言论

那是最美好的时代,那是最糟糕的时代;那是智慧的年头,那是愚昧的年头;那是信仰的时期。那是怀疑的时期;那是光明的季节,那是黑暗的季节;那是希望的春天,那是失望的冬天;我们面前什么都     

健康家居 选择会“呼吸”的材料

家庭环境的好坏不是表面的金碧辉煌或单纯的奢侈豪华,更不是昂贵材料的堆砌。尊重材料本身的特性和天然的美感并结合富有创意的设计,方能制造空间的独特个性。     

肝脓肿199例临床分析

肝脓肿(liver abscess,LA)是肝脏外科常见的严重疾病,随着超声、CT的广泛应用和外科治疗技术的不断发展,以及公共卫生、健康条件的改善,抗生素的普遍应用等,肝脓肿的病死率已由原来的70%下降到近年来的15%以下,同时其临     

37例医疗纠纷技术鉴定案例分析

医疗纠纷,是指医患双方对医疗后果、产生的原因以及如何处理而发生的分歧,或者患者对医疗服务不满意,也可以发生纠纷.医疗纠纷的发生不仅直接关系到患者的切身利益,也关系到医疗机构的工作秩序、声誉,处置不当将影响社会的安定.如何预防和处置日趋上升的医疗纠纷,已成为卫生行政部门和医院机构所面临的一个严峻的问题.     

巧妙选药不再脱发

不管在什么年代,头发对人所起的作用都不仅仅限于生物学上的保暖、防御作用,更重要的是扮演着美容修饰等重要角色.拥有健康亮丽的头发可使人充满朝气和自信,然而,随着生活节奏的加快、精神压力的增加,脱发的人数也呈上升趋势,且出现年轻化的迹象.脱发,正成为越来越多现代人的烦恼.     

美国可能出台新的"仿制生物药法案"及"FDA审批管理条例"——访Y. Philip Zhang (张引) 博士

写在开“坛”之际： “高端访坛”——本刊一个新的栏目，也是一种新的尝试。 所谓“访坛”，是指本刊编辑部根据当今国际、国内医药界的热点议题，有目的地对有关人士进行访问，并将他们的观点、看法和建议通过这个“讲坛”转达给本刊的广大读者； 而之所以称之为“高端”，是因为在我们的计划中，选择的专访对象将定位在国内医药界那些具有创新意识、有自己独特的研究领域、并已经取得一定成就的学科带头人和近距离接触国际药学研究及管理先进理念的专家和学者。 我们希望从事医药教学、科研和管理的同行能从来到本“坛”、接受采访的嘉宾们独到的视角、缜密的思维、或卓有成效的分析和解决问题的模式中得到启发和帮助，使我国的医药研究和管理水平能跨上新的台阶，使中国的医药事业能更快更好地发展，为全中国乃至全世界的人民造福。     

浅谈如何加强医疗器械的管理

医疗器械的应用在疾病的诊断、治疗及预防等各个环节都发挥着不可替代的作用,其质量的好坏直接关系到人民群众的身体健康和生命安危.2000年国务院颁布了第一部医疗器械监管法规-<医疗器械监督管理条例>,标志着我国医疗器械监管正式走上了法制化轨道,但是由于种种原因,目前我国在医疗器械的生产、经营以及使用等各个环节都存在着较为普遍和严重的问题,其监管已显得相对滞后,成为食品药品部门监管中的一个"软肋",以至于频频出现像钢板等植入性器械断裂现象和发生举国震惊的"眼球事件".本文就我县医疗器械的经营、使用现状和如何加强对医疗器械的监管作以下分析和探讨.     

心血管疾病发病情况与肾脏移植排斥反应相关性的研究

肾移植的历史从某种意义来说,就是同排斥反应进行斗争的历史。肾移植后的排斥反应主要是由抗原识别,淋巴细胞的增值、分化,靶细胞的损伤这样一连串的免疫反应引起的。随着免疫抑制剂的不断进步,移植排斥反应的发生率降低,长期存活率提高,使得肾移植成为终末期肾病患者的最有效的治疗手段。本文主要探讨了肾移植前心血管疾病与移植后慢性排异反应(CVR)相关性做了细致研究。     

在美国参与管控药物和传染病的一点经历和随想

发达国家都有一套专业架构,这是工业文明过程中发展起来的,科网有搞科技政策研究的如曹聪等老师,对科技的专业架构是内行,我是搞医学的,身在其中而感受到与国内的巨大差距,这也可以大致回答稽少臣老师提出的"为什么国内造不出黑鹰水平的直升机",国内没有独立完整的专业架构。国内对海外人才的吸引,多是行政高层的战略决策,而并无相应的架构来吸收,这些人才除了少部分在克隆发达国家的小架构中生存,绝大部分是难以生根的,实际是表面热内部冷,而回去的多数中低端海归在原有的架构中能产生的效用是有限的,这就产生了贾伟老师的归海有潮的现象。而建立新的架构必然影响现在的国内同行,而产生另一种排挤效应,所以国内最好是专业内的反省和改良,自我更新,再从外部吸收养分来自我提高,这一点日本是亚洲国家里做得最好的。国内对所谓人才的鉴别,基本还是靠头衔和职位,施一公院士问题引起的热议就很能说明问题,真正管事的并不懂专业,     

国外药物靶标开发的现状及特点分析

药物通过结合并调节特定的蛋白或核酸靶标的活性而发挥其治疗作用.大量的药物靶标已经被开发并用于创新药物的发现过程.目前的研究重点是寻找新的靶标和对现有靶标进行更为深入地研究.分析药物靶标开发的现状和特点将有助于我们理解药物的分子作用机制,发现药物靶标开发中涉及的一些规律性的东西,为我国的创新药物开发提供参考.     

Regeneration of injured airway epithelium

The airway surface epithelium is frequently injured by microorganisms and viruses due to its permanent contact with the external medium. Following injury, the epithelium is able to repair itself and regenerate through several mechanisms including spreading and migration of basal cells, cell proliferation and differentiation. The cellular and molecular factors involved in wound repair and epithelial regeneration interact closely, implying the participation of cytoskeleton proteins and integrins receptors, matrix metalloproteinases and their inhibitors as well as cytokines and growth factors secreted by airway epithelial and mesenchymal cells. The spatio-temporal modulation of the pro-inflammatory cytokines such as IL-8, and MMPs (MMP-9 and -7) during the different steps of regeneration suggests that the matrix and secretory environment are markedly involved in these mechanisms and that their dysregulation may induce remodeling of the airway mucosa. A better knowledge of the mechanisms involved in airway epithelium regeneration may pave the way to regenerative therapeutics allowing the reconstitution of a functional airway mucosa in numerous respiratory diseases such as cystic fibrosis, chronic obstructive pulmonary diseases and bronchiolitis.     

Multigeneration assessment of nonylphenol and endosulfan using a model Australian freshwater fish, Melanotaenia fluviatilis

Changes over two generations in offspring and reproductive ability were recorded in crimson-spotted rainbowfish (Melanotaenia fluviatilis), a model Australasian freshwater fish, following a 24 h exposure to nominal nonylphenol concentrations of 50, 100, 500, 1000, 2250, and 5000 microg/L and following a 4 h exposure to nominal endosulfan concentrations of 1.0, 5.0, 10, 22, 33, and 50 microg/L. There were also four replicated control treatments: control 1 and 2 and solvent control 1 and 2, as well as "positive" female and male controls: 1 microg/L estradiol 1 and 2 and 1 microg/L testosterone 1 and 2. Results suggested that there may be some parental transfer of toxicants to embryos even over this short exposure period. Fertility of M. fluviatilis was reduced by a 24 h pulse exposure of adults to 100 microg/L nonylphenol and a 4 h exposure to 1.0 microg/L endosulfan. Hatch rates were significantly reduced after exposure to nonylphenol, endosulfan, and estradiol control but not in solvent controls and testosterone control. Significant correlations were found between reproductive and physiological parameters for nonylphenol and endosulfan exposed F0 adult rainbowfish. The major reproductive effects were on hatchability of the F1 generation and the gonadosomatic indices of male F1. The respective nominal NOEC and LOEC's for nonylphenol were 50 and 100 microg/L, and for endosulfan were <1.0 and 1 microg/L. These observed effects have the potential to significantly impact exposed rainbowfish populations through the observed approximately 45% reduction of hatchability and thus larval production.     

舒芬太尼复合咪达唑仑在乳腺癌手术麻醉苏醒中的应用

目的研究舒芬太尼+咪达唑仑在乳腺癌手术麻醉复苏中的应用,术后麻醉苏醒情况及拔管时血流动力学变化。方法选取ASAⅠ级,临床诊断为乳腺癌,拟行乳腺癌改良根治术患者60例,随机分为三组,每组20例,三组均采用气管内插管全身麻醉方式,以维库溴铵诱导插管,1组(F)以芬太尼+异丙酚+咪达唑仑维持麻醉,2组(S)以舒芬太尼+丙泊酚+咪达唑仑维持麻醉,3组(T)以舒芬太尼+丙泊酚+咪达唑仑维持麻醉,于术毕前10min停止丙泊酚输注,追加舒芬太尼+咪达唑仑,观察记录手术结束,取吸痰时,拔管时及拔管后MAP,HR,与基础值进行比较,记录呼患者睁眼时间,拔除气管导管时间和OAA/S评分。结果与术毕时比,F组和S组的MAP和HR在吸痰、拔管时均明显增高(P<0.05)。在睁眼时间、拔管时间两项观察指标中,各组之间差异有统计学意义,T组患者睁眼时间及拔管时间最短,S组次之,F组最慢,OAA/S评分T组评分较F组和S组明显升高(P<0.05)。结论舒芬太尼联合咪达唑仑用于乳腺癌手术患者,能保证很好的麻醉深度,术毕前10min追加舒芬太尼+咪达唑仑,拔管时心血管反应轻,术毕苏醒时间快,清醒状况良好,值得临床推广。     

Caspofungin: pharmacology,safety and therapeutic potential in superficial and invasive fungal infections

Invasive fungal infections are important causes of morbidity and mortality in hospitalised patients. Current therapy with amphotericin B and antifungal triazoles has overlapping targets and is limited by toxicity and resistance. The echinocandin lipopeptide caspofungin is the first of a new class of antifungal compounds that inhibit the synthesis of 1,3-β-D-glucan. This homopolysaccharide is a major component of the cell wall of many pathogenic fungi and yet is absent in mammalian cells. It provides osmotic stability and is important for cell growth and cell division. In vitro, caspofungin has broad-spectrum antifungal activity against Candida and Aspergillus spp. without cross-resistance to existing agents. The compound exerts prolonged post-antifungal effects and fungicidal activity against Candida spp. and causes severe damage of Aspergillus fumigatus at the sites of hyphal growth. Animal models have demonstrated efficacy against disseminated candidiasis and disseminated and pulmonary aspergillosis, both in normal and in immunocompromised animals. Caspofungin possesses favourable pharmacokinetic properties and is not metabolised through the cytochrome P450 (CYP) enzyme system. It showed highly promising antifungal efficacy in Phase II and III clinical trials in immunocompromised patients with oesophageal candidiasis. Caspofungin was effective in patients with invasive aspergillosis intolerant or refractory to standard therapies. Based on its documented antifungal efficacy and an excellent safety profile, caspofungin has been approved recently by the US Food and Drug Administration for the treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (i.e., amphotericin B, lipid formulations of amphotericin B, and/or itraconazole). Phase III clinical trials in patients with candidaemia and in persistently febrile neutropenic patients requiring empirical antifungal therapy are ongoing. This paper reviews the preclinical and clinical pharmacology of caspofungin and its potential role for treatment of invasive and superficial fungal infections in patients.     

Strain and sex alter effects of stress and nicotine on feeding, body weight, and HPA axis hormones

Gender and genotype result in differential sensitivity to stress and to nicotine. Male and female Sprague–Dawley and Long–Evans rats exhibit different behavioral responses to immobilization stress and to chronically-administered nicotine, suggesting that these animals may be useful to model human variability in stress and nicotine sensitivity. It is possible that differences in sensitivity of the hypothalamo–pituitary–adrenocortical (HPA) axis might account for these sex and strain differences. This experiment examined corticosterone (CORT) and adrenocorticotropin hormone (ACTH) responses of male and female Sprague–Dawley (n=117) and Long–Evans (n=120) rats administered 0, 6, or 12 mg/kg/day nicotine for 14 days; half of each treatment group was exposed to immobilization stress (20 min/day). Feeding and body weight also were measured. Nicotine increased CORT and ACTH levels of Sprague–Dawley females only. Stress increased CORT and ACTH levels of all groups except for Long–Evans females. Nicotine and stress decreased feeding and body weight with greatest effects in Long–Evans females. CORT, feeding, and body weight were positively correlated among stressed females. These findings suggest that strain differences in HPA axis, body weight, and feeding responses to nicotine and to stress are robust among females but not among males. CORT reactivity and female sex hormones may explain these differences.     

Drugs for insomnia

Introduction: Sleep is a vital neurochemical process involving sleep-promoting and arousal centers in the brain. Insomnia is a pervasive disorder characterized by difficulties in initiating or maintaining or non-refreshing (poor quality) sleep and clinically significant daytime distress. Insomnia is more prevalent in women and old age and puts sufferers at significant physical and mental health risks. This review summarizes published data on the current and emerging insomnia drug classes, rationale for development and associated risks/benefits. (Summary of Product Characteristics and Medline search on "hypnotic" or specific drug names and "Insomnia").

Areas covered: GABA_A receptor modulators facilitate sleep onset and some improve maintenance but increase risk of dependence, memory, cognitive and psychomotor impairments, falls, accidents and mortality. Melatonin receptor agonists improve quality of sleep and/or sleep onset but response may develop over several days. They have more benign safety profiles and are indicated for milder insomnia, longer usage and (prolonged release melatonin) older patients. Histamine H-1 receptor antagonists improve sleep maintenance but their effects on cognition, memory and falls remain to be demonstrated. Late-stage pipeline orexin OX1/OX2 and serotonin 5HT2A receptor antagonists may hold the potential to address several unmet needs in insomnia pharmacotherapy but safety issues cast some doubts over their future.

Expert opinion: Current and new insomnia drugs in the pipeline target different sleep regulating mechanisms and symptoms and have different tolerability profiles. Drug selection would ideally be based on improvement in the quality of patients' sleep, overall quality of life and functional status weighed against risk to the individual and public health.     

脂蟾毒配基PLGA-TPGS纳米粒的质量评价

目的：以自制材料乙交酯丙交酯共聚物-维生素E聚乙二醇1000琥珀酸酯（polylactide-co-glycolide-D-α-tocopheryl polyethylene glycol 1000 succinate,PLGA-TPGS）为载体制备脂蟾毒配基PLGA-TPGS纳米粒（Resibufogenin-loaded PLGA-TPGS nanoparticles,RPTN）,并以市售材料乙交酯丙交酯共聚物（PLGA）为载体制备脂蟾毒配基PLGA纳米粒（RBG-loaded PLGA nanoparticles,RPN）,体外评价和比较2种纳米粒的质量。方法：采用超声乳化-溶剂挥发法制备RPTN和RPN,用透射电子显微镜和激光粒度仪分别测定二者的外观、粒径、表面电荷。采用反相高效液相色谱法,色谱柱为Hypersil C₁₈（4.6 mm×250 mm,5 μm）,甲醇和0.05%冰醋酸溶液（9∶1）为流动相,检测波长为298 nm,测定RBG在RPTN和RPN中的载药量、包封率和体外释放度。结果：RPTN和RPN的粒径分别为152.3 nm和331.7 nm,载药量和包封率分别为18.4%、79.3%和15.1%、68.6%。体外药物释放30 d时RPTN和RPN的体外累积释放率分别为86.7%和72.3%,RPTN释放较完全。结论：自制载体制备的RPTN比RPN粒径更小,载药量和包封率更大,体外有明显的缓释作用,释放更完全。     

Some observations on the effects of bioprocessing on biopolymer stability

A short review is given of some of the effects of the stresses encountered during bioprocessing of protein and carbohydrate-based macromolecular systems. This is of relevance to the effectiveness and safety of protein or peptide drugs themselves (such as insulin and monoclonal antibodies) and for the integrity of delivery systems (such as various carbohydrate-based hydrogel or mucoadhesive polymers). Some carbohydrate polymers are themselves bioactive or immunostimulatory and particular use is being made of polysaccharide and glycoconjugate vaccines whose effectiveness can be severely effected by chain degradation. Stability criteria include molecular weight and conformation and techniques ranging from simple viscomery measurements to sophisticated analytical ultracentrifuge and multi-angle light scattering coupled to size exclusion chromatography and precision viscometry measurements have been useful in this regard. We focus on some recent work on the degradation and aggregation of immunoglobulin G4-based monoclonal antibodies in response to repeated freezing and thawing and long-term storage, looking at the possible connection between conformation change and aggregation, the effects of storage conditions on the stability of chitosan mucoadhesive systems used for nasal and oral delivery. We look at the effects of sterilization conditions (thermal and irradiation) on the stability of a variety of other polysaccharides such as starches, κ-carrageenan, carboxymethylcellulose, alginate, low- and high-methoxy pectins, guar, and xyloglucans and consider the use of a relatively new method for the evaluation of the molecular weight distribution of glycoconjugate vaccines with molecular weights as high as 100?×?10⁶ g/mol.     

Tannins medical / pharmacological and related applications: A critical review

Tannins are natural phenolic compounds that are widespread and almost ubiquitous in the vegetal world. They can be found in fruit, wood and bark of trees, and many types of wild herbs and plants or from sustainable agriculture and forestry. Their traditional use for leather has been doubled for centuries in the popular medical and pharmacological lore by their use to cure or alleviate a variety of infections and diseases. This has indicated to modern researchers that these materials possess a great potential for the use in modern medicine and pharmacy. This review, after an introduction on tannins their structures and their basic chemistry describe what modern researchers have been able to glean and demonstrate of their real, identified and quantified effects on various diseases, from their bactericidal, anticancer and antinflammatory actions to the many other effects that putsnow in more close focus in pharmacology.     

甲基黄酮醇胺盐对大鼠学习记忆的促进作用与其抗氧化作用的关系

目的研究甲基黄酮醇胺盐对大鼠学习记忆的影响，分析该药影响学习记忆与其影响脑内自由基反应的关系。方法ｉｐ甲基黄酮醇胺盐５，１０ｍｇ·ｋｇ－１共７ｄ后，采用Ｍｏｒ－ｒｉｓ水迷宫测试大鼠的学习记忆能力，同时测定训练ｄ５和休息３０ｄ后大鼠脑内过氧化脂质（ＬＰＯ）含量和超氧化歧化酶（ＳＯＤ）活性。结果甲基黄酮醇胺盐两种剂量均可提高大鼠获取空间定位信息能力和信息贮存能力并增强记忆保持和再现过程。用药大鼠脑内ＬＰＯ含量明显低于对照组，与其记忆成绩呈正相关性。而脑内ＳＯＤ活性则高于对照组，与其记忆成绩呈负相关性。结论甲基黄酮醇胺盐对大鼠的学习记忆机能具有促进作用，而它的抗氧化作用可能为其促进学习记忆的作用机制。