Dilemma and promotion strategy of “dual channel”management policy for China’s medical insurance negotiated drugs / 中国药房

OBJECTIVE To provide reference for the smooth implementation of the “dual channel” management policy for China’s medical insurance negotiated drugs. METHODS Based on Smith policy implementation process model， the dilemmas for the implementation of “dual channel” policy for medical insurance negotiated drugs were analyzed from four aspects： implementation details and regulatory system， drug selection， drug provision and quality control， the situation of medical insurance funds and information technology capabilities. The corresponding promotion strategies were put forward. RESULTS & CONCLUSIONS The “dual channel” policy for medical insurance negotiated drugs in China might face implementation difficulties such as a lack of clear implementation rules and a full process supervision system， the suitability and operability of some medical insurance negotiated drugs need to be considered in the “dual channel” management， difficulties in drug allocation and quality control， differences in the management and operation of medical insurance funds in different regions， and insufficient informatization capability. In this regard， this study suggests that measures， such as improving the implementation rules of the “dual channel” policy， enhancing the rationality of the “dual channel” drug catalog， establishing a dynamic exit mechanism for “dual channel” pharmacies， promoting professional delivery services， and improving the electronic prescription circulation platform， which can be taken to enhance the implementation effect of the “dual channel” policy.

Two new 2,3-seco triterpenoids from Rubus pirifolius Smith / 药学学报

Eight compounds were isolated from the ethyl acetate fraction of the 80% aqueous ethanol extract of the roots and stems of Rubus pirifolius Smith by AB-8 macroporous resin, silica gel, ODS, Sephadex LH-20 column chromatography, and semi-preparative HPLC. Their structures were identified by spectral analysis such as 1D/2D NMR, MS, UV, IR and by comparison with literature information as rubussecotriterpene A (1), rubussecotriterpene B (2), cecropiacic acid (3), cecropiacic acid 3-methyl ester (4), alphitolic acid (5), betulinic acid (6), betulin (7), and obtusalin (8). Compounds 1 and 2 are new compounds, and compounds 3-8 were isolated from this plant for the first time.

Neonatal Smith-Kingsmore syndrome: case report and literature review / 中国新生儿科杂志

Objective:To study the clinical and genetic features of neonatal Smith-Kingsmore syndrome (SKS).Methods:The clinical data of a newborn with SKS admitted to our hospital in November 2021 were reviewed. Using "Smith-Kingsmore", "rapamycin gene", "newborn", "premature infant", "the mammalian target of rapamycin", "MTOR", "mTOR", "Smith-Kingsmore syndrome", "megalencephaly", "macrocephaly" and "hemimegalencephaly" as keywords, databases including CNKI, Wanfang Database, VIP database, PubMed, Embase, Web of Science and the Cochrane Library were searched from the date of establishment to January 1, 2022. The clinical and genetic features of neonatal SKS from published literature were summarized.Results:The case admitted to our hospital was a male preterm infant. The presenting symptoms were groan and hypotonia. The facial abnormalities included macrocrania, ocular hypertelorism, depressed nasal bridge and low-set ears. Brain MRI showed lateral ventricle enlargement. Whole-genome sequencing (WGS) showed mTOR gene nonsense heterozygous mutation (NM_004958.4:c.7255G>A:p.Glu2419Lys). Neither father nor mother had any pathogenic gene mutations. The infant had seizure at 2-month and phenobarbital was effective reducing seizure. Gross motor delay was present at 3-month. Sixteen related articles were retrieved, including eight articles with 10 neonatal cases. Among them, 6 cases were male. The main clinical features were megalencephaly or hemimegalencephaly (9/10), facial developmental malformation (8/10), hypotonia (6/10), large-for-gestational age (LGA) infants (5/10), cerebral ventricle dilation (4/10) and abnormal corpus callosum (4/10). All the gene mutations were missense mutations, including c.5395G>A(p.Glu1799Lys) mutation in 5 cases, c.4448G>T(p.Cys1483Phe) mutation in 1 case, c.4448G>T(p.Cys1483Tyr) mutation in 1 case, c.7235A>T(p.Asp2412Val) mutation in 1 case, c.5663T>G(p.Phe1888Cys) mutation in 1 case, c.5390C>T(p.Thr1799IIe) mutation in 1 case.Conclusions:The clinical phenotypes of neonatal SKS are diverse, including megalencephaly, facial malformation, LGA and hypotonia. The brain MR findings included (hemi) megalencephaly, cerebral ventricle dilation and corpus callosum hypoplasia. Most of the gene mutations are missense mutations and c.5395G>A(p.Glu1799Lys) is the hotspot.

A neonate with Smith-Lemli-Opitz syndrome caused by DHCR7 gene compound heterozygous variations / 中华围产医学杂志

This article reported a male neonate with Smith-Lemli-Opitz syndrome (SLOS) caused by DHCR7 gene compound heterozygous variations. The patient presented with multiple malformations and feeding difficulties after birth and was transferred to the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital) from a local hospital eight days later. Physical examination found general scleredema, scalp defects, short penis, urinary tract malformation, bilateral syndactyly of the second and third toes, and low serum cholesterol. Whole-exome and Sanger sequencing indicated a compound heterozygous mutation in the DHCR7 gene, c.852C>A(p.F284L), and a de novo mutation of c.820_825del(p.N274_V275del). SLOS is rare in the Asian populations and prone to missed diagnosis and misdiagnosis with difficulty in clinical management. The possibility of SLOS should be considered for newborns with multiple malformations and low serum cholesterol.

Diseño de dietas alimentarias para soldadores y paileros a partir de su gasto energético / Design of food diets for welders and smiths based on their energy expenditure

RESUMEN Introducción: el desempeño laboral en algunos puestos de trabajo, determina un alto nivel de carga física por parte de los trabajadores, por lo que se impone la necesidad de disponer de una adecuada dieta alimentaria para mantener la salud física y mental. Objetivo: se desarrolló una investigación para diseñar una dieta alimentaria para soldadores y paileros a partir del gasto energético en actividades laborales. Materiales y métodos: se realizó un estudio de campo que partió de una muestra no probabilística de soldadores y paileros de la Empresa Industrial Ferroviaria José Valdés Reyes. Se ejecutó un procedimiento que permitió la determinación de la dieta alimentaria de los trabajadores a partir del gasto energético de las actividades que desarrollan. Se aplicaron ciertas técnicas de observación directa, entrevistas, tormenta de ideas, medición directa de variables fisiológicas y ecuaciones para el cálculo del gasto energético. Resultados: se diseñaron tres variantes de dietas ajustadas al gasto energético de tres puestos de trabajo de la mencionada empresa. Conclusiones: se espera que la aplicación de las dietas diseñadas contribuya a mantener una buena salud de los trabajadores de esos puestos de trabajo (AU).

ABSTRACT Introduction: the working performance of certain jobs determines a high level of physical load from the part of the workers, for what the necessity is imposed of having an appropriate food diet to preserve the physical and mental health. Objective: to design a food diet for welders and smiths starting from the energy expense in working activities. Materials and methods: a field study was carried out starting from a probabilistic sample of welders and smiths from the Industrial Railroad Enterprise Jose Valdes Reyes. A procedure was performed allowing to determine the energy expenditure of the activities they develop. Several techniques like direct observation, interviews, brain storm, direct measure of physiological variable and equations were used to calculate the energy expenditure. Results: three diet variants were designed adjusted to the energy expenditure of the three working places of the before mentioned enterprise. Conclusions: it is expected the application of the designed diets will contribute to keeping good health of the workers in those working places (AU).

Study on the problems in implementing the appointment registration system at public hospitals based on the Smith-Model / 中华医院管理杂志

Objective:To analyze problems found in the implementation of the appointment registration system at public hospitals in China under the new situation, and provide a reference for the improvement and development of the system.Methods:Documents on appointment registration system published before December 31, 2020 were collected through the databases of CNKI, Wanfang, VIP and other official websites such as the National Health Commission. The Smith-Model was used as the main analysis framework in a systematical sorting and analysis of the implementation of the appointment registration system of public hospitals, in such means as qualitative interviews with relevant managers, doctors and residents and PEST analysis method.Results:The appointment registration system of public hospitals was highly idealized in its design, but there existed policy deficiencies in system standards, implementation effectiveness and supporting systems; and there were various problems in policy cognition, acceptance and implementation with its implementation agencies and target groups. Environmental factors such as politics, laws, economy, social culture and technology also posed negative effects on the implementation of policies.Conclusions:There were still some problems in the implementation of the appointment registration system in public hospitals, such as imperfect system standards, different implementation efforts in different regions, imperfect incentive and economic compensation mechanisms, and it was difficult to change residents' traditional ideas.Targeted strategies and measures should be taken regarding the policy makers, health administrative departments, business institutions, patients and environmental factors to ensure the continuous and effective implementation of the system in the future.

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.

Prenatal diagnosis and neonatal phenotype of a de novo microdeletion of 17p11.2p12 associated with Smith–Magenis syndrome and external genital defects

Smith–Magenis syndrome (SMS, OMIM: 182290) is a multiple congenital anomalies and intellectual disability syndrome due to a 3.45 Mb microdeletion involving 17p11.2 and is estimated to occur about one in 25,000 births. Up to now, the ultrasound findings of the foetus with SMS and their external genital defects in patients are rarely reported. This case indicates that foetus with SMS may present polyhydramnios and ventriculomegaly in the second trimester. The newborn male patient had an abnormal phenotype in which he has micropenis and his anus is close to the perineal body. The identification of this case may further expand the phenotypic spectrum of this genetic disorder.

Dental management for a child with smithmagenis syndrome under general anesthesia: case report

Introduction: Smith-Magenis Syndrome (SMS) is a genetic disease characterized by a neuro-behavioral deficiency caused by mutations or deletions at the 17p11.2 locus comprising the retinoic acid-induced 1 (RAI1) gene. The diagnosis is made through clinical analysis looking for characteristics and to prove this suspicion, a technique called Fluorescence In Situ Hybridization (FISH) is required. Objective: The aim of this case report is to be the first to describe the planning and execution of dental treatment for a 5yearold female patient with SMS under general anesthesia. Case report: The patient was admitted to the clinic of the Universidade Federal Fluminense, with possible dental pain, in the anamnesis the need for invasive treatment was observed in many dental elements and due to the patient's behavioral pattern, treatment under general anesthesia was chosen. Results: Procedures were performed (restorations and extractions) in the hospital in the same step. The child follow-up after the intervention every six month. Conclusion: SMS is a rare syndrome that requires extensive knowledge of the dentist and a detailed anamnesis to choose the best option to solve the case.

Introdução: A síndrome de Smith-Magenis (SMS) é uma doença genética caracterizada por uma deficiência neuro-comportamental causada por mutações ou deleções no locus 17p11.2 compreendendo o gene 1 induzido por ácido retinóico (RAI1). O diagnóstico é feito por meio de análises clínicas em busca de características e para comprovar essa suspeita, é necessária a técnica denominada Hibridização In Situ por Fluorescência (FISH). Objetivo: O objetivo deste relato de caso é o primeiro a descrever o planejamento e execução do tratamento odontológico para uma paciente do sexo feminino de 5 anos de idade com SMSsob anestesia geral. Relato do caso: O paciente deu entrada no ambulatório da Universidade Federal Fluminense, com possível dor dentária, na anamnese observou-se a necessidade de tratamento invasivo em diversos elementos dentais e devido ao padrão de comportamento do paciente optou-se pelo tratamentosob anestesia geral. Resultados: Os procedimentos foram realizados (restaurações e extrações) no hospital na mesma etapa. O acompanhamento da criança após a intervenção foi a cada seis meses. Conclusão: A SMS é uma síndrome rara que requer amplo conhecimento do dentista e uma anamnese detalhada para aescolha da melhor opção para a solução do caso.

A Comparative Study on the Fingerprint of Paris polyphylla var. Polyphylla and Paris polyphylla var. yunnanensis from Different Origins in Dali and Seven Main Steroidal Saponins by HPLC / 中国药学杂志

OBJECTIVE: To study the fingerprints of rhizomes of Paris polyphylla Smith var. polyphylla and Paris polyphylla Smith var. yunnanensis (Franch.) Hand. -Mazz from different origins in Dali and the differences of seven main steroidal saponins. METHODS: The fingerprints of rhizomes of Paris polyphylla var. polyphylla and Paris polyphylla var. yunnanensis from different origins in Dali were established by HPLC. The similarity of fingerprints and seven main steroidal saponins were compared and analyzed. RESULTS: There were 14 common peaks in the fingerprints of rhizomes of Paris polyphylla var. polyphylla from different origins in Dali, and the similarity of the fingerprints of the samples from different habitats except Jinhua Weishan and Longjie Weishan was greater than 0.9. There were 13 common peaks in the fingerprints of rhizomes of Paris polyphylla var. yunnanensis from different origins in Dali, and the similarity of the samples from different origins was greater than 0.92. There were 11 common peaks in the fingerprints of rhizomes of Paris polyphylla var. polyphylla and Paris polyphylla var. yunnanensis from different origins in Dali, and the similarity of the fingerprints was very low, between 0.057 and 0.225. Polyphyllin Ⅰ, polyphyllin Ⅱ, polyphyllin Ⅵ and polyphyllin Ⅶ are detected in the rhizomes of Paris polyphylla var. polyphylla and Paris polyphylla var. yunnanensis from different origins in Dali. The average peak areas of polyphyllin Ⅰ, polyphyllin Ⅱ, polyphyllin Ⅵ and polyphyllin Ⅶ in Paris polyphylla var. yunnanensis from different origins in Dali were higher than those of Paris polyphylla var. polyphylla. Polyphyllin H was detected in the rhizomes of Paris polyphylla var. yunnanensis from Leqiu Nanjian, Jinhua Weishan, Fengyu Eryuan, Dengchuan Eryuan, Hongyan Midu, Xiyi Heqing and the rhizomes of Paris polyphylla var. polyphylla from Wanqiao Dali, Fengyi Dali, Xiyi Heqing, Hongyan Midu and Leqiu Nanjian. Polyphyllin Ⅲ was detected in the rhizomes of Paris polyphylla var. polyphylla from the origins except Longjie Weishan. Polyphyllin Ⅴ was also detected in the rhizomes of Paris polyphylla var. polyphylla in Fengyu Eryuan and Xiyi Heqing. CONCLUSION: Polyphyllin Ⅰ, polyphyllin Ⅱ, polyphyllin Ⅵ and polyphyllin Ⅶ are detected in the rhizomes of Paris polyphylla var. polyphylla and Paris polyphylla var. yunnanensis from different origins in Dali. The similarity of the HPLC fingerprints of the rhizomes of Paris polyphylla var. polyphylla and Paris polyphylla var. yunnanensis is very low, and there are great differences in seven main steroidal saponins. The contents of polyphyllin Ⅰ, polyphyllin Ⅱ, polyphyllin Ⅵ and polyphyllin Ⅴ in Paris polyphylla var. yunnanensis are higher than those in Paris var. polyphylla.

Kadsura coccinea: A rich source of structurally diverse and biologically important compounds / 中草药·英文版

Kadsura coccinea belongs to medicinally important genus Kadsura from the Schisandraceae family. It has been used in traditional Chinese medicine (TCM) for the treatment of rheumatoid arthritis and gastroenteric disorders. The initial phytochemical work focused on the identification of some structurally novel and diverse natural products, which turned the attention of many researchers towards this plant. Thus far, 202 compounds have been reported in this plant. Lignans and terpenoids were found as the main chemical constituents of this plant. Some of the triterpenoids and sesquiterpenoids with novel structures are of particular interest for natural product researchers. The isolated compounds of this plant have shown different bioactivities including anti-tumor, anti-HIV, anti-inflammatory, nitric oxide (NO) production inhibitory and other pharmacological effects. This review systematically summarizes all the phytochemical and pharmacological work done so far on K. coccinea, and can be used as a reference for future research on this plant.

Surgical choice of posterior osteotomy way for senile osteoporotic thoracolumbar fracture with kyphosis / 中国骨伤

OBJECTIVE@#To investigate the surgical choice of posterior osteotomy way by the observation of clinical outcome of Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column re-section (VCR) for senile osteoporotic thoracolumbar fracture with kyphosis.@*METHODS@#From June 2015 to August 2017, an amount of 8 elderly patients with thoracolumbar kyphosis caused by osteoporotic vertebral fracture underwent osteotomy approach for posterior osteotomy. All patients were old osteoporotic vertebral fracture more than 6 months and received invalid conservative treatment for 3 months including nonsteroidal anti-inflammatory and analgesic drugs, anti-osteoporosis drugs and acupuncture, etc. There were 3 males and 5 females, with an average age of 73.4 years (66 to 83 years), with an average course of the disease of 34.6 months (8 to 60 months). Eight patients had a total of 8 vertebral fractures, and fracture segment was in T of 1 case, T of 1 case, T of 3 cases, L of 2 cases, L of 1 case. Eight patients showed kyphosis caused by wedge deformation of single segmental vertebral fractures. The thoracolumbar kyphosis and symptoms were progressively developing into central sagittal imbalance. SPO osteotomy was performed in 3 cases, PSO osteotomy in 3 cases, and VCR osteotomy in 2 cases. Orthopaedic effects were analyzed by imaging measurements, including pre- and post-operative kyphosis Cobb angle, localized kyphosis (LK), thoracic kyphosis (TK), lumbar lordosis (LL), sacral tilt angle (ST) and sagittal vertical axis (SVA). Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the pain and lumbar function.@*RESULTS@#All the eight patients were followed up from 8 to 24 months with an average of 13.5 months and all the symptoms of low back pain have significantly reduced or disappeared. The VAS score decreased from 5-8 points (mean 6.5 points) before surgery to 1-4 points (mean 1.88 points) at the final follow-up, and the score was significantly improved. The ODI score decreased from 36-78 points (mean 60.25 points) before surgery to 10-32 points (mean 20.38 points) at the final follow-up, and the functional score improved significantly. During the follow-up period, X-ray examination showed that some patients had a slight decrease in the height of the intervertebral fusion, and the bone graft was healed. There was no obvious corrected degree loss and internal fixation loosening, and the thoracolumbar kyphosis was significantly improved. The mean Cobb angle of T-L was reduced from 25.3° to 2.8° with corrected rate of 89.3% ; LK was reduced from 43.4° to 7.1° with corrected rate of 86.2% ; TK was reduced from 49.9° to 30.6°, LL was reduced from 43.6° to 30.8°, and ST was changed from 24.0° to 32.1°, SVA was changed from 6.23 cm to 2.40 cm.@*CONCLUSION@#For the different pathological features and deformities of senile osteoporotic thoracolumbar fracture combined with kyphosis, SPO, PSO or VCR can achieve good orthopedic effect and clinical efficacy.

Effect of inoculation time of arbuscular mycorrhizal fungi on endogenous hormone content in Paris polyphylla var. yunnanensis seedlings / 中草药

Objective: To study the effect of the inoculation time of arbuscular mycorrhizal (AM) fungi on endogenous hormone content in Paris polyphylla var. yunnanensis seedlings. Methods: The indoor pot test was applied. The seeds, one-year-old seedlings, and two-year-old seedlings of P. polyphylla var. yunnanensis were inoculated by different mixed AM fungi and cultivated in the sterilized soil matrix respectively. The contents of endogenous hormone zeatin riboside (ZR), gibberellin (GA), indole acetic acid (IAA) and abscisic acid (ABA) were determined by HPLC. Results: The results showed that the endogenous hormone (ZR, GA, IAA and ABA) contents in rhizome and fibrous roots of P. polyphylla var. yunnanensis from different regions or different time inoculated by mixed AM fungi were various. As a whole, the contents of endogenous hormone ZR and GA increased obviously in the rhizome and fibrous roots of the wild and cultivated P. polyphylla var. yunnanensis compared with the control group (CK), while the content of ABA reduced. The IAA/ABA value, GA/ABA value and ZR/ABA value increased obviously in the rhizome and fibrous roots of P. polyphylla var. yunnanensis. Conclusion: The one-year-old of P. polyphylla var. yunnanensis inoculated with S2 and S6 mixed AM fungi showed the best comprehensive effect for promoting growth of the rhizome and fibrous roots of P. polyphylla var. yunnanensis seedlings.

Comparation of HPLC fingerprints of Lagotis integra and Lagotis brevituba between different origins / 中草药

Objective: To establish HPLC fingerprints of Lagotis integra and Lagotis brevituba which were contained in National Drug Standard and compared to Lagotis ramalana, Lagotis alutacea and Lagotis brachystachya by the established method. Methods: The similarity of HPLC fingerprints of L. integra and L. brevituba was low, so the HPLC fingerprint methods were established for both. The HPLC analysis was performed on Waters X-Bridge C18 (250 mm × 4.6 mm, 5 μm), using acetonitrile and 0.2% formic acid solution as the mobile phase at a flow rate of 1.0 mL/min, the detection wave-length was 328 nm and column temperature was 35 ℃ (L. integra) and 25 ℃ (L. brevituba). Results: There were 14 common peaks in the fingerprint of L. integra, and plantamajoside, hemiphroside B, 10-O-trans-p-methoxycinnamoyl-catalpol and 10-O-[(E)-3,4-dimethoxycinna moyl]-catalpol were standardized. There were 13 common peaks in the fingerprint of L. brevituba, and echinacoside, plantamajoside and acteoside were standardized. The similarity of HPLC fingerprint was more than 0.9 between L. integra and L. alutacea, but the others had low similarity with them. The similarity of HPLC fingerprint was more than 0.9 between L. brevituba from different batches and L. ramalana, while the others had low similarity with them. Conclusion: The established method could effectively identify L. brevituba, L. integra and L. alutacea were advised to be recorded in Medical Standards of the Ministry of Health. Lagotis ramalana could be used as a new base for "Honglian" (origin: Lagotis brevituba).

A new polyketide from endophytic fungus Aspergillus oryzae derived from Paris polyphylla var. yunnanensis / 中草药

Objective: To study the secondary metabolites of the endophytic fungus Aspergillus oryzae from Paris polyphylla var. yunnanensis in order to find new compounds. Methods: The endophytic fungus A. oryzae was fermented by liquid fermentation. After extraction, silica gel and macroporous adsorption resin were used to separate and purify the extract. The structures of the compounds were identified according to their physical and chemical properties and spectroscopic data. Results: Three compounds were isolated and their structures were identified as 3-amino-4,5-dihydroxy-4,6-dimethyl-2-(2-methylbutanoyl)cyclohex-2-enone (1), 12-N-methyl- cyclo-(L-tryptophyl-L-phenylalanyl) (2) and ditryptophenaline (3). Conclusion: Compound 1 is a new polyketide named asperpolyketide A.

Two new α-pyronoids from endophytic fungus Aspergillus oryzae derived from Paris polyphylla var. yunnanensis / 中草药

Objective: To study the chemical composition and structure of the secondary metabolites of the endophytic fungus Aspergillus oryzae from Paris polyphylla var. yunnanensis. Methods: A. oryzae was fermented by liquid fermentation. After extraction, it was separated and purified by various chromatography methods. The structure of the compounds was identified according to the physical and chemical properties and spectral data. Results: Four compounds were isolated and their structures were identified as 4-hydroxy-6-[(2S,3S)-3-hydroxybutan-2-yl]-3-methyl-2H-pyran-2-one (1), (R)-4-hydroxy-6-(1-hydroxy-2- methylpropyl)-3- methyl-2H-pyran-2-one (2), flufuran (3) and flufuran methyl ester (4). Conclusion: Compounds 1 and 2 are new α-pyronoids named asper-α-pyranone A and asper-α-pyranone B.

Anti-inflammatory effect of impressic acid from Acanthopanax gracilistylus based on NF-κB signaling pathway / 中草药

Objective: To explore the anti-inflammatory effect of impressic acid (IA) from Acanthopanax gracilistylus on lipopolysaccharide (LPS)-induced RAW264.7 cells. Methods: RAW264.7 cells were stimulated by LPS to establish an inflammatory model. The cytotoxicity of IA on RAW 264.7 cells was detected by EZ4U cell proliferation and cytotoxicity analysis kit. The level of nitric oxide (NO) was determined by Griess. The levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were determined by ELISA. The expressions of TNF-α and IL-1β mRNA were detected by RT-PCR. The expression of high-mobility group box 1 protein (HMGB1) was detected by western blotting. The levels of nuclear factor-κB (NF-κB) in cytoplasm and nucleus were measured by ELISA. Results: IA significantly suppressed the levels of TNF-α and IL-1β, the expression of HMGB1 protein, and the translocation of NF-κB from cytoplasm to nucleus in LPS-induced RAW264.7 cells (P < 0.05, 0.01). Conclusion IA from A. gracilistylus has an anti-inflammatory effect on LPS-induced RAW264.7 cells.

Concordancia del volumen telediastólico final del ventrículo izquierdo medido por monitor ultrasónico y ecocardiografía / Concordance of the final telediastolic volume of the left ventricle measured by ultrasonic monitor and echocardiography / Concordância do volume telediastolólico final do ventrículo esquerdo medido por monitor ultra-sônico e ecocardiografia

Resumen: Antecedentes: La sepsis se ha asociado a alta mortalidad y disfunción cardiaca; la ecocardiografía es técnicamente difícil; el operador dependiente requiere personal capacitado y equipo disponible, por lo que la fórmula de Smith & Madigan (SMII), a través del monitor ultrasónico de gasto cardiaco, es un sustituto adecuado del inotropismo, pudiéndose inferir el volumen telediastólico final del ventrículo izquierdo (VDFVI) como un indicador de precarga. Métodos: En 56 pacientes diagnosticados con shock séptico, se midieron las siguientes fórmulas usando monitor ultrasónico de gasto cardiaco y comparándose con el volumen telediastólico final por ecocardiografía. SMII = (VS × (PAM - PVC + Gp))/(7.5 × SC × TF) VDFVI = VS × 2.7/SMII. Resultados: Comparamos los resultados medidos por ecocardiografía y fórmula de Smith & Madigan, usando el método de Bland & Altman, obtuvimos un R2=0.92, un coeficiente de Linn de 0.92 con LC95% más alto 32.45, LC95% inferior-39.45 y una tasa de error de 32%. Conclusión: La fórmula de Smith & Madigan podría ser útil para el cálculo de volumen telediastólico final del ventrículo izquierdo; aunque debemos determinar si esta medida es útil para tomar decisiones clínicas, ya que el porcentaje de error es mayor al 20%.

Abstract: Background: Sepsis has been associated with high mortality and cardiac dysfunction, echocardiography is technically difficult, depends on the operator, requires trained personnel and available equipment, so the Smith & Madigan formula (SMII) through the cardiac output monitor Ultrasonic is an adequate substitute of inotropism, being able to infer the final end-diastolic volume of the left ventricle (VDFVI) as indicator of preload. Methods: In 56 patients diagnosed with septic shock, the following formulas were measured by an ultrasonic cardiac output monitor and compared with final end-diastolic volume by echocardiography. SMII = (VS × (PAM-PVC + Gp))/(7.5 × SC × TF) VDFVI = VS × 2.7/SMII. Results: We compared the results measured by echocardiography and the Smith & Madigan formula, using the Bland & Altman method, we obtained an R2 = 0.92, a Linn coefficient of 0.92 with an LC95% higher 32.45, LC95% Lower - 39.45 and a 32% error rate. Conclusion: The Smith & Madigan formula could be useful for the calculation of final end-diastolic volume of the left ventricle. Although the percentage of error is greater than 20%, we must determine if this measure is useful for making clinical decisions.

Resumo: Contexto: A sepse tem sido associada com alta mortalidade e disfunção cardíaca. O ecocardiograma é tecnicamente difícil, operador dependente, requer pessoal treinado e equipamentos disponíveis de modo que a fórmula de Smith & Madigan (SMII) através do monitor ultra-sônico de débito cardíaco é um substituto adequado do inotropismo, sendo capaz de inferir o volume diastólico final do ventrículo esquerdo (VDFVI) como um indicador de pré-carga. Métodos: Foram mensuradas as seguintes fórmulas em 56 pacientes com diagnóstico de choque séptico, por meio de um monitor ultra-sônico do débito cardíaco e comparadas ao volume telediastólico ao final pelo ecocardiograma. SMII = (VS × (PAM-PVC + Gp))/(7.5 × SC × TF) VDFVI = VS X 2.7/SMII. Resultados: Comparou-se os resultados medidos pela ecocardiografia e a fórmula de Smith & Madigan utilizando o método de Bland & Altman, obtivemos um R2 = 0.92, um coeficiente de Linn de 0.92 com um LC95% maior 32.45, LC95% Inferior - 39.45 e uma Taxa de erro de 32%. Conclusão: A fórmula de Smith & Madigan poderia ser útil para o cálculo do volume telediastólico final do ventrículo esquerdo. Embora a porcentagem de erro seja maior que 20% devemos determinar se essa medida é útil para tomar decisões clínicas.

Smith-Kingsmore syndrome: The first report of a Korean patient with the MTOR germline mutation c.5395G>A p.(Glu1799Lys)

Smith-Kingsmore syndrome (SKS; OMIM 616638), also known as macrocephaly-intellectual disability-neurodevelopmental disorder-small thorax syndrome (MINDS; ORPHA 457485), is a rare autosomal dominant disorder, the prevalence of which is not known. It is caused by a heterozygous germline mutation in MTOR (OMIM 601231). Ten different MTOR germline mutations in 27 individuals have been reported in the medical literature to date. These were all gain-of-function missense variants, and about half of the 27 individuals had c.5395G>A p.(Glu1799Lys) in MTOR. Here, I report for the first time a Korean patient with the heterozygous germline mutation c.5395G>A p.(Glu1799Lys) in MTOR. It was found to be a de novo mutation, which was identified by whole-exome sequencing and confirmed by Sanger sequencing. The patient showed typical clinical features of SKS, including macrocephaly/megalencephaly; moderate intellectual disability; seizures; behavioral problems; and facial dysmorphic features of curly hair, frontal bossing, midface hypoplasia, and hypertelorism.

Adaptive smith predictor controller for total intravenous anesthesia automation

Anesthetic agent propofol needs to be administered at an appropriate rate to prevent hypotension and postoperative adverse reactions. To comprehend more suitable anesthetic drug rate during surgery is a crucial aspect. The main objective of this proposal is to design robust automated control system that work effi ciently in most of the patients with smooth BIS and minimum variations of propofol during surgery to avoid adverse post reactions and instability of anesthetic parameters. And also, to design advanced computer control system that improves the health of patient with short recovery time and less clinical expenditures. Unlike existing research work, this system administrates propofol as a hypnotic drug to regulate BIS, with fast bolus infusion in induction phase and slow continuous infusion in maintenance phase of anesthesia. The novelty of the paper lies in possibility to simplify the drug sensitivity-based adaption with infusion delay approach to achieve closedloop control of hypnosis during surgery. Proposed work uses a brain concentration as a feedback signal in place of the BIS signal. Regression model based estimated sensitivity parameters are used for adaption to avoid BIS signal based frequent adaption procedure and large off set error. Adaptive smith predictor with lead–lag fi lter approach is applied on 22 diff erent patients' model identifi ed by actual clinical data. The actual BIS and propofol infusion signals recorded during clinical trials were used to estimate patient's sensitivity parameters EC50 and λ. Simulation results indicate that patient's drug sensitivity parameters based adaptive strategy facilitates optimal controller performance in most of the patients. Results are obtained with proposed scheme having less settling time, BIS oscillations and small off set error leads to adequate depth of anesthesia. A comparison with manual control mode and previously reported system shows that proposed system achieves reduction in the total variations of the propofol dose. Proposed adaptive scheme provides better performance with less oscillation in spite of computation delay, surgical stimulations and patient variability. Proposed scheme also provides improvement in robustness and may be suitable for clinical practices.