目的:探讨多模态超声诊断不同分子分型乳腺癌与乳腺增生结节的价值.方法:选取医院收治的127例乳腺结节患者,经病理检查确诊为乳腺增生结节共62例,乳腺癌共65例,其中Luminal A型17例,Luminal B型17例,人表皮生长因子受体(HER)-2型16例,三阴性型15例,均予以彩色多普勒超声、超声弹性成像、超声造影和多模态超声检查,采用四格表法计算4种检查的阳性和阴性预测值,采用受试者工作特征(ROC)曲线模型分析彩色多普勒超声、弹性成像、超声造影及多模态超声诊断乳腺癌的ROC曲线下面积(AUC)、灵敏度及特异度.结果:127例乳腺结节患者经彩色多普勒超声检查后,阳性预测值为64.18％,阴性预测值为63.33％;经超声弹性成像检查后,阳性预测值为74.24％,阴性预测值为73.77％;经超声造影检查后,阳性预测值为83.58％,阴性预测值为85.00％;经多模态超声检查后,阳性预测值为96.92％,阴性预测值为96.77％.Luminal A型、Luminal B型、HER-2型及三阴性型在彩色多普勒超声检查中的内部回声、微钙化、边界及形态等影像表现比较,差异有统计学意义(x2=14.217,x2=18.878,x2=21.855,x2=22.408;P<0.05).Luminal A型、Luminal B型、HER-2型及三阴性型的弹性最大模量值(Emax)比较,差异有统计学意义(F=17.630,P<0.05);其中,HER-2型的Emax高于Luminal A型、Luminal B型和三阴性型,其差异有统计学意义(t=7.207,t=3.086,t=4.057;P<0.05).Luminal A型、Luminal B型、HER-2型及三阴性型在在增强后边界、周边呈放射性汇聚、增强后范围比较,差异有统计学意义(x2=25.366,x2=28.912,x2=23.634;P<0.05).彩色多普勒超声、超声弹性成像、超声造影和多模态超声诊断乳腺癌的AUC值分别为0.627、0.751、0.842和0.967.结论:多模态超声用于不同分子分型乳腺癌与乳腺增生结节鉴别诊断中具有较高的临床价值,有利于提高其检出率.

目的 探讨近20年熊果酸的研究热点与前沿,为该领域的研究者提供参考.方法 搜集Web of Science数据库中与熊果酸的相关研究文献,检索时限设定为2002年1月1日至2021年12月31日,采用科学计量学软件CiteSpace对文献中涉及的国家或地区、研究机构、作者、期刊和关键词等进行可视化分析,获取熊果酸的时空分布、研究前沿,通过分析关键词共现、关键词突现、关键词聚类等进一步分析熊果酸的研究现状和发展前沿.结果 与结论最终纳入有效文献3528篇,发文量前3位的国家为中国、印度和美国;发文机构分析显示,中国科学院、卡拉奇大学、中国医科大学为发文量排名前3位的研究机构;发文期刊分析显示,Molecules(127篇)、Journal of Ethnopharmacology(90篇)、Journal of Agricultural and Food Chemistry(75篇)是研究发文量较高的3个期刊;关键词分析显示,熊果酸的抗肿瘤活性、抗氧化活性、抗菌活性、抗炎活性等药理作用一直是研究的重点,熊果酸诱导细胞凋亡、氧化应激、自噬等作用机制以及熊果酸纳米颗粒等药物输送方式的研究是未来一段时间的研究方向.

Objective:To understand the clinical features of granulomatous hepatitis (GH) induced by intravesical instillation with Bacille Calmette-Guérin vaccine (BCG).Methods:Case reports of GH which was confirmed by liver biopsy and induced by intravesical BCG therapy were collected by searching PubMed and Elsevier databases as of December 2021. The following information of patients including general information, intravesical BCG situations (dose, times of instillation, traumatic catheterization occurrence), GH occurrence (onset time, clinical manifestations, laboratory tests and liver biopsy results), other adverse reactions, treatments, and outcomes were extracted and analyzed descriptively.Results:A total of 23 patients, who were all male, were entered in the analysis, aged from 34 to 80 years with a median age of 66 years. The primary diseases were bladder cancer in 22 patients and ureteral carcinoma in 1 patient. The times of instillation until GH occurred were recorded in 19 patients. Of them, 2 patients had instillation once and the time was 16 at most. Ten patients had traumatic catheterization during the last instillation, including hematuria in 7 patients, pain in 2 patients, and difficulty in urethral intubation in 1 patient. Time from the last instillation to the onset of GH was from 3 h to 440 days (≤7 days in 18 patients, 10, 14, 21, 180, and 440 days in 1 patient respectively) with a median time of 3 days. Among the 23 patients, 21 had fever, 12 had jaundice, 9 had hepatomegaly, 7 had fatigue, 5 had anorexia, 2 had weight loss, and 1 had night sweats; 12 manifested as GH alone and 11 had concomitant adverse reactions. Abnormal liver function appeared in 22 patients, mainly including elevated alkaline phosphatase and elevated aspartate aminotransferase (each in 17 patients). Mycobacterium bovis identification/culture results were recorded in 20 patients and 7 were positive. Liver biopsies showed noncaseating granuloma of epithelioid in 10 patients, noncaseating granuloma in 7 patients, epithelioid granuloma in 4 patients, and hepatic granuloma without details in 2 patients. After discontinuation of BCG instillations and treatments with anti-tuberculosis agents and/or corticosteroids, 22 patients were improved and 1 patient died of BCG sepsis and multiple organ failure.Conclusions:GH usually occurs within 1 week after intravesical instillation with BCG and mainly manifests as fever, jaundice, hepatomegaly, and abnormal liver function, which may be accompanied by other adverse reactions related to BCG instillation. Liver biopsy can help the diagnosis. The prognosis is good after combination therapy with anti-tuberculosis agents and corticosteroids, but death may occur in severe cases.

目的 促进肿瘤内科止吐药物和质子泵抑制剂的合理使用.方法 以循证医学为基础建立药物治疗临床路径,采用戴明环(PDCA)循环法进行行政干预,完善止吐药物和质子泵抑制剂用药路径管理模式.结果 药物治疗临床路径实施后,肿瘤内科5-羟色胺3(5-HT3)受体拮抗剂和质子泵抑制剂的销售金额、人均药费明显减少,用药频度和使用强度均显著下降.结论 建立药物治疗临床路径管理新模式,为合理用药精细化管理提供了新思路.

目的:分析司库奇尤单抗所致皮肤药物不良反应(cutaneous adverse drug reactions,CADR)的发生发展特点,为临床安全合理用药提供参考.方法:检索中国知网(CNKI)、维普(VIP)、万方、PubMed和Web of Science数据库收载的司库奇尤单抗致CADR的病例报告和病例系列报告并进行分析.结果:收集司库奇尤单抗致CADR的个案报道16篇共18例,其中男性6例(33.33％),女性12例(66.67％),年龄分布以40岁以上居多(12例,66.67％),发生时间主要集中在用药120 d以内(15例,83.33％),CADR类型主要为感染相关(6例,33.33％)和免疫相关(11例,61.11％)2大类.患者经停药或减量和/或对症处理后均好转.结论:对于存在皮肤损伤、慢性感染、特异性皮炎及炎性肠病病史患者,应加强司库奇尤单抗使用后3个月内的药学监护,尤其应重点关注40岁以上人群,避免严重CADR的发生,保证临床用药安全.

目的:对耐碳青霉烯类肺炎克雷伯菌(CRKP)国际研究热点进行可视化分析,了解其发展趋势,为合理使用抗菌药物提供参考.方法:使用CiteSpace5.7软件,以Web of Science核心数据库为数据来源,对2000-2020年发表的CRKP相关文献进行可视化分析.结果:共检索到研究文献5 291篇,发文量逐年增加,发文量最多的是美国,其次是中国和意大利,被引率最高的期刊为Antimicrobial Agents and Chemotherapy,发文量最高的作者是Bonomo RA,发文量最多的机构是浙江大学,该领域目前的研究重点为CRKP的治疗及分子机制.结论:CRKP国际关注度逐渐提高,其耐药机制的揭示和治疗方法的研究给临床治疗提供了依据,也为抗菌药物的合理使用提供了理论依据.

A 25-year-old male patient received intravenous infusion of tegacyclin 50 mg once per 12 hours from the 3rd day after renal transplantation because the bacterial culture of the donor kidney preservation solution showed carbapenem resistant Acinetobacter baumannii. On the 4th day after using tegacyclin, the patient developed epigastric pain, which was improved after gastric protection treatment. On the 8th day of medication, the patient developed persistent severe pain in his left lower abdomen. On the 9th day of medication, laboratory tests showed amylase 1 188 U/L and lipase 699 U/L. Pancreatic ultrasonic examination suggested acute edematous pancreatitis. Acute pancreatitis was diagnosed, which was considered to be related to tigecycline. Tigecycline was stopped. An IV infusion of octreotide acetate injection 0.6 mg dissolved in 0.9% sodium chloride injection 50 ml twice daily was given and diet was prohibited at the same time. Five days later, his symptoms of abdominal pain was improved significantly, pancreatic amylase decreased to 69 U/L, and lipase decreased to 646 U/L.

目的 为基因突变伴肾功能不全患者安全、有效应用他克莫司提供参考.方法 临床药师参与1例肾病综合征患者的临床治疗,提出他克莫司基因检测,根据检测结果CYP3A5*3突变建议他克莫司剂量减半,并进行药学监护.结果 医师采纳临床药师的建议,患者他克莫司血药浓度持续达标,临床症状有效改善,无明显药品不良反应发生.结论 临床药师通过对肾病综合征患者进行药学监护,能提高其用药有效性,减少药品不良反应发生.

Objective:To discuss the onset and development pattern and characteristics of refeeding syndrome (RFS) induced by nutrition support and to provide reference for rational drug use in parenteral nutrition management.Methods:Case reports of RFS from CNKI, Wanfang, VIP database and Pubmed from 2000 to 2020 were retrieved. The clinical data were collected and statistically analyzed.Results:A total of 17 reports, including 17 cases, were included in the analysis. Patients were 6 males(35.29%) and 11 females (64.71%). The distribution of age was from 29 weeks in a premature neonate to 87 years old. 12 cases (70.59%) of RFS occurred within 3 days after starting the nutrition support. The most common clinical manifestation were cardiovascular system symptoms (88.23%), with dyspnea as the most reported symptom (41.17%). 15 patients (88.23%) recovered after appropriate intervention and 2 patients died(11.76%).Conclusions:Refeeding syndrome is a potentially fatal condition. The risk of RFS should be assessed before initiating nutrition support. Patients at risk of RFS must be monitored closely at the early stage of nutritional support.

目的:分析地舒单抗致低钙血症的发生规律和临床特点,为临床安全用药提供参考.方法:检索2010年1月至2020年12月PubMed、Web of Science、Springer Link、中国知网(CNKI)、万方数据知识服务平台及维普数据库中地舒单抗致低钙血症的文献报道,对纳入文献的有效信息进行提取分析.结果:地舒单抗致低钙血症的文献报道共36篇,涉及41例患者,报道年份为2012-2020年,其中男16例(39％)、女25例(61％),年龄38～91岁,60岁以上患者29例(70.7％).发生低钙血症最短为用药后4d,最长为用药后4个月,部分患者为非首次用药发生.用药1个月内发生低钙血症患者34例(82.93％).41例患者中,有3例恶性肿瘤患者因疾病进展且出现反复低钙血症预后欠佳而最终死亡,余均好转或痊愈.结论:临床使用地舒单抗应严格按照说明书合理用药,重点关注高风险人群,加强肾功能、电解质、心电图等的监护、加强患者教育,警惕低钙血症发生.

目的:探讨特立帕肽致不良反应(ADRs)的规律和特点,为临床安全用药提供参考.方法:检索2002年1月-2020年12月PubMed、Web of Science、Springer Link、中国知网(CNKI)、万方数据知识服务平台及维普数据库中特立帕肽致不良反应的病例报道,对纳入文献的有效信息进行提取并分析.结果:特立帕肽ADRs病例报道11篇共14例,其中男2例(14.29％)、女12例(85.71％),60岁以上发生ADRs的患者11例(78.57％),合并基础疾病13例(92.86％);注射特立帕肽1 d内发生ADRs者3例(21.43％),1～6个月内发生ADRs者8例(57.14％),患者经停药及对症处理后症状均好转.1例(7.14％)出现无症状短暂低血压的患者继续使用特立帕肽,其余均未再次使用特立帕肽.ADRs主要表现为皮肤及附件损害4例(28.57％),肌肉骨骼系统损害和生化指标异常各3例(均为21.43％),心血管系统损害2例(14.29％),肿瘤和全身性损害各1例(均为7.14％).结论:特立帕肽致ADRs的特点是女性和60岁以上老年人占比较高,多数患者合并多种基础疾病,发生的ADRs主要涉及皮肤及附件损害、肌肉骨骼系统损害、生化指标异常等,大部分患者经停药及对症治疗后症状好转或痊愈.临床使用特立帕肽时应严格按照说明书合理用药,加强用药监护及教育,警惕ADR发生.

目的:探讨熊果酸治疗骨质疏松症(OP)的潜在分子机制.方法:运用中药系统药理学分析平台数据库、PubMed数据库、UniProt数据库筛选单体化合物熊果酸的作用靶点基因,借助GeneCards数据库检索OP相关靶点基因,并运用Venny 2.1在线作图工具获取成分-疾病的共有靶点基因;运用STRING数据库构建成分-疾病共有靶点基因的蛋白质-蛋白质相互作用关系(PPI)网络并进行拓扑学分析,筛选度值大于平均度值的核心靶点基因;使用DAVID数据库对成分-疾病共有靶点基因进行基因本体(GO)功能注释和KEGG通路富集分析.以核心靶点基因编码蛋白为受体、熊果酸为配体,采用AutoDock Vina 1.1.2软件进行分子对接.结果:共挖掘出熊果酸相关靶点基因55个、OP相关靶点基因4273个,两者共有靶点基因44个.上述共有靶点基因的PPI网络共包含节点44个、边513条,平均节点度值为23.3;核心靶点基因共24个,包括VEGFA、TP53、IL6、CASP3等.共富集到GO功能条目340个(校正后P值小于0.05),其中生物过程263个(涉及凋亡过程的负调控等)、分子功能25个(涉及蛋白质结合等)、细胞组分52个(涉及胞质溶胶等);共富集到KEGG信号通路90条(校正后P值小于0.05),如癌症通路、乙型肝炎、肿瘤坏死因子(TNF)信号通路、磷脂酰肌醇3激酶/蛋白激酶B(PI3K/Akt)信号通路等.熊果酸与TP53等6个核心靶点基因编码蛋白的结合能均低于-5 kcal/mol,有较强的结合活性.结论:熊果酸对OP的治疗作用可能是通过调控VEGFA、TP53、IL6、CASP3、JUN等核心靶点基因,作用于癌症通路、乙型肝炎、TNF信号通路等多条关键通路而实现的.

哌拉西林钠他唑巴坦钠为青霉素类抗菌药物,抗菌谱广,对革兰阳性菌、革兰阴性菌及厌氧菌均有抗菌活性,临床应用广泛[1].其常见不良反应为过敏、皮疹、恶心、呕吐等[2],部分患者出现意识丧失等休克症状,甚至导致死亡[3].本研究中报道了1例哌拉西林钠他唑巴坦钠致产妇过敏性休克病例,以优化临床治疗过程.

目的 分析2013—2018年慢性阻塞性肺疾病(COPD)住院患者黏液型与非黏液型铜绿假单胞菌(PA)耐药性,为临床控制PA感染提供参考.方法 收集青岛大学附属医院药学部2013—2018年临床分PA的病原学资料,回顾性分析其对常用抗菌药物的耐药性情况.结果 共分离出黏液型PA 489株,非黏液型PA 446株.黏液型PA对常用抗菌药物的敏感性高于非黏液型,2种类型的PA对喹诺酮类药物左氧氟沙星和环丙沙星的敏感率只有40％左右,黏液型PA对阿米卡星、庆大霉素、氨曲南、美罗培南、多黏菌素E、哌拉西林他唑巴坦保持在80％以上的敏感性;非黏液型PA仅对阿米卡星、庆大霉素、多黏菌素E保持在80％以上的敏感性.结论 黏液型与非黏液型PA耐药率差异较大,临床治疗应参考药敏,对于黏液型PA应增加剂量或联用对生物膜有清除作用的药物.

目的:探讨组织多普勒Tei指数对妊娠期糖尿病(GDM)孕妇胎儿心功能的评估价值,并分析母婴预后与血糖控制水平的关系.方法:选取2017年1月到2018年6月期间在我院行产前检查的GDM孕妇80例,根据血糖控制情况将其分为良好组(48例)和不良组(32例).另选取同期在我院行产前检查的并在我院生产的健康孕妇50例作为对照组.比较三组研究对象的等容收缩时间(ICT)、等容舒张时间(IRT)、射血时间(ET)、Tei指数、妊娠结局以及新生儿并发症.结果:不良组的ET小于良好组和对照组,Tei指数大于良好组和对照组,差异均有统计学意义(P＜0.05),不良组的巨大儿、早产、羊水过多、胎儿窘迫的发生率高于良好组和对照组,差异均有统计学意义(P＜0.05),不良组的新生儿低血糖、高胆红素血症的发生率高于良好组和对照组,差异均有统计学意义(P＜0.05).结论:组织多普勒Tei指数对GDM孕妇胎儿心功能具有较高的评估价值,可敏感地检测出胎儿心功能异常,血糖控制不良会明显增加不良妊娠结局和新生儿并发症的发生率.

目的:本文通过对儿童用药所致不良反应进行分析,探讨儿童用药导致不良反应的特点,促进儿科药物的合理使用.方法:采用回顾性调查方法进行研究,统计分析不良反应报告中涉及的年龄、药品种类、给药途径、临床表现及累及器官或系统的情况,分析儿科用药及药物不良反应发生情况.结果:1～7岁的患儿发生不良反应例数较多.抗菌药物引发的不良反应最多见,且大多通过静脉给药引起.药物不良反应涉及的器官以皮肤及其附件最多见.结论:加强儿童不良反应的监测,避免和减少儿科用药不良反应的发生,用药过程中要进行疗效的监测,必要时还应做血药浓度监测和重要组织器官功能的监测.

Objective To investigate the pharmacological monitoring for a patient with lung adenocarcinoma who is allergic to nedaplatin and cisplatin. Methods Taking a case of allergic reactions to nedaplatin and cisplatin but not allergic to carboplatin as an entry point, the related literatures were reviewed to analyze the causes of platinum allergic reactions and the corresponding treatment measures. Results Clinical pharmacists made full use of pharmacy knowledge, and timely dealt with allergic reactions with enhanced awareness of pharmaceu-tical care, and so that ensured the safety of patients. Conclusion It is conducive to patients to have safe and effective drug that clinical phar-macists participate in pharmaceutical monitoring and provide pharmacy services actively.

病例:患者,男,61岁,体重74 kg.因胸闷1周前于外院检查,冠状动脉造影未见异常,遂入住我院心血管外科行进一步检查.既往胃炎、胆囊炎病史10余年.既往用药史:泮托拉唑钠胶囊,否认肝炎等疾病,无食物、药物过敏史.

孕妇,30 岁.孕2 产1.于2015 年9 月19 日因孕23周至我院常规孕期检查.平素月经规律,于7年前顺产一正常男婴.否认孕前、孕早期感染史及服药史,否认孕期有害物质及放射线接触史,否认家族性遗传病史,配偶体健,无不良嗜好及有害物质接触史.超声检查:宫腔内可探及两个胎体回声,胎体间未见明显羊膜带分隔,胎盘位于子宫后壁,回声均匀.胎儿一各径线测量:双顶径(BPD):57 mm,头围( HC) :205 mm,腹围( AC) :187 mm,股骨长(FL):36 mm,心率(HR):148 bpm,脐动脉 Vmax:50.4 cm/s,Vmin 16.5 cm/s,阻力指数(RI):0.67,搏动指数(PI):1.05,收缩期舒张期峰值流速比值(S/D)3.1;羊水最大暗区:82 mm.胎儿颅内结构清晰,四肢活动自如,胸腔及腹腔脏器未见明显异

OBJECTIVE:To provide reference for rational selection of antibiotics against non-fermentative Gram-negative bacilli in clinic. METHODS:Etiological data of clinical isolated Pseudomonas aeruginosa(PA),Acinetobacter baumanii(AB) and Stenotrophomonas maltophilia(SM)were collected from the Affiliated Hospital of Qingdao University(called"our hospital"for short)during Jan. 2004-Dec. 2016. Drug resistance of them to commonly used antibiotics was analyzed retrospectively. RESULTS:Totally 15 587 strains of PA,7 446 strains of AB and 2 950 strains of SM were detected. Resistance rates of PA to commonly used antibiotics fluctuated but were in a decreasing tendency. Except for imipenem,resistance rates of PA to commonly used antibiotics decreased significantly,and resistance rates of PA to amikacin and gentamicin decreased to 4.60% and 7.48%, respectively. Resistance rates of AB to most commonly used antibiotics were more than 40%,but it was sensitive to tigecycline (drug resistance of 0-4.03%). Resistance rates of SM to cefoperazone sodium and sulbactam sodium increased from 3.03% in 2004 to 39.01% in 2016,but it was sensitive to sulfamethoxazole,minocycline and levofloxacin. CONCLUSIONS:Non-fermentative Gram- negative bacilli detected in our hospital are mainly PA. Resistance rate of PA to most of the antibiotics is declining;drug resistance of AB is severe;resistance rates of SM to cefoperazone sodium and sulbactam sodium show increasing tendency.Above 3 non-fermentative Gram-negative bacilli are sensitive to amikacin,tegocycline and minocycline. Clinical selection should be based on the results of drug sensitivity test.