Objective:To establish the diagnosis and treatment strategies of tirofiban induced extremely severe thrombocytopenia to provide reference for laboratory stuffs and clinicians in early accurate identification and appropriate intervention.Methods:This study is a single-center retrospective study. The clinical data of patients with acute coronary syndrome treated at Fuwai Central China Cardiovascular Hospital from June 1st, 2019, to December 31st, 2024, were collected. 12 cases of extremely severe thrombocytopenia following tirofiban treatment were selected based on inclusion and exclusion criteria. The cohort comprised 10 males and 2 females, with a mean age of (66.08±7.08) years old. Clinical parameters including tirofiban administration duration, platelet count fluctuations, concomitant medications, treatment strategies, and complications were collected. The clinical characteristics of the data were analyzed and diagnostic-therapeutic flowchart was summarized. Normality was assessed using the Shapiro-Wilk test, and intergroup comparisons were performed using the Paired t-test or Wilcoxon test, and a P<0.05 was considered statistically significant.Results:All 12 patients had generally normal baseline platelet counts [(166.50±35.27)×10 9/L], but developed severe thrombocytopenia [(4.00±2.98)×10 9/L] after tirofiban treatment(P<0.001). 10 patients had the lowest platelet count within 24 hours using tirofiban, and the lowest platelet count occurred at 37 hours and 42 hours in 2 patients. 11 patients discontinued antithrombotic therapy after thrombocytopenia, and 10 patients resumed antithrombotic therapy after their platelet counts recovered above 30×10 9/L. 3 patients received platelet transfusions, while 10 patients were treated with thrombopoietin agents in combination with high-dose glucocorticoid pulse therapy. The time from discontinuation of tirofiban to platelet recovery above 50×10 9/L was (2.75±1.06) days. Major complications included bleeding manifestations ( n=6) and allergic-like reactions ( n=3). Based on the above clinical diagnosis and treatment information, a diagnosis and treatment flow chart for extremely severe thrombocytopenia caused by tirofiban was developed. Conclusion:When using tirofiban in clinical practice, platelet count should be monitored as early as possible to promptly identify tirofiban-induced extremely severe thrombocytopenia. The antithrombotic regimen and platelet-increasing treatment should be dynamically adjusted based on the patient′s condition.

Objective:To establish the diagnosis and treatment strategies of tirofiban induced extremely severe thrombocytopenia to provide reference for laboratory stuffs and clinicians in early accurate identification and appropriate intervention.Methods:This study is a single-center retrospective study. The clinical data of patients with acute coronary syndrome treated at Fuwai Central China Cardiovascular Hospital from June 1st, 2019, to December 31st, 2024, were collected. 12 cases of extremely severe thrombocytopenia following tirofiban treatment were selected based on inclusion and exclusion criteria. The cohort comprised 10 males and 2 females, with a mean age of (66.08±7.08) years old. Clinical parameters including tirofiban administration duration, platelet count fluctuations, concomitant medications, treatment strategies, and complications were collected. The clinical characteristics of the data were analyzed and diagnostic-therapeutic flowchart was summarized. Normality was assessed using the Shapiro-Wilk test, and intergroup comparisons were performed using the Paired t-test or Wilcoxon test, and a P<0.05 was considered statistically significant.Results:All 12 patients had generally normal baseline platelet counts [(166.50±35.27)×10 9/L], but developed severe thrombocytopenia [(4.00±2.98)×10 9/L] after tirofiban treatment(P<0.001). 10 patients had the lowest platelet count within 24 hours using tirofiban, and the lowest platelet count occurred at 37 hours and 42 hours in 2 patients. 11 patients discontinued antithrombotic therapy after thrombocytopenia, and 10 patients resumed antithrombotic therapy after their platelet counts recovered above 30×10 9/L. 3 patients received platelet transfusions, while 10 patients were treated with thrombopoietin agents in combination with high-dose glucocorticoid pulse therapy. The time from discontinuation of tirofiban to platelet recovery above 50×10 9/L was (2.75±1.06) days. Major complications included bleeding manifestations ( n=6) and allergic-like reactions ( n=3). Based on the above clinical diagnosis and treatment information, a diagnosis and treatment flow chart for extremely severe thrombocytopenia caused by tirofiban was developed. Conclusion:When using tirofiban in clinical practice, platelet count should be monitored as early as possible to promptly identify tirofiban-induced extremely severe thrombocytopenia. The antithrombotic regimen and platelet-increasing treatment should be dynamically adjusted based on the patient′s condition.

Objective:To explore the changes in serum levels of miR-499 and miR-362 in patients with advanced non-small cell lung cancer (NSCLC) and their relationship with prognosis.Methods:A total of 103 patients with advanced NSCLC at Shanghai University of Medicine & Health Sciences Affiliated Chongming Hospital from January 2020 to October 2021 were selected as the NSCLC group, and 100 healthy volunteers who underwent physical examinations at our hospital during the same period were selected as the control group. Fluorescent quantitative PCR was used to determine and compare the levels of serum miR-499 and miR-362 in the two groups, and the relationship between the two indexes and different clinical characteristics of NSCLC patients was analyzed. According to the clinical outcome of 2-year follow-up, the patients were divided into survival group and death group, and the levels of serum miR-499 and miR-362 were compared between the two groups. The predictive value of miR-499 and miR-362 levels on the prognosis of advanced NSCLC patients were analyzed using receiver operator characteristic (ROC) curves.Results:The serum miR-499 level in the NSCLC group (0.34±0.10) was lower than that in the control group (1.25±0.21), while the miR-362 level (1.13±0.27) was higher than that in the control group (0.63±0.15) ( t=18.26, P<0.001; t=16.32, P<0.001). There were statistically significant differences in serum miR-499 and miR-362 levels among patients with different degrees of differentiation ( t=11.12, P<0.001; t=16.35, P<0.001), TNM staging ( t=13.64, P=0.002; t=8.73, P=0.010) and lymph node metastasis ( t=10.02, P=0.003; t=9.65, P=0.004). The serum miR-499 level in the death group ( n=77) (0.24±0.06) was lower than that in the survival group ( n=26) (0.35±0.09), while the miR-362 level (1.54±0.32) was higher than that in the survival group (1.08±0.21), with statistically significant differences ( t=8.06, P=0.006; t=8.67, P=0.005). ROC curve analysis showed that the sensitivity of miR-499 and miR-362 in predicting the prognosis of advanced NSCLC patients was 73.46% and 75.85%, respectively, with specificity of 64.42% and 65.61%, AUC of 0.739 (95% CI: 0.662-0.805) and 0.743 (95% CI: 0.640-0.793) ; the sensitivity, specificity, and AUC of serum miR-499 combined with miR-362 in predicting the prognosis of advanced NSCLC patients were 87.63%, 85.34%, and 0.875 (95% CI: 0.698-0.897), respectively; the combined prediction of miR-499 and miR-362 for AUC area was higher than the individual prediction ( Z=4.83, P=0.013; Z=5.17, P=0.009) . Conclusion:Advanced NSCLC patients show significant abnormal serum level of miR-499 and miR-362, and as the severity of the disease progressed, the serum level of miR-499 is downregulated more significantly and miR-362 is upregulated more significantly. The combined detection of miR-499 and miR-362 levels has certain predictive value for the prognosis of advanced NSCLC patients.

Objective:A structural equation model of the influencing factors on caregiver preparedness at discharge of patients with chronic heart failure was constructed based on the individual and family self-management theory, and the main paths influencing caregiver preparedness were explored.Methods:This study was a cross-sectional survey. A total of 345 caregivers of patients with chronic heart failure who were hospitalized in the Fourth Affiliated Hospital of China Medical University from October 2020 to August 2021 were selected as research objects by convenience sampling method, and they were investigated by Caregiver Preparedness Scale, Family APGAR Index, Herth Hope Index, Social Support-Rating Scale, Simplified Coping Style Questionnaire. The influencing factors on caregiver preparedness at discharge of patients with chronic heart failure were analyzed.Results:The total score of Caregiver Preparedness Scale, Family APGAR Index, Herth Hope Index, Social Support-Rating Scale, and Positive and Negative Coping Subscale of Simplified Coping Style Questionnaire in patients with chronic heart failure was (20.79 ± 4.92), (8.05 ± 1.43), (35.34 ± 4.47), (43.89 ± 6.56), (24.38 ± 5.21), (11.21 ± 4.26) points. Caregiver preparedness in patients with chronic heart failure was positively correlated with family function, hope, positive coping and social support ( r values were 0.213-0.383, all P<0.01), and negatively correlated with negative coping ( r=-0.546, P<0.01). Family function and social support in patients with chronic heart failure could directly or indirectly affect caregiver preparedness (total effect value: 0.380, 0.212), hope and negative coping directly affected caregiver preparedness (total effect value: 0.200, -0.433), and could account for 39% of the total variation in caregiver preparedness. Conclusions:Caregiver preparedness of patients with chronic heart failure needs further improvement. The effective ways to improve caregiver preparedness are to pay attention to family function, improve hope level, increase social support and reduce negative coping.

Objective:To systematically evaluate the efficacy and safety of tissue adhesive combined with lauromacrogol (modified Sandwich method) for gastric varices.Methods:Literature in the Cochrane Library, PubMed, EMbase, CNKI, VIP and Wanfang were searched by two independent researchers from the establishment of the databases to June 30, 2020, and qualified data from the eligible literature were extracted. Revman 5.3 was used to analyze outcomes including hemostatic efficiency, incidence of postoperative fever, chest and abdominal pain, ulcer, ectopic embolism and complications, and postoperative re-bleeding rate (Mantel-Haenszel method).Results:A total of 8 randomized controlled trials including 898 patients were included in this meta-analysis. The results showed that compared with the classic Sandwich method, the modified version had a better hemostatic effect ( P=0.01, OR=2.07, 95% CI: 1.17-3.68) and a lower incidence of postoperative ectopic embolism ( P=0.001, OR=0.06, 95% CI: 0.01-0.34). There were no significant differences in the incidences of postoperative fever ( P=0.58, OR=0.86, 95% CI: 0.52-1.44), chest and abdominal pain ( P=0.83, OR=0.95, 95% CI: 0.58-1.56), local ulcer ( P=0.31, OR=0.66, 95% CI: 0.30-1.47) , re-bleeding ( P=0.14, OR=0.76, 95% CI: 0.53-1.09) or overall incidence of adverse reactions ( P=0.24, OR=0.66, 95% CI: 0.33-1.32). Conclusion:The modified Sandwich method of tissue adhesive combined with lauromacrogol is an effective and safe method in the treatment of gastric varices.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.

Objective:To explore and understand the home rehabilitation experience of obese patients after metabolic bariatric surgery (MBS) , and provide a reference for the development of home nursing after MBS.Methods:Totally 12 patients who came for reexamination after MBS at the Department of Metabolic Bariatric Surgery in a Class Ⅲ Grade A hospital were selected by purposive sampling between February and May 2019. Descriptive research methods were used to conduct in-depth interviews over the patients and record the results, and content analysis was employed to organize and analyze the data.Results:Four themes were refined: suffering from changes in body image; constantly facing the puzzles of diet management; gradually choosing to give up rehabilitation exercise; and feeling emotional fluctuations, the hardship of seeking medical service and inner expectations.Conclusions:Medical staff should pay attention to the true feelings of patients' home rehabilitation post operation, strengthen the professional support outside the hospital for the health-related problems and different mental states during the rehabilitation process, provide standardized home care services, and improve the quality of life of the patients.

OBJECTIVETo investigate the protective effect of monoside against triptolide-induced liver injury and explore its molecular mechanism.

METHODSBALB/C mice treated with gastric lavage with triptolide and monoside, either alone or in combination, were examined for changes of hepatic biochemical parameters using the serological method. The growth inhibition rate of HepG2 cells treated with triptolide or monoside or both was assessed with MTT assay, and the cell morphological changes were observed using laser confocal microscopy; the expressions of the target proteins in the antioxidative stress pathway were detected using flow cytometry and Western blotting.

RESULTSIn BALB/C mice, gastric lavage of triptolide induced obvious hepatic damage. In HepG2 cells, treatment with triptolide significantly inhibited the cell growth, resulting in a cell viability as low as 72.83% at 24 h; triptolide also induced obvious cell apoptosis and cell nucleus deformation, causing an apoptosis rate of 43.1% in the cells at 24 h. Triptolide significantly reduced the expressions of Nrf2 and HO-1 proteins related with the oxidative stress pathway. Combined treatment with morroniside obviously reversed these changes, resulting in significantly decreased hepatic biochemical parameters and the liver index in BALB/C mice and in significantly lowered cell apoptosis rate, improved cell morphology, and increased Nrf2 and HO-1 protein expressions in HepG2 cells.

CONCLUSIONSMonoside protects against triptolide-induced liver injury possibly by relieving oxidative stress.

OBJECTIVETo investigate the effects of telmisartan on expression of resistin in serum and liver under conditions of nonalcoholic steatohepatitis (NASH) and insulin resistance using a rat model system.

METHODSForty-five male Sprague-Dawley rats were randomly divided into a normal control group (NC, n=10), a model control group (MC, n=15), a polyene phosphatidylcholine prevention group (PP, n=10), and a telmisartan prevention group (TP, n=10). The NC group was given a standard diet and the other groups were given a high-fat diet for 16 weeks in order to induce NASH. At the end of week 12, 5 rats in the MC group were sacrificed for pathology confirmation of the NASH model. At the end of week 12, the TP group was given telmisartan (8.0 mg/kg/d) and the PP group was given polyene phosphatidylcholine (8.4 mg/kg/d) for an additional 4 weeks by intragastric administration. At the end of week 16, all rats were sacrificed and body weights recorded. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglycerides (TG), resistin, insulin and fasting blood glucose were measured. The insulin resistance value, HOMA-IR, was assessed by homeostasis mode assessment. Liver expression of the resistin protein was detected by western blotting and of the resistin mRNA was detected by RT-PCR. The F test and LSD test were used for statistical analyses.

RESULTSCompared to the NC group, the body weight and HOMA-IR of rats in the MC group were significantly increased (P<0.01). The levels of serum resistin, and of resistin protein and mRNA in liver, were significantly higher in the MC group than in the NC group of rats (all P less than 0.01). The body weight of rats in the TP group was significantly lower than those in the MC group (P<0.05). The levels of serrn resistin, resistin protein and mRNA in the liver, and insulin resistance were significantly lower in the TP group than in the MC group of rats (all P<0.01). The PP group did not show significant differences in any of these measures, except for loss of body weight (P<0.05).

CONCLUSIONTelmisartan elicits preventive and protective effects in a NASH rat model.Telmisartan may improve insulin resistance in NASH rats by decreasing the expression of serum resistin, and liver resistin protein and mRNA.

Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Benzimidazoles ; Benzoates ; Cholesterol ; Diet, High-Fat ; Disease Models, Animal ; Insulin ; Insulin Resistance ; Male ; Non-alcoholic Fatty Liver Disease ; Rats ; Rats, Sprague-Dawley ; Resistin ; Triglycerides

Objective To investigate the effects of telmisartan on insulin resistance and oxidative stress in nonalco?holic steatohepatitis (NASH) rats. Methods Fifty male SD rats were randomly divided into five groups:control group, mod?el group, polyene phosphatidylcholine group, low-dose telmisartan group and high-dose telmisartan group by using random number table (n=10 in each group). Control group was given standard food,the other groups were given high fat diet for 12 weeks to establish NASH rat model. Then intervention groups were given either normal saline 1.0 mL/(kg·d) or polyene phos?phatidylcholine 8.4 mg/(kg·d), or telmisartan 4 mg/(kg·d) or telmisartan 8 mg/(kg·d) for 4 weeks by intragastric adminstra?tion. All rats were sacrificed at the end of the 16th week, the lever of plasma insulin resistance index (HOMA-IR), ALT, AST, TG, TC, MDA, SOD, T-AOC, CAT, GSH-PX and liver homogenate MDA, SOD, GSH-PX and liver NAS scores were tested. Results In polyene phosphatidylcholine treated group, the lever of plasma ALT, AST, HOMA-IR and liver NAS scores were degreased significantly compared with model group. The lever of plasma AST, SOD, T-AOC, CAT, GSH-PX and liver homogenate SOD, GSH-PX, liver NAS scores were improved in both low-dose and high-dose telmisartan groups com?pared with model group while plasma and liver homogenate MDA , HOMA-IR were reduced significantly in these two groups compared with model group. Besides, plasma ALT was significantly improved in high-dose telmisartan group compared with model group. Conclusion Telmisartan reduce plasma ALT, AST, oxidative stress, HOMA-IR and liver NAS scores in NASH rats. And high-does telmisartan is better than low-dose telmisartan and polyene phosphatidylcholine in treatment ef?fect.