医院药品成本控制系统方法与实践

目的 探讨系统控制医院药品成本的有效方法。方法 在系统分析药品成本的基础上,通过实施药品集中供应改革和组合措施控制药品成本。结果 医院药品采购成本降低25%,药品综合成本有效降低。结论 降低药品成本需要创新方法,树立全员成本意识,贯穿于药品管理的全过程。     

Evaluation of Potential Exposure to Metals in Laundered Shop Towels

We reported in 2003 that exposure to metals on laundered shop towels (LSTs) could exceed toxicity criteria. New data from LSTs used by workers in North America document the continued presence of metals in freshly laundered towels. We assessed potential exposure to metals based on concentrations of metals on the LSTs, estimates of LST usage by employees, and the transfer of metals from LST-to-hand, hand-to-mouth, and LST-to-lip, under average- or high-exposure scenarios. Exposure estimates were compared to toxicity criteria. Under an average-exposure scenario (excluding metals’ data outliers), exceedances of the California Environmental Protection Agency, U.S. Environmental Protection Agency, and the Agency for Toxic Substances and Disease Registry toxicity criteria may occur for aluminum, cadmium, cobalt, copper, iron, and lead. Calculated intakes for these metals were up to more than 400-fold higher (lead) than their respective toxicity criterion. For the high-exposure scenario, additional exceedances may occur, and high-exposure intakes were up to 1,170-fold higher (lead) than their respective toxicity criterion. A sensitivity analysis indicated that alternate plausible assumptions could increase or decrease the magnitude of exceedances, but were unlikely to eliminate certain exceedances, particularly for lead.     

Successful Control of Lymphatic Filariasis in the Republic of Korea

A successful experience of lymphatic filariasis control in the Republic of Korea is briefly reviewed. Filariasis in the Republic of Korea was exclusively caused by infection with Brugia malayi. Over the past several decades from the 1950s to 2006, many investigators exerted their efforts to detection, treatment, and follow-up of filariasis patients in endemic areas, and to control filariasis. Mass, combined with selective, treatments with diethylcarbamazine to microfilaria positive persons had been made them free from microfilaremia and contributed to significant decrease of the microfilarial density in previously endemic areas. Significant decrease of microfilaria positive cases in an area influenced eventually to the endemicity of filariasis in the relevant locality. Together with remarkable economic growth followed by improvement of environmental and personal hygiene and living standards, the factors stated above have contributed to blocking the transmission cycle of B. malayi and led to disappearance of this mosquito-borne ancient disease in the Republic of Korea.     

Large Extracellular Loop of Tetraspanin as a Potential Vaccine Candidate for Filariasis

Lymphatic filariasis affects nearly 120 million people worldwide and mass preventive chemotherapy is currently used as a strategy to control this infection. This has substantially reduced the incidence of the infection in several parts of the world. However, a prophylactic vaccine would be more effective in preventing future infections and will supplement the mass chemotherapy efforts. Unfortunately, there is no licensed vaccine available currently to prevent this infection. Molecules expressed on the surface of the parasite are potential candidates for vaccine development as they are exposed to the host immune system. In this study we show that the large extracellular loop of tetraspanin (TSP LEL), a protein expressed on the cuticle of Brugia malayi and Wuchereria bancrofti is a potential vaccine candidate. Our results showed that BmTSP LEL is expressed on the surface of B. malayi infective third stage larvae (L3) and sera from human subjects who are putatively immune to lymphatic filariasis carry high titer of IgG1 and IgG3 antibodies against BmTSP LEL and WbTSP LEL. We also showed that these antibodies in the sera of human subjects can participate in the killing of B. malayi L3 in an antibody dependent cell-mediated cytotoxicity mechanism. Vaccination trials in mice showed that close to 64% protection were achieved against challenge infections with B. malayi L3. Immunized animals showed high titer of anti-WbTSP LEL IgG1, IgG2a and IgG2b antibodies in the sera and IFN-γ secreting cells in the spleen. Onchocerca volvulus another filarial parasite also expresses TSP LEL. Cross-reactivity studies showed that IgG1 antibody in the sera of endemic normal subjects, recognize OvTSP LEL. Similarly, anti-OvTSP LEL antibodies in the sera of subjects who are immune to O. volvulus were also shown to cross-react with rWbTSP LEL and rBmTSP LEL. These findings thus suggested that rTSP LEL can be developed as a potential vaccine candidate against multiple filarial infections.     

三嵌段聚合物在药物制剂中的应用研究进展

三嵌段聚合物系由2 种或2 种以上不同化合物通过聚合反应而合成的一种新型多功能两亲性载体材料,在水溶液中呈现优良的自组装性能。其用作药物载体时,可依据需求,通过改变其组成和结构而使其拥有温度敏感、pH 敏感、磁敏感等多种特性,将其制成适宜剂型,能达到改善药物的溶解性等理化性质以及靶向性、缓控释性和生物利用度的目的,其在药物制剂领域具有广阔的应用前景。简介各种类型的三嵌段聚合物,着重概述近年来三嵌段聚合物在不同制剂剂型中的应用研究。     

Screening Mosquito House Entry Points as a Potential Method for Integrated Control of Endophagic Filariasis,Arbovirus and Malaria Vectors

Background

Partial mosquito-proofing of houses with screens and ceilings has the potential to reduce indoor densities of malaria mosquitoes. We wish to measure whether it will also reduce indoor densities of vectors of neglected tropical diseases.

Methodology

The main house entry points preferred by anopheline and culicine vectors were determined through controlled experiments using specially designed experimental huts and village houses in Lupiro village, southern Tanzania. The benefit of screening different entry points (eaves, windows and doors) using PVC-coated fibre glass netting material in terms of reduced indoor densities of mosquitoes was evaluated compared to the control.

Findings

23,027 mosquitoes were caught with CDC light traps; 77.9% (17,929) were Anopheles gambiae sensu lato, of which 66.2% were An. arabiensis and 33.8% An. gambiae sensu stricto. The remainder comprised 0.2% (50) An. funestus, 10.2% (2359) Culex spp. and 11.6% (2664) Mansonia spp. Screening eaves reduced densities of Anopheles gambiae s. l. (Relative ratio (RR)  = 0.91; 95% CI = 0.84, 0.98; P = 0.01); Mansonia africana (RR = 0.43; 95% CI = 0.26, 0.76; P<0.001) and Mansonia uniformis (RR = 0.37; 95% CI = 0.25, 0.56; P<0.001) but not Culex quinquefasciatus, Cx. univittatus or Cx. theileri. Numbers of these species were reduced by screening windows and doors but this was not significant.

Significance

This study confirms that across Africa, screening eaves protects households against important mosquito vectors of filariasis, Rift Valley Fever and O''Nyong nyong as well as malaria. While full house screening is required to exclude Culex species mosquitoes, screening of eaves alone or fitting ceilings has considerable potential for integrated control of other vectors of filariasis, arbovirus and malaria.     

不同类型稻种资源对稗草化感潜力差异评价

以120份不同类型稻种资源为研究对象,将田间鉴定和室内叶浸提液处理鉴定方法相结合,对其化感作用差异进行了鉴定评价.结果表明,在田间不同类型稻种资源对稗草生长的抑制效果大小趋势为地方品种＞选育品种(系)＞引进品种(系)＞杂交水稻(恢复系和不育系),对稗草苗鲜重和苗干重的抑制效果大于对苗高的抑制效果.室内叶浸提液处理鉴定结果,不同类型稻种资源间化感作用差异相对较小,但仍以地方品种较强,并对稗草根长的抑制效果大于对稗草苗高的抑制效果.地方品种中具有较强化感作用的种质资源频率高于其他类型品种,今后要加强对地方品种资源的化感潜力鉴定和评价.     

Evaluation of Bacillus subtilis for Potential Control of Apple Replant Disease

Apple seedlings (ev. Melntosh were stunted when grown in pasteurized field soil to which four fungi, previously isolated from apple replant disease (ARD) soil, were added. Twenty-one isolates of Bacillus sulnths produced inhibition zones in vitro against 20 ARD fungi. Isolate BACT-1 ol B. subtilis showed significant antagonism against 17 fungi isolated from ARD soil on potato dexirose agar and apple plant height was increased in its presence in pesteurized and fertilized soil in glasshouse pot tests. Plant height also increased in the presence of isolate F.BW-4 of B.subtilis.in pasteurized and fertilized soil in glasshouse pot tests but EBW-4 liid not show antagonism against most of the ARD tungi in vitro. The growth of apple seedlings was stunted in the presence of 12 isolates of B. subtilis. However, fertilization of non pasteurized soil with NPK 1l-55-0 reversed the stunting effect. Under field conditions, BACT-1 and EBW-4 isolates. led to increased shoot growth in unfertilized and unppasteurized ARD soil.     

非离子表面活性剂HS 15在药剂中的研究进展

Kolliphor® HS 15（HS 15）是一种新型注射用增溶剂,具有强大的增溶能力和优良的安全性,可用于提高药物的溶解度、促 进吸收以及增加生物利用度。综述HS 15 在制剂中的应用、临床研究和基础研究进展,为其在药剂中的应用研究提供参考。     

Care Wounds: Precarious Vulnerability and the Potential of Exposure

What does it mean to offer care when the act of caring is wounding to its giver? For peer specialists—individuals with lived experience as patients in the psychiatric system—this question shapes how they use their own histories to provide support for individuals experiencing psychiatric crisis. Peer support is unique in the way it draws on empathetic resonance and depends on carefully deployed vulnerability; where one connects with others through the recognition of shared experience and mutual hurt. For peers, care works when this guidance, reassurance, and "being with"—all of which draw upon their own stories of traumatic history and variegated suffering—mitigate the present crisis being experienced by another. Drawing on twenty-eight months of fieldwork with a peer-staffed crisis respite center in the eastern United States, I argue that the peer specialist becomes the embodiment of a novel intersection of intimacy and compensation; one that poses vulnerability not as a consequence, casualty, or risk factor in the commodification of care, but as its principle vector of resonance and the assumption on which it is based. For peers, care that works—in that it creates a mutual resonance for the recipient—becomes simultaneously care that wounds its giver.     

Pharmaceutical Contaminants in Potable Water: Potential Concerns for Pregnant Women and Children

There has been increasing concern of late over measurable levels of pharmaceutical contaminants in drinking water. Because most data on water contaminants pertains to aquatic organisms, we wished to assess the risk of these contaminants to human health at currently reported levels. Unlike most other chemicals, there are large amounts of information for the effects of most pharmaceuticals to humans and the current model uses the clinical dose required to cause biological effects as an endpoint to assess risks for pregnant women, children, and the healthy adult population. Twenty-six drugs have been detected in water systems worldwide: 7 in drinking water, 16 in ground water and post-treatment effluent, and 3 in both. Current water treatment practices, clearly, do not always remove pharmaceutical residues. Although healthy adults are unlikely to be adversely affected at the levels of exposure reported, children were shown to have up to eightfold higher risk and may be exposed to several drugs that are contraindicated or not established for safe use in pediatric medicine. The time taken to ingest a single clinically used dose was 3.4–34,000 years. In addition, pregnant women may be exposed to several drugs that are teratogenic (range of % single doses ingested over 36 weeks was 0.0006–12.6%) and in the post-natal period to drugs that are not recommended during breastfeeding. Albeit at low levels, the exposure of pregnant women and children to contraindicated drugs through drinking water is of concern. Further research in this area should focus on integrated ecological and human health consequences of long-term, low-level exposure to pharmaceutical contaminants, particularly in pregnancy and childhood.     

Effect of Variability in Pharmacokinetic Parameters on the Derivation of Exposure Limits for Pharmaceutical Compounds

The purpose of this study was to investigate how variability in pharmacokinetic parameters influences the determination of occupational exposure limits (OEL) for pharmaceutical compounds in potentially susceptible subpopulations. A compartmental pharmacokinetic model for quinidine was applied to derive OELs based on target blood concentrations in humans but relied on pharmacokinetic parameters in subjects with cirrhosis rather than normal subjects. Quinidine was used as the sample compound as this was used in the development of the methodology. The intent was not to set an OEL for quinidine for a particular population but rather to use the methodology to investigate how factors, which may influence susceptibility, could be incorporated into the analysis. The model was used to simulate exposure concentrations that would result in levels below those that cause undesirable pharmacological effects taking into account variability in parameters through incorporation of Monte Carlo sampling. Results indicate that cirrhotic patients did not require additional protection from occupational exposure to quinidine. These results cannot be extrapolated to other compounds, as the effects of variability in pharmacokinetics on systemic exposure are compound specific. However, this methodology does provide a framework for addressing issues related to the contribution of pharmacokinetics to susceptibility from occupational exposure to pharmaceutical compounds.     

Evaluation of Some Fungi and Bacteria for Potential Control of Safflower Rust

Some fungal and bacterial isolates applied as soil and seed treatments in greenhouse trials gave a good protection against Puccinia carthami Cda. on safflower, significantly reducing the infection from rust-infested seeds. Trichoderma viride and T. harzianum added alone and in combination as air-dried inoculum to the soil were the most effective fungal isolates. However T. viride at two higher rates reduced the rate of emergence of safflower seedlings. Among bacteria, Bacillus subtilis, B. cereus, isolates of Pseudomonas fluorescens and B. thuringiensis reduced rust infection when added both as soil drench and as seed treatment. Good results in the biocontrol of P. carthami were also obtained with some combination antagonist treatments such as T. viride + B. cereus, T. viride + P. fluorescens (16), T. viride + T. harzianum + B. cereus and T. viride +, T. harzianum + P. fluorescens (16). Fungal isolates added as soil treatment increased seedling length, whereas no similar effects were observed when these isolates were applied as seed treatment.     

Exploring the Potential for Actinobacteria as Defensive Symbionts in Fungus-Growing Termites

In fungus-growing termites, fungi of the subgenus Pseudoxylaria threaten colony health through substrate competition with the termite fungus (Termitomyces). The potential mechanisms with which termites suppress Pseudoxylaria have remained unknown. Here we explore if Actinobacteria potentially play a role as defensive symbionts against Pseudoxylaria in fungus-growing termites. We sampled for Actinobacteria from 30 fungus-growing termite colonies, spanning the three main termite genera and two geographically distant sites. Our isolations yielded 360 Actinobacteria, from which we selected subsets for morphological (288 isolates, grouped in 44 morphotypes) and for 16S rRNA (35 isolates, spanning the majority of morphotypes) characterisation. Actinobacteria were found throughout all sampled nests and colony parts and, phylogenetically, they are interspersed with Actinobacteria from origins other than fungus-growing termites, indicating lack of specificity. Antibiotic-activity screening of 288 isolates against the fungal cultivar and competitor revealed that most of the Actinobacteria-produced molecules with antifungal activity. A more detailed bioassay on 53 isolates, to test the specificity of antibiotics, showed that many Actinobacteria inhibit both Pseudoxylaria and Termitomyces, and that the cultivar fungus generally is more susceptible to inhibition than the competitor. This suggests that either defensive symbionts are not present in the system or that they, if present, represent a subset of the community isolated. If so, the antibiotics must be used in a targeted fashion, being applied to specific areas by the termites. We describe the first discovery of an assembly of antibiotic-producing Actinobacteria occurring in fungus-growing termite nests. However, due to the diversity found, and the lack of both phylogenetic and bioactivity specificity, further work is necessary for a better understanding of the putative role of antibiotic-producing bacteria in the fungus-growing termite mutualistic system.     

MicroRNAs Regulating Signaling Pathways:Potential Biomarkers in Systemic Sclerosis

Systemic sclerosis(SSc) is a multisystem fibrotic and autoimmune disease. Both genetic and epigenetic elements mediate SSc pathophysiology. This review summarizes the role of one epigenetic element, known as micro RNAs(mi RNAs), involved in different signaling pathways of SSc pathogenesis. The expression of key components in transforming growth factor-b(TGF-b)signaling pathway has been found to be regulated by mi RNAs both upstream and downstream of TGF-b. We are specifically interested in the pathway components upstream of TGF-b, while mi RNAs in other signaling pathways have not been extensively studied. The emerging role of mi RNAs in vasculopathy of SSc suggests a promising new direction for future investigation. Elucidation of the regulatory role of mi RNAs in the expression of signaling factors may facilitate the discovery of novel biomarkers in SSc and improve the understanding and treatment of this disease.     

In Vitro Evaluation of the Inhibitory Potential of Pharmaceutical Excipients on Human Carboxylesterase 1A and 2

Two major forms of human carboxylesterase (CES), CES1A and CES2, dominate the pharmacokinetics of most prodrugs such as imidapril and irinotecan (CPT-11). Excipients, largely used as insert vehicles in formulation, have been recently reported to affect drug enzyme activity. The influence of excipients on the activity of CES remains undefined. In this study, the inhibitory effects of 25 excipients on the activities of CES1A1 and CES2 were evaluated. Imidapril and CPT-11 were used as substrates and cultured with liver microsomes in vitro. Imidapril hydrolase activities of recombinant CES1A1 and human liver microsomes (HLM) were strongly inhibited by sodium lauryl sulphate (SLS) and polyoxyl 40 hydrogenated castor oil (RH40) [Inhibition constant (K_i) = 0.04±0.01 μg/ml and 0.20±0.09 μg/ml for CES1A1, and 0.12±0.03 μg/ml and 0.76±0.33 μg/ml, respectively, for HLM]. The enzyme hydrolase activity of recombinant CES2 was substantially inhibited by Tween 20 and polyoxyl 35 castor oil (EL35) (K_i = 0.93±0.36 μg/ml and 4.4±1.24 μg/ml, respectively). Thus, these results demonstrate that surfactants such as SLS, RH40, Tween 20 and EL35 may attenuate the CES activity; such inhibition should be taken into consideration during drug administration.     

Evaluation of Potential Exposure to Formaldehyde Air Emissions from a Washing Machine Using the IAQX Model

Consumers may be exposed to formaldehyde during the use of liquid laundry detergent containing a preservative. The primary objective of this analysis was to present an approach to predict formaldehyde air emissions from a washing machine and the subsequent vapor concentrations in the laundry room air using the U.S. Environmental Protection Agency's (USEPA's) Simulation Tool Kit for Indoor Air Quality and Inhalation Exposure, referred to as the IAQX model. A second objective was to identify key model input parameters for formaldehyde. This analysis recommends use of the IAQX emission Model 52 because it provided the best estimates by correlating the formaldehyde evaporation to the Henry's law constant and to the overall gas-phase mass transfer coefficient that was based on washing machine experimental results. The mass balance estimated that 99.7% of the initial formaldehyde mass in the washing machine was discharged down the drain with the wash water and the rest of the formaldehyde was emitted to the air from the top loading washing machine and the hot air clothes dryer. The predicted formaldehyde exposures were acceptable and much lower than the USEPA proposed targets for non-cancer effects and cancer risk.     

Evaluation of the Variation in Calculated Human Exposure to Soil Contaminants Using Seven Different European Models

Calculations using seven European exposure models were performed for 20 different exposure scenarios. The objective of this article is to understand the variation in the resulting calculated human exposures due to soil contamination. To this purpose, the variation in calculated exposures has been compared with the variation in calculated concentrations in contact media and in the soil compartments and with the variation in the input parameters. This led to the conclusion that most of the variation in Exposure through soil ingestion is explained by differences in the input parameter average daily soil intake. When model-specific input parameters are used the variation in Exposure through crop consumption is explained by differences in the product of total consumption rate and fraction of total consumption rate that is home-grown. When standardized input parameters are used, this variation is comparable with the variation in Concentration in root vegetables and in Concentration in leafy vegetables. The variation in Exposure through indoor air inhalation is comparable with the variation in Concentration in indoor air. This suggests that the parameters that control the variation in Concentration in the indoor air, that is, surface and volume of the building and, to a lesser extent, ventilation frequency of the building, also control the variation in Exposure through indoor air inhalation.     

Mapping of Bancroftian Filariasis in Cameroon: Prospects for Elimination

BackgroundLymphatic filariasis (LF) is one of the most debilitating neglected tropical diseases (NTDs). It still presents as an important public health problem in many countries in the tropics. In Cameroon, where many NTDs are endemic, only scant data describing the situation regarding LF epidemiology was available. The aim of this study was to describe the current situation regarding LF infection in Cameroon, and to map this infection and accurately delineate areas where mass drug administration (MDA) was required.MethodologyThe endemicity status and distribution of LF was assessed in eight of the ten Regions of Cameroon by a rapid-format card test for detection of W. bancrofti antigen (immunochromatographic test, ICT). The baseline data required to monitor the effectiveness of MDA was collected by assessing microfilariaemia in nocturnal calibrated thick blood smears in sentinel sites selected in the health districts where ICT positivity rate was ≥ 1%.Conclusion/significanceICT card test results showed that LF was endemic in all the Regions and in about 90% of the health districts surveyed. All of these health districts qualified for MDA (i.e. ICT positivity rate ≥ 1%). Microfilariaemia data collected as part of this study provided the national program with baseline data (sentinel sites) necessary to measure the impact of MDA on the endemicity level and transmission of LF important for the 2020 deadline for global elimination.