This paper discusses the rational use of traditional Chinese medicine based on chemical composition, body state and biological effect. The essence and connotations of traditional Chinese medicine are explained by modern scientific theory and technical means, and the mechanism of traditional Chinese medicine in the treatment of diseases is defined in modern medicine language, which is conducive to promoting rational and safe clinical use of drugs. Based on the chemical composition of traditional Chinese medicine,the selected genuine medicinal materials were collected and processed in a standardized way, and then used in the combination with other traditional Chinese medicines, with the aim to improve the efficacy of traditional Chinese medicine in clinical indications, increase the advantages, eliminate the disadvantages, and adapt to flexible and safe clinical drug demands. Based on the body state elements, clinical diagnosis and treatment shall be patient-centered, and doctors shall distinguish the differences of pathogenesis, symptoms and diseases, and consider the drug contraindications of special groups. According to the " dose-effect-toxicity" relationship, doctors shall select the appropriate dosage form, control the drug dosage, balance the benefits and risks of drugs, and carry out appropriate medical treatment. Based on the biological effect elements and the regulatory mechanism of traditional Chinese medicine on the target and pathway of disease, traditional Chinese medicine shall strengthen the precise positioning, provide accurate treatment; evaluate the safety of traditional Chinese medicine combination, explore the adverse reaction mechanism, strengthen the clinical safety monitoring of traditional Chinese medicine, and guide the clinical rational use of drugs, in the expectation of ensuring the safe use of traditional Chinese medicine and maximize the clinical efficacy of traditional Chinese medicine.
Contraindications, Drug ; Drug Dosage Calculations ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Medicine, Chinese Traditional ; Practice Patterns, Physicians'

The NCCN has recently released its 2017 version 1.0 guideline for colorectal cancer. There are several updates from this new version guideline which are believed to change the current clinical practice. Update one, low-dose aspirin is recommended for patients with colorectal cancer after colectomy for secondary chemoprevention. Update two, biological agents are removed from the neoadjuvant treatment regimen for resectable metastatic colorectal cancer (mCRC). This update is based on lack of evidence to support benefits of biological agents including bevacizumab and cetuximab in the neoadjuvant setting. Both technical criteria and prognostic information should be considered for decision-making. Currently biological agents may not be excluded from the neoadjuvant setting for patients with resectable but poor prognostic disease. Update three, panitumumab and cetuximab combination therapy is only recommended for left-sided tumors in the first line therapy. The location of the primary tumor can be both prognostic and predictive in response to EGFR inhibitors in metastatic colorectal cancer. Cetuximab and panitumumab confer little benefit to patients with metastatic colorectal cancer in the primary tumor originated on the right side. On the other hand, EGFR inhibitors provide significant benefit compared with bevacizumab-containing therapy or chemotherapy alone for patients with left primary tumor. Update four, PD-1 immune checkpoint inhibitors including pembrolizumab or nivolumab are recommended as treatment options in patients with metastatic deficient mismatch repair (dMMR) colorectal cancer in second- or third-line therapy. dMMR tumors contain thousands of mutations, which can encode mutant proteins with the potential to be recognized and targeted by the immune system. It has therefore been hypothesized that dMMR tumors may be sensitive to PD-1 inhibitors.
Antibodies, Monoclonal ; pharmacology ; therapeutic use ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Aspirin ; administration & dosage ; therapeutic use ; Bevacizumab ; therapeutic use ; Biological Products ; therapeutic use ; Brain Neoplasms ; drug therapy ; genetics ; Cetuximab ; therapeutic use ; Clinical Decision-Making ; methods ; Colorectal Neoplasms ; drug therapy ; genetics ; pathology ; prevention & control ; therapy ; Contraindications ; Humans ; Mutation ; physiology ; Neoadjuvant Therapy ; standards ; Neoplasm Metastasis ; drug therapy ; Neoplastic Syndromes, Hereditary ; drug therapy ; genetics ; Practice Guidelines as Topic ; Prognosis ; Secondary Prevention ; methods ; standards

Abnormalities, Drug-Induced ; etiology ; Abnormalities, Radiation-Induced ; etiology ; Antineoplastic Agents ; adverse effects ; Breast Neoplasms ; diagnosis ; therapy ; Contraindications ; Female ; Humans ; Mastectomy ; Neoplasm Staging ; Pregnancy ; Pregnancy Complications, Neoplastic ; diagnosis ; therapy ; Prognosis ; Radiotherapy ; adverse effects ; Risk Assessment ; Risk Factors ; Sentinel Lymph Node Biopsy

We describe herein a case of life-threatening hypoglycemia due to spurious elevation of glucose concentration during the administration of ascorbic acid in a type 2 diabetic patient. A 31-year-old female was admitted for proliferative diabetic retinopathy treatment and prescribed high dose ascorbic acid. During hospitalization, she suddenly lost her consciousness and her glucose concentration was 291 mg/dL, measured using self-monitoring blood glucose (SMBG) device, while venous blood glucose concentration was 12 mg/dL. After intravenous injection of 50% glucose solution, the patient became alert. We reasoned that glucose measurement by SMBG device was interfered by ascorbic acid. Physicians should be aware of this interference; high dose ascorbic acid may cause spurious elevation of glucose concentration when measuring with SMBG devices.
Adult ; Ascorbic Acid/administration & dosage/adverse effects/contraindications/*therapeutic use ; Blood Glucose ; Blood Glucose Self-Monitoring/instrumentation/standards ; Diabetes Mellitus, Type 2/blood/drug therapy ; Female ; Humans ; Hypoglycemia/*diagnosis ; Renal Dialysis

China pharmacopoeia is a civil code which is to ensure pharmaceutical quality and protect people's drug safety and effectiveness. Drug standards are consist of two parts, the pharmaceutical standards and medical standards. Medical standards include four contents, such as prescription, function and indications, usage and dosage and attentions. This paper summarized the revised contents of medical standards and suggested some propositions.
Contraindications ; Documentation ; Drug Administration Schedule ; Drug Compounding ; standards ; Drug Dosage Calculations ; Drug Prescriptions ; standards ; Drugs, Chinese Herbal ; adverse effects ; pharmacology ; standards ; Female ; Food-Drug Interactions ; Humans ; Pregnancy ; Terminology as Topic

OBJECTIVETo observe the clinical effects and complications in treating osteoporotic vertebral fractures with percutaneous kyphoplasty (PKP) and in order to found the cause and countermeasures of the complications.

METHODSFrom March 2006 to March 2007, 31 patients with osteoporotic vertebral fractures were treated with unilateral percutaneous kyphoplasty. There were 11 males and 20 females, ranging in age from 54 to 91 years with the mean of 81 years. All patients were followed up for more than three years. At pre-treatment and postoperatively immediately, 1, 2, 3 years after PKP, the height of anterior vertebral body and thoracic-lumbar and back pain were respectively analyzed by imaging data and VAS scoring.

RESULTSAt pre-treatment and postoperatively immediately, 1, 2, 3 years after PKP, the height of anterior vertebral body were (0.9 +/- 0.2), (2.6 +/- 0.3), (2.6 +/- 0.2), (2.5 +/- 0.7), (2.5 +/- 0.4) cm, respectively; the VAS soring were (7.6 +/- 1.4), (2.3 +/- 0.7), (2.4 +/- 0.5), (2.8 +/- 0.3), (3.1 +/- 0.2) scores, respectively. The height of anterior vertebral body recoveried obviously after PKP (P < 0.05); following prolongation of time, the height of anterior vertebral body gradually reduced (P > 0.05). The thoracic-lumbar and back pain relieved obviously after PKP (P < 0.05); following prolongation of time, the pain gradually aggratated, but there was no significant difference (P > 0.05). At final follow up, reinforced vertebral re-fractures was found in 2 cases, adjacent vertebral fractures in 6 cases, distal vertebral fractures in 2 cases, asymptomatic degeneration of adjacent intervertebral in 5 cases.

CONCLUSIONPKP have definite and early effects in treating osteoporotic vertebral fractures. But in mid-stage after PKP, the height of anterior vertebral body reduce and the pain aggravate gradually, especially degenerative adjacent vertebral fracture advent. Strict choosing the candidate of the precedure, improvement of materials of perfusion and reducing of volume of bone cement maybe can decrease incidence rate of complications.

Aged ; Aged, 80 and over ; Bone Cements ; adverse effects ; Contraindications ; Female ; Fractures, Compression ; surgery ; Fractures, Spontaneous ; Humans ; Kyphoplasty ; adverse effects ; methods ; Male ; Middle Aged ; Osteoporosis ; surgery ; Pain ; etiology ; Postoperative Complications ; etiology ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; drug effects ; Treatment Outcome ; Vertebroplasty ; methods

Animals ; Anticonvulsants ; adverse effects ; Brain ; drug effects ; growth & development ; Contraindications ; Epilepsy ; drug therapy ; Humans

Beta-blockers have long being used as first-line therapy for hypertension as their use had resulted in a reduction in cardiovascular morbidity and mortality in controlled clinical trials. A recent meta-analysis comparing beta-blockers to all other anti-hypertensive drugs taken together has found that stroke reduction was sub-optimal. Specifically, atenolol was associated with a 26% higher risk of stroke compared with other drugs. Several reasons may explain the less favourable outcomes with beta-blocker therapy. These include some adverse metabolic abnormalities such as dyslipidaemia and new-onset diabetes, and less effective reduction of central aortic compared with brachial blood pressure. Newer beta-blockers such as carvedilol or nebivolol are better tolerated. These beta-blockers have a vasodilating effect, which may beneficially affect systolic blood pressure in the aorta. Their long-term cardiovascular outcome in hypertension is still not known. Further studies would be required to show that stroke is adequately reduced by these newer beta-blockers. In conclusion, beta-blockers should not be the first drugs of choice in the management of uncomplicated hypertension. They may be used in addition to other antihypertensive agents to achieve blood pressure goals. However, in patients with angina pectoris, a previous myocardial infarction, heart failure and certain dysrhythmias, beta-blockers still play an important role.
Adrenergic beta-Antagonists ; therapeutic use ; Antihypertensive Agents ; therapeutic use ; Contraindications ; Humans ; Hypertension ; drug therapy ; Meta-Analysis as Topic ; Singapore ; Stroke ; chemically induced

INTRODUCTIONThe use of oral hypoglycaemic drugs in pregnancy is not recommended because of reports of foetal anomalies and other adverse outcomes in animal studies and in some human cases. However, recent studies have suggested that some oral hypoglycaemic drugs may be used in pregnancy. This review will examine these studies critically.

METHODSLiterature review of articles obtained from a PubMed search of peer-reviewed journals on oral hypoglycaemic drug use in pregnancy.

RESULTSIn two prospective studies, one of which was a randomised controlled trial, glibenclamide was as effective and safe as insulin in gestational diabetes. In several studies, metformin did not increase foetal anomalies or malformations when used during pregnancy in women with polycystic ovary syndrome (PCOS). In one prospective study on infants born to mothers who used metformin in pregnancy, follow-up for 18 months showed no adverse effects. In several prospective and retrospective studies on women with PCOS, metformin was shown to prevent early pregnancy loss, decrease insulin resistance, reduce insulin and testosterone levels, and decrease the incidence of gestational diabetes when these women got pregnant while on metformin and continued to take it throughout their pregnancy. In a single small study, acarbose did not cause any adverse effects during pregnancy.

CONCLUSIONSRecent evidence shows promising findings in the safety and efficacy of some oral hypoglycaemic agents in treating pregnant diabetics. However, larger clinical studies will be needed to ensure the safety and efficacy of these drugs in pregnancy.

Administration, Oral ; Contraindications ; Evidence-Based Medicine ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; therapeutic use ; Pregnancy ; Pregnancy in Diabetics ; drug therapy ; Safety Management ; Singapore

Adrenergic beta-Antagonists ; therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Contraindications ; Heart Failure ; drug therapy ; Humans