In April 2021,the Canadian Cardiovascular Society (CCS) and the Canadian Heart Failure Society (CHFS) released heart failure guidelines update: defining a new pharmacologic standard of care for heart failure with reduced ejection fraction,provided comprehensive recommendations and practical tips for the pharmacologic management of patients with heart failure with reduced ejection fraction (HFrEF). The guidelines focused on the role of novel pharmacologic therapies for HFrEF,defined a new standard of pharmacologic care for HFrEF that incorporates 4 key therapeutic drug classes as standard therapy for most patients. Combined with the recommendations of the guidelines and evidence-based medicine,this article interpreted the drug treatment of HFrEF,in order to provide reference for the treatment of HFrEF in China.
Objective To study the effect and mechanism of dietary fiber combined with mesalazine in ulcerative colitis (UC). Methods A C57BL/6 mouse model of UC was established by using dextran sulfate sodium. The mice were randomly divided into four groups,including normal group (Control),model control group (Model),mesalazine group (5-ASA),and dietary fiber combined with mesalazine group (F-5-ASA). The 5-ASA and F-5-ASA groups were given 200 mg·kg-1 of 5-ASA for 7 days. The F-5-ASA group was given dietary fiber feed,whereas the normal,Model and 5-ASA groups were fed with normal feed. During the study,body mass and disease activity index (DAI) score were observed. At the end of experiment,the protein expression of interleukin-1β (IL-1β),IL-6,tumor necrosis factor-α (TNF-α) and IL-10 were tested,the colon length was measured and histological pathology were observed. Intestinal flora abundance of 16S RNA was analyzed by next-generation sequencing analysis method. Results Compared with model control group,the body mass of mice in the 5-ASA group and F-5-ASA group was increased significantly (all P<0.01),the DAI score was decreased (all P<0.01) and the colon length increased significantly (all P<0.01). The pathological sections showed that the colon structure of the mice in the 5-ASA group and the F-5-ASA group was remodeled,mucous membrane was remodeled,and crypts had a small amount of inflammatory cell infiltration. In addition,F-5-ASA had better efficacy than the 5-ASA. The results showed the expression of IL-1β (P<0.01),IL-6 and TNF-α (P<0.01) (P<0.01) in the F-5-ASA group was significantly down-regulated,and IL-10 was significantly increased (P<0.01) when compared with model control group. The 16S RNA intestinal flora and metabolic pathway analysis showed that the diversity of the intestinal flora of mice in the F-5-ASA group was improved. And the abundance of species,such as Bacteroides,Parabacteroides,Campylobacter,Helicobacter and Eubacterium,was significantly increased. At the same time,22 metabolic pathways were significantly up-regulated (P<0.05),such as carbohydrate metabolism,phenylalanine,tyrosine and tryptophan biosynthesis and amino acid metabolism;and 23 metabolic pathways were significantly down-regulated (P<0.05),such as propanoate metabolism,bacteria chemotaxis and bacterial motility proteins. Conclusion Dietary fiber combined with 5-ASA can treat UC by regulating the intestinal flora.
Objective To study the anti-inflammatory and analgesic effects of different fractions of Citrullus lanatus vine extract and its mechanism. Methods The pain experiment caused by 2.5% formaldehyde solution was used to screen the anti-inflammatory and analgesic active parts of Citrullus lanatus vine. The contents of nitric oxide (NO),prostagland E2 (PGE2),5-hydroxytryptamine (5-HT),β-endorphin (β-EP),substance P and epinephrine (NE) in serum of mice induced by 2.5% formaldehyde solution were determined by ELISA kits. Reverse transcription polymerase chain reaction (RT-PCR) was used to evaluate the levels of COX-1 and COX-2 mRNA in the brain of mice before and after injection of 2.5% formaldehyde solution. Results The ethyl acetate extract of Citrullus lanatus vine could significantly reduce phase I and phase II analgesia scores of paw pain induced by 2.5% formaldehyde solution (P<0.05). High doses of ethyl acetate extract of Citrullus lanatus vine could significantly decrease the serum substance P content of the pain in mice (P<0.05),High and medium doses of ethyl acetate extract of Citrullus lanatus vine could significantly increase the serum β-EP content of the pain in mice (P<0.05),decrease the contents of NO,PGE2,5-HT and NE in serum (P<0.05),and inhibit the expression of COX-1 and COX-2 in mice brain tissue. Conclusion The effective analgesic fraction of Citrullus lanatus vine may exist in the ethyl acetate part. The analgesic effect of Citrullus lanatus vine may release by decreasing the contents of PGE2,5-HT,NO,NE and substance P in serum,increasing the content of β-EP,and inhibiting the expression of COX-1 and COX-2 in mice brain. In other words,the ethyl acetate part of Citrullus lanatus vine plays a role through central and peripheral analgesia.
Perioperative anaphylaxis may occur at many time during perioperative and may progress rapidly.It is a life-threatening event and often involves many systems.The main drugs caused anaphylaxis during perioperative period maybe differ from different regions.For example,the 6th National Audit Project in the UK has identified culprit agents included antibiotics,neuromuscular blocking agents,chlorhexidine and Patent Blue V.The latest Chinese expert consensus indicated that the causes of perioperative anaphylaxis included neuromuscular blocking agents,antibiotics,colloid,local anaesthetics,blood products and protamine.This article analyzes the drugs that cause allergic reactions during surgery both in China and abroad.
Perioperative anaphylactic shock is a rare but life-threatening event.Epinephrine is the first-line medication in the management of anaphylactic shock and the role of other drugs such as antihistamines,β - adrenoceptor agonists,glucocorticoids is still controversial.According to the pathogenesis of anaphylactic shock,some scholars have studied the drugs which can achieve therapeutic effect by blocking nitric oxide pathway,potassium channel or directly inhibiting Mas-related G protein-coupled receptor X2(MRGPRX2)and platelet-activating factor (PAF) receptor.In this paper,we reviewed the literatures of drugs for perioperative anaphylactic shock,in order to provide a reference for the clinical practice and the follow-up drug research.
Anaphylaxis is a kind of clinical emergency,and its prevalence rate is increasing year by year,which can be life-threatening if not handled properly.In recent years,countries around the world have issued guidelines for anaphylaxis.The citation evidence in the emergency drug management program of the guidelines supports epinephrine as a first-line drug.The recommendations for antihistamines,adrenergic β2 receptor agonists and glucocorticoids are different in these guidelines.In order to provide reference for the standardized use of drugs in the emergency treatment of anaphylaxis,this paper mainly introduces the contents of the emergency management of anaphylaxis in the 2014 EAACI guideline and 2020 WAO guideline,compares and analyzes the contents and quality of the citation evidence,and supplies the latest research evidence.
Anaphylaxis is a sudden,severe and potentially fatal systemic allergic reaction after exposure to sensitizing substances.Both the 2014 EAACI guideline and the 2020 WAO guideline emphasized the need for long-term management after emergency management of anaphylaxis.In order to provide references for the long-term management of anaphylaxis,this paper interprets the contents of long-term management,compares the quality level of citation evidence,and adds the latest research evidence.
By consulting,summarizing and sorting out literatures,the special decoction methods of Chinese herbal pieces was classified seven kinds,including decocted earlier,decocted later,wrap-boiling,decocted separately (stewed separately),dissolve solute (melting by heat),decoction instead of water,and others.A total of 73 Chinese herbal pieces were collected in the Pharmacopoeia of the People's Republic of China (the first volume,2020 edition).The key points and decocting parameters of the herbal pieces which need special decocting were established in order to lay the foundation for formulating the decocting technical specification of traditional Chinese medicine decoctions.
Objective To optimize the formula of the adding water's volume in decocting traditional Chinese medicine, and to select the best ratio of the water in the first decocting process and the second decocting process in order to achieve precise control of the water addition and liquid yield. Methods A multifunctional health-preserving pot was used as a decoction container to determine its evaporation coefficient of water vapor under different decocting conditions.Danggui Sini Decoction (DSD),Xiaoqinglong Decoction (XD) and Buzhong yiqi Decoction (BYD) were used as research subjects, and the total volume of decocting water was determined according to the water-adding formula.The three prescriptions were decocted at the water-adding ratio of first decoction comparing to the second decoction equals to 60:40,70:30 and 80:20,respectively.The compound decoctions' water absorption,the volume of obtained herbal liquid after the first decocting process and the second decocting process,relative density,and paste-forming rate were detected.According to the discrepancy between the practical water absorption and the theoretical water absorption of the decocting herbs,we corrected the water absorption rate,the volume of expected obtained herbal liquid,and the relative density of the decoction,respectively.The correction coefficient of the herbal pieces' water absorption rate was set as a parameter to optimize the water- adding formula.Took the deviation of the obtained herbal liquid volume,the corrected relative density and the paste-forming rate as the indicators to select the best ratio of water' volume that was added in the first decocting process and the second decocting process. Results The water vapor evaporation coefficient of the multifunctional health-preserving pot has no significant discrepancy under different decocting conditions,and the coefficient was 3.9 mL·min-1.When using the multifunctional health-preserving pot to decoct Chinese herbal pieces,the practical water absorption was 0.67 times to the theoretical water absorption,and 0.67 was determined as the correction coefficient of water absorption rate of Chinese herbal pieces.The water-adding formula was optimized as: water addition=theoretical water absorption × correction coefficient of Chinese herbal pieces' water absorption+expected obtained herbal liquid volume+the evaporation of water vapor + the consumption of decoction machine.Compared with the water-adding ratio of 70:30 and 80:20 of the first decoction to the second decoction, the ratio of 60:40 can make the average deviation of the amount of obtained liquid smallest, which was 3.78%, and the average corrected relative density and the average paste-forming rate highest, which was 1.0273 and 19.81% respectively. Conclusion This study optimized the water-adding formula and selected the best ratio of the volume of water added in the first decocting process and the second decocting process, which can achieve the scientific and precise control of the water addition and liquid yield,guaranteed the higher extraction ratio of the compound decoctions and provided references for the correction and optimization when the water-adding formula is used in different decocting machines and different decocting methods.
Objective Under different conditions,to measure and analyze the temperature and evaporation rate of the boiling liquid in the slow fire and the strong fire,and to provide a reference for the digitaliz of the slow fire and the strong fire, and precisely control of fire in the process of decoction. Methods The tap water and liquid in decoction were used as the research objects.The natural gas was used to heat.The evaporation rate of the boiling decoctions were measured at different measuring positions,decoction times,liquid volumes,liquid concentrations,and liquid type conditions when using the slow fire and the strong fire. Results There were obvious differences in the temperature and evaporation rate of the boiling liquid during the slow fire and the strong fire.The depth of the thermometer inserted into the liquid (measurement position) was positively correlated with the temperature of the boiling liquid during the slow fire and the strong fire when the measuring position was fixed.The decoction time,liquid volume and concentration of the liquid medicine basically had no effect on the temperature and evaporation rate of the boiling liquid during the slow fire and the strong fire.However,different types of chemical liquids have a slight effect on the temperature and evaporation rate of the boiling liquid during the slow fire and the strong fire. Conclusion By measuring and analyzing the different conditions' temperature and evaporation rate of the boiling liquid during the slow fire and the strong fire,the preliminary quantification of the slow fire and the strong fire is carried out.To a certain extent,it is also conducive to elaborating of the scientific connotation of the slow fire and the strong fire,which lays the foundation for the precise control of the slow fire and the strong fire of the traditional Chinese medicine decoction equipment.
Objective To evaluate the five taste grades of common Chinese herbal pieces decoction, including acidity, bitterness, sweetness, pungency, and saltiness;and to lay a foundation for a database of taste information of Chinese herbal pieces decoction. Methods The decoction of 236 kinds of traditional Chinese medicine pieces were researched.A certain concentration of anhydrous citric acid (acidity), berberine hydrochloride (bitterness), sucrose (sweetness), ginger extract (pungency) and NaCl (saltiness) was used as reference solutions of five flavors.Decoction of traditional Chinese materia medica (DCMM) was evaluated qualitatively and graded by traditional human taste panel method (THTPM). Results Among the 236 kinds of DCMM, there are 23 kinds of sour taste, 89 kinds of bitterness, 61 kinds of sweetness, 47 kinds with pungent taste, 9 kinds of salty taste, and 38 kinds of light taste. Conclusion This study used THTPM to evaluate 236 commonly used DCMM taste levels of acidity, bitterness, sweetness, pungency, and saltiness,which laid a foundation for a taste information database and a quality evaluation method for Chinese herbal decoctions.
The quality of traditional Chinese medicine (TCM) decoction affects the effectiveness and safety of medicine directly.Because the machine-based decoction preparation has the advantage of convenience,safety,and standardization,it is more suitable for fast-paced life and can serve patients better.The TCM decocting machine used in medical institutions at present makes the decocting operation more digital and objective.The quality control of TCM decoction has become a common concern of doctors,pharmacists and patients.In this paper,the effects of packaging materials,packaging methods and storage time on the quality of TCM decoction were reviewed and discussed,in order to provide reference for the quality control and quality assurance of TCM decoction.
Traditional Chinese medicine decoction is the most common dosage form in clinical application of traditional Chinese medicine,and the quality of its finished product is directly related to clinical efficacy.This paper reviewed the researches on the quality control methods of TCM decoction.These explorations included the establishment of the group standard of “the technical specification of traditional Chinese medicine decoction”,the establishment of decocting database and rule base, the development of the decocting software, and the exploration of application of artificial intelligent sensory technology in this field.Utilizing the decocting software to develop individualized quality standards is an effective mean to perform quality control of TCM decoction's finished product.Meanwhile, utilizing the decocting software to develop individualized quality standards can guarantee the objectivity,timeliness, scientificalness, professionalism and effectiveness of the quality control of TCM decoction's finished product.It is also of great significance to improve the quality of TCM decoction's finished product and to guarantee the clinical efficacy of TCM.
Traditional Chinese medicine decoction is one of the most widely used dosage forms with the longest clinical application history.It has the characteristics of modification according to syndrome,taking effect quickly,and absorbing easily.As the last link before Chinese medicine enters the human body to play its therapeutic role,the quality of decoction is directly related to the clinical efficacy of Chinese medicine.Traditional decocting technology can be adjusted according to the personalized needs of different prescriptions,but the quality of decoction varies with personal experience.Due to the needs of large-scale production,the requirements for special decocting in the process of modern decocting are reduced,which is mainly manifested as homogenization of decoction.The standardization of decoction process of traditional Chinese medicine is of great significance to standardize the decoction process and reduce the quality difference of decoction caused by subjective factors,while personalization is an important manifestation of the characteristics of syndrome differentiation and treatment of traditional Chinese medicine,and both are indispensable.Therefore,it is particularly important to explore the method of combining standardization and personalization of decoction process of traditional Chinese medicine and realize the organic integration of the two,which is particularly important to promote the sustainable development of traditional Chinese medicine industry.
Hepatitis B virus infection is a global problem of public health,which has provoked widespread concern due to its high morbidity and mortality. Currently,many drugs for treating hepatitis B have appeared on the market,but have not achieved the desired therapeutic effect. At the same time,a lot of drugs generally possess the disadvantage of high drug resistance and adverse reactions. With the in-depth study of the mechanism of hepatitis B virus,a large amount of drugs are in the clinical research stage,and the treatment concept of hepatitis B is constantly updated. In this paper,we reviewed the recent researches of new anti-hepatitis B virus drugs,in order to provide references for clinical treatment.
Objective To establish a high-performance liquid chromatography (HPLC) fingerprint analysis combined with quantitatively analyze the multi-components by single marker (QAMS) method and to provide reliable quality control methods in Baihu decoction. Methods The fingerprint of 10 batches of Baihu decoction were established by HPLC.The relative correction factors (f) of neomangiferin,liquiritin and ammonium glycyrrhetate were calculated using mangiferin as internal reference,the content of four components in Baihu decoction was determined according to f,and difference between QAMS and external standard method (ESM) was evaluated. Results HPLC fingerprint of Baihu decoction was established,the similarity values of 10 batches >0.95,a total of 18 common peaks were included and 4 of them were identified.There was no significant difference in the determination of 4 main components between QAMS and ESM methods. Conclusion The method of combining fingerprint with QAMS is simple and reliable,which can provide an alternative method for the quality control of Baihu decoction.
Objective To establish a high performance liquid chromatography (HPLC) method for determination the main active components of zedoary turmeric oil cream. Methods The column was Agilent TC-C18 (4.6 mm × 250 mm,5 μm) at the temperature of 25 ℃.The mobile phase was composed of acetonitrile and water by gradient elution in the flow rate of 1.0 mL·min-1 with the detection wavelength of 216 nm. The injection volume was 10 μL. Results The four compounds,curdione,curcumenol,germacrone,and β-elemene,were well separated with good linear correlations (r≥0.998 9). The average recoveries of four compounds were ≥93.67%. Conclusion The HPLC method was simple,rapid and suitable for the quantitative analysis of zedoary turmeric oil cream.
Objective To detect and analyze safety signals of gabapentinoids(gabapentin and pregabalin)by the data mining methods based on FDA adverse event reporting system (FAERS) database,and to provide references for clinical safe use of gabapentinoids. Methods Data from FARES from 2004Q1 to 2019Q4 (64 quarters) were downloaded. After drug names standardization by MedEx and adverse events classification by MedDRA etc.,the adverse event report cases were extracted using the gabapentin and pregabalin as the primary suspected drug,and the ADR signal detection was conducted using PRR and ROR methods. Results A total of 121 701 cases (gabapentin 27 744 cases,pregabalin 93 957 cases) were gathered. Among them,the male/female ratio was 0.46,and the median age was 59 years old. Reports from “consumers” accounted for 56.35%,and from “physicians” accounted for 21.67%.Most reports were from the United States,accounting for 81.97%. The main route of administration were oral. More than half of the cases did not report the route of gabapentinoids administration. ADR signals were detected by proportional reporting ratio (PRR) method and reporting odds ratio (ROR) method,of which 16 415 cases(18.32%)for gabapentin and 79 589 cases(27.33%) for pregabalin. The number of reported cases of “nervous system disorders”,“general disorders and administration site conditions”,“psychiatric disorders” and “injury,poisoning and procedural complications” was relatively large for both. The top 5 preferred term(PT) for gabapentin which was detected ADR daul-signals were as follow:drug hypersensitivity,somnolence,drug ineffective for unapproved indication,product use in unapproved indication,suicidal ideation,of which “suicidal ideation” has not been included in Chinese gabapentin specification yet. The top 15 preferred term(PT) for pregabalin which was detected ADR daul-signals include withdrawal syndrome,drug withdrawal syndrome,intentional product misuse and intentional product use issue. Conclusion In this study,ROR and PRR are effectively used to extract the adverse drug reaction signals of gabapentinoids. It is recommended that the appropriate attentions should be paid to the possible adverse reactions caused by gabapentinoids. Indications of drug specifications should be strictly followed in clinical practice,and monitoring should be strengthened to further reduce and evaluate the risk of ADR.
Objective To evaluate the effectiveness of the pharmaceutical care pathway management model in patients of chronic obstructive pulmonary disease (COPD),and to provide a reference for clinical pharmacists to participate in the chronic disease management (CDM) of COPD patients. Methods A total of 210 patients with COPD who met the requirements of the department of respiratory and critical care medicine from January to June 2018 in the Xuzhou Medical University Affiliated Hospital of Lianyungang were randomly divided into control group and observation group,105 patients in each group, respectively. Patients in the control group received routine treatment by doctors and nurses. Patients in the observation group were monitored and managed by clinical pharmacists according to the COPD pharmaceutical care pathway. Analysis and comparison were conducted at three time points (before in-patient,before discharge and follow-up period) including inhalation preparation use score,medication compliance score,pulmonary function index,acute aggravation/ hospitalization frequency,clinical effective control rate,and adverse drug reactions (ADR) incidence between the patients in the two groups. Results After the implementation of COPD pharmaceutical care path management,the inhalation preparation use score,medication compliance score,percentage of forced expiratory volume in the first second at 12 months after discharge (FEV1%),and clinical effective control rate of patients in the observation group were all higher than those of the same group before in-hospital and the control group after the implementation of the pharmaceutical care pathway; the differences were statistically significant (P<0.01,P<0.05). In the 12th month after discharge,acute aggravation/hospitalization frequency and ADR incidence of patients in the observation group were significantly lower than those in the control group,with statistically significant differences (P<0.05). Conclusion The management mode of COPD pharmaceutical care pathway reflects the work content and the work value of clinical pharmacists. This paper provided a reference for clinical pharmacists to participate in the CDM of COPD patients.
To understand the application status of failure mode and effects analysis (FMEA) in medication risk management,and to discuss the problems and perspectives of FMEA. This paper reviews the literature and summarizes the research on the application of FMEA to medication risk management at home and abroad. We find that FMEA has achieved good results in reducing infusion risks,reducing medication errors,promoting rational medication use,improving medication safety,optimizing medication processes,controlling preparation process risks,improving safe storage of medicines,and reducing adverse drug reactions. However,the uncertainty of medical service standards,the subjectivity of intervention strategy formulation,and the particularity of risks in the pharmaceutical industry have limited the widespread use of FMEA. This paper points out that FMEA has unique advantages in medication risk management,it is easy to applicate and operate. Because of its limitations, it will be more widely used if it was coubined with other techniques.
Objective To investigate the quality of domestic economic evaluations of statins and to point out the key points for further improvement and standardization in this field. Methods The Guidelines for Quality Assessment of Pharmacoeconomic Evaluation Report (PEERs) was used to analyze the published literatures of economic evaluation of statins in China. Results Sixty-six research literatures on pharmacoeconomic evaluations of statins were included,with a compliance rate of 27.3% according to PEERs.All literatures needed to be further improved in aspects of "extrapolation,limitation and uncertainty of results","elaboration on pharmacoeconomic evaluation methods and research design types","data integrity and processing methods" and so on. Conclusion The quality of domestic pharmacoeconomic research of statins still needs to be improved. It is recommended that Chinese scholars should refer to the evaluation elements in the PEERs guidelines to elaborate the contents of the report more comprehensively and rigorously.