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.

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 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.

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 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 impact of reducing clinical target volume (CTV) on the efficacy of intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) . Methods Between August 2003 and March 2007, 380 NPC patients were treated with IMRT with reduced CTV.CTV1, defined as high risk region, included GTV +5 - 10 mm margin and the entire nasopharyngeal mucosa +5 mm submucosal volume; CTV2, designed for potentially involved regions, included the nasopharyngeal cavity (limited to the posterior part of nasal cavity only), maxillary sinus (limited to 5 mm anterior to the posterior nasal aperture and maxillary mucosa), pterygopalatine fossa, posterior ethmoid sinus,parapharyngeal space, skull base, anterior third of clivus and cervical vertebra, inferior spheniod sinus and cavernous sinus and internal group of retropharyngeal lymph nodal regions from the base of skull to cranial edge of the second cervical vertebra. The prescription dose was: GTV 66. 00 -69. 75 Gy/30 - 33 f, CTV1 60. 00 -66. 65 Gy,CTV2/CTVN 54. 0 -55.8 Gy. 308 patients with stage Ⅲ or Ⅳ diseases also received cisplatin-based neoadjuvant chemotherapy. Results The follow-up rate was 100%. 145 patients were followed-up to 3 years. The 3-year estimated local control, regional control, metastasis-free survival,disease-free survival and overall survival rates were 94. 9%, 97.4%, 86. 2%, 80. 9% and 89. 0%,respectively. Multivariate analysis revealed that N-classification was a significant prognostic factor for metastasis-free survival (x2 = 20. 80, P = 0. 001), N-classification (x2 = 18. 30, P = 0. 003) and age (x2 =7. 31, P =0. 004) were independent prognostic factors for overall survival. Grade 2 xerostomia was observed in 5.6% of the patients after two years of IMRT, no Grade 3 or 4 xerostomia was observed. Local, regional,and distant failures were developed in 4. 2%, 2. 6% and 12. 1% of the patients, respectively. Conclusions The IMRT approach with reduced CTV2 provids a favorable outcome for NPC with acceptable toxicities.

Objective To define the incidence and perioperative risk factors of new-onset atrial fibrillation for patients with preoperative sinus rhythm after successful mitral valve replacement.Methods Retrospective analysis was performed on 586 patients with preoperative sinus rhythm who underwent successful mitral valve replacement in our hospital from 1998 to 2008.The cases were classified into postoperative atrial fibrillation (AF group) or postoperative sinus rhythm (SR group).Twenty-nine risk factors including clinical and echocardiography data were selected into univariate analysis by using student' s t test or chi-squared test according to the data type.The factors with a value of P ＜ 0.1 in univariate analysis were assessed by multivariate logistic regression.A value of P ＜ 0.05 (two-sided) was considered to be statistically significant in multivariate logistic regression. ResultsOne hundred and eighteen patients had atrial fibrillation postoperatively. The incidence was 20.1％.Univariate analysis revealed that the factors including age,chronic lung disease,left ventricular mass,left atrial volume,right atrial volume,tricuspid valve regurgitation,heart failure,valvular pathology,postoperative prosthetic mitral effective orifice area index,postoperative mechanical ventilation time,serum levels of potassium and magnesium significantly increased the risk of postoperative atrial fibrillation.However,in multivariate logistic regression,age,left atrial volume and postoperative prosthetic mitral valve effective orifice area index and serum of potassium had significant statistically significances between AF group and SR group.Conclusion Age,left atrial volume,postoperative prosthetic valve effective orifice area index and serum of potassium were significant predictors of postoperative new-onset atrial fibrillation for patients with preoperative sinus rhythm after mitral valve replacement.