Objective: Effects of human ?-calcitonin gene-related peptide (?-hCGRP) on renal function and renin-angiotensin system were studied during controlled hypotension. Method:Twenty SD rats were divided into ?-hCGRP (C) and sodium nitroprusside (S) groups. The mean blood pressure of rats was reduced to and maintained at 6.7kPa for 1h. The glomerular filtration rate (GFR),effective renal plasma flow (ERPF),plasma renal activity (PRA),angiotensin Ⅱ(AⅡ), urine volume, heart rate (HR)and the excretory rates of sodium,chloride and potassium of rats were measured beforeand 1h following hypotension. Result:GFR and ERPF increased significantly at the end of 1h hypotension when compared to pre-hypotension in the group C. GFR and ERPF decreased mark during hypotension period in group S. In both groups during hypotension,PRA and A Ⅱ increased by eight-folds or so,the excretory rates of sodium and chloride decreased significantly and the excretory rate of potassium increased slightly, urine volume de creased and HR increased markly. Conclusion:The ?-hCGRP,a potent vasodilator,has a protective effect on renal function as a controlled hypotensive agent. Sodium nitroprusside may harm renal function. The increased excitation of renin-angiotensin system may be responsible for the changes of urine volume,heart rate and the excretory rates of sodium ,chloride and potassium during hypotension.

To evaluate the influence of human ?-caleitonin gene related peptide (?-hCGRP) used in the controlled hypotension on hepatic blood flow, oxygen supply and oxygen consumption in rats. Method: Alpha-hCGRP and sodium nitroprusside were administered intravenously to reduce the blood pressure of rats to 6.7 kPa maintained for 1 h. Radiomierospheres were employd to measure hepatic arterial blood flow (HABF), portal venous blood flow (PVBF), and total hepatic blood flow (TABF). The arterial0portal,and hepatic venous blood gases were analyzed. The hepatic oxygen supply and oxygen consumption were calculated according to values of blood flow and gases. Result: HABF, TABF, and hepatic oxygen supply increased significantly, and PVBF decreased slightly during ?-hCGRPinduced hypotension. HABF, TABF and hepatic oxygen consumption increased significantly, and hepatic oxygen supply decreased significantly during sodium nitroprusside hypotension. Rebound hypertension occurred after the discontinua tion of sodium nitroprusside rather than ?-hCGRP. Conclusion: Alpha-hCGRP does not cause hepatic hypoxia during controlled hypotension, while sodium nitroprusside may result in hepatic hypoxia. Alpha hCGRP is more adequate to be used to controlled hypotension than sodium nitroprusside. No rebound hypotension is another advantage of ?-hCGRP.

Objective To search the clinical manifestations,data of laboratory examination, features of CT and MRI, therapy, prognosis in order to evaluate the progress in therapy of patients with crypotococcus meningitis(CM).Methods The findings of clinical features were analyzed and summarized for therapy of 43 CM cases identified with India-ink capsule staining.Results Primary positive rates of India-ink capsule staining were 58 1%(25/43), secondary positive rates were 30 2%(13/43),7 0%(3/43),patients diagnosed with cultivate positive. Clinical cure was achieved in 22 of 32 patients (68 7%) treated with amphotericin B, 4 patients of without efficacy using amphotericin B were cured by liposomal amphotericin B treatment.6 patients was died from cerebral hernia.Conclusions It is indicated that amphotericin B and fluconazole are effective and well tolerated in treatment of crypotococcus meningitis. If amphotericin B should inefficiency therapy of CM,liposomal amphotericin B would be consider.

Objective: To evaluate the safety of controlled hypotension produced by human ?-calcitonin gene-related peptide(?-hCGRP)and sodium nitroprusside. Method: Twenty SD rats were randomly divided into ?-hCGRP(C) and sodium nitroprusside(S) groups. Animals in group C were infused intravenously with 0.001％ ?-hCGRP and those in group S with 0.01％ sodium nitroprusside. The mean blood pressure of rat was reduced to 6.7kPa and maintained for 30 min. Cerebral glucose,lactate,ATP, and phosphocreatine levels were measured at 0 and 30th min of hypotension. Result: Cerebral glucose level increased slightly,lactate level decreased significantly,ATP and phosphocreatine contents did not change in group C at 30th min of hypotension compared with those at 0 min of hypotension,respectively.Cerebral glucose level increased slightly,lactate concentration increased significantly,ATP and phosphocreatine contents decreased significantly in group S at 30th min of hypotension in comparison with those at 0 min of hypotension, respectively. Conclusion: Hypotension induced with alpha-hCGRP can maintain adequate cerebral oxygen supply,but with sodium nitroprusside may cause cerebral hypoxia.

Objective To observe the numerical characteristics of dendritic cells (DC),the DC subsets(myeloid dendritic cell,MDC; plasmacytoid dendritic cell,PDC) and CD4+ CD25 + CD127low/-Tr cells in peripheral blood of Graves disease (GD) patients.Methods According to the clinical manifestations and serum FT3,FT4 and TSH,the GD patients were divided into the untreated-group,the clinical remission group and the clinical stable group,and set normal control group as well.The flow cytometry was used to detect DC and CD4+CD25+CD127low/-Tr cells of the percentage of CD4+ T cells in subjects peripheral blood(EDTA-K2 anticoagulated).The indicators were compared among various groups,and the correlation between the indicators with serum FT3,FT4 and TSH were observed.Results (1) In the untreated-group,the clinical remission group,the clinical stable group,and normal control group,total DCs,MDCs and MDC/PDC gradually declined,untreated-group has a significant difference from the other three groups also the significant difference was found among other three groups; (2) In the untreated-group,the clinical remission group,the clinical stable group,and normal control group,PDCs declined successively,but only the difference was found between untreated-group and normal control group; (3)In the untreated-group,the clinical remission group,the clinical stable group,and normal control group,CD4+CD25+CD127low/-Tr cells gradually raised,but only the difference between untreated-group and normal control group make sense; (4)In the untreated-group,PDCs and CD4+CD25+CD127low/-Tr cells have a certain relevance; (5)There was good correlation between DCs and serum FT3,FT4 and TSH,but CD4+CD25+CD127low/-Tr cells only have correlation with FT3 and FT4.Conclusion DC,MDC,MDC/PDC increased in the untreated-GD patients,and decreased after the therapy of anti-thyroid.Therefore,DCs and the DC subsets are expected to be used to monitor GD in the course of disease.CD4+CD25+CD127low/-Tr cells can be used as a new indicator of the onset of GD.

Background Artisan phakic intraocular lens (pIOL) implantation was demonstrated to be safe and effective for the correction of high myopia in short-term.However,long-term corneal endothelium status after operation should be concerned.Objective This study was to investigate the long-term changes of corneal endothelial cell density (ECD) and morphology following Artisan pIOL implantation for the correction of high myopia.Methods Fifty-one eyes of 27 patients who received Artisan PIOL implantation for high myopia from January 2005 to December 2008 were retrospectively analyzed.The central corneal ECDs were detected by corneal endothelial cell counter before surgery and 6 months and 1 year,2,3,4,5,6 years after surgery,and the coefficient of variation (CV) and standard deviation (SD) of cellular area were evaluated.ECD loss rate with time lapse was calculated ([preoperative ECD-postoperative ECD]/preoperative ECD× 100％).Results Six years after surgery,there were 34 eyes with BCVA ≥ 1.0,14 eyes with BCVA higher than preoperative and 8 eyes with BCVA lower than preoperative.The mean intraocular pressure was (14.23±2.14)mmHg 6 years postoperative.The preoperative mean ECD was (3 184.05±233.55)/mm2,and the ECD was gradually reduced over time with the cell loss 2.34％ in 6 months,5.32％ in 1 year,6.32％ in 2 years,8.06％ in 3 years,12.59％ in 4 years,15.63％ in 5 years and 19.49％ in 6 years after operation.Before surgery,The mean CV of cellular area was 37.17±7.12,and the SD of cellular area was 118.77±21.39,and those 6 years after surgery were 32.24 ±4.62 and 125.60± 18.49,respectively.The mean CV and SD of cellular area were significantly different among different time points (P =0.000,0.036).Eight eyes with localized iris depigmentation,6 eyes with IOL dyssymmetry,3 eyes with transient high intraocular pressure and 2 eyes with Macular hemorrhage were obtained after surgery.Conclusions Corneal endothelial cells appear obvious changes in both number and morphology after Artisan pIOL implantation in high myopia.ECD is gradually reduced with time lapse,and the shape of the cells occur remodeling during 6-year fellow-up duration.Overall,endothelial specular microscopy is mandatory before and after surgery for a long term.

is lesion size and staging in pre-operative and etiologies are the risk factors associated with postoperative progression.

Objective To evaluate the efficacy and safety of 131I-metaiodobenzylguanidine (131 I-MIBG) in treatment of malignant pheochromocytoma/malignant paraganglioma (MPHEO/MPGL).Methods The clinical data of 96 cases of MPHEO/MPGL (60/36) treated with 131I-MIBG between December 1998 and April 2014 were retrospectively reviewed.Among them,the malignant pheochromocytoma was found in 60 cases and malignant paraganglioma was found in 36 cases.Seventy-eight patients (81.2％)presented initially with hypertension,whereas 18 patients (18.8％) presented adrenal incidentaloma.Before 131I-MIBG treatment,24 h urinary norepinephrine was (409.5± 127.2) nmol,24 h urinary dopamine was (99.3±41.1) nmol,24 h urine adrenaline was (1 409.9±336.0) nmol.Before treatment,the compound iodine solution was given to each one.Then,all patients were given an initial course of 131I-MIBG therapy (5.55,7.40 GBq).Subsequent 131I-MIBG treatment (5.55,7.40 GBq) was undertaken every three to six months.The patients got symptomatic,hormonal or radiological response underwent sbsequent 131I-MIBG therapy (3.70,5.55 GBq) every year.All patients underwent clinical symptoms (headache,palpitate,sweating,hypertension),biochemical (24 h urine catecholamin) and radiological evaluation (CT/MRI) within 6 months to evaluate the efficacy and safety of 131I-MIBG treatment.Results After one to eleven sessions of 131 I-MIBG treatment,in total,266 doses of 131 I-MIBG were administered,average dose was 6.49 GBq.22.9％ of patients demonstrated radiological partial response (≥ 50％ reduction in tumor size) after first or repeated 131 I-MIBG treatment.Eleven cases (11.5％) achieved clinical complete response,41 cases (42.7％) achieved clinical partial response and 23 cases (24.0％) maintained the stable clinic symptoms.After treatment,24 h urinary norepinephrine (164.3±71.6) nmol and dopamine (49.7±24.7) nmol showed significantly decline,compared with those before treatment (P＜ 0.05).While,24 h urinary epinephrine (1 354.7±433.4) nmol had no obvious change (P＞0.05).No life-threatening adverse events were reported,but 2 MPGL patients developed transient leucopenia or thrombocytopenia after four and five times 131 I-MIBG treatment,respectively.Conclusions Treatment with repeated low dose 131I-MIBG is well tolerated and effective in controlling the progression and alleviating the clinical symptoms.The 131I-MIBG therapy is an effective and safe treatment modality for MPHEO/MPGL.

Objective To investigate role of reverse digital artery island flap combined with dig- ital nerve end to side anastomosis.Methods Reverse digital artery island flaps were used for recon- struction of 65 fingertip defects in 57cases,in which the restoration of the flap sense was attained via dig- ital nerve end to side anastomosis.Results After primary repair,all flaps survived,with good appear- ance and wear-resisting as well as satisfactory two-point discriminations.Conclusion Digital artery re- verse island flap combined with digital nerve end to side anastomosis is a simple and effective procedure for repair of finger defect.

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.