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Objective To analyze the influencing factors of unplanned extubation(UE)occurrence of peripherally inserted central catheter(PICC)in the patients with hematological diseases.Methods A retro-spective cohort study method was adopted.The data of 7 298 patients with hematological diseases implanted with PICC catheter and followed up to its removal from January 1,2016 to December 31,2020 in the Hematol-ogy Hospital of Chinese Academy of Medical Sciences were collected,including the demographic information,catheterization records,maintenance and extubation records.According to whether UE occurring,they were divided into the UE group(n=262)and normal extubation group(n=7 036).The general data were com-pared between the two groups.The COX regression was used to analyze the influencing factors of UE in pa-tients with hematological diseases.The dose-effect relationship between age and PICC UE occurrence risk was studied by the restrictive cubic spline method.Results The incidence rate of UE was 3.6%(262/7 298).The COX regression analysis results showed that the gender,disease diagnosis,fibrinogen,prothrombin time,PLT,catheter material,number of punctures during catheterization,positioning method of catheter tip,num-ber of catheter-related complications occurrence were related to PICC UE occurrence in the patients with he-matological diseases(P<0.05).The results of restricted cubic spline showed that there was a"U"-type non-linear relationship between age and UE risk(X2=17.710,P<0.05),and the risk of UE was the lowest when the age was 30 years old.Conclusion In PICC,the emphasis should be paid to the male patients with hemato-logical malignancies who have repeated punctures during catheterization,no intracardiac electrocardiographic positioning during catheterization,bleeding tendency,indwelling polyurethane catheters and repeated catheter-related complications in order to decrease the UC occurrence probability.
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Objective:To investigate the current status and influencing factors of care preparedness in primary caregivers of children with acute leukemia, so as to provide theoretical basis for targeted nursing intervention plans in the future.Methods:A total of 160 primary caregivers of children with acute leukemia in Hematology Hospital of the Chinese Academy of Medical Sciences recruited by convenient sampling were investigated by the general data questionnaire, the Preparedness for Caregiving Scale, the Herth Hope Index, the Family Caregiver Task Inventory and the Mishel Uncertainty in Illness Scale-Family Member Form. Descriptive analysis, Mann-Whitney U test, Kruskal-Wallis H test, Spearman rank correlation and multiple stepwise liner regression were used for statistical analysis. Results:One hundred and fifty-nine questionnaires were effectively collected, including 13 males and 146 females, aged (34.61 ± 8.60) years old. The total score of care preparedness, hope, uncertainty in illness, care ability for caregivers were (26.47 ± 7.53), (37.72 ± 4.11), (61.96 ± 17.02), (15.06 ± 12.94) points. The total score of care preparedness for caregivers was negatively correlated with the score of uncertainty in illness( r=-0.300, P<0.05), and positively correlated with the hope and care ability of main caregivers ( r=0.166, 0.254, both P<0.05). Caregivers′ uncertainty in illness, caregiver gender, availability of other caregivers, caregivers′ hope entered the multiple stepwise regression equation, which could explain 20.4% of the total variation of resilience. Conclusions:The preparation of the primary caregivers for children with acute leukemia is at a medium level. The primary caregivers who are male, who have insufficient knowledge of the disease, who have no co-caregivers, and who have low hope level should be focused on in clinical practice. Pertinent measures should be taken to improve care preparedness and care quality.
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Summarizing the nursing experience of a child with HHV-6B encephalitis after umbilical cord blood transplantation and CAR-T therapy. The child was 4 years old and was diagnosed with acute T lymphocytic leukemia on May 28, 2021. Nursing points: meticulously observe symptoms for early diagnosis and treatment; develop a specialized management plan, implement individualized care; enhance medication management to improve the quality of care; establish a shared decision-making communication model to prevent hospital-acquired infections; provide patient-centered care for lumbar puncture; assess the needs of the child and family, alleviate negative emotions; improve pre-discharge preparation, emphasize continuity of care. With proactive treatment and careful nursing, the child′s condition improved, and they were discharged. Follow-up for six months showed the child in a sustained remission state with no adverse sequelae, and normal life resumed.
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To summarize the experience of 5 children with relapsed and refractory acute B lymphocyte leukemia treated with Blinatumomab, during the whole nursing processes, careful nursing was carried out before, during and after infusion. The key points of nursing include: reasonable cooperation with nursing staff and specialized training, design a condition observation form, timely grasp changes in the condition, early identify adverse reactions such as cytokine storms, neurotoxicity, and allergies, and ensure the safety of the children. Through personnel, articles and personalized liquid preparation table, ensure accurate dose, smooth infusion and save hospital expenses ¥3, 846~201, 910 for children. Payattention to the psychological burden of children and their families and attach importance to psychological care. Follow the psychological burden of children and caregivers, and pay attention to psychological nursing. As the results, 3 chidlren successfully completed the first cycle of Blinatumomab. But 2 chidlren interrupted due to the tumor burden. Follow up for 5-12 months showed that 2 cases survived, 1 case died of progressive disease after discharge, and 2 cases died of transplant complications.
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OBJECTIVE@#To explore the clinical phenotype and genetic basis for a Chinese pedigree affected with Oral-facial-digital syndrome type I (OFD1).@*METHODS@#A pedigree with OFD1 who presented at Hebei General Hospital on March 17, 2021 was selected as the subject. Clinical data of the child was collected. Trio-whole exome sequencing (trio-WES) was carried out for the proband and members of her pedigree, and candidate variant was verified by Sanger sequencing.@*RESULTS@#The proband has featured hypotelorism, broad nasal root, flat nasal tip, lobulated tongue, tongue neoplasia, camptodactyly of left fifth finger, syndactyly of right fourth and fifth fingers, and delayed intellectual and language development. Trio-WES revealed that the proband and her daughter, sister and mother have harbored a heterozygous c.224A>G (p.Asn75Ser) variant of the OFD1 gene. The same variant was not found among healthy members from her pedigree.@*CONCLUSION@#The c.224A>G (p.Asn75Ser) variant probably underlay the OFD1 in this pedigree. Above discovery has enriched the spectrum of OFD1 gene variants.
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Humanos , Feminino , Linhagem , Síndromes Orofaciodigitais/genética , População do Leste Asiático , Fenótipo , Heterozigoto , Mutação , ChinaRESUMO
Objective:To investigate the efficacy of autologous fat grafting in the treatment of stable linear scleroderma.Methods:A retrospective analysis was performed on 40 patients with stable linear scleroderma who received autologous fat grafting from October 2017 to November 2020 in the Department of Dermatology, Xijing Hospital, Air Force Medical University. There were 22 males and 18 females, aged 12 - 36 (18.2 ± 4.82) years. Skin lesions involved the forehead in 16 cases, the perioral area in 4, the lower jaw in 2, the cheek in 9, the trunk in 5, and the lower limb in 4, and the size of depressed skin defects was 3 - 24 cm 3. The patients′ subjective satisfaction rate, the decrease in the size of depressed skin defects, and the incidence of adverse reactions after autologous fat grafting were analyzed during the follow-up. Results:Six months after the grafting, 40 patients were followed up and evaluated, and the size of depressed skin defects markedly decreased. The satisfaction rate for appearance improvement after the first grafting was 60% (24/40) ; 35 patients received the second grafting, with a satisfaction rate of 88.6% (31/35) ; 17 received the third grafting, with a satisfaction rate of 94.1% (16/17) ; the total satisfaction rate was 87.5% (35/40). After the grafting, local skin unevenness was observed in the grafting area in 3 patients, and in the liposuction area in 2. The incidence rate of postoperative adverse reactions was 12.5% (5/40) .Conclusion:Autologous fat grafting was markedly effective in the treatment of stable linear scleroderma.
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Pancreatic adenocarcinoma (PAAD) is one of the most lethal malignancies. Although gemcitabine (GEM) is a standard treatment for PAAD, resistance limits its application and therapy. Secoemestrin C (Sec C) is a natural compound from the endophytic fungus Emericella, and its anticancer activity has not been investigated since it was isolated. Our research is the first to indicate that Sec C is a broad-spectrum anticancer agent and could exhibit potently similar anticancer activity both in GEM-resistant and GEM-sensitive PAAD cells. Interestingly, Sec C exerted a rapid growth-inhibiting effect (80% death at 6 h), which might be beneficial for patients who need rapid tumor shrinkage before surgery. Liquid chromatography/mass spectrometry and N-acetyl-l-cysteine (NAC) reverse assays show that Sec C sulfates cysteines to disrupt disulfide-bonds formation in endoplasmic reticulum (ER) proteins to cause protein misfolding, leading to ER stress and disorder of lipid biosynthesis. Microarray data and subsequent assays show that ER stress-mediated ER-associated degradation (ERAD) ubiquitinates and downregulates YAP to enhance ER stress via destruction complex (YAP-Axin-GSK-βTrCP), which also elucidates a unique degrading style for YAP. Potent anticancer activity in GEM-resistant cells and low toxicity make Sec C a promising anti-PAAD candidate.
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Objective:To explore the factors influencing complete remission in patients with diffuse large B-cell lymphoma (DLBCL), and to explore the effect of the interaction of Karnofsky performance status scale (KPS) scores and the level of lactate dehydrogenases (LDH) on whether patients with DLBCL are completely relieved.Methods:The clinical data of 373 DLBCL patients admitted to Shanxi Province Cancer Hospital from January 2014 to December 2020 were retrospectively analyzed. SPSS 25.0 logistic regression model and Cox proportional risk regression models were used to explore the factors affecting complete remission in patients with DLBCL and to explore whether there was a multiplicative interaction between the factors. For factors with multiplicative interactions, the Matrix package, epiR package, and survival package in R 4.2.0 software were used to analyze whether there was an additive interaction. The relative excess risk of interaction (RERI), attributable proportion due to interaction (AP), and the synergy index (S) were used to evaluate the presence of additive interactions.Results:Elevated β 2 macroglobulin (β 2-MG), KPS scores below 80, and elevated LDH were risk factors for incomplete remission in patients with DLBCL (all P < 0.05). The risk of incomplete remission in patients with elevated β 2-MG, KPS scores below 80 and LDH was 1.971 times ( OR = 1.971, 95% CI 1.161-3.346), 2.056 times ( OR = 2.056, 95% CI 1.057-4.000) and 3.351 times ( OR = 3.351, 95% CI 1.783-6.300) higher than those in patients with normal β 2-MG, KPS scores above 80 and non-elevated LDH, respectively. There was a negative multiplicative interaction between the two risk factors of KPS scores below 80 and elevated LDH ( OR = 0.317, 95% CI 0.126-0.785). The estimated value of RERI, AP and S was -2.07 (95% CI -4.79-0.64),0.50 (95% CI -1.68-0.32),0.50 (95% CI 0.22-1.13), respectively; and there was no additive interaction among them. Conclusions:Elevated β 2-MG, KPS scores below 80, and elevated LDH are risk factors influencing incomplete remission for patients with DLBCL. The combined effect in patients with the combination of elevated LDH and KPS scores below 80 is lower than the single effect of the multiple of the both. There is a negative multiplicative interaction and no additive interaction in DLBCL patients with KPS scores below 80 and elevated LDH level.
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Objective:To investigate the status quo of anticoagulant therapy for patients with non-valvular atrial fibrillation (NVAF) in Beijing community health centers and to analyze the affecting factors.Methods:From September to December 2020, 164 patients with NVAF in five community health service centers in Xicheng District of Beijing were selected for a face-to-face questionnaire survey. The questionnaire included basic information of patients, complications, CHA 2DS 2-VASc score, HAS-BLED score and oral anticoagulant therapy, et al. SPSS 23.0 software was used to analyze the status of anticoagulant therapy in patients with different risk stratification of stroke, and chi-square was used to analyze the factors affecting anticoagulant therapy in high-risk patients with stroke. Results:In 161 NVAF patients with indication, 86 received anticoagulation therapy (53.4%), and the utilization rates of rivaroxaban, dabigatran and warfarin were 64.0% (55/86), 26.7% (23/86) and 9.3% (8/86), respectively. In 140 patients (85.4%, 140/164) at high risk of stroke (CHA 2DS 2-VASc score ≥2 points in males or ≥3 points in females), 30.0% (42/140) had never received anticoagulant therapy, and 29.3% (41/140) was treated with antiplatelet therapy, 17.1% (24/140) did not use any antithrombotic medication. Univariate analysis showed that gender, age, symptoms at first diagnosis and complications were not significantly associated with the application of anticoagulant therapy in NVAF patients at high-risk of stoke ( P>0.05). The qualitative study showed that the reasons for not receiving anticoagulant therapy were spontaneous cardioversion or recovery of sinus rhythm after ablation (15 cases), adverse drug reactions (7 cases), self-withdrawal of drugs (10 cases), concern about bleeding (3 cases) and so on. Conclusion:A large proportion of NVAF patients in the community are at high risk of stroke, while the overall rate of anticoagulant treatment is relatively low. Clinician in the community should actively initiate anticoagulant therapy for patients with AF and strengthen the continuous management and compliance management of anticoagulant therapy.
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Objective:To investigate the knowledge status and health education needs of patients with atrial fibrillation in the community.Methods:From September to December 2020, 277 patients with atrial fibrillation from 5 community health service centers in Xicheng District of Beijing were selected using typical sampling method for online questionnaire survey. The questionnaire mainly contained basic information of patients, the knowledge of atrial fibrillation and the health education needs. Factors affecting patients′ knowledge level and health education needs were analyzed.Results:The overall awareness rate of disease-related knowledge in 277 patients with atrial fibrillation was 67.1% (1 860/2 770), and in aspects of antithrombotic effect of aspirin [12.3% (34/277)], the benefits and risks of anticoagulation therapy [52.7% (146/277)] and atrial fibrillation discontinuation [55.2% (153/277)], the awareness rates were relatively low. Compared with patients in the age group of 66-79 years and ≥80 years old, those aged ≤65 years had higher awareness rates in knowledge of purpose of anticoagulantion therapy [89.7% (70/78)] and adverse reactions of anticoagulation drugs [89.7% (70/78)] (χ2=6.72, 8.77; P<0.05), but the awareness rate of the benefits and harms of anticoagulation therapy [43.6% (34/78)] was lower (χ2=6.11, P<0.05). The top three health education needs of patients were the impact of atrial fibrillation on the body (3.66±1.77), the method of treating atrial fibrillation (3.65±1.13) and the prognosis with different treatments (3.62±1.15). Further analysis showed that in patients with disease duration ≤5 years, the education needs for the purpose of anticoagulation therapy (3.60±1.17), exercise methods (3.62±1.12), dietary taboos (3.63±1.16), and how to communicate with family and friends(3.33±1.29) were higher than those with a disease duration of more than 5 years ( t=2.03, 2.88, 2.05, 2.07; P<0.05). Doctors [98.6% (273/277)], nurses [40.8% (113/277)] and health education lectures [36.8% (102/277)] were the main sources for patients to acquire knowledge about atrial fibrillation. Most patients had the strongest motivation to obtain health education at the time of disease diagnosis [70.0% (194/277)]. Conclusions:There is insufficient understanding of the disease in patients with atrial fibrillation in the community, and the needs for patients to get health education are high. It is necessary to pay more attention to the early health education in patients with younger age and shorter course of disease.
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This paper reported the genetic analysis of a pedigree in which three affected fetuses with short limbs were revealed by first-trimester ultrasonography in three consecutive pregnancies. Tissues of the second aborted fetus were collected and analyzed by chromosome karyotype analysis and whole exome sequencing. The results indicated compound heterozygous mutations of EX64-EX83 Del and c.8190G>T in the DYNC2H1 gene. Real-time fluorescence quantitative polymerase chain reaction and Sanger sequencing further confirmed that the two variants were inherited from the father and the mother with normal phenotypes, respectively. EX64-EX83 Del was a likely pathogenic variant and c.8190G>T was a variant of uncertain significance. Based on the above results and the medical history, it was highly suspected that the fetus had autosomal recessive short rib polydactyly syndrome type Ⅲ caused by compound heterozygous variants. Real-time fluorescent quantitative polymerase chain reaction and Sanger sequencing results of the third aborted fetus were consistent with the second fetus. Given the same phenotypes of fetuses in the second and third pregnancy, it was strongly suggested that the heterozygous variations of EX64-EX83 Del and c.8190G>T in the DYNC2H1 gene were the pathogenic variants in this pedigree.
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During the COVID-19 epidemic period, general practitioners have been actively participating in screening and triage, referrals, follow-up, education and other activities related to disease prevention and control at the grass-roots level. However, there are still some problems: such as unclear of the role of general practitioners in an epidemic setting, inadequate ability to respond to public health emergencies and lack of knowledge of infectious diseases. To meet the challenge of COVID-19 pandemic, with the reference of Accreditation Council for Graduate Medical Education (ACGME) six core clinical competencies we suggest to improve the standardized general practice residency training in following aspects: to attach importance to infectious disease rotation, to increase the stomatology and nutrition course learning, to strengthen teaching in general practice service model, preventive medicine and medical humanities, to enhance the ability for dealing with public health emergencies, the evidence-based medicine and scientific research ability and doctor-patient communication ability.
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We report a case of fetal cerebellar vermis dysplasia diagnosed prenatally by ultrasonography. Ultrasonography of the 27-year-old woman at 20 +6 gestational weeks revealed partial separation of the cerebellar vermis (Dandy-Walker variants), unclosable upper and lower lips, and polydactyly, based on which a preliminary diagnosis of multiple fetal malformations was made. Karyotype and chromosomal microarray (CMA) analysis of the amniotic fluid showed no abnormality. After genetic counseling, amniocentesis was performed again for a whole-exome sequencing test. The results suggested that there are compound heterozygous variations of c.3435G>A(P.W1145X) and c.2941C>G(p. p981A) in the exon 19 and exon 17 of the CPLANE1 gene, which were both de novo mutations and inherited from the father and mother, respectively. The fetus was diagnosed as Joubert syndrome. Given the facial and limb deformities and a significant risk of neurological abnormalities of the fetus, the patient and her family decided to terminate the pregnancy.
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OBJECTIVE:To learn from the experie nce of post-marketing risk management of biopharmaceuticals in the United States,and to provide reference for post-marketing risk management of biopharmaceuticals in China. METHODS :By studying guidance documents and website information issued by FDA ,the risk management of biopharmaceuticals after marketing in the United States was analyzed. Taking infliximab as an example ,the specific implementation situation was introduced ,the management characteristics were summarized ,and the enlightenment and relevant suggestions were put forward for the risk management of biopharmaceuticals after marketing in China. RESULTS & CONCLUSIONS :The post-marketing risk management of biopharmaceuticals in the United States mainly includes two aspects as “risk evaluation and mitigation strategy (REMS)”and “post-marketing study and clinical trials system ”. The latter included post-marketing requirement (PMR) and post-marketing commitment(PMC). Taking infliximab as an example ,since it was approved by FDA in August 1998,its manufacturer submitted REMS to FDA in 2009 and obtained approval ,and proposed post-marketing studies and clinical trials for five times. It can be seen that FDA has issued specific guidelines for post-marketing risk management of biopharmaceuticals to encourage multi-role participation in risk management , realize effective communication with patients , and continuously supervise the risk of biopharmaceuticals,so as to reduce the risk of the use of biopharmaceuticals. For biopharmaceuticals ,China has not yet formulated systematic and specific implementation rules and guidelines ,and there is still lack in post-marketing risk management. It is suggested that China can learn from the measures and system of post-marketing risk management of biopharmaceuticals in the United States ,involve stakeholders in post-marketing management ,enhance patients ’awareness of drug use risks through effective communication,and further improve the post-marketing research management system to guarantee patients ’safety of drug use.
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OBJECTIVE:To c ompare the situation of adverse drug reaction (ADR) collection by social media between European and American countries and China ,so as to provide reference for the improvement of corresponding work in China. METHODS:By retrieving relevant literatures from CNKI ,Web of Science ,Elsevier ScienceDirect ,SpringerLink and so on , referring to the official website of International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH),the current situation of ADR collection by social media in European and American countries(organizations)such as the United States ,the European Union ,the United Kingdom ,France was introduced ,and compared with the corresponding work in China. The advantages and possible problems of using social media to collect ADR were analyzed so as to put forward some suggestions on how to use social media to collect ADR in China. RESULTS & CONCLUSIONS:Since 2013,many countries in Europe and the United States have started to collect ADRs using social media (such as Twitter ,Facebook),such as the draft on drug safety issues on social media issued by the Pharmaceutical Research and Manufacturers of America (PhRMA),and the EU organization ’s Innovative Medicines Initiative (IMI)network to identify adverse drug reaction in web media (WEB-RADR)projects. Through this way ,it is more convenient for patients to report ADR ,and helpful for the pharmacovigilance department to collect ADR information in time ,and can be used as an important supplement to the traditional drug safety information report. However ,there are some advantages ,such as mismatch between the health vocabulary spontaneously reported by patients and medical professional vocabulary ,the challenges of balancing the relationship between public health maintenance and patient privacy protection ,and various deviations affecting the reporting rate and quality of ADR collected by social media. When using social media (such as Wechat ,microblog,QQ and other social media or tools ,as well as applications and small programs )to collect ADR information in China ,it is suggested to ensure the ease of use and security of reporting ADR applications ,and improve the design of applications to comply with E 2B (R3) data elements and information specifications of ICH guidelines for the electronic transmission of individu al security reports. At the same time ,we should give full play to the supervisory role of regulatory department ,consider non-regulatory factors ,and take privacy protection measures to make it conform to ethics.
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Novel Coronavirus Pneumonia (NCP) is a class B infectious disease, which is prevented and controlled according to class A infectious diseases.Recently, children′s NCP cases have gradually increased, and children′s fever outpatient department has become the first strategic pass to stop the epidemic.Strengthening the management of the fever diagnosis process is very important for early detection of suspected children, early isolation, early treatment and prevention of cross-infection.This article proposes prevention and control strategies for fever diagnosis, optimizes processes, prevents cross-infection, health protection and disinfection of medical staff, based on the relevant diagnosis, treatment, prevention and control programs of the National Health and Health Commission and on the diagnosis and treatment experience of experts in various provinces and cities.The present guidance summarizes current strategies on pre-diagnosis; triage, diagnosis, treatment, and prevention of 2019-nCoV infection in common fever, suspected and confirmed children, which provide practical suggestions on strengthening the management processes of children′s fever in outpatient department during the novel coronavirus pneumonia epidemic period.
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Objective:To understand the inner experience and growth of the students of the mouth-building therapist school in the role-playing practice class, and to explore the effect of the role-playing practice class in the training of the students of the mouth-building therapist school.Methods:Totally 19 students enrolled in a mouth-making therapist school in 2018 as a research object, after teaching the relevant courses such as mouth-building positioning and pocket replacement, the students carried out each other′s mouth-building positioning and pocket-making paste, continuously wearing pocket-making for 3 days, recording 3 days of wearing diaries and interviewing students after removing the pockets.Results:Students gained a real experience of the process of wearing pockets through the role-playing practice class, extracting three themes from the wearing diary and interviews: physical discomfort in wearing pockets, affecting social and psychological; firmly do a good job of professional care confidence.Conclusions:The role-playing practice course can not only be theoretically connected with practice, but also cultivate the nursing humanistic quality of the students, which has good teaching effect and is worthy of promotion in the training course of oral healer.
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Objective:To study the application effect of family-centered care (FCC) model in children ′s health care. Methods:The data of 200 children who came to the hospital for outpatient care in our hospital were analyzed. They were divided into two groups according to the principle of random number. 100 cases in the control group were given traditional child health care, and 100 cases in the observation group were treated with FCC. Service care, comparing the implementation of child care services under different care modes.Results:After the FCC model was used in the observation group, parents ′ knowledge of children ′s health knowledge (79.0±6.6), child care compliance 98.0% (98/100), health service effect 95.0% (95/100), nursing satisfaction 96.0% (96/100), the control group was (65.0±5.8), 88.0% (88/100), 80.0% (80/100), and 80.0% (80/100), respectively. There was statistical significance ( t value was 15.934, χ2 value was 7.68, 16.50, 12.12, P<0.05). The neuropsychological development scores were evaluated in the two groups. The observation group had a large exercise score (90.9±6.2) and a fine action score (86.8±7.2), adaptability score (96.5±6.5), language score (89.2±2.5), and social development score (88.3±2.5). The control group was (88.2±6.0), (84.0±6.0), (94.0±4.8), (87.9±3.0), (87.0±2.5), and there were statistics between the two groups. Academic significance ( t value was 2.253-3.329, P<0.05). Conclusion:The implementation of the FCC model in children ′s health care can improve children ′s understanding of disease knowledge and child care compliance.
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The morbidity and mortality caused by ischemic stroke resulted from atrial fibrillation are increasing year by year. Anticoagulation is the core strategy for the prevention and treatment of atrial fibrillation-related stroke. At present, the prominent problems in anticoagulation of atrial fibrillation in China include low rate of anticoagulation therapy, low rate of INR compliance, non-standard drug treatment, poor compliance with medication and follow-up, and so on. It has been reported that anticoagulation management service can significantly improve the effect and compliance of anticoagulation therapy, and reduce the hospitalization rate and emergency consultation rate of adverse events related to anticoagulation therapy. In this paper, the research progress of anticoagulant management service of atrial fibrillation at home and abroad is reviewed, providing reference for the establishment of anticoagulant management system under the hierarchical medical system in China.
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OBJECTIVE:To study th e improvement effect and mechanism of Dajianzhong decoction on irritable bowel syndrome(IBS)visceral pain model rats. METHODS :Totally 48 male non-weaning rats were randomly divided into normal control group ,model group ,pinaverium bromide group (positive control ,45 mg/kg)and Dajianzhong decoction high-dose , medium-dose and low-dose groups (2.16,1.08,0.54 g/kg,by crude drug ),with 8 rats in each group. Except for normal control group,IBS visceral pain model was established by mother and child separation ,acetic acid enema ,ovalbumin intraperitoneal Remote limb precondition - ing protects against ischemia induced neuronal death through ameliorating neuronal oxidative DNA damage injection in other groups for 57 d. On the 58th day ,the rats in administration groups were given the corresponding drugs intragastrically,and model group and normal control group were given constant volume of purified water ,once a day ,for consecutive 14 d. The general condition of rats was observed ;abdominal wall withdrawal reaction (AWR)was adopted to evaluate the visceral sensitivity of rats in each group under 20,40,60,and 80 mmHg (1 mmHg=0.133 kPa)pressure;HE staining method was used to observe the colon pathological features of rats in each group. Western blotting assay was used to detect the protein expression of intestinal glial cells markers fibrillary acidic protein (GFAP),nerve growth factor (NGF)and its receptor TrkA in colon tissue. RESULTS :The mucosal layer of colon tissue in rats of model group was discontinuous ,gland edema was observed and lymphocytes ,neutrophils and eosinophils were scattered in the lamina propria. In Dajianzhong decoction low-does group,the mucosal layer of colon tissue was incomplete ,some glands were slightly edematous ,and a few lymphocytes , neutrophils in the lamina propria. The colonic mucosa epithelial structure was intact ,glands arranged regularly ,and no degenerative necrosis and inflammatory cells were observed in Dajianzhong decoction medium- and high-dose groups and pinaverium bromide group. Compared with normal control group ,AWR scores under 20,40,and 60 mmHg pressure ,relative protein expression of GFAR ,NGF and TrkA were all increased significantly in model group and Dajianzhong decoction low-does groups(P<0.05 or P<0.01). Compared with model group ,AWR scores under 20,and 40 mmHg pressure in Dajianzhong decoction medium- and high-dose groups and pinaverium bromide group ,AWR scores under 60 mmHg pressure in Dajianzhong decoction high-dose group and pinaverium bromide group ,relative protein expression of GFAP ,NGF,TrkA in colon tissue in Dajianzhong decoction medium- and high-dose groups and pinaverium bromide group were all decreased significantly (P<0.05 or P<0.01). CONCLUSIONS :Dajianzhong decoction could improve the visceral pain of IBS model rats by inhibiting the activation of intestinal glial cells and reducing the expression of NGF and TrkA.