The reactivity of vascular smooh muscle cell (VSMC) of coronary artery ofguinea pig fed with grains from Keshan disease area were studied by intracellular microelec-trode method. The glass micropipette of tip resistance 30-50 M? filled with 3 M KCl wasinserted from the inner surface of the vasclar segment. The resting membrane potential (Em)of VSMC of coronary artery was observed. The results were as follows: (1) Em ofVSMC of experimental group was -49.80?5.3mV. (2) The Se induced VSMC depolari-zation revealed a dose-response dependent manner in the experimental animal. The degreeof the depolarization was smaller than those in the control guinea pig. (3) KCl and AChcaused membrane depolarization and hyperpolarization respectively in the experimental group,but the changes of Em was higher than those in the control. From these facts it wasconcluded that the reactivity of coronary artery VSMC was increased in experimentalgroup. It was suggested that the vessel's factor play an important role in the pathogenesisof myocardial necrosis in experimental group animal.

Objective To investigate the effects of comprehensive geriatric assessment (CGA) and health intervention on outcome in discharged patients.Methods Discharged patients in geriatric ward from May to July 2012 were randomly assigned to control (n=36) and intervention (n=36) groups.Patients in the two groups were given comprehensive geriatric assessment (CGA) before discharging from hospital.Both groups were followed up for 3 months.Patients in intervention group received health intervention when leaving hospital,at 1 week,3 weeks and 3 months after discharge from hospital,while patients in control group were not given any intervention.The comprehensive illness condition (MCIRS-G),ability of daily life (ADL and IADL),rehospitalization and survival rate were compared between the two groups 3 months after the intervention.Results After 3 months,the scores of MCIRS-G,ADL and IADL were significantly better in intervention group than in control group[(29.06±4.51) vs.(33.09±4.34),(75.69±16.57)vs.(63.86±19.37),(11.72±3.20) vs.(9.77±2.52),respectively,t=3.84,2.77,2.85,all P=0.01].The total times ofreadmission and readmission length were less in intervention group than in control group [3 vs.17,x2 =8.79,P=0.02; (1.94±6.68) days vs.(8.81±14.09) days,t=2.64,P=0.01].There was no difference in survival rate between the two groups [100％ (36/36) vs.97.2％ (35/36),x2=1.01,P=0.30].Conclusions Comprehensive geriatric assessment and health intervention can alleviate symptoms and improve the ability of daily life.

Objective To investigate the social support of the elderly hospitalized individuals and its relationship with outcomes and to study its influential factors.Methods The elderly in-patients aged＞65 years old who were treated from April to June 2012 in Geriatric Department were recruited.The comprehensive geriatric assessment (CGA) that included social support scale (SSRS) was used.According to SSRS,the patients were assigned to the lower or higher score group.The participants were followed up for 1 year,and 12-month mortality and re-hospitalization were recorded.Student's t test,Chi-square test and multiple logistic regression were used for data analysis.Results The total score of social support was 26.58±8.99,which was significantly lower than the national norm (34.56±3.73,t =-7.52,P＜0.05).Those with advanced age,less household,depression,insufficient ability of daily life and instrument daily life showed relatively lower SSRS (t values were-2.54,8.22,-6.61,6.72 and 6.95,respectively; all P＜0.05).The patients with no spouse also got less social support (x2 =8.58,P＜0.05).At 1 year,no significant difference of re-hospitalization and mortality was found between the two groups (x2 values were 1.94 and 3.28,respectively; both P＞0.05).In multiple logistic regression analysis,fanily member,characteristics and living ability were the major influential factors of social support.Conclusions Medical staff should pay more attention to the elderly hospitalized patients and offer them sufficient social support to improve their quality of life.

Objective To investigate prenatal diagnosis and treatment of toxoplasmosis in fetuses with fluorescence quantitative polymerase chain reaction (FQ PCR) technique Methods Of the 70 pregnant women with toxoplasma(TOX) DNA positive , TOX DNA in amniotic fluid and/or fetal umbilical cord blood was detected with FQ PCR technique to diagnose fetal infection 48 ones were given routine treatment with spiramycin for 2 therapy periods Ultrasound examination were undertaken in all of pregnant women to monitor fetal growth Results Of the 70 cases with TOX DNA positive, TOX DNA was detected in 21 fetuses TOX DNA positive rates were similar in amniotic fluid and umbilical cord blood The higher the TOX DNA, the higher fetal infectious rate Fetal infectious rate was lower in treatment group(21%) than that in control group (50%), there was a statistically difference between two groups Conclusions Maternal TOX infection may cause fetal damage Detection of TOX DNA in amniotic fluid with FQ PCR technique can diagnose fetal toxoplasmosis exactly Treatment in pregnant period may decrease intrauterine infection rate

Objective: To study the relationship between CYP2D6*10 gene polymorphism and metoprolol therapeutic effect for hypertension. Methods: A total of 60 patients with essential hypertension (EH) received metoprolol 47.5mg/d for 3d. After 3d the plasma metoprolol concentration after oral 2h was measured. Polymorphism of CYP2D6*10 gene was detected by PCR-RFLP. According to results of gene detection, the patients were divided into CC genotype group (wild type homozygote, fast metabolism type, n=14), CT genotype group (heterozygous mutation, intermediate metabolism type, n=25) and TT genotype group (homozygous mutation, slow metabolism, n=19). Metoprolol dosage was adjusted according to CYP2D6*10 genotype. After one week, plasma concentration of metoprolol after oral 2h was measured again, and mean heart rate and blood pressure were measured before and after gene-directed therapy. Results: Before gene-directed therapy, compared with CC and CT group there was significant increase in plasma concentration of metoprolol [(26.57±19.40) ng/ml vs. (23.88±12.86) ng/ml vs. (64.74±32.94) ng/ml, P<0.01] in TT group; compared with TT group, there were significant rise in mean systolic blood pressure [mSBP, (132.84±13.40) mmHg vs. (144.14±14.28) mmHg], mean diastolic blood pressure [mDBP, (76.95±9.07) mmHg vs. (81.36±7.33) mmHg] and mean heart rate [mHR, (69.13±11.83) times/min vs. (76.66±7.33) times/min] in CC group, P<0.05 all. After gene-directed therapy, there were no significant difference in plasma concentration of metoprolol, mSBP, mDBP and mHR among all groups, P>0.05 all; Compared with before gene-directed therapy, there was significant increase in plasma concentration of metoprolol, and significant decrease in mSBP, mDBP and mHR in CC group (P<0.05). There were no significant difference in blood pressure and heart rate between before and after treatment in CT group and TT group (P>0.05). Conclusion: CYP2D6*10 gene polymorphism affects metoprolol metabolism and its therapeutic effect on hypertension, gene-directed therapy can significantly improve drug therapeutic effect and reach ideal therapeutic goal in short time.

Objective:To explore therapeutic effect of bisoprolol with CYP2D6 and CYP3A4 gene targeting therapy for hypertension .Methods :A total of 100 cases with essential hypertension (EH) were selected ,among them 20 ca-ses were randomly chosen to receive routine medication (bisoprolol 5 mg/d ,routine treatment group ) ,the other 80 patients were equally divided into group A (CYP2D6*10) and group B (CYP3A4*1G) .According to detection results of CYP2D6*10 and CYP3A4*1G gene polymorphism ,they were dived into group ACC (n=13) ,group ACT (n=14) ,group ATT (n=10) ,group BCC (n=21) ,group BCT (n=17) and group BTT (n=0) .Bisoprolol dosage was adjusted according to genotypes :group ACC and group BCC received 10 mg/d ,group ACT and group BCT received 5 mg/d ,group ATT and group BTT received 2.5 mg/d .Blood drug concentration ,blood pressure and heart rate were compared among above groups after two weeks .Relationship between plasma concentration of bisoprolol and gene polymorphism of drug metabolism enzyme was evaluated .Results:Comparison between related groups with same bi-soprolol dosage :there were no significant difference in blood drug concentration ,heart rate and blood pressure be-tween ACT and routine treatment group , P>0.05 all;compared with routine treatment group ,there was significant rise in blood drug concentration [ (33.5 ± 19.1) ng/ml vs .(50.13 ± 23.21) ng/ml] ,significant reduction in heart rate [ (71.4 ± 5.16) times/min vs .(66.5 ± 6.04) times/min] and blood pressure [ (127.22 ± 10.44/82.4 ± 7.27) mmHg vs .(119.48 ± 11.97/71.2 ± 10.30) mmHg] in BCT group , P<0.05 all .Conclusion:Because gene possesses polymorphism ,therapeutic effect of bisoprolol treating hypertension is differing ;the gene targeting therapy may significantly improve therapeutic effect for hypertension .

Objective To review the clinical diagnosis and treatment of acute focal renal infarction. Methods Three cases of focal renal infarction were reported and the literature was reviewed.The patients aged from 45 to 63 years with mean age of 54. Two cases had low back pain, 1 case with abdominal pain. Based on clinical history, B-ultrasonography and CT scan, focal renal infarction was diagnosed in 3 patients. There were 2 cases on left kidney and 1 case right. All cases were applied digital subtraction angiography (DSA) and thrombolytic anticoagulant therapy. Results Two cases received DSA and thrombolytic therapy. The other one case received pethidine 50 mg, progesterone 20 mg treatment, the salvia infusion and low molecular heparin 6000 U anticoagulant therapy. All patients had symtoms relieved after 1 d. A week later CT scan, 3 cases of renal infarction were apparently disappeared. Serum creatinine and urea nitrogen were normal. Three patients were followed, mean follow-up time was 1. 5 (0. 5-2) years. Conclusions The diagnosis of acute focal renal infarction mainly depends on B-ultrasound and CT. Early diagnosis and treatment is important for achieving recovery of the compromised renal function. Renal infarction should be suspected in the presence of abdominal pain of sudden onset.

Objective:To evaluate the efficacy of epidural labor analgesia in the latent phase for the re-pregnant parturients with scar uterus.Methods:One hundred re-pregnant parturients with scar uterus who were at full-term with a singleton fetus in vertex presentation, aged 26-38 yr, with height between 158-170 cm, weighing 61-95 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups ( n=50 each) using a random number table method: epidural labor analgesia in active phase group (group A) and epidural labor analgesia in latent phase group (group B). Epidural labor analgesia was performed in active phase of labor (cervical dilatation≥3 cm) in group A and in latent phase of labor (cervical dilatation≥1 cm) in group B. Epidural labor analgesia solution contained the mixture (100 ml) of 0.1% ropivacaine and sufentanil 0.5 μg/ml, and the analgesia pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion 8 ml/h and then turned off after delivery of fetus.Visual analogue scale scores were recorded on admission to the labor room, when the cervical dilation was 1, 2, 3, 4 and 10 cm and at the time point immediately after delivery.The labor time, volume of postpartum hemorrhage, emergency cesarean section, decision-to-delivery interval, Apgar score of the newborn at 1 min after birth and results of umbilical cord blood gas analysis were recorded. Results:Compared with group A, the visual analogue scale scores in latent phases of labor were significantly decreased at each time point of latent phases, the duration of the first stage of labor was prolonged, the rate of emergency cesarean section was decreased, and the decision-to-delivery interval was shortened ( P<0.05), and no significant change was found in the volume of postpartum hemorrhage in group B ( P>0.05). There was no significant difference in the Apgar score of the newborn and results of umbilical cord blood gas analysis between two groups ( P>0.05). Conclusion:Epidural labor analgesia performed in the latent phase provides better efficacy than that performed in the active phase when used for the re-pregnant parturients with scar uterus.

Objective:To assess the value of urine heat-shock protein-70 (HSP-70) in the early diagnosis of acute kidney injury (AKI) after cardiac cardiopulmonary bypass (CPB).Methods:Patients with cardiopulmonary bypass from May 2018 to July 2018 in Henan Provincial People's Hospital were enrolled as subjects. Urine samples were collected before and after cardiopulmonary bypass at 0 h, 2 h, 4 h, 6 h, 8 h, 12 h, 24 h and 48 h. Patients were divided into AKI group and non-AKI group according to the Kidney Disease: Improving Global Outcomes Guide. Urinary HSP-70, tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) were detected by enzyme-linked immunosorbent assay (ELISA) and urine neutrophil gelatinase-associated lipocalin (NGAL) was determined by immunoturbidimetry. The receiver operating characteristic (ROC) curve was plotted to calculate the critical value, sensitivity and specificity of urine HSP-70, [TIMP-2]×[IGFBP7] and NGAL for the diagnosis of postoperative AKI after CPB.Results:A total of 45 patients were enrolled in the study. There were 24 cases in AKI group and 21 cases in non-AKI group. The level of urinary HSP-70, [TIMP-2]×[IGFBP7] and NGAL in AKI group were significantly higher than in the non-AKI group at each postoperative time point, with statistically significant differences (all P<0.05). The level of urinary HSP-70 in AKI group peaked at 2 h after CPB, which was significantly earlier than the peak time of urine [TIMP-2]×[IGFBP7] and urine NGAL (12 h after CBP and 4 h after CBP, respectively). Urinary HSP-70≥2.1 μg/L could predict postoperative AKI of CPB at 2 h after CPB, with the area under the curve ( AUC) of 1.00, the sensitivity of 100.0% and the specificity of 100.0%. Urinary [TIMP-2]×[IGFBP7]>19.1 μg 2/L 2 could predict postoperative AKI of CPB at 12 h after CPB with the AUC of 0.94, the sensitivity of 87.5%, and the specificity of 100.0%. Urinary NGAL>27.4 μg/L could predict postoperative AKI of CPB at 4 h after CPB with the AUC of 0.95, the sensitivity of 95.8%, and the specificity of 85.7%. The positive predictive value of urine HSP-70≥2.1 μg/L at 2 h after CPB was 100.0%, and the negative predictive value was 100.0%. Conclusions:The level of urinary HSP-70 increases earlier than that of urinary [TIMP-2]×[IGFBP7] and NGAL in patients with AKI after CPB. Clinical monitoring of urinary HSP-70 level contributes to early diagnosis of AKI.