OBJECTIVE:To observe the efficacy and safety of amitriptyline combined with carbamazepine in the treatment of postherpetic neuralgia(PHN). METHODS:80 patients with PHN were randomly divided into observation group and control group. Control group was orally given Carbamazepine tablets 100 mg,bid,then increased to 100 mg,tid after 3 d. Observation group was additionally given Amitriptyline tablets 12.5 mg every night before bed,d1~3;then increased to 25 mg after 3 d every night be-fore bed,d4~5;and 12.5 mg every morning from 6th d+25 mg every night before bed,and the dose could be adjusted based on the pain and adverse reactions of 2 groups. The treatment course for 2 groups was 4 weeks. Visual analogue scale score(VAS),sleep-ing time,pain disappearing time and clinical efficacy in 2 groups were compared,and the incidence of adverse reactions were re-corded. RESULTS:The total effective rate in observation group was higher than control group,VAS was lower than control group, sleeping time was longer than control group and pain disappearing time was shorter than control group,the differences were statisti-cally significant(P<0.05). There was significant difference in the incidence of adverse reactions between 2 groups(P>0.05). CON-CLUSIONS:Amitriptyline combined with carbamazepine has obvious efficacy in the treatment of PHN,with good safety.

Objective:To investigate the molecular mechanism underlying apoptosis of lung adenocarcinoma cell line A549 induced by rapamycin, a type of mammalian target of rapamycin (mTOR) signal pathway inhibitor, combined with hypoxia treatment. Methods:Rapamycin was applied to treat A549 cell line under hypoxia for 16 h. Then the discrepancy of cell apoptosis between treated and untreated control was compared by Hochest 33258 staining. After being treated with rapamycin combined with hypoxia, the mRNA and protein expressions of survivin, a kind of anti-apoptotic molecule, were tested by real-time PCR and Western blotting. Western blotting was employed to test the difference of hypoxia-inducible factor (HIF)-1α expression level before and after rapamycin was added. In additon, chromatin immunoprecipitation(ChIP) assay was further applied to explore the mechanism underlying the effects of rapamycin under hypoxia in inducing apoptosis of A549 cells. Results:Rapamycin induced apoptosis of A549 cell line under hypxia in vitro. In A549 cell line, the expressions of survivin at mRNA (P<0.01) and protein levels, were both decreased by rapamycin combined with hypoxia treatment. Besides, ChIP assay revealed that rapamycin inhibited the expression of survivin at the transcriptional level through decreasing the hypoxia-induced up-regulation of HIF-1α and its binding with the promoter of survivin gene. Conclusion:Rapamycin exerted anti-tumor effects by inhibiting the expression of HIF-1α and decreasing the binding of HIF-1α with the promoter of survivin gene, thereby down-regulating the increase in the expression of apoptosis inhibiting gene survivin.

Objective To investigate the clinical and genetic characteristics in two patients with androgen insensitivity syndrome. Methods Clinical features and laboratory data were collected from the patients and their families. All exons of the androgen receptor gene were amplified by PCR and PCR products were sequenced. Results Patient 1 presented with unambiguous female external genitalia, unilateral gynecomastia and primary amenorrhea. He did not have axillary hairs or pubic hairs. Patient 2 presented with undervirilization including scanty body hairs, gynecomastia and hypospadias. A missense mutation of

Objective To investigate the association of impaired glucose regulation and adiponectin (APN)with the clinical severity of coronary lesions.Methods A total of 210 cases of suspected coronary heart disease were examined by coronary artery angiography.The patients were differentiated as 4 groups:42 patients with normal glucose tolerance (NGT),36 patients with impaired fasting glucose(IFG),92 patients with impaired glucose tolerance (IGT;including 44 cases with postpraudial 2h plasma glucose(2 hPG) ＜ 10 mmol/L as IGT1 subgroup and 48 cases with 2h PG ≥ 10 mmol/L as IGT2 subgroup),and 40 patients with combination of IFG and IGT.Accordingly,body mass index (BMI),blood pressure,blood lipid,insulin,APN and CRP were measured to evaluate by Gensini score.Results The incidence of coronary heart disease and Gensini scores in IGT and IGT+IFG groups were significantly higher than those in either IFG or NGT subset(P＜0.05).APN in both IGT and IGT+IFG subsets was significantly lower than that in IFG or NGT subsets(P＜0.05),CRP values were significantly raised in both IGT and IGT+IFG subgroups compared with the other 2 subgroups(P＜0.05).Statistical difference in Gensini scores and APN was found between the 2 IGT subgroups (P＜0.05).Gensini scores were negatively correlated with APN level.Multivariate regression analysis showed that both APN and HOMA-IR values were independently correlated with the Gensini scores.Conclusion The lowered APN may serve as a more sensitive factor in predicting the coronary lesions in patients with IGR,especially in IGT cases.It woula be beneficial to cardiovascular complication by controlling the postprandial blood glucose level below 10 mmol/L.

Objectives:The present study was undertaken to investigate the effects of recombinant growth hormone(rhGH) on protein metabolism during intraabdominal infection.　 Methods : The study was made up of two parts: animal experiments and clinical studies. All animals were divided into three groups: normal control, sepsis control and rhGH therapy groups. All patients were divided into two groups: infection control and rhGH therapy groups. Expressions of hepatic albumin mRNA and muscle myosin heavy chain mRNA were detected.　 Results: In septic animals, rhGH accelerated nitrogen retention and recovery of body weight, improved concentrations of plasma albumin and muscle protein. Expressions of hepatic albumin mRNA and myosin heavy chain mRNA decreased significantly after infection. By using rhGH, expression of albumin mRNA and myosin heavy chain mRNA increased obviously. In clinical study, plasma concentrations of albumin, prealbumin and transferrin were higher than infectious controls after rhGH administration.　 Conclusions: rhGH improved nitrogen balance and protein synthesis of liver and muscle during sepsis .More studies were needed to determine weather rhGH was an effective metabolic intervention method during sepsis.

The relationship between abnormal circulating GH-insulin-like growth factor (IGF) axis and hypoglycaemia was explored in 2 cases of non-islet cell tumor associated hypoglycaemia (NICTH). Serum level of IGF-Ⅱ was increased, the levels of GH, IGF-Ⅰ, IGFBP-3 were decreased to some extent, and IGF-Ⅱ/IGF-Ⅰ (molar ratio) was significantly increased in these two cases. In one case, circulating GH-IGF axis returned to normal after complete removal of the tumor. In the diagnosis of NICTH, the abnormal circulating GH-IGF axis is quite valuable and IGF-Ⅱ/IGF-Ⅰ appears to be a more sensitive parameter.

Objective To study the prevalence of metabolic syndrome (MS) in women with polycystic ovary syndrome (PCOS) ,and to explore the risk factors of MS in young women. Methods The prevalence of MS and its components were evaluated in 348 young women with PCOS and 113 control subjects without PCOS. Results According to the 2005 modified Adult Treatment Panel Ⅲ criteria,MS was found in 27.0% of PCOS women,being significantly higher than 10.6% in the controls(P<0.01). The rates of MS components,except for the triglyceride (TG) level, were all significantly higher in PCOS subjects than those in control subjects ( P < 0. 05 or P < 0.01). However, the difference disappeared after adjustment for age and body mass index ( BMI, P>0. 05). The results of logistic regression analysis revealed that homeostasis model assessment insulin resistance (HOMA-IR)and BMI were the independent predictors of MS( both P<0.01) ,and the presence of PCOS was not the independent risk factor for MS (P>0. 05). Conclusions Obesity and insulin resistance are the independent predictors of MS. PCOS alone does not increase the risk of MS prevalence.

[Summary] All patients with cholesterol side-chain cleavage enzyme ( P450scc) deficiency that have been reported presented with early adrenal failure. Here we described a 35-year-old male presented with infertility as the only initial presenting complaint. He had received two separate surgeries to remove bilateral testicular masses. We reevaluated the resected tumors and found testicular adrenal rest tumor ( TART) pathology in the resected tumor. We profiled steroid hormones and found significantly elevated ACTH. CT scan revealed bilateral adrenal hyperplasia. Mutation screening identified compound heterozygous mutations (R353W and P432L) in the P450scc encoding gene (CYP11A1). The patient was finally diagnosed as congenital adrenal hyperplasia.

Objective To study insulin sensitivity and first-phase insulin secretion in obese subjects with impaired glucose regulation (ICR) in Shanghai. Methods A total of 129 subjects [38 lean controls and 91 obese subjects with ICR including 64 isolated impaired glucose tolerance (IGT) ,8 isolated impaired fasting glucose (IFC) and 19 IFC + ICT] underwent 75 g oral glucose tolerance test and insulin-modified reduced sample number (n = 12) of Bergman's minimal model method with frequently sampled intravenous glucose tolerance test (FSIGTT). Insulin resistance was determined from the insulin sensitivity index (S1) of the FSIGTT. Insulin secretion was determined during the FSIGTT by the acute insulin response to glucose (AIRg). The disposition index (DI) , the product of AIRg and S1, was used to determine whether AIRg was adequate to compensate for insulin resistance. Results (1) Compared with normal controls, the value of S1 was significantly decreased in 3 groups with ICR (all P