中国成年患者利奈唑胺治疗群体药动学研究

目的:通过回顾性分析来自恩泽医疗中心(集团)内3家医院利奈唑胺治疗患者的药物浓度监测(TDM)数据,建立中国成年患者利奈唑胺治疗群体药动学模型(PPK),为未来该群体患者利奈唑胺治疗单点谷浓度贝叶斯反馈预测个体化药动学参数,建立个体化给药方案,指导临床合理用药提供科学的实验支持。方法:从2016年3月至2018年12月收集了72例患者的血样,共监测了115个血清浓度。利用Kinetica软件中的逐步回归法研究药物清除率常数(K)和分布容积(V d)与患者个体协变量(年龄、体质量、血常规、生化指标、合并用药等)之间的关系,并通过最大似然法和贝叶斯反馈法进行模型内部和外部验证。结果:最终模型分别为V d=25.864-0.034×Fur(mg),K=0.324-0.0003×Scr-0.003×Age+0.038×Burn。基础模型和最终模型拟合的V d和K的群体典型值分别为29.719 L(5.32,52.36)、0.160 h-1(0.05,0.23)和25.322 L(2.50,52.51)、0.193 h-1(0.06,0.32)。基础模型和最终模型对应的外部验证平均绝对预测误差率分别为0.620(0.001,4.153)和0.588(0.014,3.942)。结论:本研究所建立的利奈唑胺最终PPK模型,能够良好地反映出中国成年患者的利奈唑胺PPK的变异特征;为提高治疗效果、减少不良反应以及实现个体化给药提供了重要的理论实验参考价值。

Preparation and Upconversion Luminescence of Nanocrystalline Gd_2O_3:Er^(3+),Yb^(3+)

Nanocrystalline Gd1.77Yb0.2Er0.03O3 samples were prepared by combustion and precipitation methods. Structures and upconversion luminescence properties of samples were studied. The results of XRD show that all samples are cubic structure, the average crystallite size could be calculated as 23 nm and 39 nm, respectively. The lattice constants were obtained. The FT-IR spectra were measured to investigate the vibrational feature of the samples. Upconversion luminescence spectra of samples under 980 nm laser excitation were investigated. The strong red emission of samples were observed, and attributed to 4F9/2→4I152 transitions of Er^3＋ ions, the emission intensity for sample synthesized by precipitation method is stronger compared to that of combustion method. The possible upconversion luminescence mechanisms in nanocrystalline Gd1.77Yb0.2Er0.03O3 were discussed.

医生的“街头官僚”角色扮演之文化现象浅析

医生的职业特点是需要与患者直接接触,他们对患者的治疗行为实际上属于自由裁量权的施用;医生在医疗工作中实际所扮演的是“街头官僚”的角色,这种角色是由医生的自由裁量权决定的,并同医生职业的专业性和医疗服务行为的特殊性密切相关。如何解决医生自由裁量权的滥用,需要从多方面着手。