Objective To develop a solid-phase extraction and HPLC method for the determination of midazolam and its hydroxy metabolites in child plasma. Methods Blood plasma samples were collected twenty four hours after treated with midazolam by continuous infusion of 2μg·kg-1·min-1 in our intensive care unit, the concentration of midazolam and its metabolites in plasma was detected by solid-phase extraction and RP-HPLC. The separation was performed on ZORBAX Eclipse XDB～C18 column(4.6 ×250mm,5μ m) with 7.56mmol/L ammonium sulfate - acetonitrile as mobile phase. The flow rate was 1.0ml/min,the column temperature was 25℃ and the wavelength of UV detector was 254nm. Results The retention time of 4-hydroxymidazolam, 1'-hydroxymidazolam and midazolam was detected as 8.14,9.09 and 11.18 min. The average recoveries for midazolam and its metabolites was 98.88% ～100.01% ,and RSD ＜ 4%. 29 patients took part in the study, the average plasma concentration of midazolam, 1'-hydroxymidazolam and 4-hydroxymidazolam was 0.68,0.28 and 0.08mg/L. Conclusion It is suitable for convention monitoring of the midazolam and its hydroxy metabolites concentration in the plasma

Objective To investigate the expression of Toll-like receptor 4 (TLR4) and CD80 in unexplained recurrent spontaneous abortion and their relationship,discuss its possible roles in guiding eugenics,and provide a new idea for clinical diagnosis and prevention.Methods The study group were 60 cases with unexplained recurrent spontaneous abortion patients.The control group included 30 cases of normal early pregnancy without previous history of adverse pregnancy.The expressions of TLR4 and CD80 were detected with immunohistochemistry in the peripheral blood,chorion,and decidua from each case.Results TLR4 had higher expression in the peripheral blood,the chorion and decidua from the recurrent spontaneous abortion women than that from normal pregnancy women (P ＜ 0.05).Levels of CD80 were significantly higher in recurrent spontaneous abortion group than in normal pregnancy group (P ＜ 0.05).There was a positive correlation between TLR4 and CD80 (r =0.982,0.986,and 0.776,P ＜0.01).Conclusions The study shows that TLR4 and CD80 were expressed in peripheral blood lymphocytes and villi and decidua of early pregnancy (normal pregnancy or abnormal pregnancy).Higher expressions of TLR4 and CD80 might play an important role in the occurrence of recurrent spontaneous abortion.

Objective To investigate the effects of mifepristone on apoptosis and expression of relative genes in early pregnant chorionic villi and decidua Methods The specimen of early pergnant chorionic villi and decidua obtained from 10 cases of requesting temination of pregnancy by curettage, 20 cases of mifepriston contragestation The paraffin sections were used to determine apoptotic cells by TdT mediated dUTP biotin nick end labeling method, to identify bcl 2, bax, fas, fasL and proliferating cell nuclear antigen (PCNA) by immunohistochemistry, to demonstrate fas and fasL mRNA by in situ hybridization Results In normal early pregnant specimens, apoptotic cells were mainly observed in syncytiotrophoblast, but not in cytotrophoblast cells, occationally seen in decidua cells The antigen of bax, fas, fasL were present in syncytiotrophoblast cells and decidua with lower amount While bcl 2 antigen staining was strong in cytotrophoblastic cells and in decidua PCNA protein was present in cytotrophoblastic and decidual cells only In the specimens treated with mifepristone, apoptotic cells were increased in syncytiotrophoblastic cells of villi and visualized in decidua cells The expression of fas, fasL and bax was also higher than that of nomal Conclusions Mifepristone increased apoptosis in syncytiotrophoblastic and decidua cells, but had no effect on the expression of bcl 2 and PCNA

The roles of NF-kappaB (NF-kappaB) expression, Bax activity and cytochrome C (Cyt C) release, apoptosis of islet cells induced by high concentration glucose were explored in vitro. Pancreatic islet cells, which were isolated from Kunming mice, were cultured with different concentrations of glucose in DMEM, and divided into the following groups: G1, G2, G3, G4, G5, and G6 groups, corresponding to the glucose concentrations of 5.6, 7.8, 11.1, 16.7, 22.5, and 27.6 mmol/L, respectively. After culture for 120 h, insulin secretion was evaluated by radioimmunoassay, and the NF-kappaB expression was detected by immunocytochemistry. Bax activity and Cyt C release were measured by immunofluorescence, and apoptosis was examined by Hoechst33342 assay. The results showed that in G1, G2 and G3 groups, insulin secretion was enhanced with the increase of glucose concentration, and the NF-kappaB expression was also increased (P<0.05), but Bax activity, Cyt C release and apoptosis rate showed no significant difference among them. However, in G4, G5, and G6 groups, apoptosis rate of islet cells, NF-kappaB expression, Bax activity, and Cyt C release were all significantly increased, and insulin secretion was impaired as compared with G1, G2, and G3 groups (P<0.05). It was concluded that the exposure of islet cells to high glucose could induce islet cells apoptosis as well as impaired insulin secretion. The NF-kappaB signaling pathway and mitochondria pathway in islet cells might play some roles in the progressive loss of islet cells in diabetes. The inhibition of the NF-kappaB expression could be an effective strategy for protecting pancreatic islet cells.

Objective To explore the advantages of the bedside DR,taking the quality analysis of the chest image taken from the bedside digital radiography systems (DR) and computed radiography system (CR).Method All of the 900 pieces chest image taken by bedside DR,compared with the 900 pieces CR image randomly chosen.Results Bedside DR could further reduce the rate of the remake and the radiation dose,and provided more excellent image information.Conclusion The chest image taken by bedside DR has obviously advantage than CR.It can play a positive role in the diagnosis and treatment of the critical patient and surgical patient.

OBJECTIVE:To establish a scientific evidence for evaluation of individualized administration among children.METHODS:Hydrocortisone probe was used for determination of CYP3A activity in children with quantitative method.RESULTS:CYP3A activity in the health children volunteers showed Gaussian distribution in the form of natural logarithm,the average value was1.69?1.04,with the value of1.63?0.99in males and1.75?1.09in females.CONCLUSION:There is no significant difference in CYP3A activity between the two sexes.

Objective To explore the relationship between aryl hydrocar-bon receptor (AhR),aryl hydrocarbon receptor nuclear translocator (ARNT),estradiol (E2),estrogen receptor (ER) and recurrent spontaneous abortion (RSA) through observing the level of serum AhR,ARNT,E2,and AhR,ARNT,ER in decidua and chorionic tissues of the patients with recurrent spontaneous abortion.Methods 64 cases of RSA patients who induced abortion at the Shanxi Dayi hospital from May 2015 to September2017 were chosen as RSA group,and 30 cases of healthy abortion women of the same period who had born full-term normal fetus were choosen as the normal group.The serum,villi and decidua of each case were collected during abortion.The level of AhR,ARNT,ER of both groupswere detected by enzyme-linked immunoscrbent assay (ELISA) method.The Serum E2 lever were detected by the method of chemical luminescence.The data of all the patients were analyzed.Results (1) The level of ARNT in peripheral blood of RSA group was significantly higher than that of normal group (P ＜ 0.05),and the levels of AhR and E2 in peripheral blood were not statistically significant between the two groups (P ＞ 0.05).The levels of AhR and ARNT in villi and decidua were significantly higher in RSA group than in normal group (P ＜ 0.05),while the expression of ER in villi and decidua was significantly lower in RSA group than in normal group (P ＜ 0.05).(2) There was no significant difference in the ratio of AhR/ARNT between the two groups (P ＞ 0.05);the ratio of AhR/ER and ARNT/ER in the villi and decidua of the RSA group was higher than that of the normal group (P ＜ 0.05).Conclusions Overexpression of AhR and ARNT and low expression of ER in villi and decidua tissues may be related to the occurrence of RSA.

abetes. The inhibition of the NF-κB expres-sion could be an effective strategy for protecting pancreatic islet cells.

Objective To evaluate the cost-effectiveness of budesonide/formoterol powder inhalation(BF)versus salmeterol/fluticasone powder inhalation(SF)for the treatment of persistent asthma in adolescents,and to provide economic evidence and reference for clinical medication and decision-making.Methods From perspective of Chinese healthcare,a Markov model was established based on a prospective cohort study conducted by Shanghai Fudan University Affiliated Minhang Hospital.The cycle length was 7 days,and the time horizon was 6 years.A discount rate of 5％per year was applied.Clinical parameters including asthma acute exacerbation,treatment costs,and health utility values were obtained from relevant literature.The primary outcomes were direct medical costs,quality-adjusted life-years(QALYs),and incremental cost-utility ratio(ICUR).Cost-utility analysis was performed using TreeAge Pro 2022.The one-way sensitivity analysis and probabilistic sensitivity analysis were conducted to validate the robustness of the basic analysis results.Results Compared with SF group,BF group contributed to an incremental QALYs of 0.002 5 and reduced the cost by 7 043.93 yuan,which implied that BF group was a dominating treatment.Results of one-way sensitivity analysis showed that SF price,BF price and Hazard ratio of asthma acute exacerbation(BF vs.SF)were the main sensitivity factors of model.Probabilistic sensitivity analysis demonstrated the probability of BF being cost-effective was about 80％within the willingness to pay threshold of 257 100 yuan/QALY.Conclusions It was found out in this study that BF was a more cost-effective option for the adolescents with persistent asthma compared with SF.