Heart rate turbulence (HRT)can Well reflect autonomic function.There usually exist different degrees of autonomic impairment in patients With hypertension.As a selectiveβ1 receptor blocker,metoprolol can not only de-crease patients' blood pressure,but also inhibit sympathetic activity,improve vagal activity and HRT in these pa-tients.This article made folloWing overvieW on HRT phenomenon and metoprolol intervention effect in patients With hypertension.

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 summarize the clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation(ECMO) in infants after congenital heart disease opration with cardiopulmonary bypass.Methods:From January to September in 2019, 6 cases of congenital heart disease with cardio-pulmonary bypass in our hospital were analyzed retrospectively, whose membrane obstruction occurred during ECMO treatment and replaced successfully.The hemodynamics and blood gas before and after replacement of ECMO system were observed, and the experience was summarized.Results:Six patients(3 males and 3 females), aging from 1 to 3 months and weighing from 3.0 to 4.9 kg, were received VA-ECMO adjuvant therapy.The ECMO system replacement process was smooth and took 175-209 s. The hemodynamic of the children was stable.The ECMO support time was 134-249 h. After the improvement of cardiac systolic function, all children were successfully withdrawn and survived.Conclusion:The improved method of liquid replacement in ECMO system can make full use of the blood components in the original system and avoid the loss of blood tangible components.According to the plan of rapid replacement, the risk of replacement will not be increased.

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 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.

Objective:To compare the curative effects of different venous cannulas and drainage to improve patient's whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in lung transplantation.Methods:From December 2016 to December 2019, 12 patients who were assisted by VA-ECMO in one lung transplantation in People's Hospital of Henan Province were selected as the research objects. According to the number of side holes of venous cannulas, they were divided into two groups: one group with few side holes and other group with multiple side holes. The differences in blood gas indexes among the right radial artery, left radial artery, and right internal jugular vein before and after assistance were compared, and the assistance effect was evaluated.Results:The arterial partial pressure of oxygen (PaO 2) of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance [mmHg (1 mmHg = 0.133 kPa): right and left radial artery in few side holes group: 79.5±4.2 vs. 48.3±3.8 and 88.1±3.5 vs. 48.3±3.8; right and left radial artery in multiple side holes group: 67.7±5.9 vs. 48.7±3.2 and 84.0±3.8 vs. 48.7±3.2, all P < 0.05]. The arterial partial pressure of carbon dioxide (PaCO 2) of blood gas index was significantly lower than that before assistance (mmHg: 44.2±2.6 vs. 71.7±4.4 for the right radial artery and 44.7±1.4 vs. 71.7±4.4 for the left radial artery in the group with few side holes; 46.2±2.1 vs. 71.2±3.5 for the right radial artery and 44.1±1.9 vs. 71.2±3.5 for the left radial artery in the group with multiple side holes, all P < 0.05). The partial pressure of oxygen in venous blood (PvO 2) of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group (mmHg: 56.4±3.2 vs. 88.7±1.5, P < 0.01), and the partial pressure of carbon dioxide in venous blood (PvCO 2) was significantly higher than that of multiport side holes group (mmHg: 63.6±3.7 vs. 44.2±1.7, P < 0.01). Conclusions:When VA-ECMO is used in lung transplantation, the superior vena cava blood flow can be fully drained by using intravenous cannula with few side holes. It can effectively improve the oxygenation of the upper body of lung transplant patients, avoid the dilemma of hypoxemia in the upper body and hyperxemia in the lower body, provide more effective assistance to patients undergoing single lung transplantation, and is more meaningful for improving the oxygenation status of the whole body in patients undergoing single lung transplantation.