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    15 August 2022, Volume 19 Issue 8 Previous Issue    Next Issue

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    Nonclinical research on CAR-T cell products: main concerns and key issues
    HUANG Ying, HOU Tiantian, QIN Chao, HUO Yan, WANG Sanlong, WEN Hairuo, GENG Xingchao
    2022, 19(8): 813-816. 
    DOI: 10.19803/j.1672-8629.2022.08.01

    Abstract ( 160 )   PDF (1106KB) ( 185 )  
    Objective To explore the main contents and key issues of non-clinical research on chimeric antigen receptor T (CAR-T) cell products, and to provide useful references for the research and development of CAR-T products. Methods According to the characteristics of CAR-T products, based on the evaluation practice of CAR-T cell products in our center, combined with the non-clinical research status of CAR-T cells at home and abroad and relevant literature reports, the research contents and main concerns of non-clinical safety evaluation of CAR-T cells were summarized. Results The latest progress and academic opinions on the selection of animal models, pharmacodynamic evaluation, toxicity study and biological distribution study in the non-clinical evaluation of CAR-T products were expounded and suggestions were put forward. Conclusion CAR-T cells, as a complex new biotherapy product, may have a variety of safety risks when used in vivo. In the non-clinical study of CAR-T cells, the design and test shall be carried out according to the product characteristics and specific conditions, in combination with relevant domestic and foreign standards, technical requirements and development trends.
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    In vivo pharmacodynamics of two CD19-targeting CAR-T cells immunotherapy
    WEN Hairuo, HUANG Ying, QU Zhe, QIN Chao, WANG Sanlong, LOU Xiaoyan, GENG Xingchao, YU Lei
    2022, 19(8): 817-822. 
    DOI: 10.19803/j.1672-8629.2022.08.02

    Abstract ( 96 )   PDF (2708KB) ( 109 )  
    Objective To evaluate the efficacy of two CD19-targeting chimeric antigen receptor gene modified T cells (CAR-T) in tumor-bearing immunodeficient mice so as to provide a reference for the in vivo pharmacodynamics evaluation of related products. Methods Firefly luciferase-labeled Raji cell (Raji-Luc) xenograft model was established in B-NDG mice, and both cell A and cell B (compared with cell A, on the basis of expressing the CAR structure, cell B express the IL-6 silencer fragment to interfere with the expression of IL-6) were administered for single time on this basis, and continuedly observed until 84 days after administration. The survival rate, clinical symptoms, body weight changes, fluorescence intensity of Raji-Luc cells in vivo and histopathological changes of mice were investigated. Results Both cell A and cell B could significantly prolong the survival time of tumor-bearing mice, slow down the weight loss caused by Raji-Luc cells to a certain extent, effectively alleviate the clinical manifestations caused by the loading of Raji-Luc cells, and significantly reduce Raji-luc in vivo. The fluorescence intensity of cells significantly reduced the incidence of lymphoma in various tissues and organs of Raji-Luc cell model animals, and the changes were dose-related. Conclusion The cause of death of animals in the CAR-T treatment group may be related to the continuous consumption of the tumor and the progressively worsening background lesions. Both cell A and cell B showed a certain pharmacodynamic effect in Raji-Luc tumor-bearing B-NDG mice, and there was no significant difference in the pharmacodynamics.
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    Biodistribution study of CAR-T cells in non-bearing-tumor and tumor-bearing severe immunodeficient mice
    HOU Tiantian, LI Xuejiao, SUN Lei, QIN Chao, ZHAO Jing, HUO Yan, WANG Yu, GENG Xingchao, HUANG Ying
    2022, 19(8): 823-827. 
    DOI: 10.19803/j.1672-8629.2022.08.03

    Abstract ( 88 )   PDF (2351KB) ( 107 )  
    Objective To investigate the proliferation, distribution and persistance of chimeric antigen receptor T(CAR-T)cells in non-bearing-tumor and tumor-bearing severe immunodeficient mice. Methods Non-bearing-tumor mice: The mice received intravenous infusions of CAR-T-FLuc cells that were transduced with firefly luciferase. CAR-T-FLuc cells were monitored by in vivo imaging system at different time points. The animals were sacrificed at 3 hours, 2 days, 7 days, 14 days, 28 days, 56 days, 84 days respectively. Blood, heart, liver, spleen, lung, kidney, brain, testis, epididymis, uterus, ovary, stomach, duodenum, bone marrow, fat, skeletal muscle were taken successively. By QPCR, the distribution of CAR-T-FLuc cells were detected in these apparatuses and peripheral blood. Tumor-bearing mice: A tumor model was established, mice were injected with Raji cells via the tail vein, and then the mice were intravenous injected with CAR-T-FLuc. The expression of CAR-T-FLuc cells in vivo and at different time points in various tissues were investigated by the same detection method as in non-tumor-bearing mice. Results In non-bearing-tumor mice: CAR-T-FLuc cells were mainly distributed in the lung and spleen, followed by blood. At 3 hours after administration, the cells were mainly distributed in the lung and then transferred to other organs. The expression of CAR of each organ was higher at 2 days, 14 days and 56 days. And CAR expression was close to zero at 84 days. In tumor-bearing mice: CAR-T-FLuc cells were mainly distributed in the spleen, followed by the lung and blood. CAR expression was detected in peripheral blood 5 minutes after administration, and 1 day, 6 days and 27 days were the peak time of CAR expression. In most tissues, CAR-T cells were detected 3 hours after drug administration, with the highest content in the lungs, followed by a downward trend, and the lowest at 15 days. After that, the CAR-T cell content of each tissue continued to rise, reaching a peak at 55 days. Conclusion CAR-T-FLuc cells are mainly distributed in the spleen, lung and blood in non-tumor-bearing mice and tumor-bearing mice, but the distribution trends in both animals are different. The amplification level in tumor-bearing mice was higher than that in non-tumor-bearing mice.
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    Pre-clinical toxicity evaluation of CAR-T cells for the treatment of non-Hodgkin's lymphoma
    WEN Hairuo, HUANG Ying, QU Zhe, JIANG Hua, LAN Jie, LOU Xiaoyan, GENG Xingchao, WANG Sanlong, YU Lei
    2022, 19(8): 828-835. 
    DOI: 10.19803/j.1672-8629.2022.08.04

    Abstract ( 86 )   PDF (2855KB) ( 97 )  
    Objective To evaluate the pre-clinical safety of chimeric antigen receptor T cells named U cells for non-Hodgkin's lymphoma in tumor-bearing immunodeficient mice. Methods The transplanted tumor model of Raji-Luc cells was established in NSG mice, and on this basis, U cells were given at a single dose and the mice were observed continuously until the 8th week after administration. Then the fluorescence intensity of Raji-Luc cells, survival rate, clinical symptoms, changes of body weight, hematological indexes, classification of lymphocyte subsets, cytokines and histopathological changes in mice were investigated. Results U cells could significantly reduce the fluorescence intensity of Raji-Luc cells in vivo, inhibit the proliferation of Raji-Luc cells, effectively alleviate the clinical manifestations caused by Raji-Luc cells, slow down the weight loss caused by Raji-Luc cells to some extent in tumor-bearing mice, prolong the survival time of tumor-bearing mice, increase the level of human IFN- γ, decrease the level of human IL-10 in serum of tumor-bearing mice, and increase the levels of murine TNF and IL-6, and significantly decrease the production of Raji-Luc cells, which changes in the incidence of lymphoma in various tissues and organs of model animals were dose-related. Conclusion U cells have no obvious immunotoxicity and tumorigenicity risk, and show some pharmacodynamic effects in Raji-Luc NSG mice. Given the above, the data of this study can provide a reference for the non-clinical safety evaluation of related products.
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    Cloning ability of CAR-T cells in soft agar and tumorigenicity in vitro
    HUANG Ying, WEN Hairuo, HOU Tiantian, HUO Yan, WANG Sanlong, GENG Xingchao
    2022, 19(8): 836-838. 
    DOI: 10.19803/j.1672-8629.2022.08.05

    Abstract ( 127 )   PDF (1261KB) ( 104 )  
    Objective To study whether CAR-T cells formed clones in soft agar, so as to evaluate its tumorigenicity in vitro and to provide safety data for future clinical use. Methods CAR-T cells were mixed with soft agar at different densities (1 000 ~ 5 000 per well) on 6-well culturing plates. Hela cells were set as positive control to count the clone formation rate. Results There were no cell colonies in the control group and the low (1 000 per well), medium (2 000 per well) and high dose groups (5 000 per well) within 14 days after culture. There were cell colonies in the positive control group at 14 days. Conclusion CAR-T cells do not have the ability to form soft agar clones in vitro . The tumorigenicity of CAR-T cells in vitro can be preliminarily investigated by using soft agar clone formation assay.
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    Complex network analysis of combined regimens of Xiyanping injection in the treatment of hand-foot-mouth disease
    DU Ying, WANG Zhifei, XIE Yanming, WANG Lianxin, LI Lixun, LIU Zhishuai
    2022, 19(8): 839-844. 
    DOI: 10.19803/j.1672-8629.2022.08.06

    Abstract ( 110 )   PDF (1578KB) ( 87 )  
    Objective To obtain the combined medication schemes of Xiyanping injection in the treatment of hand-foot-mouth disease in the real world. Methods The clinical data on patients with hand-foot-mouth disease treated by Xiyanping injection between December 1, 2006 and June 30, 2016 was collected from 28 large hospitals in China and analyzed with the Tabu search algorithm. Complex network modeling of large but high-quality data in the real-world research was attempted. Results The data on combined medications of a total of 19 999 patients was harvested. Based on the sub structure group of categories of core combinations with western medicine, the most frequently used combination was Xiyanping injection + vitamins, followed by Xiyanping injection + interferons and Xiyanping injection + immune enhancers. The most frequently used core combination with traditional Chinese medicine was Xiyanping injection + antipyretics, followed by Xiyanping injection + formula for resuscitation and Xiyanping injection + antipyretics or antidotes. Conclusion Xiyanping injection is often used in combination with other drugs in the treatment of mild and severe hand-foot-and mouth disease .
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    Clinical characteristics and drug combination analysis of elemene injectable emulsion in the elderly in the real world
    DONG Hanshuo, SUN Li, ZHAO Xiaoxiao, WANG Lianxin, YU Xiaokang, XIE Yanming
    2022, 19(8): 845-850. 
    DOI: 10.19803/j.1672-8629.2022.08.07

    Abstract ( 88 )   PDF (2469KB) ( 78 )  
    Objective To analyze the clinical characteristics and drug combination of elemene injectable emulsion in the treatment of the elderly in the real world so as to provide reference for clinical use. Methods The clinical data on 1 887 senile patients treated with elemene injectable emulsion from 21 big hospitals in China between January 1, 2003 and July 31, 2019 was analyzed based on the Hospital Information System(HIS). The clinical characteristics of the patients were determined based on the frequency and composition ratio, and association rules were used to analyze combined medications. Results The clinical data on 1 887 elderly patients who had been treated with at least one elemene emulsion injection was collected. Most of the patients were admitted in the early summer. Male patients outnumbered female ones and their age averaged 72.27. Patients with mild symptoms accounted for the largest proportion and were treated in the Center of Oncology. The average length of hospital stay was 31.81 days. Malignant tumors, hypertension and lung infections were prevalent among these patients. Intravenous infusion was the dominating administration route in line with the instructions. The average single dosage was 97.05 mL, and the average days of medication were 6.88. The top five drug combinations were listed in order of frequency: vitamins, dexamethasone, insulin for injection and similar drugs, thymosin, and furosemide. The top five types of combined drugs were ranked in order of frequency: anti-tumor drugs, immunostimulants, antibacterial drugs, mineral supplements and vitamins. Conclusion In clinical practice, it is worthy of note that many diseases are associated with elderly patients, and the combination of multiple drugs is common. In addition, the elderly tend to have a poor knowledge of safe drug use, which is likely to cause adverse drug reactions/events.
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    The drug combination of Danshen Ligustrazine injection in the real world
    ZHANG Hongwei, LI Yuanyuan, XIE Yanming, MA Xiaochang, WANG Lianxin, WEI Ruili, SUN Linxi, XU Hongyan, ZHUANG Yan
    2022, 19(8): 851-856. 
    DOI: 10.19803/j.1672-8629.2022.08.08

    Abstract ( 96 )   PDF (1245KB) ( 86 )  
    Objective To summarize the category of combined medication of Danshen Ligustrazine injection in the real world so as to provide reference for clinical use. Methods The category of Chinese medicine and western medicine in 38 126 patients treated with Danshen Ligustrazine Injection from 24 tertiary first-class hospitals in China from February 10, 2010 to June 19, 2019 were analyzed. Results The top three categories of the two Chinese medicines that were most commonly used in combination were listed: clearing heat and detoxifying agent combined with promoting blood circulation. Blood stasis removing agent, nourishing agent combined with activating blood and removing blood stasis agent, anti-surface agent combined with promoting blood circulation and removing stasis agent. The top three categories of the three Chinese medicines that of were listed: expectorant combined with external-relieving agent and blood-activating and stasis-removing agent, expectorant Combine heat-clearing and detoxifying agent with blood-activating and stasis-removing agent. The top three categories of the two western medicines that were most commonly used in combination were listed: anticoagulant thrombolysis and antiplatelet drugs combined with antibiotics, acid suppressants combined with antibiotics, electrolyte balance regulators combined with antibiotics; the most commonly used combined drugs. The top three categories of the three western medicines that of were listed: acid-suppressing drugs combined with anticoagulation and thrombolysis, antiplatelet drugs and antibiotics, electrolyte balance regulators combined with anticoagulant thrombolysis and antiplatelet drugs and antibiotics, acid-suppressing drugs Combined electrolyte balance regulators and antibiotics. Conclusion Danshen Ligustrazine injection has many types of combined drugs in clinical practice. Clinicians should be alert to adverse drug reactions caused by drug-drug interactions in clinical practice
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    The medication of Breviscapine injection in the treatment of angina pectoris in the real world
    ZHANG Lei, LI Yuanyuan, XIE Yanming, WANG Lianxin, YANG Xiaochen
    2022, 19(8): 857-861. 
    DOI: 10.19803/j.1672-8629.2022.08.09

    Abstract ( 121 )   PDF (1656KB) ( 91 )  
    Objective To explore the correlation of therapeutic effect and dosage of Breviscapine injection in the treatment of angina pectoris in the real world so as to provide reference for clinical use. Methods The clinical data on 2 181 patients treated with Breviscapine injection in the treatment of angina pectoris from 37 big hospitals in China between May 20, 2002 and November 8, 2019 was analyzed based on the hospital information system(HIS). The software of SAS 9.2 was used to process data first and SPSS Clementine 21.0 was used to analyze the correlation of therapeutic effect and dosage. Results Among the 2 181 patients, most of them were elderly patients who mostly have comorbidities with essential hypertension. Among the 3 174 cases of intravenous administration, 2 009 cases (63.30%) of the doses beyond the instructions were used. The top three drug combinations were listed in order of frequency: aspirin, metoprolol and amlodipine, which were commonly used drugs for the treatment of angina pectoris. 1 569 patients had effective outcome indicators. Analysis of the relationship between the dosage and therapeutic effect showed that within the range of the prescribed dosage, the cure rate and recovery rate of 50 mg were higher. At the off-label dosage, the cure rate and recovery rate of 100 mg were higher. The results of chi-square test and regression analysis showed that the effect of the control group better than breviscapine injection when dealing with angina pectoris. Conclusion Clinical treatment should adhere to the principle of safe drug use and rational drug use under standardized guidance. The drug combination of Breviscapine injection in the treatment of angina pectoris could help to improve the clinical benefit. It will works better when administered intravenously at a dose of 50 mg once a day.
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    Effect of smilax glabra extract on intestinal barriers in mice with antibiotic-associated diarrhea: an experimental study
    JIANG Zhuoxi, LIN Zhijian, ZHANG Bing, WANG Yu, XU Huizhe, MAO Qiuyue
    2022, 19(8): 862-867. 
    DOI: 10.19803/j.1672-8629.2022.08.10

    Abstract ( 74 )   PDF (2274KB) ( 71 )  
    Objective To investigate the protective effects of smilax glabra extract on intestinal barriers in mice with antibiotic-associated diarrhea. Methods Mice were divided into six groups. Amodel of ntibiotic-associated diarrhea mice was induced by ig administration of lincomycin hydrochloride. During the experiment, the incidence of diarrhea and body weight changes of mice in each group were observed, and the colonic contents of mice were collected to culture four floras: Bifidobacterium, Lactobacillus, Escherichia coli, Enterococcus. Levels of serum total protein (total protein, TP), albumin and secretory immunoglobulin A (secretory immunoglobulin A, sIgA) were observed. HE staining was used to observe intestinal pathology. Results Levels of STP, albumin, sIgA and numbers of Bifidobacterium and Lactobacillus were decreased significantly compared with the normal group. At the same time, there were some pathological changes in intestinal histology as shown by the increased number of Escherichia coli and Enterococcus. Smilax glabra could raise the levels of STP, albumin and sIgA in antibiotic-associated diarrhea mice, and improve the injured intestinal histology and disordered intestinal flora by decreasing the number of Escherichia coli and Enterococcus faecalis and increasing the number of Bifidobacterium and Lactobacillus. Conclusions milax glabra can improve antibiotic-related diarrhea by protecting the intestinal barriers.
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    Gene mutation risk assessment of phenolic compounds
    WEN Hairuo, YE Qian, YANG Ying, SONG Jie, WANG Qi, WANG Xue
    2022, 19(8): 868-872. 
    DOI: 10.19803/j.1672-8629.2022.08.11

    Abstract ( 72 )   PDF (1206KB) ( 81 )  
    Objective To evaluate the mutation risk of phenolic compounds using toxicity prediction software and bacterial reverse mutation test (Ames test). Methods The mutagenic risk of a series of phenolic compounds was predicted by toxicity software, and the six-well plate Ames test was performed at different doses, and with or without S9 metabolism, to determine the effects of different substituents on the benzene ring of these compounds on their mutagenicities. Results It was predicted by software that these compounds were all mutagenic based on the presence of hydroxybenzene rings. Under non-S9 metabolic activation, p-chlorophenylacetamide led to an increase in the number of the revertants of TA98, while p-nitrochlorobenzene increased the number of the revertants of TA100 and TA102. Under the metabolic activation of S9, p-nitrochlorobenzene led to an increase in the number of the revertants of TA100 and TA1535, and the increase was far more significant than that without metabolic activation, so there was a concentration effect correlation. Conclusion There are bacterial mutagenicities of p-chlorophenylacetamide and p-nitrochlorobenzene, and the mutagenicity of p-nitrochlorobenzene increases after metabolic activation. It is of great value to carry out related research to evaluate its toxicity risk for rational regulation of such compounds.
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    Establishment of transgenic zebrafish model regulated by nr1h4 and related studies
    LIU Caiping, CHAO Bao, FENG Yuanzhou, SUN Lan, LUO Yuan, YANG Jingfeng, DONG Wu, WANG Yongan, LI Yueting, ZHAO Baoquan
    2022, 19(8): 873-880. 
    DOI: 10.19803/j.1672-8629.2022.08.12

    Abstract ( 57 )   PDF (2244KB) ( 49 )  
    Objective A tissue-specific fluorescent labeled transgenic zebrafish model of farnesol X receptor (FXR, gene name nr1h4) was established to provide a visual detection animal model for the screening and safety warning of drugs related to bile acid metabolism. Methods The regulatory sequence of nr1h4 in zebrafish was found on UCSC website and optimized by promoter 2.0 software. Primers were designed and the nr1h4 regulatory sequence of zebrafish was obtained by PCR and constructed at the cloning site of pT2AL200R150G transposable vector. Then pTol2- nr1h4-EGFP plasmid and pCS-TP transposase mRNA were co-injected into zebrafish fertilized egg single cells to screen fluorescent individuals specifically expressed in liver and intestine, and Tg (-1.6nr1h4-EGFP) zebrafish strain was established through genetic screening. Tg (-1.6nr1h4: EGFP) zebrafish larvaes at the fourth day post fertilization were randomly divided into blank control group, solvent control group, glycine-β-muricholic acid group, obeticholic acid group, and low, medium and high concentration (10, 20 and 40 μg·mL-1) ursodeoxycholic acid group, danning tablet group, rhein group and aloe-emodin group, and were administered continuously for 4 days. And the fluorescence intensity and development of transgenic zebrafish in each group at different times were observed for 4 days, and the fluorescence intensity was analyzed. Results Tg (-1.6nr1h4: EGFP) fluorescent labeled transgenic zebrafish strain was successfully established. Green fluorescence was expressed in the abdomen of zebrafish from the somite stage and mainly concentrated in the liver and intestine at the fourth day post fertilization. Compared with the blank control group, the fluorescence expression level of transgenic zebrafish in glycine-β-muricholic acid group decreased significantly at each administration time (4dpf: P< 0.01; 5~7dpf: P<0.000 1), the fluorescence in obecholic acid group increased significantly at each administration time (P<0.000 1), and there was no significant difference between solvent control group and blank control group, which indicate the effective establishment of the model. Compared with the blank control group, the fluorescence expression level of transgenic zebrafish in low concentration ursodeoxycholic acid group and aloe-emodin group increased gradually from 2 to 4 days after administration (P<0.000 1), and in medium concentration ursodeoxycholic acid group and aloe-emodin group inecreased significantly at each administration time (P<0.000 1), and the fluorescence in high concentration aloe-emodin group increased gradually from 2 to 4 days after administration (5~6dpf: P<0.001; 7dpf: P<0.05), but the fluorescences were almost same between high concentration ursodeoxycholic acid group and blank control group. The fluorescence expression level of transgenic zebrafish in low concentration danning tablet group and rhein group were not different from that of blank control group at each administration time, and the fluorescence in medium concentration danning tablet group increased significantly at each administration time (4 and 7dpf: P<0.000 1; 5 and 6dpf: P<0.001) and in high danning tablet group still increased significantly at each administration time (P<0.000 1), and the fluorescence in medium concentration rhein group increased gradually from 2 to 4 days after administration(5dpf: P< 0.000 1; 6dpf: P<0.001; 7dpf: P<0.01) while in high concentration rhein group began to decrease from 2 to 4 days after administration (P<0.000 1). Conclusion Tg (-1.6nr1h4-EGFP) zebrafish model provides a new animal model for the study of bile acid drug mechanism, drug screening and safety evaluation. Low and medium concentration ursodeoxycholic acid, medium and high concentrationcan danning tablet, medium concentration rhein and all concentration aloe-emodin can promote bile acid transport by up-regulating FXR expression in zebrafish liver and intestine, while high concentration ursodeoxycholic acid have no significant effect on FXR, and high concentration rhein inhibit FXR expression.
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    Study on the mutagenic risk of nitrosamine compounds
    YE Qian, WANG Qi, YU Min, WANG Xue, GENG Xingchao, ZHANG Leshuai, WEN Hairuo
    2022, 19(8): 881-888. 
    DOI: 10.19803/j.1672-8629.2022.08.13

    Abstract ( 115 )   PDF (1418KB) ( 86 )  
    Objective To evaluate the mutagenic risks of 17 nitrosamine compounds using toxicology software and bacterial reverse mutation test, and explore the relationship between the substituent structure of nitrosamine compounds and their mutagenicity risk. Methods Derek Nexus and Sarah Nexus were used to predict the mutagenic risks of 17 nitrosamine compounds, and 6-well plate-based bacterial reverse mutation test of Salmonella typhimurium TA97, TA98, TA100, TA102, TA1535 and TA1537 in the absence and presence of rat S9 metabolic activation conditions was performed respectively, to evaluate their mutagenicity risks. Results Based on the nitroso structure, Derek Nexus predicted that 16 nitrosamines (excluding NDPh) had mutagenic risks. Sarah Nexus suggested all the 17 nitrosamines were mutagenic, whereas the mutagenic risks of NMEA, NEIPA and NDIPA were relatively lower. Under non-S9 metabolic activation conditions, except for NMPEA, the bacterial reverse mutation test results of all nitrosamine compounds were negative. NMPEA could only induce an increase in the number of revertants of TA1537 strain. Under rat S9 metabolic activation, NDEA, NMOR, NDPA, NPIP and NPYR showed positive results in all the TA97, TA100 and 1535 strains, and NDMA、NMEA、NEIPA、NDBA、NMPA、NNK、NDELA、NDPh and NMPEA were also positive in at least one of TA97, TA100 and TA1535 strains. Conclusion Mutagenicities of nitrosamine compounds are related to the factors of number of α-hydrogens and substitution of α-hydrogens, the presence of branched or larger/nonmetabolizable groups, and the stability of the formed diazonium ions in alkyl nitrosamine compounds, etc. This study provides the latest in vitro mutagenicity and DNA damage test data of nitrosamine compounds, validates the effect of substituent structure on the mutagenic potency of nitrosamine compounds, and can provide data support for their regulation.
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    Analysis of neuropsychiatric adverse reactions caused by zolpidem
    ZHUANG Hongyan, ZANG Yannan, LIU Shanshan, NIU Mengxi, FANG Meng, YIN Dongqing, GUO Wei
    2022, 19(8): 889-892. 
    DOI: 10.19803/j.1672-8629.2022.08.14

    Abstract ( 203 )   PDF (1280KB) ( 150 )  
    Objective To analyze the reports of adverse drug reactions(ADR) in the neuropsychiatric system caused by zolpidem, and explore the characteristics and patterns of adverse reactions, and to promote rational use of new hypnotic drugs in clinical practice. Methods Six cases of neuropsychiatric ADR caused by zolpidem reported in our hospital from January 1, 2004 to December 31, 2021 were selected and analyzed. Medications, ADR, treatments and outcomes of the patients were analyzed. The characteristics of neuropsychiatric ADR caused by zolpidem were studied. Results All the six patients were female. Most of the patients had adverse reactions soon after taking zolpidem. ADR occurred on the very night this drug was taken in most patients, and only one case of amnesia occurred on the 5th day after taking the drug. The clinical manifestations of adverse reactions included the inability to recall the abnormal behavior of the previous night and unclear consciousness. After the onset of adverse reactions, the patients discontinued this drug and shifted to other sedative and hypnotic drugs, and the symptoms were relieved or returned to normal. Conclusion ADR of the nervous system caused by zolpidem, delirium and suspected delirium make up a large proportion. There are still the chances of adverse reactions at normal daily doses. Women may be more prone to neuropsychiatric ADR after taking zolpidem, and adverse reactions should be closely monitored at the beginning of treatment, especially on the night of treatment. The indications of drugs should be kept in mind in clinical practice to ensure the safety of drug use.
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    Clinical efficacy of Trollius chinensis preparation against upper respiratory tract infection: a Meta analysis
    LIN Qiqi, ZHAO Nan, SUN Qi, WANG Lin, MENG Fanhao
    2022, 19(8): 893-896. 
    DOI: 10.19803/j.1672-8629.2022.08.15

    Abstract ( 85 )   PDF (2156KB) ( 88 )  
    Objective To evaluate the efficacy of Chinese patent medicines related to Trollius chinensis (Trollius granules, Trollius tablets) as against other drugs (ribavirin, Fufang Caoshanhu Hanpian) in the treatment of upper respiratory tract infections. Methods Related literature was searched for and collected from PubMed, Cochrane Library, CBM, CNKI, VIP and Wangfang database from inception to August 30, 2020 with Trollius chinensis and upper respiratory tract infection as the keywords. Literature was screened and data was extracted according to the inclusion and exclusion criteria. RevMan5.3 software was used for assessment of the risk of bias of the included studies and for data analysis. Results Seven randomized controlled trials were included involving 1 178 patients totally. The result of Meta analysis showed that the total effective rates of experimental groups (Trollius granules and Trollius tablets) against upper respiratory tract infections were higher than those of the control groups(ribavirin and Fufang Caoshanhu Hanpian) respectively. Conclusions uch patent Chinese medicines as Trollius granules and Trollius tablets have better clinical efficacy against upper respiratory tract infections than other drugs and clinical application could be considered. However, the samples of the included studies are not enough and the included studies have a higher risk of bias. This conclusion needs to be further verified by more high-quality, multi-center, large-sample random experiments.
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    Incidence and monitoring of AEFI of EV71 vaccine in Zhejiang province
    PAN Xuejiao, SHEN Lingzhi, LIANG Hui, TANG Xuewen, FU Jian, DING Linling, LYU Huakun
    2022, 19(8): 897-899. 
    DOI: 10.19803/j.1672-8629.2022.08.16

    Abstract ( 96 )   PDF (1155KB) ( 96 )  
    Objective To evaluate the safety of EV71 vaccine in Zhejiang province. Methods Based on the results of active and passive monitoring and using the AEFI subsystem, the data on AEFI related to EV71 vaccine in Zhejiang province from Jan 1, 2016 to Dec 31, 2019 was collected and analyzed with descriptive epidemiological methods. Results 1 830 cases of AEFI following EV71 vaccination were reported in Zhejiang province over the four years and the estimated incidence was 72.23 per 100 000 doses. Among them, 202 cases of abnormal reactions were reported and the incidence was estimated to be 7.97 per 100 000 doses. The ratio of males to females was 1.17:1 among these cases. 81.92% of the cases of AEFI involved patients between 6 and 24 months old. 51.53% of the cases occurred between April and July. 1 283 cases (70.11%) of adverse reactions started after the first dose and 1 180 cases (64.48%) within one day of vaccination. The symptoms of common adverse reactions ranged from fever, local swelling, induration to anaphylactic rashes. 79.45% of the cases of AEFI eventually recovered. Conclusion EV71 vaccine used in Zhejiang province is safe. Active monitoring is more sensitive than passive monitoring, but monitoring methods need to be optimized.
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    Pareto chart analysis of 705 problematic prescriptions in neurology
    WEI Hongtao, SHEN Su, LI Dandan, LIAO Yin
    2022, 19(8): 900-903. 
    DOI: 10.19803/j.1672-8629.2022.08.17

    Abstract ( 104 )   PDF (1677KB) ( 90 )  
    Objective To conduct a Pareto chart analysis of 705 problematic prescriptions by clinicians in the Department of Neurology in order to provide reference for clinical practice. Methods Prescriptions pre-audited in the Department of Neurology between March 1, 2017 and February 31, 2018 were collected and analyzed. The types of problems, potential risks and results of interventions were recorded. Results A total pf 10 367 prescriptions for 811 patients were reviewed, 705 of which were found to be problematic, including 511 cases of inappropriate medication methods, 66 cases of wrong indications, and 46 cases of insufficient or excessive dosage. In terms of severity, 538 cases (76.31%) were classified as Class I with a low risk of adverse drug events (ADE), 135 cases (19.15%) as Class II with a medium risk of ADE, 26 cases (3.69%) as Class III with much chance of ADE, and 6 cases (0.85%) as class IV that might cause serious ADE. Physicians took the advice of pharmacists in 541 of these cases (76.74%). Conclusion There are various medications for inpatients in a neurology department, so inappropriate medication instructions are likely. Pre-audition of prescriptions by clinical pharmacists can help identify potential risks of medication. Cooperation between physicians and pharmacists can improve the medication safety of patients.
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    Linezolid-associated thrombocytopenia in children with severe infection: a retrospective analysis
    WANG Yajie, WANG Xiaoling, QIAN Suyun, YANG Mei
    2022, 19(8): 904-907. 
    DOI: 10.19803/j.1672-8629.2022.08.18

    Abstract ( 125 )   PDF (1237KB) ( 118 )  
    Objective To investigate the effect of linezolid (LZD) on platelets of children with severe infections. Methods The clinical data on patients hospitalized in the Department of Pediatric Intensive Care Unit (PICU) due to severe infections and treated with linezolid between October 1, 2018 and July 31, 2019 was retrospectively analyzed. Results The median age of the 24 patients enrolled in this study was 5.01 (interquartile range, IQR, 1.75~9.07) years old, six of whom developed linezolid-associated thrombocytopenia (LAT) (2 children received symptomatic treatment with platelet transfusion, and 4 children returned to normal spontaneously) and the incidence of LAT was 25.0%. The median time to onset of LAT and median time to resolution of thrombocytopenia from onset were 4 (IQR, 3.25~5.50) days and 5 (IQR, 3.25~6.75) days, respectively. Conclusion Risk factors for linezolid-associated thrombocytopenia among children with severe infections include low baseline platelet count, high Cmin of linezolid and impairment of visceral function. It is suggested that the dose of LZD should be adjusted individually according to its serum concentration.
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    Safety of traditional Chinese medicine among lactating women and pharmacovigilance
    GENG Kexin, ZHANG Xiaomeng, ZHANG Bing, LIN Zhijian, SA Rina, JIANG Hao, ZOU Lina
    2022, 19(8): 908-912. 
    DOI: 10.19803/j.1672-8629.2022.08.19

    Abstract ( 218 )   PDF (1248KB) ( 182 )  
    Objective To analyze the characteristics and causes of adverse reactions (ADR) caused by traditional Chinese medicines (TCM) among lactating women, and propose targeted measures for pharmacovigilance and prevention. Methods Such databases as CNKI, Wanfang Data, VIP, CBM and PUBMED were searched to collect related literature that was published between January 1, 1964 and August 31, 2020 about the ADR caused by TCM among lactating women. The basic information about the patients, organs/systems involved in adverse reactions, clinical manifestations and Outcomes were statistically analyzed. The correlations between the four characters (FC), five tastes (FT) and channel distributions of the TCM involved in ADR were analyzed via SPSS 23.0. Results In this study, 31 pieces of literature and 34 cases of ADR were included, involving 23 types of TCM, 6 proprietary Chinese medicines and 5 compound medicines. The organs/systems involved were manifested in gastrointestinal damage, damage to the skin and its attachments, and damage to the central and peripheral nervous systems. The main causes of ADR included patients’ individual differences, toxicity reactions, irrational drug use such as self-medication, improper clinical syndrome differentiation, misallocation, improper drug processing, and improper decoction. Conclusion TCM can cause varied safety problems during lactation, ranging from nausea and vomiting, through skin rash in babies, to hemorrhagic shock, renal failure, permanent breast closure in lactating women. It is recommended that pharmacovigilance should be strengthened in terms of treatment principles and drug selections for women during lactation. Furthermore, close monitoring is required after medication to promote the safety and rationality of TCM for lactating women.
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    Risk analysis and precautions related to storage conditions specified in package inserts of western medicines in a hospital
    ZHANG Qingxia, JIANG Yongxian, DONG Yuexin, XIAN Ying, YAN Suying
    2022, 19(8): 913-918. 
    DOI: 10.19803/j.1672-8629.2022.08.20

    Abstract ( 165 )   PDF (1253KB) ( 163 )  
    Objective To comb through the risks related to storage conditions of all western medicines in the hospital, provide reference for proper maintenance of drugs, reduce the incidence of storage related adverse events, and ensure medication safety of patients. Methods According to the relevant provisions concerning general storage items in the Pharmacopoeia of 2020, and some of the special storage conditions that were likely to be ignored, the storage conditions specified in package inserts of all western medicines in our hospital were classified, the proportion and risks of each storage condition were statistically analyzed, and precautions were recommended for drugs that needed to be stored under special conditions. Results Among the 946 instructions for western medicines investigated, 380 were for injections (40.17%), 447 for oral preparations (47.25%) and 119 for topical preparations (12.58%). Standard terms of storage conditions were described correctly in 897 of these inserts, accounting for 94.82%. There were varied special storage conditions, such as specific temperature limits in the cold and at room temperature. 248 types of injections (65.26%) needed shading, 371 oral preparations (83.00%) needed to be dried or sealed, 32 external preparations (26.89% ) needed to be dried or sealed, and 73 injections (26.89%) needed to be cold-stored (21%). 42 types of drugs with the same general name and by different manufacturers required different storage conditions. 94.87% (37/39) of ophthalmic preparations were in multi dose packaging, and the storage period after opening was 4 weeks or 30 days. Conclusion There are many drugs that need to be stored under special conditions, which leads to greater safety risks. It is suggested that institutions and manufacturers concerned should be alert to this problem, and the related departments of a hospital should also pay attention to the conditions of storage and maintenance, standardize drug storage, ensure drug quality, and improve the safety and effectiveness of clinical drug use.
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    Pharmacovigilance of propacetamol hydrochloride for injection
    ZHANG Tao, ZHAO Jing, LI Jing, LI Maoxing, FENG Xia, LIN Tong
    2022, 19(8): 919-920. 
    DOI: 10.19803/j.1672-8629.2022.08.21

    Abstract ( 249 )   PDF (1122KB) ( 94 )  
    Objective To provide pharmacovigilance of propacetamol hydrochloride for injection by 2 cases of severe adverse drug reactions. Methods A retrospective analysis was performed on 2 cases of severe bilateral upper limb venous thrombosis caused by propacetamol hydrochloride for injection. Results The heavy concentrations, fast intravenous infusion and long course of treatment of propacetamol hydrochloride for injection lead to patient severe bilateral upper limb venous thrombosis. Conclusion Patients' allergy history should be carefully asked before any treatment of drugs with a reasonable dose and a reasonable route. Clinical using of propacetamol hydrochloride for injection should be strictly followed its instructions. The solvent should be NS 100ml and the infusion time is 15 minutes. Long-term and off-label indications should be forbidden.
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    One case of peripheral eosinophilia induced by posaconazole oral suspension
    ZHONG Yunming, Li Cheng, Deng Yingming, XIONG Tianzeng, MENG Xiaobin, Lei Nanfeng, LIANG Pei
    2022, 19(8): 921-923. 
    DOI: 10.19803/j.1672-8629.2022.08.22

    Abstract ( 139 )   PDF (1082KB) ( 144 )  
    Objective To explore treatments against peripheral eosinophilia induced by posaconazole oral suspension. Methods The process of diagnosing and treating one case of peripheral eosinophilia induced by posaconazole oral suspension was analyzed. The mechanism by which posaconazole oral suspension induced peripheral eosinophilia was studied with reference to literature. Results The patient was diagnosed with peripheral eosinophilia 23 days after he took posaconazole oral suspension, accompanied by head and face swelling, rash and pruritus. The drug was suspended immediately. The patient’s condition gradually improved after the treatment with oral loratadine tablets, intravenous calcium gluconate injection and dexamethasone sodium phosphate injection. Head and face swelling subsided, skin rash was significantly mitigated, and itching disappeared within 10 days of withdrawal. Posaconazole suspension was taken a second time because of the patient’s condition. Dexamethasone sodium phosphate injection was injected intravenously before each oral posaconazole suspension before peripheral eosinophils gradually returned to normal. Conclusion The use of posaconazole suspension should be stopped immediately after the occurrence of peripheral eosinophilia, and dexamethasone can be injected intravenously before medication.
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    Pharmaceutical care of a severely poisoned patient with methotrexate tablets
    YUAN Xiaolong, WAN Qihua, TAO Donghong, QI Hao, WANG Aixia
    2022, 19(8): 924-928. 
    DOI: 10.19803/j.1672-8629.2022.08.23

    Abstract ( 146 )   PDF (1204KB) ( 132 )  
    Objective To explore the effective medication plan for a patient with severe methotrexate poisoning. Methods Clinical pharmacists participated in the treatment of a patient with severe methotrexate poisoning. By analyzing the common adverse reactions and pharmacokinetic characteristics of antibiotics and based on bacterial culture and related examination indexes, clinical pharmacists recommended quickly adjusting the antibacterial treatment plan. Given the individual factors of the patient, clinical pharmacists advised the clinicians to adopt the bone marrow suppression detoxification scheme as soon as possible. According to the coagulation function, biochemical indexes and pharmacological characteristics of related drugs, the clinical pharmacists gave tips on ways of appropriate hemostasis, acid suppression, and fluid replacement. Results After hospitalization, the patient was out of danger, the overall outcome was good, and she was discharged. Conclusion Clinical pharmacists can assist clinicians in adjusting the drug regimen and improve the level of clinical medication by making full use of their knowledge of pharmaceuticals.
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