Objective To investigate the clinical diagnosis and treatment strategies for retroperitoneal paragangliomas and to enhance the diag?nostic and therapeutic levels of retroperitoneal paragangliomas. Methods The clinical data of 49 patients having retroperitoneal paragangliomas were retrospectively analyzed. We studied 21 males and 28 females between an age range 17 and 72 years(mean 45.6 years). Hypertension was observed in 19 patients,9 patients suffered from lumbago or abdominal pain,and an abdominal mass was noted in 2 cases. Physical examination re?vealed paragangliomas in 17 patients. The positive rate of localization was 77.5%(31/40),96.0%(47/49),and 100%(10/10)using B?ultra?sound,computed tomography,and MRI respectively. Serum catecholamines were measured in 19 patients,of which 16 cases(84.2%)showed ele?vated levels. Results In our study,49 patients underwent open surgery,5 patients showed multiple tumors,and 56 tumors were found during sur?gery. The most common tumor location was periaortic and pericaval(71.4%,40/56). There were 51 cases of surgery in 49 patients. 54 tumors of 49 cases were totally resected. The tumors measured 1.5?20.0 cm in diameter with a mean diameter 6.7 cm. 75%tumors had integral pelos,14.2%(8/56)invaded the surrounding organs and vessels,and 10.7%(6/56)required resection of adjacent organs. We followed up 43 patients between 6 and 138 months after surgery. Postsurgical recurrence was noted in 4 patients,and 2 patients developed metastases. One patient died from metas?tasis during the follow?up period. Conclusion Surgical resection might be the most effective method for treatment of retroperitoneal paraganglio?mas. Sufficient preoperative and perioperative management might be the key point of successful surgery. Lifelong follow?up is important as recur?rent tumors need resection.

Objective To observe the incidence of orthostatic hypotension and hypertension in the elderly hypertensive inpatients and investigate the effect of antihypertensive medication on the orthostatic blood pressure changes in the elderly hypertensive inpatients.Methods A total of 185 aged hypertensive inpatients was divided into elderly group(n =126,60～79 years old) and very elderly group(n =59,≥80 years old) according to the age.The orthostatic blood pressure was measured in supine position and after standing.Subjects were divided into 3 subgroups:orthostatic hypotension (OH),orthostatic hypertension (OHT),and orthostatic normotension (ONT) groups according to the standing blood pressure levels.Clinical characteristics of each subgroup were evaluated and analyzed according to the antihypertensive medication.Results Among 185 patients,the OH incidence was 31 (16.76％) cases,the OHT incidence was 23 (12.43 ％) cases,and the ONT incidence was 131 (70.81％) cases.There were 16 (12.70％) patients with OH and 10(7.90％) patients with OHT in elderly group,but 15 (25.42％) patients with OH and 13 (22.03％) patients with ONT in very elderly group.The prevalence of OH and OHT in each elderly group was both higher than elderly group (P ＜ 0.05).Antihypertensive medications such as Calcium channel blockers,angiotensin Ⅱ receptor-blockers,Beta-blockers,diuretics,and angiotensin converting enzyme inhibitors were not significantly different among three subgroups.Conclusions OH and OHT were common in the elderly hypertensive inpatients,especially in the very elderly people.The five-class antihypertensive medication that doctors commonly used at present might be not related to the orthostatic hypotension and hypertension.

Objective:To evaluate the effects of several kinds of surface treatment methods on the bond strength of zirconia prosthesis,and to provide references for improving the bond strength of zirconia prosthesis.Methods:Sixty zirconia blocks(10 mm×10 mm×2 mm) were divided into 6 groups according to the surface treatment methods:sandblasting,silica coating,Z-PRIME Plus,sandblasting+Z-PRIME Plus,sandblasting+silica coating,and silica coating+Z-PRIME Plus groups.The zirconia-resin specimens were fabricated using ScotchbondTM Universal;shear bond test was performed to detect the shear bond strength after treated with water storage(37℃) for 24 h by universal mechanical testing mechine;the fracture types were observed by stereoscopic microscope.One fracture specimen was randomly chosen from each group,and the morphology of the specimen was examined under scanning electron microscope.Results:The shear bond strength of the specimen in Z-PRIME Plus group was higher than those in the other groups(P<0.05).The adhesive failure was predominantly observed in sandblasting,silica coating,sandblasting+silica coating and silica coating+Z-PRIME Plus groups.There were 4 cases of mixed failure in Z-PRIME Plus group and there were 8 cases of mixed failure in sandblasting+Z-PRIME group.No cohesive failure was observed in all the groups.The scanning electron microscope results showed that the fracture surface occurred on the resin-zirconia interface of the specimens in sandblasting group,Z-PRIME Plus group,and sandblasting+Z-PRIME Plus group.The silica-zirconia fracture of specimens occurred in silica coating group and silica coating+Z-PRIME Plus group.The silica-resin interface fracture of specimens partially occurred in sandblasting+silica coating group.Conclusion:The application of Z-PRIME Plus can significantly improve the bond strength between zirconia and resin.

Objective To explore the practical method and teaching effect of problem-based learning (PBL) pattern in teaching of gastrointestinal disease for seven-year-program students during their internal medical probation.Methods The traditional pattern (gastrointestinal diseases) and PBL pattern (hepatobiliary diseases) were applied in these students to assess the teaching effects by exam scores and questionnaire.Results ① There was no significant difference between traditional training and PBL by exam scores (P＞0.05).② The PBL approach was widely accepted by students,which could contribute to the improvement of their learning motivation.It developed skills,including self-directed learning,summarizing,and clinical thinking capability and so on.Conclusion The PBL approach is a practical learning strategy that can improve the teaching effect; therefore it should be wildly practiced in future works.

This study was aimed to observe the effect ofJia-Shen prescription (JSP) on angiotensinⅡ (AngⅡ) inhibition, ventricular remodeling in myocardial infarction (MI) rat model. The anterior descending coronary artery of Sprague-Dawley rat was ligated to establish the MI rat model. Rats were randomly divided into the 3 g JSP group, 6 g JSP group, losartan group, model group, and the sham-operation group. Intragastric administration of medication was given 24 h after MI. In the 3 g and 6 g JSP group, JSP was given at the dose of 3 g·kg-1·day-1 and 6 g·kg-1day-1, respectively. Losartan was given at the dose of 10 mg·kg-1·day-1 in the losartan group. Same volume of distilled water was given to the sham-operation and model group. Four weeks later, the left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), posterior wall thickness (PWT), left ventricular ejection fraction (LVEF), left ventricular fractional shorten (LVFS), left ventricular weight index (LVWI), the distribution and content of collagen, plasma brain natriuretic peptide (BNP) and the AngⅡ content in myocardial tissues homogenate were observed. The results showed that 4 weeks after MI, compared to the model group, 6 g PJP reduced myocardial infarct size, LVWI, LVEDD and LVESD, and enhanced LVEF and LVFS (P< 0.05). In ischemic regions, compared to the model group, JSP can obviously reduce the content of collagen (P < 0.05). This effect had dose-dependent relationship. Plasma BNP and AngⅡ content in myocardial tissues homogenate were also obviously lower than the model group (P< 0.05). It was concluded that JSP can improve the ventricular remodeling of MI rat model. Its action mechanism may be through the AngⅡ inhibition, in order to improve the early stage left ventricular morphological remodeling, myocardial fibrosis and cardiac contractile function.

Objective To investigate the effectiveness and safety of wound infiltration with rop-ivacaine for postoperative analgesia as a fast-track approach in patients undergoing open hepatectomy. Methods Fifty-two patients with hepatocellular carcinoma,32 males,20 females,aged 18-70 years, scheduled for selective open hepatectomy were enrolled in this trible-blind,randomized,controlled study.Patients were randomized to receive 0.75% ropivacaine (group ROP)or 0.9% normal saline (group NS)wound infiltration before incision closures at a total volume of 10 ml.Numerical rating score (NRS)at 6,12,24 and 48 hours after surgery,length of hospital stay,time to bowel recovery,ambulation and drainage tube extraction were recorded.Side effects, including post-operative liver and renal function,allergic reaction,nausea and vomiting,and wound infection,were also assessed.Results NRS was significantly decreased at 6 [(3.85±1.29)scores vs.(5.30±1.76) scores],12 [(3.38±0.85)scores vs.(5.69 ±1.38)scores]and 24 hours [(3.69 ±0.74)scores vs. (4.42±1.13)scores]after surgery in group ROP compared to group NS (P <0.05).Group ROP al-so showed shorter postoperative hospital stays [(1 7.92±1.97)d vs.(1 9.53±2.42)d],earlier anal exsufflation [(48.07±7.49)h vs.(53.42±10.38)h]and ambulation [(2.34±0.62)d vs.(2.80± 0.84)d](P <0.05).However,there were no significant differences between the two groups in re-garding post-operative liver and renal function.The incidence of nausea and vomiting was 1 5% (4 ca-ses)and 1 9%(5 cases)in group NS and group ROP,respectively.No allergic reactions occurred in either group.Conclusion The present study shows that ropivacaine wound infiltration could effectively release post-operative pain,and could be a safe and effective fast-track approach for patients undergoing open hepatectomy.

OBJECTIVE:To explore the method for promoting drug circulation management of online pharmacies. METH-ODS:Hazard analysis and critical control point (HACCP) was applied to identify the critical control points (CCPs) and explore the effective method for drug circulation management of online pharmacies. RESULTS & CONCLUSIONS:According to the HAC-CP principle,four CCPs of drug circulation management of online pharmacies are supplier qualification,acceptance method,main-tenance and storage scheme and distribution system. It is suggested to adopt correct measures of drug circulation quality manage-ment of online pharmacy. Firstly,the supplier’s legal qualification should be determined and the quality of the drug should be regu-larly checked;secondly,drug retailers should improve the acceptance method of drugs and improve the sampling rate of drug;then,the three three four scientific conservation which required the medicine to be divided into three parts according to the pro-portion of 30%,30%,40% and checked monthly should be implemented to improve the storage and maintenance program;finally, the independent distribution system should be established to ensure the full process of the appearance inspection.

BACKGROUND: Inflammatory cells or inflammatory factors participate in the proliferation and differentiation of skeletal muscle satellite cells after denervation injury, and play an important role in the pathological process of skeletal muscle denervation. OBJECTIVE: To study the effects of passive training on skeletal muscle structure, function and expression of Actin and inflammatory factors in rats with denervated muscle atrophy. METHODS: Thirty Sprague-Dawley rats were randomly divided into sham operation group, model group and training group. In the model group and the training group, the sciatic nerve was exposed and cut off the sciatic nerve, while the sciatic nerve in the sham operation group was exposed but not cut off. Two months after modeling, rats in the training group underwent passive rehabilitation training with self-made drum for 2 months, and then the degree of muscle atrophy and motor function were evaluated by muscle wet weight ratio and Basso, Beattie and Bresnahan score. The muscle fiber fine structure and cross-sectional area were observed by hematoxylin-eosin staining, and the expression of Actin, tumor necrosis factor-α, interleukin-6 and interleukin-1β in each group was detected by immunohistochemical staining. The study protocol was approved by the Laboratory Animal Welfare Ethics Committee of Shenyang Medical College with the approval No. SYYXY2015010601. RESULTS AND CONCLUSION: The Basso, Beattie and Bresnahan score of the training group was higher than that of the model group. The wet weight ratio of the training group was higher than that of the model group; however, the cross-sectional area of the muscle fibers was lower than that of the model group (P < 0.001, P < 0.05). The expression of Actin in the training group was higher than that in the model group (P < 0.001), and the expression levels of tumor necrosis factor-α, interleukin-6 and interleukin-1β in the training group were lower than those in the model group (P < 0.001 or P < 0.05). To conclude, passive training can help to recover the muscle structure and function of denervated muscles, reduce the levels of inflammatory factors, prevent further muscle atrophy, and improve skeletal muscle strength.

Objective To establish a semi-quantitative method for measurement of HCV RNA by use of primers and probe, which was sensitive and designed by ourselves, a new europium fluorescent chelate BHHCT. Methods 44 serum samples of HCV infected patients and 20 samples of the healthy people were collected. HCV RNA in serum sample was extracted by HCV fluorescence PCR diagnostic kit produced by Zhongshan University DAAN Gene Co Ltd, and amplified by RT-PCR in which one PCR primer was pre-labeled with biotin. The amplified products were hybridized with capture probes pre-fixed on the microplate. The biotin in the amplified products was conjugated with europium labeled streptavidin. So europium was linked to the target DNA. Then the fluorescent of europium was measured. Results The linear range of this assay was 10 - 10 copies/ml. Both sensitivity and specificity were 100%. Conclusion Europium labeled RT-PCR assay is a sensitive, specific, fast and non-radioactive contaminant method for the measurement of HCV RNA.

Objective To investigatethe clinical value of troponin-I(cTnI)in patientswith septic shocka-nd left ventricular diastolic dysfunction. Methods As a retrospective analysis ,38 patients with left ventricular di-astolic dysfunction and septic shock(Sa group),as well as 20 patients with normal cardiac function(Sn group) were enrolled in this study. Moreover ,20 patients with left ventricular diastolic dysfunction and without septic shock were used as control group(Ca group). The ratio of early diastolic mitral inflow velocity to early diastolic mi-tral annulus velocity(E/e′)was measured as the evaluation index of left ventricular diastolicfunction by echocar-diography within 72 hours after admission to ICU. Level of cTnI was detected in all cases and the relationship was evaluated by E/e′. Receiver operating characteristic curve(ROC)was constructed to indicate the predictable value of left ventricular diastolic dysfunction in patients with septic shock. Results The level of cTnI was significantly elevated in both Sa group and Sn group(P<0.05),while the level of cTnI and E/e′in Sa group were significantly higher than those in Sn group(P < 0.05). cTnI was positively correlated with E/e′(r = 0.367 ,P = 0.004). The area under the curve(AUC)of cTnI was 0.834,with the cut-off value of 0.49 ng/mL(sensibility=77.6,specificity=80.7). Conclusion The level of cTnI was significantly higher in patients with septic shock. cTnI was significantly correlated to left ventricular diastolic dysfunction in patients with septic shock. cTnI ≥ 0.49 ng/mL could be an available predictor for left ventricular diastolic dysfunction in patients with septic shock.