A Collaborative for Primary Prevention and Recovery Management一个协作的初级预防与恢复管理
不同剂量阿托伐他汀治疗老年冠状动脉粥样硬化性心脏病的疗效与并发症观察
不同剂量阿托伐他汀治疗老年冠状动脉粥样硬化性心脏病的疗效与并发症观察汤利荣;赵强;李娟【摘要】Objective To observe the effect and complications of different doses of atorvastatin in treating senile coronary atherosclerosis heart disease. Methods 128 cases of senile coronary heart disease (CHD) were randomly divided into the eXperimental group and the control group, 64 cases in each group. On the basis of the conventional treatment the control group took oral atorvastatin 15 mg each time, while the eXperimental group took atorvastatin 30 mg each time. Both groups took atorvastatin once a day, with the treatment course of 5 months. The differences of HDL - C, TC, LDL - C, Tg, HS - CRP levels before and after treatment were compared between the two groups; the complications within 5 months were also compared between the two groups. The clinical curative effects were analyzed in the two groups. Results The TC, LDL - C, Tg and hs - CRP levels after treatment were significantly decreased in the two groups( P < 0. 05), but the decrease in the eXperimental group was more significant, the difference between the two groups had statistical significance ( P < 0. 05 ); the HDL - C level, complications and their occurrence rates within 5 months had no statistically significant difference be-tween the two groups. No severe complications occurred in the two groups. Conclusion Adopting larger dose of atorvastatin for treating senile CHD has no obvious aggravation of complications, can effectively improvethe inflammatory factors, decrease blood fat and relieve the cardiovascular events occurrence.%目的：观察不同剂量阿托伐他汀治疗老年冠状动脉粥样硬化性心脏病的疗效及并发症。
怎样处理学生的作弊问题英语作文
怎样处理学生的作弊问题英语作文全文共3篇示例，供读者参考篇1How to Handle the Student Cheating ProblemCheating has become a huge issue in schools these days. It seems like almost every exam or major assignment, there are always a few students trying to get ahead by cheating. As a student, I know how tempting it can be to cheat when you're stressed out, overloaded with work, or struggling in a particular class. However, cheating is never the right solution and creates way more problems than it solves. I've seen many of my peers get caught cheating and face tough consequences like getting a zero on an assignment, failing a class, or even getting suspended or expelled. It's really not worth the risk.I think the best way for schools to handle cheating is through a multi-pronged approach of preventative measures, fair but strict penalties for those caught cheating, and creating a culture of academic integrity. On the prevention side, teachers need to be very vigilant during tests and exams. They should walk around frequently, spread students out, use multiple testversions, and be aware of the common cheating techniques like writing notes on skin/clothes, programming formulas into calculators, etc. Giving clear guidelines about what is allowed during tests is also important so there is no confusion.However, preventing cheating goes beyond just strict test monitoring. The curriculum, teaching methods, and overall academic environment play a huge role. If students are overloaded and extremely stressed, they will be more tempted to cheat. Professors need to have reasonable workloads and deadlines to reduce this pressure. Courses should also be teaching practical skills and knowledge rather than just forcing students to memorize tons of information which makes cheating more appealing. Using open book tests, projects, and assignments that require critical thinking rather than just regurgitating facts would lower cheating rates significantly in my opinion.When cheating does occur, schools need to have clear and consistent penalties that are enforced fairly across all students. Usually this involves getting a zero on the assignment or test, possibly failing the whole course, and potentiallysuspension/expulsion for severe or repeat offenses. These penalties need to be clearly laid out in academic honesty policiesthat all students read and sign. They also need to be enforced consistently regardless of the student's grades, connections, race, etc. It's crucial that there is no perception of certain students receiving lighter or harsher penalties based on non-academic factors.While enforcing rules is important, I don't think harsh penalties alone will solve the cheating problem. Schools need to build a culture of academic integrity and ethics early on. Having serious discussions about why cheating is unethical and hurts the individual and school should start as soon as elementary school. Emphasizing ethical decision making, time management skills, and the importance of putting in hard work needs to be woven throughout the curriculum. Teachers and professors should be role models who uphold strong ethics and punish cheating in their own courses. There could also be required ethics courses or workshops. Building this culture of integrity will hopefully prevent many students from ever considering cheating in the first place.Another aspect schools should focus on is providing ample academic support resources so students don't feel the need to cheat due to struggling with material. Having free tutoring, teaching assistants, student study groups, and online resourcescan make a huge difference. Professors also need to be available for extra help through regular office hours. I've seen many students get desperate and cheat because they didn't understand something and felt they had no one to turn to for help. With more academic support, this could be prevented.From a student perspective, I completely understand the strong temptation and pressure to cheat. However, I've seen the consequences firsthand of getting caught cheating, and they're not worth it at all. Not only do you risk failing an assignment or even the whole course, but you miss out on actually learning the material which will come back to hurt you later on. If schools can build a culture of integrity while also providing more support and reasonable workloads, I think we'd see cheating rates go way down. It's a complex issue with no perfect solution, but taking a comprehensive approach to prevention, fair enforcement, and changing the academic culture and environment is crucial. At the end of the day, we're here to learn, and cheating is fundamentally opposed to that purpose. With some key changes, we can ensure all students uphold strong ethics and academic integrity.篇2Dealing with the Issue of Cheating in SchoolsCheating has become a significant problem in educational institutions, undermining academic integrity and creating an uneven playing field for students. As a student, I have witnessed firsthand the detrimental effects of cheating on the learning environment and the overall quality of education. In this essay, I will explore the underlying causes of cheating, its consequences, and propose potential solutions to address this issue.Firstly, it is crucial to understand the reasons why students cheat. One of the primary factors is the immense pressure to excel academically. In today's highly competitive educational landscape, students often feel overwhelmed by the expectations placed upon them by parents, teachers, and society. The fear of failure and the desire to maintain a pristine academic record can drive some students to resort to unethical means, such as cheating, to achieve their goals.Additionally, the prevalence of technology and the ease of access to online resources have made cheating more accessible than ever before. Students can easily find answers, copy assignments, or even purchase pre-written essays from dubious online sources. The temptation to take shortcuts and the perceived low risk of getting caught can further contribute to the prevalence of cheating.However, cheating carries severe consequences that extend beyond the immediate academic repercussions. Firstly, it undermines the fundamental purpose of education, which is to acquire knowledge and develop critical thinking skills. When students cheat, they deprive themselves of the opportunity to truly learn and grow intellectually. This can have long-term implications for their future careers and personal development.Moreover, cheating erodes the integrity of the educational system and creates an unfair environment for honest students who put in genuine effort. It devalues the achievements of those who work hard and can breed a culture of mistrust and cynicism within the student body.To address this issue, a multifaceted approach involving various stakeholders is necessary. Educational institutions should implement robust academic integrity policies and clear consequences for cheating. These policies should be communicated effectively to students, emphasizing the importance of ethical behavior and the long-term benefits of honest academic pursuit.Additionally, educational institutions should invest in advanced plagiarism detection software and utilize technology to monitor and discourage cheating. However, such measuresshould be balanced with respect for student privacy and due process.Furthermore, it is essential to foster an environment that encourages learning and personal growth rather than solely focusing on grades and academic performance. This can be achieved by promoting open communication between students and faculty, providing adequate support resources, and encouraging a growth mindset that celebrates effort and perseverance.Students also play a crucial role in addressing cheating. We must cultivate a culture of academic integrity among our peers, where cheating is socially unacceptable and academic honesty is valued. Student organizations and peer groups can promote ethical behavior and provide support systems for those struggling with academic pressures.Moreover, students should be encouraged to develop time management skills, effective study habits, and seek help when needed. By fostering a supportive learning environment and providing resources for academic assistance, we can reduce the temptation to cheat and promote genuine learning.In conclusion, cheating is a complex issue that requires a collaborative effort from educational institutions, faculty,students, and society as a whole. By implementing robust policies, fostering a culture of academic integrity, providing adequate support resources, and promoting ethical behavior, we can create an environment where cheating is discouraged, and academic honesty is valued. As students, we must take responsibility for our actions and strive to uphold the principles of academic integrity, not only for our own benefit but also for the greater good of the educational system and society at large.篇3How to Handle Student CheatingCheating is a serious issue that plagues educational institutions worldwide. As students, we've all been tempted by the allure of an easy shortcut, but cheating undermines the entire purpose of education and erodes the academic integrity that universities strive to uphold. However, this problem is not black and white, and addressing it requires a nuanced approach that considers the root causes and fosters an environment of honesty and ethical behavior.Let's start by acknowledging that the pressure to succeed academically can be overwhelming. With the weight of parental expectations, the prospect of securing a well-paying job, and theconstant competition among peers, it's no wonder some students succumb to the temptation of cheating. Furthermore, the ease of access to online resources and the prevalence of technology in classrooms has made cheating more convenient than ever before.Nevertheless, cheating is a violation of academic integrity that cannot be tolerated. It's a form of dishonesty that deprives students of the opportunity to truly learn and grow, and it undermines the value of the degrees and credentials we work so hard to obtain. Moreover, it's inherently unfair to those who put in the effort and play by the rules, creating an uneven playing field and potentially rewarding the undeserving.So, how can we effectively address this issue? First and foremost, we need to foster a culture of academic integrity on our campuses. This starts with clear and consistent messaging from faculty and administrators about the importance of honesty and the consequences of cheating. Universities should have robust honor codes and policies in place, and these should be thoroughly communicated to students from the moment they step foot on campus.But beyond just laying down the law, we need to cultivate an environment that incentivizes ethical behavior and discouragescheating. This could involve implementing honor pledge systems, where students affirm their commitment to academic integrity before each assignment or exam. It could also involve promoting peer accountability, where students are encouraged to hold each other to high standards and report instances of cheating without fear of retaliation.Additionally, we need to address the root causes that drive students to cheat in the first place. This could involve providing better support systems for struggling students, such as tutoring services, study groups, and academic counseling. It could also involve reevaluating the way we assess student learning, moving away from high-stakes exams that promote cramming and cheating, and towards more continuous, project-based assessments that encourage deeper engagement with the material.Furthermore, we need to acknowledge the role that technology plays in enabling cheating and take proactive measures to mitigate its impact. This could involve implementing plagiarism detection software, proctoring online exams more rigorously, and educating students on the appropriate use of technology in academic settings.Ultimately, however, the responsibility lies with us, the students. We must internalize the values of academic integrity and hold ourselves accountable for our actions. Cheating may seem like an easy way out in the moment, but it's a short-term solution with long-term consequences. By engaging in such behavior, we not only devalue our own education but also tarnish the reputation of our institutions and the degrees we hope to earn.Instead, we should embrace the challenges of academic life and strive to overcome them through hard work, dedication, and a genuine love of learning. The satisfaction of earning a degree through honest means is far more rewarding than any shortcut could ever be. And by upholding these values, we contribute to a culture of integrity that benefits us all and enhances the value of the education we receive.In conclusion, addressing student cheating requires a multifaceted approach that involves institutional policies, technological safeguards, and a fundamental shift in our attitudes towards academic integrity. It's a collective responsibility that falls on administrators, faculty, and students alike. But by working together and fostering an environment that celebrates honesty, hard work, and ethical behavior, we canovercome this issue and preserve the sanctity of education for generations to come.。
依折麦布联合阿托伐他汀治疗冠心病
临床与实践 Linchuangyushijian 《中国医学创新》第10卷 第12期（总第258期）2013年4月①河南省军区门诊部 河南 郑州 450003通讯作者：阳诚柏依折麦布联合阿托伐他汀治疗冠心病阳诚柏① 庞超① 尹磊① 赵景志① 冯天平①【摘要】 目的：评价依折麦布联合阿托伐他汀对常规剂量他汀药物血脂控制不佳的冠心病患者的疗效。
方法：选择服用常规剂量他汀药物血脂控制不佳的冠心病患者126例，随机分为依折麦布联合他汀药物治疗组62例（依折麦布10 mg/d+阿托伐他汀10 mg/d）和双倍剂量他汀药物治疗组64例（阿托伐他汀20 mg/d）。
持续24周测定两组患者的总胆固醇（TC），LDL-C，高密度脂蛋白胆固醇（HDL-C），菜油甾醇，7-烯胆甾烷醇和血浆前蛋白转化酶枯草溶菌素9（PSCK9）的含量的变化。
结果：联合依折麦布治疗组LDL-C 水平，菜油甾醇/7-烯胆甾烷醇比例和PSCK9水平明显低于双倍剂量阿托伐他汀治疗组。
双倍剂量阿托伐他汀治疗组LDL-C 水平在12周后逐渐回升而联合依折麦布治疗组LDL-C 水平降低较为平稳。
结论：对常规他汀剂量血脂控制不佳的患者联合依折麦布能有效抑制胆固醇的吸收和合成并且降低LDL-C 效果明显优于单纯加大他汀药物剂量。
【关键词】 依折麦布； 阿托伐他汀； 低密度脂蛋白； 冠状动脉疾病 Therapeutic Effect of Ezetimibe-plus-atorvastatin in Coronary Artery Disease/ YANG Cheng-bo， PANG Chao， YIN Lei，et al.// Medical Innovation of China，2013，10（12）：050-052 【Abstract】 Objective：To assess LDL-C-lowering effect of ezetimibe-plus-atorvastatin in patients with coronary artery disease whole LDL-C levels were≥70mg/dl after received conventional-dose statin. Method：Those patients （n=126） were randomly divided into two group and one ofgroups （n=62） received ezetimible 10 mg/d + atorvastatin 10 mg/d the other group （n=64） received double-dose atorvastatin （20 mg/d）. The plasma concentrations of total cholesterol （TC）， LDL-C， HDL-C， campesterol， lathosterol and protein convertase subtilisin/kexin type 9 （PSCK9） of two groups were determined for 24 weeks. Result：The levels of LDL-C， PSCK9 and campesterol/lathosterol ratio were significantly lower in ezetimibe-plus-atorvastatin group compared to double-dose atorvastatin group. The LDL-C level of double-dose atorvastatin re-increased after 12 weeks， while LDL-C reduction was stable for 24 weeks. Conclusion： The patients with coronary artery disease whole LDL-C levels didn’t achieve therapeutic goal after received routine statin took better plus ezetimible， because ezetimibe-plus-atorvastatin could simultaneously inhibit the absorption and synthesis of cholesterol and provide stable decrease in LDL-C levels. 【Key words】 Ezetimibe； Atorvastatin； Low density lipoprotein-cholesterol； Coronary artery disease First-author ’s address：Outpatient Department of Military Hospital of Henan Province， Zhengzhou 450003， China doi：10.3969/j.issn.1674-4985.2013.12.023 高血脂是心脑血管疾病的高危因素之一，降低血脂能有效减少心脑血管事件，欧洲血脂异常防治指南把降低LDL-C 作为血脂干预的首要指标[1]。
关于防毒拒毒意识的英语作文
关于防毒拒毒意识的英语作文Drug Prevention: A Comprehensive Approach.Drug abuse is a pervasive issue that affects individuals, families, and communities worldwide. Its impact transcends physical and mental health, extending to social, economic, and legal consequences. To effectively address this crisis, a comprehensive and multifaceted approach to drug prevention is essential.Education and Awareness.Education plays a pivotal role in drug prevention by empowering individuals with knowledge and skills to make informed decisions. Comprehensive drug education should begin at an early age and continue throughout adolescence and adulthood. It should cover the physical, psychological, and social effects of drug use, dispel myths and misconceptions, and promote healthy coping mechanisms.Curricula should incorporate interactive and engaging activities to foster critical thinking and decision-making abilities. Teachers, parents, and community members can collaborate to deliver effective drug education programs in schools, youth groups, and community centers.Media Literacy.The media, including television, film, music, andsocial media, has a significant influence on shaping attitudes and behaviors toward drug use. Promoting media literacy is crucial for enabling individuals to critically evaluate media messages and resist glorifying ortrivializing drug use.Media campaigns should aim to present accurate and balanced information about the dangers of drugs and promote positive alternatives. Regulating and monitoring media content can help prevent the exposure of vulnerable populations to harmful messages.Community Involvement.Community-based prevention programs play a vital rolein creating a supportive and drug-free environment. These programs engage local residents in developing and implementing strategies to prevent drug use and support recovery.Community coalitions can bring together stakeholders from various sectors, including law enforcement, healthcare, education, and faith-based organizations, to identify and address local drug problems. They can sponsor community events, distribute resources, and advocate for policiesthat promote a healthy and drug-free community.Policy and Law Enforcement.Effective drug prevention requires a collaborativeeffort between law enforcement and public health agencies. Law enforcement plays a critical role in reducing drug supply and trafficking, while public health agencies focus on prevention, treatment, and harm reduction.Strict enforcement of drug laws can deter drug use, but it should be balanced with harm reduction strategies that provide support and treatment to people who use drugs. Decriminalization or legalization of certain drugs may reduce stigma and facilitate access to healthcare services for people who engage in drug use.Treatment and Support.Prevention efforts must be complemented by accessible and effective treatment and support services forindividuals who are struggling with drug addiction. Treatment options should be tailored to individual needsand may include detoxification, medication-assisted treatment, counseling, and support groups.Access to affordable and quality treatment is essential for reducing the health and social consequences of drug use. Recovery support services, such as sober living homes, peer support groups, and job training, can help individuals maintain recovery and reintegrate into society.Reducing Stigma.Stigma associated with drug use is a significantbarrier to prevention, treatment, and recovery. Negative attitudes and discrimination prevent people who use drugs from seeking help, leading to increased health risks and social isolation.Education and awareness campaigns can challenge stigma and promote understanding and compassion. Media representations of people who use drugs should be accurate and avoid sensationalism. Peer support groups and community outreach programs can provide safe and supportive environments for individuals to overcome stigma and access help.International Cooperation.Drug prevention is a global issue that requires international collaboration. Drug trafficking networks operate across borders, and effective control requires cooperation between law enforcement agencies, customsofficials, and public health organizations.Information sharing, joint investigations, and coordinated border patrols can disrupt drug supply chains and prevent the spread of drug-related crime and violence. International agreements and treaties provide a frameworkfor cooperation and facilitate the exchange of best practices.Conclusion.Drug prevention is a complex and multifaceted undertaking that requires a comprehensive approachinvolving education, community involvement, law enforcement, treatment, reducing stigma, and international cooperation. By empowering individuals with knowledge, creating supportive communities, enforcing laws, providingaccessible treatment, and challenging stigma, we can effectively address the scourge of drug abuse and promote a healthier and drug-free society.。
《欧洲文化入门》知识点笔记
00230Both Latin and Greek belong to Indo-European language.
00240The Roman writer Horace(:e0lQCQMR65-8t^ WlN0) said captive Greece took her rude conqueror captive 0
00The world s first vast interior space.NLu
N,{ Colosseum('Yt珐) is an enormous.2)Yvsb_q_gRb
00410Sculpture(QX) She-wolf(
00; Father of History ! Herodotus ! war(between Greeks and Persians)
00This war is called Peleponicion wars. ZSWTY嬒d 3
00fH[ v^l g_洺0
00; The greatest historian that ever lived. ( geggO'YvS[) ! Thucydides ! war (Sparta Athens and Syracuse)
00200The burning of Corinth in 146 B.C. Marked Roman conquest of Greece.
00210The melting between Roman Culture and Greek Culture. (Wl_ g ^Jvh)
00220From 146 B.C. Latin was the language of the western half of the Roman Empire.
关于疾病的英文介绍作文
关于疾病的英文介绍作文Disease is a common phenomenon that affects individuals worldwide. It refers to the abnormal functioning of the body or mind that leads to specific symptoms and signs. In this essay, I will discuss the concept of disease and its impact on individuals and society.Disease can be caused by various factors, including infectious agents such as bacteria, viruses, and parasites, as well as non-infectious factors like genetic mutations, lifestyle choices, and environmental factors. When the body is exposed to these factors, it may result in an imbalance in the normal functioning of organs and systems, leading to the manifestation of disease.Diseases can be classified into different categories based on their nature and characteristics. Some common types of diseases include infectious diseases like flu, malaria, and tuberculosis, chronic diseases like diabetes, heart disease, and cancer, as well as mental healthdisorders like depression and anxiety.英文回答，Diseases have a significant impact on individuals and society as a whole. They can cause physical discomfort, pain, and disability, affecting the quality of life of those affected. In addition, diseases often require medical interventions, leading to increased healthcarecosts and a burden on healthcare systems. Furthermore, diseases can also result in social and economic consequences, such as reduced productivity and increased absenteeism from work or school.中文回答，疾病对个人和整个社会都有重大影响。
c阐述校园安全的英语作文
c阐述校园安全的英语作文标题：Ensuring Campus Safety: A Comprehensive ApproachIntroduction:Campus safety is a primary concern for educational institutions around the world. It encompasses various aspects, such as physical security, mental well-being, and emergency preparedness. In this essay, we will explore key strategies to ensure campus safety, considering prevention, intervention, and cooperation among students, faculty members, and authorities.Holistic Prevention Measures:1. Access Control:Promoting controlled access to campus facilities can reduce the risk of unauthorized entry. Installing surveillance cameras and using electronic ID systems at entrances can help monitor individuals entering and leaving the premises efficiently.2. Adequate Lighting:A well-lit campus promotes a sense of security by deterring criminal activities during nighttime. Regular maintenanceof lights and ensuring their functionality throughout the grounds is essential for creating a safe environment.3. Safety Education Programs:Educating students about potential dangers on-campus empowers them to take responsibility for their own safety. Workshops on self-defense techniques, personal safety awareness, and responsible social media usage can help students make informed decisions when faced with potential threats.Intervention Strategies:1. Behavioral Monitoring:Creating a system where faculty members and staff arevigilant about recognizing unusual behavior or signs of distress in students is crucial to providing timely support. Encouraging reporting mechanisms while respecting privacy can facilitate early intervention for individuals in need.2. Mental Health Support Services:Addressing mental health issues plays a significant role in fostering campus safety. Establishing counseling centers or providing access to resources like trained psychologists allows students to address their concerns confidentially.3. Peer Support Networks:Encouraging peer support networks cultivates an environment where students feel comfortable seeking advice from each other regarding personal challenges they may encounter onor off-campus. Establishing mentorship programs can also bridge gaps between different grade levels and promote wellbeing within the student community.Cooperation among Stakeholders:1. Collaborative Emergency Preparedness Plans:Developing comprehensive emergency response plans that involve all stakeholders, such as students, faculty members, security personnel, and local law enforcement agencies, is crucial. Conducting regular drills to test theeffectiveness of these plans ensures everyone knows their roles and responsibilities in emergencies.2. Reporting Mechanisms:Establishing confidential reporting mechanisms enables individuals to report incidents or potential threats without fear of retaliation. Regularly reviewing these reports and taking appropriate action enhances campus safety and avoids the escalation of potential risks.3. Community Engagement:Encouraging open dialogues between students, faculty members, and administrators fosters a sense of belonging and shared responsibility for campus safety. Engaging in community-building activities can help build trust among individuals, promoting a safer environment.Conclusion:Ensuring campus safety requires a holistic approach encompassing prevention measures, intervention strategies, and cooperation among various stakeholders. By implementing these strategies effectively, educational institutions can create secure environments where students can thrive academically while feeling safe physically and mentally.Campus safety must remain a top priority to foster a conducive learning environment for everyone involved.。
阿司匹林用于心血管疾病一级预防的进展
㊃专家论坛㊃阿司匹林用于心血管疾病一级预防的进展诸葛瑞琪㊀刘梅林100034北京大学第一医院老年病内科通信作者:刘梅林,电子信箱:liumeilin@DOI:10.3969/j.issn.1007-5410.2022.03.002㊀㊀ʌ关键词ɔ㊀阿司匹林;㊀心血管疾病;㊀一级预防基金项目:北大百度基金资助项目(2019BD019)Advances in aspirin for primary prevention of cardiovascular diseases㊀Zhuge Ruiqi,Liu MeilinDepartment of Geriatrics,Peking University First Hospital,Beijing100034,ChinaCorresponding author:Liu Meilin,Email:liumeilin@ʌKey wordsɔ㊀Aspirin;㊀Cardiovascular diseases;㊀Primary preventionFund program:Peking University Baidu Fund Project(2019BD019)㊀㊀多年来,阿司匹林广泛用于心血管疾病的一级和二级预防㊂多项大型临床试验和荟萃分析证实了阿司匹林在心血管疾病二级预防中的获益[1-5]㊂而近年,随着更多临床研究结果的发布,阿司匹林在心血管疾病一级预防中的作用遭受质疑,国内外心血管疾病预防指南和共识对阿司匹林的一级预防推荐也进行了更新㊂现将阿司匹林在心血管疾病一级预防中的相关研究进展概述如下㊂1㊀阿司匹林用于一级预防的研究进展阿司匹林首次出现在心血管疾病一级预防指南中是基于20世纪80年代至21世纪初的多项大型研究结果[6-9]㊂2018年以来,多项大型阿司匹林一级预防的临床研究结果陆续发表,引发学术界广泛关注和争议㊂ARRIVE研究[10]是一项随机㊁双盲㊁多中心研究,共纳入12546例中等心血管风险(10年心血管风险10%~20%)的非糖尿病患者,平均年龄(63.9ʃ7.1)岁,随机分成阿司匹林(100mg/d)组或安慰剂组,中位随访时间60个月㊂结果显示,两组主要复合终点事件发生率无统计学差异(HR:0.96, 95%CI:0.81~1.13),阿司匹林组总心肌梗死事件和非致死性心肌梗死发生率更低(HR:0.53, 95%CI:0.36~0.79;HR:0.55,95%CI:0.36~0.84),而胃肠道出血事件(主要是轻微出血)增加(HR: 2.11,95%CI:1.36~3.28)㊂ASCEND研究[11]纳入了15480例年龄ȡ40岁的糖尿病患者(5年心血管风险<5%或5%~10%),随机服用肠溶阿司匹林100mg/d或安慰剂,平均随访7.4年㊂结果显示,阿司匹林组主要复合终点事件发生率(非致死性心肌梗死㊁非致死性卒中㊁短暂性脑缺血发作㊁心血管死亡)显著低于安慰剂组(HR:0.88,95%CI:0.79~ 0.97),总死亡率无统计学差异㊂阿司匹林组大出血事件发生率显著高于安慰剂组(HR:1.29, 95%CI:1.09~1.52),其中多数为消化道出血,致死性出血及出血性卒中的发生率未增加㊂ASPREE研究[12]从社区纳入了年龄70岁以上㊁无基础心血管疾病的老年人共19114例,中位年龄74岁,随机分为肠溶阿司匹林100mg/d组和安慰剂组,中位随访4.7年㊂结果显示,两组心血管事件(HR:0.95, 95%CI:0.83~1.08)及其他主要终点事件(死亡㊁痴呆或持续性身体残疾)(HR:1.01,95%CI:0.92~ 1.11)的发生率无统计学差异,未延长5年无残疾生存期㊂阿司匹林组癌症相关死亡(HR:1.31, 95%CI:1.10~1.56)㊁全因死亡(HR:1.14,95%CI: 1.01~1.29)和严重出血事件(HR:1.38,95%CI: 1.18~1.62)的发生率均高于安慰剂组㊂TIPS-3研究[13]是一项最新的随机㊁双盲㊁对照研究,入选具有中危心血管风险㊁年龄ȡ50岁男性或ȡ55岁女性共计5713人,平均年龄63.9岁,随访时间4.6年㊂入选者随机分为阿司匹林/安慰剂组㊁复方制剂(辛伐他汀+阿替洛尔+氢氯噻嗪+雷米普利)/安慰剂组㊁阿司匹林联合复方制剂/安慰剂组㊂结果显示,相比于安慰剂,单用复方制剂可使主要复合终点事件(心血管死亡㊁心肌梗死㊁卒中㊁心力衰竭㊁心原性猝死及血运重建)风险下降21%(HR:0.79,95%CI:0.63~1.00),单用阿司匹林可使复合终点事件风险下降14%(HR:0.86,95%CI: 0.67~1.10),复方制剂联合阿司匹林75mg/d可使复合终点事件风险下降31%(HR:0.69,95%CI: 0.50~0.97)㊂此外,TIPS-3研究显示,阿司匹林75mg/d组与安慰剂组出血风险相当,并未显著增加出血风险㊂2019年,美国心脏病学会杂志(J Am Coll Cardiol)发表的荟萃分析[14]纳入了15项随机对照试验㊁共计165502例患者,结果显示阿司匹林一级预防显著降低非致死性缺血事件,同时显著增加非致死性出血事件㊂此外,在随访时间ȡ5年的人群中,阿司匹林显著降低全因死亡率㊂同年,发表在JAMA上的荟萃分析[15]纳入13项随机对照试验㊁共计164225例患者,结果显示阿司匹林显著减少主要心血管事件,同时显著增加大出血事件,主要心血管事件减少和大出血事件增加风险相似㊂Mahmoud等[16]的荟萃分析纳入了11项阿司匹林一级预防随机对照试验研究,入选157248例无心血管疾病的患者,结果显示阿司匹林治疗可减少心肌梗死发生率,不减少全因死亡率,但增加主要出血和颅内出血风险㊂2021年,Lancet杂志发表的荟萃分析[17]纳入TIPS-3㊁HOPE-3和PolyIran研究,共计18162例患者,旨在评价包含或不含阿司匹林的一级预防方案的疗效差异㊂结果显示,复方制剂组(至少包含两种降压药物及他汀类药物,同时包含或不含小剂量阿司匹林)主要复合终点事件发生率显著低于安慰剂组㊂相比不含阿司匹林的复方制剂组,包含阿司匹林的复方制剂组主要复合终点事件发生率及各分终点事件发生率降低程度更显著㊂包含阿司匹林的复方制剂组消化道出血事件发生率更高,但出血性卒中㊁致死性大出血及消化性溃疡发生率各组间无统计学差异㊂同年,一项荟萃分析[18]纳入了32024例有糖尿病的一级预防人群,结果显示服用阿司匹林进行一级预防的糖尿病患者较未服用阿司匹林的患者主要心血管事件发生率更低,总死亡率及出血事件发生率无统计学差异㊂2022年,美国预防服务工作组(United States Preventative Services Task Force,USPSTF)回顾总结了阿司匹林用于心血管疾病及结直肠癌一级预防中的最新证据并更新了USPSTF荟萃分析[19],分析结果显示,每日服用低剂量阿司匹林(ɤ100mg)降低非致死性心肌梗死和非致死性卒中的风险,但同时增加消化道大出血及颅内出血的风险(高级别证据)㊂每日服用低剂量阿司匹林有助于轻微降低心血管死亡率(中等级别证据),长期服用(超过10年)可能降低结直肠癌风险(低级别证据)㊂2022年,Calderone等[20]发表了迄今关于阿司匹林一级预防疗效最大样本量的荟萃分析,纳入21项随机对照研究㊁共173810例无心血管疾病的患者,结果显示阿司匹林可降低主要不良心血管事件风险,但增加大出血及消化道出血风险,年龄<65岁的年轻人群获益相对更大㊂2022年发表在欧洲心脏病学会(European Society of Cardiology,ESC)杂志上的一项研究[21]评估了服用阿司匹林与心力衰竭发生风险的关系,纳入6项观察性研究㊁共30827例有心力衰竭危险因素的年龄ȡ40岁的患者,平均(66.8ʃ9.2)岁,其中22069例(73.6%)为无心血管疾病的一级预防人群,结果显示在平均随访5.3年期间,相比于基线时未服用阿司匹林的患者,每日服用阿司匹林的患者发生心力衰竭的风险增加26%(HR:1.26,95%CI:1.10~1.44,Pɤ0.001)㊂在无心血管疾病的一级预防人群亚组中,每日服用阿司匹林的患者心力衰竭风险增加27%(HR:1.27, 95%CI:1.10~1.46,P=0.001)且独立于其他危险因素㊂2㊀指南及专家共识推荐继ARRIVE㊁ASCEND及ASPREE研究结果发布后,各国指南关于阿司匹林一级预防相继更新,如表1所示㊂2022年4月USPSTF发布阿司匹林用于预防心血管疾病的推荐声明[22],首次取消对于60岁以上人群个体化应用阿司匹林的建议,不推荐在ȡ60岁的成年人中开始使用低剂量阿司匹林进行心血管疾病一级预防㊂USPSTF建议,对于10年心血管疾病风险ȡ10%的40~59岁成年人可根据个体情况并充分沟通后决定是否开始使用低剂量阿司匹林进行一级预防㊂3㊀思考与展望近年关于阿司匹林一级预防的研究显示,受试者的心血管病危险因素在研究过程中得到较好的控制,较入选时的心血管病风险降低,有可能弱化了表1㊀阿司匹林用于心血管疾病一级预防的指南及共识推荐[22-27]USPSTF:美国预防服务工作组阿司匹林对心血管结局的获益㊂鉴于阿司匹林导致的出血风险增加,不推荐心血管疾病低中危风险,尤其是老年患者使用阿司匹林进行一级预防㊂2021年发布的TIPS-3研究结果显示,在已接受规范降压㊁调脂治疗且排除了高出血风险的人群,阿司匹林可能为动脉粥样硬化性心血管疾病中高危患者带来进一步获益㊂基于当前研究证据,ACC/AHA㊁ADA㊁ESC更新的心血管病预防指南,推荐阿司匹林一级预防用于40~70岁㊁动脉粥样硬化性心血管疾病风险高且出血风险较低的人群可能获益,使用与否应由患者和医师共同决策㊂笔者认为,现有的研究尚不能否定阿司匹林用于心血管病高危群体的获益,鉴于我国整体心血管危险因素控制不佳人群的占比较高,对于心血管病高风险㊁低出血风险的个体仍应考虑服用小剂量阿司匹林一级预防㊂此外,临床研究中多使用阿司匹林100mg/d,缺乏更低剂量或个体化剂量的大规模临床研究以及中国人群数据,如何评估获益-风险比使患者最大获益㊁减少出血等不良反应是今后面临的重要课题,期待未来进行相关临床研究回答目前存在的问题㊂利益冲突:无参㊀考㊀文㊀献[1]Angiolillo DJ,Capodanno D.Aspirin for Primary Prevention ofCardiovascular Disease in the21st Century:A Review of theEvidence[J].Am J 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[16]Mahmoud AN,Gad MM,Elgendy AY,et al.Efficacy and safetyof aspirin for primary prevention of cardiovascular events:a meta-analysis and trial sequential analysis of randomized controlledtrials[J].Eur Heart J,2019,40(7):607-617.DOI:10.1093/eurheartj/ehy813.[17]Joseph P,Roshandel G,Gao P,et al.Fixed-dose combinationtherapies with and without aspirin for primary prevention ofcardiovascular disease:an individual participant data meta-analysis[J].Lancet,2021,398(10306):1133-1146.DOI:10.1016/S0140-6736(21)01827-4.[18]Ma H,Gu Q,Niu H,et al.Benefits and Risks Associated WithAspirin Use in Patients With Diabetes for the Primary Preventionof Cardiovascular Events and Mortality:A Meta-Analysis[J].Front Endocrinol(Lausanne),2021,12:741374.DOI:10.3389/fendo.2021.741374.[19]Guirguis-Blake JM,Evans CV,Perdue LA,et al.Aspirin use toprevent cardiovascular disease and colorectal cancer:updatedevidence report and systematic review for the US PreventiveServices Task Force[J].JAMA,2022,327(16):1585-1597.DOI:10.1001/jama.2022.3337.[20]Calderone D,Greco A,Ingala S,et al.Efficacy and Safety ofAspirin for Primary Cardiovascular Risk Prevention in Youngerand Older Age:An Updated Systematic Review and Meta-analysis of173,810Subjects from21Randomized Studies[J].Thromb Haemost,2022,122(3):445-455.DOI:10.1055/a-1667-7427.[21]Mujaj B,Zhang ZY,Yang WY,et al.Aspirin use is associatedwith increased risk for incident heart failure:a patient-levelpooled analysis[J].ESC Heart Fail,2022,9(1):685-694.DOI:10.1002/ehf2.13688.[22]US Preventive Services Task Force,Davidson KW,Barry MJ,etal.Aspirin Use to Prevent Cardiovascular Disease:US PreventiveServices Task Force Recommendation Statement[J].JAMA,2022,327(16):1577-1584.DOI:10.1001/jama.2022.4983.[23]Murphy E,Curneen JMG,McEvoy JW.Aspirin in the ModernEra of Cardiovascular Disease Prevention[J].Methodist DebakeyCardiovasc J,2021,17(4):36-47.DOI:10.14797/mdcvj.293.[24]Arnett DK,Blumenthal RS,Albert MA,et al.2019ACC/AHAGuideline on the Primary Prevention of Cardiovascular Disease:A Report of the American College of Cardiology/American HeartAssociation Task Force on Clinical Practice Guidelines[J].Circulation,2019,140(11):e596-e646.DOI:10.1161/CIR.0000000000000678.[25]Cosentino F,Grant PJ,Aboyans V,et al;ESC ScientificDocument Group.2019ESC guidelines on diabetes,pre-diabetesand cardiovascular diseases developed in collaboration with EASD[J].Eur Heart J,2020,41(2):255-323.DOI:10.1093/eurheartj/ehz486.[26]American Diabetes Association.Cardiovascular disease and riskmanagement:Standards of medical care in diabetes-2020[J].Diabetes Care,2020,43(Suppl1):S111-S134.DOI:10.2337/dc20-S010.[27]2019阿司匹林在心血管疾病一级预防中的应用中国专家共识写作组.2019阿司匹林在心血管疾病一级预防中的应用中国专家共识[J/OL].中华心血管病杂志(网络版),2019,2:e1000020(2019-08-19)./index.php/Column/columncon/article_id/183.DOI:10.3760/cma.j.issn.2096-1588.2019.1000020.㊀Chinese Expert Working Group of Aspirin Application in PrimaryPrevention of Cardiovascular Disease.2019Chinese expertconsensus statement on aspirin application in primary preventionof cardiovascular disease[J/OL].Chinese Video Journal ofCardiology,2019,2:e1000020(2019-08-19).http:///index.php/Column/columncon/article_id/183.DOI:10.3760/cma.j.issn.2096-1588.2019.1000020.(收稿日期:2022-04-15)(本文编辑:谭潇)㊃读者㊃作者㊃编者㊃关于中国心血管杂志投稿网址的声明㊀㊀为维护广大读者和作者的权益以及中国心血管杂志的声誉,防止非法网站假冒我刊网站诱导作者投稿㊁并通过骗取相关费用非法获利,现声明如下:1.投稿-审稿-编辑进度查询:中国心血管杂志 期刊协同采编系统 由中国知网(CNKI)提供技术支持,可于中国心血管杂志官方网站()首页点击 投稿 按钮,或直接输入链接(/ EditorB3N/index.aspx),注册登录 期刊协同采编系统 ,进行投稿㊁审稿和编辑进度查询㊂我刊不接受任何其他形式的投稿,也从未委托任何代理机构和个人开展组稿㊁征稿活动㊂2.杂志信息获取:登陆中国心血管杂志官方网站(),关注官方微信(zgxxgzz,已获得腾讯认证),可查询编辑部地址㊁联系电话等信息(北京市东城区大佛寺东街6号109室,联系电话:************-8109);发送邮件至官方邮箱(zgxxgzz@),可获得自动回复以上相关信息㊂3.费用支付:若稿件通过定稿会审稿决定录用,作者将收到以我刊官方邮箱发出的录用通知和版面费缴纳通知,在此之前不收取任何费用,包括审稿费等;若稿件未通过定稿会审稿决定退稿,作者也将收到退稿邮件,本刊从未有转介其他杂志刊登的业务㊂‘中国心血管杂志“编辑部。
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November 7, 2006
TopLine Professional Strategies, LLC
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Prevention First, Inc. (PFI)
• PFI is the leading statewide nonprofit organization dedicated to the prevention of substance abuse and related issues such as teen pregnancy, violence, HIV/AIDS and juvenile delinquency. PFI provides leadership, training and resources to professionals and citizens concerned with the science and practice of prevention.
November 7, 2006
TopLine Professional Strategies, LLC
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TASC, Inc.
(Treatment Alternatives for Safe Communities)
• TASC works with criminal justice populations and understands that substance use is prevalent and overarching within that population and is a significant contributing and exacerbating factor towards recidivism, relapse, and family and community cycles of violence and criminal behavior. TASC strives to prevent relapse, decrease recidivism, and break the cycle of behavior that leads to involvement in the criminal justice system.
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Why Prevention and Recovery?
• Illinois hosted a Prevention, Treatment and Recovery conference in 2019
• It became clear at that conference how little we knew about how prevention and recovery could work together
Purpose
1. To engage in a discussion with other members of the substance use disorder field about the synergy that exists between primary prevention and recovery maintenance and management.
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Relapse Predictors
• Intrapersonal
– Coping with negative emotional states (frustration and anger)
– Coping with negative physicalphysiological states (dealing with withdrawals/physical cravings)
A Collaborative for Primary Prevention and Recovery Management
Initially presented at SAAS Conference July 10, 2019
Hyatt Regency Hotel Chicago, Illinois
• First meeting took place in June, 2019 • Meetings have been held regularly over the last 12
months (goal to meet minimum of bi-monthly)
November 7, 2006
November 7, 2006
TopLine Professional Strategies, LLC
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Prevention Strategies: The IOM Model
Source: (SAMHSA, 2019)
November 7, 2006
TopLine Professional Strategies, LLC
Prevention
Early intervention
Treatment
Recovery
November 7, 2006
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What’s wrong with the linear view of
the field?
November 7, 2006
• Current view of prevention • Relapse predictors • History of strategic alliance • Principles of primary prevention and recovery
maintenance/management • Mission, vision and goals of the strategic alliance • Next steps in the strategic alliance
• The conference was designed to increase communication and coordination across the continuum discussed
• There were obvious linkages between prevention and treatment, and between treatment and recovery
– Social pressure – Enhancement of positive
emotional states
Source: “Clinical Guidelines for Implementing Relapse Prevention Therapy: A Guideline Developed for the Behavioral Health Recovery Management Project.” G. Alan Marlatt, Ph.D., George A. Parks, Ph.D., and Katie Witkiewitz, Ph.C.
objectives
November 7, 2006
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November 7, 2006
TopLine Professional Strategies, LLC
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Why Collaborate Now?
• There is a growing paradigm shift towards recoveryoriented systems of care that recognizes the need to build capacity within systems to prevent relapse
November 7, 2006
TopLine Professional Strategies, LLC
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Agenda
• Background on Prevention First, Inc. (PFI) and TASC, Inc. (Treatment Alteபைடு நூலகம்natives for Safe Communities)
• Many individuals in recovery return to/remain in the families and communities they were a part of prior to treatment/recovery
• Prevention has been working to build capacity within communities for years
• Nothing linked recovery and prevention
November 7, 2006
TopLine Professional Strategies, LLC
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And then we had
an Aha moment!
November 7, 2006
TopLine Professional Strategies, LLC
2. To share knowledge gained over the previous twelve months as we have engaged in a dialogue about the opportunities that exist for collaboration between prevention and recovery.
– Enhancement of positive emotional states
– Testing personal control
– Giving in to temptations or urges