Care coordination needs for deprescribing benzodiazepines and benzodiazepine receptor agonists

Deprescribing of medications such as benzodiazepines and benzodiazepine receptor agonists (z-drugs) can be a complex process that varies across practices, specialties, and health care systems. Care coordination among healthcare providers, patients, families, and other healthcare system components is critical to achieving high levels of deprescribing and person-centered care. We present a framework for promoting care coordination in the context of benzodiazepine/z-drug deprescribing. Future efforts are needed to study the impact of better care coordination on benzodiazepines/z-drug discontinuation and other outcomes that are important to stakeholders.     

Matrine,oxymatrine, and compound Kushen injection from the roots of Sophora flavescens: an overview of their anticancer activities

In the present review, we updated current information on the chemistry, contents, and anticancer properties of matrine (MT), oxymatrine (OMT), and compound Kushen injection (CKI). The anticancer properties were focused on lung, breast, and liver cancer cells because they are most susceptible. Sources of information were from Google, Google Scholar, PubMed, PubMed Central, Science Direct, PubChem, J-Stage, Directory of Open Access Journals (DOAJ), and China National Knowledge Infrastructure (CNKI). Reference was also made on botanical websites, such as Flora of China and World Flora Online. MT and OMT are dominant quinolizidine alkaloids from the roots of Sophora flavescens (Kushen) of the family Fabaceae. Against lung, breast, and liver cancer cells, MT and OMT inhibit cell proliferation; induce cell cycle arrest, apoptosis, and autophagy; restrict angiogenesis; and inhibit cell metastasis, invasion, and migration. The processes involve various molecular targets and signaling pathways. CKI is a traditional Chinese medicine (TCM) composed of root extracts of S. flavescens and Smilax glabra (Baituling) of the family Smilacaceae. With MT and OMT as major components, CKI has been approved for the treatment of cancer in China more than 20 years ago. In recent years, systematic reviews and meta-analysis have been undertaken to evaluate the anticancer effects of CKI. When CKI is used alone and in combination with chemotherapy of western medicine, there is much to be learned concerning their interactions besides their individual and integrated efficacy. Some perspectives of MT, OMT, and CKI are discussed, and their suggestions for future research are provided.     

基于网络药理学和分子对接法探索复方一枝蒿颗粒治疗新型冠状病毒肺炎的潜在分子机制

目的 通过网络药理学及分子对接技术探寻复方一枝蒿颗粒治疗新型冠状病毒肺炎的作用机制。方法 应用TCMSP数据库、BATMAN-TCM数据库及文献收集复方一枝蒿颗粒活性成分及潜在靶点。通过TTD、GeneCards和OMMI数据库检索新型冠状病毒肺炎相关的靶点。将复方一枝蒿颗粒药物靶点和新型冠状病毒肺炎相关基因取交集，使用String数据库构建靶蛋白相互作用（PPI）网络。通过Cytoscape构建“药物–活性成分–靶点基因–疾病”网络。对交集靶点进行GO功能、KEGG通路富集分析。利用Autodock_vina软件对活性成分和靶点进行分子对接。结果 共筛选92个活性成分，1 627个靶点，新型冠状病毒肺炎疾病靶点464个，两者取交集筛选出87个潜在靶点。GO功能富集得到2 040个条目（P＜0.05），与病毒过程、参与共生相互作用的生物过程、活性氧代谢过程的调节、与宿主相互作用的生物过程、病毒生命周期、炎症反应的调节等生物学过程有关。KEGG通路分析共得到150条通路，与新冠肺炎密切相关的有人巨细胞病毒感染、结核、COVID-19、IL-17信号通路等。分子对接结果证实，筛选的靶点受体蛋白与活性成分可以较好地结合。结论 复方一枝蒿颗粒可通过多组分、多靶点和多途径的方式对新型冠状病毒肺炎产生治疗作用。     

多指标综合加权评分法优选复方夏枯草洗剂提取工艺研究

[目的] 优选复方夏枯草洗剂的提取工艺。[方法] 采用L₉（3⁴）正交设计，以迷迭香酸、丹酚酸B的含量及出膏率的综合评分为指标，考察料液比、提取时间、提取次数对提取效果的影响，优选复方夏枯草洗剂的最佳提取工艺。[结果] 根据综合评分的结果，优选出最佳提取工艺为加8倍水，提取3次，每次0.5 h。[结论] 该工艺准确可靠，可行性好。     

舒胃汤联合复方消化酶胶囊治疗肝胃不和型功能性消化不良临床效果观察

目的:探讨分析舒胃汤联合复方消化酶治疗肝胃不和型功能性消化不良(Functional Dyspepsia,FD)的临床效果。方法:选取2016年2月-2019年2月收治的108例肝胃不和型功能性消化不良患者随机分为观察组和对照组,观察组给予舒胃汤联合复方消化酶胶囊治疗,对照组给予复方消化酶胶囊治疗,比较两组临床疗效,治疗前后中医症状评分、胃功能指标。结果:观察组临床疗效总有效率为94.44%较对照组显著提高(P<0.05),治疗前两组中医症状评分无统计学差异(P>0.05),治疗后两组早饱、上腹灼烧感、餐后饱胀不适、上腹痛评分均显著下降,且治疗后观察组早饱、上腹灼烧感、餐后饱胀不适、上腹痛评分下降更显著(P<0.05),治疗前两组胃功能指标无统计学差异(P>0.05),治疗后两组胃排空、胃动素、胃泌素指标水平均显著提高,且治疗后观察组胃排空、胃动素、胃泌素指标水平改善更显著(P < 0.05),观察组不良反应发生率为5.56%,较对照组显著性降低(P < 0.05)。结论:舒胃汤联合复方消化酶胶囊治疗肝胃不和型功能性消化不良可显著提高临床疗效,改善患者临床症状,促进胃功能提高,降低不良反应发生率,值得应用。     

丹参注射液对带蒂皮瓣移植修复术后成活率及预后的影响

目的:探讨丹参注射液对带蒂皮瓣移植修复术后成活率及预后的影响。方法:将68例接受带蒂皮瓣移植修复术的患者简单随机分成观察组与对照组各34例。对照组给予术后常规治疗,观察组在此基础上加用丹参注射液治疗,持续给药1周。随访3～12个月,比较两组患者术后皮瓣成活率、皮瓣肿胀程度、凝血指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平变化及并发症发生率。结果:观察组患者皮瓣成活率为97.06%,明显高于对照组的76.47%,差异有统计学意义(P<0.05)。观察组术后7 d皮瓣肿胀程度明显轻于对照组,差异有统计学意义(P<0.05)。观察组患者术后3 d的PT、APTT、FIB水平[(17.84±2.45)s、(35.38±3.14)s、(2.24±0.17)g/L]均明显低于对照组患者[(23.07±2.69)s、(41.56±3.34)s、(2.79±0.32)g/L],差异有统计学意义(P<0.05)。观察组患者术后伤口感染、瓣下积液、动静脉危象的总并发症率为8.82%,明显低于对照组的29.41%,差异有统计学意义(P<0.05)。结论:丹参注射液能提高带蒂皮瓣移植修复术后成活率,减轻术后皮瓣肿胀程度,改善凝血指标,降低血管危象、皮瓣坏死等并发症风险。     

激光联合复方血栓通胶囊治疗糖尿病视网膜病变合并黄斑水肿的疗效观察

目的:分析糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效。方法:选取我院2017年1月—2019年1月收治的200例糖尿病视网膜病变合并黄斑水肿患者为研究对象,随机分为两组。对照组单独行激光治疗,观察组于对照组基础上联合复方血栓通胶囊治疗,对比两组临床疗效、治疗前后IL-6(白介素-6)、VEGF(血管内皮生长因子)、NOS(血清一氧化氮合成酶)水平变化情况。结果:对照组总有效率(68.00%,68/100)较观察组总有效率(98.00%,98/100)更高(P<0.05);与对照组对比,观察组治疗后NOS水平更高,IL-6、VEGF水平更低(P<0.05)。结论:糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效显著,值得推广。