Two Hofmann-Martius-like rearrangement products generated in the production of duloxetine hydrochloride were studied. The structures and generation mechanism of the two Hofmann-Martius rearrangement products were analyzed by LC-MS and NMR. The results showed that under the acidic conditions, the naphthol ether bond of duloxetine would break down and the intermediates of naphthol and the alkyl thiophene cation was generated; the two Hofmann-Martius-like rearrangement products were proven to be a pair of isomers produced by nucleophilic substitution between the naphthol intermediate state and the alkyl thiophene cation intermediate state at the ortho or the para position, respectively. The production of two isomers was related to the strong acidic and protic solvent environment. Therefore, in the salting process of duloxetine hydrochloride, the pH value should be controlled in the range of 3-7 and temperature should be maintained below 50 °C, as well as the nonprotic solvent acetone is chosen to avoid generation of the two isomers.

Objective To observe the clinical efficacy of Dachaihu decoction in treatment of stroke-associated pneumonia (SAP) in the elderly patients with excess-heat syndrome and acute ischemic stroke (AIS). Methods One hundred elderly patients with excess-heat syndrome and SAP admitted to the Department of Neurology of Tianjin Nankai Hospital from August 2015 to September 2016 were enrolled, and they were divided into a control group and an observation group according to the random number table, 50 cases in each group. Both groups were given conventional neurological treatment, while the observation group additionally received Dachaihu decoction (the ingredients of the decoction: bupleurum 15 g, scutellariae 10 g, pinellia 10 g, fructus aurantii immaturus 15 g, radix paeoniae alba 10 g, rhubarb 5 g, ginger 10 g, jujube 2), and according to the individual's symptoms and signs, the above ingredients can be added and/or subtracted, 1 dose per day, divided into two parts, 1 part taken in the morning and 1 part in the evening orally, 14 days as a therapeutic course. The body temperature recovery time, the duration of antibiotic treatment, the changes of Clinical Pulmonary Infection Score (CPIS) and National Institutes of Health Stroke Scale (NIHSS) score before and after treatment of the two groups were observed and the therapeutic effects in the two groups were evaluated. Results The body temperature recovery time (days: 6.56±2.70 vs. 8.08±3.23) and the duration of antibiotic treatment (days: 8.78±2.80 vs. 10.02±2.90) in the observation group were significantly shorter than those in the control group (both P ＜ 0.05); with the prolongation of treatment, after treatment, the CPIS and NIHSS score were decreased significantly in both groups, reaching the lowest levels on the 14th day, and the degrees of score descent in observation group were more significant than those of the control group (CPIS score: 0.68±0.59 vs. 1.12±0.96, NIHSS score: 6.38±2.31 vs. 7.44±2.74, both P ＜ 0.05); the total effective rate in the observation group was significantly higher than that in the control group [92% (46/50) vs. 76% (38/50), P ＜ 0.05]. Conclusion The therapeutic effect of Dachaihu decoction used for treatment of SAP in elderly patients with excess-heat syndrome is favorably effective and safe.

Objective Analysis of the teaching effect of the micro-classroom in the experimental teaching of diagnostics.Methods In the 50 classes of undergraduate clinical specialty of 2014 level of guangdong medical mniversity,2 classes were selected as the control group (n=67) by random number table method,2 classes were selected as the experience group (n=65).Theoretical knowledge and clinical skills were calculated.Recognition of two groups of students on two kinds of teaching methods.The data of two groups were compared using t-test and chi-square test.Results The results of the theoretical knowledge and clinical skills of the experimental group were significantly higher than the control group (P< 0.05).There was a significant difference between the two groups (P< 0.05),which was found to be able to deepen the understanding of theoretical knowledge,to improve the ability of clinical skills operation,to cultivate clinical thinking and to mobilize the enthusiasm of independent learning.Conclusions Micro classroom teaching can significantly improve the quality of experimental training of diagnoses.

Objective To explore the diagnostic value of MSCT in tumors of intra-abdominal cryptorchidism in children.Methods MSCT findings of 8 children with tumors of intra-abdominal cryptorchidism confirmed by surgery and pathology were analyzed retrospectively.Results Six tumors located in the right,2 (1 tumor of left cryptorchidism turned to the right abdominal) in the left.Eight children showed ovoid soft tissue tumor in abdomen.Three children displayed the long axis of the tumors consistent with regular descending course of embryonic testes.Six teratomas manifested as the cystic and solid mass with fat,calcification (ossification) insidey.Two yolk sac tumors manifested as the large cystic and solid mass with irregular necrosis and abundant tumor vessels.Conclusion The pathologic types of tumors for intra-abdominal cryptorchidism in children are different from adult.Most of them are teratomas or yolk sac tumors,and have some characteristics in MSCT.MSCT is helpful in diagnosis of tumor for intra-abdominal cryptorchidism with medical history.

Objective To investigate the effect of differential diagnosing female genital tract infection diseases by using leucorrhea microscopy method, bacteria pre-enzyme spectrum analysis method and the joint method. Methods Both leucorrhea microscopy method and bacteria pre-enzyme spectrum analysis method were respectively used to detect the vaginal discharges of 4130 women from our hospital outpatient service, and test results combined with clinical manifes-tations and treatment effect were also analyzed and compared summarily. Results 1976 patients were founded by using the leucorrhea microscopy method (detection rate and accuracy rate was 47.8%,71.6% respectively); 1302 cases were founded by using bacteria pre-enzyme spectrum analysis method (detection rate and accuracy rate was 31.5%, 58.1%respectively);2622 cases were detected by using the joint detection method (detection rate and accuracy rate was 63.5%, 91.1% respectively). Conclusion The joint method has the advantages of both leucorrhea microscopy method and bac-teria pre-enzyme spectrum analysis method, and can accurately identify five common kinds of female reproductive tract infection diseases with one sample for once.

Objective To investigate the clinical features and treatment points of diabetes patients compli-cated with parapharyngeal abscess .Methods The clinical data of 12 diabetes mellitus patients complicated with parapharyngeal abscess were analyzed .Results 12 patients were all cured and discharged without concurrent medias-tinal abscess ,intracranial infection and serious complications such as bleeding .Conclusion The development of dia-betes mellitus complicated with parapharyngeal abscess is rapid ,we must confirm the diagnosis ,timely implementation of abscess incision and drainage ,effective drainage of pus ,keep the airway open ,actively control the infection at the same time strictly control the fluctuations in blood sugar ,strengthen supportive therapy ,thus to improve treatment and reduce the incidence of complications .

OBJECTIVETo improve the occupational health management levels in electroplating enterprises with quantitative classification measures and to provide a scientific basis for the prevention and control of occupational hazards in electroplating enterprises and the protection of workers' health.

METHODSA quantitative classification table was created for the occupational health management in electroplating enterprises. The evaluation indicators included 6 items and 27 sub-items, with a total score of 100 points. Forty electroplating enterprises were selected and scored according to the quantitative classification table. These electroplating enterprises were classified into grades A, B, and C based on the scores.

RESULTSAmong 40 electroplating enterprises, 11 (27.5%) had scores of >85 points (grade A), 23 (57.5%) had scores of 60∼85 points (grade B), and 6 (15.0%) had scores of <60 points (grade C).

CONCLUSIONQuantitative classification management for electroplating enterprises is a valuable attempt, which is helpful for the supervision and management by the health department and provides an effective method for the self-management of enterprises.

Objective To explore the theoretical framework and method of community-based rehabilitation assessment for children with cerebral palsy based International Classification of Functioning, Disability and Health (ICF). Methods The system of assessment of community-based rehabilitation was developed based on the theoretical framework ICF, combined with multi-tools and self-compiled work scales.The system was used for 50 rural children with cerebral palsy after 1-year of community-based rehabilitation. Results and Conclusion The system of assessment is applicable for rural community-based rehabilitation of children with cerebral palsy, with satisfactory efficacy and compliance.

Objective To investigate the effect of pre- hospital emergency care programs in children with febrile seizures,in order to reduce damage by febrile seizures and obtain the best firstaid effect. Methods 112 cases of children with febrile seizures were treated in pediatric department of our hospital from April 2009 to February 2011.The parents of 75 children patients were given guidance of prehospital emergency care,they were set as the pre-hospital emergency care group.The other 37 cases were set as the non-pre-hospital emergency care group,routine emergency care was given until the medical personnel arrived at the spot.The conditions of aspiration,tongue bite injury,another episode of febrile seizures and brain damage were recorded in two groups of children. Results Only one case of aspiration and three cases of febrile seizures occurred in the pre-hospital emergency care group by misoperation of parents.Non brain damage and tongue bite injury occurred.The incidence rate of improper consequences was 5.3％in the pre-hospital emergency care group,lower than that of the non-pre-hospital emergency care group,51.4％. Conclusions To give pre-hospital emergency care guidance to parents of children patients by mobile phones before the health care workers reach the spot can significantly reduce accidental injury of children,stabilize the emotion of parents,decrease the impact of seizures on children,all the above has a positive effect on follow-up treatment.

Objective To explore the changes of neutrophil elastase (NE) and surfactant protein A (SP-A) in acute lung injury(ALI) rats,and the effect of antioxidant. Methods Sixty healthy mature Wister rats were divided into 2 groups, the control group and treatment group. The rats in two groups all received peritoneal injection of E. coli to establish the ALI animal model. 30 minutes after injection of E. coli,the rats in treatment group were injected reduced glutathione from vena caudalis. The levels of NE in blood and expressions of SP-A in lung tissue were detected at 3,6 and 12 hours after injection of E. coli. Results ALI symptom appeared 3 hours after injection of E. coli in the control group, obvious after 6 hours, the rats vomi-ted pink secretion after 12 hours. Lung edema and bleeding were found by pathologic examination. No obvious symptom was found in treatment group after 3 hours, slight tachypnea after 6 hours, slight edema in pulmonary tissue after 12 hours. After administration of reduced glutathione,levels of NE at 3,6 and 12 hours in the treatment group were lower than those in the control group,and indicated statistical significance in 6 and 12 hours(P <0. 05) ;Levels of SP-A in 3,6 and 12 hours in the treatment group were higher than those in the control group, and indicated statistical significance in 3,6 and 12 hours (P < 0. 05). Conclusion Dysfunction of pulmonary surfactant is secondary in ALI, degradation of SP-A is the one of reasons, the application of reduced glutathione as antioxidant, could effectively suppress NE to decompose basosexine elastin of cells and destroy surface active protein, has protective effect on ALI.