对药学无机化学的教学体会

根据药学专业无机化学的学科特点出发，就课堂授课过程中如何改革教学方法、激发学生学习兴趣、设计合理的教学过程等方面进行探讨，以提高学生认知能力和自主学习的欲望，达到善于总结和提高学习效率的目的。     

儿童系膜增殖性肾小球肾炎临床与病理关系的研究

３５例儿童非ＩｇＡ系膜增殖性肾小球肾炎，主要表现为肾病综合征、血尿及蛋白尿三种类型。对以肾病综合征表现的ＭｓＰＧＮ使用激素或细胞毒性药物治疗，其中轻度系膜病变不伴有局灶硬化者治疗效果及预后好；重度系膜增殖伴有明显局灶硬化、肾小球囊壁粘连、间质纤维化者治疗及预后均差，说明治疗效果及预后与病理形态改变轻重有关。     

The hydroxylation, dechlorination, and glucuronidation of 4,4'-dichlorobiphenyl (4-DCB) by human hepatic microsomes

Since chlorine placement and the degree of chlorination of the biphenyl nucleus play an important role in the metabolism and ultimate elimination of polychlorinated biphenyls (PCBs), we have studied the metabolism of 4,4'-dichlorobiphenyl (4-DCB) by human hepatic microsomes. This low molecular weight PCB congener is substituted at the preferred site of metabolism (para-position). 4-DCB was metabolized by human microsomes with a Km of 0.43 microM and a Vmax of 1.2 pmoles/mg microsomal protein/min. Six metabolites were identified: 4,4'-dichloro-3,3'-biphenyldiol, 4'-chloro-3-biphenylol, 4'-chloro-4-biphenylol, 4,4'-dichloro-2-biphenylol, 4,4'-dichloro-3-biphenylol (most abundant), and 3,4'-dichloro-4-biphenylol. [14C]-4-DCB equivalents were found to covalently bind to microsomal protein. Addition of a 1 mM concentration of reduced glutathione decreased the degree of covalent binding. These data suggest that human microsomes metabolize this PCB through an arene oxide and that an "NIH shift" occurs. When UDPGA was added to the incubation, human microsomal glucuronosyltransferase catalyzed the formation of the glucuronide of the major metabolite, 4,4'-dichloro-3-biphenylol. These and previous in vitro results show that the biotransformation of PCBs by humans is governed by the same principles established for the in vivo biotransformation of PCBs by the rat, mouse and monkey. That is, PCBs without two adjacent unsubstituted carbon atoms are poorly metabolized and that an unsubstituted para-position facilitates metabolism.     

卫星药房建设提升临床试验质量

试验用药品规范化管理有助于提升临床药物研究水平。从硬件设施、人员配备及资质、文件管理、质量控制等方面建设卫星药房,并采取GCP药房监管模式,实现试验用药品闭环管理。实施后,试验用药品质控问题减少,管理更加规范。卫星药房可作为GCP 药房的补充,确保试验用药品安全,提升临床试验质量。     

A Qualitative Exploration of Predominantly White Non-Hispanic Tennessee WIC Participants’ Food Retail and WIC Clinic Experiences During COVID-19

BackgroundThe novel coronavirus disease 2019 (COVID-19) has widened many existing nutrition disparities. In response, federal nutrition assistance programs have introduced flexibility waivers in programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), to rapidly respond to support the nutritional health status of income-eligible participants during COVID-19. Waivers were approved that permitted flexibilities in the WIC food package, WIC vendor guidelines, and WIC clinic experience. The impact of these waivers on WIC participants’ retail and clinic experiences remains unknown.ObjectivesOur aims were to understand the experiences of WIC participants in food retail settings and with WIC clinics during the COVID-19 pandemic and to explore WIC participants’ perceptions of the impact of COVID-19 on their family’s overall health, well-being, and daily lives.DesignWe conducted semi-structured phone interviews between April 30 and May 7, 2020.Participants/settingParticipants were 24 adults in WIC-enrolled families residing in Tennessee.AnalysisUsing grounded theory as the analytical framework, 2 coders completed an iterative, data-driven analytic process within NVivo, version 12. Hierarchical maps, coding matrices, and concept maps were used to aid direct content analysis for theme detection.ResultsFive primary themes emerged, including shopping barriers (existing compounded with new), coping strategies, impact on mental and emotional health, social comparison, and unintended consequences of COVID-19 on WIC families.ConclusionsCOVID-19 created additional barriers to food security among WIC families and negatively affected their health and well-being. To meet the needs of this vulnerable population during and beyond the pandemic, the carryover of WIC flexibilities (ie, physical presence and food package substitution waivers) after COVID-19 may improve the ease of overall program participation.     

The Effect of Medication Reconciliation via a Patient Portal on Medication Discrepancies: A Randomized Noninferiority Study

BackgroundMedication reconciliation has become standard care to prevent medication transfer errors. However, this process is time-consuming but could be more efficient when patients are engaged in medication reconciliation via a patient portal.ObjectivesTo explore whether medication reconciliation by the patient via a patient portal is noninferior to medication reconciliation by a pharmacy technician.Design (including intervention)Open randomized controlled noninferiority trial. Patients were randomized between medication reconciliation via a patient portal (intervention) or medication reconciliation by a pharmacy technician at the preoperative screening (usual care).Setting and ParticipantsPatients scheduled for elective surgery using at least 1 chronic medication were included.MeasuresThe primary endpoint was the number of medication discrepancies compared to the electronic nationwide medication record system (NMRS). For the secondary endpoint, time investment of the pharmacy technician for the medication reconciliation interview and patient satisfaction were studied. Noninferiority was analyzed with an independent t test, and the margin was set at 20%.ResultsA total of 499 patients were included. The patient portal group contained 241 patients; the usual care group contained 258 patients. The number of medication discrepancies was 2.6 ± 2.5 in the patient portal group and 2.8 ± 2.7 in the usual care group. This was not statistically different and within the predefined noninferiority margin. Patients were satisfied with the use of the patient portal tool. Also, the use of the portal can save on average 6.8 minutes per patient compared with usual care.Conclusions and ImplicationsMedication reconciliation using a patient portal is noninferior to medication reconciliation by a pharmacy technician with respect to medication discrepancies, and saves time in the medication reconciliation process. Future studies should focus on identifying patient characteristics for successful implementation of patient portal medication reconciliation.     

综合医院感染科设计分析——以天坛医院为例

从规划布局、功能布局、平战结合这三个角度,对天坛医院感染科进行分析,以期为当代综合医院感染科建设提供参考和借鉴。     

软组织外周性原始神经外胚层瘤临床病理及免疫组化分析

目的:分析软组织外周性原始神经外胚层瘤(pPNET)临床病理及免疫组化特征,为该肿瘤的诊断与治疗提供依据。方法:对8例pPNET组织常规处理,瑞氏-苏木素(HE)、过碘酸Schifff反应(PAS)、网织纤维及免疫组织化学染色。结果:临床上大部分为青年人,四肢软组织肿块,生存期短,预后差,2年生存率为33%,5年生存率为0。组织学上小圆、卵圆或梭形瘤细胞被纤维组织分割成小叶,可有或无菊形团。PAS染色阴性,网染细胞间网状纤维少或无,免疫组化染色瘤细胞表达2个以上神经性标记。结论:软组织pPNET为一种高度恶性的神经上皮瘤,临床病理与骨外Ewing瘤、Askin瘤比较无显著性意义。     

加强临床病理讨论课提高病理教学质量

为激发学生学习病理课的积极性,改善病理学教学效果,我们开展了基于临床实际病例的临床病理讨论课。通过讨论并分析疾病的临床特征与病理学改变之间的联系,学生能更有效地掌握病理学知识,同时学生的综合分析能力也得到了提高。