1.Clinical analysis of 498 papillary thyroid carcinoma cases at cNo stage
Dong WANG ; Cui ZHAO ; Youzhong LIU ; Mei ZHANG ; Wenchuan ZHAO
Chinese Journal of General Surgery 2012;27(1):17-20
Objective To explore the relationship between the status of the cervical lymphatic metastasis of papillary thyroid carcinoma(PTC)at cNo stage and tumor recurrence and the patient' s prognosis.Methods The clinical data of 498 cNo PTC patients admitted from 1986 to 1990 were retrospectively analyzed.Results All the patients were followed up for more than 10 years.16 patients died of PTC,among them 3 for metastasis,13 for local recurrence.The total cervical lymphatic metastasis rate in these 498 patients was 52.2%,in 260 cases in which detailed data were available: rate was 14.1% in zone Ⅱ,27.1% in zone Ⅲ,24.6% in zone Ⅳ,12.5% in zone Ⅴ,and 20.1% in zone Ⅵ respectively.According to the appearances of microscopic pathology,the cervical lymphatic metastasis rates in 498 cases of cNo PTC were collected as following: uncapsuled group was 65.6%,extracapsular group was 64.5%,extralobal group was 56.5%,involved the surrounding tissue and structure group was 52.0%,focal cancerous focus group was 33.3%,latent sclerosis group was 26.9%,encapsuled and introcapsule group was 0.The cervical recurrence rate was only 2% in the complete function neck dissection group and 9.9% in the selective center neck dissection group.Conclusions In cNo PTC the most common cause of death was local recurrence.Prophylactic function complete neck dissection should be performed for cNo PTC cases of highly invasive type such as without tumor capsule,extracapsular,extralobal or surrounding tissue invasion.
2.Effect of low T_3 syndrome on outcome of acute myocardial infarction
qi, SHAO ; ying, REN ; jun-min, QUAN ; dong-mei, DU ; cui-chun, ZHAO ; meng, WEI
Journal of Shanghai Jiaotong University(Medical Science) 2006;0(12):-
Objective To investigate the prevalence of low T3 syndrome in patients with acute myocardial infarction(AMI) and explore the effect of low T3 syndrome on outcome of AMI.MethodsThree hundred and thirty-eight patients with AMI admitted to cardiac care unit(CCU) underwent examinations of thyroid function and cardial ultrasound,and were further categorized according to thyroid hormone profile.The records of noninvasive bi-level positive airway pressure(BiPAP)ventilation utilization,length of hospital stay,mortality during hospitalization were evaluated,and the related factors were analysed.ResultsOne hundred and thirty-nine of the 338 patients(41.12%) with AMI complicated with low T3 syndrome.Free triiodothyronine(FT3) was the independent influential factor for length of hospital stay.Low FT3 was significantly correlated with noninvasive BiPAP ventilation utilization and mortality during hospitalization.The average time of follow-up was(21.4?8.1) months.It was revealed by multivariate Cox regression analysis that FT3 was the chief predictor for cumulative death(risk ratio,4.25;95% confidential interval,2.30-7.87),followed by age and left ventricular ejection fraction.ConclusionThe recognition of AMI complicated with low T3 syndrome plays an important role in predicting the disease severity and outcome.
3.Comparative study between the features of FFA and OCT in diabetic macular edema
Qin-Hui, WANG ; Jiu-Ping, LIU ; Dong-Mei, CUI ; Yan, HE ; Xin, TANG
International Eye Science 2014;(12):2210-2213
AlM: To assess the correlation between the features of optical coherencetomography ( OCT ) and fundus fluorescein angiography ( FFA) in diabetic macular edema ( DEM) .
METHODS: Totally 70 patients (135 eyes) with diabetic retinopathy ( DR) were evaluated by central vision, best corrected visual acuity ( BCVA ) , intraocular pressure, indirect ophthalmoscopy, slit lamp microscope combined+ 90D front mirror mydriatic fundus examination, mydriatic fundus color photography, OCT, FFA, the correlation between FFA and OCT were analyzed.
RESULTS: ln mild macular oedema cases, abnormalities in FFA was 56 eyes, abnormalities in OCT was 68 eyes (P=0. 0009);FFA showed 12 normal eyes, 10 eyes in OCT were characterized by diffused macular oedema; FFA was performed with cystoid macular oedema, OCT was 46. 7% with cystoid type .
CONCLUSlON: DME is diagnosed by Combination FFA with OCT, OCT is an indispensable tool when following up DME, and it has advantage in early application.
4.Design,Applications and Effects of "Multimedia Paper of Microbiology Experiment"
Zhan-Li CUI ; Hui TANG ; Hong-Yan ZHANG ; Dong-Mei SUN ;
Microbiology 1992;0(02):-
Based on improving experimental operating skills of students and considering the features of microbiology experimental technology and methods,we developed a new examination ways of microbiology experiment — "multimedia papers of microbiology experiments" to use among 2005 and 2006 students of sophomore(entering campus in 2005 and 2006) of biotechnology and bio-science for microbiology experiment examination.Analysis of the results of experiment examination and theoretical examination for the 2005 and 2006 students showed that the disharmony and miscorrelation between experiment examination results and theoretical examination results were overcome,and students got more interested in experimental classes,while their experimental operation is more conscious and accurate.
5.Diagnostic value of serum cysteine leukotriene levels for obstructive sleep apnea hypopnea syndrome in children
Dong-Mei MA ; Abulaiti ; Pei-Ru XU ; Cui-Cui ZHU
Chinese Journal of Applied Clinical Pediatrics 2013;28(10):764-767
Objective To assess the clinical value of the measurement of cysteine leukotriene (CysLTs) concentration in serum as a diagnostic predictor to screen the obstructive sleep apnea hypopnea syndrome (OSAHS) in children.Methods Serum CysLTs concentration was measured with ELISA kit in 75 patients with snoring before per.forming polysomnography (PSG).Subsequently,all the subjects underwent PSG test.Forty-one subjects were diagnosed as OSAHS,and 34 subjects didn't have OSAHS.These 34 non-OSAHS subjects were served as control group.Among the OSAHS group,25 subjects were the Han nationality and 12 subjects were the Uyghur nationality.According to apnea hyponea index(AHI),the OSAHS group was divided into 3 groups,which were light,moderate and severe groups.And the serum CysLTs level of the OSAHS group was taken for correlation analysis with the sleep respiratory parameters.Compared with the PSG results,the clinical value of the measurement of CysLTs concentration in serum was taken as a diagnostic predictor to screen patients with OSAHS in children.Results 1.The serum CysLTs level of OSAHS group [(683.102 ±89.825) ng/L] was significantly higher than that in the control group [(461.985 ± 84.951) ng/L] (P < 0.05).And it was correlated positively with AHI,longest apnea time,sleep apnea low aeration time (r =0.417,0.422,0.208,all P < 0.05),but correlated negatively with the lowest oxygen saturation and the mean oxygen saturation (r =-0.192,-0.255,all P < 0.05).2.The serum CysLTs level [(773.118 ± 92.015) ng/L] in severe OSAHS group was significantly higher than that in the moderate OSAHS group [(712.144 ± 41.331) ng/L] (P < 0.05),and much more significantly higher than that in the light OSAHS group [(642.206 ± 77.250) ng/L] (P < 0.05).3.When the serum CysLTs level was 560.872 ng/L,there was the best critical point with the highest sensitivity rate (92.7%)and specificity rate (94.1%),and the lowest misdiagnosis rate and the false dismissal rate,as diagnose accordance rate was 93.3%.4.The serum CysLTs level of Han [(704.417 ± 77.149) ng/L] was higher than that of Uygur [(628.053 ± 105.443) ng/L],and there was significant difference between the 2 groups (P < 0.05).Conclusions Serum CysLTs level is closely related with the severity of OSAHS.There is difference in serum CysLTs level between different nationalities.The serum CysLTs level of the Han nationality is higher than the Uygnr nationality.The serum level of CysLTs may be used as a predictor in screening 0SAHS children and a biological marker of the severity of OSAHS children.
6.Association of polymorphism of β3-adrenergic receptor gene and the leptin gene with Kazak obese children in Xinjiang
Cui-Cui ZHU ; Ji-Hong ZHANG ; Pei-Ru XU ; Min LI ; Dong-Mei MA
Chinese Journal of Applied Clinical Pediatrics 2013;28(11):816-819
Objective To investigate the association between C2549A polymorphism of leptin gene and the Trp64Arg polymorphism of the β3-adrenergic receptor gene(β3-AR gene) and obesity in Kazak school-age children.Methods Totally 92 obese children and 71 healthy controls were selected from 6 to 12 years old in Kazak school-age children from the area around Urumqi.Genotype of the C2549A polymorphism of leptin gene and the Trp64Arg polymor phism of β3-AR gene were determined by polymerase chain reaction and restriction fragment length polymorphism methods.Results 1.The difference in distribution of the β3-AR gene Trp64Arg genotype of obesity and healthy controls of Kazak children was statistically significant (x2 =10.472,P < 0.05),but the difference in distribution of the alleles was not statistically significant (x2 =3.541,P > 0.05).2.The differences in distribution of the leptin C2549A genotype and alleles of the 2 groups were all statistically significant,and the odds ratio of the alleles(0.608) and 95% CI 0.380-0.972 suggested that the mutation occurrence of obesity might have certain protective effect.3.The difference in distribution of the genotype of β3-AR gene Trp64Arg polymorphism and leptin gene promoter area C2549A polymorphism in the same individual joint action of 2 groups was statistically significant (x2 =15.978,P < 0.05),but the difference in distribution of the alleles in the same individual joint action of 2 groups was not statistically significant (x2 =6.362,P > 0.05).Conclusions 1.There were distributions of the Trp64Arg polymorphism of β3-AR gene and the C2549A polymorphism of leptin gene in Kazak school-aged children in Xinjiang.2.These results suggested that C2549A mutation of leptin gene might have certain protective effect in Kazak children obesity,and the Trp64Arg polymorphism of β3-AR gene might be associated with Kazak children obesity.3.These results suggested that the Trp64Arg polymorphism of β3-AR gene and the C2549A polymorphism of leptin gene in the same individual joint action might be associated with Kazak children obesity in Xinjiang.
7.Effects of p300/CBP on histone acetylation of Foxp3 gene in children with Kawasaki disease
Jiehua MEI ; Qin WANG ; Guobing WANG ; Pengqiang WEN ; Mingguo XU ; Gen TANG ; Dong CUI ; Cong LIU ; Dongli MA ; Chengrong LI
Chinese Journal of Microbiology and Immunology 2017;37(5):347-354
Objective To investigate the effects of p300/CBP on histone acetylation of Foxp3 gene and its roles in the immunological pathogenesis of Kawasaki disease (KD).Methods Forty-six children with KD and twenty-eight age-matched health children were consented to participate in this study.Co-immunoprecipitation and real-time PCR were performed to detect Foxp3-associated acetylation levels of histone H4 and binding abilities of p300, CBP, pSmad3 (phosphorylated mothers against decapentaplegic homolog 3) and NF-AT (nuclear factor of activated T cells) with Foxp3 gene in CD4+ T cells.The percentages of CD4+CD25high Foxp3+ cells (Treg) and the expression of Foxp3, CTLA4 (cytotoxic T-lymphocyte-associated protein 4), p300, CBP, TGF-βRⅡ (transforming growth factor β receptor Ⅱ) and pLAT1 at protein level were analyzed by flow cytometry.Quantitative real-time PCR was used to measure the expression of Foxp3, IL-10, TGF-β, TGF-βRⅠ, Egr-1 (early growth response protein 1), RARα (retinoic acid receptor α) and PLCγ1 (phospholipase C-γ1) in Treg cells at mRNA level.Plasma concentrations of TGF-β and retinol acid (RA) were measured by enzyme-linked immunosorbent assay.Results (1) The percentages of Treg cells, levels of Foxp3 and molecules associated with suppressive function of Treg cells (TGF-β, IL-10 and CTLA4), acetylation levels of histone H4 associated with promoter, conserved non-coding DNA sequence 1 (CNS1) and CNS2 of Foxp3 gene decreased remarkably during acute KD (P<0.05), but were restored after IVIG therapy (P<0.05).Meanwhile, all of the aforementioned items in KD patients with coronary artery lesions (KD-CAL+) were lower than those without coronary artery lesions (KD-CAL-) (P<0.05).No significant differences in histone H4 acetylation associated with CNS3 were found among different groups (P>0.05).(2) The levels of p300 and CBP in Treg cells and their binding abilities with Foxp3 gene were down-regulated significantly during acute KD (P<0.05), but were restored to some extent after IVIG treatment (P<0.05).The Foxp3-associated histone acetylation was positively correlated with the expression of p300 and CBP at mRNA level during acute KD (r=0.65, 0.42, P<0.05).Furthermore, the expression of p300 and CBP and their binding abilities with Foxp3 gene in KD-CAL+ group were lower than those in KD-CAL-group (P<0.05).(3) Compared with healthy subjects, plasma concentrations of TGF-β and RA and the expression of TGF-βRⅠ/Ⅱ/Egr-1, RARα and pLAT1/PLCγ1 were down-regulated during acute KD (P<0.05);the binding abilities of pSmad3 and NFAT with Foxp3 gene were reduced remarkably in patients with acute KD (P<0.05).All the items mentioned above were restored after IVIG treatment (P<0.05).Moreover, the ten items aforementioned in KD-CAL+ group were lower than those in KD-CAL-group (P<0.05).(4) Higher acetylation levels of histone H4 associated with promoter, CNS1 and CNS2, and enhanced binding abilities of p300 and CBP with Foxp3 gene were found in CD4+ T cells isolated from patients with acute KD after co-stimulation with TGF-β, RA and anti-CD3/CD28 antibodies as compared with those in CD4+ T cells without stimulation (P<0.05).However, no statistical difference in the acetylation level of histone H4 associated with CNS3 was found between the two groups (P>0.05).Conclusion Hypoacetylation of histone H4 associated with Foxp3 gene caused by insufficient expression of p300/CBP and their impaired binding abilities might be involved with immune dysfunction in KD.IVIG therapy regulates the expression of p300/CBP and their binding abilities with Foxp3 gene through up-regulating TGF-β signal.
8.Effects of SMYD3 and MLL5 on histone methylation of Foxp3 gene in children with Kawasaki disease
Jiehua MEI ; Qin WANG ; Guobing WANG ; Pengqiang WEN ; Mingguo XU ; Gen TANG ; Dong CUI ; Cong LIU ; Dongli MA ; Chengrong LI
Chinese Journal of Rheumatology 2017;21(8):518-523
Objective To investigate the effects of SMYD3 and MLL5 on histone methylation of Transcription factor forkhead box protein 3 (Foxp3) gene and its roles in the immunological pathogenesis of Kawasaki disease (KD). Methods Forty-two children with KD and 26 age-matched healthy children were consented to participate in this study. Co-Immunoprec-ipitation and real-time polymerase chain reaction (PCR) was performed to determine Foxp3-associated histone methylation levels of H3K4me3 and H3K27me3, and binding levels of SMYD3 and MLL5 with Foxp3 gene in CD4+T cells. The proportion of CD4+CD25high Foxp3+cells (Treg) and protein levels of Foxp3, cytotoxic T lymphocyte associated antigen-4 (CTLA4), TGF-βRⅡand pSmad3 were analyzed by flow cytometry. Quantitative real-time PCR was used to evaluate levels of Foxp3, interleukin (IL)-10, GITR, TGF-βRⅠand RARαmRNA in CD4+T cells. Plasma concentrations of TGF-βand retinol acid (RA) were measured by enzyme-linked Immunosorbent assay. Independent-samples t-test was used as the statistical method in this study. Results ① The proportion of Treg, expression levels of Foxp3 and molecules associated with suppressive function of Treg cells(IL-10, GITR and CTLA4), and histone methylation levels of H3K4me3 associating with promoter, conserved non-coding DNA sequence (CNS) 1 and CNS2 of Foxp3 gene decreased remarkably during acute KD [Promoter:(5.4±1.8)%vs (9.1±2.2)%;CNS1:(2.6±0.9)% vs (3.8±1.1)%; CNS2: (2.4±0.8)% vs (4.2±1.0)%; t=5.50, 6.02, 9.56, 7.92, 7.97, 4.76, 7.73, 5.01, 8.66; P<0.05], and restored after intravenous immunoglobulins (IVIG) therapy [Promoter: (7.2 ±2.1)% vs (5.4 ±1.8)%; CNS1:(3.6±1.4)% vs (2.6±0.9)%; CNS2: (3.6±1.4)% vs (2.4±0.8)%; t=5.56, 4.59, 7.01, 6.04, 5.89, 4.83, 4.45, 4.00, 5.12; P<0.05]. Meanwhile, the nine former items in KD patients with coronary artery lesions (KD-CAL+) were lower than those without coronary artery lesions (KD-CAL-) [Promoter: (4.11±1.45)% vs (6.16±1.93)%; CNS1:(1.99±0.87)%vs (2.96±1.10)%;CNS2: (1.75±0.63)%vs (2.72±1.16)%;t=6.28, 3.24, 4.56, 3.69, 3.38, 4.40, 3.65, 3.00, 3.51; P<0.05]. No significant difference of H3K4me3 associated with CNS3 and H3K27me3 were found among the groups (t=1.03, 0.91, 1.48 and 0.79, 0.82, 1.53; P>0.05). ② Binding levels of SMYD3 and MLL5 with Foxp3 gene in CD4+T cells were down-regulated significantly during acute KD (t=6.63, 6.15; P<0.05), and restored to some extent after IVIG treatment (t=5.36, 4.56; P<0.05). Positive correlations between binding levels of SMYD3 and MLL5 and expression level of Foxp3 mRNA were detected in patients with acute KD (r=0.62、0.45, P<0.05). Furthermore, Binding levels of SMYD3 and MLL5 with Foxp3 gene in KD-CAL+group were lower than those in KD-CAL- group (t=4.11, 4.31; P<0.05). ③ Compared with healthy controls, plasma concentration of TGF-β and RA, and expressions of TGF-βRⅡ, TGF-βRⅠ, pSmad3 and RARα were down-regulated during acute KD (t=11.54, 12.81, 7.43, 16.10, 8.25, 12.06; P<0.05), and elevated remarkably after IVIG treatment (t=8.40, 6.24, 5.94, 11.78, 6.27, 8.30; P<0.05). Simultaneously, all the items aforementioned in KD-CAL+ group were found to be lower than those in KD-CAL-group (t=3.58, 3.30, 3.82, 5.27, 4.71, 3.78; P<0.05). Conclusion Hypomethylation of H3K4me3 associated with Foxp3 gene caused by insufficient binding levels of SMYD3/MLL5 may be involved with immune dysfunction in Kawasaki disease.
9.Changes and significances of IL-17-associated histone methylation in the acute phase of Kawasaki dis-ease
Jiehua MEI ; Qin WANG ; Pengqiang WEN ; Mingguo XU ; Gen TANG ; Dong CUI ; Cong LIU ; Chengrong LI ; Guobing WANG
Chinese Journal of Microbiology and Immunology 2016;36(9):692-698
Objective To investigate the changes and significances of IL-17-associated histone methylation in the acute phase of Kawasaki disease (KD). Methods Forty-two children with KD and 28 age-matched healthy children were recruited in this study. Co-immunoprecipitation and real-time PCR were performed to detect the IL-17-associated histone methylation in CD4+ T cells. The percentages of CD4+IL-17+ T cells (Th17) and the expression of IL-17 and pSTAT3 at protein level were analyzed by flow cytome-try. Quantitative real-time PCR was used to measure the expression of IL-17, IL-6Rα, gp130, IL-23R, IL-23Rβ1, ETV5, SOCS1, SOCS3, TLR4, MyD88/TRIF, TNFR1 and RIP1 at mRNA level and the expres-sion of miR155 in CD4+ T cells. The levels of IL-6, IL-23 and TNF-αin plasma samples were measured by enzyme-linked immunosorbent assay. Results (1) The children with acute KD showed increased percenta-ges of Th17 cells and enhanced expression of IL-17 and H3K4me3, but inhibited expression of H3K27me3 [H3K4me3:(3.79±1. 45)% vs (1. 93±0. 31)%, H3K27me3: (54. 51±13. 60)% vs (73. 96± 22. 32)%;P<0. 05]. Moreover, the three former indexes in KD patients complicated with coronary artery lesions ( KD-CAL+) were higher than those in KD patients without coronary artery lesions ( KD-CAL-) , while the levels of H3K27me3 in KD-CAL+ group were lower than those in KD-CAL- group [ H3K4me3:(5. 11±1. 68)% vs (2. 98±0. 99)%, H3K27me3:(45. 02±14. 83)% vs (60. 35±12. 51)%;P<0. 05]. A positive correlation was observed between the ratio of H3K4me3/H3K27me3 and IL-17 at transcriptional level in patients with acute KD (r=0. 69, P<0. 05). Treatment with intravenous immunoglobulin (IVIG) restored Th17 cells, expression of IL-17 and methylation levels of H3K4me3 and H3K27me3 to normal levels [H3K4me3:(2. 44 ± 0. 77)% vs (3. 79 ± 1. 45)%, H3K27me3: (66. 52 ± 15. 73)% vs (54. 51 ± 13. 60)%;P<0. 05]. (2) The expressions of pSTAT3, ETV5 and miR155 increased significantly in pa-tients with acute KD, while the expressions of negative regulators of pSTAT3 ( SOCS1 and SOCS3 ) were down-regulated. The expressions of pSTAT3, ETV5 and miR155 in KD-CAL+ group were higher than those in KD-CAL- group (P<0. 05), while the levels of SOCS1 and SOCS3 in KD-CAL+ group were lower than those in KD-CAL- group (P<0. 05). IVIG therapy restored the indexes mentioned above to some extent (P<0. 05). (3) Compared with the healthy subjects, the levels of inflammatory cytokines (IL-6, IL-23 and TNF-α) in plasma and the expressions of surface receptors (TLR4, IL-6Rα/gp130, IL-23R/IL-23Rβ1 and TNFR1) and its downstream adaptors (MyD88, TRIF, RIP1) in CD4+T cells were up-regulated in patients with acute KD (P<0. 05), but were down-regulated significantly after IVIG treatment (P<0. 05). Moreo-ver, all of the indexes mentioned above in KD-CAL+ group were found to be higher than those in KD-CAL-group (P<0. 05). Conclusion Aberrant patterns of IL-17-associated histone methylation might be related to the immune dysfunction in patients with KD.
10.Carbachol augments Na/Ca exchange current via M2 muscarinic receptors in guinea pig ventricular myocytes.
Xiang-Li CUI ; Huan-Zhen CHEN ; Dong-Mei WU ; Bo-Wei WU
Acta Physiologica Sinica 2004;56(6):713-716
Stimulation of cardiac mAChRs by carbachol (CCh) produces a biphasic inotropic response. The mechanisms of the positive inotropic response by higher concentration of CCh appear to be paradoxical. This article was aimed to study the mechanism of the positive inotropic effect of CCh in guinea pig ventricular myocytes. The effects of CCh on L-type calcium current (I(Ca)) and Na/Ca exchange current (I(Na/Ca)) were observed in voltage-clamped guinea pig ventricular myocytes by using Axon 200A amplifier. The results showed that CCh (100 micromol/L) increased both forward mode and reverse mode I(Na/Ca) from (1.2+/-0.1) pA/pF to (2.0+/-0.3) pA/pF for forward mode (P<0.01) and from (1.3+/-0.5) pA/pF to (2.1+/-0.8) pA/pF for reverse mode (P<0.01), respectively. CCh had no effect on I(Ca). The stimulating effect of CCh on I(Na/Ca) could be blocked by application of atropine, a nonselective blocker of muscarinic receptors, which means that the stimulating effect of CCh is through the activation of muscarinic receptors. We made a further study by using methoctramine, a selective antagonist of M2 muscarinic receptors. It completely abolished I(Na/Ca) induced by 100 micromol/L CCh, indicating that the effect of CCh on I(Na/Ca) was mediated by M2 muscarinic receptors. It is generally accepted that contraction in cardiac myocytes results from elevation of intracellular Ca2+ concentration. Ca2+ enters the cells through two pathways: L-type Ca2+ channels and, less importantly, reverse mode Na/Ca exchange. The calcium influx via both pathways promotes the contraction of cardiac myocytes. Because CCh had no effect on L-type Ca2+ current, the increase in Na/Ca exchange current might be the main factor in the positive inotropism of CCh. These results suggest that the positive inotropic effect of CCh in guinea pig heart is through stimulation of Na/Ca exchange and is mediated by M2 muscarinic receptors.
Animals
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Calcium Channels, L-Type
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physiology
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Carbachol
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pharmacology
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Cardiotonic Agents
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pharmacology
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Diamines
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pharmacology
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Female
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Guinea Pigs
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Heart Ventricles
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Male
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Myocytes, Cardiac
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metabolism
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physiology
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Patch-Clamp Techniques
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Receptor, Muscarinic M2
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physiology
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Sodium-Calcium Exchanger
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physiology