OBJECTIVE:To explore the effects of olmesartan medoxomil on blood pressure variability(BPV)and vascular en-dothelial function of patients with mild and moderate essential hypertension. METHODS:Sixty patients with mild and moderate es-sential hypertension were included in study group,and other 60 healthy volunteers were included in control group. Study group was given olmesartan medoxomil 20 mg orally,qd,for 4 weeks,followed by same dose if their SBP≤140 mmHg and DBP<90 mmHg till 12th weekend;those patients with SBP>140 mmHg or DBP≥90 mmHg received double dose till 12th weekend. Aver-age blood pressure,BPV,FMD and NMD of study group were measured before and after treatment as well as the changes in se-rum concentrations of NO and ET,and then compared with control group. RESULTS:Compared with before treatment,average blood pressure,BPV and ET level of study groups were decreased significantly after treatment,serum level of NO was increased significantly,while FMD and NMD were improved significantly,with statistical significance (P<0.05);there was no statistical significance,compared with control group (P>0.05). There were 3 cases of mild diarrhea and 2 cases of mild dry cough,and they relieved after medication withont speical treatment. CONCLUSIONS:Olmesartan medoxomil can play a good effect on de-creasing blood pressure and is tolerable. It can also improve the vascular endothelial function.

Objective: To build a relationship model of perceived academic self-efficacy, learning stress, and learning burnout of high school students. Methods: 674 high school students were surveyed with Learning Stress Scale of High School Students, The Perceived Academic Self -efficacy Scale, Scale of Learning Burnout of High School Students. Results: Learning stress had a direct effect on a low level of learning efficacy, perceived alienation to teacher and physical exhaustion (The direct effect value were -0.22,0.12,0.27). At the same time, perceived basic ability and perceived control partially mediated the impact of learning stress on the low level of learning efficacy, perceived alienation to teacher and physical exhaustion (the mediated effect value were -0.155 and-0.264, 0.066 and 0.299, 0.089 and 0.233). Perceived basic ability and perceived control fully mediated the relationship between learning stress and emotional exhaustion (the mediated effect value were 0.033 and 0.387). Conclusion: The students with a higher level of stress reported suffering more learning burnout than those with a lower level of stress, and vice versa.

As the structure of shoulder joint is complex, proper method s should be adopted to treat the injured shoulder joint according to the type an d position of the trauma. Conservative treatment has been widely used to treat t he slightly displaced or stable fractures (including those of the proximal humer us, clavicle and shoulder blade), and most of the fresh dislocations of shoulder joint and acromioclavicular joint if the injuries are not serious. As for the o bvious unstable shoulder fractures, recurrent dislocation of shoulder joint, sev ere dislocation of acromioclavicular joint, dislocation of shoulder joint accomp anied with fracture, and rotator cuff tear, an operation should usually be the r ight choice. In either conservative or operative treatment, earlier systematic f unctional rehabilitation should be widely used in order to achieve satisfactory functional recovery of should joint.

Objective To evaluate the result of open rotator cuff repair and to identify potential preoperative or intraoperative factors that could affect the outcome.Methods 43 cases(44 shoulders)with rotator cuff tear who undergone open repair surgery between May 1987 and October 2002 were retrospectively studied.There were 31 shoulders ruptured in supraspinatus, 9 shoulders in supraspinatus and infraspinatus,3 shoulders in supraspinatus and subscapulafis and 1 in supraspinatus, infraspinatus and subscapularis.And there were 13 shoulders torn with small size, 18 shoulders with middle size, 10 shoulders with large size and 3 shoulders with massive size.Ruptured rotator cuff was repaired with tendon to bone suture in 25 shoulders,with tendon to tendon suture in 7 shoulders, and combined suture in 11 shoulders.One shoulder was repaired by deltoid transfer.After an average 88.2-month-long follow-up(from 52 to 250 months),we evaluate the postoperative shoulder function with University of California at Los Angeles(UCLA)score.The patient's subject satisfaction was assayed by visual analogue scale (VAS).The risk factors as age, sex,dominant side, trauma history,preoperative duration and tear size were analyzed.Results The average UCLA score was 11.5±2.8 preoperatively and 29.7±5.3 at follow-up, with 36 shoulders reaching excellent or good and 2 shoulders ranking poor.According to VAS,the subject satisfaction rate was as high as 89%,being positively related to UCLA score significantly(r=0.72,P＜0.01).Preoperative duration(r=-0.332,P=0.028)and tear size(r=-0.404,P=-0.007)was negatively relative with surgical results.Age,sex,dominant side,trauma history had no effect on prognosis.Conclusion Open rotator cuff repair could acquire satisfying outcome.Preoperative duration and tear size was negatively relative with surgical results.

Objective To study the effects of glucosamine sulfate on nitric oxide(NO)production induced by interleukin(IL)-1β in human osteoarthritis chondrocytes(HOC),and explore the possible mechanism.Methods Chondrocytes were harvested from 10 osteoarthritis patients undergoing total knee replacement(TKR)operation.Human recombinant IL-1β(5 μg/L)and glucosamine sulfate GS in different concentrations(0.2 mmol/L,2.0 mmol/L,20.0 mmol/L)were administrated into cell culture medium for 24 h.The content of NO was detected by enzyme-linked immunosorbent assay(ELISA).The mRNA and protein expression of inductive nitric oxide synthetase(iNOS)were measured by RT-PCR and Western blot,respectively.Results Stimulation of HOC with IL-1β enhanced production of NO and expressions of iNOS mRNA and protein(t=-14.81,-45.38,all P＜0.01).Pretreatment with 2.0 and 20.0 mmol/L GS showed a dose-dependent inhibition of IL-1β induced NO production(F=12.43,P＜0.05)and the expression levels ofiNOSmRNA(F=142.28,P＜0.05)and protein(F=78.08,P＜0.01).20.0 mmol/L GS alone did not influence NO production(t =-0.17,P＞ 0.05).Conclusions GS may inhibit the synthesis of NO induced by IL-1β in HOC through down-regulate mRNA and protein expressions of iNOS.

Homeobox gene Six1,as a transcription factor has been proved to participate in most malignant tumors.Its overexpression is associated with the genesis and development of breast cancer intimately.Overexpression of Six1 in mammary cells is sufficient to induce activation of stem cells.Similarly,Six1-overexpressed tumors could activate the TGF-β pathway and Wnt/β-catenin pathway,lead to malignant transformation by inducing epithelial-mesenchymal transition and mammary tumorigenesis.Research on the role of sixl will improve understanding the mechanisms of breast cancer initiation and development.

Objective To observe the reparative response and expression of basic fibroblast growth factor (bFGF) protein in the rotator cuff subjected to subacromial impingement. Methods Subacromial impingement of the infraspinatus tendon was experimentally created in 50 male SD rats by thickening the undersurface of the acromion with one platelike bony transplantation of the ipsilateral scapular spine. The contralateral shoulders that had undergone a sham operation were used as controls. The rats were sacrificed at 3, 7, 14, 28, and 56 th day, the whole shoulder joint was removed for detecting bFGF protein and the reparative response in the impinged infraspinatus tendon. Computer image analysis system were used to monitor the expression intensity and numbers of positive cells of bFGF protein. The OD scores and the size of area represent the expression intensity and numbers of positive cells respectively. Results All rats with experimental subacromial impingement showed an infraspinatus tear on the bursal side of the tendon. The shoulders in the control group were found intact without any alteration. There was proliferating cells in the fragmented tendons and vascularised connective tissue covering the area of ruptured area, whose source was the subacromial bursa. Few tenocytes and bursal cells expressed bFGF protein in unwounded tendons. In contrast, tendons subjected to impingement exhibited an increased signal for bFGF protein in both resident tenocytes concentrated along the epitenon and infiltrating fibroblasts and inflammatory cells from the subacromial bursa. Conclusion The bFGF protein is upregulated during tendon healing and the subacromial bursa is the main source of both bFGF secreting and rotator cuff repair; one should preserve as much as possible the subacromial bursa.

Objective:Now the mechanical ventilation has become the essential emergency or therapy equipment in the all sizes of hospitals. However with the widely application of ventilators, they are still the kind of high risk of medical instruments. In order to reduce various equipment failures, an overall management strategy based on traceability of two-dimension code is constructed in this article, which will provide a new direction for medical equipment management.Methods: Using the popular application of WiFi network and creating the only identified two-dimension code, the overall management strategy is established for the ventilators.Results: The centralized and decentralized management model is adopted in the preservation of ventilators. And all the operators of ventilators will be supported technology service about equipment failures and setting parameters by the respiratory department and engineering department. In addition to this, the two departments should organize the staff to learn the operation of ventilators in the hospital. All of those compose the structure of overall management.Conclusion: With the management of this method, the efficiency of ventilators is improved, and the rate of machine failures is dropped. The difficulty about technology service caused by space can be solved in time. Finally, the professional ability of the staff in hospital will be improved with the communication among the different departments.

Objective To evaluate the effect of incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus on the renal hemodynamics. Methods The hemodynamic changes of intrarenal and incisional sites in 98 cases with complex calculi were consecutively monitored by color Doppler ultrasonograph before operation and also 1 month,3 months,6 months after operation.The ratio(S/D) of the peak flow-rate in systole(S),the flow-rate at the end of diastole(D),and the resistant index(RI) of the intrarenal chief renal arteries and intersegmental arteries and interlobar arteries were analyzed.The signals of blood stream in segmental incision were divided into four classes(Ⅰ to Ⅳ) and were observed. Results The changes of the intrarenal hemodynamics were related to the degrees of hydronephrosis(P0.05),but it caused the blood stream to be obstructed in the area of incision where the signals of blood stream showed classes Ⅲ to Ⅳ.The patients generally recovered after 3 to 6 months,and the time of recovery was associated with the degrees of hydronephrosis Conclusions It is concluded that the incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus is an effective and safe method for treat-ment of complex renal calculus.

Objective To determine the sensitivity and accuracy of CT do ub le-contrast arthrography (CTA) in detecting underlying soft-tissue and bony abno rmalities of recurrent anterior glenohumeral dislocations. Methods From March 19 90 to May 2003, 31 patients with the signs and symptoms of recurrent anterior in stability, which were 23 males and 8 females with an average age of 26.7 years ( ranging, 22 to 46 years), were recruited for the study. All patients suffered fr om more than three times of glenohumeral dislocations, underwent CT arthrography after intraarticular injection of air and radiographic contrast medium before o peration. The surgical procedures included open Bristow operation in 25, Bankart operation in 3, Putti-Platt operation in 2, and a combination of Bankart and ca psular tightness operation by arthroscopy in 1. Each patient also underwent arth roscopy or open surgery and the observations were compared with CTA. Results Les ions of labrum and capsulo-ligamentous complex were the two most common abnormal ities demonstrated by surgical findings, which were respectively found in 28 and 20 patients at surgery. Anterior glenoid labral abnormalities, including of tea r, detachment, degeneration, were detected on CTA in 26 of 28, 2 of glenoid labr al degeneration were undetected on CTA, and the accuracy rate diagnosis on CTA w as 93.5%, while the sensitivity of CTA was 92.8%. Capsular lesions, including of marked medial scapular insertion, glenoid marginal stripping, and loss of inter vening scapular marginal soft tissues, were detected on CTA in 19 of 20, 1 of ca psular glenoid marginal stripping was undetected on CTA, and the accuracy rate d iagnosis on CTA was 87.1%, while, the sensitivity of CTA was 95%. Subscapularis tendon abnormalities, including of tears and irregularities, were visualized in 7 cases on CTA, but only 4 of which were identified during surgery. Furthermore, all of 15 Hill-Sachs defects, 6 Bankart bony defects, and 1 rupture of supraspi natus tendon suggested by CTA, were identified during surgery. For 26 of the pat ients with above kinds of lesion resulting in recurrent anterior glenohumeral di slocation, the accuracy rate of diagnosis was 83.7%. Conclusion The utilization of CT double-contrast arthrography can improve the understanding of multiple les ions associated with recurrent shoulder dislocation, it is contributed to select proper operative procedure.