Correlation Analysis Between Changes of D-Dimer Level and Rheumatoid Arthritis Complicated with Interstitial Lung Disease

Objective:To explore the correlation between the change of D-dimer level and rheumatoid arthritis complicated with interstitial lung disease.Methods:From January 2022 to February 2024,20 rheumatoid arthritis patients complicated with interstitial lung disease(interstitial lung disease group),20 rheumatoid arthritis patients without interstitial lung disease(without interstitial lung disease group),and 20 healthy people(control group)in Xijing Hospital were selected for this study.The fasting venous blood of the three groups of subjects was collected and their D-dimer,C-reactive protein(CRP),rheumatoid factor(RF),and erythrocyte sedimentation rate(ESR)were detected.Subsequently,the correlation between each index and rheumatoid arthritis complicated with interstitial lung disease was analyzed.Results:The D-dimer level of the interstitial lung disease group was significantly higher than the other two groups(P<0.05).The D-dimer level of the group without interstitial lung disease was significantly higher than the control group(P<0.05).CRP levels in the interstitial lung disease group and the group without interstitial lung disease were significantly higher than those of the control group(P<0.05).The ESR and RF levels of the interstitial lung disease group were significantly higher than the other two groups(P<0.05).The levels of ESR and RF levels of the group without interstitial lung disease were significantly higher than the control group(P<0.05).Conclusion:D-dimer levels of rheumatoid arthritis patients are higher than those of healthy individuals,and those complicated with interstitial lung disease present even higher levels.This finding shows that there is a correlation between D-dimer levels and rheumatoid arthritis with interstitial lung disease,which may facilitate the evaluation and diagnosis of this disease.

Mechanism of Gegen Qinlian Decoction in Treating Type 2 Diabetes Mellitus Complicated with NAFLD Based on Network Pharmacology

[Objectives]To explore the mechanism of Gegen Qinlian Decoction in treating type 2 diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD)by analyzing the effective components of Gegen Qinlian Decoction.[Methods]TCMSP database was used to analyze the active components of Gegen Qinlian Decoction,and pubchem and Swiss ADME databases were also used to predict drug targets,extract T2DM complicated with NAFLD targets from OMIM and Genecards databases.Venny plot was drawn to obtain intersection targets,and finally Cytoscape was used to make core target maps and drug-target-disease network maps.Using DAVID and Metascape database to analyze the intersection targets,the gene ontology information of Go and KEGG was obtained.Microbial informatics technology was used to visualize GO,and Cytoscape was used to make drug-target-disease network map-enrichment pathway map.[Results]The network pharmacological analysis showed that Gegen Qinlian Decoction acted on the key targets of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease,such as ALB and ALT1,through many components,and achieved the purpose of treating this disease.The chemical constituents of the drug include formononetin,5-hydroxyisomucronulatol-2,5-2-O-glucoside,cholesteryl laurate,isoliquiritigenin,etc.[Conclusions]This study provides a new idea and theoretical support for future drug research and clinical practice.

Mechanism of Wulan Shisanwei Decoction in Treating Hypertension Complicated with Hyperlipidemia Based on Network Pharmacology

[Objectives]To screen out the main effective components of Wulan Shisanwei Decoction in the treatment of hypertension complicated with hyperlipidemia based on the method of network pharmacology,predict the target and explore the possible mechanism.[Methods]13 components of Wulan Shisanwei Decoction were searched on the TCMSP data platform,the corresponding active components were found and the corresponding targets were searched in Pubchem database.GeneCards database was used to screen the corresponding targets of hypertension and hyperlipidemia.The core target PPI network of Wulan Shisanwei Decoction in the treatment of hypertension complicated with hyperlipidemia was constructed by processing in STRING database.The effective data were imported into Cytoscape 3.8.0 to analyze the network topology parameters,and they were screened according to the degree value greater than the average value.Finally,the relevant information about the core target of Wulan Shisanwei Decoction in the treatment of hypertension complicated with hyperlipidemia was obtained.GO enrichment analysis and KEGG pathway analysis were carried out for core targets in DAVID database.The visualization map of"drug-component-target-disease"was drawn by Cytoscape 3.8.0.[Results]A total of 85 active components were obtained from Wulan Shisanwei Decoction,and there were 1532 corresponding targets.A total of 303 key targets were obtained by intersecting corresponding drug targets with disease targets.3178 biological processes were obtained by GO analysis(P<0.05)and 192 signaling pathways were obtained by KEGG enrichment analysis(P<0.05).[Conclusions]It was predicted that the main active components of Wulan Shisanwei Decoction in the treatment of hypertension complicated with hyperlipidemia were stigmasterol,acacetin,pectolinarigenin,isorhamnetin,alizarin,quercetin,nordamnacanthal,kaempferol,luteolin,glyceollin,kushenol,t,3-methylkempferol,ellagic acid,etc.20 core targets were selected in the treatment of hypertension complicated with hyperlipidemia:SRC,STAT3,HSP90AA1,MAPK1,MAPK3,PIK3R1,HRAS,GRB2,PIK3CA,AKT1,PTPN11,ESR1,LCK,EGFR,FYN,EP300,RELA,JUN,LYN,RHOA.These targets were involved in PI3K-Akt signaling pathway,lipid and atherosclerosis,proteoglycan in cancer,Ras signaling pathway,etc.to exert a response to oxidative stress,cellular response to chemical stress,peptidyl-tyrosine phosphorylation and peptide tyrosine modification,and can intervene in the early stage of the disease.It may be the potential mechanism of Wulan Shisanwei Decoction in the treatment of hypertension complicated with hyperlipidemia.

Protective effects of Zuogui Jiangtang Jieyu Formula on hippocampal neurons in rats of diabetes complicated with depression via the TRP/KYN metabolic pathway

Objective To explore the protective effects and mechanism of Zuogui Jiangtang Jieyu Formula(左归降糖解郁方,ZGJTJYF)on hippocampal neurons in rats of diabetes complicated with depression(DD)via the TRP/KYN metabolic pathway.Methods(i)In vivo experiments:60 specified pathogen free(SPF)grade male Sprague-Dawley(SD)rats were randomly divided into six groups with 10 rats in each groups:control,DD model,positive(1.8 mg/kg fluoxetine+0.18 g/kg metformin),high-dose ZGJTJYF(ZGJTJYFH,40.500 g/kg ZGJTJYF),middle-dose ZGJTJYF(ZGJTJYF-M,20.250 g/kg ZGJTJYF),and lowdose ZGJTJYF(ZGJTJYF-L,10.125 g/kg ZGJTJYF)groups.Except for the control group,other groups were established DD model by high-fat emulsion intake with single tail vein streptozotocin(STZ)and four weeks of chronic unpredictable mild stress(CUMS).All drug administration groups were treated by gavage during CUMS modeling,and the control and model groups were given equal amount of distilled water.After four weeks,the serum levels of blood glucose and glycosylated hemoglobin were measured to determine the hypoglycemic effect of ZGJTJYF.Moreover,the open field test and Morris water maze test were performed to evaluate the antidepressant effect of ZGJTJYF.Changes in 5-hydroxytryptamine(5-HT)level were detected via high-performance liquid chromatography with electrochemical detection(HPLC-ECD);the levels of tryptophan(TRP),kynurenine(KYN),and indoleamine 2,3-dioxygenase(IDO)in the hippocampus were detected using enzyme-linked immunosorbent assay(ELISA);the protein expression levels of synaptophysin(SYN)and postsynaptic density material-95(PSD-95)were detected via immunohistochemistry(IHC);and the protein expression levels of N-methyl-D-aspartate receptor(NR)2 A and NR2 B were detected using Western blot.(ii)In vitro experiments:five SPF grade SD pregnant rats(E16–18)were used to obtain primary hippocampal neurons(Ne),six SD new-born rats were used to collected primary astrocytes(As)and microglia(MG),and to establish a Ne-As-MG co-culture system.All co-culture systems were divided into six groups:control(PBS),model[150 mmol/L glucose+200μmol/L corticosterone(G&P)+PBS],blank(G&P+blank serum),positive(G&P+positive drug-containing serum),ZGJTJYF(G&P+ZGJTJYF serum),and 1-methyl-D-tryptophan(1-MT,IDO inhibitor)(G&P+1-MT)groups.After 18 h of intervention by corresponding treatment,immunofluorescence was used to analyze the protein expression levels of SYN,PSD-95,NR2 A,and NR2 B;ELISA was performed to measure the levels of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,and TRP/KYN metabolic pathway-related factors[TRP,KYN,kynurenine acid(KYNA),quinolinic acid(QUIN)].Results(i)In vivo experimental results showed that ZGJTJYF-M and ZGJTJYF-L significantly improved the elevated blood glucose state of DD rats(P<0.01 and P<0.05,respectively);ZGJTJYF-H,ZGJTJYF-M,and ZGJTJYF-L increased their autonomous activity,learning,and memory ability(P<0.01,P<0.01,and P<0.05,respectively).Moreover,the levels of 5-HT and TRP were significantly increased(P<0.01),and the levels of KYN and IDO were significantly decreased in the hippocampus(P<0.01)of rats after ZGJTJYF-M treatment.The protein expression levels of SYN and PSD-95 were significantly upregulated in hippocampal neurons(P<0.01),while the abnormal activation of NR2A and NR2B was markedly inhibited in hippocampus(P<0.05)of rats after ZGJTJYF-M treatment.(ii)In vitro experimental results showed that ZGJTJYF-containing serum significantly increased the protein expression levels of SYN and PSD-95 in hippocampal neurons(P<0.01),decreased the levels of IL-1β(P<0.01),IL-6(P<0.05),TNF-α(P<0.01),IDO(P<0.05),KYN(P<0.05),and QUIN(P<0.01),and increased the levels of TRP and KYNA(P<0.01)in the simulated DD state.ZGJTJYF also had an significantly inhibitory effect on the abnormal activation of NR2A and NR2B in neurons(P<0.05)in a stimulated DD state.Conclusion ZGJTJYF can effectively improve 5-HT deficiency in the hippocampus of rats by inhibiting IDO expression and regulating the TRP/KYN metabolic pathway,and it has a favorable protective effect on hippocampal neuron injury caused by DD.Therefore,ZGJTJYF is an effective potential therapeutic drug for the prevention and treatment of DD.

Clinical Study on the Retention Enema with Modified Dahuang Mudan Decoction in Treating Lower-Jiao Obstruction Syndrome Caused by Severe Pneumonia Complicated with Heart Failure

[Objectives]To treat patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure using the retention enema with Modified Dahuang Mudan Decoction,and to observe the effect and safety of this treatment on inflammatory indicators,cardiac function,gastrointestinal function and multiple organ failure in patients with Lower-Jiao(lower energizer)Obstruction Syndrome caused by severe pneumonia complicated with heart failure.[Methods]54 patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure diagnosed in Nanchong Chinese Medicine Hospital from January 2020 to December 2021 were randomly divided into experimental group(n=27)and control group(n=27).The control group was given conventional treatment combined with 0.9%sodium chloride injection(100 mL)+glycerine enema(40 mL).The treatment group was treated with Modified Dahuang Mudan Decoction on the basis of conventional treatment for 7 d.The efficacy indicators and adverse events such as white blood count(WBC),C-reactive protein(CRP),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),Lausanne Intestinal Failure Estimation(LIFE)and multiple organ dysfunction score(MODS)were observed.[Results](i)There was no significant difference in WBC,PCT,CRP and NT-proBNP between the two groups before treatment.All indicators after treatment were significantly lower than those before treatment in both groups(P<0.05).The levels of WBC,PCT and CRP in the treatment group were lower than those in the control group after treatment(P<0.05),and there was no significant difference in NT-proBNP between the two groups after treatment(P>0.05),but the difference in NT-proBNP before and after treatment in the treatment group was higher than that in the control group.(ii)The LIFE of the two groups decreased significantly after treatment,and the improvement of LIFE of the treatment group was better than that of the control group(P<0.05).(iii)The MODS of the two groups decreased significantly after treatment(P<0.05),and the degree of decrease after treatment in the treatment group was higher than that in the control group(P<0.05).(iv)There was no significant difference in all-cause mortality between the two groups(P>0.05).(v)No serious adverse events were found in both groups during the treatment period.[Conclusions]The conventional treatment,combined with the retention enema with Modified Dahuang Mudan Decoction could further reduce the inflammatory indicators,improve cardiac function,improve intestinal function and organ function,and the safety was good.

ACUPUNCTURE TREATMENT OF FEMALE OBESITY COMPLICATED WITH PREMENSTRUAL TENSION SYNDROME

Objective： To explore mechanisms of acupuncture for the treatment of obesity complicated with prernenstrual tension syndrome （PTS）. Methods： By means of syndrome-differentiation, 45 female simple obese （SO） patients with PTS （SO＋ PTS group and 35 simple obesity patients （SO group） were treated with body acupuncture combined with ear acupuncture. Thirtythree normal women subjects were assigned to control group. Changes in symptoms, signs, obesity index, clinical indices of disease and syndrome, equilibrium index of the vegetative nervous system （Y value）, blood estradiol （E2）, progesterone （P）, aldosterone （Aid） and lipid levels were detected and compared before and after the treatment. Results： Before acupuncture treatmerit, the obesity index, clinical indices of disease and syndrome, Y value, E2/P ratio and Aid in these patients were obviously increased, and E2 and P levels decreased. After the treatment, the body weight of the patients was reduced, and the increased obesity index, clinical indices of diseases and syndromes, Y value, E2/P ratio and Aid were markedly lowered （P〈0.05, or P 〈 0.01）, and the decreased E2 and P levels elevated significantly （P〈 0.01）. Conclusion： Acupuncture exerts favorable regulative function on clinical indices of disease and syndrome, Y value, E2, P, Aid, lipid and E2/P in obese patients with PTS, which may be related to its resultant improvement of the functions of the hypothalamo-pituitary-gonedal axis, hypothalamo-pituitary-adrenal axis and the vegetative nervous system.

Study on treatment and nursing of elderly patients with gastric cancer complicated with diabetes

Objective To study and analyze the treatment and nursing of elderly patients with gastric cancer complicated with diabetes.Methods:different data were analyzed and summarized.Conclusion:the elderly patients with gastric cancer and diabetes can cooperate with the control of blood glucose during the surgical treatment,and strengthen the nursing before and after the operation.

Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

Acute necrotizing pancreatitis complicated with pancreatic pseudoaneurysm of the superior mesenteric artery: A case report

Acute necrotizing pancreatitis complicated with pancreatic pseudoaneurysm is a rare emergency associated with high mortality that demands immediate treatment to save the patient’s life. We treated a 64-year-old man who presented with a bleeding pseudoaneurysm of the superior mesenteric artery caused by acute pancreatitis, using interventional embolizing therapy. In the present report we show that interventional treatment is an effective therapeutic modality for patients with acute necrotizing pancreatitis complicated with intra-abdominal bleeding.

Comparison of efficacy and safety between late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy for cervical cancer complicated with pelvic lymph node metastasis

Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.

Effects of Progressive Muscle Relaxation Training Combined with Emotion Nursing of Traditional Chinese Medicine on Motor Function and Quality of Life in Patients with Cerebral Stroke Complicated with Hemiplegia

OBJECTIVE: To explore the effects of progressive muscle relaxation training combined with emotion nursing of traditional Chinese medicine(TCM) on the motor function and quality of life in patients with cerebral stroke complicated with hemiplegia. METHODS: A total of 100 cases of patients with cerebral stroke complicated with hemiplegia who were admitted to Rehabilitation Medicine Department of Suzhou Municipal Hospital from May 2016 to May 2017 were selected and randomly divided into study group(50 cases) and control group(50 cases), and they were nursed for 1 month. Control group was given routine nursing, and study group was given progressive muscle relaxation training combined with TCM emotion nursing on the basis of routine nursing. The scores of all items were obtained by nurses through questionnaires, and the motor function and quality of life were analyzed and compared between the 2 groups. RESULTS: After nursing, the scores of muscle strength, Barthel index(BI) and Fugl-Meyer motor function scales in study group were higher than those in control group(P < 0.05). The facing scores of coping style in study group were higher than those in control group, and the avoidance score and yielding score were lower than those in control group(P < 0.05). The scores of depression and anxiety in study group were lower than those in control group(P < 0.05). The scores of items in SF-36 life scale in study group were higher than those in control group(P < 0.05). CONCLUSION: Progressive muscle relaxation training combined with TCM emotion nursing is conducive to the recovery of motor function and improvement of quality of life in patients with cerebral stroke complicated with hemiplegia.

On-treatment isolated superior ophthalmic vein thrombosis complicated with carotid cavernous fistula: a case report

Dear Editor, We are writing this letter to present a case of ontreatment isolated superior ophthalmic vein thrombosis(SOVT) that progressed to cavernous sinus thrombosis(CST) and further complicated with carotid cavernous fistula(CCF). SOVT is a rare but potentially lethal illness. It is normally presented with orbital congestion syndrome with proptosis, ophthalmoplegia, diplopia, and high intraocular pressure(IOP)[1]. Late detection of this disease can lead to devastating complications such as optic nerve compression。

Clinical efficacy and significance of serum fibroblast growth factor-21 and ghrelin in the treatment of type 2 diabetes complicated with coronary heart disease with integrated traditional Chinese and western medicine

Objective: To treat the patients with type 2 diabetes mellitus complicated with coronary heart disease, to explore the clinical efficacy and mechanism of conventional western medicine combined with Yiqi Yangyin Huoxue herbs, and to detect the level of serum fibroblast growth factor-21 (FGF-21) and Ghrelin. Changes and significance. Methods: A randomized control method was used to collect 100 patients with type 2 diabetes mellitus complicated with coronary heart disease who were diagnosed and treated in our hospital from March 2015 to March 2018.They were randomly divided into two groups according to the random number table method: 50 patients separately. The patients in the control group were treated with conventional western medicine and basic treatment;the observation group was treated with the addition and subtraction of traditional Chinese medicine formulas on the basis of the control group;the clinical curative effect was evaluated after two months of treatment, and the treatment efficiency and scores of traditional Chinese medicine symptoms were observed in the two groups. Basic laboratory indicators were improved, and serum levels of FGF-21 and Ghrelin in patients were measured and the difference between the results of the tests was compared with the condition and efficacy. Results: After treatment, the total effective rate of the observation group (86.0%) was significantly higher than that of the control group (68.0%) (P<0.05), suggesting that the combination of Chinese and Western medicine treatment can significantly improve the clinical efficacy;before treatment,there is no difference between the two groups of Chinese medicine symptom scores (P>0.05). After treatment, the symptom scores of the two groups were significantly improved after treatment (P<0.05). The observation group was better among the two groups (P<0.05).After treatment, the basic biochemical indicators were improved. The observation group was better than the control group (P<0.05);Serum FGF-21 levels were significantly lower in both groups after treatment (P<0.05), and Ghrelin levels were significantly increased. There was a statistically significant difference between the two groups (P<0.05). Conclusion: The use of conventional western medicine in combination with Yiqi Yangyin Huoxue Chinese medicine for the treatment of type 2 diabetes mellitus patients with coronary heart disease can significantly improve the clinical efficacy, effectively promote the improvement of symptoms, and can be used in clinical work through serum FGF-21, Ghrelin levels combined detection of the value of Abnormal changes to predict the severity of type 2 diabetes mellitus with coronary heart disease severity and treatment effect should be widely used in clinical diagnosis and treatment.

Pregnancy Complicated With a Giant Pancreatic Tumor and Decompensation of Liver Cirrhosis:A Case Report and Literature Review

Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.

Risk factors related to death in patients with tuberculosis complicated with sepsis in an intensive care unit

Objective To explore the risk factors related to death in patients with tuberculosis complicated with sepsis in an intensive care unit,in order to provide reference for the clinical treatment of patients with tuberculosis complicated with sepsis.Methods A retrospective case-control study was conducted to collect the general clinical data of 384 patients with tuberculosis complicated with sepsis in intensive care unit of Public Health Clinical Center of Chengdu from March 2020 to November 2022.

Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes

Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.

Discontinuity development patterns and the challenges for 3D discrete fracture network modeling on complicated exposed rock surfaces

Natural slopes usually display complicated exposed rock surfaces that are characterized by complex and substantial terrain undulation and ubiquitous undesirable phenomena such as vegetation cover and rockfalls.This study presents a systematic outcrop research of fracture pattern variations in a complicated rock slope,and the qualitative and quantitative study of the complex phenomena impact on threedimensional(3D)discrete fracture network(DFN)modeling.As the studies of the outcrop fracture pattern have been so far focused on local variations,thus,we put forward a statistical analysis of global variations.The entire outcrop is partitioned into several subzones,and the subzone-scale variability of fracture geometric properties is analyzed(including the orientation,the density,and the trace length).The results reveal significant variations in fracture characteristics(such as the concentrative degree,the average orientation,the density,and the trace length)among different subzones.Moreover,the density of fracture sets,which is approximately parallel to the slope surface,exhibits a notably higher value compared to other fracture sets across all subzones.To improve the accuracy of the DFN modeling,the effects of three common phenomena resulting from vegetation and rockfalls are qualitatively analyzed and the corresponding quantitative data processing solutions are proposed.Subsequently,the 3D fracture geometric parameters are determined for different areas of the high-steep rock slope in terms of the subzone dimensions.The results show significant variations in the same set of 3D fracture parameters across different regions with density differing by up to tenfold and mean trace length exhibiting differences of 3e4 times.The study results present precise geological structural information,improve modeling accuracy,and provide practical solutions for addressing complex outcrop issues.

Surgical outcomes of complicated cataract with pediatric trematode granulomatous uveitis

AIM:To describe the clinical characteristics and surgical outcomes of complicated cataract with pediatric trematodal granulomatous uveitis(TGU).METHODS:Patients of cataract with TGU in the membranous(inactive) stage underwent cataract surgery with intraocular lens(IOL) implantation.Preoperative history and ophthalmic examination were conducted for all cases,whereas Schimphlug imaging and corneal topography were done for some patients.Postoperative follow up was done on the 1st,2nd,and 5th postoperative days after surgery.Then,it was done at least at one,three,and six months postoperatively.Intraoperative and postoperative complications and the methods of their management were reported.RESULTS:Twelve eyes of 12 male children were included in this study ranging from 8 to 16y.The mean best corrected Snellen visual acuity(BCVA) was significantly improved from 0.09±0.06 preoperatively to 0.37±0.11 at the final visit 6mo postoperatively(P<0.001).Schimphlug imaging and corneal topography showed flattening of the anterior surface of the inferior cornea.Intraoperative difficulties and complications included the poor dilatability of the drown down pupil,strong posterior synechia between the anterior lens capsule and the iris at the site of the inferior retrocorneal vascularized membrane and hyphema.All cases underwent primary hydrophobic IOL implantation.CONCLUSION:Surgery for this type of cataract is relatively safe and effective.It is associated with some specific difficulties and complications that should be considered during surgery and follow up.

Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?

Objective:Ureteral stents are customarily inserted to facilitate urinary drainage,but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences.The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade(Clavien-Dindo Grade 4A or above)complications.Methods:The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed.The parameters recorded included patient demographics,indwelling time,need for percutaneous nephrostomy,hemodialysis,urine culture,blood culture,total blood counts,serum creatinine,radiologic findings,management techniques,number of surgical interventions,modified Clavien-Dindo complications,follow-up,and mortality,if any.Results:Forty patients were included in the study.The median age was 52(range 6-85)years.Of the total,25(62.5%)patients had a“significant”stent load;31(77.5%)had renal failure or acute kidney injury on presentation;19(47.5%)patients had sepsis at presentation.Among the patients presented with sepsis,11(57.9%)patients demonstrated a positive urine culture;and 7/11(63.6%)patients exhibited pan-resistant organisms.Twelve out of 40(30.0%)patients in our series developed high-grade Clavien-Dindo complications.On univariate analysis,sepsis at presentation(p=0.007),stent load(p=0.031),diabetes(p=0.023),positive urine culture(p=0.007),and stent indwelling time of more than 1 year(p=0.031)were found to be significant.On multivariate logistic regression analysis,sepsis at presentation(p=0.017)and positive urine culture(p=0.016)were significant predictors for high-grade complications.Conclusion:It is prudent to identify specific risk factors,namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.