达托霉素血浆浓度的UPLC-MS/MS法测定及其在重症患者体内药代动力学

建立测定血浆和置换液中达托霉素的高通量UPLC-MS/MS方法,采用Kinetex C₁₈色谱柱(50 mm×2.1 mm,1.7 μm),柱温45 ℃,流动相为含0.1%甲酸水溶液-乙腈,流速0.4 mL/min,电喷雾离子化正离子扫描模式下,达托霉素m/z 810.9→159.1;内标来曲唑m/z 286.2→217.2,分析时长2.5 min。达托霉素在血浆(1~200 μg/mL)和置换液(0.005~20 μg/mL)中均呈现良好的线性关系,日内及日间精密度、准确度、稳定性等均符合生物样品测定要求。静脉滴注6 mg/kg达托霉素在接受持续肾脏替代治疗(CRRT)治疗的感染性休克患者体内的c_max和AUC_0-24明显低于健康受试者,下降比例分别为50%和60%,未达到预期的杀菌效果。这可能与感染性休克患者毛细血管通透性增加联合间隙水肿,从而使药物的分布容积增加有关,此外,肾脏替代治疗模式可体外滤过约16%的达托霉素,导致剂量不足和感染治疗不彻底。研究结果推荐在接受CRRT治疗的感染性休克患者中使用达托霉素应适当增加剂量,且须对该类患者进行达托霉素治疗药物浓度监测。     

五味子乙素对阿霉素在大鼠体内的药代动力学影响

考察五味子乙素和阿霉素联合用药后对SD大鼠体内阿霉素药代动力学行为的影响。建立了LC-MS/MS法测定SD大鼠血浆中阿霉素及其主要代谢产物阿霉素醇,采用Agilent Eclipse XDB-C₁₈色谱柱(100 mm×2.1 mm,3.5 μm),流动相为0.1%甲酸水溶液和乙腈,梯度洗脱方式,电喷雾离子化正离子扫描模式下,离子对分别为m/z 544.2→397.3(阿霉素)、m/z 546.2→399.2(阿霉素醇)、m/z 528.2→381.2(柔红霉素,内标)。阿霉素在0.500~500 ng/mL,阿霉素醇在0.200~50.0 ng/mL范围内线性关系良好,精密度和准确度均符合要求,各浓度提取回收率和基质效应的变异系数均小于15%。阿霉素在单独给药和联合给药组的AUC_0-t分别为(605.69±145.84)和(564.53±23.99)ng·h/mL,阿霉素醇的AUC_0-t分别为(26.69±13.41)和(29.00±2.78)ng·h/mL。结果表明五味子乙素不影响阿霉素在SD大鼠体内的药代动力学行为。     

杜鹃素在大鼠体内的药动学研究

目的 研究杜鹃素在正常大鼠体内的药动学特征。方法 杜鹃素单剂量ig给予大鼠后,采用HPLC法测定给药后不同时间点大鼠血浆中的杜鹃素,通过DAS软件程序模拟计算,得出杜鹃素在大鼠体内相应的药动学参数。结果 杜鹃素在大鼠体内的药动学模型符合二室模型,主要药动学参数为：t_1/2α＝（0.33±0.10）h,t_1/2β＝（15.22±8.98）h,CL/F＝（14.89±3.45）L/(h?kg),C_max＝（1.61±0.14）mg/L,T_max＝（0.25±0.01）h,MRT_(0-t)＝（2.35±0.08）h,AUC_(0-t)＝（3.06±0.16）mg?h/L。结论 本研究建立的HPLC方法专属性强,简便、准确,可用于杜鹃素在大鼠体内的药动学研究;大鼠ig给予杜鹃素后,其在血浆中分布较快,半衰期较短。     

UPLC-MS/MS测定人血浆中咪达那新的浓度及其生物等效性研究

用UPLC-MS/MS测定人血浆中咪达那新的浓度，并应用于咪达那新片在中国健康受试者中的药代动力学及生物等效性研究。采用Acquity UPLC BEH C₈(2.1 mm×50 mm，1.7 μm)色谱柱，流动相A为2 mmol/L乙酸铵溶液(含0.2%乙酸)，B为乙腈，梯度洗脱。采用液液萃取的前处理方法减小血浆样品的基质效应。质谱条件为正离子模式，咪达那新和咪达那新-d10 的检测离子分别为m/z 320.2→238.1和m/z 330.2→248.2。临床试验采用单剂量双周期自身交叉试验设计，24例健康受试者空腹条件下口服咪达那新片参比制剂或受试制剂。使用上述检测方法检测生物样品中咪达那新的含量，后用DAS3.2.8软件进行药代动力学及生物等效研究。咪达那新在10.0~1 000 pg/mL范围内线性良好，低、中、高浓度的样品提取回收率分别为84.0%、88.0%、90.0%，基质效应分别为105%、100%、101%。参比及受试制剂的药代动力学参数c_max分别为524.8和612.6 pg/mL，t_max分别为1.250和1.063 h，AUC_0-∞分别为2 229和2 466 pg/mL·h，参比制剂及受试制剂生物等效。     

LC-MS/MS法测定人血浆中奈比洛尔浓度及其在中国人体内的药代动力学

本文建立了一种快速测定人血浆中奈比洛尔血药浓度的LC-MS/MS法,并研究其在中国健康人体内的药代动力学行为。以氨氯地平作为内标,采用C₁₈反相柱(150 mm×2.0 mm,4.6 μm),柱温35 ℃。流动相为乙腈-水（含0.05%甲酸）（45∶55）,流速0.2 mL/min;电喷雾离子化（ESI）,正离子扫描,选择性反应监测（SRM）药和内标分别为：奈比洛尔m/z 406.2→151.0;氨氯地平m/z 409.0→238.2。在本文建立的方法下,奈比洛尔在0.025~25 ng/mL呈良好的线性关系,r=0.998 6,最低检测浓度为0.008 ng/mL,低、中、高浓度下的回收率、日内及日间精密度均符合方法学要求。健康受试者口服5 mg奈比洛尔片后的t_1/2,AUC_0-t,c_max,MRT分别为：(14.4±5.5) h,(7.35±2.48)ng?h/mL,(1.05±0.35) ng/mL,(16.5±5.3) h。结果表明：该方法专属性强,适用于奈比洛尔血样的定量分析。     

奥替拉西钾血药和尿药浓度的测定及其药代动力学和药物蓄积性评价

本实验建立了人血浆及尿液中奥替拉西钾（potassium oxonate,Oxo）的LC-MS/MS测定方法,研究单次及多次给药替吉奥胶囊（S-1）后,Oxo在晚期胃癌患者体内的药代动力学特征,并评价多次给药后Oxo在人体内的药物蓄积情况。12名晚期胃癌患者分别按体表面积（BSA）口服S-1：单次给药,受试者于早餐后给药60 mg;多次给药,连续28d,每天2次,于早餐后给药60mg;晚餐后给药60 mg（BSA≥1.5m ²）或40 mg（1.25m ² 2）。采用LC-MS/MS法分别测定血浆及尿液中Oxo药物浓度,计算其药代动力学参数,评价其药代动力学特征和药物蓄积现象。血浆及尿液中Oxo测定的线性范围为分别为2~400 ng/mL,0.02~10 μg/mL。单次给药后 c_max为（110.5±100.8）ng/mL,t_1/2为（3.4±1.4）h,t_max为（2.2 ±0.7）h,36 h内有（1.7±1.2）%的Oxo以原型方式从尿中排出;多次给药后,稳态平均血药浓度c_ss-av为（36.89±29.35）ng/mL,稳态血药浓度波动度(DF)为2.4±0.8,经统计分析,多次给药28 d后Oxo在胃癌患者体内药代动力学特征与单次给药相比并未发生变化,多次给药后未产生药物蓄积现象。与文献数据对照,Oxo在中国晚期胃癌患者与国外患者体内的药代动力学参数基本一致。     

LC-MS/MS法测定人血浆中8′-羟基二氢麦角隐亭浓度及其在生物等效性研究中的应用

建立一种快速测定人血浆中8′-羟基二氢麦角隐亭 (8′-OH-DHEC)浓度的LC-MS/MS 法,以曲马多为内标,采用C₁₈反相柱(150 mm×2.0 mm,5 μm),柱温35 ℃。流动相为甲醇-水(含0.1%甲酸),流速0.2 mL/min;电喷雾离子化(ESI),正离子扫描,选择性反应监测(SRM）8′-OH-DHEC m/z 594.3→270.0;曲马多m/z 264.1→58.3。本方法专属性强,8′-OH-DHEC在50~4 000 pg/mL 呈良好的线性关系,r =0.999 3,最低检测浓度为50 pg/mL,低、中、高浓度下的日内及日间精密度、准确度、稳定性等均符合生物样品测定要求。本方法应用于22名健康受试者口服4 mg 麦角隐亭的生物等效性研究,结果表明此方法专属性强,快速灵敏,适用于临床剂量下麦角隐亭药代动力学及生物等效性研究。     

左旋奥硝唑及磷酸左奥硝唑酯二钠在大鼠体内药代动力学比较研究

采用手性色谱LC-MS/MS法同时检测左旋和右旋奥硝唑,比较研究左旋奥硝唑［(S)-ONZ］及磷酸左奥硝唑酯二钠［(S)-ONZ-P］在大鼠体内的药代动力学差异,并监测是否发生手性转化。结果表明,大鼠单次iv给予25,50,100 mg/kg(S)-ONZ及等物质的量(S)-ONZ-P后,(S)-ONZ-P在SD大鼠体内迅速转化为(S)-ONZ,平均转化时间介于1.57~3.86 min。两组大鼠血浆中(S)-ONZ的t_1/2分别为2.04~2.31 h;2.02~2.51 h;AUC_0-∞与剂量间呈良好的线性关系,呈线性动力学过程。(S)-ONZ,(S)-ONZ-P在大鼠体内药代动力学行为无显著差异,且二者均不转化生成(R)-ONZ。     

舒尼替尼和雷米普利联合用药在大鼠体内的药代动力学相互作用

初步考察舒尼替尼和雷米普利联合用药在大鼠体内的药代动力学相互作用。18只雄性SD大鼠随机分成3组,分别灌胃给予舒尼替尼、雷米普利、舒尼替尼合用雷米普利,连续给药10 d,分别于给药第1天和第10天后不同时间点采集血样,用LC-MS/MS测定雷米普利拉和舒尼替尼的血药浓度,并计算二者药代动力学参数。单剂量联合用药时,与单用雷米普利相比,合用舒尼替尼后,雷米普利拉t_max显著减小,t_1/2显著增加,AUC_0-∞没有显著性差异,表明其吸收加快,消除减慢,但整体吸收程度不变。多剂量给药后,联合用药组雷米普利拉CL显著降低、AUC_0-∞显著增大,表明联合用药导致雷米普利拉在大鼠体内消除减慢,并有明显的蓄积。单剂量和多剂量联合用药后舒尼替尼的药代动力学行为都没有发生显著变化。结果显示,舒尼替尼和雷米普利联合用药后会导致雷米普利拉消除减慢,并且单剂量联合用药后其吸收变快,多剂量联合用药后其在体内有明显蓄积,提示二者存在一定的药代动力学相互作用。     

紫草素抑制PI3K/Akt/mTOR通路逆转人胃癌细胞奥沙利铂耐药

目的 探讨紫草素对人胃癌细胞奥沙利铂耐药的影响及机制。方法 以0、2.5、5.0、10.0、20.0、40.0μmol/L 紫草素干预对数生长期人胃癌奥沙利铂耐药细胞(MGC803/L-OHP)24h,CCK-8法检测细胞增殖抑制率,参照半抑制浓度(IC₅₀)设定后续实验紫草素浓度。取对数生长期MGC803/L-OHP细胞,设空白对照组、奥沙利铂组、紫草素+奥沙利铂组、紫草素+奥沙利铂+IGF-1(PI₃K激活剂)组。药物干预24h后,检测细胞增殖抑制率和凋亡率,GFP-LC3质粒转染后观察自噬小体,Western blot法检测p-PI₃K、p-Akt、p-mTOR、caspase-3、cleaved caspase-3、Beclin1、LC3表达。结果 紫草素对MGC803/L-OHP细胞增殖抑制作用呈剂量依赖性,IC₅₀值为9.58μmol/L,后续实验紫草素浓度设定为10μmol/L。与空白对照组比较,奥沙利铂组细胞增殖抑制率、凋亡率升高(P<0.05),自噬小体增多。与奥沙利铂组比较,紫草素+奥沙利铂组细胞增殖抑制率、凋亡率升高(P<0.05),自噬小体增多;p-PI₃K、p-Akt、p-mTOR表达下调,cleaved caspase-3、Beclin1表达上调,cleaved caspase-3/caspase-3、LC3-Ⅱ/ LC3-Ⅰ升高(P<0.05)。与紫草素+奥沙利铂组比较,紫草素+奥沙利铂+IGF-1组细胞增殖抑制率、凋亡率降低(P<0.05),自噬小体减少;p-PI₃K、p-Akt、p-mTOR表达上调,cleaved caspase-3、Beclin1表达下调,cleaved caspase-3/caspase-3、LC3-Ⅱ/ LC3-Ⅰ降低(P<0.05)。结论 紫草素可逆转人胃癌细胞奥沙利铂耐药,其机制可能与抑制PI₃K/Akt/mTOR通路而促进胃癌细胞凋亡和自噬有关。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…