地高辛中毒118例血药浓度相关因素及临床表现分析

目的研究地高辛血药浓度(CDGX)>2.4ng·ml     

我院治疗药物监测的开展与结果分析

目的：通过对我院2000年91例治疗药物检测的结果分析，统计检测结果的合格率情况，以期对其它医院提供参考。方法：对我院现开展的氨茶碱，地高辛等检测项目的结果用百分数和平均浓度进行统计，结果：氨茶碱在正常范围的百分数为25．0％，地高辛为50％，结论：我院现开展的治疗药物检测结果不在治疗范围内的所占比例较大。     

认知心理治疗2型糖尿病的应用研究

[目的]从完善心理防御机制入手,采用认知心理治疗的合理情绪疗法联合药物治疗,以降低、稳定2型糖尿病(2TDM)患者血糖。[方法]本着自愿保密的原则,对36例经过口服葡萄糖耐量实验(OGTT)检查确诊的,符合1999年世界卫生组织(WHO)糖尿病诊断标准的2TDM患者,进行为期3个月的心理治疗观察。治疗前后选用一般健康问卷-28(GHQ-28)、防御方式问卷(DSQ)、状态-特质焦虑问卷(STAI-Formy),3个自陈量表对每例入组患者进行心理测试并进行糖化血红蛋白(HbA_1C)测定。测试、化验结果进行统计学分析。[结果]治疗后患者能够频繁使用成熟防御方式,降低了焦虑,减少了不成熟防御方式的使用,HbA1C下降较明显。[结论]证明了防御方式的改变和完善对2TDM患者缓解焦虑情绪、稳定血糖有作用。     

Multi-center analytical evaluation of a novel automated tacrolimus immunoassay

Background

Tacrolimus (TAC) is a post-transplantation immunosuppressant drug used in patients for whom careful monitoring of TAC concentration is essential. A new semi-automated immunoassay for TAC measurement, the Elecsys Tacrolimus assay, is available and has been assessed in a multi-center evaluation.

Methods

Residual whole blood samples from patients undergoing TAC therapy after organ transplant were used in assay evaluation at five clinical laboratories in Europe. Experiments included imprecision according to CLSI EP5-A2 (within-run and intermediate), functional sensitivity, linearity according to CLSI EP6-A, and recovery from external quality assessment scheme (EQAS) samples. The assay was compared to LC–MS/MS used routinely at each investigational site, and to the Abbott Architect immunoassay.

Results

Linearity from 0.5 to 40 μg/L was observed and functional sensitivity of 0.3 μg/L (CV ≤ 20%) was determined. Within-run imprecision was ≤ 5.1% on cobas e 602 (5.1% at 1.5 μg/L) and ≤ 8.9% (8.9% at 0.8 μg/L) on cobas e 411. The intermediate imprecision for TAC concentrations ≥ 6.8 μg/L was ≤ 6.5%. At lower therapeutic concentrations (to 1.5 μg/L) it was consistently ≤ 10%. Deming regression analysis of method comparison to LC–MS/MS yielded slopes of 1.07 (95%CI: 1.05/1.10) for heart transplant samples, 1.13 (95%CI: 1.09/1.16) for kidney, and 1.05 (95%CI: 1.02/1.08) for lung transplant samples.

Conclusions

The Elecsys Tacrolimus assay has good linearity, functional sensitivity and intermediate imprecision and is comparable to LC–MS/MS methods. The over-all performance of ECLIA demonstrates a modern generation TAC assay that meets the demands of monitoring drug concentrations in current immunosuppressive regimens.     

TEP à la fluoroéthyltyrosine (18F) pour la détection des tumeurs cérébrales

PET with fluoroethylthyrosine (FET), amino-acid analogue, has been performed in Germany since the beginning of the decade for molecular and metabolic imaging of brain tumours, since FDG, the glucose analogue which is the reference tracer for clinical PET, has this drawback to be taken-up intensely by cerebral cortex. We report on our preliminary results on the comparison of PET/CT with FET and FDG in 10 evaluable patients presenting with a brain lesion either at diagnosis or after treatment. In an attempt to optimise specificity, FET PET/CT has been acquired as a static image 1 h after injection, while the most current practice is a dynamic 40 min acquisition starting at FET injection. With our acquisition protocol, diagnostic performance of FET was 88% sensitivity and 80% accuracy vs13% and 30% respectively for FDG.ConclusionFET is a radiopharmaceutical with clinical usefulness for the diagnosis, delineation and monitoring of brain tumours. Association with FDG allows identification of high-grade lesions or components, but it could be avoided providing that acquisition and quantification procedures of FET PET/CT would have been better optimised and standardised.     

Imagerie TDM et IRM de l’angiogenèse tumorale

Angiogenesis is the process of activating dormant endothelial cells to form new vessels, after stimulation and it is essential in tumor growth. In many types of cancer, angiogenesis results from the activation of oncogenes that stimulate the production of Vascular Endothelial Growth Factor (VEGF). However, these newly formed vessels have a great number of abnormalities: increased density of fragile and hyperpermeable microvessels, arterial-venous shunts, caliber abnormalities and flow instabilities susceptible to flow direction inversion according to interstitial pressure. Anti-angiogenic treatments inhibit VEGF activity, perceived as structural and functional normalization of the microvascular pattern, such as reduced density of microvessels and restored morphology of the remaining ones. Conventional imaging techniques are not sensible to these changes, at best they show tumor size stabilization, hence the need of new techniques. Microvascularization imaging can be achieved by detecting functional disturbances to blood flow and not by showing the microvasculature per se. These techniques are based in quantifying the enhancement in tumor due to the passage of contrast agent after injection or protons labeled by a magnetic field. Through these measurements, one can derive interstitial and blood volumes as well as the tissue perfusion and capillary wall permeability. Microvascular imaging has greatly benefited from the improvements seen in CT and MRI equipments allowing large volume coverage with high spatial and temporal resolutions as from the evolutions in the methods to calculate, present and compare maps of the microcirculation and it’s heterogeneity. However, softwares to analyze microvascularization are still rare, limiting the technique’s application and validation in large scale. Nevertheless, imaging of the microcirculation is useful throughout the care of the oncological patient: it can reinforce the suspicious nature of a lesion, suggest anti-angiogenic treatment efficacy in hypervascular lesions, and show early treatment response before morphological changes as in RECIST criteria.     

Therapeutic drug monitoring of psychotropic medications

Therapeutic drug monitoring (TDM) of a number of psychotropic medications has proven to be of value, enabling minimization of the limitations of considerable genetic variability in their metabolism and the high rates of poor compliance with many psychiatric disorders. Therapeutic ranges have been established for lithium, some of the tricyclic antidepressants, and clozapine. TDM has also been shown to be useful in avoiding toxicity (as many psychotropics have narrow therapeutic indices), particularly that due to interactions with other compounds.     

数据挖掘技术及其在医院药学中的应用

目的探讨数据挖掘技术在医学药学中的应用。方法在分析数据挖掘技术的基础上,将此技术应用于医院药学领域,从HIS中发掘新的或有用的知识。结果数据挖掘技术可应用于医院药学许多领域:(1)医院药房智能备药系统的建立;(2)制剂最佳批生产量的预测;(3)在医院治疗药物监测中的应用;(4)医保病人恶意配药在线检测等等。结论数据挖掘技术作为一门新兴技术,可从大量的数据中提取出隐含的、以前不为人知、可信而有效的信息与知识,其在医院药学领域中具有广阔的应用前景。     

高效液相色谱法测定环孢素A的全血浓度

目的　建立的全血中环孢素A的HPLC测定法。方法　全血经多步处理后采用C18柱 ( 15 0mm× 4 6mm ,10 μm)分离 ;流动相为甲醇 水 ( 80∶2 0 ) ;流量为 1 0ml/min ;检测波长为 2 14nm ;柱温为 6 5℃ ;环孢素D为内标。结果　全血中杂质不干扰样品的测定 ,标准曲线线性关系良好 (r=0 998) ;最低可定量浓度为 5 0ng/ml;高、中、低 3种浓度的日间和日内变异均小于10 0 % ;相对回收率在 95 9～ 10 5 1% ;符合药物生物样品分析要求。     

拟合药动学参数的药学监护软件编制

目的:研制可供医药工作者参考的药学监护软件(Pharmaceutic care software,PCS),以期提供合理的药物治疗方案.方法:用Visual Basic 6.0 开发PCS程序,对血药浓度监测数据进行处理,用最大似然法拟合药动学参数,优化个体给药方案.结果:PCS可根据病人基本情况,推荐可供选择的药物治疗方案.结论:PCS软件将药学信息和计算机软件有机地结合起来,能提供更接近临床需要的药物治疗方案.