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OBJECTIVE：To compare the efficacy and safety of vancomycin given by continuous infusion vs. intermittent infusion，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from PubMed ，the Cochrane Library，Embase，Wanfang database ，CNKI and VIP databases ，ranomized controlled trials （RCT）and cohort studies about vancomycin given by continuous infusion （trial group ）vs. intermittent infusion （control group ）were collected during the inception to Apr. 2020. After literature screening and data extraction ，the qualities of RCTs were evaluated by using bias risk evaluation tool recommended by Cochrane system evaluator manual 6.0. The qualities of cohort studies were evaluated by NOS ；Rev Man 5.3 software was used to perform Meta-analysis and publication bias analysis. RESULTS ：A total of 20 studies were included （3 RCTs and 17 cohort studies ），involving 2 380 patients in total. Results of Meta-analysis showed that ，target concentration attainment rate [RR ＝1.24，95％CI（1.12，1.38），P＜0.000 1] and attainment rate of target clinical efficacy [RR ＝1.20，95％CI（1.04，1.38）， P＝0.01] of trial group was significantly higher than those of control group. The incidence of nephrotoxicity [RR ＝0.56，95％CI （0.45，0.70），P＜0.000 01] was significantly lower than control group. There was no statistical significance in the therapeutic efficiency [RR ＝1.02，95％CI（0.95，1.10），P＝0.53]，drug treatment duration [MD ＝－0.50，95％CI（－1.40，0.39），P＝0.27] or mortality [RR ＝1.03，95％CI（0.78，1.35），P＝0.83] between 2 groups. The results of publication bias showed that the probability of publication bias was high when the incidence of nephrotoxicity was used as the index. CONCLUSIONS ：Vancomycin continuous infusion can improve the attainment rate of target concentration and target clinical efficacy ，reduce the incidence of nephrotoxicity ， but can not improve the treatment efficiency. Due to the inconsistent results of publication bias analysis ，the above conclusion needs to be interpreted carefully.
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OBJECTIVE:To provide reference for rational use of TCM injection. METHODS:Each 660 medical records were selected from 9 hospitals of Luzhou city before(Jan.-Mar. in 2015)and after(Jan.-Mar. in 2017)administrative intervention and pharmaceutical intervention(called"intervention"for short)according to random number tablet. The consumption sum,DDDs and B/A,utilization,per capita,cost of drug and TCM injection,rational and irrational use were compared before and after intervention. RESULTS:After intervention,total consumption sum and DDDs of 10 TCM injections were decreased in 7 hospitals compared to before intervention,but those of 2 hospitals were increased slightly. Before and after intervention,consumption sum of Xueshuangtong for injection took up the first place among 10 kinds of TCM injection. Top 5 injections in the list of DDDs were the same generally,i.e. Xuesaitong for injection,Xueshuangtong for injection,Shenmai injection,Salviae miltiorrhizae and ligustrazine hydrochloride injection and Safflower yellow for injection.10 kinds of TCM injections with B/A>1 included Xuesaitong for injection, Salviae miltiorrhizae and ligustrazine hydrochloride injection,Safflower yellow for injection and Gastrodin injection. After intervention,utilization rate of 10 TCM injections(24.70%)was significantly lower than before intervention(32.42%),rational rate of TCM injection(61.35%)was significantly higher than before intervention(41.59%),with statistical significance(P<0.01). After intervention,the per capita cost of TCM injection,the incidence of function inconsistency,excessive dose,irrational solvent selection,insufficient solvent amount and non-individual injection were significantly lower than before intervention,with statistical significance(P<0.05). There was no statistical significance in per capita cost of drug,the irrational utilization rate of repeated medication or excessive long treatment course before and after intervention(P>0.05). CONCLUSIONS:The administrative intervention combined with pharmaceutical intervention promote more safe,rational and economical use of TCM injection.
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Objective To observe the effect of Yidutiaogan mixture on rat liver fibrosis induced by CCl4 complex factors. Methods Sixty SD rats were randomly divided into normal control group, model control group, colchicine group (0.2 mg·kg-1), Yidutiaogan mixture low-, medium-, and high-dose groups(2.7, 5.4, 10.8 mL·kg-1) (n=10).Except for normal control group, the other groups were given drinking water containing 10% ethanol, subcutaneous injection of 40%CCl4 in olive oil (3 mL·kg-1,twice weekly), and high-fat diet for 8 weeks as the model control group, and they were given relevant medicine intragastrically once a day during modeling. The rats were sacrificed, and the livers were harvested and stained with Masson staining to observe liver fibrosis. Serum levels of ALT, AST, ALP, ALB, HA, LN, PCⅢ, C-Ⅳ, and the levels of TIMP-1, MMP-1, MMP-2, MMP-13, and TGF-β1 in liver tissue were detected by biochemical assay, radioimmunoassay and ELISA. Results Compared with normal control group, serum levels of ALT, AST, ALP, HA, LN, PCⅢ, and C-Ⅳ were significantly increased in model control group, while serum level of ALB was significantly decreased (P<0.01); the levels of TIMP-1, MMP-2 and TGF-β1 in liver tissue were significantly increased, while the levels of MMP-1 and MMP-13 were significantly decreased (P<0.01).Compared with the model control group, serum levels of ALT, AST, HA, LN, PCⅢ, and C-Ⅳ as well as the levels of TIMP-1, MMP-2, and TGF-β1 in liver tissue were all significantly decreased in Yidutiaogan mixture medium-dose, high-dose, and colchicine groups( P<0.05);serum level of ALB as well as the levels of MMP-1 and MMP-13 in liver tissue were significantly increased(P<0.05).However, there was no statistical significance in above indexes in Yidutiaogan mixture low-dose group(P>0.05). Conclusion Yidutiaogan mixture could be used to prevent experimental hepatic fibrosis through regulating TIMPs/MMPs, suppressing TGF-β1 , reducing deposition of extracellular matrix in liver.
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Objective To evaluate the efficacy and safety of different doses of Ipragliflozin in the treatment of type 2 diabetes patients.Methods The randomized controlled trials (RCTs) about Ipragliflozin in treatment of type 2 diabetes patients were retrieved from the databases,including Cochrane Library,PubMed,Embase,Medline,CNKI,Wangfang,VIP and CBM.The data were extracted and evaluated by two researchers independently,and the Meta-analysis was performed via RevMan5.2.Results A total of 10 RCTs involving 1 928 patients were included.The results of Meta-analysis showed that glycosylated hemoglobin (HbA1c)[12.5 mg/d:MD=-0.46,95％CI (-0.69,-0.23);25 mg/d:MD=-0.97,95％CI (-1.00,-0.94);50 mg/d:MD=-0.94,95％CI (-1.20,-0.69);100 mg/d:MD=-0.93,95％CI (-1.72,-0.15);150 mg/d:MD=-0.57,95％CI (-0.89,-0.26);200 mg/d:MD=-0.74,95％CI (-1.14,-0.34);300 mg/d:MD=-0.64,95％CI (-0.86,-0.43)],fasting blood glucose (FPG) [12.5 mg/d:MD=-1.52,95％CI(-1.58,-1.47);25 mg/d:MD=-1.98,95％CI (-2.04,-1.93);50 mg/d:MD=-2.53,95％CI(-2.59,-2.48);100 mg/d:MD=-3.27,95％CI(-3.32,-3.21);150 mg/d:MD=-1.29,95％CI (-1.90,-0.68);200 mg/d:MD=-3.34,95％CI (-4.78,-1.90);300 mg/d:MD=-1.73,95％CI(-2.28,-1.18)] and body weight [12.5mg/d:MD=-0.92,95％CI(-1.36,-0.47);25 mg/d:MD=-1.30,95％CI (-1.81,-0.79);50 mg/d:MD=-1.58,95％CI (-1.80,-1.35);100 mg/d:MD=-1.31,95％CI(-1.65,-0.97);150 mg/d:MD=-1.51,95％CI (-2.42,-0.60);300 mg/d:MD=-1.73,95％ CI (-2.63,-0.83)] were significantly reduced in the different doses of Ipragliflozin group than that in the placebo group,and the dose of 50 mg/d and 100 mg/d were better.There was no significant difference in the incidence rate of the overall adverse reaction,hypoglycemic events,urinary tract infection and genital infection between the different doses of Ipragliflozin group and the placebo group (P＞0.05),but data showed that dose of 50 mg/d was more security than 100 mg/d (RR:1.02 vs.2.18,1.83 vs.2.88,1.01 vs.1.72,1.85 vs.2.98).Conclusion Ipragliflozin is effective and safe for the patients with type 2 diabetes,which could effectively control the patients' HbA1c,FPG and body weight,and 50 mg/d may be the best dose.
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Objective To observe the effect of Yidutiaogan mixture on rat liver fibrosis induced by CCl4 complex factors. Methods Sixty SD rats were randomly divided into normal control group, model control group, colchicine group (0.2 mg·kg-1), Yidutiaogan mixture low-, medium-, and high-dose groups(2.7, 5.4, 10.8 mL·kg-1) (n=10).Except for normal control group, the other groups were given drinking water containing 10% ethanol, subcutaneous injection of 40%CCl4 in olive oil (3 mL·kg-1,twice weekly), and high-fat diet for 8 weeks as the model control group, and they were given relevant medicine intragastrically once a day during modeling. The rats were sacrificed, and the livers were harvested and stained with Masson staining to observe liver fibrosis. Serum levels of ALT, AST, ALP, ALB, HA, LN, PCⅢ, C-Ⅳ, and the levels of TIMP-1, MMP-1, MMP-2, MMP-13, and TGF-β1 in liver tissue were detected by biochemical assay, radioimmunoassay and ELISA. Results Compared with normal control group, serum levels of ALT, AST, ALP, HA, LN, PCⅢ, and C-Ⅳ were significantly increased in model control group, while serum level of ALB was significantly decreased (P<0.01); the levels of TIMP-1, MMP-2 and TGF-β1 in liver tissue were significantly increased, while the levels of MMP-1 and MMP-13 were significantly decreased (P<0.01).Compared with the model control group, serum levels of ALT, AST, HA, LN, PCⅢ, and C-Ⅳ as well as the levels of TIMP-1, MMP-2, and TGF-β1 in liver tissue were all significantly decreased in Yidutiaogan mixture medium-dose, high-dose, and colchicine groups( P<0.05);serum level of ALB as well as the levels of MMP-1 and MMP-13 in liver tissue were significantly increased(P<0.05).However, there was no statistical significance in above indexes in Yidutiaogan mixture low-dose group(P>0.05). Conclusion Yidutiaogan mixture could be used to prevent experimental hepatic fibrosis through regulating TIMPs/MMPs, suppressing TGF-β1 , reducing deposition of extracellular matrix in liver.
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Objective To evaluate the efficacy and safety of different doses of Ipragliflozin in the treatment of type 2 diabetes patients.Methods The randomized controlled trials (RCTs) about Ipragliflozin in treatment of type 2 diabetes patients were retrieved from the databases,including Cochrane Library,PubMed,Embase,Medline,CNKI,Wangfang,VIP and CBM.The data were extracted and evaluated by two researchers independently,and the Meta-analysis was performed via RevMan5.2.Results A total of 10 RCTs involving 1 928 patients were included.The results of Meta-analysis showed that glycosylated hemoglobin (HbA1c)[12.5 mg/d:MD=-0.46,95％CI (-0.69,-0.23);25 mg/d:MD=-0.97,95％CI (-1.00,-0.94);50 mg/d:MD=-0.94,95％CI (-1.20,-0.69);100 mg/d:MD=-0.93,95％CI (-1.72,-0.15);150 mg/d:MD=-0.57,95％CI (-0.89,-0.26);200 mg/d:MD=-0.74,95％CI (-1.14,-0.34);300 mg/d:MD=-0.64,95％CI (-0.86,-0.43)],fasting blood glucose (FPG) [12.5 mg/d:MD=-1.52,95％CI(-1.58,-1.47);25 mg/d:MD=-1.98,95％CI (-2.04,-1.93);50 mg/d:MD=-2.53,95％CI(-2.59,-2.48);100 mg/d:MD=-3.27,95％CI(-3.32,-3.21);150 mg/d:MD=-1.29,95％CI (-1.90,-0.68);200 mg/d:MD=-3.34,95％CI (-4.78,-1.90);300 mg/d:MD=-1.73,95％CI(-2.28,-1.18)] and body weight [12.5mg/d:MD=-0.92,95％CI(-1.36,-0.47);25 mg/d:MD=-1.30,95％CI (-1.81,-0.79);50 mg/d:MD=-1.58,95％CI (-1.80,-1.35);100 mg/d:MD=-1.31,95％CI(-1.65,-0.97);150 mg/d:MD=-1.51,95％CI (-2.42,-0.60);300 mg/d:MD=-1.73,95％ CI (-2.63,-0.83)] were significantly reduced in the different doses of Ipragliflozin group than that in the placebo group,and the dose of 50 mg/d and 100 mg/d were better.There was no significant difference in the incidence rate of the overall adverse reaction,hypoglycemic events,urinary tract infection and genital infection between the different doses of Ipragliflozin group and the placebo group (P＞0.05),but data showed that dose of 50 mg/d was more security than 100 mg/d (RR:1.02 vs.2.18,1.83 vs.2.88,1.01 vs.1.72,1.85 vs.2.98).Conclusion Ipragliflozin is effective and safe for the patients with type 2 diabetes,which could effectively control the patients' HbA1c,FPG and body weight,and 50 mg/d may be the best dose.
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OBJECTIVE:To investigate the role of clinical pharmacists in individualized antiplatelet therapy for a patient with subacute stent thrombosis after PCI.METHODS:Clinical pharmacists participated in the therapy for a myocardial infarction patient with diabetes,and the patient suffered from subacute stent thrombosis at the fourth day after PCI.Clinical pharmacists suggested performing clopidogrel-related gene detection [Cytochrome P450(CYP)2C19] through comprehensively analyzing the complexity of the lesion,the time of stent thrombosis,the number of stent implantations and combined diseases,etc.According to detection result (CYP2C19* 1/*2),clinical pharmacists suggested to additionally use Cilostazol tablets 50 mg,po,bid,on the basis of previous dual antiplatelet therapy;additionally use Alprostadil injection 10 μg,ivgtt,qd to improve microcirculation.Pharmaceutical care as therapeutic evaluation,ADR monitoring were performed,and medication education as medication notes and dietary adjustments were also provided.RESULTS:Physicians adopted the suggestions of clinical pharmacists;the patient was recovered and discharged from hospital.After discharge,the disease condition kept stable due to persistent aspirin+clopidogrel+cilostazol triple antiplatelet therapy.CONCLUSIONS:Drug metabolizing enzyme is an important cause of individual differences in antiplatelet effects and toxicity,and its gene polymorphism is closely related with clinical outcome and terminal event.Clinical pharmacists should play professional skill to assist physician to access and interpret relevant information,and formulate and adjust individualized antiplatelet therapy after considering disease condition,combined diseases and genotypes,so as to guarantee safe and effective drug use.
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OBJECTIVE:To evaluate the effectiveness and safety of rolapitant combined with 5-HT3 receptor antagonist and dexamethasone for the prevention of chemotherapy-induced nausea and vomiting systematically,and to provide evidence-based reference in clinic.METHODS:Retrieved from CJFD,VIP,Wanfang Database,PubMed,EMBase and Cochrane Library,randomized controlled trials (RCTs) about rolapitant+5-HT3 receptor antagonist+ dexamethasone (trial group) vs.placebo combined with 5-HT3 receptor antagonist+dexamethasone (control group) for the prevention of chemotherapy-induced nausea and vomiting.Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0.RESULTS:A total of 3 literatures were included,involving 4 RCTs and 2 583 patients.The results of Meta-analysis were as follows:complete remission rate [acute stage:RR=1.10,95％ CI (1.02,1.19),P=0.01;delay stage:RR=1.18,95％ CI (1.11,1.25),P＜0.001;overall stage:RR=1.19,95 ％ CI (1.12,1.26),P＜0.001] and the proportion of patients with ftmctional indexes of vomiting living ＞ 108 [RR =1.10,95 ％ CI (1.04,1.16),P ＜ 0.001] in trial group were significantly higher than control group,with statistical significance.There was no statistical significance in the incidence of ADR between 2 groups[RR=1.10,95 ％ CI (0.82,1.47),P=0.52].CONCLUSIONS:Rolapitant combined with 5-HT3 receptor antagonist and dexamethasone can effectively prevent and relieve chemotherapy-induced nausea and vomiting,and improve the quality of life with good safety.
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OBJECTIVE:To study the anti-hepatic fibrosis effects of Yidu tiaogan mixture on rats and its mechanism. METH-ODS:60 SD rats were randomly divided into normal group,model group,colchicine group(positive control,0.2 mg/kg)and Yi-du tiaogan mixture low-dose,medium-dose and high-dose groups(2.7,5.4,10.8 mL/kg). Except for normal group,liver fibrosis model was induced in other groups,and they were given relevant medicine intragastrically during modeling,once a day,for 8 weeks. Serum levels of ALT,AST,HA,PCⅢ,CⅣ,TIMP-1,MMP-1,MMP-2,MMP-13,TGF-β1 and TNF-α and the levels of Hyp,SOD,GSH-Px,CAT,MDA,TGF-β1 and TNF-α in liver tissue were detected in rats. RESULTS:Compared with normal group,the serum levels of ALT,AST,HA,PCⅢ,CⅣ,TIMP-1,MMP-2,TGF-β1 and TNF-α were increased significantly in model group,while the serum levels of MMP-1 and MMP-13 were decreased significantly(P0.05). CONCLUSIONS:Yidu tiaogan mixture exerts protective effects on liver fibrosis of rat through regulating TIMP/MMP balance,suppressing oxidative stress,decreasing the level of TGF-β1 and reducing deposition of ex-tracellular matrix in liver.
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Objective To explore the protective effects and mechanism of shenmaisanjie capsule(SMSJC) combined with methimazole on the L?thyroxine? induced hyperthyroid hepatic damage in rats. Methods so rats were divided into 5 groups randomly as normal group,model group,SMSJC group(0.48 g/kg),methimazole group (12 mg/kg)and combination group. With the exception of the normal group ,all rats were administered L?thyroxine (800 μg/kg ,ig) daily for 6 weeks. Rats were sacrificed. Blood and liver samples were collected for detecting thyroid and liver function , histological analysis and hepatic activity of SOD , GSH?Px and MDA content. Results The levels of T3,T4,FT3,FT4,ALT,AST,ALP,TBIL in serum and hepatic MDA content declined significantly. Hepatic activity of SOD ,GSH?Px increased obviously. Liver morphologic changes improved in methimazole group and combination group,whereas no significant difference of serum FT3,FT4,TSH level and liver activities of SOD and GSH?Px was noticed in SMSJC group in comparison to model group. Compared with SMSJC or methimazole mono?therapy ,the effect of combination therapy was obvious. However ,serum TRAb level was not significantly different in five groups of rats. Conclusion SMSJC combined with methimazole plays a protective role on hyperthyroidism hepatic damage induced by L?thyroxine in rat. It is proposed that the effect is association with inhibiting hepatic oxidative stress.
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OBJECTIVE:To provide reference for development of hospital pharmacy and clinical pharmacy in south Sichuan. METHODS:Questionnaire was used to investigate the general situation of secondary and tertiary hospitals in 4 cities of south Sich-uan in aspects of partition layout,staffing situation and job content. The results were statistically analyzed. RESULTS:A total of 40 questionnaires was sent out,35 were effectively received with the effective rate of 87.50%. The partition layout was unreasonable in most surveyed hospitals,and the rate of reaching the standard about the area of drug dispensing sector and warehouse was below 85%. There were 1042 pharmacists in 35 hospitals,which were mainly female of younger than 45 years old. In secondary and ter-tiary hospitals,the rate of pharmaceutical professional and technical personnel of health technology,full-time undergraduate and vice-high above title accounted for 4.78% and 3.67%,17.37% and 31.27%,3.15% and 10.73%,respectively. The number of full-time clinical pharmacists was 24 and 69 in secondary or tertiary hospitals,mainly primary title,middle title and undergradu-ate,of whom 26(27.96%)passed job training of National Health and Family Planning Commission,4(4.30%)passed teaching qualifications training. The rate of pharmacists mainly engaged in drug dispensing and clinical pharmacy was 6.32% and 11.03% in secondary and tertiary hospitals,respectively. CONCLUSIONS:The research shows irrationality of partition layout,the shortage of highly educated and highly titles personnel,especially the clinical pharmacy professionals. The large differences exist in hospitals of different levels in several aspects,and the main body of hospital pharmacy should turn to clinical pharmacy.
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OBJECTIVE: To discuss the protective effect of captopril on the nicotine-induced impairment of endothelium-dependent relaxation(EDR) in rat mesenteric arteries and explore the possible mechanisms underlying the observed protective effects of captopril.METHODS: A total of 30 rats were randomly divided into 3 groups: normal control group,nicotine group(2 mg?kg-1),captopril group(nicotine 2 mg?kg-1+captopril 3 mg?kg-1).After treatment for 4 weeks,vasodilatation rate of mesenteric arteries,the content of NO and NOS,and the SOD activities in serum were measured.RESULTS: Nicotine significantly decreased the vasodilatation rate of mesenteric arteries and decreased the content of NO and NOS,SOD activities in serum(P
