目的 评价替雷利珠单抗单药二线治疗晚期或转移性食管鳞状细胞癌(ESCC)的经济性,为临床合理用药提供参考.方法 从我国卫生体系角度出发,基于RATIONALE-302研究数据构建三状态分区生存模型,模拟时限为10年,循环周期为1个月.采用成本-效用分析法,以质量调整生命年(QALY)作为效用指标并计算增量成本-效果比(ICER),比较替雷利珠单抗单药方案相对于化疗方案二线治疗晚期或转移性ESCC的经济性.采用敏感性分析和情境分析来验证基础分析结果的稳健性.结果 基础分析结果显示,相对于化疗组,替雷利珠单抗组患者的人均增量成本为35025.32元,人均增量效果为2.71 QALYs,ICER为12892.31元/QALY,远低于以3倍2021年我国人均国内生产总值(GDP)即242928元作为的意愿支付(WTP)阈值.单因素敏感性分析结果显示,阿帕替尼成本、疾病进展状态效用值和化疗组不良反应处理成本等参数对ICER值的影响较大,但这些参数均不能导致基础分析结果翻转.概率敏感性分析结果显示,当WTP阈值大于80000元/QALY时,替雷利珠单抗单药方案具有经济性的概率为100％.情境分析结果显示,当模型模拟时限分别为5年和20年时,替雷利珠单抗单药方案的ICER值分别为8331.00元/QALY和12981.00元/QALY,均未超过以3倍2021年我国人均GDP作为的WTP阈值.结论 当以3倍2021年我国人均GDP作为WTP阈值时,相较于化疗方案,替雷利珠单抗单药方案二线治疗晚期或转移性ESCC更具有经济性.

目的 分析度伐利尤单抗所致免疫相关性神经系统不良反应的特点,为临床用药提供参考.方法 以"度伐利尤单抗"、"安全性"、"不良反应"、"神经系统"、"Durvalumab"、"ADR"、"adverse drug reac-tion"、"adverse event"、"nervous system toxicities"、"neurological irAEs"为检索词,检索中国知网、万方、维普及PubMed、Web of Science数据库公开发表的使用度伐利尤单抗致神经系统不良反应的相关文献报道并进行分析.检索时间为建库至2022 年9 月30 日.结果 共纳入文献9 篇,涉及度伐利尤单抗所致不良反应患者9 例,患者年龄66～82 岁.神经系统不良反应多发生在用药2～5 周期内(55.56％).常见的临床症状为肢体或全身无力(77.78％).9 例患者均停药,使用激素、免疫抑制剂、血浆置换等治疗.6 例恢复或好转,1 例未好转,2 例死亡.结论 临床医师应加强对度伐利尤单抗神经系统不良反应的监测,采取适当措施预防或治疗,避免严重不良反应的发生.

目的:使用还原铁粉、活性炭、氯化钠和蛭石等自发热材料,研究自发热医学美容材料最佳发热配比.方法:按L16(45)五因素四水平正交试验表设计实验,对最高温度、平均温度、启动时间及持续时间进行综合评分,评分结果采用正交设计软件进行数据分析,研究自发热材料应用于医学美容材料的最佳发热配比.结果:自发热医学美容材料的配比综合评分影响程度D>E>A>C>B(即蛭石>水>还原铁粉>氯化钠>活性炭),最佳配比为A4B2C4D2E4,即还原铁粉:活性炭:氯化钠:蛭石:水=8:4:5:2:5.结论:按正交设计法得到的最佳配比可制成自发热面膜.该面膜接触空气后缓慢反应散发热量,适合医学美容治疗需要.

目的:研究红花-甘草配伍对寒凝血瘀模型大鼠血浆及脑组织中三磷酸腺苷(ATP)、二磷酸腺苷(ADP)、一磷酸腺苷(AMP)及能荷(EC)水平的影响,从能量代谢角度探讨该配伍对寒凝血瘀证的影响.方法:采用冷水冰浴方法成功建立寒凝血瘀证SD大鼠模型,将造模成功大鼠随机分为4组,即模型对照组、红花组、甘草组、红花-甘草组,另设正常对照组.造模成功后,给药组灌胃相应的药物,剂量为20 g·kg-1,模型对照组和正常对照组给予等容积的纯净水,各组均连续灌胃15 d,检测大鼠血浆及脑组织中3种腺苷酸的含量并计算能荷值.结果:与正常对照组相比,模型对照组ATP、ADP的含量及EC值均显著降低(P＜0.01),AMP的含量降低不明显.与模型对照组相比,各给药组ATP、ADP的含量及EC值均显著升高,红花-甘草组改善上述指标的作用强于单药组,差异有显著性(P＜0.05).结论:红花和甘草均可改善寒凝血瘀模型大鼠的能量代谢,促进机体对能量物质的利用,红花-甘草配伍对改善寒凝血瘀证能量代谢显示出更佳的疗效.

Objective To investigate the cost-effect of Vancomycin and Linezolid in the treatment of MRSA infection, providing practical basis for clinical drug use. Methods Patients admitted into our hospital duringfrom January 2014 to March 2016 were retrospectively analyzed. All cases of MRSA infection using Vancomycin or (and) Linezolid as antibiotic therapy were included in this study. The efficacy and pharmacogenomics of Linezolid and Vancomycin in treatment of MRSA were recorded. Results Incidence of renal function in linezolid Linezolid group was significantly lower than that in Vancomycin group (P < 0.05). Time duration of antibiotics usage in Vancomycin group were prolonged compared with linezolid Linezolid group [(7.04 ± 0.45) d vs (5.12 ± 0.47), P < 0.05]. Longer hospitalization stay was also identified in Vancomycin group compared with Linezolid group [(10.76 ± 0.53) d vs (8.06 ± 0.58) d, P < 0.05]. DUI of Vancomycin and Linezolid were both less than 1, while therapeutic effectiveness and cost-effectiveness ratio (C/E) of Linezolid was significantly higher than that in Vancomycin group (P < 0.05).Conclusion Linezolid may be a better choice for treatment of MRSA due to better cost-effectiveness, efficacy and safety compared with Vancomycin.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的观察迷迭香酸对人肝癌HepG2细胞增殖及凋亡的影响,并探讨Vimentin/NLRP3在此过程中的作用。方法不同浓度迷迭香酸(25、50、100μmol·L^-1)作用于HepG2细胞, MTT法检测细胞增殖;TUNEL法检测细胞凋亡;Western blot检测相关蛋白的表达水平。结果迷迭香酸能抑制HepG2细胞的增殖,促进其凋亡,且呈浓度依赖性。与对照组相比,迷迭香酸组能明显上调caspase-3的表达,降低Bcl-2的表达（P&lt;0.05）,其作用机制与下调Vimentin/NLRP3信号通路有关。结论迷迭香酸能抑制HepG2细胞增殖并诱导细胞凋亡,其作用主要是通过下调Vimentin/NLRP3蛋白的表达来实现的。</span>

Objective The pathogenesis of orla ulcer has not been fully and thoroughly studied. This study aimed to investi-gate the effect and mechanism of Rosmarinic acid (RA)on oral ulcer. Methods 60 SD rats were randomly divided into control group,model group,RA groups(20,40,80 mg/kg) and Watermelon Frost group. The control group rats were fed normally and with-out any treatment. The oral ulcer model was established in the other three groups. The oral ulcer model of rat was established by injec-tion of 40% glacial acetic acid on the oral mucosa of cheek in rat. One day after the formation of ulcers,RA(20,40,80 mg/kg) and watermelon frost (200 mg/kg) was administrated. The ulcer area was measured 3,5,7 days after establishing the model. The concen-tration of IL-18 and IL-1β in ulcer tissue was measured by ELISA method and the expression of NLRP3 mRNA was measured by qRT-PCR. Results Compared with the model group, the ulcer area in the RA group and Watermelon Frost group was significantly de-ceased(P<0.05). Compared with the control group,NLRP3,IL-18 and IL-1β in the ulcer tissue was significantly elevated in model group,RA groups (20,40,80 mg/kg) and Watermelon Frost group (P<0.01). NLRP3 expressed lower in RA (40,80 mg/kg) and wa-termelon frost (200 mg/kg) group(5.27 ± 0.53, 3.25 ± 0.46, 4.75 ± 0.51) than in model group(8.71±0.35)( P<0.05). IL-18 expressed lower in RA (40, 80 mg/kg) and watermelon frost (200 mg/kg) group [(174.21±18.21), (110.12±14.23), (142.25±12.61) pg/mL] than in model group [(246.21±26.21) pg/mL](P<0.05). IL-1β expressed lower in RA (40, 80 mg/kg) and watermelon frost(200 mg/kg) group [(94.76±7.26),(81.77±7.80),(90.21±8.71) pg/mL] than in model group [(133.01±11.69) pg/mL](P<0.05). Conclusion RA has some therapeutic effect on oral ulcers,the mechanism may be related to NLRP3.

目的 调查胃息肉患者的病例资料,评估胃息肉的危险因素,为胃息肉的防治提供理论依据.方法 选择2014年1月至2016年1月在西安医学院第一附属医院接受胃镜检查确诊为胃息肉的110例患者作为胃息肉组,选择同期因消化系统疾病接受胃镜检查排除胃息肉的101例患者作为对照组,回顾性分析患者的一般资料、伴有疾病、职业特点和幽门螺杆菌(Hp)检测结果等数据,采用χ2检验评估胃息肉发生发展的相关因素.结果 胃息肉组与对照组患者的性别、年龄、职业特点和Hp阳性率差异无统计学意义;胃息肉组患者中约40.91%体质量指数异常,在体质量指数异常患者中,超重和肥胖患者占82.20%;胃息肉组患者中伴有窦性心动过缓、脂肪肝、慢性胃炎和胆囊炎的患者,胃息肉发生率均高于对照组(P均<0.05).结论 胃息肉发生可能与体质量超重、伴有窦性心动过缓、脂肪肝、慢性胃炎和胆囊炎等因素相关.

Objective:To investigate whether the combination of Carthami Flos-Glycyrrhizae Radix et Rhizoma could improve energy metabolism in the tissue of rats with blood stasis syndrome,Carthami Flos-Glycyrrhizae Radix et Rhizoma on adenosine phosphate metabolism of tissues including heart,liver,spleen,lung and kidney were observed.Methods:The SD rats were randomly divided into 4 groups,namely blank control group,model group,Carthami Flos group and Carthami Flos-Glycyrrhizae Radix et Rhizoma group.The blood stasis model rats were made with cold stimulation in cold water ice bath.The blank control group and model group were given saline.The Carthami Flos group and Carthami Flos-Glycyrrhizae Radix et Rhizoma group were given aqueous extract of Carthami Flos and aqueous extract of Carthami Flos-Glycyrrhizae Radix et Rhizoma respectively by intragastric administration once per day according to experimental design for 15 days.At the end of the drug administration for 12 h,the blood and tissues (heart,liver,spleen,lung and kidney) were obtained and hemorheology parameters of rats were measured.The contents of adenosine triphosphate (ATP),adenosine diphosphate (ADP) and adenosine monophosphate (AMP) were determined by using high performance liquid chromatography (HPLC) method.Results:The whole blood viscosity and plasma viscosity were reduced in the dose group compared with the model group.The contents of adenosine phosphate in model rats after administration of the dose group were higher than those in model group,and the Carthami Flos-Glycyrrhizae Radix et Rhizoma group was better than that of the Carthami Flos group (P＜0.05).Conclusion:Carthami Flos and Carthami Flos-Glycyrrhizae Radix et Rhizoma herb-pair could improve the energy metabolism in rats with cold coagulation blood stasis,and the effect of Carthami Flos-Glvcvrrhizae Radix et Rhizoma was stronger than that of Carthami Flos.

OBJECTIVE:To evaluate the situation and rationality of the implementation of antimicrobial therapy for patients with acute pancreatitis (AP)in our hospital. METHODS:132 AP patients admitted into our hospital during Aug. 2013-Dec. 2015 were selected and analyzed statistically in respects of the types of antimicrobial agents,drug combination,usage and dosage,etc. The rationality of antimicrobial agents use was also analyzed. RESULTS:Among 132 AP patients,there were 103 men and 29 women;mean age of them was (43.75 ± 1.26) years;mild acute pancreatitis (MAP,117 cases) accounted for 88.64%,and se-vere acute pancreatitis(SAP,15 cases)accounted for 11.36%;the top 3 causes of AP were obstruction factors(32.31%),hyper-lipidermia(27.21%)and alcohol(18.03%),respectively. Main symptoms were abdominal pain,abdominal distension and vomit-ing;among 132 AP patients,101 cases were cured and 31 cases were recovered. The antimicrobial agents were used in 107 MAP cases and 13 SAP cases,and the total utilization ratio was 90.91%(of which,90.15% belonged to therapeutic drug use). A total of 5 species were used,the combination proportion of which was 77.28%,among which two-drug combination was the most (69.70%),mainly including“sulbactam sodium and cefoperazone+tinidazole”(45.65%)and“levofloxacin+tinidazole”(27.17%). After treatment,patient’s serum amylase level MEUT and WBC recovered to normal range. CONCLUSIONS:The utilization of an-timicrobial agents in our hospital is basic reasonable for AP patients,meat the requirements of the releveant guidelines. The rational-ity of prophylactic use of agents remain to be discussed.

Objective To evaluate the efficacy and safety of antifungal drug for onychomycosis in order to provide reference for clinical medication. Methods Pub Med and CNKI database were searched and literature on terbinafine,itraconazole andfluconazole in the treatment of onychomycosis published between 1995 and 2014 was consulted. Randomized controlled trials( RCT) were collected,quality evaluation was performed and the data were analyzed using Rev Man5. 3 software. Results 17 RCT were included,involving 2694 patients. The result of Meta-analysis showed that the clinical cure rate and the mycological cure rate of terbinafine was higher than that of itraconazole and fluconazole. The difference in the adverse reaction of terbinafine,itraconazole and terbinafine was of no statistical significance. Conclosion The efficacy of terbinafine in the treatment of onychomycosis is superior to that of itraconazole and fluconazole,and their safety is of the same level.

Objective To explore the clinical significance and treatment of reperfusion injury in acute myocar-dial infarction (AMI)with hypotension and cardiogenic shock.Methods One hundred and thirty -one AMI patients with hypotension and cardiogenic shock who were undergoing emergency PCI were collected.According to the occurring or worsening of hypotension and cardiogenic shock after reperfusion,45 patients were divided into treatment group,and the other 86 patients were divided into control group.To analyze the clinical manifestations of myocardial ischemia reper-fusion injury and the efficacy of emergency PCI supported by sequential therapy with optimized vasopressors and IABP in both groups.Results After reperfusion,45 patients (34.35% )were occurred or worsen of hypotension and cardiogen-ic shock as treatment group;86 patients (65.65%)as control group.There were 100 cases of reperfusion arrhythmia (76.34%)in both groups,including 43 cases of accelerated idioventricular rhythm,31 cases of bradyarrhythmia,23 ca-ses of premature ventricular contraction,and 3 cases of ventricular fibrillation.The fatality rate and cardiovascular event (such as left ventricular failure)rate were no statistically significant difference between the treatment group and the con-trol group.However,the number of patients that must use IABP of treatment group was significantly lower than control group (P <0.05).Conclusion Reperfusion injury is one of the leading causes of AMI with hypotension and cardiogen-ic shock.It can be treated with emergency PCI supported by sequential therapy with optimized vasopressors and IABP.

The main vitamin K-deficient model, minidose warfarin, is different from the pathological mechanism of vitamin K deficiency, which is a shortage of vitamin K. The objective of this study was to establish a new method of vitamin K-deficient model combining a vitamin K-deficient diet with the intragastrical administration of gentamicin in rats. The clotting was assayed by an automated coagulation analyser. The plasma PIVKA-II was assayed by ELISA. The vitamin K status was detected by an HPLC-fluorescence system. In the diet- and gentamicin-induced vitamin K-deficient 14-day group, the rats had undetected vitamin K1 and vitamin K2 in the liver and a prolonged APTT. In the 21-day group, there was also a prolonged PT and a decrease of the FIX activities. In the 28-day group, the undetected vitamin K1 and vitamin K2, the prolonged PT and APTT, and the decrease of the FII, FVII, FIX, and FX activities prompted the suggestion that there were serious deficiencies of vitamin K and vitamin K-dependent coagulation in rats. It is suggested that the diet- and gentamicin-induced vitamin K-deficient 14-day or 21-day model can be used for studies related to the status of vitamin K. The vitamin K-deficient 28-day model can be applied to research involving both the status of vitamin K and of vitamin K-dependent coagulation. In conclusion, the combination of a vitamin K-deficient diet with the administration of gentamicin results in a useful model of vitamin K-deficieny.

Objective This study was aimed to investigate the aggregation effect of hexapeptide on dog platelets .Methods Arteria cruralis blood of dog was sampled and anticoagulated with sodium citrate .The platelet aggregation rates induced by different in‐ducers were determined with the method of turbidimetric test .Results The inhibition rates of dog platelet aggregation of 1 × 10-6 mol?L -1 hexapeptide induced by ADP ,arachidonic acid and thrombin ,were 88 .47% ± 1 .15% ,97 .68% ± 0 .72% and 32 .02% ± 3 .78% ,respectively .The aggregation rates of dog platelet aggregation of 1 × 10-8 to 1 × 10-5 mol?L -1 hexapeptide induced by ADP were significantly lower than that of control group(P<0 .01 or P<0 .05) ,and the corresponding aggregation rates of each dosage groups had significant difference(P< 0 .01 or P< 0 .05) .The anti‐platelet aggregation IC50 of hexapeptide induced by arachidonic acid ,ADP and thrombin ,were 1 .29 × 10-9 ,7 .24 × 10-8 and 2 .88 × 10-6 mol?L -1 ,respectively .For eptifibatide , the anti‐platelet aggregation IC50 were 6 .76 × 10-10 ,5 .74 × 10 -8 and 1 .62 × 10 -6 mol?L -1 ,respectively .Conclusion Hexapep‐tide can restrain dog platelet aggregation in vitro ,and the effect is similar to eptifibatide .

Context: To systematically evaluate the effects of hepatoprotective agents, when delivered either alone or in combination with other antiviral or non-antiviral drugs in patients with hepatitis B and hepatic fibrosis. Objectives: The current randomized controlled clinical trials aimed to evaluate the efficacy of combinations of antiviral and non-antiviral hepatoprotective agents on indexes of liver function and liver fibrosis in patients with hepatitis B. Data Sources: Published literatures in Chinese and English on hepatoprotective treatment strategies for chronic hepatitis B and liver fibrosis were searched in three databases and randomized controlled clinical trials were selected. Study Selection: Data were extracted according to a variety of inclusion and exclusion criteria. Meta-analysis was employed to analyze the data. Results: A total of 22 randomized controlled trials encompassing 1,714 cases were considered in the meta-analysis. The obtained results indicated that the combination of antiviral drug and hepatoprotective agent was better than antiviral drug alone to improve liver function. Similarly, regarding liver fibrosis, using two different hepatoprotective agents was better than using one agent. The normalization rates of Aminotransferase (ALT) and total Bilirubin (TBil) were improved 25.7% by two hepatoprotective agents compared to the single agent. Acetylcysteine was superior to ursodeoxycholic acid or silibinin to reduce ALT. Ursodeoxycholic acid was superior to acetylcysteine or silibinin to reduce TBIL. Conclusions: Hepatoprotective agents combined with antiviral drugs can significantly improve liver function and liver fibrosis parameters in patients with hepatitis B.

目的:探讨肝硬化自发性腹膜炎的诊疗要点,为肝硬化患者自发性腹膜炎抗菌药物的合理使用提供药学服务和支持.方法:临床药师参与1例肝硬化伴自发性腹膜炎患者抗菌药物使用的药学干预.鉴于检出的克雷伯杆菌和大肠埃希菌,临床药师建议医师将最初的第1代头孢菌素改为第3代头孢菌素,使用氨曲南腹腔灌注有助于渗出性肝硬化腹水治疗,阐明抗菌药物在肝硬化伴肾功不全患者中的合理应用.结果:患者经抗生素腹腔热灌注后腹水未再培养出细菌,腹水细胞数明显下降,血培养阴性.结论:临床药师与临床医务人员的密切配合可以提高肝硬化伴自发性腹膜炎患者用药安全性和有效性.

Objective To statistically analyze the irrational prescriptions and to improve the safety and effectiveness of medication . Methods The pharmacists in our hospital analyzed 672 unreasonable prescriptions in 2012 ,in order to reveal the common problems of outpatient prescription .Some countermeasures ,which could reduce the number of unreasonable prescriptions and improve the doctor-patient relationship ,were proposed through the prior intervention summary of pharmacists to the irrational prescriptions be-tween doctors and patients .Result The main problems of the unqualified prescriptions were prescription changes ,the usage and dosage ,and the normative writing .The prior intervention of pharmacist was the essential to reduce the irrational prescriptions . Conclusion The rational ratio improvement of clinicians′prescriptions ,and the improvement of the safety and efficacy of the drug using ,in some certain ,relay on the pharmacists′prior intervention to the irrational prescriptions .

OBJECTIVE To investigate the effect of hexapeptide on platelet aggregation activity in rabbit.METHODS The blood of rabbit carotid artery was taken,and then,the anticoagulation blood was obtained by adding sodium citrate into the whole blood.The platelet aggregation rates induced by different inducers were determined by turbidimetry.RESULTS The aggregation inhibition rates of 1×10 5 mol.L 1 hexapeptide induced by ADP,arachidonic acid and thrombin in rabbit,were(66.22±1.40)%,(67.94±2.32)% and(58.18±4.67)%,respectively.The IC 50 of aggregation inhibition rates of hexapeptide in rabbit induced by ADP,arachidonic acid and thrombin,were 3.24×10 6 mol.L 1,1.32×10 6 mol.L 1 and 7.24×10 6 mol.L 1,respectively.CONCLUSION Hexapeptide has the effect of anti-platelet aggregation in rabbit in vitro.

AIM This study aimed to investigate the anti-aggregation effects of hexapeptide on human platelets.METHODS Venous blood of healthy volunteer was taken,and was made into anticoagulation blood with sodium citrate,divided into control group,hexapeptide groups(1 × 10-9-1 × 10-5 mol.L-1) and four kinds of positive groups,including clopidogrel group(3 × 10-5mol.L-1),dipyridamole group(2 × 10-6mol.L-1),aspirin group(2.8 × 10-4 mol.L-1) and eptifibatide group(1 × 10-6 mol.L-1).Each group included 6 samples.The inducers were adenosine diphosphate(ADP) + adrenalin,arachidonic acid and thrombin,respectively.The human platelet aggregation rates induced by different inducers were determined with the method of turbidimetry.RESULTS The aggregation inhibition rates of 1 × 10-6 mol.L-1 hexapeptide in human induced by ADP,arachidonic acid and thrombin,were(98.81 ± 2.25) %,(94.58 ± 0.73) % and(33.46 ± 5.56) % respectively,and which were all significant higher than the control group(P < 0.01).Induced by ADP,the anti-platelet aggregation activity of 1 × 10-6 mol.L-1 hexapeptide was significant higher than that of clopidogrel,dipyridamole or aspirin(P < 0.01),but had no different with eptifibatide(P > 0.05).The anti-aggregation IC 50 of hexapeptide of ADP,arachidonic acid and thrombin,were 8.91 × 10-8 mol.L-1,9.33 × 10-8 mol.L-1 and 4.17 × 10-6 mol.L-1,respectively.The anti-aggregation IC 50 of eptifibatide induced by ADP was 1.00 × 10-7 mol.L-1.CONCLUSION Hexapeptide has the effect of anti-platelet aggregation in human in vitro.