Therapeutic adherence to bisphosphonates.

Therapeutic adherence of patients is a key factor of treatment success in clinical praxis, although it is often neglected. Several studies have shown that insufficient persistence and compliance cause differences in the efficiency of treatments in clinical studies and clinical praxis. A recent meta-analysis even showed a clear inverse relationship between therapeutic adherence and mortality. Factors influencing the adherence to treatment include explanations by the physician, characteristics of the disease, patient's attitudes, but also the therapeutic regime. Osteoporosis as a chronic disorder with relatively long asymptomatic initial course represents a major problem. In addition, the currently available therapeutic regimes are discomfortable and, thus, contribute to the low therapeutic adherence of the patient. One of the factors causing discomfort in bisphosphonates therapy is the frequency of application--once daily or once weekly. Several questionnaire-based studies have shown that patients clearly prefer the new alternative once monthly regime available for ibandronate. Although the efficiency of the drug is proven in large clinical trials, the effects of the once monthly regime itself on hard clinical end-points like mortality can only be analyzed in long-term follow-up studies.     

青岛地区3种根除幽门螺杆菌治疗方法的临床观察比较

目的:通过观察奥美拉唑、克拉霉素、阿莫西林、甲硝唑、呋喃唑酮不同分组短程三联疗法的临床疗效,确定青岛地区用于治疗幽门螺杆菌抗生素的耐药率,选择最合适的三联治疗方案,避免新的耐药茵株的出现.方法:396例消化性溃疡或浅表性胃炎合并幽门螺杆菌阳性患者,随机分为3组:①奥美拉唑20 mg 克拉霉素500 mg 阿莫西林1 000 mg组,132例;②奥美拉唑20 mg 阿莫西林1 000 mg 甲硝唑400 mg组,132例;③奥美拉唑20 mg 阿莫西林1 000 mg 呋喃唑酮100 mg组,132例.2次/d,每个疗程7 d.抗幽门螺杆菌治疗结束后1个月,全部做胃镜检查.结果:3组幽门螺杆菌的根除率分别为86.12%(112/130)、59.23%(77/130)和92.24%(122/132),耐药率分别为13.88%、40.77%和7.58%,①组和③组间差异无统计学意义(χ2=2.7,P＞0.05),而②组的根除率、耐药率与①组和③组间经χ2检验,差异有统计学意义(P＜0.01).3组的消化灶溃疡愈合率分别为61.11%、48.64%和82.86%,①组和②问差异无统计学意义(χ2=1.14,P＞0.05),③组与①组和②组间经χ2检验,差异有统计学意义(P＜0.01);不良反应发生率分别为2.3%(3/130)、8.5%(11/130)和6.1%(8/132).结论:青岛地区根除幽门螺杆菌的三联疗法首选方案为:①奥美拉唑20 mg 克拉霉素500 mg 阿莫西林1 000 mg组争③奥美拉唑20 mg 阿莫西林1 000 mg 呋喃唑酮100 mg组.     

Morphine, morphine-6-glucuronide and morphine-3-glucuronide pharmacokinetics in newborn infants receiving diamorphine infusions

1The pharmacokinetics of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) were studied in 19 ventilated newborn infants(24–41 weeks gestation) who were given a loading dose of 50 μg kg⁻¹ or 200 μg kg⁻¹ of diamorphine followed by an intravenous infusion of 15 μg kg⁻¹ h⁻¹ of diamorphine. Plasma concentrations of morphine, M3G and M6G were measured during the accrual to steady-state and at steady state of the diamorphine infusion. 2Following both the 50 μg kg⁻¹ or 200 μg kg⁻¹ loading doses the mean steady-state plasma concentration (±s.d.) of morphine, M3G and M6G were 86±52 ng ml⁻¹, 703±400 ng ml⁻¹ and 48±28 ng ml⁻¹ respectively and morphine clearance was found to be 4.6±3.2 ml min⁻¹ kg⁻¹. 3M3G formation clearance was estimated to be 2.5±1.8 ml min⁻¹ kg⁻¹, and the formation clearance of M6G was estimated to be 0.46±0.32 ml min⁻¹ kg⁻¹. 4M3G metabolite clearance was 0.46±0.60 ml min⁻¹ kg⁻¹, the elimination half-life was 11.1±11.3 h and the volume of distribution was 0.55±1.13 l kg⁻¹. M6G metabolite clearance was 0.71±0.36 ml min⁻¹ kg⁻¹, the elimination half-life was 18.2±13.6 h and the volume of distribution was 1.03±0.88 l kg⁻¹. 5No significant effect of the loading dose (50 μg kg⁻¹ or 200 μg kg⁻¹) on the plasma morphine or metabolite concentrations or their derived pharmacokinetic parameters was found. 6We were unable to identify correlations between gestational age of the infants and any of the determined pharmacokinetic parameters. 7M3G:morphine and M6G:morphine steady-state plasma concentration ratios were 11.0±10.8 and 0.8±0.8, respectively. 8The metabolism of morphine in neonates, in terms of the respective contributions of each glucuronide pathway, was similar to that in adults.     

Improved metabolic outcome in a Danish diabetic paediatric population aged 0–18 yr: results from a nationwide continuous Registration

The objective of the present study was to describe the changes in glycaemic control based on data from the nationwide Danish Registry of Childhood Diabetes with valid haemoglobin A1c (HbA1c) readings centrally analysed between 1996 and 2006. The glycaemic control was assessed using generalized linear mixed models. Centre, age, diabetes duration, ethnicity, sex, self-monitoring of blood glucose, insulin regimens and hypoglycaemia was tested as explanatory variables. There were 9291 HbA1c recordings from 2705 children with T1D during the 10-yr period. The unadjusted mean HbA1c value in 1997 was 9.05% (95% CI ± 0.82) and in 2006 was 8.20% (95% CI ± 0.06). Mean HbA1c was significantly reduced over the years with a linear decrease of 0.08% per year (95% CI ±0.011) (p < 0.0001). The decrease was unaffected by adjusting for number of injections, insulin/kg and use of insulin analogous. During the period, an increased frequency of self-monitored blood glucose was observed that was associated with a reduction in HbA1c (p < 0.0001). The percentage of children with severe hypoglycaemia decreased from 12.2 to 7.8% in those with HbA1c between 6 and 8%. Metabolic control in diabetic children has improved on a nationwide basis from the establishment of the national registry in 1996. The reduction in HbA1c was related to an increased number of self-monitoring of blood glucose values and a decrease in the number of hypoglycaemic events in those with the best metabolic control, whereas there were no association with the use of new analogous or insulin regimens.     

HLFP方案治疗晚期食管癌的临床观察

目的　观察HLFP方案和LFP方案治疗晚期食管癌的近期疗效及毒副反应。方法　治疗组 40例采用HLFP方案 ,对照组 40例采用LFP方案。以上方案每 2 8天为一周期 ,至少完成二周期。结果　治疗组有效率 67 5 % ,对照组有效率为 45 0 %。有显著性差异 (P <0 0 5 )。结论　HLFP方案治疗晚期食管癌疗效较好 ,毒副反应可耐受 ,值得临床推广应用。     

补肾健脾消积方联合XELOX方案治疗大肠癌根治术后患者的临床研究*

目的：观察补肾健脾消积方联合XELOX方案应用于大肠癌根治术后患者的临床疗效。方法：将58例予以大肠癌根治术的患者随机分为观察组和对照组,每组各29例,两组均采用XELOX方案化疗4个疗程,观察组在化疗基础上服用补肾健脾消积方。观测两组T细胞亚群[CD3+、CD4+、CD8+、CD4+/CD8+、自然杀伤细胞(natural killer cell, NK)]、癌胚抗原(carcinoembryonic antigen, CEA)和CA199、卡氏功能状态评分(Karnofsky performance score, KPS),并进行比较来评估补肾健脾消积方对大肠癌术后化疗患者的免疫功能影响。结果：两组化疗后CD3+、CD4+、CD4+/CD8+、NK数量均上升,观察组上升更显著(P＜0.05),而CD8+无明显变化;两组CEA与CA199均下降,观察组下降更显著(P＜0.05);观察组患者KPS评分改善优于对照组(P＜0.05)。结论：补肾健脾消积方能增加大肠癌患者化疗耐受性,提高患者的免疫功能和生活质量,是大肠癌患者术后行化疗合适的辅助用药。     

Using cost as a consideration for antiretroviral regimen selection: An example using average wholesale prices

Funding for the AIDS Drug Assistance Program (ADAP) has lagged behind the number of persons needing antiretroviral therapy, leading to waiting lists and reduction of needed treatments and services. This paper demonstrates a method of providing more treatment for the same amount of money by selecting clinically equivalent, but lower-cost drug regimens. Average wholesale prices (AWPs) were used to calculate the annual costs of preferred, alternative, and acceptable regimens. The cost of each regimen was divided into $1,000,000 to determine how many patients could be treated per $1,000,000 that an ADAP had to spend. AWPs for preferred regimens ranged from $25,318 to 35,645 per year. For alternative regimens, the range of annual AWPs was $22,002–$32,335. The range for the acceptable regimens was $19,031–$31,543. The range of person treated per $1,000,000 per year was from 28 to 52. Funding shortages will lead ADAPs to resort to waiting lists or other means of denying appropriate care unless alternative approaches to treatment are sought. Cost conscious selection of regimens where there is no harm to individual patients is one alternative approach. Medical conditions that allow exceptions to lower-cost-based regimens must be developed with the assistance of clinicians.     

曲妥珠单抗联合改良DCF方案治疗HER2阳性晚期胃癌患者的护理

目的 总结人表皮生长因子受体2（HER2）阳性晚期胃癌患者应用曲妥珠单抗联合改良DCF方案化疗的护理体会.方法 回顾性分析2011年1月至2012年12月收治的20例应用曲妥珠单抗联合改良DCF方案治疗HER2阳性晚期胃癌患者的临床资料,并总结护理要点.结果 20例患者经过联合治疗后疾病控制率为80％,主要不良反应为骨髓抑制12例、恶心或呕吐7例、心脏毒性5例、高血糖3例、低钠血症3例、肝功能损害3例、口腔炎2例,程度Ⅰ～Ⅲ级,经对症治疗与护理后,不良反应均得到缓解,取得了满意的疗效.结论 HER2阳性晚期胃癌患者应用曲妥珠单抗联合改良DCF方案化疗是一种新的、有效的治疗方法,采用针对性的护理措施可以减少和改善患者治疗期间的不良反应,提高生活质量.     

“早太极、晚八段”对社区2型糖尿病失眠患者睡眠质量的影响

目的：观察“早太极、晚八段”的中医运动养生法对社区2型糖尿病失眠患者睡眠质量的干预效果。方法：将62例社区2型糖尿病伴失眠患者以社区为单位随机分为试验组32例和对照组30冽,在常规治疗基础上,试验组采用“早太极、晚八段”的中医运动养生法进行干预,对照组每天进行步行锻炼。结果：试验组患者失眠疗效高于对照组（P〈0．05）,匹兹堡睡眠质量指数低于对照组（P〈0．05）。结沦：“早太极、晚八段”的中医运动养生法对2型糖尿病失眠患者睡眠质量有一定的改善作用。     

中低位直肠癌术前超分割放疗联合FOLFIRI方案全身化疗的临床疗效观察

目的探讨中低位直肠癌术前超分割放疗联合化疗的可行性及其临床疗效观察。方法对68例中低位直肠癌患者进行回顾性研究,按放疗方法分为术前超分割放化疗组（A组）和常规分割放化疗组（B组）。A组：DT：30Gy／10次／5d,1-2周后手术;B组：DT：40Gy／20次／5周,4周后手术。两组分别于放疗的第1天及第8天化疗2周期。结果A、B组近期毒性反应及肿瘤降期率差异无统计学意义（P〉0．05）,手术切除率为100％。A组保肛率为79．4％,B组为85．3％,两者差异无统计学意义（P〉0．05）。结论中低位直肠癌术前超分割放疗联合化疗是可行的,且疗效与常规放化疗相当,但在治疗时间上明显缩短,值得进一步研究。