Gelsemium elegans (G. elegans) is an extremely poisonous plant that is widely distributed in southern China and southeastern Asia. G. elegans poisoning events occur frequently in southern China, and are therefore an urgent public health problem requiring multidisciplinary action. However, the toxic components and toxicological mechanisms remain unclear. Here, we describe a systematic investigation on the toxic components of G. elegans, resulting in the isolation and identification of 120 alkaloids. Based on acute toxicity screening, the structure-toxicity relationship of Gelsemium alkaloids was proposed for the first time. Moreover, gelsedine- and humantenine-type alkaloids were detected in the clinical blood sample, and were confirmed to be causative in the poisoning. The most toxic compound, gelsenicine (1), had selective inhibitory effects toward ventral respiratory group (VRG) neurons in the medulla, which is the main brain region controlling respiration in the central nervous system. Gelsenicine (1) strongly inhibited the firing of action potentials in VRG neurons through its ability to stimulate GABA_A receptors, the main receptors involved in inhibitory neurotransmission. Application of GABA_A receptor antagonists successively reversed action potential firing in gelsenicine (1)-treated VRG neurons. Importantly, the GABA_A receptor antagonists securinine and flumazenil significantly increased the survival of poisoned animals. Our findings provide insight into the components and mechanisms of G. elegans toxicity, and should assist the development of effective emergency treatments for G. elegans poisoning.

Objective To discuss clinical efficacy Xiaochaihu Decoction together with Haoqin gallbladder-clearing Decoction in the treatment of chemotherapy-induced nausea and vomiting.Methods A total of 80 cases with nausea and vomiting after chemotherapy in our hospital were divided into study group and control group,with 40 cases per group,treated by Aprepitant,Xiaochaihu Decoction together with Haoqin gallbladder-clearing Decoction,respectively.After one week of treatment,the treatment efficacy was observed.After 2 weeks of follow-up,improvement of nausea and vomiting and recovery of appetite were observed.Results The total response rate,and the proportion of patients with normal appetite in the study group were better than the control group (P ＜ 0.05).Conclusion Xiaochaihu Decoction together with Haoqin gallbladder-clearing Decoction is safe and reliable in curative efficacy in nausea and vomiting after chemotherapy.And it can improve gastrointestinal function,increase appetite and nutritional status of patients.

Objective To discuss clinical efficacy Xiaochaihu Decoction together with Haoqin gallbladder-clearing Decoction in the treatment of chemotherapy-induced nausea and vomiting.Methods A total of 80 cases with nausea and vomiting after chemotherapy in our hospital were divided into study group and control group,with 40 cases per group,treated by Aprepitant,Xiaochaihu Decoction together with Haoqin gallbladder-clearing Decoction,respectively.After one week of treatment,the treatment efficacy was observed.After 2 weeks of follow-up,improvement of nausea and vomiting and recovery of appetite were observed.Results The total response rate,and the proportion of patients with normal appetite in the study group were better than the control group (P ＜ 0.05).Conclusion Xiaochaihu Decoction together with Haoqin gallbladder-clearing Decoction is safe and reliable in curative efficacy in nausea and vomiting after chemotherapy.And it can improve gastrointestinal function,increase appetite and nutritional status of patients.

Objective To analyze the related influence factors on the prognosis of hypertensive cerebral hemorrhage in basal ganglia with operation treatment,provide the basis for clinical prevention and treatment.Methods 80 patients for treatment of hypertensive cerebral hemorrhage were selected.By a retrospective study,we collected the clinical data and postoperative following -up data,status,complications,and observed the postoperative recovery.Sta-tistical different hypertension,preoperative breaking into the ventricle,disturbance of consciousness,operation time and preoperative hematoma volume of the prognosis.Results In 80 patients,48 cases(60.00%)of patients has good prognosis;moderate disability,taking care of themselves life 10 cases(12.50%);severe disability,life can not take care of 9 cases(11.25%);plant survival of 5 cases(6.25%)and 8 cases of death(10.00%).22 cases of patients with brain hemorrhage again,3 cases postoperative pulmonary infection,6 cases of secondary organ dysfunction.Poor prognosis of preoperative ventricle prognosis and disturbance of consciousness of patients was 88.26%(18 /23)and 63.64%(21 /33),which was higher than the preoperative without breaking into the ventricle and no disturbance of consciousness 24.54%(14 /57)and 36.36%(21 /33),the difference was statistically significant(χ2 =10.38,9.76, P <0.05).The timing of surgery,the prognosis of 48h patients was 69.23%(9 /13),which was higher than that of less than 6h and 6 48h patients,the difference was significance(χ2 =10.06,P <0.05).Patients with poor preopera-tive hematoma volume >60mL was 47.62%(20 /42),which was higher than the preoperative hematoma volume 40 -60mLpatients31.38%(12 /38),the difference was statistically significant(χ2 =9.12,P <0.05).Conclusion It has obvious effect on surgery operation prognosis of patients with hypertensive cerebral hemorrhage,including optimal time for operation;bleeding time,intraventricular hemorrhage,disturbance of consciousness and bleeding volume.If the clinical treatment in the prevention and treatment to improve the survival and quality of life of patients with cerebral hemorrhage.

Objective To observe the efficacy and safety of remifentanil in patients with mechanical ventilation in Intensive Care Unit (ICU) .Methods Totally 90 cases were enrolled ,patients with mechanical ventilation were randomly divided into two groups (remifentanil vs .fentanyl) ,45 cases in each group .We used facial expression score (FPS) to monitoring pain ,richmond se‐dation agitation score (RASS) was the sedation tool for measuring quality and depth of sedation .Propofol wase used for sedation therapy .We recorded the data including FPS and RASS and vital signs during the treatment .The primary outcome was the time to reach the goal of analgesia sedation ,cases of using propofol and doses of propofol .The secondory outcome was mechanical ventila‐tion time ,ICU length of stay and adverse events .Results Fentanyl and remifentanil all could achieve the desired analgesic effect . Compared with fentanyl group ,FPS scores showed significantly decreased after 5 min application of remifentanil (P< 0 .05) ,but FPS scores showed significantly decreased after 10 min application of fentanyl .Analgesia goal time of the remifentanil and fentanyl were(5 .00 ± 1 .37)min and (30 .00 ± 4 .50)min ,respectively .Only 28 .9% of the patients should be combined use of propofol in remifentanil group ,but fentanyl group was 64 .4% (P<0 .01);the dosage of propofol of remifentanil group was lower than those of fentanyl group ;there was no significant difference in central venous pressure (CVP) and heart rate(HR) between the two groups at each time point(P>0 .05) .The mechanical ventilation time ,ICU length of stay in the patients with remifentanil were significantly shorter(P<0 .05) ,and adverse events occur less(all P<0 .05) .Conclusion Remifentanil analgesia in patients mechanical ventilated patients is fast onset of action ,analgesic effect significantly ,with less sedative drug dosage .It also can shorten mechanical ventila‐tion time ,ICU length of stay and has no obvious side effects .