The bilateral idiopathic aldosteronism (IHA) is the most common subtype of aldosteronism.Spironolactone is the primary preferred agent due to the pathophysiology of IHA and the long-standing clinical experience over years.If patients faced with severe side effects of spironolactone or poorly controlled blood pressure by this first-line treatment,additional treatment alternative to spironolactone,second antihypertensive,as well as adrenalectomy are suggested.In recent years,several new agents were developed to treat IHA,such as aldosterone synthase inhibitor and eplerenone.This review introduces these new kinds of medicine in the treatment of IHA.

Objective To observe the effect of reversing myocardial remodeling and improving cardiac function in CHF patients with lotensin or lotensin and different doses of spironolactone.Methods Ninety patients were randomized to three groups,respectively lotensin,lotensin with 20mg spironolactone and lotensin with 40mg spironolactone.TNF?,Ald,AngⅡ,LA,LVEDD,LVEDV and EF were measured before and after 12 weeks treatment.Results(1)There were significant decreases in the level of TNF-?,Ald,AngⅡ,LA,LVEDD,LVEDV after treatment compared with before in three groups(P

Objective To observe the influence of metabolic syndrome(MS)on the left ventricular hypertrophy(LVH)in the essential hypertension(EH)patients.Methods 76 EH patients in middle to advanced ages were selected.Clinical examinations including blood pressure,serum lipid,plasma glucose and body mass index(BMI)were performed.The patients were divided into EH group and essential hypertension with HMS group.The left ventricular posterior wall thickness(LVPW),the left ventricular end diastolic dimension(LVDd),and interventricular septal thickness(IVS)were detected.The left ventricular mass index(LVMI)was calculated after Doppler and 30 controls were observed.Results LVPW,IVS,LVDd,LVMI and the rate of LVH were obviously higher in EH patients than that in the controlS(P＜0.05),and these were also higher in HMS than that in the controls and the EH patients(P＜0.01).Conclusions The degree of the left ventricular hypertrophy in EH patients with metabolic syndrome is more severe than that in EH patients.

In recent years,morbidity of thyroid carcinoma is rising,but its mortality decreased because of the standardized diagnosis and treatment.Pecially to the development and improvement of the surgical treatment.In this field,there has not reached the common understanding at present.In this article we review the extent of surgery,re-operation of the thyroid carcinoma,neck lymph dissection,131I ablation and thyroid hormone suppression therapy.

Objective To investigate the effect of fimH gene on type 1 fimbriae adhesion of uropathogenic Escherichia coli (UPEC) and the gene variations between type 1 fimbriae adhesion positive and negative bacteria.Methods A total of 171 UPEC strains (not catheter associated) were collected from the Second Hospital of Tianjin Medical University,Tianjin First Center Hospital,and Tianjin Children's Hospital during January 2012 and January 2013.fimH gene was detected by PCR technique,and type 1 fimbriae adhesion was detected by yeast agglutination test.RT-PCR was used to exterminate gene transcript factor impacting on adhesion.Chi-square and Yates' chi-squared tests were performed to comparefimH gene sequences between the adhesion positive and negative bacteria.Results Among 171 UPEC strains,142 (83％) werefimH gene positive,and type 1 fimbriae was expressed in 98 strains (57％).All adhesion positive strains carriedfimH gene.Among 44 strains with positivefimH gene and negative adhesion RT-PCR revealed thatfimH gene did not transcript in 8 strains (18％).The sequencing results showed that gene mutation on the 51 st amino acid site was more prevalent in the adhesion positive group compared with the negative group (x2 =6.64,P =0.010).In adhesion,mutations on the 190th and 219th amino acid sites were observed in 6 strains and 7 strains of negative group,respectively; while not observed in the adhesion positive group (x2 =4.69 and 5.87,P ＜ 0.05).Negative adhesion in other 23 strains was not attributed to single nucleotide polymorphism.Conclusion Adhesion function of type 1 fimbriae mignt be affected by mutation and deletion offimH gene.Three key site mutations may also affect the adhesion function of type 1 fimbriae.Besides fimH gene,there may be other genes that can affect the adhesion function of type 1 fimbriae.

Objective To summarize the nursing points for patients with mid-stage hepatocellular carcinoma who are receiving radiofrequency ablation (RFA) combined with 131I-chTNT treatment. Methods The clinical data of 12 patients with mid-stage hepatocellular carcinoma, who were encountered at authors’ hospital during the period from Aug. 2009 to Sep. 2011, were retrospectively analyzed. RFA combined with 131I-chTNT was carried out in all patients. Preoperative prophylactic anti-allergy medication and protection measure for the thyroid were employed. After the operation strengthened radiation protection and close observation for complications were conducted. The results were analyzed. Results After active treatment and proper nursing, the tumor shrank in all patients. All the patients were followed up for 5 - 48 months with a median follow- up time of 31 months. The median overall survival time was 43 months. No serious complications such as bone marrow suppression or thyroid dysfunction occurred. Conclusion For the treatment of mid-stage hepatocellular carcinoma, 131I-chTNT combined with RFA has satisfactory therapeutic effect. Close observation for the occurrence of complications and careful nursing can improve the quality of life and prolong the survival time.

Objective To investigate the effects of tibiofibula crossing healing on ankle joint movement. Methods A retrospective study was done for seven patients who experienced tibiofibula crossing healing for an average of 30 months (10 to 54 months) from September 1999 to November 2003. There were four left sides and three right sides. Two patients received plate fixation for their open tibiofibula fractures, while the other five intramedullary nailing for their closed fractures. The plantar flexion and dorsiflexion of the ankle were measured at the follow-ups. Results According to the Kofoed' s evaluation system for the ankle joint, six were assessed as excellent and one as good in this series. Tibiofibula crossing healing had an average influence of 6.3 degrees on the dorsiflexion of ankle, but little influence on the normal gait. Five patients reported different extents of discomfortableness at the ankle. Conclusion Tibiofibula crossing healing has a significant influence on ankle cataplasia.

Objective To explore the application and analysis of E-PASS scoring system for orthopaedic senile hip surgery risk assessment. Methods Retrospectively analyzed the data of 188 cases of elderly hip fracture patients with anesthesia and surgery, postoperative complications. Useing E-PASS scoring system to evaluate the mortality of patients with surgical risk. Results Postoperative complications mainly was respiratory system diseases, the rate of complication was 25.88%(22/85), accounting for total cases rate was 11.70% (22/188). Secondly for cardiovascular diseased and urinary system diseases. E-PASS scoring system showed that the scores of surgery risk assessment in patients with complication was significantly higher than that without complication:(0.27±0.23) scores vs. (0.17±0.16) scores, t=3.728, P<0.05. Ninety-one patients were evaluated to occur complications by E-PASS grading system, 85 patients occurred practically,the rate of actual value/forecast was 0.93.Six patients were evaluated to die, 2 patients occurred practically, the rate of actual value/forecast was 0.33, there were no significant differences ( P=0.056,0.124). Conclusion E-PASS scoring system for orthopaedic senile hip surgery risk assessment can predict the risk of complication and death effectively,it is value of interventing the preoperative risk factors and has great clinical application value.

Objective To observe the effect of ulinastatin on the expression of interleukin 15 (IL-15), connective tissue growth factor (CTGF) and malondialdehyde (MDA) in rat peritoneal mesothelial cells (RPMCs) induced by high glucose. Methods RPMCs were isolated, cultured and passaged by trypsin, then identified. The third generation of cultured RPMCs were used in the experiment. RPMCs were divided into normal control group, high glucose (1.5%, 2.5%, 4.25%) for 6 hours and 12 hours, high glucose (2.5%) for 3, 6, 12, 24 hours or ulinastatin (160, 320, 640U/ml) for 12 hours. IL-15 mRNA was detected by real-time PCR. IL-15 and CTGF protein in supernatants was detected by ELISA. MDA protein was detected by TBAS. Results Compared with the control group, the expression of IL-15, CTGF and MDA was significantly increased in the groups stimulated by high glucose (P＜0.05) in dose- and time-dependent manner. Ulinastatin could significantly decrease the expression of IL-15, CTGF and MDA induced by high glucose in dosedependent manner both in protein and gene levels (P＜0.05). Conclusions High glucose can up-regulate the expression of IL-15, CTGF and MDA in RPMCs. Ulinastatin can reverse these changes.

Objective To observe the effect of 1,25(OH)_2D_3 on expression of vitamin D receptor (VDR), tumor necrosis factor α (TNF-α) and transforming growth factor β1 (TGF-β1) in rat peritoneal mesothelial cells (RPMCs) stimulated by lipopolysaccharide (LPS), so as to provide some evidence for clinical use of 1,25 (OH)_2D_3 on peritoneal dialysis-associated peritoneal inflammation. Methods RPMCs were isolated, cultured and passaged by enzymaticdisaggregation, then identified by phase contrast inverted microscope, transmission electron microscope with immunocytochemistry method. RPMCs were incubated with LPS (1,10,100 mg/L) and LPS (10 mg/L) for 2,6,12 hours, or stimulated by 1,25(OH)_2D_3 (10~(-8) mol/L, 10~(-7) mol/L, 10~(-6) mol/L) after incubated with LPS (10 mg/L) for 2 hours. RPMCs in the control group were justincubated with medium. Expression of VDR mRNA and protein was detected by RT-PCR and Western blot. In addition, ELISA was performed to investigate the changes of TNF-α and TGF-β1 in culture medium. Results Compared with control group, the expression of VDR mRNA and protein was decreased in LPS group (P<0.05). LPS could significantly induce the expression of TNF-a and TGF-β1 in RPMC (P <0.01), which could be partially reversed by different concentrations of 1,25 (OH)_2D_3 (P<0.01). Conclusions 1,25 (OH)_2D_3 can reverse the decrease of VDR mRNA and protein induced by LPS as well as the induction of TNF-a and TGF-β1 up-regulated by LPS in RPMC in a dose- and time-dependent manner. Our research provides experimental evidence of VDR ameliorating peritoneal dialysis-associated peritoneal inflammation and peritoneal fibrosis.