亲水性纤维含银敷料覆盖肛瘘术后创面的作用

背景：亲水性纤维含银敷料在其他创面治疗中目前已取得较多临床证据,但其对肛瘘患者术后创面康复的作用研究较少。目的：观察亲水性纤维含银敷料覆盖对肛瘘患者术后创面康复的作用。方法：将 57 例肛瘘术后患者随机分为试验组 29 例和对照组 28 例,试验组在术后给予亲水性纤维含银敷料换药,3 d 1次,对照组术后给予无菌凡士林纱布换药,1 次/d,观察两组患者的首次换药创面疼痛程度、渗液明显减少时间、换药次数、创面康复时间及换药费用等指标。结果与结论：试验组首次换药时创面疼痛程度明显轻于对照组（P 〈 0.05）,渗液明显减少时间、换药次数、创面康复时间明显少于对照组（P 〈 0.05）;但试验组换药费用明显高于对照组（P 〈 0.05）。表明亲水性纤维含银敷料覆盖于肛瘘患者术后创面可减少刺激,明显减轻疼痛,提供湿性修复环境,加速创面愈合,减少换药次数,提高患者满意度。     

夏枯草口服液治疗甲状腺功能亢进症的系统评价

目的 系统评价夏枯草口服液治疗甲状腺功能亢进症的临床疗效与安全性。方法 计算机检索中文学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据库（Wanfang Data）、维普中文期刊全文数据库（VIP）、PubMed、Medline、Embase和Cochrane Library等数据库,纳入夏枯草口服液治疗甲状腺功能亢进症的临床随机对照试验（RCT）,检索时限均从建库至2021年4月30日,运用RevMan 5.3软件进行统计分析。结果 共纳入8篇RCTs,共计800例患者。Meta分析结果显示：与常规西药治疗（对照组）相比,夏枯草口服药联合常规治疗（试验组）在改善临床有效率方面更为明显［OR=0.13,95% CI=（0.07,0.18）,P<0.001］,并可以有效降低血清游离三碘甲状腺原氨酸（FT3）［SMD=-0.50,95% CI=（-0.97,-0.03）,P=0.04］、血清游离甲状腺素（FT4）［SMD=-0.46,95% CI=（-0.90,-0.02）,P=0.04］和促甲状腺素受体抗体（TRAb）水平［SMD=-1.59,95% CI=（-2.19,-0.99）,P<0.001］,提高血清促甲状腺激素（TSH）水平［SMD=0.82,95% CI（0.12,1.52）,P=0.02］,缩小甲状腺体积［MD=-0.30,95% CI=（-0.53,-0.06）,P=0.01］。安全性评价方面,两组比较差异无统计学意义［OR=0.48,95% CI=（0.19,1.22）,P=0.12］。结论 夏枯草口服液可以提高甲状腺功能亢进症的临床有效率,能有效降低FT3、FT4及TRAb水平、缩小甲状腺肿大体积、提高TSH水平。但是受到纳入研究数量和质量的限制,上述结论需要更多的临床RCTs加以验证。     

药学干预对心内科冠心病患者出院后用药依从性 及其预后的影响

目的:探讨临床药师干预对心内科冠心病患者用药干预模式,评价出院后药学干预对用药依从性及预后的影响.方法:选取2019年1～6月期间我院心内科冠心病患者80例,随机分为观察组和对照组,其中观察组40例实施出院时及出院后药学干预,包括出院时发放用药指导单、建立出院后药学服务档案、出院后电话随访用药情况等,对照组40例仅给予住院期间常规药学监护及用药教育,两组患者均于出院6个月后进行电话随访,比较分析其用药依从性、病情控制情况、再住院率.结果:干预6个月后,与对照组相比,观察组患者的用药依从性、再住院率均得到明显改善,血压及血脂达标率更高,差异有统计学意义.结论:临床药师干预可以有效改善心内科冠心病患者用药依从性及预后.     

基于UFLC-Q-TOF/MS分析黄芪-丹参药对化学成分研究

目的?应用UFLC-Q-TOF/MS对黄芪-丹参药对中的化学成分进行鉴定。方法?采用Thermo BDS C₁₈(3μm,150mm×2.1mm)色谱柱,以0.1%甲酸水-0.1%乙腈为流动相进行梯度洗脱,流速为0.3mL/min,柱温40℃,进样量5μL。离子源为电喷雾离子源（ESI）,负离子模式下采用飞行时间质谱采集数据,全扫描质量范围为m/z 100~1500。依据保留时间、精确分子量、二级质谱裂解碎片,结合对照品比对初步鉴定化合物。结果?从黄芪-丹参药对中初步鉴定或推断出28个化合物,其中丹参中15个化合物,黄芪中11个化合物,另有2个未知化合物。包括皂苷类、有机酸类、黄酮类和醌类化合物。结论?该UFLC-Q-TOF/MS可全面、快速分析黄芪-丹参药对中的化学成分,研究结果为对其进行活性成分研究和质量控制提供了一定参考。      

COPD伴抑郁障碍小鼠模型的建立及加味温胆汤的干预作用

目的?建立一种烟熏诱导的小鼠慢性阻塞性肺疾病（COPD）伴抑郁障碍模型,并评价加味温胆汤对COPD伴抑郁障碍小鼠的治疗作用及其机制。方法?将小鼠随机分为正常组与模型组,模型组每天烟熏4次。烟熏满15周后,测试正常组与模型组糖水消耗,观察二者气道和肺组织的病理改变等,在确认COPD伴抑郁障碍小鼠模型成功后,将模型组小鼠随机分为模型组、加味温胆汤高剂量组、加味温胆汤低剂量组及阳性药组,连续给药3周,给药结束后,测试各组小鼠的糖水消耗、悬尾不动时间,检测肺功能,并检测小鼠支气管肺泡灌洗液（BALF）中炎症细胞数,观察气道和肺组织病理改变等。结果?与正常组相比,模型组小鼠在烟熏满15周时,体质量下降,糖水消耗比例降低,增强呼吸间歇（Penh）升高。连续给药3周后,与模型组相比,加味温胆汤组小鼠体质量增加,糖水消耗升高,悬尾不动时间减少,说明其抑郁样症状减轻;显著降低模型组小鼠吸气阻力（RI）,升高肺动态顺应性（Cdyn）;显著降低总白细胞数与中性粒细胞数;降低肺泡灌洗液以及海马组织中炎症因子等。结论?用烟熏法所建立的COPD伴抑郁障碍小鼠模型较为符合本病的病程发展及临床特征,中药复方加味温胆汤对COPD伴抑郁障碍小鼠具有疗效,能够改善其病理与功能的改变,其机制可能与降低外周及中枢炎症有关。      

基于网络药理学探讨“桂枝-附子”温通经脉配伍治疗类风湿关节炎的作用机制

目的:基于网络药理学方法,探讨"桂枝-附子"温通经脉配伍治疗类风湿关节炎(rheumatoid arthritis,RA)可能的作用机制。方法:基于中药系统药理学数据库和分析平台,检索"桂枝""附子"的化学成分和潜在靶点,选择口服生物利用度≥30%和类药性≥0.18作为化学成分筛选条件;在Gene Cards数据库中检索RA疾病靶点;利用Cytoscape 3.6.0软件绘制"桂枝附子配伍-化学成分-靶点-RA"网络;使用STRING 11.0在线软件构建蛋白质-蛋白质相互作用网络,并挖掘核心靶点;采用David Bioinformatics Resources数据库对该配伍活性成分潜在靶点网络中的蛋白进行基因本体(gene ontology,GO)功能富集分析和基于京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes,KEGG)的通路富集分析。结果:GO功能富集分析结果提示,"桂枝-附子"温通经脉配伍主要影响半胱氨酸型内肽酶活性参与凋亡过程、肿瘤坏死因子受体超家族结合等过程。KEGG生物通路富集分析结果提示,该配伍通过肿瘤坏死因子信号通路、凋亡等多条通路影响RA的信号转导和疾病进程。结论:本研究从网络药理角度预测了"桂枝-附子"温通经脉配伍治疗RA可能的信号通路,为后续机制研究奠定了一定的基础。     

饮食失宜与慢性萎缩性胃炎相关性探讨

慢性萎缩性胃炎(CAG)属中医学胃痛、痞满等范畴,饮食失宜是其主要发病因素之一。从食量失宜、偏嗜辛辣、恣食生冷热烫、嗜食肥甘厚味、喜食腌制品等多个方面探讨内伤饮食与CAG的关系,尤其指出本病与摄食含有大量亚硝酸盐(I类致癌物质)的腌制品关系更为密切。饮食失宜易导致痰浊、湿热、气机失调,诱发胃痛。     

Improved oral absorption and anti-lung cancer activity of paclitaxel-loaded mixed micelles

The aim of this study was to establish a paclitaxel (PTX)-loaded mixed micelle delivery system (PTX-TP-M) with vitamin E-TPGS (TPGS) and Plasdone®S-630 Copovidone (PVPS630) as carriers to improve the solubility, oral absorption, and anti-tumor activity of PTX against lung cancer. In this study, PTX-TP-M was prepared using the ethanol thin-film dispersion method followed by characterization of the binary mixed micelles system. The average size of the PTX-TP-M was 83.5?±?1.8?nm with a polydispersity index of 0.265?±?0.007 and the drug loading (DL%) and entrapment efficiency (EE%) were 3.09?±?0.09% and 95.67?±?2.84%, respectively, which contributed to a high solubility of PTX about 24947-fold increase in water (4.78?±?0.14?mg/mL). In addition, TEM analysis showed that the PTX-TP-M appeared spherical in structure and was well dispersed without aggregation and adhesion. In vitro release studies showed that the PTX-TP-M displayed a sustained release compared to free PTX in the dialysis bag. The efflux ratio of PTX reduced from 44.83 to 3.52 when formulated as PTX-TP-M; a 92.15% reduction, studied using the Caco-2 monolayer model. The oral bioavailability of PTX also improved by 4.35-fold, suggesting that PTX-TP-M can markedly promote the absorption in the gastrointestinal tract. Using in vitro MTT assays, it was observed that cytotoxicity was markedly increased, and IC₅₀ values of PTX-TP-M (3.14?±?0.85 and 8.28?±?1.02?μg/mL) were lower than those of PTX solution (5.21?±?0.93 and 14.53?±?1.96?μg/mL) in A549 and Lewis cell, respectively. In vivo anti-tumor studies showed that PTX-TP-M achieved higher anti-tumor efficacy compared with PTX in Lewis bared C57BL/6 mice. Furthermore, a gastrointestinal safety assay also proved the safety of PTX-TP-M. All results demonstrated that the PTX-TP-M exhibited great potential for delivering PTX with increased solubility, oral bioavailability, and anti-cancer activity and this binary mixed micelles drug delivery system has potential to be used clinically.     

Inpatient glycemic management in internal medicine: an observational multicenter study in Nanjing,China

Aims: To evaluate the prevalence of hyperglycemia among inpatients in internal medicine, and specifically, to assess the glycemic management of inpatients in non-endocrinology departments in three large urban hospitals in China.

Methods: A multicenter observational study was conducted using electronic health records, and a survey of 1939 patients who were admitted to internal medicine units and followed until discharge. Those with previously diagnosed diabetes, newly diagnosed diabetes, or impaired fasting glucose were included. Aspects of glycemic management examined were (a) hyperglycemia, (b) endocrinology consultation for hyperglycemia and (c) hypoglycemia.

Results: The prevalence of hyperglycemia in internal medicine was 45.7% (886 out of 1939). A total of 741 (83.6%) patients were treated by non-endocrinology departments; of those, 230 (31.1%) were in poor glycemic control and needed an endocrinology consultation. Yet only 57 (24.8%) received one. In 4 cases, the physician did not follow the consultants’ advice. Among the remaining 53 consulted patients, 35 (66.1%) were still in poor glycemic control, yet only about half received a second consultation. Finally, among patients treated in non-endocrinology departments, 58 (7.8%) had hypoglycemia; less than half retested their blood glucose after treatment.

Conclusions: The majority of patients with hyperglycemia were in non-endocrinology departments. Their glycemic management was poor; the endocrinology consultation rate was low and the result was suboptimal. Also, the management of hypoglycemia was not ideal. Therefore, improving glycemic management is urgently needed in Chinese hospitals.     

Excretion and toxicity evaluation of 131I-Sennoside A as a necrosis-avid agent

1.?Sennoside A (SA) is a newly identified necrosis-avid agent that shows capability for imaging diagnosis and tumor necrosis targeted radiotherapy. As a water-soluble compound, ¹³¹I-Sennoside A (¹³¹I-SA) might be excreted predominately through the kidneys with the possibility of nephrotoxicity.

2.?To further verify excretion pathway and examine nephrotoxicity of ¹³¹I-SA, excretion and nephrotoxicity were appraised. The pharmacokinetics, hepatotoxicity and hematotoxicity of ¹³¹I-SA were also evaluated to accelerate its possible clinical translation. All these studies were conducted in mice with ethanol-induced muscular necrosis following a single intravenous administration of 131I-SA at 18.5 MBq/kg or 370 MBq/kg.

3.?Excretion data revealed that ¹³¹I-SA was predominately (73.5% of the injected dose (% ID)) excreted via the kidneys with 69.5% ID detected in urine within 72 h post injection. Biodistribution study indicated that ¹³¹I-SA exhibited initial high distribution in the kidneys but subsequently a fast renal clearance, which was further confirmed by the results of autoradiography and single-photon emission computed tomography-computed tomography (SPECT-CT) imaging. The maximum necrotic to normal muscle ratio reached to 7.9-fold at 48?h post injection, which further verified the necrosis avidity of ¹³¹I-SA. Pharmacokinetic parameters showed that ¹³¹I-SA had fast blood clearance with an elimination half-life of 6.7?h. Various functional indexes were no significant difference (p?>?0.05) between before administration and 1 d, 8 d, 16 d after administration. Histopathology showed no signs of tissue damage.

4.?These data suggest ¹³¹I-SA is a safe and promising necrosis-avid agent applicable in imaging diagnosis and tumor necrosis targeted radiotherapy.