Objective: To explore the effect of valsartan on inflammatory cytokines in patients with hypertension combining paroxysmal atrial ifbrillation (PAF).
Methods:A total of 60 patients with hypertension combining PAF converted to sinus rhythm were studied and the patients were divided into 2 groups. Control group, the patients received felodipine and Valsartan group. n=30 in each group, all patients were treated for 6 months. In addition, there was a Normal group including 30 healthy subjects. The levels of high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and left atrial diastolic diameter (LADd), the sinus rhythm maintenance rate were examined and compared before and after treatment among different groups.
Results: Compared with Normal group, the levels of hs-CRP, IL-6 and LADd were obviously higher in patients at both Control group and Valsartan group, all P<0.01. With 6 months of treatment, the levels of hs-CRP, IL-6 and LADd were decreased in both groups of patients than they were before, all P<0.01;compared with Control group, such effects were more obvious in Valsartan group, all P<0.01. The sinus rhythm maintenance rate in Valsartan group was signiifcantly higher than that in Control group, P<0.05.
Conclusion: Valsartan may inhibit inflammatory response and improve atrial structure remodeling, therefore better maintain the converted sinus rhythm in patients with hypertension combining PAF. The anti-inlfammatory effect of valsartan might be independent from its anti-hypertension effect.

Objective To evaluate the efficacy and safety of sorafenib in combination with interferon-alpha(IFN-α)as the first-line treatment in patients with advanced renal cell carcinoma.Methods Since Dec 2007 to Jun 2008,137 legal patients with advanced renal cell carcinoma (RCC)were enrolled in the trail from 22 hospitals in China.All the patients continuously received the treatment of sorafenib plus IFN-α untill disease progressed or patients were unable to tolerate.The primary end points were objective response,disease control rate and adverse effects rate.Results This interim analysis was based on the data collected from the study initiation date to 2009/3/20.The overall response rate(ORR),including complete response (CR) and partial response(PR),was 32.8%(45/137).The median follow-up time was 11.9 months,only 25 patients progressed at the cut off time.The most common adverse events were hand-foot skin reaction(48.2%),alopecia(23.4%),rash (20.4%),diarrhea(19.7 0A),fever(16.8%),lassitude(10.2%),etc.The incidence of 3 or 4 grade hand-foot skin reaction was 8.8%.Conclusions Sorafenib in combination with IFN-α as the firstline treatment in patient with advanced RCC could be effective and safe.

Objective: To observe the clinical effect of tuina plus medications on infantile diarrhea induced by rotavirus infection. Methods: After 55 cases of confirmed sick infants were divided into two groups by the order of their visits, 30 cases in the medication group were treated by intravenous infusion of Ribavirin and oral administration of Smecta; 25 cases in the tuina plus medication group were treated by the manual techniques of tonifying Pijing(脾经) and clarifying Dachangjing (大肠经), rubbing the abdomen and kneading the navel clockwise, pushing Shangqijiegu (上七节骨), kneading Guiwei (龟尾), and pinching the skin of the spine, in combination with same medications used as in the medication group. Results: The total effective rate was 96% in the tuina plus medication group, P < 0.01, in comparison with the medication group. Conclusion: tuina has a good therapeutic effect in the treatment of infantile diarrhea induced by rotavirus infection and is importantly significant for shortening the course, enhancing the therapeutic effect and lowering down the medical cost.

Objective To study and evaluate islet cell adenoma of preliminary diagnosis.Method Retrospective analysis Wag done on 22 patients clinical data of preliminarily diagnosed islet cell adenoma.They were divided into two groups according to final diagnosis,group of islet cell adenoma(n=16)and group of reacfional hypoglycemia n=6).Results There were significant differences between the two groups in term of fames,cold sweat,cataphora,Whipple triad,hungry test,the ratio offasting blood insulin and fasting blood glucose exceeding 0.3 (I/G＞0.3) (P＜0.05).No statistical differences were found on blood glucose level in hypoglycemia onset,psychiatric symptom.Conclusion The clinic data is helpful for preliminary diagnosis,and Whipple triad,hungry test,I/G＞0.3 above all.

AIM:To investigate the changes of connexin 43 (Cx43) via establishing a model of sympathomi-metic atrial fibrillation ( AF) .METHODS:The mongrels ( n=15) were randomly divided into control group , rapid atrial pacing (RAP) group and isoprenaline (ISO) perfusion+RAP group (ISO+RAP group).All mongrels’ hearts were taken out rapidly by median sternotomy to establish the cardiac model with Langendorff perfusion in vitro.The atrial effective re-fractory period ( AERP) and AF inducability were tested .The expression and distribution of tyrosine hydroxylase ( TH) were analyzed by immunohistochemistry .Total protein level of Cx 43 and phosphorylation of Cx 43 were determined by West-ern blot.The distribution of Cx43 were also observed by immunofluorescence staining .The cell apoptosis was analyzed by TUNEL staining.The generation of reactive oxygen species ( ROS) in the mitochondria was measured by fluorescence spec-trophotometry .RESULTS:No significant change of AERP was found between control group and RAP group , while that in ISO+RAP group was significantly decreased (P<0.05) and induced AF.Compared with control group, the expression of TH, apoptotic index and the generation of ROS increased gradually (P<0.05), while the content of Cx43 decreased grad-ually both in the total protein and the phosphorylation levels in RAP group and ISO +RAP group (P<0.05).The fluores-cence intensity of Cx43 was also attenuated and Cx43 were lateralized apparently in RAP group , while Cx43 were character-ized as punctate distribution in ISO +RAP group.CONCLUSION:Sympathetic nerves may activate autophagosome at in-tercalated discs and trigger cell apoptosis , resulting in remodeling and downregulation of Cx 43 via oxidative stress , thus having effects on mediating and maintaining AF .

Objective: To explore the relationship between NLRP3 inflammasome and atrial fibrillation (AF) by examining peripheral blood level of NLRP3 inlfammasome and other inlfammatory factors in relevant patients.
Method: A total of 60 AF patients were enrolled and divided into 2 groups: Paroxysmal AF (PAF) group and Non-paroxysmal atrial fibrillation (nPAF) group, n=30 in each group;in addition, there was a Control group including 26 healthy subjects from physical examination. NLRP3 expression in peripheral blood mononuclear cells (PBMCs) was measured by lfow cytometry;blood levels of IL-1β, IL-6, CRP and NT-proBNP were detected by ELISA. The correlations among different factors were studied by liner regression analysis and the differences were compared among groups.
Result:①Compared with Control group, PAF and nPAF groups had increased PBMCs level of NLRP3 and blood levels of IL-1β, IL-6, CRP, NT-proBNP, P<0.05, while NLRP3 level was similar between PAF group and nPAF group, P>0.05.②PAF and nPAF groups showed elevated blood level of NT-proBNP than Control group, P<0.05. ③PBMCs level of NLRP3 was positively related to left atrial diameter (r=0.579, P<0.05) and negatively related to left ventricular ejection fraction (r=-0.490, P<0.05) in both AF groups.
Conclusion: ① NLRP3 inflammasome was closely related to AF, which may provide a therapeutic target for AF treatment. ② AF was closely related to inflammatory response. ③ Downstream product of NLRP3 may cause the inlfammatory response which could induce the occurrence, development and maintenance of AF in relevant patients.

Objective To investigate the correlation between fatigue and coping strategies among peritoneal dialysis patients,to improve their health consciousness and reduce the fatigue.Methods A total 107 patients were surveyed with general data questionnaire,Multidimensional Fatigue Symptom Inventory-Short Form( MFSI-SF) ,and Medical Coping Modes Questionnaire,MCMQ.Results The score of fatigue was (83.32 ±1.54) points,which indicated the fatigue remained in high level.Scores from high to low were dialysis≥5years,dialysis<1year and 1year≤dialysis<5years.Patients mainly took the coping style with positive face.Pearson correlation analysis showed that fatigue was negatively correlated withface(r=-0.300,P<0.05),while it was positively correlated with withdrawand yield(r=0.227,0.300,all P<0.05).Conclusion Patiens should be encouraged to actively face the disease,pay more attention to their own state of dialysis and improve the effect of drain,reduce fatigue,then to reply for both mind and body health.

Objective To report a multiple metastatic renal cell carcinoma (RCC) case successfully treated with cytoreductive nephrectomy after neoadjuvant Sunitinib,and discuss the efficacy and treatment regime of neoadjuvant targeting therapy.Methods A 51 years man presented with painless gross hematuria for one week and admitted into our hospital in August 2010.Abdominal CT demonstrated a 6.6 cm ×6.3 cm left lower pole renal tumor associated with renal vein tumor thrombus,bulky hilar lymph nodes and extensive local invasion.The patient was also found to have lung and right tibial metastasis.The clinical stage was T3bN1 M1.Percutaneous biopsy confirmed clear cell renal carcinoma.Neoadjuvant Sunitinib 50 mg daily was administered with 4 weeks on,2 weeks off schedule for two cycles.Cytoreductive nephrectomy was preformed 2 weeks after discontinuation of neoadjuvant Sunitinib.Imaging evaluation was performed to assess the primary tumor and metastatic sites.The patient was followed up till present.Results After two cycles of neoadjuvant treatment,CT scan revealed 23％ size reduction of left renal tumor to 5.1 cm ×4.4 cm,renal vein tumor thrombus regression,local perirenal invasion improvement,lung metastasis resolution and static right tibial metastasis.According to RECIST criteria,the objective response was stabilization of disease (SD).Cytoreductive nephrectomy was successfully performed to remove the primary tumor in December 2010.Pathology revealed Fuhrman Ⅱ renal cell carcinoma with major necrosis in primary tumor and thrombus localized in renal vein.During 6 months of post-operative follow-up,there was no local recurrence,lung metastasis had vanished completely and tibial metastasis had not progressed.Local recurrence and other distant metastasis were not demonstrated in 20mon follow-up till now.Disease control of this patient was partial response (PR) by RECIST.Conclusions Neoadjuvant Sunitinib treatment could result in downstaging of primary tumor and facilitate cytoreductive nephrectomy,thus eventually increase patient overall survival.

Objective To discuss the problems of using high pressure injector in the 16-detector-row CT. Methods Reviewed and analyzed the courses of using high pressure injector in the 16-detector-row CT for 799 patients. Results 774 patients obtained successful infusion,contrast medium hydrops were occurred in 20 patients,2 patients were infusion failure and 3 patients were redid for misoperation. Conclusion Master the details of operating high pressure injector can alleviate the pain of patients,and then obtain the satisfactory effect.

Objective To measure the parameters of ealeaneal quantitative ultrasound(QUS)in nomal Hubei Yichang subjects.which were compared between different age groups after standardization by body mass index(BMI).Methods Calcaneal parameters were measured by UBIS5000 in 2912 normal Hubei Yichang subjects,from 20 to 82 years old women 1450,men 1462).Results The peak values of broadband ultrasound attenuation(BUA)and stiffness(STI)of the calcaneal were both in 45-49 year group for women.The peak value of BUA was in 50-54 year group for men.Standardized by BMI,the peak value of BUA、STI and sound of speed(SOS)were both in 20-24 year groups for women and men.Conclusion BUA、SOS and STI of the calcaneal may change with age.After the influence of body mass is eliminated,the change still exists obviously,and the parameters may gradually reduce with increasing age.