Multitasking in postanesthesia care unit following nurse interruptions, an analysis of the causes and consequences using classification tree: an observational prospective study

Abstract Background: Postanesthesia Care Unit (PACU) is an environment associated with an important workload which is susceptible to lead to task interruption (TI), leading to task-switching or concurrent multitasking. The objective of the study was to determine the predictors of the reaction of the nurses facing TI and assess those who lead to an alteration of the initial task. Methods: We conducted a prospective observational study into the PACU of a university hospital during February 2017. Among 18 nurses, a selected one was observed each day, documenting for each TI the reaction of the nurse (task switching or concurrent multitasking), and the characteristics associated with the TI. We performed classification tree analyses using C5.0 algorithm in order to select the main predictors of the type of multitasking performed and the alteration of the initial task. Results: We observed 1119 TI during 132 hours (8.5 TI/hour). The main reaction was concurrent multitasking (805 TI, 72%). The short duration of the task interruption (one minute or less) was the most important predictor leading to concurrent multitasking. Other predictors of response to TI were the identity of the task interrupter and the number of nurses present. Regarding the consequences of the task switching, long interruption (more than five minutes) was the most important predictor of the alteration of the initial task. Conclusions: By analysing the predictors of the type of multitasking in front of TI, we propose a novel approach to understanding TI, offering new perspective for prevention strategies.

Three-dimensional finite element analysis of cement flow in abutment margin-crown platform switching / 北京大学学报(医学版)

OBJECTIVE@#To analyze the cement flow in the abutment margin-crown platform switching structure by using the three-dimensional finite element analysis, in order to prove that whether the abutment margin-crown platform switching structure can reduce the inflow depth of cement in the implantation adhesive retention.@*METHODS@#By using ANSYS 19.0 software, two models were created, including the one with regular margin and crown (Model one, the traditional group), and the other one with abutment margin-crown platform switching structure (Model two, the platform switching group). Both abutments of the two models were wrapped by gingiva, and the depth of the abutment margins was 1.5 mm submucosal. Two-way fluid structure coupling calculations were produced in two models by using ANSYS 19.0 software. In the two models, the same amount of cement were put between the inner side of the crowns and the abutments. The process of cementing the crown to the abutment was simulated when the crown was 0.6 mm above the abutment. The crown was falling at a constant speed in the whole process spending 0.1 s. Then we observed the cement flow outside the crowns at the time of 0.025 s, 0.05 s, 0.075 s, 0.1 s, and measured the depth of cement over the margins at the time of 0.1 s.@*RESULTS@#At the time of 0 s, 0.025 s, 0.05 s, the cements in the two models were all above the abutment margins. At the time of 0.075 s, in Model one, the gingiva was squeezed by the cement and became deformed, and then a gap was formed between the gingiva and the abutment into which the cement started to flow. In Model two, because of the narrow neck of the crown, the cement flowed out from the gingival as it was pressed by the upward counterforce from the gingival and the abutment margin. At the time of 0.1 s, in Model one, the cement continued to flow deep inside with the gravity force and pressure, and the depth of the cement over the margin was 1 mm. In Model two, the cement continued to flow out from the gingival at the time of 0.075 s, and the depth of the cement over the margin was 0 mm.@*CONCLUSION@#When the abutment was wrapped by the gingiva, the inflow depth of cement in the implantation adhesive retention can be reduced in the abutment margin-crown platform switching structure.

Peri-implant bone level assessment of early loaded dental implants submitted to different prosthetic protocols: a case report / Avaliação do nível ósseo peri-implantar de implantes dentários com carregamento antecipado submetidos a protocolos protéticos diferentes: relato de caso

Aim: The present split-mouth case report aims to describe the clinical and radiographic long-term outcomes of the implant rehabilitation of two mandibular premolars in which the digital workflow was used to apply different prosthetic protocols. Case description: A female 42-year-old patient with the absence of both mandibular second premolars was submitted to guided surgery for the placement of platform-switching Grand Morse connection implants. Digital workflow was used for implant and prosthetic planning, applying early loading protocol 21 days after surgery. The implant on the right side received the final abutment at the time of surgery (without loading), whereas the implant on the left side had a healing abutment placed, which was replaced by a temporary abutment and then by a final abutment. Two months after surgery, both implants had final ceramic restorations delivered. The patient was followed clinically and radiographically for 30 months, presenting excellent hard and soft tissue outcomes, with bone level changes lower than 2mm for both implants. Conclusion: The use of digital workflow and early loading, made the present implant-supported rehabilitation predictable, safe and time-efficient, resulting in total patient satisfaction. Peri-implant bone level was observed to be stable after early loading protocol for both platform-switching connection implants inserted, despite the prosthetic protocol applied.(AU)

Objetivo: O presente relato de caso de boca dividida tem como objetivo descrever os resultados clínicos e radiográficos a longo prazo da reabilitação com implante de dois pré-molares inferiores em que o fluxo de trabalho digital foi usado para aplicar os conceitos de "one abutment-one time" em uma das reabilitações e troca de componente no outro. Descrição do caso: Paciente do sexo feminino, 42 anos, com ausência de ambos os segundos pré-molares inferiores, foi submetida à cirurgia guiada para colocação de implantes de conexão Grand Morse plataforma-switching. Foi utilizado fluxo de trabalho digital para planejamento de implante e prótese, aplicando protocolo de carga antecipada 21 dias após a cirurgia. O implante do lado direito recebeu o componente protético definitivo no momento da cirurgia (sem carga), enquanto o implante do lado esquerdo recebeu um cicatrizador, que foi substituído por um pilar provisório e depois por um componente definitivo. Dois meses após a cirurgia, ambos os implantes tiveram restaurações cerâmicas finais entregues. A paciente foi acompanhada clínica e radiograficamente por 30 meses, apresentando excelentes resultados de tecidos duros emoles, com alterações do nível ósseo inferiores a 2mm para ambos os implantes. Conclusão: O fluxo de trabalho digital e carregamento precoce, tornou a presente reabilitação implantossuportada previsível, segura e eficiente em termos de tempo, resultando em total satisfação do paciente. O nível ósseo peri-implantar foi observado como estável após o protocolo de carregamento inicial para ambos os implantes de conexão plataforma-switching inseridos, independente do protocolo protético aplicado. (AU)

Terpine-4-ol on inhibiting vascular smooth muscle cell calcification by improving mitochondrial dynamics / 药学学报

The aim of this study was to investigate the role and mechanism of terpinen-4-ol (T4O) on high glucose (HG) -induced calcification in vascular smooth muscle cell (VSMC). To investigate the role of T4O on HG-induced calcium deposition, osteogenic phenotypic transformation and mitochondrial dynamics in VSMC, Mdivi-1, a mitochondrial dynamin-related protein 1 (Drp-1) inhibitor, was used to analyze the correlation between mitochondrial dynamics and VSMC calcification and the role of T4O. Alizarin red S staining was used to observe calcium salt deposition and flow cytometry to detect intracellular Ca2+ content; Western blot and immunofluorescence were used to detect the expression of phenotypic switching-related markers α-smooth muscle actin (α-SMA), bone morphogenetic protein 2 (BMP2) and Runt related transcription factor 2 (Runx2), and mitochondrial dynamics-related markers mitofusin 1 (MFN1), mitofusin 2 (MFN2) and Drp-1. The results showed that low and high doses of T4O could inhibit HG-induced down-regulation of α-SMA, MFN1 and MFN2 expression levels, and up-regulation of BMP2, Runx2 and Drp-1 expression levels, reduce intracellular Ca2+ content and calcium salt deposition, and effectively inhibit HG-induced VSMC calcification and mitochondrial dynamics disorders. The T4O group, Mdivi-1 group and T4O+Mdivi-1 group were able to up-regulate the expression levels of HG-induced α-SMA, MFN1 and MFN2, down-regulate the protein expression levels of BMP2, Runx2 and Drp-1, and inhibit calcium salt deposition, and there was no significant difference between the above indexes in the T4O and T4O+Mdivi-1 groups. The above findings suggest that T4O can inhibit the expression level of Drp-1, regulate the disturbance of mitochondrial dynamics, and suppress HG-induced VSMC calcification.

Code-Switching Between Arabic and English in Selected Discourses

Code-switching is a linguistic phenomenon that has been studied on both written and spoken discourses in the recent years. This study is an attempt to analyze code-switching in selected discourses. The data were collected from Arabic Interviews on YouTube. The first interview 'Studying in the best university ever' is a broadcast by Abdullah Al-Alawy. The second interview 'Karak session' is with the broadcaster Mohammed Al-Hinai. The methodology of this study was a mixed (quantitative as well as qualitative) method. The research tries to answer three questions: 1.How many code- switching Instincts from Arabic language to English language occurred in the selected discourses? 2. Is there any translation for the code-switching? If yes, then where the translation takes its place whether before or after the code- switching? 3. How many intra-word switching occur by using Arabic grammatical morphemes within these English code-switching? The research's primary goal is to improve our understanding of the instinctive uses of code-switching from Arabic to English. In this study I found that there are 101 occurrences of code-switching within about forty minutes of Arabic discourses. The most frequent type of code-switching in these two discourses was intra-sentential code-witching. While the least used one was inter-sentential code-switching. Most of the code-switching Instincts occurred without any translation to Arabic

Efficacy and safety of switching from brand-name to domestic generic levetiracetam in children with epilepsy / 中国当代儿科杂志

OBJECTIVES@#To study the efficacy and safety of domestic generic levetiracetam in replacement of brand-name levetiracetam in the treatment of children with epilepsy.@*METHODS@#A retrospective analysis was performed on the medical data of 154 children with epilepsy who received domestic generic levetiracetam in the inpatient or outpatient service of Guangdong Provincial People's Hospital from May 2019 to December 2020. Domestic generic levetiracetam and brand-name levetiracetam were compared in terms of efficacy and safety.@*RESULTS@#For these 154 children, the epilepsy control rate was 77.3% (119/154) at baseline. At 6 months after switching to domestic generic levetiracetam, the epilepsy control rate reached 83.8% (129/154), which showed a significant increase (P<0.05). There was no significant change in the frequency of seizures from baseline to 6 months after switching (P>0.05). The incidence of refractory epilepsy in children with no response after switching treatment was significantly higher than that in children with response (P<0.05). Before switching, only 1 child (0.6%) experienced somnolence, while after switching, 3 children (1.9%) experienced mild adverse drug reactions, including dizziness, somnolence, irritability, and bad temper.@*CONCLUSIONS@#Switching from brand-name to generic levetiracetam is safe and effective and holds promise for clinical application, but more prospective randomized controlled trials are required in future.

Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer / 亚洲男科学杂志(英文版)

Corticosteroid switching can reverse abiraterone resistance in some patients with metastatic castration-resistant prostate cancer (mCRPC). Here, we investigated the potential biomarkers for predicting the efficacy of corticosteroid switching during treatment with abiraterone acetate (AA). We retrospectively analyzed 101 mCRPC patients receiving corticosteroid switching from West China Hospital and Sun Yat-Sen University Cancer Center between January 2016 and December 2018. All cases received AA plus prednisone as first-line therapy during mCRPC. Primary end points were biochemical progression-free survival (bPFS) and overall survival (OS). The risk groups were defined based on multivariate analysis. A total of 42 (41.6%) and 25 (24.8%) patients achieved 30% and 50% decline in prostate-specific antigen (PSA), respectively, after corticosteroid switching. The median bPFS and median OS on AA plus dexamethasone were 4.9 (95% confidence interval [CI]: 3.7-6.0) months and 18.8 (95% CI: 16.2-30.2) months, respectively. Aldo-keto reductase family 1 member C3 (AKR1C3) expression (hazard ratio [HR]: 2.15, 95% Cl: 1.22-3.80, P = 0.008) and baseline serum alkaline phosphatase (ALP; HR: 4.95, 95% Cl: 2.40-10.19, P < 0.001) were independent predictors of efficacy before corticosteroid switching in the multivariate analysis of bPFS. Only baseline serum ALP >160 IU l-1 (HR: 3.41, 95% Cl: 1.57-7.38, P = 0.002) together with PSA level at switch ≥50 ng ml-1 (HR: 2.59, 95% Cl: 1.22-5.47, P = 0.013) independently predicted poorer OS. Based on the predictive factors in multivariate analysis, we developed two risk stratification tools to select candidates for corticosteroid switching. Detection of serum ALP level, PSA level, and tissue AKR1C3 expression in mCRPC patients could help make clinical decisions for corticosteroid switching.

Simultaneous Determination of 5 Components in the Classical Formula Huaihua San by HPLC Wavelength Switching Method / 中国药房

OBJECTIVE：To develop a method for simultaneous determination of 5 components in classical formula Huaihua san，including rutin ，naringin，neohesperidin，quercetin and pulegone. METHODS ：HPLC wavelength switching method was adopted. The determination was performed on Cosmosil C 18 column with mobile phase consisted of acetonitrile- 0.05％ phosphoric acid solution （gradient elution ）at the flow rate of 1.0 mL/min. The detection wavelengths were set at 257 nm for rutin ，283 nm for naringin and neohesperidin ，254 nm for quercetin ，252 nm for pulegone ，respectively. The column temperature was set at 30 ℃， and sample size was 10 μL. RESULTS：The linear range was 21.7-2 170 μg/mL for rutin，46-4 600 μg/mL for naringin，22.3- 2 230 μg/mL for neohesperidin，0.96-96 μg/mL for quercetin，2.7-270 μg/mL for pulegone（all r＞0.999），respectively. RSDs of precision，stability（24 h）and reproducibility tests were all lower than 2％（n＝6）. Average recoveries were 100.70％，99.31％， 101.10％，100.03％ and 99.63％（all RSD ＜2％，n＝9）. Among 3 batches of Huaihua san samples ，the contents of above 5 components were 20.055-22.615，25.557-27.806，11.428-13.250，0.350-0.478，2.372-4.011 mg/g，respectively. CONCLUSIONS ： Established method is simple ，accurate and reproducible ，and could be used for the simultaneous determination of 5 components in Huaihua san.

A Retrospective Survey of 28 Cases with Opioid Switching by Adding Methadone to the Preceding Opioid

The guide to proper use of methadone in Japan describes the SAG method (a method of stopping all leading opioids and starting methadone). Based on strict evaluation, our palliative care department introduces methadone by adding to the preceding opioid, and then tapering or discontinuation the preceding opioid. This time, we considered the clinical significance of 28 patients who received this method. In 20 of 28 cases (71.4%), methadone reached the maximum dose, and methadone titration could be safely performed without exacerbation of pain or serious adverse events. However, in order for this method to be performed safely, it is necessary to pay attention to the pharmacological properties of methadone, which has a long half-life, and to make a detailed evaluation and drug adjustment of the analgesic effect and adverse events after the introduction of methadone.

Simultaneous Determination of 12 Components in the Classical Formula Sanhua Tang by HPLC-multi-wavelength Switching Technology / 中国药房

OBJECTIVE：To establish a method for simultaneous determination of 12 components including naringin ， hesperidin，neohesperidin，aloe emodin ，rhein，notopterol，emodin，honokiol，isoimperatorin，magnolol，chrysophanol and physcion in classical formula Sanhua tang. METHODS ： HPLC-multi-wavelength switching technology was adopted. The determination was performed on COSMOSIL C 18 with mobile phase consisted of acetonitrile- 0.1％ phosphoric acid （gradient elution）at the flow rate of 1.0 mL/min. The detection wavelength was 280 nm（naringin，hesperidin，neohesperidin），254 nm （aloe emodin ，rhein，chrysophanol，emodin methyl ether ），310 nm（notopterol，emodin，honokiol，isoimperatorin，magnolol）. The column temperature was set at 30 ℃，and the sample size was 10 μL. RESULTS：A total of 12 components were well separated without negative interference. The linear range of naringin ，hesperidin，neohesperidin，aloe emodin ，rhein，notopterol， emodin，honokiol，isoimperatorin，magnolol，chrysophanol and physcion were 55.4-5 540，3.8-380，45.6-4 560，1.2-120， 2.1-210，2.2-220，2-200，2.4-240，0.8-80，1.2-120，1.7-170，1.1-110 μg/mL（R 2≥0.999 6），respectively. The detection limits were 0.064，0.024，0.053，0.018，0.020，0.041，0.050，0.091，0.030，0.180，0.028 and 0.083 μg/mL，respectively. The limits of quantitation were 0.213，0.075，0.174，0.060，0.063，0.138， 0.166，0.323，0.130，0.600，0.094 and 0.275 μ g/mL，respec- 9721004） tively. RSDs of precision ，stability （24 h） and repeatability 2633531778@qq.com tests were all lower than 2％（n＝6）. Average recoveries were 99.54％，99.69％，100.01％，99.93％，100.36％，99.65％， 100.03％，100.47％，99.97％，100.68％，99.90％，100.17％ （all RSDs were lower than 2％，n＝6），respectively. CONCLUSIONS ：Established HPLC-multi- wavelength switching technology is simple ，specific and stable ，which could be used for the simultaneous determination of 12 components in Sanhua tang as naringin，hesperidin，neohesperidin.

Research on polymer impurities in cefazolin sodium raw materials and products / 药学学报

Research on polymer impurities has always been important in the quality control of cephalosporins. Research on polymers in cephalosporins that lack active amino groups on the C-7 side chain has not been reported. Therefore, our study used cefazolin sodium, which is widely used in the clinic, as an example. The polymer in cefazolin sodium and its product "cefazolin sodium pentahydrate for injection" was analyzed by column switching liquid chromatography-high resolution mass spectrometry. Two polymer impurity peaks were detected and the possible structures of these polymers were suggested. Through two-dimensional liquid chromatography, the chromatographic peaks following Sephadex gel chromatography and high-performance gel chromatography were compared to those obtained by reverse high-performance liquid chromatography (HPLC) for cefazolin sodium as reported in the Chinese Pharmacopoeia. The HPLC method proves more suitable for polymer detection than Sephadex gel chromatography and high-performance gel chromatography. The method of polymer detection for cefazolin sodium was established using the method of related substances HPLC as described in the Chinese Pharmacopoeia.

Quorum sensing-induced phenotypic switching as a regulatory nutritional stress response in a competitive two-species biofilm: An individual-based cellular automata model

Competition for nutrients in a polymicrobial biofilm may lead to susceptible species being subjected to nutritionalstress. The influence of bacterial growth rates and interspecies interactions on their susceptibility and response tonutritional stress is not well understood. Pseudomonas aeruginosa and Staphylococcus aureus are two prevalentcausative pathogens that coexist in biofilm-associated infections. Despite being the slower-growing species, P.aeruginosa dominates in a two-species biofilm by inducing phenotypic switching of S. aureusto a metabolicallychallenged small colony variant (SCV) via the release of 2-heptyl-4-hydroxyquinoline N-oxide (HQNO). Wehypothesize that P. aeruginosa experiences nutritional stress in competition with S. aureus, and that the release ofHQNO is an adaptive response to nutritional stress. We present an individual-based two-species biofilm model inwhich interactions between entities induce emergent properties. As the biofilm matured, the difference in growthrates of the two species caused a non-uniform distribution of nutrients leading to nutritional stress for P. aeruginosa and a concurrent increase in the proportion of S. aureus subpopulation. The latter resulted in increasedrelease of autoinducer, and subsequently the upregulation of P. aeruginosa cells via quorum sensing. UpregulatedP. aeruginosa cells released HQNO at enhanced rates, thereby inducing phenotypic switching of S. aureus toSCVs which consume nutrient at a reduced rate. This shifted the nutrient distribution back in favor of P.aeruginosa, thereby relieving nutritional stress. Increase in nutritional stress potentiated the transformation of S.aureus into SCVs. HQNO production decreased once nutritional stress was relieved, indicating that phenotypicswitching acts as a regulatory stress-adaptive response.

RP-HPLC-DAD determination of free amino acids in cocoa samples during fermentation and roasting / Determinación de aminoácidos libres en muestras de cacao durante la fermentación y el tostado por cromatografía líquida con detección DAD / Determinação de aminoácidos livres em amostras de cacau durante a fermentação e torrefação por cromatografia líquida com detecção DAD

Abstract Amino acids (AA) composition in cocoa beans can predict the synthesis of compounds which affect cocoa flavor. Thus, their determination is of great interest for the community implied in the commercialization and production of cocoa. In consequence, in this work, the analysis of AA produced during cocoa beans fermentation and roasting was carried out. A high-performance liquid chromatographic method with DAD detection at 254 nm was optimized and validated for their selective determination in six varieties of cocoa beans with different genotypes, all of them grown in Venezuela. AA were extracted by defatted milled cocoa powder ultrasonication using purified water at 70 °C. Then, they were derivatized with phenyl isothiocyanate, and their derivatives were separated, using a reversed-phase column with gradient elution, achieving a satisfactory resolution among the peaks (greater than 1.0) in less than 29 min. 110 cocoa samples were analyzed. Results showed a significant content of free AA, ranging from 3.87 to 5.97 g/kg in absence of fermentation with a predominance of acidic AA. Moreover, there is a progressive increase in the AA content while fermentation process occurs, with a predominance of hydrophobic AA such as alanine, valine, isoleucine, leucine, phenylalanine, and tyrosine. On the other hand, all cocoa types showed a partial degradation of free AA during the roasting step, especially the hydrophobic ones.

Resumen La determinación de aminoácidos (AA) en granos de cacao es de gran interés ya que estos son considerados como unos de los precursores de su sabor y aroma. Por esta razón, el presente trabajo tuvo como objetivo optimizar y validar un método por cromatografía líquida con detección DAD a 254 nm para la determinación selectiva de AA durante la fermentación y tostado en seis variedades de granos de cacao con diferentes genotipos, todos estos cultivados en Venezuela. Los AA se extrajeron del polvo de cacao molido y desgrasado con agua pura a 70 ºC, utilizando la técnica de ultrasonido. Luego, se derivatizaron con fenilotiocianato para separar sus derivados con buena resolución en menos de 29 min en una columna de fase reversa, utilizando gradiente de elución. Se analizaron 110 muestras de cacao. Los resultados mostraron un contenido significativo de AA libres, entre 3,87 y 5,97 g/kg, en ausencia de fermentación con predominio de AA ácidos, y un aumento progresivo en el contenido de AA, mientras ocurre el proceso de fermentación, con un predominio de AA hidrófobos como alanina, valina, isoleucina, leucina, fenilalanina y tirosina. Además, todos los tipos de cacao mostraron una degradación parcial de AA libres durante la etapa de tostado, especialmente los AA hidrófobos.

Resumo A determinação dos aminoácidos (AA) nos grãos de cacau é importante, pois são considerados um dos precursores de seu sabor e aroma. Neste trabalho, um método foi otimizado e validado por cromatografia líquida com detecção DAD a 254 nm para a determinação seletiva de AA durante a fermentação e torrefação em seis variedades de grãos de cacau com diferentes genótipos, todos cultivados na Venezuela. Os AAs foram extraídos do pó de cacau moído e desengordurados com água pura a 70 ºC usando a técnica de ultrassom. Em seguida, foram derivatizados com feniltiocianato, e os derivados foram separados com boa resolução em menos de 29 minutos em uma coluna de fase invertida usando eluição em gradiente. Foram analisadas 110 amostras de cacau. Os resultados mostraram um conteúdo significativo de AA livre entre 3,87 e 5,97 g/kg na ausência de fermentação com predominância de AA ácidos e um aumento progressivo no conteúdo de AA enquanto o processo de fermentação ocorre com predominância de AA hidrófobos como alanina, valina, isoleucina, leucina, fenilalanina e tirosina. Além disso, todos os tipos de cacau apresentaram uma degradação parcial do AA livre durante a fase de torrefação, principalmente o AA hidrofóbico.

A troca de psicoterapeuta e o impacto na condição global de pacientes em ambulatórios de residência em psiquiatria / The change of psychotherapist and the impact on the overall condition of patients in outpatient clinics in psychiatry

O processo de troca de psicoterapeuta durante o tratamento em psicoterapia de orientação analítica, em geral, caracteriza-se por ser prejudicial e até mesmo traumático em boa parte dos casos. Porém, trata-se da realidade assistencial em hospitais universitários, em virtude da necessidade de rodízio de atendimentos pelos médicos residentes em formação psiquiátrica durante seu treinamento em psicoterapia e de psiquiatras realizando especialização em psicoterapia. Este trabalho visa revisar este tema pouco abordado na literatura através da proposição de possíveis cenários de como a troca de terapeuta pode ser encarada pelo paciente, ilustrando com algumas vinhetas clínicas. Concluímos que o tema precisa ser expandido para avaliar o melhor encaminhamento para esse contexto clínico, institucional e socioeconômico, visto não haver consenso teórico e técnico que norteiem a abordagem mais adequada e menos traumática para o paciente.(AU)

The process of changing psychotherapist during treatment in analytically oriented psychotherapy is often harmful and even traumatic in most cases. However, this is the reality of care in university hospitals, due to the need for rotation of care by medical residents in training during their qualification in psychotherapy and psychiatrists performing specialization in psychotherapy. This paper aims to review this little addressed theme in the literature by proposing possible scenarios of how the therapist change can be viewed by the patient, illustrating with some clinical vignettes. We conclude that the theme needs to be expanded to evaluate the best referral to this clinical, institutional and socioeconomic context, since there is no theoretical and technical consensus that guides the most appropriate and least traumatic approach for the patient.(AU)

El proceso de cambio de terapeuta durante el tratamiento en psicoterapia de orientación analítica, en general, se caracteriza por ser perjudicial e, incluso, traumático en gran parte de los casos. Sin embargo, se trata de la realidad asistencial en hospitales universitarios, en virtud de la necesidad de rotación en la atención por parte de los residentes en formación en psicoterapia y psiquiatras que realizan especialización en psicoterapia. Este trabajo busca revisar este tema poco analizado en la literatura a través de la proposición de posibles escenarios de cómo el cambio de terapeuta puede ser tomado por el paciente, ilustrando algunos casos clínicos. Concluimos que el asunto necesita ser ampliado para evaluar cuál sería el mejor camino para este contexto clínico, institucional y socioeconómico, una vez que no hay consenso teórico y técnico que orienten hacia un abordaje más adecuado y menos traumático para el paciente.(AU)

Rapid Characterization of Impurity Profiles in Vancomycin Raw Material by Column-Switching LC/MSn / 中国药学杂志

OBJECTIVE: To characterize the impurity structures in vancomycin raw material. METHODS: Impurities were eluted gradiently on a Chromasil 100-5 C18(4.6 mm×250 mm, 5 μm) column, with triethylamine buffer solution (pH 3.2)-acetonitrile-tetrahydrofuran (92∶7∶1, V/V/V) as mobile phase A, and triethylamine buffer solution (pH 3.2)-acetonitrile-tetrahydrofuran (70∶29∶1, V/V/V) as mobile phase B. Stress tests were performed on the raw material to specify those impurities. By application of on-line LC/MSn method, the impurities were analyzed in positive mode and their structures were characterized based on the degradation mechanism and mass fragmentation regularity of sugar-lipopeptides. RESULTS: Totally 14 impurities were characterized in the raw material, seven of which were reported for the first time. The relationships between the chemical structures and chromatographic behaviors of vancomycin, demethylvancomycin and methylated vancomycin with their two β-isomers were summarized. CONCLUSION: The structures of related impurities in vancomycin raw material can be rapidly identified by on-line LC/MSn method together with stress degradation experiments.

Analysis of polymer impurities in cefixime raw materials and preparations / 药学学报

To establish a method for the determination of polymer impurities in cefixime raw materials and preparations, a cefixime degradation solution containing polymer impurities was prepared by forced polymerization. Polymer impurities in the degradation solution were separated and identified by high performance gel chromatography and the column switching-LC-MSn method. A new RP-HPLC method for cefixime polymer was established and validated with a Phenomenex Gemini-C18 column using a mobile phase gradient elution of 0.5% formic acid-water solution and 0.5% formic acid-acetonitrile solution. The results showed that when using this high performance gel chromatography method some small molecular weight impurities were co-eluted with the polymers, resulting in a poor specificity and poor quantitative accuracy. But when using the RP-HPLC method, three polymer impurities were detected with good specificity, sensitivity and robustness, including two cefixime dimers, and dehydrate dimer. Therefore, the described RP-HPLC method is suitable for the quality control of polymer impurities in cefixime, and cefixime degradation solution can be used as suitable solution for analysis of cefixime polymers.

Determination of 14 illicit drugs and major metabolites in human hair by UPLC-MS/MS combined with ion switching technology / 国际药学研究杂志

Objective: To establish an UPLC-MS/MS method for the determination of 14 illicit drugs and major metabolites in human hair. Methods: Samples of hair were pulverized with an SPEX 6875 Freeze Mill, and then extracted with methanol under ultra-sonication. An ACQUITY UPLC HSS C18 column was used with 20 mmol/L ammonium acetate water solution(containing 0.1% formic acid)-methanol as mobile phase at a flow rate of 0.3 ml/min. Multiple reaction monitoring(MRM)mode was performed combined with the ion switching technology for quantification in five sections. The 11-nor-9-carboxy-tetrahydrocannabinol(THCCOOH)was detected by the negative ion scanning mode, while the others were detected by the positive ion scanning mode. Results: The liner calibration curve of morphine, 6-monoacetylmorphine, codeine, heroin, ketamine, 3, 4-methylenedioxymethamphetamine, 3, 4-methylenedioxyamphetamine, amphetamine, methamphetamine, cocaine, benzoylecgonine, pethidine, Δ9- tetrahydrocannabinol, and 11-nor- 9- carboxy-tetrahydrocannabinol showed a good linearity in the concentration range of 0.05-10.00(r=0.9964), 0.05-10.00(r= 0.9912), 0.05-10.00(r=0.9967), 0.05-10.00(r=0.9933), 0.02-10.00(r=0.9961), 0.02-10.00(r=0.9938), 0.05-10.00(r=0.9782), 0.05-10.00(r=0.9900), 0.02-10.00(r=0.9974), 0.02-10.00(r=0.9949), 0.02-10.00(r=0.9959), 0.02-10.00(r=0.9957), 0.10-20.00 (r=0.9887), and 0.10-20.00 ng/mg(r=0.9911), respectively. The lowest detection limit was 0.01, 0.01, 0.01, 0.02, 5.00×10-3, 5.00× 10-3, 0.02, 0.02, 5.00×10-3, 5.00×10-3, 5.00×10-3, 5.00×10-3, 0.05, and 0.05 ng/mg, respectively. The RSD of inter-day and intra-day was less than 20%. The relative recovery was more than 55%, and the RSD was less than 15%. Conclusion: The method is accurate, sensitive and suitable for the detection and quantification of 14 illicit drugs and major metabolites in human hair.

Canonical Transient Receptor Potential Channels and Vascular Smooth Muscle Cell Plasticity

Vascular smooth muscle cells (VSMCs) play a pivotal role in the stability and tonic regulation of vascular homeostasis. VSMCs can switch back and forth between highly proliferative (synthetic) and fully differentiated (contractile) phenotypes in response to changes in the vessel environment. Abnormal phenotypic switching of VSMCs is a distinctive characteristic of vascular disorders, including atherosclerosis, pulmonary hypertension, stroke, and peripheral artery disease; however, how the control of VSMC phenotypic switching is dysregulated under pathological conditions remains obscure. Canonical transient receptor potential (TRPC) channels have attracted attention as a key regulator of pathological phenotype switching in VSMCs. Several TRPC subfamily member proteins—especially TRPC1 and TRPC6—are upregulated in pathological VSMCs, and pharmacological inhibition of TRPC channel activity has been reported to improve hypertensive vascular remodeling in rodents. This review summarizes the current understanding of the role of TRPC channels in cardiovascular plasticity, including our recent finding that TRPC6 participates in aberrant VSMC phenotype switching under ischemic conditions, and discusses the therapeutic potential of TRPC channels.

Simultaneous Determination of Eight Active Components in Material Benchmark of Shentong Zhuyutang by HPLC-DAD Wavelength Switching / 中国实验方剂学杂志

Objective::To develop high performance liquid chromatography-diode array detector (HPLC-DAD) wavelength switching for simultaneously determining the contents of inosine, loganic acid, chlorogenic acid, amygdalin, hydroxysafflor yellow A, gentiopicroside, ferulic acid and liquiritin in 15 batches of material benchmarks of Shentong Zhuyutang. Method::The quantitative analysis was carried out on a Thermo Hypersil GOLD C18 column (4.6 mm×250 mm, 5 μm) with mobile phase of acetonitrile-0.1%phosphoric acid aqueous solution for gradient elution, the flow rate was 1.0 mL·min-1, the detection wavelengths were set as 248 nm (0-11 min, inosine), 235 nm (11-14 min, loganic acid), 324 nm (14-16 min, chlorogenic acid), 220 nm (16-19 min, amygdalin and hydroxysafflor yellow A), 274 nm (19-26 min, gentiopicroside), 247 nm (26-54 min, ferulic acid and liquiritin), the column temperature was maintained at 25 ℃. According to the contents of eight active components in 15 batches of material benchmarks, orthogonal partial least squares discriminant analysis (OPLS-DA) in SIMCA 14.1 was used to evaluate the quality difference of each batch of samples. Result::Each component had good separations, the linear ranges of the above 8 components were 2.1-67.2, 1.812 5-58, 1.937 5-62, 5.212 5-166.8, 8.45-270.4, 7.075-226.4, 1.775-56.8, 3.875-124 mg·L-1, respectively (r≥0.999 6). The average recoveries of them were 99.23%, 100.09%, 99.33%, 98.85%, 99.15%, 98.75%, 99.42%, 98.96%, respectively (RSD<2%). The contents of the above eight components in 15 batches of material benchmarks were 0.183 5-0.250 3, 0.173 1-0.265 3, 0.069 5-0.169 8, 0.959 2-1.458 2, 1.905 4-2.553 3, 0.933 3-1.997 5, 0.084 6-0.143 4, 0.212 5-0.704 3 mg·g-1, respectively. Liquiritin, ferulic acid, gentiopicroside and hydroxysafflor yellow A were determined to have significant impact on the quality of different batches of material benchmarks of Shentong Zhuyutang through OPLS-DA. Conclusion::The established method for simultaneous determination of multi-components is reliable, simple and in line with the requirements of methodological verification. It is suitable for the quality control of research and development of compound preparations of Shentong Zhuyutang.

A Case of Refractory Cancer Pain Successfully Treated with Opioid Switching by Adding Methadone

We report a case of refractory cancer pain that was successfully treated with opioid switching by adding methadone to the preceding opioid. A 38-year-old man had severe epigastric pain and back pain because of paraaortic lymph node metastasis of a gastroesophageal junctional carcinoma. His pain was treated with continuous intravenous morphine administration and the frequent use of a rescue dose. When the morphine dose was increased, respiratory depression developed; thus, his pain was considered refractory to the morphine, and methadone was added on. The pain was relieved after initiating methadone, and the frequency of the rescue dose was markedly decreased. The methadone dose was gradually increased in parallel, and the morphine dose was reduced and finally discontinued. No methadone-induced side effects were noted, and the patient was discharged with good analgesia. In our case, adding methadone without decreasing the preceding opioid dose under strict monitoring made it possible to stably switch the opioid without increasing pain.