Objective To investigate the efficacy and safety of different strategy of antithrombotic therapy in elderly patients with atrial fibrillation (AF) and coronary disease.Methods 224 inpatients and outpatients with AF and coronary disease whose mean follow-up time was 2 years,were divided into warfarin group,warfarin combined with antiplatelet drug(aspirin or clopidogrel) group,antiplatelet drug(aspirin or clopidogrel) group and control group.The thromboembolic event rate and adverse events incidence were observed in different groups.Results The risk of thromboembolic events,particular emerging risk of cerebral infarction in the control group(12.50 ％) was significantly higher than other groups (P＜ 0.05).Thrombotic event rates in warfarin + single joint group(2.78％) was lower than other groups(warfarin group 4.29 ％,single joint group 5.81％),but there was no significant statistical difference.The overall risk of bleeding in the control group (3.13 ％) was significantly lower than other antithrombotic group (P＜0.05).The incidence of skin bruising in single joint group was lower than other antithrombotic groups,the overall bleeding risk,especially gasfrointestinal bleeding in warfarin+ single joint group was significantly higher than other groups (P＜ 0.05).Conclusion Elderly patients with coronary heart disease and atrial fibrillation need antithrombotic therapy to prevent thrombotic events.Using warfarin alone or warfarin combined antiplatelet drug does not lead to serious bleeding events,but generally bleeding risk should be attracted more attention.

Objective To investigate the effect of linezolid on procalcitonin ( PCT) in the treatment of methicillin resistant staphylococcus ( MRS) infection.Methods 85 cases with MRS infection in our hospital were grouped, control group received vancomycin treatment, study group received linezolid, 2 weeks for 1 courses.Clinical effect were compared to explore the linezolid effect of PCT levels in patients with MRS infection.Results After treatment, defervescence time, bacterial clearance time, bacterial clearance rate and 48 hour mortality rate between two groups of patients had no significant difference.Compared with the control group, ICU treatment time in the study group was significantly lower ( P<0.05 ) .There was no significant difference in total effective rate between two groups.After treatment, the PCT and CRP in study group were lower than control group(P<0.05).Conclusion Linezolid has significant function to reduce the serum PCT level of patients with methicillin-resistant staphylococcus infection procalcitonin, which has better clinical curative effect.

Objective:To investigate the protective effects of acupuncture pretreatment on ischemic myocardium,the protective mechanism of acupuncture pretreatment on ischemic myocardium was explored by observing the cardiac muscle cell apoptosis and the expression of HSP70 mRNA of ischemia-reperfusion injury rats treated with acupuncture pretreatment.Methods:Sixty-four Wistar rats were randomly divided into eight groups:control group,sham surgery group,ischemia-repertusion group,ischemia pretreatment group,manual acupuncture pretreatment group(once a day),electroacupuncture pretreatment group(once a day),manual acupuncture pretreatment group(twice a day),and electroacupuncture pretreatment group(twice a day).The reperfusion model of rat myocardial ischemia was made.Expression of HSP70 mRNA was assayed by in situ hyrbridization,and cell apoptosis by TUNEL.Results:Compared with those in the control group and the sham surgery group,the apoptosis and the expression of HSP70 mRNA were increased in the ischemia-reperfusion group.Compared with those in the ischemia-reperfusion group,the cardiac muscle cell apoptosis was decreased and the HSP70 mRNA was increased in the rats treated with acupuncture pretreatment;meanwhile,acupuncture pretreatment twice a day had stronger effects than acupuncture pretreatment once a day and ischemia pretreatment.Conclusion:Acupuncture pretreatment can inhibit the cardiac muscle cell apoptosis,and up-regulate the expression of HSP70 mRNA in ischemia-reperfusion rats.Acupuncture pretreatment twice a day has stronger effects than pretreatment once a day.

Objective:To explore the application of Allostatic Load (AL) in evaluation the effect of management for patients with type 2 diabetes.Methods:According to the control objectives of each indicator in the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China, the P75 and P80 of the subjects before intervention, AL was calculated, which were AL1-1, AL1-2 and AL1-3 respectively. On the basis of the above three indicators, the number of complications was taken as the numerical sum to obtain AL2-1, AL2-2 and AL2-3. Study participants were from a one-year randomized controlled intervention trial in patients with type 2 diabetes. Patients in the control group were treated with the integrated diabetes management mode used bg the tier-three medical institutions, while the intervention group added the intervention based on " Your Doctor" App on the basis of the above strategy. The changes of 6 types of AL and HbA 1C in the two groups before and after intervention were compared. Two groups of patients were treated with propensity score matching method to ensure the balanced distribution of covariates between groups. Multiple regression analysis was used to explore the factors influencing the effect of AL intervention. Two independent samples t-test, paired t-test and chi-square test were used to analyze the efficacy of the intervention. Results:After propensity score matching, the control group and the intervention group each included 483 patients. Among the six types of AL, the score of AL2-1 was the highest, while the score of AL1-3 was the lowest. Compared with baseline, all other indicators in the two groups decreased after intervention except ALL-3 in control group ( P<0.05).Patients who were residing in rural areas, having less co-habitants and more diabetic complications, and lower annual household income, shown higher AL ( P<0.05). The number of complications and the situation of urban or rural areas were the factors influencing the effect of AL intervention. Conclusions:More research is needed on AL as an early evaluation index of the effect of comprehensive management of diabetes.

Objective To analyze the value of serum procalcitonin (PCT) in patients with community acquired pneumonia (CAP),and to evaluate the role of PCT in the therapeutic effect,severity and prognosis.Methods A retrospective analysis of data and laboratory tests of 50 patients with CAP admitted from November 15,2011 to November 15,2012 in GICU was carried out.Patients with infection of other parts of body,surgical treatment and trauma were ruled out.The level of PCT (ng/mL) before and during treatment,and the relationships between PCT and respiratory failure,mechanical ventilation,treatment results were analyzed respectively.Results According to the occurrence of sepsis,50 patients were divided into sepsis group and non-sepsis group.In the non-sepsis group,the PCT level before treatment,the highest and average PCT levels during the treatment were 0.1125 (0.078,0.269),0.1235 (0.078,0.494),and 0.1355 (0.08,0.245) respectively.Correspondingly,the PCT levels in the sepsis group were 8.92 (2.715,16.33),13.53 (6.305,25.625),and 4.26 (2.1415,8.2455),and there were statistically significant differences in three values of PCT between groups (ZIst =-4.743,PIST ＜ 0.05 ; ZMax =-5.783,PMax ＜ 0.05 ; ZMean =-5.644,PMean ＜ 0.05).According to the emergence of respiratory failure during treatment,average PCT level in the patients with respiratory failure was 1.7375 (0.224,5.092),and that in the patients without respiratory failure was 0.081 ng/mL (0.049,0.146),presenting the statistically significant difference between two groups (Z =4.472,P ＜ 0.05).In case of using mechanical ventilation (MV),the average PCT level of the patients with mechanical ventilation was 1.618 ng/mL (0.224,5.092),and that in the patients without MV was 0.086 ng/mL (0.061,0.465),producing a significant difference between the two groups (Z =-3.788,P ＜ 0.05).Grouped according to the outcome of patients,the mean value of PCT level in death group was 7.4585 ng/mL (2.392,16.25),and that in the survival group was 0.1965 ng/mL (0.885,0.618),showing statistically significant difference between two groups (Z =3.857,P ＜ 0.05).The first PCT level in the GICU within 24 h after admission was used to make the receiver operating characteristic curve (ROC),and the area under the curve (AUC) was 0.9867,cutoff point was 1.25 ng/mL.Conclusions In case of CAP,the PCT level in patients with sepsis is significantly higher than that in patients without sepsis,and PCT can distinguish sepsis from pneumonia precisely.In addition,PCT is an important biomarker to judge the severity and outcomes of CAP at early stage.

Objective:To study the regulatory effects of Ligustrazine Hydrochloride(LHC)on tumor-induced immunosuppression by Colon26 cells in vitro.Methods:Colon26 cells were cultured for 48 h in the presense of LHC and either the cell fraction or the cultural supernatants was collected,with the untreated Colon26 cells as control for the study.The down-regulating effects of LHC on tumor immunosuppressions (including the suppressed NK killing and ConA induced transformation of murine spleen cells detected by MTT,and the reduced expression levels of IL-2R?,CD3?+?+ and CD3?-?+ detected by FCM) were determined.The concentrations of immunosuppressive cytokines,including TGF-?1,VEGF,IL-4,IL-6 and IL-10,in the supernatants were analyzed by quantitative ELISA.The relationship among the down-regulatory effects of LHC on secretion immunosuppressive cytokines and tumor immunosuppressions were evaluated by multiple linear regression analysis.Results:All of the cytokines assayed were found in the supernatant of Colon26 treated without LHC,in which TGF-?1 was the highest,and the significant inhibition of five immune functions mentioned above was showed.To the Colon26 treated by LHC,the concentrations of TGF-?1,IL-6 and IL-10 in the first re-cultured supernatant and its inhibition of five immunol functions decreased greatly.The concentrations of TGF-?1 and IL-6 in the second re-cultured supernatant and its inhibitions of transformation,CD3+?+ and CD3-?+resumed highly.The positive correlations existed between TGF-?1 and inhibition of immunol functions except for transformation,between IL-6 and inhibition of transformation or CD3-?+,between IL-10 and inhibition of NK killing or IL-2R? or CD3+?+,respectively.Conclusion:LHC can exert down-regulate effects on Colon26 secretion of immunosuppressors and its tumor immunosuppression.Reducing tumor immunosuppression of Colon26 through decreasing its secretion of immunosuppressors should be one of anti-tumor mechanisms of LHC.

Objective To observe the effect of Herba Hedyotis Diffusae(HHD) on expression of heat shock protein 70(HSP70) and P16 anti-oncogene protein in mice with H22 cell transplanted tumor. Methods The mice were immunized with hepatoma-lines-H22 cells which were treated by Chinese herbs firstly. According to the pretreatment of the Chinese herbs and whether the H22 cells being blocked by HSP70 monoclonal antibody,the mice were divided into 5 groups:HHD non-blocking group,HHD-blocking group,Radix Codonopsis(RC)-blocking group,RC non-blocking group,and RPMI-1640 control group. Then the treated H22 Cells were translated into the mice. The expression of HSP70 and P16 anti-oncogene protein in mice with transplanted H22 liver carcinoma was detected by immunohistochemical marking method. Results The expressions of HSP70 was up-regulated in HDD non-blocking group and RC non-blocking group,in particular in RC non-blocking group,and the difference was significant as compared with HHD-blocking group,RC-blocking group and control blank group.The expression of P16 anti-oncogene protein was up-regulated in the treatment groups,and the difference was significant in comparison with the control group. The effect on P16 anti-oncogene protein expression was stronger in HDD groups than that in RC groups,but the difference was insignificant between the blocking group and the non-blocking group of each herb. Conclusion The anti-tumor effect of HDD may be achieved by inducing HSP70 expression in transplanted H22 neoplasia and by enhancing the immunogenicity. The up-regulation of P16 anti-oncogene expression by HHD and RC has no direct relationship with the induction of HSP70,and the related mechanism needs further research.

Objective To observe the effect of heat shock protein 70 (HSP70) expression induced by Herba Hedyotis Diffusae (HHD) on the apoptosis of H22 hepatoma cells.Methlds Mice were immunized with H22 hepatoma cells from in-vivo ascites of the mice pretreated by HHD and Radix Codonopsis (RC).Mice were divided into five groups after being blocked with HSP70 monoclonal antibody:non-HHD blocking group,HHD blocking group,non-RC blocking group,RC blocking group and the blank control group,10 mice in each groups.Then the mice were attacked with cultured H22 hepatoma cells to induce transplanted tumor.The apoptosis in the transplanted tumor was detected by a terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL) method.Results Large amount of brown particles can be observed in the cell nucleus of transplanted tumor mice from HHD groups.Compared with RC groups,number of apoptotic cells and the staining intensity were increased in HHD groups.The apoptosis in HHD groups and RC groups differed from that in the blank control group,and was obvious in HHD groups.The apoptosis exerted a increasing tend in non-HHD blocking group,but the difference was insignificant between non-HHD blocking group and HHD blocking group,and between non-RC blocking group and RC blocking group.Conclusion HHD can promote the apoptosis of H22 hepatoma cells in transplated tumor through inducing the expression of HSP70 to some extent,and the related mechanism of inducing apoptosis needs further research.

Objective To investigate the effects of miR-155/miR-21 on the expression of TLR4 in patients with Kawasaki disease (KD).Methods Forty-five children with acute KD were enrolled into the study.Children were divided into the group with coronary artery lesions (KD-CAL+) and the group without coronary artery lesions (KD-CAL-).The age-matched twenty healthy children were included as the control group.The levels of TLR4 expression were analyzed by flow cytometry.The CD14+ monocytes in the peripheral blood were separated by CD14+ immunomagnetic beads.Real-time polymerase chain reaction (PCR) were performed to evaluate the expression of miR-155,miR-21 and interleukin (IL)-10,tumor necrosis factor (TNF)-α,IL-6,IL-1β in CD14+ monocytes at mRNA level.The concentration of matixmetalloproteinase (MMP)-9,HSP60,high mobility group box-1 protein (HMGB1) were measured by enzyme-linked immunosorbentassay (ELISA).T test was used to compare the differences between groups and P＜0.05 was considered to be statistically significant.Results The levels of Toll-like receptor 4 (TLR4) expression in children with acute KD were significantly higher than those in the control group [(12.4±5.1)％ vs (4.6±1.6)％,t=5.55,P＜0.05],and the levels of TLR4 expression in the KD-CAL+ group were remarkably elevated compared with the KD-CAL+group [(17.1±4.6)％ vs (9.6±2.7)％,t=5.89,P＜0.05].The plasma concentrations of HMGB11 [(10.2±7.6 vs 3.2±1.0) ng/ml,t=3.55,P＜0.05] and HSP60 [(56±23 vs 18±7) ng/ml,t=4.90,P＜0.05] in the KD group were increased(P＜0.05),but significantly decreased aftcr treatment with IVIG (P＜0.05).The levels of miR-155 [(21.0±27.0)×10 vs (4.6±3.1)×10-3,t=2.57,P＜0.05] and miR-21 (11.6±4.0 vs 8.7±2.2,t=2.78,P＜0.05)expression in the KD group were significantly higher than those in the controls (P＜0.05).The level of miR-155 expression in the KD-CAL+ group was apparently higher than that in the KD-CAL-group [(4.2±3.0)×10 vs (11.0±1.5)×104,t=4.07,P＜0.05] and the expression of miR-21 was lower than that in the KD-CAL-group (8.8±2.5 vs 12.8±4.0,t=3.46,P＜0.05).Compared with the controls,the levels of IL-10 mRNA expression in the KD group were significantly increased [(34.9 ±17.5)×10 vs (1.0±9.4)×10 4,t =5.62,P＜0.05),and IL-10 expression in the KD-CAL-group was higher than that in the KD-CAL+ group [(26.6±13.4)×104 vs (39.5±1.8)×10,t=2.36,P＜0.05].The plasma concentrations of MMP-9 in the KD group were remarkably higher than those in the controls [(1 141±541) pg/ml vs (304±94) pg/ml,t=4.83,P＜0.05],the concentration of MMP-9 in the KD-CAL+ group was higher than that in the KD-CAL-group [(1 350±625) pg/ml vs (945±370) pg/ml,t=2.21,P＜0.05].Conclusion The dysregulation of miR-155 and miR-21 may be one of the reasons that result in over-expression of TLR4 in patients with acute KD,and the persistently increased HSP60 and HMGB1 may trigger or amplify TLR4 expression.