麻黄-甘草药对抑制过敏性哮喘的效应及机制初探

目的 研究麻黄-甘草药对对过敏性哮喘的影响,并初步探讨其作用机制。方法 建立屋尘螨（HDM）诱导的过敏性哮喘模型,造模同时给予麻黄-甘草药对提取物（MG）。使用无创肺功能仪检测小鼠气道反应性,HE染色观察小鼠肺组织病理学变化,Masson染色观察小鼠肺组织的胶原沉积情况,进行血液嗜酸性粒细胞（EOS）计数,ELISA法检测支气管肺泡灌洗液（BALF）及肺组织IL-4、IL-5、IL-13、TGF-β1及血清IgE的表达,免疫组化检测肺组织E-cadherin、N-cadherin、Vimentin、α-SMA和TGF-β1蛋白表达情况。结果 MG可显著降低气道高反应性,抑制BALF及肺组织IL-4、IL-5和IL-13的表达,降低血液EOS及血清IgE的表达,并且减轻肺组织的炎症浸润及胶原沉积。进一步结果表明MG可抑制肺组织TGF-β1的表达,上调E-cadherin以及下调N-cadherin、Vimentin、α-SMA的表达。结论 MG能够通过抑制支气管上皮间质转化,从而缓解气道的炎症状态以及改善哮喘的气道重塑,进而发挥对过敏性哮喘的治疗作用。      

尤昭玲教授运用炒炭类药物治疗子宫切口假腔经验

子宫切口假腔即剖宫产术后子宫切口憩室,该病作为剖宫产术后的远期并发症之一,严重影响育龄妇女的身心健康,属于现代临床中较难治愈的妇科疾病之一。目前,现代医学对此尚无确切有效且系统的治疗方法。根据患者的临床症状,可归纳为"经期延长"、"崩漏"、"月经过多"等范畴。尤昭玲教授认为,气虚不摄,瘀热互结是本病基本病机,自创"三期三法"诊疗理论,运用炒炭药收涩、止血、抗炎等功效治疗子宫切口假腔,在临床治疗中疗效显著。     

金银花配方颗粒评价性抽验结果分析与建议

目的：通过开展金银花配方颗粒评价性抽验,比较分析不同厂家金银花配方颗粒的质量情况,并提出监管建议。方法：收集各企业金银花配方颗粒质量标准,依据企业标准进行法定检验。结果：共抽验117批金银花配方颗粒,涉及9家生产企业。按各自企业标准进行检验,总体合格率为100%。但是各企业之间金银花配方颗粒含量差异较大且每克颗粒相当的药材（饮片）量不同,转移率不同。结论：通过本次抽验发现金银花配方颗粒的整体质量较高,但是不同厂家之间所用原料药材及生产工艺存在一定差异,导致最终产品质量参差不齐。因此,有必要规范中药配方颗粒生产工艺,尽快统一标准,加强监管。     

抗逆转录病毒药物的现状与研发

获得性免疫缺陷综合征（AIDS）是威胁人类健康的最危险疾病之一,是由人免疫缺陷病毒（HIV-1）感染引起。从HIV-1病毒发现后的30余年,已有大量的抗逆转录病毒药物投入研发,抑制病毒复制增殖周期的关键阶段。抗逆转录病毒药物延长了患者生命,同时也产生了病毒的耐药变异,因此需要开发针对耐药的新药物。简述美国已上市的抗逆转录病毒药物信息,重点关注抗逆转录病毒药物的研发进展以及非临床研究中的相关问题。     

Executive summary. Consensus document of GESIDA and SPNS (Spanish Secretariat for the National Plan on AIDS) regarding combined antiretroviral treatment in adults infected by the human immunodeficiency virus (January 2012)

In the present update of the guidelines, starting antiretroviral treatment is recommended in symptomatic patients, in pregnant women, in sero-discordant couples with high transmission risk, in patients co-infected with hepatitis B requiring treatment and in patients with HIV-related nephropathy. Guidelines on combined antiretroviral treatment (cART) are included in the event of concurrent HIV infection diagnosis with an AIDS-defining event. In asymptomatic naïve patients, cART will be based on CD4 lymphocyte count, plasma viral load (VL), patient age and patient comorbidity: (i) cART is recommended if CD4 count is lower than 350 cells/μL; (ii) cART is equally recommended if CD4 count is between 350 and 500 cells/μL and may only be deferred in the event of patient refusal with stable CD4 count and low VL; (iii) if CD4 count is higher than 500 cells/μL cART can be delayed, but it may be considered in patients with liver cirrhosis, chronic virus C hepatitis, high cardiovascular risk, VL >10⁵ copies/mL, CD4 proportion lower than 14% and age over 55 years. cART in naïve patients requires a combination of three drugs and its aim is to achieve undetectable VL. Treatment adherence plays a basic role in sustaining good response. cART could and should be changed if virologic failure occurs in order to achieve undetectable VL again. Approaches to cART in HIV acute infection, in women and pregnancy and post exposure prophylaxis are also commented on.     

Prescribing of the antidepressant duloxetine: Can local clinical audit findings facilitate medicines management decisions?

Introduction. Discussions regarding the inclusion of a new antidepressant within local formulary lists and prescribing guidelines may be facilitated by audits of local prescribing practice, conducted some months after the drug first becomes available for clinical use. Method. Development of five audit standards and retrospective case-note review of prescribing recommendations for the serotonin-noradrenaline reuptake inhibitor duloxetine, made in five local outpatient clinics. Results. Follow-up data were available for audit in 27 of 43 sets of medical notes. In the majority of patients (84%), the primary diagnosis was recurrent unipolar depressive disorder, the current episode having proven resistant to treatment with two other antidepressants. Where comments were made, notes indicated that 81% of patients that received duloxetine had improved and 94% had tolerated it without reported problems. Conclusions. In this sample, duloxetine prescribing in the first months after it became available appeared to occur within an appropriate patient group. Prospective evaluations in other clinical samples are warranted.     

抗反转录病毒治疗人类免疫缺陷病毒/丙型肝炎病毒合并感染者终末期肝病的发生率及危险因素

目的 了解抗反转录病毒治疗(ART) HIV/HCV合并感染人群中终末期肝病的发生率及相关的危险因素.方法 回顾性研究HIV/HCV合并感染者的人口学资料和临床资料.单因素和多因素Logistic回归分析各变量[基线时年龄≥40岁、男性、既往有受血史、HCV持续感染时间、合并HBV感染(HBsAg阳性)、随访末时HIV RNA≥1×104拷贝/mL、随访末时HCV RNA≥1×105拷贝/mL、随访末时CD4细胞计数＞200/μL、随访末时ALT≥2×正常值上限(ULN)、包含奈韦拉平的ART、随访时间、ART持续时间＞5年、HCV基因1b型]与终末期肝病发生的相关性;Kaplan-Meier法分析终末期肝病对HIV/HCV合并感染者生存的影响.结果 共纳入427例HIV/HCV合并感染者,平均随访3.7年,55例患者(12.9％)出现终末期肝病,52例患者死亡,病死率为12.2％.多因素Logistic回归分析显示,基线时年龄≥40岁(OR=2.385,P=0.039)、ALT≥2×ULN(OR=16.374,P=0.000)、合并HBV感染(OR=2.507,P=0.042)、ART持续时间＞5年(OR=3.232,P=0.010)及CD4细胞计数≥200/μL(OR=0.364,P=0.011)与终末期肝病的发生显著相关.在有终末期肝病与无终末期肝病的HIV/HCV合并感染者中,病死率分别为50.9％和6.5％,两组比较差异有统计学意义(P=0.000).结论 随着ART的开展,终末期肝病在HIV/HCV合并感染者中仍较常见,合并终末期肝病明显缩短了HIV/HCV合并感染者的生存期.     

Antithrombotic effects of Huanglian Jiedu decoction in a rat model of ischaemia-reperfusion-induced cerebral stroke

ContextHuanglian Jiedu Decoction (HLJJD) has a variety of pharmacological activities, such as anti-inflammatory and neuroprotection against ischaemic brain injury.ObjectivesThis ex vivo study explores its antithrombosis activity and inhibition of platelet aggregation.Material and methodsTo study the antithrombosis activity of HLJJD ex vivo, saline, or HLJDD (100, 200, and 500 mg/kg) was treated prophylactically by gavage for 3 days in Wistar rats (n = 4). Based on the rat model of transient middle cerebral artery infarction (MCAO) or normal rats (n = 4), the antithrombotic activity in the normal group and HLJDD subgroups on prothrombin time, thrombus weight, platelet aggregation, and others was evaluated, followed by the antiplatelet aggregation of its main components (n = 4).ResultsThe weight of the thrombus increased significantly at 24 h after MCAO onset. HLJJD did not influence the change of PT, but significantly inhibited thrombosis by 12.5, 20.0, and 20.5% in reducing the dry weight of thrombus, and blocked collagen-induced platelet aggregation by 25.5, 39.0, and 42.7% and adhesion of blood platelet by 17.3, 26.2, and 27.3%. The IC₅₀ value of HLJJD on collagen-induced platelet aggregation was 670 mg/kg. Geniposide only facilitated antiplatelet aggregation induced by collagen, but not AA or ADP. Both baicalin and berberine showed markedly antiplatelet aggregation induced by all activators. The antithrombotic activity of baicalin was relatively higher than that of berberine (35.0–47.8% vs. 20.6–33.5%).ConclusionOur results indicated that HLJDD regulated blood circulation by inhibiting platelet aggregation and thrombosis, which might also extensively contribute to the clinical prevention and treatment of cerebrovascular diseases.