目的 探讨干扰MS4A8对苦参碱抑制胃癌细胞生长的影响.方法 构建干扰MS4A8细胞株,将所有细胞分为对照组、苦参碱组、苦参碱+shMS4A8组.采用CCK-8法检测各组细胞的增殖活性,细胞克隆实验检测细胞克隆形成,流式细胞仪检测各组细胞的凋亡情况,Western blot检测各组细胞中P13K-Akt-mTOR信号通路相关蛋白[磷酸化细胞外调节蛋白激酶(p-ERK)、磷酸化氨基未端蛋白激酶(p-JNK)、磷酸化P38丝裂原活化蛋白酶(p-p38)]和MAPKs信号通路相关蛋白[胞内磷脂酰肌醇激酶(PI3K)、磷酸化蛋白激酶B(p-Akt)、雷帕霉素靶蛋白(mTOR)]表达情况.结果 与对照组相比,苦参碱组细胞增殖率降低(LSD-t=6.93,P=0.045);与苦参碱组相比,苦参碱+shMS4A8组的细胞增殖率更低(LSD-t=6.34,P=0.005).与对照组相比,苦参碱组AGS细胞克隆数明显减少(LSD-t=3.33,P=0.045);与苦参碱组相比,苦参碱+shMS4A8组的细胞克隆数更少(LSD-t=3.03,P=0.005).与对照组相比,苦参碱组AGS细胞凋亡率增加(LSD-t=-7.76,P=0.0004);与苦参碱组相比,苦参碱+shMS4A8组的细胞凋亡率更高(LSD-t=-16.66,P=0.0001).与对照组相比,苦参碱组p-ERK、p-JNK、p-p38、PI3K、p-Akt、mTOR的相对表达量均减少(LSD-t=5.95,P=0.0117;LSD-t=9.43,P=0.0027;LSD-t=11.41,P=0.0016;LSD-t=27.10,P=0.0002;LSD-t=34.75,P=0.0001;LSD-t=13.89,P=0.0010);与苦参碱组相比,苦参碱+shMS4 A8 组 p-ERK、p-JNK、p-p38、PI3K、p-Akt、mTOR 的相对表达量均更少(LSD-t=5.41,P=0.0115;LSD-t=7.08,P=0.0044;LSD-t=4.11,P=0.0284;LSD-t=10.18,P=0.0011;LSD-t=4.22,P=0.0262;LSD-t=10.26,P=0.0011).结论 干扰 MS4A8 可通过 P13K-Akt-mTOR和MAPKs信号通路增强苦参碱抑制细胞增殖和细胞克隆数形成,增加细胞凋亡.

Objective:To investigate the protective effect of reduced glutathione (GSH) on diclo-fenac-induced acute kidney injury (AKI) in rats and its mechanism.Methods:Thirty-three male 8-week-old specified pathogen-free SD rats were randomly divided into control, model, and GSH groups (11 rats in each group) according to a random number table method. Diclofenac sodium solution (200 mg/kg) was intragastrically administered to rats in the model group and GSH group to establish the AKI model. Thirty minutes later, rats in the GSH group were treated with intragastric administration of GSH solution (500 mg/kg), while rats in the control and model groups were with 0.9% sodium chloride injection of equal volume. After 24 hours of administration, blood sample was collected and kidneys were isolated. Kidney function [blood urea nitrogen (BUN), serum creatinine (Scr)], kidney histopathology, and serum and kidney tissue oxidative stress indicators such as malondialdehyde (MDA), superoxide dismutase (SOD), and the inflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin 6 (IL-6) were examined. The results of each examination results among rats of the 3 groups were compared.Results:The BUN and Scr in rats of the model group were significantly higher than those in the control and GSH groups[BUN: (14.34±8.47) mmol/L vs. (7.89±2.20) and (8.46±3.58) mmol/L; Scr: (34.44±6.56) μmol/L vs. (24.77±9.50) and (29.28±4.33) μmol/L, all P<0.05]. Glomerular and tubular morphological changes were observed in both model and GSH rats, but the change in rats of GSH group was less severe than that of the model group. The mean levels of MDA, TNF-α, and IL-6 in both serum and kidney tissue in rats of GSH group were significantly lower than those of the model group[MDA: (9.5±0.2) nmol/ml vs. (10.2±0.6) nmol/ml, (3.6±0.3) nmol/ml vs. (4.0±0.2) nmol/ml; TNF-α: (2.9±2.5) pg/ml vs. (5.4±3.0) pg/ml, (420.9±40.3) pg/ml vs. (470.4±31.3) pg/ml; IL-6: (92.1±34.4) pg/ml vs. (123.9±16.6) pg/ml, (7 547±604) pg/ml vs. (8 047±470) pg/ml, all P<0.05], while the activity of SOD was significantly higher than that in the model group[(102.8±2.8) U/ml vs. (99.7±4.1) U/ml, (387.0±12.7) U/ml vs. (375.9±11.7) U/ml, all P<0.05]. Conclusion:GSH has a protective effect on diclofenac-induced acute kidney injury in rats, and its possible mechanism is to inhibit oxidative stress and inflammatory reactions.

目的:探索提高基层医疗机构中药服务能力的方法和途径.方法:以厦门市6个辖区内的社区卫生服务中心、乡镇卫生院的药师、医生护士为调查对象,对其所在基层医疗机构的中药服务开展现状与需求开展问卷调查.结果:在中药服务配备上,54.35％药师认为中药人员配备不足,中药配方颗粒均未配备但需求率较高,中药药学服务信息化薄弱,88.80％的被调查者希望政府投资统一搭建药学服务信息化平台.中药服务项目趋于多样化,均开展了中药饮片调剂,中药代煎代送服务得到医务人员普遍认可,临方加工虽呼声很高但受制于人才、场地、收费标准、政策解读分歧而未能开展.中药服务质量亟待提高,所有人均认为饮片质量、煎煮质量、调剂质量应重点关注,82.26％认为有必要统一厦门市中药饮片调剂给付标准,绝大多数人认为中药饮片质量、调剂质量、处方审核质量、中药煎煮质量应由本单位中药师把关.89.86％受访者认为基层缺乏人才,其中中药处方点评人才最紧缺.50.14％认为提高中药服务质量最关键在于人才培养.结论:合理配置中药专业人员,丰富中药使用形式,加大中药药学服务信息化建设,重视中药服务质量,重视中药人才培养,是提高基层医疗机构中药服务能力的方向.

目的:明确临床药师科普干预的重要性,探索儿科临床药师进行科普干预的有效方法,从而提高患者用药依从性,提升临床疗效,减少再住院率.方法:选取厦门市中医院2020年3-8月诊断为社区获得性肺炎住院患者,随机分为对照组和科普干预组各50例,其中科普干预组又进一步分为西药临床药师科普干预组25例和中西药临床药师联合科普干预组25例,分别进行临床疗效、用药依从性、科普知识知晓率、再住院率评价.结果:在提高临床疗效方面,科普干预组体温恢复正常时间、咳嗽及肺部体征明显好转时间、出院时间较对照组短,差异均有统计学意义(P＜0.05),西药科普干预组和中西药联合科普干预组比较差异无统计学意义(P＞0.05).在提高患者用药依从性方面,中西药联合科普1次即有明显效果,单纯西药科普2次有明显效果.随访6个月内对照组有2例患儿因肺炎再次入院,科普组无患儿因肺炎再次入院.结论:患儿的安全用药教育刻不容缓,临床药师的科普宣教在提升患者用药依从性、提高临床疗效方面成效显著.

Tofacitinib is a novel targeted drug for the treatment of rheumatoid arthritis. With the entry into the medical insurance catalogue, the drug will usher in a new era. This paper reviews the effectiveness and safety of tofacitinib in the treatment of rheumatoid arthritis. Generally speaking, tofacitinib has definite efficacy, few adverse reactions, and controllable safety. Tofacitinib has an advantage over biological agents, that is, tofacitinib can be orally administered. Therefore, tofacitinib is especially developed for patients who have a poor response to or who are intolerant to disease-modifying antirheumatic drugs and biological agents. However, the effectiveness and safety of tofacitinib in a Chinese population need to be confirmed by more studies.

目的:探讨中药临床药师培养新模式,提高中药临床药师培训质量.方法:从中药中毒教学入手,应用以问题为导向的教学法(PBL),对中药临床药师进行培训.结果:通过培训,中药临床药师的临床实践能力得到提高,临床思维更开阔,工作自信心增强.结论:PBL教学模式适合用于中药临床药师的培养.

目的:分析专项管理在住院患者不良事件管控中的作用.方法:选取2018年医院呼吸内科的320例老年住院患者为研究对象,采用随机分组原则分为观察组和对照组,每组1 60例.对照组采用常规护理管理,观察组在对照组的基础上采用专项管理.比较两组的不良事件发生率,以及护理配合率、知识知晓率、自我保护率.结果:观察组的不良事件发生率显著低于对照组(P＜0.05),护理配合率、知识知晓率和自我保护率均显著高于对照组(P＜0.05).结论:专项管理用于老年住院患者,能够降低跌倒、压疮、坠床等不良事件的发生率,有利于提高老年患者的知识知晓率,患者护理配合率和自我保护率也得到提升.

A 40-year-old female patient was treated with sulfasalazine 0.75 g thrice daily for spondyloarthritis. On the 20th day of medication, the patient developed skin rash all over the body, which was gradually aggravated and accompanied by fever, lymphadenectasis, and splenomegaly. Laboratory tests revealed the white blood cell count 14.4×10 9/L, the eosinophil count 0.82×10 9/L, the urinary occult blood (+++) , alanine aminotransferase 84 U/L, and aspartate aminotransferase 96 U/L. Drug-induced hypersensitivity syndrome was diagnosed and considered to be related to sulfasalazine. Sulfasalazine was discontinued and intravenous infusions of methylprednisolone combined with human immunoglobulin were given. At the same time, anti-infection, anti-allergy, and liver-protective treatments were given additionally. After 8 days of treatments, the rash began to subside and itching was improved; after 18 days, the rash basically subsided and laboratory tests showed the results returned to normal.

A 4 years and 7 months old boy was treated with IV infusions of azithromycin 0.16 g once daily and methylprednisolone sodium succinate 32 mg once daily and oral amoxicillin and clavulanate potassium for suspension 228.5 mg twice daily for bronchopneumonia complicated with multiple co-infections with mycoplasma, viruses, and bacteria. After 6 days of treatments, the boy′s symptoms were improved and his body temperature returned to normal. On the 7th day of treatments, the boy developed rash with itching, which subsided on the same day after symptomatic treatments. Amoxicillin and clavulanate potassium and azithromycin were discontinued, but the child still developed rash every time after IV infusion of methylprednisolone sodium succinate, which could subside later that day. After withdrawal of methylprednisolone sodium succinate, the boy′s rash did not recur.

目的 通过分析医院门诊、急诊药房退药原因,降低退药发生率,以保证患者用药安全,提升医疗水平.方法 对厦门市中医院2018年1—3月门诊、急诊药房退药处方进行统计分析.结果 1050张退药处方的退药原因有6种,其中以患者拒绝使用占比最高,为44.67％,其次为医师开错,为38.57％.退药科室分布广泛,门诊、急诊各科室基本都存在退药现象,现列举6个较常见的科室.急诊科退药占比最高,为29.14％,其次为儿科276例,为26.28％.结论 临床工作中,退药现象不可避免,但通过医师、药师等各方面的努力可将退药率降到最低,从而保证患者用药安全,提高医疗服务水平.

目的 探讨肺部子宫内膜异位症的临床表现、影像学、超声特点,为临床诊治提供参考.方法 对2例肺部子宫内膜异位症病例进行资料整理及文献复习.结果 2例肺部子宫内膜异位症患者临床表现为咯血,肺部CT见炎症性改变,结合生育史和月经周期性变化,临床诊断考虑为肺部子宫内膜异位症,行抗炎止血治疗.结论 肺部子宫内膜异位症患者临床表现多为咯血、气胸、血胸,肺部CT多见月经周期相关的肺部病变,诊断需结合临床病史、胸部CT,需与肺炎、肺结核进行鉴别.

目的 为了加强医疗机构抗菌药物临床应用管理,提高抗菌药物临床应用水平,促进临床合理应用抗菌药物.方法 将我院近五年抗菌药物点评结果 (包括住院病人及门、急诊病人)进行数据分析.结果我院住院病人抗菌药物使用率及门、急诊抗菌处方比例基本控制在规定的范围内,Ⅰ类切口抗菌药物的使用情况较良好,合理率逐年升高.结论 通过点评干预和医院对抗菌药物奖惩措施的落实,抗菌药物使用合理性具有一定的提高.

Objective To observe and analyze the clinical effect of cefuroxime combined with methylprednisolone in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary emphysema.Methods 92 COPD patients complicated with pulmonary emphysema were selected as study objects,and they were randomly divided into observation group and control group.46 cases in the control group were treated with antibiotic treatment, and 46 cases in the observation group were treated with cefuroxime combined with methylprednisolone.The clinical curative effect, pulmonary function, blood gas index and incidence of adverse reactions were compared between the two groups.Results The total effective rate of the observation group was 91.30%, which was significantly higher than 76.09% of the control group (x2=8.476,P<0.05).The pulmonary function indices including FVC%,FEV1,FEV1%,MVV levels in the observation group were higher than those in the control group (t=2.657,3.610,2.413,2.359,all P<0.05).The PaO2 level in the observation group [(80.3±2.8)mmHg] was higher than (74.1±3.8)mmHg in the control group, the PaCO2 level in the observation group [(34.0±1.1)mmHg] was significantly lower than (40.2±2.2)mmHg in the control group, the differences were statistically significant (t=3.021,3.952,all P<0.05).The incidence rate of adverse reactions of the observation group was 6.52%,which of the control group was 10.87%, the difference was not significant (x2=1.363,P>0.05).Conclusion In elderly COPD patients with emphysema, using cefuroxime combined with methylprednisolone therapy can effectively alleviate the clinical symptoms, improve lung function and blood gas index, and has less adverse reactions, higher safety and high clinical application value.

目的 为了加强医院抗菌药物应用的管理,指导临床医师正确、合理使用抗菌药物,减少和降低抗菌药物的不良发生率,减缓细菌耐药性的发生,降低医疗用药成本.方法 每月1.11-1.20抽取出院病历30份,抽样方法:检索出所有该时间段出院病历的病历号,按手术与非手术病历分别上传卫生部抗菌药物监测网,按随机回传病历号顺序各抽取前15份病历点评.结果 我院一月、四月、五月、六月及八月的Ⅰ类切口预防使用率均超过30％,未达标,抗菌药物使用率除了二月份超过60％(66.7％),其余均低于60％.点评的结果显示合理病历的合格率较高,除了一月和十一月为76.7％,其余的均在80％以上.结论 通过药师的点评干预和医院对抗菌药物奖惩措施的落实,抗菌药物使用合理性具有一定的提高.

目的:分析门诊药房退药原因并提出对策,旨在减少门诊退药.方法:抽取2013年7月-2013年12月572例门诊患者退药审核表进行统计分析.结果:引起退药的主要原因有药品不良反应、患者拒绝使用、临床医师因素、患者病情变化、药品管理原因5个方面.结论:应提高医师、药师业务素质,加强医患沟通,完善医院相关管理制度,以减少退药现象发生.