Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy:a meta-analysis

BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.

High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding:A meta-analysis

AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis.The primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and mortality.The meta-analysis was performed with a fixed effects model or random effects model.RESULTS:Nine eligible RCTs including 1342 patients were retrieved.The results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.

Predictors of post-treatment stenosis in cervical esophageal cancer undergoing high-dose radiotherapy

AIM To evaluate toxicity and treatment outcome of highdose radiotherapy(RT) for cervical esophageal cancer(CEC).METHODS We reviewed a total of 62 consecutive patients who received definitive RT for stage Ⅰ to Ⅲ cervical esophageal cancer between 2001 and 2015. Patients who received < 45 Gy, treated for lesions below sternal notch, treated with palliative aim, treated with subsequent surgical resection, or diagnosed with synchronous hypopharyngeal cancer were excluded. Treatment failures were divided into local(occurring within the RT field), outfield-esophageal, and regional [occurring in regional lymph node(s)] failures. Factors predictive of esophageal stenosis requiring endoscopic dilation were analyzed.RESULTS Grade 1, 2, and 3 esophagitis occurred in 19(30.6%), 39(62.9%), and 4 patients(6.5%), respectively, without grade ≥ 4 toxicities. Sixteen patients(25.8%) developed post-RT stenosis, of which 7 cases(43.8%) were malignant. Four patients(6.5%) developed tracheoesophageal fistula(TEF), of which 3(75%) cases were malignant. Factors significantly correlated with post-RT stenosis were stage T3/4(P = 0.001), complete circumference involvement(P < 0.0001), stenosis at diagnosis(P = 0.024), and endoscopic complete response(P = 0.017) in univariate analysis, while complete circumference involvement was significant in multivariate analysis(P = 0.003). A higher dose(≥ 60 Gy) was not associated with occurrence of postRT stenosis or TEF. With a median follow-up of 24.3(range, 3.4-152) mo, the 2 y local control, outfield esophageal control, progression-free survival, and overall survival(OS) rates were 78.9%, 90.2%, 49.6%, and 57.3%, respectively. Factors significantly correlated with OS were complete circumference involvement(P = 0.023), stenosis at diagnosis(P < 0.0001), and occurrence of post-RT stenosis or TEF(P < 0.001) in univariate analysis, while stenosis at diagnosis(P = 0.004) and occurrence of post-RT stenosis or TEF(P = 0.023) were significant in multivariate analysis. CONCLUSION Chemoradiation for CEC was well tolerated, and a higher dose was not associated with stenosis. Patients with complete circumferential involvement require close follow-up.

High-dose interferon-α2b induction therapy in combination with ribavirin for treatment of chronic hepatitis C in patients with non-response or relapse after interferon-a monotherapy

AIM： To evaluate the daily high-dose induction therapy with interferon-α2b （IFN-α2b） in combination with ribavirin for the treatment of patients who failed with interferon monotherapy and had a relapse, based on the assumption that the viral burden would decline faster, thus increasing the likelihood of higher response rates in this difficult-totreat patient group. METHODS： Seventy patients were enrolled in this study. Treatment was started with 10 NU IFN-α2b daily for 3 wk, followed by IFN-α2b 5 NU/TIW in combination with ribavirin （1 000-1 200 mg/d） for 21 wk. In case of a negative HCV RNA PCR, treatment was continued until wk 48 （IFN-α2b 3MU/TIW＋1000-1200 mg ribavirin/daily）. RESULTS： The dose of IFN-α2b or ribavirin was reduced in 16% of patients because of hematologic side effects, and treatment was discontinued in 7% of patients. An early viral response （EVR） was achieved in 60% of patients. Fifty percent of all patients achieved an end-oftreatment response （EOT） and d0% obtained a sustained viral response （SVR）. Patients with no response had a significantly lower response rate than those with a former relapse （SVR 30% vs 53%; P=0.049）. Furthermore, lower response rates were observed in patients infected with genotype la/b than in patients with non-1-genotype （SVR 28% vs7d%; P=0.001）. As a significant predictive factor for a sustained response, a rapid initial decline of HCV RNA could be identified. No patient achieving a negative HCV-RNA PCR at wk 18 or later eventually eliminated the virus. CONCLUSION： Daily high-dose induction therapy with interferon-α2b is well tolerated and effective for the treatment of non-responders and relapsers, when interferon monotherapy fails. A fast decline of viral load during the first 12 wk is strongly associated with a sustained viral response.

Dose-individualization Efficiently Maintains Sufficient Exposure to Methotrexate without Additional Toxicity in High-dose Methotrexate Regimens for Pediatric Acute Lymphoblastic Leukemia

Objective:Methotrexate(MTX)can be safely administered to most patients but may cause severe toxicity in others.This study aimed to summarize the characteristics of high-dose methotrexate(HD-MTX)chemotherapy and to evaluate whether the modified dose-adjustment program was able to improve the maintenance of sufficient MTX exposure levels while minimizing toxicities.Methods:We evaluated 1172 cycles of high-dose MTX chemotherapy from 294 patients who were treated according to the CCCG-ALL-2015 protocol(clinical trial number:ChiCTR-IPR-14005706)and analyzed the data of actual MTX dosage,MTX concentration,toxicity,and prognosis.We compared data between the dose-adjustment Program 1(fixed 20%reduction in dose)and the dose-adjustment Program 2(dose-individualization based on reassessment of the creatine clearance rate and the MTX concentration-monitoring point at 16 h),which were applied if the MTX clearance was delayed in the previous cycle.Results:The patients who used Program 2 had higher actual MTX infusion doses and infusion rates and were able to better maintain the MTX concentration at 44 h at the established target value than those on Program 1(P<0.001).No significant differences in toxicities were found between these two programs except that abnormal serum potassium levels and prolonged myelosuppression in intermediate-risk/high-risk patients were more frequently observed in patients using Program 2(P<0.001).No significant correlations were observed between the MTX dose,dose-adjustment programs,or MTX concentrations and relapse-free survival.Conclusion:Adjusting the MTX dose using Program 2 is more efficient for maintaining sufficient MTX exposure without significantly increasing the toxicity.

The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study

Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-centered care. Methods: Cervical cancer patients (n = 31) undergoingmultiple fraction HDR brachytherapy treatment at the National Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety intensity using 11-point verbal analog scales, at 6 key time points over 2 brachytherapy insertion procedures and 4 brachytherapy fractions. Women were evaluated for psychological status at baseline before starting the brachytherapy process using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0 - 7 = normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in 12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported, with a maximum intensity in the operating room during spinal anesthesia (3.23 ± 1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety scores were reported in 25.8% and 22.6% of patients respectively. Level of education showed a significant correlation with anxiety scores (p = 0.027). Pain increased significantly during the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary multifraction high-dose rate brachytherapy is associated with mild to moderate levels of pain and anxiety, although a subset of patients reported more severe symptoms and may require additional medical and psychological support, with particular emphasis on bed-rest duration and applicator removal. The development of effective interventions (both pharmacological and non-pharmacological) is needed to improve women’s experiences of brachytherapy for locally advanced cervical cancer.

Very-high-dose olanzapine for treatment-resistant schizophrenia

Treatment-resistant schizophrenia has an extremely negative impact on mental health and social life. If clozapine, the gold standard treatment, fails, there are very few options left. The literature suggests that high-dose olanzapine (20 - 60 mg/day) is a possible alternative. We report two cases in which very high doses of olanzapine were administered, with significant clinical improvements above 60 mg/day. Clinical, metabolic and cardiac tolerance was good. This report highlights the usefulness of very-high-dose olanzapine in treatment-resistant schizophrenia. The main hypotheses concerning the psychopharmacological mechanisms of very-high-dose olanzapine are discussed.

Comparison of High-Dose Dexamethasone and Prednisone for Initial Treatment of Adult Primary Immune Thrombocytopenia

Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the definition of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%;P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM produced longer response duration compared to a conventional dose of prednisone. Randomized clinical trials are warranted to establish the optimal initial steroid therapy for adult ITP.

A New Variant of Combined Pulmonary Fibrosis and Emphysema from Long-Term High-Dose of Glucocorticoid Therapy: A Case Report

Recent studies have described the combination of both pulmonary emphysema and idiopathic interstitial lung disease (ILDs) by means of high-resolution computed axial tomography (HRCT). Definition of this syndrome was first named by Cottin as combined pulmonary fibrosis and emphysema (CPFE). Functional and radiological findings have showed that these patients are suffering from severe breathlessness, but whose pulmonary functional tests revealed no signs of obstruction, normal static lung volumes, and depressed DLco, most with a history of smoking [1] [2]. The radiological and endoscopic studies especially show that these patients have both areas of upper-lobe predominant emphysema and lesions compatible with fibrosis in both lung bases [3]. No prior research has reported any cases of such condition in person with no prior history of smoking as well as long-term high-dose of glucocorticoid therapy. In this case report, we discuss the presentation, diagnosis, and management of a 53-year-old non-smoker with increasing shortness of breath with a long-term high-dose of glucocorticoid therapy discovered to have an abnormal variant or presentation of CPFE. The cause of disease was attributed to a certain history of smoking in most studies;other potential risk factors have yet to be properly analyzed. This clinical report features a special case about the problem and solution surrounding this issue.

基于在线柱切换液相色谱技术的红霉素软膏含量测定研究

目的建立在线柱切换高效液相色谱法测定红霉素软膏中主药含量的方法,为相关制剂的质量控制提供有效手段。方法样品经80℃提取后直接进样,柱切换系统下,采用C_(18)(50 mm×2.1 mm,5μm)色谱柱初步分离,2.5 min后转入C_(18)(150 mm×2.1 mm,5μm)柱进行分析,流速0.2 mL·min^(-1),柱温35℃。结果红霉素在1~100μg·mL^(-1)范围内线性关系良好(r=0.9994);平均加样回收率大于96.9%;日内和日间精密度小于1.29%(n=6)。结论本研究改进样品提取方法,并通过在线柱切换完成目标组分的净化和富集,该方法操作简单、准确灵敏、稳定性好,可用于红霉素软膏的含量测定。

阿奇霉素序贯疗法联合红霉素治疗儿童肺炎支原体肺炎的临床效果分析

目的:探讨阿奇霉素序贯疗法联合红霉素治疗儿童肺炎支原体肺炎的临床效果。方法:选取2017年2月—2023年2月北京丰台医院儿科收治的肺炎支原体肺炎患儿71例作为研究对象,采用随机数字表法分为观察组(n=36)和对照组(n=35)。两组均给予退热、平喘、止咳化痰、雾化吸入等对症治疗,对照组采用阿奇霉素序贯治疗,观察组在对照组基础上采用红霉素治疗。比较两组临床症状消失时间、住院时间及肺功能指标。结果:观察组发热、咳嗽、肺部啰音消失时间和住院时间短于对照组,差异有统计学意义(P<0.001)。治疗前,两组峰值呼气流速(PEF)、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC比较,差异无统计学意义(P>0.05),治疗后,两组PEF、FEV_(1)、FVC、FEV_(1)/FVC高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:阿奇霉素序贯疗法联合红霉素治疗儿童肺炎支原体肺炎的临床效果显著,可以改善患儿肺功能,促进患儿康复,缩短患儿住院时间。

强脉冲光配合异维A酸红霉素凝胶治疗寻常型痤疮对患者皮损症状、色素沉着情况的影响

目的探讨强脉冲光配合异维A酸红霉素凝胶治疗寻常型痤疮对患者皮损症状、色素沉着情况的影响。方法回顾性分析2022年5月至2023年3月聊城市人民医院皮肤科收治的116例寻常型痤疮患者,按照治疗方式的不同分为对照组和研究组,各58例。对照组采用异维A酸红霉素凝胶治疗,研究组在此基础上联合强脉冲光治疗。对比两组临床疗效、色素沉着情况、红斑程度、痤疮病情、皮肤屏障功能、不良反应。结果观察组治疗总有效率(96.43%),高于对照组治疗总有效率(71.43%),差异有统计学意义(P<0.05)。治疗后,观察组色素沉着情况、红斑程度分值比对照组明显降低,差异有统计学意义(P<0.05);两组卡迪夫痤疮伤残指数(CADI)评分以及痤疮综合分级系统(GAGS)评分显著降低,且观察组分值比对照组降低明显,差异有统计学意义(P<0.05);两组经皮水分丢失量(TEWL)、油脂含量值显著降低,且观察组比对照组显著降低,两组皮肤含水量显著提升,且观察组比对照组提升明显,差异有统计学意义(P<0.05);两组面部皮肤干燥、面部皮肤潮红、面部局部脱皮、面部红斑烧灼感比较,差异无统计学意义(P>0.05)。结论采用强脉冲光联合异维A酸红霉素凝胶治疗寻常型痤疮,可有效缓解痤疮病情,增强其疗效,减少色素沉着以及红斑情况,提升皮肤屏障功能,且安全性较好。

小剂量红霉素联合孟鲁司特钠与布地奈德吸入剂治疗儿童难治性哮喘的临床效果

目的:研究小剂量红霉素联合孟鲁司特钠与布地奈德吸入剂治疗儿童难治性哮喘的临床效果。方法:选取2016年1月—2022年12月太仓市第一人民医院收治的82例难治性哮喘患儿,将患儿随机分为对照组(n=40)和观察组(n=42),其中对照组应用孟鲁司特钠口服与布地奈德吸入剂联合方案治疗,观察组在此基础上联合小剂量红霉素治疗,连续治疗30 d。比较两组临床疗效、症状缓解时间、治疗前后肺功能指标及炎症和免疫标志物。结果:与对照组比较,观察组治疗总有效率更高,差异有统计学意义(P<0.05)。与对照组比较,观察组咳嗽和喘息缓解时间更短,差异有统计学意义(P<0.05)。两组治疗前肺功能比较,差异无统计学意义(P>0.05),治疗后,两组肺功能均有改善,且观察组的用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、最大呼气流量(PEF)、用力呼气75%肺活量的瞬间流速(FEF_(75))及最大呼气中期流速(MMEF)水平更高,差异有统计学意义(P<0.05)。两组治疗前嗜酸性粒细胞、免疫球蛋白G(IgG)及免疫球蛋白E(IgE)水平比较,差异无统计学意义(P>0.05);治疗后,两组嗜酸性粒细胞、IgG及IgE水平均低于治疗前,观察组低于对照组,差异有统计学意义(P<0.05)。结论:应用小剂量红霉素联合孟鲁司特钠与布地奈德吸入剂治疗儿童难治性哮喘可以显著提高临床疗效,提高患儿肺功能指标,降低炎症和免疫标志物。

红霉素联合阿奇霉素序贯疗法与单用阿奇霉素治疗小儿支原体肺炎的效果对比

目的对比在小儿支原体肺炎患儿治疗中采用阿奇霉素单用及红霉素联合阿奇霉素序贯疗法治疗的效果。方法选取68例小儿支原体肺炎患儿,以随机数字表法分为对照组(34例,单用阿奇霉素治疗)与研究组(34例,红霉素联合阿奇霉素序贯疗法治疗)。对比两组治疗总有效率,临床症状缓解时间及住院时间,炎性因子水平,肺功能指标。结果研究组治疗总有效率(94.12%)较对照组(73.53%)高(χ2=5.314,P<0.05)。研究组发热缓解时间(1.52±0.43)d、肺部湿啰音缓解时间(4.26±0.39)d、咳嗽缓解时间(3.74±0.43)d、白细胞计数恢复正常时间(5.35±0.46)d及住院时间(6.07±0.61)d较对照组的(3.75±0.71)、(7.04±0.64)、(7.12±0.67)、(7.62±0.55)、(8.11±0.57)d短(t=15.665、21.629、24.756、18.460、14.248,P<0.05)。治疗前,两组白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)无显著差异(P>0.05);治疗后,研究组IL-6(7.17±1.06)pg/ml、CRP(3.22±0.42)mg/L、PCT(0.29±0.08)ng/ml较对照组的(10.51±1.13)pg/ml、(5.51±0.75)mg/L、(0.56±0.12)ng/ml低(t=12.570、15.534、10.916,P<0.05)。治疗前,两组第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)无显著差异(P>0.05);治疗后,研究组FEV1(2.08±0.45)L、FVC(3.28±0.41)L、FEV1/FVC(75.34±4.02)%较对照组的(1.71±0.29)L、(2.53±0.32)L、(67.81±3.34)%高(t=4.030、8.408、8.401,P<0.05)。结论红霉素联合阿奇霉素序贯疗法对小儿支原体肺炎患儿进行治疗可提高疗效,消除机体炎症反应,改善肺功能,进而缩短患儿的恢复时间。

光电协同技术联合常规药物治疗中重度痤疮的效果观察

目的探究光电协同技术(electro opticalsynergy,ELOS)联合常规药物治疗中重度痤疮患者的效果。方法选取2022年3月至2024年3月南阳市第一人民医院收治的中重度痤疮患者99例,其中采用异维A酸红霉素凝胶治疗的49例患者纳入对照组,按治疗方法不同分为对照组,采用异维A酸红霉素凝胶联合ELOS治疗的50例患者纳入观察组。比较两组患者的治疗效果、皮肤屏障功能与不良反应,治疗前后卡迪夫痤疮伤残指数(cardiff acne disability index,CADI)以及痤疮综合分级系统(global acne grading system,GAGS)的变化。结果观察组治疗后的治疗效果、CADI、GAGS评分显著高于对照组(92.00%比77.55%),差异有统计学意义(P<0.05);治疗后观察组皮肤油脂含量及经皮水分丢失量低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论采用常规药物与ELOS联合治疗的中重度痤疮患者的临床疗效较好,能够有效控制患者病情的发展,改善皮肤屏障,不增加不良反应风险,安全性较好,值得进一步研究。

红霉素对蔬菜萌发的胁迫效应及土壤环境风险表征

为健全红霉素的陆生生物毒性数据并对红霉素在土壤环境中的风险进行表征,本研究选用生菜、油菜、油麦菜和白菜为供试蔬菜进行红霉素不同浓度下的水培试验和盆栽实验,探究了红霉素对蔬菜种子萌发的胁迫效应和机制,通过ECOTOX数据库搜集相关数据,得出红霉素在淡水环境和土壤环境中的预测无效应浓度(PNEC),并根据盆栽实验结果对红霉素进入土壤后的环境风险进行了表征。结果表明:在红霉素胁迫下,供试4种蔬菜种子的发芽率无明显变化,根长均受到显著抑制;红霉素胁迫抑制了蔬菜种子的相对吸水量,促进了膜渗透性和幼苗体内的过氧化氢酶活性;供试4种蔬菜对红霉素的敏感程度为油菜>生菜>油麦菜>白菜,半抑制浓度依次为29.387、64.075、69.255 mg·L^(-1)和127.681 mg·L^(-1),红霉素在淡水和土壤中的PNEC分别为0.2μg·L^(-1)和0.11 mg·kg^(-1),当盆栽土壤中的红霉素含量超过250 mg·kg^(-1)时土壤环境风险较高。研究表明,根长可作为红霉素的毒性敏感指标,油菜可作为红霉素毒性指示作物,红霉素影响蔬菜种子萌发的主要机制为渗透胁迫,红霉素菌渣肥料化产物进入土壤环境中的最高红霉素含量应控制在250 mg·kg^(-1)以内。

阿奇霉素序贯疗法治疗小儿支原体肺炎的效果观察

目的探究小儿支原体肺炎患儿行阿奇霉素序贯疗法治疗的效果。方法100例小儿支原体肺炎患儿作为研究对象,依据随机数字表法分为对照组和观察组,各50例。两组患儿均采用常规治疗措施,在此基础上对照组采用红霉素静脉滴注治疗,观察组采用阿奇霉素序贯疗法治疗。比较两组患儿炎症因子指标、肺功能指标、症状缓解时间、不良反应发生率及临床疗效。结果治疗后,观察组白细胞介素-6(IL-6)(11.93±2.43)pg/ml、超敏C反应蛋白(hs-CRP)(7.19±1.02)mg/L低于对照组的(16.75±2.82)pg/ml、(15.40±1.67)mg/L,差异具有统计学意义(P<0.05)。治疗后,观察组第1秒用力呼气容积(2.01±0.59)L、用力肺活量(2.34±0.53)L高于对照组的(1.78±0.55)、(1.92±0.47)L,差异具有统计学意义(P<0.05)。观察组血象恢复正常时间(6.32±0.79)d、咳嗽缓解时间(4.17±0.57)d、啰音消失时间(4.54±0.43)d、退热时间(1.68±0.39)d短于对照组的(8.21±0.96)、(6.05±0.84)、(8.63±1.06)、(3.40±0.62)d,差异有统计学意义(P<0.05)。观察组不良反应发生率4.00%低于对照组的18.00%,差异有统计学意义(P<0.05)。观察组总有效率98.00%高于对照组的86.00%,差异有统计学意义(P<0.05)。结论对小儿支原体肺炎患儿行阿奇霉素序贯疗法治疗的效果确切,可减轻患儿炎症反应,改善患儿肺功能,加快患儿症状缓解速度,安全性较高,推广可行性较高。

QuEChERS-液相色谱-串联质谱法检测鲜蛋中4种大环内酯类抗生素残留

目的建立QuEChERS-液相色谱-串联质谱法(liquid chromatography-tandem mass spectrometry,LC-MS/MS)测定鲜蛋中泰乐菌素A、泰万菌素、红霉素A、替米考星的残留方法。方法样品经80%乙腈水溶液超声涡旋提取,分析液经QuEChERS方法净化,乙腈饱和正己烷去除脂肪,以乙腈与0.1%甲酸水(含5 mmol乙酸铵)为流动相进行梯度洗脱,采用ACQUITY UPLC BEH C_(18)色谱柱进行分离,在电喷雾正离子(electrospray ionization,ESI+)模式,多反应离子监测(multiple reaction monitoring,MRM)模式下检测,基质匹配内标法进行定量。结果对于鲜蛋基质,泰乐菌素A、泰万菌素、红霉素A在0.25~50.00μg/kg,替米考星在0.50~50.00μg/kg的浓度与其相对应的峰面积之间线性关系良好,r^(2)均大于0.999,在3种不同浓度添加水平下,泰乐菌素A、泰万菌素、红霉素A、替米考星的平均回收率为89.05%~109.82%,相对标准偏差为4.59%~11.46%。结论该方法具有较高的准确度、精密度和灵敏度,适用于检测鲜蛋中的泰乐菌素A、泰万菌素、红霉素A、替米考星。

β-溶血性链球菌对红霉素、克林霉素耐药性及对大环内酯类抗生素耐药机制研究

目的探讨BHS的耐药性及耐药基因携带情况。方法采用药敏纸片法测定BHS对红霉素、克林霉素的药物敏感性,应用PCR法检测其对大环内酯类药物耐药基因ermB、mefA。结果BHS群对红霉素及林可酰胺类药物克林霉素的耐药率较高。ermB基因阳性率为84.4%,其中GCS、GFS对该基因携带率最高均为100%,7株红霉素敏感菌株中检测出ermB基因,与耐药表型不符。mefA基因阳性率为3.1%,均在红霉素耐药菌株中检出。有1株同时携带ermB、mefA基因。结论BHS群对大环内酯类药物及林可酰胺类药物耐药率较高,其对红霉素耐药主要与核糖体糖蛋白甲基化有关。

布地奈德雾化吸入联合红霉素对支原体肺炎患儿疗效及症状改善的影响

目的探究布地奈德联合红霉素治疗支原体肺炎(Mycoplasma Pneumoniae Pneumonia,MPP)的价值。方法选取2022年8月—2023年8月南京市浦口区中医院收治的108例MPP患儿为研究对象,以随机数表法分为对照组和观察组,各54例。对照组给予红霉素治疗,观察组给予布地奈德联合红霉素治疗。对比两组临床疗效、症状改善时间及住院时间、血常规指标及血清C反应蛋白水平。结果观察组治疗总有效率(96.30%)高于对照组(85.19%),差异有统计学意义(χ^(2)=3.967,P<0.05)。观察组症状改善时间及住院时间、血常规指标及血清C反应蛋白水平低于对照组,差异有统计学意义(P均<0.05)。结论在红霉素注射治疗基础上联合布地奈德雾化吸入可发挥药物的协同作用,从而显著改善患儿临床症状,在提高临床疗效的同时降低炎性因子对机体产生的影响,从而确保预后质量。