目的:本研究旨在评估我院门诊患者华法林的抗凝稳定性、合并用药情况及抗凝控制不良的预测因素.方法:回顾性分析我院服用华法林的门诊患者随访1年期间的临床特征、合并用药、国际标准化比值(INR)、监测频率.患者华法林抗凝稳定性以治疗范围内时间(T TR)确定,采用Rosendaal法计算TTR值,并通过二分类logistic回归分析确定影响TTR的因素.结果:共有110名患者纳入研究,华法林主要的适应证是机械瓣瓣膜置换术后(61.81％)和心房颤动(35.45％),高血压(31.82％)是最常见的合并症.患者平均合并用药(4.93±4.19)种药物,其中合并使用中成药的比例最高(42.73％),40.91％患者合并使用了与华法林存在潜在相互作用的药物.收集INR监测数据1011个,平均监测频率为每(39.41±18.05)天/次,INR值波动范围在0.96～5.95,超四成的INR值监测数据在1.5～2.0范围内.患者总体抗凝稳定性较差,平均TTR值为(48.18±21.49)％,仅有21.82％的患者抗凝稳定性控制良好(TTR≥65％).合并高血压(HR0.229;0.066～0.790;P＜0.05)和合并使用中成药(HR 3.048;1.124～8.263;P＜0.05)是门诊患者华法林抗凝控制不良的预测因素.结论:我院门诊患者华法林抗凝质量较低,需加强对此类患者的管理.

Objective:To explore the evidence of mirror induction intensify motor imagery of swallowing（MIS） activating swallowing related brain regions.Method:Seven healthy right-handed young adults were enrolled,and motor imagery of swallowing was induced by swallowing videos of young men and women.The trials of motor imagery of swallowing under mirrorinduced condition were the experimental group,and the trials of motor imagery of swallowing without induction were the control group.Magnetoencephalography（MEG） was used to detect event-related synchronization/desynchronization（ERS/ERD） of motor imagery of swallowing tasks in the whole brain under different conditions.Result:During the 0-to 10-seconds time windows of the tasks,both the control group and the experimental group showed a wide range of ERS activation pattern at the whole brain level.In the α and β bands,some brain regions associated with swallowing showed significant ERS pattern in the experimental group than in the control group.The brain regions of significant activation was mainly gathered in bilateral frontal and temporal lobes,a small amount of them appeared in bilateral occipital and limbic lobe,right parietal lobe and left insula lobe.Conclusion:Compared with non-induced motor imagery of swallowing training,mirror-induced motor imagery of swallowing significantly activates swallowing-related functional brain regions,suggesting that mirror induction may have a priming effect on motor imagery of swallowing and improve the quality and effect of training.Our study provides the basis for the application and improvement of motor imagery of swallowing in clinical treatment.

目的 对chin-down(低头)动作的定义、适用范围、机制及其在吞咽障碍患者中预防误吸的疗效进行综述.方法 纳入2021年7月前公开发表的国内外chin-down相关文献,综述相关内容.结果 共纳入13篇文献.chin-down是指屈曲颈部,将下巴尽量靠向胸部的动作.chin-down动作预防或减少误吸的机制是通过改变咽部结构的位置和压力,引导食团安全地进入食管.针对喉抬高不足、咽反射延迟、会厌缺损、杓状软骨缺损、声门闭合缺损等造成吞咽障碍的患者,chin-down动作有减少或预防误吸的效果.然而该动作对存在食团过早溢出、咽缩肌力量弱和口腔保留能力差的患者缺乏保护效益.结论 在吞咽障碍患者中,chin-down动作对减少或预防误吸有一定的临床价值,应选择使用.

目的:调查分析急性冠脉综合征(ACS)急性期或早期的患者在住院期间替格瑞洛与氯吡格雷相互转换的应用现状.方法:分析2019年6月～12月本院急性期或早期ACS患者院内替格瑞洛与氯吡格雷相互转换的发生率、一般临床特征、转换给药时间和给药剂量.结果:ACS患者替格瑞洛与氯吡格雷转换治疗的比率为12.9％(208/1607),最终纳入的182例患者中,63.2％(115例)由氯吡格雷换为替格瑞洛(升阶治疗组),36.8％(67例)由替格瑞洛换为氯吡格雷(降阶治疗组).升阶组和降阶组的一般临床特征存在一定的差异;两组患者均在造影术后当天至术后第一天的时间段发生转换的人数最多,且组间存在差异(58.4％vs 40.0％,P=0.018);降阶组仅有35.5％的患者在最后一剂替格瑞洛给药24 h后给予首剂氯吡格雷;仅有37.4％的患者在转换时给予所换用P2Y12受体拮抗剂的负荷剂量.结论:"指南"推荐的P2Y12受体拮抗剂转换策略尚未得到广泛认可,临床实践中转换策略的制定须结合患者情况作个体化选择.

目的 了解非瓣膜性心房颤动(NVAF)住院病人抗凝治疗的现状并探讨其影响因素.方法 回顾性分析2017年1—5月南京医科大学附属南京医院200例NVAF住院病人的临床特征及抗凝治疗方案,应用CHA2 DS2-VASc和HAS-BLED评分对卒中风险和出血风险进行评估;根据危险分层分析抗凝药物的临床应用情况;并运用logistic回归分析讨论抗栓治疗的影响因素.结果 入选病人CHA2 DS2-VASc评分平均(4.55±2.01)分,卒中高危组189例(94.5％),卒中中危组11例(5.5％);HAS-BLED评分平均(2.04±1.26)分,高出血风险组69例(34.5％),低出血风险组131例(65.5％).仅36.0％病人接受抗凝治疗,抗凝治疗率随卒中风险的增加呈先升后降的趋势,卒中高危组抗凝治疗率(36.5％)高于卒中中危组(27.3％),差异无统计学意义(χ2=1.305,P=0.521);抗凝治疗率随着出血评分的增加而降低,低出血风险组的抗凝治疗率(44.3％)高于高出血风险组(20.3％),且差异有统计学意义(χ2=11.350,P=0.003).抗凝亚组中,高出血风险组较低出血风险组倾向于选择新型口服抗凝药(P=0.031).logistic回归分析表明合并血管疾病(OR=0.867)、药物(OR=2.182)、PCI术后(OR=3.557)、房颤消融术后(OR=0.255)及病人因素(OR=4.504)均影响抗凝方案的选择,且PCI术后和病人因素的影响差异有统计学意义(P<0.05).结论 目前南京医科大学附属南京医院对NVAF的抗凝治疗与指南推荐有一定的差距,未按危险分层标准抗凝且整体的抗凝治疗率低.

Clinical data and application of beta receptor blockers of 467 hospitalized patients with acute myocardial infarction (AMI) were retrospectively analyzed, and the related factors influencing the utilization of beta receptor blockers were identified by binary logistic regression analysis. The results showed that the application rate of beta receptor blockers was only 64.0%. The multi-factor analysis showed that the pa-tients with diabetes (OR=1.761), heart failure (OR=1.654), systolic blood pressure (SBP)≥140 mmHg (OR=1.826) or heart rate＞70 beats/min (OR=1.797) at admission were more likely to accept beta receptor block-er therapy (P＜0.05); the patients with SBP＜100 mmHg (OR=0.094) or left ventricular ejection fraction (LVEF) unmeasured (OR=0.481) were less likely to receive beta receptor blocker therapy (P＜0.05). Patients with LVEF≤40% (OR=1.281) were inclined to receive beta receptor blocker therapy but without statistical significance (P＞0.05). There was an obvious gap between the present situation and the guideline for beta receptor blocker therapy in most of these patients with AMI, which should be improved.

OBJECTIVE To evaluate the potential role of co-3 fish oil in the immune function of gastrointestinal cancer patients after surgery. METHODS Computerized searches of the Pubmed, Embase, MEDLINE, Wanfang, CNKI etc. Databases were performed. Randomized controlled trials (RCTs) were included in conformity with the inclusion criteria. The methodological quality assessment was based on modified Jadad rating scale. Research data was extracted by researchers. Revman 5.3 was used to analysis. RESULTS The included trails were 12 RCTs of 848 postoperative gastrointestinal tumor patients. Meta-analysis results showed that the fish oil supplementation resulted increase levels of CD3+T cells [WMD=5.79, 95％CI (3.07, 8.50),P＜0.01],CD4+T cells [WMD=6.22, 95％CI (3.85, 8.59), P＜0.01] compared with the isocaloric nutrition regime. And the level of CD8+T cells decreased compared with the isocaloric nutrition regime [WMD=-1.74,95％CI (-2.96,-0.52), P＜0.01]. CONCLUSION ω-3 fish oil enhances parenteral nutrition effectively enhance immune function of gastrointestinal cancer patients after surgery.

目的:了解医院血流感染检出菌的分布及其耐药性.方法:回顾性收集我院近3年来收治的血流感染患者的临床资料,对其血培养检出菌及药物敏感性数据进行统计分析.结果:140例患者共检出细菌162株,前五位检出菌依次为大肠埃希菌(44株,27.2%)、凝固酶阴性葡萄球菌(35株,21.6%)、克雷伯菌属(24株,14.8%)、肠球菌属(14株,8.6%)及金黄色葡萄球菌(11株,6.8%).哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、碳青霉烯类药物及阿米卡星对肠杆菌科细菌仍保持高度敏感性,未见耐甲氧西林金黄色葡萄球菌,未见万古霉素、利奈唑胺、替加环素耐药革兰阳性菌株,但耐甲氧西林凝固酶阴性葡萄球菌检出率高,占分离菌的88.6%.结论:我院血流感染病原菌以肠杆菌科、葡萄球菌属及肠球菌属细菌多见,其中耐甲氧西林凝固酶阴性葡萄球菌检出率高,哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、碳青霉烯类药物及阿米卡星仍可作为革兰阴性杆菌血流感染的理想选择药物,但血培养显示存在革兰阳性球菌患者的经验性治疗需谨慎选择不具有抗-MRSA活性的抗菌药物.

白介素-33(interleukin 33,IL-33)是IL-1免疫球蛋白家族的新成员,可与靶细胞膜上的生长刺激表达基因2蛋白(ST2)结合形成跨膜复合体,形成IL-33/ST2信号通路,参与了与Th2活化相关的许多炎症和免疫疾病.近年来许多研究发现IL-33/ST2信号通路在冠心病等心脑血管疾病中也起到重要的作用.急性冠脉综合征是冠心病的一种严重类型,本质是冠状动脉炎性病变后,斑块的破裂和侵蚀过程.本文综述IL-33/ST2信号在急性冠脉综合征中研究进展,希望为急性冠脉综合征的治疗提供新的靶点和思路.

Objective To provide the reference for how to participate in the treatment of heparin-induced thrombocytopenia(HIT)for the clinical pharmacist.Methods Clinical pharmacist participated in the diagnosis and treatment of one case of heparin -induced severe thrombocytopenia,including the selection and evaluation of the drug,the processes of the emergency condition and the whole period clinical pharmaceutical care for the patient.Results The patient's condition and the blood routine examination were improved,with no bleeding incidents during hospitalization.Conclusions The clinical pharmacists,who play an important role in the process of the se-vere adverse drug reaction,can ensure the safety of medication use in patients.

Objective:The purpose of this Meta-analysis was to evaluate the efficacy of Alirocumab (an anti-PC-SK9 antibody) for treating dyslipidemia.Methods:Pubmed,Embase,the Cochrane Library,Clinical Trials.gov databases,CNKI,VIP database and recent conferences were searched for phase 2 and 3 randomized controlled trials (RCTs) comparing Alirocumab with placebo or ezetimibe for dyslipidemia.Meta analysis of the data were extracted and analyzed using the Software RevMan 5.3.Results:Included 18 RCTs with a total of 6 748 patients,13 RCTs were compared Alirocumab (n =3606) with ezetimibe (n =1658) and 5 RCTs were compared Alirocumab (n =864) with placebo (n =620).LDL-C in Alirocumab group was significantly decreased than those in ezetimibe group [MD =-30.50％,95％ CI:(-33.68％,-27.33 ％)],and than those in placebo group [MD =-52.25 ％,95 ％ CI:(-55.85 ％,-48.65 ％)].LDL-C in Alirocumab group was significantly decreased than those in ezetimibe group [MD =-30.30％,95％ CI:(-34.43％,-26.17％)],and than those in placebo group [MD =-50.64％,95％CI:(-54.95％ to-46.33％)] though patients were on stable statin treatment.And also significant and favorable changes were also detected in other lipids of Alirocumab group.Alirocumab substantially reduced the level of Apo B,Non-HDL-C,Lp (a),TGs and TC,increased the HDL-C and Apo A-1 level.Conclusion:The PCSK9 inhibitor Alirocumab could be an add-on therapy to lipid-lowering drugs for patients who had established dyslipidemia or high cardiovascular (CV) risk with LDL-C inadequately controlled on stable statin treatment or statin-intolerance.