ObjectiveTo investigate the risk factors related with the prognosis of patients with acute cerebral infarction after intravenous thrombolysis by alteplase in 90 days.MethodsForty patients with acute cerebral infarction treated by intravenous thrombolysis with aheplase were selected and assigned into good outcome group [modified Rankin scale (mRS) 0-1 score] and poor outcome group (mRS 2-6 scores) according to mRS at 90 days.The risk factors were compared between two groups.ResultsPoor outcome group(22 cases) comparing with good outcome group (18 cases),the values of age[ (64.64±11.30) years vs.(58.94±10.47) years ],onset to therapy time(OTT) [(376.73±316.32)min vs.( 176.00±59.74) min],National Institutes of Health stroke scale (NIHSS) score before thrombolysis [ ( 16.73±8.46)scores vs. (11.22±5.20) scores],maximum of systolic blood pressure (SBPmax) in the first 24 hours after thrombolysis[ ( 186.59±24.79 )mm Hg ( 1 mm Hg =0.133 kPa) vs.( 169.00±23.04) mm Hg] and systolic blood pressure variability (SBPV)[(17.11±3.90) mm Hg vs.(13.33±4.97) mm Hg] had significant differences (P＜ 0.05).ConclusionThe values ofage,OTT,NIHSS score before thrombolysis,SBPmax and SBPV in the first 24 hours after thrombolysis are related with the prognosis of patients with acute cerebral infarction after intravenous thrombolysis by altcplase in 90 days.

Objective To observe the changes in OLETF kideys at different stage and the beneficial influences by modulating serum lipids. Methods OLETF rats aged 8 wks were randomly divided into treated group and untreated group,and LETO rats served as normal control.Fenofibrate 20 mg/kg was given daily to the treated group.OGTT was performed at the age of 8,16 and 24 wks.Blood glucose,serum lipids and 24 h urine albumin excretion(UA) were investigated.The rats were killed at 16 and 24 wks of age,and the kidney sections were stained with PAS.Transforming growth factor-?_1(TGF?_1),vascular endothelial growth factor(VEGF) and fibronectin(FN) were investigated by immunohistochemistry assay.The electron microscope(EM) sections were made to measure GBM width and to observe the mesangial matrix.Results(1) Blood glucose had no significant difference between untreated and treated groups at 16 and 24 wks of age;(2) Fenofibrate decreased serum TG, increased HDL-C markedly but had no influence on LDL-C;(3) As aging,24hrs UA increased in untreated group,and reduced significantly in fenofibrate group at 24 wks of age;(4) TGF-?_1,VEGF and FN expressions were all higher in untreated group than in treated group at 24 wks of age.(5) EM revealed GBM obviously thickened and mesangial matrix widened in untreated group.Fenofibrate attenuated the kidney lesion greatly in EM picture.Conclusions (1) Dyslipidemia occurs prior to glucose metabolism abnormity in OLETF rats;(2) As aging,dyslipidemia progresses accompanying markedly the increased UA,enlarged glomeruli,thickened GBM and widened masangial matrix;(3) Modulating lipids early couldn′t improve glucose metabolism,but corrects dyslipidemia and reveals beneficial influence on kidneys;(4) The possible mechanism is that modulating lipids decreases TGF-?_1 and VEGF expressions.

[Objective] To establish a method for rapid identification of Fructus Citri Sarcodactylis (FCS) from different production areas. [Methods] Fourier transform infrared (FTIR) spectroscopy was adopted to identify FCS. The height and position of the characteristic absorption peaks, and I value (a quantitative parameter of peak height ratio) were compared in FCS from different production areas. [Results] Each kind of FCS had their fixed range in peak height ratio I: 0.7-0.9 in FCS from Guangdong, 1.3-1.6 in FCS from Sichuan, 0.9-1.1 in FCS from Zhejiang, indicating that I value can be used to identify FCS from different areas . [Conclusion] For the identification of FCS from different production areas, FTIR spectroscopy is an effective method, in which there is no need for isolation, purification and chemical treatment.

SUMMARY Hyperparathyroidism is the clinical syndrome that results from elevated circulating parathyroid hormones,leading to multiple systems manifestations,and is divided into three kinds: primary, secondary and ternary.This patient’s main chief complaint was intermittent melena for 3 days,with the diagnosis of upper gastrointestinal hemorrhage according to endoscopy. Hypercalcemia, hypophosphatemia and high level of circulating parathyroid hormone and chronic renal failure were also found during hospitalization. Furthermore, MIBI showed a parathyroid adenoma located near the isthmus in the lower part of the left lobe. The patient had undergone nephrectomy because of kidney carcinoma 2 years ago. Primary hyperparathyroidism usually has the common gastrointestinal syndrome , but upper gastrointestinal hemorrhage reported as the chief complaint is rare and we had never seen similar reports before.

Pregnant women with subacute thyroiditis (SAT) are rare.One case was reported and the clinical features and management principles of SAT during pregnancy were reviewed.In pregnant women with SAT,the illness is usually not serious.If subclinical or clinical hypothyroidism develops,L-T4 must be given and thyroid function be monitored routinely,and the medication be adjusted carefully to ensure the maternal-fetal safety.

Objective To investigate the relationship of serum levels of macrophage migration inhibitory factor (MIF), matrix metallo-proteinase-9 (MMP-9), hypersensitive C-reactive protein (hs-CRP) with the severity of acute cerebral infarction (ACI). Methods 101 pa-tients with ACI were envolved and divided into 3 groups according to the scores of National Institute of Health Stroke Scale (NIHSS):mild group (group A, n=38, NIHSS score<4), moderate group (group B, n=36, NIHSS score 4-15) and severe group (group C, n=27, NIHSS score>15). Meanwhile, 44 non-ACI inpatients with atherosclerosis were included as control group (group D). Their serum MIF and MMP-9 were detected with ELISA, and hs-CRP with immunoturbidimety. Results The levels of serum MIF, MMP-9 and hs-CRP ranged from more to less as groups C, B, A and D (P<0.05). There was positive correlation of MIF with MMP-9 (r=0.301, P<0.01) and hs-CRP (r=0.309, P<0.001). Conclusion Serum MIF, MMP-9 and hs-CRP levels increased with the severity in ACI patients, which may be prediction of athero-sclerotic plaque instability.

Objective To establish the HPLC fingerprints(HPLC-FPS)of Fructus Citri Sarcodactylis(FCS)from Guangdong for reflecting the internal chemical information,evaluating its internal quality of FCS and identifying them from different cultural areas.Methods The HPLC-FPS of 12 FCS samples were obtained.The HPLC separation was performed on a Kromasil C18 analytical column by gradient eluting with acetonitrile-0.5% acetic acid at the flow rate of 1.0 mL/min.The column temperature was 30 ℃,the UV detection wavelength was 290 nm,and the collection time was 75 min.Results The mutual mode of HPLC fingerprints was set up and the similar degrees to the crude drugs from different cultural areas were compared.Conclusion The method is stable,reliable,and with full information which can be used as a quality control item for FCS from Guangdong.

Objective To study the chemical constituents of Lignum Aquilariae Resinatum.MethodsThe compounds were isolated and purified by silica chromatography and their structures were identified on the basis of physicochemical constant and spectral analysis.Results The compounds were determined as 6-hydroxy-2-[2-(3'-methoxy-4'-hydroxy phenylethyl)] chromone(Ⅰ)and a triterpene,hederagenin(Ⅱ).Conclusion Compound I is a new compound and compound Ⅱ is found in this plant for the first time.

To summarize the clinical data of two cases with severe hyponatremia diagnosed as adrenal insuffiency combined with syndrome of inappropriate secret on of antidiuretic hormone(SIADH),and to review related literatures.Case 1 diagnosed as Addison's disease for 27 years and developed severe hyponatremia again but did not response well to sufficient glucocorticoid.Further examination showed SIADH caused by lung cancer and tolvaptan worked well.Case 2 was diagnosed as SIADH caused by lung cancer and responsed well to tolvaptan.However,hyponatremia reoccurred with the decreasing level of ACTH and cortisol during the chemotherapy.It was thought that hyponatremia was caused by drug-related adrenal insuffiency and glucocorticoid replacement therapy achieved good response.Both primary/secondary adrenal insuffiency and SIADH can lead to severe hyponatremia,but it is rare that the two situations exist in one patient and occur in different time.We should consider the possibility of the situations when we make differential diagnosis of refractory hyponatremia,monitoring the curative effects carefully,then correct the diagnosis timely,and reduce missed diagnosis and misdiagnosis.

Objective To explore the clinical features of adrenocortical oncocytoma for better understanding. Methods A total of 586 patients with adrenal cortical adenoma were retrospectively analyzed in our hospital from January 1993 to November 2009, in which 18 were diagnosed as adrenal cortical oncocytoma pathologically, with 7 male and 11 female, aged ( 45.5 ± 15.9 ) years, and the disease course of( 13.3 ± 13.1 )months. Results 6 patients suffered from Cushing's syndrome, 2 primary hyperaldosteronism, 1 had clinical features of both Cushing's syndrome and primary hyperaldosteronism, and 9 were nonfunctional. 4 cases were misdiagnosed as pheochromocytoma preoperatively. All 18 patients were diagnosed by B-mode ultrasound and operation ( 13 by laparoscopy, 5 by laparotomy). 11 tumors were located in the left adrenal while 7 in the right, with the average tumor size of 5.6 cm in diameter. Histopathologically, 1 was oncocytic adrenocortical carcinoma, while 17 were adrenocortical oncocytoma, in which 5 were potentially malignant and 12 were benign. 11 patients were followed up for 20.5±20.1 months. 2 patients were dead, and 9 were alive with tumor recurrence in 1 case.ConclusionsAdrenocortical oncocytoma is a pathological diagnosis and the clinical manifestations are various. The tumors are usually large in size, and can easily be found by ultrasound, but may be wrongly diagnosed as pheochromocytoma.Being different from previous reports, the majority of these patients present with endocrine dysfunction. Most of these cases are benign, but malignant potential is obvious. Therefore,follow-up is very important.