深圳地区HBV核酸检测反应性献血者两种归队模式风险评估研究

目的评估HBV核酸检测反应性献血者归队风险,为采供血机构制定献血者归队策略提供依据。方法对ELISA双试剂无反应性、HBV核酸检测反应性献血者进行跟踪检测。每次间隔3个月以上,两次直接静脉采样。归队后再跟踪两次以上献血检测结果。两家血站分别按无门槛自愿原则与增加献血10次以上要求进行采样,并对两种模式归队结果进行比对。结果无门槛自愿归队模式归队前检测3例酶免检测阴转阳(15.79%);增加献血次数门槛归队模式归队成功率88.46%;两种归队模式成功归队后再次出现不合格情况分别为20.00%、13.04%,统计无差异,但归队后人均年献血次数有较大差别。结论酶免检测无反应性而HBV核酸检测反应性被屏蔽献血者无门槛归队模式存在窗口期感染风险。建议将多次献血或固定献血、首次出现酶免检测无反应性而HBV核酸检测反应性被屏蔽的献血者列入归队目标人群。仅以HBsAg+HBV DNA作为HBV核酸检测反应性献血者的归队评价指标存在较大风险,应考虑增加化学发光法等补充试验。     

Effect of corneal stromal pocket irrigation in small-incision lenticule extraction

ObjectivesTo investigate the effect of corneal stromal pocket irrigation after small-incision lenticule extraction (SMILE) on visual acuity, intraocular pressure (IOP), corneal parameters and complications after surgery.MethodsA total of 242 eyes of 121 patients undergoing SMILE were enrolled in this prospective controlled study, and it was designed for one eye to randomly undergo SMILE with balanced salt solution irrigation of the corneal stromal pocket, while the other eye was not. The uncorrected distance visual acuity (UDVA) and slit lamp examination were recorded at 1 hour, 1 day, 1 week, and 1 month. Postoperative corneal density, corneal biomechanical, corneal endothelial cell number, and anterior OCT images were compared at 1 day, 1 week, and 1 month.ResultsCompared with the nonirrigation group, the irrigation group showed significantly higher UDVA at 1 day postoperatively (P < 0.05), but there was no significant difference during the rest of the postoperative period (1 hour, 1 week, and 1 month). In addition, no significant differences were found in IOP, corneal density, corneal biomechanics, corneal endothelial cells, and corneal morphology. No visual decline or severe postoperative complications were found in the patients in this study.ConclusionsInterlamellar irrigation did not affect IOP, corneal parameters, morphology, complications, or UDVA at 1 hour, 1 week, and 1 month after the operation, but it may promote UDVA 1 day after the operation.Subject terms: Refractive errors, Outcomes research, Surgery     

Cost–Utility Analysis of Pembrolizumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small Cell Lung Cancer With Different PD-L1 Expression Levels

To evaluate the cost–utility of pembrolizumab versus chemotherapy as the first-line setting for metastatic nonsmall cell lung cancer (NSCLC) from the US health care system perspective, a Markov model was developed to compare the lifetime cost and effectiveness of pembrolizumab versus chemotherapy for untreated metastatic NSCLC, based on the clinical data derived from phase III randomized controlled trial (KEYNOTE- 042; ClinicalTrials.gov; NCT02220894). Weibull distribution was fitted to simulate the parametric survival functions. Drug costs were collected from official websites, and utility values were obtained from published literature. Total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were computed as primary output indicators. The impact of different PD-L1 expression levels on ICER was also evaluated. One-way and probabilistic sensitivity analyses were performed to assess the model uncertainty. Compared with chemotherapy, patients treated with pembrolizumab provided an additional 1.13, 1.01, and 0.59 QALYs in patients with PD-L1 expression levels of ≥50%, ≥20%, and ≥1%, with corresponding incremental cost of $53,784, $47,479, and $39,827, respectively. The resultant ICERs of pembrolizumab versus chemotherapy were $47,596, $47,184, and $68,061/QALY, in three expression levels of PD-L1, respectively, all of which did not exceed the WTP threshold of 180,000/QALY. Probability sensitivity analysis outcome supported that pembrolizumab exhibited evident advantage over chemotherapy to be cost-effective. One-way sensitivity analysis found that ICERs were most sensitive to utility value of pembrolizumab in progression survival state. All the adjustment of parameters did not qualitatively change the result. For treatment-naive, metastatic NSCLC patients with PD-L1+, pembrolizumab was estimated to be cost-effective compared with chemotherapy for all PD-L1 expression levels at a WTP threshold of $180,000/QALY in the context of the US health care system.     

立家之本:血管外科开放手术

近年来,血管外科腔内治疗手段飞速发展和进步,因其创伤小、并发症少、术后恢复快及对患者一般情况要求较宽松等优势,使得很多临床医生和患者更倾向于通过腔内手段治疗血管疾病,逐渐忽视了外科手术治疗的重要性,甚至出现忽视患者病情的个体情况而盲目选择腔内治疗的趋势。作为血管疾病治疗的重要方式,开放手术乃是血管外科的立家之本,是血管外科临床医生的基本技能,在很多情况下有着不可替代的作用,应当再次被强调、被重视。     

多西他赛联合氟尿嘧啶、顺铂方案与多西他赛联合氟尿嘧啶、洛铂方案治疗胃癌的疗效比较

目的:比较多西他赛联合氟尿嘧啶、顺铂方案与多西他赛联合氟尿嘧啶、洛铂方案治疗晚期不可手术胃癌患者的疗效和不良反应。方法:回顾性分析2015年2月至2018年6月126例晚期不可手术的胃癌患者。洛铂组55例:多西他赛+氟尿嘧啶+洛铂，顺铂组71例:多西他赛+氟尿嘧啶+顺铂。洛铂组和顺铂组均21天为一个疗程，连续治疗四个疗程。结果:洛铂组患者客观有效率为50.91%，顺铂组为35.21%，差异无统计学意义（P＞0.05）。洛铂组患者疾病控制率达到83.64%，顺铂组为67.61%，差异有统计学意义（P＜0.05）。洛铂组患者在恶心、呕吐、白细胞减少和四肢麻木方面发生率明显低于顺铂组，差异有统计学意义（P＜0.05）。洛铂组患者血小板减少发生率高于顺铂组，差异有统计学意义（P＜0.05）。洛铂组患者严重不良反应的发生率为21.82%，顺铂组为39.44%，差异具有统计学意义（P＜0.05）。结论:将多西他赛联合氟尿嘧啶、顺铂方案中的顺铂以洛铂替代，取得了更好的疾病控制率，而患者的不良反应更轻，严重不良反应的发生率也更低，值得临床进一步研究。     

lncRNA UCA1在肾透明细胞癌中的表达与临床特征及预后的关系

目的:研究长链非编码RNA（lncRNA）尿路上皮癌胚抗原1（UCA1）在肾透明细胞癌（KIRC）患者癌组织及癌旁正常组织中的表达水平，探讨其与患者临床特征及预后的关系。方法:选取2009年2月至2013年2月在本院诊治并保存完整的KIRC患者癌组织标本56例为KIRC组，同时另取患者配对癌旁正常肾组织（距肿瘤边缘＞5 cm）作为对照组，通过实时荧光定量逆转录聚合酶链反应(qRT-PCR)法检测lncRNA UCA1表达水平，分析lncRNA UCA1表达水平与患者临床特征及预后生存的关系。结果:KIRC患者肾癌组织中lncRNA UCA1表达水平显著高于对照组（P＜0.05）。lncRNA UCA1表达水平与TNM分期、Robson分期和组织分化程度有关（P＜0.05）。lncRNA UCA1高表达组的5年生存率显著低于lncRNA UCA1低表达组（P＜0.05）。lncRNA UCA1高表达是影响KIRC患者不良预后发生的独立危险因素（P＜0.05）。结论:lncRNA UCA1在KIRC患者肾癌组织中高表达，与TNM分期、Robson分期和组织分化程度有关，是影响KIRC患者不良预后发生的独立危险因素。     

中药化学对照品木蝴蝶苷B的稳定性研究

目的对木蝴蝶苷B固体和在不同溶液中的稳定性进行研究。方法采用HPLC-DAD对不同温度下的木蝴蝶苷B固体和不同条件下的木蝴蝶苷B溶液进行色谱分离,经过归一化纯度分析对其稳定性进行比较和分析,明确木蝴蝶苷B的稳定性影响因素;然后采用HPLC-MS对木蝴蝶苷B在不同溶剂中主要降解产物进行分析。结果①木蝴蝶苷B固体在40、80和105℃下稳定、且对光稳定;②木蝴蝶B在水中较为稳定,在体积分数50%、70%甲醇、体积分数50%、70%乙醇溶液中不稳定。③木蝴蝶苷B在体积分数50%甲醇、体积分数50%乙醇和水溶液中降解产物分别为7-甲氧基黄芩素、7-乙氧基黄芩素和黄芩素。结论本次实验表明,木蝴蝶苷B对热和光稳定,但在溶液状态下不够稳定,尤其在体积分数50%甲醇溶液和体积分数50%乙醇溶液中易发生降解,建议木蝴蝶苷B对照品溶液选择采用水作为溶剂,或者临用现配,并在配制后立即放入冰箱冷藏保存。     

中性粒细胞与淋巴细胞比率对NSTE-ACS患者左主干或三支病变的预测价值

目的 探讨中性粒细胞与淋巴细胞比率(NLR)对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者左主干或三支病变独立预测价值。方法 选取150例NSTE-ACS患者,根据冠脉造影结果分析NLR水平对NSTE-ACS患者左主干或三支病变的预测价值。结果 150例患者纳入最后的分析,通过受试者工作特征曲线分析,NLR水平预测NSTE-ACS患者左主干或三支病变的最佳截断值为2.58(曲线下面积0.72,特异性78.8%,敏感性61.2%)。150例NSTE-ACS患者中,NLR水平≥2.58的患者平均年龄较NLR<2.58的患者偏大(P=0.02),出现左主干或三支病变的比例明显升高(P<0.01)。logistic回归分析显示NLR≥2.58是对NSTE-ACS患者左主干或三支病变的独立预测因素(OR:4.73,95% CI:1.94~11.54,P<0.01)。结论 NLR≥2.58是预测NSTE-ACS患者左主干或三支病变的独立危险因素。