Resection of superior polar gland flap of the breast combined with dual plane augmentation through Omega nipple root approach / 中华医学美学美容杂志

Objective:To investigate the feasibility of superior polar gland flap resection combined with biplanar augmentation mammoplasty through the root of the nipple to correct pseudoptosis/mild breast ptosis.Methods:From January 2019 to January 2021, 20 patients (40 breasts) with pseudoptosis/mild breast ptosis underwent augmentation mammoplasty with superior polar gland flap through the root of the nipple and microvilli anatomical silica gel prosthesis.Results:No postoperative complications such as hematoma infection, capsular contracture and abnormal sensation of the nipple and areola were found in 20 patients. During the follow-up of 3 to 18 months, the patients' breasts were plump and straight, the appearance was good, and the prolapse was basically corrected. Postoperative satisfaction was achieved in 20 cases (95%), and the satisfaction of incision scar was 100%.Conclusions:The comprehensive surgery restores the normal anatomical suspension system of the breast, achieves a long-term mechanical stable balance among prosthesis, muscle, breast gland and skin, and receives high satisfaction with breast shape after operation.

Progress in the treatment of diffuse idiopathic skeletal hyperostosis combined with thoracolumbar fracture / 国际外科学杂志

Diffuse idiopathic skeletal hyperostosis(DISH) is a kind of ankylosing spinal disease, which usually occurs in the middle-aged and elderly. It is mainly manifested as ossification and calcification of ligaments and tendon attachment points. It is a bone disease that mainly involves the spine but is not accompanied by severe intervertebral disc degeneration or sacroiliac joint and intervertebral facet joint ankylosis. DISH combined with thoracolumbar fracture has a high rate of delayed diagnosis and neurological deterioration, so this kind of fracture should be diagnosed and treated in time. However, there are different conclusions on the choice of treatment methods and postoperative efficacy, and there are still disputes in some academic aspects.The author consulted the relevant literature and reviewed the treatment methods of DISH combined with thoracolumbar fracture in order to provide reference for the clinical treatment of this kind of fracture.

Variations of glucose content in Massa Medicata Fermentata during processing based on quantitative proton nuclear magnetic resonance / 中国中药杂志

A quantitative proton nuclear magnetic resonance(qHNMR) method was established to determine the glucose content in commercially available Massa Medicata Fermentata(MMF) products and explore the variations of glucose content in MMF products during processing. The qHNMR spectrum of MMF in deuterium oxide was obtained with 2,2,3,3-d_4-3-(trimethylsilyl) propionate sodium salt as the internal standard substance. With the doublet peaks of terminal hydrogen of glucose with chemical shift at δ 4.65 and δ 5.24 as quantitative peaks, the content of glucose in MMF samples was determined. The glucose content showed a good linear relationship within the range of 0.10-6.44 mg·mL~(-1). The relative standard deviations(RSDs) of precision, stability, repeatability, and recovery for determination were all less than 2.3%. The glucose content varied in different commercially available MMF samples, which were associated with the different fermentation days, wheat bran-to-flour ratios, and processing methods. The glucose content in MMF first increased and then decreased over the fermentation time. Compared with the MMF products fermented with wheat bran or flour alone, the products fermented with both wheat bran and flour had increased glucose. The glucose content of bran-fried MMF was slightly lower than that of raw MMF, while the glucose content in charred MMF was extremely low. In conclusion, the qHNMR method established in this study is simple, fast, and accurate, serving as a new method for determining the glucose content in MMF. Furthermore, this study clarifies the variations of glucose content in MMF during processing, which can not only indicate the processing degree but also provide a scientific basis for revealing the fermentation mechanism and improving the quality control of MMF.

Risk factors and countermeasures of re-fracture of the injured vertebrae after vertebral augmentation for osteoporotic thoracolumbar fractures / 中华创伤杂志

Re-fracture of the injured vertebrae is a serious complication after vertebral augmentation for osteoporotic thoracolumbar fractures (OTLF), manifested by recurrent lower back pain, limitation of spinal motion and increased retroflexion deformity. The clinical treatment of re-fracture of the injured vertebrae is difficult, and some patients even need spinal function reconstruction to stabilize the fractured vertebrae, which has a serious impact on their postoperative rehabilitation, quality of life and economic burdens. Re-fracture of the injured vertebrae after vertebral augmentation for OTLF is closely related to patient factors, bone cement factors and perioperative factors. To this end, the authors discuss the risk factors for re-fracture of the injured vertebrae after vertebral augmentation for OTLF and propose corresponding management methods to provide a reference for understanding the risk of re-fracture of the injured vertebrae and improving the clinical treatment.

Unilateral secondary puncture percutaneous vertebroplasty for acute symptomatic osteoporotic thoracolumbar fractures of type ⅡA / 中华创伤骨科杂志

Objective:To explore the clinical effects of unilateral secondary puncture percutaneous vertebroplasty (PVP) in the treatment of type ⅡA acute symptomatic osteoporotic thoracolumbar fractures (ASOTLF).Methods:A retrospective case-control study was conducted to analyze the clinical data of 193 patients with type ⅡA ASOTLF who had been admitted to Department of Spine Surgery, Honghui Hospital from February 2016 to October 2018. They were 71 males and 122 females, aged from 65 to 90 years [average, (73.9±4.3) years]. The segments injured were T10 in 21 cases, T11 in 27 cases, T12 in 44 cases, L1 in 48 cases, L2 in 29 cases, L3 in 14 cases, and L4 in 10 cases. Of them, 85 received unilateral secondary puncture PVP (observation group) and 108 did not (control group). The clinical effects were evaluated by comparing between the 2 groups the operation time, bone cement injection volume, intraoperative blood loss, hospital stay, and visual analogue scale (VAS) for back pain, spinal Oswestry disability index (ODI), anterior height of the injured vertebral body (AH) and kyphosis angle (KA) of the injured vertebra before operation, at 3 days after operation and the last follow-up. The bone cement leakage and fracture of adjacent vertebral body were observed.Results:All patients were followed up for 12 to 24 months (average, 15.8 months). There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The operation time and bone cement injection volume [(36.2±1.4) min and (5.5±0.7) mL] in the observation group were significantly longer or more than those in the control group [(32.3±1.7) min and (4.0±0.7) mL] ( P<0.05). There was no significant difference in the hospital stay or intraoperative blood loss between the 2 groups ( P>0.05). The VAS, ODI, AH and KA at 3 days after operation and the last follow-up were significantly improved compared with those before operation in both groups ( P<0.05). There was no significant difference in VAS, ODI, AH or KA between the 2 groups before operation or at 3 days after operation ( P>0.05). However, the VAS, ODI, AH and KA at the last follow-up in the observation group [(2.2±0.8) points, 19.2%±5.8%, (2.90±0.21) cm, and 12.2°±1.5°] were better than those in the control group [(3.1±0.9) points, 22.8%±5.3%, (2.41±0.15) cm, and 13.3°±1.2°]. There was no significant difference between the 2 groups in the incidence of postoperative bone cement leakage or that of adjacent vertebral fracture ( P>0.05). Conclusions:In the treatment of type ⅡA ASOTLF, unilateral secondary puncture PVP can result in satisfactory clinical effects, because it effectively promotes dispersion of bone cement and prevents re-collapse of the vertebra operated but does not increase the risks of bone cement leakage and adjacent vertebral fracture.

Identification of Q-Markers from Hedan Tablet by employing “spider-web” mode and taking compounds’ hepatotoxicity into account / 中草药·英文版

Objective: Due to the complicated compounds and the synergistic effect of multi-compounds, the quality control and assessment of Chinese materia medica (CMM) encounters a great challenge about how to identify the key compounds, which are directly correlated with its efficacy and safety. On the guidance of study on quality marker (Q-Marker), identification of Q-Markers was performed from Hedan Tablet (HDT) by the aid of the “spider-web” mode and hepatotoxicity evaluation derived from our previous researches and literatures. Methods: By the established ultra performance liquid chromatography with photodiode array detector (UPLC-PDA) method, online UPLC-DPPH· and offline antioxidant assay, 21 candidate compounds of HDT were systematically investigated and comprehensively evaluated by the “spider-web” mode for them properties of Q-Marker based on “content-stability-activity”. In addition, the Q-Markers related with hepatotoxicity based on our previous researches and literatures were identified. Results: Salvianolic acid B (SaB), quercetin-3-O-glucuronide (Qug), isoquercitrin (IQ) and hyperoside (Hyp) were adopted as the preferable Q-Markers of HDT according to the shaded area (A) of tested compounds in “spider-web” mode. Psoralen (Ps), isopsoralen (IP), psoralenoside (PO) and isopsoralenoside (IPO) were also strongly recommended as Q-Markers closely related with safety by considering hepatotoxicity of the accumulated Ps and IP and conversion between glycoside (PO and IPO) and aglycone (Ps and IP). Conclusion: This study provided scientific evidence for quality control and assessment of HDT, and also provided a meaningful reference for application of Q-Markers in CMM.

Risk factors for proximal junctional kyphosis after posterior long-segment internal fixation of chronic symptomatic osteoporotic thoracolumbar fracture in the elderly / 中华创伤杂志

Objective:To investigate the risk factors associated with the occurrence of proximal junctional kyphosis (PJK) after posterior long-segment internal fixation for type IV chronic symptomatic osteoporotic thoracolumbar fracture (CSOTLF) in the elderly.Methods:A case-control study was used to analyze the clinical data of 95 elderly patients with type IV CSOTLF treated in Honghui Hospital affiliated to Xi′an Jiaotong University from January 2013 to June 2018, including 32 males and 63 females, aged from 60 to 85 years［(67.4±6.5) years］. Injured segments were T 11 in 17 patients, T 12 in 37, L 1 in 30 and L 2 in 11. All patients were treated with posterior long-segment internal fixation and divided into PJK group ( n=30) and non-PJK group ( n=65) according to whether PJK occurred after surgery. Univariate analysis was performed for the correlation of the following indices with the incidence of postoperative PJK, including general information such as gender, age, body mass index (BMI), bone mineral density (BMD), history of smoking, cause of injury, comorbidities, injury segments, American Spinal Injury Association (ASIA) classification and time from injury to surgery, preoperative imaging data such as posterior junctional angle (PJA), sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis difference (PI-LL), pelvic tilt (PT) and sacral slope (SS), basic surgical data such as posterior ligament complex (PLC) injury, location of upper instrumented vertebrae (UIV), location of lower instrumented vertebrae (LIV) and number of fixed segments. Multifactorial Logistic regression analysis was used to measure the independent risk factors associated with the occurrence of postoperative PJK. Results:Univariate analysis showed that the incidence of postoperative PJK was correlated with age, BMI, BMD, preoperative PJA, preoperative SVA, preoperative PI-LL, PLC injury, location of UIV, location of LIV and number of fixed segments (all P<0.05), rather than gender, history of smoking, cause of injury, comorbidities, injury segments, ASIA classification, time from injury to surgery, preoperative PT and preoperative SS (all P>0.05). Multifactorial Logistic regression analysis showed that age ≥70 years ( OR=32.28, 95% CI 3.83-272.29, P<0.01), BMI>28.0 kg/m 2 ( OR=7.88, 95% CI 1.63-37.99, P<0.01), BMD T value<-3.5 SD ( OR=20.84, 95% CI 2.36-183.93, P<0.01), preoperative PI-LL>20° ( OR=13.30, 95% CI 1.54-113.87, P<0.05) and PLC injury ( OR=13.98, 95% CI 1.37-142.34, P<0.05) were significantly associated with the occurrence of postoperative PJK. Conclusions:Age≥70 years, BMI>28 kg/m 2, BMD T value<-3.5 SD, preoperative PI-LL>20° and PLC injury are independent risk factors for the incidence of PJK after posterior long-segment internal fixation in elderly patients with type IV CSOTLF. Attention should be paid to soft tissue protection and sagittal balance restoration of the spine intraoperatively and weight control and anti-osteoporosis treatment postoperatively.

Stage I percutaneous vertebroplasty for treatment of acute multi-segment osteoporotic thoracolumbar compression fracture in the elderly / 中华创伤杂志

Objective:To explore the clinical effect of percutaneous vertebroplasty (PVP) at stage I in treatment of acute multi-segment osteoporotic vertebral compression fracture (OVCF) in the elderly with over 3 vertebrae operated.Methods:A retrospective case-control study was conducted to analyze the clinical data of 105 aged patients with acute multi-segment OVCF admitted to Honghui Hospital, Xi'an Jiaotong University from October 2015 to February 2019. There were 27 males and 78 females, aged 65-92 years [(73.0±14.5)years]. All patients received stage I multi-segmental PVP and standard anti-osteoporosis treatment. There were more than 3 operative vertebral segments in 30 patients (observation group) and less than or equal to 3 operative vertebral segments in 75 patients (control group). The operation time, intraoperative fluoroscopy frequency, cement injection volume, cement leakage rate and incidence of recurrent vertebral fractures were compared between the two groups. The visual analogue scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) score were compared before operation, 1 day, 1 month after operation and at the last follow-up.Results:All patients were followed up for 11-13 months [(12.5±1.8)months]. The observation group showed operation time of (71.2±12.2)minutes, intraoperative fluoroscopy frequency of (38.8±6.4)times and cement injection volume of (20.2±4.6)ml, more than those in control group [(52.3±10.6)minutes, (25.4±5.3)times, (12.3±4.3)ml] ( P<0.05). There was no significant difference in cement leakage rate and incidence of recurrent vertebral fractures between the two groups ( P>0.05). No complications such as infection, nerve damage or cement implantation syndrome occurred. Before operation, 1 day after operation, 1 month after operation and at the last follow-up, the VAS in observation group [(7.6±0.7)points, (3.0±0.8)points, (2.3±0.7)points, (2.2±0.6)points] showed no significant difference from those in control group [(7.4±0.5)points, (2.9±0.4)points, (2.1±0.5)points, (2.0±0.5)points], the ODI in observation group [(74.6±3.3)%, (36.8±4.6)%, (29.7±4.0)%, (24.0±3.6)%] did not differ from those in control group [(73.8±1.0)%, (35.1±0.9)%, (28.4±2.2)%, (22.8±0.9)%], the ADL score in observation group [(34.5±5.0)points, (54.5±3.8)points, (73.7±3.9)points] were similar with those in control group [(36.2±3.4)points, (56.8±4.7)points, (75.3±5.3)points, (81.3±4.5)points] (all P>0.05). The postoperative VAS, ODI and ADL score in both groups were significantly improved in comparison with preoperation ( P<0.05). Conclusion:For acute multi-segment OVCF in the elderly with over 3 or not more than 3 the vertebrae operated, PVP at stage I has the same advantages in early pain relief and improvement of motor function and quality of life.

Foundation of acute symptomatic osteoporotic thoracolumbar fracture classification system and its validity examination and clinical application evaluation / 中华创伤杂志

Objective:To establish the acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) classification system, and to examine the reliability and evaluate the effect of clinical application.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 293 patients with osteoporotic thoracolumbar fracture(OTLF) admitted to Honghui Hospital from January 2016 to December 2018. There were 514 males and 779 females, aged 57-90 years [(71.4±6.3)years]. The T value of bone mass density was -5.0--2.5 SD [(-3.1±-0.4)SD]. According to the clinical symptoms a and fracture morphology, OTLF was divided into 4 types, namely type I(I occult fracture), type II(compressed fracture), type III (burst fracture) and type IV(unstable fracture). The type II was subdivided into three subtypes (type IIA, IIB, IIC), and the Type III into two subtypes (type IIIA, IIIB). of all patients, 75 patients (5.8%) were with type I, 500 (38.7%) with type II A, 134 (10.4%) with type IIB, 97 (7.5%) with type IIC, 442 (34.2%) with type IIIA, 27(2.1%) with type IIIB and 18 (1.4%) with type IV. After testing the validity of the classification, different treatment methods were utilized according to the classification, including percutaneous vertebroplasty (PVP) for Type I, PVP after postural reduction for Type II, percutaneous kyphoplasty (PKP) for Type IIIA, posterior reduction and decompression, bone graft fusion and bone cement-augmented screw fixation for Type IIIB, and posterior reduction, bone graft fusion and bone cement-augmented screw fixation for Type IV. The visual analog score (VAS), Oswestry disability index (ODI), Frankel grade of spinal cord injury, local Cobb Angle, and vertebral body angle (vertebral body angle) were recorded in all patients and in each type of patients before surgery, at 1 month after surgery and at the last follow-up. The neurological function recovery and complications were also recorded.Results:The patients were followed up for 24-43 months [(29.9±5.1)months]. A total of 3 000 assessments in two rounds were conducted by three observers. The overall κ value of inter-observer credibility was 0.83, and the overall κ value of intra-observer credibility was 0.88. The VAS and ODI of all patients were (5.8±0.7)points and 72.5±6.6 before surgery, (1.8±0.6)points and 25.0±6.3 at 1 month after surgery, and (1.5±0.6)points and 19.5±6.2 at the last follow-up, respectively (all P<0.05). The Cobb angle and vertebral body angle of all patients were (13.0±9.1)° and (8.0±4.6)° before surgery, (7.9±5.2)° and (4.6±2.9)° at 1 month after surgery, and (9.1±6.0)° and (5.8±3.0)° at the last follow-up, respectively (all P<0.05). At the last follow-up, VAS, ODI, Cobb Angle and VBA of each type of patients were significantly improved compared with those before surgery (all P<0.05). The spinal cord compression symptoms were found 1 patient with type IV and 5 patients with type IIIB preoperatively. At the last follow-up, neurological function improved from grade C to grade E in 1 patient and from grade D to grade E in 5 patients ( P<0.05). The lower limb radiation pain or numbness in 3 patients with type IV and 22 patients with type III preoperatively were fully recovered after surgical treatment at the last follow-up except for three patients. Conclusions:The ASOTLF classification is established and has high consistency and reliability. The classification-oriented treatment strategy has achieved a relatively satisfactory effect, indicating that the classification has a certain guiding significance for treatment of OTLF.

The anti-aging effects of different parts of Scutellaria baicalensis Georgi based on 1H NMR urine metabolomics / 药学学报

The effects of alcohol extracts from roots, stems, leaves, and flowers of Scutellaria Baicalensis Georgi (SBG) on endogenous metabolism in D-gal-induced aging-model rats were investigated by 1H NMR metabolomics. Results showed that 32 endogenous metabolites were identified in the urine. Combined with the VIP value and t-test, 14 different metabolites were found by multivariate statistical analysis of the spectrum. Compared with the control group, the content of α-ketoglutaric acid, hippuric acid and 3-hydroxybutyrate in the urine of rats in the model group was significantly decreased (P<0.05) and the content of trimethylamine oxide, glycine, alanine, lactic acid, dimethylglycine, acetate, pyruvate, taurine, allantoin, betaine, N-acetylated glycoprotein was significantly increased (P<0.05). The metabolites were mainly derived from taurine and hypo-taurine metabolism; glycine, serine and threonine metabolism; pyruvate metabolism; glycolysis/gluconeogenesis; glyoxylic acid and dicarboxylic acid metabolism; and the tricarboxylic acid cycle. The content of differential metabolites in urine samples was altered by the alcohol extracts from the different parts of SBG. Leaves extracts of SBG had the greatest effect on urine metabolites, and mainly affected taurine and hypo-taurine metabolism; glycine, serine and threonine metabolism; and pyruvate metabolism. This study provides a reliable experimental basis for the future development of SBG. This animal experiment was approved by the Committee on the Ethics of Animal Experiments of Shanxi University (SXULL2016036).

Effect of the different smoking cessation regimens with acupuncture on smoking withdrawal and their influence factors: a multi-center randomized controlled trial / 中国针灸

OBJECTIVE@#To evaluate the clinical effect of acupuncture on smoking cessation and withdrawal symptoms and to explore the influence factors of acupuncture on smoking cessation.@*METHODS@#A total of 500 subjects with tobacco dependence were randomized into an acupuncture group, an auricular therapy group, an acupuncture plus auricular therapy group, a TENS group and a nicotine replacement therapy group (NRT group), 100 cases in each one. In the acupuncture group, acupuncture was applied at Baihui (GV 20), Lieque (LU 7), Hegu (LI 4) and Zusanli (ST 36). The treatment was given 5 times a week, once a day in the first 2 weeks. The treatment was given once every 2 days in the week 3 and 4, 3 times a week, and twice a week, once every 3 days in the week 5 to 8. In the auricular therapy group, the ear point pressure therapy was used at shenmen (TF), neifenmi (CO), pizhixia (AT) and jiaogan (AH), 3 times a week. In the acupuncture plus auricular therapy group, acupuncture and auricular therapy were adopted with the same points and manipulation as the previous two groups. Acupuncture was given 3 times a week and the auricular therapy was given twice a week. In the TENS group, SDZ-Ⅱ B type electric acupuncture apparatus was used to stimulate Lieque (LU 7) and Zusanli (ST 36), once a day. In the NRT group, the nicotine patch was used on the chest, back and the upper arms of the subjects, once a day. The duration of treatment was 8 weeks as one course in every group. Afterwards, the 16-week follow-up was conducted. The time-point withdrawal rate was evaluated by the level of urine cotinine in 8 weeks of treatment and in the follow-up in the subjects of 5 groups. The persistent withdrawal rate was evaluated by the self-report of the subjects in 8 weeks of treatment as well as in the follow-up in the 5 groups. The withdrawal effect, the score of the fagerstrom test for nicotine dependence (FTND) and the score of the heaviness of smoking index (HSI) were compared among the groups. Twenty indexes were selected as the potential influence factors, the 72 h withdrawal rate based on the level of urine cotinine in 8 weeks of treatment and in the follow-up was taken as the dependent variable. Using the two categories of Logistic regression analysis, the influence factors of therapeutic effect of acupuncture were screened for smoking cessation.@*RESULTS@#After 8 weeks of treatment, the time-point withdrawal rate in the subjects among the groups was NRT group > acupuncture plus auricular therapy group > auricular therapy group > acupuncture group > TENS group. In the follow-up, the time-point withdrawal rate was acupuncture plus auricular therapy group > NRT group > acupuncture group > TENS group > auricular therapy group, but without statistical significance in comparison (>0.05). After 8 weeks of treatment, the persistent withdrawal rate in the subjects among the groups was auricular therapy group > TENS group > acupuncture group > acupuncture plus auricular therapy group > NRT group. In the follow-up visit, the persistent withdrawal rate was auricular therapy group > TENS group > acupuncture plus auricular therapy group > acupuncture group > NRT group. The result in the auricular therapy group was better than all of the other 4 groups (0.05). The regression analysis showed that the factors, i.e. nationality, educational background, drinking frequency, pre-treatment FTND score, pre-treatment HSI score and smoking cessation for physical reason in family, were correlated significantly with the withdrawal result after 8-week treatment (<0.05). The factors, i.e. education background, smoking age, pre-treatment FTND score and different therapeutic methods, were correlated significantly with the withdrawal result in the follow-up (<0.05).@*CONCLUSION@#Acupuncture combined with auricular therapy effectively reduce nicotine dependence and smoking intensity and relieve withdrawal symptoms. There are many factors that affect the withdrawal effect in smoking cessation. Hence, the influence factors in smoking cessation with acupuncture should be clearly determined so as to develop the individual regimen for smoking cessation and improve the clinical therapeutic effect of acupuncture on smoking cessation.

Relative bioavailability of terpene lactones in Beagle dogs after ig administration of domestic and imported Ginkgo Leaf Tablets / 中草药

Objective To compare the pharmacokinetic parameters and bioavailability of terpene lactones in Beagle dogs between domestic and imported Ginkgo Leaf Tablets. Methods Beagle dogs were ig administrated demestic and imported Ginkgo Leaf Tablets, and then the plasma of Beagle dogs were detected. LC-MS was used to determine the contents of terpene lactones (including ginkgolide A, ginkgolide B, and ginkgo lactone) in plasma of Beagle dogs. Plasma concentration-time curves were drawn and analyzed by DAS software to obtain pharmacokinetics parameter. Results The area under curve (AUC0-t) of GA, GB, and BB in Beagle dogs after ig administration domestic Ginkgo Leaf Tablets was 51.64, 19.86, and 72.90 ng∙h/mL, while it was 69.98, 24.35, and 169.60 ng∙h/mL after ig administration imported G. biloba leaf extract tablets, respectively. According to the contents of three components in two preparations, the relative bioavailability of GA, GB, and BB of domestic Ginkgo Leaf Tablets respectively was 37.77%, 33.70%, and 95.98%. Conclusion The oral bioavailability of the terpene lactones in imported Ginkgo Leaf Tablets was significantly higher than that of domestic tablets.

Production pressures among anaesthesiologists in Singapore

<p><b>INTRODUCTION</b>Production pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore.</p><p><b>METHODS</b>A random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure.</p><p><b>RESULTS</b>Demographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively.</p><p><b>CONCLUSION</b>Production pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.</p>

Simultaneous Determination of Eight Constituents in Fruits of Rubus chingii by UPLC / 中草药·英文版

Objective To develop a simple, efficient, and reliable method for routine quantitative analysis of main constituents presented in the fruits of Rubus chingii, which is widely used in Chinese materia medica (CMM), known as Fupenzi (FPZ) in Chinese. Methods An ultra performance liquid chromatography-photo diode array (UPLC-PDA) system was employed for simultaneous quantification of eight compounds, i. e. adenosine, gallic acid, brevifolin carboxylic acid, ethyl gallate, ellagic acid, kaempferol-3-O-rutinoside, kaempferol-3-O-β-D-glucopyranoside, and tiliroside. The chromatographic analysis was performed on a C18 column using a gradient elution of acetonitrile −0.1% formic acid aqueous solution within a runtime of 25 min. Results All calibration curves were linear (R2 > 0.9997) over the tested ranges. The intra- and inter-day precisions as determined from sample solutions were both less than 2.45% and 2.78%, respectively. The average recoveries for the eight constituents ranged from 94.77% to 101.35% with RSD ≤ 4.41%. The newly-developed method was applied to the quality assessment of various R. chingii samples, including both ripe and unripe fruits of R. chingii from different habitats. Conclusion The relative levels of the investigated compounds vary remarkably in the fruits of R. chingii collected from different habitats. As only two of the eight compounds, adenosine and ellagic acid, are determined in the ripe fruits of R. chingii, the results may explain the reason why only the unripe fruits can be used in CMM.

Simultaneous Determination of 4 Components in Danzhi Qing’e Tablet by HPLC / 中国药房

OBJECTIVE:To establish a method for the contents determination of psoralen,isopsoralen,psoralenoside and isop-soralenoside in Danzhi qing’e tablet. METHODS:HPLC performed on the column of Eclipse XDB-C18 with mobile phase of metha-nol-water(51∶49,V/V)(isocratic elution,for psoralen and isopsoralen)and acetonitrile-0.1% formic acid(12∶88,V/V)(isocratic elution,for psoralenoside and isopsoralenoside)at a flow rate of 1.0 ml/min,the detection wavelength was 246 nm,column tem-perature was 30℃,and injection volume was 10 μl. RESULTS:The linear range was 3.138-200.8 μg/ml for psoralen(r=0.999 9), 3.175-203.2μg/ml for isopsoralen(r=0.999 9),3.181-101.8μg/ml for psoralenoside(r=0.999 9)and 3.169-101.4μg/ml for isopso-ralenoside (r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 2%;limits of quantitation were 0.627 5 ng,0.635 0 ng,3.181 0 ng and 3.169 0 ng,the limits of detection were 0.251 0 ng,0.254 0 ng,1.273 0 ng and 1.268 0 ng;recoveries were 95.68%-102.80%(RSD=2.4%,n=6),95.91%-102.10%(RSD=2.3%,n=6),98.64%-99.13%(RSD=0.23%,n=6) and 100.20%-101.70%(RSD=0.69%,n=6),respectively. CONCLUSIONS:The method is simple and accurate, and can be used for the simultaneous determination of psoralen,isopsoralen,psoralenoside and isopsoralenoside in Danzhi qing’e tablet.

"Discriminant Analysis of ""Q-Markers"" of Traditional Chinese Medical Injections——Taking Dan Hong Injection as a Model" / 世界科学技术-中医药现代化

Quality control of traditional Chinese medicine is of great importance to ensure its safety and effectiveness in clinic,and is also an obstacle impeding the modernization of traditional Chinese medicine.Though,the complexity of traditional Chinese medicine resulted in some relative weakness of quality standard researches.The critical point need addressing is to establish a sound quality standard system conforming to the characteristics of traditional Chinese medicine in the process of the modernization of Chinese medicine.In this paper,in regard to Dan Hong injection,discriminant strategy of Q-Markers from traditional Chinese medicine injection was clarified from three aspects:what ingredients,which to control and how to control,providing a new vision in the field of the quality standard researches of traditional Chinese medicine.

Comparison of efficacy of flurbiprofen axetil combined with fentanyl administered using different modes for postoperative analgesia: a prospective, multicenter, randomized, double-blind, control, parallel-group study / 中华麻醉学杂志

Objective To compare the efficacy of flurbiprofen axetil combined with fentanyl administered using different modes for postoperative analgesia.Methods This was a prospective,multicenter,randomized,double-blind,control,parallel-group study.ASA Ⅰ or Ⅱ patients,aged 14-91 yr,weighing 35-95 kg,scheduled for orthopedic,thoracic or hepatobiliary surgery under general anesthesia from January 2010 to October 2010,were randomly divided into A,B and C groups.The three groups received patient-controlled intravenous analgesia (PCIA) after surgery.In group A,flurbiprofen axetil 100 mg was injected immediately after the end of surgery and then PCIA was performed with fentanyl 1.0 mg in 100 ml of normal saline.In group B,PCIA was performed with flurbiprofen axetil 200 mg and fentanyl 0.6 mg in 100 ml of normal saline.In group C,flurbiprofen axetil 100 mg was injected immediately after the end of surgery and then PCIA was performed with flurbiprofen axetil 200 mg and fentanyl 0.6 mg in 100 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose,a 10 min lockout interval and background infusion at a rate of 2 ml/h.VAS scores at rest and during activity and sedation score were recorded at the end of surgery and 4,8 and 24 h after surgery.The effective analgesia,excessive sedation,nausea and vomiting,dizziness,somnolence and respiratory depression were recorded within 24 h after surgery.Samples from the PCIA bump were taken to do microbe culture experiment at 24 and 48 h after surgery.Results Two thousand five hundred and ninety-six cases completed this trial (875 cases in group A,946 cases in group B and 775 cases in group C).Compared with group A,VAS scores at rest and during activity at the end of surgery and 4,8 and 24 h after surgery and sedation score were significantly decreased in group B,VAS scores at rest and during activity were significantly decreased at the end of surgery and 4 and 8 h after surgery and sedation scores were significantly increased at 4 and 8 h after surgery in group C,the rate of effective analgesia was increased in groups B and C,the incidence of excessive sedation was decreased in group B,while increased in group C,the incidence of postoperative nausea and vomiting was significantly decreased in groups B and C,and the incidence of postoperative dizziness was significantly decreased in group C (P ＜ 0.05).Compared with group B,no significant change was found in the VAS scores at rest and during activity,rate of effective analgesia,and incidences of nausea and vomiting,and somnolence (P ＞ 0.05),sedation scores were significantly increased at the end of operation and 4 and 8 h after surgery,the incidence of excessive sedation was increased,and the incidence of postoperative dizziness was decreased in group C (P ＜ 0.05).Neither bacterium nor fungus was found in the PCIA pump samples.Conclusion PCIA with flurbiprofen axetil 200 mg and fentanyl 0.6 mg (background infusion at a rate of 2 ml/h,2 ml bolus dose,10 min lockout interval) provides better efficacy and the occurrence of sides effects is low for the patients undergoing moderate or major operations.

Effects of different doses of dexmedetomidine on anesthetic efficacy of propofol and remifentanil in patients undergoing plastic surgery / 中华麻醉学杂志

Objective To investigate the effects of different doses of dexmedetomidine on the anesthetic efficacy of propofol and remifentanil in patients undergoing plastic surgery.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 45-75 kg,scheduled for elective plastic surgery,were randomly assigned into 3 groups (n =20 each):control group (C group),low loading dose dexmedetomidine group (D1 group) and high loading dose dexmedetomidine group (D2 group).Dexmedetomidine was infused at a rate of 0.4 μg· kg-1 · h-1 until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.6 (group D1) or 1.0 μg/kg (group D2) was infused at 10 min before induction of anesthesia in groups D1 and D2.Anesthesia was induced with target-controlled infusion of propofol (target plasma concentraiton 4.0 μg/ml) and remifentanil (target effect-site concentraiton 2.0 ng/ml).After the patients lost consciousness,rocuronium 0.6 mg/kg was injected intravenously.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentraiton 2.0-3.5 μg/ml) and remifentanil (target effectsite concentraiton 1.5-2.5 ng/ml).Narcotrend index was maintained at Class D.Narcotrend index,systolic pressure (SP),diastolic pressure (DP) and HR were recorded before anesthesia (baseline),at 10 min of dexmedetomidine infusion,at 0,1 and 5 min after tracheal intubation,at the end of dexmedetomidine infusion,and at 0,1and 5 min after removal of the endotracheal tube.The induction time,consumption of propofol and remifentanil,time for recovery of spontaneous breathing and orientation,extubation time,and Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube were recorded.The development of sinus bradycardia during operation and complications during recovery from anesthesia were also recorded.Results Compared with group C,the total consumption of propofol and remifentanil,Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube,and incidences of nausea,bucking and agitation during recovery from anesthesia,and Narcotrend index and HR at 10 min of dexmedetomidine infusion were significantly decreased in groups D1 and D2,and induction time was shortened in D2 group (P ＜ 0.05 or 0.01).The incidence of sinus bradycardia during operation was significantly higher in group D2 than in groups C and D1 (P ＜ 0.05).There was no significant difference in the time for recovery of spontaneous breathing and orientation,and extubation time between the three groups (P ＞ 0.05).There was no significant difference in SP,DP and HR before and after tracheal intubation and before and after removal of the endotracheal tube between groups D1 and D2 (P ＞ 0.05).Conclusion Infusion of dexmedetomidine at a rate of 0.4μg·kg-1 · h-1 after a loading dose of 0.6 μg/kg infused before induction of anesthesia can shorten the induction time,reduce the consumption of propofol and remifentanil,effectively inhibit the stress responses to tracheal intubation or removal of the endotracheal tube,and decrease the occurrence of side effects in patients undergoing plastic surgery.

Variation of 4 kinds of compounds in Psoralea corylifolia processed by different methods / 中国中药杂志

<p><b>UNLABELLED</b>OBJECITVE: To established an efficient method for simultaneous quantification of 7 compounds belonging to 4 chemical types in Psoralea corylifolia processed by different methods, and to elucidate variations of 4 kinds of compounds in different processed P. corylifolia.</p><p><b>METHOD</b>The chromatographic separation was performed on an ACUITY C18 column using acetonitrile and 0.1% formic acid aqueous solution in the gradient elution at 0.4 mL x min(-1). Detection wavelength was set at 246 nm. Column temperature was fixed at 50 degrees C.</p><p><b>RESULT</b>The 4 kinds of compounds including psoralenoside, isopsoralenoside (benzofuran glycosides), psoralen, isopsoralen, psoralidin (coumarins), bavachin (flavonoids), and bakuchiol (meroterpenes) were separated in 25 min. The correlation coefficients of those compounds were over 0.9993 in the tested range. The intra- and inter-day precisions were below 1.5%. The average recoveries ranged from 99.2% to 106%.</p><p><b>CONCLUSION</b>This method is simple, rapid and accurate, which can be used for the determination of the 4 kinds of compounds in different processed P. corylifolia. In P. corylifolia processed by different methods, the contents of benzofuran glycosides, flavonoids, and meroterpenes in P. corylifolia processed by Leigong's method decrease obviously, while the contents of psoralen and isopsoralen increase significantly.</p>

Modulation of the activities and mRNA expression of cytochrome P450 isoenzymes in rat liver by Panax gingseng and coadministration with Veratrum nigrum / 中国中药杂志

<p><b>OBJECTIVE</b>To study the modulatory effect of Panax gingseng and coadministration with Veratrum nigrum on the activity and mRNA expression of cytochrome P450 isoenzymes in rat liver.</p><p><b>METHOD</b>Rat liver microsomal cytochrome P450, b5, aminopyrine N-demethylase(APND), p-nitrophenol-hydroxylase(pNPH)activities were quantitated by UV chromatography. The mRNA expression level of five CYP isoenzymes CYP1A1, CYP2B1/2, CYP2C11, CYP2E1 and CYP3A1 were detected by semi-quantitative reverse transcriptase-polymerase chain reaction(RT-PCR).</p><p><b>RESULT</b>P. gingseng coadministrated with V. nigrum obviously decreased the P450 contents of liver microsomes, and the b5 contents. Both single and combined used inhibited the activities of aminopyrine N-demethylase. At the mRNA level, the expression of CYP2C11 markedly induced exposure to V. nigrum, but combinative groups decreased the expression of CYP2C11. The combination of P. gingseng and V. nigrum induced the expression of CYP1A1. P. gingseng has inhibitory effect on CYP2B1/2 and inductive effect used with V. nigrum. The combination of P. gingseng with V. nigrum also induced the expression of CYP3A1.</p><p><b>CONCLUSION</b>P. gingseng used singly has some different modulation effects compared with combinative used, which may occur because of drug-drug interaction based on cytochrome P450. To elucidate the drug-drug interaction, it needs further analysis and metabolism research.</p>