OBJECTIVE:To investigate clinical efficacy of valsartan combined with amlodipine in the treatment of elderly primary hypertension and its effect on insulin resistance(IR)in order to provide theoretical reference for the treatment of elder primary hypertension. METHODS:120 cases of elder primary hypertension were randomized into treatment group and control group. Control group were treated with valsartan and treatment group were treated with valsartan combined with amlodipine. After 2 months of treatment,clinical efficacies of 2 groups were evaluated as well as fasting blood glucose(FBG),2-hour postprandial blood glucose(2 h PBG),fasting insulin(FINS)and insulin sensitivity index(ISI)before and after treatment. RESULTS:Conclusion:(1)Compared with before and control group,FBG and 2 h PBG in treatment group were improved significantly(P

Vasovagal syncope (VVS) was a neurally-mediated functional disease, a transient disturbance of consciousness triggered by transient cerebral ischemia due to peripheral vasodilation resulting from a variety of incentives, accompanied by the loss of muscle tone and even fainting. Children with VVS are characterized by recurrent syncopal attacks induced by prolonged standing, postural changes and muggy environment, etc. Currently treatments of VVS include non-pharmacological therapy and pharmacological therapy.

OBJECTIVE:To compare therapeutic efficacy and safety of indapamide separately combined with benazepril,irbe-sartan or amlodipine for grade 2 essential hypertension(EH). METHODS:A total of 150 patients with grade 2 EH were randomly divided into benazepril group(50 cases),irbesartan group(50 cases)and amlodipine group(50 cases). 3 groups were given Indap-amide tablet 2.5 mg orally,once a day. Benazepril group was additionally given Benazepril hydrochloride tablet 10 mg orally,once a day;irbesartan group was additionally given Irbesartan tablet 150 mg orally,once a day;amlodipine group was additionally giv-en Amlodipine tablet 5 mg orally,once a day. 3 groups were treated for 12 weeks. The levels of systolic pressure,diastolic pres-sure,heart rate,total cholesterol(TC),three triacylglycerol(TG)and serum potassium as well as the occurrence of ADR were ob-served in 3 groups before and after treatment. RESULTS:The total response rate of berazopril group,irbesartar group and a mloelip-ire group had no significant difference(90.0% vs. 88.0% vs. 92.0%,P>0.05). There were no statistical significances in the levels of systolic pressure,diastolic pressure,heart rate,TC,TG and serum potassium among 3 groups before treatment(P>0.05). Af-ter treatment,systolic pressure and diastolic pressure of 3 groups were significantly lower than before,with statistical significance (P<0.01);but there was no statistical significance among 3 groups(P>0.05). There were no statistical significance in heart rate, TC,TG of 3 groups before and after treatment and the level of serum potassium in benazepril group and irbesartan group (P>0.05). After treatment,the level of serum potassium in amlodipine group was significantly lower than before,with statistical signifi-cance (P<0.05). The incidence of ADR in irbesartan group was significantly lower than benazepril group and amlodipine group, with statistical significance (P<0.05);but there was no statistical significance between benazepril group and amlodipine group (P>0.05). CONCLUSIONS:The indapamide separately combined with benazepril,irbesartan or amlodipine have similar therapeu-tic efficacy for grade 2 EH,but the safety of irbesartan is better than those of benazepril and amlodipine.

Objective To investigate the diagnosis judgment values of trimester ultrasound screening for simple single umbilical artery fetal malformation.Methods From January 2011 to January 2015,selected the 15-28 weeks pregnant singleton pregnancies in Shunyi Hospital of Beijing Chinese Medicine Hospital for system fetal ultrasound,in which the single umbilical artery group of 50 patients,50 cases of healthy pregnant women (control group),the two groups were carried ultrasound screening with single umbilical artery flow spectrum analysis,and observed the prognosis.Results The single umbilical artery fetal bladder after abdominal oblique horizontal cross-section of the umbilical artery bypass saw one side of the bladder,and there were 24 patients the malformations with the incidence rate was 48.0％.In the two groups can be clearly demonstrated umbilical artery condition,but the umbilical artery pulsation index(PI),arterial resistance index (RI) and peak valley ratio of umbilical artery blood flow velocity (S/D) value in the single umbilical artery group were 1.02±0.17,0.66±0.06 and 3.08 ±0.57,significantly higher than those of the control group (0.75 ± 0.21,0.53 ± 0.08,2.11±0.27;t=7.298,11.874,15.983,P＜ 0.05).In the single umbilical artery group,there were 32 patients of abortion,10 patients of birth were,8 patients ogpregnancy.Perinatal death in 8 cases,the mortality rate was 16.0％,the single umbilical artery fetal malformations of perinatal mortality was significantly higher than that of children with simple single fetal umbilical artery (x2 =9.333,P ＜ 0.05).Conclusion Trimester ultrasound screening for single umbilical artery combined with simple two-dimensional ultrasound and umbilical arteryblood flow velocity conditions can improve fetal malformations value judgment,provide a reliable detection method to reduce oerinatal mortality.

目的探讨对老年性前列腺增生症合并糖尿病患者手术方法的选择和围手术期的护理。方法对49例老年性前列腺增生症合并糖尿病患者行经尿道前列腺汽化电切术(TURVP) 30例、耻骨后前列腺摘除术19例;连续监测血糖,适当调整胰岛素用量,将血糖控制在空腹<7.1mmol/L、餐后<13mmol/L;残余尿超过80ml则留置尿管引流;口服抗生素预防感染。结果行TURVP者术后6—24h尿液即清亮;行开放性手术者均采用持续膀胱冲洗;全部切口Ⅰ期愈合;血糖控制在正常水平。结论对伴有糖尿病的老年性前列腺增生症患者,选择合适的手术方式与相应的围手术期护理是手术成功的关键。

[ ABSTRACT] AIM:To explore the regulatory effect of intermedin ( IMD) on pulmonary collagen synthesis and ac-cumulation in rats with pulmonary hypertension induced by high pulmonary blood flow.METHODS: Healthy male SD rats (n=20) were randomly divided into control group (n=7), shunt group (n=7) and shunt with IMD group (n=6).The shunting of abdominal aorta and inferior vena cava was produced in rats of shunt group and shunt with IMD group.After 8 weeks, IMD was administered into the rats of shunt with IMD group subcutaneously by mini-osmotic pump for 2 weeks.Mean pulmonary artery pressure (mPAP), relative medial thickness (RMT) of pulmonary arteries, contents of hydroxyproline, collagen type I and III, bone morphogenetic protein-2 (BMP-2), and the mRNA expression of procollagen I and III in lung tissues were measured and compared.RESULTS:Compared with control group, mPAP and RMT of medium and small pul-monary arteries in the rats of shunt group were significantly increased.Meanwhile, the lung hydroxyproline, collagens I and III and BMP-2 contents, and the mRNA expression of lung procollagen I and III were all significantly increased compared with control group.However, IMD significantly decreased mPAP, alleviated the changes of pulmonary vascular micro-struc-ture, decreased the collagen accumulation and pulmonary tissue homogenate BMP-2 contents, and inhibited the mRNA ex-pression of procollagen I and III in the lung tissue of shunting rats.CONCLUSION:IMD plays a protective role in the de-velopment of pulmonary hypertension and pulmonary vascular structural remodeling induced by high blood flow by inhibiting pulmonary collagen synthesis and accumulation, possibly in association with the BMP-2 pathway.

Objective To study the levels of matrix metalloproteinase-3(MMP-3),matrix metalloproteinase-9(MMP-9) and inhibitor of metalloproteinases-1(TIMP-1) in patients with acute myocardial infarction(AMI) and mechanism of plaque rupture of coronary atherosclerosis.Methods Sixty-seven patients with AMI were selected,average invasion time was 3 h～5 d.40 cases of non-coronary heart disease were included in control group.The expressions of serum MMP-3,MMP-9,TIMP-1 and the levels of serum cTnI,CK-MB were analyzed by enzyme-linked immunosorbent assay.Results The serum MMP-3,MMP-9 and TIMP-1 levels in AMI group were higher than those in control group,there was significant difference between two groups(P

Objective To analyze the genetic variation of low density lipoprotein receptor(LDLR)gene in patients with familial hypercholesterolemia(FH).Methods Polymerase chain reaction(PCR)was used to amplify the promoter region and the 18 exons of LDLR gene family with the patients' genomic DNA as templates.DNA sequencing of the PCR production was used to find mutations in patients with FH.Results A novel missense mutation(G→T)in exon 4 was identified by DNA sequencing in the proband and his mother,and the mutation was characterized at nucleotide site of 385 in exons of coding region,with tyrosine substitute for aspartate at amino acid site of 108.Conclusion Characterization of the novel mutation provides an example of the genetic basis of LDLR causing FH.

Objective To evaluate if the difference between oversea predicted values and healthy adult measurements of spirometry in shenyang.Methods 287 healthy adult volunteers underwent pulmonary function test.The measurements of spiromenty of 230 selected objects were compared to conventional oversea predicted values.Results In male group(154 objects),the measured values were as follows:VC(4.4?0.7)L,FVC(4.3?0.7)L,FEV1(3.5?0.6)L,FEF25%～75%(3.6?1.1)L/s,PEF(7.1?1.9)L/s,IC(2.8?0.7)L,respectively.In female group(76 objects),the measured values were as follows:VC(3.1?0.7)L,FVC(3.1?0.7)L,FEV1 2.5?0.6(L),FEF25%～75%(2.6?0.9)L/s,PEF(5.0?1.4)L/s,IC(2.1?0.7)L respectively.The measurements were 2%～26% and 2%～21% lower than the predicted values in male and female respectively.The major compared values had significant difference.Conclusion The major measured values of spirometry in healthy adult in shenyang were significantly lower than the oversea predicted values.Knudson or ECCS regression equations with appropriate correction factor were suggested to use in shenyang.

Objective To understand the functional status and radiation protection requirements of helical tomotherapy (TOMO) unit when it is applied in clinic treatment so as to promote the construction of TOMO quality control system.Methods A helical tomotherapy unit with a type of tomotherapy Hi-Art was employed as the radiotherapy unit.A series of tests and analyses on dosimetric and radiation safety performance parameters of the TOMO unit were conducted with the use of a A1SL ionization chamber,a set of solid water equivalent phantoms and other test equipments.The performance parameters were compared with that of a conventional 6 MV accelerator with a type of ARTISTE.Results The deviations of static and dynamic output dose were-1.51％ and 1.18％,respectively.The values of PDD10/PDD1.5 and PDD20/PDD1.5 were 0.608 and 0.318 within the range of X-ray quality parameters calibration.Under the different field conditions of 40 cm × 5 cm,40 cm × 2.5 cm and 40 cm × 1 cm,the stability of transverse/longitudinal dose distribution curve was no more than 1.20％ and the offset distance of Jaw width was smaller than 0.5 mm.Radiation leakage ratio of the treatment rotating center from the muhileaf collimator (MLC) was 0.20％.No matter the average or the maximum value of the leakage radiation from couch plane was less than 0.02％.Conclusions The performances and testing requirements of TOMO unit are different from a conventional electron linear accelerator,the quality control index of TOMO unit should be set seperately and tested strictly in terms of the specific requirements of the unit by complying with the QC programme.The reliable quality control system should be established and effectively implemented to serve the radiotherapy quality and radiation safety effectively in the tomotherapy.