ObjectiveTo observe clinical effect of proteinuria treatment in hypertension and type 2 diabetes with enalaprilat joint losartan. Methods72 cases of hypertension and type 2 diabetes with proteinuria patients were divided into two groups randomiy,losartan and enalaprilat combination for the treatment group( n =36) ,losartan alone for the observation group( n =36) ,treatment 14 weeks. Observed two groups of blood pressure and 24h after treatment urinary albumin excretion rate. ResultsTwo groups of blood pressure than before treatment were reduced significantly(P ＜ 0.05), but after treatment between the two groups, the difference was not statistically significant (P ＞ 0.05 ).Two groups of patients after 14 weeks treatment, average 24h urine albumin excretion rate form( 105.2 ± 27.3 ) μg/min, ( 110. 3 ± 28.0) μg/min fell to(72.6 ± 26.5 ) μg/min, ( 87.5 ± 24.9 ) μg/min ( P ＜ 0. 01 ), the treatment group reduced more significant(P ＜0.05). ConclusionEnalaprilat joint losartan treatment at the same time,the effective step-down pressure, could improve the type 2 diabetes patients with early renal damage, and it suggested the early renal damage patients should be combined antihypertensive therapy as soon as possible.

Objective To explore the effect of c-Jun N-terminal kinase(JNK)on the expression of interleukin-10(IL-10) in keratinocytes induced by ultraviolet A(UVA).Methods The HaCaT cells in cultured were either sham irradiated(control) or exposured to 2.4 J/cm2 UVA radiation.The cells were collected at 0-48 h after irradiation,and JNK levels in cells were detected with the immunofluorescence.HaCaT cells were treated with SP600125(a JNK inhibitor) before irradiation,then cells and suspended medium were collected at each time-point after irradiation,and the expression of IL-10 mRNA and protein were determined by RT-PCR and ELISA.Results Compared with control cells,irradiated cells had increased levels of phospho-JNK throughout the entire 48 h following irradiation(P

Objective To observe the effect of early goal directed therapy (EGDT) on tissue perfusion,microcirculation and oxygen metabolism in patients with septic shock.Methods A prospective observational study was carried out in 69 patients with early septic shock within 24 hours.The eligible patients were treated with the standard procedure of EGDT.The partial pressure of transcutaneous oxygen (PtcO2) and transcutaneous carbon dioxide (PtcCO2) was monitored and the changes of hemodynamic data,tissue oxygen,microcirculation before and after reaching the criteria of EGDT were recorded.Results Compared with that before treatment,PtcO2,tissue oxygenation index (PtcO2/FiO2) after EGDT was increased [(78.1 ± 30.8) mmHg (1 mmHg =0.133 kPa) vs.(62.8 ± 24.1) mmHg and (141.7 ± 78.3) mmHg vs.(110.8 ± 60.5) mmHg],PtcCO2 and percutaneous arterial carbon dioxide partial pressure difference was decreased[(29.0 ±4.1) mmHg vs.(39.1 ±6.4) mmHg and (1.4 ±0.5) mmHg vs.(1.7 ±0.8) mmHg],there was significant difference(P＜ 0.05).There was no significant difference in PtcO2,PtcO2/FiO2,PtcCO2,central venous blood oxygen saturation,lactic acid,oxygen and oxygen consumption (P ＞ 0.05).Conclusion EGDT can improve local tissue perfusion and microcirculation in patients with septic shock,body tissue perfusion index before and after EGDT may not be able to reflect the local tissue perfusion.

The aim of this study was to evaluate the accuracy of transtracheal doppler (TTD) cardiac output monitoring. Eleven mongrel dogs (weight: 8～15kg) were anesthetized with intravenous thiopental 20mg?kg~(-1), and the doppler tube was inserted into trachea and fixed at a proper position where clear signal was received, and the catheter with thermistor was passed into pulmonary artery via femoral vein. CO were measured simultanously by thermodilution (TD) and TTD in the basic state, during 10 mins after intravenous administration of propofol 2mg?kg~(-1), in 30 mins following intravenous dopamine 100?g?kg~(-1) or under condition of isovolumic hemodilution in sequence. The results demonstrated that the CO measured by TTD correlated positively with that by TD (r=0.88, P

Objective To investigate the relationship between serum homocysteine(Hcy)level and endothelial function in patients with coronary heart disease(CHD).Methods A total of 209 patients having undertaken coronary angiography were enrolled in this study.The serum concentrations of homocysteine were investigated for all subjects using fluorescence polarization immunoassay.B-mode ultrasound was used to scan brachial arteries for all subjects at rest and during reactive hyperemia,and then the rates of endothelium-dependent and independent flow-mediated vasodilatation(FMD% and NTG%)of the brachial artery were calculated.Results The values of Hcy in the CHD group were higher than that in the control group(P

Objective To investigate the effects of sevoflurane on renal ischemia-reperfusion (I/R) injury in rats and the role of Na+-2Cl--K+ cotransporter 1 (BSC1) and aquaporin 2 (AQP2) in it.Methods Twentyfour male Sprague-Dawley rats,aged 8-12 weeks,weighing 125-145 g,were randomly divided into 3 groups (n =8 each) ∶ sham operation group (S group),I/R group and sevoflurane group (Sev group).Renal ischemia was induced by occlusion of the renal artery for 45 min with atraumatic microclips followed by 24 h reperfusion.In group Sev,the rats inhaled 1 MAC (2.2％) sevoflurane,renal ischemia was induced after loss of consciousness and 1 MAC (2.2％) sevoflurane was inhaled for 1 h.The urine were collected at 24 h before I/R (T1) and 24 h of reperfusion (T2) for detection of urine specific gravity and creatinine (Cr) level.The urine volume was recorded.The endogenous creatinine clearance rate (Ccr) was calculated.Blood samples were taken from the irferior vena cava at T2 for determination of concentrations of serum blood urea nitrogen (BUN) and Cr and activities of superoxide dismutase (SOD) and myeloperoxidase (MPO),malondialdehyde (MDA) concentration.The left kidney was removed for determination of MPO and SOD activities and MDA content and for microscopic examination and the pathological changes of the renal tubule were scored.The expression of AQP2 and BSC1 was detected by immunohistochemistry and Western blot.Results Compared with group S,the urine volume was enlarged,concentrations of serum BUN and Cr were significantly increased,urine specific gravity and Ccr were significantly decreased,MPO and MDA levels were significantly increased,SOD activity was significantly decreased,the pathological score was significantly increased,and the expression of AQP2 and BSC1 was down-regulated in groups I/R and Sev (P ＜ 0.05).Cer was significantly higher,conceutratious of serum BUN and Cr and MPO and MDA levels were lower,SOD activity was higher,the pathological score was lower,and the expression of AQP2 and BSC1 was higher in group Sev than in group I/R (P ＜ 0.05).Sevoflurane inhalation significantly attenuated the pathological changes.Conclusion Sevoflurane can attenuate renal I/R injury in rats through up-regulating the expression of BSC1 and AQP2.

Objective To explore the surgical techniques and clinical outcome of standard large trauma craniotomy in the treatment of acute subdural hematoma.Methods The clinical data of 51 cases with acute subdural hematoma,who underwent standard large trauma craniotomy in recent 5 years in our department,were retrospectively analyzed.Results All the patients were followed up for 3 ～ 6 months.10 cases were dead,4 persistent vegetative status,severe disability in 6 cases,midrange disability occurred in 11 cases and 20 cases were good.Postoperative complications included tardive haematoma in 4 cases,traumatic cerebral infarction in 2 cases,subdural collection of fluid in 4 cases,cerebromalacia in depressor area in 2 cases,hydrocephalus in 2 cases,and traumatic epilepsy in 3 cases.Conclusion Standard large trauma craniotomy is an effective approach in the treatment of acute subdural hematoma,due to its advantages such as satisfactory exposure for haemostasis,rapid removal of haematoma and relief of acute intracranial hypertension.

BACKGROUND: Nitric oxide in the central nervous system is involved in controlling the sympathetic outflow. The authors' recent data show that the reduction of nitric oxide in the rostral ventrolateral medulla (RVLM)enhanced the cardiac sympathetic afferent reflex (CSAR) evoked by stimulating the cardiac sympathetic afferent nerves in rats with chronic heart failure (CHF).OBJECTIVE: To further investigate the effect of nitric oxide in the RVLM on modulating the CSAR evoked by epicardial chemical stimulation in rats with CHF.DESIGN: Randomized controlled experiment.SETTING: Department of Physiology, Nanjing Medical University, and Department of Cellular and Integrative Physiology, University of Nebraska College of Medicine.MATERIALS: This study was carried out in the Department of Physiology, Nanjing Medical University from July 2003 to May 2004. A total of 52male Sprague-Dawley rats weighing 360-420 g were used, and were randomly divided into chronic heart failure group and control group with 23 in each group.METHODS: The rats were carried out either sham surgery or the left coronary artery ligation. Six to eight weeks later, all rats were anesthetized with α-chloralose and urethane and baroreceptor denervated and vagotomized. The CSAR was evoked by epicardial application of bradykinin (BK, 0.04 μg and 0.4 μg in 2.0 μL) to mimic the effect of chemical stimulation on the heart in the CHF state. The renal sympathetic nerve activity (RSNA), mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline and during elicitation of the CSAR. Cannulae were inserted into the RVLM for microinjections.croinjection of MeTC, a nitric oxide synthase inhibitor, into the RVLM on Effects of epicardial pretreatment with lidocaine on the CSAR in CHF rats.infarction of (30.6±2.0) % of the left ventricular (LV) surface. The systolic arterial pressure, pulse pressure, left ventricle peak systolic pressure and maximum of the first differentiation of left ventricular pressure were decreased and the left ventricular end-diastolic pressure was significantly ininto the RVLM had no significant effects on the CSAR in rats with CHF,of SNAP (50 nmol) into the RVLM inhibited the CSAR in both sham rats ventricle abolished the CSAR evoked by epicardial application ofBK on the same area.CONCLUSION: Nitric oxide in the RVLM inhibits the CSAR evoked by epicardial application of BK in normal rats and CHF rats, and the reduction of nitric oxide in the RVLM led to the augmentation of the CSAR in CHF rats.

Seminar is an exploratory learning model with problem-based and project-or-ganized characteristics.The application practice of Seminar learning model in the process of teaching and training postgraduates of health management shows that the model has an important influence on improving the quality of postgraduates in our country.

Objective To evaluate the efficacy and toxicity of combined pegylated liposomaldoxorubicin (PLD) and carboplatin in the treatment of patients with recurrent epithelial ovarian cancer.Methods We retrospectively reviewed 67 patients with recurrent epithelial ovarian cancer or primaryperitoneal adenocarcinoma (8 eases) who were treated with combined PLD and earboplatin. The responserate, survival and toxicity were evaluated. The mean age for 67 patients was 52.1 (39-76) years. All ofthem received eytoreductive surgery followed by platinum-based chemotherapy either with paclitaxel orcyclophosphamide and doxorubicin after diagnosis. Combined PLD and carboplatin was used as first orsecond-line treatment or even after multiple lines of treatment after disease recurred. Patients were treatedwith PLD at 35-40 mg/m2combined with carboplatin at an area under curve ( AUC ) of 5 once every 4weeks. Results Forty-nine. Patients were evaluable for response. Twenty-three (47%) patients had acomplete response, 13 (27%) had a partial response, 3 (6%) had stable disease and 10 (20%) hadprogressive disease. The estimated median progression-free survival (PFS) was 8 months. The 1-year and 2-year survival rates were 73% and 55%, respectively. All of the 67 patients were evaluated for toxicity. Thetreatment was terminated in 2 patients due to allergic-like infusion reaction. Four patients who had acuteinfusion reaction with shortness of breath and tightness of chest did not terminate the treatment because nosuch reaction occurred when restarted the infusion. There were 2 patients with G2and 3 patients with G3hand-foot syndrome, 2 patients had G4stomatitis, and 8 patients had G3leukopeni,, No G4leukopenia orcardiotoxicity eceurred. Conclusion The combination of PLD and carboplatin is an active and wellotolerated regimen in the treatment of patients with recurrent epithelial ovarian cancer.