Acute mountain sickness ( AMS) is defined as the syndromes which are induced by hypobaric hypoxia within a few hours or days of acute exposure to >2500 m or ascent to a higher altitude than residence .AMS poses a threat to the health and work capability of workers and tourists , as more people enter Tibet and other plateau areas in China .It is known that the incidence of AMS is higher among males and youths than among females , elders and children .The development of AMS is considered to be influenced by the level of sex hormones .Thus, there is the need to find more about the pathogene-sis, pathophysiology of AMS in order to treat and prevention of AMS by studying the relationship between sex hormones and AMS.

Objective: To analyze the correlations of systolic blood pressure (SBP) with uric acid, blood lipid and blood glucose in adults, so as to provide the evidence for blood pressure management and early prevention of cardiovascular diseases. Methods: Based on the China Health and Nutrition Survey, data of participants in 2004 and 2009 was collected, including demographic characteristics, blood pressure, uric acid, blood lipid and blood glucose. Participants with SBP<140 mmHg both in 2004 and 2009 were divided into the continuously normal group, participants with SBP≥140 mmHg in 2004 and <140 mmHg in 2009 were divided into the reduced group, participants with SBP<140 mmHg in 2004 and ≥140 mmHg in 2009 were divided into the elevated group, and participants with SBP≥140 mmHg both in 2004 and 2009 were divided into the continuously high group. Multivariable logistic regression model was used to analyze the correlations of SBP with uric acid, blood lipid and blood glucose. Results: A total of 5 086 subjects were included in this study with a mean age of (48.0±7.2) years, including 2 374 males (46.67%) and 2 712 women (53.33%). The median (interquartile range) of SBP was 117.00 (13.33) mmHg in the continuously normal group, 146.67 (15.33) mmHg in the reduced group, 122.67 (12.00) mmHg in the elevated group and 150.67 (18.66) mmHg in the continuously high group. Multivariable logistic regression analysis showed that compared with the continuously normal group, the reduced group was correlated with abnormal fasting blood glucose (OR=1.383, 95%CI: 1.008-1.896); the elevated group was correlated with abnormal uric acid (OR=1.495, 95%CI: 1.195-1.869), abnormal low density lipoprotein cholesterol (OR=1.226, 95%CI: 1.030-1.460), abnormal triglyceride (OR=1.446, 95%CI: 1.203-1.739) and abnormal total cholesterol (OR=1.261, 95%CI: 1.057-1.504); the continuously high group was correlated with abnormal uric acid (OR=1.603, 95%CI: 1.188-2.164), abnormal triglyceride (OR=1.619, 95%CI: 1.253-2.093) and abnormal fasting blood glucose (OR=1.565, 95%CI: 1.166-2.100), adjusting for confounding factors (gender, age, marital status, etc.). Conclusion The increase of SBP in adults were correlated with uric acid, blood lipid and blood glucose.

Objective:To study influence of renal sympathetic denervation (RDN)on cardiac function of dogs with heart failure (HF).Methods:A total of 40 dogs were randomly and equally divided into RDN group [received bilat- eral renal artery radiofrequency ablation (RFA)]and model group (only received femoral puncture).Pacemaker was implanted in every dog,and dog HF model was established using rapid right ventricular pacing.Cardiac and re-nal function indexes,BNP and sympathetic activity index levels were observed and compared between two groups be- fore RFA/sham operation,instant and four weeks after model establishment.Results:After operation four weeks, compared with model group,there were significant reductions in levels of epinephrine (E)[(362.69±42.54)ng/ml vs.(290.36±42.32)ng/ml],renin (R)[(305.46± 39.68)ng/ml vs.(230.04±32.80)ng/ml],aldosterone (AD)[(408.00±38.56)ng/ml vs.(246.00± 48.37)ng/ml],angiotensin Ⅱ (ATⅡ)[(280.00±48.08)pg/ml vs.(172.00±25.04)pg/ml]and norepinephrine (NE)[(425.65±50.54)ng/ml vs.(316.76±46.29)ng/ml]in RDN group (P<0.05 all);there were significant reductions in HR,respiratory rate (RR)and BNP level in RDN group,P<0.05 all;there were significant rise in SBP,LVEF,CO,CI,left ventricular pressure maximal rising rate (+dp/dtmax),left ventricular pressure maximal dropping rate (-dp/dtmax)and left ventricular end-systolic pressure (LVESP),and significant reductions in left ventricular end-systolic dimension (LVESd),left ventricular end-diastolic dimension (LVEDd)and left ventricular end-diastolic pressure (LVEDP)in RDN group,P<0.05 all.Conclusion:RDN can decrease renal sympathetic activity,improve heart function,inhibit myocardial remode- ling,its therapeutic effect is significant

Objective To investigate the expression pattern of microRNA (miRNA) in the kidneys of unilateral ureteral obstruction (UUO) rats and to identify specific miRNA related to renal interstitial fibrosis (RIF).Methods Forty-eight male SD rats were divided into two groups:UUO group and sham-operated (Sham) group.Rats were sacrificed at 3,7 and 14 days after operation.Histologic changes were examined by Masson staining.Forty-eight selected miRNAs were examined by stem-loop real-time qPCR.Results At the 3rd day after operation,obstructed kidneys from operation rats showed mild edema in the interstitium and mononuclear cell infiltration.At the 7th day after operation,focal interstitial fibrosis was observed.At the 14th day after operation,fibrosis became more severe.The Sham kidneys showed no pathological changes.At the 3th day after operation,25 miRNAs were differentially expressed.At the 7th day after operation,24 miRNAs were aberrantly expressed,whereas 21 miRNAs were differentially expressed at the 14th day after operation (P＜0.05).Among these miRNAs,miR-132,miR-192,miR-194,miR-29c and miR-203 were consistently up-regulated or down-regulated in a time-dependent manner after operation.There were significantly correlations between the expression of five miRNAs and severity of tubulointerstitial injury (P＜0.05).Conclusions There are at least 20 miRNAs differentially expressed in the process of RIF induced by UUO.There are significantly correlations between the expression of miR-132,miR-192,miR-194,miR-29c and miR-203 and the severity of tubulointerstitial injury.They may be closely related to RIF.A further study is needed.

OBJECTIVE:To discuss the countermeasure on the quality improvement of the drug clinical trials in our hospital based on the discovery of key links of the quality of clinical trials. METHODS:Quality results of 14 drug clinical trials in 10 ma-jors from the drug clinical trial institute in our hospital in 2014 were investigated. Referring to the grading and classifying methods of the inspection problems in European Medicines Agency,the key links of occurring problems were analyzed,and the effects of interventions for key links were evaluated. RESULTS:In 2014,totally 125 important and general problems were found,in which, the numbers of problems occurred in case report form filling,informed consent of subjects,enrolling and screening of subjects,in-vestigational products management accounted for 79.20%. The above 4 links were the key links affecting quality of drug clinical tri-als. According to strengthening the training about relevant knowledge of the researchers,improving system and standard operation procedures management,enhancing link quality control,introducing project clinical research coordinator,developing centralized drug management and other interventions,the total numbers of found important and general problems in 2015 and 2016 were 68 and 59,respectively. Compared with 2014,the differences were statistically significant(P<0.05). The numbers of found important problems in 2015 and 2016 were 7 and 4,respectively. Compared with 2014(4 important problems),the differences were not sta-tistically significant (P>0.05). There were no severe problems during 2014-2016. After interventions,numbers of occurring prob-lems in majors with less complex drug clinical trial had obviously declined in 2016. Compared with 2014,the differences were sta-tistically significant (P<0.05). While the major with relatively high complexity of drug clinical trial had no obvious decline in 2016. Compared with 2014,the differences were not statistically significant(P>0.05). CONCLUSIONS:Controlling the key links in drug clinical trial process can obviously reduce the occurrence of general problems while has little effect on the occurrence of im-portant problems. It is different for different majors in undertaking drug clinical trial projects,so as the links and degree of occur-ring problems. It should be distinguished in quality control checking.

Objective: To explore the relationship between platelet counts at admission and in-hospital mortality in patients with type A acute aortic dissection (AAD). Methods: We investigated 183 consecutive patients with CT conifrmed diagnosis of type A AAD treated in our hospital from 2012-02 to 2013-05. There were 126 (68.9%) male and the patients were divided into 3 sets of groups.①In-hospital surviving group,n=157 and In-hospital death group,n=26.②According to platelet counts, the patients were divided into 5 groups: Q1 group, platelet counts ≤ 119×109/L,n=36, Q2 group, platelet (120-149) ×109/L,n=37, Q3 group, platelet (150-173)×109/L, n=36, Q4 group, platelet (174-228)×109/L,n=37, Q5 group, platelet >228×109/L,n=37.③At admission, platelet ≤ 119×109/L,n=36 and platelet >119×109/L,n=147. In addition, the patients were further divided into another 4 groups based on operative condition: platelet ≤ 119×109/L with operation,n=18, without operation,n=18; platelet > 119×109/L with operation,n=96, without operation,n=51. The basic information at admission including platelet counts, WBC and D-dimer were studied in all groups, the primary endpoint was in-hospital mortality. Results: The overall in-hospital mortality was 14.3%. Compared with In-hospital surviving group, the In-hospital mortality group had decreased platelet counts, lower blood pressure and higher level of D-dimer. The mortality in Q1 group (38.9%) was higher than those in Q2, Q3, Q4 and Q5 groups (10.8%, 11.1%, 8.1% and 2.7%), allP<0.001. The risk of death in Q5 group was higher than Q1 group (HR=11.2, 95% CI 2.13-123.3,P=0.007). With adjusted age, gender and other relevant factors, when platelet counts ≤ 119×109/L, the risk of in-hospital mortality with Cox multivariate model I analysis was (HR3.90, 95% CI 1.67-9.09,P=0.002), with Cox model II was (HR=2.67, 95% CI 1.15 -6.19,P=0.023). Conclusion: AAD patients with admission platelet counts ≤ 119×109/L had the high risk of in-hospital death, even with operation, lower platelet counts was still related to in-hospital death.

Objective To study the effects of endothelial nitric oxide synthase (eNOS) gene transfection on endothelial progenitor cells (EPCs) transplantation in the process of injured vascular endothelium repair. Methods EPCs were cultured and expanded in vitro. EPCs were transduced with pseudotyped retroviral vectors expressing eNOS gene (pMCV-eNOS-EPCs) or green fluorescent protein gene (pMCV-GFP-EPCs). EPCs with expressing eNOS, GFP or saline were injected respectively into rat injured artery model by tail vein injection after balloon injury and again 24 hours. 14 days after transplantation. eNOS expression in injured artery was detected by RT-PCR, western blot and immunohistochemical methods. The morphology of arterial intima and media was studied by optical microscopy and image analysis system. Results Compared with GFP-EPCs group and control group, the mRNA and protein of eNOS were obviously high expressed in eNOS-EPCs group. EPCs transplantation reduce lumen stenosis and inhibit neointimalhyperplasia (eNOS-EPCs group vs.control group, 0.58±0.05 vs. 1.56±0.21, P < 0.01;GFP-EPCs group vs. control group, 0.84±0.09 vs.1.56±0.21, P < 0.05). eNOS gene transfection could further enhance this anti-proliferative effects (eNOS-EPCs group vs. GFP-EPCsgroup,0.58±0.05 vs. 0.84±0.09, P < 0.05). Furthermore, eNOS modified EPCs could improve the endothelial function of injured vascular endothelium. Conclusions eNOS gene transfection could increase the anti-proliferative effect of EPCs transplantation on injured artery and obviously ameliorate endothelial function.

Objective To explore the etiologies of fever of unknown origin(FUO)and methods for confirming di-agnosis in patients at a hospital,and provide reference for clinical diagnosis and treatment of FUO.Methods Pa-tients with FUO admitted to a hospital between January 2008 and July 2014 were performed clinical diagnosis with methods of serology,bacteriology,molecular biology,bone marrow aspiration,tissue biopsy,and diagnostic thera-py,the etiologies and final diagnosis of 224 patients were analyzed retrospectively.Results Of 224 FUO cases,189 (84.38%)eventually got confirmed diagnosis,35 (15.62%)were not confirmed.The percentage of infectious dis-eases,connective tissue diseases,malignant tumor,and other diseases were 50.45%,18.75%,9.82%,and 5.36%respectively.Among infectious diseases,the major pathogens were bacteria,followed by virus.The major connec-tive tissue diseases were systemic lupus erythematosus and polyarteritis nodosa;the main malignant tumor was he-matological tumor,lymphoma was the main form.Among 189 patients with confirmed diagnosis,30.16% and 24.34% were performed pathogenic and pathologic detection respectively,and 20.11% were performed the other (compre-hensive)methods.Conclusion Infectious diseases,connective tissue diseases,and tumor are major etiologies of FUO.

Objective To study the risk factors of mortality in severe sepsis and septic shock patients. Methods 142 patients with severe sepsis and septic shock in ICU were observed and divided into alive group (98 patients)and dead group (44 patients)by using hospital mortality.The risk factors of mortality in severe sepsis and septic shock patients were assessed by binary logistic regression.Results Independent mortality risk factors were inotropic agents (OR =4.329,95%CI:1.045 -17.937,P =0.043),blood glucose >10 mmol/L (OR =3.771,95%CI:1.214 -11.710,P =0.022)and APACHE Ⅱ score (OR =3.098,95%CI:2.012 -4.760,P =0.000),while PaO2 /FiO2 after early goal -directed therapy (EGDT)was protective factor (OR =0.682,95%CI:0.500 -0.930, P =0.016).Conclusion Severe sepsis and septic shock patients with inotropic agents,blood glucose >10mmol/L, high APACHE Ⅱ score and decreased PaO2 /FiO2 after EGDT indicate poorly prognosis.

Objective To sum up the specificity in clinical care of repetitive transcranial magnetic stimulation (rTMS),and provide reference for putting forward scientific and effective clinical care project.Methods 200 male schizophrenia patients with rTMS treatment were divided into the research group and the control group with 100 cases in each group randomly.Then,the research group adopted the specific nursing which was obtained from the pre-experiment while the control group adopted the routine care.Moreover,NORS scale was used to evaluate the treatment effect.Changhai Pain Measuring Scale was employed to assess headaches in pre-treatment and post-treatment.Results The data of the research group in NORS scale was obviously lower than the control group,and the difference between two groups had statistical significance.No case occurred adverse reaction in the research group,in contract with many cases with adverse reaction in the control group.Conclusions Specific nursing can reduce complications effectively for schizophrenia patients receiving rTMS treatment,and it is a scientific,effective and mature clinical care method.