Drug addiction, a disorder characterized by chronic relapse and compulsive drug use, poses a significant threat to public safety and human health. Addictive substances can be categorized as natural, semi-synthetic, or...Drug addiction, a disorder characterized by chronic relapse and compulsive drug use, poses a significant threat to public safety and human health. Addictive substances can be categorized as natural, semi-synthetic, or synthetic based on their origin. Additionally, they can be classified into three groups according to their pharmacological targets: opioids, hallucinogens, and cannabinoids that act on G-protein-coupled receptors (GPCRs);alcohols, nicotine, ketamine, barbiturates, and benzodiazepines (BDZs) that affect ligand-gated ion channel-type receptors;and psychostimulants that interact with monoamine transporters. Current treatments for drug addiction primarily include substitution therapy and non-pharmacological approaches. However, these methods have limitations, particularly in addressing the underlying causes of relapse. Several drugs in clinical trials have demonstrated potential therapeutic effects for addiction to opioids, heroin, cocaine, and other substances. This review examines the origins and pharmacological mechanisms of addiction to naturally-derived psychoactive substances (NPS) and provides an overview of recent advancements in pharmacotherapy for drug addiction.展开更多
OBJECTIVE:To enhance the understanding of identifying personalized pharmacotherapy options in Traditional Chinese Medicine(TCM),and further support the registration of new TCM drugs.METHODS:Generalized Boosted Models ...OBJECTIVE:To enhance the understanding of identifying personalized pharmacotherapy options in Traditional Chinese Medicine(TCM),and further support the registration of new TCM drugs.METHODS:Generalized Boosted Models and XGBoost were employed to construct a classification model to identify the bad prognosis factors in resistant hypertension(RH)patients.Furthermore,we used association analysis to explore the rules of"symptomsyndrome"and"symptom-herb"for the major influencing factors,in order to summarize prescription pattern and applicable patients of TCM.RESULTS:Patients with major adverse cardiac events mostly have complex symptoms of phlegm,stasis,deficiency and fire intermingled with each other,and finally summarized the human experience of using Chinese herbal medicine to precisely intervene in some symptoms of RH patients on the basis of conventional Western medical treatment.CONCLUSIONS:Machine learning algorithms can make full use of human use experience and evidence to save clinical trial resources and accelerate the development of TCM varieties.展开更多
This article reviews currently available pharmacological options available for the treatment of achalasia, with a special focus on the role of botulinum toxin(BT) injection due to its superior therapeutic effect and s...This article reviews currently available pharmacological options available for the treatment of achalasia, with a special focus on the role of botulinum toxin(BT) injection due to its superior therapeutic effect and side effect profile. The discussion on BT includes the role of different BT serotypes, better pharmacological formulations, improved BT injection techniques, the use of sprouting inhibitors, designer recombinant BT formulations and alternative substances used in endoscopic injections. The large body of ongoing research into achalasia and BT may provide a stronger role for BT injection as a form of minimally invasive, cost effective and efficacious form of therapy for patients with achalasia. The article also explores current issues and future research avenues that may prove beneficial in improving the efficacy of pharmacological treatment approaches in patients with achalasia.展开更多
Autism spectrum disorder(ASD)is a range of neurodevelopmental diseases characterized by social dysfunction and stereotypic behaviors.The etiology of ASD remains largely unexplored,resulting in a diverse array of descr...Autism spectrum disorder(ASD)is a range of neurodevelopmental diseases characterized by social dysfunction and stereotypic behaviors.The etiology of ASD remains largely unexplored,resulting in a diverse array of described clinical manifestations and varying degrees of severity.Currently,there are no drugs approved by a supervisory organization that can effectively treat the core symptoms of ASD.Childhood and adolescence are crucial stages for making significant achievements in ASD treatment,necessitating the development of drugs specifically for these periods.Based on the drug targets and mechanisms of action,it can be found that atypical psychotropic medications,anti-inflammatory and antioxidant medications,hormonal medications,ion channel medications,and gastrointestinal medications have shown significant improvement in treating the core symptoms of ASD in both children and adolescents.In addition,comparisons of drugs within the same category regarding efficacy and safety have been made to identify better alternatives and promote drug development.While further evaluation of the effectiveness and safety of these medications is needed,they hold great potential for widespread application in the clinical treatment of the principal symptoms of ASD.展开更多
Small bowel angiodysplasia(SBAD)is reported to account for nearly 50%of cases of small bowel bleeding.When SBAD occurs frequently,it is difficult to treat all the angiodysplasias endoscopically,and gastrointestinal bl...Small bowel angiodysplasia(SBAD)is reported to account for nearly 50%of cases of small bowel bleeding.When SBAD occurs frequently,it is difficult to treat all the angiodysplasias endoscopically,and gastrointestinal bleeding often recurs.Hormone therapy,somatostatin analogs,thalidomide and vascular endothelial growth factor(VEGF)-neutralizing antibodies have been reported to reduce gastrointestinal angiodysplasia(GIAD)bleeding.However,there is no strong evidence to recommend them.Also,there are no guidelines for their use.Hereditary hemorrhagic telangiectasia(HHT)is a hereditary disease caused by abnormalities in VEGF,resulting in multiple GIADs.A treatment guideline has been created for GIAD in HHT,and the use of tranexamic acid,an antifibrinolytic agent,is the first recommendation pharmacotherapy for GIAD with gastrointestinal bleeding that is difficult to treat endoscopically.It has been reported that fibrinolysis is accelerated in GIAD patients who are not HHT,similar to HHT patients.The use of tranexamic acid for gastric antral vascular ectasia in GIAD has been reported to be useful.However,there are very few reports of its use for SBAD.There are concerns with tranexamic acid use regarding the development of thrombosis/embolism,but there are few reports of such side effects.Future clinical trials including tranexamic acid for SBAD are desired.展开更多
Available pharmacotherapies for autism spectrum disorders(ASD)are reviewed based on clinical and research experience,highlighting some older drugs with emerging evidence.Several medications show efficacy in ASD,though...Available pharmacotherapies for autism spectrum disorders(ASD)are reviewed based on clinical and research experience,highlighting some older drugs with emerging evidence.Several medications show efficacy in ASD,though controlled studies in ASD are largely lacking.Only risperidone and aripiprazole have Federal Drug Administration approval in the United States.Methylphenidate(MPH)studies showed lower efficacy and tolerability for attention deficit hyperactivity disorder(ADHD)than in the typically developing(TD)population;atomoxetine demonstrated lower efficacy but comparable tolerability to TD outcomes.Guanfacine improved hyperactivity in ASD comparably to TD.Dextroamphetamine promises greater efficacy than MPH in ASD.ADHD medications reduce impulsive aggression in youth,and may also be key for this in adults.Controlled trials of the selective serotonin reuptake inhibitors citalopram and fluoxetine demonstrated poor tolerability and lack of efficacy for repetitive behaviors.Trials of antiseizure medications in ASD remain inconclusive,however clinical trials may be warranted in severely disabled individuals showing bizarre behaviors.No identified drugs treat ASD core symptoms;oxytocin lacked efficacy.Amitriptyline and loxapine however,show promise.Loxapine at 5-10 mg daily resembled an atypical antipsychotic in positron emission tomography studies,but may be weight-sparing.Amitriptyline at approximately 1 mg/kg/day used cautiously,shows efficacy for sleep,anxiety,impulsivity and ADHD,repetitive behaviors,and enuresis.Both drugs have promising neurotrophic properties.展开更多
Urethral stricture is characterized by the chronic formation of fibrous tissue,leading to the narrowing of the urethral lumen.Despite the availability of various endoscopic treatments,the recurrence of urethral strict...Urethral stricture is characterized by the chronic formation of fibrous tissue,leading to the narrowing of the urethral lumen.Despite the availability of various endoscopic treatments,the recurrence of urethral strictures remains a common challenge.Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates.Although drugs cannot replace surgery,they can be used as adjuvant therapies to improve outcomes.In this regard,many drugs have been proposed based on the mechanisms underlying the pathophysiology of urethral stricture.Ongoing studies have obtained substantial progress in treating urethral strictures,highlighting the potential for improved drug effectiveness through appropriate clinical delivery methods.Therefore,this review summarizes the latest researches on the mechanisms related to the pathophysiology of urethral stricture and the drugs to provide a theoretical basis and new insights for the effective use and future advancements in drug therapy for urethral stricture.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become an immense public health burden,first in China and subsequently worldwide.Developing effective control measures for COVID-19,especially measures tha...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become an immense public health burden,first in China and subsequently worldwide.Developing effective control measures for COVID-19,especially measures that can halt the worsening of severe cases to a critical status is of urgent importance.CASE SUMMARY A 52-year-old woman presented with a high fever(38.8°C),chills,dizziness,and weakness.Epidemiologically,she had not been to Wuhan where COVID-19 emerged and did not have a family history of a disease cluster.A blood test yielded a white blood cell count of 4.41×109/L(60.6±2.67%neutrophils and 30.4±1.34%lymphocytes).Chest imaging revealed bilateral ground-glass lung changes.Based on a positive nasopharyngeal swab nucleic acid test result and clinical characteristics,the patient was diagnosed with COVID-19.Following treatment with early non-invasive ventilation and a bundle pharmacotherapy,she recovered with a good outcome.CONCLUSION Early non-invasive ventilation with a bundle pharmacotherapy may be an effective treatment regimen for the broader population of patients with COVID-19.展开更多
BACKGROUND Neuromyelitis optica spectrum disorder(NMOSD)is a demyelinating autoimmune disease that affects the central nervous system.It typically manifests as optic neuritis or extensive longitudinal myelitis,with or...BACKGROUND Neuromyelitis optica spectrum disorder(NMOSD)is a demyelinating autoimmune disease that affects the central nervous system.It typically manifests as optic neuritis or extensive longitudinal myelitis,with or without the presence of anti-aquaporin protein 4 autoantibodies(immunoglobulin G).CASE SUMMARY We report the case of a 45-year-old woman with a history of Sjogren's syndrome who was diagnosed with NMOSD accompanied by spinal cord injury and left calf intermuscular vein thrombosis.The patient received hormone shock and gamma globulin therapy in the acute phase and standard rehabilitation treatment during convalescence.Upon discharge,the patient was able to control urination and defecation,stand independently,and walk short distances with the aid of a walker.CONCLUSION This case suggests that pharmacotherapy and standard rehabilitation treatment can improve the prognosis of NMSOD patients.展开更多
The global spread of severe acute respiratory syndrome coronavirus 2 has resulted in a significant number of individuals developing pulmonary fibrosis(PF),an irreversible lung injury.This condition can manifest within...The global spread of severe acute respiratory syndrome coronavirus 2 has resulted in a significant number of individuals developing pulmonary fibrosis(PF),an irreversible lung injury.This condition can manifest within a short inter-val following the onset of pneumonia symptoms,sometimes even within a few days.While lung transplantation is a potentially lifesaving procedure,its limited availability,high costs,intricate surgeries,and risk of immunological rejection present significant drawbacks.The optimal timing of medication administration for coronavirus disease 2019(COVID-19)-induced PF remains controversial.Despite this,it is crucial to explore pharmacotherapy interventions,involving early and preventative treatment as well as pharmacotherapy options for advanced-stage PF.Additionally,studies have demonstrated disparities in anti-fibrotic treatment based on race and gender factors.Genetic mutations may also impact therapeutic efficacy.Enhancing research efforts on pharmacotherapy interventions,while considering relevant pharmacological factors and optimizing the timing and dosage of medication administration,will lead to enhanced,personalized,and fair treatment for individuals impacted by COVID-19-related PF.These measures are crucial in lessening the burden of the disease on healthcare systems and improving patients'quality of life.展开更多
The aim of the current study is to analyze the cost of controlled ovarian hyperstimulation (COH) of in vitro fertilization (IVF) during the period 2009-2013 in a specialized gynecology clinic. It is a prospective, obs...The aim of the current study is to analyze the cost of controlled ovarian hyperstimulation (COH) of in vitro fertilization (IVF) during the period 2009-2013 in a specialized gynecology clinic. It is a prospective, observational study and bottom up cost analysis of the COH pharmacotherapy of IVF. The data was collected for all women admitted to the clinic, therapeutic COH protocols, prescribed medicines and doses, average length of therapy and its cost. Statistical analysis is applied towards the pharmacotherapy and cost data. On average 136 (SD 21.92) women were admitted varying from 105 to 179 for 10.7 (SD 1.47) days. 11% were on long (GnRH agonist containing) therapeutic COH protocol and all other on short (GnRH antagonist containing). Therapeutic protocols include Follitropin-α IU (103 women at average dose of 1171 IU (SD 314.16));Follitropin-β IU (299 women at average dose of 1634 IU (SD 423.5));Urofollitropin 75 IU amp (243 women at average dose of 21.3 IU (SD 7.37));urFSH + urLH 75IU:75IU/amp (354 women at average dose of 23.4 IU (SD 8.8));cetrorelix amp 0.25 mg prescribed at 264 women at average dose of 3.84 IU (SD 1.32);ganirelix amp 0.25 mg for 299 women at average dose of 4.01 mg (SD 1.32);Human chorion gonadotropin for 535 women at average dose of 6752.52 IU (SD 1216.23);Nafarelin mcg/ml for 8 women at dose of 17,700 mcg (SD 10,725);triptorelinacetat 0.1 mg amp - 63 women at doses of 5.5 (SD 3.25) mg at 14 women and average dose of 7.5 mg (SD 2.5);clomiphen citrate and letrozole for 15 women at average dose of 8 mg (SD 2.4). The average cost of COH pharmacotherapy is varying among the years with highest value of 1803.776 (SD - 624.89) BGN in 2009. Controlled ovarian hyperstimulation of in vitro fertilization is cost and resource consuming procedure in regards to pharmacotherapy. Age and reason of infertility influence significantly the cost.展开更多
Background: Obesity has become a serious global public health challenge, given that it leads to various adverse health outcomes that include cardiovascular illnesses, diabetes, and certain types of cancer. The World H...Background: Obesity has become a serious global public health challenge, given that it leads to various adverse health outcomes that include cardiovascular illnesses, diabetes, and certain types of cancer. The World Health Organization (WHO) has estimated that, at the end of 2022, 1 out of every 8 individuals were obese, and that the global adult obesity rates have over doubled since 1990, even as the adolescent obesity rates have quadrupled. Thus, as of 2022, nearly 2.5 billion adults, aged 18 years and above, were overweight, with 890 million being obese. Obesity and overweight incidence rate has been gradually increasing over the years, presenting significant challenges to the healthcare systems throughout the globe. In this regard, the objective of this systematic review was to evaluate the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. Methodology: To attain the above stated study objective, a systematic evaluation of previous studies was carried out, particularly studies that assessed the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. The authors have used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the selection of eligible studies for inclusion in the study. Results: The findings indicate that lifestyle interventions resulted in 5% - 10% weight reduction and significant improvements in metabolic indicators, while pharmacotherapy (GLP-1 receptor agonists) achieved up to 15% weight reduction and considerable metabolic health benefits. Further, comparative studies show lifestyle modifications provide overall health benefits, while medication is necessary for non-responders. Conclusion: Individualized treatment strategies are crucial, and further research is needed on long-term consequences and combination therapies.展开更多
Cirrhosis is a terminal manifestation of chronic liver disease,regardless of its cause,and was previously considered an irreversible condition.As cirrhosis progresses from the compensated to the decompensated stage,li...Cirrhosis is a terminal manifestation of chronic liver disease,regardless of its cause,and was previously considered an irreversible condition.As cirrhosis progresses from the compensated to the decompensated stage,liver disease-related events such as varices,ascites,encephalopathy,sarcopenia,jaundice,and bleeding tendency,as well as liver carcinogenesis,can occur at a high rate,and the regenerative capacity of the liver eventually fails.With the advent of new pharmacotherapies for cirrhosis in the last decade,liver fibrosis has been shown to improve with appropriate intervention,and the prognosis for cirrhotic patients has improved dramatically.According to published data from the Japan Society of Hepatology,although hepatitis C virus(HCV)used to be the leading cause of cirrhosis in Japan,alcoholic hepatitis has overtaken HCV as the leading cause,and thus a major paradigm shift has occurred in this field.There are mainly two approaches to pharmacotherapy for cirrhosis:(1)eliminating the underlying cause of cirrhosis and(2)treating the cirrhosis-related complications.This review article outlines the efficacy and clinical impact of drugs currently covered by insurance in Japan for the treatment of cirrhosis.展开更多
Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disease worldwide,placing an increasing burden on human health.NAFLD is a complex multifactorial disease involving genetic,metabolic,and environm...Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disease worldwide,placing an increasing burden on human health.NAFLD is a complex multifactorial disease involving genetic,metabolic,and environmental factors.It is closely associated with metabolic syndrome,obesity,and type 2 diabetes,of which insulin resistance is the main pathophysiological mechanism.Over the past few decades,investigation of the pathogenesis,diagnosis,and treatments has revealed different aspects of NAFLD,challenging the accuracy of definition and therapeutic strategy for the clinical practice.Recently,experts reach a consensus that NAFLD does not reflect the current knowledge,and metabolic(dysfunction)associated fatty liver disease(MAFLD)is suggested as a more appropriate term.The new definition puts increased emphasis on the important role of metabolic dysfunction in it.Herein,the shared features and potential changes in epidemiology,pathophysiology,diagnosis,and pharmacotherapy of the newly defined MAFLD,as compared with the formerly defined NAFLD,are reviewed for updating our understanding.展开更多
Non-alcoholic steatohepatitis(NASH)results from inflammation and hepatocyte injury in the setting of hepatic steatosis.Non-alcoholic steatohepatitis increases the risk of progression to liver fibrosis and cirrhosis,an...Non-alcoholic steatohepatitis(NASH)results from inflammation and hepatocyte injury in the setting of hepatic steatosis.Non-alcoholic steatohepatitis increases the risk of progression to liver fibrosis and cirrhosis,and is the most rapidly growing etiology for liver failure and indication for liver transplantation in the USA.Weight loss and lifestyle modification remain the standard first-line treatment,as no USA Food and Drug Administration-approved pharmacotherapy currently exists.The past decade has seen an explosion of interest in drug development targeting pathologic pathways in non-alcoholic steatohepatitis,with numerous phase 2 and 3 trials currently in progress.Here,we concisely review the major targets and mechanisms of action by class,summarize results from com-pleted pivotal phase 2 studies,and provide a detailed outline of key active studies with trial data for drugs in development,including obeticholic acid,elafibranor,cenicriviroc and selonsertib.展开更多
The incidence rate and mortality of liver fibrosis caused by various etiologies are high throughout the world. Liver fibrosis, the subsequent cirrhosis and other serious related complications threaten the health of pa...The incidence rate and mortality of liver fibrosis caused by various etiologies are high throughout the world. Liver fibrosis, the subsequent cirrhosis and other serious related complications threaten the health of patients and represent a serious medical burden;yet, there is still a lack of approved methods to prevent or reverse liver fibrosis. Therefore, effective hepatic antifibrotic drugs are urgently needed. The activation and proliferation of hepatic stellate cells are still the mechanisms of fibrosis that remain the focus of therapeutic research. In recent years, significant progress has been made in the development and applicability of antifibrosis drugs. In this review, we summarize the effectiveness and safety of available antifibrosis drugs utilizing different targets. In addition, some characteristics of antifibrosis drugs in phase II and III trials are introduced in detail.展开更多
Acute respiratory distress syndrome （ARDS） is one of the leading death reasons in Intensive Care Unit （ICU）. It is frustrating that there is no pharmacotherapy effective enough to reduce the mortality of ARDS. The...Acute respiratory distress syndrome （ARDS） is one of the leading death reasons in Intensive Care Unit （ICU）. It is frustrating that there is no pharmacotherapy effective enough to reduce the mortality of ARDS. The most important treatment of ARDS nowadays is supportive treatment, including mechanical ventilation （MV）, fluid management, and sedation. Successful trials of ARDS treatments usually aim to avoid further lung injury of ARDS patients, such as low tidal volume of MV and conservative fluid strategy. These strategies can only maintain the mortality around 40%.展开更多
We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019(COVID-19)requiring mechanical ventilation(MV).The patients were diagnosed based on epid...We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019(COVID-19)requiring mechanical ventilation(MV).The patients were diagnosed based on epidemiological history,clinical manifestations,and nucleic acid testing.Upon diagnosis with COVID-19 of critical severity,the patients were admitted to the intensive care unit,where they received early noninvasive-invasive sequential ventilation,early prone positioning,and bundle pharmacotherapy regimen,which consists of antiviral,anti-inflammation,immune-enhancing,and complication-prophylaxis medicines.The patients presented fever(n=7,100%),dry cough(n=3,42.9%),weakness(n=2,28.6%),chest tightness(n=1,14.3%),and/or muscle pain(n=1,14.3%).All patients had normal or lower than normal white blood cell count/lymphocyte count,and chest computed tomography scans showed bilateral patchy shadows or ground glass opacity in the lungs.Nucleic acid testing confirmed COVID-19 in all seven patients.The median MV duration and intensive care unit stay were 9.9 days(interquartile range,6.5-14.6 days;range,5-17 days)and 12.9 days(interquartile range,9.7-17.6 days;range,7-19 days),respectively.All seven patients were extubated,weaned off MV,transferred to the common ward,and discharged as of the writing of this report.Thus,we concluded that good outcomes for patients with critical COVID-19 can be achieved with early noninvasive-invasive sequential ventilation and bundle pharmacotherapy.展开更多
Both alcohol-associated liver disease(ALD)and metabolic dysfunction-associated steatotic liver disease are leading contributors to chronic liver diseases.These conditions often coexist,exacerbating disease progression...Both alcohol-associated liver disease(ALD)and metabolic dysfunction-associated steatotic liver disease are leading contributors to chronic liver diseases.These conditions often coexist,exacerbating disease progression.Despite ALD being a leading cause of liver transplantation,many individuals with alcohol use disorder(AUD)do not receive treatment.In this review,we discussed the epidemiology of ALD in AUD,various treatment options for AUD,and their efficacy on liver health.Our critical analysis of current evidence underscores the need for integrated models involving multiple stakeholders to improve ALD management.展开更多
Pharmacotherapies for tobacco cessation are efficacious and recommended during quit attempts.Racial/ethnic minorities in the United States are less likely to use medication-based aids for tobacco cessation,despite gre...Pharmacotherapies for tobacco cessation are efficacious and recommended during quit attempts.Racial/ethnic minorities in the United States are less likely to use medication-based aids for tobacco cessation,despite greater difficulty achieving long-term abstinence.The reasons for this include,among others,provider-and patient-level considerations.Primary care clinicians play an important role in encouraging racial/ethnic minority tobacco users to use cessation pharmacotherapy.To better understand pharmacotherapy use,we conducted a narrative review of patient-lev-el factors that may determine uptake and adherence.This review indicates that social and cultural factors impact pharmacotherapy use,including health care experiences,beliefs,perceptions,and norms.The proportion of individuals using pharmacotherapy during quit attempts and adhering to the full course of treatment may be enhanced with greater attention to the ethnocultural concerns of these groups.Culturally appropriate assessment and brief advice delivered by primary care providers could yield significant benefits in population health.Recommendations for treating racial/ethnic tobacco users with pharmacotherapy for cessation are offered.展开更多
基金supported by the National Natural Science Foundation of China(No.82373836).
文摘Drug addiction, a disorder characterized by chronic relapse and compulsive drug use, poses a significant threat to public safety and human health. Addictive substances can be categorized as natural, semi-synthetic, or synthetic based on their origin. Additionally, they can be classified into three groups according to their pharmacological targets: opioids, hallucinogens, and cannabinoids that act on G-protein-coupled receptors (GPCRs);alcohols, nicotine, ketamine, barbiturates, and benzodiazepines (BDZs) that affect ligand-gated ion channel-type receptors;and psychostimulants that interact with monoamine transporters. Current treatments for drug addiction primarily include substitution therapy and non-pharmacological approaches. However, these methods have limitations, particularly in addressing the underlying causes of relapse. Several drugs in clinical trials have demonstrated potential therapeutic effects for addiction to opioids, heroin, cocaine, and other substances. This review examines the origins and pharmacological mechanisms of addiction to naturally-derived psychoactive substances (NPS) and provides an overview of recent advancements in pharmacotherapy for drug addiction.
基金the China Academy of Chinese Medical Sciences,Independent Topic Project:Application Research on Named Entity Recognition and Relationship Extraction of Case Records of Renowned Traditional Chinese Medicine Practitioners(No.Z0643).China Academy of Chinese Medical Sciences,Independent Topic Project:Analysis of Research Directions and Scope in the Discipline of Traditional Chinese Medicine Statistics(No.Z0723)China Academy of Chinese Medical Sciences,Science and Technology Innovation Project:Real-world Effectiveness Evaluation of Traditional Chinese Medicine and Translational Application Research on Causal Inference(No.CI2021A04706).China Academy of Chinese Medical Sciences,Science and Technology Innovation Project:Research on Causal Inference Methodology for Real-world Clinical Evaluation in Traditional Chinese Medicine(No.CI2021B003)National Key Research and Development Program of China:Integrated Evaluation Model and Key Technologies of"Syndrome-Disease-Prescription"for Traditional Chinese Medicine in the Prevention and Treatment of Coronary Heart Disease—Statistical Data Analysis and Data Mining(No.2017YFC1700406-2)。
文摘OBJECTIVE:To enhance the understanding of identifying personalized pharmacotherapy options in Traditional Chinese Medicine(TCM),and further support the registration of new TCM drugs.METHODS:Generalized Boosted Models and XGBoost were employed to construct a classification model to identify the bad prognosis factors in resistant hypertension(RH)patients.Furthermore,we used association analysis to explore the rules of"symptomsyndrome"and"symptom-herb"for the major influencing factors,in order to summarize prescription pattern and applicable patients of TCM.RESULTS:Patients with major adverse cardiac events mostly have complex symptoms of phlegm,stasis,deficiency and fire intermingled with each other,and finally summarized the human experience of using Chinese herbal medicine to precisely intervene in some symptoms of RH patients on the basis of conventional Western medical treatment.CONCLUSIONS:Machine learning algorithms can make full use of human use experience and evidence to save clinical trial resources and accelerate the development of TCM varieties.
文摘This article reviews currently available pharmacological options available for the treatment of achalasia, with a special focus on the role of botulinum toxin(BT) injection due to its superior therapeutic effect and side effect profile. The discussion on BT includes the role of different BT serotypes, better pharmacological formulations, improved BT injection techniques, the use of sprouting inhibitors, designer recombinant BT formulations and alternative substances used in endoscopic injections. The large body of ongoing research into achalasia and BT may provide a stronger role for BT injection as a form of minimally invasive, cost effective and efficacious form of therapy for patients with achalasia. The article also explores current issues and future research avenues that may prove beneficial in improving the efficacy of pharmacological treatment approaches in patients with achalasia.
基金supported by the Key-Area Research and Development Program of Guangdong Province(No.2019B030335001)the National Natural Science Foundation of China(No.32200815)+1 种基金the National Social Science Foundation of China(No.20&ZD296)the China Postdoctoral Science Foundation(No.2022M721218)。
文摘Autism spectrum disorder(ASD)is a range of neurodevelopmental diseases characterized by social dysfunction and stereotypic behaviors.The etiology of ASD remains largely unexplored,resulting in a diverse array of described clinical manifestations and varying degrees of severity.Currently,there are no drugs approved by a supervisory organization that can effectively treat the core symptoms of ASD.Childhood and adolescence are crucial stages for making significant achievements in ASD treatment,necessitating the development of drugs specifically for these periods.Based on the drug targets and mechanisms of action,it can be found that atypical psychotropic medications,anti-inflammatory and antioxidant medications,hormonal medications,ion channel medications,and gastrointestinal medications have shown significant improvement in treating the core symptoms of ASD in both children and adolescents.In addition,comparisons of drugs within the same category regarding efficacy and safety have been made to identify better alternatives and promote drug development.While further evaluation of the effectiveness and safety of these medications is needed,they hold great potential for widespread application in the clinical treatment of the principal symptoms of ASD.
文摘Small bowel angiodysplasia(SBAD)is reported to account for nearly 50%of cases of small bowel bleeding.When SBAD occurs frequently,it is difficult to treat all the angiodysplasias endoscopically,and gastrointestinal bleeding often recurs.Hormone therapy,somatostatin analogs,thalidomide and vascular endothelial growth factor(VEGF)-neutralizing antibodies have been reported to reduce gastrointestinal angiodysplasia(GIAD)bleeding.However,there is no strong evidence to recommend them.Also,there are no guidelines for their use.Hereditary hemorrhagic telangiectasia(HHT)is a hereditary disease caused by abnormalities in VEGF,resulting in multiple GIADs.A treatment guideline has been created for GIAD in HHT,and the use of tranexamic acid,an antifibrinolytic agent,is the first recommendation pharmacotherapy for GIAD with gastrointestinal bleeding that is difficult to treat endoscopically.It has been reported that fibrinolysis is accelerated in GIAD patients who are not HHT,similar to HHT patients.The use of tranexamic acid for gastric antral vascular ectasia in GIAD has been reported to be useful.However,there are very few reports of its use for SBAD.There are concerns with tranexamic acid use regarding the development of thrombosis/embolism,but there are few reports of such side effects.Future clinical trials including tranexamic acid for SBAD are desired.
文摘Available pharmacotherapies for autism spectrum disorders(ASD)are reviewed based on clinical and research experience,highlighting some older drugs with emerging evidence.Several medications show efficacy in ASD,though controlled studies in ASD are largely lacking.Only risperidone and aripiprazole have Federal Drug Administration approval in the United States.Methylphenidate(MPH)studies showed lower efficacy and tolerability for attention deficit hyperactivity disorder(ADHD)than in the typically developing(TD)population;atomoxetine demonstrated lower efficacy but comparable tolerability to TD outcomes.Guanfacine improved hyperactivity in ASD comparably to TD.Dextroamphetamine promises greater efficacy than MPH in ASD.ADHD medications reduce impulsive aggression in youth,and may also be key for this in adults.Controlled trials of the selective serotonin reuptake inhibitors citalopram and fluoxetine demonstrated poor tolerability and lack of efficacy for repetitive behaviors.Trials of antiseizure medications in ASD remain inconclusive,however clinical trials may be warranted in severely disabled individuals showing bizarre behaviors.No identified drugs treat ASD core symptoms;oxytocin lacked efficacy.Amitriptyline and loxapine however,show promise.Loxapine at 5-10 mg daily resembled an atypical antipsychotic in positron emission tomography studies,but may be weight-sparing.Amitriptyline at approximately 1 mg/kg/day used cautiously,shows efficacy for sleep,anxiety,impulsivity and ADHD,repetitive behaviors,and enuresis.Both drugs have promising neurotrophic properties.
基金This work was supported by the Natural Science Foundation of Jiangxi Province,China(No.20202BABL206031 and No.20224BAB216024).
文摘Urethral stricture is characterized by the chronic formation of fibrous tissue,leading to the narrowing of the urethral lumen.Despite the availability of various endoscopic treatments,the recurrence of urethral strictures remains a common challenge.Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates.Although drugs cannot replace surgery,they can be used as adjuvant therapies to improve outcomes.In this regard,many drugs have been proposed based on the mechanisms underlying the pathophysiology of urethral stricture.Ongoing studies have obtained substantial progress in treating urethral strictures,highlighting the potential for improved drug effectiveness through appropriate clinical delivery methods.Therefore,this review summarizes the latest researches on the mechanisms related to the pathophysiology of urethral stricture and the drugs to provide a theoretical basis and new insights for the effective use and future advancements in drug therapy for urethral stricture.
基金We acknowledge the writing guidance provided by Prof.Kun-Mei Ji and the training camp for medical research held by Shenzhen Medical Association and Huada.We are grateful to the physicians and nurses at the Third People’s Hospital of Shenzhen who participated in clinical examinations and sample collection.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become an immense public health burden,first in China and subsequently worldwide.Developing effective control measures for COVID-19,especially measures that can halt the worsening of severe cases to a critical status is of urgent importance.CASE SUMMARY A 52-year-old woman presented with a high fever(38.8°C),chills,dizziness,and weakness.Epidemiologically,she had not been to Wuhan where COVID-19 emerged and did not have a family history of a disease cluster.A blood test yielded a white blood cell count of 4.41×109/L(60.6±2.67%neutrophils and 30.4±1.34%lymphocytes).Chest imaging revealed bilateral ground-glass lung changes.Based on a positive nasopharyngeal swab nucleic acid test result and clinical characteristics,the patient was diagnosed with COVID-19.Following treatment with early non-invasive ventilation and a bundle pharmacotherapy,she recovered with a good outcome.CONCLUSION Early non-invasive ventilation with a bundle pharmacotherapy may be an effective treatment regimen for the broader population of patients with COVID-19.
文摘BACKGROUND Neuromyelitis optica spectrum disorder(NMOSD)is a demyelinating autoimmune disease that affects the central nervous system.It typically manifests as optic neuritis or extensive longitudinal myelitis,with or without the presence of anti-aquaporin protein 4 autoantibodies(immunoglobulin G).CASE SUMMARY We report the case of a 45-year-old woman with a history of Sjogren's syndrome who was diagnosed with NMOSD accompanied by spinal cord injury and left calf intermuscular vein thrombosis.The patient received hormone shock and gamma globulin therapy in the acute phase and standard rehabilitation treatment during convalescence.Upon discharge,the patient was able to control urination and defecation,stand independently,and walk short distances with the aid of a walker.CONCLUSION This case suggests that pharmacotherapy and standard rehabilitation treatment can improve the prognosis of NMSOD patients.
基金Supported by the Project of Special Funds for Science and Technology Cooperation in Guizhou Provinces and Zunyi City,No.Shengshikehe(2015)53.
文摘The global spread of severe acute respiratory syndrome coronavirus 2 has resulted in a significant number of individuals developing pulmonary fibrosis(PF),an irreversible lung injury.This condition can manifest within a short inter-val following the onset of pneumonia symptoms,sometimes even within a few days.While lung transplantation is a potentially lifesaving procedure,its limited availability,high costs,intricate surgeries,and risk of immunological rejection present significant drawbacks.The optimal timing of medication administration for coronavirus disease 2019(COVID-19)-induced PF remains controversial.Despite this,it is crucial to explore pharmacotherapy interventions,involving early and preventative treatment as well as pharmacotherapy options for advanced-stage PF.Additionally,studies have demonstrated disparities in anti-fibrotic treatment based on race and gender factors.Genetic mutations may also impact therapeutic efficacy.Enhancing research efforts on pharmacotherapy interventions,while considering relevant pharmacological factors and optimizing the timing and dosage of medication administration,will lead to enhanced,personalized,and fair treatment for individuals impacted by COVID-19-related PF.These measures are crucial in lessening the burden of the disease on healthcare systems and improving patients'quality of life.
文摘The aim of the current study is to analyze the cost of controlled ovarian hyperstimulation (COH) of in vitro fertilization (IVF) during the period 2009-2013 in a specialized gynecology clinic. It is a prospective, observational study and bottom up cost analysis of the COH pharmacotherapy of IVF. The data was collected for all women admitted to the clinic, therapeutic COH protocols, prescribed medicines and doses, average length of therapy and its cost. Statistical analysis is applied towards the pharmacotherapy and cost data. On average 136 (SD 21.92) women were admitted varying from 105 to 179 for 10.7 (SD 1.47) days. 11% were on long (GnRH agonist containing) therapeutic COH protocol and all other on short (GnRH antagonist containing). Therapeutic protocols include Follitropin-α IU (103 women at average dose of 1171 IU (SD 314.16));Follitropin-β IU (299 women at average dose of 1634 IU (SD 423.5));Urofollitropin 75 IU amp (243 women at average dose of 21.3 IU (SD 7.37));urFSH + urLH 75IU:75IU/amp (354 women at average dose of 23.4 IU (SD 8.8));cetrorelix amp 0.25 mg prescribed at 264 women at average dose of 3.84 IU (SD 1.32);ganirelix amp 0.25 mg for 299 women at average dose of 4.01 mg (SD 1.32);Human chorion gonadotropin for 535 women at average dose of 6752.52 IU (SD 1216.23);Nafarelin mcg/ml for 8 women at dose of 17,700 mcg (SD 10,725);triptorelinacetat 0.1 mg amp - 63 women at doses of 5.5 (SD 3.25) mg at 14 women and average dose of 7.5 mg (SD 2.5);clomiphen citrate and letrozole for 15 women at average dose of 8 mg (SD 2.4). The average cost of COH pharmacotherapy is varying among the years with highest value of 1803.776 (SD - 624.89) BGN in 2009. Controlled ovarian hyperstimulation of in vitro fertilization is cost and resource consuming procedure in regards to pharmacotherapy. Age and reason of infertility influence significantly the cost.
文摘Background: Obesity has become a serious global public health challenge, given that it leads to various adverse health outcomes that include cardiovascular illnesses, diabetes, and certain types of cancer. The World Health Organization (WHO) has estimated that, at the end of 2022, 1 out of every 8 individuals were obese, and that the global adult obesity rates have over doubled since 1990, even as the adolescent obesity rates have quadrupled. Thus, as of 2022, nearly 2.5 billion adults, aged 18 years and above, were overweight, with 890 million being obese. Obesity and overweight incidence rate has been gradually increasing over the years, presenting significant challenges to the healthcare systems throughout the globe. In this regard, the objective of this systematic review was to evaluate the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. Methodology: To attain the above stated study objective, a systematic evaluation of previous studies was carried out, particularly studies that assessed the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. The authors have used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the selection of eligible studies for inclusion in the study. Results: The findings indicate that lifestyle interventions resulted in 5% - 10% weight reduction and significant improvements in metabolic indicators, while pharmacotherapy (GLP-1 receptor agonists) achieved up to 15% weight reduction and considerable metabolic health benefits. Further, comparative studies show lifestyle modifications provide overall health benefits, while medication is necessary for non-responders. Conclusion: Individualized treatment strategies are crucial, and further research is needed on long-term consequences and combination therapies.
文摘Cirrhosis is a terminal manifestation of chronic liver disease,regardless of its cause,and was previously considered an irreversible condition.As cirrhosis progresses from the compensated to the decompensated stage,liver disease-related events such as varices,ascites,encephalopathy,sarcopenia,jaundice,and bleeding tendency,as well as liver carcinogenesis,can occur at a high rate,and the regenerative capacity of the liver eventually fails.With the advent of new pharmacotherapies for cirrhosis in the last decade,liver fibrosis has been shown to improve with appropriate intervention,and the prognosis for cirrhotic patients has improved dramatically.According to published data from the Japan Society of Hepatology,although hepatitis C virus(HCV)used to be the leading cause of cirrhosis in Japan,alcoholic hepatitis has overtaken HCV as the leading cause,and thus a major paradigm shift has occurred in this field.There are mainly two approaches to pharmacotherapy for cirrhosis:(1)eliminating the underlying cause of cirrhosis and(2)treating the cirrhosis-related complications.This review article outlines the efficacy and clinical impact of drugs currently covered by insurance in Japan for the treatment of cirrhosis.
基金supported by grants from the National Natural Science Foundation of China(Nos.81670782 and 81970741)the Local Innovative and Research Teams Projects of Guangdong Pearl River Talents Program(No.2017BT01S131)+1 种基金the Guangdong High-Level Talents Special Support Program(No.2016TQ03R590)Pearl River S&T Nova Program of Guangzhou(No.201610010175)。
文摘Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disease worldwide,placing an increasing burden on human health.NAFLD is a complex multifactorial disease involving genetic,metabolic,and environmental factors.It is closely associated with metabolic syndrome,obesity,and type 2 diabetes,of which insulin resistance is the main pathophysiological mechanism.Over the past few decades,investigation of the pathogenesis,diagnosis,and treatments has revealed different aspects of NAFLD,challenging the accuracy of definition and therapeutic strategy for the clinical practice.Recently,experts reach a consensus that NAFLD does not reflect the current knowledge,and metabolic(dysfunction)associated fatty liver disease(MAFLD)is suggested as a more appropriate term.The new definition puts increased emphasis on the important role of metabolic dysfunction in it.Herein,the shared features and potential changes in epidemiology,pathophysiology,diagnosis,and pharmacotherapy of the newly defined MAFLD,as compared with the formerly defined NAFLD,are reviewed for updating our understanding.
文摘Non-alcoholic steatohepatitis(NASH)results from inflammation and hepatocyte injury in the setting of hepatic steatosis.Non-alcoholic steatohepatitis increases the risk of progression to liver fibrosis and cirrhosis,and is the most rapidly growing etiology for liver failure and indication for liver transplantation in the USA.Weight loss and lifestyle modification remain the standard first-line treatment,as no USA Food and Drug Administration-approved pharmacotherapy currently exists.The past decade has seen an explosion of interest in drug development targeting pathologic pathways in non-alcoholic steatohepatitis,with numerous phase 2 and 3 trials currently in progress.Here,we concisely review the major targets and mechanisms of action by class,summarize results from com-pleted pivotal phase 2 studies,and provide a detailed outline of key active studies with trial data for drugs in development,including obeticholic acid,elafibranor,cenicriviroc and selonsertib.
基金Tianjin Science and Technol-ogy Project (15ZXLCSY00040)
文摘The incidence rate and mortality of liver fibrosis caused by various etiologies are high throughout the world. Liver fibrosis, the subsequent cirrhosis and other serious related complications threaten the health of patients and represent a serious medical burden;yet, there is still a lack of approved methods to prevent or reverse liver fibrosis. Therefore, effective hepatic antifibrotic drugs are urgently needed. The activation and proliferation of hepatic stellate cells are still the mechanisms of fibrosis that remain the focus of therapeutic research. In recent years, significant progress has been made in the development and applicability of antifibrosis drugs. In this review, we summarize the effectiveness and safety of available antifibrosis drugs utilizing different targets. In addition, some characteristics of antifibrosis drugs in phase II and III trials are introduced in detail.
文摘Acute respiratory distress syndrome （ARDS） is one of the leading death reasons in Intensive Care Unit （ICU）. It is frustrating that there is no pharmacotherapy effective enough to reduce the mortality of ARDS. The most important treatment of ARDS nowadays is supportive treatment, including mechanical ventilation （MV）, fluid management, and sedation. Successful trials of ARDS treatments usually aim to avoid further lung injury of ARDS patients, such as low tidal volume of MV and conservative fluid strategy. These strategies can only maintain the mortality around 40%.
文摘We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019(COVID-19)requiring mechanical ventilation(MV).The patients were diagnosed based on epidemiological history,clinical manifestations,and nucleic acid testing.Upon diagnosis with COVID-19 of critical severity,the patients were admitted to the intensive care unit,where they received early noninvasive-invasive sequential ventilation,early prone positioning,and bundle pharmacotherapy regimen,which consists of antiviral,anti-inflammation,immune-enhancing,and complication-prophylaxis medicines.The patients presented fever(n=7,100%),dry cough(n=3,42.9%),weakness(n=2,28.6%),chest tightness(n=1,14.3%),and/or muscle pain(n=1,14.3%).All patients had normal or lower than normal white blood cell count/lymphocyte count,and chest computed tomography scans showed bilateral patchy shadows or ground glass opacity in the lungs.Nucleic acid testing confirmed COVID-19 in all seven patients.The median MV duration and intensive care unit stay were 9.9 days(interquartile range,6.5-14.6 days;range,5-17 days)and 12.9 days(interquartile range,9.7-17.6 days;range,7-19 days),respectively.All seven patients were extubated,weaned off MV,transferred to the common ward,and discharged as of the writing of this report.Thus,we concluded that good outcomes for patients with critical COVID-19 can be achieved with early noninvasive-invasive sequential ventilation and bundle pharmacotherapy.
文摘Both alcohol-associated liver disease(ALD)and metabolic dysfunction-associated steatotic liver disease are leading contributors to chronic liver diseases.These conditions often coexist,exacerbating disease progression.Despite ALD being a leading cause of liver transplantation,many individuals with alcohol use disorder(AUD)do not receive treatment.In this review,we discussed the epidemiology of ALD in AUD,various treatment options for AUD,and their efficacy on liver health.Our critical analysis of current evidence underscores the need for integrated models involving multiple stakeholders to improve ALD management.
文摘Pharmacotherapies for tobacco cessation are efficacious and recommended during quit attempts.Racial/ethnic minorities in the United States are less likely to use medication-based aids for tobacco cessation,despite greater difficulty achieving long-term abstinence.The reasons for this include,among others,provider-and patient-level considerations.Primary care clinicians play an important role in encouraging racial/ethnic minority tobacco users to use cessation pharmacotherapy.To better understand pharmacotherapy use,we conducted a narrative review of patient-lev-el factors that may determine uptake and adherence.This review indicates that social and cultural factors impact pharmacotherapy use,including health care experiences,beliefs,perceptions,and norms.The proportion of individuals using pharmacotherapy during quit attempts and adhering to the full course of treatment may be enhanced with greater attention to the ethnocultural concerns of these groups.Culturally appropriate assessment and brief advice delivered by primary care providers could yield significant benefits in population health.Recommendations for treating racial/ethnic tobacco users with pharmacotherapy for cessation are offered.
