An economic analysis of the cost of survival of micro preemies: A systematic review

ObjectiveThis study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g.MethodWe searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists.ResultsThe search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives.ConclusionDespite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies.     

Temporal Trends of Women Enrollment in Major Cardiovascular Randomized Clinical Trials

Background

Although it is known that women do not participate in trials as frequently as men, there are limited recent data examining how women recruitment has changed over time.

腰椎融合术前相邻节段存在退变因素对术后早期临床疗效的影响

目的探讨腰椎拟融合节段的相邻节段术前存在的椎管狭窄因素对术后早期临床疗效的影响。方法采用前瞻性对比研究，将 2015 年 7 月—2017 年 12 月收治的符合选择标准的 183 例 L₄～S₁ 腰椎管狭窄症患者，根据术前椎间盘退变情况及椎管狭窄情况判断的相邻节段退变（adjacent segment degeneration，ASD）状态不同分成两组，A 组 98 例（术前相邻节段无退变），B 组 85 例（术前相邻节段已退变）。两组患者性别、美国麻醉医师协会（ASA）分级、体质量指数（body mass index，BMI）、合并滑脱状态及术前腰、腿痛疼痛视觉模拟评分（VAS）、日本骨科协会（JOA）评分、Oswestry 功能障碍指数（ODI）等一般资料比较差异无统计学意义（P>0.05）；A 组患者年龄显著小于 B 组（t=−3.560，P=0.000）。记录并比较两组患者手术时间、术中出血量、住院时间、围术期并发症；末次随访时采用腰、腿痛 VAS 评分、JOA 评分、ODI 评分评价疗效。比较两组间末次随访时 ASD 发生情况，采用 logistic 回归分析影响患者术后出现 ASD 的独立危险因素。 结果两组患者手术时间、术中出血量及住院时间比较差异均无统计学意义（P>0.05）。A、B 组围术期并发症发生率分别为 13.3% 和 20.0%，比较差异无统计学意义（χ²=1.506，P=0.220）。两组患者均获随访，A、B 组随访时间分别为（24.9±8.8）个月和（24.8±7.8）个月，差异无统计学意义（t=0.050，P=0.960）。至末次随访时，两组患者均未出现相邻节段病变。两组患者末次随访时椎间盘 Pfirrmann 分级与术前比较差异均无统计学意义（P>0.05）；术前及末次随访时两组间 Pfirrmann 分级差异均有统计学意义（P<0.001）。至末次随访时 A、B 组分别有 21 例（21.4%）和 53 例（62.4%）出现 ASD，比较差异有统计学意义（χ²=31.652，P=0.000）；术后相邻节段椎管狭窄程度加重是术后发生 ASD 的主要原因。两组患者末次随访时各临床评分均较术前显著改善（P<0.05），末次随访时 A 组 JOA 评分显著高于 B 组（P<0.05）。B 组患者中术后出现 ASD 患者末次随访时的腰痛 VAS 评分、ODI 评分显著高于非 ASD 患者（P<0.05）。logistic 回归分析显示，术前相邻节段存在退变因素与 BMI 是影响患者术后出现 ASD 的独立危险因素（P<0.05）。 结论术前相邻节段存在退变因素，会显著影响患者术后早期临床疗效及增加术后出现 ASD 的风险，相邻节段椎管狭窄程度加重是术后早期 ASD 主要的病理类型。应根据术前相邻节段椎管的整体退变情况评估术前相邻节段的退变状态。     

乳房血供及乳房缩小术的研究进展

目的总结近年来乳房血供及乳房缩小术式的研究进展。方法广泛查阅近年来有关乳房神经分布、血供、乳房缩小术式的发展和术后哺乳功能等情况的国内外文献，并结合临床经验进行分析总结。结果随着对乳房腺体及乳头乳晕复合体的神经分布与血供的解剖研究，乳房缩小术已形成了多种手术方式，各有优缺点，适应证亦不同。通过辅助检查技术的应用，术后乳头、乳晕坏死等严重并发症发生率明显降低；通过对切口与蒂部位置的选择、保留蒂部腺体量的程度、辅助吸脂技术的应用和缝合技术方面的改进，减轻了术后切口瘢痕，更好地保留了乳头乳晕感觉，获得了更为满意的乳房形态。行乳房缩小术后部分分娩患者具有一定哺乳功能。结论乳房缩小术需根据患者特点采用个性化手术方式。在如何更好地保留乳头、乳晕感觉，获得良好而持久的乳房形态，生育期妇女术后哺乳功能保留等方面有待进一步研究。     

富血小板血浆治疗兔跟腱病的实验研究

目的探讨富血小板血浆（platelet-rich plasma，PRP）治疗兔跟腱病的效果，为 PRP 治疗跟腱病的临床应用提供实验依据。方法取成年新西兰大白兔 48 只，体质量 2.5～3.0 kg，雌雄不限，随机分为模型组（A 组）、模型对照组（B 组）、模型+治疗对照组（C 组）、模型+治疗组（D 组），每组 12 只。A、C、D 组注射Ⅰ型胶原酶制备兔跟腱病模型，B 组注射等剂量生理盐水。D 组取自体耳中心动脉血，采用二次离心法制备 PRP，血小板计数提示 PRP 血小板达全血的 3～5 倍。模型制备后，C、D 组于造模部位分别注射生理盐水、自体 PRP，每周 1 次，每次 0.8 mL，连续 4 周。于 PRP 注射结束后 1 周，采用超声弹性定量成像检测技术评价各组跟腱相对硬度，以 HRD%（硬度百分比）表示；万能电子拉力试验机测定跟腱最大断裂负荷；ELISA 法测定Ⅰ、Ⅲ型胶原蛋白含量；HE 染色和 Masson 染色观察跟腱胶原纤维形态。结果各组动物均存活至实验完成。超声弹性定量成像检测及力学试验示，A 组跟腱硬度评价指标 HRD% 及最大断裂负荷显著小于 B 组（P<0.05），C 组显著小于 D 组（P<0.05）。ELISA 检测示，A 组Ⅰ型胶原蛋白含量显著低于 B 组、C 组显著低于 D 组，A 组Ⅲ型胶原蛋白含量显著高于 B 组、D 组显著高于 C 组，差异均有统计学意义（P<0.05）。HE 染色和 Masson 染色示，A 组跟腱胶原纤维呈不规则卷曲，结构严重破坏；B 组呈平行有序排列、结构完整；C 组呈不规则卷曲，结构紊乱；D 组呈轻微卷曲，结构较为完整。 结论Ⅰ型胶原酶注射可成功构建兔跟腱病模型，PRP 治疗可增加跟腱硬度和最大断裂负荷，上调Ⅰ、Ⅲ型胶原蛋白表达水平，改善跟腱胶原纤维结构和形态，促进兔跟腱病的恢复。     

The oncogenic impact of RNF2 on cell proliferation,invasion and migration through EMT on mammary carcinoma

Mammary carcinoma (MC) is one of most common malignancy in women, and ring finger protein 2 (RNF2) possesses various roles in vast human tumors. In MC tissues as well as in cell lines RNF2 exhibited high expression, had significant association with tumor size, lymph node status, TNM stage, patients’ poor survival, and promoted cell proliferation, colony formation, cell migration and invasion of MC cell lines which was mediated by downregulation of E-cadherin protein. These data reveal that RNF2 protein plays a vital role in the development of MC and may be a potential therapy target of MC.     

Nation's compensation for war wounds and work incapacities. The creation of a new welfare system for physically disabled veterans and civilians of the First World War in Interwar Belgium, 1918–1928

This article explores the creation of a new social welfare system for physically disabled veterans and civilians of the Great War in Belgium during the early interwar period. Through an analysis of debates among ministers and legislators, doctor's opinions and the member's periodicals of the two largest national associations for war-wounded veterans and civilians it examines how these actors shaped a new set of benefits that caused significant socio-economic inequalities inside and between both groups of victims and in relation to physically disabled citizens without war injuries. Consequently, this article reveals how the welfare system characterised a reimagining of war compensation, the physically disabled worker and disability equality in Belgium.     

Survivin-shRNA对视网膜母细胞瘤HXO-RB44细胞自噬及凋亡的影响

目的:研究Survivin-shRNA对视网膜母细胞瘤HXO-RB44细胞自噬及凋亡的影响。方法:培养视网膜母细胞瘤HXO-RB44细胞，构建Survivin-shRNA载体。按照处理不同分为Survivin-shRNA组、GFP组和CON组。分别采用流式细胞术检测Survivin-shRNA对HXO-RB44细胞凋亡和细胞周期的影响，应用MTT法检测Survivin-shRNA对HXO-RB44细胞活性的影响，Western blot法检测Survivin-shRNA对HXO-RB44 细胞自噬相关蛋白LC3、p62 与mTOR 表达的影响。结果:流式细胞术结果表明，与Control组和GFP组相比，Survivin-shRNA组细胞凋亡率增加，差异有统计学意义（P＜0.05）；随着作用时间的延长，S期出现阻滞，48 h阻滞最强，显著高于对照组（P＜0.05）。MTT结果发现Survivin-shRNA可抑制HXO-RB44细胞增殖活性，与Control组和GFP组相比，差异有统计学意义（P＜0.05）；Western blot结果发现，与对照组相比，LC3表达量显著增加（P＜0.01）；而mTOR表达量降低（P＜0.01）。结论:Survivin-shRNA可促进视网膜母细胞瘤HXO-RB44细胞的凋亡和自噬水平，进而特异性杀伤肿瘤细胞。