OBJECTIVE To evaluate the efficacy and safety of guideline-directed medical therapy （GDMT） combined with vericiguat in treating heart failure with reduced ejection fraction （HFrEF）. METHODS A retrospective study was conducted on 346 patients with HFrEF who received standardized diagnosis and treatment at the First People’s Hospital of Changzhou from January 2023 to May 2024. They were divided into standard treatment group （n＝215） and vericiguat group （n＝131）. Patients in the standard treatment group received GDMT， while patients in the vericiguat group received GDMT combined with vericiguat. Propensity score matching （PSM） was used to balance confounding factors between two groups， and the effectiveness （including outcome and prognostic indicators） and safety （occurrence of adverse events） of both groups were evaluated. Kaplan-Meier survival curves for primary and secondary outcome events were drawn， and the influential factors of primary outcome events were screened through univariate and multivariate Cox regression analysis. RESULTS After PSM， there were 100 patients in the standard treatment group and 100 patients in the vericiguat group， and there was no statistically significant differences in baseline data between two groups （P＞0.05）. During a 1-year follow-up， there were statistically significant differences in the cumulative incidence of major outcome events between the standard treatment group and the vericiguat group， cumulative incidence of hospitalization events due to heart failure， changes in N-terminal pro-B-type natriuretic peptide levels before and after treatment between the standard treatment group and the vericiguat group （P＜0.05）. There was no statistically significant difference in the incidence of adverse events between the two groups （P＞0.05）. Multivariate Cox regression analysis results showed that left ventricular ejection fraction ≤35% was a risk factor for the occurrence of major outcome events within 1 year [hazard ratio （HR）＝ 2.090， 95% confidence interval （CI）： 1.175-3.718， P＝0.012]， while the use of vericiguat was a protective factor for the occurrence of major outcome events within 1 year （HR＝0.505， 95%CI： 0.284-0.899， P＝0.020）. CONCLUSIONS Compared with GDMT， GDMT combined with vericiguat can improve the clinical symptoms and prognosis of HFrEF patients， and has good safety.

In recent years, the rapid increase in cancer treatment costs in China had brought a huge economic burden to society, and it was urgent to standardize the rational application of anti-tumor drugs. In the context of the reform of group payment related to disease diagnosis, a tertiary first-class hospital focused on the needs of patients and guided by value-based healthcare, established a professional and normalized refined anti-tumor drug management system, setted up a multidisciplinary diagnosis and treatment team, and promoted " Internet plus pharmaceutical services" in December 2018.From 2019 to 2021, the proportion of hospital drugs were 30.8%, 30.1%, and 27.3%, respectively. The amount of money spent on anti-tumor drugs were 83.25 million yuan, 76.41 million yuan, and 62.48 million yuan, respectively, showing a decreasing trend year by year. The practice of refined management of anti-tumor drugs fully reflected the core concept of value based healthcare, achieving closed-loop management of the entire process of drugs, improving the level of rational drug use, reducing the economic burden on patients, and providing reference for improving the level of rational use of anti-tumor drugs in public hospitals.

A 63-year-old male patient with lung metastases from bladder cancer received IV infusions of nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) once every 21 d. On day 3 after the second medication, the patient developed paroxysmal chest tightness, which could be self-mitigated by lying down for several minutes. Laboratory tests showed high-sensitive troponin Ⅰ 4 340 ng/L and creatine kinase (CK)-MB 98.9 μg/L. Immune-related myocarditis due to combination use of nivolumab and ipilimumab was considered. After methylprednisolone with prednisone sequentially and symptomatic and supportive treatments such as fluid infusion, liver and stomach protection, improvement of myocardial metabolism, and reduction of oxygen consumption, the patient′s symptoms were improved obviously. Laboratory tests showed high-sensitive troponin Ⅰ 192 ng/L and CK-MB 28.4 μg/L.

A 63-year-old male patient with lung metastases from bladder cancer received IV infusions of nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) once every 21 d. On day 3 after the second medication, the patient developed paroxysmal chest tightness, which could be self-mitigated by lying down for several minutes. Laboratory tests showed high-sensitive troponin Ⅰ 4 340 ng/L and creatine kinase (CK)-MB 98.9 μg/L. Immune-related myocarditis due to combination use of nivolumab and ipilimumab was considered. After methylprednisolone with prednisone sequentially and symptomatic and supportive treatments such as fluid infusion, liver and stomach protection, improvement of myocardial metabolism, and reduction of oxygen consumption, the patient′s symptoms were improved obviously. Laboratory tests showed high-sensitive troponin Ⅰ 192 ng/L and CK-MB 28.4 μg/L.

Inhaled drug was delivered through the oral and nasal cavities,which can avoid the liver first pass effect and nervous system barriers.Inhaled drugs can directly reach the disease site,which play a critical role in the treatment of respiratory diseases,infectious diseases,endocrine system diseases,nervous system diseases,tumor diseases,surgical perioperative respiratory tract management,preventive medicine and so on.Furthermore,as a non-invasive drug delivery method,inhalation has many ad-vantages such as high bioavailability, good stability, and targeted binding to lesion site, low systemic drug exposure, low side effects and easily acceptance.It will play an important role in the treatment of systemic diseases with whole body.In this paper,the research progress in the prevention and treatment of diseases in various systems by inhalation administration is reviewed.in order to explore the value of inhalation administration in the treatment of diseases,to improve the awareness of medical nursing staff on the way of inhalation treatment and to make patients have more benefit.

OBJECTIVE:To explore the new method for clinical pharmacists training,and provide reference for improving the quality of clinical pharmacists training. METHODS:Based on the full-awareness of Definition and characteristics of stage-progres-sive learning(SPL)and problem-based learning(PBL)teaching method,SPL-PBL teaching method was used in the teaching of the-oretical and clinical practice in the process of students training in clinical pharmacist training base. The teaching course of theoreti-cal knowledge was mainly SPL in first half and PBL in another half. While in the clinical practice teaching of ward rounds,check-ing doctor's advice,participation in the development of treatment programs and case discussion,PBL was mainly used interspersed by SPL;SPL was mainly in inquiry,pharmaceutical care and medication education interspersed by PBL. RESULTS:SPL-PBL teaching method had not only effectively aroused the enthusiasm of the students'learning,enhanced the sense of responsibility and improved their clinical professional knowledge and practice ability,but also strengthened the cultivation of students communication ability,document retrieval ability,writing communication ability and self-learning ability(four abilities) to make students more quickly into the role and improve their subjective initiative. CONCLUSIONS:Practice has proved that the SPL-PBL teaching meth-od not only gives consideratin to the inndividual differences among studengts,but also mobilizes the enthusiam,and not only gives consideration to the teaching about basic theoretical knowledge,but also strengthens the training for clinical thingkig andfour abili-ties,wich can be used for the clinical pharmacists training. Meanwhile,SPL has expanded the aplication surface of PBL beacuse that SPL has reduced the requirements of PBL for overall qulity. However,it needs to be improved because of the short time appli-cation.

Objective:To study the inhibition effects of four dihydropyridine calcium antagonists felodipine, nicardipine, lercani-dipine and nifedipine on CYP3A4 enzyme to provide the theoretical basis for the understanding of the drug interactions between dihydro-pyridine calcium antagonists and other drugs. Methods:Using the probe drugs method, the SD female rats induced by 80 mg·kg-1 · d-1 dexamethasone for three days were divided into the negative control group, positive control group, four DHPs groups with six ones in each. Dapsone was used as the probe substrate, and the concentration was determined by HPLC. Data analysis software WinNonLin was used in the pharmacokinetic model fitting process and the paired t-test was used in the statistical analysis. Results: AUC0-24 and CL/F of dapsone in the negative control group showed statistically significant differences when compared with those in the four DHPs groups and the positive group (P<0. 05). Although the inhibition effect of the four DHPs was in the order of nifedipine inhibition >nicardipine > lercanidipine > felodipine, the difference was not statistically significant (P>0. 05). Cmax of dapsone in the DHPs groups and the positive group had no statistically significant difference when compared with that in the negative control group ( P>0. 05). Conclusion:Although there are different inhibition effects on CYP3A4 among the four DHPs, the differences are not significant in vivo, and there is no influence on the combination drugs which is not mainly metabolized by CYP3A4.

Objective To explore the role of CRUSADE score for evaluating the risk of gastrointestinal bleeding due to antiplatelet agents. Methods The hospitalized patients with coronary heart disease and received antiplatelet therapy for more than 1 year before hospitalization in department of internal medicine in the Third People's Hospital of Cixi,Zhejiang Province from September 1010 to September 1013 were enrolled into the study. The patients were divided into the gastrointestinal bleeding group and the non-gastrointestinal bleeding group according to whether gastrointestinal bleeding occurred due to antiplatelet agents. The CRUSADE score was evaluated in the 1 groups and the relationship between the CRUSADE score and gastrointestinal bleeding was analyzed. Results A total of 787 patients with coronary heart disease who received antiplatelet therapy more than 1 year were collected. Forty patients with gastrointestinal bleeding were enrolled into the gastrointestinal bleeding group. One hundred and sixty patients were enrolled into the non-gastrointestinal bleeding group by equidistant sampling method randomly. The gastrointestinal bleeding group comprised 31 male and 9 female with age from 45 to 88( 71 ± 9 ) years. The non-gastrointestinal bleeding group comprised 100 male and 60 female with age from 36 to 89(65 ± 13)years. There was statistically significant difference in age between the 1 groups(P ﹤0. 05). The percentage of cases of receiving aspirin enteric-coated tablets,clopidogrel hydrogen sulfate tablets,and both the above-mentioned drugs in the gastrointestinal bleeding group and the non-gastrointestinal bleeding group were 55%(11/40),10%(4/40),35%(14/40)and 54%(86/160),7%(11/160),39%(63/160),respectively. The difference was not statistically significant(P ﹥0. 05). The percentage of cases who had history of gastroin-testinal bleeding and peptic ulcer in the gastrointestinal bleeding group and the non-gastrointestinal bleeding group were 30. 0%(11/40)and 11. 9%(19/160),respectively. The difference was statistically significant(P ﹤0. 05). There were 17. 5%(11/40)and 17. 5%(11/40)cases with the results of CRUSADE score at high risk and very high risk in the gastrointestinal bleeding group,8. 1%(13/160)and 10. 6%( 17/160 ) cases in the non-gastrointestinal bleeding group,respectively. The difference was statistically significant(P﹤0. 05). Conclusions CRUSADE score can help to evaluate the risk of gastrointestinal bleeding in patients with coronary heart disease who received antiplatelet therapy. It is suggested that the patients with coronary heart disease as well as the CRUSADE score of high risk and very high risk should receive the combination of antiplatelet agents and the proton pump inhibitor,in order to prevent or reduce the gastroin-testinal bleeding.

Objective To explore the role of CRUSADE score for evaluating the risk of gastrointestinal bleeding due to antiplatelet agents. Methods The hospitalized patients with coronary heart disease and received antiplatelet therapy for more than 1 year before hospitalization in department of internal medicine in the Third People's Hospital of Cixi,Zhejiang Province from September 1010 to September 1013 were enrolled into the study. The patients were divided into the gastrointestinal bleeding group and the non-gastrointestinal bleeding group according to whether gastrointestinal bleeding occurred due to antiplatelet agents. The CRUSADE score was evaluated in the 1 groups and the relationship between the CRUSADE score and gastrointestinal bleeding was analyzed. Results A total of 787 patients with coronary heart disease who received antiplatelet therapy more than 1 year were collected. Forty patients with gastrointestinal bleeding were enrolled into the gastrointestinal bleeding group. One hundred and sixty patients were enrolled into the non-gastrointestinal bleeding group by equidistant sampling method randomly. The gastrointestinal bleeding group comprised 31 male and 9 female with age from 45 to 88( 71 ± 9 ) years. The non-gastrointestinal bleeding group comprised 100 male and 60 female with age from 36 to 89(65 ± 13)years. There was statistically significant difference in age between the 1 groups(P ﹤0. 05). The percentage of cases of receiving aspirin enteric-coated tablets,clopidogrel hydrogen sulfate tablets,and both the above-mentioned drugs in the gastrointestinal bleeding group and the non-gastrointestinal bleeding group were 55%(11/40),10%(4/40),35%(14/40)and 54%(86/160),7%(11/160),39%(63/160),respectively. The difference was not statistically significant(P ﹥0. 05). The percentage of cases who had history of gastroin-testinal bleeding and peptic ulcer in the gastrointestinal bleeding group and the non-gastrointestinal bleeding group were 30. 0%(11/40)and 11. 9%(19/160),respectively. The difference was statistically significant(P ﹤0. 05). There were 17. 5%(11/40)and 17. 5%(11/40)cases with the results of CRUSADE score at high risk and very high risk in the gastrointestinal bleeding group,8. 1%(13/160)and 10. 6%( 17/160 ) cases in the non-gastrointestinal bleeding group,respectively. The difference was statistically significant(P﹤0. 05). Conclusions CRUSADE score can help to evaluate the risk of gastrointestinal bleeding in patients with coronary heart disease who received antiplatelet therapy. It is suggested that the patients with coronary heart disease as well as the CRUSADE score of high risk and very high risk should receive the combination of antiplatelet agents and the proton pump inhibitor,in order to prevent or reduce the gastroin-testinal bleeding.

OBJECTIVE: To establish Access database to conserve and manage patients’ clinical information in therapeutic drug monitoring (TDM). METHODS: Therapeutic Drug Monitoring Database Management Software was established to analyze the utilization of digoxin and CsA in renal transplantation patients combining with the situation of TDM in our hospital. RESULTS: The database had the advantages of convenient data processing and rapid inquiry. CONCLUSIONS: Access database is convenient for information management of case history and can afford a great support for clinical pharmacists.