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  • 05 August 2019 Volume 38 Issue 8
      

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  • Wentao HUANG,Liu XIAO,Lu CHENG,Geng ZHANG,Quanwei YANG
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    Objective To study the percutaneous permeation characteristics of baicalin,baicalein and wogonin in the cataplasm of Qinshu for dysmenorrhea. Methods Using the modified France Proliferation pool, the skin penetration rates of baicalin,baicalein and wogonin were determined by HPLC under the skin barrier isolated from mice. Results The transdermal rate of baicalin, baicalein and baicalein on the isolated skin was 21.34%, 22.31% and 25.77%, respectively. Conclusion In vitro percutaneous osmotic behavior of mice with Baobab was optimized with Higuchi equation fitting, and the degree of mimicry was the highest, indicating that Baobab was a sustained release preparation and belonged to the skeleton dissolution drug release system.
  • Longmei LI,Meng MAO,Zhiyun DENG,Huirong SONG,Yamin LUO,Jialin LI,Jiajie WU,Xiaoqiao REN
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    Objective To explore the feasibility of establishing the model of post-traumatic stress disorder (PTSD) after stroke in rats with middle cerebral artery occlusion (MCAO). Methods A total of 45 rats were randomly divided into model control group, sham-operation group and single-prolonged stress(SPS)group. The rats in both model control group and sham-operation group were modeled by MCAO, and the rats in SPS group were modeled by single-prolonged stress. On 7 and 14 days after modeling, the behavior changes of rats in different treatment groups were observed by using the elevated plus maze and social avoidance experiment.Moreover, on day 14, the expression of GAD67, GAD65 and GLT1 in the hippocampus of rats was detected. Results In the social avoidance experiment, compared with the sham operation group, the incubation period of the model control group and the SPS group were prolonged at two time points (P<0.05, P<0.01) and the times to enter the social area were significantly reduced (P<0.01). In addition, the times of entering the social area and standing were significantly reduced at 14 days (P<0.01). In the overhead plus maze experiment, compared with the sham operation group, the open wall entry time ratio and the entry times ratio of the model control group and the SPS group were reduced at day14 (P<0.05). At two points in the two experiments, there was no significant difference in the behavior of the rats between the model control group and the SPS group (except the number of standing). PCR showed that compared with the sham group, the expression of GAD67, GAD65 and GLT1 in the hippocampus of the rats in the model control group and the SPS group were decreased (P<0.05, P<0.01), and there was no significant difference in the expression of GAD67 in the SPS group. Conclusion Middle cerebral artery occlusion makes rats manifest a certain degree of the state of PTSD.
  • Yang FU,Bo ZHU,Bicheng ZHANG
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    The treatment of advanced lung cancer has entered the era of new immunotherapy represented by immunological checkpoint inhibitors (ICIs). Immunotherapy for advanced lung cancer not only covers all pathological types, but has also been approved for a large number of indications throughout the world. However, there are still many unresolved issues in this area. Finding suitable biomarker, paying attention to the characteristics of special population, exploring the best combination therapy mode, and studying the pathological and immunological features, are the key development directions in the field of advanced lung cancer immunotherapy.

  • Zhonghui QI,Lu SI
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    The high mortality and poor prognosis of malignant melanoma make it a serious threat to human health.With the rapid development of basic immunology and tumor biology,the immunotherapy of malignant melanoma is entering a new era,immunotherapy for the occurrence, development, invasion and metastasis of malignant melanoma is entering a new stage, and the survival of melanoma patients has been significantly improved.At present, immunotherapy mainly focuses on the combination of PD-1 monoclonal antibody, CTLA-4 monoclonal antibody and immunotherapy.Pembrolizumab, Nivolumab, Ipilimumab used alone, Nivolumab in combination with Ipilimumab and Talimogene laherparepvec have been proven to be effective and safe and have been approved by the FDA for the treatment of malignant melanoma.This article will review the latest advances in immunotherapy drugs and discuss their prospects and challenges.

  • Yi ZHOU,Jianguo SUN
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    Immune checkpoint inhibitors (ICIs) have showed dramatic effect in the treatment of advanced malignancies, meanwhile a series risk of immune-related adverse events (irAEs) are caused by ICIs. For the management on monitoring, grade, treatment of irAEs, Europe, the United States and China have made their own guidelines, but there are still many topics that are not covered or controversial in this field. In this review, we will discuss some considerations about the category, mechanism, treatment and biomarkers of irAEs.

  • Xiufeng LIU,Shukui QIN
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    Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world,especially in China. 70%-80% of patients are diagnosed at advanced stage and can only receive palliative care. Sorafenib has been the standard drug for the treatment of HCC for 10 years, and FOLFOX4, a systematic chemotherapy regimen, has been recommended as a guideline for HCC in China. However, all approved systemic therapies still unsatisfied with limited objective response rates and poor overall survival.The application of immune checkpoint inhibitors in many solid tumors opens up a new prospect of systemic therapy. Immune checkpoint pathway molecules play an important role in the occurrence and development of viral hepatitis, liver cirrhosis and liver cancer, and are also one of the resistance mechanisms of Sorafenib in the treatment of failed HCC on September 23, 2017, FDA approved the application of Nivolumab in HCC based on the results of phase I/II clinical study, marking the arrival of a new era of HCC immunotherapy.

  • Bicheng ZHANG,Shicong ZHU,Qibin SONG
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    Although malignant tumors have entered into the era of immunotherapy, immunotherapy for breast cancer has been difficult. With the publication of the Phase III IMpassion 130 study at the end of 2018 at the Eurapean Society of Medical Oncology (ESMO) annual meeting, the immune era of breast cancer has begun At present, immunotherapy research on breast cancer mainly focuses on vaccines, chimeric antigen receptor-engineered T cells (CAR-T) treatment and immune checkpoint inhibitors (ICIs). How to reasonably select the population and treatment mode is the key development direction in the field of breast cancer immunotherapy in the future.

  • Jining ZHOU,Dian ZHONG,Fang WANG,Jin ZUO
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    Objective To explore the effects of Shensong yangxin capsule on early recurrence after radiofrequency ablation in patients with atrial fibrillation(AF). Methods 120 patients with AF treated with radiofrequency ablation in Renmin hospital of wuhan university from October 2014 to March 2016 were enrolled and then randomly allocated to control group(conventional treatment) and treatment group(conventional treatment plus Shensong yangxin capsule) equally. Blood biochemistry test, 24 h Holter monitoring and echocardiography were examined in all patients pre-ablation and 3 months post-ablation, then recording resting ventricular rate, left atrial diameter(LAD), left ventricular ejection fraction(LVEF), and early recurrence. Results Early recurrence were recorded in 16 cases(26.7%) in control group and 7 cases(11.7%) in treatment group, which were statistical significance in early recurernce rate between the two groups(P=0.04). Compared with pre-ablation, resting ventricular rate and LAD in the two groups decreased apparently 3 months post-ablation, and they were in treatment group obviously lower than in control group(P<0.01). LVEF in the two groups increased 3 months post-ablation, and it was significantly higher in treatment group than in control group(P<0.01). Conclusion Shensong yangxin capsule can significantly reduce early AF recurrence, resting ventricular rate and LAD after radiofrequency ablation
  • Xuehui ZHANG,Na LI,Taiyu JIN,Linyan XIE,Jing WU,Ping ZHAO
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    Objective Use serum procalcitonin (PCT) levels to guide the use of antibiotics to reduce exposure time and reduce medical costs in patients with lower respiratory tract infections. Methods Collecting 131 cases of adult lower respiratory tract infection patients from 2015 to 2017. Patients were randomly divided into experimental group (73 cases) and control group (58 cases). The control group was treated with anti-infective treatment according to the relevant guidelines. The use of antibiotics in experimental group according to the PCT level. The study ended with patient death, transfer to ICU, complications, and recurrent infection within 30 days. The differences in the course and amount of antibacterial drugs and hospitalization costs between the two groups were compared. Results There were no significant differences between the two groups in terms of death, transfer to the ICU, complications, and relapse infection within 30 days(P<0.05). The clinical effective rate of the experimental group was 93.2%, which was higher than that of the control group. The course of antibiotics in the experimental group and the control group were (6.14±2.19) d and (8.16±2.95) d, respectively. The difference between the two groups was statistically significant (P<0.05). The amount of antibiotics in the experimental group and the control group were (1 219.92±868.80) yuan and (1 977.82±1 042.18) yuan, respectively; the hospitalization expenses were (5 621.57±1 335.09) yuan and (7 415.05±1 553.47) yuan, respectively. The difference between the two groups was statistically significant(P<0.05). Conclusion Serum PCT level can guide adult anti-infection of lower respiratory tract infection, which can reduce the exposure of antibiotics and reduce the cost of hospitalization without increasing the safety risk. It has certain clinical value.
  • Jing ZHANG,Chen GONG,Kai QIN,Dingyu LI
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    Objective To compare the effect of Kangfuxin fluid combined with the compound berberine retention enema, to single-use compound berberine in the treatment of cervical cancer radiotherapy-induced acute proctitis. Methods 50 patients with cervical cancer radiotherapy-induced acute proctitis were randomly divided into 2 groups: Kangfuxin fluid combined with the compound berberine treatment group (treatment group), and the compound berberine treatment group (control group). All patients’ symptoms, stool frequencies, stool white blood cell and red blood cell counts, were recorded before and two weeks after the treatment. Evaluate the efficiency of the two groups. Results The effective rates of the treatment group and control group were 96.0% and 72.0% respectively, which were statistically significant difference (P<0.05). Conclusion The Kangfuxin fluid combined with compound berberine retention enema in the treatment of cervical cancer radiotherapy-induced acute proctitis, can significantly improve the clinical symptoms and the life quality of patients.
  • Pu ZHANG
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    Objective To investigate and compare the analgesia effects of combined spinal epidural block (CSEA) and remifentanil intravenous analgesia on the whole delivery. Methods From January 2014 to June 2017, 150 cases voluntarily received the whole labor analgesia in our hospital were selected as the research object.All the cases were divided into treatment group and control group with 75 cases in each group randomly.The treatment group was given CSEA analgesia, and the control group was given remifentanil intravenous analgesia.Analgesic effects and delivery prognosis were recorded. Results There were no significant difference in time length between the first and second stages of labor (P>0.05).The 1min and 5min Apgar in the treatment group were higher than those of the control group (P<0.05).The VAS scores in the latent period, the palace mouth open, fetal disengagement in the treatment group were lower than those of the control group (P<0.05).The incidence of adverse reactions such as hypotension, nausea, vomiting, pruritus and respiratory depression in the treatment group were 2.7%, and it was 16.0% in the control group, with significant difference (P<0.05).The CORT values at the t1 and t2 time points in treatment group were lower than those in control group (P<0.05), and the CD4+/CD8+ value at t3 time point was higher than that in control group (P<0.05), but there was no significant difference at other time points (P>0.05). Conclusion Compared with remifentanil intravenous analgesia, CSEA applied in the whole labor analgesia can effectively reduce maternal stress, has a protective effect, and can reduce the negative impact on maternal and neonatal, so it plays a better analgesic effect.
  • Jinling ZHANG,Rong MAO,Guang DU
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    The flavor of radix aconite is symphonic, bitter, hot and extremely poisonous; The meridians of the heart, liver, kidney and spleen; Main treatment dispel wind dehumidification, warm through pain. In this paper, the chemical composition and pharmacological action of radix aconite were reviewed based on the data of recent years.In order to provide some reference for clinical medication.

  • Lihua ZHANG,Peng ZHAO,Tingting ZHANG,Yongpeng DU
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    Objective To determine the best route for ultrasonic assisted extraction of polysaccharides from fragrant tree Platycarya strobilacea Sieb. et Zucc tree. Methods The extraction rate of polysaccharides was evaluated by changing the ultrasonic time, ultrasonic power temperature, ratio of material to liquid and extraction times. The response surface analysis method was used to optimize the optimal extraction conditions. Results The ultrasonic time is 40 min, the ultrasonic power is 290 W, the temperature is 52 ℃, the liquid ratio is 25 (mL·g-1), and extract 3 times is the best technological condition for the ultrasonic-assisted extraction of polysaccharides from Platycarya strobilacea Sieb. et Zucc tree. The average extraction rate of polysaccharides obtained was 3.959%. Conclusion Ultrasonic -assisted extraction technology with the advantages of high extraction rate and short extraction time.
  • Xiaofang YAN,Haibo ZHANG,Jiamin LIU,Ying SUN,Shuang HU,Xi LI,Lixin JIANG
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    Objective To determine current usage rates and temporal trends in statin therapy, and to analyze factors associated with the lack of statin therapy among patients hospitalized with acute myocardial infarction (AMI) in rural China hospitals from the year 2001 to 2011. Methods A representative sample of patients in rural China admitted to hospital for AMI was created from a two-stage random sampling. A simple random-sampling procedure was used to identify participating hospitals. Patients admitted to each participating hospitals for AMI in 2001, 2006, and 2011 were selected using a systematic sampling approach. Clinical information was obtained via central medical record abstraction for each patient, and then in-hospital statin use was analyzed. A multilevel logistic regression models with use of generalized estimating equations were performed to explore associated factors of the use of statin therapy. Results Among 105 sampled rural hospitals, 99 hospitals participated. Totally, 5664 patients were identified eligible for statin therapy to determine rates of statin use and the intensity of statin therapy. Rates of statin use among hospitalized patients with AMI in rural China increased from 12.8% in 2001 to 60.4% in 2006, and 84.3% in 2011 (P<0.001 for trend). Among the patients treated with statin, those receiving moderate and above intensity statin therapy increased from 15.3% in 2001 to 55.7% in 2006, and 78.8% in 2011 (P<0.001 for trend). The variation in statin use in different density lipoprotein cholesterol (LDL-C) group and years decreased overtime. And in the multivariable model, several patient factors were associated with statin therapy. Patients without LDL-C measured during the hospitalization were significantly less likely to receive statin therapy. Patients with hypertension or chest pain or high level of LDL-C were associated with high possibility to receive statin therapy. Conclusion From the year 2001 to 2011 in rural China, the use of statin therapy has dramatically increased. However, gaps still persist among guideline and clinical practice. Initiatives promoting the use of statin therapy would support further improvements in practice.
  • Fangyuan TIAN,Bin WU,Mei ZHAN,Min LUO,Ting XU
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    Objective To overview the systematic reviews/meta-analyses (SRs/MAs) of the correlation between gene polymorphisms and acute rejection in renal transplant recipients. Methods Databases including Medline, EMBase, The Cochrane Library (Issue 8, 2017), CBM, CNKI, VIP and Wan Fang Data were searched to collect the SRs/MAs of the correlation between gene polymorphism and acute rejection in renal transplant recipients from inception to August 2017. Two reviewers independently screened literatures, extracted data and then AMSTAR tool was used to assess the methodological quality of included SRs/MAs. Results A total of 11 studies were included. The results of the AMSTAR evaluation showed that the items with the worst report were item 1 “Is the previous design proposal provided” (11 articles not provided), item 4 “Is the publication fact included in the inclusion criteria” (11 articles not satisfied), and item 7 "Whether to evaluate and report on the scientific nature of the study included" (11 articles not provided). In addition, AA / AG genotypes in CTLA4 + 49A / G genotype patients compared with GG genotype, G genotype patients compared with genotype A patients, genotype AA / AG in TNF-A-308 patients compared with GG gene, DD + ID genotype in IL-10-1082 G/A compared with genotype II, AG / GG and GG genotypes in CTLA-4 CT60 compared with genotype AA, G genotype compared with genotype A have a higher risk of developing acute rejection of kidney transplants. Conclusion Current evidence shows that the overall quality of evidence included in the study is low, and the limited evidence shows that genetic polymorphism of CTLA4+49A/G, TNF-A-308, IL-10-1082 G/A, CTLA-4 CT60 affects acute rejection in renal transplant recipients. Due to the impact of the quantity and quality of the studies involved, the above conclusion still needs to be confirmed by a large sample of high-quality clinical studies.
  • Lichao YANG,Chunyang ZHAO,Jiayi CAI,Suhua CHEN,Mingyan JIANG
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    Objective To evaluate the preventive effect of traditional Chinese medicine on the radiation pneumonia. Methods By means of Meta-analysis, A computer-based online search of PubMed, EMBASE and the Cochrane Library, and CNKI, CBM, Wanfang were conducted.The time is from the database establishment to June 1, 2017.Through Revman 5.0 to assess the bias of the included studies, stata 12.0 was used to evaluate the extraction of the incidence of radiation pneumonitis and auxiliary indicators. Results A total of 64 studies involving 5354 patients were included, and methodological quality had moderate bias.Compared with the control group, Chinese medicine effectively prevented radioactive pneumonia(RR=0.529,95%CI(0.473,0.592), Z=11.17, P=0.000), and reduced the occurrence of radiation-induced lung fibrosis(RR=0.418,95%CI(0.339,0.516), Z=8.14, P=0.000), improved the quality of life of patients(RR=1.668,95%CI(1.444,1.927), Z=6.96, P=0.000).Sub analysis group analysis and regression analysis showed that the preventive effect was independent of the type of drug used, concurrent chemotherapy, duration of the medication, and the patient’s tumor type and age. Conclusion The traditional Chinese medicine can effectively prevent the occurrence of radioactive pneumonia and the occurrence of radiological pulmonary fibrosis, and improve the quality of life of the patients.
  • Yu WANG,Xiaofen YE,Jie LIU
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    Objective To analyze the causes of persistent hyponatremia induced by pituitrin and the role of clinical pharmacists during treatment. Methods The clinical pharmacist participated in the analysis of hyponatremia in the course of drug treatment of hemoptysis with pituitrin in 1 case, assisted the physician to adjust the drug treatment program, monitored the blood electrolyte concentration, and avoided adverse consequences. Results The physician adopted the advice of the clinical pharmacists, and the patient's hemoptysis improved, and blood sodium level returned to stability. Conclusion The participation of clinical pharmacists in the formulation and adjustment of treatment programs can guarantee the safety of patients' medications.
  • Lei ZHANG,Ping ZHAO,Cheng XIE
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    Objective To provide experience for clinical pharmacists participating in the treatment of clopidogrel resistance after percutaneous coronary interrention (PCI) treatment. Methods The antithrombotic therapy for a case of clopidogrel resistance after PCI was analyzed retrospectively. Results During the hospital stay, there were no major cardiovascular adverse events such as instent restenosis or myocardial infarction.No adverse reactions such as gastro-intestinal discomfort and bleeding occurred. Conclusion For patients who may have clopidogrel resistance, antithrombotic therapy can take more programs, according to the specific circumstances of patients, given individual antithrombotic treatment program.
  • Dongmei LI,Jing YANG,Qiong DIN
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    Objective To investigate the pathogenesis, clinical manifestation, treatment and prognosis of epileptic seizure caused by β-lactam antibiotics in hemodialysis patients with end-stage renal disease,and to guide the rational use of drugs. Methods 11 hemodialysis patients of end-stage renal disease in our hospital from March 2016 to May 2018 had epileptic seizures after the use of β-lactam antibiotics, and their clinical data were retrospectively analyzed. Results The average age of 11 patients was(83.6±6.7)years old. The patients had no neurological signs before and after the onset. The head CT examination showed no acute cerebral infarction or cerebral hemorrhage lesions. The kidney function,hemoglobin,blood glucose, electrolyte and other indicators had no significant change (P>0.05). After withdrawing the drugs and symptomatic treatment, 6 patients with epileptic symptoms disappeared within 24-72 hours, 1 patient with epileptic symptoms disappeared within 15 days, 4 patients died of other diseases. Conclusion The use of β-lactam antibiotics for uremic hemodialysis patients, especially the elderly, may lead to epileptic seizure. Once epileptic seizure is found,the drugs should be timely withdrawn, and most of the prognosis is good.