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OBJECTIVE To study the metabolites of four diterpenoids of Euphorbia fischeriana in liver microsomes of rats and to investigate its metabolic regularity. METHODS In vitro incubation system of liver microsomes of rats was built. The jolkinolide A，jolkinolide B ，17-hydroxyl jolkinolide A and 17-hydroxyl jolkinolide B were added into incubation system of liver microsomes in rats activated by reduced nicotinamide adenine dinucleotide phosphate ，incubated at 37 ℃ for 30 min，and then terminated the reaction with acetonitrile. Taking the negative group （adding acetonitrile firstly and then starting incubation for 30 min）as the reference，the ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry was used ；Anaylyst®TF 1.7.1、PeakView® 2.2，MetabolitePilot 1.5 and MasterView 1.2 software were used to speculate and identify the fragmentation law of mass spectrometry and metabolites. RESULTS Four diterpenoids were easy to lose neutral fragments such as H 2O and CO in secondary mass spectrometry. Jolkinolide A and 17-hydroxyl jolkinolide A showed similar metabolism pathway ，including dihydroxylation，dehydrogenation，and monohydroxylation ；six and five metabolites were identified respectively. Jolkinolide B and 17-hydroxyl jolkinolide B showed similar metabolism pathway ，including monohydroxylation ，hydration and isomerization. Five metabolites were identified. CONCLUSIONS Both jolkinolide A and 17-hydroxyl jolkinolide A produce the metabolites of hydroxylation and dehydrogenation in liver microsomes of rats ；both jolkinolide B and 17-hydroxyl jolkinolide B produce the metabolites of hydroxylation ，hydration and isomerization in liver microsomes of rats. The metabolites of four diterpenoids are phase Ⅰ metabolites.

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OBJECTIVE： To analyze the metabolites of jolkinolide B in rats， and predict its metabolism pathway. METHODS： The rats were randomly divided into blank group （0.5％ CMC-Na， ig） and administration group （jolkinolide B， ig， 100 mg/kg）， with 8 rats in each group. The fecal samples were collected at ＞0-12， ＞12-24， ＞24-36 hours after administration； the urine samples were collected at ＞0-2， ＞2-8， ＞8-12， ＞12-24， ＞24-36， ＞36-48 hours after administration； the blood samples were collected at 1， 2， 8， 12， 24， 36 hours after administration. UPLC-Q-TOF/MS combined with Analyst® TF 1.7.1 and PeakView® 2.2 software were used to analyze and identify the metabolites in the samples after treated with ultrasonic extraction， solid phase extraction and protein precipitation. RESULTS & CONCLUSIONS： Prototype drugs and seven metabolites were detected in rat’s fecal samples， and one or two metabolites were detected in urine and blood samples， respectively. After intragastric administration， the metabolism of jolkinolide B in rats is mainly through ring opening， oxidation， dehydration， deoxygenation and hydrogenation of phase Ⅰ， but no phase Ⅱ metabolites were detected.

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Objective To investigate the cognitive function of patients with prostate cancer after maximal androgen blockade therapy and its influenced factors,and to provide a new way for early prevention strategy.Methods Montreal cognitive assessment (MoCA),hospital anxiety depression scale (HAD),social support rating scale (SSRS) and self-designed questionnaire were used in 56 cases treated with maximum androgen blockade therapy for more than six months and 37 cases who underwent radical prostatectomy treatment to evaluate their cognitive function and collect the observation indexes between January 2013 and October 2015.Based on MoCA score,all patients were divided into cognitive dysfunction group (n =40) and normal cognitive function group (n =53).The observation indexes in two groups were compared and cognitive function with different treatment in two groups were analyzed.The changes on the influencing factors of cognitive function in patients were filtered using multivariable logistic regression analysis.Results In the cognitive dysfunction group and normal group,the proportion of MAB treatment was 80.0％ (32/40) vs.45.3％ (24/53),the age was 73.7 vs.73.7 years,the proportion of solitary was 32.5％ (13/40) vs.13.2％ (7/53),the proportion of depressive symptoms was 87.5％ (35/40) vs.62.3％ (33/53),the social support level was 32.5 vs.41.1 and the proportion of testosterone decreased was 95.0％ (38/40) vs.45.3％ (24/53).All events showed statistically significant differences (P ＜0.05).Compared MAB treatment group with radical surgical treatment group,the testosterone level was (0.27-±O.15) vs.(12.14 ± 1.86) nmol/L,visual space and executive function score was 4.18 ±0.79 vs.4.54 ±0.56,attention score was 4.73 ±0.99 vs.5.16 ±0.79,delayed memory score was 3.75 ± 1.21 vs.4.30 ± 1.05 and MoCA score was 26.13 ± 1.48 vs.27.27 ± 1.39,which all showed the statistically significant difference (P ＜ 0.05).The results of multiple regression analysis showed that age (OR =1.183,95％ CI 1.135-1.223),depressive symptoms (OR =1.092,95％ CI 1.047-1.149),social support (OR =0.897,95％ CI O.838-0.956),testosterone (OR =2.105,95％ CI 1.369-4.083) were the influenced factors of cognitive dysfunction.Conclusions The incidence of cognitive dysfunction in patients with prostate cancer after maximal androgen blockade therapy more than six months was higher than others.Age,depression,social support level and testosterone levels were related to the occurrence of cognitive dysfunction.

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OBJECTIVE@#To evaluate the preoperative virtual CT endoscopy about the simple congenital middle ear malformations and its clinical application.@*METHOD@#Thirteen cases (16 ears) with simple congenital middle ear malformations were undergone high resolution CT scannig to collect the original image data, followed by 3-dimensional reconstruction to process the images to evaluate the possible lesions of the ossicular chain. Then, a comparative analysis was made between the finding of virtual CT endotoscopic and the finding that actually found during the operation of the ossicular chain lesions.@*RESULT@#We found malleus and upper strcture of incus abnormity or embeded in upper inner wall of atticus in 5 ears; malleus, incus and stape all abnormity or absence in 3 ears, in the former two conditions we both selected auricular incision through attic pathway remaining intact canal wall; we found crus longum incudis hypoplasia orstructure suprastapedialis absence,stapes aberrance or absence in 8 ears, then we selected vestibular window fenestration and artificial stapes surgery. Postoperative external auditory canals and tympanic membranes were intact in 16 ears,and speech frequency hearing improved by average of 25-45 dB. The coincidence between virtual CT endoscopy and the ossicular chain abnormity under operating views were 100% in cases with congenital ear deformity.@*CONCLUSION@#Virtual CT endoscopy is a reliable reference for preoperative evaluation on congenital middle ear malformations.

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<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of clarithromycin combined with tanshinone in the treatment of rhinosinusal and laryngeal radiation injury induced by radiotherapy in patients with nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>A total of 255 NPC patients with rhinosinusal and laryngeal radiation injury following radiotherapy were randomized into 3 groups for treatment with clarithromycin (group A, n=69), tanshinone (group B, n=69), and clarithromycin + tanshinone (group C, n=69), and the clinical outcomes of the patients were evaluated.</p><p><b>RESULTS</b>In all the 3 groups the patients responded favorably to the treatments and showed obvious improvements (P<0.05). The therapeutic effects were similar between groups A and B (P>0.05), but the patients in group C showed the most obvious improvements (P<0.05).</p><p><b>CONCLUSIONS</b>Clarithromycin combined with tanshinone can be an effective regimen for treatment of rhinosinusal and laryngeal radiation injury induced by radiotherapy in NPC patients.</p>

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OBJECTIVE@#To evaluate the therapeutic effects of epitympanum approach tympanotomy in treating traumatic ossicular chain disruption.@*METHOD@#Ten patients with temporal bone fracture and trauma of ear, whose CT scan of temporal bone showed that Malleoincudal joint irregular shape in the axial view and incudostapedial joint dislocation in the coronal view, were included in this study, Virtual endoscopy showed Malleoincudal joint separation, incudostapedial joint dislocation and interruption, ossicular chain disruption in all patients. The surgical approach was opening the atticus via temporal line, remaining the intact posterior and superior wall of external acoustic meatus, exposing the atticus and posterior tympanic cavity sufficiently, and treating the lesions of ossicular chain.@*RESULT@#One patient with the long process of the incus fracture, adopted the fitted incus prosthesis between the handle of the malleus and the head of the stapes. Six patients with Malleoincudal joint separation or incudostapedial joint dislocation, 3 patients with incus body dislocation completely, adopted incus positioning two articulation decis. The air-conducting hearing levels had an enhancement of 25-50dB in average after surgery.@*CONCLUSION@#The effect of intact canal wall epitympanum approach ossicular reposition in treating traumatic ossicular chain disruption is satisfying.

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OBJECTIVE@#To investigate the function of virtual endoscopy in assessing ossicular chain deformity in the congenital ear malformation.@*METHOD@#In 23 cases 28 ears with congenital atresia of external auditory meatus. A high resolution spiral CT is used to display the temporal bone by axial and direct coronal planes. Perspective virtual endoscopy was processed using the virtual endoscopy software. To compare the views of the operative exploration and the virtual endoscopy then draw the responding conclusions.@*RESULT@#Twenty-eight ears with congenital microtia were showed ossicular deformity in 25 ears, while flache pauke in 3 ears. Twenty-four ears treated by canaloplasty of external auditory meatus and tympanoplasty, hammer and incus hypoplasia in 19 ears, stapes abnormity were demonstrated in 11 ears, ossicles absence in 3 ears, vestibular window clausura in 1 ears. The coincidence between Virtual endoscopy and operating view were 100% in cases with congenital ear deformity.@*CONCLUSION@#Virtual endoscopy can provide reliable information on the ossicles pathological conditions in congenital congenital aural atresia.

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OBJECTIVE To study the relative factors affecting auditory effects after tympanoplasty. METHODS 118 cases (126 ears) of tympanoplasty were reported,16 factors that might influence auditory effects were analysed. RESULTS There were 10 in 16 factors affecting auditory effects after tympanoplasty, including course, the degree of pathological changes, air-bone gap, function of eustanchian tube, remaining handle of malleus, the type of surgery, condition of tympanic mambrane after operation and so on. The results of single-variance analysis had statistical differences (P＜0.05). CONCLUSION Auditory effects after tympanoplasty were influenced by a series of factors, the major factors were the degree of pathological change and type of surgery.

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OBJECTIVE To study the clinical usability of virtual endoscopy(VE) in tympanoplasty.METHODS A total of 102 patients (204 ears) were observed by virtual endoscopy. Tympanoplasty was performed in 72 cases (75 ears) including 53 cases (55 ears) with chronic otitis media and 19 cases (20 ears) with congenital microtia and middle ear dysmorphia. Ossicular chain reconstruction was conducteded in 65 ears at the same time. RESULTS The ossicular chain was showed eroded in 19 ears of 23 patients with cholesteatoma otitis media pre-operatively by VE, but was found eroded in all of 23 ears during operation. The ossicular chain was showed eroded in 29 ears of 32 patients with osteitis otitis media pre-operatively by VE, but during operation it was found 23 ears with malleus and incus eroded, 11 ears without head of stapes or up-structure of stapes. VE showed 18 ears with congenital microtia and middle ear malformation and 2 ears with small tympanic cavity and no ossicular chain preoperatively, and operation proved 17 ears with severe ossicular malformation, 2 ears without stapes, 1 ear with vestibular window atresia. There were 2 ears with sudden hearing loss after tympanoplasty, the VE showed ossicular displacement. The coincidence rates between VE and operation view were 92 % in patients with otitis media and 100 % in patients with congenital microtia and middle ear malformation. CONCLUSION VE can supply reliability data for evaluation of the damaged ossicular chain and efficacy of tympanoplasty.