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PubMed2002

Anatomic variation of prescription points and treatment volume with fractionated high-dose rate gynecological brachytherapy.

The purpose of this report is to evaluate the geometric movement (relative to the bony pelvis) and dose variation of brachytherapy reference points in the same patient at repeated high-dose rate (HDR) intracavitary implants. A study was also concluded to find the variation in treatment volume from repeated fractions. Twenty-five consecutive cervical cancer patients (all stages) treated with external beam and fractionated HDR intracavitary implants at the University of Wisconsin were reviewed. Each brachytherapy insertion had a different plan generated prior to treatment delivery. ICRU #38 prescription points (A, B, P, bladder, and rectum) were used. Dose volume histogram was generated and treated volume to the prescription dose was recorded for each fraction. Motion analysis of the various points (from a common origin) in subsequent fractions relative to the first fraction revealed a shift of 2-9 mm in a single plane. Vector analysis revealed the magnitude of the average shift ranged from 10-13 mm. These shifts resulted in a dose difference of >20% for the bladder and rectum points, but < than 8% for the other points. Dose volume histograms revealed that with the change in the anatomy of the cervix and upper vagina during a patient's course of treatment, the treatment volume changes considerably. Thirty-six percent of all patients (9/16) had a reduction in the size of the ovoid during the treatment course. Sixty percent of all patients (15/25) had volume changes <10%. Sixty-two and one half percent of patients (10/16) who did not undergo a reduction of avoid size during the entire course of the treatment had volume change <10%. Since there is a change in the anatomy of the cervix and upper vagina during the course of a treatment along with the irreproducibility of the packing, there is movement of the absolute position of the prescription points between fractions, thus emphasizing the importance of individual dosimetry. Moreover, due to the same reasons, there are significant changes in the treatment volume among implants for the same patient. Volume reduction caused by reduction in ovoid size alone could not be extracted from this study.

Brachytherapy↗
PubMed2001

Uk audit of childhood growth hormone prescription, 1998.

AIMS: To identify all young people prescribed growth hormone in the UK as of 1 October 1998 and to determine their age, sex, and the indication for therapy. METHODS: Cross sectional national postal audit through members of the British Society for Paediatric Endocrinology and Diabetes (BSPED) and other paediatricians identified as potential prescribers of growth hormone. Main outcome measures were age, sex, and numbers of children receiving growth hormone by diagnostic category, analysed throughout the UK and by NHS region. RESULTS: A total of 3228 children (aged 0.3 to 23.9 years) receiving growth hormone were identified by contacting 171 paediatricians (149 BSPED members). Of these, 2395 (74%) were identified who were under 16 years-representing 19.8/100 000 children in that age range in the UK-and in whom full data concerning diagnostic category were available. In the under 16s, there were 1209 (50.4%) boys and 1186 (49.6%) girls (excluding the 477 girls with Turner's syndrome: 63% boys and 37% girls). A total of 78% of the prescriptions were for licensed indications (primary and secondary growth hormone deficiency, Turner's syndrome, and chronic renal disease); 22% were for unlicensed indications (intrauterine growth restriction, bony dysplasia, Noonan syndrome, and other "short normals"). These proportions are similar to those reported in previous audits and by postmarketing surveillance from Pharmacia & Upjohn Ltd in the year 2000. Patterns of treatment were relatively uniform between regions. CONCLUSIONS: A national audit of UK growth hormone prescription indicates uniform prescribing practice between regions, low levels of prescription beyond licensed indications, and stable patterns of prescribing practice over the past two years.

Adolescent↗
PubMed1996

The place of perceived exertion ratings in exercise prescription for cardiac transplant patients before and after training.

OBJECTIVE: Heart rate provides a poor guide to exercise prescription after cardiac transplantation. This study explores whether the rating of perceived exertion (RPE) provides useful alternative information. METHODS: Borg's original categoric scale was applied to 36 male patients [T, age 47(SD 9 years] as they performed a progressive cycle ergometer test an average of seven months (range two to 23 months) after cardiac transplantation. The test was repeated after 16(7) months of progressive exercise centred rehabilitation. Sedentary but healthy controls [C, n = 45, age 45(7) years] performed a similar progressive cycle test. RESULTS: Initially, 13 RPE units corresponded to 66(12)% of peak VO2 in T and 50(11)% in C. Rehabilitation augmented peak VO2 (by 19%) and estimated lean body mass (by 3.5%) in the cardiac transplant patients. The increase of heart rate (HR) at 13 RPE units [delta HR = 10(17) beats.min-1] showed moderate correlations with gains of lean mass (r = 0.72) and gains of peak VO2 (r = 0.58). The relative oxygen intake at 13 RPE units remained unchanged at 68(12)% of peak VO2. CONCLUSIONS: Large inter-individual variations of RPE at a given VO2 limit the value of perceived exertion in exercise prescription. Ratings seem best restricted to fine tuning fixed distance/fixed speed exercise prescriptions in patients undergoing rehabilitation after cardiac transplantation.

Adult↗
PubMed1994

Impact of internal audit on pacemaker prescription and the immediate costs of pacing in the northern region: towards implementation of the recommendations of the British Pacing and Electrophysiology Group.

BACKGROUND: In September 1990 a working party of the British Pacing and Electrophysiology Group recommended the routine use of physiological pacing systems in patients with bradycardia. An audit of the impact of these recommendations on pacemaker prescription in the Freeman Hospital between March 1990 and August 1991 has previously been reported. This paper considers the effect of that internal audit on subsequent pacemaker prescription from September 1991 to February 1993. PATIENTS AND METHODS: The records of 1228 patients who underwent first pacemaker implantation at the Freeman Hospital between March 1990 and February 1993 were audited retrospectively. The patient's age, indication for pacing, pacing mode, and cost of the generator and leads were recorded. The indications for pacing were sinus node dysfunction (24.9%) (including patients with coexistent sinus node dysfunction and atrioventricular block), atrioventricular block (57.2%), atrioventricular block and atrial fibrillation (12.2%), and carotid sinus syndrome (5.7%). There was an increase in carotid sinus syndrome (2.7% to 8.1%) between the two study periods but no other differences in the distribution of case mix or characteristics of patients. The cost of the working party's recommended optimal pacing mode was calculated from multiplication of the mean cost of the recommended unit over the second half of the study period by the number of patients who would have received that unit. RESULTS: Between March 1990 and August 1991 atrial pacing for sinus node dysfunction (AAI, AAIR, DDD, or DDDR) increased by 138% (from 25.0% to 59.6%), mainly because of increased use of AAI mode. Physiological pacing for atrioventricular block (DDD or VVIR) increased by 41% (from 17.0% to 24.0%), and VVIR pacing for atrioventricular block with atrial fibrillation increased by 111% (from 10.5% to 22.2%). After the internal audit (that is, between September 1991 and February 1993), physiological pacing for atrioventricular block increased by a further 126% (from 24.0% to 54.2%). Sixty three per cent of this increase was in the first six months after the internal audit. Pacemaker prescriptions in sinus node dysfunction and atrioventricular block with atrial fibrillation were unchanged (59.6% physiological pacing for sinus node dysfunction and 22.2% v 27.3% VVIR pacing for atrioventricular block with atrial fibrillation). These changes in practice were accompanied by an increase in the age of patients receiving physiological units. Costs of pacemaker hardware for the final six months of the audit (excluding carotid sinus syndrome) increased by 38% over the costs that would have accrued had pacing policy remained the same as for the initial six month period before the circulation of the recommendations of the working party. Adoption of the guidelines of the working party in full would lead to a further 66% increase in the costs of hardware. CONCLUSIONS: The principal effect of the recommendations of the working party alone was increased use of AAI pacing for sinus node dysfunction, with little change in the costs of hardware. The internal audit was followed by an increase in physiological pacing for atrioventricular block, and this has had important financial consequences. Internal audit was followed by closer adherence to the recommendations of the working party.

Aged↗
PubMed1996

Trends in pacemaker mode prescription 1984-1994: a single centre study of 3710 patients.

OBJECTIVE: To evaluate trends in pacemaker mode prescription from 1984 to 1994 with particular reference to the changes in pacemaker mode prescription for patients aged 80 years and older at implant. DESIGN: Prospective evaluation of indications for pacing and pacemaker mode prescription in all patients undergoing new pacemaker implantation from 1992 to 1994. Comparison with retrospectively obtained data for patients paced from 1984 to 1991. SETTING: Tertiary referral cardiothoracic centre. PATIENTS: Group 1: 2622 patients paced at one centre and entered into the national pacing database from 1984 to 1991. Group 2: 1088 consecutive patients paced from 1992 to 1994. RESULTS: Use of atrial (AAI) and dual chamber (DDD) pacemakers increased progressively in patients of all ages from 1984 to 1994. There was an increase in the proportion of patients aged 80 years and older from 25.4% (group 1) to 40.5% (group 2). Patients of all ages in group 2 were more likely to receive DDD units for atrioventricular block (odds ratio (95% confidence interval) (CI) 9.0 (7.0 to 11.5)) and AAI or DDD units for sinus node disease (odds ratio (95% CI) 11.0 (7.7 to 15.8)) than those in group 1. Elderly patients (age > or = 80 at implant) with atrioventricular block or sinus node disease and a suitable atrial rhythm were less likely to receive DDD or AAI pacemakers than younger patients in both groups. CONCLUSIONS: Use of atrial and dual chamber pacing modes has increased substantially in patients of all ages over the last decade. Although elderly patients represent an increasing proportion of the paced population, they remain less likely to receive atrial or dual chamber pacemakers than younger patients.

Age Factors↗
PubMed1998

Usage patterns of transdermal nicotine when purchased as a non-prescription medicine from pharmacies.

OBJECTIVE: To assess nicotine patch use in smokers who purchased the product as a non-prescription medicine from pharmacies. DESIGN: A questionnaire administered at the time of purchase. SETTING: Community pharmacies throughout New Zealand. SUBJECTS: A total of 805 male and female purchasers of nicotine patches aged 18 through 87 years. MAIN OUTCOME MEASURES: Patterns of usage including self-reported smoking history, previous quit-smoking attempts, previous and current use of transdermal nicotine and other products, side effects, and concomitant smoking. RESULTS: Most respondents (74%) had attempted to quit smoking previously, many of whom (53%) had used a non-prescription nicotine replacement product. Approximately 60% of purchasers were first-time users. For those continuing a course of treatment, there was no evidence of use for longer than the manufacturer's recommendation (12 weeks). Twenty-eight per cent of respondents reported continuing smoking while using transdermal nicotine, although the number of cigarettes smoked was much less than in the reported smoking history. Side effects were reported by 24% of patch users in the current course, but there was no evidence of significant safety problems. CONCLUSIONS: This survey provides preliminary data on the non-prescription usage of transdermal nicotine when purchased through pharmacies.

Administration, Cutaneous↗
PubMed1989

The hypoglycemic effect of the crude drug prescription resources from Taiwan on experimental diabetic-mellitus (II)--the antihyperglycemic effect of tang-niao-tung no. 2 and no. 3.

The water extracts of crude drugs of Taiwan Tang-Niao-Tung (T.N.T.) No. 2 and No. 3 were administered to normal and diabetic rats for investigating the antihyperglycemic effect of these two prescriptions. It was found that the blood glucose level in normal rats was temporarily increased after T.N.T. No. 2 and No. 3 administration; this may be caused by the starch content of the drugs component. In contrast, the diabetic rats have shown a significant decrease (P less than 0.01) of blood glucose in 2, 4, 6 hours after T.N.T. No. 2 and No. 3 have been given. The blood glucose percentage at 6 hours was 78.1% of T.N.T. No. 2 and 79.2% of T.N.T. No. 3 as compared to the original level. The hypoglycemic effect of T.N.T. No. 2 and No. 3 on alloxan-induced diabetic rats have suggested that action mechanism might not mediate through the release of insulin or positive feedback of glucose to insulin, neither acted on insulin receptor. It might be possible by the indirect promoting of enzyme activity. However, the pharmacological effect of some drugs could elucidate the hypoglycemic action of these prescriptions. Temporary promotion of blood glucose in normal rats will decline to normal level by 12 hours after T.N.T. No. 2 and No. 3 administration. The pharmacological effect of these herb prescriptions for diabetic rats is valuable for further study.

Animals↗
PubMedDate not supplied

Propofol use precludes prescription of estimated nitrogen requirements.

The objective was to determine whether reducing enteral nutrition to accommodate 1% Propofol-derived energy results in suboptimal nitrogen prescription. This was a prospective observational study of 85 consecutive patients requiring mechanical ventilation and receiving 1% Propofol. Enteral nutrition prescription often failed to meet nitrogen requirements (<90%, in 50.6%; <80%, in 21.1%), whereas fat provided 51% of total energy input, exceeding 2 g fat/kg/d in 20%. However, gastroparesis was common, resulting in suboptimal nutrition (median of requirements: energy 71%; nitrogen 57%). If energy balance had been strictly maintained, substituting 1% with 2% Propofol would reduce the number of patients failing to meet nitrogen requirements (1% vs 2%: <90%: in 58.8% vs 17.6%, P< .001; <80% in 35.3% vs 4.7%, P< .014). These effects are directly related to the amount of fat delivered with Propofol. Intensive care unit-associated gastroparesis commonly reduces enteral nutrition input. However, even where this is overcome, use of 1% Propofol frequently precludes prescription of estimated nitrogen requirements; either 2% Propofol or a non-Propofol alternative should be considered.

Adult↗
PubMed1980

Education of independent elderly in the responsible use of prescription medications.

A pilot study to test the effectiveness of medication instruction was carried out using 61 voluntary participants age 65 and older. They were interviewed regarding their medication taking, and instruction was individualized using one of four teaching modes: oral; written; oral and written; and oral and written combined with memory aids. Postinstruction interviews revealed no significant difference in compliance among all groups. The preinstruction mean compliance score of all subjects was 98.8 percent. Although compliance, judged specifically on the basis of the prescription label instructions, was extremely high both before and after instruction, drug-taking behavior and knowledge did change. The preinstruction compliance score does not necessarily reflect safe or desirable drug-taking behavior. There was no specific information given to clients with their prescriptions and prescription medications, indicating, for drug-therapy decision makers, a much broader problem than non-compliance.

Aged↗
PubMed2006

Drug utilization of ezetimibe in rehabilitation centres: registry analysis of factors influencing prescription and effectiveness of treatment.

BACKGROUND: While randomized controlled trials (RCTs) generate informative data about clinical outcomes, by their nature they cannot provide information about drug utilization and factors influencing prescribing decisions. In the secondary prevention of patients with cardiac events, lipid lowering therapy with statins and other agents, such as cholesterol absorption inhibitors (CAI, e.g. ezetimibe) plays a pivotal role and is often initiated or modified in rehabilitation centres. The aims of the present study were to analyse factors that influence the prescribing decisions of physicians, and to investigate success rates of lipid lowering therapy with ezetimibe after adjustment for covariates. METHODS: Ninety-three rehabilitation centres throughout Germany documented a total of 17029 patients in cardiac rehabilitation, of which 6976 (41.6%) were prescribed a CAI. A logistic regression model with forward selection based on 31 potential regressors for ezetimibe prescription (demographics, diagnosis, risk factors etc.) was used to construct a propensity score, which reflects the inclination of physicians to prescribe CAI. This score was subsequently used for bias reduction in the comparison of co-medications and success rates. RESULTS: Nineteen variables were associated with ezetimibe prescriptions, the most important ones being total cholesterol, level of education, unstable angina pectoris and arterial hypertension. Ezetimibe was more frequently prescribed together with simvastatin and pravastatin than with other statins, and frequently together with aspirin or beta blockers, respectively. After adjustment for baseline lipid values and covariates, the probability of target level achievement appears to be substantially higher for patients on ezetimibe than for those without ezetimibe. CONCLUSIONS: Other factors than conventional risk factors contribute to the CAI prescription habits of physicians. Additional lipid level reductions due to ezetimibe are seen in routine health care corresponding to findings from randomized studies.

Aged↗
PubMed2007

Rates of inappropriate antiretroviral prescription among injection drug users.

BACKGROUND: Although the survival benefits of antiretroviral therapy (ART) for the treatment of HIV infection are well established, the clinical management of HIV disease continues to present major challenges. There are particular concerns regarding access to appropriate HIV treatment among HIV-infected injection drug users (IDU). METHODS: In a prospective cohort study of HIV-infected IDU in Vancouver, Canada, we examined initial ART regimens vis-à-vis the provincial government's therapeutic guidelines at the time ART was initiated. Briefly, there have been four sets of guidelines: Era 1 (1992 to November 1995; double-drug (dual NRTIs) ART for patients with a CD4 cell count of 350 or less); Era 2 (December 1995 to May 1996; double-drug therapy for patients with a CD4+ cell count of 500 or less); Era 3 (June 1996 to June 1997; triple-drug therapy (dual NRTIs with a PI or NNRTI) for patients who had a plasma viral load of > 100,000 HIV-1 RNA copies/mL; dual therapy with two NRTIs for those with a plasma viral load of 5,000 to 100,000 HIV-1 RNA copies/mL); Era 4 (since July 1997; universal use of triple drug therapy as first-line treatment). RESULTS: Between May 1996 and May 2003, 431 HIV-infected individuals were enrolled into the cohort. By May 31, 2003, 291 (67.5%) individuals had initiated ART. We noted instances of inappropriate antiretroviral prescription in each guideline era, with 9 (53%) in Era 1, 3 (12%) in Era 2, 22 (28%) in Era 3, and 23 (15%) in Era 4. Of the 57 subjects who received an inappropriate ART regimen initially, 14 never received the appropriate therapy; among the remaining 43, the median time to the initiation of a guideline-appropriate ART regimen was 12 months (inter-quartile range 5-20). CONCLUSION: The present study identified measurable rates of guideline-inappropriate ART prescription for patients who were injection drug users. Rates were highest in the era of dual therapy, although high rates persisted into the triple-therapy era. As therapeutic guidelines continue to evolve, it is critical that mechanisms be put in place to ensure prescription of ART combinations for IDU that are consistent with current expert recommendations.

Journal Article↗
PubMed1998

A comparison of handwritten and computer-assisted prescriptions in an intensive care unit.

BACKGROUND: We conducted a prospective comparative study to evaluate the potential benefit of computer-assisted prescribing (CAP). We compared the accuracy, completeness and time use of CAP with that of conventional handwritten prescribing at the intensive care unit (ICU) of the John Radcliffe Hospital, Oxford, UK. RESULTS: Twenty-five clinicians and 2409 drug entries were evaluated for accuracy, completeness, legibility and time spent prescribing. One hundred and twenty-eight handwritten and 110 CAP charts were monitored. One hundred percent of CAP charts were complete compared to 47% of handwritten charts.Drug prescriptions were divided into three categories: intravenous fluids, intravenous infusions and intermittent drugs. Percentage of correct entries in each category were 64%, 47.5% and 90% for handwritten, compared to 48%, 32% and 90% for CAP charts, respectively.The mean time taken to prescribe was 20 s for hand written prescribing and 55 s for CAP. CONCLUSIONS: Computer-assisted prescriptions were more complete, signed and dated than handwritten prescriptions. Errors in prescribing, including failure to discontinue a drug were not reduced by CAP. Handwritten prescribing was quicker than CAP. Simple enhancements of the computer software could be introduced which might overcome these deficiencies. CAP was successfully integrated into clinical practice in the ICU.

Journal Article↗
PubMed2006

Impact of computerized physician order entry on medication prescription errors in the intensive care unit: a controlled cross-sectional trial.

INTRODUCTION: Medication errors in the intensive care unit (ICU) are frequent and lead to attributable patient morbidity and mortality, increased length of ICU stay and substantial extra costs. We investigated if the introduction of a computerized ICU system (Centricity Critical Care Clinisoft, GE Healthcare) reduced the incidence and severity of medication prescription errors (MPEs). METHODS: A prospective trial was conducted in a paper-based unit (PB-U) versus a computerized unit (C-U) in a 22-bed ICU of a tertiary university hospital. Every medication order and medication prescription error was validated by a clinical pharmacist. The registration of different classes of MPE was done according to the National Coordinating Council for Medication Error Reporting and Prevention guidelines. An independent panel evaluated the severity of MPEs. We identified three groups: minor MPEs (no potential to cause harm); intercepted MPEs (potential to cause harm but intercepted on time); and serious MPEs (non-intercepted potential adverse drug events (ADE) or ADEs, being MPEs with potential to cause, or actually causing, patient harm). RESULTS: The C-U and the PB-U each contained 80 patient-days, and a total of 2,510 medication prescriptions were evaluated. The clinical pharmacist identified 375 MPEs. The incidence of MPEs was significantly lower in the C-U compared with the PB-U (44/1286 (3.4%) versus 331/1224 (27.0%); P < 0.001). There were significantly less minor MPEs in the C-U than in the PB-U (9 versus 225; P < 0.001). Intercepted MPEs were also lower in the C-U (12 versus 46; P < 0.001), as well as the non-intercepted potential ADEs (21 versus 48; P < 0.001). There was also a reduction of ADEs (2 in the C-U versus 12 in the PB-U; P < 0.01). No fatal errors occurred. The most frequent drug classes involved were cardiovascular medication and antibiotics in both groups. Patients with renal failure experienced less dosing errors in the C-U versus the PB-U (12 versus 35 serious MPEs; P < 0.001). CONCLUSION: The ICU computerization, including the medication order entry, resulted in a significant decrease in the occurrence and severity of medication errors in the ICU.

Adult↗
PubMed2002

Direct-to-consumer advertising of prescription medications: implications for patients with cancer.

PURPOSE/OBJECTIVES: To review the phenomenon of direct-to-consumer (DTC) advertising of prescription medications in the media, with an overview of pertinent studies in the literature regarding patients' and healthcare professionals' perspectives on DTC advertising. DATA SOURCES: Journal articles, media, and clinical experience. DATA SYNTHESIS: DTC advertising of prescription medications is extremely prevalent in U.S. society. Advertising of medications is an expensive business; yearly spending is expected to reach $7.5 billion by 2005. Although opinions vary regarding DTC advertising, healthcare professionals, including oncology nurses, must be prepared to discuss DTC-advertised medications and treatments with their patients. CONCLUSIONS: Communication is the key to helping patients decipher the deluge of DTC advertisements in the media and determine the accuracy of this ever-increasing source of medical information. IMPLICATIONS FOR NURSING: Oncology nurses need to be aware of the increases in DTC advertising of prescription medications and the importance of guiding patients through appropriate medication choices by education.

Advertising↗
PubMed2006

Secondary-prevention drug prescription in the very elderly after ischemic stroke or TIA.

BACKGROUND: An age bias may exist in the prescription of important secondary-preventive therapies in the elderly. OBJECTIVE: To evaluate patterns of drug prescription for cardiovascular prevention in the very elderly following hospitalization for an acute ischemic stroke or TIA. METHODS: The authors compared subjects ages > or = 80 with those < 80 in the California Acute Stroke Prototype Registry to evaluate the impact of age on receipt of secondary-prevention medications at the time of hospital discharge. Prespecified secondary-prevention drug classes studied were antithrombotics, lipid-lowering agents, and antihypertensives. RESULTS: Overall, there were 260 patients age > or = 80 and 534 age < 80 admitted with stroke or TIA during the study period. Patients > or = 80 years were less likely to receive actual treatment with antithrombotic medications (p = 0.002) and lipid-lowering medications (p = 0.005) but were more likely to receive antihypertensive medications (p = 0.0007) than their younger counterparts. With regard to optimal treatment (defined as receipt of, or a valid contraindication to, treatment in each category), those > or = 80 were equally likely to receive antithrombotic medications and lipid therapy but remained more likely to receive antihypertensive treatment (77.7 vs 67.0%; p = 0.0007). There were no differences in receipt of optimal combination therapy (defined as optimal treatment in all three therapeutic classes) between patient age groups, even when adjusted for medical history. CONCLUSION: After hospitalization for stroke or TIA, no differences in overall optimal treatment prescription of secondary-prevention medications between patients ages > or = 80 and their younger counterparts were observed.

Age Factors↗
PubMed1994

Beneficial effects of DX-9386, a traditional Chinese prescription, on memory disorder produced by lesioning the amygdala in mice.

The amygdala is one of the key areas of the brain involved in learning and memory. Bilateral lesions of the amygdala in 9-week-old mice induced impairment of memory acquisition and retention. DX-9386, a traditional Chinese medicinal prescription consisting of ginseng, polygala, acorus and hoelen, was orally administered to the lesioned mice after the operation until all the experiments were completed. From 15d after surgery, learning behavior in the step-down test was observed daily for 10 d. DX-9386 treatment ameliorated the memory acquisition deficit. The number of step-down events in the first testing trial was significantly decreased by administration of 250 mg/kg of the prescription to the lesioned group of mice. Choline acetyltransferase activity in the cerebral cortex of the lesioned mice was significantly decreased, while repeated administration of the prescription did not affect this biochemical parameter. These results indicate that the memory acquisition enhancing effect of DX-9386 may not be achieved by direct activation of cholinergic transmission in the brain but by some other mechanism(s).

Amygdala↗
PubMed2002

Metabolism of constituents in Huangqin-Tang, a prescription in traditional Chinese medicine, by human intestinal flora.

In the course of studies on the metabolism of active components of Huangqin-Tang by human intestinal flora (HIF), Huangqin-Tang and all individual herbs in the decoctions were incubated with a human fecal suspension separately. By using a high-performance liquid chromatographic (HPLC) method which was previously established in our laboratory, the metabolites in both the compound prescription and all the single herb decoctions were identified and determined both qualitatively and quantitatively. We found that the constituents of Huangqin-Tang, incluing baicalin (baicalein 7-glucuronide; BG), wogonoside (wogoninoglucuronide; WG), oroxylin-A-glucuronide (OG) from Scutellariae Radix, paeoniflorin (PF) from Paeoniae Radix, liquiritin (liquiritigenin 4'-O-glucoside; LG), isoliquirtin (isoliquiritigenin 4-glucoside; ILG) and glycyrrhizic acid (GL) from Glycyhhizea Radix, were converted to their metabolites baicalein (B), wogonin (W), oroxylin-A (O), paeonimetabolin-I (PM-I), liquiritigenin (L), isoliquiritigenin (IL) and glycyrrhetinic acid (GA) by HIF. The contents of the metabolites in Huangqin-Tang and in each single herb decoction increased significantly after incubation with intestinal flora. Comparing with single herb decoctions, the transformation of BG, WG, OG, LG and ILG in the compound prescription was promoted, however, that of PF and GL was inhibited. All the results suggested that the glycosides of many medicinal herbs could be converted to aglycones by HIF, and the metabolism of most glycosides was improved in the compound prescription.

Area Under Curve↗
PubMed2001

[Cellular mechanism of seizure discharge and its normalization by a herbal mixture prescription "saikokeishito-ka-shakuyaku" (SK)].

Epilepsy is one of the most frequently occurring nervous diseases. However, the fundamental cause of epilepsy is still unclear. We tried to elucidate the cellular mechanism of seizure discharge. During this research we unexpectedly found that a herbal mixture prescription shows very good effects on epileptics. Therefore, we also performed experiments on the anticonvulsant mechanism of this herbal mixture prescription, "Saikokeishito-ka-Shakuyaku" (SK). SK showed normalizing effects on intracellular calcium-related and protein-related pathological changes induced by pentylenetetrazol (PTZ) application in snail neurons and cultured neurons from the cerebral cortex of mice. In addition, SK showed marked protective effects against neuron damage induced by the cobalt focus epilepsy model, cytochalasin B and severe stress. SK also showed normalizing effects on developmental defects of cultured neurons from the cerebral cortex of an epilepsy animal model, EL mice. Moreover, SK showed complete preventive effects on the abnormal expression of one of the seizure-related (SEZ) genes, PTZ-17, induced by PTZ in Xenopus oocytes injected with PTZ-17 RNA. We also determined mouse chromosomal loci of the SEZ gene group and PTZ sensitive trait loci by linkage analysis for comparison with human synteny of epileptic families. The above-mentioned findings suggest that some herbal prescriptions will become promising drugs for the therapy against intractable nervous diseases which can not be ameliorated by pure chemical drugs in the future.

Animals↗