STAT3 gain-of-function mutation in an adult patient / Paciente adulto portador de una mutación con ganancia de función en el gen STAT3

Abstract Germline gain-of-function (GOF) mutation of the signal transducer and activator of transcription 3 (STAT3) gene causes a disease clinically characterized by a significant lymphoproliferation, includ ing lymphadenopathy and/or hepatosplenomegaly, as well as childhood onset autoimmunity. Here we present an adult patient who, during his early years of life, presented recurrent infections, autoimmune hemolytic anemia and benign lymphoproliferative disease, characterized by hepatosplenomegaly and lymphadenopathy, being diagnosed with common variable immunodeficiency (CVID) at 13 years of age. He was diagnosed with lymphocytic interstitial pneumonia at the age of 20. When he was 40 years old, after a diagnostic review, it was decided to perform genetic studies. A heterozygous mutation in STAT3 NM_003150 c.2141C>T, p.P714L was detected by whole exome sequencing and validated by Sanger. Previously published functional studies performed in two siblings showed that this mutation resulted in gain-of-function. They were initially diagnosed with autoimmune lymphoproliferative syndrome, and later with STAT3 GOF as a second genetic defect. Our patient developed severe pulmonary disease and died, without access to treatment targeted to his molecular defect due to the advanced nature of his pulmonary involvement and the fact that many of the therapies were still in develop ment at that time. The diagnosis of STAT3 GOF mutations should be suspected in patients with early-onset of lymphoproliferative disease, autoimmunity and hypogammaglobulinemia. This must be considered especially in the group of CVID patients with these characteristics, in order to allow the implementation of treatments target ing the molecular defect (JAK inhibitors and Il-6 receptor antagonists) that could modify the disease evolution.

Resumen Mutaciones en línea germinal con ganancia de función (GOF) del gen transductor de señales y acti vador de la transcripción 3 (STAT3) provocan una enfermedad caracterizada por importante linfoproliferación, incluyendo linfadenopatías y/o hepatoesplenomegalia, así como autoinmunidad de inicio en la infancia. Presen tamos un paciente adulto que, durante sus primeros años de vida, presentó infecciones recurrentes, anemia hemolítica autoinmune y enfermedad linfoproliferativa benigna, caracterizada inicialmente por hepatoespleno megalia y linfoadenopatías, diagnosticado de inmunodeficiencia común variable (IDCV) a los 13 años. A los 20 años, al ser estudiado por compromiso pulmonar, se diagnosticó neumonía intersticial linfocítica. A los 40 años, tras revisión diagnóstica se decidió realizar estudios genéticos. Por secuenciación del exoma completo se detectó una mutación heterocigota en STAT3 NM_003150 c.2141C>T, p.P714L, que se validó por Sanger. Estudios funcionales previamente publicados realizados en dos hermanos con diagnóstico inicial de síndrome linfoproliferativo autoinmune, mostraron que esta mutación daba lugar a una ganancia de función. Nuestro pa ciente desarrolló enfermedad pulmonar grave y falleció a los 41 años, sin posibilidad de acceder a tratamiento dirigido a su defecto molecular por lo avanzado de su compromiso pulmonar y a que muchas de las terapias se encontraban en ese momento en desarrollo. El diagnóstico de mutaciones STAT3 GOF debe sospecharse en pacientes con enfermedad linfoproliferativa temprana, autoinmunidad e hipogammaglobulinemia. Esto debe ser considerado especialmente en pacientes con IDCV con estas características, para permitir la implementación de tratamientos dirigidos al defecto molecular (inhibidores de JAK y antagonistas del receptor de Il-6) que podrían modificar la evolución de la enfermedad.

Transcranial magnetic stimulation can improve upper limb function after a stroke / 中华物理医学与康复杂志

Objective To explore any changes in the patterns of cortical activation after repetitive transcra-nial magnetic stimulation ( rTMS) using functional near-infrared spectroscopy when rTMS is used to treat paralyzed upper limbs. Methods Thirty hemiplegic stroke survivors were randomly divided into a treatment group and a con-trol group, each of 15. Those in the treatment group received 1 Hz rTMS on the M1 area of the unaffected hemisphere for 21 days, while the control group was given sham stimulation. The Fugl-Meyer motor assessment ( FMA-UE) was used to assess the paralyzed upper limbs before the treatment and after 7, 14 and 21 days of treatment. Oxy-hemoglo-bin ( HbO2 ) levels were measured in the premotor cortex, the supplementary motor area and the sensorimotor areas ( SMCs) of the affected and unaffected hemispheres before and after the treatment using the functional near-infrared spectroscopy. Results Before the treatment there was no significant difference between the two groups in their aver-age FMA-UE scores. The average FMA-UE scores of both groups increased significantly after 14 and 21 days of treat-ment, with the average scores at 21 days significantly better than after 14 days for both groups. But after 14 and 21 days the treatment group's average score was significantly better than that of the control group. The average HbO2 level in the SMC area of the unaffected hemisphere in the treatment group had decreased significantly after 21 days of treat-ment, and it was then significantly lower than the same level in the control group. Conclusion Twenty-one days of rTMS of the unaffected hemisphere can decrease cortical activation in the unaffected SMC area and promote the recov-ery of upper limb function.

The effect of short-term, intensive rehabilitation exercises on the respiration, life quality and sleep of persons with obstructive sleep apnea and chronic obstructive pulmonary disease / 中华物理医学与康复杂志

Objective To explore the effect of short-term intensive rehabilitation training on respiratory function, motor function and the life quality of patients with obstructive sleep apnea combined with chronic obstruc-tive pulmonary disease ( OSA-COPD) . Methods Fifty-seven patients with OSA-COPD were randomly divided in-to an observation group and a control group. Both groups were treated with non-invasive positive pressure ventilation ( NPPV) , oxygen therapy and a bronchodilator, while the observation group was additionally provided with 8 weeks of intensive lung rehabilitation training, including respiratory function training and limb exercise training. Polysom-nography was used to monitor the apnea hyponea index ( AHI) , the lowest oxygen saturation level during the night ( LowSpO2 ) and the nocturnal oxygen saturation ratio for ＜ 90% of total sleep time ( tst90) . Arterial blood gases, forced vital capacity ( FVC) and forced expiratory volume in one second ( FEV1 ) were measured. The 6-minute walk test (6MWT) and St. George's respiratory questionnaire ( SGRQ) were used to evaluate all the patients before and after the intervention. Results After 8 weeks of treatment, the average AHI, LowSpO2 , TST90 and PaO2 had improved significantly in both groups. There was no significant difference between them. After the treatment the average FVC, FEV1 and 6MWT time of the observation group were significantly better than before the treatment and the significantly better than the control group's averages. After treatment, the average SGRQ score and activity abili-ty score of the observation group were also significantly improved and significantly better than the control group's av-erages. Conclusions NPPV can effectively improve OSA-COPD patients'tolerance of short-term intensive pulmo-nary rehabilitation training. With that assistance, short-term intensive rehabilitation training can promote the recov-ery of respiratory function and motor function, and improve the life quality of patients. Therefore, such therapy is worthy of clinical promotion and application.

Relationship between the expression of serum BNP levels and cardiac function,heart failure in children with ventricular septal defect of congenital heart disease / 中国基层医药

Objective To explore the relationship between the expression of serum B －type natriuretic peptide(BNP) levels and cardiac function,heart failure(HF) in children with ventricular septal defect of congenital heart disease(CHD).Methods From October 2013 to July 2017,150 children with ventricular septal defect of CHD who were treated in Yuncheng Central Hospital were selected ,and they were divided into no HF group (n＝40),mild HF group(n＝46) and moderately severe HF group ( n＝64) according to the New York university pediatric heart failure index(NYU PHFI) evaluation standard.Meanwhile,148 healthy children were selected as control group.The serum BNP levels,left ventricular ejection fraction (LVEF),left ventricular ejection fraction shortening rate (LVFS), left ventricular end diastolic diameter index (LVEDDI) and cardiac output index (CI) were measured in all subjects. The levels of BNP,LVFS,LVEF,LVEDDI and CI in the study group were compared with those in the control group. The levels of BNP,LVEF,LVFS,LVEDDI and CI in children with CHD ventricular septal defect were compared.The relationship between the level of BNP and LVEF ,LVFS,LVEDDI and CI in patients with ventricular septal defect of CHD was analyzed.Results The serum level of BNP in the study group was (268.47 ±25.48) ng／L,the levels of LVEF,LVFS,LVEDDI and CI in the study group were (55.56 ±4.23)%,(27.96 ±2.74)%,(77.56 ±6.54)mm／m2, (3.35 ±0.41) L· min－1·( m2 )－1 ,respectively.The serum level of BNP in the control group was (33.41 ± 6.21)ng／L,and the levels of LVEF,LVFS,LVEDDI and CI in the control group were (65.43 ±5.12)%,(36.24 ± 3.23)%,(57.32 ±5.31) mm／m2 ,(4.27 ±0.46)L· min－1·(m2 )－1 ,respectively.The serum levels of BNP and LVEDDI in the study group were significantly higher than those in the control group (t＝109.077,29.306,all P＜0.05),while the levels of LVEF,LVFS and CI in the study group were significantly lower than those in the control group(t＝18.152,23.875,18.231,all P＜0.05).With the increased severity of HF ,the levels of BNP and LVEDDI were increased,while the levels of LVEF,LVFS and CI were gradually decreased ( F＝332.232,245.400,all P＜0.05).The level of serum BNP was negatively correlated with LVEF ,LVFS,CI(r＝－0.705,－0.692,－0.718,all P＜0.05),but it was positively correlated with LVEDDI and HF (r＝0.721,0.735,all P＜0.05).Conclusion The level of serum BNP in patients with ventricular septal defect of CHD is correlated with cardiac function indicators ,and serum BNP is positively correlated with HF in children with ventricular septal defect of CHD ,which plays an important role for the diagnosis,treatment and prognosis of HF.

Robot-assisted training can improve the bladder and intestinal functions of paraplegic patients / 中华物理医学与康复杂志

Objective To explore the clinical effect of training assisted by a lower limb rehabilitation robot on the bladder and intestinal function of paraplegic spinal cord injury survivors. Methods Thirty-eight paraplegic patients with spinal cord injury were divided according to their admission order into an experimental group ( n=19) and a control group (n=19). Both groups were given conventional rehabilitation training, while the experimental group was additionally provided with robot-assisted lower limb training in three stages:adaptation, training and con-solidation. It lasted 30 minutes daily, 5 days per week for 12 weeks. Before and after the training, an urodynamics examination system was used to evaluate the maximum urine flow, bladder capacity, residual urine volume, bladder pressure and detrusor pressure. Colon transit time, mean rectal pressure and intestinal function were measured using the colon transit test, a mean rectal pressure test, and the Functional Independence Measure ( FIM) scale respective-ly. Results The average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance, average rectal pressure and intestinal FIM score of the robot training group after training were all significantly better than before the training, as were the average residual urine volume and colon transit time. After the training, the average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance and average rectal pressure of the robot training group were all significantly higher than those of the control group, while the average residual urine volume and colon transit time were significantly smaller. Then, 32％ of the patients in the experimental group achieved no less than 6 points for their average FIM score, significantly higher than in the control group. Conclusion Robot-assisted lower limb training combined with comprehensive rehabilitation training can effectively improve the bladder and intestinal function of paraplegic patients after a spinal cord injury.

Graded motor imagery for rehabilitating upper extremity motor function after stroke / 中华物理医学与康复杂志

Objective To investigate the effect of graded motor imagery ( GMI) therapy combined with rou-tine occupational therapy on the recovery of upper extremity function after stroke. Methods Thirty stroke survivors who met inclusion criteria were randomly assigned to a control group ( n=15) or a GMI group ( n=15) . The control group received routine medication, conventional physical therapy and routine occupational therapy ( one hour a day) , while the GMI group received 30 minutes of routine occupational therapy and 30 minutes of graded motor imagery therapy every day in addition to conventional medication and physical therapy. Before and after four weeks of treat-ment, the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities ( FMA-UE) , the Box and Block Test ( BBT) and Brunnstrom arm and hand staging. Surface electromyography of the biceps brachii and triceps brachii was performed as the affected elbow flexed and stretched in maximum isometric contrac-tions, and the co-contraction ratios ( CRs) were calculated. Results After the treatment, the average FMA-UE score, Brunnstrom arm and hand stage, BBT and CR scores in both groups had improved significantly. The average improvement in the GMI group was significantly greater than in the control group. Conclusions Graded motor im-agery therapy can significantly promote motor recovery of the upper extremities of hemiplegic patients after a stroke.

Experimental study on mouse acute toxicity and analgesic pharmacodynamics of new compound L11 / 中国药理学通报

Aim To observe the effect of new com-pound L11 on the affinity and function of sigma-1 re-ceptor,as well as the mouse acute toxicity and analge-sic effect, so as to provide the experimental basis for its pharmacodynamics and preliminary toxicity evalua-tion. Methods Using binding and function test of sig-ma-1 receptor in vitro, the acute toxicity and formalin model test of mice,as well as the rat chronic constric-tion injury(CCI) model test in vivo,the effects of L11 on the inhibitory rate and function of sigma-1 receptor, LD50,lifting/licking time of mice and mechanical pain threshold of rats were respectively measured to evaluate the analgesic effect and mechanism of L11. Results The inhibitory rate and Kiof L11 on the sigma-1 recep-tor were 103.07% and 4.81 nmol·L-1,respectively. The Kivalue was 8.10 nmol·L-1while adding pheny-toin (sigma-1 receptor allosteric modulator). The in-tragastric administration of L11 in mice was 1 680.03 mg·kg-1LD50,and the 95% confidence interval was (1 559.35 ~1 819.40) mg·kg-1. Compared with model group, the II phase lifting/licking time of mice was significantly reduced and the mechanical pain threshold of rat obviously increased by L11. Conclu-sions The new compound L11 has high affinity to sig-ma-1 receptor, which belongs to the antagonist of sig-ma-1 receptor;L11 is less toxic to intragastric adminis-tration and has obvious analgesic effect on the formalin model of mice and CCI model of rats, which may be relative with the sigma-1 receptor antagonism.

Clinical Observation of Xingnaojing Injection Combined with Butylphthalide in the Treatment of Middle Cerebral Artery Infarction / 中国药房

OBJECTIVE:To investigate the effects and safety of Xingnaojing injection combined with butylphthalide on neuro-logical function,cognitive function,coagulation function and living activity. METHODS:A total of 106 patients with middle cere-bral artery infarction in Wuhan University People's Hospital during Jun. 2014-Dec. 2015 were divided into control group and obser-vation group according to random number table,with 53 cases in each group. Besides routine symptomatic treatment,control group was given Butylphthalide soft capsules 0.2 g,po,tid. Observation group was additionally given Xingnaojing injection 20 mL added into 0.9% Sodium chloride injection 250 mL,ivgtt,qd. Both groups were treated for 14 d. The neurological function score (NI-HSS,NFDS),cognitive function score (MoCA,MMSE),coagulation function indexes (PT,APTT,FIB),BI score were ob-served in 2 groups before and after treatment. The occurrence of secondary remote damage and ADR were recorded. RESULTS:Eight patients withdrew from the study,including 3 patients of control group and 5 of observation group. Before treatment,there was no statistical significance in neurological function scores(NIHSS,NFDS),cognitive function scores(MoCA,MMSE),coag-ulation function indexes or BI scores between 2 groups (P>0.05). After treatment,NIHSS,NFDS scores and FIB of 2 groups were decreased significantly compared to before treatment,and the observation group was significantly lower than the control group,with statistical significance (P0.05). CONCLUSIONS:For middle cerebral artery infarction,the application of Xingnaojing injection combined with butylphthalide can reduce the risk of remote damage,promote the recovery of neurological function and cognitive func-tion,and improve coagulation function and living activity with good safety.

The short-term efficacy of inhaled steroids combined with long-acting beta2-agonists for asthma-COPD overlap syndrome / 实用医学杂志

Objective To evaluate the short-term efficacy of inhaled corticosteroids(ICS)combined with long-acting beta2-agonists(LABA)for asthma-COPD overlap syndrome(ACOS). Methods The patients with stable COPD or ACOS who had been treated during the period of March 2012 to March 2015 were selected and divided into COPD group(88 patients)and ACOS group(36 patients). Pulmonary function,chest X-ray,and blood eosinophil count were detected;and mMRC scale was measured. Both groups received ICS combined with for 3 months. ACOS was defined as the patients had a self-reported survey and positive responses on bronchodilator. Results After a 3-month treatment with ICS and LABA ,an increase in forced expiratory volume in 1 second (FEV1)was significantly greater in ACOS patients than in those with COPD alone(250 ± 42.9 and 63.1 ± 25.3, P=0.003). According to the severity of baseline FEV1,the ACOS group showed a significant difference in patients with severe to very severe airflow limitation. Conclusions Inhaled steroids combined with long-acting beta2-agonists is more efficacious in the treatment of ACOS than COPD. Lung function improves more evidently in ACOS patients with mild-to-moderate airflow limitation after treatment.

Clinical Observation of 2 Kinds of Glucocorticoid Administration Regimens for Elderly Patients with AE-COPD / 中国药房

OBJECTIVE:To investigate the effects and safety of 2 kinds of glucocorticoid administration regimens including 5 d and 15 d on clinical efficacy,pulmonary function,quality of life in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). METHODS:A total of 160 elderly patients with AECOPD selected from Haikou Forth People's Hos-pital during May 2013-Dec. 2015 were divided into group A and B according to lottery method,with 80 cases in each group. Both groups received symptomatic treatment as eliminating phlegm and relieving asthma,controlling infection,etc. Based on it,group A was given Methylprednisolone sodium succinate for injection,40 mg/d for 15 d;group B was given Methylprednisolone sodium succinate for injection,40 mg/d for 5 d. Clinical efficacies were compared between 2 groups as well as the levels of pulmonary ven-tilation function indexes,blood gas analysis indexes,Spitzer life quality index scale (QLI) scores before and after treatment. The occurrence of ADR was also compared between 2 groups. RESULTS:Total response rate of group A was 92.50%,and that of group B was 90.00%,without statistical significance(P>0.05). Before treatment,there was no statistical significance in the levels of pulmonary ventilation function indexes,blood gas analysis indexes,QLI scores between 2 groups (P>0.05). After treatment, FVC,FEV1,FEV1% and PaO2 of 2 groups were significantly higher than before treatment,while PaCO2 was significantly lower than before treatment,with statistical significance (P0.05). QLI scores of 2 groups were significantly higher than before treatment,and the group B was significantly higher than the group A, with statistical significance (P<0.05). The incidence of ADR in group B (6.25%) was significantly lower than group A (22.50%),with statistical significance(P<0.05). CONCLUSIONS:Glucocorticoid administration regimen including 5 d and 15 d in the treatment of elderly patients with AECOPD possess the same effects in improving lung function;glucocorticoid administra-tion regimen for 5 d application is superior in effectively improving the quality of life of patients,reducing the risk of ADR,and has clinical value.

Shenci capsule's effect on the immunologic function and hematological toxicity in the treatment of advanced non-small cell lung cancer adopting GP regime / 实用医学杂志

Objective To observe Shenci capsule's effect on immunologic function and hematological tox-icity of patients with advanced non-small cell lung cancer.Methods 60 cases of patients with advanced non-small cell lung cancer were chosen and divided into the therapy group and the control group randomly with 30 cases in each group respectively. While patients in the control group were administered simple GP chemotherapy regime, patients in the therapy group were administered Shenci capsule treatment orally in addition to the therapy in the control group.Comparisons were made of the variations in the subgroup of T lymphocyte(including the absolute val-ue of CD3+cell,the absolute value of CD4+cell,the absolute value of CD8+cell and CD4+/CD8+ratio)of hematology before and after chemotherapy between the two groups of patients. Results No significant discrepancy was found in the comparison of the absolute value of CD3+cell,the absolute value of CD4+cell,the absolute value of CD8+cell and CD4+/CD8+ratio before the chemotherapy between the two groups(P > 0.05)and the absolute value of CD3+cell,and the absolute value of CD4+cell of both groups decreased significantly after the chemotherapy(P<0.05), especially in the control group(P < 0.05). The hematological toxicity of the therapy group was lower than that in the control group(P < 0.05)after the chemotherapy. Conclusion Shenci capsule was capable of enhancing the body immunity in advanced non-small cell lung cancer and alleviating hematological toxicity.

Relationship between MDSC level and immune function and HBV-DNA replication level in patients with hepatitis B / 中国基层医药

Objective To investigate the relationship between myeloid-derived suppressor cell ( MDSC) levels and immune function and hepatitis B virus DNA ( HBV-DNA) replication level in patients with hepatitis B. Methods 96 patients with hepatitis B were included in the study.40 normal persons who received physical examina-tion in the hospital during the same period were included as the control group.The content of MDSC was detected by flow cytometry and HBV-DNA level was detected by real-time fluorescence quantitative PCR technique.Statistical analysis was performed.Results The content of MDCS in hepatitis B group (8.77 ±3.69)%was significantly high-er than (1.64 ±1.26)%in the control group (t=16.80,P107 IU/mL ( 90.91%) was significantly higher than that in HBsAg negative group (2.70%)(P<0.05).The content of MDSC in HBV DNA positive group[(10.82 ±3.26)%] was significantly higher than that in HBV DNA negative group[(5.84 ±2.16)%](t=8.42,P<0.05).Spearman's correlation analy-sis showed that the level of MDCS expression was positively correlated with the level of DNA replication (r=0.769, P<0.05).Conclusion The increased level of MDSC content can cause the immune suppression and is positively correlated with the degree of HBV DNA replication.

Research progress of immunoglobulin receptors as new therapeutic target / 中国药理学通报

Immunoglobulins ( Ig ) , also called antibodies, are important components in humoral -mediated immunity. Ig can bind with their receptors, called immunoglobulin receptors ( IgR ) , trigger biologic activities respectively. Different sub-types of Igs show different function. And IgRs have been treated as therapeutic targets in inflammation and immunity related dis-eases for many years. This article reviewed the recent progresses in the study of IgR function and its therapeutic role in inflamma-tion and immunity related diseases.

Role of TNF-αin propofol-induced neuronal apoptosis and long-term cognitive impairment in neonatal rats / 中国药理学通报

Aim To investigate the role of TNF-αin propofol-induced neuronal apoptosis and long-term cog-nitive impairment in neonatal rats .Methods Seven-day-old SD rats were randomly divided into 3 groups:Control group ( n =12 ) , P ( single ) group ( n =6 ):propofol 50 mg · kg -1 was injected intraperitoneally (ip.)once;P(repeated) group(n=6):propofol 50 mg · kg -1 was injected ip.once daily, and for seven times. Hippocampal TNF-αlevel was measured 2 hours after propofol anesthesia , there were two time points(n=6) in Control group as control levels (post-natal day 7 for P ( single ) group and postnatal day 13 for P ( repeated ) group ) .In another experiment , 7-day-old rats were randomly divided into 5 groups:Con-trol group; P ( single ) group; P ( repeated ) group; P ( single ) +ETN group: ETN ( etanercept ) 0.4 mg · kg -1 was injected intracerebroventricularly 30 min be-fore propofol administration; P ( repeated ) +ETN group:ETN 0.4 mg· kg -1 was injected intracerebrov-entricularly 30 min before the 1st and 4th administration of propofol , which was injected ip .for seven times , once daily .Hippocampal neuronal apoptosis was detec-ted at postnatal day 7 [ P ( repeated ) and P ( repeated )+ETN groups not involved at this time point ] , 13, 21 and 35 , cognitive function was measured at postnatal day 36 to 41 using Morris water maze test .Results Propofol with different exposure times could increase hippocampal TNF-αlevels(P0.05 );in P ( repeated ) group, active caspase-3 positive neurons were more significantly increased at postnatal day 13, 21 and 35 than those in control group ( P0.05 ) .Con-clusion TNF-αmediates hippocampal neuronal apop-tosis and long-term cognitive impairment induced by propofol in neonatal rats , and long-term cognitive im-pairment may be related with persistent neuronal apop-tosis.

Clinical Observation of Eprosartan in the Treatment of Hypertensive with Coronary Heart Disease / 中国药房

OBJECTIVE:To observe the efficacy and safety of eprosartan in the treatment of hypertensive patients with coro-nary heart disease. METHODS:160 hypertensive patients with coronary heart disease randomly divided into observation group and control group. All patients were given aspirin,nitroglycerin,low molecular weight heparin,statins and other conventional treat-ment;control group was additioanlly given 50 mg Losartan potassium tablet,orally,once a day. Observation group was additional-ly given 600 mg Eprosartan tablet,orally,once a day. The treatment course for both groups was 6 months. Clinical efficacy,sit-ting systolic blood pressure and diastolic blood pressure,alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea (UREA),creatinine(Cr),uric acid(UA),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol (LDL-C),the Mini-Mental status (MMSE) scale and activities of daily living (ADL) scale scores before and after treatment and incidence of adverse reactions in 2 groups were observed. RESULTS:There was no signifi-cant difference in the total effective rate between 2 groups(P>0.05). After treatment,the sitting systolic blood pressure and diastol-ic blood pressure,MMSE and ADL scale scores in 2 groups were significantly lower than before,and sitting systolic blood pres-sure in observation group was lower than control group,the differences were statistically significant(P0.05),and no signifi-cant differences in ALT,AST,UREA,Cr,UA,TC,TG,HDL-C and LDL-C between 2 groups before and after treatment(P>0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Eprosartan can effectively reduce sitting systol-ic blood pressure in hypertensive patients with coronary heart disease,and improve cognitive function,with good safety.

Clinical Observation of Piperazine Ferulate Combined with Glutathione in the Treatment of Diabetic Ne-phropathy / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of piperazine ferulate combined with glutathione in the treatment of diabetic nephropathy. METHODS:80 patients with diabetic nephropathy in our hospital were divided into observation group and control group according to random number table,with 40 cases in each group. Both groups was given general treatment as blood glucose,blood lipid and blood pressure control. Control group was additionally given Reduced glutathione tablets 400 mg, tid,on the basis of general treatment. Observation group was additionally given Piperazine ferulate tablets 100 mg,tid,on the ba-sis of control group. Both groups were treated for 12 weeks. The fasting plasma glucose(FPG),2 h postprandial plasma glucose(2 hPG),blood pressure,blood lipid,serum creatinine (Scr),blood urea nitrogen (BUN),24 h urinary total protein and albumin, urine β2 microglobulin(β2-MG)and N-acetyl-β-glucosaminidase(NAG)of 2 groups were detected before and after treatment. The occurrence of ADR was observed. RESULTS:Before treatment,there was no statistical significance in FPG,2 hPG,blood pres-sure,blood lipid,Scr,BUN,24 h urinary total protein and albumin,urine β2-MG and NAG between 2 groups(P>0.05). After treatment,above indexes of 2 groups were improved significantly,and the observation group was better than the control group, with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:In the treatment of diabetic ne-phropathy,piperazine ferulate combined with glutathione can improve blood glucose,blood pressure,blood lipid levels and renal function with good safety.

Effects Evaluation of Clinical Pharmacists Participating in Disease Management of Chronic Heart Failure / 中国药房

OBJECTIVE:To evaluate the effects of clinical pharmacists participating in disease management of chronic heart failure(CHF). METHODS:A total of 180 CHF inpatients selected from cardiovascular medicine department of our hospital during Jan. 2013 to Dec. 2014 were divided into control group and pharmacist management group according to random number table,with 90 cases in each group. The control group was given routine treatment. The pharmacist management group additionally received indi-vidualized pharmaceutical care,such as pharmaceutical monitoring,psychological counseling,medication education and 6-month follow-up. The comprehensive self-care ability of the 2 groups were compared on admission and on discharge;re-hospitalization and mortality were compared between 2 groups within 6 months after discharged;the patients’NYHA classification,LVEF,plas-ma level of NT-proBNP and quality of life were compared between 2 groups on admission and 6 months after discharge. RE-SULTS:There was no statistical significance in the cognition of patients to disease,self-care ability,medication compliance score and total comprehensive self-care ability score between 2 groups on admission (P>0.05). Each score and total score of 2 groups were better on discharge than on admission,and the pharmacist management group was better than control group,with statistical significance(P0.05). There was no statistical significance in NYHA classification,LVEF,plasma level of NT-proBNP be-tween 2 groups on admission(P>0.05). 6 months after discharge,the above 3 indexes of pharmacist management group as well as NYHA classification and plasma level of NT-proBNP of control group were improved significantly compared to on admission;NYHA classification,LVEF and plasma level of NT-proBNP of pharmacist management group were better than those of control group at corresponding period,with statistical significance (P0.05). 6 months after discharge,each score and total score of 2 groups were all better than on admission,and the pharmacist management group was better than control group, with statistical significance (P<0.05). CONCLUSIONS:The participation of clinical pharmacists in the disease management of CHF can significantly improve comprehensive self-care ability,decrease re-hospitalization rate,ameliorate cardiac function and en-hance the quality of life.

Effects of Xinnaoxin Pills on CAT Score,Cardiopulmonary Function and Hemorheology of Patients with Pulmonary Heart Disease Complicating with Coronary Heart Disease / 中国药房

OBJECTIVE:To explore the effects of Xinnaoxin pills on CAT score,cardiopulmonary function and hemorheology of patients with pulmonary heart disease complicating with coronary heart disease. METHODS:In retrospective study,80 cases of pulmonary heart disease complicating with coronary heart disease were randomly divided into control group and observation group with 40 cases in each group. Control group was given routine treatment as relieving asthma,eliminating phlegm and oxygen inhala-tion,anti-infective treatment,correcting acid-base balance,cardiotonic and diuretic treatment. Observation group was additionally given Xinnaoxin pills 1.0 g/time,bid after meal,on the basis of control group. CAT score,cardiopulmonary function and hemorhe-ology index were compared between 2 groups before and after treatment as well as ischemic ECG improvement effect and the occur-rence of ADR after treatment. RESULTS:After treatment,hematocrit hematocrit had changed slightly among hemorheology index-es,and CAT score,other hemorheology indexes and cardiopulmonary function indexes were improved significantly;the improve-ment of observation group was better than that of control group,with statistical significance(P0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Xinnaoxin pills can effectively improve CAT score and cardiopulmonary function of patients with pulmonary heart disease complicating with coronary heart dis-ease. It also can improve hemorheology and shows good clinical efficacy,but great importance should be attached to the safety of drug use in the clinic.

Evaluation of right ventricular systolic function in patients with primary pulmonary hypertension using real-time three -dimensional echocardiography(RT -3DE)and ultrasonic two -dimensional speckle tracking imaging technology / 中国基层医药

Objective To evaluate the right ventricular(RV)systolic function in patients with primary pulmonary hypertension(PPH)using real -time three -dimensional echocardiography(RT -3DE)and ultrasonic two-dimensional speckle tracking imaging(STI).Methods Patients with PPH were divided into three groups according to pulmonary arterial systolic pressure(PASP),consisted of mild group,moderate group and severe group,with 20 cases in each group.20 healthy cases were included as the control group.The global RV dysfunction,including RV end -diastolic volume(EDV),end -systolic volume(ESV),stroke volume(SV),ejection fraction(EF),tricuspid annular plane systolic excursion(TAPSE),longitudinal peak systolic strain(SL),longitudinal peak systolic strain rate(SRL), longitudinal peak systolic velocity(VL)in RV free wall and interventricular septum for basal,mid and apical segment were detected by using RT -3DE and STI.Results Global RV ESV increased in all groups(t =3.10,7.53,7.72,all P 0.05).Conclusion RT -3DE and STI technology can be useful in assessing RV function every period.

The application of respiratory exerciser tri-ball in pulmonary rehabilitation patients with chronic obstructive pulmonary disease / 重庆医学

Objective To discuss the function of respiratory exerciser tri‐ball in pulmonary rehabilitation (PR) patients with chronic obstructive pulmonary disease(COPD) .Methods Prospectie case‐control study was used in COPD patients ,the patients were randomly divided into three groups ,60 COPD patients (group A) using respiratory exerciser TRI‐BALL ,58 COPD patients (group B) using traditional pursed lips ventral breathing training ,and 58 COPD patients(group C) using general internal medicine treatment .Results Group A :compared with before breath training ,the increases of FEV1/FEV1 predicted (% ) and MVV/MVV predicted (% ) and the decrease of quality of life score (QOL) were statistically significant after breath training (P0 .05) .Group B :compared with before breath training ,the decrease of QOL was statistically significant (P0 .05) .Compared with control group after breath training ,the increases of FEV1/FEV1 predicted (% ) and MVV/MVV predicted (% ) and the decrease of quality of life score (QOL) were statistically significant in group A (P0 .05) .Compared the changes of pulmonary function test(PFT) index and QOL between group A and B ,the increments of FEV1/FEV1 predicted (% ) and MVV/MVV predicted (% ) were statistically significant in group A(P0 .05) .Conclusion It is useful to improve the pulmonary function and quality of life in patients with COPD using respiratory exerciser tri‐ball .It is more effective than traditional pursed lips ventral breathing training ,due to the equipment is very small ,cheap ,easy to quantify training and convenient for household use ,it is worth to be popularized in primary hospital .