以孕酮水平确定冻融胚胎移植时间的临床研究

目的比较基于排卵监测的方案(MOR)与基于孕酮水平监测的方案(MPR)确定自然周期冻融胚胎移植(FET)时机的临床结局。方法回顾性分析190个自然周期FET的临床资料。结果 61.1%(116/190)的周期应用MPR方案,38.9%(74/190)为MOR方案;MOR组生化妊娠率为9.5%,同MPR组(1.7%)相比显著升高(P=0.014);然而,MPR、MOR组的临床妊娠率相似,分别为53.4%及51.4%,种植率、持续妊娠率及活产率的差异亦无统计学意义(P0.05)。多元Logistic回归分析显示移植方案是生化妊娠的独立影响因素,MPR与生化妊娠呈负相关[(OR0.050,95%CI(0.004,0.593)](P=0.018)。结论在基本情况及周期治疗情况相似的患者中,与MOR方案相比,MPR方案进行自然周期FET可能获得更低的生化妊娠率(即更低的妊娠丢失率),但仍需进一步研究证实。     

Development of reduced-intensity hematopoietic stem cell transplantation in the National Cancer Center Hospital,Japan

Reduced-intensity hematopoietic stem cell transplantation (RIST) is a new approach of stem cell transplantation, which has shown promising features as reported in multiple phase I and II studies. Elderly patients, who are not eligible for conventional myeloablative hematopoietic stem cell transplantation (HSCT), are now treatable with RIST. It has also reduced regimen-related toxicity and provided better prognosis in short-term follow-up than that of conventional HSCT. Favorable results have been reported particularly in hematological malignancies, such as chronic myelocytic leukemia and malignant lymphoma. Among solid tumors, metastatic renal cell carcinoma was found to respond well to RIST. Clinical studies are currently being conducted to evaluate the efficacy of RIST in other types of solid tumors. However, the mechanism of graft-versus-host disease and graft-versus-tumor remains unclear. More knowledge on the mechanism is crucial to enhance antitumor effect and to further improve the prognosis.     

根据致伤因素建立伤员分流方案的依据

通过分析美军历次战争的致伤因素,得出不同战争类型各种武器装备致伤人员比例,根据致伤因素分别对伤类和伤部进行分类统计其比例;创建一种能把住院数据与患者伤情编码体系相联系的方法,将伤员分流与受伤的解剖学部位相挂钩。利用这种计算机辅助的运算法则可以方便的建立应对各种作战模式(如突发事件、应急作战、平时保障行动及全球反恐行动)和不同方案的伤员分流表,从而合理分配有限的卫生资源。     

3种方案根除幽门螺杆菌的药物经济学分析

目的观察3种方案根除幽门螺杆菌（helicobacter pylori,Hp）药物成本与效果的关系。方法 182例患者随机分为3组：A组64例,给予雷贝拉唑10mg,克拉霉素0.5g,呋喃唑酮0.1g,每天2次;B组61例,给予奥美拉唑20mg,呋喃唑酮0.1g,替硝唑0.4g,每天2次;C组57例,给予奥美拉唑20mg,克拉霉素0.5g,阿莫西林1.0g,每天2次;1周后停药并分析疗效及药物经济学。结果 3种方案药品成本分别为148.40、8.55、146.95元,有效率分别为92.2%、90.2%、86.0%,差异无统计学意义（P〉0.05）;B组成本-效果分析及敏感度均优于A组和C组,差异均有统计学意义（P〈0.05）。结论 A治疗方案疗效可靠,价格合理,经济条件较好可以使用;B方案疗效可靠,价格便宜,农村患者可以推广;C方案疗效稍逊一筹,价格昂贵,不宜推广。     

Induktionsbehandlung der akuten myeloischen Leukämie mit Cytosin-Arabinosid — Daunorubicin,zusätzlicher Effekt von Ifosfamid und Vincristin

Summary 31 adult patients (study A) with acute myelocytic leukaemia were treated for remission induction with cytosine arabinoside (ARA-C, 100 mg/ m²/day) by a 7 (5) day continuous infusion. 3 (2) doses of daunorubicin (DNR, 45 mg/m² i.v.) were added at daily intervals. For maintenance 5 day ARA-C was given monthly in sequential combination with DNR, thioguanine (TG), or ifosfamide (IFOS). 16 (52%) patients achieved complete remission (C.R.) after 1.8 (1–23) courses and 6.7 (3–10) weeks from treatment start. The median survival for responders and non-responders was 11.5 months, early death rate within 6 weeks was 3 (10%). Median remission duration was 13.5 months. Among 11 patients surviving for 7–22 months 7 patients are in first remission for 5.5–20.5 months.DNR, IFOS and TG were not given before the 3rd day of ARA-C infusion. In a previous group of 34 leukaemic patients and in 44 therapy courses DNA histograms of bone marrow cells using pulse cytophotometry showed marked accumulation in S-phase for 75% of courses. Also (G₂ + M)-cells in the DNA distribution and thymidine pulse labelling indices were markedly increased in most cases, whereas thymidine uptake by scintillation counter was diminished and mitotic indices had not changed significantly.In now 15 patients (study B) the induction regimen was intensified by adding vincristine (VCR, 2 mg i.v.) and 3 doses of IFOS (600 mg/m² i.V.). Preliminary results are 50% C.R. after 1,7 (1–2) courses and 6.8 (5–10) weeks from initiation of therapy. 2 patients died in the first 6 weeks.Modification and intensification of established drug combinations for AML on the basis described appear reasonable and possible.

Herrn Prof Dr. W. H. Hauss zum 70. Geburtstag gewidmet.     

MOAP方案治疗急性淋巴细胞白血病疗效观察

目的观察MOAP方案治疗急性淋巴细胞白血病（ALL）的近期疗效和不良反应。方法我科于2003年1月-2008年12月应用MOAP方案治疗30例ALL,对照组用TOLP方案,2个疗程评价化疗方案的疗效,同时记录不良反应。结果MOAP组治疗初治ALL缓解率90.9%,对照组86.2%。MOAP组达到缓解的时间（15.7±6.4）d,对照组（19.8±3.2）d。MOAP组感染率、药物不良反应均低于对照组。结论MOAP方案治疗ALL有良好的疗效,且耐受性好。     

如何避免儿童的不合理用药

提供良好的药学服务,促进用药水平的提高,改变过去传统的服务方式,让医生在了解疾病的同时多了解一些病人和用药的情况;药师在了解用药的同时,更多的了解病人的信息,使患者在接受医疗服务同时,还能接受药学服务。充分考虑到儿童生理特点、疾病的性质、个人的身体状况、对药物的敏感程度,以及药物之间的相互作用、用药时间的长短,从而制定合理的给药方案。     

Índice de masa corporal y eficacia y seguridad del ticagrelor frente al prasugrel en pacientes con síndrome coronario agudo

Introduction and objectivesThe efficacy and safety of ticagrelor vs prasugrel in patients with acute coronary syndromes (ACS) according to body mass index (BMI) remain unstudied. We assessed the efficacy and safety of ticagrelor vs prasugrel in patients with ACS according to BMI.MethodsPatients (n = 3987) were grouped into 3 categories: normal weight (BMI < 25 kg/m²; n = 1084), overweight (BMI ≥ 25 to < 30 kg/m²; n = 1890), and obesity (BMI ≥ 30 kg/m²; n = 1013). The primary efficacy endpoint was the 1 year incidence of all-cause death, myocardial infarction, or stroke. The secondary safety endpoint was the 1 year incidence of Bleeding Academic Research Consortium type 3 to 5 bleeding.ResultsThe primary endpoint occurred in 63 patients assigned to ticagrelor and 39 patients assigned to prasugrel in the normal weight group (11.7% vs 7.5%; HR, 1.62; 95%CI, 1.09-2.42; P = .018), 78 patients assigned to ticagrelor and 58 patients assigned to prasugrel in the overweight group (8.3% vs 6.2%; HR, 1.36; 95%CI, 0.97-1.91; P = .076), and 43 patients assigned to ticagrelor and 37 patients assigned to prasugrel in the obesity group (8.6% vs 7.3%; HR, 1.18; 95%CI, 0.76-1.84; P = .451). The 1-year incidence of bleeding events did not differ between ticagrelor and prasugrel in patients with normal weight (6.5% vs 6.6%; P = .990), overweight (5.6% vs 5.0%; P = .566) or obesity (4.4% vs 2.8%; P = .219). There was no significant treatment arm-by-BMI interaction regarding the primary endpoint (P_int = .578) or secondary endpoint (P_int = .596).ConclusionsIn patients with ACS, BMI did not significantly impact the treatment effect of ticagrelor vs prasugrel in terms of efficacy or safety.Clinical Trial Registration: NCT01944800.