目的观察中医药对糖尿病痛性神经病变的康复治疗效果。方法对20例糖尿病痛性神经病变患者,应用中医药治疗8周,比较治疗前后的变化。结果中医药治疗后,患者的疼痛计分降低,右胫感觉神经传导速度增快(P<0.05)。结论中医药对糖尿病痛性神经病变有较好的康复效果。

Objective To investigate the changes of epidemiological and clinical features of patients with hemmorrhagic fever renal syndrome (HFRS) over past 10 years in Harbin region. Methods The epidemiological, clinical and laboratory data of patients with HFRS in 1995 and 2005 in The Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. The genotypes of Hantaan virus of patients in 2005 having an onset within 5 days were examined by reverse transcriptase polymerase chain reaction (RT-PCR). Positive rates in different groups were compared using chi square test. Results One hundred and sixty-five cases were collected, including 78 in 1995 and 87 in 2005. There were significant differences in epidemiological area (X2=10. 483, P<0.05), clinical classification (X2=7. 907, P<0.05), clinical stage (X2=10.500, P<0.05), the variance of total white blood cells (X2=20. 315, P<0.01) and blood sugar changes (X2=9.958, P<0.01) between two groups of patients. Bases on clinical manifestations, there were significant differences in two groups (1995 and 2005): headache, 70.5% and 50.6% (X2=6.812, P<0.01); lumbago, 60.3% and 40.2% (X2=6.598, P<0.05); fossaorbitalis pain, 50.0% and 19.5% (X2=17.019, P<0.01); melena, 60.3% and 40.2% (X2=6.598, P<0.05); bleeding point and eeehymosis, 50.0% and 33.3% (X2=4.715, P<0.05) ; flush of faee, neck and upper chest, 59.0% and 40.2% (X2=5.782, P<0.05); membrane-like object in urine, 44.9 % and 29.9% (X2=3.964, P<0.05) rates of thrombocytopenia, 79.5% and 64.4% (X2=4.615, P<0.05) ; rates of liver dysfunction, 50.0% and 80.5% (X2=17.019, P<0.01); rates of cardiac muscle enzymoiogy dysfunction, 50.0% and 92.0% (X2=36.003, P<0.01). The genotypes of patients in 2005 were Hantaan virus (34.8%) and Seroul virus (65.2%). Conclusion The differences in epidemiological and clinical feature of patients with HFRS over past 10 years may be related with the change of virus genotypes, and further study should be done.

Objective To study the clinical features of patients with hemorrhagic fever with renal syndrome(HFRS)complicating hyponatremia encephaledema and therapeutic effect of manicol and high sodium hemodialysis.Methods Eighty-three patients with HFRS complicating hyponatremia encephaledema were randomly divided into high sodium hemodialysis treatment group(n=41)and control group(n=42).The serum levels of potassium,sodium,chlorine,creatinine,osmotic pressure,normalization rates and normalization time of serum sodium,mortality of patients in two groups post-treatment were compared.Statistical analysis was performed using t test or chi square test.Resalts The serum levels of sodium [(128.95±7.3)mmol/L],chlorine[(96.7±6.2)mmol/L],osmotic pressure[(253.1±7.5)mOsm/L]of patients post-treatment in high sodium hemodialysis treatment group were all significantly higher than those[(117.8±7.1)mmol/L],[(92.2±6.9)mmol/L],[(242.1±8.4)mOsm/L]of patients in control group (t=7.14,t=3.12,t=15.22,respectively;all P＜0.05).The serum sodium normalization number of patients(12/19 cases)with moderate encephaledema in high sodium hemodialysis treatment group was significantly higher than that(6/19 cases)in control group(X2=3.867,P=0.049).The serum sodium normalization time of patients with moderate encephaledema in high sodium hemodialysis treatment group WaS(4.9±1.3)d,which was significantly shorter than that[(8.3±1.9)d]in control group(t=6.438,P=0.001).The serum sodium normalization number of patients(7/14 cases)with severe encephaledema in high sodium hemodialysis treatment group was significantly higher than that(2/14 cases)in control group(X2=4.094,P=0.043).The serum sodium normalization time of patients with severe encephaledema in high sodium hemodialysis treatment group was(7.8±1.9)d,which was significantly shorter than that[(11.6±2.8)d]in control group(t=3.235.P=0.034).The mortality in high sodium hemodialysis treatment group was 36.6%(15/41 cases),which was significantly lower than that(61.9%,26/42 cases)in control group(X2=5.321,P=0.021).Conclusions The conditions of patients with HFRS complicating hyponatremia encephaledema tend to be severe.In patients with HFRS complicating moderate or severe encephaledema,manicol and high sodium hemodialysis can improve the normalization rate and normalization time of serum sodium,and reduce the mortality.

Objective To investigate epidemiological and clinical features of patients with clonorchiasis sinensis infection. Methods The epidemiological, clinical, laboratory and treatment data of clonorchiasis patients in Department of Infectious Diseases, Second Affiliated Hospital, Harbin Medical University from 2002 to 2004 were retrospectively analyzed. Results Sixty-eight point two percent patients had a history of eating raw freshwater fish and shrimp. Patients with occupations as cook, fish stock man, fishing man and fishmonger accounted for 22.6%. The transmission route was not clear in 9.1% of patients. The common clinical manifestations were abdominal pain (60.3%), fatigue (52.3%), diarrhea (33.0%), anorexia (69.3%), jaundice (23.9%), hepatomegaly (59.1%), splenomegaly (8.0%), dizziness (20.9%), fever (5.7%) and biliary colic (14.8%). Twenty-eight point four percent were asymptomatic. Other findings included liver dysfunction (70.4 %) and eosinophile granulocyteosis(69.3 %). Negative rate of stool egg of clonorchis sinensis after treatment with praziquantel or albendazole was 91.9% or 86.5%, respectively. There was no significant difference between the two groups ( χ2 = 0.561, P = 0.454). Conclusions Clinical manifestations of patients with clonorchiasis sinensis are complicated and often accompanied with liver dysfunction. Clonorchiasis sinensis is often misdiagnosed and should be paid much attention.

Objective To investigate the effects of Chinese herb formula Tangtongfang by bathing the affected feet of patients with diabetic peripheral neuropathy (DPN) in the pattern of Qi deficiency and blood stasis. Methods A parallel, randomized, controlled clinical research was performed. 70 diabetics in the inpatient and outpatient divisions of the Department of Endocrinology, Guanganmen Hospital, from January 2005 to October 2007 were investigated. They were divided randomly into two groups, treatment group and control group, 35 cases in each group. Before study, there were no statistic differences between the two groups, including gender, age, course of diabetes mellitus(DM), course of DPN, blood glucose (including fasting blood glucose and postprandial blood glucose), traditional Chinese medicine(TCM) symptom scores and nerve conduction velocity (NCV). The treatment group were treated with Tangtongfang bathing and the control group were treated with warm water bathing. Each group was also administered Vitamin B1 20 mg, t.i.d and Vitamin B6 20 mg, t.i.d respectively. All patients were keeping their routine treatment and diabetic care to control their blood glucose, such as diets, practices and drugs. Clinical symptoms and electrophysiological tests in diabetic peripheral neuropathy syndrome were investigated. The period of treatment was 8 weeks.Results After study, 9 cases retreated from this clinical trial totally, 4 cases in the treatment group whereas 5 in the control group. Among 4 common single symptoms, coolness feeling of the feet of diabetic patients was significantly improved (P<0.05) after bathed with Tangtongfang. The change of TCM symptom scores and tibialis NCV was significantly improved (P＜0.001, P<0.05) in the treatment group. The improvement ratio was 45.2% and 61.3% in the treatment group, while was 10% and 3.3% in the control group. In each group there was no statistical difference between pre-and post-study with blood test, urine test, blood ALT, blood BUN and Cr, ECG examination (P>0.05). No adverse event was observed in each group.Conclusion Tangtongfang bathing improved several symptoms of patients suffering from DPN, especially the symptom of coolness feeling of the patients' feet. No adverse event was observed. This result showed that Tangtongfang bathing was worthy of using as a safe agent in treatment of DPN.

Objective The aim of this study was to investigate the effect of hepatitis C virus (HCV) replication on expression of silent information regulator 1 (SIRT1) and glucose metabolism of hepatocytes using Huh 7.5 cells harboring HCV replicon.Methods The level of reactive oxygen species (ROS),value of nicotinamide adenine dinucleotide (NAD+)/reduced form of nicotinamide adenine dinucleotide (NADH) was detected by flow cytometry and chromatometry.The activity,mRNA expression,and protein level of SIRT1 were detected by a scintillation counter,real-time fluorescence quantitative polymerase chain reaction (RT-PCR),and Western blot,respectively.Glucose uptake by hepatocytes and gluconeogenesis were detected using radioactive isotope method and glucose oxidase method.The mRNA levels of SIRT1 downstream glucose-metabolism genes were measured by RT-PCR.Measurement date were compared by t test.Results In replicon cells,the level of ROS (3.8±0.5 vs 1.0±0.2; t=12.736,P＜0.01) was increased and the value of NAD+/NADH (0.03±0.01 vs 0.12±0.03; t=6.971,P＜0.01) decreased compared with Huh 7.5 cells.The activity (0.3±0.1 vs 1.0±0.2; t=7.668,P＜0.01),mRNA expression(0.4±0.1 vs 1.0± 0.3; t=4.648,P＜0.01) and protein level(0.3±0.1 vs 0.8±0.2; t=5.941,P＜0.01) of SIRT1 were reduced.Inhibition of SIRT1 not only increased insulin receptor substrate-1 (IRS-1) phosphorylation (0.7±0.2 vs 0.4±0.1; t=3.286,P＜0.01),decreased protein kinase B (Akt) phosphorylation (0.3 ± 0.1 vs 0.6 ± 0.2; t=3.286,P＜0.01),down regulated cell surface expression of glucose transporler 2 (GLUT2,0.4±0.1 vs 1.0 ± 0.2; t =6.573,P＜0.01) and suppressed cellular glucose uptake (count per minute:4600±500 vs 21 000±4600; t=8.682,P＜0.01); but also decreased phosphorylation of forkhead box O1 (FoxO1,0.2＝0.1 vs 0.5±0.1; t=5.196,P＜ 0.01),up-regulated phosphoenolpyruvate carboxykinase (PEPCK,2.8±0.6 vs 1.0±0.3; t=6.573,P＜0.01) and glucose 6-phosphatase (2.6±0.5 vs 1.0±0.2; t=7.278,P＜0.01) genes,and promoted glucose production (2.5±0.5 vs 1.0±0.2; t=5.543,P＜0.01).Conclusions HCV replication decreases NAD+/NADH ratio,which might down-regulate the activity and the expression of SIRT1,leading to changes in the expression profile of glucose metabolism related genes and causing glucose metabolism disorders of hepatocytes by a decrease in glucose uptake and an increase in glucose production,and promotes HCV replication.

ObjectiveTo investigate the effect of adding metformin to peginterferon alfa-2a and ribavirin on the efficacy in patients with genotype 1 chronic hepatitis C and insulin resistance.Methods Ninety-eight patients with genotype 1 chronic hepatitis C and insulin resistance were randomized into the treatment group (n=49) and the control group (n=49).The patients in the control group were treated with peginterferon alfa-2a and ribavirin,and those in the treatment group were treated with metformin in addition to peginterferon alfa-2a and ribavirin. The virologic response rate,the homeostasis model assessment for insulin resistence index (HOMA-IR) and incidence of side effects were compared between two groups.The related factors of sustained virological response (SVR) were studied by multivariate logistic regression analysis.ResultsThe SVR rate of the patients in the treatment group was significantly higher than that of the control group (59.2％ vs 38.8％; x2 =4.083,P=0.043).The HOMA-IR of patients in the treatment group at week 12,24,48 of treatment and week 24 of follow-up were 3.00±0.65,1.90±0.45,1.75±0.40 and 1.60±0.35,respectively,which were all lower than those in the control group (3.50±0.72,2.90±0.64,2.74± 0.48 and 2.60±0.55,respectively) (t=3.610,8.947,11.091 and 10.738,respectively; all P＜ 0.01).The incidence of diarrhea in the treatment group was higher than the control group (28.6％ vs 10.2％ ; x2 =5.288,P=0.021).In multivariate logistic regression analysis,the independent factors associated with SVR were metformin treatment (P =0.009) and HOMA-IR＜ 2 at week 24 of treatment (P=0.011 ). Conclusion The combination of metformin,peginterferon alfa-2a and ribavirin improves insulin sensitivity and increases SVR rate of patients with hepatitis C genotype 1 and insulin resistance with good safety profile.

Objective To study the epidemiological and clinical features of the patients with forest encephalitis. Methods The epidemiological, clinical and laboratory data and prognosis of forest encephalitis patients with forest encephalitis virus-specific antibody positive were retrospectively analyzed. Results The onsets of 79 patients with forest encephalitis were mainly in May to August. Fifty-six of them were forestry workers, 9 were forest beekeepers, 8 were inhabitants with experience of getting potherb and 6 were tourists. Of the 79 patients, cases with mild, moderate and severe type were 5, 35 and 39, respectively; 7 cases died and 13 presented sequelae, such as head drooping, paralysis of the upper extremities, epilepsy, trembling and psychonosema. All 79 patients presented fever, headache, nausea and vomiting; and some of them presented other symptoms including 32 (40.5%) conscious disturbance, 74 (93.7%) neck rigidity, 74 (93.7%) meningeal irritation sign positive, 20 (25.3%) convulsion, 38 (48.1%) complexion flush, conjunctiva and oral mucosa congestion, 19 (24.1%) neck, shoulder, upper extremity muscle and limbs paralyzed, 4 (5.1%) respiratory muscle paralysis and 3 (3.8%) dysphagia. The abnormal laboratory findings included that 60 (80.0%) elevated cerebrospinal fluid pressure, 66 (88.0%) increased cell counts, 65 (82.3%) diffused and scattered slow waves on electroencephalograms, 8 (10.1%) liver dysfuncted and 18 (22.8%) elevated cardiac muscle enzymes. Conclusions Forest encephalitis is characterized by hyperpyrexia and central nervous system damage. The morbidity of severe patients is high, and the sequelae are common as well, to which we should pay much attention.

Objective To develop a method for the determination of five furostanol saponins(timosaponin N,timosaponin L, timosaponin BⅡ,25R-timosaponin BⅡ,and 25S-officinalisnin-Ⅰ)in rhizome and fibrous root of Anemarrhena asphodeloides Bge. by HPLC with the charged aerosol detector(CAD). Methods The analysis was performed on TechMate C18-ST-II(250 mm×4.6 mm,5μm)with acetonitrile:water(22:78,V/V),the flow rate of 1.0 ml/min and column temperature at 30℃. The Corona parameters were as follows:sampling rate 10 Hz,filter 5 s,and the nebulizer temperature 55℃. Results The approach showed good linearity for five saponins. The correlation coefficients(r2)for calibration curves varied from 0.9992 to 0.9998. The limits of detection(LOD)were 0.28,0.92,0.92,0.92 and 0.92 ng for five steroidal saponins,respectively. The limits of quantitation(LOQ)were found to be 0.92, 2.77,2.77,2.77 and 2.76 ng,respectively. RSD calculated from peak area of precision,repeatability and stability in 48 h were all less than 3.0%. The average recoveries of timosaponin N,timosaponin L,timosaponin BⅡ,25R-timosaponinBⅡ,and 25S-officinalis-nin-Ⅰwere 98.17%,101.37%,98.53%,97.63%,and 98.17%,respectively. Conclusion The developed method is accurate,reli-able,which could be applied to the quality control of multiple components in A. asphodeloides Bge.

Objective To design and synthesize compounds with protein tyrosine kinase(PTK)inhibitory activity with L029 as the lead compound. Methods L029 derivatives were designed and synthesized from L029 by reduction and/or substitution with the 3-dimethylamino-1-propyl,methyl acetate,methyl propionate in its active H and other sites. PTK activity was measured by enzyme-linked immunosorbent assay(ELISA). The inhibitory rate was calculated to screen out the compounds with PTK inhibitory activity. Re-sults Five target compounds were synthesized and their structures were confirmed by 1H NMR and MS. Three compounds T2,T3 and T5 were screened out with strong PTK inhibitory activity. Conclusion The synthetic routes of the target compounds are simple with mild reaction condition,and 3 compounds show strong inhibitory activity by ELISA. These results can provide reference for the further design and synthesis of this kind of molecules.