ObjectiveHeadspace solid-phase microextraction-gas chromatography-mass spectrometry（HS-SPME-GC-MS） and GC-triple quadrupole MS（GC-QqQ-MS） in combination with non-targeted and targeted metabolomics were employed to systematically analyze the chemical composition differences of Xihuangwan prepared with natural musk and artificial musk， and establish an identification system for them. MethodsThe volatile components of 9 batches of Xihuangwan samples from 8 manufacturers were analyzed by HS-SPME-GC-MS non-targeted metabolomics， and identified by comparing their MS data with the National Institute of Standards and Technology（NIST） spectral library. Orthogonal partial least squares-discriminant analysis（OPLS-DA） was used to identify differential volatile components of Xihuangwan prepared with natural musk and artificial musk. Additionally， GC-QqQ-MS targeted metabolomics was applied to quantify the levels of α-pinene， β-elemene， muscone， dehydroepiandrosterone， bornyl acetate， and octyl acetate in 27 batches of samples from 9 manufacturers. Cluster analysis， principal component analysis（PCA）， and partial least squares-discriminant analysis（PLS-DA） were conducted to further explore the differences in volatile components between Xihuangwan samples prepared with natural musk and artificial musk. ResultsNon-targeted metabolomics identified 291 volatile compounds in Xihuangwan， including alkanes， esters， alkanes， alcohols， ketones， naphthalenes and others. OPLS-DA analysis revealed distinct separation between Xihuangwan samples containing artificial musk（A1， C1， D1， E1， F1， G1， I1） and those containing natural musk（H1， H3）. A total of 30 differential metabolites were identified. The relative contents of these 30 differential metabolites were visualized using a radar chart， revealing significant differences in the levels of octanol， borneol acetate and muscone. Cluster analysis and PCA results from targeted metabolomics indicated that Xihuangwan could be classified into two distinct groups：one composed of natural musk（H1， H3） and the other of artificial musk， sample H2. PLS-DA identified muscone， octyl acetate， and dehydroepiandrosterone as key differential volatile components. Although no significant difference was observed in the content of octyl acetate between the two groups， statistically significant differences were found for muscone and dehydroepiandrosterone（P<0.05）. ConclusionMuscone and dehydroepiandrosterone can be used for the differentiation of Xihuangwan samples containing natural musk from those containing artificial musk. This study systematically and comprehensively analyzed the differences in the types and contents of major volatile components in Xihuangwan prepared with natural musk and artificial musk， providing a scientific basis for quality evaluation and control of Xihuangwan.

ObjectiveHeadspace solid-phase microextraction-gas chromatography-mass spectrometry（HS-SPME-GC-MS） and GC-triple quadrupole MS（GC-QqQ-MS） in combination with non-targeted and targeted metabolomics were employed to systematically analyze the chemical composition differences of Xihuangwan prepared with natural musk and artificial musk， and establish an identification system for them. MethodsThe volatile components of 9 batches of Xihuangwan samples from 8 manufacturers were analyzed by HS-SPME-GC-MS non-targeted metabolomics， and identified by comparing their MS data with the National Institute of Standards and Technology（NIST） spectral library. Orthogonal partial least squares-discriminant analysis（OPLS-DA） was used to identify differential volatile components of Xihuangwan prepared with natural musk and artificial musk. Additionally， GC-QqQ-MS targeted metabolomics was applied to quantify the levels of α-pinene， β-elemene， muscone， dehydroepiandrosterone， bornyl acetate， and octyl acetate in 27 batches of samples from 9 manufacturers. Cluster analysis， principal component analysis（PCA）， and partial least squares-discriminant analysis（PLS-DA） were conducted to further explore the differences in volatile components between Xihuangwan samples prepared with natural musk and artificial musk. ResultsNon-targeted metabolomics identified 291 volatile compounds in Xihuangwan， including alkanes， esters， alkanes， alcohols， ketones， naphthalenes and others. OPLS-DA analysis revealed distinct separation between Xihuangwan samples containing artificial musk（A1， C1， D1， E1， F1， G1， I1） and those containing natural musk（H1， H3）. A total of 30 differential metabolites were identified. The relative contents of these 30 differential metabolites were visualized using a radar chart， revealing significant differences in the levels of octanol， borneol acetate and muscone. Cluster analysis and PCA results from targeted metabolomics indicated that Xihuangwan could be classified into two distinct groups：one composed of natural musk（H1， H3） and the other of artificial musk， sample H2. PLS-DA identified muscone， octyl acetate， and dehydroepiandrosterone as key differential volatile components. Although no significant difference was observed in the content of octyl acetate between the two groups， statistically significant differences were found for muscone and dehydroepiandrosterone（P<0.05）. ConclusionMuscone and dehydroepiandrosterone can be used for the differentiation of Xihuangwan samples containing natural musk from those containing artificial musk. This study systematically and comprehensively analyzed the differences in the types and contents of major volatile components in Xihuangwan prepared with natural musk and artificial musk， providing a scientific basis for quality evaluation and control of Xihuangwan.

Objective:To investigate the association of body weight and body mass index (BMI) with bone mineral density (BMD) and osteoporotic risk in elderly men with type 2 diabetes mellitus (T2DM).Methods:210 elderly male patients with T2DM admitted to the Department of Endocrinology of the First Hospital of Changsha from June 2017 to May 2018 were selected as the research objects. The height, weight and bone mass index (BMI) were measured. BMDs of the left hip [including femoral neck (FN), greater trochanter (G.T.), intertrochanter (InTro), and total hip (TH)] and lumbar spine (LS) were measured in 210 elderly male patients with T2DM by dual-energy X-ray absorption method. Patients were divided into three groups according to BMI: the overweight group (24.0 kg/m 2≤BMI<28.0 kg/m 2), the obesity (BMI≥28.0 kg/m 2) group, and the normal group (18.5 kg/m 2≤BMI<24.0 kg/m 2). The influence of body weight and BMI on BMD and osteoporotic risk in these elderly men with T2DM was analyzed. Results:The BMDs in various sites of the hip of the overweight group and obesity group were higher compared with those in the normal weight group ( P<0.05). There was a positive correlation between weight and BMI with BMDs in various sites of the hip femoral neck (including FN, G. T., InTro, and TH) ( r=0.239-0.427, P<0.05). All patients were divided into different tertiles (T1-T3) stratified by weight and BMI respectively. The BMDs in various sites of the hip increased with tertiles stratified by weight ( P<0.05). The TH-BMD also increased with tertiles stratified by BMI ( P<0.05). The odd ratios ( OR) were calculated using T3 as the control group and T1 as the case group, using T2 as the control group and T1 as the case group, respectively. The osteoporotic risks of T1/T3, T1/T2 at FN stratified by weight were significantly increased by 4.50 times ( OR=4.50, 95% CI: 1.41-14.35) and 9.27 times ( OR=9.27, 95% CI: 2.03-42.30); The osteoporotic risks of T1/T3, T1/T2 at TH were significantly increased by 3.25 times ( OR=3.25, 95% CI: 1.10-9.59) and 8.50 times ( OR=8.50, 95% CI: 1.85-38.99). The osteoporotic risks of T1/T3, T1/T2 at FN stratified by BMI respectively were significantly increased by 4.13 times ( OR=4.13, 95% CI: 1.28-13.25) and 5.58 times ( OR=5.58, 95% CI: 1.53-20.42); while the osteoporotic risks of T1/T3, T1/T2 at TH stratified by BMI were not significantly increased ( P>0.05). There was no statistically significant difference in BMDs and the osteoporotic risks of the LS among T1, T2, and T3, regardless of stratified by weight or BMI ( P>0.05). Conclusions:For elderly males with T2DM, weight and BMI are important factors affecting BMDs in the hip, and also affecting the osteoporotic risks of the hip, especially that of FN. Osteoporotic risks of the FN decrease with the increase of weight and BMI within a certain range.

OBJECTIVE: To investigate the changes in diversity, relative abundance and distribution of intestinal flora in patients with chronic rhinosinusitis and nasal polyps (CRSwNP) using high-throughput sequencing technology identify the intestinal flora significantly related to pathogenesis and progression of CRSwNP. METHODS: Ten patients with CRSwNP hospitalized in the Department of Otolaryngology-Head and Neck Surgery of Guangdong Provincial People's Hospital were selected as the case group with 10 healthy volunteers recruited in the same period as the control group. Fecal genomic DNA extraction kit was used to extract the DNA in the fecal samples, and the DNA fragment length was measured and quantified. The V3 and V4 highly variable regions of the 16S rDNA gene of prokaryotes were amplified followed by library construction, Illumina MiSeq sequencing, sequence alignment and species identification analysis. The relative abundance, diversity and distribution characteristics of the intestinal flora were analyzed, and the relevant metabolic pathways were predicted. RESULTS: Compared with the control group, the patients with CRSwNP had significant changes in the overall structure of the intestinal flora, highlighted by increased abundance of Saccharopolyspora and decreased contents of , , and . Among the metabolic pathways predicted to be associated with CRSwNP, 9 showed significant changes in patients with CRSwNP as compared with the control group ( < 0.05). CONCLUSIONS Patients with CRSwNP have significant changes in the structural characteristics of intestinal flora related with multiple metabolic pathways, and these changes may play an important role in the development of chronic rhinosinusitis.

Objective To discuss the efficacy and safety of covered Cheatham-Platinum stent (CCPS) implantation in treating coarctation of the aorta (CoA).Methods The clinical data of 11 patients with CoA who had received CCPS implantation were retrospectively analyzed.Results Successful implantation of single CCPS was accomplished in all 11 patients.After the implantation,the diameter of coarctation site was immediately dilated from preoperative (4.76+0.89) mm to postoperative (12.86+0.90) mm (t=24.86,P＜0.001),and the average systolic blood pressure difference across the coarctation was immediately reduced from preoperative (38.55+10.02) mmHg to postoperative (9.82+6.60) mmHg,the difference was statistically significant (t=10.8,P＜0.001).The patients were followed up for 3-79 months,with a mean of (31.91±27.58) months.The clinical symptoms were relieved in all patients and the activity tolerance was obviously improved.No complications such as endoleak,acute injury of aortic wall,re-coarctation or re-stenosis,vascular injury of puncture site,or death occurred in all patients.Conclusion For the treatment of CoA,implantation of CCPS has excellent short-term and mid-term effect,meanwhile,this technique can effectively avoid complications such as aortic wall iniurv.(J Intervent Radiol.2017.26:211-214)

Objective: To explore the peri-operative application of GLP-1 analogue and insulin on myocardial perfusion and clinical prognosis in patients of acute ST segment elevation myocardial infarction (STEMI) with stress-induced hyperglycemia. Methods: Our research was a prospective single center randomized control study. A total of 114 consecutive STEMI patients received percutaneous coronary intervention (PCI) within 12h of onset were enrolled, the patients had no diabetes while blood glucose ≥11.1mmol/L at immediate admission. Based on random number table, the patients were divided into 2 groups: Observation group, the patients received GLP-1 analogue, n=59 and Control group, the patients received insulin, n=55. The post-operative myocardial perfusion, indicators of myocardial damage and cardiac function, myocardial infarct area (MIA) and myocardial salvage index (MSI) were compared between 2 groups. The patients were followed-up for 6 months to record the incidence of major adverse cardiovascular events (MACE). Results: At peri-operative period, compared with Control group, Observation group had decreased peak values of creatine kinase isoenzyme (CK-MB) and troponin T (cTnT), P<0.05. At 6 months post-operation, compared with Control group, Observation group showed increased myocardial perfusion and left ventricular ejection fraction (LVEF), P<0.05, reduced MIA (15±12) g vs (20±14) g, P<0.05 and 12% elevated MSI as (0.64±0.13) vs (0.56±0.12), P<0.001. The MACE incidence was similar between 2 groups, P=0.217. Conclusion: In STEMI patients with stress-induced hyperglycemia, peri-operative application of GLP-1 analogue may safely regulate blood glucose, improve cardiac perfusion and function, reduce MIA; while it had no influence on myocardial perfusion at peri-operative period and no impact on MACE occurrence at 6 months post-operation.

Objective To explore imaging findings and pathological features of ovarian collision tumors. Methods A retrospective analysis of preoperative imaging findings was performed in 8 female patients with surgical-pathological proven ovarian collision tumors. CT scans were performed in 5 cases, both CT and MRI were performed in 2 cases, and non-enhanced MR scans were performed in 1 pregnancy woman. Imaging results were compared with pathologic findings. Results Ovarian collision tumors in the eight patients consisted of 2 types tumors, originated from different ovarian tissues including surface epithelial cells, germ cell, or sex cord-stromal cell. Of the 8 ovarian collision tumors, 5 were located in the left ovary, and 3 in the right ovary. Ovarian collision tumors consisted of surface epithelial tumor and germ cell tumor (n=6) including mucinous cystadenoma and teratoma (n=4), mixed cystadenoma and teratoma (n=1), and serous cystadenoma and struma-ovarii (n=1). Ovarian collision tumors in two cases consisted of surface epithelial tumor and sex cord-stromal tumor, and were mucinous cystadenoma and fibroma, respectively. Imaging findings included:all tumors in the 8 cases presented big or huge multiple complicated cystic mass with 9 to 26 cm in diameter. Germ cell tumor or sex cord-stromal tumor in collision tumor was smaller and located inside the tumor (n=3) and on the tumor wall (n=5). The boundary between two types of tumors in ovarian collision tumor was distinct and clear. Typical imaging features and densities (signals) of different tumors in ovarian collision tumors can be found on CT or MRI. Conclusions Ovarian collision tumors has some specific imaging and pathological characteristics. Imaging examination is helpful for most accurate diagnosis of ovarian collision tumors.

As a pilot program of teaching reform,some excellent undergraduates majoring in nursing were selected to take specialized courses in ICU in order to cultivate the intensive care specialized nurses.The teaching team of specialized courses in ICU was established to guarantee the teaching quality.The team was in charge of the ICU specialized curriculum building,textbooks selection and teaching content examination.The high leveled teaching team of specialized courses in ICU was organized by taking teaching and researching section as a unit to improve theoretical teaching level,using clinical department as training base to enhance practice skill and participating in special subject classes and in-service study to promote specialized quality.

Objective To investigate CT features on increased cerebral vascular density and its pathological mechanism in patients with cyanotic congenital heart disease(CCHD).MethodsPreoperative brain CT scan and clinical data in 82 patients suffering from CCHD were analyzed. According to the increased levels of vascular density,patients were divided into 4 groups:normal,mild,moderate and severe.Relationships between the increased levels of vascular density and Hb,RBC,HCT,as well as the degree of cyanosis,were studied.AVONA was carried out to test blood CT value of cerebral sinuses,Hb,RBC and HCT in different groups. Descriptive analysis and linear regression were adopted to study the correlation between blood CT value and Hb concentration.The relationship of increased vascular density todegrees of cyanosis was analysed by Spearman.Results Among 82 patients,12 patients ( 14.6％ ) werefound in the group of normal vascular density and 70 patients ( 85.4％ ) in the increased vascular density group.Among 70 patients with increased vascular density,22 patients (26.8％ ) with (55.4 ± 2.6) HU,(169 ±6)g/L of Hb,(5.8 ±0.3) × 1012/L of RBC and 0.51 ±0.03 of HCT,29 patients (35.4％) with (61.3 ± 2.9) HU,(209 ± 15 ) g/L,(7.1 ± 0.4) × 1012/L,0.66 ± 0.06 and 19 patients ( 23.2％ ) with ( 68.8 ± 4.2) HU,( 242 ± 23 ) g/L,( 8.3 ± 0.9 ) × 1012/L,0.78 ± 0.08 were observed in the mild,moderateand severe group,respectively.There were significant differences in distribution of blood CT value ( HU),Hb,RBC and HCT in different groups ( F =163.263,134.703,120.974,136.541 ;P ＜ 0.01 ).Blood CT value was positively correlated with Hb concentration ( r =0.98,P ＜ 0.01 ). Vascular density was also positively correlated with the degree of cyanosis ( r =0.86,P ＜ 0.01 ). Conclusions Cerebral vascular density of patients suffering from CCHD presented different levels of increases based on CT scan results due to rise of RBC stimulated by anoxia.The increased level of vascular density was positively correlated with blood Hb concentration,and also associated with RBC accunulation caused by abnormal blood circulation.Moreover,it was positively correlated with the degree of cyanosis.

Objective Traditional nasolacrimal duct stenting possesses some shortcoming including difficulty of pulling ball head guide wire from the nasal cavity with turbinate hypertrophy and nasal septal deviation. The new method of nose-oral tube track establishment can overcome the forementioned and increase the successful rate. Methods 5 F catheter and arterial sheath were modified to be nasolacrimal duct stent delivery device respectively. Antegrade dacryocystography was taken firstly to display the obstructed site and followed by the modified protocol of inserting the guide wire through nasolacrimal duct and nasal cavity, and establishing the stent delivery track for retrograde stent placement. Results 5 epiphora patients with failure implantation by traditional method were all succeeded through the modified stenting(100%). During 6-mouth follow-up, no serious complications and reocclusion occurred. Conclusion The establishment of eye-nose-mouth-nose of external nasal guide wire track can improve the successful rate of nasolacrimal duct stenting.