我院2009-2010年革兰阳性菌耐药性分析与临床用药对策

目的:分析我院革兰阳性菌耐药情况,提出指导和干预临床合理使用抗生素的对策。方法:分离本院2009-2010年住院患者各类标本的非重复革兰阳性菌,采用K-B纸片扩散法测定细菌对15种抗菌药物的敏感性,用WHONET5.4软件进行数据分析,并将耐药率结果与Mohnarin监测结果比较,据此提出指导和干预临床用药的对策。结果:2年共分离革兰阳性菌1082株,除金黄色葡萄球菌对监测药物组合的耐药率明显低于Mohnarin监测结果(P<0.05)外,溶血葡萄球菌、表皮葡萄球菌对监测药物的耐药率与Mohnarin监测结果无显著性差异,葡萄球菌属已出现对喹奴普丁/达福普汀的耐药菌株,耐药率为0.35%～16.67%;肠球菌未发现对阿莫西林/克拉维酸钾不敏感菌株;链球菌属对左氧氟沙星的耐药率明显高于Mohnarin细菌耐药监测结果。结论:金黄色葡萄球菌感染可优选复方磺胺甲唑治疗;溶血葡萄球菌、木糖葡萄球菌感染则需要选择含酶抑制剂的抗菌药物,不能控制症状时可考虑选择喹奴普丁/达福普汀;表皮葡萄球菌、凝固酶阴性葡萄球菌感染可优选苯唑西林治疗;肠球菌感染使用阿莫西林/克拉维酸钾治疗;链球菌感染避免使用喹诺酮类药,优选β-内酰胺类抗生素治疗;万古霉素依然对革兰阳性菌显示了良好的抗菌活性,可以在其他药治疗无效时选用。     

Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization

Abstract

Objective: To address gaps in the literature on healthcare resource utilization (HRU) and costs among patients with schizophrenia and prior hospitalization who transition from oral risperidone or paliperidone (oral ris/pali) to once-monthly paliperidone palmitate (PP1M) in a real-world setting by comparing treatment patterns, HRU, and costs 12-months pre- and post-transition to PP1M among Veterans Health Administration (VHA) patients affected by schizophrenia who have had ≥1 hospitalization.

Methods: VHA patients with schizophrenia (aged ≥18?years) who initiated oral ris/pali, had ≥1 all-cause inpatient stay, and transitioned to PP1M from January 2015–March 2017 were included from the VHA database. The first transition date to PP1M was identified as the index date. Patients were required to have continuous health plan eligibility for 12?months pre- and post-PP1M. Outcomes were compared using the Wilcoxon signed-rank and McNemar’s test, as appropriate.

Results: The study included 319 patients (mean [SD] age?=?51.6 [4.2] years) during 12 months of baseline and follow-up. During pre-PP1M transition, 7.2% of the patients were adherent (proportion of days covered [PDC]?≥?80%) to oral ris/pali. Post-PP1M transition, 27.6% of the patients were adherent to PP1M. Comparison of HRU outcomes from the pre- to post-PP1M transition revealed significantly lower all-cause inpatient stays (3.5 vs 1.4, p?<?.0001) and shorter inpatient length of stay (43.4 vs 18.3?days, p?<?.0001). Similar trends were seen for mental health and schizophrenia-related HRU. Cost outcome comparison indicated significantly lower all-cause inpatient costs ($64,702 vs $24,147, p?<?.0001), total medical costs ($87,917 vs $56,947, p?<?.0001), and total costs ($91,181 vs $69,106, p?<?.0001). A similar trend was observed for mental health and schizophrenia-related costs.

Conclusions: Transitioning from oral ris/pali to PP1M may significantly improve HRU and provide potential cost savings in VHA patients with schizophrenia and ≥1 prior hospitalization.     

Abaloparatide in patients with mild or moderate renal impairment: results from the ACTIVE phase 3 trial

Abstract

Objective: To evaluate, post hoc, the efficacy and safety of abaloparatide by degree of renal impairment.

Methods: ACTIVE was a phase 3, 18-month, randomized, double-blind, active-comparator, placebo-controlled study of postmenopausal women with osteoporosis who received subcutaneous abaloparatide 80?µg, placebo, or open-label teriparatide 20?µg daily. Patients with serum creatinine >2.0?mg/dL or 1.5–2.0?mg/dL with an estimated glomerular filtration rate (eGFR) <37?mL/min, calculated by Cockcroft-Gault formula, were excluded.

Results: At baseline, 660 patients had eGFR ≥90?mL/min, 1276 had 60 to ?90?mL/min, and 527 had <60?mL/min. Older age and lower T-scores were associated with greater renal impairment. Among renal-function subgroups, there were no meaningful changes in bone mineral density, fracture risk reduction, or overall incidence of treatment-emergent adverse events in the active-treatment arms. Anemia, nausea, hypercalcemia, and upper-respiratory-tract infection tended to be more frequent with increasing renal impairment. Hypercalcemia measured by albumin-adjusted serum calcium occurred significantly less frequently with abaloparatide than teriparatide in patients with eGFR <60?mL/min (3.6% versus 10.9%; p?=?.008) and in the overall ACTIVE safety population (3.4% versus 6.4%; p?=?.006). Computed tomography scans in 376 patients revealed no evidence of increased renal calcification.

Conclusion: Increased exposure to abaloparatide and teriparatide in patients with renal impairment led to no meaningful differences in efficacy or safety. These results support the use of abaloparatide without dosage adjustment in patients with renal impairment, provided those with severe renal impairments are monitored for adverse events.     

2型糖尿病并发泌尿系统感染的病原菌分布与耐药性

目的分析2型糖尿病并发泌尿系统感染的病原菌分布及其耐药性,为临床合理选择抗菌药物提供依据。方法以常规方法分离病原菌, 细菌鉴定采用法国生物梅里埃公司VITEK32鉴定到种, K B纸片扩散法进行体外药敏试验;酵母样真菌的鉴定,采用柯玛嘉念珠菌显色培养基。结果共分离256株病原菌,其中革兰阴性杆菌150株（58.59％）,革兰阳性球菌71株(27.74％),酵母样真菌35株（13.67％）。检出的大肠埃希菌、肺炎克雷伯菌产ESBLs率高,分别为42.86％、37.78％;对亚胺培南、美罗培南、哌拉西林/他唑巴坦、阿米卡星、头孢西丁、头孢吡肟有较好的敏感性（耐药率0.00%～29.41%）。检出的凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌属对万古霉素、利奈唑胺、氯霉素等有较好的敏感性（耐药率0.00%～20.00%）。结论革兰阴性杆菌为2型糖尿病并发泌尿系统感染的主要病原菌,真菌感染呈上升趋势。应重视糖尿病合并泌尿系统感染时的病原学检查及药敏结果。     

铀促排药物研究——Ⅲ.2,3-二羟基-5-烷氧羰基苄基胺羧酰胺螯合剂的合成

In searching for new chelation therapy drugs against uranium intoxication, a series of N-carboxymethyl-N-(substituted carbamoylmethyl)-2, 3-dihydroxy-5-carboalkyloxybenzylamine was synthesized starting with 2, 3-dihydroxy-5-carboalkyloxybenzylamine diacetic acid. The effect on the elimination of uranium salts from animal bodies was tested. Four of them (Ⅳ_n, Ⅳ_q, Ⅳ_u and Ⅳ_v) were shown to be more effective than tiron or phosphicine in accelerating uranium excretion in rats.     

附睾内注射三羟基丙烷的抗生育作用

将THP直接注入大鼠附睾头部,对其抗生育作用进行了初步研究。于注射后14,30,60及90d分别以鼠数1:1合笼。给药组生育力明显下降,至少持续2个月,3个月后略有恢复趋势。注入THP24,44d,附睾尾部精子数骤减,甚至无精子,90d时部分鼠精子计数恢复至对照水平。放射免疫法测定血清睾酮水平与对照组比较无显著差别。组织学检查可见睾丸形态正常,但附睾头内精子明显减少,出现退行性变化。     

Prostaglandin E2 differentiates between two forms of glucose transport inhibition by lipolytic agents

Summary The inhibition of insulin-stimulated glucose transport by lipolytic agents was studied in isolated rat adipose cells. Two different mechanisms for the inhibition of glucose transport by lipolytic hormones and agents were distinguished by use of the antilipolytic agent prostaglandin E₂ (PGE₂). The inhibition of glucose transport induced by lipolytic hormones such as glucagon, catecholamines or ACTH in the presence of adenosine deaminase was antagonized by PGE₂. In contrast, inhibition of hexose transport by alkylxanthines was only partially (20–30%) attenuated by PGE₂, although the eicosanoid had antagonized cyclic AMP accumulation and stimulation of lipolysis in response to all tested lipolytic agents. The inhibition of glucose transport by IBMX was immediate, whereas the lipolytic hormones (isoprenaline and ACTH) exhibited a latency of 2–3 min. In addition, the inhibition induced by the lypolytic hormones disappeared after cooling of the cells to 22°C, at which temperature IBMX was still inhibitory. Thus, the PGE₂-sensitive component of the effect of lipolytic agents on glucose transport appears to be mediated by adenylate cyclase or its subunits N _s/N _i. The PGE₂-insensitive effect of alkylxanthines probably reflects a direct interaction of the agents with a regulatory site at the transporter or a related protein. Send offprint requests to H. J. Steinfelder at the above address     

辅酶Q_(10)口服胶囊治疗频发性室性早搏59例

本文报告辅酶Q_(10)口服胶囊用双盲对照治疗频发室性早搏59例的疗效,计有效率为88％、显效率为68％,均较安慰剂对照组为显著(p<0.01)。此外,对辅酶Q_(10)的药理及其抗心律失常的机理也作了探讨。     

苦木内酯甲治疗高血压病136例

观察了苦木内酯甲(nigakinone A)治疗高血压病136例,并设降压灵29例作双盲对照。结果治疗组总有效率为84.5％,对照组总有效率为79％。动物实验证明其降压作用部位在中枢,可能属α受体兴奋剂。用药前、后心电图、肝肾功能、血象对比证明对心、肝、肾、血象等无明显毒性损害。我们认为该药具有剂量小、毒副作用少、降压疗效显著等优点,值得扩大临床使用和研究。