浅谈抗菌药物在我院传染病治疗中的应用现状

目的通过统计分析住院部患者使用抗菌药物的情况,为基层医院抗菌药物临床合理应用提供参考和指导依据。方法检索医院HIS系统中2011年至2012年住院患者对于抗菌药物使用情况。其中检索的内容主要包括抗菌药物型号规格、药物名称、费用金额及消耗数量等,并通过频度（DDDs）进行分析。结果 2011至2012年间抗菌药物使用强度与使用率分别从2011年的79.30%和166.37DDD下降到2012年的54.45%和163.53DDD;人均花费从2011年的3270.27元上升至2012年的3957.96元;头孢菌素类为主要的抗菌药物,2011年67.62%下降至61.23%。结论住院患者抗菌药物依然存在不合理现象,需规范抗菌药物的使用情况或须采取行政干预措施。     

我院抗菌药物临床应用专项整治的干预措施及成果分析

目的:介绍我院抗菌药物临床应用专项整治活动采取的干预措施并评价其成效。方法:选取我院2011年5月–2012年10月就诊患者为研究对象,以抗菌药物使用强度、使用率和I类切口围术期抗菌药物应用情况等为观察指标,对比整治前后抗菌药物控制指标的变化。结果:通过实施干预措施,住院患者抗菌药物使用率和使用强度显著降低,分别由2011年5月的67.37%和92 DDD下降至2012年10月的49.16%和41 DDD,I类切口预防用抗菌药物使用率由78.1%下降至29.5%,术后用药时间由3.5 d下降至1.8 d,微生物送检率大于60%,门诊抗菌药物处方比率小于20%。结论:我院抗菌药物临床应用专项整治措施加强了抗菌药物临床应用的管理,提高了抗菌药物合理应用水平,并建立了长效的管理机制。     

苏州大学附属传染病医院住院患者抗菌药物的使用分析

目的:分析苏州大学附属传染病医院住院患者抗菌药物的使用情况,为传染病医院临床合理使用抗菌药物提供参考。方法:检索医院HIS系统中2010年—2011年两年间住院患者抗菌药物使用情况,检索内容包括抗菌药物名称、规格、消耗数量与消耗金额等,并对其使用频度(DDDs)进行分析。结果:两年间抗菌药物使用率与使用强度(DDD/100人·d)分别从2010年的79.28%和166.39DDD下降到2011年的54.49%和163.73DDD;人均日费用(元)则呈上升趋势,从2010年的3268.27元上升至2011年的3972.96元;抗菌药物的使用率主要以头孢菌素类为主,2010年67.55%下降至61.06%。结论:住院患者抗菌药物存在不合理使用现象,需进一步规范抗菌药物的临床使用或须采取行政干预措施。     

综合运用干预措施对我院抗菌药物应用的效果评价

目的评价综合干预措施对干预前后抗菌药物应用的对比变化以及综合干预的效果,规范医师合理使用抗菌药物,提高治疗水平。方法通过制定规范、加强教育、分级管理、检查反馈等措施来干预临床抗菌药物不合理使用现象。对医院干预前(2012年1—4月份)和干预后(2012年5—8月份)住院患者抗菌药物使用情况进行统计、对比和分析。结果干预后住院患者抗菌药物使用比例由66.90%下降至60.88%,住院患者抗菌药物使用强度由75.91DDD下降至62.93DDD,Ⅰ类手术切口抗菌药物预防使用率由100%下降至29.58%,微生物送检率由17.71%提高至30.62%,干预效果显著。结论综合干预措施对促进医院抗菌药物合理使用是可行的和有效的。     

2011~2013年某院抗菌药物专项整治效果评价

目的：分析某院2011~2013年抗菌药物专项整治情况,为巩固专项整治活动成果提出可持续管理措施。方法：采用回顾性调查方法,对2011~2013年该院门急诊及住院患者抗菌药物使用率和使用强度进行统计、分析;并对住院患者各抗菌药物使用量、Ⅰ类切口围术期预防用药情况进行对比分析。结果：2013年门诊患者抗菌药物处方比例、急诊患者抗菌药物处方比例、住院患者抗菌药物使用率、住院患者抗菌药物使用强度、Ⅰ类切口手术抗菌药物预防使用率分别由2011年的16.65%、56.51%、65.54%、66.89DDD、80.56%降至14.02%、42.60%、46.87%、42.61DDD、50.64%。住院患者大部分抗菌药物使用频度及使用强度均有所下降。结论：抗菌药物专项整治活动有效地促进了抗菌药物的合理使用;医院需进一步巩固专项整治成果。     

2010～2011年我院住院患者抗菌药物使用分析

目的:分析我院住院患者抗菌药物的使用情况,为临床合理用药提供参考.方法:采用限定日剂量(DDD)分析法,对我院2010～2011年住院患者抗菌药物的销售金额和用药频度进行统计、综合分析.结果:2010～2011年间抗菌药物销售金额占当年西药销售金额的比例呈下降趋势,两年间抗菌药物使用率和使用强度(DDD/100人.天)分别从2010年的71.91％和89.01 DDD下降到2011年的67.75％和82.88 DDD.抗菌药物的使用率主要以头孢菌素类、喹诺酮类和其他β内酰胺类为主.结论:住院患者抗菌药物使用存在不合理现象,有待进一步规范抗菌药物的临床使用.     

襄阳市第一人民医院专项整治活动中抗菌药物应用分析

目的：了解我院开展抗菌药物专项整治活动后抗菌药物应用情况及活动效果,为临床合理用药提供参考。方法：对2011年6月—2012年5月我院执行《2011年全国抗菌药物临床应用专项整治活动方案》中抗菌药物使用情况的相关数据进行汇总分析。结果：门诊患者抗菌药物使用率由37.37%降至19.0%,住院患者抗菌药物使用率由68.05%降至54.87%;抗菌药物使用强度（AUD）由52.11 DDD降至37.27 DDD;Ⅰ类切口手术抗菌药物使用率由97.18%降至45.00%左右。结论：我院经过开展抗菌药物专项整治活动以来,取得了一定成绩,但仍存在一定的问题,应加强重视和行政干预力度,以达到持续改进的目的。     

2011与2012年某院抗菌药物专项整治活动效果对比分析

目的：通过从医院管理层面对比分析2011与2012年某院抗菌药物使用和管理情况,为巩固专项整治活动成果提出可持续管理措施。方法：采用回顾性调查方法,对2011与2012年该院全院和各科室住院患者抗茵药物使用率（AUR）和抗茵药物使用强度（AUD）进行统计、对比及分析;并对该院抗茵药物的品规数、分级管理和销售金额占比变化进行对比分析。结果：2012年该院全院住院患者AUR和AUD较2011年（57．06％和46．96DDD）均降低近10个百分点（45．54％和36．08DDD）,均低于卫生部规定的指标。2012年该院多个f临床科室的抗菌药物指标较2011年有所降低,抗菌药物的品规数和分级管理结构更加合理化,进一步降低了抗菌药物销售金额占比。结论：抗菌药物临床应用专项整治活动有效地促进了抗菌药物的合理使用,可持续的管理措施将经一步巩固专项整治成果。     

产科住院患者抗菌药物合理使用分析

目的：对采取干预措施后产科抗菌药物的使用情况进行分析,为临床合理用药提供参考。方法：以2012年对抗菌药物采取干预措施为节点,将2011年产科住院患者设为干预前组,2012年产科住院患者设为干预后组,对两组抗菌药物使用不合理率、抗菌药物使用率、术后感染率、标本送检率、平均住院时间与费用等进行统计分析。结果：干预后组平均抗菌药物使用不合理率为2.75%、抗菌药物使用率为56.27%、术后感染率为2.43%、标本送检率为98.74%、平均住院时间为（6.15±1.16）d、平均住院费用为（3726.34±68.16）元;各项指标较干预前组有明显改善。结论：通过实施制订本院抗菌药物合理使用制度、培训与学习、行政监督、业务监督等综合措施,我院抗菌药物不合理使用情况明显好转。     

口腔专科医院开展抗菌药物专项整治效果分析

目的了解口腔专科医院抗菌药物临床使用情况,评估“专项整治活动”取得的实效。方法对我院2011和2012年住院患者抗菌药物使用情况进行回顾性调查分析。比较2组抗菌药物使用强度、使用率、外科手术预防用药术前0．5～2h给药比率、微生物标本送检率等指标。结果2012年抗菌药物使用强度为56．78 DDD ,明显低于干预前79．84 DDD （ P＜0．05）,且2012年12月使用强度下降至33．72 DDD ,达到了卫生部标准要求;外科手术预防用药术前0．5～2 h给药比率为75．67％,明显高于干预前的33．47％（ P＜0．05）;住院患者抗菌药物使用率以及治疗性用药微生物标本送检率干预前、后无改善。结论开展抗菌药物临床应用专项整治活动后,口腔专科医院抗菌药物临床应用水平有了显著提高,但仍存在问题,需继续整改提高。     

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.     

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.     

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.