小柴胡汤联合干扰素治疗慢性乙型肝炎疗效与安全性的系统评价

目的系统评价小柴胡汤联合干扰素治疗慢性乙型肝炎与单用干扰素比较,在安全性和临床疗效方面的差异。方法计算机检索PubMed、CBMdisc、CNKI、VIP、医中誌Web,查找治疗组采用小柴胡汤联用干扰素,对照组单用干扰素治疗慢性乙型肝炎的随机对照试验(RCT)。按照Cochrane系统评价的方法,选择试验、评价质量和提取数据后,采用RevMan 5.0.24软件进行Meta分析。结果共纳入7个RCT,其方法学质量均为C级,共包括668例患者。Meta分析结果显示:与单用干扰素相比,加服小柴胡汤能够显著提高HBV-DNA阴转率[RR=1.44,95%CI(1.18,1.76),P=0.000?4]和HBeAg阴转率[RR=1.54,95%CI(1.21,1.94),P=0.000?4];治疗时间大于12周时,能显著提高ALT复常率[24周:RR=1.39,95%CI(1.17,1.66),P=0.000?2;12周:RR=1.79,95%CI(1.23,2.61),P=0.002],并能显著减少干扰素流感样症状的发生率[保肝治疗:RR=0.54,95%CI(0.40,0.73),P<0.000?1;无保肝治疗:RR=0.75,95%CI(0.59,0.95),P=0.02];小柴胡汤在ALT复常方面的疗效可能与治疗时间长短有关。结论本系统评价结果显示,小柴胡汤联合干扰素治疗慢性乙型肝炎较之单用干扰素能显著改善患者主要病毒学、血清学和生化指标,并能降低干扰素流感样症状的发生率。但鉴于本系统评价纳入研究质量均为C级且例数有限,又与日本文献报道小柴胡汤可能会增加干扰素所致间质性肺炎的结论相左,因此上述结论尚需开展更多高质量的多中心随机双盲临床试验加以验证。     

克拉生坦防治动脉瘤性蛛网膜下腔出血后脑血管痉挛的疗效及安全性的系统评价

目的系统评价克拉生坦防治动脉瘤性蛛网膜下腔出血(a SAH)后脑血管痉挛(CVS)的疗效及安全性。方法检索Pub Med数据库、中国期刊全文数据库(CNKI)、中国学术期刊数据库(万方数据库)、中国生物医学文献数据库(Sino Med)搜集关于克拉生坦防治a SAH后CVS的随机对照试验的所有文献,应用Cochrane偏倚风险评估工具进行质量评价,对符合入选标准的文献采用Rev Man5.3软件进行Meta分析。结果最终纳入4个随机对照试验,共计2 161例患者。Meta分析结果显示:(1)与对照组相比,治疗组血管痉挛的发生率低于对照组,其差异有统计学意义[RR=0.58,95%CI(0.48,0.71),P<0.000 01];治疗组血管痉挛相关的脑梗死的发生率低于对照组,其差异有统计学意义[RR=0.79,95%CI(0.63,1.00),P=0.05];治疗组血管痉挛所致的迟发性缺血性神经系统缺损(DINDs)的发生率低于对照组,其差异有统计学意义[RR=0.75,95%CI(0.62,0.91),P=0.004];治疗组因血管痉挛引起的补救性治疗的使用低于对照组,其差异有统计学意义[RR=0.79,95%CI(0.63,1.00),P=0.05];(2)与对照组相比,治疗组肺部并发症的发生率高于对照组,其差异有统计学意义[RR=1.79,95%CI(1.52,2.11),P<0.000 01];治疗组贫血的发生率高于对照组,其差异有统计学意义[RR=1.44,95%CI(1.17,1.78),P=0.000 7];治疗组低血压的发生率高于对照组,其差异有统计学意义[RR=2.42,95%CI(1.69,3.45),P<0.000 01]。结论本研究结果提示克拉生坦能够有效防治a SAH后CVS及引起的不良后果,同时会增加肺部并发症、贫血、低血压不良反应的发生。     

生长激素治疗烧伤的随机对照试验的系统评价

目的评价生长激素治疗烧伤的有效性和安全性.方法检索中国生物医学文摘数据库、MEDLINE、EMBASE和Cochrane图书馆,收集所有相关随机对照试验,对其逐个进行质量评价,并进行Meta-分析.结果纳入9个高质量研究,共治疗732例患者.①有助于烧伤创面的愈合[WMD-11.25,95%CI(-14.84,-7.66),P＜0.000 01];②有助于供皮区创面的愈合[WMD-1.87,95%CI(-2.28,-1.47),P＜0.000 01];③有助于缩短住院时间[WMD-8.10,95%CI(-10.40,-5.79),P＜0.000 01];④使用生长激素后,患者静息能量消耗有降低的趋势但尚无统计学意义[WMD-0.04,95%CI(-0.08,0.00),P=0.06];⑤生长激素会引起血糖升高[SMD 0.98,95%CI(0.54,1.42),P＜0.000 01],和血胰岛素升高[SMD 0.86,95% CI(0.43,1.30),P=0.000 1];病死率[OR 1.15,95%CI(0.15,8.53),P=0.9]和脓毒血症的发生方面无差异[OR 1.08,95% CI(0.50,2.34),P=0.8]及呼吸机需求方面无差异[OR1.51,95%CI(0.72,3.16),P=0.3].结论目前资料表明烧伤患者在监测和控制好血糖水平的条件下运用生长激素是安全、有效的.     

莫西沙星治疗支原体肺炎的Meta分析

目的系统评价莫西沙星治疗支原体肺炎的疗效和安全性。方法计算机检索Pub Med、The Cochrane Library(2014年第4期)、ISI、CBM、CNKI、VIP和Wan Fang Data等数据库,纳入莫西沙星治疗支原体肺炎的随机对照试验(RCT),检索时限均为从建库至2014年4月。由2位研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果共计16个RCT,1 401例患者。Meta分析结果显示:与红霉素或阿奇霉素比较,莫西沙星有较高的治愈率[OR=2.35,95%CI(1.76,3.15),P<0.000 01]和细菌转阴率[OR=3.74,95%CI(1.76,7.96),P=0.000 6],且退热时间较短[MD=–1.07,95%CI(–1.43,–0.71),P<0.000 01];莫西沙星与阿奇霉素联用较单用阿奇霉素有较高的治愈率[OR=1.63,95%CI(1.09,2.42),P=0.02]和细菌转阴率[OR=5.78,95%CI(2.41,13.84),P<0.000 1],且退热时间较短[MD=–0.99,95%CI(–1.52,–0.47),P=0.000 2]。莫西沙星治疗与红霉素或阿奇霉素治疗相比有较低的肝功能损伤发生率[OR=0.16,95%CI(0.04,0.72),P=0.02],而胃肠道不良反应发生率相似。结论莫西沙星较大环内酯类红霉素或阿奇霉素能更有效治疗支原体肺炎,且不良反应发生率较低。受纳入研究数量及质量限制,上述结论尚需开展更多高质量、大样本、多中心的RCT加以验证。     

布洛芬治疗早产儿动脉导管关闭有效性和安全性的Meta分析

目的系统评估布洛芬治疗早产儿动脉导管未闭(PDA)的有效性和安全性。方法计算机检索PubMed、Ovid-EMbase、The Cochrane Library(2014年11期)、CNKI、WanFang Data和VIP数据库,搜集布洛芬治疗早产儿动脉导管未闭的随机对照试验(RCT)和半随机对照试验,检索时限均为建库至2014年12月。由2名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入37个RCT,包括2 370例患者。Meta分析结果显示:与安慰剂/空白对照组相比,布洛芬组可以提高早产儿动脉导管闭合率[低体重儿:RR=1.93,95%CI(1.25,2.99),P=0.003;极低体重儿:RR=1.23,95%CI(1.02,1.48),P=0.03和超低体重儿:RR=2.86,95%CI(1.51,5.41),P=0.001],减少败血症的发生率[极低体重儿:RR=0.21,95%CI(0.07,0.64),P=0.006],且差异均有统计学意义;与吲哚美辛相比,布洛芬组可以减少血清肌酐升高发生率[低体重儿:RR=0.11,95%CI(0.04,0.37),P=0.000 2],小肠坏死性结肠炎发生率[低体重儿:RR=0.52,95%CI(0.29,0.95),P=0.03]和少尿发生率[低体重儿:RR=0.30,95%CI(0.16,0.56),P=0.000 2;极低体重儿:RR=1.40,95%CI(1.03,1.92),P=0.03],且差异均有统计学意义;与静脉注射布洛芬相比,口服布洛芬组动脉导管闭合率高于静脉注射布洛芬[低体重儿:RR=1.35,95%CI(1.12,1.62),P=0.002;极低体重儿:RR=1.42,95%CI(1.07,1.87),P=0.01],且差异有统计学意义。结论当前证据表明,与乙酰氨基酚相比,布洛芬治疗效果尚不明确,但与其他常规药物相比,布洛芬治疗早产儿动脉导管未闭有一定优势,且可明显减少不良反应。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。     

乌司他丁联合生长抑素治疗重症急性胰腺炎的系统评价

目的 系统评价乌司他丁(UTI)联合生长抑素治疗重症急性胰腺炎(SAP)的疗效和安全性.方法 计算机检索美国<医学索引>(MEDLINE)、生物医学与药理学文摘数据库(EMbase)、Cochrane 临床试验数据库、中国生物医学文献数据库(CBM)、维普(VIP)、中国期刊网全文数据库(CNKI),查找建库至2011年8月UTI联合生长抑素治疗SAP的随机对照临床试验(RCT)和半随机对照临床试验(q-RCT),文献由两位研究者按照事先制定的纳入和排除标准筛选文献,提取资料,进行方法学质量评价后,采用RevMan 5.0软件进行荟萃分析(Meta分析).结果 纳入12篇RCT和5篇q-RCT,共计1169例,其中治疗组589例,对照组580例.Meta分析结果显示:UTI联合生长抑素治疗SAP较单用生长抑素治疗能提高治愈率[评价标准A:相对危险度(RR) =1.41,95%可信区间 (95%CI)为(1.17,1.69),P=0.0003;评价标准B:RR=1.17,95%CI(1.02,1.34),P=0.03];降低病死率[RR=0.45,95%CI(0.29,0.71),P=0.0006];此外,缩短腹痛、腹胀时间[RR=-0.92,95%CI (-1.13,-0.71),P＜0.000 01]、降低中转手术率[RR=0.47,95%CI (0.28,0.80),P=0.006],但对并发症发生率无明显影响[RR= 0.70,95%CI (0.45,1.08),P=0.11].结论 本系统评价结果提示,UTI联合生长抑素治疗SAP较单用生长抑素治疗疗效显著.但由于本系统评价纳入研究的质量较低,存在偏倚的高度可能性,影响了结果的论证强度,应谨慎对待上述结论,并期待更多高质量的随机双盲对照试验以提供更高质量的证据.     

血栓通联合常规西药治疗冠心病心绞痛疗效和安全性的Meta分析

目的系统评价血栓通治疗冠心病心绞痛的疗效及安全性。方法计算机检索Cochrane图书馆临床对照试验资料库(2013年第12期)、Medline(建库至2013年10月)、EMbase(建库至2013年10月)和万方(建库至2013年10月)、维普数据库(建库至2013年10月)、中国知网(建库至2013年10月)、中国生物医学文献服务系统(建库至2013年10月)。搜集血栓通治疗冠心病心绞通的随机对照试验。按照纳入和排除标准,由3名研究者独立筛选试验、提取资料及评估方法学质量。交叉核对后应用Rev Man 5.1软件进行Meta分析。结果共纳入13个随机对照试验,共1 298例患者。Meta分析结果显示在冠心病心绞痛的临床有效性方面,血栓通联合常规西药组(血栓通组)疗效优于单纯常规西药组(对照组),差异有统计学意义[RR=1.22,95%CI(1.16,1.29),P<0.000 01],亚组分析显示血栓通组治疗稳定型心绞痛和不稳定型心绞痛疗效均优于对照组[RR=1.24,95%CI(1.12,1.37),P<0.000 1;RR=1.22,95%CI(1.15,1.29),P<0.000 01];在改善心电图表现方面,血栓通组疗效同样优于对照组,差异有统计学意义[RR=1.21,95%CI(1.13,1.29),P<0.000 01],亚组分析显示血栓通组治疗稳定型心绞痛和不稳定型心绞痛在总体改善心电图方面均优于对照组[RR=1.30,95%CI(1.11,1.51),P=0.000 8;RR=1.18,95%CI(1.10,1.28),P<0.000 1]。在不良反应发生率方面,两组差异无统计学意义[RR=4.50,95%CI(0.99,20.53),P=0.05]。结论血栓通联合常规西药在治疗冠心病心绞痛有效性和改善心电图表现方面均优于单纯常规西药治疗,且尚不能认为两组不良反应发生率有差别。但由于所纳样本量少、方法学质量偏低、存在偏倚风险,有必要开展设计合理、大样本量、多中心的临床随机对照试验以进一步验证血栓通联合常规西药治疗冠心病心绞痛的有效性及安全性。     

芦荟预防与治疗化疗性静脉炎Meta分析

[目的]系统评价芦荟在预防与治疗化疗性静脉炎中的应用价值。[方法]检索MEDLINE、EMBASE、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等文献数据库,按照系统评价PRISMA流程,运用RevMan 5.0软件进行系统评价。[结果]按标准流程筛选,本研究最终纳入10篇有关静脉炎预防的文献和6篇治疗的文献,共涉及临床病例4 725例。Meta分析结果显示:同常规方法比较,芦荟外敷处理组化疗性静脉炎总发生率较低,OR值为0.13[95%CI(0.08,0.20),P0.000 01]。进一步亚组分析显示:芦荟外敷处理组Ⅰ度、Ⅱ度、Ⅲ度化疗性静脉炎发生率OR值分别是:0.53[95%CI(0.21,1.33),P=0.18],0.10[95%CI(0.07,0.14),P0.000 01]和0.10[95%CI(0.03,0.34),P=0.000 2],提示芦荟外敷可降低各种程度静脉炎的发生;与硫酸镁处理组相比,芦荟治疗化疗性静脉炎总有效率与治愈率RR值分别为:1.29[95%CI(1.19,1.39),P0.000 01]和2.38[95%CI(1.27,4.47),P=0.007],差异均有统计学意义。[结论]芦荟外敷在化疗性静脉炎预防与治疗方面具有一定应用价值,但仍需进一步研究。     

肠内营养与肠外营养治疗重症急性胰腺炎疗效的Meta分析

目的营养支持是治疗重症急性胰腺炎(SAP)十分重要的措施之一。目前营养支持治疗的两种方式分别是肠内营养(EN)和肠外营养(PN)。本文对EN支持与PN支持分别治疗SAP的效果进行系统的评价,提供更多循证医学依据。方法根据中英文检索词通过计算机检索数据库Pub Med、万方数据知识服务平台、中国知网(CNKI),检索的时间段至2015年1月。关于EN支持治疗和PN支持治疗SAP的文献均纳入,而后对所得研究的参考文献进一步检出相关文献。对所出文献一一阅读,通过阅读其摘要或全文,根据制定的纳入/排除标准进一步筛选,对筛选出的文献中至少含有其中一种主要分析指标进行数据提取和质量评价后行统计学分析。结果共有9篇文献、450例患者符合。Meta分析结果显示:与PN组相比,EN组SAP患者病死率降低[RR=0.43、95%CI(0.23,0.78)、P=0.006],差异有统计学意义;外科手术干预率下降[RR=0.52、95%CI(0.36,0.74)、P=0.000 3],差异有统计学意义;感染及并发症的发生率降低[RR=0.56、95%CI(0.42,0.77)、P=0.000 2],差异有统计学意义;而在多器官衰竭发生率方面[RR=0.61、95%CI(0.25,1.47)、P=0.27],差异无统计学意义;在平均住院时间方面,EN组与PN组之间差异无统计学意义[WMD=0.73、95%CI(-9.23,10.69)、P=0.89]。结论早期EN支持治疗SAP患者在多器官衰竭发生率、平均住院时间方面与PN支持治疗比较差异无统计学意义,但其可降低病死率、感染与并发症的发生率及外科手术干预率,患者的预后比PN支持治疗效果好。因此,SAP患者的首选营养支持方式为早期EN支持治疗。     

艾灸治疗肩周炎疼痛的Meta分析

[目的]系统评价艾灸对肩周炎疼痛症状的影响。[方法]计算机检索Cochrane Library、PubMed、EMBase、Web of Science、CNKI、WanFang Data、VIP、CBM,检索建库至2018年2月公开发表的关于艾灸治疗肩周炎疼痛的随机对照试验。按照纳入和排除标准筛选文献,应用偏倚风险评估工具评价纳入研究的质量,提取文献数据并运用RevMan 5.3软件进行Meta分析。[结果]纳入17项研究,共1 916例病人。Meta分析结果显示:在总有效率方面,艾灸与针刺相比[RR=1.19,95%CI=(1.14,1.25),P0.000 01],与电针相比[RR=1.11,95%CI=(1.05,1.17),P0.001],与常规西医相比[RR=1.47,95%CI=(1.10,1.97),P=0.008],疗效较好,差异有统计学意义;与布洛芬缓解胶囊相比,差异无统计学意义[RR=1.13,95%CI=(0.96,1.33),P=0.15]。在视觉模拟评分(Visual Analogue Scale,VAS)方面,艾灸与针刺相比[MD=-0.90,95%CI=(-1.12,-0.68),P0.000 01],与常规西医相比[MD=-1.88,95%CI=(-2.16,-1.60),P0.000 01],疗效较好,差异有统计学意义;与电针相比[MD=-0.32,95%CI=(-0.94,0.29),P=0.31],与体外冲击波相比[MD=0.10,95%CI=(-0.10,0.30)P=0.34],差异无统计学意义;与布洛芬缓解胶囊相比,差异有统计学意义[MD=0.33,95%CI=(0.02,0.64),P=0.04]。[结论]艾灸治疗肩周炎疼痛疗效明显,但由于本次纳入研究质量偏低,以上结论仍需更多大样本、多中心、高质量的随机对照试验予以进一步验证。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."