Objective To investigate the clinical value of wire-guided tubal recanalization under hysteroscope combined with laparoscope for the treatment of occluded oviduct infertility.Methods A total of 63 cases of infertility were diagnosed by hysterosalpingography(HSG) as having bilateral oviduct obstruction,of which at least one side of oviduct was proximally occluded.After laparoscopic exploration and hysteroscopic hydrotubation were performed for clarifying the diagnosis and managing related pelvic lesions,wire-guided tubal recanalization was conducted under hysteroscope combined with laparoscope for the treatment of proximal oviduct obstruction.Results Out of the 63 cases,a total of 118 oviducts were involved(eight oviducts had been previously resected).Of the 118 oviducts,59 were proximally occluded,45 were distally occluded or blinded,and 14 were proximally and distally occluded.After the surgery 99 oviducts were unobstructed.Intrauterine pregnancy was obtained within 1 year in 23 cases(36.6%).There were 25 cases of unpregnancy within 1 year,which were re-examined with HSG,presenting a re-obstruction in 7 cases.Conclusions Wire-guided tubal recanalization under hysteroscope combined with laparoscope is an ideal option for the treatment of occluded oviduct infertility.

Z-Ligustilide, a major phthalide isolated from a widely used traditional Chinese medicine Ligusticum chuanxiong, possesses various pharmacological activities including neuroprotective, anti-inflammatory, antiproliferative and vasorelaxing effects. However, it is unstable and inclined to degrade in natural conditions, which limits its study and application greatly. In this study, degradation behavior of Z-ligustilide and its degradation products stored at room temperature under direct sunlight were investigated and structure elucidated by HPLC-UV, UPLC-QTOF-MS and NMR. Z-ligustilide degradation and total five degradation products were generated and detected. Two degradation products were unequivocally identified as senkyunolide I and senkyunolide H by comparison with reference compounds. Another two degradation products were further isolated by semi-preparative HPLC and structure elucidated as (E)-6, 7-trans-dihydroxyligustilide and (Z)-6, 7-epoxyligustilide by 1H and 13C NMR, respectively. The degradation pathways of Z-ligustilide were finally proposed. Oxidation, hydrolysis and isomerization are the major degradation reactions.

Objective To explore the clinical therapeutic effects of intravenous infusion of dihiazem in com-bination with metoprolol for treating aortic dissection. Method From June 2005 to January 2008, fourteen patients with aortic dissection (male 8, female 4) in the First Hospital of Yichang,were treated with diltiazen 1～5 μg/(kgrate 30 min,60 min, 120 min,6 h, 1 d and 7 d after treatment were recorded. All data were analyzed using self-matching t test. Results The heart rate reduced significantly 60 min after treatment. The heart rate reduced (21±5) beats/min from the baseline. The total effective rate was 100% .The blood pressure reduced significantly 30min after treatment. The systolic pressure reduced to (126.2±11.1 ) mmHg and diastolic pressure declined to (80.3±8.1) mmHg. No severe cardiac side-effect observed. Conclusions Dihiazem in combination with meto-prolol can reduce heart rate and blood pressure markedly and safely in aortic dissection patients.

Objective To evaluate the efficacy and safety of continuous erythropoietin receptor activator (C.E.R.A.) once every 4 weeks by subcutaneous administration on hemoglobin (Hb)maintenance in dialytic patients with chronic renal anemia who had been treated with stable dose of erythropoietin (EPO).Methods This was an open,randomized,controlled,multi-center trial.All the hemodialysis or peritoneal dialytic patients in EPO maintenance treatment received subcutaneous EPO-β during the 6-week pre-treatment period to maintain Hb level between 100 g/L and 120 g/L.Eligible patients were randomized (2∶1 ) to accept either C.E.R.A.once every 4 weeks by subcutaneous administration ( C.E.R.A.group,n =187 ) or subcutaneous EPO-β 1-3 times weekly ( EPO group,n =94) for 28 weeks (including 20-week dose titration period and 8-week efficacy evaluation period ). The starting dose of C.E.R.A.was converted according to the dose of EPO-β administered in the week preceding the first study drug administration.The primary outcome was the change of Hb level between the baseline and that in the efficacy evaluation period.Results Totally 253 patients completed the whole 28-week treatment.The change of baseline-adjusted mean Hb was +2.57 g/L for C.E.R.A.group and + 1.23 g/L for EPO group,resulting in a treatment difference of 1.34 g/L (95％ CI - 1.11-3.78 g/L).Since the lower limit of 95％ CI was greater than the pre-defined non-inferiority margin -7.5 g/L( P ＜ 0.0001 ),C.E.R.A.once every 4 weeks by subcutaneous administration was clinically non-inferior to EPO regarding the maintenance of stable Hb level.The proportion of patients maintaining Hb level within the range of 100-120 g/L through efficacy evaluation period was similar between the two groups ( 69.0％ for C.E.R.A.group vs 68.9％ for EPO group,P ＞0.05 ).The overall incidence of adverse events was similar between the C.E.R.A.(41.7％)and EPO (46.2％ ) groups ( P ＞ 0.05 ).The safety findings were in accordance with the patients' primary diseases rather than the administration.Conclusions Conversion from EPO to C.E.R.A.once every 4 weeks by subcutaneous injection could maintain the Hb in target level in dialytic patients with renal anemia,and it was non-inferior to EPO.In general,subcutaneous administration of C.E.R.A.is well tolerated in dialytic patients with chronic renal anemia.