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 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 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.

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 evaluate the efficacy of vitreoretinal surgery for the treatment of complicated rhegmatogenous retinal detachment and to study the correlated factors affecting the surgical outcomes. Methods Complete follow up data from 103 patients (eyes) with complicated rhegmatogenous retinal detachment treated with vitreoretinal surgery were analyzed retrospectively. Conditions of the eyes included macular hole in 21 eyes [with proliferative vitreoretinopathy (PVR) stage C2 or more serious in 12 eyes], giant hole in 11 eyes, and PVR stage C2 to D3 in 71 eyes. Filling with C3F8 was performed in 82 eyes, and silicone oil in 21 eyes. A follow up for 3-18 months was conducted. Results The reattachment of retina was achieved in 99 eyes (96.1%) and functional success in 68 eyes (66.0%). In eyes with functional success, visual acuity of 0.02-0.08 was achieved in 18 eyes, 0 1-0 4 in 39 eyes, 0.5-0.9 in 10 eyes, and 1.0 in 1 eye. Conclusion Vitreoretinal surgery is an effective way for the management of complicated rhegmatogenous retinal detachment. Early surgery may result in satisfactory surgical outcomes.

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.

Objective To develop the method for simultaneous identification and quantification of morphine,6-monoactylmorphine,codeine,heroin,ketamine,3,4-Methylenedioxyamphetamine (MDA),3,4-methylenedioxymethamphetamine (MDMA),amphetamine and methylamphetamine in human plasma.Methods UPLC-MS/MS was adopted to analyze plasma with protein precipitated using 10％ trichloroacetic acid.Plasma samples were separated on ACQUITY UPLC HSS C18 column with aqueous solution (0.01％ formic acid)-methanol (0.01％ formic acid) as the mobile phase,and at a flow rate of 0.3 mL·min-1.The multiple reaction monitoring (MRM) mode was performed combined with the positive ion mode for quantification in four sections.Results The retention time,the characteristic fragment ions,and the relative abundance ratio of the molecular ion peak could be used to identify these nine compounds sensitively.The liner calibration curve of morphine,codeine,heroin,ketamine,6-monoacetylmorphine,MDA,MDMA,amphetamine and methamphetamine were obtained in the concentration range of 5.00×10-3～5.00 (r=0.9934),1.00× 10-2～ 10.00 (r=0.9905),1.00× 10-2～ 10.00 (r=0.9929),2.50× 10-3 ～2.50 (r=0.9960),5.00× 10-3 ～ 5.00 (r=0.9925),5.00× 10-4 ～ 5.00 (r=0.9910),5.00× 10-4 ～ 5.00 (r=0.9924),5.00× 10-4 ～ 5.00 (r=0.9920) and 5.00×10-4～5.00 μg·mL-1 (r=0.9900) respectively.The lowest detection limit was 1.00,1.00,1.00,0.50,0.50,0.10,0.10,0.10 and 0.10 ng· mL-1 respectively.The relative standard deviation (RSD) of the inter-day and intra-day were less than 18％.The relative recovery was more than 60％,and the RSD were less than 15％.Conclusion The method is accurate,sensitive and suitable for identification and quantification of 9 drugs of opiates,ketamine and amphetamines in human plasma.

Objective To compare the effect of water-infusion colonoscopy and conventional air-infusion colonoscopy on the bowel cleanliness during withdrawing.Methods A single blind randomized controlled trial was conducted. 222 patients were randomly divided into water-infusion group (group A, 112 cases) and air-infusion group (group B, 110 cases). The cleanliness scores, scores improvement, pain scores, time of reaching cecum, depth of colonoscopy, rate of whole colon examination, adenoma detection rate (ADR), operator’s dififculty and complications were compared between the two groups.Results The cleanliness score during withdrawing was higher in group A [M(8)/IQR(1) vs M(8)/IQR(2),P = 0.000], the improvement was higher in group A [(0.53 ± 0.74) vs (0.23 ± 0.55), P = 0.000], the abdominal pain score was signiifcantly lower in group A [M(2)/IQR(1) vs M(4)/IQR(2),P = 0.000] and the ADR was higher in group A (36.61 % vs 23.64 %,P = 0.041). The operator’s dififculty evaluation score was signiifcantly lower in group A [M(1)/IQR(1) vs M(2)/IQR(1),P = 0.005]. There were no signiifcant differences at the time of reaching cecum, the depth of colonoscopy and the whole colon examination rate between the two groups.Conclusion Water-infusion colonoscopy could signiifcantly improve the bowel cleanliness during withdrawing scope, improve the ADR and reduce abdominal pain of patients, without increasing the time to reach cecum.

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.

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.