Objective To investigate the protective effects of angiotensin Ⅱ receptor antagonist losartan on diabetic nephropathy (DN).Methods 37 DN cases complicated by renal insufficiency were divided into two groups which were treated with losartan and enalapril,respectively.Blood pressure,plasma creatinine,blood urea nitrogen (BUN),uricemia,urinary protein and albumin were measured before and at 2,4,8,12 weeks after treatment.Results Losartan and enalapril lowered blood pressure remarkably (P0.05).Losartan decreased uricemia remarkably (P

Objective To summarize the diagnosis and therapeutic experience of insulinoma in order to improve the surgical success rate and prognosis. Methods The clinical data of 138 patients with insulinoma from 1966 to 2007 were retrospectively analyzed. Results In this group of patients, hypoglycemia of different levels and Whipple triad were detected. 64 patients expressed different psychic symptom, 12 patients' psychic symptom were still present after blood glucose normalized after operation. Fasting serum insulin values in 88 patients were measured, and the insulin release index was higher than 0. 3. Before operation, tumor was detected in 8 of 75 patients by B-ultrasound scan, and in 17 of 68 patients by CT, and in 5 of 10 patients by MRI. The intra-operative B-ultrasound (IOUS) examination was applied in 44 cases, and 43 cases were successfully detected. The operations included enucleation of insulinoma (n=88) , resection of the body and tail of pancreass (n = 44) , pancreaticoduodenectomy (n=2) , and biopsy (n=1). The blood glucose symptoms normalized postoperatively in 132 patients. The blood glucose rebound in 110 patients, but blood glucose normalized within 2 weeks. After operation, 20 patients developed pancreatic fistula, 32 patients developed acute pancreatitis. Conclusions Insulinoma could be qualitatively diagnosed according to Whipple triad and the insulin release index. Operations with IOUS were simple and effective methods to localize the tumors. The only way to cure insulinoma was operation, and IOUS guided operation could avoid main pancreatic duct and vessel injury, decrease post-operative complications.

Objective To investigate the efficacy of recombinent human B-type natriuretic peptide (rhBNP) in peripartum cardiomyopathy (PPCM) with refractory heart failure (RHF).Methods From January 2010 to January 2014,a total of 61 patients with PPCM-RHF of the First Hospital of Qinhuangdao were enrolled into this study.All patients were randomly assigned into the rhBNP group (30 cases) and control group (31 cases).rhBNP was given 1.5 μg/kg,2 mim intravenously in rhBNP group and then infused intravenously 0.007 5-0.030 μg/(kg · min) for 24 hours,0.015-0.030 μg/(kg · min) for 24 hours when systolic blood pressure(SBP) ≥ 85 mmHg (1 mmHg =0.133 kPa) and mean brachial arterial pressure (MBP) ≥ 65 mmHg.Routine therapy followed the clinic practice was administrated in control group for 24 hours.Recorded the dyspnea change.Blood samples were collected at different time points to investigate BNP at 6 h,14 d and 30 d.Ultrasonic cardiography (UCG) was performed to evaluate left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension(LVEDD) before the initiation of the infusion,at day 1,14 and 30 after the infusion.All patients were followed up for one month to record the main adverse cardiac events (MACE),including heart failure recurrence,cardiac death and ventricular fibrillation and tachycardia.Results The time of dyspnea resolved in rhBNP group was significantly shorter than control group ((1.69 ± 1.07) h vs (2.69 ±1.39) h,P =0.002).Concentration of plasma BNP(6 h:(296.50±123.25) ng/L,14 d:(141.37±69.54) ng/L,30 d:(107.41±33.69) ng/L) was signifisantly reduced in both groups than basic line (727.07 =± 146.84) ng/L,and it was significantly different between two groups.LVEF raised and LVEDD decreased were observed at 24 hours((52.23±4.54) mm),14 d((49.60±4.20) mm) and 30 d((42.59±3.90) mm) in rhBNP group and were significant better than the control group ((56.33 ± 4.38) mm,(53.03 ± 4.95) mm,(48.85±4.96) mm;P ＜0.05).There was no significant difference in term of LVEF between two groups after treatment.However,24 h(4.12±41.13)％,14 d(4.10±43)％,30 d(44.52±3.43)％ were significantly higher than the baseline(36.73±5.82)％ in rhBNP group.MACEs were lower in rhBNP group at 30 dayscontrast to the control(10％ (3/30) vs.42％ (13/31);P =0.005).Conclusion Compared with conventional treatment,rhBNP can effectively improve the heart function in patients with PPCM-RHF,reduce the occurrence of major adverse cardiac events in 30 d,and improve the prognosis of patients.

ObjectiveTo investigate the risk factors and pathogenic characteristics of catheterrelated infection (CRI) in intensive care unit (ICU),so as to find a better way for its treatment.Methods Retrospective analysis was performed on 247 deep-venous catheter (DVC) from January 2007 to December 2010.ResultsAmong 247 patients,positive results of 41 patients diagnosed CRI,negative results of 206 patients undiagnosed CRI.Compared with undiagnosed CRI patients,found the correlation of the underlying infectious diseases,indwelling time of catheter and puncture sites associated with CRI occurred(P ＜ 0.05 ).CRI major pathogen was gram-positive bacteria (58.5％,24/41 ),in which Staphylococcus epidermis was the major pathogenic bacteria(22.0％,9/41).The drug resistance occurred in most pathogen.Conclusions The occurrence of CRI is related with multiple clinical factors.The gram-positive bacteria is the major pathogen.The etiological monitor should be enforced in patients with DVC.

Objective To summarize the experience in the diagnosis and management of insulinoma. Methods From January 1966 to December 2007, the clinical data of 131 patients with insulinoma were retrospectively analyzed. Results All the 131 cases had Whipple triad syndrome and 64 eases suffered from psychoneurosis symptoms. The fasting blood glucose or insultus blood glucose concentration of all the cases was lower than 2.8 mmol/L. The ratios of serum insulin to glucose were all higher than 0.3. Before operation, tumor was detected in 8 of 75 patients by B-us scan, and in 17 of 68 by CT, and in 5 of 10 by MRI. The intraoperative ultrasonography(IOUS) was applied in 44 eases, and tumor was found in 43 cases. Surgery included enucleation of insulinoma (88 cases), resection of the corpus and eauda of the pancreas (40 cases), duodenopancreatectomy (2 cases), and biopsy (1 case). The low blood glucose symptoms disappeared postoperatively in 130 cases. Pancreatic fistulae occurred in 20 cases, acute pancreatitis occurred in 32 cases. Conclusions Insulinoma can be diagnosed based on symptoms of Whipple triad and the ratio of serum insulin to glucose. Exploration and IOUS are the simple and effective methods to localize insulinoma.

Objective To report and analyze the renal function improvement in a case with ad-vanced bilateral renal cell carcinoma after targeted therapy. Methods The patient was a 60-year-old man who complained of lower back pain for 1 month. Ultrasound and CT scan detected bilateral renal masses, left lesion was 11.0 cm×9.4 cm×8.5 cm, and the right one was 3.5 cm×4.3 cm×4.1 cm. X-ray examination showed metastatic lesions in liver and lower right lung. GFR was 20.39 ml/min of left kidney, 25.40 ml/min of right kidney. The renal biopsy confirmed renal clear cell carcinoma. Sorafenib was administrated 400 mg twice or once daily for 12 weeks. Results After the targeted therapy, the decreased bilateral kidney tumor sizes were identified by CT scan. There was liquid nec-rosis in the tumor, and no new metastatic lesion detected. The kidney function was improved as well. The total GFR increased to 71.38 ml/min. Left kidney GFR increased to 31.57 ml/min, right kidney GFR increased to 39.81 ml/min, respectively. Conclusion Targeted therapy could improve renal function in advanced renal cell carcinoma cases by controlling tumor development.

By skin prick test,three kinds of mite allergens(Dermatophagoides pteronyssinus,Dermatophagoides farinae,Blomia tropicalis)were tested in a group of asthma children in Jinhua area from Oct 2005 to Sep 2006.The pos-itive rate to allergen from D.pteronyssinus and D.farinae was 80.6% and 77.8% respectively,higher than that of Blomia tropicalis(61.1%)(?2=21.39,P

Objective To investigate the clinical features , diagnosis and key technique points of laparoscopic partial adrenalectomy for small adrenal pheochromocytoma . Methods From Oct.2006 to Jun. 2011, clinical data of 32 cases with small adrenal pheochromocytoma (≤3.0 cm) were collected and retro-spectively analyzed .Hypertension was observed in 12 patients, whereas 20 patients presented with adrenal incidentaloma .Thirteen patients had a left adrenal neoplasm , eighteen patients had a right adrenal tumor , while one patients had bilateral tumors .The positive rate of plasma-free metanephrines ( MNs) and 24-hours urinary catecholamine (CA) in diagnosing small renal pheochromocytomas was 92.6%(25/27) and 81.3%(26/32) respectively.The main localization diagnosis included ultrasonography , 131I-MIBG, and CT or MRI, with positive rates of 71.9%(23/32), 93.8%(15/16) and 96.9%(31/32) respectively.All the laparoscopic adrenalectomies were performed retroperitoneally .During the surgery , the internal part of the adrenal gland closing to the retroperitoneum was dissected first , and the whole adrenal gland was resected completely. Results Partial adrenalectomy was performed for 30 cases and radical adrenalectomy for 2 ca-ses.All operations were successful without perioperative or postoperative complications .The maximum diame-ter of tumor was 1.7±0.2 (1.0-3.0) cm.Histopathological results showed that all the cases were benign pheochromocytoma.The operative time was 82 (40-210) min.The estimated blood loss was 57 (20-180) ml.No patient required blood transfusion . Conclusions Plasma-free MNs, 24-hours urinary CA and VMA are important qualitative examinations in detection of adrenal pheochromocytoma .Ultrasonography , CT,MRI, and 131 I-MIBG are important in the localization of adrenal tumors .Retroperitoneal laparascopic partial adrenalectomy is the preferred choice in the management of small adrenal pheochromocytoma .Dissecting the internal part of the adrenal gland closing to the retroperitoneum first and exploring the whole adrenal tissue are the key technique points during the operations .

AIM: To investigate the functional role of TGF-?_1 signal protein Smad2/3 in tubulointerstitial fibrosis associated with unilateral ureteral obstruction in rats. METHODS: The unilateral ureteral obstruction (UUO) model was induced by the ligation of left ureter. Rats were sacrificed at 1, 3, 7, 14, 21, and 28 days after UUO was initiated. TGF?_1 protein, phosphorylated Smad2/3 and interstitial ?-smooth muscle actin (?-SMA) expression were assayed by immunohistochemical staining. TGF-?_1 mRNA in the obstructed kidney was analyzed with in situ hybridration. HE and Masson staining were used for histological and morphometric studies of the pathological change in obstructed kidney. RESULTS: The results showed that upregulation of TGF-?_1 in tubulointerstitium of both cortex and medulla at day 3 (a 3.1 fold increase vs control, P

AIM:To investigate the expression and probable role of extracellular signal-regulated protein kinase(ERK1/2)in renal fibrosis associated with diabetic in mice.METHODS:Male homozygous C57BL/6 mice were divided at random into control group(intraperitoneally injected with citrate buffer)and diabetes group(received 5 consecutive daily intraperitoneal injections of streptozotocin at dose of 50 mg?kg-1?d-1).All mice were followed up for 16 weeks.Diabetes was confirmed by serum glucose levels exceeding 16.7 mmol/L.Mice were killed at 0,4,8,12 and 16 weeks respectively after streptozotocin injection.The kidney tissues were obtained from diabetic and control mice.Serum glucose,kidney weight/body weight(KW/BW),24 h albumin excretion rate(UAE)and the serum creatinine(Scr)were measured.The kidney tissue was used for histological and morphometric studies of glomerular size,glomerular matrix expansion(PAS),and the expression of TGF-?1,phosphorylated ERK1/2 and collagen Ⅲ by immunohistochemical staining.RESULTS:The serum level of glucose in streptozotocin-induced diabetic mice increased significantly.The kidney weight/body weight ratio,glomerular volume and glomerular matrix expansion in diabetic mice were obviously higher than those in control mice.Serum creatinine and 24 h albumin excretion rate in diabetic mice increased significantly compared with control mice.TGF-?1,phosphorylated ERK1/2 and collagen Ⅲ levels were obviously increased in the kidney of diabetic mice compared with those in control mice(P