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BACKGROUND:Premature birth is a major global health problem associated with high mortality and morbidity.White matter injury is the most common brain injury in preterm infants.Salvia miltiorrhiza is a traditional herbal plant that is commonly used to treat cardiovascular and cerebrovascular diseases in Asian countries. OBJECTIVE:To investigate the therapeutic effect of Salvia miltiorrhiza on white matter injury in preterm infants. METHODS:Eighteen neonatal male Sprague-Dawley rats at 3-day gestational age were selected and randomized into normal group,white matter injury group,and Salvia miltiorrhiza group.Animal models of preterm white matter injury were established by permanent ligation of the right common carotid artery in the latter two groups.Rats in the Salvia miltiorrhiza group were given intraperitoneal injection of Salvia miltiorrhiza(5 mg/kg·d)for 7 consecutive days.Normal group and white matter injury group were given the same volume of PBS for intervention.On the 14th day after modeling,the rats were sacrificed.Brains were pathologically observed by hematoxylin-eosin staining under microscope,and the expression levels of myelin basic protein and CC1 in brain tissue were visualized using immunofluorescence.Furthermore,liquid chromatography-tandem mass spectrometry was used to analyze possible pathways for the action of Salvia miltiorrhiza. RESULTS AND CONCLUSION:In the white matter injury group,the structure of the corpus callosum was irregular and the cells appeared swollen and necrotic.In addition,induction of white matter injury resulted in significantly reduced myelin formation,with irregular and loosely arranged nerve fibers and significantly decreased myelin sheaths.Interestingly,white matter injury rats treated with Salvia miltiorrhiza had reduced cellular swelling,reduced lesions,and increased myelin sheaths.The expression of myelin basic protein was closely related to myelin formation,and CC1 was a marker of myelin oligodendrocytes.Salvia miltiorrhiza significantly up-regulated the expressions of myelin basic protein and CC1 in white matter injury rats(P＜0.000 1),indicating that Salvia miltiorrhiza alleviated white matter injury.Liquid chromatography-tandem mass spectrometry analysis showed that the therapeutic effect of Salvia miltiorrhiza in the rat model of white matter injury was closely related to the regulation of complement and coagulation cascades.To conclude,Salvia miltiorrhiza may be a potential therapeutic agent for treating preterm white matter injury.
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Objective:To evaluate the efficacy and safety of preoperative intravitreal conbercept (IVC) as an adjunct to pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR).Methods:A systematic search in EMbase, PubMed, Cochrane Library, Chinese periodical full text database (CNKI), Wanfang database and VIP database were conducted, studies about the effectiveness and safety of IVC combined with PPV in the management of PDR were collected.Two researchers independently screened the studies according to the inclusion criteria and exclusion criteria, and extracted the data.The quality of the randomized controlled trial (RCT) was evaluated by the modified Jadad scale, and the quality of the cohort study or case-control study was evaluated by the Newcastle Ottawa scale (NOS). Rev Man 5.3 was applied for data analysis.Results:A total of 11 RCTs, 2 cohort studies and 10 case-control studies involving 1 625 patients and 1 844 eyes were included.The final Jadad score for each RCT was more than 3, and the final NOS score for each cohort study and case-control study was more than 5.The results of Meta-analysis showed that the total effectiveness of treatment was significantly higher in the preoperative IVC group than that in the simple PPV group ( RR=1.31, 95% CI: 1.21-1.42, P<0.001). The average operation duration was significantly shorter in the preoperative IVC group compared with that in the simple PPV group (MD=-21.11, 95% CI: -26.39--15.83, P<0.001). The level of VEGF was significantly lower in the preoperative IVC group than that in the simple PPV group (MD=-15.33, 95% CI: -19.40--11.26, P<0.001). Preoperative IVC could reduce the incidences of intraoperative bleeding, iatrogenic retinal breaks, postoperative recurrent vitreous hemorrhage and temporary increase of intraocular pressure, with statistically significant differences between them (all at P<0.05). Conclusions:Preoperative intravitreal injection of conbercept shows better effect and safer than vitrectomy alone, and it has no serious side effect.
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OBJECTIVE： To provide reference for reasonable selection of tyrosine kinase inhibitors （TKI） in chronic myeloid leukemia （CML） patients with BCR-ABL35INS mutation. METHODS： Using “BCR-ABL insertional mutation” “ABL1 35ins mutation” “BCR-ABL c.1423_1424ins35” “ABL1 p.C475Tyrfs*11” as keywords， retrieved from CNKI， Wanfang database， Medline and COSMIC database， BCR-ABL35INS mutation CML patients were summarized and analyzed in respects of general information and treatment （treatment plan， patient compliance and drug withdrawal）， therapeutic effect （molecular biological mitigation and disease progress） and safety data （ADR） during 2007-2018. RESULTS： Totally 9 related literatures were included， involving 70 patients with BCR-ABL35INS mutation， all of them were foreign cases. Among them， 39 cases were male and 31 cases were female， with a median age of 49.2 years. The median time from the diagnosis of CML to the detection of BCR-ABL35INS mutation was 19 months. After detecting gene mutation， 39 cases were treated with imatinib （initial dose of 400 mg， po， once a day）， and molecular biological remission was achieved in 5 patients （12.9％）； 15 cases （38.5％） had molecular biological response but had disease progression； 8 patients （20.5％） had no response. Seventeen patients were treated with dasatinib （100 mg， po， once a day or 2 divided dose）， and 8 cases （47.1％） achieved molecular biological response. Twenty-one patients were treated with nilotinib （400 mg， po， 2 divided dose）， and 3 patients （14.3％） achieved molecular biological response； 2 patients achieved molecular biological response， but the disease progressed. Seven， three and seven of these patients stopped taking drugs due to adverse reactions， accounting for 17.9％， 17.6％ and 33.3％ respectively. All the ADRs were classified as grade 3-4 of the National Cancer Institute’s Common Terminology Criteria for Adverse Events， and most of them were hematological toxicity. CONCLUSIONS： CML patients with BCR-ABL35INS mutation are less likely to achieve molecular response on imatinib therapy but are more sensitive to dashatinib. In the course of treatment， we should strengthen the monitoring of blood system and other related indicators to ensure the safety and effectiveness of drug use.
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Objective To systematically evaluate the efficacy and safety of alprostadil injection in patients with viral hepatitis.Methods Medline,Embase,The Cochrane Library,CBMdisc,CNKI,Wanfang Database and VIP were searched.The quality of included studies such as randomization,blinding,allocation concealment and loss of follow-up were evaluated and meta-analysis was performed by RevMan5.1 software.Results In total,14 RCTs and 1 232 patients were included.Meta-analysis showed that in patients with viral hepatitis,the total effective rate of alprostadil injection treatment was significantly superior to that of conventional therapy (P<0.000 01).Serious adverse drug reactions (ADRs) induced by alprostadil injection were not reported.Conclusion Alprostadil injection is effective and safe for treating viral hepatitis.However,the evidence is not strong due to the generally low methodological quality of RCTs.Further high quality and large sample-sized randomized controlled trials and more pharmacoeconomics studies should be carried out.
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Objective To explore how clinical pharmacists exert their effects in drug therapy.Methods The pharmaceutical practice of clinical pharmacist participating in the treatment of one case of warfarin related nephropathy (WRN) was reported.Early identification of warfarin associated nephropathy and early treatment were necessary and the anticoagulant regimen was optimized.Pharmaceutical education was conducted by clinical pharmacist.Results With guidance by clinical pharmacist,the psychological burden of the patient was reduced,the patient compliance was improved,and the patient understanding of adverse drug reactions was increased.Conclusion Clinical pharmacists involved in clinical treatment practice is conducive to timely detecting and treating patients with adverse drug reactions,and improving the level of drug treatment.
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Objective To investigate the influence of zoledronic acid injection on body temperature of patients with primary osteoporosis.Methods A total of 142 patients with primary osteoporosis who received intravenous zoledronic acid treatment in Peking university people's hospital during 2013-2014 were enrolled in this study.The body temperature before and after intravenous zoledronic acid treatment were recorded and analyzed with SPSS 17.0 software.Results The patients'body temperature at different time points after intravenous zoledronic acid treatment was significantly different (P =0.000).Prophylactic use of NSAIDs could significantly reduce patients' body temperature at the second day after intravenous zoledronic acid.Conclusion NSAIDs can be given orally on the same day of intravenous injection of zoledronic acid,and continued for three days.
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Objective To investigate the potential tigecycline resistance of Klebsiella pneumoniae during treatment.Methods The minimum inhibitory concentrations (MICs) and the mutant prevention concentrations (MPCs) of tigecycline were determined for K.pneumoniae isolates with four different resistant profiles.Corr.elations between MICs and MPCs were analyzed.We combined with the pharmacokinetic parameters of tigecycline to estimate the potential of emerging resistance to tigecycline monotherapy in K.pneumoniae.Results The MPCs of tigecycline for the carbapenem-and fluoroquinolone-resistant isolates were found to be 8-fold higher than those for carbapenem-and quinolones-susceptible isolates.Our data showed that the MPCs range and MPC90 values of tigecycline were 4-512 mg/L and 64 mg/L,respectively,which were much higher than the therapeutic concentrations of tigecycline in serum and tissues.Conclusions Long-term tigecycline monotherapy may predispose the emergence of resistance in K.pneumoniae,which is not recommended.It is desirable to carry out ongoing monitoring of K.pneumoniae susceptibility and tigecycline treatment effect.
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OBJECTIVE:To systematically review the effect of CYP2C19 genetic polymorphism on lansoprazole pharmacoki-netics,and provide evidence-based reference for clinical individualized medication of lansoprazole. METHODS:Retrieved from PubMed,EMBase,Web of science,Cochrane Library and CJFD,retrospective studies about the effect of CYP2C19 genetic poly-morphism on lansoprazole pharmacokinetics were collected,Meta-analysis was performed by Rev Man 5.2 software after data ex-tract and quality evaluation. RESULTS:Totally 11 retrospective studies were included,involving 200 patients. The gene type in-cluded homozygote express metabolizers (EM),heterozygous express metabolizers (HEM) and slow metabolizers (PM). Results of Meta-analysis showed CYP2C19 polymorphism significantly affected cmax,AUC,t1/2,tmax and CL/F. The cmax and AUC in group PM were higher than group HEM and group EM;CL/F in group EM was higher than group HEM and group PM;t1/2 in group PM was higher than group HEM and group EM,while there was no significant difference in the t1/2 between group HEM and group EM;tmax in HEM and group PM were higher than group EM,while there was no significant difference in the tmax between group PM and group HEM. CONCLUSIONS:CYP2C19 genetic polymorphism shows obvious effect on lansoprazole pharmacokinetics, which is the key factor for causing efficacy of lansoprazole and individual differences among adverse reactions,and clinic should take into account individualized dose regimen of lansoprazole.
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Objective To systematically evaluate the clinical efficacy and safety of azithromycin(Az)versus amoxicillin-cla?vulanic acid(A-Cva)in the treatment of some acute respiratory infections in children. Methods Pubmed,EMBase,Medline,Co?chrane Library and CJFD were retrieved to collect the randomized controlled trial(RCT)of their clinical efficacy and safety in the treat?ment of acute respiratory infections in children. The methodological quality of included studies was evaluated.The RevMan 5.2 software was chosen for data analysis. Results Twenty RCTs involving 4980 pediatric patients were included for assessment of the clinical effi?cacy. Meta-analysis showed that Az had more significant effect on the treatment of some bacterial repiratory infections in children〔OR=0.78,95%CI(0.65,0.93),P=0.007〕than A-Cva. In the treatment of upper respiratory infections,acute otitis media and so on,Az had more significant effect〔OR=0.75,95%CI(0.62,0.91),P=0.003〕;in the treatment of lower respiratory infections,such as community acquired pneumonia and so on,Az and A-Cva acid had the similar effect〔OR=1.20,95%CI(0.62,2.33),P=0.58〕. Thirteen RCT in?volving 3474 pediatric patients were included for assessment of the clinical safety. Meta-analysis shows that the difference between Az and A-Cva is statistic significant in the treatment of some bacterial repiratory infections in children〔OR=0.49,95%CI(0.40,0.60),P<0.000 01〕. Conclusion Overall,Meta-analysis shows that Az is more effective and safer in the treatment of some bacterial repiratory infections in children than A-Cva.
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OBJECTIVE:To investigate the way to provide suitable pharmacecaical care for antineophastic drug-induced ADR by clinical pharmacists. METHODS:For one case of 5-FU chemotherapy-induced neutropenia associated with fever and diarrhea, clinical pharmacists provided advices on antibacterial treatment,including imipenem/cilastatin 0.5 g,q6 h,ivgtt;norvancomycin 0.4 g,q6 h,po;levofloxacin 0.4 g,qd,ivgtt;loperamide with initial dose of 4 mg for anti-diarrheal medication,maintaining at 2 mg,q4 h. RESULTS:After 22 days of appropriate antibacterial and anti-diarrheal treatment,the patient's body temperature and he-mogram returned to normal,diarrhea stopped and β-HCG decreased to 61.58 U/L;then the patient was discharged from hospital. CONCLUSIONS:It is beneficial to optimize chemotherapy plan and ADR disposal,and ensure the safety of the treatment that clini-cal pharmacists assist physicans to optimize therapy plan and provide pharmaceutical care.
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OBJECTIVE:To investigate the characteristics and related factors of drug-induced hyperkalemia,present preven-tive measures and provide reference for the rational drug use. METHODS:46 literatures of individual cases and group cases of drug-induced hyperkalemia publicly reported in domestic medical journals from 1979 to 2014 were collected and analyzed statistical-ly,including 66 cases. RESULTS:66 cases with drug-induced hyperkalemia were mainly involved in cardiovascular drugs and im-munosuppressants. Most of them were improved after drug withdrawal and symptomatic treatment,and 2 cases died. CONCLU-SIONS:Drug-induced hyperkalemia are potentially dangerous. It is necessary to be vigilant,prevent and control timely and reduce the incidence of severe adverse reactions.
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OBJECTIVE:To systematically evaluate the efficacy and safety of simvastatin vs. pravastatin in the treatment of hy-perlipidemia,and provide evidence-based reference for the clinical treatment. METHODS:PubMed,Medline,EMBase,Cochrane Library and CJFD were retrieved to collect the randomized controlled trial(RCT)of efficacy and safety of simvastatin(test group) and pravastatin (control group) in the treatment of hyperlipidemia. The methodological quality of included studies was evaluated. The Rev Man 5.2 software was chosen for data analysis. RESULTS:14 RCT involving 1 019 patients were included. Meta-analysis showed that simvastatin had more significant effect in the decreasing of TC [MD=-0.34,95%CI(-0.52,-0.16),P<0.001] and LDL-C[MD=-0.31,95%CI(-0.45,-0.17),P<0.001] than pravastatin;and simvastatin and pravastatin had the similar effect in TG[MD=-0.06,95%CI(-0.18,0.05),P=0.28)] and HDL-C[MD=0.00,95%CI(-0.04,0.04),P=0.85]. Adverse drug reaction rate results showed they were similar[OR=0.70,95%CI(0.36,1.39),P=0.31]. CONCLUSIONS:Simvastatin is more effective in lipid-lowering than pravastatin with similar safety. Due to the limited number and low quality of included studies,it remains to be further verified with more reasonably designed,multi-center and large-sample studies.
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Phosphodiesterase-4 ( PDE4 ) has been one of the most popular drug targets during recent years due to its critical role in the control of intracellular cyclic adenosine monophos-phate ( cAMP ) concentration and downstream signal transduc-tion. PDE4 is widely distributed in the central nervous system ( CNS) with different expression levels of its four subtypes. Re-cent data indicate that altered PDE4 expression and/or activity is relevant to multiple CNS disorders, such as depression, memory deficiency, drug dependence, and neural lesion. Selective PDE4 inhibitors exhibit therapeutic effects on these disorders and might be a promising pharmacotherapy. The paper highlights recent re-search progress in the roles of PDE4 in CNS function, and dis-cusses the prospects of PDE4 as a novel therapeutic target for CNS disorders.
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OBJECTIVE To prevent infection during the processes of dispensation and distribution of disinfectant. METHODS All the key processes were put under strictly control including purchase,preservation of disinfectant,quality of dispensing processes and administration of the disinfectant distribution. RESULTS Both effective ingredients and microorganism were coincided with the definite criterion. CONCLUSIONS Quality control and administration of disinfectant in manufacturing laboratory is important to guarantee the quality of disinfectant dispensation and to prevent from nosocomial infection as well.