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BackgroundAs a special type of hypertension, resistant hypertension has complex etiology, is difficult to treat, and more likely to lead to target organ damage. Recent studies have found that common triple combination antihypertensive therapies plus low-dose spironolactone could effectively control blood pressure in patients with resistant hypertension, but the efficacy and safety of such treatments need to be further verified due to small scales of these studies.ObjectiveTo perform a systematical review of the efficacy and safety of spironolactone for resistant hypertension.MethodsRandomized controlled trials (RCTs) on spironolactone for resistant hypertension were identified in databases of PubMed, Web of Science, The Cochrane Library, CNKI, VIP, and WanFang Date from inception to May 3rd, 2021. Two researchers separately screened the RCTs, extracted data and assessed the risk bias of eligible studies. Meta-analysis was conducted using RevMan 5.3.ResultsTwenty RCTs were included, nine of which did not report randomization methods, one used randomization based on the sequence of numbers including odd and even numbers of admission (pseudo-randomization) , seven did not report whether blinding was used, four were open-labeled, three described allocation concealment, and one had no complete results with no safety parameters for post-treatment of the controls. Meta-analysis revealed that compared to placebo and blank control groups, spironolactone-treated group had much lower clinic blood pressure, 24-hour ambulatory blood pressure (ABP) , daytime blood pressure and nighttime blood pressure (P

Objective: To discuss the correlation between shock index (SI) and severity and the values to forecast the prognosis in patients with septic shock., Methods: 127 patients with septic shock admitted to intensive care unit (ICU) of Zhejiang Provincial People's Hospital from January 1st, 2016 to October 31st, 2017 were enrolled, and they were divided into survival group and death group according to the outcomes after 28-day hospitalized. The vital signs, laboratory indexes, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), lactate clearance rate (LCR) of 3 hours after fluid resuscitation, and shock index on admission (SI 1 ) and shock index of 3 hours after fluid resuscitation (SI 2 ) were compared between the two groups. The correlation among SI and APACHE II, SOFA, LCR was analyzed. The receiver operating characteristic curve (ROC) was drawn to evaluate the prognostic value of SI in patients with septic shock., Results: A total of 127 patients were included, 52 in survival group (40.9%) and 75 in death group (59.1%). The SI 1 , SI 2 , APACHE II and SOFA in the death group were significantly higher than those in the survival group (SI 1 : 1.62±0.46 vs. 1.35±0.32, SI 2 : 1.36±0.24 vs. 0.93±0.15, APACHE II: 17.5±4.0 vs. 13.6±3.5,SOFA: 9.5±2.3 vs. 6.3±1.5), and LCR was significantly lower than that in the survival group [(14.4±5.2)% vs. (28.6±8.6)%], with statistically significant differences (all P < 0.01). The correlation analysis showed that SI 1 was significantly positively correlated with APACHE II (r = 0.458, P = 0.000) and SOFA (r = 0.535, P = 0.000), SI 2 was also significantly positively correlated with APACHE II (r = 0.624, P = 0.000) and SOFA (r = 0.656, P = 0.000), while SI 1 and SI 2 were significantly negatively correlated with LCR (r values were -0.348, -0.435, both P = 0.000), and the SI 2 were more remarkable. ROC curve analysis showed that the area under ROC curve (AUC) of SI 1 for predicting the prognosis of septic shock was 0.720 [95% confidence interval (95%CI) = 0.620-0.831, P < 0.05]; when SI 1 = 1.68, the sensitivity, specificity, Yoden index, positive predictive value and negative predictive value were 79.5%, 65.6%, 0.451, 0.759 and 0.636, respectively. The AUC of the SI 2 to predict prognosis of septic shock was 0.826 (95%CI = 0.739-0.826, P < 0.05); when SI 2 = 1.37, the sensitivity, specificity, Yoden index, positive predictive value and negative predictive value were 85.7%, 87.6%, 0.733, 0.893 and 0.902, respectively., Conclusions: Compared with SI 1 , SI 2 was more correlated with the severity in patients with septic shock and it had more values to predict prognosis.

Objective: To investigate the correlation between long time systolic blood pressure variability(SBPV)and short time SBPV in aged population., Methods: A total of 752 subjects aged ≥60 years of Kailuan Group who took part in 2006-2007, 2008-2009, 2010-2011 and 2012-2013 health examination were included by cluster sampling method.Long time SBPV was calculated by standard deviation of mean systolic blood pressure measured in 2006-2007, 2008-2009, 2010-2011 and 2012-2013, standard deviation represents short time systolic blood pressure which is derived from 24 hour ambulatory blood pressure monitoring. The observation population was divided into three groups according to the third tertiles of the time systolic blood pressure variability: the first point(<9.09 mmHg (1 mmHg=0.133 kPa)), second point (≥9.09 mmHg, and <14.29 mmHg), and third point (≥14.29 mmHg). Multivariate logistic regression analysis was used to analyze the correlation between long time systolic blood pressure variability and short time systolic blood pressure., Results: (1) The participants' age were (67.0±5.7) years old (284 women). (2) The 24 hours and daytime SSD were (14.7±4.0) mmHg, (14.7±3.5) mmHg, (15.7±4.4) mmHg (P=0.010) and (14.1±4.4) mmHg, (14.2±3.5) mmHg and (15.4±4.6) mmHg (P<0.001) according to the tertiles of long time systolic blood pressure variability, respectively, nighttime SSD were (12.0±4.4) mmHg, (11.8±4.8) mmHg and (11.9±4.9) mmHg (P=0.900). (3) Multiple logistic regression analysis showed that the tertiles of long time SSD was the risk factor for increasing daytime SSD>14.00 mmHg (OR=1.51, 95%CI: 1.03-2.23, P=0.037), but not a risk factor for increasing 24 hours SSD>14.41 mmHg (OR=1.10, 95%CI: 0.75-1.61, P=0.639) and nighttime SSD>11.11 mmHg (OR=0.98, 95%CI: 0.67-1.42, P=0.899)., Conclusion: Increased long time SBPV is a risk factor for increasing daytime SBPV.

Objective: To explore the effects of L-carnitine and bisoprolol on endoplasmic reticulum stress-mediated myocardial injury after cardiopulmonary resuscitation in rats., Methods: A total of 75 Sprague-Dawley rats were randomly divided into 5 groups of sham operation (sham); cardiopulmonary resuscitation (CR), L-carnitine (L), bisoprolol treatment (B) and L-carnitine and bisoprolol treatment (LB). Myocardial pathological changes were detected by hematoxylin and eosin, myocardial apoptosis by terminal deoxynucleotidyl transferase mediated dUTP nick and the expressions of key factors in endoplasmic reticulum (ER) by Western blot., Results: Compared with sham group, apoptosis and pathological lesions significantly increased in other groups (P < 0.05). And the levels of GRP78, CHOP and Caspase-12 were significantly higher (P < 0.05). The expression of ER factor protein and the degrees of myocardial injury in LB and B groups decreased compared with CR group. And LB group was the most obvious., Conclusions: Combined use of levocarnitine and bisoprolol exerts protective effects on cardiopulmonary resuscitation in rats. And the mechanism may be related to an inhibition of ER stress.

Objective: To compare the prevalence of hypertension between low birth weight infant (LBWI) women and non-LBWI women., Methods: A retrospective cohort study was applied and 3 172 pregnant women giving births during October 1976 to December 2008 in our hospital and underwent physical check-up between 2010 and 2011 at the Kailuan medical group were included and divided into LBWI group and non-LBWI group by the history of LBWI. Prevalence of hypertension was obtained during the follow-up program. Multiple logistic regression analysis was used to assess the relative risk of hypertension., Results: A total number of 3 172 women, with an average age of 42.3 years old were divided into LBWI group (n = 147) and non-LBWI group (n = 3 025), with the average birth weights of their infants were 2.31 kg and 3.39 kg, respectively. The prevalence of hypertension from the follow-up program was significantly higher in LBWI group than that in the non-LBWI group (23.8% vs. 16.9%, P < 0.05). After adjustment for other traditional risk factors, the risk of hypertension in LBWI group was 1.60 (95%CI:1.02-2.53) folds higher than that in the non-LBWI group., Conclusion: Prevalence of hypertension in women with LBWI was higher than that in those women without LBWI. History of LBWI seemed to have had an increased risk to develop hypertension.

Three different kinds of ECG data including the healthy, angina and myocardial infarction from the ECG database were analyzed to obtain the morphological difference sequence of their P-waves, QRS-wave and T-wave, and their RR interval sequences. Then the variability of these four sequences was analyzed by detrended fluctuation analysis (DFA) method. The results indicate that, the changing pattern in the DFA index of RR interval sequence from the healthy to the morbidity is different from those of the P-wave, QRS-wave and T-wave. The DFA indices of the RR interval sequence are about 1 in all three states, while the DFA indices of the other three sequences are about 0.5 in the healthy and all decrease from the healthy to morbidity.