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Prevalence and clinical implications of polypharmacy and potentially inappropriate medication in elderly patients with heart failure: results of six months' follow-up

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Journal of Geriatric Cardiology 2023年第7期20卷 495-508页

作者： Man LI Na WEI Han-Yu SHI Xue-Jiao JING Xiao-Hong KAN Hai-Qing GAO Yun-Ling XIAO department of Geriatric Medicine Qilu Hospital of Shandong UniversityJinanShandongChina Key Laboratory of Cardiovascular Proteomics of shandong Province Qilu Hospital of Shandong UniversityJinanShandongChina

OBJECTIVES To investigate the prevalence of polypharmacy and potentially inappropriate medication(PIM)in elderly patients with heart failure(HF)and their impact on readmission and mortality.METHODS We conducted a study of 274 participants aged 60 years or older with HF.The prevalence of polypharmacy(defined as the use of five or more medications)was calculated,and the 2019 American Geriatrics Society Beers criteria were applied to access PIMs.Medications and PIMs were characterized at admission and discharge,and changes in prescriptions during hospitalization were compared.The impact of polypharmacy and PIM on readmission and mortality were investigated.RESULTS The median age of this study population was 68 years old.The median number of prescribed drugs was 7 at admission and 10 at discharge.At discharge,99.27%of all patients were taking five or more drugs.The incidence of composite endpoint and cardiovascular readmission increased with the number of polypharmacy within 6 months.The use of guideline-directed medical therapy reduced the incidence of composite endpoint events and cardiovascular readmission,while the use of noncardiovascular medications increased the composite endpoint events.The frequency of PIMs was 93.79%at discharge.The incidence of composite endpoint events increased with the number of PIMs.“PIMs in older adults with caution”increased cardiovascular readmission and“PIMs based on kidney function”increased cardiovascular mortality.Several comorbidities were associated with cardiovascular mortality or non-cardiovascular readmission.CONCLUSIONS Polypharmacy and PIM were highly prevalent in elderly patients with HF,and their use was associated with an increased risk of composite endpoint events,readmission and mortality.Non-cardiovascular medications,“PIMs in older adults with caution”,“PIMs based on kidney function”and several comorbidities were important factors associated with hospital readmission and mortality.Our findings highlight the importance of medication optimization in the management of

关键词： medication patients drugs

Effects of TRPA1 activation and inhibition on TRPA1 and CGRP expression in dorsal root ganglion neurons

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Neural Regeneration Research 2019年第1期14卷 140-148页

作者： Xiao-Lei Wang Li-Wei Cui Zhen Liu Yue-Ming Gao Sheng Wang Hao Li Hu-Xiang Liu Ling-Jia Yu department of Rheumatology Qilu Hospital of Shandong University department of Respiratory Medicine Qilu Hospital of Shandong University department of Orthopedics Qilu Hospital of Shandong University

Transient receptor potential ankyrin 1(TRPA1) is a key player in pain and neurogenic inflammation, and is localized in nociceptive primary sensory dorsal root ganglion(DRG) neurons. TRPA1 plays a major role in the transmission of nociceptive sensory signals. The generation of neurogenic inflammation appears to involve TRPA1-evoked release of calcitonin gene-related peptide(CGRP). However, it remains unknown whether TRPA1 or CGRP expression is affected by TRPA1 activation. Thus, in this study, we examined TRPA1 and CGRP expression in DRG neurons in vitro after treatment with the TRPA1 activator formaldehyde or the TRPA1 blocker menthol. In addition, we examined the role of extracellular signal-regulated protein kinase 1/2(ERK1/2) in this process. DRG neurons in culture were exposed to formaldehyde, menthol, the ERK1/2 inhibitor PD98059 + formaldehyde, or PD98059 + menthol. After treatment, real-time polymerase chain reaction, western blot assay and double immunofluorescence labeling were performed to evaluate TRPA1 and CGRP expression in DRG neurons. Formaldehyde elevated mRNA and protein levels of TRPA1 and CGRP, as well as the proportion of TRPA1-and CGRP-positive neurons. In contrast, menthol reduced TRPA1 and CGRP expression. Furthermore, the effects of formaldehyde, but not menthol, on CGRP expression were blocked by pretreatment with PD98059. PD98059 pretreatment did not affect TRPA1 expression in the presence of formaldehyde or menthol.

关键词： CGRP 神经原 PD98059 背面激活 md ERK1/2 聚合酶链反应

Dual therapy for Helicobacter pylori infection

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Chinese Medical Journal 2023年第1期136卷 13-23页

作者： Miao Duan Jing Liu Xiuli Zuo department of Gastroenterology Qilu Hospital of Shandong UniversityJinanShandong 250012China Laboratory of Translational Gastroenterology Qilu Hospital of Shandong UniversityJinanShandong 250012China Robot Engineering Laboratory for Precise Diagnosis and Therapy of Gastrointestinal Tumor Qilu Hospital of Shandong UniversityJinanShandong 250012China

Bismuth-containing quadruple therapy(BQT)has long been recommended for Helicobacter pylori(H.pylori)eradication in China.Meanwhile,in the latest national consensus in China,dual therapy(DT)comprising an acid suppressor and amoxicillin has also been recommended.In recent years,the eradication rate of H.pylori has reached>90%using DT,which has been used not only as a first-line treatment but also as a rescue treatment.Compared with BQT,DT has great potential for H.pylori eradication;however,it has some limitations.This review summarizes the development of DT and its application in H.pylori eradication.The H.pylori eradication rates of DT were comparable to or even higher than those of BQT or standard triple therapy,especially in the first-line treatment.The incidence of adverse events associated with DT was lower than that with other therapies.Furthermore,there were no significant differences in the effects of dual and quadruple therapies on gastrointestinal microecology.In the short term,H.pylori eradication causes certain fluctuations in the gastrointestinal microbiota;however,in the long term,the gastrointestinal microbiota eventually returns to its normal state.In the penicillin-naïve population,patients receiving DT have a high eradiation rate,better compliance,lower incidence of adverse reactions,and lower primary and secondary resistance to amoxicillin.These findings suggest the safety,efficacy,and potential of DT for H.pylori eradication.

关键词： Dual therapy Gastrointestinal microbiome Helicobacter pylori Quadruple therapy

Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

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World Journal of Clinical Cases 2024年第15期12卷 2542-2550页

作者： Xian-Quan Cui Lu-Wei Zhang Peng Zhao Jing-Jing Feng department of Organ Transplantation Qilu Hospital of Shandong UniversityJinan 250012Shandong ProvinceChina department of Blood Purification Qilu Hospital of Shandong UniversityJinan 250012Shandong ProvinceChina

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have anti

关键词： Carrimycin Organ transplantation Severe pneumonia Immunosuppressant Infection Antiviral drugs

Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage

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Journal of Geriatric Cardiology 2017年第4期14卷 266-273页

作者： Wen-Ming LIU Xue-Guang ZHANG Ze-Li ZHANG Gang LI Qi-Bing HUANG department of Emergency Surgery Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University Jinan ShandongChina department of neurosurgery Liaocheng People's Hospital Liaocheng Shandong China department of neurosurgery Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University Jinan Shandong China

为了探索 thalamic 出血的 6 月的临床的结果的预言者，并且如果最低限度地侵略的 thalamic hematoma 排水(THD ) 能与自发的 thalamic 改进它 54 个病人的 prognosis.MethodsA 总数，评估，出血回顾地被评估。包括人口分布，击风险因素... 详细信息

为了探索 thalamic 出血的 6 月的临床的结果的预言者，并且如果最低限度地侵略的 thalamic hematoma 排水(THD ) 能与自发的 thalamic 改进它 54 个病人的 prognosis.MethodsA 总数，评估，出血回顾地被评估。包括人口分布，击风险因素， neuroimaging 变量，承认上的格拉斯哥昏迷分数(GCS ) ，外科的策略，和结果，临床的数据是镇定的。临床的结果用修改 Rankin 规模被估计，六 ? 在发作以后的月。 Univariate 分析和 multivariate 逻辑回归分析被执行决定差的 outcome.ResultsConservative 治疗的预言者为五个病人(9.3%)被执行，为 20 个病人(37.0%)的外部室的排水( EVD )，为四个病人(7.4%)的 THD ，并且 EVD 为 25 个病人(46.3%)与 THD 结合了。在在发作以后的六个月， 21 (38.9%) 病人们完成了有利结果，当(61.1%) 33 有差的结果时。在 univariate 分析，差的 6 月的结果的预言者是承认上的更低的 GCS (P = 0.001 ) ，更大的 hematoma 体积(P < 0.001 ) ，中线移动(P = 0.035 ) ，急性脑水肿(P = 0.039 ) ，并且没有 THD (P = 0.037 ) 。差的结果的独立预言者，根据 multivariate 逻辑回归分析，不是 volume.ConclusionsMinimally 侵略的 THD，在一些天以内移开大多数 hematoma，改进了的 THD 和更大的 hematoma thalamic 的 6 月的结果出血。因此， THD 能广泛地被使用与 thalamic 出血对待病人。

关键词：脑出血 logistic回归分析预后血肿引流丘脑单因素分析临床资料

Fibroblast growth factor 15,induced by elevated bile acids,mediates the improvement of hepatic glucose metabolism after sleeve gastrectomy

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World Journal of Gastroenterology 2023年第21期29卷 3280-3291页

作者： Meng Wei Wei-Bo Cao Ru-Dong Zhao Dan-Ping Sun Yi-Ze Liang Ya-Di Huang Ze-Wei Cheng JunOuyang Wen-Shuo Yang Wen-Bin Yu department of General Surgery Qilu Hospital of Shandong UniversityJinan 250012Shandong ProvinceChina

BACKGROUND Fibroblast growth factor(FGF)15/19,which is expressed in and secreted from the distal ileum,can regulate hepatic glucose metabolism in an endocrine manner.The levels of both bile acids(BAs)and FGF15/19 are elevated after bariatric surgery.However,it is unclear whether the increase in FGF15/19 is induced by BAs.Moreover,it remains to be understood whether FGF15/19 elevations contribute to improvements in hepatic glucose metabolism after bariatric surgery.AIM To investigate the mechanism of improvement of hepatic glucose metabolism by elevated BAs after sleeve gastrectomy(SG).METHODS By calculating and comparing the changes of body weight after SG with SHAM group,we examined the weight-loss effect of SG.The oral glucose tolerance test(OGTT)test and area under the curve of OGTT curves were used to assess the anti-diabetic effects of SG.By detecting the glycogen content,expression and activity of glycogen synthase as well as the glucose-6-phosphatase(G6Pase)and phosphoenolpyruvate carboxykinase(Pepck),we evaluated the hepatic glycogen content and gluconeogenesis activity.We examined the levels of total BA(TBA)together with the farnesoid X receptor(FXR)-agonistic BA subspecies in systemic serum and portal vein at week 12 post-surgery.Then the histological expression of ileal FXR and FGF15 and hepatic FGF receptor 4(FGFR4)with its corresponding signal pathways involved in glucose metabolism were detected.RESULTS After surgery,food intake and body weight gain of SG group was decreased compare with the SHAM group.The hepatic glycogen content and glycogen synthase activity was significantly stimulated after SG,while the expression of the key enzyme for hepatic gluconeogenesis:G6Pase and Pepck,were depressed.TBA levels in serum and portal vein were both elevated after SG,the FXR-agonistic BA subspecies:Chenodeoxycholic acid(CDCA),lithocholic acid(LCA)in serum and CDCA,DCA,LCA in portal vein were all higher in SG group than that in SHAM group.Consequently,the ileal expression of FXR and FGF15 were also advanced i

关键词： Sleeve gastrectomy Fibroblast growth factor 15 Bile acids Hepatic glucose metabolism Type 2 diabetes mellitus

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

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World Journal of Gastroenterology 2023年第29期29卷 4571-4579页

作者： Chang Chen Xiang Zhang Zhi-Qiang Cheng Bin-Bin Zhang Xin Li Ke-Xin Wang Yong Dai Yan-Lei Wang department of Colorectal Surgery Qilu HospitalShandong UniversityJinan 250012Shandong ProvinceChina department of Nursing Qilu Hospital of Shandong University De Zhou HospitalDezhou 254300Shandong ProvinceChin department of General Surgery Huantai Branch of Qilu Hospital of Shandong UniversityZibo 255000Shandong ProvinceChina

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the department of Colorectal Surgery of qilu hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient i

关键词： Enterostomy Abdominal wound closure technique Suture techniques Surgical wound infection hospital costs hospital stay

Portopulmonary hypertension: Current developments and future perspectives

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Liver Research 2022年第1期6卷 10-20页

作者： Huawei Xu Baoquan Cheng Renren Wang Mengmeng Ding Yanjing Gao department of Gastroenterology Qilu Hospital of Shandong UniversityJinanShandongChina

Portopulmonary hypertension(POPH)is a severe pulmonary vascular disease secondary to portal hy-pertension and a subset of Group 1 pulmonary hypertension(PH).The pathological changes of POPH are indistinguishable from other PH phenotypes,including endothelial dysfunction,pulmonary vasocon-striction,and vascular remodeling.These changes cause a progressive increase in pulmonary vascular resistance and afterload of the right ventricle,eventually leading to severe right heart failure.The prognosis of POPH is extremely poor among untreated patients.POPH is associated with a high risk of death after liver transplantation(LT),and severe POPH is considered an absolute contraindication for LT.However,pulmonary arterial hypertension(PAH)-targeted therapies are administered to patients with POPH,and aggressive drug treatment significantly optimizes pulmonary hemodynamics and reduces the risk of death.Therefore,early diagnosis,aggressive PAH-targeted therapies,and proper selection of liver transplant candidates are vital to reduce the risk of surgery and improve clinical outcomes.This article aims to review the results of previous studies and describe biological mechanisms,epidemiology,po-tential risk factors,and diagnostic approaches of POPH.Moreover,we introduce recent therapeutic in-terventions for the early diagnosis of POPH and efficient clinical management decisions.

关键词： Portopulmonary hypertension(POPH) Portal hypertension Pulmonary arterial hypertension(PAH) Liver transplantation(LT) Evaluation Treatment

Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries:A case report and literature review

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Chinese Journal of Traumatology 2023年第1期26卷 33-40页

作者： Lin Cheng Cheng Qiu Xin-Yu Liu Xi-Guang Sang department of Emergency Medicine Qilu Hospital of Shandong UniversityJinan250012China department of Orthopaedic Surgery Qilu Hospital of Shandong UniversityJinan250012China Cheeloo College of Medicine Shandong UniversityJinan250012China

Spondyloptosis in the clinic is rarely reported.We herein present a 47-year-old female,who suffered from a crush injury directly by a heavy cylindrical object from the lateral side.She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas.Staged surgical procedures were conducted and a three-year follow-up was obtained.Eventually,normal spinal alignment was restored,and neurological deficits were gradually improved.At three years follow-up,the motor strength scores and function of the sphincters were incompletely improved.Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed.First,thoracolumbar and lumbosacral junction were mostly predilection sites.Second,numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A.Third,lumbar spondyloptosis was commonly coupling withcauda equina injury.Finally,the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity.Based on this case report and literatures review,we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas.Furthermore,we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.

关键词： Spondyloptosis Multiple trauma Fracture dislocation American Spinal Injury Association Lumbar spine