Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic,which poses a serious threat to all human beings.In response to this global public health crisis,the development and vaccination of vaccines are underway.Currently,19 vaccines have been included in the World Health Organization (WHO) emergency use assessment list,their effectiveness and safety have also attracted widespread attention.Based on data from phase III clinical trials and real-world studies,this paper presents a comprehensive evaluation of the efficacy and safety of eight vaccines on the emergency use evaluation list,which including inactivated vaccines,mRNA vaccines,viral vector vaccines and protein subunit vaccines.Hopefully this paper provides a reference for the clinical application and clinical safety monitoring of vaccines.
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.
Objective To explore the inhibitory effect of lipopolysaccharide on the expression of nuclear receptor NR4A1 in U251 cells and to study its molecular mechanism. Methods U251 cells were treated with dimethyl sulfoxide,lipopolysaccharide,lipopolysaccharide combined with Toll-like receptor 4 inhibitor CLI-095,or myeloid differentiation factor (MyD88) inhibitor ST 2825 for 24 hours.Using genetic engineering technology,human aromatic hydrocarbon receptor (AhR) expression plasmids,Ah receptor nuclear translocator protein (ARNT) expression plasmids,and human NR4A1 promoter fragment luciferase reporter were constructed.U251 cells transiently transfected human AhR and ARNT expression plasmids.quantitative real-time PCR (qRT-PCR) detects the expression of NR4A1,AhR and ARNT;293T cells are transiently transfected with human AhR and ARNT expression plasmids and the luciferase report of human NR4A1 promoter fragments plasmid,dual luciferase reporter experiment to detect fluorescence intensity.Chromatin immunoprecipitation analysis was performed to detect the effect of lipopolysaccharide on the binding of AhR protein to the NR4A1 promoter site. Results Compared with dimethyl sulfoxide,lipopolysaccharide down-regulated the expression of NR4A1 and AhR in a dose-dependent manner (P<0.05);compared with lipopolysaccharide alone,CLI-095 significantly reversed the down-regulation of NR4A1 and AhR mRNA expression by lipopolysaccharide (P<0.01),ST 2825 partially reversed its down-regulation (P<0.05).The results of qRT-PCR showed that the high expression of AhR/ANRT in U251 cells after transfection significantly induced the expression of NR4A1,which was up-regulated by 2.63 times (P<0.01).The analysis of dual luciferase report experiment showed that the fluorescence intensity of 293T cells after transfection significant increased to 19.08 times (P<0.01).Chromatin immunoprecipitation analysis showed that compared with dimethyl sulfoxide,lipopolysaccharide significantly inhibited the binding of AhR protein to the NR4A1 promoter site,down-regulating by 32.7% (P<0.05). Conclusion Lipopolysaccharide inhibits the expression of AhR in U251 cells through the TLR4-MyD88 signaling pathway,and inhibits the binding of the heterodimer formed by AhR/ARNT to the NR4A1 promoter site,thereby inhibiting the expression of NR4A1 at the transcriptional level.
Objective To observe the long-term toxic reaction of Xiaoer Xuanfei Zhike granules on rats,and to provide reference for its clinical application. Methods One hundred and twenty rats were randomly divided into normal control group,high,medium,and low dose group of Xiaoer Xuanfei Zhike granules (30 rats in each group).The rats were orally administrated with 3.00,7.80 and 20.25 g·kg-1·d-1of water dissolved granules in low,medium,and high dose group for one month,respectively.The normal control group was given equal volume of pure water.The general condition,body mass,food consumption,hematology,blood biochemistry,ophthalmology,urine,organ coefficient and histopathological changes of all the rats were observed. Results There was no obvious effect on animal hematology,urine,ophthalmology,and organ coefficients in all the rats.The granule has a certain inhibitory effect on the body weight of rats,especially in high dose group,and it has more obvious effects in male animals than in female animals.There was a certain inhibitory effect on food consumption in male rats of high dose group.The high dose of granule can cause mild liver damage.The toxic reactions can be reversed and no delayed toxic reactions were observed after 4 weeks. Conclusion The dose of non-toxic response of Xiaoer Xuanfei Zhike granules is 7.80 g·kg-1 in rats.
Objective To investigate the medication rules of cancer pain prescriptions in the digestive system by data mining techniques. Methods The formulas of cancer and pain in the digestive system were collected from the Dictionary of Tumor Formulas,The Complete Compilation of Good Tumor Formulas,The Chinese Pharmacopoeia,The National Compendium of Proprietary Chinese Medicines,and The Pharmaceutical Standards of the Ministry of Health of the People's Republic of China.The formulas were screened and organized.The analysis was performed by Microsoft Excel 2019 for frequency statistics,IBM SPSS Modeler 14.1 for correlation rule analysis and IBM SPSS Statistics 25 for cluster analysis and factor analysis.The statistic packages of arules and arulesViz from R4.0.2 were used to visualize association rules under different compatibility principles. Results A total of 123 digestive system cancer pain formulas involving 304 Traditional Chinese Medicine (TCM) were included in the study.Thirty-three TCMs were used more than 10 times,with the effects of promoting blood circulation and resolving blood stasis,tonifying deficiency,and regulating qi.The association rule analysis showed that a total of 26 rules were obtained,with citri reticulatae pericarpium → aucklandiae radix being the most frequently used,and 14 rules for 3 TCM drug groups,with olibanum + myrrh → borneol being the most frequently used.Visual network of association rule showed that the herb pair with the strongest relevance is olibanum - myrrh.A total of 10 TCM combinations were extracted from the cluster analysis.A total of 12 metric factors were extracted from the factor analysis,and the highest load factors were Curcuma longa,Boswellia serrata,Sanliang and Myrrh. Conclusion In the treatment of cancer pain of digestive system,the ancient and modern medical prescriptions mainly used the strategies of Qi circulation to relieve pain,blood circulation to remove blood stasis,supplemented by strengthening the body and tonifying deficiency,anti-cancer and detoxification,phlegm and dampness,which was consistent with the core concepts of pathogenesis of cancer pain in traditional Chinese medicine theory.
With the more and more extensive application of targeted drugs in tumor treatment,its related gastrointestinal adverse reactions have become a clinical problem.The common adverse reactions of targeted drugs include diarrhea,nausea and vomiting,loss of appetite,etc.;and their pathogenesis is related to the injury of gastrointestinal mucosa.Traditional Chinese medicine (TCM) has obvious advantages in the prevention and treatment of targeted drug-related adverse reactions.Through its advantages in syndrome differentiation and combining different characteristic technologies for internal and external use,significant curative effects can be achieved by TCM,which can improve the quality of life of patients and improve the comprehensive curative effect of tumor treatment.The mechanism,manifestations,and TCM prevention and treatment of gastrointestinal adverse reactions caused by targeted drugs were discussed in this paper.
The natural compounds derived from Chinese herbs are relatively complex and have different degrees of side effects on kidney.As an important metabolism and excretion center of human body,kidney is the primary target organ of toxic drugs.It is of great significance to study the nephrotoxicity mechanism of traditional Chinese herbs.In the treatment of most diseases,some Chinese herbs can induce kidney injury through different mechanisms.In this paper,we review the mechanisms of kidney injury induced by Chinese herbs,such as the progress of oxidative stress,apoptosis,inflammatory response,mitochondrial injury,fibrosis,Na+-K+-ATPase and transporter,to provide reference for the research on prevention and treatment of kidney injury induced by Chinese herbs.
In addition to some patients with metabolic endocrine diseases,osteoporosis mainly occurs in postmenopausal women and the elderly.Osteoporosis is prone to fractures,deformities,and disablement,which is one of the main factors affecting the quality of life of patients with metabolic bone disease and the elderly.Due to the characteristics of osteoporosis,such as a large number of basic population,high rate of injury and disability,and poor clinical treatment,the prevention and treatment of osteoporosis has gradually become a worldwide public health problem.And it is also one of the important topics of medical research both at home and abroad.This article reviews the causes of osteoporosis and the research progress of traditional Chinese and Western medicine on postmenopausal osteoporosis both domestic and overseas.
Based on the etiology and pathogenesis of collateral disease,the Traditional Chinese Medicine treatment focuses on the development of prevention and treatment of pulmonary collateral disease.Starting from the pathological characteristics of "long-term disease entering the collaterals" and "lung deficiency and collateral stasis",we analyze the principle of "collateral" method in the treatment of chronic obstructive pulmonary disease (COPD).In this paper,we discuss about collateral disease,lung collaterals,and COPD in clinical practice,so as to take references for pulmonary collateral disease theory in the treatment of COPD,and to provide new ideas for the prevention and treatment of COPD with Traditional Chinese Medicine.
Objective To evaluate the safety and effect of tranexamic acid and hemocoagulase agkistrodon on hemostatic function in internal fixation for senile femoral trochanter fracture. Methods One hundred patients with femoral trochanter fractures undergoing orthopedic surgery were randomly divided into tranexamic acid and hemocoagulase agkistrodon groups, 50 cases in each group.Thirty minutes before the skin incision,tranexamic acid group was intravenously dripped with 1 g of tranexamic acid and before closing the incision,1 g of tranexamic acid was diluted to 20 mg·mL-1 for subfascial and intramuscular injection.Hemocoagulase agkistrodon group was injected with 2 U of hemocoagulase agkistrodon,15 min before operation. Hemoglobin,red blood cell count,and platelet hematocrit before and after surgery were detected. Apparent blood loss,blood transfusion rate,blood transfusion volume,and occurrence of adverse events in each group were recorded. According to the Gross linear equation,the total blood loss and latent blood loss were calculated for the two groups during the perioperative period. Results The latent blood loss in the tranexamic acid group and hemocoagulase agkistrodon group were (215.17±148.65) mL and (340.27±170.85) mL,respectively(P<0.01).The blood transfusion volume were (140.30±161.48) mL and (207.20±182.59) mL respectively (P<0.05),postoperative D-dimer were (4.45±4.16) mg·L-1 and (10.09±8.18) mg·L-1 (P<0.01).There was no significant difference in significant blood loss,blood transfusion rate,and the incidence of adverse events at the last follow-up between the two groups(P>0.05). Conclusion Tranexamic acid is better than hemocoagulase agkistrodon in hemostatic effect on senile femoral trochanter fracture,especially for latent blood loss.
Small interfering RNA (siRNA) regulates gene expression through a mechanism of RNA interference (RNAi),which specifically degrades target messenger RNA (mRNA) and has recently been used in the treatment of various skin diseases.However,due to the strong hydrophilicity and electronegativity,siRNA is easily degraded by nucleases and difficult to transduce across the barrier of the skin cuticle,which limits its clinical applications.Therefore,the need for a safe and efficient delivery system is urgent.This article reviews the recent literatures on the preparation of transdermal drug delivery system using nano-carrier carrying siRNA for the treatment of skin diseases,with the perspective for providing safer,more effective,and more practical methods for drug delivery in the treatment of skin diseases.
Objective To optimize the formulation and process parameters of ibuprofen double-release bilayer tablets based on the concept and method of quality derived design (QbD). Methods The critical process parameter (CPP) was determined based on the risk assessment and fishbone analysis.The Plackett- Burman design (PBD) was used to screen out significant influencing factors,and then Box-Behnken design (BBD) was used to optimize CPPs. The design space was established and 95% confidence interval was added,which make the design space more stable and reliable.And then the design was verified. Results By screening and optimizing CPPs,the design space was determined to be 6%-7% disintegrating agent,15%-18% sustained-release material,and 5.5%-6.5% pore-making agent. Conclusion The establishment of design space reduces the risk in the production process,and makes the preparation process of ibuprofen double-release double-layer tablets simple,stable and feasible.It is suitable for large industrial production.
Objective To establish ultra-performance liquid chromatography-mass spectrometry(UPLC-MS/MS) method for determining the equilibrium solubility and the apparent oil-water partition coefficient of trilobatin in different pH solutions. Methods Kinetex XB C18 column (100 mm× 2.1 mm,2.6 μm) was used.The mobile phase included 0.1% formic acid solution (A) and acetonitrile (B).A gradient elution procedure was carried out.90% of A and 10% of B were set at 1.00 min.The percentage of B increased gradually to 80% from 1.00 to 8.00 min and this setting continued to 12.00 min.Then the percentage of B reduced to 10% at 12.01 min and this procedure lasted till 15.00 min.The equilibrium solubility and the apparent oil-water partition coefficient between n-octyl alcohol and phosphate buffers were studied with a shaking flask method. Results The equilibrium solubility of trilobatin were 0.90,1.16,1.83,2.72,3.91,11.73,15.51,and 23.79 mg·mL-1 in buffer solutions with pH values of 1.2,2.0,4.5,6.5,7.5,9.0,10.5 and 12.0,respectively.The lgP values ranged from -0.58 to 0.26 when the pH values of buffers changed from 1.2 to 12.0. Conclusion Trilobatin is an insoluble drug,and the apparent oil-water partition coefficients and the equilibrium solubility of trilobatin are affected by pH.The equilibrium solubility increased markedly with the pH values of solutions increased,while the apparent oil-water partition coefficient decreased significantly.
Objective To establish the commodity specification and grade standard of Schisandra chinensis (Turcz.) Baill,and to evaluate its quality. Methods Through therbalogical study and market investigation to select the traditional grading indicators,we combined with descriptive statistical analysis,analysis of variance,according to the actual production condition,we developed the grading standards of schisandra;The moisture,ash,alcohol extract and schisandrin were used as internal indexes to analyze the quality difference between grades and the correlation between appearance and internal components. Results The herb research and market research showed that schisandra was famous for bright color and plump flesh;we use the chroma a*,diameter,per grain and dry rate as the classification index of schisandra.The correlation analysis showed that the intrinsic indexes of schisandra were significantly correlated with the appearance traits,and the intrinsic indexes were also significantly correlated.There was significant difference of the moisture,ash,alcohol extract between the two specifications,but first grade the determination of schisandrin is more highter. Conclusion The commodity specification and grades standard of schisandra was established,which can provide the basis for the establishment of industry standard or national standard.
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 review the pharmacogenomic research of methotrexate (MTX) in the treatment of psoriasis,and to provide references for personalized pharmaceutical services and medical research. Methods The related literatures were retrieved from the web of scienceTM core database,Wanfang,and VIP database with the subject retrieval method,scoping from 2000 to 2019.The indicators were analyzed,such as the year of publication,literature types,countries and regions,institutions and authors,cited situation,research direction,etc. Results Area total of 39 foreign literatures and 8 domestic researches on the effectiveness and toxicity of MTX and pharmacogenomics were concluded in this analysis.Most publications were from the UK,the United States,Canada,and China;and the publications with the higher citation distributed in the UK,Ireland and the United States.Among the top 10 cited literatures,4 were published in British Journal of Psychiatry,and most of them were British scholars,such as Warren RB.in the UK.MTX transporter coding genes (SLC19A1,ABCC1,ABCG2),metabolizing enzyme coding genes (MTHFR,DHFR),drug targets (TYMS,ATIC,ADORA2a) and other gene polymorphisms may change the pharmacokinetic and pharmacodynamic characteristics of MTX,thus affecting the safety and effectiveness of MTX,which may explain the individual differences in the treatment of psoriasis by MTX to a certain extent. Conclusion The research on pharmacogenomics,efficacy and toxicity of MTX in the treatment of psoriasis has been carried out all over the world.Chinese academic researchers should pay more attention to these fields because of the difference between the gene backgrounds of different races and nationalities to ensure the safety and efficacy of MTX in the treatment of psoriasis.
Since fluoroquinolones are characterized by broad-spectrum antibacterial activity,strong bactericidal activity,low toxicity and high efficacy,fluoroquinolones drugs have become a commonly used anti-infective drugs in clinical practice.However,with the application of fluoroquinolones becoming more and more widely,there are more and more reports about its adverse reactions,which are increasing year by year.Therefore,the study on the occurrence and mechanism of adverse reactions has gradually deepened.Among them,fluoroquinolones drugs interfere with the balance of collagen synthesis and degradation,which are considered to play an important role in a variety of adverse reactions.In this paper,the relevant literatures published in recent years both at domestic and abroad is reviewed to provide a more comprehensive overview of the clinical manifestations of collagen-related adverse effects of fluoroquinolones and progress in the field of molecular mechanisms of research,thus hoping to draw the attention of clinicians,pharmacists,and nurses.At the same time,for the clinical safety and rational use of fluoroquinolones drugs to provide some reference.
The inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) is a new kind of lipid-lowering drug that have attracted much attention in recent years.PCSK9 inhibitors significantly reduce low density lipoprotein-cholesterol (LDL-C) levels and have a positive impact in preventing cardiovascular events.Although PCSK9 inhibitors have high safety and tolerability,understanding their adverse reactions still has important significance for clinical treatment.This article reviews the adverse reaction reports of evolocumab,including injection site reaction,nasopharyngitis,myalgia and neurocognitive impairment.
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.