贝伐珠单抗联合紫杉醇治疗转移性乳腺癌的成本效果分析

【摘要】 目的 从现阶段医疗卫生角度出发,评价四川地区贝伐珠单抗联合紫杉醇治疗转移性乳腺癌的成本 效果优势。方法〓根据E2100临床试验数据,结合四川地区医疗费用水平,采用成本 效果分析法,以增量成本 效果比（ICER）为评价指标,评价贝伐珠单抗联合紫杉醇治疗转移性乳腺癌方案的优劣,并分析结果敏感度。结果〓紫杉醇与贝伐珠单抗联合组与紫杉醇单药组相比,ICER值远远高于3倍GDP;敏感度分析结果提示,当贝伐珠单抗药品费用下降50%时,联合组仍不具有成本 效果优势。贝伐珠单抗使用成本和医疗检查成本对总成本影响最大,其他参数影响较小。结论〓从我国现阶段医疗卫生角度出发,四川地区转移性乳腺癌使用贝伐珠单抗联合紫杉醇治疗,尚不具有成本效果优势。     

羟基喜树碱对肠癌细胞体外作用的研究

目的探讨羟基喜树碱对肠癌细胞的体外作用。方法 :采用改良的MTT法检测了 78例肠癌细胞对 5种化疗药物的体外敏感性。结果 :78例肠癌细胞对化疗药物的敏感性 ,由高到低依次为羟基喜树碱 (HCPT)、5-氟脲嘧啶 (5 -Fu)、丝裂霉素 (MMC)、平阳霉素 (PYM)、长春新碱 (VCR)。HCPT和 5 -Fu的敏感性差异无显著性 (P >0 .0 5 ) ,但均明显高于MMC、PYM及VCR(均P <0 .0 0 1) ,对 5 -Fu不敏感的病例中 ,5 7.8%对HCPT敏感或中度敏感。结论 :HCPT和 5 -Fu皆可作为肠癌的首选化疗药物 ,如果 5 -Fu耐药 ,则可选用HCPT。正确取材是MTT法成功的关键。     

新疆喀什地区2010年细菌耐药性监测分析

目的了解新疆维吾尔自治区喀什地区2010年2家地区级医院临床分离株的耐药情况。方法采用纸片扩散法（K-B法）对临床分离株进行药敏试验,采用CLSI 2009年版判断标准。结果 2 768株临床分离株中,革兰阳性菌占34.57%,革兰阴性菌占65.43%。排名前6位的病原菌是：大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、表皮葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌。146株铜绿假单胞菌对亚胺培南、美罗培南的耐药率分别为8.46%和10.00%,对阿米卡星、哌拉西林/他唑巴坦、妥布霉素的耐药率在14.94%-17.36%;对136株鲍曼不动杆菌耐药率小于30%的药物从低到高分别为美洛培南、阿米卡星、亚胺培南、哌拉西林/他唑巴坦、妥布霉素;MRSA占所有金黄色葡萄球菌的38.89%,葡萄球菌属未发现对万古霉素、利奈唑胺的耐药菌株;发现4株屎肠球菌和4株粪肠球菌对万古霉素耐药,但对利奈唑胺均敏感。结论喀什地区的抗生素耐药率与全国情况稍有差别,如铜绿假单胞菌及鲍曼不动杆菌对碳青霉烯类耐药率明显低于全国水平,可能与经济情况相关。但细菌耐药性普遍存在,亦发现了多耐药及泛耐药菌株,因此加强抗菌药耐药监测是目前合理应用抗生素的当务之急。     

洗必泰醇对产诱导型β-内酰胺酶阳性菌株的敏感性研究

目的 探讨临床常用消毒剂洗必泰醇对产诱导型β-内酰胺酶(IB)阳性菌株的敏感性.方法 收集住院患者的标本,经MICROSCAN自动微生物分析仪检测,并同时以纸片扩散法(K-B)验证,进行IB阳性确证,检测其最小杀菌浓度及最小抑菌浓度,并与标准菌株作对照,分析其与标准菌株的差异.结果 当洗必泰醇浓度为4 200 mg/L、将所有IB阳性菌株杀灭,而标准菌株只需洗必泰醇3 600 mg/L就可杀灭.结论 IB阳性菌株与标准菌株相比对消毒剂的敏感性有一定差异,有耐药倾向.     

直接测序法检测结肠癌患者K-ras基因的灵敏度及其临床价值分析

目的 探讨结肠癌患者应用直接测序法测定K-ras 基因的灵敏度及其临床价值。方法 选取我院2016 年2 月~2017 年4 月收治的结肠癌患者80 例，随机分为研究组和对照组两组，研究组患者通过直接测序法、对照组患者通过sanger 测序法检测患者体内的K-ras 基因突变情况，分析K-ras 基因突变率与患者肿瘤大小、肿瘤部位、患者年龄等一般资料之间的相关性。结果 研究组患者测定K-ras 基因突变的灵敏度明显高于对照组（P<0.05），肿瘤直径在5 cm 以上患者的K-ras 基因突变率明显低于直径在5 cm 以下的患者（P<0.05）研究组检出率与患者肿瘤部位及分化程度、患者年龄等存在相关性。结论 应用直接测序法检测结肠癌患者K-ras 基因的突变情况具有较高的灵敏度，直接测序法的检出率与患者的肿瘤大小、肿瘤分化程度以及患者的年龄等存在较强的相关性，对于临床上结肠癌等恶性肿瘤疾病的诊断具有较强的应用价值，值得临床上广泛推荐使用。     

The sensitivity of ct scans in diagnosing occult femoral neck fractures

Non-displaced hip fractures can be difficult to diagnose on plain film radiographs. When there is ongoing clinical suspicion of an occult fracture, further imaging is obtained. We investigated the sensitivity of computed tomography (CT) scans in detecting these fractures and the delays to surgery that three-dimensional imaging causes. We identified 78 CT scans performed for possible hip fractures over the past 3 years with the presence and absence of a fracture recorded. Based on subsequent imaging, the accuracy of CT scans was determined. CT scanning yielded sensitivity was 86% and specificity 98% for occult hip fracture (OHF). The median delay to definitive diagnosis was 37 h. Our results demonstrate that CT scan does not bear sufficient sensitivity to detect all OHFs. We therefore recommend that MRI should be offered when a fracture is suspected. CT scans should be reserved for when MRI is not available, but a negative scan should be confirmed with subsequent MRI.     

Sensitivity and specificity of in vitro diagnostic device used for influenza rapid test in Taiwan

The pandemic influenza A/H1N1 outbreak resulted in 18,449 deaths in over 214 countries. In Taiwan, the influenza rapid test, an in vitro diagnostic device (Flu-IVD), only requires documented reviews for market approval by the Taiwan Food and Drug Administration. The purpose of this study was to investigate the analytical sensitivity and specificity of Flu-IVDs used in Taiwan. Analytical sensitivity and specificity tests were performed for influenza antigens A/California/7/2009 (H1N1) virus, A/Victoria/210/2009 (H3N2) virus, B/Brisbane/60/08 virus, and human coronavirus OC43. A total of seven domestic and 31 imported Flu-IVD samples were collected, of which, 20 samples had inadequate labeling, including those with removed package inserts or incorrect insert information. The analytical sensitivity of Flu-IVDs for A/H1N1, A/H3N2, and Flu B was 500–1000 ng/mL, 1000 ng/mL, and 1000 ng/mL, respectively. For the 50% cell culture infective dose (CCID₅₀) label, the average A/H1N1 and A/H3N2 sensitivity for Flu-IVDs was log₁₀ 5.8 ± 0.5 and log₁₀ 6.6 ± 0.5 CCID₅₀/mL, respectively. As to the specificity test, no product cross-reacted with human coronavirus OC43. This study provides important information on the Flu-IVD regulation status and can thus help the government formulate policies for the regulation of in vitro diagnostic devices in Taiwan.     

The minimal clinically important difference determined using item response theory models: an attempt to solve the issue of the association with baseline score

ObjectivesDetermining the minimal clinically important difference (MCID) of questionnaires on an interval scale, the trait level (TL) scale, using item response theory (IRT) models could overcome its association with baseline severity. The aim of this study was to compare the sensitivity (Se), specificity (Sp), and predictive values (PVs) of the MCID determined on the score scale (MCID-Sc) or the TL scale (MCID-TL).Study Design and SettingThe MCID-Sc and MCID-TL of the MOS-SF36 general health subscale were determined for deterioration and improvement on a cohort of 1,170 patients using an anchor-based method and a partial credit model. The Se, Sp, and PV were calculated using the global rating of change (the anchor) as the gold standard test.ResultsThe MCID-Sc magnitude was smaller for improvement (1.58 points) than for deterioration (−7.91 points). The Se, Sp, and PV were similar for MCID-Sc and MCID-TL in both cases. However, if the MCID was defined on the score scale as a function of a range of baseline scores, its Se, Sp, and PV were consistently higher.ConclusionThis study reinforces the recommendations concerning the use of an MCID-Sc defined as a function of a range of baseline scores.     

Leaving hip rotation out of a conventional 3D gait model improves discrimination of pathological gait in cerebral palsy: A novel neural network analysis

BackgroundComplex clinical gait analysis results can be expressed as single number gait deviations by applying multivariate processing methods. The original Movement Deviation Profile (MDP) quantifies the deviation of abnormal gait using the most trusted nine dynamic joint angles of lower limbs.Research questionWhich subset of joint angles maximises the ability of the MDP to separate abnormal gait from normality? What is the effect of using the best subset in a large group of patients, and in individuals?MethodsA self-organising neural network was trained using normal gait data from 166 controls, and then the MDP of 1923 patients with cerebral palsy (3846 legs) was calculated. The same procedure was repeated with 511 combinations of the nine joint angles. The standardised distances of abnormal gait from normality were then calculated as log-transformed Z-scores to select the best combination. A mixed design ANOVA was used to assess how removing the least discriminating angle improved the separation of patients from controls. The effect of using the optimal subset of angles was also quantified for each individual leg by comparing the change in MDP to the independent FAQ levels of patients.ResultsRemoval of hip rotation significantly (p<0.0005) increased the separation of the patient group from normality (ΔZ-score 0.24) and also at FAQ levels 7-10 (ΔZ-score 0.38, 0.27, 0.22, 0.14). The MDP of individual patients changed in a wider range of -4.65 to 1.12 Z-scores and their change matched their independent FAQ scores, with less functional patients moving further from, and more functional patients moving closer to normality.SignificanceIn existing gait databases we recommend excluding hip rotation from data used to calculate the MDP. Alternatively, the calculation of hip rotation can be improved by post-hoc correction, but the ultimate solution is to use more accurate and reliable models of hip rotation.     

Performance of EAST in diagnosing inhalant allergens in children with allergic rhinitis

The performance of enzyme linked immunosorbent assays (EAST) for identifying six indoor allergens was evaluated using skin prick test (SPT) as reference tests in 154 children with allergic rhinitis. Sensitivity of EAST ranged from 9% (cat) to 54% (HDM) with specificity of 74%(cockroach) to 100% (cat) with an agreement ranged from 58 to 86%. Cut off values ?> ?0.35 kU/L showed best sensitivity and specificity. Our findings agree with extant literature which suggests that the ability of EAST to determine the precipitating allergen is moderate. Assays for definitively identifying the inhalant allergen are currently not available.