OBJECTIVE:To observe the clinical efficacy and safety of Kudiezi injection combined with alprostadil in the treat-ment of posterior circulation ischemic vertigo. METHODS:Totally 180 patients with posterior circulation ischemia were randomly divided into group A,group B and group C. All patients were given aspirin,atorvastatin,nutrition nerve,antihypertensive,hypo-glycemic and other conventional treatment. On this basis,group A was given Alprostadil injection 10 μg,adding into 0.9% Sodium chloride injection 100 ml,iv,once a day;Kudiezi injection 30 ml,adding into 0.9% Sodium chloride injection 250 ml,iv,once a day. Group B was given Alprostadil injection(the same usage as group A);group C was given Kudiezi injection(the same usage as group A). The course was 14 d. The clinic data was observed,including clinical efficacy;blood flow velocity in left vertebral ar-tery(LVA),blood flow velocity in right vertebral artery(RVA),blood flow velocity of basilar artery(BA),changes of peak laten-cy(PL)and incubation period latency(IPL)before and after treatment;and the incidence of adverse reactions. RESULTS:The to-tal effective rate in group A was significantly higher than group B and C,with significant difference(P<0.05). After treatment,the blood flow velocity of LVA,RVA and BA in each group were significantly higher than before,group A was higher than group B and C;PL-Ⅰ,PL-Ⅲ,PL-Ⅴ,IPL-Ⅰ-Ⅲ and IPL-Ⅲ-Ⅴ were significantly lower than before,group A was lower than group B and C,with significant differences(P<0.05);however,there were no significant difference between group B and C(P>0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Kudiezi injection combined with alprostadil has better effica-cy than only Kudiezi injection or alprostadil in the treatment of posterior circulation ischemic vertigo,with good safety.

Objective To find out what kind of disease the uterine mass diagnosed by B-ultrasound is and discuss its outcome treated by hysteroscopy. Methods 78 cases of uterine mass were treated by hysteroscopy in our hospital from Auguest 2000 to July.2001, Masses were detected,cut out and sent for pathologic diagnosis. Results sixty-two cases (79.49%)(62/78)came to see their doctors with the symptoms,including abnormal bleeding (58) and abnormal discharge or abdominal pain(4).The other 16 cases were detected in regular physical examination without any complaint.No complication occurred during the operation.The results of pathology were as follows:endometrial polyp 51.3%(40/78),simplex hyperplasia 20.5%(16/78),complex hyperplasia 1.3%(1/78),atypical hyperplasia 2.6%(2/78),endometrial adenocarcinoma 1 3% (1/78),leiomyoma or adenomyoma 14.1%(11/78),incomplete abortion 1.3%(1/78),and no abnormolily 5 cases(6.4%).Thirty-five cases of mass were discovered in postmenopausal women and 85.7%(30/35)of cases were benign.Sixty-nine patients(88.5%)were followed up for (2～12)months after the operation.Sixty-five of them were satisfied with treatment.The satisfying rate was 94.2%.Especially with the postmenopausal women,all 31 cases were satisfied with the operation though 4 cases no longer contacted us. Conclusions Most of utering masses diagnosed by B ultrasound are benign.Hysteroscopy therapy is an appropriate method for the uterine mass in postmenopausal women.

Objective To investigate the clinicopathologic characteristics of premalignant and malignant endometrial polyps (EP) in premenopausal and postmenopausal women.Methods A retrospective analysis was conducted in 42 cases of premalignant and malignant EP from 1993 to 2012.Polyps were classified into premenopausal (group A,10 cases) and menopausal (group B,32 cases),including 26 cases of endometrioid adenocarcinoma,4 of clear cell carcinoma,9 of serous adenocarcinoma,and 3 of atypical hyperplasia.Results The prevalence rate of premalignant and malignant EP was 1.42％ (42/2 965),the prevalence rate of malignancy in postmenopausal and postmenopausal women was 0.48％ (10/2 064) and 3.55％ (32/901),respectively.The mean size of EP was (1.6 ± 0.8) cm,abnormal uterine bleeding was positive in 90％ (38/42) of cases.The EP pathological diagnosis showed all were endometrioid adenocarcinoma in group A,while there were 4 of clear cell carcinoma,9 of serous adenocarcinoma in group B.The mean size of EP was (1.1 ± 0.6) and (1.7 ± 0.9) cm in group A and B respectively (P ＜0.05).According to immunohistochemistry,all cases of group A were ER positive,but 41％ (11/27) of group B were ER negative (P =0.059).The PR positive rate was 8/9 and 56％ (15/27) in group A and B,respectively (P =0.169).Conclusions The risk of the EP malignancy rate is higher,while ER,PR positive rate are lower in postmenopausal womcn.Postmenopausal EP,especially accompanied by abnormal uterine bleeding and large polyps should be removed as soon as possible.

Objective To evaluate the role of P2X3 receptors in dorsal root ganglion in development of incisional pain in rats.Methods Twenty-four healthy male SD rats weighing 200-220 g were randomly divided into 3 groups(n = 8 each): control group(group C),incisional pain(group IP)and P2X3 receptor antagonist + IP group(group A).In group IP and A,a 1 cm longitudinal incision was made in the plantar surface of left hindpaw according to the method described by Brennan et al.in isoflurane-anesthetized rats.P2X3 receptor antagonist TNP-ATP 200 nmol was injected into the plantar surface of left hindpaw 30 min after plantar incision was made in group A,while equal volume of normal saline was given instead of TNP-ATP in group C and IP.The behavior of the hindpaw of the rats were assessed using cumulative pain score within 1 h after injection.The animals were sacri ficed 2 h after injection and the dorsal root ganglion was removed for determination of P2X3 receptor expression and intracellular Ca2+ concentrations.ResultsThe cumulative pain scores,P2X3 receptor expression and Ca2 + concentrations were significantly higher in group IP and A than in group C(P ＜ 0.05).The cumulative pain scores,P2X3 receptor expression and Ca2+ concentrations were significantly lower in group A than in group IP(P ＜0.05).Conclusion P2X3 receptors in dorsal root ganglion is involved in the development of incisional pain through increasing intracellular Ca2+ concentrations in rats.

Objective To evaluate the effects of anisodamine on apoptosis in cardiomyocytes and inflammatory response in overtrained rats. Methods Twenty-four male Wistar rats, weighing 200-220 g, were randomly divided into 3 groups ( n = 8 each) : control group (group C) , overtraining group (group O) , anisodamine group (group A) . The model of overtraining-induced acute heart injury was established by exhausting swimming. Anisodamine 10 mg/kg was given intraperitoneally 20 min before overtraining in group A. Blood samples were taken at 6 h after overtraining for measurement of serum CK-MB activity. The rats were then sacrificed and myocardial tissues taken for determination of TNF-α content and NF-κB activity (by immunohistochemistry) . The apoptosis rate was detected by flow cytometry. Results The CK-MB activity, apoptosis rate, TNF-α content and NF-κB activity were significantly higher at 6 h after overtraining in groups O and A than in group C, while lower at 6 h after overtraining in group A than in group O ( P < 0.05) . Conclusion Anisodamine can inhibit apoptosis in cardiomyocytes by reducing inflammatory response in overtrained rats.

Objective To study the feasibility of endometrial sampling device as a sampling tool during the follow-up visit for endometrial cancer patients undergone conservative treatment.Methods Before the hysteroscopy examination,endometrial sampling device was used to take the endometrium specimens 43times in 19 patients who had been diagnosed as endometrial cancer or atypical hyperplasia,and were undergone conservative treatment during May 2012 to Mar.2013.All cases accepted vaginal ultrasound screening before every sampling by endometrial sampling device.The histological results were compared with those done by hysteroscopy.Results The average age of those patients was (30 ± 6) years old.The mean thickness of the endometrium during the treatment was (0.81 ± 0.65) cm.The qualified rate for the sampling was 95％ (41/43).Compared with the specimens undergone by hysteroscopy direct sampling,32samples got by the endometrial sampling device with thicker endometrium (0.93 ± 0.70) cm had the same histological results,while the other 9 patients with thinner endometrium (0.40 ± 0.14) cm were not (P =0.031).Conclusion The endometrial sampling device could be used during the follow-up visit for the conservative treatment patients with endometrial cancer or atypical hyperplasia,the vaginal ultrasound screening should be used together to figure out those with thinner endometrium.

ObjectiveTo investigate effects of anisodamine on myocardial caspase-1 and interleukin-18 expression following overtraining-induced acute myocardial injury in rats.Methods Forty-eight male Wistar rats weighing 200-220 g were randomly divided into 3 groups:group control (group C,n =8) ; group exhausting swim (group ES,n =24) and group anisodamine (group AD,n =16).The animal model of overtraining-induced acute myocardial injury was developed by exhausting swim The animals were forced to swim until they were exhausted.The animals sank to the bottom and no righting reflex or escape response was elicited when they were taken out of water in groups ES and AD.In group AD anisodamine 10 mg/kg was given intraperitoneally 20 min before overtraining.Blood samples were taken from inferior vena cava immediately (T1) and at 6 and 24 h after overtraining (T2,T3 ) in group ES and at T2,T3 in group AD for determination of serum cardiac troponin 1 (cTnI) concentration (by ELISA).The animals were sacrificed after blood sampling and myocardial specimens were obtained for microscopic examination and determination of caspase-1 and interleukin-18 expression (by immuno-histochemistry).ResultsOvertraining significantly increased serum cTnI concentration and up-regulated myocardial caspase-1 and interleukin-18 expression in group ES as compared with group C.Anisodamine significantly attenuated overtraining-induced increase in serum cTnI concentration and myocardial caspase-1 and interleukin-18 expression in group AD as compared with group ES.ConclusionAnisodamine can reduce overtraining-induced acute myocardial injury by down-regulating caspase-1 and interleukin-18 expression.

Objective To evaluate the prophylactic efficacy of compound sulfamethoxazole (SMZco)combined with ganciclovir on severe pulmonary infection in the early stage of renal transplantation. Methods Between January 2005 and January 2006,two hundred and forty renal allograft patients in our hospital were enrolled in this study.All the patients were divided into two groups.Group A(n=84)received oral SMZco combined with intravenous ganciclovir.Group B(n=156)received intravenous ganciclovir only as control.According to the time of SMZco administration,group A was divided into two subgroups:group A1(within 2weeks after transplantation,n=43)and group A2(more than 2 weeks after transplantation,n=41).All the patients were followed up for 9 months.Incidence of pulmonary infection and effects on graft function by SMZco at different time point were investigated. Results The incidence of severe pulmonary infection and mortality of infection were significantly lower in group A than those in group B (2/84 vs 16/156,P=0.027;0/2 vs 2/16,P＜0.01).There were no significant differences between two groups in terms of age,gender,warm or cold ischemia,complement dependent cytotoxieity test results,incidence of urinary infection and Scr.The incidence of elevatedScr was significantly lower in group A2 than that in group A1(15/43 vs 2/41,P＜0.01),however,all the elevated Scr returned to basal level within 1 week after SMZco was discontinued.Conclusions Oral SMZco combined with ganciclovir administration after renal transplantation is effective on preventing severe pulmonary infection and thus improves graft and recipient survival.The administration of oral SMZco initiated more than 2 weeks after transplantation is better for graft function.

Objective To analyze the effects of losartan and amlodipine on leptin,adiponectin and insulin sensitivity in obese hypertensive patients.Methods 126 patients with obesity related hypertension were selected,and they were randomly divided into losartan group and amlodipine group according to the digital table,63 cases in each group.The losartan group were treated with losartan 50mg/time,1 time/d.The amlodipine group was given amlodipine 50mg/time,1 time/d.The two groups were given the corresponding drugs for 16 weeks.The body mass index (BMI),heart rate,systolic blood pressure (SBP),diastolic blood pressure (DBP),leptin,adiponectin,HOMA-IR and norepinephrine(NE) levels were measured before and after treatment in the two groups.Results After treatment,the BMI of the losartan group decreased significantly,the difference was statistically significant (t =6.660,P ＜ 0.05),but there was no significant difference in heart rate (t =0.180,P ＞0.05).After treatment,the BMI of the amlodipine group decreased significantly (t =3.647,P ＜ 0.05),heart rate increased significantly,the difference was statistically significant (t =3.098,P ＜ 0.05).After treatment,the BMI and heart rate in the losartan group were significantly lower than those in the amlodipine group,and the differences between the two groups were statistically significant (t =3.106,3.256,all P ＜0.05).After treatment,the SBP and DBP in the two groups were significantly decreased,the differences were statistically significant (tlosartan group =9.503,13.095;tamlodipine group =10.254,11.776,all P ＜ 0.05),there were no statistically significant differences between the two groups (t =0.975,0.659,all P ＞ 0.05).After treatment,the level of adiponectin in the losartan group was significantly increased,the leptin level and HOMA-IR score decreased significantly,the differences were statistically significant (t =4.462,2.004,5.572,all P ＜ 0.05),there was no significant difference in the level of NE (t =0.481,P ＞ 0.05).After treatment,NE level of the amlodipine group was significantly higher,the difference was statistically significant (t =6.090,P ＜ 0.05),there were no statistically significant differences in the levels of leptin,adiponectin and HOMA-IR score (t =0.126,0.053,0.448,all P ＞ 0.05).Conclusion Losartan and amlodipine can effectively control hypertension,but losartan can effectively regulate the metabolic disorder of obesity related hypertension patients with obesity alone,therefore,losartan alone has more significant effect compared with amlodipine.

Objective:To analyze the incidence, biochemical and molecular characteristics, and gene mutation spectrum of neonatal methylmalonic acidemia (MMA) in Shaanxi province.Methods:This study involved 146 152 newborns undergoing neonatal screening for methylmalonic acidemia by tandem mass spectrometry in Northwest Women's and Children's Hospital from January 2014 and December 2019. Clinical manifestations and follow-up data of newborns diagnosed with MMA and their acylcarnitine profiles and gene mutations were analyzed. According to whether they had elevated homocysteine or not, these patients were divided into two groups, the complicated group and the isolated MMA group. The control neonates were those excluded from having methylmalonic acid by re-examination. Kruskal-Wallis and Mann-Whitney U test was conducted for statistical analysis. Results:(1) Twenty-one cases of MMA were confirmed with an incidence of 1/6 960, including 11 cases (52.4%) of isolated MMA (isolated MMA group) and 10 (47.6%) complicated by elevated homocysteine (complicated group). Eight patients in the isolated group had symptoms within one month after birth, mainly feeding difficulties, vomiting, drowsiness, poor response and infection, and five died. Patients in the complicated group were all diagnosed before developing typical clinical symptoms, and no developmental abnormalities were reported during follow-up. (2) Blood propionyl carnitine and its ratios to acetylcarnitine and free carnitine in the isolated MMA and complicated groups were higher than those in the control group [ M (min-max), 9.26 (3.70-37.78) μmol/L and 7.27 μmol/L (3.58-13.62 μmol/L) vs 4.51 μmol/L (1.48-8.69 μmol/L), H=23.239; 1.12 (0.32-2.43) and 0.74 (0.36-1.90) vs 0.25 (0.09-0.45), H=47.061; 0.94 (0.12-1.92) and 0.56 (0.18-1.03) vs 0.17 (0.06-0.38), H=36.868; all P<0.001]. The blood methionine level in the complicated group was significantly lower than that in the isolated MMA group [7.64 μmol/L (3.40-19.25 μmol/L) vs 24.22 μmol/L (10.73-56.55 μmol/L), U=3.000, P<0.001]. (3) All 21 patients carried complex heterozygous mutations or homozygous mutations in pathogenic genes, including 15 distinct MMUT mutations and 13 distinct MMACHC mutations. In the isolated MMA group, the most common mutation was c.323G>A (p.Arg108His) in the MMUT gene with a positive rate of 13.6%, and an unreported mutation, c.1676+11A>G, with unidentified clinical significance, was also found. The most common mutations in the complicated group were c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in the MMACHC gene, and the positive rates were both 20.0%. Moreover, two unreported variants, c.430-2A>C and c.648_650delAGA (p.216_217delSEinsS), were detected and suspected to be pathogenic. Conclusions:MMA is not uncommon in Shaanxi province. Children with isolated MMA tend to be more severe clinically. The identification of hotspot mutations, including c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in MMACHC gene and c.323G>A (p.Arg108His) in MMUT gene, provides a foundation for further genetic screening, counseling, and prenatal diagnosis, and is conducive to reduce the mortality and disability rate of neonatal MMA.