OBJECTIVE:To observe clinical efficacy and safety of rhBNP combined with levosimendan in the treatment of acute heart failure,and to investigated the effects of drug combination on serum UA and BNP levels. METHODS:68 patients with acute heart failure were randomly divided into observation group and control group,with 34 cases in each group. Both groups re-ceived routine treatment;control group was additionally given Levosimendan injection 5 ml added into 0.9% Sodium chloride in-jection 45 ml with persistent micropump injection:at pump rate of 12 μg/(kg·min)within first 1 h,and then at pump rate of 0.5μg/(kg·min)for consecutive 23 h;observation group was additionally given rhBNP 1.5 μg/kg for intravenous shock,and then giv-en consecutive intravenous injection of rhBNP at rate of 7.5 ng/(kg·min)continuous 3-7 days on the basis of control group. Clini-cal efficacy of 2 groups were observed,and serum levels of UA and BNP,heart function index,the safety of drug use were ob-served before and after treatment. RESULTS:After treatment,total effective rate of observation group(94.11%)was significantly higher than that of control group (70.59%),with statistical significance (P<0.05). The improvement of serum levels of UA and BNP in observation group was more significant than in control group,with statistical significance (P<0.05). The stroke volume and left ventricular ejection fraction of observation group were significantly better than those of control group,with statistical signif-icance (P<0.05). There was no statistical significance in the incidence of ADR between observation group (2.94%) and control group(5.88%)(P>0.05). CONCLUSIONS:rhBNP combined with levosimendan have significant clinical efficacy and high safety in the treatment of acute heart failure.

Objective:To determine the mechanism of sunitinib-induced autophagy in renal cell carci-noma cells.Methods:MTS assay was applied to detect the cell viability alteration under the treatment of sunitinib (2,8 μmol /L).The sunitinib-induced autophagy as well as cell apoptosis was measured and compared after knocking down autophagy-related protein Beclin1 and microtubule associated protein 1 light chain 3 fusion protein (LC3)by RNA interference.The transmission electron microscope was used to observe the formation of autophagosomes in ACHN cells.The fluorescence microscope was used to mo-nitor distribution and aggregation of endogenous LC3-Ⅱ.The expressions of protein such as LC3-Ⅱ,the autophagic regulation molecules protein kinase B /mammalian target of rapamycin (Akt/mTOR)and the symbol of apoptosis poly ADP-ribose polymerase (PARP)were capable to be detected by immunoblotting assay.Results:Sunitinib was able to significantly trigger cell viability loss in the renal carcinoma cell ACHN,which was both in a concentration-dependent and time-dependent manner (P <0.05 ).After reducing the autophagy by knocking down Beclin1 and LC3,the number of cleavage of PARP was in-creased remarkably,whereas there was nearly not any cleavage in the mock group.By the transmission electron microscope,there were more autophagic vacuoles in ACHN cells after being administrated with sunitininb compared with the control.And the nuclear-to-cytosol translocation as well as aggregation of LC3-Ⅱ was presented after sunitinib treatment by the fluorescence microscope,which was the proof of the enhanced autophagy.According to the immunoblotting,sunitinib was able to increase the accumula-tion of LC3-Ⅱ.At the same time,the result of sunitinib combined with chloroquine,a drug which blocked the fusion of autophagosomes and lysosomes,demonstrated that the increasing amount of LC3-Ⅱwas due to the enhanced autophagy flux by sunitinib treatment in ACHN cells.However,phosphorylation of Akt as well as mTOR was decreased at the same time.The rapamycin (mTOR inhibitor)or knocking down Akt subunits could change the sunitinib-induced LC3-Ⅱ accumulation,whereas overexpression of Akt subunits decreased the autophagic flux,indicating that Akt/mTOR was the target of sunitinib in auto-phagy.Conclusion:Sunitinib induced autophagy via suppressing Akt/mTOR pathway,and the auto-phagy was involved in apopotosis.

Objective To evaluate the efficacy difference between flupentixol and melitracen combined with conventional medicine and conventional drug alone in the treatment of irritable bowel syndrome (IBS).Methods Studies on flupentixol and melitracen combined with conventional medicine (pinaverium bromide and trimebutine maleate) and conventional medicine alone in the treatment of IBS were collected and reviewed through searching the Chinese Academic Journals Full-text Database,Chinese VIP Full-text Database and PubMed database.After that,the test for homogeneity and the combined effect test were estimated. Results A total of 12 clinical studies on flupentixol and melitracen combined with conventional medicine for four to twelve weeks in the treatment of IBS were collected six studies indicated the homogeneity test of flupentixol and melitracen combined with pinaverium bromide (x2 =1.90,df=5,P=0.86,I2 =0).For the fixed-effect model,the odds ratio was 7.92 and 95％ CI was between 4.85 and 12.95,which suggested the combined therapy was better.The other six studies indicated the homogeneity test of flupentixol and melitracen combined with trimebutine maleate (x2 =5.60,df=5,P =0.35,I2 =10.6 ％).For the fixed-effect model,the odds ratio was 5.91 and 95％ CI was between 4.06 and 8.61,which suggested the combined therapy was better.After merging the 12 studies it indicated the homogeneity test of flupentixol and melitracen combined with conventional medicine (x2 =8.40,df =11,P =0.68,I2 =0).For the fixed effect model,the odds ratio was 6.63 and 95％ CI was between 4.92 and 8.93.Conclusion The efficacy of flupentixol and melitracen combined with conventional medicine in the treatment of IBS was better than that of conventional medicine alone,however,still more high quality trials are needed for further confirmation.

Objective To evaluate the clinical efficacy of uterine artery chemoembolization (UACE) and uterine artery embolization (UAE) with subsequent curettage in treating cesarean scar pregnancy (CSP). Methods A total of 79 patients with clinically-confirmed CSP were randomly divided into two groups:group A (UACE group,n=43) and group B (UAE group,n=36). Patients in each group were subdivided into two subgroups: endogenous type subgroup and exogenous type subgroup. Interventional management (UACE for group A and UAE for group B) with subsequent curettage was carried out in all patients of both groups. The amount of blood loss during curettage, the recovered time of human chorionic gonadotropin (HCG) level, the twice treatment rate and the success rate of treatment were measured and were used as the therapeutic evaluation parameters. The results were compared between group A and group B as well as between the subgroups. Results After UACE or UAE, the uterine dilation and curettage was successfully accomplished in all patients of both groups. Hysterectomy was not needed in all patients. Statistically significant differences in the recovered time of HCG level, occurrence of complications and the twice treatment rate existed between the two groups (P<0.05). The endogenous type of cesarean scar pregnancy in group A and group B was confirmed in 28 cases and 25 cases respectively, and the success rate of treatment for them was 100% (28/28) and 96.0% (24/25) respectively (P>0.05). The exogenous type of cesarean scar pregnancy in group A and group B was proved in 15 cases and 11 cases respectively, and the success rate of treatment for them was 86.7%(13/15) and 45.5%(5/11) respectively (P<0.05). The differences in postoperative vaginal bleeding time, the menstrual recovery time, the recovered time of HCG level, the twice treatment rate and the success rate of treatment between the two exogenous type subgroups were statistically significant (P<0.05 in all). Conclusion For the treatment of cesarean scar pregnancy, both UAE and UACE with subsequent curettage are safe and effective. For the treatment of endogenous type of CSP, it is better to use UAE, while for the treatment of exogenous type of CSP, it is better to use UACE.

Objective To explore the effects of Jiedu Quyu Ziyin Recipe (JQZR) on the apoptosis and expressions of bcl-2 and bax mRNA of peripheral-blood lymphocyte in MRL/lpr mice. Methods 80 MRL/lpr mice were randomly divided into model group,TCM group, Western medicine group and TCM and Western medicine group,20 mice in each group, meanwhile,20 Kunming mice were selected as normal group, then intragastrically administered normal sodium, JQZR apozem, prednisone suspension and JQZR apozem and prednisone suspension, 0. 5ml every time,once daily for 12 weeks respectively. At the end of the 12th week, peripheral-blood lymphocytes of every mice purified by gradient centrifugation were cultivated for 48 hours ,then the apoptosis was detected by flow cytometry. Furthermore,the expressions of bcl-2 and bax mRNA of peripheral-blood lymphocyte were detected by RT-PCR. Results At Oh or 48h,the apoptosis ratios of PBLC in normal group, TCM group,Western medicine group and TCM and Western medicine group are higher than model group and the differences are significant(P <0. 05 ,P <0. 01 ) ,while,at Oh,which are not significant within Western medicine group, normal group and TCM and Western medicine group ( P > 0. 05) ,even if which are significant between TCM group and TCM and Western medicine group or between model group and TCM and Western medicine group( P < 0. 05 ). At 48h, the differences of apoptosis ratios of PBLC are significant between Western medicine group and TCM and Western medicine group( P < 0. 05 ), and between TCM group and TCM and Western medicine group or between model group and TCM and Western medicine group which are significant, too( P < 0. 01 ). The ratios of bcl-2/bax mRNA of normal group,TCM group and TCM and Western medicine group are significantly lower than which of model group or Western medicine group ( P < 0. 05, P < 0. 05, P <0. 01 ,respectively) ,but there is no significant difference between which of model group and Western medicine group.Conclusion JQZR has adjustable effects on the apoptosis and expressions of bcl-2 and bax mRNA of peripheralblood lymphocyte in MRL/lpr Mice.

Objective To verify the presence of anti-ovary antibodies in systemic lupus erythematosus (SLE) and its possible correlations with serum levels of hormone profile and menstrual disturbances in patients with SLE.Methods Clinical data of 78 consecutive paticnts who fulfilled 4 or more of the ACR 1997 revised criteria for SLE were studied and compared with 40 age-matched healthy controls,including anti-ovary antibodies.Results 27 (34.6％ ) patients with SLE,and 1 (2.5％) of the healthy controls tested positive of anti-ovary antibodies.The levels of E2 and T and P decreased[ E2:( 80.96 ± 36.2 ) ng/L vs ( 118.53 ± 42.4 ) ng/L; T:( 3.85 ± 1.18 ) nmol/L vs ( 6.43 ± 2.28 ) nmol/L; P:( 1.37 ± 0.59 ) μg/L vs ( 3.92 ± 1.23 ) μg/L],and the levels of FSH and LH and PRL increased in SLE patients when compared with healthy controls [ FSH:( 19.17 ± 9.26)IU/L vs (10.18 ±7.27 )IU/L; LH:( 21.19 ± 12.44)IU/L vs (13.79 ±8.27)IU/L;PRL:(6.18 ± 2.27 ) μg/L vs (2.37 ±0.63)μg/L,P ＜0.05 orP ＜0.01].The higher SLEDAI score,higher rate of menstrual disturbances (6.3 ±2.8 vs 3.5 ± 1.7,81％ vs 47％,P ＜0.05 or P ＜ 0.01 ) and decreased serum level of E2 [ (64.13 ± 26.36 ) ng/L vs ( 82.83 ± 28.71 ) ng/L,P ＜ 0.05 ]were found in SLE patients with anti-ovary antibodies positive than in SLE patients with anti-ovary antibodies negative.Conclusions The presence of anti-ovary antibodies was 34.6％ in SLE,and may correlate to decreased serum level of E2 and menstrual disturbance.

ObjectiveToclarifytheprotectiveactionofaChinesemedicine,Jie-Du-Qu-Yu-Zi-Shen prescription, on the lupus nephritis in MRL/lpr mice through the TLR9-MyD88-NF-κB signaling pathway .Methods Thirty MRL/lpr mice were randomly divided into model group , prednisone group , and traditional Chinese medicine ( TCM) group (n=10).Each treatment group received appropriate treatment or drug therapy for 8 weeks.The pathological changes of mouse renal tissues in the three groups were examined and compared using HE , PAS, and Masson staining .Real-time PCR was performed to compare the expression of TLR-9, MyD88, NF-κBm RNA mRNA in each group of the mice . Results Compared with the model group , the Chinese medicine Jie-Du-Qu-Yu-Zi-Shen prescription significantly improved the renal pathological tissue damages in the MRL/lpr mice.Real-time PCR assay showed that the expression levels of TLR-9, MyD88, NF-κB mRNA in the TCM group were significantly lowered (P<0.01 for all).The differences between the TCM group and prednisone group were statistically not significant ( P >0.05 ) .Conclusions Jie-Du-Qu-Yu-Zi-Shen prescription has protective effect on the kidney of MRL /lpr mice, alleviating its pathological changes , and delaying the disease course, probably, through inhibiting the TLR-9-MyD88-NF-κB signaling pathway in the kidneys of MRL/lpr mice.

Objective By measuring the height loss of humeral head and combined with the clinical curative effect of the contrast,to investigate the correlation between the medial column support with locking proximal humerus plate fracture efficacy.Methods From June 2009 to August 2012,70 cases with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed.Based on the presence of medial support,all the cases were divided into 2 groups according to the proximal humeral fracture block.By measuring the change of postoperative loss of lateral humeral head height and evaluating the shoulder function,to comparative analysis of the effect of medial column support in the recovery reduction maintenance and patient function.Results There were 66 cases access the follow-up of this study,loss of 4 cases in follow-up,with an average follow-up period of 13 months (range,10-18).Thirty-eight cases of medial support group loss to follow-up 3,and no medial support group 32 cases lost to follow-up 1.Intraoperative iliac bone graft in 7 cases,including 3 cases of medial support and 4 cases of no inner support.All cases achieved clinical bone healing in the last follow-up time.Medial support can effectively reduce the degree of reduction and loss,and the average height loss of humerus head is 1.4mm (standard deviation.1.0 mm).The average height loss of humerus bead is 6.2 mm (standard deviation.3.7 mm) in no support group,which was substantially higher than the medial support group.The inner support group had no obvious complications,and in the absence of 31 cases of medial support,3 cases showed screws wear out of the articular surface,2 cases showed screws loose.In 3 cases of screw penetrating the articular surface were underwent two operation to remove or replace screws.In the medial support group,according to the Neer centesimal system score,the results were excellent in 32 cases,good in 3.The excellent and good rate was 100％.In the no medial support group,the results were excellent in 25 cases,good in 1,and fair in 5.The excellent and good rate was 83.8％.Conclusion Locking plate in tension side does not fully support the humeral head.The medial column support can obtain better maintenance of reduction and postoperative effect through improving the medial column mechanical stability.