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??OBJECTIVE To study the chemical constituents of Fomes fomentarius (L.Ex.Fr.). METHODS The compounds were isolated by chromatography on silica gel column, Sephadex LH-20 column, and their structures were elucidated by spectral analysis. RESULTS Six compounds were obtained and identified as fomentarinin (1), 2-hydroxy hexacosanoic acid ethyl ester (2),syringic acid (3), syringyl alcohol (4), vanillin (5), and ergosta-7,22-diene-3,6-dione (6), respectively. CONCLUSION Compound 1 is a new compound, and compound 2-6 are isolated from the fungus for the first time.
     

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??OBJECTIVE To analyze the connotation and composition of the clinical value of drugs, and to build the index system for the evaluation of drug's clinical value, hence to provide references for its scientific evaluation. METHODS We designed the preliminary constructs index system referencingmedicine clinical evaluation indicatorsof German and French firstly. And then the expert interview and Delphi survey were used to analysis to determine the index system and index weight of medicine clinical evaluation. RESULTS The classified index system of the clinical value was established, which was composed of 2 first-grade indexes including clinical value and innovation value and 15 grade two indexes. Experts were invited to assess the value ranking according to the background information of rosuvastatin, atorvastatin and simvastatin statin drugs by their generic names. The expert's scoring results were summarized to determine the sequence. And it were compared with the average market prices in Germany, France, Britain, the United States, South Korea, Japan and analyzed. CONCLUSION The clinical value of drugs is an international standard for determining the reasonable price of drugs. This research method is feasible to determine the drug prices sequencing by the classified clinical value of drugs in the same kind of product. The price sequencing of some generic names of statin drugs did not correspond with its clinical value sequence, and the price can not reflect its value. The integrity and authenticity of the background data directly determine the classification of the clinical value. Various parties are needed to participate in providing detailed data and information.     

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??Polygonati Rhizoma as one of the most common Chinese herbal medicine and food was widely distributed in China. In TCM clinic, it was used for diabetes, hyperlipemia and rehabilitation therapy of cancer. Nowadays, with the rapid development of health industry, Polygonati Rhizoma shows excellent functions on healthcare, and then a surge of demands was coming. But there are so many species belongs to this genus and the classification criteria are not unified, so some important problems become urgently to be resolved, such as how to guarantee the quality and how to keep sustainable development. In this paper, the origin, distribution in China, chemical composition, pharmacological, and clinical application are reviewed. Its prospect is discussed to be helpful to promote the comprehensive development of Polygonatum.     

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??OBJECTIVE Blood tends to deposit in atrium to form thrombus in patients with atrial fibrillation. Patients with diabetes are in high coagulation state, for whom thrombosis is easy to occur. The number of diabetic patients with atrial fibrillation is large. Warfarin is one of the most widely used oral anticoagulants, which can cause major or fatal bleeding, so it is necessary to perform regular monitoring of international normalized ratio (INR) on all patients treated with warfarin. New kinds of antidiabetic drugs are widely used in clinic, among which a lot affect INR levels achieved with warfarin therapy. Clinical pharmacists should pay attention to drug interactions and monitor adverse drug reactions. As a new antidiabetic drug, exenatide has less reports of interaction with warfarin. The characteristic of the interaction between exenatide and warfarin was investigated, with the aim to optimize the rational and individualized medication. METHODS A case was introduced in which exenatide was administrated combined with warfarin, so that the possible mechanism of exenatide affecting to warfarin were analyzed. RESULTS INR declined from 2.13 to 1.57 after exenatide being added, and decreased further to 1.43 with concurrency of the increasing exenatide dose. On the contrary, INR was on rise as result of discontinuing exenatide. At last, INR returned to 1.78 when the patient discharged. CONCLUSION Exenatide inhibited the absorption of warfarin, which lead to INR decline attributed to its effect of slowing down the gastric emptying. When exenatide and warfarin are combined,the dose of warfarin must be adjusted based on INR under clinical monitoring.     

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??OBJECTIVE To study and collate the literature on rare diseases in domestic and abroad, and comparative analysis, provide a scientific basis for the domestic rare diseases research. METHODS Retrieved the Web of Science, China National Knowledge Infrastructure from January 2011 to June 2016 published literature about rare diseases. RESULTS Through the screening of literature, finally determine the 200 articles for analysis. It is divided into seven research directions:rare diseases policy research, rare diseases legal and regulatory research, rare diseases medical social security study, orphan drugs availability research, orphan drugs economic evaluation study, orphan drug development research, rare diseases defined standard research. CONCLUSION Rare diseases policy research is the focus of research both domestic and abroad. Compared with foreign countries, the domestic research on the availability and economic evaluation of orphan drug is less, especially the economic evaluation research is almost blank. It is suggested that the researchers study the multiple aspects of rare diseases and drugs, and to provide the basis and reference for build rare disease policy in China.In addition to the field of rare diseases research, rare diseases drugs face many difficulties in pharmaceutical research, production and supply.The precondition to solve these problems is the nation formulate specific policies and regulations for rare diseases,and then clear the official definition standards of rare diseases,establish relevant policies to encourage pharmaceutical companies to develop rare diseases drugs.     

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??OBJECTIVE To synthesize 5-substituted indole-3-deoxypodophyllotoxin derivatives and study their antitumor activity. METHODS The target compounds were synthesized through a series of reactions and their anti-tumor activity in vitro were evaluated against Hela, K562 and K562/A02 cell lines by MTT as assay. RESULTS Ten target compounds were synthesized and confirmed by ¹H-NMR, ¹³C-NMR, and HR-ESI-MS. All the target compounds had different degrees of cytotoxic activity in vitro. Most of the compounds had significant anti-MDR activity in vitro. CONCLUSION 5-Substituted indole-3-deoxypodophyllotoxin derivatives have good antitumor activity and worth of further study.     

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??OBJECTIVE To determine the effects of saxagliptin and exenatide on humerus cancellous bone of diabetes-induced osteopenia rats by histomorphometry. METHODS Thirty-five Cases of female SD rats were randomly divided into normal group (N group, n=7), control group (C group, n=7), and the remaining rats were used to establish the type 2 diabetic model by combination of high-fat&sugar-diet feeding for 4 weeks and then low-dose streptozotocin injection(STZ, 30 mg??kg^-1) . After 10 d, the oral glucose tolerance test and the fasting blood glucose were measured, rats with high OGTT(2 h) above 11.1 mmol??L^-1 and high FBG above 16.7 mmol??L^-1 were divided into model group (M group, n=5), saxagliptin group (G group, n=5) and exenatide group (D group, n=6), and continuously treated for 30 d. The left humerus (proximal humeru metaphometry, PHM) were fixed with 4% paraformaldehyde for 48 h, uncalcified embedded in methyl methacrylate after dehydrated and cleared, and sections were taken for bone histomorphometry after Masson-Goldner Trichrome stained. RESULTS In PHM, there was no statistical significance between N and C group, the trabecular bone area ratio( BV/TV) and trabecular quantity were significantly decreased (P??0.01) in M group, while the trabecular separation degree was increased, comparing with those in C group (P??0.01), and the trabecular bone area ratio( BV/TV) and trabecular quantity in G and D group were higher (P??0.01) than those of model rats, while the trabecular separation degree was decreased, comparing with those in M group (P??0.01). Cell parameters showed no statistical significance between N and C group, the osteocllast number and percentage of osteocllast surface perimeter were significantly reduced(P??0.05, P??0.01) in M group, while the osteoclast number and percent osteocllast surface perimeter were significantly increased (P??0.01) as compared with those in C group, saxagliptin and exenatide were found to significantly induce osteocllast number (P??0.01) and percentage of osteoblast surface perimeter (G group P??0.05, D group P??0.01), while reduce osteoclast number (P??0.01) and percent osteoblast surface perimeter (P??0.05) compared with M group. In growth-plate, there was no statistical significance between N and C group, the thickness of growth-plate and the diameter of the mast cells were reduced in M groups (P??0.01), while the thickness of growth-plate (P??0.01) and the diameter of the mast cells (P??0.05) were increased in G and D group,compared with M group. CONCLUSION Therapeutic effects of saxagliptin and exenatide on diabetes -induced osteopenia rats was showed, and the mechanism may be related to the improved growth rate of growth-plate and the changed bone turnover status.     

阿托伐他汀联合二甲双胍治疗2型糖尿病合并持续性心房颤动的效果分析

目的评估2型糖尿病合并持续性心房颤动患者实施阿托伐他汀与二甲双胍联合治疗的可行性。方法针对76例东明县中医医院诊治的2型糖尿病合并持续性心房颤动患者纳入实验资料,抽取时间为2019年1月~2020年1月,以随机数字表法对患者分成实验组与参照组,每组各38例。分别行二甲双胍治疗、阿托伐他汀与二甲双胍联合治疗,比对两组治疗前后血脂相关指标、血糖及动脉血管内皮功能相关指标。结果2型糖尿病合并持续性心房颤动患者治疗前总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯指标及血糖、血管内皮依赖性舒张功能具有一致性,显示出数据检验无统计学意义(P>0.05)。实验组治疗后总胆固醇、低密度脂蛋白、甘油三酯低于参照组,显示出数据检验统计学意义(P<0.05)。较之于参照组,实验组治疗后高密度脂蛋白、血管内皮依赖性舒张功能水平较高,显示出数据检验统计学意义(P<0.05)。结论2型糖尿病合并持续性心房颤动患者予以阿托伐他汀与二甲双胍联合治疗效果显著。     

文迪雅或二甲双胍联合胰岛素治疗2型糖尿病的疗效比较

目的　对比探讨文迪雅与二甲双胍治疗单纯胰岛素控制血糖欠佳的2型糖尿病的临床疗效。方法　将4 3例使用皮下注射胰岛素控制血糖欠佳的2型糖尿病患者,随机分为2组,一组加服文迪雅,一组加服二甲双胍,观察治疗前后的空腹血糖(FBG)、餐后2h血糖(2hBG)、糖化血红蛋白(HbA1C)、C肽、胰岛素(INS)用量、胆固醇(TC)、三酰甘油(TG)的变化。结果　FBG、2hBG、HbA1C、INS用量、TG均有明显下降,餐后2hC肽明显上升。结论　文迪雅和二甲双胍均能降低血糖和改善INS抵抗,而文迪雅效果更显著、不良反应少。     

盐酸小檗碱联合二甲双胍治疗2型糖尿病合并高脂血症的疗效探析

目的：探讨盐酸小檗碱联合二甲双胍治疗2型糖尿病合并高脂血症的临床效果。方法：选择2型糖尿病合并高脂血症患者53例,分为治疗组（27例）和对照组（26例）,治疗组予盐酸小檗碱联合二甲双胍治疗,对照组单纯予二甲双胍治疗。2个月后对比两组患者血糖、血脂及体重指数的变化,以评价治疗效果。结果：治疗组患者血糖、血脂各项指标及体重指数均较对照组好转,差异均有统计学意义（P〈0.05）。结论：盐酸小檗碱联合二甲双胍治疗2型糖尿病合并高脂血症,降糖效果确切,并可改善高脂血症并发症及降低患者体重指数。     

参芪降糖颗粒联合二甲双胍治疗2型糖尿病38例

目的观察参芪降糖颗粒联合二甲双胍治疗2型糖尿病的临床疗效。方法选取2012年12月至2013年12月收治的2型糖尿病患者76例,其中对照组38例,采用常规二甲双胍治疗;观察组38例,采用参芪降糖颗粒联合二甲双胍治疗。12周后比较两组的血糖水平。结果两组血糖比较差异具有统计学意义（P〈0.05）,观察组优于对照组。结论参芪降糖颗粒联合二甲双胍治疗2型糖尿病的疗效显著,值得临床推广。     

甘精胰岛素在高龄2型糖尿病患者中的应用

目的观察甘精胰岛素治疗高龄2型糖尿病患者的疗效。方法选择血糖控制差的高龄2型糖尿病患者10例,年龄75~91岁,检测空腹血糖、餐后2 h血糖、糖化血红蛋白、肝肾功能、乳酸、尿常规,作为对照组。停用对照组磺脲类及双胍类降糖药,改为甘精胰岛素治疗,对餐后2 h血糖控制不佳者,加用或保留阿卡波糖,作为治疗组。2组饮食、运动无变化,比较2组血糖水平及低血糖发生情况。结果对照组空腹血糖为(13.20±7.59)mmol/L、餐后2 h血糖为(14.36±3.48)mmol/L;治疗组空腹血糖为(6.25±0.69)mmol/L(t=2.884,P=0.018)、餐后2 h血糖为(9.31±0.92)mmol/L(t=4.438,P=0.001),未见低血糖发生。结论甘精胰岛素治疗高龄2型糖尿病安全有效,方法简单易行。     

葫芦巴总皂苷联合磺脲类降糖药治疗2型糖尿病36例临床观察

目的:观察葫芦巴总皂苷(TFGs)与磺脲类降糖药(SU)合用对继发性失效2型糖尿病(T2DM)的临床疗效。方法:72例单纯使用SU血糖控制不良的T2DM患者,按就诊顺序随机分为对照组(36例)和治疗组(36例),在服用SU的基础上,分别加服安慰剂和TFGs,观察其疗效。结果:治疗组总有效率明显高于对照组(P<0.01);与治疗前相比,治疗组空腹血糖、餐后2 h血糖、糖化血红蛋白、临床症状积分显著下降(P均<0.01),体重指数和肝肾功能无明显变化。结论:TFGs联合SU治疗T2DM,显示了较好的降糖效果,同时能改善临床症状,且有较好的安全性。     

阿托伐他汀改善糖尿病血糖代谢的机制

目的：探讨阿托伐他汀改善糖尿病患者血糖代谢的机制。方法：收集120例2型糖尿病患者,随机分为10mg／Qd和20mg／Qd阿托伐他汀治疗组,比较治疗前、治疗后第3和6个月时血糖、血脂、脂联素水平和血糖控制率。收集40例非糖尿病健康者作为对照。结果：糖尿病组血糖、血脂高于对照组,而脂联素低于对照组。阿托伐他汀治疗后两组血脂代谢得到改善,两组间无差别（P=0．158）,20mg／Qd组脂联素水平高于10mg／Qd组（P〈0．05）。Logistic回归分析提示脂联素和阿托伐他汀与血糖控制率呈正相关。结论：阿托伐他汀可提高糖尿病血糖控制率,可能是通过增加脂联素水平。     

糖维胶囊联合盐酸二甲双胍片治疗2型糖尿病60例疗效观察

目的观察糖维胶囊联合盐酸二甲双胍片治疗2型糖尿病的临床疗效。方法将110例2型糖尿病患者随机分为2组。对照组50例予盐酸二甲双胍片治疗,治疗组60例在对照组治疗基础上加用糖维胶囊治疗。2组均治疗3个月。测定治疗前后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbAlc)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、体质量指数(BMI)、全血黏度、血浆黏度及血小板黏附率。结果治疗组总有效率88.34%,对照组总有效率72.00%,2组总有效率比较差异有统计学意义(P<0.05),治疗组疗效优于对照组。2组治疗后FPG、2 h PG、HbAlc、TG及LDL-C均较本组治疗前降低(P<0.05),且治疗组治疗后FPG、2 h PG、HbAlc降低明显(P<0.05)。2组治疗后全血黏度、血浆黏度及血小板黏附率均较本组治疗前降低(P<0.05),且治疗组治疗后较对照组降低明显(P<0.05)。结论糖维胶囊联合盐酸二甲双胍片对2型糖尿病患者在改善血糖和血脂方面有一定疗效,且安全性较好。     

罗格列酮联合二甲双胍治疗2型糖尿病疗效观察

目的观察罗格列酮联合二甲双胍治疗2型糖尿病的临床疗效及其机制。方法将150例2型糖尿病患者随机分为2组。对照组75例二甲双胍750 mg/d口服;治疗组75例在口服二甲双胍的基础上口服罗格列酮4 mg/d。比较2组治疗前及治疗3个月后空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、脂联素、肿瘤坏死因子-α(TNF-α)和高敏C反应蛋白(hs-CRP)的变化。结果治疗后,2组FBG、2hPG、HbA1c、FINS、HOMA-IR、TNF-α和hs-CRP水平均较治疗前明显降低,治疗组降低更为明显。治疗后2组HOMA-β和脂联素水平均较治疗前明显升高,治疗组升高更为明显。结论罗格列酮联合二甲双胍治疗2型糖尿病患者,可通过降低TNF-α和hs-CRP水平和升高脂联素水平,改善胰岛素抵抗,从而改善糖代谢。     

《金匮》肾气丸合二甲双胍对实验性2型糖尿病胰岛素抵抗大鼠血糖血脂影响的研究

目的观察《金匮》肾气丸对2型糖尿病胰岛素抵抗大鼠血糖及血脂的影响。方法选用40只SD大鼠,随机分为两组,正常对照组8只和模型组32只。正常对照组大鼠予以普通基础饲料,模型组大鼠予以高脂高糖饲料,30d后小剂量链脲佐菌素50mg／kg腹腔注射诱导2型糖尿病胰岛素抵抗大鼠,造模成功后13d,模型组大鼠随机分为糖尿病模型组、肾气丸组、二甲双胍组及肾气丸合二甲双胍组。各治疗组大鼠开始分别连续灌胃,正常对照组和糖尿病模型组等体积蒸馏水灌胃。30d后禁食12h,尾静脉采血检测血糖、血脂等生化指标。结果与正常对照组比较,糖尿病模型组空腹血糖、BUN、CH01、TG和LDL—C水平均明显增高（P〈0．001）,HDL—C水平则降低（P〈0．001）;肾气丸组、二甲双胍组及肾气丸合二甲双胍组均能降低模型大鼠空腹血糖、BUN、CHOL、TG和LDL—C水平（P〈0．05或P〈0．01）;二甲双胍组则既可降低TG和LDL—C,又可提高血清HDL-C含量（P〈0．05）。结论《金匮》肾气丸合二甲双胍可显著改善2型糖尿病胰岛素抵抗大鼠的血糖及血脂水平。