Objective]To research professor Chang's experience in treating adolescaria functional metrorrhagia . [Method]By following professor Chang diagnosis long time,it summarizes professor Chang's experience in treating adolescaria functional metrorrhagia from the aspects of the reason and mechanism,syndrome differentiation and treatment,treating characteristics,and for a case. [Result]Professor Chang considers the adolescaria functional metrorrhagia connected with stagnation of liver Qi,insufficiency of kidney and deficiency of spleen Qi,weakness,stagnation,dampness.Treatment must address both the symptoms and root causes in accordance with seasonal conditions .She regulating menstrual cycle attaches great importance to the liver , spleen and kidney,and uses the auricular points,couplet medicines.The prescription rule is convenient and specialized.The recipe case embodies the evidence-based medicines, according to the menstrual period, the late, and the inter-phase and premenstrual period of drug treatment of yin and yang change. Professor Chang's ideas and characteristics curative effect are outstanding. [Conclusion]Professor Chang thinks the adolescaria functional metrorrhagia is complicated,then perfect pragmatic value is worthy of study and understanding.

Objective To investigate the correlation between serum glutamate levels and post-stroke depression (PSD). Methods The consecutive patients with acute ischemic stroke were enroled. At 3 month after onset, the PSD diagnosis was conducted according to the American Diagnostic and Statistical Manual of Mental Disorders (4th Edition) somatic disease caused mood disorder and Hamilton depression scale (HAMD) was used to evaluate the severity of depressive symptoms in patients with PSD. The demographics and baseline clinical data were compared and analyzed in the PSD group and the non-PSD group. Results A total of 177 patients were enroled in the study, including 55 in the PSD group and 122 in the non-PSD group. The age (64. 4 ± 7. 8 years vs. 60. 1 ± 11. 1 years; t = - 2. 575, P = 0. 012), NIHSS scores (median and interquartile: 6 [5 - 8] vs. 3 [2 - 5 ]; Z = - 5. 463, P = 0. 002 ), serum homocysteine (16. 9 ± 4. 9 μmol/L vs. 14. 3 ± 3. 9 μmol/L; t = - 3. 929, P = 0. 001 ), high-sensitivity C-reactive protein (1. 0 [0. 8 - 1. 7] mg/L vs. 0. 4 [0. 7 - 1. 3] mg/L; Z = - 3. 439, P = 0. 002 ), glutamate levels (279 [205 - 345] μmol/L vs. 161 [110 - 209] μmol/L; Z = - 6. 172, P = 0. 001 ), as wel as the proportion of women (50. 9% vs. 34. 4% ; χ2 = 4. 308, P = 0. 038) in the PSD group were significantly higher than those in the non-PSD group, while the education level was significantly lower than that in the non-PSD group (χ2 = 9. 679, P = 0. 003). Spearman correlation analysis showed that serum glutamate levels were significant positive correlated with HAMD scores ( r = 0. 491, P < 0. 001 ). Multivariate logistic regression analysis showed that the increased serum glutamate level (odd ratio 1. 016, 95% confidence interval 1. 010 - 1. 023; P = 0. 002) was an independent risk factor for PSD in patients with acute ischemic stroke. Conclusions The increased serum glutamate level may be an independent risk factor for PSD.

We Injecte(?) 12-16 ?l 20—40% HRP in normal sanne into the myocardium orthe anterior wall of the left ventricle in six rats and 10 ?l choleragenoid-horsera-dish peroxidase conjugate(CB-HRP)in three rats.The Th1-3 DRG and the nodoseganglia of both side were removed.The sections of these ganglia were proceeded bythe TMB chromogentic reaction for HRP and immunohistochemical reaction(the firstantibody is the substance P antiserum).There are three types of labeled cells——theHRP labeled cells.Sp-IR cells,and HRP-Sp-IR double labeled cells were observedin the Th1-3 DRG and nodose ganglia of both side.The parts of Sp-IR nerve fib-ers in the heart wall originate from the DRG and nodose ganglia and these neuronsprojecting the HRP-Sp-IR nerve fiber contained substanse P.Their functions may berelated to the pain(nociceptive)sensation of the heart.This study may also be aevidence of the main function of the cardiac sympathetic afferent fiber is the con-duction of the pain sensation.A few of HRP-Sp-IR double labeled cells in thenodose ganglion observed suggest that the cardiac parasympathetic afferent fibermay participate in conduction of the pain sensation.This question requires furtherstudy.

Objective:To investigate the therapeutic effects of noninvasive ventilation on heart failure(HF)after acute myocardial infarction(AMI)in rats.Methods:A rat model of HF after AMI was established by ligation of the left ventricular branch.Thirty male Wistar rats were randomly divided into three groups according to the random number table method: sham operation group, non-treatment group and noninvasive ventilation treatment group(n=30, each group). Echocardiography was performed on the third day after surgery, and parameters including left atrial diameter(LAD), left ventricular end diastolic diameter(LVEDD), interventricular septum thickness(IVS)and left ventricular ejection fraction(LVEF)were recorded.Serum levels of brain natriuretic peptide 45(BNP45), tumor necrosis factor α(TNF-α), matrix metalloproteinase-2(MMP-2), matrix metalloproteinase-9(MMP-9), and heat-shock protein 70(HSP70)were measured at day 3 after operation by enzyme-linked immunosorbent assays(ELISA). Morphological changes of myocardial tissue were analyzed with hematoxylin-eosin(HE)staining, and cardiomyocyte apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling(TUNEL).Results:Compared with the non-treatment group, LVEDD decreased[(153.9±8.1)mm/m 2vs.(164.7±10.4)mm/m 2, P<0.05]and LVEF increased[(63.9±7.6) % vs. (54.4±9.4) %, P<0.05]in the noninvasive ventilation group .Compared with the non-treatment group, serum levels of BNP45[(0.65±0.07) % vs. (0.73±0.07) μg/L, P<0.05], TNF-α(361.5±13.1) μg/L vs. (399.1±12.6) μg/L( P<0.05), MMP-2(6 892.8±530.2) μg/L vs. (7 406.0±667.5) μg/L( P<0.05)and MMP-9(143.8±5.9) μg/L vs. (151.1±8.3) μg/L( P<0.05)decreased and levels of HSP70[(1.7±0.1)μg/L vs.(1.4±0.1)μg/L, P<0.05]increased in the noninvasive ventilation group.HE staining showed focal accumulation of neutrophils in the epicardium, loss of muscle striation, disorganized cell polarity and enlarged nuclei in the non-treatment group.Meanwhile, alleviated inflammation, scattered neutrophils between cardiomyocytes and misaligned muscle striation were observed in the noninvasive ventilation group.TUNEL results showed that the myocardial apoptotic index was lower in the noninvasive ventilation group than in the non-treatment group( P<0.05). Conclusions:Noninvasive ventilation can effectively improve heart function, reduce inflammatory response and cardiomyocyte apoptosis in rats with AMI-induced HF and may be an effective treatment for HF after AMI.

Objective:To understand influencing factors on the deaths of HIV/AIDS patients receiving antireviral treatment in Butuo county of Liangshan Yi Autonomous Prefecture (Liangshan) from 2010 to 2019, to provide data for drug replacement and sustainable antiviral treatment strategy.Methods:A matched case-control study was used to collect basic and follow-up information on AIDS death patients receiving antiviral treatment in Butuo county of Liangshan from 2010 to 2019. The control group was formed by sampling twice the number of cases. The logistic regression model was used to analyze the risk factors affecting mortality.Results:In 3 355 patients of HIV/AIDS treated with antiviral therapy, 1 179 cases in the death group and 2 176 cases in the control group. Including 81.34% were 30-49 years old, 69.09％males, 99.55% Yi nationality, 91.12% were married or cohabitated, 95.77% had junior high school education or below, and 88.41% peasants. Amultivariate logistic stepwise regression model showed that among the death risk factors, age ≥50 years old was 5.08 times (95% CI:3.05-8.48) that of the 18-29, female was 0.70 times (95% CI: 0.52-0.94) than male, the transmission rate of intravenous drug use was 1.43 times (95% CI: 1.06-1.91) that of heterosexual transmission, CD4 +T lymphocyte (CD4) count ≥350 cells/μl before treatment was 0.38 times (95% CI: 0.30-0.48) that of CD4 <200 cells/μl before treatment, the most recent antiviral treatment regimen containing LPV/r was 0.04 times (95% CI: 0.01-0.18) than that of stavudine (d4T) + lamivudine (3TC) + nevirapine (NVP)/efavirenz (EFV) regimen, drug resistance was 3.40 times (95% CI: 2.13-5.42) of non-drug resistance, non-viral load and non-drug resistance test results were 12.98 times (95% CI: 10.28-16.40) of non-drug resistance. Conclusions:Age, gender, transmission route, CD4 before treatment, the latest antiviral treatment program, and drug resistance test after antiviral therapy were the influencing factors of HIV/AIDS death in Butuo county. It is necessary to expand the coverage of viral load and drug resistance test to change the antiviral therapeutic schedule scientifically and carry out publicity and education on the compliance of patients with antiviral treatment and medical staff training in order to reduce the mortality of patients with antiviral treatment.

Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders.In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment.After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders.In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment.After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

OBJECTIVE： To screen the hepatoprotective active fractions from Ixeris chinensis and study its chemical constituents. METHODS：The petroleum ether，ethyl acetate，n-butanol and residual water fractions from 70％ ethanol extract of I.chinensis were extracted by systematic solvent method. Human hepatocytes HL-7702 were induced by acetaminophen to induce liver injury model. MTT method was used to detect the protective effect of the above fractions（40 μg/mL，by the dosage of crude drug）on injured cells，and the active fractions were screened. The active fractions were separated and purified by silica gel column and Sephadex column chromatography. The structure of the compounds were identified by physical and chemical properties and spectral data （hydrogen spectrum，carbon spectrum）. RESULTS：After treated with different fractions of I. chinensis，the cell survival rate of each administration group was increased significantly，compared with model group（P＜0.01），and the n-butanol and water fractions had the strongest activity （the cell survival rates were 49.3％ and 52.2％ ，respectively）. Six compoundswere isolated from n-butanol fraction and identified as sonchifolignan A（Ⅰ），apigenin-7-O-β-D-glucopyranoside methyl ester（Ⅱ），luteolin-7-O-β-D-glucuronopyranoside methyl ester （Ⅲ），luteolin-7-O-β-D-glucopyranoside （Ⅳ），apigenin-7-O-β-Dglucopyranoside（Ⅴ）and luteolin（Ⅵ）. CONCLUSIONS：The n-butanol fraction is regarded as an effective position for protecting liver，and flavonoids are the main active omponents.KEYWORDS Ixeris chinensis；Hepatoprotective activi

Objective:To investigate the prevalence of pretreatment drug resistance and the genetic polymorphism of CRF08_BC strains among HIV-1 patients in China.Methods:This cross-sectional survey involved the plasma samples of HIV patients in a national pretreatment HIV drug resistance survey conducted in 2018. RNA was extracted from the samples. The fragments containing protease and partial reverse transcriptase (PR/RT) regions were obtained and sequenced. Drug resistance was analyzed using Stanford HIVdb Program. Differences in polymorphic mutations between drug-resistant and non-drug-resistant HIV-1 strains were analyzed by Chi-square test or Fisher′s exact test. The association between drug-resistant and polymorphic mutations was evaluated using CorMut R package. Molecular transmission networks were constructed using HIV-TRACE software. Results:Totally 465 partial pol sequences were obtained from individuals with CRF08_BC infection in 25 provinces and cities. The total pretreatment drug resistance rate was 17.8% (83/465). The pretreatment drug resistance rates to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) were 16.6% (77/465), 1.1% (5/465) and 0.9% (4/465), respectively. The resistance rate to rilpivirine (RPV) was the highest (15.7%, 73/465). The most common mutation was E138A (11.6%, 54/465). There were six polymorphic mutations (S162C, K102Q, T200A, V179E, I202V, T200M) that co-variated with E138A. The molecular transmission network showed that patients infected with CRF08_BC strains carrying the resistant mutations at position E138 mainly gathered in clusters in Yunnan and Sichuan, and the highest degree of connection was in Lincang, Yunnan. Conclusions:In China, HIV-1 CRF08_BC-infected patients showed a high rate of pretreatment resistance to one of the second-generation NNRTIs, namely RPV. Further researches were warranted to evaluate the impacts of co-mutations of the E138A mutation and polymorphic sites on HIV resistance and replicative capacity.

Objective:To explore the resistance to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and integrase inhibitors (INSTIs) of HIV-1 CRF55_01B and the transmission of drug-resistant strains among HIV-1 CRF55_01B infected patients before antiviral treatment in China.Methods:HIV-1 RNA was extracted from plasma samples of the patients infected with CRF55_01B in the national surveillance of HIV drug resistance before antiviral treatment in 2018. A 1 056 bp gene fragment of protease/reverse transcriptase (PR/RT) region and an 846 bp gene fragment of integrase (IN) region were obtained and sequenced. Drug resistance was analyzed by using all drugs included in the Stanford University HIV db Program, HIV-1 molecular network analysis was performed with software HIV-TRACE and polymorphism mutations of CRF55_01B integrase gene region were analyzed.Results:A total of 178 samples from 26 provinces, municipalities and autonomous regions in China were analyzed, and 170 sequences of CRF55_01B PR/RT region and 170 sequences of IN region of corresponding samples were obtained. The drug resistance rate was 15.3% (26/170). The drug resistance rates of PIs, NRTIs, NNRTIs and INSTIs were 1.2% (2/170), 1.2% (2/170), 15.3% (26/170), 0.6% (1/170), respectively. The level of drug resistance was mostly low. NNRTIs drug resistance mutations were mainly V179D/E co-appeared with other mutations, and 84.1% (143/170) of the infected patients carrying V179D/E alone showed potential drug resistance. INSTIs drug resistance mutation was G163R, and showed low resistance to EVG and RAL. The molecular network access rate was 30.0%(51/170)according to the 0.9% gene distance threshold. The resistant strains were transmitted between men with homosexual transmission and heterosexually transmitted people, and both carried resistant mutations E138G and V179E. In the integrase region, CRF55_01B and CRF01_AE and B subtypes showed high mutation frequency difference in 5 sites (T215A、G134N、I135V, K136R and L101I/V).Conclusions:Before antiviral treatment, CRF55_01B infected patients in China had a high resistance to NNRTIs. Strains carrying both E138G and V179E resistance mutations were transmitting in clusters. The prevalence of CRF55_01B integrase inhibitor resistant strains is low, but some genetic polymorphisms with high mutation rate in the integrase gene region have potential influence on drug sensitivity. The influence of drug resistance of new recombinant strains on antiviral therapy in China needs to be further monitored and analyzed.