Objective To explore an UPLC method for simultaneous content determination of the five nucleosides (cytidine, uridine, adenine, thymidine and adenosine) in Hedyotis diffusa and its adulterants; To compare the content differences.Methods The analysis was performed on a BEH C18 column (2.1 mm×50 mm, 1.7 μm) by UPLC eluted with acetonitrile and water in gradient mode. The flow rate was 0.5 mL/min; the detection wavelength was set at 254 nm; the column temperature was set at 30℃.Results Five nucleosides have good linear relationship, precision, stability, and repeatability according to the requirements of the methodology determination. The recoveries were among 98.7%–101.5%. Five nucleosides in Hedyotis diffusa and its adulterants from different areas were determined by the UPLC method.Conclusion The method is certified to be simple, rapid, accurate and reliable, which can be used for the determination of nucleosides in Hedyotis diffusa and its adulterants.

Objective To investigate the relationship between single nucleotide polymorphisms (SNPs) of UGT1 A6 and aspirin response in a cohort of Chinese Han population.Methods A total of 323 ischemic stroke patients consecutively registered in Nanjing Stroke Registry Program from September 2011 to October 2014 were enrolled.Three SNPs (rs6759892,rs2070959 and rs1105879) of UGT1A6 were genotyped in these ischemic stroke patients.Association of genotypes and aspirin response was evaluated by generalized linear model.Indicated with the inhibition rate of platelets,aspirin response was assessed by thromboelastograph.Results The mutation allele (G) of rs2070959 was positively related to platelets inhibition (β =0.084,P =0.010,Pcorrected =0.029),especially in male (β =0.098,P =0.006,Pcorrected =O.019).The dominant models of rs6759892,rs1105879 were also modestly related to aspirin response (P=0.015,Pcorrected=0.046 in both SNPs) in male.Thus the polymorphisms of UGT1A6 showed a relationship with aspirin response,especially in males.Conclusions The results indicated that genetic polymorphism of UGT1A6 might have an effect on individuals' aspirin response,especially in males.These findings can help clinicians to optimize the antiplatelet therapy for ischemic stroke patients.

Objective To evaluate Alberta stroke programme early CT score on diffusion-weighted imaging (DWI-ASPECTS)and clot burden score on MR angiography (MRA-CBS)in predicting hemorrhagic transformation(HT) in acute anterior circulation cerebral infarction after thrombolysis in diffusion-weighted imaging Alberta stroke program.Methods A total of 37 consecutive patients with acute anterior circulation cerebral infarction were treated with thrombolysis.The clinical information , score of DWI-ASPECTS before thrombolysis , score of MRA-CBS before thrombolysis and images of enhanced gradient echo T 2*-weighted angiographywithin ( ESWAN) 24 hours before and after thrombolysis were all collected.The interval between onset and the two MRI scans were recorded respectively.We identified HT according to the images of ESWAN scanned after thrombolysis , and divided patients into 2 groups:with HT(14 cases) and without HT (23 cases).Differences of clinical data and imaging indicators between the two groups were compared by using Fisher′s exact test and Wilcoxon rank sum test.Logistic regression analysis was performed by taking HT as the dependent variable , and the scores of NIHSS , DWI-ASPECTS and MRA-CBS at admission were taken as independent variables.The variables which were statistically significant in logistic regression analysis were enrolled in receiver operating characteristic analysis.Results In HT group, the scores of NIHSS, DWI-ASPECTS and MRA-CBS were 15.00 ±5.30, 6.00(4.75,7.00) and 7.00(0.75,8.50) respectively.In the other group without HT, these scores were 7.00 ±4.80, 9.00(8.00,10.00)and 10.00(6.00,10.00) respectively.Compared with patients without HT , patients with HT had a higher baseline NIHSS score ( Z=-3.72,P<0.01), a lower DWI-ASPECTS (Z=-4.13,P<0.01) and a lower MRA-CBS (Z=-2.00, P<0.05).Logistic regression analysis showed that the scores of DWI-ASPECTS ( OR 0.42,95%CI 0.21-0.87,P <0.05 ) and NIHSS ( OR 1.22, 95%CI 1.00-1.48, P <0.05 ) at baseline predicted HT development independently.Receiver operating characteristic analysis showed that the optimal cut -off point of DWI-ASPECTS to predict the development of HT was≤7.Its sensitivity, specificity and area under ROC curve were 92.9%, 78.3% and 0.902 respectively ( P<0.01 ).Conclusions ASPECTS on DWI is of great value in predicting HT after thrombolysis in acute cerebral infarction.CBS on MRA can provide additional information for predicting HT.

BACKGROUND: It is difficult to conduct the operation of ossification of ligamentum flavum (OLF) in thoracic spine, and the operation needs complecated operative skill, and unmerited disposal tends to worsen neurological dysfunction.OBJECTIVE: To analyze the operative method for OLF of thoracic spineand functional restoration.DESIGN: Case analysis.SETTING: Department of Orthopaedics, Changzheng Hospital, SecondMilitary Medical University of Chinese PLA.PARTICIPANTS: Totally 56 patients with OLF of thoracic spine, whowere treated at the Department of Orthopaedics, Changzheng Hospital fromAugust 1996 to August 2003.METHODS: The operative therapy was performed in all the patients, and the method was determined by the results of MRI and CT examination: ①The 19 patients, whose OLF in thoracic spine was focal type, and range of lesion did not exceed two segments, were treated with simple resection and decompres sion in posterior wall of vertebral canal. ②Fenestration and sledging-allocating manipulation in the whole piece unilateral lamina of vertebra were carried out in 29 cases involving more than 2 segments. ③If coplanar OLF in thoracic spine combined with protrusion of thoracic spine disc or ossification of posterior longitudinal ligament, decompression of posterior midline approach+posterior lateral approach was performed, totally 8 cases.MAIN OUTCOME MEASURES: Post-operation functional restoration was evaluated with Epstein standard, excellent: recovery of sensation and exercise was near to normal; good: spinal cord function was improved significantly, and permitted to walk with brace; fair: small partial restoration of sensory and motor function, unable to walk; bad: Inefficiency or becoming severe.RESULTS: A total of 55 cases were followed up for more than one year and 1 case only for two months after operation. ①Functional restoration: excellent: 39 cases; good: 8 cases; fair: 5 cases; bad: 4 cases. ②Symptom recovery after operation was confirmed by disappearance of tight sensation, reduction of muscular tension, relieving of numbness in order. ③The recovery was rapid for 3 to 6 months after operation. Part of patients' condition was still ameliorating during one year after operation, and rare advancement 2 years later. The recovery of complete paraplegics was bad, so was the severe paraplegia with long history. CONCLUSION: Compressive myelopathy caused by OLF in thoracic spine should be treated in an earlier period by operation. Resection and decompression of posterior wall of thoracic spine and decompression of posterior approach could be choosed according to different condition.

Objective To compare the clinical outcome of unipedicular versus bipedicular vertebroplasty treating for osteoporotic vertebral compression fracture.Methods Sixty-four patients(68 vertebra)were divided into two groups by treated methods:unipedicular kyphoplasty group(33 cases)and bipedicular vertebroplasty group(31 cases).The Cobb angle and vasual analogue pain scale(VAS)were measured preoperatively and postoperatively.The operation time was recorded.Compared the Cobb angle,VAS and the operation time between two groups.Results Of unipedicular kyphoplasty group preoperative,24 hours and 3 months after operation,VAS were(8.42 ± 1.33),(2.21 ± 1.67),(2.09 ± 1.58)scores,the Cobb angle were(31.24 ±9.12)°,(14.21 ±9.21)°,(14.43 ±9.36)° ;while those of bipedicular vertebroplasty group were(8.36 ± 1.52),(2.13 ± 1.80),(2.00 ± 1.71)scores and(30.84 ±8.77)°,(13.94 ± 8.87)°,(14.07 ± 9.87)°.VAS and the Cobb angle of both groups at 24 hours and 3 months after operation were lower than those preoperative(P＜ 0.01).VAS and the Cobb angle of both groups were similar at the same time preoperatively and postoperatively(P ＞ 0.05).The operation time of unipedicular kyphoplasty group and bipedicular vertebroplasty was(45.00 ± 8.76),(72.00 ± 9.32)min,respectively,there was statistically significant difference between two groups(P ＜ 0.01).Conclusions Compared with the bipedicular vertebroplasty,the advantages of unipedicular kyphoplasty are as follows:less trauma,less operation time and less X-rays rediation accepted of the patient and the operator.And it has the similar clinical outcome with the bipedicular vertebroplasty.

Stroke has become the leading cause of death in Chinese residents. As the cornerstone of the primary and secondary prevention of ischemic stroke, aspirin can prevent the occurrence and recurrence of ischemic stroke in a certain extent. However, some patients stil have vascular events after taking aspirin regularly or higher platelet aggregation rate. This phenomenon is caled aspirin resistance or aspirin low reactivity. This article reviews the occurrence, detection methods, and treatment measures of aspirin resistance in patients with ischemic stroke.

Objective ToinvestigatetherelationshipbetweenmuscleRASoncogenehomolog (MRAS)genepolymorphismandyoungpatientswithischemicstroke.Methods Atotalof243young patients with ischemic stroke from Nanjing Stroke Registry Program from December 2009 to October 2012 were enrolled retrospectively. At the same time,512 age-and sex-matched healthy controls were selected. The polymorphisms of MRAS genes rs3755751 and rs9289559 loci were analyzed by the modified multiplex PCR-ligase detection reaction assay. The genotype of each locus and the allele frequencies were analyzed and compared. Results (1)The frequencies of AA,AG and GG genotypes for rs3755751 in the stroke group (n=243)were 7. 4%(n=18),37. 0%(n=90),and 55. 6%(n=135),respectively. There were no significant differences compared with those (6. 4%[n=18],36. 9%[n=189]and 56. 6%[n=190]) in the control group (n=512)(P>0. 05). The frequencies of AA,AG and GG genotypes for rs9289559 in stroke group were 7. 0 (n=17)%,42. 0%(n=102),and 51. 0%(n=124),respectively. There were no significant differences compared with 6. 1%,(n=31)37. 9%(n=194),and 56. 1%(n=287)in the control group (P>0. 05). (2)Further construction of an effect model (AA vs. AG+GG and GG vs. AG+AA),there was no significant difference between the stroke group and the control group (P >0. 05 ). Analyzing the effects of different genotypes on plasma lipid levels showed that the high-density lipoprotein cholesterol level of the GG genotype subgroup in the young ischemic stroke group was significantly higher than that rs3755751 of the AG +AA genotype subgroup (OR,6. 80,95%CI 2.18-21.27, P=0. 001 ). Conclusions MRAS gene polymorphism may have no significant correlation with the genetic susceptibility in young patients with ischemic stroke. Polymorphism of rs3755751 may be correlated with the level of serum high-density lipoprotein cholesterol.

BACKGROUND:Acelular dermal matrix is a cel-free natural tissue scaffold similar to human soft tissue, which is easy to shape and has non-toxic side effects. It has been used to repair the urethra and ureter. OBJECTIVE:To investigate the effect of acelular dermal matrix on the repair of bile duct injury. METHODS:Thirty Diannan miniature pigs were randomly divided into three groups: in blank group, the bile duct was resected folowed by end to end anastomosis; in experimental group, bile duct defect model was made folowed by repair with acelular dermal matrix; in control group, bile duct defect model was made folowed by repair with expanded polytetrafluoroethylene. At 6 and 24 weeks after repair, bile duct patches and surrounding tissues were taken for immunohistochemical observation and RT-PCR detection. RESULTS AND CONCLUSION: Compared with the control and blank group, the expression of cytokeratin was higher, but the expression of transforming growth factor β1 was lower in the experimental group. Within 24 weeks after repair, the total mRNA level of transforming growth factor β1 was lower in the experimental group than the other two groups (P < 0.05), but the total mRNA levels of insulin-like growth factor 2 and vascular endothelial growth factor were higher in the experimental group (P < 0.05). These findings indicate that the acelular dermal matrix for repair of bile duct injury can promote angiogenesis and bile duct epithelial regeneration, but not increase the formation of scars.

Objective To evaluate the optimum ratio of medicine dosage for dexmedetomidine mixed with sufentanil used for patient?controlled intravenous analgesia ( PCIA) after Nuss procedure in pedi?atric patients with pectus excavatum. Methods Sixty pediatric patients diagnosed with pectus excavatum, aged 5-12 yr, weighing 18-50 kg, of ASA physical statusⅠorⅡ, scheduled for elective Nuss procedure under general anesthesia, were randomly divided into 3 equal groups using a random number table:different ratios of medicine dosage while dexmedetomidine was added to sufentanil groups ( SD1-3 groups) . Postopera?tive analgesia was as follows: group SD1 received sufentanil 1 μg∕kg + dexmedetomidine 2 μg∕kg; group SD2 received sufentanil 1 μg∕kg + dexmedetomidine 3 μg∕kg; group SD3 received sufentanil 1 μg∕kg +dexmedetomidine 4 μg∕kg. A mixture of tropisetron 0?1 mg∕kg and dexamethasone 0?1 mg∕kg ( in 100 ml of normal saline) was added in each group. The PCA pump was programmed to deliver 0?5 ml with a lockout interval of 15 min and background infusion at 2 ml∕h. The PCA pump was connected immediately after the end of operation, and sufentanil with a dosage of 0?1μg∕kg was used as a rescue analgesic within 48 h post?operatively. The VAS score was maintained below 4. The requirement for rescue analgesics was recorded. The Ramsay sedation scores was recorded at 4, 8, 12, 24 and 48 h postoperatively, and the occurrence of adverse reactions such as nausea and vomiting, bradycardia, over?sedation, respiratory depression, agitation and shivering was recorded within 48 h after surgery. Results No pediatric patients developed nausea and vomiting, respiratory depression, bradycardia, over?sedation, and shivering. No pediatric patients required rescue analgesics in SD2 and SD3 groups. Compared with group SD1 , the requirement for rescue analgesics and incidence of agitation were significantly decreased, and Ramsay sedation scores were increased at 4 and 8 h after operation in SD2 and SD3 groups. Ramsay sedation scores were significantly higher at 4 h after oper?ation in SD3 group than in SD2 group. Conclusion Dexmedetomidine 3 μg∕kg mixed with sufentanil 1μg∕kg is the optimum ratio of medicine dosage when used for PCIA after Nuss procedure in pediatric patients with pectus excavatum.

Objective To investigate the relationship between the carotid calcification and the prognosis in patients with ischemic stroke. Methods A total of 522 patients with non-cardiac ischemic stroke registered in the Nanjing Stroke Registry Program (NSRP )from December 2009 to October 2012 were enrolled. All patients underwent head and neck CT angiography (CTA). The original data of CT scan were transmitted into the Siemens workstation. Calcium score measurement was performed using the same reconstruction conditions and Agatston calcium score to measure calcification score. The patients were divided into no (0),mild (0