Traditional Chinese Medicine Targets mTOR Signaling Pathway for Treatment of Diabetic Kidney Disease： A Review / 中国实验方剂学杂志

Diabetic kidney disease （DKD）， a chronic kidney disease with unique pathological structural and functional alterations in the kidney， is a common complication of diabetes mellitus （DM）. The majority of researchers believe that the occurrence of this disease is associated with glucose metabolism disorders， oxidative stress， inflammation， endoplasmic reticulum stress， autophagy， and disorders of lipid metabolism and exosome release. The mammalian target of rapamycin （mTOR） signaling pathway， which can maintain glomerular podocyte homeostasis and participate in autophagy， renal fibrosis， oxidative stress， lipid metabolism disorders， and inflammatory response in DKD， has been discovered to play a key role in DKD. Therefore， it has emerged as a novel target for the treatment of DKD. Studies have demonstrated that traditional Chinese medicine can prevent the renal damage in DKD by regulating the mTOR signaling pathway to delay the disease progression and improve the prognosis and the quality of life of the patients. This article summarizes the structure and role of the mTOR signaling pathway in DKD and briefs the research progress in the prevention and treatment of DKD via this signaling pathway by the active components， extracts， and compound prescriptions of Chinese medicines， aiming to present new ideas and approaches for the clinical treatment of DKD with traditional Chinese medicine.

Traditional Chinese Medicine in Prevention and Treatment of Renal Fibrosis in Diabetic Nephropathy by Targeting Notch Signaling Pathway： A Review / 中国实验方剂学杂志

Diabetic nephropathy （DN） is one of the common chronic kidney diseases （CKD） worldwide and a major cause of end-stage renal disease （ESRD）， seriously threatening and affecting the life and health of the global population. Currently， the pathogenesis of DN is considered to be closely related to factors such as glucose metabolism disorders， abnormal lipid metabolism， oxidative stress， activation of inflammatory factors， autophagy， and cell apoptosis in the continuous high-glucose environment of the body. Renal fibrosis is an important pathological feature and ultimate pathological outcome of DN. Timely intervention in renal fibrosis is of significant clinical and practical importance for the prevention and treatment of DN. Due to the limitations of western medicine in treating DN， traditional Chinese medicine （TCM） intervention in the process of renal fibrosis in DN has been widely used as a routine and potential treatment method due to its multi-component， multi-effect， and multi-target effects， effectively delaying the progression of the disease. It has been found that the Notch signaling pathway plays an important role in the development and maintenance of homeostasis in the body， and abnormal activation of the Notch signaling pathway is associated with DN. Activation of this signaling pathway plays a key role in the process of renal fibrosis. This article reviewed the regulatory mechanism of the Notch signaling pathway in renal fibrosis in DN， focusing on the relationship between targeting Notch signaling pathway by Chinese medicinal monomers and prescriptions and renal fibrosis in DN in order to provide a theoretical basis for the development of new drugs， basic research， and clinical application of TCM in the prevention and treatment of DN.

Enlightenment of Japan expanded access clinical trial system to China’s compassionate drug use system / 中国药房

The system of compassionate drug use in China is in the preliminary exploration stage， and the formal management methods and specific implementation rules have not been promulgated， which needs to be further optimized and perfected. Japan realizes the advanced use of unapproved drugs by expanded access clinical trial system， and makes clear provisions on information acquisition， target patient， informed consent， subject of application， implementation plan， handling of refusal to administer medication， drug expenses， implementation deadline， compensation for accidental damages， post-approval data review after expanded access clinical trials. When the enterprise refuses to give drugs because of the “legitimacy reasons of the system”， the attending physician can also apply to the Ministry of Health， Labor and Welfare， and the Ministry of Health， Labor and Welfare will conduct the licensing evaluation to maximize the drug for patients. This “refusal to administer” reprocessing is a unique regulation in Japan， which ensures the accessibility of drugs to the greatest extent possible. Based on the analysis of the expanded access clinical trial system in Japan， it is found that our country could further build the information platform for compassionate drug use， play the leading role of physicians， protect the interests of enterprises， pay attention to the ethical review， and make drug cost payment problems further clear in order to improve and optimize the system of compassionate drug use.

Study on the Optimization of Family Doctor Team Based on Rational Drug Use in Primary Medical Institutions / 中国药房

OBJECTIVE： To provide reference for optimizing the structure of family doctor team and improving rational drug use in primary medical institutions of China. METHODS： Combined with relevant literatures and author’s work experience， the situation of rational drug use in primary medical institution and the development of family doctors team were reviewed. The problems existing in the rational drug use service provided by family doctor team were analyzed to put forward relevant suggestions. RESULTS & CONCLUSIONS： There are some problems in primary medical institutions， such as blind selection or abuse of antibiotics， high frequency of injection use. Provinces and municipalities that implement the family doctor model in China have gradually formed five kinds of family doctor contract service modes， such as “1+1+1” contract service mode， “basic package+personality package” contract service mode. The existing family doctors team have problems in the development of rational drug use services， such as lack of pharmaceutical service personnel， low business ability， limited pharmacy knowledge of team members， and insufficient participation of pharmacists. A reasonable family doctor team should pay attention to the cultivation of pharmacy service pharmacists， strengthen pharmacy professional knowledge training of medical staff， and build a corresponding “pharmaceutical joint” platform by means of the medical association platform if necessary so as to promote rational drug use in primary medical institutions.

Management of Non-medical Prescribing in Britain and Its Enlightenment to China / 中国药房

OBJECTIVE:To systematically investigate the management mode of non-medical prescribing in Britain and its enlightenment to the establishment and implementation of non-medical prescribing in China. METHODS:By retrieving domestic and foreign literatures,non-medical prescribing in Britain was introduced systematically in terms of development history,types, core elements,implementation status and effect;the suggestions were put forward for the development of non-medical prescribing in China. RESULTS & CONCLUSIONS:Britain implemented non-medical prescribing since 1994. After years of practice and a series of legislation and revision,independent prescribers (including nurses and pharmacists) have owned the statutory right to prescribe any medicine for patients by 2012. In Britain,non-medical prescribing is divided into independent prescribing which mainly exists in community pharmacies and is limited to specific diseases,supplementary prescribing which exists in hospitals or clinic and needs to be signed with doctors. The management institutions are mainly composed of one state administrative department (British Department of Health) and three professional associations (British Nursing and Midwifery Council,The Royal Pharmaceutical Society of Great Britain,The Pharmaceutical Society of Northern Ireland). There are detailed and strict stipulations on the qualification and corresponding responsibilities of the prescribing authority. The British government has provided legal protection for the development of the non-medical prescribing model,and the number of non-medical prescribers is increasing. The implementation of this model has increased the patients'access to medical services. Drawing lessons from the development of non-medical prescribing management in Britain,our country needs to improve legislation,provide legislative protection for the implementation of non-medical prescribing,expand the scope of practice of nurses and pharmacists,establish and improve the training program of non-medical prescribing professionals to promote the development of non-medical prescribing model in China.

Origin and Role Evolution of Pharmacists and the Enlightenment to the Legislation of Pharmacists Law in China / 中国药房

OBJECTIVE:To investigate the role orientation of pharmacists in China,and to provide legislative suggestions for the formulation of pharmacist law in China. METHODS:Through literature study,the career and evolution process of pharmacists at home and abroad were traced. The obstacles of the role change of pharmacists in China were analyzed to put forward the enlight-enment to the legislation of pharmacist law in China. RESULTS & CONCLUSIONS:Pharmacists in the world had generally en-tered the stage of"taking medication safety of patients as the center"pharmaceutical care,but pharmacists in China were still in the transition stage from"taking drugs as the center"traditional pharmacy to"taking safe medication as the center"clinical phar-macy. The role cognition of pharmacists needed to be improved. Pharmaceutical care should be taken as the role orientation,and the scope of pharmacist law adjustment should be defined;the qualification admittance threshold of pharmacists should be im-proved with the goal of pharmaceutical care-oriented talents;Taking pharmaceutical care as the content,the rights and obligations of pharmacists should be defined. The legislation of pharmacists should be conducted in China to speed up the transformation of pharmacist's role into pharmaceutical care.

Analysis of the Legislation on Pediatric Drug Use in US and Its Enlightenment to China / 中国药房

OBJECTIVE:To provide reference for promoting the development of related legislation work on ensuring pediatric drug use in China. METHODS:The legislation process of pediatric drug use in US,the effects of current Best Pharmaceuticals for Children Act and Pediatric Research Equity Act on pediatric drug use in US were intrduced and analyzed,suggestions on guarantee-ing the accessibility and safety on pediatric drug use in China were put forward. RESULTS & CONCLUSIONS:The policy6-month period of pediatric exclusive protectionin Best Pharmaceuticals for Children Act has motivated the enthusiasm of phar-maceutical companies developing pediatric studies,while it affects the marketing of generic drugs. Pediatric Research Equity Act has achieved remarkable effect in terms of ensuring the safety of pediatric drug use by forcing pharmaceutical companies to carry out pediatrics assessments,while there is no enough force for the marketed drugs that has not been widely used for children. En-couragement and enforcement are useful methods for promoting development of pediatric drug use. It is suggested to take measures like modifingone drug two formsin Prescription Management Regulations,accelerating approvals of related pediatric drugs on the premise that safety is guaranteed,implementing tax preference for related pharmaceutical companies that produced pediatric drugs,promoting the entry of drug reimbursement list and empowering CFDA to force pharmaceutical companies to implement pedi-atric studies to promote the accessibility and safety of pediatric drugs.

Influence of resistive respiratory training for patients with chronic obstructive pulmonary disease on rehabili-tation effect / 中国基层医药

Objective To explore the influence of resistive respiratory training for patients with chronic obstructive pulmonary disease(COPD) on rehabilitation effect.Methods According to the digital table,68 COPD patients were randomly divided into the observation group and control group,34 cases each group.The observation group were taken respiratory muscle training under the supervision of rehabilitation nurses for 8 weeks,and the respir-atory muscle training including shrinkage lip diaphragm breathing training and abdominal muscle resistance training. Before and after the abdominal muscle resistance training and training were given 1 h double nasal oxygen tube contin-uous low flow oxygen inhalation.The control group were taken pursed lips abdominal breathing training.In the two groups before treatment and 8 weeks after, the blood gas analysis ( PaO2 , PaCO2 ) , pulmonary function test ( FEV1 , FEV1/FVC%) and respiratory muscle function( MIP,MEP) were detected.Results After treatment,blood gas anal-ysis in the two groups comparison(tPaO2 =2.95,tPaCO2 =2.07),pulmonary function(tFEV1 =2.38,tFEV1/FVC%=2.04) and respiratory muscle physiology index(tMIP =6.40,tMEP =4.04),the differences were statistically (all P<0.05).In the observed group before and after treatment,blood gas analysis(tPaO2 =19.23,tPaCO2 =3.05),pulmonary function(tFEV1 =2.67,tFEV1/FVC%=4.19)and respiratory muscle physiology index(tMIP=9.09,tMEP=9.67) were compared,the differences were statistically(all P<0.01).Conclusion Respiratory mus-cle resistance training can improve COPD patients with respiratory muscle strength and endurance,and it has the cura-tive effect to improve pulmonary function.

Application of plain radiography for diagnosis of vascular calcification in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To evaluate the sensitivity and specificity of plain radiography in the diagnosis of vascular calcification in maintenance hemodialysis (MHD) patients. Methods Multi-slice computed tomography (MSCT) was used as the reference standard in the assessment of vascular calcification in MHD patients. A total of 54 MHD patients, 26 male and 28 female, mean age (60.4±13.3) years, underwent both MSCT and plain radiography of lateral abdomen and pelvis to evaluate abdominal aortic calcification, bilateral iliac and femoral artery calcification. Abdominal aorta was divided into upper and lower segment by L2-L3 intervertebral space. The severity of vascular calcification by MSCT was graded from score 0 to 5. Two independent radiologists analyzed the results of plain radiography and MSCT, and inter-observer agreements were calculated by using K statistics. Results According to the results of MSCT, the calcification rate of abdominal aorta was 86.1%, and the calcification rate of iliac and femoral artery was 74.5%. There was significant difference of the calcification rate between large artery and muscular arteries. Inter-observer agreement of calcification was excellent (K =0.864-0.893). Compared with MSCT, the specificity of plain radiography with regard to detection of abdominal aortic, iliac and femoral calcification were 100%. The sensitivity of plain radiography was different according to the different MSCT score, which was as follows: MSCT score ≥ grade 1: 60.2% and 24.8% for lateral abdomen radiography to detect abdominal aortic calcification and pelvic radiography to detect iliac, femoral calcification respectively; MSCT score ≥ grade 2: 76.9% and 43.5% respectively; MSCT score grade 3: 100% and 74.4% respectively. Conclusions The sensitivity of plain radiography in the assessment of vascular calcification increases with the severity of calcification. The sensitivity in the assessment of abdominal aortic calcification is higher than that of iliac and femoral artery calcification. Plain radiography can be used to detect moderate to severe vascular calcification in MHD patients.

The comprehensive observation of the curative effect of the female chronic pelvic pain / 中国基层医药

Objective To search the effective treatment for the female chronic pelvic pain.Methods The drugs of ?-receptor inhibitor,antianxietic,psychotherapy and proper movement were taken.It was six weeks for a course of treatment.Results Of the study group(48 cases),complete recovery were noted in 36 cases,remarkable improvement in 5 cases,remarkable inefficacy in 4 cases,the total curative rate was 91.66%,which was significantly better than the control group(60.42%).Conclusion It is an effective treatment for the female chronic pain.

Comparison of ureteroscopy pneumatic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of distal ureteral calculi / 中国基层医药

Objective To evaluate the therapeutic effect and safety of ureteroscopy pneumatic lithotripsy(PL) and extracorporeal shock wave lithotripsy(ESWL) in the treatment of distal ureteral calculi.Methods 368 cases of distal ureteral calculi were divided into the PL treatment group(178 cases) and the ESWL treatment groups(190 cases).The clinical datas were compared between the two groups.Results PL treatment group 97.19% patients became stone free in 4 weeks,and in ESWL treatment group the stone free rate was 73.16%(P