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Diarrhea caused by chemotherapy is called chemotherapy-related diarrhea （CRD）. CRD can lead to reduced treatment effectiveness and compliance， affect the long-term outcome of tumor patients， and can be life-threatening in severe cases. In addition to conventional chemotherapy drugs， many molecularly targeted drugs are also associated with CRD， including small molecule epidermal growth factor receptor （EGFR） inhibitors， anti-EGFR monoclonal antibodies， phosphoinositide 3-kinase inhibitors， small molecule inhibitors of vascular endothelial growth factor receptor， BCR-ABL1 and KIT inhibitors， human epidermal growth factor receptor 2 target inhibitors， cyclin-dependent protein kinase inhibitors， antibody-drug conjugates and other molecularly targeted drugs. The occurrence mechanism may be related to the intestinal mucosal injury or enteritis caused by molecularly targeted drugs. The clinical manifestations are increased stool frequency and/or loose imposition， and patients are often associated with excess hyperproduction and/or colic. The incidence of CRD varies with different drugs. Great importance should be attached to collecting medical history and differential diagnosis， actively intervening and conducting dynamic evaluation， strengthening patient education， and timely detecting and preventing the occurrence of intestinal toxicity.
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Diffuse large B cell lymphoma （DLBCL） is a malignant tumor derived from mature B cells. Currently， chemotherapy is still the main clinical treatment. However， some patients experience recurrence or refractory conditions after treatment. On June 15， 2023， the FDA approved the marketing of glofitamab， a CD3/CD20 bispecific monoclonal antibody， to provide the new treatment plan for patients with recurrent or refractory DLBCL after receiving 2-line or above systemic treatment. This article reviews pharmacological effects， clinical studies， safety， usage and dosage of glofitamab. Glofitamab mainly plays a therapeutic role in DLBCL by promoting the activation and proliferation of T cells，activating T cells to release tumor cell-killing proteins， and mediating the lysis of B cells. Clinical studies have shown that glofitamab has a better complete and objective response rate for recurrent or refractory DLBCL. Common adverse reactions caused by glofitamab include mild/moderate cytokine release syndrome， musculoskeletal pain， rash， fatigue， and so on，without significant drug interactions.
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OBJECTIVE To carry out data mining on the prescriptions of traditional Chinese medicine （TCM） for the treatment of renal anemia， and to explore the medication rules of TCM in the treatment of renal anemia. METHODS The Chinese and English databases including PubMed， the Cochrane Library， Web of Science， CNKI， Wanfang， VIP and CBM were searched by computer to screen the related literature about TCM in the treatment of renal anemia. Excel software was used to extract prescription information， including frequency of use， property and flavor， meridian tropism and efficacy of single TCM. Association rule analysis and hierarchical clustering analysis were performed for each ingredient of TCM with R language. RESULTS A total of 268 literature were included， involving 169 ingredients with a total use frequency of 3 919 times. Among them， Astragalus memeranaceus， Angelica sinensis， Atractylodes macrocephala， Rheum officinale， Poria cocos， Radix Rehmanniae Praeparata， Radix Codonopsis， Salvia miltiorrhiza and Ligusticum chuanxiong were used more than 100 times. The properties and flavors of the drugs were mainly warm and sweet； meridian tropism mainly targeted spleen， liver and kidney； the function was mainly in replenishing qi， nourishing blood， promoting blood circulation and removing blood stasis， and clearing damp and promoting diuresis， purgation. The result of association rule analysis showed that the core ingredients were A. memeranaceus， A. sinensis， A. macrocephala， P. cocos and S. miltiorrhiza. Hierarchical cluster analysis showed that the clustering results were divided into grade 1， 2 and 3， and the cluster classification of A. memeranaceus and A. sinensis was always the same. CONCLUSIONS The core prescription for treating renal anemia includes A. memeranaceus， A. sinensis， A. macrocephala， P. cocos and S. miltiorrhiza； among them， A. memeranaceus and A. sinensis are at the center of the core prescription and indispensable. The medication rule is mainly guided by drugs for invigorating qi， nourishing blood， strengthening spleen， and removing dampness. According to the characteristics of different symptoms of patients， dialectical treatment is made， and other TCM is added or subtracted on the basis of the core prescription.
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In 2022, the American Gastroenterological Association(AGA)published an expert consensus on the AGA's clinical practice update on PPI prescription cancellation in the Journal of Gastroenterology.In view of the excessive and unreasonable use of proton pump inhibitors(PPIs), experts were organized to formulate a set of ten practical suggestions on how to guide outpatient patients to reduce and stop using PPI.Based on the current situation of PPI use in China and the needs of clinical practice, this paper interpreted the consensus from the perspective of pharmacists, so as to provide reference for further regulating the rational use of PPI and reducing the excessive use and adverse reactions of PPI.
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The management model of chronic noncommunicable diseases(chronic diseases)in the elderly is related to the outcome and outcome of patients.The main advantages of chronic disease management in foreign countries are the burden of medical insurance, the interconnection of medical institutions in a limited scope, the primary health workers leading, and the active participation of patients.Although the form of chronic disease management in the community is also included in China and guidance documents have been issued, there is still a need for improvement in policy implementation, information system, community resources and patient education.
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OBJECTIVE：To systematically evaluate the efficacy and safety of decitabine monotherapy in the treatment of myelodysplastic syndrome （MDS），and to provide evidence-based reference to the clinic. METHODS ：Retrieved from Embase ， Cochrane Library ，PubMed，Medline，Clinical Key ，Google Scholar ，CNKI，CBM and Wanfang data ，during the inception to Jun. 26th， 2020， randomized controlled trials （RCTs） about decitabine （decitabine group ） versus traditional combined chemotherapy（control group ）in the treatment of MDS were collected. After literature screening and data extraction ，literature quality evaluation with bias risk evaluation tool recommended by Cochrane systematic evaluator manual 5.2.2，Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：A total of 590 patients with 11 RCTs were included. Meta-analysis results showed that complete remission rate [OR ＝1.82，95％ CI（1.23，2.70），P＝0.003] and total response rate [OR ＝1.54，95％ CI（1.05， 2.27），P＝0.03] of decitabine group were significantly higher than those of control group ；the incidence of ADR [OR ＝0.26，95％ CI（0.16，0.40），P＜0.000 01]，the incidence of infection [OR ＝0.48，95％ CI（0.27，0.85），P＝0.01] and the incidence of myelosuppression [OR＝0.37，95％ CI（0.17，0.81），P＝0.01] in decitabine group were significantly lower than control group. The results of subgroup analysis according to the course of treatment showed that there was no significant difference in the complete remission rate and total response rate between 2 groups in the treatment course of 3 and 4 months（P＞0.05）；but there was significant difference in the treatment course of 1 month or 2 months，the decitabine group was significantly higher than control group（P＜0.05）. CONCLUSIONS：Decitabine has good efficacy and safety in the treatment of MDS patients ，and when the treatment time is less than or equal to 2 months，the complete remission rate and total response rate of decitabine in MDS lis1270755@163.com patients are better.
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OBJECTIVE： To reduce ADEs due to potential drug interaction （short for drug interaction） by improving medical staffs’ recognition， and to provide reference for making clinical guidelines for chronic disease. METHODS： According to the Survey Reprots on Chinese Resident’s Nutrition and Chronic Disease and related literatures， nine common chronic diseases （hypertension， type 2 diabetes mellitus， dyslipidemia， depression， primary lung cancer， rheumatoid arthritis， ischemic stroke， chronic heart failure and chronic obstructive pulmonary disease） and latest corresponding clinical guidelines， developed by the Chinese Medical Association or National Health and Family Planning Commission were selected to evaluate the improvement of drug interaction in the guidelines. Retrieving Micromedex， Stockley’s Drug Interactions， Medscape， Adverse drug interactions： A Handbook for prescribers and drug instructions， centered on the clinical guidelines for hypertension， type 2 diabetes and dyslipidemia， which were most likely to coexist with other chronic diseases and had the highest incidence， the number of drug interactions （mild/medium and severe drug interaction） of drugs recommended by 3 chronic disease guidelines and 8 other guidelines were counted， and drugs with a large number of severe drug interactions were also counted. RESULTS： There was no guideline to discussing the interaction between recommended drugs for comorbidity. The number of mild/mediuem drug reactions recommended by clinical guidelines for hypertension， type 2 diabetes， dyslipidemia and other 8 disease were 759， 681 and 68， respectively； those of severe drug interaction were 262， 17 and 37， respectively. The drugs with a high number of severe drug interactions were digoxin （24）， aspirin （22）， diuretics （12 kinds of drugs， 14-17）. CONCLUSIONS： When patients suffer from multiple chronic diseases， clinical pharmacists should pay attention to drug interactions. Selected clinical guidelines for chronic diseases still need to be completed the content of drug interactions.
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Objective To investigate the relationship of blood concentration of tacrolimus with efficacy and safety in treatment of patients with myasthenia gravis.Methods The clinical data of 74 patients with myasthenia gravis admitted in our hospital from January 2013 to December 2015 were analyzed retrospectively.The blood concentrations of tacrolimus were determined by chemiluminescence microparticle immunoassay.Treatment effects were evaluated with clinical relative scoring in China.Results There were 41 men and 33 women in 74 patients with the mean age of (56.7 ± 15.8) years.According to the Osserman classification,there were 7 cases of type Ⅰ,18 cases of type Ⅱ b,27 cases of type Ⅱ a,5 cases of type Ⅲ and 17 cases of type Ⅳ.Forty seven patients underwent thymectomy,including 9 cases of thymoma and 38 cases of hyperplasia.Patients were followed up for (28.1 ± 14.5)days,and the effective rate was 74 ％ (55/74).There was no significant correlation between tacrolimus blood concentration and clinical efficacy.The incidence of adverse reaction of tacrolimus was 22％ (16/74),and the incidence of adverse reactions increased with the increase of blood concentration.Conclusion Tacrolimus is effective in treatment of myasthenia gravis.The correlation of blood concentration of tacrolimus with the clinical efficacy needs to be further studied,but certainly,the monitoring of blood concentration can reduce the incidence of adverse reactions.
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Objective To understand the patterns of outpatient prescription medications in the hospital's elderly patients.Methods Data for all outpatient prescriptions at our hospital written for seniors (≥60 years old) between 2013 and 2014 were collected and medications were ranked based on the price.The top 100 medications were chosen for analysis.Results The most expensive and most frequently prescribed three therapeutic groups were drugs for cardiovascular,endocrine & metabolic,and bone & joint disorders.Medication numbers and prices varied among different age groups,with the 60-64 and 75-79 groups representing the highest numbers and prices.The average price (460.3 yuan) per prescription for male patients was higher than that (399.3 yuan) for female patients.Conclusions The cost of prescription drugs in elderly patients is higher than in middle-aged patients,with drugs for non communicable chronic diseases accounting for most of the expenses.Polypharmacy is also a prominent issue.Prescriptions for chronic illnesses in the elderly should follow well established guidelines and appropriately managed.
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Objectives To examine clinical characteristics,predisposing factors,treatment and care of depression and/or anxiety symptoms in hospitalized patients with cardiovascular diseases.Methods A retrospective analysis of clinical data of 1 005 hospitalized patients with cardiovascular diseases at our hospital from January 2015 to December 2015 was conducted and psychological assessment for all patients was carried out using the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale.The incidence of depression and anxiety and predisposing factors were investigated.The effectiveness of psychological intervention in addition to cardiovascular medications was evaluated.Results The overall incidence of depression and anxiety was 23.4％ (235 cases) among the 1 005 hospitalized patients with cardiovascular diseases.Of the 235 cases,73 cases(31.1％) had anxiety,33 cases had depression (14.0％),and 129 cases had both anxiety and depression (54.9％).The occurrence of anxiety was significantly higher than that of depression(P＜0.05).Risk factors for anxiety and depression in patients with cardiovascular diseases included work-related fatigue,working conditions and health status.The rate of effectiveness of psychological intervention was 95.4％,and no serious adverse events were observed.Conclusions Depression and anxiety are common in hospitalized cardiovascular patients and can be attributed to factors such as work-related fatigue,working conditions and health status.Favorable clinical outcomes can be achieved through psychological interventions,in addition to cardiovascular drug therapy.
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Pharmacogenomics is the study of the impact of genetic variations or genotypes of individuals on their drug responses or drug metabolism.Compared to traditional genomics research,pharmacogenomic research is more closely related to clinical practice.Pharmacogenomic discoveries may effectively assist clinicians and healthcare providers in determining the right drugs and the proper doses for each patient,which can help avoid side effects or adverse reactions and improve the effect of drug therapy.Currently,pharmacogenomic approaches have proved to be valuable when it comes to the use of cardiovascular drugs,antineoplastic drugs,aromatase inhibitors,and agents for infectious diseases.The rapid innovation in sequencing technology and genome-wide association studies has led to the development of numerous data resources and dramatically changed the landscape of pharmacogenomic research.Here we describe some of these web resources along with their names,web links,main contents,and our ratings.
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OBJECTIVE:To provide reference for the standardization of package insert of common drugs for elderly patients. METHODS:Outpatient prescriptions in our hospital from 2013 to 2014 were collected,and common drugs of elderly patients(≥60 years old)were ordered by consumption sum,and package inserts of top 100 drugs were statistically analyzed for absent items. RESULTS:The 100 common drugs for elderly patients included 28 Chinese traditional drugs and 72 chemical drugs. The Chinese traditional drug had more absent items,mostly were pharmacokinetics and drug overdose(92.9%),medication of elderly patients (85.7%),drug interactions(78.6%)and pharmacological actions(50.0%);the proportion of contraindications(16/28),adverse re-actions(15/28) and precaution(9/28) with uncertainty was relatively high. Items of chemicals package insert were better than Chi-nese traditional drug,absent items were pharmacokinetics and drug overdose(5.6%),medication of elderly patients and pharmaco-logical actions (2.8%) and drug interactions (1.4%);the proportion of medication of elderly patients (16/72),drug interaction and drug overdose(12/72)with uncertainty was relatively high. CONCLUSIONS:The common problem existing in the drug manu-al is characterized by absence of usage for elderly,drug descriptions is not clear,etc. Package inserts should be further improved to strengthen its standardization.
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Objective To investigate the relationship between heart failure with normal ejection fraction and cardiac remodeling.Methods One hundred and eighty-eight cases with chronic heart failure were collected from January 2009 to March 2012 from Department of Cardiology of Longkou People's Hospital.In strictly accordance with the diagnostic criteria,participants were divided into HFNEF(n =109) and HFREF groups (n =79).According to the NYHA classification,HFNEF and HFREF patients were further divided into three subgroups respectively (HFNEF patients:52 cardiac function Ⅱ,36 cardiac function Ⅲ,21 cardiac function Ⅳ ;HFREF patients:13 cardiac function Ⅱ,27 cardiac functionⅢ,39 cardiac functionⅣ).The measurements of the left ventricular ejection fraction (LVEF),left atrial diameter (LAD),interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT),right ventricular diameter (RVD) were conducted in all objects and their clinical data were statistically analyzed.Results Compared with HFREF patients,HFNEF group had older mean age ((64.59 ± 5.34) yrs vs.(58.89 ± 4.23) yrs,t =3.345,P =0.001),more female patients (58.7％ (64/109) vs.41.8％ (33/79),x2 =5.265,P =0.022),higher incidence of hypertension (81.65％ (89/109) vs.63.29％ (50/79),x2 =8.012,P =0.005).LVPWT,IVST,LAD,RVD gradually increased in HFNEF patients with the severity of cardiac function,with significant differences in LVPWT ((9.05 ± 1.89) mm vs.(11.30 ± 2.67) mm vs.(13.90 ± 2.77) mm,F =3.578,P =0.028),IVST ((9.35 ±1.75)mm vs.(11.51 ±2.48)mm vs.(12.98 ±3.01)mm,F =3.081,P =0.048),LAD ((31.23 ±5.98)mm vs.(35.55 ±7.31)mm vs.(44.81 ± 10.72)mm,F =6.711,P ＜0.001),but no difference in RVD ((18.95 ±1.02) mm vs.(19.21 ± 1.11) mm vs.(19.99 ± 0.98) mm,F =2.751,P ＞ 0.05).There was significant difference in LVPWT ((13.90 ±2.77)mm vs.(7.45 ±2.01)mm,t =11.439,P ＜0.001),IVST ((12.98 ±3.01)mm vs.(7.23 ± 1.94)mm,t =10.318,P ＜0.001),RVD ((19.99 ±0.98)mm vs.(23.51 ± 1.10)mm,t =2.838,P ＜ 0.001) between HFNEF and HFREF patients with Ⅳ level of cardiac function,while there was no statistical difference ((44.81 ± 10.72) nn vs.(46.30 ± 11.76) mm),t =1.451,P =0.151) on LAD.Conclusion Senior age,high proportions of women and essential hypertension are found in HFNEF patients.Impaired cardiac function has increasing impact on cardiac remodeling with the increase of severity but it almost has no effect on the right ventricle.Ventricular structural changes exist significantly different from HFNEF to HFREF.Therefore clinicians should have in-depth understanding of the characteristics of the HFNEF and its epidemiology,pathophysiology,diagnostic criteria and treatment principles in order to improve diagnosis and treatment of this class of patients.