丹参酮ⅡA磺酸钠联合辛伐他汀治疗冠心病心绞痛的临床研究

目的观察丹参酮ⅡA磺酸钠注射液联合辛伐他汀治疗冠心病心绞痛的临床疗效和安全性。方法 98例冠心病心绞痛患者随机分为试验组49例与对照组49例。试验组口服辛伐他汀10 mg·d^-1,静脉滴注丹参酮ⅡA磺酸钠60mg·d^-1,加入250 m L葡萄糖溶液中。对照组口服辛伐他汀10 mg·d^-1。2组疗程均为1个月。比较2组的临床疗效、血脂、心功能、血流动力学水平,并观察2组不良反应发生情况。结果试验组总有效率为87.75%,显著高于对照组的71.43%（P<0.05）。2组血脂水平各指标治疗后均较治疗前显著下降（P<0.05）,试验组显著低于对照组（P<0.05）。2组心功能水平各指标治疗后均较治疗前增加（P<0.05）,试验组显著高于对照组（P<0.05）;2组血流动力学各指标治疗后均较治疗前显著下降（P<0.05）,试验组显著低于对照组（P<0.05）。治疗期间均无严重不良反应发生。结论丹参酮ⅡA磺酸钠注射液联合辛伐他汀治疗冠心病心绞痛临床疗效显著,可明显改善患者的血脂、心功能及血流动力学,且安全可靠。     

小金片联合NX方案治疗紫杉类及蒽环类耐药晚期乳腺癌的临床研究

目的观察小金片联合NX化疗方案(长春瑞滨联合卡培他滨)治疗紫杉类及蒽环类耐药晚期乳腺癌的临床效果。方法选取2019年1月—2020年1月南阳市第二人民医院收治的100例紫杉类及蒽环类耐药晚期乳腺癌患者,根据信封抽签法分为对照组和治疗组,每组各50例。对照组给予NX化疗方案治疗,第1、8天静脉滴注酒石酸长春瑞滨注射液,25 mg/m²;第1~14天口服卡培他滨片,1 000 mg/m²,2次/d。治疗组在对照组基础上口服小金片,2片/次,2次/d。以21 d为1个周期,两组患者共治疗4个周期。观察两组疗效,比较两组的KPS评分、细胞免疫功能指标、血清肿瘤标志物。结果治疗后,治疗组的客观缓解率为64.00%,较对照组的44.00%更高(P<0.05)。治疗后,两组KPS评分升高(P<0.05),且治疗组KPS评分高于对照组(P<0.05)。治疗后,两组患者CD8+升高,CD³⁺、CD⁴⁺、CD⁴⁺/CD8+下降(P<0.05),治疗后治疗组CD8+比对照组高,CD³⁺、CD⁴⁺、CD⁴⁺/CD8+比对照组更低(P<0.05)。治疗后,两组癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原199(CA199)水平下降(P<0.05),且治疗组CEA、CA125和CA199水平比对照组更低(P<0.05)。结论小金片联合NX化疗方案治疗紫杉类及蒽环类耐药晚期乳腺癌具有较好的疗效,可有效阻止疾病进展,提高生活质量,减轻免疫抑制,降低患者血清肿瘤标志物水平,安全较好。     

尼可地尔对冠心病介入治疗后心绞痛患者症状及近期预后的影响分析

目的探讨尼可地尔对冠心病介入治疗后心绞痛患者症状及近期预后的影响。方法80例冠心病介入治疗后心绞痛患者,根据治疗模式的差异分为对照组及研究组,每组40例。对照组实施常规治疗,研究组在对照组基础上实施尼可地尔治疗。比较心绞痛视觉模拟评分法(VAS)评分、心功能分级、血小板计数、血脂指标(低密度脂蛋白胆固醇、总胆固醇、甘油三酯)、治疗效果及不良反应发生情况。结果治疗后,研究组心绞痛VAS评分(1.24±0.12)分、心功能分级(1.21±0.12)级、血小板计数(114.56±12.12)×10⁹/L均显著低于对照组的(2.45±0.67)分、(2.34±0.55)级、(148.56±12.21)×10⁹/L,差异有统计学意义(P<0.05)。治疗后,研究组低密度脂蛋白胆固醇、总胆固醇、甘油三酯均显著低于对照组,差异有统计学意义(P<0.05)。研究组治疗总有效率97.50%高于对照组的80.00%,差异有统计学意义(P<0.05)。研究组不良反应发生率2.50%低于对照组的20.00%,差异具有统计学意义(P<0.05)。结论冠心病介入治疗后心绞痛患者采用尼可地尔治疗可更好改善病情,并有利于改善心功能和血脂水平,值得推广。     

白蛋白结合型紫杉醇联合顺铂腹腔灌注治疗晚期卵巢癌的效果研究

目的：探究白蛋白结合型紫杉醇联合腹腔灌注疗法治疗晚期卵巢癌的临床疗效及安全性。方法：选取2019年1月—2022年1月本院收治的晚期卵巢癌患者80例,随机分为对照组和观察组,各40例。对照组行白蛋白结合型紫杉醇顺铂治疗,观察组行白蛋白结合型紫杉醇联合顺铂腹腔热灌注化疗(IHPC),比较两组临床疗效、肿瘤标志物水平、免疫功能指标及不良反应发生情况。结果：观察组近期治疗有效率为92.50%,高于对照组的75.00%(P<0.05);治疗后,观察组CEA、CA125、CA199以及HE4水平低于对照组,CD³⁺、CD⁴⁺、CD⁸⁺以及NK水平高于对照组(P<0.05);两组胃肠道反应、骨髓抑制、关节酸痛、肾功能损害发生率比较,差异无统计学意义(P>0.05)。结论：对晚期卵巢癌患者行白蛋白结合型紫杉醇联合腹腔灌注疗法治疗的近期疗效良好,可调节肿瘤标志物水平与免疫功能,且安全系数较高。     

达那唑治疗老年难治性免疫性血小板减少性紫癜临床疗效及对患者T淋巴细胞影响

目的 分析达那唑治疗老年难治性免疫性血小板减少性紫癜的临床疗效,及对患者T淋巴细胞的影响。方法 选取2011年1月至2020年10月我院收治的62例老年难治性免疫性血小板减少性紫癜患者为研究对象,将其随机分为对照组和观察组,每组31例。两组患者均予以环孢素A治疗;观察组再予以达那唑治疗。两组患者均连续治疗3个月为一疗程。所有患者治疗前、治疗后均采集空腹静脉血检测T淋巴细胞构成（CD⁺₃、CD⁺₄、CD⁺₈、CD⁺₄/CD⁺₈）;治疗3个月后,对两组患者的临床疗效进行测评并行组间比较,收集两组患者治疗期间药物不良反应并行组间比较。结果 （1）治疗3个月后,观察组患者临床总有效率高于对照组患者,差异有统计学意义（P<0.05）;（2）两组患者治疗前CD⁺₃、CD⁺₄、CD^...     

生长抑素联合艾司奥美拉唑对ERCP术后胰腺炎的防治意义及其对血清淀粉酶、炎症指标和T细胞的影响

目的：探讨生长抑素联合艾司奥美拉唑对ERCP术后胰腺炎(PEP)的防治意义及其对血清淀粉酶、炎症指标和T细胞的影响。方法：纳入2021-01～2022-10在本院行ERCP术的患者66例进行研究，并以随机数字表法将其分为研究组和对照组两组，每组33例。两组均行ERCP术，对照组于ERCP术后1h给予生长抑素治疗，研究组则于术后1h采用生长抑素联合艾司奥美拉唑治疗，两组均连续治疗5d。比较ERCP术后两组高血清淀粉酶和PEP发生率、治疗前后AMS、炎性因子(IL-6、CRP)和外周血T淋巴细胞(CD⁺₃、CD⁺₄、CD⁺₈、CD⁺₄/CD⁺₈)水平。结果：与对照组相比较，研究组术后PEP和高淀粉酶血症发生率较低(P<0.05);治疗后6h、24h两组AMS水平降低，且观察组各项指标优于对照组(P<0.05);治疗后两组IL-6、CRP水平降低，CD^+...     

肝动脉化疗栓塞术联合阿帕替尼对原发性肝癌患者疾病缓解率、免疫功能的影响

目的：探讨肝动脉化疗栓塞(TACE)术联合阿帕替尼对原发性肝癌(PLC)患者疾病缓解率、免疫功能的影响。方法：选取2018-09～2020-09本院收治的PLC患者97例，按照治疗方案分组，将行TACE术治疗的47例作为常规组，将采用TACE术联合阿帕替尼治疗的50例作为实验组。对比两组疾病缓解率、术前1 d、术后2周免疫功能。结果：实验组疾病缓解率较常规组高(P<0.05);术后2周，实验组CD⁺₃、CD⁺₄、CD⁺₄/CD⁺₈较常规组高，CD⁺₈较常规组低(P<0.05)。结论：TACE术联合阿帕替尼治疗PLC可提高疾病缓解率，改善免疫功能。     

孟鲁司特钠联合福莫特罗干粉吸入剂治疗小儿支气管哮喘的临床疗效观察

目的 探讨在小儿支气管哮喘治疗中应用孟鲁司特钠+福莫特罗干粉吸入剂,对患儿疗效、血清炎性因子、免疫因子水平的影响。方法 选取小儿支气管哮喘患儿100例,随机分为对照组和实验组,各50例。对照组采用福莫特罗干粉吸入剂治疗,实验组采用孟鲁司特钠+福莫特罗干粉吸入剂治疗,比较两组疗效差异。结果 治疗后,实验组IL-6、CRP水平低于对照组,CD4⁺、CD8⁺、CD4⁺/CD8⁺水平高于对照组（P<0.05）;实验组疗效总优良率高于对照组（P<0.05）。结论 在小儿支气管哮喘治疗中,给药孟鲁司特钠联合福莫特罗干粉吸入剂,可有效改善患儿的机体炎症反应,提升免疫水平,整体疗效表现突出。     

利胆合剂对肝病综合征患儿的临床疗效及其对炎症因子的影响

目的 观察利胆合剂对婴儿肝病综合征的临床疗效及其对炎症因子影响。方法 82例肝病综合征患儿随机分为试验组和对照组,每组41例。对照组患儿给予更昔洛韦抗病毒治疗,诱导期5 mg·kg^-1,每天2次,连用14 d;维持期5mg·kg^-1,每天1次,连用14 d。试验组患儿在此基础上加用利胆合剂口服或灌肠治疗,28 d为1个周期。比较2组患儿的临床疗效、巨细胞病毒免疫球蛋白M（CMV-IgM）转阴率、症状消失时间、肝功能指标、炎症因子变化水平和不良反应发生率。结果 试验组患儿治疗有效率和CMV-IgM转阴率分别为92.7%和87.8%,显著高于对照组的75.6%和68.3%（P<0.05）。试验组黄疸消退天数、肝脾回缩天数显著低于对照组（P<0.05）,但体重增长差异无统计学意义（P>0.05）。试验组患儿治疗后总胆红素、直接胆红素、丙氨酸氨基转移酶、总胆酸、γ-谷氨酰转肽酶水平均显著低于治疗前和对照组（P<0.05）。试验组患儿肿瘤坏死因子α和白细胞介素6水平分别为（206.7±48.6）,（29.7±5.0）ng·L^-1,显著优于对照组的（283.6±34）,（38.9±3.1）ng·L^-1（P<0.05）。2组患儿不良反应发生率差异无统计学意义（P>0.05）。结论 中西医结合治疗对婴儿肝病综合征临床疗效显著,通过减轻患儿炎症反应改善整体症状。     

宫颈癌应用放化疗联合复方苦参注射液治疗对细胞免疫功能影响分析

目的:通过观察放化疗联合复方苦参注射液治疗宫颈癌临床疗效及对患者细胞免疫功能及生活质量影响,从而为临床宫颈癌患者治疗提供有力依据。方法:按照随机数字表法将诊断为80例Ⅲ_a~Ⅳ期宫颈癌患者分组为对照组与治疗组,各40例。对照组采用放化疗治疗;治疗组于放化疗治疗基础上加用复方苦参注射液治疗;28 d为1个周期,2组均治疗3个周期。于治疗前及治疗后第2天检测2组患者细胞免疫功能,统计2组患者临床疗效、生活质量、不良反应。结果:经治疗3个周期后,治疗组CD³⁺、CD⁴⁺、NK细胞及CD⁴⁺/CD⁸⁺值较治疗前明显提高,而CD⁸⁺值较治疗前明显下降,且优于对照组,P<0.05;对照组CD⁸⁺及NK细胞数较治疗前稍增加,其他指标较治疗前略下降,P>0.05。治疗组总有效者19例(总有效率为47.5%)明显高于对照组13例(32.5%),P<0.05。治疗组生存质量改善者为37例(改善率为92.5%)明显高于对照组29例(72.5%),P<0.05;治疗组不良反应率明显低于对照组,P<0.05。结论:应用复方苦参注射液联合放化疗治疗宫颈癌,其可减少不良反应,增强患者细胞免疫功能,从而提高临床疗效及患者生活质量。     

中西药联合胆肾推经仪治疗肝内胆管结石38例临床观察

目的 观察胆维他、25％硫酸镁、中药消炎利胆Ⅰ号联合胆肾推经仪治疗肝内胆管结石的临床疗效。方法 38例肝内胆管结石患者口服消炎利胆Ⅰ号溶石化石，胆维他利胆消炎保肝，25％硫酸镁解痉止痛扩张肝胆管。配合胆肾推经平板式电极刺激和手柄式电极推按，确定排石体位、结石部位，调节仪器频率和强度，疗程为10天和30天。结果 治疗后，经B超、胆囊造影、CT检查对比，排石总有效率91．61％。其中排净27例（占71．05％），显效8例（占20．56％），无效3例（占7．9％），与治疗前相比，差异有显著性（P〈0．1〉。结论 中西药联合胆肾推经仪治疗肝内胆管结石可明显提高排石率，改善胆道炎症，消除黄疸，是一种安全有效，经济方便的治疗方法。     

Association of Vancomycin Serum Concentrations With Outcomes in Patients With Gram-Positive Bacteremia

We attempted to determine if an association exists between vancomycin serum concentrations resulting from traditional dosing regimens, and efficacy and toxicity outcomes. We reviewed the medical charts of 273 consecutive patients prescribed 273 courses of vancomycin therapy for documented, gram-positive bacteremia. Of the 273 courses of therapy, 45 and 31 patients met all criteria and were evaluated for toxicity and efficacy, respectively. The duration of fever and abnormal white blood cell counts, length of hospital stay, overall mortality, serum creatinine, and serum vancomycin concentrations were evaluated retrospectively. No association between initial peak or trough levels with mortality was noted. However, patients were more likely to become afebrile within 72 hours if peak and trough concentrations were 20 μg/ml or greater and 10 μg/ml or greater, respectively (p<0.01). Patients were also more likely to have their white blood cell count return to normal within 72 hours if trough concentrations were 10 μg/ml or above (p<0.01). No statistically significant correlation between nephrotoxicity and initial serum creatinine, days of hospital stay, or days of vancomycin therapy were found. Serum concentrations of vancomycin, assessed before the development of nephrotoxicity, were significantly higher in patients who became nephrotoxic. Mean (SD) trough concentrations were 23.2 (2.5) μg/ml and 10.2 (3.8) μg/ml in nephrotoxic and nonnephrotoxic patients, respectively. Our results suggest that the commonly accepted therapeutic range for vancomycin trough concentrations (<10 μg/ml) may be too restrictive in patients receiving vancomycin therapy alone.     

苦参注射液联合放疗治疗老年食管癌的疗效

目的:探讨苦参注射液联合放疗治疗老年食管鳞癌的疗效及毒性.方法:选取 70 例老年食管鳞癌患者,随机分为单纯放疗组(单放组)35 例和苦参联合放疗组(综合组)35 例.两组均采用调强放疗技术;综合组联合应用苦参注射液 20 ml + 氯化钠注射液 250 ml,静脉滴注,1 次/ d,放疗全程应用.结果:两组患者疗效差别有统计学意义(P < 0. 05);综合组急性血液毒性及急性放射性食管炎的发生率低于单放组;两组急性放射性肺炎的发生率差异无统计学意义.结论:苦参注射液可提高老年食管癌单纯放疗的疗效,减轻放疗毒副作用.     

Immunomodulation With Intravenous Immunoglobulin

Since its introduction over a decade ago for the treatment of primary immunodeficiencies, intravenous immunoglobulin (IVIG) has demonstrated activity in a variety of autoimmune disorders. An understanding of IVIG's immunomodulatory effects provides the rationale for its potential application in the management of autoimmune disorders. The agent has exhibited the ability to block fragment crystallizable receptors on phagocytes, interact with the idiotype-anti-idiotype network, and modulate T lymphocyte, B lymphocyte, and natural killer cell populations, as well as complement activity. Its immunomodulatory effects have been demonstrated in a variety of disorders such as idiopathic thrombocytopenic purpura, Guillain-Barré syndrome, Kawasaki disease. Numerous case reports and small studies revealed IVIG's activity in a variety of other autoimmune disorders, but controlled clinical trials are necessary to clarify these initial observations.     

Anaphylactoid Reaction With Suramin

Suramin, a drug used to treat parasitic diseases, is currently being investigated as a treatment for metastatic prostate cancer. A 73–year-old man had an anaphylactoid reaction following the first dose of suramin. It was treated successfully with epinephrine, diphenhydramine, and hydrocortisone. Investigators should be aware of the possibility of such a reaction with parenteral administration of this drug.     

Optimal Designs With Interim Analyses for Randomized Studies With Long-Term Time-Specific Endpoints

With the advent of novel cancer therapies targeting molecular pathways or the immune system, time-to-event variables evaluated at longer times (e.g., 6 or 12 months) are increasingly used as the primary endpoint in randomized Phase II trials. Two-stage “Simon” designs have often been used in single-group phase II oncology trials to reduce the expected sample size under the null hypothesis. We develop optimal two-stage and three-stage randomized two-group designs with analogous optimality criteria. Accurate implementation of the Simon design can be difficult, and the difficulty increases with a longer-term endpoint, because it requires complete information from each accrued patient. Earlier work of Case and Morgan generalized the Simon design so it can be implemented without an accrual pause. We derive optimal designs that allow a brief preplanned pause (? 0) in accrual before interim analyses to more efficiently use data from the accrued patients, and to allow focused data collection before the interim analyses. We provide software (R package OptInterim) that creates the optimal designs and also simulates their properties to check asymptotic approximations and the robustness of the designs to differing conditions. Various design options are illustrated using an example based on a recent colorectal cancer drug trial.