中药与佳乐定对失眠症疗效的对照研究

目的　探讨中药与佳乐定治疗失眠症的疗效与不良反应。方法　对 91例符合CCMD - 3失眠症诊断标准的患者按心理测验时的单双序号分为研究组 (中药 ) 4 6例和对照组 (佳乐定 ) 4 5例 ,其中 86例完成了 2w治疗。在治疗前后用睡眠障碍评定量表、汉密尔顿焦虑量表及临床总体印象量表评定疗效 ,用副作用量表评定不良反应。结果　经过 14d治疗 ,睡眠障碍评定量表评定结果显示 ,研究组有效率为 5 8.7% ,对照组为 6 4 .4 % ,两组与治疗前比较均有极显著性差异 (P <0 .0 1) ,两组间无显著性差异 (P >0 .0 5 )。两组汉密尔顿焦虑量表及临床总体印象量表评定与治疗前比较均有极显著性差异 (P <0 .0 1) ,两组间比较无显著差异 (P >0 .0 5 ) ,但研究组不良反应少 ,依从性好。结论　中药可以作为治疗失眠症的一种有效方法     

Expression of NY-ESO-1, MAGE-A3, PRAME and WT1 in different subgroups of breast cancer: An indication to immunotherapy?

ObjectivesCancer Testis Antigens are immunogenic tumor-specific proteins. We investigated NY-ESO-1, MAGE-A3 and PRAME, in addition to WT1 expression in different Breast Cancer (BC) subtypes. We then evaluated the expression rate of NY-ESO-1 in early Triple Negative breast cancer (TNBC), and investigated whether its expression would be maintained or lost in the metastatic setting to explore possible immunotherapy indication.Materials and methodsThree subgroups of BC patients were selected by the expression of ER, PgR and Her2. Tissue microarray was performed on a total of 92 Invasive BC. Sections were stained for NY-ESO-1, MAGE-A3, PRAME and WT1. The second cohort was composed by 26 metastatic TNBC patients from whom both the primary and secondary lesion tissues were available. Sections were stained for NY-ESO-1.ResultsNY-ESO-1 was the only differentially expressed antigen and was absent in ER+ and ER-PgR + tumors, as for an exclusive expression of either NY-ESO-1 or at least one hormonal receptor (HR+). NY-ESO-1 was particularly represented in TNBC. No correlation has been found between MAGE-A3 and PRAME expression and subtype WT1 had low expression, except in the Her2+ group. In the second cohort, NY-ESO-1 was expressed in 12 and 24% of primary and metastatic lesions respectively.ConclusionsThis study defines a distinction between HR+ and HR-tumors through NY-ESO-1 expression.TNBC subgroup has the highest frequency of NY-ESO-1+ cases, and it could be the candidate population for the development of anti-NY-ESO-1 vaccine, both in the adjuvant or metastatic setting, and for the selection of cases suitable for immunotherapy.     

Effectiveness of MRNA booster vaccine among healthcare workers in New York City during the Omicron surge,December 2021 to January 2022

ObjectiveTo describe effectiveness of mRNA vaccines by comparing 2-dose (2D) and 3-dose (3D) healthcare worker (HCW) recipients in the setting of Omicron variant dominance. Performance of 2D and 3D vaccine series against SARS-CoV-2 variants and the clinical outcomes of HCWs may inform return-to-work guidance.MethodsIn a retrospective study from December 15, 2020 to January 15, 2022, SARS-CoV-2 infections among HCWs at a large tertiary cancer centre in New York City were examined to estimate infection rates (aggregated positive tests / person-days) and 95% CIs over the Omicron period in 3D and 2D mRNA vaccinated HCWs and were compared using rate ratios. We described the clinical features of post-vaccine infections and impact of prior (pre-Omicron) COVID infection on vaccine effectiveness.ResultsAmong the 20857 HCWs in our cohort, 20,660 completed the 2D series with an mRNA vaccine during our study period and 12461 had received a third dose by January 15, 2022. The infection rate ratio for 3D versus 2D vaccinated HCWs was 0.667 (95% CI 0.623, 0.713) for an estimated 3D vaccine effectiveness of 33.3% compared to two doses only during the Omicron dominant period from December 15, 2021 to January 15, 2022. Breakthrough Omicron infections after 3D + 14 days occurred in 1,315 HCWs. Omicron infections were mild, with 16% of 3D and 11% 2D HCWs being asymptomatic.DiscussionStudy demonstrates improved vaccine-derived protection against COVID-19 infection in 3D versus 2D mRNA vaccinees during the Omicron surge. The advantage of 3D vaccination was maintained irrespective of prior COVID-19 infection status.     

Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports

BACKGROUNDAppendectomy is the procedure of choice for the treatment of acute appendicitis. However, surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis (AP). Endoscopic retrograde appendicitis treatment (ERAT) may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARYWe report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy. One patient had moderately severe AP due to hyperlipidemia, while the other patient had a gallstone induced by moderately severe AP. Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP. Therefore, the alternative and minimally invasive ERAT was considered. After written informed consent was collected from the patients, the ERAT procedure was performed. Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSIONERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.     

System impact research – increasing public health and health care system performance

Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population.

Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs).

Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs.

Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality.

Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.

• Key messages

• The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.

• SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services.

• SIR creates the scientific basis for policy decisions. Leaders at all levels of health and social care can use the evidence from SIR for the benefit of the patients and the population.

     

对胸外科手术患者浅低温综合护理干预的效果评价

目的降低胸外科手术患者浅低温的发生率，提高围术期的护理质量。方法将普通胸外科手术患者各155例分为两组，比较手术患者浅低温综合护理干预的临床效果。对照组为常规护理；实验组采取如下干预方法：恒定室温、冲洗体腔盐水加温、铺垫38℃水循环变温毯、手术裸露部位用不同形状棉毯保护、热空气暖风装置保护体温，并制定手术患者浅低温预防的护理常规、流程、制度。评价指标为：患者年龄、手术时间、切口感染、肺部感染和浅低温发生率。结果两组浅低温发生率分别为57．41％、18．06％；切口感染率分别为8．38％、0．64％；肺部感染率分别为29．67％、5．8％。3项评价指标均有显著性差异（P〈0．01）。结论胸外科围术期患者的体温保护应成为手术室的护理常规，体温保护是提高围术期患者的护理质量、降低术后并发症的重要影响因素，应成为胸外科手术护理不可忽视的重要护理内容。     

The cost‐effectiveness and budgetary impact of a dolutegravir‐based regimen as first‐line treatment of HIV infection in India

Introduction

Dolutegravir (DTG)‐based antiretroviral therapy (ART) is recommended for first‐line HIV treatment in the US and Europe. Efavirenz (EFV)‐based regimens remain the standard of care (SOC) in India. We examined the clinical and economic impact of DTG‐based first‐line ART in the setting of India's recent guidelines change to treating all patients with HIV infection regardless of CD4 count.

Methods

We used a microsimulation of HIV disease, the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐International model, to project outcomes in ART‐naive patients under two strategies: (1) SOC: EFV/tenofovir disoproxil fumarate (TDF)/lamivudine (3TC); and (2) DTG: DTG + TDF/3TC. Regimen‐specific inputs, including virologic suppression at 48 weeks (SOC: 82% vs. DTG: 90%) and annual costs ($98 vs. $102), were informed by clinical trial data and other sources and varied widely in sensitivity analysis. We compared incremental cost‐effectiveness ratios (ICERs), measured in $/year of life saved (YLS), to India's per capita gross domestic product ($1600 in 2015). We compared the budget impact and HIV transmission effects of the two strategies for the estimated 444,000 and 916,000 patients likely to initiate ART in India over the next 2 and 5 years.

Results

Compared to SOC, DTG improved 5‐year survival from 76.7% to 83.0%, increased life expectancy from 22.0 to 24.8 years (14.0 to 15.5 years, discounted), averted 13,000 transmitted HIV infections over 5 years, increased discounted lifetime care costs from $3040 to $3240, and resulted in a lifetime ICER of $130/YLS, less than 10% of India's per capita GDP in 2015. DTG maintained an ICER below 50% of India's per capita GDP as long as the annual three‐drug regimen cost was ≤$180/year. Over a 2‐ or 5‐year horizon, total undiscounted outlays for HIV‐related care were virtually the same for both strategies.

Conclusions

A generic DTG‐based regimen is likely to be cost‐effective and should be recommended for initial therapy of HIV infection in India.

     

主动脉根部缺如的房间隔缺损经导管介入治疗疗效分析

目的:探讨主动脉根部缺如的继发性房间隔缺损(atrial septal defect,ASD)患者介入治疗的安全性及有效性。方法:采用回顾性的研究方法,收集了自2016年1月至2018年1月复旦大学附属中山医院心血管内科收治的402例ASD患者的临床资料。分为主动脉根部缺如组和正常组,所有患者均接受单一封堵器介入治疗,探究主动脉根部缺如组ASD患者行介入封堵治疗的安全性及有效性。结果:主动脉根部缺如与边缘正常所有患者术后均未出现重大手术并发症,术后右心重构明显改善,肺动脉压力下降,三尖瓣反流减少,但左室射血分数无明显变化。结论:主动脉根部缺如的ASD的介入封堵治疗是安全可行性,能够显著改善患者的右心功能,改善心室重构。     

Secondary data sources for health services research in urologic oncology

Background

Though secondary data analyses of large datasets may reduce logistical and financial barriers required to perform significant and innovative work, such research requires specialized skills in data handling and statistical techniques as well as thorough and detailed knowledge of the data sources being used.