Objective To investigate the the effect of Amiodaroneo on acute myocardial infarction (AMI) and atrial fibrillation (AF) in elderly patients,and provide the basis for the treatment.Methods A total of 108 patients with AMI and AF in our hospital from January 2009 to June 2013 were collected and randomly divided into control and experimental groups,each group of 54 cases.The control group was treated with cedilanid and the experimental group were treated with amiodarone.AF control rate,sinus rhythm maintenance rate and adverse reactions of the two groups were analyzed and compared after treatment.Results The AF control rate of experimental group was significantly higher than that of control group in 6 h,12 h,24 h and 48 h after treatment (x2=5.173,5.066,4.757,6.684,P＜0.05).Sinus rhythm maintenance rate of experimental group was increased compared with control group (47 cases vs.24 cases,x2=21.748,P＜0.01).Adverse reaction rates of the experimental group was lower than the control group (x2 =15.621,P＜0.01).Conclusions The treatment of AMI and AF by amiodarone is betterr and safe than cedilanid alone,so it is worth popularizing and applying on clinic.

T-type calcium channels are expressed in various tis-sues and play key roles in physiology and pathophysiology,inclu-ding neuronal firing,hormone secretion,pain,and cancer,etc. Hence,it is critical to understand the molecular mechanisms un-derlying the regulation of T-type channels.Substantial literature suggests many G protein-coupled receptors (GPCRs)and related second messengers can modulate T-type channel in some extent. Here,this review focuses on the modulation of T-type calcium channels by GPCRs and related second messengers.

Objective To study the significance and feasibility of modified early warning scores (MEWS) assessing the conditions and death prediction among the pre-hospital acute poisoning patients.Methods We performed a prospective,observational study of the pre-hospital acute poisoning patients between January 1,2010 and December 31,2010.Data was collected to calculate the MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was expressed in mean with standard deviation,and P ＜ 0.05 was considered to be different with statistical significance.Observation lasted for 90 days after admission to get the results as observation index and ROC was drew and the area under the curve and the predicting index were calculated.The patients without vital signs and unsuccessful resuscitation were not included in this study.Results It showed 287 person times with 0 ～ 6 scores,accounting 94.4％,17 person times with 7-13 scores,accounting 5.59％,among the dead patients,MEWS were more than those of the survival group with statistical significance (P ＜ 0.05).The area under ROC was 0.99 indicating that MEWS≥7 was the board line for severe pre-hospital acute poisoning patients with sensitivity of 91.7％,specificity of 97.9％,accuracy of 97.7％ and Youden of 0.896 for predicting death.It showed high significance of the application of MEWS in assessing acute poisoning patients and death prediction.Conclusions MEWS assess pre-hospital acute poisoning patients and predict death with good resolution and strong application significance,which is simple,practical and applicable.

Objective To evaluate the application value of prehospital index (PHI) in hospitalized patients with acute trauma.Methods A study was done in 1802 hospitalized patients with acute trauma by random sampling.PHI and injury severity score (ISS) were made respectively.Receiver operating characteristic curve (ROC curve) was used for detecting optimal cut-off point by taking the date of discharge as the endpoint and the outcome as observed indicator.In order to compare the predicting prognosis value of PHI in hospitalized patients with acute trauma,the corresponding predicting indicators were calculated and ISS was used for reference.Results The area under the ROC curve was 0.871 (95％ CI:0.855-0.886) by the score of PHI and 0.792 (95％ CI:0.773-0.811) by the score of ISS,and there was statistically difference between the two scoring systems (Z =2.674,P =0.007),and the optimal cut-off point was used for judging the potential for critically ill patients when PHI was ≥ 4,ISS ≥ 22.The sensitivity predictors of critically ill patients death of PHI was superior to ISS (x2 =6.975,P =0.008),the specificity and the accuracy of PHI and ISS showed no significant difference (P ＞ 0.05).Conclusions PHI has high potential for assessing patient condition and predicting the death of hospitalized patients with acute trauma,and it is equivalent to ISS in prediction value.The advantages of PHI are simple in operation,easy to learn,reflecting the condition timely and reliably,suitable for dynamic evaluation and comparison,which is suitable for critical patients with trauma of preliminary screening.

Objective To investigate the value of ISS in predicting mortality after multiple trauma.Methods A total of 550 patients with multiple trauma treated from March 2007 to May 2011 were divided into survivor group (n =473) and death group (n =77) according to the outcome.ISS and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ]) were used to predict patients' risk of death.Receiver operation characteristic curve (ROC) was developped to compare the area under the curve (AUC),optimal cut-off point,and prediction index for the two scoring systems.Results ISS and APACHE Ⅱ score were higher in death group than in survivor group (P ＜ 0.05).ISS showed the diagnostic cut-off point of ≥20,with a sensitivity of 76.7％,specificity of 83.7％,concordance rate of 82.7％,and AUC of 0.835.With regard to APACHE Ⅱ,the diagnostic cut-off point was ≥20,with a sensitivity of 80.5％,specificity of 89.2％,concordance rate of 88.0％,and AUC of 0.922.ISS and APACHE Ⅱ were equivalent in predicting mortality (P ＞ 0.05).Conclusion ISS presents a moderate value for predicting the mortality of multiple trauma patients and it is more rational to set ISS≥20 points as the criteria for severe multiple trauma.

Objective To study the utility and feasibility of CRAMS score to assess prognosis of patients with acute trauma.Methods A retrospective review of 1 802 patients with acute trauma was conducted to calculate CRAMS and ISS score.Receiver operation characteristic curve (ROC) was used to measure the prognostic role of CRAMS in comparison with ISS.Results Area under the curve (RUC) was 0.885 for CRAMS (95 ％ CI 0.870-0.900) and was 0.792 for ISS (95％ CI 0.773-0.811),with statistical difference of the two scoring systems (Z=4.280,P ＜0.01).To identify patients with potential critical illness,optimal cut-off point was≤7 for CRAMS and≥24 for ISS.CRAMS presented better sensitivity (x2 =16.910,P ＜ 0.01),but lower specificity (x2 =5.260,P ＜ 0.05) and accuracy (x2 =0.693,P ＞ 0.05) for predicting mortality when compared with ISS.Conclusions CRAMS is better than ISS in predicting prognosis for patients with acute trauma and exhibits a high discrimination.RAMS has advantages of simple operation,easy grasping and accurate and timely reflection of illness severity,which facilitates the early detection and treatment of critical illness in inhospital trauma patients.

Objective To evaluate the impact of laparoscopic cholecystectomy(LC) on the prognosis of unsuspectedgallbladder cancer(GC).Methods A retrospective clinicopathologic study was performed on 21 patients with unsuapective GC,but diagnosed gallbladder cancer postoperatively by pathology.Of which,11patients underwent LC and 10 patients underwent open cholecystectomy(OC),The correlation was evaluatedbetween cumulative survival rates and the following 5 prognostic factors:histopathological grade,pathologic stage,occurrence of bile spillage,type of cholecystectomy(LC or OC),and additional surgical treatments.Results Eight patients(73%) after LC and 7 patients(70%) after OC had cancer recurrence,and the difference was of no statistical significance(P=0.86).There were no recurrences of cancer in the abdominal wall after either LC or OC.Survival rate was statistically correlated to tumor stage(P=0.006),and to the occurrence of bile spillage(P=0.003).Survival rate did not differ according to whether the operation was carried out using LC or OC(P=0.74).Conclusions LC does not worsen the prognosis of unsuspected gallbladder cancer.

Objective To evaluate the results of breast conservation surgery combined with radiotherapy for early stage breast cancer.Methods The cinical data of 76 breast cancer patients who underwent breast(conservation) operation plus radiotherapy at Changzheng Hospital in the recent 6 years were retrospectively(analyzed).Results The 3-,and 5-year survival rate was 96.05% and 94.8%,respectively,the 3-,and 5-year local recurrence rate was 5.3% and 6.6% respectively,and the 3-,and 5-year breast conservation rate was 96.05% and 93.3%,respectively.Only one case had chest wall recurrence and there was no mortality.The case with recurrence was a 25-year old unmarried woman,who had an intense desire for breast conservation.After tumor recurrence,mastectomy was performed again and chemotherapy was(administered).The patient is presently alive and in good health.Postoperative cosmetic physical results were(satisfactory) in 80.5% of cases.Conclusions Breast conservation surgery plus radiotherapy can get(satisfactory) results.The important aspects for success of breast conservation treatment are standardization of(resection) and postoperative radiotherapy and integrated systemic therapy.

Objective To investigate the radiographic body posture selection and improvement and it's application value.Methods We selected the uncommon postures optimal for radiographic diagnosis according to different body parts of compound injury patients,and offered the filming process and cautions of some improved postures in radiographic practice.Results Appropriate body posture,improved filming position and processes,optimized parameters of exposure,and the application of digital imaging devices could ensure the image quality of diagnosis.Conclusion Effective filming processes,improved body postures and variable digital devices should be selected in compound injury patients according to practical condition.

Objective To explore the relationship of serum uric acid level with estimated glomerular filtration rate (eGFR) of elderly patients with hypertention based on a retrospective cohort study.Method The subjects included 465 cases who had a readmission after 3 years of follow-up in an original cohort of 1648 patients with diagnosis of essential hypertension in Fujian Provincial Hospital from August 2007 to September 2009.Multiple regression analysis was performed to examine the effect of serum uric acid level on renal function.Results Four hundred and sixty-five subjects were followed up for an average of 3.9 years.Mean patient age was 68.3 ± 9.7 years.There was no significant difference in uric acid between the baseline and 3 years later (P ＞ 0.05).Multiple regression analysis showed that after adjustment for age,gender,diabetes,body mass index,blood pressure etc,each 100 μmol/L-higher uric acid at baseline was associated with 4.40 ml· min-1· (1.73m2)-1 decrease in eGFR[95％ confidence interval (CI):-6.25--2.55,P ＜ 0.01].According to the alteration of the serum uric acid,all patients were divided into the group with decreased uric acid and the group with increase uric acid.The eGFR was lower in patients with increased uric acid than that in patients with decreased uric acid 3 years later [(70.63±21.54) ml· min-1 · (1.73m2)-1 vs (79.62±21.16) ml· min-1· (1.73 m2)-1,P ＜ 0.01] and there was no significant difference at baseline between the two groups (P ＞ 0.05).Multiple logistic regression analysis showed that after adjusting for aging,gender,diabetes,alteration of blood pressure etc,baseline uric acid was associated with a higher risk for eGFR decreasing more than 10 ml· min-1· (1.73 m2)-1 3 years later [hazard ratio (HR)=2.11,95％CI:1.24-3.59,P ＜ 0.01]; increased uric acid 3 years later resulted in a higher risk for renal function deterioration (HR=2.60,95％ CI:1.67-4.07,P ＜ 0.01).Conclusions Elderly hypertensive patients with baseline hyperuricemia have a lower eGFR,resulting an increased risk of chronic kidney disease.While the patients with declined uric acid had a lesser imparied renal function.It suggests that the improvement of uric acid may help to slow down the deterioration of renal function in elderly hypertensive patients.