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  • 2023 Volume 20 Issue 7
    Published: 25 July 2023
      
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  • Research Progress in Pharmacological Effects of Berberine against Urological Tumors and Its Mechanisms
    ZHANG Ming-fa, SHEN Ya-qin
    2023, 20(7): 671-676. https://doi.org/10.13493/j.issn.1672-7878.2023.07-001
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    Though berberine is mainly used for the clinical treatment of intestinal infections, it actually features a wide range of pharmacological effects, such as anti-inflammation, cardioprotection, hypoglycemic effect, blood lipid regulation, and immunomodulation. In addition, animal and cellular experiments also reveal that berberine exhibits favorable pharmacological effects on various types of tumors, such as lung cancer, liver cancer, esophageal cancer, colon cancer, cervical cancer, breast cancer, bladder cancer, prostate cancer, lymphoma and melanoma. This article mainly reviews the role of berberine against bladder cancer, renal cell carcinoma, prostate cancer and other urological tumors and its mechanisms, and analyzes the related research progress.
  • Research Progress in Polypeptide Fusion Inhibitors Targeting HIV-1 Transmembrane Protein gp41
    LIU Chuan-ming, ZENG Dian-dian, LI Xie, LU Xi-kui, CHEN Jie
    2023, 20(7): 677-681. https://doi.org/10.13493/j.issn.1672-7878.2023.07-002
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    Transmembrane protein gp41 is an important target for the treatment of acquired immunodeficiency syndromes. Enfuvirtide is the first polypeptide fusion inhibitor targeting gp41 approved by FDA. However, with relatively short half-life, relatively low genetic barrier to drug resistance and low efficacy, the clinical use of enfuvirtide has been limited. In recent years, polypeptide fusion inhibitors developed to target gp41 have demonstrated promising efficacy and stability. In this regard, this article mainly reviews the research status of polypeptide fusion inhibitors targeting transmembrane protein gp41.
  • Pharmaceutical Care of Anti-infective Therapy in Patients Complicated by Intra-abdominal Infection after Choledocholithotomy
    ZHANG Jian-wei, SONG Ming-hui, ZHANG Rong-hou
    2023, 20(7): 682-685. https://doi.org/10.13493/j.issn.1672-7878.2023.07-003
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    Objective: To analyze the process of pharmaceutical care of anti-infective therapy in patients complicated by intra-abdominal infection after choledocholithotomy, so as to provide reference for the anti-infective therapy of such patients. Methods: A patient was transferred to our hospital with symptoms of infection such as persistent fever and peri-incisional redness and swelling after choledocholithotomy, and then Enterococcus gallinae (EG) and Enterobacter aggregatus (EA) were detected successively in the abdominal incision secretions. Based on the drug susceptibility test results for 2 bacteria and the actual clinical circumstances, the clinical pharmacist recommended an adjustment to the administration record of linezolid, as well as the addition of etimicin, tigecycline, and imipenem-cilastatin sodium, all of which were accepted by the physician. Results: After 10 days of treatment with linezolid, no EG was reported on the patient's microbiological test results; for EA infection, after treatment with etimicin, tigecycline and imipenem-cilastatin sodium successively for more than half a month, the patient's body temperature basically returned to normal, and the level of procalcitonin also decreased significantly, and the patient was discharged from hospital successfully. Conclusion: During pharmaceutical care of anti-infective therapy, clinical pharmacists can assist physicians in developing more personalized therapies based on their professional expertise, which can not only improve the work efficiency of the entire medical team, but also guarantee the therapeutic effect and medication safety of patients.
  • Analysis of Clinical Treatment of One Patient with Extranodal NK/T-Cell Lymphoma (Nasal Type) Complicated with Nasal Infection
    LIU Qing-lai
    2023, 20(7): 686-689. https://doi.org/10.13493/j.issn.1672-7878.2023.07-004
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    Objective: To analyze the clinical treatment and pharmaceutical care process of patients with extranodal NK/T-cell lymphoma (nasal type) (ENKTCL-NT) complicated with nasal infection, so as to provide reference for the anti-infective therapy of such patients. Methods: One patient with ENKTCL-NT was admitted to the hospital due to nasal ulcer with pus during treatment. After admission, the clinical pharmacist immediately performed pharmaceutical care, during which the patient developed recurrent high fever, with C reactive protein (CRP) level reaching 115.9 mg/L, and Staphylococcus aureus (SA) and Enterococcus faecalis were cultured successively in the ulcer secretion, of which SA was methicillin-resistant bacterial strain. Results: Based on the patient's presentation of nasal ulcer, recurrent high fever, CRP level, etc., the clinical pharmacist could basically determine that this was nasal infection and that the pathogenic bacterium was SA. Based on the drug susceptibility test results, the physician was advised to prescribe moxifloxacin and compound sulfamethoxazole for systemic anti-infective therapy, and to apply mupirocin ointment locally; a week later, despite intermittent fever, the symptoms of infection improved significantly and the patient requested to be discharged; a reexamination almost one month later showed that there were no signs and symptoms of infection. Conclusion: For patients with infection of unknown pathogenic bacteria, clinical pharmacists should keep a close eye on the symptomatic changes and microbial culture results of the patients during pharmaceutical care, and assist physicians in adjusting the anti-infective therapy regimen according to the bacterial drug susceptibility test results and the effects of existing anti-infective therapy, so as to ensure the final therapeutic effects of patients.
  • Analysis of Clinical Characteristics of Thrombocytopenia in Children with Severe Infection Caused by Vancomycin
    OUYANG Shui-chang
    2023, 20(7): 690-693. https://doi.org/10.13493/j.issn.1672-7878.2023.07-005
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    Objective: To analyze the clinical characteristics of thrombocytopenia in children with severe infection caused by vancomycin, so as to provide reference for the prevention and treatment of vancomycin-induced thrombocytopenia. Methods: Chinese and English terms of vancomycin, thrombocytopenia, severe infection, and adverse drug reaction were selected as search terms, and all related literature was retrieved from domestic and international databases such as CNKI, Wanfang Database, CQVIP, SinoMed, PubMed, and Web of Science from database establishment until December 2022. Cases eligible for screening were selected on the basis of below 14 years old, and the characteristics associated with the occurrence of thrombocytopenia in the children were analyzed. Results: A total of 592 relevant articles were retrieved after searching, and 10 articles were finally included after checking and screening, with 26 cases involved. Among 26 children, 16 males and 10 females were mainly diagnosed with pneumonia (10 cases), pneumonia combined with sepsis (5 cases), and urinary tract infection (5 cases). The main pathogenic bacteria detected included methicillin-resistant Staphylococcus aureus (8 cases) and methicillin-resistant coagulase negative staphylococcus (5 cases). The dose of vancomycin administered to the children ranged from 15 to 60 mg/(kg·d), with a median value of 33 mg/(kg·d). The time from vancomycin administration to the onset of thrombocytopenia ranged from 3 to 12 d, with a median value of 7 d. The platelet counts of the children were (89-360) × 109/L with a median value of 243 × 109/L before medication, whereas the platelet counts decreased to (9-95) × 109/L with a median value of 47 × 109/L after medication. After treatment, all patients had an improvement in 3-7 d. The evaluation results of correlation between thrombocytopenia and vancomycin showed that there were 3 "definite" cases, 16 "highly probable" cases, and 7 "possible" cases. Conclusion: Vancomycin can cause thrombocytopenia in children with severe infection in the course of treatment; however, the children can basically get improved after timely detection and treatment, therefore, attention should be paid to care and observation clinically when vancomycin is used for the treatment of children, so as to ensure their medication safety.
  • Case Analysis of Patients with Hematuria Caused by Piperacillin-Tazobactam Sodium
    FAN Hong-yan, FU Song-quan, SI Jiang-hua
    2023, 20(7): 694-696. https://doi.org/10.13493/j.issn.1672-7878.2023.07-006
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    Objective: To analyze the pathogenesis and therapeutic process of patients with hematuria caused by piperacillin-tazobactam sodium, so as to provide reference for the treatment of similar cases. Methods: A patient was admitted to the hospital for acute exacerbation of chronic obstructive pulmonary disease (COPD), treated with piperacillin-tazobactam sodium and other medicines on the same day, and in the evening the patient developed gross hematuria with marked symptoms of frequent urination, urgent urination, and painful urination. Results: A retrospective review of the medical history of the patient did not reveal any associated underlying disease that could lead to hematuria. The medication of the day was analyzed and piperacillin-tazobactam sodium was identified as an adverse drug reaction risk of hematuria. In addition, hematuria occurred about 2 h after the administration of piperacillin-tazobactam sodium, so hematuria was considered to be caused by piperacillin-tazobactam sodium. Therefore, piperacillin-tazobactam sodium was discontinued, etamsylate, hemocoagulase, dexamethasone, tamsulosin, and sodium bicarbonate were administered for symptomatic treatment, and the conditions completely disappeared in the patient 2d later. Conclusion: Hematuria is a common clinical condition, and trauma, disease, and medication are the main factors for its occurrence. In clinical judgment and treatment, the patient's medical history and medication should be known as detailed as possible, and the cause of disease should be identified as early as possible, thereby carrying out targeted symptomatic treatment to ensure the safety and health of patients.
  • Review and Analysis of Rational Use of Antibacterial Drugs in Tuberculosis Department of a Hospital
    OUYANG Shu-ping, OUYANG Han-yi, FU Zhi-gang
    2023, 20(7): 701-704. https://doi.org/10.13493/j.issn.1672-7878.2023.07-008
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    Objective: To review and analyze the rational use of antibacterial drugs in Tuberculosis Department of the hospital, so as to provide reference for the rational use of antibacterial drugs in clinical practices. Methods: 3 694 prescriptions (or doctor's advices) for antibacterial drugs in Tuberculosis Department of the hospital from January 2021 to December 2022 were selected as the research data, and the use of antibacterial drugs was reviewed based on authoritative information such as related guidelines, experts' consensus and drug instructions, so as to analyze the characteristics of irrational use of antibacterial drugs. Results: According to the review, 311 prescriptions (or doctor's advices) out of 3 694 prescriptions (or doctor's advices) for antibacterial drugs were irrational, with an irrationality occurrence rate of 8.42%. Based on the types of reasons, 311 irrational prescriptions (or doctor's advices) can be categorized into irregular prescriptions (or doctor's advices) (232, mainly for irregular diagnosis writing) and inappropriate prescriptions (or doctor's advices) (79, mainly for inappropriate usage and dosage of drugs). Among 311 irrational prescriptions (or doctor's advices), the main types of antibacterial drugs involved were levofloxacin (86, 27.65%), amoxicillin-clavulanate potassium (56, 18.01%) and moxifloxacin (52, 16.72%). 60 prescriptions (or doctor's advices) with inappropriate usage and dosage of drugs were mainly for moxifloxacin (29, 48.33%). Conclusion: The use of antibacterial drugs in Tuberculosis Department of the hospital is rational on the whole, but there are relatively more irrational situations in individual varieties. It is necessary to strengthen the clinical training and management of related drugs, so as to promote the clinical rational use of antibacterial drugs.
  • Analysis of Clinical Use of Anti-rheumatic Hospital Preparations in a Hospital*1
    WEI Ke-xin, XUE Xiang-nan, MENG Lu, MA Yi-lin, ZHANG Hong
    2023, 20(7): 705-708. https://doi.org/10.13493/j.issn.1672-7878.2023.07-009
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    Objective: To analyze the characteristics and rational use of clinical medication of anti-rheumatic hospital preparations in the hospital, so as to provide reference for the rational use of anti-rheumatic hospital preparations in hospitals. Methods: 2 445 prescriptions for anti-rheumatic hospital preparations from outpatient and emergency clinics of Luoyang Orthopedic-Traumatological Hospital of Henan Province from April 2021 to April 2022 were selected as the research data to analyze the use distribution and rational use of anti-rheumatic hospital preparations in each department. Results: Among 2 445 prescriptions for anti-rheumatic hospital preparations, the main varieties involved were Wanbiqing pills (1 195, 48.88%) and Wanbikang pills (694, 28.38%), followed by Wanbile pills (315, 12.88%) and Wanbitong pills (241, 9.86%); in terms of department distribution, rheumatology department was the most popular (1 442, 58.98%), followed by neck, shoulder and lumbar-leg pain department (262, 10.72%) and osteoarthrosis department (226, 9.24%). According to the prescription review results, among 2 445 prescriptions for anti-rheumatic hospital preparations, there were 102 irrational prescriptions (with an irrationality rate of 4.17%), and the main reason for irrationality was incomplete writing of clinical differentiation (56, 54.90%). Conclusion: In selecting the varieties of anti-rheumatic hospital preparations, outpatient and emergency clinics of the hospital mostly take Wanbiqing pills and Wanbikang pills, and in terms of department distribution, rheumatology department is the main department. In terms of rational drug use, the overall situation is reasonable, but there are still some unreasonable circumstances. It is necessary to continuously strengthen the clinical training and management in related aspects so as to improve the clinical rational drug use level.
  • Analysis of Diagnostic Value of High-Frequency Ultrasound for Tuberculosis of Cervical Lymph Nodes *1
    ZHU Min-jia, QIAN Jie, SHEN Guo-qian, WU Hai-yan, WANG Yan-yan
    2023, 20(7): 720-723. https://doi.org/10.13493/j.issn.1672-7878.2023.07-0013
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    Objective: To analyze the application value of high-frequency ultrasound in the diagnosis of tuberculosis of cervical lymph nodes, and provide a reference for the accurate diagnosis of tuberculosis of cervical lymph nodes clinically. Methods: 70 patients with enlargement of cervical lymph nodes who were treated in Suzhou Fifth People's Hospital from 2017 to 2021 were selected as the subjects, and they received surgical pathological examination and high-frequency ultrasonic examination. By using the pathological results as a gold standard, the sensitivity, specificity, missed diagnosis rate and misdiagnosis rate of high-frequency ultrasonic examination in the diagnosis of tuberculosis of cervical lymph nodes were analyzed. Results: Among 70 patients, 51 cases were diagnosed with tuberculosis of cervical lymph nodes by high-frequency ultrasonic examination, and 48 of which were identified as tuberculosis of cervical lymph nodes by pathological examination. The sensitivity, specificity, missed diagnosis rate, and misdiagnosis rate of the high-frequency ultrasonic examination in the diagnosis of tuberculosis of cervical lymph nodes were 87.27%, 80.00%, 12.73%, and 20.00%, respectively; the Youden index was 67.27%; the high-frequency ultrasound image characteristics of 48 true-positive patients showed string-like arrangement of cervical lymph nodes, solitary, with a rounded shape, L/T less than 2, and internal echo inhomogeneity; they were manifested as a mixture of hypoecho, anecho, and strong echo, shift, narrowing or disappearance of lymph node hilus, and blurred boundaries and mutual fusion of lymph nodes. Conclusion: High-frequency ultrasound has a high value in the diagnosis of tuberculosis of cervical lymph nodes and can assist clinicians in making accurate diagnosis.
  • Comparative Analysis of Different Smear and Staining Methods of Cerebrospinal Fluid in Diagnosis of Intracranial Infection *1
    LIN Wei, DENG Mao-qing, CHEN Li-ping, XIAO Ting, LU Yong-fang
    2023, 20(7): 724-728. https://doi.org/10.13493/j.issn.1672-7878.2023.07-0014
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    Objective: To compare and analyze the application of different smear and staining methods of cerebrospinal fluid in the diagnosis of intracranial infection, so as to provide reference for the accurate clinical diagnosis of intracranial infection. Methods: 845 cerebrospinal fluid specimens clinically submitted to Longyan First Hospital from September 2017 to August 2021 were selected as the research data, different smear and staining methods were employed for experiments and compared with the results of routine culture and identification to analyze the value of different smear and staining methods in the diagnosis of intracranial infection. Results: According to the culture and identification results, among 845 cerebrospinal fluid specimens, 99 were positive for microbial culture results, and 103 strains of pathogenic bacteria were isolated in total, including 79 strains of Gram-positive bacteria, 9 strains of Gram-negative bacteria, and 15 strains of funguses. The positive coincidence rates of the experimental results of Gram staining and Wright's staining under enriched culture smears and the culture and identification results were higher than 95.00%, while the positive coincidence rates of the experimental results of Gram staining, ink staining, and acid-fast staining under centrifugal smears and the culture and identification results were lower than 50.00%; compared with the culture and identification results, the coincidence between the Gram staining results of enriched culture smears was remarkably excellent (Kappa values above 0.90), while the coincidence of the Gram staining results of centrifugal smears was relatively poor (Kappa values below 0.80). Conclusion: Gram staining and Wright's staining of cerebrospinal fluid enriched culture smears have relatively high positive coincidence rates, which can assist physicians in better and more accurate diagnosis of intracranial infection in conjunction with the culture method under certain conditions, so as to avoid missed diagnosis and misdiagnosis.
  • Impact of QCC Activities on Improving the Implementation Rate of Standardized Respiratory Rehabilitation Training for Elderly Patients with Pulmonary Tuberculosis
    LIU Ling, LIU Xiao-ling, WANG Jin
    2023, 20(7): 729-732. https://doi.org/10.13493/j.issn.1672-7878.2023.07-0015
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    Objective: To investigate the impact of quality control circle (QCC) activities on improving the implementation rate of standardized respiratory rehabilitation training for elderly patients with pulmonary tuberculosis, and provide reference for improving the respiratory rehabilitation of elderly patients with pulmonary tuberculosis. Methods: A QCC team was established, using "Improving the implementation rate of standardized respiratory rehabilitation training for elderly patients with pulmonary tuberculosis" as the activity theme. 60 elderly patients with pulmonary tuberculosis who were hospitalized in the Tuberculosis Department of The Second Hospital of Nanjing from January to June 2023 were selected as the research subjects to analyze the impact of the QCC activities on improving the implementation rate of respiratory rehabilitation training for elderly patients with pulmonary tuberculosis. Results: Through the implementation of QCC activities, the implementation rate of standardized respiratory rehabilitation training for elderly patients with pulmonary tuberculosis increased from 41.67% to 78.79%, the target achievement rate was 131.91%, and the progress rate was 89.08%; during the implementation of the QCC, the team members had improved their problem-solving abilities, sense of responsibility, communication and coordination skills, self-confidence, team cohesion, enthusiasm, quality control techniques and harmony degrees to a certain extent. Conclusion: The implementation of QCC activities has effectively improved the ability of medical staffs to analyze and solve problems, thereby improving the level of clinical medical services and ensuring the treatment effects of patients.
  • Analysis of Occurrence of Unscheduled Secondary Surgeries and Nosocomial Infections in Surgical Patients in a Hospital
    LI Shuai, NIU Gui-lin, ZHU Jin-yu, YAN Xiao-yan, REN Xu
    2023, 20(7): 733-736. https://doi.org/10.13493/j.issn.1672-7878.2023.07-0016
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    Objective: To analyze the occurrence of unscheduled secondary surgeries and nosocomial infections in surgical patients in the hospital, so as to provide reference for reducing the occurrence of unscheduled secondary surgeries and related infections. Methods: 105 467 surgical patients admitted to Nanyang Central Hospital from December 2019 to October 2021 were selected as the study objects, and information of patients was collected such as age, gender, department, name of surgery, reason for surgery, number of surgeries, and occurrence of infections, to analyze the occurrence characteristics of unscheduled secondary surgeries and nosocomial infections in the patients. Results: Among 105 467 surgical patients, 179 (0.17%) underwent unscheduled secondary surgeries, mainly in gastroenterology (43 cases, 24.02%), neurosurgery (41 cases, 22.91%), and hepatobiliary, pancreatic, and spleen surgery (31 cases, 17.32%). The main reasons for unscheduled secondary surgeries were postoperative hemorrhage (102 cases, 56.98%), followed by incision infection (20 cases, 11.17%) and poor healing (16 cases, 8.94%). Among 179 patients undergoing unscheduled secondary surgeries, 52 (with incidence of infection at 29.05%) had nosocomial infections, with 29 (55.77%) of these infections after the secondary surgeries and 22 (42.31%) after the initial surgeries. In addition, the infection was predominantly at the surgical site (26 cases, 50.00%), followed by the respiratory tract (18 cases, 34.62%). Conclusion: The overall incidence of unscheduled secondary surgeries in the hospital is relatively low, with postoperative hemorrhage as the main cause; in addition, the incidence of nosocomial infections is higher in patients undergoing unscheduled secondary surgeries. Clinically, it is necessary to continuously strengthen the intra-operative and postoperative management of patients, so as to reduce the incidence of secondary surgeries and related complications.
  • Analysis of Detection Situation of Gram-negative Bacteria and Their Drug Resistance Changes in Patients with Pulmonary Tuberculosis Complicated with Lower Respiratory Tract Infection in a Hospital from 2019 to 2022 *1
    WANG Min-yuan, WANG Biao, WU Qian-hong
    2023, 20(7): 755-762. https://doi.org/10.13493/j.issn.1672-7878.2023.07-0022
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    Objective: To analyze the detection situation of Gram-negative bacteria and their characteristics of drug resistance changes in patients with pulmonary tuberculosis complicated with lower respiratory tract infection in a hospital from 2019 to 2022, so as to provide reference for the prevention and treatment of lower respiratory tract infection in patients with pulmonary tuberculosis. Methods: A total of 10 790 respiratory specimens such as sputum, alveolar lavage fluid, and throat swab from patients with pulmonary tuberculosis complicated with lower respiratory tract infection admitted to Shaanxi Provincial Tuberculosis Prevention and Control Hospital from January 2019 to December 2022 were collected as research data. The microbial cultivation and drug susceptibility test were conducted to analyze the detection situation of Gram-negative bacteria in patients' specimens and their characteristics of drug resistance changes. Results: 1 384 strains of Gram-negative bacteria were cultured and isolated from 10 790 specimens (with a total detection rate of 12.83%) in total, among which the top five strains were Escherichia coli (284 strains, 20.52%), Klebsiella pneumoniae (279 strains, 20.16%), Pseudomonas aeruginosa (251 strains, 18.14%), Acinetobacter baumannii (107 strains, 7.73%) and Stenotrophomonas maltophilia (81 strains, 5.85%); through the multidrug resistance test, a total of 204 extended-spectrum β-lactamase-producing strains (including 134 strains of Escherichia coli, 57 strains of Klebsiella pneumoniae, and 13 strains of Klebsiella oxytoca), and 55 carbapenem-resistant strains (including 22 strains of Pseudomonas aeruginosa, 21 strains of Acinetobacter baumannii, and 12 strains of Klebsiella pneumoniae) were detected. The drug susceptibility test results showed that the resistance rates of Escherichia coli to imipenem, meropenem, cefoperazone-sulbactam sodium, piperacillin-tazobactam sodium, and amikacin were always low (less than 10.00%) in 4 years; the resistance rates of Klebsiella pneumoniae to imipenem and meropenem were always low (less than 10.00%), while its resistance rates to cefazolin, cefuroxime, ceftazidime, ceftriaxone, ciprofloxacin, compound sulfamethoxazole, and chloramphenicol showed an upward trend (P<0.05); the resistance rates of Pseudomonas aeruginosa to imipenem, meropenem, piperacillin-tazobactam sodium, and amikacin were always low (less than 10.00%), while its resistance rates to gentamicin and tobramycin showed a downward trend (P<0.05); the resistance rate of Pseudomonas aeruginosa to minocycline was always 0.00%, and its resistance rates to ticarcillin-clavulanate potassium, piperacillin-tazobactam sodium, ceftazidime, meropenem, amikacin, gentamicin, ciprofloxacin, and levofloxacin showed an upward trend (P<0.05). Conclusion: Gram-negative bacteria detected in patients with pulmonary tuberculosis complicated with lower respiratory tract infection in the hospital are mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, and most of them have strong drug resistance. Clinically, it is necessary to strengthen the pathogenic surveillance continuously in order to guide the rational use of antibacterial drugs and reduce the occurrence of bacterial resistance.