Large Disparity between Prevalence and Treatment Rates for Hepatitis C in Western China.

Background and Aims: Recently, the World Health Organization adopted the first-ever global hepatitis strategy with the dream of eliminating viral hepatitis as a public health threat by 2030. However, the epidemiology and treatment rates of hepatitis C virus (HCV) infection in Western China are still unknown. Methods: A total of 111,916 adult individuals (15-96 years) who underwent the HCV-antibody (HCV-Ab) test in the Second Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were included in this study. We retrospectively analyzed the electronic medical records' data for each, and the positivity of HCV-Ab and the treatment of HCV RNA-positive patients were evaluated. Results: During 2013-2015, the crude prevalence of HCV-Ab was 1.4% (95%CI: 1.4-1.5; 1,611/111,916) and the adjusted prevalence of HCV-Ab was 1.7% (95%CI: 1.6-1.8), which was higher than in the 2006 national study (0.43%). The prevalence was 2-times higher in males than females (2.0% vs. 1.1%, p < 0.01). Notably, only 46% (434/951) of the HCV RNA-positive patients received standard peg-interferon plus ribavirin treatment, with 370 (82%) that completed treatment, of whom 272 (74%) achieved sustained virologic response (SVR). Particularly, 11% (32/292) of HCV RNA-positive patients were HBsAg-positive, and the SVR rate for them was lower than for the HBsAg-negative patients, but no significant difference was observed. Conclusions: HCV infection may have increased since 2006 in Western China. The SVR rate of peg-interferon plus ribavirin treatment was high, but the proportion of untreated HCV patients was large. Thus, more efforts need to be made by the government to create a scientific-based policy for HCV treatment and prevention.

Development and clinical application of a length-adjustable water phantom for total body irradiation.

A new type of water phantom which would be specialised for the absorbed dose measurement in total body irradiation (TBI) treatment is developed. Ten millimetres of thick Plexiglas plates were arranged to form a square cube with 300 mm of edge length. An appropriate sleeve-type piston was installed on the side wall, and a tabular Plexiglas piston was positioned inside the sleeve. By pushing and pulling the piston, the length of the self-made water phantom could be varied to meet the required patients' physical sizes. To compare the international standard water phantom with the length-adjustable and the Plexiglas phantoms, absorbed dose for 6-MV X ray was measured by an ionisation chamber at different depths in three kinds of phantoms. In 70 cases with TBI, midplane doses were metered using the length-adjustable and the Plexiglas phantoms for simulating human dimensions, and dose validation was synchronously carried out. There were no significant statistical differences, p > 0.05, through statistical processing of data from the international standard water phantom and the self-designed one. There were significant statistical differences, p < 0.05, between the two sets of data from the standard and the Plexiglas one. In addition, the absolute difference had a positive correlation with the varied depth of the detector in the Plexiglas phantom. Comparing the data of clinical treatment, the differences were all <1 % among the prescription doses and the validation data collected from the self-design water phantom. However, the differences collected from the Plexiglas phantom were increasing gradually from +0.77 to +2.30 % along with increasing body width. Obviously, the difference had a positive correlation with the body width. The results proved that the new length-adjustable water phantom is more accurate for simulating human dimensions than Plexiglas phantom.

A cost-effectiveness analysis of docetaxel versus pemetrexed in second-line chemotherapy for stage IIIb or IV non-small cell lung cancer in China.

BACKGROUND: To study the cost-efficacy of docetaxel and pemetrexed as single agents versus platinum-based combination agents in second-line treatment of stage IIIb or IV non-small cell lung cancer (NSCLC) patients by evaluating chemotherapeutic indexes and medical costs. METHODS: Treatment responses were evaluated by progression-free survival (PFS), overall survival (OS), hematological and gastrointestinal toxicities. RESULTS: Two hundred and seven stage IIIb or IV NSCLC patients were recruited to this clinical observation retrospective study. Thirty-four subjects were treated with docetaxel (group A), 98 with platinum-based doublet chemotherapy with docetaxel (group B), 42 with pemetrexed (group C), and 33 patients with platinum-based doublet combination therapy with pemetrexed (group D). The average PFS of groups A and B was 3.28 and 4.58 months, respectively (p = 0.042). The mean PFS of groups C and D was 3.1 and 4.98 months, respectively (p = 0.017). The mean OS of these groups was 12.88, 13.17, 12.40 and 13.04 months, respectively, without significant differences. The total medical costs in these four groups amounted to USD 5,533, 7,745, 8,569 and 15,291, respectively. CONCLUSIONS: Platinum-based doublet chemotherapy with docetaxel or pemetrexed could significantly increase PFS, however, without significant OS improvement in comparison with using them as single agents. The medical expenses associated with doublet therapy were much higher than those associated with single therapy with a significant portion of the medical expenses spent on treating hematological and gastrointestinal toxicity.