Economic impact of interventional study on rational use of antiseptics and disinfectants in Super Speciality Hospital of Nagpur

Objective:

To measure the impact of interventions on rational use of antiseptics and disinfectants (A and D) for cost containment in Super Speciality Hospital (SSH) of Government Medical College, Nagpur (GMCN), India.

Materials and Methods:

This study was conducted from October 2003 to March 2007 in SSH of GMCN. In the pre-interventional phase (Phase-I), purchase, stocking and distribution of A and D was studied to find problem areas. Based on this formative data an intervention was planned (Phase-II) during which rationing of the A and D was done. Rational quantities needed for different A and D procedures were calculated based on recommendations of National Aids Control Organization (NACO) with modifications to suit our hospital setup. Detailed information, education, communication and training about rational use of A and D were provided to the hospital staff. In the post-interventional phase (Phase-III), the use of A and D was rationalized at the distribution level and the efficacy of in-use A and D was tested at user sites. Data about medicine expenditure, patient record and A and D usage in various departments was obtained from hospital records. Savings on A and D as against total annual medicine expenditure was calculated taking the cost of A and D in the post-intervention period.

Results:

The expenditure on A and D as a result of intervention decreased by 20.7%. Out of the total medicine expenditure, the expenditure on A and D which accounted for 6.2% before intervention, decreased to 1.95% after the intervention.

Conclusion:

The information, education and communication (IEC) interventions attempted by us resulted in significant decrease in the use and expenditure of A and D.     

布洛芬片剂生物利用度的研究

本文试制出新处方布洛芬片剂,选择山东新华制药厂三种片剂:市售处方A、新处方片剂B和C,以及英国Boots公司的片剂D,进行体外溶出速率和人体生物利用度试验,并测定了生产A,B(和C),D片剂的布洛芬原料A′,B′,D′的粒度,比较了A′,D′的晶型。实验表明,国内外原料晶型相同,A′,B′,D′平均粒径分别为130.0,36.6,56.6μm。A与D生物不等效,B和C与D生物等效。提高国产片剂生物利用度的因素主要与原料粒度、处方组成和制备工艺有关。     

Phenotypic resolution of spontaneous and D1-like agonist-induced orofacial movement topographies in congenic dopamine D1A receptor 'knockout' mice

A novel system was used to assess the role of D(1)-like dopamine receptors in distinct topographies of orofacial movements in mice with congenic D(1A) receptor knockout. Under spontaneous conditions, vertical jaw movements in wild-types declined with time at a rate that was reduced in D(1A) mutants, while horizontal jaw movements emerged progressively in wild-types but not in D(1A) mutants; tongue protrusions were absent in D(1A) mutants, while incisor chattering was initially reduced in D(1A) mutants but rose subsequently to reach the level of wild-types. D(1A) receptors exert a topographically specific role in regulating individual spontaneous orofacial movements, and these involve interactions with psychomotor processes which 'sculpt' behavioural change over time. The anomalous D(1)-like agonist SK&F 83959, which fails to stimulate, and indeed inhibits the stimulation of adenylyl cyclase induced by dopamine, readily stimulated vertical jaw movements, tongue protrusions and incisor chattering, and these response topographies were absent in D(1A) mutants. These results suggest that D(1A) receptors may exert some form of permissive role over orofacial topographies initiated via a novel, putative D(1)-like site not linked to adenylyl cyclase, or that some D(1A) receptors might be coupled to a transduction system other than adenylyl cyclase.     

不同胰岛素治疗方法用于2型糖尿病禁食患者效果观察

目的探讨糖尿病患者禁食状态下使用不同胰岛素治疗方法的临床效果。方法244例2型糖尿病患者禁食状态下按照使用胰岛素的不同分为：胰岛素泵组（A组）60例,甘精胰岛素注射组（B组）64例,微量注射泵组（c组）59例,精蛋白生物合成人胰岛素（NPH）皮下注射组（D组）61例,观察其血糖达标时间、胰岛素用量及低血糖发生率。结果相同治疗目标下,血糖达标所用时间：A组（2．89±1．32）d、B组（3．14±1．25）d、C组（4．91±2．81）d、D组（5．62±2．52）d,A组与其他三组、B组与C、D组差异均有统计学意义（均P〈0．05）,而C、D两组差异无统计学意义（P〉0．05）。胰岛素用量：A组（30．61±2．21）IU／d、B组（31．12±3．38）IU／d、C组（42．25±4．01）IU／d、D组（44．31±3．22）IU／d,A、B两组差异无统计学意义（P〉0．05）,A、B组分别同C、D组比较,差异均有统计学意义（均P〈0．05）,而c、D两组差异无统计学意义。低血糖发生率：A组3．3％、B组4．7％、C组15．2％、D组16．4％,A、B两组差异无统计学意义（P〉0．05）,A、B组分别同C、D组比较,差异均有统计学意义（均P〈0．05）,而C、D两组差异元统计学意义。结论胰岛素泵治疗比其他胰岛素治疗方法在血糖达标时间、胰岛素用量及低血糖发生上有明显优越性,可以推广在禁食的糖尿病患者中应用。     

Ligand-dependent oligomerization of dopamine D(2) and adenosine A(2A) receptors in living neuronal cells

Adenosine A(2A) and dopamine D(2) receptors (A(2A) and D(2)) associate in homo- and heteromeric complexes in the striatum, providing a structural basis for their mutual antagonism. At the cellular level, the portion of receptors engaging in homo- and heteromers, as well as the effect of persistent receptor activation or antagonism on the cell oligomer repertoire, are largely unknown. We have used bimolecular fluorescence complementation (BiFC) to visualize A(2A) and D(2) oligomerization in the Cath.a differentiated neuronal cell model. Receptor fusions to BiFC fluorescent protein fragments retained their function when expressed alone or in A(2A)/A(2A), D(2)/D(2), and A(2A)/D(2) BiFC pairs. Robust fluorescence complementation reflecting A(2A)/D(2) heteromers was detected at the cell membrane as well as in endosomes. In contrast, weaker BiFC signals, largely confined to intracellular domains, were detected with A(2A)/dopamine D(1) BiFC pairs. Multicolor BiFC was used to simultaneously visualize A(2A) and D(2) homo- and heteromers in living cells and to examine drug-induced changes in receptor oligomers. Prolonged D(2) stimulation with quinpirole lead to the internalization of D(2)/D(2) and A(2A)/D(2) oligomers and resulted in decreased A(2A)/D(2) relative to A(2A)/A(2A) oligomer formation. Opposing effects were observed in cells treated with D(2) antagonists or with the A(2A) agonist 5'-N-methylcarboxamidoadenosine (MECA). Subsequent radioreceptor binding analysis indicated that the drug-induced changes in oligomer formation were not readily explained by alterations in receptor density. These observations support the hypothesis that long-term drug exposure differentially alters A(2A)/D(2) receptor oligomerization and provide the first demonstration for the use of BiFC to monitor drug-modulated GPCR oligomerization.     

G169R mutation diminishes the metabolic activity of CYP2D6 in Chinese.

The molecular basis of the reduced ability of a Chinese to metabolize debrisoquine was explored by sequencing all of the nine exons of the CYP2D6 gene. The subject has T188, A1846, T2938, and C4268 (CYP2D6*14) instead of C188, G1846, C2938, and G4268 as in wild-type subjects. XbaI restriction fragment length polymorphism indicated that the subject has a 29-kb allele and a gene deletion (11.5 kb) in another allele (CYP2D6*5). A CYP2D6*14 allele together with a CYP2D6*5 allele may cause the poor metabolism of the subject. T188, T2938, and C4268 are common haplotypes in Chinese-extensive metabolizers. The effect of G1846 to A mutation in CYP2D6 metabolism has not been reported. A polymerase chain reaction-based endonuclease digestion test was designed for the G/N1846 polymorphism and 124 Chinese subjects were screened. With DNA sequencing, two other subjects showed the heterozygous G/A1846 and have a relatively high metabolic ratio of debrisoquine hydroxylation. The site-directed mutagenesis was used to create recombinant CYP2D6 cDNA with T188, A1846, or C4268. The cDNA was then transfected into Rat-1 cells. The transfection was confirmed by Southern, Northern, and Western blots. Based on the same microsomal protein level, the bufuralol 1'-hydroxylation activity of CYP2D6(T188) or CYP2D6(A1846) was significantly lower than that of the wild-type CYP2D6. P34S mutation (C188 to T) significantly decreased CYP2D6 activity. G169R mutation (G1846 to A) also decreased CYP2D6 activity and may further reduce the metabolic activity of CYP2D6 protein with P34S, R296C, and S486T mutations.     

Agonist-induced cell surface trafficking of an intracellularly sequestered D1 dopamine receptor homo-oligomer

The role of oligomerization in D1 dopamine receptor trafficking to the cell surface was examined using conformationally distinct variants of this receptor. Substitution of the highly conserved aspartic acid (Asp103) in transmembrane domain 3 resulted in a constitutively active receptor, D103A, that did not bind agonists or antagonists but trafficked to the cell surface as oligomers. Coexpression of D103A with the wild-type D1 receptor in human embryonic kidney 293t cells resulted in inhibition of cell surface expression of the D1 receptor because of receptor oligomerization, causing intracellular retention of both proteins. Rescue of the intracellularly retained oligomer could be achieved only by membrane-permeable full and partial agonists, which resulted in cell surface expression of the D1 receptor, whereas cell-permeable antagonists and cell impermeable agonists had no effect. Cell surface fluorescence resonance energy transfer studies of cells coexpressing D103A and D1 revealed no signal before agonist treatment but a robust signal after agonist treatment, indicating that the intact D1/D103A oligomer reached the cell surface only after agonist treatment but not under basal conditions. This suggests that rescue of the retained D1/D103A oligomer to the cell surface was a result of an agonist-induced change in the conformation of D1, permitting cell surface trafficking of the D1/D103A receptor oligomeric complex from the endoplasmic reticulum.     

Dopamine as a novel anti-migration factor of vascular smooth muscle cells through D1A and D1B receptors

To elucidate the roles of rat vascular dopamine D1A and D1B receptors in vascular smooth muscle cell migration, the effect of antisense oligonucleotides to D1A receptors (+1 to +21 of rat D1A receptors) and to D1B receptors (-12 to +6 of rat D1B receptors) on dopamine-mediated suppression of platelet-derived growth factor BB-mediated vascular smooth muscle cell migration, evaluated by the Boyden's chamber method, was studied. Increased vascular smooth muscle cell migration by platelet-derived growth factor BB (5 ng/ml) was suppressed significantly by co-incubation with dopamine (0.025-10 micromol/l) (by 15-59%). This suppression by 10 micromol/l dopamine was reversed by D1A antisense oligonucleotides (46%) and D1B antisense oligonucleotides (51%), but by neither the sense nor the random sense oligodeoxynucleotides to these receptors. The suppression by antisense oligodeoxynucleotides (21-51%) is dose dependent (1-10 micromol/l) and time dependent (0-4 h). Dopamine (10 micromol/l)-induced cyclic AMP formation is also suppressed by D1A antisense oligonucleotides (50%) and D1B antisense oligonucleotides (58%), but by neither the sense nor the random sense oligodeoxynucleotides to these receptors. The platelet-derived growth factor BB (5 ng/ml)-mediated activation of phospholipase D and protein kinase C activities were significantly suppressed by co-incubation with 10 micromol/l dopamine, which was reversed by D1A antisense oligonucleotides (45%) and D1B antisense oligonucleotides (50%) but by neither the sense nor the random sense oligodeoxynucleotides to these receptors. These results suggest that vascular D1A and D1B receptors inhibit migration of vascular smooth muscle cells, possibly through cyclic AMP activation and the suppression of phospholipase D and protein kinase C activities.     

肺移植患者术后使用他克莫司1年CYP3A5、CYP3A4、ABCB1、POR~*28基因多态性与他克莫司个体化用药的关系研究

目的:研究肺移植患者术后使用他克莫司1年CYP3A5、CYP3A4、ABCB1、POR*28基因多态性与他克莫司给药剂量(D)和稳态血药浓度/给药剂量比值(c0/D)的关系。方法:采用回顾性分析方法,选取2017年5月-2018年5月期间在中日友好医院接受肺移植术的46例受试者为研究对象,统计受试者术后使用他克莫司1年后他克莫司的c0和D,并计算c0/D。收集受试者CYP3A5(rs776746)、CYP3A4(rs2242480、rs28371759)、ABCB1(rs1045642、rs2032582、rs1128503)和POR*28(rs1057868)位点的基因型,对基因多态性与D、c0/D的关系进行统计学分析。结果:本研究中涉及位点的基因型频率均符合Hardy-Weinberg平衡(P>0.05)。维持他克莫司c0在治疗窗范围内的条件下,受试者的CYP3A5(rs776746)和CYP3A4(rs2242480)基因型多态性对他克莫司的D、c0/D有显著影响(P<0.05);其他位点各基因型之间的D、c0/D差异均无统计学意义(P>0.05)。联合CYP3A5(rs776746)和CYP3A4(rs2242480)两个位点分析受试者CYP3A代谢型发现,同时携带CYP3A5(rs776746)*1和CYP3A4(rs2242480)*1G等位基因的快代谢型受试者与只携带CYP3A5(rs776746)*1或CYP3A4(rs2242480)*1G等位基因的正常代谢型受试者和不携带CYP3A5(rs776746)*1和CYP3A4(rs2242480)*1G等位基因的慢代谢受试者比较,D、c0/D差异具有统计学意义(P<0.05),其中快代谢型受试者的他克莫司D最高,慢代谢型受试者的他克莫司D最低。结论:检测CYP3A5(rs776746)和CYP3A4(rs2242480)基因多态性对肺移植患者术后使用他克莫司1年后他克莫司的个体化给药具有指导意义。     

Role of D1-like receptors in amphetamine-induced behavioral sensitization: a study using D1A receptor knockout mice

RATIONALE: The role played by D(1)-like receptors in amphetamine-induced behavioral sensitization has been examined using both the D(1)-like receptor antagonist, SCH 23390, and the D(1A) receptor knockout mouse (i.e. D(1A)-deficient mice). Studies using these two approaches have provided conflicting evidence about the importance of D(1)-like receptors for amphetamine-induced behavioral sensitization. OBJECTIVE: The purpose of the present study was to determine: (a) whether D(1A)-deficient mice exhibit amphetamine-induced locomotor sensitization after 3 and 17 drug abstinence days, and (b) whether SCH 23390, which binds to both D(1A) and D(1B) receptor subtypes, blocks development of amphetamine sensitization in wild-type and D(1A)-deficient mice. METHODS: In the first experiment, adult wild-type and D(1A)-deficient mice were injected with amphetamine (0, 1, 2, 4, or 8 mg/kg, IP) for 7 consecutive days. In the second experiment, wild-type and D(1A)-deficient mice were pretreated with SCH 23390 (0, 0.15, or 0.5 mg/kg, IP) 30 min prior to being injected with amphetamine (0 or 8 mg/kg, IP). After each daily amphetamine injection, mice were placed in activity chambers where distance traveled (i.e. horizontal locomotor activity) was measured for 60 min. On the test days, which occurred after 3 or 17 drug abstinence days, mice were injected with 1 mg/kg amphetamine and locomotion was measured for 120 min. RESULTS: Both wild-type and D(1A)-deficient mice exhibited amphetamine-induced locomotor sensitization. Pretreatment with 0.5 mg/kg SCH 23390 blocked the development of locomotor sensitization in wild-type mice, but did not alter the sensitized responding of D(1A)-deficient mice. CONCLUSIONS: It appears that D(1)-like receptors are necessary for the development of amphetamine sensitization in wild-type mice, while neither the D(1A) nor D(1B) receptor subtypes are necessary for the amphetamine-induced locomotor sensitization of D(1A)-deficient mice. A possible explanation for these conflicting results is that D(1A)-deficient mice may have a compensatory mechanism (not involving D(1B) receptors) that allows them to exhibit amphetamine-induced behavioral sensitization in the absence of the D(1A) receptor.     

Long-term effects of diltiazem and atenolol on blood glucose, serum lipids, and serum urate in hypertensive patients. Swedish-Finnish Study Group

The purpose of this long-term treatment study was to evaluate health-related quality of life by comparing the effects of diltiazem and atenolol on some important metabolic parameters. SUBJECTS, MATERIAL AND METHODS: In a Swedish-Finnish long-term multicenter study 256 patients with mild to moderate hypertension were randomized to treatment with diltiazem retard (D) (n = 127) or atenolol (A) (n = 129). Doses could be increased and additional captopril medication be given to achieve adequate blood pressure (BP) reduction. The treatment in group D lasted for two years while group A was treated for 1 year and then was given D for another 2 years. RESULTS: After 1 year BP was significantly reduced in both groups and to a similar degree. The BP reduction was maintained during the rest of the study. After 1 and 2 years, HDL had increased significantly (p < 0.001) in group D. There was a corresponding significant reduction of the LDL/HDL ratio. In group A there were no changes after 1 year regarding lipoprotein levels. After the switch to D, group A showed similar improvements regarding HDL and the LDL/HDL ratio as the original D group. CONCLUSION: It is concluded that D and A are equally effective in lowering BP. However, long-term treatment with D, but not with A, has a favorable effect on HDL concentrations and the LDL/HDL ratio. According to these findings D affects the risk factor profile in hypertension.     

Receptor crosstalk: characterization of mice deficient in dopamine D1 and adenosine A2A receptors.

Here we report the development of D1A2A receptor knockout mice to investigate whether interactions between dopamine D1 and adenosine A2A receptors participate in reward-related behavior. The combined deletion of D1 and A2A receptors resulted in mice with decreased weight and appetitive processes, reduced rearing and exploratory behaviors, increased anxiety, and a significantly poorer performance on the rotarod, compared to wild-type littermates. D1A2A receptor knockout mice shared phenotypic similarities with mice deficient in D1 receptors, while also paralleling behavioral deficits seen in A2A receptor knockout mice, indicating individual components of the behavioral phenotype of the D1A2A receptor knockout attributable to the loss of both receptors. In contrast, ethanol and saccharin preference in D1A2A receptor knockout mice were distinctly different from that observed in derivative D1 or A2A receptor-deficient mice. Compared to wild types, preference and consumption of ethanol were decreased in D1A2A receptor knockout mice, the reduction in ethanol consumption greater even than that seen in D1 receptor-deficient mice. Preference and consumption of saccharin were also reduced in D1A2A receptor knockout mice, whereas saccharin preference was similar in wild-type, D1, and A2A receptor knockout mice. These data suggest an interaction of D1 and A2A receptors in the reinforcement processes underlying the intake of rewarding substances, whereby the A2A receptor seems involved in goal-directed behavior and the motor functions underlying the expression of such behaviors, and the D1 receptor is confirmed as essential in mediating motivational processes related to the repeated intake of novel substances and drugs.     

The enhancement of dopamine D1 receptor desensitization by adenosine A1 receptor activation

The present study was designed to examine the effects of adenosine A(1) receptor on dopamine D(1) receptor desensitization in a human embryonic kidney 293 cell line stably cotransfected with human adenosine A(1) receptor and dopamine D(1) receptor cDNAs (A(1)D(1) cells) by means of cAMP accumulation assay. Long-term exposure of A(1)D(1) cells to dopamine D(1) receptor agonist (+/-)-1-phenyl-2,3,4,5-tetrahydro-(1H)-3-benzazepine-7,8-diol hydrochloride (SKF38393) caused a rapid desensitization of dopamine D(1) receptor. Coadministration of adenosine A(1) receptor agonist N(6)-cyclopentyladenosine (CPA) potentiated the effect of SKF38393. This enhancement effect of CPA was blocked by adenosine A(1) receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX) but not by pertussis toxin, indicating that this effect of CPA was mediated by adenosine A(1) receptor and was G(i) protein independent. Furthermore, the blockade of endogenous adenosine by adenosine deaminase or DPCPX attenuated dopamine D(1) receptor desensitization. Collectively, these results suggest that adenosine A(1) receptor plays an important role in the regulation of dopamine D(1) receptor by potentiating ligand-induced desensitization.     

Congenic D1A dopamine receptor mutants: ethologically based resolution of behavioural topography indicates genetic background as a determinant of knockout phenotype.

D(1A)-null mice were backcrossed over 14 generations into a C57BL/6 background to result in essential elimination (to <0.005%) of any contribution from the 129/Sv component of their initially mixed (129/SvxC57BL/6) background. Their phenotype was assessed using an ethologically based approach that resolves each individual topography of behaviour in the natural repertoire. Habituation of sniffing, locomotion, rearing seated, and rearing to wall in wild types over several hours was profoundly retarded in congenic D(1A) mutants; conversely, rearing free and sifting were essentially abolished. Resultant increases in individual topographies of behaviour were substantially greater in congenic D(1A) mutants than in those on a mixed background. This phenotype was little altered by the selective D(1)-like antagonist SCH 23390 and could not be blocked by the selective D(2)-like antagonist YM 09151-2. The selective D(1)-like agonist SK&F 83959 could not further elevate those behaviours already heightened in congenic D(1A) mutants, while the induction of stereotyped sniffing and plodding locomotion by the selective D(2)-like agonist RU 24213 was disrupted. Genetic background appears to modulate critically the magnitude but not the general nature of the D(1A)-null phenotype, which may involve compensatory processes independent of other D(1)-like or D(2)-like receptors.     

Effects of Hydrophobicity on the Antifungal Activity of α‐Helical Antimicrobial Peptides

We utilized a series of analogs of D‐V13K (a 26‐residue amphipathic α‐helical antimicrobial peptide, denoted D1) to compare and contrast the role of hydrophobicity on antifungal and antibacterial activity to the results obtained previously with Pseudomonas aeruginosa strains. Antifungal activity for zygomycota fungi decreased with increasing hydrophobicity (D‐V13K/A12L/A20L/A23L, denoted D4, the most hydrophobic analog was sixfold less active than D1, the least hydrophobic analog). In contrast, antifungal activity for ascomycota fungi increased with increasing hydrophobicity (D4, the most hydrophobic analog was fivefold more active than D1). Hemolytic activity is dramatically affected by increasing hydrophobicity with peptide D4 being 286‐fold more hemolytic than peptide D1. The therapeutic index for peptide D1 is 1569‐fold and 62‐fold better for zygomycota fungi and ascomycota fungi, respectively, compared with peptide D4. To reduce the hemolytic activity of peptide D4 and improve/maintain the antifungal activity of D4, we substituted another lysine residue in the center of the non‐polar face (V16K) to generate D5 (D‐V13K/V16K/A12L/A20L/A23L). This analog D5 decreased hemolytic activity by 13‐fold, enhanced antifungal activity to zygomycota fungi by 16‐fold and improved the therapeutic index by 201‐fold compared with D4 and represents a unique approach to control specificity while maintaining high hydrophobicity in the two hydrophobic segments on the non‐polar face of D5.     

An inducible cytochrome P450 3A4-dependent vitamin D catabolic pathway

Vitamin D(3) is critical for the regulation of calcium and phosphate homeostasis. In some individuals, mineral homeostasis can be disrupted by long-term therapy with certain antiepileptic drugs and the antimicrobial agent rifampin, resulting in drug-induced osteomalacia, which is attributed to vitamin D deficiency. We now report a novel CYP3A4-dependent pathway, the 4-hydroxylation of 25-hydroxyvitamin D(3) (25OHD(3)), the induction of which may contribute to drug-induced vitamin D deficiency. The metabolism of 25OHD(3) was fully characterized in vitro. CYP3A4 was the predominant source of 25OHD(3) hydroxylation by human liver microsomes, with the formation of 4β,25-dihydroxyvitamin D(3) [4β,25(OH)(2)D(3)] dominating (V(max)/K(m) = 0.85 ml · min(-1) · nmol enzyme(-1)). 4β,25(OH)(2)D(3) was found in human plasma at concentrations comparable to that of 1α,25-dihydroxyvitamin D(3), and its formation rate in a panel of human liver microsomes was strongly correlated with CYP3A4 content and midazolam hydroxylation activity. Formation of 4β,25(OH)(2)D(3) in primary human hepatocytes was induced by rifampin and inhibited by CYP3A4-specific inhibitors. Short-term treatment of healthy volunteers (n = 6) with rifampin selectively induced CYP3A4-dependent 4β,25(OH)(2)D(3), but not CYP24A1-dependent 24R,25-dihydroxyvitamin D(3) formation, and altered systemic mineral homeostasis. Our results suggest that CYP3A4-dependent 25OHD(3) metabolism may play an important role in the regulation of vitamin D(3) in vivo and in the etiology of drug-induced osteomalacia.     

CYP3A5和POR基因多态性对肾移植患者住院期间他克莫司浓度剂量的影响

目的：研究CYP3A5和POR基因多态性对肾移植患者住院期间他克莫司（FK506）浓度（C）、剂量（D）以及浓度剂量比（C/D）的影响。方法：以290例肾移植患者为研究对象,使用聚合酶链式反应（PCR）-限制性内切片段长度多态性（RFLP）法和测序法检测患者CYP3A5*3 A>G（rs776746）和POR*28 C>T（rs1057868）基因型,比较肾移植术后28 d内不同基因型患者之间FK506的C、D以及C/D的差异。结果：CYP3A5*3 GG型患者FK506的C和C/D在术后7、14、21、28 d均显著高于CYP3A5*3 AA型和AG型患者（P<0.01）。POR*28 CT型患者术后21 d和28 d的C/D与CC型患者相比具有显著性差异（P<0.05）,而POR*28基因型对其他各时间点FK506的C、D以及C/D均无影响。根据CYP3A5*3基因分层后发现,POR*28基因多态性对CYP3A5*3 AA型患者FK506的C、D以及C/D影响最大,其次是CYP3A5*3 AG型,而对CYP3A5*3 GG型患者各时间点的C、D以及C/D均无影响。在CYP3A5*3 AA型患者中,术后各时间点POR*28 CC型FK506的D均低于CT和TT型患者,CC型患者的C/D均高于CT型和TT型,且在多个时间点处有统计学差异。结论：肾移植初期,CYP3A5*3和POR*28基因多态性对FK506的浓度剂量有影响,且POR*28基因多态性对CYP3A5*3 AA型患者FK506浓度剂量的影响最大。     

抗CD44 mAb A3D8对卵巢癌球形体形成细胞增殖和凋亡的影响*

摘要 目的：探讨抗CD44单克隆抗体(mAb)A3D8对3种卵巢癌球形体形成细胞增殖和凋亡的影响,并探讨其作用机制。方法：用MTS法检测A3D8对细胞增殖的影响;采用PI染色及流式细胞仪检测A3D8对细胞周期的影响;用Annexin V-FITC/PI凋亡检测试剂盒检测A3D8在细胞凋亡中的作用;用罗丹明123试剂盒检测A3D8对细胞线粒体膜电位的影响;并采用Western Blotting法检测A3D8作用于3种卵巢癌球形体形成细胞后,CDK2、cyclinA、Bcl-2和caspase-3的改变。结果：A3D8可抑制3种卵巢癌球形体形成细胞的增殖,且此抑制作用呈现剂量和时间依赖性;A3D8可在阻滞S期的同时降低G0/G1期比例;A3D8可促进3种细胞凋亡,与DDP联用,细胞凋亡率较单独使用DDP增高;A3D8的处理可导致3种细胞的线粒体膜电位损失,CDK2、cyclinA、Bcl-2蛋白表达下调,caspase-3表达上调。结论：A3D8可能是通过影响p21/CDK2/cyclinA途径阻滞细胞周期达到抑制3种卵巢癌球形体形成细胞增殖的结果,并且可通过线粒体途径促进细胞凋亡。     

Daily rhythms of heart rate, temperature and locomotor activity are modified by anaesthetics in rats: a telemetric study

The aim of this study was to evaluate the effect of anaesthesia (ether or ketamine) on daily rhythms of temperature (T), heart rate (H) and locomotor activity (A) in unrestrained rats by using implanted radio-telemetry transmitters. T, H and A were measured every 10min, in Wistar male rats, and analysed using Cosinor. The mean±SEM days needed, after surgical implantation, to detect a daily rhythm in H, T and A were also assessed. Six rats were anaesthetized for about 50min either by ketamine or ether in a 3 by 3 cross-over design. Mesors, amplitudes and acrophases of T, H and A were calculated three days before (D-3; D-2; D-1), the day of anaesthesia (D0) as well as the three following days (D1; D2; D3). ANOVA was performed in order to detect, firstly a possible effect due to the order of application of anaesthesia, secondly a significant difference between ether or ketamine-induced anaesthesia and finally a modification of the mesors, amplitudes and acrophases of T, H and A, induced by each anaesthesia, for D0, D1, D2 and D3 when compared to D-1. Our results indicate: (1) Alterations of the acrophases, mesors and amplitudes, except for the amplitude of A, of the daily rhythms of T, H and A on D0 of ketamine anaesthesia while regarding ether anaesthesia only amplitude of T and H and acrophase of A were modified on D0. Some of these modifications were still observed on the days following anaesthesia. A significant difference between ether and ketamine-induced anaesthesia was also observed. (2) A non-detection of T, H and A daily rhythms after surgical implantation, which was not observed after injection of either ether or ketamine alone. Almost 10 days were needed to detect a significant daily rhythm for T, H and A. The authors suggest that, the general anaesthetic agent was responsible for a perturbation of the mesors, amplitudes and acrophases of the daily rhythms of H, T and A while the non-detection of these rhythms after implantation was more due to the surgical aggression. Received: 10 September 1996 / Accepted: 30 January 1997     

Inverse agonist properties of dopaminergic antagonists at the D(1A) dopamine receptor: uncoupling of the D(1A) dopamine receptor from G(s) protein.

The interaction of dopaminergic antagonists with the D(1A) dopamine receptor was assessed in PC2 cells that transiently express this receptor. The maximal binding and dissociation constants for the D(1A) dopamine receptor, using the ligand [(125)I]SCH23982 were 0.38 +/- 0.09 nM and 1 to 4 pmol/mg, respectively, when assessed 48 h after transfection with cDNA encoding the rat D(1A) receptor. Basal adenylyl cyclase activity increased 50 to 60% in membranes of transfected PC2 cells compared with control membranes. The dopaminergic antagonists clozapine, cis-flupenthixol, (+)-butaclamol, haloperidol, chlorpromazine, and fluphenazine inhibited constitutive adenylyl cyclase activity in membranes of cells expressing the D(1A) receptor. SCH23390, a selective D(1) dopamine receptor antagonist, and (-)-butaclamol did not alter basal cyclase activity, whereas dopamine increased enzyme activity in membranes expressing the D(1A) dopamine receptor. The coupling of D(1A) receptors with G(s) proteins was examined by immunoprecipitation of membrane G(salpha) followed by immunoblotting with a D(1A) dopamine receptor monoclonal antibody. Clozapine, cis-flupenthixol, (+)-butaclamol, haloperidol, and fluphenazine but not SCH23390 or (-)-butaclamol decreased D(1A) receptor-G(salpha) coupling by 70 to 80%, and SCH23390 was able to prevent the receptor-G(salpha) uncoupling induced by haloperidol or clozapine. These results indicate that some dopaminergic antagonists suppress basal signal transduction and behave as inverse agonists at the D(1A) dopamine receptor. This action of the dopamine receptor antagonists may contribute to their antidopaminergic properties that seem to underlie their clinical actions as antipsychotic drugs.