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 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 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.

Auditory Perception ; physiology ; Child Development ; physiology ; Hearing ; physiology ; Humans ; Infant, Newborn ; growth & development ; Intensive Care Units, Neonatal ; Noise ; adverse effects

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

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

Objective To observe the therapeutic effect and prognosis of patients with severe traumatic craniocerebral injury treated by Lund program combined with Angong Niuhuang pill. Methods A prospective study was conducted. Forty-nine patients with severe traumatic craniocerebral injury were divided into two groups:combined treatment group (25 cases) and control group (24 cases). All the patients in the two groups received conventional therapy. Additionally, the combined treatment group was treated by the Lund program combined with Angong Niuhuang pill, the patients after admission into the intensive care unit (ICU), indwelling of gastric tube was immediately given (the tube inserted and retained through mouth in cases with cranial base bone fracture), one pill of Angong Niuhuang was fed nasally twice a day for consecutive 15 days. Before and after treatment, the intracranial pressure (ICP), cerebral perfusion pressure (CPP), Glasgow coma scale (GCS) score, the mean flow velocity of middle cerebral artery (MCA), and the incidence of complication, clinical efficacy and prognosis in the two groups were observed. Results There were no statistically significant differences in the levels of ICP, CPP, GCS score and the average flow velocity of MCA before treatment and the first day after treatment between the two groups. Beginning from 3 days after treatment, the degrees of improvement in the above indexes in the combination treatment group became much better than those in the control group [ICP (mmHg, 1 mmHg=0.133 kPa):16.78±4.50 vs. 18.80±5.67, CPP (mmHg):71.35±1.63 vs. 58.11±1.47, GCS score:9.53±0.38 vs. 8.23±0.44, the mean blood flow velocity (cm/s):152.23±3.33 vs. 178.86±5.23, all P<0.05]. The incidences of complications such as hyperpyrexia [8.0%(2/25) vs. 41.7%(10/24)], hyperspasmia [12.0%(3/25) vs. 45.8%(11/24)] and cerebral hernia [8.0%(2/25) vs. 33.3%(8/24)] in the combined treatment group were significantly lower than those in the control group (all P < 0.05). The rates of renal failure, electrolyte imbalance and pulmonary infection in combined treatment group were also lower than those in the control group, but the differences were not statistically significant (all P>0.05). The rate of good therapeutic effect in combination treatment group was obviously higher than that of the control group [72.0% (18/25) vs. 33.3% (8/24), P < 0.05], while the mortality was markedly lowered [8.0% (2/25) vs. 33.3% (8/24), P < 0.05]. Conclusions The combination of Lund program and Angong Niuhuang pills for treatment of patients with severe traumatic craniocerebral injury can reduce the degree of increase of ICP at early stage, ameliorate cerebral edema and its development, elevate CPP and improve cerebral ischemia and hypoxia. In the aspects of controlling hyperpyrexia, decreasing limbs twitches and the incidence of hernia, elevating the quality of patients' life, reducing mortality and improving prognosis, the therapy has relatively good therapeutic effects.

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.

Recently,the relationship between psoriasis and coronary heart disease(CHD)have been casting close attention.It has been demonstrated that the prevalence of CHD in patients with psoriasis is more than one time higher than that of healthy people. Meanwhile,the prevalences of hypertension,diabetes mellitus, hyperlipoidemia and smoking in patients with psoriasis are higher than those of normal people,and some drugs for treatment of psoriasis may induce CHD.Therefore,the relationship between psoriasis and CHD is still unclear.In this paper,two cases of psoriasis complicated with CHD are reported,and the relationship between psoriasis and CHD is explored.

Allostasis ; physiology ; Chronic Disease ; General Adaptation Syndrome ; physiopathology ; Humans ; Stress, Psychological ; physiopathology