Differences in regional distribution and inequality in health workforce allocation in hospitals and primary health centers in China: A longitudinal study.

BACKGROUND: In 2009, China launched a new round of healthcare reform to provide households with secure, efficient, convenient, equitable and affordable healthcare services. Healthcare reform is underpinned by three critical pillars: the health workforce, funding, and infrastructure, with reform of the health workforce being particularly significant. OBJECTIVE: This study analyses the disparities in regional distribution and the inequity of healthcare workforce allocation across hospitals and primary health centers in China over twelve years. DESIGN: Retrospective longitudinal data from the National Health Statistics Yearbook 2011-2022 and National Statistical Yearbook in China from 2011 to 2022 were collected for analysis. PARTICIPANTS: The focus was on hospitals and primary health centers, explicitly examining their health technician and nursing workforce. METHODS: The research utilized four key indicators of the healthcare workforce to evaluate the distribution of health resources between hospitals and primary health centers. Furthermore, the Gini coefficient and Theil index were employed to assess the inequality in allocating the health workforce. RESULTS: Between 2010 and 2021, there was a nationwide increase in the ratio of health workers per 1000 population in hospitals and primary health centers. It is noted that rural districts had higher ratios than urban districts in terms of the number of health technicians and nurses per 1000 population, whether in hospitals or primary health centers; western districts had higher ratios than eastern and central districts did. In the same year, at different levels of medical institutions, the Theil indices of health technicians and nurses in hospitals were lower than those in primary health centers in terms of both demographic and geographical dimensions. Regarding the allocation of the health workforce by population, the Gini coefficient remained below 0.3, while for geographical allocation, it exceeded 0.4. CONCLUSIONS: This study analyzed the temporal trends and inequality of health-resource allocation at the hospital and primary health center levels in China, noting trends of improvements in the quantity and inequality in health workforce allocation from 2010 to 2021, suggesting the success of the government's efforts to advance healthcare reform since 2009. The allocation of health workforce based on population exhibits greater fairness compared to geographical distribution.

Multiple geriatric syndromes in community-dwelling older adults in China.

This study aims to assess the prevalence of geriatric syndromes and identify factors associated with multiple geriatric syndromes in community-dwelling older adults in China. We utilized a convenience sampling method to recruit older adults and from one rural and one urban community in Chengdu, China, from October 2022 to March 2023. A total of 706 older adults aged 60 years or older were included. Ten geriatric syndromes were investigated including two mental disorders: depressive symptoms, cognitive impairment; and eight somatic disorders: pain, falls, sleep disturbance, constipation, polypharmacy, multimorbidity, malnutrition and frailty. Multiple geriatric syndromes were defined as an individual having two or more geriatric syndromes. The data obtained were analysed using descriptive statistics. The independent risk factors for multiple geriatric syndromes were assessed using a logistic regression model. This study found that 90.5% of the participants had at least one geriatric syndrome, with 72.8% experiencing multiple geriatric syndromes. The top four geriatric syndromes in our study were polypharmacy (58.5%), malnutrition/at risk of malnutrition (43.1%), multimorbidity (42.1%), and frailty/prefrailty (34.3%). Of the older adults, 368(52.1%) had only somatic disorders, 18(2.5%) had only mental disorders and 253 (35.8%) had somatic-mental disorders. According to the logistic regression analysis, residence, age, marriage, BMI, and self-related health were significantly associated with multiple geriatric syndromes among older adults. This study highlights that multiple geriatric syndromes are prevalent among community-dwelling older adults in China, and underscores the significance of certain demographic factors in their occurrence. Future longitudinal studies are needed to establish the temporal relationship between multiple geriatric syndromes and these demographic factors, as well as to explore causal relationships and effective prevention strategies for geriatric syndrome.

Association of daily health behavior and activity of daily living in older adults in China.

This study aims to describe the activity of daily living (ADL) situation and determine the relationship between health behavior and ADL among older adults in China. A cross-sectional, observational study was conducted in one urban community and one rural community in Chengdu (a city located in Southwest China), China, from October 2022 to March 2023. A total of 706 older adults were included in this study. The associations between health behaviour and ADL were assessed by logistic regression model. Of the 706 older adults, 169 (23.9%) were disabled in ADL. According to the logistic regression analysis, age (60-69 years old: OR = 0.015, 95% CI 0.007 to 0.035, P < 0.001; 70-79 years old: OR = 0.116, 95% CI 0.060 to 0.227, P < 0.001), resident(OR = 0.568, 95% CI 0.330 to 0.976, P = 0.041), chronic disease (0 type: OR = 0.023, 95% CI 0.001 to 0.379, P = 0.008; 1-4 types: OR = 0.357, 95% CI 0.219 to 0.582, P < 0.001), no exercise (OR = 4.562, 95% CI 2.263 to 8.026, P < 0.001), and physical examination (OR = 2.217, 95% CI 1.294 to 3.496, P = 0.003) were significantly associated with ADL among older adults in Southwest China. This study showed that older adults had a higher ADL disability ratio. Age, resident, chronic disease, exercise and physical examination were associated with ADL among older adults. The study indicates that medium/high exercise maybe a protective factor for older adults, and nursing staff can encourage older adults to exercise when carrying out primary prevention measures. The government and public health institutions should give special attention to older adults and help them to acquire the habit of having an annual physical examination.

Recent advances on the molecular mechanisms of exercise-induced improvements of cognitive dysfunction.

Physical exercise is of great significance for maintaining human health. Exercise can provide varying degrees of benefits to cognitive function at all stages of life cycle. Currently, with the aging of the world's population and increase of life expectancy, cognitive dysfunction has gradually become a disease of high incidence, which is accompanied by neurodegenerative diseases in elderly individuals. Patients often exhibit memory loss, aphasia and weakening of orientation once diagnosed, and are unable to have a normal life. Cognitive dysfunction largely affects the physical and mental health, reduces the quality of life, and causes a great economic burden to the society. At present, most of the interventions are aimed to maintain the current cognitive level and delay deterioration of cognition. In contrast, exercise as a nonpharmacological therapy has great advantages in its nontoxicity, low cost and universal application. The molecular mechanisms underlying the effect of exercise on cognition are complex, and studies have been extensively centered on neural plasticity, the direct target of exercise in the brain. In addition, mitochondrial stability and energy metabolism are essential for brain status. Meanwhile, the organ-brain axis responds to exercise and induces release of cytokines related to cognition. In this review, we summarize the latest evidence on the molecular mechanisms underlying the effects of exercise on cognition, and point out directions for future research.

Care willingness and demand of residents under 60 years of age in western China: a cross-sectional study.

OBJECTIVES: The objective was to examine care willingness and demand of residents under 60 years of age after retirement. SETTING: The staged cluster sampling method was used between August and October 2018 in Dujiangyan, Sichuan Province, China. PARTICIPANTS: 2282 participants under 60 years of age were surveyed in 2018 by the staged cluster sampling method in China. PRIMARY AND SECONDARY OUTCOME MEASURES: The results of care willingness and demand were assessed by multiple comparisons of χ2 test and multivariable logistic regression. RESULTS: The respondents who preferred institution-based care, home-based care and community-based care accounted for 39.5%, 38.3% and 20.2% respectively, whereas only 2.1% preferred home-based self-care. The main reasons for the respondents to choose institution-based care included better medical care (31.9%), better daily care (27.0%), burden reduction for children (26.3%), better accommodation (22.8%), satisfied living environment (21.6%) and low consumption (12.3%). The factors that affected care willingness and demand included age, ethnicity, educational attainment, marital status, occupation and the current type of residence. CONCLUSIONS: The results revealed the care willingness and demand of residents under 60 years of age after retirement and relevant decision factors. This study provides a certain theoretical and practical significance for the development of the care willingness mode and promotes the cognition of policy-makers and researchers, and also provides the basis for decision-making.

Study on the Salivary Microbial Alteration of Men With Head and Neck Cancer and Its Relationship With Symptoms in Southwest China.

This study explored the association between oral microbes and head and neck cancer (HNC) as well as symptoms related to patients with HNC before surgical treatment. Fifty-six patients with HNC and 64 matched healthy controls were recruited from West China hospital in Southwest China. The demographic, clinical, and symptom data were collected. Salivary samples were collected to determine the microbial characteristics using 16S rRNA gene sequencing. Patients with HNC presented increased Capnocytophaga abundances. The oral microbial markers as Capnocytophaga (area under the curve=0.81) achieved a high classification power between the HNC patients and healthy controls. Moreover, using Capnocytophaga in conjunction with symptom of voice/speech difficulty achieved an overall predicting accuracy of 92.5% comparing with using Capnocytophaga alone (79.2% accuracy) in distinguishing the HNC patients from healthy controls. Salivary microbial profiles and HNC symptoms may be potential biomarkers for HNC screening.

[Diagnostic Value of Abnormal Prothrombin in HBV-related AFP-negative Hepatocellular Carcinoma].

OBJECTIVE: To evaluate the diagnostic value of abnormal prothrombin (DCP) in Alpha-fetoproteins (AFP)-negative (AFP≤20 ng/mL) hepatocellular carcinoma and the relationship between DCP level and Child-Pugh grade, tumor size, TNM stage as well as differentiation. METHODS: The inpatients diagnosed with hepatitis B-related liver disease were collected from June 2016 to December 2017, The diagnostic efficacy of DCP for AFP-negative HCC was analyzed by ROC. Area under the curve ( AUC), the best cut point, sensitivity, specificity, positive predictive value and negative predictive value were calculated. The relationship between DCP levels and the clinical characteristic of HCC was analyzed. RESULTS: A total of 459 hepatitis B markers positive patients were included, including 136 cases of hepatocellular carcinoma, 173 cases of hepatitis B cirrhosis and 150 cases of chronic hepatitis B. DCP in AFP-negative hepatocellular carcinoma group was significantly higher than that in non-HCC group (CHB and LC) ( P<0.05). The AUC of DCP was 0.858, P<0.05. The optimal cut-off point for the diagnosis of hepatocellular carcinoma was 61 mAU/mL. The corresponding sensitivity, specificity, positive predictive value and negative predictive value were 72.8%, 88.2%, 61.1% and 89.7%, respectively. In different size of hepatocellular carcinoma, DCP level of those with diameter>3 cm was significantly higher than those with diameter≤3 cm ( P<0.05). In different TNM stages, DCP level in stage Ⅱ and Ⅲ was significantly higher than that in stage Ⅰ ( P<0.05). There was no significant difference of DCP level among different Child-Pugh grades and differentiation ( P>0.05). CONCLUSION: DCP has diagnostic value for AFP-negative hepatocellular carcinoma, its level may reflects the degree of tumor progression.

[Construction of Graded Nursing Care Index System for Patients With Alzheimer's Disease].

Alzheimer's disease (AD) is one of the most common diseases in older populations. Its main clinical features include cognitive dysfunction, affective disorder, and abnormal mental behavior. Due to the lack of therapeutic drugs, professional care has become an important diagnostic and therapeutic strategy for Alzheimer's disease patients. At present, most Alzheimer's disease patients are cared for at home by relatives or caregivers, and less than l0% of city-based patients receive care in old-age institutions. Due to mixed treatment regimens in the hospital, care services do not necessarily match patient care needs and thus Alzheimer's disease patients do not receive adequate treatment. Developed countries have a mature care system for the elderly, but no graded care model for the elderly with Alzheimer's disease currently exists in China. In this paper, the author draws on the experience of developed countries to construct an index system for the graded care of Alzheimer's disease patients that is suited to conditions in China. This article addresses the burden faced by the elderly with Alzheimer's disease and the current standard of care for the elderly at home and abroad. After explaining the necessity of constructing a care model for the elderly with Alzheimer's disease, the author then explains the practicability of the care system proposed in this study in order to provide a whole-course care model for the mentally impaired elderly in China.

[Living Arrangement Intentions of the Elderly and Its Influencing Factors in Western China].

BACKGROUND: China is the country with the largest population of elderly, accounting for more than 17.3% of the total population. The arrival of the so-called "silver wave" has generally reduced the abilities of daily life of the elderly and has continued to increase endowment pressures. Assisting the elderly in China to age successfully is an urgent problem. PURPOSE: To understand the living arrangement intentions of the elderly in Western China and to provide a reference for the reformation of the social endowment service system. METHODS: A self-designed questionnaire and Barthel self-care ability scale were conducted on 2,078 elderly people living in Guangxi and Ningxia Provinces in China. RESULTS: A total of 1,634 participants (78.6%) chose home-based care, 187 (9.0%) chose community care, and 257 (12.3%) chose institutional care. Differences in age, ethnic group, household registration, education level, family monthly income, family income and expenditure situation, and religion all significantly affected living arrangement intention (all p < .05). Logistic regression showed that age, ethnicity, household registration, religion, marital status, family monthly income, and length of hospital stay were all primary factors of influence on the home care intention of the elderly people (all p < .05). CONCLUSIONS: A significant majority of the elderly in this study expressed an intention to choose home-based care. It will be necessary to build a home-based mode of care that incorporates medical-care functions. In addition, the health service functions of community and institutions should be improved and perfected, as the intention to live in these settings is also growing. Appropriate services should be provided to meet the living arrangement intentions of the elderly in order to start a new era of elderly care customization. Finally, the development and expansion of "Internet Plus" should be leveraged to build a social endowment service system that meets the comprehensive range of elderly-care needs.

[The Effectiveness of a Multi-Disciplinary Intervention for Deglutition Disorders in Elderly Inpatients].

BACKGROUND: While many studies have examined multidisciplinary interventions for swallowing disorder, most have focused on acute stroke patients. It is essential to confirm the efficacy of multidisciplinary interventions for all causes of swallowing disorder. PURPOSE: To investigate the efficacy of a nurse-led, multi-disciplinary intervention for hospitalized elderly patients with swallowing disorder. METHODS: One hundred and forty-five elderly patients with swallowing problems from a well-respected affiliate hospital of a university were studied. Patients were randomly allocated using cluster sampling and opaque envelop into either the multi-disciplinary intervention group (n = 73) or the control group (n = 72). The participants were interviewed at baseline and at 30 and 90 days after the intervention. The questionnaires included: a demographics datasheet, Charlson Comorbidity index, Acute Physiology and Chronic Health Evaluation II, short portable mental status questionnaire, Barthel Index, Standardized Swallowing Assessment, Short-form min-nutritional assessment, and aspiration pneumonia. RESULTS: The intervention group showed a significantly higher ratio of SSA (67.1% vs. 44.5%, p < .05), lower aspiration pneumonia (5.5% vs. 23.6%, p <.05), and lower incidence of malnutrition (2.7% vs. 11.1%, p <.05) at 90 days than the intervention group. Moreover, the intervention group showed a significantly higher ADL (activities of daily living) score at 90 days (83.3 ± 22.1 vs. 81.1 ± 22.1, p <.017) than the control group (p <.05). CONCLUSIONS: A nurse-led, multi-disciplinary intervention is a potential option for elderly patients with deglutition disorder to improve swallowing function and ADL and to reduce the incidence of inhaled pneumonia and malnutrition.

Attitudes of Older Chinese Patients Toward Death and Dying.

BACKGROUND: Due to the aging population of China, the need for palliative care will increase. However, one of the barriers to utilization of palliative care is the traditional belief that talking about death and dying is taboo. OBJECTIVE: The aim of this study was to examine to what extent older Chinese patients were willing to answer questions about death and dying by asking them about "fear of death" and their desire to "use advanced life support when dying." DESIGN: Survey questionnaire. SETTING/SUBJECTS: Convenience sample (N = 993 hospitalized patients). RESULTS: Only 215 (21.7%; 95% confidence interval [CI] 16.2%-27.1%) and 99 (9.9%; 95% CI 4.1%-15.8%) patients did not answer the questions related to "fear of death" and "use of advanced life support when dying," respectively, while 439 (44.2%; 95% CI 38.7%-49.7%) answered "yes" and 339 (34.1%; 95% CI 28.7%-39.6%) answered "no" for "fear of death" and 382 (38.5%; 95% CI 32.6%-44.3%) answered "yes" and 512 (51.6%; 95% CI 45.7%-57.4%) answered "no" for "use of advanced life support when dying." In multinomial logistic regression analysis, fear of death was associated with younger age, lowest level of function, and desire to use advanced life support. CONCLUSIONS: The majority of older patients were willing to answer the two questions about death and dying. About one-third of patients were not afraid of death, and older patients were less likely to be afraid of death. More than 50% of patients answered that they would not choose advanced life support when dying. More research in this area is needed to help advance palliative care in China.

[Localization Establishment of an Interdisciplinary Intervention Model to Prevent Post-Operative Delirium in Older Patients Based on 'Hospital Elder Life Program'].

BACKGROUND: Postoperative delirium is a significant complication in elderly patients. The occurrence of delirium may increase the related physical and psychological risks, delay the length of hospital stays, and even lead to death. According to the current evidence-based model, the application of interdisciplinary intervention may effectively prevent delirium, shorten the length of hospital stays, and save costs. PURPOSE: To establish a culturally appropriate interdisciplinary intervention model for preventing postoperative delirium in older Chinese patients. METHODS: The authors adapted the original version of the Hospital Elder Life Program (HELP©) from the Hebrew Senior Life Institute for Aging Research of Harvard University by localizing the content using additional medical resources and translating the modified instrument into Chinese. Furthermore, the final version of this interdisciplinary intervention model for postoperative delirium was developed in accordance with the "guideline of delirium: diagnosis, prevention and management produced by the National Institute for Health and Clinical Excellence in 2010" and the "clinical practice guideline for postoperative delirium in older adults" produced by American geriatrics society in 2014. Finally, the translated instrument was revised and improved using discussions, consultations, and pilot study. RESULTS: The abovementioned procedure generated an interdisciplinary intervention model for preventing postoperative delirium that is applicable to the Chinese medical environment. The content addresses personnel structure and assignment of responsibility; details of interdisciplinary intervention protocols and implementation procedures; and required personnel training. CONCLUSIONS: The revised model is expected to decrease the occurrence of post-operative delirium and other complications in elderly patients, to help them maintain and improve their function, to shorten the length of their hospital stays, and to facilitate recovery.

[The Association Between Multimorbidity and Medication Non-Adherence in Elderly With Hypertension in Western China].

BACKGROUND: The prevalence of hypertension increases with aging. Medication non-adherence is an important reason for the failure to control hypertension effectively, which increases the risks of cardiovascular and cerebrovascular incidents and of mortality. Multimorbidity is common among the elderly and has become a WHO-supported priority of research worldwide. While recent research suggests an association between multimorbidity and medication non-adherence, the results are not yet conclusive. PURPOSE: The present study describes the condition of medication non-adherence and multimorbidity among a population of elderly with hypertension in western China and explores the extent of the association between multimorbidity and medication non-adherence. METHODS: A cross-sectional design with multi-stage sampling was used to recruit 1,316 elderly with hypertension from nine community health centers in the cities of Chengdu, Chongqing, and Urumqi. Data were collected using the study questionnaire and analyzed using the mean, percentage, independent samples t test, Chi-square test, Kruskal-Wallis H test, and binary logistic regression. RESULTS: The prevalence of medication non-adherence was 28.7%, and the prevalence of multimorbidity was 77.0%. Binary logistic regression analysis found the number of comorbidities to be a predictor of antihypertensive drug non-adherence, with those elderly with three (OR = 1.742, 95% CI [1.017, 2.984], four (OR = 2.601, 95% CI [1.489, 4.544] and more than five (OR = 3.262, 95% CI [1.839, 5.788] chronic conditions at significantly higher risk of non-adherence than their peers with no comorbidities. Other associated factors included poor health behaviors (OR = 1.715, 95% CI [1.263, 2.330] and region of residence. CONCLUSIONS: A positive association was found between medication non-adherence and the number of comorbidities in elderly with hypertension. This suggests the need for closer monitoring of the antihypertensive-drug prescription adherence of elderly with multiple chronic conditions and for further research to explore the measures that are necessary to improve medication adherence in this population.

[The Relationship of Serum Leptin Level and Metabolism in Elderly People with Stable Chronic Obstructive Pulmonary Disease].

OBJECTIVE: To investigate the correlation of serum leptin and to energy consumption and metabolization in the patients with chronic obstructive pulmonary disease (COPD). METHODS: We included 92 outpatients with stable COPD in West China Hospital of Sichuan University as trail group (COPD group) and 80 healthy elderly people in community as control group. All patients and healthy control received the measurements of body mass index (BMI), fat mass, resting energy expenditure (REE), lung function, serum leptin and tumor necrosis factor-α (TNF-α). RESULTS: The concentrations of serum leptin, BMI and lung function were lower in COPD group than those in control group (P < 0.01). The concentrations of serum leptin between two groups were not difference after the adjusted results of BMI and fat mass.. There was no difference of REE and TNF-α concentrations in these two groups. The serum leptin had positive correlation with BMI and fat mass, but there were no correlation between of TNF-α and serum leptin. CONCLUSION: In elderly people with stable COPD, the decline on the serum leptin is related to the decrease of BMI and fat mass, but barely related to the level of TNF-α.

[Development of the comprehensive geriatric assessment scale for Chinese elderly].

OBJECTIVE: To establish a comprehensive geriatric assessment scale which fit the situations of Chinese old people most, and to provide an evaluation tool for the proposal and intervention of functional health problems for the elderly. METHODS: The comprehensive geriatric assessment scale was produced by Delphi method combing with Chinese cultural background, some methods such as literature review and experts evaluation were conducted. The manuscript of this questionnaire was developed through Delphi and pre-experiment. Then the manuscript questionnaires were used among 300 old people, to analyze and assess the reliability, validity and reactivity. RESULTS: The experiment analysis demonstrated that the total Cronbach alpha coefficient was 0. 909 and that of each index ranged from 0.718-0.960, most of the dimension-related coefficients were over 0.5. The construct validity was validated by factor analysis and the cumulative contribution rate was up to 76.88%. Results of non-parametric test on reactivity showed that the differences of total scores and each dimension' scores and substitute scores between the elderly from different institutions were statistically significant (P < 0.01). CONCLUSION: The comprehensive geriatric assessment scale owns a reasonable reliability, validity and reactivity, and this scale can be used as an evaluation instrument for the finding and intervention of the elder's health problems.

Functional CLOCK gene rs1554483 G/C polymorphism is associated with susceptibility to Alzheimer's disease in the Chinese population.

OBJECTIVE: To examine the association between the circadian locomotor output cycles kaput (CLOCK) gene rs1554483 G/C polymorphism and susceptibility to Alzheimer's disease in Chinese people. METHODS: This case-control study determined apolipoprotein E (APOE) and CLOCK rs1554483 G/C genotypes using polymerase chain reaction restriction fragment length polymorphism. RESULTS: Unrelated patients with Alzheimer's disease (n = 130) and healthy controls (n = 188) were analysed for an association between the CLOCK gene rs1554483 G/C polymorphism and susceptibility to Alzheimer's disease. In the whole sample and in APOE ε4 isoform noncarriers, the prevalence of CLOCK gene rs1554483 G allele carriers was significantly higher in patients with Alzheimer's disease than in controls. Among APOE ε4 carriers, the prevalence of CLOCK rs1554483 G allele carriers was not significantly different between patients with Alzheimer's disease and controls. CONCLUSION: Among APOE ε4 noncarriers, but not APOE ε4 carriers, the CLOCK rs1554483 G allele was associated with increased susceptibility to Alzheimer's disease.

[Prevention of falls of hospitalized elderly patients using clinical pathway].

OBJECTIVE: To explore effective strategies for preventing falls of hospitalized elderly patients using clinical pathway. METHODS: A total of 2442 patients aged > or = 70 years who were hospitalized during December 2009 and December 2010 were recruited for the study. The patients were assessed with "Falls Risk Assessment and Nursing Care Inventory" and 1796 were identified as with high risk of falls. The clinical pathway for preventing falls was applied to those patients with high risk of falls. The interventions included timely assessments, safe environment and facilities, targeted health education, extended nursing care on patients with high risk, improved hand-off, rational use of medicine, and so on. RESULTS: Only 4 patients fell, with an incidence of 0.22%. Sex, age, disease, psychological factors, clothing, hospital environment, drug effects, and history of falls were associated with the occurrence of falls. CONCLUSION: Risk assessment and targeted intervention through clinical pathway are effective strategies for preventing falls of hospitalized elderly patients.

[K562 cell line resistance to nilotinib induced in vitro and preliminary investigation of its mechanisms].

OBJECTIVE: To establish a bcr-abl(+) cell line resistance to nilotinib, and to investigate the possible mechanisms of resistance. METHODS: K562 cells were treated with gradually increasing concentrations of nilotinib to generate resistance cell line K562-RN. The folder of drug-resistance was evaluated by MTT assay. Cells apoptosis rate was detected by flow cytometry, the mRNA level of bcr-abl fusion gene by FISH, and the expression of apoptosis relative gene mRNA and protein (such as bcr-abl, HO-1, mdr1, Bcl-2 and caspase-3) by RQ-PCR and western blot. RESULTS: The resistant cell line K562-RN was successfully established, with 2.01 fold resistant to nilotinib compared with K562 cell line \[the IC(50) value of nilotinib to K562 and K562-RN were (12.320 ± 1.720) µmol/L and (24.742 ± 2.310) µmol/L, respectively\]. It also had the cross resistance to adriamycin, homoharringtonine, etoposide and imatinib. Treated with different concentrations of nilotinib, cell apoptosis rate of K562-RN was significantly lower than that of K562 cells. The rate of bcr-abl gene positive cells was 92% in K562-RN by FISH assay. The mRNA and protein levels of bcr-abl, HO-1 and mdr1 expression up-regulated in K562-RN cells, while those of caspase-3 expression down-regulated, being significantly statistical difference when compared with K562 cells (P < 0.05). CONCLUSION: Human leukemic cell line resistance to nilotinib, K562-RN is established successfully by gradually increasing concentrations of drug. The mechanisms of resistance in K562-RN is probably associated with increasing expression of bcr-abl, HO-1, mdr1 and decreasing expression of caspase-3 mRNA and protein levels.