Chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) is an independent risk factor for gastric cancer. Long-term inflammation and oxidative stress response stimulate the physical and mental state of patients. Under the modern medical model, proton pump inhibitors and gastric mucosal protective agents are increasingly unable to meet the high drug resistance of patients. It is urgent to seek effective new Chinese medicine treatments and multiple methods to treat CAG and IM.

To evaluate the clinical efficacy and safety of modified Piwei Peiyuan Decoction combined with acupuncture in the treatment of CAG with IM.

From January 2022 to September 2023, 202 patients with CAG and IM diagnosed by gastroscopy and pathological examination in the Department of Spleen and Stomach, the Center for Preventive Treatment of Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine and the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine were selected. The patients were divided into control group (n=67), treatment group A (n=68) and treatment group B (n=67) by random number table method. All patients participated in 6 weeks of treatment: (1) Control group: aluminum magnesium suspension combined with folic acid tablets (3 times/d) ; (2) Treatment group A: to add and subtract syndrome types of Piwei Peiyuan Decoction (2 times/d) ; (3) Treatment group B: Piwei Peiyuan Decoction (the same as group A) combined with acupuncture (1 time/d), with Zusanli, Liangqiu, Gongsun, Neiguan, Zhongwan as the main points, according to the syndrome type selection of acupoints. Before and 6 weeks after treatment, OLGA, OLGIM staging, gastric mucosal pathological efficacy, gastric mucosal pathological score, clinical symptom score, PRO scale score, drug-related adverse events (AE) and adverse drug reactions (ADR) were recorded.

A total of 192 patients completed the 6-week course of treatment (62 in the control group, 66 in the treatment group A, and 64 in the treatment group B). The effective rate of the control group was 48.39% (30/62), the effective rate of the treatment group A was 69.70% (46/66), and the effective rate of the treatment group B was 71.88% (46/64). There was a statistically significant difference in the effective rate among the three groups (χ²=9.144, P=0.01). After treatment, the gastric mucosal pathological score, clinical symptom score and PRO scale score in the three groups were lower than those in the same group before treatment (P<0.05). Pathological score of gastric mucosa: the scores of chronic inflammation, atrophy and IM in treatment group A and treatment group B were lower than those in control group, and the scores of active inflammation and dysplasia were higher than those in control group (P<0.05). Clinical symptom score: the scores of epigastric fullness and epigastric pain in treatment group A and treatment group B were lower than those in control group (P<0.05). The PRO scale score: the treatment group A and the treatment group B were lower than the control group in acid reflux, dyspepsia, defecation, psychological state, systemic symptoms and total score (P<0.05). There was no significant difference in the incidence of AE and ADR among the three groups (P>0.05) .

The overall clinical efficacy of Piwei Peiyuan Decoction combined with acupuncture is better than that of aluminum magnesium suspension combined with folic acid tablets, which is better than that of traditional antacids and gastric mucosal protective agents.

The Beers criteria is a tool for evaluating potentially inappropriate medication (PIM) in elderly patients widely used in various fields, such as clinical practice, teaching research, supervision and administration. The 2023 American Geriatrics Society Beers criteria (AGS Beers criteria) for PIM use in older adults are the seventh overall update, using the development methodology following previous versions, which includes the rigor of the evidence review and synthesis process. This paper provides a detailed interpretation of the new version of AGS Beers criteria. The AGS Beers criteria aims to reduce the incidence of PIM in older adults by optimizing drug selection. The 2023 AGS Beers criteria can also be used in the education of clinicians and patients, assessment of care quality, health care costs and drug use patterns in older adults. In addition to the five tables associated with PIM as main contents, several drugs and criteria have been added based on updated evidence, mainly on the revisions and streamlining of existing drugs and criteria. The added and revised content mainly involves anticoagulants, antiplatelet agents and hypoglycemic agents. The synthesis of anticoagulation recommendations has been added in the new version of AGS Beers criteria. Thirty-three drugs were removed due to low usage or not on the U.S. market. The 2023 AGS Beers criteria summarizes seven principles on the application of Beers criteria to ensure proper clinical use. Overall, the 2023 AGS Beers criteria have improved its accuracy and utility, which can better identify and reduce PIM prescriptions for the elderly patients and further guide the clinical development of rational drug use regimens.

As population aging progresses, the prevalence of multimorbidity and polypharmacy is increasing in older adults, which may increase the risk of potentially inappropriate medication, causing adverse health outcomes.

To systematically assess the prevalence and associated factors of potentially inappropriate medication in community-dwelling Chinese older adults, in order to provide a reference for developing relevant intervention strategies.

In June 2022, we searched databases of CNKI, CQVIP, Wanfang Data, SinoMed, PubMed, EmBase, and Web of Science from inception to June 2022 for studies on potentially inappropriate medication in community-dwelling older adults in China. Two reviewers independently selected studies, extracted data and assessed the quality of included studies according to the Agency for Healthcare Research and Quality methodology checklist. Meta-analysis was conducted using Stata 12.0.

A total of 24 studies were included, including two with high quality and 22 with moderate quality. Meta-analysis showed that the pooled prevalence of potentially inappropriate medication was 34.8%〔95%CI (31.3%, 38.3%) 〕in community-dwelling older adults in China. Pooled estimates showed 75 years or above〔OR (95%CI) =1.261 (1.074, 1.481) 〕, five or more comorbidities〔OR (95%CI) =3.287 (1.405, 7.691) 〕, and taking five or more medications〔OR (95%CI) =1.800 (1.305, 2.481) 〕or taking 10 or more medications〔OR (95%CI) =4.380 (2.612, 7.347) 〕were associated factors of potentially inappropriate medication.

Potentially inappropriate medication is common in community-dwelling older adults in China, whose risk is associated with older age, multimorbidity and polypharmacy. Prevention and management of potentially inappropriate medication should be paid attention to individuals with the above characteristics.

Clinical treatment often achieves unsatisfactory effect for irritable bowel syndrome (IBS) , a common complex functional gastrointestinal disease. Huangqi Jianzhong Decoction is widely used for diarrhea IBS (IBS-D) , and its efficacy has been recognized, but the mechanism is unclear and relevant studies are rare.

To explore the potential mechanism of Huangqi Jianzhong Decoction in the treatment of IBS-D based on network pharmacology and molecular docking.

TCMSP database was adopted to acquire the active ingredients and corresponding targets of all herbals in Huangqi Jianzhong Decoction. And targets related to IBS-D were identified using GeneCards, OMIM, TTD, Drug Bank and PharmGKB databases. Then the intersection of herbal targets and IBS-D-related targets were selected to obtain the potential therapeutic targets of Huangqi Jianzhong Decoction for IBS-D. Cytoscape, String and Metascape were used to construct an "herbals-active ingredients-target" network map, draw the protein-protein interaction network (PPI) , and conduct genetic ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. AutoDock Vina and PyMOL were used for the visualization of molecular docking results.

Finally, we obtained 123 active ingredients and 247 potential targets of Huangqi Jianzhong Decoction, 3 486 IBS-D related targets, and 180 intersected herbals targets and IBS-D-related targets. A total of 2 376 items of biological process, 194 items of molecular function and 115 items of cellular component were identified through GO enrichment analysis. Enrichment analysis of KEGG signaling pathway revealed MAPK, NF-κB, cAMP, estrogen and other related signal pathways. The molecular docking results showed that the main active ingredients of Huangqi Jianzhong Decoction in the treatment of IBS-D are quercetin, kaempferol, β-sitosterol, isorhamnetin, formononetin, stigmasterol, calycosin, 7-O-methylisomucronulatol, and they showed good binding to core proteins AKT1, TP53, TNF, IL-6, CASP3, IL-1B, EGFR and CTNNB1.

Therefore, we speculated that Huangqi Jianzhong Decoction may plays a role in the treatment of IBS-D by enhancing intestinal barrier function, reducing visceral hypersensitivity, reducing inflammatory response and regulating intestinal flora.

The presence of symptom clusters is associated with poor treatment outcomes and decreased quality of life in patients with cancer, and holistic interventions for symptom clusters can improve the management efficiency. Numerous non-pharmacologic interventions are available for symptom clusters in patients with cancer, but there is disagreement as to which interventions is the most effective.

To explore and compare the effectiveness of different non-pharmacological interventions in reducing the severity of symptom clusters in cancer patients.

In September 2021, randomized controlled trials (RCTs) about non-pharmacological interventions in reducing the severity of symptom clusters in cancer patients were searched in SinoMed, CNKI, Wanfang Data, CQVIP, the Cochrane Library, PubMed, Web of Science and Wiley Online Library databases from inception to September 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Cochrane handbook for systematic reviews of interventions (version 5.1.0) . RevMan 5.3 was adopted for heterogeneity test using a traditional method and publication bias analysis. Addis 16.6 was used to make a network meta-analysis.

Twelve RCTs were finally included, involving 1 116 cases, and eight non-pharmacologic interventions: cognitive behavior intervention, mindfulness-based stress reduction, acupoint massage, multiple-modality exercise, exercise and health counseling, auricular point sticking therapy, narrative nursing, and attention control. Network meta-analysis results showed that, for reducing the severity of symptom clusters in cancer patients, acupoint massage was superior to interventions other than mindfulness-based stress reduction, mindfulness-based stress reduction was superior to usual care and narrative nursing, and cognitive behavioral intervention was superior to multiple-modality exercise, usual care and narrative nursing (P<0.05) . The surface under the cumulative ranking curve score for the interventions in reducing the severity of symptom clusters in cancer patients ranked from highest to lowest was: acupoint massage>mindfulness-based stress reduction>cognitive behavior intervention>auricular point sticking therapy/attention control>multiple-modality exercise>usual care>narrative nursing>exercise and health counseling.

Based on the results of network meta-analysis and probability ranking, acupoint massage was recommended as the clinical priority non-pharmacological intervention to alleviate the severity of symptom clusters in cancer patients, followed by mindfulness-based stress reduction. In the future, high-quality, large-sample, multicenter, double-blind RCTs are needed to further validate the effects of different non-pharmacological interventions on improving symptom clusters in cancer patients, and to provide more reliable evidence for supporting the development of interventions for symptom clusters in these patients.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disorder. At present, there are great differences in evaluation indicators of clinical randomized controlled trials (RCTs) on OSAHS treated by traditional Chinese medicine (TCM ) . Therefore, it is of great significance to further explore the evaluation indicators of clinical RCTs of OSAHS.

To analyze the evaluation indicators of clinical RCTs on OSAHS treated by TCM, in order to provide reference for the selection of appropriate Chinese medicine for the treatment of OSAHS in RCTs outcome indicators.

The RCTs in the TCM treatment of OSAHS were retrieved from CNKI, WanFang Data, VIP, CBM, PubMed and other data bases from 2015-01-01 to 2021-10-20. The basic characteristics of the collected literature included the first author, sample size, gender, age, course of disease, intervention measures, TCM syndrome type, course of treatment, and outcome indicators. According to the functional attributes, the evaluation indicators were divided into TCM syndrome, physical and chemical indicators, life quality indicators, long-term prognosis indicators, safety events indicators, and Western medicine signs indicators. The quality of the included literature was evaluated using a systematic bias risk assessment tool recommended by the Cochrane Collaboration, and the literature quality was evaluated using RevMan 5.4 software.

A total of 41 RCTs were included, including 2 971 patients, involving 270 outcomes of 70 indicators, which were classified as TCM syndrome, physical and chemical indicators, safety events indicators, Western medicine signs indicators, and quality of life indicators. Among them, physical and chemical indicators, symptoms and signs indicators are the most, quality of life indicators are less. There are 14 items of 2 kinds of combination indicators, 16 items of 3 kinds of combination indicators and 7 items of 4 kinds of combination indicators. The measurement time ranged from 7 days to 6 months, and the most was 1 month (15 RCTs, 36.59%) , followed by 3 months (11 RCTs, 31.70%) .

At present, there are large differences in evaluation indicators of TCM treatment of OSAHS, relatively insufficient attention on TCM syndrome score, poor attention on quality of life indicators, no unified standard for evaluation indicators, large span of measurement time points, and no long-term prognostic indexes.

The number of elderly diabetic patients is increasing rapidly with the aggravation of population aging. The coexistence of multiple conditions and polypharmacy are common in elderly diabetic patients. Strengthening clinically rational drug use can effectively reduce the incidence of adverse drug events and improve outcomes in these patients.

To understand the characteristics and patterns of polypharmacy including hypoglycemic, antihypertensive, lipid-lowering, antiplatelet agents in elderly patients with type 2 diabetes, so as to provide a reference for promoting rational medication use.

This study retrospectively selected 240 elderly inpatients with type 2 diabetes who were hospitalized in Department of Endocrinology, the Second Affiliated Hospital of Xi'an Jiaotong University from April 1, 2020 to March 31, 2022 by cluster sampling method in April 2022. The drugs used during hospitalization and post-discharge medication regimens were investigated. Descriptive analysis was used to analyze the treatment regimens of hypoglycemic, antihypertensive, lipid-regulating and antiplatelet.

On average, the participants had (13.93±3.12) diagnoses at discharge, (16.48±5.41) kinds of medications during hospitalization, and (8.21±2.46) kinds of long-term medications after discharge. The rate of polypharmacy after discharge reached 89.2% (214/240). After discharge, 216 cases (90.0%) received hypoglycemic treatment, among whom 44.9% (97/216) used single drug therapy, and 58.3% (126/216) were treated with insulin. One hundred and eighty-three cases (76.2%) were treated with antihypertensive therapy, including 44.3% (81/183) with single drug therapy and 79.2% (145/183) with calcium channel blockers. One hundred and eighty-seven cases (77.9%) received lipid-regulation therapy, and 83.4% (156/187) of them received atorvastatin. One hundred and seventeen cases (48.7%) used antiplatelet drugs, among whom 77.8% (91/117) used aspirin. Eighty-four cases (35.0%) received hypoglycemic, antihypertensive, lipid-regulating and antiplatelet therapies.

Polypharmacy is common in elderly patients with type 2 diabetes, including hypoglycemic, antihypertensive, lipid-regulating, antiplatelet and other therapies, which indicates that they have received pre-treatment relatively comprehensive condition evaluation by medical workers. Although the rate of comprehensive management is high in this group, there are still some potential risks of adverse drug events due to irrational use of some drugs alone or in combination.

As a global health challenge, multidrug-resistant Enterobacteriaceae (MDR-EB) infection in inpatients shows an upward trend in its incidence and degree of severity.

To systematically evaluate the efficacy and safety of ceftazidime/avibactam (CAZ/AVI) in MDR-EB infection.

Databases including China National Knowledge Infrastructure, Wanfang Data, CQVIP, PubMed, EMBase, and Cochrane Library were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) about treating MDR-EB infection using CAZ/AVI (experimental group) versus other treatments (control group) from inception to February 2021. Literature selection, data extraction and quality evaluation were carried out by two reviewers. Meta-analysis was performed using the RevMan 5.1.

In all, 12 articles involving 15 trials were included. Meta-analysis indicated that both groups had no significant differences in clinical cure rate〔OR=1.02, 95%CI (0.73, 1.43), P=0.90〕, MDR-EB clearance rate〔OR=1.23, 95%CI (0.96, 1.58), P=0.10〕 and rate of adverse drug reactions〔OR=1.02, 95%CI (0.85, 1.22), P=0.84〕. But the mortality rate〔OR=0.72, 95%CI (0.52, 0.99), P=0.04〕 was lower for experimental group. The funnel plot was basically symmetrical in shape in assessing the existence of publication bias in the articles in terms of the clinical cure rate. Egger's test identified no publication bias in the articles regarding clinical cure rate, MDR-EB clearance rate and mortality rate (P=0.234, 0.679, 0.056) .

CAZ/AVI treatment could reduce the mortality rate in patients infected with MDR-EB, which may be used as an alternative for MDR-EB infection, especially carbapenem-resistant Enterobacterales infection.

Tolvaptan is widely used in elderly patients with chronic heart failure (CHF) , but the effect of different doses of tolvaptan on the prognosis of elderly CHF patients is unclear.

To investigate the effect of two commonly used doses of tolvaptan, 7.5 mg/d and 15.0 mg/d, on the prognosis of elderly patients with CHF.

This is a retrospective cohort study. This study selected patients (age≥80 years) with CHF treated with tolvaptan in the health care ward of the 960th Hospital of PLA Joint Logistics Support Force of China from February 2016 to February 2022, and analyzed their clinical data. The patients were divided into 7.5 mg/d and 15.0 mg/d groups based on the dose of tolvaptan. The end point of follow-up was the occurrence of all-cause mortality or cardiovascular mortality or until the end of follow-up. This study used Kaplan-Meier method to perform survival curves analysis and used Cox proportional hazards regression models to analyze the effect of two doses of tolvaptan on all-cause mortality and cardiovascular mortality in elderly patients with CHF.

This study enrolled 212 elderly patients with CHF, and the follow-up was 374.5 (155.5, 940.5) days. 124 (58.5%) patients died from all-cause mortality and 54 (25.5%) patients died from cardiovascular mortality during the follow-up. Kaplan-Meier survival curve showed that 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with 7.5 mg/d group (P=0.004 3, P=0.001 2) . Multivariate Cox proportional hazards regression model analysis showed that after adjusting for age, NYHA cardiac functional class, chronic kidney disease, diabetes, hypertension, coronary artery disease, diuretics, albumin (ALB) , serum N-terminal brain natriuretic peptide precursor (NT-proBNP) and estimated glomerular filtration rate (eGFR) , 15.0 mg/d group had a 1.03-fold increased risk of all-cause mortality〔HR=2.03, 95%CI (1.34, 2.99) 〕and 1.51-fold increased risk of cardiovascular mortality〔HR=2.51, 95%CI (1.40, 4.50) 〕compared with 7.5 mg/d group. This study stratified analysis by eGFR, age, ALB, and NT-proBNP, the results showed that tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality.

Tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with tolvaptan 7.5 mg/d in elderly CHF patients (age≥80 years) . We may recommend using low-dose tolvaptan.

Depression is a common psychiatric disorder with limited treatment options. Deep transcranial magnetic stimulation (dTMS), as a new non-invasive neuromodulation technique, has been utilized in the treatment of major depressive disorder (MDD), but there is less evidence from clinical studies.

To explore the clinical efficacy of dTMS combined with escitalopram oxalate (Esc) in the treatment of depression, and provide further reliable data reference for dTMS in the treatment of depression patients.

A total of 73 patients with depression who attended Department of Psychiatry, Affiliated Hospital of Guizhou Medical University from December 2021 to January 2023 were selected as the study subjects and divided into the control group (n=35) and combined treatment group (n=38) according to the random number table. Patients in the control group were given Esc ( 10 mg per day in the first week and 20 mg per day from the second week for 2 consecutive weeks). The combined treatment group received the treatment of dTMS (left DLPFC as the stimulation target, 18 Hz, 120%MT, 1 980 times per day for 2 weeks, 10 times in total) based on the same treatment for the control group. The depressive symptoms and cognitive improvement of patients in the two groups were evaluated before and after the two weeks of treatments by Hamilton depression scale (HAMD), Beck Scale for Suicide Ideation (BSS), Montreal Cognitive Assessment Scale (MoCA) and the mean oxygenated hemoglobin (oxy-Hb) concentration in the prefrontal cortex measured by functional near-infrared spectroscopy (fNIRS) based on the verbal fluency text (VFT) task.

The actual completion of the trial was 30 cases in the control group and 31 cases in the combined treatment group. After treatment, the HAMD and BSS scores of the combined treatment group were lower than those of the control group, and the MoCA score was higher than that of the control group (P<0.05). After treatment, the HAMD and BSS scores of patients in the two groups were lower than those before treatment, and the MoCA score was higher than that before treatment (P<0.05). There was no significant activation of the prefrontal cortex after treatment in both groups. The improvement of depression symptoms and cognitive function in the combined treatment group was better than that in the control group.

The combination of dTMS and Esc can improve the depressive symptoms and cognitive function better than Esc treatment alone in depression patients.

Polypharmacy is increasingly common in the elderly. The medication compliance of polypharmacy is closely related to its therapeutic effect and safety. Therefore, it is of great significance to understand the medication compliance and its influencing factors in the elderly with polypharmacy at early stage. However, the conclusions of current studies vary greatly, and there is no clear and unified standard.

To systematically evaluate the current status of polypharmacy in the elderly and its influencing factors, in order to provide reference for improving medication compliance of polypharmacy in the elderly, reducing adverse reactions, and further developing individualized intervention programs.

PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid, CBM, CNKI, Wanfang Data and VIP were searched for cohort studies, case-control studies, cross-sectional studies and other observational studies on the influencing factors of medication compliance of polypharmacy in the elderly from inception to March 2023. Two researchers independently screened the literature, evaluated the quality and extracted the data according to the inclusion and exclusion criteria. Stata 17.0 and RevMan 5.3 software were used for meta-analysis.

A total of 19 studies were included with the total sample size of 130 047 subjects, including 50 852 subjects with good medication compliance. Meta-analysis results showed that the medication compliance rate of polypharmacy in the elderly was 41%〔95%CI (34%, 47%) 〕, which was associated with age〔OR=2.62, 95%CI (1.60, 4.78), P<0.000 1〕, gender〔OR=1.70, 95%CI (1.30, 2.23), P=0.000 1〕, education level〔OR=1.73, 95%CI (1.38, 2.16), P<0.000 01〕, residential lifestyle〔OR=2.85, 95%CI (2.18, 3.72), P<0.000 01〕, medication knowledge level〔OR=1.14, 95%CI (1.04, 1.25), P=0.005〕, medication belief〔OR=2.06, 95%CI (1.44, 2.93), P<0.000 1〕, depression〔OR=2.52, 95%CI (1.96, 3.24), P<0.000 01〕, daily living ability (ADL) 〔OR=2.39, 95%CI (1.68, 3.38), P<0.000 01〕, history of falls〔OR=3.51, 95%CI (2.03, 6.06), P<0.000 01〕, professional guidance 〔OR=3.75, 95%CI (1.92, 7.33), P=0.000 1〕, the number of drug types〔OR=2.58, 95%CI (1.96, 3.41), P<0.000 1〕, adverse drug reactions〔OR=3.08, 95%CI (2.17, 4.38), P<0.000 1〕, medication regimen complexity〔OR=1.08, 95%CI (1.03, 1.14), P=0.004〕, medication management〔OR=1.92, 95%CI (1.34, 2.75), P=0.000 3〕 and medication cost〔OR=2.60, 95%CI (1.30, 5.17), P=0.000 7〕. Sensitivity analysis showed that the results of meta-analysis were relatively stable. Begg's test (P=0.441) and Egger's test (P=0.674) suggested that there was a low risk of publication bias for medication compliance of polypharmacy in the elderly in the included studies.

The compliance rate of polypharmacy in the elderly is 41%. And the available evidence shows that general factors (age, gender, education level, residential lifestyle), psychological and social factors (depression, ADL, history of falls, medication knowledge level, medication belief, professional guidance), drug factors (medication management, medication cost, medication regimen complexity, the number of drug types, adverse drug reactions) are the influencing factors of medication compliance of polypharmacy in the elderly. Medical staff should formulate individualized intervention measures and optimize disease management in the elderly with polypharmacy according to the influencing factors of medication compliance of polypharmacy.

From previous studies, the frequency of administration of recombinant human erythropoietin injection (rHuEPO) has no association with its therapeutic effect in renal anemia in chronic kidney disease (CKD), and there is no significant difference in the efficacy between weekly single dosing and divided dosing. Most hemodialysis patients are clinically treated with moderate-dose rHuEPO, but there is a lack of research on the safety of single and divided administration of moderate-dose rHuEPO.

To compare the safety between weekly single and divided administration of moderate-dose rHuEPO for renal anemia in maintenance hemodialysis patients.

This study was designed as a randomized, parallel-group controlled, non-inferiority clinical trial. Eighty-eight patients with renal anemia who underwent maintenance hemodialysis at the Hemodialysis Room, Tongzhou Branch, Dongzhimen Hospital, Beijing University of Chinese Medicine from January 2019 to May 2021 were selected and randomly divided into an experimental group and a control group with 44 in each. For comparing the safety and efficacy of weekly single and divided administration of moderate-dose rHuEPO, 29 cases (experimental subgroup 1) and other 15 cases (experimental subgroup 2) in the experimental group received an rHuEPO dose of 6 000 U, and an rHuEPO dose of 4 000 U, once a week, respectively; 30 cases (control subgroup 1) in the control group received a single rHuEPO dose of 2 000 U, three times a week (6 000 U per week in total), and other 14 cases (control subgroup 2) received a single rHuEPO dose of 2 000 U, twice a week (4 000 U per week in total) .

Safety analysis: two-factor repeated-measures ANOVA showed that the type of intervention scheme and duration had no interaction effects on systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pre-dialysis serum potassium between experimental subgroup 1 and control subgroup 1, and between experimental subgroup 2 and control subgroup 2 (P>0.05), and produced no main effects on systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pre-dialysis serum potassium in experimental subgroup 1 and control subgroup 1, and between experimental subgroup 2 and control subgroup 2 (P>0.05). The serum levels of AST, ALT and TBiL were similar between experimental subgroup 1 and control subgroup 1 at baseline and 12 weeks of treatment (P>0.05). Likewise, they were similar between experimental subgroup 2 and control subgroup 2 at baseline and 12 weeks of treatment (P>0.05). No thromboembolic, cardiovascular or cerebrovascular events and gastrointestinal reactions related to rHuEPO occurred in any of the subgroups during the 12-week treatment. Efficacy analysis: the hemoglobin level (reference range was 110-130 g/L) in experimental subgroup 1 〔65.5% (19/29) 〕was similar to that in control subgroup 1 〔73.3% (22/30) 〕at 12 weeks of treatment (χ^2=0.425, P=0.514). The serum levels of hemoglobin were similar between experimental subgroup 2 and control subgroup 2 at 12 weeks of treatment (P>0.05). The levels of red blood cell count, hematocrit, percentage and absolute number of reticulocytes, ferritin and transferrin saturation did not vary between experimental subgroup 1 and control subgroup 1, and between experimental subgroup 2 and control subgroup 2 either at baseline or 12 weeks of treatment (P>0.05) .

Weekly single and divided administration of moderate-dose erythropoietin had no significant difference in medication safety in the treatment of renal anemia in maintenance hemodialysis patients.

Previous research has found that multi-drug resistant (MDR) bacteria can be transmitted between ICU patients, and the infections caused by MDR bacteria may negatively affect the efficacy of current treatment. As the speed of diagnostic testing to identify MDR bacteria is relatively slow in clinical practice, the research regarding the prediction of MDR bacteria infections has developed.

To develop an evidence-based risk prediction model for MDR bacterial infections in ICU patients, and to verify it using the real-world clinical data collected retrospectively.

Potential risk factors for MDR bacterial infections in ICU patients were identified by a meta-analysis of studies regarding MDR bacterial infections in ICU patients included in databases of PubMed, EMBase, the Cochrane Library, CNKI, Wanfang, China Science and Technology Journal Database, Ace Base of CMA during January 2012 to June 2020 using Stata/SE 12.0 software, and were used to develop a risk prediction model by transforming effect size to the standardized regression (β) coefficient. Next the model was fully established and externally verified using the clinical data of adult ICU patients (n=3 908) recruited from Shanghai General Hospital from January 2018 to June 2021. ROC analysis was used to describe the predictive accuracy of the prediction model.

Seventeen potential risk factors of MDR bacterial infections in ICU patients were identified through the meta-analysis of 31 included studies. The MDR bacterial infection risk prediction model incorporating these 17 factors with corresponding β value as coefficient (derived from converting the risk effect size of each factor) was developed: Logit (P) =-2.476 3 +0.086X₁〔gender (male) 〕+0.191X₂ (history of hospitalization) +0.392X₃ (being transferred from another hospital) +1.723X₄ (length of ICU stay) +0.315X₅ (other infections) +0.385X₆ (chronic obstructive pulmonary disease) +0.131X₇ (diabetes) +0.536X₈ (renal disease) +0.285X₉ (renal failure) +0.565X₁₀ (dialysis) +0.148X₁₁ (mechanical ventilation) +0.742X₁₂ (central venous catheter) +0.336X₁₃ (urinary catheter) +3.483X₁₄ (types of used antimicrobial drugs) +0.174X₁₅ (history of antimicrobial use) +0.975X₁₆ (history of carbapenems use) +1.151X₁₇ (history of aminoglycosides use) . External verification of the model revealed that the model had 64.36% sensitivity, 80.39% specificity, and 0.447 4 Youden index, and an AUC of 0.724.

Our model has been proved to have good performance in predicting the MDR bacterial infection risk in ICU patients, as well as relatively good applicability, scientificity, and practicability. The development regimen may be used as a reference for developing a risk prediction model for other diseases.

Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases (ASCVD), but the values and preferences of community patients for pharmacotherapy remain unclear.

To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD, which would help clarify the individualized treatment burden and provide patient-centered clinical practice.

This study employed a sequential exploratory mixed-methods design. Firstly, we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu City from November 2021 to January 2022. for a focus group discussion, aiming to collect qualitative insights into their experience, values, and preferences for medication use. The software MAXQDA 2020 was used to support qualitative data analysis, and Colaizzi's seven-step approach was further used to identify themes. After completing the qualitative phase, a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy.

Four themes emerged from the qualitative data, including knowledge and use of medications, barriers of medication use, facilitators of medication use, and need for medical services. A total of 186 valid questionnaires were collected in the quantitative study (response rate of 93.5%). The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants. Although preferences in medication use were highly heterogeneous, participants generally preferred taking fewer medications with less frequency, and were less likely to use injectable medications.

The study suggests that it may be appropriate to increase the use of compound preparations, and make treatment plans in accordance with patients' daily lives and work to reduce the treatment burden of pharmacotherapy. In addition, we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients' medication adherence.

As the most common clinical manifestation and a major complication in chronic kidney disease, anemia affects the patients' quality of life, increases the risk of renal disease progression and death. Hence, it is important to improve anemia, and monitor and evaluate drug efficacy and safety in the treatment of renal anemia.

To compare the efficacy and safety between roxadustat and erythropoiesis stimulating agents (ESAs) in treating renal anemia in patients with dialysis-dependent chronic kidney disease.

We searched PubMed, FMRS, Wanfang Data and ClinicalTrials.gov from inception to January 19, 2022 for randomized controlled trials (RCTs) about maintenance hemodialysis patients with dialysis duraion≥3 months treated with oral roxadustat (experimental group), versus injection of ESAs (control group). Two researchers independently conducted literature screening, data extraction and quality evaluation. Meta-analysis was performed using Review Manager 5.3.

A total of 5 studies with 6 RCTs were included, involving 901 patients (549 in the experimental group and 352 in the control group). Meta-analysis showed that roxadustat was superior to ESAs in improving the levels of serum iron〔MD=2.49, 95%CI (0.82, 4.16), P=0.004〕, transferrin〔MD=0.31, 95%CI (0.17, 0.44), P<0.000 01〕, total iron-binding capacity〔MD=7.51, 95%CI (5.01, 10.01), P<0.000 01〕. The incidence of adverse events did not differ significantly between the two groups〔RR=1.10, 95%CI (0.99, 1.22), P=0.07〕.

Roxadustat demonstrates better effects than ESAs in increasing the levels of serum iron, transferrin and total iron-binding capacity, without increasing the risk of adverse events during a short-term duration of use.

Due to long treatment cycle and medication dependence, patients with chronic heart failure (CHF) face many risks of out-of-hospital medication. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based patient safety tool, which has been studied rarely in the management of out-of-hospital medication safety in CHF patients.

To discuss the role of TeamSTEPPS in the out-of-hospital medication safety management in CHF patients.

A total of 134 CHF patients hospitalized in the First Affiliated Hospital of Chongqing Medical University from June 2019 to June 2020 were selected, and were divided into the intervention group (n=62) and control group (n=61) according to the number of ward, receiving routine medication safety management, and TeamSTEPPS-based medication safety management, respectively. The medication error was evaluated before discharge and 6 months after discharge by the Medication Error Questionnaire developed by us. The medication knowledge, attitude and practice (KAP) were evaluated before discharge, 1, 3 and 6 months after discharge by a self-developed Medication KAP Scale. Cardiac function, dyspnea and edema were evaluated before discharge, 3 and 6 months after discharge. The readmission and all-cause mortality were collected 3 and 6 months after discharge. The safety attitude of medical workers was measured before intervention and 6 months after intervention by the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) .

The prevalence of ignoring the content of the prescription, omission error, wrong time error, wrong dose error, taking medication without a doctor's advice and unauthorized drug withdrawal differed between the two groups 6 months after discharge (P<0.05) . The readmission rates of the intervention group 3 and 6 months after discharge were lower than those of the control group (P<0.05) . The scores of teamwork climate, safety climate, perceptions of management, job satisfaction and stress recognition in medical workers providing services for the intervention group 6 months after intervention were higher than those before intervention (P<0.05) . The results of two-factor repeated measures ANOVA showed that the duration and type of medication safety management had significant interaction effects on the medication KAP scores, NYHA class, dyspnea and edema in two groups (P<0.05) . The duration of medication safety management had an significant main effect on the medication KAP scores, dyspnea and edema in two groups (P<0.05) . The type of medication safety management had a significant main effect on the medication KAP and edema in two groups (P<0.05) . The medication knowledge scores of the intervention group 3 and 6 months after discharge were higher than those of the control group (P<0.05) . The intervention group had higher medication attitude score but lower medication practice score than the control group 1, 3 or 6 months after discharge (P<0.05) . The medication knowledge and medication attitude scores increased in both groups 1, 3, 6 months after discharge (P<0.05) . The medication practice score increased in the intervention group 1, 3, 6 months after discharge, but decreased in the control group at 1 month after discharge (P<0.05) . The medication knowledge score at 1 month after discharge was lower than that 3 or 6 months after discharge in the intervention group (P<0.05) , but the opposite was found in the control group (P<0.05) . The dyspnea score at 6 months after discharge was lower than that before discharge in the intervention group (P<0.05) . The edema score before discharge was higher than that 3 and 6 months after discharge in the intervention group (P<0.05) . The intervention group had higher edema score 3 and 6 months after discharge than the control group (P<0.05) .

The use of TeamSTEPPS in out-of-hospital medication safety management in CHF patients could improve the medication safety and symptoms in patients as well as enhance the safety culture of the healthcare team.

Both frailty and potentially inappropriate medication (PIM) are relatively highly prevalent in adults with mild cognitive impairment (MCI) in the community, but the association of PIM with frailty in MCI population remains to be further explored.

To examine the association between PIM and frailty in older adults with MCI in the community.

This study was conducted between March to July 2021. By use of multistage sampling, older adults with MCI (n=230) were recruited from Baohe District, Hefei City. Sociodemographics, lifestyle indicators and physical functions of the subjects were collected by using the General Information Questionnaire developed by our research team. Frailty was assessed by the Comprehensive Frailty Assessment Instrument. PIM was assessed by the 2017 Criteria of Potentially Inappropriate Medications for Older Adults in China. Logistic regression analysis was applied to analyze the association of the number and types of PIM with frailty.

The prevalence of frailty and PIM in these older adults with MCI was 59.1% (136/230) and 59.1% (136/230) , respectively. The prevalence of PIM in the frailty group was much higher than that of non-frailty group〔80.9% (110/136) vs 27.7% (26/94) 〕 (P<0.05) . Multivariate Logistic regression analysis demonstrated that compared with MCI older adults without PIM, the risk of frailty was 4.591 times higher in those with only one PIM〔95%CI (1.903, 11.076) 〕, and 8.859 times higher in those with two or more PIMs〔95%CI (2.589, 30.321) 〕. Compared with MCI older adults with neurological disease but without PIM, the risk of frailty was 5.310 times higher in those with PIM〔95%CI (1.011, 27.877) 〕. The risk of frailty was 3.108 times higher in those with cardiovascular disease and PIM than that in those without PIM〔95%CI (1.173, 8.241) 〕.

The prevalence of frailty and PIM was higher in older adults with MCI in the community, and PIM was significantly associated with frailty. To decrease the prevalence of frailty and delay the progression of dementia in this population via reducing the prevalence of PIM, community-based health efforts should be made to strengthen the screening for frailty, enhance the identification of frailty related to medication use, and promote medication review and management.

As an intractable disease recognized by the WHO, current available treatments have limitations for ulcerative colitis (UC) . Although the effectiveness of fecal microbiota transplantation (FMT) has been confirmed, the reported efficacies are various.

To compare the effect of FMT between a mouse model of common UC and a mouse model of damp-heat UC, and the medicinal flavor of fecal microbiota (new jinzhi) .

This experiment was implemented from December 9th to 28th, 2019. Thirty-five male SPF C57BL/6 mice were equally divided into seven groups: normal control group (no intervention) , common UC model (CUCM) group (received interventions to be a CUCM according to the requirements) , CUCM+FMT group (received interventions to be a CUCM successfully, then received an enema of 0.2 ml prepared fecal microbiota solution) , CUCM+5-aminosalicylic acid (5-ASA) group (received interventions to be a CUCM successfully, then received an enema of 0.019 5 g/ml 5-ASA) , damp-heat UC model (DUCM) group (received interventions to be a DUCM according to the requirements) , DUCM+FMT group (received interventions to be a DUCM successfully, then received an enema of 0.2 ml prepared fecal microbiota solution) , and DUCM+5-ASA group (received interventions to be a DUCM successfully, then received an enema of 0.019 5 g/ml 5-ASA) . The intestinal tissues of each group of mice were taken out when the experiment ended, and were stained with H&E for observing the morphology, and ultrastructure of them was observed using transmission electron microscope, Th1 and Th2 cells in them were detected using flow cytometry, and microbial community in them were detected using high-throughput 16S rRNA gene sequencing. Routine blood test was conducted to measure the levels of white blood cell count (WBC) , red blood cell count (RBC) , platelet count (PLT) and hemoglobin (HGB) . Nimodipine method was used to evaluate the efficacy index before and after intervention.

The mice in each group were successfully established. The morphology of intestinal tissues stained with H&E: the intestinal mucosal surface of CUCM group and DUCM group had different degrees of defect or shedding and necrosis, while the intestinal mucosa was basically intact in CUCM+FMT group, CUCM+5-ASA group, DUCM+FMT group and DUCM+5-ASA group. The DUCM+FMT group had more neatly arranged and compacted glands than did CUCM+FMT group. The ultrastructure of intestinal tissue observed using transmission electron microscope: the surface microvilli of epithelial cells in CUCM and DUCM groups were sparse with decreased goblet cells. The CUCM+FMT, CUCM+5-ASA, DUCM+FMT and DUCM+5-ASA groups had denser microvilli with more goblet cells. Compared with the CUCM+FMT group, the DUCM+FMT group had denser microvilli and more goblet cells. Th1 and Th2 cell contents: there were significant differences in Th1 and Th2 cell contents, WBC, RBC, PLT and HGB across all groups of mice (P<0.001) . Efficacy analysis: the efficacy index of CUCM+5-ASA group, DUCM+FMT group or DUCM+5-ASA group was better than that of CUCM+FMT group (P<0.05) . Microbial community analysis: the genus with significantly decreased abundance in CUCM and DUCM groups was Ruminococcus, and the increased abundance was Akkermansia. The CUCM+FMT and DUCM+FMT groups had a tendency of gradually increasing similarities to the control group, indicating that the intestinal flora of these two groups were improving.

FMT were effective for mice models of UC, especially for the mice model of damp-heat UC. The new jinzhi has a bitter and cold flavor, which may work by regulating the intestinal flora to improve the Th1/Th2 balance for therapeutic purposes.

Dilated cardiomyopathy has an extremely poor prognosis, sacubitril/valsartan and dapagliflozin are important drugs to improve the prognosis. However, patients with dilated cardiomyopathy tend to have low blood pressure, which would make it unable to use both drugs at the same time. There is no comparative study of the efficacy and safety of sacubitril/valsartan and dapagliflozin in the treatment of dilated cardiomyopathy with low blood pressure.

To investigate the efficacy and safety of sacubitril/valsartan and dapagliflozin in dilated cardiomyopathy patients with low blood pressure.

A total of 124 patients with dilated cardiomyopathy admitted to the First Affiliated Hospital of Xi'an Jiaotong University from March 2021 to May 2022 were selected as the study subjects. All patients were diagnosed with dilated cardiomyopathy for the first time, and the systolic blood pressure (SBP) was 95-110 mmHg before medication. Patients were prescribed with sacubitril/valsartan (50 mg/time, twice a day) or dapagliflozin tablets (10 mg/time, once a day) before or at discharge and divided into the sacubitril/valsartan group (71 cases) and dapagliflozin group (53 cases) according to clinical drug use. The outpatient follow-up was performed 6 months after discharge until November 2022. General information of the two groups such as age and gender were collected through the hospital electronic medical record system, baseline and 6-month follow-up SBP, diastolic blood pressure (DBP) , and BMI of the two groups were recorded. Baseline and 6-month biochemical indicators〔N-terminal pro-B-type natriuretic peptide (NT-proBNP) , glycated hemoglobin (HbA_1c) , fasting blood glucose (FBG) , estimated glomerular filtration rate (eGFR) , blood potassium〕, cardiac function indicators〔left ventricular ejection fraction (LVEF) , left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic diameter (LVESD) , left atrial diameter (LAD) 〕, 6 min walking test (6MWT) and clinical events were collected. The biochemical indicators, cardiac function indicators and incidence of clinical events before and after treatment were compared between the two groups.

Compared with the pre-treatment period, the levels of blood potassium, LVEF and 6MWT were increased in the sacubitril/valsartan group and dapagliflozin group after 6 months of treatment (P<0.05) , and the elevations of 6MWT level in the dapagliflozin group was higher than that in the sacubitril/valsartan group (t=2.444, P=0.016) . Compared with the pre-treatment period, the levels of SBP, DBP, BMI, NT-proBNP, HbA_1c, FBG, LVEDD, LVESD, LAD were decreased in the sacubitril/valsartan group and dapagliflozin group after 6 months of treatment (P<0.05) , the reductions of SBP (Z=5.217, P<0.001) , DBP (t=3.070, P=0.003) , eGFR (Z=2.495, P=0.013) levels in the sacubitril/valsartan group and BMI (Z=4.410, P<0.001) , HbA_1c (Z=4.493, P<0.001) , FBG (t=4.832, P<0.001) , LAD (Z=2.830, P=0.005) levels in the dapagliflozin group were higher. There were no deaths or hypoglycemic discontinuation events in the two groups during 6 months of follow-up, and there were no statistical differences in the incidence of hypotension discontinuation, hyperkalemia discontinuation, renal insufficiency discontinuation, urinary system infection discontinuation and heart failure re-hospitalization between the two groups (P>0.05) .

Both sacubitril/valsartan and dapagliflozin were effective in improving cardiac function in dilated cardiomyopathy patients with low blood pressure. The safety of the two groups is similar. However, the use of sacubitril/valsartan should be noted for the risk of hypotension and renal insufficiency.

Immunotherapy represented by programmed death protein-1 (PD-1) inhibitors has gradually become the standard treatment of advanced non-small cell lung cancer (NSCLC) in recent years, changing the treatment landscape of advanced NSCLC. However, most PD-1-related studies excluded patients with NSCLC more than 70 or 75 years, resulting in relatively limited data about the efficacy and safety of PD-1 inhibitors in elderly patients.

This study aims to evaluate the efficacy and safety of PD-1 inhibitors in elderly patients with advanced NSCCL.

This study selected elderly patients with advanced NSCLC over 65 years who received PD-1 inhibitors monotherapy in Department of Thoracic Surgery and Oncology of the Fourth Affiliated Hospital of Gansu University of Traditional Chinese Medicine from October 2018 to November 2021. A total of 63 elderly patients with NSCLC were included. The PD-1 inhibitors of the study were approved in Chinese market, including camrelizumab, sintilimab and pembrolizumab. The data about efficacy and safety of PD-1 inhibitors were collected in the hospital electronic medical record system. All patients were followed up regularly to obtain the long-term prognostic data until 2022-03-15. The efficacy data of PD-1 inhibitors, the prognosis of elderly patients with advanced NSCLC and the toxicity and side effects of PD-1 inhibitors were collected. Cox comparative risk model was used to explore the influencing factors of the prognosis of elderly patients with advanced NSCLC.

The median age of the 63 elderly patients with advanced NSCLC was 71 (65, 89) years. The best response assessment during PD-1 inhibitors therapy showed that no patients had complete response, 14 patients had partial responses, 21 patients had stable status, and 28 patients had progressive status. The objective response rate (ORR) of patients with advanced NSCLC treated with PD-1 inhibitors monotherapy was 22.2% (14/63) , and the disease control rate (DCR) was 66.7% (14/21) . Prognostic data showed that the median progression free survival (PFS) of the 63 patients with advanced NSCLC was 3.3 (2.0, 4.6) months and the median overall survival (OS) was 10.2 (6.1, 14.3) months. Among 63 elderly patients with NSCLC, 46 of them (73.0%) had treatment related adverse reaction during PD-1 inhibitors monotherapy, and the rate of grade 3 or above adverse reactions was 14.3%. The most common adverse reactions were fatigue, diarrhea, rash and abnormal liver function with the rates of 23.8% (15/63) , 19.1% (12/63) , 15.9% (10/63) and 14.3% (9/63) , respectively. Cox comparative risk model analysis suggested that ECOG performance status and number of metastatic lesions might be independent factors of PFS in patients with advanced NSCLC treated with PD-1 inhibittors.

PD-1 blockades monotherapy demonstrated potential efficacy and acceptable safety for elderly patients with NSCLC. ECOG performance status and number of metastatic lesions might be potential risk factors that predict the PFS of the patients.

With the accelerated population aging, the number of elderly patients with chronic diseases is growingly elevated. Adherence to medication regimens is pivotal for the health outcomes of chronic diseases. Existing research mainly analyzed influencing factors for medication adherence and the outcome of medication adherence by interventions. A single analysis of medication adherence from the aspect of medication experience is one-sided.

To understand the current situations of medication experience and medication adherence in elderly patients with chronic diseases, and to explore the influence of medication experience at multiple dimensions on medication adherence, thus proposing countermeasures to improve medication adherence in elderly patients with chronic diseases.

From September 2023 to December 2023, a total of 2 432 residents of three cities in Shandong Province were selected by stratified random sampling according to the economic level and social development. Elderly patients (>60 years of age) with chronic diseases and long-term medications were screened according to the inclusion and exclusion criteria. A self-designed Medication Experience Scale, consisting of 7 dimensions and 28 items was used to investigate the medication experience. A Chinese version of 4-item Medication Adherence Scale was used to investigate the medication adherence. Current status of patients' medication experience and medication adherence were described. Multiple linear regression was performed to analyze the dimensions of medication experience that greatly influenced medication adherence.

A total of 2 432 questionnaires were distributed in this survey, and 2 415 were retrieved. After excluding samples with missing data on the main variables, a total of 1 544 samples were included in this study. The mean score of medication experience of elderly patients with chronic diseases was (4.31±0.39) point, with the highest score in the dimension of life influenced by medication (4.72±0.58) points, and lowest in the dimension of convenience (3.86±0.49) points. The mean score of medication adherence in elderly patients with chronic diseases was (3.48±0.62) points. A total of 698 (45.2%) patients were identified as a poor adherence. The most common cause for non-adherence was 'forgetting to take medication' (77.1%, 538/698). Medication adherence scores were significantly lower in female elderly, or elderly patients with two or more chronic diseases than those of counterparts (P<0.05). The results of multivariate linear regression showed that medication adherence was worse in female elderly patients (β=-0.056) and elderly patients with two or more chronic diseases (β=-0.053) (P<0.05). Among the dimensions of the Medication Experience Scale, the dimensions of effectiveness (β=0.083), and affordability (β=0.135) positively predicted patients' medication adherence (P<0.05) .

The proportion of elderly patients with poor medication adherence to chronic diseases in Shandong Province is 45.2%, among whom, female patients and elderly patients with two or more chronic diseases have a worse medication adherence. The effectiveness and affordability dimensions of the medication experience are positive predictors of medication adherence. Relevant departments should focus on continuously reducing the price of chronic disease medicines, and doctors should strengthen the pharmacy guidance service provided to female patients and elderly patients with two or more chronic diseases.

Dyslipidemia is closely related to the occurrence of acute myocardial infarction (AMI) and affects the prognosis of patients. Understanding blood lipid changes in patients with AMI is of great significance for improving lipid-lowering treatments for these patients.

To explore the evolution of blood lipid levels in patients with AMI during hospitalization and post-discharge follow-up.

This study consecutively selected 457 cases of AMI who were hospitalized in Department of Cardiology, Peking University People's Hospital from January 1, 2015 to February 28, 2018. They were monitored for blood lipid levels during hospitalization and the first post-discharge follow-up. The patient's medication status was recorded.

The low-density lipoprotein cholesterol (LDL-C) level in AMI patients varied statistically significantly by the measurement time point (P<0.05). Specifically, LDL-C showed a decreasing trend within 24 h after the onset of AMI, then reached (2.21±0.63) mmol/L at about 24 h after the onset, which decreased by (0.98±0.34) mmol/L on average compared with the admission level. After that, the level of LDL-C gradually stabilized. The total cholesterol (TC) level differed statistically significantly across measurement time points (P<0.05). To be specific, it decreased by an average of (1.34±0.46) mmol/L at about 24 h after the onset of the disease, and then stabilized. There were statistically significant differences in the high-density lipoprotein cholesterol (HDL-C) level of AMI patients at different time points (P<0.05). The HDL-C level of patients decreased within 12 h after onset, and then stabilized. There were statistically significant in triglyceride (TG) levels of AMI patients at different time points (P<0.05). After the onset of the disease, the TG level of the patients increased within 12 h and decreased after 24 h, and then stabilized. In terms of lipid-regulating therapy, 36.8% (168/457) of AMI patients received lipid-regulating therapy before the hospitalization. Among those who were not engaged in lipid-regulating treatment prior to hospitalization, 28.2% (129/457) had already suffered from arteriosclerotic cardiovascular disease. During the hospitalization, 99.2% (453/457) of the patients were treated with lipid-regulating therapy, mainly statins at medium doses. By one year after discharge, only 59.3% (271/457) of patients still regularly took lipid-regulating drugs. In the follow-up period after discharge, 43.7% (200/457) of patients met the standard of blood lipids.

At about 24 h after the onset of AMI, the LDL-C of AMI patients dropped to the bottom, and the trend of decline was more obvious in those who received no lipid-lowering drugs before hospitalization. The lipid-lowering treatment for them was mainly based on medium-dose statins, and the in-hospital statin usage rate reached 99.2%, but the rate of patients meeting the target LDL-C level during follow-up period was 43.7%, which may be enhanced by improving patient compliance.