国冢级继续医学教育项目“临床思维和临床决策”学习班报名通知（项目编号：2009-15-01-002）

临床思维和临床决策是临床工作者（医师、药师、护师、营养师、心理师、康复师和检验师）的逻辑思维能力和临床处置能力。临床思维是临床决策的前提,而临床决策则是临床思维的结果;临床思维和临床决策都以临床信息和医药知识作为基础。临床思维和临床决策是否得当,决定了临床信息的收集是否全面,分析是否得当,疾病诊断是否正确,病情判断是否适当,治疗方案是否合理,治疗监护是否充分。一句话,正确的临床思维和临床决策让病人承受必要的痛苦、承担必须的风险、     

临床治疗团队中临床药师应有的基本要素界定

目的:界定临床治疗团队中临床药师应有的基本要素。方法:考察在临床中设定临床药师制度的目的、临床治疗团队中临床药师与临床医师的不同工作范畴以及不同专业要求等,从而界定出临床治疗团队中临床药师应有的基本要素。结果与结论:我国实行临床药师制度是医院临床制度建设的重大进步,而临床治疗团队中的临床药师必须具备其应有的临床责任、临床作用、临床能力和临床效果这四大临床应有的基本要素。只有这样,临床药师才能在临床治疗团队中成为不可替代的重要组成部分。     

临床医师参与临床药师带教工作的体会与探讨

目的探讨临床医师参与培养临床药师的方法。方法结合临床医师带教5名临床药师的实践经验，探讨、总结临床药师的培养。结果通过带教临床药师医疗查房、参与病例讨论、具体病例的药物应用等，培养了临床药师的临床思维，对药物的临床应用、治疗效果以及药物的不良反应等有了具体的感性认识，取得了较好的培养效果。结论临床医师参与培养临床药师的教学实践，有利于临床药师尽快成为临床治疗团队中的一员。     

肛肠外科临床药师参与临床治疗的实践与体会

目的:交流肛肠外科临床药师深入临床参与临床治疗、提供药学服务的经验与体会。方法:将肛肠外科临床药师参与临床治疗的典型案例进行总结、分析。结果:临床药师参加危重患者的救治、为患者和临床医师提供药学服务、协助临床医师做好临床治疗工作,起到了一定的作用。结论:临床药师深入临床参与临床治疗,是新形势下医院药学服务模式的重大转变,是非常重要的。     

浅谈临床药师开展临床药学服务的途径和方法

目的探讨临床药师开展临床药学服务的途径和方法。方法查阅大量相关文献,对其进行研究整理,并结合我院临床药师开展工作的具体情况,总结出临床药师开展临床药学服务的基本途径和方法。结果临床药师可以通过参与医师查房与会诊、制定个体化给药方案、提供药学咨询服务、临床使用药物的不良反应监测、处理临床中的药品不良反应事件、撰写药历等途径和方法为临床提供药学服务。结论临床药师可为临床提供多种形式的药学服务,临床药师参与临床治疗工作,可减少药物不良反应的发生,促进合理用药。     

某专科医院不合理用药典型案例分析

目的:分析临床不合理用药的原因,为临床合理用药提供参考。方法:通过临床药师参与临床查房,发现10例不合理用药的典型案例,利用临床药师在药效学、药动学、药物相互作用、配伍禁忌、药物不良反应等方面的专业知识,分析临床不合理用药的原因,进行必要的干预。结果:临床用药中存在抗生素不合理使用、选药不当、药物配伍禁忌、药品服用时间不适当、用药疗程过长和自带药品风险等原因,及时发现、干预临床不合理用药,所提建议均被临床医生采纳。结论:临床药师参与临床查房,及时发现和干预临床不合理用药现象,可提高临床合理用药水平,保证患者临床用药的安全、有效。     

充分发挥临床药师对合理用药的监督指导作用

论述临床药师积极参与临床医疗活动的意义，提出应充分发挥临床药师在指导临床用药方案、加强临床用药管理、指导临床护士使用药物、对患者及其家属开展合理用药知识教育等方面的作用。     

我院临床药学工作现状与展望

介绍本院临床药学工作开展情况和展望。从临床药师查房、药品不良反应（事件）监测工作、药物咨询和合理用药宣传、抗菌药物合理使用监控、参与医院临床会诊、带教工作等方面,叙述了临床药学具体的工作内容。进一步开展上市药物的再评价、临床药学科研、临床中药师的培养工作。本院临床药学已经有了较好的开端,但是还要进一步努力。临床药学工作应该进一步与临床紧密结合,促进临床合理用药。     

临床药师参与1例氯氮平所致肠梗阻患者会诊的案例分析

目的探讨临床药师通过临床会诊参与临床治疗的方法和作用。方法临床药师参与1例氯氮平所致肠梗阻患者的会诊,从患者肠梗阻的原因、治疗等方面进行综合分析。结果临床药师根据分析结果协助医师合理用药,提出的会诊意见和建议得到了临床认可。结论临床药师参与临床查房和会诊,对提高临床诊疗水平及保障患者用药安全、有效、经济、合理具有极大的帮助和促进作用。     

中药临床药学几个值得探讨的问题

摘 要 目的： 探讨中药临床药学当前面临的几个重要问题。方法: 分析中药临床药学名称、与中医药理论关系、开展模式、人才培养、服务质量评价、开展中药临床药学的重要性和必要性等中药临床药学方面存在问题,提出解决方法。结果与结论: 针对中药临床药学面临的几个问题,需要从规范中药临床药学名称、正确认识并重视中药临床药学工作、加强合格中药临床药师培养、建立多层次与多元化的中药临床药学开展模式和中药临床药学服务质量评价体系等方面加强工作,推动中药临床药学工作广泛开展。     

A template of information needs for decision-making about delaying remediation on contaminated lands to protect human health

ABSTRACT

The contamination legacy of industrialization, militarization, and nuclear arms race poses current or future risks to populations and the environment. Responsible parties and regulators make decisions regarding which sites to clean up, how, how much, and when. This study aimed to provide an information needs template to evaluate and reduce risks to human health when considering whether to initiate or delay remediation. This investigation focused on four aspects of timing and prioritization: 1) management, planning and implementation, 2) source terms, pathways, and exposures, 3) risks and receptors, and 4) external drivers. Within each type, issues were identified and described. Management class included personnel, health and safety data, funding, equipment, and structural integrity. Source term included contaminant sources, pathways, initiating events, and barriers to exposure. Risk included types and exposures to workers and general public. External drivers included regulatory framework, stakeholders, Congressional mandates, and economic and social contexts. Risk may increase over time as contamination spreads, enters aquifers, and reaches receptors, and may decline as radionuclides decay, and plumes dissipate. The overall objective was to provide a template of information that is useful to managers and regulators, and might be used by the public to understand the risks and benefits of re-prioritization cleanup.     

凸阵探头实时组织弹性成像、声辐射力脉冲弹性成像与瞬时弹性成像诊断慢性乙肝相关肝纤维化程度的比较

目的 比较凸振探头实时组织弹性成像（C-RTE）、声辐射力脉冲弹性成像（ARFI）及瞬时弹性成像（TE）评 估肝纤维化的诊断效能。方法 选取167例慢性乙肝（CHB）患者,分别进行C-RTE、ARFI及TE检查及肝穿刺活检, 以病理学结果为金标准。比较病理纤维化分期之间各弹性成像肝硬度检测指标差异,分析C-RTE、ARFI及TE与病 理纤维化分期的相关性,构建受试者工作特征（ROC）曲线分析3种成像方法的诊断效能,并采用DeLong法比较不同 检测方法的曲线下面积（AUC）。结果 除C-RTE及ARFI诊断S0/S1和S3/S4之间,TE诊断S0/S1和S0/S2之间差异 无统计学意义（P＞0.05）,余各组间比较差异均有统计学意义;C-RTE、ARFI及TE与病理肝纤维化分期的相关系数 分别为 0.72、0.65、0.68（P＜0.001）;C-RTE、ARFI 及 TE 3 者诊断≥S1、≥S2、≥S3 及 S4 期的曲线下面积分别为 0.812、 0.917、0.848及0.785;0.824、0.818、0.858及0.822;0.858、0.833、0.876及0.884,最佳临界值分别为1.3、1.74、2及2.64; 5.3 kPa、7.2 kPa、8.9 kPa及19.4 kPa;1.29 m/s、1.71 m/s、1.89 m/s及2.02 m/s;且在≥S2时,C-RTE的诊断效能优于ARFI 及TE（Z分别为2.56和2.84,P＜0.01）。结论 C-RTE对各级肝纤维化具有较高的诊断价值,值得临床推广。     

狗脊的化学成分及药理作用研究进展

狗脊Cibotium barometz中主要含有挥发油类、蕨素类、芳香族类、酚酸类、黄酮类、皂苷类、糖苷类及氨基酸类成分,多年来的研究结果表明其具有多种药理作用,包括防治骨质疏松、抑制血小板聚集、止血与镇痛、抑菌、抗炎、抗风湿、保肝、抗氧化及抗癌等,极具应用前景和开发价值。对近十年来中外期刊有关狗脊的研究成果进行检索,归纳总结了从狗脊中分离并鉴定的化学成分及药理活性研究进展,为更好地利用该植物资源提供依据。     

阿维菌素研究进展与产业综述

摘要：阿维菌素是阿维链霉菌发酵产生的十六元大环内酯类抗生素,主结构与米尔贝霉素相似,用于农业害虫防治和动物 的杀虫杀螨,还具有抗病毒、抗肿瘤、抗菌、消炎和醒酒等功效。它通过抑制RNA复制酶,阻止病毒蛋白进入细胞核以及封闭 剌突蛋白等方式,阻止病毒的复制感染和传播。已经产生抗药性的分枝杆菌和金黄色葡球菌也能被阿维菌素抑制。阿维菌素世 界上年需求量为5000吨左右,基本由中国企业生产。本文回顾了阿维菌素在菌种技术、发酵技术、提取技术、制剂技术发展和 组合生物学手段在本产业中的应用,建议通过菌种筛选技术、胞壁通透性调整、途径工程指导的基因改造、发酵过程的代谢流 控制、气升式发酵罐应用及细胞融合育种来提高发酵水平,将阿维链霉菌与米贝霉素链霉菌细胞融合育种。     

新癀片抗炎镇痛作用机制的蛋白组学研究

目的分析新癀片抗炎镇痛作用机制,通过蛋白组学方法寻找其作用的蛋白靶点。方法大鼠随机分成对照组、模型组、吲哚美辛(2 mg/kg)组以及新癀片23.8、47.5、95.0 mg/kg组。给药组均ig给药10 m L/kg,对照组及模型组ig给予同体积去离子水。1次/d,连续3 d。于末次给药后30 min,除对照组外,在大鼠右后足垫部sc 1%角叉菜胶0.05 m L/只致炎。在致炎前和致炎后1、2 h,记录大鼠抬足潜伏期。剖杀大鼠取肝脏,肝组织蛋白经提取、双向电泳、染色和图谱分析,确定差异表达蛋白,进行蛋白质质谱分析。结果与模型组比较,新癀片23.8、47.5、95 mg/kg组差异表达蛋白个数依次为67、71、94,其中上调个数为10、11、33,下调个数为57、60、61;新癀片95 mg/kg组与吲哚美辛(2 mg/kg)组比较,差异表达蛋白89个,其中上调27个,下调62个。共鉴定出11个差异蛋白质。与模型组比较,新癀片组均可以抑制Shank3、ANXA5、TPI、PSMA2表达,增强PAH、LZTS1表达。结论新癀片可调节的蛋白明显增多,能够抑制多种相关炎症因子和肿瘤因子,增强抗炎因子及抑癌因子的表达,为新癀片"增效"作用机制提供重要理论依据。     

Differential modulation of catecholamines by chlorotriazine herbicides in pheochromocytoma (PC12) cells in vitro.

Epidemiological, wildlife, and laboratory studies have pointed to the possible adverse health effects of chlorotriazine herbicide (i.e. , atrazine, simazine, and cyanazine) exposure. However, the cellular mechanism(s) of action of these compounds remains unknown. Recently, it was reported by Cooper et al. (2000, Toxicol. Sci. 53, 297-307) that atrazine disrupts ovarian function by altering hypothalamic catecholamine concentrations and subsequently the regulation of luteinizing hormone (LH) and prolactin (PRL) secretion by the pituitary. In this study, we examined the effect of three chlorotriazines on catecholamine metabolism in vitro using PC12 cells. Intracellular norepinephrine (NE) and dopamine (DA) concentrations and spontaneous NE release were measured following treatment with different concentrations of atrazine, simazine (0, 12. 5, 25, 50, 100, and 200 microM) and cyanazine (0, 25, 50, 100, and 400 microM) for 6, 12, 18, 24, and 48 h. Atrazine and simazine significantly decreased intracellular DA concentration in a concentration-dependent manner. Intracellular NE concentration was also significantly decreased by 100 and 200 microM atrazine and 200 microM simazine. Similarly, there was a dose-dependent inhibition of NE release with 100 and 200 microM concentrations of both compounds. Although 100 and 400 microM cyanazine increased intracellular NE concentration, 50, 100, and 400 microM cyanazine significantly increased NE release at 24 and 36 h. In contrast, intracellular DA concentration was decreased by cyanazine, but only at 400 microM. The GABA(A)-receptor agonist, muscimol (0, 0.01, 0.1, and 1.0 microM) had no effect on either the release or on intracellular catecholamine concentrations from 6 through 24 h of treatment. Cell viability was somewhat lower in the groups exposed to 100 and 200 microM atrazine and simazine. However, the reduction in viability was significant only in the highest dose of atrazine used (200 microM) at 24 h. Cyanazine did not have an effect on the viability at any of the doses tested, and the cells were functional, even up to 48 h of exposure. These data indicate that both atrazine and simazine inhibit the cellular synthesis of DA mediated by the tyrosine hydroxylase (TH), and NE mediated by dopamine beta-hydroxylase (DbetaH), and, as a result, there is a partial or significant inhibition of NE release. Cyanazine, on the other hand, stimulated the synthesis of intracellular NE, and not DA. Thus, chlorotriazine compounds presumably act at the enzymatic steps or sites of CA biosynthesis to modulate monoaminergic activity in PC12 cells.     

A review of poisonous plants that cause reproductive failure and malformations in the ruminants of Brazil

The objective of this review is to provide a report on toxic plants causing reproductive problems in ruminants in Brazil. Aspidosperma pyrifolium causes abortion or stillbirth in goats, as well as most likely in sheep and cattle, in the semiarid regions of Northeastern Brazil. Intoxications by Ateleia glazioveana, Tetrapterys acutifolia and T. multiglandulosa result in abortion and neonatal mortality in cattle and sheep, and the same signs have been experimentally observed in goats. These three plants can also cause cardiac fibrosis and a nervous disease with spongiosis of the central nervous system. Other plants known to cause abortion include Enterolobium contortisiliquum, E. gummiferum, Stryphnodendron coriaceum, S. obovatum and S. fissuratum. These plants can also cause digestive signs and photosensitization. Abortions have been reported in animals intoxicated by nitrates and nitrites as well. Infertility, abortions and the birth of weak offspring have been reported in animals intoxicated by plants containing swainsonine, including Ipomoea spp., Turbina cordata and Sida carpinifolia. Trifolium subterraneum causes estrogenism in cattle. Mimosa tenuiflora and, most likely, M. ophthalmocentra cause malformations and embryonic mortality in goats, sheep and cattle in the semiarid regions of Northeastern Brazil.     

脂肪酶抑制剂产生菌筛选

为了开发减肥用品的微生物菌种 ,用脂肪酶活性为筛选模型分别以肉汤培养基和马铃薯培养基培养土壤分离获得 1 1个菌株LA、LB、LC、LD、LE、LF、LG、MA、MB、MC和MD ,且同时考察了各菌株发酵液对淀粉酶、蛋白酶的抑制效果 ,结果表明LC、LE、LF、LG、MC和MD对淀粉酶有抑制作用 ,其抑制率分别为3 7%、5 8%、32 %、3 2 %、70 2 %和 73 5 % ;LA、LB、LC、MB对蛋白酶有抑制效果 ,抑制率分别为 55 %、31 2 5 %、37 5 %和 2 7 3 % ;LA、LB、LC、LD、LE、LF、MC和MD对脂肪酶有抑制效果 ,抑制率分别为 79%、54 8%、2 0 9%、1 2 9%、61 3 %、80 6 %、2 4 7%和 35 1 %。菌种LF对脂肪酶有较强的抑制作用 ,对淀粉酶抑制作用较小 ,对蛋白酶没有抑制作用。初步鉴定该菌属于芽孢杆菌属 ,命名为BacillusspLF。     

Natural and synthetic polymers for wounds and burns dressing

In the last years, health care professionals faced with an increasing number of patients suffering from wounds and burns difficult to treat and heal. During the wound healing process, the dressing protects the injury and contributes to the recovery of dermal and epidermal tissues. Because their biocompatibility, biodegradability and similarity to macromolecules recognized by the human body, some natural polymers such as polysaccharides (alginates, chitin, chitosan, heparin, chondroitin), proteoglycans and proteins (collagen, gelatin, fibrin, keratin, silk fibroin, eggshell membrane) are extensively used in wounds and burns management. Obtained by electrospinning technique, some synthetic polymers like biomimetic extracellular matrix micro/nanoscale fibers based on polyglycolic acid, polylactic acid, polyacrylic acid, poly-?-caprolactone, polyvinylpyrrolidone, polyvinyl alcohol, polyethylene glycol, exhibit in vivo and in vitro wound healing properties and enhance re-epithelialization. They provide an optimal microenvironment for cell proliferation, migration and differentiation, due to their biocompatibility, biodegradability, peculiar structure and good mechanical properties. Thus, synthetic polymers are used also in regenerative medicine for cartilage, bone, vascular, nerve and ligament repair and restoration. Biocompatible with fibroblasts and keratinocytes, tissue engineered skin is indicated for regeneration and remodeling of human epidermis and wound healing improving the treatment of severe skin defects or partial-thickness burn injuries.