国冢级继续医学教育项目“临床思维和临床决策”学习班报名通知（项目编号：2009-15-01-002）

临床思维和临床决策是临床工作者（医师、药师、护师、营养师、心理师、康复师和检验师）的逻辑思维能力和临床处置能力。临床思维是临床决策的前提,而临床决策则是临床思维的结果;临床思维和临床决策都以临床信息和医药知识作为基础。临床思维和临床决策是否得当,决定了临床信息的收集是否全面,分析是否得当,疾病诊断是否正确,病情判断是否适当,治疗方案是否合理,治疗监护是否充分。一句话,正确的临床思维和临床决策让病人承受必要的痛苦、承担必须的风险、     

临床治疗团队中临床药师应有的基本要素界定

目的:界定临床治疗团队中临床药师应有的基本要素。方法:考察在临床中设定临床药师制度的目的、临床治疗团队中临床药师与临床医师的不同工作范畴以及不同专业要求等,从而界定出临床治疗团队中临床药师应有的基本要素。结果与结论:我国实行临床药师制度是医院临床制度建设的重大进步,而临床治疗团队中的临床药师必须具备其应有的临床责任、临床作用、临床能力和临床效果这四大临床应有的基本要素。只有这样,临床药师才能在临床治疗团队中成为不可替代的重要组成部分。     

肛肠外科临床药师参与临床治疗的实践与体会

目的:交流肛肠外科临床药师深入临床参与临床治疗、提供药学服务的经验与体会。方法:将肛肠外科临床药师参与临床治疗的典型案例进行总结、分析。结果:临床药师参加危重患者的救治、为患者和临床医师提供药学服务、协助临床医师做好临床治疗工作,起到了一定的作用。结论:临床药师深入临床参与临床治疗,是新形势下医院药学服务模式的重大转变,是非常重要的。     

浅谈临床药师开展临床药学服务的途径和方法

目的探讨临床药师开展临床药学服务的途径和方法。方法查阅大量相关文献,对其进行研究整理,并结合我院临床药师开展工作的具体情况,总结出临床药师开展临床药学服务的基本途径和方法。结果临床药师可以通过参与医师查房与会诊、制定个体化给药方案、提供药学咨询服务、临床使用药物的不良反应监测、处理临床中的药品不良反应事件、撰写药历等途径和方法为临床提供药学服务。结论临床药师可为临床提供多种形式的药学服务,临床药师参与临床治疗工作,可减少药物不良反应的发生,促进合理用药。     

我院临床药学工作现状与展望

介绍本院临床药学工作开展情况和展望。从临床药师查房、药品不良反应（事件）监测工作、药物咨询和合理用药宣传、抗菌药物合理使用监控、参与医院临床会诊、带教工作等方面,叙述了临床药学具体的工作内容。进一步开展上市药物的再评价、临床药学科研、临床中药师的培养工作。本院临床药学已经有了较好的开端,但是还要进一步努力。临床药学工作应该进一步与临床紧密结合,促进临床合理用药。     

临床药师药学服务实践与体会

目的介绍临床药师参与临床的工作实践与体会。方法以用药咨询、药学知识宣导、合理用药监控、参与会诊、参与查房等工作实例,阐述临床药师的工作技巧与体会。结果临床药师参与临床,深受临床科室欢迎。结论领导重视,是药师能否参与临床工作的首要因素;端正心态,学会临床思维,学会沟通是药师能否参与临床工作的必备因素。     

国家级继续医学教育项目“临床思维和临床决策”学习班报名通知

临床思维和临床决策是指临床工作耆（医师、药师、护师、营养师、心理师、康复师和检验师）的逻辑思维能力和临床处置能力。正确的临床思维和临床决策让病人承受必要的痛苦、承担必须的风险、支付合理的费用、花费适当的时间去赢得病症的适当转归，从而降低病死率和病残率，提高生命质量。本学习班在上海中山医院长期开展临床思维研究的基础上，又增添了临床决策的内容，     

某专科医院不合理用药典型案例分析

目的:分析临床不合理用药的原因,为临床合理用药提供参考。方法:通过临床药师参与临床查房,发现10例不合理用药的典型案例,利用临床药师在药效学、药动学、药物相互作用、配伍禁忌、药物不良反应等方面的专业知识,分析临床不合理用药的原因,进行必要的干预。结果:临床用药中存在抗生素不合理使用、选药不当、药物配伍禁忌、药品服用时间不适当、用药疗程过长和自带药品风险等原因,及时发现、干预临床不合理用药,所提建议均被临床医生采纳。结论:临床药师参与临床查房,及时发现和干预临床不合理用药现象,可提高临床合理用药水平,保证患者临床用药的安全、有效。     

临床医师参与临床药师带教工作的体会与探讨

目的探讨临床医师参与培养临床药师的方法。方法结合临床医师带教5名临床药师的实践经验,探讨、总结临床药师的培养。结果通过带教临床药师医疗查房、参与病例讨论、具体病例的药物应用等,培养了临床药师的临床思维,对药物的临床应用、治疗效果以及药物的不良反应等有了具体的感性认识,取得了较好的培养效果。结论临床医师参与培养临床药师的教学实践,有利于临床药师尽快成为临床治疗团队中的一员。     

中药临床药师在神经内科开展中药临床药学服务的探索与实践

中药临床药师是合理用药的倡导者、实践者和监督者,承担着临床中药合理用药的具体任务。为促进临床合理用药,提高中药临床药师服务质量,为医护人员和患者提供优质的中药临床药学服务,文章介绍了某院中药临床药师在面临挑战和机遇时,正在开展的中药临床药师药学服务现状,从药学查房、中药处方点评、中药不良反应上报、中药用药教育、中药用药咨询和药物治疗监护等内容出发,阐述了该院神经内科中药临床药师在开展有关中药合理用药药学服务的主要内容,探讨当前工作模式下中药临床药师深入临床、服务临床的切入点,在实践中探索科学、合理的中药临床药师药学服务模式。     

Physiological response of carp,Cyprinus carpio,exposed to raw sewage containing fish processing wastewater

Physiological changes of carp exposed to raw sewage were investigated by the use of clinical examination methods. All carp exposed to raw sewage died within 6 h. On hour 48, 10, 40, and 90% of exposed carp survived in 60, 20, and 10% sewage, respectively. Carp exposed to 50 and 20% sewage increased ammonia, glucose, Mg, Cu, and Br, and decreased Fe and Zn in plasma. Even in 10% sewage, ammonia, glucose, and Br in plasma increased. Forty-eight hours of exposure to 50 and 20% sewage caused severe pathological changes in the gills. In the kidney, light abnormalities were observed at this time. When exposed to 50 and 20% sewage, atrioventricular conduction time and duration of electrical systole measured by electrocardiogram shortened briefly, and then extended gradually. In 50 and 20% sewage, heart rate and respiratory frequency increased briefly, and then decreased gradually. Cough reaction increased with the exposure. © 1997 by John Wiley & Sons, Inc. Environ Toxicol Water Qual 12: 1–9, 1997     

过量奥卡西平致定向力障碍及共济失调

1例6岁男性癫痫患儿,曾先后口服苯妥英钠、拉莫三嗪、丙戊酸钠、苯巴比妥治疗,因不能规律服药致使癫痫反复发作且进行性加重,家属自行给予其口服奥卡西平300 mg、3次/d,上述症状未再发作。但40 d后出现行走不稳、反应迟钝,且癫痫症状也加重。入院诊断为癫痫,全身强直-阵挛发作,奥卡西平致定向力障碍及共济失调。停用奥卡西平,给予丙戊酸钠、还原性谷胱甘肽、维生素C,次日癫痫得到控制。第8天定向力障碍及共济失调消失,癫痫未再发作,遂出院。出院后规律服用丙戊酸钠和氯硝西泮。随访1个月,未再出现癫痫发作、定向力障碍和共济失调。     

Alpinia zerumbet,a ginger plant with a multitude of medicinal properties: An update on its research findings

In this review, the botany and uses of Alpinia zerumbet (yan shan jiang) are described, and the current knowledge of its phytochemistry, pharmacological properties, and clinical trials is summarized. An important ginger crop in East Asia, A. zerumbet has many uses, both medicinal and non-medicinal. Leaves are used to produce essential oils and herbal teas. Rhizomes are consumed as spices, and stem fibers are made into paper, fabrics, and handicrafts. In Brazil, tea from A. zerumbet leaves is believed to have hypotensive, diuretic, and anti-ulcerogenic properties. This species possesses many medicinal properties due to its chemical constituents, including flavonoids, phenolic acids, phenylpropanoids, kava pyrones, sterols, and terpenoids. Extracts of A. zerumbet display antioxidant, antimicrobial, insecticidal, anthelmintic, tyrosinase and melanogenesis inhibitory, anti-atherogenic, anti-aging, anti-glycation, integrase and neuraminidase inhibitory, lifespan prolongation, hair growth promotion, anticancer, antidepressant, anxiolytic, anti-obesity, analgesic, anti-inflammatory, hypolipidemic, anti-ulcerogenic, anti-platelet, osteoblastic, osteogenic, thrombolytic, and cardiacarrhythmogenic activities. Essential oils of A. zerumbet leaves have antimicrobial, larvicidal, antinociceptive, hypotensive, vasorelaxant, myorelaxant, antispasmodic, antidepressant, anxiolytic, anti-neuraminidase, anti-atherogenic, anti-aging, anti-melanogenic, anti-tyrosinase, cytoprotective, cardiodepressive, antipsychotic, analgesic, anti-inflammatory, and tissue healing activities.Clinical trials conducted in Brazil showed that extracts of A. zerumbet have hypotensive and diuretic effects whereas topical application of the essential oil has positive therapeutic effects on patients with fibromyalgia. Spanning two continents of Asia and South America, A. zerumbetis truly a multi-purpose ginger plant with promising medicinal properties.     

A review of anti-inflammatory,antioxidant, and immunomodulatory effects of Allium cepa and its main constituents

ContextAllium cepa L. (Liliaceae), known as onion, is consumed throughout the world. Onion and its derivatives including saponins, aglycones, quercetin, cepaenes, flavonoids, organosulfurs, and phenolic compounds, showed various pharmacological properties and therapeutic effects.ObjectiveAnti-inflammatory, antioxidant, and immunomodulatory effects of A. cepa and its main constituents, along with the underlying molecular mechanisms are presented.MethodsDatabases including, Web of Knowledge, Medline/PubMed, Scopus, and Google Scholar were checked for articles published between 1996 and the end of July 2020, using the key-words Allium cepa, quercetin, anti-inflammatory, antioxidant and immunomodulatory.ResultsA. cepa and its constituents mainly quercetin showed anti-inflammatory effects mediated via reduction of total and differential WBC counts, inhibition of chemotaxis of polymorphonuclear leukocytes, COX, and LOX pathways and prevented formation of leukotrienes and thromboxanes, prostaglandin E2 (PGE2) as onVCAM-1, NF-κB, MARK,d STAT-1, JNK, p38 and osteoclastogenesis. A. cepa and its derivatives showed antioxidant effect by decreasing lipid peroxidation, NAD(P)H, MDA, NO, LPO and eNOS but enhancing antioxidants such as SOD, CAT, GSH, GPx, GSPO, TrxR, SDH, GST and GR activities and thiol level. Immunomodulatory effects of the plant and quercetin was also shown by reduction of Th2 cytokines, IL-4, IL-5, and IL-13 as well as IL-6, IL-8, IL-10, IL-1β and TNF-α and IgE levels, but increased CD4 cells, IFN-γ level and IFN-γ/IL4 ratio (Th1/Th2 balance).ConclusionsThe effect of onion and its constituents on oxidative stress, inflammatory and immune system were shown indicating their therapeutic value in treatment of various diseases associated with oxidative stress, inflammation, and immune-dysregulation.     

Effects of typical and atypical antipsychotics on glucose–insulin homeostasis and lipid metabolism in first-episode schizophrenia

Rationale Glucose and lipid metabolism dysfunction is a significant side effect associated with antipsychotics. Although there are many studies about the linkages between drugs and metabolic dysfunction, most of these studies have compared the effects of two antipsychotics on only one metabolic measure: either glucose or lipid metabolism.Objectives The present study aimed to investigate the effects of clozapine, olanzapine, risperidone, and sulpiride on glucose and lipid metabolism in first-episode schizophrenia.Materials and methods One hundred twelve schizophrenics were assigned randomly to receive clozapine, olanzapine, risperidone, or sulpiride for 8 weeks. Planned assessments included body mass index (BMI), waist-to-hip ratio, fasting glucose, insulin, C-peptide, insulin resistance index (IRI), cholesterol, and triglyceride. All measures were collected at baseline and at the end of the 8-week treatment.Results After treatment, insulin, C-peptide, and IRI were significantly increased in the four groups, but not fasting glucose levels. Cholesterol and triglyceride levels were significantly increased in the clozapine and olanzapine groups. Patients treated with clozapine and olanzapine had higher fasting insulin, C-peptide, and IRI levels than those treated with risperidone and sulpiride. Among the four antipsychotics, the increases of mean BMI from high to low were as follows: clozapine, olanzapine, sulpiride, and risperidone.Conclusions This study confirmed that the four antipsychotic drugs were associated with an increase of insulin, C-peptide, and IRI. It was found that clozapine and olanzapine were associated with an increase in cholesterol and triglyceride levels. The effects of clozapine and olanzapine on the glucose and lipid metabolism outweighed those of risperidone and sulpiride.     

Neuropharmacological studies of phencyclidine (PCP)-induced behavioral stimulation in mice

A variety of drugs were screened to determine which were capable of blocking the behavioral stimulation produced in mice by acute administration of phencyclidine (PCP). Chlorpromazine and clozapine blocked PCP-induced stimulation, while haloperidol, reserpine, and alpha-methyl-p-tyrosine did not. The GABA receptor agonists imidazole acetic acid and muscimol blocked PCP, but other drugs that influence GABA, such as dipropylacetic acid, baclofen, and diazepam, were ineffective. Yohimbine and methysergide also blocked PCP in high dosages, but other drugs with comparable alpha-noradrenergic and serotonergic blocking properties (phentolamine, cyproheptadine, and cinnanserin) were ineffective. Cholinergic and anticholinergic drugs, beta-noradrenergic and opiate antagonists, and nonspecific sedatives and convulsants were also ineffective. These finding suggest that chlorpromazine, clozapine, yohimbine, and methysergide may share a property that is unlike their primary known modes of action on dopaminergic, alphanoradrenergic, and serotonergic neurotransmitter systems, and that this property accounts for their ability to block PCP. However, the effectiveness of GABA agonists appears to be mediated through direct activation of GABA receptors. It is suggested that chlorpromazine and imidazole acetic acid should be considered as possible drug treatments for PCP toxicity.     

Comparison of the gastrointestinal anatomy,physiology, and biochemistry of humans and commonly used laboratory animals

In addition to metabolic differences, the anatomical, physiological, and biochemical differences in the gastrointestinal (G.I.) tract of the human and common laboratory animals can cause significant variation in drug absorption from the oral route. Among the physiological factors, pH, bile, pancreatic juice, and mucus and fluid volume and content can modify dissolution rates, solubility, transit times, and membrane transport of drug molecules. The microbial content of the G.I. tract can significantly affect the reductive metabolism and enterohepatic circulation of drugs and colonic delivery of formulations. The transit time of dosage forms can be significantly different between species due to different dimensions and propulsive activities of the G.I. tract. The lipid/protein composition of the enterocyte membrane along the G.I. tract can alter binding and passive, active, and carrier-mediated transport of drugs. The location and number of Peyer's patches can also be important in the absorption of large molecules and particulate matter. While small animals, rats, mice, guinea pigs, and rabbits, are most suitable for determining the mechanism of drug absorption and bioavailability values from powder or solution formulations, larger animals, dogs, pigs, and monkeys, are used to assess absorption from formulations. The understanding of physiological, anatomical, and biochemical differences between the G.I. tracts of different animal species can lead to the selection of the correct animal model to mimic the bioavailability of compounds in the human. This article reviews the anatomical, physiological, and biochemical differences between the G.I. tracts of humans and commonly used laboratory animals.     

Impact of Fusarium-Derived Mycoestrogens on Female Reproduction: A Systematic Review

Contamination of the world’s food supply and animal feed with mycotoxins is a growing concern as global temperatures rise and promote the growth of fungus. Zearalenone (ZEN), an estrogenic mycotoxin produced by Fusarium fungi, is a common contaminant of cereal grains and has also been detected at lower levels in meat, milk, and spices. ZEN’s synthetic derivative, zeranol, is used as a growth promoter in United States (US) and Canadian beef production. Experimental research suggests that ZEN and zeranol disrupt the endocrine and reproductive systems, leading to infertility, polycystic ovarian syndrome-like phenotypes, pregnancy loss, and low birth weight. With widespread human dietary exposure and growing experimental evidence of endocrine-disrupting properties, a comprehensive review of the impact of ZEN, zeranol, and their metabolites on the female reproductive system is warranted. The objective of this systematic review was to summarize the in vitro, in vivo, and epidemiological literature and evaluate the potential impact of ZEN, zeranol, and their metabolites (commonly referred to as mycoestrogens) on female reproductive outcomes. We conducted a systematic review (PROSPERO registration CRD42020166469) of the literature (2000–2020) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources were primary literature published in English obtained from searching PubMed, Web of Science, and Scopus. The ToxR tool was applied to assess risk of bias. In vitro and in vivo studies (n = 104) were identified and, overall, evidence consistently supported adverse effects of mycoestrogens on physiological processes, organs, and tissues associated with female reproduction. In non-pregnant animals, mycoestrogens alter follicular profiles in the ovary, disrupt estrus cycling, and increase myometrium thickness. Furthermore, during pregnancy, mycoestrogen exposure contributes to placental hemorrhage, stillbirth, and impaired fetal growth. No epidemiological studies fitting the inclusion criteria were identified.     

聚氯乙烯和聚烯烃热塑性弹性体输液器对4种常用注射液稳定性及吸附性影响

目的：比较聚氯乙烯（PVC）输液器与聚烯烃热塑性弹性体（TPE）输液器对4种常用注射液的稳定性与吸附性的影响。方法：将乳酸环丙沙星氯化钠、左氧氟沙星氯化钠、乳酸左氧氟沙星氯化钠和托烷司琼氯化钠4种常用注射液迅速充满输液器并封存放置或正常流经输液器,采用HPLC法测定环丙沙星、左氧氟沙星和托烷司琼浓度,比较各药标示量变化,评价各药稳定性和输液器吸附性。结果：PVC和TPE输液器乳酸环丙沙星氯化钠注射液、左氧氟沙星氯化钠注射液、乳酸左氧氟沙星氯化钠注射液、托烷司琼氯化钠注射液最终（90 min）各药百分含量分别为94.11%,98.42%,98.02%,100.59%,101.91%,102.73%,99.04%,102.89%,2组含量变化无显著差异（P<0.05）,提示各药稳定。PVC和TPE输液器90 min各药百分含量分别为101.74%,100.21%,101.04%,99.37%和101.64%,103.10%,103.35%,103.27%,2组间含量变化无显著差异（P<0.05）,提示2种输液器吸附性相当。结论：PVC和TPE输液器不影响乳酸环丙沙星氯化钠注射液、左氧氟沙星氯化钠注射液、乳酸左氧氟沙星氯化钠注射液、托烷司琼氯化钠注射液的稳定性,对4种注射液中各药亦无吸附发生,可常规使用。