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Objective:To investigate the effect of antidepressant therapy on cellular immunity and quality of life of patients with depression after thoracoscopic radical resection of esophageal cancer.Methods:Between June 2015 to March 2019, our hospital during the period of line thoracoscope comorbid depressive patients, 186 cases of esophageal cancer radical, according to the indicator method were randomly divided into treatment group and the control group (n=93), the treatment group after surgery for antidepressant treatment, the control group did not give any postoperatively in patients with depressive drugs treatment, routine for psychological counseling. Self-rating Depression Scale SDS and Generic Quality of Life Inventory-74 (GQoli-74) were used to evaluate the changes of depression status and Quality of Life in 2 groups before and after treatment. Flow cytometry was used to detect the levels of CD 4+ and CD 8+ subsets in peripheral blood to evaluate the changes of immune system function in 2 groups before and after treatment. Results:After treatment, the SDS score of the treatment group was significantly lower than that before treatment, the difference was statistically significant( P<0.05), while the SDS score of the control group was not significantly changed before and after treatment, the difference was not statistically significant( P>0.05). After antidepressant treatment, CD 4+ and CD 4+ /CD 8+ levels in the immune system in the treatment group were significantly increased, and CD 8+ levels were significantly decreased, with statistical significance ( P<0.05), while CD 4+ , CD 8+ and CD 4+ /CD 8+ levels in the control group were not significantly changed before and after treatment. There was no significant difference ( P>0.05). After treatment, the body function, psychological function, social function, material state and total score of quality of life of patients in the treatment group were significantly improved compared with before treatment, the difference was statistically significant ( P<0.05), while the score of quality of life of patients in the control group was not significantly changed before and after treatment, the difference was not statistically significant ( P>0.05). Conclusion:Antidepressant therapy can significantly improve the depression status of postoperative esophageal cancer patients, and improve the immune system function and quality of life.
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Objective To investigate the effect of CYP3A5 and MDR1 gene polymorphisms on blood concentration of tacrolimus and creatinine level in uremic patients during the early phase after kidney transplantation in real clinical practice. Methods 131 patients who underwent kidney transplantation for the first time with triple immunotherapy based on tacrolimus in single-center from 2013 to 2017 were enrolled for retrospective study. Tacrolimus daily dose, blood concentration, blood concentration-to-dose ratio, and serum level were compared according to the various genotypes of CYP3A5 and MDR1 polymorphisms in renal transplantation recipients, respectively. Results The dosage of tacrolimus in CYP3A5*3/*3 (GG) kidney transplantation recipients within 4 weeks after kidney transplantation was lower than those of CYP3A5*1/*1 (AA) and CYP3A5*1/*3 (AG). The serum creatinine levels of patients whose tacrolimus concentration in the range of 10-13 ng/ml were close to the normal value. Conclusion CYP3A5 gene polymorphism affects the blood concentrations of tacrolimus in renal transplant recipients. No association has been found between the blood concentrations of tacrolimus and MDR1 gene polymorphism. Tacrolimus concentration in the range of 10-13 ng/ml might contribute to restore the early kidney graft function.
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OBJECTIVE：To investi gate the role of clinical pharmacists in the treatment of delayed excretion of acute renal failure （ARF） with epileptic seizure caused by HD-MTX in a patient ，and to provide reference for rational drug use and pharmaceutical care in such type of patients. METHODS ：A patient with diffuse large B-cell lymphoma was given HD-MTX for chemotherapy，and ARF caused by delayed methotrexate excretion occurred on the second day after methotrexate administration. Clinical physicians adjusted the rescue dose and frequency of calcium folinate but the effect was poor. Clinical pharmacists analyzed the causes of delayed methotrexate excretion by reviewing literature and combining with the patient ’s condition. It was suggested to monitor the blood concentration of methotrexate ，strengthen alkalization and hydration ，increase the volume of intravenous sodium bicarbonate from 125 mL to 250 mL，take Sodium bicarbonate tablets orally ，and monitor the pH value of urine （pH value of urine maintained above 7）. In addition ，the pharmacist told the patient to drink water as much as possible to ensure the daily urine output reached 3 000 to 4 000 mL. The blood concentration of methotrexate was 16.14 μmol/L 44 h after administration ，which proved to be excretion delay. The patient had epileptic seizure on the 13th day after methotrexate medication. The physician gave sodium valproate 0.8 g intravenously to control epilepsy. The clinical pharmacist conducted pharmaceutical care for the patient ，and found that the compliance of the patient taking Sodium bicarbonate tablets and Sodium valproate tablets orally was not good ，so medication education and pharmaceutical care were conducted ，then the patient accepted and took the drugs on time. RESULTS ： The physician adopted the suggestions of the pharmacist to monitor the blood concentration of methotrexate and performed symptomatic treatment. The urine volume of the patient increased ，the edema was reduced ，serum creatinine gradually returned to normal，and renal function recovered gradually ；the symptoms of epilepsy was controlled. CONCLUSIONS ：In the treatment process of ARF complicated with epileptic seizure caused by excretion delay of HD-MTX ，the clinical pharmacist assisted physician to improve the treatment plan and conducted pharmaceutical care and medication education for the patient ，therefore ensure the safe and rational use of drugs .
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Objective To study the protective effect of Shengxian decoction and the single herb decoction against myocardial injury induced by hypoxia/reoxygenation. Methods The H9c2 cells were cultured to establish hypoxia/reoxygenation model. Rats were divided into 8 groups: normal control group, hypoxia/reoxygenation group (model group) and treated groups (Shengxian decoction and the single herb decoction). The apoptotic rate of cardiomyocytes, the activity of reactive oxygen species (ROS) and intracellular calcium concentration (Ca2+) were measured. Results Compared with hypoxia/reoxygenation group, the apoptosis rate, ROS activity and intracellular Ca2+ concentration were significantly lower in all treated groups (P<0.05). The ROS activity and intracellular Ca2+ concentration was decreased by 41.37% and 15.20% in Shengxian decoction group compared to the model group. Conclusion Shengxian decoction and the single herb decoction had protective effect on myocardial injury induced by hypoxia/reoxygenation.
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Objective To establish a method to determine 11 main components in Hanshi yufei decoction. Methods The method adopted UHPLC-MS/MS with an Agilent ZORBAX SB-C18 (3.5 μm，2.1 mm×150 mm) column. The mobile phase was consisted of 0.2% formic acid plus 10 mmol/L ammonium acetate aqueous solution(A) - acetonitrile(B) and gradient elution (0–0.6 min, 80%–40%A; 0.6–1 min, 40%–30%A; 1–4.3 min, 30%–5%A) at 0.3 ml/min. The column temperature was 40 ℃ and 11 main components including vanillic acid, magnolol, honokiol, wogonin, sophorin, 6-gingerol, citrinin, qianghuo alcohol, nobiletin, nodakenin, and hesperidin were quantified in a multiple reaction monitoring mode. The reserpine was the standard. Results The 11 main components in Hanshi Yufei decoction had a good linear relationship within their concentration range (r>0.98), and the average recovery was 93.11%～111.73%. Conclusion The UHPLC-MS/MS method established in this experiment is easy to operate and has good reproducibility, which provides a laboratory basis for the quality control of Hanshi Yufei decoction.
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Objective To optimize the manufacture process for Zhibai Anshen oral liquid. Methods The orthogonal designed experiments were conducted to monitor the effects of three factors on the content of mangiferin. The three factors included the amount of water, extraction time and alcohol precipitation concentration. Six month accelerated stability study and twelve month long term stability study were performed. Results Optimum percolation process was boiling the mixture with 10 times of water for 1 hour, followed by deposition with 60% alcohol. Conclusion This optimized process can be used for mass production.
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ABSTRACT OBJECTIVE：To establish a method for content determination of paclitaxel in malignant ascites of tumor patients. METHODS：LC-MS/MS method was adopted. Using vindoline as internal standard，the content of paclitaxel in ascites of tumor patients was determined. The separation was performed on Zorbax SB-C18 column with mobile phase consisted of aqueous solution （containing 0.1％ formic acid and 10 mmol/L ammonium acetate）-acetonitrile（40 ∶ 60，V/V）at the flow rate of 0.25 mL/min. the column temperature was 30 ℃，and sample size was 5 μL. The ion source was electrospray ion source，and the detection mode was multiple ion monitoring positive ion mode. MS parameters were set as following as dry gas temperature 350 ℃，dry gas flow rate 10 L/min，capillary voltage 4 000 V. Quantitative determination was operated in the multiple reaction monitoring（MRM）mode， with the ion transitions m/z 876.5→308.0 for paclitaxel and m/z 457.3→188.1 for the internal standard. The fragment voltage/ collision energy for paclitaxel and the internal standard were 250 V/30 eV，and 150 V/20 eV，respectively. RESULTS：The linear range of paclitaxel were 25-2 500 ng/mL（r2＝0.996 5，n＝7）. The lowest limit of quantitation was 25 ng/mL. RSDs of inter-day and intra-day precision tests were 0.61％ -3.62％（n＝5，3）. Accuracies were 95.34％ -98.76％（n＝5，3）. RSDs of extraction recovery were 3.19％-3.72％（n＝3）. CV of matrix effect were 1.52％-2.93％（n＝3）. RE of stability tests were lower than 3％（n＝ 3）. CONCLUSIONS：The method is simple，accurate and suitable for the content determination of paclitaxel in malignant ascites of tumor patients.
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Objective To strengthen the system of drug supply chain collaborative service platform in drug supply, decrease drug inventory backlog, and improve the outpatient pharmacy management capacity in outpatient pharmacy.Methods Failure mode and effects analysis (FMEA) method was used to discover the potential risks in the drug supply chain collaborative service platform and formulate the corresponding improvement measures.Results The number of drug-receiving errors dropped from 137times to 32times and the risk reduction rate was 76.64％after improving the procurement process of the supply chain service platform, which significantly reduced the risk of contracting errors.Conclusion FMEA method could help to figure out the loopholes and hidden dangers of the pharmacy system, which made the outpatient pharmacy more reasonable and accurate by constantly improving the measures of the drug supply chain collaborative service platform.
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OBJECTIVE： To analyze the regularity and characteristics of ADE induced by Tanreqing injection， and to lay the foundation for ADE mechanism study. METHODS： Using “Tanreqing injection” and “ADE” as keywords， the literatures about ADE induced by Tanreqing injection were retrieved from CJFD， VIP， CBM and Wanfang database during Jan. 1st， 2014 to Oct. 30th， 2018. Patient’s gender， age， drug allergy history， primary diseases， drug dosage， solvent， organs or systems involved， main clinical manifestation of ADE， occurrence time， drug combination were all analyzed statistically. RESULTS： A total of 126 literatures were included， involving 1 577 patients. There were 906 male （57.45％） and 671 female （42.55％）； the age ranged from 6 months to 98 years old， of which 625 cases （39.63％） were aged from 0 to 10 years. Among 1 577 patients， primary diseases of 537 patients were recorded and mainly were bronchitis and pneumonia （323 cases， 60.15％）. Drug dosages of 687 patients were recorded， among which there were 612 cases of normal dose （89.08％）， 75 cases of off-label dose （10.92％）. 779 cases of solvent （mainly containing 5％ Glucose injection or 0.9％ Sodium chloride injection， 715 cases， 91.78％）. 1 960 case times of ADE were recorded， mainly including lesion of skin and its appendents （930 case times， 47.45％）， followed by systemic response （231 case times， 11.79％）， digestive system （221 case times， 11.28％） and cardiovascular system （220 case times， 11.22％）. Occurrence time of ADE was recorded in 1 172 cases， mainly 10-30 min after medication （434 cases）. Detailed drug use was recorded in 1 356 patients， among which there were 521 cases of drug combination， mainly containing antibiotics， followed by TCM injection for clearing away heat and toxic material and antiviral drugs， etc. CONCLUSIONS： Attention should be paid to ADE induced by Tanreqing injection. On the one hand， ADE monitoring should be strengthened to summarize， analyze and evaluate ADE； on the other hand， attention should be paied when patients have above situations， so as to promote rational and effective clinical measures and to ensure drug safety of patients.
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Antiangiogenic target therapy has been a hot topic in cancer treatment recently.Apatinib is a category 1.1 new medication developed domestically.It effectively inhibits angiogenic and exhibits promising anti-tumor activity in preclinical studies.Apatinib has been successfully applied in clinical trials of multiple malignancies,such as gastric cancer,lung cancer and breast cancer with satisfactory safety and efficacy profile.However,its mechanism of action is still not fully understood. Further researches should be carried on to improve its safety,effectiveness and marketability.This review summarized the mechanism of action,pharmacokinetics,clinical efficacy,safety and biomarkers,discussed the recent progress,hot issues and clinical prospects of apatinib,
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OBJECTIVE:To optimize the workflow of electronic pharmaceutical system(ePS),and improve the work efficiency of outpatient pharmacy. METHODS:The problems about the application of ePS on tollying in outpatient pharmacy of our hospital were analyzed. The improvement measures were put forward and implemented. The effectiveness was summarized by evaluating relevant work indicators 6 months before and after optimization. RESULTS:Referring to main problems during the application of ePS on tollying as repetition of tallying drugs,complexity of stocking checking,low efficiency in the management of drug expiry date,deviation in the tracking of"batch/expiry",a series of measures were carried out in outpatient pharmacy of our hospital,including optimizing tallying process,updating tracking process,adding the function of alerting the near-expiry drug, etc.The system optimization shortened the time of replenishment(26.32 s vs. 7.78 s,improving by 3.38 times)and stock checking [(165.50±5.75)s vs.(146.70±4.54)s,shortening by 11.36%],realized accurate tracing of drug information"batch/expiry"and improved drug management [(58.00±1.88)s vs.(18.00±1.23)s,shortening by 68.97%]. CONCLUSIONS:The optimization of ePS on tallying in our hospital improves work efficiency of pharmacists and guarantees the accuracy of tracing drug"batch/expiry".
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OBJECTIVE: To study the effects of Wuzhi capsule/schisantherin A (SchA) combined with cyclophosphamide on the pharmacokinetics of cyclophosphamide (CTX) in rats. METHODS: A total of 36 rats were randomly divided into CTX group (via tail vein, iv, CTX solution 300 mg/kg), CTX+WZC group (ig, Wuzhi capsule 300 mg/kg+via tail vein, iv, CTX solution 300 mg/kg), CTX + SchA low-dose, medium-dose, high-dose and excessive high-dose groups (ig, SchA 30, 300, 3 000, 30 000 μg/kg+via tail vein, iv, CTX solution 300 mg/kg) with 6 rats in each group. Blood samples were collected from orbital venous plexus of rats before medication and 0.083, 0.25, 0.5, 1, 2, 3, 4, 6, 8, 12, 24, 36, 48 h after medication.UPLC-MS/MS method was applied for concentration determination of CTX and its metabolites [de-chloroethyl CTX (DC-CTX), 4-ketone CTX (4-keto CTX), carboxyl phosphamide (CPM)] in plasma of rats. The plasma concentration-time curve was obtained. The pharmacokinetic parameters were fitted by using DAS 2. 0 software. RESULTS: The maximum plasma concentration (cmax) of DC-CTX in CTX group, CTX+WZC group, CTX+SchA low-dose, medium-dose, high-dose and excessive high-dose groups were (22 167. 85 ±2 844. 93), (10 920. 53 ± 1 490. 89), (18 951. 29 ± 1 558. 81), (18 622. 08 ± 791. 19), (18 515. 20 ± 2 560. 61), (15 133. 21 ± 1 305. 07) μg/mL, respectively; the area under the curves (AUCo-48 h) were (173 864. 01 ± 65 342. 21), (100 996. 98 ± 33 530. 02), (137 028. 16 ± 45 975. 19), (131 650. 18 ± 53 196. 41), (113 699. 40 ± 34 131. 36), (110 773. 27 ± 30 307. 15) μg·mL/h, respectively. Compared with CTX group, cmax of DC-CTX in CTX group, CTX+SchA low-dose, medium-dose, high-dose and excessive high-dose groups were decreased by 50. 74％, 14. 51％, 16. 10％, 16. 48％, 31. 73％, respectively. AUC0-48 h were decreased by about 42. 23％, 21. 45％, 24. 63％, 33. 37％, 36. 55％, respectively; with statistical significance (P<0. 05). The pharmacokinetic indexes as t1/2, tmax had no significant change. CONCLUSIONS: To some degree, both WZC and SchA can reduce the generation of DC-CTX, which indicates both of them can inhibit CTX toxicity metabolism pathway so as to reduce the generation of toxic metabolite chloroacetaldehyde. The inhibitory effect of SchA on toxicity metabolism pathway is weaker than that of WZC, and does not have a dose-dependent inhibitory effect.
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Objective Identifying laccases, as one of the key synthetases in the lariciresinol biosynthetic pathway, by analyzing the transcriptome sequencing results in Isatis indigotica would provide a dependable foundation for later functional study of Isatis indigotica′s laccases. Methods Bioinformatical softwares and kinds of analytical methods online were used to find out the characteristics of the laccases from I. indigotica, including physical and chemical properties, homology, and the properties after induction of MeJA. Results The transcriptional results showed that Iilac3 and Iilac5 from I. indigotica were corresponded ith the accumulation of the effective metabolites, making them the potential functional genes participated in lariciresinol synthesis. Conclusion Through the detailed bioinformatical analysis of Iilacs,which laid a solid foundation for the further study of the physiological and biochemical mechanisms and structural characteristics of the functional proteins.
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Objective To introduce the teaching practice and experience of Pharmacy Administration in new era using a variety of teaching methods .Methods To review the characteristics and difficulties in teaching Pharmacy Administration ,as well as some practices and experiences with multiple teaching methods .Results The multiple teaching methods ignite student′s desire for learning and improve the quality of teaching .Conclusion Utilization of multiple teaching methods in Pharmacy Ad-ministration has achieved good results .These methods can be used as an effective way to optimize the teaching model .
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Objective To confirm the hepatotoxicity of valproic acid (VPA ) and its metabolites (2-propyl-4-pentenoic acid ,3-hydroxy valproic acid ,5-hydroxy valproic acid) on human liver cells .Methods Cells were divided into control group and VPA-treated group .The control group was conventionally cultured while the VPA-treated group was treated with valproic acid and its metabolites . The rate of cell proliferation was assayed by CCK 8 protocol . The mRNA levels of CYP1A1 , CYP1A2 ,PCNA ,Bax and Bcl-2 were measured by real time PCR .The correlated protein levels were measured by Western Blotting .The activity of LDH ,AST and ALT were also detected .Results Compared to the control group ,with the increases of concentrations and reaction time of VPA and its metabolites ,the proliferation rate of L02-cell was reduced ,the mRNA and protein levels of CYP1A1 ,CYP1A2 ,and Bax was increased ,the mRNA and protein level of PCNA and Bcl-2 was decreased , AST ,ALT ,and LDH were also elevated in the treated group .Conclusion Valproic acid and its metabolites were positively re-lated to hepatotoxicity .
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The resources and quality of Chinese herbal medicine is the foundation and guarantee for the sustainable development of the whole industry chain of traditional Chinese medicine.The effective component,having clinical curative effect,is the material base of Chinese herbal medicine,and is the core for the quality of medicinal material factors (quality).The accumulation of efficacy material is closely related to the genetic background of the original plant.By clarifying active ingredients biosynthesis,revealing medicinal material quality formation mechanism,regulating the content of effective components,the quality of medicine could be guarantee and ascend.The quality control technology based on active ingredients of Traditional Chinese medicine quality includes integrated analysis of high-throughput sequencing and systems biology data,revealing synthetic genetic mechanisms of active ingredients,excavating molecular markers of the quality,creating excellent germplasm,forming cultivation techniques,establishing classification standard of medicinal materials,and finally realizes the full industrial chain control of Chinese herbal medicine production.Taken all of these together could ensure the quality of medicinal materials.
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OBJECTIVE:To compare therapeutic efficacy and safety of different chemotherapy regimens in the treatment of small cell esophageal cancer. METHODS:In retrospective analysis,58 patients with small cell esophageal cancer were divided into group A(18 cases),B(26 cases)and C(14 cases)according to chemotherapy regimens. Group A was given Cisplatin injection 75 mg/m2 intravenously,d1-3+Paclitaxel injection 175 mg/m2,d1-3. Group B was given Cisplatin injection 30 mg/m2 intravenously,d1-3+Et-oposide injection 100 mg/m2,d1-3. Group C was given Vinorelbine tartrate injection 25 mg/m2 intravenously,d1-3+Gemcitabine hydro-chloride for injection 1000 mg/m2,d1-3. A treatment course of 3 groups lasted for 21 d,and they all received 2 cycles of treatment. Clinical efficacies,1,2,3-year survival rate and the incidence of Ⅲ-Ⅳ degree toxic reaction(cough,fever,expectoration,short-ness of breath,fatigue,chest pain,bone marrow suppression,gastrointestinal reactions) were compared among 3 groups. RE-SULTS:Total response rate and 1,2,3-year survival rate were in descending order:group C>group B>group A;the incidence of Ⅲ-Ⅳ degree cough,fever,expectoration,shortness of breath,fatigue,chest pain were in ascending order:group C0.05). CONCLUSIONS:Therapeutic efficacy and 1,2,3-year survival rate of vinorelbine combined with gemcitabine are significantly higher than those of cisplatin combined with paclitaxel or etoposide with better safety.
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OBJECTIVE:To strengthen the supervision of clinical antibiotics use through establishing electronic consultation system. METHODS:Based on hospital information system(HIS)and antibiotic management system,consultation system for anti-biotics of special use(ASU)was established,and the effects of the system after used(Jan. 2014)were also evaluated. RESULTS:Real-time consultation of ASU medical orders and related consultation results inquiry and statistics could be achieved through de-signing ASU consultation application form,establishing consultation experts and confirming their working content,adding statistics function,etc. The consultation have been finished 8275 times from 2014 to 2015. The inspection rate for pathogenic microbes in ASU patients rose from 78.68% in 2013 to 83.90% in 2015. CONCLUSIONS:The establishment and application of ASU consulta-tion system can improve consultation efficiency and quality,so as to promote rational use of antibiotics in the clinic.
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OBJECTIVE:To explore the role of clinical pharmacists providing pharmaceutical care for hemodialysis patients complicated with subacute infective endocarditis(IE). METHODS:Clinical pharmacists participated in the anti-infection treatment for a hemodialysis patients complicated with subacute IE,according to the antimicrobial spectrum,laboratory and imaging find-ings,and patient’s condition changes,assisted physician to optimize the regimen,clinical pharmacists suggested to give imipenem cilastatin sodium after hemodialysis,adjust the initial dose of teicoplanin and give 1 g vancomycin firstly,and maintained 0.5 g af-ter hemodialysis,then adjust its dose based on blood plasma concentration;during treatment,clinical pharmacists closely observed the treatment effect and adverse reactions,providing blood plasma concentration monitoring,medication reminding and medication education. RESULTS:Physicians adopted parts of suggestions of clinical pharmacists,no fever was found,hemogram returned to normal,no abnormal echocardiography,and patient discharged. CONCLUSIONS:Clinical pharmacists guarantee the safety and ef-ficacy of drug use by adopting dose of anti-infection drugs,evaluating efficacy,monitoring adverse reactions and vancomycin plas-ma concentration,and assisting physicians to optimize treatment regimen.
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Isatidis Radix,the root of Isatis indigotica Fort.(Cruciferae),is a representitive herb widely used for clearing away heat-toxin in traditional Chinese medicine (TCM).Lariciresinol is a representitive component of lignans and an important efficacious substance with the antiviral effect.This review elucidated the progress on its biosynthetic pathways,the screening of key regulatory genes and metabolic engineering of lignans components in Isatidis Radix,providing a favorable reference for the full understanding of biosynthesis of antiviral active components,the quality improvement of Isatidis Radix and the sustainable utilization of TCM resources.