The precursor of B-type natriuretic peptide (proBNP) is cleaved by a specific enzyme into the biologically active BNP and biologically inactive N-terminal fragment (NT-proBNP).Plasma BNP and NT-proBNP concentrations are affected by gender,age,obesity (higher BMI) and renal function.BNP is primary metabolized by clearance receptors,NT-proBNP is suggested by renal excretion,so plasma concentrations of NT-proBNP are more affected by renal function than that of BNP.The differential diagnosis of acute dyspnea and acute heart failure (AHF) is one of the most important clinical applications of BNP and NT-proBNP.Two cut-off points were used:a lower one with a high negative predictive value to reliably exclude acute heart failure (AHF) as the cause of acute dyspnoea (rule-out cutoff value),and a second higher one with a high positive predictive value to rule in AHF as the cause of dyspnoea (rule-in cutoff value).The rule-in cutoff values of NT-proBNP divided into three levels according to the age,these cutoff values apply irrespective of gender,obesity and renal function,but the rule-in cutoff point of BNP need to be corrected by obesity and renal function.In addition,BNP/NT-proBNP has been shown to provide diagnosis,prognosis and therapy-guiding information in chronic heart failure and coronary heart disease.

Common drugs for cardiovascular disease include aspirin , clopidogrel, warfarin, nitroglycerin and statins etc .Because of individual differences , the effect of same drug treatment in different patients is not the same , and more and more studies found that genetic factors were important reasons to cause the efficacy of individual differences .The single nucleotide polymorphisms of important genes such as COX-1, GPⅡ b/Ⅲa, CYP2C19, CYP2C9, VKORC1, ALDH2 and that relate to drug absorption , distribution, metabolism as well as excretion have been discovered .Development of clinical gene detection and the implementation of individualized drug treatment based on genetic test results will significantly improve the therapeutic effect .The development of individualized medicine in the future on the above basis has important clinical value.

Objective To investigate the incidence of non-alcoholic fatty liver disease (NAFLD) in essential hypertension patients and the relation between NAFLD and multiple metabolic disorders.Methods Cross-sectional study.Between January 2006 and July 2008,1109 inpatients in Beijing Anzhen hospital diagnosed with essential hypertension were enrolled into this study (542 femal,567 male,mean age 61 ± 11).All patients had ultrasound screening for fatty liver.The prevalence of NAFLD,serum alanine aminotransferase abnormality ratio,the relationship between NAFLD and multiple metabolic abnormalitiesincluding glucose,dyslipidemia,hyperuricemia.471 cases of non-EH as a control group in the same period of admission(216 femal,255 male,mean age 62 ± 10).The measurement data of two groups were compared with t test,while the count data were compared with x2 test.Multiple Logistic regression was used to analysis therisk factors of EH with NAFLD.Results Among 1109 recruited patients,37.3％ (414/1109) had fatty liver by ultrasonography.EH patients were divided into NAFLD group and non-NAFLD group.In EH coexisted with NAFLD group,the prevalence of diabetes mellitus (21.0％ ∶ 10.8％),metabolic syndrome (59.4％ ∶ 44.7％),overweight (71.3％ ∶ 62.9％) and the levels of BMI (26.90 ± 3.66∶ 26.35 ± 3.56),TC (5.30±1.17∶ 5.12 ± 1.09),TG(2.11 ± 1.43∶1.85 ± 1.33),ALT(45.18 ± 37.62∶39.22 ±32.27) were significantly higher than those in the non-NAFLD group (P ＜0.05).HDL-C (1.53 ±0.53∶1.62 ±0.54)was significantly lower than that in the non-NAFLD group (P ＜ 0.05).In non-NAFLD group,prevalence of overweight and the levels of BMI,TC,TG,ALT were signific antly higher than those in non-EH group (P ＜ 0.01).By multivariable logistic regression analysis,diabetes mellitus,hypercholesteremia,hyperuricemia and BMI were risk factors in NAFLD patients with essential hypertension.Conclusion NAFLD was more prevalent in patients with EH complicated with multiple metabolic disorders,such as hyperlipemia and hyperuricemia.

Soluble ST2 (sST2) is a decoy receptor of IL-33 in blood.sST2and ST2L (receptor on cell membrane) seem to be markedly induced in mechanically overloaded cardiac myocytes,especially the expression of sST2.A large number of sST2 bind IL-33 thus subtracting IL-33 from the interaction with ST2L,potentially attenuating the cardioprotective effects of IL-33/ST2L pathway.Recently,sST2 has emerged as a novel for heart failure biomarker.Though sST2 was a less robust marker for the diagnosis of heart failure than NT-proBNP,it has been implicated in the prognostication of patients with acute dyspnea,acute or chronic heart failure and myocardial infarction,with particular value for mid-and long-term prognosis.However,further studies are needed in order to better point out the evidence for a routine use of sST2 evaluation in patients suffering from cardiovascular diseases.

Objective To investigate the effect of sevoflurane preconditioning on the expression of Toll-like receptor 4(TLR4) during myocardial ischemia reperfusion(IR) in rats.Methods Thirty male SD rats weighing 250-300 g were randomly divided into 3 groups (n=10 each):sham operation group (S group) , IR group and sevoflurane preconditioning group(SP group).Myocardial ischemia was produced by temporary ligation of anterior descending branch of left coronary artery for 30 min followed by 2 h reperfusion. In SP group, the animals inhaled 2.5% sevoflurane for 30 min followed by 15 min washout before ischemia. The rats were sacrificed at 2 h of reperfusion, hearts removed and myocardial tissues obtained for microscopic examination.The expression of TLR4, NF-κB and TNF-α was detected using Western blot. Results The expression of TLR4, NF-κB and TNF-α was significantly up-regulated in IR and SP groups compared with group S (P＜0.05).The expression of TLR4, NF-κB and TNF-α was significantly down-regulated in group SP compared with group IR (P＜0.05).The myocardial injury was attenuated in group SP.Conclusion Sevoflurane preconditioning can attenuate myocardial IR injury by inhibiting the up-regulation of TLR4 expression and reducing the inflammatory response.

Objective To investigate the clinical efficacy of imipenem and cilastatin sodium on the clinical efficacy of elderly patients with severe bacterial infection, and to observe the clearance rate to different floras.MethodsA total of 206 elderly patients with severe bacterial infection as the research object in our hospital outpatient treatment, were divided into control group and observation group, the patients were collected with sputum, blood and urine samples sent for bacterial culture.All patients were given positive treatment and nursing care, the observation group was given imipenem and cilastatin sodium treatment,the control group was given cefotaxime sodium treatment.The clinical efficacy, bacterial clearance and adverse reactions of the two groups were recorded and compared.ResultsThe total efficiency rate was 91.26% in the observation group, and 79.61% in the control group.The number of effective cases was significantly higher in the observation group than in the control group (P<0.05), the number of ineffective cases was significantly lower than that of the control group (P<0.05);The bacterial clearance rate was 85.71% in the observation group, and 43.33% in the control group, the clearance rate of Bauman Acinetobacter, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus was significantly higher in the observation group than in the control group (P<0.05).Through the detection of adverse reactions showed that the observation group and the control group after treatment, few patients mild symptoms of nausea and vomiting and itching rash, on the occurrence of adverse reactions of the two groups of patients were compared, the difference was not statistically significant.ConclusionFor elderly patients with severe bacterial infection with imipenem and cilastatin sodium for treatment, the effective rate is high and can timely remove a variety of pathogenic bacteria, and rare adverse reactions, high safety, worthy of clinical application.

This paper reports the use of three different types of anti-keratin antibodies and immuno-peroxidase technique in the staining of various skin tumors paraffin-embedded. The results showed that three types of anti-keratin antibodies (Cam5.2, AF2 and PK)didn't stain none-pithelial tumors and,expressed their inherent different staining patterns for epithelial tumors derived f from different tissues. Therefore, three types of. anti-keratin antibodies may be helpful for diagnosis, differential diagnosis and classification of complex skin tumors in routine histopathology of skin

The primary problems in preventive medicine teaching in clinical medicine are analyzed,and some countermeasures are proposed,including understanding the important strategic status of preventive medicine,strengthening teachers construction and im- proving teaching ways so as to promote teaching effect of preventive medicine.

Aged ; Aneurysm ; Female ; Humans ; Middle Aged ; Temporal Arteries ; pathology

Child ; Churg-Strauss Syndrome ; pathology ; Female ; Humans