2022 Volume 24 Issue 1 Published: 28 January 2022
  

  • Select all
    |
  • Strengthening the safety management of traditional Chinese medicine in medical institutions
    Wang Xiaomeng, Lin Xiaolan, Zhuang Wei
    2022, 24(1): 3-6. https://doi.org/10.3760/cma.j.cn114015-20211218-01273
    Abstract ( ) PDF ( )
    Traditional Chinese medicine (TCM) is widely used in medical institutions in China. Because TCM is often regarded as "natural and non-toxic", the irrational use of TCM is more common, such as repeated medication, incompatibility, long-term prescription, inappropriate usage and dosage, and inapprop- riate drug combination. The development and application of TCM prescription pre-audit system is of great significance to the safety management of TCM, but the existing TCM decoction prescription audit system still has some defects and needs to be further improved. The safety of TCM can be further improved by setting up TCM clinical pharmacist post, and strengthening the monitoring of adverse reactions and the study of the interaction between TCM and western medicines. In medical institutions, the management measures of TCM safety should be constantly explored and the pharmaceutical service level of TCM should be improved to ensure the patient safety.
  • fingerprint and toxicity of Gelsemium elegans after fermentation by Ganoderma lucidum for different time
    Huang Meixia, Li Qun, Wang Yingzheng, Liao Huajun, Wang Yinghao, Wu Shuisheng
    2022, 24(1): 7-12. https://doi.org/10.3760/cma.j.cn114015-20210719-00798
    Abstract ( ) PDF ( )
    Objective To explore the relationship between high performance liquid chromato- graphy (HPLC) fingerprint and toxicity of Gelsemium elegans fermented by Ganoderma lucidum (Ganoderma lucidum-Gelsemium elegans) for different time.　Methods Gelsemium elegans was processed by biphasic solid-state fermentation with Ganoderma lucidum. A total of 10-samples of Ganoderma lucidum- Gelsemium elegans were collected after fermentation for 9, 11, 13, 15, 17, 19, 21, 23, 25, 27 days (sampling twice on day 27, number: S1-S10) and the fingerprints were determined by self-established HPLC. One hundred specific pathogen-free ICR mice were randomly divided into 10 groups (each group comprised 10 mice, half were male and half were female). The median lethal dose of Ganoderma lucidum-Gelsemium elegans collected after fermentation for 11 days in mice was used as the final concentration in toxicity test. S1-S10 Ganoderma lucidum-Gelsemium elegans solutions were prepared and given to 10 groups of mice respectively by gavage administration and the death of mice was observed. According to the calculation formula of grey correlation analysis, the correlation coefficients between the common peaks of S1-S10 Ganoderma lucidum-Gelsemium elegans in chromatographic fingerprint and their toxicity test results (death rate in mice) was calculated and the main components contributing to the toxicity of Ganoderma lucidum-Gelsemium elegans were analyzed.　Results A total of 17 common peaks were identified in the chromatographic fingerprint spectrum of S1-S10 Ganoderma lucidum-Gelsemium elegans. The mortalities in mice caused by S1-S10 of Ganoderma lucidum-Gelsemium elegans were 1.00, 1.00, 0.80, 0.70, 0.60, 0.60, 0.50, 0.40, 0, and 0, respectively. The grey correlation analysis showed that the correlation coefficients of common peak 7, 3, 6, 9, 1, 8, 17, and 12 to toxicity were 0.868, 0.838, 0.830, 0.828, 0.824, 0.820, 0.818, and 0.802, respectively. The chemical components represented by these 8 chromatographic peaks had more contribution to the toxicity of Ganoderma lucidum-Gelsemium elegans.　Conclusions With the extension of fermentation time, the toxicity of Ganoderma lucidum-Gelsemium elegans decreased gradually, and toxicity was the lowest at 27 days of fermentation. The toxicity of Gelsemium elegans after fermentation was the result of a join action from multiple components. The identification of the main toxicity components can provide a reference for the quality control of Ganoderma lucidum-Gelsemium elegans and the fermentation process optimization.
  • Analysis and evaluation on enhancement of anticoagulant effect of warfarin by herbal and dietary supplements based on case report literature
    Chen Bing, Wang Lijun, Zhang Peng, Cai Haodong
    2022, 24(1): 13-23. https://doi.org/10.3760/cma.j.cn114015-20211118-01174
    Abstract ( ) PDF ( )
    Objective To analyze and evaluate the enhancement of anticoagulant effect of warfarin by herbal and dietary supplements (HDS) based on case report literature.　Methods The case reports on enhancement of anticoagulant effect of warfarin by HDS were selected by searching the relevant databases at home and abroad (up to October 10, 2021). The degree of enhancement of anticoagulant effect of warfarin by HDS was evaluated according to the increase of International Standardized Ratio and the occurrence of bleeding events in patients in the case reports. The reliability scoring standard of HDS-warfarin interaction was established according to the causatity evaluation results between HDS and enhancement of anticoagulant effect of warfarin, the number of case reports, and the other evidences (warnings issued by relevant national institutions, clinical studies, pharmacokinetic/pharmacodynamic studies, experimental animal studies, etc.) and the reliability of enhancement of anticoagulation effects of warfarin by HDS was evaluated. The reliability was evaluated as highly, relatively, possible, and suspicious reliable if the total score was ≥9, 6-8, 3-5, and
    ≤2 points, respectively.　Results A total of 41 case reports were enrolled in the analysis, involving 56 patients and 26 kinds of HDS. Five kinds of HDS increased the anticoagulant effect of warfarin slightly, including Chinese angelica (Radix Angelicae Sinensis), melilotus extract tablets, pumpkin seed, fish oil, and milk thistle; 6 kinds of HDS increased the anticoagulant effect of warfarin moderately, including ginger (Rhizoma Zingiberis Recens), mango, bee pollen, scarponon grape, Persian walnut, and grifola frondosa; and 15 kinds of HDS increased the anticoagulant effect of warfarin severely, including cranberry, danshen (Salvia miltiorrhiza), glycyrrhiza (Radix Glycyrrhizae), safflower (Flos Carthami), dandelion (Herba Taraxaci), Lyciumbar barum L., grapefruit, matricaria chamomilla, pomegranate juice, astaxanthin, Artemisia absinthiu, royal jelly, bilberry(Vaccinium vitis-idaea), red dates, and St. John′s wort (Hypericum perforatum L.). The reliability of enhancement of anticoagulant effect of warfarin was evaluated as highly reliable in 1 kind of HDS, namely cranberry (11 points), relatively reliable in 8 kinds of HDS, including danshen, glycyrrhiza, safflower, dandelion, Lycium barbarum L., grapefruit, matricaria chamomilla, and pomegranate juice (8, 7, 7, 7, 6, 6, and 6 points, respectively), possibly reliable in 12 kinds of HDS, including Chinese angelica, ginger, melilotus extract tablets, mango, astaxanthin capsules, bee pollen, Artemisia absinthium, royal jelly, scarponon grape, Persian walnut, bilberry, and grifola frondosa (5, 5, 5, 5, 4, 4, 4, 3, 3, 3, 3, and 3 points, respectively), and suspicious reliable in 5 kinds of HDS, including pumpkin seed, red dates, fish oil, milk thistle, and St. John′s wort (2, 2, 2, 0, and -1 points, respectively).　Conclusions The degree and reliability of enhancement of anticoagulant effect of warfarin by cranberry, danshen, glycyrrhiza, safflower, dandelion, Lycium barbarum L, grapefruit, matricaria chamomilla, and pomegranate juice are higher, which should be avoided during warfarin therapy.
  • Effects of adverse drug events on readmission of renal transplant recipients and survival of kidney transplants
    Han Zhongling, Wu Jianhua, Xue Yufeng, Yang Li, Zheng Haiyan, Yang Jing, Teng Liang
    2022, 24(1): 24-29. https://doi.org/10.3760/cma.j.cn114015-20210601-00624
    Abstract ( ) PDF ( )
    Objective To explore the impact of adverse drug events (ADE) on readmission in renal transplant recipients and survival of the transplanted kidney.　Methods The hospital information system was searched and medical records of patients who underwent renal transplantation in Beijing Road Medical Area of Xinjiang Military Region General Hospital from January 2008 to December 2018 and were re-admitted at least once (as of December 2020) were collected and analyzed retrospectively. Patient information such as gender, age, weight, ethnicity, kidney transplantation status, postoperative immunosuppressive treatment plan, readmission status, and kidney transplant survival time was extracted and the ADE signals were detected through reviewing the patient re-admission medical history using a self-established global trigger tool. The correlation between ADE and readmission was evaluated by Karch and Lasagna method; patients were included in the ADE-related readmission group (ADE admission group) and the non-ADE- related readmission group (non-ADE admission group) based on the correlation results. The clinical characteris- tics and the cumulative survival rate of kidney transplants between the 2 groups were compared.　Results A total of 198 patients (1-426 times of readmission) were entered in the analysis, including 154 males and 44 females with an age of 14-62 years, and 118(59.6%) were Han nationality. The immunosuppressive drugs included cyclosporine, tacrolimus, sirolimus, etc. After renal transplantation, 240 times of readmission (16.8%) in 94 patients (47.5%) were associated with ADE. In the ADE readmission group, the number of diagnosed diseases and postoperative readmission times were more and the length of hospital stay was longer than those in the non-ADE readmission group ［4 (3,6) vs. 3 (2,5), P=0.001; 6(3, 9) times vs. 4 (2, 8) times, P=0.022; 20(13, 33) days vs. 14 (11, 25) days, P=0.010］. Kaplan-Meier curve showed that the 1-, 3-, 5-, and 10-year cumulative survival rates of kidney transplants were 90.1%, 84.1%, 79.0%, and 57.6% in ADE- related readmission group, which were 99.0%, 94.7%, 90.8%, and 80.4% in non-ADE-related readmission, and the difference was statistically significant (P=0.001).　Conclusions ADE can increase the readmission times, prolong the length of hospital stay, and reduce the cumulative survival rate of kidney transplants. The monitoring of ADE in renal transplant recipients should be strengthened.
  • Research progress in pathophysiological mechanism and treatment of chemotherapy-induced neuropathic pain
    Yang Gangqi, Lu Wanting, Lu Yinying, Li Fei, Li Hongyan
    2022, 24(1): 30-34. https://doi.org/10.3760/cma.j.cn114015-20210223-00207
    Abstract ( ) PDF ( )
    Chemotherapy-induced neuropathic pain (CINP) is a common adverse reaction in cancer chemotherapy, which is dose-dependent. CINP initially presents as acute pain syndrome and can lead to chronic neuropathic pain if not cured or recurrent. The pathophysiological mechanisms of CINP include mitochondrial dysfunction, calcium dyshomeostasis, oxidative stress, activation of apoptotic pathways, loss of myelin and non-myelin fibers, activation of the immune system, and increased expression of ion channels, etc. The mechanism of neuropathic pain induced by different chemotherapeutic drugs is different. There is a lack of effective CINP control measures and the highly recognized therapeutic drug is serotonin and norepinephrine reuptake inhibitor duloxetine.
  • Severe liver injury due to Rupi Sanjie capsules (乳癖散结胶囊) and Xiangshao granules (香芍颗粒)
    Ma Yanli, Zhou Yang, Zhang Donglei, Zhang Lijuan, Ning Meiying, Zhao Jing
    2022, 24(1): 35-37. https://doi.org/10.3760/cma.j.cn114015-20210223-00212
    Abstract ( ) PDF ( )
    A 25-year-old female patient took 4 Rupi Sanjie capsules orally (0.55 g/capsule) thrice daily and Xiangshao granules 1 bag (4 g/bag) orally thrice daily by herself for breast nodule. After 2 months, the patient developed yellow urine, skin itching, and yellowish skin and sclera. Laboratory tests showed alanine aminotransferase (ALT) 1-334-U/L, aspartate aminotransferase (AST) 717-U/L, alkaline phosphatase (ALP) 164-U/L, total bilirubin (TBil) 88-μmol/L, and γ-glutamyltransferase (γ-GT) 127-U/L. Liver injury caused by Rupi Sanjie capsules and Xiangshao granules were considered. The 2 drugs were stopped and the treatments of liver protection and cholagogic were given. Three weeks later, her symptoms above-mentioned disappeared and the laboratory tests showed ALT 106-U/L, AST 88-U/L, ALP 88-U/L, TBil 13-μmol/L, and γ-GT 32-U/L. At 1 month of follow-up, the patient′s liver function returned to normal. The patient′s liver injury might be related to the component of bupleurum in Rupi Sanjie capsules and Xiangshao granules and the component of prunella vulgaris in Rupi Sanjie capsules.
  • Liver injury caused by raw Dioscorea bulbifera L.
    Wang Yan, Fei Yuanyuan, Ji Huichun
    2022, 24(1): 37-39. https://doi.org/10.3760/cma.j.cn114015-20210518-00587
    Abstract ( ) PDF ( )
    A 34-year-old female patient intermittently ate 7 or 8 raw Dioscorea bulbifera L. due to rhinitis. After a 1-year interval, she ate 1 raw Dioscorea bulbifera L. again. Four days later, the patient developed nausea and yellowish skin and sclera. Laboratory tests showed alanine aminotransferase (ALT) 732-U/L, aspartate aminotransferase (AST) 597-U/L, gamma glutamine transferase (γ-GT) 204-U/L, alkaline phosphatase (ALP) 202-U/L, total bilirubin (TBil) 203.7-mmol/L, and direct bilirubin (DBil) 122-mmol/L. Abdominal magnetic resonance imaging showed early liver cirrhosis, and liver transient elastography showed early liver fibrosis. The liver injury caused by viral hepatitis, autoimmune hepatitis, hepatolenticular degeneration, abnormal iron metabolism and other reasons was excluded by various laboratory examinations. It was considered that the liver injury was associated with Dioscorea bulbifera L. Then liver-protective drugs such as magnesium isoglycyrrhizinate injection, polyene phosphatidylcholine injection, reduced glutathione for injection, ademetionine 1,4-butanedisulfonate for injection, and ursodeoxycholic acid were given. Forty-two days later, the patient′s symptoms disappeared basically and laboratory tests showed TBil 55.3-mmol/L, DBil 18.1-mmol/L, ALT 24-U/L, AST 25-U/L, γ-GT 44-U/L, and ALP 124-U/L.
  • Anaphylactic shock caused by sulphur hexafluoride microbubbles for injection
    Ma Huanqing, Ma Changxing, Zhang Erfeng, Sun Bo
    2022, 24(1): 40-42. https://doi.org/10.3760/cma.j.cn114015-20210305-00271
    Abstract ( ) PDF ( )
    A 74-year-old male patient was hospitalized for cerebral infarction, hypertension, diabetes mellitus, and coronary atherosclerotic heart disease. During the hospitalization, a thyroid ultrasound examination revealed suspicious nodules. In order to make a definite diagnosis, thyroid ultrasonography was performed, during which 2.4-ml of sulphur hexafluoride microbubbles for injection and 5-ml of 0.9% sodium chloride injection were given intravenously. Ten minutes later, the patient developed fever, confusion, profuse sweating, red skin rash, and blood pressure 80/60-mmHg, and anaphylactic shock caused by sulphur hexafluoride microbubbles for injection was considered. The patient was given intravenous injection of dexamethasone 10-mg, intravenous infusion of adrenaline 1-mg dissolved in 0.9% sodium chloride injection 250-ml, intramuscular injection of promethazine 25-mg, and mask oxygen. About 3-minutes later, the patient′s consciousness gradually turned clear, and the blood pressure rose (103/72-mmHg); 1.5-hours later, the patient′s consciousness was completely recovered, the blood pressure was 143/86-mmHg, the heart rate was 98 beats/min, and the blood oxygen saturation was 0.98. Twenty-four hours later, the rash was basically disappeared, and the patient′s condition was stable.
  • Complete ileus due to montmorillonite powder
    Wang Xiao, Liu Huaxue
    2022, 24(1): 42-43. https://doi.org/10.3760/cma.j.cn114015-20210223-00209
    Abstract ( ) PDF ( )
    A 50-year-old male patient had diarrhea due to unclean diet. According to the doctor′s advice, the patient received the first dose of montmorillonite powder 6 g orally. The next day, he developed abdominal pain, abdominal distention, and no defecation. Enema was ineffective. Physical examination showed abdominal distension, percussion drum sound, obvious abdominal tenderness, and reduced bowel sound. The patient was diagnosed with complete ileus by abdominal CT. After 5 days of symptomatic treatments such as diet prohibition, gastrointestinal decompression, and enema defecation, the patient returned to normal exhaust and defecation. After excluding other intestinal lesions through abdominal X-ray, enhanced CT, and enteroscopy, it is considered that the patient′s complete ileus was related to montmorillonite powder.
  • Dalteparin sodium-induced thrombocytopenia and arterial thrombosis
    Liu Hongming, Wang Jian, Ding Zheng
    2022, 24(1): 44-46. https://doi.org/10.3760/cma.j.cn114015-20210318-00323
    Abstract ( ) PDF ( )
    A 64-year-old male patient underwent laparoscopic radical cystectomy for bladder squamous cell carcinoma, followed by anticoagulant therapy with subcutaneous injection of dalteparin sodium injection 5 000 U once daily. On the 8th day of dalteparin sodium treatment, the patient developed thrombocytopenia ［platelet count (PLT) decreased from 132×109/L before operation to 65×109/L after operation］; on the 10th day, the patient developed weakness, swelling, and low skin temperature and cyanosis in the left thigh. Laboratory tests showed PLT 22×109/L and positive serum heparin/platelet factor 4 complex antibody. CT angiography of the left lower limb showed thrombosis of the left arteria iliaca communis.  Heparin-induced thrombocytopenia with thrombosis was diagnosed. Dalteparin sodium was discontinued and replaced by subcutaneous injection of fondaparinux sodium 7.5-mg once daily. Two days later, the swelling in the left thigh was relieved and PLT was 62×109/L; 8 days later, the swelling of left lower limb subsided and PLT was 128×109/L; 18 days later, CT angiography of the left lower limb showed that the location of thrombus in the left arteria iliaca communis was partially recanalized and PLT was 185×109/L.
  • Lactic acidosis induced by tenofovir alafenamide
    Wang Dongxue, Xu Feng, Hou Jiqiu
    2022, 24(1): 46-48. https://doi.org/10.3760/cma.j.cn114015-20210322-00342
    Abstract ( ) PDF ( )
    A 32-year-old female patient received anti-virus treatment with tenofovir alafenamide one month after regular hemodialysis due to stage 5 chronic kidney disease complicated with chronic hepatitis B. At the same time, recombinant human erythropoietin injection and iron sucrose injection was periodically used to correct anemia. Her hemoglobin was about 96-g/L without clinical manifestations of anemia such as nausea and fatigue. Eight months after tenofovir alafenamide treatment, she developed dizziness, headache, nausea, fatigue, and lethargy. Laboratory tests showed hemoglobin 94-g/L and serum creatinine 856-μmol/L; blood gas analysis showed pH 7.05, lactate 3.3-mmol/L, arterial partial pressure of oxygen 80-mmHg, arterial partial pressure of carbon dioxide 23-mmHg, base excess -7.4-mmol/L, and bicarbonate 15.6-mmol/L. It was considered that the patient had lactic acidosis, which might be associated with tenofovir alafenamide. The drug was stopped and replaced by entecavir and symptomatic treatments such as fluid rehydration and liver protection were given. One day later, symptoms of dizziness and headache, etc. in the patient were improved and blood gas analysis showed pH 7.25, lactate 2.9-mmol/L, base excess -3.0-mmol/L; 5 days later, the above symptoms basically disappeared and blood gas analysis showed pH 7.45, lactate 1.5-mmol/L, base excess -2.0-mmol/L.
  • Death due to myelosuppression and multiple organ failure associated with over dose of methotrexate
    Zhao Yanhua
    2022, 24(1): 49-51. https://doi.org/10.3760/cma.j.cn114015-20210226-00237
    Abstract ( ) PDF ( )
    A 77-year-old male patient with rheumatoid arthritis was given methotrexate 10-mg once a week, tripterygium glycosides 20-mg twice daily, and methylprednisolone 8-mg once daily orally. However, the patient confused the medication frequency of methotrexate with tripterygium glycosides and mistakenly took methotrexate 5-mg twice daily. After 4 days of medication (taking methotrexate 7 times, 35-mg in total), the patient developed severe oral ulcers, generalized rash, fever, cough, and expectoration. Laboratory tests showed white blood cell count 1.21×109/L, serum creatinine 288-μmol/L, γ-glutamyl- transferase 163-U/L, alanine transaminase 82-U/L, and alkaline phosphatase 235-U/L. After 6 days of medi- cation, laboratory tests showed white blood cell count 0.13×109/L, neutrophil count 0.01×109/L, serum creatinine 317-μmol/L, estimated glomerular filtration rate 18-ml/(min·1.73 m2), C-reactive protein 233.8-mg L, and procalcitonin 14.31-μg/L. The patient was diagnosed as having methotrexate poisoning, myelosuppres- sion, renal insufficiency, and pulmonary infection. All drugs were discontinued immediately. Blood perfusion, intravenous injection of calcium folinate, and symptomatic treatments such as anti-infection, elevation of white blood cells, blood transfusion, rehydration, and mouth care were given. However, the patient′s infection and myelosuppression continued to worsen, and he died of multiple organ failure 12 days later.
  • Severe diarrhea and hypokalemia caused by gefitinib
    Pan Bobo, Huang Jie, Huang Yuena, Zhong Han, Dai Youqin
    2022, 24(1): 51-53. https://doi.org/10.3760/cma.j.cn114015-20210106-00023
    Abstract ( ) PDF ( )
    An 83-year-old female patient received gefitinib 0.25 g once daily due to right lung adenocarcinoma with left lung metastasis and suspicious liver metastasis. She developed severe diarrhea with nausea and vomiting 27 days after treatment. Laboratory test showed that blood potassium was 2.1-mmol/L. The results of fecal culture were negative, and infectious diarrhea was excluded. Gefinib was continued. After 4 days of treatments with potassium supplement and antidiarrheal, the patient recovered. Four days later, the patient developed the above symptoms again, and the laboratory test showed that the blood potassium was 2.96-mmol/L. Diarrhea and hypokalemia were considered to be related to gefitinib. The drug was withdrawn and the symptomatic treatments such as potassium supplement, antidiarrheal, antiemetic, and stomach protection were given. Nine days of drug withdrawal, her symptoms of diarrhea, nausea, and vomiting were relieved, and laboratory test showed that blood potassium was 3.52-mmol/L; 22 days of drug withdrawal, the diarrhea, nausea, and vomiting disappeared, and the laboratory test showed that blood potassium was 4.69-mmol/L.
Office
Journal
Download
More...
Link
More...