中药白花前胡提取工艺的优化

目的为合理提取白花前胡中降肺动脉高压的活性成分提供实验依据。方法采用正交试验法,考察提取溶媒、提取次数、提取时间对提取效率的影响;采用HPLC法,以8-甲氧基补骨脂素含量为指标测定提取物含量。结果白花前胡的最佳提取工艺为用质量分数80%的乙醇提取3次,提取时间分别为1.0、0.5、0.5 h,3次所用溶媒量分别为药材质量的8、6、4倍;按照筛选出的最佳工艺条件进行的3次重复性实验,测得浸膏中8-甲氧基补骨脂素含量质量分数为0.094%,折合1 g生药中含量为0.1712 mg,与预测值基本一致。结论所确定的最佳提取工艺可合理提取白花前胡中的活性成分。     

人血白蛋白临床应用合理性评价

目的：统计分析我院人血白蛋白的使用情况,评价其合理性。方法：采用回顾性分析方法,对我院2011年12月~2012年11月所有使用人血白蛋白的病例进行分析,获取临床使用人血白蛋白的信息数据,建立相关评价标准并对其使用合理性进行评价。结果：应用合理病例740例,占50.9%;欠合理病历35例,占2.4%;不合理病历679例,占46.7%。人血白蛋白用于肝硬化、肝切除占25.3%,癌症占16.4%,糖尿病占9.7%,骨折占7.6%,颅脑疾病占7.4%。结论：人血白蛋白的临床应用存在不合理的现象较普遍,应规范人血白蛋白的临床使用,制定其使用标准和指南。     

Comparison of the repeated dose toxicity of isomers of dinitrotoluene

Dinitrotoluene (DNT) is a nitroaromatic explosive used in propellant mixtures and in the production of plastics. Isomers of DNT were administered daily via oral gavage to male Sprague-Dawley rats for 14 days to determine the subacute toxicity of individual isomers of DNT. The 3,5-DNT isomer was the most toxic isomer, inducing weight loss and mortality within 3 days. Cyanosis and anemia were observed for all isomers. Exposure to 2,4-, 2,6-, and 3,5-DNT resulted in decreased testes mass and degenerative histopathological changes. Increased splenic mass was observed for 2,4-, 2,6-, and 2,5-DNT. Extramedullary hematopoiesis of the spleen was noted for all isomers, while lymphoid hyperplasia of the spleen was noted for all isomers except 2,5-DNT. Increased liver mass was observed for 2,3-DNT and 3,4-DNT. Hepatocellular lesions were observed for 2,6-DNT and 2,4-DNT. Neurotoxic effects were noted for 3,4-DNT, 2,4-DNT, and 3,5-DNT.     

促排合剂提取工艺研究

目的优选促排合剂的提取工艺。方法采用正交设计试验对促排合剂提取工艺的影响因素进行设计,并在设计的工艺条件下进行试验,以处方中有效成分2,3,5,4-四羟基二苯乙烯-2-O—β—D-葡萄糖苷的含量及出膏率为考察指标,筛选出促排合剂最佳提取工艺。结果最佳工艺条件为加10倍于药材量的水,浸泡药材22h,煎煮3次,每次煎煮2h。对所选最优结果重复3次验证,促排合剂出膏率为61．23％～62．04％,有效成分2,3,4,5-四羟基二苯乙烯-2-O—β—D-葡萄糖苷的含量为0．48～0．58mg·mL-1。结论所优选的工艺条件合理、可行。     

成人胆总管囊肿38例临床分析

目的 探讨胆总管囊肿不同手术方式对预后的影响.方法 通过对38例不同种类成人胆总管囊肿的临床表现和不同手术方式进行比较.结果 行胆总管囊肿空肠Roux-Y吻合术5例.行囊肿切除,肝总管空肠Roux-Y吻合术27例,间置空肠肝总管十二指肠内引流术2例.单纯囊肿切除1例.肝左叶切除,肝内、外胆管空肠双吻合术3例.3例癌变患者均在半年内死亡.结论 胆总管囊肿首选囊肿切除,肝总管空肠Roux-Y内引流术或间置空肠肝总管十二指肠内引流术.     

阿奇霉素治疗小儿肺炎不良反应的分析

目的探讨阿奇霉素治疗小儿肺炎的临床不良反应（ADR）的规律和特点。方法回顾2005年1月～2011年12月本院儿科静脉滴注阿奇霉素治疗小儿肺炎,所出现86例不良反应患儿进行统计分析。结果阿奇霉素所致ADR可累及全身各个系统,胃肠道系统损害占55.8%,皮疹占27.9%,过敏性休克占2.3%,循环系统损害占4.7%,神经系统损害占2.3%,泌尿系统损害占7.0%;男性占47.7%,女性占52.3%,ADR可发生于用药后的各个时间段。结论应重视阿奇霉素所致过敏性休克反应,加强监测,以减少不良反应的发生。     

18 例胰岛素瘤的诊疗分析及文献复习

目的 分析胰岛素瘤的临床表现特点, 探讨胰岛素瘤的诊断和治疗方法。方法 回顾性分析 2008 年 1 月—2015 年 12 月我院收治的 18 例胰岛素瘤患者的临床资料, 并结合国内外相关文献进行诊治分析和总结。结 果 18 例患者均有典型 Wipple 三联征表现, 低血糖症状中以意识障碍发生率最高（15/18）。18 例中 5 例曾被误 诊。14 例患者行糖耐量-胰岛素释放试验, 其中 12 例在试验中出现低血糖值, 胰岛素/血糖值＞0.4 的患者至 3 h 时 有 8 例, 至 5 h 时有 12 例。各种影像学检查阳性比例分别为 B 超 6/15、 CT 平扫 1/6、 增强 CT 11/13、 灌注 CT 2/3、 核 磁平扫 10/12、 增强核磁 5/5、 超声内镜 1/1、 数字减影血管造影 （DSA） 1/2、 术中超声 2/2。18 例患者均行手术治疗, 术 后患者均未再有低血糖发作。结论 胰岛素瘤引起的低血糖症状中以意识障碍发生率最高。行 5 h 糖耐量-胰岛素 释放试验比行 3 h 更有意义。可采用多种检查方式联合使用进行肿瘤定位。手术治疗仍是胰岛素瘤患者的首选治 疗方法。     

Use of computer-assisted prediction of toxic effects of chemical substances

The current revision of the European policy for the evaluation of chemicals (REACH) has lead to a controversy with regard to the need of additional animal safety testing. To avoid increases in animal testing but also to save time and resources, alternative in silico or in vitro tests for the assessment of toxic effects of chemicals are advocated. The draft of the original document issued in 29th October 2003 by the European Commission foresees the use of alternative methods but does not give further specification on which methods should be used. Computer-assisted prediction models, so-called predictive tools, besides in vitro models, will likely play an essential role in the proposed repertoire of "alternative methods". The current discussion has urged the Advisory Committee of the German Toxicology Society to present its position on the use of predictive tools in toxicology. Acceptable prediction models already exist for those toxicological endpoints which are based on well-understood mechanism, such as mutagenicity and skin sensitization, whereas mechanistically more complex endpoints such as acute, chronic or organ toxicities currently cannot be satisfactorily predicted. A potential strategy to assess such complex toxicities will lie in their dissection into models for the different steps or pathways leading to the final endpoint. Integration of these models should result in a higher predictivity. Despite these limitations, computer-assisted prediction tools already today play a complementary role for the assessment of chemicals for which no data is available or for which toxicological testing is impractical due to the lack of availability of sufficient compounds for testing. Furthermore, predictive tools offer support in the screening and the subsequent prioritization of compound for further toxicological testing, as expected within the scope of the European REACH program. This program will also lead to the collection of high-quality data which will broaden the database for further (Q)SAR approaches and will in turn increase the predictivity of predictive tools.     

盐酸表柔比星质量标准的比较与探讨

目的 对盐酸表柔比星质量标准的可行性进行评价,为进一步完善该品种的检验标准提供参考.方法 比对最新版《欧洲药典》(EP)、《英国药典》(BP)、《美国药典》(USP)、《日本药局方》(JP)和《中国药典》2015版5部药典中盐酸表柔比星质量标准及注射用盐酸表柔比星国内现行的4部质量标准,并进行评价.结果 5部现行版药典收载的盐酸表柔比星质量标准在检验项目上大体相同,但在检验方法和判断标准上有部分差异.结论 注射用盐酸表柔比星国内现行的4个质量标准的项目基本相似,为了更好地进行药品质量控制,建议统一标准.     

安全使用化妆品调查分析

目的了解公众安全使用化妆品的现状和对化妆品不良反应认知度,为药监部门和医疗机构监测化妆品不良反应提供理论依据。方法开展合理用药、安全使用化妆品宣传活动,设计统一的调查表,随机进行化妆品安全使用情况调查,发放调查表480余份,回收420份,有效表415份,并对有效调查表进行汇总分析。结果 415例受访者女性374人(90.12%),男性41人(9.88%);涉及22种职业,300人知晓化妆品不良反应,占72.29%;会留意产品警示信息的有247人,占59.92%,84人有化妆品过敏史,占20.24%;119人选择出现不良反应后自认倒霉,不会找相关部门解决,占28.67%。结论公众对化妆品安全使用和不良反应相关知识认识不足,应加强普及化妆品不良反应知识,及时公布化妆品安全信息,提高公众科学、安全使用化妆品意识。     

果糖注射液与5种药物的配伍稳定性考察

目的:探讨果糖注射液与注射用头孢拉定、利巴韦林注射液、注射用阿昔洛韦、注射用盐酸左氧氟沙星、注射用青霉素钠的配伍稳定性。方法:考察果糖注射液与5种药物分别配伍后的外观、pH值、含量及不溶性微粒的变化,用紫外分光光度法进行光谱扫描。结果:果糖注射液与注射用头孢拉定、利巴韦林注射液、注射用阿昔洛韦、注射用青霉素钠配伍后,外观、含量和pH值均无明显变化,配伍后性质稳定。与注射用盐酸左氧氟沙星配伍后24h内含量显著下降,pH值略有下降,同时混合液出现浑浊现象。结论:果糖注射液与注射用头孢拉定、利巴韦林注射液、注射用阿昔洛韦、注射用青霉素钠在室温下可配伍使用;与注射用盐酸左氧氟沙星的配伍在临床上则应谨慎。     

视网膜母细胞瘤组织发生的探讨

应用免疫组织化学方法探讨视网膜母细胞瘤的组织来源。结果显示;神经胶质细胞标记物GFAP(12/25)、神经元标记物NSE(18/25)、S-100蛋白(10/25)瘤细胞呈不同程度的阳性反应。Vimentin瘤细胞全部呈阴性反应。结果提示:视网膜母细胞瘤来源于神经外胚层上皮,向神经元和光感受器方向分化。神经胶质细胞可能是反应性增生,但也不排除向神经胶质细胞方向分化的可能性。     

The use of isothermal microcalorimetry in the study of small degrees of amorphous content of a hydrophobic powder

The crystallinity of a hydrophobic drug (L-365,260) has been investigated by X-ray powder diffraction (XRPD), differential scanning calorimetry (DSC) and isothermal microcalorimetry. The crystallinity was assessed in the isothermal microcalorimeter by taking a ratio of the responses seen when an unknown sample and an amorphous standard were exposed to ethanol vapour. It was found that large amounts of the material (up to 75%) became amorphous with protracted micronisation. The XRPD, DSC and isothermal microcalorimetry methods could all be used to characterise the amorphous content for these highly disordered samples. When the drug was milled in a ball mill, considerably less of the sample mass became amorphous (less than 10% even for reasonably long milling times) and for such samples, only isothermal microcalorimetry was a suitable technique for quantifying the degree of disorder as no difference was observed by use of DSC or XRPD for materials with up to 10% amorphous content. Microcalorimetry is a suitable approach for crystallinity studies on hydrophobic powders, giving a lower limit of detection for amorphous content that is in the order of 1% or less, which is well below that seen for XRPD.     

某院抗肿瘤药静脉输液过程调查分析

目的：调查某院抗肿瘤静脉输液过程,为制定某院抗肿瘤药静脉输液管理规范奠定基础。方法：收集某院2015年10月-2016年1月肿瘤科及放疗科住院化疗患者共1 093袋抗肿瘤药静脉输液信息,就给药顺序、预处理时机、滴注时间、冲管、稳定性、水化等方面进行汇总分析。结果：仅有1例联合用药顺序错误;预处理时机达标情况为紫杉醇脂质体43.29%、多西他赛100%;滴注时间达标情况为紫杉醇脂质体14.20%、多西他赛2.26%、奥沙利铂85.82%、奈达铂99.59%、依托泊苷100%、伊立替康38.64%、培美曲塞100%、吉西他滨13.04%;冲管达标情况为紫杉醇脂质体20.45%、多西他赛8.47%、奥沙利铂5.22%、奈达铂19.50%、伊立替康0%、培美曲塞14.59%、吉西他滨0%;多西他赛成品输液在4 h内用完的占40%;奈达铂输液结束后继续点滴输液量达1 000 mL以上的占47.58%。结论：某院抗肿瘤药静脉输液过程中还存在一定不足之处,需要医、药、护三方共同协作,制定管理规范。     

抗生素生物标准品的确定

本文从抗生素标准品效价单位的定义着手,系统地阐述了抗生素标准品的确定原则,首批制备时应综合考虑溯源性,同质性、连续性和稳定性问题,而以后的制备则应采用协作标定的方法来保证标准品的连续性,并举例说明了首批抗生素标准品的制备过程。     

国内外监管机构对制药用水质量控制的要点分析

制药用水广泛用于药品生产过程和药物制剂的制备，同时也被用作溶剂、冲洗剂等。制药用水的质量直接影响药品的质量，与药品的安全息息相关。概述分析了中国、美国和欧盟制药用水的管理、质量控制要求及其差异，同时探讨了制药用水分类、注射用水制法及制药用水微生物控制，为国内制药用水相关技术标准建设及科学监管提供参考。     

口腔科医患纠纷原因分析及事前防范

目的分析口腔医患纠纷产生原因,探讨预防措施。方法通过对我院2009年1月至2012年1月在口腔医疗过程中发生的164例医患纠纷原因进行回顾性分析,制定出相应的防范措施。结果口腔医患纠纷与许多因素有关,其主要因素为患者期望值过高23.17%、知情同意未告知19.51%、服务态度不好17.07%、医疗技术不高15.85%、收费方面12.41%,其他11.99%。结论针对不同的医患纠纷采取有效的事前防范措施,可将医疗纠纷甚至是恶性事件消灭于萌芽之中,是避免医疗场所暴力行为的最有效的措施。     

A systematic review of meta-analyses of the efficacy of oral atypical antipsychotics for the treatment of adult patients with schizophrenia

INTRODUCTION: Meta-analyses are a convenient way for clinicians and researchers to review data regarding different interventions. Meta-analyses can overcome many of the limitations of individual studies, namely the power to detect differences, and help resolve the results of inconsistent studies. AREAS COVERED: This paper is a review of meta-analyses of oral atypical antipsychotics for the treatment of schizophrenia, located through PubMed and the Cochrane Database of Systematic Reviews. A total of 91 meta-analyses were identified that included efficacy outcome data for the 10 atypical antipsychotics available in the USA (11 focused on clozapine, 17 for risperidone, 8 for olanzapine, 5 for quetiapine, 3 for ziprasidone, 10 for aripiprazole, 5 for paliperidone, 1 for iloperidone, 0 for asenapine or lurasidone, and 31 others that were classified more broadly). These include Cochrane Reviews and other similarly executed reports, as well as pooled analyses meta-tagged in PubMed as a meta-analysis. EXPERT OPINION: In general, there is heterogeneity among the atypical antipsychotics in terms of efficacy, with clozapine evidencing consistent superiority over typical antipsychotics, trailed behind by olanzapine and risperidone. Meta-analyses generally do not support efficacy differences between the other atypical antipsychotics compared with the older typical agents. Although this review is focused on efficacy, other considerations are also important, including the large tolerability differences among all the agents and the need to individualize medication choice based on past history of therapeutic response, past history of tolerability issues and the individual's personal values and preferences.     

谷红注射液不良反应303例分析及文献回顾

目的分析谷红注射液不良反应的发生特点,为临床合理用药提供参考。方法采用回顾性研究方法选择谷红注射液所致不良反应报告303例,分析患者性别、年龄、原患疾病、严重不良反应表现等。结果303例患者中,男143例(47.19%),女160例(52.81%);61岁以上老年患者占52.14%;原患疾病中脑梗死、冠心病占比最高,占37.62%,其次为高血压、糖尿病、骨折等。严重不良反应80例(142例次)占26.40%,主要表现为全身性损害。不良反应主要发生于用药后当天207例(68.32%),发生于用药1~3 d 51例(16.83%)。结论临床应加强老年患者用药监护,避免超说明书用药,建议企业说明书不良反应项增加内容,同时在临床使用环节增加警示,生产企业要不断改进生产工艺,控制杂质,提高药品质量。     

癌症患者经疗用药分析

目的：了解黄山市人民医院住院癌症患者化疗药物的选用情况,评估使用的合理性。方法：查阅住院化疗303例患者的处方及病历,包括病情、体表面积、化疗药物的名称、剂量、用法、使用途径、使用时间、总用药量及合理性。结果：注射剂18种,口服制剂5种;注射给药合计1718d,口服867d,灌注49d;剂量过大者2种。结论：该院患者化疗药物使用大部分合理。