Objective: To explore the diagnostic value of head-up tilt test with sublingual isosorbide dinitrate （HUTSI）in patients with vasovagal syncope (VVS). Methods: A total of fifty-two consecutive patients with clinically vasovagal syncope (VVS group) and thirty-eight control subjects without prior experience of syncope (normal control group) were evaluated by baseline head-up tilt table test (BHUT) , then the BHUT negative subjects underwent HUTSI test. . Results: (1) Positive BHUT test rate of VVS group and normal control group were 25% (13/52) and 0 respectively; from supine to HUT positive, there were significant decrease in heart rate [(73.1±8.5) times/min vs. (56.2±11.2) times/min] and mean arterial pressure [MAP, (81.2± 10.8) mmHg vs. (50.2±10.4) mmHg，P<0.05 both] in BHUT positive subjects. There were 21 HUTSI positive cases（53.9%）among the other 39 VVS patients, and two cases（5.3%）among the 38 subjects of normal control group. From supine to HUTSI positive, there were significant decrease in heart rate [(65.2±7.5) times/min vs. (52.9±10.5) times/min] and MAP [(78.3±10.7) mmHg vs. (48.8±11.2) mmHg, P<0.05 both] in HUTSI positive subjects. Duration from tilt started to positive reaction occurred in HUTSI positive group was significantly shorter than that of BHUT positive group [(10.8±9.3) min vs. (21.1±11.5) min，P<0.05]. All subjects can tolerate the test and only two cases in VVS group and one case in normal control group occurred headache and face red. Conclusion: Head-up tilt test with sublingual isosorbide dinitrate is a practical and easy-to- perform method with high sensitivity, specificity and few side effects for diagnosis of vasovagal syncope.

Objective:To compare influence of valsartan (Val) combined amlodipine (Am) or hydrochlorothiazide (Hyd) on blood pressure variability and quality of life in aged patients with hypertension .Methods:A total of 127 aged patients with hypertension stage 2 and 3 were randomly divided into Val + Am group (n=64) and Val + Hyd group (n=63) .Circadian rhythm and variability of blood pressure and quality of life were observed in both groups before and after treatment .Results:(1) After treatment ,the 24hSBP ,DBP ,SBPV , DBPV and daytime SBP , DBP ,SBPV ,DBPV ,and nighttime ,morning surge of SBP and DBP all significantly reduced in both groups;(2) Compared with Val+ Hyd group ,there were significant reductions in 24hSBP [(120.6 ± 10.2) mmHg vs . (110.9 ± 11.3) mmHg] ,daytime SBP [(120.6 ± 11.3) mmHg vs .(111.6 ± 11.37) mmHg] ,nighttime SBP [(118.5 ± 11.6) mmHg vs .(108.6 ± 11.9) mmHg] ,morning surge of SBP [ (26.2 ± 13.7) mmHg vs .(23.0 ± 10.4) mmHg] (P<0.05 or <0.01);24hSBPV [ (10.7 ± 2.2) mmHg vs .(8.2 ± 2.0) mmHg] ,daytime SBPV [ (10.4 ± 1.9) mmHg vs .(8.1 ± 2.1) mmHg] (P<0.01 all);significant rise in improved percentages of physical health ,mental health and total function in quality of life (P<0.05 or <0.01) in Val + Am group .Conclusion:Valsartan combined am-lodipine or hydrochlorothiazide can both effectively improve blood pressure variability and quality of life in aged pa-tients with hypertension ,and the effect of the former is even better .

Objective To better understand the role of CREB signaling pathway in chronic mild stress (CMS), we investigated the alteration of CREB and p-CREB in CMS rats with and without fluoxetine hydrochloride. Methods Fifty adult male Sprague-Dawley rats were randomly divided into three groups:CMS group (26), fluoxtine group (12) and con-trol group (12). The rats in CMS group and fluoxtine group received 8 weeks of chronic mild stress. Rats in fluoxtine group were administered daily injections of fluoxetine 10mg/kg I.P. Sucrose preference tests and open-field test were car-ried out after the 8th week. Based on endpoint sucrose-intake, animals were further divided into 4 groups:CMS sensitive group, CMS resilient group, fluoxtine group and control group. Western blot was used to detect the expression levels of CREB and p-CREB in the hippocampus and prefrontal cortex. Results The sucrose consumption was significantly de-creased in CMS resilience group compared to sensitive group, control group and fluoxetine-intervention group (all P<0.05). Similarly, the numbers in total arm entries, percentage of entries into open arms and time spent in open arms was significantly lower in CMS resilience group compared to control group(all P<0.05), but not different compared to CMS sensitive group(all P<0.05). The p-CREB in the hippocampus was significantly lower in CMS sensitive rat compared to CMS resilience group, control group and fluoxetine-intervention group(all P<0.05), but CREB was not dfferent among the four groups(all P<0.05). Conclusions The elevated phosphorylation of CREB in the hippocampus and prefrontal cortex of resilience CMS rats may contribute to the mood alteration induced by stress.