Objective To evaluate the effectivity and safety of dual antiplatelet therapy with clopidogrel and aspirin in patients with ST-segment elevation acute yocardial infarction(AMI).Methods We searched for randomized controlled trials(RCTs)and quasi-RCTs in the following electronic databases:PubMed,EMBASE,The Cochrane Library(Issue 3,2007),CBM,CNKI,VIP and Wanfang.Quality assessment and data extraction were conducted by two reviewers independently.Disagreement were resolved through discussion.All data were analyzed by using Review Manager 4.2. Results Ten studies involving a total of 52 433 participants met the inclusion criteria.Metaanalysis results showed that:(1)Compared with aspirin alone,the incidence rates of death caused by any reason(RR=0.91,95% CI:0.85～0.97),recurrent myocardial infarction(RR=0.80,95% CI:0.72～0.89),stroke(RR=0.81,95% CI:0.68～0.96),post-infarction angina(RR=0.35,95% CI:0.19～0.66),incoronary thrombus(RR=0.73,95% CI:0.64～0.83)and the combined endpoint events of death,reinfarction or stroke(RR=0.89,95% CI:0.84～0.95)could be reduced by clopidogrel and aspirin.(2)There were no significant differences in ameliorating the cardiac function and increasing TIMI blood flow of infarct-related artery between the two groups RR=0.97,95% CI:0.92～1.03;RR=1.14,95% CI:1.00～1.30;both P＞0.05.(3)There was no significant difference in bleeding between the tWO groups(RR=1.11,95% CI:0.92～1.34). Conclusions Compared with aspirin alone,clopidogrel plus aspirin has good effects on reducing the incidence rates of death caused by any reason,recurrent myocardial infarction,stroke,post-infarction angina,incoronary thrombus and the combined endpoint events of death,reinfarction or stroke in patients with ST-segment elevation AMI,and it has the same efficacy in ameliorating the cardiac function,increasing TIMI blood flow of infarct-related artery and bleeding.

Objective To investigate the effect of chemotherapy combined with amino acid on quality of life(QOL)in elderly patients with non-small cell lung cancer(NSCLC). Methods Seventy-four elderly patients with NSCLC were divided randomly into experimental group and control group.The same NP(cisplatin+vinorelbine)chemotherapy was carried out in all the 2 groups for 3 cycles.Except of chemotherapy,experimental group were treated with amino acid 500 ml/d in the same time,while control group recieved chemotherapy only.After 3 monthes,the QOL was analyzed using Chinese Version of European Organization for Researeh and Treatment of Cancer(EORTC)core questionnaire(QLQ-C30)and specific lung cancer module QLQ-LC13,and therapeutic effectiveness was evaluated according to WHO standard as well. Results After chemotherapy,the body function,mood function,social function were better in experimental group than in control group(all P＜0.05),the effective rate was 87.8%,83.8%and 77.0%in experimental group;77.0%,45.9%and 45.9%in control group.Insomnia(8.1%),suppressed appetite(5.4%),weary(47.3%)were less serious in experimental group than in control group(17.6%,17.6%and 59.5%)(all P＜0.05).The primary symptoms were cough,emptysis,thoracalgia and dyspnoea in both 2 groups before chemotherapy.All the symptoms were alleviated after chemotherapy.Some patients have side effects such as tongue pain,alopecie,hand and foot tingle.But the number of patients with tongue pain was less in experimental group(8.3%)than in control group(18.4%).The chemotherapy effect had no difference by the WHO standard. Conclusions The QOL of elderly patients with NSCLC can be improved by chemotherapy combined with amino acid treatment,and the treatment with amino acid 500 ml/d is safety.

[ ABSTRACT] AIM: To explore whether autophagy is involved in the excessive death of renal tubular epithelial cells in subtotal nephrectomy ( SNx) rats and the relationship between autophagy and necroptosis in the kidney of SNx rats. METHODS:Male Sprague-Dawley rats were randomly assigned to control group ( n=6 ) and SNx group ( n=42 ) .The rats in SNx group were subjected to SNx.Sham surgery was performed in the rats in control group.The rats in SNx group were divided into subgroups at 0, 4, 8 and 12 weeks ( n=6) and the other rats in SNx group were divided into SNx+vehi-cle group, SNx+necrostatin-1 (Nec-1) group and SNx+3-methyladenine (3-MA) group.The expression of RIP1, RIP3, LC3 and beclin-1 at mRNA and protein levels was measured at 0, 4, 8 and 12 weeks by qPCR and immunohistochemistry. The effects of Nec-1 or 3-MA on the protein expression of LC3-I, LC3-II and beclin-1, and production of reactive oxygen species ( ROS) in the rat kidney were determined by Western blot and DCFH-DA staining.The death of renal tubular epi-thelial cells in the SNx rats was observed by TUNEL staining and electron microscopy.Finally, the effects of Nec-1 and 3-MA on blood urea nitrogen ( BUN) , serum creatinine ( SCr) and the pathological changes of the renal tissues were ana-lyzed.RESULTS:The highest mRNA and protein levels of RIP1, RIP3, LC3 and beclin-1 appeared at the 8th week after SNx (P<0.01).Compared with the rats in SNx+vehicle group, the protein over-expression of LC3-II/I and beclin-1, re-nal tubular epithelial cells with typical morphological features of necroptotic cell death and TUNEL-positive renal tubular
cells were decreased in the SNx rats treated with Nec-1 and 3-MA (P<0.01), but 3-MA did not reduce the increased con-centration of ROS.In addition, treatment with Nec-1 and 3-MA obviously reduced BUN, SCr (P<0.05), glomeruloscle-rosis index and tubulointerstitial injury score (P<0.01).CONCLUSION:Autophagy participates in the excessive death of renal tubular epithelial cells in SNx rats.Inhibition of autograph prevents necroptotic cell death of renal tubular cells, and alleviates chronic renal injury in SNx rats.

Objective To investigate effect of Murphy's law on the nursing safety management of the hemodialysis patients. Methods 4598 hemodialysis cases in a blood purification center of a first class grade A hospital from April to July in 2011 was assigned as pre-implementation group.Then Murphy's law was used in the nursing practice.In the following,another 5683 hemodialysis cases from November in 2011 to January in 2012 were assigned as post-implementation group.The incidence of nursing risks and hemodialysis equipment failures were compared between the two groups.Result The incidences of nursing risks and hemodialysis equipment failures in the post-implementation group were significantly lower than those of the pre-implementation group(P<0.05).Conclusions Murphy’s law is effective for the declines of nursing manipulative defects and hemodialysis equipment failures.Besides,the law can be good for the strengthened awareness of safety and enhanced consciousness of all staff participating in the safety management so as to ensure the safety and quality of hemodialysis.

Objective To analyze the clinical outcome of concurrent ehemo-radiotherapy in stage Ⅳ non-small cell lung cancer(NSCLC).Methods From Jan.1997 to Dec.2006,214 patients with patho logically or cytologically proven stage Ⅳ NSCLC were included in this analysis.Of those patients,98 re ceived radiotherapy concurrently with 3-week cycle chemotherapy(group A),18 received radiotherapy con currently with weekly chemotherapy(group B) ,44 received chemotherapy alone,37 received radiotherapy a lone and 13 received sequential chemo-radiotherapy.The primary tumor was treated by three-dimensional conformal radiotherapy(3DCRT) or conventional radiotherapy with conventional fraefionation or late-course accelerated hyperfraction (LA H RT).Group A received 21-28 days cycle cisplatin-based chemotherapy (cis platin combined with PTX,DTY,NVB or Vp-16) ,and group B received weekly DDP combined with PTX or topteeon for 4-6 weeks.Results The follow-up rate was 99%.The 1-and 2-year overall survival rates of group A,group B,chemotherapy alone,radiotherapy alone and sequential chemo-radiotherapy were 41% and 11% ,16% and 0,31% and 7% ,34% and 10% ,26% and 3% ,respectively(x2 = 11.18,P=0.025).The patients with concurrent 3DCRT,LAHRT and radiotherapy dose≥70 Gy had better survival in group A than those in chemotherapy alone group.Patients who received≥2 cycles chemotherapy with concurrent radio therapy had longer survival time than those who had ≥2 cycles chemotherapy alone. Conclusions Con current chemotherapy and 3DCRT,LAHRT with the dose ≥70 Gy can improve the overall survival of patients with stage Ⅳ non-small cell lung cancer.

Means of information technology can achieve information sharing and optimize the management process, and tackle the challenges encountered in the process of ophthalmic day surgery, namely surgery appointment, patient education, ward management and patient follow-up. The authors analyzed the current situation and challenges of day surgeries at an ophthalmic hospital, and presented its practices in building and using the day ophthalmic surgery informationized management system by such information technology means as cloud computation, artificial intelligence and face recognition. This system comprised the day surgery pre-hospitalization management system, Internet platform for wards, follow-up management platform, electronic medical archiving of day surgery, and specialized nursing robot for day surgery process. As compared with the data one year before and after the system in place, the rate of missed surgery, unplanned secondary surgery and patient satisfaction before and after, fell from 2.40% and 0.24% before to 1.00% and 0.08% after. In addition, patient satisfaction increased from 94.5% before to 99.1% after. All the differences were significant statistically( P<0.01). This system can help patients in medical access, and ensure the medical safety and efficiency of day surgeries, serving as a good reference for ophthalmic departments of other hospitals in building their informationized system for ophthalmic day surgeries.