Objective To investigate the prevalence of orthostatic hypotension in hypertensive patients aged 80 or over and associated risk factors at level A tertiary hospitals.Methods A multicenter cross-sectional study was conducted among very old hypertensive patients (≥ 80 years) at 28level A tertiary hospitals by using questionnaire-based surveys.A total of 1298 hypertensive subjects aged between 80 and 101 years were enrolled in this study.Blood pressures was measured in the supine position and the upright position within three minutes of standing,and 316 patients were assigned to the orthostatic hypotension(OH) group and the other 982 patients to the non-orthostatic hypotension(NOH) group.Additional information was acquired through patients' medical records and the questionnaire.Results The prevalence of OH was 24.3％ (316 cases) There were no significan different betueen OH patienl with NOHones in gender and age.OH patients had higher supine systolic and diastolic blood pressure(P=0.003 and 0.000,respectively),lower standing systolic and diastolic blood pressure(P=0.000 and 0.000,respectively),and higher rates of past coronary heart disease,stroke and renal abnormalities (P =0.037,0.001 and 0.014,respectively) than NOH patients.Logistic regression analysis showed that the prevalence of OH in the patients was positively correlated with supine systolic blood pressure(OR=1.196,CI:1.153-1.242,P=0.000) and supine diastolic blood pressure (OR =1.740,CI:1.602-1.885,P =0.000) and was negatively correlated with standing systolic blood pressure(OR =0.824,CI:0.795-0.855,P=0.000) and standing diastolic blood pressure (OR =0.584,CI:0.539-0.634,P =0.000).Conclusions The prevalence of orthostatic hypotension is high in hypertensive patients aged 80 years or over at level A tertiary hospitals.Poor blood pressure control may increase the risk of orthostatic hypotension.

Objective To evaluate the long-term therapeutic results of intersphincteric resection (ISR) in the treatment of ultra-low rectal cancer.Methods Sixty cases of ultra-low rectal cancer with the inferior border of the tumor within 5 cm to the edge of anus underwent intersphincteric resection (ISR),and the clinical data were analyzed retrospectively.There were 39 males,21 females and their average age was 55 years old (range from 30 to 77 years old).The inferior border of the tumor were from 28 to 50 mm to the edge of anus,averaging 42 mm.Results Sixty patients underwent intersphincteric resection successfully with 3 cases developing anastomotic leakage and 2 cases anastomotic stenosis postoperatively.After a median follow-up period of 49 months (range from 18 to 90 months),local and distant recurrence were observed in 6 and 4 patients respectively.Five-year overall survival rate and disease-free survival rate were 88.3％ and 83.3％ respectively.The mean stool frequency were (3.8 ± 1.3) times in each day based on data from 53 patients,and the stool control function of 73.6％ of all patients was preserved satisfactorily according to Kirwan classification.Conclusions This study indicated that intersphincteric resection might be a candidate technique in the treatment of early stage ultra-low rectal cancer restricted within rectal wall and could achieve satisfactory long-term results in both oncologic and functional respects.

A 36-year-old female presented with multiple dark brown papules on the chest and abdomen for more than 10 years,which had gradually increased in number.Physical examination revealed dozens of dark brown,flat papules measuring 1-3 mm in diameter in the chest and abdomen.Most of the lesions had a smooth surface,and some lesions gave a papilloma-like appearance,with no confluent trend.Biopsy of abdominal lesions showed mild hyperkeratosis of epidermis,acanthosis,extension of epidermal protrusions forming a reticulated appearance,horn pseudocysts in prickle cell layer,enhanced pigmentation of basal layer,and a sparse lymphocytic perivascular infiltrate in superficial dermis.A diagnosis of dermatosis papulosa nigra (DPN) was made.

Objective To assess the Chinese System for Cardiac Operative Risk Evaluation (SinoSCORE) model in patients undergoing heart valve surgery at our center.Methods From January 2009 to December 2011,2098 consecutive adult patients who underwent heart valve surgery at our center were collected and scored according to the SinoSCORE model.All patients were divided into three risk subgroups.The entire cohort and each risk subgroup were analysed.Calibration of the SinoSCORE model was assessed by the Hosmer-Lemeshow(H-L) test.Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve.Results Observed mortality of all 2098 patients was 3.00％.Despite there were significant differences between the SinoSCORE population and our own population sample,the SinoSCORE model showed good calibration(Hosmer-Lemeshow:P =0.783) and discriminative power (area under the ROC curve of 0.752)in predicting in-hospital mortality at the entire cohort.Conclusion The SinoSCORE model give an accurate prediction for individual operative risk in heart valve surgery patients at our center.

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.

Objective To identify the factors related to radiation pneumonia (PR) in lung cancer treated with intensity modulated radiotherapy (IMRT).Methods Data from 163 lung cancer patients treated with IMRT were analyzed with clinical factors and physical parameters related to the dose-volume histogram.The patients were followed for 6 months after radiotherapy.The relationship between survival status and PR was analyzed.Results The incidence rate of over grade 2 patients was 28.22 ％ (46/163).Univariate analysis revealed a significant relationship between many parameters associated with such as the site of lobe (P =0.033),COPD (P =0.020),chemotherapy (P =0.020) and prophylactic using of glucocorticoid and antibiotic (P =0.025).Multilogistic regression analysis showed that V20 in the contralateral site,the V5 of the all lungs and PTVV were independent factors.Conclusion The RP is associated with multiple factors.Individualized treatment plans should be made according to the specific circumstances of patients.

Objective:To investigate the effect of simvastatin on the expression of vascular endothelial growth factor (VEGF)and its receptor in cultured human umbilical vein endothelial cells(HUVEC).Methods:Cells were randomly divided into simvastatin group,tumor necrosis factor-?(TNF-?)group,simvastatin+TNF-?group,interleukin-1?(IL-1?)group,simvastatin+IL-1?group and control group.The effects of TNF-?,IL-1?and simvastatin on the protein levels of VEGF and its receptor in HUVEC were studied by immunocytochemistry.Results:The protein levels of VEGF and its receptor in TNF- ?group and IL-1?group were significantly higher than those of control group,and simvastatin decreased the protein levels of VEGF and its receptor in TNF-?group and IL-1?group.Conclusion:Simvastatin can decrease the protein levels of VEGF and its receptor in HUVEC. [

Objective To evaluate the long-term functional outcome after ileal pouch anal anastomosis with modified double-stapled technique.Methods From January 2002 to March 2011,forty-five patients underwent ileal pouch anal anastomosis with modified double-stapled technique.The clinical data of these patients were reviewed.The postoperative anal function was assessed by Kirwan classification and Oresland pouch-specific function score.Results During the median follow-up of 65 months,2 patients with malignant adenomatous polyps died,2 patients were diagnosed dysplasia by biopsy,4 patients developed mild to moderate anastomotic narrowing,1 patient developed persistent anastomotic stricture needing surgical intervention,16 patients developed at least 1 episode of pouchitis.There was no incontinence in these patients,and the median functional Oresland score was 6,3 and 2 after 1 year,2.5 years and 5 years respectively.Conclusion The functional results of ileal pouch anal anastomosis with modified double-stapled technique are promising,with no incontinence in our patients.

Objective To compare the application,safety and theraputic effect of local resection of early rectal tumours by transanal endoscopic microsurgery(TEM) and the conventional transanal excision(TAE).Methods The data of seventy-six patients who were treated by conventional transanal excision from January 2003 to July 2006 and fifty-three patients who were treated by transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed.Results Age,sex,tumour size,blood loss,postoperative hospital stay were similar in the two groups(P＞0.05).The median distance from the anal verge was significantly higher in the TEM group ( TEM/TAE =7.0/5.0 cm,P ＜ 0.01 ).The operation time was significantly longer in the TEM group (TEM/TAE =70.00/30.00 min,P ＜ 0.01 ).There was no operation-related mortality in both groups (P ＞ 0.05 ).Two patients in the TEM group developed postoperative haemorrhage,and one patient developed pulmonary infection and retention of urine respectively.There were two secondary haemorrhage cases in the TAE group.On median follow-up of 30 months,there was 7.8％ recurrence rate in the TEM group,compared with 23.2％ the in TAE group.Conclusions Transanal endoscopic microsurgery is a safe and effective mininally invasive surgical technique for the treatment of early rectal neoplasm.It has broader indication,and better theraputic effect than the conventional transanal excision.