A study on pharmaceutical text relationship extraction based on heterogeneous graph neural networks

Effective information extraction of pharmaceutical texts is of great significance for clinical research. The ancient Chinese medicine text has streamlined sentences and complex semantic relationships, and the textual relationships may exist between heterogeneous entities. The current mainstream relationship extraction model does not take into account the associations between entities and relationships when extracting, resulting in insufficient semantic information to form an effective structured representation. In this paper, we propose a heterogeneous graph neural network relationship extraction model adapted to traditional Chinese medicine (TCM) text. First, the given sentence and predefined relationships are embedded by bidirectional encoder representation from transformers (BERT fine-tuned) word embedding as model input. Second, a heterogeneous graph network is constructed to associate words, phrases, and relationship nodes to obtain the hidden layer representation. Then, in the decoding stage, two-stage subject-object entity identification method is adopted, and the identifier adopts a binary classifier to locate the start and end positions of the TCM entities, identifying all the subject-object entities in the sentence, and finally forming the TCM entity relationship group. Through the experiments on the TCM relationship extraction dataset, the results show that the precision value of the heterogeneous graph neural network embedded with BERT is 86.99% and the F1 value reaches 87.40%, which is improved by 8.83% and 10.21% compared with the relationship extraction models CNN, Bert-CNN, and Graph LSTM.

[Analysis and suggestions on harvest period standards of plant medicinal materials in 2020 edition of Chinese Pharmacopoeia]

The improvement of the harvest period standards is critical in the quality control of Chinese medicinal materials. The present study statistically analyzed the harvest period standards of plant medicinal materials in the 2020 edition of Chinese Pharmacopoeia(Vol.Ⅰ) and put forward the existing problems and suggestions based on herbal records and modern research to provide references for the improvement of the standards. According to the statistical analysis, in 499 types of plant medicinal materials, harvest period standards are recorded under 486 types, accounting for 97.4%, and are lacking in the remaining. Only one medicinal material(Stellariae Radix) is recorded with the standard of the harvest year. The standards of the harvest season and phenological period are recorded under 233 types, accounting for 46.7%. For 237 types, only harvest season is specified, accounting for 47.5%, and for 15 types, only harvest phenological period is specified, accounting for 3.0%. Among 222 types mainly derived from cultivation and 51 types from wild resources and cultivation, only 11 types are recorded with harvest period of cultivated products. Only Stellariae Radix is recorded with the harvest period standards for the wild and cultivated products separately. The harvest period standards of plant medicinal materials with different medicinal parts have certain rules to follow. The main problems about the harvest period standards are discovered. Specifically, no harvest period standards are recorded under 13 types of plant medicinal materials. Almost all perennial cultivated medicinal materials are not recorded with harvest year standard. No phenological period standard is found under 250 types of plant medicinal materials. There is no clear distinction between the harvest period standards of cultivated and wild products. The evidence for harvest period standards of 26 types of plant medicinal materials that can be harvested all year round is insufficient. As a result, it is proposed to strengthen basic research in response to the above-mentioned problems and improve the harvest period standards as soon as possible to ensure the quality of Chinese medicinal materials.

Ensuring public trust in digital therapeutics: a pharmacopeial perspective

DISCLOSURES: No funding supported the writing of this commentary. The author is employed by US Pharmacopeia. This article was requested by JMCP as a response to the companion Viewpoints article "Decision Makers Need an Approach to Determine Digital Therapeutic Product Quality, Access, and Appropriate Use" by Parcher and Coder (see page 536). Digital Therapeutics Alliance, which is mentioned in this article, is a member of the USP Convention.

Recent updates from the BNF (BNF 81)

The BNF is jointly published by the Royal Pharmaceutical Society and BMJ. BNF is published in print twice a year and interim updates are issued and published monthly in the digital versions. The following summary provides a brief description of some of the key changes that have been made to BNF content since the last print edition (BNF 80) was published.

An investigation of the pharmacological applications used for the Ancient Egyptian systemic model 'ra-ib' compared with modern Traditional Chinese Medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Ancient Egyptian texts only offer glimpses into their conceptual understandings of the inner-body and illness manifestation. Explanations of how prescribed materia medica were believed to work are rare and obscure, often resulting in modern approximations for ancient terminology such as 'ra-ib'-an ancient Egyptian classification predominantly translated as 'stomach'-leading to misunderstandings of historical texts, and therefore their use of pharmacology.

AIM OF THE STUDY

To investigate the ra-ib and the explanatory models of illness from the Egyptian perspective, and to explore the link between these and the prescribed selection of materia medica. To then compare the conceptual mechanics of these treatment strategies with those of another non-Western tradition-namely Traditional Chinese Medicine (TCM)-to provide further insight into potential conceptual frameworks.

MATERIALS AND METHODS

We conducted a case study of a unit of Ancient Egyptian texts focusing on the ra-ib. Totalling 34 prescriptions, the first stage lexicographically analysed the texts using cognitive linguistic and translation theories to produce our new understanding. This enabled our comparison of the mechanics of materia medica usage within these texts with those found in TCM outlined by the Pharmacopoeia of the Peoples Republic of Pharmacopeia of the People's Republic of China 2015 for the relevant ingredients.

RESULTS

the study demonstrated that-rather than denoting the organ 'stomach'-ra-ib instead constitutes a system running from the mouth, downward to the anus. This is best translated as 'inner thoroughfare', and changes the way in which we attempt to understand potential motivations in the selection of ingredients. By exploring common themes in the use of eleven securely translated ingredients from the Egyptian corpus and the Pharmacopoeia of the People's Republic of China-representing a modern traditional system which understands the body via a series of interconnected systems-we were able to highlight certain themes which might be 'universal' to system-based traditions; this provided new insights into the Egyptian motivations for treatment selection.

CONCLUSIONS

Having gained the ancient view of the body and illness, cultural comparisons are important for providing further potential insights and clarifications of a discontinued historical healing tradition. The new understanding of the ra-ib from our study greatly changes the way in which we understand the dynamics of Egyptian ethnopharmacological source material from this period.

Recent updates from the BNF (BNF 80)

The BNF is jointly published by the Royal Pharmaceutical Society and BMJ. BNF is published in print twice a year and interim updates are issued and published monthly in the digital versions. The following summary provides a brief description of some recent key changes that have been made to BNF content.

Development and evaluation of an educational game to support pharmacy students

INTRODUCTION

United Kingdom pharmacy students need to efficiently navigate the British National Formulary (BNF), a standard medicines reference source. "Pharmacy Challenge" is a web-based prototype game based on the BNF. This research aimed to evaluate the game in terms of design, content, and impact on students' performance and confidence.

METHODS

Evaluation was comprised of three phases: implementation, perception, and impact. Game design and evaluation methods were modelled using adapted elements of the Relevance Embedding Translation Adaption Immersion and Naturalisation framework. Qualitative and quantitative questionnaires were utilised to assess students' perceptions of the game and its role in their education and to evaluate changes in confidence and performance after playing the game. Quizzes were developed to determine changes in performance.

RESULTS

The questionnaire evaluation (n = 152) found students' confidence increased significantly (p < .05) in speed of using, knowledge of BNF sections, extracting information, and knowing where to look for the answer. Most students (88%) felt they had learnt something new and 86% felt that it reinforced their learning. A significant (p < .05) increase in pre- and post- BNF quiz marks was observed.

CONCLUSIONS

Statistically significant improvement in students' perceived confidence was noted. The study identified design elements such as the need for a simple interface to encourage engagement. The prototype has undergone a design transformation based on the feedback provided and is now released under the name "DOSE" with a bank of 300 questions, improved graphics, a leadership board, and medals.

Introduction of Air-Segmentation Approach to Flow Titration by Feedback-based and Subsequent Fixed Triangular Wave-controlled Flow Ratiometry

An air-segmentation approach has been introduced to a feedback-based and subsequent fixed triangular wave-controlled flow ratiometry to suppress axial dispersion in flow titration. The flow rate of a base solution containing an indicator is linearly varied with a control signal, Vc, supplied by a computer. The solution is merged with an acid solution under a constant total flow rate. Air is introduced to the merged solution in order to segment the solution with air bubbles. Both phases are led to a UV/Vis detector without phase separation. Air signals are removed by signal processing. The effect of the lag time between the merging of solutions upstream and the sensing of the corresponding signal downstream is offset by feedback-based upward and downward Vc scans, and thus the Vc that gives the equivalence composition is determined. Subsequently, fixed triangular wave control is applied to a narrower Vc range with a higher scan rate to enhance the throughput rate (maximally 11.8 titrations/min). Air-segmentation has been found to be effective to reduce axial dispersion and to preserve the titrand/titrant composition upon their just being merged. Consequently, the applicable range is extended especially to lower titrand concentration. The proposed method has been successfully applied to various acid-base titrations, including the nonaqueous titration of the Japanese Pharmacopoeia drug.

Identification of herbal categories active in pain disorder subtypes by machine learning help reveal novel molecular mechanisms of algesia

Chronic pain is highly prevalent and poorly controlled, of which the accurate underlying mechanisms need be further elucidated. Herbal drugs have been widely used for controlling various pain disorders. The systematic integration of pain herbal data resources might be promising to help investigate the molecular mechanisms of pain phenotypes. Here, we integrated large-scale bibliographic literatures and well-established data sources to obtain high-quality pain relevant herbal data (i.e. 426 pain related herbs with their targets). We used machine learning method to identify three distinct herb categories with their specific indications of symptoms, targets and enriched pathways, which were characterized by the efficacy of treatment to the chronic cough related neuropathic pain, the reproduction and autoimmune related pain, and the cancer pain, respectively. We further detected the novel pathophysiological mechanisms of the pain subtypes by network medicine approach to evaluate the interactions between herb targets and the pain disease modules. This work increased the understanding of the underlying molecular mechanisms of pain subtypes that herbal drugs are participating and with the ultimate aim of developing novel personalized drugs for pain disorders.

Recent updates from the BNF

The BNF is jointly published by the Royal Pharmaceutical Society and BMJ. BNF is published in print twice a year and interim updates are issued and published monthly in the digital versions. The following summary provides a brief description of some recent key changes that have been made to BNF content.

Performing a United States Pharmacopeia Chapter <800> Compliant Assessment of Risk

United States Pharmacopeia Chapter <800>, which became effective on December 1, 2019, addresses handling of hazardous drugs in facilities that make compounded preparations. The Chapter includes minimum facility, engineering controls, personal protective equipment, and other requirements under which all hazardous drugs must be handled. For certain hazardous drugs, an assessment of risk may be performed to determine alternative containment strategies or work practices. This article addresses the legal enforceability of Unites States Pharmacopeia Chapter <800>, how to determine whether a drug is eligible for an assessment of risk, and details important considerations when performing assessments of risk.

Association between US Pharmacopeia (USP) monograph standards, generic entry and prescription drug costs

Despite the importance of pharmacopeial standards, little is known regarding their effect on drug competition. Such information is of particular relevance given the rising costs of prescription drugs and the focus of policy-makers and other stakeholders on addressing these costs. We examined 982 prescription drugs approved by U.S Food and Drug Administration since 1982 to examine the association between U.S. Pharmacopeia (USP) standards, generic entry and prescription costs. The presence of a USP drug product monograph was not associated with the time to the third generic entrant or with the likelihood of having a generic competitor. However, on average, drugs with USP drug product monographs had approximately fifty percent more generic manufacturers in the U.S. than their counterparts after accounting for factors such as market volume, age, route of administration and vintage. This greater competition was associated with an approximate savings of $6.22 billion in 2016, suggesting that USP drug product monographs may play an important role in promoting pharmaceutical competition and reducing prescription drug costs.

United States Pharmacopeia Safety Review of Willow Bark

Willow bark (Salix spp.) is an ingredient in some dietary supplements. No serious adverse effects were reported from trials of willow bark extracts delivering 120 - 240 mg salicin (the purported active constituent) daily for up to 8 weeks. All studies involved adults only; none involved special subpopulations such as pregnant or breastfeeding women, or children. The most common adverse effects associated with willow bark are gastrointestinal; a few allergic reactions were also reported. Some publications advise caution when taking willow bark. There is a risk of increased bleeding in vulnerable individuals, salicylates cross the placenta and are eliminated slowly in newborns, some persons are sensitive or allergic to aspirin, and children are at risk of Reye syndrome. Concurrent use with other salicylate-containing medicines increases these risks. Metabolism of 240 mg salicin from willow bark could yield 113 mg of salicylic acid, yet dietary supplement products are not required to be labeled with warnings. In contrast, over-the-counter low-dose aspirin (81 mg strength), which delivers 62 mg salicylic acid, is required by law to include cautions, warnings, and contraindications related to its use in pregnant and nursing women, children, and other vulnerable subpopulations, e.g., those using anticoagulants. In the interest of protecting public health, the United States Pharmacopeia has included a cautionary labeling statement in the United States Pharmacopeia Salix Species monograph as follows: "Dosage forms prepared with this article should bear the following statement: 'Not for use in children, women who are pregnant or nursing, or by persons with known sensitivity to aspirin.'".

Hmong herbal medicine and herbalists in Lao PDR: pharmacopeia and knowledge transmission

BACKGROUND

In Lao PDR, the Hmong ethnic group has extensive knowledge about the use of medicinal plants. However, despite the importance of the Hmong pharmacopeia as a primary health care resource, no study has been undertaken to thoroughly document medicinal plant knowledge and its transmission. Objectives of this study are (i) to describe and characterize Hmong pharmacopeia, and (ii) to understand how medicinal plant knowledge is transmitted and spread among Hmong in Lao PDR, in order to assess whether this knowledge base is under threat.

METHODS

In order to describe Hmong pharmacopeia, a total of 14 interlocutors were interviewed in three provinces (Bokeo, Xieng Khouang, and Vientiane), using "walk in the wood" methodology. To gain insight about knowledge transmission, semi-structured interviews were conducted with 28 people. Twenty of them were herbalists. Data analysis was performed using univariate analysis for the description of the pharmacopeia. Medicinal plant knowledge consistency was assessed through use and plant name overlapping. Answers to the semi-structured interview on knowledge transmission were analyzed qualitatively.

RESULTS

Three hundred thirty-three different medicinal species were collected. The majority of uses attributed to plants were gastrointestinal conditions (22% of total use reports), gynecological conditions and sexually transmitted disease (12%), skin affections (8%), kidney and bladder problems (5%), physical traumas (5%), and aphrodisiac (or male tonics; 5%). Use convergences are more marked in the gynecological sphere, but there is a strong heterogeneity in practices and knowledge. Medicinal plant knowledge transmission is oral, gained from direct experience since childhood, matrilineal, and kept strictly within the family lineage. Apparent limited consensus on uses might stem from the method of knowledge transmission and to the economic value given to medicinal plants.

DISCUSSION

Use pattern of species from the Hmong pharmacopeia does not appear to be strikingly different from the national Lao pharmacopeia. Differences may lie in the methods and reasons for knowledge transmission. It can be proposed that the economic value given to plants helps in keeping the knowledge alive, and encourages its transmission.

CONCLUSION

Hmong traditional medicine is constantly evolving in a dynamic process and aims to respond to health problems faced by the local population. Herbalists appear as health fully fledged actors and should be recognized and valued as such.

Medicinal plants of the Caatinga, northeastern Brazil: Ethnopharmacopeia (1980-1990) of the late professor Francisco José de Abreu Matos

ETHNOPHARMACOLOGICAL IMPORTANCE

The Caatinga (semi-arid region), is an exclusively Brazilian biome. Considering the scarcity of ethnobotanical and ethnopharmacological studies in this region before the year 2000, this study presents data from ethnobotanical expeditions carried out between 1980 and 1990, by the late professor Francisco José de Abreu Matos (1924-2008). The information revealed in this present work are valuable and remained unpublished until now.

MATERIALS AND METHODS

The objective was to organize, systematize and analyze ethnobotanical and ethnopharmacological data using ethnobotanical analytical techniques. The most cited native species in each use category were selected for literature review of the pharmacological studies related to their ethnomedicinal uses.

RESULTS

Revision of the botanical nomenclature led to the botanical confirmation of 272 plants, of which 84 (30.9%) were reclassified. These represented 71 families and 220 genera that were cited 1957 times. 153 (56.3%) of these plant species are native to Brazil, of which 36 (23.4%) are endemic to the Caatinga. The use reports (RU) associated with these plants, according to the body systems (ICPC-2) in decreasing order of UR and the ICF values were respiratory system (93 species, 407 UR, ICF 0.77), digestive system (119 species, 373 UR, ICF 0.68), general and nonspecific symptoms (95 species, 219 UR, ICF 0.58), female genital system (60 species, 184 UR, ICF 0.68), skin (71 species, 156 UR, ICF 0.55), cardiovascular (50 species, 99 UR, ICF 0.50), blood and immune system diseases (46 species, 96 UR, ICF 0.53), urological (44 species, 88 UR, ICF 0.51), musculoskeletal (33 species, 80 UR, ICF 0.60), psychological (21 species, 71 UR, ICF 0.60), while others represent less than 10.0% of the UR. The most cited plants in the disease categories were Dysphania ambrosioides (28), Pombalia calceolaria (28) Hymenaea courbaril (26), Myracrodruon urundeuva (50), Brassica juncea subsp. integrifolia (16), Scoparia dulcis (22), Phyllanthus niruri (14), Egletes viscosa (25), Lippia alba (16), Erythroxylum vacciniifolium (9) and Salvia rosmarinus (21). The most prominent clades of the medicinal plants based on cluster analysis were the Lamiids (Euasterids)-497 UR and the Fabids (Eurosids I) - 468 UR. Association between certain phylogenetic clades and use-category were also observed and discussed.

CONCLUSION

This study demonstrated a new approach in ethnopharmacology by mapping plant usages to diseases prevalent in a community from old ethnobotanical travel reports. In addition to revealing the therapeutic potential of Caatinga species using cluster analysis.

Medicines in the forest: Ethnobotany of wild medicinal plants in the pharmacopeia of the Wichí people of Salta province (Argentina)

ETHNOPHARMACOLOGICAL RELEVANCE

This article presents the results of a study on wild plant pharmacopeia and medical ethnobotany of the Wichí people of the South American Gran Chaco region, where native forest still persist. Few previous works on the former subjects exist, with only partial information. Traditionally, shamans are in charge of healing serious diseases and wild plants are used for treating minor problems. Some ethnobotanists believe that much of the present pharmacopeia of native peoples of the Gran Chaco comes from the Criollos (local non-native people) and that medicinal plants and uses would have been much fewer in the past.

AIMS OF THE STUDY

The study aims to: a) document the wild medicinal plants used by the Wichís and the associated ethnobotanical knowledge, b) discuss the use of medicinal plants in the current sanitary, epidemiological and ethnomedical context of the Wichís, and c) analyse the similarities between the medicinal plants and uses of the Wichís and those reported for the Criollos of the study area, for the We'enhayek (Wichís of Bolivia) and for other indigenous peoples of the Gran Chaco. All of them will help to answer a general research question: are medicinal wild plants of the Wichís present pharmacopoeia long-dated or are they relatively new adquisitions?

MATERIALS AND METHODS

Original data were obtained between 2005 and 2017 from 51 informants through open and semi-structured interviews, participant observation, "walks-through-the-forest" technique and gathering of plant vouchers. Consensus of Use (CU) per species, use, ailment and use-category were calculated. Species and uses of the Wichís and those reported for other groups of the region were compared confronting the data, a similarity index (Sorensen) was calculated and a cluster analysis was carried out. An interpretative analysis of the results was performed.

RESULTS

Original data consist of 408 applications for which 115 plants of 48 botanical families are used for treating 68 ailments or symptoms. Species are mainly used for treating prevalent health disorders in Wichí epidemiological context (skin and digestive disorders, fever, respiratory affections) and feminine issues.

CONCLUSIONS

The similarity of the current Wichí pharmacopoeia with the other ethnic groups of the region seem to respond more to a geographical proximity than to cultural affinity. Much (but not all) of their pharmacopoeia seem to be novel, resulting from a permanent seek for solutions to both old and new health problems in the native forests. Many medicinal plants, but not specific uses, seem to come from the neighbouring Criollos, whilst traditional remedies seem to be simultaneously preserved. Hence, I propose that the ethnobotanical "diversification hypothesis", slightly modified, applies in the case of wild medicinal plants of the Wichís, as new wild medicines are being added to the old ones to fill therapeutic vacancies that for several sociocultural and historical reasons appear in their traditional pharmacopoeia. Altogether, results provide novel information of interest for ethnopharmacology, medical ethnobotany and related disciplines, expand the knowledge of Wichí pharmacopoeia and constitute a baseline for future diachronic and cross-cultural studies in the Gran Chaco region.

Evidence for the effectiveness of anti-hypertensive medicines included on the Chinese National Reimbursement Drug List

BACKGROUND

Evidence-based decision on drug list or formulary has been applied worldwide. Although the importance of scientific evidence was emphasized, the decision-making procedures for including medicines into the national reimbursement drug list were often challenged by their process opacity and relying on subjective expert opinion. This study aimed to explore and assess the evidence for the effectiveness of anti-hypertensive medicines included on the Chinese National Reimbursement Drug List (NRDL), and to provide recommendations for further improvement.

METHODS

Three international evidence-based guidelines were selected to serve as reference criteria. The antihypertensive medicines included in NRDL of Urban Employee Basic Medical Insurance (UEBMI) were compared with recommended drugs in three international guidelines. Medicines recommended by at least two guidelines were considered to have sound evidence support for the effectiveness. Otherwise, published literature with high evidence grade, namely systematic review, meta-analysis and randomized controlled trial (RCT), were searched for further assessment. Medicines reported as fairly good effectiveness by literature with high evidence grade can be also considered having sound evidence for the effectiveness. Methodological quality of systematic review or meta-analysis was evaluated by AMSTAR scale and PRISMA statement. Literature quality of RCTs was assessed by Jadad scale.

RESULTS

For the 97 antihypertensive medicines in NRDL, there were sound evidence supports for the effectiveness of 56 kinds of medicines. Specifically, twenty-six of them were supported by international evidence-based guidelines, twenty were supported by systematic review or meta-analysis and the other ten by RCT. However, for the rest 41 medicines, there is insufficient evidence for their effectiveness.

CONCLUSIONS

Some antihypertensive medicines in NRDL did not have sufficient evidence for their effectiveness. Further evaluation and revision were required. It is also recommended to standardize decision-making procedures for inclusion of medicines, set up high quality evidence database to timely provide sound evidence, and so on.

Theory and practice of pharmacopoeial control of quality of drugs and excipients X. Number of parallel determinations, processing of results and their use in the assessment of the content of active substances and excipients in the European Pharmacopoeia (Ph. Eur.)

In the European Pharmacopoeia (Ph. Eur.) there is no prescribed number of parallel determinations of the content of active substances and excipients. The authors suggest adding at least three determinations. The results of parallel determinations suggest to test for outliers before using test based on the ratio of the range of results (p = 0.95) and not to compare individual results with the tolerance limits given in Ph. Eur., but with their arithmetic mean. Furthermore, they propose to extend the Chapter 5.3. of the European Pharmacopoeia so as to be applicable not only to bioassays, but also to chemical, physicochemical and physical assays and tests, starting with the content of active substances and excipients.

Assessment of Extractable Elements from Elastomers

Compendia methods have historically been used to assess heavy metals in both drug products and packaging material extracts. However, these methods have been found to be inadequate for elemental specificity and accurate measurements. The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) has published the Q3D, Guideline for Elemental Impurities, to provide a risk-based approach that specifies elements to be considered in a drug product risk assessment and permitted daily exposures (PDEs) depending on toxicological concern and route of administration. Consistent with these efforts, the United States Pharmacopeia (USP) withdrew the <231> Heavy Metals test procedure as of January 2018. The USP published new methods consistent with ICH Q3D risk-based approaches, <232> Elemental Impurities - Limits and <233> Elemental Impurities - Procedures. These new tests are intended for evaluation of drug products, leaving a gap in the assessment of extractable elements for packaging components. This gap prompted the need for a better understanding of the potential for elements of concern to extract from packaging materials and contribute to drug product elemental impurities. The present study investigated multiple extraction conditions coupled with modern analytical techniques to understand the capacity for elements to extract from elastomeric components. Most elements of interest, based on ICH or their potential for occurrence in elastomers, were ultimately recovered at levels below designated thresholds, allowing for correlation to PDE. These results highlight that although extractable elements from elastomeric components have the potential to contribute elemental impurities to a drug product, the actual contribution to cumulative levels would need to be calculated among all other potential sources as part of the process of elemental impurities assessment.LAY ABSTRACT: Compendia methods have historically been used to assess heavy metals in final drug products and extracts from packaging materials. However, these methods were found to provide inadequate data to address the evolving risk concerns of elemental impurities in drug products and their potential toxic effects. The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use member countries are working toward implementing a risk-based approach that specifies elements to be considered in a drug product safety assessment and permitted daily exposures. The United States Pharmacopeia is coordinating with this goal by withdrawing the traditional procedure and replacing it with the tests that can inform safety risk assessments. However, the new tests are intended for evaluation of only final drug products, leaving a gap in the assessment of extractable elements for packaging components. The present study addressed this gap by focusing on elastomeric components used in injectable packaging systems and exploring appropriate elastomeric extraction methods coupled with modern analytical techniques to better understand the full potential for elements to extract from elastomers and contribute to the elemental impurity profile of a drug product.

Henischs translation of pharmaceutical works

Bardejov-born Georg Henisch (1549-1618) translated four pharmaceutical texts from Latin into German, three works by the French author A. Mizauld and one by Sextus Placitus, an author of the late Classical Period. The Latin texts had been published several times before Henisch translated them, but his translation enables us to identify the original which he used. Henischs German versions were also issued several times in the identical form during his lifetime. All of them were published in quick succession in the years 1574-1575. Apart from these translations, Henisch also produced other works in that period, despite being just 25 years old in 1574 and still a student of medicine in Basle. All four works have a similar theme: unusual curative substances which could be easily procured from plants, metals and animals. They were intended for the general public, belonging in the genre of Kräuterbücher, herbal books, but they do not represent the typical form of this genre, for example not containing any illustrations. In his translations Henisch does not adhere strictly to the original texts, leaving out some smaller parts, translating freely and adapting his version to suit his German readers.

Developing User Personas to Aid in the Design of a User-Centered Natural Product-Drug Interaction Information Resource for Researchers

Pharmacokinetic interactions between natural products and conventional drugs can adversely impact patient outcomes. These complex interactions present unique challenges that require clear communication to researchers. We are creating a public information portal to facilitate researchers' access to credible evidence about these interactions. As part of a user-centered design process, three types of intended researchers were surveyed: drug-drug interaction scientists, clinical pharmacists, and drug compendium editors. Of the 23 invited researchers, 17 completed the survey. The researchers suggested a number of specific requirements for a natural product-drug interaction information resource, including specific information about a given interaction, the potential to cause adverse effects, and the clinical importance. Results were used to develop user personas that provided the development team with a concise and memorable way to represent information needs of the three main researcher types and a common basis for communicating the design's rationale.

Compatibility and stability of dezocine and tropisetron in 0.9% sodium chloride injection for patient-controlled analgesia administration

Tropisetron is an adjuvant for dezocine used in intravenous patient-controlled analgesia (PCA) and has been reported to provide superior pain control. It is efficacious in reducing the institutional incidence of postoperative nausea and vomiting (PONV), which decreases resource utilization and cost. However, no scientific evidence has been reported in the literature demonstrating analytical confirmation of the compatibility and stability of the combination of dezocine and tropisetron. Thus, the present study aimed to investigate the stability of dezocine with tropisetron in 0.9% sodium chloride injection form for PCA administration.Commercial solutions of dezocine and tropisetron were combined and examined for compatibility and stability when diluted with 0.9% sodium chloride injection in polyolefin bags and glass bottles stored at 4°C or 25°C for up to 14 days. The initial concentrations were 40 mg/100 mL dezocine and 5 mg/100 mL tropisetron. For all samples, the compatibility parameters (including precipitation, cloudiness, discoloration, and pH values) were evaluated. Chemical stability was also determined using high-performance liquid chromatographic (HPLC) analysis.After a 14-day period of storage at 4°C or 25°C, the initial concentrations of dezocine and tropisetron were maintained at at least 98%. All of the mixtures remained clear and colorless throughout the observation period, and no color change or precipitation was observed.These results indicated that admixtures of 40 mg/100 mL dezocine and 5 mg/100 mL tropisetron in 0.9% sodium chloride injection were stable for at least 14 days when stored in polyolefin bags or glass bottles at 4°C or 25°C and protected from light.

Analysis of Particulate Matter in Liquid-Finished Dosage Forms

Pharmacopeias recognize particulate matter as a common phenomenon. The current regulatory requirements relating to particulate matter in parenterals state that solutions for injections or infusions are clear and "practically" (or "essentially") free from ("readily detectable") particles when examined under defined conditions of illumination. Pharmaceutical companies are required to know their processes and have them under control. In order to control and reduce the potential influx of particulate matter, Novartis Technical Operations in Unterach developed a particle life-cycle program that involved an establishment of a dedicated particle laboratory operating under clean room conditions. The analytical capabilities of this particle laboratory were crucial for the characterization of particles and supported identification of potential sources of particulate matter. After implementing this program and respective actions, product and process understanding significantly improved. This resulted in a decrease of reject rates, AQL (Acceptable Quality Limit) failures, and corresponding batch rejections, thereby increasing the availability of Novartis products from Unterach for the patients. The main objective of this article is to show the detailed particle characterization approach including Quality by Design (QbD), methods, and equipment. Examples from projects and particulate matter investigations are presented.LAY ABSTRACT: Parenteral formulations should not contain particulate matter. However, as external contamination as well as formation of particles during manufacturing cannot be entirely excluded, pharmaceutical companies use visual inspection and AQLs to monitor occurrence of particles. To ensure patient safety, Novartis Technical Operation in Unterach established a particle-free analytical laboratory with a focus on particle characterization and root cause analysis of particle formation. The ultimate goal is to reduce occurrence of particles in formulations altogether, and increase process understanding. The approach toward particle characterization adopted at Novartis Technical Operations in Unterach is presented in the article.

Essential cancer medicines in the national lists of countries of the WHO South-East Asia Region: a descriptive assessment

BACKGROUND

In 2015, the need for equitable access to cancer treatments in low- and middle income countries was underscored by the addition of 16 essential cancer medicines to the 19th World Health Organization (WHO) model list of essential medicines (WHO EML). This study assessed the degree to which this expanded WHO EML from 2015 has influenced inclusion of cancer medicines in the most recent national essential medicines lists of the countries of the WHO South-East Asia Region.

METHODS

The inclusion of a selected list of 38 essential cancer medicines in the 2015 WHO EML was assessed in the most recent national lists of essential medicines from the 11 countries of the WHO South-East Asia Region. Additionally, the availability of six essential cancer medicines common to the national lists of essential medicines from six countries of the WHO South-East Asia Region was explored.

RESULTS

Of the 38 selected essential cancer medicines included in the 19th WHO EML, a mean of 18.0 (range 2-33) were included in the national lists of countries of the WHO South-East Asia Region. Of the 25 essential cancer medicines included in the WHO EML prior to the 19th revision, a mean of 14.6 (range 2-21) were included in national lists; notably fewer of the 13 cancer medicines added in the 2015 revision were included: mean 3.4 (range 0-12).

CONCLUSION

Compared with the WHO EML, there is a lag in the inclusion of essential cancer medicines in national lists of essential medicines in the WHO South-East Asia Region. Alignment of essential cancer medicines in national lists of essential medicines among the 11 countries in the region varies significantly. These differences may hinder regional strategies to improve access to essential cancer medicines, such as pooled procurement of selected high-cost medicines. The link between the availability and affordability of essential cancer medicines warrants further investigation, in the context of access to medicines for universal health coverage.

Quality Assurance and Quality Control: Being Prepared for U.S. Food and Drug Administration Inspections and Staying in Compliance with United States Pharmacopeia Chapter <797>: Part 1

Compounders engaged in making sterile preparations need to employ a quality assurance system of documented policies and procedures to attempt to reduce the possibility of contamination. The quality-assurance program will be monitored through the facility's quality control system. Compounders should be aware of the requirements of each state they are licensed in as well as the inspection observations commonly noted in 483s issued by the U.S. Food and Drug Administration. In part 1 of this 2-part article, we discuss the currently evolving regulatory environment and why sterile compounding requires planning and monitoring to deliver quality compounds to patients. Part 2 will examine the United States Pharmacopeia's discussion on the principles of quality assurance and quality control in sterile compounding.

Endotoxins from a Pharmacopoeial Point of View

A pyrogen is a substance that causes fever after intravenous administration or inhalation. Gram negative endotoxins are the most important pyrogens to pharmaceutical laboratories. In the International, United States, Japanese and European Pharmacopoeias, there are two official methods to evaluate pyrogenicitythat is, the bacterial endotoxin test, and the pyrogen test. The main objective of this review is to compare the monographs of each test among the different Pharmacopeias, to detect similarities and differences. The former can be considered fully harmonized, and only non-significant differences were detected. The latter, which is the only available assay for some products and formulations to demonstrate apyrogenicity, shows large differences, which should be considered.

An evaluation of prescribing trends and patterns of claims within the Preferred Drugs Initiative in Ireland (20112016): an interrupted time-series study

OBJECTIVE

To examine the impact of the Preferred Drugs Initiative (PDI), an Irish health policy aimed at enhancing evidence-based cost-effective prescribing, on prescribing trends and the cost of prescription medicines across seven medication classes.

DESIGN

Retrospective repeated cross-sectional study spanning the years 2011-2016.

SETTING

Health Service Executive Primary Care Reimbursement Service pharmacy claims data for General Medical Services (GMS) patients, approximately 40% of the Irish population.

PARTICIPANTS

Adults aged ≥18 years between 2011 and 2016 are eligible for the GMS scheme.

PRIMARY AND SECONDARY OUTCOMES

The percentage of PDI medications within each drug class per calendar quarter. Linear regression was used to model prescribing of the preferred drug within each medication group and to assess the impact of PDI guidelines and other relevant changes in prescribing practice. Savings in drug expenditure were estimated.

RESULTS

Between 2011 and 2016, around a quarter (23.59%) of all medications were for single-agent drugs licensed in the seven drug classes. There was a small increase in the percentage of PDI drugs, increasing from 4.64% of all medications in 2011 to 4.76% in 2016 (P<0.001). The percentage of preferred drugs within each drug class was significantly higher immediately following publication of the guidelines for all classes except urology, with the largest increases noted for lansoprazole (1.21%, 95% CI: 0.84% to 1.57%, P<0.001) and venlafaxine (0.71%, 95% CI: 0.15% to 1.27%, P=0.02). Trends in prescribing of the preferred drugs between PDI guidelines and the end of 2016 varied between drug classes. Total cost savings between 2013 and 2016 were estimated to be €2.7 million.

CONCLUSION

There has been a small increase in prescribing of PDI drugs in response to prescribing guidelines, with inconsistent changes observed across therapeutic classes. These findings are relevant where health services are seeking to develop more active prescribing interventions aimed at changing prescribing practice.

Calcium Chloride and Calcium Gluconate in Neonatal Parenteral Nutrition Solutions without Cysteine: Compatibility Studies Using Laser Light Obscuration Methodology

There are no compatibility studies for neonatal parenteral nutrition solutions without cysteine containing calcium chloride or calcium gluconate using light obscuration as recommended by the United States Pharmacopeia (USP). The purpose of this study was to do compatibility testing for solutions containing calcium chloride and calcium gluconate without cysteine. Solutions of TrophAmine and Premasol (2.5% amino acids), containing calcium chloride or calcium gluconate were compounded without cysteine. Solutions were analyzed for particle counts using light obscuration. Maximum concentrations tested were 15 mmol/L of calcium and 12.5 mmol/L of phosphate. If the average particle count of three replicates exceeded USP guidelines, the solution was determined to be incompatible. This study found that 12.5 and 10 mmol/L of calcium and phosphate, respectively, are compatible in neonatal parenteral nutrition solutions compounded with 2.5% amino acids of either TrophAmine or Premasol. There did not appear to be significant differences in compatibility for solutions containing TrophAmine or Premasol when solutions were compounded with either CaCl₂ or CaGlu-Pl. This study presents data in order to evaluate options for adding calcium and phosphate to neonatal parenteral nutrition solutions during shortages of calcium and cysteine.

Enchiridion medicinae by Georg Henisch (1549-1618)

Georg Henisch (1549-1618), a native of Bardejov, for all of his life as a teacher at St. Anne's Grammar School in Augsburg, Germany. He was a very prolific polyhistor, publishing spiritual and occasional poetry, works on medicine, mathematics, rhetoric, dialectics, astronomy, linguistics and geography, editions of some ancient authors, and several translations. In 1573 he issued the pharmaceutical guide Enchiridion medicinae, which presents medications and remedies for individual health problems without any further comment on their effects and usage. However, this guide had a precursor, published in Paris in 1571, but with no mention of the author, and it is not certain that Henisch produced it. The text is de facto identical, there are only minimal variations, but the second edition has a longer title, it is extended with an introduction and the final part containing some prescriptions. In 1571, when the first edition was issued, Henisch was just 22-years old, and in 1573 he was still only 24, so in his case life experience cannot be taken into account. Comparison of the work with contemporary medical literature has shown that Enchiridion medicinae is not an original work, but a compilation of three works by other authors: De materia medicinali et compositione medicorum by G. Rondelet from 1556, a commentary to Galen´s Quos, quibus quando purgare oporteat by the French author Sebastien Coquilitus Scipio from 1553, and the book Lilium medicinae by Bernard de Gordon from 1550. Key words: Georg Henisch • pharmacy in the 16th century • pharmaceutical handbook Enchiridion medicinae.

Did the accuracy of oral amoxicillin dosing of children improve after British National Formulary dose revisions in 2014? National cross-sectional survey in England

OBJECTIVES

Inaccurate antibiotic dosing can lead to treatment failure, fuel antimicrobial resistance and increase side effects. The British National Formulary for Children (BNFC) guidance recommends oral antibiotic dosing according to age bands as a proxy for weight. Recommended doses of amoxicillin for children were increased in 2014 'after widespread concerns of under dosing'. However, the impact of dose changes on British children of different weights is unknown, particularly given the rising prevalence of childhood obesity in the UK. We aimed to estimate the accuracy of oral amoxicillin dosing in British children before and after the revised BNFC guidance in 2014.

SETTING AND PARTICIPANTS

We used data on age and weights for 1556 British children (aged 2-18 years) from a nationally representative cross-sectional survey, the Health Survey for England 2013.

INTERVENTIONS

We calculated the doses each child would receive using the BNFC age band guidance, before and after the 2014 changes, against the 'gold standard' weight-based dose of amoxicillin, as per its summary of product characteristics.

PRIMARY OUTCOME MEASURE

Assuming children of different weights were equally likely to receive antibiotics, we calculated the percentage of the children who would be at risk of misdosing by the BNFC age bands.

RESULTS

Before 2014, 54.6% of children receiving oral amoxicillin would have been underdosed and no child would have received more than the recommended dose. After the BNFC guidance changed in 2014, the number of children estimated as underdosed dropped to 5.8%, but 0.5% of the children would have received too high a dose.

CONCLUSIONS

Changes to the BNFC age-banded amoxicillin doses in 2014 have significantly reduced the proportion of children who are likely to be underdosed, with only a minimal rise in the number of those above the recommended range.

Animal-derived natural products of Sowa Rigpa medicine: Their pharmacopoeial description, current utilization and zoological identification

ETHNOPHARMACOLOGICAL RELEVANCE

The Bhutanese Sowa Rigpa medicine (BSM) uses animal parts in the preparation of numerous polyingredient traditional remedies. Our study reports the taxonomical identification of medicinal animals and the description of traditional uses in English medical terminologies.

AIM OF THE STUDY

To taxonomically identify the medicinal animals and their derived natural products used as a zootherapeutic agents in BSM.

MATERIALS AND METHODS

First, the traditional textbooks were reviewed to generate a list of animal products described as ingredients. Second, animal parts that are currently used in Bhutan were identified. Third, the ethnopharmacological uses of each animal ingredients were translated into English medical terminologies by consulting Traditional Physicians, clinical assistants, pharmacognosists, and pharmacists in Bhutan. Fourth, the animal parts were taxonomically identified and their Latin names were confirmed by crosschecking them with online animal databases and relevant scientific literature.

RESULTS

The study found 73 natural products belonging to 29 categories derived from 45 medicinal animals (36 vertebrates and 9 invertebrates), comprising of 9 taxonomic categories and 30 zoological families. Out of 116 formulations currently produced, 87 of them contain one or more extracts and products obtained from 13 medicinal animals to treat more than 124 traditionally classified illnesses. Only five animal ingredients were found available in Bhutan and rest of the animal parts are being imported from India.

CONCLUSIONS

Out of 73 natural products described in the traditional textbooks, only 13 of them (some omitted and few substituted by plants) are currently included in 87 formulations of BSM.

Change Is In the Air: What You Need to Know About Pharmacy Ventilation Under United States Pharmacopeia <800>

On July 1, 2018, United States Pharmacopeia <800> takes effect in those states that adopt it, and the discussion within this article may be applicable to those states that develop their own standards. United States Pharmacopeia <800> changes requirements for storage and compounding of hazardous drugs. The new requirements have important implications for air management and ventilation in some pharmacies. This article discusses how United States Pharmacopeia <800> compares to United States Pharmacopeia <797>, how the changes impact room ventilation and pressurization requirements, and how high-performance airflow control systems that ensure compliance and safety are impacted.

As vivid as a weed… Medicinal and cosmetic plant uses amongst the urban youth in French Guiana

ETHNOPHARMACOLOGICAL RELEVANCE

French Guiana is a French overseas territory with a rich history of migration that has led to a highly intercultural society. Today, its population is one of the youngest in the French territory and is rapidly increasing. Despite a context of cultural revival seeking "tradition", a distanced baseline of local practices is still lacking. This work addresses some aspects of the cultural hybridizations in progress in urban areas.

METHODS

Semi directed interviews were conducted with willing participants aged between 18 and 40. Interviews took place in French Guiana's two main urban centres: Cayenne and Saint Laurent du Maroni. People were interviewed about the last medicinal plant they used in the preceding year. Due to the high use of plant baths in French Guiana, a focus was made on baths.

RESULTS AND DISCUSSION

Eighty-three people answered: 43 women and 40 men (mean age of 28.7 years old). In total, 226 remedies were counted in our study, 155 single plant remedies and 71 compound remedies leading to 316 use reports of plants from 16 cultural groups. A surprising number of 108 botanical species were recorded. Eighty-one recipes for baths were also collected. Despite this high citation rate, a rather low proportion of people declare a systematic and regular recourse upon local pharmacopoeia (46%; 38/83). Although many interviewees used plants, far from the majority used them on a regular basis. In practice, 50% of the species (54/108 spp.; 99/316 URs) are non-native but domesticated exotic species, imported from Asia, Europe, Africa or remote parts of America, either during colonization, the slave trade era, or more recently with the latest migrations.

CONCLUSION

Although phytotherapy use is often thought to be related to countryside dwellers and older people, medicinal plants seem to play an important role in the lives of urban French Guianese youth. Research shows a large diversity of medicinal species used linked with the great cultural diversity of the Guianese cities. One characteristic of this population is the hybridization process leading to a perpetual renewal of practices, both in terms of species and practice.

[Historical evolution and change of differentiation on dried ginger, fresh ginger and baked ginger]

Ginger is commonly used as dietetic Chinese herbs, medicinal ginger mainly divided into dried ginger, fresh ginger and baked ginger. In this article, by sorting and studying literature of Chinese materia medica, textual criticism the historical evolution and change of differentiation on dried ginger, fresh ginger and baked ginger. Results indicate that, as the changes of the dynasty, dried ginger, fresh ginger and baked ginger gradually differentiation in producing area and processing method. Dried ginger beginning in Shennong Bencao Jing（Shennong's Classic of Materia Medica）, Mingyi Bielu（Records of Famous Physicians） respectively included fresh ginger and dried ginger for the first time. Dried ginger and fresh ginger differentiation in producing area. Between the period of Shennong Bencao Jing（Shennong's Classic of Materia Medica）and Bencao Gangmu（Compendium of Materia Medica）, dried ginger was made from fresh ginger by water, peeled and sunlight; After Bencao Gangmu（Compendium of Materia Medica）, most herbalists support the view of Li Shizhen, thought that dried ginger was made by mother ginger. Baked ginger appeared in Han Dynasty. Depei Bencao（De Pei Materia Medica） in Qing Dynasty listed the baked ginger separately as a herb medicine ingredient, thought that baked ginger was made by dried ginger. As the changes of the dynasty, genuine producing areas of ginger were changed, but mainly concentrated in Yangtze river basin. Sichuan Qianwei is the main authentic region of modern medicinal ginger, in accordance with all previous dynasties materia medica. Since the Ming Dynasty, a lot of herbalists thought that good quality of dried ginger is meat thick full, color white and texture solid.

Identification of crude drugs in the Japanese pharmacopoeia using a DNA barcoding system

Kampo is the general designation for traditional Japanese herbal medicines, which are recognized as official medicines and listed in the Japanese pharmacopoeia (JP). In most cases, it is difficult to identify the crude drug materials to species level using only traditional identification methods. We report the first online DNA barcode identification system, which includes standard barcode sequences from approximately 95% of the species recorded in the JP (16th edition). This tool provides users with basic information on each crude drug recorded in the JP, DNA barcoding identification of herbal material, and the standard operating procedure (SOP) from sampling to data analysis. ITS2 sequences (psbA-trnH was an alternative when ITS2 could not be amplified) were generated from a total of 576 samples to establish the database. An additional 100 samples (from different medicinal parts, from both single origin and multiple origins and from both retailers and the planting base) were identified using the system. A total of 78% of the test samples were identified as the species listed on their label. This system establishes a model platform for other pharmacopeias from countries like China, Korea, the US and the European Union, for the safe and effective utilization of traditional herbal medicines.

Lipid Injectable Emulsions: 2006

Lipid injectable emulsions are an essential source of fatty acids, as well as a daily source of calories. They have been used in the clinical setting for almost 40 years, but despite this, there are no established official standards governing pharmaceutical quality. After 15 years of development, the United States Pharmacopeia (USP), which writes such standards for all FDA-approved pharmaceuticals, is poised to adopt an official monograph for lipid injectable emulsions that sets pharmaceutical requirements on all manufacturers placing limits on pH, free fatty acid concentrations and globule size (both mean droplet size and the population of large fat globules larger than 5 micrometers). Recent animal data has shown pathophysiologic changes in vital organs for lipids that fall outside the USP-proposed globule size limits. From a clinical perspective, newer lipid injectable emulsions show great promise in certain patient settings, most notably in the intensive care unit in both adults and infants. The clinical use of alternative oils, such as medium-chain triglycerides, fish oil and olive oil show benefits over conventional soybean oil formulations. In adults, for example, the administration of omega-fatty acids via soybean oil-based lipids produces a heightened inflammatory response via production of 2-series prostaglandins, whereas substitution of a portion of the lipid with omega-3 fatty acids via fish oil can favorably dampen the inflammatory response. In infants, for example, substitution of soybean oil with fish oil has recently been shown to reverse parenteral nutrition-associated liver disease. These advances should lead to safer infusion therapy in patients receiving lipid injectable emulsions.

The British National Formulary

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The CPD article introduced the revised format of the British National Formulary (BNF) and explained how the information it contains may be accessed. It discussed the importance of developing healthcare professionals' knowledge and understanding of the BNF to enable safe and effective prescribing, dispensing, administration and monitoring of medicines.

FREE RADICAL FORMATION IN ROSUVASTATIN DURING THERMAL STERILIZATION AT DIFFERENT TEMPERATURES

Rosuvastatin was thermally sterilized at temperatures 160⁰C during 120 min, 170⁰C during 60 min and 180⁰C during 30 min, according to Polish pharmacopoeia norms. Free radicals formed in the heated rosuvastatin samples were examined by electron paramagnetic resonance (EPR) spectroscopy. The best conditions of thermal sterilization of rosuvastatin were searched. EPR spectra were measured for the analyzed drug independent on heating temperature. Decrease of free radical concentrations in rosuvastatin with increasing of heating temperature was stated. The optimal conditions for thermal sterilization of rosuvastatin were temperature 180⁰C and heating time of 30 min and resulted in the lowest free radical concentration. The changes of amplitudes (A) and linewidths (∇Bpp) of EPR spectra of the heated rosuvastatin were characteristic for homogeneous broadening EPR lines. Slow spin-lattice relaxation processes existed in the all rosuvastatin samples. The confirmation of usefulness of electron paramagnetic resonance spectroscopy in pharmacy was presented.

Rhododendron groenlandicum (Labrador tea), an antidiabetic plant from the traditional pharmacopoeia of the Canadian Eastern James Bay Cree, improves renal integrity in the diet-induced obese mouse model

Content Our team has identified Labrador tea [Rhododendron groenlandicum L. (Ericaceae)] as a potential antidiabetic plant from the traditional pharmacopoeia of the Eastern James Bay Cree. In a previous in vivo study, the plant extract was tested in a high-fat diet (HFD)-induced obese model using C57BL/6 mice and it improved glycaemia, insulinaemia and glucose tolerance. Objective In the present study, we assessed the plant's potential renoprotective effects. Materials and methods Rhododendron groenlandicum was administered at 250 mg/kg/d to mice fed HFD for 8 weeks to induce obesity and mild diabetes. Histological (periodic acid-Schiff (PAS), Masson and Oil Red O staining), immunohistochemical (IHC) and biochemical parameters were assessed to evaluate the renoprotective potential of R. groenlandicum treatment for an additional 8 weeks. Results Microalbuminuria and renal fibrosis were developed in HFD-fed mice. Meanwhile, there was a tendency for R. groenlandicum to improve microalbuminuria, with the values of albumin-creatinine ratio (ACR) reducing from 0.69 to 0.53. Renal fibrosis value was originally 4.85 arbitrary units (AU) in HFD-fed mice, dropped to 3.27 AU after receiving R. groenlandicum treatment. Rhododendron groenlandicum reduced renal steatosis by nearly one-half, whereas the expression of Bcl-2-modifying factor (BMF) diminished from 13.96 AU to 9.43 AU. Discussion and conclusions Taken altogether, the results suggest that R. groenlandicum treatment can improve renal function impaired by HFD.

[Oligopeptides in plant medicines cited in Chinese Pharmacopoeia]

In total, 23 plant plant medicined containing oligopeptides were cited in Chinese Pharmacopoeia (1 part) of 2015 version including Rubia cordifolia, Linum usitatissimum, Aster tataricus, Psammosilene tunicoides, Pseudostellaria heterophylla, Stellaria dichotoma, Vaccaria segetalis, Dianthus superbus, Celosia argentea, Lycii Cortex, Citrus medica, C. aurantium, Panax ginseng, Parmx notoginseng, Schisandra chinensis, Sparganium stoloniferum, Euryale ferox, Ophiopogon japonicas, Pinellia ternate, Achyranthes bidentata, Physalis alkekengi, Polygonatum odoratum, and Leonuri Fructus. There were 187 oligopeptides in plant medicines above as reported. Oligopeptides consisted mainly of linear peptides and cyclic peptides. The linear peptides included dipeptides, tripeptides and pentapeptides, and cyclic peptides included cyclic, bicyclic and tricyclic peptides. The number of residues of single cyclic peptides ranged from two to twelve. Bicyclic peptides were isolated mainly from R. cordifolia and C. argentea. Modern pharmacological study showed that oligopeptides had many pharmacological effects, including antitumor, anticoagulant, antibacterial, immune suppression and so on.

Compounding a Problem?

Allergist-immunologists say a U.S. Pharmacopeia proposal will mess with an allergy treatment system that's worked for more than a century. The revised standards, if adopted, would remove a key exemption separating allergen extract preparations from the stricter requirements of other compounds. Immunologists say the exemption has allowed them to compound allergen extracts in their own offices, and they've done so safely and effectively millions of times a year.

Transition of Psychotropic Drugs in Japanese Pharmacopoeia (JP) (Part 17) Transitions in the Standards and Test Methods of Valproic Acid and Sodium Valproate in Japanese Pharmacopoeia (JP), Pharmacopoeia of the USA (USP), British Pharmacopoeia (BP), and the Knowledge and Judgment about Japanese Valeriana, and Valproic Acid from Valeric Acid

Valproic acid (VPA) and sodium valproate (VPA-Na) are used for the treatment of various things today, such as epilepsy and manic-depressive states. Moreover, use has expanded to a variety of applications, such as the prevention of migraine headaches. As a result, a high demand has been maintained. The chemical structure is a branching low-grade saturated fatty acid, which is simpler than other psychotropic drugs. VPA is called 2-propyl-pentanoic acid and 2-propyl-valeric acid under the IUPAC system, and is derived from Valeric acid. This time, the author researched transitions in the standards and testing methods for VPA and VPA-Na in JP, USP and BP. It was found that each countryʼs pharmacopoeia described a detection test for substances related to VPA. It can be explained that VPA is derived from Valeric acid based on the test contents. Valeric acid is a component of Japanese Valeriana and Valerian root. It is believed that there is a sense of value as the origin of VPA is Japanese Valeriana and Valeriana root.

Do ferns and lycophytes function as medicinal plants? A study of their low representation in traditional pharmacopoeias

ETHNOPHARMACOLOGICAL RELEVANCE

Ethnobotany is becoming an important tool for understanding how traditional medical systems are organized and which variables affect their structure and dynamics. However, some phenomena observed in ethnobotanical studies led us to question whether such phenomena are real or methodological artifacts. The small proportion of ferns and lycophytes in ethnobotanical surveys of medicinal plants is one such phenomenon, and its causes should be identified using different approach levels. The present study aimed to clarify the reasons for a low representation of these two groups in studies of medicinal plants.

MATERIALS AND METHODS

The present study considered the following hypotheses: 1) ferns and lycophytes are little represented in different ethnobotanical studies because of inadequate data collection methods to record these species; 2) ferns and lycophytes are little represented because of the local perception of their low therapeutic efficacy; and 3) species of ferns and lycophytes are represented in local pharmacopoeias in proportion to the size of their families. We chose rural communities from Chapada do Araripe, Northeast Brazil to test our hypotheses. Data on the medicinal plant repertoires of the communities and on the perceived therapeutic efficacy of ferns were obtained using two different methods, semi-structured interviews associated with free lists and a checklist interview, both applied to local specialists. The resulting data were analyzed differently for each test. In addition, data regarding the total flora x medicinal flora ratio were obtained with a floristic survey and accessing data banks from previous studies performed by our research team.

RESULTS

All hypotheses were confirmed, showing that all three factors contributed to the low representation of these plant groups as medicinal resources. The present study showed that free-list interviews are not a good method to access traditional knowledge of medicinal ferns and lycophytes and that the use of visual stimuli can help the memory of the informants, thus making it possible to associate the perceived characteristics with plant use. The results also showed that individuals perceive these plants as inferior therapeutic resources compared to angiosperms, which contributes to knowledge of their use not being transmitted. The final result of the present study was that the distribution of medicinal fern and lycophyte species within families was consistent with the total flora x medicinal flora ratio. This result indicates that even if the most appropriate data collection method was used for the ethnobotanical survey, the number of species would not be as expressive as that of angiosperms.

Spirits and liqueurs in European traditional medicine: Their history and ethnobotany in Tuscany and Bologna (Italy)

ETHNOPHARMACOLOGICAL RELEVANCE AND BACKGROUND

Fermented drinks, often alcoholic, are relevant in many nutritional, medicinal, social, ritual and religious aspects of numerous traditional societies. The use of alcoholic drinks of herbal extracts is documented in classical pharmacy since the 1st century CE and it is often recorded in ethnobotanical studies in Europe, particularly in Italy, where are used for a wide range of medicinal purposes. Formulations and uses represent a singular tradition which responds to a wide range of environmental and cultural factors.

AIMS

This research has two overarching aims To determine how long ancient uses, recipes and formulas for medicinal liqueurs from the pharmacopoeias and herbals of the 18th century persisted in later periods and their role in present ethnobotanical knowledge in areas of Tuscany and Emilia-Romagna (Italy). To trace other possible relationships among ancient and recent recipes of alcoholic beverages, from both popular and 'classic' (learned) sources in N-C Italy and neighboring areas.

METHODS

The review of herbals and classical pharmacopoeias, and ethnobotanical field work in Alta Valle del Reno (Tuscany and Emilia Romagna, Italy) were followed of a systematic study of ingredients and medicinal uses with multivariate analysis techniques.

RESULTS

The multivariate analysis clearly shows six different styles of preparing medicinal alcoholic beverages: 1. The medicinal wine formulae by Dioscorides (1st century CE). 2. The pharmacopoeias of Florence and Bologna in the 18th century CE. 3. The formularies of Santa Maria Novella and Castiglione (19th and early 20th centuries CE). 4. The ethnobotanical data from Appennino Tosco-Emiliano; home-made formulations based almost exclusively on the use of local resources. 5. Traditional recipes from NE Italy and Austria. 6. Traditional recipes from NW Italy, Emilia, and Provence (France). A total of 54 ingredients (29 fruits) from 48 species are used in different combinations and proportions in Alta Valle del Reno (Italy) to produce fermented beverages, liqueurs, distilled spirits and aromatized wines. Among these, 37 ingredients (33 species) are used as medicinal remedies. 15 ingredients (14 species) are also used to prepare specific medicinal liqueurs. Most are addressed to the treatment of diseases of the digestive system, dyspepsia in particular, followed by diseases of the respiratory system symptoms, not elsewhere classified and diseases of the skin and subcutaneous tissue, fundamentally of allergic origin.

CONCLUSIONS

Although medicinal wines, liqueurs and spirits are recorded in numerous classical herbals and pharmacopoeias in Italy and other countries of Europe these show in terms of formulations and ingredients little influence in the ethnobotanical formulations recorded in Alta Valle del Reno (Italy), they apparently play no role in present ethnobotanical knowledge in Appennino Tosco-Emiliano and similarly in other areas of Italy, France and Austria. No (or very poor) persistence was found of ancient uses, recipes and formulas for medicinal liqueurs from pharmacopoeias and herbals of the 16th century CE in later periods in the formulas in use in the pharmacies of Tuscany. Popular recipes are strongly dependent on the availability of local wild and cultivated plants. Overall, Alta Valle del Reno ethnobotanical formulations of medicinal wines and spirits are extremely simple involving from one single ingredient to a few, which are locally produced or collected and selected among relevant medicinal resources used for a wide range of diseases in form of non-alcoholic aqueous extracts. Fruits gathered in the forests are the main ingredients which in this aspect show similarities with those from Tyrol (Austria). Medicinal liqueurs and wines are in analyzed ethnobotanical data mainly employed as digestives.

[Compatibility of intravenous medications needs attention. Catheter occlusion, treatment failure and embolisms can be prevented]

When dealing with more drugs than available lumens, intravenous medications need to be co-administered in the same catheter. This type of scenario may induce therapeutic risks, such as catheter occlusion, changes in drug effect or embolization of precipitated particles. Various sources are available to provide information on compatibilities of intravenous medications. When using these sources, the applicability of the information must be assessed, comparing concentrations, diluents used and other pharmaceutical aspects. For the last three years, a group of pharmacists at Sahlgrenska University Hospital has worked on a project collecting and validating compatibility data for intravenous medications. In the future, this data will be available to more hospitals in Sweden.

The national pharmacopoeias of the Baltic States

After Estonia, Latvia and Lithuania proclaimed their independence in 1918 and began to create their national health care systems, one of their stated priorities was the formulation and publication of national pharmacopoeias. In order to accomplish this, working groups as well as commissions composed of pharmacists, medical specialists and even linguists had to be formed. The process was long and difficult. New terminology in native languages had to be created. Sources for the monographs had to be chosen, researched, analyzed and compared. There were organizational and financial problems. Nevertheless, by the late 1930s, all three Baltic States published their national pharmacopoeias. Officially, they were not able to use them for long because during World War II all three were occupied and annexed by the Soviet Union. Pharmacists in those countries were obliged to use the Soviet pharmacopoeias, although unofficially, they also made good use of their national ones. Currently, the European Pharmacopoeia is in use in Estonia, Latvia and Lithuania.