浅谈医药营销中的企业伦理

与一般消费品不同,药品是一种直接关系到最终消费者生命与健康的特殊商品。在生产经营中,医药企业既要为了实现赢利的目的而积极参与残酷的市场竞争,同时又必须对消费者和社会承担起重要的责任。因而,医药企业在形成企业的营销理念以及在药品的营销过程中对“利”与“德”的取舍或偏重直接影响着企业的伦理取向以及企业的整个经营行为。本文仅就国内医药企业的营销理念及其部分营销行为的企业伦理（businessethics）作一初浅的探讨。     

Preparation and characterization of a novel strontium-containing calcium phosphate cement with the two-step hydration process

A novel Sr-containing calcium phosphate cement (CPC) with excellent compressive strength, good radiopacity and suitable setting time was developed in this work. The two-step hydration reaction resulted in a high compressive strength, with a maximum of up to 74.9 MPa. Sr was doped into the calcium-deficient hydroxyapatite as a hydrated product during the hydration reaction of the CPC. Because of the existence of Sr element and the compact microstructure after hydration, the Sr-containing CPC shows good radiopacity. It is expected to be used in orthopedic and maxillofacial surgery for bone defects repairing.     

脑出血患者预后影响因素的多因素分析

目的探讨脑出血患者早期死亡及致残的危险因素。方法回顾性收集2004年9月-2006年6月南京医科大学附属南京第一医院神经内科住院的312例急性脑出血病例,采用电话或写信等方式随访患者发病后3月的生存及残疾情况。采用Logistic回归分析对影响患者死亡及致残的27项危险因素进行单因素和多因素分析。结果脑出血患者周一周二就诊病死率及致残率较其他时间低。影响脑出血患者死亡的危险因素有年龄（P=0．012）、意识障碍（P=0．016）、入院时收缩压（P=0．018）、尿素氮（P=0．036）、低蛋白血症（P=0．000）、合并感染（P=0．000）、合并消化道出血（P=0．031）;影响脑出血患者致残的危险因素有性别（P=0．023）、年龄（P=0．000）、意识障碍（P=0．000）、合并感染（P=0．031）。结论高龄、有意识障碍、入院时收缩压高、尿素氮高、有低蛋白血症、合并感染、合并消化道出血是脑出血患者死亡的独立危险因素。性别、年龄、有意识障碍、合并感染是脑出血患者致残的独立危险因素。     

The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus

Objective

The antimalarial medication hydroxychloroquine has been proposed as a thromboprotective agent in systemic lupus erythematosus (SLE), but studies thus far have been limited by the possibility of confounding by indication. This study was conducted to assess whether exposure to antimalarial drugs is associated with a decrease in thrombovascular events (TEs) in patients with SLE.

Methods

The study was designed as a nested case–control study embedded in an inception cohort of patients with SLE, which allowed adjustments for possible confounding by calendar year, duration of disease, duration of observation, and severity of lupus. After controlling for the possible confounding variables in conditional logistic regression models, the use of antimalarial drugs was assessed for its effects on the development of TEs in lupus patients.

Results

Fifty‐four cases of TE were identified, and these were matched with 108 control subjects (lupus patients without TEs). Univariate analyses identified older age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01–1.07) or being older than age 50 years (OR 3.5, 95% CI 1.4–8.6) and ever having hypertension (OR 2.5, 95% CI 1.0–5.8) as being associated with an increased risk of TEs, whereas use of antimalarial drugs (OR 0.31, 95% CI 0.13–0.71) was associated with a decreased risk of TEs. Separate analyses were done for arterial and venous TEs, which yielded similar results. In multivariate analyses, use of antimalarial drugs (OR 0.32, 95% CI 0.14–0.74) and older age (OR 1.04, 95% CI 1.01–1.07) were the only 2 variables that remained significant.

Conclusion

The results from this nested case–control study demonstrate that, after accounting for the effects of disease severity, disease duration, and calendar year, antimalarial drugs were found to be thromboprotective, being associated with a 68% reduction in the risk of all TEs, with a range of risk reduction of at least 26% up to as high as 86%.

     

Erlotinib resistance is altered after gemcitabine chemotherapy for recurrent non-small-cell lung cancer

We report the case of a male Mongolian lifelong non-smoker with recurrent non-small-cell lung cancer (NSCLC) who developed resistance to the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor erlotinib after initially responding to this agent but then subsequently had another response to a second course of erlotinib treatment after intervening gemcitabine chemotherapy. Sixteen months after the patient received chemoradiotherapy with gemcitabine/cisplatin plus radiotherapy, his recurrent mediastinal metastases were found to have progressed. Treatment with erlotinib was followed by an initial, partial response but evidence of progression was again observed 6 months later. The patient was then treated with gemcitabine chemotherapy, which resulted in a reduction in tumour volume. One month later, progression of mediastinal metastases was again observed and the patient received a second course of erlotinib. Another partial response occurred and the patient's disease remained stable at the 9-month follow-up visit (and with no reported symptom progression at an 11-month telephone follow-up). Genetic examination of tumour tissue collected at the time of the original diagnosis and during the second course of erlotinib therapy revealed activating exon 19 mutation in the EGFR gene. This case suggests that resistance to erlotinib may change following chemotherapy and that repeat erlotinib therapy may be worth considering after chemotherapy in NSCLC patients who initially respond positively to erlotinib treatment but subsequently experience recurrence of disease.     

重症监护病房医院感染病原菌分布及耐药性分析

目的了解我院综合ICU医院感染病原菌的分布及耐药情况,为临床合理使用抗生素、预防医院感染提供依据。方法对2008年1-12月本院综合ICU病房住院患者各类标本分离出的病原菌采用相应的微生物鉴定仪及药敏试剂条检测,对致病菌耐药性进行分析。结果分离出的病原菌中G^-杆菌占47.67％,其中以鲍曼不动杆菌（21.65％）、铜绿假单胞菌（8.00％）、嗜麦芽寡单胞菌（6.33％）、肺炎克雷伯菌（4.00％）为主;G^＋球菌占9.56％,其中以金黄色葡萄球菌（5.56％）和屎肠球菌（1.44％）为主;真菌占42.78％,以白色假丝酵母（24.44％）和光滑假丝酵母（10.89％）为主。G^-杆菌耐药率整体水平较高,真菌的耐药率较低。结论应加强ICU病原菌培养及耐药率的监测,此措施对指导临床合理用药、减少多重耐药菌产生具有重大意义。     

A PAI-1 mutant, PAI-1R, slows progression of diabetic nephropathy

Plasminogen activator inhibitor-1 (PAI-1) has been implicated in renal fibrosis. In vitro, PAI-1 inhibits plasmin generation, and this decreases mesangial extracellular matrix turnover. PAI-1R, a mutant PAI-1, increases glomerular plasmin generation, reverses PAI-1 inhibition of matrix degradation, and reduces disease in experimental glomerulonephritis. This study sought to determine whether short-term administration of PAI-1R could slow the progression of glomerulosclerosis in the db/db mouse, a model of type 2 diabetes in which mesangial matrix accumulation is evident by 20 wk of age. Untreated uninephrectomized db/db mice developed progressive albuminuria and mesangial matrix expansion between weeks 20 and 22, associated with increased renal mRNA encoding alpha1(I) and (IV) collagens and fibronectin. Treatment with PAI-1R prevented these changes without affecting body weight, blood glucose, glycosylated hemoglobin, creatinine, or creatinine clearance; therefore, PAI-1R may prevent progression of glomerulosclerosis in type 2 diabetes.     

光生物调节在重症肺部感染辅助治疗中的研究进展

肺部感染是临床最常见的感染性疾病之一,其发病率和病死率逐年上升,重症肺部感染,尤其是COVID-19,给社会和家庭带来巨大的负担。因此,我们迫切需要研究和开发可用于控制肺部感染发生发展的有效抗菌抗炎策略。光生物调节（PBM）治疗主要是通过细胞内的光化学反应影响细胞代谢途径和基因表达模式,具有抗菌杀菌、消除炎症、调节免疫、促进血液循环和组织修复等作用,逐渐成为医学领域的新型治疗手段。本综述以PBM治疗的细胞和分子机制为切入点,深入探讨PBM辅助治疗肺部感染的可行性,以期为临床重症肺部感染患者寻求新的治疗策略,改善患者预后。     

Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect

Background: Right ventricular (RV) volume overload is a well‐known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long‐term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD. Methods: We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three‐dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure. Results: We found that: (1) the right ventricular end‐diastolic volume (RVEDV) and right ventricular end‐systolic volume (RVESV) (respectively 106.54±25.97 vs 69.78±10.46 mL, P < 0.05; 59.73±17.59 vs 33.84±7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%±4.51% vs 54.11%±5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61±16.49] ms vs (64.09±11.82) ms, P < 0.05; [28.04±9.57] ms vs [20.45±6.53] ms, P < 0.05) were prolonged and ejection time ([250.02±24.21] ms vs [272.73±20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41±0.07 vs 0.31±0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly. Conclusions: Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

伤筋活血合剂的研制及疗效观察

目的:研制伤筋活血合剂,观察该合剂对踝关节骨折和挠骨下端骨折的临床疗效。方法:建立该合剂的质量控制方法;将踝关节骨折和挠骨下端骨折二组病人随机分组,分别用伤筋活血合剂和相应对照药物治疗,观察疗效。结果:伤筋活血合剂制备工艺简单,质量可靠,性质稳定。在相同时间内治疗组疗效优于对照组,在 4～6周期间治疗组与对照组经统计学处理有显著性差异(P<0.05)。结论:根据中医理论的整体观念而组方制成的伤筋活血合剂,制备工艺可行,临床疗效良好。