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    15 January 2021, Volume 18 Issue 1 Previous Issue    Next Issue

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    Role of Standards in Medical Device Evaluation
    ZHANG Shiqing, ZHANG Xingdong
    2021, 18(1): 1-3. 
    DOI: 10.19803/j.1672-8629.2021.01.01

    Abstract ( 409 )   PDF (1140KB) ( 260 )  
    Medical device standards are important reference for evaluation of medical devices.However,there has been little study on the role of standards in medical device evaluation or on ways to give full play to the technical support of standards.This article was intended to discuss the role of standards in medical device evaluation based on the work experience of the author and offer recommendations for personnel concerned.
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    Thoughts and Suggestions on Safety Evaluation of Combined use of Traditional Chinese Medicine in Clinical Research
    CHENG Jinlian, OUYANG Huitian, JIN Hongtao, ZHU Xueqi, XIAO Shuang, LEI Xiang, GAO Chunsheng, LIU Qingquan
    2021, 18(1): 4-10. 
    DOI: 10.19803/j.1672-8629.2021.01.02

    Abstract ( 415 )   PDF (1165KB) ( 463 )  
    Objective To study methods for safety evaluation of combined use of traditional Chinese medicine in clinical research in order to meet the needs of clinically safe and effective medication.Methods Starting with the clinical study of Traditional Chinese medicine,this paper analyzes the problems with the safety of combined use of traditional Chinese medicine in clinical study,and offers solutions to the major problems.Results A safety evaluation system for drug combination of TCM and Western medicine needed to be established and improved.Conclusion The safety evaluation of drug combination of TCM and Western medicine should start with the early stage of development and run through the life cycle of new drugs from clinical trial to post-marketing evaluation.Importance should be attached to research design and risk-benefit assessment.A dynamic research model of research design-monitoring evaluation-analysis prediction-risk management is to be adopted,and a multidisciplinary comprehensive assessment system established.
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    Mathematical Flaws of Commonly Used Calculating Methods of Multi-drug Combination and Solution Based on One Belt and One Line Model Method
    YUAN Shoujun
    2021, 18(1): 11-17. 
    DOI: 10.19803/j.1672-8629.2021.01.03

    Abstract ( 914 )   PDF (1697KB) ( 515 )  
    Multi-drug combination is very common in clinical settings of refractory diseases.The multi-level interactions between drugs will make difference to the efficacy of drugs,as drug combinations may either increase the efficacy and reduce the toxicity or bring the risk of decreased efficacy and increased toxicity.There are a number of calculation methods for quantitative evaluation of the synergy,addition and antagonism of multi-drug combination.However,many of the methods used in this industry are all consensus methods or empirical formulas,so that the same set of data is processed by different methods,and different and contradictory conclusions often arise.In this paper,we used mathematical methods to analyze the flaws of several commonly used calculation methods in the industry,including Loewe's equivalent line method,Bliss's independent model method,Chou's median effect method and Jin's method.And by introducing the mathematical law of efficacy addition in multi-drug combination found in our laboratory,we established a one-belt and one-line model,which can be used as a universal and reliable method for quantitative evaluation of efficacy in multi-drug combination,which is expected to help to fully uncover the benefits of multi-drug combination and minimize the risk of efficacy reduction and toxicity enhancement.
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    Research Progress in Safety of Herb-drug Interactions Mediated by Metabolizing Enzymes and Transporters
    WANG Shuting, QIU Caixia, WANG Fenglin, JIN Hongtao
    2021, 18(1): 18-23. 
    DOI: 10.19803/j.1672-8629.2021.01.04

    Abstract ( 169 )   PDF (1039KB) ( 188 )  
    Objective To analyze the possible mechanism by which drug metabolizing enzymes and transporters mediate herb-drug interactions (HDIs) and causes of adverse reactions,and summarize the data about potential interactions between commonly used herbs and conventional chemical drugs.Methods Such databases as PubMed,Web of Science and CNKI were searched with "herbs" "transporters" and "metabolizing enzymes" as the key words.Results The use of herbs combined with chemical drugs was not always conducive and safe.Herbs can mediate the activity of drug metabolic enzymes and transporters to produce HDIs,which can potentially lead to risks of adverse reactions.Conclusion Inappropriate combination of herbs and drugs will increase the chance of potential adverse reactions,and adverse reactions caused by herb-drug interactions deserve the attention of clinicians,pharmaceutical companies and drug regulators.
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    Acute and Subchronic Toxicity of Erdosten Ambroxol Hydrochloride Mixture by Gavage in Beagle Dogs
    WANG Shuting, LI Hui, WANG Jiangxue, ZHANG Zixuan, MU Wenbo, GUO Xinmiao, YE Xiangfeng, JIN Hongtao
    2021, 18(1): 24-29. 
    DOI: 10.19803/j.1672-8629.2021.01.05

    Abstract ( 401 )   PDF (1126KB) ( 785 )  
    Objective To observe the acute and subchronic toxicity after oral administration of erdostatin hydrochloride ambroxol mixture in Beagle dogs,and to provide reference for clinical safe dose design and toxicity monitoring.Methods Beagle dogs were selected for acute and 13-week subchronic toxicity tests.During the acute experiment,dogs were divided into erdostine hydrochloride ambromine mixture dose group (5.04 g/kg),erdostine hydrochloride group (4.80 g/kg),ambroxol hydrochloride group (0.24 g/kg) and blank control group using the maximum dose method.In the subchronic toxicity test,dogs were assigned to the high dose group (180 mg/kg),medium dose group (60mg/kg) and low dose group (20 mg/kg) of erdostine hydrochloride ambroxol mixture,while erdostine hydrochloride (171.4 mg/kg) group,ambroxol hydrochloride (8.6 mg/kg) group and blank control were also set up.The drug was given for thirteen consecutive weeks before the general condition,biochemical indexes and histopathology of the animals were examined.Results The results of acute toxicity tests showed that the main toxic reactions of animals were proneness,lethargy,tremor,inactivity and fatigue at a single dose (5.04 g/kg) of erdostatin hydrochloride ambroxol mixture,but these animals basically returned to normal on the second day,and the post-drug toxicity was similar to that of erdostine group and ambroxol hydrochloride group.The subchronic toxicity tests showed that at the end of administration and recovery,the levels of creatinine slightly increased in high dose group of erdostine hydrochloride ambroxol mixture and erdostine group,but no abnormality was found in the other groups.Conclusion The maximum dose of erdostatin hydrochloride ambroxol mixture was 5.04 g/kg in beagle dogs.Compared with erdosten (4.80 g/kg) and ambroxol hydrochloride (0.24 g/kg),the toxicity of the mixture group did not increase.The results of 13-week repeated administration of erdosten ambroxol hydrochloride mixture in beagle dogs showed that the middle dose (60 mg/kg)group had no observed adverse toxic reactions.This study may provide reference for clinical application of erdosten ambroxol hydrochloride mixture.
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    Early Warning of Risks of Sennae Folium to Constipation Patients with Breast Cancer by Bioinformatics
    MAO Qiuyue, LIN Zhijian, WANG Yu, ZHANG Bing, SA Yi
    2021, 18(1): 30-37. 
    DOI: 10.19803/j.1672-8629.2021.01.06

    Abstract ( 290 )   PDF (1886KB) ( 421 )  
    Objective To explore the potential adverse reactions of Sennae Folium in constipation patients with breast cancer based on the bioinformatics and warn the risks so as to provide reference for the research on rational use of drugs in constipation patients with breast cancer.Methods of bioinformatics were employed.The microarray data of GSE85871 was downloaded from GEO database,and analyzed by means of gene ontology annotation,Kyoto Encyclopedia of Genes and Genomes pathway analysis and protein-protein interaction networks.Results The analysis showed that when used in constipation patients with breast cancer,Sennae Folium might lead to melanosis coli,along with abnormalities of appetite,cell signaling,carbohydrate metabolism,inflammatory response,myocardial contraction and mood,thus affecting the development of breast cancer.Conclusion It is recommended that close attention should be paid to the body state of patients related to digestive,nervous,immune,cardiovascular systems and carbohydrate metabolism.Clinicians should keep track of the development of patients' preexisting disease.
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    Safety Comparison of Foscarnet and Ganciclovir in the Treatment of Cytomegalovirus Infection with AIDS
    XUE Xiaola, XIA Yuchao, LI Chaofeng, CHEN Yuanyuan
    2021, 18(1): 38-42. 
    DOI: 10.19803/j.1672-8629.2021.01.07

    Abstract ( 839 )   PDF (1148KB) ( 792 )  
    Objective To compare the safety of foscarnet and ganciclovir in the treatment of cytomegalovirus in patients with AIDS so as to provide reference for safe and rational use of drugs.Methods A total of 315 cytomegalovirus infection patients with AIDS treated with foscarnet or ganciclovir between January 2018 and January 2019 were collected,who were divided into the foscarnet group(n=155) and the ganciclovir group(n=160).Safety was evaluated after treatment.Results Foscarnet could induce regional numbness,twitch and abnormalities of electrolytes,while ganciclovir often led to myelosuppression and gastrointestinal reactions.The incidence of adverse reactions (ADR) in the foscarnet group(45.155) was statistically lower than in the ganciclovir group(72.50%).The withdrawal rate of foscarnet due to ADRs was 44.28%,compared with 64.66% for ganciclovir.The ganciclovir group was more likely to switch to an alternative treatment.After withdrawal of foscarnet or ganciclovir and symptomatic treatment,most of the symptoms disappeared and no serious sequelae or death occurred.Conclusion Foscarnet is safer than ganciclovir.According to the clinical manifestations of adverse reactions caused by foscarnet or ganciclovir,drugs that are likely to cause the same adverse reactions as the drugs being used should not be used to reduce the superposition of adverse reactions when AIDS patients are CMV infected.The incidence of ADRs,the withdrawal rate of foscarnet due to ADRs and the proportion of cases of switch to an alternative treatment in the foscarnet group are all lower than in the ganciclovir group,so foscarnet can be considered once ganciclovir is not tolerated.
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    Overview and Thoughts on WHO International Drug Monitoring
    FAN Rong, DONG Duo
    2021, 18(1): 43-46. 
    DOI: 10.19803/j.1672-8629.2021.01.08

    Abstract ( 687 )   PDF (1143KB) ( 471 )  
    This article was intended to review the history of the World Health Organization (WHO) Programme for International Drug Monitoring and the WHO Collaborating Centres,and to introduce the work of Uppsala Monitoring Center (UMC),including data management and technical support,scientific research,and WHO Drug Global so as to provide reference for future cooperation.
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    Issues Related to Expanded Access to Investigational Drugs for Compassionate Use
    MA Jing, GAO Jinghong, LIU Chunguang
    2021, 18(1): 47-51. 
    DOI: 10.19803/j.1672-8629.2021.01.09

    Abstract ( 321 )   PDF (1194KB) ( 344 )  
    Objective To study the laws and regulations and application approval by some foreign drug regulatory agencies concerning expanded access to investigational drugs for treatment use so as to provide reference for the design of related guidelines in China.Methods By referring to the laws and regulations,technical guidelines,annual reports and relevant literature issued by drug regulatory agencies of the United States and the European Union,the relevant concepts,categories,application requirements,risk and benefit assessment of drugs used in overseas extended clinical trials were analyzed in depth.Results and Conclusion Compassionate use of clinical trial drugs is a potential way in which patients obtain research drugs when they are suffering from serious diseases or life-threatening diseases that cannot be effectively treated with marketed drugs.As research drugs are not approved into the market,evidence about their safety and efficacy is lacking.In order to ensure the safety of subjects,ethical committees need to perform their duties by conducting strict examination of treatments.
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    Prevention of Harmful Drug Reactions in Pharmacovigilance System
    SONG Yingjie, WANG Haiyan, LI Yujia
    2021, 18(1): 52-55. 
    DOI: 10.19803/j.1672-8629.2021.01.10

    Abstract ( 491 )   PDF (1197KB) ( 486 )  
    The pharmacovigilance system is the most basic system for drug safety risk management throughout the life cycle of drugs,involving the detection,identification,assessment and prevention of harmful drug reactions.Among the four tasks,prevention,which is the most advanced element of the pharmacovigilance system compared with the adverse drug reaction monitoring system,is overlapping with the other three,which is why the research on prevention should be strengthened.By interpreting the concept of pharmacovigilance systems in China ,analyzing China's practices and summarizing foreign experience on prevention of harmful drug reactions,this paper proposes that we can strengthen the prevention of harmful drug reactions by enhancing the awareness of risk prevention in the early stage of drug research and development,making registration review and approval rigorous,attaching importance to the monitoring of adverse reactions in individual cases,formulating relief systems for drug misadventures,promoting the safety of medicine use,and encouraging exploratory research.
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    Global Trigger Tool for Monitoring Adverse Drug Events in Elderly Patients
    ZHANG Weiwei, WANG Na
    2021, 18(1): 56-63. 
    DOI: 10.19803/j.1672-8629.2021.01.11

    Abstract ( 286 )   PDF (1191KB) ( 262 )  
    Objective To evaluate the feasibility of global trigger tool (GTT) in monitoring adverse drug events in elderly patients.Methods Based on the triggers recommended by IHI Global Trigger Tool for Measuring Adverse Events and those used in domestic studies,and considering the scope of biochemical indexes,drug catalogues and prescription habits in the hospital,some triggers were adjusted.A total of 31 triggers were finally developed.The clinical records of 360 patients aged above 65 years and discharged from the Department of Geriatrics from December 26,2015 to December 25,2016 were randomly selected.These records were reviewed by GTT and related ADE were determined using the Naranjo method.All the ADE were evaluated for severity classification,drug classification and involved system - organs.Statistical analysis was conducted with SPSS software,version 21.0,for window.Results Among the 360 elderly patients,169 records were positive according to the GTT method,so the positive rate was 46.94%.Nineteen of the 31 triggers were positive.There were 98 ADE identified that involved 75 patients.The incidence of ADE was 20.83%.Ninety-seven cases were category E and one case was category F.A total of 9 classes of drugs were involved in ADE.The incidence of ADE induced by cardiovascular drugs was the highest (58.16%).Eleven system-organs were involved.The percentage of ADE related to metabolism and nutrition was 42.86%.Authenticity indexes of GTT included a sensitivity of 100.00%,a specificity of 67.02%,and a Youden's index of 0.67.As for reliability indexes,the consistency rate was 73.89%,Kappa value was 0.46 and PPV was 44.38%.Logistic regression analysis found that age,length of hospital stay,the number of medications,the number of positive triggers and the number of preexisting diseases were significantly correlated with ADE among the elderly patients.Conclusion The validity and reliability of GTT for monitoring ADE in elderly patients are good,and PPV is high,but some triggers need to be improved.
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    Analysis of 133 Cases of Adverse Drug Reaction Induced by Creatine Phosphate Sodium for Injection in Children
    XU Lili, TIAN Yuejie, XIE Yanjun, SUN Chunxiao, CHANG Hong, HUO Yanfei, WU Shifu, WANG Chunting
    2021, 18(1): 64-67. 
    DOI: 10.19803/j.1672-8629.2021.01.12

    Abstract ( 316 )   PDF (1185KB) ( 418 )  
    Objective To probe into the status,characterstics and influencing factors of ADR cases induced by creatine phosphate sodium for injection in children,so as to provide reference for clinic safe use of drugs.Methods We analyzed 133 ADR cases induced by creatine phosphate sodium for injection in children which were collected by Shandong adverse drug reaction monitoring database from January 1st 2009 to September 30st 2019.The patient's age,original diseases,ADR occurrence time,adverse drug reactions involved system and the manifestation etc were analyzed.Results The ADR induced by creatine phosphate sodium for injection in children mainly involved in skin and local lesions and systemic lesions,ADR occurred most frenquently within 1day of medication,hypocalcemia easy occurred in newborns patient,most patients were prematures.Conclusion Clinic should pay attention to the ADR induced by creatine phosphate sodium for injection in children.Drug manufacturers should strengthen research on children's medication and improve the drug package inserts so as to ensure the drug use safety.
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    Analysis of 688 Cases of Adverse Drug Reaction Induced by Misoprostol
    YUAN Sisi, WANG Yue, FENG Xin, FU Na
    2021, 18(1): 68-71. 
    DOI: 10.19803/j.1672-8629.2021.01.13

    Abstract ( 308 )   PDF (1112KB) ( 276 )  
    Objective To analyze the adverse drug reactions (ADR) induced by misoprostol,find out about the characteristics of such ADR and to provide technical support for safe clinical application of misoprostol.Methods Data on ADR of misoprostol between 2003 and 2018 was provided by Beijing Adverse Drug Reaction Monitoring Center.Statistical analysis was performed on the basic information of patients with ADR,types of ADR,involved system-organ and clinical manifestations,and outcomes.Results A total of 668 reports of ADR were included in the analysis.ADR mainly manifested themselves in gastrointestinal diseases,systemic diseases,skin and its appendage diseases,and nervous system diseases.There were a total of 5 cases of severe ADR,including one case of death,in which anaphylactic shock was observed.Conclusion Most of the patients who reported ADR were females who used misoprostil for abortion purposes.This indicates the need to strengthen the safe and rational use of misoprostol in clinic.Pharmaceutical care and intervention should be carried out for high-risk groups to make clinical medication safe,proper and effective.
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    Eight Cases of Hypocalcemia Induced by Tigecycline
    TAO Hong, SHEN Zhu, CAO Guowen, SHI Aiming, PAN Jie
    2021, 18(1): 77-79. 
    DOI: 10.19803/j.1672-8629.2021.01.15

    Abstract ( 307 )   PDF (1059KB) ( 215 )  
    Objective To improve the safety of clinical use of tigecycline.Methods Patients with hypocalcemia caused by tigecycline were screened from July 1,2018 to June 30,2019 with active monitoring software for adverse reactions before data was analyzed using electronic medical records and adverse reaction criteria.Results The use of tigecycline was associated with hypocalcemia.Conclusion It is recommended that the monitoring of serum calcium be enhanced when tigecycline is used in clinic.
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    Pharmaceutical Intervention for Pulmonary Embolism in a Rectal Cancer Patient Treated with New Assisted Chemotherapy
    QU Guohong, CHEN Zhe
    2021, 18(1): 80-83. 
    DOI: 10.19803/j.1672-8629.2021.01.16

    Abstract ( 154 )   PDF (1012KB) ( 186 )  
    Objective To introduce the pharmaceutical disposal one case of pulmonary embolism induced by bevacizumab.Methods Two clinical pharmacists participated in the evaluation of adverse reactions of pulmonary embolism induced by bevacizumab in combination with chemotherapy by consulting related literature and guidelines.Based on the patient's condition and willingness,the pharmacist gave advice on the selection of anticoagulants.Results The clinical pharmacists recommended solutions to the ADR,the physician adopted the recommendation,the patient's pulmonary embolish was well controlled.Conclusion Clinical pharmacists are expected to cooperate with clinicians,give a top priority to the safety of patients and give advice on clinical rational drug use.
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    One case of Hypersensitivity Syndrome Induced by Oxcarbazepine Combined with Olanzapine and Piropilone
    LI Huanfen, WANG Jinbao, WANG Laihai, ZHANG Ruiling
    2021, 18(1): 84-86. 
    DOI: 10.19803/j.1672-8629.2021.01.17

    Abstract ( 268 )   PDF (813KB) ( 714 )  
    Objective To analyze the drug-induced hypersensitivity syndrome (DISH) caused by the combination of oxcarbazepine,olanzapine and piropilon.Methods The clinical data about one patient with schizophrenia who developed fever,redness of the skin with rash and abnormalities of the blood system caused by olanzapine,oxcarbine and piropilon was analyzed based on related literature at home and abroad.Results and Conclusion Oxcarbazepine is probably an allergenic drug that causes DISH.However,genetic testing before drug administration is still not easily accessible,so early identification of DISH and quick drug discontinuation are the keys to reducing severe adverse reactions.
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    One Case of Cesarean Scar Pregnancy with Severe Aphthous Ulcer and Ⅲ Degree Myelosuppression Induced by Methotrexate
    HE Shouyun, WU Yingqi
    2021, 18(1): 87-89. 
    DOI: 10.19803/j.1672-8629.2021.01.18

    Abstract ( 167 )   PDF (1026KB) ( 115 )  
    Objective To provide reference for more rational clinical use of methotrexate in order to reduce adverse drug reaction(ADR) and treatment methods after ADR.Methods Clinical pharmacists participated in a case for cesarean scar pregnancy with severe aphthous ulcer and III degree myelosuppression caused by methotrexate chemotherapy ,analyzed the ADR causes,prevention and cure,and pharmaceutical care.Results The ADR of methotrexate can be avoided or alleviated through the detection of MTHFR genotype in patients and preventive measures in advance.Conclusion The participation of clinical pharmacists in the treatment of patients can provide pharmaceutical care and medication education for patients,improve the level of clinical treatment,and provide more safe,effective,economical and reasonable pharmaceutical care for patients.
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    Pharmaceutical Care for Drug-induced Liver Injury in a Patient with Idiopathic Thrombocytopenic Purpura Complicated with Pulmonary Thromboembolism
    WANG Yingkai, CUI Xiangli, LIU Lihong
    2021, 18(1): 90-93. 
    DOI: 10.19803/j.1672-8629.2021.01.19

    Abstract ( 243 )   PDF (1067KB) ( 209 )  
    Objective To study the importance of pharmaceutical care through a clinical pharmacist involved in the treatment of a patient with idiopathic thrombocytopenic purpura,pulmonary thromboembolism,and drug-induced liver injury.Methods A clinical pharmacist assisted the physician in selecting an anticoagulant and its dose,adjusting the hepatoprotective drug,and identifying the drug that might have caused liver damage in a patient with primary thrombocytopenia and pulmonary thromboembolism so that the physician was able to make an individualized treatment plan.Results After treatment,the patient's liver functions basically returned to normal,and the anticoagulation medication was safe and effective.Conclusion Clinical pharmacists' participation in pharmaceutical care can improve the efficacy of medication and ensure the safety of patients.
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    Research Progress on Pharmacological Effects and Toxicity of Gardenia jasminoides Ellis and Related Mechanisms
    WANG Xiaohui, ZHANG Fan, XI Lili, XIA Wenbin, WEI Yuhui
    2021, 18(1): 94-99. 
    DOI: 10.19803/j.1672-8629.2021.01.20

    Abstract ( 434 )   PDF (1121KB) ( 213 )  
    Gardenia jasminoides Ellis (G.jasminoides)is a commonly used traditional Chinese medicine and also a healthy food in China.It is mainly used for the treatment of acute/chronic viral hepatitis,hyperbilirubinemia,children's fever,hyperlipidemia and diabetes,with significant pharmacological effects.However,in recent years,more reports and studies have suggested that G.jasminoides has apparent toxicity and results in adverse effects,which restricts clinical administration of G.jasminoides.Therefore,in order to improve the rational use of G.jasminoides in clinic,enhance the efficacy of G.jasminoides and prevent or reduce the toxicity caused by gardenia,this review summarized the pharmacological effects and toxicity of G.jasminoides and the relatedt mechanisms.
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