OBJECTIVE: To discuss about one patient with Alzheimer′s disease and urinary incontinence and to investigate the prescribing cascade between cholinesterase inhibitors and anticholinergic drugs further more. METHODS: Clinical pharmacists participated in a medication therapy management program aiming at one patient with Alzheimer′s disease and urinary incontinence. By doing this they successfully identified and interrupted a prescribing cascade. Then some constructive advices were provided to doctors and patients on the rational administration of drugs. RESULTS: The drug treatment plan was adjusted by clinical pharmacists and doctors after evaluating the benefits and risks about the use of cholinesterase inhibitors and anticholinergic drugs in the elderly patient with chronic disease. And this change directly led to a significant relief of urinary incontinence in the patient. CONCLUSION: The use of cholinesterase inhibitors in Alzheimer′s patients increases the risk of urinary incontinence, and at the same time additional use of anticholinergic drugs in the treatment of urinary incontinence can further damage the cognition.Therefore, clinical pharmacists and doctors should pay great attention to the prescribing cascade of cholinesterase inhibitors and anticholinergic drugs. To identify and interrupt prescribing cascades is important when clinical pharmacists and doctors are prescribing prescriptions for elderly patients with chronic diseases. They must work closely for the optimization of prescriptions and the improvement of medication safety in elderly patients.

This study was performed to evaluate prostate-specific antigen-age volume (PSA-AV) scores in predicting prostate cancer (PCa) in a Chinese biopsy population. A total of 2355 men who underwent initial prostate biopsy from January 2006 to November 2015 in Huashan Hospital were recruited in the current study. The PSA-AV scores were calculated and assessed together with PSA and PSA density (PSAD) retrospectively. Among 2133 patients included in the analysis, 947 (44.4%) were diagnosed with PCa. The mean age, PSA, and positive rates of digital rectal examination result and transrectal ultrasound result were statistically higher in men diagnosed with PCa (all P < 0.05). The values of area under the receiver operating characteristic curves (AUCs) of PSAD and PSA-AV were 0.864 and 0.851, respectively, in predicting PCa in the entire population, both performed better than PSA (AUC = 0.805; P < 0.05). The superiority of PSAD and PSA-AV was more obvious in subgroup with PSA ranging from 2.0 ng ml-1 to 20.0 ng ml-1. A PSA-AV score of 400 had a sensitivity and specificity of 93.7% and 40.0%, respectively. In conclusion, the PSA-AV score performed equally with PSAD and was better than PSA in predicting PCa. This indicated that PSA-AV score could be a useful tool for predicting PCa in Chinese population.

The performances of the Prostate Cancer Prevention Trial (PCPT) risk calculator and other risk calculators for prostate cancer (PCa) prediction in Chinese populations were poorly understood. We performed this study to build risk calculators (Huashan risk calculators) based on Chinese population and validated the performance of prostate-specific antigen (PSA), PCPT risk calculator, and Huashan risk calculators in a validation cohort. We built Huashan risk calculators based on data from 1059 men who underwent initial prostate biopsy from January 2006 to December 2010 in a training cohort. Then, we validated the performance of PSA, PCPT risk calculator, and Huashan risk calculators in an observational validation study from January 2011 to December 2014. All necessary clinical information were collected before the biopsy. The results showed that Huashan risk calculators 1 and 2 outperformed the PCPT risk calculator for predicting PCa in both entire training cohort and stratified population (with PSA from 2.0 ng ml-1 to 20.0 ng m). In the validation study, Huashan risk calculator 1 still outperformed the PCPT risk calculator in the entire validation cohort (0.849 vs 0.779 in area under the receiver operating characteristic curve [AUC] and stratified population. A considerable reduction of unnecessary biopsies (approximately 30%) was also observed when the Huashan risk calculators were used. Thus, we believe that the Huashan risk calculators (especially Huashan risk calculator 1) may have added value for predicting PCa in Chinese population.

Objective To explore the effects of ginsenoside metabolite Compound K (CK) on TNF-α-induced RANTES secretion in human bronchial epithelial cell line BEAS-2B and to elucidate its possible mechanism. Methods BEAS-2B cells were cultured and treated with CK in different dosages, and then the secretion of RANTES in BEAS-2B cells exposed to inflammatory stimuli was measured by ELISA kits. Expressions of RANTES mRNA and protein were detected by RT-PCR and Western blotting analysis, respectively. Reporter gene assay was employed to elucidate the interaction between CK and activator protein 1(AP-1), glucocorticoid receptor (GR). CK antagonist mifepristone was used to observe whether the inhibitory effect of CK against RANTES was mediated by GR. Results TNF-α-induced secretion of RANTES in BEAS-2B was markedly inhibited by CK (3-30 μmol/L). Treatment with CK also reduced RANTES mRNA and protein expression. Reporter gene assays indicated that CK was a GR agonist and could repress TNF-α-induced AP-1 transactivation. The inhibitory effects of CK on RANTES secretion were antagonized by mifepristone, suggesting a pivotal role of GR. Conclusion These results suggest that CK may inhibit TNF-α-induced RANTES secretion in human bronchial epithelial cells, which might be associated with GR pathway activation and AP-1 pathway inhibition.

To clarify the relationship between VLA-4 (CD49d) expression and hematopoietic cell migrating direction, mice were injected subcutaneously with diluted rhG-CSF for different times. The expressions of CD49d on Sca-1(+) cells were examined by flow cytometry. The relations between CD49d expression and Sca-1(+) cell enumerations were performed by statistical analysis. The results showed that with the administration of G-CSF, the expressions of CD49d in bone marrow (BM) and peripheral blood (PB) declined, meanwhile the number of Sca-1(+) cells in peripheral blood reached the peak in sharp contrast to BM nucleated cell number dropping on the seventh to ninth day. When CD49d expression rose again, the PB Sca-1(+) cells descended with the rising of BM nucleated cell number. In conclusion, VLA-4 mediates the hematopoietic cell adhesion to BM microenvironment. The regulation of CD49d expression may result in different migrating direction of hematopoietic cell between bone marrow and peripheral blood.
Animals ; Bone Marrow Cells ; cytology ; drug effects ; metabolism ; Cell Count ; Cell Movement ; drug effects ; Female ; Flow Cytometry ; Granulocyte Colony-Stimulating Factor ; pharmacology ; Hematopoietic Stem Cell Mobilization ; Hematopoietic Stem Cells ; cytology ; drug effects ; physiology ; Integrin alpha4beta1 ; blood ; Mice ; Mice, Inbred BALB C ; Time Factors

OBJECTIVETo study the changes of adhesion molecules' expressions during the recombinant human granulocyte-colony-stimulating factor (rhG-CSF) mobilization in peripheral blood stem cell transplantation (PBSCT), and to confirm the influence of rhG-CSF on hematopoietic stem cells, which are proposed to guide mobilization in PBSCT.

METHODSMice were injected subcutaneously with diluted rhG-CSF or normal saline for 7 days. The blood Sca-1(+) stem cell count and bone marrow (BM) nucleated cell count were enumerated. The expressions of CD49d and CD44 and the adhesive ability of mononuclear cells to bone marrow matrix (fibronectin) were examined by flow cytometry and (51)Cr adhesive assay, respectively.

RESULTSThe mobilizing effect of rhG-CSF on mice was the same as on humans. The number of Sca-1(+) cells in peripheral blood reached the peak on the seventh day, the BM nucleated cell count was reduced, and the expressions of CD49d and the cells' adhesive ability in BM and PB declined.

CONCLUSIONSrhG-CSF can reduce some cell adhesion molecules' expressions and the adhesive ability of hematopoietic stem cells to BM matrix, therefore mobilizing hematopoietic stem cells (HSC) from the BM to the peripheral blood.

Animals ; Bone Marrow Cells ; drug effects ; physiology ; Female ; Fibronectins ; physiology ; Granulocyte Colony-Stimulating Factor ; pharmacology ; Hematopoietic Stem Cell Mobilization ; Hematopoietic Stem Cell Transplantation ; Hyaluronan Receptors ; analysis ; physiology ; Integrin alpha4 ; analysis ; physiology ; Leukocytes, Mononuclear ; physiology ; Mice ; Mice, Inbred BALB C ; Recombinant Proteins

Gastroesophageal reflux disease(GERD) is pronouncedly increased among obese population due to the incompetence of anti-reflux barrier resulting from adiposity.While lifestyle changes, medications and anti-reflux surgery have limited effects, bariatric surgery is the best treatment for GERD in patients with obesity. Roux-en-Y gastric bypass is an ideal procedure and sleeve gastrectomy can also be accepted as an option despite its controversy over GERD.Besides, some combination surgeries have emerged to be worth attempts. In case of the postoperative reflux, causes for that should be found and treated. Revisional surgery can be performed when it is necessary.

Visual snow syndrome(VSS)is a visual-disturbance disease characterized by continuous flickering tiny dots in the entire visual field, sometimes with visual symptoms like photophobia or nyctalopia and non-visual symptoms such as anxiety and depression.VSS can remain stable or worsen, causing distress to patients′ visual experience and mental state. The pathological mechanism of VSS is still unclear and a hypothesis indicates a relationship between VSS and increased cortical excitability of the visual cortex. Some case reports suggest anti-seizure medications, colored filters and TMS may help eliminate symptoms, but futher studies are required to verify these treatments. This review will systematically introduce what we know about VSS so far.

Spasticity is one of the common symptoms in patients with spinal cord injury, the mechanism can be summarized that the disappearance of the inhibition signals of descending pass of the spinal cord lead to the change of the balance between the circuit of the feedback and feedforward formed by the intra spindle muscle and extra spindle muscle, and the spasticity appear. Transcranial magnetic stimulation (TMS) can release the spasticity through increasing the excitability of the inhibitory interneurons to decrease the excitability of the spinal level. This article discussed about the mechanism of the spasticity after spinal cord injury first and then summarized the application and the therapeutic theory of the TMS on it.