OBJECTIVE：To provide evidence-based reference for c linical drug selection and decision by rapidly evaluating the effectiveness，safety and economy of treprostinil in the treatment of pulmonary arterial hypertension （PAH）. METHODS ：Retrieved from Chinese and English database such as PubMed ，Embase，Web of Science ，the Cochrane Library ，Epistemonikos，HTA database（University of York ），CNKI and Wanfang databases ，included the health technology assessment （HTA）report，systematic/ Meta-analysis and pharmacoeconomic evaluation of treprostinil compared with placebo or other drugs in the treatment of PAH. The search time limit is from the construction of the database to May 1st，2020. HTA checklist ，AMSTA and CHEERS were applied to evaluate the quali ty of the literatures about HTA ，systematic review/Meta-analysis analysis a nd pharmacoecono mic evaluation and the inclusion studies was analyazed by descriptive summary. RESULTS：A total of 18 literatures were included ，involving 1 HTA report ，12 systematic review/Meta-analysis ，5 pharma- coeconomic studies. The analysis results of effectiven- ess mail： showed that compared with placebo ，treprostinil could signifi- cantly increase 6-MWD while decrease Borg dyspnea score of PAH p atients（P＜0.05），but had no significant effect on mortality，the rate of clinical deterioration ，WHO functional grading ，the rate of hospitalization ，mPAP，PVR，cardiac index and mRAP（P＞0.05）. In addition ，compared with placebo combined with endothelin receptor antagonist and/or phosphodiesterase inhibitors，oral administration of treprostinil combined with endothelin receptor antagonist and/or phosphodiesterase inhibitors could extend 6-MWD significantly. Compared with riociguat ，treprostinil could significantly reduce Borg dyspnea score of patients. The analysis results of safety displayed that ，although the incidence of drug withdrawal due to can ’t tolerate ADR increased in patients receiving treprostinil ，there was no significant difference in the incidence of serious adverse events compared with placebo or other treatments，and it was better tolerated when administered by inhalation or intravenous injection. The analysis results of pharmacoeconomic studies showed that ICER of treprostinil was higher than the willingness payment threshold ，although the willingness payment threshold was different in different countries and different payers. CONCLUSIONS ：Treprostinil treatment is effective for PAH. Patients may stop taking it due to can ’t tolerate ADR ，but the risk of serious adverse events are not increase. Although the price is high ，it is still an important alternative for PAH patients with clinical progress or poor prognosis.

Objective:To explore the therapeutic effect of Integration of Traditional Chinese and Western Medicine in the treatment of irritable bowel syndrome of diarrhea type of liver depression and spleen deficiency, and its influence on inflammatory factors and intestinal mucosal barrier function.Methods:From May 2017 to May 2019, 86 patients with diarrhea-predominant irritable bowel syndrome admitted to the Traditional Chinese Medicine Hospital of Wenling were randomly divided into observation group (43 cases) and control group (43 cases) according to random number table method.The patients in the control group were given trimetastatin tablets, while the patients in the observation group were given traditional Chinese medicine decoction on the basis of the control group.The two groups were treated for 6 weeks.The therapeutic effects, main symptom scores, inflammatory factors, intestinal mucosal barrier function and adverse reactions were compared between the two groups before and after treatment.Results:The total effective rate of the observation group was 93.02%(40/43), which was higher than 67.44%(29/43) of the control group(χ 2=8.871, P<0.05). The main symptom scores of the observation group were (0.52±0.16)points, (0.46±0.12)points, (0.58±0.15)points, (0.39±0.09)points and (0.41±0.10)points, repectively, which were lower than those of the control group[(1.28±0.25)points, (1.16±0.26)points, (1.34±0.27)points, (0.95±0.14)points and (0.93±0.17)points]( t=16.790, 16.030, 16.135, 22.064, 17.289, all P<0.05). The serum levels of IL-6[(8.27±1.38)μg/L] and IL-8[(2.63±0.43)μg/L] in the observation group were lower than those in the control group[(14.39±2.37)μg/L and (4.37±0.56)μg/L]( t=14.633, 16.160, all P<0.05). The levels of plasma endotoxin[(2.68±0.46)U/mL] and D-lactate[(4.87±0.79)μg/L] in the observation group were lower than those in the control group[(3.97±0.63)U/mL and (7.39±0.95)μg/L]( t=10.844, 13.374, all P<0.05). No serious adverse reactions occurred in both two groups. Conclusion:The combination of traditional Chinese and western medicine has good clinical effect in treating diarrhea-predominant irritable bowel syndrome, which can alleviate inflammation and improve intestinal mucosal barrier function, with fewer adverse reactions.

Objective:To explore the clinical effect of integrated traditional Chinese and western medicine in the treatment of functional dyspepsia of liver-stomach disharmony.Methods:From June 2018 to June 2019, 92 patients with functional dyspepsia admitted to Wenling Hospital of Traditional Chinese Medicine were divided into observation group(46 cases) and control group(46 cases) according to random number table method.The control group was treated with trimebutine maleate orally, while the observation group was treated with self-made traditional Chinese medicine decoction on the basis of the control group.Both two groups were treated for 4 weeks.The therapeutic effect, the changes of TCM symptom score, gastric motility index and adverse reactions were compared between the two groups before and after treatment.Results:The total effective rate of the observation group(93.48%) was higher than that of the control group(69.57%)(χ 2=8.731, P<0.05). After treatment, the scores of upper abdominal pain, abdominal distension and early saturated belch acid in the two groups were lower compared with those before treatment(all P<0.05). After treatment, the scores of upper abdominal pain, abdominal distension and early saturated belch acid in the observation group were lower than those in the control group( t=11.068, 22.320, 15.073, 14.369, all P<0.05). After treatment, the levels of serum MLT and LEP in the two groups were higher than those before treatment(all P<0.05), while the level of CRH were lower than those before treatment(all P<0.05). After treatment, the levels of serum MLT and LEP in the observation group were higher than those in the control group, while the level of CRH in the observation group was lower than that in the control group, the differences between the two groups were statistically significant( t=12.022, 15.884, 16.536, all P<0.05). The incidence of adverse reactions in the observation group(4.35%) was lower than that in the control group(23.91%)(χ 2=7.256, P<0.05). Conclusion:The combination of traditional Chinese and western medicine has good effect on functional dyspepsia of liver-stomach disharmony, it can improve gastric motility, and has few adverse reactions, which is worthy of clinical reference.

OBJECTIVE: To identify mitochondrial gene variants associated with statin-induced myalgia in Chinese patients with coronary artery disease (CHD). METHODS: This study was conducted in a cohort of 403 patients with CHD receiving rosuvastatin therapy, among whom 341 patients had complete follow-up data concerning myalgia and 389 patients had documented measurements of plasma creatine kinase (CK) level. All these patients underwent genetic analysis using GSA chip for detecting mitochondria gene variants associated with myalgia. A logistic regression model was used to assess the association between 69 mitochondrial single-nucleotide polymorphisms (SNPs) and myopathy in 341 patients. The impact of these mutation sites on CK levels in 389 patients was evaluated by linear regression analysis. RESULTS: G12630A variant was identified to correlate with an increased risk of myalgia in CHD patients (OR: 8.689, 95% CONCLUSIONS Mitochondrial G12630A variation is associated with statin-induced myalgia in patients with CHD, indicating the necessity of different treatment strategies for patients who carry this risk allele.
China ; Coronary Artery Disease/genetics* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects* ; Mitochondria ; Myalgia ; Polymorphism, Single Nucleotide

Objective To observe the expression of triggering receptor expressed on myeloid cells (TREM),Caspase-3 and interleukin (IL)-6 in optic nerve tissue of ischemic optic neuropathy (ION).Methods Twenty Sprague-Dawley rats were randomly divided into control group and model group,10 rats in each group.The permanent ligation of bilateral internal carotid arteries (BICA) was performed for 14 days to establish subacute ION model as model group.The control group were separated BICA without ligation.The expressions of TREM-1,TREM-2,Caspase-3 and IL-6 in rat retina were detected by reverse transcription PCR and Western blot,respectively.Results Compared with the control group,the expressions of TREM-1,Caspase-3,IL-6mRNA (t=6.058,7.86,6.055) and protein (t=9.671,9.524,14.501) in the optic nerve tissue of the model group were increased,while the expression ofTREM-2 mRNA and protein (t=9.283) was decreased,and the difference was statistically significant (P＜0.05).Conclusion In ischemic optic nerve tissue,TREM-1 mRNA and protein were significantly expressed,the expressions of TREM-2 mRNA and protein decreased significantly.

Objective To investigate the lens and pituitary dose impacted by additional filtration and collection field in head and neck DSA examinations. Methods All images were acquired by a Philips ALLura Xper FD 20 DSA machine. The combination of the different collection fields (48 cm, 42 cm, 31 cm, 22 cm) and additional filtrations (0.9 mmCu+1.0 mmAl, 0.4 mmCu+1.0 mmAl, 0.1 mmCu+1.0 mmAl) were adjusted when the anthropomorphic phantom filled with dosimeter was scanned in anterioposterior and lateral positions with 2D?DSA and 3D?DSA. The dose area product (DAP), air kerma (AK) and the radiation dose values of bilateral lens and pituitary were measured and recorded. The 2D and 3D?DSA regional absorption dose on lens and pituitary were analyzed using t' test, the correlations between DAP and AK parameters and different regional absorption doses were evaluated by Pearson rank correlation coefficient. Results Absorption doses of left lens, right lens and pituitary with 2D?DSA (n=12) were as following:(2.77 ± 0.68), (6.23 ± 3.54), (8.65 ± 2.62) mGy, while the parameters with 3D?DSA (n=12) were (1.78 ± 0.82), (2.18±1.15), (3.32±0.64) mGy, respectively;the results revealed a significant difference (t'=3.20, 3.76 and 6.85, P<0.01). DAP [(8 739±5 731) mGy·cm2] had a relationship with absorption dose of pituitary, left lens and right lens [(5.988 ± 3.299),( 2.258 ± 0.872),( 4.207 ± 3.303) mGy, r values were 0.766, 0.684, 0.727; P<0.01]. AK values was (31 ± 23) mGy and it had a relationship with pituitary absorption dose (r value was 0.894, P<0.01). The lens dose was reduced when the additional filtration was increased and the collection field was decreased, the radiation dose of the pituitary was reduced when both the additional filtration and the collection field were increased. Conclusions In the head and neck DSA examinations, the radiation dose of the lens and the pituitary had different changes with the different additional filters and collecting fields. The organ dose with 3D?DSA was significantly less than that with 2D?DSA.

Objective To investigate the effect of different additional filtration thickness of DSA on image quality and radiation dose with cerebral angiography. Methods Prospective collected 90 patients with DSA examination of the whole cerebral artery, patients were divided into A, B and C group according to the time of the examination, each group included 30 cases. Patients underwent conventional DSA, the additional filtration of group A, B and C were (1.0 mmAl+0.1 mmCu), (1.0 mmAl+0.4 mmCu) and (1.0 mmAl+0.9 mmCu), respectively. Dose area product (DAP), air kerma (AK), tube current and tube voltage of anteroposterior and lateral radiography of the whole brain were recorded, and scored the image quality. Eye lens organ dose values were obtained by using simulation phantom and LiF dosemeter under A, B and C groups with three different additional filtrations for cerebral angiography. The image quality scores and the radiation dosewere analyzed by one-way ANOVA tests or Kruskal-Wallis tests. Results The image quality comprehensive score of three groups showed significant difference (F=40.07,P<0. 01), which were (3.8±0.4), (3.6 ± 0.5) and (3.0 ± 0.6), respectively. The DAP and AK value of anteroposterior and lateral radiography of three groups also showed significant difference (P<0.05), B and C group were lower than the A group. Left and right eye lens organ dose were decreased along with the increase of the additional filtration thickness, and the difference between the 3 groups also had significant difference (P<0.01). Conclusion Both the image quality and radiation dose can acquire when conducted the whole brain DSA with 1.0 mmAl+0.4 mmCu additional filtration.

OBJECTIVE:To study the pharmacodynamics of Compound xiangqi granules in vitiligo model guinea pigs. METH-ODS:The vitiligo guinea pigs model was established by chemical decolorization with hydrogen peroxide. Then guinea pigs were randomly divided into 5 groups after modeling,including model control group (water),vitiligo capsules group [positive control, 50 mg/(kg·d)] and Compound xiangqi granules low-dose,medium-dose and high-dose groups [25,100,and 400 mg/(kg·d)]. They were given related medicines intragastrically once a day for 40 days. The distribution of skin melanin and the number of black hair follicle were observed,and cholinesterase (ChE) activity,malondialdehyde (MDA) content of plasma and hemorheology in-dexes were detected. Blank control group had also been established. RESULTS:Compared with blank control group,the distribu-tion of skin melanin,the number of black hair follicle and ChE activity decreased in model control group,while plasma viscosity, whole blood viscosity and hematocrit increased significantly,and erythrocyte sedimentation rate decreased significantly;there was statistical significance(P<0.05 or P<0.01). Compared with model control group,except erythrocyte sedimentation rate and hema-tocrit of low-dose group,above indicators of positive control group and Compound xiangqi granules low-dose,medium-dose and high-dose groups were all improved;there was statistical significance(P<0.05 or P<0.01),showing good effectiveness-dose rela-tionship. CONCLUSIONS:Compound xiangqi granules improve relative indicators of experimental vitiligo model guinea pigs effec-tively.

Objective To investigate the clinical features of gynecological malignant tumor related multiple primary malignant neoplasms (MPMN).Methods Apply retrospective and comprehensive analysis to the clinical data of 30 patients with gynecological malignant tumor related MPMN.Results Synchronous MPMN were found in 9 patients.Their average age was 50.2 years old and their median age was 49 years old.The neoplasms were located at ovary,uterus,cervix,breast and intestine.Metachronous MPMN were found in 21 patients.Their average age was 57.7 and their median age was 57 years old.The median interval between the first and the second primary malignant neoplasm was 4.0 years.The neoplasms were located at breast,ovary,uterus,gastrointestinal tract,uterine cervix,lung etc.In 30 cases,26 of them were treated by surgical operation and further adjunctive treatment of chemotherapy and (or) radiotherapy was conducted as per the neoplasm staging and its pathological results.The rest 4 patients (first primary malignant neoplasms were excised from 3 of them and another one was not treated by surgical operation) received adjunctive treatment of chemotherapy and (or) radiotherapy.Followed ups,which varied from 6 to 60 months,were made to 29 patients and 20 out of the 29 were alive.5-year survival rate of patients with gynecological malignant tumor related MPMN was 47.8％,2-year survival rate was 73.9％,and 1-year survival rate was 88.6％.Conclusion Pay more attention to the patients with gynecological malignant tumor related MPMN,examine the high-risk patients with malignant tumor comprehensively,identify whether it is recurrence,metastasis or new growth of malignant neoplasm,and further ensure early diagnosis and proper treatment,avoiding misdiagnosis and missed diagnosis.

Objective To investigate the probable pathologic basis of amido proton transfer(APT) imaging by analysing APT signal intensity and pathologic features of different grades of glioma.Methods Twenty-eight patients with glioma confirmed by postoperative pathology underwent APT scan.All the patients were divided into two groups,including 11 cases in low grade (WHO Ⅰ and Ⅱ) and 17 cases in high grade (WHO Ⅲ and Ⅳ) group.The APT rate of tumor core was measured.The specimens were processed with routine hematoxylin-eosin (HE) staining and immunohistochemistry of Ki-67 and CD34.Independent-samples t test was used to detect the difference of APT rate,cellularity,microvessel density and Ki-67 labeling indices of tumor core between low grade and high grade group.Pearson correlation analysis and multi-variable linear regression analysis were used to detect the relationship of APT rate with cellularity,microvessel density and Ki-67 labeling indices of the tumor core.Results The APT rate,cellularity and proliferation index were (2.3±0.6) ％,(9.4±2.4) ％ and (14.2±5.4) ％ in low grade group,while (3.6±0.7) ％,(18.4±4.7) ％ and (31.7±4.5) ％ in high grade group,respectively.Microvessel density was (19.0±7.4) per high-power field in low grade group and (38.9±11.3) in high grade group.There were statistical differences of the APT rate,cellularity,microvessel density and proliferation index between the low grade group and the high grade group (t=-4.94,-5.89,-5.13,and-9.28,respectively,P＜0.01).The APT rate was positive correlated with cellularity,microvessel density and proliferation index.The coefficient of correlation were 0.904,0.598,and 0.750,respectively,(P＜0.01).Multiple linear correlative analysis showed that increasing cellularity (X1),microvessel density (X2) and proliferation index (X3) were the main factors for increasing APT rate,and the correlation equation was Y=0.801 + 0.12X1-0.003X2 + 0.026X3 (F=46.437,P＜0.01,R2=0.853).Conclusions The APT signal intensity of the tumor core could reflect the pathologic features of glioma.The APT rate was positive correlated with cellularity,microvessel density and proliferation index,which indicate the higher APT rate the higher grade tumor.