Objective To observe the curative effect of telmisartan on sinus rhythm maintenance in patients with nonvalvular paroxysmal atrial fibrillation (AF) after the recovery of sinus rhythm with amiodarone. Methods Seventy-six patients with nonvalvular paroxysmal atrial fibrillation who visited our hospital were randomly divided into two groups: control group (amiodarone, n=36) and treatment group (telmisartan plus amiodarone, n=40). The maintenance of sinus rhythm and the change of left atrial diameter between the two groups at 3, 6 and 12 months after therapy were observed. Results The left atrial diameter and the maintenance rate of sinus rhythm between the two groups at 3 and 6 months after therapy had no statistically significant difference (t=0.04, 0.51, 0.03, 1.12, all P>0.05). After 1-year treatment, the maintenance rates of sinus rhythm were 48.4% and 73.5% in treatment group and control group ,respectively (t=4.33,P<0.05), and the left atrial diameter was significantly shorter in treatment group than in control group [(34.38±3.85) mm vs. (37.26±4.85)mm ,t=2.66, P<0.05]. Conclusions The combination of telmisartan and amiodarone is more effective than amiodarone alone on maintenance of sinus rhythm in patients with nonvalvular paroxysmal AF after the recovery of AF. The curative effect may be due to telmisartan effects on inhibiting the activation of renin-angiotensin system, decreaseing the cardiac burden and delaying the cardiac remodeling.

Objective To investigate the expression changes of victims suffering from sudden cardiac death(SCD), eurological calcium adhesion proteins (N-Cadherin) and Bax and explore their significance in forensic medicine. Methods Separately select 33 samples of myocardial tissue suffering from sudden cardiac death and 29 samples of myocardial tissue from the cases which were diagnosed not dying of heart disease as SCD and controls. Histological methods were used to examine the morphologic changes in myocardial tissue, examining the expression changes of N-Cadherin and Bax and analyzing them in a statistic way. Results N-Cadherin was weakly positively expressed in myocardial tissue of group SCD and the cells shew disordered arrangement, which is obviously lower than the controls. The cells exhibited obvious features ordered arrangement in control group. The positive expression of Bax was detected in myocardial tissue of group SCD, which is obviously higher than the controls. Conclusion The expression changes observation of N-Cadherin and Bax will make a difference to the sudden cardiac death.

Objective To observe the changes of carotid intima-media thickness(CIMT) and vascular endothelia function in patients with geriatric carotid plaque before and after intensive lipid lowering was performed.Methods 102 patients diagnosed with carotid plaque were ramdomly divided into common group (atorvastatin 10 mg/d,n=48) and intensive lipid lowering group (atorvastatin 20 mg/d,n=54).After one year of treatment,the fasting venous blood total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),high density lipeprotein cholesterol (HDL-C) and triglyceride (TG) were assayed,and the thickest and thinnest CIMT and brachial arterial.endothelium dependent diastolic function (FMD) and carotid artery plaque index(PI) were measured by ultrasound.Results Two groups in the thickest CIMT and PI had no significant difference before and after treatment (P＞0.05).The levels of FMD,TC,LDL-C,TG and the thinnest CIMT had significant difference before and after therapy [common group:GIMT(0.85±0.20)mm,(0.83±0.22) mm,FMD(3.85±1.41)%,(7.91±1.05)%,TC(6.46±1.05) mmol/L,(4.82±1.26) mmol/L,LDL-C (4.71±1.00) mmol/L,(3.16±1.00) mmol/L,TG (1.55±0.45) mmol/L,(1.49±0.44) mmol/L;intensive lipid lowering group:CIMT(0.84±0.20) mm,(0.63±0.17) mm,FMD (3.74±1.38) %,(0.25±1.58)%,TC (6.36±1.06) mmol/L,(4.10±1.00) mmol/L,LDL-C (4.73±1.01) mmol/L、(2.28±1.26) mmol/L,TG (1.56±0.53) mmol/L,(1.50±0.49) mmol/L,P＜0.05].After one year's therapy,the difference in intensive lipid lowering group was more obvious than in common group (P＜0.05).Conclusions Intensive lipid lowering therapy is more effective to decrease TC,LDL-C and CIMT and to improve the vascular endothelia function.Atorvastatin is effective to stabilize the plaque and to retard the atheroscleresis development.

Objective To evaluate pulmonary protection of dexmedetomidine under general anesthesia in the patients with sepsis.Methods Fifty patients with sepsis,aged 50-64 yr,weighing 50-75 kg,of ASA physical status Ⅲ or Ⅳ,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium,and maintained with infusion of remifentanil and propofol and intermittent iv boluses of cisatracurium.The patients were endotracheally intubated and mechanically ventilated.In group D,dexmedetomidine 1.0 μg/kg was infused over 10 min,followed by infusion at 0.4 μg · kg-1 · h-1 for 2 h before induction of anesthesia.While the equal volume of normal saline was given in group C.BIS value was maintained at 40-60.Immediately before skin incision,at 2 h after beginning of skin incision,and at 24 h after operation,arterial and venous blood samples were taken for blood gas analysis and for determination of the concentrations of serum procalitonin,interleukin-6 and tumor necrosis factor-alpha.Oxygenation index was calculated.Results Compared with group C,oxygenation index was significantly increased,the concentrations of serum procalitonin,tumor necrosis factor-alpha and interleukin-6 were decreased,and the rate of improvement of pulmonary function was increased in group D.Conclusion Dexmedetomidine (infusion at 0.4 pg · kg-1 · h 1 for 2 h after infusion of 1.0 μg/kg) before induction of anesthesia provides pulmonary protection under general anesthesia in the patients with sepsis.

Objective To investigate the effect of dexmedetomidine on inflammatory response during the perioperative period in patients with acute craniocerebral trauma.Methods Seventy ASA Ⅰ-Ⅳ patients of both sexes,aged 20-68 yr,with craniocerebral trauma,who required decompressive craniectomy within the next 24 h,were randomly divided into 2 groups (n =35 each) ∶ control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with remifentanil,sevoflurane and propofol and intermittent iv boluses of cisatracurium.In group D,dexmedetomidine 1 μg/kg was infused over 10 min,followed by infusion at 0.4 μg· kg-1 · h-1 for 2 h.Venous blood samples were taken before induction of anesthesia (baseline),2 h after the beginning of operation,at the end of operation and at 24 h after operation (T1-T4) to determine the concentrations of serum neurone specific enolase (NSE),interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α).Results Compared with group C,the concentrations of serum NSE,IL-6 and TNF-α were significantly decreased in group D (P ＜ 0.05).The concentrations of serum NSE,IL-6 and TNF-αwere significantly higher at T2 and T3,and the concentration of serum TNF-α was significantly lower at T4 than at T1 in group C (P ＜ 0.05).The concentrations of serum NSE and IL-6 were significantly higher at T2 and T3 and lower at T4 and the concentration of serum TNF-α was significantly higher at T3 and T4 than at T1 in group D (P ＜0.05).Conclusion Dexmedetomidine protects the brain against acute craniocerebral trauma by inhibiting systemic inflammatory response during the perioperative period.

Objective To discuss the value of prenatal ultrasound and MRI in diagnosis of fetal agenesis of corpus callosum (ACC). Methods Sixty-seven fetuses from Hubei Maternal and Children's Hospital performed fetal MRI from July 2013 to December 2014 were included in this study. All fetuses (67 cases) with suspected ACC were studied with a 1.5T MR unit within 3 days after ultrasound examination. Prenatal ultrasound and MRI findings were studied. Results All the 67 ACCs previously suspected on ultrasound were confirmed by MRI. Among the 67 ACCs, 58 cases were complete ACC and 9 cases were partial ACC. Corpus callosum body and/or splenium absence was found in all 9 partial ACC cases. In all cases, on MRI, corpus callosum complete or partial absence was showed on the median sagittal images, and mild to moderate ventriculomegaly and abnormal morphology in lateral ventricle was shown on the axial or coronary images. Conclusions MRI has high value in diagnosis of ACC. When ACC is found or suspected by ultrasonophy, MRI examination is suggested to confirm the diagnosis.

ObjectiveTo explore the imaging features of fetal tuberous sclerosis complex by ultrasonography and magnetic resonance imaging.MethodsRetrospective analysis on the imaging characteristics of the 10 cases of fetuses confirmed as tuberous sclerosis complex who were examined in Hubei Maternal and Child Healthcare Hospital in July 2013 to December 2014 by ultrasonography and MRI, which was compared with the pathological data of specimens and follow-up after birth.ResultsEighteen cases were diagnosed as fetal cardiac rhabdomyoma by ultrasonography among all of the 996 fetuses, in which lesions were located on the ventricular wall near septum or elsewhere in the heart cavity on ultrasonography. Fetal cardiac rhabdomyoma was characterized by circular, homogeneous high echo (singleton in 4 cases, multiple in 14 cases). Among them no subependymal nodule was found by ultrasonographic. Ten cases of subependymal nodule were found by magnetic resonance imaging, which were diagnosed as tuberous sclerosis complex with cardiac rhabdomyomas, including 3 cases of brain subcortical tubers. The subependymal nodules under the lateral ventricle wall showed characteristic low signal nodules on T2WI, protruding from the ependymal surface. Of 18 cases, only 4 cases of fetal cardiac rhabdomyoma were found by MRI. Nine cases of ifnally had termination of pregnancy. Two cases were conifrmed as cardiac rhabdomyoma with intracranial nodules after pathological examination, and 1 case was conifrmed as tuberous sclerosis complex after birth. ConclusionsPrenatal ultrasonography can diagnose fetal cardiac rhabdomyoma successfully, and MRI can diagnose the fetal brain nodules sensitively. Once ultrasonography finds cardiac rhabdomyoma, it may be promising to diagnose fetal tuberous sclerosis complex by ultrasonography combined with MRI.

Objective To investigate the diagnostic value of ultrasound and MRI in fetal bronchopulmonary sequestration (BPS). Methods The 7 pregnant women with suspected fetal BPS were examined with a 1.5 T MR unit within 24 h after prenatal ultrasound in Hubei Maternal and Children's Hospital during July 2013 to February 2015. The imaging protocol included half-fourier acquisition single shot turbo SE (HASTE), true fast imaging with steady state precession (True FISP) in axial, frontal and sagittal planes relative to the fetal thorax. Prenatal MRI findings have been compared with postnatal enhanced computed tomography or biopsy. Results The locations of BPS were in left side in 5 cases and in right side in 2 cases. One case was complicated with congenital cystic adenomatoid malformation (CCAM) of lung. Ultrasound showed the intrathoracic mass as a hyperechoic lesion and the feeding artery could be found by Doppler ultrasonography. T2WI could reveal not only the hyperintense lesions with clear boundary, but also the hypointense feeding artery originating from systemic circulation. Compared with pathological examination or enhanced CT, both of the ultrasound and the MRI could locate the lesions;however 2 feeding arteries were misjudged. Conclusions Prenatal ultrasound is the first-choice diagnostic modality for BPS. MRI can demonstrate the location, morphology and the feeding arteries of the fetal BPS, and also estimate the volume of normal lungs, which could be an important supplement to prenatal ultrasound in prenatal diagnosis and prognostic prediction of BPS.

Objective To improve the quality of the management of the elderly patients with cancer in Sichuan province,and to understand the attitudes and perspectives of elderly surgeons and oncologists for the management and treatment of elderly patients with cancer.Methods A face-toface questionnaire interview was conducted with oncologists (n 64) and geriatricians (n =64).128 physicians were involved in this study.Results The cancer management and therapeutics were deemed appropriate at present by 9.38％ (6/64)of the geriatricians and 25.00％ (16/64)of the oncologists.The 39.06％ (25/64) of geriatricians used to notice geriatric syndromes,while 81.25％ (52/64)of oncologists never concerned about the geriatric syndrome(P=0.011).As for the causes of the therapy-associated toxicity,oncologist versus geriatrician payed an attention to malnutrition (100.00％ vs.100.00％ in both groups),to mobility disorders(65.63％ vs.65.63％,84/128 in both groups),to cognitive impairment/mood disorder (89.06％ in geriatrician group vs.75.00％ in oncologist group,P=0.038).For the factors affecting treatment decisions,a physical ability attention (oncologists vs geriatricians:70.31％ vs.92.19％;P =0.002),and comorbidity (oncologists vs geriatricians:62.50％ vs.79.69％,P =0.032) had statistically significant difference.In addition,lack of geriatrics knowledge was also reported by more oncologists.However,one hundred percent of participants wanted very much to cooperate with each other in their clinical work.When responding to the clinical scenario,the 10.94％ (7/64)of geriatricians and 32.81％ (21/64)of oncologists chose modified treatment for 65-74 years old patient with cancer(P =0.003).When the age of the patients was 75-84 years old,only 12.50 ％ (8/64) of geriatricians prefer end-of-life care,while 31.25 ％ (20/64) of oncologists chose it (P =0.010).Conclusions Selection of treatment decisions in the elderly patients with cancer affect by ageing.Both oncologists and geriatricians are concerned with the elderly patients with cancer,ageing syndrome,total sickness and functional status.And these doctors support an establishment of a multi disciplinary team cooperation for the elderly patients with cancer.Therefore,the establishment of mutual cooperation between the two professionals is necessary and feasible.

Objective:To understand the temporal and spatial characteristics of fluoride in rural drinking water in Jinan City.Methods:From 2015 to 2018, the factory water and terminal water samples of centralized rural water supply system were collected from all townships (streets) in 7 agriculture-related districts (counties) in Jinan City during dry season and high water season. Water samples were collected, stored, transported and tested in accordance with the "Standard Examination Methods for Drinking Water" (GB/T 5750-2006). The time, region, endemic areas (Zhangqiu, Jiyang, Shanghe, Licheng, Changqing) and non-endemic areas (Pingyin, Tianqiao) of drinking water type fluorosis, water periods (dry season and high water season), water samples (factory water and terminal water), water sources (shallow well water, deep well water, river water and reservoir water) of water fluorine were analyzed descriptively.Results:A total of 1 638 water samples were collected from 2015 to 2018, the median of water fluorine was 0.400 mg/L, ranging from 0.002 to 2.700 mg/L. The differences in water fluorine of different year (0.400, 0.430, 0.490, 0.360 mg/L) were statistically significant ( H = 33.907, P < 0.01). Total water fluorine excess rate was 5.49% (90/1 638), there were 3 districts with water fluorine excess, namely Jiyang [26.11% (59/226)], Zhangqiu [6.12% (30/490)] and Licheng [0.53% (1/188)]. The median of water fluorine in endemic areas (1 398 samples) was 0.420 mg/L, the non-endemic areas (240 samples) was 0.320 mg/L, and the water fluorine in endemic areas was significantly higher than that in non-endemic areas ( Z =-6.490, P < 0.01). The water fluorine excess rate in endemic areas was 6.44% (90/1 398), and there was no water fluorine excess in non-endemic areas. The median of water fluorine in both dry season (819 samples) and high water season (819 samples) was 0.400 mg/L. The median of water fluorine of factory water (392 samples) was 0.320 mg/L, the terminal water (1 246 samples) was 0.450 mg/L, and the water fluorine of terminal water was significantly higher than that of factory water ( Z =-6.881, P < 0.01). The water fluorine excess rates of shallow well water and deep well water were 31.76% (47/148) and 3.82% (43/1 126), respectively, and there were no water fluorine excess in river water and reservoir water. Conclusions:Fluoride of drinking water in rural areas of Jinan City exceeds the standard, mainly concentrated in Jiyang District. The water fluorine in endemic areas is higher than that in non-endemic areas, water fluorine of terminal water is higher than that of factory water, shallow well water and deep well water as the sources of water has excessive water fluoride, and the general survey and detection of fluoride content in residents' drinking water should be continuously carried out.