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OBJECTIVE To investigate the effects of individualized dosing regimen on blood trough concentration of vancomycin and renal function in critically ill patients. METHODS According to relevant guidelines and the results of Vancomycin Calculator， clinical pharmacists formulated an individualized dosing regimen of vancomycin including loading dose and maintenance dose for critically ill patients based on the two independent variables of body weight and creatinine clearance rate. Using the method of retrospective study， patients who were admitted to the department of intensive care unit （ICU） of the Second Affiliated Hospital of Guangzhou Medical University and used the regimen from July 2018 to December 2021 were selected as the trial group， and patients who were treated with vancomycin and received blood drug concentration monitoring in ICU from January 2015 to June 2018 were recruited in the control group. The difference in trough concentration distribution and the incidence of acute kidney injury （AKI） after medication were compared between the two groups， the change of serum creatinine before and after medication in the trial group was analyzed. RESULTS Totally 197 patients were included in the trial group and 144 patients were in the control group. There was no significant difference between the two groups in the clinical information （gender， age， body weight， acute physiology and chronic health evaluation Ⅱ score， the proportion of patients with renal insufficiency， etc.） （P＞0.05）. The proportions of major infection sites （including lung， urinary， abdominal， blood and central nervous system） and treatment type （target or empirical treatment） also had no significant difference between the two groups （P＞0.05）. There was no significant difference in the attainment rate of ideal trough concentration （15-20 μg/mL） and the proportion of patients with trough concentration ＞20 μg/mL between the two groups （P＞0.05）， while the attainment rate of target trough concentration （10-20 μg/mL） and the proportion of patients with trough concentration ＜10 μg/mL were significantly different between the two groups （P＜0.05）. The attainment rate of target trough concentration in patients with chronic renal insufficiency in trial group was significantly higher than that in control group （P＜0.05）. There was no significant difference in the incidence of AKI and vancomycin-associated AKI between the two groups （P＞0.05）. In the trial group with medication duration ≥7 days ， the level of serum creatinine on the 7th day of treatment was increased significantly， compared with that on the 3rd day of treatment （P＜0.05）. CONCLUSIONS This individualized dosing regimen can improve the attainment rate of target trough concentration of vancomycin in critically ill patients， especially those with chronic renal insufficiency， during the first standardized monitoring， and not increase the risk of renal injury compared with previous empirical medication.
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OBJECTIVE：To provide reference for the participation of clinical pharm acists in outpatient antibiotics management so as to promote the rational use of antibiotics in outpatient department. METHODS ：The pharmacist reset medication rules ， classified irrational medication levels ，formulated warning contents ，and established a diagnosis database of mild to moderate non- complex infections ，according to the problems found in the post review of outpatient antibiotics prescription through sorting out the previous rules of antibiotics use in the Yiyao Rational Drug Use Management Software （called“review software ”for short ）in our hospital. The special pre-review was performed by using combination of system review and manual review. Pharmacists used the review saftware to count the data of outpatient antibiotics prescriptions before （the first quarter of 2020）and after （the second ， third and fourth quarters of 2020）the implementation of special pre-review. The post review for antibiotics prescriptions in Dec. 2019（before the implementation of special pre-review ）and Dec. 2020（after implementation of special pre-review ）were performed by pharmacists to evaluate the impact of the implementation of special pre-review on promoting rational use of outpatient antibitics. RESULTS：Comared with before the implementation of special pre-review in the first quarter of 2020，the prompt rate of the review software for antibiotics prescriptions was decreased ，and the interception rate was increased after the implementation of special pre-review in the second quarter of 2020（P＜0.05）. Compared with before the implementation of special pre-review in Dec. 2019，the proportion of outpatient antibiotics prescriptions in all outpatient prescriptions ，the ratio of bi-antibiotics prescriptions in all antibiotics prescriptions in the same month ，the ratio of prescriptions with unsuitable indications in all antibiotics prescriptions in the same month were all decreased E-mail：phdloveyou@163.com significantly （P＜0.01）， while the ratio of prescriptions with rational antibiotics use in all antibiotics prescriptions in the same month was increased significantly （P＜0.01）. CONCLUSIONS：Pharmacists establishing a rule for rational use of antibiotics in outpatient department b ased o n the hospital ’s situation，implementing a special pre-review for antibiotics prescriptions with the help of review software ，can promote the rational use of antibiotics in outpatient department.
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Aim To explore the role of cardiac-specific overexpression of RIP140 in cardiac function and inflammation signaling pathway.Methods Direct intra-myocardial injection of adenovirus vector expressing RIP140 drove transgene expression in heart tissue.RIP140 overexpression was confirmed using immunofluorescence technique in heart.Cardiac function was assessed by echocardiographic and hemodynamic assessment.TNF-α,IL-2 and IL-1β inflammatory cytokines were detected by ELISA,and the protein levels of p65 and IκB-α were measured by Western blot.Results Adenovirus-mediated foreign gene of RIP140 was successfully transferred in cardiac tissue.RIP140 overexpression in heart induced ventricular dilation,decreased left ventricular ejection fraction and cardiac malfunction,as well as increased releases of TNF-α,IL-2 and IL-1β inflammatory cytokines,p65 protein translocation into the nucleus and IκB-α protein degradation in cytoplasm.Conclusion Adenovirus-mediated RIP140 overexpression in cardiac tissue impairs cardiac function,activates NF-κB/p65 inflammatory signaling pathway and induces the release of inflammatory cytokines.
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Aim The limited transfection efficiency for plasmid in primary neonatal rat cardiomyocytes,which are terminal differentiated cells,and long foreign DNA (the RIP140 gene sequence are as long as 3.5 kb) cause us to choose a better system to study RIP140 gene expression in primary non-replicative cells. Methods Full-length of RIP140 was cloned into pAdTracker-CMV shuttle vector,and then recombined with virus backbone pAdEasy-1 vector in BJ5183 bac-teria.Positive recombinant plasmid was confirmed by sequence analysis and restriction enzyme determina-tion,and then transfected into AD293 cells for amplifi-cation.Titers of virus particles were determined by Tis-sue Culture Infectious Dose 50 (TCID50 )method and cell vitality was analyzed by CCK-8 kit in cardiomyo-cytes.RIP140 gene was identified by Western blot. Results Sequence analysis suggested that full-length RIP140 gene was cloned correctly into AdEasyTM sys-tem.Virus titers of Ad-RIP140 and Ad-GFP were 1011.3 and 1011.7 PFU·mL-1 ,respectively.Cell vitali-ty was not affected when the Multiplicity of Infection (MOI)was lower than 200.Green fluorescent protein (GFP)and Western blot analysis showed RIP140 gene was remarkably increased in cardiomyocytes for 12h in-fection by Ad-RIP140 (P<0.05 ).Conclusion Re-combinant adenovirus containing RIP140 gene was suc-cessfully constructed and effectively expressed in car-diomyocytes.These will be helpful for further research on the function of RIP140 in cardiomyocytes.
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OBJECTIVE:To determine the plasma mycophenolic acid concentration by HPLC, and study the multidoses pharmacokinetics character of mycophenolic acid in Chinese kidney transplantation patients. METHODS: The samples were precipitated with acetonitrile before injection. Diamonsil C18 column was used. The mobile phase consisted of acetonitrile-10 mmol?L-1 KH2PO4 (5∶6) at a flow rate of 1.1 mL?min-1. The detection wavelength was 254 nm and the column temperature was 40 ℃. This method was used to determine the multidoses pharmacokinetics in 12 kidney transplantation patients. RESULTS: MPA was well-separated from internal standard in chromatography, and endogenous foreign substance in plasma had no interference on the determination. The liner range for MPA was 0.38～59.00 ?g?mL-1,and the lowest detectable concentration of MPA was 0.38 ?g?mL-1. The recovery rate stood at 89.32%～97.63%; Both intra-day and inter-day RSD were less than 8.00%. Significant individual difference was noted among the patients treated with MMF in pharmacokinetic results, which was in line with the literature. CONCLUSION: This method is accurate and simple and applicable for the pharmacokinetics study of mycophenolic acid.
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0 05),the cost-effectiveness ratios were 762 49 and 111 85 respectively(P
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AIM: To compare the therapeutic effects, adverse reactions and the costs between recombinant human growth hormone(rhGH) and human serum albumin(HSA) in treatment of liver cirrhosis patients with hypoproteinemia METHODS: Using pharmacoeconomic cost-effectiveness analysis , rhGH was compared with HSA in treatment of 66 liver cirrhosis patients with hypoproteinemia(divided into two groups). RESULTS:After 4 weeks treatment, the effective rates of rhGH and HSA we- re 69.70% and 84.85%, the cost-effectiveness ratios were 27.36, 38.89, respectively. After 8 weeks treatment, the effective rates of rhGH and HSA were 78.79% and 54. 57% ,the cost-effectiveness ratios were 2420, 60.47, respectively. CONCLUSI- ON: rhGH can effectively treat liver cirrhosis with hypoproteinemia and can obviously increase serum albumin level. From a Long-term point of view, its cost effectiveness ratio is superior to that of HSA.
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OBJECTIVE:To explore the feasibility of using international index of rational drug use for the intervention and evaluation of rational use of antimicrobial agents during perioperative period in patients undergoing thyreoidectiomy.METHODS:The patients in the common surgical department were divided into intervention group and non-intervention group.An intervention control study was performed before intervention(from Mar.to Aug.in 2007)vs.after intervention(from Mar.to Aug.in 2008)on the synchronously discharged thyreoidectomy patients with the international index of rational drug use as references.RESULTS:After prophylactic use of antibiotics in the intervention group,the average antimicrobial application time was decreased from 6.83 days to 2.50 days,the average hospital stay of patients was decreased from 8.24 days to 7.15 days,the average hospitalization fee decreased from 1 895.99 yuan to 1 375.26 yuan,the cost of antibacterials decreased from 852.11 yuan to 538.53 yuan,and the proportion of the cost of antibacterials in the total hospitalization cost reduced slightly.However,all the indexes in the non-intervention group showed little change.CONCLUSION:It is effective and feasible to adopt the international index of rational drug use in the intervention and evaluation of rational use of antimicrobial agents during perioperative period.
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OBJECTIVE:To evaluate the utilization status of cephalosporins antibiotics and the tendency of which in some hospitals of Guangzhou city.METHODS:The cephalosporins antibiotics used in35hospitals of Guangzhou city in2001～2004were statistically analyzed in respect to the varieties,drug consumption sum and DDDs etc.RESULTS:During the4years,the varieties,consumption sum and DDDs of cephalosporins antibiotics increased year by year with total drug consumption sum and DDDs increased by13.18%and10.41%,respectively.The third generation cephalosporins antibiotics dominated the first place in terms of consumption sum,which had a fastest increase.The varieties of both oral cephalosporins antibiotics and cephalosporins antibiotics for injection increased with mean annual rates of increase of consumption sum and DDDs of oral cephalosporins antibiotics at7.63%and14.29%,respectively and9.41%and12.82%,respectively for cephalosporins antibi-otics for injection.CONCLUSION:To retard bacterial drug resistance,it is suggested that the utilization of cephalosporins antibiotics should be further normalized.