药物治疗方案咨询系统的研究

目的：建立药物治疗方案咨询系统。为医院药师开展药学服务提供一种新型工具。方法：对临床疾病药物治疗方案的相关资料进行收集整理，按国际疾病分类(ICD)系统分类。使用Access建立数据库，运用VB、ASP语言、Java Script脚本语言实现前台咨询与后台数据库之间的互动。结果：建立了3650种疾病的药物治疗方案咨询系统，将疾病药物治疗方案信息资源由传统媒体转变为以光盘、网络等为载体的数字化媒体，实现了信息资源的共享和充分利用。结论：药物治疗方案咨询系统在大、中、小型医院及门诊部等医疗单位的单机、局域网和互联网上应用，证实该系统是医院药师参与临床疾病药物治疗，为病人提供药学服务，提高医疗质量的有力工具。     

Favorable outcome of patients with relapsed or refractory Hodgkin's disease treated with high-dose chemotherapy and stem cell rescue at the time of maximal response to conventional salvage therapy (Dexa-BEAM)

Background: Disease status before high-dose chemotherapy with autologous bone marrow transplantation (ABMT) or peripheral blood stem cell transplantation (PBSCT) is an important predictor of transplantation-related toxicity and event-free survival (EFS) for patients with relapsed or refractory Hodgkin's disease (HD). We performed a phase II study in patients with relapsed or refractory HD to evaluate the feasibility of four cycles of Dexa-BEAM followed by high-dose chemotherapy with ABMT or PBSCT.Patients and methods: Twenty-six patients (median age 30, range 20–40 years) were treated with 2–4 courses of dexamethasone, carmustine, etoposide, cytarabine and melphalan (Dexa-BEAM) as salvage chemotherapy in order to attain maximal response. Patients achieving complete response (CR) or partial response (PR) received high-dose chemotherapy with ABMT or PBSCT. The conditioning regimen used was CVB (cyclophosphamide, carmustine, etoposide).Results: Eighteen patients responded to Dexa-BEAM, resulting in a response rate of 69%. At the time of transplant 16 patients were in CR two patients in PR. At present 14 patients transplanted are in continous CR (median follow-up 40 months, range 14–60 months). Two patients with PR after four courses of Dexa-BEAM relapsed and died three months posttransplantation. Two patients with CR at the time of transplant relapsed after nine and 13 months respectively. Eight patients had rapid progressive disease after 2–4 cycles of Dexa-BEAM. One patient with progressive disease died in gram-negative sepsis after four cycles of Dexa-BEAM. There was no transplantation-related death.Conclusion: These data suggests the use of high-dose chemotherapy followed by stem cell transplantation at the time of maximal response.     

基于Excel软件的二室模型血管外给药的方案设计

为获得一种简便的二室模型血管外给药的给药方案设计方法 ,采用 Excel软件编写与给药方案相关的各种数值的计算程序。Excel规划求解法计算 tpeak、cmax,Excel单变量求解获得最大给药剂量 dmax(或最低有效剂量 dmin)。结果显示 ,输入基本参数α、β、ka、k2 1 、V1 、吸收分数 ( F )、滞后时间 ( tlag) ,以及给药间隔 (τs)、最低有效浓度 ( MEC)或最小中毒浓度 ( MTC)后 ,输入选定的维持量、给药周期 ( n)后 ,电子表格显示第 n周期 (或稳态 )第 s次给药后的瞬时血药浓度、达坪分数、负荷剂量 ,并采用单变量求解获得给药间隔内的有效血药浓度累积时间 ( tec)。     

Comparison of docetaxel and docetaxel-irinotecan combination as second-line chemotherapy in advanced non-small-cell lung cancer: a randomized phase II trial.

BACKGROUND: The aim of this study was to evaluate whether docetaxel (taxotere) treatment with or without irinotecan improved patient outcomes with similar toxicity in recurrent non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients with recurrent platinum-refractory NSCLC with Eastern Cooperative Oncology Group performance status of 0-2 were randomized to either docetaxel 30 mg/m(2) and irinotecan 60 mg/m(2) (days 1 and 8) or docetaxel 75 mg/m(2) (day 1), both administered every 3 weeks. RESULTS: A total of 130 patients were randomized. The response rate (RR) (20% versus 14%), overall survival (6.5 months versus 6.4 months) and 1-year survival (37% versus 34%) were similar in the combination and docetaxel arms, respectively. The combination arm demonstrated a longer time to tumor progression (TTP) (5.6 versus 4.8 months; P=0.065). Grade 3-4 neutropenia and anemia were similar in the combination and docetaxel arms. Grades 3-4 non-hematological toxicity (except diarrhea) was mild and was similar in the two groups. Grade 3-4 thrombocytopenia (17% versus 6%; P=0.04) and diarrhea (12% versus 3%; P=0.05) occurred more frequently in the combination arm. CONCLUSIONS: The administration of irinotecan with docetaxel in platinum-refractory NSCLC prolonged TTP, but did not improve significantly RR, median survival or 1-year survival. Second-line docetaxel monotherapy offers significant and reproducible efficacy in platinum-refractory NSCLC.     

鲑鱼降钙素不同给药方案治疗骨质疏松症所致腰背痛的成本-效果分析

目的:评价鲑鱼降钙素不同给药方案治疗骨质疏松症所致腰背痛的成本-效果。方法:将123例患者随机分为2组,甲组给予鲑鱼降钙素喷鼻,乙组给予鲑鱼降钙素肌肉注射,以药物经济学成本-效果法进行分析。结果:甲、乙组的总成本分别为1596元、2634·66元(P<0·05);疗效分别为95%、95·2%(P>0·05);成本-效果比分别为16·8、27·7。结论:甲方案优于乙方案。     

近5a视网膜静脉阻塞临床特点的回顾性分析

目的：回顾分析5a内佛山市第二人民医院眼科中心视网膜静脉阻塞的临床诊治变化。

方法：回顾性分析2013-01-01/2017-12-31于我院眼科中心的住院患者,以诊断“视网膜静脉阻塞”为检索词查阅病历信息管理系统,就其相关住院诊治情况作统计分析。

结果：5a内视网膜静脉阻塞的住院患者共351例,住院次数473人次,伴随全身疾病(高血压、糖尿病、肾功能不全)的老年人常见; 住院天数各年度间有差异,2017年较前明显缩短。5a间RVO的发病人数逐年上升,BRVO较CRVO的发病趋势增加明显,2017年两种疾病的发病比率与各年度间均有差异(P<0.005)。RVO主要采用视网膜激光光凝、玻璃体腔内注药或两者相结合的治疗方案。5a内玻璃体腔内注药治疗的注射率有差异(P<0.05),主要表现为2013年的低注射率; “1+PRN”的注射方案多于“3+PRN”。

结论：近5a BRVO较CRVO的增长趋势更明显,激光联合“1+PRN”的玻璃体腔内注药方案是我院RVO患者的主要治疗手段。     

康柏西普不同给药方案治疗视网膜分支静脉阻塞继发黄斑水肿

目的：对比康柏西普1+PRN和3+PRN方案玻璃体腔注射治疗BRVO继发ME的短期临床疗效。

方法：前瞻性随机对照研究,选取BRVO继发ME患者共40例40眼,随机分入1+PRN组18眼和3+PRN组22眼,对比两组患者BCVA和CMT变化及平均注药次数,分析视力预后的影响因素。

结果：治疗后6mo,3+PRN组BCVA(LogMAR)由0.86±0.22提高到0.41±0.12,CMT由517.4±75.1μm降低到280.1±41.8μm, 1+PRN组BCVA由0.79±0.20提高到0.42±0.14,CMT由472.7±80.7μm降低到271.6±39.6μm,治疗前后各时间点组间BCVA和CMT比较无差异(P>0.05)。3+PRN、1+PRN组平均注药次数分别为3.64±0.66、2.78±0.94次(P>0.05))。多元回归分析中,年龄、病程、基线BCVA、椭圆体带完整性表现出和良好的视力预后有关。

结论：康柏西普1+PRN和3+PRN方案治疗BRVO继发ME在短期内可以取得类似的疗效。     

Treatment of HIV infection with once-daily regimens

Introduction: Treatment for HIV infection requires a lifetime antiretroviral therapy. In order to improve adherence, once daily (OD) is thus a preferred regimen.

Areas covered: Evidence-based information and most recent guidelines recommendation, both from resource-rich and resource-limited settings, on antiretroviral regimens that can be administered OD will be reviewed. Sources of evidences were from the late clinical development studies (Phase III and II) published in Medline or major international conferences.

Expert opinion: Nine OD US FDA-approved regimens and one new integrase inhibitor OD regimen have been shown to be efficient and well tolerated. For the fixed-dose single-tablet regimens (STRs), there are two currently approved regimens: Atripla® and Complera®. Another STR elvitegravir/cobicistat/emtricitabine/tenofovir (QUAD, Stribild®) is recently approved by the US FDA (August 20, 2012), whereas two additional SRTs, including abacavir/lamivudine/dolutegravir and darunavir/cobicistat/emtricitabine/GS-7340 are undergoing Phase III and II trials, respectively. Three OD regimens are currently recommended by the US DHHS guidelines as the preferred regimens for treatment-naïve patients (efavirenz, boosted atazanavir and boosted darunavir). EFV-based regimen is the only OD regimen available for resource-limited countries. Nevertheless, it should be noted that each of these OD regimens has its own advantages and disadvantages and therefore should be selected accordingly.     

Dual views of SRF: a genomic exposure

Esnault and colleagues (pp. 943–958) take a genomics approach to investigate the role of SRF (serum response factor) in the serum response of fibroblasts. The well-established dual role of SRF with alternative cofactors and responsiveness to two signaling pathways is illustrated at the genome-wide level, yet new insight comes from this global picture.