ObjectiveTo elucidate the chemical composition of Danshenyin and its blood components in rats after oral administration. MethodsUltra performance liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry（UPLC-Q-TOF-MS/MS） coupled with PeakView 1.2 software was used to systematically characterize and identify the components of Danshenyin aqueous extract and its migratory components in rat blood after oral administration based on the retention time， quasi-molecular ion peaks， secondary fragmentation ions， and literature reports， and a preliminary compounds identification of Salviae Miltiorrhizae Radix et Rhizoma aqueous extract， the co-decoction of Santali Albi Lignum and Amomi Fructus was carried out to attribute the chemical constituents of the aqueous extract of Danshenyin. ResultsA total of 73 compounds， including 21 phenolic acids， 23 diterpenes， 6 flavonoids， 7 organic acids， 3 volatile oils and 13 others， were identified from the aqueous extract of Danshenyin. And 36 prototypes and 15 metabolites were identified in rat plasma， the major metabolic pathways included reduction， hydration， hydroxylation， demethylation， methylation， sulfation and others， these metabolites were mainly derived from tanshinones and salvianolic acids. ConclusionThe main blood components of the aqueous extract of Danshenyin are salvianolic acids and tanshinones， which may be the material basis of the efficacy. This study can provide reference for pharmacological research， quality control， and clinical application of Danshenyin.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.

ABSTRACT OBJECTIVE：To establish a method for content determination of paclitaxel in malignant ascites of tumor patients. METHODS：LC-MS/MS method was adopted. Using vindoline as internal standard，the content of paclitaxel in ascites of tumor patients was determined. The separation was performed on Zorbax SB-C18 column with mobile phase consisted of aqueous solution （containing 0.1％ formic acid and 10 mmol/L ammonium acetate）-acetonitrile（40 ∶ 60，V/V）at the flow rate of 0.25 mL/min. the column temperature was 30 ℃，and sample size was 5 μL. The ion source was electrospray ion source，and the detection mode was multiple ion monitoring positive ion mode. MS parameters were set as following as dry gas temperature 350 ℃，dry gas flow rate 10 L/min，capillary voltage 4 000 V. Quantitative determination was operated in the multiple reaction monitoring（MRM）mode， with the ion transitions m/z 876.5→308.0 for paclitaxel and m/z 457.3→188.1 for the internal standard. The fragment voltage/ collision energy for paclitaxel and the internal standard were 250 V/30 eV，and 150 V/20 eV，respectively. RESULTS：The linear range of paclitaxel were 25-2 500 ng/mL（r2＝0.996 5，n＝7）. The lowest limit of quantitation was 25 ng/mL. RSDs of inter-day and intra-day precision tests were 0.61％ -3.62％（n＝5，3）. Accuracies were 95.34％ -98.76％（n＝5，3）. RSDs of extraction recovery were 3.19％-3.72％（n＝3）. CV of matrix effect were 1.52％-2.93％（n＝3）. RE of stability tests were lower than 3％（n＝ 3）. CONCLUSIONS：The method is simple，accurate and suitable for the content determination of paclitaxel in malignant ascites of tumor patients.

Objective:To observe the effects of alprostadil at different doses on C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in patients with angina pectoris.Methods:From August 2017 to April 2018, 120 patients with angina pectoris admitted to China Coast Guard Hospital of the People's Armed Police Force were selected and divided into control group (60 cases) and observation group (60 cases) by random number table method.Both two groups received routine anti-angina treatment, while the control group received 10 μg alprostadil, the observation group received 20 μg alprostadil for 2 weeks.The changes of CRP, TNF-α, IL-6 and hemorheological indicators before and after treatment were compared between the two groups.Results:Before treatment, there were no statistically significant differences in the CRP, TNF-α and IL-6 between the two groups (all P>0.05). After treatment, the CRP, TNF-α and IL-6 levels in the observation group were (4.63±0.62)mg/L, (0.46±0.08)μg/L, (46.59±4.72)ng/L, respectively, which were significantly lower than those in the control group [(6.18±0.74)mg/L, (1.19±0.28)μg/L, (58.62±5.07)ng/L]( t=12.437, 19.418, 13.452, all P<0.05). The high shear viscosity, low shear viscosity, plasma viscosity and platelet aggregation rates in the observation group were (4.27±0.46)mPa/s, (8.07±0.18)mPa/s, (1.03±0.25)mPa/s, (37.42±1.05)%, respectively, which were lower than those in the control group [(5.14±0.588)mPa/s, (10.43±0.42)mPa/s, (2.01±0.46)mPa/s, (40.19±1.86)%] ( t=9.103, 40.006, 14.499, 10.046, all P<0.05). Conclusion:The conventional dose of alprostadil (20 μg) is effective in the treatment of angina pectoris.It can improve CRP, TNF-α, IL-6 and hemorheological parameters of patients.

Objective:To observe the efficacy of meglumine adenosine cyclophosphate (MAC) in the adjuvant treatment of chronic congestive heart failure(CHF) in the elderly, and its effects on cystatin C(Cys-C) and plasma B-type natriuretic peptide(BNP).Methods:From August 2017 to August 2018, 110 elderly patients with chronic CHF admitted to Zhejiang Provincial Armed Police Corps Hospital were selected and randomly divided into control group(55 cases) and observation group(55 cases) by random number table method.The control group was treated with routine treatment, while the observation group was treated with MAC on the basis of routine treatment.Both two groups were treated for 2 weeks.The clinical efficacy, left ventricular ejection fraction (LVEF), cardiac output, Cys-C and plasma BNP were compared between the two groups.Results:The total improvement rate of the observation group was 94.55%(52/55), which was higher than 78.18%(43/55) of the control group, the difference was statistically significant(χ 2=6.253, P<0.05). Before treatment, there were no statistically significant differences in LVEF, cardiac output, BNP and Cys-C between the two groups(all P>0.05). After treatment, the LVEF[(44.16±6.82)%], cardiac output[(8.07±1.45)L/min] of the observation group were significantly higher than those of the control group[(40.71±5.38)%, (6.44±1.37)L/min], and BNP[(1.65±0.24)mg/L], Cys-C[(552.79±10.46)mg/L] of the observation group were significantly lower than those of the control group[(2.31±0.48)mg/L, (681.73±12.71)mg/L], the differences were statistically significant( t=2.945, 6.060, 9.121, 0.551, all P<0.05). Conclusion:MAC has significant effect in the treatment of elderly patients with chronic CHF.It can improve the cardiac function of patients and reduce the plasma concentrations of Cys-C and BNP.

Objective: To evaluate the effect of height (HT), total body weight (TBW), body mass index (BMI), lean body weight (LBW), body surface area (BSA) and blood volume (BV) on aortic and liver contrast enhancement during upper abdominal contrast-enhanced CT scans. Methods: One hundred and thirteen enrolled patients underwent upper abdominal multiphase contrast-enhanced CT scans. The enhancement (ΔHU) of aorta in hepatic arterial phase and liver parenchyma in portal venous phase were measured and calculated. The ΔHU values difference of aorta and liver parenchyma in subgroups between males and females, TBW<60 kg and TBW≥60 kg, BMI<25 kg/m² and BMI≥25 kg/m² were compared. To evaluate the effect of the patient′s body parameters on aortic and hepatic enhancement, we performed simple linear regression analyses between the change in CT numbers per gram of iodine (ΔHU/gI) at aorta and liver and each of the following: HT, TBW, BMI, LBW, BSA, and BV. Pearson and t test were used. Results: The mean ΔHU values of aorta and liver were significantly lower at males than that of at females (P<0.05). They were higher at TBW<60 kg patients than at TBW≥60 kg patients(P<0.05), and the mean ΔHU values of the liver at BMI<25 kg/m² patients were significantly higher than at BMI≥25 kg/m² patients(P<0.05). The proportion of the ΔHU values at liver less than 50 HU was higher at males (18.3%, 11/60) than at females (7.5%, 4/53). The most obvious negative correlation coefficients were found between the ΔHU/gI of aorta and LBW at hepatic arterial phase (r=-0.559, P<0.01), and between the ΔHU/gI of liver and BSA at portal venous phase (r=-0.680, P<0.01). Conclusion LBW or BSA could be the alternative body index to TBW for the calculation of personalized iodine dose protocol at aortic and liver enhanced CT scans.

Objective To explore the optimal body size index for the calculation of iodine contrast agent dose required for multiphase liver enhanced CT scans based on the total body weight (TBW),lean body weight (LBW)and body surface area (BSA).Methods Two hundred and twenty enrolled patients were randomly divided into three groups,TBW-group (n＝75),LBW-group (n＝72)and BSA-group (n＝73),and administrated iodine doses were 600 mg I/TBW(kg),780 mg I/LBW(kg)and 22 g I/BSA(m2 ),respectively.All patients had taken upper abdominal plain scans and triple-phase enhanced CT scans.The enhanced values (ΔHU)of the aorta at hepatic arterial phase (HAP),the portal vein and liver parenchyma at portal venous phase (PVP)were compared.The correlation coefficients of adjusted maximal hepatic enhancement(aMHE)with TBW,LBW and BSA in three groups were evaluated,respectively.Results There were no statistical differences in the ΔHU values of the aorta at HAP and the portal vein and liver parenchyma at PVP in the three groups respectively.The smallest variances of the aorta at HAP,the portal vein and liver parenchyma at PVP were found in the LBW group. The aMHE showed mildly positive correlation with TBW (r＝0.230)with a P value of 0.047,but it was consistent with LBW (r＝0.158)and BSA (r＝－0.1 54)with corresponding P values of 0.1 85 and 0.1 9 2 ,respectively.Conclusion Compared with TBW and BSA,iodine contrast agent dose calculated based on the patient’s LBW can improve the patient-to-patient uniformities on aorta,portal vein and liver enhancement during the liver multiphase enhanced CT scans.The LBW is the best body index for the calculation of iodine dose on liver enhanced CT scans.

Antiangiogenic target therapy has been a hot topic in cancer treatment recently.Apatinib is a category 1.1 new medication developed domestically.It effectively inhibits angiogenic and exhibits promising anti-tumor activity in preclinical studies.Apatinib has been successfully applied in clinical trials of multiple malignancies,such as gastric cancer,lung cancer and breast cancer with satisfactory safety and efficacy profile.However,its mechanism of action is still not fully understood. Further researches should be carried on to improve its safety,effectiveness and marketability.This review summarized the mechanism of action,pharmacokinetics,clinical efficacy,safety and biomarkers,discussed the recent progress,hot issues and clinical prospects of apatinib,

Objective To study the effect of laparoscopic myomectomy on the curative effect and postoperative rehabilitation of patients with uterine fibroids (UM).Methods From March 2014 to March 2016, selected 84 patients with UM in the people's hospital of Baoding Xushui district were divided into observation group (n=43) and control group(n=41) according to the different operation procedures, the observation group were treated with laparoscopic myomectomy and the control group were treated with open uterine fibroids.Serum T cell subsets (CD4+, CD8+, CD4+/ CD8+) between the two groups before and 1 day after operation were compared, and CA125, Cor, IL-1β levels, and surgery condition, postoperative recovery, complicationsand postoperative 12 months of recurrence were statistically compared.Results The serum CD4+, CD8+, CD4+/CD8+ levels in the observation group were significantly higher than those in the control group at 1 day after operation, the difference was statistically significant (P<0.05);the first exhaust time and hospitalization of the observation group were significantly shorter than those of the control group, and the intraoperative blood loss and postoperative pain score (VAS) were significantly lower than those in the control group (P<0.05);The incidence of postoperative complications in the observation group (6.98%, 3/43) was significantly lower than that in the control group (26.83%, 11/41), by follow-up, the recurrence rate (2.33%, 1/43) was lower than that of the control group (19.51%, 8/41), the difference was statistically significant (P<0.05).Conclusion Treatment of uterinemyoma using laparoscopic myomectomy gets a significant effect, and the body inflammation, stress response lighter and the effect of immune function is small, which can reduce the postoperative complications and recurrence rate and promote the rehabilitation of patients, and less impact on immune function.

Objective To compare the clinical effect of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus pesticide poisoning.Methods 86 patients with organophosphorus pesticide poisoning were selected and randomly assigned to the observation group and the control group according to the digital table,43 cases in each group.The two groups were given conventional treatment,while the control group was treated with atropine,the observation group was given penehyclidine hydrochloride.The disappearance time of main symptoms, rescue success rate and adverse reactions of the two groups were observed.Results After salvage treatment, the rescue success rate of the observation group was 97.8%,which of the control group was 88.4%,the difference was statistically significant (x2=1.433,P<0.05).The disappear time of M like symptoms,N like symptoms and central nervous system symptoms in the observation group was significantly shorter compared with the control group (all P<0.05).The number of drugs,dosage,cholinesterase recovery time and hospitalization time between the two groups had statistically significant differences (P<0.05).The incidence rates of blurred vision,restlessness,heart rate and urinary retention in the control group were significantly higher than those in the observation group (all P<0.05).Conclusion Penehyclidine hydrochloride for acute organophosphorus pesticide poisoning can significantly reduce the incidence of symptoms,shorten the disappearance time of symptoms,reduce hospitalization time,improve the efficacy of rescue,reduce the incidence of adverse reactions, it is safe,effective and has great clinical significance.