Direct oral anticoagulants,include direct thrombin inhibitor and direct factor Xa inhibitor.As the pharmacokinetics and pharmacodynamics of these drugs are known,their plasma concentration is not food-effective,and theoretically it is not necessary to monitor routinely.However, clinical practice in recent years has shown that anticoagulant effect of DOACs is required to evaluate in patients with thrombosis, major bleeding, emergency surgery, hepatic/renal dysfunction and other special situations.Recent studies have shown that routine coagulation assays such as activated partial thromboplastin time(APTT) and thrombin time(TT) can be used as laboratory screening tests for direct thrombin inhibitor dabigatran and prothrombin time(PT) can be used as laboratory screening test for direct factor Xa inhibitor rivaroxaban.DOAC′s quantitative measurements include dilute thrombin time(dTT),hemoclot thrombin inhibitor (HTI),ecarin clotting time (ECT) and ecarin chromogenic assay (ECA) for direct thrombin inhibitor and anti-FXa assay(rivaroxaban calibration) for rivaroxaban.Laboratories should establish their own monitoring range when performing these assays.

Manual microscopic differential of white blood cell has been challenged by multiparameter flow cytometry,using monoclonal antibodies to define the different leukocyte types.Compared with manual differential,flow cytometry method is more sensitive,specific,objective and has good repeatability.Recent studies demonstrated flow cytometric differential correlates well with manual microscopic method and has good clinical performance for blast and immature granulocyte.Meanwhile more leukocyte populations can be identified with flow cytometric method,such as lymphocyte subset and CD 16 + monocyte,thus helping in monitoring blast in acute leukemia,B lymphocyte proliferative disorder differential diagnosis and minimal residual disease.With the development and improvement of flow cytometric differential,it might be a candidate reference method of leukocyte differential,gradually applied in the routine work.

This study was aimed to build up a diagnosis and treatment procedure of traditional Chinese medicine (TCM) for HIV/AIDS headache. Domestic and foreign articles correlated to HIV/AIDS headache diagnosed and treat-ed by TCM were summarized. The specialist questionnaire of clinical diagnosis and treatment standard operating pro-cedures of TCM for HIV/AIDS headache was designed by focus group discussions. And the national specialist ques-tionnaire survey was carried out twice. The results showed that the standard operating procedure of TCM clinical di-agnosis, treatment, nursing and therapeutic efficacy assessment for HIV/AIDS headache was preliminarily established. It was concluded that this regulation identified concept, etiology and pathogenesis of HIV/AIDS, established TCM standard diagnosis and treatment service. It also demonstrated features of propaganda and education, follow-ups, con-secutive diagnosis and treatment inside or outside the hospital.

This study was aimed to establish traditional Chinese medicine (TCM) diagnosis and treatment procedure of varicella zoster virus (VZV) in AIDS, and to construct questionnaires for key points and revision of the procedure. The TCM draft of diagnosis and treatment procedure for VZV in AIDS was established through literature retrieval and peer review. Two rounds of surveys were carried out to investigate the confirmation and advice of in-group specialist to key points of TCM or integrative medicine draft including diagnosis, treatment and nursing. Then, diagnosis and treatment procedure were revised according to survey results. The results showed that the recovery of complete ques-tionnaires in the first-round survey was 96%. More confirmation of specialists were given to concept, clinical feature, cause, mechanism, case history and general examination, diagnostic criteria, syndrome differentiation and treatment of dampness-heat of liver channel syndrome, skin, dietary and psychological nursing, treatment course and therapeutic effect standard. The coefficient of variations (CVs) of experiential effective recipe, moxibustion and massage, auxiliary examination, syndrome differentiation and treatment of dampness stagnancy due to spleen deficiency syndrome and qi stagnation and blood stasis syndrome, and western medicine treatment were large. The weight coefficients of all items were within 0.043 6 and 0.046 2. The Cronbach Coefficient Alpha (CCA) was 0.996 and the split-half reliability R was 0.86. Recovery of complete questionnaires in the second-round survey was 100%. More confirmation of special-ists were given to outline, cause, mechanism, case history and general examination, diagnostic criteria, syndrome dif-ferentiation and treatment of three syndromes, experiential effective recipe, skin, dietary and psychological nursing. The CV was 0. The CV of auxiliary examination, moxibustion and massage was 0.063 8, which was less than those of first-round survey. The consistency of specialist was relatively increased. The weight coefficients of all items in the second-round survey were within 0.058 2 and 0.059 0. The CCA was -0.041 and the split-half reliability R was 0.79. A new revised procedure was preliminarily established according to results of two rounds of surveys. It was concluded that the activeness, concentration and coordination of specialists were good in two rounds of surveys. Con-sensus in key points of the procedure draft was reached including diagnosis, treatment and nursing.

Objective To explore the potential value of tuberculosis protein chip for clinical diagnosis of tuberculosis.Methods The antibody level of tuberculosis protein ESAT-6,CFP10,16 KD,38 KD and LAM was determined in 4 093 patients,inclu-ding 441 tuberculosis and 3 652 non-tuberculosis cases by protein chip.Results The tuberculosis antibody was positive in 297 of the 441 tuberculosis cases and 647 of the 3 652 non-tuberculosis cases.Tuberculosis protein chip provided a sensitivity of 67.35% and specificity of 82.28% in the diagnosis of tuberculosis.Conclusions Tuberculosis protein chip test is a quick,easy and effective method for identifying potential tuberculosis patients with good specificity.

Objective To compare the bio-medical parameters in SIV infected Chinese rhesus monkeys with diverse disease progression,by which the pathogenesis of simian AIDS were to be investigated.Methods Sixteen Chinese rhesus monkeys were inoculated intravenously with SIVmac239 and followed-up for 18 months.Based on their progression patterns and plasma viral loads,animals were divided into 3 groups,including 1 rapid progressor( RP),13 normal progressors(NP),and 2 elite controllor(EC).Their parameters of haematology,virology,immunology and pathology were examined and compared. Results Compared with other animals,RM449(RP) showed higher viral load,unresponsive humoral immunity,and higher level of auto-antibodies against lymph node,thymus,and spleen.Additionally,its effector memory CD4 count was lower,with the transformation progress being blocked-like from naive/central memory subsets to effector memory subset,as the flow-cytometry assay showed.Notable decrease in its peripheral B cell was also observed,especially to the sub-population of tissue-like memory B cells and activated memory B cells.Pathological examination showed the depletion of lymphoid tissue,atrophy of spleen and loss of thymus.Moreover,most of these parameters of RM450 and RM453 (EC) changed opposite to that of RP.Conclusion The hallmarks of RM449 were higher viraemia and lower SIV specific IgG level,which may due to the disturbance of T cells and B cells development and differentiation.Moreover,destructions of organs of the immune system may contribute to the disturbance.Our study suggest that the change of micro-environments of thymus induced by SIV infection,which is necessary in T cell and B cell development and differentiation,may contribute at least partially to the AIDS pathogenesis.

Objective:To evaluate the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine mixed with subanesthetic dose of ketamine on anxiety and depression in the patients with advanced cancer pain.Methods:Sixty patients of either gender with advanced cancer pain, aged 24-82 yr, with poor analgesic effect or obvious adverse reactions after three-step analgesic treatment, were selected and randomly divided into 2 groups ( n=30 each) using a random number table method: routine treatment group (group R) and dexmedetomidine mixed with ketamine group (group DK). The initial dose of morphine for PCIA was 1/3 of the oral dose in group R. In group DK, ketamine 5.4 mg/kg (90 μg·kg -1·h -1) and dexmedetomidine 6 μg/kg (0.1 μg·kg -1·h -1) were added on the basis of group R. Tropisetron 8 mg was added to analgesics and diluted to 200 ml with normal saline in both groups.The analgesic pump was programmed to deliver 4 ml with an initial dose of 4 ml, lockout interval of 15 min and background infusion at 4 ml/h.The numerical rating scale score, Ramsay sedation score, Chinese version of State-Trait Anxiety Inventory score and Beck Depression Inventory-Ⅱ score were recorded before PCIA and at 4, 12, 24 and 48 h of PCIA.The development of effective analgesia and satisfactory sedation, occurrence and degree of depression, score for patient's quality of life and satisfaction score, consumption of morphine and adverse reactions such as constipation, nausea and vomiting, agitation and respiratory depression were recorded within 48 h of PCIA. Results:Compared with group R, the NRS score was significantly decreased, the rate of effective analgesia was increased, Beck Depression Inventory-Ⅱscore and Chinese version of State-Trait Anxiety Inventory score were decreased, the incidence and degree of depression were decreased, incidence of nausea and vomiting and constipation, consumption of morphine and pressing times of PCIA pump were decreased, and the score for patient's quality of life and satisfaction score were increased in group DK ( P<0.05). Conclusion:PCIA with dexmedetomidine mixed with subanesthetic dose of ketamine can significantly enhance the analgesic effect, improve anxiety and depression, and raise the quality of life when used for the patients with advanced cancer pain.