Risk factors of poor early prognosis in the treatment of COVID-19 with nematevir and ritonavir tablets and the establishment of prediction model / 药学实践杂志

Objective To explore risk factors of poor early prognosis in the treatment of COVID-19 by nematevir and ritonavir tablets Paxlovid and establish the prediction model to provide reference for improving the effect of such patients. Methods 92 inpatients of COVID-19 treated with Paxlovid in three military tertiary hospital in southern Fujian from January 2023 to March 2023 were retrospectively analyzed. The clinical indicators of 92 inpatients were collected for univariate and multivariate analysis by single factor and multiple factors and the independent risk factors of poor early prognosis in Paxlovid were screened out. Logistic model equation was transformed to construct the combined predictors, and ROC curve was used to determine the area under the curve (AUC) and the optimal critical value of the combined predictors. Results Among 92 patients, 31 (33.70%) developed poor early prognosis, including 11 deaths (35.48%), 17 critical cases (54.84%) and 3 severe cases (9.68%). Multi-factor Logistic regression analysis showed that the disease days, lymphocyte count, aspartate aminotransferase(AST), C reactive protein(CRP) and ventilator-assisted ventilation were independent risk factors for poor early prognosis in Paxlovid. A formula for calculating the combined predictors (Y) was established as Ycombinedpredictors=7.875Xdisease days+126.188Xlymphocyte count+1.438XAST+XCRP+220.500Xventilator-assisted ventilation based on the above independent risk factors, and the ROC curve was drawn. With the maximum area under the ROC curve of the combined predictors being 0.939, the prediction value was best, and the optimal critical value of the ROC curve corresponding to the maximum Youden index (0.756) was 447.920.Theoretical accuracy of the model was 89.10%. Conclusion The disease days, lymphocyte count, AST, CRP and ventilator-assisted ventilation were independent risk factors for poor early prognosis in Paxlovid. Combined predictors could be calculated by the above risk factors before medication. The efficiency should be improved by taking more active treatment, including combining with other anti-COVID-19 drugs when the prediction result exceeds 447.920.

Prediction and analysis of Q-markers of Elephantopus scaber based on its UPLC fingerprint, content determination of components, and in vitro a nti-tumor activity / 中国中药杂志

This study aimed to provide scientific evidence for predicting quality markers(Q-markers) of Elephantopus scaber by establishing UPLC fingerprint of E. scaber from different geographical origins and determining the content of 13 major components, as well as conducting in vitro anti-cancer activity investigation of the main components. The chromatographic column used was Waters CORTECS UPLC C_(18)(2.1 mm×150 mm, 1.6 μm), and the mobile phase consisted of acetonitrile and 0.1% formic acid solution(gradient elution). The column temperature was set at 30 ℃, and the flow rate was 0.2 mL·min~(-1). The injection volume was 1 μL, and the detection wavelength was 240 nm. The UPLC fingerprint of E. scaber was fitted using the Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine(2012 edition) to determine common peaks, evaluate similarity, identify and determine the content of major components. The CCK-8 assay was used to explore the inhibitory effect of the main components on the proliferation of lung cancer cells. The results showed that in the established UPLC fingerprint of E. scaber, 35 common peaks were identified. Thirteen major components, including neochlorogenic acid(peak 1), chlorogenic acid(peak 2), cryptochlorogenic acid(peak 3), caffeic acid(peak 4), schaftoside(peak 6), galuteolin(peak 9), isochlorogenic acid B(peak 10), isochlorogenic acid A(peak 12), isochlorogenic acid C(peak 18), deoxyelephantopin(peak 28), isodeoxyelephantopin(peak 29), isoscabertopin(peak 31), and scabertopin(peak 32) were identified and quantified, and a quantitative analysis method was established. The results of the in vitro anti-cancer activity study showed that deoxyelephantopin, isodeoxyelephantopin, isoscabertopin, and scabertopin in E. scaber exhibited inhibition rates of lung cancer cell proliferation exceeding 80% at a concentration of 10 μmol·L~(-1), higher than the positive drug paclitaxel. These results indicate that the fingerprint of E. scaber is highly characteristic, and the quantitative analysis method is accurate and stable, providing references for the research on quality standards of E. scaber. Four sesquiterpene lactones in E. scaber show significant anti-cancer activity and can serve as Q-markers for E. scaber.

The method of determination for butyronitrile and isobutyronitrile in the air of workplace by dissolved desorption-gas chromatography / 中华劳动卫生职业病杂志

Objective: To establish a method for the determination of butyronitrile and isobutyronitrile in the air of workplace by gas chromatography. Methods: In March 2020, butyronitrile and isobutyronitrile in the air of workplace was collected by silica gel, eluted with methanol, separated and determined by gas chromatogram with flame ionization detector, the characteristics of determination of nitrile and isobutyronitrile by gas chromatography were analyzed. Results: The limit of detection for butyronitrile and isobutyronitrile was 0.33 μg/ml. The linear range of butyronitrile determined by this method was 1.60-1600.00 μg/ml, y=2.295x-3.480, and the coefficient correlation was 0.99998, and the minimum detection concentration was 0.22 mg/m(3) (collected sample volume was 1.50 L) . The within-run precisions were 2.43%-4.12%, the between-run precisions were 1.72%-3.70%, and the desorption rates were 93.26%-98.41%. The linear range of isobutyronitrile determined by this method was 1.52-1520.00 μg/ml, y=2.208x-0.102, and the coefficient correlation was 0.99998, and the minimum detection concentration was 0.22 mg/m(3) (collected sample volume was 1.50 L) . The within-run precisions were 2.52%-3.22%, the between-run precisions were 1.20%-3.82%, and the desorption rates were 96.85%-102.50%. The sealed samples could be stored at least 10 days at room temperature without significant loss. Conclusion: The method has the advantages of good precision, high sensitivity and simple operation. It is suitable for the simultaneous determination of butyronitrile and isobutyronitrile in the air of workplace.

Lipid markers and targets of coronary artery disease based on lipidomics / 药学学报

Coronary artery disease is the leading cause of death worldwide, the coronary artery stenosis or occlusion caused by atherosclerosis leads to myocardial ischemia, hypoxia, or necrosis, that is main histopathological features of coronary artery disease. Atherosclerosis relates closely to abnormal lipid regulation, chronic inflammation, and endothelial dysfunction. Cardiac enzymes and high, low-density lipoprotein are currently used to diagnose a variety of coronary artery diseases, but the evidence is inadequate. Thus, new cardioprotective therapies are required to explore sensitive molecular markers for the prediction of cardiovascular events. Lipids have an important role in maintaining the myocardial cell structure as well as cardiac function. Lipidomics is a newly emerged discipline that studies lipids on a large scale. Recent advancements in lipidomics on coronary artery disease have shown that certain lipids, such as ceramide, sphingosine, lysophosphatidic acid, oxidized lipids, and so on, are associated with the clinical classification and characteristics of coronary artery disease. In addition, recent studies of lipid profiles of the cardiac, fat, liver, and other tissue samples in animal models also have provided a novel viewpoint. Given the increasing application of lipidomics techniques for coronary artery disease, we provide a review of lipidomics technology, sensitive lipid markers, recent studies of therapeutic targets, and drug discovery for coronary artery disease.

Analysis of Chemical Constituents in Microctis Folium by UPLC-Q-TOF-MS/MS / 中国实验方剂学杂志

Objective:To analyze the chemical constituents in Microctis Folium by ultra performance liquid chromatography-quadrupole-time-of-flight high resolution mass spectrometry （UPLC-Q-TOF-MS/MS）. Method:Waters CORTECS UPLC C₁₈ column （2.1 mm×150 mm， 1.6 μm） was used for chromatographic separation with the mobile phase of methanol （A） -0.1% formic acid solution （B） for gradient elution （0-4 min， 14%-30%A； 4-16 min， 30%-58%A； 16-25 min， 58%-78%A； 25-25.1 min， 78%-98%A； 25.1-29 min， 98%A）， the flow rate was 0.25 mL· min^-1， the injection volume was 1 μL. The electrospray ionization （ESI） was adopted for determining the chromatographic effluent under positive and negative ion modes， the main chromatographic peaks were assigned and distinguished by Q-TOF， and the scanning range was <italic>m</italic>/<italic>z</italic> 100-1 500. Result:A total of 31 chemical constituents in Microctis Folium were identified by confirmation of reference substances， literature comparison and high resolution mass spectrometry data analysis. The chemical constituent cluster was composed of 28 flavonoids （9 flavone C-glycosides， 10 flavonols and their glycosides， 8 proanthocyanidins， 1 xanthone） and 3 organic acids （caffeic acid， <italic>p</italic>-coumaric acid， ferulic acid）. Conclusion:UPLC-Q-TOF-MS/MS technique provides a simple， rapid and accurate method for the identification of chemical constituents in Microctis Folium. Flavone C-glycosides， flavonol oxyglycosides and proanthocyanidins are the main chemical constituents. The 7 proanthocyanidins are reported for the first time in this herb. In conclusion， the chemical profile of Microctis Folium is characterized and the findings are meaningful for the in-depth quality assessment and material basis clarification of Microctis Folium.

Clinical Efficacy and Mechanism of Quyu Qingjintang on Stroke Complicated with Lung Infection with Phlegm-heat Accumulation Lung Syndrome and Blood Stasis Syndrome / 中国实验方剂学杂志

Objective:To explore the clinical efficacy and mechanism of Quyu Qingjintang in the treatment of stroke complicated with lung infection （SCLI） with phlegm-heat accumulation lung syndrome and blood stasis syndrome. Method:The 60 patients with SCLI with phlegm-heat accumulation lung syndrome and blood stasis syndrome were selected and divided into control group （30 cases） and observation group （30 cases）. The patients in both groups received basic treatments such as thrombolysis and anticoagulation， and were injected with imipenem cilastatin sodium and ambroxol hydrochloride. The patients in control group additionally received Tanreqing capsule on the basis of the conventional treatment while those in observation group were additionally treated with Quyu Qingjintang on the basis of the conventional treatment. The clinical efficacy， lung function， inflammatory factor levels， time to symptoms disappearance， haptoglobin （HPT） and amyloid A （SAA） levels， T lymphocyte subset level and safety index were compared between two groups. Result:The total effective rate was 93.33% （28/30） in observation group， significantly higher than 70.00% （21/30） in control group （<italic>χ²=</italic>5.450， <italic>P</italic><0.05）. After treatment， the symptoms of both groups were improved （<italic>P</italic><0.05）. The scores of fever， cough， wheezing， and expectoration in observation group were lower than those in control group （<italic>P</italic><0.05）. The levels of interleukin-6（IL-6）， white blood cell（WBC）， procalcitonin（PCT）， C-reactive protein（CRP）， HPT， and SAA in observation group were significantly lower than those in control group （<italic>P</italic><0.05）. The forced expiratory volume in one second （FEV₁）， forced vital capacity （FVC） and peak expiratory flow rate （PEF） in observation group were better than those in control group （<italic>P</italic><0.05）. The levels of CD3⁺， CD4⁺， CD4⁺/CD8⁺ in observation group were significantly higher than those in control group （<italic>P</italic><0.05）. The recovery time of WBC count， hospitalization time， lung rales， the time to fever and cough disappearance in observation group were lower than those in control group （<italic>P</italic><0.05）， no serious adverse reactions occurred in two groups. Conclusion:Quyu Qingjintang in the treatment of stroke complicated with lung infection with phlegm-heat accumulation lung syndrome and blood stasis syndrome can significantly improve the treatment efficiency， improve the symptoms of pulmonary infection， reduce the level of inflammatory factors， and improve lung function， with less adverse reactions and high safety， so it is worthy of clinical application.

Determination of 15 kinds of vapor state organic acids in workplace air by dissolved desorption-gas chromatography / 中国职业医学

OBJECTIVE: To establish a method for simultaneous determination of 15 kinds of vapor state organic acids in workplace air by solvent desorption-gas chromatography.METHODS: A total 15 kinds of vapor state organic acids such as acetic acid, propanoic acid, butyric acid and pentanoic acid in the air of workplace were collected by silica gel, eluted with acetone, separated by DB-FFAP capillary chromatograph column, and detected by gas chromatography with flame ionization detection. RESULTS: There was a good linear relationship in the selected range of 15 kinds of organic acids. The coefficient correlation was 0.999 97-0.999 98. The limit of detection of this method was 0.04-0.29 mg/L, and the minimum detection concentration was 0.03-0.19 mg/m~(3 )(collected sample volume was 1.50 L). The average desorption efficiency was 92.9%-98.5%. The within-run and between-run relative standard deviation was 0.3%-1.6% and 1.5%-3.0%, respectively. The samples could be kept for at least 15 days at room temperature. CONCLUSION: The method is simple for operation, with high sensitivity, and good precision, which is suitable for simultaneous determination of 15 kinds of vapor state organic acids in the air of workplace and sites of emergency accident.

Analysis of Chemical Constituents in Bushao Tiaozhi Capsules by UPLC-Q-TOF-MS / 中国实验方剂学杂志

Objective:To analyze the main chemical constituents of traditional Chinese medicine compound Bushao Tiaozhi capsules by using UPLC-Q-TOF-MS technology. Method:The separation was eluted with Waters CORTECS UPLC C18 column（2.1 mm×150 mm，1.6 μm） in a gradient mode， with methanol-0.1% formic acid as the mobile phase. The column temperature was 40 ℃，the flow rate was 0.24 mL·min-1，and the injection volume was 1 μL. The mass spectrometry condition was X500R QTOF mass spectrometry，the positive and negative electrospray ionization （ESI） was adopted for determine the chromatographic effluent，and the main chromatographic peaks were assigned and distinguished by Q-TOF. Result:A total of 53 chemical constituents were identified by reference confirmation，literature comparison，and high mass spectrometry data analysis. The chemical constituent cluster was composed of 21 flavonoids，10 phenolics，5 monoterpene glycosides，7 diterpene lactones and 10 sesquiterpenes. Furthermore，all of the constituents were surveyed and classified according to their medicinal materials derivation. Among them，the 5 flavonoids components（mangiferin，isoquercitrin，typhaneoside，isorhamnetin 3-O-neohesperidoside，tiliroside）were identified in Microctis Folium for the first time. Conclusion:This study shows that UPLC-Q-TOF-MS technology provides a simple，rapid，and accurate method for the identification of chemical constituents in Bushao Tiaozhi capsules. The identified chemical components mostly cover the main constituents of each medicinal material in the formula，so as to provide a new technological method and theoretical foundation for further defining the pharmacological basis and mechanism of action and optimizing the quality control of Bushao Tiaozhi capsules.

Study on Inhibitory Effect of Huayu Qutan Recipe on Myocardial Fibrosis in Atherosclerotic Rabbits Based on Mitochondrial Fusion-lysis / 中国实验方剂学杂志

Objective::To analysis the effect of Huayu Qutan recipe on myocardial fibrosis in atherosclerotic rabbits based on mitochondrial fusion-lysis. Method::The 36 SPF healthy male rabbits were selected, and 6 rabbits were selected randomly as the normal group, and given normal pellet feed, another 30 rats were fed with high fat diet to establish atherosclerosis model.After successful replication of animal models, they were randomly divided into model group, Huayu Qutan recipe low-dose, medium-dose and high-dose group (4.0, 8.0, 16.0 g·kg-1) and simvastatin group (1.4 mg·kg-1), 6 rats each.Each group was given corresponding drugs according to the dosage, continuous administration for 4 weeks.The serum lipid levels in rabbits of each group were detectived by automatic biochemical analyzer, the degree of myocardial fibrosis was measured by Masson staining, and expression levels of mitochondrial fusion protein 1 (Mitofusin 1), mitochondrial fusion protein 2 (Mitofusin 2), optic atrophy protein 1 (Opa1), promoter protein 1 (Drp1), mitogen 1 (Fis1) in myocardial tissue were detected by immunohistochemistry. Result::Compared with normal group, the levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) in model group were significantly increased, levels of density lipoprotein cholesterol (HDL-C) were significantly decreased, the expression levels of Mitofusin 1, Mitofusin 2 and Opa1 in myocardial tissue were significantly decreased, the expression levels of Drp1 and Fis1 were significantly increased(P<0.05, P<0.01), compared with model group, the levels of serum TC, TG, LDL-C in simvastatin group and Huayu Qutan recipe low-dose, medium and high-dose group were significantly decreased, levels of HDL-C were significantly increased, the expression levels of Mitofusin 1, Mitofusin 2 and Opa1 in myocardial tissue were significantly increased, the expression levels of Drp1 and Fis1 were significantly decreased (P<0.05, P<0.01), compared with the Huayu Qutan recipe high-dose group, the levels of serum TC, TG, LDL-C in simvastatin group and Huayu Qutan recipe low, medium-dose group were significantly increased, the expression levels of Mitofusin 1, Mitofusin 2 and Opa1 in myocardial tissue were significantly decreased, the expression levels of Drp1 and Fis1 were significantly increased(P<0.05, P<0.01). Conclusion::Huayu Qutan recipe can effectively regulate blood lipid and inhibit myocardial fibrosis in atherosclerotic rabbits, and the higher the dose of Huayu Qutan recipe, the more obvious the effect is, it is speculated that its effect may be related to the regulation of the expression of mitochondrial fusion-lysis related proteins such as Mitofusin1, Mitofusin2 and Opa1, Drp1 and Fis1 in myocardial cells.

Effect of Yuebi Jia Banxiatang on Inflammatory Markers and Prognosis of Patients with Community Acquired Pneumonia in Old People / 中国实验方剂学杂志

Objective:To observe the efficacy of Yuebi Jia Banxiatang on old patients with community acquired pneumonia （CAP） combined with syndrome of phlegm heat damming lung， and observe effect on inflammatory markers and prognosis. Method:A total of 120 patients with CAP were randomly divided into control group （60 cases） and observation group （60 cases） by random number table. In control group， 55 patients finished the therapy （3 patients fell off or were lost to follow-up， 2 were eliminated）， 55 patients in observation group completed the therapy （5 patients fell off or were lost to follow-up）. Both groups' patients got anti-infection and other comprehensive therapies. Patients in control group got Feilike mixture， 20 mL/time， 3 times/day. Patients in observation group obtained Yuebi Jia Banxiatang， 1 dose/day. The course of treatment for the two groups continued for 10 days. Antipyretic time and antipyretic rate at the 5th day after treatment， relief time of cough， expectoration and lung rale were recorded. And clinical pulmonary infection score （CPSI）， time （CPSI<6） and time to stop antibiotics were recorded. Before and after treatment， syndrome of phlegm heat damming lung was scored， and failure of initial treatment was also recorded. Levels of procalcitonin （PCT）， red blood cell volume distribution wid （RDW）， D-dimer （D-D） and synpeptin， high sensitivity C-reactive protein （hs-CRP）， tumor necrosis factor-α （TNF-α）， interleukin （IL-1β） and IL-6 were measured. Recurrence rate of chest radiograph was recorded， and safety was evaluated. Result:Relief time of antipyretic， cough， expectoration and lung rale in observation group were less than those in control group （P<0.01）. Antipyretic rate at the 5th day after treatment， antibiotic discontinuation rate， recurrence rate of chest radiograph were 85.45% （47/55）， 94.55% （52/55） and 90.91% （50/55）， which were higher than 65.45% （36/55）， 81.82% （45/55） and 74.55% （45/55） in control group. And initial treatment failure rate was 5.54% （3/55）， which was lower than 20.00% （11/55） in control group （P<0.05）. Scores of CPSI and syndrome of phlegm heat damming lung were less than those in control group （P<0.01）. And levels of PCT， RDW， D-D， peptide， hs-CRP， TNF-α， IL-1β and IL-6 were all below the level in control group （P<0.01）. Total effective rate of traditional Chinese medicine （TCM） syndrome was 96.36% （53/55）， which was higher than 83.64% （46/55） in control group （χ2=4.949， P<0.05）. And there was no adverse reactions relating to traditional Chinese medicine. Conclusion:In addition to anti-infection and other comprehensive therapies， Yuebi Jia Banxiatang can control the clinical symptoms， reduce the degree of pulmonary infection and disease， control the inflammatory reaction， shorten the course of disease and improve the prognosis， with a significant effect and safety in clinical use.

Clinical Efficacy of Modified Qingjin Huatan Tang on Bronchiectasis with Syndrome of Phlegm-heat Accumulating Lung at Acute Exacerbation / 中国实验方剂学杂志

<b>Objective::To observe the clinical efficacy of modified Qingjin Huatan Tang on bronchiectasis with syndrome of phlegm-heat accumulating lung at acute exacerbation and its inhibitory effect on pro-inflammatory factors and proteolytic activity. <b>Method::One hundred and thirty patients were randomly divided into control group and observation group by random number table. Patients in control group got tazobactam sodium and piperacillin sodium for injection, 3.375 g/time, 1 time/6 hours, and the types of antibiotics were regulated according to the bacterial culture results. And patients in control group also got Ambroxol Hydrochloride injection, 30 mg/time, 2 time/days, and postural drainage. In addition to the therapy of control group, patients in observation group were also given modified Qingjin Huatan Tang, 1 dose/day. Before and after treatment, symptoms and signs were scored. And levels of white blood cell count (WBC), neutrophile granulocyte (GRAN), C-reactive protein (CRP), procalcitonin (PCT) were detected. And scores of forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), peak expiratory flow rate (PEFR) and BODE were graded. And levels of tumor necrosis factor-<italic>α</italic> (TNF-<italic>α</italic>), interleukin-4 (IL-4), IL-6 and IL-8 in sputum, peripheral neutrophil elastase (NE) and cathepsin G were detected. <b>Result::By rank sum test, the clinical efficacy in observation group was better than that in control group (Z=2.086, <italic>P</italic><0.05), while scores of symptoms and signs in observation group were lower than those in control group (<italic>P</italic><0.01). WBC, GRAN, CRP, PCT, airflow limitation (O), dyspnea (D), motor ability (E) score, BODE index, TNF-<italic>α</italic>, IL-4, IL-6, IL-8, plasma NE and cathepsin G were all lower than those in control group (<italic>P</italic><0.01). And levels of FEV₁, FVC, PEF and FEV₁/FVC were higher than those in control group (<italic>P</italic><0.01). <b>Conclusion::In addition to routine anti-infection and expectoration western medicine therapy, modified Qingjin Huatan Tang can be added to control symptoms and signs, alleviate the degree of illness, improve pulmonary function and the quality of life of patients, and inhibit expression of airway pro-inflammatory factor and proteolysis, with a better clinical efficacy than pure western medicine.

Study on Protective Effect of Huayu Qutan Decoction on Vascular Dementia / 中国实验方剂学杂志

Objective: To study the protective effect of Huayu Qutan decoction on vascular dementia (VD) gerbils and to explore whether its mechanism is related to Calcium ion-calmodulin-dependent protein kinase Ⅱ (CaMKⅡ)/cyclic adenosine effect element binding protein (CREB)/brain-derived neurotrophic factor (BDNF) signaling pathway. Method: Forty healthy gerbils were randomly divided into sham operation group, model group, low, medium and high dose groups (5.35, 10.7, 21.4 g·kg-1) of removing blood stasis and expelling phlegm. Eight gerbils in each group were divided into model group and removing blood stasis and expelling phlegm group. Gerbils were given corresponding drugs twice a day after operation. Water maze experiment was conducted 21 days later to investigate the spatial learning and memory ability of gerbils. The expression of p-CaMKⅡ/CaMKⅡ, p-CREB/CREB and BDNF in the hippocampus of gerbils were detected by Western blot and immunohistochemistry. Result: Compared with sham operation group, the incubation period and the number of platform trips of gerbil in the model group were significantly reduced, p-CaMKⅡ/CaMKⅡ, p-CREB/CREB, and BDNF protein expression were significantly reduced (PPPConclusion: Huayu Qutan decoction improves the learning and memory abilities of gerbils with vascular dementia, and its mechanism may be related to the activation of CaMKⅡ/CREB/BDNF signaling pathway.

Penoplasty with T-shaped incision and three-point fixation for concealed penis / 中华男科学杂志

<p><b>Objective</b>To search for a safe and effective method of penoplasty with low incidence of complications for concealed penis by evaluating penoplasty with T-shaped incision and three-point fixation in comparison with modified Devine's technique.</p><p><b>METHODS</b>We retrospectively analyzed 169 cases of concealed penis treated in our center by penoplasty with T-shaped incision and three-point fixation (group A, n = 110) or modified Devine's surgery (group B, n = 59). We compared the operation time, postoperative complications, and recurrence rate between the two groups of patients.</p><p><b>RESULTS</b>Operations were successfully completed in all the cases, the urinary catheters removed at 3 days and the elastic bandages applied for 2 to 4 weeks. The patients were followed up for 4 to 12 months. The penis was satisfactorily exposed. The operative time was significantly shorter in group A than in B (［52.8 ± 6.9］ vs ［61.5 ± 10.6］ min, P < 0.001), the postoperative complication rate was obviously lower in the former than in the latter (prepuce edema: 17.27% ［19/110］ vs 33.89% ［20/59］, P = 0.021; bleeding: 0.90% ［1/110］ vs 3.38% ［2/59］, P = 0.552; skin necrosis: 0.90% ［1/110］ vs 5.08% ［3/59］, P = 0.123; skin infection: 0.90% ［1/110］ vs 5.08% ［3/59］, P = 0.123), and so was the recurrence rate (0.90% ［1/110］ vs 6.77% ［4/59］, P = 0.032).</p><p><b>CONCLUSIONS</b>Penoplasty with T-shaped incision and three-point fixation deserves to be popularized clinically for its advantages of minor invasion, clear exposure, reliable penile fixation, low incidence of postoperative complications and recurrence, and satisfactory outcomes.</p>

Etiological factors for calculus-associated seminal vesiculitis: Analysis of calculus composition in 6 cases / 中华男科学杂志

Objective@#To explore the etiological factors for calculus-associated seminal vesiculitis by analyzing the composition of seminal vesicle calculus samples.@*METHODS@#This retrospective study included 6 cases of recurrent hematospermia diagnosed with seminal vesicle calculus by non-contrast pelvic CT. The patients were aged 28 to 69 years, with persistent or recurrent hematospermia for 3 months to 6 years, and 5 of them with a history of acute urethritis. All the patients underwent seminal vesiculoscopy, which confirmed calculus-associated seminal vesiculitis. The calculus samples were obtained with a spiral dislodge and their composition was determined with a second-generation infrared calculus composition analyzer. The patients were followed up for 2 to 12 weeks postoperatively, during which non-contrast pelvic CT was employed for observation of recurrent calculus in the reproductive tract.@*RESULTS@#Pelvic CT scanning indicated recurrence of seminal vesicle calculus in 3 cases at 12 weeks postoperatively, of which, 2 were accompanied with recurrent hematospermia, both observed at 4 weeks after operation. As for the composition of the calculus, the infrared calculus composition analyzer revealed struvite (magnesium ammonium phosphate hexahydrate) in 5 cases and a mixture of calcium oxalate dihydrate, calcium oxalate monohydrate, and carbonate apatite in the other one.@*CONCLUSIONS@#Seminal vesicle calculi are most commonly composed of struvite, and infection is the main etiological factor for calculus-associated seminal vesiculitis.

Study on Serum Metabolite Profiling in Pi-deficiency Rats Based on LC-MS Technique / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore metabolite profiling changes in serum of rats with pi-qi deficiency syndrome (PQDS) and pi-yang deficiency syndrome (PYDS) based on liquid chromatograph-mass spectrometer (LC-MS) technique, and to explore the essence of Pi-deficiency syndrome (PDS) from small molecule metabolite level.</p><p><b>METHODS</b>Totally 21 male SD rats of SPF grade were randomly divided into three groups, the normal control group, the PQDS group, and the PYDS group, 7 in each group. Rats in the PQDS group overate for 1 day and fasted for 2 days. They drank freely and then swam to be exhausted in water at 35 degrees C - 37 degrees C for 15 successive days. The PYDS model was established by the same method for PQDS rats plus drenching 20% Folium sennae water extract (2 mL/100 g), once in the morning and once in the evening for one successive week. After modeling, models were evaluated according to rat general state, changes in body weight and rectal temperature. Serum metabonomic profiles were detected using LC-MS technique. Difference in inter-group metabolite spectrograms was analyzed using orthogonal partial least squares discriminant analysis (OPLS-DA). Potential biomarkers related to syndrome types in rat serum were selected via the parameter of variable importance in the projection (VIP).</p><p><b>RESULTS</b>The weight of rats in the PQDS group and the PYDS group decreased more significantly after modeling. The difference in prepost weight was statistically significant from that of the normal control group (P < 0.01). It was more obviously lowered in the PYDS group than in the PQDS group (P < 0.05). Compared with the normal control group, the rectal temperature of rats in the PYDS group and the PQDS group decreased (P < 0.05, P < 0.01). It decresed more in the PYDS group than in the PQDS group (P < 0.05, P < 0.01). Compared with the normal control group, levels of PC(19:0)/PE(22:0), PC(17:0)/PE(20:0), capric acid, oleic acid, stearic acid, succinic acid, fumaric acid, malic acid, glucose increased; arachidonic acid, linolenic acid, lauric acid, androsterone, 4-heptanone, dihydroxyacetonephosphate (DHAP) (6:0), and uridine decreased in the PYDS group and the PQDS group. Compared with the PQDS group, levels of PC(22:1), PC (22:6), PE (18:0)/PC (15:0), retinol, and deoxycytidine increased significantly in the PYDS group; PC (18:1), PC(19 :3), PC (20:3), PC (17:0)/PE (20:0), PC (19:1)/PE (22:1), PC (19:0)/PE (22:0), PC (17:1)/PE (20: 1), PC (16:1)/PE (19:1), cholic acid, hippuric acid, furoic acid, undecanedicarboxylic acid, palmitoleic acid, hydroxy stearic acid, eicosatrienoic acid, phenylalanine, tyrosine, glutamic acid, serine, carbamoyl aspartic acid, palmitoyl carnitine, tetradecanoyl carnitine, acetylcarnitine, and linoleylcarnitine decreased more significantly in the PYDS group.</p><p><b>CONCLUSIONS</b>Comparative contents of various serum metabolites changed significantly in PQDS and PYQS model groups. Some potential small molecular biomarkers related to PDS were preliminarily identified. These results might provide some data reference for exploring scientific connotation and pathological mechanisms of PDS.</p>

Application value of Toshiba 320-row dynamic volumetric CT angiography in the diagnosis of venous erectile dysfunction / 中华男科学杂志

<p><b>Objective</b>To investigate the application value of Toshiba 320-row dynamic volumetric CT angiography in the diagnosis of venous erectile dysfunction (VED).</p><p><b>METHODS</b>We enrolled in this study 33 patients diagnosed with ED by audiovisual sexual stimulation screening in the outpatient department. Penile erection was induced in the patients by injection of 2 mg phentolamine plus 30 mg papaverine into the corpus cavernosum, followed by that of contrast agent of iobitridol through the vein and corpus cavernosum successively. Then 320-row dynamic volumetric CT angiography was performed and the images of the corpus cavernosum in the arterial and venous phases were collected and processed.</p><p><b>RESULTS</b>Different degrees of abnormal venous drainage were observed in 29 of the patients, including 7 cases (24.1%) of back deep venous leakage, 6 cases (20.7%) of foot venous leakage, 3 cases (10.3%) of dorsal superficial venous leakage, 1 case (3.5%) of intervertebral venous leakage, 2 cases (6.9%) of cavernous venous leakage, and 10 cases (34.5%) of mixed venous leakage. Ten of the patients underwent surgery, dorsal deep penile vein ligation in 2 cases, dorsal deep vein embedding plus foot vein ligation in 4, and foot vein ligation in the other 4. Eight of the patients were followed up for 3－12 months post-operatively, during which 2 achieved obvious erectile improvement, while the other 6 gained normal penile erection.</p><p><b>CONCLUSIONS</b>Toshiba 320-row dynamic volumetric CT angiography is a reliable method for the diagnosis of VED, which displays the precise location of venous leakage for clinical treatment, with the advantages of clearer images, lower doses of contrast agent and radiation, and faster examination than X-ray penile angiography.</p>

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

<p><b>INTRODUCTION</b>Unscheduled reattendances at the paediatric emergency department may contribute to overcrowding, which may increase financial burdens. The objectives of this study were to determine the rate of reattendances and characterise factors influencing these reattendances and hospital admission during the return visits.</p><p><b>METHODS</b>Medical records of all patients who attended the emergency department at KK Women's and Children's Hospital, Singapore, from 1 June 2013 to 31 May 2014 were retrospectively reviewed. We collected data on patient demographics, attendance data and clinical characteristics. Planned reattendances, recalled cases, reattendances for unrelated complaints and patients who left without being seen were excluded. A multivariate analysis was conducted to determine the odds ratio of variables associated with hospital admission for reattendances.</p><p><b>RESULTS</b>Of 162,566 children, 6,968 (4.3%) returned within 72 hours, and 2,925 (42.0% of reattendance group) were admitted on their return visits. Children more likely to reattend were under three years of age, Chinese, triaged as Priority 2 at the first visit, and were initially diagnosed with respiratory or gastrointestinal conditions. However, children more likely to be admitted on their return visits were over 12 years of age, Malay, had a higher triage acuity or were uptriaged, had the presence of a comorbidity, and were diagnosed with gastrointestinal conditions.</p><p><b>CONCLUSION</b>We identified certain subgroups in the population who were more likely to be admitted if they reattended. These findings would help in implementing further research and directing strategies to reduce potentially avoidable reattendances and admissions.</p>

Intervention of Huayu Qutan Recipe on liver SREBP-2 signal pathway of hyperlipidemia rats of pi deficiency syndrome / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the intervention of Huayu Qutan Recipe (HQR) on liver SREBP-2 signal pathway of hyperlipidemia rats of Pi deficiency syndrome (PDS).</p><p><b>METHODS</b>Totally 100 SPF grade SD rats were randomly divided into the blank control group, the hyperlipidemia group, the hyperlipidemia treatment group, the PDS hyperlipidemia group, and the PDS hyperlipidemia treatment group, 20 in each group. Common granular forage was fed to rats in the blank control group. High fat forage was fed to rats in the hyperlipidemia group and the hyperlipidemia treatment group. Rats in the PDS hyperlipidemia group and the PDS hyperlipidemia treatment group were treated with excessive labor and improper diet for modeling. They were administered refined lard by gastrogavage (3 mL each time, twice per day) and fed with high fat forage on the odd days, and fed with wild cabbage freely on even days. The modeling lasted for 30 days. Rats in the hyperlipidemia treatment group and PDS hyperlipidemia treatment group were administered with Huayu Qutan Recipe (20 mL/kg) by gastrogavage, once a day, for 30 successive days. Levels of serum cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and serum amylase (AMY) were detected by automatic biochemical analyzer. D-xylose excretion rate was determined using phloroglucinol method. Morphological changes of liver and the lipid deposition in liver were observed using HE stain and oil red O stain respectively, mRNA and protein expression levels of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), cholesterol 7α-hydroxylase 1 (CYP7A1), LDL-R, and sterol regulatory element binding protein-2 (SREBP-2) were detected using real time RT-PCR and Western blotting.</p><p><b>RESULTS</b>Compared with the blank control group, serum levels of TC (1.84 ± 0.19 mmol/L, 2.23 ± 0.43 mmol/L) and LDL-C (0.99 ± 0.24 mmol/L, 1.13 ± 0.56 mmol/L) were higher in the hyperlipidemia group and the PDS hyperlipidemia group, serum levels of HDL-C (0.41 ± 0.66 mmol/L, 0.41 ± 0.11 mmol/L) and AMY activities (351 ± 45 mmol/L, 153 ± 30 mmol/L) were lower, and urinary D-xylose excretion rates were lower (26.9 ± 2.1 ng/mL, 15.0 ± 1.7 ng/mL) (all P < 0.05). Lipid deposition occurred in liver cells. Much fat vacuoles occurred in the cytoplasm. Expression levels of HMGCR, CYP7A1, LDL-R, and SREBP-2 mRNA and proteins in liver significantly decreased (P < 0.01). Compared with the hyperlipidemia group, serum levels of TC and LDL-C significantly increased (P < 0. 05), AMY activities and urinary D-xylose excre- tion rates significantly decreased in the PDS hyperlipidemia group (P < 0.01). A large amount of lipid deposition occurred in liver. The atrophy of liver cells was obviously seen. Expression levels of CYP7A1, LDL-R, and SREBP-2 mRNA and proteins in liver were significantly lower (P < 0.01, P < 0.05). Serum levels of TC and LDL-C significantly decreased (P < 0.05), AMY activities and urinary D-xylose excretion rates significantly increased in the hyperlipidemia treatment group (P < 0.01). Expression levels of CYP7A1, LDL-R, and SREBP-2 mRNA and proteins in liver were significantly increased (P < 0.01, P < 0.05). Compared with the PDS hyperlipidemia group, serum level of TC significantly decreased (P < 0.05), HDL-C levels, AMY activities and urinary D-xylose excretion rates significantly increased in the PDS hyperlipidemia treatment group (P < 0.01),expression levels of CYP7A1, LDL-R, and SREBP-2 mRNA and proteins in liver were significantly increased (P < 0.01). Similar changes occurred in the two treatment groups.</p><p><b>CONCLUSIONS</b>Pi deficiency exacerbates abnormal serum TC level and the lipid deposition in liver. These might be related to regulating expression levels of LDL-R, HMGCR, and CYP7A1 genes in the SREBP-2 signal pathway. HQR could regulate this pathway to intervene abnormal metabolism of TC.</p>

Adjunctive therapy of xuezhikang capsule for coronary heart disease: a systematic review and meta-analysis of randomized controlled trials / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To systematically evaluate the effect and safety of Xuezhikang Capsule (XZKC) for adjuvant treatment for coronary heart disease (CHD) patients accompanied with or without dyslipidemia.</p><p><b>METHODS</b>China National Knowledge Infrastructure (CNKI) Database, Chongqing VIP Database (VIP), Wanfang Data base, Cochrane Library, and Medline (PubMed) were retrieved with the deadline of August 30, 2013. Randomized controlled trials (RCT) of XZKC in treating CHD patients with or without dyslipidemia were all included. Assessment of bias risk for included studies was conducted according to the Cochrane Handbook for Systematic Reviews of Intervention (Version 5.0.2): Criteria for judging risk of bias in the "risk of bias" assessment tool. Review Management (5.1.0) was employed for data statistics. If there was no significant heterogeneity, results from the random-effect model were presented. If the heterogeneity was not substantial, a meta-analysis was not performed and a narrative and qualitative summary was performed instead.</p><p><b>RESULTS</b>A total of 28 RCTs (6,949 patients) were included after screening results. The methodological quality of included trial was generally lower. Results of Metaanalysis showed that XZKC was beneficial for CHD patients in decreasing cardiovascular events: when compared with the basic treatment group, the relative risk (RR) was 0.53 and 95% confidence interval (CI) was [0.35, 0.81]; when compared with the placebo + basic treatment group, RR was 0.52 and 95% CI was [0.42, 0.65]; when compared with the basic treatment group, RR for improving symptoms of angina was 1.20 and 95% CI was [1. 12, 1.30]; when compared with the basic treatment group, RR for improving abnormal ECG was 1.38 and 95% CI was [1.21, 1.57]. Thirteen studies showed that XZKC + basic treatment was obviously superior in lowering total cholesterol (TC) to that of the basic treatment group. Three studies showed that XZKC + basic treatment was obviously superior in lowering total cholesterol (TC) to that of the placebo + basic treatment group. Thirteen studies showed that XZKC + basic treatment was obviously superior in lowering low density lipoprotein cholesterol (LDL-C) to that of the basic treatment group. Three studies showed that XZKC + basic treatment was obviously superior in lowering LDL-C to that of the placebo + basic treatment group. A total of 18 studies describing adverse reactions (ADs) involved 61 ADs in the XZKC + basic treatment group. All suffered from mild symptoms or were improved after treatment. No severe ADs occurred.</p><p><b>CONCLUSION</b>Treatment of CHD by XZKC might lower the occurrence of cardiovascular events in CHD patients accompanied with or without dyslipidemia, relieve clinical symptoms, improve ECG, lower blood lipid levels, and with less adverse reactions.</p>

Portal vein flow rate used as a early predictor of portal vein thrombosis after periesophagastric devascularization / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the predictive value of portal vein flow rate preoperative for portal vein thrombosis (PVT) after periesophagastric devascularization in hepatitis B cirrhosis-related portal hypertension.</p><p><b>METHODS</b>From January 2007 to July 2008, 45 patients with portal hypertension caused by hepatitis B cirrhosis were performed splenectomy with peri-esophagogastric devascularization in the same medical group in West China Hospital of Sichuan University. The portal vein flow rate and the diameter of portal vein were measured with doppler sonography respectively before and after the operation. At the same time, the level of PT and PLT were detected. The weight of spleens were measured after operation.</p><p><b>RESULTS</b>Thirteen cases suffered from PVT postoperatively. Portal vein flow rate was significantly lower in patients with PVT postoperation than that in patients without PVT (P < 0.01). In patients with PVT (n = 13) postoperation, the preoperative portal vein flow rate was (19.5 +/- 5.3) cm/s. Among the 13 cases, there were 12 cases whose flow rate were lower than 25 cm/s, and 1 case whose flow rate was 32. 3 cm/s; In patients without PVT (n = 32), the preoperative portal vein flow rate was (9.6 +/- 8.0) cm/s. In patients with lower rate (n = 17), the incidence rate of PVT was 70.6%; in patients with higher rate (n = 28), the incidence rate of PVT was 3.6%. The incidence rate of PVT in patients with lower rate was significantly lower than patients with higher rate (P < 0.01). The diameter of portal vein in patients with PVT was significantly wider than patients without PVT. The diameter of portal vein was negative correlative with the portal vein flow rate. The value 25 cm/s was of diagnostic efficiency, the sensitivity was 92.3%, and specificity was 70.6%.</p><p><b>CONCLUSIONS</b>The portal vein flow rate preoperative can be used as an early predictor of portal vein thrombosis after periesophagastric devascularization in hepatitis B cirrhosis-related portal hypertension to give a guide to clinical work.</p>