22 October 2020, Volume 19 Issue 10

    

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Clinical Application of Venoactive Drug
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  Application of venoactive drugs in chronic venous diseases of lower limbs

  HUANG Dian, LI Xiao-qiang

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 1-7. https://doi.org/10.3969/j.issn.1672-3384.2021.10.001

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  Chronic venous disease （CVD） is a common vascular disease. It is a series of symptoms and signs caused by high distal venous pressure，and poor venous blood refluxing or flowing backwards resulted from abnormal venous structure or function of lower limbs. The etiology of CVD is complicated， and the most common etiology of CVD is venous hypertension resulted from blood regurgitation due to venous valve insufficiency. Inflammation plays an important role in the progression of CVD. Currently available intravenous active drugs could improve venous tension and contractility， reduce edema and inflammation， perfect microcirculation and venous ulcer healing， and have been confirmed by a large number of clinical studies. This review aimed to evaluate currently available intravenous active agents in terms of mechanism of action， clinical benefit， and guideline status.
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  Clinical application of venoactive drugs in hemorrhoids

  XIA Shi-jun, FAN Xiao-hua

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 8-11. https://doi.org/10.3969/j.issn.1672-3384.2021.10.002

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  Hemorrhoids is a kind of vascular disease. Local arteriovenous dysregulation is the main factor in terms of etiology and histological characteristics. Regarding the treatment of hemorrhoids， whether it is medical treatment or surgical operation， the use of venoactive drugs in different periods and in different ways can improve venous tension， stabilize capillary permeability and increase lymphatic drainage， so as to alleviate bleeding， edema and pain in patients with hemorrhoids. In recent years， numerous clinical studies of the treatment of acute and chronic hemorrhoids with venoactive drugs have been carried out， which have shown good clinical effects.
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  Clinical research progress of venoactive drugs in the treatment of chronic venous diseases

  AI Chao, TANG Jing, AN Yang, ZHANG Wei, ZHANG Ya-xin

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 12-16. https://doi.org/10.3969/j.issn.1672-3384.2021.10.003

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  Chronic venous disease （CVD） is a common vascular disease. Its pathological changes were caused by chronic inflammation and blood flow disorder. The current therapeutic drugs included intravenous active drugs （VADs） and drugs that affected blood flow characteristics. This paper briefly introduced the common therapeutic drugs for CVD and their safety， and analyzed the limitations of existing clinical research.
Review
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  Research progress on nutrition support for audlt patients receiving extracorporeal membrane oxygenation

  YE Fan, LIU Rui-jve, ZHU Yao-xiang

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 17-21. https://doi.org/10.3969/j.issn.1672-3384.2021.10.004

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  Extracorporeal membrane oxygenation（ECMO） is a mechanical circulatory assisted technique that provides continuous extracorporeal respiration and circulatory support for patients with cardiopulmonary failure to correct hypoxemia， improve oxygen metabolism， and maintain hemodynamic stability.These patients are seriously ill， at this time，the body is often in a state of high catabolism，Reasonable nutritional support can improve the nutritional status of patients and reduce the incidence of complications.Exploring the characteristics of nutritional support and understanding the nutritional management measures of ECMO patients for promoting the body recovery of patients is of important clinical significance. This article reviews nutrition risk screening， the safety of early enteral nutrition， the influence of enteral nutrition on inflammatory factors and gastrointestinal hormones， the use of parenteral nutrition and nutrition requirements of adult ECMO patients，so as to provide evidence for nutritional support for ECMO patients.
Drug in the Future
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  Complement system regulator B targeted inhibitor—Iptacopan

  WANG Huan, FENG Xun, SONG Bing, XIE Fei

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 22-27. https://doi.org/10.3969/j.issn.1672-3384.2021.10.005

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Lastest Drug
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  A new drug for multiple sclerosis——Ponesimod

  LIU Yang, ZHANG Hai-ying

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 28-32. https://doi.org/10.3969/j.issn.1672-3384.2021.10.006

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Original Article
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  Guidelines and consensuses evaluation of H₁-antihistamines in the treatment of allergic diseases in children： an evaluation and review

  ZHOU Xin, ZHOU Peng-xiang, ZHOU Wei, ZHAI Suo-di

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 33-39. https://doi.org/10.3969/j.issn.1672-3384.2021.10.007

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  Objective To summarize the recommendations for the use of non-venous H₁-antihistamines for the treatment of allergic diseases in children， and to evaluate the methodological quality of guidelines and consensuses， so as to provide a reference for pharmacotherapy and the development of guidelines. Methods Literatures were systematically retrieved from PubMed， Embase， Wanfang， CNKI and SinoMed from the inception to 19^th November， 2020. Guidelines or consensuses for the non-venous H₁-antihistamine treatments for allergic diseases in children were included. The recommendations from guidelines and consensuses were qualitatively summarized according to the diseases. Each of the included guidelines or consensuses was assessed by using the AGREE Ⅱ instrument with six quality domains， i.e.， "scope and purpose" "stakeholder involvement" "rigour of development" "clarity of presentation" "applicability" and "editorial independence"， with calculating ICC values to assess the consistencies. Results A total of 11 literatures were included， which were from China， the United Kingdom， or other regions/international organizations， ranging from 2000 to 2019. The AGREE Ⅱ evaluation results indicated that only three domains （"scope and purpose" "clarity of presentation" "applicability"） were averagely scored more than 50%； the scores for "stakeholder involvement" "rigour of development" and "editorial independence" were generally much lower. The overall evaluation of included guidelines or consensuses was moderate-quality. All guidelines and consensuses recommended that second generation H₁-antihistamines as a first choice for most kinds of pediatric allergic diseases； several guidelines and consensuses recommended against the routine use of first-generation H₁ antihistamines in children due to potential adverse reactions. Furthermore， it was suggested that the escalation or combination therapeutic schedules for certain diseases were different， including medications like intranasal corticosteroids， leukotrienes receptor antagonists， ciclosporins， etc. Conclusion The overall quality of the guidelines and consensuses for the use of non-venous H₁-antihistamines in the treatments of children allergic diseases is moderate. The second-generation H₁-antihistamines are considered as first-line medications for most allergic diseases in children. It is suggested that the formulation of guidelines should further consider the particularity of children's medication while improving the quality of guidelines.
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  Effect of transcatheter arterial embolization combined with local injection of Lauromacrogol in the treatment of hemangioma with rich blood supply in children

  DI Qi, LI San-lin, ZHANG Jing, YU Chun-xin, LIU Jing, SHEN Gang

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 40-43. https://doi.org/10.3969/j.issn.1672-3384.2021.10.008

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  Objective To investigate the efficacy and safety of transcatheter arterial embolization （TAE） combined with local injection of Lauromacrogol in the treatment of superficial hemangioma with rich blood supply in children. Methods A total of 64 children with hypervascular hemangioma admitted to the Children's Hospital Capital Institute of Pediatrics from March 2018 to March 2020 were randomly divided into observation group （n=32） and control group （n=32）. The observation group was treated with TAE combined with Lauromacrogol local injection， while the control group was treated with TAE alone. The curative effect， severity of hemangioma， depth of tumor and incidence of complications were compared between the two groups. Results Each children in the control group was treated with TAE 3-5 times， and 3.6 times on average. Each children in the observation group was treated with TAE 1-2 times， and 1.4 times on average， which was significantly less than the control group （P<0.05）. After 3 months of treatment， the total effective rate of the observation group was 96.9%， significantly higher than that of the control group （81.2%， P<0.05）. The scores of hemangioma severity in the observation group was significantly lower than that in the control group （P<0.05）， but there was no significant difference in tumor depth and incidence of complications between the two groups （P>0.05）. Conclusion TAE combined with Lauromacrogol local injection in the treatment of hypervascular hemangioma in children has significant efficacy and high safety， which is worthy of clinical promotion.
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  Efficacy and safety of different doses iron in the treatment of iron deficiency anemia in children： a systematic review

  ZHANG Ying, HE Shi-yu, HUANG Lin, YANG Chang-qing, FENG Yu-fei

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 44-51. https://doi.org/10.3969/j.issn.1672-3384.2021.10.009

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  Objective To evaluate the efficacy and safety of different doses iron in the treatment of iron deficiency anemia （IDA） in Chinese children. Methods Clinical research documents on the different doses iron in the treatment of IDA in Chinese childre was searched from Datebases （CNKI， Wanfang， VIP， PubMed， Embase， Central） from inception to 26 April， 2021. Literature screening and data extraction were carried out independently by two researchers， and meta-analysis was carried out by Revman 5.4 software. Results A total of 18 literatures were enrolled. There was no significant difference in cure rate between the high dose group （5-6 mg·kg^-1·d^-1） and low dose group （1-2 mg·kg^-1·d^-1）（RR=1.05， 95% CI：0.98～1.13， P=0.19， I²=0%）. Compared to high dose iron， low dose of iron could significantly reduce the incidence of adverse drug reactions （RR=0.32， 95% CI：0.25-0.40， P<0.001， I²=0%）. There were no significant differences in changes of serum ferritin （WMD=0.40， 95% CI：-1.31-2.10， P=0.65， I²=0%） and hemoglobin （WMD=0.10， 95% CI：-1.28-1.48， P=0.88， I²=0%） between the two groups. Conclusion Low dose of iron （1-2mg·kg^-1·d^-1） has the same cure rate as high dose iron （5-6mg·kg^-1·d^-1）， and could reduce the incidence of adverse reactions significantly. However， due to the shortcomings of the current clinical research design， it still needs high-quality clinical evidence for verification.
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  Clinical application evaluation of drugs for treatment of neovascular age-related macular degeneration and diabetic macular edema

  CHENG Wen-di, JIN Chun-lin, LUO Ya-shuang, LIU Xin, WANG Hai-yin

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 52-59. https://doi.org/10.3969/j.issn.1672-3384.2021.10.010

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  Objective To compare the clinical value of first-line treatment drugs （Ranibizumab， Conbercept， Aflibercept） for neovascular age-related macular degeneration （nAMD） and diabetic macular edema （DME） through clinical application evaluation of drugs. Methods Firstly， according to the Guideline for Clinical Application Evaluation of Drug Management， a comprehensive evaluation index system for first-line treatment of nAMD and DME was constructed through literature review， expert investigation and expert demonstration. Secondly， using the methods of systematic literature review， Meta-analysis and other relevant data， as well as combined with supplementary data analysis， the dimensions and indicators of Ranibizumab， Conbercept， Aflibercept were analyzed qualitatively and quantitatively according to the index system. Results The comprehensive evaluation results of all dimensions showed that in terms of safety， the medical products administration monitoring of Aflibercept was better than that of Ranibizumab. According to the indications of nAMD， the incidence of endophthalmitis of Aflibercept was significantly higher than that of Ranibizumab， and the incidence of cardio-cerebrovascular events was at low level in both Aflibercept and Ranibizumab. According to the indications of DME， there was no significant difference in the incidence of endophthalmitis between Aflibercept and Ranibizumab. In terms of effectiveness， the clinical efficacy of nAMD indications was significantly better than that of Ranibizumab and Conbercept.According to the indications of DME， there was no significant difference in the clinical efficacy of the three drugs. In terms of economy， the cost-effectiveness of Conbercept and Aflibercept was better than that of Ranibizumab. In terms of suitability， the doctor's recommendation and patient compliance of Aflibercept were higher than those of Ranibizumab and Conbercept. In terms of accessibility， the affordability of Conbercept was highest and Aflibercept was higher than that of Ranibizumab. In terms of innovation， Aflibercept and Conbercept had broader targets， and their innovative value was significantly better than that of Ranibizumab. Conclusion Compared with Ranibizumab and Conbercept， Aflibercept has obvious advantages in there dimensions， including effectiveness， economy and suitability. In the dimensions of safety， the performance of Aflibercept was similar to Ranibizumab. In the dimensions of innovation and accessibility， the performance of Aflibercept is worse than that of Conbercept and better than that of Ranibizumab.
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  Intravenous Ibuprofen for antipyretic and analgesic treatment in children： a health technology assessment

  ZHOU Peng-xiang, TIAN Shu-xia, HE Lan-zhi, ZHAI Suo-di

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 60-65. https://doi.org/10.3969/j.issn.1672-3384.2021.10.011

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  Objective To evaluate the benefits and risks of Intravenous Ibuprofen （IVIB） for antipyretic and analgesic treatment in children， and to provide evidence-based evidence for decision-making. Methods PubMed， Embase， Cochrane Library， ClinicalTrials.gov， CNKI， Wanfang and SinoMed databases were systematically searched， from the inception to February 10^th， 2021. We included all kinds of clinical trials on the efficacy， safety and compliance of IVIB for antipyretic and analgesic treatment in children as well as economic studies. Addtionally， the references of the relative literatures was manually searched as a supplement. The quality of included studies were evaluated and the outcome indicators were analyzed by Meta-analysis or qualitative descriptive analyse according to indications and control groups. Results A total of 1430 records were initially selected， and 3 studies were included eventually， including 2 randomized controlled trials（RCTs） and 1 cohort study. RCTs were evaluated as medium-quality， and an unpublished economic report was added. In antipyretic treatment， compared with intravenous paracetamol， IVIB showed more advantages in change of area under the temperature-time curve at 0 ~ 2 h and 0 ~ 4 h significantly， but there was no significant difference in the time to return normal temperatures. In analgesic treatment， compared with placebo， IVIB could significantly reduce the injection times and dosage of fentanyl as rescue analgesia in tonsillectomy. However， there were no significant differences in pain score， the time of first rescue analgesia and length of hospital stay between the two comparions.The safety of IVIB and acetaminophen in antipyretic and placebo in tonsillectomy was similar， and there was no significant difference in the incidence of bleeding events between IVIB and placebo. There was no evidence for compliance. In addition， IVIB had an economic advantage over intravenous paracetamol in the antipyretic treatment of children whose body weight was over 7.5 kg， and was more economical than normal saline in the analgesic effect of tonsillectomy. Conclusions Based on the current limited evidence， IVIB is a feasible scheme for postoperative analgesia in pediatric tonsillectomy， and may have better antipyretic effect and economic advantage than intravenous acetaminophen. Further clinical trials and practice are needed to confirm its use in children.
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  Clinical application evaluation of the first-line system therapy drugs for treatment of advanced liver cancer

  FU Yu-yan, JIN Chun-lin, SUN Hui, WANG Hao-de, XIE Chun-yan, WANG Hai-yin

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 66-70. https://doi.org/10.3969/j.issn.1672-3384.2021.10.012

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  Objective To compare the clinical application evaluation of the first-line system therapy drugs for advanced liver cancer （Sorafenib， Lenvatinib and FOLFOX4）， in order to provide reference for the hospital's clinical rational use and catalogue access decision-making. Methods Firstly， a clinical application evaluation index system for the first-line system therapy drugs of advanced liver cancer was constructed through literature review， expert surveys and expert demonstrations， and the analytic hierarchy process was used to determine the weight of each index. Secondly， using systematic literature review， Meta analysis and other related data analysis methods， Sorafenib， Lenvatinib and FOLFOX4 were analyzed according to the indicator system. Results The incidence of grade 3 side effects of Sorafenib in patients with advanced liver cancer is lower than that of Lenvatinib and FOLFOX4. Sorafenib and Lenvatinib have clear clinical effects and have been recommended by many clinical guidelines， which are significantly better than the FOLFOX4. Due to the short time to market and higher price of Lenvatinib， the cost-effectiveness of Sorafenib is better than that of Lenvatinib. Sorafenib and FOLFOX4 have a higher drug provision rate which can meet the needs of patients， which is significantly better than Lenvatinib. Conclusion The comprehensive clinical value of Sorafenib is higher than that of Lenvatinib and FOLFOX4.
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  Effects of Valproate combined with group cognitive behavioral therapy on inflammatory factors levels and quality of life in patients with bipolar disorder

  ZHANG Qing-hui, AI Li-ying, CHEN Wei, YUAN Yuan, WANG Lu, YANG Gui-juan, YANG Hai-dong

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 71-75. https://doi.org/10.3969/j.issn.1672-3384.2021.10.013

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  Objective This study was designed to investigate the effect of Valproate combined with group cognitive behavioral therapy （G-CBT） on the inflammatory factors levels of and quality of life in patients with bipolar disorder. Methods A total of 146 patients with bipolar disorder diagnosed and treated in Geleshan Campus of Chongqing Mental Health Center from June 2017 to June 2019 were recruited as participants， and they were divided into treatment group （n=72） and control group （n=74）， and 64 participants in each group completed this research. The patients in control group were treated with magnesium valproate， and those in treatment group were given magnesium Valproate combined with group-congnitive behavioral therapy（G-CBT）. After 8 weeks， the treatment effects of the two groups were compared. The levels of interleukin-1β，IL-1β， intorleukin-2，IL-2， and tumor necrosis factor-α，TNF-α inflammatory factors were measured by enzyme-linked immunosorbent assay， and the quality of life of the study subjects was evaluated using the quality of life summary table （SF-36）. Results The total effective rates of treatment group and control group were 90.6% and 76.6% respectively with statistically significant difference （P<0.05）. The levels of IL-1β， IL-2 and ，TNF-α in both groups before treatment were not statistically significant （P>0.05）. After treatment， the levels of inflammatory factors in the two groups decreased significantly. The levels of IL-1β and TNF-α in treatment group were significantly lower than those in the control group （P<0.05）， but the level of IL-2 was not statistically different between the two groups （P>0.05）. There was no statistically significant difference in the scores of the eight dimensions of the SF-36 scale before treatment （P>0.05）. Except for the bodily pain dimension， each dimension including physical function， role limitations due to physical health， general health， vitality， social function， role limitations due to emotional problems， and mental health of the treatment group scores were significantly higher than those in the control group （P<0.05） after treatment. Conclusion Valproate combined with G-CBT is effective in the treatment of bipolar disorder and it can effectively improve the quality of life of patients. After combined treatment， the levels of IL-1β and TNF-α inflammatory factors were significantly reduced.
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  Analysis on children's pharmacokinetic information of labeling for pediatric drug

  WANG Qian, ZHANG Yi, LIANG Yu-guang, GUO Chun-yan, DING Qian, YANG Yu-xin, WANG Xiao-ling

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 76-80. https://doi.org/10.3969/j.issn.1672-3384.2021.10.014

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  Objective This study was designed to investigate the status of children's pharmacokinetic information of labeling for pediatric drug in China， so as to provide reference for standardizing and improving drug instructions. Methods The content and format of pharmacokinetic sections in guidelines approved by Food and Drug Administration （FDA）， European Medicines Agency （EMA） and National Medical Products Administration （NMPA） were analyzed comparatively. The labeling conditions of pediatric drugs in 8 hospitals were collected， and pharmacokinetic information were analyzed according to the disease types， pharmacokinetic data sources， pharmacokinetic parameters. Results A total of 1719 drug labels were collected， there were 914 varieties marked with adult pharmacokinetic information in the instructions， and the labeling rate was 53.17%； there were 150 varieties labeled with children's pharmacokinetic information， and the labeling rate was 8.73%. The number of data derived from pediatric clinical trials accounted for 70.67% of the total number of drug labels contained pediatric pharmacokinetic information. The main pharmacokinetic parameters were t_1/2 （88.00%）， t_max （76.00%） and C_max （47.30%） respectively. Conclusion The information on children's pharmacokinetic is insufficient. It is suggested to establish pharmacokinetic database and optimization system of pharmacokinetic research methods in children to meet regulatory requirements and ensure appropriate consistency in the format and content of pharmacokinetic section.
Drug and Clinic
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  A new drug for bone marrow protection in small cell lung cancer chemotherapy patients——Trilaciclib

  LI Hong-dou, XING Kong-lang, CHAI Fang, DENG Li-li

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 81-85. https://doi.org/10.3969/j.issn.1672-3384.2021.10.015

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Medication Therapy Management
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  Diagnosis and drug treatment of influenza-like syndrome caused by Gemcitabine：a case report

  WANG Ming-rui, TU Wen-lian

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 86-88. https://doi.org/10.3969/j.issn.1672-3384.2021.10.016

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Case Report
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  Elevated blood pressure in cancer patients induced by apatinib： a case report

  ZHANG Yu-lian, LOU Mei-mei, ZHANG Hai-ying, TIAN Ling

  CLINICAL MEDICATION JOURNAL. 2021, 19(10): 89-92. https://doi.org/10.3969/j.issn.1672-3384.2021.10.017

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