T-type calcium channels are expressed in various tis-sues and play key roles in physiology and pathophysiology,inclu-ding neuronal firing,hormone secretion,pain,and cancer,etc. Hence,it is critical to understand the molecular mechanisms un-derlying the regulation of T-type channels.Substantial literature suggests many G protein-coupled receptors (GPCRs)and related second messengers can modulate T-type channel in some extent. Here,this review focuses on the modulation of T-type calcium channels by GPCRs and related second messengers.

Objective To investigate the the effect of Amiodaroneo on acute myocardial infarction (AMI) and atrial fibrillation (AF) in elderly patients,and provide the basis for the treatment.Methods A total of 108 patients with AMI and AF in our hospital from January 2009 to June 2013 were collected and randomly divided into control and experimental groups,each group of 54 cases.The control group was treated with cedilanid and the experimental group were treated with amiodarone.AF control rate,sinus rhythm maintenance rate and adverse reactions of the two groups were analyzed and compared after treatment.Results The AF control rate of experimental group was significantly higher than that of control group in 6 h,12 h,24 h and 48 h after treatment (x2=5.173,5.066,4.757,6.684,P＜0.05).Sinus rhythm maintenance rate of experimental group was increased compared with control group (47 cases vs.24 cases,x2=21.748,P＜0.01).Adverse reaction rates of the experimental group was lower than the control group (x2 =15.621,P＜0.01).Conclusions The treatment of AMI and AF by amiodarone is betterr and safe than cedilanid alone,so it is worth popularizing and applying on clinic.

Objective To study the significance and feasibility of modified early warning scores (MEWS) assessing the conditions and death prediction among the pre-hospital acute poisoning patients.Methods We performed a prospective,observational study of the pre-hospital acute poisoning patients between January 1,2010 and December 31,2010.Data was collected to calculate the MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was expressed in mean with standard deviation,and P ＜ 0.05 was considered to be different with statistical significance.Observation lasted for 90 days after admission to get the results as observation index and ROC was drew and the area under the curve and the predicting index were calculated.The patients without vital signs and unsuccessful resuscitation were not included in this study.Results It showed 287 person times with 0 ～ 6 scores,accounting 94.4％,17 person times with 7-13 scores,accounting 5.59％,among the dead patients,MEWS were more than those of the survival group with statistical significance (P ＜ 0.05).The area under ROC was 0.99 indicating that MEWS≥7 was the board line for severe pre-hospital acute poisoning patients with sensitivity of 91.7％,specificity of 97.9％,accuracy of 97.7％ and Youden of 0.896 for predicting death.It showed high significance of the application of MEWS in assessing acute poisoning patients and death prediction.Conclusions MEWS assess pre-hospital acute poisoning patients and predict death with good resolution and strong application significance,which is simple,practical and applicable.

Objective To evaluate the application value of prehospital index (PHI) in hospitalized patients with acute trauma.Methods A study was done in 1802 hospitalized patients with acute trauma by random sampling.PHI and injury severity score (ISS) were made respectively.Receiver operating characteristic curve (ROC curve) was used for detecting optimal cut-off point by taking the date of discharge as the endpoint and the outcome as observed indicator.In order to compare the predicting prognosis value of PHI in hospitalized patients with acute trauma,the corresponding predicting indicators were calculated and ISS was used for reference.Results The area under the ROC curve was 0.871 (95％ CI:0.855-0.886) by the score of PHI and 0.792 (95％ CI:0.773-0.811) by the score of ISS,and there was statistically difference between the two scoring systems (Z =2.674,P =0.007),and the optimal cut-off point was used for judging the potential for critically ill patients when PHI was ≥ 4,ISS ≥ 22.The sensitivity predictors of critically ill patients death of PHI was superior to ISS (x2 =6.975,P =0.008),the specificity and the accuracy of PHI and ISS showed no significant difference (P ＞ 0.05).Conclusions PHI has high potential for assessing patient condition and predicting the death of hospitalized patients with acute trauma,and it is equivalent to ISS in prediction value.The advantages of PHI are simple in operation,easy to learn,reflecting the condition timely and reliably,suitable for dynamic evaluation and comparison,which is suitable for critical patients with trauma of preliminary screening.

Objective To investigate the radiographic body posture selection and improvement and it's application value.Methods We selected the uncommon postures optimal for radiographic diagnosis according to different body parts of compound injury patients,and offered the filming process and cautions of some improved postures in radiographic practice.Results Appropriate body posture,improved filming position and processes,optimized parameters of exposure,and the application of digital imaging devices could ensure the image quality of diagnosis.Conclusion Effective filming processes,improved body postures and variable digital devices should be selected in compound injury patients according to practical condition.

Objective To investigate the value of ISS in predicting mortality after multiple trauma.Methods A total of 550 patients with multiple trauma treated from March 2007 to May 2011 were divided into survivor group (n =473) and death group (n =77) according to the outcome.ISS and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ]) were used to predict patients' risk of death.Receiver operation characteristic curve (ROC) was developped to compare the area under the curve (AUC),optimal cut-off point,and prediction index for the two scoring systems.Results ISS and APACHE Ⅱ score were higher in death group than in survivor group (P ＜ 0.05).ISS showed the diagnostic cut-off point of ≥20,with a sensitivity of 76.7％,specificity of 83.7％,concordance rate of 82.7％,and AUC of 0.835.With regard to APACHE Ⅱ,the diagnostic cut-off point was ≥20,with a sensitivity of 80.5％,specificity of 89.2％,concordance rate of 88.0％,and AUC of 0.922.ISS and APACHE Ⅱ were equivalent in predicting mortality (P ＞ 0.05).Conclusion ISS presents a moderate value for predicting the mortality of multiple trauma patients and it is more rational to set ISS≥20 points as the criteria for severe multiple trauma.

Objective To study the utility and feasibility of CRAMS score to assess prognosis of patients with acute trauma.Methods A retrospective review of 1 802 patients with acute trauma was conducted to calculate CRAMS and ISS score.Receiver operation characteristic curve (ROC) was used to measure the prognostic role of CRAMS in comparison with ISS.Results Area under the curve (RUC) was 0.885 for CRAMS (95 ％ CI 0.870-0.900) and was 0.792 for ISS (95％ CI 0.773-0.811),with statistical difference of the two scoring systems (Z=4.280,P ＜0.01).To identify patients with potential critical illness,optimal cut-off point was≤7 for CRAMS and≥24 for ISS.CRAMS presented better sensitivity (x2 =16.910,P ＜ 0.01),but lower specificity (x2 =5.260,P ＜ 0.05) and accuracy (x2 =0.693,P ＞ 0.05) for predicting mortality when compared with ISS.Conclusions CRAMS is better than ISS in predicting prognosis for patients with acute trauma and exhibits a high discrimination.RAMS has advantages of simple operation,easy grasping and accurate and timely reflection of illness severity,which facilitates the early detection and treatment of critical illness in inhospital trauma patients.

Objective A considerable percentage of gallbladder cancers are accompanied by su-perficial cancer spread adjacent to the main tumor. Therefore, cholecystectomy for early gallbladder cancer must be performed carefully to avoid leaving cancer cells at the surgical margins. Methods Thirty-six patients with gallbladder cancer invading no more than perimuscular connective tissue un-derwent surgical resection at our medical center. After operation, the resected specimens were investi-gated macroscopically and microscopically to clarify the clinicopathological features and the risk factors of superficial cancer spread. Results Seventy percent of all cases (25 cases) had superficial cancer spread. Comparison between the cases having superficial cancer spread and the cases without it re-vealed that the macroscopic morphology of the primary tumor and the depth of cancer invasion in the gallbladder wall were significantly different between the two groups. Furthermore, multivariate analy-sis indicated that 'superficial raised type' in macroscopic morphology was an independent predictive factor for having superficial cancer spread. Superficial cancer spread from the main tumor located in the neck of the gallbladder grew predominantly in the direction of the fundus. More advanced gallbladder cases were accompanied by more extensive superficial spread. Conclusion Superficial cancer spread is frequently observed adjacent to the gallbladder cancer, especially in the superficial raised type. A negative margin should be confirmed by intraoperative frozen section while performing cholecystectomy.

BACKGROUND: There are many clinical applications of oral medication in treatment of primary osteoporosis, but there are few reports on integration of point injection and electric acupuncture in treatment of primary osteoporosis.OBJECTIVE: To observe the effects of intervention with point injection and electric acupuncture on the basis of western drug on primary osteoporosis and to compare the therapeutic effects with simple western medical treatment.DESIGN: Case comparison was designed.SETTING: Hygiene Clinic of Engineering College of Nanjing University of Agriculture and First Affiliated Hospital to Nanjing University of Medical Sciences.PARTICIPANTS: Totally 46 cases of primary osteoporosis were selected from the outpatients in Hygiene Clinic of Engineering College of Nanjing University of Agriculture from April 2000 to June 2004 and all of the cases were in the observation voluntarily. Two groups were randomized according to visiting sequence, named acupuncture+drug group (23 cases), aged (67±4) years and drug group (23 cases), aged (66±5) years.METHODS: ① In acupuncture+drug group, on the basis of medication of alfacalcidol and calcium carbonate, the integrative therapy of point injection and electric acupuncture was applied. Pont injection: Xue-saitong zhusheye was injected on zusanli (ST 36), iaixi (KI 3), sanyinjiao (SP 6) and xuanzhong (GB 39) 1.67-3.33 cm in depth. Two points were selected each time and 2 mL on each point, once/day and the points were injected bilaterally and alternatively. Electric acupuncture:The points were pishu (BL21), shenshu (BL 23) and qihaishu (BL24).Electric apparatus was attached on the points after arrival of qi, with continuous wave, 2 Hz, 30 minutes, once a day. One month treatment for either point injection or electric acupuncture was taken as one course.The second course was followed afterbreak for 5 days. Totally, 6 months were required. Western medical treatment: α Vit. D3 0.5 μg per day was administrated orally, onceaday and calcium carbonate, 1 tablet, once a day,continuously for 6 months. ② Drug control: Only western drugs were administrated orally and the usage was same as the acupuncture +drug group. The patients in two groups were treated for 6 months. Bone mineral density (BMD) of L2-4 and upper end of femur was assayed with X-Ray absorptiometry.MAIN OUTCOME MEASURES: BMD of L2-4 and upper end of femur before and 6 months after treatment in two groups.RESULTS: All of 46 cases of primary osteoporosis entered result analysis, no dropped out case. ① Comparison of BMD of lumbar vertebras before and 6 months after treatment in two groups: After 6-month treatment,in acupuncture +drug group, BMD of L2-4 was improved significantly [(0.829±0.049), (0.791±0.043) g/cm2, (t=2.80, P ＜ 0.01)] compared with that before the treatment. In drug control, BMD of L2-4 was improved significantly [(0.813±0.051), (0.788±0.048) g/cm2, (t=1.71, P ＜ 0.05)]compared with that before the treatment. Concerning to the variations of BMD between two groups, the variation in acupuncuture+drug group was more than that in drug control [(0.038±0.020), (0.025±0.025) g/cm2 (t=1.95,P ＜ 0.05)]. ②) Comparison of BMD of femur before and 6 months after treatment in two groups: There was no significant difference in BMD before and after treatment in two groups (P ＞ 0.05).CONCLUSION: Compared with simple western drug treatment, the integrative therapy of point injection and electric acupuncture improves very significantly BMD of lumbar vertebras, aiming at effective treatment of primary osteoporosis. But the change in BMD of femur is not obvious before and after treatment, which is probably associated with lack of adequate blood circulatiou in femoral region.

Objective To assess the economic efficiency of glycated haemoglobin(HbA1C)determination in screening the undiagnosed diabetes among hospitalised patients. Methods Exclusive criteria were made based on the information of the electronic patient history,including age<18 years,hospitalization for diabetes treatment, and having received a transfusion within half a year. Pathology samples from participants were collected for blood routine analysis and HbA1C screening test. Screening the undiagnosed diabetes was based on the level of HbA1C. Results In this study ,1012 patients were enrolled ,78 patients with diabetes ,and 934 patients haven′t been diagnosed before. Among the 934 patients ,HbA1C level of 51 patients was over 6.5%(48 mmol/mol). These 51 patients (5.46%) were determined to have previously unknown diabetes. The prevalence of undiagnosed diabetes was 5.46% during the study period. The cost of HbA1C test was ￥1098 per new diagnosis of diabetes. Conclusions HbA1C is a simple ,inexpensive screening test for diabetes ,which can significantly improve the diagnostic efficiency,and the early detection of diabetes can slow the progression of complication and reduce the medical care expenditures.