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Objective

Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non–small cell lung cancer has not been extensively studied.

Methods

Patients with cT2-4N0-1M0 non–small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were overall survival, chemotherapy tolerance, and ability of Response Evaluation Criteria In Solid Tumors response to predict survival. Survival was estimated using the Kaplan–Meier method, compared using the log-rank test and Cox proportional hazards models, and stratified using matched pairs after propensity score matching.

Results

In total, 330 patients met the inclusion criteria (n = 92/group after propensity-score matching; median follow-up, 42 months). Five-year disease-free survival was 49% (95% confidence interval, 39-61) for neoadjuvant chemotherapy versus 48% (95% confidence interval, 38-61) for adjuvant chemotherapy (P = .70). On multivariable analysis, disease-free survival was not associated with neoadjuvant chemotherapy or adjuvant chemotherapy (hazard ratio, 1.1; 95% confidence interval, 0.64-1.90; P = .737), nor was overall survival (hazard ratio, 1.21; 95% confidence interval, 0.63-2.30; P = .572). The neoadjuvant chemotherapy group was more likely to receive full doses and cycles of chemotherapy (P = .014/0.005) and had fewer grade 3 or greater toxicities (P = .001). Response Evaluation Criteria In Solid Tumors response to neoadjuvant chemotherapy was associated with disease-free survival (P = .035); 15% of patients receiving neoadjuvant chemotherapy (14/92) had a major pathologic response.

Conclusions

Timing of chemotherapy, before or after surgery, is not associated with an improvement in overall or disease-free survival among patients with cT2-4N0-1M0 non–small cell lung cancer who undergo complete surgical resection.  相似文献   
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The Yakima Valley Farm Workers Clinic (YVFWC) is one of the largest community health centers in the country with clinics throughout south-central Washington and northern Oregon. Its dental program consists of 14 dental clinics providing general and specialty services to the low-income populations it serves. Modeling itself after the YVFWC medical managed care program; the Dental program recently added value-based metrics to its dental practice after Oregon offered a value-based dental reimbursement plan in 2019. This is the first-step YVFWC's dental program that has taken to prepare for value-based reimbursement and transform its dental practice in order to reduce the disease burden in its patient population. The purpose of this article is to describe the processes YVFWC undertook to prepare itself for the new reimbursement model, which included the development of metrics, a metric validation process, a clinical dashboard, and a method for improving metrics. It also outlines its medical/dental integration improvement brought about by embedding hygienists into the medical primary care teams.  相似文献   
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《中国现代医生》2020,58(4):84-86+90
目的评价西药联合穴位贴敷中西医结合治疗复治肺结核的临床疗效。方法选择本院2017年1月~2018年1月收治的60例复治肺结核患者进行分组研究,全部患者根据治疗方法不同随机分为两组,每组各30例。两组均采取西药进行治疗,采用2HRZE/6HRZ标准化疗方案,实验组同时联合穴位贴敷中西医结合进行治疗,治疗后对比分析两组病灶吸收情况及两组临床症状改善情况。结果实验组病灶恶化9例,其病灶显著吸收率达50.0%,总有效率达70.0%,对照组病灶恶化6例,不变5例,其病灶显著吸收率达33.3%,总有效率达63.3%,两组病灶吸收总有效率组间比较,差异具有显著性(P0.05);实验组的疗效指数治疗6个月后显著高于对照组,组间比较,差异具有显著性(P0.05)。结论西药联合穴位贴敷中西医结合治疗复治肺结核疗效确切,可以显著促进病灶吸收,改善临床症状,安全性好,且还可以扶助人体正气,提高机体免疫力,调节全身状态,以达到治疗目的,是治疗复治肺结核的有效方法之一,值得临床广泛推广和应用。  相似文献   
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目的探讨品管圈活动在喜疗妥联合新鲜马铃薯外敷治疗小儿输液外渗中的应用效果。方法选取我院2016年8月至2018年12月收治的输液外渗患儿100例,随机分为两组各50例。对照组给予50%硫酸镁湿敷治疗与常规护理,干预组采用喜疗妥联合新鲜马铃薯外敷,进行品管圈活动。对比两组的临床疗效、损伤痊愈时间和完全消肿时间。结果干预组的总有效率为90.00%,高于对照组的74.00%(P <0.05)。干预组的损伤痊愈时间和完全消肿时间短于对照组(P <0.05)。结论品管圈活动在喜疗妥联合新鲜马铃薯外敷治疗小儿输液外渗中的效果较好,可缩短临床症状消失时间,加快康复进程。  相似文献   
6.
骨碎补是历代临床常用中药,具有疗伤止痛、补肾强骨、消风祛斑等功效。其主要含黄酮、苯丙素、三萜、酚酸及其苷等类化学成分,现代研究表明骨碎补具有抗骨质疏松、促进骨折愈合、促软骨再生、护牙健齿、保护肾功能、抗炎、防治中毒性耳聋、降血脂等多种生物活性,开发前景广阔。本文对近年来骨碎补的化学成分、药理作用及临床应用研究进行综述,以期为骨碎补的进一步深入系统的研究和开发利用提供依据。  相似文献   
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A survey of mycology laboratories for antifungal susceptibility testing (AFST) was undertaken in France in 2018, to better understand the difference in practices between the participating centers and to identify the difficulties they may encounter as well as eventual gaps with published standards and guidelines. The survey captured information from 45 mycology laboratories in France on how they perform AFST (number of strains tested, preferred method, technical and quality aspects, interpretation of the MIC values, reading and interpretation difficulties). Results indicated that 86% of respondents used Etest as AFST method, with a combination of one to seven antifungal agents tested. Most of the participating laboratories used similar technical parameters to perform their AFST method and a large majority used, as recommended, internal and external quality assessments. Almost all the participating mycology laboratories (98%) reported difficulties to interpret the MIC values, especially when no clinical breakpoints are available. The survey highlighted that the current AFST practices in France need homogenization, particularly for MIC reading and interpretation.  相似文献   
10.
Determining aortic stenosis (AS) severity is clinically important. Calculating aortic valve (AV) area by means of the continuity equation assumes a circular left ventricular outflow tract (LVOT). The full impact of this assumption in calculating AV area is unknown. Predictors of noncircular LVOT shape in patients with AS are undefined.In 109 adult patients with AS who underwent multiplanar transesophageal echocardiography, we calculated AV area by means of the standard continuity method and by a modified method involving planimetric LVOT area.We found 54 circular, 37 horizontal-oval, 8 vertical-oval, and 10 irregular LVOTs. Area derived by direct planimetry correlated better with the modified than the standard continuity method (r=0.89 vs r=0.85; both P=0.0001). Valve areas of patients with mild, moderate, or severe AS by planimetry were more often mischaracterized with use of the standard than modified method (29 vs 18; P <0.0001). Horizontal-oval AV area derived by planimetry (1.28 ± 0.55 cm2) was underestimated by the standard method (1.05 ± 0.47 cm2; P=0.001), but not by the modified method. Congenital AV morphology and low cardiac index were the only multivariate predictors of horizontal-oval shape. Low cardiac index was the only predictor of noncircular shape.More than half our patients with AS had noncircular LVOTs. Using the modified method reduces mischaracterizations of AS severity. Congenital AV morphology and low cardiac index predict horizontal-oval or noncircular shape. These data suggest the value of direct LVOT measurement to calculate AS severity in patients who have congenital AV or a low cardiac index.  相似文献   
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