Objective To investigate the difference and treatment strategy of malignancy-associated dermatomyositis and other para-neoplastic neurological syndromes (PNS).Methods The clinical characteristics of a patient with malignancy-associated dermatomyositis and poly radiculoneuropathy was reported and the relevant literature was reviewed.Results Patients with dermatomyositis had increased risk of malignancies,and should routinely screened.Dermatomyositis and polyradiculoneuropathy was clinically similar,but could rarely be seen in the same malignant patient.Malignancy -associated dermatomyositis and PNS had similar pathogenesis.The treatment strategy of both was similar.Malignancy specific treatment should be initiated and immune suppressive agents should be prescribed concurrently.Conclusion Rheumatolgists should aware the association between dermatomyositis and potential underlying malignancies.Multiple para-neoplastic syndromes could be seen in the same patient,but the diagnosis should be considered as one.

Objective To estimate the frequency of heart valvular involvement in Chinese patients with Takayasu arteritis (TAK) and its correlation with other clinical features. Methods Ninety-one patients with TAK were studied and their clinical manifestations, laboratory test, vascular images and echocardio - gra-phic findings were retrospectively reviewed. The data were compared between patients who had heart valvular involvement and those who had not. Mann-Whitney U-test or Student's t-test, Chi-squared test or Fisher's exact test were used for analysis. Results Aortic regurgitation and mitral regurgitation were both confirmed in 20 (22%) patients. Tricuspid regurgitation and pulmonary valve regurgitation were observed in 10 (11%) and 2 (2%) patients, respectively. Older age at onset, longer disease duration, hypertension and involvement of the ascending aorta were all significantly more frequent in TAK patients with aortic regurgitation (t=2.903, P<0.01; Z=-2.759, P<0.01; χ2=7.918, P<0.01; Z=-4.454, P<0.01) than those without. However, the constitutional symptoms and acute phase reactants [erythrocyte sedimentation rate (ESR) and C reactive protein (CRP)] were not statistically different between patients with and without valvular regurgitation (P>0.05). Aortic valvular pathology examination of the three TAK patients who had underwent aortic valve replacement showed no inflammatory cell infiltration. Conclusion This study has demonstrated that heart valve involvement is common in patients with TAK, mainly in the form of regurgitation, and which may be secondary to hypertension and other cardiovascular complications. We should pay more attention to the screening and treatment of heart valvular involvement in TAK patients.

Objective To examine the effects of intracerebroventricular administration of adrenomedullin (AM) on the expression of Fos and spontaneous electric activity of area postrema (AP) neurons in sino-aortic denervated rats. Methods To determine the expression of Fos and the spontaneous electrical activity of AP neurons in male Sprague-Dawley rats by immunohistochemistry. Results Following Intracerebroventricular administration of AM (1 nmol/kg, 3 nmol/kg), Fos-like immunoreactive (Fos-LI) neurons and the discharge rate of AP neurons markedly increased. Pretreatment with calcitonin gene-related peptide(CGRP) receptor antagonist CGRP8-37 (30 nmol/kg) significantly inhibited the effects of AM (3 nmol/kg). Conclusion AM may activate the neurons in AP via CGRP receptors.

The authors conceive of dispersing and transferring medical risks by means of insurance. They suggest developing two modules of insurance business, including malpractice insurance and medical accident insurance. They also discuss such basic issues as risk financing, financial compensation and choice of insurance undertakers.

We examined the effects of intracerebroventricular ( i. c. v) administration of adrenomedullin (ADM) on catecholaminergic neurons and the expression of c-fos gene in rat brain nuclei involved in cardiovascular regulation using double immunohistochemical method for Fos and tyrosine hydroxylase (TH). The results showed that: ( 1 ) Following icy administration of ADM (3 nmol/kg) , double-labeled neurons for Fos and TH were significantly increased in the area postrema ( AP), the nucleus of the solitary tract ( NTS), the nucleus paragigantocelluaris laterialis (PGL) and the locus coeruleus (LC). (2) Pretreatment with calcitonin gene-related peptide receptor antagonis CGRP8-37 (30 nmol/kg) significantly reduced the action of ADM (3 nmol/kg) in the brain. The present study suggested that ADM might activate the neurons of the brain nuclei involved in cardiovascular regulation, and supported the hypothesis that the central action of ADM were induced by activating the catecholaminergic neurons of brainstem nuclei involved in cardiovascular regulation, CGRP receptor might mediate the effects of ADM.

Until now, although the molecule of EDHF has not been cloned, some characteristics of EDHF has been clarified by scientists. It is different from NO and prostacyclin, and it is considered to play an important role in the regulation of vascular tone by stimulating the channels of K + and Ca 2+ .

Objective To investigate the clinical value of argon plasma coagulation (APC)trans-choledochoscopy in biliary tract complications following liver transplantation. Methods All 27 patients underwent T-tube-choledochoscopy or percutaneous transhepatic cholangioscope (PTCS).APC was used to burn the hyperplasia of bile duct stenosis and then expended the stenosis with bougienage. The bile duct foreign bodies were burnt by APC and then eliminated. The granulation tissues of bile duct were burnt by APC after biopsied. The sutures of anastomoses were burnt by APC and then eliminated. Results In general, the therapeutic achievement ratio of stenosis of bile duct in 25 cases of 28 locations was 78. 6% (22/28). The clearance ratio of bile duct foreign bodies was 85. 7% (6/7). The elimination ratio of granulation tissues was 100% (5/5), the same as the elimination ratio of sutures of anastomoses. There were no treatment-related complications about APC. The recurrence ratio of bile duct stenosis was respectively 4.5% (1/22) and 13. 6% (3/22)after follow-up for 3 and 6 months respectively. All the recurrent stenosis was non-anastomotic. The recurrence ratio of bile duct foreign bodies was respectively 16. 7% (1/6) and 33.3% (2/6) after follow-up for 3 and 6 months respectively. Conclusion APC trans-choledochoscopy in treatment of biliary anastomotic stenosis, mural foreign bodies, mural biliary cast, granulation tissues of bile duct and sutures of anastomoses following liver transplantion has a high success ratio and a sure long-term efficacy without treatment-related complications.

Objective To study the clinical features,diagnosis and treatment of polycystic liver disease (PLD)complicated with portal hypertension (PHT).Methods The clinical data of one patient with PLD and PHT was retrospectively analyzed,and relevant literature was reviewed.Results The patient presented fatigue,dyspepsia, abdominal distension and lower limb edema.Laboratory examination showed mild liver dysfunction(Alkaline phospha-tase 291.2U/L,gamma glutamyl transpeptidase 168.1U/L,59.9g/L,total protein,albumin 32.2g/L,21.0μmol /L, total bilirubin,direct bilirubin 11.5μmol /L).Abdominal ultrasound (US)and computerized tomography (CT) showed multiple noncommunicating cysts of varying size in both liver and kidney.Antioxidant supplements and diuretic were introduced,and the therapy was approved to be effective.Conclusion The case in this report illustrates that PLD could occasionally present with PHT.Physician should be alert to prevent misdiagnosis.

Objective To investigate the clinical features and treatment protocol and prognosis for the hypophosphataemic osteomalacia related to adefovir dipivoxil.Methods Analysis was made upon a case of patient with chronic hepatitis B developed hypophosphataemic osteomalacia after administration of adefovir dipivoxil.Literature review was carried out to survey the global prevalence of hypophosphataemic osteomalacia after administration of adefovir dipivoxil among patients with chronic hepatitis B.Results The clinical symptoms started paralleling to the time taking adefovir dipivoxil,and alleviated after the patient withdrawn adefovir dipivoxil 10 weeks and was given phosphorus.Meanwhile,serum inorganic phosphorus recovered to normal ( 0.98 mmol/L),which lowest level was 0.77 mmol/L.Systematic review of the literature showed that hyperphosphaturia related to adefovir dipivoxil was dose-dependent,time-dependent and reversible.All reported cases of hypophosphataemic osteomalacia secondary to adefovir dipivoxil ( 10mg/d) were from Asian population.ConclusionsAdefovir dipivoxil induced hypophosphataemic osteomalacia is rarely seen in clinical practice.Those patients with chronic hepatitis B who take adefovir dipivoxil,no matter dosages,should take periodical examinations including blood calcium and serium inorganic phosphorus to monitor whether hypophosphataemic osteomalacia occurs.Other anti-virus drugs could be used when it happens.

Objective To investigate the effects of metabolically correlated factors on pig renal tubule in cellular level by observing effects of glucose,insulin and uric acid on activity of haemachrome oxygenase in renal tubular epithelial cells.Methods Pig near renal tubular cell line(LLC-PK1) was selected as experimental object.After stimulating cells respectively with glucose(5,10,22,33mmol/L),uric acid(0,0.1,0.2,0.4mmol/L);and insulin(0,10~(-9),0~(-8),10~(-7)mol/L) in different concentrations for 48 hours,the activity of HO-1 within the cells was determined.Results In uric acid group the activity of HO-1 was significantly increased in a concentration-dependent manner,while in glucose and insulin groups,the activity of HO-1 did not change.Conclusion After LLC-PK1 was stimulated by uric acid of different concentrations,HO-1 was induced evidently,which indicates that uric acid might affect oxidative stress in renal tubule cell line.