Objectiye To improve the diagnosis and treatment of chromophobe renal cell carcinoma(CRCC). Methods The clinical dota of 25 patients of CRCC were reviewed.Thirteen were xmales and 12 were females and thirteen on the left and twelve on the right.The mean age was 51 years.Sixteen(64%)patients were asymptomatic.Gross hematuria,low back pain and discomfort and fever occurred in the other 9 patients.Laboratory investigations showed 1 patient had raised alanine aminotransferase and 1 had high erythrocyte sedimentation rate. Results B-ultrasound was mainly characterized by low echo renal mass with intact capsule and low blood flow signals.CT and MR of CRCC were typically well circumscribed,homogeneous(unenhanced CT was 70%,MR was 73%)with no necrosis and hemorrhage,homogenous enhancement(CT was 65%,MR was 67%)and mild enhanced(CT was 65%,MR was 67 %)renal mass.Twenty-two patients with tumors＞4.0 cm had radical nephrectomy and three with tumors≤4.0 cm had partial nephrectomy.The average diameter of tumors was 7.6 cm.The cross-sections of the tumors were grossly homogeneous,pale or dark brown solid.Light microscopy showed that the tumors were composed of trabeculae or sheets with voluminous cells in pale or eosinophilic cytoplasm.Immunohistochemical assay was positive of CK8 and negative of Vimentin.The pathologic TNM stages were 8 with T1a,9 with T1b,6 with T2 and 2 with T3a.Twenty-three patients were followed up.After mean follow-up of 28 months,22 cases were tumor free.One patient had pulmonary metastasis 58 months after operation and had no reaction to interferon-α and chemotherapy and died. Conclusions The majority of CRCC patients are asymptomatic and usually with low-stages.There are some features in CT and MR appearance of CRCC such as well circumscribed and homogenous.Surgical treatment should follow the treatment principles of renal cell carcinoma and carries an excellent prognosis for most localized tumors but there has been no effective measures to treat metastasis disease.The interval between operation and metastasis is relatively long and the time of follow-up should be prolonged in CRCC.

Objective To discuss the relationship of hypertension with ageing and comorbidities in 6426 inpatients. Methods The data of 6426 inpatients with hypertension from May 2005 to May 2009 were analyzed retrospectively. All inpatients were divided into four groups: the young-aged group from 18 to 44 yrs (n= 312, 4. 8%), the middle-aged group from 45 to 59 yrs (n= 1529,23.8%), the elderly group from 60 to 79 yrs (n=3847, 59.9%) and the old old group from 80 to 99 yrs (n=738, 11.5%). The percentages of hypertension patients in the same age group over the same period were calculated and the comorbidities were observed respectively. Results Of 6426 hypertensive cases, there were 3438 males (53.5%) and 2988 females (46.5%), ranging from 18 to 99 yrs with the average age of (66.3± 12. 1) yrs. There were 25 504 inpatients over 18 years old including 11 208 in the youth group, 5389 in the middle-aged group, 7596 in the elderly group and 1311 in the old old group. The proportions of hypertension inpatients to total in-patients in the four age groups were 2.8%, 28. 4%, 50.7% and 56.3% respectively. In the youth and middle-aged groups, numbers of males with hypertension were more than of females, however there was no significant difference in gender in the elderly and the old old groups. Within 6426 inpatients with hypertension, 2069 (32.2 %) had diabetes mellitus, 1508 (23.5%) had hyperlipidemia, 105 (1.6 % )had sleep apnea syndrome, 1061 (16.5%) had coronary artery disease, 904 (14.1%) had heart failure, 2353 (36.6%) had stroke and 678 (10. 6%) had kidney failure. Conclusions The prevalence of hypertension increases with ageing significantly. The correlated risk factors for hypertension include diabetes mellitus, hyperlipidemia and sleep apnea syndrome, being a clustering phenomenon, especially for elder patients. These risk factors also deteriorate the damage on heart,brain, kidney and other target organs, which might ultimately result in serious cardio-cerebral vascular events. Therefore, besides control of blood pressure, we should strengthen the complex treatment on hypertension to prevent and delay the occur of complicating diseases.

Objective To investigate the related risk factors in patients with atrial fibrillation in order to prevent and delay the occurrence of atrial fibrillation.Methods Five hundred and fifty-eight inpatients with atrial fibrillation were retrospectively analyzed from June 2005 to June 2008.They were divided into several groups according to the age and the characteristics of the elder patients with atrial fibrillation were analyzed.Results In the 558 cases with atrial fibrillation, there were 298 males (53.4%) and 260 females (46.6%) aged from 21 to 97 years.The average age was (72.8 ±10.1) years.There were 57 cases aged 21-59 years(10.2 %)and 501 cases aged 60-97 years(89.8 %).The total number of inpatients in our hospital was 11 869, and there were 4049 cases aged<60 years, 2527 cases aged 60-69 years, 3971 cases aged 70-79 years, 1244 cases aged 80-89 years and 78 cases aged>90 years.The proportions of the inpatients with atrial fibrillation in the above five age groups of inpatients were 1.4%(57 cases), 4.2%(107 cases), 6.6% (262 cases), 9.5%(118 cases)and 17.9% (14 cases), respectively.In 558 cases with atrial fibrillation, there were 230 cases (41.2%) with paroxysmal atrial fibrillation, 44 cases (7.9%) with persistent atrial fibrillation and 284 cases (50.9%) with permanent atrial fibrillation.The most common underlying disease was hypertension in the 558 cases, followed by coronary heart disease, heart failure, diabetes, rheumatic heart disease and so on.Conclusions The prevalence of atrial fibrillation is increased with aging.Hypertension, coronary heart disease, rheumatic heart disease, heart failure, hyperthyroidism,diabetes, chronic pulmonary disease and renal failure are all the risk factors for atrial fibrillation.

OBJECTIVE To study the pathogenic bacteria and its resistance to antibiotics in chronic suppurative otitis media. METHODS Secretion from 132 cases with chronic suppurative otitis media were cultured. Drug sensitivity tests were done to separate pathogenic bacteria. RESULTS 152 strains pathogenic bacteria were isolated from middle ear secretion. The main pathogenic bacteria were staphylococcus aureus (49 strains), pseudomonas aeruginosa (25 strains) and fungus (5 strains). Staphylococcus aureus was sensitive to fluorquinolones, and the sensitivity rate was 79.6 %. Pseudomonas aeruginosa was sensitive to fluoroquinolones and floxacin, and the sensitivity rates were 84 % and 64 %. CONCLUSION Staphylococcus aureus and pseudomonas aeruginosa are main pathogens of chronic suppurative otitis media in our region. Both of them are sensitive to fluorquinolones. Meanwhile, pseudomonas aeruginosa is also sensitive to ceftazidime of the third cephalosporins. So doctors should choose the sensitive antibiotics for treatment of the chronic suppurative otitis media, that may avoid the bacteria with drug resistance come into being. The fungus can not be neglected as the pathogen in chronic suppurative otitis media.

Objective To evaluate the effectiveness of professional nurses in atrial fibrillation (AF) anticoagulation management system.Methods 217 consecutive patients with nonvalvular AF were enrolled.All patients received warfarin therapy for 3-6 months after catheter ablation for AF,who were divided into experimental group (n=102) and control group (n=115) by random digits table.The patients of control group adjusted their warfarin doses by following doctor's advice when discharged and by visiting the outpatient clinic regularly after discharged.The patients of treatment group adjusted their warfarin doses under the guidance of one well-trained nurse.Days of the international normalized ratio (INR) value achieved therapeutic anticoagulation range (2.0-3.0) for the first time,the effective anticoagulation rate that defined as more than 70％ of INR values between 2.0-3.0 after titration period,the ratio of times of INR value 2.0-3.0 to total times after titrating and INR monitoring frequency were compared between the 2 groups.Results In treatment group,days of the INR value achieved therapeutic 2.0-3.0 for the first time were less than that in control group (8 d vs.15 d,P＜0.01),the effective anticoagulation rate [45.1％(46/102)] and the ratio of times of INR value 2.0-3.0 to total times after titrating (67.6％±18.5％) was significantly higher than that in control group [31.3％(36/115) and 62.0％±23.1％ respectively,P＜0.05].INR monitoring during the whole period and after titrating were more frequently in treatment group [(9.4±2.2)times vs.(8.4±2.7) times,P＜0.05;(7.9±2.4) times vs.(6.3±2.8) times,P＜0.01].The number of patients in treatment group who monitor INR less than 3 times after titrating was larger than that in control group (18 vs.1,P＜0.01).Conclusions The participation of professional nurses in atrial fibrillation anticoagulation management system was helpful not only in achieving INR 2.0-3.0 more quickly but also in improving the effective anticoagulation rate.

The present study aims to predict the action targets of antidepressant active ingredients of Xiaoyaosan to understand the "multi-components, multi-targets and multi-pathways" mechanism. Using network pharmacology, the reported antidepressant active ingredients in Xiaoyaosan (saikosaponin A, saikosaponin C, saikosaponin D, ferulic acid, Z-ligustilide, atractylenolide I, atractylenolide II, atractylenolide III, paeoniflorin, albiflorin, liquiritin, glycyrrhizic acid and pachymic acid), were used to predict the targets of main active ingredients of Xiaoyaosan according to reversed pharmacophore matching method. The prediction was made via screening of the antidepressive drug targets approved by FDA in the DrugBank database and annotating the information of targets with the aid of MAS 3.0 biological molecular function software. The Cytoscape software was used to construct the Xiaoyaosan ingredients-targets-pathways network. The network analysis indicates that the active ingredients in Xiaoyaosan involve 25 targets in the energy metabolism-immune-signal transmutation relevant biological processes. The antidepressant effect of Xiaoyaosan reflects the features of traditional Chinese medicine in multi-components, multi-targets and multi-pathways. This research provides a scientific basis for elucidation of the antidepressant pharmacological mechanism of Xiaoyaosan.

Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.

Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid (UA) metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical characteristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure (n = 553). By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid (SUA) formed part of a principal cluster of renal functional variables which included serum creatinine (SCr) and blood urea nitrogen (BUN). Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN (r = 0.48, P < 0.001) and SCr (r = 0.47, P < 0.001). Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.

BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol(TCL), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and triglycerides(TG)]and right ventricle end diastolic diameter (RVEDD), left ventricle end diastolic diameter (LVEDD), right atrium diameter (RA), left atrium diameter (LA), or left ventricle ejection fraction (LVEF) were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD (r=-0.34,P<0.001) and RA (r=-0.36,P<0.001). Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.

Objective To investigate six yearsˊ outcome of children with asthma. Methods Children with asthma diagnosed in the epidemiological survey of childhood asthma in urban area of Beijing in 2010 were selected in this study. The field follow-up was conducted in 2016(6 years later)to obtain information about asthma attack,di-sease control,medication usage,and comorbidities of allergic diseases. The skin prick test,lung function and exhaled ni-tric oxide were performed during field follow - up stage. Results Sixty - four children,aged 7 - 19 years old [(13. 59 ± 3. 48)years old],completed the field follow-up survey. Among 35. 9%(23/64 cases)children,the asth-ma symptoms still persisted within 2 years(without remission),while 64. 1%(41/64 cases)children had no symp-toms within 2 years and above(remission). The course of children without remission(9. 0 years)was significantly lon-ger than that of children with remission(5. 5 years),and there was statistical significance(z＝ -3. 775,P<0. 001). Among the children without remission,the number of uncontrolled children in the last month accounted for 13. 0%(3/23 cases),partially controlled for 17. 4%(4/23 cases),and under controlled for 69. 6%(16/23 cases). The majority of unrelieved children were treated with intermittent control drug[43. 5%(10/23 cases)υs. 12. 2%(5/41 cases), χ2 ＝8. 036,P<0. 01]. A total of 47. 8%(11/23 cases)of children without remission were completely unaffected by physical activity,while 92. 7%(38/41 cases)of children with clinical remission were completely unaffected by physi-cal activity(χ2 ＝14. 117,P<0. 001). The proportion of children without remission with eczema and atopic dermatitis lasting longer than 6 years old was 56. 5%(13/23 cases),which was significantly higher than that of children with re-mission[29. 3%(12/41 cases),χ2 ＝4. 598,P<0. 05]. In 2010 and 2016,there were 46 children with allergen re-sults. Compared with 2010,the proportion of animal fur and pollen allergy increased in 2016[19. 6%(9/46 cases)υs. 52. 2%(24/46 cases),36. 9%(17/46 cases)υs. 67. 4%(31/46 cases)],and there were statistical significances (χ2 ＝10. 632,8. 538,all P<0. 01). In 2016,the number and degree of total allergens in the clinical unrelieved chil-dren were higher than that in the relieved children. Further analysis showed that the unrelieved children had higher cigarette allergy positivity(21. 7% υs. 2. 5%,χ2 ＝4. 239,P<0. 05). There was no significant difference in lung func-tion and exhaling nitric oxide between the clinical unrelieved children and the relieved children. Conclusions Six years later,the proportion of animal fur and pollen allergy increased in children with asthma. Compared with children with remission,the children without remission had more treatment with intermittent control drug,with higher proportion of eczema and atopic dermatitis over six years old,and higher percentage of cigarette allergy positivity.