1例卵巢癌伴脑转移患者的疼痛治疗方案调整与分析

摘 要 目的：通过分析1例卵巢癌伴脑转移患者疼痛的治疗方案,为临床药师参与该类型的疼痛治疗提供借鉴和参考。方法: 对患者进行全面和动态评估,查阅相关文献和指南,协助医师调整镇痛方案。结果: 在综合考虑患者的临床疾病、疼痛特征及程度、心理状况等多方面因素后,镇痛方案最终调整为以强阿片类药物为基础,联合使用三环类抗抑郁药和抗惊厥药物,同时加用激素类药物,使得该患者得到有效的镇痛治疗,同时避免不良反应的发生。结论: 卵巢癌伴脑转移引起的疼痛往往比较严重且难治,临床药师需对患者进行全面和动态的评估,规范阿片类药物滴定过程,同时结合患者的疼痛情况合理使用辅助药物,最终达到尽快控制疼痛,提高患者生存质量的目标。     

1例肺炎并发急性脓胸患者的病例分析

摘 要 目的：探讨1例由肺炎引起的急性脓胸患者抗菌药物使用、镇痛药选择以及胸腔内纤溶治疗的合理性。 方法: 临床药师参与1例肺炎并发急性脓胸患者的药物治疗方案分析与调整,充分考虑患者感染症状、体征的变化、疼痛耐受程度以及胸腔积液的性质,提出自己的观点,建议医师选用或停用相关药物,推荐合理化的治疗方案。 结果: 临床药师协助医师制订最佳用药方案,使患者得到及时、有效的治疗。结论:临床药师应发挥自身优势,积极帮助医生解决实际问题,做到个体化用药。     

临床药师参与1例尖端扭转型室速患者的治疗实践

摘 要 目的：探究临床药师参与ICU危重症患者抢救的药学实践切入点。方法: 通过参与1例尖端扭转型室速患者的药物治疗,结合患者既往用药史,协助医师快速诊断药源性疾病并制定用药方案,针对患者心律失常、电解质紊乱及抗感染治疗过程中的用药情况开展药学监护。结果: 通过全程药学监护保障患者药物治疗的有效性和安全性,患者各项生命体征、临床指标显著好转,顺利转出ICU。结论:临床药师参与重症患者抢救过程中应充分发挥专业特色,使用药学思维协助医师制定合理的药物方案,保障临床用药的安全有效。     

1例脑胶质瘤切除术后肺部感染患者的药学监护

摘 要 目的：研究ICU重症感染患者的药学监护重点。方法: 通过参与1例脑胶质瘤切除术后肺部感染患者的药物治疗,结合患者病史、临床症状和实验室检查,协助医师制订用药方案并针对抗感染治疗、镇静镇痛、抗血小板治疗以及用药过程中的药物相互作用、注意事项以及药品不良反应进行全程药学监护。结果: 通过全程药学监护提高了患者药物治疗的安全性和有效性,患者各项生命体征平稳,抗感染治疗有效,顺利转出ICU继续巩固治疗。结论:临床药师在参与临床药物治疗过程中,应根据患者具体情况协助医师制订合理有效的个体化用药方案,为患者提供专业、有效、优质的药学服务。     

临床药师参与1例曲妥珠单抗致不良反应治疗方案的制定

摘 要 目的： 探索临床药师参与药物治疗方案的制定。方法: 临床药师开展药学查房,通过对1名乳腺癌术后化疗继发肺炎患者询问用药史,考虑由曲妥珠单抗引起的非感染性肺浸润可能性大,结合药品说明书、相关文献及个案报道,及时向医师提出用药建议,参与患者药物治疗方案的制定。结果: 医师采纳临床药师意见,患者在使用甲泼尼龙琥珀酸钠后第2日,症状好转,影像学检查也趋于好转,未再复发。结论:临床药师参与临床用药方案的制定,对于提高临床治疗水平具有重要意义。     

临床药师参与1例胃癌术后腹腔感染合并蜂窝组织炎患者的药学监护

目的 通过临床药师参与1例胃癌术后腹腔感染合并蜂窝组织炎患者的治疗,探讨术后感染治疗的药物选择及药学监护与对患者的用药教育。方法 临床药师从药学角度结合临床实际去思考患者的药物选择,在治疗过程中,与医师沟通、协助医师优化治疗方案,对患者进行用药教育等方式,参与患者的药学监护过程。结果 在临床药师的干预下,医师更改用药方案,在一定程度上促使患者感染症状得到有效控制,病情逐渐好转至出院。结论 临床药师结合专业知识选择最优的抗菌药物方案治疗术后感染,给予患者全方位药学监护,体现了药师在药学监护中的重要性。     

临床药师参与1例门冬胰岛素诱发自身免疫性低血糖的治疗分析

摘 要 目的： 为临床药师参与治疗药物致自身免疫性低血糖提供参考。方法: 临床药师参与了1例门冬胰岛素诱发自身免疫性低血糖的治疗,分析治疗方案并提出建议,提供药学服务。结果: 临床药师的建议被采纳,患者病情好转出院。结论:临床药师能协助医师制定安全、有效的治疗方案,给患者提供良好的药学监护与用药教育。     

临床药师参与一例晚期肿瘤患者疼痛治疗的案例分析

目的 临床药师参与癌痛患者止痛治疗,为患者提供药学服务,保障临床安全、合理用药。方法 根据癌症晚期患者疼痛治疗原则及疼痛特点,对患者进行疼痛评估、用药教育、药学监护,并分析可能存在的药物相互作用。结果 根据三阶梯治疗原则,通过全面评估患者疼痛,加用辅助药物协同镇痛,使患者疼痛得到有效控制。同时,临床药师在患者服药期间和减量过程中均进行用药指导,对药物不良反应进行监护,发现可能存在的药物相互作用,向临床医生提出合理建议并被采纳,使患者在有效镇痛的同时得到用药安全保障。结论 临床药师参与临床疼痛治疗,为患者提供药学服务,有效地协助临床医生用药,使用药更加安全,极大地提高了患者的满意度和生活质量。     

临床药师参与1例重症医院获得性肺炎患者的治疗实践与体会

摘 要 目的： 小结临床药师参与1例医院获得性肺炎患者临床药物治疗实践的实践与体会。方法: 临床药师在治疗过程中,从药物选择、方案调整以及降阶梯治疗等方面提出优化建议。结果: 医师采纳临床药师提出的抗感染治疗药物及剂量调整建议,经治疗患者体温恢复正常,生命体征平稳,感染得到有效控制。 结论:临床药师要以自己的专业特长参与到治疗方案的优化调整中,特别关注老年、危重患者的用药安全,为临床安全合理用药提供技术支持与保障。     

1例类风湿性关节炎合并重症肺炎患者的药学监护

摘 要 目的：探讨临床药师在临床药物治疗中的药学监护和作用。方法: 临床药师参与1例类风湿性关节炎合并重症肺炎患者的临床药物治疗,从抗感染治疗方案的调整、药物的选择到疗效评估和药物不良反应监护等方面给出合理化建议。结果: 临床药师全程参与该患者的药物治疗,医师采纳临床药师提出的抗感染治疗药物的选择、剂量调整以及药物不良反应处置的建议。结论:临床药师发挥自身专业特长,在药物治疗方案优化调整中起到积极作用,为患者用药安全及临床合理用药提供了保障。     

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.