Objective To evaluate the efficacy of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in the treatment of idiopathic pulmonary fibrosis through the method of system evaluation. Methods A computer-based online search of Pubmed, Embase, Cochrane Library, CNKI, CBM and Wanfang were used for database retrieval. Revman 5.0 was used to assess the bias of the included studies. The Stata 14.0 was used to evaluate the extraction indexes of efficacy, p (O2), p (CO2), DLco, FEV1 and VC. GRADE score was used to evaluate the level of evidence. Results A total of 17 articles (related with 1381 patients) were included in this study, including 14 studies using ARB and 3 studies using ACEI. Compared with the control group ACEI and ARB drugs showed advantages in the treatment of pulmonary fibrosis (RR=1.34, 95%CI:1.24-1.44, Z=7.81, P<0.001). Auxiliary index analysis showed that the test groups were treated with enalapril (SMD=0.72, 95%CI:0.21-1.22, Z=2.77, P=0.006), telmisartan (SMD=3.86, 95%CI:2.44-5.27, Z=5.35, P<0.001), valsartan (SMD=1.94, 95%CI:1.33-2.55, Z=6.27, P<0.001) and captopril (SMD=0.60, 95%CI:0.11-1.09, Z=2.41, P=0.016), the p(O2) levels were significantly improved in patients ≥65 years old (SMD=0.76, 95%CI:0.52-1.00, Z=6.18, P<0.001) and patients < 65 years old (SMD=3.97, 95%CI:2.61-5.32, Z=5.73, P<0.001), and disease duration≥5 years (SMD=1.39, 95%CI:0.45-2.33, Z=2.89, P=0.004) and disease duration<5 years (SMD=3.26, 95%CI:2.06-4.46, Z=5.34, P<0.001) compared with those of control group (SMD=2.95, 95%CI:1.95-3.94, Z=5.82, P<0.001). The curative effect of telmisartan was better than that of other drug groups (P < 0.001), and which was much better for patients under 65 years old (P<0.001). There was no significant difference in the disease duration between two groups (P=0.307). The p (CO2) levels were significantly improved in patients treated with telmisartan [SMD=-12.94,95%CI:(-14.01)-(-11.86),Z=23.51,P<0.001), valsartan [SMD=-1.95,95%CI:(-2.56)-(-1.34),Z=6.29,P<0.001] compared with those of control group [SMD=-11.13,95%CI:(-17.03)-(-5.24),Z=3.70,P<0.001]. The effect of telmisartan was better than that of valsartan (P<0.001). In addition, values of DLco (SMD=0.64, 95%CI:0.45-0.83, Z=6.72, P<0.001), FEV1 (SMD=1.19, 95%CI:0.52-1.86, Z=3.47, P<0.001) and VC (SMD=0.51, 95%CI:0.16-0.85, Z=2.85, P=0.004) were improved in test group compare with those of control group. And the GRADE scores of relevant indexes were low quality to moderate quality. Conclusion ACEI and ARB can improve the efficacy, the p (O2) and p (CO2) in the treatment of pulmonary fibrosis. Patients with age<65 years old and treated with telmisartan have the best curative effect, and which is not related to the disease duration.

Objective: To summarize the characteristics of arrhythmia with the relevant factors affecting its prognosis in patients of apical hypertrophic cardiomyopathy (AHCM). Methods: A total 283 AHCM patients with echocardiography or cardiac magnetic resonance (CMR) conifrmed diagnosis in our hospital from 2005-01 to 2012-08 were summarized. The patients were divided into 2 groups: With arrhythmia group, n=103 and Without arrhythmia group,n=180. The endpoint event was followed-up by clinical and telephone visits in both groups and the relevant risk factors affecting AHCM prognosis were investigated by Cox regression analysis. Results: There were 269 patients ifnished the follow-up investigation, 98 in With arrhythmia group, 171 in Without arrhythmia group, and the death rate was 4.08% vs 1.17%, the occurrence of endpoint event was 18.37% vs 5.58%respectively. Cox regression analysis indicated that age (HR=23.051, 95% CI 1.08-1.068,P<0.005), left atrial diameter (HR=4.113, 95%CI 1.002-1.119,P=0.043) and NT-proBNP (HR= 18.653, 95% CI 3.433-26.650,P<0.005) were the independent risk factors affecting prognosis in AHCM patients. Conclusion: Arrhythmia is one of the common presentations of AHCM, it does not have much impact on survival, while it may cause ventricular ifbrillation and increase the occurrence of cardiovascular events.

Objective To evaluate the efficacy and safety of transurethral thulium-Yag laser(Tm-Yag Laser) resection of bladder tumor in the treatment of non-muscle invasive bladder cancer(NMIBC).Methods The clinical data of 186 patients who underwent transurethral resection with pathologically identified of NMIBC were retrospectively analyzed.76 cases and 110 cases were in the transurethral resection of bladder cancer Tm-Yag Laser group and TURBT group,respectively.The operative time,intraoperative blood loss,incidence of obturator nerve reflex,days for urethral catheterization,duration of hospitalization after surgery,detection rate of muscle layer in postoperative pathologic examination and recurrence between the two groups were compared.All patients were followed up for 24 months.Regularly gemcitabine intravesical instillation chemotherapy and cystoscopy were performed postoperation.Results The operative time [(27.08±5.56) min vs.(25.55±5.37) min,P>0.05]and intraoperative blood loss [(14.23±4.05) mL vs.(15.10±3.24) mL,P>0.05]showed no differences between the two groups.The incidence of obturator nerve reflex in Tm-Yag laser group was lower than that in TURBT group (0.0% vs.5.5 %,x2=4.28,P=0.038).The days for urethral catheterization [(3.48±1.05) d vs.(4.02±1.14) d,t=3.328,P=0.001]and the duration of hospitalization after surgery [(4.47±1.08) d vs.(5.02±1.13) d,t=3.350,P=0.001]in Tm-Yag laser group were significantly shorter than those in TURBT group.In Tm-Yag laser group,the detection rate of muscle layer in postoperative pathologic examination was higher than that in TURBT group(x2=14.96,P=0.001).The total rate of tumor recurrence in Tm-Yag laser group was significantly lower than that in TURBT group(13.2 % vs.25.5%,x2=4.18,P=0.041).Conclusion Transurethral Tm-Yag laser is safe and effective in the treatment of NMIBC.It can avoid the incidence of complications and reduce tumor recurrence rate,which is worthy of promotion.

Objective To investigate the clinical characteristics of the results of coronary artery CT angiography and coronary artery angiography in 36 patients with probable positive results of treadmill exercise test(TET).Methods Thirty-six patients due to chest pain received 1ET and coronary artery CT angiography and coronary artery angiography in 2 weeks after admission.The coronary plaques were categorized as noncalcified and calcified plaque on CTA images.Results In 36 patients with probable positive results of TET.23 patients were confirmed as coronary artery disease by coronary artery angiography,and the other 13patients had normal coronary artery.Of 23 coronary artery disease patients,9 patients were presented as onevessel disease,5 patients were presented as two-vessel disease,and 9 patients were presented as three-vessel disease,29 non-calcified plaques and 23 calcified plaques were demeted On CTA.Conclusion TET was useful in confirming the diagnosis of coronary artery disease.The characteristics of the coronary artery plaque is correlated with probable positive results of TET.

Objective To evaluate the effectiveness of the treatment of high risk benign prostatic hyperplasia (BPH) with transrectal high-intensity focused ultrasound (TR-HIFU) by urodynamic test. Methods One hundred and thirty patients with BPH, most of who suffering with diabetes mellitus,cardio-cerebrovascular disease, respiratory disease. All patients were given the operation with Sonablate-500 high-intensity focused ultrasound (HIFU). International prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), post void residual urine volume (PVR), pressure-flow tests (A-G) were employed for the evaluation of curatives effect on preoperation, 30th and 90th day after the treatment. Results The duration of the TR-HIFU prostate ablation treatment was 15-85 rain. One hundred and seven patients after treatment were followed up for 3 months. Compared the effect before treatment with that after treatment, IPSS improved from (27.0 ±11.5) scores to (8.5±1.4) scores, Qmax increased from (5.7±2.3) ml/s to (14.1±4.2) ml/s, PVR decreased from (118.5±78.0) ml to (30.0±15.0) mI,A-G parameters reduced from 62.4±19.3 to 25.6±13.0 and urine volume (VV) increased from (85.8 + 42.0) ml to (194.0±52.0) ml. The parameters all altered obviously (P < 0.05). Conclusions TR-HIFU appears highly attractive as a new optional, safe and efficacious and minimally invasive treatment for the high risk BPH. Main post-operative urodynamie parameters are more obviously improved than those of the preoperation.

Objective To analyze videourodynamic characteristics of female bladder outlet obstruction (BOO). Methods Retrospective analysis of videourodynamic characteristics were performed in 42 women with BOO. On the basis of the videourodynamic findings, women with BOO were categorized into five groups: bladder neck obstruction, middle urethra (urethral sphincter) obstruction, distal urethra obstruction, external orifice of urethra obstruction, high-grade pelvic organ prolapse. Data of five groups were compared in Qmax, maximum cystometric capacity, Pdet at Qmax, residual urine, detrusor instability and hydronephrosis. Data of all patients were analyzed by SPSS13 statistical software, measurement data by t-test and enumeration data by x2-test. Results Five groups had not significant deviation in the maximum cystometric capacity. however patients with bladder neck obstruction had significant deviation with others in Pdet at Qmax (78. 0 ± 23. 6)cm H2O, residual urine (120. 6±115.2)ml, Qmax (7.0±2.3)ml/s (P<0.05). There was significant deviation between middle urethra (urethral sphincter) obstruction(76.9%)and others in detrusor instability(P<0. 05). In all patients with hydronephrosis, bladder neck obstruction(57. 1 %) had significant deviation with others (P<0. 05). Conclusions Videourodynamic tests could assess lower urinary tract function, and may guide clinic management. The bladder neck obstruction was most serious and harmful to upper urinary tract.

Objective To analyze the clinical features, diagnosis, treatment and prognosis of neurosyphilis. Methods Clinical data on and laboratory findings in 18 cases with neurosyphilis collected in the Affiliated Provincial Hospital, Anhui Medical University from 2006 to 2008 were retrospectively studied.Results Among the 18 patients, 3 sufferred from asymptomatic neurosyphilis, 1 from meningeal syphilis, 7 from meningovascular syphilis, 5 from paralytic dementia, and 2 from intracranial space-occupation. Toluidine red unheated serum reagin test (TRUST) and Treponema pallidum particle agglutination test (TPPA) of sera were positive in all the patients; cerebrospinal fluid (CSF) TRUST was positive in 16 patients, and CSF TPPA in all patients. An increase was observed in CSF leukocyte count in 7 patients and in CSF protein in 13 patients.The findings on cerebral magnetic resonance imaging (MRI) mainly included demyelination, brain atrophy,cerebral infarction, etc. All the patients, except 2 with a TRUST titer of 1:4, experienced a 4-fold decrease in TRUST titer within a 3-month follow up. Clinical symptoms of neurosyphilis improved in all patients except 1 with paralytic dementia. Conclusions The diversity of clinical manifestations usually leads to the misdiagnosis of neurosyphilis, which should be diagnosed based on comprehensive analysis of clinical characteristics as well as laboratory and imaging findings. Early diagnosis and treatment are beneficial to its prognosis.

Objective To evaluate the efficacy of the suprapubic arch sling(SPARC)in female stress urinary incontinence by video-urodynamic tests.Method From January 2007 to October 2008,video-urodynamic tests,the pad test and ICI-Q-SF had been performed in all patients who received the SPARC before operation and 3,6 months after operation.Results Thirty-two cases of an effective follow-up for 6 to 20 months,31 patients were satisfied with urinary control,1 patient had mild urinary incontinence.Urodynamics:3,6 months after operation the maximum bladder capacity(MCC),residual urine(RU),detrusor pressure at maximum flow rates(Pdet,Qmax)were no statistical differences compared with those before operation(P＞ 0.05),3 months after operation,abdominal leak point pressure(ALPP)difference was statistically significant compared with that before operation(P =0.000),6 months after operation,the maximum urinary flow rate(Qmax),ALPP differences were statistically significant compared with those before operation(P values were 0.003,0.000).Static urethral pressure profile parameters before operation and 3,6 months after operation,the maximum urethral closure pressure(MUCP)was(35.2 ± 20.4),(53.1 ±22.5),(62.3 ± 19.8)cm H2O(1 cm H20 =0.098 kPa),respectively,functional urethral length(FUL)was (3.5 ± 1.3),(3.9 ± 0.9),(4.2 ± 1.1)cm,respectively,6 months after operation,MUCP,FU L differences were statistically significant compared with before operation(P values were 0.000 and 0.002).Conclusion Urodynamic evaluation by image,SPARC is one of the effective methods to treat the female stress urinary incontinence,the image within 6 months of urodynamic evaluation prompt surgery can increase urethral pressure,strengthen the control of urinary function,while no significant effect on bladder function.

OBJECTIVETo investigate the correlation between CT image presentations and biochemical indexes in adrenal adenomas and pheochromocytomas.

METHODSWe retrospectively analyzed the CT features, cortisol rhythm, supine and orthostatic hypertension and 24-h urine methoxy in 209 patients with benign adrenal tumors. The relationship between CT findings and the biochemical indexes were analyzed in patients with different benign adrenal tumors.

RESULTSThe 209 cases analyzed included 53 cases of cortisol adenoma, 65 cases of aldosterone adenoma, 45 cases of non-functional adenoma and 46 cases of pheochromocytomas. The plain CT scan values of the 4 groups were 17.25 ± 1.81, 14.52 ± 1.57, 12.20 ± 2.05, 42.42 ± 0.97 HU, enhanced CT values (arterial phase) were 47.82 ± 3.07, 39.23 ± 2.37, 45.35 ± 6.46, and 104.93 ± 5.84 HU, respectively, and the differences between CT scan and enhanced CT values were 30.58 ± 2.29, 24.71 ± 1.55, 33.15 ± 5.18, and 62.51 ± 5.73 HU, respectively. In cortisol adenoma group, cortisol levels measured at 16:00 and 24:00 were positively correlated with plain CT scan value (r=0.506, P=0.0001; r=0.504, P=0.0001) and enhanced CT value (r=0.514, P=0.0001; r=0.554, P=0.0001). In pheochromocytoma group, plain scan CT value and the difference between plain and enhanced CT scan value were correlated with 24-h urine methoxy adrenaline (Rho;=0.342, 0.350; P=0.020, 0.017, respectively) and norepinephrine (Rho;=0.419, 0.412; P=0.004, 0.004, respectively).

CONCLUSIONPlain and enhanced CT scan values and their combination have important value in differential diagnosis of adenoma and pheochromocytoma tumor, CT values combine with biochemical indexes can reduce misdiagnosis and missed diagnosis of pheochromocytoma.

Adenoma ; chemistry ; diagnosis ; Adrenal Gland Neoplasms ; chemistry ; diagnosis ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Hydrocortisone ; Hypertension ; Pheochromocytoma ; chemistry ; diagnosis ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To determine whether an increased number of transrectal biopsy cores improves the accuracy of biopsy Gleason score. Methods This study reviewed a total of 86 patients who were diagnosed as prostate cancer by transrectal needle biopsy and subsequently underwent radical prostatectomy (RP) without neoadjuvant therapy.The rate of grading concordance between biopsy and RP specimens was analyzed by dividing these patients into 2 groups according to the biopsy cores:group A,46 patients who underwent transrectai biopsy sampling of 6 cores,and group B,40 patients who underwent biopsy sampling of 13 cores. Results The concordance between prostate biopsy and radical prostatectomy Gleason score was 65.0%and 34.8% for 13 core and 6 core biopsy,respectirely (P＜0.05).Furthermore,these findings tended to be more prominent as the biopsy Gleason score was lower.Multivariate analysis identified the number of biopsy cores and percent of positive biopsy cores as independent predictors of accurate Gleason grading regardless of other parameters examined in this study. Conclusion Extended needle biopsy may increases the accuracy of biopsy Gleason score for assessing final prostate cancer grade.