Breakthrough pain is a common,challenging pain that is particularly found in patients with cancer.In order to standardize the clinical pathway of breakthrough cancer pain,experts from the committee of rehabilitation and palliative care and Chinese association for the study of pain published a consensus in 2019.The aim of this article is to interpret the key points of this experts’ consensus,in order to serve for clinical practice.
Objective To investigate the effect of psoralidin inhibits cancer-associated fibroblast (CAFs) differentiation in human bone mesenchymal stem cells (hBMSCs) or human umbilical cord mesenchymal stem cells (hUCMSCs) in vitro. Methods The hBMSCs and hUCMSCs were co-cultured with four female related cancer cells (BT-549,HEC-1B,Hela and SK-OV-3) in Transwell system.The hBMSCs and hUCMSCs treated by gradient concentration of psoralidin to calculate the half maximal inhibitory concentration (IC50),and 10 μmol ·L-1 psoralidin was used to treated each groups.The cell viability detected by CCK-8 assay,expression level of α-SMA detected by flow cytometric method,and the Western blotting used to measure p-JAK2 and p-STAT3 expression. Results The IC50 of psoralidin against hBMSCs and hUCMSCs were 477.34 and 364.83 μmol·L-1, respectively,and the inhibition rates were (3.77±1.65)% and (3.70±2.11)% in 10 μmol ·L-1 psoralidin treated hBMSCs and hUCMSCs.The α-SMA level of hBMSCs and the viability,p-JAK2,and p-STAT3 of four cancer cells were increased in Transwell couture system,but psoralidin deceased all of these.The α-SMA,p-JAK2,and p-STAT3 level of hUCMSCs did not affected by psoralidin or cancer cells co-cultured,while the viability of cancer cells decreased by psoralidin in hUCMSCs co-cultured. Conclusion Psoralidin inhibits CAFs differentiation and cancer cells proliferation in hBMSCs in Transwell couture system.
Objective To compare the pharmacokinetics consistence of the main active ingredients between Qingyi decoction and granules. Methods After the gastric administration of Qingyi decoction and granules in rats,liquid chromatography-mass spectrometry (LC-MS/MS) was used to detect the content of aloe-emodin,emodin,rhein and chrysophanol in the plasma,and then PkSolver software was used to calculate the pharmacokinetic parameters. Results In Qingyi decoction group,the peak time (tmax) of aloe emodin,emodin,rhein and chrysophanol were 0.72,0.45,0.60 and 0.20 h,respectively;the plasma elimination half-life (t1/2) were 9.36,9.68,5.18,5.47 h;the peak concentration (Cmax) were 107.27,14.92,1 363.6,96.02 ng·mL-1,respectively;the area under the blood concentration time curve (AUC0-∞) were 496.31,105.60,3 831.79,481.75 ng·h·mL-1。 In Qingyi granule group,the tmax of aloe emodin,emodin,rhein and chrysophanol were 0.08,0.18,0.18,0.47 h;t1/2 were 5.61,6.96,4.66,6.51 h;Cmax were 96.83,11.46,1 249.27,96.68 ng·mL-1;AUC0-∞ were 369.68,70.59,5 536.66,435.77 ng·h·mL-1,respectively.The main pharmacokinetic parameters(tmax,t1/2,Cmax,AUC0-∞) of the four components in Qingyi granule group were not significantly different from those in decoction group (all P>0.05). Conclusion Qingyi granules and decoctions had similar pharmacokinetic characteristics.The four components were absorbed rapidly.This study can provide reference for the clinical application of Qingyi preparation.
Objective To investigate the protective effect of aseptic dendrobium officinale nanoparticles (DON) on liver and its related mechanism. Methods The chronic liver injury mouse model of CCl4 was established,at the same time,the intervention was performed by intragastric administration of tested drugs for 8 weeks.Mice were randomly divided into normal control group,model control group,DON group and dendrobium officinale powders (DOP) group.The activity levels of glutamic oxalacetic transaminase (AST),glutamic pyruvic transaminase (ALT),lactate dehydrogenase (LDH) and catalase (CAT) in plasma of mice were assayed and compared.The levels of TNF-α and IL-6 were detected by ELISA.The expression of IL-1β in liver was observed by the immunohistochemical method.The pathology examination of the mice’s liver tissues was performed.Ultrastructural changes of liver tissues were observed by transmission electron microscopy. Results Comparing with the model control group,DON and DOP could reduce the activity of serum ALT,AST and LDH,and elevate serum CAT activity.The expression of TNF-α and IL-6 were down-regulated.They could decrease the level of IL-1β protein expression which was tested by the immunohistochemical method.Liver histopathology and ultrastructure of hepatocytes were improved to some extent.Compared with the DOP group,the improvement effect of the above indicators was more significant in the DON group. Conclusion DON has a more obvious liver protection effect on chronic liver injury.The mechanism may be that dendrobium officinale nanoparticles are more likely to promote the antioxidant activity,inhibit the oxidative stress induced by CCl4 and the anti-inflammatory effect after particle size modification.
Objective To investigate the pharmacokinetics of the combination of notoginseng total saponins (main components are notoginsenoside R1,ginsenoside Rg1,ginsenoside Re,ginsenoside Rb1,ginsenoside Rd) and breviscapine (main component is scutellarin) in healthy Beagle dogs,and compared with the pharmacokinetic parameters when using the notoginseng total saponins for injection or breviscapine for injection alone. Methods The LC-MS/MS method was established to determine the concentration of notoginseng total saponins and the concentration of scutellarin in the blood samples of Beagle dogs at different time points after drug administration.The pharmacokinetic parameters of each component were calculated. Results After a single dose of compound powder,the plasma elimination half-life (t1/2) of notoginsenoside R1,ginsenoside Rg1,ginsenoside Re,ginsenoside Rb1,ginsenoside Rd and scutellarin were (1.08±0.30),(0.95±0.16),(1.40±0.39),(51.08±10.42),(64.84±17.70) and (2.00±0.88) h,respectively;peak concentration (Cmax) were (4 641.00±758.84),(11 325.00±14 18.62),(1 822.00±253.37),(39 380.00±5 644.03),(12 964.00±2 738.41) and (2 669.00±841.79) ng·mL-1,respectively;the area under the curve (AUC0-∞) were (2 832.31±308.38),(3 454.00±473.08),(1 210.80±161.06),(1 360 410.90±277 244.88),(320 529.65±101 345.47) and (450.68±90.50) ng·mL-1·h,respectively.Compared with the single administration of notoginseng total saponins or breviscapine,the blood drug concentration-time curve was similar after a single administration of the compound powder;The Cmax of notoginsenoside R1,ginsenoside Rg1,ginsenoside Re,and ginsenoside Rd was significantly increased (P<0.05);There was no significant difference in the Cmax of ginsenoside Rb1 and scutellarin(P>0.05);no significant difference in t1/2 and AUC0-∞ for all components (P>0.05). Conclusion The combination use of notoginseng total saponins for injection and breviscapine for injections can increase the Cmax of some components of the notoginseng total saponins, but has no significant effect on the pharmacokinetics of scutellarin.
Cancer-related pain (cancer pain) is the main complication of cancer patients,which seriously affects the patient's survival quality. Drug treatment is an important part of cancer pain treatment.Reasonable use of existing drugs and treatment knowledge can relieve cancer pain in most patients.Nowadays,with the deepening understanding of the pathogenesis of cancer pain and the progress of clinical research on drugs,cancer pain drug treatment concept is constantly developing.In this review,the authors wrote a brief introduction of commonly used drugs for cancer pain.Then,based on the three-step analgesic concept proposed by the World Health Organization (WHO),we explained the concept changes in the fields of cancer pain related medicine,the development of the ladder analgesic concept,the change of opioid titration concept,the evolution of cancer pain treatment goals,etc.It is expected to provide references for the clinical treatment of patients with cancer pain and future clinical research in this field.
Opioids are the basic drugs for the treatment of cancer pain.They are widely used in the treatment of cancer pain due to their good safety,various ways of administration,easy dose-titration,and effective for all types of pain.As cancer treatments improve and patients live longer,cancer survivors receive opioid treatment for longer periods of time,often at higher risk of abuse than previously thought.The purpose of this review is to summarize the risk factors,risk assessment tools,and surveillance methods for opioid abuse in order to predict,identify,and manage opioid abuse in patients with cancer pain,and to optimize the balance between opioid access,efficacy,and safety.
Opioids are common medications used to treat moderate and severe pain in cancer patients.However,as their significant individual variation in efficacy and medication risk among patients,the dosage of opioids often needs to be accurately titrated or conversed mutually to alleviate pain and avoid adverse reactions caused by overtreatment.Currently,the common calculation used in opioid dosage includes opioid titration,opioid dosage calculation of outbreak pain,opioid rotation between different drugs or formulations,dosage adjustment associated with liver and renal insufficiency,et al. In order to provide reference for clinical rational drug use, we reviewed those dose calculations of opioids based on domestic and foreign reports.
Objective To investigate and analyze the current status and existing problems of pharmaceutical services of cancer pain by bibliometric methods. Methods By searching the literatures related to pharmaceutical services of cancer pain in China published from January 2000 to December 2018 in Chinese and English databases,then executed statistical analysis from publication time,first author province,journal distribution,document type and literature content. Results A total of 276 articles were obtained,the amount of literature in the field of pharmaceutical service of cancer pain has been increasing in the past 20 years.These articles were covering 28 provinces and municipalities.And their content involved 9 aspects,such as clinical drug utilization research,working mode discussion,pharmaceutical monitoring,etc.The number of documents issued by coastal and southern provinces was significantly higher than that of northern provinces,and more than half of them were published in journals included in “the key magazine of China technology”. Conclusion In the past few years,great progress has achieved in the field of pharmaceutical services of cancer pain.However,there ware still some shortcomings,such as unbalanced regional development,low level and insufficient application of new technologies and research methods,which need to be further strengthened.
Opioids are important drugs to control cancer pain.When the wrong kind of opioids or wrong dose are used,it will further cause kidney injury. Cancer patients may be associated with renal dysfunction due to the progression of the disease itself or complications.Therefore,cancer pain patients with the risk of renal dysfunction must correctly evaluate the state of renal function,and correctly select the variety and dose of drugs according to the degree of pain and the characteristics of opioids.This article reviews the pharmacokinetic characteristics of commonly used opioids and the selection of opioids in patients with renal dysfunction and dialysis patients,in order to provide clinical reference for rational use of opioids.
Objective To understand the cancer pain control situation in the tumor center of our hospital,to promote the rational use of narcotic analgesics,to reduce the occurrence of drug-related problems (DRPs),and to discuss the role of pharmacists in the future. Methods The medical records of cancer pain patients in the cancer center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were collected and screened.The incidence and causes of opioid related problems in the medical records of cancer pain patients in our hospital were analyzed and counted by using the pharmaceutical care network Europe (PCNE) classification system. Results From March 2018 to April 2019,568 patients,including 356 males and 212 females,were identified as cancer pain patients in the tumor center of our hospital.The age was from 9 to 86,average age was (55.56±12.05).Lung cancer was the most common primary cancer,followed by gastrocolic carcinoma and tumors of head and neck.The number of DRPs was 144,accounting for 25.35%.The main problems focused on "therapeutic effect",accounting for 77.08%.The causes of all DRPs were analyzed and summarized,among which "patient-related" causes accounted for the highest DRPs (50.98%),the second factor was "drug selection" (33.33%).Further analysis of the results showed that "Inappropriate timing of administration " caused the highest proportion of DRPs (24.18%). Conclusion Most patients with cancer pain in the tumor center of our hospital obtained ideal pain treatment,but there were still shortcomings.The clinical pharmacists could use PCNE to find problems and causes,find key points in pharmaceutical monitoring,and improve the analgesic efficiency in patients with cancer pain.
Objective To understand the familiarity and related influencing factors of patients with cancer pain with medical treatment knowledge,and to provide reference for medical treatment management of cancer pain. Methods A total of 394 patients with cancer pain in 7 hospitals in Hubei province were investigated by cluster sampling.Questionnaire survey was conducted on the basic characteristics of the patients and their familiarity of drug usage,dosage,storage,precautions,side effects and dependence.Chi-square test and binary logistic regression were used for statistical analysis. Results A total of 372 effective questionnaires were received,and most of the patients' payment types were the new rural cooperative medical system (NCMS) and medical insurance.The proportion of patients suffered pain more than one month was 56.5%,and more than 60% of patients were familiar with medical treatment knowledge for cancer pain.There were statistically significant differences in patients' education level,payment type,family income and pain time with the familiarity of cancer pain medication knowledge (P<0.05 or P<0.01).Further regression analysis showed that education level,gender,family income and pain time were the influencing factors of patients' familiarity with cancer pain medication knowledge. Conclusion The patient's familiarity with medical treatment knowledge of cancer pain is affected by many factors,thus education project on cancer pain and analgesics knowledge should be carried out to improve the patient's cognition and the management of cancer pain medication.
Objective To explore the correlation between endometrial lesions induced by selective estrogen receptor modulators (SERMs) and ERα gene rs9340799 and rs2234693 single nucleotide polymorphisms (SNPs) after breast cancer surgery. Methods One hundred and sixty-four breast cancer patients who underwent tamoxifen or toremifene treatment (>1 years) were enrolled and hospitalized.The ERα gene rs9340799 and rs2234693 sites were sequenced and compared the correlation between comparative genotype and endometrial thickness,endometrial scraping rate. Results The ERα gene rs9340799 locus A/G genotype was thicker than the A/A and G/G genotypes,and the number of patients with vaginal curettage was more than (P<0.05).Among the patients with the same genotype,there was no significant difference in endometrial thickness and number of diagnosis between different drug groups (tamoxifen or toremifene citrate) (P>0.05).In addition,a significant correlation was found between the first endometrial scraping time and the rs9340799 SNPs (P<0.01).Compared with patients with the same genotype,the number of endometrial scraping in one year of patients with A/G genotype was significantly more than who were treated more than one year (P<0.05). Conclusion SERMs-related endometrial lesions may be related to ERα gene phenotype.In ERα gene rs9340799 and rs2234693 loci,A/G alleles may be susceptible genes for aromatase inhibitor-related endometrial lesions.Patients with susceptibility genes have a higher rate of endometrial lesions within 1 year of taking the drug.
Objective To observe the curative effect of children’s procaine hydrochloride oral liquid on children vomiting caused by digestive system diseases,and to provide clinical use data for its follow-up research. Methods From March 2018 to March 2019,the clinical data of children’s procaine hydrochloride oral liquid used in pediatric department of Sichuan Provincial People's Hospital were collected.The age,indications,usage,dosage,and the effect and adverse reactions of child patients were statistically analyzed. Results A total of 550 patients received procaine hydrochloride oral liquid,the range of their age from 25 days to 13 years. It was used for vomiting caused by gastroenteritis,also applicable to vomiting caused by gastritis,tonsillitis,mesenteric lymphadenitis,upper respiratory tract infection,gastrointestinal dysfunction.The dosage was less than 1 mL for newborns and children under 1 year old.The average dosage for children aged 1 year was 1 ml,the dosage for children aged over 1 year increased by 1 mL,and the maximum clinical dosage was 10 mL.Adverse reactions were allergic reactions and decreased appetite.The children got cured in 467 cases,improved in 78 cases,and ineffective in 5 cases. Conclusion Children’s procaine hydrochloride oral liquid is suitable for children,especially newborns.It has antiemetic or analgesic effect on vomiting and pain caused by digestive system diseases in children.
The pandemic of coronavirus disease 2019 (COVID-19) poses a huge threat to the world health,however,no clinical proven effective methods of treatment of COVID-19 were currently available.Recent study indicated that dipeptidyl peptidase 4 (DPP4) may be a potential receptor for the SARS-CoV-2,however,whether DPP4 directly participated in the adhesion or infection of SARS-CoV-2 to the target cells,and whether inhibition or modulation of DPP4 activity or expression could prevent the progression of COVID-19 still remain unclear.Previous studies revealed the anti-inflammatory and anti-fibrotic effects of DPP4 inhibitors.Thus,it is speculated that DPP4 inhibitors may play a protective role in inhibiting inflammatory response and pulmonary fibrosis in patients with COVID-19,but it still needs to be further confirmed.
Chitosan and its derivatives have non-toxic,bio-degradable and good biocompatibility,which have good application prospects in drug delivery systems.The folate receptor is overexpressed in tumor cells and utilizes the specific binding of folic acid to its receptor to achieve tumor-targeting.This article briefly summarizes the application of folic acid modified chitosan in cancer targeting agents.
Objective To establish a rational evaluation criteria for salvianolate in a hospital,and to analyze the use of salvianolate by weighted technique for order preference by similarity to ideal solution(TOPSIS)method,so as to provide a reference for the rational use of salvianolate in clinical practice. Methods Establishing the rational evaluation criteria of salvianolate by the drug label,basic principlesof clinical use of traditional Chinese medicine injection issued by the State Administration of Food and Drugs,and relevant literature.According to this standard rules to analyze and evaluate 80 cases of salvianolate archived medical records in a hospital in 2018 by weighted TOPSIS method. Results Among the 80 cases,64 cases (80.0%) had relative degree of proximity of more than 60%,12 cases (15.0%) from 50% to 60%,and 4 cases (5.0%) from 40% to 50%. Conclusion The rationality evaluation method for salvianolate based on the weighted TOPSIS method can combine multiple evaluation indicators,it has strong operability and intuitive evaluation results.The application of salvianolate in this hospital is relatively standardized,but it still have some problems.Therefore,education and management should be strengthened to promote rational clinical medication.
Objective To investigate the labelling problems of pregnancy contraindications and pediatric medication in the package inserts of Chinese patent medicine(CPM),and to put forward the suggestions. Methods A total of 90 package inserts of CPM in General Hospital of Yangtze River Shipping were collected.Referring to the prohibited,contraindicated and caution materials and decoction pieces in Chinese pharmacopoeia (part 1,2015 edition),based on “note” item in Chinese pharmacopoeia and clinical application guidelines (2015 edition),problems existing in pregnancy contraindication and pediatric medication information labeling of package inserts were compared and analyzed. Results Among 90 package inserts of CPM,only 47 of them were labeled as pregnancy contraindications, and 43 of them were lacking.The rate of labelling was 52.2%.Meanwhile,there were 5 package inserts of CPM have pediatric medication,and 85 of them were lacking,in which the labeling lack rate were 6%and 94%,respectively.Above all,only 3 kinds of pregnancy contraindications and 2 kinds of pediatric medication were consistent with the labeling in Chinese Pharmacopoeia and Clinical Application Guidelines. Conclusion Most CPM have serious absence labels among pregnancy contraindications and pediatric medication.Pregnancy contraindications of CPM cannot be simply taken as an indication and contraindications to evaluate pregnancy medication.More clinical data and evidence-based pharmaceutical data are needed to support pregnancy and child medication information of CPM.
Objective To assess the cost-effectiveness indacaterol/glycopyrrolate FDC in patients with moderate to very severe chronic obstructive pulmonary diseases (COPD) in China,and to provide a basis for clinical medication decisions. Methods Markov model cohort simulation was used to estimate the long-term efficacy and cost of two drugs for COPD. Results The average cost of indacaterol/glycopyrrolate FDC and salmeterol/fluticasone for the treatment of COPD were 86 393.01 yuan,81 537.16 yuan,respectively,and obtained 5.47 and 5.32 QALYs.The ICER of indacaterol/glycopyrrolate FDC compared with salmeterol/fluticasone was 32 372.33 yuan/QALY. Conclusion Indacaterol/glycopyrrolate FDC is slightly more costly and effective in treating COPD than salmeterol/fluticasone at the level of willingness to pay.
Objective To improve the rational use of antibiotic prophylaxis and postoperative analgesics in orthopaedics department. Methods Our hospital tried to establish a refined management model based on clinical pathway of medicine treatment,and carried out the drug route of perioperative prophylactic antibacterial drugs and analgesics in orthopedics departments. Results After the implementation of the clinical pathway of medicine treatment,the intensity of antimicrobial use,drug cost per capita,and daily drug cost per bed were significantly reduced by 51.50%,23.86% and 8.28%,respectively.Significant improvement have been achieved in promoting rational drug use. Conclusion The establishment of a refined management model of "Clinical Pathways for Medicine Treatment " provides a new idea to promote the rational drug administration.