我院白内障患者围手术期抗菌药物使用调查分析

目的:探讨空军总医院眼科白内障手术围手术期使用抗菌药物的合理性。方法:采用回顾性调查的方法,随机抽取该院白内障手术患者102例(186只患眼),以构成比或百分比对数据进行统计,并参照有关指南对其围手术期抗菌药物的使用情况进行分析。结果:该院白内障手术围手术期用药中,术前24⁴8h、24h和348h、24h和3⁴h和术后24h内以妥布霉素注射液80mg溶于20m L生理盐水(浓度4%)冲洗泪道和结膜囊患眼数,占总眼数百分比分别为50.54%、100%和49.46%,局部滴眼以左氧氟沙星滴眼液为主,构成比为91.6%;术后以复方妥布霉素滴眼液和软膏眼内局部使用为主,构成比均为49.73%。调查的186例眼中均未出现眼内炎。结论:该院白内障手术围手术期抗菌药物使用情况基本合理。     

我院眼科老年性白内障患者围手术期抗菌药物预防性应用情况调查

目的调查我院眼科老年性白内障患者围术期抗菌药物预防性应用情况。方法采用病例回顾的方法,对我院眼科2007～2010年诊断为老年性白内障患者病历共945份,其中手术患者858份,对围术期应用抗菌药物种类、用药时间、给药时机等进行统计、分析并进行合理性评价。结果眼科老年性白内障患者围手术期抗菌药物预防性应用:局部用药(滴眼)选用的抗菌药物品种有限,选用基本合理。全身用药(静脉注射)的药物选择方面:喹诺酮类药物的预防性应用情况明显改善,但仍存在头霉素用于手术预防性应用的情况。手术预防性应用时间合理率得到了极大提高。结论自2008年以来我院就逐步加强了对抗菌药物合理使用的监督管理,从本次调查看到2010年,措施起到了一定的效果,我院眼科围手术期预防性应用抗菌药物仍需要进一步规范,特别是眼科I类切口预防性应用抗菌药物在品种选择方面。加强术前局部预防用药,减少全身用药是眼科手术预防用抗菌药物的努力方向。     

白内障患者围手术期预防性应用抗菌药物调查分析

目的总结本院眼科白内障手术围术期预防用抗菌药物的经验,以期为制订我国眼科围手术期预防应用抗菌药物的临床指南提供参考。方法采用病历回顾的方法,对本院眼科2010～2012年诊断为白内障的1 573例患者围术期预防性应用抗菌药物的种类、用药途径、总用量、住院天数、继发感染等情况进行统计分析。结果局部用药者达100%。全身用药者抗菌药使用率从2010年的79.84%下降到2012年的1.14%;使用强度从2010年的33.87下降到2012年的1.18;眼内炎的发生率由2010年的0.20%下降为0。结论在医院的行政干预、适当处罚和积极宣传鼓励下,本院白内障患者预防用抗菌药物的方案取得了良好效果,值得推广学习。     

白内障患者围手术期预防性应用抗菌药物的调查分析

目的了解白内障患者围手术期预防性使用抗菌药物的基本情况,为白内障患者围手术期预防性使用抗菌药物提供科学依据。方法从白内障患者围手术期预防性使用抗菌药物的病例中随机抽取312例（360只眼）患者病例,对其作出合理性评价。结果随机抽取的2008年1月-2009年12月白内障患者复明手术病例500例,对其中围手术期预防性使用抗菌药物312例（360只眼）调查,发现联合使用3种或3种以上抗菌药物感染率显著升高,术前0.5-2 h用药与术中、术后用药感染率差异大（P〈0.05）,抗菌药物用药4 d以上感染发生率高。结论抗菌药物不合理应用的现象基层较常见,进一步加强抗菌药物的合理应用尤其重要。     

我院眼科抗菌药物围术期预防使用分析与合理性评价

目的评价医院眼科围术期预防使用抗菌药物情况。方法随机抽取2012年1月至6月医院眼科出院手术病历114份,对其诊断、手术、抗菌药物局部用药、全身用药、用药时机、用药疗程等信息进行统计,对其用药合理性进行评价。结果围术期局部预防使用抗菌药物达100％,但存在用药时间过长问题,左氧氟沙星滴眼液（可乐必妥）和复方妥布霉素滴眼液（典必殊）术前术后交替应用多见。全身预防性应用抗菌药物比率过高,大都选用克林霉素磷酸酯针（福德）或头孢拉定针,以术中用药为主,部分病例用药疗程过长。结论眼科围术期预防使用抗菌药物以局部用药为主,辅以全身用药,但仍有一些问题亟待改进。     

我院白内障围术期用药干预的调查与分析

目的：调查我院白内障围术期抗菌药物的用药情况,分析行政干预前后的结果。方法调查克拉玛依市中心医院2013年7月—2014年6月白内障手术归档病历327例,对围术期抗菌药物的用药数据进行统计分析。结果白内障围术期均使用抗菌药物,2013年下半年白内障手术是采用全身性抗菌药物联合局部用药的方法预防感染,2014年上半年白内障手术仅使用局部抗菌药物;白内障手术的切口愈合情况基本相同,但住院时间、住院费用、抗菌药物占总费用的比例均有下降。结论通过行政干预,白内障围术期停止使用全身性抗菌药物,可以降低医院的一类切口抗菌药物使用率,促进抗菌药物的合理使用。     

白内障手术围术期全身性抗菌药物使用的必要性研究

目的 了解白内障手术围术期抗菌药物临床使用的合理性及抗菌药物使用与术后感染的相关性.方法 对眼科1327例白内障手术病例就围术期抗菌药物使用及术后眼部感染情况进行统计,分析抗菌药物使用的合理性及其与术后感染的相关性.HT5"H结果 围术期抗菌药物使用合理率100.00％.是否使用全身性抗菌药物与切口感染的发生率无显著性差异(P>0.05).结论 高危因素的存在不增加白内障术后眼内感染的发生率,无需使用全身性抗菌药物.     

我院眼科围手术期抗菌药物预防性使用情况调查分析

目的:分析眼科围手术期预防性使用抗菌药物的使用,探求减少抗菌药物全身使用的方法,促进抗菌药物的合理使用。方法:随机抽取我院2010年及2012年的眼科清洁手术患者病历各100份,对75号文出台前后抗菌药物的使用率、使用强度、选用品种、给药方式、用药时间及术后感染的发生率等情况进行分析比较。结果:2012年较2010年预防性抗菌药物的使用率下降56%,抗菌药物的使用品种、给药方式及给药时间合理,术后感染的发生率没有变化。结论:在加强抗菌药物使用干预,强化医生认识、提高手术技能,充分发挥药师及职能科室作用,加强围手术期各种无菌化操作及局部抗菌药物的合理使用的前提下,眼科围手术期全身抗菌药物的使用可以得到控制,达到合理化使用。     

老年性白内障围手术期预防性应用左氧氟沙星滴眼液不同给药时机的临床观察

目的：分析老年性白内障术前局部应用左氧氟沙星滴眼液不同给药时机对术后感染的影响,得出最优给药时机,合理指导临床用药。方法：回顾性分析某医院711例（711眼）老年性白内障并行手术治疗患者的临床资料,根据术前应用左氧氟沙星的时间分为术前用药≥ 3 d组（A组,221例）及术前用药<3 d组（B组,490例）,比较术后2组患者结膜囊细菌培养阳性率及分析白内障术后眼部主要菌株分布情况。结果：在711例患者中仅A组有1例并发眼内炎。A组术后细菌培养阳性61例（27.60%）,B组术后细菌培养阳性142例（28.97%）,2组间差异无统计学意义（P>0.05）。培养结果显示以革兰阳性球菌及革兰阴性杆菌多见,主要包括表皮葡萄球菌、金黄色葡萄球菌、大肠埃希杆菌等,2组间菌株数量比较差异无统计学意义。结论：老年性白内障术前应用左氧氟沙星滴眼液超过2 d并不能减少细菌培养的阳性率,即并不能减少患者术后感染率,同时也不影响术后结膜囊细菌分布情况,建议老年性白内障患者术前预防性应用左氧氟沙星滴眼液不超过3 d。     

白内障患者围术期抗菌药物预防性应用调查与合理性评价

目的:调查我院眼科白内障患者围术期抗菌药物预防性应用情况。方法:随机抽取我院眼科2009年白内障手术患者100例,对围术期应用抗菌药物种类、用药时间、给药时机、切口愈合情况、住院药品费用等进行统计、分析并进行合理性评价。结果:所有患者均在围术期全身和局部预防性应用抗菌药物(100%);全身用药包括应用乳酸左氧氟沙星(67例,占67%)、注射用头孢呋辛钠(25例,占25%)、克林霉素磷酸酯注射液(2例,占2%)、注射用头孢他啶(6例,占6%);仅术前30min给药1次63例(63%),术前30min给药1次、术后给药<24h12例(12%),二者合计75%;术前给药1次、术后给药>24h25例(25%),其中最长为4d,平均用药时间为2.5d。结论:我院不合理用药主要表现在术后应用抗菌药物时间偏长、预防用药选择不当等方面。应加强抗菌药物干预并强化医师围术期预防应用抗菌药物的合理化意识。     

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.