Objective To study the clinical effect and prognosis of lyophilized recombinant human brain natriuretic peptide at different times for acute left heart failure.Methods A total of 58 consecutive patients diagnosed as acute left heart failure from February 2013 to February 2014 were randomly divided into early group (30 patients) and late group (28 patients).The patients in early group received lyophilized recombinant human brain natriuretic peptide and other common treatment immediately after arriving at hospital,and the patients in late group received lyophilized recombinant human brain natriuretic peptide until symptoms were hard to control.Results After treatment,the NYHA class and the levels of brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) in early group and late group were significant differences:(1.4 ± 0.5) grade vs.(2.6 ± 0.7) grade,(934.2 ± 52.4) ng/L vs.(1 632.5 ± 147.6) ng/L,(49.6 ± 5.4)％ vs.(31.2 ± 6.7)％,P ＜ 0.01 or ＜ 0.05.The average stay and expenses in early group were significandy less than those in control group:(11.2 ± 3.4) d vs.(19.7 ± 4.2) d,(15.8 ± 4.6) thousand Yuan vs.(27.4 ± 6.3) thousand Yuan,P ＜ 0.05.The total effective rate and survival rate in early group were significantly higher than those in late group:66.7％(20/30) vs.39.3％(11/28),P ＜ 0.05.Conclusion Earlier application of lyophilized recombinant human brain natriuretic can significantly improve the symptoms in acute left heart failure patients.

The application of information management for ethical review work help improve the quality of audit work quality and efficiency in our country , further standardize the ethical review work , also helps to protect the pri-vacy of the subjects in medical research , and establish the medical research ethics review information system in our country has certain feasibility .Therefore , can be based on the experience of the informatization construction of drug clinical trials , through the establishment of ethical review information and tracking system , to set up the electronic signature of information rights management system , building the continuing education training , establish a commu-nication platform with the principal investigator , to build and perfect the medical research ethics review information system.

Objective To compare the clinical efficacies between warm needling and Ibuprofen sustained release capsules (a nonsteroidal anti-inflammatory drug, NSAID) in treating patients with dysmenorrhea in adenomyosis. MethodSixty-five patients with dysmenorrhea induced by adenomyosis were randomized into a treatment group of 33 cases and a control group of 32 cases. The control group was intervened by oral administration of Ibuprofen sustained release capsules, while the treatment group was intervened by warm needling.The intervention lasted 3 menstrual cycles and a 3-month follow-up was studied. The Visual Analogue Scale (VAS), dysmenorrhea symptoms scores and clinical efficacy were compared between the two groups.ResultThe VAS scores after the intervention and inthe first and second months of the follow-up study were significantly different from the pre-treatment score in the two groups (P<0.01); the VAS score of the 3-month follow-up was significantly different from the score before the intervention in the treatment group (P<0.01). There were significant differences in comparing the VAS score after the intervention and in the follow-up study between the two groups (P<0.01), and the treatment group was superior to the control group. The dysmenorrhea symptoms scoresdeclined significantly after the intervention and in the first and second months of the follow-up study in both groups (P<0.01); the dysmenorrhea symptoms score of the 3-month follow-up study decreased in the treatment group and was significantly different from the pre-treatment score (P<0.01). There were significant differences in comparing the dysmenorrhea symptoms scores in the second and third months of the follow-up study between the two groups (P<0.01). The total effective rate was 93.9% in the treatment group, significantly better than 62.5% in the control group (P<0.01).ConclusionWarm needling is effective in easing pain and improving the symptoms of dysmenorrhea in adenomyosis, and can produce a consistent efficacy after the termination of thetreatment; it's superior to NSAIDs in comparing both short-term and long-term treatment efficacies.

Objective To study the early changes of the coagulation system in type 2 diabetic nephropathy.Methods Sixty-two cases of patients with type 2 diabetic nephropathy were divided into two groups:normal albuminuria group ( N-UAlb group,UACR ＜ 30 mg/g,32 cases ),microalbuminuria group ( MUAlb group,UACR:30～300 mg/g,30 cases).Thirty healthy persons constituted a control group (NC group).Fibrinogen( FIB ),antithrombin Ⅲ ( AT-Ⅲ ),protein C ( PC ),protein S ( PS ) were measured by coagulation analyzer,while yon willebrand factor (vWF) and platelet granule membrane protein 140 (GMP-140) were detected by ELISA assay,platelet count (PLT),mean platelet volume(MPV),platelet hematocrit (PCT),platelet distribution width(PDW) by hematology analyzer.Results The level of fibrinogen,GMP-140 and vWF in the M-UAlb group were (4.20 ± 1.53 ) g/L,( 30.03 ± 7.77 ) μg/L,and ( 315.53 ± 47.24 ) ％ respectively,vwhich were significantly higher than those in the N-UAlb group [ ( 3.21 ± 0.89 ) g/L,( 18.22 ± 5.08 ) μg,/L and ( 191.88 ± 57.25 ) ％ respectively ] and the NC group [ ( 2.75 ± 0.53 ) g/L,( 14.26 ± 2.29 ) μg/L and ( 138.12 ± 61.27 ) ％ respectively ] ( F =5.42,10.42,30.44,P ＜ 0.05 or 0.01 ).The fibrinogen,vWF,GMP-140 were positively correlated with UACR ( r =0.313,P ＜ 0.05 ; r =0.620,P ＜ 0.01 ; r =0.680,P ＜ 0.01 ) and PC was negatively correlated with UACR ( r =-0.255,P ＜ 0.05 ).Conclusion Hypercoagulable state in diabetic nephropathy is associated with the high fibrinogen,endothelial dysfunction and platelet activation,and these changes have already emerged in patients without albuminuria.This might mind us that we should strengthen anticoagulant therapy on patients when they are not progressing to albuminuria.

Objective To investigate changes in the expression of prepro-orexin and orexin receptor-1 ( OX1R) following permanent middle cerebral artery occlusion ( MCAO ) with or without preconditioning through electrical stimulation of the cerebellar fastigial nucleus (FNS). Methods Wistar rats were subjected to permanent MCAO and randomly divided into 5 groups: a sham-operated control group (PO), an FNS preconditioning + shamoperated control group (FNS-PO) , an ischemia group, an FNS preconditioning + ischemia group (FNS-PI) and a cerebellar fastigial nucleus injury + FNS preconditioning + ischemia group (FNL-FNS-PI). Each group was divided into 5 subgroups according to the time at which the animals were sacrificed after the MCAO ( 1, 3, 6, 12 and 24 h).RT-PCR was used to detect expression of OX1R mRNA, and ELISA to measure the levels of orexin-A in the hypothalamus and plasma. Results The immunoreactivity of prepro-orexin decreased significantly in the PI groups, with further decreases over time. At the 12th h after MCAO, the immunoreactivity of prepro-orexin reached a minimum.There were significant differences between the rats in the PO and FNS-PO groups. On the contrary, the immunoreactivity of OX1R increased significantly in the PI groups, with further increases continuing over time, peaking at 12 h after the MCAO. There were significant differences between the PO and FNS-PO groups. In the rats with FNS preconditioning (PI-FNS) , the decrease in prepro-orexin and the increase in OX1R were significantly inhibited compared to the PI subgroups at the 6th and 12th hour. There was no significant difference between the FNL-PIFNS group and the PI group. The expression of OX1R mRNA increased significantly in the PI group, with further increases continuing over time, peaking at 24 hours. The plasma levels of orexin-A were not significantly different among the groups, but the levels of orexin-A in the hypothalamus decreased significantly in the PI and FNL-PI-FNS groups, with further decreases continuing over time. At the 12th h after the MCAO the levels were significantly different compared with the PO and PO-FNS groups. While in the rats with FNS preconditioning (PI-FNS) , the decrease in orexin-A level was reversed and there was no significant difference compared with PO and PO-FNS groups. Conclusions The orexinergic system is altered following cerebral ischaemia. FNS preconditioning may be able to regulate these changes.

Objective To investigate the mechanism and prevention of syncope on patients with hypertrophic cardiomyopathy (HCM). Methods Seventy-six cases of HOCM (obstruction group) were successfully operated by PTSMA and oral ACEI/ARB. After six months , they were treated with β-receptor blocker. Another 29 patients (control group) with LVOTPG < 50 mmHg or < 70 mmHg after pharmacologic stress test (PST), have being treated with β-receptor blocker. The results was observed as follow: (1) the difference of between syncope incidence and positive incidence induced by PST in control group; (2) the difference of syncope incidence at half year, a year and admission in control group; (3) the difference of syncope incidence in obstruction group before and after operation; (4) the difference of syncope incidence after six months between two groups at same period; (5) the difference of syncope incidence one year between two groups. Results In control group, the syncope positive incidence induced PST was 55.5%. Treating with medications for half a year , syncope incidence significantly dropped than that on admission (P < 0.05); Obstruction group syncope incidence in the history obviously lower than the control group syncope positive induced PST (P < 0.05), and half a year after takingβ-receptor blocker syncope incidence was significantly dropped than before (P < 0.01). Conclusions The mechanism of syncope with HOCM is not only obstruction but also neuronal reflex. PST is an very useful inspection item for screening the ablation indication, analysis syncope mechanism, and guiding clinical medication.β-receptor blocker is an effective drug on treating and preventing syncope with HCM.

Objective To investigate the relationship between body mass index (BMI) and coronary artery calcification in order to provide theoretical and clinical basis for the prevention and treatment of coronary artery calcification.Methods Ninety hundred and eighty-three cases were selected as our subjects who were hospitalized in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from Jan.2010 to Jul.2010 and undergone dual source CT coronary angiography.Of them,419 cases were male(male group),and 564 female (female group).The general information,clinical and biochemical indexes and coronary CTA results were collected.The patients were divided according to the BML Multivariate logistic regression analysis was applied to analyzed the relationship between BMI and coronary artery calcification,and multiple linear regression analysis was applied to analyzed the relationship between coronary artery calcification and BMI.Results There were significant differences between male group and female group in terms of age,height,body mass,BMI,smoking history,glomerular filtration rate (eGFR),triglyceride (TG),high density lipoprotein (HDL-C),left ventricular ejection fraction (LVEF),serum calcium,with peripheral vascular disease,as well as the baseline drugs,angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB),calcium antagonists (CCB),statins compared the differences were statistically significant (P ＜ 0.05).The rate of slight coronary artery calcification in male group and female groups were not statistically significant(x2 =0.714,P =0.398),while the rate of no calcification,severe calcification were statistically significant (P ＜ 0.05).Multivariate Logistic regression analysis showed that high BMI(regression coefficient was-1.670,OR =0.967,95％ CI =0.953 ～ 0.980,P =0.005),age (regression coefficient was 1.422,OR =4.416,95％ CI:1.015 ～ 16.927,P =0.001),history of hypertension (regression coefficient was 0.128,OR =1.521,95％ CI:1.262 ～ 1.830,P =0.002),history of diabetes mellitus (regression coefficient was 0.364,OR =1.439,95 ％ CI:1.098 ～ 1.885,P =0.008),eGFR (regression coefficient was-0.5420,OR =0.004,95％ CI:0.001-0.019,P =0.014),LVEF (regression coefficient was-1.153,OR =0.316,95％ CI:0.127-0.787,P =0.002) and statins(regression coefficient was-6.745,OR:0.323,95％ CI:0.138-0.754,P =0.032) were correlated with coronary artery calcification.Multiple stepwise linear regression analysis showed that only eGFR(r =0.79,95％ CI:0.69-0.92,P =0.001) was in the equation.Conclusion High BMI is a protective factor for severe coronary artery calcification,but there is on linear correlation between BMI and moderate to severe coronary artery calcification score in patients.

Objective To explore the impact of nucleos(t)ide analogue antiviral therapy on anxiety and depression of patients with chronic hepatitis B (CHB),and analyze the related factors.Methods Before nucleos(t)ide analogue antiviral therapy,1 year and 2 years after antiviral therapy,120 CHB patients were investigated with self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The demography data of patients were collected.Serum levels of alanine transaminase (ALT) and hepatitis B virus (HBV) DNA and other biochemical indicators were measured regularly.Results Before nucleos(t)ide analogue antiviral therapy,1 year and 2 years after antiviral therapy,both the mean scores of SAS and SDS became lower gradually (F=12.661 and 22.395,respectively;both P＜0.01).The percentage of patients with SAS and SDS scores more than 50 were 5.8％,4.2％,1.7％ and 13.3％,7.5％,5.0％,respectively.After 2 years of therapy,the anxiety improvement rate of the patients obtained HBV DNA＜1000 copy/mL was 69.0％,while those with HBV DNA≥1000 copy/mL was 22.2％ (x2 =22.325,P＜0.01).Meanwhile,after 2 years of therapy,the depression improvement rate of the patients obtained HBV DNA＜1000 copy/mL was 77.4％,while those with HBV DNA≥1000 copy/mL was 22.2％ (x2 =32.179,P＜0.01).Multiple factors Logistic regression analysis indicated that the odds ratios (OR) of improvement of anxiety and depression in patients with HBV DNA＜1000 copy/mL were 7.751 (95％ CI:3.026-19.853) and 15.069(95％ CI:5.309-42.770),respectively,compared with those with HBV DNA≥1000 copy/mL; and OR of improvement of depression in patients with ALT≤40 U/L waa 4.103 (95％ CI: 1.376 - 12.238).Conclusions Nucleos(t) ide analogue antiviral therapy could improve the anxiety and depression of CHB patients.The HBV DNA negativity is the independent impact factor of improvement of anxiety and depression in CHB the patients.

Objective：To evaluate bioequivalence and relative bioavailability of domestic and imported repaglinide tablets in healthy volunteers. Methods： Twenty two healthy male volunteers were randomized into A and B groups. A single dose (4 mg) of domestic and imported repaglinide tablets were given respectively according to an open 2-way crossover study design. The washout period was 1 week. Plasma concentrations of repaglinide were determined by HPLC method. Results：The pharmacokinetic parameters of domestic and imported drugs were as follows: t1/2 were(0.86±0.24) and (0.83±0.31) h；tmax were( 0.79±0.37) and (0.75±0.41) h；cmax were (52.43±20.92) and (53.32±24.94) μg/L. AUC0-t were (79.87±36.48) and (74.95±30.57) μg*h*L-1，respectively. The relative bioavailability of domestic formulation was (106.55±16.15)%. Conclusion： The results of variance analysis and two one-side t test show that 2 formulations are of bioequivalence.

Objective To investigate the characteristics of coronary vessel re-endothelialization after placement of drug-eluting stents (DES), and to provide clinical evidence for the double anti-platelet treatment. Methods Optical coherence tomography (OCT) was performed in 43 patients in 1 year after DES implantation. Characteristics of re-endothelialization and percentage of neointimal coverage of stent struts were evaluated by OCT. Results The rate of stent struts intimal coverage was 90.70%, and the remain was lack of endothelial coverage; The ratio of neointimal thickness (NIT) between 0-99, 100-199 and above 200 microns was 19.92%, 37.55% and 42.53%, respectively. The rate of neointimal coverage was higher and the degree of neointimal hy-perplasia was more extensive in patients with DM and in patients with ACS than those of patients without DM and of patients with stable angina pectoris. Conclusion One year after stent placement, most of the stent struts were covered with neointima and few struts obtained poor coverage of endothelial. DM and ACS may be impact factors for the progress of re-endothelialization after DES placement.