Objective To evaluate therapeutic drug monitoring and efficacy of meropenem in patients with continuous renal replacement therapy(CRRT) and patients with renal insufficiency but without CRRT,and to evaluate the effect of CRRT on the clearance of meropenem. Methods Patients with renal insufficiency receiving meropenem treatment and therapeutic drug monitoring in the Affiliated Suzhou Hospital of Nanjing Medical University from January 2019 to June 2021 were collected retrospectively.They were divided into the CRRT group and the non-CRRT group.Dosage regimen,blood trough concentration,and clinical efficacy were compared between the two groups. Results A total of 74 patients were included and divided into the CRRT group(21 cases)and the non-CRRT group(53 cases).The blood trough concentration of CRRT group was higher than that of non-CRRT group(P<0.01).The blood trough concentration of the CRRT group in dose of 1 g,q8h was higher than that of the non-CRRT group(P<0.05).The rate of clinical efficacy in the non-CRRT group was higher than that in the CRRT group(P<0.05).The clearance rate of gram-negative bacteria in the group with blood trough concentration>4MIC was higher than that of another group with blood trough concentration<4MIC(P<0.01).The linear regression analysis results indicated a certain correlation between blood trough concentration and ultrafiltration rate(r=-0.454,P<0.05). Conclusion Patients with CRRT had higher blood trough concentration and less clearance of meropenem than patients with renal insufficiency but without CRRT.There was a certain correlation between blood trough concentration and ultrafiltration rate in CRRT patients.For patients with Multi-resistant pathogens,keep blood through concentration>4MIC can obtain better clearance of gram-negative bacteria.

With the gradual promotion of drug selection and evaluation in some provinces and cities in China,it is urgent for medical institutions to establish a complete and quantifiable drug selection and evaluation system. Based on the development of pharmacy and the adjustment of national drug policies in recent years,this guideline has revised and refined the evaluation indicators of drug evaluation and selection in medical institutions on the basis of the first version,so that the quantitative scoring can better reflect the priority of drugs in medical institutions,and also more fulfill the requirements of the national policy. Moreover,the scoring items are more detailed,clear and easy to use. In this guideline,five dimensions of pharmaceutical properties (28 points),effectiveness (27 points),safety (25 points),economy (10 points) and others (10 points) were quantified and scored,so as to objectively conduct selection and evaluation of drugs in medical institutions.

Pharmacists play an irreplaceable role in the development process of global chronic disease management.Foreign pharmacists provide pharmacy services such as medication therapy management,chronic disease prevention and screening,and medication use review in social pharmacies,community hospitals,and home environments,and have achieved significant results.In China's hierarchical medical system,relevant policies have been introduced to promote the development of grassroots pharmacy services.However,community pharmacy services are still at an early stage and need more experience to learn from.This article provides a summary of the working models and service content,policy documents,pharmacist qualifications,and pharmacy service payment mechanisms of community pharmacists in the United States,United Kingdom,Australia,and Japan,providing a reference for the practice of community pharmacists and the development of community pharmacy in China.

Objective To provide medical institutions with expert recommendations for the rational off-label use of key monitored drugs and to guide healthcare professionals in further standardizing the application of national monitored drugs. Methods The research design for reaching expert consensus on the rational clinical use of national monitored drugs beyond their approved indications followed the guidelines of the World Health Organization (WHO).A systematic search was conducted to extensively collect common issues related to the off-label use of the second batch of national monitored drugs in various provinces.The Delphi method was used to survey experts and identify common off-label use items for the key monitored drugs.Literature research and expert experience were utilized to collate and form relevant body of evidence,and quality evaluation was carried out in accordance with the GRADE approach.Consensus was reached again through the Delphi method regarding the recommended advice and evidence level,which ultimately led to the formation of the “Expert Consensus on the Rational Clinical Use of Nationally Monitored Drugs Beyond Their Approved Indications.” Results A survey questionnaire was conducted among 60 experts through an online survey,and a consensus on off-label use items was reached using the Delphi method,covering drug categories such as proton pump inhibitors,antibiotics,glucocorticoids,and other medications.A total of 37 clinical issues were identified,resulting in a total of 38 recommended pieces of advice. Conclusion This consensus provides a reference and supplement for medical institutions to develop clinical application norms and prescription (medical order) review rules for national monitored drugs,to ensure the effectiveness and safety of their use.It further improves the quality of medical services,reduces the risk of adverse events related to national monitored drugs,promotes rational drug use.

药学服务体系是健康中国建设不可或缺的组成部分,该体系建设是医疗保障管理精细化与可持续发展的有力保证,药学服务是符合国情且世界通行的医保支付服务。《推进药学服务体系建设和医疗保障协同发展专家共识》从药学服务项目、内涵与支付标准三个方面阐述了药学服务体系建设的社会价值和意义。药学服务体系与医疗保障体系二者相互依存、相互促进,该共识旨在明确二者的协同发展是当今大众健康的重要保障,同时厘清医保支付体系下的药学服务付费的社会发展需求和实施路径。

Chronic diseases pose a serious threat to human health and impose a serious burden on national healthcare systems.The United States of America,Germany,Japan,the United Kingdom and Australia have studied chronic disease management earlier,and a number of management strategies have been formulated,such as the American community plan,the German disease management programs,Japanese specific health examination and guidance,the British general practice-centered management model,and the general practitioner management plan launched in Australia.The chronic disease management strategies in these countries have achieved good results after years of practice.This paper reviewed the subjects,strategies and effects of chronic disease management in these countries,and provided reference for the formulation of chronic disease management strategies in China.

近二十多年来,多种因素导致临床上侵袭性真菌感染的发病率不断上升,在各种疾病治疗过程中过多使用化学治疗或放射治疗,使机体免疫功能受到损伤或出现缺陷,增加了真菌感染的发病率。侵袭性真菌感染主要是真菌侵入患者的机体,侵袭各个组织、器官和血液系统,导致患者出现严重的炎症反应和组织损伤。而抗侵袭性真菌感染的新药研发远不能满足临床治疗的需要。二十多年来临床上使用的安全有效品种主要是三唑类、多烯类及棘白菌素等3类药物,并且受到耐药性和不良反应等因素的制约,研发新型抗真菌药已迫在眉睫。2002年6月,美国Scynexis制药公司研制的Ibrexafungerp(艾瑞芬净)是具有全新作用机制的新一代三萜类抗真菌新药,靶向β-1,3-葡聚糖合酶,破坏其完整的细胞壁,直接杀灭真菌细胞。该公司最初与美国默克公司签订许可协议,授予默克公司在全球独家开发权;在2013年5月,Scynexis制药公司要求修改合作协议,收回对该产品的开发和商业化权,答应支付默克公司阶段性补偿款和专利权使用费。2013年9月,Scynexis制药公司与俄罗斯制药商R-Pharm公司签订在俄罗斯和土耳其开发艾瑞芬净及其商业化的协议。2021年2月,中国江苏豪森药业公司与Scynexis制药公司签订在大中华区合作开发艾瑞芬净及其商业化的协议。2020年10月14日Scynexis制药公司向美国食品药品管理局(FDA)提出枸橼酸艾瑞芬净片剂上市申请,该品曾获得罕用药、快速通道、合格感染疾病产品(QIDP)和优先审评等资质。2021年6月1日获FDA批准上市,用于成人和月经初潮后女性外阴阴道念珠菌病(VVC)的治疗,商品名为Brexafemme^®。这是美国FDA 近二十多年来批准的首款新型抗真菌类药物,也是唯一可口服或注射治疗的非唑类阴道酵母菌感染的首创新药。该文对治疗深部真菌感染新药——艾瑞芬净的非临床和临床药理毒理学、临床研究、不良反应、适应证、剂量与用法、用药注意事项及知识产权状态和国内外研究进展等进行介绍。

Opioids are potent analgesics,and they are not easy to cause injury to important organs.However,they are specially managed anesthetics.The treatment of chronic non-cancer pain (CNCP) is a long-term and continuous process.Opioids have been paid more and more attention in the treatment of chronic non-cancer pain.In March 2021,the European Pain Federation (EFIC) issued the clinical practice recommendations on opioids for chronic non-cancer pain.Therefore,in order to deepen medical staff's understanding of the guidelines and promote the standardized treatment of opioids in chronic non-cancer pain,this paper interprets the practice recommendations,including the role of opioids in the treatment of chronic non-cancer pain,clinical practice,and the use of opioids in special cases.

Rhodiola is a precious medicinal plant in China.Early studies demonstrated that Rhodiola exerts beneficial effects in diabetes mellitus and its complications.Multiple pharmacological mechanisms in the actions of Rhodiola were disclosed, including regulations of inflammatory response,oxidative stress and glucolipid metabolism.In this study,the advances in anti-diabetic effects of Rhodiola were summarized,in order to provide a new insight on exploitation of Rhodiola in future.

With the deepening of modern drug research,traditional computer simulation can not meet the needs of future drug design experiments.As a classic technology of standard computer simulation,molecular simulation can construct and analyze complex molecular models to study the dynamic processes of molecular motion.However,the simulation results are easy to be affected by human factors.In recent years,the integration of artificial intelligence and molecular simulation has become a new method of drug design research.Artificial intelligence technology uses big data to screen out the corresponding compounds for molecular simulation and feedback on the simulation results to the artificial intelligence system to optimize the artificial neural network.The combination of artificial intelligence and molecular simulation technology improves the efficiency of drug design research,reduces the influence of human factors on simulation results,and increases the credibility of simulation results.In this review,we summarized the progress of artificial intelligence and molecular simulation technology in drug design to provide a reference for the change from computer assisted drug design (CADD) to artificial intelligence-aided drug design (AIDD) in future pharmaceutical development.

Noncommunicable chronic diseases (NCDs) pose a significant risk to human health,which accounts for 60% of global mortality.Patients with NCDs often require lifelong treatment.Effective self-care contributes to optimizing treatment outcomes,reducing complications and saving treatment costs for patients with NCDs.In the developed countries,such as the United States of American,Japan,Australia,and the United Kingdom,pharmacists are involved in the self-care of patients with NCDs through medication guidance,education,monitoring,follow-up,and referral.Their works encourage healthy lifestyles,reasonable use of medications,improved medication adherence,and the management of NCDs risk factors.In order to provide examples for the work of pharmacists in China,this article reviewed the current status of pharmacists' involvement in self-care of patients with NCDs in foreign countries.Their works in diabetes,cardiovascular diseases,cancer,chronic respiratory diseases,mental diseases,and mental health were introduced as examples.

Objective To investigate the relationship between PAI-1 4G/5G gene polymorphisms and venous thromboembolism (VTE) in tumor patients and to provide reference for early identification of high-risk groups of VTE and prevention of VTE. Methods ① Comparison of genetic differences: malignant tumors patients were enrolled by His system of our hospital and divided into a venous thromboembolism group (30 cases) and a non-venous thromboembolism control group (118 cases) according to whether VTE occurred or not. PAI-1 4G/5G gene screening was performed on both groups of patients, and the differences in gene distribution frequency and Hardy-Weinberg genetic balance test were compared between the two groups. ② Gene intervention study:malignant tumor patients without VTE were randomly divided into the gene guidance group (n=30) and the non-gene guidance group (n=30) by a single-blind randomized number table method. The gene guidance group took VTE preventive measures according to the results of gene testing, while the non-gene guidance group did not take VTE preventive measures without gene screening. The number and incidence of venous thromboembolism events were compared between the two groups. Results The gene distribution frequency of the VTE group and the non-venous thromboembolism control group was statistically different (P<0.05) and all were in consistent with Hardy-Weinberg genetic balance;The number of venous thromboembolism events in the gene guidance group was 0, and that in the non-gene guidance group was 4 (13.33%), the difference was statistically significant (P<0.05). Conclusion The 4G/5G polymorphism of PAI-1 gene can be used as a risk-discriminating factor for VTE in tumor patients, and at the same time, it can provide certain guidance for early identification of high-risk groups of VTE and intervention measures.

Objective To explore the methods for continuous improvement of the prescription review system for outpatient service. Methods The pharmacists in a large hospital in Beijing provided continuous maintenance of the basic rule database of the prescription checking system,such as setting refinements in the indications-usage,administration route-usage,contraindications,repeated medication,and off-label use of drugs.And the drug prescription units in the Health Information System (HIS) system were matched with the limit dose units set by the prescription audit system.The influence of the continuous improvement on the irrational rate of outpatient prescription,the success rate of irrational prescription intervention by the pharmacists via the system,and the false positive rate of the system checking for 6 months was analyzed. Results The pharmacists in the hospital has independently maintained and revised a total of 137 basic rules of the prescription review system over the past six months.The main rule types involved were usage (24.8%), contraindications (21.9%), repeated medication (17.5%) and indications (16.1%).The irrational rate of outpatient prescription dropped from 0.54% to 0.22% (a decrease about 60.0%),and showed a continuous downward trend.The success rate of irrational prescription intervention by the pharmacists via the system increased from 84.0% to 92.0%,and the false positive rate of the system decreased from 78.0% to 45.0%. Conclusion Continuous and independent maintenance,and revision of the basic rule database of the prescription review system is an effective method for pharmacists to improve the quality of the prescription review for outpatient.

In recent years,there are lots of studies on baicalin in liver diseases.Baicalin was used to adjuvant treatment of acute hepatitis,chronic hepatitis and persistent hepatitis.This review will focus on the pharmacological effects of baicalin on fatty liver disease,such as anti-oxidant effects,inhibiting lipogenesis,improve insulin resistance,upregulate angiopotietin like proteins 6 and anti-inflammation effect,etc.

Since the end of 2019,the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide and become among the leading causes of death internationally. To mitigate the effects of the virus on public health,economy and society,vaccine research and developing organizations worldwide are actively developing various types of vaccines,including inactivated vaccines,virus-vectored vaccines,protein subunit vaccines,mRNA vaccines, and DNA vaccines. We review the most up-to-date published data regarding the safety and efficacy of 8 main vaccines to provide references for vaccine development and clinical use.

In February 2021,the International Lipid Expert Panel (ILEP) issued A Position Paper of Optimal Use of Lipid-Lowering Therapy after Acute Coronary Syndrome (ACS),which supplemented the existing guidelines on the lipids management of patients with ACS,and proposed practical solutions for the people who failed to reach the standard of lipid-lowering.The recommendation is to immediately start the combination therapy to improve access and compliance to lipid-lowering therapy of these patients.It also defines an ‘Extremely High Risk’ group of individuals after ACS,and formulates specific measures for lipid-lowering treatment for these patients.In this paper,combined with the latest 《Expert Consensus on Clinical Pathway for Blood Lipid Management in Patients With Acute Coronary Syndrome》 and 《Chinese expert consensus on lipid management of very high-risk atherosclerotic cardiovascular disease patients》,the opinion was interpreted in detail,focusing on the definition of ‘Extremely High Risk’ patients and the lipid-lowering treatment pathways of different clinical situations,in order to provide references for lipid-lowering treatment after ACS in China.

Objective To analyze the efficacy and safety of hepatic artery infusion chemotherapy(HAIC)based therapy in patients with unresectable hepatocellular carcinoma. Methods Participants who underwent HAIC-based therapy from October 2020 to November 2021 were evaluated retrospectively by the conversion rate of surgery,objective response rate(ORR),disease control rate(DCR),overall survival(OS),and safety. Results In total,29 patients were included(HAIC-monotherapy,n=9;HAIC-multitherapy,n=20). A proportion of 10.34% of patients received surgery after HAIC-based therapy were all HAIC-multitherapy group. OS,ORR,and DCR of all patients were 15.9 months [95%CI=(11.4,20.3)],34.45% and 89.66%,respectively.There was no significant difference in OS,ORR,and DCR between HAIC-monotherapy and HAIC-multitherapy groups.Subgroup analysis showed that patients with CNLC Ia-IIa,initial treatment,and AFP≤200 ng · mL^-1 had higher ORR significantly(Ⅰa-Ⅱa vs. Ⅱb-Ⅲa 80.00% vs. 25.00%,P=0.036;initial treatment vs. non-initial treatment 52.94% vs. 8.33%,P=0.019;AFP≤200 ng·mL^-1 vs. AFP>200 ng·mL^-1 58.33% vs.16.67%,P=0.045).The most common HAIC-related adverse reaction was anorexia. And the grade 3-4 adverse reactions accounted for 19.35%,which mainly manifested as liver injury and thrombocytopenia. Conclusion HAIC-based therapy for patients with unresectable hepatocellular carcinoma has satisfactory efficacy and acceptable adverse reactions.

Objective To evaluate the level of medication literacy of primary caregivers of children in China and its potential association with medication errors in children, in order to take effective measures to promote drug safety in children. Methods The study conducted an electronic questionnaire survey among primary caregivers attending pediatric outpatient clinics with children in 104 hospitals across China from June 1st to August 31st,2018.The survey included the pediatric drugs in family medicine cabinets and the medication cognition and behavior of caregivers.Logistic regression analysis method was used to analyze the related influencing factors on health literacy of caregivers. Results A total of 49 982 valid questionnaires were included in the final analyses.Cold medicine (85.09%),antipyretic analgesics (oral) (46.41%),and antitussive and expectorant drugs (29.39%) were the top three pediatric drugs in family medicine cabinets in China.The majority of those giving medicine to children were parents (84.34%).Caregivers had a high awareness of reading the drug labels (97.00%) and consulting professionals (92.60%).Incorrect medication perceptions and behaviors were still common,and 50.89% of respondents had given adult drugs to children,and drug poisoning had occurred in 16.06% of families.Caregivers aged 22-40 showed significantly higher health literacy than caregivers younger than 22.Grandparents showed significantly lower medication health literacy than parents.Caregivers with higher education levels showed significantly lower risk of giving adult drugs and causing drug intoxication to children. Conclusion Higher education levels of the primary caregivers showed higher health literacy,and improving the education level of caregivers will be conducive to medication safety for children.Grandparents and parents younger than 22 had a relatively low level of medication health literacy.

Objective To understand changes in the treatment cost of anti-Parkinson's disease drugs in clinic and to explore differences of the clinical efficacy and cost between monoamine oxidase B inhibitors (MAO-BI) and dopamine receptor agonists (DAs) in delaying the progression of Parkinson's disease. Methods The prescriptions of medicines for Parkinson's disease in outpatients of 30 hospitals in China from 2014 to 2019 were statistically analyzed,and the per capita yearly drug payment amount,per capita yearly drug intake,and average daily treatment cost of anti-Parkinson's disease drugs were summarized.In addition,the typical treatment schemes of two medications for delaying the progression of Parkinson's disease (DAs and MAO-BI) were analyzed for cost-effectiveness. Results A total of 8420 patients with Parkinson's disease were included in this study;prescription analysis results showed that the per capita yearly drug intake and the per capita yearly drug payment amount decreased by 14.0% and 18.2% from 2014 to 2019,respectively.On the other hand,the proportion of prescription payment and the ratio of drug selegiline intake increased by 268.8% and 317.2%,respectively,and the average daily treatment cost was 3.68 CNY/day.The results of the cost-effectiveness analysis showed that compared with the control group,the average time of adding the third class of drugs into the compound levodopa combined with the MAO-BI group was prolonged by 60.57 days,and the average daily treatment cost was reduced by 16.20 CNY per day (P<0.05). Conclusion The per capita treatment cost of anti-Parkinson's disease drugs in patients decreased continuously from 2014 to 2019,and the proportion of prescription payment and drug intake of MAO-BI are increasing.Meanwhile,the average daily treatment cost is decreasing.The addition of MAO-BI to the compound levodopa has apparent advantages over the addition of dopamine receptor agonists in delaying the use of the third anti-Parkinson's disease drug and reducing the average daily treatment cost.

Objective To summarize the packaging standard system and its development in European Pharmacopoeia, and to provide reference for the establishment and optimization of the pharmaceutical packaging standard system in China. Methods The structure of the packaging standard system and the contents of the standards in European Pharmacopoeia were analyzed, the relationship between the standards was compared,and the applicability of the relevant strategy was evaluated. Results The packaging standard system in European Pharmacopoeia has remained relatively stable and been continuously improved in line with the needs of development.The standards of materials were of distinctive characteristics, and the suitability and operability of the standards are reasonably balanced. Conclusion The expectation management of packaging standards and the management policy of materials and accepted additives in European Pharmacopoeia are of great reference value to the construction of the pharmaceutical packaging standard system in our country.

Through literature review,questionnaire surveys,medical case analysis and other methods,Chinese Hospital Association Pharmaceutical Specialized Committee conducted research on the current status and development direction of pharmacy administration and pharmacy practice in healthcare institutions,summarized systematically the key issues in the fields of pharmacy practice,pharmaceutical supply services and pharmacy administration in healthcare institutions,studied relevant domestic and foreign literature in recent years,referenced existing domestic laws,regulations and rules,as well as domestic and foreign standards,and ultimately established a group standard system framework.The group standard system was named “Pharmacy administration and Pharmacy practice in Healthcare institutions”,and included 51 volumes in four parts,which were general principles,pharmacy practice,pharmaceutical supply services and pharmacy administration.

Objective To study on the pharmaceutical packaging standard system and the latest progress in the United States Pharmacopoeia (USP),and to provide reference for the establishment and optimization of the pharmaceutical packaging standard system in China. Methods The structure of the pharmaceutical packaging standard system in USP and their contents were analyzed,the relationship among the packaging products standards,method standards,guidance for pharmaceutical packaging in USP were compared and analyzed. Results The pharmaceutical packaging standard system in USP is relatively complete,and the evaluation standards for pharmaceutical packaging materials have distinctive characteristics.The applicability of the standards is more comprehensively throughout the entire life cycle of pharmaceutical packaging material and pharmacopoeia forum updates periodically. Conclusion The relatively complete standards for pharmaceutical packaging materials in USP,mutually-supporting product standards plus evaluation standards throughout the entire life cycle of pharmaceutical packaging material are of great reference value to the construction of Chinese pharmaceutical packaging standard system.

At present,vaccine is the most economical and effective product for human beings to prevent infectious diseases. Since the birth of smallpox vaccine in the 18th century,vaccine research and development has experienced hundreds of years of development,which can be divided into three stages:traditional vaccine, genetic engineering vaccine, and nucleic acid vaccine. With the development of reverse vaccinology and other technologies,vaccine research and development ushered in new broad prospects for development. This paper summarized the history of vaccine development,the characteristics of all kinds of vaccines,the general situation of coronavirus disease 2019 (COVID-19) vaccine research and the prospect of vaccine development.

Objective To explore the effect of selenium yeast tablets on Hashimoto's thyroiditis patients with normal thyroid function in the real world. Methods A total of 187 Hashimoto's thyroiditis patients with normal thyroid function were treated with selenium yeast tablets and followed up for 6 months.The changes in thyroid peroxidase antibody (TPOAb),thyroglobulin antibody (TgAb),thyroid stimulating hormone (TSH),free triiodothyronine (FT₃),and free thyroxine (FT₄) before and after treatment were retrospectively analyzed.The patients were divided into groups according to the changes in thyroid antibodies after treatment,and the differences among various factors such as age,gender,the course of disease,daily dose of selenium,and levels of baseline antibody were compared. Results After the treatment with selenium yeast tablets,the levels of TPOAb and TgAb decreased significantly after 3 months of treatment and after 6 months of treatment (P<0.05),but the levels of TSH,FT₃,and FT₄ showed no significant changes after 6 months of treatment (P>0.05).The decreased amplitude of TPOAb was significantly higher than that of TgAb (P<0.05).There was no significant difference in the percentage of the decreases of TPOAb and TgAb between the first 3 months of treatment and the following 3 months of treatment (P>0.05).There was no significant differences in age,sex,course of disease,daily selenium dosage,and levels of baseline antibody between people whose TPOAb decreased after selenium yeast treatment and those whose TPOAb did not decrease (P>0.05).Compared with the patients whose TgAb decreased after treatment,the patients whose TgAb did not decrease after treatment had a larger mean age,a higher proportion of female patients,and a lower mean baseline concentration of TgAb (P<0.05).There was no significant difference in the changes of both TPOAb and TgAb between the groups treated by different selenium dosage (P>0.05). Conclusion Selenium yeast tablets treatment may reduce the levels of thyroid antibodies and improve the immune response in patients with Hashimoto's thyroiditis.

Macrophages can be divided into classically activated macrophages and alternately activated macrophages.Macrophages play an indispensable role in maintaining the body's stable state,and participate in the development of various metabolic diseases.This article introduces the classification and function of macrophages,describes the role of macrophages in atherosclerosis,non-alcoholic fatty liver,and type 2 diabetes and other metabolic diseases,and the commonly used dosage forms of macrophage targeting.We reviews macrophage targeting strategies from three aspects:inhibition of monocyte recruitment,inhibition of macrophage activation,and adjustment of macrophage polarization state;and then discusses the possibility of macrophages treating metabolic diseases.

Objective To evaluate the efficacy and safety of escitalopram and sertraline in the treatment of depression. Methods Retrieved from PubMed,Embase,Cochrane Library,Wanfang database,VIP,CNKI and CBM,randomized controlled trials(RCT)about escitalopram and sertraline in the treatment of depression were collected.The Meta-analysis of each outcome index was carried out by RevMan5.3 software. Results A total of 26 RCT,items were included in a total of 1987 patients with depression.The results of Meta-analysis showed that the total effective rate [RR=1.05,95%CI (1.02,1.09),P=0.004] and the cure rate [RR=1.12,95%CI (1.02,1.24),P=0.02] of escitalopram were significantly higher than those of sertraline.At the end of 2 weeks of treatment,the HAMD score of escitalopram group was significantly lower than that of sertraline group [MD=-1.21,95%CI (-2.03,-0.39),P=0.004].After treatment,the HAMD score of escitalopram group was significantly lower than that of sertraline group [MD=-0.82,95%CI (-1.50,-0.13),P=0.02].The incidence of nausea and headache in the escitalopram group was significantly lower than that in the control group,but there was no significant difference in the incidence of other adverse reactions between the two groups (P>0.05).The total effective rate of escitalopram in elderly patients with depression [RR=1.07,95%CI (1.01,1.14),P=0.02] was significantly higher than that of sertraline,and the treatment cure rates were comparable (P>0.05). Conclusion The clinical effect of escitalopram is better than that of sertraline,with a rapid onset of action and a lower incidence of nausea.

Objective To observe the effect of Shenhong Tongluo Prescription on aortic plaque in atherosclerotic rats. Methods A total of 80 male SD rats were randomly divided into sham operation group,model control group,high-dose group,low-dose group and simvastatin group with 16 rats in each group.Atherosclerosis model was prepared in other groups except for sham operation group.After successful modeling,the low-dose group and the high-dose group were given fried-free granule of Shenhong Tongluo Prescription 7.15 and 28.60 g·kg^-1·d^-1 by gavage (dissolved in 2 mL warm water),respectively.The simvastatin group was given simvastatin 1 mg·kg^-1·d^-1 by gavage(dissolved in 2 mL warm water).The sham operation group and model control group were given the same volume 0.9% sodium chloride solution once a day for 8 weeks.Enzyme-linked immunosorbent (ELISA) method was used for detection of oxidized low density lipoprotein (ox-LDL),soluble CD40 ligand (sCD40L) levels.The hematoxylin-eosin (HE) staining was used to observe the histopathological changes in common carotid arteries.The immunohistochemical method to observe intercellular adhesion molecule - 1 (ICAM - 1),tumor necrosis factor alpha (TNF-α),quantitative polymerase chain reaction (qPCR) method to detect atherosclerotic plaque inside CD40 mRNA and interleukin 1 beta (IL-1β) mRNA expression level in the plaque. Results Compared with the model control group,the contents of ox-LDL and sCD40L in the high-dose group and the low-dose group decreased ( P<0.05 andP<0.01).And the expressions of ICAM-1 and TNF-α in the plaque were significantly reduced.HE staining results of common carotid artery showed that the intima was relatively smooth and smooth muscle cells arranged relatively regularly after the intervention of traditional Chinese medicine.Accumulation of smooth foam cells and smooth muscle hyperplasia; high dose group can significantly reduce the expression of CD40 mRNA and IL-1β mRNA in plaques of rats (P<0.01). Conclusion Shenhong Tongluo Prescription has good effects on inhibiting inflammatory factors,anti-atherosclerosis and stabilizing atherosclerosis,which may be achieved by interfering with CD40/CD40L signal transduction.