提升“湘九味”品牌价值 高质量发展湖南中药材产业

湖南省历经8年聚力打造“湘九味”中药材品牌，已逐渐形成品牌品种引领的产业链发展模式。为达成湖南省中药材产业链千亿发展目标，梳理了“湘九味”品牌培育历程，厘清并阐释了相关概念，分析了产业发展现状及问题，研判了大健康应用背景下未来的中药材产业的发展趋势，并提出相关发展建议。     

Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review

We designed a systematic literature review to identify available evidence on adherence to and persistence with antidiabetic medication in people with type 2 diabetes (T2D). Electronic screening and congress searches identified real-world noninterventional studies (published between 2010 and October 2020) reporting estimates of adherence to and persistence with antidiabetic medication in adults with T2D, and associations with glycaemic control, microvascular and/or macrovascular complications, hospitalizations and healthcare costs. Ninety-two relevant studies were identified, the majority of which were retrospective and reported US data. The proportions of patients considered adherent (median [range] 51.2% [9.4%-84.3%]) or persistent (median [range] 47.7% [16.9%-94.0%]) varied widely across studies. Multiple studies reported an association between greater adherence/persistence and greater reductions in glycated haemoglobin levels. Better adherence/persistence was associated with fewer microvascular and/or macrovascular outcomes, although there was little consistency across studies in terms of which outcomes were improved. More adherent and more persistent patients were typically less likely to be hospitalized or to have emergency department visits/admissions and spent fewer days in hospital annually than less adherent/persistent patients. Greater adherence and persistence were generally associated with lower hospitalization costs, higher pharmacy costs and lower or budget-neutral total healthcare costs compared with lower adherence/persistence. In conclusion, better adherence and persistence in people with T2D is associated with lower rates of microvascular and/or macrovascular outcomes and inpatient hospitalization, and lower or budget-neutral total healthcare expenditure. Education and treatment strategies to address suboptimal adherence and persistence are needed to improve clinical and economic outcomes.     

Niven and Scott (2003): Sixteen years of hindsight

This paper revisits a 2003 publication in Nursing Philosophy: The need for accurate perception and informed judgement in determining the appropriate use of the nursing resource: hearing the patient's voice. The author suggests that the basic ideas and focus of this 16‐year‐old paper are still topical and relevant in considerations of nursing care. However, it is also suggested that greater attention to the importance of the nurse–patient relationship in considerations of resource allocation, and potential rationing of nursing care, would have strengthened the original paper.     

辛味中药在治疗消渴证中的应用价值及中药五味理论现代研究的思考

辛味是中药五味学说中的重要性味之一,通常具有“发散”“行气”和“行血”的作用,且辛味中药在传统医学临床应用中占有较大比例。结合中药辛味的功效内涵及传统中医理论对消渴证的认识,阐述辛味中药与消渴证治疗之间的内在联系,总结辛味中药对“消渴三消”的治疗意义与价值。并在此基础上,对中药五味理论的现代研究趋势和发展方向进行思考,为同行研究提供参考。     

Interleukin-34 drives macrophage polarization to the M2 phenotype in autoimmune hepatitis

BackgroundAutoimmune hepatitis is a chronic inflammatory disease, the abnormal immunological function is the main pathogenesis. Interleukin-34 is a newly identified cytokine that shares the same receptor as colony stimulating factor-1.MethodsWe used interleukin-34 knockout and wild-type mice in a Con A-induced hepatitis model and cocultured RAW264.7 macrophage cells with interleukin-34. We then detected associated inflammatory cytokine and chemokine levels to elucidate the role of interleukin-34.ResultsIn this study, we found that the loss of interleukin-34 resulted in higher sensitivity to Con A-induced hepatitis. RAW264.7 macrophage cells were able to differentiate to the M2 phenotype upon interleukin-34 stimulation.ConclusionsWe conclude that interleukin-34 may protect the liver from Con A-mediated hepatitis by driving M2 macrophage polarization and suppressing inflammation.     

The clinical and cost impact of switching to fingolimod versus other first line injectable disease-modifying therapies in patients with relapsing multiple sclerosis

Background: There is limited evidence on the effectiveness and healthcare costs of switching to fingolimod versus another first line injectable therapy (FLIT) in patients with relapsing multiple sclerosis (RMS) who have already been treated with FLIT.

Objective: The objectives of the study were to assess the annualized relapse rate (ARR), socio-demographic and clinical characteristics, persistence and adherence rates, healthcare resource utilization and cost among patients with RMS who either switch to fingolimod or another FLIT in routine clinical practice.

Methods: A multicenter, observational, retrospective chart review was conducted across eight clinics in Canada between 1 May 2011 and 30 June 2013. The data was collected from two cohorts: patients who switched to fingolimod and patients who switched to FLIT from a previous FLIT.

Results and conclusions: A total of 124 patients were included in the study: 82 and 42 switched to fingolimod and FLIT, respectively. There were no significant differences in the patient characteristics at the date of switch except for number of previous disease-modifying therapies (DMTs) which was higher in the fingolimod cohort (fingolimod: 1.52; FLIT: 1.10, p?<?.001). The ARR during the first year of switching was numerically higher in the FLIT cohort compared to the fingolimod cohort (FLIT: 0.9 [95% CI 0.3–1.6]; fingolimod: 0.3 [95% CI 0.1–0.5]). The negative binomial model adjusted for the number of previous DMTs confirmed a statistically significant difference in ARR between the fingolimod and FLIT cohorts at 12?months of follow-up (p?=?.012). In the fingolimod cohort, 20.7% of patients experienced at least one relapse compared to 38.1% in the FLIT cohort. In both groups, a high proportion of patients (>90%) showed good treatment adherence (≥80% of prescribed doses).     

香药“一带一路”溯源、资源开发及功效探讨

香药是古代"丝绸之路"交流发展逐渐传入中国的传统药物,补充并丰富了我国药用资源。为积极倡导国家"一带一路"建设,推进我国外来香药资源的进一步开发和利用,服务"一带一路"沿线国家广大人民尤其是少数民族人群健康用药,通过查阅大量文献,梳理了香药的"一带一路"溯源及目前研究现状;在此基础上,从中医功效角度对其进行分类,并总结常用代表性香药的香味物质基础、功效及临床用途;并提出香药的进一步开发和利用策略,以促进其在新时代"一带一路"倡议中的快速发展,进一步增强民族医药文化自信。     

中医药分期防治新型冠状病毒肺炎的药性功效分析

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情严峻复杂,探讨中医药防治COVID-19处方的用药规律及特点具有重要意义。该研究收集2020年1月1日至2月18日国家卫生健康委员会,7个省市卫生健康委员会、国家中医管理局发布的和《新型冠状病毒肺炎中医诊疗手册》收录的中医药防治COVID-19诊疗方案以及3位国医大师、4位知名中医药专家所拟的方药,按照纳入、排除标准进行筛选,应用EpiData 3.0软件,建立"防治新型冠状病毒肺炎中医处方库""防治新型冠状病毒肺炎常用中药库",共收集有效中药处方93首,组成药物共计157味。应用SPSS 18.0软件进行数据分析,结果发现:①药性寒、温居多,其中性寒69味,占43.95%;性温57味,占36.31%;性热较少,仅占1.27%;②味苦、辛、甘药物较多,不同时期药味有异,初期以辛味居多,中期、重症期以苦味为主,恢复期多用甘味药;③归经以入肺、胃、心者多,入肺经最多,占24.55%;初、中期多入肺胃,重症期则入心肾;④口服药物多无毒,仅6味药物具有毒性,分别是苦杏仁、绵马贯众、重楼、细辛、半夏、炮附片;⑤以具有解表、化湿、清热、补虚、化痰止咳平喘5类功效的药物居多,初期解表与清热并重,各占18.81%;中期化痰止咳平喘药物使用多,占29.61%;重症期清热使用最多,占33.33%;恢复期补虚使用最多,占36.47%。中药防治COVID-19的药性特点和功效分布与中医对其病因、病位、病机的认识紧密相关,临证辨治尤需注重分期用药及因地制宜。     

我国中药材产地市场整合研究——以金银花、枸杞子、板蓝根和太子参为例

中药材专业市场交易量逐渐下降,产地市场交易成为趋势。研究产地市场整合程度有利于了解中药材市场的运行情况,对于合理规划中药材生产和提高市场效率具有重要意义。选取大宗中药材金银花、枸杞子、板蓝根和太子参研究中药材市场整合程度,利用2013—2019年价格指数,运用协整检验、误差修正模型和格兰杰因果检验进行实证分析。结果表明,我国中药材产地市场长期整合程度较高;中药材产地市场的短期整合程度远不及长期整合程度。为此提出4点政策建议:完善中药材价格信息平台、打造非道地产区中药材优质品牌、加快建成中药材质量追溯体系和建设中药材现代物流体系。     

北京市2017-2018年卫生资源公平性分析

基于对北京市居民对基本社会医疗保险制度的调查及《北京市统计年鉴》的数据,运用卫生资源分布图、集中指数和卡瓦尼指数等方法从资源总体配置公平性、卫生筹资公平性、卫生资源分布公平性3个方面分析北京市2017年、2018年卫生资源配置的情况。2017年、2018年的集中指数、基尼系数、卡瓦尼指数分别为-0.148、0.244、-0.392及-0.065、0.220、-0.285。并针对性提出统筹城乡基本医保,重视卫生资源的合理配置,保障低收入人群诊疗权益,满足不同人群对医保的需求,增加制度的灵活性,使医保向更公平的方向发展等可操作性政策建议。