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Griffith ST, Conrow KD, Go M, McEntee ML, Daniulaityte R, Nadesan MH, Swinburne MR, Shill HA, Leung MCK. Cannabis use in Parkinson's disease: Patient access to medical cannabis and physician perspective on product safety. Neurotoxicology 2024; 103:198-205. [PMID: 38834158 DOI: 10.1016/j.neuro.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
The rate of medical cannabis use has increased in parallel with the number of states legalizing its use. Parkinson's disease (PD) patients are of particular concern due to their higher cannabis use rate than in the general US population (25-40 % PD patient cannabis users vs. ∼18 % in the general population), as well as their susceptibility to environmental contaminants in cannabis, including pesticides, toxic elements, solvents, microbes, and mycotoxins. In order to address the complex nature of this industry, we examined the changes in PD-related qualifying conditions in the U.S. from 2019 to 2023. We also conducted an online survey to gain insight into the knowledge, risk perceptions, and opinions regarding medical cannabis and contamination issues from physicians who treated PD patients. The number of states including PD-related qualifying conditions increased over the past 5 years from 28 to 36 states. These conditions included PD (increasing from 14 to 16 states), muscle spasms (14 to 24), anxiety (1 to 5), and pain (17 to 35). State-by-state comparisons revealed high variability in the language used to describe the different qualifying conditions. Online surveys were sent out to 45 neurologists and movement disorder specialists who primarily treated PD patients. The response rate was 44 % from nine states (AZ, CA, FL, MA, MN, WI, PA, IL, and NM). When asked if they were aware of any contaminants in cannabis products, we found that 65 % of the physicians were unaware of any contaminants commonly found in cannabis and only 25 %, 15 %, and 15 % of them were aware of pesticide, toxic element, and solvent contaminants, respectively. In their free-text opinion response on the health impact of cannabis-borne contaminants, "long-term effect" (35 %) and "comorbidities and PD prognosis" (40 %) were identified as the two most common themes. These results point to the need for further regulatory deliberation regarding risks and susceptibility to cannabis contaminants. Additionally, education is needed to inform physicians on cannabis safety issues. Further research will identify the implementation strategies to reduce contaminant exposure and protect patient health.
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Affiliation(s)
- Symone T Griffith
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States; ASU-Banner Neurodegenerative Disease Research Center, Arizona State University, Tempe, AZ, United States
| | - Kendra D Conrow
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ, United States
| | - Michael Go
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA
| | - Mindy L McEntee
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Raminta Daniulaityte
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Majia H Nadesan
- School of Social and Behavioral Sciences, Arizona State University, Glendale, AZ, United States
| | - Mathew R Swinburne
- Francis King Carey School of Laws, University of Maryland, Baltimore, MD, United States
| | - Holly A Shill
- Muhammad Ali Parkinson Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Maxwell C K Leung
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States; ASU-Banner Neurodegenerative Disease Research Center, Arizona State University, Tempe, AZ, United States; School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ, United States.
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Davis AP, Wiegers TC, Wiegers J, Wyatt B, Johnson RJ, Sciaky D, Barkalow F, Strong M, Planchart A, Mattingly CJ. CTD tetramers: a new online tool that computationally links curated chemicals, genes, phenotypes, and diseases to inform molecular mechanisms for environmental health. Toxicol Sci 2023; 195:155-168. [PMID: 37486259 PMCID: PMC10535784 DOI: 10.1093/toxsci/kfad069] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
The molecular mechanisms connecting environmental exposures to adverse endpoints are often unknown, reflecting knowledge gaps. At the Comparative Toxicogenomics Database (CTD), we developed a bioinformatics approach that integrates manually curated, literature-based interactions from CTD to generate a "CGPD-tetramer": a 4-unit block of information organized as a step-wise molecular mechanism linking an initiating Chemical, an interacting Gene, a Phenotype, and a Disease outcome. Here, we describe a novel, user-friendly tool called CTD Tetramers that generates these evidence-based CGPD-tetramers for any curated chemical, gene, phenotype, or disease of interest. Tetramers offer potential solutions for the unknown underlying mechanisms and intermediary phenotypes connecting a chemical exposure to a disease. Additionally, multiple tetramers can be assembled to construct detailed modes-of-action for chemical-induced disease pathways. As well, tetramers can help inform environmental influences on adverse outcome pathways (AOPs). We demonstrate the tool's utility with relevant use cases for a variety of environmental chemicals (eg, perfluoroalkyl substances, bisphenol A), phenotypes (eg, apoptosis, spermatogenesis, inflammatory response), and diseases (eg, asthma, obesity, male infertility). Finally, we map AOP adverse outcome terms to corresponding CTD terms, allowing users to query for tetramers that can help augment AOP pathways with additional stressors, genes, and phenotypes, as well as formulate potential AOP disease networks (eg, liver cirrhosis and prostate cancer). This novel tool, as part of the complete suite of tools offered at CTD, provides users with computational datasets and their supporting evidence to potentially fill exposure knowledge gaps and develop testable hypotheses about environmental health.
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Affiliation(s)
- Allan Peter Davis
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Thomas C Wiegers
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Jolene Wiegers
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Brent Wyatt
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Robin J Johnson
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Daniela Sciaky
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Fern Barkalow
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Melissa Strong
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Antonio Planchart
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - Carolyn J Mattingly
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27695, USA
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Willow J, Silva AI, Taning CNT, Smagghe G, Veromann E. Towards dsRNA-integrated protection of medical Cannabis crops: considering human safety, recent- and developing RNAi methods, and research inroads. PEST MANAGEMENT SCIENCE 2023; 79:1267-1272. [PMID: 36514999 DOI: 10.1002/ps.7323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Owing to the expanding industry of medical Cannabis, we discuss recent milestones in RNA interference (RNAi)-based crop protection research and development that are transferable to medical Cannabis cultivation. Recent and prospective increases in pest pressure in both indoor and outdoor Cannabis production systems, and the need for effective nonchemical pest control technologies (particularly crucial in the context of cultivating plants for medical purposes), are discussed. We support the idea that developing RNAi tactics towards protection of medical Cannabis could play a major role in maximizing success in this continuously expanding industry. However, there remain critical knowledge gaps, especially with regard to RNA pesticide biosafety from a human toxicological viewpoint, as a result of the medical context of Cannabis product use. Furthermore, efforts are needed to optimize transformation and micropropagation of Cannabis plants, examine cutting edge RNAi techniques for various Cannabis-pest scenarios, and investigate the combined application of RNAi- and biological control tactics in medical Cannabis cultivation. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Jonathan Willow
- Chair of Plant Health, Estonian University of Life Sciences, Tartu, Estonia
| | - Ana I Silva
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Neuroscience and Mental Health Research Institute, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Clauvis Nji Tizi Taning
- Department of Plants and Crops, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Guy Smagghe
- Department of Plants and Crops, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Eve Veromann
- Chair of Plant Health, Estonian University of Life Sciences, Tartu, Estonia
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Quantitative determination of pesticides in human plasma using bio-SPME-LC-MS/MS: a robust tool to assess occupational exposure to pesticides. Anal Bioanal Chem 2023:10.1007/s00216-023-04589-8. [PMID: 36840808 DOI: 10.1007/s00216-023-04589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/26/2023]
Abstract
Analysis of biofluids, such as plasma, can be used to investigate occupational pesticide exposure in the agricultural industry. Considering the chemical complexity and variability of plasma samples, any protocol for pesticide analysis should achieve efficient sample cleanup to minimize matrix effects and enhance method sensitivity through analyte pre-concentration. In this work, a high-throughput method was developed for analysis of 79 pesticides, commonly used in agricultural practices, in human plasma, using biocompatible solid-phase microextraction (SPME) coupled to liquid chromatography-tandem mass spectrometry. An SPME method was developed using a biocompatible hydrophilic-lipophilic balance/polyacrylonitrile (HLB/PAN) extraction phase and demonstrated negligible matrix effects. The performance of the developed SPME method was compared to a QuEChERS -Quick, Easy, Cheap, Effective, Rugged, and Safe- method, the most common sample preparation and cleanup approach for pesticide analysis in complex matrices. Comparable accuracy and precision were achieved for both methods, with accuracy values within 70-120% and relative standard deviation < 15%. Overall, the developed SPME and QuEChERS methods extracted 79 out of 82 monitored pesticides in human plasma. The SPME protocol demonstrated higher sensitivity than the QuEChERS method and a drastic reduction of matrix effects.
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Seltenrich N. What's in Your Gummy? State Cannabis Contaminant Rules Vary Widely. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:104001. [PMID: 36306206 PMCID: PMC9616122 DOI: 10.1289/ehp12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
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Davis AP, Wiegers TC, Johnson RJ, Sciaky D, Wiegers J, Mattingly C. Comparative Toxicogenomics Database (CTD): update 2023. Nucleic Acids Res 2022; 51:D1257-D1262. [PMID: 36169237 PMCID: PMC9825590 DOI: 10.1093/nar/gkac833] [Citation(s) in RCA: 143] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 01/30/2023] Open
Abstract
The Comparative Toxicogenomics Database (CTD; http://ctdbase.org/) harmonizes cross-species heterogeneous data for chemical exposures and their biological repercussions by manually curating and interrelating chemical, gene, phenotype, anatomy, disease, taxa, and exposure content from the published literature. This curated information is integrated to generate inferences, providing potential molecular mediators to develop testable hypotheses and fill in knowledge gaps for environmental health. This dual nature, acting as both a knowledgebase and a discoverybase, makes CTD a unique resource for the scientific community. Here, we report a 20% increase in overall CTD content for 17 100 chemicals, 54 300 genes, 6100 phenotypes, 7270 diseases and 202 000 exposure statements. We also present CTD Tetramers, a novel tool that computationally generates four-unit information blocks connecting a chemical, gene, phenotype, and disease to construct potential molecular mechanistic pathways. Finally, we integrate terms for human biological media used in the CTD Exposure module to corresponding CTD Anatomy pages, allowing users to survey the chemical profiles for any tissue-of-interest and see how these environmental biomarkers are related to phenotypes for any anatomical site. These, and other webpage visual enhancements, continue to promote CTD as a practical, user-friendly, and innovative resource for finding information and generating testable hypotheses about environmental health.
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Affiliation(s)
- Allan Peter Davis
- To whom correspondence should be addressed. Tel: +1 919 515 5705; Fax: +1 919 515 3355;
| | - Thomas C Wiegers
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Robin J Johnson
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Daniela Sciaky
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Jolene Wiegers
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Carolyn J Mattingly
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA,Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695, USA
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Simple Extraction of Cannabinoids from Female Inflorescences of Hemp ( Cannabis sativa L.). MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27185868. [PMID: 36144607 PMCID: PMC9504406 DOI: 10.3390/molecules27185868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
The high interest in non-psychoactive cannabidiol increases the need for efficient and straightforward cannabidiol (CBD) extraction methods. The research aimed to compare simple methods of cannabinoid extraction that do not require advanced laboratory equipment. This work assesses the content of total CBD and Δ9-tetrahydrocannabinol (Δ9-THC) in popular solvents such as water and ethanol extracts. Hemp raw material was analyzed with Gas Chromatography with a Flame Ionization Detector (GC-FID), while extracts were tested by High-Performance Liquid Chromatography (HPLC). The female inflorescences of three varieties of industrial hemp were tested: Futura 75, KC Dora, and Tygra (different sowing and N fertilization densities). Tygra (T/10/30) showed the highest content of CBD (0.064%) in water extracts. However, in 80% tincture from Futura 75 (F/30/30), a higher CBD content of 1.393% was observed. The use of 96% ethanol for extraction and ultrasound enabled the highest CBD content to be obtained: 2.682% in Futura 75 (F/30/30). Cold water extraction showed no effect on Δ9-THC content, while hot water extraction increased content from 0.001% in KC Dora to 0.002% in Futura 75 (F/30/30) and Tygra, but the changes were statistically insignificant. Application of 80% ethanol revealed the significantly highest content of Δ9-THC in KC Dora, from 0.026% (K/30/90) to 0.057% (K/30/30), as well as in Tygra (T/30/30) (0.036%) and Futura 75 (F/30/30) (0.048%). The use of ethanol extraction in combination with ultrasound could be an efficient method of obtaining cannabinoids.
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Jameson LE, Conrow KD, Pinkhasova DV, Boulanger HL, Ha H, Jourabchian N, Johnson SA, Simeone MP, Afia IA, Cahill TM, Orser CS, Leung MC. Comparison of State-Level Regulations for Cannabis Contaminants and Implications for Public Health. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:97001. [PMID: 36102653 PMCID: PMC9472674 DOI: 10.1289/ehp11206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND The presence of contaminants in cannabis presents a potential health hazard to recreational users and susceptible patients with medical conditions. Because of the federally illegal status of cannabis, there are no unified regulatory guidelines mitigating the public health risk of cannabis contaminants. OBJECTIVE To inform further research and provide solutions to the public health risk of cannabis contaminants at a national level, we examined the current landscape of state-level contaminant regulations, and cannabis contaminants of concern, as well as patient populations susceptible to contaminants. METHODS We examined the regulatory documents for medical and recreational cannabis in all legalized U.S. jurisdictions and compiled a complete list of regulated contaminants, namely, pesticides, inorganics, solvents, microbes, and mycotoxins. We data mined the compliance testing records of 5,654 cured flower and 3,760 extract samples that accounted for ∼6% of California's legal cannabis production in 2020-2021. We also reviewed the publicly available medical cannabis use reports to tabulate the susceptible patient populations. RESULTS As of 18 May 2022, 36 states and the District of Columbia listed a total of 679 cannabis contaminants as regulated in medical or recreational cannabis, including 551 pesticides, 74 solvents, 12 inorganics, 21 microbes, 5 mycotoxins, and 16 other contaminants. Different jurisdictions showed significant variations in regulated contaminants and action levels ranging up to four orders of magnitude. A failure rate of 2.3% was identified for flowers and 9.2% for extracts in the California samples. Insecticides and fungicides were the most prevalent categories of detected contaminants, with boscalid and chlorpyrifos being the most common. The contaminant concentrations fell below the regulatory action levels in many legalized jurisdictions, indicating a higher risk of contaminant exposure. Cannabis use reports indicated usage in several patient populations susceptible to contamination toxicity, including cancer (44,318) and seizure (21,195) patients. DISCUSSION Although individual jurisdictions can implement their policies and regulations for legalized cannabis, this study demonstrates the urgent need to mitigate the public health risk of cannabis contamination by introducing national-level guidelines based on conventional risk assessment methodologies and knowledge of patients' susceptibility in medical use. https://doi.org/10.1289/EHP11206.
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Affiliation(s)
- Laura E. Jameson
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
| | - Kendra D. Conrow
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
| | - Dorina V. Pinkhasova
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
- Pharmacology and Toxicology Program, New College of Interdisciplinary Arts and Sciences, ASU, Glendale, Arizona, USA
| | - Haleigh L. Boulanger
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
- Biological Data Science Program, New College of Interdisciplinary Arts and Sciences, ASU, Glendale, Arizona, USA
| | - Hyunji Ha
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
- Biological Data Science Program, New College of Interdisciplinary Arts and Sciences, ASU, Glendale, Arizona, USA
| | | | | | | | | | - Thomas M. Cahill
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
| | - Cindy S. Orser
- ASU Library Data Science and Analytics, ASU, Tempe, Arizona, USA
| | - Maxwell C.K. Leung
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
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Zhang X, Xu P, Lin B, Deng X, Zhu J, Chen X, Liu S, Li R, Wang N, Chen L. Chimonanthus salicifolius attenuated vascular remodeling by alleviating endoplasmic reticulum stress in spontaneously hypertensive rats. Food Funct 2022; 13:6293-6305. [PMID: 35611700 DOI: 10.1039/d1fo04381a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chimonanthus salicifolius (CS), the leaves of Chimonanthus salicifolius S. Y. Hu., is an effective tea to prevent and treat hypertension in China. This study aimed to explore the effect and mechanism of CS in the protection against vascular remodeling in hypertension. Spontaneously hypertensive rats (SHRs) were orally administered with aqueous extracts of CS for 6 months. The blood pressure and morphological changes of the aorta were measured. Their mechanisms were studied by combining chemical identification, network pharmacology analysis and validation in vivo. Hypertensive rats showed an impaired vascular structure and dyslipidemia as illustrated by the increase of the vascular media thickness and collagen deposition in the aorta. CS treatment exhibited significant beneficial effects on blood pressure control and aortal morphology. A total of 21 compounds from CS were identified, which were linked to 106 corresponding targeted genes for vascular remodeling. The network pharmacology predicted that CS prevented vascular remodeling through the endoplasmic reticulum stress pathway. The in vivo experiments further showed that CS treatment upregulated Glucose-Regulated Protein 78 and downregulated CCAAT-enhancer-binding protein homologous protein at both mRNA and protein levels, paralleling reduced apoptotic cells in the arterial wall. Additionally, CS diminished the low-density lipoprotein cholesterol levels, total cholesterol contents and triglyceride/high-density lipoprotein cholesterol ratios in the sera of SHRs, which might also contribute to its protection of vessels. Collectively, CS protects against vascular modeling by suppressing endoplasmic reticulum stress-related apoptosis in hypertension, and it could be a potential agent for the prevention and treatment of vascular modeling.
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Affiliation(s)
- Xiaoqin Zhang
- Department of Pharmacy, Lishui hospital of traditional Chinese medicine, Lishui, Zhejiang, 323000, China.
| | - Pingcui Xu
- Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310007, China.
| | - Bingfeng Lin
- Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310007, China.
| | - Xuehui Deng
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310007, China.
| | - Jiazhen Zhu
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310007, China.
| | - Xinyi Chen
- Department of Pharmacy, Lishui hospital of traditional Chinese medicine, Lishui, Zhejiang, 323000, China.
| | - Shuang Liu
- Department of Pharmacy, Lishui hospital of traditional Chinese medicine, Lishui, Zhejiang, 323000, China.
| | - Rui Li
- Department of Pharmacy, Lishui hospital of traditional Chinese medicine, Lishui, Zhejiang, 323000, China.
| | - Nani Wang
- Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310007, China. .,School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310007, China.
| | - Liping Chen
- Department of Pharmacy, Lishui hospital of traditional Chinese medicine, Lishui, Zhejiang, 323000, China. .,School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310007, China.
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