2012～2014年我院质子泵抑制剂的应用分析

目的:了解我院质子泵抑制剂(PPI)使用情况,为临床合理用药提供参考.方法:对我院2012～2014年质子泵抑制剂(PPI)的应用金额、用量、用药频度、限定日费用(DDC)等进行统计、分析.结果:2012～2014年我院PPI的总销售金额呈逐年增长趋势,销售金额排序居前3位的药品分别为泮托拉唑、奥美拉唑、兰索拉唑.我院注射用质子泵抑制剂的销售金额远远大于口服制剂.结论:PPI在我院临床使用广泛,应用基本合理,但仍存在无适应症使用、盲目预防性应用等不合理现象,建议医院制定质子泵抑制剂合理应用指南,临床用药严格把握用药指征,避免过度使用.     

重点监控药品政策对样本地区质子泵抑制剂使用的影响研究

目的:探究安徽省、四川省重点监控药品政策对样本医院质子泵抑制剂(PPI)使用的影响,为减少质子泵抑制剂滥用现象、促进质子泵抑制剂合理使用、完善与推进重点监控药品管理政策提供依据。方法:以全国各省份监控目录形成的重点监控药品库为基础,结合安徽省、四川省的重点监控药品目录,综合考虑药品典型性及临床替代品等因素,遴选出安徽省奥美拉唑被监控品种(商品名)作为样本药品,奥美拉唑未被监控品种及4种PPI(通用名)作为对照药品,另外四川省纳入5种PPI(通用名)作为研究对象,进一步提取安徽省3家三级医院2014年11月至2017年9月的月度数据、四川省成都市9家三级医院2014年一季度至2017年一季度的季度数据。研究通过有对照的间断时间序列(interrupted time series,ITS)模型,分析样本药品及对照药品用量与金额的变化。结果:(1)安徽省、四川省实施重点监控政策后,除四川省埃索美拉唑使用下降趋势不显著外,被纳入监控目录的PPI品种的用量、金额均出现显著下降(P值均小于0.05);(2)安徽实施重点监控政策后,奥美拉唑未被监控品种(商品名)使用显著上升,所有奥美拉唑(通用名)使用显著下降(P值均小于0.05)。(3)安徽省将奥美拉唑纳入监控目录后,其他PPI品种(通用名)的使用显著下降,PPI类药品的整体使用受到有效限制(P值均小于0.05)。结论:安徽省重点监控药品政策有效限制了奥美拉唑的使用,同时使PPI类药品的整体使用显著下降。四川省重点监控药品政策使纳入监控目录的5种PPI整体的使用受到有效限制,政策效果显著。     

2010—2012 年解放军第二七二医院质子泵抑制剂应用分析

目的：了解我院质子泵抑制剂（PPI）的应用情况,为临床合理用药提供参考.方法：依托我院“医院药品库存管理系统”的原始数据,对2010-2012年我院PPI的品种、销售量、销售金额、用药频度（DDDs）、限定日剂量（DDC）等进行回顾性统计、分析.结果：我院PPI的总DDDs及总销售金额呈逐年增长趋势,DDDs及销售金额排序居前3位的药品分别为奥美拉唑、泮托拉唑、兰索拉唑;注射用PPI的销售金额构成比及DDDs构成比均逐年增加,且增幅较大;各药的DDC呈平稳趋势.结论：PPI在我院临床使用广泛,存在无适应证使用、盲目预防性应用、偏爱使用注射剂型等不合理现象,应加强PPI的合理应用管理.     

我院住院患者质子泵抑制剂的使用分析

目的分析我院2015年住院患者质子泵抑制剂(proton pump inhibitor,PPI)的使用情况。方法对我院2015年住院患者PPI的品种、销售量、消耗金额、用药频度(DDDs)和日均费用(DDC)等情况进行统计分析。结果我院PPI品种DDDs排序前3位的为雷贝拉唑肠溶胶囊、注射用奥美拉唑和注射用泮托拉唑;销售金额排序前3位的为注射用兰索拉唑、注射用奥美拉唑和注射用泮托拉唑;以雷贝拉唑肠溶胶囊序号比值>1的情况最为突出,其余大多数药品的序号比值为1;住院患者使用PPI病例数占首位的为消化内科;DDDs占首位的为心血管内科。结论 PPI在我院临床使用基本合理,但存在无适应证使用、盲目预防性使用等不合理现象,特别是外科;医院应加强对PPI使用的监管,促进合理用药。     

某院质子泵抑制剂的使用情况分析

目的分析研究我院2009年²012年质子泵抑制剂(PPI)的使用情况,了解我院近年质子泵抑制剂的用药结构现状,为今后临床合理用药提供参考。方法纳入我院2009年2012年质子泵抑制剂(PPI)的使用情况,了解我院近年质子泵抑制剂的用药结构现状,为今后临床合理用药提供参考。方法纳入我院2009年²012年四年的PPI的用药品种、用药金额、药品日用费用(DDC)、用药频度(DDDs)基本资料信息,进行回顾性分析统计。结果 2009年2012年四年的PPI的用药品种、用药金额、药品日用费用(DDC)、用药频度(DDDs)基本资料信息,进行回顾性分析统计。结果 2009年²011年PPI的销售金额与DDDs呈快速增长态势,2012年双项指标因药品调价,而且控制用量,所以日均费用和PPI所占百分比较2011年有所下降;2010年至2012年连续三年中口服给药与注射给药DDDS奥美拉唑均排在首位。结论 PPI作为治疗消化道疾病上的一种良好药物,其在我院的销售金额与其DDDs同步性较好,我院整体用药基本合理。     

基于限定日剂量和ABC-改进VEN法的2018年亳州市人民医院质子泵抑制剂应用分析

目的:了解亳州市人民医院(以下简称“我院”)质子泵抑制剂(proton pump inhibitor,PPI)的使用情况,明确需重点管控的PPI品规,向临床提供关于PPI选择的相关建议。方法:调查2018年我院PPI消耗数据,采用限定日剂量(defined daily dose,DDD)法和ABC-改进VEN法进行统计分析,并根据分析结果和管理优先级别确定Ⅰ(高)、Ⅱ(低)和Ⅲ(中)组。结果:ABC-改进VEN法基于减轻患者负担和医院成本对PPI进行分类,便于管理。涉及的PPI共18个品规,销售金额合计14051911.21元;其中Ⅰ组包含AN类和DDD分析加入的品规,共5个,销售金额为9405764.53元(占66.94%),代表药品包括注射用泮托拉唑钠(40 mg)、注射用雷贝拉唑钠(20 mg);Ⅱ组包含CV类5个品规,销售金额为886138.62元(占6.31%),代表药品为奥美拉唑肠溶片(20 mg);Ⅲ组包含10个品规,销售金额为3760008.06元(占26.76%),代表药品为奥美拉唑肠溶片(40 mg)。结论:我院PPI应用结构不甚合理,应重点监控Ⅰ组药品,减少不合理用药情况,向临床推荐Ⅲ组药品,并保障供应。     

2009—2011年十堰市太和医院质子泵抑制剂应用分析

目的:了解我院质子泵抑制剂(PPI)的应用情况,为临床合理用药提供参考。方法:采用限定日剂量(DDD)法对2009—2011年我院PPI的销售金额、用药频度(DDDs)等进行统计分析。结果:我院PPI的总销售金额及总DDDs呈逐年增长趋势;销售金额及DDDs排序居前3位的药品分别为奥美拉唑、泮托拉唑、雷贝拉唑;口服PPI的DDDs构成比较高,应用较多;注射用PPI的销售金额构成比及DDDs构成比均逐年增加,应用增长较快。结论:我院PPI应用广泛,总体呈上升趋势,用药情况较合理。     

肝胆外科患者质子泵抑制药使用情况及合理性分析

目的评估北京朝阳医院西院(以下简称"我院")肝胆外科住院患者质子泵抑制药(PPI)使用合理性。方法利用我院药品信息系统提取患者PPI使用品种、使用数量、使用金额等数据,采用限定日剂量法,以PPI使用率、用药频度(DDDs)、使用强度(UD)、限定日费用(DDC)、药物利用指数(DUI)、处方日剂量(PDD)为指标进行统计分析。用医院电子病历管理系统,提取使用PPI住院患者的病历信息,回顾性分析PPI使用情况及合理性。结果本研究共收集使用PPI患者963例,PPI使用率、DDDs、UD、DUI和PDD较高。PPI不合理使用涉及621例(64.49%)患者,以无指征用药(39.36%)和预防用药不合理(21.91%)为主。结论在PPI应用中,存在无指征用药、给药途径不适宜、给药剂量大、用药疗程长、给药时机不恰当、联合用药不适宜等情况,应加强无指征用药及预防用药的管理与干预,规范PPI合理使用。     

某综合性三甲医院门急诊患者质子泵抑制剂应用分析

目的:了解某综合性三甲医院门急诊质子泵抑制剂(PPI)的临床应用情况,为临床合理使用提供参考。方法:随机抽取该院2009年含PPI的门急诊处方,全面记录处方相关信息,按新的《处方管理办法》"四查十对"之规定,逐项进行分析讨论,合理性标准参照《新编药物学》、药品说明书及国内外循证医学研究结果等。结果:该院门急诊PPI应用总体较为合理,与酸相关性消化系统疾病诊治最新进展保持同步。但部分处方PPI用法用量和合并用药方面的合理性值得商榷;临床诊断与就诊科室的专科特点不一致;处方书写欠规范等。结论:建议临床医师遵从药品说明书处方,超常规用药宜仔细向患者交待清楚,增加患者用药的依从性,同时维护自身的医疗安全。     

质子泵抑制剂门诊处方调查

目的:通过对医院门诊处方调查,了解质子泵抑制剂(PPI)在门诊的应用情况.方法:回顾性调查浙江省奉化市人民医院2002年8月至2003年7月份共12个月的门诊处方,综合分析PPI的处方使用频率、患者性别及年龄、药物的品种及消耗量、合并用药、合理用药等情况.结果:12个月门诊处方量共293 720张,其中使用PPI的处方为5 886张(2.0%),以金奥康的处方使用频率最高;患者男:女=1.9:1,平均年龄男性(47.6±12.7)岁,女性(43.6±13.6)岁;89.4%的处方合并1种或以上的药物,不合理用药处方占4.5%.结论:门诊PPI处方应根据患者的病情及经济负担等情况加以选择,应加强合理用药的管理工作.     

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.     

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.     

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.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.