C—erbB-2、bcl-2禾口nm23蛋白在结肠癌组织中的表达及意义

为探讨C—erbB-2、bcl-2及nm23蛋白在结肠癌组织中的表达及意义，采用免疫组化S—P法检测45例原发性结肠癌组织中C—erbB-2、bcl-2及nm23蛋白的表达。结果为bcl-2、nm23蛋白的表达与结肠癌肿块大小无关（P〉0．05），C—erbB-2的表达与结肠癌肿块大小相关（P〈0．01）；c—erbB-2、bcl-2与分化程度相关，nm23蛋白表达与肿瘤分化程度无关（P〉0．05）；C—erbB-2、bcl-2、nm23蛋白表达与肿瘤浸润深度、淋巴结转移和远隔转移有关。结论为C—erbB-2、bcl-2和nm23蛋白异常表达在结肠癌发生发展和浸润转移中起重要作用；联合检测C—erbB-2、bcl-2和nm23蛋白对判断结肠癌患者预后和转移有一定的价值。     

16排螺旋CT在膀胱移行细胞癌中的应用

目的:探讨16排螺旋CT对膀胱移行细胞癌的诊断价值。方法:回顾性分析36例经手术病理证实为膀胱移行细胞癌癌患者的CT及临床资料。结果:36例术前CT检出33例,3例未见异常。CT表现为局限性膀胱壁增厚7例,呈菜花状向腔内突出23例,乳头状突向腔内6例;增强扫描肿块均有不同程度强化。结论:16排螺旋CT对膀胱移行细胞癌的诊断有其独特的优越性,临床应用价值较高,可在临床推广应用。     

地塞米松降低顺铂对肝癌原代细胞的毒性效果

分离2例经病理学确诊为原发性肝细胞性肝癌的原代细胞，悬于20％小牛血清的RPMI 1640培养液，置于37℃、5％CO2培养箱培养，并进行显微镜观察和细胞计数。再经不同浓度的顺铂＋／-地塞米松处理，采用MTT法检测肝细胞癌原代细胞增殖状况，评价地塞米松对肝癌化疗效果的影响。在2例肝细胞癌的原代细胞培养中，地塞米松均有降低顺铂对肝细胞癌的原代细胞的坏死作用，增加了肝癌细胞的存活率。说明地塞米松对顺铂的细胞毒性有降低作用，可以缓解肝癌伴肝功能减低患者的化疗毒性作用。     

Economic value and cost-effectiveness of biventricular versus right ventricular pacing: results from the BLOCK-HF study

Abstract

Aims: The Biventricular vs Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK-HF) demonstrated that biventricular (BiV) pacing resulted in better clinical and structural outcomes compared to right ventricular (RV) pacing in patients with atrioventricular (AV) block and reduced left ventricular ejection fraction (LVEF; ≤50%). This study investigated the cost-effectiveness of BiV vs RV pacing in the patient population enrolled in the BLOCK-HF trial.

Methods: All-cause mortality, New York Heart Association (NYHA) Class distribution over time, and NYHA-specific heart failure (HF)-related healthcare utilization rates were predicted using statistical models based on BLOCK-HF patient data. A proportion-in-state model calculated cost-effectiveness from the Medicare payer perspective.

Results: The predicted patient survival was 6.78?years with RV and 7.52?years with BiV pacing, a 10.9% increase over lifetime. BiV pacing resulted in 0.41 more quality-adjusted life years (QALYs) compared to RV pacing, at an additional cost of $12,537. The “base-case” incremental cost-effectiveness ratio (ICER) was $30,860/QALY gained. Within the clinical sub-groups, the highest observed ICER was $43,687 (NYHA Class I). Patients receiving combined BiV pacing and defibrillation (BiV-D) devices were projected to benefit more (0.84?years gained) than BiV pacemaker (BiV-P) recipients (0.49?years gained), compared to dual-chamber pacemakers.

Conclusions: BiV pacing in AV block patients improves survival and attenuates HF progression compared to RV pacing. ICERs were consistently below the US acceptability threshold ($50,000/QALY). From a US Medicare perspective, the additional up-front cost associated with offering BiV pacing to the BLOCK-HF patient population appears justified.     

Costs and absence of HCV-infected employees by disease stage

Abstract

Objectives:

Quantify the costs and absenteeism associated with stages of the Hepatitis C virus (HCV).     

外耳道原发性腺样囊性癌的研究

通过分析3例外耳道原发性腺样囊性癌的临床表现,探讨了外耳道原发性腺样囊性癌的诊断和治疗。结果表明,外耳道原发性腺样囊性癌早期诊断困难,术后局部易复发,治疗主要采用手术切除辅以放疗,术后应长期随访。     

早期阴茎癌局部病灶切除18例临床分析

目的:探讨阴茎癌局部病灶切除的疗效。方法:对邯郸市中心医院1999年1月至2009年1月收治的18例早期阴茎癌患者的临床资料进行回顾性分析。18例均为鳞状细胞癌。其中6例有腹股沟肿大淋巴结进行了活检,均呈阴性。结果:18例早期阴茎癌患者均选择局部病变切除治疗。其中10例加术后放射治疗。随访1—10年。生存率100%。结论:I期和II期阴茎癌患者采用局部病灶切除或加术后放射治疗是治疗阴茎癌合理有效的方法。     

Health economic evaluation of Gd-EOB-DTPA MRI vs ECCM-MRI and multi-detector computed tomography in patients with suspected hepatocellular carcinoma in Thailand and South Korea

Objective: The effectiveness of treatment decisions and economic outcomes of using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) were compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and multi-detector computed tomography (MDCT) as initial procedures in patients with suspected hepatocellular carcinoma (HCC) in South Korea and Thailand. Methods: A decision-tree model simulated the clinical pathway for patients with suspected HCC from the first imaging procedure to a confirmed treatment decision. Input data (probabilities and resource consumptions) were estimated and validated by clinical experts. Costs for diagnostic alternatives and related treatment options were derived from published sources, taking into account both payer’s and hospital’s perspectives. Results: All experts from Korea and Thailand agreed that Gd-EOB-DTPA-MRI yields the highest diagnostic certainty and minimizes the need for additional confirmatory diagnostic procedures in HCC. In Korea, from the payer’s perspective, total cost was USD $3087/patient to reach a confirmed treatment decision using Gd-EOB-DTPA-MRI (vs $3205/patient for MDCT and $3403/patient for ECCM-MRI). From the hospital’s perspective, Gd-EOB-DTPA-MRI incurred the lowest cost ($2289/patient vs $2320/patient and $2528/patient, respectively). In Thailand, Gd-EOB-DTPA-MRI was the least costly alternative for the payer ($702/patient vs $931/patient for MDCT and $873/patient for ECCM-MRI). From the hospital’s perspective, costs were $1106/patient, $1178/patient, and $1087/patient for Gd-EOB-DTPA-MRI, MDCT, and ECCM-MRI, respectively. Conclusions: Gd-EOB-DTPA-MRI as an initial imaging procedure in patients with suspected HCC provides better diagnostic certainty and relevant statutory health insurance cost savings in Thailand and Korea, compared with ECCM-MRI and MDCT.     

Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case

Objective:

To evaluate the cost-benefit of using levosimendan compared with dobutamine, in the perioperative treatment of patients undergoing cardiac surgery who require inotropic support.

Methods:

A two-part Markov model was designed to simulate health-state transitions of patients undergoing cardiac surgery, and estimate the short- and long-term health benefits of treatment. Hospital length of stay (LOS), mortality, medication, and adverse events were key clinical- and cost-inputs. Cost-benefits were evaluated in terms of costs and bed stays within the German healthcare system. Drug prices were calculated from the German Drug Directory (€/2014) and published literature, with a 3% annual discount rate applied. The base case analysis was for a 1-year time horizon.

Results:

The use of levosimendan vs dobutamine was associated with cost savings of €4787 per patient from the German hospital perspective due to reduced adverse events and shorter hospital LOS, leading to increased bed capacity and hospital revenue.

Limitations:

A pharmacoeconomic calculation for the specific situation of the German healthcare system that is based on international clinical trial carries a substantial risk of disregarding potentially relevant but unknown confounding factors (i.e., ICU-staffing, co-medications, standard-ICU care vs fast-tracking, etc.) that may either attenuate or increase the outcome pharmacoeconomic effects of a drug; however, since these conditions would also apply for patients treated with comparators, their net effects may not necessarily influence the conclusions.

Conclusions:

The use of levosimendan in patients undergoing cardiac surgery who require inotropic support appears to be cost-saving. The results of the analysis provide a strong rationale to run local clinical studies with pharmacoeconomic end-points which would allow a much more precise computation of the benefits of levosimendan.     

胃癌根治切除术治疗老年胃癌患者的疗效分析

目的探讨胃癌根治切除术治疗老年胃癌患者的疗效。方法对157例老年胃癌患者采用胃癌根治切除术治疗和围术期处理措施的效果进行回顾分析。结果 157例患者术后发生并发症39例,1年内病死56例。结论手术技术的进步和有力的围术期支持治疗,可以保证老年患者胃癌根治切除术患者取得较好疗效。