Efficacy of Immune Checkpoint Inhibitors in KRAS-Mutant Non-Small Cell Lung Cancer (NSCLC)

IntroductionKRAS mutation is the most frequent molecular alteration found in advanced NSCLC; it is associated with a poor prognosis without available targeted therapy. Treatment options for NSCLC have been recently enriched by the development of immune checkpoint inhibitors (ICIs), and data about its efficacy in patients with KRAS-mutant NSCLC are discordant. This study assessed the routine efficacy of ICIs in advanced KRAS-mutant NSCLC.MethodsIn this retrospective study, clinical data were extracted from the medical records of patients with advanced NSCLC treated with ICIs and with available molecular analysis between April 2013 and June 2017. Analysis of programmed death ligand 1 (PD-L1) expression was performed if exploitable tumor material was available.ResultsA total of 282 patients with ICI-treated (in the first line or more) advanced NSCLC (all histological subgroups) who were treated with ICIs (anti–programmed death 1, anti–PD-L1, or anti–cytotoxic T-lymphocyte associated protein 4 antibodies), including 162 (57.4%) with KRAS mutation, 27 (9.6%) with other mutations, and 93 (33%) with a wild-type phenotype, were identified. PD-L1 analysis was available for 128 patients (45.4%), of whom 45.3% and 19.5% had PD-L1 expression of 1% or more and 50%, respectively (49.5% and 21.2%, respectively, in the case of the 85 patients with KRAS-mutant NSCLC). No significant difference was seen in terms of objective response rates, progression-free survival, or overall survival between KRAS-mutant NSCLC and other NSCLC. No significant differences in overall survival or progression-free survival were observed between the major KRAS mutation subtypes (G12A, G12C, G12D, G12V, and G13C). In KRAS-mutant NSCLC, unlike in non–KRAS-mutant NSCLC, the efficacy of ICIs is consistently higher, even though not statistically significant, for patients with PD-L1 expression in 1% or more of tumor cells than for those with PD-L1 expression in less than 1% of tumor cells, and this finding is especially true when PD-L1 expression is high (PD-L1 expression ≥50%).ConclusionFor patients with KRAS-mutant NSCLC (all mutational subtypes), the efficacy of ICI is similar to that for patients with other types of NSCLC. PD-L1 expression seems to be more relevant for predicting the efficacy of ICIs in KRAS-mutant NSCLC than it is in other types of NSCLC.     

门诊服务性投诉量及构成与门诊总量的关系

目的研究门诊服务性投诉的构成及其与门诊总量之间的关系。方法回顾性调查2009年1月²013年7月我院服务性投诉中,沟通不足、服务态度欠佳、等待时间过长以及其它原因等4种类型每月发生的例次。分析服务性投诉总量、沟通不足投诉量或服务态度欠佳投诉量与门诊总量之间的相关性。结果 691例次服务性投诉中沟通不足66.14%(457例次)、服务态度欠佳51.52%(356例次)。服务性投诉、沟通不足投诉以及服务态度欠佳投诉数量与门诊总量之间均存在一定的相关性(r=0.646,0.447,0.455;p<0.001,p=0.001,p<0.001)。结论沟通不足投诉、服务态度欠佳投诉是服务性投诉中的两个最主要类型,并与门诊总量存在着一定的相关性,提示可能需要增加门诊医护工作人次、改善流程、加强沟通培训以减少门诊投诉。     

上海市奉贤区服务行业从业人员肠道致病菌检测结果分析

目的了解和分析上海市奉贤区2004-2008年饮食服务和公共场所从业人员肠道致病菌携带情况及菌型分布。方法对从业人员肛拭标本进行肠道菌检测及血清分型鉴定。结果共检测标本154 097份,检出阳性菌株545份,总检出率0．35％。其中检出沙门菌537株,志贺菌8株。537株沙门菌经生化及血清学鉴定分为6个血清群46个血清型。其中E群占的比例为38．79％。最常见的血清型依次为伦敦,山夫登堡,德比。结论奉贤区饮食服务和公共场所从业人员沙门菌检出率较高,应加强健康检查,及时调离阳性者。     

广东地区预防HIV母婴传播服务需求与能力分析

目的  分析广东省各地预防艾滋病母婴传播（mother-to-chlid transmission,MTCT）的服务需求与能力,了解工作的薄弱地区和环节。 方法  收集2014年-2017年广东省感染人类免疫缺陷病毒（human acquired immunodeficiency virus,HIV）的孕产妇及暴露婴儿的服务需求及干预情况,使用SPSS 21.0软件分析各地服务需求与能力差异,以及各地助产机构和母婴保健人员数量与HIV的MTCT之间相关性。 结果  感染HIV孕产妇文化程度不高,以初中为主（54.49%）;各地感染HIV的孕产妇服务需求不同,珠三角区外来少数民族（12.96%）、山区非本地居住（43.75%）、东翼感染途径不详（77.78%）孕产妇占比高;各地服务能力不同,山区和东翼孕产妇多产时/产后确诊（占比41.67%和44.44%）、治疗晚（山区和东翼超过36周治疗或未治疗占比43.75%和55.56%）、孕产妇和婴儿未治疗比例高（山区和东翼为2.08%和33.33%）,且东翼母乳喂养比例高（11.11%）;东翼助产服务机构和母婴保健服务人员数量少,覆盖面小;各地助产机构和母婴保健人员数量与MTCT均无相关性（均有P>0.05）。 结论  山区和东翼是广东省预防HIV的MTCT工作薄弱地区,检测晚、干预不规范、信息质量低是薄弱环节。有针对地消除服务能力的地区差异,是实现广东省消除HIV的MTCT目标的关键。     

Defining psychiatry in primary care: Origins,opportunities, and obstacles

Society's demand for more comprehensive health services, and psychiatry's pursuit of a more medical orientation, have together fueled interest in the psychiatric aspects of primary care medicine. We have begun to define the content of the field by transplanting selected aspects of existing clinical psychiatry into this new setting. Yet general medical patients present new types of psychiatric, interpersonal, and behavioral problems, and the psychosocial aspects of the medical care process are important in primary care. We need to acknowledge these characteristics in establishing a body of knowledge and clinical investigation that comprise the psychiatric aspects of primary care. Doing so will make our teaching and clinical care in primary care settings more valuable, will establish a solid academic foundation for the field, and will help to subject the “art” of medicine to more rigorous study.     

从护理投诉谈构建和谐护患关系

目的：探讨构建和谐护患关系的方法与对策。方法：分析53例护理投诉原因的构成，建立护理投诉的防范对策。结果：服务态度、护理技术是护理投诉的主要原因。结论：建立良好的护患沟通制度提高护理人员的服务意识、护理人员技术水平是构建合谐护患关系的关键。     

发展健康管理服务的思考

随着科学技术的发展和生活水平的提高,人们的健康意识和行为发生了明显变化,促进了预防性医疗服务及体检市场的兴起,健康保险和健康维护服务需求的增长,使健康的消费需求已从简单、单一的医疗性向疾病预防型、保健型和健康促进型转变。在这种情况下,要强化健康管理理念,积极发展健康管理服务,以满足社会公众的健康服务需求。     

借助互联网及移动客户端优化门诊服务流程

目的探讨基于互联网及移动客户端优化医院门诊服务的价值。方法以北京某公立医院为研究样本,梳理门诊服务流程,提出优化门诊服务流程方案。结果传统就医模式下医院门诊服务流程繁琐、反复排队,即诊区待诊、挂号、缴费等待时间长,而医技待检时间较短;优化医院门诊服务后,挂号、检查缴费、取药缴费、取药所需时间明显缩短（P＜0.05）,患者就医满意度明显提高（P＜0.05）。结论基于互联网及移动客户端的医院门诊服务流程,有效缓解了门诊部患者人流量积压,可为优化公立医院门诊服务提供参考。     

关于完善新型农村卫生服务体系的思考

目前,各地普遍存在着医疗卫生资源分布不均,优质资源大部分集中在城市,而农村相对缺乏。对此,必须注重加强市、镇、村三级卫生服务网络建设,不断夯实基层医疗卫生服务网底,为广大农村群众提供优质的医疗卫生资源,着力化解“看病难、看病贵”的问题。