Atrial structural remodeling and electrical remodeling are the core of atrial fibrillation.Oxidative stress directly activates calcium/calmodulin-dependent protein kinase Ⅱ (CaMKⅡ), and induces electrical remodeling and atrial structural remodeling characterized by reduced atrial effective refractory period, which becomes the pathological basis of atrial fibrillation.Therefore, the study of the relationship between the oxidative CaMKⅡ and atrial remodeling will help to elucidate the pathogenesis of atrial fibrillation and to prevent or reverse atrial remodeling by lowering CaMKⅡ phosphorylation to reduce the incidence of atrial fibrillation.

Objective To discuss on the management of the medicines in ward pharmacy of primary hospitals and ex-plore effective measures to improve the quality of medicines management .Methods Based on the real situation , managing the quantity of medicines in inpatient pharmacy, including the setting of the reasonable quantity, the procedures of storing and de-livering, the quality control on the general medicines and the management of high -risk medicines, to improve the quality of management of the medicines in ward pharmacy .Conclusion The use of medicines in ward pharmacy of primary hospitals is becoming more and more standardized and rationalized by strengthening the management of the medicines in inpatient pharmacy .

Objective To investigate standard diagnosis and treatment of cerebrospinal fluid (CSF) leakage to improve the prognosis of the patients. Methods A retrospective study was done on 75 patients with CSF leakage from January 2004 to March 2007 in our hospital. There were 51 patients with rhinorrhea, nine with otorrhea and 15 with wound/incision leakage. Of all, 39 patients had traumatic leakage, 32 postoperative leakage and four spontaneous leakage. In the study, 23 patients were cured by position testing and drug therapy and 16 by cerebrospinal fluid drainage and/or wound debridement but 36 were treated with surgeries including craniotomy repair in 17, extracranial repair in 17 and CSF shunt in five (three received CSF shunt after repair). Results Of all, 64 patients were cured, 10 gained im-provement but one died. Conclusion Standard diagnosis and treatment of CSF leakage helps improve cure rate and reduce complications.

Objective:To understand the molecular pat hophysiology of hepatocellular carcinoma and pancreatic cancer.Methods: We studied novel gene expression by cDNA microarray method. The PCR pro ducts of 4 096 genes and 12 800 gene were spotted onto a kind of chemical-mater ial-coated-glass slide in array. Both the mRNAs from 5 cases of hepatocellular carcinoma and 3 cases of pancreatic cancer were reversely transcribed to cDNAs with the incorporation of fluorescent-labeled dUTP to prepare the hybridization probes. After hybridization, BioDoor4096 and BioDoor12800 cDNA microarray were scanned for the fluorescent intensity. Tumor invasion-related gene expression w as screened through the analysis of difference in gene expression profile.Results:Among 4 096 and 12 800 target genes, there were 15 genes who se expression level differed from normal and carcinoma tissues. Therefore, they might be associated with metastasis.Conclusion:Further analysis of these differentially expressed metastasis-associated genes will be helpful for understanding the molecular mechanism of malignant carcinoma.

Objective:To investigate the role of pleiotrophin (PTN) gene in carcino genesis using cDNA microarray and in situ hybridization. Methods:The expression of PTN gene in 5 cases of glioma, 10 laryngeal squamous cell carcinoma, 6 cases of hepatocarcinoma, and normal controls were detected by BioDoor 4096 type cDNA microarray and in situ hybridization. Results: The expression of PTN gene in carcinoma samples were significantly higher than in normal controls by cDNA microarray, the results was the same as by in situ hybridization. Conclusion: cDNA microarray is an effective technique in analysis of functional study of associated genes in carcinoma. High expression of PTN gene might be correlated with mechanism of multiple carcinoma. [

Objective: To investigate the effect and related mechanism of homocysteine (Hcy) on calcium overload in neonatal rat atrial cells (NRICs). Methods: NRICs were assigned to 9 groups after culture for 3 days: (1) control group; (2) Hcy group (0, 50, 100, 200, 500 μmol/L for 48 hours); (3) antioxidant group (NAC, 10 μmol/L for 24 hours); (4) Hcy+NAC group (500 μmol/L Hcy for 48 hours, then treated with 10 μmol/L NAC for 24 hours); (5) calcium/calmodulin dependent protein kinase Ⅱδ (CaMKⅡδ) inhibitor group (KN-93, 3 μmol/L KN-93 for 5 hours); (6) specific sodium current inhibitor group (ELE, 1 μmol/L ELE for 5 hours); (7) Hcy+KN-93 group (500 μmol/L Hcy for 48 hours, then treated with 3 μmol/L KN-93 for 5 hours); (8) Hcy+ELE group (500 μmol/L Hcy for 48 hours, then treated with 1 μmol/L ELE for 5 hours; (9) Hcy+KN-93+ELE group (500 μmol/L Hcy for 48 hours, then treated with 3 μmol/L KN-93 and 1 μmol/L ELE for 5 hours). Moreover, NRICs were also treated with CaMKⅡδ-siRNA lentivirus, and Nav1.5-siRNA lentivirus, negative lentivirus carrier containing green fluorescent protein (GFP) for 24 hours. The MOI values of the three groups were 10. Infection efficiency of lentivirus was determined by observing the percentage of GFP fluorescence under inverted fluorescence microscope after transfection for 24 hours, and cultured regularly with simultaneous Puro screening, then cells were grouped as Hcy+CaMKⅡδ-siRNA group, Hcy+Nav1.5-siRNA group and Hcy+negative group. The concentration of Ca²⁺ in NRICs ([Ca²⁺]i) of various groups was detected through Fluo-4/AM fluorescence probe, then 2', 7'- two chlorofluorescein diacetate (DCFH-DA) was used as a probe to detect reactive oxygen species (ROS) in NRICs by flow cytometry. The malondialdehyde (MDA) was detected by the activity of superoxide dismutase (SOD) and xanthine oxidase was detected by thiobarbituric acid colorimetry. The protein and mRNA expression level of CaMKⅡδ and Nav1.5 in NRICs were detected by Western blot and quantitative real-time PCR. Results: (1) ROS, MDA and SOD were similar between NAC group and control group, ROS and MDA were significantly increased, while SOD was significantly reduced in Hcy group in a concentration-dependent manner. (2) [Ca²⁺]i: The level of [Ca²⁺]i was (155.57+7.25), (187.43+13.07), (248.98+27.22) and (307.36+15.09) nmol/L in 50, 100, 200 and 500 μmol/L Hcy groups, which was significantly higher than that in the control group ((123.18+7.24) nmol/L, P<0.01). In addition, the level of [Ca²⁺]i in Hcy+NAC group ((222.87+23.71)nmol/L) was significantly lower than that in Hcy 500 μmol/L group ((305.15+39.45) nmol/L, P<0.05), while [Ca²⁺]i level was similar between NAC group and the control group. (3) The protein expression of CaMKⅡδ and Nav1.5 was significantly upregulated in Hcy groups than in the control group. The protein expression level of CaMKⅡδ-Thr287 was significantly lower in NAC group than in Hcy 500 μmol/L group (P<0.01), however, there was no significant difference on the protein expression levels of CaMKⅡδ-Thr287 and Nav1.5 between NAC group and control group (all P>0.05). (4) The protein expression levels of CaMKⅡδ-Thr287 and the concentration of [Ca²⁺]i were significantly lower in Hcy+KN-93 group and Hcy+KN-93+ELE group than in Hcy 500 μmol/L group (P<0.05). [Ca²⁺]i concentration was significantly lower in Hcy+KN-93 group, Hcy+ELE group and KN-93+ELE+Hcy group than in Hcy 500 μmol/L group (P<0.05). (5) The mRNA and protein expression levels of CaMKⅡδ and Nav1.5 in each group infected with lentivirus: the GFP expression was ideal post lentivirus transfection for 24 hours (up to 90%), which was significantly lower in the CaMKⅡδ-siRNA group and Nav1.5-siRNA group than in the negative infection group (all P<0.05), which was similar between negative infection group and control group (P>0.05). Moreover, the mRNA and protein expression levels of CaMKⅡδ and CaMKⅡδ-Thr287 was significantly lower in Hcy+Nav1.5-siRNA group than in Hcy+negative infection group (P<0.05). The protein and mRNA levels of Nav1.5 were similar between Hcy+CaMKⅡδ-siRNA group and Hcy+negative infection group (P>0.05). Conclusions Hcy can induce calcium overload in NRICs by increasing oxidative stress, upregulating the sodium channel protein, and activating the late sodium current and phosphorylating CaMKⅡδ.

Objective:To explore different strategies of central repair first or malperfusion first to treat type A aortic dissection complicated with limb malperfusion.Methods:From January 2020 to December 2021, 302 patients were diagnosed with acute type A aortic dissection, and 17 consecutive patients were diagnosed as type A acute aortic dissection complicated with limb malperfusion and underwent Sun’s procedure. There were 16 males and 1 female with an average of(52.6±4.2)years. Surgical strategies were as follows: immediate central repair-Sun’s procedure in 14 patients, endovascular stenting followed by central repair in 3 patients, endovascular stenting after central repair in 1 patient.Results:The incidence rate of limb malperfusion of acute Stanford A aortic dissection was 5.6%(17/302). Average extracorporeal circulation time was(271.8±38.9)min, average aortic cross-clamp time was (186.3±31.8)min, and the average circulatory arrest time was (48.75±11.3)min. Early mortality rate was 17.6%(3/17). Two patients were left hospital voluntarily because of cerebral infarction. One patient underwent leg incision osteofascial compartment syndrome and discharged unevently. Five patients underwent continuous renal replacement therapy and hemoperfusion. Follow-up results showed that patients with serious limb malperfusion have symptoms of nerve dysfunction including amyosthenia and sensory disturbance, but recovered gradually with rehabilitation.Conclusion:Sun’s procedure is safe and feasible for type A acute aortic dissection complicated with mild limb malperfusion. For serious limb malperfusion, endovascular stent followed by Sun’s procedure is a good choice with CRRT and hemoperfusion.

Objective:To investigate the association between occupational stress and carotid atherosclerosis among the workers in a steel plant.Methods:In October 2018, a total of 2947 workers from a steel plant, who underwent occupational health examination in the center for occupational health examination from March to May 2017, were selected as subjects. Job Content Questionnaire (JCQ) and Effort-Reward Imbalance (ERI) were used to investigate the job content and the degree of occupational stress. According to the results of carotid artery examination, the subjects were divided into normal carotid artery group with 2013 workers, increased carotid intima-media thickness (IMT) group with 277 workers, stable plaque group with 236 workers, and unstable plaque group with 421 workers. A unified questionnaire was distributed to each group, and related physical and biochemical examinations were performed. A multivariate unconditional logistic regression analysis was performed to investigate the risk factors for unstable plaque.Results:There were significant differences between the groups in sex, educational level, marital status, work in shifts, smoking, drinking, age, and working years ( P<0.05) , while there was no significant difference in exercise between groups ( P>0.05) . Based on the JCQ score, 761 (25.8%) had no stress, 959 (32.5%) had mild stress, 699 (23.7%) had moderate stress, and 528 (17.9%) had severe stress; based on the ERI score, 2526 (85.7%) had high effort and low reward and 421 (14.3%) did not have the high-effort and low-reward conditions. There was a significant difference in the composition of JCQ and ERI scores between groups ( P<0.05) . Moderate stress (odds ratio [ OR]=1.695) , severe stress ( OR=5.443) , ERI ( OR=7.391) , work in shift ( OR=1.784) , old age ( OR=1.009) , high systolic blood pressure ( OR=1.105) , high fasting blood glucose ( OR=1.212) , abnormal total cholesterol ( OR=3.693) , abnormal apolipoprotein B ( OR=39.215) , and abnormal high-sensitivity C-reactive protein ( OR=1.632) were the risk factors for unstable plaque. Conclusion:Occupational stress may be involved in the development of carotid atherosclerosis.

Objective:To investigate the abnormal patterns of spontaneous neural activity of patients with type 2 diabetes comorbid depression (T2DD) by using resting-state functional magnetic resonance imaging (rs-fMRI) fractional amplitude of low-frequency (fALFF) analysis, and determine the neuroimaging features of brain damage in T2DD patients.Methods:A perspective study was performed. Fifty-nine type 2 diabetes mellitus (T2DM) patients and 52 T2DD patients, admitted to and accepted treatment in Department of Endocrinology of our hospital from November 2017 to November 2020, were chosen; another 57 healthy controls matched with gender, age and education level, admitted to our hospital at the same time period were enrolled. Their clinical data, neuropsychological test and rs-fMRI data were collected; whole brain fALFF values were calculated, and fALFF values of different brain regions were compared in subjects of the 3 groups. Pearson correlation analysis was used to verify the correlations of fALFF values with clinical variables and neuropsychological scale scores.Results:The fALFF values in bilateral precuneus showed significant difference among the three groups ( P<0.05). The fALFF values in bilateral precuneus of the T2DD and T2DM groups were significantly lower than those in heathy control group ( P<0.05), and those in the T2DD group were lower than those in the T2DM group without significant difference ( P>0.05). Pearson correlation analysis showed that there were no correlations of fALFF values with clinical data and psychometric scale scores in T2DD group and T2DM group ( P>0.05). Conclusion:The abnormal patterns of spontaneous brain activity in the bilateral precuneus may be the neuroimaging markers of brain damage in T2DD patients.

Objective:To investigate the association between occupational stress and carotid atherosclerosis among the workers in a steel plant.Methods:In October 2018, a total of 2947 workers from a steel plant, who underwent occupational health examination in the center for occupational health examination from March to May 2017, were selected as subjects. Job Content Questionnaire (JCQ) and Effort-Reward Imbalance (ERI) were used to investigate the job content and the degree of occupational stress. According to the results of carotid artery examination, the subjects were divided into normal carotid artery group with 2013 workers, increased carotid intima-media thickness (IMT) group with 277 workers, stable plaque group with 236 workers, and unstable plaque group with 421 workers. A unified questionnaire was distributed to each group, and related physical and biochemical examinations were performed. A multivariate unconditional logistic regression analysis was performed to investigate the risk factors for unstable plaque.Results:There were significant differences between the groups in sex, educational level, marital status, work in shifts, smoking, drinking, age, and working years ( P<0.05) , while there was no significant difference in exercise between groups ( P>0.05) . Based on the JCQ score, 761 (25.8%) had no stress, 959 (32.5%) had mild stress, 699 (23.7%) had moderate stress, and 528 (17.9%) had severe stress; based on the ERI score, 2526 (85.7%) had high effort and low reward and 421 (14.3%) did not have the high-effort and low-reward conditions. There was a significant difference in the composition of JCQ and ERI scores between groups ( P<0.05) . Moderate stress (odds ratio [ OR]=1.695) , severe stress ( OR=5.443) , ERI ( OR=7.391) , work in shift ( OR=1.784) , old age ( OR=1.009) , high systolic blood pressure ( OR=1.105) , high fasting blood glucose ( OR=1.212) , abnormal total cholesterol ( OR=3.693) , abnormal apolipoprotein B ( OR=39.215) , and abnormal high-sensitivity C-reactive protein ( OR=1.632) were the risk factors for unstable plaque. Conclusion:Occupational stress may be involved in the development of carotid atherosclerosis.