OBJECTIVE:To observe clinical efficacy and safety of intrathecal injection of meropenem combined with vanco-mycin for intracranial infections after craniotomy. METHODS:In retrospective analysis,46 patients with intracranial infections af-ter craniotomy selected from our hospital during May 2014 to Jun. 2016 were divided into control group(20 cases)and observation group(26 cases)according to treatment method. Control group was given Vancomycin hydrochloride for injection 1.0 g,ivgtt,bid+Meropenem for injection 2.0 g,ivgtt,tid. After cerebrospinal fluid release of lumbar cistern drainage,observation group was given Vancomycin hydrochloride for injection 20 mg slowly,and the given Meropenem for injection 20 mg,bid,after washing tube with 0.9% Sodium chloride injection 2 mL. Both groups received treatment for 2 weeks. Cerebrospinal fluid bacterial culture,clinical ef-ficacy,healing time and treatment cost were observed in 2 groups,and the occurrence of ADR and sequela in 6 months after treat-ment were recorded. RESULTS:The positive rate of cerebrospinal fluid bacterial culture of 46 patients was 45.7%. The healing rate of observation group(92.3%)was significantly higher than that of control group(65.0%). Healing time and treatment cost of ob-servation group were significantly shorter or lower than control group;and total incidence of ADR (7.7%) was also significantly lower than control group (40.0%),the incidence of sequelae (3.8%) was significantly lower than control group (20.0%),with statistical significance(P<0.05). CONCLUSIONS:Therapeutic efficacy of intrathecal injection of meropenem combined with van-comycin is superior than intravenous administration for intracranial infections after craniotomy,can significantly shorten the treat-ment time and reduce treatment cost with good safety.

Objective To establish a rabbit model of hypoglycemia and evaluate the accuracy and timeliness of hypoglycemia monitoring by continuous glucose monitoring system (CGMS).Methods Sixteen female New Zealand white rabbits were randomly divided into 4 groups, with 4 rabbits in each group.The rabbits in the control group were given intravenous infusion of saline.The animals in the experimental group were infused with insulin continuously, which were divided into 0.1 U/kg/h insulin group (RI=0.1 U group), 0.2 U/kg/h insulin (RI=0.2 U group) group and 0.4 U/kg/h insulin group (RI=0.4 U group) accordingly.During the experiment, CGMS was monitored for 240 min.Blood samples were collected at a 30-minute interval and the blood glucose level was measured by a hand glucose meter.Results A total of 1296 CGMS monitoring data were obtained during the study period, and 136 BG monitoring data matched with CGMS time were obtained.After the insulin administration, BG and CGMS were significantly decreased.The reduction rates of BG and CGMS were 0.016 and 0.017 mmol/L/min in the RI=0.1 U insulin group, 0.04 and 0.027 mmol/L/min in the RI=0.2U insulin group, and 0.049 and 0.032 mmol/L/min in the RI=0.4 U group.According to whether BG monitoring value was lower than 4.4 mmol/L, the BG-CGMS paring data were divided into hypoglycemia and normoglycemia.In hypoglycemia, the average deviation of BG-CGMS was 0.55 mmol/L (the upper and lower limits were-0.98 and 2.08 mmol/L, respectively) and the absolute difference percentage (RAD) was 40.2% ± 45.2%.The mean deviation of BG-CGMS in normal blood glucose was-0.19 mmol/L (upper and lower limits were-1.38 and 1.00 mmol/L, respectively) and 5.8% ± 5.3% in RAD.The error grid analysis (EGA) showed that the proportion of zone A was 93.4%, 0.7% in zone B, and 5.9% in zone D, and the zone D was distributed in area of low BG and high CGMS.Conclusions The results of this study indicate that CGMS has a significant hysteresis phenomenon when blood glucose is reduced rapidly.When the blood glucose levels fall below 4.4 mmol/L, CGMS may have a risk of overestimating blood glucose.Such risk should be fully considered during CGMS clinical application.

Objective To investigate the present status of Chinese patent medicine with realgar (As2S2) and to research arsenic dissolution in different pH values. Methods Data on the amount of Chinese patent medicine with realgar, the content of realgar, the method of taking medicine and so on were collected from the Chinese traditional medicine protection and criterions issued by the Chinese Ministry of Health in 2005, and evaluated the using status of Chinese patent medicine with realgar. The realgar powder was dissolved in solutions at different pH values (1, 3, 5, 7, 9, 11) in 37℃ water for 4 h, respectively, then arsenic was determined with cold trap hydride generation atomic absorption spectrometry to calculate the amount of dissolved arsenic. Results One hundred and twenty-one (3.13%) realgar medicaments were recorded in a total of 3 860 various Chinese patent medicaments, including 74 medicaments with both realgar and cinnabar (HgS) . Of all medicaments with realgar, 97 medicaments (80.17%) were for oral application, 10 medicaments (8.26%) were for external application, and 14 medicaments (11.57%) were for both oral and external application. 45 medicaments with realgar (1.17%) could be used in children; 108 medicaments with realgar (89.26%) contained arsenic 15%; The relative amount of arsenic in medicaments with realgar was from 0.46% to 27.52%. Daily intake of arsenic was 500 mg for 11 medicaments (9.09%). Only inorganic arsenic (iAs) was detected when 1 mg realgar was dissolved in solution with pH values of 1, 3, 5, 7, 9, 11. The levels of dissolved iAs seemed increased with the pH values, which were 1.58 ?g, 1.24 ?g, 1.57 ?g, 1.62 ?g, 2.28 ?g and 4.76 ?g, respectively. Conclusion Considering the common use of realgar in Chinese patent medicine and the high level of arsenic in realgar, the potential danger can not be ignored. It is possible that arsenic in realgar may be much easier to be absorbed in intestine than in stomach.

Objective To investigate the correlations of body mass index (BMI) with plasma apelin, waist-hip ratio (WHR), fasting plasma glucose (FPG), glycosylated hemoglobin (HbAlc), biochemical indicator, blood fat and ultrasonic cardiogram (UCG) figures in patients with congestive heart failure (CHF).Methods A total of 41 elderly CHF patients (20 males and 21 females, aged 66.0±12.3 years) were divided into 3 groups according to BMI: normal group (n= 16), overweight group (n=13) and obese group (n= 12).And they were also divided into 2 subgroups: grade Ⅲ heart function group (n=22) and grade Ⅳ heart function group (n= 19).Enzyme linked immunosorbent assay was used to detect the levels of plasma apelin, and BMI, WHR, C-reactive protein (CRP), FPG, creatine kinase (CK), CK-MB, blood fat, electrolyte and UCG of all patients were detected .Results There were significant differences in waist circumference, hip circumference and WHR among the 3 groups (P<0.05 or P<0.01).But there were no significant differences in high density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol (TC), triglyceride (TG), FPG, HbAlc, CK, CK-MB, potassium, sodium, CRP, left ventricular internal diameter at end-diastole (LVIDd), left ventricular internal diameter at end-diastole (LVIDs), interventricular septal thickness at end diastole (IVSd) and left ventrieular ejection fraction (LVEF) among the 3 groups (all P> 0.05).The apelin level was higher in obese group than in normal group and in overweight group ((0.48±0.15) mg/L vs.(0.18±0.15) mg/L and (0.27±0.06) mg/L, both P<0.01].And the plasma apelin level was higher in grade Ⅳ heart function group than in grade Ⅲ heart function group [(0.35±0.16) mg/L vs.(0.26±0.13)mg/L, P<0.05].The level of plasma apelin was positively correlated with BMI, white blood cell, CK, hemoglobin and TG, and was negatively correlated with cardiac function and LVEF.The influencing factors for the plasma apelin were BMI (β=0.672, P<0.01), age (β=0.244, P<0.05) and HDL (β=-1.000, P<0.01).Conclusions The plasma apelin level is closely correlated with the development of heart failure.Cardiac dysfunction is more severer when the level of plasma apelin is higher.The high level of plasma apelin may be one of factors for the higher survival rate of the obese CHF patients.Plasma apelin level may be used as an indicator of state of illness.

AIM: To qualitatively detect the concentration of recombinant human glucagon-like peptide-1(7-36)[rhGLP-1(7-36)] in human blood.METHODS: RhGLP-1(7-36) concentrations of standard and blood samples were detected by ELISA kits.RESULTS: The parameters of specificity,sensitivity,detection limits,reproducibiltiy and recovery can meet the requirements for pharmacokinetic studies.CONCLUSION: The concentration measuring method of rhGLP-1(7-36) in blood samples using ELISA kit produced by LINCO company can meet the detection methods of biological production,which can be used as a measuring method of rhGLP-1(7-36) concentration and for its pharmacokinetic studies.

Objective To explore the clinical value of real-time contrast-enhanced ultrasonography and ultrasonography in the diagnosis and staging of cervical cancer.Methods 80 cervical cancer patients were selected as the research subjects,they were randomly divided into two groups.40 patients in the observation group received real time contrast-enhanced ultrasound,40 cases of the control group received conventional ultrasonography.The detection rate,diagnosis of cervical cancer,cervical cancer tissue and normal tissue parameters were compared between the two groups.Results 35 patients were detected in the observation group,the detection rate was 87.5%,23 patients were detected in the control group,the detection rate was 57.5%,the detection rate of the observation group was significantly higher than the control group (x2=9.028,P=0.002).In the observation group,7 patients in stage Ⅰ(17.5%),1 case in the control group (2.5%),there was significant difference between the two groups (x2=5.000,P=0.025),the differences in phase Ⅱ,Ⅲ and Ⅳ were not statistically significant(P>0.05).In observation group,the peak intensity of cervical cancer was (65.43±10.55)%,and the peak time was (22.09±2.82)min,the peak intensity of normal tissue was (58.21±14.12)%,peak time was (28.27±3.01)min,the peak intensity of cervical cancer was higher than normal tissue,the peak time was shorter than normal tissues,the differences were statistically significant(t=2.590,9.476,all P<0.05).The differences of the area under the curve and the average transit time between normal tissue and cervical cancer tissue were not statistically significant(P>0.05).Conclusion Compared with conventional ultrasonography,the contrast-enhanced ultrasonography can clearly show the range of tumor,quantitative analysis of time intensity curve parameters,can better reflect the characteristics of cervical cancer lesions,can improve the diagnostic rate and clear clinical stage.

[Objective]To investigate the treatment effects of the anatomical plate on proximal humeral fractures and analyze the structural characteristics of the plate clinically.[Method]From June 2003 to June 2005,comminuted fractures of the proximal humerus of 32 patients(18 males and 14 females,with average age of 39 years)were treated with anatomical plates.Fractured proximal humerus was exposed by a standard deltopectoral approach after a dissection from the deltoid and pectoral muscle.Anatomical plates were placed on lateral sides of the humerus after reduction.The arm was immobilized in a sling,passive movement was begun on the first day after surgery,and active movement of the shoulder was started after three week.Active movement with resistance was allowed when there was radiological evidence of bone healing which usually occurred after six weeks.The patients were reviewed clinically and radiologically.[Result]All 32 patients were available at follow up with mean duration of 20 months (7~28 months).No complications such as nonunion of fractures,infection,the loosening and breakage of the plate were ever occurred.The clinical results were graded as excellent in 21 patients,good in 7,fair in 2,and poor in 2 according to the Neer's classification.The excellent and good rate was 87.5%.[Conclusion]Anatomical plate for the proximal humerus holds a 3-dimensional structure,which facilitates the fracture exposure,bone fragments reduction and fixation.It is concluded that rigid fixation of displaced fractures of the proximal humerus with an anatomical plate provides sufficient primary stability to allow early functional treatment.And is advocated that primary open reduction and rigid internal fixation using anatomical plates for the proximal humerus fracture.

This study was aimed to develop a maximum a posteriori Bayesian (MAPB) estimation method to estimate individual pharmacokinetic parameters based on D-optimal sampling strategy. Meanwhile, the performance of MAPB was compared with the multiple linear regression (MLR) method in terms of accuracy and precision. Pharmacokinetic study of pioglitazone was employed as the example case. The population pharmacokinetics was characterized by nonlinear mixed effects model (NONMEM). The sparse sampling strategy (1-4 points) was identified by D-optimal algorithm using WinPOPT software. The simulated data generated by Monte Carlo method were used to access the performance of MAPB and MLR. As the number of samples per subject decreased, the accuracy and precision of MAPB method tended to get worse. The estimation for CL and Vby MAPB using D-optimal two-point design had less bias with low inter-individual variability, and had more bias and imprecision with high residue variability. The estimation of AUC by MAPB using D-optimal 2 points design had similar accuracy and precision to MLR. However, MAPB estimation was better than MLR while adjusting the sampling time to one hour. Overall, the MAPB method had similar predictive performance as MLR, but MAPB could provide more pharmacokinetic information with higher sampling flexibility.

目的观察盐酸文拉法辛治疗慢性疼痛的临床疗效。方法慢性疼痛中具有抑郁症状的患者90例分为两组，每组45例。Ⅰ组：曲马多缓释剂100 mg，每日2次；Ⅱ组：曲马多缓释剂100 mg,每日2次，盐酸文拉法辛75 mg，每日1次。4周后记录Zung氏抑郁评分（SDS）和疼痛视觉模拟评分(VAS)。结果治疗后组内和组间的SDS、VAS值均有显著性差异。结论盐酸文拉法辛可增加镇痛药物疗效。

Objective: To investigate the influence of esculentoside A（EsA） on production of IL-1 and TNF by rabbit synovial cells induced by LPS. Methods: levels of IL-1 and TNF in the supernatant of rabbit synovial cell were determined by examining proliferation of thymic cells and by bioassay L929 cells as target cells, respectively. Results: EsA in 5-40 μg/ml could significantly inhibit the production of IL-1 and TNF from rabbit synovial cells induced by LPS. Conclusion: EsA can inhibit the production of IL-1 and TNF from synovial cells. It suggests that EsA may play a role in improving the rheumatoid arthritis.