不同抗菌药物预防闭合性骨折围手术期感染最小成本分析

目的 比较头孢唑林与头孢曲松预防闭合性骨折切开复位术围手术期感染的效果和成本.方法 回顾性分析我院行闭合性骨折切开复位术术后有预防性使用抗菌药高危因素的患者126例,根据预防性使用抗菌药物品种不同分为头孢唑林组即A组和头孢曲松组即B组.比较两组患者预防围手术期切口感染的效果和成本.结果HT6K 两组患者白细胞计数、中性粒细胞百分比、体温比较,P>0.05,组间差异均无统计学意义;两组患者预防有效率均为100%,P>0.05,组间差异无统计学意义;A组患者预防性使用抗菌药物金额为(4.47±2.52)元,B组患者金额为(120.07±25.03)元,两组比较,A组明显低于B组,P<0.05,组间比较差异有统计学意义.两组患者治疗期间均未发生明显不良反应.结论HT6K 头孢唑林与头孢曲松预防闭合性骨折切开复位术围手术期感染的疗效与安全性均较好,但从经济学角度看,头孢唑林经济性更佳.     

某院甲状腺患者围术期预防用药情况调查分析

目的：了解某院外科甲状腺手术患者围术期预防性应用抗菌药物的现状。方法：回顾性抽取2009年7月～2010年4月全部甲状腺手术患者出院病历共108份,对其中符合条件的97份病历的围术期抗菌药物预防性应用情况进行调查分析。结果：甲状腺手术患者围术期抗菌药物预防性应用率为100%,选用抗菌药物的前3位分别是头孢替唑、头孢硫脒、头孢呋辛,术后首次预防用药的患者占94.85%,平均术后预防用抗生素疗程为6.07d。结论：该院外科围术期抗菌药物的预防性应用,亟待加强管理和规范。     

膀胱癌髂内动脉化疗栓塞（灌注）术后预防性应用抗生素的价值

目的探讨膀胱癌髂内动脉化疗栓塞（灌注）术后预防性应用抗生素的作用。方法入组对象为未行外科手术或已行膀胱癌部分切除术的膀胱癌患者,共60例,行髂内动脉化疗栓塞或灌注术,共85例次。随机分为两组：介入术后应用环丙沙星组（预防组）,介入术后不用抗生素组（非预防组）。术后观察体温、外周血白细胞计数、中性粒细胞计数、尿常规及体征1个月。对疑似感染病例行血、尿培养。比较两组术后感染率。结果预防组2例感染,感染率5％（2／42）。非预防组3例感染,感染率为7％（3／43）。两组术后感染率比较分析差异无统计学意义（P〉0．05）。结论膀胱癌髂内动脉化疗栓塞或灌注术患者一般不必预防性应用抗生素,但某些患者（特别是行化疗栓塞者）应综合考虑术式、患者的体质及免疫力等多方面因素,必要时须预防性应用抗生素治疗。     

临床药师干预对内镜中心围术期预防性应用抗菌药物的效果评价

目的:评价临床药师采用专项处方点评模式干预对复旦大学附属中山医院内镜中心围术期抗菌药物预防使用的效果。方法:参考国内外最新指南和专家共识，以卫健委《抗菌药物临床应用指导原则(2015年版)》为依据，制定围术期预防性应用抗菌药物点评标准，借助行政干预等措施，建立专项处方点评模式。根据手术种类分层抽样，选取复旦大学附属中山医院2020年9月至2021年2月内镜中心248例手术患者为对照组，2021年9月至2022年2月实施干预的256例手术患者为干预组，比较2组患者每月度围术期预防性使用抗菌药物的情况以及住院指标。结果:临床药师干预后，内镜中心围术期抗菌药物预防使用点评不合理率显著下降(78.2%vs. 17.6%,P<0.05),且人均住院时间、人均抗菌药物使用时间、人均住院费用、人均药品费用以及人均抗菌药物费用均有不同程度的降低，差异具有统计学意义(P<0.05)。干预前，围术期频繁使用头孢米诺或拉氧头孢联合甲硝唑预防感染；干预后，围术期预防感染抗菌药物以头孢唑林或头孢呋辛为主，且内镜中心每月抗菌药物使用强度均在规定范围，较干预前差异具有统计学意义。结论:临床药师的干预极大...     

两种头孢唑林预防Ⅰ类切口围手术期感染的最小成本分析

目的:比较五水头孢唑林与头孢唑林预防Ⅰ类切口围手术期感染的疗效和经济性。方法:回顾性分析我院行Ⅰ类切口手术乳腺手术、甲状腺手术、疝修补术后需要预防性使用抗菌药物的患者240例,根据预防用药的种类均分为A组(五水头孢唑林)和B组(头孢唑林)。比较两组患者预防感染的疗效和经济性。结果:两组患者体温、白细胞计数、中性粒细胞百分比比较差异均无统计学意义(P>0.05);两组患者预防有效率均为100%,差异无统计学意义(P>0.05);A组患者治疗费用为(7 444.4±980.2)元,B组患者治疗费用为(6 633.9±972.9)元,B组显著低于A组,两组比较差异有统计学意义(P<0.05)。两组患者治疗期间均未见明显不良反应发生。结论:两种头孢唑林预防Ⅰ类切口围手术期感染的疗效与安全性均较好,但从经济学角度看,头孢唑林经济性更佳。     

临床药师干预在Ⅱ类切口手术围术期预防性应用抗菌药物中的效果

目的探讨临床药师干预在Ⅱ类切口手术围术期预防性应用抗菌药物中的效果。方法选取宁夏医科大学总医院心脑血管病医院2017年1-6月出院患者为干预前组,2018年1-6月出院患者为干预后组,每组343例。分析Ⅱ类切口手术围术期预防性应用抗菌药物情况。结果干预前后组耳鼻喉头颈外科、妇科、泌尿外科、肝胆外科抗菌药物使用率比较,差异无统计学意义(P>0.05)。干预后组总用药不合理发生率低于干预前组(P<0.05)。干预前后抗菌药物排名前3位为头孢呋辛、头孢美唑、头孢替安,干预后头孢硫脒使用率明显升高。干预前后两组给药时机均为术前0.5~1 h或麻醉诱导前及术后给药。干预后组用药疗程短于干预前组,但差异无统计学意义(P>0.05)。结论通过临床药师干预,Ⅱ类切口手术围术期预防性应用抗菌药物应用率总体呈现下降趋势,在预防用药疗程、用药时机、药物选择、用药指征等方面均更加规范、合理。     

3种头孢菌素预防Ⅰ类切口感染的疗效及经济性比较

目的比较头孢硫脒、五水头孢唑啉及头孢唑啉对预防Ⅰ类切口手术(疝、乳腺及甲状腺手术)围手术期感染的疗效及经济性。方法 2012年3月至9月,行以上3种Ⅰ类切口手术且术前预防用头孢硫脒、五水头孢唑啉或头孢唑啉的患者总共78例,根据预防用药的种类分为A、B和C 3组,用法均为手术前30min静脉滴注1次,用量为2.0g,术后用量为2.0g,2次/日,术后使用1⁴d。比较3组预防感染的疗效及经济性。结果 3组患者术后均未发生感染,体温、白细胞计数、中性粒细胞百分比差异无统计学意义(P>0.05),也未见药品不良反应;人均每日抗菌药物费用及住院总费用3组间差异具有统计学意义(P<0.05)。结论头孢硫脒、五水头孢唑啉及头孢唑啉在预防Ⅰ类切口感染方面的疗效相当,但经济性差异有统计学意义,头孢唑啉经济性最佳。     

127例Ⅰ类切口手术围术期预防性应用抗菌药物情况调查分析

目的：调查分析Ⅰ类切口手术围术期预防性应用抗菌药物情况。方法：采用回顾性分析方法,随机抽取我院Ⅰ类切口手术患者127例,对其围术期预防性应用抗菌药物情况包括药品名称、用药例次、用药时机、联合用药等进行分析与评价。结果：我院Ⅰ类切口手术围术期抗菌药物预防性应用率达68.50%,预防用抗菌药物以第一代头孢为主;使用最多的是头孢唑林30例次,占32.26%;其次是头孢拉定17例次,占18.28%。32例患者于术前0.5~2h给药,72例患者于术后给药;联合用药6例,占6.90%。结论：我院Ⅰ类切口手术围术期预防性应用抗菌药物基本符合卫生部《抗菌药物临床应用指导原则》的要求,但仍存在总体用药频率过高、给药时机不合理、术后给药时间过长及盲目联合用药等情况,需要提高本院医师的合理用药水平。     

758例骨科手术围术期预防性应用抗菌药物合理性分析

目的：了解广西梧州市中医医院骨科围术期预防性应用抗菌药物应用情况,评价我院骨科手术围术期预防性应用抗菌药物的合理性,为临床合理用药提供参考。方法：对2010年1月—2011年12月我院758例骨科手术患者围术期预防性应用抗菌药物情况进行回顾性调查与分析。结果：758例骨科手术患者有721例使用了抗菌药物,使用的药品主要为头孢唑林、头孢呋辛、头孢曲松、头孢他定等。不合理用药主要表现在抗菌药物使用率过高、预防性给药时间与持续用药时间不合理、药物选择不合理、用法与用量不合理及更换抗菌药物不合理。结论：我院骨科手术围术期预防性应用抗菌药物存在一定不合理现象,应加强质量监控,规范用药行为,提高医疗质量,确保用药安全、有效。     

剖宫产术围手术期预防应用抗菌药物100例调查分析

目的调查该院剖宫产术围手术期预防应用抗菌药物的现状,为临床合理用药提供参考依据。方法采用回顾性调查方法,对该院2011年1～12月100例剖宫产患者围手术期预防应用抗菌药物的情况进行统计、分析。结果 100例剖宫产患者围手术期均预防性应用抗菌药物;应用品种以头孢唑啉、头孢西丁、头孢尼西、头孢替安、氨曲南、奥硝唑为主;结扎脐带后立即给药67例;中位用药天数为4.82d。结论该院剖宫产患者围手术期预防应用抗菌药物基本符合规范要求,但尚存在给药时机不当及用药时间过长等不合理之处;应进一步加强用药监管,以促进抗菌药物的合理使用。     

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.