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Objective:To estimate the predictive performance of the population pharmacokinetics software JPKD-vancomycin on predicting the vancomycin steady-state trough concentration, and to analyze the related factors affecting the predictive performance.Methods:The clinical data of patients who were treated with vancomycin and received therapeutic drug monitoring (TDM) admitted to Suzhou Hospital Affiliated to Nanjing Medical University from July 2013 to December 2018 were enrolled. All patients were designed an empirical vancomycin regimen (initial regimen) according to vancomycin medication guidelines. Steady-state trough concentrations of vancomycin were determined at 48 hours after the first dose and 0.5 hour before the next dose. Dosage regimen was adjusted when steady-state trough concentration was not in 10-20 mg/L (adjustment regimen), and then the steady-state trough concentration was determined again 48 hours after adjustment. First, the JPKD-vancomycin software was used to calculate the initial regimen and predict the steady-state trough concentration according to the results calculated by classic pharmacokinetic software Vancomycin Calculator. Second, the JPKD-vancomycin software was used to adjust the vancomycin dosage regime and predict the steady-state trough concentration of adjustment regimen. The weight residual (WRES) between the predicted steady-state trough concentration (C pre) and the measured steady-state trough concentration (C real) was used to evaluate the ability of the JPKD-vancomycin software for predicting the vancomycin steady-state trough concentration. The TDM results of initial regimen were divided into accurate prediction group (WRES < 30%) and the inaccurate prediction group (WRES ≥ 30%) according to the WRES value. Patient and disease characteristics including gender, age, weight, height, the length of hospital stay, comorbidities, vasoactive agent, mechanical ventilation, smoking history, postoperative, obstetric patients, trauma, laboratory indicators, vancomycin therapy and TDM results were collected from electronic medical records. Univariate and multivariate Logistic regression analysis was used to screen the related factors that influence the predictive performance of JPKD-vancomycin software, and the receiver operating characteristic (ROC) curve was drawn to evaluate its predictive value. Results:A total of 310 patients were enrolled, and 467 steady-state trough concentrations of vancomycin were collected, including 310 concentrations of initial regimen and 157 concentrations of adjustment regimen. Compared with the initial regimen, the WRES of adjusted regimen was significantly reduced [14.84 (6.05, 22.89)% vs. 20.41 (11.06, 45.76)%, P < 0.01], and the proportion of WRES < 30% increased significantly [82.80% (130/157) vs. 63.87% (198/310), P < 0.01]. These results indicated that JPKD-vancomycin software had a better accuracy prediction for steady-state trough concentration of the adjusted regimen than the initial regimen. There were 198 concentrations in the accurate prediction group and 112 in the inaccurate prediction group. Univariate Logistic regression analysis showed that women [odds ratio ( OR) = 0.466, 95% confidence interval (95% CI) was 0.290-0.746, P = 0.002], low body weight ( OR = 0.974, 95% CI was 0.953-0.996, P = 0.022), short height ( OR = 0.963, 95% CI was 0.935-0.992, P = 0.014), low vancomycin clearance (CL Van; OR < 0.001, 95% CI was 0.000-0.231, P = 0.023) and postoperative patients ( OR = 1.695, 95% CI was 1.063-2.702, P = 0.027) were related factors affecting the predictive performance of JPKD-vancomycin software. Multivariate Logistic regression analysis indicated that women ( OR = 0.449, 95% CI was 0.205-0.986, P = 0.046), low CL Van ( OR < 0.001, 95% CI was 0.000-0.081, P = 0.015) and postoperative patients ( OR = 2.493, 95% CI was 1.455-4.272, P = 0.001) were independent risk factors for inaccurate prediction of JPKD-vancomycin software. The ROC analysis indicated that the area under ROC curve (AUC) of the CL Van for evaluating the accuracy of JPKD-vancomycin software in predicting vancomycin steady-state trough concentration was 0.571, the sensitivity was 56.3%, and the specificity was 57.1%. The predictive performance of JPKD-vancomycin software was decreased when CL Van was lower than 0.065 L·h -1·kg -1. Conclusions:JPKD-vancomycin software had a better predictive performance for the vancomycin steady-state trough concentrations of adjustment regimen than initial regimen. JPKD-vancomycin software had a poor predictive performance when the patient was female, having low CL Van, and was postoperative. The predictive performance of JPKD-vancomycin software was decreased when CL Van was lower than 0.065 L·h -1·kg -1.
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Objective To investigate the effect of dexmedetomidine on early postoperative cognitive func-tion in elderly patients undergoing liver resection. Method Fifty-four ASAⅡ~Ⅲelderly patients scheduled for liver resection were divided into 3 groups(18 in each group):the control group(group C),group D1 and group D2. The levels of serum 8-iso-PGF2α,IL-6,TNF-α and S100β protein were measured,and Da-jvO2,CjvO2and CERO2were calculated at the time before operation and at the end of operation,respectively.Incidence of postoper-ative cognitive dysfunction(POCD)were recorded within seven days after operation. Results Compared with the time before operation,levels of serum 8-iso-PGF2α,IL-6,TNF-α,S100β protein and Da-jvO2,CERO2of patients in 3 groups significantly increased at the end of operation(P < 0.05,respectively). The levels of serum 8-iso-PGF2α,IL-6,TNF-α,S100β protein and Da-jvO2,CERO2of patients decreased in group D1 and D2 than those in group C at the end of operation(P<0.05).Incidence of POCD in group D1 and D2 was lower than that of group C (P<0.05).Conclusion Dexmedetomidine can decrease the incidence of POCD for the elderly patients undergo-ing liver resection,the potential mechanism is that dexmedetomidine can reduce oxidative stress response,inhibit inflammatory response in patients and improve the cerebral oxygen metabolism during the operation.
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OBJECTIVE:To explore the effects of PDCA(plan,do,check,action)cycle theory in the ADR monitoring of our hospital. METHODS:The problems of ADR monitoring in our hospital in 2012 were analyzed and intervened by PDCA cycle. The effects of PDCA cycle were evaluated 1 year later. RESULTS:After implementation of PDCA cycle,we had improved the manage-ment system,brought ADR monitoring into the appraisal of clinical pharmacists,established the networking platform of ADR report-ing,strengthened the training of physicians and nurses,the publicty of ADR information and ADR monitoring of important medi-cine. The number of ADR reports increased by 18.37% in 2013,the proportion of new and serious ADR reports obviously in-creased(increasing from 22.28% to 38.42%);in terms of ADR reporting source,the ADR reporting in wards obviously increased (increasing from 8.16% to 43.84%). The proportion of ADR induced by antibiotics or TCM preparation decreased significantly(re-spetively decreasing from 54.52% to 43.84% and 23.03% to 13.30%);in term of ADR clinical manifestations,the proportion of skin and its appendants involved decreased significantly (decreasing from 53.64% to 39.41%). CONCLUSIONS:The application of PDCA cycle obviously improves the management of ADR monitoring in our hospital.
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Objective To investigate and evaluate the effects of different test methods on the results of Chlamydia trachomatis detection .Methods Enzyme-linked immunosorbent assay(ELISA) method and the immune colloidal gold technique were adopted to detect the Chlamydia trachomatis in 354 specimens .Results Compared the detection results of ELISA and immune colloidal gold technique ,differences of detection rates of overall specimens and female specimens was not statistically significant (P>0 .05) .The positive rate of male specimens detected by ELISA was 11 .02% (13/118) ,which was significantly higher than that of female speci-mens[4 .2% (5/118)](P<0 .05) .Conclusion The specificity and sensitivity of ELISA were higher than those of immune colloidal gold technique ,which is important for the early diagnosis of male urethral Chlamydia trachomatis infection .
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According to the inclusion and exclusion criteria, we searched for relevant original articles in some big Chinese and English databases. The qualities of the studies were evaluated with QUADAS quality assessment tool. A software program, Meta-disc, was used to obtain the pooled estimates and heterogeneity test for sensitivity, specificity, SROC curve, and so on. Finally the 17 article were included. On a per-patient basis, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), Q*, SROC area under curve for 99mTc-MDP bone scan and computed tomography (CT) were 0. 87 and 0.99, 0.81 and 0.98, 3.88 and 13.86, 0.2 and 0.03, 27.73 and 612.17, 0.8418 and 0.9732, 0.9097 and 0.9952, respectively. On a per-focus basis, the pooled SEN, SPE, LR+, LR-, DOR, Q*, SROC area under curve for 99mTc-MDP bone scan was 0.86, 0.97, 13.32, 0.16, 102.4, 0.8944, 0.9528, respectively. For CT, only 1 article were included. This paper demonstrate: whether 99mTc-MDP or CT both have high diagnostic efficiency for bone metastase of breast cancer.
Subject(s)
Female , Humans , Bone Neoplasms , Diagnosis , Breast Neoplasms , Pathology , Sensitivity and Specificity , Technetium Tc 99m Medronate , Tomography, X-Ray ComputedABSTRACT
The paper introduced a few models characteristic of pharmaceutical service(PS)in the hospital,classifying the service applicable in the hospital into personalized PS based on time,social PS based on space,and connotative PS based on expertise.This way pharmacist,doctors and nurses can work as a close team,providing not only high quality PS to a greater population,but also personalized and integrated PS to patients of special needs.In the end,PS can help improve hospital quality of care in general.
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Autophagy is an adaptive response of cells to physiological and pathological conditions.The down-regulation of autophagic activity in some types of tumor cells is believed to play a critical role of tumorogenesis.Many anticancer drugs can activate autophagy in cancer cells and participate in the molecular regulation of autophagy.These drugs also induce apoptosis of cancer cells.The actual role of autophagy in antitumor effects of these drugs,however,depends on concentrations of drugs and the types of tumor cells.The induction of autophagy by anticancer drugs produces dual effects on viability of tumos cells. Autophagy as a therapeutic target of tumor chemotherapy has a promising application in the future.