梅毒血清抵抗患者经中医辨证治疗的临床效果

目的分析梅毒血清抵抗患者经中医辨证治疗的临床效果。方法随机选取48例我院门诊于2010年1月至2014年6月收治的梅毒血清抵抗患者进行研究,并随机分成对照组(24例,行西医治疗)和观察组(24例,行中医辨证治疗),随访12个月,比较两组患者血清反应素的变化。结果对照组患者的血清转阴率为25%,复发率为29.17%;观察组的转阴率为62.5%,复发率为4.17%;经比较,观察组的血清转阴率高于对照组,复发率低于对照组,两项指标差异均具有统计学意义(P<0.05)。结论梅毒血清抵抗患者经中医辩证治疗可有效治疗疾病,并抑制复发,临床效果显著,具有临床应用价值。     

康艾注射液配合化疗治疗晚期大肠癌患者的临床效果

目的探讨康艾注射液配合化疗治疗晚期大肠癌患者的临床效果。方法选取2019年4月至2020年4月于沈阳市肛肠医院就诊的80例晚期大肠癌患者作为研究对象,随机分为对照组与观察组,各40例。对照组采用化疗药物治疗,观察组采用康艾注射液配合化疗治疗,比较两组的治疗效果。结果观察组治疗有效率为72.5%,高于对照组的45.0%,差异有统计学意义(P<0.05);观察组不良反应发生率低于对照组(P<0.05);观察组1年、3年生存率高于对照组(P<0.05);治疗后,观察组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组,CD8⁺低于对照组,差异有统计学意义(P<0.05)。结论针对晚期大肠癌患者在接受化疗治疗的基础上联合康艾注射液治疗可获得更加满意的疗效,不良反应低。     

中医辨证分型治疗2型糖尿病的临床疗效

目的研究2型糖尿病患者经中医辨证分型治疗的疗效。方法选取共乐社区卫生服务中心在2013年2月至2015年1月间收治的106例2型糖尿病患者的临床资料,将患者随机分为两组,各有53例。对照组给予常规降糖药物治疗,观察组在对照组基础上采用中医辨证治疗。比较两组患者的治疗效果、餐后2 h血糖、空腹血糖指标。结果 1观察组治疗有效率为96.23%,对照组治疗有效率为81.13%,比较有统计学意义(P<0.05)。2观察组治疗后的血糖指标改善效果优于对照组,比较有统计学意义(P<0.05)。结论 2型糖尿病患者经中医辨证分型治疗,可以提高临床治疗有效率,改善患者的餐后2 h血糖、空腹血糖指标,值得临床推广应用。     

晚期肺癌化疗患者发生医院感染的病原菌检测结果及耐药性

目的 探讨晚期肺癌化疗患者发生医院感染的病原菌检测结果及耐药性。方法 选取2018年6月至2021年6月本溪市中医院收治的200例晚期肺癌化疗后发生医院感染患者作为研究对象。取患者呼吸道分泌物、伤口分泌物作为标本,并进行病原菌检测及药敏试验。分析晚期肺癌化疗患者发生医院感染的部位分布、病原菌分布,主要革兰阴性杆菌、革兰阳性球菌、真菌对抗菌药物的耐药情况。结果 经病原菌检测,200例晚期肺癌患者化疗后医院感染发生于呼吸系统、泌尿系统、口咽部位的占比较高,共检测出210株病原菌：其中革兰阴性杆菌139株（66.19%）,铜绿假单胞菌、肺炎克雷伯菌占比较高;革兰阳性球菌55株（26.19%）,金黄色葡萄球菌占比较高;真菌16株（7.62%）,白色假丝酵母菌占比较高;铜绿假单胞菌对氨苄西林、头孢唑林、头孢曲松、头孢替坦的耐药性较高;肺炎克雷伯菌对头孢唑林、头孢曲松的耐药性较高;鲍氏不动杆菌对氨苄西林、头孢唑林、头孢曲松、头孢替坦的耐药性较高;金黄色葡萄球菌对青霉素G、氨苄西林、环丙沙星的耐药性较高;粪肠球菌对青霉素G、氨苄西林、利福霉素的耐药性较高;白假丝酵母菌对氟康唑、氟胞嘧啶的耐药性较高。...     

功能性消化不良的中医辨证治疗分析

目的探讨中医辨证治疗功能性消化不良的方法及疗效,总结临床经验。方法对我科收入的85例功能性消化不良患者根据不同证型给予对症治疗,记录并作回顾性分析。结果 85例FD患者经过中医辨证治疗后治愈34例,显效28例,好转19例,无效4例,总有效率为95.29%。结论中医辨证治疗功能性消化不良效果明显,值得进一步研究推广。     

化疗联合艾迪注射液治疗中晚期非小细胞肺癌临床分析

目的探讨分析化疗联合艾迪注射液治疗中晚期非小细胞肺癌的临床效果。方法选择2009年5月~2013年3月在我院接受治疗的中晚期非小细胞肺癌患者104例,随机分成对照组和观察组各52例,对照组给予单纯化疗治疗,观察组在其基础上联合艾迪注射液治疗,对比两组患者的近期疗效以及不良反应的发生情况。结果治疗结果显示观察组的近期疗效优于对照组,分别为84.6%(44/52)与71.2%(37/52),两组比较差异显著(P<0.05);同时观察组患者不良反应的发生率明显低于对照组,分别为21.2%(11/52)与42.3%(22/52),两组比较差异显著(P<0.05)。结论应用化疗联合艾迪注射液治疗中晚期非小细胞肺癌意义显著,缓解患者病灶,不良反应发生率低,值得临床推广。     

中医辨证施治治疗创伤性肘关节炎患者的临床疗效

目的：探讨中医辨证施治治疗创伤性肘关节炎患者的临床疗效。方法收集2011年6月至2014年6月深圳龙华新区人民医院骨科收治的76例创伤性肘关节炎患者资料,按随机数字表法将患者分为试验组与对照组,各38例。试验组患者给予中医辨证施治治疗,对照组患者给予盐酸氨基葡萄糖与塞来昔布治疗。比较两组患者的临床疗效。结果治疗后,试验组患者的JOA评分明显高于对照组,且患者的膝关节HSS评分优良率明显高于对照组,差异均有统计学意义（均P＜0.05）。结论中医辨证施治治疗创伤性肘关节炎的临床疗效十分明显,其治疗效果明显优于消炎镇痛药物和氨基单糖药物治疗。     

中医治疗慢性结肠炎65例临床效果分析

目的探究分析对于慢性结肠炎患者应用中医治疗方法的临床效果。方法选自我院2011年～2013年收治的慢性结肠炎患者共65例,根据患者的临床表现进行中医辨证治疗,观察患者治疗之后的效果。结果患者经过一段时间临床治疗后,治疗总有效率为93.8%（61/65）。结论对慢性结肠炎患者进行中医辨证治疗,能够对患者的中医证候进行有效的改善,促进患者临床治疗效果以及患者生活质量的提高。     

中医辨证分型疗法治疗面部激素依赖性皮炎的效果分析

目的探究面部激素依赖性皮炎中医辨证分型疗法治疗的临床疗效。方法选取江西省上饶市婺源县地方病防治院2014年2月至2017年7月收治的面部激素依赖性皮炎60例作为研究对象,根据随机数字表发分为观察组和对照组,每组30例。观察组患者给予中医辨证分型治疗,对照组患者给予西药维生素E软膏及地氯雷他定片治疗,观察两组患者中医症候评分、临床疗效及不良反应,并给予统计学分析。结果治疗后,观察组患者的中医症候评分低于对照组,治疗总有效率高于对照组,不良反应发生率低于对照组,差异均有统计学意义(均P<0.05)。结论根据传统中医辨证分型可以更加有效治疗面部激素依赖性皮炎患者的面部症状,促进患者尽早康复,且安全性高。     

紫杉醇联合顺铂化疗在晚期非小细胞肺癌患者中的应用效果

目的 探讨紫杉醇+顺铂化疗在晚期非小细胞肺癌（NSCLC）患者中的应用效果。方法 选取2020年7月至2021年1月于阳江市人民医院住院治疗的50例晚期NSCLC患者作为研究对象,根据治疗方法不同分为观察组与对照组,各25例。对照组患者予以放疗治疗,观察组患者在对照组基础上采用紫杉醇+顺铂化疗,比较两组临床疗效、血清肿瘤标志物水平、不良反应发生率、肺癌患者生存质量测定量表（FACT-L）评分。结果 观察组治疗有效率（80.00%）高于对照组（54.00%）,观察组治疗后血清糖类抗原242(CA242)、糖类抗原19-9(CA19-9)、癌胚抗原（CEA）水平低于对照组,观察组治疗后FACT-L评分高于对照组,差异有统计学意义（P<0.05）。观察组不良反应发生率（16.00%）与对照组（20.00%）比较,差异无统计学意义（P>0.05）。结论 紫杉醇+顺铂化疗可有效抑制晚期NSCLC患者疾病进展,降低血清肿瘤标志物水平,改善生命质量,且不良反应较少。     

Targeted erlotinib for first-line treatment of advanced non-small cell lung cancer: a budget impact analysis

Objectives:

A recent phase III trial showed that patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor specific EGFR mutations significantly benefit from first-line treatment with erlotinib compared to chemotherapy. This study sought to estimate the budget impact if coverage for EGFR testing and erlotinib as first-line therapy were provided in a hypothetical 500,000-member managed care plan.

Methods:

The budget impact model was developed from a US health plan perspective to evaluate administration of the EGFR test and treatment with erlotinib for EGFR-positive patients, compared to non-targeted treatment with chemotherapy. The eligible patient population was estimated from age-stratified SEER incidence data. Clinical data were derived from key randomized controlled trials. Costs related to drug, administration, and adverse events were included. Sensitivity analyses were conducted to assess uncertainty.

Results:

In a plan of 500,000 members, it was estimated there would be 91 newly diagnosed advanced NSCLC patients annually; 11 are expected to be EGFR-positive. Based on the testing and treatment assumptions, it was estimated that 3 patients in Scenario 1 and 6 patients in Scenario 2 receive erlotinib. Overall health plan expenditures would increase by $0.013 per member per month (PMPM). This increase is largely attributable to erlotinib drug costs, in part due to lengthened progression-free survival and treatment periods experienced in erlotinib-treated patients. EGFR testing contributes slightly, whereas adverse event costs mitigate the budget impact. The budget impact did not exceed $0.019 PMPM in sensitivity analyses.

Conclusions:

Coverage for targeted first-line erlotinib therapy in NSCLC likely results in a small budget impact for US health plans. The estimated impact may vary by plan, or if second-line or maintenance therapy, dose changes/interruptions, or impact on patients’ quality-of-life were included.     

Treatment patterns and cost-effectiveness of first line treatment of advanced non-squamous non-small cell lung cancer in Medicare patients

Aim: To assess the cost-effectiveness of first-line pemetrexed/platinum and other commonly administered regimens in a representative US elderly population with advanced non-squamous non-small cell lung cancer (NSCLC).

Materials and methods: This study utilized the Surveillance Epidemiology and End Results (SEER) cancer registry linked to Medicare claims records. The study population included all SEER-Medicare patients diagnosed in 2008–2009 with advanced non-squamous NSCLC (stages IIIB–IV) as their only primary cancer and who started chemotherapy within 90 days of diagnosis. The study evaluated the four most commonly observed first-line regimens: paclitaxel/carboplatin, platinum monotherapy, pemetrexed/platinum, and paclitaxel/carboplatin/bevacizumab. Overall survival and total healthcare cost comparisons as well as incremental cost-effectiveness ratios (ICERs) were calculated for pemetrexed/platinum vs each of the other three. Unstratified analyses and analyses stratified by initial disease stage were conducted.

Results: The final study population consisted of 2,461 patients. Greater administrative censorship of pemetrexed recipients at the end of the study period disproportionately reduced the observed mean survival for pemetrexed/platinum recipients. The disease stage-stratified ICER analysis found that the pemetrexed/platinum incurred total Medicare costs of $536,424 and $283,560 per observed additional year of life relative to platinum monotherapy and paclitaxel/carboplatin, respectively. The pemetrexed/platinum vs triplet comparator analysis indicated that pemetrexed/platinum was associated with considerably lower total Medicare costs, with no appreciable survival difference.

Limitations: Limitations included differential censorship of the study regimen recipients and differential administration of radiotherapy.

Conclusions: Pemetrexed/platinum yielded either improved survival at increased cost or similar survival at reduced cost relative to comparator regimens in the treatment of advanced non-squamous NSCLC. Limitations in the study methodology suggest that the observed pemetrexed survival benefit was likely conservative.     

建立中药产业的比较优势

随着经济市场化，全球化进程加快，我国传统农业在经历转型的阵痛。走质量效益型道路已成为农业现代化的必然选择，不同学者已经从不同的角度作了有益的探索，中国药产业在上游阶段同农业生产存在密切的联系，通过创新性地发展传统中药行业，建立中药产业比较优势，是推动农业现代化进程的一种值得考虑的途径。     

Cost-effectiveness analysis of first-line pembrolizumab treatment for PD-L1 positive,non-small cell lung cancer in China

Purpose: Pembrolizumab was recently approved in several countries as a first-line treatment for patients with PD-L1 positive, non-small cell lung cancer (NSCLC). However, it is expensive. This study aimed to assess the cost-effectiveness of pembrolizumab in treating advanced NSCLC patients with PD-L1 positive cancer in China.

Methods: A Markov model was developed to compare the cost-effectiveness of pembrolizumab with chemotherapy for patients with PD-L1 expression on at least 50% of NSCLC tumor cells. Model inputs for transition probabilities and toxicity were derived from published clinical trial data, while health utilities were estimated from a literature review. Costs for drugs were updated to standard fee data from West China Hospital in 2017. Health outcomes were measured in quality-adjusted life years (QALYs), and cost-effectiveness was measured as the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were conducted to test the robustness of the model.

Results: Pembrolizumab gained 0.45 QALYs at an incremental cost of $46,362 compared to chemotherapy for an ICER of $103,128 per QALY gained. In most scenarios, the ICER exceeded three times the Chinese Gross Domestic Product per capita. Two-way sensitivity analysis showed that, when the utility of the progression-free status increased to the maximal value of 0.845 and the 1?mg dose price decreased to $10.50, the ICER reduced to $25,216/QALY.

Conclusions: Pembrolizumab is not likely to be cost-effective in the treatment of PD-L1 positive, NSCLC for Chinese patients. Less aggressive pricing may increase accessibility for patients in China.     

中医特色校园网络文化体系建设研究

高校校园网络文化已融入了大学生的生活世界,越来越明显地影响着当代大学生的政治立场、思想道德观念和行为方式,日益成为对大学生进行思想政治教育的重要内容和手段。党的十七大提出“加强网络文化建设和管理,营造良好网络环境”的新要求。坚持正确舆论导向,不断丰富校园网络文化产品,打造具有校园特色的网络文化品牌,是繁荣发展高校校园网络文化的关键所在。     

Budget impact of erlotinib for maintenance therapy in advanced non-small cell lung cancer

Abstract

Objective:

Assess the budgetary impact of adding erlotinib for maintenance therapy (MTx) in advanced non-small cell lung cancer (NSCLC) from a US health plan perspective.

Methods:

A budget impact model was developed to analyze the costs (drug, administration, adverse events) associated with adding erlotinib MTx to a hypothetical 500,000 member US health plan. Treatment durations and dosing were derived from randomized controlled trials, FDA labeling, and National Comprehensive Cancer Network guidelines. Treatment patterns and assumptions were based on market research data, the SEER registry, and published literature. Cost data were obtained from Centers for Medicare and Medicaid Services payment rates and a drug pricing database. Sensitivity analyses were conducted to assess uncertainty.

Results:

Overall health plan expenditures increased by $0.010 per member per month (PMPM). The main driver of additional cost was the erlotinib drug cost (～$66,000) with the administration ($464) and side-effect ($47) costs being relatively modest. One-way sensitivity analyses showed that the results were most sensitive to the proportion of members receiving MTx; however, the PMPM did not exceed $0.013.

Conclusions:

The overall budget impact to a health plan of expanding the use of erlotinib from the 2nd/3rd-line advanced NSCLC setting to include the maintenance setting was relatively small. This was primarily due to the proportion of patients who would receive erlotinib MTx, the low cost of side-effects and minimal cost of drug administration. Additional research may be warranted to estimate the relative clinical and economic impacts of erlotinib MTx versus alternative MTx treatments.     

中药炮制对含苷类药物疗效和不良反应的影响

目的探讨中药炮制对含苷类药物疗效和不良反应的影响。方法选取辽宁省盘锦市中心医院2017年5月至2019年5月收治的160例接受含苷类药物治疗的患者作为研究对象,随机分为两组,对照组80例患者接受未炮制的含苷类药物治疗,试验组80例患者接受经过炮制的含苷类药物治疗,比较两组临床疗效、不良反应发生率、生命质量评分。结果临床治疗有效率试验组(97.50%)明显高于对照组(81.25%),试验组不良反应发生率(2.50%)明显低于对照组(16.25%),试验组生命质量评分明显高于对照组,差异有统计学意义(P<0.05)。结论中药炮制可显著提高含苷类药物的临床治疗效率,降低不良反应发生率,提高患者生命质量。     

Budget impact analysis of comprehensive genomic profiling in patients with advanced non-small cell lung cancer

Aims: Broad molecular profiling of patients with advanced non-small cell lung cancer (NSCLC) is strongly advised to optimize genomic matching with available targeted treatment options or investigational agents. Unlike conventional molecular diagnostic testing, or smaller hotspot panels, comprehensive genomic profiling (CGP) identifies genomic alterations across hundreds of clinically relevant cancer genes from a single tissue specimen. The present study sought to estimate the budget impact of increased use of CGP using a 324-gene panel (FoundationOne) vs non-CGP (represented by a mix of conventional molecular diagnostic testing and smaller NGS hotspot panels) and the number needed to test with CGP to gain 1 life year.

Materials and methods: A decision analytic model was developed to assess the budget impact of increased CGP in advanced NSCLC from a US private payer perspective. Model inputs were based on published literature (epidemiology and treatment outcomes), real-world data (testing and rates, medical service costs), list prices for CGP and anti-cancer drugs, and assumptions for clinical trial participation.

Results: Among 2 million covered lives, 532 had advanced NSCLC; 266 underwent molecular diagnostic testing. An increase in CGP among those tested, from 2% to 10%, was associated with $0.02 per member per month budget impact, of which $0.013 was attributable to costs of prolonged drug treatment and survival and $0.005 to testing cost. Approximately 12 patients would need to be tested with CGP to add 1 life year.

Limitations: The model incorporated certain assumptions to account for inputs with a limited evidence profile and simplify the possible post-CGP treatments.

Conclusions: An increase in CGP utilization from 2% to 10% among patients with advanced NSCLC undergoing molecular diagnostic testing was associated with a modest budget impact, most of which was attributable to increased use of more effective treatments and prolonged survival.     

Regression analysis of indicating multiple incremental cost-effectiveness ratios for non-small cell lung cancer treatment

Objectives:

The value of a health technology can be measured in terms of cost and benefit on two-dimensional co-ordinates. This study is to quantitatively analyze the correlation and to conduct a regression on the X-Y plane constituted by cost and QALYs (quality-adjusted life years) associated with the first line treatment, the maintenance treatment, and the second line treatment for non-small cell lung cancer (NSCLC).

Methods:

The cost-effectiveness data of the cost and QALYs were extracted, with respect to the three categories of the NSCLC treatment, from the CEA Registry at Tufts Medical Center, regarding the literature published from 2000–2011. As a result, 44 QALY-cost ratios were identified.

Results:

Based on those extracted data, the correlation and regression analyses were performed by mathematical model using log and square-root functions. The plotted ratios stratified by the three stages for the NSCLC treatment were visually grouped into three clusters. There were statistically significant differences among the correlation coefficients of the cluster. In regression, the log model was found to be better fitted than the square-root model; formulating QALY?=??1.12?+?0.16 log(Cost), ?1.99?+?0.28 log(Cost), and ?0.69?+?0.10 log(Cost) for the first line, the maintenance, and the second line treatment, respectively. Monetary units were standardized to 2008 US dollars.

Conclusion:

A good methodological potential was confirmed so as to assess the Incremental Cost Effectiveness Ratio (ICER) variations, considering stratification by multiple factors such as disease and treatment categories. This study has certain limitations, such as the small number of included articles and the stratification, not reflecting a factor of new genetic findings.     

Budget impact analysis of everolimus for the treatment of hormone receptor positive,human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer in the United States

Abstract

Objective:

To estimate the budget impact of everolimus as the first and second treatment option after letrozole or anastrozole (L/A) failure for post-menopausal women with hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC).