Asymmetrically Substituted Poly(diitaconates) Obtained by Reversible Addition‐Fragmentation Chain Transfer (RAFT) Polymerization: Synthesis,Copolymerization Parameters,and Antimicrobial Activity

Asymmetrically substituted poly(diitaconate) copolymers are synthesized from 1‐((N‐tert‐butoxycarbonyl)‐2‐aminoethyl)‐4‐propyl diitaconate (PrIA) and different comonomers (N,N‐dimethyl‐acrylamide, DMAA; acrylic acid; or ((N‐tert‐butoxycarbonyl)‐2‐aminoethyl)methacrylate) by reversible addition–fragmentation chain transfer polymerization (RAFT). The RAFT copolymerization parameters of PrIA and DMAA are r_DMAA = 0.49 and r_PrIA = 0.17, compared to r_DMAA = 0.52 and r_PrIA = 0.54 obtained by free radical copolymerization (FRP). Thus, the RAFT process has a stronger trend to alternating polymerization than the FRP process. The polydispersity index of the RAFT copolymers is around 1.2–1.8, compared to 2.8–2.9 for the corresponding FRP copolymers. After removal of the tert‐butoxycarbonyl protective groups, antimicrobially active synthetic mimics of antimicrobial peptides are obtained. The thus activated poly(PrIA‐co‐DMAA) copolymers (repeat unit ratio 1:1) have an increasing activity against Escherichia coli and Staphylococcus aureus with increasing molar mass. The RAFT copolymers are slightly more active and less toxic than comparable FRP polymers, leading to a higher selectivity for bacteria over mammalian cells. Higher molar fractions of PrIA in poly(PrIA‐co‐DMAA) copolymers (up to 80 mol%) do not increase their antimicrobial activity; reduction of the BuIA content in poly(BuIA‐DMAA) (down to 10 mol%) leads to a loss of activity against both E. coli and S. aureus.     

The clinical pharmacology of integrase inhibitors

Introduction: Treatment of HIV infection has consistently evolved in the last three decades. A steady improvement in efficacy tolerability, safety, and practical aspects of treatment intake has made HIV infection much easier to manage over the long term, and in optimal treatment conditions the life expectancy of persons living with HIV infection now approaches the values of the general population. The last category of antiretrovirals to be fully developed for clinical use is the one of strand-transfer integrase inhibitors (INSTIs).

Areas covered: In this review, the evolution of the knowledge on INSTIs use in the clinical setting is reviewed, analyzed, and interpreted. Emphasis is placed on the properties possibly accounting for several superiority results achieved by INSTIs in non-inferiority designed comparative clinical trials, which led to their inclusion as first line options in all versions of HIV therapeutic guidelines.

Expert commentary: Some unprecedented clinical-pharmacological properties of INSTIs, such as their rapid and sustained action against HIV replication, the optimal tolerability and safety profile and a clinically proven robust genetic barrier are the main factors justifying the successful clinical use of INSTIs. Based on these unique features, novel INSTIs-based treatment modalities are being developed, including the reduction of antiretroviral regimens to two drugs only.     

定坤丹联合炔诺酮治疗月经不调的临床研究

目的探讨定坤丹联合炔诺酮治疗月经不调的临床疗效。方法选取2017年3月—2019年3月在开封市人民医院治疗的月经不调患者92例,根据用药的差别分为对照组(46例)和治疗组(46例)。对照组口服炔诺酮片,2.5mg/次,4次/d;治疗组在对照组基础上口服定坤丹,7 g/次,2次/d。两组患者均经过3个月经周期治疗。观察两组患者临床疗效,同时比较治疗前后两组患者临床症候积分、性激素水平、月经失血图(PBAC)、中华生存质量量表(Ch QOL)、高温相评分(HPS)、匹茨堡睡眠质量指数量表(PSQI)评分以及血清细胞因子水平。结果治疗后,对照组临床有效率为82.61%,显著低于治疗组的97.83%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者症候积分明显下降(P0.05),且治疗组临床症候积分明显低于对照组(P0.05)。治疗后,两组血清孕酮(P)、雌二醇(E2)水平显著升高(P0.05),黄体生成激素(LH)、促卵泡成熟激素(FSH)水平显著下降(P0.05),且治疗组E2、P、LH和FSH水平明显好于对照组(P0.05)。治疗后,两组PBAC和PSQI评分显著下降(P0.05),Ch QOL和HPS评分显著升高(P0.05),且治疗组PBAC、PSQI、Ch QOL和HPS评分明显好于对照组(P0.05)。治疗后,两组患者血清表皮生长因子(EGF)、血管内皮生长因子(VEGF)水平均明显升高(P0.05),且治疗组EGF和VEGF水平明显高于对照组(P0.05)。结论定坤丹联合炔诺酮片治疗月经不调可有效改善患者临床症状,改善机体性激素水平,提高患者睡眠和生活质量。     

Natural course of keratoacanthoma and related lesions after partial biopsy: Clinical analysis of 66 lesions

There is some confusion regarding the classification of keratoacanthoma (KA) and related lesions that have crateriform architecture. We examined the clinical courses of 66 KA lesions and related lesions after a partial biopsy to clarify the nosological concept of KA. We histopathologically classified these lesions into five types: (i) KA at various stages (53 lesions); (ii) KA‐like squamous cell carcinoma (SCC) (3 lesions); (iii) KA with malignant transformation (3 lesions); (iv) infundibular SCC (5 lesions); and (v) crateriform SCC arising from solar keratosis (2 lesions). We analyzed the clinical course in each group. The regression rate of KA was 98.1% and that of KA‐like SCC/KA with malignant transformation was 33.3%. No regression was observed in either infundibular SCC or crateriform SCC arising from solar keratosis. Thus, KA is a distinct entity that should be distinguished from other types of SCC with crateriform architecture based on the high frequency of regression. The regression rate of 33.3% in KA‐like SCC/KA with malignant transformation indicated that KA lesions with an SCC component still have the potential for regression. However, this result also indicated that KA is biologically unstable, and some KA tend to evolve into conventional SCC with a gradual loss of the capacity for the spontaneous regression. Infundibular SCC and crateriform SCC arising from solar keratosis are fundamentally different from KA, not only according to the histopathological findings but also based on the biological properties.     

浙江省临床护理教师岗位培训现状及需求的调查与分析

目的调查浙江省二级以上综合医院临床护理教师的培训现状及需求,为完善浙江省临床护理教师培训体系提供参考。方法采用自制的《浙江省临床护理教师培训现状及需求调查问卷》调查浙江省二级以上医院800名临床护理教师。结果参与调查的临床护理教师平均年龄(33.8±5.2)岁,中级职称以上占67.3%,最高学历本科以上占90.9%。临床护理教师参加培训的内容主要包括带教方法及技巧培训(38.3%)、护理质量控制及改进(25.9%)和护理管理与技巧(24.9%);培训形式以专题讲座(43.4%)、短期培训班(31.3%)为主;48.3%临床护理教师在培训前未进行个性化评估,临床护理教师认为以往的培训存在的主要问题是培训内容缺少需求分析、培训针对性不强(41.9%),培训内容随机、无系统性(32.4%)。临床护理教师希望的培训内容主要包括带教方法与技巧培训(51.6%)、护理管理与技巧(40.9%)和专科前沿知识(40.3%);临床护理教师喜欢的培训形式以到院外参观(44.5%)、短期培训班(43.3%)、专题讲座(35.4%)为主;临床护理教师选择经验交流(49.3%)、案例分析(45.6%)、情景模拟(42.0%)等能互动的培训方法。结论应建立针对性强、形式灵活、考核有效的临床护理教师培训体系,从根本上提高临床护理教师的护理教育水平。     

护理干预对心内科住院患者睡眠质量的临床效果观察

目的 探讨护理干预对心内科住院患者睡眠质量的临床效果.方法 收集心内科住院高血压患者90例,随机分为治疗组和对照组各45例,采用国际通用的匹兹堡睡眠质量指数及调查表进行评分及调查.结果 护理干预后,治疗组在主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、睡眠药物运用、日间功能障碍各项均优于对照组(P＜0.05);治疗组的收缩压与舒张压均优于对照组(P＜0.05).结论 医护人员对高血压患者进行常规药物治疗时,应注重改善患者睡眠质量,积极干预影响睡眠的危险因素.