炎性肠病药物治疗的循证医学研究进展

目的:从循证医学的角度解析炎性肠病药物治疗的相关进展。旨在提高对临床证据的认知,帮助临床医生评估新的治疗,从批判的视角重新看待以往的治疗。方法:收集国外近期相关文献进行评价。结果及结论:炎性肠病(IBD)的发病机制尚不清楚,众多的治疗方案可供选择。因此,循证医学研究结果有非常重要的临床指导意义。IBD的研究方面取得了可喜的进步。但是,有关CD活动指数(CDAI)和临床分型系统仍有待于改进。通过循证医学的研究证据有望确定安全和易于耐受的药物,并能发现目前诊治方面存在的缺陷和问题,更好地解决患者的病痛。     

耐药对肺结核病治疗效果的影响

目的 评价耐药对地区肺结核病治疗效果的影响.方法 对上海地区2004年2月-9月新登记敏感及耐药肺结核病人1年治疗转归进行分析和比较.结果 在全市各区（县）结核病定点医院新登记1 597例肺结核病病人中,805例培养阳性,其中731例经菌型鉴定为结核分枝杆菌的病人纳入分析.731例病人的总耐药率为18.7%,耐多药率为6.7%.敏感组治疗成功率达到93.0%,非MDR的耐药病人治疗成功率达到85%以上,MDR组治疗成功率为71.4%.经x2检验,差别有统计学意义（x2=83.996 8,P＜0.01）.在68例治疗不成功的病人中,耐药病人占38.2%;而在30例治疗失败的病人中,耐药病人占60%.复治敏感病人的治疗成功率（92.0%）与初治敏感病人（93.1%）相当,但是复治耐药病人的治疗成功率远低于初治耐药病人.结论 （1）上海地区肺结核病病人治疗管理效果良好;（2）耐药是肺结核病治疗失败的重要因素,应加强和改进对耐药结核病的治疗措施;（3）耐药和敏感病人治疗效果存在较大差异,应分别评价.     

同步放化疗治疗中晚期食管癌60例

目的 观察对中晚期食管癌患者同步放化疗,疗效及毒副作用.方法 中晚期食管癌120例,随机分放化疗组60例(简称放化组)和单纯放疗组60例(简称单放组).放疗采用常规分割,DT40 Gy后缩小照射野,避开脊髓斜野照射,加量DT20～30 Gy,6～7周完成.放化组放疗1、4周后应用顺铂(DDP)20 mg/d、亚叶酸钙(CF)0.1 g/d,CF静脉滴注1/2量时5-氟尿嘧啶(5-Fu)500 mg/d静脉滴注,连续5 d为1个周期,化疗当天进行放疗.结果 放化组与单放组1、2、3年生存率分别为67%、46%、34%和52%、38%、24%;放射性肺炎分别为14例和12例;外周血细胞下降分别为26例和17例;胃肠道反应分别为25例和9例;死亡分别为38例和48例.两组治疗效果比较差异有统计学意义(P＜0.05).结论 放疗同步PLF方案化疗治疗中晚期食管癌生存率高,毒副作用及不良反应低.     

Selective coating of cylindrical matrices with a central hole. I. An interpretation of the swelling process

Cylindrical matrices were prepared by compression either of polyvinyl alcohol 100000 or mixtures of the excipient and a drug (sodium salicylate or theophylline). To modify the cylindrical shape, a hole was bored in the centre of the flat surface through both sides of the matrices. Different swellable systems were obtained applying an impermeable coating to one, two or three surfaces of the perforated matrices. The swelling of the perforated matrices was modified according to the number and the position of the coated surfaces (selective coating) and the loaded drug. Pseudo-zero order kinetics were obtained when the interior hole was the only uncoated surface.     

Drug Education: Supporting Parents to Support Children

Such research evidence as exists on effective drug strategies in prevention and education draws attention to the importance of involving parents along with other community agencies and school governors. Much depends nevertheless on the way in which 'involvement' is interpreted and the assumptions that are made about parents' knowledge of drugs and drug education as well as their attitudes to drug issues. As the age of initial experimentation and contact with drugs continues to fall, the importance of enskilling parents to support drug education programmes for 5 year olds and upwards continues to rise. This paper reports the first wide ranging survey of parents' knowledge of drugs and drug issues across an entire English county embracing younger as well as older children. The need for more coordinated, informed and systematic guidance to parents is established.     

The Problem of Intractability: The Continuing Need for New Medical Therapies in Epilepsy

Summary: Treatment of epilepsy, one of the most common neurologic disorders, has evolved from "institutional" poly-therapy to "dogmatic" monotherapy, and, most recently, to "rational" polypharmacy. The introduction of bromides for the treatment of epilepsy was followed first by phenobarbital and then by phenytoin as therapeutic options. Although attempts to combine medications were legion, none was supported by studies that demonstrated the benefit of such combinations. The issue of adverse effects became a principal argument in favor of monotherapy. Monotherapy, using newly developed drugs, avoided problems due to drug interactions but was ineffective in 20–30% of patients. A greater understanding of basic disease mechanisms and developments in molecular biology have led to an increased number of effective drugs for the estimated 6–12% of patients with epilepsy whose condition is intractable. Clinical research continues to build on the work of basic scientists in attempting to develop treatments based on a desire to move beyond the palliative and to affect the causative mechanisms of the disease. Novel medical approaches now under exploration include the use of drugs with complementary mechanisms of action, stimulation of various components of the nervous system, biochemical manipulations, focal intracerebral drug perfusion, and gene therapy.     

Pharmacological interactions between serotonin and dopamine on behavior in the squirrel monkey

 The behavioral effects of GBR 12909, a selective dopamine uptake inhibitor, were determined in squirrel monkeys trained to respond under a fixed-interval (FI) schedule of stimulus termination and a second-order schedule of IV drug self-administration. Intermediate doses of GBR 12909 increased FI response rate markedly, and the highest dose decreased response rate below control values. The 5HT uptake inhibitors, alaproclate and fluoxetine, and the 5HT agonist, quipazine, attenuated the behavioral-stimulant effects of GBR 12909, whereas the 5HT_2A/2C antagonist, ritanserin, enhanced the behavioral-stimulant effects of the lowest dose. GBR 12909 reliably maintained self-administration, and ritanserin increased response rate maintained by the highest dose. The dopamine agonist, quinpirole, increased FI response rate in only one of three subjects, and ritanserin enhanced the behavioral-stimulant effects of quinpirole in that subject. The dopamine agonist, apomorphine, only decreased FI response rate, and ritanserin did not alter its behavioral effects. The pharmacological profile of GBR 12909 administered alone and in combination with selective 5HT drugs in the present study was similar to that obtained previously with cocaine, further demonstrating that 5HT can reliably modulate the behavioral effects of psychomotor stimulants with prominent dopaminergic actions. Received: 9 July 1996 / Final version: 22 November 1996     

Neuropharmacology and Drug Interactions in Clinical Practice

Summary: Absorption, distribution, and clearance are key pharmacokinetic principles. These parameters can be highly variable among patients and among compounds, and are factors that must be considered in the wide variability in response to medications. Current antiepileptic drugs (AEDs) present many challenges in their administration. However, understanding and utilizing pharmacokinetic principles can assist the clinician in the appropriate optimization of AEds.     

Drug related hospital admissions

Summary As part of a high-intensity monitoring study of drug events as the cause of admission to departments of internal medicine, the effect of an educational intervention programme was studied. Two departments were included, one specialising in geriatrics and one that received patients by non-selected referral. The series consisted of 607 consecutive admissions studied before and 703 after the intervention. The drug events considered were adverse drug reactions and dose-related therapeutic failures, mainly due to non-compliance.A modest, statistically non-significant decrease in drug related hospital admissions (DRH) was seen, from 14% before to 13% after the intervention period. However, DRHs classified as definitely avoidable showed the significant decrease of 83%.There was no apparent relationship between the topics selected for the intervention programme and changes in the pattern of DRHs. No relationship between alterations in sales data and hospital admissions caused by a given drug could be demonstrated. A blinded external evaluation of case abstracts did not disclose any significant shift in the investigators' assessments.The intervention may have had an non-specific effect on avoidable DRHs.     

Two genes for chloramphenicol resistance common to Staphylococci and streptococci

Southern blot hybridization and pneumococcal transformation were used to study the epidemiology at a molecular level of the genes for chloramphenicol resistance (cat) in streptococci and staphylococci. The cat gene of staphylococcal plasmid pC194 showed homology to the cat genes of the chromosomal elements of 5 different strains of Streptococcus pneumoniae and of Streptococcus agalactiae B109. DNA sequence homology was also detected between the cat gene of staphylococcal plasmid pC221 and the cat gene of broad host range conjugative plasmid pIP501, originally isolated from S. agalactiae. Two different cat genes appear to be present in clinical isolates of both streptococci and staphylococci.