Oral aminophylline therapy. Increased dosage requirements in children

While monitoring oral aminophylline (theophylline ethylenediamine) therapy, larger doses (milligrams per kilogram) were necessary for children than for adults to achieve similar therapeutic serum levels. The mean apparent theophylline clearance (ATC) determined in 59 children was significantly higher (P less than .001) than determined in 114 adults (84.8 versus 51.4 ml/hr/kg). Additionally, the younger children (1 to 9 years) eliminated theophylline more rapidly than the older children (0 to 18 years) (93.8 versus 77.3 ml/hr/kd). When initiating continuous oral aminophylline therapy, dosage guidelines, based on the mean ATC calculated for each group, were predicted, and trough theophylline serum levels of 10mug/ml were obtained. The guidelines for aminophylline were 28.0, 23.2, and 15.6 mg/kg/day administered in four divided doses for the younger children, older children, and adults, respectively. Monitoring of serum levels is suggested to further individualize the patient's aminophyline therapy.     

Influences of pyrexia and age on theophylline clearance in young children with asthma

Fifty hospitalized children with asthmatic bronchitis and bronchial asthma were treated with a continuous intravenous drip infusion of aminophylline. To investigate the pharmacokinetics of theophylline in the presence of pyrexia, patients were divided into two groups based on body temperature: a pyrexia group (> or = 38 degrees C) and a non-pyrexia group (< 38 degrees C). Theophylline clearance was 0.064 +/- 0.017 liters/kg/hr in the non-pyrexia group and 0.049 +/- 0.010 liters/kg/hr in the pyrexia group. Theophylline clearance in the non-pyrexia and pyrexia groups was 0.044 +/- 0.007 liters/kg/hr and 0.030 +/- 0.009 liters/kg/hr (< or = 6 months), 0.071 +/- 0.011 liters/kg/hr and 0.047 +/- 0.008 liters/kg/hr (6 to < or = 12 months), 0.084 +/- 0.012 liters/kg/hr and 0.055 +/- 0.006 liters/ kg/hr (1 to < or = 2 years), and 0.065 +/- 0.007 liters/kg/hr and 0.051 +/- 0.001 liters/kg/hr (2 to < or = 3 years), respectively. In all age groups, theophylline clearance of the pyrexia group was significantly less than that of the non-pyrexia group (p < 0.01), showing that there was a significant pharmacokinetic difference in theophylline clearance between the groups. Multivariate statistical analysis showed that theophylline clearance was affected by pyrexia and age. This study showed that the presence of pyrexia decreases theophylline clearance, and that it affects theophylline clearance in an age-dependent manner. Based on the results of this study, dosages should be designed based on the clearance at the time of pyrexia.     

参藿口服液对动物免疫系统的影响

目的研究参藿口服液对动物免疫系统的影响。方法小鼠脾淋巴细胞增殖实验、小鼠溶血素(HC50)和单核巨噬细胞吞噬功能测定,小鼠皮肤迟发型过敏反应(DCH)实验。结果参藿口服液10～20mlkg连续口服6d,可显著促进小鼠脾淋巴细胞增殖反应,参藿口服液25～10mlkg连续口服6d,明显恢复免疫抑制小鼠单核巨噬细胞的吞噬活性和抗体产生能力,参藿口服液25～10mlkg连续口服10d,明显增强免疫抑制小鼠DCH反应,促进机体细胞免疫功能。结论参藿口服液能明显增强小鼠的体液免疫和细胞免疫功能。     

Serum theophylline concentrations during multiple dosing with two sustained release methylxanthine preparations in normal subjects.

In normal subjects, receiving multiple dosing regimens with Slophyllin and Phyllocontin in does calculated to give either 4 mg/kg or 6mg/kg theophylline free acid twice daily, serum theophylline concentrations were frequently less than 8 mg/l. Accumulation of the serum theophylline trough concentration occurred during the first 3 days of multiple dosing, and was followed by subsequent stabilization or even decline in serum theophylline trough concentrations. Side effects were noted with both Slophyllin and Phyllocontin, but only on the higher dosage regimens; they occurred within 24--48 hr of starting the drug, and tended to diminish if dosing was continued. The accumulation effect of serum theophylline concentrations may explain the timing of adverse effects, and should be avoided by starting methylxanthine therapy at a low dose. This may be increased after a few days. Further dosage adjustment may be necessary in some patients and should be facilitated by measurement of serum theophylline trough concentrations.     

Severe theophylline poisoning: charcoal haemoperfusion or haemodialysis?

Theophylline poisoning with a blood level of 183 mg/l in a 38-year-old man was treated with activated charcoal by mouth, but despite this the blood level of theophylline rose and there was circulatory collapse with rhabdomyolysis, acute renal failure and hyperthermia. Treatment with charcoal haemoperfusion and simultaneous haemodialysis was given, followed by continuous arteriovenous haemodialysis (CAVHD). Mean extraction rates of theophylline were 26% during CAVHD, and 86% during combined dialysis and charcoal haemoperfusion. During combined treatment, the mean extraction rate of haemodialysis was 62%, compared with 48% for charcoal haemoperfusion. In summary, activated charcoal given by mouth may be unable to prevent a rise in blood levels and the development of complications after substantial theophylline overdose. If theophylline is to be removed from the blood, a combination of charcoal haemoperfusion and haemodialysis will give the best clearance, but haemodialysis alone may be effective.     

Digoxin overdose. Limitations of hemoperfusion-hemodialysis treatment.

We used charcoal hemoperfusion coupled with hemodialysis to treat a woman with massive digoxin ingestion complicated by hyperkalemia. Although dialysis controlled the serum potassium levels, hemoperfusion removed less than 1% of the total ingested dose. Hemoperfusion has a relatively minor impact on digoxin elimination and remains of unproved value in the therapy for digoxin overdose.     

Relation of oral dose of oxtriphylline to serum theophylline level.

Serum theophylline levels were studied in relation to oral doses of oxtriphylline in 30 patients with reversible airway obstruction. A wide scattering of levels was observed and was attributed to widely differing rates of metabolism of the drug. From the data obtained it was concluded that the most commonly prescribed daily dose of oxtriphylline, 800 mg, will produce a therapeutic level of theophylline in only about one quarter of patients. A daily starting dose of 15 to 20 mg/kg, however, will produce therapeutic levels in approximately one third of patients without significant toxic effects. Once the patient's conditions is stable the serum theophylline concentration should be measured; if it is subtherapeutic the dose of oxtriphylline should be increased slowly and the serum theophylline concentration remeasured until a level of 10 to 20 microgram/ml is achieved.     

山茱萸对小鼠免疫系统的影响

山茱萸水煎剂10,20g/kg ig使小鼠胸腺明显萎缩;减慢网状内皮系统对碳粒的廓清速率:10g/kg升高小鼠血清溶血素抗体的含量,而5g/kg作用不显著;山茱萸5,10g/kg均使血清抗体IgG含量明显升高,并能抑制SRBC所致小鼠迟发型足垫肿胀;10,20g/kg于抗原攻击前给药明显减轻DNCB所致小鼠接触性皮炎;而20g/kg于抗原攻击后3～15h给药亦对接触性皮炎有较明显的抑制作用。     

复方蒲黄冲剂对白癜风症小鼠免疫功能的影响

目的：探讨复方蒲黄冲剂对小鼠白癜风症免疫功能的有关药效学作用。方法：制作机体免疫功能低下模型,观察不同剂量复方蒲黄冲剂对小鼠胸腺、血清溶血素、细胞免疫及碳廓清速率的影响。结果：胶腔注射复方蒲黄冲剂30g生药/kg和15g生药/kg,可明显对抗雷帕霉素所致免疫功能低下小鼠的胸腺萎缩,对血清溶血素的生成具有明显的促进作用。碳廓清试验和DNCB诱导的迟发型超敏反应试验表明该药对正常小鼠的非特异性免疫及细胞免疫无明显影响。结论：复方蒲黄冲剂对白癜风症小鼠具有双向免疫调节作用。     

人参培养细胞多糖与人参多糖的免疫作用比较

人参培养细胞的多糖可明显增加小鼠脾重量,而对小鼠胸腺重量影响不大。能显著增强小鼠碳粒廓清速率,明显促进小鼠溶血素抗体的活性,提高正常小鼠血清IgG含量,对SRBC所致迟发型超敏反应有促进作用,而对小鼠的移植物抗宿主反应(GVHR)影响不大。与栽培人参多糖的作用无明显差异。     

Hypoglycemic effect of Catharanthus roseus in normal and streptozotocin-induced diabetic rats

The effects of crude juice (at 0.5 and 1 ml/kg b.w.) and aqueous extract (at 0.30 and 0.45 gm/kg b.w.) of leaves of Catharanthus roseus on serum glucose level in streptozotocin induced diabetic rats were examined at 8 hours, 12 hours and 24 hours following single oral administration. The administration of crude juice at 1 ml/kg b.w. continued for another 9 doses (total 10 single morning doses given) and its effect was examined on the 4th and 11th day. The rats were made diabetic by single intraperitoneal injection of streptozotocin at 45 mg/kg b.w. Glibenclamide was used in the study for comparison. The crude leaf juice at 0.5 and 1 ml/kg b.w. reduced the serum glucose level in streptozotocin induced diabetic rats throughout the 24-hour period significantly (P varies between 0.05 and 0.001 at different times). The aqueous extract at 0.30 and 0.45 gm/kg reduced the serum glucose level in streptozotocin diabetic rats at 8 and 12 hour significantly (P varies between 0.05 to 0.01 at different times) but not at the 24 hour. Glibenclamide, at 500 mug/kg, also reduced the serum glucose level in streptozotocin induced diabetic rats throughout the 24-hour period (P<0.001). The crude leaf juice at 1 ml/kg also significantly reduced the serum glucose level in the streptozotocin induced diabetic rats on the 4th and 11th day (P<0.001 on both occasions). The effect of crude leaf juice at 1 ml/kg b.w administered daily orally over a 10 day period was also examined on a group of normal rats at different times. The study showed significant reduction at 8 hr (P<0.05), 12 hr, 24 hr and on the 4th day (P<0.01 on these 3 occasions) and also on the 11th day (P<0.001).     

升白冲剂的升白作用及其对免疫功能的影响

升白冲剂由黄芪、红枣等中药组成,对环磷酰胺和照射~(60)Co所致的小鼠白细胞降低有较强的升白作用。以15ml/kg(1ml相当于0.75g原药材)灌胃给药,能增加小鼠免疫器官重量,提高其碳粒廓清作用和溶血素抗体活性。     

血液灌流联合血液透析治疗尿毒症皮肤瘙痒临床观察

目的：探讨血液灌流联合血液透析治疗尿毒症的临床疗效。方法：维持性血液透析患者24例,随机分为两组,治疗组12例,采用血液灌流联合透析治疗;对照组12例,单纯透析治疗。两组均采用肝素抗凝,血流量200～250ml/min,透析液流量500ml/min。检测治疗前后血肌酐、尿素氮、甲状旁腺激素、β2微球蛋白、血压及临床症状。结果：治疗组皮肤瘙痒减轻及甲状旁腺激素、β2微球蛋白清除显著高于对照组（P〈0.05）。结论：血液灌流联合血液透析治疗尿毒症病人,可清除中分子物质,可有效减轻皮肤瘙痒。     

不同血液净化模式对维持性血液透析患者血清内脏脂肪素的影响

目的 探讨不同血液净化模式对维持性血液透析患者(MHD) 内脏脂肪素(visfatin)表达水平的影响。方法 选择规律血液透析患者60例,并选取健康对照组60例,观察患者血清内脏脂肪素的表达水平及与微炎症状态的关系,随后将60例患者随机分为血液透析组(HD)、血液灌流+血液透析组(HD+HP)和血液透析滤过组(HDF)3组,观察三种治疗模式单次治疗4 h后、连续治疗3个月后与治疗前内脏脂肪素的表达水平及清除率。结果 维持性血液透析患者内脏脂肪素水平明显高于健康对照组,内脏脂肪素表达水平与IL-6、超敏C-反应蛋白(Hs-crp)呈明显正相关,HD组治疗前后血清visfatin无明显变化,HDF、(HD+HP)组治疗前4 h及3个月后血清visfatin均明显降低,差异有统计学意义,(HD+HP)组清除率大于HDF组,差异有统计学意义。结论 血液透析患者血清内脏脂肪素明显升高,与患者微炎症状态明显相关,血液透析滤过与血液灌流均能清除内脏脂肪素,血液灌流效果优于血液透析滤过,血液透析无法清除内脏脂肪素。     

Sustained-release theophylline-uniphyllin in nocturnal asthmatics

For a period of six months, we collected 12 cases of nocturnal asthmatics (7 males, 5 females); their ages ranged from 20 to 66 (the average age is 49). We found that administration of Uniphyllin (10 mg/kg) once a day at 6 PM could maintain the blood level of theophylline within therapeutic range at least 12 to 24 hrs. The peak expiratory flow rate of the 6 cases we collected, were significantly improved. The result of pharmokinetic parameters: 1) The average of a single dose (12 cases) is AUC (ug. hr/ml) 275.1 +/- 62. k; Kel (hr-1) 0.068 +/- 0.019; Ka (hr-1) 0.33 +/- 0.07); Tmax (hr) 6.3 +/- 1.4; T 1/2 (hr) 11.2 +/- 4.4; Clearance/F (ml/kg/hr) 37.9 +/- 9.0.2). The average of steady state (12 cases) is Css (mg/L) 5. 7 +/- 2.6; Cmax-Cmin (mg/L) 10.09 +/- 1.46.3). The average of relative bioavailability (3 cases) is 82%, 83%, 102%. However, the extent of absorption data is available for only 3 subjects. There are too few subjects to draw any meaningful conclusions about this relative bioavailability. Four cases show slight symptoms, including 1 case of dizziness, 2 cases of nausea, and 1 case gaseousness. It is suggested that the drug be administered at about 6-8 PM to coincide peak levels in the early morning in nocturnal asthmatics.     

血液透析联合血液灌流清除血清β2微球蛋白、甲状旁腺激素疗效的Meta分析

目的：系统评价血液透析联合血液灌流清除血清β2微球蛋白、甲状旁腺激素有效性。方法通过计算机检索中国知网、维普数据库、万方学位论文全文数据库、PUBMED、SPRINGER外文数据库、SCIENCE等数据库,手工检索国内各种医学期刊、专著以及会议资料和学位论文,时间为该数据库建立至2013年4月30日,全面收集有关血液透析联合血液灌流清除血清β2微球蛋白、甲状旁腺激素的相关文献。制定文献纳入及排除标准,由两名研究者分别独立筛选文献,并对符合纳入标准的文献按Jadad量表评分进行文献质量评估。应用RevMan 5.2软件进行Meta分析,计量资料采用平均差（MD）及其95%可信区间（CI）表示。结果按照检索策略共查到相关文献1013篇,均来自电子数据库,包含手工检索出的文献。根据纳入标准和剔除标准,经逐一筛选、评价,最终纳入文献7篇,均为中文文献。文献质量依据Jadad量表评分,其中4个研究评分为2分,其余3个研究评分为1分,为低质量研究。共306例尿毒症维持性血透患者纳入本研究。Meta分析结果显示,与对照组比较,血液透析联合血液灌流治疗能提高血清β2微球蛋白的清除率[共纳入6个RCT,266个患者（治疗组134例,对照组132例）,MD=12.05,95%CI（1.31,22.79）,P=0.03];与对照组比较,血液透析联合血液灌流治疗与单纯血液透析对甲状旁腺激素的清除作用相当[共纳入7个RCT,306例患者（治疗组154例,对照组152例）,MD=394.82,95%CI（-267.92,1057.56）,P=0.24]。结论血液透析联合血液灌流在清除血清β2微球蛋白方面优于单纯血液透析,而在清除甲状旁腺激素方面与单纯血压透析疗效相当。由于纳入研究在相关并发症及随访方面不尽详细,故未予进行评价,故无法判断其远期疗效,还需要大型、随机、多中心研究进一步证实。     

Delayed elimination of caffeine by women in the last 2 weeks of pregnancy.

Caffeine elimination was studied in 15 women at 38 to 40 weeks' gestation. The mean hourly caffeine clearance, 37 ml/kg, determined from assays of saliva, was only 39% of the value previously reported for nonpregnant adults (94 ml/kg). Reassessment in four of the women 2 to 12 weeks post partum showed that in each woman the caffeine clearance had increased more than threefold and that the mean caffeine concentration in the saliva after no intake of caffeine for 24 hours was now much lower (0.07 v. 0.84 microgram/ml).     

高效毛细管电泳法快速测定内江猪血清头孢唑啉钠

报道用高效毛细管电泳技术快速测定内江猪血清头孢唑啉钠（ｃｅｆａｚｏｌｉｎｓｏｄｉｕｍ,ＣＥＺ）的方法,血清用乙腈去除蛋白质,经离心后上清直接进样,毛细管血径７５μｍ,在５０ｍｍｏｌ／Ｌ碳酸钠／碳酸氢钠ｐＨ１０）中,电压２０ＫＶ分离５分钟,２５４ｎｍ紫外检测,此方法操作简单,测定迅速,线性范围为５－３２０μｇ／ｍｌ,日内相对标准偏差为１．７％,日间相对标准偏差为８．０％,平均加样回收率为１０７．９％     

Tobramycin nephrotoxicity. A prospective clinical study

The nephrotoxicity of tobramycin given at a dose of 4·5 mg/kg/day for a period of 12 days to a group of 90 patients with a mean age of 62·9 years was studied. Toxicity was determined on the basis of 3 main criteria (oliguria <400 ml/24 hr, serum creatinine 0·4 mg increase over a minimum basal level of 1·2 mg/100 ml, BUN 5 mg increase over a minimum of 25 mg/100 ml); and 3 minor criteria (proteinuria, microhaematuria and cylindruria). These parameters were determined before treatment at 7, 10, 14, 17, 21, and 30 days afterwards. The age and coexistence of factors such as hypertension, diabetes, anaemia, cardiac insufficiency, shock and dehydration were considered. Nephrotoxicity level ranges from 3·3 to 38·8% depending on the criterion used, and is related to hypertension (P<0·001), age (P<0·005) and association with ampicillin (P<0·005). Nephrotoxicity was reversible spontaneously in 96·7% of the cases and no differences have been observed between patients with moderate renal insufficiency and those with normal renal function on the initiation of treatment.     

血液灌流串联血液透析对血清甲状旁腺激素的影响

目的:研究血液透析与血液透析串联血液灌流清除血清甲状旁腺激素(PTH)的效果。方法:将32例维持性血液透析患者随机分为两组:血液透析组(HD)、血液灌流+血液透析组(HP+HD)。比较两组单次治疗对血清PTH的清除率。结果:两组治疗后PTH均有所下降,P值均小于0.05;治疗后HP+HD组较HD组下降明显(P<0.05)。结论:HP+HD能比HD更有效清除PTH。