Objective To establish a UPLC-MS/MS method to measure the content of monoester-alkaloids(benzoylmesaconine,benzoylaconine,benzoylhypaconine)and diester-alkaloids(mesaconitine,hyp-aconitine,aconitine)in Fengshiantai tablets.To provide a basis for quality control by conducting chemometric analysis and risk assessment on the measurement results.Methods The components were separated on Waters BEH C18 column(2.1 mm×100 mm,1.7 μm)with methanol and 0.1%formicacid aqueous solution as the mobile phase by gradient elution at a flow rate of 0.3 mL·min-1.The column temperature was set at 35℃.The injection volume was 1 μL.The detection was carried out by electrospray ionization(ESI),and electron spray ionization source was adopted in positiveion detection with multiple reaction monitoring mode(MRM).Results Six components showed good linear relationships within their own ranges(r≥0.9990),whose average recovery rate of samples were 90.3%-107.6%with the RSD of 0.9%-1.8%.In 23 batches of tested samples,the diester-alkaloids contents ranged from 1.35 to 19.49 μg per tablet,which indicated low risk of drug safety;the monoester-alkaloids contents ranged from 20.17-99.55 μg per tablet.The results of chemometrics showed that 23 batches of samples were classify into four categories,and there were certain differences in sample quality among different production enterprises.Conclusion The established method is stable and reliable,and can be used for quality control of Fengshi Antai tablets.

Objective:To explore the application value of chromosome karyotype analysis, chromosomal microarray analysis (CMA) and whole exome sequencing (WES) in prenatal diagnosis of isolated corpus callosum abnormality (CCA) fetus.Methods:Fetuses diagnosed with isolated CCA by ultrasound and MRI and receiving invasive prenatal diagnosis in Guangzhou Women and Children′s Medical Center and Qingyuan People′s Hospital from January 2010 to April 2021 were selected. Karyotype analysis and/or CMA [or copy number variation sequencing (CNV-seq)] were performed on all fetal samples, and WES was performed on fetal samples and their parents whose karyotype analysis and/or CMA (or CNV-seq) results were not abnormal.Results:Among 65 fetuses with isolated CCA, 38 cases underwent karyotype analysis, and 3 cases were detected with abnormal karyotypes, with a detection rate of 8% (3/38). A total of 49 fetuses with isolated CCA underwent CMA (or CNV-seq) detection, and 6 cases of pathogenic CNV were detected, the detection rate was 12% (6/49). Among them, the karyotype analysis results were abnormal, and the detection rate of further CMA detection was 1/1. The karyotype results were normal, and the detection rate of further CMA (or CNV-seq) detection was 14% (3/21). The detection rate of CMA as the first-line detection technique was 7% (2/27). A total of 25 fetuses with isolated CCA with negative results of karyotyping and/or CMA were tested by WES, and 9 cases (36%, 9/25) were detected with pathogenic genes. The gradient genetic diagnosis of chromosomal karyotyping, CMA and WES resulted in a definite genetic diagnosis of 26% (17/65) of isolated CCA fetuses.Conclusions:Prenatal genetic diagnosis of isolated CCA fetuses is of great clinical significance. The detection rate of CMA is higher than that of traditional karyotyping. CMA detection could be used as a first-line detection technique for fetuses with isolated CCA. WES could increase the pathogenicity detection rate of fetuses with isolated CCA when karyotype analysis and/or CMA test results are negative.

Objective To study the detection rate of pathogens from sputum , blood, and bronchoalveolar lavage fluid ( BALF ) samples in acquired immunodeficiency syndrome ( AIDS ) patients complicated with pulmonary infection.Methods Seventy-three hospitalized AIDS patients complicated with pulmonary infection in Beijing Ditan Hospital , Capital Medical University were enrolled from February 2018 to September 2018.Blood, sputum and BALF samples were collected.Blood samples were cultured to detect anaerobic bacteria, aerobic bacteria, fungi and mycobacteria.Antigen agglutination method was applied in blood samples to detect cryptococcus neoformans.The sputum samples were tested for Mycobacterium tuberculosis by acid-fast staining and were cultured to detect bacteria and fungi.The sputum samples were observed under microscope for sporotrichosis and fungal spores.The BALF samples were cultured to detect bacteria and fungi. The BALF samples were tested for Mycobacterium tuberculosis by polymerase chain reaction amplification and acid-fast staining.Pneumocystis were detected in BALF samples by methenamine silver staining method .The BALF samples were observed under a microscope for sporotrichosis and fungal spores .The detection rate of pathogens from blood, sputum and BALF samples were compared.Chi-square test was conducted for statistical analysis.Results In 73 AIDS patients complicated with pulmonary infection , the pathogen detection rates in blood, sputum and BALF samples were 8 (11.0%), 23 ( 31.5%) and 48 (65.8%), respectively.The difference was statistically significant ( F ＝48.513, P ＜0.01 ).The detection rate in BALF samples was significantly higher than that in blood or sputum samples ( χ2 ＝43.349 and 17.136, respectively, both P＜0.01).The detection rate in sputum samples was significantly higher than that in blood (χ2 ＝9.215, P＜0.05). The highest detection rates of pathogens in blood , sputum and BALF samples were Talaromyces marneffei 4.1%(3), viridans group streptococci 16.4%(12) and 35.6%(26), respectively.Conclusions The detection rate of pathogens in BALF samples from AIDS patients complicated with pulmonary infection is the highest , followed by sputum and blood samples.

OBJECTIVE:To investigate risk factors of multidrug-resistant organisms (MDROs) infection in elderly patients of ICU,and to provide reference for formulation and implementation of MDROs prevention and control measures.METHODS:A total of 146 elderly patients were selected from ICU of our hospital during Dec.2013-Jun.2016.Throat swab,sputum swab and anal swab specimens (1 copy,respectively) were collected to conduct active screening of MRSA and ESBLs-producing Enterobacteriaceae.Risk factors of MDROs infection,pathogen distribution and drug resistance were analyzed.RESULTS:Among samples of 146 patients,there were 34 MRSA positive samples in throat swab with positive rate of 23.3％;there were 30 MRSA positive samples in sputum swab with positive rate of 20.5％;there were 99 ESBLs-producing bacteria positive samples in anal swab (containing 50 ESBLs-producing Escherichia coli positive samples and 49 ESBLs-producing Klebsiella pneumoniae positive samples) with positive rate of 67.8％.The positive rate of throat swab MRSA screening was not correlated with patient's gender,age,tracheal intubation or mechanical ventilation (P＞0.05),but it was related with hospitalization time in ICU (P＜0.05).The positive rate of sputum swab MRSA screening was not correlated with patient' s gender,tracheal intubation or mechanical ventilation;the positive rate of anal swab ESBLs-producing bacteria screening were not related with patient's gender(P＞0.05).But they were related with age and hospitalization time in ICU (P＜0.05).Compared with negative patients,there was no statistical significance in the times of fiberoptic bronchoscopy in throat/sputum swab MRSA screening positive patients (P＞0.05).The times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter in anal swab ESBLs-producing bacteria screening positive patients were significantly more or longer than negative patients,with statistical significance (P＜0.05).Binary Logistic regression analysis showed that hospitalization time in ICU was risk factor of positive active screening of throat swab in elderly patients of ICU[OR=1.119,95 ％ CI (1.071,1.385),P=0.021];age was risk factor of positive active screening of sputum swab[OR=1.893,95 ％ CI (1.232,4.042),P=0.032];age and hospitalization time in ICU were risk factors of positive active screening of anal swab [OR were 1.046,1.022,95％CI were (1.005,1.088) (1.006,3.283),P were 0.027,0.031].A total of 163 strains of MDROs were detected,among which there were 64 strains of MRSA,50 strains of ESBLs-producing E.coli and 49 strains of ESBLs-producing K.pneumoniae.They were generally highly resistant to compound preparation containing enzyme inhibitors.CONCLUSIONS:The results of MDROs active screening in elderly patients of ICU are related with age,hospitalization time in ICU,the times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter.Age and hospitalization time in ICU were risk factors of MDROs infection.The pathogens are mainly ESBLs-producing Enterobacteriaceae,and drug resistance is severe.For elderly critical patients with MDROs infection,clinical prevention and intervention measures should be taken to prevent and control the prevalence and spread of MDROs in ICU.

Objective To investigate the clinical status of disease self-management ability in patients with chronic hepatitis B liver fibrosis and to analyze the effect of gratitude,social support and perceived stress on the ability.Methods Totally 236 patients with chronic hepatitis B liver fibrosis were selected from Guangzhou Red Cross Hospital by convenient sampling from January 2016 to June 2017 and investigated with the general information questionnaire,the Chronic Hepatitis B Self-Management Scale,the Gratitude Resentment and Appreciation Test (GRAT),the Social Support Rating Scale and the Perceived Stress Scale-Chinese (CPSS).PASW Statistics 18.0 and AMOS 18.0 were used to analyze the effects.Results The disease self-management score in patients with chronic hepatitis B liver fibrosis was (94.41 ± 16.78).According to correlation analysis,gratitude,social support and perceived stress were positively correlated with disease self-management (r=0.327,0.339;P ＜ 0.05);while perceived stress was negatively correlated with disease self-management (r=-0.574,P ＜ 0.05).The multiple linear regression analysis and model fitting showed that gratitude had direct effect on disease self-management (β=0.314);social support had direct influence (β=0.354) and indirect (β=0.199) effect on it;and perceived stress had direct (β=-0.567) and indirect (β=-0.058) on it.Conclusions The patients with chronic hepatitis B liver fibrosis show a relatively poor disease self-management ability.Clinical medical and nursing staff shall cultivate the patients' gratitude,mobilize their social support,reduce their perceived stress and improve their disease self-management ability.

Objective To investigate the pathogen distribution and drug resistance condition in patients after lung transplantation so as to guide the reasonable use of antibiotics.Methods The clinical specimens from 242 lung transplantation patients in Wuxi People's Hospital between Jan.2010 to Dec.2016 were retrospectively analyzed.Among the 242 patients,182 were males and 60 were females with the average age of (52 ± 15) years old.Automatic analysis instrument VITEK-2 was applied for pathogen detection and K-B method was used to test drug resistance.Results From 2373specimens,1005 strains of pathogens were isolated and the detection rate was 42.35％ (1005/2373),in which gram-negative bacteria accounted for 81.79％ (822/1005).The specimens mainly resulted from sputum (76.19 ％) and bronchoalveolar lavage (19.76 ％).Among those strains,acinetobacter baumannii (28.76％),pseudomonas aeruginosa (16.62％),klebsiella pneumonia (14.33％),escherichia coli (5.57％) and Stenotrophomonas maltophilia (4.88％) ranked the top five species.Acinetobacter baumannii strains were highly resistant to most of antibiotic agents,with the drug resistant rate from 59.52％ to 100％,except cefperazone-sulbactam (＜ 50％).Pseudomonas aeruginosa strains were highly resistant to cefazolin,ceftriaxone,cefotetan,ampicillin,ampicillinsulbactam with the resistance rate of 80.24％-98.80％,while compared to other anibiotics with the resistance rate less than 50％.Stenotrophomonas maltophilia strains with intrinsic drug resistance to imipenem were sensitive to trimethoprim-sulfamethoxazole,cefperazone-sulbactam,piperacillintazobactam,levofloxacin,ciprofloxacin with the drug resistance rate of 12.24％,14.29％,32.65％,16.33％ and 18.37％ respectively.Klebsiella Klebsiella pneumoniae and escherichia coli,whose resistant rate to ceftazidime,cefperazone-sulbactam,piperacillin-tazobactam,aztreonam,amikacin and tobramycin was all less than 50％,were highly sensitive to imipenem,with the resistance rate of 24.31％ and 7.14％ respectively.Gram-positive bacteria were accounted for 9.35％,mainly Staphylococcus aureus,Staphylococcus haemolyticus and Staphylococcus epidemics,and drug resistant rate of them to vancomycin was all less than 20.00％.Fungi were accounted for 8.86％,mainly Candida albicans and Filamentous fungi,whose drug resistance rate to 5 antifungal drugs was less than 20.00％.The drug resistance rate of C.glabrata strains and C.krusei strains to fluconazole was 80.00％ and 100.00％,respectively.Conclusion The incidence of gram-negative bacteria infection and multiple bacterial strain infection in patients after lung transplantation is very high and the nonfermentation bacteria are highly resistant to multiple antibiotics.So,the rational antibiotics' use inclinical practice should be based on drug sensitivity results in order to improve the lung transplant recipients' survival rate.

Objective To compare the fetal and maternal outcomes of labor undergoing epidural block anesthesia with and without using hand-and-knee position in the second stage of labor.Methods A total of 1,158 subjects were included in the study.There were 560 subjects in the study group and 598 cases in the control group.All the subjects were divided into study and control group according to the randomized numbers.Both groups underwent epidural block anesthesia and used the same labor way in stage I and stage 3.In the study group,the hand-and-knee position was used for 15～30 minutes combined with uterine contractions and the delivery was done in the lithotomy position.In the control group,the gradidea took the semi-recumbent position with bent knees and bed elevated 40°,combined with uterine contractions until the delivery was done in the lithotomy position.The labor time of stage1,stage2,stage3 and all abor,labor way,perinaueum,complications and newborns were compared.Results The average time of the second stage labor and all labor in the observation group were significantly shorter than those of the control group (P＜0.05).The labor ways in the observation group was better than that of the control group (P＜0.05).The incidence of postpartum urinary retention in the observation group was significantly lower than that of the control group (P＜0.05).The differences of labor time for stage 1,stage2,perinaueum,blood loss rate,newboms' s tomor and neonatal asphyxia between two groups were not statistically significant (P＞0.05).Conclusions Under continuous epidural block anesthesia,the use of the hands-and-knees position in the second stage of labor can reduce the incidence of operative delivery,shorten the labor process,and reduce maternal complications.The method is worthy of promotion.

Objective To investigate the effect of osthole on the proliferation and apoptosis of breast cancer cell line MCF-7 and its potential mechanisms.Methods Breast cancer cell line MCF-7 was treated by osthole 0,25,50,100,150 and 200 μmol/L respectively.MTT method was used to detect cell survival rate.HE staining was used to observe morphological changes,Annexin V-PI flow cytometry was used to analyze cell apoptosis,and RT-PCR and Western blot method were used to detect the mRNA and protein expression of peroxisome proliferator-activated receptor γ (PPARγ) and farnesoid X receptor (FXR),respectively.Results MTT assay showed that strong cytotoxicity of cell line MCF-7 was induced after administration of osthole for 72 h in a dose-dependent manner.Especially,the maximum inhibitory rate,73.0 ％ appeared in the 200 μmol/L group.HE staining showed that the number of MCF-7 cells decreased,hyperchromatic nuclei and apoptotic bodies appeared after treatment with osthole for 72 h in a significant dose-effect manner.Flow cytometric analysis revealed that osthole could induce extensive apoptosis in MCF-7 cultures after treatment for 72 h compared with normal group (P ＜ 0.05,P ＜ 0.01).In particular,when the concentration of osthole reached 50 μmol/L,the proportion of early apoptotic cells was significantly increased in a dose-dependent manner (P ＜ 0.01),especially.The maximum apoptosis rate (46.2±9.0) ％ appeared in the 200 μmol/L group,which was consistent with the results obtained from MTT assays.Moreover,osthole could significantly increased PPARγand FXR mRNA and protein expressions (P ＜ 0.01).Conclusion These data suggest that osthole could inhibit the proliferation of breast cancer MCF-7 cells and promote its apoptosis,which might be associated with the regulation of PPARγ and FXR-mediated target genes involved in cell growth and metabolism.

Objective By using optical coherence tomography (OCT) to evaluate the vascular neointimal hyperplasia and the stent strut coverage degree in patients with acute myocardial infarction (AMI) and in patients with stable angina (SA) one year after receiving drug-eluting stent (DES) implantation, and to compare the clinical results between the two groups. Methods A total of 39 patients, who received DES implantation due to coronary heart disease, including AMI (n=16, AMI group) and SA (n=23, SA group), during the period from March 2011 to July 2012, were enrolled in this study. One year after DES implantation, coronary angiography and OCT reexaminations were performed in all patients. The neointimal hyperplasia (NIH) thickness, NIH area, NIH volume, strut coverage and apposition rate were determined with OCT. The results were compared between the two groups. Results OCT measuring results showed that the mean NIH thickness of AMI group and SA group was ( 66 . 8 ± 20 . 7 ) mm and ( 121 . 6 ± 135 . 7 ) mm respectively (P=0.022); the NIH volume ratio were 5.66%±3.18% and 11.88%±8.22% respectively (P=0.005); the percentage of cross-section with NIH thickness over 100 μm was 22.56%±23.99% and 40.14%± 30.01% respectively (P=0.034); and the percentage of overall stent strut coverage was 89.27%±6.40% and 93.42%±7.03% respectively (P=0.007). All the above mentioned data of AMI group were obviously lower than those of SA group. Conclusion After DES implantation, the intimal repair, intimal hyperplasia and stent strut coverage in AMI patients are poorer.

ABSTRACT:Objective To investigate the efficacy of continuing nursing in treatment of pa-tients with permanent colostomy.Methods A total of 87 discharged patients with permanent colostomy in department of gastrointestinal surgery were divided into continuing nursing group and control group.The control group was treated with conventional discharge education,while contin-uing nursing group were conducted with phone follow up,home visits,network platform,follow-up colostomy sodality.Permanent colostomy related knowledge,incidence rate of complications and nursing satisfactory degree were compared between two groups.Results Permanent colostomy re-lated knowledge of the observation group was significantly better than the control group,the inci-dence rate of complications was significantly lower than the control group,and nursing satisfactory degree was significantly higher than the control group(P <0.05).Conclusion Continuing nurs-ing can improve the self-care ability of patients,reduce the incidence of complications and improve satisfactory degree of patients.