Analysis of the burden of polypharmacy and its influencing factors among elderly tuberculosis patients in Guizhou province / 中国药房

OBJECTIVE To understand the polypharmacy burden and influencing factors of elderly tuberculosis （TB） in Guizhou province， and to provide reference for reducing the polypharmacy burden of patients. METHODS From April to July 2022， 405 elderly TB outpatients were selected from three designated TB hospitals in Guiyang City， Bijie City， and Qiandongnan Miao and Dong Autonomous Prefecture of Guizhou Province by convenience sampling method as investigation objects. The general situation questionnaire and the Living with Medicines Questionnaire （LMQ） were used for face-to-face survey. Descriptive analysis， one-way ANOVA and multivariate linear regression analysis were used to understand the score of polypharmacy burden of elderly TB patients and explore the factors effecting polypharmacy burden in TB patients. RESULTS The total polypharmacy burden score of 405 elderly TB patients was （112.65±14.59） points， which was higher than the threshold （110 points） for high burden standard in LMQ. Multivariate linear regression analysis showed that aged 80 to 92 years， self-financed+medical insurance， retreatment， drug resistance， and adverse drug reactions were the risk factors for polypharmacy burden in elderly TB patients （P＜0.05）； living in the city， family member management， volunteer management and intelligent tool-assisted management were the protective factors （P＜0.05）. CONCLUSIONS The burden of polypharmacy in elderly TB patients from Guizhou province is heavy， and is influenced by patient’s age， residence， payment method， treatment classification， drug resistance， adverse drug reactions， and medication management. It is recommended that medical staff should provide key populations with medication guidance based on influential factor for polypharmacy burden so as to reduce their polypharmacy burden.

The mechanism of Danzikang Knee Granule in regulating the chondrogenic differentiation of mesenchymal stem cells based on TGF-ß signaling pathway in cartilage repair in knee osteoarthritis.

This study aimed to explore the mechanism of Danzikang Knee Joint Granules in regulating the differentiation of mesenchymal stem cells into cartilage to cartilage repair of knee osteoarthritis based on the TGF-ß signaling pathway. For this purpose, 60 SD rats were divided into four groups; the control group and treated groups with low, medium, and high concentrations of Danzikang. The histopathology of rats was analyzed and TGF-ß signaling pathway-related proteins were determined. Results showed that the average optical density in serum of the Danzikang Granule intervention group was significantly higher than the control group (P<0.05), and the average optical density increased with drug concentration increasing (P<0.05). Compared with the control group, Danzikang knee granule cell survival in the intervention group was elevated the serum and reduced cell apoptosis rate (P < 0.05). Danzikang knee infusion concentrations were positively correlated with bone marrow mesenchymal stem cell survival rates (P < 0.05), and negatively correlated with apoptosis rate (P < 0.05). TGF-ß1, BMP2, and BMP4 were significantly increased in the three concentrations of the Danzikang Granule serum intervention group (P<0.05). TGF-ß1, BMP2 and BMP4 were significantly increased in the high concentration group, while TGF-ß1, BMP2 and BMP4 were significantly decreased in the low concentration group (P<0.05). The Wakitani histological score of the control group was significantly lower than the other three groups (P<0.05). In general, Danzikang Knee Granule plays a role in cartilage repair in knee osteoarthritis by promoting mesenchymal stem cell proliferation and cartilage differentiation, and the specific mechanism may be related to TGF-ß1/BMPs signaling pathway.

Time trend prediction and spatial-temporal analysis of multidrug-resistant tuberculosis in Guizhou Province, China, during 2014-2020.

BACKGROUND: Guizhou is located in the southwest of China with high multidrug-resistant tuberculosis (MDR-TB) epidemic. To fight this disease, Guizhou provincial authorities have made efforts to establish MDR-TB service system and perform the strategies for active case finding since 2014. The expanded case finding starting from 2019 and COVID-19 pandemic may affect the cases distribution. Thus, this study aims to analyze MDR-TB epidemic status from 2014 to 2020 for the first time in Guizhou in order to guide control strategies. METHODS: Data of notified MDR-TB cases were extracted from the National TB Surveillance System correspond to population information for each county of Guizhou from 2014 to 2020. The percentage change was calculated to quantify the change of cases from 2014 to 2020. Time trend and seasonality of case series were analyzed by a seasonal autoregressive integrated moving average (SARIMA) model. Spatial-temporal distribution at county-level was explored by spatial autocorrelation analysis and spatial-temporal scan statistic. RESULTS: Guizhou has 9 prefectures and 88 counties. In this study, 1,666 notified MDR-TB cases were included from 2014-2020. The number of cases increased yearly. Between 2014 and 2019, the percentage increase ranged from 6.7 to 21.0%. From 2019 to 2020, the percentage increase was 62.1%. The seasonal trend illustrated that most cases were observed during the autumn with the trough in February. Only in 2020, a peak admission was observed in June. This may be caused by COVID-19 pandemic restrictions being lifted until May 2020. The spatial-temporal heterogeneity revealed that over the years, most MDR-TB cases stably aggregated over four prefectures in the northwest, covering Bijie, Guiyang, Liupanshui and Zunyi. Three prefectures (Anshun, Tongren and Qiandongnan) only exhibited case clusters in 2020. CONCLUSION: This study identified the upward trend with seasonality and spatial-temporal clusters of MDR-TB cases in Guizhou from 2014 to 2020. The fast rising of cases and different distribution from the past in 2020 were affected by the expanded case finding from 2019 and COVID-19. The results suggest that control efforts should target at high-risk periods and areas by prioritizing resources allocation to increase cases detection capacity and better access to treatment.

Implementation status and suggestions of centralized volume-based procurement policy for drugs and medical consumables in China / 中国药房

OBJECTIVE To provid e reference and sugge stions for improving the volume-based procurement of drugs and medical consumables （hereinafter referred to as “consumables”）in China. METHODS The relevant policy documents of centralized volume-based procurement of drugs and consumables published from November 2018 to November 2021 were retrieved ； the implementation status and problems of centralized volume-based procurement of drugs and consumables in China were analyzed by using the policy analysis method and referring to relevant research literatures. RESULTS & CONCLUSIONS National health department and healthcare security administration guaranted the rational use of selected products in medical institutions through incentive and supervision measures ；healthcare security administration should optimize the way of medical insurance payment ， promote the medical institutions to control the fees by themselves ，and conduct the credit evaluation of bidding and procurement ； medical products administration should evaluate the consistency of drugs and supervise the quality of selected products. With the normalization of centralized volume-based procurement of drugs and consumables organized by the state and trans-regional alliance ， the drug varieties and dosage forms included in centralized procurement were increasingly in line with the demand of Chinese pharmaceutical market. The price of most selected drugs decreased by more than 50％，and the decrease of consumables was significantly higher than that of drugs. The selected enterprises were mainly domestic generic drug enterprises ，and domestic consumables had gradually become the competitors and substitute of imported consumables. However ，there were still some problems such as repeated bidding and procurement in various alliances and provinces （autonomous regions and municipalities ）， unclear construction of compensation mechanism in medical institutions ，inconsistent bidding and procurement rules and quality evaluation standards for consumables ，low localization rate of some consumables ，low innovation level and profitability of pharmaceutical enterprises and consumables manufacturers. Local centralized volume-based procurement should be encouraged ，and the bidding and procurement rules and quality evaluation standards of “one product ，one policy ”should be gradually established. Great importance should be paid to the construction of compensation mechanism of medical institutions ，standardize zhangqiuyu739632@126.com the dynamic adjustment of medical serv ice prices ；pharma- ceutical enterprises and consumables manufacturers should increase research and development investment to transform into innovative and diversified enterprises ，so as to improve the competitiveness of domestic drugs and consumables.

Noninvasive Transdermal Delivery System of Lidocaine Using an Acoustic Droplet-Vaporization Based Wearable Patch.

Current technologies for managing acute and chronic pain have focused on reducing the time required for achieving high therapeutic efficiency. Herein a wearable transdermal patch is introduced, employing an acoustic droplet vaporization (ADV) methodology, as an effective noninvasive transdermal platform, for a fast local delivery of the anesthetic agent lidocaine. The skin-worn patch consists of a flexible drug reservoir containing hundreds of micropores loaded with lidocaine, and mixed with the perfluorocarbon (PFC) emulsion. The ultrasound-triggered vaporization of the PFC emulsion provides the necessary force to breach dermal barriers. The drug release kinetics of our model was investigated by measuring the amount of lidocaine that passed through phantom tissue and pigskin barriers. The ADV platform increases the payload skin penetration resulting in shorter treatment times compared to passive diffusion or ultrasound alone, holding considerable promise for addressing the delayed therapeutic action and slow pain relief of existing delivery protocols. It is envisioned that the integration of ADV-based transdermal devices could be expanded to the depth-dependent delivery of other pain management, vaccines, and gene therapy modalities.

Investigation and Countermeasures Research on the Current Situation of Guizhou Province Pharmaceutical Industry Development / 中国药房

OBJECTIVE:To provide reference for the sustainable development of pharmaceutical industry in Guizhou province.METHODS:By literature review,personal interview and questionnaire survey,the current situation about the development of pharmaceutical industry in Guizhou province were investigated and analyzed,and the corresponding countermeasures and suggestions were put forward.RESULTS:The literatures were obtained from network literature by Baidu search engine,published data by government portal website of administrative department,documents by CNKI and VIE Five personal interviews involved the relevant management personnel in Policies and Regulations Department,Medicine and Cosmetics Production Supervision Department,Medical Device Supervision Department of Guizhou Province Food and Drug Administration.A total of 70 questionnaires (drug production enterprises as object) were sent out,and 57 valid questionnaires were collected with the effective recovery rate of 81.4％.In the present,there were a total of 175 pharmaceutical production enterprises (56.5％ in Guiyang city) and 106 medical device manufacturers in Guizhou province.Of 57 pharmaceutical manufacturing enterprises investigated,87.8％ of them were certified by the 2010 edition of Good Manufacturing Practice (GMP).The number of varieties of Chinese herbal medicines in Guizhou province ranked second in the whole country;total area of Chinese herbal medicine planting,wild protection and tending ranked third in the whole country in 2015;the industrial output value of Chinese patent medicine accounted for 85.1％ of the total output value of the pharmaceutical industry;but no approved new medicines were class 1 and 2 new medicines;R&D personnel with high education levels took small proportion significantly.The output capacity of chemical medicine industry was far lower than the average national level;the chemical industry output value accounted for only about 10％ of the total output value of the pharmaceutical industry in the province;the rate of success approval was almost zero for new drugs declared by drug manufacturers in recent years.Biological products industry was an emerging industry,currently there were only 3 biological products production enterprises.Of 341 products in medical device industry,there were 146 class Ⅰ products,190 class Ⅱ products and 5 classⅢproducts,manifesting as narrow coverage,few production type,relatively backward level.Seven percent of pharmaceutical production enterprise involved in the derivatives industry,and the development of TCM health care industry attracted more and more attention.CONCLUSIONS:The Chinese and national medicine industry has been the dominant force,the development of chemical medicine,biological products and medical device indusmy has lagged behind,and medicine derivatives industry needs to promote the integration of TCM and health-and-fitness.Thewhole industry strategic consciousness is comparatively backward,high-end R&D personnel is lack,and independent innovation ability is weak.It is suggested to done the top design,guide enterprises mergers and restructuring;develop characteristic medicine,support small molecule chemical medicines and biological products enterprises deeply;deepen the understanding of industrial policy,and increase investment in independent innovation;develop new medicine derivatives,and expand the pharmaceutical e-commerce sales channel;broaden the industry chain depth,breadth and width,and excavate medical big data.

Diagnostic value of improved pleural biopsy combined with biomarker in pleural effusion of unknown origin / 重庆医学

Objective To investigate the diagnostic value of improved pleural biopsy combined with biomarker and cytology detection in pleural effusion of unknown origin.Methods The clinical data in 216 cases of pleural effusion were respectively analyzed including 106 cases of tuberculous pleural effusion(tuberculosis group) and 110 cases of malignant pleural effusion(malignant group).All cases were performed the improved pleural biopsy,cytology examination and detection of pleural effusion ADA,CEA and LDH,and serum CEA.The pleural biopsy diagnosis rate was performed the statistics,and pleural effusion ADA,CEA and LDH,serum CEA,and pleural effusion CEA/serum CEA were compared between the two groups.Results Among 216 cases,241 times of pleural biopsy puncture were conducted,the first time puncture success rate was 94.9 ％ (205/216).Having the diagnostic value among pathological results of pleural biopsy materials in first puncture success accounted for 58.8％ (127/216),and the overall diagnosis rate was 65.3 ％ (141/216).The incidence rate of adverse reactions was 5.8 ％ (14/241).In the tuberculosis group,no case showed cytology tumor cell positive,while the cytology tumor cell positive rate in the malignant group was 54.5％ (60/110);pleural effusion CEA and LDH,serum CEA and pleural effusion CEA / serum CEA levels and positive rates in the malignant group were significantly higher than those in the tuberculosis group,while the pleural effusion ADA level and positive rate were significantly lower than those in the tuberculosis group the difference was statistically significant(P＜0.01).Conclusion Improved pleural biopsy,pleural effusion cytology,pleural effusion biomarkers have a certain limitation in alone auxiliary diagnosis of pleural effusion.The various indicators can be combined to determine the etiology of pleural effusion in clinic for guiding treatment.

The clinical observation of ultra-sound guided lumbar plexus and sciatic plexus nerve block combined with general anesthesia on elderly patients undergoing hip replacement surgery / 临床麻醉学杂志

Objective To observe the clinical effects of ultra-sound guided lumbar plexus and sciatic plexus nerve block combined with general anesthesia on elderly patients undergoing hip replace-ment surgery.Methods Eighty elderly patients scheduled for unilateral hip replacement surgery were randomly divided to lumbar plexus and sciatic plexus nerve block combined with general anesthesia group (group N)and general anesthesia group (group G).The airways of all the patients were con-trolled by laryngeal mask airway (LMA)in both groups.The bispectral index (BIS)of patients in both groups was maintained in the range of 45-55.The dosage of sulfentanyl,visual analogue scale (VAS)at 2,4,8 and 24 h after surgery,and the dosage of patient controlled analgesia (PCA)drugs were recorded.The period from end of surgery to extubation,off-bed activity and discharged from hospital,mortality in 30 days after surgery were recorded.Meanwhile,postoperative delirium (POD) and postoperative cognitive dysfunction (POCD),and severe cardiovascular and pulmonary complica-tions were evaluated.Results No patient died in 30 days after surgery in both two groups.One patient suffered from severe pulmonary infection in group G.The dosage of sulfentanyl of group N was less than the value of group G (P <0.05),the periods from end of surgery to extubation,off-bed activity and discharged from hospital of group N were shorter than those in group G (P <0.05 ).The VAS scores and incidence of POD and POCD in group N were lower than those in group G (P < 0.01 ). Conclusion In elderly patients undergoing hip replacement surgery,ultrasound-guided lumbar plexus and sciatic plexus nerve block combined with general anesthesia could help reduce usage of opioids during operation,offer better analgesia effect,shorten the period of off-bed activity and discharged from hospital and reduce incidence of POD and POCD in elderly patients.

Synchrotron radiation-based Fourier-transform infrared spectromicroscopy for characterization of the protein/peptide distribution in single microspheres

The present study establishes a visualization method for the measurement of the distribution and localization of protein/peptide constituents within a single poly-lactide-co-glycolide (PLGA) microsphere using synchrotron radiation-based Fourier-transform infrared spectromicroscopy (SR-FTIR). The representative infrared wavenumbers specific for protein/peptide (Exenatide) and excipient (PLGA) were identified and chemical maps at the single microsphere level were generated by measuring and plotting the intensity of these specific bands. For quantitative analysis of the distribution within microspheres, Matlab software was used to transform the map file into a 3D matrix and the matrix values specific for the drug and excipient were extracted. Comparison of the normalized SR-FTIR maps of PLGA and Exenatide indicated that PLGA was uniformly distributed, while Exenatide was relatively non-uniformly distributed in the microspheres. In conclusion, SR-FTIR is a rapid, nondestructive and sensitive detection technology to provide the distribution of chemical constituents and functional groups in microparticles and microspheres.

Quantitative structure characteristics and fractal dimension of Chinese medicine granules measured by synchrotron radiation X-ray computed micro tomography / 药学学报

The shape and structure of granules are controlled by the granulation process, which is one of the main factors to determine the nature of the solid dosage forms. In this article, three kinds of granules of a traditional Chinese medicine for improving appetite and promoting digestion, namely, Jianwei Granules, were prepared using granulation technologies as pendular granulation, high speed stirring granulation, and fluidized bed granulation and the powder properties of them were investigated. Meanwhile, synchrotron radiation X-ray computed micro tomography (SR-µCT) was applied to quantitatively determine the irregular internal structures of the granules. The three-dimensional (3D) structure models were obtained by 3D reconstruction, which were more accurately to characterize the three-dimensional structures of the particles through the quantitative data. The models were also used to quantitatively compare the structural differences of granules prepared by different granulation processes with the same formula, so as to characterize how the production process plays a role in the pharmaceutical behaviors of the granules. To focus on the irregularity of the particle structure, the box counting method was used to calculate the fractal dimensions of the granules. The results showed that the fractal dimension is more sensitive to reflect the minor differences in the structure features than the conventional parameters, and capable to specifically distinct granules in structure. It is proved that the fractal dimension could quantitatively characterize the structural information of irregular granules. It is the first time suggested by our research that the fractal dimension difference (Df,c) between two fractal dimension parameters, namely, the volume matrix fractal dimension and the surface matrix fractal dimension, is a new index to characterize granules with irregular structures and evaluate the effects of production processes on the structures of granules as a new indicator for the granulating process control and optimization.

Clinical significance of sserum Hcy levels for patients with non-small-cell lung cancer when undergoing chemotherapy / 国际检验医学杂志

Objective To investigate the dynamic change of serum Hcy level in patients with non-small lung cancer when under-going chemotherapy,and to study the value of monitoring serum Hcy for chemotherapy efficieney in non-small-cell carcinoma.Meth-ods In our study,we enrolled 62 patients with non-small-cell carcinoma when undergoing chemotherapy.The concentrations of ho-mocysteine,carcino-embryonic antigen and cytokeratin 1 9 fragments were detected,and then these results were analyzed by statisti-cal methods.Results Compared with before treatment,the serum homocysteine,carcino-embryonic antigen and cytokeratin 1 9 frag-ments levels in patients who had effective response decreased.After 2 courses of chemotherapy,the levels of the three markers were significantly lower than those detected before chemotherapy (P 0.05).The positive rates of the three markers were statisti-cally significant between single lung squamous cell carcinoma and adenocarcinoma of the non-small-cell carcinoma.Conclusion The detection of the dynamic changes of serum Hcy in patients with non-small-cell carcinoma when undergoing chemotherapy is useful in evaluating the effect of chemotherapy and tumor activity.

Polyethersulfone hollow fiber membrane for hemodialysis--preparation and evaluation / 生物医学工程学杂志

Polyethersulfone (PES) hollow fibers were fabricated by dry-wet spinning method for hemodialysis application. The effects of additives polyethylene glycols (PEG) in the dope solution and of fiber thickness and inner diameter fiber on the membrane mechanical characters were investigated. The dialysis tests were conducted by using a simulated solution prepared by dissolving bovine serum albumin (BSA), lysozyme and urea in de-ionized water to test the effects of membrane characters and operating conditions on dialysis efficiency. The results indicated that the reduction of PEG concentration from 27.6 wt% to 24.1 wt% in the dope solution improved the clearance of toxins, but slightly decreased the mechanical characters. The reduction of fiber thickness or fiber inner diameter was found to improve the clearance of toxins by removing 64.2% of lysozyme and 89.4% of urea (membrane area 0.2 m2), whilst BSA retention was found being maintained above 98%. The dialysis efficiency was also noted to increase with the increase in the flow rate of either the simulated or the dialysate solution, or increasing the membrane area. Moreover, The result of a comparison on the clearance of toxins between commercial F60S and PES dialyzers indicated higher dialysis efficiency per area of the fabricated PES membrane.