P-glycoprotein is one of the members in the superfamily of ATP-binding cassette transporters. It is expressed in many sites in vivo, and is correlated with multidrug resistance. Under physiological conditions, as an efflux pump, P-glycoprotein in the blood-brain barrier can eliminate endogenous substrates and xenobiotics to maintain the balance of internal environment. But at the same time, it also limits the concentration of therapeutic drugs in brain, and thus reduces therapeutic efficacy. P-glycoprotein inhibitors can get drugs across the blood-brain barrier. It is of great importance to improve the blood concentration in brain and bioavailability of central nervous system drugs.

Objective To investigate the therapeutical effect of Tetrandrine(Tet)combined with Glutathione(GSH)in rats with Parkinson's disease(PD).Methods The PD model rats were established through stereotactic microinjection of 6-hydroxydopamine,then they were randomly divided into PD group,GSH group,L-dopa group,GSH+Tet+L-dopa group and GSH+Tet group.The rats were peritoneal injected with corresponding medicines.The circling behavior of rats were observed induced by Apomorphine.The levels of GSH in substantia nigra and MAO-B in striatum were assayed after treatment,the numbers of dopaminergic neuron were observed by immunohistochemistry and the contents of TH mRNA were also be assayed in each group.Results(1)Compared with pretherapy,the rotation times of groups L-dopa,GSH +Tet+L-dopa,GSH+Tet had statistical significance(P

Objective To investigate the genotypic characteristics of hepatitis B virus(HBV) in Tibet.Methods Serum samples from 60 cases of hepatitis B in Tibet Autonomous Region were collected from January 2000 to March 2004.HBV genotypes were analyzed by sequencing S region and precore/core region.Results HBV isolated from 60 cases were all found to be D genotype by S region sequencing.Dc mixture was found in 59 cases,showing the recombination between their precore/core gene and genotype B virus at 1804-2299 nucleotide.The other one case showed Dbc mixture genotype,showing recombination between its precore/core gene and genotype B and C genes.Conclusions All Tibet cases in this study show mixture genotype D with recombination with genotvpe C or both genotype B and C at precore/core region.No case of pure genotype D is found.

Objective To explore the horseshoe kidney of prenatal ultrasonography for detecting birth defects.Methods A total of 3260 women during 22～42 gestational weeks underwent real-time color Doppler ultrasongraphy to find out fetal mati kidney.All the cases were tracked within two month after delivery.Results In all 3260 pregnant women,104 cases were diagnosed on ultrasonography of 100%accordance with clinical diagnosis.Conclusions A systemic prenatal ultrasonographic examination in the second-trimester pregnancy is important for prenatal diagnosis of congenital malformations,which play a very significant role in decreasing fetal birth defects and improving new born population quality.

Objective To investigate the effect of aspirin on the endometrium of patients with severe intrauterine adhesions after electrical resection.Methods 130 patients with severe intrauterine adhesions after electrical resection from August 2013 to August 2015 in our hospital were selected and randomly divided into the observation group and the control group ( 65 cases in each group ); The control group were given progestogen sequential therapy, while the observation group were given aspirin for treatment on basis of the control group; All the two groups were treated for three menstrual cycles; Before and after treatment indexes including uterine endometrial thickness, ovulation of the uterine artery blood flow index artery pulsatility index in ultrasound (PI), resistance index (RI), endometrial blood flow parameters[vascular index (VI), flow index (FI) and vascular blood flow index (VFI)] were recorded and compared, as well as menstruation and uterine cavity shape 3 menstrual cycles after treatment;All the two groups were followed up for one year, and one year pregnancy rates in the two groups were recorded.Results After treatment, the total efficiency in the observation group was 92.3% significantly higher than 69.2% in the control group ( P <0.05 ) .After treatment, in the two groups endometrial thickness, PI, RI, VI, FI and VFI were significantly improved compared with before treatment (P<0.05), but the observation group improved more obviously (P<0.05).Within one years in the observation group the pregnancy rate was 57.1%higher than that in the control group 26.5%(P<0.05) .Conlcusions Application of aspirin can significantly improve the endometrial thickness on the basis of estrogen and progesterone sequential therapy , increase the endometrial blood flow and improve the pregnancy rate, which mechanism may be related to promoting endometrial repair and improving blood perfusion of the uterus.

Symptomatology and medical history taking are the focuses of diagnostics study. With the improvement of teaching and learning, students can basically master the standard process of clinical inquiry of chief complaints to family history efficiently. However, due to the lack of systematic learning of clinical diseases, it's difficult for most students to form a targeted, logical and speculative inquiry thinking pattern, so they are unlikely to write a medical history of present illness that reflects their thinking on disease inclusion and exclusion. In this study, we come up with the characteristics and defects of symptomatology teaching at present, and put forward a new idea of symptomatology teaching by introducing clinical manifestations of diseases and examples of inquiry.

AIM: To measure microcirculation function in type 2 diabetic patients and non-diabetic subjects with a new measurement method called capillary recruitment. METHODS: 276 type 2 diabetic patients in Shanghai downtown were enrolled and categorized into several groups, those with diabetes duration

Objective:To investigate the predictors of early neurological deterioration (END) in patients with acute ischemic stroke (AIS) based on the Oxfordshire Community Stroke Project (OCSP) classification system.Methods:Patients with AIS admitted to the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from February 2018 to November 2020 were enrolled retrospectively. According to the OCSP criteria, the patients were classified into total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI), and lacunar infarct (LACI). END was defined as the National Institutes of Health Stroke Scale (NIHSS) total score within 72 h after onset increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Multivariate logistic regression analysis was used to determine the independent risk factors for END in AIS patients with different OCSP types. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of each index for END in AIS patients with different OCSP types. Results:A total of 405 patients with AIS were enrolled. Their age was 68.84±12.27 years, and 250 were males (61.7%); 132 patients (32.6%) were in the TACI group, 108 (26.7%) were in the PACI group, 61 (15.1%) were in the POCI group, and 104 (25.7%) were in the LACI group. END occurred in 136 patients (33.6%). Multivariate logistic regression analysis showed that homocysteine (Hcy) (odds ratio [ OR] 1.065, 95% confidence interval [ CI] 1.012-1.212; P=0.015), baseline NIHSS score ( OR 1.209, 95% CI 1.095-1.335; P<0.001) and the time from onset to admission ( OR 1.663, 95% CI 1.282-2.082; P<0.001) were significantly and independently correlated with END in the TACI group. Hcy ( OR 1.137, 95% CI 1.040-1.244; P=0.005), fasting blood glucose ( OR 1.714, 95% CI 1.272-2.311; P<0.001), neutrophil to lymphocyte ratio (NLR) ( OR 1.370, 95% CI 1.016-1.848; P=0.039) and the time from onset to admission ( OR 1.266, 95% CI 1.056-1.519; P=0.011) were significantly and independently correlated with END in the PACI group. NLR ( OR 1.446, 95% CI 1.031-2.027; P=0.033) was significantly and independently correlated with END in the POCI group. Fasting blood glucose ( OR 1.301, 95% CI 1.006-1.683; P=0.045), NLR ( OR 1.393, 95% CI 1.025-1.894; P=0.034) and the time from onset to admission ( OR 1.171, 95% CI 1.008-1.361; P=0.039) were significantly and independently correlated with END in the LACI group. ROC curve analysis showed that the areas under the curve (AUC) of Hcy and baseline NIHSS score for predicting END in the TACI group were 0.617 (95% CI 0.521-0.713; P=0.021) and 0.784 (95% CI 0.706-0.862; P<0.001). The optimal cut-off values were 15.91 μmol/L and 19.5 points, respectively. The sensitivity and specificity were 63.7% and 85.2%, 62.0% and 86.9%, respectively. The AUC of Hcy, fasting blood glucose and NLR for predicting END in the PACI group were 0.672 (95% CI 0.548-0.797; P=0.005), 0.794 (95% CI 0.697-0.891; P<0.001) and 0.674 (95% CI 0.560-0.788; P=0.005), respectively. The optimal cut-off values were 15.2 μmol/L, 6.85 mmol/L, and 3.71, respectively. The sensitivity and specificity were 61.3% and 77.9%, 80.6% and 72.8%, 67.7% and 79.4%, respectively. The AUC of NLR for predicting END in the POCI group was 0.850 (95% CI 0.735-0.964; P<0.001). The optimal cut-off value was 5.2. The sensitivity and specificity were 84.2% and 81.4% respectively. The AUC of fasting blood glucose and NLR for predicting END in the LACI group were 0.728 (95% CI 0.614-0.842; P<0.001) and 0.731 (95% CI 0.614-0.842; P<0.001), respectively. The optimal cut-off values were 5.44 mmol/L and 2.71 respectively. The sensitivity and specificity were 80.0% and 62.7%, 76.0% and 79.2%, respectively. Conclusion:The predictors of END in AIS patients with different OCSP types are different.

Objective To explore the effect of caregiver reaction on coping styles in cerebral infarction patients with the treatment of rehabilitation. Methods A total of 352 patients with cerebral infarction and their caregiver were valued by the Chinese version caregiver reaction assessment scale and Chinese version medical coping questionnaire. Pearson correlation analysis and multiple linear regression analysis were used to explore the effect of caregiver reaction on coping styles in patients with cerebral infarction. Results The scores of health problems, time arrangements disturbed, economic problems and lack of family support and self-esteem were respectively (2. 80 ± 0. 61), (3. 51 ± 0. 82), (3. 19 ± 0. 63), (2. 61 ± 0. 51) and (4. 08 ± 0. 90). For the coping styles, the scores of confrontation, surrender and avoidance were respectively (17. 85 ± 1. 64), (9. 61 ± 1. 34) and (17. 10 ± 1. 74). Pearson correlation analysis showed that the score of confrontation was significantly negatively correlated with health problems, time arrangements disturbed, economic problems and lack of family support (P<0. 05), but significantly positive correlated with self-esteem (P <0. 05); and the scores of surrender and avoidance were significantly positive correlated with health problems, time arrangements disturbed, economic problems and lack of family support (P <0. 05), but it negatively correlated with self-esteem (P<0. 05). There were significant difference of the score of confrontation, surrender, avoidance in the patients with different sex, age, educational level, marital status, family income, payment method, course of disease, NIHSS, frequency of attack and the the main caregivers with different sex, age and relationships with patients (P<0. 05). Multiple linear regression analysis showed that family income, course of disease, NIHSS and caregiver reaction were the influence factors of coping styles in patients with cerebral infarction (P<0. 05). Conclusions The caregiver reaction is an important influence factor of coping styles in patients with cerebral infarction.

Objective To study the clinical features of patients with neuromyelitis optica (NMO) having initial symptom of intractable hiccup and nausea (INH) to improve the recognition of the disease.Methods Fourteen patients with NMO having INH as onset,admitted to our hospital from January 2015 to April 2016,were chosen.The onset characteristics,cerebrospinal fluid (CSF) results,serum aquaporins (AQP)4 antibody level,head and neck MR imaging of these patients were retrospectively analyzed.Results NMO with INH as onset was more common in young and middle-aged women;and the symptom was stubborn.Leukocyte increased slightly and total protein was normal or slightly increased in CSF.The positive rate of AQP4 antibody in serum was 79％ and oligoclonal band in CSF was 17％.MR imaging showed 8 patients (57％) had lesions in bulbar tegmentum and area postrema,6 patients (43％) had high cervical cord lesions without medullary lesion;most of the lesions in medulla oblongata and high cervical cord were linear;5 patients (36％) had abnormal signal of brain stem,corpus callosum and cerebral cortex.It was isointense or hypointensity on T1WI and hyperintense on T2WI and FLAIR sequences.Conclusions Antiemetic therapy of NMO with INH as onset is ineffective;the initial symptom is INH,followed by optic neuritis and/or myelitis symptoms.MR imaging shows lesions including bulbar tegmentum and area postrema,or linear signal changes in medulla and spinal cord.