Treatment of hypertension in the elderly is currently an important issue,but also the current social problems.Elderly hypertensive patients more special and ordinary compared to patients with essential hypertension,the risks of them are higher and the characteristics of drugs are more complex.We are mainly reviewed the hypertension situation,physical characteristics and antihypertensive treatment strategies of the elderly.

Objective To analyze the causes of inappropriate discharge of implantable cardioverter defibrillator (ICD) in elderly patients and to discuss the corresponding solutions.Methods Totally 95 elderly patients with ICD were collected.They were followed up and the inappropriate ICD discharges were recorded and analyzed.Results All patients were followed up for 235 times/year totally.There were 16 patients with inappropriate ICD discharges.The causes of inappropriate ICD discharges included ventricular oversensing in 7 patients (43.7％),supraventricular tachycardia misclassified into ventricular tachycardia in 4 patients (25.0％),electrode fracture in 2 patients (12.5％),and electromyogram (EMG) interference,electromagnetic interference and electrode fracture with EMG interference in 1 patients respectively (6.3％ each).11 inappropriate ICD discharges were reduced and avoided by reprogrammed and noninvasive treatment in 16 patients.1 patient with the underdetected ventricular fibrillation after reprogramming and the problem was solved by external defibrillation.The other 5 patients got better by the invasive treatment.Conclusions Different causes account for inappropriate discharges in patients with ICD.Reprogramming the corresponding parameters in different ICD can reduce or avoid inappropriate discharges without affecting the sensitivity of ICD.

Objective To investigate the changes of the weight of testis and epididymis,sperm numbers in cauda of epididymis,the structure of testis and the expression of 3?-HSD in rat testis after removing submandibular gland in rats.Methods On the day 14,28 and 42 after the operation,the testis and the epididymis were weighed and the epididymis sperm were counted.The changes of the testis were showed by HE stain.The changes of 3?-HSD expression were analyzed by immunohistochemistry.Results On the day 28 and 42 after the operation,the weight of body,testis and epididymis decreased markedly(P0.05),but increased apparently on the day 28(P

Objective To study the localizations and the quantity of GnRH receptor in stomach of Sprague-Dawley (SD) rats under stress.Methods The model of stress SD rats was established by fear. Then, stomachs were taken from the rats in acute stress group (2h-12h), chronic stress group (1d-4w) and the control group respectively.The localizations and the quantity of GnRH receptor in stomachs were detected using immunohistochemistry and Western blotting.Results The results of immunohistochemistry showed that immunoreactivity of GnRH receptor was displayed in the gastric parietal cells and the epithelial cells of the gastric pits in stomachs of rats in all groups. The immunoreactive materials were distributed in membrane and cytoplasm of all positive cells, but not in nuclei. Meanwhile, the results of Western blotting showed that the number of GnRH receptor decreased significantly when SD rats were in stress from 2h to 2w (P

Objective To evaluate abdominal aortic balloon occlusion during pelvic tumors surgery and mamagement of related vascular complications. Methods We retrospectively analyze the clinical data of 265 pelvic tumor cases from December 2005 to April 2010.Before pelvic tumor operation,we place a sheath by Seldinger maneuvre in common femoral artery and send a balloon catheter in the abdominal aorta below the level of renal artery.The balloon catheter occluded the blood flow below the level of renal artery totally during the time of removing the tumors.After the procedure,we pull the balloon catheter out and normally retain the sheath for 6 hours. Results The procedure was successful in all cases and the average time of abdominal aorta blockade was (66 ± 4) min.There was no abdominal aortic rupture and acute renal dysfunction.Emergency angiography was performed on the operative region to diagnose the cause of massive bleeding after the open surgery in 6 cases.Among them,3 cases underwent embolization of internal iliac artery to stop bleeding and 1 case underwent embolization of lumber artery.Small covered stent was deployed in the common iliac artery to stop bleeding in 2 cases.Thrombosis of femoral artery at the puncture site occurred in 6 cases and bilateral thrombosis developed in 1 case. Blood flow was restowed to the femoral artery by open thrombectomy.Pseudoaneurysm formation around the puncture point occured in 2 cases and they underwent open surgical repair,then recovered well. Conclusions Balloon catheter occlusion of abdominal aorta is an effective method to control the hemorrhage in the pelvic tumors' operation.

Objectives To evaluate the method and short-term result of endovascular repairing for distal tears of Debakey type Ⅲ dissecting aneurysm. Methods In this study the continously existing distal intima tears were repaired using different method in 15 Debakey type Ⅲ dissections after previous successful repair of the proximal entry.All patients have symptoms caused by unclosed distal tears or increased false lumen in abdominal aorta.7 visceral artery tears ( 1 celiac and 6 renal),4 abdominal aorta and 7 iliac artery tears were repaired (3 cases have both viscera and iliac tears).All abdominal aorta entries were repaired by bifurcation stent grafts.Blocking umbrella was used in 1 renal tear,and all other viscera and iliac tears were repaired by small covered stents. Results All endovascular procedures were successfully completed.No any endo-leak occurred in abdominal and iliac entry repairs.One near renal tear was totally blocked by an umbrella which also blocked blood flow from false lumen to right renal artery.One major endo-leak and 2 minor endo-leak occurred in visceral artery tearing repair,all other visceral tears were completely repaired.All patients were followed up from 2 to 10 months (average 5.0 ± 2.0 months).Follow-up CTA revealed false lumen thrombosis in non-endo-leak cases.Three endo-leak cases still have blood flow in false lumen with partly thrombosis. Conclusions In selected patients,salvage endovascular repair for left over distal tears in Debakey Ⅲ dissecting aneurysm after initial repair is feasible and safe.

Objective To evaluate the surgical results for patients with lower-extremity arteriosclerotic occlusive disease. Methods We performed a respective analysis of 358 patients who underwent various consecutive surgical treatments including open artery reconstruction and intervention in our hospital between 2002 and 2007.Results In this study,358 patients(mean age 66 ± 10;293 male,65female)experienced a total of 413 surgical interventions including traditional bypass,interventional surgery and amputation.Postoperatively 310 patients(86.8%)were followed up from 6 months to 64 months.The 1-year,2-year and 3-year primary patency rates of iliac balloon angioplasty and stent placement were significantly higher than that of femoropopliteal balloon angioplasty and stent placement(P＜0.01),but not higher than that of aortoiliac or aortofemoral bypass(all P＞0.05).The 2-year and 3-year primary patency rates of femoropopliteal bypass above knee were significantly higher than that of femoropopliteal bypass below knee(P＜0.01),but that was not the case in 1-year group.There is no statistical difference in 1-year primary patency rates between femoropopliteal balloon angioplasty and distal popliteal balloon angioplasty (P＞0.05).Amputation rate was 8.7%(37/358).Perioperative mortality was 3.9%(14/358).Mortality during follow-up period was 6.4%(23/358).Conclusion A satisfactory result can be obtained in most patients with the lower-extremity arteriosclerotic occlusive disease by using the appropriate surgical treatment.

Objective To assess the changes of right atrial size and mechanical function after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation using real-time threedimensional echocardiography(RT-3DE), and to study the correlation between the changes of left atrial(LA)and right atrial(RA) volume and function. Methods Thirty-five patients with paroxysmal atrial fibrillation were undergone radiofrequency catheter ablation (RFCA) successfully. Transthoracic echocardiography (TTE),tissue Doppler imaging(TDI) and RT-3DE were performed before, 1 month and 3 months after procedure respectively. Late systolic volume and area of RA and LA,ejection fraction(EF) of RA and LA,late diastolic peak velocity of mitral valve inflow, tricuspid valve inflow and late diastolic peak velocity of mitral annulus and tricuspid annulus were recorded. Results The 3DE images of all patients were satisfied.LA max area and 3DE LA max volume were significantly reduced at 1 months and 3 months after procedure compared with basic stage [ ( 18.8 ± 6.3) cm2 vs (21.5 ± 6.2) cm2 , (38.8 ± 17.0) ml vs (46.1 ± 20.0) ml,P ＜ 0.05]. 3DE LA EF also declined markedly at 1 month after RFCA, and restored at 3 months later compared with baseline [(41.1 ± 13.7) % vs (51.7 ± 15.9) %, (41.1 ± 13.7) % vs (45.6 ± 18.3) %, P ＜0.05]. The size and mechanical function of the right atrial after procedure were no obvious changes. There were no evidently correlation between the changes of LA and RA volume and function. Conclusions RT3DE can provide a precise method to quantify the value of atrial volume and function. The LA size and volume are significantly reduced after RFCA in patients with paroxysmal atrial fibrillation, however, the RA size and function are no obvious changes.

Objective To summarize our experience on the diagnosis and management of 8 patients with popliteal artery entrapment syndrome (PAES). Methods Clinical data of 8 PAES cases admitted from Jul 2002 to Jul 2010 were retrospectively analyzed. There were 7 males and 1 female with the mean age of (29 ± 14)years (ranging 16 -56 years). In 6 cases posterior "S" shaped incisions in the popliteal fossa were applied and anomalous anatomic structures were verified. Segmental stenosis and post-stenotic popliteal arterial aneurysm was identified in 2 cases, and partial resection of the aneurismal wall and arterioplasty including one with saphenous vein patch were applied; For 4 cases with short segmental occlusion of the popliteal artery, surgical treatment included thromboendarterectomy in 2 cases (with saphenous vein patch plasty in one case), saphenous vein interposition in 1 case, and saphenous vein bypass grafting in 1 case.Medial longitudinal incisions and saphenous vein bypass grafting were applied in 2 cases with long segmental occlusion in popliteal artery without exploration for anatomic anomalies. Results All patients recovered uneventfully without any notable complication. During the follow-up period ranging from 4 to 99 months [average (50± 37) months], no ischemic symptom reoccurred in 7 cases with patent arteries or grafts, and recurrent claudication occurred in 1 case with distal anastomostic stenosis. The stenosis was subsequently treated with balloon angioplasty and vein graft thrombsis occurred one month later. Medicine and exercise were recommended for the patient and now mild claudication still remains without affecting his normal life.Conclusions PAES is a disease of relatively low incidence resulting in lower extremity ischemia, which can be successfully cured with proper management.

Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.