Objective To investigate the effect of tirofiban hydrochloride in the treatment of coronary heart disease and its influence on homocysteine level.Methods 92 patients with coronary heart disease were selected as research subjects.They were randomly divided into the observation group and the control group,46 cases in each group.The control group was treated with anti-thrombotic,nitrates and other conventional western medicine.The observation group was treated with tirofiban hydrochloride based on the conventional treatment.Results The total effective rate of the observation group was 95.65%,which was higher than 82.61% of the control group,the difference was significant (χ2=4.039,P<0.05).And the homocysteine level in the observation group was (5.38±1.02)μmol/L,which was lower than (7.27±1.19)μmol/L in the control group,the difference was statistically significant (t=8.179,P<0.01).After treatment,the cardiac function CO level[(4.96±0.98)L/min],EF level[(62.48±11.16)%]and SV level[(86.37±11.47)mL]in the observation group were higher than those in the control group,the differences were statistically significant (t=2.271,2.954,2.911,all P<0.05).After treatment,the hs-CRP level[(4.25±1.32)mg/L]and Fib level[(3.14±0.73)g/L] in the observation group were lower than those in the control group,the differences were statistically significant (t=7.981,3.174,all P<0.01).ConclusionTirofiban hydrochloride in the treatment of coronary heart disease can effectively contribute to the reduction of homocysteine levels and alleviate atherosclerosis lesion progression,not only can reduce severity of myocardial ischemia and fibrinogen and high-sensitivity C-reactive protein levels,but also can reduce the thrombosis and inflammation produced by the degree of harm to the patients.

Objective To explore the risk factors of cognitive impairment in rural elderly patients from Changzhi urban. Methods Totally 118 elderly patients were examined with minimental state examination (MMSE). The common data and histories of coronary heart disease,hypertension,diabetes and chronic obstructive pulmonary disease were collected. Results The prevalence of cognitive impairment was 14.4％.Multivariate analysis showed that MMSE scores was associated with age,stroke history,homocysteine and low density lipoprotein(LDL-C) (x2 =21.166,19.323,13.672,3.698,P＜0.01 or P＜0.05),and cognitive impairment was not associated with gender,alive spouse,hypertension,coronary heart disease, diabetes and chronic obstructive pulmonary disease(P＞0.05).Age(OR=0.853,95％ CI:0.765-0.951),stroke history(OR=0.764,95％ CI:0.629-0.929),LDL-C (OR =0.208,95％ CI:0.062-0.701 ) and activities of daily living (ADL)(OR=0.839,95％ CI:0.725-0.972)were independent risk factors of cognitive impairment in rural elderly patients. Conclusions Age,stroke and LDL-C are independent risk factors for rural elderly patients in the community.

Objective: To explore the role of clinical pharmacist played in treating patients with acute myocardial infarction. Methods:The clinical pharmacists participated in the therapy for a patient with acute myocardial infarction and provided individual pharmaceutical care. The clinical pharmacist optimized the therapy by means of recognizing the drug-drug interactions and adverse drug reactions as well as evaluating the risk of thrombosis versus bleeding for the patient. Results:The therapeutic suggestions of the clinical pharmacist were accepted by the physicians. The patient was treated effectively and discharged from hospital. Conclusion: Clinical pharmacist can provide beneficial contributions to safe, effective and optimal medication.

Objective To evaluate the effects of different types of acute respiratory distress syndrome (ARDS) on high frequency oscillatory ventilation (HFOV)-improved extravascular lung water and pulmonary vascular permeability in piglets.Methods Twelve healthy piglets,weighing 15-20 kg,were randomly allocated into 2 groups (n =6 each) using a random number table:endogenous ARDS (P group) and exogenous ARDS (EXP group).Anesthesia was induced with midazolam and propofol.The tracheal tube was inserted.Anesthesia was maintained with iv infusion of propofol and fentanyl.ARDS was induced with normal saline infused via the tracheal tube in group P.ARDS was induced with oleic acid 0.05 ml/kg injected intravenously over 45-60 min in group EXP.Then 4 h of HFOV was performed.Before ARDS (T0),immediately after ARDS (Ti) and at 1,2,3 and 4 h of HFOV (T2-5),arterial blood samples were collected for blood gas analysis and the variables such as extravascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),and extravascular lung water (EVLW)/intra thoracic blood volume (ITBV) were monitored.The oxygenation index (PaO2/FiO2) was calculated.Results Compared with the baseline value at T0,the oxygenation index was decreased at T1,and the oxygenation index was less than 200 mm Hg in the two groups (P ＜ 0.05).There was no significant difference in the maximum degree of changes in EVLWI,PVPI and EVLW/ITBV between the two groups (P ＞ 0.05).Conclusion Endogenous and exogenous ARDS disease factor does not affect HFOV-improved extravascular lung water and pulmonary vascular permeability in piglets.

Objective To evaluate the effect of high-frequency oscillatory ventilation (HFOV) on lung injury in the piglets with acute respiratory distress syndrome (ARDS).Methods Twelve male piglets,aged 6-8 weeks,weighing 14-16 kg,were randomly divided into 2 groups (n=6 each) using a random number table:conventional mechanical ventilation with low tidal volume group (CMV group) and HFOV group.ARDS was induced by bilateral pulmonary lavages with isotonic saline (38 ℃),repeated every 10 min until the oxygenation index＜200 mmHg.After successful establishment of the model,CMV group was ventilated using conventional mechanical ventilation with low tidal volumes.After successful establishment of the model,HFOV group was ventilated using HFOV,lung recruitment was performed,the airway pressure was set at 25 cmH2O and maintained at this level for 30 s,and the airway pressure was then adjusted 5 cmH2O higher than that after successful establishment of the model,with bias flow 25 L/min,inspiratory time ratio 33％,frequency 8 Hz,amplitude 40-80 cmH2O,and inspiratory oxygen fraction 1.0.In both groups,carbon dioxide partial pressure was maintained between 35 and 50 mmHg.Before establishment of the model (baseline),after successful establishment of the model (T1),and at 0.5,1.0,2.0 and 4.0 h after beginning of mechanical ventilation (T2-5),blood samples were collected from the femoral artery and central vein for blood gas analysis,arterial oxygen partial pressure and carbon dioxide partial pressure were recorded,oxygen delivery index,oxygen consumption index,oxygenation index and intrapulmonary shunt were calculated,and the improvement in pulmonary function (oxygenation index ≥ 200 mmHg) was recorded.At T0,T1 and T5,venous blood samples were collected for determination of the concentrations of serum Clara cell secretory protein 16,soluble intercellular adhesion molecule-1,and high-mobility group box 1.Results Compared with CMV group,the arterial oxygen partial pressure at T35 and oxygenation index at T4.5 were significantly increased (P ＜ 0.05),and no significant change was found in the other parameters in HFOV group (P＞0.05).Conclusion Compared with conventional mechanical ventilation with low tidal volumes,although HFOV improves lung oxygenation,the degree is small in the piglets with ARDS.

Objective To investigate the type 2 diabetic patients with glomerular filtration rate and urinary albumin value as renal finction evaluation.Methods A total of 1217 patients with type 2 diabetic nephropathy from August 1,2010 to June 31,2012 were selected.Evaluated glomerular filtration rate (eGFR) was calculated according to the currently recommended simplified modification of diet in renal disease study (MDRD) formula.According to the K/DOQI guidelines for chronic kidney disease,patients were divided into three groups:group A [eGFR ≥90 ml/ (min ·1.73 m2)] of 891 cases,group B [60 ml/(min· 1.73 m2) ≤eGFR ＜ 90 ml/(min· 1.73 m2)] of 256 cases,group C[eGFR ＜ 60 ml/(min· 1.73 m2)]of 70 cases,respectively.Eight-hour urinary albumin excretion rate (UAER) was compared between and among the groups; according to 8-hour UAER,patients were divided into three groups:group a (8-hour UAER ＜20 μg/min) of 946 cases,group b (20 μg/min≤8-hour UAER ＜200 μg/min) of 193 cases,group c(8-hour UAER ≥ 200 μ g/min) of 78 cases.eGFR was calculated and compared between and among the groups.Results Eight-hour UAER was (32.71 + 79.62),(57.56 + 130.59),(107.50 + 222.64) μ g/min in group A,B,C,and the difference among three groups was statistically significant (P＜0.05).eGFR was (110.78 ±32.75),(108.26 ±45.78),(94.96 ±32.30) ml/ (min ·1.73 m2) in group a,b,c,and the difference between group a and group c,or between group b and group c was statistically significant (P ＜0.05),but the difference between group a and group b was not statistically significant (P ＞0.05).Conclusion When evaluating the function of type 2 diabetic nephropathy,two indicators should be considered:glomerular filtration rate and urinary albumin.

Objective To study the relationship between urinary albumin excretion rate(UAER)and cardiac structure and function in type 2 diabetes mellitus(T2DM).Methods Five hundred and twenty patients with T2DM were divided into three groups by 8 h UAER:normoalbuminuria group(424 cases),microalbuminuria group(75 cases)and macroalbuminuria group(21 cases).At the same time,50 healthy people were selected as control group.The cardiac structure and function in four groups were evaluated by echocardiographic measurements.Results Left atrial dimensio[(34.39±3.46)mm],left ventricular posterior wall thickness[(10.34±1.05)mm],relative wall thickness(0.46±0.05),interventricular septal thickness[(10.49±1.07)mm],left ventricular mass[(167.37±32.12)g],left ventricular mass index[(87.62±12.16)g/m2]in macroalbuminuria group were significantly higher than those in control group[(32.59±2.71)mm,(9.30±0.77)mm,0.42±0.04,(9.75±0.81)mm,(147.33±27.23)g,(80.14±13.81)g/m2](P＜0.05),mean while the ratio of E/A(0.82±0.19)in macroalbuminuria group was significantly lower than that in control group(1.21±0.16)(P＜0.05).Conclusions In T2DM patients with albuminuria,the cardiac structure and function have changed.With the increase of UAER,the impairments are more prominent.And it may predict diabetes cardiomyopathy.

Objective To investigate the relationship between the severity of diabetic retinopathy and serum bilirubin level. Methods From August 1 2008 to December 31 2009, hospitalized patients of 1062 cases with type 2 diabetes were divided into three groups according to fundus examination: no diabetic retinopathy (NDR) group (457 cases), non-proliferative diabetic retinopathy (NPDR) group (484 cases)and proliferative diabetic retinopathy (PDR) group ( 121 cases). The difference in serum bilirubin level was compared. Results Total bilirubin in PDR, NPDR and NDR group were (9.96 ± 3.84), ( 11.41 ± 3.82),( 13.38 ± 3.98) μ mol/L respectively. There was significant difference among three groups (P ＜ 0.01 ). Logistic multivariate regression analysis showed that a drop in serum total bilirubin level was an independent risk factor of diabetic retinopathy. Conclusions Bilirubin level and the severity of diabetic retinopathy have some relationship. The antioxidant bilirubin and anti-inflammatory effect should be paid attention to.

Aim To investigate the effects of DGK in-hibitor R59022 on ET-1-induced myocardial hypertro-phy and autophagy, and explore the possible mecha-nisms. Methods Myocardial hypertrophy was in-duced by ET-1 in cultured rat neonatal cardiomyo-cytes. Western blot was used to detect the expression of microtubule-associate protein 1 light chain 3 ( LC3 ) , beclin-1, p62, p-Akt and Akt. mRNA expression of brain natriuretic peptide ( BNP) and beta mysion heav-y chain (β-MHC) and the cell size of cardiomyocytes were detected by RT-PCR and immunofluorescence, respectively. Results Treatment cardiomyocytes with ET-1(10 -7 mol·L-1 ) for 24 h induced the myocardi-al hypertrophy in cultured neonatal rat cardiomyocytes with the activation of autophagy as evidenced by the in-creased expression of autophagy-related proteins LC3-II/I and beclin-1 , as well as the increased p62 degra-dation. While, myocardial hypertrophy induced by ET-1 , including the increased myocardial cell size and the mRNA expression of fetal gene BNP and β-MHC, could be reversed by autophagy inhibitor 3-methyl ade-nine (3-MA) and chloroquine ( CQ) ,but promoted by autophagy agonist rapamycin ( RAPA ) . Pretreatment cardiomyocytes with R59022, an inhibitor of DGK, en-hanced ET-1-induced myocardial hypertrophy by en-hancing autophagy in cardiomyocytes. Furthermore,ET-1 treatment inhibited the activation of Akt by the down-regulation of the Akt phosphorylation, and R59022 en-hanced the effect of ET-1 on the activation of Akt. Conclusions Enhanced autophagy contributes to car-diomyocyte hypertrophy. R59022 deteriorate ET-1-in-duced myocardial hypertrophy by activating autophagy. The possible mechanism may be related to the inhibi-tion of activation of mTOR signaling pathway by inhibi-ting the activation of Akt.

Objective To observe the intervention effects of fluid wax on the therapeutic course of patients with adhesive small bowel obstruction.Methods Two hundreds and eighty-eight patients with adhesive small bowel obstruction admitted into the Department of Gastrointestinal Surgery of Huzhou Central Hospital from December 2014 to June 2016 were enrolled, and they were divided into a fluid wax group and acontrol group by mechanical sampling method, each group 144 cases. The control group was treated with conventional comprehensive non-surgical treatment, in the fluid wax group, on the basis of the above conventional treatment, additionally after 2 hours of gastrointestinal decompression, the fluid wax 3 mL/kg was injected through a gastric tube that then was closed by a clip for 2 hours. The first exhaust and defecation times, the time for amelioration of abdominal pain, the time of gas-liquid flat disappearance, the length of stay in hospital, the rate of operation and the occurrence of adverse reactions were observed in the two groups.Results After treatment, the first exhaust time, the first defecation time, the time of relieving abdominal pain, the time of gas-liquid flat disappearance and the length of stay in hospital were significantly shorter in fluid wax group than those in control group [the first exhaust time (hours): 29.97±19.71 vs. 49.28±33.61, the first defecation time (hours): 60.25±28.37 vs.74.23±50.12, the time of relieving abdominal pain (hours): 35.78±20.98 vs. 51.83±25.02, the time of gas-liquid flat disappearance (hours): 71.60±39.50 vs. 90.98±57.91, the length of stay in hospital (days): 7.00±3.77 vs. 9.00±5.81, allP < 0.05], and the rate of operation in the fluid wax group was lower than that in the control group [18.75% (27/144) vs. 27.08% (39/144),P < 0.05]. No patients died in the two groups. In nearly 1 year follow-up, there were no adverse reactions associated with the study in the fluid wax group.Conclusion The intervention of fluid wax combined with conventional non-surgical methods can significantly shorten the disease course, reduce the rate of operation and the hospitalization time in patients with adhesive small bowel obstruction.