Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal(GI) injury with combined protective medications.METHODS:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang University.The hospital has 2300 beds and 2.5 million outpatient visits annually.Data mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in 2011.Concomitant use of proton-pump inhibitors(PPIs),histamine 2-receptor antagonists(H2RA) and mucoprotective drugs(MPs) were analyzed.A defined daily dose(DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs(NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs(misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring records.The annual incidence of major GI bleeding due to low-dose aspirin was estimated for outpatients.RESULTS:Prescriptions for aspirin users receiving PPIs,H2RA and MPs(n = 1039) accounted for only 3.46% of total aspirin prescriptions(n = 30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82%,0.12%,0.40% and 0.12%,respectively.No statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or MPs.The combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs(2.82% vs 0.40%,P < 0.05) and aspirin/H2RA(2.82% vs 0.12%,P < 0.05).The values of DDDs of MPs in descending order were as follows:gefarnate,hydrotalcite > teprenone > sucralfate oral suspension > L-glutamine and sodium gualenate granules > rebamipide > sucralfate chewable tablets.The ratio of MP plus aspirin prescriptions to the total MP prescriptions was as follows:rebamipide(0.47%),teprenone(0.91%),L-glutamine and sodium gualenate granules(0.92%),gefarnate(0.31%),hydrotalcite(1.00%) and sucralfate oral suspension(0.13%).Percentages of prescriptions containing aspirin and intestinal protective drugs among the total aspirin prescriptions were:rebamipide(0.010%),PPI/rebamipide(0.027%),teprenone(0.11%),PPI/teprenone(0.037%),gefarnate(0.017%),and PPI/gefarnate(0.013%).No prescriptions were found containing coadministration of aspirin and other NSAIDs.Among the 3196 prescriptions containing aspirin/clopidogrel,3088(96.6%) prescriptions did not contain any GI protective medicines.Of the 389 prescriptions containing aspirin/corticosteroids,236(60.7%) contained no GI protective medicines.None of the prescriptions using aspirin/warfarin(n = 22) contained GI protective medicines.Thirty-five patients were admitted to this hospital in 2011 because of acute hemorrhage of upper digestive tract induced by low-dose aspirin.The annual incidence rates of major GI bleeding were estimated at 0.25% for outpatients taking aspirin and 0.5% for outpatients taking aspirin/warfarin,respectively.CONCLUSION:The prescribing pattern of low-dose aspirin revealed a poor awareness of preventing GI injury with combined protective medications.Actions should be taken to address this issue.

Analysis on Clinical Characteristics and Combination Medications of Elemene Injection in the Treatment of Esophageal Cancer in Real World Research

Objective:To explore the clinical characteristics of Elemene Injection in the treatment of patients with esophageal cancer.Methods:A total of 310 patients diagnosed with esophageal cancer from the Hoptital Information System(HIS)of 21 hospitals across the country were selected in the study,and these patients all had been treated with Elemene Injection.In this study,the clinical general medication record information,diagnosis scheme information,general treatment information and combined medications information were analyzed by frequency statistics and association rules.Results:Elemene Injection was used most in patients aged 46-65(177 cases,57.10%);male patients were more than female.Among the main diagnoses of the most seasons and solar terms in hospitalization,the top three diagnoses were esophageal malignant tumor,malignant tumor,and hypertension.In terms of combination medication,the combination of western medicine blood substitutes and perfusion fluids,general nutritional drugs,vitamins,antibacterial drugs,and immune-promoting drugs were the main ones;the combination of traditional Chinese medicine was mainly anti-tumor drugs(48.71%).In addition,among the combination medications,the highest frequency of Elemene Injection combined with western medicine and traditional Chinese medicine were Xiaoaiping Injection(消癌平注射液)and ascorbic acid.Conclusion:The main susceptible people of esophageal cancer was middle-aged around 46-65,and there were more male patients than female;through the first diagnosis of western medicine,it can be found that in addition to patients suffering from esophageal cancer or other cancers,patients with high blood pressure,heart disease,and diabetes could use Elemene Injection.Therefore,when receiving such patients,attention should be paid to checking whether the patient had such diseases.At the same time,when using Elemene Injection,it's necessary to pay attention to certain combined medications to avoid adverse reactions.

Clinical observation of acupuncture combined with medication for mild-to-moderate depression

Objective:To discuss the clinical efficacy and plausible mechanism of Tiao Yang Qu Xie(regulating Yang to eliminate pathogenic factors)needling method plus paroxetine in treating mild-to-moderate depression.Methods:Sixty-six patients with mild-to-moderate depression were divided into an observation group and a control group using the random number table method,each consisting of 33 cases.Another 25 healthy subjects were recruited as a healthy group.The control group took oral paroxetine tablets for treatment,and the observation group received additional acupuncture treatment 3 times weekly.Both groups underwent 4-week treatment.Before treatment,after 2-week and 4-week treatment,and 2 weeks after treatment(follow-up),the patients were assessed using the Hamilton depression scale-17-item(HAMD-17),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and traditional Chinese medicine(TCM)pattern element identification scale for depression.The two groups each randomly contributed 25 cases to detect the protein content of brain-derived neurotrophic factor(BDNF)before treatment and after 4-week treatment,and compared with the healthy group.Results:After 2-week treatment,the markedly effective and total effective rates were significantly higher in the observation group than in the control group(P<0.05);after 4-week treatment,the observation group significantly surpassed the control group in comparing the markedly effective rate(P<0.05).After 2 and 4 weeks of treatment and at the follow-up,the HAMD-17 total score and sleep disorder factor score were lower in the observation group than in the control group(P<0.05);the anxiety-somatic score was lower in the observation group than in the control group after 2-week treatment(P<0.05).After 2 and 4 weeks of treatment and at the follow-up,the observation group was lower than the control group in comparing the scores of SDS,SAS,and TCM pattern element identification scale for depression(P<0.05).After 4-week treatment,the observation group had an increased serum BDNF protein content,higher than that in the control group(P<0.05)and had no significant difference compared to the healthy group(P>0.05).Conclusion:Compared to the use of oral paroxetine alone,acupuncture plus paroxetine can produce more significant efficacy in treating mild-to-moderate depression and act faster in improving sleep disorder and anxiety-somatic symptoms;increasing the serum BDNF protein content may be a part of the mechanism underlying its antidepressant actions.

Effect of Glycerol Fructose Combined with Mannitol on Patients with Cerebral Hemorrhage and Cerebral Edema

Objective:To observe the effect of glycerol fructose combined with mannitol in the treatment of patients with clinical intracerebral hemorrhage complicated by cerebral edema and increased intracranial pressure,and to evaluate the clinical application value of this treatment.Methods:Seventy patients with cerebral hemorrhage complicated by brain edema were randomly divided into observation and control groups.Both groups had exactly the same number of study participants.There were some differences in specific treatment methods.The specific process is as follows:The control group was treated with mannitol,while the observation group was treated with dual-purpose glycerol fructose.Several important indicators after treatment in the two groups were scored,the effects between different groups were compared,and the effect of clinical treatment was evaluated.Results:The final effect was compared and analyzed.After data analysis,we found that the intracranial pressure of the observation group was lower,the volume of brain edema was significantly reduced(P<0.05),and the NIH Stroke Scale/Score(NIHSS)was lower(P<0.05).Conclusion:Using mannitol combined with glycerol fructose can achieve better treatment effect by significantly improving the problem of brain edema.

Clinical characteristics of Danshen Ligustrazine injection in the treatment of coronary heart disease with hypertension-A real world study

Objective:To explore the characteristics and rules of Danshen Ligustrazine Injection in the treatment of coronary heart disease with hypertension.Methods:From the information systems of 12 tertiary tier-one hospitals across the country,we extracted the medical data of the application of Danshen Ligustrazine Injection in the treatment of patients with coronary heart disease and hypertension.After normalization,the model was established by Apriori algorithm,and the association rules were analyzed by Clementine 12.0 software.Results:Most of the 1928 patients were between 75 and 90 years old(54.26%).There were more males than females,most with type 2 diabetes,cerebral infarction,etc.Each dose was more than 10 mL(52.78%).Aspirin enteric-coated tablets(67.63%),L-carnitine injection(58.77%),and atorvastatin calcium capsules(50.93%)were often used in combination with safflower yellow pigment(22.20%),Shexiang Baoxin Pill(16.55%),Suxiao Jiuxin Pill(15.09%);the most commonly used combination of western medicine was anticoagulant thrombolytic and antiplatelet drugs(85.84%),and the type of Chinese medicine was Huoxuehuayu(72.98%);The most common combination of two western medicines was L-carnitine injection+aspirin enteric-coated tablets,with a support of 41.9%;The most common combination of two Chinese and western medicines is western medicine·anti-anginal medicine+western medicine·anticoagulant thrombolytic and antiplatelet drugs with a support of 67.6%.Conclusion:Danshen Ligustrazine injection is mainly used in elderly patients with coronary heart disease and hypertension,with many comorbidities.The dosage standard needs to be optimized.The combination of drugs and guidelines should coordinate with each other,which provide clues for clinical diagnosis and treatment and optimization of medication.

Cardiotoxicity of current antipsychotics:Newer antipsychotics or adjunct therapy?

Use of newer antipsychotics for substitution of current antipsychotics might be one way awaiting to be clinically verified to address antipsychotic cardiotoxic effects.Alternatively,the combination of existing antipsychotics with cardioprotective agents is also beneficial for patients with mental disorders for avoiding cardiotoxicity to the maximum.

DEVELOPMENT ON CLINICAL TREATMENT OF CONSTIPATION WITH ACUPUNCTURE AND MOXIBUSTION

In the present paper, the authors review recent developmarrt of clinical treatment of constipation with acupunctire and moxibustion from ① body acupuncture therapy including special needling manipulations, as Ziwu Daojiu Needling, etc. and acupoint combination,②electrcacupunture therapy, ③ scalp-acupuncture therapy, ④ auricular acupuncture therapy, ⑤ needleembedding and acupoint-catgut-embedding therapies, ⑥ acupoint-application therapy, ⑦ combinged acupuncture aud medication therapy, ⑧ other therapies such as cupping therapy and holo-therapy, and ⑨ considerations about the action of acupuncture in the treatmnt of constipation and its prospect. Up to now, researches on the effect of acupuncture in treating constipation are seldom seen, thus, much attention should be paid about this by clinical and experimental researchers.

The role of government in the mode of ＂medical care and support＂

Along with the acceleration of population aging process, the government as a social security gatekeeper responsibility has become increasingly prominent, improve public finance policy, properly solve the pension problem has become the important work of governments at all levels. Under the guidance of national policy, the State Council ＂on promoting health and pension services combined guidance＂ put forward to 2020, the medical and health care services and resources to achieve the ordered shared, covering urban and rural areas, appropriate scale.functional^reasonable.comprehensive and continuous medical support with service network is basically formed. In this paper, the background of the aging population, the interpretation of the meaning of the combination of medical and support, analysis of the combination of medical support mode. It is pointed out that in public finance from the perspective of medical support with the development mode will face the difficulty of system design is not sufficient, the division of responsibilities is unknown, limitations of existing policies, human, financial and material resources lack of. At last on the basis of the proposed development of medical support combined with the pension service model emphasizes the role of the govenunent to speed up the system construction and innovation of financial subsidies. improve the policy system and other measures.

Research on the path of medical service combination from the perspective of departmental cooperation

As an innovative mode of social endowment, combining medical care with modern medical care technology and old-age service is an important direction of a series of social problems caused by the deepening of aging and the intensification of aging process in China. It is the inevitable choice for the development of Chinese characteristics for the aged. At present, with the continuous development of the combination of medical care and rehabilitation, the process of combination of medical care and breeding is slow, and the problems of inter departmental cooperation, high cost of resource integration and low service efficiency have emerged. The paper puts forward that multi head management of different responsibility management body is a bottleneck problem that hinders the integration of medical care. From the objective and subjective two points of view, the administrative system level barrier and the inter departmental interest game are the important reasons that obstruct the medical support and break through the estrangement of the Department and realize the cooperation. Then, according to the theory of large part system reform, the author boldly proposes the idea of establishing a new comprehensive functional department that specializes in the management of pension related affairs.

COMMENTS ON THE STUDY OF ACUPOINT COMBINATION AND REMEDIES FOR TREATMENT OF DIABETES MELLITUS WITH ACUPUNCTURE AND MOXIBUSTION

In the present paper, the author reviews the progresses in the study on acumoxi (acupuncture-moxi-bustion) treatment of diabetes mellitus (DM) from Chinese ancient classical works, Chinese and foreign journals. The therapeutic results reveal that acupuncture treatment of DM is effective in improving DM patients' symptoms via vagal-nerve reflex, regulation of neuroendocrine and immune functions. The author holds that ① correct selection of acupoints in accordance with syndrome differentiation and the related meridians and combined application of acupuncture and Chinese herbal medicines (for oral administration) are the key points for raising the therapeutic effect; and ② acupoint combination and curative methods need to be researched further.

Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective:To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes.Methods:From January 2018 to December 2018,86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group.The control group received the routine publicity and education and visiting,while the observed group adopted the cooperative nursing model of medical treatment combination.Then compare the healing status and nursing satisfaction of the two groups.Results:Of the 43 patients with pressure ulcers in the observed group,18 had been in the second stage of pressure ulcers and 16 had been healed;14 had been in the third stage of pressure ulcers and 8 had been healed;11 had been in the fourth stage of pressure ulcers and 5 had been healed.The nursing satisfaction of the patients in the observed group was 95.35%.Conclusion:Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’and their families’awareness of pressure ulcer nursing,standardize their nursing behaviour,help recover the patients themselves and promote the patients’satisfaction.

Therapeutic Observation on Swift Needling with Fire Needle plus Medication for Herpes Zoster

Objective:To discuss the effectiveness and safety of swift needling with fire needle plus medication in treating herpes zoster and the change of substance P.Methods:Seventy-nine patients with herpes zoster were selected and randomized into a fire-acupuncture group(41 cases)and a Westernmedication group(38 cases).The fire-acupuncture group was intervened by swift needling with fire needle,and simultaneously prescribed with Valaciclovir Hydrochloride tablets and Vitamin B1;the Western-medication group was by the same oral medicines alone.The therapeutic efficacies were evaluated afterwards.Results:The total effective rate was 95.1%in the fire-acupuncture group versus 89.5%in the Western-medication group,and the difference was statistically significant(P<0.05).After treatment,the concentration of substance P and visual analogue scale(VAS)score dropped significantly in both groups(both P<0.05);the inter-group differences were statistically significant(both P<0.05).Conclusion:Swift needling with fire needle plus medication has better therapeutic efficacy than medication alone in treating herpes zoster.

Two cases of corona virus disease 2019(COVID-19)treated with the combination of acupuncture and medication in bedridden patients

The paper reports the experiences in treatment of two cases of corona virus disease 2019(COVID-19)with the combination of acupuncture and medication in bedridden patients confirmed in C7 Inpatient Ward,Wuhan Leishenshan Hospital,China.The combined treatment of acupuncture with the oral administration of"Shanghai leishen No.1 formula"was given every day.The prescription was modified weekly according the symptoms of the patients.Besides,the antivirus,anti-infectious and symptomatic treatment of western medicine was combined.Both of the two cases were improved and discharged.It is anticipated that the treatment experiences in these two cases may provide the instruction and enlightenment for the prevention and treatment of COVID-19.

Clinical Study on Treatment of Knee Osteoarthritis with Combined Acupuncture and Medication

Objective： To observe the effect of treatment for proliferative knee osteoarthritis （KOA） using combined acupuncture and medicated compression. Method： All 328 cases were randomized into an observation and control group, 164 cases in each. Combined acupuncture and medicated compression were adopted in the observation group, while oral administration of Zhui Feng Tou Gu Wan （Wind-removing and Bone-penetrating Pills） were adopted in the control group. The clinical effects in the two groups were evaluated 40 days after the treatment. Result： There were significant differences in both marked and total effective rates （P〈0.05）. Conclusion Combined acupuncture and medicated compression can obtain better effect for KOA than oral administration of the Wind-Removing and Bone-Penetrating pills.

Treatment of 65 Cases of Cervical Vertigo Treated by Acupuncture plus Medication

Objective： To investigate the efficacy of acupuncture plus puerarin and glucose injection for treating cervical vertigo. Method： 110 cases of cervical vertigo were divided into the treatment group and control group. 65 cases in the treatment group were treated by acupuncture plus puerarin and glucose injection and 45 cases in the control group were treated with Western medications. Results： In the treatment group, the results showed cure in 33 cases, effect in 29 cases and failure in 3 cases, and the total effective rate in 95.38%. In the control group, the results showed cure in 12 cases, effect in 23 cases and failure in 10 cases, and the total effective rate in 77.87%. In comparison of the total effective rate between the two groups, the treatment group was better than the control group （P〈0.01）. Conclusion： The therapeutic effect is better in the treatment of cervical vertigo by acupuncture plus herbal medicine.than that by Western medications.

Therapeutic Effect Analysis on Combined Acupuncture and Medication for Peripheral Facial Paralysis

Objective： To investigate the therapeutic efficacy of combined acupuncture and medication for peripheral facial paralysis. Methods： Sixty-six cases with peripheral facial paralysis were randomly allocated into a treatment group and a control group, 33 cases in each group. The cases in the treatment group were treated with combined electroacupuncture and Chinese medicine formula, while the cases in the control group were treated by electroacupuncture alone. Results： The recovery rate in the treatment group was significantly higher than the control group （P〈0.05）. In addition, the time length for recovery in the treatment group tended to be shorter than the control group. Conclusion： Combined acupuncture and medication can obtain better effect than electroacupuncmre alone for peripheral facial paralysis.

Clinical Study on Combined Needle-embedding and Medication for Depressive Sleep Disorder

Objective： To observe the clinical efficacy of combined needle-embedding and SSRIs for depressive sleep disorder. Method： Upon admission, 71 depression cases were randomized into needle-embedding group of 24 cases, using combined needle-embedding and SSRls, acupuncture group of 21 cases, using combined acupuncture and SSRIs, and medication group of 26 cases, using SSRIs alone. Alter 1, 2, 4 and 6 weeks of treatment, the HAMD sleep scores were compared. Result： The HAMD sleep scores in the needle-embedding and acupuncture group were remarkably superior to the medication group and there was significant statistical difference after 1, 2 and 4 weeks of treatment （P〈0.01）. However, there was no statistical difference after 6 weeks of treatment. Conclusion： SSRIs can improve HAMD sleep scores. The combined needle-embedding or acupuncture with SSRIs can work faster and better than medication alone. There was no statistical difference between needle-embedding and acupuncture group, however, needle-embedding can reduce the treatment frequencies and therefore has more active clinical meaning.

Observation on Therapeutic Effect of Acupuncture and Medication for 30 Cases of Post-Stroke Depression

Objective： To investigate the therapeutic effects and adverse reaction of acupuncture plus medication and single medication for post-stroke depression（PSD）. Methods： In an open control study, 93 cases of the patients with depression were randomly allocated to three groups： 30 cases in the acupuncture-medication group （AM）, 30 cases in Prozac Group A （A）, and 33 cases in Prozac Group B （B）. The acupuncture-medication group was treated by oral administration of Prozac 20 mg/d plus acupuncture. Prozac Group A was treated by oral administration of Prozac 20 mg/d. Prozac Group B was treated by oral administration of Prozac 20-40 mg/d. All three groups were treated for 6 weeks. The therapeutic effects and adverse reaction were evaluated by Hamilton Depression Scale （HAMD） and Treatment Emergent Symptom Scale （TESS） respectively in the three groups. Results： The effective rate was 86.7% in the acupuncture-medication group, 63.3% in Prozac Group A and 87.9% in Prozac Group B. The therapeutic effect was better in the acupuncture-medication group than in Prozac Group A, and there was no significant difference in comparisonwith Prozac Group B （P〉0.05）. But the occurrence rate of drug adverse reaction was higher in Prozac Group B than in the acupuncture-medication group. Conclusion： Simultaneous application of acupuncture and medication is a therapeutic method with affirmative effect and less side effect for post-stroke depression.

Clinical Observation of Combined Acupuncture ＆ Medications in Treating Dysspermia Infertility

Objective： To observe the curative effect of combined acupuncture and medication on infertility due to seminal abnormality. Method： Thirty-eight patients with seminal abnormality were separately treated by acupuncture and traditional Chinese medications （“Erxian Decoction”） plus Clomiphene. Results and Conclusion： The total effective rate was 96.0% in the acupuncture plus traditional Chinese medication group （26 cases） and 66.7% in the acupuncture and western medication groups （12 cases）. Statistical analysis showed a significant difference （P〈0.05）. The cure rate and the pregnancy rate were 38.5% and 30.8% respectively in the acupuncture and traditional Chinese medication group. Both of them were higher than 8.3% and 8.3% in the acupuncture and western medication group respectively, but there were no statistically significant differences. In the two groups of patients, seminal volume, liquefaction time and viscosity and spermatozoal density, death rate and one-hour survival rate took a significant turn for the better after treatment as compared with before treatment （P〈 0.05）. In the acupuncture and traditional Chinese medication groups of patients, symptoms markedly improved after treatment as compared with before treatment.

Therapeutic effect observation on acupuncture plus medication for post-stroke depression

Objective: To observe the clinical efficacy of acupuncture with medication for post-stroke depression. Methods: A total of 96 patients with post-stroke depression were randomized into an observation group and a control group, with 48 cases in each group. The control group was treated with oral fluoxetine hydrochloride capsules, and the observati on group was treated with acup un cture on the basis of the treatme nt of the con trol group. After 6 mon ths of treatment, the traditional Chinese medicine (TCM) symptom scores, and Hamilton depression scale (HAMD) component scores and total scores of the two groups before and after treatment were observed, and the clinical efficacy and adverse reaction rate were compared between the two groups. Results: The total effective rate was 95.8% in the observation group and 83.3% in the control group, and the differenee between the two groups was statistically significant (Pv0.05). After treatment, the intra-group differences in TCM symptom scores and HAMD score of both groups were statistically significant (all P<0.01). In the observation group, the scores of in differe nt expressi on, emoti onal restlessness, and sen time ntality in the TCM symptoms were statistically differe nt from those in the control group (all P<0.01). The scores of desperate factor and sleep disorder factor and total score in HAMD in the observation group were significantly different from those in the control group (all P<0.01). The incidenee of adverse reactions was 6.3% in the observation group and 4.2% in the control group, and the differenee was not significant between the two groups (P>0.05). Conclusion: Acupuncture plus medication is an effective method for post-stroke depression, and it can further improve the patient's bad mood.