Objective To compare the reduction in left ventricular hypertrophy (LVH) caused by monotherapy with ramipril or losartan or the combination of these two drugs,in patients with hypertensive LVH and to evaluate the value of three-dimensional echocardiography (3DE) on LVH regression.Methods Ninety-six essential hypertensive patients with LVH were enrolled in this study.All patients were randomly divided into 3 groups: ramipril group,losartan group,combination group with ramipril and losartan.Left ventricular mass(LVM) was calculated by M-mode echocardiography,two-dimensional echocardiography and 3DE at baseline and after 6 months treatment with ramipril or losartan.Results Of 96 patients enrolled,59 patients have complete follow-up datum.LVM of ramipril,losartan and combination group decreased 16.9% , 17.9% and 18.8% compared with before treatment.LVM by 3DE decreased 11.6% , 14.7% and 13.6% respectively.The difference of LVM derived from 3DE showed obviously lower than derived from M-mode echocardiography.Conclusions Applying M-mode echocardiography and two-dimensional echocardiography to evaluate the regression of LVH will overestimate the effects of drugs.Three-dimensional echocardiography may detect the changes of LVM more accurately.

Objective To evaluate the effects of angiotensin converting enzyme inhibition(ACEI) or angiotensin II receptor blocker(ARB) on coronary hemodynamics in hypertensive patients with left ventricular hypertrophy(LVH) by Doppler ultrasound.Methods Sixty essential hypertensive patients with LVH were enrolled in this study.All patients were randomly divided into 3 groups: ramipril group,losartan group and combination group.Left ventricular mass(LVM) was calculated by three dimensional echocardiography and coronary hemodynamics was evaluated by transesophageal echocardiography with left anterior descending artery.Coronary flow reserve(CFR) was calculated as the ratio of coronary flow velocity,after intravenous injection of dipyridamole,to rest peak velocity.All the indexes of the coronary hemodynamics were corrected by LVM.Results Fifty patients had complete follow up datum.The systolic blood pressure(SBP),diastolic blood pressure(DBP) and LVM were significantly decreased in ramipril,losartan and combination group after 6 months′ treatment (All P

Objective To explore the relationship of glucagon in many phases with insulin and blood glucose in patients with insulin resistance syndrome,and to provide theory and practice support for the treatment of insulin resistance syndrome.Methods Totally 93 patients with insulin resistance syndrome (observation group),107 patients with type 2 diabetes (diabetes group) and 80 patients without diabetes (non-diabetes group) in our hospital from July 2008 to October 2011 were selected.The general information were collected.Patients with stable blood glucose stopped taking anti-diabetic drug for 10 hours.The fasting blood glucose,fasting insulin,and fasting glucagon were tested.Then patients took 75 g glucose,blood glucose,insulin and glucagon were respectively tested after 30 and 120 minutes.Data were processed by SPSS 17.0 software,and P＜0.05 was considered as being statistically significant.Results The levels of fasting glucose,early phase glucose and late phase glucose were lower in observation group than in diabetes group,but higher than in non-diabetic group,and the differences were statistically significant (all P＜0.05).The levels of fasting insulin,the early phase insulin,and late phase insulin were higher in observation group than in diabetes group and non-diabetic group,and the differences were statistically significant (both P＜0.05).The insulin levels in observation group and diabetes group were lowest after fasting and were highest at 120 minutes after the oral glucose load,but the insulin levels were highest at 30 minutes and decreased at 120 minutes after the oral glucose load in non diabetic group.The differences in fasting glucagon,early phase glucagon and late phase glucagon among three groups were statistically significant (all P＜0.05).The glucagon levels in observation group and diabetes group were lowest after fasting and highest at 120 minutes after the oral glucose load,but the glucagon levels in non-diabetic group were highest after fasting and were lowest at 120 minutes after the oral glucose load.There were positive correlations between glucagon and glucose in 3 phases in observation group (r=0.65,0.63,0.67,respectively,all P＜0.05).Conclusions Glucagon and glucose in different phases are positively correlated in patients with insulin resistance syndrome,and blood glucose can be controlled by improving glucagon secretion.

Objective To investigate the diagnostic value of D-dimer age-adjusted threshold in elderly patients with Pulmonary thromboembolism(PTE).Methods Collected patients older than 50 years of suspected PTE,who visited Yan′an People′s Hospital and the Hospital Affiliated to Yan′an University from June 2015 to September 2016,using the revised Geneva criteria for clinical probability assessment firstly.The low-risk group was excluded from the study;the patients with moderate-to-high risk were performed D-dimer detection and CTPA.All patients determined both by D-dimer age-adjusted thresholds and traditional thresholds,comparing the diagnostic efficacy of the two methods subsequently.Results 163 patients were diagnosed with PTE by CTPA among the 549 subjects,the positive rate was 29.69％.The diagnostic sensitivity of plasma D-dimer was 83.44％,78.53％,the specificity was 17.88％,31.61％ respectively,the missed diagnosis rate was 16.56％,21.47％,respectively.The misdiagnosis rates were 82.12％ and 68.39％,respectively,and the Younden index was 0.013 2 and 0.101 4 respectively.All subjects were divided into four groups according to age:50-60 years,60-70 years,70-80 years,and equal or greater than 80 years age group.Compared with the traditional threshold,the misdiagnosis rates of the four groups of age-adjusted thresholds decreased by 4.00％,15.70％,21.36％ and 17.39％,respectively and the specificity was increased by 1.23,1.65,2.56 and 3.00 times,respectively.Conclusion The diagnostic accuracy of the age-corrected threshold is higher than the traditional threshold;combined with clinical practice,the optimal threshold is determined by the ROC curve,the clinician can serve as a reference.

Objective To investigate the thawing modes on stability of coagulation control products after frozen,looking for a new theoretical basis for cost control and the quality and safety of laboratory.Methods Using ACL TOP 700 automated co-agulation analyzer and supporting the same batch of reagents and quality control materials conduct of the study:after daily QC,recycled the remaining control materials immediately and dispensed into two EP tubes and frozen at-40℃,respectively thawed by room-temperature and 37℃water bath after 24 hours,and examined together with the date of quality control ma-terial,got 20 pairs of data for analysis the financial impact of two alternate ways on coagulation QC parameters.Results For the room-temperature thawing group,FIB high value increasedby an average 0.23 g/L (t=4.026 9,P<0.05);TT normal value average reduction of 0.46 s (t=-3.813 8,P<0.05),TT high value reduced by an average 0.41s (t=-3.972 8,P<0.05);D-Dimer low-value increased by an average of 14.75 ng/ml FEU (t=2.281 6,P<0.05),while APTT,PT normal and high value,FIB normal value,D-Dimer high value were no significant difference after thawing (P>0.05).For the 37℃water bath group,both normal and high value of APTT,PT,FIB,TT and D-Dimer were no significant difference after tha-wing (P>0.05).Conclusion The commercialization of coagulation control materials can be for the second QC,just follow the principle of rapid after melting and timely detection,other laboratories can be used as a reference.

Objective To study the protective effects of Tianma xingnao capsule on brain blood circulation in mice and rats.Methods The arteria carotis externa was ligated,and arteria carotis interna was kept.The left carotid artery was exposed and placed over an ultrasonic flow probe.The brain flow volume was recorded with an Ultrasonic Volume.The pursiness time of mice was observed to evaluate the effect of Tianma xingnao capsule on cerebral ischemia and anoxia.The permeability of normal blood-cerebral barrier was investigated in mice.Results Tianma xingnao capsule significantly increased brain blood flow and prolonged mouse pursiness time.Tianma xingnao capsule at a dose of 4 g/kg significantly elevated the content of Evans in mouse brain.Conclusions Tianma xingnao capsule can increase the brain blood flow in rats and improve brain blood circulation in mice.It is obviously advantageous to protect against cerebral ischemia and hypoxia.

Mesaconitine was incubated with rat liver microsomes in vitro. The metabolites of mesaconitine in rat liver microsomes were identified by ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method with high resolution power. A typical reaction mixture of 100 mol L-1 Tris-HCI buffer (pH 7.4) containing 0.5 gL-1 microsomal protein and 50 micro molL-1 mesaconitine was prepared. The above reaction mixture was divided into six groups, and the volume of each group was 200 micro L. The incubation mixture was pre-incubated at 37 degrees C for 2 min and the reactions were initiated by adding NADPH generating system. After 90 min incubation at 37 degrees C, 200 micro L of acetonitrile was added to each group to stop the reaction. The metabolites of mesaconitine were investigated by UPLC-MS/MS method. Mesaconitine and 6 metabolites M1-M6 were found in the incubation system. The structures were characterized according to the data from MS/MS spectra and literatures. The metabolic reactions of mesaconitine in rat liver microsomes included the demethylation, deacetylation, dehydrogenation and hydroxylation. The major metabolic pathways of mesaconitine in rat liver microsomes were determined by UPLC-MS/MS on multiple reaction monitoring (MRM) mode combined with specific inhibitors of cytochrome P450 (CYP) isoforms, including alpha-naphthoflavone (CYP1A2), quinine (CYP2D), diethyldithiocarbamate (CYP2E1), ketoconazole (CYP3A) and sulfaphenazole (CYP2C), separately. Mesaconitine was mainly metabolized by CYP3A. CYP2C and CYP2D were also more important CYP isoforms for the metabolism reactions of mesaconitine, but CYP1A2 and CYP2E1 haven't any contribution to MA metabolism in rat liver microsomes.
Aconitine ; analogs & derivatives ; metabolism ; Animals ; Chromatography, High Pressure Liquid ; Cytochrome P-450 CYP3A ; metabolism ; Cytochrome P-450 CYP3A Inhibitors ; Cytochrome P-450 Enzyme Inhibitors ; Cytochrome P-450 Enzyme System ; metabolism ; Enzyme Inhibitors ; pharmacology ; Ketoconazole ; pharmacology ; Male ; Metabolic Networks and Pathways ; Microsomes, Liver ; enzymology ; metabolism ; Quinine ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Sulfaphenazole ; pharmacology ; Tandem Mass Spectrometry

Objective:To investigate the correlation between lumbar bone mineral density (BMD), musculoskeletal perfusion andmuscle mass.Methods:From May 2019 to August 2020, totally 91 patients who applied for CT perfusion (CTP) examination of abdomen (the scan range included the vertebral body of L1－L3) in Shanghai Tenth People′s Hospital of Tongji University were retrospectively analyzed. The mean BMD of L1－L3 vertebral body was measured by quantitative CT (QCT) at the same time of CT plain scan. According to BMD, the subjects were divided into normal BMD group ( n=33), osteopenia group ( n=41) and osteoporosis (OP) group ( n=17). The L3 level perivertebral muscle mass index and fat fraction were calculated based on QCT examination. The lumbar vertebral and perivertebral muscle perfusion parameters were measured based on CTP images. The parameters of QCT and CTP among three groups were analyzed by Kruskal-Wallis H test or one-way ANOVA. The correlation analysis was conducted between these parameters using Pearson or Spearman analysis. Results:The differences of the perivertebral muscle mass index and fat fraction among three groups were statistically significant ( P<0.05). The differences of the lumbar vertebral perfusion parameters including blood flow (BF), blood volume (BV) and flow extraction product (FE) among three groups were statistically significant ( P<0.05), and BF, BV and FE were positively correlated with BMD ( r=0.444, 0.312 and 0.266 respectively, all P<0.05; adjusted for age and gender r=0.437, 0.340 and 0.337 respectively, all P<0.05). There was no statistically significant difference in perivertebral muscle perfusion parameters among three groups ( P>0.05). Perivertebral muscle mass index was negatively correlated with fat fraction ( r=-0.599, P<0.001; adjusted for age and gender r=-0.404, P<0.001), and there was no correlation between perivertebral muscle mass index and muscle perfusion parameters, as well as perivertebral muscle fat fraction and muscle perfusion parameters. Conclusions:With the changes of BMD, bone mass and perivertebral muscle mass at L3 level are synchronous. Decreased vertebral bone mass is accompanied with reduced perivertebral muscle mass, increased muscle fat and decreased bone perfusion. The changes of vertebral perfusion and perivertebral muscle perfusion at L3 level are asynchronous, which implies that reduced perfusion in OP patients may be confined to the bone.

Objective To compare the clinical effect of two kinds of internal fixation of locking plate and anatomical plate in the treatment of Pilon fracture.Methods 64 patients with Pilon fracture undergoing elective surgery were randomly divided into study group and control group by digital table method,32 cases in each group.The study group received locking plate internal fixation for the treatment,the control group was treated with anatomical plate internal fixation.The clinical efficacy and safety of two kinds of internal fixation methods were compared.Results After treatment,the excellent rate of ankle joint function in the study group(96.88%)was significantly higher than that in the control group (81.25%),and the difference had statistical ssignificance (χ2 =4.01,P <0.05 ).The operative time,hospitalization time and fracture healing time[(57.32 ±10.98)min,(13.72 ±591 )d,(15.72 ± 2.82)weeks]in the study group were shorter than those in the control group[(68.11 ±11.85 )min,(16.62 ± 5.21)d,(17.81 ±3.42)weeks],and the differences had statistical significance(t =3.98,3.11,321,all P <0.05). The amount of bleeding (153.32 ±21.36)mL in the study group was less than that in the control group [(188.65 ± 26.24)mL](t =5.46,P <0.05).The incidence rate of delayed fracture healing of the study group (3.13%)was significantly lower than that in the control group(28.13%),the difference had statistical significance(χ2 =7.59,P <0.05).There were no significant differences in the incidence of other complications between the two groups(χ2 =1.95,102,102,0.35,all P >0.05).Conclusion Locking plate fixation in the treatment of Pilon fractures could significantly promote the recovery of joint function,and has the advantages of short operation time,fast fracture healing,less complications and other advantages,it is better than anatomical plate internal fixation.