Objective:To evaluate potentially inappropriate medication (PIM) in hospitalized elderly patients with bacterial pneumonia, and explore its influencing factors.Methods:It was a single-center cross-sectional study. The study focused on elderly patients with bacterial pneumonia who were admitted to Xuanwu Hospital, Capital Medical University from January 2018 to November 2022. Patients′ gender, age, weight, length of hospital stay, diagnosis at admission, physical examination, diagnosis at discharge, comorbidities, medications, and laboratory test results were extracted from hospital information system and electronic medical records. Medication use of patients included in the analysis during their hospitalization were evaluated according to the classification of PIMs in the 5 lists of the Beer′s criteria of American Geriatrics Society. Based on whether PIM occurred, the patients were divided into with PIM group and without PIM group. The clinical features between the 2 groups were compared and the influencing factors of PIM were analyzed using multivariable logistic regression.Results:A total of 2 720 patients were included, in which 1 734 (63.75%) were male. The median age was 78 (70, 85) years and their ages ranged from 65 to 103 years. The number of drugs used per patient was 14 (10, 18) kinds, ranging from 1 to 57 kinds. The length of hospital stay was 12 (9, 17) days, ranging from 1 to 162 days. Charlson comorbidity index (CCI) was 6 (5, 8) points. Among the 2 720 patients, 1 894 (69.63%) experienced PIM, with a total of 6 166 cases of PIM. The top 3 drugs ranked by the number of PIM occurrence were antiplatelet agents (1 357 cases), benzodiazapine receptor agonists (956 cases), and antipsychotics (884 cases). The comparison of clinical characteristics between the 2 groups showed that differences in age, CCI, length of hospital stay, and number of medications between with PIM and without PIM patients were statistically significant (all P<0.001). Multivariable logistic regression results showed that CCI, length of hospital stay, and number of medications were independent influencing factors for PIM. The risk increased by 8% and 1% with one point increase in CCI and one day extension in length of hospital stay [odds ratio ( OR)=1.08, 95% confidence interval ( CI): 1.04-1.13, P<0.001; OR=1.01, 95% CI: 1.00-1.03, P=0.03]. PIM risk of patients with more than 15 concurrent medications had a 22.16 times higher PIM risk than those with less than 5 concurrent medications ( OR=22.16, 95% CI: 14.15-34.72, P<0.001). Conclusions:Hospitalized eldery patients with bacterial pneumonia who have more severe comorbidities, longer hospital stay, and multiple concomitant medications are at a higher risk of PIM occurrence. Rational medication use among these patients should be paid attention to in clinical practice.

Objective To evaluate the effectiveness,safety and economy of generic venlafaxine sustained-release capsules and the original drug in clinical practice based on real world clinical data.Methods This is a multicenter,retrospective real-world study.The information of outpatients who used venlafaxine sustained-release capsules in 7 hospitals from October 2021 to October 2022 was collected,including prescription data and laboratory data.They were divided into generic drug group and original drug group.After the baseline level was corrected by propensity score match method,the prescription daily dose,plasma concentration,medication possession ratio,the continuous medication rate for 3,6 and 9 months,dressing change rate,the incidence of adverse reactions,the frequency of drug use,the average daily cost,the annual cost per capita and the proportion of the average annual cost of drugs were compared between the two groups.Results After the baseline level was corrected by propensity score matching method,the prescription daily dose and medication possession ratio(MPR≥0.8)in the generic drug group were higher than that of the original drug group(P＜0.05).There was no statistically difference in plasma concentration between the two groups(P=0.294).The continuous medication rate for 3,6 and 9 months in the generic drug group were statistically higher than those in the original drug group(P＜0.01).The single dressing change rate of the generic drug group was lower than that of the original drug group(P=0.032).There was no significant difference in the rate of secondary dressing change between the two groups(P=1.000).There were no significant differences in the incidence of abnormal ALT,AST,TC,Na,APTT,and PLC between two groups(P＞0.05).The average daily cost of the generic drug group was lower than that of the original drug group.The per capita annual cost of drugs and the proportion of average annual cost of drugs in the generic drug group were significantly lower than those in the original drug group(P＜0.01).Conclusion In the actual clinical diagnosis and treatment,no clinically significant differences in effectiveness and safety were found between the generic venlafaxine sustained-release capsule and the original-patented,while the economic advantages of the generic drug were better than that of the original-patented drug.

Objective To evaluate the effectiveness,safety and economy of generic venlafaxine sustained-release capsules and the original drug in clinical practice based on real world clinical data.Methods This is a multicenter,retrospective real-world study.The information of outpatients who used venlafaxine sustained-release capsules in 7 hospitals from October 2021 to October 2022 was collected,including prescription data and laboratory data.They were divided into generic drug group and original drug group.After the baseline level was corrected by propensity score match method,the prescription daily dose,plasma concentration,medication possession ratio,the continuous medication rate for 3,6 and 9 months,dressing change rate,the incidence of adverse reactions,the frequency of drug use,the average daily cost,the annual cost per capita and the proportion of the average annual cost of drugs were compared between the two groups.Results After the baseline level was corrected by propensity score matching method,the prescription daily dose and medication possession ratio(MPR≥0.8)in the generic drug group were higher than that of the original drug group(P＜0.05).There was no statistically difference in plasma concentration between the two groups(P=0.294).The continuous medication rate for 3,6 and 9 months in the generic drug group were statistically higher than those in the original drug group(P＜0.01).The single dressing change rate of the generic drug group was lower than that of the original drug group(P=0.032).There was no significant difference in the rate of secondary dressing change between the two groups(P=1.000).There were no significant differences in the incidence of abnormal ALT,AST,TC,Na,APTT,and PLC between two groups(P＞0.05).The average daily cost of the generic drug group was lower than that of the original drug group.The per capita annual cost of drugs and the proportion of average annual cost of drugs in the generic drug group were significantly lower than those in the original drug group(P＜0.01).Conclusion In the actual clinical diagnosis and treatment,no clinically significant differences in effectiveness and safety were found between the generic venlafaxine sustained-release capsule and the original-patented,while the economic advantages of the generic drug were better than that of the original-patented drug.

Objective:To evaluate potentially inappropriate medication (PIM) in hospitalized elderly patients with bacterial pneumonia, and explore its influencing factors.Methods:It was a single-center cross-sectional study. The study focused on elderly patients with bacterial pneumonia who were admitted to Xuanwu Hospital, Capital Medical University from January 2018 to November 2022. Patients′ gender, age, weight, length of hospital stay, diagnosis at admission, physical examination, diagnosis at discharge, comorbidities, medications, and laboratory test results were extracted from hospital information system and electronic medical records. Medication use of patients included in the analysis during their hospitalization were evaluated according to the classification of PIMs in the 5 lists of the Beer′s criteria of American Geriatrics Society. Based on whether PIM occurred, the patients were divided into with PIM group and without PIM group. The clinical features between the 2 groups were compared and the influencing factors of PIM were analyzed using multivariable logistic regression.Results:A total of 2 720 patients were included, in which 1 734 (63.75%) were male. The median age was 78 (70, 85) years and their ages ranged from 65 to 103 years. The number of drugs used per patient was 14 (10, 18) kinds, ranging from 1 to 57 kinds. The length of hospital stay was 12 (9, 17) days, ranging from 1 to 162 days. Charlson comorbidity index (CCI) was 6 (5, 8) points. Among the 2 720 patients, 1 894 (69.63%) experienced PIM, with a total of 6 166 cases of PIM. The top 3 drugs ranked by the number of PIM occurrence were antiplatelet agents (1 357 cases), benzodiazapine receptor agonists (956 cases), and antipsychotics (884 cases). The comparison of clinical characteristics between the 2 groups showed that differences in age, CCI, length of hospital stay, and number of medications between with PIM and without PIM patients were statistically significant (all P<0.001). Multivariable logistic regression results showed that CCI, length of hospital stay, and number of medications were independent influencing factors for PIM. The risk increased by 8% and 1% with one point increase in CCI and one day extension in length of hospital stay [odds ratio ( OR)=1.08, 95% confidence interval ( CI): 1.04-1.13, P<0.001; OR=1.01, 95% CI: 1.00-1.03, P=0.03]. PIM risk of patients with more than 15 concurrent medications had a 22.16 times higher PIM risk than those with less than 5 concurrent medications ( OR=22.16, 95% CI: 14.15-34.72, P<0.001). Conclusions:Hospitalized eldery patients with bacterial pneumonia who have more severe comorbidities, longer hospital stay, and multiple concomitant medications are at a higher risk of PIM occurrence. Rational medication use among these patients should be paid attention to in clinical practice.

Objective To evaluate the effectiveness,safety and economy of the clinical application of levetiracetam(LEV)concentrated solution for injection generic drug and the original drug in the national centralized volume-based procurement.Methods The information of inpatients using original LEV concentrated solution for injection in the Xuanwu Hospital of Capital Medical University(original drug group)and inpatients using generic LEV concentrated solution for injection in the First Affiliated Hospital of Wannan Medical College(generic drug group)was retrospectively analyzed after the implementation of the procurement policy(from November 2021 to March 2022).To compare the effectiveness,safety and economy of the two in the prevention and treatment of epilepsy.Results In the original drug group and the generic drug group,18 and 17 patients were enrolled in the treatment of epilepsy respectively,the effective rates were 50.00％and 58.82％,the incidence of adverse reactions were both 0％,and the median daily cost was 255.00(255.00,510.00)yuan and 131.78(131.78,131.78)yuan.After propensity score matching,both the original drug group and the generic drug group had 76 patients each received preventive medication,the effective rates were 97.37％and 100％(P＞0.05),and the incidence of adverse reactions were both 0％.The median daily fee for the original the generic drug group was 170.00(170.00,170.00)yuan and 131.78(131.78,131.78)yuan,there were significant difference(P＜0.01).Conclusion The clinical effect of generic and original LEV concentrated solution for injection in preventing epilepsy is basically the same,the clinical safety are equivalent,the generic has better economy than the original.The effective rate of the treatment of epilepsy is similar,while the sample size needs to be further expanded to verify the results.

It was a very common phenomenon that an original drug was replaced by a generic drug after its patent expires. In order to further verify the efficacy and safety of domestic generic drugs selected in the national centralized volume-based procurement, the National Healthcare Security Administration guided a number of medical institutions to carry out large-scale real-world studies on clinical efficacy and safety of generic drugs, involving drugs for treating cardiovascular and cerebrovascular diseases, neuropsychiatric diseases, chronic hepatitis B, and tumor, and anesthetics. More than 110 thousands patients were included in the study. Evidence from real world studies and randomized controlled trials can complement each other. Because of the diversity of data, the complexity of design, the high requirements of analytical methods, and the uncertainty of the interpretation of results in the real world studies, higher requirements for the safety and efficacy evaluation and regulatory decision-making of generic drugs are put forward. Possible recommendations to constantly promote the scientificalness and standardization of the production and use of real world evidence are as follows: further strengthen the informatization construction in medical institutions and promote the standardization and convenience in real world data use, improve the scientificalness of research design and data processing, explore and improve the real world evidence quality evaluation criteria, strengthen the awareness of data security and pay attention to the participants' privacy protection, etc.

Objective:To compare the clinical efficacy and safety of cefdinir dispersible tablets selected in the national centralized volume-based procurement (VBP) and the original drug cefdinir capsules.Methods:Clinical data of single-use cefdinir in outpatient of Xuanwu Hospital, Capital Medical University between January 1, 2020 and December 31, 2021 were collected through the hospital information system. The clinical data included gender, age, type of medical insurance, type of infection, application of cefdinir, whether to combine other antibacterial drugs, laboratory test results such as blood routine, C-reactive protein, liver and kidney function before and after cefdinir treatment, and adverse reaction report of cefdinir. After propensity score matching (PSM) of the age, sex, type of medical insurance, type of infection and whether to combine with other antibacterial drugs in the cefdinir dispersible tablets group selected in the VBP (VBP group) and the original cefdinir group (original group), the clinical application in patients in the 2 groups was compared to indirectly evaluate the efficacy of the 2 drugs. The white blood cell count, neutrophils percentage, and C-reactive protein levels before and after the use of cefdinir was compared to evaluate the efficacy. Adverse drug reaction report of cefdinir and liver and kidney function before and after the use of cefdinir were compared to evaluate the safety.Results:A total of 9 514 patients treated with cefdinir were entered, including 7 037 patients in the VBP group and 2 477 patients in the original group. After PSM, each group comprised 1 268 patients, the differences in gender, age, type of infection, and combination with other antibacterial drugs were not statistically significant (all P>0.05). The daily dose, course, and use density of cefdinir in the VBP group were lower than those in the original group[(0.30±0.04) g vs. (0.35±0.12) g, P<0.001; 8(4, 8) d vs. 10(8, 10) d, P<0.001; (3.96±1.70) g vs. (5.22±2.03) g, P<0.001]. The white blood cell count, neutrophils percentage, and C-reactive protein levels after the cefdinir application in patients in the VBP group were lower than those before the use of the cefdinir [11.2(8.7, 13.8)×10 9vs. 7.2(5.5, 9.9)×10 9, P<0.001; 80(74, 87)% vs. 66(56, 73)%, P<0.001; 23(10, 64) mg/L vs. 13(6, 44) mg/L, P=0.032]. No adverse drug reactions related to cefdinir were reported in the 2 groups. The differences in alanine aminotransferase, aspartate aminotransferase, blood creatinine, and urea nitrogen levels in patients between the 2 groups before and after use of cefdinir were not statistically significant (all P>0.05). The difference in aspartate aminotransferase before and after use of the cefdinir in the original group was statistically significant [21(18, 23) U/L vs. 23(20, 29) U/L, P=0.040], and the differences in alanine aminotransferase, blood creatinine, and urea nitrogen levels were not statistically significant (all P>0.05). The detection values of liver and kidney function in the 2 groups before and after use of the cefdinir were within the reference range. Conclusion:No significant differences were found in the clinical efficacy and safety between the VBP cefdinir dispersible tablets and the original cefdinir capsules.

It was a very common phenomenon that an original drug was replaced by a generic drug after its patent expires. In order to further verify the efficacy and safety of domestic generic drugs selected in the national centralized volume-based procurement, the National Healthcare Security Administration guided a number of medical institutions to carry out large-scale real-world studies on clinical efficacy and safety of generic drugs, involving drugs for treating cardiovascular and cerebrovascular diseases, neuropsychiatric diseases, chronic hepatitis B, and tumor, and anesthetics. More than 110 thousands patients were included in the study. Evidence from real world studies and randomized controlled trials can complement each other. Because of the diversity of data, the complexity of design, the high requirements of analytical methods, and the uncertainty of the interpretation of results in the real world studies, higher requirements for the safety and efficacy evaluation and regulatory decision-making of generic drugs are put forward. Possible recommendations to constantly promote the scientificalness and standardization of the production and use of real world evidence are as follows: further strengthen the informatization construction in medical institutions and promote the standardization and convenience in real world data use, improve the scientificalness of research design and data processing, explore and improve the real world evidence quality evaluation criteria, strengthen the awareness of data security and pay attention to the participants' privacy protection, etc.

Objective:To compare the clinical efficacy and safety of cefdinir dispersible tablets selected in the national centralized volume-based procurement (VBP) and the original drug cefdinir capsules.Methods:Clinical data of single-use cefdinir in outpatient of Xuanwu Hospital, Capital Medical University between January 1, 2020 and December 31, 2021 were collected through the hospital information system. The clinical data included gender, age, type of medical insurance, type of infection, application of cefdinir, whether to combine other antibacterial drugs, laboratory test results such as blood routine, C-reactive protein, liver and kidney function before and after cefdinir treatment, and adverse reaction report of cefdinir. After propensity score matching (PSM) of the age, sex, type of medical insurance, type of infection and whether to combine with other antibacterial drugs in the cefdinir dispersible tablets group selected in the VBP (VBP group) and the original cefdinir group (original group), the clinical application in patients in the 2 groups was compared to indirectly evaluate the efficacy of the 2 drugs. The white blood cell count, neutrophils percentage, and C-reactive protein levels before and after the use of cefdinir was compared to evaluate the efficacy. Adverse drug reaction report of cefdinir and liver and kidney function before and after the use of cefdinir were compared to evaluate the safety.Results:A total of 9 514 patients treated with cefdinir were entered, including 7 037 patients in the VBP group and 2 477 patients in the original group. After PSM, each group comprised 1 268 patients, the differences in gender, age, type of infection, and combination with other antibacterial drugs were not statistically significant (all P>0.05). The daily dose, course, and use density of cefdinir in the VBP group were lower than those in the original group[(0.30±0.04) g vs. (0.35±0.12) g, P<0.001; 8(4, 8) d vs. 10(8, 10) d, P<0.001; (3.96±1.70) g vs. (5.22±2.03) g, P<0.001]. The white blood cell count, neutrophils percentage, and C-reactive protein levels after the cefdinir application in patients in the VBP group were lower than those before the use of the cefdinir [11.2(8.7, 13.8)×10 9vs. 7.2(5.5, 9.9)×10 9, P<0.001; 80(74, 87)% vs. 66(56, 73)%, P<0.001; 23(10, 64) mg/L vs. 13(6, 44) mg/L, P=0.032]. No adverse drug reactions related to cefdinir were reported in the 2 groups. The differences in alanine aminotransferase, aspartate aminotransferase, blood creatinine, and urea nitrogen levels in patients between the 2 groups before and after use of cefdinir were not statistically significant (all P>0.05). The difference in aspartate aminotransferase before and after use of the cefdinir in the original group was statistically significant [21(18, 23) U/L vs. 23(20, 29) U/L, P=0.040], and the differences in alanine aminotransferase, blood creatinine, and urea nitrogen levels were not statistically significant (all P>0.05). The detection values of liver and kidney function in the 2 groups before and after use of the cefdinir were within the reference range. Conclusion:No significant differences were found in the clinical efficacy and safety between the VBP cefdinir dispersible tablets and the original cefdinir capsules.

Aim Toinvestigatewhetherexposureto Sanguinarine (SAN ) can inhibit cell proliferation in human mammary adenocarcinoma cells (MCF-7 ) and thepossiblemechanism.Methods WeexposedMCF-7 to anticancer compound SAN,cell viability was as-sessed by using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT ) reduction assay. ROS was measured using confocal microscopy,expres-sion of caspase-3 ,caspase-8 and caspase-9 were calcu-latedusingchemiluminescencemethod.Results SAN remarkably inhibited growth of human mammary adeno-carcinoma MCF-7 cells by decreasing cell proliferation. ROS release and caspase-3,caspase-8,caspase-9 ex-pression were stimulated by SAN in MCF-7 ,and these changes were abolished by the antioxidant,N-acetyl-cysteine(NAC).Conclusion Regulationofcaspases expression and release from MCF-7 cells are possibly e-voked by SAN through reactive oxygen species.