Objective To study the individualized dose of warfarin in treating atrial fibrillation in elderly patients. Methods Forty-one elderly in-patients with atrial fibrillation were recruited.Warfarin was used tO start anti-coagulation therapy with the target INR value 1.6-2.5.The data of demographic variables,concomitant diseases,medications and laboratory values were collected,then correlated these factors with the maintenance dose of warfarin. Results Warfarin dose requirements were significantly associated with age(r=-0.535,P＜0.01),sex(r=-0.494,P＜0.01),height (r=0.484,P＜0.01),weight(r=0.453,P＜0.01),body surface area(r=0.388,P＜0.05),concomitant use of a sulfonylurea medication(r=-0.446,P＜0.01)and serum albumin level(r=0.520,P＜0.01).The multivariate regression model includedthe variables of age,sex,serum albumin level and concomitant use of a sulfonylurea medication.This algorithm explained 65.4%of the variance in the maintenance dose of warfarin(R=0.808,R2=65.4%). Conclusions The warfarin dose in treating atrial fibrillation in elderly patients can be estimated from demographic,clinical and laboratory factors that can be obtained at the time of warfarin initiation.

Adolescent ; Adult ; Aged ; Agranulocytosis ; complications ; drug therapy ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Child ; Female ; Humans ; Leukemia ; complications ; drug therapy ; Male ; Middle Aged ; Treatment Outcome ; Vancomycin ; administration & dosage ; therapeutic use ; Young Adult

Objective Ouabain is a cardiotonic steroid that can induce the apoptosis of many tumorous cells .This study was to investigate the anti-tumor mechanisms of ouabain by observing its effects on the apoptosis of T lymphoblastic leukemia Jurkat cells and the expressions of hTERT and c-myc mRNA and protein . Methods Jurkat cells were treated with ouabain at the concentrations of 50 and 100 nmol/L for 24 and 48 hours, and those treated with 1 ×PBS served as the control .Then the apoptosis rate of the cells was detected by flow cytometry after Annexin V/PI staining, the expressions of hTERT and c-myc mRNA determined by RT-PCR, and those of hTERT and c-myc protein by Western blot . Results The apoptosis rates of the Jurkat cells in the 50 and 100 nmol/L oua-bain groups were (5.67 ±3.71)%and (9.63 ±4.83)%respectively at 24 hours, and (19.67 ±4.55)%and (37.60 ±11.89)%at 48 hours, significantly higher than (4.23 ±1.01)%in the PBS control group at 48 hours (P<0.05).Compared with the control, the expressions of hTERT and c-myc mRNA were decreased by 200%and those of hTERT and c-myc protein by 224%and 400%, re-spectively, at 48 hours (P<0.05).There was a positive correlation between the reduction of the mRNA levels and that of the protein levels of hTERT and c-myc (P<0.05). Conclusion Ouabain can down-regulate the mRNA and protein expressions of hTERT and c-myc, which may be one of the mechanisms of its induction of the apoptosis of Jurkat T lymphocyte leukemia cells .

Janus kinase 2,myeloproliferative leukemia virus and tet encogene family member2 mutations affect a variety of cytokines signal transduction pathway in BCR/ABL-negative myeloproliferative neoplasms (MPN). In the influence of mutation load,co-mutation and genetic susceptibility,these mutations can induce different MPN phenotypes,and affect the characteristics of patients,the distribution of peripheral blood cells and prognosis. But how these mutations contribute to disease initiation,development,and transformation needs further reseach.

Objective To investigate the level of anxiety and emotional intelligence in general nurses of community health service centers in Shenzhen city, and provide theoretical basis for the intervention of anxiety in general nurses by analyzing the relationship between anxiety and emotional intelligence . Methods The self-rating anxiety scale ( SAS ) and emotions intelligence scale ( EIS ) were employed for the survey among 92 general nurses from 20 community health service centers in Shenzhen city . Results The SAS scores was 40.18 ± 7.26, significantly higher than the national norm. The rate of anxiety was 54.35%. Thirty-nine contracted anxiety at a low level, accounting for 42.39%, 10 did at a moderate level, accounting for 10.87%, and 1 did at a higher level, accounting for 1.09%. The EIS score was 3.49 ± 0.47. The highest dimension score was management of emotions for others and the lowest score was emotional perception. The dimension of management of emotions for others was positively related to social anxiety (P<0.05), and the dimension of use of emotions negatively related to social anxiety (P<0.05). Conclusions General nurses of community health service centers in Shenzhen suffer from anxiety at a high level and their emotional intelligence is at a medium level. Both factors predict the level of social anxiety in general nurses of community health service centers . Improving the emotional intelligence can be an approach to reduce the level of anxiety.

Objective To investigate the characteristics of the heart rate variability(HRV) in the elderly bedridden patients. Methods 91 hospitalized patients (age≥60 years ) were divided into three groups according to the function independent measure: independent group (32 cases), partial dependent group (31 cases), dependent group(28 cases). Eight items of HRV were measured, including 24 hour standard deviation of successive normal-to-normal R-R interval(SDNN), total power (TP),standard deviation of all means of 5-minutes R-R interval all over 24 hour(SDANN), low frequency (LF), root mean squared successive difference(MSSD),Edingburgh Index(PNN50), high frequency(HF)and ratio of LF to HF(LF/HF). Results Seven items of HRV of the dependent group and partial dependent group were significantly lower than those of independent group (P0.05). SDNN and FIM were positively correlated (r =0.853, P=0.017). Other factors such as pathogen and the number of concomitant diseases did not affect on HRV in the elderly bedridden patients. Conclusions The HRV in the elderly bedridden patientsdecreased , the changes relatedthe decrease of the activity.

Objective To explore the occurrence of anemia, anaemia type, iron metabolism situation,variation of serum Prealbumin (PA), and the relationship among them in cancer patients. Methods Three hundred and seventy cancer patients, admitted from July 2007 to April 2010 to our hospital, were enrolled into the study. The clinical data of all subjects were analyzed retrospectively. Results The incidence of anemia in 370 patients was 55.67% (206/370). Among all 206 anemia cases,129 cases had mild anaemia and 77 cases had middle to severe anaemia. In the last group ( n = 77 ), we found significant decrease in serum iron level ( [ 8. 37 ± 6. 09 ] μmol/L) and increase in serum ferritin level ( [ 474. 57 ± 327. 58 ] μg/L); and the correlation between serum iron and the anemia degree( Ps ＜ 0. 05 ). However, we found no significant differences of serum ferritin level between the groups with different degree of anemia(P ＞0. 05). Among all 206 anemia cases ,187(90. 77% ) patients had a low level of serum PA, but no relationship between the degree of anemia and the drop of serum PA ( P ＞ 0. 05 ). Conclusion The anemia was very popular in cancer patients, which had correlation with iron metabolism situation but not PA.

Objective To determine the optimum dose of bupivacaine for spinal anesthesia with epidural volume extension (EVE) in patients undergoing cesarean delivery.Methods A total of 100 parturients,weighing 55-100 kg,with body height of 155-170 cm,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective cesarean delivery,were included and randomized to receive bupivacaine at 5 different doses (A,B,C,D,and E groups) using a random number table,with 20 patients in each group.In A,B,C,D,and E groups,bupivacaine 6.75,7.50,8.25,9.00 and 9.75 mg were injected into the subarachnoid space,respectively,and the volume was all 1.5 ml.After successful spinal anesthesia,an epidural catheter was placed,and normal saline 10 ml was given through the catheter to perform EVE.A successful spinal block was defined as attainment of sensory block of at least T5 within 15 min after EVE along without requirement for additional local anesthetics within 60 min after EVE.The rate of successful spinal anesthesia,time to reach sensory block of T5,the maximum level of sensory block,and the first requirement for local anesthetics were recorded.The occurrence of hypotension,tachycardia,bradycardia,nausea,vomiting,chest distress,dyspnea,shivering,and referred pain and consumption of metaraminol were recorded during spinal anesthesia.Apgar scores at 1 and 5 min after birth were recorded.Results With the increasing doses of bupivacaine,the efficacy of spinal anesthesia was enhanced,and the occurrence of adverse reactions was increased.Compared with group C,the rate of successful spinal anesthesia,and the maximum level of sensory block were significantly increased,the time to reach sensory block of T5 was shortened,and the incidence of hypotension and nausea and consumption of metaraminol were increased in group E;the time to reach sensory block of T5 was significantly shortened,Apgar scores at 1 min after birth were increased (P＜0.05),and no significant change was found in the rate of successful spinal anesthesia,the first requirement for local anesthetics,the rate of time to reach sensory block ofT5≤ 15 min,and the maximum level of sensory block in group D (P＞0.05).Compared with group D,the time to reach sensory block of T5 was significantly shortened,the incidence of nausea and consumption of metaraminol were increased (P＜0.05),and no significant change was detected in the rate of successful spinal anesthesia,the first requirement for local anesthetics,the rate of time to reach sensory block of T5 ≤ 15 min,and the maximum level of sensory block in group E (P＞0.05).Conclusion The optimum dose of bupivacaine for spinal anesthesia with EVE is 9.00 mg in patients undergoing caesarean delivery.

OBJECTIVE:To provide reference for promoting clinical rational use of Aidi injection. METHODS:Some inpa-tient records that used Aidi injection in our hospital from Jan. to Jun. 2015 were randomly selected and statistically reviewed by us-ing Excel(2011 edition) in aspects of gender,age,tumor location,usage and dosage,solvents usage,treatment course,adverse reactions,etc. RESULTS:In the 125 patients who used Aidi injection,male was more than female,with average age of 58.4 years;the tumor location of 66 patients (52.80%) was consistent with the indications in instructions;treatment course of 30 pa-tients(24.00%)was consistent with the instructions;all solvent types were consistent with the instruction recommendation,while only 6 patients(4.80%)showed consistence in solvent usage and instructions;122 patients(97.60%)showed consistence in single dosage and instructions;7 patients had adverse reactions,mainly rash and gastrointestinal reactions. CONCLUSIONS:The use of Aidi injection in our hospital shows off-label drug use,non-standardized treatment course and inappropriate solvent usage. Physi-cians,clinical pharmacists and relevant departments should further strengthen the rational use,medical advice comments,supervi-sion and management of Aidi injection in the hospital to promote the rational drug use.

[Objective]To analyze the clinical features and related risk factors in diabetic retinopathy(DR)and diabetic periph?eral neuropathy(DPN),the two micro-peripheral vascular diseases in newly diagnosed type 2 diabetes mellitus.[Methods]A retro?spective study of 211 cases of newly diagnosed type 2 diabetes mellitus inpatient from 2009 to 2012 ,and compare the two micro-peripheral vascular complications.[Results]The morbidity of DPN was(33.6%),which was higher than that of DR,some cases of DR co-existed with DPN,DR was related with DPN(r=0.158,P=0.020). Age and systolic blood pressure were the common risk factors in DR and DPN by single factor analysis.[Conclusion]It should be paid attention to the screening of both DR and DPN in each age group in newly diagnosed type 2 diabetes mellitus. Except for the control of blood glucose ,the control of the systolic blood pressure is important in the prevention and treatment in the two micro-peripheral vascular diseases.