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 observe the effect of intravenous administration of amiodarone on postoperative heart failure and ventricular arrhythmia.METHODS:A total of 42 postoperative heart failure patients with ventricular tachycardia and multi-source ventricular premature beat were treated with lidocaine,but clinical efficacy was not obtained.Those patients received intravenous administration of diluted amiodarome 150 mg.After 30 minutes the dose of amiodarone was kept at 0.5～1.0 mg?min-1,and the total dosage ranged from 1 000 mg to 1 200 mg within 24 h.Clinical symptoms were recorded in every hour,such as cardiac rhythm,heart rate,blood pressure,heart failure.RESULTS:After 24 h of treatment,17 cases of ventricular arrhythmia had apparent effect(40%),20 cases of partial effect(47%),5 cases of no effect(12%),there were statistical significance in difference before and after treatment(P

Objectives:To investigate the relationship between calcitonin gene-related peptide(CGRP) in rat dental pulp and tooth movement.Methods:The first maxillary molars in 36 SD rats were moved mesially by orthodontic force,18 were examined 3,7 and 14 day after application of the appliance whereas another 18 rats were observed 7,14 and 28 days after removal of the appliance respectively.6 control rats were without treatment.Then,CGRP immunoreactivity was demonstrated by indirect immunoflurescence on frozen sections of dental pulp samples.Results:3,7 and 14 days after application of orthodontic force, the CGRP containing nurve fiber counts in each pulp were 17.57?4.42,24.04?3.55 and 21?4.11 respectively,those in the control pulps were 8.03?4.49. 7,14 and 28 days after removal of the appliance, the counts were 19.23?5.23,18.23?5.08 and 8.12?5.01 respectively.Conclusions:CGRP immunoreactive nerve fibres may take an active part in tissue responses in pulp tissues during experiment tooth movement.

Objective To studythe efficacy of levosimendan in treating refractory heart failure complicating severe renal in sufficiency.Methods Sixty-seven cases of refractory heart failure complicating severe renal insufficiency in the internal medicine department of our hospital were randomly divided into the levosimendan treatment group(L group,n=33)and dopamine treatment group(D group,n=34).The changes of N-terminal pro-B-type natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction (LVEF)and glomerular filtration rate(GFR)before treatment and on 1,3,7,30 d after treatment were compared between the two groups and analyzed.Results Before the treatment,there were no statistically significant differences in the baseline indicators between the two groups(P＞0.05).The group L:the NT-pro-BNP level on 1,3,7 d after treatment was decreased significantly(P＜ 0.05),LVEF on 3,7 d was significantly increased compared with th baseline(P＜0.05)and GFR on 1,3,7,30 d was significantly increased compared with the baseline(P＜0.05).The group D:the NT-pro-BNP level on 7 d of treatment was significantly decreased(P＜0.05),LVEF on 7 d of treatment was significantly increased compared with the baseline(P＜0.05),and no statistically significant changes were observed in GFR on 1,3,7,30 d(P＞0.05).After treatment,NT-pro-BNP,LVEF and GFR significant level values in the group L were better than those in the group D.Conclusion Levosimendan is superior to dopamine in improving heart and renal function for the patients with refractory heart failure complicating severe renal insufficiency.

For this cross-sectional study , the clinical data of 1979 patients at our emergency department from October 2012 to June 2013 were collected and analyzed.The relevant data included gender , age,visit time,complaints,signs and diagnosis.The ratio of female:male was 1 to 0.71.The age groups of 50-59 and 70-79 years were the most.The peak of visit time was 8-10 am accounting for 21.26%.The common complaints included dizziness ,headache and paralysis.The most frequent emergency diseases were acute cerebral vascular accident , dizziness or vertigo due to various diseases , headache and peripheral neuropathy.Ischemis stroke was the top one disease in elders.Conclusion The middle-aged and elderly are the main populations at our emergency department.And cerebrovascular disease is a common disease.

Objective To investigate the current status of nursing undergraduate students′ self-differentiation and career adaptability and analyze the correlation of the two, so as to provide a reference for nursing educators to offer employment guidance. Methods The Undergraduate Self-Differentiation Scale and The College Students′Career Adaptability Questionnaire were used to investigate 341 nursing undergraduates. Results The mean scores of the self-differentiation and the career adaptability were (3.70±0.60) points and (3.60±0.42) points, respectively. It showed that the total score of self-differentiation and its each dimension were positively correlated with career adaptability, the Pearson correlation coefficients were career adjustment 0.26, career interpersonal 0.38, career curiosity 0.32, career confidence 0.39, career concerns 0.27, career control 0.46, and the coefficients between two total scales were 0.46 (all P<0.05). Conclusions The self-differentiation level of nursing undergraduates could affect their career adaptation level, and clinical nursing educators can take corresponding measures to improve their career adaptability based on the characteristics of nursing students′self-differentiation.

Objective To study the value of carotid plaque magnetic resonance imaging (MRI) in pre-operation assessment in the elderly patients with carotid atherosclerosis and explore the possibility of minimizing the contrast weightings to gain sweeptime. Methods Totally 70 elderly patients with cerebral ischemia (average age of 68.8 years) underwent carotid MRI and digital subtraction angiography (DSA) due to the appearance of carotid plaque detected by ultrasound. Carotid plaque MRI was acquired with 3.0T MR scanner and 8 channel surface coil. The standard carotid plague MRI program included pre-and post-contrast T1 weighted imaging (T1WI), T2 weighted imaging, proton density weighted imaging and 3D time of flight MR angiography (3D TOF MRA). All these program were divided into two combinations: the 5-sequence MRI (all the sequences) and 2-sequence MRI (T1WI and TOF MRA). Digital subtraction angiography (DSA) in coronal and lateral views of carotid artery was performed with GE Advantx LCN+. The software SPSS 13.0 was used to statistically analyze the difference between MRI and DSA, and that of two sequence combinations was used in the detection of luminal stenosis and fibrous cap (FC) rupture. Results Totally 135 arteries were analyzed while 3 arteries in one patient were excluded due to the poor quality image and stent placement. The degree of luminal stenosis were (38.3±31.0)% and (38.5±30.9)%, respectively, detected by the two MRI sequence-combination with no significant difference (t=2.447, P＞0.05) and was (35.1±31.8)% by DSA. There was a good concordance between MRI and DSA in luminal stenosis detection (Kappa value: 0.773). No statistical difference was found between two MR sequence combinations in detecting FC rupture (both in 36 vessels). DSA detected FC rupture of 16 vessels, showing remarkably difference contrast to MRI(χ2=12.0, P＜0.01). Conclusions MRI can accurately detect the luminal stenosis and FC rupture. The short time scanning resulting from sequence optimization could make MRI much more suitable than DSA to do the pre-operation assessment for senile carotid atherosclerotic patients.

Objective To investigate the correlative factors of sentinel lymph node(SN) metastasis status in breast cancer.Methods The clinical data of 115 patients with breast cancer who underwent sentinel lymph node biopsy(SLNB) and axillary lymph node dissection(ALND) during June 2004 through April 2006 were retrospectively analysed.The SN metastasis were evaluated with regard to tumor size(≤2cm, 2.1cm~4cm)and C-erbB-2、p53、nm23、ER、PR status.Results Of the 115 patients SN was identified in 110(95.65%).An average of 1.97 SNs were examined per patient.Ninety-five(86.37%)of 110 patients were correctiy diagnosed in SN and AN.Thirty-six(37.89%)of 95 patients were SN positive,and 59(62.11%)were SN negative.Among the patients,SN metastasis rate in tumors 2.1cm~4cm((50.94)%) in diameter was highter compared with those ≤2cm(23.43%) in size(P0.05).Conclusions Tumor size and C-erbB-2 status were significantly associated with SN metastasis and may be used to predict SN metastasis in invasive breast cancer.

Objective To investigate the potential role of Lycium bararum polysaccharide (LBP) with or without interferon -inducible protein 10 ( CXCL10) in inducing dendritic cells ( DC) functional maturation by monitoring the alteration of cytokines for inducing DC maturation in peripheral blood and by detecting the expression of S-100 protein in tumor tissue, thus to reveal its mechanism of inhibiting experimental liver cancer. Methods H22 bearing mice model was established. The mice were randomized into model group, LBP group (50 mg/kg, ig), CXCL10 (right axillary subcutaneous injection of 15 μg/kg), LBP + CXCL10 group (LBP 50 mg/kg, ig, and right axillary subcutaneous injection of CXCL10 15 μg/kg), 5- fluorouracil (5FU) group ( intraperitoneal injection of 12mg/kg) , 12 mice in each group. The mice were administered the corresponding medicine once a day. After treatment for 2 continuous weeks, blood was sampled from infraorbital vein, and the tumor mass, spleen, thymus were extracted for the calculation of anti-tumor rate, thymus index and spleen index separately . The mRNA expression levels of interleukin 12 (IL-12) and tumor necrosis factor-α (TNF-α) in peripheral blood were detected by fluorescence quantitative PCR, the expression of S-100 protein in tumor tissues was detected by immunohistochemical assay. Results Compared with the model group, tumor growth in LBP group and LBP+CXCL10 group was obviously inhibited, and tumor-inhibitory rate was 55.90%, 50.91%, respectively. Meanwhile, the mRNA expression level of IL-12 was 2.94 folds higher in LBP group and 3.39 folds higher in LBP + CXCL10 group, and TNF-α mRNA expression level was 1.55 folds higher in LBP group and 4.74 folds higher in LBP+CXCL10 group than the model group, the differences being statistical significant ( P<0.05 or P<0.01). Results of immunohistochemical assay showed that S-100+DC number in LBP group and LBP+CXCL10 group was larger than that in the model group (P<0.05 ). Conclusion LBP and LBP+CXCL10 exert significant effect on inhibiting experimental liver cancer. The mechanism may be related with inducing the secretion of IL-12 and TNF-α, which plays a key role in inducing DC maturation, and with the increase of the number of DC in tumor microenvironment.

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.