease and guiding the practice of national wide control of Keshan disease.In the past 10 years,we have continued improving the technical norms to guide the work of national prevention and control of Keshan disease,and conducting translational research in response to the challenges of national Keshan disease prevention and control emerged in the new era.To realize the China dream of Keshan disease prevention and control,we must strive to achieve fully and sustainable elimination of Keshan disease,and to summarize the experiences in Keshan disease elimination for generalizing in other disease control and elimination,to continue to write the big article of the China dream of Keshan disease prevention and control.

Breakthroughs in the immunotherapy of acute leukemia have been achieved in recent years. The paper summarizes the clinical results, experience, and prospect in this area. One of the most significant advancements is the finding that anti-CD19 chimeric anti-gen receptor T cells (CAR-T) or CD3/CD19 bispecific antibody increases the rate of complete remission in patients with refractory re-lapse acute B lymphocytic leukemia. The disease-free survival of patients with low or intermediate risk was dramatically improved by combining chemotherapy and adoptive cytokine-induced killer or natural killer cells. Many immunotherapy methods, such as those fo-cusing on other targets of CAR-T, T-cell antigen receptor-modified T cell, and other targets of bispecific antibodies, are currently being examined. Combined methods can further increase cure rate and improve patients' quality of life, decreasing application of allogeneic hematopoietic cell transplantation which increases risks and reduces the quality of life.

Objective To observe the clinical effect of Zhongfeng-Tengtong decoction combined with tramadol in the treatment of central post-stroke pain (CPSP). Methods A total of 121 patients with stroke were recruited in our hospital. The patients were randomly divided into 2 groups by the ramdom number table method, 61 patients in the treatment group and 60 in the control group. All patients received conventional treatment of stroke secondary prevention, and the control group received oral tramadol hydrochloride sustained release tablets, while the treatment group received Zhongfeng-Tengtong decoction based on the intervention of control group. Both groups were treated for 14 days. The outcomes included Numerical Rating Scale (NRS), Fugl-Meyer Assessment (FMA), Stroke Specific Quality of Life Scale (SS-QOL), and the changes of hemorheology indexes of the 2 groups before and after treatment. Results After treatment, the NRS scores of treatment group were significantly lower than the control group (2.5 ± 0.4 vs. 4.6 ± 0.7;t=20.303, P<0.01). and FMA and SS-QOL scores of treatment group were significantly higher than the control group (FMA 57.1 ± 18.1 vs. 44.2 ± 12.5;t=4.702, P<0.01), (SS-QOL 193.4 ± 25.6 vs. 165.4 ± 22.8;t=6.536, P<0.01). The whole blood viscosity, plasma viscosity, fibrinogen and thrombosis coefficient of treatment group were significantely lower than the control group (whole blood viscosity 4.22 ± 0.13 mPa?s vs. 4.56 ± 0.41 mPa?s, t=14.452, P<0.01;plasma viscosity 1.72 ± 0.31 mPa?s vs. 2.33 ± 0.23 mPa?s, t=14.258, P<0.01; fibrinogen 3.72 ± 0.49 g/L vs. 4.98 ± 0.41 g/L, t=17.783, P<0.01; thrombosis coefficient 0.76 ± 0.30 vs. 1.11 ± 0.20, t=8.178, P<0.01). Conclusions Zhongfeng-Tengtong decoction combined with tramadol could alleviate the pain symptom in patients with CPSP, improve the movement function of limbs and improve the quality of life.

Ubiquitin-specific proteases (USPs) regulate the deconjugation of ubiquitin tag from substrate proteins. Dysregulation of USPs has been linked to many diseases. Despite extensive efforts by academia and industry,high quality chemical molecules targeting the USPs family of ubiquitin enzymes are still scarce. In this commentary,I propose the criteria of a high quality chemical probe and the strategies to target USPs.