Accidents, Traffic ; statistics & numerical data ; Adolescent ; Adult ; Female ; Humans ; Injury Severity Score ; Male ; Maxillofacial Injuries ; epidemiology ; physiopathology ; prevention & control ; Young Adult

The 2010 Chinese guidelines for the management of hypertension is an update of the previous versions in 2005 and 1999. A guideline committee of nearly 100 members appointed by the Chinese Hypertension League (CHL) and the National Centre for Cardiovascular Disease (NCCD), in collaboration with the Chinese societies of cardiology, nephrology, neurology, gynecology and endocrinology, convened on several occasions and discussed the guidelines, drafted by a core writing group. The prevalence of hypertension has been increasing in China for decades, and reached 18.8% in the year 2002. The rates of awareness, treatment and control for hypertension patients remain low compared to high income countries, in spite of substantial improvements since 1991. In some communities, the control rate of hypertension increased up to 60%. The mortality rate of stroke, which is the major complication of hypertension in the Chinese population, gradually decreased during the period, more so in urban areas than in rural areas for the middle-aged and elderly populations; in the younger age groups, however, it increased. As hypertension is a "cardiovascular syndrome", the management strategy should be based on the overall risk of cardiovascular disease estimated with all related risk factors, target organ damage and co-morbidity of patients. The target blood pressure is set at SBP/DBP < 140/90 mm Hg (1 mm Hg = 0. 133 kPa) in uncomplicated hypertension; < 150/90 mm Hg for the elderly (> or = 65 years) or, if tolerable, < 140/90 mm Hg; and < 130/80 mm Hg for those with diabetes, coronary heart disease or renal disease. For these high risk patients, the management should be individualised. In general, lifestyle modification, such as sodium restriction, smoking cessation, moderation of body weight and alcohol consumption, and increasing dietary potassium intake and physical activity, should be implemented for prevention and control of hypertension. Five classes of antihypertensive drugs, including calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin type II receptor blockers, diuretics and beta-blockers, as well as single pill combinations of these agents, can be used for initial and maintenance of antihypertensive treatment. Several populations require special attention in the prevention and control of hypertension, such as children and adolescents, the elderly, pregnant women, and patients with various cardiovascular complications. Since health-care policies and resources vary substantially from one place to another, two levels of recommendations of management are proposed: a sophisticated and a basic, allowing doctors-in-charge to manage their patients in a more feasible way.
China ; Humans ; Hypertension ; prevention & control

Objective To identify the role of autopahgy in the protective mechanism of heme oxygenase 1(HO-1) against hepatic ischemia/reperfusion (I/R) injury.Methods Forty healthy male Sprague-Dawley (SD) rats were randomly (random number table) divided into five groups (n =8 in each group),namely sham group,model group,cobalt protoporphyrin (CoPP) group,zinc protoporphyrin (ZnPP) group and 6-amino-3-methylpurine (3-MA) group.Partial hepatic I/R model was established by clamping the pedicles of left and median lobes for 1 hour and reopening for 6 hours in rats,and the rats in sham group were only received celiotomp without hepatic I/R.In the CoPP group,CoPP (a HO-1 inducer,5 mg/kg) was administered i.p 24 hours before I/R.In the ZnPP or 3-MA group,besides pretreatment with CoPP,the rats were given ZnPP (a HO-1 inhibitor,25 mg/kg) or 3-MA (an autophagy inhibitor,30 mg/kg) i.p 1 hour before I/R.Serum alanine aminotransferase (ALT) was determined with automatic biochemistry analyzer.The hepatic pathological scores (PS) were determined under light microscope using hematoxylin-eosin (HE) staining.The hepatocyte apoptosis index (AI) was assessed with terminal dexynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining.Autophagosomes in liver tissue were counted under electron microscope.The mRNA expressions of HO-1,caspase-3,Beclin-1 and Atg-5 in the liver were determined by reverse transcription-polymerase chain reaction (RT-PCR).The HO-1 activity was also measured by the generation of bilirubin with the method of double-wave spectrophotometry.Results Compared with the sham group,the level of serum ALT significantly increased in the I/R group (U/L:560.3±73.6 vs.49.1 ± 13.8,P ＜ 0.01),HE staining showed a severe hepatic injury (PS:12.0±2.0 vs.1.3±0.9,P ＜ 0.01),TUNEL staining showed a higher hepatocytes apoptosis and the expression of caspase-3 significantly increased [AI:(19.38±3.07)％ vs.(3.25±1.28)％,caspase-3 mRNA (2-△△CT):4.62±0.40 vs.1.05±0.15,both P ＜ 0.01].However,there was no significant difference in the expression of HO-1 and the genes associated with autophagy between the two groups.In the CoPP group,the hepatic injury was blunted compared with that in the I/R group [ALT (U/L):223.3 ± 34.4 vs.560.3 ± 73.6,PS:5.6 ± 2.3 vs.12.0 ± 2.0,AI:(11.38± 2.39)％ vs.(19.38 ± 3.07)％,caspase-3mRNA (2-△△CT):2.42±0.33 vs.4.62±0.40,all P ＜ 0.01].HO-1 was induced in the CoPP group and autophagy was also increased significantly after I/R when compared with those in the I/R group [HO-1 mRNA (2-△△CT):3.01 ±0.71vs.1.14 ± 0.20,HO-1 activity (pmol ·mg-1 · h-1):259 ± 37 vs.113 ± 26,the number of autophagosomes:8.75 ± 0.87 vs.1.25±0.71,Beclin-1 mRNA (2-△△CT):2.85±0.28 vs.1.15±0.11,Atg-5 mRNA (2-△△CT):2.44±0.25 vs.1.14±0.12,all P ＜ 0.01].In the ZnPP group,the activity of HO-1 was much lower than that in the CoPP group,and as a result autophagy was decreased and liver injury was increased.In the 3-MA group,although there was no difference in the activity of HO-1 compared with that in the CoPP group,autophagy was inhibited,and the protective effect of CoPP was eliminated.Conclusion HO-1 could regulate the level of autophagy during liver I/R,and in turn autophagy might mediate the protective effects of HO-1 against liver I/R injury.

Objective To evaluate the methods and outcome of laparoscopic degradable bio-patch repair of umbilical hernia in adults. Methods From January 2003 to October 2008, 21 adult patients underwent elective laparoscopic patch repair of umbilical hernia. There were 15 women and 6 men. The mean age was 56 years old (range of 36-73). The diameter of hernia ring was from 3 to 7.5 cm averaging at 5.2 cm. All patients received general anesthesia. Preoperative bowel preparation routinely started one day before the operation. The patients received prophylaxis systemic antibiotics 30 minutes before the operation. An appropriate size of prosthetic patch (Composix E/X, Bard, USA) was that extended the defect margin for about 3-5 cm. The mesh was then inserted into the peritoneal cavity and spreaded flattening, with the polyplypylene side facing outside and it's center coinciding with that of the defect. The mesh was fixed to the abdominal wall with staple tacks in two rings, which was 3-5 cm along the hernia ring and 1-2 cm along the edge of the mesh. Results There was no conversion to open repair. The operative time was 30 to 96 rain and the average was 52 min. Two patients suffered from a transient postoperative tympanites and which subsided 2 to 3 days after the operation. One patient had a severe pain in the repair area around the umbilical and underwent oral medicine treatment, which disappeared one week after operation. There was no seroma and incision or mesh infection occurred. The postoperative hospital stay was 3 to 8 days and the average was 4. 2 days. The follow-up time was 3 months to 5 years and the average was 32 months. No ileus or hernia recurrence during the follow-up. Conclusion Laparoscopic patch repair of umbilical hernia in adults is a safe and effective procedure.

0.05).Thirty-four cases of newly diagnosed children with CR rate was 88.2% (30 cases).Which the expression of PRAME gene,WT1 gene were both positive and negative groups of children with CR rates were 62.5% and 100.0%,there was no significant difference between the 2 groups(P

Electromyography ; Electrophysiology ; Genetic Testing ; Humans ; Neuromuscular Diseases ; diagnosis ; genetics

Objective To evaluate the therapeutic effectiveness of echo-guided percutaneous radiofrequency ablation(RFA) by using a LeVeen needle electrode combination in the treatment of large liver tumor,and to discuss the relationship between the amount as well as the distribution pattern of the electrodes and the therapeutic effectiveness.Methods During the period of Feb.2006-Dec.2008,echo-guided RFA was performed in 113 patients with large and unresectable liver tumor,with a total of 118 lesions.According to the size of the tumor,the patients were divided into four groups.The tumor’s diameter of Group A(n = 64) was 4.0-5.0 cm,Group B(n = 28) was 5.1-6.0 cm,Group C(n = 11) was 6.1-7.0 cm and Group D(n = 10) was 7.1-9.3 cm.Based on the tumor’s diameter,the amount of the electrodes to be used and the sites to be ablated were determined.After the procedure,the follow-up checks with MRI or CT scanning were carried out to observe the necrotic extent and the local recurrence.Results Two months after the treatment,the complete necrosis rate of the tumor in Group A,B,C and D was 88.4%,78.6%,63.6% and 40.0%,respectively,with an overall necrosis rate of 79.7% in total 118 lesions.During a follow-up period of 3-36 months,the local recurrence rate in Group A,B,C and D was 5.5%,10.0%,28.6% and 50.0%,respectively.Severe complications,including intrahepatic infection(n = 2),puncture passage bleeding(n = 1),symptomatic pleural effusion(n = 4) and biloma(n = 2),occurred in 9 cases.No death related to RFA treatment occurred.Conclusion Echo-guided percutaneous radiofrequency ablation by means of multi-sites superimposition method with a LeVeen needle electrode combination is an safe and effective therapy for the hepatic tumors with the diameter over 4 cm.

Objective To evaluate the effects of anterior approach preperitoneal repair for inguinal hernia with modified Kugel mesh.Methods Clinical data of 35 cases receiving inguinal hernia repair with modified Kugel mesh from May 2004 to June 2006 were reviewed.The critical surgical procedures:the hernial sac was dissected at high position,then reversed and reduced into abdominal cavity;a 10 cm?10 cm preperitoneal space was dissociated around the internal ring,into which a modified Kugel mesh was placed.The mesh was fixed to the conjoined tendon by superior tape,and to the shelving edge of inguinal ligament by inferior tape.Results The operation time was(47?10)min.No analgesic requirement in any case.The postoperative hospital stay was(6?4)days.All the wounds healed uneventfully without any seroma or infection.No recurrent case was found in the follow-up of 1-25 months(mean:13.2 months)in the 35 cases.Conclusions Modified Kugel mesh used in inguinal herniorrhaphy causes less pain and swelling response to the wound,therefore it is quite suitable for repairing Ⅲ and Ⅳ type hernia.

Objective To evaluate the safety、feasibility and the long-term effectiveness of polyurethane stent placement for treatment of nasolacrimal duct obstruction. Methods Fifty-three cases (64 eyes) with complete nasolacrimal duct obstruction received the lacrimal stent placement. Dacryocystography was performed before and after the procedure. The average follow-up period was 48.3 months (range, 13-78months), the long-term patency and the effectiveness after stents removal were analyzed. Results Stent placement was technically successful in 62eyes, and the success rate was 96.9% with no severe complications. On long-term follow up, the stent patency rate was 76.8% at 1 year. However, it decreased to 33.3% at 3 years and 28.6% at 5 years. Nine stents were removed when the symptoms recurred, including granulation tissue in 4 stents and mucous material in 5. After removal, 2 nasolacrimal ducts were patent, and 2 kept patent after stents replacement, but all reoccluded within 6 months. Conclusions Interventional placement of polyurethane stent in the obstructed nasolacrimal duct is a simple and safe outpatient procedure, but the long-term patency is not encouraging, and the right stent removal time has not yet been approved.

Objective To study the method of internal boundary parameters identification of middle ear.Method The numerical model is created using CT technology.Based on Matlab tools,the neural network for identifying internal boundary is proposed.Result The uniform pressure of 105 dB is applied at the outside of the tympanic membrane,and the harmonic analysis is calculated on the model to take the training samples.The internal condition parameters are identified using the good neural network.Conclusions The investiga-tion shows that the inverse method reveals a fast convergence and a high degree of accuracy.