Renin-angiotensin system inhibitors prescriptions in Chinese hospitalized chronic kidney disease patients

BACKGROUND Many guidelines have recommended renin-angiotensin system inhibitors(RASI)as the first-line treatment for patients with chronic kidney disease(CKD).We studied RASI prescription trends from 2010 to 2019,and analyzed the characteristics associated with RASI prescription in Chinese hospitalized CKD patients.AIM To study the prescription of renin angiotensin system inhibitors in hospitalized patients with CKD in China.METHODS It was retrospectively,cross-sectional reviewed RASI prescriptions in hospitalized CKD patients in China from 2010 to 2019.RASI prescribing trends were analyzed from 2010 to 2019,and bivariate and multivariate logistic regression analyses were conducted to identify characteristics associated with RASI prescription.RESULTS A total of 35090 CKD patients were included,with 10043(28.6%)RASI prescriptions.Among these patients,18919(53.9%)met the criteria for RASI treatments based on the 2012 kidney disease:Improving global outcomes guidelines.Of these,7246(38.3%)patients received RASI prescriptions.RASI prescriptions showed an initial rapid increase from 2011 to 2012,reached its peak around 2015 and 2016,and then exhibited a subsequent slight decreasing trend.Both bivariate and multivariate analyses showed that several characteristics,including the male gender,age less than 60-year-old,nephrology department admission,lower CKD stage,history of hypertension or diabetes,proteinuria,glomerulonephritis as the CKD etiology,and non-acute kidney injury were associated with RASI prescriptions.CONCLUSION The frequency of RASI prescriptions showed an initial increase but a slight decreasing trend in more recent years.CKD patients with certain characteristics such as elderly age,advanced disease stage,surgery department admission,or acute kidney injury were less likely to receive RASI prescriptions.In the application of RASI in hospitalized CKD patients is insufficient.The actual clinical practice needs to be improved.The development of related research is helpful to guide the correct choice of clinical treatment strategy.

Research on the Progress of Treating Gastroesophageal Reflux Disease with Modified Classic Traditional Chinese Medicine Prescription

Gastroesophageal reflux disease (GERD) is a high-incidence digestive system disease. Western medicine mainly uses drugs such as proton pump inhibitors to inhibit gastric acid secretion, but some patients are accompanied by symptoms such as non-acid reflux and gas reflux, which cannot effectively treat the disease. It is necessary to actively explore other treatment schemes. Traditional Chinese medicine (TCM) has a long history of research on gastroesophageal reflux disease, which emphasizes the treatment based on syndrome differentiation as a whole. Through the treatment of various and multi-component TCM prescriptions, the patient’s body condition can be adjusted, and the treatment effect on gastroesophageal reflux disease is reliable, which has obvious therapeutic advantages. To further clarify the treatment of gastroesophageal reflux disease, this study reviewed and analyzed the research progress of the treatment of liver disease with modified prescriptions, and the report is as follows.

A Review on Application and Development of General Prescriptions for Treating Epidemic Diseases in Traditional Chinese Medicine

In thousands of years'struggling against epidemic diseases,traditional Chinese medicine(TCM),with its unique and advantageous theories and methods,has protected prosperity of the Chinese nation,composing a brilliant chapter.There are many famous prescriptions and medicines for prevention and treatment of epidemic diseases in TCM.In view of characteristics of epidemic diseases,application of general prescriptions in fighting against epidemic diseases has its unique effects and advantages.Through combing and studying the application of TCM general prescriptions for treating epidemic diseases in different historical periods,summarizing experience and reflecting on lessons,this paper tries to define the concept of TCM general prescriptions for treating epidemic diseases,explore elements of their efficacy guarantee,analyze their advantages and limitations,as well as reveal their enlightenment significance and application prospects,or provide ideas and reference for clinical application.

China Association of Chinese Medicine Paper notice for seminar on clinical application of TCM classic prescriptions and herbs in the treatment of emotional diseases

Hosted by ChinaAssociation of Chinese Medicine,and organized by World Journal of Integrated traditional and western Medicine,seminar on clinical application of TCM classic prescriptions and herbs in the treatment of emotional diseaseis planned to be held in Yichang,Hubei province from June 22nd to 24th.

Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy.Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training,the effects and underlying mechanisms of exercise remain unclear.Thus,the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol.This review summarizes the latest exercise prescription treatments for 26 different diseases:musculoskeletal system diseases(low back pain,tendon injury,osteoporosis,osteoarthritis,and hip fracture),metabolic system diseases(obesity,type 2 diabetes,type 1 diabetes,and nonalcoholic fatty liver disease),cardio-cerebral vascular system diseases(coronary artery disease,stroke,and chronic heart failure),nervous system diseases(Parkinson’s disease,Huntington’s disease,Alzheimer’s disease,depression,and anxiety disorders),respiratory system diseases(chronic obstructive pulmonary disease,interstitial lung disease,and after lung transplantation),urinary system diseases(chronic kidney disease and after kidney transplantation),and cancers(breast cancer,colon cancer,prostate cancer,and lung cancer).Each exercise prescription is displayed in a corresponding table.The recommended type,intensity,and frequency of exercise prescriptions are summarized,and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.

Evidence-Based Medicine Research on Prescriptions in Synopsis of the Golden Chamber in the Treatment of Pelvic Inflammatory Disease

Purpose: Based on the National Natural Science Foundation of China, we collect and sort out the literature published in approximately the last 30 years, which use prescriptions in Synopsis of the Golden Chamber to treat pelvic inflammatory disease (PID). This study provides theoretical basis for the treatment of PID;we recommend this achievement to colleagues. Method: Firstly, we searched and collected the literatures from last three decades in CNKI, Wanfang and VIP databases, which are about classical prescriptions treating endometriosis. Then, by screening all the literatures, we obtained the clinical research literatures and individual case reports. Finally, we went through the internal quality of the two categories of literatures to get the dominant prescriptions. Using a retrospective study of evidence-based medicine research, we comprehensively collect literature, standardize the disease spectrum, classify the evidence, and then evaluate the internal quality. Results: We refine 4 prescriptions which commonly are used in the treatment of PID;in other words, they are also the clinical symptoms of PID: Gui Zhi Fu Ling Wan symptom, which manifests blood stasis and cold-damp stagnancy;Dang Gui Shao Yao San symptom, which manifests disharmony of liver and spleen, qi-blood stasis and damp obstruction;Da Huang Mu Dan Tang symptom, which manifests the gathering toxic heat and qi-blood stasis;Yi Yi Fu Zi Bai Jiang San symptom, which manifests the internal toxic heat and qi-blood injury. Conclusion: This study is gospel for the patients with recurrent episodes of PID who can’t often use antibiotics. At the same time, it is also a green therapeutics which Chinese ancients dedicated to human medicine.

Short Term Prediction of Infectious Diseases Patients from Prescription Surveillance

In Japan, the incidence of almost all common pediatric infectious diseases has been monitored, with 7 - 10 day delays, at medical institutions through the National Official Sentinel Surveillance of Infectious Diseases (NOSSID). On the other hand, based on prescriptions filled at external pharmacies, Prescription Surveillance (PS) collects information and provides estimated numbers of influenza, varicella, and gastroenteritis infectious (GI) patients to the public the following morning. For precise, and real-time estimation of incidences of common pediatric infectious diseases, we evaluated predictive power of PS for diseases other than influenza, varicella, and GI. Results demonstrated that PS information has sufficient predictive power for pharyngoconjunctival fever, group A streptococcal pharyngitis, exanthem subitum, and mumps, some predictive power for RS virus infection, erythema infectiosum and herpangina, but insufficient predictive power for hand, foot and mouth disease.

Who could and should give exercise prescription:Physicians,exercise and health scientists,fitness trainers,or ChatGPT?

Benefits of exercise for personal health,as well as preventing and treating chronic diseases,have been well documented during the past several decades.1 Exercise prescription is a specialized field that involves assessing an individual’s health status,fitness level,and specific goals to create a tailored exercise program based often on the FITT-VP principle.

Taohong Siwu Decoction:a classical Chinese prescription for treatment of orthopedic diseases

The pathogenesis of orthopedic diseases is intimately linked to blood stasis,frequently arising from damage to primary and secondary blood channels.This disruption can lead to“blood leaving the meridians”or Qi stagnation,resulting in blood stasis syndrome.Taohong Siwu Decoction(THSWD)is a renowned classical Chinese medicinal formula extensively used to promote blood circulation and mitigate blood stasis.Clinical studies have demonstrated its significant therapeutic effects on various orthopedic conditions,particularly its anti-inflammatory and analgesic properties,as well as its efficacy in preventing deep vein thrombosis post-surgery.Despite these findings,research on THSWD remains fragmented,and its interdisciplinary impact is limited.This review aims to provide a comprehensive evaluation of the efficacy and pharmacological mechanisms of THSWD in treating common orthopedic diseases.Additionally,we employ bibliometric analysis to explore research trends and hotspots related to THSWD.We hope this review will enhance the recognition and application of THSWD in orthopedic treatments and guide future research into its pharmacological mechanisms.

Opioid Prescriptions in Women: Is the Data Accurate?

Background: In 2012, U.S. health care providers wrote more than 259 million opioid prescriptions, which is twice as many as in 1998. Approximately 1 in 10 women report the use of opioids for pain management during pregnancy. The Centers for Disease Control and Prevention (CDC) estimated that between 2008 and 2012, 39% of reproductive-aged women on Medicaid had filled a prescription for opioid medication each year, as did 28% of women with private insurance. The opioid epidemic extends to the state of New Jersey (NJ);however, limited data is available regarding opioid prescriptions among Medicaid and private insurance patients within the state. Objective: Evaluate opioid prescriptions filled in reproductive-aged women presenting in labor at a community teaching hospital in suburban New Jersey. Methods: We performed a retrospective cohort study using data obtained from patient records and the New Jersey Prescription Monitoring Program (NJPMP) database. We enrolled 200 patients that were admitted in labor between May 2015 and May 2016. Data was collected from reproductive-aged women during the one year preceding labor admission. We compared our findings to national data reported by the CDC using Chi-square analysis. Maternal demographic data were extracted from patient records and included age, insurance status (private insurance, Medicaid, and no insurance), race, and ethnicity. The primary outcome was opioid prescriptions filled. Results: Of the 200 women admitted in labor, 129 had private insurance, 63 had Medicaid, and 8 had no insurance. We found that 5.4% (7/129) of patients with private insurance, 4.8% (3/63) of patients with Medicaid, and 12.5% (1/8) of patients with no insurance filled opioid prescriptions. Overall, 5.5% (11/200) of women filled opioid prescriptions during the study period. Opioid prescriptions confirmed via NJPMP were significantly lower than rates reported by the CDC in Medicaid (4.8% vs. 41.4%, p-value 0.001) and private insurance (5.4% vs. 29.1%, p-value < 0.001) patients, respectively. Conclusion: Rates of opioid prescriptions filled were lower among our suburban cohort of women in New Jersey than national rates reported by the CDC. We did not confirm that patients with Medicaid filled more prescriptions than patients with private insurance. These discrepancies raise the question of whether a federal prescription monitoring program would better capture data than state-wide programs. Further research is needed to ensure that prescription monitoring programs are actually capturing accurate data.

Analysis of prescription rules in the treatment of diabetic heart disease based on traditional Chinese medicine inheritance support system

Diabetes is a common clinical disease and has many complications,among which diabetic heart disease is the leading cause of death in diabetic patients.This article collected the prescriptions for the treatment of diabetic heart disease,and used the traditional Chinese medicine inheritance support system to explore the prescription formulation rules.Finally,we included 43 prescriptions for analysis.We found that the rules of formulas for treating diabetic heart disease are complex,but Chinese medicines in these formulas are mainly with the effects of nourishing Qi,nourishing Yin and activating blood circulation.At the same time,we obtained 3 new prescriptions and discussed the clinical rationality of the new prescriptions.The purpose of this article is to provide reference for clinical prescription in the treatment of diabetic heart disease and the development of related new drugs.

祛瘀通络方联合灌汤1号对盆腔炎性疾病后遗症患者炎症因子的影响

目的探讨祛瘀通络方联合灌汤1号对盆腔炎性疾病后遗症患者炎症因子的影响。方法选取100例盆腔炎性疾病后遗症患者,随机分为对照组与治疗组,每组50例,对照组采用桂枝茯苓丸口服治疗,治疗组采用祛瘀通络方口服联合灌汤1号保留灌肠治疗,疗程3个月。观察中医证候积分、局部症状及血清白细胞介素-8(Interleukin-8,IL-8)、白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子(Tumor necrosis factor-α,TNF-α)变化。结果两组患者治疗前中医证候积分比较差异无统计学意义(P>0.05),治疗后中医证候积分较治疗前下降,治疗组下降程度明显大于对照组,比较差异有统计学意义(P<0.05);两组患者治疗前局部症状评分比较差异无统计学意义(P>0.05),治疗后局部症状的评分较治疗前下降,治疗组下降程度明显大于对照组,比较差异有统计学意义(P<0.05);两组患者治疗前血清IL-8、IL-6、TNF-α比较差异无统计学意义(P>0.05),治疗后IL-8、IL-6、TNF-α水平较治疗前下降,治疗组下降程度明显大于对照组,比较差异有统计学意义(P<0.05);治疗组治疗疗效明显优于对照组(P<0.05),治疗组治疗总有效率为96.00%(48/50),高于对照组80.00%(40/50),比较差异有统计学意义(P<0.05)。结论盆腔炎性疾病后遗症患者采用祛瘀通络方联合灌汤1号治疗,可改善自觉症状及妇科阳性体征,降低血清促炎因子水平,提高治疗疗效。

论基于“病、证、征结合”方剂的主治表述

目前对方剂主治的规范性研究较少,通过对方剂主治源流的梳理并分析《方剂学》教材中方剂主治描述中存在的问题,提出“病、证、征结合”3个层次的方剂主治描述规范,从而有利于临证依法用方、规范教材和规范方剂的科学研究。

苓桂剂类方方证分析与传承创新

苓桂剂类方是仲景基于水气病而设的,以茯苓、桂枝为主要配伍的一类组方。仲景经典的苓桂剂类方有7个,分别是苓桂术甘汤、苓桂枣甘汤、苓桂姜甘汤、苓桂味甘汤、五苓散、茯苓泽泻汤和防己茯苓汤。对苓桂剂的7个类方方证进行了系统梳理,从组方配伍、以方测证、方证对应、核心病机等方面进行了比较和分析,然后介绍了叶天士、刘渡舟和本研究团队对苓桂剂类方在传承中的丰富和发展。最后结合现代医学进展,总结了苓桂剂类方在临床的应用拓展与创新。传承是中医发展的基石,在传承中创新是中医赋予我们的使命,苓桂剂类方方证的传承是中医传承创新的典范。

调补心肾方通过活化PI3K/Akt/mTOR通路促进阿尔茨海默病5xFAD转基因小鼠突触可塑性相关蛋白的合成

目的探讨调补心肾方(党参、制首乌、枸杞子、黄芪等)对阿尔茨海默病5xFAD转基因小鼠突触可塑性的影响及机制。方法取5月龄雄性野生型(WT)小鼠和5xFAD转基因小鼠各18只,分别随机分为对照组(0.9%NaCl)、调补心肾方组(颗粒剂,4.18 g·kg^(-1))、安理申组(盐酸多奈哌齐,0.625 mg·kg^(-1)),每组6只。按照上述分组灌胃给药,每日1次,共60 d。采用透射电镜观察小鼠海马组织超微结构;Western Blot法检测小鼠皮层组织中Synaptophsin、PSD-95、p-NMDAR1、NMDAR1、p-CaMKⅡa、CaMKⅡa、PI3K、p-Akt、Akt、p-mTOR、mTOR蛋白表达水平。结果与WT对照组比较,5xFAD对照组小鼠海马CA1区突触的超微结构不规则,线粒体萎缩、减少,线粒体嵴断裂、消失,突触膜弯曲不规则,突触囊泡减少,突触后致密物(PDS)变薄甚至断裂;皮层组织中Synaptophsin、PSD-95、p-NMDAR1/NMDAR1、p-CaMKⅡa/CaMKⅡa、PI3K、p-Akt/Akt、p-mTOR/mTOR蛋白表达均明显下调(P<0.05)。与5xFAD对照组相比较,5xFAD调补心肾方组小鼠海马CA1区突触的超微结构有明显变化,线粒体数量增加,突触囊泡增多,突触膜完整,突触后致密物有增厚现象;皮层组织中Synaptophsin、PSD-95、p-NMDAR1/NMDAR1、p-CaMKⅡa/CaMKⅡa、PI3K、p-Akt/Akt、p-mTOR/mTOR蛋白表达明显上调(P<0.05)。结论调补心肾方可能通过活化PI3K/Akt/mTOR通路,促进突触可塑性相关蛋白合成,进而改善AD的认知功能障碍。

以麻黄为主药系列经方在儿童过敏性疾病辨治中的运用

以麻黄为主药系列经方在儿童过敏性疾病辨治中的运用。儿童过敏性疾病多年来是临床治疗的难点,以麻黄为主药系列方治疗该病临床疗效确切肯定。儿童过敏性疾病多因正气不足,肺、脾、肾功能低下,痰饮等伏邪宿根停留于体内,外邪引动而发病。麻黄为治疗咳喘之圣药,通过合理的配伍,麻黄与杏仁宣降相成,麻黄与石膏寒温并举,麻黄与附子温通表里。为了确保疗效,要重视遵循经方的原配伍比例、剂量、组方、煎服法和调护法。此外,还要明确麻黄类方及方证应用,即对方证,抓主证。

基于“醇正和缓”理论自拟方剂治疗脾肾气虚型慢性肾脏病2~3期的临床研究

目的探究基于“醇正和缓”理论自拟方剂治疗脾肾气虚型慢性肾脏病(CKD)2~3期的临床效果。方法选取江苏省常州市武进中医医院2021年11月至2023年4月收治的2~3期CKD患者88例,采用随机数字表法将其分成对照组和观察组,各44例。对照组予以复方α-酮酸片治疗,观察组予以复方α-酮酸片联合自拟方剂和缓养肾方治疗,两组均以2个月为1个疗程,共治疗2个疗程。比较两组疗效及用药安全性,比较两组治疗前后的中医症状、体征积分及肾小管、肾功能。结果观察组疗效优于对照组(P<0.05)。治疗后,两组中医症状、体征积分均低于治疗前,且观察组低于对照组(P<0.05)。治疗后,两组N-乙酰-β-D-葡萄糖苷酶、α_(1)-微球蛋白、β_(2)-微球蛋白、视黄醇结合蛋白、血尿素氮、血肌酐、血尿酸、半胱氨酸蛋白酶抑制剂C、24 h尿蛋白定量均低于治疗前,且观察组α_(1)-微球蛋白、视黄醇结合蛋白、血尿素氮、血肌酐、血尿酸、半胱氨酸蛋白酶抑制剂C、24 h尿蛋白定量均低于对照组(P<0.05)。两组治疗期间均未发生不良反应,两组治疗前后谷丙转氨酶、总胆红素比较,差异无统计学意义(P>0.05)。结论基于“醇正和缓”理论的自拟中药和缓养肾方用于2~3期CKD患者临床治疗,可明显提升效果,改善患者临床中医症状,提升肾小管功能,促进肾功能恢复,且用药安全可控。

马晓燕撷经典方剂治疗内科杂病经验浅谈

郁证的主要临床表现为情绪抑郁不宁、心胸满闷、胸部以及胁肋部胀痛,或有善哭易怒,亦或咽中如有炙脔等不适。相当于现代医学中的神经衰弱、癔症及焦虑症等。常因喜怒忧思,郁滞不舒,而导致肝疏泄功能失职,脾脏失其健运之功,心失其养,脏腑、气血、阴阳功能紊乱;而消渴常因禀赋不足亦或是饮食不节等因素导致阴津亏损,燥热偏盛,而出现“三多一少”的症状,即多饮、多尿、多食以及形体消瘦,相当于现代医学的“糖尿病”。马教授投身于对于郁证和消渴的证候及治疗的研究,熟读经典、精求古训,并且在长期的诊疗疾病过程中,对于使用经典方剂加减化裁辨治郁证和消渴等内科杂病积累了丰富的临床经验。现撷马教授以经典方剂治疗郁证和消渴等内科杂病的经验作总结与探析。其临床疗效确切。

“润肺止咳方”干预新型冠状病毒感染后咳嗽的回顾性分析

目的:评价2022年冬季北京大学第三医院“润肺止咳方”治疗新型冠状病毒感染后咳嗽患者的临床疗效。方法:回顾性收集2022年12月15日至2023年1月5日北京大学第三医院中医科门诊收治的新型冠状病毒感染后咳嗽患者108例,其中包括观察组68例和对照组40例。观察组给予“润肺止咳方”治疗,对照组对为未采用中医治疗的新型冠状病毒感染后咳嗽的临床患者,但可能有西医对症治疗。收集患者的基本资料、中医证候和用药情况,比较2组患者的体温复常时间、核酸转阴时间以及临床疗效。结果:与对照组比较,观察组的体温复常时间和核酸转阴时间差异无统计学意义(P=0.892,P=0.967)。观察组的临床治愈率为52.9%(36/68)、总有效率为88.2%(60/68),显著优于对照组的临床治愈率12.5%(5/40)、总有效率47.5%(19/40)(均P<0.01)。结论:北京大学第三医院“润肺止咳方”可改善新型冠状病毒感染患者的咳嗽症状,提高了中医治疗新型冠状病毒咳嗽后遗症的有效率和治愈率。

经方丹栀逍遥丸对代谢相关脂肪性肝病小鼠巨噬细胞抗慢炎状态的调节作用

目的 评价经方丹栀逍遥丸(JF-DZXYW)对代谢相关脂肪性肝病小鼠巨噬细胞抗慢性炎症的调控作用,对巨噬细胞吞噬能力、巨噬细胞表面标志物MHC-Ⅱ、CD86、CD80、TLR4表达及巨噬细胞内活性氧表达(ROS)的影响,并阐述其诱导免疫系统发挥抗炎症作用。方法 40只体质量18~22 g雄性昆明种小鼠,随机分为对照组(生理盐水组)、JF-DZXYW低剂量组(125μg/mL)、JF-DZXYW中剂量组(250μg/mL)和JF-DZXYW高剂量组(500μg/mL),灌胃0.4 mL/t/d,共15 d。第16天小鼠行腹腔注射0.2 mL 10%蛋白胨,3 d后小鼠腹腔注射新配制的5%鸡红细胞各0.5 mL,提取小鼠腹腔巨噬细胞进行巨噬细胞吞噬功能检测、细胞表面标志物流式细胞分析及ROS表达检测。结果 3个剂量组的JF-DZXYW汤剂吞噬百分率及吞噬指数均显著高于对照组(P<0.01)。JF-DZXYW低、中、高剂量组小鼠腹腔巨噬细胞表面标志物MHC-Ⅱ、CD86、CD80表达明显高于对照组(P<0.01),JF-DZXYW中、高剂量组小鼠腹腔巨噬细胞表面标志物TLR4表达均明显高于对照组(P<0.01)。JF-DZXYW低剂量组小鼠腹腔巨噬细胞内ROS表达明显高于对照组(P<0.05),JF-DZXYW中、高剂量组小鼠腹腔巨噬细胞内ROS表达均明显高于对照组(P<0.01)。结论 JF-DZXYW可以通过上调巨噬细胞功能、促巨噬细胞表面标志物MHC-Ⅱ、CD86、CD80、TLR4及巨噬细胞内活性氧表达提升机体免疫功能从而抑制慢性炎症状态。