Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

Pyoderma gangrenosum (PG) is an extra-intestinal skin lesion in inflammatory bowel disease (IBD) as is erythema nodosum. Vedolizumab (VED) is a monoclonal antibody that targets α4β7 integrin and has an intestinal selective mechanism. Despite good therapeutic effects on colitis, the effect on extra-intestinal manifestations (EIMs) remains unclear. Here we report a case of ulcerative colitis complicated by PG during treatment with VED, which was successfully treated with prednisolone in combination with adsorptive granulocyte and monocyte apheresis (GMA). The patient was a 50-year-old woman with a past medical history of extensive ulcerative colitis managed by golimumab (GLM). She developed flare symptoms due to loss of response to GLM, and treatment was switched to VED. Her gastrointestinal symptoms were improved with VED treatment with less frequent bowel movements. However, infiltrative erythema with pain appeared on the right lower leg and right knee, and expanded and gradually ulcerated. Her skin lesions were treated with corticosteroid, but showed poor improvement. Therefore, granulocyte and monocyte apheresis (GMA) treatment was administered in combination with prednisolone. After 3 months, the ulcer gradually improved, and at the time of this writing, the eruptions were nearly replaced by epithelial tissue. This case study showed that patients with UC and EIMS may respond well to combination therapy of VED and GMA. GMA has a very favorable safety profile. On the other hand, the causal connection between VED and PG is still unclear. We believe that a combination therapy involving VED and GMA in IBD patients with EIMs warrants consideration.     

山西省医疗机构儿科药学服务问题研究

目的：调查山西省146所设有儿科的医疗机构儿科药学服务现状及225名药师药学服务能力基本情况，研究目前山西省儿科药学服务存在的问题。方法：以“问卷星”的形式发放调查表，对山西省医疗机构儿科药学人员配备情况、硬件水平及药学服务能力水平等进行调查，并进行统计分析。结果：省内医疗机构未配备药学智能化设备占比53.42%，配备情况有待提高；儿科临床药师配备较少，仅占16.44%；受访医疗机构开展的药学服务在儿科患者用药交代、用药咨询及用药教育、处方(医嘱审核)、药学科普服务等方面占比较大，在开展儿童静脉药物集中调配、药学门诊、慢病管理及治疗药物监测(TDM)等药学服务占比较小，分别占比11.64%、10.27%、4.79%以及4.11%。结论：本次调查在一定程度上反映山西省目前医疗机构儿科药学服务存在的相关问题，药学服务水平需要整体提升，服务模式目前尚属于探索性阶段，需要逐渐模式化、规范化及统一化，为患者提供同质化的药学服务。     

Fentanyl inhibits acute myeloid leukemia differentiated cells and committed progenitors via opioid receptor‐independent suppression of Ras and STAT5 pathways

Fentanyl is a common sedative/analgesic used for intrathecal chemotherapy injection in children with acute leukemia. Given the contradictory findings that fentanyl has both inhibitory and stimulatory activities in cancer cells, we investigated the biological effects of fentanyl alone and its combination with standard of care in acute myeloid leukemia (AML) cells at all stages of development. We showed that fentanyl at clinically relevant concentration inhibited growth and colony formation of AML differentiated cells and committed progenitors without affecting their survival. Compared to AML cells without FLT3 mutation, cells harboring FLT3‐ITD mutation are likely to be more sensitive to fentanyl. However, fentanyl did not affect the most primitive AML stem cells. Fentanyl significantly augmented the efficacy of cytarabine but not midostaurin in AML differentiated cells and committed progenitors. We further demonstrated that fentanyl inhibited AML cells via suppressing Ras/Raf/MEK/ERK and STAT5 pathway, and this was not dependent on opioid receptor system. Our findings demonstrate the anti‐leukemia activity of fentanyl and synergistic effects between fentanyl and cytarabine in AML, via opioid receptor‐independent suppression of Ras and STAT5 pathways. Our work is the first to suggest the beneficial effects of fentanyl in children with leukemia.     

中国-老挝传统药物在传染性疾病治疗中的应用比较和前景分析＊

老挝是中国依山带水的友好邻邦，其传统医药受中医文化影响较深，在药材选用、临床治疗等方面具有相似相通之处，且受益于自身独特的生物多样性，老挝传统医药亦颇具创新之处。在“一带一路”的倡议下，中老在医药领域开展了广泛的合作，极大地促进了两国传统医药的发展。本文总结了传统医药在中老两国常见传染性疾病中的应用和效果评价，并分析了传统医学交流的现状和发展前景。中老传统医药的“交流互鉴”将推动两国传统医药更高水平的发展，为走向世界、融入主流医学奠定基础。