Evaluation of the algorithm of Anticlot Assistant: an anticoagulant management system based on mobile health technology.

The purpose is to evaluate the algorithm of Anticlot Assistant, a novel anticoagulant management system based on mobile health technology which was developed to facilitate patient self-management. The eligible patients managed warfarin therapy with usual care, following the prescriptions of the doctors. The actual prescriptions of doctors and the virtual recommendations by Anticlot Assistant were compared and analyzed. There were no significant differences between the next test dates recommended by Anticlot Assistant and those prescribed by doctors. The mean warfarin dosage prescribed by doctors was lower than that recommended by Anticlot Assistant (2.74 ±â€Š1.17 vs. 2.79 ±â€Š1.21 mg, 95% confidence interval for the difference: -0.01--0.09, P = 0.019, n = 139), resulting in the international normalized ratio a high time below the therapeutic range (TTR) (29.9 ±â€Š17.9%), and a low time above TTR [0.0% (0.0-18.7%)]. A mixed linear model revealed that 'the variations of the dosages prescribed by doctors from those recommended by Anticlot Assistant' were positively correlated with 'variations of next international normalized ratios from TTR' after controlling for other factors (estimate of the effect = 0.231, 95% confidence interval: 0.034-0.428, P = 0.022). Anticlot Assistant can mimic the doctors' prescriptions for the next test date and the warfarin dosages recommended by Anticlot Assistant might be more reasonable than those prescribed by doctors, which indicated that the algorithm was reliable and it was possible for the patients to manage warfarin therapy themselves with the aid of Anticlot Assistant.

Patient compliance with an anticoagulation management system based on a smartphone application.

We developed a novel anticoagulation management system (Anticlot Assistant) based on a smartphone application (App). This study was performed to evaluate patient compliance with Anticlot Assistant. This prospective case series study involved patients receiving warfarin therapy. The eligible patients were managed via Anticlot Assistant, and outcome data were analyzed. Thirty patients were recruited. The mean time within the therapeutic range (TTR) was 56.5% ± 26.2% and the mean patient compliance with Anticlot Assistant was 52.7% ± 40.4%. The patients in good compliance group had higher TTR (65.6 ± 25.0% vs. 40.0 ± 21.0%, P = 0.009), lower time in the extremely low range (9.4 ± 10.6% vs. 27.4 ± 13.2%, P = 0.000) and in the extremely high range (1.3 ± 2.8% vs. 14.1 ± 22.3%, P = 0.004) than those in poor compliance group. Logistic regression analysis revealed that receiving an education of > 6 years was the only independent predictor of good compliance (odds ratio 8.400, 95% confidence interval 1.274-55.394, P = 0.027). Patient compliance is critical important for good outcomes and it might increase with improvements in education and more widespread use of information technology. Although further improvement is needed, Anticlot Assistant is promising and this study offered valuable experiences for further research.

[Myocardial protective effect of L-carnitine in cardioplegia solution on patients undergoing heart valve replacement operation].

OBJECTIVE: To investigate the myocardial protective effect of L-carnitine as an ingredient of cardiac arresting solution in the process of heart valve replacement operation. METHODS: 69 cases undergoing heart valve replacement with cardiopulmonary bypass (CPB), 47 males and 22 females, aged 48.17 +/- 14.22 (16 approximately 74 years), were divided into 3 groups: test group I (n = 22, 12 g/L L-carnitine was put in the St. Thomas II cold crystal cardiac arresting liquid), test group II (n = 24, 6 g/L L-carnitine was put in the St. Thomas II cold crystal cardiac arresting liquid), and control group (n = 23, no L-carnitine was put in the St. Thomas II cold crystal cardiac arresting liquid). Before operation, 20 minutes after the beginning of shunt, after the finish of shunt, and 8 hours, one day, 3 days, and 7 days after operation venous blood was drawn to test the serum cardial tropnin I (cTnI), aspartate transaminase, lactate dehydrogenase, creatine kinase (CK) and CK-MB isozyme. Heart color ultrasonography was conducted to test the cardiac index (CI) and left heart ejecting fraction (EF) one day before operation and 7 days after operation. Before shunt and by the end of intracardiac procedure a bit of myocardial tissue was taken to undergo electron microscopy. The amounts of vaso-active drugs, such as dopamine and dobutamine, used postoperatively, and the postoperative cardiac auto-rebeating rate were recorded. RESULTS: The Amounts of vaso-active drugs used after operation was 329 +/- 54 mg in the test group I and 339 +/- 47 mg in the test group II, both significantly less than in the control group (669 +/- 56 mg, both P < 0.01) without a significant difference between the 2 test groups. Since the end of CPB to 3 days after operation, the serum levels of cTnI, aspartate transaminase, lactate dehydrogenase, CK and CK-MB isozyme were significantly lower in the 2 test groups than in the control group (P < 0.05 or P < 0.01). The serum level of cTnI in test group I was significantly lower than in the test group II (5.71 +/- 1.14 ng/ml vs 7.87 +/- 1.89 ng/ml 1 day postoperatively (P < 0.05), and 5.01 +/- 0.89 ng/ml vs 7.53 +/- 1.43 ng/ml 3 days postoperatively (P < 0.05). The postoperative cardiac auto-rebeating rate was 87.9% in the test group I and 74.3% in the test group II, both significantly higher than that in the control group (45.7%, P < 0.05 and P < 0.01). Heart color ultrasonogram showed that 7 days postoperatively the CI index was 2.86 +/- 0.55 and 2.74 +/- 0.56 in the 2 test groups, significantly higher than that in the control group (2.11 +/- 0.35, both P < 0.05), and the left heart EF were 64.3 +/- 8.6 and 59.1 +/- 6.7 in the 2 test groups, both significantly higher than that in the control group (51.7 +/- 4.9, both P < 0.05). Electron microscopy showed only slight swelling of mitochondria in the cardial cell and the myocardial fiber was intact by the end of operation in the 2 test groups without significant difference between these 2 groups, however, in the control group swelling of mitochondria with vesicle formation, fissure of part of mitochondrial ridges, and disappearance of glycogen particles were found. CONCLUSION: Antegrade coronary perfusion of L-carnitine has a good protective effect on myocardium and is worth spreading for heart valve replacement patients with cardiopulmonary bypass.

[Tear film function in non-insulin dependent diabetics].

OBJECTIVE: To investigate whether diabetes mellitus is correlated with tear film dysfunction. METHODS: In 100 non-insulin dependent diabetic cases (200 eyes) and 80 non-diabetic controls, the tear break-up time was determined, and the staining with fluorescein sodium on the cornea and conjunctival impression cytology were performed. RESULTS: When compared with the healthy control group, the diabetic group showed decreased tear film break up time (u = 12.60, P < 0.01), increased rate of staining with fluorescein sodium on the cornea (chi(2) = 71.370, P < 0.01) and abnormal conjunctival epithelium. CONCLUSIONS: Non-insulin dependent diabetics are correlated with tear film dysfunction, so they are susceptible persons of the dry eye. The tear film break up time and staining with fluorescein sodium on the cornea should become routine tests of ophthalmology in diabetes mellitus.