硝酸酯类静脉剂型使用情况调查及合理性评价

目的 调查心血管内科使用硝酸酯类静脉剂型的情况并评价其合理性。方法 通过临床用药决策支持软件分别抽取2014年2~9月使用硝酸酯类静脉剂型的心血管内科病历;随机抽取符合条件的病历100份,根据《硝酸酯在心血管疾病中规范化应用的专家共识》及《硝酸酯类药物静脉应用建议》,对患者的适应证、静脉用药持续时间、是否与单硝酸异山梨酯缓释片联用等进行统计及合理性评价。结果 2014年2~9月,静脉单硝酸异山梨酯共计使用2 003例次;静脉硝酸异山梨酯共计使用45例次;静脉硝酸甘油共计使用1 092例次。随机抽取100份使用硝酸酯类静脉剂型的病历,79例使用单硝酸异山梨酯静脉剂型,药物选择不合理;3例使用硝酸异山梨酯静脉剂型和38例使用硝酸甘油静脉剂型,药物选择合理。82例与单硝酸异山梨酯缓释片联合使用,联合用药不合理。平均疗程分别为8.5 d和9.5 d,疗程偏长。结论 2014年2~9月,新乡医学院第一附属医院硝酸酯类静脉剂型选择品种不当;静脉剂型联合使用口服缓释剂型不合理;静脉用药疗程无依据,无评估。     

治疗心血管疾病药物使用情况的调查分析

目的 了解心血管疾病药物使用情况及其合理性.方法 随机抽取我院2013年1-5月出院病历493份,以使用26种治疗心血管口服药的病历作为调查对象,占238份,对心血管疾病患者用药情况进行调查和分析,计算药物利用指数（DUI）.结果 男性使用心血管药物的比例大;而各年龄段中,60岁以上的人使用心血管药的例数最多.使用频率较高的依次为阿司匹林、阿托伐他汀、厄贝沙坦、螺内酯、氯吡格雷.26种心血管口服药物中限定日剂量值（DDD）值较高的依次为胺碘酮、美西律、厄贝沙坦,氨氯地平、单硝酸异山梨酯、缬沙坦、辛伐他汀、氯吡格雷、阿司匹林DUI＞1,其余20种药物的DUI≤1.结论 绝大多数治疗心血管疾病的药物在临床应用上基本能做到合理用药.     

我院心血管类药物的用药分析

目的 考察及了解本院心血管类药物使用的趋势及其合理性。方法 应用回顾性调查分析，对我院2001年1月至2003年l2月347份出院病历中应用心血管类药物进行分析。结果 抽查的347份病历中，含有6类9种治疗心血管疾病药物病历有63份，占18．2％，其中内科48份，占76．2％，年龄≥6l岁，使用该类药物用药例数30例，占47．6％，硝酸异山梨酯出现例数最多，26例，占25．1％，其次是卡托普利，2l例，占20．4％，其中卡托普利的DUI≥1．0(1．07)。结论 分析结果表明男性用药频率高于女性，中老年人为心血管疾病的多发时期，9种药物在我院的临床使用基本合理，无滥用倾向。     

门诊心血管药物利用研究和处方分析

目的 :了解医师处方习惯、监测用药的合理性、发现药物使用的流行趋势。方法 :采用 WHO推荐的限定日剂量 (DDD)和药物利用指数 (DUI)作为药物利用研究单位 ,对北京安贞医院一个月门诊处方进行分析。结果 :13 43 14张门诊处方中有 63 96张使用心血管药物 ,约占 18.64 % ;2使用的 11类心血管药物有 12 0个品种 ,出现频率最高的有肠溶阿司匹林、美托洛尔、硝苯地平、烟酸生育酚酯、长效硝酸异山梨酯 ;3该 11类心血管药的使用与患者年龄有关 ;43 0种药物 DUI<1,仅 9种药 DU I稍 >1。结论 :我院医师应用心血管药物基本合理 ,有少数药物运用不当     

应用5-单硝酸异山梨酯注射剂型的合理性分析

目的:分析在心血管疾病中选择5-单硝酸异山梨酯注射剂型的合理性。方法:对某院2010年10月-2011年5月硝酸酯类药物注射剂的销售情况及心血管内科现行病历中硝酸酯类药物的使用进行分析。结果:《硝酸酯在心血管疾病中规范化应用的专家共识》提出5-单硝酸异山梨酯静脉剂型缺乏合理性,应予以摒弃;局域网查询该院5-单硝酸异山梨酯注射剂的销售量占硝酸酯类药物注射剂总销售量的47.41%;48份硝酸酯类药物适应证病历中的23份使用了5-单硝酸异山梨酯注射剂型。结论:该院5-单硝酸异山梨酯注射剂型的使用比例偏高是不合理的。临床医师和药师应认真学习《硝酸酯在心血管疾病中规范化应用的专家共识》并在临床实践中加以应用,真正发挥循证医学在心血管疾病治疗中的重要作用。     

冠心病口服治疗药物利用分析

目的：了解我院冠心病治疗药物应用情况与趋势,为合理用药提供参考.方法：采用WHO推荐的限定日剂量（DDD）和药物利用指数（DUI）及用药频度（DDDs）、用药频率（DUR）作为药物利用研究单位,分析我院出院病历中818例冠心病患者的口服治疗药物用药情况.结果：冠心病治疗药物最常用有抗血小板药、钙拮抗药、降血压药、防治心绞痛药、活血化瘀药、β受体阻断药等,使用频率居前的有肠溶阿司匹林、噻氯匹定、培哚普利、曲关他嗪、非洛地平、单硝酸异山梨酯等.多数药物的DUI接近于1,仅2种药物DUI稍＞1.结论：我院冠心病治疗药物应用基本合理.     

硝酸异山梨酯治疗慢性肺心病心衰的临床观察

目的 评价硝酸异山梨酯治疗慢性肺原性心脏病心衰的疗效。方法 将64例慢性肺心病心衰患随机分为2组,治疗组32例在常规治疗的基础上加用硝酸异山梨酯静滴（25mg qd或bid,10d为1疗程）;对照组32例为常规治疗。结果 治疗组总有效率为90．6％,对照组总有效率为62．5％。两组疗效比较差异有显意义（P＜0．01）。结论 硝酸异山梨酯治疗慢性肺心病心衰疗效确定,并且可相应减少利尿剂和洋地黄的用量而减少这些药物引起的副作用。     

硝酸酯对心肌梗塞范围、再灌注和心室重构的影响

急性心肌梗塞（AMI）患者静脉滴注硝酸酯，能明显降低病死率。据证明，硝酸酯通过有益的血流动力学效应并增加冠脉侧支血流，而缩小梗塞范围2与溶栓药相互作用。而加速或稳定再灌注；对于再灌注失败病例，则能防止有害的心室重构．301例AMI患者。除溶栓治疗外，急性期（1－3日）随机静脉滴注硝酸异山梨酯（150例）或安慰剂（151例）；亚急性期（3～42日）则随机口服单硝酸异山梨酯或安慰剂，共6周。硝酸异山梨酯滴速为，前壁AMI、收缩压＞16．7kPa（＞16．67hP7）者每小时ling，其他患者每小时0．5mg，每30分钟增加剂量1次（每次增加每…     

2003～2007年我院心血管系统药物利用分析

目的：评价我院心血管系统药物的应用现状。方法：对我院2003～2007年心血管系统药物的销售金额、用药人数、用药频度等进行回顾性分析。结果：心血管药物销售金额逐年上升,年均增长率大于所有药物销售金额年均增长率;防治心绞痛药的销售金额和用药频度（DDDs）排序均位于心血管系统药物的第1位;调节血脂及抗动脉粥样硬化药销售金额一直位于第2位;5年间用药频度排序前7位药物没有改变。结论：我院心血管药物用药较为稳定;心绞痛、高血压和高脂血症为该地区心血管系统疾病的高发病;硝苯地平、复方丹参、单硝酸异山梨酯、尼莫地平、尼群地平、硝酸异山梨酯和阿司匹林肠溶片为我院治疗心血管系统疾病的基础药物。     

2007年～2008年我院120例住院患者抗冠心病心绞痛药物使用分析

我院2007～2008年应用抗冠心病心绞痛药物的出院病历120份,对用药品种数、药物利用、联合用药情况及其合理性进行分析。结果用药例/次排序前3位为硝酸酯类,中药,钙拮抗剂类;限定日剂量数排序前3位是：曲美他嗪,硝酸甘油片,单硝酸异山梨酯;药物利用指数均≤1;用药方式以单独用药、二联用药为主。我院用药基本合理。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.