OBJECTIVE: To investigate the effect of HR-HPV positive,HR-HPV load and SCC-Ag positive on the recurrence of cervical cancer after radical resection.METHODS: The clinical data of cervical cancer patients who underwent radical resection of cervical cancer in People's Hospital of Zengcheng District from January 2010 to January2019 were retrospectively collected.The patients were followed up regularly,and the preoperative HR-HPV positive,loading,the amount of SCC-Ag expression were determined;the recurrence and metastasis of cervical cancer were analyzed,and the value of HR-HPV positive,HR-HPV loading and SCC-Ag in predicting the recurrence and metastasis of cervical cancer were analyzed.RESULTS: A total of 438 patients with cervical cancer were included.There was no significant difference in pathological type,or postoperative Meigs-Brunschwig pathological staging between the recurrence group(n=42)and the non-recurrence group(n=396)(P>0.05).The difference in the proportion of HRHPV positive(40/42 vs. 144/396),HR-HPV loading and SCC-Ag positive(34/42 vs. 64/396)was statistically significant between non-recurrence group and recurrence group(P<0.05).The difference in HR-HPV positive in pelvic recurrence and distant metastasis was statistically significant(P<0.05).There was no significant difference in HR-HPV load or SCC-Ag in pelvic recurrence and distant metastasis(P>0.05).Multivariate logistic regression analysis showed that distant metastasis,FIGO staging of cervical cancer,HR-HPV positive,and SCC-Ag were independent factors affecting cervical cancer recurrence(P<0.05).When predicting by individual indicator,the specificity and positive predictive value of HR-HPV positive for predicting cervical cancer recurrence were 99.18% and 95.23% at the highest,and the negative predictive value of HR-HPV was87.37% at the highest.When SCC-Ag was used to predict cervical cancer recurrence,the sensitivity was up to 33.33%.The sensitivity of combined prediction was 64.51%,the specificity was 99.46%,the positive predictive value was97.41%,and the negative predictive value was 94.44%.CONCLUSION: Distant metastasis,FIGO staging,HR-HPV positive,and SCC-Ag are independent factors affecting cervical cancer recurrence.The combination of HR-HPV positive,HR-HPV loading and SCC-Ag has certain value for predicting recurrence of cervical cancer,and the prediction value is the highest.

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 investigate the prevention of acute kidney injury (AKI) by earlier application of rosuvastatin in patients after coronary artery bypass grafting (CABG).Methods A total of 200 patients with CABG were enrolled from May 2013 to April 2017.According to whether rosuvastatin were used routinely before operation or not,all patients were divided into the trial group (n =136) and the control group (n =64).Demographics,and clinical data were collected before and after CABG.The renal function markers including blood urea nitrogen (BUN),serum creatinine (sCr),endogenous creatinine clearance rate (GFR),emergence of AKI of two groups were documented and compared.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test,and P ＜ 0.05 was considered to be significant.Results There were no differences in sCr (t =-1.156,P ＞ 0.05) but differences in BUN and eGFR (t =-2.915,3.690,respectively,P ＜ 0.05) before operation between two groups.After operation,the BUN was decreased (t =2.486,P ＜ 0.05) compared with that of pre-operation in the trial group,but there were no significant difference in sCr and eGFR (t =-1.877,-0.752,respectively,P ＞0.05).The BUN and sCr were increased (t =-3.792,-5.027,respectively,P ＜ 0.05) after operation compared with that of pre-operation in the control group,while the eGFR was decreased (t =5.540,P ＜0.05).Compared with the control group,BUN,sCr and the incidence of AKI were significantly decreased in the trial group (t/x2 =5.759,4.196,15.506,respectively,P ＜0.05),while the eGFR was increased (t =-6.215,P ＜ 0.05).Conclusions Earlier application of rosuvastatin before CABG can effectively protect renal function and reduce the incidence of AKI.

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.