OBJECTIVE:To evaluate the efficacy and safety of telmisartan in the treatment of hypertension.METHODS:The efficacy and safety of telmisartan versus losartan in treating hypertension reported in 5 studies were comprehensively evaluated with the meta-analysis in homogeneity test and combined test.RESULTS:Of the five randomized controlled trials(RCT) in which 771 patients who met the inclusion criteria were included,two studies were of high methodological quality according to Jadad scale.Meta analysis indicated that there was statistical significance between telmisartan and losartan in effectiveness(OR=1.55,95% confidence interval(1.12,2.16),P0.05).CONCLUSION:The effectiveness of telmisartan in the treatment of hypertension is significantly higher than that of losartan;however,there is no signficant differce in safety between the two drugs.

Hepatitis C, Chronic ; Humans

Objective To determine whether ultrasound (US) exposure combined with microbubble destruction could be used to enhance non-viral gene delivery in rat C6 glioma cells. Methods Microbubbles were prepared and gently mixed with plasmid DNA. The mixture of the DNA and microbubbles was administered to cultured C6 cells under different US/microbubble conditions. US parameters adopted in this study were frequency 1 MHz, output intensity 1 W/cm2, duty cycle 20%, exposure time 30 seconds. Transfection efficiency and cell viability were assessed by FACS analysis, confocal laser scanning microscopy, and Try pan blue staining. Results Microbubble with US exposure could significantly enhance the reporter gene expression as compared with other groups. No statistical significant difference was observed in the glioma cell viability between different groups. Conclusions US-mediated microbubble destruction has the potential to promote safe and efficient gene transfer into C6 cells,and it may be useful for safe clinical gene therapy of brain cancer without a viral vector system.

Objective To explore the value of 6 commonly-used quantitative measures on crosssectional MR images to diagnose the patellofemoral instability.Methods Clinical data of 32 patients with patellofemoral instability(34 knees) confirmed by arthroscopy surgery were retrospective analyzed.Knee MR imaging at full extension of the knee was performed in them.Their MR images were compared with those of 23 asymptomatic volunteers.Trochlear facet asymmetry,lateral trochlear inclination,trochlear depth,patellar tilt angle,lateral patellar displacement,and tibial tuberosity-trochlear groove distance(TTTG) were measured in transverse fat-suppressed turbo spin-echo proton density-weighted MR images.Independent sample t test or Mann-Whitney U test were used to compare the differences of these measurements.ROC was used to calculate the area under curve(AUC) and to define the diagnostic threshold value of each measure.Results Trochlear facet asymmetry,lateral trochlear inclination,and trochlear depth in patients were 45.0％±9.2％,10.9°±5.0° and(3.7±1.3) mm,while these measurements were 68.0％±10.5％,21.1°±3.4° and (6.3 ± 1.0) mm in volunteers.These measures were significantly lower in patients than those in volunteers (t values were 10.123,10.862 and 9.835,P＜0.01).Patellar tilt angle and lateral patellar displacement were significantly higher in patients than those in volunteers(24.8°±9.0° vs.12.3°±5.2°,7.36 mm vs.-3.93 mm,t value and Z value were-7.657 and-6.953,P＜0.01).TTTG showed no significant difference between the 2 groups(P=0.798).AUC of trochlear facet asymmetry,lateral trochlear inclination,trochlear depth,patellar tilt angle,and lateral patellar displacement were 0.957,0.957,0.947,0.921 and 0.961,respectively.The recommended diagnostic threshold values for these 5 measures were＜55％,＜15°,＜5 mm,＞17° and＜3 mm,respectively.The sensitivity for these five measurements were 91.2％ (31/34),85.3％ (29/34),91.2％ (31/34),82.4％ (28/34) and 79.4％ (27/34),respectively.The specificity for these five measures were 91.3％ (42/46),97.8％ (45/46),89.1％ (41/46),89.1％ (41/46) and 100.0％ (46/46),respectively.AUC of TTTG was 0.520.Conclusions At full extension of the knee,trochlear facet asymmetry,lateral trochlear inclination,trochlear depth,patellar tilt angle and lateral patellar displacement are all effective in evaluating patellofemoral instability.The diagnostic value of TTTG is relatively poor.

AIM: To investigate the effect of high concentration of chlorine gas(Cl 2) exposure on lung haemodynamic and respiratory function in intact and isolated perfused rabbit lungs (IPLs). METHODS: 8 intact and 10 IPLs were exposed to Cl 2 at high concentration(50?10 -4 )for 20 min, as measured group, 8 additional intact and 9 IPLs, which were similarly treated but not exposed to Cl 2, served as controls. The changes of lung weigh of IPL(△W)?pressure of pulmonary artery(Pa)and venous pressure(Pv)?airway pressure and tidal volume(TV) were continuously measured and recorded simultaneously. RESULTS: In IPL group: While the perfusing blood flow was kept constant (133.3 mL/min), and Pv did not change, following the exposure, the Pa increased slightly, then the lung weight were increased significantly and the TV decreased . Hematocrit of perfusate of EIPL and parameters of lung water increased also. In intact group : Pa increased slightly, respiratory rate accelerated immediately, and TV decreased. CONCLUSION:Although mean Pa increased continuously and slightly in both intact and IPL group following the exposure to high concentration of Cl 2, the primary cause of edema was most likely to alter pulmonary capillary permeability. The respiratory rate accelerated and TV decreased due to exposure to Cl 2 enhanced hypoxia of intact rabbits.

Objective:To investigate the correlation between body composition and cardiovascular disease (CVD) in patients with chronic kidney disease (CKD).Methods:CKD patients who were hospitalized in the Department of Nephrology of Chongqing General Hospital from January 2017 to December 2019 and had complete clinical biochemical data were divided into CKD patients with CVD and CKD patients without CVD according to their medical history and corresponding auxiliary examinations. Clinical data were collected and anthropometric measurements were conducted. Skeletal muscle index (SMI), appendage lean mass/height 2, total body fat (TBF), visceral adipose tissue (VAT), bone mineral capacity, bone mineral density and et al, were measured by dual-energy X-ray absorptiometry. T test, U test and Chi-square test were used for statistical analysis. Logistic regression was used to analyze the relationship between body composition and CVD. Results:A total of 604 CKD patients were included in this study, including 560 patients (92.7%) with CKD stage 3, 44 patients (7.3%) with CKD stage 4, and 180 CKD patients with CVD (29.8%), 424 CKD patients without CVD (70.2%). Compared with CKD patients without CVD, the proportion of men, the proportion of hypertension, the proportion of diabetes, age, duration of CKD, systolic blood pressure, blood uric acid, waist to hip ratio and waist circumference were higher (all P<0.05), while low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, and estimated glomerular filtration rate (eGFR) were lower in CKD patients with CVD (all P<0.05). In terms of body composition, SMI ( t=-11.964, P<0.001) and body mass index ( t=-4.462, P<0.001) in CKD patients with CVD were significantly lower than those in CKD patients without CVD, but VAT ( t=3.089, P=0.002) and TBF ( t=5.177, P<0.001) in CKD patients with CVD were significantly higher. After adjusting for confounders such as age, CKD duration, hypertension history, diabetes history, LDL-C, body mass index, eGFR, TBF, etc. by multivariate logistic regression analysis, the risk of CKD patients suffering from CVD increased significantly with the decrease of SMI [with SMI high tertile (36.37%-50.80%) as reference, SMI middle tertile (28.23%-36.31%): OR=1.49, 95% CI 1.24-1.71, P=0.003; SMI low tertile (15.28%-28.19%): OR=2.17, 95% CI 1.79-2.62, P<0.001], and VAT was not found to be associated with the risk of CVD in CKD patients ( P>0.05). Conclusion:Reduction of SMI is independently associated with CVD in CKD patients.

Objective To compare the transfection rate of AAV2-EGFP and AAV2/1-EGFP to human skin fibroblast(HFB).Methods Two recombinant adeno-associated viruses(AAV) encoding enhanced green fluorescent protein(EGFP) were constructed and transfected to HFB at multiple of infection MOI ranging from 104 to 106.Twenty-four hours after the infection,the expression rates of EGFP on cultured HFB were assessed by flow cytometry and the transfected cells were observed under fluorescence microscope.The killing effect of the virus on the infected cells was assayed by MTT.Results The transfection efficiency of AAV2-EGFP was increased as MOI increased.When MOI was 104,the transfection efficiency of AAV2-EGFP was 7.68%?1.18%;When MOI was 105,that was 52.12%?1.59%;When MOI was 106,that showed no significant increase.However,the transfection efficiency of AAV2/1-EGFP showed no obvious changes at any MOI.Conclusion AAV2 is more efficient than AAV2/1 in transfecting HFB,but neither AAV has a high transfection efficiency.

Objective To summarize the experience in transanal local excision (LE) for rectal cancer (RC). Methods The clinical data of 28 cases of RC treated by LE from 1988 to 1998 were analyzed retrospectively. Results In this series, five-year survival rate was 83.4?6.2%, and the local recurrence rate (LRR) was 17.8%. In well-differentiated carcinoma, 4 cases were convinced as local recurrence with a LRR of 17.4%(4/23); in moderately- differentiated carcinoma, one case with a LRR of 20.0%(1/5). The LRR in T 1 and T 2 group was 15.0% (3/20) and 25.0% (2/8) respectively. LRR was 16.7% (4/24) in patients with less than 1/3 bowel wall involved, LRR was 16.7%(4/24),whereas LRR was 25.0%(1/4) in more than 1/3 bowel wall involved group. In total bowel wall resection group the LRR was 16.7%(3/18) while in partial resection group was 20.0% (2/10). In patients with tumour size larger than 4 cm LRR was 22.2% (2/9), tumour size smaller than 4 cm LRR was 15.7% (3/19). Conclusion LE for RC might only be successfully performed in selected patients (T 1～T 2, N 0M 0, well or moderately-differentiated carcinoma,low RC within 6 cm from anal edge). The indications of transanal LE must be controlled strictly. Total excision of tumor and prevention of implantation of carcinoma are the main points in the prophylaxes of recurrence. Postoperative follow-up is needed in order to find local recurrence as early as possible.

Objective To investigate the value of the combined test in the diagnosis of thalassemia and iron deficiency anemia (IDA) .Methods From August 2013 to February 2015 ,36 patients with thalassemia ,34 patients with IDA ,and 30 healthy people who had undergone physical examination were enrolled in the study .The blood samples of those people were tested ,and items of the combined test included content of red blood cell volume(MCA) ,red blood cell volume distribution width(RDW) ,hemoglobin(Hb) electrophoresis and red blood cell(RBC) .Results The patients with IDA or thalassemia had reduced MCA and RBC fragile ,pa‐tients with IDA had increased RDW ,and patients with thalassemia had increased HbA2 ,compared with the control group the differ‐ences were all statistically significant(P<0 .05) .The sensitivity of RDW to IDA was 70 .6% ,and to thalassemia was 77 .8% ,the difference was not statistically significant (P> 0 .05) .The sensitivities of MCV ,Hb electrophoresis ,RBC fragility to thalassemia were 97 .2% ,88 .9% ,77 .8% respectively ,and the specificity were 80 .0% ,90 .0% ,83 .3% respectively .The sensitivities of MCA test combined with Hb electrophoresis ,hemoglobin electrophoresis combined with RBC brittleness test and parallel combined test of MCA ,Hb electrophoresis and RBC brittleness to thalassemia were 100 .0% ,97 .2% ,100 .0% respectively ,which were significantly higher than those of single tests ;the specificities were 96 .7% ,100 .0% and 100 .0% respectively ,which were significantly higher than those of single tests ;the differences were statistically significant(P<0 .05) .Conclusion The application of hematological pa‐rameters ,Hb and RBC in the diagnosis of anemia and IDA could significantly improve the diagnostic accuracy ,and it is worthy of popularization and application .

Objective To evaluate the effect of epidural block on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 65-75 yr,with preoperative Mini-Mental State Examination (MMSE) score ＞ 23,scheduled for elective laparoscopic radical operation for gastric cancer under general anesthesia,were randomized into epidural block group (group E,n =30) and control group (group C,n =30) using a random number table.Epidural block was performed at T8,9 interspace before induction of anesthesia.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg,propofol 1.0-1.5 mg/kg,fentanyl 3-4 μg/kg and rocuronium 0.9 mg/kg.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of remifentanil 0.15-0.25 μg· kg-1· min 1 and propofol target-controlled infusion (target plasma concentration 2.5-3.0μg/ml).In group E,10 ml of mixture of 0.25％ ropivacaine and 0.04 mg/ml butorphanol was injected via the epidural catheter at 30 min before skin incision.In the two groups,the mixture 10 ml mentioned above was administered via the epidural catheter at 10 min before the end of operation followed by patientcontrolled epidural analgesia.The development of postoperative cognitive dysfunction (MMSE score ＜ 21) was recorded within 72 h after operation.Blood samples were collected from the internal jugular vein to detect the concentration of serum protein S-100β.Results The concentration of serum protein S-100β was significantly lower at 6,12 and 24 h after operation,and the incidence of postoperative cognitive dysfunction within 72 h after operation was lower in group E than in group C (P ＜ 0.05).Conclusion Epidural block can decrease the development of postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia.