Signal mining of valproic acid-induced adverse drug events based on FAERS / 中国药房

OBJECTIVE To provide reference for clinically safe and rational drug use through mining and analyzing adverse drug event （AE） signals induced by valproic acid （VPA）. METHODS Reporting Odds Ratio （ROR） and Bayesian Confidence Propagation Neural Network （BCPNN） methods of Measures of Disproportionality were performed to mine and analyze the data of VPA-related AE reports in the US FDA Adverse Event Reporting System （FAERS） database from the first quarter of 2013 to the fourth quarter of 2022. RESULTS A total of 1 253 （ROR） and 1 109 （BCPNN） valid signals of preferred terms （PT） were obtained after data processing by the two analysis methods， involving 27 system organs （SOC）， mainly focusing on nervous system disorders， psychiatric disorders， general disorders and administration site conditions. Signals that did not appear in the instruction were associated with 2 SOCs： ear and labyrinth disorders， infections and infestations. CONCLUSIONS As a first-line broad-spectrum anti-epileptic drug， attention should also be paid to eye toxicity and infection risk in the clinical application in addition to paying attention to common adverse events in the instruction.

Copper homeostasis dysregulation promoting cell damage and the association with liver diseases / 中华医学杂志(英文版)

Copper plays an important role in many metabolic activities in the human body. Copper level in the human body is in a state of dynamic equilibrium. Recent research on copper metabolism has revealed that copper dyshomeostasis can cause cell damage and induce or aggravate some diseases by affecting oxidative stress, proteasome, cuprotosis, and angiogenesis. The liver plays a central role in copper metabolism in the human body. Research conducted in recent years has unraveled the relationship between copper homeostasis and liver diseases. In this paper, we review the available evidence of the mechanism by which copper dyshomeostasis promotes cell damage and the development of liver diseases, and identify the future research priorities.

Effectiveness of increasing alcohol excise taxes in the management of alcohol-associated liver disease in China / 临床肝胆病杂志

Increasing alcohol excise taxes has been confirmed by the World Health Organization as the most cost-effective public policy for reducing alcohol consumption at the population level. In recent years, studies in foreign countries have believed that increasing alcohol excise taxes can improve the burden of alcohol-associated liver disease (ALD), but it is still unclear whether this policy is applicable to ALD management in China. Therefore, with reference to related research evidence in China and globally, this article analyzes the key factors influencing the effectiveness of the policy of increasing alcohol excise taxes from the perspective of ALD management in China, including tax shifting, price elasticity of demand, and unrecorded alcohol, and introduces other public policies that help curb ALD. We think that increasing alcohol excise taxes is currently a useful but not effective policy for improving the burden of ALD in China.

Retrospective study on the types and characteristics of shock in polytrauma patients at different stages after trauma / 中华急诊医学杂志

Objective:To investigate the types, incidences, and clinical characteristics of shock in polytrauma patients at different stages after polytrauma.Methods:A retrospective study was conducted on polytrauma patients admitted to multiple trauma centers from June 2020 to December 2021. The inclusion criteria were patients >18 years old and treated due to polytrauma. Exclusion criteria included an admission time of more than 48 h after trauma, a history of malignancy, or metabolic, consumptive, and immunological diseases. The early stage was defined as the period of ≤48 h after polytrauma, and the middle stage was defined as the period between 48 h and 14 days. The patient’s medical history, clinical manifestations, laboratory tests, imaging examination, injury severity score (ISS), and Glasgow coma scale (GCS) were collected. The types, incidences, and clinical characteristics of shock in different stages after polytrauma were analyzed, according to the diagnostic criteria of each type of shock. The differences between the groups were compared by Student’s t test, χ2 test or Mann-Whitney U test. Results:The incidence of the early and middle stage shock after polytrauma were 73.1% and 36.4%, respectively, with statistically significant difference between stages ( P<0.01). There were significant differences in the incidence of hypovolemic shock (83.6% vs. 28.4%), distributed shock (13.7% vs. 80.9%) and cardiogenic shock (3.5% vs. 6.6%) between stages (all P<0.05). The incidence of obstructive shock (8.4% vs. 9.7%, P>0.05) was similar between stages. The incidence of undifferentiated shock was 1.6% and 1.2%, respectively. There were 9.5% patients with multifactorial shock in the early stage and 14.4% in the middle stage. Totally 7 combinations of multifactorial shock were found in different stages after polytrauma. In the early stage, the combination of HS and DS accounted the highest ratio (42.3%) and followed by HS and OS for 28.8%. In the middle stage, the combination of HS and DS was the most common (48.6%) and followed by DS and OS (24.3%). Conclusions:The incidence of shock in polytrauma patients is high. Different types of shock can occur simultaneously or sequentially. Therefore a comprehensive resuscitation strategy is significant to improve the success rate of treatment.

Mechanism of ferroptosis and its role in liver diseases / 临床肝胆病杂志

Ferroptosis is a newly discovered regulatory cell death induced by the accumulation of iron-dependent lipid peroxides, with the morphological manifestations of decreased mitochondrial volume, increased mitochondrial membrane density, and reduction or disappearance of mitochondria. The mechanism of ferroptosis is mainly associated with disturbance of iron metabolism, imbalance of amino acid antioxidant system, and accumulation of lipid peroxides. Studies have shown that ferroptosis plays different roles in different liver diseases, and ferroptosis can participate in the progression of various liver inflammatory diseases and inhibit the formation of liver fibrosis, the development of hepatocellular carcinoma, and sorafenib resistance. This article summarizes the advances in the mechanism of ferroptosis and its role in liver diseases, so as to provide a reference for further research and treatment of liver diseases.

New advances in the treatment of pancreatic cancer by targeting tumor microenvironment / 临床肝胆病杂志

Pancreatic cancer is the malignant tumor of the digestive tract with the lowest 5-year survival rate, and current first-line treatment regimens cannot significantly improve the overall prognosis of patients, so it is necessary to explore new treatment methods. A large number of studies have shown that the tumor microenvironment of pancreatic cancer, such as stromal barrier, immune microenvironment, and exosomes, plays an important role in promoting the proliferation, invasion, metastasis, and chemoradiotherapy resistance of pancreatic cancer cells. This article summarizes the potential targets associated with the tumor microenvironment of pancreatic cancer and related clinical research advances, in order to provide new ideas for the treatment of pancreatic cancer.

A prospective clinical study of endoscopic foam sclerotherapy combined with rubber band ligation in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids (with video) / 中华消化内镜杂志

Objective:To evaluate the safety and long-term effectiveness of endoscopic foam sclerotherapy (FS) combined with endoscopic rubber band ligation (ERBL)in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids.Methods:Consecutive patients diagnosed as having grade Ⅱ-Ⅲ internal hemorrhoids in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January to December 2020 were prospectively enrolled in the study, and randomly divided into ERBL group and FS combined with ERBL group. The 24 h visual analogue scale (VAS) for pain and 1-week degree of bleeding were evaluated after the treatment. After follow-up of 6 months, the effectiveness of treatment was evaluated.Results:A total of 84 patients with age of 54.4±7.9 years were enrolled, 57.1% (48/84) males, and 73.8% (62/84)grade Ⅱ internal hemorrhoids. Forty-three patients were assigned to the ERBL group and 41 to the FS combined with ERBL group. There was no significant difference between the two groups in baseline data ( P>0.05). In the FS combined with ERBL group, the mean amount of polidocanol foam was 13.8±2.5 mL, the mean number of injection site was 4.7±1.2, and the median scores of VAS was 0 (0, 3), which was significantly lower than that of ERBL group [2 (0, 4), Z=-2.116, P=0.034]. The bleeding rate 1 week after treatment in the ERBL and FS combined with ERBL group were 20.9% (9/43) and 29.3% (12/41), respectively, and mild bleeding was the main symptom. There was no significant difference between the two groups in the bleeding degree ( U=807.0, P=0.378). After 6 months of follow-up, the total effective rates in the ERBL group and the FS combined with ERBL group were 81.4% (35/43) and 90.2% (37/41), respectively ( U=684.5, P=0.044). Conclusion:FS combined with ERBL can effectively relieve post-treatment perianal pain, and improve the long-term effectiveness.

Advances in research on alcoholic liver disease complicated with sepsis / 中华全科医师杂志

Alcoholic liver disease is often complicated with sepsis at the end stage of the disease, inducing acute-on-chronic liver failure and multiple organ and system injuries, with high short-term mortality. At present, there is still a lack of effective methods for early diagnosis and prognosis, and measures for prevention and treatment in alcoholic liver disease complicated with sepsis. This article reviews the research progress of alcoholic liver disease complicated with sepsis to provide reference for clinical practice.

Effect of unilateral mastication on the remodeling of the glenoid fossae in Wistar rats / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of unilateral mastication on glenoid fossae by means of animal experiment.</p><p><b>METHODS</b>An animal model of unilateral mastication was established by extracting right mandibular molars of Wistar rats. The rats were sacrificed in different period to examine the location changes of glenoid fossae through sagittal and horizontal plane.</p><p><b>RESULTS</b>The anterior points of glenoid fossae in non-masticatory side of experimental groups were more anterior than those in masticatory sides. The anterior points of the glenoid fossae of non-masticatory sides in experimental groups were more anterior than those of the same sides in the control groups after inducing unilateral mastication for two and four months. After inducing unilateral mastication for two and four months, the anterior and the posterior points of the glenoid fossae of non-masticatory sides in experimental groups became closer to the midline by comparison with masticatory sides as well as the same sides in control groups. Locations of glenoid fossae in masticatory sides showed no changes in comparison with the same side of the control groups.</p><p><b>CONCLUSION</b>The forward and inward remodeling of the glenoid fossae can be observed after unilateral mastication was induce to the non-masticatory sides of experimental rats. It is concluded that unilateral mastication might be one of the etiologic factor of temporomandibular joint disorders.</p>