Objective:To investigate the effect of ultrasound-guided sciatic nerve block via lateral suprapopliteal approach on postoperative pain and motor function in elderly patients undergoing total knee arthroplasty(TKA).Methods:A retrospective analysis was conducted on 83 patients who underwent TKA at our hospital from December 2021 to November 2024.Patients were divided into two groups based on postoperative analgesia methods:the control group(n=41)and the observation group(n=42).Both groups received the combined spinal-epidural.The observation group received the ultrasound-guided sciatic nerve block via lateral suprapopliteal approach combined with intravenous analgesics,and the control group only adopted intravenous analgesics.The general data,Visual Analog Scale(VAS)scores at different time points,first press time and number of the analgesic pump on vein,the time to first ambulation,Fugl-Meyer Assessment(FMA)score of lower limb and the incidence of adverse reactions between two groups were analyzed.Results:The VAS scores at the rests of 12 h,24 h,36 h,and 48 h,and at the motion after surgery in observation group were significantly lower than those in the control group,with statistically significant differences(t=3.124,11.617,12.886,4.474,5.235,12.187,5.028,5.119,P<0.05).The number of first press of the analgesic pump,the time to first ambulation,and the adverse reactions in observation group were significantly lower than those in control group,and the differences were significant(t=65.134,39.193,2.162,P<0.05).The time of first press of the analgesic pump at the 48th h after surgery,and the FMA scores at the 2nd week and 4th week after surgery in the observation group were significantly higher than those in the control group(t=21.192,3.786,3.626,P<0.05).Conclusion:The ultrasound-guided sciatic nerve block via lateral suprapopliteal approach combined with intravenous analgesics can effectively relieve the pain levels in elderly TKA patients,and decreases the medication usage of analgesic pump,and reduce the incidence of adverse reactions.

Objective To investigate the efficacy and safety of CT-guided radioactive 125I seed implantation(ISI)for blocking celiac plexus in the treatment of refractory abdominal cancerous pain.Methods The clinical data of 60 patients with refractory cancerous pain caused by abdominal malignancies(visual analogue scale score ≥4 points)were retrospectively analyzed.Patients of group A(n=29)received anhydrous ethanol injection treatment and patients of group B(n=29)received ISI treatment.The primary endpoints were pain score(visual analogue scale,VAS),daily morphine consumption(DMC),and local tumor control(LTC)rate.Secondary endpoints included the success rate of the procedure and postoperative complications.Results The technical success rate of surgery was 100％in both groups,and no serious complications occurred after surgery.The VAS pain scores in both groups showed a continuous decline from 1 to 8 weeks after surgery,but the difference was not statistically significant.However,the VAS scores in group A was significantly increased at T8 to T12 weeks(P＜0.01).In contrast,the pain relief time in group B remained stable until T16 to T24 weeks when an increase in pain improvement was observed.At T8 week,the LTC rate in group B was significantly better than that in group A,and the difference was statistically significant(P＜0.01).Conclusion Celiac plexus block with ISI can effectively alleviate the refractory cancerous pain caused by abdominal tumors.Compared with anhydrous ethanol injection,ISI has a longer pain relief time(up to T16-T24 weeks)and can effectively control the growth of local tumor,which is worthy of clinical promotion and application.

Objective:To investigate the effect of ultrasound-guided sciatic nerve block via lateral suprapopliteal approach on postoperative pain and motor function in elderly patients undergoing total knee arthroplasty(TKA).Methods:A retrospective analysis was conducted on 83 patients who underwent TKA at our hospital from December 2021 to November 2024.Patients were divided into two groups based on postoperative analgesia methods:the control group(n=41)and the observation group(n=42).Both groups received the combined spinal-epidural.The observation group received the ultrasound-guided sciatic nerve block via lateral suprapopliteal approach combined with intravenous analgesics,and the control group only adopted intravenous analgesics.The general data,Visual Analog Scale(VAS)scores at different time points,first press time and number of the analgesic pump on vein,the time to first ambulation,Fugl-Meyer Assessment(FMA)score of lower limb and the incidence of adverse reactions between two groups were analyzed.Results:The VAS scores at the rests of 12 h,24 h,36 h,and 48 h,and at the motion after surgery in observation group were significantly lower than those in the control group,with statistically significant differences(t=3.124,11.617,12.886,4.474,5.235,12.187,5.028,5.119,P<0.05).The number of first press of the analgesic pump,the time to first ambulation,and the adverse reactions in observation group were significantly lower than those in control group,and the differences were significant(t=65.134,39.193,2.162,P<0.05).The time of first press of the analgesic pump at the 48th h after surgery,and the FMA scores at the 2nd week and 4th week after surgery in the observation group were significantly higher than those in the control group(t=21.192,3.786,3.626,P<0.05).Conclusion:The ultrasound-guided sciatic nerve block via lateral suprapopliteal approach combined with intravenous analgesics can effectively relieve the pain levels in elderly TKA patients,and decreases the medication usage of analgesic pump,and reduce the incidence of adverse reactions.

Objective:To compare the occurrence and clinical characteristics of hypersensitivity reactions induced by 3 non-ionic iodine contrast media (NICMs) during percutaneous coronary intervention (PCI).Methods:The patients who developed hypersensitivity reactions in iopromide, iohexol, and iodixanol application during PCI were screened out from adverse drug reaction reports of Beijing Anzhen Hospital from January 1, 2013 to December 31, 2018 and the total number of patients who underwent the PCI during that period and received the above NICMs was obtained by searching the hospital information system. The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions and incidences of those induced by each of the 3 NICMs were calculated and their clinical characteristics were analyzed.Results:The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions induced by the 3 NICMs were 0.603% (422/69 955) and 0.024% (17/69 955). The incidences of hypersensitivity reactions induced by iohexol, iopromide, and iodixanol were 0.418% (109/26 097), 0.364% (83/22 787), and 1.092% (230/ 21 071), respectively; the incidences of severe hypersensitivity reactions were 0.023% (6/26 097), 0.039% (9/22 787), and 0.009% (2/21 071), respectively. Iodixanol had a higher incidence of hypersensitivity reactions than iopromide and iohexol (both P<0.001) but the lowest incidence of severe hypersensitivity reactions, which was significantly different from that of iopromide ( P=0.047). Of the 422 patients who developed hypersensitivity reactions, 327 were male and 95 were female with an average age of 59 years (range: 27-101 years). The time of hypersensitivity reactions occurrence was recorded in 373 patients and time from NICMs injection to hypersensitivity reactions occurrence were 30 minutes to 90 hours with the median time of 5 hours; hypersensitivity reactions were immediate type (latency ≤1 hour) in 127 patients (34.0%) and delayed type (latency>1 hour) in 246 patients (66.0%). The hypersensitivity reactions induced by iopromide were mainly immediate type (79.5%, 62/78), while those induced by ioxamol were mainly delayed type (87.7%, 193/220). The proportion of patients with a previous history of allergy in the immediate type patients was significantly higher than that in the delayed type patients [15.0% (15/100) vs. 7.1% (14/197), P=0.030]. The most common clinical manifestation of hypersensitivity reactions was rash [78.0% (329/422)]. Among 17 cases of severe hypersensitivity reactions, 15 (88.2%) were anaphylactic shock, 1 was laryngeal edema, and 1 was dyspnea, all of which were immediate type. Hypersensitivity reactions were all improved after treatments, but PCI failed to be fully performed in 6 patients due to severe hypersensitivity reactions. Conclusions:The safety of 3 NICMs for PCI was good and the incidence of hypersensitivity reactions was low; the incidence of severe hypersensitivity reactions due to iopromide was the highest. Severe hypersensitivity reactions such as anaphylactic shock might affect the performance of PCI and caution should be given.

Objective:To compare the occurrence and clinical characteristics of hypersensitivity reactions induced by 3 non-ionic iodine contrast media (NICMs) during percutaneous coronary intervention (PCI).Methods:The patients who developed hypersensitivity reactions in iopromide, iohexol, and iodixanol application during PCI were screened out from adverse drug reaction reports of Beijing Anzhen Hospital from January 1, 2013 to December 31, 2018 and the total number of patients who underwent the PCI during that period and received the above NICMs was obtained by searching the hospital information system. The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions and incidences of those induced by each of the 3 NICMs were calculated and their clinical characteristics were analyzed.Results:The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions induced by the 3 NICMs were 0.603% (422/69 955) and 0.024% (17/69 955). The incidences of hypersensitivity reactions induced by iohexol, iopromide, and iodixanol were 0.418% (109/26 097), 0.364% (83/22 787), and 1.092% (230/ 21 071), respectively; the incidences of severe hypersensitivity reactions were 0.023% (6/26 097), 0.039% (9/22 787), and 0.009% (2/21 071), respectively. Iodixanol had a higher incidence of hypersensitivity reactions than iopromide and iohexol (both P<0.001) but the lowest incidence of severe hypersensitivity reactions, which was significantly different from that of iopromide ( P=0.047). Of the 422 patients who developed hypersensitivity reactions, 327 were male and 95 were female with an average age of 59 years (range: 27-101 years). The time of hypersensitivity reactions occurrence was recorded in 373 patients and time from NICMs injection to hypersensitivity reactions occurrence were 30 minutes to 90 hours with the median time of 5 hours; hypersensitivity reactions were immediate type (latency ≤1 hour) in 127 patients (34.0%) and delayed type (latency>1 hour) in 246 patients (66.0%). The hypersensitivity reactions induced by iopromide were mainly immediate type (79.5%, 62/78), while those induced by ioxamol were mainly delayed type (87.7%, 193/220). The proportion of patients with a previous history of allergy in the immediate type patients was significantly higher than that in the delayed type patients [15.0% (15/100) vs. 7.1% (14/197), P=0.030]. The most common clinical manifestation of hypersensitivity reactions was rash [78.0% (329/422)]. Among 17 cases of severe hypersensitivity reactions, 15 (88.2%) were anaphylactic shock, 1 was laryngeal edema, and 1 was dyspnea, all of which were immediate type. Hypersensitivity reactions were all improved after treatments, but PCI failed to be fully performed in 6 patients due to severe hypersensitivity reactions. Conclusions:The safety of 3 NICMs for PCI was good and the incidence of hypersensitivity reactions was low; the incidence of severe hypersensitivity reactions due to iopromide was the highest. Severe hypersensitivity reactions such as anaphylactic shock might affect the performance of PCI and caution should be given.

Under the background of deepening the medical and health system reform, it is necessary to explore the measures of fine and rational drug use management and strengthen the rational drug use. Through giving full play to the management functions of pharmacy administration and pharmacotherapeutics committee, formulating the performance evaluation index system of pharmacy affairs in the hospital, adhering to the prescription doctor′s advice review and prescription pre audit, continuing to carry out drug dynamic monitoring, implementing standardized-path antimicrobial drug management, the hospital implemented refined and rational drug use management. Before and after the management, the average drug cost, prescription unqualified rate, auxiliary drug amount and antibacterial drugs related indicators were significantly improved, suggesting that fine pharmacy management could promote the rational use of drugs in the whole hospital, promote the transformation of pharmacists′ work, and control the unreasonable growth of drug costs.

Objective:To explore the occurrence and risk factors of bleeding events in acute coronary syndromes (ACS) patients treated with ticagrelor combined with aspirin.Methods:The study subjects were selected from ACS patients who were admitted to Beijing Anzhen Hospital, Capital Medical University from January to December 2017 and treated with ticagrelor and aspirin (aspirin 100 mg/d, ticagrelor 180 mg/d). Medical records of the patients who met the inclusion criteria(at age>18 years, with medication duration ≥ 1 year, and with complete follow-up records) were collected and retrospectively analyzed. The patients were divided into bleeding group and non-bleeding group according to whether there were bleeding events within 1 year. Baseline clinical characteristics such as gender, age, type of ACS, comorbidities, combined drugs, history of percutaneous coronary intervention, routine blood parameters, liver and kidney function, and etc. in patients between 2 groups were compared. The risk factors of bleeding events were analyzed using logistic regression method and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results:A total of 180 patients were entered in the analysis, including 135 males and 58 females, aged (57±10) years, with the range of 31 to 81 years. There were 39 patients in the bleeding group and 141 patients in the non-bleeding group, and the incidence of bleeding events was 21.7%. None of the differences in gender distribution, age, comorbidities, history of percutaneous coronary intervention or combined drugs in patients between the 2 groups were statistically significant (all P>0.05). The platelet count of patients in the bleeding group was significantly lower than that in the non-bleeding group [(197±49) ×10 9/L vs. (220±60) ×10 9/L, t=2.254, P=0.025]. The shortest time from medication to the onset of bleeding of the 39 patients in the bleeding group was 14 days and the longest one was 12 months. The cumulative incidences of bleeding events at 3, 6, and 12 months of medication were 12.2% (22/180), 18.3% (33/180), and 21.7% (39/180), respectively. All bleeding events were minor bleeding, and the skin mucous ecchymosis had the highest incidence, which was 15.0% (27/180), followed by gingival bleeding or nosebleed, which was 7.2% (13/180). The incidence of fundus hemorrhage was 1.7% (3/180) and incidences of gastrointestinal bleeding and hematuria were both 0.6% (1/180). Multivariate logistic regression analysis showed that low platelet count was an independent risk factor for bleeding events [ OR=0.991, 95 %CI: 0.984-0.999, P=0.020]. Conclusions:ACS patients have a relative high risk of bleeding events when treated with ticagrelor combined with aspirin, but most of them were minor. For ACS patients with low platelet counts, this anti-platelet regimen should be used with caution and drug monitoring should be done in the whole course.

Objective:To explore the occurrence and risk factors of bleeding events in acute coronary syndromes (ACS) patients treated with ticagrelor combined with aspirin.Methods:The study subjects were selected from ACS patients who were admitted to Beijing Anzhen Hospital, Capital Medical University from January to December 2017 and treated with ticagrelor and aspirin (aspirin 100 mg/d, ticagrelor 180 mg/d). Medical records of the patients who met the inclusion criteria(at age>18 years, with medication duration ≥ 1 year, and with complete follow-up records) were collected and retrospectively analyzed. The patients were divided into bleeding group and non-bleeding group according to whether there were bleeding events within 1 year. Baseline clinical characteristics such as gender, age, type of ACS, comorbidities, combined drugs, history of percutaneous coronary intervention, routine blood parameters, liver and kidney function, and etc. in patients between 2 groups were compared. The risk factors of bleeding events were analyzed using logistic regression method and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results:A total of 180 patients were entered in the analysis, including 135 males and 58 females, aged (57±10) years, with the range of 31 to 81 years. There were 39 patients in the bleeding group and 141 patients in the non-bleeding group, and the incidence of bleeding events was 21.7%. None of the differences in gender distribution, age, comorbidities, history of percutaneous coronary intervention or combined drugs in patients between the 2 groups were statistically significant (all P>0.05). The platelet count of patients in the bleeding group was significantly lower than that in the non-bleeding group [(197±49) ×10 9/L vs. (220±60) ×10 9/L, t=2.254, P=0.025]. The shortest time from medication to the onset of bleeding of the 39 patients in the bleeding group was 14 days and the longest one was 12 months. The cumulative incidences of bleeding events at 3, 6, and 12 months of medication were 12.2% (22/180), 18.3% (33/180), and 21.7% (39/180), respectively. All bleeding events were minor bleeding, and the skin mucous ecchymosis had the highest incidence, which was 15.0% (27/180), followed by gingival bleeding or nosebleed, which was 7.2% (13/180). The incidence of fundus hemorrhage was 1.7% (3/180) and incidences of gastrointestinal bleeding and hematuria were both 0.6% (1/180). Multivariate logistic regression analysis showed that low platelet count was an independent risk factor for bleeding events [ OR=0.991, 95 %CI: 0.984-0.999, P=0.020]. Conclusions:ACS patients have a relative high risk of bleeding events when treated with ticagrelor combined with aspirin, but most of them were minor. For ACS patients with low platelet counts, this anti-platelet regimen should be used with caution and drug monitoring should be done in the whole course.

Objective To evaluate the risk of acute kidney injury (AKI) induced by sodium glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin,dapagliflozin,empagliflozin,and ertugliflozin).Methods Reports of AKI events induced by SGLT2 inhibitors and non-SGLT2 inhibitors received from January 1,2013 to September 30,2018 in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database were collected.The relationship between the drugs mentioned above and the AKI events in all patients and especially in patients with diabetes mellitus,respectively,were analyzed by the method of reporting odds ratio (ROR).Results A total of 2 949 reports of SGLT2 inhibitors-induced AKI (2.50％ of 117 843 AKI event reports in the database during the study period),and 114 894 reports of non-SGLT2 inhibitors-induced AKI were retrieved from the database.The ROR values of AKI events induced by overall SGLT2 inhibitors,canagliflozin,dapagliflozin,and empagliflozin in all patients were 4.14 (95％ CI:3.98-4.30),5.58 (95％ CI:5.35-5.83),2.62 (95％ CI:2.35-2.92),and 1.96 (95％ CI:1.76-2.19),respectively,and in patients with diabetes mellitus were 2.84 (95 ％ CI:2.71-2.98),3.90 (95 ％ CI:3.69-4.12),1.70 (95％CI:1.48-1.94),and 1.30 (95％CI:1.15-1.48),respectively.Due to the short time to market,less than 3 reports of AKI events induced by ertugliflozin were reported,thus ROR analysis was not conducted for ertugliflozin.The analyses of combined medication showed that in all patients,the ROR value of AKI events induced by SGLT2 inhibitors was 8.05 (95％ CI:7.10-9.13) when SGLT2 inhibitors were combined with diuretics,which increased by 80.90％ compared with that when SGLT2 inhibitors were given alone and in patients with diabetes mellitus,it was 6.07 (95％ CI:5.27-7.00),which increased by 92.09％;in all patients,the ROR value of AKI events induced by SGLT2 inhibitors was 5.87 (95％CI:4.89-7.04) when SGLT2 inhibitors were combined with non-steroidal anti-inflammatory drugs (NSAID),which increased by 39.43％ compared with that when SGLT2 inhibitors were given alone and in patients with diabetes mellitus,it was 4.66 (95％ CI:3.79-5.74),which increased by 61.25％;in all patients,the ROR value of AKI events induced by SGLT2 inhibitors was 5.60 (95％ CI:5.12-6.14) when SGLT2 inhibitors were combined with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers,which increased by 25.56％ compared with that when SGLT2 inhibitors were given alone and in patients with diabetes mellitus,it was 4.05 (95％ CI:3.66-4.48),which increased by 27.36％.Conclusions SGLT2 inhibitors might increase the risk of AKI and this risk was mainly from canagliflozin,suggesting that dapagliflozin and empagliflozin were relatively safe to patients.The risk of AKI might increase when SGLT2 inhibitors were combined with diuretics or NSAID.

Objective To evaluate the risk of acute kidney injury (AKI) induced by sodium glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin,dapagliflozin,empagliflozin,and ertugliflozin).Methods Reports of AKI events induced by SGLT2 inhibitors and non-SGLT2 inhibitors received from January 1,2013 to September 30,2018 in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database were collected.The relationship between the drugs mentioned above and the AKI events in all patients and especially in patients with diabetes mellitus,respectively,were analyzed by the method of reporting odds ratio (ROR).Results A total of 2 949 reports of SGLT2 inhibitors-induced AKI (2.50％ of 117 843 AKI event reports in the database during the study period),and 114 894 reports of non-SGLT2 inhibitors-induced AKI were retrieved from the database.The ROR values of AKI events induced by overall SGLT2 inhibitors,canagliflozin,dapagliflozin,and empagliflozin in all patients were 4.14 (95％ CI:3.98-4.30),5.58 (95％ CI:5.35-5.83),2.62 (95％ CI:2.35-2.92),and 1.96 (95％ CI:1.76-2.19),respectively,and in patients with diabetes mellitus were 2.84 (95 ％ CI:2.71-2.98),3.90 (95 ％ CI:3.69-4.12),1.70 (95％CI:1.48-1.94),and 1.30 (95％CI:1.15-1.48),respectively.Due to the short time to market,less than 3 reports of AKI events induced by ertugliflozin were reported,thus ROR analysis was not conducted for ertugliflozin.The analyses of combined medication showed that in all patients,the ROR value of AKI events induced by SGLT2 inhibitors was 8.05 (95％ CI:7.10-9.13) when SGLT2 inhibitors were combined with diuretics,which increased by 80.90％ compared with that when SGLT2 inhibitors were given alone and in patients with diabetes mellitus,it was 6.07 (95％ CI:5.27-7.00),which increased by 92.09％;in all patients,the ROR value of AKI events induced by SGLT2 inhibitors was 5.87 (95％CI:4.89-7.04) when SGLT2 inhibitors were combined with non-steroidal anti-inflammatory drugs (NSAID),which increased by 39.43％ compared with that when SGLT2 inhibitors were given alone and in patients with diabetes mellitus,it was 4.66 (95％ CI:3.79-5.74),which increased by 61.25％;in all patients,the ROR value of AKI events induced by SGLT2 inhibitors was 5.60 (95％ CI:5.12-6.14) when SGLT2 inhibitors were combined with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers,which increased by 25.56％ compared with that when SGLT2 inhibitors were given alone and in patients with diabetes mellitus,it was 4.05 (95％ CI:3.66-4.48),which increased by 27.36％.Conclusions SGLT2 inhibitors might increase the risk of AKI and this risk was mainly from canagliflozin,suggesting that dapagliflozin and empagliflozin were relatively safe to patients.The risk of AKI might increase when SGLT2 inhibitors were combined with diuretics or NSAID.