Objective To investigate the gamma glutamine carboxylase (GGCX ,rs6738645) genotype distribution in Chinese Han population and the correlation between GGCX (rs6738645) polymorphism and the warfarin stable dose in the patient after valve replacement .Methods The genotypes of 228 cases were detected by the Snapshot technology in order to explore the genotype and allele frequencies .The correlation between the gene polymorphism in 176 cases after valve replacement and the stable dose of warfa-rin was compared .Results In total of 228 research subjects ,the number of TT ,GT and GG genotype were 84(36 .84% ) ,122 (53 .51% ) and 22(9 .65% ) .The frequencies of T and G allele were 63 .60% and 36 .40% respectively ;in 176 patients after the valve replacement ,the maintenance stable dose of warfarin was lower in GG group than in the TT and GT groups ,the differences between the groups showed statistical significance (P<0 .01) .The PT value and INR value had no statistical difference among 3 genotype groups(P>0 .05) .Conclusion The GGCX(rs6738645) polymorphism in Chinese Han population may be the influencing factor of warfarin individual dose difference in the patients after valve replacement .

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.

This article inherited and summarized the application of Professor Tang Xudong's"New Eight Principles in the Syndrome Differentiation and Treatment of Spleen and Stomach Diseases"(abbreviated as"New Eight Principles")in the field of chronic liver disease.It believed that chronic liver disease should be distinguished from the four aspects of"zangfu organs-qi and blood-deficiency and excess-cold and heat".The differentiation of zangfu organs is mainly focused on regulating the liver and spleen,while also taking into account other organs;the differentiation of qi and blood emphasizes the knowing of its excess and deficiency,and the administrative levels of the disease;the differentiation of deficiency and excess is based on the principle of qi-deficency and blood-stasis,and strengthens body resistance and eliminating evil;for the differentiation of cold and heat,liver-gallbladder dampness-heat syndrome is the most common,but do not forget the liver cold syndrome.On this basis,Tongjiang theory is used as the treatment legislation,making it easier to be mastered,and guiding the prescription and medication of chronic liver disease throughout the entire stage,which can achieve good efficacy.

Objective To investigate the CYP2C18,VKORC1 and CYP2C9 genotype distribution situation and the correlation between their polymorphism with warfarin stable dose.Methods A total of 176 Yungui plateau Han patients with continuously warfarin anticoagulation therapy after valve replacement in this hospital from January 2011 to January 2014 served as the research subjects.The venous blood was collected for detecting genotypes at various loci.The genotype and allele frequency distribution were analyzed,and the correlation between the gene polymorphism with warfarin stable dose was analyzed.Results The genotypes and allele frequencies at various loci conformed to the Hardy-Winberg genetic balance (P＞0.05).The polymorphisms of CYP2C18 (rs7896133),VKORC1 (rs9923231),CYP2C9(rs1057910) and CYP2C9(rs4086116) gene loci were correlated with warfarin stable dose (P＞0.05).Conclusion The gene polymorphism of CYP2C18(rs7896133),VKORC1 (rs9923231),CYP2C9(rs1057910) and CYP2C9(rs4086116) in Yungui plateau H an patients may be the influence factors which contribute to warfarin stable dose personalized difference.

Based on Chaihu Biejia Decoction （柴胡鳖甲汤， CBD） created by Professor LIU Duzhou， a newly modified CBD has been formulated. The differentiation and treatment of liver cirrhosis can be divided into three stages， that is， the early stage when liver cirrhosis is about to be， the middle stage when liver cirrhosis is formulated after long accumulations， and the late stage when liver cirrhosis has been transformed. Following the pathogenesis， it is recommended to differentiate the abnormal exuberance of zang-fu （脏腑） organs， qi or blood， deficiency or excess， cold or heat in three stages， and newly modified CBD is taken as the basic formula for further modifications. In early stage of liver cirrhosis， the treatment is mainly to invigorate blood and dissolve stasis， clear dampness and heat， and modifications should be made in accordance with the different causes flexibly. The treatment for the middle stage is to soften hardness and dissipate masses， dissolve stasis and clear heat， while fortifying the spleen and supplementing kidneys is accompanied. In the later stage when the healthy qi declines， and the disease is severe and evil prevails， the treatment is to reinforce healthy qi and supplement deficiency， take mild purgation and dispersion， and medicinals to promote urination， stanch bleeding， direct the turbid downward， or open the orifices can be added in accordance with the syndromes so as to treat the branch.

Hepatic osteodystrophy （HO） should be treated by stages based on the differentiation of root deficiency and branch excess. The root cause of HO is the insufficiency of the liver， spleen， and kidney， and the branch onset should be differentiated by stages that in the incubation， the pathogenesis is shaoyang （少阳） constraint and block and cardinal disturbance， while in the attack period， it is turbid toxin， static heat， scorching marrow and withering bones. In treatment， attention should be paid to regulating and tonifying the depletion of the liver， spleen， and kidney to cultivate the foundation. In the incubation period， it is suggested to put focus on unblocking cardinal disturbance of shaoyang liver and gallbladder so as to regulate and harmonize qi and blood. In the attack period， the focus should be on dissolving stasis， removing turbidity， and clearing the source to promote gallbladder function and bone strength. In clinical practice， medication should be modified according to individual symptoms， and the root and the branch， the primary and the secondary should be differentiated to closely follow the pathogenesis and be tailored according to the symptoms. At the same time， reasonable and safe medication should be emphasized to protect liver function.

Nitroxide radicals are a kind of stable organic free radicals.Due to the presence of N-O·and unpaired electrons in its structure,it has many characteristics,and thus can be used as a spin marker to explore the mechanism of biological reactions;with its magnetic properties,it can be used for the development of multifunctional magnetic molecular materials and used as a polymerization inhibitor and catalyst in organic reactions.More importantly,it has a variety of biological activities such as anti-oxidation and anti-tumor,and so has attracted much attention in the research and development of new drugs.For example,the spin labeling of nitroxide radicals on anticancer drug podophyllotoxin can enhance the efficacy and reduce the toxicity,and can be easily to be absorbed by the body,thus obtaining a new anti-cancer drug 4-[4″-(2″,2″,6″,6″-tetramethyl-1″-piperidinyloxy nitroxide radical)amino]-4′-demethyl epipodophyllotoxin(GP-7).It is an effective way to seek new drugs by introducing pharmacophore to modify nitroxide radicals or it can be spin-labeled on active natural products to obtain new compounds with high efficiency and low toxicity.The research progress of derivatives and its biological activitives of nitroxide radicals are summarized,aiming to provide theoretical basis for the developing and utilizing of nitroxide radicals and searching for new drugs.

Objective:To explore the incidence, clinical and microbiological characteristics and risk factors of infection in patients with acute lymphoblastic (ALL) , non-Hodgkin lymphoma (NHL) , and multiple myeloma (MM) within 28 days after CAR-T cell infusion. It provides data support for early identification of infection and the rational use of antibacterial drugs in these patients.Methods:We retrospectively analyzed the baseline data of 170 patients with ALL, NHL and MM who received chimeric antigen receptor-modified T (CAR-T) -cell treatment in the Department of Hematology of Wuhan Union Hospital from January 2016 to December 2020, and the clinical characteristics of infection within 28 days after infusion, including 72 patients with ALL, 56 patients with NHL, and 42 patients with MM; we used Poisson regression and Cox proportional hazard regression models to assess high-risk factors for infection before and after infusion, respectively.Results:Among 170 patients, 119 infections occurred in 99 patients within 28 days, with a cumulative infection rate of 58.2%. Seventy-eight patients had 98 bacterial infections and the cumulative incidence of bacterial infection was 45.9%. The infection density was 2.01, and the median time for the first infection was about 12 days after infusion. The adjusted baseline characteristic model showed that ALL patients, previous 30 days of infection history, refractory disease, absolute neutrophil count (ANC) <0.5×10 9/L before infusion and ≥4 prior antitumor treatment regimens had a higher infection density within 28 days; grade 3 or 4 CRS was the only high-risk factor related to infection after infusion in the multivariate analysis. Conclusion:Infection is a common complication of CAR-T cell therapy in patients with hematologic malignancy. Bacterial infections occur in most patients regardless of the type of disease. ALL patients, previous 30 days of infection history, refractory disease, ANC<0.5×10 9/L before infusion and grade 3 or 4 CRS are risk factors for infection. Chinese Clinical Trial Register::ChiCTR-OIC-17011180, ChiCTR1800018143

It is believed that patients with cirrhotic ascites exhibit a pathological mechanism characterized by the decline of healthy qi and the accumulation of pathogenic factors. Clinically， treatment should be based on the theory of tonification and purging， with a staged approach distinguishing between the active phase and the remission phase. The balance between tonification and purging should be adjusted according to the progression of pathogenic and healthy actors. In the acute phase， purging should take precedence over tonification， using purging as a means of tonification to facilitate the flow of water and qi through the triple energizer. The severity of water retention， dampness， blood stasis， and heat should be carefully assessed to ensure thorough elimination of pathogenic factors while avoiding harm to healthy qi. Medication adjustments should be made once the pathogenic factors are significantly weakened. In the remission phase， an integrated approach combining both tonification and purging should be adopted， incorporating purging within tonification to clear residual pathogens and prevent recurrence. Concurrently， proactive treatment of the underlying disease is essential to achieve complete recovery and prevent the recurrence of ascites.