Case Analysis of 15 Cases of Immune-related Myocarditis Induced by Pembrolizumab / 中国药房

OBJECTIVE：To investigate the ru les and characteristics of pembrolizumab-induced immune-related myocarditis ， and to provide reference for rational drug use in clinic. METHODS ：Using“pembrolizumab/keytruda”“myocarditis”“cardiotoxicity” “Pembrolizumab/Keytruda”“Cardiac toxicity ”“Myocarditis”“Cardiotoxity”“Cardiotoxicity”as Chinese and English retrieval words ， CBM，VIP，CNKI，Wanfang database ，PubMed，Wiley Online Library and Embase database were searched on the case reports of pembrolizumab-induced immune-related myocarditis during the inception to Aug. 2020. After eliminating the suspected case literature and repetitive literature ，gender，age，medication cause ，medical history ，drug combination ，drug dosage ，occurrence time of ADR ，clinical manifestation ，intervention measure and outcome of patients in the included literature were analyzed. RESULTS & CONCLUSIONS：A total of 15 literatures were included ，involving 13 English literatures and 2 Chinese literatures. Totally 15 patients were involved ，including 12 males and 3 females，with an average age of 71.35 years. There were 4 cases of non-small cell lung cancer ，4 cases of melanoma ，2 cases of bladder cancer ，1 case of urothelial cancer ，1 case of multiple osteosarcomas，1 case of gastric cancer ，1 case of thymic cancer ，1 case of nasopharyngeal carcinoma. There were 6 patients with previous medical history ，of which 5 had no history of heart disease and 1 had hypertension and hyperlipidemia ；there were 9 patients recorded the combined use of drugs ；the dosage and frequency of pembrolizumab were recorded in 12 patients. Immunological myocarditis of 93.3％ patients occurred after the first to second cycle of pembrolizumab administration ，and the average occurrence time was 15.5 days after the last administration. The most common clinical symptoms were dyspnea ，fatigue， dizziness or syncope. 9 patients showed cardiac block on electrocardiogram. All patients were treated with glucocorticoids when they developed immune-associated myocarditis ，and 5 patients died after hospitalization ；another one patient was restarted with pembrolizumab for one cycle after control of immune-related myocarditis ，but developed a recurrence of myocarditis and died of myocarditis ADR. It is suggested that baseline examination and routine monitoring of cardiac function should be done well when patients are treated with pembrolizumab. Once the patient is su spected to have immune-related myocarditis ，they should timely improve the cardiograms and other cardiac function-relatedtests，and start the treatment of high-dose glucocorticoids as 198177） soon as possible ，and are alert to the risk of death due to recurrence of myocarditis after readministration.

The epigallocatechin gallate derivative Y reverses drug resistance mediated by the ABCB1 transporter both and

Previously, we reported that Y, a new epigallocatechin gallate derivative, is efficacious in reversing doxorubicin (DOX)--mediated resistance in hepatocellular carcinoma BEL-7404/DOX cells. In this study, we evaluated the efficacy of Y in reversing drug resistance both and by determining its effect on the adenosine triphosphate-binding cassette protein B1 transporter (ABCB1 or P-glycoprotein, P-gp). Our results showed that Y significantly sensitized cells overexpressing the ABCB1 transporter to anticancer drugs that are ABCB1 substrates. Y significantly stimulated the adenosine triphosphatase activity of ABCB1. Furthermore, Y exhibited a higher docking score as compared with epigallocatechin gallate inside the transmembrane domain of ABCB1. In addition, in the nude mouse tumor xenograft model, Y (110 mg/kg, intragastric administration), in combination with doxorubicin (2 mg/kg, intraperitoneal injection), significantly inhibited the growth of BEL-7404/DOX cell xenograft tumors, compared to equivalent epigallocatechin gallate. In conclusion, Y significantly reversed ABCB1-mediated multidrug resistance and its mechanisms of action may result from its competitive inhibition of the ABCB1 drug efflux function.

Reduction of Dispensing Errors of Similar Drugs in Hospital Outpatient Pharmacy and Realizing of Drug Traceability System by Using Drug Electronic Regulatory Code / 中国药房

OBJECTIVE:To reduce the dispensing errors of similar drugs in hospital outpatient pharmacy,and realize the drug traceability. METHODS:Based on adding drug electronic regulatory code field in drug dictionary background database of hospital information system (HIS), prescription dispensing process in outpatient pharmacy of our hospital was improved. Drug electronic regulatory code was added for scanning code review before secondary review dispensing, and drug terminal traceability was real-ized based on it. Through comparing the dispensing outing error rate before and after 12 months of improvement, ratio of"special abnormal data"related with dispensing error of similar drugs in checking, patients'waiting time and other indicators, the pre-scription dispensing quality of outpatient pharmacy before and after improvement was evaluated. RESULTS:After adding drug elec-tronic regulatory code for scanning code review, the dispensing outing error of similar drugs was decreased from 22 cases to 1 case (accounting for 0.0197‰, 0.0103‰, respectively), number of"special abnormal data"was decreased from 836 to 436 (accounting for 31.5%, 16.8%, respectively), and the average waiting time of patients had no obvious extension(10.85 min, 10.88 min, respectively). It had achieved the traceability inquiry of most outpatient drugs from the pharmacy to the patients. CON-CLUSIONS:The drug electronic regulatory code can reduce the dispensing outing error of similar drugs in outpatient pharmacy, which is conducive to the establishment of drug traceability chain and has improved the quality of pharmaceutical care.

Reduction of Dispensing Errors of Similar Drugs in Hospital Outpatient Pharmacy and Realizing of Drug Traceability System by Using Drug Electronic Regulatory Code / 中国药房

OBJECTIVE:To reduce the dispensing errors of similar drugs in hospital outpatient pharmacy,and realize the drug traceability. METHODS:Based on adding drug electronic regulatory code field in drug dictionary background database of hospital information system (HIS), prescription dispensing process in outpatient pharmacy of our hospital was improved. Drug electronic regulatory code was added for scanning code review before secondary review dispensing, and drug terminal traceability was real-ized based on it. Through comparing the dispensing outing error rate before and after 12 months of improvement, ratio of"special abnormal data"related with dispensing error of similar drugs in checking, patients'waiting time and other indicators, the pre-scription dispensing quality of outpatient pharmacy before and after improvement was evaluated. RESULTS:After adding drug elec-tronic regulatory code for scanning code review, the dispensing outing error of similar drugs was decreased from 22 cases to 1 case (accounting for 0.0197‰, 0.0103‰, respectively), number of"special abnormal data"was decreased from 836 to 436 (accounting for 31.5%, 16.8%, respectively), and the average waiting time of patients had no obvious extension(10.85 min, 10.88 min, respectively). It had achieved the traceability inquiry of most outpatient drugs from the pharmacy to the patients. CON-CLUSIONS:The drug electronic regulatory code can reduce the dispensing outing error of similar drugs in outpatient pharmacy, which is conducive to the establishment of drug traceability chain and has improved the quality of pharmaceutical care.

Evidence-based Guidelines on Medication Therapy for Purulent Meningitis in Children:A Systematic Review / 中国药房

OBJECTIVE:To systematically review the related evidence-based guidelines of purulent meningitis in children,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,CBM,Wanfang Data-base,CJFD and VIP,NGC,GIN,TRIP and websites of domestic and international medical associations and industry bodies,the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extrac-tion and quality evaluation. RESULTS:Finally 3 guidelines were enrolled in total,with development time ranging from 2004 to 2012,from USA,Britain and Australia,respectively. All of the recommendations were level B,scope and purpose and clarityshowed the higher scores in AGREEⅡ,more than 70%,and applicability showed generally low scores. Penicillin and cefotaxi-me were recommended in purulent meningitis of neonates,and vancomycin combined with cefotaxime or ceftriaxone were recom-mended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different,and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS:The recommendations of medicines for the treatment of pu-rulent meningitis are basically unanimous,with no regional difference,but there are some differences about dose and the course of treatment. In addition,the classification criteria of the levels of evidence and recommendation are still suboptimal,which needs fur-ther improvement. And guidelines on purulent meningitis should be improved inrigourandapplicabilityin future.

Content Determination of Notoginsenoside R1, Ginsenoside Rg1 and Rb1 in Shuxuening Capsules by HPLC / 中国药师

Objective:To determine the content of notoginsenoside R1 , ginsenoside Rg1 and Rb1 in Shuxuening capsules. Meth-ods:The three constituents were determined on a Hypersil ODS-2 C18 column (250 mm × 4. 6 mm, 5 μm) with gradient elution using acetonitrile (A) -aqueous solution (B) (0-8 min, 20%A→20%A, 8-40 min, 20%A→30%A, 40-60 min, 30%A→45%A) at the detection wavelength of 203 nm with a flow rate of 1. 0 ml·min-1 . The column temperature was 25℃ and the injection volume was 20μl. Results:The calibration curve showed good linearity within the concentration range of 0. 05-0. 50 mg·ml-1 for notogisenoside R1 , and 0.20-2.00 mg·ml-1 for ginsenoside Rg1 and Rb1(r =0.999 9). The average relative recovery was 98.79%, 98.42% and 98. 89% for each constituent(RSD=0. 85%, 0. 97% and 0. 74%, respectively, n=6). The intra-day RSD was 0. 49%, 0. 20% and 0. 39%, and the inter-day RSD was 0. 75%, 0. 56% and 0. 51%, respectively. The RSDs of stability test and repeatability test were less than 1%. Conclusion:The method is simple with good accuracy and repeatability, which can be used for the determination of no-toginsenoside R1 , ginsenoside Rg1 and Rb1 in Shuxuening capsules.

Evidence-based evaluation of the effect of mouse nerve growth factor on fracture healing / 中国生化药物杂志

Objective To evaluate the effect of mouse nerve growth factor on fracture healing.Methods Cochrane library, Pubmed, EMbase, CNKI,VIP,Wanfang Data and CBM were searched for the randomized controlled trials(RCTs)of mouse nerve growth factor on fracture healing from the date of establishment of the databases to May 2014.Three independent rese archers evaluated the included studies using GRADE,according to recommend classification method of GRADE system by three researchers,crtical evaluated and data extracted of the quality of the included studies,which conform to the quality standard of RCT was analyzed by Meta analysis.The extracted data were analyzed by RevMan 5.0 and GRAED proiler.Results A total 5 trials were discovered and all of these were in Chinese.Compared with conventional treatment was improved a lot[MD =-8.74,95%CI( -9.79,-7.68),P<0.0001].However, adverse drug reaction in patients with mouse nerve growth factor were increased[OR =14.66,95%CI(1.89, 113.99),P=0.01].The both outcomes were low quality in the GRADE system.Conclusion Mouse nerve growth factor can improve fracture healing and the side effects will also increase.

Drug Purchase Management and Drug Use Monitoring in Our Hospital / 中国药房

OBJECTIVE: To introduce the methods of drug purchase management and drug use monitoring in our hospital,and to provide reference for drug management in hospitals.METHODS: Sunshine Project of New Drug Purchase and scientific selection methods for contract drugs were carried out in order to control the quality of drugs and monitor the whole process of new drugs.RESULTS: 82 kinds of new drugs were purchased in our hospital since 2005 and 1 500 kings of drugs were voted by randomly selected experts to apply in the clinic.The consumption sum of drugs in our hospital were controlled within 500 million yuan,and the drug use was basically rational.CONCLUSIONS: Methods for new drugs purchase and use in our hospital can promote rational use of drugs in the clinic.