OBJECTIVE:To guide the rational use of anti-epileptic drugs(AEDs)in clinical practice.METHODS:In a retrospective review,there were733patients in Xuanwu hospital who suffered from poor curative effect or intoxication of AEDs from March2000to March2001.The results of blood concentration of anti-epileptic drugs(AEDs Css)were ana?lyzed.RESULTS:The Css of37.6%of the patients were within the normal Css range,and6.4%were higher and55.9%were lower than the normal.In combined use of AEDs and other drugs,79.1%of the patients had higher or lower Css than nor?mal.In addition,chemosynthetic components were detected in90%of the patients who took Chinese medicine.Among them,86%of the patients had abnormal Css.CONCLUSION:Css monitoring should be done when AEDs were administrated.It is advisable to use only one or two kinds of AEDs,and to pay attention of the chemosynthetic components in Chinese medicine.

Atrial fibrillation is one of the commonest cardiac arrhythmia in the elderly, the incidence increased with increasing ages. Atrial fibrillation can induce severe cardiac insufficiency and thromboembolism, stroke is also a very important complication with high morbidity and mortality. Thus it is very necessary to pay special attention to the study of atrial fibrillation in the field of geriatric cardiovascular diseases.

Metabolic syndrome was once regarded as deadly quartet.This is make up by diseases of various metabolism.The incidence is increased with age.This review is to introduce recent advances in the epidemic,major risk factors,clinical symptoms and diagnosis.Early health education,diet therapy,exercises and drugs can prevent or delay the occurrence and progress of metabolic syndrome.

Hypertrophic cardiomyopathy is one of the most common inherited cardiovascular diseases and characterized by ventricular hypertrophy and myofibrillar disarrays. HCM affects patients of all ages, but is frequently diagnosed in patients over age 50. The pathology, genetics, diagnosis and treatment of HCM are reviewed.

OBJECTIVE:To understand the safety of Puerarin injection in clinical use.METHODS:The adverse drug re?actions(ADRs)and administration of Puerarin injection at Xuanwu Hospital from Oct.2002to Feb.2003were investigat?ed.RESULTS:According to the dosage in drug intruction,the Puerarin injection was diluted in0.9%sodium chloride of5%glucose solution and infused alone with a infusion rate of40～60drops/min,which would be safe and induce less ADRs,and use in overdose markedly increased the incidence of ADRs.CONCLUSION:Use of this preparation should strictly be in accordance with the specification.

Objective: Invasion and metastasis are the main causes of carcinoma mortality; hence, the timely blocking of the invasion and metastasis of carcinoma has become a research hotspot. The present study aims to investigate the expression levels of Tiam-1 mRNA and HPA-1 mRNA and their correlation with the invasion and metastasis of hepatocellular carcinoma. Methods: From May 2009 to Jan 2012, 65 hepatocellular carcinoma patients admitted consecutively in our hospital for surgical treatment were included in this study. Real-time fluorescent quantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to investigate the expression levels of Tiam-1 mRNA and HPA-1 mRNA in hepatocellular carcinoma, paired adjacent hepatocellular carcinoma (2 cm from the carcinoma), and surgical marginal normal hepato mucosa tissues (5 cm from the carcinoma). RT-PCR was also used to analyze their correlation with the clinicopathological characteristics of hepatocellular carcinoma. Results: The expression level of HPA-1 mRNA was significantly higher in hepatocellular carcinoma (43.83±11.62) than in paired adjacent hepatocellular carcinoma (14.82±8.16) and normal hepato mucosa tissues (6.02±5.36) (P<0.001). The expression level of HPA-1 mRNA was higher in paired adjacent hepatocellular carcinoma than in normal hepato mucosa tissues (P<0.05). The expression of Tiam-1 mRNA was higher in hepatocellular carcinoma (35.28±11.81) than in paired adjacent hepatocellular carcinoma (12.94±6.25) and normal hepato mucosa tissues (4.17±3.49) (P<0.05). The expression level of Tiam-1 mRNA was higher in paired adjacent hepatocellular carcinoma than in normal hepato mucosa tissues (P<0.05). The expression levels of Tiam-1 mRNA and HPA-1 mRNA were closely associated with the degree of differentiation, depth of infiltration, lymph node metastasis, vessel metastasis, and TNM (Tumor, Node, Metastasis)staging of gastric carcinoma (P<0.05). Spearman rank correlation analysis demonstrated a significant correlation between Tiam-1 and HPA-1 (OR=0.523, P<0.05). Conclusion: The expression levels of Tiam-1 mRNA and HPA-1 mRNA were high in hepatocellular carcinoma. Meanwhile, the increased ex-pression levels of Tiam-1 and HPA-1 can promote the invasion and metastasis of hepatocellular carcinoma. Moreover, the determination of Tiam-1 and HPA-1 may be valuable for the treatment and prognosis of hepatocellular carcinoma.

Objective: To evaluate the effect and safety of continuous veno-venous hemofiltration(CVVH) in the treatment of multiple organ failure(MOF) in senile patients.Methods: Sixteen patients with multiple organ failure,aged over 80 years,were divided into a survival group,who lived more than 20 days,and a non-survival group,less than 20 days after CVVH,and observed for such clinical indexes as of renal function,K+and blood gas analysis,APACHEⅡ scores and complications.Results: After CVVH,eleven of the patients survived for over 20 days,with 1 case up to 3 years.CVVH effected a significant improvement in BUN,Scr,K+and blood gas as well as a marked reduction in complications.APACHE Ⅱ scores decreased significantly after CVVH in the survival group though not in the non-survival group,as compared with those before CVVH,which were significantly lower in the former than in the latter.Conclusion: CVVH is a safe,effective and well-tolerated method for the treatment of MOF in senile patients.Patients with higher APACHEⅡscores have a poor prognosis.

OBJECTIVE: To utilize the clindamycin injection safely.METHODS: 167 cases of hospitalized patients, who underwent clindamycin injection during the period between March 22, 2004 and April 27, 2004 were followed up and analyzed through the self-made questionnaires. RESULTS: 98 cases were for preventing infections; 76 cases were for treating infections; in 107(47+60) cases clindamycin injection was used in combination with other anti-infective drugs to prevent and treat infections; the average dosage was 0.6g～1.2g,bid,and the average length of time was (17?15)d;the incidence of ADR was 6.6%(11/167), and the main clinical manifestations were sickness, vomiting, diarrhea, numbness of mouth and lip, fever, and mycoinfection. CONCLUSION: Only by strict control of signs for drug use and ways of administration can the clinical safety be improved.

Objective To explore the impact of genetic background on pancreatic p-cell first-phase secretion function with L-arginine (L-ARG) stimulation test.Methods Plasma insulin level was detected in 201 cases before and after L-ARG stimulation test.Among them, 61 cases were newly diagnosed type 2 diabetic patients with family history of diabetes ( FH + DM ) , 55 newly diagnosed type 2 diabetic patients without family history of diabetes ( FH - DM) ,31 with normal glucose tolerance and family history of diabetes ( FH + ) 54 with normal glucose tolerance but without family history of diabetes ( FH - ).Homeostasis model assessment ( HOMA) was used to estimate insulin resistance (HOMA-IR).Results It was premised that gender, age and BMI were similar among the 4 groups.(1)TC,TG,fasting plasma glucose,2h plasma glucose,fasting insulin and HOMA-IR in the two groups of newly diagnosed type 2 diabetic patients with or without family history of diabetes were significantly higher than those in the two groups of normal glucose tolerance with or without family history of diabetes.The multiples of the peak level and the base level of insulin secretion in the groups of newly diagnosed diabetes were significantly lower than those in the groups of normal glucose tolerance with and without family history(P <0.05).(2) Insulin secretion reached a peak in 2 minutes and started to decline in 4 minutes in all the four groups.( 3 ) The multiples of the peak level and the base level of insulin secretion in normal glucose tolerance group with family history of diabetes were 20.8% lower than those in the group without family history, being 7.27 and 9.18 respectively ( P < 0.05 ).(4)Two-minute peak insulin secretion, HOMA-IR and age in the newly diagnosed type 2 diabetic group with family history of diabetes was significantly lower than these in the group without family history ( P < 0.05 ).The multiples of the peak level and the base level of insulin secretion in the newly diagnosed type 2 diabetic group with family history of diabetes and that group without family history were 5.18 and 5.31 respectively and there was no significant difference between the two groups( P >0.05).(5) When the normal glucose tolerance subjects with family history of diabetes progressed to suffer from diabetes, the multiples of the peak level and the base level of insulin secretion declined 43.6% (P < 0.05) more than those in the subjects still with normal glucose tolerance without family history.Conclusion In the early course of diabetes, insulin resistance dose not function significantly, but genetic background make the first-phase secretory function of the p-cell to decline gradually and type 2 diabetes occurs easily.In the absence of genetic background, insulin resistance makes first-phase the secretion of insulin to decline relatively slow.