Reliability and feasibility of home-based dried blood spot in therapeutic drug monitoring: a systematic review and meta-analysis.

PURPOSE: Dried blood spot (DBS) is one of promising home sampling methods for therapeutic drug monitoring (TDM). However, the associated reliability and feasibility (including yield, adherence, and preference), which are criteria for the promotion of home-based DBS, remain unknown. This systematic review and meta-analysis aimed to evaluate the reliability and feasibility of TDM using DBS sampling. METHODS: In this study, a combination of MeSH and free terms for (dried blood spot*[title/abstract])AND ("Drug Monitoring"[Mesh])AND(home OR venous)was surveyed using EMBASE, PubMed, Cochrane Library, and Web of Science upon gathering published. we registered this study protocol with the International Prospective Registry of Systematic Reviews (CRD42021247559). RESULTS: Approximately half (35/75) of the evaluations reported good agreement between DBS and plasma, and the results for drugs with poor agreement may be improved using a haematocrit-based physiological equation. The yield and adherence to home-based DBS exceeded 87%, and questionnaire-based preference for DBS was 77%. CONCLUSIONS: DBS may be a reliable and feasible home sampling method; however, it requires intricate design and evaluation before implementation.

Dosimetry study on radioactive particle brachytherapy in oral carcinoma.

PURPOSE: To investigate the therapeutic effects of different doses of 125I radioactive particle brachytherapy on oral cancer. METHODS: Between September 2012 and September 2015, 78 patients with oral cancer who received 125I radioactive particle brachytherapy for the first time in our hospital were enrolled in this study. Patients were divided into high dose (≥3) and low dose (<3) groups. The treatment outcome, serum tumor marker levels and the expression levels of autophagy and apoptotic genes in tumor cells were compared between groups. RESULTS: Complete remission (CR)+partial remission (PR) ratio in the high dose group was significantly higher than that of the low dose group. Stable disease (SD)+ progressive disease (PD) ratio was significantly lower in the high dose group. The serum levels of TSGF, SCCA, CEA, CA125, CA15.3, CA19.9 and PSA oral cancer markers were significantly lower than those of the low dose group. In the high dose group, the expression levels of Beclin-1 and MAP1LC3 (autophagic genes) mRNAs were significantly higher than those of the low dose group, while the expression levels of EMMPRIN and MMP-14 (invasive genes) mRNAs were significantly lower in the high dose group. Also survival rates in the responsive patients were significantly better in comparison to non-responsive patients. CONCLUSION: High dose particle brachytherapy with radioactive 125I is a safe and effective treatment and its clinical results were more beneficial than the low dose therapy.

A retrospective study of the efficacy and safety of levofloxacin in children with severe infection.

Objectives: Levofloxacin is widely used because of its broad-spectrum antimicrobial activity and convenient dosing schedule. However, the relevance of its use in children remains to be investigated. The purpose of this study is to investigate the efficacy and safety of levofloxacin use in children with severe infections. Methods: We conducted a retrospective observational study of patients <18 years of age who received levofloxacin intravenously in the Pediatric Intensive Care Unit (PICU) of our hospital during the period between 2021 and 2022. Patient demographics, course characteristics, clinical effectiveness, and adverse event correlations were extracted through a retrospective tabular review. Results: We included 25 patients treated with 28 courses of levofloxacin. The mean age of these children treated with levofloxacin was 4.41 years. Conversion of pathogenic microbiological test results to negative after levofloxacin treatment was detected in 11 courses (39.29%). A decrease in inflammatory markers, white blood cell or C-reactive protein counts, was detected in 18 courses (64.29%). A total of 57 adverse events occurred during the treatment period, of which 21 were possibly related to levofloxacin and no adverse events were probably related to levofloxacin. Conclusion: The effectiveness of levofloxacin use in children with serious infections is promising, especially for the treatment of multidrug-resistant bacteria. Adverse events occurring during the initiation of levofloxacin therapy in children are reported to be relatively common, but in this study, only a small percentage of them were possibly related to levofloxacin, and none of them were highly possibly related to levofloxacin.

Applicability of vancomycin, meropenem, and linezolid in capillary microsamples vs. dried blood spots: A pilot study for microsampling in critically ill children.

Introduction: Therapeutic drug monitoring (TDM) has been shown to be clinically beneficial for critically ill patients. However, this is a burden for neonates or children with small circulating blood volumes. Here, we aimed to develop and validate a microsampling TDM platform (including dried blood spots (DBS) and capillary microsamples (CMS)) for the simultaneous quantification of vancomycin, meropenem, and linezolid. Methods: Paired DBS and CMS samples were obtained from an intensive care unit (ICU) to evaluate its clinical application. Estimated plasma concentrations (EPC) were calculated from DBS concentrations. Agreement between methods was evaluated using Deming regression and Bland-Altman difference plots. Results: The microsampling methods validation showed excellent reliability and compatibility with the analysis of the sample matrix and hematocrit range of the studied population. The DBS and CMS accuracy and precision results were within accepted ranges and samples were stable at room temperature for at least 2 days and 8 h, respectively. Hematocrit had no impact on CMS, but sightly impacted DBS measurements. The CMS and DBS antibiotic concentrations correlated well (r > 0.98). The drug concentration ratio in DBS samples to that in CMS was 1.39 for vancomycin, 1.34 for meropenem, and 0.94 for linezolid. The EPC calculated from the DBS using individual hematocrit ranges presented comparable absolute values for vancomycin (slope: 1.06) and meropenem (slope: 1.04), with a mean of 98% and 99% of the measured CMS concentrations, respectively. Discussion: This study provides a microsampling TDM platform validated for clinical use for a rapid quantification of three antibiotics and is suitable for real-time TDM-guided personalization of antimicrobial treatment in critically ill children.

Pharmaceutical Care for Tacrolimus-associated Posterior Reversible Encephalopathy Syndrome in A Pediatric Patient with Nephrotic Syndrome / 医药导报

Objective To present a pharmaceutical care case of a pediatric patient with nephrotic syndrome developing tacrolimus-inducedposterior reversible encephalopathy syndrome(PRES)during tacrolimus treatment,and to accumulate experience for the treatment and pharmaceutical services of related diseases.Methods Clinical pharmacists conduct an analysis and evaluation of the correlation of drug-induced PRES caused by tacrolimus in a pediatric patient.Simultaneously,regarding the latest evidence-based information,they propose optimized drug therapy recommendations and provide personalized pharmaceutical services.Results After treatment with antispasmodics,blood pressure control,intracranial pressure reduction,and tapering of tacrolimus,the clinical symptoms of the child improved.Follow-up cranial MRI demonstrated partial absorption of abnormal signals in the brain,and the lesions were significantly smaller than before.Conclusion For tacrolimus-related PRES,clinical pharmacists can enhance the long-term safety and effectiveness of patient medication through aspects such as choosing antihypertensive drugs,adjusting treatment plans based on drug concentration monitoring,and implementing targeted pharmaceutical monitoring and educatio.

Predictive value of coronary plaque burden for recurrent myocardial infarction after PCI in elderly patients with AMI / 中华老年心脑血管病杂志

Objective To explore the predictive value of coronary plaque burden for recurrent myo-cardial infarction in elderly patients with acute myocardial infarction(AMI)after PCI.Methods A retrospective study was conducted on 212 AMI patients undergoing PCI in our hospital from January 2019 to December 2021.All of them were followed up for 1 year after surgery,and were divided into a recurrent myocardial infarction group(32 cases)and a control group(180 cases)based on whether they had recurrent myocardial infarction or not.The clinical characteristics were compared between the two groups.ROC curve was plotted to analyze the predictive value of coro-nary plaque burden for recurrent myocardial infarction in elderly AMI patients.Results There was no statistical difference in the nutritional risk index between the two groups(P＞0.05).The carotid intima media thickness(1.44±0.17 mm vs 1.33±0.17 mm,P=0.000),non-calcified plaque burden[(15.45±3.08)％vs(9.72±2.69)％,P=0.000],calcified plaque burden[(22.07± 5.13)％vs(18.48±4.36)％,P=0.000],and total plaque burden[(37.52±6.18)％vs(28.20± 5.08)％,P=0.000]were significantly higher,while the LVEF value was lower[(58.09±7.16)％vs(66.50±7.83)％,P=0.000]in the recurrent group than the control group.Non-calcified plaque burden,calcified plaque burden,total plaque burden,carotid intima media thickness and LVEF were all valuable in predicting recurrent myocardial infarction in these patients after PCI(P＜0.05).The predictive value of non-calcified plaque burden was the highest,with an area under the curve of 0.906(95％CI:0.848-0.965,P=0.000).Conclusion Coronary plaque burden is of cer-tain value in predicting recurrent myocardial infarction in elderly AMI patients after PCI,and can be used to identify high-risk population for recurrent myocardial infarction.

Radiomic signature based on bi-parametric MRI predicting International Society of Urological Pathology grading in prostate cancer / 实用放射学杂志

Objective To investigate the predictive value of preoperative bi-parametric MRI radiomics for the International Society of Urological Pathology(ISUP)grading of prostate cancer(PCa).Methods One hundred and sixty-five patients with PCa confirmed by pathology were analyzed retrospectively.According to the ISUP grading system,PCa patients were divided into five subgroups:G1 group(Gleason score=6),G2 group(Gleason score=3+4),G3 group(Gleason score=4+3),G4 group(Gleason score=8)and G5 group(Gleason score=9 or 10).A total of 3 948 radiomics features were extracted from T2WI,diffusion weighted imaging(DWI),and apparent diffusion coefficient(ADC)images of each patient.Patients were classified into two categories based on Gleason score≥4+3 or ≤3+4.A radiomics signature(Rad-score)was constructed after reduction of dimension by the minimum redundancy maximum relevance(mRMR)and the least absolute shrinkage and selection operator(LASSO).The Spearman rank correlation test was used to evaluate the correlation between Rad-score and ISUP grading groups.The Kruskal-Wallis test was used to compare the difference of Rad-score among the five groups.Results Eleven most valuable features were selected as the Rad-score after reducing the dimension by mRMR and LASSO algorithm.Moderate correlation existed between Rad-score and ISUP grading(r=0.53,P＜0.05).There were significant differences in Rad-score between G1 and G2 groups and G3,G4 and G5 groups(P＜0.05),no significant difference existed between the remained two groups(P＞0.05).The area under the curve(AUC)of receiver operating characteristic(ROC)curve for Rad-score were 0.827,0.762,0.563,0.657,0.698 for G1,G2,G3,G4 and G5 groups,respectively.Conclusion The radiomics based on bi-parametric MRI can be used to predict grade 1,2 PCa patients in the ISUP grading system.

Research progress of smart responsive nanocarriers for nucleic acid drug delivery / 中国药房

Nucleic acid drugs ha ve received increasing attention and are considered to be potential for the therapy of many diseases such as tumor therapy. This is due to their selective regulation of specific protein expression ，simple sequence design ，easy synthesis and modification ，and clear mechanism of action. However ，nucleic acid drugs have to be delivered by carriers to produce therapeutic effects ，because nucleotides must rely on effective carriers to overcome their limitations and various transmembrane barriers. Currently ，most non-viral nucleic acid delivery carriers have the disadvantage of poor transfection efficiency. The researchers design a series of smart responsive nanocarriers that respond to the pathological environments in vivo or physical stimulations in vitro . By responding to internal special changes such as pH values and redox conditions or to external stimuli such as temperature ，ultrasound，magnetic field and light ，the smart responsive nanocarriers can achieve precise regulation of drug release ，enhance the transfection efficiency of nucleotides in target cells and reduce the toxic side effects on normal tissues and cells. This review summarizes the progress of smart responsive nanocarriers in the field of nucleic acid drugs delivery and introduces the functional design and features of smart responsive nanocarriers. The intent is to provide a reference for the development of nucleic acid drugs and their delivery systems.

Establishment of quantitative analysis of multi -components by single marker and quality evaluation of Gushen dingchuan pills / 中国药房

OBJECTIVE To establish quantitative analysis of multi -components by single marker （QAMS） method to simultaneously detect the contents of cinnamic acid ，cinnamaldehyde，plantamajoside，verbascoside，isoacteoside，calceolarioside B ， psoralen，isopsoralen，neobavaisoflavone and bavachin in Gushen dingchuan pill ，and to perform quality evaluation of Gushen dingchuan pill by combining with chemical pattern recognition . METHODS High-performance liquid chromatography was adopted . Using psoralen as internal standard ，the relative correction factors of the other 9 components were established ，and the contents of each component were calculated and compared with those determined by external standard method . Cluster analysis ，principal component analysis and partial least squares discrimination analysis were performed by the results of QAMS method ，and the qualities of 15 batches of Gushen dingchuan pills were evaluated . RESULTS The above 10 components showed a good linear relationship in their respective ranges （r＞0.999 0）. RSDs of precision ，repeatability，stability and recovery tests were all lower than 2.00%. There was no significant difference between QAMS method and external standard method （P＞0.05）. The results of cluster analysis and principal component analysi showed that 15 batches of Gushen dingchuan pills could be clustered into 3 categories. The results of partial least squares discrimination analysis showed that psoralen ，verbascoside，cinnamaldehyde and isopsoralen were the main potential markers affecting the quality of Gushen dingchuan pills . CONCLUSIONS Established QAMS method for quantitative control of multi index components and chemical pattern recognition can be used for the quality evaluation of Gushen dingchuan pills .

Correlation between three-dimensional histogram analysis of dynamic contrast-enhanced MRI and Gleason score in prostate cancer / 中华老年医学杂志

Objective:To investigate the correlation between three-dimensional histogram analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Gleason score(GS)in prostate cancer(Pca)from two hospital, and its diagnostic efficacy for discriminating low-grade from high-grade Pca.Methods:A total of 102 pathologically confirmed Pca patients in the First Affiliated Hospital of Zhejiang Chinese Medical University and Hangzhou Traditional Chinese Medical Hospital(TCM Hospital)Affiliated to Zhejiang Chinese Medical University from January 2017 to October 2020 were retrospectively analyzed.The quantitative parameters of Pca, including transport constant(K trans), rate constant(K ep), percent volume of the extravascular extracellular space(V e)and fraction of the Intraplasmic contrast volume(V p), were obtained by manually layer by layer delineating of interested regions of all lesions on the original DCE-MRI imaging.Then the three-dimensional histogram analysis of the above parameters were performed to obtain the minimum, maximum, median, mean, area, 10 thpercentile, 25 thpercentile, 75 thpercentile and 90 thpercentile.The correlations between quantitative parameters and GS, and diagnostic efficiencies were analyzed. Results:102 Pca patients were divided into low-grade prostate cancer group(GS≤3+ 4)(n=44)and high-grade Pca group(GS≥4+ 3)(n=58). There were no statistically significant differences in age and location of lesions between the two groups( P>0.05), but there were statistically significant differences in Gleason score, PSA level and lesion diameter between the two groups( U=0.000, 730.000, 711.000, all P<0.05). The median, mean, 10 thpercentile, 25 thpercentile, 75 thpercentile, 90 thpercentile derived from K trans, and K ep(median, mean, 10%, 25%, 75%, 90%)together with maximum of K transand mean for V e were positively correlated with GS( r=0.405 to 0.583, P<0.05), in which mean of K transhad the highest positive correlation( r=0.583, P=0.000). The histogram parameters derived from V pwere negatively correlated with GS( r=-0.301 to 0.341, P<0.05). The area under ROC of 75th percentile derived from K transwas the highest(0.832). When the cut-off value of 75 thpercentile derived from K transwas ≥0.680/min, its Youden index, sensitivity, and specificity were 0.594, 0.776, 0.818, respectively. Conclusions:The three-dimensional histogram of DCE-MRI quantitative parameters has correlation with GS in Pca patients, can be used to discriminate low-grade from high-grade Pca.

Anti-hepatocellular Carcinoma Activity and Related Mechanism of Apigenin-7-O-Glucoside / 肿瘤防治研究

Objective To investigate the inhibitory effect of apigenin-7-o-glucoside (AGL) on the viability of Huh7 cells and tumor growth in Huh7-xenograft tumor nude mice. Methods CCK-8 was used to detect the proliferation inhibitory effect and the half inhibitory concentration of AGL on Huh7 cells. The mitochondrial membrane potential measurement was used to analyze the early apoptosis of Huh7 cells after AGL treatment. Flow cytometry was used to analyze the effect of AGL on Huh7 cell apoptosis, and Western blot was used to explore the expression level of the proteins associated with apoptosis and inflammation, as well as the possible related mechanism. In Huh7-xenograft tumor nude mice, vernier caliper was used to measure tumor volume to analyze the effect of AGL on tumor growth rate. HE staining was used to observe the pathological state of mouse organs, and the inflammation-related factors in serum were detected with ELISA. Results After Huh7 cells were treated with AGL, the mitochondrial membrane potential reduced, the content of ROS increased and the apoptosis rate was increased to 25.23% by 50 μmol/L AGL treatment; while the expression levels of Bax, Bad, Cleaved Caspase-3 and Cleaved Caspase-9 increased, and the expression levels of Bcl2 and Bcl-xL decreased, the phosphorylation level of NF-κB, IKKα/β and IκBα decreased; the tumor growth rate decreased, the serum IL-6 and TNF-α levels significantly decreased, while the IL-2 and IL-10 levels increased. Conclusion AGL could promote the apoptosis of Huh7 cells and relieve the tumor development in Huh7-xenograft tumor nude mice, which may be related to the NF-κB pathway.

Prognostic factors of salvage radiotherapy after radical prostatectomy / 中华泌尿外科杂志

Objective:To investigate the prognosis after salvage radiotherapy with or without hormone therapy for prostate cancer.Methods:From May 2014 to December 2020, 248 patients undergoing salvage radiotherapy due to prostate-specific antigen (PSA)persistence or biochemical progression after radical prostatectomy at Sun Yat-sen University Cancer Center (n=157) and West China Hospital, Sichuan University (n=91) were analyzed. Median age was 66 (45-78) years old. Median PSA was 23.50 (0.18-845.00) ng/ml. The number of PSA persistence and biochemical progression were 143 (59%) and 105 (42%). The number of pT 2, pT 3a, pT 3b, pT 4, and unknown T stage was 99, 49, 78, 15 and 7 cases.The number of N 0, N 1 and unknown N stage was 153, 44 and 51 cases. 165 cases had positive surgical margin. Gleason score of 6, 7, 8, >8 score and unknown was in 12, 104, 34, 90 and 8 patients. Early and late salvage radiotherapy was performed in 117 and 131 patients, and 70 patients (28%) were CRPC. Hormone therapy was used combined with radiotherapy in 182 patients (73%). PSA decline after radiotherapy was compared with Chi-squre test. Kaplan-Meier method and log-rank test were used to compare progression free-survival (PFS)after radiotherapy. Univariate and multivariate analyses of PFS were performed using Cox proportional hazards model. Early salvage radiotherapy was defined as PSA≤0.5 ng/ml before radiotherapy, and late salvage radiotherapy was defined as PSA>0.5ng/ml. Results:PSA response (PSA decline ≥50%) rate was 94% (233/248), and 82% (203/248) patients had PSA decline ≥ 90%. Twelve (5%) patients had rising PSA after completing radiotherapy, but only 4 (2%) had real progression. The median PFS was 69 months (95% CI 68-70), and 3-year and 5-year PFS rate were 80% and 67%. PFS of PSA persistence and biochemical progression were similar ( HR =0.71, 95% CI 0.37-1.37, P=0.311). Compared with late salvage radiotherapy, early salvage radiotherapy had better PFS [69 (95% CI 68-70) vs. 59 (95% CI 44-74) months, P<0.001]. Compared with hormone sensitive, castration-resistant was associated with worse PFS (5-year PFS rate 74% vs. 51%, P<0.001). In multivariate analysis, Gleason score>8, castration-resistant and late salvage radiotherapy were unfavorable prognostic factors. Conclusions:In patients receiving salvage radiotherapy with or without hormone therapy for PSA persistence and biochemical progression after radical prostatectomy, high PSA level before radiotherapy and castration resistant is associated with poor prognosis.

Pharmaceutical Care for a Patient with Severe Pemphigus by Clinical Pharmacist / 中国药房

OBJECTIVE：To investiga te the role of clinical pharmacists in drug therapy for patients with severe pemphigus. METHODS：Clinical pharmacists participated in drug therapy for a patient with severe pemphigus. Clinical pharmacist adjusted the doctor’s medication plan in time according to the symptoms and adverse reactions of the patients. In view of several new blisters on the hand palms and back that may be caused by hormone reduction ，the clinical pharmacist suggested that the dosage of Prednisone acetate tablets should be adjusted to 70 mg before administration ，once a day. For poor infection control ，it was recommended to adjust the dose of minocycline to 100 mg，bid；for hypokalemia ，the clinical pharmacist advised the patients to take potassium orally，and added it into juice ，milk or honey for taking ；in order to prevent osteoporosis caused by glucocorticoid ，the clinical pharmacist suggested that patients supplement Calcium carbonate and vitamin D 3 chewable tablets and Alendronate sodium and vitamin D 3 tablets 70 mg at the same time ，once a week. For Candida albicans in patient ’s oral mucosa ，according to the results of drug sensitivity test ，the clinical pharmacists suggested that Itraconazole capsules should be adjusted to Fluconazole capsules 50 mg，once a day. At the same time ，pharmacist paid close attention to the adverse reactions after the infusion of Rituximab injection and pharmaceutical care was provided ，such as ADR monitoring ，discharge medication education. RESULTS ：The doctors took all the advice of clinical pharmacists. The patient recovered and was discharged 47 days later. CONCLUSIONS ：During drug therapy for the patient with severe pemphigus. Clinical pharmacists can help doctors improve the treatment plan so as to ensure the effectiveness and safety of patients ’medication.

Correlation Study of “Dose-effect-toxicity”of Miao Medicine Wikstroemia indica on Anti-immune Inflammation of Mice before and after Processed by “Sweat Soaking Method ” / 中国药房

OBJECTIVE：To investigate the “dose-effect-toxicity”correlation of Miao medicine Wikstroemia indica before and after processed on anti-immnue inflammation of mice . METHODS ：Mice were divided into blank group ，model group ，ethanol extract of W. indica raw product groups 1-6，ethanol extract of W. indica processed product by “sweat soaking method ”groups 1-6 （hereinafter called “raw groups 1-6”“processed groups 1-6”for short ，drug dosage were 0.13，0.20，0.26，0.52，1.04，2.6 g/kg）， positive group （cyclophosphamide，36.4 mg/kg），with 10 mice in each group. Except for blank group ，other groups were given 1％ 2，4-dinitrofluorobenzene-acetone-sesame oil mixed solution to induce delayed type hypersensitivity model. After modeling， blank group and model group were given constant volume of 1.0％ CMC-Na solution intragastrically ，and administration groups were given relevant medicine 20 mL/kg intrag astrically，oncea day ，for consecutive 5 d. A fter last medication ，ear swelling degree of mice were recorded ；the inhibition rate of swelling degree， half effective dose （ED50） and 95％ confidence 158-02-32）； interval（CI）of raw and processed products were calculated ； the weight of heart ，liver，spleen，lung and kidney were measured and the indexes of organs were calculated ；ELISA 1161472062@qq.com and modified chemical oxidation method were used to determine the serum levels of inflammatory factors （TNF-α， IL-10） and liver and renal function indexes （ALT，AST， TBIL，BUN，CREA）. RESULTS：Compared with blank group ，the degree of ear swelling in the model group was significantly increased（P＜0.05）. Compared with model group ，ear swelling degree of mice were decreased significantly in different doses groups of ethanol extract of raw and processed products of W. indica （P＜0.05）. The inhibition rate of swelling increased with the increase of dose ，ED50 and 95％CI of delayed hypersensitivity ear swelling were 0.239 6（0.129 0，0.445 2）g/kg and 0.147 3（0.076 8，0.282 7）g/kg，respectively. Compared with blank group ，liver index and serum TNF-α level of mice were increased significantly in model group ，while lung index and serum IL- 10 level were decreased significantly （P＜0.05）. Compared with model group ，the levels of liver indexes （positive group ，raw group 3，processed groups 1-6）and serum TNF-α levels（positive group ，raw groups 1-3，processed groups 1-4） were decreased significantly in different administration groups ；while the levels of lung indexes （positive group ，raw groups 3-6 and processed groups 3-6），serum IL- 10 levels（raw groups 1，2，4 and 5，processed groups 2-6），ALT，AST，BUN and CREA levels （raw groups 4-6），TBIL levels （raw groups 3-6 ）were increased significantly （P＜ 0.05）. CONCLUSIONS ：The ethanol extract of raw product of W. indica has certain anti-inflammatory activity ，and has certain hepatorenal toxicity to mice ，with certain “dose-effect-toxity”correlation. The ethanol ectract of processed product of W. indica has certain anti-inflammatory activity too ，but its hepatorenal toxicity was lower than raw product. The “sweat soaking method ” possesses the function of “retaining efficiency and reducing toxicity ”for processing W. indica .

Investigation of pharmacist-managed clinic in Guangdong and concept of quality management / 中华医院管理杂志

Objective To investigate the implementation of pharmacist-managed clinic(PMC) in Guangdong, and to provide reference for quality management of pharmacist-managed clinics. Methods Collection of a list of all medical institutions that have established pharmaceutical clinics in Guangdong province before July 2018. The development of PMCs at these institutions found in the list was investigated by conducting a questionnaire survey via WeChat and telephone interviews. Results 41 questionnaires were completed, of which 40 were valid, accounting for 97.6% . A total of 40 institutions established PMCs, in which 39 were tertiary hospitals(22.5% of the total number of tertiary hospitals in the province), and 1 was level-1 hospital ( 0.26% of the total number of first-class hospitals in the province). The main PMC categories are chronic disease management clinics, followed by anticoagulant/thrombolytic clinics, pregnant and lactating PMC, COPD management clinics, and drug counseling comprehensive clinics. 81.7% of the visiting pharmacists were of head pharmacist qualifications. The average daily outpatient volume of the 25 hospitals were 3-5 patients. The service time was about 10 -60 minutes per patient in most cases. Their common causes for consultation were adverse drug reactions, drug interactions or incompatibility, drug usage and dosage, drug adjustment and drug selection. Only 9 institutions established a management system, working process and standardized medical records for medication therapy management. Conclusions PMC is an important part of medical services. To ensure its service quality, we should learn from the concept of three-level management of medical quality, and perfect the construction of quality management system of pharmaceutical outpatient clinics.

Pharmaceutical Care for a Case of Refractory Mycoplasma Pneumoniae Pneumonia Combined with Cerebral Infarction in Child by Clinical Pharmacist / 中国药房

OBJECTIVE： To introduce the pharmaceutical care for refractory mycoplasma pneumoniae （MP） pneumonia combined with cerebral infarction in child by clinical pharmacist， and to improve further understanding of MP-induced cerebral infarction and the management level of the clinical pharmacist. METHODS： Clinical pharmacist provided whole course pharmaceutical care for a child case of refractory PM pneumonia complicated with cerebral infarction admitted to the Children’s Hospital of Fudan University in Oct. 2018. The drug use in anti-infection， anti-inflammatory， treatment of cerebral infarction， possible drug interactions and suspected ADR were analyzed during treatment. RESULTS： The child admitted to the hospital for treatment due to MP pneumonia. During the treatment， the child suffered from cerebral infarction symptoms. The child was given a series of treatment programs， such as Azithromycin for injection for anti-infection， Methylprednisolone sodium succinate for injection for anti-inflammation， Nadroparin calcium injection for anticoagulation， Mannitol injection for reducing intracranial pressure， Dextran 40 glucose injection anti-thrombosis， Compound glycyrrhizin injection for protecting liver function， Hydrotalcite tablets for protecting gastric mucosa， intravenous immunoglobulin symptomatic supportive treatment. During the treatment， due to the poor therapeutic effect of Azithromycin for injection， it was considered that the patient may have cerebral infarction caused by refractory MP infection， so the patient’s prognosis was good when Azithromycin injection was replaced with Levofloxacin hydrochloride injection for anti-infection. For the increase of liver enzyme during the treatment， clinical pharmacist suggested that anti-infection combined with liver protection was provided   for the child and then the liver enzyme returned to normal. During the treatment， clinical pharmacist mainly monitored the interaction and possible adverse reactions among anticoagulants， glucocorticoids， liver protecting drugs， drugs for reducing cranial pressure， antipyretic and analgesic drugs， and at the same time， made medication publicity and education for the family members of the child， and inform them of the adverse reactions of drugs to be paid attention to and the precautions for taking stomach protecting drugs， glucocorticoids and other drugs. CONCLUSIONS： Cerebral infarction caused by refractory MP pneumonia in children is because of excessive immune response directly or indirectly mediated by MP. The principle of treatment is to inhibit the inflammatory response， to solve the primary disease， and symptomatic supportive treatment. Multi-drug combination is needed in the course of treatment， so it is more necessary for the clinical pharmacist to participate in the whole process and to manage the drug refinement and ensure the safety of drug use.

Application of superselective lingual artery embolization in treatment of severe hemorrhange in patients with carcinoma of tongue / 中华口腔医学杂志

To explore the clinical value of superselective lingual artery embolization in treating the severe hemorrhage in patients with advanced carcinoma of tongue. Four patients with advanced tongue cancer hemorrhage from March 2014 to February 2016 were enrolled in this study. T3N2M0 (2 cases) and T4N1M0 (2 cases) were diagnosed preoperatively. Two cases of advanced tongue carcinoma tumors had severe bleeding and the other 2 cases of hemorrhage were after radiotherapy. All cases including 3 squamous cell carcinoma and 1 adenocarcinoma were firstly demonstrated by arterigraphy under seldinger technique with digtial subtraction angiogarphy to ensure the rupture site and then all cases were followed by superselective artery embolization. The efficacy and complications of interventional embolizationg were observed. There was no serious complication of central nervous system injury such as hemorrhage and hemiplegia during follow-up. Superselective lingual artery embolization can accurately locate the responsibility of blood vessels, and the injury is small, significant effect, fewer complications.

Correlation between blood pressure variability and early neurological deterioration in patients with acute anterior circulation large artery atherosclerotic stroke / 国际脑血管病杂志

Objective To investigate the correlation between blood pressure variability (BPV) and early neurological deterioration (END) in patients with acute anterior circulation large artery atherosclerotic (LAA)stroke. Methods From January 2015 to June 2018, consecutive patients with anterior circulation acute ischemic stroke admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were enrolled prospectively. According to the etiological classification, they were divided into LAA group and non-LAA group. By monitoring the blood pressure within 72 h of hospitalization, the mean, maximum (max)and minimum (min) values, and the difference between max and min (max-min), standard deviation (SD),and coefficient of variation (CV; CV = SD × 100/mean) were calculated. END was defined as the highest score of the National Institutes of Health Stroke Scale (NIHSS) within 72 h of admission increased by ≥2than the baseline. Multivariate logistic regression analysis was used to determine the correlation between BPV parameters and END. Results A total of 271 patients with anterior circulation acute ischemic stroke were enrolled, including 101 females (37. 3％) and 170 males (62. 7％), with an average age of 64. 99 ± 11. 51 years. There were 95 patients (35. 1％) with LAA and 176 (64. 9％) with non-LAA. In the LAA group and non-LAA group, 36 patients (37.9％) and 50 patients (28.4％) developed END respectively. The comparison between END patients and non-END patients in the LAA group showed that there were significant differences in age, sex, diabetes mellitus, baseline NIHSS score and C-reactive protein, as well as SBPmax , SBPmax-min , SBPSD , SBPCV, DBPmax , DBPmax-min , DBPSD , and DBPCV in BPV indices (all P < 0. 05).Multivariate logistic regression analysis showed that many BPV indices were the independent risk factors for END, including SBPmax (odds ratio [OR] 1. 027, 95％ confidence interval [CI] 1. 003-1. 052; P = 0. 027),SBPmax-min (OR 1. 041, 95％CI 1. 015-1. 068; P = 0. 002), SBPSD (OR 1. 177, 95％ CI 1. 048-1. 322; P =0. 006), SBPCV (OR 1. 226, 95％ CI 1. 036-1.451; P = 0. 018), DBPmax (OR 1. 073, 95％ CI 1. 017-1. 133;P = 0. 010), DBPmax-min (OR 1. 107, 95％CI 1. 044-1. 174; P = 0. 001), DBPSD (OR 1. 693, 95％CI 1. 268- 2. 260; P < 0. 001), and DBPCV(OR 1. 726, 95％CI 1. 311-2. 271; P < 0. 001). In the non-LAA group, there were no significant association between all BPV parameters and the occurrence of END. Conclusion BPV was significantly correlated with END in patients with anterior circulation LAA.

In vitro accelerated release of triptorelin acetate microspheres and the in vivo/in vitro correlation / 国际药学研究杂志

Objective To establish an in vitro accelerated release method of triptorelin acetate microspheres with good in vi-tro/in vivo correlation(IVIVC). Methods The in vivo release of triptorelin acetate from microspheres was obtained by residual method in rats. Influences of pH value,concentration of ethanol,temperature,rotation speed and concentration of antiseptic on the in vitro accel-erated release were studied,then the correlation between in vitro accelerated release and in vivo release of the microspheres was estab-lished by adjusting the release conditions. Results The in vitro accelerated release medium of triptorelin acetate microspheres composed of 15%ethanol solution(containing 0.06%Tween 80 and 0.1%benzalkonium chloride)at 55℃with rotating rate of 200 r/min. The cumulative release of triptorelin acetate from microspheres was 87.35%at 30 h under accelerated release condition,equivalent to in vivo release for 30 days. The established in vitro accelerated release had a good correlation with that of in vivo(y=0.8845x+12.4510, R2=0.9938). Conclusion The in vitro accelerated release of triptorelin acetate microspheres could correlate well with in vivo release and has a potential application in rapid and effective evaluation of triptorelin acetate microspheres.

Determination of related substances for metolazone and valsartan in compound metolazone tablets by HPLC / 国际药学研究杂志

Objective To establish an HPLC method to determine the related substances of metolazone and valsartan in com?pound metolazone tablets. Methods An Agilent Eclipse SB-C18 column (4.6 mm × 250 mm,5 μm) was used with 0.01 mol/L KH2PO4 buffer(pH=3.5)-acetonitrile as the mobile phase with gradient elution at a flow rate of 1.0 ml/min. The column temperature was 30℃ and the detection wavelength was 237 nm. Injection volume was 20 μl. Results Metolazone,valsartan and related sub?stance B of valsartan were separated completely. The calibration curves were linear within the range of 3-30μg/ml for metolazone, 0.1-2.0μg/ml for valsartan and 0.08-2.0μg/ml for related substane B of valsartan. The average recoveries were 102.97%,100.81%and 100.44%,respectively. The repeatability and intermediate precision met with requirements. The test solution was stable within 24 h. Conclusion The method is specific,sensitive,accurate and reliable,thereby can be used for the determination of metolazone and valsartan related substances in compound metolazone tablets.