Investigation of Pretreatment Methods for Comprehensive Resource Utilization of Magnoliae Officinalis Cortex Dregs / 中国实验方剂学杂志

ObjectiveTo explore the pretreatment methods to promote the enzymatic digestion and extraction of active ingredients from Magnoliae Officinalis Cortex dregs（MOCD）， and to provide a reference basis for the utilization of resource components in MOCD. MethodLiquid chromatography-mass spectrometry（LC-MS） was used for qualitative analysis of resource components in MOCD with an Agilent C18 reversed-phase column（3.0 mm×100 mm， 2.7 µm） at the flow rate of 0.4 mL·min-1， the mobile phase was water（A）-acetonitrile（B） for gradient elution（0-3 min， 25%-48%B； 3-6 min， 48%-59%B； 6-10 min， 59%-80%B； 10-20 min， 80%-90%B； 20-25 min， 90%B）， electrospray ionization（ESI） was employed with negative ion mode scanning and scanning range of m/z 50-1 200. A high performance liquid chromatography（HPLC）， which refered to the determination in the 2020 edition of Chinese Pharmacopoeia， was used for quantitative analysis of resource components in MOCD. Four kinds of pretreatment agents were used to separate the resource components from MOCD， and the mechanism of different pretreatment agents was investigated by field emission scanning electron microscopy（FESEM）， X-ray powder diffraction（XRD） and Fourier transform infrared spectroscopy（FT-IR）. ResultMagnolol， honokiol and lignocellulose were identified as the main resource components of MOCD by qualitative and quantitative analysis. Under the conditions of 1% NaOH， reaction temperature at 80 ℃ and reaction time of 60 min， the concentration of reducing sugar produced by the enzymatic hydrolysis was 32.18 g·L-1， which was 79.8% higher than that of the untreated MOCD. After adding tween-80， the enzymatic hydrolysis time was reduced to 1/3 of the original time， the concentration of reducing sugar was increased by 102.0%. And the total recovery of magnolol and honokiol in the pretreatment solution was 69.23%. ConclusionMagnolol， honokiol and lignocellulosic components in MOCD are valuable for development and utilization， the combination of alkaline pretreatment and tween-80 can realize the recovery and utilization of these three resource components， which can provide a new idea for comprehensive utilization of resource components in MOCD.

Patient characteristics, disease burden, treatment patterns and outcomes in patients with acromegaly: Real-world evidence from the Malaysian acromegaly registry / Journal of the ASEAN Federation of Endocrine Societies

Objective@#This study aims to report the demographic features of patients with acromegaly the disease burden, and the corresponding treatment patterns and outcomes in Malaysia.@*Methodology@#This is a retrospective study that included patients from the Malaysian Acromegaly registry who were diagnosed with acromegaly from 1970 onwards. Data collected included patient demographics, clinical manifestations of acromegaly, biochemical results and imaging findings. Information regarding treatment modalities and their outcomes was also obtained.@*Results@#Registry data was collected from 2013 to 2016 and included 140 patients with acromegaly from 12 participating hospitals. Median disease duration was 5.5 years (range 1.0 – 41.0 years). Most patients had macroadenoma (67%), while 15% were diagnosed with microadenoma. Hypertension (49.3%), diabetes (37.1%) and hypopituitarism (27.9%) were the most common co-morbidities for patients with acromegaly. Majority of patients had surgical intervention as primary treatment (65.9%) while 20.7% were treated medically, mainly with dopamine agonists (18.5%). Most patients had inadequate disease control after first-line treatment regardless of treatment modality (79.4%).@*Conclusion@#This registry study provides epidemiological data on patients with acromegaly in Malaysia and serves as an initial step for further population-based studies.

Analysis of epidemiological and economic data of hemophilia A patients in Brazil / Análise de dados epidemiológicos e econômicos de pacientes com hemofilia A no Brasil

Objective: To describe the annual medical direct costs per hemophilia A (HA) patient in the Brazilian public healthcare system (SUS) and to understand and describe the patients' hospital journey, demographical characteristics, and the procedures in the. Methods: This retrospective analysis of DataSUS databases. Data from individuals with registries of HA treatment were gathered between January 1st, 2018, and June 30th, 2021. Besides the D66 ICD-10th code (HA), were also considered the occurrence of some procedures like factor VIII dosage and by-pass therapy dispensation or administration as inclusion criteria. Exclusion criteria were occurrence of factor IX dispensation and female patients were excluded, among others. A record linkage using sociodemographic characteristics was conducted to identify unique patients. Results: Were identified 2,298 individuals underwent ambulatory and 1,018 underwent hospital treatments. The results show that most patients are from the Southeast region of the country, white and middle-aged individuals. The median cost of HA treatment per patient-year was BRL 90.36 for ambulatory care and BRL 1,015.31 for hospital care procedures. The costs were significantly higher for more severe patients and for those between 12 and 18 years old (BRL 1,974.75 and BRL 1,049.09, respectively). Conclusion: The evidence demonstrated encourages the implementation of policies aiming to improve the quality of care provided to patients with HA. Providing referral centers for hemophiliac patients is primordial for the success of the treatment and can result in efficiency.

Objetivo: Descrever os custos médicos diretos anuais por paciente com hemofilia A (HA) no sistema público de saúde brasileiro (SUS) e compreender e descrever a jornada do paciente em âmbito hospitalar, as características demográficas e os procedimentos realizados no SUS. Métodos: Análise retrospectiva das bases de dados do DataSUS. Foram coletados dados de indivíduos com registro de tratamento de HA entre 1º de janeiro de 2018 e 30 de junho de 2021. Além do código D66 CID-10 (HA), foi considerada a ocorrência de procedimentos como dosagem do fator VIII e dispensação ou administração de terapia de by-pass como critérios de inclusão. Dentre os critérios de exclusão, destacam-se a dispensação do fator IX e indivíduos do sexo feminino. Um pareamento de registros usando características sociodemográficas foi realizado para identificar pacientes únicos. Resultados: Foram identificados 2.298 indivíduos em tratamento ambulatorial e 1.018 em tratamento hospitalar. Os resultados mostraram que a maioria dos pacientes são da região Sudeste do país, brancos e de meia-idade. O custo médio do tratamento da HA por paciente-ano foi de R$ 90,36 para atendimento ambulatorial e de R$ 1.015,31 para atendimento hospitalar. Os custos foram significativamente maiores para pacientes mais graves e entre 12 e 18 anos (R$ 1.974,75 e R$ 1.049,09, respectivamente). Conclusão: As evidências demonstradas incentivam a implementação de políticas que visem melhorar a qualidade da assistência prestada aos pacientes com HA. A disponibilização de centros de referência para pacientes hemofílicos é primordial para o sucesso do tratamento e pode resultar em maior eficiência.

Referral Patterns of Outpatient Palliative Care among the Head and Neck Cancer Population

Abstract Introduction Patients with head and neck cancer (HNC) experience unique physical and psychosocial challenges that impact their health and quality of life. Early implementation of palliative care has been shown to improve various health care outcomes. Objective The aim of the present study was to evaluate the patterns of referral of patients with HNC to outpatient palliative care as they relate to utilization of resources and end-of-life discussions. Methods We performed a retrospective review of 245 patients with HNC referred to outpatient palliative care services at two Louisiana tertiary care centers from June 1, 2014, to October 1, 2019. The control group consisted of those that were referred but did not follow-up. Reasons for referral were obtained, and outcome measures such as emergency department (ED) visits, hospital readmissions, and advance care planning (ACP) documentation were assessed according to predictive variables. Results There were 177 patients in the treatment group and 68 in the control group. Patients were more likely to follow up to outpatient palliative care services if referred for pain management. Hospital system, prior inpatient palliative care, and number of outpatient visits were associated with an increased likelihood for ED visits and hospital readmissions. Those in the palliative care treatment group were also more likely to have ACP discussions. Conclusion Early implementation of outpatient palliative care among patients with HNC can initiate ACP discussions. However, there are discrepancies in referral reasons to palliative care and continued existing barriers to its effective utilization.

Chronic pain patients in the Brazilian private healthcare system: a claim database study with the experts' perspective / Pacientes com dor crônica no sistema de saúde suplementar brasileiro: um estudo de banco de dados com a perspectiva dos especialistas

Objective: This study aimed to describe the demands and costs from chronic pain patients over the private Brazilian healthcare system. Methods: This was a retrospective claim database study to assess the resource utilization of pain patients in the private setting. We used a four-year follow-up period to assess inpatient, outpatient, and procedures reported. Further, we promoted a forum of discussion with five pain experts and healthcare managers to address the management of chronic pain and assistance models.Results: We identified 79,689 patients with chronic pain. The orthopedist was the main medical specialist consulted with a total number of 38,879 visits performed. The ophthalmologist, cardiologist, gynecologist, and general practitioner were also frequently consulted (rheumatologist was seldom consulted). Among non-medical specialists, the physical therapist was consulted 87,574 times by 12,342 patients (15% of the entire cohort), Among chronic pain patients, 96% performed at least one exam and 86% of the patients presented at least one ER visit during the follow-up period. In 4 years, we estimate that pain patients costed more than 3 billion reais to the private health care system. According to the experts' opinions, a fragmented healthcare system and the lack of patient centered interdisciplinary approaches contributes to a high ineffective pain management leading to a high use of resources. Conclusion: There is an urgent need to change the chronic pain care model in the Brazilian private setting. Qualification in pain management, a multidisciplinary patient centered care, integrated approaches, pain centers, and patients' education may help changing this scenario.

Objetivo: O objetivo do estudo foi descrever as demandas e custos dos pacientes com dor crônica no sistema privado de saúde brasileiro. Métodos: Neste estudo retrospectivo do banco de dados administrativo, avaliamos a utilização de recursos de pacientes com dor no ambiente privado. Em um período de quatro anos, avaliamos internações, visitas ambulatoriais e procedimentos. Adicionalmente, promovemos um fórum de discussão com cinco especialistas em dor e gerentes de saúde para abordar o manejo da dor e os modelos de assistência. Resultados: Identificamos 79.689 pacientes com dor crônica. O ortopedista foi o principal especialista médico consultado, com 38.879 visitas realizadas. O oftalmologista, o cardiologista, o ginecologista e o clínico geral também foram consultados com frequência (o reumatologista foi raramente consultado). Entre os especialistas não médicos, o fisioterapeuta foi consultado 87.574 vezes por 12.342 pacientes (15% de toda a coorte). Entre os pacientes, 96% realizaram pelo menos um exame e 86% apresentaram pelo menos uma consulta de emergência durante o período. Em 4 anos, estimamos um custo de mais de 3 bilhões de reais para o sistema privado de saúde. De acordo com as opiniões dos especialistas, um sistema de saúde fragmentado e a falta de abordagens centradas no paciente contribuem para um manejo ineficaz da dor, resultando em um alto uso de recursos. Conclusão: Há necessidade de mudar o modelo de manejo da dor crônica no sistema privado brasileiro. Qualificação dos profissionais, atendimento multidisciplinar centrado no paciente, abordagens integradas, centros de dor e educação dos pacientes podem ajudar a mudar esse cenário.

Research on collection, preservation and resource utilization of clinical isolates / 中华检验医学杂志

Strain-resource engineering is often considered as an important infrastructure of microbiology related research and industry. The western developed countries took the lead in establishing the classical microbial resource utilization method, and continuously improved the preservation system, species annotation technology and global sharing mechanism, which realized the expansion and reserve of biological resources since end of the 19th century. The rich and diversified germplasm resources, standard strains and production strains not only have important economic values, but also maintain the advantages of scientific research, bioeconomy (such as antimicrobial agents, vaccines, detection reagent development and standard development, etc.) and national security. Although there has been a lot of progress in related research in recent years, compared with developed countries, there is still a big gap in related fields in China. The investment and top-level design in this area lag far behind the western developed countries, and it is not commensurate with the current level of economic and social development in my country. Drawing lessons from the practice of WFCC and WDCM (World Data Center for Microorganisms, Global microbial data Center, affiliated to WFCC), for the purpose of collecting new clinical species/strains, this paper puts forward some suggestions on the identification, preservation and upload system of isolates.

Resource Value Discovery and Utilization of Wastes in Industrialization of Rhei Radix et Rhizoma / 中国实验方剂学杂志

The recycling of traditional Chinese medicine （TCM） wastes is an important research topic to be solved urgently in the industrialization of TCM resources. Rhei Radix et Rhizoma is a bulk Chinese herb mainly derived from Rheum palmatum，R. tanguticum，and R. officinale. At present，these three medicinal plants have been cultivated on a large scale and widely used in the fields of medicine，health care，food，cosmetics，and veterinary medicine，with an annual demand of more than 5 500 tons（1 ton=1 000 kg）. However，a large number of wastes such as non-medicinal parts and residues produced in the production and deep processing are discarded because there is no effective way of utilization，resulting in serious waste of resources and environmental pollution. The non-medicinal parts contain not only the chemical components and pharmacological effects similar to those of roots and rhizomes but also a variety of amino acids，mineral elements，and conventional nutrients. They have a long history of use，and the content of some resource components is higher than that in roots and rhizomes. In particular，their stems and leaves exhibit great potential to be consumed as food and medicine due to high safety. Besides，the content of anthraquinones in Rhei Radix et Rhizoma residue is high and it possesses good antibacterial activity. It can be seen that the waste from the industrialization of Rhei Radix et Rhizoma has high utilization value. Hence，based on the relevant literature and investigation on the application of producing areas in China and abroad，the paper summarized the utilization status of their medicinal and non-medicinal parts，the waste production in the industrialization，as well as the active substances and utilization ways and put forward the multi-level and multi-path utilization strategy of Rhei Radix et Rhizoma wastes，in order to provide reference for the rational development and application of Rhei Radix et Rhizoma resources and promote the effective utilization and green development of the corresponding wastes.

Características demográficas e utilização de recursos por pacientes com dermatite atópica no Sistema Único de Saúde (SUS) / Demographic characteristics and use of resources by patients with atopic dermatitis in the Brazilian Unified Health System (SUS)

Objetivo: O estudo tem por objetivo entender as características demográficas e a utilização de recursos para o tratamento da dermatite atópica (DA) no Sistema Único de Saúde (SUS). Métodos: Estudo observacional retrospectivo de dados disponibilizados pelo Departamento de Informática do SUS (Datasus). Os pacientes de interesse foram selecionados por meio do CID-10 L20 (DA). Os dados de interesse foram extraídos do Sistema de Informações Hospitalares (SIH) e Ambulatoriais (SIA) do SUS. Foram extraídos dados de janeiro de 2015 a junho de 2020. Resultados: Foram identificados 27.813 pacientes que realizaram algum procedimento (ambulatorial ou hospitalar) relacionado diretamente com o CID-10 L20. A maior prevalência dos pacientes encontra-se no estado de SP, com 28,6% do total. Foram identificados 116 pacientes que utilizaram alguma das terapias sistêmicas utilizadas no tratamento da DA, sendo a ciclosporina o medicamento mais utilizado (53%). Todas as dispensações estão vinculadas a CIDs de doenças diferentes da DA, porém, pelas premissas adotadas nesse estudo, assumimos que os medicamentos utilizados foram para tratamento da DA, com exceção daqueles relacionados a transplante. Foram realizados 49.245 procedimentos/atendimentos. Identificaram-se 5.006 internações, realizadas por 4.616 pacientes. Foi observado um repasse total de R$ 2.007.757,13 para atendimentos; 77% desse total representam gastos com hospitalizações. Conclusões: Entender o perfil da população afetada pela DA no Brasil e o padrão de uso de recursos pode ajudar a compreender a carga da doença para o sistema público de saúde e auxiliar no desenvolvimento de protocolos clínicos e diretrizes terapêuticas para o tratamento da doença

Objective: The study aims to understand the demographic characteristics and use of resources related to atopic dermatitis (AD) treatment in the Brazilian Unified National Health System (SUS). Methods: Retrospective observational study of data obtained from Brazilian Health Informatics Department (Datasus). Patients of interest were selected using the ICD-10 L20 (AD). The data of interest were extracted from the Hospital (SIH) and the Outpatient Information System (SIA). Data were extracted from January 2015 to June 2020. Results: We identified 27,813 patients who underwent some procedure (outpatient or hospital) directly related to ICD-10 L20. The highest prevalence of patients is in the state of SP, with 28,6% of the total. We identified 116 patients who used some of the systemic therapies used in the treatment of AD, and cyclosporine was the most used drug (53%). However, all dispensations are linked to ICDs of diseases other than AD, but due to the premises adopted in this study, we assumed that the use of the drugs were for the treatment of AD, except for those related to transplantation. 49,245 procedures/visits were performed. A total of 5,006 hospitalizations were identified by 4,616 patients. A total transfer of 2,007,757.13 BRL was observed for health care, and 77% of this total represent hospitalization expenses. Conclusions: Understanding the profile of the population affected by AD in Brazil and the pattern of resource use can help to understand the burden of the disease on the public health system and assist in the development of clinical protocols and therapeutic guidelines for the treatment of the disease

Research on Development Strategies of Traditional Chinese Medicine Enterprises Based on SWOT Analysis / 中国实验方剂学杂志

Traditional Chinese medicine (TCM), as the unique health resources, huge potential economic resources, scientific and technological resources with original advantages, excellent cultural resources and important ecological resources, has made remarkable achievements in Chinese economic and social development in recent years. However, there are still some problems in the reform and development of TCM, especially the lack of willingness to innovate and low ability in commercialization of research and development findings in such companies. Meanwhile, the globalization level of TCM is not high. All these problems have seriously restricted the overall development of TCM. Taking TCM enterprises as the research object, this paper uses SWOT analysis to carry out comprehensive strategic analysis on its advantages, disadvantages, opportunities and risks. It is concluded that TCM enterprises in China should focus on research and development of classical formula compound preparations and innovative TCM products, and then propose product development and innovation strategies.

Status and prospects of resource utilization of non-medicinal parts of medicinal Chrysanthemum morifolium / 中草药

Chrysanthemum morifolium is a traditional Chinese medicinal material in China. The yield of non-medicinal parts is much higher than the inflorescence, and the yield of stems and leaves of C. morifolium is 3.5 times of medicinal parts. For a long time, the non-medicinal parts of C. morifolium have not been fully used, resulting in great waste of resources and environmental pollution. Therefore, the in-depth research and development of non-medicinal parts of C. morifolium deserve attention. Research shows that the non-medicinal parts of C. morifolium is rich in volatile oil, flavonoids, phenolic acids, polysaccharides and other components, which have antibacterial, anti-inflammatory, antioxidant, anti-convulsion and improvement of intestinal disorders. This article summarizes the research situation of chemical components, pharmacological effects, and resource utilization status of stems, leaves, roots and other non-medicinal parts produced during the cultivation and production of medicinal C. morifolium, in order to provide the scientific basis and reference for the development, utilization and industrialization of the non-medicinal parts of medicinal C. morifolium.

Analysis on liver and renal toxicity of leaves of Tussilago farfara using zebrafish / 中草药

Objective: To compare the toxicity of the flower buds and leaves from Tussilago farfara, and provide scientific basis for the utilization of the leaves of T. farfara. Methods: The 3 dpf (day post fertilization) healthy AB and transgene zebrafish were selected. The flowers, the leaves, the flowers coupled with Aster tataricus, and the leaves coupled with A. tataricus were prepared at the concentration of 0.5, 1.0, and 1.5 mg/mL. The fluorescent area of the liver and ALT and AST levels were measured after 72 h of drug treatment. For the renal toxicity assay, the morphology of zebrafish and the nutrient solution protein were also determined. Results: Compared with the control group, there were no significant differences in liver biochemical indexes in the four drug treatment groups. However, the fluorescence area of liver decreased in the flowers and flowers coupled with A. tataricus group at the concentration of 1.5 mg/mL. No significant difference was observed in the four groups of the nephrotoxicity assay. Conclusion: The flower and the flower coupled with A. tataricus showed minor hepatotoxicity at higher doses, and the leaves showed no stronger toxicity than the flower buds in comparison with the flower buds. It can provide refercences for the resource utilization of the leaves of T. farfara.

Protective effect and mechanism of extracts and main components from stem and leaves of Salvia miltiorrhiza on HUVECS / 中草药

Objective: To investigate the protective effects of the extracts and active components from stems and leaves of Salvia miltiorrhiza on oxidative stress and high glucose-injured human umbilical endothelial cells (HUVECs). Methods: The models of oxidative stress and high glucose injury in HUVECs were established. The ethanol extract of S. miltiorrhiza stems and leaves (CJ), ethanol extract of S. miltiorrhiza roots (CG), water extract of S. miltiorrhiza stems and leaves (SJ), water extract of S. miltiorrhiza roots (SG), rosmarinic acid, salvianolic acid B, rutin, isoquercitrin, cryptotanshinone, aminoguanidine and VC were administrated to cells. MTT were used to observe the cell viability. The levels of glutathione peroxidase (GSH-Px), catalase (CAT), nitric oxide (NO), endothelin (ET-1), ICAM-1 and TNF-α were detected. Result:s Compared with the control group, H2O2 decreased the levels of GSH-Px, CAT and NO (P < 0.01) and increased the level of ET-1 (P < 0.01), glucose increased the levels of ICAM-1 and TNF-α (P < 0.01) and decreased the level of NO (P < 0.01). Compared with the model group, the levels of GSH-Px, CAT and NO in CJ, CG, SJ and SG groups were increased, and the levels of ET-1, ICAM-1 and TNF-α were decreased (P < 0.05, P < 0.01). VC, rosmarinic acid, salvianolic acid B and rutin high and medium dose groups, and isoquercitrin, cryptotanshinone high dose group significantly increased the levels of GSH-Px, CAT and NO (P < 0.05, P < 0.01) and decreased the level of ET-1 (P < 0.05, P < 0.01). ICAM-1 levels were significantly decreased in the high dose groups of salvianolic acid B, isoquercitrin and rutin as well as in the high and medium dose groups of rosmarinic acid (P < 0.01). In addition to the aminoguanidine group, the levels of TNF-α of other groups were significantly lower than the model group (P < 0.05, P < 0.01). Except the aminoguanidine group and isoquercetin low dose group, the levels of NO of other groups were significantly higher than the model group (P < 0.05, P < 0.01). Conclusion: In certain concentration range of alcohol extract and water extract of stems, leaves and roots of S. miltiorrhiza, rosmarinic acid, salvianolic acid B, rutin and isoquercitrin have protective effects on HUVECs injured by H2O2 and glucose. And the mechanisms are related to inhibition of intercellular adhesion molecule expression and regulation of NO and TNF-α production. This study will provide reference for the discovery and transformation of the resource value of non-medicinal stems and leaves produced during the production of S. miltiorrhiza.

Analysis of Zingiberaceae in E'mei Area Using ITS2 Sequences / 中国实验方剂学杂志

Objective: To evaluate the use of ITS2 sequences as DNA barcode to identify the Zingiberaceae medicinal plants from E'mei area. Method: The genomic DNAs were extracted from 43 Zingiberaceae medicinal plant samples from Sichuan E'mei area. The ITS2 sequences of these samples were amplified and bidirectionally sequenced by PCR. 40 ITS2 sequences were downloaded from the GenBank,and then the interspecific and intraspecific genetic distances were calculated and analyzed by using MEGA 6.0 to construct Neighbor-joining (NJ) tree; TAXON DNA software was also used to analyze intraspecific and interspecific variations and barcoding gaps. The differences in secondary structure of the ITS2 sequences were predicted and compared. Result: The minimum interspecific distance in Zingiberaceae samples was greater than the maximum intra specific distance,with obvious barcoding gap. The NJ tree showed that the samples were clustered into five different branches,Alpinia,Curcuma,Globba,Hedychium,and Zingiber respectively,and further cluster into sub-branches. Significant differences were also present in the secondary structures of ITS2 between different samples. Conclusion: ITS2 sequences as DNA barcode can be used to conduct accurate and rapid identification of the Zingiberaceae plants and clearly figure out the phylogenetic relationship among them,providing guidance for the study of the distribution of medicinal plants of this genus,as well as theoretical basis for the quality control,medication safety and rational development of Zingiberaceae medicinal plants in E'mei area.

Examining the Impact of Refractory Myasthenia Gravis on Healthcare Resource Utilization in the United States: Analysis of a Myasthenia Gravis Foundation of America Patient Registry Sample

BACKGROUND AND PURPOSE: Patients with refractory myasthenia gravis (MG) experience ongoing disease burden that might be reflected in their healthcare utilization. Here we examine the impact of refractory MG on healthcare utilization. METHODS: The 825 included participants were aged 18–64 years, enrolled in the Myasthenia Gravis Foundation of America Patient Registry between July 2013 and February 2018, and had been diagnosed with MG ≥2 years previously. RESULTS: Participants comprised 76 (9.2%) with refractory MG and 749 (90.8%) with nonrefractory MG. During the 6 months before enrollment, participants with refractory MG were significantly more likely than those with nonrefractory MG to have experienced at least one exacerbation [67.1% vs. 52.0%, respectively, p=0.01; odds ratio (OR)=1.882, 95% confidence interval (CI)=1.141–3.104], visited an emergency room at least once [43.4% vs. 27.1%, p<0.01; OR=2.065, 95% CI=1.276–3.343], been hospitalized overnight at least once (32.9% vs. 20.5%, p=0.01; OR=1.900, 95% CI=1.140–3.165), ever been admitted to an intensive care unit (ICU) (61.8% vs. 33.4%, p<0.01; OR=3.233, 95% CI=1.985–5.266), or ever required a feeding tube (21.1% vs. 9.1%, p<0.01; OR=2.671, 95% CI=1.457–4.896). A total of 75.8% younger females with refractory disease (<51 years, n=33) experienced at least one exacerbation, 69.7% had been admitted to an ICU, and 30.3% had required a feeding tube. For older females with refractory disease (≥51 years, n=33), 60.6%, 54.6%, and 6.1% experienced these outcomes, respectively (between-group differences were not significant). CONCLUSIONS: Refractory MG is associated with higher disease burden and healthcare utilization than nonrefractory MG.

Metabolomics analysis and quantitative determination of five components in Malus leaves / 中草药

Objective The aim of this experiment is to compare the chemical composition of Malus leaves from different origins, which can be as a fundamental research for the comprehensive utilization and resource development. Methods A UPLC-DAD method has been developed for the determination of five compounds (phlorizin, trilobatin, phloretin, rutin, and quercitrin) in Malus leaves, and UPLC-QTOF-MS based metabonomics was applied to the comparison among different groups from different origins and species. Results There were significant difference in the content of five compounds, of which phlorizin was widely contained and its content was relatively high in the range of 1.01% -17.15%. Phloretin, rutin, and quercutrin were also widespread, while the trilobatin was only in Ser. Baccatae (Rehd.) Rehd and Sect. Sorbomalus Zabel, which was not detected in the cultivating-varieties. The results of metobonomics showed that the chemical composition in leaves of Malus between Ser. Pumilae (Rehd). Rehd and Ser. baccatae (Rehd). Rehd were clearly distinguished, and 26 discrimination markers as the basis for distinction were identified; The chemical composition of Malus leaves from different sources of origins were different while the wild species were similar to the cultivating- varieties. Conclusion The Malus leaves generally contain phlorizin and other polyphenols, which are the potential drugs and health products resources; There is certain difference in chemical composition and content of Malus leaves, which provide the scientific basis for the next utilization; Malus leaves are so rich and renewable that are worthy of further research and development.

ITS2 sequence analysis and identification of medicinal Artemisia plants / 中国中药杂志

Artemisia hedinii occupies an important position in the Tibetan medicine. Plants in Artemisia vary a lot and are widely distributed in the Qinghai-Tibet Plateau, many plants in Artemisia look similar, making traditional identification methods laborious. In this article, ITS2 sequences were used as DNA barcoding to identify four kinds of confusable Tibetan medicine plants in Artemisia, aiming to establish a rapid and accurate identification methods. Twenty-one samples in Artemisia were collected from the Qinghai-Tibet Plateau, ITS2 sequence PCR amplification and sequencing were conducted after the extraction of DNA. Another 11 sequence downloaded from Genbank were added to the analysis. Genetic distance calculation and analysis, building Neighbor Joining (NJ) phylogenetic tree were conducted by MEGA 6.0, also comparison of secondary structures of ITS2 sequences among samples. A. hedinii, A. annua, A. dubia and A. argyi shared close genetic distance, but the maximum distance between the four species was much greater than the minimum distance within each species, NJ tree showed that the four species went to four separate branches, differences among secondary structures of ITS2 sequences also made it clear to identify these medical plants. It could be an accurate and rapid method for identification and recognition, as well as the evolutionary relationships between the species by using ITS2 sequence as DNA barcode for plants of Tibetan Artemisia. The study provides theoretical basis for quality control, medication safety and rational exploitation.

Separation of polysaccharides from industrialization waste in Mailuoning Injection by ultrafiltration membrane technology and screening for active indicators / 中草药

Objective: In this study, ultrafiltration membrane process is employed first to separate the polysaccharides from industrialization waste in Mailuoning Injection and to promote the resources utilization of the waste. Methods: The waste ethanol sediments in the production of Mailuoning Injection mainly include dendrobium polysaccharides, Achyranthes bidentata polysaccharides (ABPS), and honeysuckle polysaccharides, and the active components of polysaccharide with high content were selected through the immune activity. Six different relative molecular weight cut-off membranes ( 3 × 105) made of polyether sulfone (PES) were used. Six fractions were obtained and named as MFP1, MFP2, MFP3, MFP4, MFP5, and MFP6. Meanwhile, polysaccharides and protein content were determined by phenol-sulfuric acid colorimetry and Coomassie brilliant blue G-250 staining method; Polysaccharides species was analyzed by ELSD-HPLC; Immunocompetence of different fractions were investigated in vitro, including mouse spleen lymphocytes proliferation, transformation, and production of nitric oxide after acting on the macrophage RAW264.7. Results: The results showed MFP4 (3 × 104-1 × 105) have the highest content and immunocompetent, MFP5 (1 × 105-3 × 105) immunocompetent followed, compared to others, purity, and recovery of MFP4 are 76.80% and 10.81%, purity and recovery of MFP5 are 73.23% and 14.73%, respectively. Conclusion: The findings reveal MFP4 and MFP5 serves as our object of exploitation in the future; Moreover, separation of polysaccharides from "Mailuoning Injection" by the membrane is feasible with high recovery and low cost in the realization of circular economy.

A study on the influencing factors of stroke patients′continuous rehabilitation care in the community / 中国实用护理杂志

Objective To investigate the status of stroke patients′continuous rehabilitation care and it′s influencing factors in the community. Methods Questionnaires were used to investigate 174 stroke patients from 6 communities of Zhengzhou. Results The implementation of continuous care was not satisfactory. Occupation, medical payment method and medical resource utilization were important predicting factors. Conclusions In order to promote continuous rehabilitation care, the health resources should be fully used, the payment methods of the patients should be improved, and the occupational characteristics should be considered.

Resource components analysis on Salvia miltiorrhiza residues in production process of Danhong Injection and its transformation mechanism / 中草药

Objective: To analyze the resource components (tanshinones and salvianolic acids) in Salvia miltiorrhiza residues in production process of Danhong Injection, explore the constituents transformation mechanism, and discover the resource utilization pathway for S. miltiorrhiza residues. Methods: The chemical constituents in S. miltiorrhiza and S. miltiorrhiza residues were extracted by methanol ultrasonic method. The HPLC-PDA analysis was carried out on a BDS HYPERSIL C18 (250 mm×4.6 mm, 5 μm) column with acetonitrile-0.1% formic acid solution as mobile phase for gradient elution. The flow rate was 1.0 mL/min, the column temperature was maintained at 30℃. Then the residues resource utilization was further explored based on the research results and previous work. Results: The tanshinone components were virtually unused and remained in the residues during the production process of Danhong Injection. The contents of salvianolic acid A and protocatechuic aldehyde in the residues are higher than those in the salvia herbs. Conclusion: The tanshinones in S. miltiorrhiza residues are worthy of further development and utilization during the Danhong Injection production process. It provides a main basis for the resource utilization and development of S. miltiorrhiza residues.

Investigation and analysis on the present situation of the library resources and services in medical college taking Chongqing Medical University as an example / 中华医学教育探索杂志

Objective To understand the support effect of the resources and services provided by the library on the scientific research of medical postgraduates. Methods Taking 150 graduate stu-dents in Chongqing Medical University as the research object, through questionnaire survey and inter-view method, the characteristics of medical graduate students' selection of document resources, as well as their application of the resources and services provided by the library were investigated. Results 65% (98/150) of students chose Chinese literature as the preferred source of information, 6% (9/150) of graduate students did not borrow books at the library, 54% (81/150) of graduate students chose library website as the data retrieval entrance at the time of obtaining the preferred document, 9% (14/150) of students did not participate in the library reader training. Conclusion Library resources are still the first choice for the graduate students to obtain the literature, and the library should be improved in the aspects of resource allocation, service mode, in order to meet the needs of graduate students' scientific research.