2009～2013年浙江省11家医院肺癌患者升血小板药物利用调查

摘 要 目的:了解浙江省肺癌患者升血小板药物应用现状,为促进合理用药提供参考。方法：以肿瘤患者升血小板药物指南推荐的重组人白细胞介素-11（IL-11）和重组人血小板生成素(rhTPO)作为研究对象,抽取浙江省11家医院2009～2013年全院肺癌患者每年40d的用药医嘱,回顾性分析用药金额、用药频度（DDDs）、限定日费用（DDC）、科室分布及各药物所占比例。结果：2009～2012年肺癌患者使用升血小板药物的用药金额呈逐年上升趋势,且升血小板药物在所有药物中所占比例逐年上升,至2013年略有下降。药物使用的DDDs与DDC值总体呈上升趋势。使用金额比例排名前3位的分别为放疗科（38.94%）、肿瘤科(34.43%)、肿瘤内科（10.04%）。2010~2013年升血小板药物使用金额以日均费用较低的IL 11所占比例较高。结论：2009~2013年浙江地区肺癌患者升血小板药物的使用情况基本合理,使用趋势偏向价格适中的药物,符合药物经济学原则。     

浙江省11家医院2009~2013年肺癌患者静脉营养制剂应用分析

摘 要 目的:为评价浙江省11 家医院肺癌患者使用静脉营养制剂的应用状况,对其近5年的用药数据进行分析。方法：抽取浙江省11 家医院2009~2013年肺癌患者每年40 d静脉营养制剂的用药医嘱,分析其使用静脉营养制剂用药金额、用药频度（DDDs）、DDC等情况。结果：5年来,该11家医院肺癌患者使用静脉营养制剂的用药总金额呈逐年上升趋势,尤其是2012年和2013年,增长速度很快,年增长百分比均达100%以上。其中占主要因素的是静脉脂肪乳剂金额的大幅增长,而2010~2012年氨基酸类静脉营养制剂使用金额的增幅不显著,2013年用药金额增加。结论：浙江省临床医生对于肺癌患者营养风险的重视程度越来越高,静脉营养制剂特别是特殊营养素呈现持续快速增长趋势,其在临床的合理化应用也有待进一步加强。     

浙江省11家医院2009~2014年肺癌合并糖尿病患者口服降糖药使用调查

摘 要 目的：分析浙江地区11家医院肺癌合并糖尿病患者口服降糖药的使用情况,为肺癌合并糖尿病患者此类药物的临床合理应用提供依据。方法：选取浙江地区11家医院肺癌合并糖尿病患者口服降糖药2009~2014年每年40d的医嘱数据,分析口服降糖药的用药金额、用药频度（DDDs）、限定日费用（DDC）和药物利用指数（DUI）等指标。结果：用药金额占前三位药物的分别是阿卡波糖、格列齐特和瑞格列奈;DDDs排前四位是阿卡波糖、二甲双胍、瑞格列奈和格列美脲;DDC排前四位是罗格列酮、西格列汀、格列齐特和阿卡波糖;12种口服降糖药的DUI值介于0.27~2.94。结论：浙江地区11家医院肺癌合并糖尿病患者口服降糖药的使用存在不合理现象,临床用药时应进一步掌握合理用药指征。     

2017—2019年南京地区抗流感病毒药物使用情况分析

目的 分析江苏省南京地区2017—2019年53家医院抗流感药物的临床应用情况与变化趋势,为其临床合理使用提供参考依据。方法 采用用药频度（DDDs）排序法与金额排序法,对南京地区53家医院2017—2019年使用的抗流感药物的品种、销售金额、构成比、用药频度（DDDs）、限定日费用（DDC）等进行回顾性统计和分析。结果 2017—2019年,南京地区抗流感药物的年销售金额与年DDDs逐年增长;炎琥宁与奥司他韦2种药物的销售金额连续3年位列前茅,且所占总销售金额的比例3年均超过50%。金刚烷胺、炎琥宁、板蓝根与奥司他韦4种药物的DDDs值连续3年位于前4位,且所占总DDDs的比例3年均超过80%,金刚乙胺持续排在末尾。结论 抗流感药物在南京地区医院应用广泛,销售金额与使用量均呈快速增长的趋势,部分药物的DDC呈降低趋势。     

武汉地区 31家医院2014~2016年儿童止咳中成药使用分析

摘 要 目的：了解武汉地区医院儿童止咳中成药的使用情况与特点。方法：对武汉地区31家医院2014~2016年儿童止咳中成药的应用品种数、销售金额、用药频度（DDDs）、与日均费用（DDC）等进行回顾性统计分析。结果：武汉地区医院儿童止咳中成药的用药金额与DDDs所占比例呈逐年减少趋势,但儿童专用止咳中成药用药金额与DDDs所占比例逐年明显增长。儿童止咳中成药用药金额与DDDs同步性良好,DDC值趋于稳定。结论：武汉地区医院儿童专用止咳中成药的临床使用越来越多。临床需要合理选用儿童止咳中成药,并注意相关事项。     

2009~2015年浙江省11家医院肺癌患者表皮生长因子受体酪氨酸激酶抑制药使用调查

摘 要 目的：了解2009~2015年浙江省11家医院肺癌患者表皮生长因子受体酪氨酸激酶抑制药（EGFR-TKI）的利用现状,分析其用药合理性。 方法: 抽取2009~2015年浙江省11家医院每年40天的医嘱数据,对肺癌患者使用EGFR-TKI的用药金额、用药频度（DDDs）、限定日费用（DDC）以及药物利用指数（DUI）进行统计分析。 结果: 埃克替尼、厄洛替尼和吉非替尼是目前最主要的3种EGFR-TKI,其中埃克替尼2013年之后才开始使用。EGFR TKI的用药总金额总体呈上升趋势,2015年的销售总金额是2009年的4.67倍;厄洛替尼的DDDs总体呈降低趋势,吉非替尼和埃克替尼的DDDs逐年升高;DDC排序最高的是厄洛替尼,吉非替尼次之,埃克替尼最低;3种靶向药物的DUI值均在1左右。 结论:浙江省11家医院EGFR TKI的用量逐年升高,但使用相对合理。     

浙江省11家医院2010~2014年肺癌患者麻醉药品使用情况分析

摘 要 目的：了解浙江省11家医院2010~2014年肺癌患者麻醉药品的使用情况及用药趋势,为麻醉药品临床合理应用提供参考。方法: 抽取浙江省11家医院2010~2014年肺癌患者的医嘱,对麻醉药品的用药金额、用药频度（DDDs）、限定日费用（DDC）、排序比以及口服缓控释制剂与贴剂用量比值进行分析。结果: 浙江省11家医院肺癌患者2010~2014年抽样医嘱中药品消耗总金额与麻醉药品销售金额均逐年增加,麻醉药品金额构成比也逐年增加,5年来麻醉药品金额构成比增加了81.34%。2010~2014年盐酸羟考酮缓释片销售金额、DDDs均有显著增加,为目前最常用的缓控释麻醉药品。即释吗啡销售金额及DDDs也呈明显上升趋势,一定程度上表明疼痛滴定和爆发痛解救合理性有所上升。此外,缓控释制剂中口服与贴剂用量比值逐步升高,符合WHO首选口服的癌痛治疗理念。结论:浙江省11家医院肺癌患者2010~2014年抽样医嘱中麻醉药品的使用不断趋于合理,麻醉药品用于癌痛治疗的规范性有所提升。     

2014~2016年杭州地区11家医院肺癌患者铂类药物的应用分析

摘 要 目的：分析2014~2016年杭州地区11家医院肺癌患者使用铂类药物的情况,为铂类药物的临床合理应用提供依据。方法: 抽取杭州地区11家医院肺癌患者2014~2016年每年40天铂类药物的医嘱数据,分析不同种类铂类药物的使用金额、用药频度（DDDs）、限定日费用（DDC）及药物利用指数（DUI）等指标。结果: 2014~2016年铂类药物的销售总金额呈下降趋势,与2014年相比,2016年铂类药物的销售总金额下降了6.64%,使用金额最高的是卡铂,其次是顺铂和奈达铂;DDDs居首位的是顺铂,卡铂和奈达铂分别排在第二、三位;铂类药物的DDC值与DDDs相反,顺铂的DDC最低,DDC较低的还有卡铂和奈达铂;奈达铂的DUI稍低于1（0.84~0.89）,其他4种铂类药物的DUI接近1。结论: 杭州地区11家医院2014~2016年肺癌患者铂类药物的使用金额稍有下降,安全有效、DDC较低的铂类药物在临床使用中占优势。     

2014~2016年南京地区35家医院免疫调节药物利用分

摘 要 目的：了解南京地区免疫调节药物的最新应用情况和发展趋势,为临床合理使用免疫调节药物提供参考。方法：根据江苏省医药情报研究所提供的南京地区2014～2016年免疫调节药物的销售数据,采用金额排序法和用药频度分析法,对本地区35家医院近三年免疫调节药物的销售金额、用药频度（DDDs）、限定日费用（DDC）、序号比值等指标进行回顾性统计分析。结果：免疫抑制药销售金额排名前3位的药物是他克莫司、吗替麦考酚酯和环孢素,DDDs排名前3位的药物是雷公藤总苷、他克莫司和吗替麦考酚酯,总销售金额和总DDDs均呈增长趋势,销售金额与DDDs的序号比值在0.5～4.0之间;免疫增强药销售金额排名前3位的药物是白细胞介素、乌司他丁和匹多莫德,DDDs排名前3位的药物是白细胞介素、羧甲基淀粉钠和匹多莫德,总销售金额和总DDDs呈波动性,销售金额与DDDs的序号比值在0.3～2.0之间。结论：南京地区免疫调节药物的应用现状基本符合当前患者的用药需求。建议治疗时根据药物的特点和患者实际情况实施个体化给药,避免滥用,保证临床用药安全、有效、经济的基本原则。     

2014~2016年武汉地区31家医院质子泵抑制药的使用情况分析

摘 要 目的：分析2014~2016年武汉地区31家医院质子泵抑制药（PPIs）的使用情况,为临床上该类药物的合理应用提供参考依据。方法: 对2014~2016年武汉地区31家医院PPIs的使用品种、用药剂型、销售金额、用药频度（DDDs）、限定日费用（DDC）、药品销售金额排序（B）/DDDs排序（A）以及进口用药构成比等进行统计,分析PPIs的应用现状。结果:2014~2016年武汉地区31家医院PPIs的销售金额与DDDs呈逐年递增趋势。用药剂型以口服为主,但注射用药构成比仍然较高。3年中销售金额与DDDs增速最快的分别是口服泮托拉唑与注射用兰索拉唑;注射用奥美拉唑的销售金额与DDDs却呈现大幅下降的趋势。口服泮托拉唑的DDDs排序连续3年居第1位,且其B/A值远大于1。大多数PPIs的同步性较好且DDC逐年减少。除埃索美拉唑外,PPIs的用药均以国产为主。结论:2014~2016年武汉地区31家医院PPIs的使用基本趋于合理,但仍存在不合理用药的可能性,需进一步加强监控,促进临床合理用药。     

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.