OBJECTIVE:To investigate the anticoagulation effects of warfarin on the lower extremity deep venous thrombosis (LEDVT),and to analyze its influential factors,in order to provide scientific basis for individualized medication of warfarin in the clinic. METHODS:Totally 140 cases of LEDVT were selected and treated with warfarin on the and day after admission with initial dose of 5.0 mg,qd,2.5 mg for following 2 days,orally,qd. The dose of warfarin was adjusted 72 h after medieation according to INR of patients. The dose of warfarin wasused as the maintenance dose when INR reached the anticoagulant target. Clinical data of patients were recorded,and blood biochemical indexes and coagulation function were detected. The influential factors of anticoagu-lation effects were analyzed by multiple-linear regression. At the same time,the results of INR were recorded before medication and 24,48,72 h after medication. RESULTS:INR of patients receiving warfarin had the potential to increase,compared to before medication;24,48,72 h after medication,INR value showed a gradual upward trend,without statistical significance(P>0.05). The change of INR within 24 h after medication was less than that within 24-48 h after medication;the change of INR within 24-48 h after medication was less than that within 48-72 h after medication,with statistical significance (P<0.01). The influence of various factors on the anticoagulant effect of warfarin in descending order was as follows:age,weight,low density lipoprotein cholesterol,plasma albumin,disease duration. Among them,age and low density lipoprotein cholesterol were positively correlated with anticoagulation,while body weight,plasma albumin and disease duration were negatively correlated with anticoagulation. CONCLUSIONS:Both age and body weight are the main influential factors for anticoagulation effect of warfarin. Individualized medication should be implemented in order to improve the anticoagulation effects of warfarin.

Objective To evaluate the clinical efficacy of three chemotherapy regimens and partial excision of the affected vertebrae for spinal tuberculosis. Methods Between December 1998 and November 2003, 76 cases with spinal tuberculosis were treated with chemotherapy and surgical intervention. All pa-tients were divided into three groups randomly to receive one of three different courses of chemotherapy. Among these, 38 cases were selected to receive ultra-short-course chemotherapy regimen with 2SHRZ/ 2.5H2R2Z2, 23 of short-course with 3SHRZ/5H2R2Z2, and 15 of standard with 3SHRZ/9H2R2Z2. The duration of the preoperative chemotherapy of the three groups was about the same with an average of 21 days (15 to 40 days). All patients underwent anterior partial excision of the affected vertebrae, large iliac strut graft and anterior or posterior fixation. Results The mean follow-up time of the ultra-short-course, short-course and standard chemotherapy groups were 23, 28 and 45 months respectively. The observed indices included: 1) Clinical manifestation: disappearance of TB symptoms, the nerve function recovered, life and the work activ-ities. 2) Lab tests: both ESR and CRP data or either of them in normal or near normal status. 3) X-ray, CT and MRI examination: abscesses, new lesion, absorption of the bone grafts, translucent line between bone graft and vertebral body, and correction of kyphotic deformity. 4) Ultrasonic examination: no opaque dark area at the sites where there might be the paravertebral or gravity abscesses. 5) Drug complications: the hepatic and renal function of patients at follow up were normal or close to normal. The follow-up showed that all the three groups achieved excellent results. Conclusion Treatment of spinal tuberculosis with anterior partial excision of pathologic vertebrae, large iliac strut graft and anterior or posterior internal instrumental fixation in either ultra-short-course, short-course or standard chemotherapy all achieved excellent therapeutic effects. There was no difference among three different courses of chemotherapy.

Objective To investigate the feasibility of breast conserving surgery after neoadjuvant chemotherapy for Ⅱ and Ⅲ stage breast cancer.Methods Forty-six patients,suffering from Ⅱ and Ⅲ stage breast cancer admitted to 309 Hospital of PLA from Jun.2003 to Dec.2008,and received breast conserving surgery after neoadjuvant chemotherapy,were followed-up.Chemotherapy protocol included intravenous injection of epirubicin 60mg/m2 on day 1 and continuous intravenous infusion of paclitaxel 150 mg/m2 for 3 hours on day 2.The neoadjuvant chemotherapy was repeated every 21 days for 2-4 cycles.Patients eligible for breast conserving therapy received quadrantectomy or wide excision of tumor plus axillary lymph node resection.Evidence of local recurrence and distant metastasis and breast contour were followed up after surgery.Results After neoadjuvant chemotherapy,9 patients showed complete clinical response(CR),37 patients showed partial response(PR).Post-operative pathological examination showed that there were varied degrees of apomorphosis and necrosis of tumor cells,interstitial edema,fibrous hyperplasia,and inflammatory cell infiltration,among them pathological remission was found in 4 cases.The patients were followed up for 8 to 70 months with a mean of 58 months,local recurrence was found in 4 cases distant metastasis was found in 3 patients,and 2 of them died.Assessment of breast contour was carried out in 31 cases 1 year after breast conserving therapy,and excellent results were obtained in 6 cases,good in 18 cases and poor in 7 cases.Conclusions It is safe for patients with Ⅱ-Ⅲ stage breast cancer to receive preoperatively treatment with neoadjuvant chemotherapy.Routine operation,postoperative irradiation and chemotherapy and systemic support are the keys to achieve satisfactory result of breast conserving therapy.

0.05),while significant differences were observed among different involvement depth,size,and location of tumors(P

0.05). After operation, in the pedicle screw fixation group the indexes were restored, but the restoration was lost gradually at later follow- up stage. Their superior- inferior endplate angle before operation averaged 19.5? , but 8.6? after operation, and 20.0? at the latest follow- up. Their wedged angle before operation averaged 20.7? , but 9.1? after operation, and 15.9? at the latest follow- up. In the non- pedicle- screw fixation group, the indexes decreased gradually at the later follow- up. Their average superior- inferior endplate angle before operation was 16.6? , 14.6? after operation, and 23.0? at the latest follow- up. Their average wedged angle before operation was 15.6? , 16.6? after operation, and 22? at the latest follow- ups. Conclusions The height of the fractured vertebra may be lost and the wedged vertebra may occur again after surgery but conditions may become stable in 2 years. The spinal kyphosis deformity, however, may go on. Its possible causes are structural changes of the vertebra after surgery, the early degenerative changes of the adjacent intervertebral discs, and osteoporosis.

Objective To investigate the efficiency and safety of transfection green fluorescent protein plasmid to mouse cornea mediated by SonoVue and ultrasound.Methods Saline,plasmid+saline,plasmid+SonoVue and liposome+plasmid were injected respectively to mouse eye anterior chamber.Then the mouse eye of plasmid+saline and plasmid+SonoVue injection group were exposed to pulse wave ultrasound under 50 Hz pulse reDetition frequence,2 W/cm2 intensity and 10 minutes duration time.Fluorescence stereomicroscope was used to observe the expression of EGFP in the eye at the 1 st day,3rd day,7th day,14th and 21 st day after injection.Two mice were taken randomly from each group and were sacrificed at the 3rd day after injection.Their eyes were enucleated and made into frozen coronal sections.And fluorescence microscopy was performed to observe the type and distribution of EGFP positive cell.Tissue damage was observed in pathological section.Results EGFP was exDressed over the ocular surface in SonoVue and ultrasound group,and it obviously higher than only ultrasound exDosure group and liposome group.The expression of EGFP was not detect ed over the ocular surface in other groups.Pathological sections were not found any difference in each group.Conclusions SonoVue and ultrasound can successfully and safely transfer gene to ocular in vivo study.

Objective To improve the recognition of diagnosis, treatment and leukemia transformation of primary myelofibrosis (PMF). Methods One case with PMF which transformed into acute myeloid leukemia (AML) was reported and the literatures on this topic were reviewed. Results The patient was diagnosed according to the 2008 version of the WHO classification of PMF leukemia transformation was diagnosed after 2.5 years. The JAK2 V617F gene mutation was detectable both before and after leukemia transformation. The outcome of low dose chemotherapy could keep a short time. Conclusion JAK2 V617F gene could remain detectable after leukemia transformation in PMF patients. It is difficult to control the disease progress by low dose chemotherapy.

Objective To observe the visual acuity change in patients with different patterns of optical coherence tomography (OCT) of diabetic macular edema (DME) after intravitreal ranibizumab injection and/or laser photocoagulation.Methods A retrospective observational case series.Seventy patients (99 eyes) with DME were enrolled.Best-corrected visual acuity (BCVA) was evaluated using the international vision test chart,and then convert the result to the logarithm of the minimum angle of resolution (logMAR).According to the morphological characteristics of OCT,the DME was divided into 3 patterns,including diffuse macular edema (DRT),cystoid macular edema (CME) and serous neuroepithelial layer detachment.The average follow-up was (80.43 ± 74.89) days.The patients were divided into 3 groups according to the different treatments,including intravitreal ranibizumab injection group (group A,21 patients,25 eyes),intravitreal ranibizumab injection and laser photocoagulation group (group B,23 patients,26 eyes),laser photocoagulation group (group C,26 patients,48 eyes).The changes of absolute BCVA (ABCVA) and improved visual acuity were compared between different treatment groups and different OCT patterns.ABCVA =logMAR BCVA before treatment-logMAR BCVA after treatment.Improvement more than 0.3 of logMAR value was considered as improved visual acuity.Results There was no significant difference in ABCVA between different treatment groups (F=0.050,P＞0.05).The improved visual acuity in group A and B were great than group C (x2=5.645,6.301;P＜0.05).In group A,B and C,there was no significant difference in ABCVA and improved visual acuity between different OCT patterns (P＞0.05).Improved visual acuity of DRT and CME eyes were higher in group A&B (70.59％ and 50.00％) than in group C (26.47％ and 14.29％),the difference was statistically significant (x2=5.075,4.453;P＜0.05).Conclusions There is no obvious change of visual acuity in patients with different OCT patterns of DME after the same treatment by intravitreal ranibizumab injection and/or laser photocoagulation.The improved visual acuity is not consistent in same OCT patterns after different treatment.

Objective To investigate the detection of human bocavirus (HBoV) in children with acute respiratory infection and to explore the relationship between viral load and clinical characteristics of acute respiratory infection in children.Methods A total of 4 501 nasopharyngeal secretion samples were collected from hospitalized children with acute respiratory infection from January 2013 to June 2013.HBoV-positive children were divided into simple infection group and mixed infection group.Children with HBoV DNA≥1 × 104 copy/mL were categorized into high viral load group,while those with HBoV DNA ＜1 × 104 copy/mL were categorized into low viral load group.HBoV was determined by fluorescence quantitative polymerase chain reaction (PCR).Respiratory syncytial virus (RSV),influenza virus (Inf)-A,Inf-B,parainfluenza virus (Pinf)-Ⅰ 、Pinf-Ⅱ 、Pinf-Ⅲ and adeno virus antigen were detected by direct antigen-specific immunofluorescence assays.Mycoplasm Pnuemonia was detected by real-time fluorescence quantitative PCR.Serum mycoplasma antibodies were detected by enzyme-linked immunosorbent assay (ELISA).Bacteria was detected by sputum culture.Over the same period,23 children undergoing elective inguinal hernia operation with no respiratory infection or fever were considered as control group.The percentage of peripheral blood T lymphocyte subsets were tested by flow cytometry.Inter-group differences were compared using Chi-square test or Fisher exact test.Viral loads were compared using Mann-Whitney test.Results Two hundred and twenty-two HBoV-positive cases were detected with a positive rate of 5.41％ (222/4 105),33.33％ (74/222) of which were with high viral load and 66.67％ (148/222) were with low viral load.There was a high incidence in the age group of 1-2 years.The simple HBoV infection accounted for 24.32％,including 26 cases with high viral load and 28 cases with low viral load.Wheezing was more common in patients with high viral load than those with low viral load,and the difference was statistically significant (88.46 ％ vs 42.86 ％,x2 =12.295,P=0.001).Among the 222 HBoV-positive cases,the median viral load of HBoV in simple infection group was 3.86 × 103 copy/mL,and 1.0× 103 copy/mL in mixed infection group.The difference of the viral load between these two groups was statistically significant (Z =2.906,P =0.004).Mycoplasma and Streptococcus pneumonia were most commonly detected in the 168 patients with mixed infection.Percentages of CD3+ and CD3+/CD8+ subsets were significantly lower in HBoV simple infection group and mixed infection group,compared to control group (both P＜0.05).However,percentages of CD3 /CD19+,CD19+/ CD23+ subsets were significantly higher in HBoV simple infection group and mixed infection group,compared to control group (both P＜0.05).Conclusions HBoV is one of the pathogens causing acute respiratory tract infection in children,which lead to cellular immunity dysfunction in children.Moreover,children with higher HBoV load are more likely to develop wheezing.Co-infection with other pathogens should be considered in children with low HBoV load.