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Objective To explore the efficacy and safety of dabigatran etexilate in the treatment of elderly patients with non-valvular atrial fibrillation (NVAF), so as to provide reference for clinical treatment and rational drug use. Methods Eighty elderly patients with NVAF in The Seventh People's Hospital of Shanghai from December 2020 to June 2021, aged 65 to 80 years, were enrolled in a self-controlled study. Dabigatran etexilate 110 mg was given orally, twice a day (one in the morning and one in the evening) for 6 months. During the follow-up visit, the coagulation function indexes including APTT, TT, FIB and D-D were observed in patients taking medicine for 1 month and 6 months. Liver function indexes including ALT, AST and TBIL, renal function indicators including UREA and eGFR, and blood routine indexes including HGB and ESR, also were observed in patients taking medicine for 1 month and 6 months. Results Patients were compared at 1 month and 6 months after treatment with dabigatran and before: the difference of coagulation function indexes as APTT and TT was statistically significant (P<0.05);There was no significant difference in liver function index, renal function index and blood routine index (P>0.05); A total of 25 adverse events occurred, and the incidence rate of adverse reactions was 31.25%, there was no adverse events such as serious hemorrhage，life threatening and organ failure hemorrhage occurred．Conclusion Dabigatran has good efficacy and safety in the treatment of the elderly NVAF.
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Objective To explore the starting point of pharmaceutical care by clinical pharmacists for patients after heart valve replacement. Methods Combined with typical cases, the content, focus and effects of pharmaceutical care for patients after heart valve replacement were summarized. Results Clinical pharmacists provided pharmaceutical services such as anticoagulant care and warfarin dosage adjustment, infection monitoring and rational use and care of antibacterial, perioperative airway management, stress ulcer (SU) prevention and pharmaceutical care, and warfarin medication education for patients, which had promoted the rational use of drugs and improved the treatment results of patients. Conclusion Pharmaceutical care by clinical pharmacists could be helpful to improve the safety and efficacy of drug treatment for patients after heart valve replacement.
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Objective To explore the strategies of perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation. Methods The antithrombotic therapy in one patient undergoing revision total hip arthroplasty after coronary stent implantation was analyzed with the review of related literatures. Results The patient developed non-ST segment elevated myocardial infarction due to the stop of aspirin three days before operation and no low molecular weight heparin was used. The antithrombotic treatment and prevention of venous thromboembolism were analyzed. Conclusion Antithrombotic therapy should be selected reasonably in patients undergoing revision total hip arthroplasty after coronary stent implantation.
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Objective To investigate the anti-inflammatory role of α7 nicotinic acetylcholine receptor (α7nAChR) under inflammatory stress and its mechanisms. Methods PNU282987 was used for the activation of α7nAChR and LPS was administrated as inflammatory stressor. Realtime PCR was used for the detection of IL-1β, IL-6, TNF-α, M1 macrophage marker CD68, CD86 and M2 macrophage marker CD206, Arg1. Cell immunofluorescence was used for the detection of M1/M2 ratio and Western blot was applied for the detection of autophagy-related proteins. Results Under the stimulation of LPS, the mRNA levels of proinflammatory cytokines IL-1β, IL-6 and TNF-α, the proportion of M1 macrophage and autophagy process were increased in BV2 microglial cells. However, the administration of PNU282987 significantly decreased the mRNA levels of IL-1β, IL-6 and TNF-α and the proportion of M1 macrophage while increased the proportion of M2 macrophage and the level of autophagy process. Conclusion Activating α7nAChR plays an anti-inflammatory role in microglial cells under inflammatory stress due to the regulation of M1/M2 macrophage ratio and increase of autophagy level.
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OBJECTIVE:To evaluate the feasibility of using CYP2C19 gene to guide the use of antiplatelet agents in acute cor-onary syndrome(ACS)patients undergoing interventional operation in China from the viewpoint of pharmacoeconomics. METH-ODS:Based on global PLATO trial data,the patients were divided into 3 groups according to treatment strategies(clopidogrel group,ticagrelor group,genetic test group). By applying Treeage Pro 2011 software,short-term decision tree model and long-term Markov model were established,and related data were imported to evaluate cost-effectiveness of different treatment strategies. RE-SULTS&CONCLUSIONS:For ACS patients,according to the level of GDP in China,conventional use of ticagrelor is of pharma-coeconomic advantage for in Shanghai and uninsured patients insured patients;the use of antiplatelet agents guided by CYP2C19 gene test is of pharmacoeconomic advantage among nationwide insured patients.
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Objective To explore the role of clinical pharmacists in analyzing and dealing with abnormal INR value fluc-tuations caused by the drug interaction of warfarin and amiodarone in a post heart valve replacement patient .Methods By com-paring interactions between warfarin and other drugs ,we investigated the drugs the patient was using ,found the cause of unu-sual INR value fluctuations ,and regulated warfarin dosage in time .After that ,we intensified the monitoring of coagulation function and offered detailed pharmaceutical care to the patient .In addition ,we studied the possible reasons for the phenome-non from the following aspects such as the drug action mechanisms of warfarin and amiodarone ;the interaction mechanisms of the two drugs ;the correlation of anticoagulation effects of warfarin ,the dosage and concentration of combined use of these two drugs .Results The reason for unusal INR value fluctuations was identified as the drug interaction between warfarin and amio-darone .Amiodarone can enhance the anticoagulant effects of warfarin ,increase the risk of bleeding .By stoping warfarin for 3 days ,INR value was restored to the target range .Then we continued the anticoagulant therapy ,and the condition of the pa-tient was controlled steadily ,and he was discharged smoothly .Conclusion Clinical pharmacists can help doctors find out prob-lems related to drug therapy in time by providing effective pharmaceutical care to patients ,so doctors may adjust the treatment in time .When using the drugs interacted with warfarin ,we have to consider the those drug effects on anticoagulant therapy .In order to adjust regimens in time ,we must understand the pharmacology and pharmacokinetics of the drugs we used at the same time;as well ,we must intensify monitoring .Therefore ,we can improve the safety and rationality of clinical medication ,and also can provide better pharmaceutical care for patients .
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Objective To explore and analyze the current status of the postgraduate education of clinical pharmacy in China for improving its level and quality .Methods Comprehensive analysis and evaluation were applied for the education mod-els and trends of clinical pharmacy in China through the internet and related databases .Results 136 articles were analyzed ,of which 70 articles (51 .47% ) involved status analysis ,education pattern discussion ,in China and international comparison and curriculum optimization .The analysis result indicates that there are two main cultivation models for postgraduate education of clinical pharmacy :professional degree and scientific degree .The educational model is still immature in curriculum and teaching methods .The main problems are:curriculum unreasonable ,lack of clinical practice hours ,and disconnection of teaching con-tents and clinical needs .Conclusion The current postgraduate education of clinical pharmacy in China cannot achieve the goal of postgraduate education ,it is hard to meet the needs of clinical pharmacy postgraduate talents .We recommended that clinical pharmacy postgraduate training process should focus on linking theory with practice ,outstanding mastery medicine as well as clinical pharmacy ,optimizing teaching content and methods ,and regulating the quality of teaching standards .
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Objective To investigate the features and risk factors associated with lymph node metastasis in colorectal neuroendocrine neoplasm.Methods Clinical and pathological data of 63 patients with colorectal neuroendocrine neoplasm treated in Yinzhou People's Hospital between June 1997 to December 2012,were analyzed retrospectively.Comparisons of categorical data and univariate analysis of risk factors of lymph node metastasis were conducted by x2 test,multivariate analysis was conducted by Logistic regression analysis.Results Of the 63 patients the rate of regional lymph node metastasis was 30％ (19/63) with 58％ limited to para-intestinal lymph nodes in 11 cases,26％ limited to mesenteric lymph nodes in 5 cases,and 16％ limited to mesenteric root central lymph nodes in 3 cases.No metastasis exceeding central lymph nodes was observed.According to univariate analysis,tumor size,depth of invasion,ulceration in mucous membrane,invasion of lymphatic vessel and pathological grading suggested by WHO were related to regional lymph node metastasis (P ＜ 0.01).Multivariate regression analysis revealed that tumor size,invasion of lymphatic vessel and pathological grading were independent risk factors for lymph node metastasis in colorectal neuroendocrine neoplasm (P ＜ 0.05).Conclusions Colorectal neuroendocrine neoplasm with larger tumor size,invasion of lymphatic vessel or higher grade (G2,G3) has high risk of regional lymph node metastasis.
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Objective To evaluate the antibacterial activity of Cefdinir compared with other four antimicrobial agents against common isolates in vitro.Methods Minimal lnhibitory Concentrations (MIC) were determined by agar dilution method Results Staphylococcus aureus (MSSA) showed highest susceptibility to Cefdinir with 100% susceptible rate, Streptococcus pneumoniae (including PSSP and PISP) showed higher susceptibility to Cefdinir with 63 6% 100 0% susceptible rate Hemophilus influenza and Moraxelle catarrhalis both showed good susceptibility to three kinds of cephalosporins and Azithromycin Klebsiella pneumoniae (including ESBLs positive strains) were resistant to three kinds of cephalosporins, while ESBLs negative Klebsiella pneumoniae were sensitive to three kinds of cephalosporins, with 73 10%~88 50% susceptible rate Conclusion Compared with other four antimicrobial agents, Cefdinir has a powerful antibacterial activity to pathogen from respiratory tract infections