硝唑尼特体外抑杀阴道毛滴虫效果观察

目的观察硝唑尼特体外抑杀阴道毛滴虫效果。方法分别以2、1、0.5、0.25、0.125、0.062 5和0.031 25mg/ml,硝唑尼特作用于阴道毛滴虫携病毒株与无病毒株12和24 h,观察体外抑杀效果。实验以甲硝唑作为药物对照。结果随着药物浓度的增加和作用时间的延长,硝唑尼特对两种虫株的抑制率均增高,显微镜下可见滋养体活力下降,培养基底部有死亡虫体沉淀,染色后可见滋养体细胞质内有空泡,鞭毛脱落,虫体变形,细胞核变形,细胞膜破裂,细胞溶解。经统计学分析,硝唑尼特对阴道毛滴虫两种虫株的抑制率差异无统计学意义(χ2=0.12,P>0.05)。在24 h时,甲硝唑对阴道毛滴虫无病毒株抑制率为81.06%,硝唑尼特(1 mg/ml)对阴道毛滴虫两种虫株的抑制率可达100%,硝唑尼特对阴道毛滴虫无病毒虫株的抑制率显著高于甲硝唑(χ2=4.43,P<0.01)。结论硝唑尼特对阴道毛滴虫两种虫株均有较好的抑杀作用,其中对无毒株阴道毛滴虫的抑杀效果硝唑尼特优于甲硝唑。     

猪三毛滴虫对4种药物的体外药敏试验

目的探讨硝唑尼特、替硝唑、甲硝唑和制霉菌素4种药物对猪三毛滴虫的作用效果,以期为临床用药提供依据。方法在体外培养条件下,用24h敏感性试验确定4种药物对猪三毛滴虫24h的最低致死浓度(MLC);绘制时间-杀虫曲线,分析不同浓度受试药物作用不同时间对猪三毛滴虫的杀灭效果。结果 4种药物均具有不同程度的抑制或杀灭猪三毛滴虫的作用,其中硝唑尼特杀灭猪三毛滴虫的效果较好,24hMLC为12.50mg/L;替硝唑和甲硝唑24hMLC均为25.00mg/L,但时间-杀虫曲线显示替硝唑效果好于甲硝唑;制霉菌素的杀虫效果较差。结论猪三毛滴虫对硝唑尼特和替硝唑敏感。     

硝唑尼特和阿苯达唑联合治疗小鼠原发性和继发性泡状棘球蚴病的机制探讨

目的观察硝唑尼特、阿苯达唑及硝唑尼特／阿苯达唑联合治疗原发性和继发性泡状棘球蚴病小鼠的疗效。方法分别通过腹腔注射泡状棘球蚴原头节和口服泡状棘球蚴虫卵的方式建立继发性和原发性泡状棘球蚴病小鼠模型,建模2个月后分别进行药物治疗,药物经口灌胃,疗程持续35d后,检测各组小鼠泡状棘球蚴囊湿重及病理改变并检测血清IL-2、IL-4、TNF—α和Ig—E的含量。结果治疗35d后,继发性泡球蚴感染小鼠用药组与模型对照组比较,用药组泡球蚴的平均湿重显著下降（P〈0．01）,结果现示硝唑尼特单独及联合均有明显抑制小鼠泡状棘球蚴生长的作用（抑囊率分别为51．56％、67．68％、88．06％）,其中联合用药明显优于单独用药。继发性和原发性泡球蚴感染实验小鼠血清IL-2、IL-4及Ig-E的含量,用药组和模型对照组比较差异有统计学意义（P〈0．01）,与空白对照组比较差异无统计学意义（P〉0．05）;TNF—α含量用药组和模型对照组与空白对照组比较差异有统计学意义（P〈0．05）,用药组与模型对照组比较差异有统计学意义（P〈0．05）。结论硝唑尼特及硝唑尼特／阿苯达唑联合用药对小鼠泡状棘球蚴感染有一定的抑制作用。     

多种药物对体外培养泡球蚴作用的观察

目的观察6种药物单独或联合用药对体外培养泡球蚴的作用。方法泡球蚴体外培养5周后,收集囊泡,随机分为17组,每组约120~140个囊泡,分别加入不同药物进行培养,①单独用药组:阿苯达唑组(1μg/ml、10μg/ml)、伊曲康唑组(0.7 mg/ml)、伊维菌素组(1.75 mg/ml)、米替福新组(0.5μg/ml、2.5μg/ml和7.5μg/ml)、硝唑尼特组(0.1μg/ml、1μg/ml和10μg/ml)、利福平组(10μg/ml);②联合用药组:硝唑尼特联合阿苯达唑10μg/ml+10μg/ml组、10μg/ml+1μg/ml组、1μg/ml+10μg/ml组和1μg/ml+1μg/ml组;③对照组:二甲基亚砜组(2μl/ml)和空白对照组。培养6周,观察囊泡塌陷情况,对囊泡进行计数,并绘制囊泡曲线。6周后停药,联合用药组连续观察3周、3个月和6个月,观察泡球蚴囊泡生长情况。将各药物组体外培养的泡球蚴接种于雌性BALB/c小鼠,饲养8周后处死并剖检观察小鼠腹腔内有无泡球蚴生长并称重,测试泡球蚴活力。结果伊维菌素、米替福新和利福平对泡球蚴无抑制或杀灭作用。阿苯达唑、伊曲康唑、硝唑尼特,及硝唑尼特与阿苯...     

难辨梭菌相关性疾病治疗新方法

据好医生网4月12日报道（原载Ann Pharmacother2006，40（12）：2164），美国Jodlowski等对难辨梭菌相关性疾病（CDAD）的新治疗方法进行了总结，包括硝唑尼特、tolvamer、静脉用免疫球蛋白（IVIG）、利福昔明和替硝唑等。[第一段]     

经口及皮下注射硝唑尼特对弓形虫急性感染小鼠治疗效果评价

目的 探究经口给药及皮下注射硝唑尼特对弓形虫急性感染小鼠的治疗效果。方法 用弓形虫RH株建立小鼠急性感染模型,分别采用经口给药及皮下注射两种途径治疗。经口给药治疗组按100 mg/kg体重剂量给药;皮下注射分3组,按100、50、25 mg/kg体重剂量给药。记录两种给药途径下小鼠存活时间,比较肝脏和肺脏荷虫量、细胞因子水平变化及肝脏病理变化。结果 两种给药途径硝唑尼特治疗小鼠存活时间均未显著延长(均P>0.05)。经口给药与100、50 mg/kg剂量皮下注射给药小鼠肝脏、肺脏荷虫量显著减少(均P<0.05),与未给药组相比肝脏荷虫量分别减少93.53%、92.59%、40.63%,肺脏荷虫量分别减少97.73%、95.71%、63.53%。硝唑尼特治疗小鼠IFN-γ水平显著升高(P<0.05),与未给药组相比升高169.81%、348.24%、416.44%、472.24%。经口给药与100、50 mg/kg剂量皮下注射给药小鼠IL-12水平显著降低(均P<0.05),与未给药组相比分别降低83.55%、61.62%、56.36%。经口给药和皮下注射100 ...     

广谱抗肠道寄生虫药硝唑尼特(nitazoxanide)研究进展

硝唑尼特是一种新的广谱抗肠道寄生虫药。它是自苯丙咪唑类药问世30多年来值得注意的一个新发展。它的广谱活性对许多种类的原虫,特别如肠道孢子形成类原虫,以及许多常见的蠕虫,包括绦虫、线虫和吸虫均有特效。进一步的临床和基础研究将有利于使该药更有效地应用。     

泰国寄生虫感染的治疗

原虫感染:阿米巴病:Nitroimidazole衍生物是治疗侵袭性阿米巴病的首选药物。对有症状的肠阿米巴病用灭滴灵或替硝唑。对带包囊者用二氯尼特糖酸酯(Diloxanide furoate)或甲苯达唑。阿米巴性肝脓肿患者服灭滴灵1.2—2.4g单剂或替硝唑2g单剂即可。贾第鞭毛虫病:替硝唑或奥硝唑(Ornidazole)2g单剂,治愈率达90％。滴虫病:灭滴灵2g单剂,有高度疗效。替硝唑或奥硝唑2g单剂,治愈率达     

墨西哥儿童肠道寄生虫的流行调查和硝唑尼特的疗效观察

为评价广谱抗寄生虫感染药物硝唑尼特(nitazoxanide)单剂量治疗混合感染肠道寄生虫(肠道原虫和蠕虫)儿童的疗效和耐受性，墨西哥Diaz等对墨西哥北部85个家庭的272名2～14岁儿童做了寄生虫感染的调查，其中6～12岁184名(68％)，男性占54％。粪便样本采集时间为1997年3月至     

抗隐孢子虫药物的研究进展

隐孢子虫(Cryptosporidium)是一种重要的机会致病性人兽共患寄生原虫,发展中国家第二大儿童致腹泻病原体,隐孢子虫病每年导致近840万伤残调整生命年。硝唑尼特是被美国FDA批准用于治疗隐孢子虫病的唯一药物,然而其对艾滋病人合并隐孢子虫感染者无效。由于临床上抗隐孢子虫药物的迫切需要,先后有超过200种化合物被用于隐孢子虫病的治疗研究,然而到目前仍没有筛选到适合的抗隐孢子虫药物。本文将近些年来国内外有关抗隐孢子虫药物的种类及作用方式的研究进展进行综述,以期对临床治疗隐孢子虫病提供帮助。     

培养医师临床思维能力 提高对疾病的诊治水平

临床医学是一门实践科学、经验科学,要求临床医师在临床实践中逐渐认识疾病。合格的临床医师不但具有宽厚、扎实的基本理论知识,亦应具有较强的临床技能和思维能力。临床医师应学会并掌握正确、合理的临床思维路线、思维程序和思维方法 ,使自己对疾病的认识由感性认识逐步提高到理性认识,不断地丰富自己的临床经验。临床思维的目的是指导诊断与治疗,是诊治疾病的核心,可帮助临床医师更深刻地认识疾病规律。病例讨论是提高医师临床思维能力的必要环节。     

Enrolment of patients to clinical trials in haematological cancer in New South Wales: current status,perceived barriers and opportunities for improvement

Background: Enrolment of cancer patients in clinical trials is associated with significant positive outcomes. There are, however, limited Australian data on enrolment of patients with haematological malignancies to clinical trials. Aim: The aim of this study is to document the number of patients with haematological malignancies enrolled on clinical trials in NSW, to establish the barriers to trial recruitment and to examine possible means by which clinical trials participation may be improved. Methods: Quantitative data on clinical trial accrual were obtained from all sites participating in clinical trials in haematological malignancies in NSW from 2004 to 2007 and were compared with the cancer incidence data for that period. Qualitative data on barriers and strategies for improvement were gathered using semi‐structured interviews with clinical trials professionals from throughout NSW. Results: Between 2004 and 2007 there were significant increases in the number of active centres, clinical trials and trial participation, and by 2007, 10.5% of all eligible patients with haematological malignancies in NSW were enrolled in relevant clinical trials. Resource constraints were the greatest perceived barrier to participation, but the success of clinical trials is also challenged by difficulties associated with communication, ethics review, trial coordination, trial design and support for emerging centres. Conclusion: While participation in clinical trials in haematological cancer in NSW improved between 2004 and 2007, participation in clinical trials remains suboptimal. The development of specific strategies to address barriers to participation may facilitate increased enrolment and ultimately improve clinical outcomes in patients with haematological malignancies.     

An Overview of the Adaptive Designs Accelerating Promising Trials Into Treatments (ADAPT-IT) Project

Randomized clinical trials, which aim to determine the efficacy and safety of drugs and medical devices, are a complex enterprise with myriad challenges, stakeholders, and traditions. Although the primary goal is scientific discovery, clinical trials must also fulfill regulatory, clinical, and ethical requirements. Innovations in clinical trials methodology have the potential to improve the quality of knowledge gained from trials, the protection of human subjects, and the efficiency of clinical research. Adaptive clinical trial methods represent a broad category of innovations intended to address a variety of long-standing challenges faced by investigators, such as sensitivity to previous assumptions and delayed identification of ineffective treatments. The implementation of adaptive clinical trial methods, however, requires greater planning and simulation compared with a more traditional design, along with more advanced administrative infrastructure for trial execution. The value of adaptive clinical trial methods in exploratory phase (phase 2) clinical research is generally well accepted, but the potential value and challenges of applying adaptive clinical trial methods in large confirmatory phase clinical trials are relatively unexplored, particularly in the academic setting. In the Adaptive Designs Accelerating Promising Trials Into Treatments (ADAPT-IT) project, a multidisciplinary team is studying how adaptive clinical trial methods could be implemented in planning actual confirmatory phase trials in an established, National Institutes of Health-funded clinical trials network. The overarching objectives of ADAPT-IT are to identify and quantitatively characterize the adaptive clinical trial methods of greatest potential value in confirmatory phase clinical trials and to elicit and understand the enthusiasms and concerns of key stakeholders that influence their willingness to try these innovative strategies.     

Clinical pathologist in Korea--training program and its roles in laboratories

A rapid development of practice of laboratory medicine in Korea owes its success to the clinical pathologists (CP), who have played a role of a pathfinder for laboratories. The Korean CP postgraduate education (residency) program is unique in that it is exclusively for laboratory medicine. The training program for clinical pathologists includes diagnostic hematology, diagnostic immunology, clinical microbiology, clinical chemistry, blood bank, diagnostic genetics, informatics and laboratory management. The program has produced a strong group of about 600 laboratory physicians, officially clinical pathologists since 1963. Most of Korean clinical pathologists work as laboratory directors, directors of university hospital laboratories or teaching faculty members in medical schools. The roles of clinical pathologists are laboratory management, interpretation of laboratory test results, clinical consulting services to clinicians and patients, ordering secondary tests after reviews of requested test results and utilization management. The clinical pathologists have developed clinical laboratories to be a main contributor for improved medical practice. During the last 40 years under the turbulent healthcare system, clinical pathologists have significantly contributed to safeguard the laboratory interests. The education program and the role of clinical pathologists are described.     

胃食管反流病的中医药应用进展

胃食管反流病（GERD）是临床常见病、多发病,临床症状复杂,易复发,逐渐受到临床重视。中医药治疗GERD具有改善临床症状、降低复发率、提高生活质量等优势,临床疗效良好。本文从GERD的中医病因病机、中医药治疗进展、中医药作用机制三方面进行归纳,以为临床诊治提供些许借鉴和参考。     

Determining the efficacy of antiplatelet therapies for the individual: lessons from clinical trials

This article focuses on lessons learned from clinical trials of antiplatelet therapies-in particular, that the degree of inhibition of ex vivo platelet aggregation does not necessarily directly translate into clinical efficacy. As an example, the case of the oral platelet glycoprotein IIb/IIIa inhibitors is presented, in which despite consistent evidence of substantial inhibition of platelet aggregation, this class of drugs provided no clinical benefit in Phase III trials and, in fact, was harmful. Several hypotheses for these unexpected findings have been proposed, but none has been confirmed. The connection between ex vivo inhibition of platelet aggregation and clinical benefit of platelet P2Y(12) antagonists is also not straightforward and is currently being tested in large clinical trials. A link between inflammatory status and clinical benefit from antiplatelet agents continues to emerge and highlights the fact that biomarkers beyond ex vivo platelet aggregation may predict the clinical benefit of antiplatelet agents that can reduce platelet activation (i.e., aspirin and thienopyridines). Results of past and ongoing trials hold valuable clues to determining the appropriate targets for maximizing antiplatelet efficacy, but the current lack of a proven ex vivo assay that correlates with clinical outcomes hampers clinical investigation, drug development programs, and clinical practice.     

社区获得性肺炎临床路径实施效果的评价与分析

目的 了解社区获得性肺炎临床路径的实施情况,分析我院临床路径实施的效果.方法 回顾性分析我院2011年11月～2012年8月收治的253例成人社区获得性肺炎患者的临床资料,了解入径率、路径组与非路径组平均住院日、路径组抗生素使用、CURB-65评分对临床路径的价值以及未进入临床路径的原因.结果 入径率为81.0％;路径组平均住院日为（10.46±4.36）天,非路径组平均住院日为（22.31±12.53）天;路径组抗生素使用基本符合指南要求;CURB-65评分越低,越有可能进入临床路径;未能进入临床路径的原因有病情加重转入ICU,合并肺癌、肾功能衰竭、泌尿系感染、脑血管病等基础疾病、住院时间过长、使用了指南之外的抗生素、因经费问题要求出院等.结论 实施社区获得性肺炎临床路径能缩短平均住院日,促进抗生素使用规范,减少平均住院费用,有利于促进医院整体医疗安全、质量、效率及费用控制等综合管理水平的提高.     

卒中临床路径实施概述

文章介绍和总结了国外目前卒中临床路径实施的概况,包括临床路径的简介、卒中临床路径的模式、实施效果（优点及存在的问题）以及卒中临床路径的制订。     

3例韦格纳肉芽肿误诊分析及文献回顾

目的阐述韦格纳肉芽肿(WG)的诊治经验及误诊原因。方法分析3例WG患者的临床表现、影像学特点、诊断及治疗经验,并复习相关文献。结果 3例WG患者曾被误诊为肺癌、肺结核、肺脓肿、多形性红斑,提示WG和肺癌、结核、肺脓肿有许多相似之处,且可合并严重皮肤损害,容易误诊。结论 WG临床表现复杂多样,缺乏特异性,临床医师对本病认识不足是导致误诊的主要原因,提高对WG临床特点、影像学特征的认识、建立良好的临床思维是减少误诊的关键。     

Content and classification of clinical trials at a university hospital in Japan

"Standards on the Implementation of Clinical Trials on Drugs (New GCP)" is a Japanese government policy established in April 1998 with the aim of satisfying scientific and ethical requirements for industry-sponsored research, i.e., registration-directed clinical trials and clinical trials intended to support reexamination or reevaluation applications. Since then, efforts for more effective implementation of clinical trials have been promoted, including establishment of a system to invite more active participation of subjects in clinical trials and improvement of a network of medical institutions conducting clinical trials. These efforts should help to reactivate clinical trials in Japan, which reportedly have become stagnant. Although the New GCP addresses the quality of industry-sponsored clinical trials, investigators also construct study protocols without industry involvement. We reviewed clinical trials submitted by investigators at Gunma University Hospital to institutional review boards (IRBs) from June 1999 to February 2002. Ten clinical research coordinators contributed to the present survey. A total of 151 investigator-initiated clinical trials reviewed included a wide variety of content; and investigators from many institutions and organizations conducted trials. Most of the ethical guidelines for approving proposed trials represented the provisions of the Declaration of Helsinki. However, additional guidelines prepared by the Japanese Ministry of Health, Labour and Welfare were also helpful. Development of a support system for clinical trails requires the contribution of clinical research coordinators. Flexible management and careful attention to both the protocol and its execution by the investigators were also important for promoting clinical trials on the basis of meticulous patient care.