ObjectiveTo evaluate the economics of duplizumab in combination with optimal supportive care versus optimal supportive care for moderate-to-severe atopic dermatitis in adults from the perspective of our health system. MethodsA Markov model embedded in a decision tree was constructed to compare the long-term cost-utility of dupilumab combined with optimal supportive care versus optimal supportive care, and a sensitivity analysis was performed on the results. ResultsThe results of the basic analysis showed that compared with the optimal supportive care, dupliyuzumab in combination with optimal supportive care resulted in 3.82 more QALYs, while its cost was 125 549.42 yuan more. The ICER was 32 854.83 yuan/QALY, which was less than one times China's per capita GDP in 2022, and was economical. Univariate sensitivity analysis showed that factors such as Dupilumab-16-week post - no response utility value, Dupilumab-52-week post response rate and Dupilumab-52-week adherence had a greater impact on the cost changes. The results of the probabilistic sensitivity analysis showed a stable model structure and good robustness. ConclusionIn adult patients with moderate-to-severe atopic dermatitis, dupliyuzumab in combination with an optimal supportive care regimen is more cost-effective compared to an optimal supportive care regimen.
Objective To investigate the clinical effect of digital drainage system (DDS) in patients after robot-assisted lobectomy. MethodsThe clinical data of the patients who underwent da Vinci robot-assisted lobectomy from August 2020 to December 2021 were retrospectively analyzed. The patients were divided into a DDS group and a conventional group (using traditional single thoracic drainage tube device) according to different drainage devices used after operation. The preoperative data, intraoperative blood loss, total drainage volume within 48 h after operation, postoperative extubation time and postoperative hospital stay were compared between the two groups. ResultsFinally, 170 patients were collected, including 76 males and 94 females with an average age of 61.8±8.7 years. Postoperative extubation time [5.53 (6.00, 7.00) days vs. 6.36 (6.00, 8.00) days, Z=–2.467, P=0.014] and postoperative hospital stay [7.80 (8.00, 10.00) days vs. 8.94 (9.00, 10.00) days, Z=–2.364, P=0.018] in the DDS group were shorter than those in the conventional group. For patients with postoperative persistent air leak, postoperative extubation time (Z=–2.786, P=0.005) and postoperative hospital stay (Z=–2.862, P=0.003) in the DDS group were also shorter than those in the conventional group. ConclusionDDS has a positive effect on enhanced recovery after robot-assisted lobectomy, which is safe and stable, and is beneficial to postoperative rehabilitation and shortening the average hospital stay.
Objective To investigate the clinical characteristics, therapeutic methods, and prognostic factors of patients with rectal stromal tumor. Methods The clinicopathological data of 33 patients with rectal stromal tumor who treated in the Affiliated Hospital of Xuzhou Medical University from January 2008 to November 2014 were retrospectively reviewed, and the therapeutic methods and prognostic factors of these patients were further analyzed. Results The major clinical manifestations of 33 patients included abdominal discomfort in 21 patients, changes of defecation habit and fecal property in 15 patients, bloody stool in 13 patients, and anal pain in 9 patients. CT and MRI examination showed a mass in the pelvic with the clear boundary, growed through the wall of rectum, with the heterogeneous density and signal, sometimes with necrosis, calcification, and haemorrhage. The results of immunohistochemical staining showed that, 31 patients were strongly positive for CD117, 28 patients were strongly positive for CD34, 15 patients were positive for smooth muscle actin (SMA), 13 patients were positive for vimentin, and 3 patients were positive for soluble acid protein (S-100). The therapeutic methods of 33 patients included local excision in 13 patients, low anterior resection in 11 patients, abdominal pelvic resection in 5 patients, and conservative treatment in 4 patients. A total of 26 patients underwent surgery combiend with imatinib therapy. The follow-up time was 10–102 months and the median time was 58 months. During follow-up period, there were 8 patients suffered from recurrence or metastasis, and 15 patients died. The results of Cox proportional hazards regression model showed that, postoperative relapse and metastasis were prognostic factors for survival〔RR=19.338, 95% CI was (2.821, 132.568), P=0.003〕. The survival situation of the patients suffered from postoperative relapse and metastasis was poor. Conclusions CD117 and CD34 could serve as valuable diagnostic indexes for rectal stromal tumor. Surgery is an effective treatment for rectal stromal tumor.
Real-world data is been increasingly valued nowadays. This paper combined with related requirements of clinical evaluation of medical devices in China, studied the role of real-world evidence in pre-marketing clinical evaluation of medical devices in terms of technical evaluation, in aim of providing reference for the future application of China's real-world evidence in pre-marketing clinical evaluation.
Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.
ObjectiveTo evaluate the economics of nafamostat mesylate compared with unfractionated heparin for continuous renal replacement therapy anticoagulation. MethodsA decision tree model was constructed to calculate the cost difference between the two anticoagulation methods. Survival analysis data comes from retrospective literature in Asian countries. The cost data comes from procurement data and the prices of medical and health services in some regions. A 72-hour scenario analysis is performed and a sensitivity analysis is performed on key parameters. ResultsThe basic analysis results showed that compared with the unfractionated heparin group, the total cost difference of nafamostat in the 144-hour CRRT treatment was 5 350.34 yuan, and the unfractionated heparin was more economical. In the 72-hour scenario analysis, unfractionated heparin is also more economical. Univariate sensitivity analysis showed that the cost of single-use hemodialysis filters and supporting pipelines and the cost of plasma antithrombin Ⅲ activity (AT-Ⅲ) measurement had a greater impact on the change of the cost difference. The results of probability sensitivity analysis show that the model structure is stable and robust. When the unit price of nafamostat is about 110.82 yuan/piece, the cost of nafamostat and unfractionated heparin in 144-hour CRRT treatment is both 19 185.37 yuan, and the cost difference is 0.ConclusionWhen the unit price of nafamostat mesylate drops to a sufficiently low level, it could have an advantageous health economy.
目的 探讨优质护理服务在妇科临床护理路径（CNP）实施中的应用效果。 方法 2010年4月－2011年4月纳入妇科CNP的住院患者中随机抽取150例，并选择同期病区全部17名护士作为对照组；在2011年5月－12月纳入妇科CNP并实施优质护理服务的住院患者中随机抽取150例，并选择同期病区全部22名护士作为试验组。比较两组患者疾病相关知识知晓率、患者及护士工作满意率、平均住院日的差异。 结果 试验组患者疾病相关知识知晓率、患者及护士满意率优于对照组，且平均住院日明显缩短。 结论 优质护理服务应用于改进CNP管理质量，可提高患者疾病相关知识知晓率和护患满意率，缩短住院时间，减轻医疗负担，有利于CNP的实施。
Objective To summarize our initial experience in robot-assisted lobectomy for the treatment of non-small cell lung cancer （NSCLC）. Methods A total of 20 NSCLC patients underwent robot-assisted pulmonary lobectomy in General Hospital of Shenyang Military Command from March to September 2012. There were 13 males and 7 females, and their age was 43-80 （60.40±8.07） years. Single-direction thoracoscopic lobectomy technique was used，and systemic mediastinal and hilar lymph node dissection was routinely performed during the operation. There were 4 right upper lobectomies，7 right lower lobectomies，1 right middle lobectomy，7 left lower lobectomies，and 1 left upper lobectomy. Results Postoperative pathological examination showed adenocarcinoma in 12 patients，squamous cell carcinoma in 5 patients，adenosquamous carcinoma in 2 patients，and mucoepidermoid carcinoma in 1 patient. One patient undergoing left upper lobectomy had intraoperative pulmonary artery bleeding of 500 ml，who was healed by pulmonary artery repair via an accessory small incision and blood transfusion of 400 ml. All the other 19 patients successfully underwent robot-assisted lobectomy with their mean intraoperative blood loss of 60.00±42.95 （10-200） ml, and no blood transfusion was needed for them. All the patients were successfully extubated after operation, and none of the patients had severe postoperative complication. The mean thoracic drainage time was 9.35±3.48 （3-15） days. All the patients were discharged uneventfully and followed up for 2-9 （6.01±2.09） months without recurrence or metastasis. Conclusions Robot-assisted pulmonary lobectomy using Da Vinci S Surgical System is safe and feasible，and especially advantageous for lymph node dissection. It can be used for the treatment of early stage NSCLC.
ObjectiveTo analyze the value of indocyanine green (ICG) fluorescence imaging in the evaluation of blood flown of ipple-areola complex (NAC) and implant selection during single-port endoscopic breast reconstruction. Methods From November 2018 to March 2020, 19 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital were retrospectively collected. ICG fluorescence imaging technology was used to evaluate the blood supply pattern and the risk of ischemic necrosis of NAC, so as to guide the selection of implant. At the same time, 14 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital from February 2017 to October 2018 were selected as the historical control group (control group). NAC ischemic necrosis, breast satisfaction and implant removal were compared between the two groups. Results In the ICG group, there were3 cases of V1 pattern and 2 cases of NAC ischemic necrosis (1 case of grade 1, 1 case of grade 2). There was no NAC ischemic necrosis in 16 patients with V2 mode and V3 mode. No implant loss occurred in any of the patients. In the control group, 5 cases had NAC ischemic necrosis (all were severe ischemic necrosis), and 2 cases had implant loss. The rate of severe NAC ischemic necrosis in the ICG group was lower than that in the control group (P<0.01), but there was no significant difference in implant loss rate between the two groups (P=0.17). The breast satisfaction score of the ICG group was higher than that of the control group (P<0.01), but there were no significant difference in satisfaction scores of chestwell-being, psychological well-being and sexual well-being between the two groups (P>0.05). Conclusions ICG imaging can be used to evaluate the blood supply pattern during the operation of prosthetic body mass reconstruction, guide the choice of implant in immediate breast reconstruction, so as to further improve postoperative breast satisfaction.
ObjectiveTo evaluate the diagnostic value of 99Tcm-methoxy isobutyl isonitrile (MIBI) dual-time imaging for parathyroid adenoma (PA) and parathyroid hyperplasia (PH).MethodsClinical data of 187 patients with pathologically confirmed hyperparathyroidism (HPT) who admitted to the First Affiliated Hospital of Xi’an Jiaotong University School of Medicine from July 2011 to December 2018 were retrospectively collected. Taking postoperative pathology as the standard, the diagnostic value of preoperative 99Tcm-MIBI dual-time imaging was analyzed.ResultsThe serum PTH level of PH patients was higher than that of PA patients (Z=–3.23, P<0.01). Te/N (T: focal area radioactive count, N: the normal tissue radioactivity count of the corresponding thyroid gland on the opposite side of the lesion) in PA and PH patients were lower than Td/N (Z=–3.61, P<0.01; Z=–3.47, P<0.01). The positive rates of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH lesions were 67.9% (36/53) and 20.6% (86/418), respectively, and the positive rate of PA were higher (χ2=52.51, P<0.01). The positive rate of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH single lesions was higher than that of multiple lesions (χ2=15.79, P<0.01; χ2=64.73, P<0.01). Conclusions99Tcm-MIBI dual-time imaging shows a higher positive rate for PA and a lower positive rate for PH. When HPT is clinically suspected, but 99Tcm-MIBI dual-time imaging is negative and serum PTH is positive, PH should be considered, and B ultrasound and other examinations should be performed to determine the lesion site.