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In-stent restenosis is one of the main causes of postoperative complications after percutaneous coronary intervention and a challenge in the field of intervention.Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are new oral hypoglycemic agents used in the treatment of diabetes in recent years. In addition to lowering bloodglucose, they also have the effects of lowering blood pressure, improving blood lipids, and reducing weight, thereby protecting cardiovascular function. Recent studies have shown that SGLT2i can reduced the occurrence of in-stent restenosis and significantly improved the prognosis of patients with coronary heart disease receiving interventional therapy.This article reviews the clinical studies and mechanisms of SGLT2i in the prevention of restenosis after percutaneous coronary intervention, providing new ideas for improving the clinical prognosis of patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Aim To systematically evaluate the effect of non-vitamin K antagonist oral anticoagulants (NOAC) on liver function. Methods The PubMed, Embase, Cochrane Library, Wanfang, CNKI and VIP databases were searched to collect randomized controlled trials (RCT) related to non-vitamin K antagonist oral anticoagulant treatment published openly before June 30, 2023. Data were extracted according to the inclusion criteria. The quality of the included studies was evaluated. Meta-analysis was performed on the related data using R language. Results A total of 22 RCT studies were included, with 64 063 patients receiving non-vitamin K antagonist oral anticoagulant treatment. Compared with the control group, non-vitamin K antagonist oral anticoagulants did not increase the risk of abnormal liver function (alanine transaminase (ALT)>3 ULN) (RR=0. 72, 95%CI: 0. 61 ~0. 84, I² =59%, P<0. 01), or the risk of severe liver injury (ALT> 3 ULN combined with total bilirubin (TBIL)>2 ULN) (RR=0. 98, 95% CI: 0. 80 ~ 1. 19, I² =0%, P =0. 01). When used for preventing deep vein thrombosis after orthopedic surgery, compared with the control group, non-vitamin K antagonist oral anticoagulants reduced the risk of abnormal liver function (RR=0. 69, 95%CI: 0. 61 ~0. 79, I² =0%, P<0. 01). Conclusions Non-vitamin K antagonist oral anticoagulants have high liver safety. The occurrence of non-vitamin K antagonist oral anticoagulant-associated liver injury may be dose-dependent. Regular monitoring of liver function is recommended when applying non-vitamin K antagonist oral anticoagulants clinically to patients with a history of liver disease. [ABSTRACT FROM AUTHOR]

This article reviews research on antihypertensive medications including vasodilators, β-blockers, and angiotensin II receptor antagonists that have been approved by the FDA (Food and Drug Administration) since 2011. It covers the discovery of lead compounds, mechanisms of action, structural modifications, structure-activity relationships, and synthesis methods, aiming to serve as a reference for the development of antihypertensive drugs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To mine the risk signals of three new oral anticoagulants such as dabigatran etexilate, rivaroxaban and apixaban based on big data sample analysis, so as to provide reference for rational clinical drug use. METHODS: Based on the FDA Adverse Event Reporting System ( FAERS) database, OpenVigil 2. 1 platform was used to extract reports from the 1st quarter of 2004 to the 3rd quarter of 2021. Reporting odds ratio (ROR) and proportional reporting ratio ( PRR) were used for signal mining. The risk signals were described and classified according to the preferred terms (PT) and systematic organ classification ( SOC) in the MedDRA (Edition 25. 0). RESULTS: A total of 54 932, 112 642, and 108 850 adverse drug event reports were retrieved for dabigatran etexilate, rivaroxaban and apixaban, respectively. Adverse drug reactions with the first number of cases of dabigatran etexilate, rivaroxaban and apixaban were respectively gastrointestinal haemorrhage ( PRR = 28. 31, ROR = 32. 01), gastrointestinal haemorrhage (PRR= 46. 45, ROR= 54. 47), and haemorrhage (PRR= 6. 09, ROR= 6. 25). Adverse drug reactions with the first signal intensity were gastric occult blood positive ( PRR = 66. 55, ROR = 66. 56), haemorrhagic arteriovenous malformation ( PRR = 689. 45, ROR = 692. 06), and spinal subarachnoid haemorrhage (PRR = 50. 58, ROR = 50. 59). Meanwhile, rivaroxaban may lead to acute kidney injury ( the 10th ranked by occurrence), apixaban may lead to renal impairment (the 9th ranked by occurrence) and hypoacusis (the 10th ranked by occurrence) and auditory disorder ( the 7th ranked by signal strength), which were not mentioned in the drug instructions and should be taken into account. The overall incidence of bleeding risk for the three new oral anticoagulants was rivaroxaban > dabigatran etexilate > apixaban. CONCLUSIONS: Dabigatran etexilate, rivaroxaban and apixaban need to be used with a focus on bleeding risk, and new risk signals for rivaroxaban and apixaban need to be followed. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus（T2DM）is a group of metabolic disease characterized by chronic hyperglycemia, which tranditional require long-term medication with hypoglycemic drugs. However, more recent studies have shown that some diabetic patients can be alleviated by intensive intervention of diet and exercise, hypoglycemic drug which can loss weight, or short-term intensive insulin therapy, metabolic surgery. This article will discuss the definition of T2DM remission and intervention methods. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To construct the comprehensive clinical evaluation system for sodium-glucose cotransporter 2 (SGLT-2) inhibitors, so as to provide methodological reference for comprehensive evaluation of oral hypoglycemic drugs. METHODS: The clinical comprehensive evaluation methods of SGLT-2 inhibitors in medical institutions was discussed from the aspects of theme selection, evaluation content and dimensions, index selection and construction, evaluation method and comprehensive value judgment of drugs. RESULTS: The method of scientific, objective and quantifiable clinical comprehensive evaluation method for SGLT-2 inhibitors was constructed. The investigator could through literature studies, real-world studies and economic studies conduct a comprehensive analysis of the practical application of the drug in terms of efficacy, safety, economy, appropriateness, innovation, and accessibility. CONCLUSIONS: In the future, when carrying out clinical comprehensive evaluation of SGLT-2 inhibitors and other oral hypoglycemic drugs, it is necessary to follow the requirements of relevant national guidelines, focus on the clinical medication practice and decision-making needs of diabetic patients, and conduct integrated analysis of qualitative and quantitative data on the evaluated drugs to achieve multi-dimensional comprehensive evaluation of drugs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To analyze the application of antidiabetic drugs through spot check on routine medication in inpatients with type 2 diabetes mellitus ( T2DM), so as to provide reference for clinical practice. METHODS: Retrospective analysis method was adopted, totally 100 medical records were randomly extracted from inpatients with T2DM in the endocrinology department of a Class Ⅲ Grade A hospital in 2021, the general information, therapeutic regimens and blood glucose levels were collected to analyze the application of antidiabetic drug and evaluate its rationality. RESULTS: In the 100 medical records of T2DM inpatients, totally 26 kinds of antidiabetic drugs were used, among which the top 4 drugs ranked by frequency of application were acarbose tablets,metformin hydrochloride tablets,insulin aspart injection and dapagliflozin tablets; the proportion of patients with drug combination was 95% (95 cases), mainly were three-drug and four-drug combination, the most common therapeutic regimen was insulin intensive therapy combined with other antidiabetic drugs with different mechanisms of action. Meanwhile, it was also found that some patients had irrational drug combination (5 cases, 5%), irrational medication frequency (3 cases, 3%) and irrational medication dose (1 case, 1%). The patients’ blood glucose level at discharge was significantly better than that at admission, with statistically significant difference ( P < 0. 05), but some patients had not fully reached the standard. CONCLUSIONS: The application of antidiabetic drugs is basically reasonable in 91% patients with T2DM, the new oral hypoglycemic drug dapagliflozin is used more frequently and the combined application of antidiabetic drugs is common. However, 9% of patients still have irrational medication, and about 40% of patients’ blood glucose levels have not fully reached the standard, which require targeted strategies to improve the rationality and effectiveness of clinical medication. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the common diseases, commonly used drugs and polypharmacy in the elderly, so as to provide basis for the formulation of drug rearrangement strategies in the elderly. METHODS: The oral drug information of local and military patients of three tertiary hospitals was collected, the drug information of retired officers living in sanatoriums in Shanghai was investigated by questionnaire survey method, and the disease and medication of outpatients and retired officers were analyzed. RESULTS: A total of 15 356 patients were enrolled in the analysis, including 459 local patients in hospital A, 598 local patients in hospital B, 13 213 local patients in hospital C, 366 military patients in hospital C, and 720 retired officers in sanatoriums. The mean age (84. 55±10. 09) years, the mean number of diseases (5. 78±3. 34) categories, and the mean number of drugs (6. 43±3. 80) categories of retired officers in sanatoriums were higher than those of other elderly patients, with statistically significant differences (P<0. 01). Among local patients in hospital A, local patients in hospital B, local patients in hospital C, military patients in hospital C, and anretired officers in sanatoriums, those taking 5 or more drugs accounted for 6. 32%(29 / 459), 10. 37% (62 / 598), 13. 04% (1 723 / 13 213), 60. 93% (223 / 366) and 68. 61% (494 / 720). In addition to the old cadres under the age of 70, the prevalence of polypharmacy in retired officers with other different characteristics were more than >50%,and the polypharmacy was remarkably serious among the elderly with older age, lower education and worse sleep quality. Retired officers were mainly suffering from chronic diseases, and the mean number of medications used by patients in different disease groups and drug groups with various drugs was more than 7. Except for the osteoporosis disease group (56. 04%, 181 / 323), the prevalence of polypharmacy used by patients in other groups was > 70%, and the phenomenon of polypharmacy was prevalent for each common chronic disease and its commonly used therapeutic drugs. CONCLUSIONS: The prevalence of comorbidity and polypharmacy in the elderly is serious, and outpatient prescription intervention cannot effectively solve the problem of polypharmacy, and it is necessary to formulate the medication reconciliation strategy suitable for the elderly. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the anticoagulant timing of oral anticoagulant rivaroxaban in patients with cerebral infarction complicated with atrial fibrillation and its effects on clinical complex vascular events. METHODS: A total of 153 patients with cerebral infarction complicated with atrial fibrillation admitted into the hospital from Jul. 2019 to Oct. 2020 were extracted to be divided into group A, B and C by simple randomization, with 51 cases in each group. Anticoagulant therapy was started within 3 d after cerebral infarction in group A, from 3 to 14 d after cerebral infarction in group B, and more than 14 d after cerebral infarction in group C. The coagulation function indicators [thrombin time ( TT), activated partial thromboplastin time ( APTT), prothrombin time ( PT ), international normalized ratio (INR)] were compared among three groups before and after treatment. Patients were followed up for 6 months, and the incidence of clinical compound vascular events in three groups was analyzed. RESULTS: After treatment, TT, APTT and PT in group B were longer than those in group A and C, with statistically significant difference (P<0. 05). After 6 months of follow-up, the incidence of clinical compound vascular events in group B (5. 88%, 3 / 51) was lower than that in group A ( 23. 53%, 12 / 51) and group C ( 19. 61%, 10 / 51 ), with statistically significant difference (P<0. 05). CONCLUSIONS: It is the best time for anticoagulant therapy for patients with cerebral infarction complicated with atrial fibrillation from 3 to 14 d after cerebral infarction, which helps to reduce the risk of clinical compound vascular events. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the status of medical orders with overdose oral drugs in central pharmacy of this hospital before and after the implementation of prescription pre-review system, and explore the role of the prescription pre-review system in the quality management of hospital prescriptions, so as to promote the clinical rational drug use. METHODS: Retrospective analysis was performed on medical orders with overdose oral drugs in central pharmacy of the hospital from Oct. 17, 2017 to Oct. 16, 2018 (before the implementation of prescription pre-review system) and from Oct. 17, 2018 to Sept. 16, 2021 (after the implementation of prescription pre-review system) . RESULTS: Before the implementation of prescription pre-review system, drugs involved in medical orders with overdose oral drugs in the central pharmacy of the hospital were mainly cardiovascular system drugs ( 20. 0%, 650/3 245), and the department with the largest distribution of medical orders with overdose oral drugs was the respiratory and critical care medicine ( 23. 6%, 766/3 245). After the implementation of prescription pre-review system, the incidence of medical orders with overdose oral drugs in central pharmacy of this hospital decreased from 20. 0% ( 3 245/16 201) before the implementation to 7. 7% ( 2 424/31 630). CONCLUSIONS: There are many kinds of drugs in medical orders with overdose oral drugs in central pharmacy of this hospital, the departments are widely distributed, and the occurrence of overdose is relatively common. In order to standardize the dosage of medical orders, prescription pre-review system is used to set rules for the interception, which can significantly improve the occurrence of medical orders with overdose oral drugs and the status of clinical irrational drug use, improve the quality of medical orders with oral drugs for inpatients, and promote the rational drug use. Meanwhile, it is recommended that the hospital establish its own self-maintenance knowledge base and fine-tune the setting of drugs, which can not only prevent the issuance of irrational prescriptions/ medical orders, but provide basis for the individualization medication according to the message prompt. [ABSTRACT FROM AUTHOR]

BACKGROUND: Elderly with femoral intertrochanteric fractures experienced more adverse events after surgical treatment, such as such as coxa vara, screw penetration, and hip pain. In recent years, study on the posterior medial wall of intertrochanteric femur has been deepened. The reconstruction and fixation of the posteromedial wall have gradually been used in clinical work. OBJECTIVE: To investigate the application characteristics and efficacy of posteromedial wall reconstruction in surgical treatment of A2 type intertrochanteric fractures of the elderly. METHODS: The medical records of 75 patients with type A2 intertrochanteric fractures who were treated with proximal femoral nail antirotation in Third Affiliated Hospital of Anhui Medical University from March 2016 to March 2020 were retrospectively analyzed. Patients undergoing posteromedial wall and fixation served as trial group (n=32) and those without reconstruction as control group (n=43). After long-term follow-up, the Harris function score, fracture healing time, full weight bearing time, and adverse events of the two groups were compared. RESULTS AND DISCUSSION: (1) Operation time and intraoperative blood loss had no significant difference in both groups (P > 0.05). (2) Compared with the control group, the fracture healing time was early; Harris hip function scores were high at postoperative 1, 3, and 6 months; complications were less in the trial group; and the above differences were statistically significant (P < 0.05). (3) Follow-up data were obtained from both groups for more than 12 months. One case of sciatic nerve injury occurred in the trial group. In the trial group, there was one case of sciatic nerve injury, which was numb on the back of the foot on the same side after injury, and returned to normal after oral medication. In the control group, there were six cases of coxa vara, three cases of screw penetration, and one case of heterotopic ossification. (4) The results showed that after the reconstruction and fixation of the posteromedial wall, the patients could get down to the ground early and experience effective recovery of the hip function, with less postoperative adverse events and satisfactory clinical effect. [ABSTRACT FROM AUTHOR]

OBJECTIVE:To investigate the drugs taken orally within 3 months in the elderly with acute kidney injury (AKI),so as to provide evidence for clinical prevention of AKI in the elderly. METHODS:The clinical data, basic medical history and oral medication in recent 3 months of the elderly diagnosed with AKI who underwent renal needle biopsy in China-Japan Friendship Hospital from Jan. 2001 to Jun. 2020 were retrospectively analyzed. RESULTS:A total of 121 elderly patients with AKI met the inclusion criteria,including 65 male patients(53. 7%) and 56 female patients(46. 3%). The median age was 65(62,69) years old. The pathological results of renal needle biopsy were acute interstitial nephritis in 37 cases ( 30. 6%) and subacute interstitial nephritis in 84 cases ( 69. 4%). The median serum creatinine level was 216. 0(156. 5,323. 4) μmol / L at admission. After excluding the use of common nephrotoxic drugs such as non-steroid anti-inflammatory,antiviral drugs and antibiotics,the commonly used oral drugs were divided into antihypertensive drugs, hypoglycemic drugs, lipid-lowering drugs, diuretics, Chinese herbal medicines,anticoagulants or platelet aggregation inhibitors,uric acid-lowering drugs,gastrointestinal drugs and others (methotrexate and epalrestat) . There were 103 cases ( 85. 1%) treated with antihypertensive drugs, 44 cases (36. 4%) with hypoglycemic drugs, 25 cases ( 20. 7%) with lipid-lowering drugs, 25 cases ( 20. 7%) with diuretics,44 cases ( 36. 4%) with traditional Chinese medicine, 20 cases ( 16. 5%) with anticoagulant or platelet aggregation inhibitors,9 cases(7. 4%) with uric acid-lowering drugs and 3 cases(2. 5%) with gastrointestinal drugs, and 34 cases(28. 1%) with other drugs. According to the number of types of drugs taken at the same time,there were 21 cases(17. 4%) took one type of drug,49 cases(40. 5%) took two types of drugs,23 cases(19. 0%) took three types of drugs,19 cases ( 15. 7%) took four types of drugs,7 cases ( 5. 8%) took five types of drugs and 2 cases (1. 7%) took six types of drugs,the median of medication was 2(2,3). CONCLUSIONS:The elderly are at high risk of drug-related AKI. Although they are taking common drugs,the drug combination of multiple common drugs has the risk of AKI. Therefore,during the medication period,attention should be paid to monitoring the changes in the patients’ renal function. [ABSTRACT FROM AUTHOR]