几种常用药物联用计算方法的数学瑕疵和一带一线模型法的解决方案

多药联用在临床实践中很常见,药物间的相互作用会使药物效应发生改变,联用组合有可能使疗效增加和毒性减少,也有可能会带来药效降低和毒性增大的风险。已有多种计算方法用于定量评价药物联用产生的协同、相加和拮抗,但业内所用的许多计算方法均为共识性方法或经验公式,同一组数据用不同的方法处理,常会得出不同的、相互矛盾的结论。本文用数学方法分析了业内常用的几种计算方法的瑕疵,包括:Loewe等效线法、Bliss独立模型法、周氏中效法和金氏法等,并通过介绍本实验室发现的药物联用药效相加的数学规律,发展了具有自主知识产权的一带一线模型法,作为解决多药联用效应定量评价的通用方案,为充分体现多药联用带来的益处和规避多药联用带来的疗效和毒性风险提供可靠的计算方法。     

基于CiteSpace的脑卒中就医延迟可视化分析

目的 直观展现近10年国际脑卒中就医延迟研究态势,为国内脑卒中就医延迟研究提供参考。方法 以2008-2018年Web of Science数据库中收录的脑卒中就医延迟相关文献为基础,运用CiteSpace软件进行可视化分析。结果 国际脑卒中就医延迟领域的研究文献稳步增长;研究力量主要集中在美国;研究热点主要集中在卒中治疗方法、就医延迟风险因素等方面;研究前沿主要集中在血管内治疗、质量改进研究等方面。结论 未来对于脑卒中就医延迟的研究,应加强国家之间的相互合作,聚焦国际高频引文,深入探索国际研究热点。     

Decrease in the incidence and in hospital mortality of community-acquired pneumonia among children in Spain (2001–2014)

ObjectivesTo describe trends in the incidence and outcomes of community-acquired pneumonia (CAP) hospitalizations among Spanish children from 2001 to 2014 and to assess the effect of the pneumococcal vaccination (PCV) coverage in this period.MethodsThis study was conducted using the Spanish National Hospital Database from 2001 to 2014 including subjects <18 years. We selected discharges with a primary diagnosis of CAP.Study variable included age, sex, comorbid conditions, procedures, isolated pathogens and hospital outcome variables.In order to estimate the effect of coverage of pneumococcal vaccination in hospitalizations for CAP, we used the number of commercialized doses of PCV (PCV7 PCV10, and PCV13) for each year.Incidence rates of admissions for CAP were calculated by dividing the number of admissions per year, sex, and age group by the corresponding number of people in that population group according to the census data.ResultsWe identified 194,419 admissions for CAP. Incidence rate was highest among children younger than 2 years and decreased significantly by 3.67% per year over the study period in this age group. Among children aged 2–4 years incidence of CAP seem to decrease after year 2009. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In children aged <2 years and 2–4 years increase in PVC was associated to a decrease in the incidence of CAP hospitalizations.Overall crude in hospital mortality following CAP fell significantly from 4.1‰ in 2001–2003 to 2.8‰ in 2012–2014.ConclusionsCAP incidence rates decreased significantly among children <2 years of age from 2001 to 2014. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In hospital mortality paralleling CAP fell significantly in children and adolescents from 2001 to 2014. Improvement in vaccination coverage seems to have a mitigating effect on hospitalizations and outcomes for CAP in children.     

UPLC-MS/MS法测定抗风湿中成药及保健品中非法添加10种抗风湿性化学成分

目的 建立UPLC-MS/MS法检测中成药及保健品中非法添加的10种抗风湿类化学成分的含量。方法 以ACQUITY UPLC BEHC₁₈（50 mm×2.1 mm,1.7 μm）为色谱柱,以含0.1%乙酸0.02 mol/L醋酸铵溶液-乙腈为流动相梯度洗脱,体积流量为0.3 mL/min;质谱采用电喷雾离子源（ESI）,多反应监测（MRM）模式进行定性定量分析。结果 10种化学物质的质谱检测线性范围宽,线性关系良好,r ≥ 0.996 1,平均方法回收率为92.5%~101.8%,RSD为0.9%~3.1%,检出限为0.001 5~0.018 μg,定量限为0.004 5~0.55 μg,27批样品中有10批样品检出了非法添加的化学物质。结论 本方法操作简单,灵敏度高,结果准确,可作为抗风湿类中成药及保健品中非法添加化学物质的测定方法。     

Downward deviation of progressive addition lenses in a myopia control trial

PURPOSE: To clarify how the downward deviation of progressive addition lenses (PALs) reduces their near-addition effect in schoolchildren participating in a myopia control trial. METHODS: Among 95 schoolchildren wearing PALs for 6 months (age range: 6-12 years; refractive error range: -6.00 to -1.25 D), facial images were captured with a digital still camera placed 60 cm in front of the eyes while he or she was looking ahead with natural head posture. The vertical deviations of PALs from their ideal position (mm) were evaluated by analysing these images. RESULTS: The mean (+/-SD) downward deviations of PALs for the right and left eyes were 3.7 +/- 2.3 and 3.7 +/- 2.0 mm, respectively, and the largest downward deviation was 10.2 mm. For simulations using the average downward deviation, the near-addition effect of PALs was reduced to 30 and 63% of the expected value at the 10 degrees and 20 degrees downward eye positions, respectively. CONCLUSIONS: The downward deviation of PALs is a significant factor in reducing their therapeutic effect for near-addition. To ensure the proper alignment of PALs in children, the conventional spectacle-frame-fitting procedure is not sufficient, and repeated confirmation using a testing method similar to that used in this study is required.     

紫外二阶导数光谱标准加入法测定中药复方制剂中合成鱼腥草素含量

将紫外二阶导数光谱与标准加入法相结合应用于药物分析，定量测定中药复方制剂中合成鱼腥草素的含量。根据比尔定律推导出标准加入体系的含量计算公式为Ｘ＿ｉ＝Ｘ＿ｉ×Ｃ＿ｉ／Ｋ－Ｃ＿ｉ×Ｖ＿ｉ。方法精密度ＣＶ１．３％；平均回收率９９．４０％，回收率ＣＶ１．９％。本法消除了中药复方制剂中样品基质的干扰，结果准确可靠。     

金锁匙口服液药效学及毒性研究

通过对金锁匙口服液的药效学及毒性的研究表明：本品能明显抑制吗啡依赖性小白鼠停药后的跳跃反应，协同戊巴比妥钠催眠作用，提高小鼠热板法痛阈值，抑制醋酸引起的小鼠扭体反应，提示金锁匙口服液对吗啡类成瘾患者有一定的治疗作用，毒理研究表明；本品服用无药物依赖性、安全、无毒。     

Pseudoaccommodation and progressive addition lenses

The limitations of traditional multifocal lenses to replace normal ocular accommodation are well known. The recent development of progressive addition lenses circumvent many of those problems, furnishing smoothly varying power in desired amounts for various distances and allowing freedom from distracting lines. Optical characteristics, screening considerations, prescribing and fitting requirements, and the advantages and limitations of progressive addition lenses are discussed.     

A comparison of the responses of the isolated vas deferens of the rat to field stimulation and to noradrenaline added cumulatively and non-cumulatively

The maxima, slopes and positions of cumulative and non-cumulative dose-response curves for noradrenaline were determined on the isolated vas deferens of the rat. Cumulative log dose-response curves were flatter and reached a lower maximum than the non-cumulative curves. However transformation of the responses to fractions of the maximal responses produced curves with identical slopes and only slight differences in positions. Field stimulation led to larger and more rapidly attained maximal responses than did the addition of exogenous noradrenaline. Responses to field stimulation applied at the plateau of the cumulative dose-response curves were similar to those occurring in the control situation. It is suggested that the effectiveness of noradrenaline in producing contraction of the vas deferens may be related to the rate at which its concentration rises at the effector cells.     

Automated external defibrillators and in-hospital cardiac arrest: patient survival and device performance at an Australian teaching hospital

Aims

To evaluate the effect of automated external defibrillators (AEDs) on patient survival and to describe the performance of AEDs after in-hospital cardiac arrest.

Methods

Prospectively collected data were analysed for cardiac arrests in the general patient care areas of a teaching hospital during the 3 years before and the 3 years after the deployment of AEDs. The association between availability of an AED and survival to hospital discharge was assessed using multivariate logistic regression. AED performance during automated management of the initial rhythms was assessed using information captured by the AEDs.

Results

There were 84 cardiac arrests in the AED period and 82 in the pre-AED period. Patient and event characteristics were similar in each period. The initial rhythm was shockable in 16% of cases. Return of spontaneous circulation was higher in the AED period (54% vs. 35%, P = 0.02) but the proportion of hospital survivors in each period was similar (22% vs. 19%, P = 0.56). The adjusted odds ratio for hospital survival when an AED was available was 1.22 (95% CI 0.53-2.84, P = 0.64). An AED was applied in 77/84 (92%) possible cases. Median interruption to chest compressions was 12 s (inter-quartile range 12-13). An automated shock was delivered in 8/13 (62%) possible cases.

Conclusions

Availability of AEDs was not independently associated with hospital survival. Shockable presenting rhythms were not common and, in keeping with the manufacturer's specifications, the AEDs did not shock all potentially shockable rhythms. The hands-off time associated with automated rhythm management was considerable.