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Tablet characteristics and pharmacokinetics of orally disintegrating tablets containing coenzyme Q10 granules prepared by different methods. 不同方法制备辅酶Q10颗粒口腔崩解片的片剂特性及药动学研究
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0007
Yasuharu Kashiwagura, Shota Takusagawa, Yasuyuki Ikematsu, Shimako Tanaka, Noriyuki Namiki, Shinya Uchida

This study aimed to elucidate the characteristics and pharmacokinetics of orally disintegrating tablets (ODTs) containing coenzyme Q10 (CoQ10) granules prepared by spray drying, hot-melting, and wet granulation. The hardness and disintegration times of CoQ10-ODTs containing 5 % crospovidone were 61.6-81.8 N and < 30 s, respectively; these values indicate that the as-prepared ODTs were adequate for clinical use. The hardness and disintegration times of all ODTs did not change significantly after a 28-day storage period at 30 °C/10 % relative humidity (RH), but storage under high temperature and humidity affected their characteristics. The dissolution and pharmacokinetics of CoQ10-ODTs showed that ODTs prepared using the spray-drying method had the highest dissolution and absorbability among the CoQ10-ODTs tested. These results provide useful information for the preparation of ODTs using CoQ10.

研究了喷雾干燥法、热熔法和湿法制备辅酶Q10颗粒剂口腔崩解片的特性和药代动力学。含5%交叉维酮的CoQ10-ODTs硬度为61.6 ~ 81.8 N,崩解时间< 30 s;这些值表明制备的odt足以用于临床。在30°C/ 10%相对湿度(RH)条件下贮藏28 d后,所有odt的硬度和崩解时间均无明显变化,但高温高湿条件下贮藏会影响其特性。CoQ10-ODTs的溶出度和药代动力学结果表明,喷雾干燥法制备的CoQ10-ODTs溶出度和吸收度最高。这些结果为利用辅酶q10制备odt提供了有用的信息。
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引用次数: 0
Effects of 3R, 16S-2-hydroxyethyl apovincaminate (HEAPO), donepezil and galantamine on learning and memory retention in naïve Wistar rats. 3R、16s -2-羟乙基载疫苗(HEAPO)、多奈哌齐和加兰他敏对naïve Wistar大鼠学习记忆保持的影响。
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0006
Darinka Dimitrova, Damianka Getova, Kremena Saracheva

The effects of 3R,16S-2-hydroxyethyl apovincaminate (HEAPO, RGH-10885) compared with those of two cholinesterase inhibitors, donepezil and galantamine, were examined in naïve Wistar rats using standard active and passive avoidance tests. The active avoidance test (shuttle box) and two passive avoidance tests (step-through and step-down) were performed according to the experimental design. There were 10 groups of rats (n = 8) and the substances studied were applied orally before each testing session. In the active avoidance test, the number of conditioned stimuli (avoidances), unconditioned stimuli (escapes) and intertrial crossings were observed. In step-down and step-through passive avoidance tests, the latencies of reactions were observed. All the studied compounds showed positive effects in the learning and memory tests, compared to the controls. It was concluded that HEAPO, donepezil and galantamine had a memory-enhancing effect in active and passive avoidance tests.

在naïve Wistar大鼠中,采用标准主动和被动回避试验,比较3R, 16s -2-羟乙基apovinaminate (HEAPO, rgh10885)与两种胆碱酯酶抑制剂多奈哌齐和加兰他明的作用。按照实验设计进行主动回避实验(穿梭箱)和两个被动回避实验(穿越和降压)。10组大鼠(n = 8),每次试验前口服所研究物质。在主动回避实验中,观察条件刺激(回避)、非条件刺激(逃避)和试验间交叉的数量。在逐步下降和逐步通过的被动回避实验中,观察反应的潜伏期。与对照组相比,所有被研究的化合物在学习和记忆测试中都显示出积极的效果。结论HEAPO、多奈哌齐和加兰他敏在主动和被动回避实验中均有增强记忆的作用。
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引用次数: 0
Intensive critical care and management of asthmatic and smoker patients in COVID-19 infection. COVID-19感染哮喘和吸烟患者重症监护与管理
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0002
Dongming Lu, Obaid Yaqoob, Manish Kumar, Ajay Singh Kushwah, Rahul Kumar Sharma, Devinder Kumar, Yogendra Mavai, Rukaiya Khan

This century's most serious catastrophe, COVID-19, has been dubbed "the most life-threatening disaster ever". Asthmatic persons are even more prone to COVID-19's complex interplay with the underlying inflammatory condition. In order to protect themselves against COVID-19, asthmatic patients must be very vigilant in their usage of therapeutic techniques and drugs (e.g., bronchodilators, 5-lipoxygenase inhibitors), which may be accessed to deal with mild, moderate, and severe COVID-19 indications. People with asthma may have more severe COVID-19 symptoms, which may lead to a worsening of their condition. Several cytokines were found to be elevated in the bronchial tracts of patients with acute instances of COVID-19, suggesting that this ailment may aggravate asthma episodes by increasing inflammation. The intensity of COVID-19 symptoms is lessened in patients with asthma who have superior levels of T-cells. Several antibiotics, antivirals, antipyretics, and anti-inflammatory drugs have been suggested to suppress COVID-19 symptoms in asthmatic persons. Furthermore, smokers are more likely to have aggravated repercussions in COVID-19 infection. Being hospitalized to critical care due to COVID-19, needing mechanical breathing, and suffering from serious health repercussions, are all possible outcomes for someone who has previously smoked. Smoking damages airways and alveoli, which significantly raises the risk of COVID-19-related health complications. Patients with a previous record of smoking are predisposed to severe COVID-19 disease symptoms that essentially require a combination of bronchodilators, mucolytics, antivirals, and antimuscarinic drugs, to cope with the situation. The present review discusses the care and management of asthmatic and smoker patients in COVID-19 infection.

本世纪最严重的灾难COVID-19被称为“有史以来最危及生命的灾难”。哮喘患者更容易受到COVID-19与潜在炎症的复杂相互作用的影响。为了保护自己免受COVID-19的侵害,哮喘患者在使用治疗技术和药物(例如支气管扩张剂、5-脂氧合酶抑制剂)时必须非常警惕,这些技术和药物可能用于治疗轻度、中度和重度COVID-19适应症。哮喘患者可能有更严重的COVID-19症状,这可能导致病情恶化。在COVID-19急性患者的支气管中发现了几种细胞因子升高,这表明这种疾病可能通过增加炎症来加重哮喘发作。在t细胞水平较高的哮喘患者中,COVID-19症状的强度会减轻。一些抗生素、抗病毒药物、解热药和抗炎药已被建议用于抑制哮喘患者的COVID-19症状。此外,吸烟者更有可能加重COVID-19感染的后果。由于COVID-19而住院接受重症监护,需要机械呼吸,并遭受严重的健康影响,这些都是以前吸烟的人可能出现的结果。吸烟会损害气道和肺泡,这大大增加了与covid -19相关的健康并发症的风险。既往有吸烟记录的患者易出现严重的COVID-19疾病症状,基本上需要联合使用支气管扩张剂、黏液解药、抗病毒药物和抗毒蕈碱药物来应对这种情况。现就哮喘和吸烟患者新冠肺炎感染的护理与管理进行综述。
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引用次数: 0
The opposite effect of convulsant drugs on neuronal and endothelial nitric oxide synthase - A possible explanation for the dual proconvulsive/anticonvulsive action of nitric oxide. 惊厥药物对神经元和内皮型一氧化氮合酶的相反作用——一氧化氮具有惊厥/抗惊厥双重作用的可能解释。
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0004
Lourdes A Vega Rasgado, Eva Ramón-Gallegos, Lorena Rodríguez-Páez, Verónica Alcántara-Farfán

Nitric oxide (NO) participates in processes such as endothelium-dependent vasodilation and neurotransmission/neuromodulation. The role of NO in epilepsy is controversial, attributing it to anticonvulsant but also proconvulsant properties. Clarification of this dual effect of NO might lead to the development of new antiepileptic drugs. Previous results in our laboratory indicated that this contradictory role of NO in seizures could depend on the nitric oxide synthase (NOS) isoform involved, which could play opposite roles in epileptogenesis, one of them being proconvulsant but the other anticonvulsant. The effect of convulsant drugs on neuronal NO (nNO) and endothelial NO (eNO) levels was investigated. Considering the distribution of neuronal and endothelial NOS in neurons and astrocytes, resp., primary cultures of neurons and astrocytes were used as a study model. The effects of convulsant drugs pentylenetetrazole, thiosemicarbazide, 4-aminopyridine and bicuculline on NO levels were studied, using a spectrophotometric method. Their effects on NO levels in neurons and astrocytes depend on the concentration and time of treatment. These convulsant drugs caused an increase in nNO, but a decrease in eNO was proportional to the duration of treatment in both cases. Apparently, nNO possesses convulsant properties mediated by its effect on the glutamatergic and GABAergic systems, probably through GABAA receptors. Anticonvulsant properties of eNO may be the consequence of its effect on endothelial vasodilation and its capability to induce angiogenesis. Described effects last as seizures do. Considering the limitations of these kinds of studies and the unexplored influence of inducible NO, further investigations are required.

一氧化氮(NO)参与内皮依赖性血管舒张和神经传递/神经调节等过程。一氧化氮在癫痫中的作用是有争议的,归因于它的抗惊厥和前惊厥特性。澄清一氧化氮的这种双重作用可能有助于开发新的抗癫痫药物。本实验室先前的结果表明,NO在癫痫发作中的矛盾作用可能取决于所涉及的一氧化氮合酶(NOS)异构体,它们在癫痫发生中可能起相反的作用,其中一个是前惊厥剂,另一个是抗惊厥剂。观察惊厥药物对神经细胞一氧化氮(nNO)和内皮细胞一氧化氮(eNO)水平的影响。考虑到神经元和星形胶质细胞中神经元和内皮细胞NOS的分布。以神经元和星形胶质细胞原代培养物为研究模型。采用分光光度法研究了惊厥药物戊四唑、硫代氨基脲、4-氨基吡啶和双柳碱对一氧化氮水平的影响。它们对神经元和星形胶质细胞NO水平的影响取决于处理的浓度和时间。在两种情况下,这些惊厥药物引起一氧化氮增加,但一氧化氮的减少与治疗时间成正比。显然,nNO具有惊厥特性,其作用可能是通过GABAA受体介导的谷氨酸能和GABAA能系统。eNO的抗惊厥特性可能是其对内皮血管扩张的影响和诱导血管生成的能力的结果。所描述的效果会像癫痫发作一样持续。考虑到这些研究的局限性和诱导NO的未探索的影响,需要进一步的研究。
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引用次数: 0
Sodium butyrate attenuate hyperglycemia-induced inflammatory response and renal injury in diabetic mice. 丁酸钠减轻糖尿病小鼠高血糖诱导的炎症反应和肾损伤。
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0008
Man Yan, Yan-Yan Zhang, Yue Xi, Long-Kun Ding, Chang Sun, Li-Juan Qu, Xin Qian, Jing-Wen Xu, Wen Sun, Liang Wu

The activation of the monocyte-macrophage system and the damage to the renal and pancreatic tissue are common complications in patients with diabetes induced by hyper-glycemia. This study aimed to evaluate the effect and mechanism of butyrate (NaB), a metabolite of intestinal flora, on inhibiting the inflammatory response of human monocyte-macrophages (THP-1 cells) induced by high glucose and the damage of pancreatic and renal tissue in diabetic mice. The results showed that high concentration glucose significantly up-regulated the expressions of IL-1β, TNF-α, and NLRP3 in THP-1 cells and mouse spleen, and that NaB could inhibit the overexpression of those genes. The abundance of Beclin-1, LC3B and reactive oxygen species (ROS) in THP-1 cells is increased due to the high glucose concentration, and NaB can inhibit the genes responsible for upregulating the expression. In diabetic mice, vacuolar degeneration of renal tubules was observed. Then we observed that some of the epithelial cells of the renal tubules were exfoliated and some formed tubules. NaB could alleviate these pathological lesions, but NaB cannot alleviate pancreatic injury. Our results indicated that NaB could be used for the prevention and adjuvant treatment of diabetic kidney injury.

单核-巨噬细胞系统的激活和对肾脏和胰腺组织的损害是高血糖引起的糖尿病患者常见的并发症。本研究旨在探讨肠道菌群代谢物丁酸盐(NaB)对高糖诱导的人单核巨噬细胞(THP-1细胞)炎症反应及糖尿病小鼠胰腺和肾脏组织损伤的抑制作用及其机制。结果表明,高浓度葡萄糖可显著上调THP-1细胞和小鼠脾脏中IL-1β、TNF-α和NLRP3的表达,NaB可抑制这些基因的过表达。由于高葡萄糖浓度,THP-1细胞中Beclin-1、LC3B和活性氧(ROS)的丰度增加,NaB可以抑制上调表达的基因。在糖尿病小鼠中,观察到肾小管空泡变性。我们观察到肾小管上皮细胞部分脱落,部分形成小管。NaB可减轻这些病理病变,但不能减轻胰腺损伤。提示NaB可用于糖尿病肾损伤的预防和辅助治疗。
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引用次数: 1
The in vitro anticancer effects of FS48 from salivary glands of Xenopsylla cheopis on NCI-H460 cells via its blockage of voltage-gated K+ channels. 非洲爪蟾唾液腺FS48通过阻断电压门控K+通道对NCI-H460细胞的体外抗癌作用
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0010
Weichen Xiong, Huizhen Fan, Qingye Zeng, Zhenhui Deng, Guanhui Li, Wancheng Lu, Bei Zhang, Shian Lai, Xin Chen, Xueqing Xu

Voltage-gated K+ (Kv) channels play a role in the cellular processes of various cancer cells, including lung cancer cells. We previously identified and reported a salivary protein from the Xenopsylla cheopis, FS48, which exhibited inhibitory activity against Kv1.1-1.3 channels when assayed in HEK 293T cells. However, whether FS48 has an inhibitory effect on cancer cells expressing Kv channels is unclear. The present study aims to reveal the effects of FS48 on the Kv channels and the NCI-H460 human lung cancer cells through patch clamp, MTT, wound healing, transwell, gelatinase zymography, qRT-PCR and WB assays. The results demonstrated that FS48 can be effective in suppressing the Kv currents, migration, and invasion of NCI-H460 cells in a dose-dependent manner, despite the failure to inhibit the proliferation. Moreover, the expression of Kv1.1 and Kv1.3 mRNA and protein were found to be significantly reduced. Finally, FS48 decreases the mRNA level of MMP-9 while increasing TIMP-1 mRNA level. The present study highlights for the first time that blood-sucking arthropod saliva-derived protein can inhibit the physiological activities of tumour cells via the Kv channels. Furthermore, FS48 can be taken as a hit compound against the tumour cells expressing Kv channels.

电压门控K+ (Kv)通道在包括肺癌细胞在内的多种癌细胞的细胞过程中发挥作用。我们之前从非洲爪蚤中鉴定并报道了一种唾液蛋白FS48,该蛋白在HEK 293T细胞中表现出对Kv1.1-1.3通道的抑制活性。然而,FS48是否对表达Kv通道的癌细胞有抑制作用尚不清楚。本研究旨在通过膜片钳、MTT、伤口愈合、transwell、明胶酶酶谱、qRT-PCR和WB检测揭示FS48对Kv通道和NCI-H460人肺癌细胞的影响。结果表明,FS48能有效抑制NCI-H460细胞的Kv电流、迁移和侵袭,且呈剂量依赖性,但不能抑制细胞增殖。Kv1.1和Kv1.3 mRNA和蛋白的表达显著降低。最后,FS48降低了MMP-9的mRNA水平,同时提高了TIMP-1的mRNA水平。本研究首次强调了吸血节肢动物唾液源蛋白可以通过Kv通道抑制肿瘤细胞的生理活动。此外,FS48可以作为一种打击表达Kv通道的肿瘤细胞的化合物。
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引用次数: 1
Recent approaches in the drug research and development of novel antimalarial drugs with new targets. 具有新靶点的新型抗疟药物研究和开发的最新途径。
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0001
Naveen Kumar Reddy Chinnappanna, Gopi Yennam, Chaitanya Budagam Haima Naga Venkata Chaitanya, Shinu Pottathil, Pobitra Borah, Katharigatta N Venugopala, Pran Kishore Deb, Raghu Prasad Mailavaram

Malaria is a serious worldwide medical issue that results in substantial annual death and morbidity. The availability of treatment alternatives is limited, and the rise of resistant parasite types has posed a significant challenge to malaria treatment. To prevent a public health disaster, novel antimalarial agents with single-dosage therapies, extensive curative capability, and new mechanisms are urgently needed. There are several approaches to developing antimalarial drugs, ranging from alterations of current drugs to the creation of new compounds with specific targeting abilities. The availability of multiple genomic techniques, as well as recent advancements in parasite biology, provides a varied collection of possible targets for the development of novel treatments. A number of promising pharmacological interference targets have been uncovered in modern times. As a result, our review concentrates on the most current scientific and technical progress in the innovation of new antimalarial medications. The protein kinases, choline transport inhibitors, dihydroorotate dehydrogenase inhibitors, isoprenoid biosynthesis inhibitors, and enzymes involved in the metabolism of lipids and replication of deoxyribonucleic acid, are among the most fascinating antimalarial target proteins presently being investigated. The new cellular targets and drugs which can inhibit malaria and their development techniques are summarised in this study.

疟疾是一个严重的世界性医疗问题,每年造成大量死亡和发病率。可获得的治疗方法有限,而且耐药寄生虫类型的增加对疟疾治疗构成了重大挑战。为了预防公共卫生灾难,迫切需要具有单剂量治疗、广泛治疗能力和新机制的新型抗疟药。开发抗疟疾药物有几种方法,从改变现有药物到创造具有特定靶向能力的新化合物。多种基因组技术的可用性,以及寄生虫生物学的最新进展,为开发新的治疗方法提供了各种可能的靶点。现代已经发现了许多有前途的药理干扰靶点。因此,我们的综述集中在新的抗疟药物创新方面的最新科学技术进展。蛋白激酶、胆碱转运抑制剂、二氢乳酸脱氢酶抑制剂、类异戊二烯生物合成抑制剂以及参与脂质代谢和脱氧核糖核酸复制的酶是目前正在研究的最令人着迷的抗疟疾靶蛋白。本文综述了新的抑制疟疾的细胞靶点和药物及其开发技术。
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引用次数: 3
Effects of tranquilization therapy in elderly patients suffering from chronic non-communicable diseases: A meta-analysis. 镇静治疗对老年慢性非传染性疾病患者的影响:一项荟萃分析
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2023-03-01 DOI: 10.2478/acph-2023-0003
Jing Li, Jing Li, Yulan Cui, Honggeng Li, Xiaoxuan Hou, Fang Zhao, Qing Zhao, Junlan Zhao, Pengchao Lin

The current meta-analysis searched the literature connected to different tranquilizers used to treat elderly people and assessed it in terms of dose, types of outcomes and adverse effects, to determine a safe and acceptable tranquilizer and its optimal dose. A systematic literature review was undertaken for randomized controlled trials, case-control, retrospective and prospective studies on the use of tranquilizers in elderly patients, using PubMed, Ebsco, SCOPUS and Web of Science. PICOS criteria were used to select studies, and pertinent event data was collected. This meta-analysis includes 16 randomized control trials spanning the years 2000 to 2022, using the data from 2224 patients. The trials that were included used various tranquilizers such as diazepam, alprazolam, temazepam and lorazepam, and indicated high treatment efficacy and low adverse effects. With a p-value of 0.853 for Egger's test and 0.13 for Begg's test, the current meta-analysis shows a minimal probability of publication bias. A recent meta-analysis supports the use of tranquilizers in older people to treat sleeplessness, epilepsy or anxiety, but only at modest doses, because large doses are harmful and produce numerous withdrawal symptoms.

当前的荟萃分析检索了与用于治疗老年人的不同镇静剂相关的文献,并从剂量、结果类型和不良反应方面进行了评估,以确定一种安全可接受的镇静剂及其最佳剂量。采用PubMed、Ebsco、SCOPUS和Web of Science对老年患者使用镇定剂的随机对照试验、病例对照、回顾性和前瞻性研究进行系统文献综述。采用PICOS标准选择研究,并收集相关事件资料。这项荟萃分析包括2000年至2022年的16项随机对照试验,使用了2224名患者的数据。纳入的试验使用了地西泮、阿普唑仑、替马西泮、劳拉西泮等多种镇定剂,疗效高,不良反应低。Egger检验的p值为0.853,Begg检验的p值为0.13,当前的荟萃分析显示发表偏倚的可能性很小。最近的一项荟萃分析支持在老年人中使用镇定剂来治疗失眠、癫痫或焦虑,但只能使用适度剂量,因为大剂量是有害的,会产生许多戒断症状。
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引用次数: 0
In vitro effects of ascorbic acid on viability and metabolism of patients' osteosarcoma stem cells. 体外抗坏血酸对骨肉瘤干细胞活力和代谢的影响。
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2022-12-01 DOI: 10.2478/acph-2022-0040
Marijana Šimić Jovičić, Maja Pušić, Maja Antunović, Maja Ledinski, Lucija Librenjak, Robert Kolundžić, Tomislav Ribičić, Vladimir Trkulja, Inga Urlić

Stagnation in novelties of osteosarcoma (OS) treatment indicates the need for new therapeutic methods. OS cancer stem cells (OS-CSC) are taught to have the ability to self-renew and develop mechanisms of anticancer drug resistance, and this is why it is difficult to eradicate them. Their metabolism has been recognized as a potential target of therapeutic action. Ascorbic acid (AA) is considered to act pro-oxidative against OS-CSC in vitro by oxidative effect and by inhibition of glycolysis. This study examined an in vitro impact of AA on OS-CSC metabolism isolated from patients' biopsies, with the aim of better understanding of OS-CSC metabolism and the action of AA on OS-CSC. OS-CSC were isolated using a sphere culture system and identified as stem cells using Hoechst 33342 exclusion assay. Determination of the dominant type of metabolism of OS-CSC, parental OS cells, human mesenchymal stem cells (hMSC) and U2OS OS lineage before and after AA treatment was done by Seahorse XF (Agilent). Cytotoxicity of high-dose AA was confirmed by the MTT test and was proven for all the examined cell types as well as HEK293. Seahorse technology showed that OS-CSC can potentially use both glycolysis and oxidative phosphorylation (OXPHOS), and can turn to glycolysis and slow metabolic potential in unfavorable conditions such as incubation in AA.

骨肉瘤(OS)治疗新进展的停滞表明需要新的治疗方法。癌症干细胞(OS- csc)被认为具有自我更新的能力,并发展出抗癌耐药性机制,这就是为什么很难根除它们的原因。它们的代谢已被认为是治疗作用的潜在目标。抗坏血酸(AA)在体外通过氧化作用和抑制糖酵解作用,被认为对OS-CSC具有促氧化作用。本研究通过检测AA对患者活检分离的OS-CSC代谢的体外影响,旨在更好地了解OS-CSC代谢以及AA对OS-CSC的作用。采用球培养系统分离OS-CSC,采用Hoechst 33342排斥试验鉴定为干细胞。采用Seahorse XF (Agilent)检测AA处理前后OS- csc、亲代OS细胞、人间充质干细胞(hMSC)和U2OS OS系的优势代谢类型。MTT试验证实了高剂量AA的细胞毒性,并证实了对所有被检测细胞类型以及HEK293的细胞毒性。海马技术表明,OS-CSC可以同时使用糖酵解和氧化磷酸化(OXPHOS),并且可以在不利条件下(如在AA中孵育)转向糖酵解和缓慢代谢潜能。
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引用次数: 0
Therapeutic alliance impact on analgesic outcomes in a real-world clinical setting: An observational study. 在现实世界的临床环境中,治疗联合对镇痛结果的影响:一项观察性研究。
IF 2.8 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2022-12-01 DOI: 10.2478/acph-2022-0035
Jordi Barrachina, César Margarit, Blanca Andreu, Thomas Zandonai, Pura Ballester, Javier Muriel, Esperanza Cutillas, Ana M Peiró

A good therapeutic alliance is relevant for healthcare providers exposed to patients' suffering, especially since patients and physicians may understand the painful experience differently. Our aim was to explore the impact of therapeutic alliance on analgesic outcomes in a real-world interdisciplinary pain unit (PU). A cross-sectional observational study was conducted on outpatients (n = 69) using opioids on a long-term basis for the treatment of chronic non-cancer pain, where clinical pharmacologists and pharmacists advised patients about their opioid treatment. Responses to the patient-doctor relationship questionnaire (PDRQ), sociodemographic and clinical information (pain level, quality of life and hospital use) were collected, whereas pharmacology data (analgesic prescription, adverse events, and compliance) were obtained from electronic health records. Patients were predominantly middle-aged (75 % women, 72 % retired), experiencing moderate pain (VAS 40-70 mm) on average, and under a high morphine equianalgesic dosage (95 ± 88 mg per day, mainly tapentadol or fentanyl). Patients with better PDRQ outcomes, and therefore better therapeutic alliance, showed lower pain intensity than patients with worse PDRQ outcomes (pain intensity: high scores 60 ± 47 mm and medium scores 60 ± 45 mm vs. low scores 80 ± 75 mm, p < 0.01). Along with this, pain intensity was lower when patients affirmed that, thanks to the health-care providers, they "gained new insight", "felt better", or "felt content with their doctor's treatment". What´s more, patients who affirmed "I benefit from the treatment" experienced increased pain relief (benefit 40 ± 30 vs. non-benefit 19 ± 26 mm, p = 0.010) and improved quality of life (benefit 33 ± 25 vs. non-benefit 18 ± 16 mm, p = 0.031). However, there was a percentage of patients who did not fully understand the provided information, which is something to be taken into account to improve in clinical routine. Therapeutic alliance supported by pharmacist experts on pain management can be an effective strategy to improve analgesic outcomes. Further efforts are needed to improve communication strategies for pain management. Future directions of research should include the analysis of the role of the pharmacist in poly-professional consultations as related to the advice of patients about their medication, and the mutual trust with the patients.

一个良好的治疗联盟是相关的医疗保健提供者暴露于患者的痛苦,特别是因为患者和医生可能理解痛苦的经验不同。我们的目的是探讨治疗联盟对现实世界跨学科疼痛单位(PU)镇痛结果的影响。对长期使用阿片类药物治疗慢性非癌性疼痛的门诊患者(n = 69)进行了一项横断面观察性研究,临床药理学家和药剂师建议患者使用阿片类药物治疗。收集了对医患关系问卷(PDRQ)、社会人口学和临床信息(疼痛程度、生活质量和住院情况)的回应,而药理学数据(镇痛处方、不良事件和依从性)则从电子健康记录中获得。患者主要为中年人(75%为女性,72%为退休人员),平均疼痛中度(VAS 40-70 mm),吗啡等量镇痛剂量高(每天95±88 mg,主要为他苯他多或芬太尼)。PDRQ预后较好的患者疼痛强度低于PDRQ预后较差的患者(疼痛强度:高评分为60±47 mm,中评分为60±45 mm,低评分为80±75 mm, p < 0.01)。与此同时,当患者确认由于医疗保健提供者,他们“获得了新的见解”,“感觉更好”或“对医生的治疗感到满意”时,疼痛强度降低了。更重要的是,确认“我从治疗中获益”的患者经历了更多的疼痛缓解(获益40±30 vs非获益19±26 mm, p = 0.010)和生活质量的改善(获益33±25 vs非获益18±16 mm, p = 0.031)。然而,有一定比例的患者不能完全理解所提供的信息,这是在临床常规中需要考虑的问题。由疼痛管理方面的药剂师专家支持的治疗联盟是改善镇痛效果的有效策略。需要进一步努力改善疼痛管理的沟通策略。未来的研究方向应包括分析药师在多专业会诊中与患者用药建议相关的作用,以及与患者的相互信任。
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