氟康唑在预防早产儿真菌感染中的临床意义

目的：探讨口服氟康唑在预防出生胎龄≤32周和/或出生体质量≤1 500 g的早产儿真菌感染中的临床意义。方法：选择2012年2月至2014年12月在本院新生儿重症监护室（NICU）分娩后收治的早产儿118例,其中未预防性给予氟康唑的早产儿（对照组）56例,预防性给予氟康唑的早产儿（预防组）62例,分析比较两组患儿的临床特点及真菌感染的发生情况,同时监测两组患儿的生化指标,观察氟康唑口服治疗有无肝肾损害,并记录早产儿视网膜病（ROP）、支气管肺发育不良（BPD）、新生儿坏死性小肠结肠炎（NEC）、脑损伤、出院时体质量、住院时间、住院费用等相关情况。结果：预防组发生真菌感染率明显低于对照组,差异有统计学意义（x2=10.59,P<0.01);预防组病死率、NEC发生率低于对照组,住院时间较短、费用少,但与对照组比较差异无统计学意义（P均>0.05）;两组ROP发生率、BPD发生率、脑损伤发生率、出院时体质量等方面比较差异无统计学意义（P均>0.05）;动态监测预防组患儿无明显肝肾损害。结论：采用口服氟康唑预防早产儿真菌感染安全、有效,值得临床推广。     

初乳口腔免疫疗法联合益生菌对早产儿胃肠道功能及肠道菌群的影响观察

目的 观察初乳口腔免疫疗法联合益生菌对早产儿胃肠道功能及肠道菌群的影响。方法 选取86例早产儿，采用随机数字表法分成2组，各43例。对照组采取常规干预加益生菌，观察组加用初乳口腔免疫疗法。观察效果与安全性及干预2 d、1周、2周后双歧杆菌、乳酸杆菌浓度、分泌型免疫球蛋白A(SIgA)、免疫球蛋白M(IgM)浓度。结果 两组比较观察组恢复时间相对较短，体质量增速较对照组高，差异有统计学意义（P<0.05）；观察组不良事件发生率2.33%较对照组18.60%低，差异有统计学意义（P<0.05）；干预1周、2周后观察组双歧杆菌、乳酸杆菌浓度较对照组高，差异有统计学意义（P<0.05）；干预1周、2周后观察组SIgA、Ig M浓度较对照组高，差异有统计学意义（P<0.05）。结论 对早产儿进行初乳口腔免疫疗法联合益生菌干预，能调节肠道菌群，增强早产儿免疫力，改善其胃肠道功能，减少不良事件发生。     

非营养性吸吮联合益生菌与红霉素治疗晚期早产儿喂养不耐受的临床疗效对比分析

目的观察非营养性吸吮联合益生菌与红霉素治疗晚期早产儿喂养不耐受的临床疗效、安全性以及不良反应的发生情况,探讨晚期早产儿喂养不耐受的治疗方法。方法将2009年11月至2012年11月汾西县人民医院新生儿科收治的60例喂养不耐受的晚期早产儿随机分为非营养性吸吮(后简称吸吮)联合益生菌组30例、红霉素组30例。两组均给予保暖、体位疗法,部分静脉营养及改善喂养策略等常规治疗。吸吮联合益生菌组在常规治疗的基础上加用吸吮联合益生菌(常乐康0.5g/次,Bid,口服);红霉素组在常规治疗基础上加用红霉素(3mg/kg次。Tid,口服)治疗,疗程3~5d。结果吸吮联合益生菌组和红霉素组治疗晚期早产儿喂养不耐受在病程、呕吐时间、胃残余、平均增加体质量、日增加奶量以及临床有效率比较,差异无统计学意义(P>0.05)。吸吮联合益生菌组腹泻发生率低于红霉素组,差异均有统计学意义(P<0.05)。除腹泻发生率外,吸吮益生菌组和红霉素组均未发生新生儿坏死性小肠结肠炎。差异均无统计学意义(P>0.05)。结论吸吮联合益生菌与红霉素治疗晚期早产儿喂养不耐受疗效相当,但红霉素在治疗过程中腹泻相对明显,在无胃肠道发育畸形的情况下,吸吮联合益生菌更有利于晚期早产儿胃肠系统的发育,且安全有效。     

多感官干预在早产儿管饲喂养及疼痛干预中的作用

目的 探讨多感官干预在早产儿管饲喂养及疼痛干预中的作用。方法 选择2020年3月至2021年3月本院收治的早产儿90例,随机分为对照组和观察组各45例。对照组应用常规管饲喂养干预,观察组在对照组基础上予以多感官干预。比较两组喂养过渡、留置胃管、肠外营养维持及住院时间、体重、胃内残余、新生儿疼痛评估量表(NIPS)、神经行为能力评分情况。结果 观察组多感官干预后肠外营养维持、留置胃管、喂养过渡时间均较对照组缩短(P<0.05),两组住院时间比较差异无统计学意义(P>0.05);两组干预前体重比较差异无统计学意义(P>0.05),观察组多感官干预后出院及完全喂养时体重均高于对照组(P<0.05);观察组3d、5d、7d以及9d的胃内残余量均少于对照组(P<0.05);观察组NIPS评分低于对照组(P<0.05);观察组不良反应发生率较对照组低(P<0.05);观察组早产儿出院时对安慰的反应、手握持能力、前臂肌张力及下肢肌张力等出院时各神经行为发育评分均高于对照组(P<0.05)。结论 在早产儿管饲喂养中行多感官干预,有利于缩短喂养进程,缓解疼...     

复方嗜酸乳杆菌片预防抗菌药物相关性腹泻的分析

目的：观察复方嗜酸乳杆菌片对抗菌药物相关性腹泻（AAD）的预防作用。方法103例静脉注射抗菌药物治疗的患者随机分为2组,观察组在使用抗菌药物治疗过程中口服或鼻饲复方嗜酸乳杆菌片,对照组在出现AAD前不使用益生菌。比较分析2组患者AAD发生的情况。结果观察组AAD发生率（7.69%）比对照组发生率（23.5%）低,差异有统计学意义（P＜0.05）。结论在静脉注射抗菌药物治疗时,使用复方嗜酸乳杆菌片可预防AAD发生。     

益生菌治疗小儿抗生素相关性腹泻(AAD)的临床价值

目的探讨益生菌治疗小儿抗生素相关性腹泻的临床价值。方法对我院在2011年7月至2012年7月收治的288例小儿抗生素相关性腹泻的患儿随机分为观察组和对照组,观察组的患儿使用益生菌复方嗜酸乳杆菌进行治疗,对照组的患儿给予口服思密达进行治疗。结果观察组治疗疗效的总有效率明显高于对照组(P<0.05),观察组的治疗方法明显减少了患儿的腹泻程度和次数,使大便的形状得到了改变,两组患者在不良反应的发生率上没有明显的差异性(P>0.05)。结论益生菌用于治疗小儿抗生素相关性腹泻取得的临床疗效显著,值得在临床上使用和推广。     

不同的胃管拔管时间对早产儿生长发育的影响

目的探讨早产儿胃管喂养的拔管时间对早产儿生长发育的影响。方法选择我院新生儿室早产儿120例,根据拔管时间随机分为三组,五天组、七天组、十天组,每组各40例,三组均采用经口置胃管,用同一种配方乳喂养,三组性别、胎龄、体质量、差异无显著意义(P>0.05),总结三组体质量、身长、头围的增长量、大便性状、住院天数及相关并发症,并进行统计学分析。结果三组早产儿体质量、身长、头围的增长量、大便性状及相关并发症比较,差异有统计学意义(P<0.05)。结论通过本文的研究在患儿留置胃管七日拔管,既能满足患儿的生长需求,也能减少合并症的发生,而且早产儿的吸吮和吞咽功能已基本成熟。     

口服益生菌联合早期微量喂养对早产儿肠道菌群及免疫功能的影响

目的探讨口服益生菌联合早期微量喂养对早产儿肠道菌群及免疫功能的影响。方法选择2014年1月~2016年1月间我院收治的早产儿200例作为研究对象,将其随机分成两组,分别定为观察组和对照组,每组100例,对照组采取在早产儿出生24h内开始非营养性吸吮、早期微量喂养,观察组在对照组基础上给予口服益生菌,测量患儿出生后3、7、14d粪便中肠道乳酸杆菌及双歧杆菌,并对两组患儿治疗前后免疫功能进行统计学分析。结果两组治疗前CD3~+、CD4~+、CD8~+、CD4~+/CD8~+T等T淋巴细胞亚群比较差异无统计学意义(P0.05);观察组患者治疗后CD4~+、CD4~+/CD8~+T等T淋巴细胞亚群均高于对照组治疗后,且比较差异均有统计学意义(P0.05);观察组患儿治疗3d粪便中双歧杆菌和乳酸菌测定结果与对照组患儿比较差异无统计学意义(P0.05);观察组患儿治疗7d、14d粪便中双歧杆菌和乳酸菌测定结果均高于对照组,且比较差异均有统计学意义(P0.05)。结论对早产儿实施口服益生菌联合早期微量喂养,能够有效促进患儿病情恢复,改善早产儿肠道菌群,提高免疫功能,临床价值显著。     

嗜酸乳杆菌联合三联疗法治疗幽门螺杆菌感染的疗效

目的观察嗜酸乳杆菌片联合三联疗法治疗幽门螺杆菌(Hp)感染的疗效。方法 Hp感染患者258例随机分为三组,分别采用雷贝拉唑+克拉霉素+阿莫西林(三联组,86例)、三联组方案+复方嗜酸乳杆菌(益生菌组,85例)和三联组方案+铋剂(四联组,87例)治疗,测定各组胃黏膜IL-8表达,比较Hp根除率和不良反应发生情况。结果益生菌组Hp根除率为80.0%,高于三联组的60.5%(P<0.05)。益生菌组胃黏膜IL-8含量为(60.7±25.1)pg/ml,低于三联组的(73.1±27.7)pg/ml(P<0.05)。益生菌组腹泻、食欲减退、便秘等不良反应发生率低。结论嗜酸乳杆菌联合三联疗法能显著提高Hp根除率,减轻炎症反应,减少抗生素治疗相关不良反应。     

益生菌预防肝硬化自发性腹膜炎的疗效

目的探讨预防肝硬化腹水并自发性膜腹炎的方法与效果。方法选择肝硬化腹水并自发性腹膜炎患者共43例,随机分为益生菌组15例,抗生素组15例,对照组13例。三组患者住院后均给予抗感染、护肝、利尿、对症支持等常规治疗10~14 d。此后,益生菌组给予双歧三联活菌胶囊0.63 g/d,6个月;抗生素组给予诺氟沙星胶囊200 mg,口服,每日1次;对照组未做特殊处理。三组均于用药内6个月进行定期复查,评价其有效率、自发性腹膜炎再发率及小肠细菌过生长情况。结果 (1)疗效:6个月内益生菌组总有效率为86.7%,再生率为13.3%,抗生素组有效率为93.3%,再发率为6.7%;对照组自发性腹膜炎再发率为46.2%。益生菌组与抗生素组的总有效率、再生率比较,差异无统计学意义(P>0.05),但两者与对照组相比,差异均有统计学意义(P<0.05)。(2)小肠细菌过生长情况:治疗前后对照组阳性率无变化,益生菌组及抗生素组阳性率显著下降(P<0.05),益生菌组与抗生素组与对照组相比,差异有统计学意义(P<0.05),益生菌组下降率与抗生素组比较,差异无统计学意义(P>0.05)。结论益生菌及抗生素在预防和治疗自发性腹膜炎方面均有良好疗效,不良反应少、复发率低,值得临床推广。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.