Objective To explore the best safe dose of warfarin in patients with heart valve replacement.Methods One hundred patients with heart valve replacement were selected.They were divided into ≤60 kg group(47 cases) and ＞ 60 kg group(53 cases),postoperative time ≤3 months group (39 cases) and postoperative time ＞ 3 months group(61 cases),international normalized ratio(INR) ＜ 1.5 (group Ⅰ,23 cases),INR 1.5-2.5 (group Ⅱ,66 cases),INR ＞ 2.5 (group Ⅲ,11 cases).The dose of warfarin,plasma thrombus precursor protein(TpP) and D-dimer(D-D) were compared.Results The dose of warfarin was (2.90 ± 1.11) mg in ≤ 60 kg group and (2.47 ± 0.18) mg in ＞ 60 kg group,and there was significant difference between two groups (P ＜0.05).There was no significant difference in the dose of warfarin between postoperative time ≤3 months group and postoperative time ＞ 3 months group (P＞ 0.05),but there was significant difference in TpP and D-D [(6.32 ± 0.01) mg/L vs.(4.97 ± 0.81) mg/L,(879 ± 52) μ g/L vs.(151 ± 35) μ g/L] (P ＜ 0.05).The incidence of complications was 2.6％ (1/39) in postoperative time ≤3 months group,which was lower than that in postoperative time ＞ 3 months group[18.0％(11/61)],and there was significant difference between two groups (P＜ 0.05).There was significant difference in the dose of warfarin and D-D between group Ⅰ and group Ⅱ,group Ⅲ [(2.56 ±0.21) mg vs.(2.94 ±0.57),(3.07 ±0.44) mg,(793.92 ±42.73) μg/L vs.(100.96 ± 21.56),(61.08 ± 20.34) μg/L](P＜ 0.05),but there was no significant difference between group Ⅱ and group Ⅲ (P ＞0.05).There was significant difference in TpP among three groups [(8.50 ± 0.63),(5.42 ± 0.78),(3.16 ± 0.38) mg/L in group Ⅰ,Ⅱ,Ⅲ respectively] (P ＜ 0.05).Conclusion With warfarin dose and the incidence of complications,the best dosage of wadarin is (2.94 ± 0.57) mg; the optimal range of INR is 1.5-2.5.

Objective To explore the values and relationship among the contents of thrombus precursor protein(TpP)and plasma D-dimer(D-D),complications after mechanical heart valve replace-ment and their correlation with international normalized ratio(INR)in anticoagulation therapy and monito-ring.Methods A total of 150 patients with mechanical heart valve replacement were enrolled.TpP,D-D, INR,other indicators and complications were compared to draw conclusions.Results There were signifi-cant differences in TpP among the groups(P<0.0083).Significant differences in D-D among the postop-erative group(100.96 ±61.56),thrombosis group(17.78 ±5.94)and control group(5.97 ±1.58)were observed(P<0.0083).Significant differences in INR among the postoperative group(1.65 ±0.34),hem-orrhage group(2.22 ±0.65)and control group(1.11 ±0.10)were observed(P<0.0083),but the effec-tiveness of INR monitoring for determining the state of thrombosis was limited to a certain extent.Conclu-sion TpP and D-D examination can facilitate monitoring after mechanical heart valve replacement,and it has a certain guiding significance for determining anticoagulation therapy and monitoring of complications after mechanical heart valve replacement.

Objective: To compare the early and long-term outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in elder female patients.
Methods: A total of 763 female patients elder than 65 years of age received isolated CABG in our hospital from 1999-01 to 2008-12 were retrospectively studied. The patients were divided into 2 groups according to operational method: On-pump group,n=331 and Off-pump group,n=432. The mortality at 30 days post-operation, in-hospital clinical indexes and long term mortality with MACCE as all cause death, myocardial infarction (MI), stroke and repeated revascularization were compared between 2 groups.
Results: Compared with On-pump group, the patients in Off-pump group had the elder age (P<0.01), with the higher rate of cerebral vascular accident (P=0.023); less family history of coronary artery disease (P=0.012), angina (P<0.001) and emergent operation (P=0.015), less venous distal anastomoses (P<0.001) ; while higher incomplete revascularization (P<0.001). Logistic regression model comparison indicated that Off-pump group had the lower mortality at 30 days post-operation (P=0.038), less application of blood products (P<0.001), lower rate of >24h mechanical ventilation (P<0.001), less renal failure (P=0.022), pulmonary complications (P<0.001) and re-exploration for bleeding (P=0.021). The morbidity of all post-operative complications were similar between 2 groups (P=0.110). Cox regression model comparison showed that long-term all cause mortality (P=0.477) and occurrence of MACCE (P=0.265) were similar between the two groups.
Conclusion: Off-pump CABG would reduce the mortality at 30 days post-operation, have less application of blood products, shorter post-operative mechanical ventilation, less early post-operative renal failure, pulmonary complications and re-exploration for bleeding. While it could not reduce the long-term mortality and MACCE occurrence.

Objective:To investigate whether celastrol can increase the cytotoxic activity of γδ T cells against osteosarcoma (OS) cells line HOS through TRAIL way. Methods:The death receptors 4/5 (DR4/5) protein levels in the OS cell lines HOS was in-vestigated by Western blot analysis. Zoledronate ( ZOL) was used to induceγδT cells from PBMCs of healthy volunteers.γδT cell cy-totoxicity against HOS cells was investigated by a standard lactate dehydrogenase release assay ( LDH ) . Results:Celastrol increased DR4/5 protein expression in HOS ( P<0. 05 ) .γδ T cells from PBMCs of healthy volunteers showed cytotoxicity against HOS ( P<0. 05). Following co-culture with HOS pre-treated with celastrol (1 μmol/L) for 24 h,γδ T cells showed significantly higher cytotoxicity against HOS (P<0. 05). The induction of DR4/5 molecules increased lysis of HOS by γδ T cells which was abolished by addition of a blocking TRAIL antibody. Conclusion:Celastrol can enhance γδ T cells'cytotoxic activity against OS cells line HOS through TRAIL way.

Objective To investigate the effects of esophagogastric intramural anastomosis on preventing reflux esophagitis by restoring the cardiac function after esophagectomy.Methods The clinical data of 66 esophagem or cardiac cancer patients(test group)who received esophagogastrie intramural anastomosis at Second Affiliated Hospital of Xi'an Jiaotong University from January 2002 to October 2008 were retrospectively analyzed.Sixty-five patients who received stapled anastomosis during the same period were in control group.Postoperative conditions of patients in the 2 groups were compared by chi-square test and t test.Results (1)Reflux condition:there were 3 patients with degree I and 63 without reflux in test group,and 23 with degree Ⅰ,19 with degree Ⅱ,7 with degree Ⅲ and 16 without reflux in control group.There was a significant difference between the 2 groups(X~2=137.3,P<0.05);(2)results of barium meal fluoroscopy:12 patients in test group and 41 patients in control group had barium reflux,with significant difference between the 2 groups(X~2=27.4,P<0.05);(3)results of gastroscopy:9 patients in test group and 46 patients in control group had morphological changes of mucosa,with significant difference between the 2 groups(X~2=43.5,P<0.05);(4)esophageal sphincter pressure:the pressure of lower esophageal sphincter was(3.4±0.8)kPa in test group and(2.5±0.6)kPa in control group,and the pressure of upper esophageal sphincter wag(7.4±1.7)kPa in test group and(4.2±0.8)kPa in control group.There was a significant difference in esophageal sphincter pressure between the 2 groups(t=4.98,11.59,P<0.05).Conclusion Esophagogastric intramural anastomosis can partly restore the cardiac function and prevent reflux esophagitis effectively.

Objective To investigate the long-term anticoagulation starus and relation of INR and complica-tion,best anticoagulation range and clinical significance in patients after mechanical heart valve replacement. Meth-ods The data of blood clotting test series(containing PT,PT% ,PTR,INR,Fbg,APTT) for patients after 6 months of mechanical heart valve replacement were collected, then the cases were divided into 4 groups according to their INR levels( group Ⅰ : INR < 1.5; group Ⅱ : INR 1.5 ～ 2.0 ; group Ⅲ : INR 2.1 ～ 2.5 ; group Ⅳ : INR > 2.5 ). Results Group Ⅰ contained 28 person-times, with their dosage of warfarin for (3.61 ± 1.44 ) mg, INR 1.38 ± 0. 12, core-bral embolism occurred for 4 person-times,with a inception rate of 14%. Group Ⅱ contained 92 person-times,with their dosage of warfarin for (3.5±1.37)mg,INR 1.65±0. 14,hemorrhinia occurred for 2 person-times,with a in-ception rate of 2%. Group Ⅲ contained 80 person-times, with their dosage of warfarin for (3.18±1.63 )mg, INR 2.23±0.19 ,bematuria occurred for 2 person-times, bemorrhinia occurred for 2 person-times, with a total inception rate of 5% ; Group Ⅳ contained 16 person-times, with their dosage of warfarin for ( 2.32 ± 1. 23 ) mg, INR 2.80± 0.19, hemorrhinia occurred for 2 person-times and hemoptysis occurred for 1 person-times, with a total inception rate of 18.7%. The person-times in group Ⅱ and Ⅲ accounted for 79.6% and the complication rate was the lowest when INR was between 1.5-2.5. Conclusions INR levels between 1.5-2.5 is the most secure, which is the best antico-agu]ation range in our region. Since the anticoagulation strength dynamically changes, the long-term anticoagulation status in patients after mechanical heart valve replacement should be deeply concerned.

The definition and function of epidemiological investigation report on food safety accident is described and its impact on the business behavior,civil liability,administrative responsibility,and criminal responsibility of food producers,marketers,supervisory and management department is presented.It suggests that center for disease prevention and control should give attention to timeliness,authenticity,accuracy,normalization of epidemiological investigation report on food safety accidents and cases.The purpose is to avoid accountability on investigation of food safety accidents and ensure the epidemiological investigation report not been challenged in legal proceedings as evidence.

Objective To observe the leading effect of end-tidal pressure of carbon dioxide in artery ( PET CO2 ) on mechanical ventila-tion in New Zealand white rabbits, and to establish parameters for medical animal experiments in terms of hemodynamics, blood gas, blood glucose, electrolyte. Methods 31 anesthetized New Zealand rabbits were practiced tracheostomy tube and mechanical ventilation. Respira-tion rate was 40 breaths/min and tidal volume was adjusted so that PET CO2 was 29 mmHg. Invasive blood pressure, electrocardiogram and PET CO2 were monitored. Blood gas analysis, electrolyte, hemoglobin and blood glucose were tested. Results When PET CO2 was maintained at 29 mmHg, the results were as follows:PH (7.42 ±0.07), 95% confidenceinterval (7.40~7.45);PaCO2(38.5 ±5.8) mmHg, 95%confidenceinterval (36. 4~40. 6) mmHg;BE (1. 45 ± 2. 80) mmol/L,95% confidenceinterval (0. 43~2. 48) mmHg. Conclusion Moni-toring of PET CO2 is good to guide mechanical ventilation in New Zealand white rabbits.

Objective To detect the expression of VIP1R and VIP2R mRNA in gallbladder tissues of patients with gallbladder diseases. Methods The expression of VIP1R and VIP2R mRNA in gallbladder tissues were detected in 25 patients with gallstone, 8 patients with gallbladder polyps and 7 control liver transplantation donors by RT-PCR. Results The VIP2R mRNA level of the control group (1. 09 ?0. 58 ) was lower than that of the gallbladder polyps group (1.64?0.56 ),P

Objective To assess the acute effects of daily mean temperature,cold spells,and heat waves on stroke mortality in 12 counties across Hubei province,China.Methods Data related to daily mortality from stroke and meteorology in 12 counties across Hubei province during 2009-2012,were gathered.Distributed lag nonlinear model (DLNM) was first used,to estimate the county-specific associations between daily mean temperature,cold spells,heat waves and stroke mortality.Multivariate Meta-analysis was then applied to pool the community-specific relationships between temperature and stroke mortality (exposure-response relationship) as well as both cold-and-heatassociated risks on mortality at different lag days (lag-response relationship).Results During 2009-2012,a total population of 6.7 million was included in this study with 42 739 persons died of stroke.An average of 2.7 (from 0.5 to 6.0) stroke deaths occurred daily in each county,with annual average mean temperature as 16.6 ℃ (from 14.7 ℃ to 17.4 ℃)during the study period.An inverse J-shaped association between temperature and stroke mortality was observed at the provincial level.Pooled mortality effect of cold spells showed a 2-3-day delay and lasted about 10 days,while effect of heat waves appeared acute but attenuated within a few days.The mortality risks on cold-spell days ranged from 0.968 to 1.523 in 12 counties at lag 3-14,with pooled effect as 1.180 (95％ CI:1.043-1.336).The pooled mortality risk (ranged from 0.675 to 2.066) on heat-wave days at lag 0-2 was 1.114 (95％CI:1.012-1.227).Conclusions An inverse J-shaped association between temperature and stroke mortality was observed in Hubei province,China.Both cold spells and heat waves were associated with increased stroke mortality,while different lag patterns were observed in the mortality effects of heat waves and cold spells.