Objective:To investigate the polymorphism of the (MTHFR) C677T and its correlation with the severity of hypertension in Shanxi Province.Methods:A total of 306 patients with essential hypertension from the Second Hospital of Shanxi Medical University from January 2017 to January 2018 were selected as subjects. The clinical data of these patients were extracted from the hospital information system. The biochemistry index, including homocysteine (Hcy) were collected from the hospital laboratory test system and the polymorphism of MTHFR C677T gene was analyzed by polymerase chain reaction (PCR). Logistic regression analysis was used to estimate the severity of hypertension.Results:The frequencies of CC, CT and TT genotypes in patients with essential hypertension in Shanxi were 22.22%, 47.06% and 30.72. The C677T genotype and allele frequency revealed no signifcant departures from Hardy-Weinberg equilibrium in the population from the Shanxi region. Compared with MTHFR 677CC, MTHFR 677CT and MTHFR 677TT genotypes could increase the severity of hypertension by 2.29-fold and 2.24-fold. Smoking, family history of hypertension , Hcy and TG were independent risk factors for increasing the severity of essential hypertension ( OR=2.04, 1.81, 1.04, 1.26). Conclusions:MTHFR C677T genotype, smoking, family history of hypertension, Hcy and triglycerides could be important genetic and high-risk factors for development of severe hypertension , which will help to identify populations at high-risk of hypertension and may facilitate the development of hypertension control strategies.

It is recommended that cyclophosphamide combined with corticosteroids should be used as the first-line treatment of ANCA ( antineutrophil cytoplasmic antibody) associated with systemic vasculitis ( AASV) , however, cyclophosphamide has notable ad-verse reaction of causing pulmonary fibrosis ( PF) . In this paper, whether cyclophosphamide should be used in an AASF patient with PF was analyzed in order to decide whether AASV with PF is one of contraindications of cyclophosphamide in clinical practice.

Objective To investigate the effect of proanthcyaindin on angiogenesis of rats with ischemic hindlimb.Methods Twelve male SD rats were randomized divided into control group (n =6) and proanthcyaindin group (PC group,n =6).Lower limb ischemia rat model was establish,rats in both group were administration by oral daily,and PC group was given proanthocyanidins 200 mg/(kg · d),while the control group received the same volume of saline.Forteen days after surgery,ischemic tissues of adductor were collected for several tests including the expression of CD31 in the ischemic muscle tissue and the number of new blood vessels by immunohistochemical staining,hypoxia inducible factor-1 protein expression by western blot,and vascular endothelial growth factor level test by enzyme-linked immunosorbent assay.Results The capillary count showed that the angiogenesis situation of PC group was (69.67 ±3.11)/HP,higher than that in control group((111.00 ± 3.11)/HP,t =13.350,P ＜ 0.0001).The HIF-1 protein expression in PC group was (1.90 ± 0.25),remarkable higher than that in control group (0.54 ± 0.21,t =4.183,P =0.0058).Compared with control group,VEGF level in PC group increased((432.86 ± 13.00) μg/L vs.(326.68 ± 11.08) μg/L,t =6.216,P ＜0.0001).Conclusion Proanthcyaindin plays a positive role in angiogenesis after ischemia.PC may induce up-regulation of HIF-1 and VEGF,and then promote the formation of endovascular through multiple signaling pathways consequently.

Objective To investigate the related risk factors of old cerebral infarction patient.Methods Tbe related data of 248 old male patients(>65)who weared the 24-h ambulatory blood pressure monitoring at our depanment from September of 2007 to December of 2007 were retrospectively analyzed.They were divided into two groups according to WHO diagnostic criteria for cerebral infarction:cerebral infarction group(n=58)and non-cere-bral infarction group(n=147).The correlation between related risk factors with cerebral infarction were further stud-ied.Results①The result of multiple factor logistic regression analysis(α=0.05,β=0.01 is the selected criteri-on) showed:cerebral Lacunar infarction and the level of blood uric acid had the significant impact on the occurrence of cerebral infarction.To compare with non-cerebral lacunar infarction,the relative risk of cerebral infarction morbili-ty was 7.443 in cerebral lacunar infarction.The level of blood uric acid decreasing l μmol/L,the relative risk of cer-ebral infarction morbility increased 0.994.②Every ingredient of blood pressure deploy independent-samples T test showed that the highest value of systolic blood pressure(167.12±22.08)and the highest value of pulse pressure (88.03±20.81)raised up obviously compared with non-cerebral infarction group.Conclusion In old male,the incidence rate of cerebral infarction is predominantly correlated with cerebral lacunar infarction and the level of blood uric acid,and is closely correlated with the highest value of systolic blood pressure and the higheat value of pulse pressure in all the ingredients of blood pressure.

Objective To investigate the clinical significance of the levels of D-dimer and hs-CRP in the elderly patients with coronary disease. Methods One hundred and twenty-two patients with coronary disease were divided into four groups according to their clinical manifestations, there were old myocardial infarction group ( OMI, n =27 ) , stable angina pectoris group ( SAP, n = 29), acute coronary syndromes group ( ACS, n = 32) and old myocardial infarction with acute cardiovascular syndrome group (OMI + ACS,n =34). The control group included the patients without coronary disease (n =30). The patients who had infection, malignant tumors, liver and kidney dysfunction, cerebral infarction, venous embolism in lower extremities and pulmonary embolism were not included, and the patients enrolled should not be on medication of antiplatelet drugs, anticoagulants and antibiotics within the last two weeks. The levels of D-dimer and hs-CRP in all groups were determined by immunoturbidimetric assay and immune scattering assay respectively. Results In each comparison between two groups, the level of D-dimer has no significant difference between the OMI and the SAP ( P > 0. 05 ) , ACS and the OMI + ACS ( P > 0. 05 ) ; but significant difference between the OMI and the control groups ( P < 0. 05) and more significant difference between the other groups were found (P < 0. 01). As for the level of hs-CRP, there was no significant difference between the OMI and the SAP groups (P > 0. 05) or between the ACS and the OMI + ACS groups (P > 0. 05); but significant difference between the other groups (P < 0. 01). the positive relationship between the levels of D-dimer and hs-CRP have in coronary disease in the elderly patients was also found(r = 0. 81 ,P <0.01). Conclusions D-dimer and hs-CRP can be used as the clinical makers to predict the occurrence of the coronary disease in the elderly patients. D-dimer and hs-CRP can be used as the clinical makers to determine the stability of cardiovascular atherosclerotic plaque and the risk of acute cardiovascular syndrome occurrence. They can also be used as the clinical makers to predict the recurrence of the acute cardiovascular syndrome in the patients with old myocardial infarction. However, they can not be used to determine whether the patients with acute cardiovascular syndrome had old myocardial infarction already or not. The levels of D - dimer and hs - CRP are closely related in coronary disease in the elderly patients.

Objective To investigate the relationship between carotid artery plaque formation and blood pressure(BP),pulse pressure(PP),mean blood pressure(MBP) in elderly men.Methods A total of 1461elderly men were divided into carotid artery plaque group(n =1012)and non-carotid artery plaque group(n =449) according to vascular ultrasound examination.Systolic blood pressure(SBP) and diastolic blood pressure(DBP) were recorded by 24-hour ambulatory blood pressure monitoring(ABPM),at the same time pulse pressure (PP)and mean arterial blood pressure(MBP)were calculated.The relationship between carotid artery plaque formation and SBP,DBP,PP,MBP were analyzed.Results The age in carotid artery plaque group was significantly higher than that in non-carotid artery plaque group[(80.5±5.4) years old vs(77.3±5.9) years old,t =-4.233,P ＜ 0.01];The levels of SBP,PP and M BP in artery plaque group were significantly higher than those in non-carotid artery plaque group[SBP:(132.2±17.0) mm Hg vs(127.5±16.0) mm Hg,t =-4.893,P ＜ 0.001; PP:(60.8±13.4) mm Hg vs(55.9±12.5) mm Hg,t =-5.021,P ＜0.001) ;MBP:(92.6±10.3)mm Hg vs(91.0±9.9)mm Hg,t =-3.897,P ＜ 0.01].The incidence of carotid artery plaque was closely related to age(OR =1.061,P =0.0001),myocardial infarction(OR =1.896,P =0.0135),hypertension grades(OR =1.177,P =0.0019),high cholesterol(OR =1.353,P =0.0335),reduced systolic function(OR =2.466,P =0.0001),lower extremity arterial plaque(OR =5.453,P =0.0001).Conclusion In elderly men,formation of the carotid artery plaque is closely related to increased SBP,PP and MBP,but independent to DBP.

OBJETCTIVE:To establish a method for the content determination of ethacridine lactate in Compound ethacridine ointment. METHODS:HPLC was performed on the column of Agilent ZORBAX SB-C18 with mobile phase of 0.1% Octanesulfon-ic acid sodium solution-acetonitrile(70∶30,V/V)at a flow rate of 1.0 ml/min,the detection wavelength was 270 nm,the column temperature was 30℃,and the injection volume was 10 μl. RESULTS:The linear range of ethacridine lactate was 10.002-50.010μg/ml(r=0.999 9);RSDs of precision,stability and reproducibility tests were less than 1%;recovery was 98.96%-100.36%(RSD=0.49%,n=9). CONCLUSIONS:The method is simple,accurate and reproducible,and can be used for content determina-tion of ethacridine lactate in Compound ethacridine ointment.

Objective , To investigate the influence of blood pressure variability on cerebral infarction in older men. Methods Ambulatory blood pressure was measured in 1527 elderly men ( older than 65 yrs) with atherosclerosis. All cases were divided into 2 groups: Six hundred and seven patients with cerebral infarction ( group A)and 920 patients without cerebral infarction ( group B). Smooth curve method was used to analyze each patient's ambulatory blood pressure data and the trend of each patient's blood pressure curve was portrayed. The differences between the actual blood pressure and the blood pressure on the curve was defined as blood pressure variability,and the blood pressure variability between the 2 groups was compared. Results The systolic blood pressure variability in 24 hours in group A was significantly higher than that in group B( [8.4'±2. 2]mm Hg vs [ 8.0 ± 2. 0 ] mm Hg, P ＜ 0. 01 ), especially for the systolic blood pressure variability in daytime( [ 8. 2 ± 2. 2 ] mm Hg vs [ 7. 8 ± 2. 1 ] mm Hg, P ＜ 0. 01 ). However, the systolic blood pressure variability at night was not significantly different between the 2 groups( [ 8.9 ± 3. 9 ] mm Hg vs [ 8. 7 ± 3.7 ] mm Hg,P ＞ 0. 05 ). There were no significant difference between the diastolic blood pressure of 24 hours( [5. 5 ± 3.8 ] mm Hg vs [5.5 ± 1.5 ]mm Hg,P ＞0. 05),during daytime([5.4 ± 1.5]mm Hg vs [5.3 ± 1.4] mm Hg,P ＞0.05)and nighttime ( [ 6. 1 ± 2.7 ] mm Hg vs [ 6. 1 ± 2. 6 ] mm Hg, P ＞ 0. 05 ). Conclusion In elderly men with atherosclerosis,cerebral infarction was closely related to systolic blood pressure variability,but independent of nighttime systolic blood pressure and diastolic blood pressure variability.

Objective:To explore the clinical characteristics of elderly patients with type 2 diabetes mellitus (T2DM) complicated with coronary atherosclerotic heart disease (CHD) and analyze the risk factors of CHD in patients with T2DM.Methods:Using the method of retrospective cohort study, 406 elderly male patients with T2DM (≥75 years old) admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University from January 2017 to January 2020 were selected and divided into T2DM without CHD group (165 cases) and T2DM with CHD group (241 cases). The clinical characteristics in elderly patients with T2DM complicated with CHD and risk factors for CHD were analyzed.Results:The age ((86.78±5.35 )years old), course of T2DM((12.32±0.46) years), fasting blood glucose(FPG)((7.64±2.81) mmol/L), hemoglobin a1c (HbA1c)((7.59±1.21)%), the proportion of hypertension(84.65%(204/241)), D-dimer((0.50±0.13) mg/L), the incidence of thromboembolic events(46.06%(111/241)), blood serum creatinine ((94.81±12.70) μmol/L), urea nitrogen((8.31±4.46) mmol/L), uric acid((376.44±116.01) μmol/L) in T2DM with CHD group were higher than those in T2DM without CHD((78.51±4.81)years old, (10.66±0.67)years, (6.84±2.19) mmol/L, (7.02±2.15)%, 63.03%(104/165), (0.21±0.04 ) mg/L, 13.33%(22/165), (83.01±14.40) μmol/L, (6.79±2.89) mmol/L, (333.56±95.15) μmol/L ), and the differences were statistically significant( t=15.908, t=2.042, t=3.055, t=3.088, χ 2=23.828, t=5.059, χ 2=42.098, t=2.401, t=4.188, t=4.075; all P<0.05). The total bilirubin(TBil)(8.80(6.60, 11.60) μmol/L), glomerular filtration rate(GFR)((76.49±29.80) mL/(min·1.75 m 2)) in T2DM with CHD group were lower than those in T2DM without CHD group (11.25(8.23, 15.28) μmol/L, (91.81±28.31) mL/(min·1.75 m 2)), the differences were statistically significant( Z=2.304, t=5.126; all P<0.001). The total cholesterol((3.84±0.85) mmol/L), low-density lipoprotein cholesterol(LDL-C)((2.12±0.68 ) mmol/L) in T2DM with CHD group were lower than those in T2DM without CHD group((4.10±1.00) mmol/L, (2.45±0.85) mmol/L), the differences were statistically significant( t=2.828, 4.156; all P<0.05). The rate of starting lipid-lowering and stable plaque treatment in T2DM with CHD group (82.57%(199/261))was higher than that in T2DM without CHD group(42.42%(70/165)), and the difference was statistically significant (χ 2=70.614, P<0.001). Influenced by lipid-lowering therapy, the total cholesterol and LDL-C in T2DM patients with CHD were significantly decreased.Logistic regression analysis showed that age elevated( OR 1.346, 95% CI 1.263-1.434, P<0.001), elevated hemoglobin a1c concentration( OR 1.427, 95% CI 1.140-1.785, P=0.002), complicated with hypertension( OR 3.534, 95% CI 1.684-7.418, P=0.001), elevated D-dimer concentration( OR 3.969, 95% CI 1.227-12.841, P=0.021)and elevated uric acid concentration( OR 1.005, 95% CI 1.001-1.008, P=0.006)were independent risk factors for CHD in elderly male patients with T2DM. Conclusion:Elderly patients with T2DM complicated with CHD are more likely to be in hypercoagulable state, more likely to have thromboembolic events, and more obvious renal function damage.Poor fasting blood glucose control and decreased total bilirubin concentration are the influencing factors of CHD in elderly male patients with T2DM.Age elevated, elevated hemoglobin a1c concentration, complicated with hypertension, elevated D-dimer concentration and elevated uric acid concentration are independent risk factors for CHD in elderly male patients with T2DM.

Myasthenia gravis crisis (MC) often involves respiratory muscles and requires mechanical ventilation urgently. As non-invasive mechanical ventilation (NIV) technology unceasing development, its use in acute respiratory failure caused by MC shows obvious advantages. However, how to identify the occurrence of MC at early stage, predict the relevant indicators of NIV for MC treatment, and apply different ventilation strategies to improve the effect of treatment are worthy of attention. In addition, the new development of NIV modes in recent years also provides new direction for the treatment of MC. Therefore, this article reviews recent advance in the clinical application of NIV in MC to provide clinical references.