Warfarin is a well-accepted drug used for preventing thromboembolic diseases. It is important to monitor the dosage of warfarin. Prothrombin time is one of the screening tests of extrinsic coagulation path,which is the first choice to monitor the oral use of warfarin. Standardized prothrombin time, namely international normalized ratio ( INR ) is used to adjust warfarin dosage in clinical practice. Many herbal medicines and foods may enhance the effect of warfarin therapy,and some of them may weaken this effect,which can result in severe clinical complications.

OBJECTIVE:To systematically review the efficacy and safety of Kanglaite injection combined with radiothreapy in the treatment of the non-small cell lung cancer (NSCLC),and provide evidence-based reference for clinical treatment. METH-ODS:Retrieved from PubMed,Cochrane Library,EMBase,VIP,CJFD,Wanfang database and CBM,randomized controlled tri-als(RCT)about the efficacy and safety of Kanglaite injection combined with radiothreapy in the treatment of NSCLC were collect-ed. Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation with modified Jadad scale. RESULTS:Totally 9 RCTs were included,involving 561 patients. Results of Meta-analysis showed,Kanglaite injection com-bined with radiothreapy can significantly improve the effective rate [OR=2.99,95%CI(2.07,4.31),P<0.001] and improvement rate of life quality [OR=3.74,95%CI(2.36,5.92),P<0.001],and reduce the incidence of radiation pneumonitis [OR=0.23,95%CI (0.12,0.47),P<0.001] and radiation esophagitis [OR=0.10,95%CI(0.05,0.21),P<0.001] of NSCLC patients,the differences were statistically significant. CONCLUSIONS:Both the efficacy and safety of Kanglaite injection combined with radiothreapy in the treatment of NSCLC are superior to radiothreapy alone.

Objective To systematically evaluate the performance of the Sysmex CS2000i Automatic Blood Coagulation Analysis System .Methods According to the standards of the Clinical and Laboratory Standards Institute (CLSI) ,the precision ,accuracy ,lin‐earity ,biological reference interval and carry‐over rates of the Sysmex CS2000i Automatic Blood Coagulation Analysis System were detected ,meanwhile the detections of 5 clinical specimens were compared between this system and the Sysmex CA 1500 Automatic Blood Coagulation Analysis System .Results The intra‐assay precision coefficient of variation (CV) ,inter‐day precisions CV carry‐over rate ,accuracy and linearity of plasma prothrombin time ,activated partial thromboplastin time ,fibrinogen and D‐dimmer detec‐ted by the Sysmex CS2000i Automatic Blood Coagulation Analysis System were all consistent with the quality target requirements of our laboratory .Conclusion The Sysmex CS2000i Automatic Blood Coagulation Analysis System has better performance in vari‐ous aspects ,the detection results could be used for the clinical diagnosis and treatment of related diseases .

ObjectiveTo explore the effects of perceived trust and occupational risk on job burnout of physicians.MethodsA multi-step random sample of 1910 physicians from medical organizations in Jinan,Weifang and Dezhou was selected and assessed with Perceived Trust Scale,Occupational Risk Scale and Maslach Burnout Inventory.ResultsPublic trust could significantly positively predict cynicism,negatively predict reduced professional efficacy ( β =0.10,-0.10; P ＜0.01 ),Patient's trust could significantly negatively predict exhaustion,cynicism and reduced professional efficacy ( β =-0.14,-0.20,-0.22; P ＜ 0.01 ).Regulator's trust could significantly negatively predict exhaustion,cynicism,and reduced professional efficacy(β=-0.12,-0.08,-0.12;P＜0.05 ).Occupational risk could significantly positively predict exhaustion and cynicism(β=0.30,0.13; P ＜0.01 ).Perceived social trust and occupational risk could together explain 22％ of exhaustion,7％ of cynicism and 13％ of reduced professional efficacy.ConclusionPerceived trust and occupational risk have significant predictive effects on dimensions of job burnout.

Objective To analyze clinical characteristics of premenopausal and postmenopausal female patients with kidney stones.Methods The clinical data of 1 194 female adults with kidney stones from December 2004 to December 2014 were analyzed retrospectively.The incidence of kidney stones in different age groups was analyzed firstly.The post-hysterectomy patients or those taking estrogen for breast cancer were excluded, and then 1 166 patients were enrolled.The patients were divided into premenopausal group (464 cases, 39.8％) and postmenopausal group (702 cases, 60.2％), and clinic features of different groups were evaluated.Results The peak age of female patients with kidney stones is between 50 and 59 years old.There were 105 (22.6％) patients in premenopausal group and 204 (29.1％) patients in postmenopausal group complicated with urinary infection.Fifty-eight (12.5％) patients had genitonrinary malformations such as horseshoe kidney, medullary sponge kidney, ectopic kidney, duplex kidney or pyeloplasty for ureteropelvic junction (UPJ) stricture in premenopausal group, as well as 36 (5.1％) in postmenopausal group.Twenty patients (4.3％) had renal insufficiency in premenopausal group, and 66 (9.4％) in postmenopausal group.These differences were statistically significant (P ＜ 0.05).The patients complicated with hydronephrosis (251 vs.346) and ureteral calculi (63 vs.110) of two groups were not significant different (P ＞ 0.05).Multiple factors Logistic analysis indicated that age and urinary infection were statistically significant factors in the occurrence of renal insufficiency (OR =1.037,1.772, P ＜ 0.05).Conclusions The occurrence of genitourinary malformations was higher among premenopausal female patients with kidney stones, while urinary infection and renal insufficiency were more common for postmenopausal patients.Age and urinary infection were the independent factors for the occurrence of renal insufficiency.

Objective:To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).Methods:In this study,461 patients with type 2 diabetes who received PCNL in Peking Uni-versity People’s Hospital from June 2006 to December 2015 were reviewed.There were 281 males and 180 females with an average age of 57 years were included,of whom,137 were diagnosed with SIRS after PCNL.The demographic data,clinical features,and test results were compared between the patients with SIRS and without SIRS,trying to identify the correlation between their clinical characters and the occur-rence of SIRS.Results:The SIRS was significantly correlated with the patients’preoperative white blood cell counting (×109 /L)[7.76 (4.00 -17.96)vs.6.31 (2.00 -17.40),P <0.001 ],preopera-tional blood glucose level (mmol /L)[7.30 (3.08 -19.90)vs.6.40 (3.42 -16.78),P <0.001], operative time (min)[75 (20 -270)vs.60 (20 -200),P <0.001 ],length of stay (d)[12 (2 -46)vs.11 (3 -29),P =0.019],staghorn stones [38.8% (33 /85)vs.27.7% (104 /376),P =0.042],and preoperational urinary tract infection [36.8% (50 /136)vs.26.6% (81 /304),P =0.032].There was no significant correlation between the SIRS and the patients’age,body mass index, preoperative hemoglobin level,preoperative serum creatinine,and transfusion.In multivariate analysis, abnormal preoperative white blood cell counting (OR =3.194,95% CI:1.531 -6.666,P =0.002), operative time longer than 60 min (OR =1.635,95% CI:1.088 -2.456,P =0.018),and preopera-tional blood glucose level higher than normal 7.1 mmol /L were significantly correlated with the presence of SIRS.Conclusion:The high level of preoperational blood glucose,abnormal preoperative white blood cell counting,and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Objective To study the dynamic changes of plasma C-reactive protein (CRP) and cortisol (COR) and their clinical value in prognosis of patients with sepsis. Methods Daily CRP and COR detection was conducted to record the dynamic changes of CRP and COR for cases of sepsis patients in ICU then the rela-tionship between dynamic changes of serum CRP and COR and prognosis were analyzed. Results Serum CRP and COR levels of dead patients were significantly higher than those of survival patients after treatment (P <0.05). According to the difference of the dynamic changes of CRP and COR, the data were divided into typeⅠ:sustained elevated type , typeⅡ: up-and-down type , type Ⅲ: fluctuated type and type Ⅳ: normal or mild ele-vation type. The mortality of CRP typeⅠ patients was significantly higher than that of type Ⅱ and type Ⅳ(P <0.001). The mortality of COR typeⅠ and COR Ⅲ patients was significantly higher than that in COR Ⅱand COR Ⅳ (P < 0.001). Further analysis showed that the mortality of group with significant elevation of CRP and COR were obviously higher than that of group with significant increase of CRP or COR and that of group with no significant elevation of CRP and COR (P < 0.001); the mortality of group with significant increase of CRP or COR was also significantly higher than that of group with no significant elevation of CRP and COR (P < 0.001). Conclusions The dynamic changes of COR and CRP in patients with sepsis present certain regularity and monitor-ing the dynamic changes of the two provides accurate assessment of the prognosis of sepsis.

Objective To explore the application value of the sequential colorectal cancer screening program in population completed health check-ups .Methods The healthy individuals were enrolled from November 2013 to July 2014 .Questionnaire survey of risk factors quantity assessment and fecal occult blood test (FOBT) were used for initial screening for colorectal cancer .According to the results of initial screening ,subjects were divided into high-risk group and low-risk group .The detection rates of polyps and cancers of two groups were compared .Chi-square test was performed for statistic alanalysis .Results A total of 525 individuals completed the colonoscopy .There were 187 individuals in high-risk group and 338 individuals in low-risk group .The results of colonscope examination showed that 70 cases of high-risk group were detected with polyps or colorectal cancer ,including 7 (10 .0% ) cases of colorectal cancers , 8(11 .4% ) cases of advanced adenoma ,30(42 .9% ) cases of non-advanced adenoma and 25(35 .7% ) cases of inflammatory polyps . In low-risk group , 63 individuals had polyps or colorectal cancer , including 5(7 .9% ) cases of advanced adenoma ,38(60 .3% ) cases of non-advanced adenoma and 20(31 .7% ) cases of inflammatory polyps .The differences of polyps and colorectal cancer detection rates between two groups were statistically significant (χ2=3 .905 and 10 .136 ,P=0 .048 and 0 .001) .Conclusion The sequential colorectal screening program including colorectal cancer risk factors quantity assessment questionnaire and FOBT seems to be a valuable tool in clinical practice .

Objective:The aims of this study were to compare the efficacy between salvage liver transplantation (sLT) and rehepatectomy (RR) basing on the propensity score matching (PSM), and to explore the prognositc factors of patients with recurrent hepatocellular carcinoma (HCC).Methods:124 patients with intrahepatic recurrence after hepatectomy in our center from January 2012 to August 2018 were divided into sLT group( n=46) and RR group( n=78). 34 patients were selected for data analysis base on 1∶1 propensity score matching (PSM). The advantages and disadvantages of the two surgical methods and the prognostic factors of the patients were discussed by comparing the basic clinical data, OS and DFS of the two groups before and after matching. Results:Before matching, the pre-operative serum total bilirubin, the occurrence of multiple tumors, the proportion of preoperative TACE and the proportion of patients within Milan criteria of the sLT group were higher than those of the RR group, and the maximum tumor diameter of the sLT group was shorter than that of the RR group ( P<0.05); the time of operation, the amount of intra-operative blood loss, the positive of MVI and the proportion of postoperative Clavien grade Ⅲ and above of RR group were higher than those of RR group ( P<0.05). After matching, the operation time, intra-operative blood loss and the proportion of postoperative complications of sLT group were higher than those of RR group; there was nosignificant difference between 1-, 3- and 5- years OS of sLT group and RR group( P>0.05), the 1-, 3- and 5-years DFS of sLT group were better than those of RR group( P<0.05); AFP≥100 μg/L was the independent risk factor of OS, and the type of operation and AFP≥100 μg/L were independent risk factors of DFS. Conclusions:The pre-operative condition of sLT group was more severe, and the operation time, intra-operative blood loss and post-operative severe complication rate of sLT group were higher than those of RR group, and the DFS time of sLT group was longer than that of RR group, but there was no significant difference in OS between the two groups.

Objective To evaluate the relevance and accuracy of fibrinogen (Fib) detection by using PT-der assay and Von-Clauss assay on Sysmex CA-1500 Automated Coagulation Analyzer .Methods PT-der assay and Von-Clauss assay on Sysmex CA-1500 Automated Coagulation Analyzer were employed to detect the plasma Fib concentrations of 755 blood samples .The dilution ratios of samples with high Fib concentration were 1∶8 ,2∶7 ,3∶6 ,4∶5 ,5∶4 ,6∶3 ,respectively .The dilution ratios were served as the abscissa ,and the Fib concentrations measured by two methods as the ordinate ,a simple linear regression analysis was per-formed .Results When Fib concentration was in 2 .0- <6 .0 g/L ,the Fib value obtained by Von-Clauss assay was higher than that by PT-der assay(P<0 .01) .When Fib concentration was below 2 .0 g/L or above 6 .0 g/L ,the Fib value obtained by PT-der assay was higher than that by Von-Clauss assay(P<0 .01) .The linear regression equations of PT-der assay and Von-Clauss assay were Y=4 .537 7X+1 .551 3(R2 =0 .897 3) ,Y = 7 .792 2X+ 0 .290 0(R2 =0 .980 5) ,respectively .Conclusion Von-Clauss assay can better reflect the Fib level of human body which has a blood clotting function .