Objective To find out the correlation of elderly blood pressure variability and heart and cerebrovascular diseases.Methods 133 cases of non-hypertensive elderly accepted the 24 hour ambulatory blood pressure monitoring,the 24 hours,day,night systolic blood pressure variability and diastolic blood pressure variation were analyzed,and incidence of coronary heart disease,arrhythmia,hyperlipidemia were investigated according to the degree of variation.Results The incidence of arrhythmia,coronary heart disease and hyperlipidemia of the elderly which 24 hours,day,night systolic blood pressure variation standard deviation or diastolic blood pressure variation standard deviation were greater than the upper limit of normsl were significantly higher than the elderly whose value within the normal range ( P ＜ 0.05 or P ＜ 0.01 ).Conclusion Elderly non-hypertensive blood pressure variability and cardiovascular and cerebrovascular diseases have significant contact,blood pressure variability can be as important risk factors which determine the pathogenesis and prognosis of cardiovascular disease in this population.

Objective To change the traditional disposal of the third stage of labor, we exsanguinate the placental blood from the maternal termination of umbilical cord after delivery, then the pressure of placental sinus decrease rapidly, the vessels contract, the placenta seperate from the uterine wall and expuse quickly, the third stage of labor is shortened and postpartum bleeding amount is decreased. Methods We chose 200 cases of vaginal delivery puerperants from October 2004 to August 2005 in our hospital as the test group (group A), 100 cases of vaginal delivery puerperants in the same period as the control group (group B). The statistics of the third stage of labor and the postpartum bleeding amount is made so as to evaluate and analyse the effect. Results In group A, the third stage of labor is obviously shortened and the postpartum hemorrhage is obviously reduced. There is singnificant difference between the two groups (P

Botulinum neurotoxin(BoNT) is the most lethal biotoxin known to mankind. It inhibits acetylcholinerelease from the cholinergic nerve ending by cleavage of SNARE proteins, followed by neuromuscular blockadeand paralysis. Gangliosides are considered to act as a first receptor of BoNT with low affinity.Then the membranebound gangliosides-BoNT complex moves laterally to reach and bind the toxin specific protein receptor,synaptotagmin, with a high affinity constant. At last the gangliosides-BoNT-synaptotagmin complex undergoesreceptor-mediated endocytosis. This double-receptors theory is widely accepted. The research data are summarizedand reviewed.

Objective To investigate clinical features,pathogen distribution and prognostic risk factors of candidemia in patients from non-intensive care unit (ICU) wards.Methods Seventy two patients with blood culture-confirmed candidemia were admitted in non-ICU wards in the First Affiliated Hospital of Zhejiang University during January 1 st 2011 and January 31 th 2014.The clinical data of patients,including clinical features,pathogen distribution,treatment and prognosis were retrospectively analyzed.The risk factors for the infection and the fatality of patients were assessed by chi-square test,Fisher exact probability test and multivariate Logistic regression analysis.Results Among 72 patients with candidemia,29 (40.28％) were related to Candida albicans and 43 (59.72％) were related to non-Candida albicans.Univariate analysis showed that elderly people (x2 =6.109,P ＜ 0.05),male (x2 =5.258,P ＜ 0.05),solid tumor (x2 =7.186,P ＜ 0.01),parenteral nutrition (x2 =6.512,P ＜ 0.05),surgery within 30 d (x2 =4.284,P ＜ 0.05),indwelling gastric tube (x2 =4.164,P ＜ 0.05),and indwelling urethral catheter (x2 =3.952,P ＜ 0.05) were risk factors of Candida albicans-related candidemia;while patients with hematologic malignancies (P ＜ 0.0l) and neutropenia (P ＜ 0.05) were prone to non-Candida albicansrelated candidemia.Fourteen cases died within 28 days from the diagnosis of candidemia with an overall 28-d fatality rate of 19.44％.Multivariate Logistic regression analysis indicated that septic shock(OR:84.818,95％ confidential interval:3.560-2020.567,P ＜ 0.01)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score (OR:1.252,95％ confidential interval:1.035-1.515,P ＜ 0.05) were independent risk factors of death,while removal or replacement of central venous catheter (OR:0.002,95 ％ confidential interval:0-0.135,P ＜ 0.01) was a protective factor.Conclusions There are more non-Candida albicans-related candidemia than Candida albicans-related candidemia in non-ICU wards.Patients with high APACHE Ⅱ score and septic shock usually have poor prognosis,while removal or replacement of central venous catheter may improve the prognosis.

Objective To evaluate the role of clinical features,radiography and histopathology in differential diagnosis between chronic necrotizing pulmonary aspergillosis(CNPA)and aspergilloma.Methods Thirty-four patients including 8 cases of CNPA and 26 of aspergilloma comfirmed by operation and histopathology in First Affiliated Hospital,Zhejiang University were investigated retrospectively.The clinical manifestations,radiological and pathological findings of all the patients were analyzed and related references were reviewed. Results The age of onset was not significantly different between CNPA and aspergilloma.Obsolete pulmonary tuberculosis and lung abscess were predisposing factors of them.Productive cough was presented in all 8 cases of CNPA,haemoptvsis in 7,and 5 were presented with constitutional symptoms.The most common symptom of aspergilloma was haemoptysis, which was presented in 25 cases.The less common symptoms were cough and sputum,which was presented in 17 cases.Only two cases were presented with constitutional symptoms."Air crescent"sign at radiography was typical and suggestive of diagnosis in both CNPA and aspergilloma,but the wall of cavity in CNPA was thicker and irregular,infiltrates were often to be seen around the cavity.Histologically,CNPA and aspergilloma both showed septate fungal hyphae branching at an acute angle.CNPA was characterized with the presence of tissue invasion by aspergillus,tissue necrosis and granulomatous inflammation. Fungal hyphae ware only found in a preexistent cavity or ectatic bronchus without tissue invasion in aspergilloma.Conclusions Histopathology is gold standard of differential diagnosis of CNPA and aspergilloma. Meanwhile, clinical features and radiological findings appear to be valuable for the diagnosis.

Objective To find out social support status and its influencing factors in left-home-kids in rural areas. Methods 893 left-home-kids and 335 non-left-home-kids were interviewed with the social support rating scale. Results The total score of social support of left-home-kids was obviously lower than that of non-left-home-kids; in the same way, the score of female was higher than male, the score of low age group was higher than high age group, the score of kids with father or mother as the custodian was higher than that of other custodian subjects; the score of children whose left-home duration was more than five years was higher than that of lower than one year. Conclusions The social support of left-home-kids was poorer than non-lefthome-kids. There is some difference in the social support in left-home-kids with different sex, age, custodian subject, left-home duration. Social support should be given to children with low social support.

Objective To evaluate the safety of CT guided percutaneous lung biopsy in the elderly,and to analyze the risk factors for its complications.Methods Totally 204 elderly patients aged ≥65 years underwent transthoracic needle biopsy under CT guidance.Clinical data,complication and its risk factors were analyzed retrospectively.Results The complications included pneumothorax accounting for 15.2％ (31/204),hemoptysis 21.6％ (44/204),and no mortality was found.Logistic regression analysis showed that needle path ≥5.00 cm,lesion size ≤2.00 cm and emphysema around the lesion were the independent risk factors for postoperative pneumothorax (OR=4.05,2.54 and 3.97,all P＜0.05).Meanwhile,the enhancement degree by CT ＞40 HU,needle path ≥5.00 cm and lesion size ≤2.00 cm were the independent risk factors for postoperative bleeding (OR=2.27,2.82 and 2.33,all P＜0.05) in elderly patients undergoing lung biopsy.The sensitivity and specificity for postoperative pneumothorax and bleeding obtained by forecasting equation were 87.1％ and 49.1％,54.5％ and 80.8％ respectively.Conclusions The length of needle path,lesion size and emphysema around the lesion are correlated with pneumothroax,and length of needle path,lesion size and the CT enhancement degree are correlated with bleeding after percutaneous lung biopsy in the elderly.

Objective To investigate the correlations between ambulatory arterial stiffness index and intracranial/extracranial arterial stenosis.Methods One hundred and twenty-eight cases of ischemic cerebrovascular disease were collected in our hospital from January 2010 to March 2012.Joint diagnosis of cranial computer tomography(TCD) and magnetic resonance angiography (MRA) and,or CT angiography (CTA) were used to detect the degree and number of intracranial arteries,and in accordance with the lesions level,patients were divided into stenosis group,the mild stenosis group,the moderate stenosis group and severe stenosis group.24 h ambulatory blood pressure was monitored and ambulatory arterial stiffness index (AASI) was calculated and statistically analyzed.Results (1) Age,sex,hypertension proportion of diabetes,body mass index(BMI) of different Intracranial arterial stenosis in four groups did not have significant differences (P ＞0.05),but in AASI the without stenosis group is 0.48 ± 0.15 ; the mild stenosis group 0.62 ± 0.16,the moderate stenosis group 0.61 ± 0.17,severe stenosis group 0.64 ± 0.15,and there was significant difference (F =3.955,P =0.001).(2) Age,sex,hypertension proportion of diabetes,BMI of different extracranial arterial stenosis in four groups did not have significant differences (P ＞ 0.05),but in AASI the without stenosis group was 0.48 ± 0.01 ; the mild stenosis group 0.57 ± 0.11,the moderate stenosis 0.59 ± 0.12,and severe group 0.60 ±0.15,and there was significant difference (F =3.643,P =0.002).In comparison between any two group:light,moderate and severe stenosis AASI were significantly higher than those without stenosis,and there was significant difference (P ＜ 0.05).And there was significant different in AASI among different intracranial and extracranial arterial lesions (F =7.395,P ＜ 0.001).Compared to 0 branch pathological changes,1 branch,2 branch,3 branch and above,there was was significant difference(P ＜ 0.05).Conclusion Based on a 24-hour ambulatory blood pressure monitoring indicators,AASI was mainly reflecting the impact of atherosclerosis on blood pressure,associated with intracranial and extracranial artery stenosis.AASI would play a major role in clinical diagnosis and treatment of ischemic cerebrovascular and forecast.

Objective:To observe the effects of the Increasing-Energy and Renewing-Wisdom granule on vascular dementia(VD) patients. Methods:42 VD patients were divided randomly into 2 groups. The patients in treatment group administered the Iincreasing-Energy and Renewing-Wisdom granule. The patients in control group administered piracetam. All the patients were treated for 3 months. Results: The patients' scores of HDS, MMSE, Wechsler (order), MQ in the treatment group were higher than those before the study (P

Objective To investigate the eitect oi Yiqi Fuzhi Granule in improving learning and memory of rats with mul- ti-infarct dementia (MID). Methods MID rat models were established by embolus injection through the common carotid artery. Effects of Yiqi Fuzhi Granule(24. 84 g/kg, 12.42 g/kg, 6.21 g/kg, ig)on rat learning and memory and cerebral structure were observed. Results Yiqi Fuzhi Granule could obviously increase the scores of maze test and protect cerebral tissue from damage of multi-infarction rats. Conclusion Yiqi Fuzhi Granule has good effect in improving intellect and treating dementia.