Research progress on chemical constituents of Schisandra chinensis and its effect on nonalcoholic fatty liver disease / 中国中药杂志

Schisandra chinensis, a traditional Chinese medicinal herb, is rich in chemical constituents, including lignans, triterpenes, polysaccharides, and volatile oils. Clinically, it is commonly used to treat cardiovascular, cerebrovascular, liver, gastrointestinal, and respiratory diseases. Modern pharmacological studies have shown that S. chinensis extract and monomers have multiple pharmacological activities in lowering liver fat, alleviating insulin resistance, and resisting oxidative stress, and have good application prospects in alleviating nonalcoholic fatty liver disease(NAFLD). Therefore, this study reviewed the research progress on chemical constituents of S. chinensis and its effect on NAFLD in recent years to provide references for the research on S. chinensis in the treatment of NAFLD.

Evaluation of input and output efficiency of scientific research in hospital by Bootstrap data envelopment analysis / 中华医学科研管理杂志

Objective:To comprehensively evaluate the input and output efficiency of scientific research in hospital by bootstrap data envelopment analysis, to provide useful information for optimization of scientific performance appraisal and hospital discipline development strategy.Methods:37 disciplines were included as decision making unit, input variables include research expenditure and number of research personnel, and output variables include number of science and technology awards, research projects, patent transfer, paper, composition, and academic influence. The bootstrap-DEA method was used to evaluate the efficiency of all DMUs.Results:The main of overall efficiency and pure technical efficiency in basic DEA model are 0.858 and 0.909, but are 0.804 and 0.853 in Bootstrap DEA model, the differences between two models have statistically significant ( P<0.001). There are 11 DMUs with an overall efficiency in 0.9~1.0, 14 DMUs in 0.8~0.9, 7 DMUs in 0.6~0.8, 5 DMUs lower than 0.6. There are 3 DMUs are increasing return to scale, 16 DMUs are constant return to scale, 18 DMUs are decreasing return to scale. No statistically significance was observed between different types of DMUs( P>0.05). There are 4 DMUs reveal input slacks in number of research staffs and 10 DMUs reveal output slacks. Conclusions:The results of Bootstrap-DEA are more accurate than the basic methods for the evaluation of the input-output efficiency of hospital scientific research, so that it is worth popularizing and applying. According to the evaluation results, the hospital management department and disciplines could optimize their discipline development strategies and put forward targeted improvement measurements.

Research progress of poly (β-amino ester)s-based gene vector / 药学学报

Poly (β-amino ester)s (PβAEs) contain tertiary amine backbones and biodegradable ester bonds, making them highly biocompatible and pH-responsive. Meanwhile, originated from combinatorial libraries, PβAEs are simple to synthesize, easy to obtain raw materials and can be easily adapted to meet the different performance needs of gene carriers by adjusting the monomer type, monomer ratio and reaction time. Therefore, PβAEs are promising material for non-viral gene carriers. This paper provides a comprehensive overview of the properties and synthesis of PβAEs gene carriers and summarizes the progress of research on the gene delivery of each type of PβAEs.

Research progress on culture technologies,chemical components,and pharmacological activities of Saussurea involucrata cells / 中国中药杂志

Saussurea involucrata,a traditional Chinese medicinal material,is effective in the treatment of rheumatoid arthritis with cold-dampness blockage syndrome,cold pain in lower abdomen,and menstrual irregularities. However,due to the specific habitat,low natural reproduction rate,slow growth,and overexploitation,it is at the high risk of extinction. S. involucrata cells can be obtained through callus culture,suspension culture,and hairy root culture. This study highlighted the influences of reactor type,culture system,precursor,elicitor type, and light wavelength on the suspension culture of S. involucrate cells. The chemical components of S. involucrata cells mainly include phenylpropanoids,flavonoids,lignans,and steroids,among which phenylpropanoids are the most abundant. S. involucrata cells have multiple pharmacological activities of anti-inflammation,analgesia,activating blood and resolving stasis,immunoregulation,increasing bone density,lowering blood lipids,anti-hypoxia,anti-exercise fatigue,anti-radiation,anti-obesity,and anti-oxidation. Moreover,it has the potential of treating aplastic anemia. This study reviews the cell culture technologies,chemical components,and pharmacological activities of S. involucrata cells,laying a basis for the further research,development,and utilization.

Optimization of process parameters of 3D printed clozapine dispersive tablets and establishment of personalized dose model / 药学学报

This study aims to establish the design space of the key processes for drop-on-powder 3D printing based on design of experiment (DoE). By utilizing Minitab, an experimental scheme with three factors, two levels and three center points was designed to analyze the factors that significantly affected the tablet quality attributes. Furthermore, the factor interactions were analyzed using Minitab. subsequently, the computer aided drafting (CAD) software was used to adjust the model volume with fixed radius/height ratio (r/h = 1.25) and establish a linear regression equation between model volume and dose. As a result, the drug dose could be controlled in a flexible manner. The finally determined process parameters were: ink-jet level is 12, layer thickness is 150 μm, and the X-axis printing head speed of 635 mm·s-1. Regression equation between drug content (y) and model volume (x) was y = 0.062 x - 0.582 7 (R2 = 0.999 9) showing good linear relationship. This indicated that robust and feasible process parameters were obtained through DoE, and the preparation of personalized-dose tablets was realized with good reproducibility.

Genome sizes of four important medicinal species in Kadsura by flow cytometry / 中草药·英文版

Objective: Dianjixueteng is a geoherb in Yunnan Province, the source plant of which is Kadsura interior. However, the formation of this geoherb is not clear in genetic mechanism, in which genome size is the first step that should be known on the genomic level. In this study we aimed to estimate the genome sizes of source plants of K. interior and three related herbs K. heteroclita, K. longipedunculata, and K. coccinea by flow cytometry (FCM) and make a comparison. Methods: The genome sizes of K. interior, K. heteroclita, K. longipedunculata and K. coccinea, i.e., the source plants of Dianjixueteng and its relative medicinal materials, were estimated by FCM. The nuclei of K. interior were isolated using modified LB01 buffer, for the rest species, by the Galbraith's buffer. Results: The genome sizes of K. interior, K. heteroclita, K. longipedunculata, and K. coccinea were 7.36, 7.12, 7.01, and 5.15 pg/1C, respectively. Genome size of K. interior had no significant variation with those of K. heteroclita and K. longipedunculata (P = 0.296), which was significantly larger than that of K. coccinea. Conclusion: Genome size can not distinguish K. interior from K. heteroclita and K. longipedunculata, but could distinguish them from K. coccinea, which lays the foundation for future studies on genetic mechanism of the geoherb formation.

Postsynaptic Targeting and Mobility of Membrane Surface-Localized hASIC1a / 神经科学通报·英文版

Acid-sensing ion channels (ASICs), the main H

Identification and characterization of DIR gene family in Schisandra chinensis / 中国中药杂志

Dirigent(DIR) proteins are involved in the biosynthesis of lignin, lignans, and gossypol in plants and respond to biotic and abiotic stresses. Based on the full-length transcriptome of Schisandra chinensis, bioinformatics methods were used to preliminarily identify the DIR gene family and analyze the physico-chemical properties, subcellular localization, conserved motifs, phylogeny, and expression patterns of the proteins. The results showed that a total of 34 DIR genes were screened and the encoded proteins were 156-387 aa. The physico-chemical properties of the proteins were different and the secondary structure was mainly random coil. Half of the DIR proteins were located in chloroplast, while the others in extracellular region, endoplasmic reticulum, cytoplasm, etc. Phylogenetic analysis of DIR proteins from S. chinensis and the other 8 species such as Arabidopsis thaliana, Oryza sativa, and Glycine max demonstrated that all DIR proteins were clustered into 5 subfamilies and that DIR proteins from S. chinensis were in 4 subfamilies. DIR-a subfamily has the unique structure of 8 β-sheets, as verified by multiple sequence alignment. Finally, through the analysis of the transcriptome of S. chinensis fruit at different development stages, the expression pattern of DIR was clarified. Combined with the accumulation of lignans in fruits at different stages, DIR might be related to the synthesis of lignans in S. chinensis. This study lays a theoretical basis for exploring the biological functions of DIR genes and elucidating the biosynthesis pathway of lignans in S. chinensis.

Application of "Quality by Design" in the preparation of acetaminophen sustained-release tablets by 3D printing / 药学学报

The aim of this study is to prepare acetaminophen sustained-release tablets by hot melt extrusion 3D printing technology based on the concept of "Quality by Design" (QbD). Firstly, the failure mode and effect analysis (FMEA) was used to determine the critical process parameters (CPPs), then full-factor experimental design was used to analyze the critical quality attributes (CQAs) and to establish the design space. The results showed that the content of plasticizer, the path spacing and the shell numbers are independent variable for the experimental design. The design space was concluded to be plasticizer content: 9%, and the shell number: 3-5, the path spacing: 1.05-1.2 mm. In this study, 3D printing technology was used to prepare acetaminophen sustained-release tablets in accordance with the concept of QbD, which improved the durability of the process and ensured the uniform and controllable quality of the preparation and also provided experimental basis for personalised medicine.

Cloning and expression analysis of 2-oxoglutarate-dependent dioxygenase from Schisandra chinensis / 药学学报

The 2-oxoglutarate-dependent dioxygenase (2-ODD) gene is regarded as the key enzyme gene involved with aryl naphthalene lignan-podophyllotoxin synthesis. To study the expression pattern and function of the Sc2-ODD gene, a full-length cDNA of the gene was cloned. Bioinformatic analysis, the expression pattern, and prokaryotic expression and purification were implemented. The open reading frame of Sc2-ODD gene was 1 077 bp and encoded 358 amino acids with a molecular weight of 40.16 kD. The Sc2-ODD protein contained the conserved 2OG-FeII-oxy sequence of the 2-ODD protein. The results of phylogenetic analysis revealed that Sc2-ODD is most closely related to Corchorus olitorius 2-ODD. qRT-PCR results showed that Sc2-ODD expression displayed obvious up-regulation at the fruit-swelling stage, then down-regulation in the fruit-coloring period. The Sc2-ODD gene was cloned into the bacterial expression vector pGS21T, the recombinant Sc2-ODD protein was expressed in Escherichia coli Rosetta (DE3) cells and the fusion protein was obtained and purified by GST fusion protein purification technology. This study will lay a foundation for further research on the function and expressional regulation of the Sc2-ODD gene in the aryl naphthalene lignans biosynthesis pathway, and also provides a scientific basis for improving the lignan content and the medicinal quality of Schisandra chinensis using plant genetic engineering.

Analysis of clinical features of 58 patients with severe or critical 2019 novel coronavirus pneumonia / 中华急诊医学杂志

Objective:To analyze the clinical features of severe or critical 2019 novel coronavirus pneumonia (NCP) patients.Methods:Clinical data of 58 patients with severe or critical NCP in Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 29 to February 26, 2020 were collected. The general information, clinical symptoms, results of blood test and chest computed tomography (CT) imagings, treatments and outcomes of patients were analyzed retrospectively.Results:Among the 58 patients, 36 patients (62.1%) were severe and 22 (37.9%) were critical, 28 (48.3%) were male and 30 (51.7%) female, with an average age of (62.12±12.95) years. Twenty-eight patients (48.2%) had previous underlying diseases, including 21 patients (36.2%) with hypertension, 11 patients (19.0%) with diabetes mellitus, 6 patietns (10.3%) with coronary heart disease, 2 patients (3.4%) with chronic renal failure, and 1 patient (1.7%) with malignant tumor. The symptoms included fever (54 cases, 93.1%), dyspnea (48 cases, 82.8%), cough (46 cases, 79.3%), muscle soreness (32 cases, 55.2%), sore throat (15 cases, 25.9%), and diarrhea (6 cases, 10.3%). Decreased or increased white blood cell count was found in 7 patients (12.1%) and 6 patietns (10.3%). Decreased percent of lymphocyte, increased percent of neutrophil, and decreased hemoglobin level were found in 35 patients (60.3%), 27 patients (46.6%), and 24 patients (41.4%), respectively. Elevated CRP, PCT and D-dimmer level were demonstrated in 38 patients (65.5%), 36 patients (62.1%), and 45 patients (77.5%). Increased level of ALT, AST, LDH and decreased serum albumin were found in 32 patients (55.2%), 25 patients (43.1%), 39 patietns (67.2%) and 43 patietns (74.1%), respectively. The main features of CT imaging were diffuse lesion in both lungs, which were mainly manifested as multiple patchy shadows and ground-glass shadows, bilateral and peripheral distribution, consolidation and interlobular septal thickening. Twenty-nine patients (50.0%) were treated with antibiotics, and 14 patients (24.1%) with systemic glucocorticoid. In addition to supportive and antivirus treatment, oxygen therapy methods including nasal catheter (9 cases, 15.5%), oxygen mask (33 cases, 56.9%), high-flow nasal catheter (8 cases, 13.3%) and invasive mechanical ventilation were adopted. Twenty-one patients (36.2%) were discharged from the hospital, 27 patients (46.6%) in remission were still in the isolation wards, 3 patients (5.2%) were transferred to the ICU for further treatment, and 7 patients (12.1%) died.Conclusions:Severe and critical NCP are at higher risk in the elderly and those having underlying diseases. Severe/critical NCP patients often show extrapulmonary abnormity as well as lung dysfunction. Comprehensive treatment as early as possible is the key to improve the prognosis and reduce the mortality.

Study on Material Basis and Processing Principle of Fishy Smell of Pheretima aspergillum by Electronic Nose and HS-GC-MS / 中国实验方剂学杂志

Objective:To analyze and compare the fishy components in raw, stir-fried, liquorice-processed, vinegar-processed and wine-processed products of Pheretima aspergillum, and explore the material basis and processing principle of fishy smell of P. aspergillum. Method:Heracles Ⅱ ultra-fasted gas chromatography electronic nose technology combined with chemometrics was used for the overall analysis of volatile components in raw P. aspergillum and its processed products. Headspace gas chromatography-mass spectrometry (HS-GC-MS) was used to analyze and identify the volatile compositions in the raw products and processed products. Gas chromatographic conditions were as following：temperature program (initial temperature at 60 ℃, kept for 5 min, up to 120 ℃ with the heating rate of 3 ℃·min-1, and then up to 230 ℃ with the heating rate of 10 ℃·min-1 and finished), the inlet temperature at 280 ℃, high purity helium as the carrier gas, the flow rate of 1.0 mL·min-1, the split ratio of 20∶1. Mass spectrum conditions were as following：electron impact ionization (EI), electron collision energy of 70 eV, ion source temperature of 230 ℃, quadrupole temperature at 150 ℃, scanning range of m/z 50-550. The relative content of each component was calculated by peak area normalization. Result:Principal component analysis (PCA) and discriminant factor analysis (DFA) of the electronic nose showed that the raw products and its processed products could be clearly distinguished from each other. Among them, the difference between raw products and stir-fried, liquorice-processed products was small, but the difference between raw products and vinegar-processed, wine-processed products was large. A total of 25, 27, 22, 26 and 33 components were respectively identified from raw, stir-fried, liquorice-processed, vinegar-processed and wine-processed products of P. aspergillum, there were 13 common components in these products, including 4 aldehydes (isovaleraldehyde, 2-methylbutyraldehyde, hexanal, benzaldehyde), 2 ketones (2-heptanone, 2-tridecanone), 1 carboxylic acid (lauric acid), 4 heterocyclic compounds (2-methylpyrazine, 2,5-dimethyl pyrazine, 2-pentylfuran, 2-ethyl-6-methyl pyrazine), 1 amine (trimethylamine) and 1 alcohol (1-octen-3-ol). Conclusion:The odorous components in the raw products are mainly derived from aldehydes (isovaleraldehyde, 2-methylbutyraldehyde, isobutyraldehyde, 2-ethylhexanal, hexanal) and amines (trimethylamine). Odorous components of P. aspergillum can be reduced effectively by stir-fried and liquorice, vinegar, wine processing, while flavoring substances can be increased by wine processing to cover its ugly odor. This paper can provide scientific basis for the deodorization of P. aspergillum by processing, and also provide reference for the analysis and correction of ugly odor of other animal medicines.

Comparison on Volatile Oil Content and Chemical Constituents Among Different Parts of Ligusticum chuanxiong and Pieces with Different Processing Methods / 中国实验方剂学杂志

Objective::To compare the difference of the content of volatile oil and the total relative percentage of phthalein compounds in volatile oil among different parts about Ligusticum chuanxiong, or among different decoction pieces with different processing methods. Method::Steam distillation was used(in the extraction of volatile oil.The chemical constituents of the volatile oil were identified by GC-MS analysis, and relative content of each component was determined by normalization method. Result::The contents of volatile oil in different parts were obviously different, and the order of the contents from high to low was rhizome(1.12%)>fibrous root(0.75%)>aerial part(0.41%). The GC-MS analysis similar compounds find in the three different volatile oils, and the order of total relative percentages of phthalein compounds from high to low was roots(83.29%)>rhizomes(44.5%)>aerial part(39.95%). On the other hand, the volatile oil content of three different Chuanxiong Rhizoma pieces with different processing methods was C(0.87%)>A(0.75%)>B(0.7%). The total relative percentages of phthalein compounds analyzed by GC-MS was C(79.14%)>A(73.09%)>B(67.29%). Conclusion::The content of phthalein compounds in the volatile oil of fibrous root was higher than that of rhizome, thus it can be appropriately used.The volatile oil content and chemical composition of different Chuanxiong Rhizoma pieces were significantly different.The content of volatile oil and phthalein compounds in fresh-cut Chuanxiong Rhizoma pieces were the most high, thus fresh-cutting can be used as a new processing method for Chuanxiong Rhizoma pieces.

Research Progress on Application and Mechanism of Traditional Chinese Medicine in Gout / 中国实验方剂学杂志

Gout is the second largest metabolic disease after diabetes, with a high incidence worldwide. Gout is a common and complex arthritic disease that, if left untreated, can damage joints and, in severe cases, lead to kidney stones and even life-threatening kidney failure. Although western medicine has also made significant achievements in the treatment of gout, it is often accompanied by gastrointestinal reactions, liver injury and other adverse reactions, and is prone to relapse after drug withdrawal, making the radical treatment of gout a difficult problem. Traditional Chinese medicine (TCM) used in gout have relatively long history, TCM has the characteristics of multiple ingredients targets, not only can produce related enzyme activity by inhibiting the uric acid(UA) and lowering uric acid generation, also can reduce uric acid by promoting uric acid excretion, except the uric acid reduction most applied in gout neighborhood of TCM can effectively reduce joint inflammation. TCM is mild, and the incidence of adverse reactions in the treatment of gout is significantly lower than that of western medicine. Some TCM can even play a role while protecting the kidney, so TCM is expected to solve the problem of treating gout. In recent years, a large number of studies have been conducted on the application of TCM in the gout neighborhood at home and abroad. By summarizing the studies on the application of TCM in the gout disease in the past 10 years, the mechanism of action and material basis have been summarized and analyzed, in the hope of providing references for the studies on the prevention and treatment of gout by TCM.

Preparation of acetaminophen tablets by 3D printing technology / 国际药学研究杂志

Objective: To prepare acetaminophen tablets by hot-melt extrusion 3D printing technique. Methods:The acetaminophen tablets were prepared by the direct combination of hot-melt extrusion technology and 3D printing. Soluplus was used as hot-melt matrix and PEG6000 as plasticizer. The physical properties and molecular structure of the materials in the tablets were investigated, and in vitro release of the tablets was studied. Results:The printing of acetaminophen tablets was completed successfully, and the size, internal structure and shape of the tablets could be changed by 3D printing technology. The thermogravimetric analysis showed that all materials could maintain thermal stability at printing temperature. The results of crystal form study showed that all materials solidified in a amorphous form after the hot-melt 3D printing. The IR, Raman, MS and 1 H NMR data showed that the molecular structure of acetaminophen kept unchanged after the 3D printing. The in vitro release studies showed that the release of printed tablets could achieve over 80% within 24 h in the pH 6.8 phosphate buffer medium, by adding the disintegrating agent, kolidon cl-F, and changing the path spacing and shell numbers in the printing process. Conclusion:The acetaminophen tablets could be prepared by the hot-melt extrusion 3D printing technology, and the release of the tablets could be adjusted by the change of printing-related parameters.

Correlation Between Effective Components Content and Color Values of Indigo Naturalis Basde on Chromatometry / 中国实验方剂学杂志

Objective: To study the correlation between the color of Indigo Naturalis (powder and it's extracting solution) and effective components (indigo and indirubin) content. Method: The contents of indigo and indirubin in 27 batches of Indigo Naturalis were determined by HPLC,and the chromaticity values L*,a* and b* of powder and extracting solution were determined by color colorimeter. SPSS 20.0 software was used to analyze the correlation and multiple linear regression between the content of active components and the chromaticity values of Indigo Naturalis. Result: By visual observing the appearance of the powder,we find that,as the powder color deepened,the brightness values (L*) of the powder and extract were decreased,while the red-green value (a*) were increased. The correlation analysis showed that the contents of indigo were negatively correlated with the brightness value (L*) of the powder(Pa*)(PL*) of powder and extract (Pa*) (PConclusion: The darker the powder color of Indigo Naturalis,the higher the content of indigo and indirubin. The L* and a* values of indigo powder were more correlated with indigo and indirubin content than with the extracting solution. The color of powder was significantly correlated with the content of indigo and indirubin,which provided reference for rapid identification of Indigo Naturalis. The method of measuring the color of Indigo Naturalis by color colorimeter is stable,scientific and reliable.

Cell-Type Identification in the Autonomic Nervous System / 神经科学通报·英文版

The autonomic nervous system controls various internal organs and executes crucial functions through sophisticated neural connectivity and circuits. Its dysfunction causes an imbalance of homeostasis and numerous human disorders. In the past decades, great efforts have been made to study the structure and functions of this system, but so far, our understanding of the classification of autonomic neuronal subpopulations remains limited and a precise map of their connectivity has not been achieved. One of the major challenges that hinder rapid progress in these areas is the complexity and heterogeneity of autonomic neurons. To facilitate the identification of neuronal subgroups in the autonomic nervous system, here we review the well-established and cutting-edge technologies that are frequently used in peripheral neuronal tracing and profiling, and discuss their operating mechanisms, advantages, and targeted applications.

Ginkgo Leaf Extract and Dipyridamole Injection as Adjuvant Treatment for Angina Pectoris: A Meta-Analysis of 41 Randomized Controlled Trials / 中国结合医学杂志

OBJECTIVE@#To provide information about the effectiveness and safety of Ginkgo Leaf Extract and Dipyridamole Injection (GD) as one adjuvant therapy for treating angina pectoris (AP) and to evaluate the relevant randomized controlled trials (RCTs) with meta-analysis.@*METHODS@#RCTs concerning AP treated by GD were searched in China Biology Medicine Disc (SinoMed), PubMed, the China National Knowledge Infrastructure Database (CNKI), the Chinese Scientifific Journals Database (VIP), Wanfang Database, Embase, and the Cochrane Library, from inception to February, 2017. The Cochrane Risk Assessment Tool was adopted to assess the methodological quality of the RCTs. The Review Manager 5.3 software was utilized to conduct the meta-analysis.@*RESULTS@#A total of 41 RCTs involving 4,462 patients were included in the meta-analysis. The results indicated that the combined use of GD and Western medicine (WM) against AP was associated with a higher total effective rate [risk ratio (RR)=1.25, 95% confifidence interval (CI): 1.21-1.29, P<0.01], total effective rate of electrocardiogram (RR=1.29, 95% CI: 1.21-1.36, P<0.01). Additional, GD combined with WM could decrease the level of plasma viscosity [mean difference (MD)=-0.56, 95% CI:-0,81 to-0.30, P<0.01], fifibrinogen [MD=-1.02, 95% CI:-1.50 to-0.54, P<0.01], whole blood low shear viscosity [MD=-2.27, 95% CI:-3.04 to-1.49, P<0.01], and whole blood high shear viscosity (MD=-0.90, 95% CI: 1.37 to-0.44, P<0.01).@*CONCLUSIONS@#Comparing with receiving WM only, the combine use of GD and WM was associated with a better curative effect for patients with AP. Nevertheless, limited by the methodological quality of included RCTs more large-sample, multi-center RCTs were needed to confifirm our fifindings and provide further evidence for the clinical utility of GD.

The clinical research on the screening,diagnosis and treatment of the left subclavian artery stenosis before the coronary artery bypass grafting / 天津医药

Objective To discuss the meanings and methods of the screening, diagnosis and treatment of the left subclavian artery stenosis before the coronary artery bypass grafting (CABG). Methods A total of 612 patients intend to perform coronary artery bypass grafting in Tianjin Thoracic Hospital,and who were with severe stenosis or occlusion with left subclavian artery were screened by non invasive arteriosclerosis before operation. The diagnosis was confirmed by computerized tomography angiography(CTA),then the stenting angioplasty to the left subclavian artery was performed.The off-pump bypass surgery with the left internal thoracic artery(LITA)-left anterior descending artery (LAD) bypass was performed one week after operation.Results The CTA and digital subtraction angiography(DSA)confirmed the results of the left subclavian stenosis according to the non-invasive artery testing.All the 5 patients were performed with the stenting angioplasty to the left subclavian artery successfully,and the residual stenosis rate was<10%.The clinical symptoms were markedly improved after operations in all symptomatic patients,and the systolic pressure difference was<20 mmHg in two upper extremities.The blood flow was enough in LITA during the LITA-LAD bypass.The angina pectoris was improved after the operation. No coronary-subclavian artery steal phenomenon occurred. Neither stroke, myocardial infraction nor death occurred during perioperative period.All the patients were followed up for a time of 6-12 months,and the average time was about 10 months.No posterior circulation,upper limbs or myocardial ischemia occurred,and the systolic pressure difference was<20 mmHg in two upper extremities.Conclusion The non-invasion testing is of unique value in the screening of the left subclavian artery stenosis.

Consistency between symptoms and colorectoanal function tests in elderly patients with functional constipation / 中华全科医师杂志

Objective To analyze the consistency between constipated symptoms and the parameters of gastrointestinal transit time (GITT),anorectal manometry (ARM) in elderly patients with functional constipation.Methods Total 111 patients (54 males and 57 females) with an average age of (70.2±6.5) years,who met Rome Ⅲ criteria of functional constipation were enrolled from June 2010 to October 2012.After enrollment,patients took two-week diary,recording the spontaneous bowel movements per week,stool type of Bristol Stool Form,the frequency and severity of defecation straining,sensation of anorectal obstruction,manual maneuvers and sensation of incomplete evacuation.The GITT and ARM tests were performed,and the consistency between symptoms and test results were analyzed.Results Patients with symptoms of slow transit,defecation disorder and mixed symptoms were 19.8％ (22/111),16.2％ (18/ 111) and 59.5％ (66/111) respectively;and 4.5％ (5/111) patients had scattered symptoms.Based on results of GITT,slow transit subtype,defecation disorder subtype and mixed subtype were 54.1％ (59/109),1.8％ (2/ 109) and 29.4％ (32/109) respectively;and 14.7％ (16/109) patients were with normal transit time.ARM results showed that 38.0％ (41/109) of patients had dyssynergic defecation.The percentage of slow transit in GITT test showed no significant difference between patients with slow transit symptoms and mixed symptoms [50.0％ (11/22)vs.57.9％(33/57),x2=0.401,P=0.527].The consistency of predominant symptom with GITI subtype was low (κ=-0.013).The percentage of dyssynergic defecation detected with ARM showed no significant difference between patients with defecation disorder-predominant symptom and with mixed symptom [23.1％ (6/24)vs.38.2％ (21/55),x2=1.813,P=0.178].The consistency of defecation disorderpredominant symptom with dyssynergic defecation in ARM was low (κ=-0.019).Conclusion The mixed subtype symptoms are the most common presentations of elderly patients with functional constipation,and the consistency of predominant constipated symptoms with GITI,ARM test results is poor.