BACKGROUND:About 50% patients with coronary heart disease have no symptoms of cardiac disease before the first onset of myocardial infarction. Therefore, it is of great importance to make early and accurate detection of coronary heart disease and myocardial ischemia.OBJECTIVE: To measure the time of heart repolarization with magnetocardiography and probe into the role of non-invasive magnetocardiographic examination in evaluating cardiac function in patients with coronary heart disease.DESIGN: Case-control observation.SETTING: Department of Cardiology of Philippustift Hospital, Essen,GermanyPARTICIPANTS: Totally 52 patients hospitalized for suspected coronary heart disease in the Department of Cardiology of Philippustift Hospital(Essen, Germany) between March 1998 and December 2002 were recruited,and another 10 patients diagnosed as old myocardial infarction were set as myocardial infarction group. Informed consents were obtained from the patients. Totally 32 healthy volunteers aged above 40 years old were recruited as the control group.METHODS: All the patients received the following examinations: physical and laboratory examinations, rest and stress electrocardiography(ECG), echocardiography, coronary artery angiography and magnetocardiography(MCG) examination. The control group received only rest ECG and MCG examination. The values of QT dispersion with ECG and MCG were compared between the patients and healthy controls. The diagnostic criteria for coronary heart disease: stenosis of one coronary artery ≥ 75% according to coronary artery angiography; index of repolarization time of the heart was measured with MCG QT dispersion and MCG dispersion coincidence (the mean of probe signal and QT dispersion of peripheral probe in each MCG).MAIN OUTCOME MEASURES: ECG QT dispersion, MCG QT dispersion as well as coincidence index of QT dispersion of the observed subjects in each group.RESULTS: The 52 patients with suspected coronary heart disease,10 with myocardial infarction, and 32 healthy controls all entered the result analysis. The patients with suspected coronary disease were divided into 2 groups: group with coronary heart disease (n=27) and group without coronary heart disease (n=25). [1] Comparison of ECG QT dispersion: there was no significant difference among the groups(P ＞ 0.05). [2] Comparison of MCG QT dispersion: MCG QT dispersion in myocardial infarction group was significantly higher than that in control group [81.3±21.5, 52.4±13.6 (F=13.113, P ＜ 0.05)]. [3]Comparison of coincidence index of QT dispersion: Coincidence index of QT dispersion in myocardial infarction group and coronary heart disease group was both significantly higher than that in control group [15.6±4.2, 14.9±4.1, 10.2±2.7 (F=2.403, 3.332, P ＜ 0.01)].CONCLUSION: Compared with ECG, MCG can better reflect changes in the repolarization process of patients with coronary heart disease,and coincidence index of dispersion is superior to QT dispersion. This is because MCG is more sensitive to tangential currents presented at the precardial region when myocardial ischemia and infarction occur.

Objective To study the relationship between the change of resting electrocardiogram ST-T in chronic stable coronary atherosclerotic heart disease(CAD) and left ventricle enjection fraction(LVEF).To know the significance that the change of ST-T may predict the function of left ventricle.Methods 80 patients with CAD in our c ardaic department were analyzed retrospectively,40 patients with the change of ST-T (positive group) and 40 patients without the change of ST-T(negative group) were analyzed the outcome of LVEF and the extent of coronary lesion.Results The LVEF of positive group was lower than negative group obviously,the comparision between both groups had statistical significance (t =6.125,P =0.000).In the electrocardiogram positive group,the number of the patients who had 2 and more than 2 branches lesion was more than negative group,the comparision between both groups had statistical significance(x2 =9.683,P =0.008).Conclusion The change of ST-T may predict the function of left ventricle of patients with chronic stable coronary atherosclerotic heart disease,the relationship may be connected with the degree of coronary lesion.

Objective To investigate the correlation of fasting plasma glucose (FPG) in early period of pregnancy and abnormal glucose metabolism during gestation period.Methods Two hundred and seventy-seven women with single pregnancy and non-propregnant diabetes mellitus were selected.FPG,fasting insulin,insulin resistance index were detected in early period of pregnancy ( ＜19 weeks).One hundred g oral glucose tolerant test (OGTT) was taken during 24-36 weeks.According to OGTT,patients were divided into gestational impaired glucose tolerance (GIGT) group (24 cases),gestational diabetes mellitus(GDM) group(23 cases),OGTT 1 h higher blood glucose (HG-1) group (26 cases) and normal group (204 cases).Results FPG,fasting insulin and insulin resistance index of GDM group and HG-1 group were obviously higher than those of normal group [( 4.58 ± 0.36 ),( 4.58 ± 0.38) mmol/L vs.( 4.20 ±0.33) mmol/L,(9.4 ± 1.1),(9.3 ±2.1) U/L vs.(7.0 ± 2.1) U/L,2.0 ± 0.4,2.0 ± 0.3 vs.1.3 ± 0.4,P＜ 0.05].FPG of GIGT group [(4.45 ±0.36) mmol/L] was higher than that of normal group (P ＜0.05).After controlled age,body mass index,family history of type-2 diabetes mellitus and sport exercises,the relative risk degree of blood glucose metabolism had correlation with FPG,fasting insulin and insulin resistance index in early period of pregnancy (P ＜ 0.05).Conclusion FPG,fasting insulin and insulin resistance index in early period of pregnancy can predict abnormal glucose metabolism.

OBJECTIVE To discuss about the recurrent respiratory tract infections(RRTI) treatment by traditional Chinese medicine.RRTI is very commonly in children. METHODS According to clinical experience, as well as integrated with Western medicine,we think about the mechanism of RRTI from two sides.The main reason was the function of lung and spleen deficiency in traditional Chinese medicine theories;another reason was attached with outside evils.We treaed RRTI with different syndromes with different methods,such as dispelling the evil in the superficies with acrid drugs and cod drugs,regulating the function of lung and spleen;supplement Qi and supporting superficies, regulating Ying and Wei,nourishing Yin to reduce heat,strengthening the spleen and nourishing lung. RESULTS It has a good theropentio effective with traditional Chinese medicine on RRTI.During acute infectious period,we treated mainly eliminate evils,as well as to support healthy energy.During recovery period,we treated mainly support healthy energy,as well as to eliminate evils. CONCLUSIONS Traditional Chinese medicine has long time therapentir effect on RRTI,with less recurrence.

Objective To investigate the changes in auditory evoked potential index(AAI)value and bispectral index(BIS)value produced by treatment of hypotension with ephedrine or phenylephrine during induction of general anesthesia.Methods Seventy-five ASA Ⅰ or Ⅱ patients of both sexes aged 30-50 yr with body mass index ＜ 30 kg/m2 underwent elective abdominal surgery under general anesthesia.Anesthesia was induced with 8%sevoflurane,midazolam 0.1 mg/kg and fentanyl 3 μg/kg.Tracheal intubation was facilitated with succinylcholine 2 mg/kg.Anesthesia was maintained with sevoflurane inhalation.BIS value was maintained at 40-50 and AAI value at 20-30 by adjusting the concentration of sevoflurane.When the desired level of BIS value and AAI value was reached during induction of anesthesia,hypotension(MAP ＜ 80 % of the baseline)was treated with intravenous ephedrine 0.1 mg/kg(group E,n = 25)or phenylephrine 2 mg/kg(group P,n = 25)or 6% HES(130/0.4)10 ml/kg(group C,n = 25)at random.MAP,HR,BIS value and AAI value value were recorded before(T0)and at 2,5,7,10 min after fluid or vasoactive agent administration(T1-4).Results MAP significantly increased after treatment at T1-4 as compared with MAP at To in all 3 groups.BIS and AAI values were significantly increased after administration of ephedrine at T3,4 as compared with MAP at To in group E.There were no significant differences in BIS and AAI values before and after administration of phenylephrine and 6% HES in group P and C.Con-clusion Treatment of hypotension with ephedrine during induction of general anesthesia can increase BIS and AAI and decrease the depth of anesthesia but phenylephrine cannot.

Objective To compare the effects of sedation induced with dexmedetomidine and propofol on intracranial pressure and cerebral oxygen metabolism in patients with permissive hypercapnia. Methods Twentyfour patients with acute respiratory distress syndrome (ARDS) were randomly divided into 2 groups ( n = 12 each) :dexmedetomidine group (group D) and propofol group (group P) . Their APACHE Ⅱ scores were 11-18. The patients were mechanically ventilated (VT 5-7 ml/kg, RR 12-17 bpm, PEEP 6-10 cm H2O, FiO2 40-60%). PaCO2 was maintained at 50-65 mm Hg. Radial artery was cannulated for direct BP monitoring and blood sampling. Right internal jugular vein was cannulated and the catheter was advanced cephalad until jugular bulb. Continuous infusion of dexmedetomidine was started at 0.5 μg· kg-1· h-1 and TCI of propofol was started at target plasma concentration (Cp) of 0.4 μg/ml. The infusion of both drugs was gradually increased until Ramsay score (1= fully awake, 6 =asleep, unresponsive to loud verbal stimulus) reached 3,4,5. Transcranial Doppler monitoring was used to determine cerebral blood flow velocity (CBFV), pulsatility index (PI) and resistance index (RI) before administration of dexmedetomidine and propofol (T0 ) and at 30 min after the 3 levels of sedation were reached (T1-3) . Meanwhile blood samples were taken from radial artery and jugular bulb for blood gas analyses. Cerebral O2 metabolic rate (CMRO2), cerebral A-V O2 content differences (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated .ResultsCBFV, PI, RI and CMRO2 were significantly decreased at T1-3 as compared with the baseline values at T0 in both groups. CBFV was positively correlated with CMRO2 in both group D (r = 0.80) and group P ( r = 0.76) . CBFV, PI and RI were significantly lower at T1-3 in group D than in group P. There was no significant change in Da-jvO2 and CERO2 at T1-3 as compared with the baseline values at T0 in both groups. Conclusion At different sedation levels, dexmedetomidine results in lower intracranial pressure than propofol and maintains the balance between cerebral O2 supply and demand in patients with permissive hypercapnia.

Objective To investigate neuro-biochemical changes of bilateral anterior cingulate cortex (ACC) in the patients with major depressive disorder (MDD) and the correlation between abnormal metabolism and the cognitive function before and after treatment.Methods Fifteen patients with major depression and 15age-,sex-and education-matched healthy controls (HC) were involved.The neurochemical abnormalities including the levels of N-acetylaspartate (NAA),choline-containing compounds,glutamate/glutamine and myoinostol were measured by single-voxel proton magnetic resonance spectroscopic (1H-MRS).The subjects were then assessed with executive function with neuropsychological tests including Wisconsin cards sorting test (WCST),verbal fluency Task (vF),StrooP Color and Word Test (SCWT).After this,the patients took selectivity serotonin reuptake inhibitors (SSRIs) for eight weeks.Then,we examined the changes in NAA,Cho,Glx and MI in ACC of patients and assessed their executive function with the neuropsychological tests again.Results 1) In ACC,baseline NAA ((7.36 ± 1.67) mmol/L),GLx ((11.68 ± 1.65) mmol/L) and MI levels ((5.28 ± 0.66) mmol/L) were significantly lower in MDD compared to those of HC (NAA (9.27 ± 1.37)mmol/L,Glx (15.20 ± 1.91)mmol/L,MI (7.80 ± 2.73) mmol/L) (P ＜0.01) ; After treatment,the NAA ((9.34 ± 2.45) mmol/L) and Glx ((16.79 ±3.96) mmol/L) increased significantly after treatment compared to those prior to pretreatment (NAA(7.36 ± 1.67)mmol/L,Glx(11.68±1.65)mmol/L,P＜0.05).2) The normal controls exhibited better in Performance of WCST and Performance of completion time of SCWT than our MDD patients (P＜0.05 or P＜0.01).The patients made significant improvements in Performance of WCST and completion time of SCWT(C form) after treatment (P＜0.05 or P＜0.01).3) In post-treatment MDD,the ACC Glx level was significantly positively correlated with the categories completes of WCST (r=0.739,P=0.009) and inversely related with the numbers to complete the first categories of WCST (r=-0.699,P=0.017) and the completion time of SCWT(C form) (r=-0.651,P=0.030) ;elevated MI(r=-0.705,P=0.023) and NAA(r=-0.735,P=0.010) levels in ACC of post-treatment MDD were both negatively correlated with the numbers to complete the first categories of WCST.Conclusion The ACC may be a key region involved in antidepressant treatment in MDD.The increased ACC NAA,Glx and MI in MDD after treatment may be significantly correlated with the improve of executive function.

Objective To learn the prevelance of Acinetobacter baumannii and its drug resistance related with Ⅰ class integron. Methods 22 kinds of antibiotics commonly used in our hospital were used to detect the sensitivity of the clinically separated Acineto-bacter baumannii.Methods PCR was used to detect Ⅰ class integron enzyme gene of Acinetobacter baumannii,and then parts of variable region of Ⅰ class integron enzyme gene were amplified and analyzed for gene sequence.Results The drug resistance of Acinetobacter baumannii phenomenon was very serious,which was multiple drug resistance.The resistance rate of Acinetobacter baumannii to CPZ/SB was 1.2%.And the resistance rates to tigecycline,ofloxacin,imipenem,biapenem,and amikacin were 1 5.4%-69.5%,but the resistance rates to other antibiotics were above 71%.There were 72 of 102 strains including Ⅰ class integron (positive rate was 70.2%).The resistance of strains with Ⅰ class integron was stronger than that of the strains without.The varia-ble area of Ⅰ class integron produced the same enzyme bands when analyzed with double enzyme,suggesting the Acinetobacter bau-mannii was homologous.The gene sequence analysis of Ⅰ class integron showed that the Ⅰ class integron of the Acinetobacter bau-mannii carried kinds of resistant genes such as aacA4,catB8 and aadA13.Conclusion From 2010 to 2013,the Acinetobacter bau-mannii in our hospital is highly resistant to cephalosporins,broad-spectrum penicillin,aminoglycosides and fluoroquinolones and is severely multiple drug resistant.So the antimicrobial drugs for the treatment of infections caused by Acinetobacter baumannii are limited.Ⅰ class integron is closely related to the multiple drug resistance of Acinetobacter baumannii.

Objective To explore the clinical and molecular-genetic features and prognosis of mitochondrial encephalopathy in children. Methods A total of 11 patients diagnosed with mitochondrial encephalopathy were collected from 2008 to 2013 in Chinese PLA General Hospital, Department of Pediatrics. The clinical manifestations, laboratory tests, muscle pathology and mitochondrial gene sequencing in patients were analyzed and followed-up. Results The onset age of the patients ranged from 6 months to 12 years with the duration of disease from 2 months to 3 years. Of the 11 patients, 6 cases were diagnosed with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), 5 cases with mitochondrial disorder induced by mitochondrial respiratory chain enzyme deifciency. Main manifestations included convulsions, vomiting, headache, mental retardation, paralysis, etc. 10 patients had elevated lactate, and 7 patients had elevated pyruvate;6 cases showed increased slow wave in EEG background;Cranial MRI showed the damage involved in bilateral basal ganglia in 2 cases, temporal and occipital lobes in 3 cases, , multiple lesions in 2 cases, frontal and parietal occipital lobes in one patient and hypothalamus in one patient;3 patients were underwent MRA examination, 2 cases were normal, the other showed less shunts in contralateral left artery in the brain;3 cases who underwent MRS showed lactate peak. 2 cases of children underwent skeletal muscle biopsy, and one case showed abnormal mitochondria accumulation. Mitochondrial respiratory chain complex (I~V) defects test showed complex IV defects in 2 cases, complex V defects in 1 case, and combined defects of complex I+III in 2 case. 5 cases were found with mitochondrial DNA mutations in different sites of white blood cells including T8993G, T8993C, A3243G and 11,777 mutations. Conclusions Clinical manifestation of mitochondrial encephalopathy in children is strongly heterogeneous. Laboratory tests, brain imaging, gene mutation and respiratory chain enzyme examination can help to make early diagnosis and treatment. These diseases have poor prognosis.

Objective:To evaluate the quality condition and problems of acetylspiramycin at present. Methods:According to the standard described in Chinese Pharmacopoeia (2015 edition), acetylspiramycin and its preparations were determined, and the overall quality level of domestic acetylspiramycin was evaluated. The related substances, components and dissolution were analyzed to further explore the quality status. Results:In 258 batches of samples, the dissolution of only one batch did not meet the standard with the passing rate of 99. 6%. The results of exploratory research showed that the content of impurities in raw material was determined by the synthesis process, and the impurity profile of domestic and foreign formula was different. The dissolution behavior of domestic and for-eign formula in four kinds of media was not similar as well. Conclusion: The quality of domestic acetylspiramycin is promising. The research of related substances provides the reference for controlling the target impurities. The consistency assessment of dissolution pro-vides the reference for the formula process improvement and clinical application of acetylspiramycin tablets.