某院3种预防剖宫产术后感染方案的成本-效果分析

目的:评价3种用药方案预防剖宫产术后感染的成本-效果。方法:采用药物经济学的成本-效果分析法,对某院2012年1月至2012年8月随机抽查的141例产科剖宫产术后3种预防感染方案(A:美洛西林钠舒巴坦钠+妥布霉素;B:哌拉西林钠他唑巴坦钠+妥布霉素;C:头孢他啶),进行回顾性分析评价。结果:3种方案成本(C,元)分别为322.8、327.6、153.6,有效率(E,%)分别为88.52%、88.37%、91.89%,成本效果比(C/E)分别为3.65、3.71、1.67。A、B方案相对于C方案的增量成本-效果比(△C/△E)分别为-50.21、-49.43,所以C组方案(头孢他啶)为最佳方案。结论:C方案预防剖宫产术后感染较为经济、合理。     

3种抗生素治疗婴幼儿支气管肺炎的成本-效果分析

目的:分析3种抗生素治疗婴幼儿支气管肺炎的成本-效果。方法:78例支气管肺炎患儿,随机分为A、B、C3组,分别给予头孢唑啉钠、头孢曲松钠和头孢他啶3种抗菌素,计算比较3组的总有效(E)、总成本(C)、成本-效果(C/E),以A、B、C3组分别作为参照标准计算增加成本-效果(ΔC/ΔE)。结果:3组总有效率分别为84.6%,88.5%和92.3%;总成本分别为25.2元,165.2元和277.2元;成本-效果分别为0.3,1.9和3.0;达到相同的治疗效果所需追加的成本C组最低。结论:使用头孢他啶治疗婴幼儿支气管肺炎其经济性与合理性优于头孢唑啉钠和头孢曲松钠,有临床推广使用的意义。     

肺癌化疗过程中4种止吐方案的成本-效果分析

目的:比较4种止吐方案对预防肺癌化疗所致呕吐的成本-效果。方法:对120例接受含顺铂化疗的肺癌患者分为4组,分别用昂丹司琼(A组)、托烷司琼(B组)、雷莫司琼(C组)、甲氧氯普胺(D组)预防化疗所致呕吐,观察其疗效并进行成本-效果分析。结果:4组止吐有效率分别为87.3%、92.7%、90.7%、61.3%,成本-效果比分别为684.77、906.37、222.33、45.02;以D组为参照,A、B、C组的增量成本-效果比分别为2193.08、2587.90、592.01。结论:应用雷莫司琼是较为合理的治疗方案。     

3种丹参制剂治疗冠心病心绞痛的成本-效果分析

目的:比较3种丹参制剂治疗冠心病心绞痛的成本-效果。方法:将137例符合诊断标准的病例,分别采用3种给药方案治疗:方案A给予丹参酮ⅡA磺酸钠注射液;方案B给予丹参注射液;方案C给予注射用丹参无菌粉末,均每天1次静脉滴注。治疗14d后观察疗效,并运用成本-效果法进行分析。结果:3组心绞痛改善总有效率分别为86.96%、70.21%、86.36%。成本分别为4896.23、3502.33、3807.25元,成本-效果比分别为5630.44、4988.36、4408.58。结论:C组方案治疗冠心病心绞痛成本-效果比更优。     

急性脑梗死3种药物治疗方案的成本-效果分析

目的:比较3种治疗急性脑梗死(ACI)用药方案的成本-效果。方法:123例ACI患者分别采用3种给药方案治疗,方案Ⅰ为奥扎格雷钠注射液,方案Ⅱ为银杏达莫注射液,方案Ⅲ为奥扎格雷钠注射液+银杏叶注射液,运用药物经济学方法进行成本-效果分析。结果:3种方案治疗成本分别为9766.51元、5562.22元、8273.05元,显效率分别为36.84%、32.50%、71.11%,成本-效果比分别为265.11、171.15、116.34。结论:方案Ⅲ为较佳治疗方案。     

剖宫产术后不同抗菌药物预防用药方案的成本-效果分析

目的:评价4种抗菌药物用药方案预防剖宫产术后感染的成本-效果。方法:对我院1066例产科剖宫产术后应用A(头孢哌酮钠/舒巴坦钠+甲硝唑)、B(氨苄西林钠/舒巴坦钠+甲硝唑)、C(头孢拉定+甲硝唑)、D(头孢哌酮钠/舒巴坦钠)4种方案预防感染,进行回顾性成本-效果分析。结果:4种方案成本分别为4954.13、4752.77、3870.16、3988.22元;有效率分别为98.5%、87.4%、84.6%、96.8%;成本-效果比分别为50.30、54.38、45.75、41.20;A、B、D方案相对于C方案的增量成本-效果比分别为77.98、315.22、9.68。结论:D方案预防剖宫产术后感染较为经济、合理。     

莆田市农村妇女增补叶酸预防出生缺陷效果分析

目的 为了解实施国家重大公共卫生项目《农村妇女增补叶酸预防神经管缺陷》后,对降低神经管缺陷等出生缺陷发生率的干预效果分析,为制定降低出生缺陷措施提供依据.方法 2009~2015年莆田市农村妇女于孕前和孕早期3个月免费给予小剂量(1日0.4mg)叶酸补充,采用莆田市20所医院出生缺陷监测资料分析增补叶酸与出生缺陷发生率变化的关系.结果 ①通过项目实施后,2015年全市农村妇女免费增补叶酸服用率达92.15%,叶酸服用依从率达79.68%,增补叶酸预防神经管缺陷知识知晓率达95.63%.②服用叶酸与神经管缺陷发生率关系密切,7年间呈逐年快速下降,下降幅度达92.42%.在监测的20类出生缺陷中主要有唇腭裂、先天性脑水肿发生率呈现不同程度下降,而先天性心脏病、先天性膈疝发生率呈上升趋势.结论 农村妇女于孕前和孕早期3个月增补叶酸对降低神经管缺陷发生效果明显,可能也是唇腭裂、先天性脑水肿等出生缺陷发生率下降的影响因素之一;服用叶酸预防神经管缺陷效果不仅取决于服用的时间,更重要的是取决于服用的依从率〔1〕,加强宣教和随访工作,提高叶酸服用依从率.探索增补叶酸长效机制,以期进一步降低神经管缺陷等出生缺陷发生率,提高出生人口素质.     

格拉司琼与恩丹西酮预防化疗后恶心、呕吐的成本-效果分析

目的 :比较格拉司琼与恩丹西酮预防化疗后恶心呕吐的疗效、不良反应及成本 -效果。方法 :以相关疗效指标及药物经济学成本 -效果分析法进行评价 ,观察药物不良反应。结果 :格拉司琼预防化疗后恶心、呕吐的有效率分别为83 6 %和86 8 %,每化疗周期人均费用为210 48元 ,成本 -效果比分别为251 77和242 37 ;恩丹西酮的有效率分别为72 9 %和83 7 %,每化疗周期人均费用为381 35元 ,成本 -效果比分别为523 11和456 62。两组患者均未发现不良反应。结论 :格拉司琼能有效地预防化疗后的恶心、呕吐 ,成本 -效果比优于恩丹西酮。     

出生缺陷二级预防策略模型的敏感性分析

采用决策树模型对出生缺陷二级预防策略中的参数变化进行分析,结果表明孕妇筛查接受率、超声筛查灵敏度是影响模型效果的敏感因素。实际筛查工作中,应提高孕妇的筛查接受率与超声筛查和诊断水平,以提高缺陷儿的检出率,降低出生缺陷的出生率。     

奥美拉唑、兰索拉唑和泮托拉唑预防重症脑卒中患者应激性溃疡的成本-效果分析

目的 探讨3种质子泵抑制剂预防重症脑卒中患者应激性溃疡的成本-效果.方法 310 例重症脑卒中患者随机分为3组;A组105例,B组102例,C 组103例.3组均予常规治疗,A组采用奥美拉唑预防,B组采用兰索拉唑预防,C组采用泮托拉唑预防.比较各组的溃疡发生率、医院获得性肺炎发病率和总病死率,并进行成本-效果分析.结果 3组溃疡发生率、预防应激性溃疡出血的有效率比较差异无统计学意义（ P＞0.05）.与B组和C组比较,A组医院获得性肺炎发病率较高,差异有统计学意义（P＜0.05）;A组、C组病死率比较差异有统计学意义（P＜0.05）,B组和C组比较差异无统计学意义（P＞0.05）.3组成本-效果分别为23.5,23.1和11.4.结论 泮托拉唑成本效果优于奥美拉唑和兰索拉唑.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.