ObjectiveTo investigate the etiology, exacerbating factors and outcome of geriatric patients with acute renal failure (ARF) in emergency and critical internal medicine. MethodsClinical features of elderly inpatients with ARF who were diagnosed in internal medicine of our hospital during the past 10 years were retrospectively analyzed. Patients were divided into community-acquired ARF (CA-AFR) group and hospital-acquired ARF (HA-ARF) group. Comparisons between CA-ARF group and HA-ARF group, and between elderly patients and non-elderly patients with ARF in internal medicine were performed. ResultsAmong 381 elderly ARF patients in internal medicine, there were 218 (57.2%) CA-ARF patients and 163 (42.8%) HA-ARF patients. Most of the HA-ARF patients (153 cases) were distributed in medical intensive care. Compared with CA-ARF group, patients in HA-ARF group were older, with more underlying diseases, a higher ratio of infections and/or heart failure and more severe acute renal failure. Infection and heart failure/severe myocardial isehemia were the major exacerbating factors for HA-ARF. Of the 163 patients with HA-ARF, 146 patients died and 17 patients survived. Patients in the death group had more underlying diseases, a higher ratio of severe infections and heart failure/severe myocardial ischemia, a higher ratio of cases with multiple organ dysfunction syndrome(MODS) and a higher score of APACHE Ⅱ.When compared with non-elderly patients with ARF, the elderly patients had a higher proportion ofHA-ARF, a higher ratio of MODS, a higher score of APACHEⅡ and a higher mortality of ARF.ConclusionsThe elderly critical patients are susceptible to HA-ARF with more chronic underlying diseases. Infection and heart failure/severe myocardial ischemia are the major exacerbating factors.The prognosis depends on the treatment of predisposing diseases and removal of exacerbating factors.

Objective To improve the recognition of sarcoidosis in elderly patients.Methods Clinical data of 13 elderly patients with sarcoidosis were retrospectively analyzed.Results There were three cases without symptom and five cases with intra-pulmonary and extra-pulmonary manifestations respectively.Eight cases had atypical radiological appearances and five cases showed inflammatory changes through bronchofibercopy.There were three cases with increased percentage of lymphocytes and high ratio of CD4/CD8 in bronchoalveolar lavage fluid (BALF) respectively.Seven cases were diagnosed through biopsy.And the symptoms of all thirteen patients diminished after treatmeit.Conclusions The clinical symptom and radiologieal manifestation of sarcoidosis in elderly patients are varied and usually atypical.The diagnosis should be based on comprehensive analysis including clinical manifestation and examination.The elderly patients with indication of treatment can be given corticosteroid therapy with close clinical monitoring.

Objective To investigate the relative relationship between the degrees of seriousness of obstructive sleep apnea hypopnea syndrome and the variation of blood pressure in exercise Methods 49 patients with obstructive sleep apnea hypopnea syndrome without using anti hypertension drugs, were used as our objectives We performed the exercise test with bicycle like instrument During the test, we measured the blood pressure, plasma lactic acid and arterial blood gases Then we analysed the blood pressure in exercise, BMI, clinical symptoms and the mean of the lowest SpO2 measured by over night polysomnography Results The variation of blood pressure in exercise was related to the clinical symptoms and the mean of the lowest SpO2, but not to the BMI Conclusion The degrees of seriousness of obstructive sleep apnea hypopnea syndrome may be related to the elevation of blood pressure

Slow coronary flow phenomenon(SCFP) is an angiographic observation characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Only limited studies have been focused on the etiologies, clinical manifestations and treatment of this unique angiographic phenomenon. In our case report, we described an 85-year-old man who came with significant ST segment elevation in leads V1-V4 and V3R-V5R without increase in myocardial enzyme. The patient also developed respiratory failure requiring intubation and mechanical ventilation. Coronary angiography revealed only mild atherosclerosis without spasm or thromboembolic occlusion. Slow flow was seen in all coronary arteries, especially in the left anterior descending and right coronary arteries. This case speculated that transmural myocardial ischemia with ST segment elevation might be resulted from slow coronary flow. Transmural myocardial ischemia can occur owing to abnormalities of the coronary microcirculation.

Objective To explore the correlation between non-Hodgkin lymphoma (NHL) and hepatitis C virus (HCV) infection.Methods HCV infection of 208 NHL patients was investigated from the Affiliated Tumor Hospital of Zhengzhou University.Patients with leukemia or other tumors,and healthy people were used as the control and were pair matched on age and gender.ELISA method was used to detect the HCV-antibody in serum.Results HCV-antibody positive rate in NHL patients [11.5 ％ (24/208)] was significantly higher than those in leukemia patients [3.8 ％ (8/208)] (x2 =8.667,P =0.003),patients with other tumors (6/208,2.9 ％) (x2 =11.639,P =0.001) and healthy people [1.0 ％ (2/208)] (x2 =19.856,P =0.000).Conclusion HCV infection is related to NHL in Henan area.

To investigate plasma N-terminal pro-brain natriuretic peptide (NT-BNP) levels and to assess their clinical significance in elderly patients with isolated diastolic dysfunction. Methods Plasma NT-BNP level were measured by electrochemiluminescence immunoassay in 34 symptomatic patients (Group 1), 34 asymptomatic patients (Group 2) with isolated diastolic dysfunction, and in 16elderly healthy subjects (control group, Group 3), serving controls. Colored Doppler echocardiography was performed to evaluate the patients' cardiac structures and functions. Results The plasma NT-BNP level in Group 1 was significantly higher than those in Group 2 and Group 3 and increased with the severity of heart failure. There was no significant difference of plasma NT-BNP levels between Group 2 and Group 3 (p＞0.05). A NT-BNP value of 102.75 pg/mL showed a sensitivity of 88.2%, a specificity of 87.5%, and an accuracy of 88.1% for diagnosing diastolic dysfunction. Patients with restrictive filling pattern on echocardiography had higher NTBNP levels than those of impaired relaxation pattern (1961.2±304.9 versus 460. 1±92.7pg/mL, p＜0.001). Conclusion The elevation of plasma NT-BNP level in elderly patients with isolated diastolic dysfunction correlates with the severity of their diastolic abnormalities.The level of plasma NT-BNP has an important clinical value in the diagnosis of elderly patients with isolated diastolic dysfunction.

Objective To verify the dose delivery accuracy of volumetric-modulated arc therapy plan by log-file analysis of linear accelerator that can be created when a dynamic delivery occurs.Methods Accelerator log file in binary format recorded the accelerator execution plan for each control point corresponding to the gantry angle,multi-leaf collimator leave position,cumulative machine monitor units ( MU).These information were read from the accelerator log file with Matlab7.1,then the original control points in the plan file replaced the corresponding information for the log,which generated a new plan.New plan was exported into the planning system to reculculate the dose.The volume dose histogram (DVH) and dose distribution was contrasted to determine the accuracy of the accelerator plan of implementation between two plans.Results Compared with the original plan,antry angle difference over ± 1° accounted for about 35％ of the entire arc of control points in 4 of 12 arcs and the percentage of the leave error of ±0.5 mm was about 95％.MU error of a single control point was larger,but the cumulative MU for each are was small which was located between-0.09％ to 0.11％ in the selected 12 arcs.Between the targets,the maximum dose,minimum dose,the mean dose differences were from-0.07％ to 0.42％,-0.38％ to 0.40％,0.03％ to 0.08％,respectively.The maximum dose and mean dose differences of organs at risks were located from-1.16％ to 2.51％,-1.21％ to 3.12％,respectively.Conclusions Accelerator log-file analysis to verify the VMAT plan nan be supplyed to the experimental method supplement.

Idiopathic pulmonary fibrosis (IPF) is one of the most common idiopathic interstitial pneumonia.The main symptoms for IPF are dry cough and exertional shortness of breath,which is worsen gradually with the development of pulmonary fibrosis.Patients with IPF often suffer from sleep disordered breathing (SDB).Sleep architecture for these patients including the sleep efficiency,deep sleep,rapid eye movement sleep and arousal index,are changed,which seriously affects the quality of life.In the absence of effective therapies,optimizing the quality of life may become a major therapeutic target for IPF.The diagnosis and treatment of SDB can significantly improve the quality of life for patients with IPF.

OBJECTIVE:To study the stability of baicalin magnesium salt. METHODS:The stability of baicalin magnesium salt at high temperature(60 ℃),high humidity(90%),strong illumination(4000 lx),different temperatures(20,37,50,60 ℃) and pHs(6.80,5.70,4.60,4.30,3.90,3.60,3.20) was investigated,and HPLC was used to detect the drug contents. RESULTS:High humidity test indicated that the quality of baicalin magnesium salt was increased by (6.17 ± 0.12)% in the 5th day and in-creased by(6.92±0.05)% in the 10th day. Drug contents in the 10th day were respectively(94.78±0.12)%,(94.79±0.20)%, (94.66±0.15)% in the high temperature,high humidity,strong illumination tests(n=3). In phosphate buffer solution(pH 6.80), baicalin magnesium salt was stable only when the temperature was below 20 ℃;and it was yet stable in pure water(pH 6.76)at 37 ℃. pH stability test showed that the most stable pH was 4.30. CONCLUSIONS:Baicalin magnesium salt has hygroscopicity to some extent. Strong illumination affects the stability more seriously than high temperature and high humidity. The stability of ba-icalin magnesium salt in pure water is superior to in phosphate buffer solution,and the salt is stable in weak acid solution.

Objective To compare the characteristics of dose distribution between hypofractionated intensity modulated radiotherapy (IMRT) and hypofractionated stereotactic radiotherapy (SRT) plans in lung tumor and to select an optimal clinical approach. Methods SRT plans were designed for 16 patients with lung tumors who had received IMRT between April 2007 and April 2008. The dose distribution of target volume and normal tissues, conformal index (CI) and heteregenous index (HI) were analyzed using the dose-volume histogram (DVH) for the IMRT and SRT plans. Results The mean dose and equivalent uni-form dose of planning target volume (PTV) in IMRT were similar to those in SRT. SRT had significantly better CI and HI than IMRT (t = 2.77, P < 0.05 and t = - 4.38, P < 0.01 ). The mean lung dose of IMRT and SRT was (492.4 ±368.5) cGy and ( 310.0 ± 73.1 ) cGy, respectively ( t = 1.68, P > 0.05 ). The lung V20 of IMRT and SRT was 6.9% ± 2.1% and 4.2%± 1.9%, respectively ( t = 3.30, P < 0.01 ). No sig-nificant differences were found in the mean dose to the heart or the spinal cord between IMRT and SRT. Conclusions When PTV is less than 57 cm3 or the long diameter of tumor is less than 4.7 cm, hypofrac-tionated SRT has similar dose distribution to hypofractionated IMRT, while the lung dose was lower in the former.