主办单位：上海医药行业协会
10 May 2024, Volume 45 Issue 9
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 1-2.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 3-9.
The practical nature of medicine and the individuality of diseases have led to high misdiagnosis rates, and clinical decision support system (CDSS) based on artificial intelligence and medical big data can provide decision support for doctors in the diagnosis of diseases, which has become an important means of solving such problems, and has now also achieved certain results. However, despite the potential advantages of CDSS in improving the accuracy and efficiency of medical decision making, there are a series of problems in its implementation that may affect the reliability, usability and safety of CDSS. This paper summarizes and analyses the current status of the application of diagnostic CDSS, the challenges it faces, and the future development trend, with a view to providing reference for the development of CDSS towards intelligence and knowledge in China.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 10-13.
In recent years, the massive accumulation of health and medical data driven by the development of medical informatization has propelled the medical field into the era of big data. The construction and application of disease-specific databases have gradually become an important way to improve clinical diagnosis and treatment levels and promote the development of clinical research. This paper aims to provide reference for the construction of disease-specific databases in the future by reviewing relevant literature, summarizing key parts, technologies and the main applications of disease-specific databases, and proposing future development suggestions.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 14-18.
Objective: To establish a special disease database based on clinical diagnosis and treatment data of pediatric allergic diseases so as to provide data support for multidisciplinary diagnosis and treatment and maximize the role of information technology in promoting the improvement of clinical diagnosis and treatment level and medical research progress. Methods: Based on the clinical diagnosis and treatment data of children with allergic diseases in Shanghai Children’s Hospital from January 2013 to July 2018, the clinical data was uniformly cleaned and stored using the extract-transform-load technology. The structured indicators in the original business system were mapped and standardized, while the unstructured content was manually labelled. Natural language processing technology was then applied for post-structured governance to create a specialized disease data model, which was used to build a dedicated pediatric allergic disease database. Results & Conclusion: The special disease database consists of 6 thematic data modules, including 16 items and 60 fields. We have achieved the collection and standardization of clinical diagnosis and treatment data for 333 029 children with allergic diseases, and further explored the distribution of diseases. The establishment of a special database for pediatric allergic diseases has enabled the storage, mining, and analysis of massive clinical data in the real world, providing support for the subsequent expansion of database based specialized management and decision-making assistance.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 19-22.
In recent years, real world study as an important type of clinical research has gradually attracted the attention of medical professionals. Hospital health information system (HIS)/laboratory information system (LIS) stores a huge amount of real patient diagnosis and treatment data, therefore, how to conduct standardized clinical research based on these data from HIS/LIS is a hot topic. Starting from the concept of real world research, this article focuses on the characteristics of hospital HIS/LIS data, as well as the key aspects and points of real world clinical research so as to provide a reference basis for clinicians and researchers.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 23-28.
Objective: To systematically evaluate the difference in efficacy and safety of duloxetine and agomelatine in the treatment of patients with first-episode depression. Methods: The head-to-head clinical randomized controlled studies of two drugs in patients with first-episode depression were included by searching in the National Knowledge Infrastructure Database (CNKI), VIP, Wanfang, PubMed, Web of Science and other databases, the data on the efficacy and safety were extracted, and meta-analysis was performed using RevMan 5.4. Results: A total of 6 papers were included. Meta-analysis showed that there were significant differences in the HAMD-17 scores (P<0.05) and effective rate between the agomelatine group and the duloxetine group after treatment (P=0.002), however, the difference in cure rate (P=0.10) and the incidence of total adverse reactions (P=0.11) were not statistically significant. Conclusion: Agomelatine for the treatment of first-episode depression has comparable safety and superior efficacy compared with duloxetine.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 29-32.
Objective: To investigate the clinical efficacy and mechanism of low molecular weight heparin calcium combined with Shoutai pill plus or minus prescription in the treatment of early threatened abortion complicated with subchorionic hematoma (SCH). Methods: Sixty cases of the patients were randomly divided into a control group and a treatment group with 30 cases each. Both groups were first treated with Shoutai pill plus or minus prescription and then low molecular weight heparin calcium was additionally given in the treatment group. The therapeutic effect, the time for symptom remission, the serum indexes and drug safety were compared between the two groups. Results: The total effective rate was higher, the time for symptoms remission was shorter, and the improvement of serum indexes was better in the treatment group than the control group (P<0.05). There were no obvious adverse reactions in the two groups. Conclusion: Combination therapy has a definite effect and a high safety profile, can quickly relieve patients’ symptoms and improve serum index levels.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 33-36.
Chronic glomerulonephritis proteinuria is a common clinical manifestation of kidney disease. Traditional Chinese medicine has unique advantages in the treatment of this disease. Professor JIANG Chunbo believes that dampness-heat is the core pathogenesis of this disease considering the lifestyle of modern society, thus its treatments should revolve around clearing away dampness-heat. The methods of dispelling wind and removing exterior dampness, strengthening spleen and replenishing gasifying dampness, promoting blood and removing dampness, separating dampness and heat from three jiao were adopted. A case was attached to support this.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 37-39.
Objective: To explore the medication experience of CHEN Bangming in the treatment of chronic renal failure disease based on the traditional Chinese medicine inheritance support system, aiming to better guide the clinical practice. Methods: One hundred and twenty prescriptions written by CHEN Bangming from January 2022 to March 2023 for patients with chronic renal failure in the outpatient clinic of our hospital were collected and organized. Using the software “traditional Chinese medicine inheritance support system (V2.5)”, the frequency and pattern of drug use and formula rules in the prescriptions were mined and new combinations of prescriptions were evolved. Results: There were 23 drugs with a frequency of ≥50 in the prescriptions, and the formula rule of the prescriptions was set to 69, the confidence level was 0.9, and there were 25 groups of drug combinations with a frequency of 110 or more, and 7 new prescriptions were derived. Conclusion: Based on this system, the medication rules of Director CHEN Bangming can be comprehensively and objectively summarized to further improve the clinical efficacy.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 40-42.
Objective: To explore the therapeutic effect of Xueshuantong combined with alprostadil in the treatment of lower limb atherosclerotic occlusive disease. Methods: One hundred and ten patients with lower limb atherosclerotic occlusive disease were divided into a control group and an observation group with 55 cases each according to the admission time to the hospital. Both groups were treated with alprostadil and then Xueshuantong was additionally given in the observation group. The ankle-brachial index (ABI) and toe-brachial index (TBI) indices, hemodynamic indexes, the incidence of adverse reactions and the effective rate of the treatment were compared between the two groups before and after the treatment. Results: After treatment, the treatment efficiency, ABI and TBI indexes were higher and the hemodynamic indexes and the incidence of adverse reactions were lower in the observation group than the control group (all P<0.05). Conclusion: Xueshuantong combined with alprostadil for the treatment of lower limb atherosclerotic occlusive disease has exact clinical efficacy and can effectively improve the hemodynamic indexes and the quality of life of the patients.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 43-47.
Objective: To observe the clinical efficacy of Yifeijiangu formula combined with albuterol sulfate and alendronate sodium in the treatment of chronic obstructive pulmonary disease (COPD) complicated with osteoporosis (OP) in the elderly. Methods: Seventy-six cases of the patients were randomly divided into a control group and an observation group with 38 cases each. Both groups were first given salbutamol sulfate nebulized inhalation and albuterol sulfate oral treatment and then oral Yifeijiangu was additionally given in the observation group, and the treatment was lasted for 3 months. Lung function, St. George’s Respiratory Questionnaire (SGRQ) score, 6-minute walking test (6MWT) distance, bone mineral density, bone metabolism indexes in serum, and levels of inflammatory factors were compared between the two groups. Results: After treatment, the 6MWT distance, the levels of lung function indexes, bone density of lumbar vertebrae L1~4, and bone alkaline phosphatase in the observation group were all longer or higher, and SGRQ score, the levels of β-C-terminal telopeptide of typeⅠcollagen, interleukin-6, and tumor necrosis factor-α were lower in the observation group than the control group as well as after than before treatment (P<0.05). Conclusion: The combination of Yifeijiangu formula with albuterol sulfate and alendronate sodium is of benefit to the improvement of lung function, quality of life, exercise endurance, and bone density in the elderly with COPD complicated with OP, which may be related to the improvement of bone metabolism and the reduction of inflammatory response.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 48-52.
Objective: To observe the clinical efficacy of Bufei Yishen Formular combined with respiratory muscle functional exercise in the treatment of elderly chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension (PH). Methods: One hundred and sixteen elderly patients with COPD complicated with PH were randomly divided into a control group and an observation group with 58 cases each. Both groups were given conventional treatment with Western medicine, and the control group was additionally given respiratory muscle functional exercise and the observation group was given Bufei Yishen Formular orally on the basis of the control group. The treatment was lasted for 2 weeks. Chinese medical syndrome scores, lung function, mean pulmonary artery pressure (mPAP), Borg respiratory index, 6-minute walking test (6MWT) distance, and levels of serum factors were compared between the two groups. Results: The total clinical efficacy and indexes of pulmonary ventilation function were higher, the scores of Chinese medicine syndrome, mPAP, Borg respiratory index and hematocrit, the levels of C-reactive protein, brain natriuretic peptide and D-dimer were lower, and the distance of the 6MWT was longer in the observation group than the control group (P<0.05). Conclusion: Bufei Yishen Formular combined with respiratory muscle functional exercise is of benefit to reducing clinical symptoms, improving lung function, exercise endurance and blood rheology, and decreasing pulmonary arterial pressure and inflammatory response in elderly patients with COPD complicated with PH.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 53-56.
Objective: To investigate the clinical efficacy of reformed Yuye decoction combined with metformin and insulin degludec and insulin aspart injection in patients with type 2 diabetes mellitus (T2DM) with deficiency of both Qi and Yin. Methods: Sixty patients with T2DM were randomly divided into a control group (n=30) and an observation group (n=30). Both groups were treated with metformin combined with insulin degludec and insulin aspart injection and the observation group was additionally treated with reformed Yuye decoction. The Chinese medicine symptom scores, glycated hemoglobin (HbAlc), fasting plasma glucose (FPG), and 2-hour postprandial blood glucose (2hPG), mean intraday glucose fluctuation (MAGE), insulin resistance index (HOMA-IR) and insulin secretion index (HOMA-IS) were compared between the two groups after treatment. Results: After treatment, the total effective rate of the observation group was significantly higher than that of the control group (93.33 % vs 86.67 %). The indexes of Chinese medicine symptom score, HbAlc, FPG, 2hPG, MAGE and HOMA-IR of the observation group were lower than those of the control group, and HOMA-IS was higher than that of the control group (all P<0.05). Conclusion: Reformed Yuye decoction combined with metformin and insulin degludec and insulin aspart injection has significant efficacy in patients with T2DM with deficiency of Qi and Yin, which can effectively control the patients’ blood glucose and improve the pancreatic islet function.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 57-60.
Objective: To observe the clinical effect of acupuncture therapy on constipation in patients with maintenance hemodialysis. Methods: A total of 60 patients with constipation who had long term maintenance hemodialysis in the blood purification center of Putuo Hospital, Shanghai were selected and randomly divided into a treatment group and a control group with 30 patients in each group. The control group was given routine treatment such as lactulose, kaiseru defecation, and the treatment group was given routine defecation treatment combined with acupuncture point treatment for a total course of 12 weeks. The clinical efficacy and the expression of related inflammatory factors were observed in the two groups. Results: Constipation symptoms were improved after treatment in both groups after treatment, TCM symptoms curative effect in the treatment group was better than that in the control group (P<0.05), the differences in clinical effect and constipation scores in two groups had no obvious statistical significant (P<0.05). After treatment, blood phosphorus and blood calcium decreased compared to before treatment, and reduction amplitude of blood phosphorus level in the treatment group was greater than that in the control group (P<0.05); parathyroid hormone level in the treatment group decreased compared to before treatment (P<0.01), which was greater than that in the control group (P<0.01). The two groups after treatment could decrease the inflammation factors associated (IL-6, IL-8, IL-10), and the IL-8 level in the treatment group decreased greater than that in the control group (P<0.05). Conclusion: Acupuncture therapy can improve the constipation condition of patients with maintenance hemodialysis, reduce the blood phosphorus level, and improve the indicators of related inflammatory factors in serum, which are closely related to IL-8 and have good clinical effects.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 61-64.
Objective: To observe the efficacy of fecal microbiota transplantation (FMT) in improving immunomodulation and cardiac function in patients with chronic heart failure. Methods: Eighty-six patients with chronic heart failure were randomly divided into a control group (n=43) and an observation group (n=43). Both groups were treated with conventional therapy and the observation group was given FMT treatment besides. The changes in cardiac function, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and the levels of immune function, inflammatory factor and tumor necrosis factor-α (TNF-α) were compared between the two groups before and after treatment, and the incidence of adverse reactions during the treatment was counted. Results: After treatment, the levels of LVEDD, LVESD, HR, SBP, DBP, CD8+ T, IL-1, IL-6, IL-8 and TNF-α were lower and the levels of LVEF, CD3+ T, and CD4+ T were higher in the observation group than the control group (all P<0.05). There were no statistically significant differences in the incidence of adverse reactions in the observation group (6.98%) compared with the control group (13.95%) (P>0.05). Conclusion: FMT for the treatment of patients with chronic heart failure can effectively improve the cardiac function and the symptoms of heart failure, correct intestinal flora disorders and regulate the body’s immune system, which is safe and reliable.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 65-68.
Objective: To investigate the effect of epidural anesthesia and analgesia on the process and outcome of spontaneous labor. Methods: The data from 197 pregnant women were retrospectively analyzed, and they were divided into a primigravid analgesia group (n=79), a primigravid control group (n=44) and a transplacental analgesia group (n=45) and a transplacental control group (n=29) according to the number of labor and the presence or absence of analgesia in labor. The visual analogue score (VAS) of pain, duration of labor, hemorrhage in postpartum 2 h, neonatal Apgar score, and the cesarean section rate were compared among the groups. Results: The VAS score and the caesarean section rate was lower and the duration of the second stage of labor was longer in the primigravida analgesia group than the control group (all P<0.05), and the differences in other indicators were not statistically significant. The VAS score of the transplacental analgesia group was lower than that of the control group (P<0.05), and the differences in other indicators were not statistically significant. Conclusion: Epidural anesthesia analgesia can relief labor pain of primiparous and transient women, extend the second stage of labor of primiparous women and reduce the rate of caesarean section in primiparous women, however, it has no significant effect on the other stages of labor, post-partum hemorrhage and neonatal Apgar score.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 69-73.
Objective: To investigate the application effect of etomidate combined with different doses of alfentanil in painless ultrasonic gastroscopy of elderly patients. Methods: One hundred and twenty elderly patients who underwent painless ultrasound gastroscopy were randomly divided into group S, A and B with 40 cases each. Group S was given etomidate for anesthesia, and group A and B were given etomidate combined with alfentanil 5 or 10 μg/kg for anesthesia, respectively. The dosage of etomidate, length of examination and awakening time in the three groups were recorded; vital signs before induction, immediately after examination, 5 and 10 min after induction, and at the end of examination and the incidence of adverse events were also recorded. Results: The intraoperative dosage of etomidate in group A and B was less than that in group S (P<0.05), whereas there was no significant difference between group A and B (P>0.05). The postoperative awakening time was in group A< group S< group B (P<0.05). The proportion of respiratory depression and circulatory suppression in group A was lower than that in group B (P<0.05). The proportions of injectable pain and myoclonus in group A and B were significantly less than that in group S (P<0.05), while the incidence of hypotension was higher in group B (P<0.05). Conclusion: Etomidate combined with low-dose (5 μg/kg) alfentanil is safe and effective for painless ultrasound gastroscopy in elderly patients with fewer adverse effects.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 74-78.
Objective: To compare the safety and efficacy of temperature-sensitive liquid embolic agent (TSLEA) with traditional embolic materials in the treatment of gastrointestinal bleeding (GIB), and to analyze the value of its application. Methods: The clinical data from GIB patients were retrospectively analyzed, and the patients were divided into two groups according to whether or not they used TSLEA intraoperatively and the differences were compared between the two groups. Results: There were 10 cases with 14 responsible vessels in the TSLEA group and 24 cases with 31 responsible vessels in the non-TSLEA group. The technical success rate of both groups was 100%, and the average postoperative follow-up time was 16.07 months. The clinical success rate was 91.67% with the incidence of postoperative complication 8.33% in the non-TSLEA group and 90.00% without significant complications in the TSLEA group. The differences of the incidence of complication and the clinical success rate between the two groups showed no statistical significance (P=0.888, P=0.837). Conclusion: TSLEA has similar technical and clinical success rates and complication incidence compared with traditional embolic materials, but it can pass through twisted and slender duty vessels and is a good material for embolization.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 79-82.
Objective: To discuss correlation between the change of tumor abnormal protein (TAP) and gastric cancer-related antigen MG7-Ag levels and the recurrent metastasis of cancer in patients undergoing laparoscopic-assisted radical gastrectomy. Methods: One hundred and ten patients with gastric cancer who underwent laparoscopic-assisted radical surgery were selected and divided into a recurrent metastasis group (n=37) and a no recurrent metastasis group (n=73) 12-monthes after follow-up, and meanwhile another 55 healthy patients with physical examination were recruited as a healthy group. The pre- and post-operative TAP and MG7-Ag levels were compared, and the correlation between the TAP and MG7-Ag levels and the recurrent metastasis of tumor was analyzed by Pearson. Results: The pre- and post-operative TAP and MG7-Ag levels were higher in the recurrent metastasis group than the no recurrent metastasis group and TAP and MG7-Ag levels were positively correlated with the recurrent metastasis of tumor after radical surgery in gastric cancer patients (r=0.654, 0.579, P<0.005). Conclusion: The change of TAP and MG7-Ag levels can be used for the assessment of the recurrent metastases of tumor in patients undergoing laparoscopic-assisted radical gastrectomy.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 83-85.
Objective: To collect idiopathic membranous nephropathy (IMN) case samples, determine the expression level of TIPE2 and study its association with macrophage polarization-associated cytokines and IL-17/IL-10 induced by IMN. Methods: Sixty cases of patients with IMN were selected as a IMN group, and 50 cases of healthy subjects were recruited as a control group. The level of TIPE2 were determined by a literature method, while the contents of TNF-α, IL-2, IL-17 and IL-10 by ELISA. Results: Serum and urinary β2-microglobulin contents and urinary protein indexes were higher and creatinine content was lower in the IMN group than the control group (P<0.001), and TIPE2, TNF-α, IL-2 levels and IL-17/IL-10 value were significantly higher in the IMN group than the control group (P<0.001). TIPE2 level was positively correlated with the TNF-α, IL-2 levels and IL-17/IL-10 ratio (P<0.001). Conclusion: This study can provide a new direction for clinical treatment and drug development and a basis for immune regulation involving basic molecules.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 86-88.
Objective: To understand the regularity and characteristics of adverse drug reaction (ADR) of antiepileptic drugs. Methods: All the ADRs of antiepileptic drugs reported by our hospital to the National ADR Monitoring System were extracted for analysis. Results: Sixty-nine ADRs of antiepileptic drugs were collected, involving 6 kinds of antiepileptic drugs, including sodium valproate, oxamazepine, carbamazepine, lamotrigine, levetiracetam and phenytoin sodium. Their most common manifestations involving in the nervous system were dizziness, drowsiness, headache and so on, followed by hepatobiliary, gastrointestinal and metabolic system diseases. Conclusion: Attention should be paid in clinic to the ADRs of antiepileptic drugs and the monitoring of antiepileptic drugs use should be strengthened.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 89-91.
Objective: To analyze the use of commonly used Western medicinal ointment for surgery in the outpatient prescriptions. Methods: Surgical prescriptions collected from January 2020 to December 2022 at this center were used for statistics, analysis and discussion. Results: The top three ointments were mupirocin ointment, ketoconazole cream (Jindaknin) and hydrocortisone butyrate cream, which were mostly used for the treatment of rashes. Among them, mupirocin ointment and ketoconazole cream were mostly used for the treatment of rashes and ringworm, respectively. In addition, there were also a few cases of the combination of mupirocin ointment and hydrocortisone butyrate cream. Conclusion: The total dosage and total sales of mupirocin ointment ranked first, and the situation of these three ointments for diseases alone is basically reasonable, and the combination of mupirocin ointment and hydrocortisone butyrate cream is feasible, and may be attempted to be promoted in the clinic.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 92-97.
Objective: To summarize the application of personalized traditional Chinese medicine (TCM) preparation in our hospital, with a view to continuous quality improvement. Methods: We selected and analyzed the prescription data of TCM in our hospital from May 2021 to December 2022, and used questionnaires to collect feedback on patients’ knowledge and use. Results: The proportion of personalized TCM preparation in our hospital was on the rise, accounting for (1.40±0.49)% of Chinese medicine prescription. The top three departments were cardiology, endocrinology and hepatology, and its use in pediatrics accounted for only 0.05%. The age distribution of its use in the patients was similar to that of the use of tablets, with 21-80 years old accounting for more than 80%, and ≤10 years old only 0.13%. The flavors of the medicines were mostly 21-30. The expense of the medicines was mostly RMB 501-2 000, which was less than 50% of the formula granules. The awareness rate of the patients about the personalized TCM preparation was only 24.51%, and those who had used it were 100% satisfied with its quality and appearance, and no adverse reactions were observed. Conclusion: The personalized TCM preparation has become an important supplement to the Chinese medicine dispensing in our hospital, with a high degree of patient satisfaction and a good value for application and promotion, but there are still problems such as low awareness rate, high processing costs and out-of-pocket expenses and inconvenience in the production of pediatric prescriptions.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 98-103.
Objective: To explore the establishment and effect evaluation of medication therapy management mode for patients with acute coronary syndrome (ACS) in primary hospitals. Methods: A medication therapy management mode for patients with ACS was created by combining the current situation of primary hospitals. A joint management team of physicians and pharmacists was established to formulate a standard management process so as to manage patients’ medication throughout the whole process. The differences between the standard and traditional management modes were compared in terms of patients’ cognition of drug treatment, medication compliance, risk factor control, and rationality of medication. Results: The patients’ cognition of drug treatment, medication compliance, and compliance rate of blood pressure, heart rate, blood lipids, blood glucose and other indexes were higher. The incidence of medication-related problems with the exception of “overdose” was lower in the standard management mode than the traditional management mode (all P<0.05). Conclusion: Medication therapy management in primary hospitals can improve medication compliance and compliance rate of risk factor in ACS patients and reduce irrational medication use, which is recommended to be promoted in primary hospitals.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 104-107.
Based on the concept of job competence, this paper combines the key points of the work of clinical research nurses in dermatology, explores the implementation of the index system of job competence of clinical research nurses in dermatology, and puts forward the strategy of improving the job competence of dermatology, so as to provide reference for the comprehensive cultivation of the job competence of dermatological clinical research nurses.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 108-110.
A newly diagnosed patient with cardia adenocarcinoma scheduled for surgery presented with a history of long-term chronic cough and severe mixed ventilatory dysfunction was prescribed inhaled ICS/LABA/LAMA therapy in combination with oral compound methoxyphenamine capsules to improve lung function. After half a month of treatment, his lung function was improved, but the bronchodilator test showed a positive, suggesting he had a diagnosis of uncontrolled asthma. The clinical pharmacist analyzed the common causes of poor asthma control after the use of control drugs and finally found his inspiratory step was incorrect during the use of the inhalation device inhaler and the peak inspiratory flow rate was less than the minimum inspiratory flow rate of 30 L/min. Through pharmacist’s guidance, he mastered the inhalation technique, and subsequently his peak inspiratory flow rate was measured to be 58 L/min, which reached the ideal range. This case suggests that bronchodilator test can also detect whether asthma treatment is standardized, which can be used as a potential predictor of the effectiveness and standardization of ICS.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 111-113.
A patient with liver cirrhosis complicated with Mycoplasma pneumoniae pneumonia had poor effect on azithromycin to control the infection and the clinical pharmacist recommended to adjust to levofloxacin considering the factors such as bacterial resistance and the patient’s pathophysiology and so on. The resistance rate of azithromycin to adult community-acquired Mycoplasma pneumoniae in China is high, while azithromycin may increase the risk of acute liver injury and mortality in patients with liver cirrhosis. Levofloxacin may be one of the drugs of choice for Mycoplasma pneumoniae pneumonia in adults and the patients with decompensated liver function do not require dosage reduction.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 114-117.
Objective: To explore the role of medication therapy management (MTM) in the intervention of the medical orders by specialty clinical pharmacist and physician. Methods: Six hundred hospitalized patients with type 2 diabetes mellitus were randomly divided into a control group and an intervention group with 300 cases each. The control group was not intervened with medical orders based on MTM while the intervention group was intervened with MTM by clinical pharmacists. The irrational medical orders were compared between the two groups. Results: There were a total of 290 unreasonable medical prescriptions, 232 in the control group and 58 in the intervention group. In terms of drug indications, safety, and efficacy medication issues, the rate of unreasonable medical prescriptions in the intervention group was lower than that in the control group (P<0.05). The top three unreasonable medical prescriptions were the medication without indications or no effectiveness for the current condition and the reduction of effective dose due to drug interactions. Conclusion: Clinical pharmacists perform intervention of medical orders based on MTM, which can improve the quality of medical order review and promote the rational and safe use of drugs in clinical practice.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 118-121.
Berberine is an important alkaloid with significant antibacterial effects. The methyl impurity in the condensation/reduction reaction during its synthesis was isolated by column chromatography and analyzed by 1H-NMR, 13C-NMR, 1H-1HCOSY, HSQC, HMBC and DEPT135 o.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 122-126.
Objective: To optimize the extraction process of water-soluble active ingredients in the formula of Lotse Kunsel. Methods: The yield of dry extract, the transfer rate of hydroxysafflower yellow A and the yield of solid content extracted by ethyl acetate were used as indexes. The effects of water addition ratio, extraction time and extraction times on the extraction process were investigated. L934 orthogonal test was used to optimize the extraction process. Results: The best process was to add 12 times of water and extract three times for 1 hour each. Conclusion: The optimized process is stable and reliable and the transfer rate of active ingredients is high.
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Determination of citrate ion content in porcine fibrinogen by high performance liquid chromatographyShanghai Medical & Pharmaceutical Journal. 2024, 45(9): 127-130.
Objective: To establish a method for the determination of citrate ion content in porcine fibrinogen of biological products by high performance liquid chromatography (HPLC), and the method was validated. Methods: A refractive index detector and Agilent Hi-plex H column (7.7 mm×300 mm, 8 μm) were used and the HPLC was performed with 4 mmol/L sulfuric acid solution as mobile phase at column temperature 50 ℃, flow rate 0.8 mL/min, and sample volume 5 μL. Results: The standard curve was linear over the range of 5.01-15.04 mmol/L with linear correlation coefficient r 0.999 5. The average recoveries at low, medium and high concentrations were 104.0%, 102.8% and 97.6%, respectively and the overall average recovery was 101.5% (n=9), and the overall relative standard deviation (RSD) was 3.16% (n=9). The RSD obtained from the intermediate precision was only 0.75% (n=12) and the durability ratio was 99.71%-100.49%. Conclusion: This method has strong specificity, good accuracy, precision, and durability, and is suitable for the determination of citric acid ion content in porcine fibrinogen.
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Shanghai Medical & Pharmaceutical Journal. 2024, 45(9): 131-135.
Objective: To establish high-voltage leak detection and microbiological challenge test (microbial ingress method) to determine the package integrity of the injection vial. Methods: The package integrity of the injection vial was determined using the high-voltage leak detection and microbiological challenge test (microbial ingress method). Results: The positive detection rates of 1, 3, 5 and 10 μm laser-bored hole samples were 0%, 30%, 60% and 70% by microbiological challenge test (microbial ingress method), respectively and 100% by high-voltage leak detection method. The sensitivity of positive rate was 1.4 μm by the microbial ingress method, and 1 μm by the high-voltage leak detection, and the later was higher than the former. Conclusion: Both the high-voltage leak detection and microbiological challenge test (microbial ingress method) can be used to evaluate the container closure integrity of injection vials.
