三种治疗下呼吸道感染药物的经济学评价

目的 评价下呼吸道感染中的3种治疗方案所产生的药物经济学效果.方法 选择374例下呼吸道感染病例并分成3组,运用药物经济学成本-效果分析法对阿奇霉素组(A)、左氧氟沙星组(B)和头孢哌酮组(C)治疗方案进行分析.结果 3组治疗方案的有效率分别为94.08%、96.39%和93.14%;成本-效果比分别为15.84%、15.54%和15.66%.结论 左氧氟沙星组(B)为最佳的治疗方案,开展药物经济学分析有利于临床合理用药和选用最佳治疗方案.     

3种肺癌化疗方案的药物经济学分析

目的:探讨肺癌不同治疗方案治疗效果的药物经济学分析.方法:74例肺癌患者,根据不同治疗方案随机分为A、B和C 3组,运用药物经济学成本-效果分析方法对3组治疗方案进行回顾性分析、评价.结果:A组(CAP方案)有效率37.5%,1个疗程费用10080元,有效率每增加1个百分点成本为268.8元;B组(MVP方案)和C组(NP方案)有效率分别为54.5%和46.2%,1个疗程费用分别为19680元和27680元,有效率每增加1个百分点成本分别为361.1元和599.1元.B组方案优于A和C组.结论:药物经济学在优化治疗方案,指导合理用药,提高经济效益,节约卫生资源方面具有重要意义.     

4种抗生素治疗细菌性上呼吸道感染的成本-效果分析

目的:评价治疗细菌性上呼吸道感染的4种抗生素药物的成本-效果。方法:将102例细菌性上呼吸道感染患者随机分为G1、G2、G3、G4组,分别给予琥乙红霉素分散片、罗红霉素胶囊、阿奇霉素分散片、克林霉素分散片治疗,疗程分别为10、10、5、10d,运用药物经济学方法进行成本-效果分析。结果:G1、G2、G3、G4组的成本分别为143.20、114.00、69.55、323.20元;有效率分别为88.89%、91.67%、91.30%、92.86%(P>0.05);成本-效果比分别为161.10、124.36、76.18、348.05;G1、G2、G4组相对于G3组增量成本-效果比分别为—3056.02、12013.51、16259.62,G1、G2、G4组的成本-效果比显著高于G3组(P<0.05)。结论:阿奇霉素分散片治疗方案较好。     

3种抗菌药物方案治疗下呼吸道感染的成本-效果分析

目的 讨论不同治疗方案治疗下呼吸道感染的药物的成本-效果.方法 将12 0例下呼吸道感染患者随机分为阿奇霉素静脉滴注(A组)、莫西沙星静脉滴注(B组)、头孢曲松静脉滴注(C组),对3种方案进行药物经济学成本-效果分析.结果 A、B、C组成本分别为:716.10、2014.60、679.70元;有效率分别为:85.00%、93.00 %、82.00%;成本-效果比分别为:8.40、21.66、8.29.结论 3 种抗菌药物方案治疗下呼吸道感染B组方案较好.     

3种药物治疗抑郁症的成本-效果比较

目的 比较3种药物治疗抑郁症的成本-效果.方法 将符合抑郁症诊断标准的门诊患者共90例随机分为A组(给予文拉法新治疗)、B组(给予氯米帕明治疗)、C组(给予氟西汀治疗),每组30例,3组均口服给药,疗程8周,应用药物经济学成本-效果分析方法 进行评价.结果 A、B、C 3种方案的总成本依次为294.00、284.76、435.54元,痊愈率分别为50%,36.6%和43.3%,有效率分别为76.6%,70.0%和76.6%.结论 A方案痊愈率、有效率的成本-效果比均最低,不良反应较少,为最佳治疗方案.     

3种抗菌药物治疗急性支气管炎的成本-效果分析

目的 探讨3种抗菌药物治疗急性支气管炎的药物经济学情况. 方法 入选病例120例,按就诊顺序分为A、B、C组各40 例,运用药物经济学成本-效果分析法对莫西沙星片(A组)、阿奇霉素片(B组)、头孢克洛胶囊(C组)进行对比分析评价. 结果3组药物治疗方案总成本分别为19 263.20,18 690.80,19 266.80元;有效率分别为97.50%,77.50%,70.00%,差异有统计学意义(P<0.05);成本-效果比分别为197.57,241.17,275.24. 结论 成本-效果显示莫西沙星为急性支气管炎治疗最佳方案.     

胰岛素类似物与口服降糖药治疗2型糖尿病成本-效果分析

目的 比较不同药物治疗方案治疗2型糖尿病的经济效果,以利糖尿病患者用药更安全、经济、有效.方法 将259例患者随机分为3组,运用药物经济学成本-效果分析方法,比较格列吡嗪控释片联合盐酸二甲双胍片(A组)、阿卡波糖口服(B组)、注射胰岛素类似物诺和锐30(C组)3种方案治疗糖尿病的疗效、直接医疗费用和间接费用,并以最小成本分析法进行药物经济学评价.结果 A组、B组、C组总有效率分别为51.16%,62.07%,88.37%,成本-效果比分别为13.85,16.76,12.20.结论 从成本-效果分析看,C组为最佳治疗方案.     

4种给药方案治疗念珠菌性阴道炎的成本-效果分析

目的:探讨4种给药方案治疗念珠菌性阴道炎的经济学效果。方法:将182例念珠菌性阴道炎患者随机分为4组,分别给予保妇康栓(A组)、咪康唑栓+咪康唑霜(B组)、聚维酮碘软膏(C组)、裸花紫珠栓(D组) ,运用药物经济学方法进行成本-效果分析。结果:4组成本分别为56. 2元、69 .4元、75. 3元、53. 9元;有效率分别为93. 3 %、91 .3 %、91. 3 %、80 .0 % ;成本-效果比分别为0 .60、0. 76、0 .82、0 .67 ;A、B、C方案相对于D方案的增量成本-效果比分别为0 .17、1 .37、1 .89。结论:保妇康栓方案治疗念珠菌性阴道炎较佳。     

脑梗死4种药物治疗方案的成本-效果分析

目的:评价4种药物治疗方案治疗脑梗死的成本-效果。方法:231例脑梗死患者随机分为A(银杏达莫)、B(葛根素)、C(血塞通)、D(复方丹参)4组,分别观察其疗效和不良反应,并运用药物经济学成本-效果法进行分析。结果:A、B、C、D组成本分别为3 648.51、3 320.91、3 003.81、2 438.91元;有效率分别为91.67%、84.21%、86.44%、65.45%;成本-效果比(C/E)分别为39.80、39.44、34.75、37.26;A、B、C组相对于D组的增量成本-效果比(ΔC/ΔE)分别为46.13、47.01、26.91。结论:C组血塞通方案为较佳治疗方案。     

3种方案治疗小儿轮状病毒肠炎的成本-效果分析

目的:探讨3种药物治疗方案治疗小儿轮状病毒肠炎的成本-效果比率,从而指导临床合理用药。方法:采用药物经济学回顾性调查法,收集2013年9月~2015年2月之间小儿轮状病毒肠炎住院病例120例,按照使用药物的治疗方案不同分成A(热毒宁)、B(单磷酸阿糖腺苷)、C(干扰素)3组,运用药物经济学方法进行成本-效果分析。结果:3组总成本分别为1967.68元、2013.42元、1598.14元;有效率分别为84.21%、88.10%、95.00%;成本效果比分别为23.37、23.88、16.82。每治愈1例患儿的成本B组最高,C组成本最低,说明C组比其他组更有成本效率优势。结论:3种药物治疗方案治疗小儿轮状病毒肠炎,使用干扰素治疗,为最经济有效治疗方案。     

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.

     

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.     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.