Objective To investigate the reasonable anticoagulant therapy for patients over sixty five years old in Yunnan-Guizhou plateau after heart biological valve replacement , and study the standard of reasonable anticoagulant therapy. Methods We collected the recent cases by retrospective way . Low-intensity anticoagulation standard INR (1.5~2.5) was used on 130 patients over sixty five years old. The warfarin dose and anticoagulation INR values in different surgery operation were compared when the patients reached the stable anticoagulation status. The frequency of INR values and warfarin dosage were studied. The differences between the patients with high risk factors and the ordinary patients without the high risk factors in INR values and warfarin dosage were investigated. Results The INR values and warfarin doses showed no significant difference (P > 0.05) in different operation groups when they reached stable anticoagulation status. The INR values was 1.94 ± 0.50 and the daily warfarin dose was (2.45 ± 0.82)mg/d. No significant differences in INR values and warfarin doses were found between the high-risk group and the general group (P>0.05) in steady-state. During follow-up, both the incidence rate of thrombosis and general bleeding were 0.77%. Conclusion The precent study showed that the low-intensity anticoagulation INR values (1.5~2.5) can be the standard of reasonable anticoagulation in Yunnan-Guizhou plateau after heart biological valve replacement with satisfactory anticoagulant effect.

Objective To investigate the clinical efficacy and cosmetic outcome of two methods of immediate breast reconstruction and modified radical mastectomy for the patients with breast cancer after breast cancer surgery. Methods The clinical data of 95 patients with early breast cancer in the First Affiliated Hospital of Jinzhou Medical University from October 2014 to September 2018 were retrospectively analyzed. The patients were divided into latissimus dorsi combined with implants group (27 cases), titanium-coated polypropylene mesh combined with implants group (18 cases) and modified radical group (50 cases). The differences of surgical data, postoperative complications and quality of life were compared in the three groups. The postoperative cosmetic effect of two immediate reconstruction groups was observed. Results The differences of drainage duration and intraoperative blood loss in the three groups were not statistically significant (both P > 0.05). There were statistical differences in the hospital stay and the postoperative quality of life score (both P < 0.01). The incidence of postoperative complications in latissimus dorsi combined with implants group, the titanium-coated polypropylene mesh combined with implants group and the modified radical group was 48.1％ (13/27), 22.2％ (4/18) and 12.0％ (6/50), respectively. And the difference between latissimus dorsi combined with implants group and the modified radical surgery group was statistically significant (χ 2 = 12.33, P < 0.01). The good rate of cosmetic effect in titanium-coated polypropylene mesh group was higher than that in latissimus dorsi combined with implants group, and there was no statistically significant difference [83.3％ (15/18) vs. 81.5％ (22/27), χ 2 = 0.025, P > 0.05]. Conclusions Immediate breast reconstruction including latissimus dorsi combined with implants or titanium-coated polypropylene mesh combined with implants after radical mastectomy on the basis of indications can improve the quality of life and the cosmetic results of patients, but postoperative treatment is necessary for the increased complications after the two reconstruction methods.

Objective To establish and evaluate a gas chromatography-tandem mass spectrometry(GC-MS/MS)method for the detection of six common drugs(methamphetamine,meperidine,caffeine,codeine,cocaine and ketamine)in blood,and to improve the determination basis of results.Methods The above six drugs were added into the blank blood,and GC-MS/MS was used for detection after ether extraction.The collection,quantification and confirmation were carried out under the mode of multi-reaction monitoring(MRM).The qualitative results of the above six drugs were evaluated based on the maximum allowable deviation of the retention time and relative ion abundance ratio in the qualitative results of GC-MS/MS.Results There was a good linear relationship between the six common drugs,among which ketamine and caffeine had the lowest detection limit(0.01 μg/mL),methamphetamine had the highest detection limit(0.5 μg/mL).The retention time(RT)and relative retention time(RRT)of the target substance were stable under the six supplemental levels,and the absolute deviation(ΔRTabsolute)of RT was within±0.025 min.The absolute deviation of RRT(ΔRRTabsolute)was within±0.004.The relative ion abundance ratio absolute deviation(ΔIabsolute)is±20%,and the relative ion abundance ratio relative deviation(ΔIrelative)is±50%.Conclusion This study clarified the reference range for qualitative determination of six common drugs in blood matrix detected by GC-MS/MS,and effectively supplemented the qualitative determination indicators of existing instrumental analysis methods.