OBJECTIVE To evaluate the effect of manipulation of Imipenem and cisplatin sodium (ICS) for injection on the consistency of its main drug imipenem (IPN) content,and the stability of different concentrations of ICS solution,to provide a reference for the safe and effective use of ICS in children.METHODS Three operators prepared ICS solutions according to the two commonly used dosage methods for children (10 mL or 20 mL 0.9％ Sodium chloride injection to prepare the initial ICS solution and draw the required dose from the initial suspension).The content of IPN was determined by ultra-high performance liquid chromatography-tandem mass spectrometry after parallel processing.The content consistency of solutions in each group was determined according to the coefficient of variation (CV)<15％ of the IPN content.ICS test solution X1 was prepared according to the instructions,and then test solutions X2 and X3 were prepared by diluting X1 with 0.9％ Sodium chloride injection in the volume ratios of 1:1 and 1:2,which were stored at room temperature[(23.0±0.5) ℃],in a thermostatic water bath at 30 ℃,and in a refrigerator at 2-8 ℃.The stability of the drug solution was determined by the ratio of the IPN mass concentration measured at the specified temperature and time to the initial (0 h) mass concentration (if the ratio was≥90％,it was considered that the drug solution was stable).RESULTS CV of IPN content was<15％ in each group of solutions prepared with two manipulation methods by each operator,indicating a small deviation in IPN content.The solutions at the three concentration levels were stable at room temperature for 6 h or refrigerated for 18 h.The test solutions X1 and X2 were also stable when placed at 30 ℃ for 6 h,but the IPN concentration in test solution X3 decreased by about 20％ compared with that of 0 h.CONCLUSIONS The consistency of the content of IPN is good in the two commonly used methods for ICS manipulation in children.The stability of ICS solution is affected by concentration,temperature and time.Lower concentrations at higher temperatures resulted in decreased stability of IPN.Clinical attention should be paid to controlling the amount of solvent as well as temperature and time during preparation and use.
OBJECTIVE To know about the perception and current status of drug risk management among pharmacists in Chinese medical institutions,providing insights and recommendations for enhancing the drug risk management system in medical institutions.METHODS A questionnaire survey was conducted across 28 provinces,cities,and autonomous regions;stratified radom sampling was employed to study the population of medical workers and pharmaceutical professionals in medical institutions nationwide.The survey included information on the survey population,the current status of drug risk management implementation in medical institutions,the cognition,definition and process of drug risk management related concepts,and the content and mode of drug risk management work in medical institutions.Finally,suggestions were collected from various medical institutions on the system construction of drug risk management.Descriptive statistical analysis was adopted to summarize the obtained data.RESULTS A total of 446 questionnaires were collected in this survey,including 420 valid questionnaires and 26 invalidquestionnaires.The questionnaire collection rate was 100％,and the effective rate was 94.17％.51.19％ of the respondents based their understanding of drug risk management on Management Measures for Adverse Drug Reaction Reports and Monitoring,while 87.38％ recognized the need for drug risk management throughout the drug use process.63.33％ of the participants stated that their medical institutions had dedicatedpositions related to drug risk management,with the highest proportion (72.17％) was in third-grade class A medical institutions.66.43％ reported implementing risk management across all drug use stages.Suggestions for the development of drug risk management systems in medical institutions by the research participants focused on enhancing guiding documents,clarifying concepts,establishing information-sharing mechanisms.CONCLUSIONS The overall awareness of drug risk management in China's medical institutions is high,with practices in place across various stages in multiple forms.However,there remains a need to strengthen institutional documents,management regulations,system development,and information-sharing mechanisms to improve collaborative governance,improve drug management levels,and ensure patient safety.
OBJECTIVE To explore the practice and application effect of lean Six Sigma (LSS) management in the cost-benefit management of PIVAS operation in a tertiary comprehensive hospital (hereinafter referred to as "S Hospital"),providing reference for the operation and management of PIVAS in hospitals.METHODS The five steps (define,measure,analyze,improve and control,i.e.DMAIC) of LSS management were implemented for PIVAS operation cost-benefit of S Hospital,and lean management was implemented for its cost-benefit management elements (human resource cost,medical and health material cost,and all-in-one parenteral nutrition preparation income).Several intervention measures including personnel training and performance assessment,refined management system of consumables,and doctor's advice package of full parenteral nutrition were developed.Finally,the overall improvement effect was evaluated by the total benefit,total cost and net benefit of PIVAS.The effects of human resource allocation optimization and improvement were evaluated by the work efficiency,work quality,job satisfaction,turnover rate and accumulated rest days.The effects of consumables cost management were evaluated by the amount of medical and health materials cost.The improvement effects of all-in-one parenteral nutrition preparation income were evaluated by the profit amount,quantity and the proportion of single bottle of parenteral nutrition.RESULTS After implementing DMAIC in S Hospital,the total benefit of PIVAS was increased from (471366.50±9201.5) yuan/month to (479679.50±14320.14) yuan/month (P>0.05),the total cost was decreased from (305878.88±3201.75) yuan/month to (294610.59±5007.33) yuan/month (P<0.05),and the net benefit of PIVAS was increased by 11.83％ compared with that before the improvement.The work efficiency,work quality and job satisfaction of employees were significantly improved,the accumulated rest days were significantly reduced,and the turnover rate of third-party employees was reduced from 15.0％ before the improvement to 7.5％ after the improvement.The cost of medical and health materials significantly decreased from (67826.42±2812.76) yuan/month before improvement to (56384.33±4607.67) yuan/month after improvement (P<0.05).The quantity of all-in-one parenteral nutrition was significantly increased from (1263.75±135.83)group/month before improvement to (2061.25±89.04) group/month after improvement (P<0.05),and the proportion of users of single bottle of parenteral nutrition in total users decreased from 93.25％ before improvement to 58.75％ after improvement.The profit of all-in-one parenteral nutrition was 63.18％ higher than that before implementing DMAIC.CONCLUSIONS The implementation of PIVAS operation cost-benefit management based on DMAIC is conducive to strengthening the cost control of PIVAS and promoting the healthy development of PIVAS.
OBJECTIVE To systematically evaluate the relationship of semaglutide with malignant neoplasms in type 2 diabetes mellitus (T2DM) patients.METHODS Retrieved from the Cochrane Library,PubMed,Embase,ClinicalTrials.gov,CNKI,Wanfang data and CBM,randomized controlled trials (RCTs) about semaglutide in the treatment of T2DM patients with outcome measures including malignant tumor events were collected from the establishment of the database to June 2024.Meta-analysis was performed by using RevMan 5.3 software to assess the risk of malignant neoplasms.RESULTS A total of 24 RCTs (26 trials) involving 24145 patients were included.Results of meta-analysis showed that compared to placebo,there was no statistical significance in the risk of semaglutide in pancreatic cancer[RR=0.39,95％CI(0.10,1.50),P=0.17],thyroid cancer[RR=1.29,95％CI(0.38,4.36),P=0.68],prostate cancer[RR=1.05,95％CI(0.36,3.12),P=0.92],skin cancer[RR=1.27,95％CI(0.80,2.02),P=0.31],gastrointestinal cancer[RR=1.00,95％CI(0.47,2.14),P=1.00],colorectal cancer[RR=0.96,95％CI(0.40,2.26),P=0.92],lung cancer[RR=1.62,95％CI(0.74,3.55),P=0.23],breast cancer[RR=1.25,95％CI(0.45,3.51),P=0.67]or all malignant neoplasms[RR=0.96,95％CI(0.76,1.21),P=0.73].Compared to other antidiabetic drugs,there was no statistical significance in the risk of semaglutide in pancreatic cancer[RR=0.62,95％CI(0.18,2.09),P=0.44],thyroid cancer[RR=1.09,95％CI(0.25,4.78),P=0.90],prostate cancer[RR=2.09,95％CI(0.46,9.47),P=0.34],skin cancer[RR=1.76,95％CI(0.65,4.72),P=0.26],gastrointestinal cancer[RR=0.68,95％CI(0.19,2.35),P=0.54],colorectal cancer[RR=0.60,95％CI(0.20,1.78),P=0.36],lung cancer[RR=1.00,95％CI(0.24,4.11),P=1.00],breast cancer[RR=0.82,95％CI(0.25,2.66),P=0.74]or all malignant neoplasms[RR=1.36,95％CI(0.96,1.94),P=0.09].CONCLUSIONS Semaglutide does not increase the risk of any type of malignant neoplasms in T2DM patients.
OBJECTIVE To explore the clinical features,diagnosis,treatment and management measures of multiple immune-related adverse event (irAE) after toripalimab treatment,in order to provide reference for the clinical management of similar cases.METHODS A retrospective analysis was conducted on a post-operative bladder cancer patient who developed various irAEs after toripalimab treatment.The patient's medical history,laboratory tests,imaging studies,treatment course and outcomes were detailed.The Naranjo scale was used to assess the relationship between the irAEs and toripalimab.RESULTS The patient developed irAEs after receiving toripalimab,such as immune-related myocarditis,liver dysfunction,and myasthenia.According to the Naranjo scale evaluation,it was assessed that these adverse events were related to the administration of toripalimab.After high-dose corticosteroid pulse therapy and immunoglobulin immunomodulation,the patient's symptoms were effectively relieved,with a improved trend in various physiological indicators and significant improvement in the degree of system/organ damage.CONCLUSIONS Toripalimab may lead to multiple irAEs,including immune-related myocarditis,liver injury,and myasthenia.Early recognition,timely diagnosis,and appropriate treatment of irAE are crucial for improving patient's prognosis.
Tacrolimus is a crucial therapeutic drug for preventing immune rejection after solid organ transplantation in children.Due to the narrow treatment window and significant individual variability,personalized treatment is often required.In recent years,with the promotion of therapeutic drug monitoring technology,individualized treatment models based on tacrolimus drug concentration have developed rapidly.This article reviews the research progress of individualized dosing models for tacrolimus in children both domestically and internationally over the past decade.It includes dose simulation methods based on population pharmacokinetics,physiologically based pharmacokinetics,machine learning,and multiple linear regression.The characteristics of each model and its application in pediatric individualized dosing are analyzed and summarized.Additionally,the current development status of decision support systems for individualized tacrolimus dosing is introduced.
OBJECTIVE To optimize the simmering technology of Rheum palmatum from Menghe Medical School and compare the difference of chemical components before and after processing.METHODS Using appearance score,the contents of gallic acid,5-hydroxymethylfurfural (5-HMF),sennoside A+sennoside B,combined anthraquinone and free anthraquinone as indexes,analytic hierarchy process (AHP)-entropy weight method was used to calculate the comprehensive score of evaluation indicators;the orthogonal experiment was designed to optimize the processing technology of simmering R.palmatum with fire temperature,simmering time,paper layer number and paper wrapping time as factors;validation test was conducted.The changes in the contents of five anthraquinones (aloe-emodin,rhein,emodin,chrysophanol,physcion),five anthraquinone glycosides (barbaloin,rheinoside,rhubarb glycoside,emodin glycoside,and emodin methyl ether glycoside),two sennosides (sennoside A,sennoside B),gallic acid and 5-HMF were compared between simmered R.palmatum prepared by optimized technology and R.palmatum.RESULTS The optimal processing conditions of R.palmatum was as follows:each 80 g R.palmatum was wrapped with a layer of wet paper for 0.5 h,simmered on high heat for 20 min and then simmered at 140 ℃,the total simmering time was 2.5 h.The average comprehensive score of 3 validation tests was 94.10 (RSD<1.0％).After simmering,the contents of five anthraquinones and two sennosides were decreased significantly,while those of 5 free anthraquinones and gallic acid were increased to different extents;a new component 5-HMF was formed.CONCLUSIONS This study successfully optimizes the simmering technology of R.palmatum.There is a significant difference in the chemical components before and after processing,which can explain that simmering technology slows down the relase of R.palmatum and beneficiate it.
OBJECTIVE To explore the effects of leonurine on growth arrest-specific protein-6 (GAS6)/Axl signaling pathway,and clarify its mechanism of alleviating myocardial injury in rats with coronary heart disease.METHODS The rat model of coronary heart disease was constructed;successfully modeled rats were randomly separated into model group,leonurine low-dose and high-dose groups (intragastric administration of leonurine 25,100 mg/kg+intraperitoneal injection of normal saline 75 mg/kg),and leonurine high-dose+GAS6/Axl signaling pathway inhibitor group (intragastric administration of leonurine 100 mg/kg+intraperitoneal injection of R42875 mg/kg),with 12 rats in each group.Additional 12 normal rats were selected as control group.Each administration group was given relevant medicine;control group and model group were given a constant volume of normal saline intragastrically and intraperitoneally,once a day,for 48 consecutive days.After administration,the heart function of rats,and serum levels of inflammatory factors and myocardial injury markers were detected;the pathological morphology of myocardial tissue was observed;the myocardial cell apoptosis rate,the expressions of apoptosis and GAS6/Axl signaling pathway-related proteins were determined.RESULTS Compared with control group,model group showed disorders in the arrangement of myocardial cells and myocardial fibers,hypertrophy of myocardial cells,and nuclear condensation;left ventricular ejection fraction,left ventricular fractional shortening,ratio of early-diastolic and late-diastolic motion velocity of the mitral ring,the protein expression of GAS6,B-cell lymphoma 2/B-cell lymphoma 2 associated X protein and phosphorylated Axl/Axl ratios were decreased significantly (P<0.05).The levels of tumor necrosis factor-α,interleukin-1β,interleukin-6,creatine kinase isoenzyme,troponin Ⅰ and myoglobin,the cell apoptosis rate,and cleaved caspase-3/caspase-3 ratio were increased significantly (P<0.05).Leonurine could obviously improve the above pathological conditions and detection indicators (P<0.05),and the effect of leonurine high-dose group was more significant than that of leonurine low-dose group (P<0.05);R428 treatment could reverse the ameliorating effect of high-dose of leonurine on myocardial injury in rats with coronary heart disease (P<0.05).CONCLUSIONS Leonurine can alleviate myocardial injury in rats with coronary heart disease,and its mechanism of action is related to the activation of the GAS6/Axl signaling pathway.
OBJECTIVE To compare the long-term cost-effectiveness of gonadotrophin-releasing hormone analogue (GnRHa) combined with recombinant human growth hormone (rhGH) (combination therapy regimen) versus GnRHa monotherapy (monotherapy regimen) in the treatment of central precocious puberty (CPP).METHODS From the societal perspective and based on a real-world study conducted at West China Second Hospital of Sichuan University,the cost-effectiveness analysis was performed to compare the long-term cost-effectiveness of two pharmacotherapy regimens for CPP girls,with final height as outcome indexes,using per capita disposable income of rural residents and urban residents (20133-49283 yuan) in 2022 as the social willing-to-pay (WTP) threshold.The robustness of the basic analysis result was verified by using one-way sensitivity analysis and probability sensitivity analysis,and the cost-effectiveness of different combinations of long-acting preparations was compared using scenario analysis.RESULTS The basic analysis result showed that the combination therapy regimen required an additional cost of 25193.49 yuan for every one-centimeter improvement in the final height of girls with CPP compared with the monotherapy regimen,which was not cost-effective for residents in rural areas,but it was cost-effective for residents in urban areas.One-way sensitivity analysis showed that the uncertain factors with potential impacts on the results were,in order,the price of rhGH,the final height of pediatric patients in the combination therapy regimen group,the course of rhGH in the combination therapy regimen group,and the final height of pediatric patients in the monotherapy regimen group.Probabilistic sensitivity analysis indicated that the probability of the combination therapy regimen being cost-effective was higher than that of the monotherapy regimen when WTP was more than 26010 yuan/cm.When GnRHa long-acting preparation was used for intramuscular injection every 3 months,the combination therapy regimen was not cost-effective for rural residents,but was cost-effective for urban residents;when rhGH long-acting preparation was injected subcutaneously once a week,the combination therapy regimen was not cost-effective for residents in both rural areas and urban areas.CONCLUSIONS The combination of GnRHa and rhGH is only recommended for CPP children with better affordability to improve final height.The benefits,risks,and affordability of treatment should be comprehensively considered before the decisions on pharmacotherapy,to avoid abuse of rhGH due to the blind pursuit of height growth.
OBJECTIVE To explore the effect and potential mechanism of the compatibility of Astragali Radix-Puerariae Lobatae Radix on ferroptosis of liver cells in type 2 diabetes mellitus (T2DM) insulin resistance (IR) rats.METHODS Sixty male SD rats were randomly divided into control group (12 rats) and modeling group (48 rats).The modeling group was fed with a high-fat diet for 4 consecutive weeks and then given a one-time tail vein injection of 1％ streptozotocin to establish T2DM IR model.The model rats were randomly divided into model group,the compatibility of Astragali Radix-Puerariae Lobatae Radix group[QG group,4.05 g/(kg·d),intragastric administration],ferroptosis inhibitor ferrostatin-1 group[Fer-1 group,5 mg/kg by intraperitoneal injection,once every other day],the compatibility of Astragali Radix-Puerariae Lobatae Radix+ferroptosis inducer erastin group[QG+erastin group,4.05 g/(kg·d) by intragastric administration+erastin 10 mg/(kg·d),intraperitoneal injection].After 4 weeks of intervention,serum fasting blood glucose (FBG) and fasting insulin (FINS) were measured in each group of rats,and homeostasis model assessment of insulin resistance (HOMA-IR) and the natural logarithm of insulin action index(IAI) were calculated;the serum levels of total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C),aspartate transaminase (AST) and alanine transaminase (ALT),Fe2+and Fe content,glutathione (GSH),malondialdehyde (MDA) and superoxide dismutase (SOD) levels,NADP+/NADPH ratio and reactive oxygen species (ROS) were determined.The pathological morphology of its liver tissue was observed;the protein expressions of glutathione peroxidase 4 (GPX4),ferritin heavy chain 1 (FTH1),long-chain acyl-CoA synthetase 3 (ACSL3),ACSL4,ferritin mitochondrial (FTMT),and cystine/glutamate anti-porter (xCT) in the liver tissue of rats were detected.RESULTS Compared with control group,the liver cells in the model group of rats showed disordered arrangement,swelling,deepened nuclear staining,and more infiltration of inflammatory cells,as well as a large number of hepatocyte vacuoles and steatosis;FBG (after medication),the levels of TC,TG,LDL-C,AST,ALT,FINS,MDA and ROS,HOMA-IR,Fe2+and Fe content,NADP+/NADPH ratio and protein expression of ACSL4 were significantly increased or up-regulated,while the levels of HDL-C,GSH and SOD,IAI,protein expressions of GPX4,FTH1,ACSL3,FTMT and xCT were significantly reduced or down-regulated (P<0.01).Compared with the model group,both QG group and Fer-1 group showed varying degrees of improvement in pathological damage of liver tissue and the levels of the above indicators,the differences in the changes of most indicators were statistically significant (P<0.01 or P<0.05).Compared with QG group,the improvement of the above indexes of QG+erastin group had been reversed significantly (P<0.01).CONCLUSIONS The compatibility decoction of Astragali Radix-Puerariae Lobatae Radix can reduce the level of FBG in T2DM IR rats,and alleviate IR degree,ion overload and pathological damage of liver tissue.The above effects are related to the inhibition of ferroptosis.
OBJECTIVE To investigate the effects of borneol on pharmacodynamic and pharmacokinetic effects of Corydalis saxicola total alkaloids in depression model rats.METHODS Thirty male SD rats were divided into blank control group,negative control group,positive control group (fluoxetine 10 mg/kg,i.g.),single drug group (C.saxicola total alkaloids 210 mg/kg,i.g.) and combined drug group (C.saxicola total alkaloids 210 mg/kg+borneol 50 mg/kg,i.g.) according to the random number table method,with 6 rats in each group.By lipopolysaccharide (LPS) induction modeling,except blank control group (no model and no administration) received intraperitoneal injection of the same amount of normal saline,the rats in the other groups were intraperitoneally injected with LPS once a day to establish a rat model of depression.After 1 week of modeling,each administration group was given relevant drug intragastrically according to the corresponding dose,and blank control group and negative control group (without drug treatment) were administered intragastrically with an equal volume of solvent to dissolve the drug;continued modeling while administering the drug.After two weeks of continuous administration,the effects of C.saxicola total alkaloids versus the combination of C.saxicola total alkaloids and borneol on the behavior of depressed rats were tested by behavioral experiments;the levels of tumor necrosis factor-α,interleukin-1β and interleukin-6 in rats were determined;the histopathological changes of the hippocampus of rats were observed.Blood sample was collected from the orbit at different time points after administration on the 15th day,and the upper plasma was obtained.Ultra-performance liquid chromatography-triple quadrupole tandem mass spectrometry was established for the simultaneous determination of dehydrocarvedine,tetrahydropalmatine,coptisine,palmatine,jatrorrhizine,berberine,berberrubine and epiberberine in rat plasma.The average plasma concentration-time curve was depicted,the area under the curve (AUC) was calculated,and the pharmacokinetic parameters were analyzed by DAS 3.2.2 software.RESULTS Compared with blank control group,the negative control group had a decrease in body mass and sugar water preference rate,a decrease in the total distance of open field,a prolonged swimming immobility time,and a increased in the expression of inflammatory factors in serum (P<0.05);compared with negative control group,the single drug group and the combined drug group increased the preference rate of sugar water,increased the total distance of open field,shortened the time of swimming immobility,and decreased the expression of inflammatory factors in serum (P<0.05).There was no significant difference in the above indicators between the single drug group and the combined drug group in rats (P>0.05).Pharmacokinetic results showed that compared with single drug group,AUC0-t of coptisine,AUC0-t,AUC0-∞,tmax and cmax of jatrorrhizine,AUC0-t,AUC0-∞,t1/2 and cmax of berberrubine,and AUC0-t of epiberberine,cmax of dehydrocarvedine,cmax of palmatine were significantly increased in combined drug group,but there was no significant difference,indicating that borneol didn't have a significant effect on the efficacy of Corydalis saxicola nigra at this dose.CONCLUSIONS Both C.saxicola total alkaloids alone and in combination with borneol can improve depression-like behavior in depression model rats,reduce serum inflammatory cytokine levels,and protect hippocampal neurons.Compared with the use of Corydalis saxicola base alone,the combination with borneol do not show significant pharmacodynamic differences,bu can improve the absorption of coptisine,jatrorrhizine in model rats.
OBJECTIVE To evaluate the cost-effectiveness of finerenone combined with standard treatment regimen in the treatment of diabetic nephropathy (DN).METHODS From the perspective of healthcare service providers,a Markov model was established to simulate the dynamic changes of each stage in DN patients who received finerenone combined with the standard treatment regimen or the standard treatment regimen alone based on the phase Ⅲ clinical trial study of finerenone for DN.Markov model was used to perform the cost-effectiveness of long-term effects and the costs of the two therapies with a simulation cycle of 4 months,a simulation period of 15 years and an annual discount rate of 5％.At the same time,one-way sensitivity analysis and probability sensitivity analysis were performed,and the stability of the results was validated.RESULTS Accumulative cost of the standard treatment regimen was 579329.54 yuan,and the accumulative utility was 8.0524 quality-adjusted life year (QALYs);the accumulative cost of finerenone combined with the standard treatment regimen was 332520.61 yuan,and the accumulative utility was 8.1874 QALYs.Finerenone combined with the standard treatment regimen was more cost-effective.The results of one-way sensitivity analysis showed that dialysis status utility value,DN stage 3 utility value and DN stage 4 utility value had a great influence on the incremental cost-effectiveness ratio,but did not affect the robustness of the model.The results of probability sensitivity analysis showed that finerenone combined with the standard treatment regimen was more cost-effective with 100％ probability.CONCLUSIONS For DN patients,finerenone combined with the standard treatment regimen is more cost-effective as an absolute advantage option.
OBJECTIVE To explore the correlation between drug consumption index and diagnosis related groups (DRG) overspending cases,and provide a basis for hospitals to optimize the cost structure and strengthen the refined management.METHODS Based on the data of DRG patients enrolled in a third-grade class A hospital from September to November 2023,the multivariate Logistic regression model and restricted cubic spline (RCS) model were used to analyze the correlation of drug consumption index with DRG overspending cases and its threshold effect,respectively.At the same time,rational drug use evaluation was conducted based on the drug consumption index,precise cost control and management were carried out,and the changes in the main pharmaceutical indicators of the whole hospital were analyzed before control (January-June 2023) and after control (January-June 2024).RESULTS The results of multivariate Logistic regression analysis showed that long hospitalization days,high drug consumption index,transfer to other departments and combined diabetes mellitus were the risk factors for DRG overspending (P<0.05).The results of the RCS model showed that the drug consumption index had a non-linear relationship with DRG overspending.When the drug consumption index was ≥0.64,the drug consumption index was positively correlated with the risk of DRG overspending(P<0.05).Compared with the same period before the control,medical cost per time,drug cost per time and drug consumption index decreased significantly after the control (P<0.01).CONCLUSIONS The drug consumption index is a risk factor for DRG overruns,there is a non-linear relationship and threshold effect between it and DRG overruns.Each hospital can set a reasonable threshold and implement dynamic monitoring and intervention by comprehensively considering the actual drug usage,disease spectrum characteristics,and cost control targets,as well as factors such as medical quality,patient needs,and the payment capacity of medical insurance,which can effectively achieve precise control over drug usage.
OBJECTIVE To establish the fingerprint of Pinghuo tea standard decoction and a method for determination of multi-component to clarify the transfer relationship of quantities and quality from pieces and standard decoction.METHODS Fifteen batches of Pinghuo tea standard decoction were prepared and the extract rate was determined;the fingerprint of the preparation was established by using high-performance liquid chromatography(HPLC);the similarity evaluation and the determination of common peaks were performed,and chemometric analysis was performed;the same method was used to determine the content of indicator components and the transfer rate was calculated.The chromatographic column was Venusil C18 column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid solution (gradient elution);the column temperature was 30 ℃,and the detection wavelengths were 238 nm (0-37 min,85-102 min) and 330 nm (37-85 min) at a flow rate of 1.0 mL/min with an injection volume of 10 μL.RESULTS The similarity of HPLC fingerprints for 15 batches of Pinghuo tea standard decoction was not lower than 0.968.A total of 24 common peaks were calibrated and 9 peaks were recognized,which were as follows neochlorogenic acid (peak 3),chlorogenic acid (peak 6),geniposide (peak 9),glycyrrhizin (peak 10),galuteolin (peak 11),isochlorogenic acid A (peak 14),luteolin (peak 21),kaempferol (peak 23) and glycyrrhizic acid (peak 24).Cluster analysis,principal component analysis and orthogonal partial least squares discriminant analysis showed consistent results,all of which could classify the 15 batches of samples into three categories.The linear range of indicator components in 15 batches of Pinghuo tea standard decoction,such as geniposide,luteolin,isochlorogenic acid A,glycyrrhizin,and glycyrrhizic acid,were 0.020580-0.411600,0.001617-0.080850,0.006076-0.607600,0.005125-0.071740,and 0.017288-0.432200 mg/mL,respectively;RSDs of precision,repeatability,stability and recovery rate tests were all not higher than 4％ (n=6).The mass fractions ranged 3.2279-10.0022,0.2974-0.5546,3.3501-6.1596,0.7206-1.0733,2.0031-3.0301 mg/g;transfer rates from the pieces and standard decoction were 19.7628％-35.8405％,12.1233％-21.2540％,46.0972％-82.8694％,58.7088％-91.6296％,39.1143％-63.7106％.The transfer rates of the extract from 15 batches of Pinghuo tea standard decoction ranged from 61.15％-84.68％.CONCLUSIONS Established HPLC fingerprint and content determination methods in this study are simple and accurate,which can provide reference for the quantitative value transfer study,quality control,clinical application and the development of subsequent formulations of Pinghuo tea standard decoction.
OBJECTIVE To further standardize the dispensing management standard of intravenous infusion drugs for clinical trials in pharmacy intravenous admixture services (PIVAS),and provide reference for medical institutions to provide high-quality pharmaceutical services.METHODS Initiated by PIVAS Group,Hospital Pharmacy Professional Committee,Shanghai Pharmaceutical Association,jointly led by Longhua Hospital,Shanghai University of Traditional Chinese Medicine and Shanghai Geriatric Medical Center,a writing group was established by PIVAS experts from multiple medical institutions to discuss the basic requirements and dispensing process of intravenous infusion drugs for clinical trials in PIVAS.The experts from the leading unit sorted out,summarized,analyzed,fed back and revised the opinions,and finally reached Expert Consensus on Dispensing Management of Intravenous Infusion Drugs for Clinical Trials in PIVAS.RESULTS & CONCLUSIONS The main contents of this consensus include information management,operation process,fund management and document management of intravenous infusion drugs for clinical trials in PIVAS.This consensus establishes a more standardized model for dispensing management of intravenous infusion drugs for clinical trials in PIVAS,by standardizing clinical trail drug management operational procedures,accurately recording and preserving drug-related information,with the aim of achieving standardized and meticulous management of PIVAS's receipt of clinical trial drugs.
OBJECTIVE To investigate the mechanism of Pangshi antai zhixue decoction in the improvement of spontaneous abortion with heat syndrome by regulating the NOD-like receptor protein 3 (NLRP3) inflammasome.METHODS The binding activities of 13 main components in Pangshi antai zhixue decoction with NLRP3,apoptosis-associated speck-like protein containing a CARD (ASC),and caspase-1 precursor (pro-caspase-1) were predicted by molecular docking.Sixty 1-day-old pregnant rats were randomly divided into normal group,model group,dexamethasone group (0.002 g/kg),and Pangshi antai zhixue decoction low-,medium-,and high-dose groups (11.025,22.05,44.10 g/kg),with 10 rats in each group.Each group was given distilled water/corresponding medicinal solution intragastrically,once a day,for 12 consecutive days.Except for normal group,other groups were given traditional Chinese medicine for warming yang and mifepristone to establish a model of spontaneous abortion with heat syndrome.24 h after the last medication,serum levels of triiodothyronine (T3),thyroxine (T4),interleukin-2 (IL-2),IL-4,IL-6,IL-10,and interferon-γ (IFN-γ) were all detected;the abortion rate and uterine coefficient were calculated;the pathological morphology of the pregnant uterus was observed;protein expressions of NLRP3,ASC and caspase-1 were detected.RESULTS The molecular docking results showed that the binding energies of 13 main components of Pangshi antai zhixue decoction with NLRP3,ASC,and pro-caspase-1 were all less than-5 kJ/moL.The animal experiment results showed that compared with normal group,the uterine coefficient and serum levels of IL-4,IL-6 and IL-10 were decreased significantly in model group (P<0.05);the abortion rate and serum levels of T3,T4,IL-2 and IFN-γ as well as protein expressions of NLRP3,ASC and caspase-1 were increased significantly (P<0.05);there were abortion lesions in the pregnant endometrium.Compared with the model group,most of the quantitative indicators mentioned above were significantly reversed in Pangshi antai zhixue decoction groups (P<0.05),and the endometrial miscarriage lesions in pregnancy were improved to varying degrees.CONCLUSIONS Pangshi antai zhixue decoction influences the immune balance between mother and fetus by regulating the formation of NLRP3 inflammasome,down-regulating pro-inflammatory cytokines such as IFN-γ and IL-2,and up-regulating anti-inflammatory cytokines such as IL-4,IL-6 and IL-10,thereby improving spontaneous abortion with heat syndrome.
OBJECTIVE To investigate the improvement effect and potential mechanism of Qingxue xiaozhi jiangtang formula on insulin resistance (IR) in type 2 diabetes mellitus (T2DM) rats.METHODS T2DM rat model was established by intraperitoneal injection of 30 mg/kg streptozotocin combined with high-fat and high-sugar diet.The rats were randomly divided into normal control group,model group,Qingxue xiaozhi jiangtang formula low-dose and high-dose groups (6.525,13.05 g/kg,calculated by raw material) and metformin group (positive control,0.18 g/kg),with 8 rats in each group.Administration groups were given relevant medicine intragastrically;normal control group and model group were given constant volume of normal saline intragastrically,once a day,for consecutive 6 weeks.Body mass and fasting blood glucose (FBG) were determined,and oral glucose tolerance test was conducted.Serum fasting insulin (FINS) level was measured to calculate the insulin resistance index (HOMA-IR) and insulin sensitivity index (ISI).Additionally,the level of serum lipids,liver function,oxidative stress indicators and inflammatory factors were assessed.The phosphorylation levels of kinase R-like endoplasmic reticulum kinase (PERK) and forkhead box O1 (FOXO1) protein in liver tissue of rats were determined.RESULTS Compared with model group,the body weight,ISI,the levels of high-density lipoprotein cholesterol and superoxide dismutase were increased significantly in Qingxue xiaozhi jiangtang formula high-dose group and metformin group (P<0.05);FBG,blood glucose level at 120 minutes of glucose loading,area under the curve of glucose,FINS,HOMA-IR,low-density lipoprotein cholesterol,total cholesterol,triglyceride,alanine transaminase,aspartate transaminase,alkaline phosphatase,malondialdehyde,interleukin-6,tumor necrosis factor-α,and C-reactive protein levels were significantly reduced (P<0.05);the pathological damage of liver tissue had significantly improved,and the phosphorylation levels of PERK and FOXO1 proteins in liver tissue were significantly decreased (P<0.05).CONCLUSIONS Qingxue xiaozhi jiangtang formula can regulate glucose and lipid metabolism,inflammation factor and oxidative stress levels,and alleviate insulin resistance in T2DM rats.Its mechanism of action may be related to the inhibition of the PERK/FOXO1 signaling pathway.
OBJECTIVE To analyze the factors influencing patient satisfaction in the outpatient pharmacy of tertiary maternity and child specialist hospitals in Chongqing,and provide a reference for improving the pharmaceutical management capability of tertiary maternity and child specialist hospitals and enhancing patients'medical experience.METHODS Utilizing KANO model,a questionnaire was developed and data were analyzed.Key influencing factors were identified through the categorization of requirement attributes,Better values,Worse values,and two-dimensional matrix analysis.The impact of these categorized demand factors on overall satisfaction was further validated through Structural Equation Modeling (SEM).RESULTS Cronbach's α coefficient for the survey questionnaire was 0.855,exceeding the acceptable threshold of 0.7;Bartlett test for sphericality yielded a value of 5538.56 with P<0.01,indicating good reliability and validity of the survey results.Through the KANO model's factor selection process,the top four key factors influencing patient satisfaction in outpatient pharmacies were determined to be:medication pick-up time (r=0.45),pharmacist service attitude (r=0.45),rational medication consultation (r=0.41),self-service calling system (r=0.40),all of which were subsequently validated through SEM.CONCLUSIONS The four factors of medication pick-up time,self-service calling system,pharmacist service attitude,and rational medication consultation significantly influence patient satisfaction in the outpatient pharmacies of tertiary maternity and child hospitals in Chongqing.
OBJECTIVE To investigate the use of drugs and the development of pharmaceutical care in the tight medical alliance (shorted for "medical alliance") of Wanzhou District of Chongqing,and provide reference for the further construction of the medical alliance.METHODS A survey form was designed and distributed to 21 constituent units (5 leading units and 16 member units) of 5 medical alliances in Wanzhou District of Chongqing.The statistical analysis was conducted in aspects of basic drug allocation and use,pharmaceutical personnel team construction,the development of pharmaceutical care,and rational use of antibiotics.RESULTS Among the 21 constituent units,4 leading units and 14 member units achieved the target for the proportion of essential drug procurement varieties,with a total compliance rate of 85.71％;4 leading units and 13 member units achieved the target for the proportion of national essential drug allocation and usage amount,with a total compliance rate of 80.95％.The proportions of personnel with doctoral degrees in the 5 leading units and 16 member units were 1.71％ and 0 respectively,and the proportions of personnel with senior professional titles were 8.56％ and 1.63％,respectively.A total of 5 pharmacy or pharmaceutical combined outpatient clinics were set up in the 21 medical alliance units,and 5 clinical pharmacy information service platforms were established;all 5 leading units were able to regularly carry out clinical pharmacy projects,while only 4 out of 16 member units had conducted medical order review and evaluation.The proportions of irrational use of antibiotics in outpatient prescriptions and inpatient medical records of the 16 member units (4.81％,5.21％) were significantly higher than those of the 5 leading units (2.80％,4.00％).CONCLUSIONS The allocation and usage of national essential drugs in 21 constituent units from Wanzhou District of Chongqing are both in good standing.However,the data on the allocation of pharmaceutical professionals and the number,qualifications,and job titles of clinical pharmacists in member units are generally low.Moreover,the pharmaceutical service projects and service quality in member units need to be further improved.
OBJECTIVE To investigate the effects and potential mechanism of persimmon leaf (PL) extract against ferroptosis induced by H2O2 in IEC-6 cells.METHODS Using IEC-6 cells as object,the effects of ferroptosis inhibitor ferrostatin-1 on IEC-6 cell viability induced by H2O2 were investigated;IEC-6 cells were divided into control group,H2O2 group,H2O2+PL 25 μg/mL group and H2O2+PL 50 μg/mL group.The levels of oxidant stress indexes[content of malondialdehyde (MDA),activity of superoxide dismutase (SOD),and levels of reactive oxygen species (ROS)],mitochondrial membrane potential (MMP) as well as mRNA and protein expressions of nuclear factor-erythroid-2 related factor 2 (Nrf2),heme oxygenase-1 (HO-1),NADPH/quinone oxidoreductase-1 (NQO-1),cystine/glutamate anti-porter (xCT),glutathione peroxidase 4 (GPX4) and ferritin heavy chain (FTH) were detected.RESULTS Ferroptosis inhibitor ferrostatin-1 could significantly increase the survival rate of H2O2-induced cells (P<0.01).Compared with the control group,MDA content,ROS level,mRNA expressions of Nrf2 and NQO-1 as well as protein expressions of Nrf2 and HO-1 were increased or up-regulated significantly,while SOD activity,MMP,mRNA expressions of xCT,GPX4 and FTH as well as protein expressions of GPX4 and FTH were decreased or down-regulated significantly (P<0.01 or P<0.05).Compared with the H2O2 group,oxidative stress indexes of H2O2+PL 25,50 μg/mL groups were reversed to different extents,MMP level was increased significantly,as well as mRNA and protein expressions of Nrf2,HO-1,NQO-1,xCT,GPX4 and FTH were up-regulated to different extents;there were statistical significances in some indexes between groups (P<0.01 or P<0.05).CONCLUSIONS PL extract can alleviate mitochondrial membrane damage and abnormal accumulation of ROS caused by H2O2,which may be related to the inhibition of ferroptosis by activating the Nrf2/HO-1 signaling pathway.
