Application and Analysis of High-quality Evaluation for Jianwei Xiaoshi Tablets / 中国实验方剂学杂志

Jianwei Xiaoshi tablets， as a common variety of Chinese patent medicine with "one product with many manufacturers"， have many manufacturers and huge market sales. However， the phenomenon about uneven quality and discrepant price is prominent. Based on this， this study was carried out for the quality evaluation of Jianwei Xiaoshi tablets by applying the high-quality evaluation criteria with the quality as core for Chinese patent medicine， which was based on the full production cycle， from the multi-dimension including raw material selection， production process， quality control， post-marketing research and so on. The evaluation results showed that the quality evaluation scores of Jianwei Xiaoshi tablets from different manufacturers varied greatly （ranging from 35 to 66）， indicating that the quality was significantly different. In the actual production， generally inadequate attention was paid to the quality of raw materials， and the quality of raw materials was insufficient with the score ratio of 43%， especially the poor consistency control of them. The role of good manufacturing practice was obvious， and the scores of production process were generally high with the average score ratio of 62%， and the maximum up to 80%. The technological advancement of the manufacturer was outstanding. The score ratio of quality control was only 31% that the internal quality standard of each manufacture almost stayed at the qualified line， which was equal to the national standard， and the consistency of products was insufficient. The post-marketing research was lacking with the score ratio of 37%. Manufacturers with high brand awareness and market share were upper scores， while the others lagged far behind. The results of this evaluation are in line with the overall prediction， which can provide a reference for the high-quality evaluation of Chinese patent medicine， and supply the scientific data for high-quality and high-price application.

Short-term clinical outcomes of outpatient total hip arthroplasty / 中华骨科杂志

Objective:To investigate the safety, economic effect, and short-term clinical efficacy of ambulatory total hip arthroplasty (THA) in the treatment of hip osteopathy within.Methods:This study retrospectively reviewed patients who underwent 48-hour outpatient THA and conventional primary THA from July 2020 to July 2021. Gender, age, body mass index (BMI), clinical diagnosis, place of resident, length of hospital stay, duration of the surgery, hemoglobin, albumin, C-reactive protein (CRP) and D-dimer before and 1 day after surgery, the visual analogue scale (VAS) was obtained postoperative day 2, hip joint modified Harris score before and 1 month after surgery, readmission and reoperation within 1 month after operation as the data of evaluations were extracted and compared in this study.Results:A totally of 150 cases were involved in this study, which including 75 cases with 48-hour outpatient primary THA and 75 cases with conventional primary THA. There was no significant difference between the two groups in terms of age, sex, BMI, education level, preoperative diagnosis, and preoperative Harris score ( P>0.05), but a significant difference was found in term of residence (χ 2=6.29, P=0.043), that the patients in the outpatient group were all from Zhejiang Province and 48% (36/75) of them were from Hangzhou City. While, in the conventional group, 6 patients were from other provinces. The length of stay was 2.13±0.52 days and operation time was 59.73±18.91 minutes in the outpatient group, which were both shorter than those (6.71±1.44 days and 66.91±22.40 min) in the conventional group ( t=25.91, P<0.001 for the length of hospital stay; t=2.12, P=0.036 for operation time). Compared with the conventional group, outpatient group saved the average hospital cost (4.60±0.44 vs. 5.20±0.72 ten thousand yuan, t=6.16, P<0.001). The VAS on the second day after surgery 3.45±0.75 was higher in the outpatient group than in the conventional group (3.45±0.75 vs. 3.16±0.94 points, t=2.09, P=0.039). The modified Harris score was without statistical significance ( t=0.42, P=0.677) 1 month after surgery in both groups. 75 patients in the outpatient group, 7 patients delayed discharge (were not discharge within 48 hours), and the rate of delayed discharge was 9.3%. Reasons for delayed discharge included poor pain control in two cases, one case had postoperative nausea and vomiting, one case had failed to meet rehabilitation standards, hypotension in one case, the intraoperative infection in one case and postoperative fever within 48 hours in one case. Conclusion:Outpatient THA can reduce the length of hospital stay, operative time and total cost of hospitalization. It has similar safety and early clinical efficacy as conventional THA. However, a small proportion of patients would delay discharge.

Effects of astragaloside Ⅳ on inflammatory response and percentage of peripheral blood Th17 cells in mice with ulcerative colitis / 中国中药杂志

This study aimed to investigate the anti-inflammatory effect of astragaloside Ⅳ in mice with ulcerative colitis(UC) and its effect on the percentage of peripheral blood T helper(Th17) cells. Following the establishment of UC mouse model with 2% sodium dextran sulfate(DSS), mice in the positive control group and low-and high-dose astragaloside Ⅳ groups were treated with corresponding drugs by gavage. Disease activity index(DAI) was calculated, and serum interleukin-17(IL-17), tumor necrosis factor-α(TNF-α), and transforming growth factor-β(TGF-β) levels were assayed by ELISA. The pathological changes in colon tissue were observed by HE staining, and Th17/regulatory T cells(Treg) ratio in the peripheral blood was determined by flow cytometry. Western blot was conducted for detecting the relative protein expression levels of forkhead box protein P3(Foxp3) and retinoic acid-related orphan nuclear receptor γT(ROR-γt). The findings demonstrated that in normal mice, the colonic structure was intact. The goblet cells were not reduced and the glands were neatly arranged, with no mucosal erosion, bleeding, or positive cell infiltration. In the model group, the colonic mucosal structure was seriously damaged, manifested as disordered arrangement or missing of glands, vascular dilatation, congestion, and massive inflammatory cell infiltration. The pathological injury of colon tissue was alleviated to varying degrees in drug treatment groups. Compared with the normal group, the model group exhibited elevated percentage of Th17 cells, increased IL-17 and TNF-α content, up-regulated relative ROR-γt protein expression, lowered TGF-β, reduced percentage of Treg cells, and down-regulated relative Foxp3 protein expression. The comparison with the model group showed that DAI score, pathological score, percentage of Th17 cells, IL-17 and TNF-α content, and relative ROR-γt protein expression in the positive control group, low-dose astragaloside Ⅳ group, and high-dose astragaloside Ⅳ group were decreased, while TGF-β content, percentage of Treg cells, and relative Foxp3 protein expression were increased. The DAI score, pathological score, percentage of Th17 cells, IL-17 and TNF-α content, and relative ROR-γt protein expression in the low-dose astragaloside Ⅳ group were higher than those in the positive control group, whereas the content of TGF-β, percentage of Treg cells, and relative Foxp3 protein expression were lower. DAI score, pathological score, percentage of Th17 cells, IL-17 and TNF-α content, relative ROR-γt protein expression in the high-dose astragaloside Ⅳ group declined in contrast to those in the low-dose astragaloside Ⅳ group, while the TGF-β content, percentage of Treg cells, and relative Foxp3 protein expression rose. There was no significant difference between the positive control group and the high-dose astragaloside Ⅳ group. Astragaloside Ⅳ is able to inhibit inflammatory response and diminish the percentage of Th17 cells in mice with UC.

Mid-term results of endovascular intervention for transplant renal artery stenosis / 中华普通外科杂志

Objective:To evaluate the mid-term results of endovascular treatment for transplant renal artery stenosis (TRAS).Methods:The clinical and follow-up data of TRAS patients undergoing endovascular treatment at the First Affiliated Hospital of Zhengzhou University from Jan 2014 to Jan 2021 were retrospectively analyzed.Results:A total of 2 230 patients underwent kidney transplantation, 78 cases(3.6%) developed TRAS, among those 27 patients received endovascular treatment and followed-up from 12 to 80 months(mean 36 months). Thirteen patients (48.1%) underwent renal graft angiography and balloon dilatation, of which 2 patients underwent stent placement, 14 patients (51.9%) underwent renal graft angiography with balloon dilatation and stenting. The serum creatinine 2 weeks postoperatively and 12 months postoperatively were 127.6 μmol/L (47-220 μmol/L) and 103.4 μmol/L (63-166 μmol/L), respectively, significantly lower than the preoperative 217.1 μmol/L (98-541 μmol/L), ( P<0.05). Glomerular filtration rate (GFR) before surgery was 8.3-105.3 ml/min, 2 weeks and 12 months after surgery compared to 24.6-132.2 ml/min and 47.3-113.9 ml/min( P<0.05). The preoperative peak systolic velocity (PSV) of the transplanted renal artery during the systolic phase was 234 cm/s (75-457 cm/s), compared to 129 cm/s (52-290 cm/s) ( P<0.05) 2 weeks and 118 cm/s (57-300 cm/s) 12 months postoperatively ( P<0.05). During the follow-up period, 2 patients (7.4%) died of multiple organ failure. Conclusions:TRAS is the most common vascular complication after kidney transplantation. Endovascular treatment has a high success rate and low complication rate.

Efficacy and tolerability of dolutegravir plus lamivudine as a switch simplified strategy in treatment-experienced human immunodeficiency virus/acquired immunodeficiency syndrome patients / 中华传染病杂志

Objective:To evaluate the efficacy and tolerability of the dual therapy of dolutegravir (DTG) plus lamivudine (3TC) as a switch simplified strategy in treatment-experienced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients.Methods:Treatment-experienced HIV/AIDS patients who switched to a dual therapy containing DTG (50 mg, once daily) plus 3TC (300 mg, once daily) were included in Beijing You′an Hospital, Capital Medical University from September 2016 to May 2019. HIV RNA, CD4 + T lymphocyte count, blood lipid indexes, renal function indexes were collected when patients changed the treatment regimen (baseline) and after 48 weeks of treatment. Efficacy (HIV RNA<50 copies/mL) and safety of the dual therapy were analyzed. Statistical comparisons were performed using the Wilcoxon matched-pairs signed rank test. Results:The reasons for 33 patients switching the treatment regimen were virologic failure (four cases, 12.1%), simplification of regimen (11 cases, 33.3%), and drug toxicity (18 cases, 54.5%). The patients were treated with anti-retroviral therapy (ART) for 2.13 (1.05, 4.23) years before regimens switching. Twenty-nine (87.9%) patients were virologically suppressed at baseline, and four (12.1%) patients were virological failure. After switching to DTG plus 3TC, all 33 patients showed HIV RNA<50 copies/mL after 48 weeks of treatment. The baseline CD4 + T lymphocyte count was 543 (363, 595)/μL. After switching the treatment regimens for 48 weeks, CD4 + T lymphocyte count was significantly increased to 625 (455, 651)/μL, and the difference was statistically significant ( Z=3.14, P=0.002). Compared with baseline, low-density lipoprotein-cholesterol was increased after 48 weeks of treatment (2.35(1.80, 3.08) mmol/L vs 3.12(2.74, 3.87) mmol/L), while triglyceride (2.21(1.27, 4.37) mmol/L vs 1.61(1.20, 2.22) mmol/L), the ratio of total cholesterol to high-density lipoprotein-cholesterol (5.02 (4.13, 6.40) vs 4.70 (3.55, 5.35)) and estimated glomerular filtration rate (106.4(78.2, 118.2) mL/(min·1.73 m 2) vs 88.6 (75.7, 107.9) mL/(min·1.73 m 2)) were decreased. The differences were all statistically significant ( Z=4.89, 2.37, 2.09 and 2.83, respectively, all P<0.050). No patient discontinued due to adverse events. Conclusions:The use of dual therapy containing DTG and 3TC is effective and well-tolerated in treatment-experienced HIV/AIDS patients under any prior ART without significant adverse events.

A survey of awareness of retinopathy among diabetic patients in communities of Shenzhen / 中华眼底病杂志

Objective:To investigate the awareness of diabetic retinopathy (DR) prevention and treatment knowledge of diabetic patients in the community of Shenzhen, and analyze its influencing factors.Methods:A cluster random sampling method was used to select 904 patients with diabetes diagnosed in 6 community health service centers in 2 administrative districts of Shenzhen and included in this study. Questionnaire survey of patients were performed to understand their knowledge of DR prevention and treatment. The multi-factor logistic regression analysis method was used to analyze the related influencing factors of DR prevention knowledge awareness.Results:Among 904 patients, 144 patients (15.93%, 144/904) knew about DR prevention and treatment knowledge. The highest awareness rate were about "Diabetes can affect vision and even cause blindness" (88.60%, 801/904). The lowest awareness rate (6.20%, 56/904) were about "DR treatment methods". About "diabetes requires regular fundus examinations" and "diabetics", the awareness rate of fundus examination interval were less than 50.00%. The results of multivariate logistic regression analysis showed that gender [odds ratio ( OR)=1.595], education level ( OR=2.963, 3.937), monthly income level ( OR=3.871, 4.675), diabetes course ≥15 years ( OR=1.829), treatment measures ( OR=3.318, 4.512). Whether people had DR ( OR=1.605) were important factors that affected the awareness of DR prevention and treatment knowledge ( P<0.05). Conclusions:The overall awareness of DR prevention and treatment knowledge among diabetic patients in the community of Shenzhen is relatively low. Males, low education and income levels are the main influencing factors.

Oblique branch of anterolateral thigh flap: Understand it and issues to handle / 中华显微外科杂志

Objective:To summarize the oblique branches found in the transfer of anterolateral thigh flap (ALTF) and to handle the issues of oblique branch.Methods:Thirty patients who require surgery of ALTF transfer from May, 2017 to October, 2019 were enrolled. CTA examination was perfected prior surgery and the origin of ALTF vessels was preliminarily determined. During the surgery, Three-longitudinal-and-five-transverse methods were used to locate and design the flap. The ALTF was taken according to the flap design. Attention should be paid to the location of the oblique branch and the separation of the vessels of oblique branch to avoid a damage as much as possible. The vessels of oblique branch should be completely explored and separated. One or 2 vascular pedicles were cut according to whether the oblique branch vessels and the descending branch vessels were joined together during surgery. Clamping tests were carried out on the 2 vascular pedicles to determine an arterial blood supply. Super drainage of vascular pedicle veins according to the situation of blood circulation. After the surgery, routine treatment was carried out. Blood supply, skin temperature, swelling degree, exudation and survival of the flap were closely observed and regular follow-up was carried out.Results:Among the 30 ALTF examined by CTA, 13 patients were identified with oblique branch vessels before operation. During operation, 11 oblique branch vessels (The occurrencce rate was 36.6%)were found to enter the flap, and were completely preserved. Of the 11 identified oblique branch vessels, 8 had 2 vascular pedicles taken and the vascular pedicles were treated by venous super drainage technique. The postoperative blood supply of the flap was good; The skin temperature was closed to surrounding normal skin; Swelling of flap was minor and there was little seepage. The flaps all survived after surgery with stage one healing. Followed-up time was 3-32 (average 16.1) months. The recipient site healing was good, and the function and appearance were satisfactory. The joint movement at the donor site was normal, and there was no obvious loss of local sensation.Conclusion:More than one third of the oblique branches appear in this group. The oblique branch vessels should be preserved as much as possible to avoid issues in relation to the oblique branch. Reasonable handling of oblique branch is the key to the success of the surgery.

Grade Evaluation of Salviae Miltiorrhizae Radix et Rhizoma Decoction Pieces Based on Relative Quality Constant / 中国实验方剂学杂志

Objective:To establish the grade evaluation standard of Salviae Miltiorrhizae Radix et Rhizoma decoction pieces combining traditional character evaluation and modern intrinsic quality analysis. Method:The appearance character parameters （thickness and weight） and contents of internal index components （tanshinones and salvianolic acid B） of 18 batches of Salviae Miltiorrhizae Radix et Rhizoma decoction pieces were determined， and the relative quality constant was calculated. The maximum value of the percentage quality constants of the tested samples was assumed to be 100%， the value ≥80% was classified as the first-class， ≥50% and <80% as the second-class， <50% as the third-class. Result:The relative quality constants of 18 batches of Salviae Miltiorrhizae Radix et Rhizoma decoction pieces ranged from 349 to 884. According to the percentage quality constant， 18 batches of samples were successfully divided into three grades. The relative quality constant of the first-class product was ≥707， including samples ds5， ds8 and ds14， accounting for about 17% of the total number of samples. The relative quality constant of the second-class product was ≥442 and <707， accounting for about 61% of the total number of samples. the other samples were of the third-class， and their relative quality constants were all <442. Conclusion:The method of relative quality constant overcomes the one-sidedness of the single method in the grade evaluation of Salviae Miltiorrhizae Radix et Rhizoma decoction pieces， and the evaluation results can objectively， reasonably and scientifically classify the grade of the decoction pieces， which can provide reference for the establishment of the grade standard of other decoction pieces.

Reuse of Resource Components in Residue of Shaoyao Gancaotang / 中国实验方剂学杂志

Objective:Aiming at the residue of Shaoyao Gancaotang， the extraction， qualitative and quantitative study of the small molecule resource components were carried out to clarify the residual small molecule chemical components in the residue and explore the ways of its resource utilization. Method:The ultra-performance liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry （UPLC-QTOF-MS/MS） was used to qualitatively identify the residual small molecule substances in the dregs of Shaoyao Gancaotang. Agilent C₁₈ reversed-phase chromatographic column （3.0 mm×100 mm， 2.7 µm） was used at the flow rate of 0.4 mL·min^-1， the injection volume was 5 µL， and the mobile phase was gradient eluted with 0.05% formic acid aqueous solution （A）-acetonitrile （B） （0-1 min， 14%-17.5%B； 1-3 min， 17.5%-19%B； 3-4 min， 19%-20%B； 4-5 min， 20%B； 5-6 min， 20%-21%B； 6-9 min， 21%B； 9-22 min， 21%-36%B； 22-23 min， 36%B； 23-32 min， 36%-43%B）， electrospray ionization （ESI） was employed with negative ion mode scanning and scanning range of <italic>m</italic>/<italic>z</italic> 50-1 200. A high performance liquid chromatography （HPLC） was established for the quantitative analysis of its main components with Agilent C₁₈ reversed-phase chromatographic column （4.6 mm×150 mm， 5 µm）， the detection wavelength was set at 235 nm， the flow rate was 0.8 mL·min^-1， and the injection volume was 5 µL. Mobile phase was 0.05% phosphoric acid （A）-acetonitrile （B） for gradient elution （0-1 min， 14%-19%B； 1-4 min， 19%B； 4-18 min， 19%-50%B）. The content changes of main components in the residue of Shaoyao Gancaotang were compared before and after two different techniques of organic solvent extraction and enzymatic extraction. Result:A total of 16 chemical components in the residue of Shaoyao Gancaotang were qualitatively analyzed， and quantitative analysis found that there were many chemical components in the residue， among which the residues of 6 index components such as paeoniflorin and liquiritin reached more than 70% in the original decoction piece. After enzymolysis by cellulase， liquiritin in the residue could be converted into liquiritigenin. The content of crude polysaccharide in enzymatic extract of the residue was 6 times higher than that in the blank group， and the content was up to 12%. Conclusion:There are still many small molecule resource components in the residue of Shaoyao Gancaotang， which has great development potential. Organic solvents can be used to re-extract the target components in the residue， and liquiritin can be converted into liquiritigenin by biological fermentation technology， and the crude polysaccharide from the residue can be extracted by enzymatic method to develop animal feed. This study can provide reference basis and approach for reusing the residues of Shaoyao Gancaotang preparations and dispensing granules， so as to realize the high-value utilization of Shaoyao Gancaotang.

Analysis on Prescription Research and Historical Evolution of Mahuangtang / 中国实验方剂学杂志

Based on the ancient Chinese medical literature and modern clinical application literature， Mahuangtang was systematically analyzed， including its origin， composition， processing requirements and others， in order to provide support for the development of this famous classical formula. It was found that there were some doubts about Mahuangtang， such as the original variety， the processing of decoction pieces， and the dose conversion ratio. On the basis of fully considering the actual needs of the development of famous classical formula preparations and the usage habits of modern clinical practice， the development suggestions of the author were as follows：Ephedrae Herba should be selected Ephedra sinica without removing knots， Cinnamomi Ramulus should be selected from Cinnamomum cassia， Glycyrrhizae Radix et Rhizoma should select Glycyrrhiza uralensis and be roasted with honey， and Armeniacae Semen Amarum should be selected as Dan-processed products. The total dose of Mahuangtang was 24 g after conversion according to 1 Liang equal to 3 g as following the transition phenomenon and law. The preparation and usage method was as follows：took 1.8 L of water， first added Ephedrae Herba in water for decocting， evaporated 400 mL of water， removed the upper foam， then added the other three drugs， cooked over gentle heat to 500 mL， filtered the residue， took three times a day， about 160 mL warm decoction once. The major function recorded of Mahuangtang in ancient books was exterior sthenia syndrome of exogenous wind cold， it often used in the clinical treatment of cold， acute bronchitis， bronchial asthma and other diseases through the flexible application of the later doctors.

Analysis on the diagnosis and treatment of necrotizing fasciitis complicated with sepsis / 中华危重病急救医学

Objective:To recognize the characteristics of necrotizing fasciitis patients complicated with sepsis and summarize the experience the treatment.Methods:A retrospective study was conducted. The clinical data of 57 patients with necrotizing fasciitis complicated with sepsis admitted to Guangdong Provincial People's Hospital from July 2009 to December 2019 was analyzed by collecting such factors as gender, age, complications, infection sites, pathogens, surgery information, treatment options and outcome. The patients were divided into debridement group ( n = 14) and control group ( n = 43) according to whether the debridement was completed within 48 hours of admission, and the mortality during hospitalization between the two groups was compared. A telephone follow-up had been done to record the long-term outcome of these patients. Results:Among 57 patients with necrotizing fasciitis complicated with sepsis, there were 43 males and 14 females with the average age of (57.9±12.1) years old. Most of the underlying diseases were diabetes mellitus (70.17%), other diseases included hypertension (8.77%), tumor chemotherapy (7.02%), liver disease (hepatitis, cirrhosis, 7.02%), coronary artery heart disease (3.51%), systemic lupus erythematosus (3.51%), etc. Most of the infection site was lower limbs (71.93%). There were 78 pathogens cultured in 57 patients, in which 52 were non-drug resistant bacteria (66.67%), and 26 were drug resistant bacteria (33.33%). There were 40 Gram positive (G +) bacteria (51.28%), 29 Gram negative (G -) bacteria (37.18%), 8 fungi (10.26%) and 1 mixed bacteria (1.28%). Finally, of 57 patients, 46 patients were cured, and 11 patients died with hospital mortality of 19.30%. Among 57 patients, the hospital mortality in the debridement group was significantly lower than that in the control group [0% (0/14) vs. 25.58% (11/43), P < 0.05]. Among the 46 cured patients, 11 had accepted amputations, accounting for 23.91%. In December 2020, 43 patients who were cured (3 patients were lost to follow-up) were followed up by telephone. Twenty-three patients were completely self-care, 9 patients were partly self-care, 8 patients were completely unable to take care of themselves, and 3 patients died. Conclusions:Necrotizing fasciitis with sepsis mostly occurs in people with weakened immunity, and has a high mortality and disability rate. Early identification and active surgical debridement may be the key to improve the treatment effect.

Inhibitory effect and mechanism of PSD-007 photodynamic therapy on human nasopharyngeal carcinoma transplanted tumors in nude mice / 国际肿瘤学杂志

Objective:To explore the inhibitory effect and mechanism of photocarcinorin (PSD-007) photodynamic therapy (PDT) on human nasopharyngeal carcinoma transplanted tumors in nude mice.Methods:A total of 50 transplanted tumor nude mice models of human nasopharyngeal carcinoma were established and randomly divided into 5 groups: control group (group A), simple PSD-007 group (group B), simple light group (group C), local injection of PSD-007 + light group (group D), intraperitoneal injection of PSD-007 + light group (group E) using the method of random number table, 10 mice in each group. After 7 days of treatment, the tumor mass and tumor volume of nude mice in each group were measured and the tumor inhibition rate was calculated. HE staining was used to detect the histopathological changes of tumors in nude mice. Western blotting was used to detect the expressions of autophagy-related gene Beclin 1, microtubules associated protein 1 light chain 3-β (LC3) and phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling pathway related proteins. Real-time fluorescent quantitative PCR was used to detect LC3, Beclin 1 mRNA expressions in tumor tissues.Results:After treatment, the tumor mass of nude mice bearing human nasopharyngeal carcinoma in group A, B, C, D and E were (2.05±0.18) g, (2.02±0.20) g, (2.04±0.15) g, (0.43±0.11) g and (0.94±0.12) g, and the tumor volumes were (1.11±0.13) cm 3, (1.18±0.16) cm 3, (1.13±0.14) cm 3, (0.51±0.07) cm 3and (0.65±0.10) cm 3, and there were statistically significant differences among the 5 groups ( F=236.749, P<0.001; F=62.418, P<0.001). Compared with group A, B and C, the tumor mass and tumor volumes of nude mice in group D and E were significantly reduced, and there were statistically significant differences (all P<0.001); compared with group E, the tumor mass and tumor volume of nude mice in group D were significantly reduced ( P<0.001; P=0.023). The tumor inhibition rates of group B, C, D and E were (1.07±0.11)%, (0.55±0.06)%, (79.11±0.06)% and (54.05±0.08)%, with a statistically significant difference ( F=235.987, P<0.001), compared with group B, C and E, group D had the most obvious tumor suppressing effect (all P<0.05). HE staining results showed that compared with group A, B and C, group D and E had larger tumor necrosis areas, more inflammatory cell infiltration, more vacuolar degeneration, and obvious nuclear shrinkage. The tumor necrosis degree in group D was higher than that in group E. The relative expressions of PI3K protein of group A, B, C, D and E were 1.01±0.06, 1.00±0.05, 1.01±0.05, 0.23±0.02, 0.48±0.04, p-Akt/Akt protein relative expressions were 0.66±0.06, 0.65±0.05, 0.64±0.05, 0.06±0.02, 0.17±0.02, p-mTOR/mTOR protein relative expressions were 1.06±0.06, 1.01±0.06, 1.01±0.06, 0.30±0.02, 0.45±0.04. The protein relative expression ratios of LC3 Ⅱ/LC3 Ⅰ were 0.85±0.05, 0.83±0.05, 0.83±0.06, 0.22±0.02, 0.41±0.04, and Beclin 1 protein relative expressions were 0.66±0.06, 0.64±0.05, 0.64±0.06, 1.67±0.07, 1.02±0.05, LC3 mRNA relative expressions were 0.98±0.29, 0.92±0.25, 1.02±0.26, 3.76±0.28, 2.38±0.28, and Beclin 1 mRNA relative expressions of were 1.11±0.40, 1.19±0.29, 1.16±0.24, 6.84±0.54, 2.94±0.48. There were statistically significant differences ( F=190.160, P<0.001; F=160.014, P<0.001; F=160.183, P<0.001; F=119.964, P<0.001; F=186.257, P<0.001; F=211.089, P<0.001; F=374.835, P<0.001). Compared with group A, B and C, PI3K, p-Akt/Akt and p-mTOR/mTOR protein relative expression levels and protein relative expression ratios of LC3 Ⅱ/LC3 Ⅰ in nude mice tumors of group D and E were significantly reduced, and LC3 mRNA, Beclin 1 protein and mRNA relative expression levels were significantly increased, with statistically significant differences (all P<0.001); PI3K, p-Akt/Akt and p-mTOR/mTOR protein relative expression levels and protein relative expression ratio of LC3 Ⅱ/LC3 Ⅰ in nude mice tumors of group E were significantly higher than those of group D, while Beclin 1 protein relative expression levels, LC3 and Beclin 1 mRNA relative expression levels were reduced (all P<0.05). Conclusion:PSD-007 PDT has an inhibitory effect on human nasopharyngeal carcinoma transplanted tumors in nude mice, which may be related to the inhibition of PI3K/Akt/mTOR signaling pathway activation and the promotion of autophagy. Compared with intraperitoneal injection, local injection of PSD-007 PDT is more effective.

Analysis of the epidemiological characteristics of new occupational pneumoconiosis in Jiangxi Province, 2010-2019 / 中国职业医学

OBJECTIVE: To analyze the epidemiological characteristics of new occupational pneumoconiosis(hereinafter referred to as pneumoconiosis) in Jiangxi Province from 2010 to 2019. METHODS: The data of new pneumoconiosis cases in Jiangxi Province from 2010 to 2019 were collected through the Occupational Disease and Occupational Disease Health Information Monitoring Subsystem in the China Disease Prevention and Control Information System, and a retrospective analysis was conducted. RESULTS: From 2010 to 2019, there were 4 450 new cases of pneumoconiosis in Jiangxi Province. Among these cases, the main disease types were coal workers′ pneumoconiosis and silicosis, accounting for 98.5%. The number of new cases of pneumoconiosis showed a decreasing trend with the increase of years for the last ten years(P<0.05). The median age and the 0 th-100 th percentile [M(P_0-P_(100))] of new-onset pneumoconiosis diagnosis was 56.6(34.0-97.0) years old. The service length M(P_0-P_(100)) with dust-exposure was 12.0(1.0-48.0) years. The main industry of the new pneumoconiosis cases was concentrated in the coal mining and washing industry(63.4%). The distribution of economic types of enterprises with new pneumoconiosis cases was mainly state-owned enterprises(70.0%). The enterprise scale was medium-sized and small enterprises(65.9% in total). The types of work were mainly coal blenders, rock drillers, and coal miners, accounting for 56.5%. CONCLUSION: The incidence of occupational pneumoconiosis in Jiangxi Province is not optimistic. It is necessary to strengthen the prevention and control of occupational diseases on workers exposed to dust in key industries, enterprises and types of work.

Clinical features of 40 elderly patients with pulmonary thromboembolism: a retrospective study / 中华危重病急救医学

Objective:To evaluate the clinical characteristics, diagnosis, treatment and outcome of elderly patients with acute pulmonary embolism (APE), in order to strengthen the awareness of diagnosis of APE and reduce missed diagnosis and misdiagnosis.Methods:A retrospective analysis of clinical data of 40 elderly patients (age ≥ 60 years old) diagnosed with APE admitted to TEDA International Cardiovascular Hospital from January 2008 to December 2018, including risk factors, clinical features, symptoms and signs, laboratory tests, risk of pulmonary embolism (Wells score), simplified pulmonary embolism severity index (sPESI), radiological tests, treatment, and outcome, etc. were conducted. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of Wells score and spiral CT pulmonary angiography (CTPA) in APE.Results:A total of 40 elderly patients with APE were enrolled, male was 52.5%, and the age was (69.6±8.2) years old. The most common risk factor was deep vein thrombosis (DVT, 52.5%), followed by hypertension (37.5%) and heart failure (35.0%). The main clinical symptoms were exertional dyspnea (87.5%) and chest tightness (80.0%). Only 10.0% of patients had the triad of dyspnea, chest pain and hemoptysis at the same time. In addition, palpitation (65.0%) and lower limb swelling and pain (42.5%) were also common symptoms. The main clinical signs were shortness of breath (respiratory rate > 25 bpm, 80.0%), lung moist rales (52.5%), and tachycardia (heart rate > 100 bpm, 50.0%). The Wells score showed that 95% of the patients Wells ≥ 2, including moderate (Wells 2-6, 62.5%) and severe (Wells ≥ 7, 32.5%). Laboratory examination showed that 80.0% of patients had D-dimer > 0.5 mg/L, 72.5% had arterial partial pressure of oxygen (PaO 2) < 60 mmHg (1 mmHg = 0.133 kPa), and 75.0% had arterial partial pressure of carbon dioxide (PaCO 2) < 35 mmHg, 67.5% had brain natriuretic peptide (BNP) > 500 ng/L or N-terminal pro-BNP (NT-proBNP) > 300 ng/L, and 47.5% had cardiac troponin I (cTnI) > 0.3 μg/L. The confirmed diagnosis rate of CTPA in APE was 88.6% (31/35); 5 cases were diagnosed by pulmonary ventilation/perfusion imaging in 6 cases; 4 cases were diagnosed by magnetic resonance pulmonary angiography (MRPA). The sPESI score showed that 36 patients were moderate-risk patients [26 patients with sPESI ≥ 1, and 10 patients with sPESI 0 but right ventricular dysfunction (RVD) and/or elevated cardiac biomarkers]. Thrombolytic therapy and anticoagulant therapy were performed on 17 of them: 8 were cured, 8 were improved, and 1 died; anticoagulant therapy was performed on 18 moderate-risk patients: 9 were cured, 7 were improved, 1 left the hospital without cure, and 1 died; the other 1 moderate-risk patient with PE caused by right atrial myxoma was treated by operation and ultimately died. Four low-risk patients were treated by anticoagulant therapy: 2 were cured and 2 improved. The area under the ROC curve (AUC) of Wells score combined with CTPA was 0.82 (95% confidence interval was 0.73-0.98, P < 0.01), the sensitivity was 74.2%, and the specificity was 90.0%. Conclusions:DVT and chronic diseases are the most common risk factors for APE in the elderly patients, often accompanied by dyspnea, chest tightness, and lower limb swelling and pain. Early anticoagulation therapy in elderly APE can make a good prognosis. Wells score has an important predictive value for the diagnosis of APE, while blood D-dimer is an important exclusion parameter. CTPA test is the main diagnostic method for APE. The sPESI score can suggest risk stratification and prognosis, and further guided treatment.

Research Strategies and Key Problems Analysis over Substance Benchmark of Famous Classical Formulas / 中国实验方剂学杂志

With continuous introduction of relevant national policies on famous classical formulas, the research of famous classical formulas is popular all over the country. Different from other new drugs, in the research and development process of famous classical formulas, substance benchmark is earlier than the product, suggesting that the research and development of substance benchmark is of great significance. Based on previous work of the authors, content of substance benchmark of famous classical formulas was analyzed, which was included in the document <italic>The Management Regulation of Simplified Registration and Approval over Chinese Herbal Medicine Compound Preparations of Ancient Famous Classical Formulas</italic> released by the National Medical Products Administration in May 2018. In this paper, the significance of substance benchmark development was described, a five-stage of research strategy was proposed, covering the prescription textual research and historical evolution, the collection and quality evaluation of medicinal materials, the processing method and quality evaluation of decoction pieces, the preparation and quality research of substance benchmark, the drafting and formulating of quality standard over substance benchmark. At the same time, some suggestions were put forward to the feasibility of compound preparations development over famous classical formulas, the implementation difficulty of resource evaluation over Chinese medicinal materials, and the irrationality on the quality correlation of Chinese medicinal materials. All of these are expected to provide reference and enlightenment for the development and policy officially landed over ancient famous classical formulas.

Current studies on quality of Chinese patent drugs with consistency as core and discussions on new high-quality evaluation model / 中国中药杂志

The consistency of quality on Chinese patent drugs is a hotspot and difficulty in the control of traditional Chinese medicine preparations, and has become one of the bottlenecks restricting its internationalization. Based on the analysis of current studies on quality and problems of Chinese patent drugs, this paper explored relevant methods of quality evaluation on Chinese patent drugs and possible factors affecting the consistency of quality in the pharmaceutical cycle by consulting relevant literatures about quality evaluation methods and consistency control techniques of large-scale Chinese patent drugs. And it put forward the evaluation system on high-quality Chinese patent drugs with "consistency" as the core, so as to promote the overall improvement of the quality of Chinese patent drugs, guide the rational price of Chinese patent drugs of the same species, and provide a new reference model for the quality evaluation of Chinese patent drug.

Study on quality evaluation method of classical prescription Mahuang Decoction primary standard substances / 中国中药杂志

This study aimed to establish the HPLC characteristic chromatogram and content determination method for index components with the primary standard substances of the classical prescription Mahuang Decoction, and to provide data basis for the establishment of its quality standard and the development and utilization of compound preparations. First, HPLC was used to establish the material reference chromatograms of Mahuang Decoction, and 15 batches of standard samples of Mahuang Decoction were determined. Their similarity was calculated by the median method. Secondly, the content of the standard substances was determined and a simplecontent determination method was established by HPLC. Relevant methodology was investigated, and the extraction ratio, index component transfer rate and moisture content of 15 batches of primary standard samples were calculated. The results showed that the two sets of HPLC methods had their own characteristics. The six chromatographic peaks identified from the 10 common peaks in the former characteristic chromatogram covered all the herbal medicines in the standard substances, which can better indicate the quality characteristics of the standard substances of Mahuang Decoction. The latter method(content determination method) was simple and practical, so it was suitable for establishing the quality standard of its compound preparation. Two sets of methods were jointly used to evaluate the quality of 15 batches of Mahuang Decoction. The results were as follows: the similarity of 15 batches of samples was greater than 0.90; the average extraction ratio was 18.1%; the average moisture content was 9.7%; the average content and transfer rate of the standard ingredients ephedrine hydrochloride and total pseudoephedrine hydrochloride were 2.3% and 26.7% respectively, and the average content and transfer rate of amygdalin were 2.2% and 48.3% respectively. None of the data showed dispersion(beyond 70%-130% of the mean value), which met the application data requirements for the substance standards of ancient classical Chinese herbal compound preparations(draft for comments). Based on the above research, the primary substance quality standard of Mahuang Decoction was established in order to provide reference for the development and research of the compound preparation of Mahuang Decoction.

Analysis of Excretion Behavior of GK-A from Ginkgo Semen in Urine and Bile of Rats / 中国实验方剂学杂志

Objective::To investigate excretion of GK-A, a antitussive compound separated from Ginkgo Semen, in the urine and bile of rats. Method::UPLC-MS/MS was used to determine the concentration of GK-A in rat urine and bile samples. The separation was performed on a C18 column, the mobile phase consisted of 0.1%formic acid aqueous solution (A) and acetonitrile (B) for gradient elution (0-1 min, 95%A; 1-3 min, 95%-85%A; 3-7.5 min, 85%-40%A; 7.5-8 min, 40%A). The detection was carried out by a triple quadrupole mass spectrometer in the positive ion mode with an electrospray ionization (ESI). Multiple reaction monitoring (MRM) mode was employed. After intragastric administration of GK-A, the urine and bile samples were collected at different time points, and the contents of GK-A in the samples were determined, and the cumulative excretion and cumulative excretion rate were calculated. Result::After 72 h of administration, the cumulative excretion of GK-A in urine was (12.35±2.69) μg, and the cumulative excretion rate was (0.58±0.13)%. Meanwhile, after 24 h of administration, the cumulative excretion of GK-A in bile was (55.16±29.22) μg, and the cumulative excretion rate was (1.57±0.83)%. Only a small amount of GK-A was excreted from urine and bile of rats with a slow speed. Conclusion::After intragastric administration, the excretion of GK-A in rat urine and bile is not the main elimination pathway.

Grade Evaluation of Polygoni Multiflori Caulis Based on Quality Constant Method / 中国实验方剂学杂志

Objective::To establish a scientific and reasonable grade evaluation standard for Polygoni Multiflori Caulis. Method::The quality constant method was used to conduct a grade evaluation study on Polygoni Multiflori Caulis. A total of 16 batches of samples were collected from Chinese herbal slices enterprises and medicinal materials markets. By measuring its appearance traits (average quality and average thickness of the decoction pieces) and the intrinsic quality indicators (content of 2, 3, 5, 4′-tetrahydroxystilbene-2-O-β-D-glucoside), then its quality constant and percentage quality constant were calculated comprehensively, finally, the grades of Polygoni Multiflori Caulis were classified by quality constant method. Result::The quality constant of 16 batches of the decoction pieces was 0.054-0.417, and the percentage quality constant was 12.98-100.00.If these samples were divided into three grades, the quality constant shall be ≥0.334 for the first-grade decoction pieces, the quality constant shall be <0.334 and ≥0.209 for the second-grade decoction pieces, while for the third-grade decoction pieces, the quality constant shall be <0.209. Conclusion::The grade evaluation method based on quality constant can overcome the shortcomings of traditional evaluation method for decoction pieces, and can realize scientific, objective and simple classification of Polygoni Multiflori Caulis. This study enriches the research data of modern grade evaluation of Polygoni Multiflori Caulis, and provides reference for grade evaluation and market circulation of other decoction pieces.

Overview of Famous Classical Formulas and Discussion on Its Exploitation / 中国实验方剂学杂志

The famous classical formulas （FCF）， which occupy the most important position in the prescription theory， had been brought out following the progress of traditional Chinese medicine （TCM）. Its formation and exploitation， essentially the ingredient constitution and preparation technology， is an objective trend of TCM. The development of related product under the guidance of relevant national policies has its historical inevitability， as the development of formula granules in recent decades had laid a solid foundation for it. The key to exploit these FCF is to refine and standardize the clinical applications through the ages with the guidance of TCM theory， for the process design of massive industrial production. As a result of the analysis of its definition and connotation， it is clear that the core connotation of FCF is the medicinal substances with fixed formula compatibility and stable preparation process. Furthermore， the screening strategy， the exploitation value， and the applicability between ancient prescriptions and nowadays diseases， had also been discussed based on the current policy situation and research status.