BackgroundPost-traumatic stress symptoms （PTSS） is highly prevalent in adolescents who have experienced earthquake， which seriously threatens their physical and mental health， yet there is currently a lack of research on the effects of loneliness， social support and social media use on PTSS among post-earthquake adolescents. ObjectiveTo assess the PTSS among adolescents experiencing MS6.0 Luxian， Sichuan， earthquake on 16 September 2021， and to investigate the effects of loneliness， social support and social media use on PTSS， so as to provide references for the intervention of PTSS among post-earthquake adolescents. MethodsOn November 12， 2021， simple random sampling technique was used to select 2 522 post-earthquake adolescents in Luxian county of Luzhou city in Sichuan province. All subjects were assessed using Post-Traumatic Stress Disorder Checklist for DSM-5 （PCL-5）， Multidimensional Scale of Perceived Social Support （MSPSS）， Short-form UCLA Loneliness Scale （ULS-3） and Social Media Use Scale （SM-10）. Binary Logistic regression was used to determine the factors influencing PTSS among post-earthquake adolescents. ResultsPTSS was detected in 91 （3.61%） adolescents. Binary Logistic regression revealed that perceived social support from family members （OR=0.926， 95% CI： 0.879~0.976） was a protective factor for PTSS among post-earthquake adolescents. Lack of companionship （OR=1.764， 95% CI： 1.141~2.727）， feeling isolated （OR=2.037， 95% CI： 1.282~3.236）， and viewing negative emotional response of disaster victims through social media （OR=1.615， 95% CI： 1.291~2.020） were risk factors for PTSS among post-earthquake adolescents. ConclusionLack of companionship， feeling isolated， and viewing negative emotional response of disaster victims through social media pose a negative impact on PTSS among post-earthquake adolescents， while perceived social support from family members exert a positive impact on PTSS among post-earthquake adolescents. ［Funded by Humanity and Social Science Youth foundation of Ministry of Education of China （number， 22YJC190019）； Natural Science Foundation of Sichuan Province （number， 2023NSFSC1486）］

OBJECTIVE To establish a determination method for the related substances of LPM3480392, a novel Gi protein-biased opioid receptor(MOR) agonist. METHODS The separation was carried out with Waters Symmetry Shield RP18 (150 mm×4.6 mm, 3.5 μm) by gradient elution method, using a mixture of 0.002 5 mol·L–1 sodium 1-octanesulfonate monohydrate in 0.01 mol·L–1 potassium dihydrogen phosphate-water solution(containing 0.1% triethylamine, adjusted pH to 2.50 with phosphate acid) and acetonitrile as the mobile phase at a flow rate of 1.0 mL·min–1 and the UV detection wavelength was set at 210 nm. RESULTS The chromatographic peaks of LPM3480392 and impurity A, impurity B, impurity C, impurity E and impurity F could be completely separated, the linear relationship of LPM3480392 was good in 0.064 9−5.191 2 μg·mL–1, while impurity A, impurity B, impurity C, impurity E and impurity F showed good linear relationship within 0.066 6−7.610 4 μg·mL–1, 0.166 0−3.794 0 μg·mL–1, 0.209 2−4.463 2 μg·mL–1, 0.167 9−7.672 6 μg·mL–1 and 0.016 4−7.505 7 μg·mL–1, respectively. The recovery rate was within 93.0%−103.2%. CONCLUSION The method is suitable for the determination of related substances in LPM3480392, and can provide valuable reference for the follow-up research and development of LPM3480392.

Objective To explore the predictive value of INR in early stage of warfarin therapy (early INR)for anticoagulation intensity after 7 days of treatment. Methods The medical records of patients hospitalized in the Department of Cardiology,Linyi People′s Hospital,Shandong University from January 2012 to May 2015 were collected,who received warfarin anticoagulation therapy and underwent INR tests in the morning after 3 or 7 days of medication. The early INR meant INR after 3 days of warfarin treatment. According to INR after 7 days of warfarin treatment,the patients were divided into 2 groups, anticoagulation up to standard(INR 2. 0﹣3. 0)group and over﹣anticoagulation(INR﹥3. 0)group. The best critical value of early INR for predicting INR after 7 days of warfarin treatment was obtained by plotting ROC curve. The risk of over﹣anticoagulation after 7 days of warfarin treatment was compared in patients with early INR ≥critical value and﹤critical value. Univariate analysis was used to compare the clinical characteristics in the 2 groups. The indexes with P ﹤0. 100 were used as covariate and multivariate logistic regression analysis was performed. The odds ratio( OR)and its 95% confidence interval( CI)was calculated and independent risk factors of INR ﹥3. 0 after warfarin treatment were screened. Results A total of 75 patients with atrial fibrillation were enrolled in the study,including 38 males and 37 females,aged(64 ± 9),42 patients in the anticoagulation up to standard group and 33 patients in the over﹣anticoagulation group. There were significant differences in body weight,INR after 3 days of medication,and the number of patients with hypoproteinemia between the 2 groups(all P﹤0. 05),but no significant differences in other indicators (all P﹥0. 05). The results of ROC curve showed that the best critical value of anticoagulation intensity predicted by early INR was 1. 67,the area under the curve was 0. 915[95% CI:0. 828﹣0. 967],and the sensitivity and specificity were 0. 95 and 0. 82,respectively. The risk of over﹣anticoagulation in patients with 7 days of warfarin treatment in the group with early INR ≥1. 67 was significantly higher than that in the group with early INR ﹤1. 67[90. 0%(27/30)vs. 13. 3%(6/45),χ2 ＝39. 883,OR＝58. 50,95% CI:13. 45﹣254. 48,P﹤0. 001]. Multivariate logistic regression analysis showed that early INR≥1. 67 was an independent risk factor for over﹣anticoagulation after 7 days of treatment( OR＝48. 719,95% CI:10. 891﹣217. 940,P﹤0. 001). Conclusions The early INR can predict anticoagulation intensity after 7 days of treatment. Early INR≥1. 67 is an independent risk factor for over﹣anticoagulation after 7 days of warfarin treatment.

Objective To explore the predictive value of INR in early stage of warfarin therapy (early INR)for anticoagulation intensity after 7 days of treatment. Methods The medical records of patients hospitalized in the Department of Cardiology,Linyi People′s Hospital,Shandong University from January 2012 to May 2015 were collected,who received warfarin anticoagulation therapy and underwent INR tests in the morning after 3 or 7 days of medication. The early INR meant INR after 3 days of warfarin treatment. According to INR after 7 days of warfarin treatment,the patients were divided into 2 groups, anticoagulation up to standard(INR 2. 0﹣3. 0)group and over﹣anticoagulation(INR﹥3. 0)group. The best critical value of early INR for predicting INR after 7 days of warfarin treatment was obtained by plotting ROC curve. The risk of over﹣anticoagulation after 7 days of warfarin treatment was compared in patients with early INR ≥critical value and﹤critical value. Univariate analysis was used to compare the clinical characteristics in the 2 groups. The indexes with P ﹤0. 100 were used as covariate and multivariate logistic regression analysis was performed. The odds ratio( OR)and its 95% confidence interval( CI)was calculated and independent risk factors of INR ﹥3. 0 after warfarin treatment were screened. Results A total of 75 patients with atrial fibrillation were enrolled in the study,including 38 males and 37 females,aged(64 ± 9),42 patients in the anticoagulation up to standard group and 33 patients in the over﹣anticoagulation group. There were significant differences in body weight,INR after 3 days of medication,and the number of patients with hypoproteinemia between the 2 groups(all P﹤0. 05),but no significant differences in other indicators (all P﹥0. 05). The results of ROC curve showed that the best critical value of anticoagulation intensity predicted by early INR was 1. 67,the area under the curve was 0. 915[95% CI:0. 828﹣0. 967],and the sensitivity and specificity were 0. 95 and 0. 82,respectively. The risk of over﹣anticoagulation in patients with 7 days of warfarin treatment in the group with early INR ≥1. 67 was significantly higher than that in the group with early INR ﹤1. 67[90. 0%(27/30)vs. 13. 3%(6/45),χ2 ＝39. 883,OR＝58. 50,95% CI:13. 45﹣254. 48,P﹤0. 001]. Multivariate logistic regression analysis showed that early INR≥1. 67 was an independent risk factor for over﹣anticoagulation after 7 days of treatment( OR＝48. 719,95% CI:10. 891﹣217. 940,P﹤0. 001). Conclusions The early INR can predict anticoagulation intensity after 7 days of treatment. Early INR≥1. 67 is an independent risk factor for over﹣anticoagulation after 7 days of warfarin treatment.

Objective To evaluate the effectiveness of anticoagulation management by physician-clinical pharmacist team for patients with valvular atrial fibrillation. Methods One hundred and seventy two patients with valvular atrial fibrillation received warfarin therapy for anticoagulation during hospitalization in Linyi People′s Hospital from January 2014 to December 2016, the patients continued to receive warfarin therapy for>6 months after discharge. The patients were randomly assigned in two groups:the anticoagulation management was given by physician-clinical pharmacist team in 87 cases (trial group), while the dosage of wargarin was adjusted in outpatient department by physicians alone in 85 cases (control group). The goal attainment rate of international normalized ratio (INR), the proportion of patients with a stable warfarin dose, knowledge of anticoagulants, belief of medication, medication compliance were compared between two groups. Results There were no significant differences in age, sex, body weight, smoking and drinking habits, valvular disease type, comorbidities; and the initial INR, knowledge of anticoagulants, belief of medication and medication compliance at admission between two groups (all P>0.05). The goal attainment rate of INR (52.17％vs. 41.02％,χ2=8.178, P=0.004), the proportion of patients with a stable dose of warfarin (74.71％ vs. 56.47％,χ2=6.349, P=0.012), the knowledge of anticoagulants (11.03 ± 2.25 vs. 10.08 ± 1.86, t=3.018, P=0.003), the belief of medication[(12.23 ± 2.07) vs. (11.67 ± 1.48), t=2.042, P=0.043], and the medication compliance[(7.36 ± 0.89) vs. (7.04 ± 1.10), t=2.1128, P=0.036] in the trial group were significantly higher than those in control group. Conclusion Anticoagulation management by physician - clinical pharmacist team can improve the management level of anticoagulation and the knowledge of anticoagulans, enhance the medication belief, improve the goal attainment rate of INR and the compliance rate of medication in patients with valvular atrial fibrillation.

OBJECTIVE:To evaluate the effects of clinical pharmacists participating in clinical pathway management for chron-ic heart failure(CHF). METHODS:A total of 107 CHF adult inpatients in Linyi People's Hospital during Jan. 2014-Oct. 2015 were divided into control group(56 cases,3 withdrawal,53 in total)and trial group(58 cases,4 withdrawal,54 in total)accord-ing to random number table. Control group received routine clinical pathway management method of CHF;trial group received clin-ical pathway management with the participation of clinical pharmacists. Clinical efficacy,the utilization of heart failure drugs,eco-nomic indexes,medication compliance after discharge,re-hospitalization rate due to heart failure were compared between 2 groups. RESULTS:Total response rate of trial group was significantly higher than control group,with statistical significance(P<0.05). The utilization rate of ACEI/ARB,β-receptor blocker,target dose rate of ACEI/ARB in trial group were significantly higher than control group,with statistical significance(P<0.05);target dose rate of β-receptor blocker was higher than control group,without statistical significance(P>0.05). Hospitalization time,drug cost,total hospitalization cost and drug ratio of trial group were short-er or lower than control group,without statistical significance(P>0.05). One month after discharge,the proportion of medication compliance in trial group was significantly higher than control group,with statistical significance(P<0.05);re-hospitalization rate was lower than control group,without statistical significance(P>0.05). Three months after discharge,the proportion of medica-tion compliance in trial group was higher than control group,while re-hospitalization rate was lower than control group,with statis-tical significance(P<0.05). CONCIUSIONS:The participation of clinical pharmacists in clinical pathway management of CHF can significantly improve the utilization rate of recommended drugs by guideline,clinical efficacy and medication compliance,and reduce re-hospitalization rate.

Objective To select drugs inducing international normalized ratio (INR) elevation by concomitant use of warfarin in inpatients.Methods The data of inpatients with increased INR rise (INR>3.50) because of concomitant use of warfarin and other drugs in Linyi People′s Hospital, Shandong University from January 2012 to December 2016 were collected and analyzed retrospectively.The baseline conditions, combination drugs, INR rise during treatments, bleeding events, treatments and outcomes in inpatients were recorded.Drugs that could increase anticoagulant effect of warfarin were screened. Results A total of 100 patients were enrolled in this study, including 43 men and 57 women aged from 26 to 86 years with an average age of (64±13) years.Primary diseases in 64 patients were atrial fibrillation, in 15 patients were after heart valve replacements, in 10 patients were pulmonary embolism, in 7 patients were lower extremity venous thrombosis, and in 4 patients were myocardial infarction with left ventricular thrombus.Hospital stay were 5-39 d and the average time was (17±7) d;the time of warfarin treatments were 3-36 d and the average time was (11±5) d.Of the 302 kinds of drugs combined with warfarin in the 100 patients, 40 kinds of drugs were found to induce INR elevation, including 16 kinds of anti-infective drugs (66 cases), 7 kinds of endocrine system drugs (28 cases), 4 kinds of cardiovascular system drugs (30 cases), 4 kinds of nervous system drugs (5 cases), 3 kinds of proton pump inhibitors (21 cases), 3 kinds of blood system drugs (4 cases), 2 kinds of proprietary Chinese medicine preparations (10 cases), 1 kind of non-steroidal anti-inflammatory drugs (2 cases).According to the number of drug use, the top ten drugs were piperacillin sodium and tazobactam sodium (27 cases), methylprednisolone (22 cases), levofloxacin (20 cases), amiodarone (20 cases), omeprazole (19 cases), cefoperazone sodium and sulbactam sodium (11 cases), fluvastatin sodium (10 cases), compound liquorice preparations (9 cases), voriconazole (7 cases), latamoxef (4 cases), and moxifloxacin (4 cases).The number of drug combination was 1-5 kinds in each patient, combination drug was 1 kind in 31 cases, 2 kinds in 46 cases, 3 kinds in 18 cases, 4 kinds in 4 cases, and 5 kinds in 1 case.Of the 100 patients with INR elevation, 83 patients stopped taking warfarin and 13 patients were given intramuscular injection of vitamin K1 at the same time, 17 patients′warfarin dose was decreased from 1.25-3.75 mg to 0.75-3.00 mg, then the INR levels in all patients decreased to <3.0.Seven patients had mild bleeding before warfarin withdrawal, including 4 cases of subcutaneous hemorrhage, 1 case of subarachnoid hemorrhage, 1 case of hematochezia, and 1 case of blood in phlegm.Conclusions Many commonly used drugs in clinical practice, such as compound preparations of β-lactam antibiotics and β-lactamase inhibitors, quinolones, glucocorticoid, anti-arrhythmic drugs, and proton pump inhibitors, etc., could cause INR elevation and increase bleeding risk.

Objective To select drugs inducing international normalized ratio (INR) elevation by concomitant use of warfarin in inpatients.Methods The data of inpatients with increased INR rise (INR>3.50) because of concomitant use of warfarin and other drugs in Linyi People′s Hospital, Shandong University from January 2012 to December 2016 were collected and analyzed retrospectively.The baseline conditions, combination drugs, INR rise during treatments, bleeding events, treatments and outcomes in inpatients were recorded.Drugs that could increase anticoagulant effect of warfarin were screened. Results A total of 100 patients were enrolled in this study, including 43 men and 57 women aged from 26 to 86 years with an average age of (64±13) years.Primary diseases in 64 patients were atrial fibrillation, in 15 patients were after heart valve replacements, in 10 patients were pulmonary embolism, in 7 patients were lower extremity venous thrombosis, and in 4 patients were myocardial infarction with left ventricular thrombus.Hospital stay were 5-39 d and the average time was (17±7) d;the time of warfarin treatments were 3-36 d and the average time was (11±5) d.Of the 302 kinds of drugs combined with warfarin in the 100 patients, 40 kinds of drugs were found to induce INR elevation, including 16 kinds of anti-infective drugs (66 cases), 7 kinds of endocrine system drugs (28 cases), 4 kinds of cardiovascular system drugs (30 cases), 4 kinds of nervous system drugs (5 cases), 3 kinds of proton pump inhibitors (21 cases), 3 kinds of blood system drugs (4 cases), 2 kinds of proprietary Chinese medicine preparations (10 cases), 1 kind of non-steroidal anti-inflammatory drugs (2 cases).According to the number of drug use, the top ten drugs were piperacillin sodium and tazobactam sodium (27 cases), methylprednisolone (22 cases), levofloxacin (20 cases), amiodarone (20 cases), omeprazole (19 cases), cefoperazone sodium and sulbactam sodium (11 cases), fluvastatin sodium (10 cases), compound liquorice preparations (9 cases), voriconazole (7 cases), latamoxef (4 cases), and moxifloxacin (4 cases).The number of drug combination was 1-5 kinds in each patient, combination drug was 1 kind in 31 cases, 2 kinds in 46 cases, 3 kinds in 18 cases, 4 kinds in 4 cases, and 5 kinds in 1 case.Of the 100 patients with INR elevation, 83 patients stopped taking warfarin and 13 patients were given intramuscular injection of vitamin K1 at the same time, 17 patients′warfarin dose was decreased from 1.25-3.75 mg to 0.75-3.00 mg, then the INR levels in all patients decreased to <3.0.Seven patients had mild bleeding before warfarin withdrawal, including 4 cases of subcutaneous hemorrhage, 1 case of subarachnoid hemorrhage, 1 case of hematochezia, and 1 case of blood in phlegm.Conclusions Many commonly used drugs in clinical practice, such as compound preparations of β-lactam antibiotics and β-lactamase inhibitors, quinolones, glucocorticoid, anti-arrhythmic drugs, and proton pump inhibitors, etc., could cause INR elevation and increase bleeding risk.

Objective To investigate the prevalence and clinical features of fulminant type 1 diabetes.Methods Using data retrieved from Second Xiangya Hospital of Central South University,all patients diagnosed with type 1 diabetes from Jan.1,2001 to Dec.31,2007 were identified.The patients were divided into fulminant type 1 diabetes (F1D) group,typical type 1 diabetes (T1A) group,and idiopathic type 1 diabetes(T1B) group.Their clinical features were compared.Results Eight patients (9.1%) fulfilled the criteria for fulminant type 1 diabetes among 87 newly diagnosed type 1 diabetes,and the percentage of fulminant type 1 diabetes reached 14.0% among type 1 diabetic patients with age of onset of 18 years or older.Patients of F1D group had a markedly higher plasma glucose concentration compared with patients of T1A group and T1B group(P=0.004).Serum amylase was higher in F1D group than that in T1A group(P = 0.021).Four (50%) patients were GADA positive,among whom 1 patient was Coxsackie B virus (CVB) IgM positive and 1 patient was Herpes Simplex virus 1 (HSV1) IgM positive.Conclusions Fulminant type 1 diabetes accounts for about 10% of the type 1 diabetes in the Chinese individuals with ketosis-or ketoacidosis-onset.Patients with this subset of diabetes had severe metabolic derangement.Viral infection and autoimmunity may be involved in the pathogenesis of fulminant type 1 diabetes.

Objective To investigate the changes of serum angiopoietin-like protein 3 (Angptl3) and adiponectin levels in patients with metabolic syndrome (MS) in order to understand their association with the MS. Methods Serum Angptl3 and adiponectin levels were measured by sandwich ELISA in a group of 111 patients with MS and 152 normal controls. Results Serum adiponectin was lower in the MS patients than in the control subjects [4.22(1.01-23.29) μg/mL vs. 5.41(0.97-22.27) μg/mL, P＜0.05]. With regard to serum Angptl3, there was no significant difference between the 2 groups(P＞0.05). Serum adiponectin was correlated to Angptl3 and high density lipoprotein-cholesterol (HDL-C)(P＜0.001) and negatively correlated to body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), triglyceride (TG), fasting plasma glucose (FBG), fasting insulin (FINS) and homeostatic model assessment method-insulin resistance (HOMA-IR) (P＜0.001). Serum Angptl3 was positively correlated with adiponectin (P＜0.001). Serum adiponectin was found to be independently positive determinant for Angptl3 concentrations (b′=0.256, P＜0.001). Adiponectin was inversely correlated with TG and HOMA-IR (b′=-0.234, -0.145, P＜0.001). Conclusion Adiponectin is decreased in MS patients and may be correlated to Angptl3.