Volume 89  ·   Issue 28  ·  2009

orthostatic intolerance (OI) is a common disease in childhood. It refers to a series of symptoms caused by upright standing. The symptoms can be relieved after lying down. The symptoms mainly include dizziness, which can be accompanied by pale complexion, exercise intolerance, fatigue, blurred vision, chest tightness, shortness of breath, long exhalation, palpitations, tremors, cold sweat, anxiety, seasickness, abdominal pain when upright, acral pain when upright, pain caused by upright standing, flushing, change of consciousness and sleep disturbance, etc. In subsevere cases, syncope can occur.

Objective To explore the efficacy of midodrine hydrochloride in the treatment of vasovagai syncope (VVS) in children. Methods Forty-eight children with unexplained syncope mid prodromata (21 males ,27 females, aged 6 - 17 years, mean 11 years±3 years) were randomly assigned into 3 groups. They were health education group, oresol group mid midodrine hydrochloride group respectively. Oresol group was comprised of children given oresol as first-line therapy in addition to health education and midodrine hydrochloride group patients given midadrine hydrochloride on the basis of oresol group. Repeated head-up tilt testing (HUTT) and follow-ups of at least 6 months were conducted to evaluate the therapeutic efficacy, side effects of midodrine hydrochloride and hemodyuamic changes in treating pediatric VVS. (12/15) respectively. It was significantly higher in cases of midedrine hydrochloride group mid oresol group than that of health education group (P <0.05). However,there was no significant difference in the HUTT- follow-up period, the recurrence rate of syncope was significantly lower in midodrine hydrochloride group than in'other two groups (P <0.05). However, there was no significant difference in the recurrence rate of supine hemodynamic indices (HR, SBP, DBP) between before and after treatment in 3 groups. After midedrine therapy, the effects of midodrine upon changes in systolic and diastolic pressures and heart rate, between upright beginning and supine positions, were statistically significant (P < 0.05). Conclusion Health education and oresol are conventional therapies for pediatric VVS. The efficacy can be enhanced by supplementing midodrine hydrochloride. Such a regimen is effective and safe in treating pediatric VVS.

Objective To examine the diagnostic value of head-up tilt test in children with unexplained syncope (UPS). Methods A total of 379 children (171 males, 208 females) aged 3 -18 years, mean age(12±3) years with unexplained syncope from Beijing, Hunan, Hubei and Shanghai and undergoing baseline head-up tilt tests (BHUTY) or head-up tilt tests potentiated with nitroglycerine (SNHUTT) under a quiet circumstance were selected as the syncope group. Ten healthy children (5 males, 5 females) aged 9 -15 years with a mean age of (11.4±2.1) years,were recruited as the control group. SPSS 10.0 software was used for data analysis. Results In 379 children with unexplained syncope, 67 (17.7%) were of postural orthostatic tachycardia syndrome (POTS), 157 (41.4%) of vasovagal syncope vasoinhibitory pattern, 14 (3.7%) of vasovagal syncope cardioinhibitory pattern, 47 (12.4%) of vasovagal syncope mixed pattern, 1 (0.3%) of orthostatic hypotension (OH) and 93 children (24.5%) of UPS. In syncope group and control group, the positive rate of BHUTT was 55.9% and 0 respectively and it was 75.5% and 20.0% respectively for SNHUTT. During BHUTT, the mean time of positive response occurrence was (16±12) minutes, and the posture when positive response appeared was at a tilt angle of 60 degrees. For SNHUTT, the mean time of positive response occurrence was (6±4) minutes and the posture was at a tilt angle of 60 degrees when potentiated with nitroglycerine. Conclusion HuTr is an objective diagnostic tool of UPS. With a high diagnostic positive rate, SNHUTT can improve the diagnostic positive rate of BHUTT. Meanwhile the time of positive response occurrence during SNHUTT is markedly shorter than BHUTT.

Objective To investigate the effects of probueol, aspirin and atorvastatin (PAS) combination therapy upon atherosclerosis. Methods A total of 436 patients with coronary artery disease were selected and randomly divided into control group (aspirin 100 mg, atorvastatin 10 mg daily) and PAS group (aspirin 100 mg, atorvastatin 10 mg and probucol 0.25 g daily). After a 1-year treatment course, 378 cases remained in the study (201 in control group vs. 177 in PAS group). These patients were followed for throughout the study course and their serum levels of high density lipoprotein (HDL), ox-LDL, TXB2 and MMP-9 were measured at 6 and 12 months respectively. Twenty cases were diagnosed with carotid artery plaque by carotid ultrasound and 16 cases remained in the PAS group. They were followed with ultrasound for plaque thickness. Results In the control group, the pre-treatment level of MMPs and ox-LDL were not statistically different from the post-treatment level (P > 0.05). In the PAS group, the pre-treatment level of ox-LDL was (23.46±0.01) mmol/L and the post-treatment level (16.13±0.02) mmol/L. There was a decrease of 31.7% (P < 0.05). The pre-treatment level of MMPs and MMP-9 in the control group was not statistically different from the post-treatment level The pre-treatment level of MMP-9 in the PAS group was (7.15±0.01)mmol/L and the post-treatment level(4.19±0. 02) mmol/L There was a decrease of 42.4% (P < 0.05). During the course of follow-up, the hospitalization rate, angina recurrence rate, myocardial infarction rate and mortality rate for the control group were 23 (11.4%), 28 (13.9%), 4 (2.0%) and 2 (1.0%) respectively. In the PAS group, the corresponding values were 6 (3.4%), 13 (7.3%), 1(0.6%) and 0 respectively. All parameters of adverse events showed a significant decrease in the PAS group(P <0.05). Among the cases with carotid plaque, the pretreatment measurements of intima thickness and plaque thickness were(0.103±0.002)cm and (0.248±0.001)cm while the post-treatment corresponding measurements (0.097±0.001) cm and (0.209 ±0.002) cm respectively. There was a significant difference between the PAS group and the control group (P < 0.05). Conclusion Antioxidant probucol significantly inhibits the generation of ox-LDL and MMP-9. PAS therapy also reduces the plaque thickness and decreases the rate of adverse event in patients with atherosclerosis. Antioxidants can be considered as a new adjunct therapy in the treatment of atherosclerosis.

Objective To evaluate the feasibility and clinical efficacy of employing a homemade lasso to control the renal blood flow in retroperitoneal laparoscopic nephron-sparing surgery forthe treatment of renal tumors. Methods Eight patients with benign renal tumors and 14 with malignant renal tumors underwent enucleation and wedge resection of renal tumors through retroperitoneal laparoscopy. Of these 22 patients, 15 were males and 7 females with a mean age of 45 years old. The mean tumor diameter was 3.2 era. Results All the procedures were technically successful without conversion to open surgery in all 22 patients. The mean operative time was 150 rain and mean blood loss 80 mL The mean postoperative hospital stay was 8 days. No intraoperative or postoperative complication occurred. All 14 cases of malignant renal tumors had a negative surgical margin. With a follow-up of 5 -29 months, no recurrence occurred. Conclusion Retroperitoneal laparoscopie partial nephrectomy is feasible and safe for selective patients with renal tumors. Using a homemade lasso to control the renal blood flow in retroperitoneal laparoscopic partial nephrectomy is simple and less interferential.

Objective To summarize the clinical significance and 13q- characters of 100 multiple myeloma (MM) patients detected by interphase fluorescence in situ hybridization (i-FISH). Methods Specimens of bone marrow were collected from 100 patients with MM who visited the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences in Tianjin, China. Chromosome R- banding analysis and i-FISH were conducted. Results (1) i-FISH was used to investigate 1000 patients with MM , whose median age was 56 years and 19 (19.0%) cases showed chromosome 13q deletions/ monosony13 (△13); conventional cytogenetics (CC) revealed informative MM karyotypes in 24 patients (24.0%) ,with △13 in 10(10.0%) of them. Detection rate of the two methods had no significant difference (P = 0.053), but in newly diagnosed patients i-FISH was much more sensitive than CC test (Detection rate,25.3% vs 9.3%, P = 0.008). (2) Among the whole cases, 93 of them had complete follow-up information. The overall survival (OS) of the 93 patients was 41 (1 - 69) months. Univariate analysis showed that the positive rate of △13 detected by i-FISH > 50%, clonal chromosome 13 abnormality (C13A), nonhyperdiploidy, △13 detected by both CC and i-FISH, β2-MG≥3.5 mg/L were associated with significantly shorter OS. Multivariate analysis indicated that the positive rate of △13 detected by i-FISH > 50% and β2-MG≥3.5 mg/L were the independent unfavorable factors. (3) According to the two independent unfavorable factors mentioned above, we divided the 93 patients into three groups: low-risk, standard-risk and high-risE And there were significant differences of OS among the 3 groups (P < 0.05). Conclusion (1)FISH studies demonstrate a high sensitivity at detecting chromosome 13 abnormality and should be used in the routine evaluation of MM. (2) the positive rate of △13 detected by i-FISH >50% and β2-MG≥3.5 mg/L were the independent adverse prognostic factors.

Objective To conduct a histopathology study of adolescents with chronic rhinosinusitis (CRS) to compare the sinus mucosa with adult CRS and to explore their different pathological characteristics and lesion patterns. Methods Twenty cases of adolescents (median age: 14 years; range: 11 - 16 years) and 16 cases of adult CRS (median age: 36 years; range: 21 -56 years) were performed functional endoscopy operation despite conventional medical therapy, histopathology of uneinate process mucosa were analyzed for inflammatory cell and morphologic studies. Archival tissue from adolescents and adults with CRS were stained with HE, AB-PAS (alcian blue-periodic acid-schiff) as well as Van Gieson. Statistical analysis t-test was performed using SPSS. Results Adolescents CRS sinus mucosa, as compared with adult CRS control, had a higher density of submucosal lymphocytes (t = 2.09, P = 0.04), higher density of submucosal plasma cell(t = 2.46, P = 0.02), lower density of submucosal eosinophils (t = - 3.72, P = 0.01), thinner basement membranes and more intact epithelium (t = - 2.50, P = 0.02 and t = 5.63, P = 0.00 respectively) and fewer submucosal mucous glands (t = - 2.13, P = 0.04). There were significant differences between two groups. Conclusion Lymphocytes were the predominant inflammatory cell type in the sinus mucosa of adolescents with CRS. But it has less eosinophilic inflammation, more plasma cell infiltration, basement membrane thickening, and mucus gland hyperplasia in characteristic adult CRS. Differences between adolescents and adult CRS suggest differing pathogenic mechanisms or progression in the inflammatory response with a protracted disease.

Objective To evaluate the efficacy, adverse effect and safety of terlipressin in the treatment of hepatorenal syndrome (HRS). Methods Correlated randomized controlled clinical trials (RCTs) comparing terlipressin with other therapies in the treatment of HRS were searched in Medline, Embase, Cochrane Library, VIP and National Knowledge Infrastructure (CNKI). Stata 9.0 was used for meta-analysis. Results 7 RCTs including 305 cases were selected for analysis in accordance with the enrollment criteria. HRS reversal rate of terlipressin was superior to that of placebo (total OR =6.76, 95% CI=3.37 -13.56, P=0.000) ; Myocardial infarction rate (total OR =1.37, 95%CI=0.26 -7.31, P= 0.715), arrhythmic rate (total OR = 3.25, 95% CI = 0. 49 - 21.31, P = 0.222), suspected intestinal ischemic rate (total OR = 2.14, 95% CI = 0.46 - 10.02, P = 0.336) and peripheral ischemic rate (total OR = 1.72, 95% CI= 0.34 - 8.76, P = 0.516) of terlipressin were similar with those of placebo; Mortality rate of terlipressin was a little lower than that of placebo (total OR = 0.55, 95% CI = 0.31 - 0.98, P = 0.044). HRS reversal rate (total OR = 0.92, 95% CI = 0.32 - 2.67, P = 0.877), myocardial infarction rate (total OR =0.92, 95%CI=0.06- 15.34, P=0.952), arrhythmic rate (total OR =0.32, 95%CI= 0.03 - 3.73, P = 0.364), suspected intestinal ischemic rate (total OR = 0.92, 95 % CI = 0.06 - 15.34, P = 0.952), peripheral ischemic rate (total OR = 0.92, 95% CI = 0.06 - 15.34, P = 0.952) and mortality rate (total OR = 0.80, 95% CI = 0.29 - 2.24, P = 0.673) of terlipressin were similar to those of noradrenalin. Conclusion Terlipressin and noradrenalin are effective and safe in the treatment of HRS, the relationship between terlipressin and HRS mortality rate should be elucidated with further studies.

Objective To investigate the optimal sequence of adjuvant radiotherapy and hormonal therapy in patients with breast cancer. Methods From January 1998 to December 2003, 163 patients with breast cancer at our Cancer Center were eligible for this retrospective study. They underwent mastectomy or conservative surgery and received both adjuvant radiotherapy and hormonal therapy with either tamoxifen (TAM) or aromatase inhibitors (AI). According to whether hormonal therapy was administered sequentially after completion of radiotherapy or concurrently with radiotherapy, the patients were grouped as TAM sequential (TAM-SEQ) (n =65), TAM concurrent (TAM-CON) (n =52) and AI sequential (AI-SEQ) (n =27) and AI concurrent (AI-CON) (n = 21). Treatment complications and prognostic outcomes were followed up and analyzed. Results The median follow-up was 84, 79 months for TAM_SEQ, TAM-CON groups, and 67, 63 months for AI-SEQ, AI-CON groups. The occurrence rate of lung and skin fibrosis were 3.2% vs 7.7% (P =0.407), 4.8% vs 9.6% (P =0.464) in the TAM-AEQ and TAM-CON groups, and 7.4% vs4.8% (P=0.595),11.1% vs9.5% (P=0.594) in AI-SEQ and AI-CON groups. TAM-CON group was more frequent than TAM-SEQ group in the occurrence of lung and skin fibrosis. The local relapse rate and distant metastasis rate were 28.6% vs 25.0% (P = 0.668), 33.3% vs 32.7% (P = 0.942) in the TAM-AEQ and TAM-CON groups, and 22.2% vs 9.5% (P = 0.437), 25.9% vs 19.0% (P = 0.733) in AI-SEQ and AI-CON groups. Local relapse rate in AI-SEQ group was a little higher. There were no significant difference between either TAM-SEQ and TAM-CON groups or AI-SEQ and AI-CON groups in relapse-free survival and overall survival (P > 0.05). The COX multivariate analysis revealed AI-CON was a favorable independent prognostic factor for relapse-free survival (P = 0.025). Conclusion The sequential or concurrent sequence of adjuvant radiotherapy and hormonal therapy does not affect the local control and survival prognosis significantly, especially with TAM. However, TAM administered concurrently with radiotherapy slightly increases the occurrence rate of lung and skin fibrosis. Concurrent administration of AI and sequential TAM with radiotherapy is preferred in clinical practice. Further prospective randomized trials will be needed to validate these results.

Objective To compare the efficacy and safety of insulin aspart (IAsp) and human insulin (HI) when applied as meal-time insulin with neutral protamine Hagedorn insulin (NPH) at bedtime in diabetics. Methods A total of 220 Chinese subjects with type 1 or type 2 diabetes from 5 dfferent hospitals were randomized by a ratio of 1:1 into two groups accepting IAsp or HI combined with NPH respectively. The main cndpoints were assessed by fasting plasma glucose (FPG), 2 hour postprandial plasma glucose (2 h PPG), HbA1c and hypoglycemia. Results A greater reduction in mean 2 h PPG was achieved in the IAsp group[(14.6±5.3)mmol/L] as compared with the HI group [(8.4±4.1)mmol/L| (P< 0.01, adjusted for baseline value, center effect and diabetes type). Significantly mare IAsp-treated subjects reached the 2 h PPG target (50.0% vs 25.5%, P <0.01). HbAlc was reduced mare in IAsp/NPH group [(9.3±1.4)% vs (7.7±1.3)%] than in HI/NPH group [(9.2±1.2)% va (7.7±1.2)%] . HbAIc target was reached by 24.5% (IAap) vs 14.5% (HI) of subjects (P<0.05). No major hypoglycemia or serious adverse events were observed for the IAsp group, Lower incidence of nocturnal hypoglycemia (IAsp/ NPH: 3% vs HI/NPH: 4%) was reported in the IAsp group. Average daily insulin doses were 0.60/0.23 (IAsp/NPH) and 0.65/0.24 (HI/NPH) IU/kg respectively. Conclusion Treatment of IAsp in basal-bolus therapy in combination with NPH provides a superior postprandial glucose control and allows mare subjects to reach the glycemic target without elevating the nocturnal hypoglycemic risk or adverse events.

Objective To evaluate the value of NT-proBNP in predicting in-hospital mortality in patients with decompensated systolic heart failure. Methods Plasma NT-proBNP levels within 24 hours of admission were obtained in 366 patients with decompensated systolic heart failure. The levels were compared between dying patients in hospital and survival patients at discharge. ROC analyses were performed to evaluate if NT-proBNP was a predictor for in-hospital mortality and identify the optimal NT-proBNP cut-off point for predicting in-hospital mortality. A binary logistic regression analysis was used to evaluate if NT- proBNP was an independent predictor for in-hospital mortality. Results 19 cases of the 366 patients died in hospital. NT-proBNP levels of the dying cases were much higher than those of the survivals 3970 (3452, 6934) pmol/L vs 2340 (1132, 4002) pmol/L respectively, P < 0.01). ROC analysis of NT-proBNP to predict in-hospital mortality had an area under the curve (AUC) of 0. 762 (95% CI:0.657-0.857, P < 0.01), the optimal NT-proBNP cut-off point for predicting in-hospital mortality was 3500 pmol/L with a sensitivity of 73.7%, a specificity of 66.9% , an accuracy of 67.6% and a negative predictive value of 97.9%. Patients whose NT-proBNP levels were equal or more than 3500 pmol/L had an in-hospital mortality of 10.9%, compar with 2.1% in those NT-proBNP levels less than 3500 pmol/L (P < 0.01). Binary logistic regression analysis demonstrated that NT-proBNP was an independent predictor for in-hospital mortality in patients with decompensated systolic heart failure (P < 0.01). Conclusion Admission plasma NT-proBNP level is an independent predietor for in-hospital mortality in patients with decompensated systolic heart failure. The optimal NT-proBNP cut-off point for predicting in-hospital mortality is 3500 pmoL/L.

Objective To verify the inhibitory effect of mitochondrial calcium uniporter in remote preconditioning-induced cardioprotection. Methods By occlusion and reperfusion of left anterior descending artery, the rat hearts were subjected to 30 min regional ischemia and 120 min reperfusion in vivo. Thus the ischemic reperfusion model was established. The rats were randomly assigned to undergo one of the following maneuvers: (1) remote preconditioning; (2) ruthenium red (an inhibitor of mitochondrial calcium uniporter); (3) spermine or SB202190 (an opener of mitochondrial calcium uniporter) . Remote preconditioning was elicited by three cycles of 5 rain of right femoral artery occlusion interspersed with 5 min of reperfusion. The mean arterial blood pressure, heart rate and lactate dehydrogenase released in plasma were measured during reperfusion but the infarct size was measured after reperfusion. Results In comparison with I/R group, remote preconditioning limited infarct size [(20.4±2.5)% vs (51.0± 6.0) %] and lactate dehydrogenase release [(271±9) U/L vs (339±39) U/L] during reperfusion. On the contrary, spermine or SB202190 attenuated the reduction of infarct size and lactate dehydrogenase release induced by remote preconditioning. The group of spermine was [(40.8±9.2) % vs (20.4±2.5) %] and [(383±43)U/L vs (271±9)U/L] while the group of SB202190 was [(44.3±6.8)% vs (20.4± 2.5)%] and[(356±26)U/L vs(271±9)U/L]. Conclusion Inhibition of mitochondrial calcium uniporter opening is involved in the remote preconditioning-induced cardioprotection.

Objective To establish an objective method to estimate the disparity between the cold and hot natures on the basis of an intrinsic correlation between temperature tropism of mice and the cold and hot natures of Chinese medicines. Methods Male KM mice were randomly divided into 7 groups of 6 each, namely the normal group (NM), the weak model group (WM), the strong model group (SM), the weak model plus Radix ginseng rubra group (WM + RG), the weak model plus Panax quinquefolius L. group (WM + PQ), the strong model plus Radix ginseng rubra group (SM + RG) and the strong model plus Panax quinquefolius L. group (SM + PQ). The specific herbal drugs were administered intragastricly. To induce the weak model, mice were fed with a limited supply of feed and forced to swim in cold water until almost drowning while the strong model induced by feeding a high-protein diet with an unlimited feed access. The doses of Radix ginseng rubra and Panax quinquefolius L. were 35 mg/g of body weight per day (counted by the quantity of crude materlal) and lasting for seven days. The NM and model groups without dosing were intragastricly administered with physiological saline of the same volume to the dosing groups. The percentage of the remaining time of mouse on a high temperature (40 ℃) pad to the total monitoring time was recorded by a self-designed intelligent animal behavior monitoring system. Meanwhile, the drinking volume of mice in each group was measured. Immediately after experiment, the activities of Na+ K+ -ATPase and superoxide dismutase (SOD) in liver tissue were measured by assay kits of phosphorus and xanthine oxidase methods respectively. Results The features of deficient and cold symptom, such as fatigue, stagnant weight growth, decreased water intake, cold limbs and tail etc, were observed in WM group. And the features of heat symptom, such as increased weight and water intake, hyperactivity etc, were observed in SM group. The percentage of time that the mouse remained on 40 ℃ pad of the WM group within the seven days experiment was significantly higher than that of the normal group (70.6%±21.3% vs 52.1%±6.5%, P <0.05). While the value of SM group (45.7%±4.6%) was significantly lower than that of the normal group (P < 0.05) ; the value of WM + RG group and WM + PQ group were 65.6%±7.8% and 75.3%±13.0% respectively (both P < 0.05 compared with WM group) ; the values of SM + RG group and SM + PQ group were 36.1%±15.5% and55.5%±7.7% respectively (both P<0.05 compared with SM group). The activities of Na+ K+ -ATPase and SOD of WM mice treated with either Radix ginseng rubra or Panax quinquefolius L were found to have a significant up-regulation (P <0.05) as compared with untreated WM mice. But only the Panax quinquefolius L. showed an up-regnlating effect upon Na+ K+ ATPase and SOD in SM mice. Conclusions The external cold and hot natures of Radix ginseng rubra and Panax quinquefolius L can be represented in an ethological way by the changes of animal's temperature tropism. And such a tropism may be internally regulated by body's energy metabolism.

Objective To investigate the protective effects and potential mechanisms of TZD upon pancreatic β-cells. Methods Apoptosis was induced in vitro by interleukin-1β (IL-1β) and interferon-γ (IFN-γ). After treatment with resiglitazoue(RSG)/ pioglitazone (PIG) at the final concentrations of 1 μmol/L, 10 μmol/L, 20 μmol/L respectively, the apoptotic rate of NIT-1 cells was determined by Hoechest33342 staining and Annexin V-FITC/PI flow cytometry respectively. Caspase-3 specific activity of NIT-1 cells was determined by Caspase-3 assay and insulin secretion measured by ELISA. Results After treatment of different concentrations of RSG/PIG, the apoptotic rate of NIT-1 cells decreased to 29.3%, 14.0%, 28.1% and 27.4%, 16.7%, 23.5% respectively. There were significant differences in apoptotic rote between the RSG/PIG treatment group and IL-1β/IFN-γ group (P < 0.01). After treatment with RSG/ PIG, glucose-stimulated insulin secretion (GSIS) of NIT-1 cells recovered in different degrees [(6.8± 0.7)ng/ml, (5.9±0.9)ng/ml,P <0.01]. There were significant differences in GSIS between the RSG/ PIG treatment group and IL-1 β/IFN-γ group (P < 0.01). Moreover, most of the protective effects of TZD upon pancreatic β-cells could be blocked by a PPAR-γ inhibitor, GW9662. Conclusion TZD might protect pancreatic β-cells direcdy via inhibiting cytokine-induced apoptosis and recovering insulin secretion. And the mechanism may be correlated with the down-regulation of caspase-3 activity.

The patient was a 41-year-old female who was diagnosed with follicular lymphoma for 7 months. In February 2008, she underwent totally consistent hematopoietic stem cell transplantation with her sister as the donor. Before transplantation, the patient started with abdominal distension and weight loss in May 2007. Abdominal CT showed retroperitoneal space-occupying lesions, 38mm ×107mm, and abdominal aorta, superior mesenteric artery and bilateral renal arteries were invaded. Multiple enlarged lymph nodes were found in the pericardium, splenic hilum and pancreatic head.

The concept of orthostatic tachycardia has been applied as early as 1940, but it was not until 1993 that the concept of orthostatic tachycardia syndrome (POTS) was formally proposed by Schondorf and Low, and it has become the research hotspot of functional cardiovascular diseases after vasovagal syncope in recent years [1]. Studies have shown that at least 500,000 people in the United States suffer from orthostatic intolerance (OI), and 25% of them can be unable to work and live normally due to these symptoms. About 75% ~80% of POTS patients are women, and the onset age is 15~50 years old [2].

Tinnitus is a common clinical symptom, which refers to the subjective sensation of sound in the ear without any external sound source or stimulation. It is conservatively estimated that about 130 million [1] people in China suffer or have perceived tinnitus. With the acceleration of life pace and various pressures in modern society, the number of tinnitus patients in China has increased exponentially. The diagnosis and treatment of tinnitus has become one of the difficult problems that need to be solved urgently in clinic. This article will focus on the classification, etiology, epidemiology, pathogenesis and treatment progress of tinnitus.

Hospital antimicrobial management is a management measure taken by medical institutions to promote the rational use of antimicrobial drugs [1]. The main strategies include prescription review and feedback of antimicrobial drugs, hierarchical management, electronic management, recycling and strengthening the education of antimicrobial drug use guidelines. However, the ideal management method is still inconclusive.

Early pregnancy reaction refers to the symptoms of dizziness, tiredness, food selection, loss of appetite, mild nausea and vomiting in pregnant women in early pregnancy, which mostly disappear after 12 weeks. If the early pregnancy reaction is severe, nausea and vomiting are frequent, and they can't eat, which affects physical health or even threatens the life of pregnant women, it is called hyperemesis gravidarum. In the United States and Canada, vitamin B6 and doxylamine are mostly used to antiemetic pregnant women, and metoclopramide is only used when the condition is severe.

Although there are many studies on the adverse health effects of tropospheric ozone with elevation,the mortality rate from prolonged exposure to ozone-contaminated air remains uncertain.Recently, a large-scale cohort study in the United States revealed the potential role of ozone on the risk of death from cardiopulmonary diseases, especially respiratory-related diseases,and its results were published in the New Enslans Journal of Medical (NEJM, 2009, 360:1085-1095).

To better understand the relationship between atrial fibrillation (AF) and humoral cell markers of inflammation after coronary artery bypass surgery, Fontes and colleagues of Cornell University Weill School of Medicine, USA, conducted a prospective and descriptive study to investigate whether increased white blood cell counts before coronary artery bypass surgery predict an increased incidence of AF after surgery. The results were published online (http: / /www.ncbi.nlm.nih.gov/pubmed, 2009-7.1) in the Journal of Cardiothorac and Vascular Anesthesia (J Cardiothorac Vascanest, 2009 Apr 9).

Case 1: A 48-year-old female with chronic diarrhea for 2 and a half years, nausea and anorexia for 1 month and a history of chronic anemia for 20 years. Physical examination showed that the spleen was subcostal with two fingers, without abdominal pain and hepatomegaly. Hemoglobin: 94 g/L, ferritin: 4.9 μ g/L; Hyperechoic nodules in the left lobe of liver were found by abdominal B-ultrasound; Spiral CT showed irregular thickening of the gastric wall on the side of the great curvature of the stomach and small nodules in the left liver, both of which enhanced in the arterial phase;

A 27-year-old male was diagnosed with acute myeloid leukemia in June 2004, partially differentiated type (M2 type). Karyotype analysis showed 46, XY, t (8; 21), and AML1-ETO expression (+). After complete remission of chemotherapy, multiple regimens were consolidated for t years, and then the treatment was stopped. In March 2007, bilateral pain and numbness in buttocks and lower limbs appeared without obvious trigger, which was radioactive, without other discomfort such as fever. CT showed lumbar intervertebral disc herniation, and the symptoms were slightly relieved after corresponding treatment.

In June 2007, 35 members (including 8 patients) were collected from a family of V generation hand-foot cleft deformity (SHFM) in Yiyang, Hunan Province. The proband (IV:2) had no other abnormalities except hand-foot deformity (Figure 1). The clinical manifestations of Ⅱ:4 and Ⅲ:8 were similar to those of the proband, and the right hand of Ⅲ:2, IV:7 and V:2 had three fingers, and the other clinical phenotypes were similar to those of the proband.

A 75-year-old male was admitted to the hospital on October 10, 2007 due to cough for 2 months and shadow in the lungs found on physical examination for 1 day. The patient developed cough without obvious trigger 2 months ago, mainly dry cough, a small amount of white clear phlegm, and no fever. The symptoms were relieved after taking antibiotics for several days. He was in good health before, and visited relatives in Arizona, USA 7 months ago, and returned to China 1 month ago. No obvious abnormalities were found on physical examination at admission. The erythrocyte sedimentation rate was 46 mm/1 h. X-ray chest radiograph: right middle lung mass foci with unclear edge.