Objective To analyze the clinical characteristics and risk factors of noninfectious fever after endovascular repair of aortic dilatation diseases, and to explore management strategies. Methods A retrospective analysis was conducted on the clinical data of patients who underwent endovascular aortic repair for aortic dilatation diseases from January 2021 to October 2023. Based on inclusion and exclusion criteria, the enrolled patients were divided into a febrile group and an afebrile group according to the presence of postoperative fever. Clinical data, including demographics and surgical details, were compared between the two groups. Multivariate logistic regression analysis was performed on indicators with P≤0.05 in the univariate analysis, and receiver operating characteristic (ROC) curves were generated to analyze the predictive value of risk factors for postoperative noninfectious fever. Results A total of 305 patients were included in the final analysis. Postoperative noninfectious fever occurred in 75.08% (229/305) of the patients, with 98.25% of cases occurring within the first two postoperative days. The febrile group (n=229) had a median age of 65.0 (IQR: 53.0, 73.0) years with 83.4% males, while the afebrile group (n=76) had a median age of 71.0 (IQR: 65.0, 76.7) years with 84.2% males. Univariate analysis showed that the age, prevalence of coronary heart disease, preoperative statin use, and prevalence of aortic aneurysm were significantly lower in the febrile group compared to the afebrile group. Logistic regression analysis indicated that age, surgical site, disease type, preoperative elevated body temperature, and stent type were significantly associated with noninfectious fever, while preoperative statin use was negatively correlated. ROC curve analysis demonstrated that age, surgical site, preoperative elevated body temperature, and stent type had significant predictive value for postoperative noninfectious fever (P<0.01). Conclusion Noninfectious fever is highly prevalent following aortic repair. The relationship between fever and infection should be comprehensively evaluated based on risk factors and changes in the patient's condition to promote the rational use of antibiotics.

Objective To evaluate the predictive efficacy of individualized dosage support software-Smart Dose,PharmVan and JPKD-on vancomycin plasma concentration in patients undergoing infective endocarditis(IE)surgery,and to analyze the influencing factors.Methods A retrospective analysis was conducted in IE patients who received intravenous vancomycin in our hospital from January 2019 to December 2022.The above softwares were used to predict the steady-state trough concentration of vancomycin,and the relative prediction error and absolute weight deviation(AWE)between the predicted and measured values were compared.According to the AWE value,the results were divided into accurate prediction group(AWE＜30％)and the inaccurate prediction group(AWE≥30％).Univariate analysis and Logistic regression analysis were used to explore the influencing factors,and to evaluate the predictive value through the receiver operating characteristic curve(ROC).Results A total of 27 patients were enrolled,with 27 concentrations of initial regimen and 35 of adjustment regimen.When PharmVan predicted the adjusted concentration,the AWE was 24.84(11.54,39.78)％,with higher accuracy than other predicted results.The Univariate analysis of factors influencing the performance of PharmVan in predicting the adjusted concentration showed that patients in the accurate prediction group was significantly younger than that in the inaccurate prediction group(P＜0.05).Multivariate analysis showed that advanced age was an independent risk factor for the inaccurate prediction of PharmVan for adjustment concentration[OR=0.856,95％CI was(0.757,0.969),P=0.014].ROC curve analysis indicated that when patients were older than 48.5 years old,the risk of inaccurate prediction was increased with a sensitivity of 78.9％and a specificity of 93.7％.Conclusions Only the PharmVan software has a higher accuracy in predicting the adjusted concentration among the three softwares,but it is still need to be cautious in combination with the analysis results of ROC curve.Therefore,when using vancomycin in IE patients,attention should be paid to renal function and plasma concentration should be actively monitored.

Objective To explore the clinical characteristics and features of noninfectious fever in elderly patients with aortic dilation disease.Methods A total of 599 elderly patients diagnosed with aortic dilation disease(including 274 cases of acute disease and 325 cases of chronic disease)in the Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2021 to June 2024 were recruited.According to their age,the patients with acute disease were divided into aged group 1(105 cases)and non-age group 1(169 cases),and those with chronic disease were into aged group 2(231 cases)and non-age group 2(94 cases).For the 520 patients(246 cases of acute disease and 274 cases of chronic disease)subjected for endovascular repair surgery,they were assigned into aged group 3(90 cases)and non-aged group 3(156 cases)for those with acute dis-ease,and aged group 4(206 cases)and non-aged group 4(68 cases)for those with chronic disease.For the 230 patients experiencing postoperative non-infectious fever,they were divided into acute-febrile(50 cases),acute-afebrile(20 cases),chronic-febrile(106 cases)and chronic-afebrile(54 cases)groups.Their general data was compared among the groups.Multivariate logistic regression analysis was conducted to identify the risk factors for postoperative noninfectious fever.ROC curve was plotted to analyze the predictive performance of our model for postoperative noninfec-tious fever.Results The surgical rate of endovascular repair surgery was 86.81％(520/599).The aged patients had significantly lower incidences of postoperative fever and non-infectious fever than the non-aged patients(P＜0.05,P＜0.01).There were no statistical differences in the ratio of using first and second generation cephalosporins or clindamycin and the duration of postopera-tive medication between the febrile group and afebrile group(P＞0.05).Multivariate logistic re-gression analysis showed that for acute disease,implantation of polytetrafluoroethylene stents(OR=7.931,95％CI:1.945-32.337,P=0.004)was a risk factor,while administration of statins(OR=0.160,95％CI:0.032-0.807,P=0.026)was a protective factor for non-infectious fever.ROC curve analysis indicated that showed our model based on above results of multivariate logis-tic regression analysis had an AUC value of 0.836,a sensitivity of 60.0％and a specificity of 95.0％.For chronic disease,implantation of polytetrafluoroethylene stents(OR=2.558,95％CI:1.250-5.235,P=0.010)and preoperative increased temperature(OR=4.615,95％CI:1.502-14.181,P=0.008)were risk factors for non-infectious fever.Based on these results,the construc-ted model obtained an AUC value of 0.714 in ROC curve analysis.Conclusion For elderly patients undergoing aortic repair surgery,it is unnecessary to upgrade the variety of antibiotics or extend the course of treatment due to advanced age.Individualized analysis of possible infections should be conducted to promote the rational use of antibiotics.

Objective To explore the clinical characteristics and features of noninfectious fever in elderly patients with aortic dilation disease.Methods A total of 599 elderly patients diagnosed with aortic dilation disease(including 274 cases of acute disease and 325 cases of chronic disease)in the Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2021 to June 2024 were recruited.According to their age,the patients with acute disease were divided into aged group 1(105 cases)and non-age group 1(169 cases),and those with chronic disease were into aged group 2(231 cases)and non-age group 2(94 cases).For the 520 patients(246 cases of acute disease and 274 cases of chronic disease)subjected for endovascular repair surgery,they were assigned into aged group 3(90 cases)and non-aged group 3(156 cases)for those with acute dis-ease,and aged group 4(206 cases)and non-aged group 4(68 cases)for those with chronic disease.For the 230 patients experiencing postoperative non-infectious fever,they were divided into acute-febrile(50 cases),acute-afebrile(20 cases),chronic-febrile(106 cases)and chronic-afebrile(54 cases)groups.Their general data was compared among the groups.Multivariate logistic regression analysis was conducted to identify the risk factors for postoperative noninfectious fever.ROC curve was plotted to analyze the predictive performance of our model for postoperative noninfec-tious fever.Results The surgical rate of endovascular repair surgery was 86.81％(520/599).The aged patients had significantly lower incidences of postoperative fever and non-infectious fever than the non-aged patients(P＜0.05,P＜0.01).There were no statistical differences in the ratio of using first and second generation cephalosporins or clindamycin and the duration of postopera-tive medication between the febrile group and afebrile group(P＞0.05).Multivariate logistic re-gression analysis showed that for acute disease,implantation of polytetrafluoroethylene stents(OR=7.931,95％CI:1.945-32.337,P=0.004)was a risk factor,while administration of statins(OR=0.160,95％CI:0.032-0.807,P=0.026)was a protective factor for non-infectious fever.ROC curve analysis indicated that showed our model based on above results of multivariate logis-tic regression analysis had an AUC value of 0.836,a sensitivity of 60.0％and a specificity of 95.0％.For chronic disease,implantation of polytetrafluoroethylene stents(OR=2.558,95％CI:1.250-5.235,P=0.010)and preoperative increased temperature(OR=4.615,95％CI:1.502-14.181,P=0.008)were risk factors for non-infectious fever.Based on these results,the construc-ted model obtained an AUC value of 0.714 in ROC curve analysis.Conclusion For elderly patients undergoing aortic repair surgery,it is unnecessary to upgrade the variety of antibiotics or extend the course of treatment due to advanced age.Individualized analysis of possible infections should be conducted to promote the rational use of antibiotics.

Objective To evaluate the predictive efficacy of individualized dosage support software-Smart Dose,PharmVan and JPKD-on vancomycin plasma concentration in patients undergoing infective endocarditis(IE)surgery,and to analyze the influencing factors.Methods A retrospective analysis was conducted in IE patients who received intravenous vancomycin in our hospital from January 2019 to December 2022.The above softwares were used to predict the steady-state trough concentration of vancomycin,and the relative prediction error and absolute weight deviation(AWE)between the predicted and measured values were compared.According to the AWE value,the results were divided into accurate prediction group(AWE＜30％)and the inaccurate prediction group(AWE≥30％).Univariate analysis and Logistic regression analysis were used to explore the influencing factors,and to evaluate the predictive value through the receiver operating characteristic curve(ROC).Results A total of 27 patients were enrolled,with 27 concentrations of initial regimen and 35 of adjustment regimen.When PharmVan predicted the adjusted concentration,the AWE was 24.84(11.54,39.78)％,with higher accuracy than other predicted results.The Univariate analysis of factors influencing the performance of PharmVan in predicting the adjusted concentration showed that patients in the accurate prediction group was significantly younger than that in the inaccurate prediction group(P＜0.05).Multivariate analysis showed that advanced age was an independent risk factor for the inaccurate prediction of PharmVan for adjustment concentration[OR=0.856,95％CI was(0.757,0.969),P=0.014].ROC curve analysis indicated that when patients were older than 48.5 years old,the risk of inaccurate prediction was increased with a sensitivity of 78.9％and a specificity of 93.7％.Conclusions Only the PharmVan software has a higher accuracy in predicting the adjusted concentration among the three softwares,but it is still need to be cautious in combination with the analysis results of ROC curve.Therefore,when using vancomycin in IE patients,attention should be paid to renal function and plasma concentration should be actively monitored.

OBJECTIV E To develop the infor mation-based pharmaceutical care pathway of anticoagulant therapy in patients with atrial fibrillation and improve the efficacy and safety of treatment for them. METHODS The“anticoagulant pharmaceutical care”module was developed on the basis of medical intelligent and decision system. Patients with atrial fibrillation were taken pharmaceutical care in the whole anticoagulant treatment by evaluating the thromboembolism and bleeding risks ，pre-reviewing antithrombotic prescriptions ，monitoring efficacy and drug interactions ，and warning adverse reactions. RESULTS A total of 1 228 patients receiving anticoagulant therapy were enrolled. It was found after analysis of their doctor ’s orders that 9.27％ of the patients adjusted the improper antithrombotic therapies ，3.99％ modulated treatments according to the effects of potential drug interactions or the risk of adverse reactions ，and 70.29％ of the wrong prescriptions were intervened successfully. After the information-based pharmaceutical care ，the anticoagulation treatment rate increased from 88.73％ to 97.40％，the rate of patients ’achievements to warfarin’s international normalized ratio in hospital increased from 38.64％ to 66.67％，and the incidence of serious bleeding events decreased from 2.94％ to 0.37％ （P＜0.05）. CONCLUSIONS The information-based pharmaceutical care path of anticoagulant therapy achieved comprehensive ，efficient and accurate management of patients with atrial fibrillation ，and improved the rationality ，effectiveness and safety of anticoagulant therapy.

A 16-year-old female patient received ethinylestradiol and cyproterone acetate tablets (1 tablet once daily for 21 days) for artificial menstrual cycle treatment due to irregular menstruation. On the 7th day of medication, the patient developed swelling of the distal right lower extremity, accompanied by pain, and slight limitation of movement, which did not attract attention. The drug was stopped 21 days later. On the 2nd day after drug withdrawal, the patient had vaginal withdrawal bleeding and blood expectoration occurred once on the same day. After 16 days of drug withdrawal, the swelling and pain of the right lower limb was aggravated. Ultrasound showed deep vein thrombosis in the right lower limb, and CT angiography of the pulmonary artery showed embolism in the right lower pulmonary artery. Deep vein thrombosis complicated with subacute pulmonary embolism were diagnosed. Enoxaparin sodium for anticoagulation and symptomatic treatments were given, the symptoms were improved 17 days later. Laboratory tests showed that the platelet count was 90×10 9/L, the anticardiolipin antibody IgG was 209 GPL/ml, and the platelet-related antibody was positive. Antiphospholipid syndrome was diagnosed. It was considered that the thrombosis was related to ethinylestradiol and cyproterone acetate tablets.

A 16-year-old female patient received ethinylestradiol and cyproterone acetate tablets (1 tablet once daily for 21 days) for artificial menstrual cycle treatment due to irregular menstruation. On the 7th day of medication, the patient developed swelling of the distal right lower extremity, accompanied by pain, and slight limitation of movement, which did not attract attention. The drug was stopped 21 days later. On the 2nd day after drug withdrawal, the patient had vaginal withdrawal bleeding and blood expectoration occurred once on the same day. After 16 days of drug withdrawal, the swelling and pain of the right lower limb was aggravated. Ultrasound showed deep vein thrombosis in the right lower limb, and CT angiography of the pulmonary artery showed embolism in the right lower pulmonary artery. Deep vein thrombosis complicated with subacute pulmonary embolism were diagnosed. Enoxaparin sodium for anticoagulation and symptomatic treatments were given, the symptoms were improved 17 days later. Laboratory tests showed that the platelet count was 90×10 9/L, the anticardiolipin antibody IgG was 209 GPL/ml, and the platelet-related antibody was positive. Antiphospholipid syndrome was diagnosed. It was considered that the thrombosis was related to ethinylestradiol and cyproterone acetate tablets.

Objective To study the antidepressant-like effect of Butanol Extract from Stevia (BEFS) and its possible corresponding mechanisms.Methods Forty-five mice were randomly divided into control group,model group,model + Fluoxetine group,model + BEFS-3 g/kg group and model + BEFS-6 g/kg group.The chronic unpredictable mild stress(CUMS) for 3 weeks was used to make up depressive animal model.It was based on body weight,crossing numbers,rearing numbers and sucrose preference to assess whether the model was a success.After continuous lavage giving BEFS and fluoxetine for 2 weeks and subsequent behavioral test,the mRNA transcription of Single immunoglobulin interleukin-1 receptor-related molecule (SIGIRR) and nuclear factor kappa-B (NF-κB) in liver tissue of mice were detected by using quantitative real time-PCR.Results Three weeks after CUMS,behavior parameters were significantly decreased in mice exposed to CUMS compared with control group[(17.28 ±0.49) g vs (22.47 ± 0.82) g,P =0.000;(43.35 ± 1.68) scores vs (125.25 ± 3.07) scores,P =0.000;(3.92 ± 0.18) scores vs (15.92 ± 1.78) scores,P =0.000;(49.39 ± 2.05) ％ vs (67.18 ± 4.46) ％,P =0.001].However,2 weeks after dosing,body weight,crossing numbers,rearing numbers and sucrose preference were (19.03 ± 0.44) g,(70.50 ± 6.56) scores,(3.08 ± 0.77) scores and (41.27 ± 7.59) ％,respectively in model group.Compared to model group,behavior parameters of BEFS (3 and 6 g/kg BEFS) groups were significantly increased [BEFS-6 g/kg group:(24.42 ± 1.46) g,(99.75 ± 5.07) scores,(13.08 ± 1.60) scores,(64.31 ± 1.92) ％,all P ＜ 0.05;BEFS-3 g/kg group:(23.82 ± 1.72) g,(91.67 ± 5.69) scores,(6.92 ± 1.05) scores,(59.56 ± 5.31) ％,respectively,all P ＜ 0.05].Correspondingly,BEFS could reverse the mRNA expression of SIGIRR lowering and NF-κB rising in the liver of mice exposed to CUMS(BEFS-6 g/kg group:1.208 1 ± 0.102 2,1.437 7 ± 0.352 9;BEFS-3 g/kg group:0.768 0 ± 0.108 6,2.186 2 ± 0.203 8,all P ＜ 0.05).Conclusions BEFS can remarkably improve depression-like behaviors in CUMS mice and its antidepressant activity is mediated,at least in part,by upregulating SIGIRR and downregulating NF-κB in the liver.