Objective To discuss the correlation of serum TNFR level with renal function injury in patients with type 2 diabetes mellitus (T2DM)and normal albumin excretion.Methods 90 T2DMpatients with normal albu-min excretion(24h urine albumin excretion rate <20μg/min)were divided into three groups according to the esti-mated glomerular filtration rate level:eGFR >90mL · min -1 · (1.72m2 )-1 ,eGFR 60 -90mL · min -1 · (1.72m2 )-1 and eGFR <60mL·min -1 ·(1.72m2 )-1 ,30 cases in each group.The serum TNFRs level and related clinical data were measured and analyzed statistically.Results The levels of serum TNFR1,TNFR2 were negatively correlated with eGFR(r =-0.428,-0.335,all P <0.05),and positively correlated with Scr(r =0.476,0.225,all P <0.05)in patients with T2DM and normal albumin excretion.The course of disease and the levels of BUN,Scr, CysC,α1 -MG,β2 -MG were increased as the degree of renal function injury.All these index had statistically signifi-cant differences in three groups(F =3.758,5.851,71.738,25.751,7.530,13.735,all P <0.05).Logistic regres-sion analysis showed that the levels of serum TNFR1,TNFR2 were independent risk factors for renal impairment in patients with T2DMand normal albumin excretion(OR =2.009,1.143,all P <0.05).Conclusion TNFRs may be involved in the development and progression of renal impairment,and may become a new conventional indicator for DN because of reflecting the degree of renal function injury in some extent in T2DMpatients with normal albumin excretion.

Objective]To investigate the effect of acupuncture-assisted anesthesia on cerebral state index(CSI) under the steady-state anesthesia of sevoflurane. [Methods] Fifty patients scheduled for elective knee arthroscopy operation were randomly divided into two groups with 25 in each. All patients were induced with sevoflurane, the end-tidal concentrations of sevoflurane in two groups were adjusted to 1.0 MAC and maintained for 15 min after tracheal intubation, acupuncture-assisted anesthesia was used on the affected side in group A, Yanglingquan(GB34) and Zusanli(ST36) were selected as the acupoints. The positive and negative electrodes of the electropuncture apparatus(G8650) were respectively connected with Yanglingquan(GB34) and Zusanli(ST36). People reccived transcutaneous electrical acupoint stimulation with condensation-rarefaction wave(2/15 Hz, 8~12mA) untill the end of operation, patiant's body types SBP, SDP, MAP, HR and CSI were recorded at lying still for 5 min(T1), steady state of sevoflurane(T2), acupuncture-assisted anesthesia after 20 and 30 min(T3, T4). [Results] SBP, DBP, MBP, HR and CSI at T3~T4 were significantly lower in group A than those in group B and T2(P<0.05). [Conclusion]Acupuncture-assisted anesthesia can reduce the CSI under the steady-state anesthesia of sevoflurane and lower blood pressure and heart rate at the same time.

Objective To systematically evaluate the survival rate difference between minimally invasive surgery(MIE)and traditional open surgery(Open)in treating esophageal cancer perioperative complications and long-term follow-up.Methods Embase,Pubmed,Cohorane library search,Medline,Wanfang and HowNet were retrieved,and the related researches were collected.The literatures screening,data extraction and literature quality evaluation were conducted according to the 5.0 Coehrane reviewers manual.Then the meta analysis was conducted by using the Stata11.0 software.Results This study included 20 non-randomized control trials,with a total sample size of 3 568 cases(1 859 cases in the MIE group and 1 709 cases in the Open group),the pooled results showed that the MIE group had shorter operative time,shorter hospital stay,less intraoperative blood loss and more intraoperative lymph nodes clearing(P＜0.05),and perioperative complications,respiratory system complications,circulatory system complications and perioperative mortality rates were lower(P＜0.05).But postoperative ICU stay time,perioperative complications of digestive system and surgery-related complications,incidence of anastomotic fistula and 3-year survival had no statistically significant differences between the two groups(P>0.05).Conclusion MIE surgery is feasible in the treatment of esophageal cancer,and has lower incidence of perioperative complication compared with traditional surgery.

Objective To observe the curative effect of lumbar sympathetic nerve injury combined with systemic and local medication in intractable lower limb ischemic pain.Methods21 patients with intractable lower limb ischemic pain accepted lumbar sympathectomy,at the same time foot topical Votalinemulgel used and Combined with anticonvulsants and opioids according to circumstances,the visual analogue scale of resting pain(visual analogue scale,VAS),the Local skin temperaturebefore and after treatment were observed and evaluated.ResultsAfter Lumbar sympathetic nerve block and topical Votalinemulgel,21 patients had pain relief.After treatment, 2 patients had poor effect,the remaining 19 patients had pain relief to VAS<3, 4 patients did not need systemic analgesic drugs,the rest of the patients need systemic analgesic drugs.ConclusionIt is necessary to adopt multimodal comprehensive treatment for intractable lower limb ischemic pain.

The relationship of dose and effect in TCM formulae was an important subject in the TCM modernization research.Some characteristic properties of TCM dose-effect relationship were proposed in this paper: the dose-effect relationship of TCM had a specifi c regulation from the whole-view idea in traditional medical theories besides common properties,nonlinear character from the compatibility of medicine properties,and multi-effects varied with the different compatibility from the alternation of doses.The subjects of dose-effect relationship included single medicine,drug pair and formulae.The study on the dose-effect relationship of TCM might be helpful to the explanation of conception,connotation,ideas and methods of TCM,provide scientifi c supports and instructions for the TCM clinical practices,and provide research bases for the TCM innovation.

OBJECTIVE:To study the bioequiavailability of both the domestic and the imported azithromycin tablets in healthy human body.METHODS:The serum concentrations in 12 healthy volunteers was determined by HPLC-UV after administration of a single oral dose of 500mg azithromycin tablets by a cross-over design.The compartment model was discriminated by F-test and AIC method and the pharmacokinetic parameters were calculated by DAS program.RESULTS:The optimal compartment model fitted to two-compartment model.The main pharmacokinetics parameters of the domestic azithromycin tablets vs.the imported ones were the following:Cmax was(437.4 670? 51.5 670),(442.9 670? 61.5 030)? g/L;t1/2? was(44.7 450? 13.1 750),(49.2 670? 15.1 740)h;tmax was(2.5 830? 0.5 150),(2.5 830? 0.5 150)h;AUC0～ 144 was(13.2 799? 2.9 827),(12.1 953? 2.9 140)(mg? h)/L.The relative bioavailability of the domestic azithromycin tablets was(101.7? 0.1)%.CONCLUSION:The domestic azithromycin tablets and the imported ones were bioequivalent.

OBJECTIVE Toexploretheantagonisticeffectofadrenaline(Adr)onproarrhythmiain-duced by Chinese herbal intravenous injection of Shuanghuanglian Injection (SHL).METHODS ① In vivo ECG recording was made to analyze effects of jugular intravenous (iv)injection of SHL alone and SHL plus adrenaline on ECG in guinea pigs.SHL and/or adrenaline were injected accumulatively in this order:SHL 276 mg·kg -1→2760 mg·kg -1→adrenaline 0.0078 mg·kg -1→adrenaline 0.039 mg·kg -1 .② In vitro ECG recording was made to analyze effects of SHL and SHL plus adrenaline on ECG in isola-ted hearts of guinea pigs.SHL and/or adrenaline were perfused in this order:SHL 0.3 g·L-1→SHL 1 .5 g·L-1→SHL 1 .5 g·L-1 +Adr 0.42 mg·L-1→SHL 1 .5 g·L-1→control perfusion solution.③ Single ventricular myocyte action potential was recorded to analyze the effect of SHL alone and SHL plus adren-aline on the action potential durations at 50% (APD50 )and 90% (APD90 )repolarization levels.SHL alone was perfused in such order:SHL 0.3 g·L-1 →SHL 1 .5 g·L-1 →SHL 3 g·L-1 +adrenaline 0.83 mg·L-1 .RESULTS ①SHL (2760 mg·kg -1 )significantly reduced heart rate and prolonged QRS and QTc intervals in vivo ECG.Adrenaline (0.0078 mg·kg -1 and 0.039 mg·kg -1 )significantly amelio-rated the proarrhyth mia of SHL by shortening QTc,P-R intervals and increasing heart rate.② SHL (1 .5 g·L-1 )remarkably reduced heart rate and prolonged P-R interval in isolated guinea pig hearts in vitro.Adrenaline (0.42 mg·L-1 )significantly increased heart rate and shortened the QTc interval.③ SHL (3 g·L-1 )remarkably prolonged the APD50 and APD90.Adrenaline abolished the prolonged effectofSHLonAPD50APD90.CONCLUSION Adrenalinemightbeclinicallyusedtotreatsevere adverse drug reactions induced by SHL based on its antagonistic effect on arrhythmia.

OBJECTIVE To explore the effect and underlying mechanism of promethazine(PMZ) on proarrhythmia in guinea pigs. METHODS ① InvivoECG recordings were made to analyze effects of jugular intravenous(iv)injection of PMZ on ECG in guinea pigs. PMZ was injected in this order:3.83→7.67→15.33→38.33 mg·kg-1 cumulatively. ② In vitroECG recordings were made to analyze effects of PMZ on ECG in isolated hearts of guinea pigs. PMZ was perfused in such order:0. 1 → 1 → 10 →50 μmol·L-1 . ③ L-type Ca2+ currents from ventricular myocytes in guinea pigs were recorded to investi-gate the PMZ's blocking effect. PMZ was perfused in such order:0.1→1→10→50 μmol·L-1→washout.④ hNav1.5 and hERG currents were recorded to investigate the PMZ's blocking effects. PMZ-perfused in such order:1→3→10→30 μmol·L-1 for hNav1.5 current analysis,and 0.3→1→3→10 μmol·L-1 for hERG current analysis. RESULTS ① PMZ(15.33 mg·kg-1 )significantly prolonged QRS intervals in guinea pigs invivoECG(P﹤0.05). PMZ(38.33 mg·kg-1 )prolonged QRS,QTc,and P-R intervals but reduced the heart rate( P﹤0.05). PMZ(10 μmol·L-1 )reduced the heart rate of isolated guinea pig hearts. PMZ 50 μmol·L-1 prolonged QRS and QTc intervals and further reduced the heart rate(P﹤0.05).③ PMZ inhibited the L-type Ca2+ current from ventricular myocytes in guinea pigs in a concentration-dependent manner with the lC50 of(8.9±1.0)μmol·L-1 . ④ PMZ inhibited the hNav1.5 and hERG currents in a concentration-dependent manner with the lC50 of 6.1±1.5 and(1.6±0.2)μmol·L-1 ,respectively. CONCLUSION PMZ might cause arrhythmia at overdoses and incombination with other drugs which have potential blocking effect on /Na ,Ca2+ and /kr currents. The proarrhythmic effect of PMZ might be mediated by the blocking effect on /Na ,Ca2+ and /kr currents.

OBJECTIVE To explore kinetic features and its underlying mechanism of the positive inotropic effect of liguzinediol(LZDO)in rats. METHODS ①An In vivo study was made to record the effect of LZDO 20 mg · kg-1 injected for 30 consecutive min from the left external jugular vein on pressure-volume relationships. ②Ex vivo study was used to record the antagonistic effect of LZDO on reduced contractility induced by caffeine. Caffeine and LZDO were perfused as follows:normal perfusion solution, caffeine 0.5 mmol · L-1,and then caffeine 0.5 mmol · L-1+LZDO 100 μmol · L-1. ③ Ca2+ transient from cardiomyocyte sarcoplasmic reticulum (SR) was measured to analyze the effect of LZDO on Ca2 +release blocked by thapsigargin. Thapsigargin and LZDO were perfused as follows:normal perfusion solution,thapsigargin 2 μmol · L-1,and then thapsigargin 2 μmol · L-1+LZDO 100 μmol · L-1.④The SR vesicles were prepared and the effect of LZDO(1,10 and 100μmol·L-1)on sarcoplasmic reticulum Ca2+ATPase(SERCA2a)activity was determined according to the ultramicro-Ca2+-ATP enzyme kit. RESULTS ① LZDO 20 mg · kg- 1 significantly reduced the end-systolic volume (Ves) and enhanced the end-systolic pressure (Pes),stroke volume (SV),ejection fraction (EF),cardiac output(CO),peak rate of rise of left ventricular pressure(+dp/dtmax)and stroke work(SW)(P<0.05). However,LZDO 20 mg · kg-1 did not significantly change the heart rate(HR )or the end-diastolic volume (Ved). ② Caffeine 0.5 mmol · L- 1 significantly enhanced HR,left ventricular developed pressure (LVDP ),and+dp∶dtmax at 5 min after caffeine and decreased at 30 min. However,LZDO 100μmol·L-1 restored the reduced HR,LVDP,and+dp/dtmax induced by caffeine at 30 min(P<0.05).③Thapsigargin 2μmol·L-1 significantly reduced the SR Ca2+transient from perfusion solution group(100±5)%to(51± 5)%(P<0.05) and LZDO 100 μmol · L-1 failed to restore the decreased Ca2+ transient〔(49 ± 4)%〕. Normalized Ca2+transients were reduced by thapsigargin 2μmol·L-1 and thapsigargin 2μmol·L-1+LZDO 100 μmol · L-1. ④ LZDO(10 and 100 μmol · L-1)significantly increased the activities of SERCA2a in perfusion solution group 0.98±0.10 to 1.17±0.20 and (1.43±0.09)μmol Pi·g-1·h-1,respectively(P<0.05). CONCLUSION LZDO can enhance SR Ca2+ gradient by activating the SERCA2a and might be developed to serve as a potential positive inotropic agent in clinical settings.

Objective To investigate the clinical characteristics and etiology in infants undergoing colonoscopy in order to improve the understandings of lower gastrointestinal tract diseases and their endoscopic manifestations.Methods The clinical and endoscopic data of the infants aged ≤ 3 years old who underwent conoloscopy at the Department of Gastroenterology,Children's Hospital of Chongqing Medical University,from July 2010 to December 2014,were retrospectively analyzed.A total of 223 children were included,148 male and 75 female.The age range was from 26 d to 3 years old(＜6 months:41 cases;6-12 months:68 cases;1-3 years old:114 cases).Results A total of 235 colonoscopies were performed under deep sedation by single or double manipulators.Cecal intubation was successful in 192 colonoscopies and terminal ileal intubation was completed in 29 colonoscopies,with a high success rate of 94.0％ (221/235 colonoscopies).The main symptoms included hematochezia (124 cases,55.6％),persistent/chronic diarrhea (55 cases,24.7％),hematochezia with chronic diarrhea(22 cases,9.5％),and others(22 cases,9.5％).Of the 223 patients,clear diagnosis were established for 215 children (96.4％),with food protein-induced proctocolitis (FPIPC) (78/223 cases,35.0％),colonic polyps (50/223 cases,22.4％),colitis (29/223 cases,13.0％),antibiotic associated diarrhea (AAD) (19/223 cases,8.5％),FPIPC with AAD (10/223 cases,4.5％).Conclusions Colonoscopy serves as a very important tool for the accurate diagnosis of lower gastrointestinal diseases with hematochezia and/or chronic diarrhea.FPIPC and colonic polyps are the most common causes for hematochezia and/or chronic diarrhea.AAD may be another important cause of chronic diarrhea and bloody stool in infants.Moreover,ghe application of colonoscopy in combination with histopathology can also play an important role in the diagnosis of some rare diseases,such as intestinal tuberculosis,primary intestinal lymphangiectasia,Behcet's disease and primary immunodeficiency disease.