OBJECTIVE:To observe clinical efficacy and safety of flupirtine maleate for pain caused by acute lumbar sprain. METHODS:60 patients with acute lumbar sprain were selected and divided into trial group and control group according to even and odd-numbered admission order. Trial group received flupirtine maleate capsule,1 piece/time,3 times/d;control group was giv-en codeine sustained-release tablet,2 tablets/time,2 times/d. The VAS score,clinical efficacy and ADR were compared between 2 groups. RESULTS:The VAS score of treatment group after treatment was significantly lower than that of control group,with statis-tical significance(t=2.375,P=0.013). The clinical efficacy of trial group was significantly higher than that of control group,with statistical significance (u=9.431,P=0.024). The ADR of trial group was mild,and there was no significant difference between two groups(χ2=0.131,P=0.717). CONCLUSIONS:Flupirtine maleate has a good clinical efficacy and safety in the treatment of pain caused by acute lumbar sprain.

Objective To assess the left ventricular contraction asynchrony in patients with acute myocardial infarction(AMI) by velocity vector imaging(VVI).Methods Sixty AMI patients and 40 healthy volunteers were included.Using VVI,the time to peak longitudinal systolic velocity (TL-V) was measured in the left ventricular long axis views,the time to peak radial systolic velocity (TR-V) was measured in parasternal short axis views.The deviation of the earliest and the latest TL-V and TR-V (Ts max-min) was measured,and the standard deviation of TL-V and TR-V (TS-SD) was also measured.Results ①TL-V ,TR-V of the infarcted and non-infarcted segments in patients with acute myocardial infarction were longer than those of the normal segments (P ＜0.05).②The longitudinal Tsmax-min,Ts-SD and the radial Tsmax-min,Ts-SD in infarcted patients were increased compared with the healthy volunteers (P ＜0.001).③Ts of the infarcted segments was increased in turn from the class Ⅰ to class Ⅳ of the cardiac function (P ＜0.001).Conclusions VVI could be used to assess the left ventricular contraction asynchrony in patients with AMI.VVI is a new useful method to determine the infarcted segments.

Objective To investigate the radioactivity level of natural rocks in Lhasa in order to obtain the radionuclide contents and availiability of the rock.Methods Radiation monitoring and sampling were carried out in the natural rock mining area in Lhasa,and the contents of radionuclides in the samples were analyzed.Both internal and external exposure indexes were calculated,and the rocks were classified according to the relevant national standards on building materials.Results The average specific activity of 40K,226Ra,232Th and 238U in the rock samples were 912,59.0,77.1,and 64.4 Bq/kg,respectively.Internal and external exposure indexes were both less than 1.Conclusions The radioactivity level in natural rocks in Lhasa were lower than the national levels.The natural rocks could be used as main building materials and Class A decoration materials.

Clinical data of 27 children with renal calculi (11 cases on the right side and 16 on left)who were treated with extracorporeal shockwave lithotripsy (ESWL) using HB-ESWL-VG lithotripter from April 2006 to October 2008 were retrospectively reviewed.The size of stones ranged from 5 mm to 17 mm in diameter (mean 11 mm).In 22 out of 27 cases (82%) stones were crushed completely after the first course.Eleven of 27 ESWL cases were stone-free in 7 days,8 patients in a month after treatment;the stonefree rate was 96% when patients were followed up for 1 year.The results suggest that ESWL is a safe and effective method for treatment of renal calculi in children.

Objective To study clinical characteristics,causes of misdignosis and diagnostic and therapeutic methods for primary hyperparathyroidism (PHPT).Methods Retrospective analysis was done for 51 patients of PHPT,47 confirmed by biopsy after surgical operation and 4 without operation diagnosed based on their serum levels of calcium,alkaline phosphatase ( ALP),intact parathyroid hormone ( iPTH ),and computed tomography (CT) or 99mtechnetium sestamibi (99mTcMIB1) imaging at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou during June 1997 to November 2010.Results Bone-related complications were the most common clinical manifestation,accounting for 51％ (26/51 ) of the cases,and adenoma,a benign,enlarged and hyperactive parathyroid gland,in 34 of 47 cases ( 72％ ).In orthotopic lesions,the right inferior was affected in 19 of 46 cases (41％),followed by the left inferior in 13 cases (28％),while 5 of 51 cases (10％) with ectopic parathyroid gland.PHPT was easily misdiagnosed as urolithiasis,rheumatic disease,primary osteoporosis,etc,accounting for 92％ of the cases in our study.Preoperative serum levels of calcium,ALP and iPTH in the patients varied with their clinical type and pathological classification,the highest in patients with urolithiasis-bone-related complications [ (3.22 ±0.35) mmol/L,(1455 ± 1091 ) U/L and (1669 ± 515 ) ng/L,respectively ] and in patients with parathyroid carcinoma [ (3.46 ± 0.40) mmol/L,( 1410 ± 426) U/L and ( 1861 ± 768) ng/L,respectively ].Sensibility of preoperative localization diagnosis using ultrasonography,CT and 99mTcMIBI was 88％ (35/40),97％ (30/31) and 97％ (31/32),respectively.Conclusions PHPT is frequently misdiagnosed as other diseases.Measurement of serum calcium should be included in routine physical examinations,supplemented with measurement of serum ALP and iPTH,as well as medical imaging,which can help avoid misdiagnosis.CT combined with 99mTcMIBI imaging can improve accuracy of preoperative localization diagnosis.

Objective To explore the diagnostic value of the combined detection of serum Dickkopf-1 (DKK1 )and EB viral capsid antigen immunoglobulin A (VCA-IgA)in patients with nasopharyngeal carcinoma (NPC).Methods Serum levels of DKK1 and VCA-IgA were measured by enzyme-linked immunosorbent assay (ELISA)for the 80 patients with NPC and 65 normal controls.Receiver operating characteristic (ROC) curve was used to calculate the diagnostic value.Results The serum levels [M(QR )]of DKK1 in patients with NPC were significantly higher than those in normal controls [580.773 (429.1 46 )pg/ml vs.31 6.1 74 (252.965)pg/ml],with a significant difference (Z=4.846,P<0.000 1 ).ROC curves showed that the opti-mum diagnostic cutoff for serum DKK1 was 611.981 pg/ml,with an area under curve (AUC)of 0.734 (95%CI:0.654-0.81 5,50.0% sensitivity,96.9% specificity).Measurement of VCA-IgA demonstrated an AUC of 0.71 4 (95%CI:0.631-0.798,47.5% sensitivity,95.4% specificity).The combined detection of DKK1 and VCA-IgA demonstrated an AUC of 0.849 (95%CI:0.783-0.91 4,76.3%sensitivity,95.4%spe-cificity).For patients with early-stage NPC,the detection effect of combined detection of DKK1 and VCA-IgA was much better than that in normal controls,with a significant difference (χ2 =23.784,P <0.001 ). Conclusion Serum DKK1 has potential diagnostic value for NPC.Combined detection of DKK1 and VCA-IgA may aid the early diagnosis of NPC.

Objective To discuss the diagnosis and treatment of the postoperative acquired primary hyperfibrinolysis secondary to bipolar plasmakinetic transurethral resection of the prostate ( BP-TURP ) . Methods A case with benign prostatic hyperplasia was retrospectively reviewed, who was an 88-year-old patient admitted on 14th October, 2013 because of repeated urinary retention for 10 years, and catheter indwelling for 20 days.Blood pressure was 101/59 mmHg on admission (1 mmHg=0.133 kPa).Digital rectal examination showedⅡ°prostate, smooth surface, rubbery and no nodules.Routine blood showed the leucocyte 4.6 ×109/L, neutrophils 0.62, hemoglobin 108 g/L, red blood cells 3.30 ×1012/L, platelet 90 ×109/L.Preoperative coagulation function showed prothrombin time (PT) 12.8 s (10-14), activated clotting time live enzymes (APTT) 34.8 s (21 -37), fibrinogen (FiB-C) 2.38 g/L (2 -4), D-dimer 0.50 mg/L (0-0.55), fibrin degradation products (FDP) 2.0 mg/L ( <5.0).Abdominal ultrasound showed hyperplasia of prostate ( 52 mm ×46 mm ×37 mm ) , protruding into the bladder about 20 mm. Abdominal CT scanning showed bladder diverticulum and stones, hyperplasia of prostate and calcification. The operation time of BP-TURP was 90 min with no significant intraoperative bleeding, and continuous bladder irrigation drainage was clear.Results Four hours after the operation, continuous bladder irrigation drainage became bright red.Seven hours after operation, blood pressure was 83/56 mmHg, and blood routine showed white blood cells 8.1 ×109/L, neutrophils 0.92, red blood cells 2.93 ×1012/L, hemoglobin 95 g/L, platelet 67 ×109/L.Transfusion of 4.5 U red blood cell suspension was administered.The prostatic fossa hemorrhage was suspected and bleeding was not alleviated after adjusting the catheter.Prostatic fossa electro-coagulation hemostasis was performed and bladder neck obvious oozing of blood was detected intraoperatively, and no venous sinus bleeding or obvious blood clots were detected.Four hours after the secondary surgery, continuous bladder irrigation drainage became pink again, and the conservative treatment had no effect.Blood coagulation function showed PT 16.9 s, APTT 43.5 s, FiB-C 0.34 g/L, D-dimer 1.70 mg/L, FDP 57.4 mg/L.The patient was diagnosed as postoperative acquired primary hyperfibrinolysis, and repeat plasma, red blood cell suspension, and tranexamic acid transfusion was administered.Continuous bladder irrigation drainage gradually became clear.Blood coagulation function index gradually returned to normal.Routine urine test showed red blood cells ( microscopy ) 4 -5/HPF. Conclusions After BP-TURP, acquired primary hyperfibrinolysis may occur.The outcome is good after timely diagnosis and effective treatment.

Objective To explore the feasibility of using the consensus of European Working Group on Sarcopenia in Older People(EWGSOP) to diagnose sarcopenia among community-dwelling women aged from seventy to seventy-nine in Shanghai.Methods Twenty-two healthy community-dwelling women were recruited as the subject group(group S),and another ten young girls were randomly selected as the control group(group C).The anthropometry,bioelectrical impedance analysis(BIA)and dual energy X-ray absorptionmetry(DEXA)were used to evaluate the circumferences of upper and lower limbs,and the dimension of muscle mass,according to relative appendicular skeletal mass(RASM)and skeletal muscle index(SMI).The grip dynamometer and isokinetic dynamometer were used to measure the muscle strength of upper and lower limbs.The ten meters gait speed,functional reach test,timed up and go test,Berg balance scale and short physical performance battery were all applied to assess the physical performance.The criteria of EWGSOP consensus were applied to diagnose the situation of sarcopenia.Results Firstly,the average biceps circumference and fat mass of upper limbs in group S were significantly higher than group C (P＜0.01),while no significant differences were observed in the muscle mass(P＞0.05).Secondly,RASM values gained from BIA and DEXA in S group were significantly higher than C group(P＜0.05),while the SMI values of the former were significantly lower than the latter(P＜ 0.01).Thirdly,absolute grip strength,relative grip strength and other bio-mechanical indexes of lower limbs in the s group were significantly lower than the C group(P＜0.01);the relative grip strength showed significant correlation with most bio-mechanical indexes of lower limbs.Fourthly,the physical performance in group S declined significantly compared with that of the c group(P＜O.05),and no significant correlation was found between muscle strength and physical performance of upper limbs except the absolute grip strength and gait speed.The prevalence was 0％ according to the RASM index,while the prevalence was 63.6％ and 45.4％ according to the BIA and DEXA respectively.Conclusion The assessing pattern from EWGSOP consensus could not be simply copied to applying on Chinese old people due to serious difference between RASM and SMI.The combination of SMI+relative grip strength+ TUG/SPPB/Berg may be better than the classical mode of RASM+absolute grip strength+gait speed in diagnosing sarcopenia.

Objective A previously reported female diagnosed with type A insulin resistance syndrome bearing a heterozygous missense mutation of R1174W in the insulin receptor gene was followed for 7 years since the age of 16 years. Methods Five-hour oral glucose tolerance tests (OGTT) were done on baseline, the 3rd, 6th and 7th year respectively, with serum insulin and C-peptide measured at the same time points. Areas under of curve (AUC) of glucose, insulin and C-peptide were compared between the years.Acute insulin response (AIR) was determined at baseline and the 7th year. The dose response were insulin secretion rates at each time point during OGTT being plotted over the corresponding glucose levels, and the slopes of which quantified the insulin secretion responding to glucose. Results The follow up data showed that the glucose metabolism of the subject did not deteriorate over time with yearly glycosylated hemoglobin A1c (HbAlc) being normal (4.6%-5.5%), and hyperinsulinemic hypoglycemia was a persistent phenomenon observed at 4-5 hours post-load. The fasting and AUCs of serum insulin and C-peptide tended to decline without simultaneously increase of those of plasma glucose. The AIR decreased by 56% as compared to baseline. The dose response curves shifted downward as years went by. Conclusions It supports that with the alleviation of physiological insulin resistance after puberty, the gross hyperinsulinemia tends to ameliorate, and β-cell secretion does not deteriorate over time as glucose homeostasis maintains.

Objective To study the effect of smoking on resting energy expenditure ( REE ) and the relationships among REE, smoking , inflammation and oxidative stress in patients with diabetic kidney disease. Methods A case control study of 31 smokers and 40 non-smokers with early stage of diabetic kidney disease( stage Ⅲ ) were performed to evaluate the chronic effect of smoking on REE. REE/fat free mass( FFM ), biomarkers of oxidative stress malondialdehyde ( MDA ), superoxide dismutase ( SOD ) and inflammation high-sensitivity C-reactive protein (hs-CRP), adiponectin, TNFα were also measured in these subjects. Data were analyzed by Pearson correlation analysis. Results Compared with non-smokers, REE/FFM in smokers group was significantly increased by 15.96% ( P =0.001 ). Pearson analysis showed that smoking was significantly correlated with REE/FFM ( t = 0.395, P = 0.001 ). There were significantly different between smokers and non-smokers in MDA, SOD and hs-CRP ( P＜0.05 ). But no difference between two groups in adiponectin and TNFα ( P ＞ 0.05 ). No significant relationships between REE/FFM and MDA, SOD, hs-CRP, adiponectin, TNFα was found ( P ＞ 0.05 ). Conclusion Chronic smoking can lead to increased REE, arouse oxidative stress and inflammatory in patients with early stage of diabetic kidney disease. However, there is no relationship between increased REE due to smoking and oxidative stress and inflammatory.