Clinical characteristics of choledocholithiasis combined with periampullary diverticulum and influencing factor analysis for difficult cannulation of endoscopic retrograde cholangiopan-creatography: a report of 1 920 cases / 中华消化外科杂志

Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.

Identification of Andrographis Herba and its common products using mini-barcode / 中国天然药物

Andrographis Herba, the aerial part of Andrographis paniculata (Burm. f.) Wall. ex Nees (Acanthaceae), has a wide geographic distribution and has been used for the treatment of fever, cold, inflammation, and other infectious diseases. In markets, sellers and buyers commonly inadvertently confuse with related species. In addition, most Chinese medicinal herbs are subjected to traditional processing procedures, such as steaming and boiling, before they are sold at dispensaries; therefore, it is very difficult to identify Andrographis Herba when it is processed into Chinese medicines. The identification of species and processed medicinal materials is a growing issue in the marketplace. However, conventional methods of identification have limitations, while DNA barcoding has received considerable attention as a new potential means to identify species and processed medicinal materials. In this study, 17 standard reference materials of A. paniculata, 2 standard decoctions, 27 commercial products and two adulterants were collected. Based on the ITS2 sequence, it could successfully identify A. paniculata and adulterants. Moreover, a nucleotide signature consisting of 71 bp was designed, this sequence is highly conserved and specific within A. paniculata while divergent among other species. Then, we used these new primers to amplify the nucleotide signature region from processed materials. In conclusion, the DNA barcoding method developed in the present study for authenticating A. paniculata is rapid and cost-effective. It can be used in the future to guarantee the quality of Andrographis Herba of each regulatory link for clinical use.

Role of N / 临床肝胆病杂志

The phenomenon of N 6 -methyladenosine (m 6 A)-methylation is commonly observed in various tissues and cells of the human body and is the most common type of internal modification in eukaryotic mRNA. m 6 A-methylation is dynamic and reversible, which is regulated by various methyltransferases, demethylases, and m 6 A binding protein. Recent studies have shown that m 6 A modification can affect viral gene expression and plays an important role in the process of HBV infection. This article summarizes the current research status and mechanism of m 6 A-methylation, especially its association with HBV infection. This article also elaborates on the effect of m 6 A modification on HBV transcripts, reviews the research findings of m 6 A in immune response of HBV infection, and summarizes the effect of HBV infection on m 6 A modification in normal host hepatocytes and hepatitis B liver cancer, so as to discuss the development direction and potential value of m 6 A in HBV infection.

Research progress on mechanism of phytohormones in regulating flavonoid metabolism / 中国中药杂志

Phytohormones play an important role at all stages of plant growth, influencing plant growth and development and regulating plant secondary metabolism, such as the synthesis of flavone, flavonol, anthocyanin, and other flavonoids. Flavonoids, a group of important secondary metabolites ubiquitous in plants, have antioxidative, anti-microbial, and anti-inflammatory activities and thus have a wide range of potential applications in Chinese medicine and food nutrition. With the development of biotechnology, phytohormones' regulation on flavonoids has become a research focus in recent years. This study reviewed the research progress on the mechanism of common phytohormones, such as abscisic acid, gibberellin, methyl jasmonate, and salicylic acid, in regulating flavonoid metabolism, and discussed the molecular mechanism of the synthesis and accumulation of flavonoids, aiming at clarifying the key role of phytohormones in modulating flavonoid metabolism. The result is of guiding significance for improving the content of flavonoids in plants through rational use of phytohormones and of reference value for exploring the mechanism of hormones in regulating flavonoid metabolism.

Analysis of clinical data of 3 cases of hemophagocytic syndrome and literature review / 中国基层医药

Objective:To analyze the clinical characteristics, diagnosis, treatment and prognosis of three children with hemophagocytic syndrome (HPS) and provide diagnosis and treatment clues for reasonable treatment and prevention of serious complications and reduction of misdiagnosis and mistreatment.Methods:The clinical data of three children with HPS who received treatment in Taiyuan Maternal and Child Health Care Hospital from March 2018 to March 2020 were retrospectively analyzed. Related literature was retrieved. The clinical data of the three children were summarized to analyze the outcomes.Results:Fever (≥ 39 ℃) was the first symptom in all three cases. In the end, red blood cell line, white blood cell line, and platelet line were reduced to different degrees in all three cases. Hepatosplenomegaly was found in two cases. Transaminase highly increased in two cases, and slightly increased in one case. Ferritin greatly increased, fibrinogen decreased, and hypertriglyceridemia did not occur in all three cases. Two cases had skin rash during fever. Skin rash appeared late in one of them.All three cases had different degrees of lymphadenopathy. Bone puncture examination showed reticulocyte phagocytosis in bone marrow in one case and leishmania in bone marrow smear in another case. These two cases were cured and discharged. One case died of multiple organ failure due to rapid disease progression, and adrenal masses were found at autopsy.Conclusion:HPS has diverse clinical manifestations, complex etiology and different clinical prognoses. HPS should be considered in case of unexplained fever with hemocytopenia. The medical history and living history should be inquired in detail and relevant auxiliary examinations should be improved as soon as possible.

Effect of intensive intervention for improving the referral rate among preschoolers with vision abnormalities / 中国学校卫生

Objective@#To explore effect of intensive intervention for improving the referral rate of children with visual refractive disorders, and to provide a reference for myopia prevention and control of children and adolescents.@*Methods@#A total of 4 464 preschool children were selected from Zhuanqiao county, Minghang district in Shanghai for the eyesight investigation during April to June in 2019. Stratified random cluster sampling method was used to divide 1 724 children into intervention group and (896) control group (828) depending on the type of kindergartens. The intervention group was provied with an intensive intervention, including children s vision health assessment, parental self management guidance for children s eye care, and community based eye care services, while the control group carried out routine intervention measures.@*Results@#In 2019, the incidence of visual and primary refractive screen abnormalities in preschoolers of Zhuanqiao community was 38.62%. The incidence of naked eye vision abnormalities was 4.40%, the incidence of myopia risk group, hyperopia risk group and astigmatism risk group was 37.10%, 2.20%, and 6.10 %, respectively. After the intervention, the referral rate of the intervention group (68.75%) was significantly higher than that of the control group (17.15%)( χ 2=465.09, P <0.01). The differences between two groups were statistically significant in choosing the hospital for treatment ( χ 2=10.01, 51.51, 15.40, 27.79, 19.96, 24.24, P <0.01).@*Conclusion@#The vision and refractive status of preschoolers worths further attention. Intensive intervention can improve the referral rate for children with screened vision abnormalities, which facilitates the prevention and early diagnosis of vision problems among preschoolers.

Regulation of β-mercuryl alcohol metabolic flow in Saccharomyces cerevisiae cells / 中国中药杂志

In this study, citrate synthase gene(CIT2), and malate synthase gene(MLS1) were successfully knocked out in β-amyrin-producing yeast cells by using CRISPR/CAS9. The promoter of phosphoglucose isomerase gene(PGI1) was replaced by that of cytochrome c oxidase subunit Ⅶa(Cox9)to weaken its expression, aiming to channel more carbon flux into the NADPH-producing pathway. The fermentation results showed that CIT2 deletion had no effect on the β-amyrin production. Compared with the control strain, the production of β-amyrin was increased by 1.85 times after deleting MLS1, reaching into 3.3 mg·L~(-1). By replacing the promoter of PGI1, the β-amyrin yield was 3.75 times higher than that of the control strain, reaching up to 6.7 mg·L~(-1). This study successfully knocked out the CITT2 and MLS1 genes and weakened the PGI1 gene by using CRISPR/CAS9, which directly influenced the production of β-amyrin and provided some reference for the the metabolic engineering of triterpernoid producing strain.

Analysis of Flavonoid Content and Key Gene Expressions in Sprout and Seedling of Tartary Buckwheat / 中国实验方剂学杂志

Objective:To reveal the dynamic changes of flavonoids secondary metabolites and relevant genes expressions in the process of germination of tartary buckwheat seeds by investigating the content of catechins，epicatechins，rutin，and quercetin，and the expressions of their relevant genes in tartary buckwheat sprouts and seedlings，in order to provide scientific basis for the selection of high-quality, high-nutrition tartary buckwheat sprouts.Method:Contents of catechin，epicatechin，rutin，and quercetin in tartary buckwheat sprouts and seedlings were detected by UPLC-ESI-QQQ-MS，and the expression levels of genes relating to flavonoids synthesis in tartary buckwheat sprouts and seedlings were detected by real-time quantitative PCR.Result:There were differences between tartary buckwheat sprouts and seedlings in the relative contents of catechin，epicatechin，rutin and quercetin，as well as the expressions of relevant genes in the synthesis pathway, including FtPAL，FtC4H，Ft4CL，FtCHS，FtCHI，FtF3H，FtF3'H，FtFLS，FtDFR，FtLAR，FtANS，FtANR. The contents of flavonoids and the expressions of relevant genes in tartary buckwheat sprouts were higher than those in tartary buckwheat seedlings.Conclusion:The higher accumulation of secondary metabolites and flavonoids in tartary buckwheat sprouts may be related to tartary buckwheat seeds' resistance to the external environment in the initial growth stage of germination. From the perspective of application，there are more flavonoids in tartary buckwheat sprouts than in tartary buckwheat seedlings, indicating that tartary buckwheat sprouts have a higher nutritional value.

Determination of Biflavones in Ginkgo biloba Leaves of Different Ages by UPLC-TQ-MS / 中国实验方剂学杂志

Objective: To establish an ultra-high performance liquid chromatography coupled with triple quadrupole mass for the determination of five biflavones. Method: Chromatographic separation was carried out on a ACQUITY UPLC BEH C18 column (2.1 mm×100 mm,1.7 μm) with gradient elution of acetonitrile and 0.10%formic acid at a flow rate of 0.3 mL·min-1,and the column temperature was set at 35℃. Result: Amentoflavone,bilobetin,ginkgetin,isoginkgetin,sciadopitysin showed a good linearity within the ranges of 0.02-13.20 mg·L-1(r=0.996 3),0.05-23.60 mg·L-1(r=0.995 5),0.09-18.60 mg·L-1(r=0.992 7),0.10-21.00 mg·L-1(r=0.998 8),0.06-16.00 mg·L-1(r=0.996 7),with average recoveries of 101.50%,98.78%,97.59%,97.24%,101.09%, and RSDs of 2.7%,2.7%,3.1%,2.8%,1.3%. The contents of amentoflavone,bilobetin,ginkgetin,isoginkgetin,sciadopitysin ranged between 121.30-434.74,268.39-847.14,251.80-1 297.10,195.87-691.10,477.48-3 003.90 μg·g-1. The total biflavones ranged between 1 474.45-5 635.40 μg·g-1. It shows a certain regularity that the low-vinegar leaves contain higher total flavonoids,and the total flavonoid content gradually decreases with the increase of tree age. Conclusion: The method was simple, and can be used for qualitative and quantitative analysis of biflavones.

Suspension Culture and Alkaloid Content of Pinelliae Rhizoma Tuber Under Stimulation of Salicylic Acid / 中国实验方剂学杂志

Objective: To study the suspension culture of tuber and its alkaloid content based on the stimulation of salicylic acid. Method: The tubers of Pinelliae Rhizoma in suspension tube were treated with different concentrations of exogenous salicylic acid to analyze the growth status. The content of alkaloids in tuber was detected by HPLC. Test conditions:chromatographic column for Agilent Eclipse plus C18 column (4.6 mm×250 mm,5 μm),mobile phase of acetonitrile water(4:96),the column temperature was maintained at 35℃,detection wavelength for inosine 250 nm,guanosine 260 nm,volume flow rate 1.0 mL·min-1. Result: The results showed that the exogenous salicylic acid had a certain effect on the growth of suspension tuber of Pinelliae Rhizoma. When the salicylic acid concentration was 150 μmol·L-1,the culture lasted for 25 days and the fresh weight reached the maximum value of 7.483 8 g. It also accumulates a certain amount of alkaloids. The linear range of guanosine was 0.03-0.45 μg (R2=0.999 6). After 10-days cultivatation in the salicylic acid concentration of 50 μmol·L-1,guanosine content of Pinelliae Rhizoma tubers reached a maximum of 1.353 3 mg·g-1. The linear range of inosine 0.003-0.045 μg (R2=0.999 5). When the salicylic acid concentration was 200 μmol·L-1,cultured for 30 days,the content of inosine in Pinelliae Rhizoma tubers reached the maximum value of 0.149 8 mg·g-1. Conclusion: The results of this experiment provide a reference for the study of tissue culture and rapid propagation of Pinelliae Rhizoma tubers and regulation of alkaloids,which are of great significance for the development of Pinelliae Rhizoma industry.

Analysis of SCN4A gene variation in a Chinese pedigree affected with skeletal muscle sodium channelopathies / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical features of a Chinese pedigree affected with skeletal muscle sodium channelopathies due to variation of SCN4A gene.@*METHODS@#Potential variation of the 24 exons of the SCN4A gene was screened using PCR and Sanger sequencing.@*RESULTS@#Four family members were affected with the disease in an autosomal dominant inheritance pattern. Three patients had normekalemic periodic paralysis, while 1 showed paramyotonia congenita. Genetic analysis detected a missense variation c.2078T>C (p.Ile693Thr) in exon 13 of the SCN4A gene in the proband and other 3 affected relatives.@*CONCLUSION@#Normokalemic periodic paralysis and paramyotonia congenita can occur in different family members with skeletal muscle sodium channelopathies due to c.2078T>C(p.Ile693Thr) variation of SCN4A gene.

Study of heterologous efficient synthesis of β-amyrin and high-density fermentation / 中国中药杂志

In this study, the synthetic pathway of β-amyrin was constructed in the pre-constructed Saccharomyces cerevisiae chassis strain Y0 by introducing β-amyrin synthase from Glycyrrhiza uralensis, resulting strain Y1-C20-6, which successfully produced β-amyrin up to 5.97 mg·L~(-1). Then, the mevalonate pyrophosphate decarboxylase gene(ERG19), mevalonate kinase gene(ERG12), 3-hydroxy-3-methylglutaryl-CoA synthase gene(ERG13), phosphomevalonate kinase gene(ERG8) and IPP isomerase gene(IDI1)were overexpressed to promoted the metabolic fluxto the direction of β-amyrin synthesis for further improving β-amyrin production, resulting the strain Y2-C2-4 which produced β-amyrin of 10.3 mg·L~(-1)under the shake flask fermentation condition. This is 100% higher than that of strain Y1-C20-6, illustrating the positive effect of the metabolic engineering strategy applied in this study. The titer of β-amyrin was further improved up to 157.4 mg·L~(-1) in the fed-batch fermentation, which was almost 26 fold of that produced by strain Y1-C20-6. This study not only laid the foundation for the biosynthesis of β-amyrin but also provided a favorable chassis strain for elucidation of cytochrome oxidases and glycosyltransferases of β-amyrin-based triterpenoids.

Investigation and optimization on ability of enzymatic hydrolysis of Mori Cortex residue / 中国中药杂志

Residue of Mori Cortex was studied to optimize its enzymatic hydrolysis process, and explore its potential as a carbon source for biochemistry and biofuel production. The cellulose content of diluted acid pretreated (DAP) and non-pretreated from Mori Cortex were measured in this study, and the results showed that the cellulose content of DAP and non-pretreated from Mori Cortex were 52.5% and 47%, respectively. This higher cellulose content indicated that residue of Mori Cortex had the potential to act as a carbon source for biochemistry and biofuel production. Enzymatic hydrolysis of pretreated and non-pretreated from Mori Cortex was conducted under different enzyme loading amount. 40 FPU·(g DW）⁻¹ enzyme loading was determined as the optimal amount by comparing the yield of sugar and the rate of enzymolysis. Under this condition, the concentrations of glucose, xylose, arabinose sugar were 23.82, 4.84, 3.6 g·L⁻¹, and the corresponding enzymatic hydrolysis rate was 45.33% which was 2.3 times higher than that of non-pretreated from Morus alba residues. Fed-batch enzymatic hydrolysis was conducted finally to get higher sugar yield, and the final glucose concentration reached up to 38 g·L⁻¹ with the enzymatic hydrolysis rate of 36.19%. The results indicated that Mori Cortex residue had higher cellulose and hemicellulose contents, so it had the potential to become a carbon source to produce the bio-chemicals and biofuels. Through enzymatic hydrolysis, it can be converted into microbial available monosaccharides; and through fermentation, it can be converted into high value-added chemicals, biofuels, etc., to solve the problem of residue pollution, and achieve the sustainable development and greening of Chinese pharmaceutical production process.

Influence of light on gene expression of key synthesis enzyme genes FtANR and FtLAR about proanthocyanidin in seeds of homologous plant of food and medicine Fagopyrum tataricum / 中国中药杂志

Tartary buckwheat Fagopyrum tataricum is an important medicinal and functional herb due to its rich content of flavonoids in the seeds. F.tataricum exhibited good functions for free radicals scavenging， anti-oxidation， anti-aging activities. Although much genetic knowledge of the synthesis， regulation， accumulation of rutin， the genetic basis of proanthocyanidins(PAs) in tartary buckwheat and their related gene expression changes under different lights(blue， red， far red， ultraviolet light) remain largely unexplored. In this study， we cloned one anthocyanidin reductase gene(ANR) and two leucocyanidin reductase gene(LAR) named FtANR，FtLAR1，FtLAR3 involved in formation of(+)-catechin and(-)-epicatechin precusor proanthocyanidin by digging out F. tataricum seed transcriptome data. The expression data showed that the opposite influence of red light on these gene transcript level compared to others lights. The expression levels of FtANR and FtLAR1 decreased and FtLAR3 appeared increment after exposed in the red light， while the expression levels of those genes appeared opposite result after exposed in the blue and far red light.

Identification of bear bile powder and its adulterants by using DNA barcoding technology / 中国中药杂志

To identify the precious bile powder and its adulterants by DNA barcoding, and establish its standard experimental process to ensure the safe and effective utilization. Total twelve sequences from samples of bear bile powder which come from Ursus thibetanus for DNA extraction, PCR(polymerase chain reaction) and sequence, then using CodonCode Aligner V 7.0.1 shear primer region to obtain COI sequence. The COI sequences of U. arctos and their adulterants were obtained from GenBank. MEGA7.0 software was applied for analyzing mutation, calculating intraspecific and interspecific K2P(Kimura 2-Parameter) genetic distance and constructing the Neighbor-joining tree(NJ). The results showed that the maximum K2P genetic distance of bear bile powder of U. thibetanus and U. arctos are far less than minimum K2P genetic distance within its adulterants species, and the results of NJ tree demonstrated that each species could be distinguished from the counterfeits obviously. DNA barcoding is a safe, convenient and reliable technique for species identification, and it is important to establish the standard sequence of COI sequences for animal medicines.

Endoscopic radiofre-quency ablation combined with metal stent implantation and simple metal stent implan tation forunrespectable cholangiocarcinoma / 实用医学杂志

Objective To retrospectively analyze the therapeutic effect of endoscopic ablation combined with metal stent implantationon biliary obstruction caused by unrespectable cholangiocarcinoma. Methods Fourty-seven patients with unrespectable cholangiocarcinoma were enrolled in this study ,who were treated in our department from June 2013 to June 2016. Patients in the experimental group(n = 24)underwent ERCP combined with metal stent implantation for biliary tract ablation. Patients inthe control group(n=23)underwent ERCP with simple metal stent implantation. Liver function indicators,complications,patency rate and survival rate were analyzed between the two groups. Results A total of 51 patients were satisfactorily performed the operation of metal stent implantation. One week after operation,the levels of total bilirubin(TBIL),alkaline phosphatase(ALP),gamma-glu-tamyltransferase(GGT)and alanine aminotransferase(AST)in the experimental group were much lower than those in the control group(P<0.05,respectively). After 3-month follow-up,the patency rate in the experimental group was significantly greater than that in the control group(P<0.05). The patency and survival time of patients in the experimental group were significantly higher than thosein the control group ,with 8.56 ± 1.12 vs 5.73 ± 0.81 months and 13.88±1.45 vs 9.48±1.38 months,respectively(P<0.05). No postoperative bleeding,perforation and other se-rious complications were found in all cases,8 patients with postoperative biliary tract infection and the increased blood amylase received anti-infective treatments,such as inhibition of symptomatic improvement after treatment. Conclusion The results of endoscopic radiofrequency ablation combined with metal stent implantation for the treatment of unrespectable cholangiocarcinoma were significantly better than those of simple metal stent implantation.

Simultaneous determination of six constituents in Xuanmai Ganju Granules by HPLC / 中成药

AIM To establish an HPLC method for the simultaneous content determination of six constituents in Xuanmai Ganju Granules (Scrophulariae Radix,Ophiopogonis Radix,Glycyrrhizae Radix et Rhizoma,Platycodonis Radix).METHODS The analysis of 80％ methanol extract of this drug was performed on a 35 ℃ thermostatic ZORBAX SB-C18 column (4.6 mm × 250 mm,5 μm),with the mobile phase comprising of acetonitrile0.1％ phosphoric acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelengths were set at 210,250,278 nm.RESULTS Harpagide,liquiritin apioside,liquiritin,harpagoside,cinnamic acid and glycyrrhizic acid showed good linear relationships within the ranges of 2.177-43.539 μg/mL(r =0.999 6),1.713-34.261 μg/mL (r =0.999 5),1.946-38.916 μg/mL(r =0.999 6),2.070-41.395 μg/mL(r =0.999 7),2.06-41.2 pg/mL (r =0.999 6) and 3.623-72.454 μg/mL (r =0.999 6),whose average recoveries (RS-Ds) were96.08％ (2.1％),95.55％ (2.5％),95.04％ (2.6％),94.86％ (2.7％),95.70％ (1.9％) and 95.47％ (1.9％),respectively.CONCLUSION This simple and accurate method can be used for the quality control of Xuanmai Ganju Granules.

Rapid identification of Gekko gecko by loop-mediated isothermal amplification based on 12S rRNA sequence / 中国中药杂志

Gekko gecko (Tokay Gecko) is a valuable traditional Chinese medicine. In this study, the loop-mediated isothermal amplification (LAMP) technique was introduced for visual rapid identification of G. gecko from adulterants. A total of sixty-five 12S rRNA sequences of fourteen species of G. gecko and its adulterants were obtained. The results showed that G. gecko could be identified from its adulterants through BLAST analysis based on 12S rRNA regions. The 12S rRNA sequences of ten batches of G. gecko were conserved. There were only two haplotypes and three variation sites in the available regions for primers design. Six specific LAMP primers were successfully designed online based on 12S rRNA sequences. The visual rapid detection of G. gecko could be achieved with the optimized conditions (64 °C for 1 h and 80 °C for 5 min). And the required minimal template concentration was 5 μg·L⁻¹ while conventional PCR with 0.5 mg·L⁻¹. Consequently, the LAMP method established from this study was rapid, specific, highly sensitive, and simple. It could be applied to detect G. gecko from its adulterants efficiently.

Influence of secondary turntable abdomen insulin injection positioning ruler on blood glucose and com-plications in patients with diabetes mellitus / 心血管康复医学杂志

Objective:To explore influence of secondary turntable abdomen insulin injection positioning ruler (STAI-IPR)on blood glucose level and complications in aged patients with diabetes mellitus (DM).Methods:A total of 120 aged DM patients treated in our hospital from Jan 2016 to Dec 2016 were selected.According to random number ta-ble,patients were randomly and equally divided into random rotation group (received random rotated injection)and STAIIPR group (received positioning injection by STAIIPR),both groups were injected for 1000 times.Levels of fasting blood glucose (FBG)and 2h postprandial blood glucose (2hPG)before and after treatment,pain score and incidence of complications after treatment were observed and compared between two groups.Results:Compared with before treatment,there were significant reductions in levels of FBG and 2hPG in both groups after treatment, P =0.001 all.Compared with random rotation group after treatment,there were significant reductions in levels of FBG [(6.58±1.07)mmol/L vs.(5.67±1.58)mmol/L],2hPG [(9.35±1.59)mmol/L vs.(8.41±1.27)mmol/L]and incidence rate of complications (20.0% vs.5.0%);and significant rise in percentage of 0 pain score (30.0% vs.55.0%)in STAIIPR group,P <0.05 or <0.01. Conclusion:Insulin injection by STAIIPR can disperse injection point without overlap.It can effectively control blood glucose level,reduce complications of injection sites and is easy for patients to do it themselves in aged DM patients,which is worth clinical extension.

Influence of secondary turntable abdomen insulin injection positioning ruler on blood glucose and com-plications in patients with diabetes mellitus / 心血管康复医学杂志

Objective:To explore influence of secondary turntable abdomen insulin injection positioning ruler (STAI-IPR)on blood glucose level and complications in aged patients with diabetes mellitus (DM).Methods:A total of 120 aged DM patients treated in our hospital from Jan 2016 to Dec 2016 were selected.According to random number ta-ble,patients were randomly and equally divided into random rotation group (received random rotated injection)and STAIIPR group (received positioning injection by STAIIPR),both groups were injected for 1000 times.Levels of fasting blood glucose (FBG)and 2h postprandial blood glucose (2hPG)before and after treatment,pain score and incidence of complications after treatment were observed and compared between two groups.Results:Compared with before treatment,there were significant reductions in levels of FBG and 2hPG in both groups after treatment, P =0.001 all.Compared with random rotation group after treatment,there were significant reductions in levels of FBG [(6.58±1.07)mmol/L vs.(5.67±1.58)mmol/L],2hPG [(9.35±1.59)mmol/L vs.(8.41±1.27)mmol/L]and incidence rate of complications (20.0% vs.5.0%);and significant rise in percentage of 0 pain score (30.0% vs.55.0%)in STAIIPR group,P <0.05 or <0.01. Conclusion:Insulin injection by STAIIPR can disperse injection point without overlap.It can effectively control blood glucose level,reduce complications of injection sites and is easy for patients to do it themselves in aged DM patients,which is worth clinical extension.