Tropane alkaloids,such as hyoscyamine (or its more stable racemate atropine) and scopolamine,are remembered as the oldest drugs in medicine with wide pharmaceutical applications clinically for their mydriatic,antispasmodic,anticholinergic,analgesic and sedative properties.Presently,the supply of tropane alkaloids are entirely rested on their isolation from plant materials,yet the low contents of tropane alkaloids in plants raise the requirement to breed new varieties of high-yield tropane alkaloids and improving the production of tropane alkaloids in hairy root cultures or plants by biotechnology has be a research focus in the field of secondary metabolism.For the past decade,there have been important progresses on biosynthesis of tropane alkaloids and their molecular biology,some new pathway genes have been identified and many achievements have also been acquired in metabolic engineering of tropane alkaloids.This review summarized the recent advances in above aspects,and the problems and orientations of future research are also discussed and proposed.

This study was aimed to evaluate effects of traditional Chinese medicine ( TCM ) five elements music therapy on the quality of life for both senior and non-senior advanced cancer patients , and improve TCM com-prehensive treatment mode . A total of 170 patients were stratified according to 70-year-old in a randomized controlled trial ( RCT ) with a parallel single-blind design . The ratio of patients among three groups was 2:2:1 . In the experimental group , TCM five elements music was given in the treatment . In the positive control group , western music was used in the treatment . And in the negative control group , no music was given in the treat-ment . The treatment was given for 30 min , 5 times per week . And the observation duration was 3 weeks . The Hospice Quality of Life Index-Revised ( HQOLI-R ) , Karnofsky Performance Scale ( KPS ) and Symptom Diary Score recorded by patients were used in the evaluation . The results showed that when comparing HQOLI-R , KPS and Symptom Diary Score before and after treatment among all advanced cancer patients in each group , there was a significant difference before and after treatment in the TCM five elements music therapy group ( P< 0 . 05 ) . But there was no significant difference before and after treatment in the western music therapy group or the negative control group ( P > 0 . 05 ) . It was concluded that TCM five elements music therapy is effective in improving quality of life and subjective symptoms for both senior and non-senior advanced cancer patients . However , the sensitivity of using the Symptom Diary Score as an evaluation index among senior patients still needs to be further proved .

Objective To investigate the effects of remifentanil in painless bronchoscopic examination of elderly panents.Methods One hundred and twenty elderly patients undergoing painless bronchoscopic examination were randomly divided into 4 groups (n=30),the group A was administered with propofol and the groups B,C and D were administered with propofol and remifentanil(remifentanil dose:0.05 μg · kg-1 · min-1 in the group B,0.10μg · kg-1 · min-1 in the group C and 0.15 μg · kg-1 · min-1 in the group D).The body moving response,hemodynamic changes,propofol dose,examination time,wake-up time,departure time and adverse reactions in each group were observed during the examination process.Results During the examination process,the body moving response and bucking of the group A were significantly higher than those of the other three groups(P＜0.05);in hemodynamics,the group A fluctuated greatly,while the group B,C and D were relatively stable,but the incidence rate of hypotension,bradycardia and transient respiratory depressionof the group D were higher than those of the other three groups(P＜0.05);propofol dose of the group A was significantly higher than that of the other three groups (P＜0.05)and the group B was higher than the group C and D(P＜0.05).In wake-up time and departure time,the groups B,C,D were significantly better than the group A(P＜0.05),while the group C and D were better than the group B(P＜0.05).Conclusion Remifentanil can be used in painless bronchoscopic examination for elderly patients,and the effect is better by using propofol combined with remifentanil at a dose of 0.1 μg · kg-1 · min-1.

Objective To explore the effect of Ginkgo biloba extract (EGb761) on apoptosis of K-ras mutational human colon cancer cells DLD1(DLD1/G13D)and its mechanism. Methods Human colon cancer cell lines DLD1/G13D and DLD1 with K-ras wild type(DLD1/WT)were cultured in vitro,the cell proliferation and apoptosis after 24 h of EGb761 were measured. Proteins involved in related signal pathway were detected by Western blot or ELISA. Results EGb761 reduced cell proliferation and induced cell apoptosis in a concentration-dependent manner in DLD1/WT and DLD1/G13D cells. EGb761 downregulated the expression of RIP1, impaired the phosphorylation of IκB and decreased the level of NF-κB in DLD1/WT and DLD1/G13D cells[DLD1/G13D: (24±4)%, DLD1/WT: (29±9)%(P<0.05). Conclusion EGb761 restrains the proliferation and induces the apoptosis of DLD1/WT and DLD1/G13D cells. The mechanism may be related to the degradation of RIP-1 and inhibition of activation of NF-κB signaling pathway.

OBJECTIVE：To observe therapeutic efficacy and safe ty of Huhuang burn liniment on the prevention and treatment of radiation dermatitis patients with nasopharyngeal carcinoma （NPC）. METHODS ：Totally 129 NPC patients were collected from our hospital during Aug. 2018-Feb. 2020. They were numbered according to the order of radiotherapy ，the ones with odd number were included into observation group （65 cases）and the ones with even number into control group （64 cases）. Both groups received routine radiotherapy and skin nursing. Control group were evenly smeared with Shirun shaoshang cream in the radiation field during radiotherapy ，and observation group were smeared with Huhuang burn liniment. The smearing area should be 1 cm beyond the edge of radiation field ，3 times a day until the end of stage 1 radiotherapy（33-38 times in total ）. The skin lesions of the two groups were observed ；the appearance time and healing time of skin lesion ，RTOG score and NRS score were recorded. The levels of serum cytokines （TNF-α，IL-6，IL-8 and IL- 10）were detected in 2 groups at 0，15th and 30th time of radiotherapy. The occurrence of ADR was recorded in 2 groups during treatment. RESULTS ：The appearance time of skin lesion in observation group was significantly longer than control group ；the healing time of skin lesion in observation group was significantly shorter than control group （P＜0.01）. RTOG grading of radiodermatitis in the two groups was mainly grade 1，but no grade 3 or 4 was found. There was no significant difference in the proportion of patients with differen RTOG grades （P＞0.05）. The highest NRS score of control group and observation group were 3 and 2 points respectively ，and the proportions of patients with 0-3 points in the two groups were statistically significant （P＜0.05）. There was no significant difference in serum cytokine levels between @qq.com 2 groups at 0 time of radiotherapy （P＞0.05）. The serum cytokine levels of 2 groups were increased significantly at 15th @qq.com time of radiotherapy ， but t he observation group was significantly lower than control group at the same period （P＜0.05 or P＜0.01）. At 30th time of radiotherapy ，the cytokine levels of 2 groups decreased significantly ，compared with 15th time of radiotherapy ，the observation group was significantly lower than the control group at the same period （P＜0.05 or P＜0.01）；the levels of TNF-α，IL-6 and IL- 10 in control group as well as the level of IL- 6 in observation group were significantly higher than the same group at 0 time of radiotherapy （P＜0.05 or P＜0.01）. There was no ADR such as allergy ，rash，smear site infection in the two groups during the treatment. CONCLUSIONS ：Huhuang burn liniment has a good effect of preventing and treating radiation dermatitis of NPC patients ，delays the occurrence of skin lesion，shortens the healing time of skin lesion ，relieves pain and reduces the level of serum cytokines with good safety.

OBJECTIVE：To investigate the role of clinical pharmacists in the therapy of gefitinib-caused liver injury complicated with cholecystitis in a patient with lung adenocarcinoma ，and to provide reference for the therapy of similar type of patients. METHODS ： Clinical pharmacists participated in the treatment for gefitinib-caused liver injury complicated with cholecystitis in a patient with lung adenocarcinoma. The patient took Gefitinib tablets orally for a long time for anti-tumor treatment，and was hospitalized due to abnormal increase of transaminase. The doctors gave intravenous infusion of tiopronin sodium+ acetylcysteine+reduced glutathione+citicoline to protect liver ，but the effect was not good. After consulting the literature and analyzing the patient ’s condition ， clinical pharmacists suggested that gefitinib should be stopped ， and Magnesium isoglycyrrhizinate injection 0.2 g+5％ Glucose injection 250 mL，ivgtt，qd for liver protection treatment. After discharge ，the patient took Gefitinib tablets orally and was admitted to hospital again due to abnormal increase of transaminase ，and suffered from non-infectious and non-calculous cholecystitis. Clinical pharmacists suggested continuing intravenous drip of Magnesium isoglycyrrhizinate injection 0.2 g+5％ Glucose injection 250 mL，qd for liver protection treatment ，oral administration of Danshu capsules 0.9 g，tid for conservative treatment ；at the same time ，closely monitoring the changes of related indicators. After discharge，clinical pharmacists instructed patients to stop gefitinib ，and take Icotinib hydrochloride tablets 0.125 g，tid+Compound Taxus capsules 0.6 g，tid for anti-tumor treatment. RESULTS ：The doctors adopted the opinions of clinical pharmacists ，and the transaminase levels returned to normal ，and the symptoms of cholecystitis basically subsided. CON CLUSIONS：In the treatment of gefitinib-caused liver injury complicated with cholecystitis in patients with lung adenocarcinoma ， clinical pharmacists 135） assisted doctors to improve the treatment plan and ensure the effectiveness of drug use.

OBJECTIVE：To explore the role of clinical pharm acists in anti-infective therapy in patients with septic shock in the ICU. METHODS ：A total of 180 patients with septic shock were retrospectively collected from ICU of Chongqing Qianjiang Central Hospital during Jan.-Dec. 2018. According to whether clinical pharmacists participated in anti-infective therapy in the whole process，the patients were divided into intervention group （92 cases）and control group （88 cases）. Both groups were given routine treatment according to clinical diagnosis ；on this basis ，clinical pharmacists participated in the whole anti-infective therapy of the intervention group ，including participating in pharmaceutical rounds ，formulating anti-infective programs ，guiding nurses to implement anti-infective plan ，and providing pharmaceutical care for patients. The effectiveness ，safety and antibiotics clinical use indexes（such as proportion ，treatment course and cost of key monitored drugs ）were evaluated in 2 groups. RESULTS ：The cure rate of intervention group （98.91％）was significantly higher than that of control group （93.18％），while the incidence of ADR in the intervention group （8.70％）was significantly lower than control group （23.86％）. The use of antibiotics types was more rational（the proportion of carbapenems used in intervention group and control group were 20.65％，36.36％；those of quinolones were 15.22％，28.41％，respectively）；the duration of antibiotics use in the intervention group [ （15.18±2.25）d] was significantly shorter than control group [ （19.84±3.81）d]. The cost of antibiotics per capita [ （2 846.99±712.48）yuan] was significantly lower than control group [ （3 991.26±577.82）yuan]，with statistical significance of all above （P＜0.05 or P＜0.01）. CONCLUSIONS ： Clinical pharmacists participating in the anti-infective treatment of ICU patients with septic shock and providing pharmaceutical care，can improve the anti-infective effect ，reduce adverse drug reactions and drug-induced diseases ，optimize the use of antibiotics and reduce medical cost.