Objective To explore the best safe dose of warfarin in patients with heart valve replacement.Methods One hundred patients with heart valve replacement were selected.They were divided into ≤60 kg group(47 cases) and ＞ 60 kg group(53 cases),postoperative time ≤3 months group (39 cases) and postoperative time ＞ 3 months group(61 cases),international normalized ratio(INR) ＜ 1.5 (group Ⅰ,23 cases),INR 1.5-2.5 (group Ⅱ,66 cases),INR ＞ 2.5 (group Ⅲ,11 cases).The dose of warfarin,plasma thrombus precursor protein(TpP) and D-dimer(D-D) were compared.Results The dose of warfarin was (2.90 ± 1.11) mg in ≤ 60 kg group and (2.47 ± 0.18) mg in ＞ 60 kg group,and there was significant difference between two groups (P ＜0.05).There was no significant difference in the dose of warfarin between postoperative time ≤3 months group and postoperative time ＞ 3 months group (P＞ 0.05),but there was significant difference in TpP and D-D [(6.32 ± 0.01) mg/L vs.(4.97 ± 0.81) mg/L,(879 ± 52) μ g/L vs.(151 ± 35) μ g/L] (P ＜ 0.05).The incidence of complications was 2.6％ (1/39) in postoperative time ≤3 months group,which was lower than that in postoperative time ＞ 3 months group[18.0％(11/61)],and there was significant difference between two groups (P＜ 0.05).There was significant difference in the dose of warfarin and D-D between group Ⅰ and group Ⅱ,group Ⅲ [(2.56 ±0.21) mg vs.(2.94 ±0.57),(3.07 ±0.44) mg,(793.92 ±42.73) μg/L vs.(100.96 ± 21.56),(61.08 ± 20.34) μg/L](P＜ 0.05),but there was no significant difference between group Ⅱ and group Ⅲ (P ＞0.05).There was significant difference in TpP among three groups [(8.50 ± 0.63),(5.42 ± 0.78),(3.16 ± 0.38) mg/L in group Ⅰ,Ⅱ,Ⅲ respectively] (P ＜ 0.05).Conclusion With warfarin dose and the incidence of complications,the best dosage of wadarin is (2.94 ± 0.57) mg; the optimal range of INR is 1.5-2.5.

Objective To explore the values and relationship among the contents of thrombus precursor protein(TpP)and plasma D-dimer(D-D),complications after mechanical heart valve replace-ment and their correlation with international normalized ratio(INR)in anticoagulation therapy and monito-ring.Methods A total of 150 patients with mechanical heart valve replacement were enrolled.TpP,D-D, INR,other indicators and complications were compared to draw conclusions.Results There were signifi-cant differences in TpP among the groups(P<0.0083).Significant differences in D-D among the postop-erative group(100.96 ±61.56),thrombosis group(17.78 ±5.94)and control group(5.97 ±1.58)were observed(P<0.0083).Significant differences in INR among the postoperative group(1.65 ±0.34),hem-orrhage group(2.22 ±0.65)and control group(1.11 ±0.10)were observed(P<0.0083),but the effec-tiveness of INR monitoring for determining the state of thrombosis was limited to a certain extent.Conclu-sion TpP and D-D examination can facilitate monitoring after mechanical heart valve replacement,and it has a certain guiding significance for determining anticoagulation therapy and monitoring of complications after mechanical heart valve replacement.

Objective To investigate the therapeutic outcome and its influencing factors after laparoscopic conservative surgery in treatment of tubal pregnancy. Methods From January 2003 to December 2008, 226 cases with tubal pregnancy were treated by laparoscopic conservative surgery. The tubal pateacy was evaluated in 152 cases given by hysterosalpingography (HSG) and 6 cases given by second laparoscopic exploration at 3-6 months after surgery. In their first laparoscopic surgeries, 209 got successful treatment and 19 underwent fail treatment. At 3-6 months after surgery, 89 cases with tubal patency among 207 cases with successful treatment were enrolled in group A. Nineteen cases who were failed in their first laparoscopic conservative surgery and treated by salpingectomy and 63 cases with tubal obstruction were enrolled in group B. The rate of tubal patency was calculated on patients with characteristics of gestational sac less or more than 5 era, the level serum human chorionic gonadotropin (hCG) less than 2000 IU/L,2000 IU/L to 5000 IU/L, and more than 5000 IU/L Results There was no significant difference in age,parity, amenorrhea, location of tubal pregnancy, rupture, pelvic adhesion between group A and group B.Two hundred and seven cases (91.6%, 207/226) were successfully treated at initial laparescopy. One hundred and fifty-two cases got follow up and 55 cases lost follow up at 3 to 6 months after surgery. There was statistical difference in preoperative hCG value which median were 980 (55-12 000) IU/L in group A,3150 (570-40 000) IU/L in group B(P<0.01); the diameter of tubal gestational sac were (3.4±1.3)cm in group A and (5.0±1.7) cm in group B(P<0.01); respectively, the volume of peritoneal bleeding were 200 (0-1500) ml and 300 (0-1600) ml, the rate of live tubal embryo was 2% (2/89) in group A and 11% (9/82) in group B, which all reached statistical difference (P<0. 05). Among 171 cases in both group A and 8, the rate of tubal patency were 65% (67/103) in 103 cases with maximal diameter of tubal gestational sac less than 5 cm and 32% (22/68) in 68 cases with maximal diameter of tubal gestational sac more than 5 cm, which reached statistical difference (P < 0.01). The rate were 72% (73/102) in patients with serum level of hCG less than 2000 IU/L, 29% (12/42)in patients with 2000 IU/L to 5000 IU/L and 15% (4/27)in patients with more than 5000 IU/L, which also showed statistical difference (P <0.05). It was observed that preoperative serum hCG level (OR=0.277, P<0.01), the maximal diameter of gestational sac (OR=0.577, P<0.01) and the volume of peritoneal bleeding (OR=0.999, P < 0.05) were significant factors influencing successful laparoscopy treatment by logistical regression analysis.Conclusion In order to preserve fertility, laparoscopic conservative surgery was a safe and feasible approach in treatment of tubal pregnancy. Preoperative serum hCG levels, size of tube gestational sac were significant factors influencing successful laparoscopic surgery.

The field of integrative medicine (IM) has grown tremendously in the United States over last two decades, in terms of clinical practice, research, and education. Its growing popularity among patients has led to increased need for physicians with appropriate counseling skills and a knowledge base of the efficacy and safety of complementary and alternative medicine (CAM) therapies. Family medicine is the first specialty as a whole to embrace IM, which encounters similar ailing conditions and emphasizes similar core values-person centered, evidence based, proactive, and continuous in nature. As integrative family medicine emerges, family medicine educators have developed suggested curriculum guidelines and approved measurable competencies to implement the best of evidence-based CAM and principles of IM. There are currently over 40 family medicine residencies that officially advertise CAM/IM in their programs. Meanwhile, IM centers have also been developing their own primary care programs based on their unique characteristics. This physician-led IM workforce is similar to that of China's IM in the early 1960s. As the Chinese government embarks on repeating its efforts to educate more Western medicine trained physicians in Chinese medicine in primary care training programs, the process and insights related to implementation of their practice in the United States would provide useful food for thought.
China ; Complementary Therapies ; Curriculum ; Education, Medical ; Humans ; Integrative Medicine ; education ; Internship and Residency ; Physicians ; Primary Health Care ; United States

Animals ; Brain ; metabolism ; Brain Ischemia ; blood ; enzymology ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Nitric Oxide ; blood ; Phytotherapy ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; metabolism

Objective To investigate the association of blood transfusion volume with early death among recipients with known duration of infection in rural central China. Methods From January 1, 1999 to December 30, 2003, 76 individuals with duration of blood transfusion who met the study criterion had been found to be infected in the HIV/AIDS notified system in rural of Yuncheng Prefecture of Shanxi Province, China. A retrospective study was conducted to investigate Socio-demographic characteristics, transfusion volume, and mortality. Cox' proportional hazard regression model was used to analyze the data. Results By December 30, 2003, among 76 subjects with transfusion-acquired HIV infection, 24 recipients had died. Mortality rate and median survival was 45.64 and 8.3 per 1000 person years, respectively. Transfusion volume (HR=3.12, 95% CI: 1.18～8.25; P=0.0218) was significantly associated with mortality in recipients in the multiply Cox' proportional hazard regression model. Conclusions This study suggests that more units of transfusion in recipients with known duration of HIV infection can influence time to death in recipients in China.

OBJECTIVE To investigate the expiry date of sterile articles packed by 4 different materials and preserved in different conditions after pressure steam sterilizing. METHODS The bacteria growth of the materials sterilized by pressure steam sterilizing method and stored in the supply department,treatment room,dressing room,nursing cabinet and ambulance vehicle was observed. RESULTS The axenic periods of the sterile materials in the supply department preserved by methods A,B,C,D were 14 days,14 days,7 months and 8 months,respectively in summer;while the sterile periods of the materials in the treatment room,dressing room,nursing cabinet and ambulance vehicle preserved by methods A,B,C,D were 11 days,11days,6 months and 7 months,respectively. CONCLUSIONS Management of expiry date of sterile materials is an important measure to guarantee safe use of sterile materials and prevent against nosocomial infection.

0.05).Conclusions There is imbalance of Th1/Th2 cells in CHB children.Th1 cytokines are positively correlated with hepatic inflammatory activity.In the course of disease,Th2 cytokines are predominant and they have a correlation to the chronic prognosis of the illness.So we can conclude the degree and prognosis of disease by observing the change of Th1/Th2 cytokines in CHB children.

Animals ; Biogenic Monoamines ; metabolism ; Brain ; drug effects ; metabolism ; Female ; Lipid Peroxidation ; drug effects ; Male ; Mice ; Paraquat ; toxicity

Acupuncture Therapy ; Database Management Systems ; Integrative Medicine ; Internationality ; Medicine, Chinese Traditional ; Research Design