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OBJECTIVE To study the clinical characteristics of leflunomide-induced int erstitial pneumonia （Lef-IP），and to provide reference for its clinical diagnosis ，treatment and prevention. METHODS Lef-IP cases published in domestic and foreign journals from January 2004 to June 2021 were collected. Relevant information of patients were extracted and analyzed retrospectively， including basic characteristics ，clinical manifestations ，imaging manifestations ，laboratory examinations ， histopathological examinations ，treatment and outcome. RESULTS A total of 54 Lef-IP patients from case reports of 24 publications were included ，with a median age of 61 years（9-83 years）. Pulmonary symptoms appeared from 3.3 weeks to 132.9 weeks（median time of 14.5 weeks）. Patients with a loading dose of leflunomide have a shorter median time to pulmonary symptoms appearing （7.5 weeks）. The main clinical manifestations were dyspnea （85.2％），cough（57.4％），fever（53.7％）. CT imaging examination showed 19 cases with ground-glass shadow in both lungs ，and 29 cases showed interstitial infiltration in both lungs on chest radiograph；blood gas analysis showed hypoxemia and hypocapnia ；the levels of C-reactive protein and Krebs von Den lungen- 6 （KL-6）increased；histopathological examination mainly showed interstitial pneumonia （8 cases），including 3 cases of diffuse alveolar injury ，4 cases of lymphocytes in bronchoalveolar lavage fluid ，and 1 case of noncaseating granuloma. After discontinued leflunomide and symptomatic treatment （antibiotics，hormones，colecenamine，plasma exchange ），35 patients（64.8％）recovered or improved their lung symptoms. Twelve patients （22.2％）died，and patients with fever may had a higher mortality rate （34.5％， P＝0.02）. CONCLUSIONS The main clinical manifestations of Lef-IP are dyspnea ，cough and fever. Loading doses of leflunomide should be avoided at the beginning of treatment. When lef-IP occurs ，leflunomide is discontinued and corresponding treatment is given，and most of the patients ’pulmonary symptoms can return to normal or be improved.
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OBJECTIVE： To provide reference for the formulation of primary medication regimen for antibacterial drug treatment of ICU patients with Escherichia coli infection. METHODS： Based on the surveillance report on E. coli resistance in hospitals issued by CHINET China bacterial drug resistance surveillance network in 2016， 19 third class A hospitals in China were collected as E. coli clinically isolated from ICU wards. Antibiotics with resistance rate of less than 40％ to E. coli and with high utilization rate in clinical practice were selected as the research objects， and a simulated drug delivery scheme was formulated. Monte Carlo simulation method was used to simulate the clinical effect of different dosage regimens on 10 000 cases among “patients with E. coli infection” in ICU wards. The target thresholds were ％fT＞MIC＞50％ （piperacillin/tazobactam， cefoperazone/sulbactam），％fT＞MIC＞40％ （meropenem）， fcmax/MIC＞10 （amikacin）. The cumulative response percentage （CFR） to the target threshold requires that CFR be greater than 90％ for the optimal regimen. The results were compared with those of 275 clinical ICU pationts. RESULTS： Four antibiotics were identified， namely cefoperazone/sulbactam， piperacillin/tazobactam， meropenem and amikacin； sixteen medication regimen were simulated， including 1 kind of cefoperazone/sulbactam “3.0 g， q8 h”； 3 kinds of piperacillin/tazobactam “2.25 g， q6 h” “3.375 g， q8 h” and “3.375 g， q6 h”； 2 kinds of meropenem “0.5 g， q8 h” “1.0 g， q8 h”； 3 kinds of amikacin “0.4 g， q24 h” “0.6 g， q24 h” and “0.8 g， q24 h”. Their CFR values were higher than 90％， all of them could be regarded as primary medication regimen. The clinical results were basically consistent with the simulation results. CONCLUSIONS： Above medication regimen of piperacillin/tazobactam， cefoperazone/sulbactam， meropenem and amikacin can be used as initial empirical drug selection for patients with E. coli infection in ICU.
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BACKGROUND:Liquid chip techniques (Luminex) is a recently rising method for detecting anti-panel reactive antibody, which is characterized by high sensitivity, and strong specificity, less interference and high flux. OBJECTIVE:To compare the sensitivity and detection difference of panel reactive antibody in serum of kidney disease patients detected by enzyme-linked immunosorbent assay and Luminex. METHODS:Serum samples of 280 patients with kidney disease were selected. The enzyme-linked immunosorbent assay and Luminex methods were used to measure positive rate of panel reactive antibody. Chi-square test for fourfold table data was utilized for statistical analysis. RESULTS AND CONCLUSION:The positive rates of panel reactive antibody were respectively 18.9%and 33.6%as detected by enzyme-linked immunosorbent assay and Luminex method. The positive rates of anti-HLA-I antibody and anti-HLA-II antibody were respectively 12.8%and 12.5%, as detected by enzyme-linked immunosorbent assay. The positive rates of anti-HLA-I antibody and anti-HLA-II antibody were respectively 25.0%and 20.7%, as detected by Luminex method. Positive detection rate was significantly higher in the Luminex group than that in the enzyme-linked immunosorbent assay group. Moreover, Luminex method could precisely detect the low-concentration antibody. Chi-square test for fourfold table data showed P<0.01. Significant differences in the differences of panel reactive antibody of kidney disease patients were detected between the two methods. Results demonstrated that compared with enzyme-linked immunosorbent assay, Luminex method is more sensitive and accurate, and more suitable for clinical detection.
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OBJECTIVE To explore the rational application of aminoglycosides antibiotics.METHODS We randomly selected 520 patients' records of applying aminoglycosides antibiotics from Jan to Dec in 2007.Types of antibiotics,dosages,usage,ways of delivery and periods and combination of medicines were analyzed.RESULTS Out of the 520 cases,the oldest patient was 89 year and the youngest one was 7 years.The application rate of amikacin was the highest(35.6%),which was delivered mainly by iv,the combination of medicines accounted for 92.7%.CONCLUSIONS The application of aminoglycosides antibiotics in our hospital is basically rational.In some cases the improper antibiotics are used and the duration is a little longer,which should be supervised.
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OBJECTIVE:To improve the HPLC method for the content determination of Methotrexate(MTX)for injection.METHODS:The determination was performed on Inertsil C 8 column,mobile phase consisted of acetonitrile-water-acetic acid glacial-triethylamine(14:86:0.5:0.3)at flow rate of 0.8 mL?min-1.UV detection wavelength was set at 306 nm.Metronidazolum was selected as internal standard for internal standard method to replace external standard method stated in Chinese Pharmacopeia.Result of internal standard method was compared with that of external standard method.RESULTS:The linear range of MTX was 0.52～3.64?g?mL-1(r=0.999 7)with an average recovery of 99.77%(RSD=0.42%).Two kinds of methods obtained similar results.CONCLUSION:Improved method is convenient,accurate and reproducible for quality control of MTX.
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OBJECTIVE:To establish an ion-pair RP-HPLC method for determination of the concentration of netilmicin sulfate in human serum.METHODS:The determination was performed on Luna C18 column with column temperature set at 40℃;the mobile phase consisted of acetonitrile-water (15∶85,pH 2.0,containing 10 mmol?L-1 sodium heptanesulfonate) at a flow rate of 0.8 mL?min-1.The detection wavelength was set at 205 nm.RESULTS:The linear range of netilmicin was 2～20 mg?L-1(r=0.997 6) with a recovery rate of 93.66%～96.05%.The intra-day and inter-day RSD were both less than 10%,respectively.CONCLUSION:The method is sensitive and simple with accurate and reliable results,and it is able to satisfy the requirement for the determination of serum concentration of netilmicin.
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OBJECTIVE:To prepare Xielong liquor and establish its quality control.METHODS:Xielong liquor was prepared by classic merceration.Paeonia lactiflora in the formulation was identified by TLC,and the content of the active component ferulaic acid was determined by HPLC.RESULTS:The preparation was yellowish-brown in color and its TLC spots were clear and well-isolated.The linear range of ferulaic acid was 3.66～36.64 mg?L-1(r=0.999 8)and its the average recovery was 100.47%(RSD=0.84%,n=15).CONCLUSION:The preparation technology of Xielong liquor is simple and feasible and the quality of the preparation is stable and controllable,thus the established standard is applicable for the quality control of Xielong Liquor.
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Objective:To study the effects of tamoxifen on proliferation and ER expression of human hepatocellular carcinoma cells.Methods:HepG2 cells were treated with tamoxifen at different concentration and different action time.MTT was used to determine the suppression rate of human hepatocellular carcinoma cell.The effects of tamoxifen on human hepatocellular carcinoma cell ER performance were observed by immunohistochemistry.Results:Tamoxifen inhibited the proliferation of human hepatocellular carcinoma cells and suppressed human hepatocellular carcinoma cell ER performence.Conclusions:Tamoxifen may suppress human hepatocellular carcinoma cell proliferation ER performance.