Objective The metabolites of tolvaptan in rats were identified by ultra-performance liquid chromatography-quadrupole-exactive orbitrap high-resolution mass spectrometry(UFLC-Q-Exactive Orbitrap MS),and the possible metabolic pathways of tolvaptan in rats were discussed.Methods Plasma,urine and fecal samples from rats were collected after a single oral administration of 60 mg·kg-1 tolvaptan solid dispersion solution.The protein in the samples was precipitated with acetonitrile.UFLC-Q-exactive orbitrap MS technology was adopted for the sample analysis and the data were processed by Xcalibur 2.0 software.Results According to the retention time,precise relative molecular mass,characteristic fragment ions and related literature reports of each compound,35 metabolites were identified in rat biological samples.Moreover,23,26 and 30 metabolites in the plasma,urine and feces were identified,respectively.The major metabolic pathways of tolvaptan were identified as hydroxylation,carboxylation,hydrolysis,dehydrogenation,glucuronidation and acetylation.Conclusion Our study confirmed the major metabolites of tolvaptan in rats,enriched the metabolite spectrum of tolvaptan in vivo,and provided an experimental basis for the in-depth study of the pharmacodynamic substance basis of tolvaptan.

Central nervous system (CNS)diseases are complicated and the knowledge we get about them is very limited.PET plays an important role in the diagnosis of CNS diseases since it is noninvasive. Exploring the functional changes of the brain with PET has become a hot topic.The key of PET brain ima-ging is the molecular targeting probes.This review summarizes the research progress of CNS PET tracers on the basis of 2016 Society of Nuclear Medicine and Molecular Imaging (SNMMI)annual meeting.

Objective To understand the genotype distribution of Mycobacterium tuberculosis and the drug susceptibility of M.tuberculosis with different genotypes in Changping district of Beijing and evaluate the application of genotyping of M.tuberculosis in local tuberculosis (TB) prevention and control.Methods A total of 1 099 M.tuberculosis strains isolated in Changping from 2011 to 2015 were used.Spoligotyping and 12-locus VNTR recommended by Gao were used for the genotyping of these isolates.In addition,the susceptibility of the M.tuberculosis isolates to rifampin (RFP),isoniazid (INH),ethambutol (EMB),streptomycin (SM),amikacin (AMK) and ofloxcin (OFX) were detected by using conventional drug susceptibility test.Results From 2011 to 2015,the detection rate of OFX-resistance increased from 2.9％ to 8.9％ (P=0.01).Of all the M.tuberculosis isolatcs,976 belonged to Beijing genotype (88.8％),and the other 123 belonged to non-Beijing genotype (11.2％).In addition,there were 189 ancient Beijing genotype isolates and 787 modern Beijing genotype isolates,respectively.The proportion of Beijing genotype strains showed no significant increase in the past five years (81.1％ in 2011 vs.82.0％ in 2015).On the basis of VTNR genotyping,only 2 isolates belonged to one cluster (0.1％).In addition,the AMK resistant rate of Beijing genotype strains (1.7％)was significantly lower than that of non-Beijing genotype strains (4.9％,P=0.02).Compared with modern Beijing genotype strains,the SM resistant rate of ancient Beijing genotype strains was significantly higher (28.0％ vs.15.7％,P=0.01).Conclusions In the past five years,the OFX-resistant rate of M.tuberculosis in Changping was in increase.There was no significant difference in the detection of Beijing genotype strains during this period.In addition,the low clustering rate indicated that the TB transmission rate was low in Changping.

Objective: To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods: Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results: The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) . Conclusions Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.

Objective To explore the influence of extubation time of urinary catheter on post-operational urination and comfort degree of patients with orthopedic surgery, so as to and make clear the best extubation time of urinary catheter for them. Methods 900 patients treated with operation in Department of Orthopaedics in the Third Hospital of Hebei Medical University from April to June in 2016 were selected by convenience sampling and divided, according to extubation time of urinary catheter, into group A, B and C, each with 300 cases. For patients in group A, urinary catheters were removed in the morning the day after the operation(12~24 h after operation), while in group B, 6 h after, and in group C, 2 h after. Rate of successful urination after extubation of urinary catheter, bladder discomfort, incidence rate of acute urinary retention and comfort degree of indwelling catheter in the three groups were compared. Results Difference in rate of successful urination and incidence rate of frequent micturition, urgent urination, micturition pain and acute urinary retention of patients in the three groups showed statistic significance (P<0.05). It was shown in pairwise comparison that rates of successful urination in group A and B were higher than that in group C, while incidence rates of acute urinary retention were lower (P < 0.05), and that incidence rate of frequent micturition, urgent urination and micturition pain in group A was higher than that in group B and C (P<0.05). Difference in comfort degree of indwelling catheter in the three groups showed statistic significance (P < 0.05). Incidence rates of discomfort in degree Ⅱ in group B and C were less than that in group A, while incidence rate of discomfort in degree Ⅲ in group C was less than that in group A and B (P<0.05). Conclusions For orthopedic patients,the best extubation time of urinary catheter is 6 h after the operation, which helps to raise rate of successful urination, lower urethra irritative symptoms due to cathetering, and reduce bladder discomfort after extubation.

Objective To explore clinical practice value of Disease Severity Evaluation Scale (DSAS), and divide patient's nursing level according to the results of DSAS. Methods The assessment group was set up for evaluation of the scale, DSAS was used to determine the nursing level of 3 713 hospitalized patients (age > 18 years old) from 17 clinical departments, from April to May 2014. Results Nursing level determined by DSAS was compared with the standard nursing level, kappa coefficient was 0.72, P < 0.05, suggesting that the consistency was better. According to the kappa coefficient, 17 clinical departments could be divided into three categories, namely the applicability of DSAS were different in different departments. Conclusions DSAS can be used as a objective basis for division of nursing level and has a certain clinical significance. But in order to make it guide clinical work better, scoring system with department characteristic should be developed on the basis of DSAS.

Objective To investigate feasibility and effectiveness of combined level-one quality control and management mode. Methods Contents of combined level-one quality control and management mode were introduced, including determining departments combination, establishment and work procedure of the combined quality control group, frequency of combined quality control, and approaches of continuous quality improvement. Quality control data of the Nursing Department from January 2013 to December 2014 were taken to statistically analyze compliance rate of 6 nursing quality standards, satisfaction of hospitalized patients, and incidence of nursing defects, before and after implement of combined quality control&management mode. Results Compared with before, after implementation of combined level-one quality control and management mode, compliance rates of nursing documentation, basic nursing, treatment safety, head nurse management, and ward management, as well as satisfaction of hospitalized patients, and incidence of nursing defects were statistically significant (χ2 =4. 182, 8. 177, 6. 157, 5. 148, 5. 135, 7. 875, 7. 754; P <0. 05). Compliance rates of health education quality before and after the implementation were not statisticallysignificant (χ2 = 4. 182, P > 0. 05 ). Conclusions Implementation of combined level-one quality control and management mode can improve compliance rate of nursing quality standards and satisfaction of hospitalized patients, and decrease incidence of nursing defects, which is a new feasible and effective management mode in clinical work.

Objective To develop a satisfaction scale in orthopaedic inpatient and test the reliability and validity.Methods A research team was founded in March 2015.The primary items were obtained through literature review and semi-structured interview with orthopaedic inpatients.After expert consultation,the pretesting scale was developed.212 patients with orthopedic in the Third Hospital of Hebei Medical University were recruited in the study to finish the questionnaire from May to November 2015.After the test of reliability and validity,the final scale was developed.Results The final scale consisted of five dimensions and forty nine items.The Cronbach's α coefficient was 0.987 for the total scale and the dimensions were ranged from 0.874 to 0.928.The split-half reliability was 0.929.The item-content validity index (I-CVI) was 0.786-1.000.The scale-content validity index (S-CVI) was 0.893.The CVI of dimensions was 0.83-0.93.Exploratory factor analysis totally extracted five common factors,and the load value of each entry factor was 0.480-0.480.The cumulative variance contribution rate was 70.625％.Conclusions The orthopaedic inpatient satisfaction scale has good reliability and validity.It can be used as the evaluation tool for the satisfaction in orthopedic hospitalized patients and it also can provide references for the interventions in effect evaluation of satisfaction.

Objective To explore the application of compound sequential technology on sputum exclusion for patients with cervical spinal cord injury. Methods A total of 86 patients with cervical spinal cord injury ( CSCI) were divided into intervention group and control group from January 2011 to December 2013 in our hospital on average. The patients of intervention group adopted compound sequential technology on sputum exclusion, while the patients in the control group underwent conventional nursing measures. We evaluated the occurrence of pulmonary infection and atelectasis, and the usage of artificial airway. Results In the intervention group, the incidence of lung infection and atelectasis (9. 3%) was lower than that of the control group (37. 2%), and the difference was statistically significant (χ2 =9. 382,P< 0. 05). The cure time in the intervention group was shorter that of the control group (t = -6. 339,P <0. 05). Utilization rate of artificial airway in the intervention group was 7. 0% compared with 30. 2% in the control group (χ2 =7. 679,P<0. 05). The length of carrying tube in the intervention group was lower than that of the control group (t = -5. 490,P <0. 05). Conclusions The compound sequential technology can improve the effect of sputum exclusion in patients with CSCI, decrease pulmonary infection and atelectasis, shorten the time of carrying tube, and enhance cure rate.

Objective To study the relationship between chromosomal abnormalities of diffuse large B-cell lymphoma and its survival time.Methods Chromosome preparations were made by using modified method.Karyotypes were analyzed by stain of G-banding. And all patients were treated by chemotherapy. All patients' survival time was calculated.Results Mitotic cells that could be used for analysis were found in 28 cases.5 of 28 karyotypes were normal and 8 cases were polyploid.There were 4 cases with t(14,18)(q32;q21),5 cases with t(3; 14) (q27;q32),2 cases with t(2;3) (p11 ;q27),1 case with t(3 ;22) (q27 ;q11) respectively.There were 2 cases with ectopia between 7 chromosome and other chromosomes and 1 case with ectopia between 17 chromosome and other chromosomes.The survival time of patients with normal karyotype,t(14,18) (q32;q21)or 3q+ was longer than that of other groups.The survival time of group in Ⅰ, Ⅱ stages was longer than that in Ⅲ, Ⅳ stages. Conclusion The treatment, survival time and prognosis could be expected according to chromosomal abnormalities and its relevance to stages in diffuse large B-cell lymphoma.