临床药师参与脓毒症休克患者继发泛耐药鲍曼不动杆菌感染的病例分析

摘要：本文旨在探讨临床药师参与耐药菌感染药学监护模式及在抗感染治疗中的作用。临床药师参与1例脓毒症休克患者继发泛耐药鲍曼不动杆菌（XDR-AB）感染的治疗,结合相关指南和文献报道,综合抗菌药物的药动学/药效学（PK/PD）特点,从抗菌药物品种选择、剂量、疗程、给药方式及不良反应等方面开展临床药学服务,协助临床医师制订抗感染方案,最终患者感染得到有效控制。临床药师利用药学知识,协助临床制订抗感染治疗方案,对XDR-AB感染患者实施精准药学监护,提高脓毒症休克及XDR-AB感染药物治疗的有效性和安全性,提高患者生存率,体现临床药师自身价值。     

基于PK/PD理论优化1例脓毒性休克患者抗感染治疗方案的病例分析

目的 探讨亚胺培南/西司他丁钠持续输注给药方案用于脓毒性休克合并急性肾损伤患者的疗效及临床药师参与药物治疗方案的作用。方法 临床药师参与1例脓毒性休克合并急性肾损伤且未行持续肾替代治疗患者的抗菌药物治疗,基于抗菌药物PK/PD特性及脓毒性休克患者的病理生理学改变对抗菌药物药动学(PK)/药效学(PD)参数的影响方面,分析亚胺培南/西司他丁钠持续输注给药及剂量调整对药物治疗有效性及安全性的影响。结果 结合患者病理生理学状态,并且根据亚胺培南/西司他丁钠PK/PD特性和静脉输注方法的循证医学依据,调整亚胺培南/西司他丁钠给药剂量、给药间隔和静脉输注方法,可获得满意的治疗效果。结论 临床药师依据抗菌药物PK/PD理论并结合脓毒性休克患者的病理生理学特点,参与药物治疗方案的制定及调整,可以提高药物治疗的疗效和安全性。     

1例脓毒症合并急性肾损伤患者的药学监护

摘要：临床药师参与1例脓毒症合并急性肾损伤患者的抗感染治疗,结合患者病理生理情况,在疾病治疗过程中协助制定抗感染方案,对抗菌药物的给药方式及治疗方案进行了优化,使感染得到有效控制,治疗有效。临床药师参与临床实践,优化药物治疗方案,为临床合理使用抗菌药物发挥积极的作用。     

1例尿毒症伴原发性肺淋巴瘤合并脓毒症患者的抗感染治疗分析与药学监护

临床药师参与1例尿毒症伴原发性肺淋巴瘤合并脓毒症患者的治疗，结合血液透析、残余肾功能、感染严重程度、抗菌药物的药动学/药效学、影像学与感染指标动态变化、文献资料等，制定了详细的个体化抗感染治疗方案，包括抗菌药物的选择、给药方案的优化等，使患者的感染得到有效控制。同时，通过实施药学监护，无明显不良反应发生，残余肾功能得到充分保护，患者得到安全有效的药物治疗，体现了临床药师的专业价值。     

基于药动学理论脓毒症患者替考拉宁个体化给药分析

目的 探讨临床药师利用药动学理论指导脓毒症患者替考拉宁个体化给药的可行性。方法 临床药师通过参与1例脓毒症抗感染治疗案例,结合监测结果和患者药动学分析,为临床提供药物处置对策和监护建议。结果 临床药师在2次会诊中,结合监测结果对患者进行抗菌药物药动学分析,提出替考拉宁个体化的处置对策和监护计划,保障个体化给药的实施。结论 临床药师对脓毒症患者药动学改变进行全面评估,配合治疗药物监测手段,能够辅助临床医生做好个体化用药工作。     

1例脓毒症休克合并急性肾功能不全患者使用美罗培南的药学实践

临床药师协助医师对1例脓毒症休克合并急性肾功能不全患者的美罗培南给药方案进行调整，建议采用缩短给药间隔以及采用两步滴定法给药。医师采纳临床药师建议，治疗取得良好效果，患者病情明显好转出院。     

脓毒症休克伴急性肾损伤新生儿抗菌药物剂量调整的个体化治疗实践

摘要：以1例脓毒症休克合并急性肾损伤新生儿为例,探讨临床药师在危重症患儿抗菌药物剂量调整中发挥的作用。临床药师综合分析了抗菌药物在脓毒症休克患儿体内药动学的改变及连续性肾脏替代治疗对抗菌药物清除作用的影响,协助医生上调美罗培南剂量至140 mg q12h,并延长其输注时间至4 h,同时监测万古霉素血药浓度并两次给出剂量调整建议。该患儿转归良好,未发生药品相关的严重不良反应。面对危重症新生儿抗感染治疗的挑战,临床药师发挥专长,开展治疗药物监测,给予个体化用药建议,可保障药物治疗的有效性及安全性。     

临床药师参与1例脑出血合并肺部感染患者的药学监护

目的探讨临床药师在脑出血合并肺部感染患者治疗过程中的药学服务方法。方法临床药师参与1例脑出血合并肺部感染患者的治疗过程,利用掌握的药学专业知识,与临床医师共同制定个体化给药方案。结果调整抗菌药物等药物给药方案,提高了临床药物治疗水平。结论临床药师应主动服务,根据指南,发挥药理学药动学优势开展药学监护。     

临床药师对外科髂窝脓肿患者治疗的药学监护

目的：探讨临床药师通过对髂窝脓肿患者治疗进行药学监护的要点,为临床提供合理用药建议。方法：针对1例外科髂窝脓肿病例,临床药师根据抗菌药物的抗菌谱及药代动力学特点为患者提供个体化给药及药品不良反应的分析,进行抗菌药物局部使用情况的探讨。结果：临床药师为髂窝脓肿患者选择了克林霉素联合单环口一内酰胺类抗菌药物氨曲南的抗感染治疗方案,并指出了庆大霉素＋甲硝唑局部冲洗的不规范使用,给予了合理化使用建议。结论：通过临床药师对患者的药学监护,为患者制定个体化给药方案,促进了临床合理用药。     

临床药师对脓毒症重症肺炎患儿抗感染治疗的药学监护

目的:通过参与脓毒症重症肺炎患儿抗菌药物治疗过程,探讨儿科临床药师在抗菌药物合理使用中如何发挥作用。方法:临床药师对1例脓毒症重症肺炎患儿进行抗菌药物治疗监护,在患儿入院初期根据患儿情况建议临床不采用哌拉西林/他唑巴坦联用万古霉素方案,治疗中建议调整哌拉西林/他唑巴坦治疗剂量,并对抗真菌药物如制霉菌素在儿童特殊人群的使用 等进行药学监护。结果:临床药师对抗菌药物治疗情况判断正确,处理得当,协助临床医师正确合理地使用了抗菌药物。结论:临床药师参与脓毒症重症肺炎患儿临床抗菌药物治疗,进行药学监护,可以提高抗菌药物治疗效果,减少不良反应发生。     

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.     

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.     

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.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.