军队医院引入医务社会工作的思考

医务社会工作在医院的日常管理和医疗服务中的功能和作用已被医疗机构和社会所认可.本文通过对医院引入医务社会工作的意义进行阐述,对在门诊部开展医务社会工作提出具体措施和发展建议.     

Analysis of endometrial microbiota by 16S ribosomal RNA gene sequencing among infertile patients: a single‐center pilot study

Purpose

The present study aimed to analyze the endometrial and vaginal microbiome among a Japanese infertile population by sequencing and the impact of the endometrial and vaginal environment on implantation.

Methods

In total, 102 infertile (79 in vitro fertilization [IVF] and 23 non‐IVF) patients and seven healthy volunteers were recruited from August to December, 2017. Endometrial fluid and vaginal discharge samples for sequencing were collected by using an intrauterine insemination catheter. The bacterial status of the endometrium and vagina were analyzed.

Results

The Lactobacillus‐dominated microbiota (>90% Lactobacillus spp.) in the endometrium vs vagina was 38% (30/79) vs 44.3% (44/79) in the IVF patients, 73.9% (17/23) vs 73.9% (17/23) in the non‐IVF patients, and 85.7% (6/7) vs 85.7% (6/7) in the healthy volunteers. The percentage of endometrial Lactobacillus in the healthy volunteers was highly stable within the same menstrual cycle and even in the following cycle. The major taxonomies were Gardnerella, Streptococcus, Atopobium, Bifidobacterium, Sneathia, Prevotella, and Staphylococcus. Fifteen patients achieved pregnancy by a single vitrified‐warmed blastocyst transfer during this study; the median percentage of Lactobacillus in the pregnant women was 96.45 ± 33.61%.

Conclusion

A considerable percentage of non‐Lactobacillus‐dominated (NLD) microbiota was found in the endometrium of Japanese infertile women. Increasing the endometrial level of the Lactobacilli to >90% might favor the implantation outcome of NLD infertile patients.     

The effect of omeprazole on the pharmacokinetics of metronidazole and hydroxymetronidazole in human plasma, saliva and gastric juice

Aims To evaluate the effect of omeprazole on the pharmacokinetics of metronidazole and hydroxymetronidazole in plasma, gastric juice and saliva following intravenous infusion or oral dosing of metronidazole. Methods Eight volunteers received single doses of metronidazole (400 mg) intravenously and orally, whilst taking placebo or omeprazole (40 mg, twice daily for 5 days) in a randomized 4-way crossover study. Metronidazole and hydroxymetronidazole concentrations in plasma, saliva and gastric juice samples were determined by h.p.l.c. Pharmacokinetic parameters for metronidazole and hydroxymetronidazole were calculated, and the significance of the mean differences in parameters between omeprazole and placebo co-administration was assessed using a two-tailed, paired t-test. Results There were no significant differences (P<0.05) in any of the plasma or saliva pharmacokinetic parameter values for metronidazole between volunteers receiving omeprazole or placebo when metronidazole was administered either as an intravenous infusion or orally. Following intravenous administration of metronidazole to the placebo group and omeprazole treated group respectively, the gastric transfer of metronidazole was significantly reduced from 15.5±10.4% to 2.6±1.0% of the dose (P=0.007; 95% CI of difference 4.8 to 21.0) with concomitant changes in the metronidazole AUC (from 77.5±18.0 μmol l⁻¹ h to 352.6±182.1 μmol l⁻¹ h; P=0.0003; 95% CI of difference 127.6 to 422.7), C_max (from 61.4±26.5 μmol l⁻¹ to 271.8±104.3 μmol l⁻¹; P=0.0001; 95% CI of difference 118.6 to 302.1). Similarly, the gastric juice AUC of hydroxymetronidazole was significantly reduced from 3.2±1.9 μmol l⁻¹ h to 1.5±0.8 μmol l⁻¹ h of the dose (P=0.0043; 95% CI of difference 0.4 to 3.0) with a concomitant change in C_max (from 5.0±2.5 μmol l⁻¹ to 3.0±1.2 μmol l⁻¹; P=0.0007; 95% CI of difference 0.7 to 3.4). Conclusions Omeprazole had little effect on the plasma and salivary pharmacokinetics of metronidazole (or its hydroxymetabolite) after intravenous or oral administration, but it did have a substantial effect on the pharmacokinetics of metronidazole and hydroxymetronidazole in gastric juice.     

Azithromycin modulates neutrophil function and circulating inflammatory mediators in healthy human subjects

Effects on human neutrophils and circulating inflammatory mediators were studied in 12 volunteers who received azithromycin (500 mg/day, p.o.) for 3 days. Blood was taken 1 h before treatment, 2.5, 24 h and 28 days after the last dose. An initial neutrophil degranulating effect of azithromycin was reflected in rapid decreases in azurophilic granule enzyme activities in cells and corresponding increases in serum. The oxidative response to a particulate stimulus was also acutely enhanced. These actions were associated with high plasma and neutrophil drug concentrations. A continuous fall in chemokine and interleukin-6 serum concentrations, within the non-pathological range, accompanied a delayed down-regulation of the oxidative burst and an increase in apoptosis of neutrophils up to 28 days after the last azithromycin dose. Neutrophils isolated from blood at this time point still contained detectable drug concentrations. Acute neutrophil stimulation could facilitate antibacterial effects of azithromycin, while delayed, potentially anti-inflammatory activity may curtail deleterious inflammation.     

Evaluation of side effects of sildenafil in group of young healthy volunteers

We evaluated the safety and side effects of sildenafil in a group of sexually active volunteers younger than 40 years under conditions without sexual stimulation. Single oral dose of 50 mg dildenafil (n = 20) or placebo (n= 20) was randomly administered to 40 sexually active volunteers with the mean age of 26.80 ± 5.29 in sildenafil group and 25.70 ± 4.95 in placebo group. All the subjects were informed about the study, but not about the medicine. The following tests were performed immediately before and 90 minutes after the administration of the medicine: resting heart rate, blood pressure, electrocardiogram, visual acuity, color vision. The subjects were also asked to describe any discomfort or difference. Mann Whitney U test was used for statistical analyses. The only statistically significant difference was between heart rates before and after the administration of the sildenafil (p = 0.02). Color vision, visual acuity tests yielded no differences. The decrease in blood pressure was not significant. The most common side effects were flushing (75% and 0%), headache (50% and 5%), dyspepsia (15% and 5%), unintentional incomplete sexual arousal (15% and 0%) and palpitation (15% and 10%) in groups of sildenafil and placebo, respectively. The only serious side effect requiring medical treatment was arthralgia on the knee in one subject. Although these side effects can be acceptable, the likelihood of these side effects needs to be made clear to potential users of this medication. This revised version was published online in June 2006 with corrections to the Cover Date.     

对健康成人志愿者进行临床试验的药物安全起始剂量估计

推荐一种确定在健康成人志愿者进行新药临床试验的最大推荐起始剂量(MRSD)的方法.将相关动物研究得到的不良反应未明显增加的最高剂量(NOAEL)用标准系数换算成人等效剂量(HED),根据科学判断,从最合适动物得到的HED除以安全系数(SF)得到MRSD.这种计算方法可用于已做动物研究的新药或新的生物制剂确定MRSD,但不包括预防性疫苗和用生理浓度的内生蛋白.     

血站全面质量管理体系建设实践及体会

随着卫生部新的《血站管理办法》、《血站质量管理规范》和《血站实验室质量管理规范》的颁布实施,对血液的采集供应及质量管理提出了严格的要求。文章就血站质量管理及无偿献血进行了探讨,并提出了一些具体的措施与对策。     

Pharmacokinetics of metadoxine for injection after repeated doses in healthy volunteers

Alcohol-induced liver disease is one of the main epidemic problems nowadays. Metadoxine is a pyridoxine-pyrrolidone carboxylate with significant scavenging property. Metadoxine is able to accelerate the elimination of alcohol from the blood and tissues, help restore the functional structure of the liver and relieve neuro-psychological disorders associated with alcohol intoxication.1-3 The purpose of the study was to assay the pharmacokinetics of domestic metadoxine after repeated doses.     

志愿者参与小学口腔健康教育课的效果评价*

目的对小学生进行口腔健康教育,对志愿者的教育效果与口腔专业教师的教育效果进行比较,为大学生志愿者参与小学口腔健康教育课提供依据。方法在珠海市金湾区随机选取3所小学,整群抽取一年级学生为研究对象,分为专业组和志愿者组,分别对他们开展口腔健康教育,并采取问卷调查方式评价健康教育效果。结果实施健康教育后,两组小学生在每天刷牙2次、睡前不吃东西等口腔卫生行为方面,差异无统计学意义(P0.05),仅在牙线使用方面专业组好于志愿者组(P0.05)。对口腔知识知晓情况,志愿者组与专业组比较差异无统计学意义(P0.05)。结论大学生志愿者对小学生开展口腔健康教育可以提高小学生的口腔健康水平,并达到与口腔专业人员宣教相同的效果,该种方式可以有效地缓解因专业人员不足导致的学校口腔健康宣教无法广泛深入开展的问题,适合在本地区推广。