ABSTRACT
OBJECTIVE：To evaluate the economy performance of dexamethasone （DXM）combined with rituximab （RTX） for the first-line treatment of chronic primary immune thrombocytopenia （ITP）in adults. METHODS ：From the perspective of China ’s medical and health system ，Markov model for eight states was constructed with a period of 4 weeks and a time limit of 20 years， using DXM regimen as control. The cost-utility of DXM+RTX regimen for the treatment of chronic ITP in adults were evaluated. The parameters of clinical efficacy and utility value were derived from own published literature ；cost parameters were from the MENET website and the official websites of local health committees and medical insurance bureaus ；one-way sensitivity analysis ， probability sensitivity analysis and scenario analysis were performed to observe the uncertainty of model and data source. RESULTS：The average cost of DXM+RTX regimen was 51 064 dollars and that of DXM regimen was 50 455 dollars. Compared with DXM regimen ，DXM+RTX regimen yielded an additional 0.14 QALYs for each patient ；the incremental cost-effectiveness ratio（ICER）was 4 356 dollars/QALY，and was lower than the willingness-to-pay threshold of China ’s per capita gross domestic product（GDP）in 2020. In the one-way sensitivity analysis ，the cost of drugs was the main driver in the model. Probability sensitivity analysis demonstrated that DXM+RTX regimen had 57.5％-61.0％ probability of being cost-effective at a willingness- to-pay threshold of 1-3 times per capita GDP in 2020. The results of scenario analysis showed that DXM+RTX regimen would have obvious long-term benefits ，and the utility value had little impact on the conclusion. CONCLUSIONS ：DXM + RTX is more economical than DXM in the treatment of chronic ITP in adults ，but the results have the uncertainty.
ABSTRACT
Objective To observe the effect of ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section in patients with thrombocytopenia. Methods Sixty parturients recruited for the first cesarean delivery with thrombocytopenia (Plt<7.0 ×109/L),aged 20-32 years,in ASA physical status Ⅰ or Ⅱ,having no preterm birth and no fetal distress before surgery,were randomly divided into two groups:transversus abdominis plane block, ilioinguinal-iliohypogastric nerve block combined with remifentanil group (group T)and general anes-thesia group (group G).Both groups received patient-controlled intravenous analgesia (PCIA)after cesarean delivery;the delivery time from the cut to the fetus,Apgar score after delivery of the fetus, hemodynamics of the two groups of patients before surgery (T1 ),immediate cut (T2 )and fetal deliv-ery (T3 )and 48 h postoperative analgesic satisfaction were recorded and compared between the two groups.Results Compared with group G,the delivery time from the cut to the fetus was extended in group T (P < 0.05 ),but the fetus were removed within 6 minutes in the two groups.The Apgar score of 1 min after birth of newborns was significantly higher in group T than that in group G (P <0.05).Compared with group G,the blood pressure and the heart rate had increased at T3 in group T (P <0.05 ),but the parturients did not appear obvious symptoms.Compared with group G,the number of successfully delivered doses within 48 h were significantly lower in group T (P <0.05 ), TAP guided by sonography had excellent effect.Conclusion Ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section has little effect on neonatal,similar anesthesia effect to general anesthesia and obvious postoperative analgesia.
ABSTRACT
Objective To analyze the functional changes and the clinical significance of B cell specific mono-clonal murine leukemia virus integration site -1 (Bmi -1 )and Th1 /Th2 cells in children with newly diagnosed im-mune thrombocytopenia(ITP)by testing the mRNA expressions of Bmi -1,helper T cell -related cytokine interferon (IFN)-γand interleukin(IL)-4 in children with newly diagnosed ITP.Methods Thirty -six cases of patients with newly diagnosed ITP in the experimental group came from the inpatient and outpatient children admitted to the Depart-ment of Pediatrics of the First Affiliated Hospital of Xinxiang Medical University from April to December 201 3.In the control group,26 cases of children requiring selective operation were admitted to the Department of Pediatric Surgery during the same period.The mRNA expressions of Bmi -1,IFN -γand IL -4 in the peripheral blood lymphocytes were detected by means of the reverse transcription -polymerase chain reaction(RT -PCR)method,and were analyzed and compared by t test and linear correlation analysis.Results (1 )The mRNA expressions of Bmi -1,IFN -γand IL -4 in peripheral blood lymphocytes in the experimental group were 2.63 ±0.54,3.84 ±0.43 and 1 .44 ±0.39,respec-tively;while the mRNA expressions of Bmi -1,IFN -γand IL -4 in the peripheral blood lymphocytes in the control group were 3.91 ±0.92,2.88 ±0.57 and 1 .87 ±0.34,respectively.The levels of IFN -γof the experimental group were significantly higher than those of the control group (P 0.05).Conclusions Bmi -1 may be involved in the pathogenesis of ITP by regulating Th cell, and Th cell dysfunction may occur in the children with ITP,and the disproportion between Th1 and Th2 may be due to the advantages of Th1 .