Objective To explore the impact of amlodipine ,enalapril ,telmisartan and metoprolol on the blood pressure variability (BPV) in the patients with essential hypertension(EH) .Methods 120 patients with EH were divided into the amlodipine ,enala-pril ,telmisartan and metoprolol groups with 30 cases in each group .The ambulatory blood pressure monitoring (ABPM ) was adopt-ed and BPV before treatment and after 8-week treatment was observed .Results The anti-hypertensive effect of amlodipine and telmisartan was more obvious ,and the anti-hypertensive effect of metoprolol on the diastolic blood pressure was significant ,but the anti-hypertensive effect of enalapril was unobvious .Amlodipine and telmisartan lowered BPV at most time .Amlodipine mainly re-duced the daytime diastolic BPV ,while telmisartan reduced the night BPV significantly ;metoprolol and enalapril increased the day-time systolic BPV and decreased the nighttime BPV in 24 h BPV .Conclusion Amlodipine ,enalapril ,telmisartan and metoprolol can reduce the blood pressure in the patients with EH ,but their influences on BPV have difference .The impact of different anti-hyper-tensive drugs on BPV is inconsistent with the anti-hypertensive effect .

This paper explores subjective and objective reasons for missed diagnosis and diagnostic errors in health examination,aiming to improve mutual communication between patients and health staff,enhance people's consciousness in ethics,promote the medical concept which stresses preclinical prevention and early treatment for diseases,decrease the rate of missed diagnosis and diagnostic errors,and makes health examination profitable for both medical institutes and recipients.

Objective To investigate the effects of Xiao Yao San on intracellular Ca2 + concentration in cultured rat hippocampal neurons in the state of chronic stress and study the mechanism of chronic stress injuring and XiaoYao San protecting. Methods MK-801 acts as tool,cultured rat hippocampal neurons were divided into seven groups, those were group 1 (control), group 2 (normal serum), group 3 (normal serum + Glu), group 4 (model serum + Glu), group 5 (model serum + Glu + MK-801), group 6 (Xiaoyaosan + Glu), group 7 (Xiaoyaosan + Glu + MK-801). to detect intracellular Ca2+ concentration in cultured hippocampal neurons in the simulated micro - environment of chronic stress and after intervention with the serum treated with Xiao Yao San by confocal laser microscope at the same period of time. Results Compared with group 1 (779.97 ± 36.81), concentration of Ca2+ intracellular of group 2 (1092.38 ± 36.41), group 3 (1472.49 ± 76. 19), group 4 (1509.52 ±104.69) and group 5 (1186.97 ±41.92) all increased significantly (P＜0.01) ,group 6 (908.74 ±40.24) increased too (P ＜ 0.05), compared with group 2, concentration of Ca2 + intracellular of group 3,4 and 5 all increased significantly (P ＜ 0.01), but group 7 (721.99 ± 60.33) decreased significantly (P ＜ 0.01). Compared with group 4, concentration of Ca2+ intracellular of group 6 and 7 decreased significantly (P＜ 0.01), group 5 decreased too (P ＜ 0.05), compared with group 6, concentration of Ca2 + intracellular of group 5 increased significantly (P ＜ 0.01),when group 7 decreased significantly (P＜0.01). Conclusion Serum of chronic stress treated with Xiao Yao San has the effect of inhibiting Ca2+ overload in hippocampal neurons,it may work through a variety of signaling pathways including Glu-NR-Ca2+ to maintain the steady-state of Ca2+ concentration in hippocampal neurons, and then to protect neurons from the neurotoxic effects of excitatory.

Objectves To investigate the effectiveness and safety of bronchoalveolar lavage for the treatment of neonatal pulmonary atelectasis under ultrasound monitoring.Methods Thirty-two neonates diagnosed with pulmonary atelectasis by lung ultrasound,and hospitalized in the Neonatal Intensive Care Unit of Bayi Children's Hospital,the General Hospital of the Chinese People's Liberation Army between July 2014 and June 2016,were included in this study.Bronchoalveolar lavage was performed in all the patients by injection of lavage fluid (0.9％ NaC1 or 0.9％ NaCl plus ambroxol hydrochloride and/or exogenous pulmonary surfactant) 1.5 to 3.0 ml via tracheal intubation.Lung ultrasonography was performed immediately after each lavage to reveal the status of lung recruitment.Repeated lavage one to three times made up of one course of treatment.The bronchoalveolar lavage could be performed for one to two courses daily according to the status of atelectasis recovery.Medical records were reviewed to analyze descriptively the effectiveness,side effects and complications of the bronchoalveolar lavage.Results Bronchoalveolar lavage was significantly effective in 25 patients (78.1％) with disappearance of pulmonary atelectasis after one course of treatment;effective in five cases (15.6％) with disappearance or reduction of atelectasis after two or three courses;with a total effectiveness rate of 93.8％(30/32).Bronchoalveolar lavage was ineffective in two cases (6.2％) with no remarkable change in atelectasis after three courses of treatment.Vital signs were stable in all the infants during the bronchoalveolar lavage,and no adverse effects and complications occurred.Conclusions Bronchoalveolar lavage is effective for the treatment of neonatal pulmonary atelectasis under ultrasound monitoring,and it is easy to operate and with no adverse effects and complications,and thus worth of clinical application.

Objective To explore the efficacy of multiple target therapy in treatment of patients with chronic moderate and severe IgA nephropathy with hyperuricemia.Methods Seventy-six patients with chronic progressive moderate and severe IgA nephropathy with hyperuricemia were enrolled the current study and randomly divided into observation group and control group.Patients in control group were treated with allopurinol,prednisone,benner pury and valsartan,while those in observation group were treated with urokinase,mycophenolate mofetil besides the basis of control group for 6 months.The blood uric acid (UA),24 h urine protein,mean arterial pressure (MAP) and creatinine clearance rate (Ccr) were determined and analyzed.Results The levels of UA,24 h urinary protein,MAP and Ccr in observation group and control group were same before treatment (P ＞ 0.05).After 6 months treatment,the levels of UA,24 h urine protein,MAP and Ccr in observation group were (413.7 ± 90.7) μmol/L,(1.15 ± 0.57) g/L,(87.7 ± 10.6) mmHg and (81.9 ± 3.7) ml/min respectively,significantly different from those of the control group ((369.6 ± 67.2) μ mol/L,(0.77 ±0.51) g/L,(81.6 ±12.3) mmHg and (86.4 ±6.8) ml/min;t =2.219,2.802,2.132,3.230;P ＜0.05).The rate of adverse reactions in two groups was not significantly differnent(9.7％ (3/31) vs 9.1％ (3/33) ; x2 =0.006,P =0.936).Conclusion Multiply target therapy is effective and safe in terms of treating chronic progressive moderate and severe IgA nephropathy with hyperuricemia.

Objective To investigate the epidemiologic characteristics of patients with severe acute pancreatitis (SAP) and the effects of its complications on prognoses in past 7 years in the north area of Guizhou province. Methods Data of 209 patients with SAP admitted to the Department of Critical Care Medicine of Affiliated Hospital of Zunyi Medical College from January 2009 to January2016 were retrospectively analyzed, and they were divided into a survival group (178 cases) and a death group (31 cases) according to the prognosis. The gender, age, diagnosis (primary and recurrent), the length of stay in hospital, the levels of creatinine and total bilirubin (TBil), the time of blood purification, hematocrit (HCT) level on the first day after admission, pathogenesis, complications [infection, pseudocyst, intra-peritoneal hemorrhage, acute renal failure (ARF), acute respiratory distress syndrome (ARDS), abdominal compartment syndrome (ACS), pancreatic encephalopathy, multiple organ dysfunction syndrome (MODS)], sequential organ failure (SOFA) score (maximum SOFA score during hospital stay), application of hormones, surgical interference, etc. related factors were compared, the SAP epidemiological characteristics, factors affecting prognosis and the effect of complications on prognosis in intensive care unit (ICU) were analyzed in the two groups.Results Of the 209 patients 98 cases were diagnosed biliary pancreatitis accounting for the majority (46.9%), hyperlipidemic pancreatitis 76 cases (36.3%), alcoholic pancreatitis 6 cases (2.8%) and idiopathic pancreatitis29 cases (13.9%). The age (years: 47.1±13.5 vs. 53.2±12.0), creatinine (μmol/L: 109.4±100.3 vs. 335.7±222.4), the ration of intra-peritoneal hemorrhage [4.5% (8) vs. 38.7% (12)], ARF [1.1% (2) vs. 54.8% (17)], ACS [1.1% (2) vs. 9.7% (3)], MODS [18.5% (33) vs. 74.2% (23)] and SOFA score (3.3±2.4 vs. 10.5±5.4), percentage of patients using hormones [5.6% (10) vs. 29.0% (9)] were significantly lowered (allP < 0.05) and the time of blood purification was shortened (days: 1.95±1.97 vs. 4.81±5.84) in survival group than those in death group; while the gender, diagnosis, the length of stay in hospital, TBil, HCT on the first day after admission, pathogenesis, complications (infection, pseudocyst, ARDS and pancreatic encephalopathy) and surgical treatment situation were compared between the two groups, no statistical significant differences were seen (allP > 0.05). Logistic regression analysis showed that creatinine > 300μmol/L [odds ratio (OR) was 2.651, 95% confidence interval (95%CI) was 1.459-3.935,P = 0.017], intra-peritoneal hemorrhage (OR was 5.231, 95%CI was 3.517-7.159,P = 0.000), ARF (OR was 3.731, 95%CI was 2.641-4.857,P = 0.000), ACS (OR was 2.517, 95%CI was 1.003-3.098,P = 0.000), use of hormone (OR was 1.012, 95%CI was 0.825-2.051,P = 0.000) and SOFA score (OR was 3.179, 95%CI was 2.630-6.021 andP = 0.000), MODS (OR was 4.716, 95%CI was 2.086-7.902 andP = 0.031) were the risk factors having critical effects on the prognosis of thedisease, The higher the creatinine level, the worse the prognosis. The mortality of ARF was very high reaching 89.5%; the mortalities of patients with complications as intra-peritoneal haemorrhage, ACS, MODS, pancreatic encephalopathy, AKI, infection, pancreatic pseudocyst and ARDS were as follows: 60.0%, 60.0%, 41.1%, 33.3%, 32.1%, 23.1%, 17.7%, 13.1% respectively.Conclusion Biliary disease andhyperlipidemia are the major causes of SAP in north area of Guizhou province, creatinine > 300μmol/L, intra-peritoneal hemorrhage, ARF, ACS, SOFA score, use of hormones are the independent risk factors leading to poor outcome in patients with SAP and the use of hormones cannot ameliorate the disease situation.

Objective To observe the mechanisms that Xiaoyao powder influences the hypothalamus-pituitary-adrenal (HPA) axis of chronic-stress rats. Methods Chronic stress rats were as researching object,and RU-38486 acted as tool drugs. The serum-GC density of rats were tested with ELISA,and the glucocortcoid(GR) in hippocampus neuron were tested with immunofluorescence,the CRH mRNA in hypothalamus were tested by in situ hybridization (ISH). Results Compared with normal group ( 1.09 ± 0.11 ;0.57 ± 0.10), the expression of GR in hippocampus of model group decreased(0.65 ± 0. 10; P ＜ 0. 01 ), and the expression of CRH mRNA in hypothalamus of model group increased ( 1.12 ±0. 11; P＜0. 0l ) ,the GR in hippocampus of RU-38486 group increased ( 1.59 ± 0. 11; P ＜ 0. 01 ), and the expression of CRH mRNA in hypothalamus of RU-38486 group reduced (0.48±0.10; P＜0.05) ,but both the expression of GR in hippocampus and the CRH mRNA in hypothalamus of Xiaoyao powder group were no change (0.62 ±0.08;0.97 ±0.13; P＞0.05). Compared with model group,both the expression of GR in hippocampus of RU-38486 and Xiaoyao powder group increased (P＜0. 01) ,and both the expression of CRH mRNA in hypothalamus of RU-38486 and Xiaoyao powder group reduced (P＜0.01). Conclusion Multi-stress can result in the expression of GR in hippocampus of rats decreasing and the expression of CRH mRNA in hypothalamus increasing, but those changes can be restrained by Xiaoyao powder, and it is the maybe mechanism of Xiaoyao Powder resisting chronic stress in HPA axis.

With the development of imaging technology,the detection rate of gallbladder benign lesions has increased year by year.And part of the diseases may evolve into gallbladder cancer through a series of pathophysiologic processes.There are some misunderstandings in the understanding of gallbladder benign lesions for surgeons,so it is difficult for the clinical decision-making.The relationship between gallbladder benign lesions and gallbladder cancer should be correctly understood.Surgeons can neither exaggerate the risk of gallbladder cancer nor miss optimal timing of operation.The key point of the diagnosis and treatment of gallbladder benign lesions should be based on making full use of imaging data and strictly grasp pre-and intraoperative indications,and it is important to identify the malignant transformation of gallbladder benign lesions as soon as possible and carry out standardized treatment.

Objective To explore the influence of elevating the oxygen pressure on articular chondrocytes in vitro.Method A hydrogen peroxide induced human articular chondrocyte damage model was established.Then the articular chondrocyte viability was detected using the CCK-8 kit.Collagen Ⅱ(COL Ⅱ),The expression levels of aggrecan (ACAN),matrix metalloproteinase 13 (MMP13) and adisintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5) were detected using the realtime PCR and Western blotting.Result The viability of articular chondrocytes improved at 12 h but decreased at 24 h after the stimulation of hydrogen peroxide.Twenty-four hours later,the average expression level of COL Ⅱ and ACAN decreased(P＜0.05),while that of MMP13 and ADAMTS5 elevated(P＞0.05).Conclusion Hydrogen peroxide induced elevation of the extracellular oxygen pressure can influence the synthesis and degradation of the articular chondrocyte extracellular matrix.

OBJECTIVE:To investigate the effects of 3 types of antihypertensive drugs on cognitive function in elderly hyper-tensive patients after acetabular surgery. METHODS:Ninety hypertensive patients receiving antihypertensive drugs for a long term (not changed antihypertensive drugs within 2 weeks before surgery)undergoing selective acetabular surgery were included sequen-tially and divided into angiotensin receptor blocker(ARB)group,angiotensin converting enzyme inhibitor(ACEI)group and cal-cium channel blocker(CCB)group according to the types of antihypertensive drugs,with 30 cases in each group. All patients re-ceived acetabular surgery under epidural anesthesia. The cognitive function of patients was evaluated by using MMSE 1 d before sur-gery(T0),1 d after surgery(T2)and 3 d after surgery(T3). The concentration of S100β protein serum was determined 1d before surgery (T0),immediately after surgery (T1) and 1 d after surgery (T2). RESULTS:Compared with T0,MMSE score of ARB group at T2,those of ACEI group and CCB group at T2 and T3 were decreased significantly,with statistical significance(P<0.05). Compared with ARB group,MMSE score of ACEI group and CCB group at T2,T3 were decreased significantly,with statistical sig-nificance(P<0.05). Compared with ACEI group,MMSE score of CCB group at T2,T3 were decreased significantly,with statisti-cal significance(P<0.05). Compared with T0,the concentration of S100β protein in serum 3 groups were increased significantly, with statistical significance (P<0.05). Compared with ARB group,the concentration of S100β protein serum in ACEI group and CCB group were increased significantly,with statistical significance(P<0.05). Compared with ACEI group,the concentration of S100β protein serum in CCB group at T1,T2 were increased significantly,with statistical significance(P<0.05). The incidence of cognitive dysfunction was in ascending order of ARB group (30%)