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• 01 June 2021 Volume 40 Issue 6

    

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  Interpretation of “2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or with Atherosclerotic Cardiovascular Disease”

  YIN Qinan,HAN Lizhu,BIAN Yuan,CHEN Lu,HUANG Xuefei,LEI Yang,SONG Yujie,TONG Rongsheng

  2021, 40(6): 703-714. https://doi.org/10.3870/j.issn.1004-0781.2021.06.001

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  In November 2020,the American College of Cardiology (ACC) published “2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease”,which provides a framework for decision-making among patients who require concomitant use of an anticoagulant(AC) and antiplatelet therapy(APT).Expert consensus decision pathway (ECDP) made antithrombotic recommendations for four clinical situations: a patient with atrial fibrillation(AF) receiving an OAC who now needs percutaneous coronary intervention(PCI) and APT,a patient on APT for ASCVD with new-onset AF requiring an OAC,a patient with prior venous thromboembolism (VTE) receiving an AC who now needs PCI and APT,a patient on APT for ASCVD with a new VTE requiring an ACP.This paper has made a comprehensive interpretation of this path,including a number of path maps and medication forms,in order to provide reference for clinical treatment.

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  Mechanism of Effect of Scutellariae Radix-Sophora Japonica L. in the Treatment of Hypertension based on Network Pharmacology

  GUAN Yiqing,CHEN Kai,TIAN Yuanxin,QUAN Dongling,ZHANG Jingru,LYU Lin,ZHANG Guohua

  2021, 40(6): 715-722. https://doi.org/10.3870/j.issn.1004-0781.2021.06.002

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  Objective To screen the target of Scutellariae Radix and Sophora Japonica L. in the treatment of hypertension using network pharmacology, in order to define the mechanism of antihypertension effect. Methods All the chemical constituents of Scutellariae radix and Sophora japonica L. were searched and retrieved from Traditional Chinese Medicine systems pharmacology database and analysis platform (TCMSP), and the targets of action were screened. The intersections of the chemical constituents and the hypertension related targets in TTD, OMIM, CTD and Genecards database were obtained. The corresponding active component-target network was established by software Cytoscape 3.6.0. The gene GO function and the KEGG pathway enrichment were analyzed using the Metescape online analysis platform, and the Sybyl 7.3 molecular docking software was used to analyze the binding of critical components to targets. Furthermore, animal experiments were used to verify the mechanism. Results Network of active component-targets related to hypertension of “Scutellariae Radix-Sophora Japonica L.” couplet medicine consisted of 45 hypertensive targets, 26 compounds, and 142 edges, reflecting the complex interaction between components and targets. The gene GO functional analysis suggested that molecular functions, biological processes and cell components were involved. Gene KEGG pathway enrichment analysis showed that it was related to 17 signaling pathways including HIF-1 signaling pathway, calcium signaling pathway and Apelin signaling pathway. The docking results of Sybyl 7.3 showed that isorhamnetin in Sophora Japonica L. had good binding activity with endothelial nitric oxide synthase, and moslosooflavone in Scutellariae Radixas had strong interaction with angiotensin converting enzyme. Isorhamnetin could increase eNOS in serum or endothelium and moslosooflavone could decrease ACE in serum in spontaneously hypertensive rats. Conclusion It is the first time to construct and preliminarily verify the network diagram of active components and targets of Scutellariae Radix-Sophora Japonica L. in the treatment of hypertension, which is helpful to elucidate the mechanism for the pharmacological research and clinical application of the couplet medicine.
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  Effect of Xingpi Jieyu Decoction on Memory Function of Aged Mice after Sevoflurane Anesthesia

  GAO Yuan,LI Xiuju,ZHAO Xue,ZONG Chuancheng,WANG Ling

  2021, 40(6): 723-728. https://doi.org/10.3870/j.issn.1004-0781.2021.06.003

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  Objective To observe the effect of Xingpi Jieyu decoction on the memory function of aged mice after sevoflurane anesthesia. Methods C57BL/6J mice were divided into normal control group,model control group,low-,medium- and high-dose Xingpi Jieyu decoction group,with 8 mice in each group.Water maze was used to detect the spatial memory ability of mice in each group.ELISA was used to detect the expressions of superoxide dismutase (SOD),malondialdehyde (MDA),glutathione peroxidase (GSH-PX),interleukin-17A (IL-17A),interleukin-2 (IL-2),interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in hippocampus and cerebral cortex of mice in each group.The contents of NO in hippocampus and cerebral cortex of mice in each group were detected by biochemical test.The expressions of B-cell lymphoma-2 (Bcl-2),Bcl-2 associated protein (Bax),and cysteine-containing aspartate-specific proteases-3 (caspase-3) in hippocampus of mice in each group were detected by Western blotting. Results Compared with mice in the model control group,the escape latency of the mice in low-,medium- and high-dose Xingpi Jieyu decoction group were significantly shortened,and the number of times for the mice which crossed the platform and the time they spent in the quadrant were increased.The contents of SOD,GSH-PX and NO in the hippocampus and cerebral cortex of mice in low-,medium- and high-dose Xingpi Jieyu decoction group were significantly increased (P<0.05),and the contents of MDA,IL-17A,IL-2,IL-6 and TNF-α were significantly decreased in a dose-dependent manner (P<0.05).Compared with model control group,the expressions of Bax and caspase 3 proteins in the hippocampus of the low-,medium- and high-dose Xingpi Jieyu decoction group were significantly decreased (P<0.05),and the expression of Bcl-2 protein was significantly increased in a dose-dependent manner (P<0.05). Conclusion Xingpi Jieyu decoction can effectively relieve the impairment of cognitive function induced by sevoflurane in a dose-dependent manner through its antioxidative effect,inhibiting the excessive release of inflammatory factors,and regulating apoptosis-related protein expression.
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  Expression and Optimizated of Liraglutide Precursor Peptide,GLP-1(7-37)K34R,in Escherichia coli

  LI Pengyan,ZHOU Chenghui,LI Qian,ZHAO Wei,LUO Xuegang

  2021, 40(6): 729-734. https://doi.org/10.3870/j.issn.1004-0781.2021.06.004

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  Objective To establish the GLP-1(7-37)K34R gene engineering expression system so as to lay a foundation for the industrial development of liraglutide biological similar drugs. Methods The codons were optimized and the GLP-1(7-37)K34R encoding gene (glp1a) was obtained by overlapping PCR amplification.The fusion expression of glp1a with GST,Ub and SUMO tag proteins in Escherichia coli were constructed,and the expression conditions of the three tag proteins were optimized from the aspects of induction moment,induction temperature,induction time and IPTG concentration.Furthermore,the target protein was purified by Ni-NTA affinity chromatography,and the tag was digested by enterokinase.Acquired purified protein was then analyzed by SDS-PAGE and HPLC. Results Among the three tags,the expression level of Ub-GLP-1(7-37)K34R protein was the highest.The highly expressed Ub-GLP-1(7-37)K34R protein was purified and recovered by enzyme digestion.Compared with the standard protein,the obtained protein was completely correct,and the calculated content was up to 130 mg·L^-1. Conclusion The GLP-1(7-37)K34R protein was successfully expressed by Escherichia coli.The optimal conditions and the optimal fusion label for protein expression were determined,and the protein purification system was established to obtain the target protein with high content and purity.
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  Expression of Fas/FasL in Spinal Posterior Dorsal Horn Cell Apoptosis Induced by Ropivacaine in Rat

  ZHANG Fuyu,ZENG Lian,LUO Zhao,SANG Ming,SUN Xiaodong,LUO Huiyu

  2021, 40(6): 735-739. https://doi.org/10.3870/j.issn.1004-0781.2021.06.005

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  Objective To investigate the expression of Fas/FasL in ropivacaine-induced apoptosis of rat spinal dorsal horn cells,and to explore the possible mechanism of neurotoxicity of ropivacaine. Methods Twenty-five adult male Sprague-Dawley rats were randomly divided into 5 groups: blank control group,model control group,low-,medium- and high-dose ropivacaine group,with 5 rats in each group. Except for the blank control group,the rats of other groups received intrathecal catheterization and 0.5%,1%,2% ropivacaine or 0.9% sodium chloride solution at the dosage of 0.12 mL·kg^-1 were injected into the sheath after 3 days of model building.The morphological changes of spinal cord cells were detected by HE staining; TUNEL staining was used to detect the apoptosis of the spinal cord cells; Immunohistochemistry was used to detect the expression of Fas and FasL in the spinal cord tissue. Results Compared with the blank control group,there was no significant difference in MWT of the model control groups before and after intrathecal catheterization (P>0.05). And 24 hours after the injection,the MWT of rats in the medium- and high-dose ropivacaine groups was significantly higher than that before the intrathecal injection (P<0.05).HE staining showed that the low-dose ropivacaine group had little edema in the spinal dorsal horn tissue compared with the model control group had; and in the medium- and high-dose ropivacaine groups,the interstitial edema was observed and the vacuoles were increased (P<0.05).Compared with the model control group,the expression of Fas was increased in each ropivacaine treatment group (P<0.05),and the high-dose ropivacaine group was significantly higher than the low- and medium-dose groups (P<0.05); The expression of FasL was only significantly elevated in the high-dose ropivacaine group (P<0.05). Conclusion Ropivacaine may induce neuronal injury and apoptosis of spinal dorsal horn cells by up-regulating the expression of Fas/FasL.
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  Pharmaceutical Study of Novel Azacyclocarbene Platinum (Ⅱ) Complexes on Antitumor Activity

  LIANG Bingbing,TANG Chengfei,HE Juan,YAO Huagang

  2021, 40(6): 740-744. https://doi.org/10.3870/j.issn.1004-0781.2021.06.006

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  Objective To design and synthesize two planar square platinum (Ⅱ) complexes with different structures, and to explore their anti-tumor activity and mechanism. Methods The in vitro cytotoxicity of complex 4 and 5 were tested by thiazole blue (MTT) method; the intracellular distribution of complexes was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) method; The protein immunoblotting method was used to detect the effect of the complex on the changes of the γH2AX antibody in the tumor cell nucleus; The Caspase-Glo^® kit was used to detect the form of damaged cells through scanning electron microscopy for the designed and synthesized complex. Results The experimental results show that the IC₅₀ values of the two platinum (Ⅱ) complexes designed and synthesized in this paper were significantly lower than those of cisplatin in Hela cells with the values of (4.4±0.2) μmol·L^-1 vs (8.2±0.2) μmol·L^-1. It means the cytotoxicity of complex 4 was about 4 times higher than that of cisplatin; Complex 4 and Complex 5 could be located in the cell nucleus, and cause damage in the nuclear DNA leading to the apoptosis. Both complexes have strong anti-tumor activity in vitro. Conclusion The azacyclocarbene platinum (Ⅱ) complex has good cytotoxicity and kills tumor cells by inducing DNA damage.
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  Active Ingredients and Mechanism of Guanxin Shutong Capsule Based on Network Pharmacology

  SHI Chang,SUN Guannan,WANG Dan,WANG Han,YAN Jiuxing

  2021, 40(6): 745-751. https://doi.org/10.3870/j.issn.1004-0781.2021.06.007

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  Objective To explore the active components, potential targets and mechanism of Guanxin Shutong capsule in the treatment of coronary heart disease using network pharmacology research method. Methods Through Traditional Chinese Medicine(TCM) systematic pharmacology database and analysis platform (TCMSP) and other databases and literature mining, all compounds of Guanxin Shutong capsule and their pharmacological properties were retrieved. The oral bioavailability (OB), Caco-2 permeability (Caco-2) as well as drug-likeness (DL) analysis were screened to filter the candidate ingredients for further study. Using the Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine (BATMAN-TCM), the candidate targets were predicted, and then were entered into TTD, Pharm GKB, and other databases to screen potential targets related coronary heart disease (CHD). The compound-target and target-disease networks were constructed by Cytoscape software, then network topology parameters were calculated and analyzed. Results A total of 384 compounds were obtained, and their pharmacological properties parameters showed that the components in Guangzao and Salvia miltiorrhiza were similar in pharmacological properties, which was consistent with the compatibility rules of Guanxin Shutong capsule. There were 42 candidate compounds that met the screening conditions, and 282 related targets were obtained, of which 32 were related to coronary heart disease. Network topology analysis showed that there were 16 potential active compounds whose topological parameter values were higher than the mean value, of which 12 had been confirmed by the literatures to have anti-inflammatory, antioxidant and anti-apoptotic activities. Target-disease network analysis showed that in addition to coronary heart disease, Guanxin Shutong capsule may also be used to treat various diseases such as Alzheimer's disease. Conclusion Sixteen active compounds were identified by network pharmacological method, which produced therapeutic effects on CHD by exhibiting the anti-inflammatory, antioxidant and anti-apoptotic activities on multiple targets in the body. In addition, Guanxin Shutong capsule also has potential of treating other diseases, such as Alzheimer's disease.
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  Effect of Pinggan Zhixian Compound Granules Combined with Carbamazepine on Autophagy and Apoptosis of Hippocampus in Intractable Epilepsy Rats

  WANG Qiang,XUE Hong,GUO Leilei,LOU Jinbo,LI Ruozhao,LIU Yunquan

  2021, 40(6): 752-757. https://doi.org/10.3870/j.issn.1004-0781.2021.06.008

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  Objective To investigate the effect of Pinggan Zhixian compound medicine combined with carbamazepine on autophagy and apoptosis of hippocampus in rats with intractable epilepsy. Methods The intractable epilepsy model rats induced by kainic acid and phenytoin sodium were divided into model control group,carbamazepine group (0.03 g·kg^-1·d^-1),Pinggan Zhixian compound medicine (4.8 g·kg^-1·d^-1) combined with carbamazepine group (0.03 g·kg^-1·d^-1),and sham operation group (8 rats in each group). At the end of modeling,rats in the drug intervention groups were given the corresponding drugs by gavage, and rats in sham operation group and model control group were given the same volume of 0.9%sodium chloride solution by gavage. After 28 days of administration,HE staining was used to observe the pathological changes of hippocampal tissue; Nissl staining was used to observe the changes of neuron Nissl body; Transmission electron microscopy was used to observe the changes of autophagy of neurons; TUNEL method was used to detect the changes of apoptosis in hippocampal tissues; Western blot was used to detect the expression of Bcl-2 related X protein (Bax),B lymphoma-2 (Bcl-2),Caspase-3,Beclin 1,LC3Ⅱ/Ⅰ in hippocampus. Results Compared with the sham operation group,the pathological damage,autophagosome number and Bax,Caspase-3,Beclin 1,LC3Ⅱ/Ⅰprotein expressions of hippocampus in the model control group were increased(P<0.05),while Nissl body and bcl-2 protein were decreased(P<0.05);Compared with the model control group,the pathological damage,autophagy number and Bax,Caspase-3,Beclin 1,LC3Ⅱ/Ⅰprotein expressions of hippocampus in the carbamazepine group were decreased(P<0.05),and Nissl body and bcl-2 protein expression were decreased(P<0.05).Compared with carbamazepine group,the number of autophagy and the expressions of Bax,Caspase-3,Beclin1,LC3Ⅱ/Ⅰ protein in the group of Pinggan Zhixian compound combined with carbamazepine were decreased(P<0.05),while the Nissl and bcl-2 protein were increased(P<0.05). Conclusion Pinggan Zhixian compound combined with carbamazepine has protective effect on hippocampal neurons of intractable epilepsy rats,and its specific mechanism may be related to autophagy regulation and apoptosis inhibition.
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  Advances in Drug Therapy in Different Stages of Parkinson's Disease

  LIU Yongfang,MA Kaili

  2021, 40(6): 758-763. https://doi.org/10.3870/j.issn.1004-0781.2021.06.009

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  Parkinson's disease (PD) can be probably divided into four parts: prodromal stage,early stage (stable stage),mid-late stage(unstable stage),and advanced stage.Currently,the treatment for motor symptoms of PD includes dopamine drugs,dopamine receptor agonists,monoamine oxidase B inhibitors,catecholamine-O-methyltransferase inhibitors,anticholinergic drugs,etc.. The treatment of non-motor symptoms is mainly symptomatic treatment.The symptoms of PD are different in different stages,and the goals and emphasis of treatment are also different. Therefore,this article reviews the drug treatment of different stages of Parkinson's disease.

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  Pharmacokinetics and Safety of Huperzine A in Chinese Elderly Subjects

  QIAN Hongjie,ZHANG Mengqi,ZOU Yang,LIU Shuyun,WANG Wei,CHEN Qian,LIU Gangyi,LIU Yun,YU Chen,JIA Jingying

  2021, 40(6): 764-767. https://doi.org/10.3870/j.issn.1004-0781.2021.06.010

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  Objective To investigate the pharmacokinetics and safety of huperzine A in Chinese elderly subjects. Methods Fourteen subjects aged 60-80 years,without cognitive impairment,received a single dose of 0.1 mg huperzine A.Blood and urine samples were collected to measure the pharmacokinetic profiles within 48 h after the drug administration.A validated LC-MS/MS method was used to determine drug concentration in biological samples.Safety parameters including adverse events were monitored throughout the study. Results The maximum observed concentration (C_max) in plasma was (0.92±0.28) ng·mL^-1; t_max was (2.61±1.67) h; AUC_(0-72h) was (15.12±4.73) ng·h·mL^-1and AUC_(0-∞) was (16.99±4.92) ng·h·mL^-1. Elimination half-life (t_1/2) was (14.38±3.87) h.Accumulated excretion rate was 34.76% within 48 h after huperzine A administration.One case subject(7.1%) reported mild AE which were unlikely to be related to the study drug. Conclusion The results showed that huperzine A was well tolerated in Chinese elderly subjects.Pharmacokinetic data demonstrated a relative slower process of absorption and elimination,and higher exposure of huperzine A in the elderly population compared to non-elderly population.
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  Mechanism of Calculus bovis in the Treatment of Ischemic Stroke Based on Network Pharmacology

  CHEN Hai,LI Hongyan,WANG Jian,XIE Qian,FU Yin

  2021, 40(6): 768-772. https://doi.org/10.3870/j.issn.1004-0781.2021.06.011

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  Objective To explore the potential targets and signaling pathways of Calculus bovis in treating ischemic stroke. Methods The target genes of major active components of Calculus bovis and ischemic stroke related genes were searched based on the databases of Traditional Chinese Medicine Systems Pharmacology database and analysis platform (TCMSP), PubChem Compound-NCBI, GeneCards, KEGG, DisGeNET and gene-disease association. A protein-protein interaction (PPI) network was constructed between the target genes and the active component of Calculus bovis. And Go function enrichment analysis and KEGG pathway enrichment analysis were further performed. Results The results showed that 60 target genes of active components of Calculus bovis, 260 target genes for ischemic stroke and 8 common targets were obtained: HMGCR, PPARA, CYP2C19, ESR1, ESR2, MMP1, MAPT, CASP3. The results of GO and KEGG analysis enrichment suggested that the treatment of ischemic stroke by Calculus bovis was associated with steroid hormone biosynthesis, metabolic pathway and neuroactive ligand-receptor interaction of steroids. Conclusion It is preliminarily predicted that Calculus bovis may act on ischemic stroke by targeting 8 key proteins of HMGCR, CYP2C19, ESR1, ESR2, CASP3, CYP11, CYP17 and CYP19, as well as through the biosynthesis and metabolism related pathways of steroid hormones. However, further experiment is still needed to verify.
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  Potential Association of PCSK9,with Brain Cholesterol Homeostasis and Alzheimer's Disease

  LI Yuan,ZHAO Zhenyu,Md Sayed Ali Sheikh,HU Tao,XIA Ke

  2021, 40(6): 773-775. https://doi.org/10.3870/j.issn.1004-0781.2021.06.012

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  Pre-protein-converting enzyme subtilisin kexin9 (PCSK9) inhibitors have attracted much attention in lipid management. However, the potential association of PCSK9 with brain cholesterol homeostasis and Alzheimer's disease (AD) is little known.Studies have shown that brain cholesterol depends on in situ synthesis, and the level of PCSK9 in the cerebrospinal fluid of patients with AD is elevated,but PCSK9 cannot cross the blood-brain barrier.This paper will elaborate the possible mechanism and targets of PCSK9 involve in brain cholesterol homeostasis and AD,and further explore whether the application of PCSK9 inhibitors in the cardiovascular field has an impact on the neurocognitive function of patients.

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  Effect of Shuxin Oral Liquid on the Clinical Efficacy and Sleep in Patients with Stable Coronary Heart Disease and Anxiety

  WANG Junli,LI Liwei,TIAN Qiangqiang,ZHANG Beibei,GONG Xue,XU Jinmei,MEI Junhua

  2021, 40(6): 776-781. https://doi.org/10.3870/j.issn.1004-0781.2021.06.013

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  Objective To explore the effect of Shuxin oral liquid combined with conventional western medicine on sleep,exercise ability and clinical symptoms in patients with stable coronary heart disease (CHD) and anxiety based on the theory of “psycho-cardiology disease” in Traditional Chinese Medicine (TCM). Methods Patients with stable coronary heart disease and anxiety were randomly divided into the treatment group and the control group,with 43 cases in each group.The patients in both groups were equally treated with conventional western medicine,while the treatment group was additionally treated with Shuxin oral liquid (20 mL,bid) for 12 weeks.All patients were conducted face-to-face communication before treatment,and were followed up at the 4th week and the 12th week during the treatment. The general vital signs,clinical-related adverse events,frequency of angina pectoris and nitroglycerin consumption were recorded. At the same time using the TCM syndrome score scale,HAMA,PSQI,PSG and 6MWT were measured to evaluate the clinical symptoms,emotional and sleep state,and exercise ability of the two groups. Results Before treatment,total scores of TCM syndromes,HAMA scores,PSQI scores,PSG monitoring indicators,and 6MWT distances were not significantly different between the groups (P>0.05); During the follow-up period,total scores of TCM syndromes,HAMA scores,PSQI scores,PSG monitoring indicators,and 6MWT distances in the treatment group were significantly different from those at the last follow-up time (P<0.05); At the same time points of the follow-up,total scores of TCM syndromes,HAMA scores,PSQI scores,PSG monitoring indicators,and 6MWT distances in the treatment group were significantly different from those in the control group (P<0.05). Conclusion Shuxin oral liquid in the combination therapy for stable coronary heart diseaseand anxiety patients can improve the clinical symptoms,sleep efficiency and exercise ability,and reduce the frequency of cardiac-related clinical events,which provide a theoretical basis for treating "psycho-cardiology disease" using traditional Chinese medicine.
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  Clinical Effect of Minimaive Needle-knife Scope Combined with Medicine in the Treatment of 30 Cases of Rheumatoid Arthritis

  ZHANG Yong,WU Wei,ZHANG Mengyun,DING Xiaojuan,YU Qiao,YANG Wenchao,XIAO Jingjing,HE Dongchu

  2021, 40(6): 782-785. https://doi.org/10.3870/j.issn.1004-0781.2021.06.014

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  Objective To explore the mechanism and clinical efficacy of minimaive needle-knife scope combined with medicine in the treatment of rheumatoid arthritis. Methods A total of 60 RA patients from January 2018 to October 2019 were collected.The patients were randomly divided into treatment group and control group with 30 cases in each group.The treatment of the control group was as follows: celebrex 200 mg,po,bid,methotrexate 10 mg,po,qw,hydroxychloroquine 0.2 g,po,bid, 4 weeks of treatment .The treatment group was once treated with minimaive needle-knife scope on the basis of the control group.At the end of the course of treatment,the changes of ESR,CRP,DAS28,Lysholm knee score and the standard indexes of the improvement of American rheumatology society (ACR20,ACR50 and ACR70) were observed before and after treatment.The indexes of inflammatory factors in synovial fluid at the beginning and end of operation in the treatment group were analyzed. Joint fluid was not detected in the control group. Results After 4 weeks of treatment,the improvement of ESR,CRP and ACR in the treatment group was better than those in the control group (P<0.05),and the DAS28 and Lysholm knee score in the treatment group were significantly better than those in the control group (P<0.01).Analysis of synovial fluid in the treatment group showed that IL-6 in synovial fluid increased significantly before the operation .IL-4,IL-10,INF-γ and TNF-α increased slightly,while IL-2 was normal.The level of IL-6 in synovial fluid was positively correlated with CRP and DAS28 (P<0.01).After the operation,the levels of IL-6 and other related inflammatory factors in synovial fluid decreased significantly (P<0.01). Conclusion Minimaive needle-knife scope treatment of rheumatoid arthritis,can quickly reduce the level of IL-6 and other inflammatory factors in synovial fluid,relieve the symptoms of joint swelling and pain,and improve the condition.
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  Effects of Telmisartan on Uric Acid Metabolism and Microinflammatory State in Patients with Renal Impairment of Metabolic Syndrome

  LONG Li,QIN Huiqun,ZHANG Jibo,YU Jianfeng,JIN Sheng,XU Min,LIU Hao

  2021, 40(6): 786-791. https://doi.org/10.3870/j.issn.1004-0781.2021.06.015

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  Objective To explore the effects of the treatment of temisartan on uric acid metabolism and microinflammatory state in patients with renal function in metabolic syndrome. Methods A total of 187 cases with metabolic syndrome in patients with high uric acid hematic disease were divided into 3 groups:telmisartan 40 mg (group A),telmisartan 80 mg (group B) and the control group (group C). Retrospective analysis of the three groups of patients before and after 8 weeks treatment was carried out for the blood uric acid,eGFR、fasting blood glucose,blood lipids,hs -CRP and IL-6 and TGF-β₁,MCP-1indicators. The blood uric acid,eGFR,blood glucose,blood lipids,inflammatory reaction index changes were compared between groups after treatment. Spearman correlation was used to analyze the correlation between changes in serum uric acid and changes in inflammatory response indicators and eGFR. Results After treatment,the levels of serum uric acid,blood glucose,blood lipid,hs-CRP,IL-6,TGF-β₁ and MCP-1 in group A and group B were significantly lower than those before treatment,and eGFR was significantly higher in group B than group A.The difference between groups was statistically significant (P<0.05).The serum levels of uric acid,eGFR,blood glucose,blood lipid,hs-CRP,IL-6,TGF-β₁ and MCP-1 in group C showed no significant in changes compared with those before treatment (P>0.05).In 8 weeks after treatment,the change of blood uric acid (ΔUA) and the hs-CRP,IL-6,TGF-β₁,the change of MCP -1 index were positively correlated (r>0.5,P<0.05); The changes of serum creatinine (ΔCr) and the hs-CRP,IL-6,TGF-β₁ and the change of MCP-1 was positively correlated (r>0.4,P<0.05). Conclusion Telemisartan can reduce uric acid and inhibit microinflammatory response in patients with renal damage of metabolic syndrome,which is dose-dependent.The increase of serum uric acid may be one of the important factors that promote the microinflammatory response in patients with renal damage of metabolic syndrome which further lead to the progress of renal function.
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  Research Progress on Active Compounds of Traditional Chinese Medicine for Promoting Osteogenesis

  SUN Miaomiao,LIANG Pengchen,LI Luyi,CHANG Qing,YI Qingqing

  2021, 40(6): 792-796. https://doi.org/10.3870/j.issn.1004-0781.2021.06.016

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  The surface of titanium has good biological properties, and its implant can promote osteogenesis in bone tissue. However, in the process of implant integration into bone tissue, bone infection, bone defect, osteoporosis, and other related diseases also appear one after another. Traditional Chinese Medicine (TCM) is used to prevent, treat, and diagnose diseases. It is a very effective method to apply its active compounds in titanium implants to promote osteogenesis. Therefore, it is of great significance to construct the carrier for active compounds of TCM, to study its loading mode and to realize the surface combination of TCM and titanium implants. This paper reviews the osteogenic effect of active compounds of TCM, the carrier of drug loading on the surface of titanium implants, the mode of drug binding, and the application of active compounds of TCM on the surface of titanium implant. It is hoped that the active compounds of TCM can be better applied to the surface of titanium implants and provide new research ideas for promoting local osteogenesis.

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  Optimization on the Preparation of Gardenoside Liposomes by Central Composite Design-Response Surface Method

  CAO Juan,HOU Xueqin,WANG Fugang

  2021, 40(6): 797-800. https://doi.org/10.3870/j.issn.1004-0781.2021.06.017

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  Objective To optimize the preparation of gardenoside liposomes by the central composite design-response surface method and to evaluate its quality. Methods The film-dispersion method was used to prepare geniposide liposomes.The formulation was optimized and validated by a single factor and central composite design-response surface method with the entrapment efficiency and drug loading as the evaluation indexes. Results The second-order polynomial equation had good satisfactory predictability.The optimum preparation conditions were as follows: the ratio of lipid to drug was 32:1,the ratio of soybean lecithin to cholesterol was 6:1,and the amount of hydration solvent was 32 mL.The particle size of the liposomes was (157.0±6.4) nm,the encapsulation efficiency was (87.8±1.68)%,and the drug loading was (4.48±2.58)%. Conclusion The preparation method is simple, reasonable and feasible,which can provide a reference for the further study for the new formulation of geniposide.
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  Application of Serum Lithium Level and Critical Value in Department of Psychiatric

  ZHANG Shaochuan,CHEN Zhixiang,HUANG Qiuyan,ZHANG Haiqing,YANG Bo,ZHOU Li,HU Yi,HUANG Chaohong,YANG Chunxia

  2021, 40(6): 806-810. https://doi.org/10.3870/j.issn.1004-0781.2021.06.019

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  Objective To analyze the monitoring and critical value of serum lithium concentration in a third-grade psychiatric hospital in the past three years, and to provide clinical basis for the rational and safe use of lithium carbonate in psychiatric hospitals. Methods A retrospective analysis was made on the monitoring data of serum lithium concentration of 1915 cases from January 2015 to May 2018, as well as the occurrence rate of critical value, clinical treatment rate, and adverse drug reactions (the lithium reference range was set from 0.4 to1.2 mmol·L^-1, and the critical value range was more than 1.5 mmol·L^-1). Results Among the 1915 cases of serum lithium level monitoring results, the serum lithium concentration of female patients was higher than that of male patients, and the difference of median serum lithium concentration between male and female patients was statistically significant (P<0.01). And the serum lithium concentration gradually decreased with age, and the difference of serum lithium concentrations among different age groups was statistically significant (P<0.01). In the monitoring of serum lithium concentration in 1915 cases, the incidence rate of critical value was 2.04% (39 cases), and the clinical treatment rate was 100.00%, and the incidence rate of adverse drug reactions was 88.89%. Conclusion Due to the large differences in the individualization of lithium salts in clinical use, it is recommended to regularly monitor the lithium ion concentration for patients who have been treated with lithium for a long time. At the same time, a reasonable critical value reporting system should be established to promote the coordination and cooperation between doctors, nursing staff, and inspection personnel, thereby reducing the occurrence of medical accidents and ensuring the safety for patients.
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  Signal Detection and Analysis of Adverse Drug Event Related to Hepatic Disorders Induced by Low-dose Methotrexate

  WANG Hualing,HU Qiaozhi,XU Ting

  2021, 40(6): 827-830. https://doi.org/10.3870/j.issn.1004-0781.2021.06.024

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  Objective To detect various kinds of adverse hepatic event of low-dose methotrexate in post-marketing experience and supply guidelines for clinicians so as to provide reference for clinical rational application of low-dose methotrexate. Methods Data from FDA Adverse Event Reporting System (FAERS) from January 1, 2018 to December 31, 2019 were downloaded. All the methotrexate-induced adverse hepatic event were screened by standardized MedDRA queries (SMQ) and were analyzed by reporting odd ratio (ROR) algorithm, and the impacts of gender, age, administration route were analyzed. Results A total of 10 755 628 ADE reports for all drugs were obtained, and 45 496 reports with low-dose methotrexate as the primary suspected drug were extracted. And 31 ADR signals of low-dose methotrexate related liver diseases were detected by ROR method. The statistical analysis results showed that no significant differences were observed between adverse hepatic event and other adverse drug events in gender (P=0.067), age (P=0.088), administration route (P=0.134). Conclusion In the clinical practice of methotrexate, attention should be paid to new adverse drug event such as abnormal coagulation factor V level and drug related hepatic disorders in all patients.
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  Literature Analysis of 93 Cases of Drug-Induced Renal Impairment

  LI Ying,XIONG Di,ZOU Jili,SONG Yanyan,WANG Jie,ZHANG Jianghong,YANG Xinqiang,QIAO Yi,YANG Zhifu,WANG Jingwen,WEN Aidong

  2021, 40(6): 831-834. https://doi.org/10.3870/j.issn.1004-0781.2021.06.025

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  Objective To investigate general rules and characteristics of drug-induced renal impairment and provide references for clinical safe drug use. Methods Case reports of drug-induced renal impairment in CNKI,Wanfang Database,and VIP database were searched,and 76 articles were collected for statistical analysis. Results A total of 93 cases of drug-induced renal impairment were collected,and 38 cases were induced by antimicrobial drugs,accounting for 40.86%;14 cases were induced by TCM drugs,accounting for 15.05%;11 cases were induced by analgesic drugs,accounting for 11.83%;30 cases were induced by other drugs,accounting for 32.26%.In 93 cases of drug-induced renal impairment patients,91 cases were improved,and 2 cases were died. Conclusion Attentions should be paid to the drug-induced renal impairment, must be alert to the renal function damage caused by antibiotics and Traditional Chinese Medicine, and should strengthen medication monitoring and timely symptomatic treatment.
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  Practice of Outpatient Prescription Review based on Clinical Rational Drug Use Intelligent Management System

  ZHANG Xufeng,SHI Xiangfen,LU Xiaojing,GAO Songwei,CHEN Xiaoxu,LI Hongmeng,DU Shuzhang

  2021, 40(6): 837-840. https://doi.org/10.3870/j.issn.1004-0781.2021.06.027

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  Objective Using the intelligent management system of clinical rational drug use to promote the software examination of prescriptions, and to improve the quality of prescriptions and rational use of drugs. Methods To introduce the implementation method of prescription software review system, and analyze the usage and dosage of outpatient prescription before and after the implementation. Results After the implementation of software review of prescription, with the reasonable modification of usage and dosage rules, the reviewer party was more humane; the proportion of outpatient unreasonable prescription in usage and dosage decreased from 37.18% to 4.86%. Conclusion With the reasonable modification of the usage and dosage rules, the quality of the prescription was improved significantly, which promote the rational clinical use of drugs.
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  Reduce the Incidence of Multidrug-Resistant Bacteria in NICU by PDCA Management

  HAN Jingjing,DENG Min,CHENG Yujia

  2021, 40(6): 841-845. https://doi.org/10.3870/j.issn.1004-0781.2021.06.0

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  Objective To explore the effect of PDCA management on reducing the incidence of multidrug-resistant bacteria in NICU. Methods From July 2016 to December 2017, the PDCA method was used to comprehensively manage the prevention and control of nosocomial infection and the use of antibiotics in NICU. The incidence of nosocomial infection, the per capita cost and use of antibacterial drugs, the detection of MDRO and the hospital infection caused by MDRO were compared before and after the intervention. Results The incidence of nosocomial infection in NICU decreased from 2.03% to 0.75% after the intervention. The average cost of using antibiotics per capita decreased from (1 266.28±234.54) yuan to (906.11±189.24) yuan; the average days of using antibiotics per capita decreased from (10.21±3.64) d to (8.76±2.81) d; And the utilization rate of antibiotics for special use decreased from 30.19% to 18.00 %. The detection rate of MDRO decreased from 37.70% to 4.25% (P<0.001), and the detection of key MDRO reduced from 23.77% to 0 (P=0.001). The patients with multiple resistant bacteria detected by NICU decreased from 2.76% to 0.30% (P<0.001), and MDRO-induced nosocomial infection decreased from 1.31% to 0.15% (P=0.031). Conclusion After strengthening the prevention and control of nosocomial infection and standardizing the use of antibiotics through PDCA management method, the incidence of nosocomial infection and the detection of MDRO in NICU can be significantly reduced, and the use of antibiotics has been significantly improved.