Individualized treatment of intraventricular hemorrhage guided by modified Graeb criteria score and Glasgow coma scale / 中华危重病急救医学

Objective@#To investigate the clinical effect of modified Graeb criteria score and Glasgow coma score (GCS) in individualized treatment of intraventricular hemorrhage.@*Methods@#113 patients with intraventricular hemorrhage admitted to the department of neurosurgery of Second Affiliated Hospital of Guangxi Medical University from June 2014 to February 2018 were enrolled, and they were divided into 13-15, 9-12, and 3-8 groups according to GCS score at admission, and modified Graeb criteria score was classified as grade Ⅰ, Ⅱ and Ⅲ at the same time. In GCS 9-12 and 3-8 groups, patients with modified Graeb criteria score grade Ⅲ were treated with bilateral extra ventricular drainage, patients with modified Graeb criteria score grade Ⅱ were treated with bilateral extra ventricular drainage or lumbar cistern drainage (GCS 9-12 group was more prior to lumbar cistern drainage, 3-8 group was given priority to extra ventricular drainage), and patients with modified Graeb criteria score grade Ⅰ were treated conservatively. In GCS 13-15 group, bilateral extra ventricular cerebral drainage or lumbar cistern drainage was performed if the modified Graeb criteria score grade was Ⅲ, lumbar cistern drainage or conservative treatment was performed if the modified Graeb criteria score grade was Ⅱ, and conservative treatment was performed if the modified Graeb criteria score grade was Ⅰ. The changes in GCS score at 1 month after individualized treatment and the favourable prognosis rate at 6 months after treatment were observed [favourable prognosis was defined as Glasgow outcome score (GOS) Ⅳ-Ⅴ] as well as the basic clearance time of intraventricular hematomas, and the occurrence of complications such as intracranial infection, pulmonary infection and hydrocephalus were recorded.@*Results@#113 patients with intraventricular hemorrhage were enrolled in the final analysis, including 39 patients in GCS 13-15 group, 27 in 9-12 group, and 47 in 3-8 group; 21 patients with the first grade of modified Graeb criteria score, 42 with the second grade and 50 with the third grade. At 1 month after individualized treatment, the GCS scores in GCS 13-15 and 9-12 groups were significantly higher than those at admission (14.8±0.2 vs. 13.7±0.8, 13.1±1.7 vs. 10.7±1.1, both P < 0.05). When comparing the GCS score of the same patient at admission with that of 1 month after treatment, the GCS scores of the three groups were significantly improved, indicating that the consciousness of patients with different coma levels at admission had been significantly improved after individualized treatment. The basic clearance time of intracerebroventricular hematomas in patients with the second grade of modified Graeb criteria score was (7.0±2.8) days, in patients with the third grade was (6.1±2.0) days. At 6 months after individualized treatment, among 113 patients, GOS score was grade Ⅰ in 7 patients (6.2%), grade Ⅱ in 13 patients (11.5%), grade Ⅲ in 28 patients (24.8%), grade Ⅳ in 27 patients (23.9%), and grade Ⅴ in 38 patients (33.6%), with the favourable prognosis rate of 57.5% (65/113). Among 113 patients, intracranial infection occurred in 5 patients (4.4%), pulmonary infection in 22 patients (19.5%), hydrocephalus in 2 patients (1.8%) and rebleeding in 4 patients (3.5%). In 83 patients with lumbar cistern drainage, 1 patient had post-drainage infection (1.2%), 3 patients had plugging (3.6%), 6 patients had accidental drop of drainage tube (7.2%), and none of them had occipital macroforamen hernia after drainage. Seven of the 113 patients died including 2 patients died of cerebral hernia caused by rebleeding, 5 patients died of severe pneumonia or automatic discharge from hospital.@*Conclusion@#The combination of modified Graeb criteria score and GCS score can individualize treatment for patients with intraventricular hemorrhage and effectively improve the prognosis of patients with intraventricular hemorrhage.

Individualized treatment of intraventricular hemorrhage guided by modified Graeb criteria score and Glasgow coma scale / 中华危重病急救医学

To investigate the clinical effect of modified Graeb criteria score and Glasgow coma score (GCS) in individualized treatment of intraventricular hemorrhage. Methods 113 patients with intraventricular hemorrhage admitted to the department of neurosurgery of Second Affiliated Hospital of Guangxi Medical University from June 2014 to February 2018 were enrolled, and they were divided into 13-15, 9-12, and 3-8 groups according to GCS score at admission, and modified Graeb criteria score was classified as grade Ⅰ, Ⅱ and Ⅲ at the same time. In GCS 9-12 and 3-8 groups, patients with modified Graeb criteria score grade Ⅲ were treated with bilateral extra ventricular drainage, patients with modified Graeb criteria score grade Ⅱ were treated with bilateral extra ventricular drainage or lumbar cistern drainage (GCS 9-12 group was more prior to lumbar cistern drainage, 3-8 group was given priority to extra ventricular drainage), and patients with modified Graeb criteria score grade Ⅰ were treated conservatively. In GCS 13-15 group, bilateral extra ventricular cerebral drainage or lumbar cistern drainage was performed if the modified Graeb criteria score grade was Ⅲ, lumbar cistern drainage or conservative treatment was performed if the modified Graeb criteria score grade was Ⅱ, and conservative treatment was performed if the modified Graeb criteria score grade was Ⅰ. The changes in GCS score at 1 month after individualized treatment and the favourable prognosis rate at 6 months after treatment were observed [favourable prognosis was defined as Glasgow outcome score (GOS) Ⅳ-Ⅴ] as well as the basic clearance time of intraventricular hematomas, and the occurrence of complications such as intracranial infection, pulmonary infection and hydrocephalus were recorded. Results 113 patients with intraventricular hemorrhage were enrolled in the final analysis, including 39 patients in GCS 13-15 group, 27 in 9-12 group, and 47 in 3-8 group;21 patients with the first grade of modified Graeb criteria score, 42 with the second grade and 50 with the third grade. At 1 month after individualized treatment, the GCS scores in GCS 13-15 and 9-12 groups were significantly higher than those at admission (14.8±0.2 vs. 13.7±0.8, 13.1±1.7 vs. 10.7±1.1, both P < 0.05). When comparing the GCS score of the same patient at admission with that of 1 month after treatment, the GCS scores of the three groups were significantly improved, indicating that the consciousness of patients with different coma levels at admission had been significantly improved after individualized treatment. The basic clearance time of intracerebroventricular hematomas in patients with the second grade of modified Graeb criteria score was (7.0±2.8) days, in patients with the third grade was (6.1±2.0) days. At 6 months after individualized treatment, among 113 patients, GOS score was grade Ⅰ in 7 patients (6.2%), grade Ⅱin 13 patients (11.5%), grade Ⅲ in 28 patients (24.8%), grade Ⅳ in 27 patients (23.9%), and grade Ⅴ in 38 patients (33.6%), with the favourable prognosis rate of 57.5% (65/113). Among 113 patients, intracranial infection occurred in 5 patients (4.4%), pulmonary infection in 22 patients (19.5%), hydrocephalus in 2 patients (1.8%) and rebleeding in 4 patients (3.5%). In 83 patients with lumbar cistern drainage, 1 patient had post-drainage infection (1.2%), 3 patients had plugging (3.6%), 6 patients had accidental drop of drainage tube (7.2%), and none of them had occipital macroforamen hernia after drainage. Seven of the 113 patients died including 2 patients died of cerebral hernia caused by rebleeding, 5 patients died of severe pneumonia or automatic discharge from hospital. Conclusion The combination of modified Graeb criteria score and GCS score can individualize treatment for patients with intraventricular hemorrhage and effectively improve the prognosis of patients with intraventricular hemorrhage.

Simultaneous Determination of 9 Components of Bufadienolide in Liushen Pills by HPLC / 中国药房

OBJECTIVE:To establish a method for simultaneous determination of gamabufotalin,arenobufagin,telocinobufa-gin,desacetylcinobufotalin,bufotalin,cinobufotalin,bufalin,cinobufagin and resibufogenin in Liushen pills. METHODS:HPLC method was adopted. The determination was performed on ODS-2 C18 column with mobile phase consisted of acetonitrile-0.15%phosphoric acid(gradient elution)at the flow rate of 1.0 mL/min. The detection wavelength was set at 296 nm,and column temper-ature was 40 ℃. The sample size was 10 μL. RESULTS:The linear ranges of gamabufotalin,arenobufagin,telocinobufagin,de-sacetylcinobufotalin, bufotalin, cinobufotalin,bufalin, cinobufagin and resibufogenin were 1.10-70.39 μg/mL(r=0.9996), 4.03-257.78 μg/mL(r=0.9999),4.09-261.89 μg/mL(r=0.9999),0.67-42.96 μg/mL(r=0.9999),3.36-214.73 μg/mL(r=0.9999), 5.73-366.44 μg/mL(r=0.9999),3.77-241.56 μg/mL(r=0.9999),7.31-468.11 μg/mL(r=0.9999),5.18-331.56 μg/mL(r=0.9999). The limits of quantitation were 1.10,0.85,1.02,0.34,0.84,1.43,0.94,3.66,2.59 μg/mL;the limits of detection were 0.27, 0.21,0.51,0.17,0.42,0.72,0.47,0.91,1.30 μg/mL,respectively. RSDs of precision,stability and reproducibility tests were all lower than 3.0%. The recoveries were 96.35%-103.10%(RSD=2.72%,n=6), 96.76%-103.24%(RSD=2.49%,n=6), 97.01%-101.39%(RSD=1.64%,n=6),97.32%-104.01%(RSD=2.61%,n=6),95.76%-103.60%(RSD=2.92%,n=6), 95.07%-102.59%(RSD=2.92%,n=6),95.77%-101.43%(RSD=2.03%,n=6),95.11%-103.72%(RSD=3.19%,n=6), 95.23%-103.34%(RSD=3.24%,n=6),respectively. CONCLUSIONS:The method is simple,rapid,accurate,reliable and can be used for the determination of bufadienolide in Liushen pills .

Identification and differentiation of major components in three different "Sheng-ma" crude drug species by UPLC/Q-TOF-MS

Cimicifugae Rhizoma (Sheng ma) is a Ranunculaceae herb belonging to a composite family and well known in China. has been widely used in traditional Chinese medicine. Thecontains three varieties ((Turcz.),L. andKom.) which have been used clinically as "Sheng-ma". However, the chemical constituents of three components of "Sheng-ma" have never been documented. In this study, a rapid method for the analysis of the main components of "Sheng-ma" was developed using ultra-high performance liquid chromatography with quadrupole-time-of-flight mass spectrometry (UPLC/Q-TOF-MS). The present study reveals the major common and distinct chemical constituents of,andand also reports principal component and statistical analyses of these results. The components were identified by comparing the retention time, accurate mass, mass spectrometric fragmentation characteristic ions and matching empirical molecular formula with that of the published compounds. A total of 32 common components and 8 markers for different "Sheng-ma" components were identified. These findings provide an important basis for the further study and clinical utilities of the three "Sheng-ma" varieties.

Effects of Different Drying Methods on Contents of 4 Active Ingredients in Leaves of Eucommia ulmoides / 中国药房

OBJECTIVE:To investigate the effects of different drying methods on contents of active ingredients in leaves of Eu-commia ulmoides,and provide reference for establishing its drying methods after habitat harvesting. METHODS:Different drying methods [natural drying in the shade for 72 h,natural drying in the sunlight for 36 h,drying beside or over a fire(60℃6 h,80℃2 h,100℃1 h,120 ℃ 0.5 h),microwave vacuum freeze drying for 12 h,vacuum freeze drying for 12 h] were used for process-ing. HPLC was conducted to determine the contents of aucubin,geniposidic acid,chlorogenic acid and geniposide in samples and compare with the untreated fresh products. RESULTS:Contents of 4 ingredients in samples after the 2 freeze drying were close to these in fresh samples,which were higher than samples after other drying. CONCLUSIONS:Drying methods show significant ef-fects on the effective ingredients in leaves of E. ulmoides. Compared with natural drying in the shade and natural drying sunlight and drying beside or over a fire,microwave vacuum freeze drying and vacuum freeze drying can make better retention of the active ingredients in fresh leaves of E. ulmoides.

Effects of Different Drying Methods on Contents of 4 Active Ingredients in Leaves of Eucommia ulmoides / 中国药房

OBJECTIVE:To investigate the effects of different drying methods on contents of active ingredients in leaves of Eu-commia ulmoides,and provide reference for establishing its drying methods after habitat harvesting. METHODS:Different drying methods [natural drying in the shade for 72 h,natural drying in the sunlight for 36 h,drying beside or over a fire(60℃6 h,80℃2 h,100℃1 h,120 ℃ 0.5 h),microwave vacuum freeze drying for 12 h,vacuum freeze drying for 12 h] were used for process-ing. HPLC was conducted to determine the contents of aucubin,geniposidic acid,chlorogenic acid and geniposide in samples and compare with the untreated fresh products. RESULTS:Contents of 4 ingredients in samples after the 2 freeze drying were close to these in fresh samples,which were higher than samples after other drying. CONCLUSIONS:Drying methods show significant ef-fects on the effective ingredients in leaves of E. ulmoides. Compared with natural drying in the shade and natural drying sunlight and drying beside or over a fire,microwave vacuum freeze drying and vacuum freeze drying can make better retention of the active ingredients in fresh leaves of E. ulmoides.

Screening technologies of pharmaceutical cocrystals:research advances / 国际药学研究杂志

Recently,the screening technologies of pharmaceutical cocrystals have become a research focus of improving drug solubility and stability. The technique changes medicine properties by intermolecular forces without changing the molecular structure , which provides new ways for the development of the insoluble drug. In addition,the formation of cocrystal gives new properties to drugs and intellectual property rights are effectively protected. This review focuses on screening technique ,which provides references for fur?ther studies of pharmaceutical cocrystal.

Some Key Problems during Quality Standard Research of Pieces of Chinese Crude Drugs / 世界科学技术-中医药现代化

Quality standard research of pieces of Chinese crude drugs is the important content of research of Chinese medicine processing, and it is also the key point of the whole standardization system of Chinese medicine. Although we have set up a preliminary quality standard system of pieces of Chinese crude drugs, it still under a low level. During the research of quality standard of pieces of Chinese crude drugs, we still face some problems, such as how to set up a more comprehensive, scientific, and reasonable quality standard. In this paper, we proposed some advices that we should pay more attention to traditional processing theories, processing mechanisms and effective substances during research of quality standard research of pieces of Chinese crude drugs.

Analysis of Chemical Components in Baihe Zhimu Tang and Its Single Herbs by High Performance Liquid Chromatography- Electrospray Ionization-Mass Spectrometry / 分析化学

A method was established for identifying the chemical components of a traditional Chinese medicinal formula Baihe Zhimu Tang and its single herbs by combining high performance liquid chromatography and electrospray ionization mass spectrometry(HPLC-ESI-MS). The molecular ions of compounds in both negative and positive modes were observed for molecule mass information, and the potential structures were identified by attentive studying on the mass spectra of compounds and comparing with Reference data and some of standards. The results show that in MS detection, saponins in Baihe Zhimu Tang and its single herbs are easily to become positive ions in the electrospray ionization procedure, and they have strong responses, but the mass spectrometric signals of flavonoids and phenolic glucosides are week. 38 compounds in Baihe Zhimu Tang including 3 flavonoids, 4 phenolic glucosides and 31 saponins were identified through analyzing and comparing the total ion chromatograms(TIC) and mass spectra of Baihe Zhimu Tang and its single herbs. This method has the advantages of simple operation, rapid measurement and it is a powerful tool for identification of chemical components in Baihe Zhimu Tang.