OBJECTIVE: To study the in vivo metabolism of granatum tannins by liquid chromatography-mass spectrometry and clarify their metabolic pathways. METHODS: The rat urine samples were collected after intragastric administration of tannins preparation of Punica granatum L. husk. The analysis was performed on a Venusil MP-C18 column with gradient elution system of acetonitrile and water containing 0.1% formic acid. Using electrospray ionization (ESI) in negative ion mode with scanning range from m/z 100 to 1000, the metabolites were identified by comparing the MS spectra and MS data with the literatures. RESULTS: Seven metabolites were detected in the rat urine, among which six were identified according to their second mass spectra to be U-1 (urolithin B), U-2 (urolithin A methyl ether), U-3 (urolithin A), U-4 (urolithin A glucuronide), U-5 (ellagic acid) and U-6 (urolithin C). CONCLUSION: Tannins in Punica granatum L. husk are metabolized after oral administration mainly through hydrolysis, glucuronidation gly-cosidation, decomposition and methylation reaction to generate a series of derivatives of urolithin. These results preliminarily indicate the metabolic pathway and material basis of the pharmacological activity of tannins in Punica granatum L. husk in rats.

Objective: To study the improvement of tannins from Granati Pericarpium on renal fibrosis in rat. Methods: SD rats were randomly divided into five groups, Sham operation, model, Valsartan, high-dose (60 mg/kg), and low-dose (20 mg/kg) tannins groups. Renal fibrosis model of rats was constructed using left ureter ligation method except the rats in the Sham operation group in which the left side ureter of rats was not ligated or cut. The ig administration started at the day of operation, Urinary protein of 24 h, the concentration of Ca2+ and P3+ in urine, and the levels of Scr and BUN in serum were detected in 1-3 week after the operation. The staining of HE and Masson to the kidney tissue was carried out to investigate how tannins from Granati Pericarpium could impact the indexes of renal fibrosis in rats on the morphological basis. Results: The results of urine and blood test showed that the levels of urine protein, Scr, and BUN were deviated from the normal level. The concentration of Ca2+ was increased, while the concentration of P3+ was reduced. The staining of HE and Masson showed that the renal tissue was damaged, the left side of kidney was found renal fibrosis, tannins from Granati Pericarpium could improve the renal fibrosis in rats in some extent. Conclusion: Tannins from Granati Pericarpium have the great improvement on the renal fibrosis in rats and are able to adjust the disorders of Ca2+ and P3+ in rats.

Objective: A urinary metabonomics method based on liquid chromatography-mass spectrometry (HPLC-MS) was used to inspect the effect of tannins from Granati Pericarpium on endogenous metabolism of rats with glomeruloscerosis, the potential biomarkers were searched and the metabolic pathways were analyzed to provide relevant theory for treatment of glomeruloscerosis. Methods: Forty-eight SD rats were divided into control group, model group, benazepril hydrochloridec group, and three doses of pomerganate tannis groups. Glomerular sclerosis model was established by unilateral nephrectomy combined with two tail iv adriamycin; 24 h urine of rats was collected after the rats were orally given tannins from Granati Pericarpium for 8 weeks; HPLC-MS was used for testing and analyzing the urine; Principal component analysis (PCA), partial least squares-discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were used for data treatment of each group to search the potential biomarkers and build the metabolicomics pathways. Results: The urinary metabolism of rats was clustering. Ten potential biomakers were screened by analysis and identification of important variables; The metabonomics pathways involved tryptophan, alanine, aspartate, glutamate metabolism, etc. Conclusion: The trend of endogenous metabolism of rats with glomeruloscerosis is normal after intervened by tannis in pomegranate tannins from Granati Pericarpium. It provides the basement with the further research of clarifying the mechanism of tannins from Granati Pericarpium inpacting on rats with glomeruloscerosis.

OBJECTIVETo explore the value of anal sphincter electromyography (ASEMG), orthostatic hypotension (OH), and dizziness in diagnosing multiple system atrophy (MSA).

METHODThe characteristics of ASEMG and OH were compared among patients with dizziness (MSA and non-MSA), patients without OH (MSA and non-MSA), and patients with probable MSA (OH and non-OH).

RESULTSTotally 476 patients underwent ASEMG examinations. Dizziness was the onset symptom in 69 patients. Between the MSA group and non-MSA group, the mean duration of dizziness [(14.6 +/- 2.1) vs. (12.8 +/- 2.0) ms, P < 0.01] and satellite potential occurrence rate [(22.7 +/- 11.8)% vs. (12.2 +/- 8.9)% , P < 0.01] were significantly different, while the OH rate (84.6% vs. 55.2% ) and the difference of the blood pressure between standing and supine positions were not significantly different. In 162 patients with symptom of dizziness, the mean duration of dizziness [(15.3 +/- 2.7) vs. (12.8 +/- 1.9) ms, P < 0.001], satellite potential occurrence rate [(25.4 +/- 12.8)% vs. (13.5 +/- 10.4)%, P < 0.001] , and difference of the diastolic blood pressure [(18.5 +/- 17.0) vs. (11.7 +/- 12.7) mmHg, P < 0.05] were significantly different between the MSA group and non-MSA group, while the normal rate of blood pressure at standing position (60% vs. 41.9%) and the difference of systolic blood pressure were not significantly different. In 146 patients with abnormal blood pressure at standing and supine positions, the mean duration of dizziness [(15.0 +/- 2.4) vs. (12.8 +/- 1.7) ms, P < 0.001] and satellite potential occurrence rate [(22.0 +/- 12.2)% vs. (10.6 +/- 8.5)%, P < 0.001] were significantly different between the MSA group (n = 61) and non-MSA group (n = 85). In 125 patients with probable MSA, the mean duration of dizziness [(15.5 +/- 2.4) vs. (15.9 +/- 2.2) ms, P > 0.05] and satellite potential occurrence rate [(24.3 +/- 12.6)% vs. (22.7 +/- 12.4)%, P > 0.05] were not significantly different between those with OH and those without OH. The rates of dizziness and the percentage of dizziness as the onset symptom were 93.2% and 52.3% in OH group and 44.4% and 8.3% in non-OH group.

CONCLUSIONSASEMG is better than OH in diagnosing patients with dizziness suspected as MSA. Neurogenic lesion can be found by ASEMG in patients without OH, which is helpful in the early diagnosis of MSA.

Adult ; Aged ; Aged, 80 and over ; Anal Canal ; chemistry ; physiopathology ; Dizziness ; physiopathology ; Electromyography ; Female ; Humans ; Hypotension, Orthostatic ; physiopathology ; Male ; Middle Aged ; Multiple System Atrophy ; diagnosis ; physiopathology

Objective To explore the effect of smoking on blood glucose level among male patients with type 2 diabetes in Changshu City.Methods Totally 41 57 male patients with type 2 diabetes involved in the national basic public health service were selected and assigned into four groups,including heavy smokers,current mild smokers,former smokers and non -smokers.All of them were investigated about the general social demographic data,living habits and health condition.Height,weight,waist and hipline were measured.BMI and WHR were calculated.FPG and HbA1 c were checked.Covariance analysis was used to correct the confounding factors,and the methods of multiple linear regression and partial correlation were used to evaluate the relationship between smoking and blood glucose level.Results FPG of the heavy smokers was higher than the current mild smokers,former smokers and non -smokers(P <0.05),but after the correction of the confounding factors,the differences were not statistically significant(P >0.05).HbA1 c of the heavy smokers and current mild smokers were higher than the former smokers and non -smokers(P <0.05 ),and after the correction of the confounding factors,the differences were still statistically significant(all P <0.05).Daily smoking amount was one of the influencing factors of HbA1 c(β=0.07,P <0.05).There was no correlation between the age of smoking initiation and FPG,HbA1 c(P >0.05).Daily smoking amount was positively correlated with HbA1 c(r =0.06,P <0.05), but was not correlated with FPG(P >0.05).Conclusion Smoking has a certain degree of influence on blood glucose level among male patients with type 2 diabetes in Changshu City,and we need to reduce the smoking rate among male patients with type 2 diabetes by health education.

Aim To investigate the absorption characteristics of gallic acid in the intestine, and to provide a theoretical basis for improving the bioavailability of tannins. Methods Single-pass intestinal perfusion (SPIP) model was used for rat in situ and HPLC to determine the concentration of gallic acid. The absorption rate constant Ka and effective apparent permeability coefficient Peff of gallic acid in each intestinal segment were calculated. The effects of different intestinal segments, drug concentrations, pH value, P-glycoprotein (P-gp), and multidrug resistance protein2 (MRP2) on intestinal absorption were assessed. Results The absorption rate constant (Ka) of gallic acid decreased following the sequence of jejunum > duodenum > ileum ≈ colon. With the increase of drug concentration, there was no significant difference in the absorption of gallic acid. The acidic environment (pH 5. 5) was conducive to the absorption of gallic acid. After the addition of P-gp and MRP2 inhibitors, the absorption of gallic acid was significantly different from that without P-gp and MRP2 inhibitors (P < 0. 05). Conclusions Gallic acid can be well absorbed in the intestine of rats, and is best absorbed in jejunum. The absorption mechanism is determined to be passive diffusion. The gallic acid absorption process is affected by the efflux of P-gp and MRP2, which may be the P-gp and MRP2 substrates.

Objective To investigate the status of Cryptosporidium infection in the population in Nanjing City so as to pro-vide the evidence for the prevention and control of cryptosporidiosis. Methods A total of 100 fecal samples were collected from each of three districts(Liuhe,Qixia and Gaochun)and one hospital(Nanjing Zhongda Hospital)in 2015 and 2016 respective-ly. The fecal samples were detected for Cryptosporidium with microscopy(by using the gold amine phenol-modified acid-fast staining)and the positive samples were detected again for the molecular biology confirming by using the fluorescence quantita-tive PCR. Results During the two years,581 cases of normal population who lived in the city were surveyed and no Cryptospo-ridium infection was found. Among 202 cases of outpatients with chronic diarrhea,there were 9 Cryptosporidium positive cases with the microscope scanning method (4.46％),and among the 9 cases,7 cases showed obvious logarithmic amplification curves showing positive Cryptosporidium nucleic acid,but 2 cases without the obvious logarithmic amplification curves,and the Cryptosporidium nucleic acid positive rate was 3.47％. Conclusions Cryptosporidium infection is not found in the normal popu-lation of Nanjing City,but the Cryptosporidium infection is found in the chronic diarrhea patients. The results imply that we should strengthen the detection of Cryptosporidium in the chronic diarrhea patients,so as to provide the evidence for improving the diagnosis and treatment of cryptosporidiosis.

OBJECTIVETo investigate the therapeutic effect and safety of acupuncture at points of The Liver and Gallbladder Meridians for treatment of migraine.

METHODSMulti-central, randomized and controlled trial was used and 253 cases of migraine were divided into an acupuncture group and a western medicine group. The acupuncture group was treated with acupuncture at points of The Liver and Gallbladder Channels with Taichong (LR 3), Yang-lingquan (GB 34), Fengchi (GB 20), Ququan (LR 8) selected as main points, and the western medicine group with oral administration of Flunarizine tablets for 4 therapeutic courses. The total therapeutic effects 3 and 6 months after the treatment, the scores of various symptoms of migraine before and after treatment, and the stability of therapeutic effect in one-year following-up survey were observed in the two groups.

RESULTSAfter treatment, mean times and duration of the headache attack were significantly improved in the two groups (all P < 0.01) with the acupuncture group better than the western medicine group (P < 0.05). The total effective rates for stopping pain after treatment, 3 months and 6 months after treatment in the acupuncture group were 93.0%, 93.0% and 87.7%, respectively, which were better than 85.6%, 86.5% and 69.2% in the western medication group (all P < 0.01). One year later, the stability of the therapeutic effect in the acupuncture group was better than that in the western medicine group (P < 0.05); the adverse reaction and the compliance in the acupuncture group were significantly superior to those in the western medicine group.

CONCLUSIONAcupuncture at points of The Liver and Gallbladder Meridians for treatment of migraine is safe, effective, and with stable long-term therapeutic effect.

Acupuncture Points ; Acupuncture Therapy ; methods ; Administration, Oral ; Adolescent ; Adult ; Aged ; Female ; Flunarizine ; administration & dosage ; therapeutic use ; Gallbladder ; pathology ; Headache ; prevention & control ; Histamine H1 Antagonists ; administration & dosage ; therapeutic use ; Humans ; Liver ; pathology ; Male ; Meridians ; Middle Aged ; Migraine Disorders ; drug therapy ; pathology ; therapy ; Treatment Outcome ; Young Adult

BACKGROUNDHirayama disease is a rare disease characterized by juvenile-onset of asymmetric amyotrophy, of which etiology has not been clarified. The aim of our study was to investigate the clinical and neurophysiologic characteristics of Hirayama disease.

METHODSNeurophysiological tests, including nerve conduction studies (NCS), F-wave and routine electromyography (EMG), were performed in seventy-three patients with Hirayama disease. EMG was selectively performed on upper and lower extremities, sternocleidomast and thoracic paravertebral muscles according to the clinical features of the patients.

RESULTSAbnormal NCS parameters, including decreased compound muscle action potentials or delayed distal motor latency, were found in 34.2% (25/73) and 12.3% (9/73) of the patients, respectively. A total of 24.6% (18/73) of the patients showed decreased F-wave frequency. EMG demonstrated the presence of neurogenic lesions in all patients with spontaneous potentials, prolonged duration or augmentation of amplitude in motor unit potentials (MUPs), or a single pattern of MUP recruitment. About 17.8% (13/73) of the patients showed neurogenic lesions, mostly in the C7-8 level of the cervical cord, only in the upper extremity of affected side, whereas 35.6% (26/73) of the patients possessed lesions in the upper extremities bilaterally. A total of 46.6% (34/73) of patients exhibited abnormalities in the lower extremities, sterno- cleidomast or thoracic paravertebral muscle. Changes in motor NCS were significantly correlated with muscle strength.

CONCLUSIONSEMG detects diffused subclinical neurogenic lesion in a high proportion of patients with Hirayama disease. Results of our study challenge the hypothesis that Hirayama disease is a type of cervical myelopathy.

Adolescent ; Adult ; Electromyography ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Neural Conduction ; Spinal Muscular Atrophies of Childhood ; pathology ; physiopathology ; Young Adult

OBJECTIVETo assess the early therapeutic and cognitive effect of repetitive transcranial magnetic stimulation (rTMS) combined with antidepressant medication in treatment of first-episode patients with major depression.

METHODSSixty first-episode depressed inpatients aged 18-45 y, who met the DSM-IV clinical criteria for major depressive episode were randomly assigned to citalopram treatment (20 mg/d) in combination with a two-week period of either rTMS (study group)or sham procedure (control group) on left dorsal-lateral prefrontal cortex (10 Hz, 90% motor threshold). The Hamilton Depression Rating Scale (HAMD) was used to assess the severity of depression. The Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT) were used to assess cognitive function of depression.

RESULTThe response rate was significantly greater in the study group compared to the control group after treatment (57% compared with 29%,P<0.05). The HAMD scores significantly declined after treatment in two groups, and the study group showed lower scores compared to the control group after 2 weeks (P<0.01). Neuropsychological assessments showed that there was no significant difference between the two groups except for the significant improvement in the categories on WCST in study group compared to the baseline (P<0.05) and the control group (P<0.05)after 2 weeks treatment. No serious event occurred in the patients during the rTMS study.

CONCLUSION10 Hz rTMS enhances early effects of citalopram and improves cognitive function in first-episode major depressive patients.

Adolescent ; Adult ; Antidepressive Agents ; therapeutic use ; Citalopram ; therapeutic use ; Combined Modality Therapy ; Depressive Disorder, Major ; therapy ; Humans ; Middle Aged ; Transcranial Magnetic Stimulation ; Treatment Outcome ; Young Adult