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OBJECTIVE To analyze the current status， hotspots and development trends of research on the treatment of non-alcoholic fatty liver disease （NAFLD）， providing reference for subsequent research. METHODS Searching the Web of Science database， the literature related to the treatment of NAFLD from the establishment of the database to December 31， 2022 were collected. CiteSpace 6.1.R6 was used to construct a visual atlas， perform collaborative network analysis on authors， countries and institutions， and conduct keyword co-occurrence， clustering and emergence analysis to explore its research status and hotspots. RESULTS A total of 3 882 articles were included， and the number of publications had been increasing year by year. The top three countries in terms of publication volume were China， the United States， and Japan. The author with the highest volume of publications was Sanyal from the United States （37 articles）， while the institution with the highest volume of publications was the University of California， San Diego （75 articles）. A closely connected research team abroad mainly conducted large-scale randomized controlled trials （RCT） to evaluate the effectiveness and safety of various interventions， including medication and lifestyle， in treating NAFLD. However， domestic researches mainly focused on basic researches about the treatment of NAFLD with effective medicinal ingredients， and were characterized by traditional Chinese medicine. There were relatively few high-quality large-scale RCT studies related to it. Keyword analysis showed that researches in various countries mainly focused on regulating liver oxidative stress and inflammation， improving the overall balance of glucose and lipid metabolism. Except for hypoglycemic drugs， drugs that act on various comprehensive metabolic homeostasis targets in the body had entered clinical research， and had enormous therapeutic potential. CONCLUSIONS The research on NAFLD treatment continues to grow in popularity and tends to research targets and drugs for regulating systemic metabolic homeostasis. As the main force of research， China should strengthen communication with the international community， grasp the trends and directions of basic research， attach importance to clinical research， and continuously tap the therapeutic potential of traditional Chinese medicine.
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OBJECTIVE：To provide reference for clinical safe and rational drug use by mining adverse drug events （ADE） signals for tocilizumab. METHODS ：Data of ADE reports related to tocilizumab in the first quarter of 2015 to second quarter of 2020 were collected from US FDA adverse event reporting system. After data standardization ，the proportional imbalance method was used for ADE signal mining. RESULTS ：A total of 163 718 ADE reports were extracted ，in which tocilizumab was primary suspected drug ，involving 26 674 patients. In 26 674 patients，the proportion of female （73.69％）was higher than that of male （19.04％），and the age was mainly 60-74 years old （21.19％）. Among the 163 718 ADE reports ，the main reporting countries were the United States （70.15％），Canada（15.95％），Japan（3.33％），Australia（3.05％）and Brazil （1.43％）；consumers （31.35％）and doctors （24.94％）were the main reporting staff. A total of 747 ADE signals for tocilizumab were obtained ， commonly rheumatoid arthritis ，joint pain and pain ；and the signals as the increase of disability assessment scale score ，the decrease of disability assessment scale score ，abnormal diastolic blood pressure and abnormal systolic blood pressure were strong. A total of 33 kinds of ADE signals were found ，which were not recorded in the instructions of tocilizumab ，and mainly abnormal laboratory indicators such as decreased oxygen saturation ，decreased blood pressure and abnormal heart rate. ADE mainly involved 27 system organs ，including musculoskeletal and connective tissue ，various reactions of systemic diseases and drug delivery site ， various examinations. CONCLUSIONS ：In addition to the ADE mentioned in the drug instructions ，when using tocilizumab in clinic，attention should also be paid close to blood oxygen saturation ，blood pressure ，blood routine indexes and other laboratory indicators，and intervention measures should be taken early when ADE occurs ，so as to ensure the safety and effectiveness of drug use.
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Objective To investigate the application prospect of the most extensive genome engineering pig internationally in preclinical xenotransplantation. Methods Porcine endogenous retrovirus (PERV) knockout combined with 3 major heterologous antigen gene knockouts and 9 humanized genes for inhibition of complement activation, regulation of coagulation disorders, anti-inflammatory and anti-phagocytosis were transferred into a pig (PERV-KO/3-KO/9-TG) as a donor, and the heart, liver and kidney were obtained and transplanted to 3 Rhesus macaque recipients respectively to establish a preclinical research model of pig-to-Rhesus macaque xenotransplantation. The functional status of xenografts after blood flow reconstruction was observed and the survival of recipients was summarized. The hemodynamics of xenografts were monitored. The change of hematological indexes of each recipient was compared. The histopathological manifestation of xenografts was observed. Results After the blood flow was reconstructed, all xenografts showed ruddy color, soft texture and good perfusion. The transplant heart, liver and kidney showed full arterial and venous blood flow and good perfusion at 1 d after operation. The postoperative survival time of heart, liver, and kidney transplant recipients was 7, 26, and 1 d, respectively. The levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase increased in heart transplant recipient at 1 d after operation, and gradually recovered to near normal levels at 6 d after operation. All indexes increased sharply at 7 d after operation. The level of aspartate aminotransferase increased in liver transplant recipients at 2 d after operation, and the alanine aminotransferase basically returned to normal at 10 d after operation, but the total bilirubin continued to increase. Both aspartate aminotransferase and alanine aminotransferase increased at 12 d after operation, and reached a peak at 15 d after operation. The kidney transplant recipient developed mild proteinuria at 1 d after operation, and died of sudden severe arrhythmia. Histopathology showed that the tissue structure of cardiac and renal xenografts was close to normal, and liver xenografts presented with patchy necrosis, the liver tissue structure was disordered, accompanied by inflammatory damage, interstitial hemorrhage and thrombotic microangiopathy. Conclusions PERV-KO/3-KO/9-TG pig shows advantages in overcoming hyperacute rejection, mitigating humoral rejection and coagulation dysregulation. However, whether it can be used as potential donor for clinical xenotransplantation needs further evaluation.
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OBJECTIVE： To explore the role of clinical pharmacists in medication therapy management （MTM）. METHODS： Referring to the practice model of MTM in the United States， taking a noninfectious chronic disease （obesity diabetes mellitus） patient as an example， clinical pharmacists of endocrinology specialty carried out MTM according to five processes， such as patient information collection， medication therapy review， the formulation of medication-related action plan （MRP）， interventions related to direct communication with physicians or advising patients to consult relevant medical service personnel， record and follow-up. RESULTS： The information of patients collected by clinical pharmacists included past medical history， family history， allergy history and medication history， etc. It was the top priority MRP for this patient to identify inappropriate hypoglycemic drug therapy， obesity-induced obstructive sleep apnea-hypopnea syndrome and hyperlipidemia. For obesity patients with type 2 diabetes mellitus， clinical pharmacists recommend that patients changed insulin drugs to non-insulin drugs， and liraglutide was recommended. In view of the poor control of blood lipid level， fenofibrate was recommended for patients on the basis of oral administration of simvastatin. The patient’s attending physician agreed with the above suggestion and adjusted the prescription. Clinical pharmacists provided medication education for the patients about the importance of each drug， control of total energy intake， balanced diet and physical exercise. The follow-up results after 6 months showed that blood glucose （fasting blood glucose 5-7 mmol/L， postprandial blood glucose 8-10 mmol/L） and blood lipid （total cholesterol 4.80 mmol/L， triglyceride 1.60 mmol/L， low density lipoprotein 3.05 mmol/L） of the patient were effectively controlled and body weight was reduced by 3 kg， but the improvement of lifestyle was poor， mainly due to the nature of his work. Clinical pharmacists once again communicated with him and emphasized the importance of proper physical exercise. The patients agreed to continue the follow-up. CONCLUSIONS： Clinical pharmacists can provide professional consultation and service for patients with chronic diseases by means of MTM service mode， which has certain value for improving medical quality.
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OBJECTIVE:To investigate the status quo of knowledge-attitude-practice(KAP)of medication in residents,and to explore potential risk factors that may affect medication. METHODS:By approximate random sampling,online(wenjuanxing)and offline method (5 communities of Chengdu city) were used to collect general information (gender, age, monthly income, residence,medical insurance,education level,working condition,occupation)of the residents aged 19 year-old above and conduct KAP investigation during Jul.-Aug. 2017. Multiple linear regression analysis was used to analyze the influence of residents'general information on KAP. RESULTS:A total of 517 online and offline valid questionnaires were obtained, including 200 offline questionnaires were sent out and 184 valid questionnaires were returned with recovery rate of 92％. Average scores of medication knowledge,attitude and practice were (71.4 ± 32.3),(33.7 ± 14.0),(60.7 ± 19.4),which all reached"good"in the evaluation standard of questionnaire results. The results of multiple linear regression showed that elderly and low education level were the significant influential factors of residents'lack of medication knowledge. The male,elderly,low income and low education level were the influential factors of poor drug use behavior. The residents with poor attitudes towards medication were low income and low educated population. CONCLUSIONS:The average risk of residents'medication in China is low,but it is still necessary to strengthen medication education for special people. It is requisite to focus on the elderly,the low education level,the low income population and the male residents.
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OBJECTIVE:To establish the method for the detection of the known glucagon-like peptide 1 receptor (GLP1R) gene mutation site rs3765467(NT_007592.16,position:39065819),and to evaluate its accuracy and practicability. METHODS:Peripheral venous blood samples of 72 healthy subjects were collected in medical examination center of our hospital during Oct. 2015-Feb. 2016. The whole blood DNA was extracted by column extraction method. After amplified by touch down PCR,high reso-lution melting(HRM)method was adopted to analyze amplified product. Sequencing verification by double stranded chain termina-tion method(Sanger sequencing method)was performed for 38 test samples. The results of 2 methods were compared. RESULTS:The results of mutation scanning showed that there were 39065817 and 39065819 polymorphism sites in amplified segments. Four types of mutations were detected by HRM method [GCG/GCG,GCA/GCG or ACG/GCG,GCA/GCA or ACG/ACG,A(G) CA(G)],but 6 types of mutations was detected by Sanger sequencing method [GCG/GCG,ACG/GCG,ACG/ACG,A(G)CA (G),GCA/GCG,GCA/GCA]. CONCLUSIONS:HRM method can identify GCG/GCG and A(G)CA(G)genotype,but can not identify GCA/GCG and ACG/GCG heterozygous mutation,GCA/GCA and ACG/ACG homozygous mutation. The method is not suitable for the detection of single nucleotide polymorphism for multiple neighboring sites. In the detection of single nucleotide mu-tation,economical and simple method should be selected after comprehensive analysis of sequence.
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OBJECTIVE:To provide reference for investigating the disease burden of diabetic patients and promoting rational drug use. METHODS:Open-ended questionnaires were adopted to survey the willingness to pay(WTP)of some diabetic patients in Sichuan Provincial People’s Hospital and collect the data about personal information,health status,the affordability of disease and WTP,the data was sorted with Excel (version 2013) software by two operators and analyzed with SPSS 17.0 software by step-wise multiple linear regression to explore the influential factors of WTP values. RESULTS:Totally 120 questionnaires were sent out and 106 were effectively received with effective rate of 88.3%. The average age of respondents was (59.9 ± 13.9) years old,the average body mass index (BMI) of respondents was (24.5 ± 0.5) kg/m2,the highest proportion of monthly diabetes fees was no more than 300 yuan,followed by more than 300-500 yuan and more than 500-1 000 yuan;the awareness rates of fasting plasma glucose (FPG),2 h postprandial blood glucose (2 h PG) and glycated hemoglobin (HbA1c) were 95.3%,86.8% and 68.9%,respectively;and patients with more than 2 complications accounted for 29.5%. The WTP values of respondents to the complete recovery of HbA1c,FPG and 2 h PG were 1 604.1,1 617.9 and 1 683.7 yuan/month,the median values were 1 000 yuan/month;the WTP values of respondents to the 10% recovery were 867.4,908.5 and 877.9 yuan/month,the median values were 500,575 and 510 yuan/month,respectively. The influential factors with positive effects and significant differences on WTP values in step-wise multiple linear regression were total annual household income,complications,hospital experience,family history of di-abetes,diabetes mental status and cost of diabetes in the past months;those with negative effects and significant differences on WTP values were age,FPG level and education level. CONCLUSIONS:Diabetic patients,particularly,with peripheral neuropa-thy,high blood lipids or diabetic foot have higher WTP value,which shows they hole heavier mental burden and disease burden than others. Patients recovered 10% percent were closer to actual treatment state,which better show the influential factors of WTP values actually,and patients with a family history of diabetes,depressed mood,higher fees in the average monthly cost,and hospi-tal patients have higher WTP values.
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OBJECTIVE:To provide reference for promoting the further implementation of national essential medicine system and related policies. METHODS:Hospital information system(HIS),Excel 2007 and SPSS 13.0 software were adopted to statisti-cally compare the changes in equipping the specific varieties of national essential medicines and the differences in the overall use of national essential medicines before and after implementing the National Essential Medicine System (2012 edition)(referred to NEMS,2012 edition) and cancelling drug addition policy in a public hospital in Chengdu. RESULTS:After implementing the NEMS(2012 edition),60 kinds of equipping national essential medicines increased in the hospital,including 38 kinds of chemical medicines and biological products,22 kinds of Chinese patent medicines;compared with before,the percentage of essential medi-cines to prescription drugs,prescription rate of essential medicines,average essential medicine in a single prescription and prescrip-tion rate of all essential medicines were significantly improved(P0.05). CONCLUSIONS:After implementing the NEMS(2012 edition)and cancelling drug addition policy,the equipping na-tional essential medicines are still insufficient,some indexes do not meet the requirements of Sichuan Province. It is suggested that the public medical and health institution at county-level should to choose suitable national essential medicines based on its specific situation;strengthen publicity and education,improve the popularity of physicians to national essential medicine system;strengthen the assessment and management of the use of essential medicines for physicians. Meanwhile,the government and the relevant de-partments are suggested to explore more effective and reasonable compensation mechanism to improve the enthusiasm of physicians to use the national essential medicines.
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OBJECTIVE:To provide reference for formulating related provisions,guidelines and regulations for off-label drug use,standardizing medical behavior in medical health institutions. METHODS:According to the connotation of off-label drug use,Questionnaire for off-label drug use was developed for medical institutions,in which drug name,treatment disease,the type and use evidence ofoff-label drug usewere included. The questionnaires were delivered to pharmacists who participatedClinical phar-macist practice skills training in Sichuan province to collect the related information of off-label drug use for statistical analysis, and suggestions were put forward. RESULTS:Totally 150 questionnaires were sent out,124 were effectively received with effec-tively recovery of 82.7%;the surveyed pharmacists came from 22 medical institutions,including 18 tertiary hospitals and 4 second-ary hospitals;there were 128 information about off-label drug use,including 14 (10.9%) with incomplete reporting information. The another 114 information were major in“super indication”(61) and“super administration”(43),accounting for 53.5% and 37.7%,respectively,and there are 8 other drug overdose(7.0%),2 super object(1.8%). The relevant off-label drug use mainly included anti-infection drugs (34 information,29.8%),anti-tumor drugs (16 information,14.0%),TCM injections (8 informa-tion,7.0%),and etc.;the relative concentration of varieties were metronidazole,dexamethasone,gentamicin,methotrexate, azithromycin,irinotecan,vancomycin,nystatin,etc.. Some medical institutions were absence of effective regulatory measures. CONCLUSIONS:Off-label drug use is quite common in medical institutions of Sichuan province,some of them exist obvious med-ication risk. It is suggested that the state should be as soon as possible to develop related provisions,guidelines and regulations for off-label drug use,endowing legal force for off-label drug use;medical staff should avoid no evidence-based drug use,unreason-able or even unnecessary off-label drug use;pharmaceutical production enterprises should strengthen communication with medical institutions and pay attention to collect information related to the clinical medication,timely update the drug instructions to ensure the legitimate rights for patients and the interests for medical staff.
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Objective:To investigate the application of drug utilization evaluation( DUE) as a kind of clinical pharmacy work model in the antibacterial drug special rectification. Methods: Following the steps of DUE schedule,retrospective method was conducted to collect the data of the use of vancomycin in one institution and the model of clinical drug use was improved by the evaluation result. Re-sults:The rationality of vancomycin use was improved in the institution. The index of drug use reasons and key disease course indica-tors was improved significantly. The qualification rate of indications and drug indications was increased from 79. 5% to 95. 0%,and the qualification rate of antibacterial drugs classification management was increased from 63. 3% to 92. 7%. The qualification rate of dosing frequency was increased from 72. 5% to 96. 0%. Conclusion:As a program for continual improvement of new clinical pharmacy work mode and medical care quality,the mode plays an important role in the institution and improves the rational use of vancomycin.
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OBJECTIVE: To explore an effective approach for clinical pharmacists to provide pharmaceutical care to outpatients.METHODS: Based on our personal experience and the mode of pharmaceutical consultation service in our hospital as well as the case study,the setting up and operational model of drug consultation service for outpatients were introduced.RESULTS & CONCLUSIONS: If requirements on personnel and hardware & software satisfied,setting drug consultation service for outpatients that operated in 5 steps including probing into patient's basic condition and analyzing patient's medication condition etc can greatly enhance patients' medication compliance.