Nanog在肿瘤细胞中表达的Meta分析

目的:研究Nanog蛋白在肿瘤细胞中表达的意义。方法:计算机检索Pub Med、Embase、Cochrane图书馆、CNKI、中国生物医学文献和万方数据库,检索时间均从建库到2014年5月,手工检索相关文献,收集Nanog在肿瘤细胞和正常细胞中表达的随机对照实验。对符合纳入标准的临床研究进行质量评价和资料提取后,采用Rev Man5.2软件进行Meta分析。结果:共纳入9篇原始文献,包括852例组织芯片(其中癌细胞组520例,正常细胞组332例)。Meta分析结果显示:癌细胞组中Nanog蛋白表达风险是正常细胞组的13.78(95%CI:9.60~19.77)倍。敏感性分析Z=14.24,P<0.00001,即分析结果稳定且不存在明显偏倚。结论:Nanog在肿瘤细胞中较正常细胞中显著高表达。     

Cost effectiveness of a 92-gene assay for the diagnosis of metastatic cancer

Objectives:

To estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the 92-gene assay can be used to standardize the diagnostic process and costs for clinicians, patients, and payers.

Methods:

Four decision-analytic models were developed to project the lifetime clinical and economic impact of incorporating the 92-gene assay compared with standard care alone. For each model, total and incremental costs, life-years, quality-adjusted life-years (QALYs), incremental cost–effectiveness ratios (ICERs), and the proportion of patients treated correctly versus incorrectly were projected from the payer perspective. Model inputs were based on published literature, analyses of SEER (Surveillance Epidemiology and End Results) data, publicly available data, and interviews with clinical experts.

Results:

In all four models, the 92-gene assay increased the proportion of patients treated correctly, decreased the proportion of patients treated with empiric therapy, and increased quality-adjusted survival. In the primary model, the ICER was $50,273/QALY; thus, the 92-gene assay is therefore cost effective when considering a societal willingness-to-pay threshold of $100,000/QALY. These findings were robust across sensitivity analyses.

Conclusions:

Use of the 92-gene assay for diagnosing metastatic tumors of uncertain origin is associated with reduced misdiagnoses, increased survival, and improved quality of life. Incorporating the assay into current practice is a cost-effective approach to standardizing diagnostic methods while improving patient care. Limitations of this analysis are the lack of data availability and resulting modeling simplifications, although sensitivity analyses showed these to not be key drivers of results.     

贝伐珠单抗治疗转移性结直肠癌的效果与成本研究综述

目的综合回顾有关贝伐珠单抗联合化疗治疗效果及不良反应的Meta分析,及联合化疗对比单一化疗的成本效果分析,探讨贝伐珠单抗联合化疗为转移性结直肠癌患者带来的效果及不良反应及成本效果分析,为贝伐珠单抗在治疗的应用提供一定的参考。方法检索Pubmed、中国期刊全文数据库(CNKI)等发表的对比mCRC患者中贝伐珠单抗联合化疗及单一化疗的Meta分析及成本效果分析。综述Meta分析及成本效果分析的结果。结果纳入的6个Meta分析,显示贝伐珠单抗联合化疗较单一化疗显著提高了患者无进展生存时间、中位总生存期,然而使用贝伐珠单抗可能增加高血压、蛋白尿、出血等风险,而对胃穿孔、血栓等并无显著差异。成本效果分析表明,贝伐珠单抗相较于西妥昔单抗在成本上具有优势,效果相差并不非常显著。结论贝伐珠单抗具有较高成本,然而贝伐珠联合化疗能显著提高患者的生存收益,一定程度上增加不良反应,基于中国本土数据的成本效果分析还需进一步开展。     

毛细支气管炎患儿潮气呼吸肺功能评价的临床研究

目的评价潮气呼吸肺功能检测评价毛细支气管炎病情的疗效。方法选择2012年1月至2013年1月于我院接受治疗的毛细支气管炎患儿75例,纳入观察组,对照组则选同期日常保健健康儿45例。比较毛细支气管炎患儿急性期和恢复期的潮气呼吸肺功能,并观察各因素与肺功能间的关系。结果观察组急性期患儿呼吸频率增快,达峰时间、达峰容积均明显低于对照组,各项指标的组间差异均有统计学意义(P<0.01)。恢复期达峰时间、达峰容积均优于本组急性期,差异有统计学意义(P<0.01)。潮气呼吸功能参数变化比较,观察组急性期患儿潮气量减低,达峰时间比、达峰容积比和吸呼时间比均明显低于对照组,组间各项指标的差异均有统计学意义(P均<0.01)。恢复期吸呼时间比好于本组急性期,差异有统计学意义(P<0.01)。结论婴幼儿潮气呼吸肺功能是评价毛细支气管炎病情的客观指标及进行早期干预治疗的依据之一。     

超声联合核磁共振检查诊断乳腺癌的效率及经济性分析

目的：结合病理组织学探讨联合应用彩色超声成像和核磁共振（MRI）对乳腺癌的诊断价值。方法：回顾性分析经手术或组织学活检病理证实的74例乳腺癌患者（97个病灶）及良性肿块70例患者（75个病灶）的术前彩色超声成像及核磁共振检查资料,比较两种检查方法及联合应用的诊断效率,同时与病理组织学结果对照。结果：超声、核磁共振及两者联合应用,对乳腺癌诊断的敏感性分别为76．3％、82．5％和87．6％,特异性分别为92．0％、88．0％和96．0％,符合率分别为83．1％、84．9％和91．3％,统计学分析比较无显著性差异（P〉0．05）。两种检查方法及联合应用的经济性分析显示,采用超声检查,其费用支出仅为MRI的约1／10,为联合应用法的约1／11;如都实施穿刺病理检查,则超声穿刺法的费用支出较MRI或联合法节约一半以上。结论：超声、核磁共振检查对乳腺癌的诊断都具有较高的特异性和敏感性,而联合检查可以有效地提高符合率。考虑到经济性效率,采用超声结合病理穿刺诊断乳腺癌更适于高危人群筛查。     

腹腔热灌注化疗联合热疗治疗卵巢癌伴腹水的护理

目的探讨腹腔热灌注化疗联合热疗治疗卵巢癌伴腹水的临床护理体会。方法对我科2012年1月至2012年12月收治的18例卵巢癌伴腹水的患者采取多西他赛全身化疗加卡铂腹腔灌注联合热疗的护理,并观察其疗效。结果对采取多西他赛全身化疗加卡铂腹腔灌注联合热疗的患者采取综合护理。患者积极配合,取得有效的治疗效果,提高了护理质量无并发症发生。结论腹腔灌注化疗联合热疗治疗卵巢癌伴腹水效果肯定,采取综合护理,可提高疗效,减轻各种并发症的发生,值得临床推广。     

Framing and Efficacy: The Effect of Regulatory Fit on Skin Cancer Prevention and Detection

Australia has one of the highest rates of skin cancer in the world, representing 80% of all diagnosed cancers each year (Cancer Council Australia, n.d. Cancer Council Australia. (n.d.). Citing Websites. In Skin Cancer Facts and Figures. http://www.cancer.org.au/cancersmartlifestyle/SunSmart/Skincancerfactsandfigures.htm (http://www.cancer.org.au/cancersmartlifestyle/SunSmart/Skincancerfactsandfigures.htm)  [Google Scholar]). The dissemination of information regarding the prevention and detection of skin cancer through social marketing campaigns is a vital element in protecting the well being of Australians. In drawing on self-regulatory focus theory, this study is the first to examine the role of message framing (i.e., gain framing vs. loss framing) in conjunction with an individual's efficacy appraisals (i.e., self-efficacy vs. response efficacy) associated with skin cancer behaviors (i.e., prevention vs. detection behaviors). Findings show the effectiveness of social marketing campaigns is contingent upon good “regulatory fit,” which is achieved when gain framing is coupled with self-efficacy appeals and loss framing is coupled with response-efficacy appeals. For social marketers, who constantly strive to maximize the effectiveness of advertising expenditure, the findings of this study are highly significant.     

右美托咪定对老年结直肠癌患者术后疼痛及应激反应的影响

目的 探讨右美托咪定对老年结直肠癌患者术后疼痛及应激反应的影响.方法 选取2017年12月至2020年2月于阜新市中心医院接受结直肠癌根治术的老年原发性结直肠癌患者118例作为研究对象,按照随机数字表法分为对照组与观察组,各59例.对照组患者接受常规静脉全身麻醉,观察组患者在麻醉诱导后、麻醉维持过程中分别泵注右美托咪定...     

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.     

Economic burden of chemotherapy-treated recurrent and/or metastatic squamous cell carcinoma of the head and neck in France: real-world data from the permanent sample of national health insurance beneficiaries

Aims: Overall survival (OS) of patients with recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) is extremely poor. New therapeutic options emerge but need to establish their economic value. The objective was to describe the direct and related costs of R/M SCCHN in France.

Materials and methods: We selected all adult patients treated with chemotherapy for R/M SCCHN between 1 January 2009 and 31 December 2014 from the permanent sample of the French national health insurance database (EGB). Data were analyzed from the index date (first chemotherapy) until patients’ death or 31 December 2015. “Treatment period” and “end-of-life” (EoL) (from last chemotherapy until death) were distinguished. Costs included all hospitalizations for SCCHN and ambulatory care. Costs of hospitalized and non-hospitalized adverse events (AEs) were estimated.

Results: Among 267 patients identified, 85% were men, 44% had metastases at the index date and the mean age was 62.0 years (±9.9). The most common tumor location was oropharynx (29%) but 39% of patients had multiple locations. Median OS was 9.3 (95% CI: 7.9–11.8) months for the overall population. The average total direct cost per patient was €49,954, broken down into €32,908 (95% CI: 29,525–36,290) for hospitalizations and €17,047 (14,941–19,152) for ambulatory care. Main cost drivers were drug acquisition and administration (€14,538) during the treatment period (209?days on average) and palliative care (€3,750) during the EoL period (125?days). Regarding related costs, around 12% of patients received disability pensions (€1,397 per patient [624–2,171]) and sick leave payments (€1,592 [888–2,297]). “Metabolism and nutrition disorders” and “Infections and infestations” were the most expensive hospitalized AEs (€1,513 and €1,180 per patient, respectively). Febrile neutropenia was the most expensive non-hospitalized AE (€766 per patient).

Conclusions: This analysis of real-world data confirms the poor prognosis of patients with R/M SCCHN and provides cost data for future economic evaluations.