Ozone therapy improves early stages of osseointegration in ovariectomized rats

Abstract Objective the aim of this study was to analyze the influence of ozone therapy (OZN) on peri-implant bone repair in critical bones by installing osseointegrated implants in the tibia of ovariectomized rats. Methodology ovariectomy was performed on 30 Wistar rats, aged six months (Rattus novergicus), and, after 90 days, osseointegrated implants were installed in each tibial metaphysis. The study groups were divided into the animals that received intraperitoneal ozone at a concentration of 700 mcg/kg — OZ Group (n=15) — and a control group that received an intraperitoneal saline solution and, for this reason, was named the SAL group (n=15). The applications for both groups occurred during the immediate post-operative period on the 2nd, 4th, 6th, 8th, 10th, and 12th day post-surgery. At various stages (14, 42, and 60 days), the animals were euthanized, and tests were performed on their tibiae. These tests include histomorphometric and immunohistochemical analyses, computerized microtomography, sampling in light-cured resin for calcified sections, and confocal microscopy. The obtained data were then analyzed using One-way ANOVA and the Shapiro-Wilk, Kruskal-Wallis, and student t-tests (P<0.05). Results our findings indicate that the OZ group (3.26±0.20 mm) showed better cellular organization and bone neoformation at 14 days (SAL group, 0.90±1.42 mm) (P=0.001). Immunohistochemistry revealed that osteocalcin labeling was moderate in the OZ group and mild in the SAL group at 14 and 42 days post-surgery. The data from the analysis of calcified tissues (microtomography, histometric, and bone dynamism analysis) at 60 days showed no statistically significant differences between the groups (P=0.32). Conclusion it was concluded that ozone therapy anticipated the initial phases of the peri-implant bone repair process.

Research progress of microfluidic chips in age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

Age-related macular degeneration(ARMD)is the primary cause of severe visual impairment and blindness in people over 60 years old. With the aging of the global population, the incidence of the disease is also rising year by year. However, the pathogenesis and treatment strategy of ARMD need to be further explored. As a cutting-edge science and technology, microfluidic chips can build a comprehensive microsystem that simulates the condition and function of human tissues and organs, which has the advantages of less sample consumption and short analysis time. In recent years, many studies have confirmed that microfluidic chips can bring brand new technology solutions to the basic and clinical research of ARMD. This article will discuss and review the application progress of microfluidic chips in the areas of ARMD mechanism research, drug evaluation and clinical translation, providing a theoretical reference for further research on the diagnosis and treatment of ARMD.

Quality control of the technology method of clinical comprehensive drug evaluation / 中国药房

At present， there are still some problems in China’s clinical comprehensive drug evaluation， such as the unscientific design of the evaluation content， the nonstandard evaluation method and organizational process， and the evaluation results not meeting the decision-making needs. It is urgent to carry out quality control over the whole process of the clinical comprehensive drug evaluation project. From the technical point of view， the quality control methods of clinical comprehensive drug evaluation are discussed through three links of the evaluation content and design （giving the quality control key points of the theme selection process and scheme design）， the evaluation method （discussing the quality control elements of two common evaluation methods， i. e. documentary evidence method and real-world research） and result application transformation （giving suggestions on quality control from the comprehensive analysis of evaluation results， transformation of evaluation results and decision-making）， so as to promote the quality improvement of clinical comprehensive drug evaluation.

Drug clinical comprehensive evaluation of tetrandrine in the treatment of pneumoconiosis / 中华劳动卫生职业病杂志

Objective: To analyze the safety, effectiveness, economics, innovation, suitability and accessibility of tetrandrine in the treatment of pneumoconiosis, and provide evidence-based basis for health policy decision-making and clinical practice. Methods: In July 2022, the system searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang, SinoMed databases (the retrieval time was from the establishment of the database to June 30, 2022), screened the documents that meet the standards, extracted and evaluated the data, and used the "HTA checklist" developed by the International Network of Agencies for Health Technology Assessment (INAHTA) to evaluate the HTA report. AMSTAR-2 Scale was used to evaluate the quality of systematic evaluation/Meta analysis. CHEERS Scale was used to evaluate the quality of pharmacoeconomics research. The included cohort study or case-control study was evaluated with the Newcastle-Ottawa Scale. The included randomized controlled trial (RCT) studies were evaluated using the Cochrane Risk Bias Assessment Tool (Cochrane RCT) quality evaluation criteria. Comprehensive comparison and analysis based on the characteristics of the data included in the study. Results: A total of 882 related literatures were detected from the initial screening. According to relevant standards, 8 RCT studies were finally selected for analysis. Statistical results showed that basic treatment with tetrandrine could better improve FEV(1) (MD=0.13, 95%CI: 0.06-0.20, P<0.001), FEV(1)/FVC (MD=4.48, 95%CI: 0.61-8.35, P=0.02) and clinical treatment efficiency. Tetrandrine had a low incidence of adverse reactions. The affordability coefficient of tetrandrine tablets was 0.295-0.492. Conclusion: Tetrandrine can improve the clinical symptoms and pulmonary ventilation function of pneumoconiosis patients, most of the adverse reactions are mild, and the clinical application is safe.

Progress in A Real-world Study of Abiraterone Acetate Versus Docetaxel in Patients with Metastatic Hormone-sensitive Prostate Cancer / 肿瘤防治研究

The safety and survival benefits of abiraterone acetate and docetaxel in the treatment of patients with metastatic hormone-sensitive prostate cancer have been confirmed by randomized controlled trials and clinical studies abroad. However, real-world studies remain lacking. In this article, we review the progress of real-world studies of abiraterone acetate and docetaxel in the treatment of patients with metastatic hormone-sensitive prostate cancer and the problems faced in clinical practice against the background of differentiated real-world studies. Further research is needed to address clinically important issues, such as individualized dosing, combination dosing, and monitoring of adverse effects.

Advances in research based on primary human hepatocytes in vitro / 中华肝胆外科杂志

Due to the special functions of liver, the topic of liver physiological function and pathophysiological changes has always been the main issue in life science area. Human liver is composed of multiple types of cells, among which the hepatocyte is the most essential one. Primary human hepatocytes are considered as the gold standard model in vitro for the liver study and the ideal cell for hepatocyte transplantation and bioartificial liver. Nowadays, primary human hepatocytes play a vital role in the field of basic science research and applied research. Therefore, we presented recent advances in research based on primary human hepatocytes in vitro.

Pharmacological action and clinical evaluation of difelikefalin, a new drug for the treatment of uremic pruritus / 中国基层医药

Uremic pruritus is one of the skin complications that perplex patients with end-stage renal disease undergoing hemodialysis or peritoneal dialysis. Because the specific pathogenesis is not clear, there is no unified treatment plan in the world. In August 2021, the US Food and Drug Administration approved the use of difelikefalin (under the trade name Korsuva) for the treatment of moderate to severe pruritus associated with chronic kidney disease in adult patients undergoing hemodialysis. Studies have shown that difelikefalin can remarkably reduce the intensity of pruritus and improve sleep and pruritus-related quality of life. The recommended dose of difelikefalin is 0.5 μg/kg, and difelikefalin is well tolerated and has high safety. This paper reviews the pharmacological effects, pharmacokinetics, clinical efficacy and safety of difelikefalin.

Multi-factor combined biomarker screening strategy to rapidly diagnose Alzheimer's disease and evaluate drug effect based on a rat model / 药物分析学报

Alzheimer's disease(AD)represents the main form of dementia;however,valid diagnosis and treatment measures are lacking.The discovery of valuable biomarkers through omics technologies can help solve this problem.For this reason,metabolomic analysis using ultra-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry(UPLC-Q-TOF-MS)was carried out on plasma,hippocampus,and cortex samples of an AD rat model.Based on the metabolomic data,we report a multi-factor combined biomarker screening strategy to rapidly and accurately identify potential bio-markers.Compared with the usual procedure,our strategy can identify fewer biomarkers with higher diagnostic specificity and sensitivity.In addition to diagnosis,the potential biomarkers identified using our strategy were also beneficial for drug evaluation.Multi-factor combined biomarker screening strategy was used to identify differential metabolites from a rat model of amyloid beta peptide 1-40(Aβ1-40)plus ibotenic acid-induced AD(compared with the controls)for the first time;lysophosphati-dylcholine(LysoPC)and intermediates of sphingolipid metabolism were screened as potential bio-markers.Subsequently,the effects of donepezil and pine nut were successfully reflected by regulating the levels of the abovementioned biomarkers and metabolic profile distribution in partial least squares-discriminant analysis(PLS-DA).This novel biomarker screening strategy can be used to analyze other metabolomic data to simultaneously enable disease diagnosis and drug evaluation.

Expert Consensus on the Application of Multiple criteria Decision Analysis in Comprehensive Clinical Evaluation of Orphan Drugs(2022) / 罕见病研究

@#Comprehensive clinical drug evaluation is an important technical tool for decision-making on drug supply. Traditional evaluation on health technology provides methodological references for comprehensive clinical evalu-ation of drugs. However, data from clinical trials for orphan drugs are often insufficient. It is difficult to evaluate the clinical and economic value of orphan drugs by using the criteria of ordinary drugs. Particularity of orphan drugs makes it difficult to use the traditional evaluation methods for health technology. Multiple criteria decision analysis explores the comprehensive value of drugs from different angles. It promotes the transparency and scientific thinking on the basis of evidence-based medicine, improves the quality of decision-making, and thus provides a possible solution to the comprehensive clinical evaluation of orphan drugs. However, its application in the comprehensive evaluation of orphan drugs in China is still in its infancy and trial stage, and no methodological guidelines is available. In order to optimize the construction of a diversified system for comprehensive clinical evaluation of orphan drugs in China, the Multi-disciplinary Team for Rare Diseases of Peking Union Medical College Hospital and China Alliance for Rare Disease organized experts in related fields to formulate this consensus, aiming to provide standardized methodological guideline to the comprehensive clinical evaluation of orphan drugs.

Ascending， Descending， Floating and Sinking Properties of Descurainiae Semen Lepidii Semen Based on Pulmonary Edema Model / 中国实验方剂学杂志

ObjectiveThe pulmonary edema （PE） model where the disease was located in the viscera was established according to the treatment principle that patients with the disease location inside should be treated with descending and sinking medicine， combined with changes in the disease tendency， to verify the scientificity of descending and sinking properties of Descurainiae Semen Lepidii Semen （SD）， and to preliminarily elucidate the scientific connotation of descending， ascending， floating and sinking of Chinese medicine. MethodSixty male SD rats were randomly divided into normal control group， model group （20 mg·kg-1）， positive drug group （dexamethasone， 0.075 mg·kg-1） and SD low （1.167 g·kg-1）， medium （2.334 g·kg-1）and high （4.668 g·kg-1） dose groups. The PE model was established by intrapleural injection of 1% carrageenan （2 mL·kg-1）. The evaluation indexes （lung autopsy， amount of pleural effusion， number of white blood cells， lung wet/dry weight ratio， lung water content and lung permeability） were tested to determine the optimal dose of SD decoction for intervention of PE. The relevant indexes of the five major systems （central nervous system， respiratory system， circulatory system， digestive system and urinary system） closely related to the body's Qi movement were detected and changes in the disease tendency in PE rats were analyzed， to determine the descending， ascending， floating and sinking properties of SD. In addition， histopathological changes were investigated by hematoxylin-eosin （HE） staining， and types and numbers of inflammatory cells and mediators were detected to preliminarily explore the mechanism of SD in improving PE. ResultCompared with the conditions in the normal control group， the amount of pleural effusion， number of white blood cells in pleural effusion， lung wet/dry weight ratio， lung water content and lung permeability were increased （P<0.01） in the model group， where the rats presented cough， dyspnea， shortness of breath and arched back， and a small number of them had wet nose and bubble liquid in nostrils. In the autopsy of the rats in the model group， the lungs were enlarged or accompanied by congestion and plenty of pink bubble liquid appeared at the trachea. Compared with the conditions in the model group， SD reduced the amount of pleural effusion， number of white blood cells in pleural effusion， lung coefficient， lung wet/dry weight ratio and lung water content （P<0.01）， and improved pulmonary edema symptoms such as damage， inflammation and infiltration around the lumen， thickening of the trachea， and accumulation of edema fluid， and the SD medium dose group had the best effect on the treatment of PE. In terms of respiratory system， compared with the normal control group， the model group had reduced latent time of cough and asthma （P<0.05， P<0.01） and elevated number of cough and wheezing （P<0.01）. The three SD groups had increased latent time of cough and asthma and decreased number of cough and wheezing （P<0.01）. In terms of urinary system， compared with the normal control group， the model group presented decreased urine volume. The SD low， medium and high dose groups had increased urine volume （P<0.05， P<0.01）， but they had no effect on perspiration. In terms of digestive system， compared with the conditions in the normal control group， the gastric residual rate and gastrin （GT） level were increased （P<0.05， P<0.01）， and the gastric emptying rate and small intestine transit rate were decreased （P<0.01）. The SD low dose group had elevated small intestine transit rate （P<0.01）， and the SD high and medium groups had enhanced gastric emptying rate and small intestine transit rate （P<0.01）， reduced gastric residual rate， lowered GT level to promote gastrointestinal movement and transportation （P<0.01）， and increased motilin （MTL） level to promote gastric emptying in rats （P<0.05， P<0.01）. In terms of circulatory system， compared with the normal control group， the model group displayed reduced left ventricular ejection fraction （LVEF）， left ventricular short axis shortening rate （LVFS） and cardiac output （CO） （P<0.01）， and elevated tendency of heart rate， systolic blood pressure （SBP， P<0.01） and diastolic blood pressure （DBP， P<0.05）. Compared with the model group， the SD low dose group increased LVEF and decreased DBP （P<0.05）， while the SD medium dose group increased LVEF， LVFS， CO and SBP （P<0.01） and decreased DBP （P<0.05）， and the SD high dose group increased LVFS （P<0.01） and decreased SBP （P<0.01） and DBP （P<0.05）. In terms of central nervous system， compared with the conditions in the normal control group， the standing times dropped in the model group （P<0.01）. SD reduced the movement distance， movement time， standing times and activity time in the center of the open field， and increased the rest time and activity time at the edge of the open field （P<0.05， P<0.01）. Moreover， compared with the normal control group， the model group had serious inflammatory infiltration around the lung lumen， thickened trachea with accumulated edema fluid， seriously damaged lung tissue， increased number of white blood cells and percentage of neutrophils in blood （P<0.01）， elevated percentage of monocytes， interleukin-4 （IL-4）， immunoglobulin E （IgE） level and reactive oxygen species （ROS） level in lung tissue （P<0.05，P<0.01）， and decreased IFN-γ in alveolar lavage fluid （P<0.01）. Compared with the model group， SD decreased the number of white blood cells， neutrophil accumulation， pulmonary congestion and interstitial edema， IFN-γ and IL-4 levels in alveolar lavage fluid and ROS level in lung tissue， and increased IgE level （P<0.05， P<0.01）. ConclusionSD had a significant improvement effect on PE model where the disease was located in the viscera. It could regulate the excretion of water by purgation， regulate Qi movement and expel Qi stagnation by descending and sinking lung Qi， and promote purification and descent of lung qi to make Qi movement downward. This indicated SD had the descending and sinking properties. The medium dose of SD decoction exerted the best effect， and its mechanism of action might be through regulating the neutrophil inflammatory response.

Analysis of current situation of researches on comprehensive evaluation of drugs in China based on CiteSpace / 中国药房

OBJECT IVE To analyze the situation of comprehensive drug evaluation research in China. METHODS Using the method of bibliometrics ，CiteSpace 5.8.R3 analysis tool was used to summarize the research situation and hotspots from 6 dimensions，such as safety ，effectiveness，economy，innovation，suitability and accessibility. RESULTS & CONCLUSIONS At present，there were many types of researches on safety and effectiveness. The economic evaluation was increasing. There were still not much researches on the comprehensive evaluation of drugs from 6 dimensions. Researchers were concentrated ，and there was less collaboration between researchers or research institutions. In terms of methods ，systematic review ，meta-analysis，clinical observational research and retrospective research were more common. The topic selection of antibacterial drugs ，anti-tumor drugs ， and cardiovascular drugs were more popular. It is recommended to establish a unified method and standard for clinical comprehensive evaluation of drugs ，clarify the coordination medianism of the comprehensive drug evaluation ，make full use of real-world data to enrich the contents of 6 dimensions，implement quality control for all segments of the evaluation ，and form a comprehensive evaluation report with sufficient evidence and definite results ，so as to promote the clinical application of the results.

Reacciones adversas a medicamentos utilizados para la COVID-19 en cinco países de América Latina / Adverse reactions to drugs used for COVID-19 in five Latin American countries / Reações adversas a medicamentos utilizados para a COVID-19 em cinco países da América Latina

RESUMEN Objetivo. Caracterizar y describir las notificaciones de sospechas de reacciones adversas de un grupo de medicamentos que se utilizaron en Colombia, Costa Rica, Cuba, Chile, El Salvador, México y Perú para tratar o prevenir la enfermedad por el coronavirus (COVID-19, por su sigla en inglés) entre el 1 de marzo y el 31 de agosto del 2020. Métodos. Se elaboró una lista de los 13 medicamentos utilizados para tratar o prevenir la COVID-19, según fuentes oficiales y no oficiales. Desde las bases de datos de los programas nacionales de farmacovigilancia de los países participantes, se recopilaron las notificaciones de sospechas de reacciones adversas a estos medicamentos recibidas en el período comprendido entre el 1 de marzo y 31 de agosto de año 2020. Resultados. Se recibieron 3 490 notificaciones de sospechas de reacciones adversas desde los programas de farmacovigilancia de Perú (n = 3 037), Cuba (n = 270), Colombia (n = 108), Chile (n = 72) y El Salvador (n = 3). Los medicamentos con mayor número de notificaciones de reacciones adversas fueron la azitromicina, la ivermectina y la hidroxicloroquina. La diarrea fue el evento más frecuente (15,0%). Del total de las sospechas de reacciones adversas, 11,9% fueron notificadas como graves. La más frecuente fue la prolongación del intervalo QT posterior al uso de hidroxicloroquina. De estas sospechas de reacciones adversas graves, 54,5% ocurrieron en personas mayores de 65 años. Conclusión. Si bien no es posible establecer una relación causal a partir de la evaluación de informes espontáneos, el presente estudio confirma la presencia de reacciones adversas, algunas graves, con medicamentos que se utilizaron para tratar o prevenir la COVID-19.

ABSTRACT Objective. Characterize and describe reports of suspected adverse reactions to a group of drugs used in Colombia, Costa Rica, Cuba, Chile, El Salvador, Mexico, and Peru to treat or prevent coronavirus disease (COVID-19) between 1 March and 31 August 2020. Methods. A list of the 13 drugs used to treat or prevent COVID-19 was prepared, based on official and unofficial sources. Drawing on the databases of the national pharmacovigilance programs of the participating countries, reports of suspected adverse reactions to these drugs were collected for the period from 1 March and 31 August 2020. Results. A total of 3 490 reports of suspected adverse reactions were received from the pharmacovigilance programs of Peru (n = 3 037), Cuba (n = 270), Colombia (n = 108), Chile (n = 72), and El Salvador (n = 3). The drugs with the highest number of reported adverse reactions were azithromycin, ivermectin, and hydroxychloroquine. Diarrhea was the most frequent event (15.0%). Of the total suspected adverse reactions, 11.9% were reported as serious. The most frequent was QT prolongation following use of hydroxychloroquine. Of these suspected serious adverse reactions, 54.5% occurred in people over 65 years of age. Conclusions. While it is not possible to establish a causal relationship from the evaluation of spontaneous reports, the present study confirms the presence of adverse reactions—some of them serious—involving drugs used to treat or prevent COVID-19.

RESUMO Objetivo. Caracterizar e descrever as notificações de suspeitas de reações adversas a um grupo de medicamentos utilizados na Colômbia, Costa Rica, Cuba, Chile, El Salvador, México e Peru, para tratar ou prevenir a doença do coronavírus (COVID-19), entre 1º de março e 31 de agosto de 2020. Métodos. Foi elaborada uma lista dos 13 medicamentos usados para tratar ou prevenir a COVID-19, segundo fontes oficiais e não oficiais. A partir das bases de dados dos programas nacionais de farmacovigilância dos países participantes, foram coletadas notificações de suspeitas de reações adversas a esses medicamentos, recebidas no período entre 1º de março e 31 de agosto de 2020. Resultados. Foram recebidas 3.490 notificações de suspeitas de reações adversas dos programas de farmacovigilância do Peru (n = 3.037), Cuba (n = 270), Colômbia (n = 108), Chile (n = 72) e El Salvador (n = 3). Os medicamentos com maior número de notificações de reações adversas foram azitromicina, ivermectina e hidroxicloroquina. A diarreia foi o evento mais frequente (15,0%). Do total de suspeitas de reações adversas, 11,9% foram notificadas como graves. A mais frequente foi o prolongamento do intervalo QT após o uso de hidroxicloroquina. Dessas suspeitas de reações adversas graves, 54,5% ocorreram em pessoas com mais de 65 anos. Conclusão. Embora não seja possível estabelecer uma relação causal com base na avaliação de relatos espontâneos, o presente estudo confirma a presença de reações adversas - algumas graves - a medicamentos que foram usados para tratar ou prevenir a COVID-19.

Prescription de l'oxygène dans le service d'urgence d'un hôpital de référence de Mahajanga

Introduction : L'oxygène est un médicament. Une prescription non appropriée peut occasionner une insuffisance ou un excès d'apport source de dépenses hospitalières dans les pays en développement. L'objectif était d'évaluer la prescription de l'oxygénothérapie dans un service d'urgence et de soins intensifs et d'observer les modalités d'utilisation pour permettre d'ajuster les objectifs et les cibles thérapeutiques en prenant comme référence les recommandations. Matériels et Méthodes : Il s'agit d'une étude prospective descriptive sur trois mois, en 2018, de la prescription de l'oxygène au service des urgences et de soins intensifs dans un hôpital de référence de Mahajanga. Quatre obus et quatre extracteurs étaient les sources d'oxygène pour 18 lits d'accueil, de déchoquage et de soins intensifs. Ni un générateur d'oxygène ni des matériels de ventilation spécifique n'étaient disponibles. L'étude statistique a été réalisée avec le logiciel SPSS® v.20, le test Khi2 utilisé pour la comparaison des valeurs avec un seuil de signification p˂0,05. Résultats : Sur 599 admissions, 244 patients (40,7%) bénéficiant d'un apport en oxygène ont été inclus dans l'étude. L'âge moyen était de 47,6 ans avec prédominance masculine (sex-ratio de 1,4). Une saturation d'au plus 90% a été retrouvée dans 25% des cas. Les 40% des patients ont été référés pour une « oxygénothérapie ¼. Les pathologies en cause étaient neurologiques dans 34,4% des cas, touchant la tranche d'âge de 40 à 60 ans (p=0,006), respiratoires pour 21,7% et cardio-vasculaires dans 13,9%. Les lunettes à oxygène étaient utilisées à 71,7%, l'obus à oxygène à 69,3% dans les premières 24 heures (p=0,001). La mortalité était de 22,5% avec 60,6% des patients décédés qui avaient une saturation en oxygène de 90% au maximum (p=0,05). Conclusion : Un algorithme standard avec une saturation pulsée en oxygène ciblée et des techniques plus appropriées auraient permis d'économiser l'oxygène hospitalier et de réduire la mortalité.

Background: Oxygen is a drug. An inappropriate prescription can lead to insufficient or excessive intake, which is a source of hospital expenditure in low-income countries. The aim of the study was to assess the prescription of oxygen therapy in an emergency and intensive care unit and to observe the modalities of its use to allow adjustment of the therapeutic objectives and targets according to the current recommendations. Materials and Methods: We conducted a prospective descriptive study over three months, in 2018, of the prescription of oxygen in the Emergency and Intensive Care Department, of a referral hospital in Mahajanga. Four oxygen cylinder and 4 concentrators were available as oxygen sources for 18 beds intended for patient reception, destock and intensive care. The hospital did not have an oxygen generator or specific ventilation equipment. The statistical study was carried out with SPSS® v.20 software, the Khi2 test used for the comparison of values with a significance level p˂0.05. Results: Of 599 admissions, 244 patients (40.7%) receiving oxygen were included in the study. The average age was 47.6 years with a male predominance (sex ratio : 1.4). Oxygen saturation ≤90% was found in 25% of cases. The 40% of patients were referred for "oxygen therapy". The main disease were neurological in 34.4%, affecting the age group of 40 to 60 years (p=0.006); respiratory for 21.7% and cardiovascular in 13.9%. Nasal cannulas were used in 71.7%, the oxygen cylinder in 69.3% in the first 24 hours (p=0.001). Mortality was 22.5% of which 60.6% had oxygen saturation ≤90% (p=0.05). Conclusion: Using a standard algorithm with targeted SpO2 and more appropriate techniques would have saved hospital oxygen and reduced mortality.

Use of Severe ADR-inducing Drugs in Special Population in Our Hospital Guided by the Detailed Quantitative Scoring Rules of Quick Guide for Drug Evaluation and Selection in Chinese Medical Institutions / 中国药房

OBJECTIVE：To promote the safe use of severe ADR-inducing drugs in special population in our hospital. METHODS：According to detailed quantitative scoring rules of Quick Guide for Drug Evaluation and Selection in Chinese Medical Institutions，comprehensive evaluation database of drugs in our hospital was established. Drugs with ADR rating or ADE general terminology standard rating of 1，2，3 and 4 under the "safety" dimension were obtained from the database. According to the difference of the incidence of ADR ，4 kinds of severe ADR-inducing drugs ，such as very common （incidence≥10％），common （incidence 1％-＜10％），occasional（incidence 0.1％-＜1％）and rare （incidence ＜0.1％），were obtained. According to the quantitative scores of these 4 kinds of drugs in six special groups ，such as children ，pregnant women ，lactating women ，the elderly，patients with abnormal liver function ，and patients with abnormal kidney function ，the feasibility for special population to use drugs that cause severe ADR was analyzed. RESULTS ：Among 1 172 chemical drugs in drug comprehensive evaluation database of our hospital ，18，73，61，and 357 kinds can cause very common ，common，occasional and rare severe ADR ， respectively. Among them ，the incidence of severe ADR caused by tumor drugs was high ，so it was necessary to pay close attention to the use of tumor drugs in special populations. Totally 173 kinds of drugs were prohibited for children because the instructions clearly showed organ toxicity ，cytotoxicity and there were no guidelines recommending their use in children ，so the clinical medication should be used with extraordinary caution. There were 278 and 228 drugs prohibited for pregnant women and lactating women，which were prohibited for pregnant or lactating period due to embryonic toxicity and reproductive toxicity. There were 13 prohibited drugs for the elderly ，most of which were specialized drugs. Five kinds of drugs were prohibited in patients with abnormal liver function and seven were prohibited in patients with abnormal kidney function ，most of which were tumor drugs with strong hepatorenal toxicity. CONCLUSIONS ：Established quantitative score system can provide effective guidance for the safe use of severe ADR-inducing drugs among 6 special populations as children ，pregant women ，lactating women ，the elderly ，the patients with abnormal liver function and the patients with renal

Perfil de seleção e consumo de medicamentos em uma instituição de ensino superior: diagnóstico situacional para promoção da saúde / Profile of drug selection and consumption in a higher education institution: situational diagnosis for health promotion

Resumo A seleção de medicamentos é um processo interdisciplinar baseado no perfil epidemiológico, econômico e técnico local. Os medicamentos selecionados devem apresentar eficácia e segurança, de acordo com a Política Nacional de Medicamentos. Este trabalho teve como objetivo identificar o perfil de seleção e consumo de medicamentos dispensados em uma instituição de ensino superior. A partir de pesquisa descritiva com característica quantitativa e qualitativa, foram utilizados os mapas de dispensação de medicamentos para a enfermagem da Divisão de Saúde de 2018 e 2019. Em 2018, 21% dos medicamentos padronizados não foram consumidos. Por esta razão, em 2019 houve nova seleção e 17,2% dos medicamentos foram excluídos. De acordo com o perfil de consumo de medicamentos, observou-se que o consumo de analgésicos foi superior ao consumo de fármacos com propósito anti-inflamatório, de acordo com a classificação Anatomical Therapeutic Chemical (ATC). Conclui-se que o perfil abordado neste estudo possibilita um diagnóstico situacional de seleção e consumo, tendo como necessidade a implantação do seguimento farmacoterapêutico com o intuito de minimizar as possíveis reações adversas produzidas por medicamentos, como estratégia de prevenção e promoção da saúde.

Abstract Drug selection is an interdisciplinary process based on the local epidemiological, economic and technical profile. The selected drugs must be effective and safe, in accordance with the National Drug Policy. This study aimed to identify the profile of selection and consumption of drugs dispensed in a higher education institution. From descriptive research with quantitative and qualitative characteristics, drug dispensing maps for the Nursing Division of the Health Division of 2018 and 2019 were used. In 2018, 21% of standardized medicines were not consumed. For this reason, in 2019 there was a new selection and 17.2% of medicines were excluded. According to the medication consumption profile, the consumption of analgesics was higher than the consumption of drugs with anti-inflammatory purposes, according to the Anatomical Therapeutic Chemical (ATC) classification. It is concluded that the profile addressed in this study allows a situational diagnosis of selection and consumption, with the need to implement pharmacotherapeutic follow-up in order to minimize the possible adverse reactions produced by drugs, as a health promotion strategy.

The effect of natural products in animal models of temporomandibular disorders

Abstract Treatment of temporomandibular disorders (TMD) is a challenge for health care professionals. Therefore, new approaches have been investigated, such as the use of natural products. Objective This systematic review aims to summarize the natural products used in treatment of experimental models of TMD. Methodology A systematic search was performed in the databases Medline, Web of Science, Scopus, Embase, SciELO, LILACS, and Scholar Google databases in January 2020, dating from their inception. Pre-clinical studies with natural products for intervention in experimental TMD were included. Two reviewers independently selected the studies, extracted the data, and evaluated the risk of bias. Results 17 records were selected, and 17 different natural products were found, including three lectins, three plants or algae extracts, three sulfated polysaccharides, three cocoa preparations, and five isolated compounds. Concerning the risk of bias, most studies lacked on randomization and blinding. Nociception induced by phlogistic agents was evaluated in most articles, and in five studies it was associated with analysis of inflammatory parameters. In order to investigate the mechanism of action of the natural products used, eight studies evaluated expression of neural or glial molecular markers. Conclusions 16 of 17 natural products found in this review presented positive results, showing their potential for treatment of TMD. However, the lack of methodological clarity can influence these results.

Analysis on new research and development ideas and technical points of traditional Chinese medicine for prevention and treatment of chronic heart failure / 中国中药杂志

Chronic heart failure(CHF), a serious and end stage of various heart diseases, is a common chronic cardiovascular disease in the 21 st century. Literature data show that the 5-year mortality rate of hospitalized patients with heart failure is as high as 50%. Nowadays, the development of drugs treating heart failure has become a hot spot, meanwhile, traditional Chinese medicine(TCM) has shown the advantages in the treatment of chronic heart failure. In this article, four stages to develop traditional Chinese medicine for chronic heart failure were proposed. Firstly, discuss and screen ideas and methods with regard to the development of TCM and its prescriptions based on clinical needs. Secondly, study the preparation process and quality control method by referring to the existing clinical background of TCM prescriptions and analyzing the chemical compositions and pharmacological action characteristics of each herb in the prescription. Then, design non-clinical evaluation programs and carry out researches on pharmacodynamics and toxicology by combining the experience of clinical use of TCM prescriptions and future clinical positioning, and gradually adjust and improve the programs during implementation. Finally, conduct clinical trial application(IND) by submitting registration application data which are base on the clinical drug experience, preclinical research pharmacy, main pharmacodynamics, safety test results of the prescription, clinical positioning, and reasonable clinical trial plan designed by the theory of TCM. After passing the IND technical review, the clinical trial study shall be officially launched to achieve the desired results and obtain effective Chinese patent medicines for heart failure treatment.

Fatores de crescimento e cicatrização: experiência em um serviço de Dermatologia / Growth factors and healing: experience in a Dermatology service

Introdução: A cicatrização é um fenômeno que ocorre após lesão tecidual e envolve mecanismos celulares e moleculares complexos. Os fatores de crescimento parecem ser um complemento eficaz e seguro no tratamento das feridas. Objetivo: Avaliar a cicatrização de feridas após eletrocoagulação, comparando-se o veículo isolado à sua associação com o fator de crescimento epidérmico. Métodos: Ensaio clínico duplo-cego em Serviço de Dermatologia entre 2016 e 2018. Incluídos pacientes de ambos os sexos, acima de 18 anos, submetidos à eletrocoagulação de duas lesões e posterior aplicação de veículo (cold cream) em uma e fator de crescimento epidermico em cold cream na outra. Avaliações com sete, 14 e 28 dias, analisaram: eritema, edema, crosta, secreção e cicatrização. Utilizou-se o teste binomial para duas proporções e o teste exato de Fisher para dados dicotômicos. Resultados: Em relação a eritema, edema, crosta e secreção foram encontrados resultados variáveis, ora favorecendo o veículo, ora o fator de crescimento, porém sem significância estatística. Quanto à cicatrização, a epitelização mostrou-se mais rápida com fator de crescimento epidermico (p<0,05). Conclusões: Os resultados deste estudo, que avaliou o impacto do fator de crescimento epidérmico no processo de cicatrização, corroboram os dados da escassa literatura atual e servem de base para estudos futuros.

Introduction: Healing is a phenomenon that occurs after tissue injury and involves complex cellular and molecular mechanisms. Growth factors seem to be an effective and safe complement for the treatment of wounds. Objective: To evaluate wound healing after electrocoagulation, comparing the vehicle in isolation and its association with epidermal growth factor. Methods: Double-blind clinical trial in a Dermatology service between 2016 and 2018. Patients of both genders, older than 18 years of age, submitted to electrocoagulation of two lesions and subsequent application of the vehicle (cold cream) on one and epidermal growth factor in cold cream on the other were included. Evaluations after 7, 14 and 28 days, analysed erythema, edema, crusting, discharge and healing. Analyzed: edema, edema, crusting, discharge and healing. The binomial test was used for two ratios and Fisher's exact test was used for dichotomic data. Results: Variable results were found regarding erythema, edema, crusting and discharge, sometimes favoring the vehicle, sometimes the growth factor, however with no statistical significance. Regarding healing, epithelialization was quicker with epidermal growth factor (p<0.05). Conclusions: This study evaluated the impact of epidermal growth factor in the healing process, and its results reinforce scarce data of the current literature and are a foundation for future studies.

Valor terapéutico y precio de los nuevos fármacos comercializados en Argentina: ¿valen lo que cuestan? / Therapeutic value and price of the new pharmaceuticals commercialized in Argentina: Are they worth what they cost?

RESUMEN En Argentina, los nuevos medicamentos pueden ser autorizados presentando el certificado de aprobación en al menos uno de los 15 países considerados de alta vigilancia sanitaria, sin necesidad de realizar una evaluación propia de eficacia, seguridad o valor terapéutico agregado por el nuevo producto. En este artículo, evaluamos los nuevos medicamentos comercializados en Argentina en el año 2016, utilizando diferentes enfoques: su aprobación por otras agencias reguladoras, demostración de eficacia en ensayos clínicos aleatorizados, tipo de desenlaces estudiados, calificación del valor terapéutico agregado por medio de dos escalas reconocidas y el precio de venta al público. Se concluye que, como reflejo de lo que ocurre en los países desarrollados, los nuevos medicamentos ingresan con precios exorbitantes, pero la mayoría no representa un avance terapéutico significativo. El resultado es un aumento de riesgos para los pacientes y una sobrecarga para los sistemas de financiación públicos y privados.

ABSTRACT In Argentina, new drugs can be authorized by presenting the drug's certificate of approval in at least one of 15 countries considered to have rigorous health surveillance, without needing to carry out a local evaluation of the efficacy, safety or added therapeutic value of the new product. In this article, we evaluate the new drugs commercialized in Argentina in 2016 using different approaches: their approval by other regulatory agencies, the demonstration of their efficacy in randomized clinical trials, types of outcomes studied, rating of their added therapeutic value using two widely recognized scales, and their sale price to the public. It is concluded that, as a reflection of what occurs in developed countries, new drugs enter the market at exorbitant prices, but the majority do not represent a significant therapeutic advancements. The result is increased risks to patients and an overburdening of the public and private funding systems.

Added therapeutic value of new drugs approved in Brazil from 2004 to 2016 / Valor terapêutico acrescentado de novos medicamentos aprovados no Brasil de 2004 a 2016 / Valor terapéutico añadido de los nuevos medicamentos aprobados en Brasil desde 2004 a 2016

Abstract: This study aimed to assess the level of therapeutic innovation of new drugs approved in Brazil over 13 years and whether they met public health needs. Comparative descriptive analysis of therapeutic value assessments performed by the Brazilian Chamber of Drug Market Regulation (CMED) and the French drug bulletin Prescrire for new drugs licensed in Brazil, from January 1st 2004 to December 31st 2016. The extent to which new drugs met public health needs was examined by: checking inclusions into government-funded drug lists and/or clinical guidelines; comparing Anatomical Therapeutic Chemical Classification (ATC) codes and drug indications with the list of conditions contributing the most to the national disease burden; and assessing new medicines aimed to treat neglected diseases. 253 new drugs were approved. Antineoplastics, immunossupressants, antidiabetics and antivirals were the most frequent. Thirty-three (14%) out of 236 drugs assessed by the Brazilian chamber and sixteen (8.2%) out of 195 assessed by the French bulletin Prescrire were considered innovative. Thirty-six drugs (14.2%) were selected for coverage by the Brazilian Unified National Health System (SUS), seven of which were therapeutically innovative, and none were aimed to treat neglected disease. About 1/3 of the drugs approved aimed to treat conditions among the top contributors to Brazil's disease burden. Few therapeutically innovative drugs entered the Brazilian market, from which only a small proportion was approved to be covered by the SUS. Our findings suggest a divergence between public health needs, research & development (R&D) and drug licensing procedures.

Resumo: O objetivo foi avaliar o nível de inovação terapêutica de novos medicamentos aprovados no Brasil ao longo de 13 anos e se eles atendem a necessidades de saúde pública. Foi feita uma análise comparativa descritiva da avaliação de valor terapêutico realizada pela Câmara de Regulação do Mercado de Medicamentos (CMED) e pelo boletim de medicamentos francês Prescrire para novos medicamentos licenciados no Brasil entre 1º de janeiro de 2004 e 31 de dezembro de 2016. Examinamos em que medida os novos medicamentos atendem a necessidade de saúde pública por meio de: checagem da inclusão em listas de medicamentos financiados pelo governo e/ou diretrizes clínicas; comparação de códigos da Classificação Anatômica Terapêutica Química (ATC, em inglês) e indicações de medicamentos com a lista de condições que mais contribuem para a carga de doença nacional; e avaliação de se os novos medicamentos tinham por objetivo tratar doenças negligenciadas. Foram aprovados 253 novos medicamentos. Antineoplásicos, imunossupressores, antidiabéticos e antivirais foram os mais frequentes. Trinta e três (14%) dos 236 medicamentos avaliados pela Câmara brasileira e 16 (8,2%) dos 195 avaliados pelo boletim francês Prescrire foram considerados inovadores. Trinta e seis medicamentos (14,2%) foram selecionados para cobertura no Sistema Único de Saúde (SUS), sete dos quais eram inovadores do ponto de vista terapêutico e nenhum dos quais tinha por objetivo tratar uma doença negligenciada. Em torno de 1/3 dos medicamentos aprovados tinha por objetivo o tratamento de doenças que figuram entre as principais contribuidoras da carga de doença no Brasil. Poucos medicamentos inovadores do ponto de vista terapêutico entraram no mercado brasileiro, dos quais apenas uma pequena proporção foi aprovada para ser coberta pelo SUS. Nossos resultados sugerem uma divergência entre necessidades de saúde pública, pesquisa e desenvolvimento (P&D) e procedimentos de licenciamento de medicamentos.

Resumen: El objetivo fue evaluar el nivel de innovación terapéutica de los nuevos medicamentos aprobados en Brasil durante 13 años y si cumplen con las necesidades sanitarias. Llevamos a cabo un análisis comparativo descriptivo acerca del valor terapéutico presente en las evaluaciones realizadas por la Cámara de Regulación del Mercado de Medicamentos (CMED) y la revista francesa Prescrire sobre los nuevos medicamentos autorizados en Brasil, desde el 1º de enero 2004 hasta el 31de diciembre de 2016. Su alcance, es decir, hasta qué punto los nuevos medicamentos cumplían con las necesidades de salud pública se comprobaron revisando las inclusiones en listas de medicamentos subvencionados por el gobierno y/o directrices clínicas; comparando los códigos de la Classificación Anatómicos Terapéuticos Químicos (ATC por sus siglas en inglés) y las indicaciones de los medicamentos respecto a la lista de enfermedades que contribuían a la mayor carga de morbilidad nacional; y asesorando si los nuevos medicamentos tenían como objetivo tratar enfermedades desatendidas. Se aprobaron 253 nuevos medicamentos. Los antineoplásicos, inmunosupresores, antidiabéticos y antivirales fueron los más frecuentes. Treinta y tres (14%), aparte de los 236 medicamentos evaluados por la Cámara Brasileña, y 16 (8,2%), aparte de los 195 evaluados por la revista francesa Prescrire, se consideraron innovadores. Treinta y seis medicamentos (14,2%) se seleccionaron para que tuvieran cobertura por el Sistema Único de Salud (SUS), siete de ellos eran terapéuticamente innovadores, y ninguno tenía como meta tratar enfermedades desatendidas. Alrededor de 1/3 de las medicinas aprobadas tenían como meta tratar problemas de salud entre las enfermedades con mayor carga de morbilidad en Brasil. Pocos medicamentos terapéuticamente innovadores accedieron al mercado brasileño y de éstos sólo una pequeña parte fueron aprobados para que fueran cubiertos por el SUS. Nuestros resultados sugieren una divergencia entre las necesidades públicas de salud, investigación & desarrollo (I&D) y los procedimientos para la autorización de medicamentos.