某院三年抗菌药物专项整治效果对比分析

目的了解医院开展抗菌药物专项整治活动前后抗菌药物使用的变化趋势和行政干预效果,为常态化抗菌药物临床应用管理提供参考。方法对2011年-2013年全院抗菌药物使用金额、使用率、用药频度、I类切口抗菌药物预防使用比率、住院患者微生物检验样本送检率等进行统计分析。结果本院、科两级抗菌药物临床应用各项指标发生明显变化,均达到卫生部规定。结论本院抗菌药物专项整治各项措施的制定及实施效果明显,抗菌药物临床应用趋于合理。     

抗菌药物临床应用专项整治活动在我院的实践及成效

2011年5月,卫生部开展了抗菌药物临床应用专项整治活动。活动开展以来,我院积极响应卫生部和北京市卫生局号召,实施一系列举措以规范抗茵药物在我院的临床应用．经过两年的实践,我院抗菌药物临床应用情况得到明显改善,抗菌药物使用率、使用强度及抗茵药物治疗住院患者微生物检验样本送检率等指标均达到卫生部要求。本文介绍了我院开展抗菌药物专项整治活动的经验,并针对我院目前在抗菌药物使用方面的不足,提出改进意见,旨在进一步规范抗菌药物在我院的应用情况。     

某院2011年抗菌药物临床应用的调查分析

目的了解我院"抗菌药物临床合理应用专项整治活动"前后抗菌药物合理使用的情况,整治后的效果,为我院长期合理应用抗菌药物提供参考。方法采用回顾性方法,对我院2011年度"抗菌药物临床合理应用专项整治活动"前后的处方、病历进行抽查得出数据,包括门诊抗菌药物使用率、住院患者抗菌药物使用率、微生物送检率、Ⅰ类切口抗菌药物预防使用率、抗菌药物使用强度、销售金额进行统计分析。结果我院2011年门诊抗菌药物使用率、住院患者抗菌药物使用率、Ⅰ类切口抗菌药物预防使用率、抗菌药物使用强度、销售金额在"整治活动"后明显下降;微生物送检率则明显提高。结论我院抗菌药物通过抗菌药物临床合理应用专项整治活动应用的更为合理,切实落实抗菌药物的分级管理制度、围手术期预防性使用抗菌药物规定的要求。     

抗菌药物专项整治活动的开展对我院微生物送检率的影响分析

目的 探讨我院开展抗菌药物专项整治活动对我院微生物送检率的影响成效.方法 将我院2011年之前(整治前)与2011年至今(整治后)的微生物送检率指标,通过EXCEL制作综合报表并进行对比分析.结果 整治后我院接受抗菌药物治疗住院患者微生物检验样本送检率由2010年的23.33％逐渐上升到2013年的54.44％,上升较为明显,2013年住院患者应用限制使用级抗菌药使用前药敏送检率60.69％和应用特殊使用级抗菌药使用前药敏送检率91.44％均符合卫生部的相关要求.结论 抗菌药物专项整治活动取得了一定的成效.     

某院实施抗菌药物专项整治效果的分析

目的评价我院实施抗菌药物专项整治工作的效果。方法采取回顾性分析的方法,分析我院开展3年抗菌药物专项整治工作以来各项指标的完成情况。结果经过3年抗菌药物专项整治,我院抗菌药物使用率、住院使用强度、Ⅰ类切口手术围术期抗菌药物预防使用率、病原微生物送检率均达标;各类抗菌药物的DDDs、AUD的变化充分体现了"总量控制,结构调整"。结论采取有效可行的持续性干预措施,对促进抗菌药物合理应用,巩固抗菌药物专项整治取得的成果具有重要意义。     

口腔专科医院开展抗菌药物专项整治效果分析

目的了解口腔专科医院抗菌药物临床使用情况,评估“专项整治活动”取得的实效。方法对我院2011和2012年住院患者抗菌药物使用情况进行回顾性调查分析。比较2组抗菌药物使用强度、使用率、外科手术预防用药术前0．5～2h给药比率、微生物标本送检率等指标。结果2012年抗菌药物使用强度为56．78 DDD ,明显低于干预前79．84 DDD （ P＜0．05）,且2012年12月使用强度下降至33．72 DDD ,达到了卫生部标准要求;外科手术预防用药术前0．5～2 h给药比率为75．67％,明显高于干预前的33．47％（ P＜0．05）;住院患者抗菌药物使用率以及治疗性用药微生物标本送检率干预前、后无改善。结论开展抗菌药物临床应用专项整治活动后,口腔专科医院抗菌药物临床应用水平有了显著提高,但仍存在问题,需继续整改提高。     

行政干预对住院患者抗菌药物合理应用的影响

目的 探索抗菌药物合理使用方案实施的可行性,提高医院抗菌药物合理使用水平.方法 医院2009年至2012年对抗菌药物实施的监管分为3个阶段,采用分层抽样法,对各阶段住院患者抗菌药物使用率、特殊使用级抗菌药物使用率、病原送检率的指标进行对比研究;通过等级相关的统计方法,研究Ⅰ类切口手术平均预防用药天数逐季度变化值与医院对抗菌药物临床合理使用实施行政干预强度变化的关系.结果 3个阶段抗菌药物使用率呈逐渐下降趋势,限制级/特殊级抗菌药物使用前微生物检验样本送检率及预防用药合理性虽然呈逐渐上升趋势,但处于较低水平;Ⅰ类切口手术平均预防用药天数与行政干预强度呈负相关.结论 医院现阶段各项管理制度及采取措施提高了住院患者抗菌药物使用的合理性,但Ⅰ类切口手术抗菌药预防使用率、病原送检率还未达到《2012年全国抗菌药物临床应用专项整治活动方案》的要求,需要持续改进,同时医院应加强监管力度,以确保患者安全、有效、合理用药.     

某三级医院抗菌药物专项整治的效果评价

目的了解抗菌药物临床应用专项整治活动在某三级医院的实施效果,并总结经验。方法对该院2011年5月—7月(整治前)和2013年5月—7月(整治后)抗菌药物应用的数据指标进行统计,包括住院药占比、菌占比、住院患者抗菌药物使用率、门诊患者抗菌药物使用率、抗菌药物使用强度、限制使用级抗菌药物药敏试验率、微生物送检率、Ⅰ类切口手术抗菌药物预防使用率、Ⅰ类切口手术预防用药疗程合理率等指标。结果整治后的各项抗菌药物应用指标较整治前都有明显的提高和改善。结论通过抗菌药物专项整治活动,该院抗菌药物应用情况明显改善,但尚存部分控制指标不达标,还需要进一步的加强宣传培训和管理。     

我院抗菌药物专项整治活动效果调查分析

目的：分析并评价该院抗菌药物专项整治活动情况,为进一步提高临床合理使用抗菌药物提供参考。方法抽查门、急诊处方和出院病历,计算抗菌药物使用强度及各种控制指标等,评价抗菌药物专项整治活动的开展情况及效果。结果医院能按要求开展抗菌药物专项整治活动,明确控制指标,签订责任状,落实抗菌药物管理制度,开展处方点评工作。门、急诊患者抗菌药物使用率达标,但住院患者抗菌药物使用率不达标,住院患者清洁手术预防性用药率高,品种选择不当,疗程长等不合理现象仍存在。结论通过开展为期3年的抗菌药物专项整治活动,医院部分管理指标达标,仍需加大管理和整治力度,对不合理用药进行干预,以提高合理应用抗菌药物水平。     

我院抗菌药物临床应用专项整治的干预措施及成果分析

目的:介绍我院抗菌药物临床应用专项整治活动采取的干预措施并评价其成效。方法:选取我院2011年5月–2012年10月就诊患者为研究对象,以抗菌药物使用强度、使用率和I类切口围术期抗菌药物应用情况等为观察指标,对比整治前后抗菌药物控制指标的变化。结果:通过实施干预措施,住院患者抗菌药物使用率和使用强度显著降低,分别由2011年5月的67.37%和92 DDD下降至2012年10月的49.16%和41 DDD,I类切口预防用抗菌药物使用率由78.1%下降至29.5%,术后用药时间由3.5 d下降至1.8 d,微生物送检率大于60%,门诊抗菌药物处方比率小于20%。结论:我院抗菌药物临床应用专项整治措施加强了抗菌药物临床应用的管理,提高了抗菌药物合理应用水平,并建立了长效的管理机制。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.