采用综合干预措施 加强抗菌药物使用管理

目的 通过采取综合干预措施,促进住院患者抗菌药物的临床合理应用。方法 采用抗菌药物合理使用国际指标进行基线调查后,进行多手段干预,用SPSS12.0软件进行统计分析调查结果,评价干预措施的有效性和可行性。结果 接受抗菌药物治疗的住院患者使用抗菌药物的平均品种数从干预前的2.06种降到干预后的1.78种,抗菌药物治疗的平均费用从干预前的1 038.26元降到干预后的696.21元,抗菌药物的平均使用天数从干预前的6.99 天下降到干预后的5.81天,接受抗菌药物治疗患者的平均住院日从干预前的13天下降到干预后的10天,其他多项指标均有改善。结论 综合干预措施对提高合理用药水平效果显著,促进了管理水平的提升。     

质量管理工具在抗菌药物使用强度管理中的运用

目的 探讨质量管理工具在抗菌药物使用强度管理中的应用价值。方法 采用PDCA循环、追踪方法学、根本原因分析法、头脑风暴法、鱼骨图、决策树等管理工具,寻找医院抗菌药物使用强度管理中存在的问题并进行持续质量改进。结果 通过质量管理工具的应用,医院抗菌药物使用强度明显下降,并控制在每百人天40 DDDs以下。结论 质量管理工具应用于抗菌药物使用强度管理,能有效发现并解决问题,促进抗菌药物临床合理使用。     

2009年我院抗菌药物用药强度分析

目的 分析住院患者2009年抗菌药物用药强度。方法 以限定日剂量（DDD）为单位,以DDD/100人天值计算抗菌药物使用强度。结果 住院患者抗菌药物平均用药强度为88.32。二代头孢、三代头孢、其他β内酰胺类和头孢呋辛钠、头孢米诺钠、头孢哌酮舒巴坦钠分别位于各类别及各品种抗菌药物用药强度的前3位。各科室抗菌药物用药强度的中位数为78.37,泌尿外科、普外二科和腔镜外科位于前3位。结论 医院可能存在抗菌药物用药过度、用药集中等问题,应进一步加强监督管理。     

某三甲医院抗菌药物临床规范化应用的现状分析

??????? 目的 分析和调查抗菌药物临床应用的情况,研究规范化应用抗菌药物在临床使用的效果。方法 根据计算机管理系统提供的抗菌药物用药信息,对某三甲综合医院抗菌药物临床应用专项整治前、后医院门诊患者抗菌药物处方比例及住院患者抗菌药物使用率、使用强度、I类手术预防用药率等指标进行调查及分析。结果 门诊患者抗菌药物处方比例降低至6.2﹪;住院患者抗菌药物使用率降低至49.7﹪;抗菌药物使用强度降低至42.48;I类手术预防用药率降低至32.1﹪。结论 抗菌药物临床规范化应用,促进医院抗菌药物临床合理使用的效果显著。     

按病种管理在降低妇科抗菌药物使用强度中的应用

目的 探讨按病种管理在降低抗菌药物使用强度中的应用效果。方法 通过对妇科4个病区5个常见病种（子宫平滑肌瘤、卵巢囊肿、卵巢恶性肿瘤、子宫内膜恶性肿瘤和宫颈恶性肿瘤）使用抗菌药物的对比分析,找到问题症结所在,对妇科围手术期抗菌药物使用存在问题进行改进,并将改进前后状况进行比较。结果 妇科抗菌药物使用强度从42DDD下降到38DDD,达到国家标准。结论 按病种管理在降低抗菌药物使用强度管理中取得了较好的效果,值得推广。     

循证医学视角下的超说明书用药分级管理研究

目的 为规范超说明书用药的管理,促进临床合理用药,保障患者用药安全,对超说明书用药进行分级管理。方法 以循证医学证据为分级管理依据,启动了全院临床科室超说明书用药备案评审工作。结果 在406条备案药物中,抗肿瘤药物超说明书用药占78.8%,依据国际指南用法的比例最高,占48.8%,其次为其他循证支持用法（包括文献报道）占36.4%,再次为国内指南用法占11.1%。结论 超说明书用药的管理应重点集中于证据等级较低、药物不良反应发生率较高,且曾发生过医患纠纷的药物。     

医院抗菌药物临床应用专项整治持续效果分析

?????? 目的 分析抗菌药物临床应用专项整治对医院住院患者抗菌药物临床用药的持续效果。方法 采用回顾性调查方法,以开展抗菌药物临床应用专项整治前后的2010—2012为研究时间,对医院住院患者抗菌药物使用率、使用强度、用药金额及清洁手术预防用药率、清洁手术术后24小时停药率进行调查及分析。结果 2010—2012年,抗菌药物使用率分别为70.0%、64.4%和49.3%,抗菌药物使用强度分别为73.3、58.2和37.9,抗菌药物用药金额占药费总额比例分别为21.9%、16.2%和11.1%;清洁手术预防用抗菌药物比率分别为95.5%、91.0%和50.3%,清洁手术术后24小时停药率分别为11.0%、27.2%和42.0%。结论 抗菌药物临床应用专项整治对抗菌药物的合理使用起到了积极的促进作用。     

国家基本药物制度对基层医疗卫生机构合理用药影响分析

目的 了解在实施国家基本药物制度之后,基层医疗卫生机构在合理用药方面的变化情况。方法 采用定量分析与定性研究相结合的研究方法,选取黑龙江已开展基本药物制度工作的四个县市在实施基本药物制度前后的共1630张处方进行定量分析,并对关键人物进行定性访谈。结果 对比2008年与2013年实施基本药物制度前后,每处方用药种数由3.04种下降到1.57种,抗生素使用率由53.29%下降到38.62%,其他指标也均呈下降趋势,差异具有统计学意义。结论 基本药物制度对改善合理用药具有一定的促进作用,但抗生素与注射剂不合理使用现象仍然存在。     

我国抗菌药物临床应用专项整治情况调查与分析

目的 了解抗菌药物临床应用专项整治以来,我国医院的抗菌药物使用情况。方法 2011年和2012年分别选取了241所医院进行调查。运用系统随机抽样方法抽取5—9月期间医院的门诊处方和住院病历进行分析。抗菌药物使用强度（每百人天DDDs值）、门诊患者抗菌药物处方比例、综合I类切口手术预防使用抗菌药物比例等为主要分析指标。结果 从2011年至2012年,被调查医院的平均抗菌药物使用强度和综合I类切口手术预防使用抗菌药物比例下降有统计学意义;门诊患者抗菌药物处方使用率整体变化不显著,联合用药情况仍普遍存在。且医院的规模与抗菌药物使用存在显著关联性。结论 仍需通过进一步加强抗生素耐药性监测以及对医务工作者和公众抗菌药物使用培训等管理措施,从本质上改善抗菌药物使用情况。     

Preparation of hair for measurement of elements by inductively coupled plasma-mass spectrometry (ICP-MS)

The preparation of hair for the determination of elements is a critical component of the analysis procedure. Open-beaker, closedvessel microwave, and flowthrough microwave digestion are methods that have been used for sample preparation and are discussed. A new digestion method for use with inductively coupled plasma-mass spectrometry (ICP-MS) has been developed. The method uses 0.2 g of hair and 3 mL of concentrated nitric acid in an atmospheric pressurelow-temperature microwave digestion (APLTMD) system. This preparation method is useful in handling a large numbers of samples per day and may be adapted to hair sample weights ranging from 0.08 to 0.3 g. After digestion, samples are analyzed by ICP-MS to determine the concentration of Li, Be, B, Na, Mg, Al, P, S, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Ge, As, Se, Rb, Sr, Zr, Mo, Pd, Ag, Cd, Sn, Sb, I, Cs, Ba, Pt, Au, Hg, Tl, Pb, Bi, Th, and U. Benefits of the APLTMD include reduced contamination and sample handling, and increased precision, reliability, and sample throughput.     

A phylogenetic analysis of 100+ genera and 50+ families of euasterids based on morphological and molecular data with notes on possible higher level morphological synapomorphies

 A data matrix of 143 morphological and chemical characters for 142 genera of euasterids according to the APG system was compiled and complemented with rbcL and ndhF sequences for most of the genera. The data were subjected to parsimony analysis and support was assessed by bootstrapping. Strict consensus trees from analyses of morphology alone and morphology + rbcL + ndhF are presented. The morphological data recover several groups supported by molecular data but at the level of orders and above relationships are only superficially in agreement with molecular studies. The analyses provide support for monophyly of Gentianales, Aquifoliales, Apiales, Asterales, and Dipsacales. All data indicate that Adoxaceae are closely related to Dipsacales and hence they should be included in that order. The trees were used to assess some possible morphological synapomorphies for euasterids I and II and for the orders of the APG system. Euasterids I are generally characterised by opposite leaves, entire leaf margins, hypogynous flowers, “early sympetaly” with a ring-shaped corolla primordium, fusion of stamen filaments with the corolla tube, and capsular fruits. Euasterids II often have alternate leaves, serrate-dentate leaf margins, epigynous flowers, “late sympetaly” with distinct petal primordia, free stamen filaments, and indehiscent fruits. It is unclear which of these characters represent synapomorphies and symplesiomorphies for the two groups, respectively, and there are numerous expections to be interpreted as reversals and parallelisms. Received August 28, 2000 Accepted August 7, 2001     

外泌体在白血病中的重要调控作用

目前,白血病复发是患者死亡的主要原因之一。肿瘤细胞和微环境的相互作用,以及隐匿在骨髓中的肿瘤干细胞,促进了白血病的复发和向淋巴组织的转移,因此白血病的治疗、转移和复发问题受到广泛关注。外泌体是由绝大多数细胞分泌的双层脂质膜囊泡,可以调控细胞间的交流和信息传递。在白血病细胞、基质细胞和内皮细胞之间的相互联系中都涉及到外泌体,白血病细胞来源的外泌体存在于白血病患者的血浆中,能把其携带的白血病相关抗原及微小RNA呈递给靶细胞,促进白血病肿瘤细胞的增殖,有助于肿瘤细胞实现免疫逃避,保护白血病细胞抵抗化疗药物导致的细胞毒性作用,促进血管生成及肿瘤细胞的迁移。因此,外泌体与白血病的转移、治疗及预后密切相关,可以用来检测和监测白血病的进展。本文综述了外泌体的来源、形成与分泌机制,以及外泌体在白血病发生前、发展中、预后和免疫治疗中所扮演的重要角色。     

Assessing burrowing, nest construction, and hoarding in mice

Deterioration in the ability to perform "Activities of daily living" (ADL) is an early sign of Alzheimer's disease (AD). Preclinical behavioural screening of possible treatments for AD currently largely focuses on cognitive testing, which frequently demands expensive equipment and lots of experimenter time. However, human episodic memory (the most severely affected aspect of memory in AD) is different to rodent memory, which seems to be largely non-episodic. Therefore the present ways of screening for new AD treatments for AD in rodents are intrinsically unlikely to succeed. A new approach to preclinical screening would be to characterise the ADL of mice. Fortuitously, several such assays have recently been developed at Oxford, and here the three most sensitive and well-characterised are presented. Burrowing was first developed in Oxford. It evolved from a need to develop a mouse hoarding paradigm. Most published rodent hoarding paradigms required a distant food source to be linked to the home cage by a connecting passage. This would involve modifying the home cage as well as making a mouse-proof connecting passage and food source. So it was considered whether it would be possible to put the food source inside the cage. It was found that if a container was placed on the floor it was emptied by the next morning., The food pellets were, however, simply deposited in a heap at the container entrance, rather than placed in a discrete place away from the container, as might be expected if the mice were truly hoarding them. Close inspection showed that the mice were performing digging ("burrowing") movements, not carrying the pellets in their mouths to a selected place as they would if truly hoarding them. Food pellets are not an essential substrate for burrowing; mice will empty tubes filled with sand, gravel, even soiled bedding from their own cage. Moreover, they will empty a full tube even if an empty one is placed next to it. Several nesting protocols exist in the literature. The present Oxford one simplifies the procedure and has a well-defined scoring system for nest quality. A hoarding paradigm was later developed in which the mice, rather than hoarding back to the real home cage, were adapted to living in the "home base" of a hoarding apparatus. This home base was connected to a tube made of wire mesh, the distal end of which contained the food source. This arrangement proved to yield good hoarding behaviour, as long as the mice were adapted to living in the "home base" during the day and only allowed to enter the hoarding tube at night.     

日本北海道虻类雌性外生殖器形态(双翅目：虻科)(英文)

【目的】利用日本北海道虻类评估和验证外生殖器在分类学上的意义。【方法】将虻类成虫标本浸渍在生理盐水中并置于双目显微镜下通过针和镊子在培养皿中进行解剖并绘图,观察第9背板、第10背板、尾叶、第8腹板、受精囊、受精囊管及生殖叉器的形态特征。【结果】在日本北海道共记录了虻科(Tabanidae) 3亚科7属38种。我们观察并描述了3亚科其中的6属24种的雌性外生殖器的主要特征。亚科之间存在明显差异;然而在一般情况下属之间很难建立一种方法来确定共同点;种之间只有在斑虻属Chrysops中有相似之处,其他属中则比较多样化。因此,亚科鉴定根据第9背板、第8腹板及受精囊足以进行区分,属及种鉴定需要结合第9背板、第10背板、尾叶、第8腹板、受精囊、受精囊管及生殖叉器各自的特征组合在一起才能区分开来。我们也制作了虻类外生殖器的检索表。【结论】和许多其他昆虫一样,外生殖器是虻科的重要分类特征,对于促进分类学和系统学的发展具有重要意义。本研究首次对分布在日本北海道的虻科雌性外生殖器进行了系统研究。     

Staining protocols for human pancreatic islets

Estimates of islet area and numbers and endocrine cell composition in the adult human pancreas vary from several hundred thousand to several million and beta mass ranges from 500 to 1500 mg. With this known heterogeneity, a standard processing and staining procedure was developed so that pancreatic regions were clearly defined and islets characterized using rigorous histopathology and immunolocalization examinations. Standardized procedures for processing human pancreas recovered from organ donors are described in part 1 of this series. The pancreas is processed into 3 main regions (head, body, tail) followed by transverse sections. Transverse sections from the pancreas head are further divided, as indicated based on size, and numbered alphabetically to denote subsections. This standardization allows for a complete cross sectional analysis of the head region including the uncinate region which contains islets composed primarily of pancreatic polypeptide cells to the tail region. The current report comprises part 2 of this series and describes the procedures used for serial sectioning and histopathological characterization of the pancreatic paraffin sections with an emphasis on islet endocrine cells, replication, and T-cell infiltrates. Pathology of pancreatic sections is intended to characterize both exocrine, ductular, and endocrine components. The exocrine compartment is evaluated for the presence of pancreatitis (active or chronic), atrophy, fibrosis, and fat, as well as the duct system, particularly in relationship to the presence of pancreatic intraductal neoplasia. Islets are evaluated for morphology, size, and density, endocrine cells, inflammation, fibrosis, amyloid, and the presence of replicating or apoptotic cells using H&E and IHC stains. The final component described in part 2 is the provision of the stained slides as digitized whole slide images. The digitized slides are organized by case and pancreas region in an online pathology database creating a virtual biobank. Access to this online collection is currently provided to over 200 clinicians and scientists involved in type 1 diabetes research. The online database provides a means for rapid and complete data sharing and for investigators to select blocks for paraffin or frozen serial sections.     

Genetic Manipulation in Δku80 Strains for Functional Genomic Analysis of Toxoplasma gondii

Targeted genetic manipulation using homologous recombination is the method of choice for functional genomic analysis to obtain a detailed view of gene function and phenotype(s). The development of mutant strains with targeted gene deletions, targeted mutations, complemented gene function, and/or tagged genes provides powerful strategies to address gene function, particularly if these genetic manipulations can be efficiently targeted to the gene locus of interest using integration mediated by double cross over homologous recombination.Due to very high rates of nonhomologous recombination, functional genomic analysis of Toxoplasma gondii has been previously limited by the absence of efficient methods for targeting gene deletions and gene replacements to specific genetic loci. Recently, we abolished the major pathway of nonhomologous recombination in type I and type II strains of T. gondii by deleting the gene encoding the KU80 protein^1,2. The Δku80 strains behave normally during tachyzoite (acute) and bradyzoite (chronic) stages in vitro and in vivo and exhibit essentially a 100% frequency of homologous recombination. The Δku80 strains make functional genomic studies feasible on the single gene as well as on the genome scale^1-4.Here, we report methods for using type I and type II Δku80Δhxgprt strains to advance gene targeting approaches in T. gondii. We outline efficient methods for generating gene deletions, gene replacements, and tagged genes by targeted insertion or deletion of the hypoxanthine-xanthine-guanine phosphoribosyltransferase (HXGPRT) selectable marker. The described gene targeting protocol can be used in a variety of ways in Δku80 strains to advance functional analysis of the parasite genome and to develop single strains that carry multiple targeted genetic manipulations. The application of this genetic method and subsequent phenotypic assays will reveal fundamental and unique aspects of the biology of T. gondii and related significant human pathogens that cause malaria (Plasmodium sp.) and cryptosporidiosis (Cryptosporidium).     

A Microplate Assay to Assess Chemical Effects on RBL-2H3 Mast Cell Degranulation: Effects of Triclosan without Use of an Organic Solvent

Mast cells play important roles in allergic disease and immune defense against parasites. Once activated (e.g. by an allergen), they degranulate, a process that results in the exocytosis of allergic mediators. Modulation of mast cell degranulation by drugs and toxicants may have positive or adverse effects on human health. Mast cell function has been dissected in detail with the use of rat basophilic leukemia mast cells (RBL-2H3), a widely accepted model of human mucosal mast cells^3-5. Mast cell granule component and the allergic mediator β-hexosaminidase, which is released linearly in tandem with histamine from mast cells⁶, can easily and reliably be measured through reaction with a fluorogenic substrate, yielding measurable fluorescence intensity in a microplate assay that is amenable to high-throughput studies¹. Originally published by Naal et al.¹, we have adapted this degranulation assay for the screening of drugs and toxicants and demonstrate its use here.Triclosan is a broad-spectrum antibacterial agent that is present in many consumer products and has been found to be a therapeutic aid in human allergic skin disease^7-11, although the mechanism for this effect is unknown. Here we demonstrate an assay for the effect of triclosan on mast cell degranulation. We recently showed that triclosan strongly affects mast cell function². In an effort to avoid use of an organic solvent, triclosan is dissolved directly into aqueous buffer with heat and stirring, and resultant concentration is confirmed using UV-Vis spectrophotometry (using ε₂₈₀ = 4,200 L/M/cm)¹². This protocol has the potential to be used with a variety of chemicals to determine their effects on mast cell degranulation, and more broadly, their allergic potential.     

Automated High-throughput Behavioral Analyses in Zebrafish Larvae

We have created a novel high-throughput imaging system for the analysis of behavior in 7-day-old zebrafish larvae in multi-lane plates. This system measures spontaneous behaviors and the response to an aversive stimulus, which is shown to the larvae via a PowerPoint presentation. The recorded images are analyzed with an ImageJ macro, which automatically splits the color channels, subtracts the background, and applies a threshold to identify individual larvae placement in the lanes. We can then import the coordinates into an Excel sheet to quantify swim speed, preference for edge or side of the lane, resting behavior, thigmotaxis, distance between larvae, and avoidance behavior. Subtle changes in behavior are easily detected using our system, making it useful for behavioral analyses after exposure to environmental toxicants or pharmaceuticals.