Research progress and maturity assessment of continuous manufacturing of traditional Chinese medicine / 中国中药杂志

The pharmaceutical manufacturing model is gradually changing from intermittent manufacturing to continuous manufacturing and intelligent manufacturing. This paper briefly reviewed the supervision and research progress in continuous pharmaceutical manufacturing in China and abroad and described the definition and advantages of continuous pharmaceutical manufacturing. The continuous manufacturing of traditional Chinese medicine(TCM) at the current stage was summarized in the following three terms: the enhancement of the continuity of intermittent manufacturing operations, the integration of continuous equipment to improve physical continuity between units, and the application of advanced process control strategies to improve process continuity. To achieve continuous manufacturing of TCM, the corresponding key technologies, such as material property characterization, process modeling and simulation, process analysis technology, and system integration, were analyzed from the process and equipment, respectively. It was proposed that the continuous manufacturing equipment system should have the characteristics of high speed, high response, and high reliability, "three high(H~3)" for short. Considering the characteristics and current situation of TCM manufacturing, based on the two dimensions of product quality control and production efficiency, a maturity assessment model for continuous manufacturing of TCM, consisting of operation continuity, equipment continuity, process continuity, and quality control continuity, was proposed to provide references for the application of continuous manufacturing technology for TCM. The implementation of continuous manufacturing or the application of key continuous manufacturing technologies in TCM can help to systematically integrate advanced pharmaceutical technology elements and promote the uniformity of TCM quality and the improvement of production efficiency.

The Association Between Overtime Hours and Perceived Stress, Depression, and Anxiety Among COVID-19 Community Health Workers / 생물치료정신의학

Objectives@#This study aimed to examine the association between overtime hours and perceived stress, depression, and anxiety among coronavirus disease 2019 (COVID-19) community health workers. @*Methods@#Self-report data were collected from 1,181 community health workers in Busan between 15 June and 2 July 2021. The data collected were analyzed using analysis of variance and logistic regression to examine how average weekly overtime hours affect perceived stress, depression, and anxiety. @*Results@#The proportion of individuals who perceived a high degree of stress was higher in the groups with average weekly overtime of 5-10 hours (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.09-3.01) and 10 or more hours (OR 2.26, 95% CI 1.33-3.82) than in the group with average weekly overtime of less than 5 hours. Among the groups with average weekly overtime of 5-10 hours and 10 or more hours, the proportion of individuals at a high risk of depression was OR 1.74 (95% CI 1.31-2.31) and OR 3.39 (95% CI 2.53-4.54), respectively. In the same two groups, the proportion of individuals at a high risk of anxiety was OR 1.75 (95% CI 1.31-2.33) and OR 3.34 (95% CI 2.51-4.46), respectively. @*Conclusions@#This study shows that perceived stress, depression, and anxiety levels significantly increase as average weekly overtime hours increase among COVID-19 community health workers.

Historical Evolution and Modern Research Progress of Rehmanniae Radix / 中国实验方剂学杂志

Rehmanniae Radix is a common medicine of traditional Chinese medicine， which has the function of nourishing Yin and tonifying the kidney， and has a long application history of processing. This medicine was first recorded in Synopsis of Golden Chamber （《金匮要略》）， which was mainly produced by steaming and boiling. Its processing materials were diverse. In addition to rice wine， honey， Amomi Fructus， milk， Aquilariae Lignum Resinatum， and Carthami Flos were also recorded in ancient books， but with the evolution of time， the characteristic excipients gradually disappeared. Based on this， starting with different excipients， the author consulted the classics of materia medica and processing specifications in various regions， sorted out the historical evolution of Rehmanniae Radix processing， and explored new methods and new ideas to exert the maximum efficacy on this basis. At the same time， the effects of different processing excipients on the chemical components and pharmacodynamic effects of Rehmanniae Radix were analyzed. After literature review， it was found that Rehmanniae Radix mainly had the effects of clearing heat and cooling blood， nourishing Yin and generating fluid. Its traditional processing excipients generally used rice wine， Carthami Flos and others. After processing with different excipients， there was different effects on the chemical components and pharmacological effects of Rehmanniae Radix. In summary， this paper can provide useful reference for standardized research on different processed products of Rehmanniae Radix.

The Effect of Patient-Engaged Bedside Handoffs Protocol in Comprehensive Care Units / 임상간호연구

Purpose@#The purpose of this study was to apply patient-engaged bedside handoffs in comprehensive care units, and to evaluate the effects of bedsides to nurses and patients. @*Methods@#This study employed a cluster randomized cross-over design.Electrical Medical Record (EMR)-based handoffs and patient-engaged bedside handoffs were alternatively applied to 104 patients, who were assigned to a total of 30 clusters (nursing handoff teams) in 4 comprehensive care units at the S medical center in Seoul, and the patients evaluated each type of handoffs. A total of 139 nurses were also participated in the same units and evaluated each type of handoffs. Data were analyzed using t-test, Wilcoxon rank sum test, ANOVA, and Kruskal-Walls test. @*Results@#The patient's satisfaction of the patient-engaged bedside handoffs was higher than that of the EMR-based handoffs (Z=-5.16, p<.001). On the other hand, the nurse's satisfaction of the patient-engaged bedside handoffs was significantly lower than that of the EMR-based handoffs (t=13.21, p<.001). There were no differences in length of the reporting time between two types of handoffs (t=-0.48, p=.634). @*Conclusion@#Patient satisfaction with the patient-engaged bedside handoffs was higher than that of EMR-based handoffs, and nurses' satisfaction with the patient-engaged bedside handoffs was significantly lower than that of EMR-based handoffs. Future studies are needed regarding the impacts of patient-engaged bedside handoffs on the quality of healthcare by identifying the benefits of the handoffs.

Factors associated with Empathy in Patients with Schizophrenia in Psychiatric Rehabilitation Centers / 정신간호학회지

Purpose@#Empathy is the most important communication skill, and patients with schizophrenia in recovery should be taught empathy for vocational rehabilitation and social life. The purpose of this study was to investigate factors affecting empathy, as well as motivation-pleasure and social anhedonia, in patients with schizophrenia in psychiatric rehabilitation. @*Methods@#This study followed a descriptive design using a cross-sectional survey to assess the empathy, social anhedonia, and motivation-pleasure levels of patients with schizophrenia. The participants were 118 patients with schizophrenia from five mental health rehabilitation centers in South Korea. @*Results@#The results of this study show a high correlation among empathy, motivation-pleasure, and social anhedonia. The variables affecting empathy were age, motivation-pleasure, and social anhedonia, and the explanatory power of the variables was 32.6%. @*Conclusion@#The results of this study suggest that improving communication skills and negative symptoms will contribute positively to patients’ social lives and vocational rehabilitation.

Surface characterization of calcium phosphate coating formed on chitosan and alkali-treaDted titanium metal / 대한치과재료학회지

The calcium phosphate coating on various pretreated metals was prepared by soaking in modified simulated body fluid (m-SBF) solution. The coating structure and its surface morphologies were determined by x-ray diffraction, Fourier transform infrared spectroscopy, and scanning electron microscopy. The results revealed significant differences in morphology and composition of the calcium phosphate coatings with and without chitosan and NaOH-pretreated commercially pure titanium (cp-Ti) substrate. The calcium phosphates formed on chitosan coated-Ti pretreated with NaOH were ~ 350 nm-sized resulting in strong bonding of the apatite layer with the substrates and a uniform gradient of stress transfer from coating materials to the Ti-substrate. After NaOH pretreatment, the hydroxyl groups bind to Ca²⁺ to attract PO₄³⁻ anions, eventually resulting in a continuous layer of calcium phosphate on chitosan coated-Ti substrate during immersion in m-SBF solution. The chitosan coated-Ti showed hydrophobic surface while NaOH pretreatment resulted in maximum hydrophilicity to the Ti substrate. Due to improved wettability of Ti by NaOH pretreatment before chitosan coating, aggregation of calcium phosphate was prevented and size-controlled composite materials were obtained.

Retrospective analysis and discussion on 74 cases of adverse reactions of traditional Chinese medicine injection / 中国中药杂志

As a modern dosage form drug with rapid effect, traditional Chinese medicine (TCM) injection has been more and more used in clinical practice. Meanwhile the safety of TCM injection has attracted more and more attention. The retrospective analysis on 74 cases of adverse reaction of TCM injections collected from 2007 to 2016 in the Third Affiliated Hospital of Beijing University of Chinese Medicine showed that the proportion of men and women with adverse reactions was 0.54:1; the average age was 62.5 years old; 21 kinds of TCM injections were involved. Among them, the most reported were blood-regulating agents. The top four kinds of TCM injections with highest adverse drug reactions (ADRs) were Tanreqing injection, Danhong Injection, Shuxuening Injection and Xuesaitong for injection. The top three clinical manifestations of adverse reactions were lesions of skin and its appendages, damage of circulatory system and damage of nervous system. The potential causes of the adverse reactions of TCM injections were analyzed, and it was believed that individual difference, medicine, pharmaceutical excipients, solvent and TCM syndrome differentiation may be the main five causes for the adverse reactions of TCM injections. In order to reduce the adverse reactions of TCM injections, it is suggested that the clinical pharmacists should participate in the application management of TCM injections in the hospital; the production enterprises shall strengthen the whole life cycle management of the drugs; and at the same time, the drug control and administration authorities should improve the drug management methods constantly and encourage the development of TCM injections to the high quality level.

Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

PURPOSE: Intussusception is a common cause of intestinal obstruction in children. While most patients can be treated by enema reduction, about 20% require surgery. We investigated the usefulness and feasibility of laparoscopic surgery and the intraoperative risk of bowel resection. METHODS: We retrospectively reviewed pediatric patients who underwent surgery for intussusception from 2010 to 2017. We collected data for age, gender, body weight, associated symptoms, duration of symptoms, white blood cell count, operating time, and postoperative complications. RESULTS: Of 155 patients, 37 (23.8%) underwent surgery due to enema reduction failure in 29 (78.3%), recurrence in 6 (16.3%), a suspicious lead point in 1, and suspicious ischemic change observed on ultrasonography in 1. The mean age was 26.8±18.9 months (range, 3.5~76.7 months), and the mean body weight was 12.9±3.9 kg (range, 5.4~22.2 kg). Laparoscopic surgery was successful in 29 patients (78.4%), and 7 (18.9%) needed bowel resection and anastomosis. The mean operating time was 56.7±32.8 min. A lead point was found in 3 patients in the bowel resection group (p=0.005); in addition, the operating time and hospital stay were longer in this group. There were no intra- or postoperative complications. CONCLUSION: Laparoscopic surgery was successful in 78.4% of the patients with a short hospital stay and early oral intake. The only predictive factor for bowel resection was the presence of a lead point. Laparoscopic surgery may be an optimal treatment intervention for children with intussusception, except for those who show initial peritonitis.

Analysis on structure and phylogeny of chloroplast genomes in Araliaceae species / 中草药

Objective: To obtain the structural characteristics and phylogentic relationships of the chloroplast genome in Araliaceae species. Methods: we used 20 chloroplast genomes which have sequenced as materials, they were from 20 species belonging to 10 genus of Araliaceae. Analysis the differences of genomes and the dilation or shrink of four boundaries for IR, we used MEGA 4.0 to build the phylogenetic tree with Angelica gigas of sibling species as the outgroup and analysis their phylogentic relationships. Results: There was a small difference among the chloroplast genomes size, and the largest difference is 1 909 bp. All of species had existed gene replacements, cemA replaced ycf10, and number of genes existed some differences, they were mainly caused by tRNA. The four boundaries of IR was relatively conservative, only Panax vietnamensi, Panax notoginseng and Schefflera delavayi were special, their boundary genes were in IR. All nodes of the phylogenetic tree of Araliaceae which was based on Angelica gigas were of high supports, and the tree had good resolution to reflect the genetic relationships among Araliaceae. Conclusion: Chloroplast genomes have a lot of information, it can be used to analysis phylogeny among the species which are affinity or faster evolution.

Analysis of transicriptomes and exploring flavonoid biosynthetic pathway genes in Lithocarpus polystachyus / 中国中药杂志

The sweet taste and health effect of Lithocarpus polystachyus are mainly related flavonoid. To obtain Lithocarpus transcriptome database and flavonoid biosynthesis-related genes, the RNA-Seq techology (Illumina HiSeq 4000) was used to sequence its transcriptome. Six Gb database was assembled after assembly steps, and 41 043 of L. polystachyus unigenes were obtained. With blasting them with 7 data banks, all unigenes were involved in 51 GO-terms and 237 metabolic pathways. And furthermore 28 genes of the flavonoid biosynthesis-related were found. After using the MicroSatallite, 18 161 SSR were obtained, the single-nucleotide-repeated was the richest at 7 346. These data represent abundant messages about transcripts and provide valuable genome data sources in molecular biology of L. polystachyus.

Analysis of transicriptomes and differentially expressed genes in Eleutherococcus senticosus / 中草药

Objective: To obtain the transcriptome database and differentially expressed genes of Eleutherococcus senticosus. Methods: We choose the high content group and the low content group of saponin as experimental materials, and use the high-throughput sequencing technology (Illumina HiSeq 4000) to sequence the transcriptome of E. senticosus, then we systematically analyze the sequencing results in the bioinformatic way. Results: We have assembled 8.34 Gb database, after assembly steps, we get 77 087 of E. senticosus unigenes, then blasting them with five data banks. All unigenes are involved in 55 GO-terms and 116 metabolic pathways. Though the differentially expressed analysis of two materials, we get 530 differentially expressed genes, the up-regulated genes account for 42.08%, the down-regulated genes account for 57.92%. After GO and Pathway enrichment analysis, we get 408 GO-natations and 40 metabolic pathways. Conclusion: These data represent the abundant messeges about transcripts and provide the valuable genome data sources in molecular biology of E. senticosus.

Effects on Critical Thinking Disposition and Empathy on Cultural Competency in Nursing Students / 정신간호학회지

PURPOSE: This study was conducted to investigate the effects of critical thinking disposition and empathy on cultural competency in nursing students. METHODS: The participants were 199 nursing students from D, H, and W universities in J province. Data were collected from April 1 to May 30, 2016, and analyzed using SPSS/WIN 21.0. RESULTS: The mean score for critical thinking disposition was 3.53±0.37, for empathy, 3.73±0.33, and for cultural competency, 3.23±0.40. Critical thinking disposition showed a positive correlation with cultural competency (r=.32, p<.001) and empathy showed a positive correlation with cultural competency (r=.31, p<.001). Critical thinking disposition showed a positive correlation with empathy (r=.36, p<.001). Significant factors that influenced cultural competency were critical thinking disposition, empathy, foreign residents in the family, and participating in cultural education. These variables explained 18% of cultural competency. CONCLUSION: These findings indicate that critical thinking disposition and empathy enhancement programs should be developed to increase cultural competency in nursing students. There is also a need for further studies to examine effects of developed programs.

A Study on the Retentive Force of Stud Attachments for Implant Overdenture / 치위생과학회지

The purpose of this study was to compare the changes of retentive force in different stud attachment systems for implant retained overdenture. Two commercially available attachments with different retentive forces were investigated: Kerator (pink, blue, red) and O-ring (orange, red). Two implant fixtures were vertically embedded in base mountings. Five pairs of each attachment were evaluated. A universal testing machine was used to evaluate the retentive force of two attachments during wear simulation. Surface characteristics of each attachment system were evaluated with scanning electron microscopy. Five pairs of each attachment were evaluated. Kerator pink showed the highest initial retention. After 2,500 cycles of wear-simulation, Kerator pink noted the largest decrease in retention. According to results of surface analysis, Worn surfaces were obtained in matrices and patrices. Heavy wears were observed in matrices. After 2 year-wear simulation, most attachments exhibited retention loss. Attachments using different kind of material exhibited dissimilar surface alterations.

Economic Evaluation of Rosuvastatin and Atorvastatin for the Treatment of Dyslipidemia from a Korean Health System Perspective

OBJECTIVE: This study aims to analyze cost-effectiveness of two most-commonly used statins from the perspective of the Korean national health system. METHODS: The scope of the analysis included rosuvastatin (5 mg, 10 mg, and 20 mg) and atorvastatin (10 mg, 20 mg, 40 mg, and 80 mg). Effectiveness was defined as percentage (%) and absolute (mg/dL) reductions of low-density lipoprotein cholesterol (LDL-C) from the baseline. They were derived from published randomized controlled studies for rosuvastatin and atorvastatin. Effectiveness was defined as reductions in LDL-C levels per mg dose of the drugs. The annual direct medical costs including drug acquisition costs and monitoring costs over the one-year time horizon were calculated for each alternative. The average cost-effectiveness ratios (ACERs) and incremental cost-effectiveness ratios (ICERs) for each statin dose were calculated. RESULTS: The ACERs for all doses of rosuvastatin (5 mg, 10 mg, and 20 mg) were lower than those for all doses of atorvastatin (10 mg, 20 mg, 40 mg, and 80 mg). Rosuvastatin 10 mg was the most cost-effective statin for LDL-C reduction. In cost-effectiveness analyses for corresponding doses of rosuvastatin and atorvastatin, rosuvastatin was the superior strategy which suggests both higher effectiveness and lower costs than atorvastatin. However, we have to consider this analysis is highly influenced by current price of statins in each market. CONCLUSIONS: For reduction of LDL-C levels in Korean patients with dyslipidemia, rosuvastatin 10mg is the most cost-effective statin in the current Korean market.

Frequency, Intensity and Daily Life Distress of Urinary Dysfunction in Women with Cervical Cancer after Radical Hysterectomy

PURPOSE: This study was done to identify frequency, intensity of urinary dysfunction and daily life distress in women after a radical hysterectomy for cervical cancer. METHODS: One hundred and fifty seven women who had undergone a radical hysterectomy and one hundred and sixty five women as healthy controls completed questionnaires on intensity of urinary dysfunction and daily life distress caused by urinary dysfunction. RESULTS: Women with cervical cancer showed higher frequency of urinary dysfunction than healthy controls. Major urinary dysfunction for women with cervical cancer in order of frequency were night-time incontinence (odds ratio=10.39, p<.001), difficulty in starting urination, weak urine stream and sense of incomplete emptying of bladder. The highest score on intensity was difficulty in starting urination, followed by urgency, weak urine stream, daytime frequency and sense of incomplete emptying. Night-time incontinence was the urinary symptom causing the most daily life distress for cervical cancer women followed by difficulty in starting urination, urgency, sense of incomplete emptying, and night-time frequency. CONCLUSION: Results suggest that nurses should address the potential postoperative urinary complications and develop long term interventions to decrease urinary dysfunction and daily life distress for women who have had a radical hysterectomy for cervical cancer.

Dietary evaluation of a low-iodine diet in Korean thyroid cancer patients preparing for radioactive iodine therapy in an iodine-rich region

BACKGROUND/OBJECTIVES: Despite the importance of a low-iodine diet (LID) for thyroid cancer patients preparing for radioactive iodine (RAI) therapy, few studies have evaluated dietary intake during LID. This study evaluated the amount of dietary iodine intake and its major food sources during a typical diet and during LID periods for thyroid cancer patients preparing for RAI therapy, and examined how the type of nutrition education of LID affects iodine intake. SUBJECTS/METHODS: A total of 92 differentiated thyroid cancer patients with total thyroidectomy were enrolled from Seoul National University Hospital. All subjects completed three days of dietary records during usual and low-iodine diets before 131I administration. RESULTS: The median iodine intake was 290 µg/day on the usual diet and 63.2 µg/day on the LID. The major food groups during the usual diet were seaweed, salted vegetables, fish, milk, and dairy products and the consumption of these foods decreased significantly during LID. The mean energy intake on the LID was 1,325 kcal, which was 446 kcal lower than on the usual diet (1,771 kcal). By avoiding iodine, the intake of most other nutrients, including sodium, was significantly reduced during LID (P < 0.005). Regarding nutritional education, intensive education was more effective than a simple education at reducing iodine intake. CONCLUSION: Iodine intake for thyroid cancer patients was significantly reduced during LID and was within the recommended amount. However, the intake of most other nutrients and calories was also reduced. Future studies are needed to develop a practical dietary protocol for a LID in Korean patients.

Regulation of Stem Cell Fate by ROS-mediated Alteration of Metabolism

Stem cells have attracted much attention due to their distinct features that support infinite self-renewal and differentiation into the cellular derivatives of three lineages. Recent studies have suggested that many stem cells both embryonic and adult stem cells reside in a specialized niche defined by hypoxic condition. In this respect, distinguishing functional differences arising from the oxygen concentration is important in understanding the nature of stem cells and in controlling stem cell fate for therapeutic purposes. ROS act as cellular signaling molecules involved in the propagation of signaling and the translation of environmental cues into cellular responses to maintain cellular homeostasis, which is mediated by the coordination of various cellular processes, and to adapt cellular activity to available bioenergetic sources. Thus, in this review, we describe the physiological role of ROS in stem cell fate and its effect on the metabolic regulation of stem cells.

A bird's eye view of the air pollution-cancer link in China / 癌症

Air pollution in China comes from multiple sources, including coal consumption, construction and industrial dust, and vehicle exhaust. Coal consumption in particular directly determines the emissions of three major air pollutants: dust, sulfur dioxide (SO(2)), and nitrogen oxide (NOx). The rapidly increasing number of civilian vehicles is expected to bring NOx emission to a very high level. Contrary to expectations, however, existing data show that the concentrations of major pollutants [particulate matter-10 (PM10), SO(2), and nitrogen dioxide (NO(2))] in several large Chinese cities have declined during the past decades, though they still exceed the national standards of ambient air quality. Archived data from China does not fully support that the concentrations of pollutants directly depend on local emissions, but this is likely due to inaccurate measurement of pollutants. Analyses on the cancer registry data show that cancer burden related to air pollution is on the rise in China and will likely increase further, but there is a lack of data to accurately predict the cancer burden. Past experience from other countries has sounded alarm of the link between air pollution and cancer. The quantitative association requires dedicated research as well as establishment of needed monitoring infrastructures and cancer registries. The air pollution-cancer link is a serious public health issue that needs urgent investigation.

Active and passive smoking with breast cancer risk for Chinese females: a systematic review and meta-analysis / 癌症

Previous studies suggested that smoking and passive smoking could increase the risk of breast cancer, but the results were inconsistent, especially for Chinese females. Thus, we systematically searched cohort and case-control studies investigating the associations of active and passive smoking with breast cancer risk among Chinese females in four English databases (PubMed, Embase, ScienceDirect, and Wiley) and three Chinese databases (CNKI, WanFang, and VIP). Fifty-one articles (3 cohort studies and 48 case-control studies) covering 17 provinces of China were finally included in this systematic review. Among Chinese females, there was significant association between passive smoking and this risk of breast cancer [odds ratio (OR): 1.62; 95% confidence interval (CI): 1.39-1.85; I2 = 75.8%, P < 0.001; n = 26] but no significant association between active smoking and the risk of breast cancer (OR: 1.04; 95% CI: 0.89-1.20; I2 = 13.9%, P = 0.248; n = 31). The OR of exposure to husband's smoking and to smoke in the workplace was 1.27 (95% CI: 1.07-1.50) and 1.66 (95% CI: 1.07-2.59), respectively. The OR of light and heavy passive smoking was 1.11 and 1.41, respectively, for women exposed to their husband's smoke (< 20 and ≥ 20 cigarettes per day), and 1.07 and 1.87, respectively, for those exposed to smoke in the workplace (< 300 and ≥ 300 min of exposure per day). These results imply that passive smoking is associated with an increased risk of breast cancer, and the risk seems to increase as the level of passive exposure to smoke increases among Chinese females. Women with passive exposure to smoke in the workplace have a higher risk of breast cancer than those exposed to their husband's smoking.

Comparison of OCT Parameters between the Dominant and Nondominant Eye

PURPOSE: To evaluate the anatomical difference between the dominant and nondominant eyes in healthy, young adults by measuring macular, peripapillary retinal nerve fiber layer (PRNFL), and macular ganglion cell layer (MGCL) thicknesses. METHODS: Two hundred healthy adults were recruited and assessed for ocular dominance using 'a hole in the card test'. PRNFL, macular and MGCL thicknesses of both eyes were measured using spectral domain optical coherence tomography (OCT). RESULTS: There were no statistically significant differences for average thicknesses of MGCL in each of the six areas between the dominant and nondominant eyes. No difference was observed between temporal, inferior, average PRNFL thickness and macular thickness in dominant and nondominant eyes. CONCLUSIONS: There was no intraocular anatomical difference between the dominant and nondominant eyes in healthy, young adults.