目的:临床中治疗类风湿性关节炎的生物制剂多种多样,其疗效及安全性差异尚不明确,文章旨在比较不同生物制剂治疗类风湿性关节炎的有效性及安全性的差异。方法:检索中国知网、维普、万方、中国生物医学文献系统数据库、PubMed、Cochrane...目的:临床中治疗类风湿性关节炎的生物制剂多种多样,其疗效及安全性差异尚不明确,文章旨在比较不同生物制剂治疗类风湿性关节炎的有效性及安全性的差异。方法:检索中国知网、维普、万方、中国生物医学文献系统数据库、PubMed、Cochrane图书馆、Web of Science和Embase数据库的文献,收集各数据库建库至2022-10-01符合要求的关于类风湿性关节炎生物制剂治疗的随机对照试验。运用EndNote软件筛选文献,RevMan 5.3软件对纳入的文献进行质量评价;采用Stata 14.2软件对ACR20(美国风湿学会20%缓解率)、ACR50(美国风湿学会50%缓解率)、ACR70(美国风湿学会70%缓解率)、红细胞沉降率及不良反应指标进行直接Meta分析及网状Meta分析。结果:共纳入符合要求的文献39篇,5篇低风险文献,4篇含高风险文献,剩余30篇含有风险未知偏倚,共13种治疗措施。网状Meta分析结果:①在ACR20方面,英夫利昔单抗联合甲氨蝶呤(OR=5.54,95%CI:1.33-23.01,P<0.05)、阿巴西普+甲氨蝶呤片(OR=3.21,95%CI:1.13-9.10,P<0.05)、托珠单抗(OR=2.95,95%CI:1.61-5.44,P<0.05)的治疗效果均优于甲氨蝶呤片,且排名靠前;ACR20概率排序结果为:英夫利昔单抗+甲氨蝶呤片>阿巴西普+甲氨蝶呤片>托珠单抗>培塞利珠单抗>依那西普+甲氨蝶呤片。②在ACR50方面,依那西普联合甲氨蝶呤片(OR=4.04,95%CI:2.13-7.66,P<0.05)、英夫利昔单抗联合甲氨蝶呤片(OR=4.79,95%CI:1.19-19.26,P<0.05)、托珠单抗联合甲氨蝶呤片(OR=3.54,95%CI:1.36-9.22,P<0.05)治疗效果优于甲氨蝶呤片,且排名靠前;ACR50概率排序结果为:依那西普+甲氨蝶呤片>英夫利昔单抗+甲氨蝶呤片>托珠单抗+甲氨蝶呤片>托珠单抗>培塞利珠单抗+甲氨蝶呤片。③在ACR70方面,英夫利昔单抗联合甲氨蝶呤片(OR=8.00,95%CI:2.31-27.69,P<0.05)、依那西普联合甲氨蝶呤片(OR=4.26,95%CI:2.51-7.21,P<0.05)、托珠单抗+甲氨蝶呤片(OR=3.51,95%CI:1.82-6.80,P<0.05)的治疗效果优于甲氨蝶呤片;ACR70概率排序结果为英夫利昔单抗+甲氨蝶呤片>依那西普+甲氨蝶呤片>托珠单抗+甲氨蝶呤片>培塞利珠单抗>阿达木单抗+甲氨蝶呤片。④在红细胞沉降率方面,依那西普联合甲氨蝶呤片(SMD=-9.23,95%CI:-16.55至-1.92,P<0.05)治疗效果优于依那西普及甲氨蝶呤片(SMD=14.59,95%CI:7.28-21.91,P<0.05)。红细胞沉降率概率排序结果为依那西普+甲氨蝶呤片>英夫利昔单抗+甲氨蝶呤片>依那西普>阿达木单抗+甲氨蝶呤片>甲氨蝶呤片。⑤在不良反应方面,安慰剂(OR=0.62,95%CI:0.39-0.99,P<0.05)优于英夫利昔单抗和培塞利珠单抗(OR=0.44,95%CI:0.25-0.78,P<0.05)。不良反应概率排序结果为安慰剂>英夫利昔单抗>依那西普+甲氨蝶呤片>培塞利珠单抗>依那西普。结论:基于39篇随机对照试验的文献证据表明,英夫利昔单抗联合甲氨蝶呤片(高级强推荐)在临床中可作为治疗类风湿性关节炎首选,有效性及安全性相对较好,依那西普联合甲氨蝶呤片(高级强推荐)可作为次选。展开更多
目的:临床研究发现柳氮磺吡啶、依那西普、注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(以下简称为益赛普)及沙利度胺等其他药品治疗强直性脊柱炎可明显改善患者症状,提高患者生活质量,但缺乏系统评价。文章以此系统评价不同药物治...目的:临床研究发现柳氮磺吡啶、依那西普、注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(以下简称为益赛普)及沙利度胺等其他药品治疗强直性脊柱炎可明显改善患者症状,提高患者生活质量,但缺乏系统评价。文章以此系统评价不同药物治疗强直性脊柱炎的临床疗效和安全性的差异。方法:运用计算机检索中国知网、万方数据、维普、SinoMed中国生物医学文献服务系统、PubMed、Cochrane图书馆和Web of Science数据库,收集自建库至2020-09-30关于不同药物治疗强直性脊柱炎的随机对照试验类文章。运用EndNote软件筛选文献,采用Cochrane风险偏倚评估工具及RevMan 5.3对纳入的文献进行质量评价,采用Stata 14.2进行网状Meta分析。结果:文章共纳入29项随机对照试验,其中高风险文献21篇,低风险文献8篇;对照组治疗措施包括柳氮磺吡啶、益赛普、沙利度胺等3种用药措施,观察组采用益赛普、依那西普、沙利度胺及柳氮磺吡啶联合益赛普、益赛普联合沙利度胺治疗、沙利度胺联合柳氮磺吡啶、依那西普联合柳氮磺吡啶等7种用药措施。网状Meta分析结果显示:①临床总有效率:益赛普联合沙利度胺治疗(OR=0.07,95%CI:0.03-0.17,P<0.05)、益赛普治疗(OR=0.23,95%CI:0.13-0.40,P<0.05)、益赛普联合柳氮磺吡啶治疗(OR=0.18,95%CI:0.10-0.33,P<0.05)均优于柳氮磺吡啶治疗,总有效率排序结果为:益赛普+沙利度胺治疗(97.0%)>柳氮磺吡啶+益赛普治疗(67.7%)>沙利度胺+柳氮磺吡啶治疗(60.0%)>益赛普治疗(52.2%)>依那西普+柳氮磺吡啶治疗(47.9%)>依那西普治疗(45.4%)>沙利度胺治疗(29.7%)>柳氮磺吡啶治疗(0.2%);②不良反应发生率:益赛普治疗(OR=0.21,95%CI:0.05-0.81,P<0.05)、沙利度胺治疗(OR=0.32,95%CI:0.17-0.61,P<0.05)不良反应发生率较柳氮磺吡啶低,不良反应发生率由高到低排序为:依那西普治疗(91.8%)>柳氮磺吡啶治疗(84.8%)>依那西普联合柳氮磺吡啶治疗(58.8%)>柳氮磺吡啶+益赛普治疗(44.5%)>益赛普+沙利度胺治疗(32.3%)>沙利度胺治疗(24.9%)>益赛普治疗(12.9%)。结论:基于不同药物治疗强直性脊柱炎的29项随机对照试验结果,在提高临床疗效和降低不良反应方面综合考虑,益赛普联合沙利度胺联合疗法可作为首选药物治疗方案,而益赛普单独治疗可作为次选药物治疗方案。展开更多
A growth-type polycrystalline diamond compact （PDC） was synthesized under high temperature and high pressure （HPHT）. The infiltration technique was used with an Fe55Ni29Co16 （KOV） alloy as the sintering solvent....A growth-type polycrystalline diamond compact （PDC） was synthesized under high temperature and high pressure （HPHT）. The infiltration technique was used with an Fe55Ni29Co16 （KOV） alloy as the sintering solvent. The morphology and weight ra- tio of the PDC were investigated through scanning electron microscopy （SEM） and electron dispersion spectroscopy （EDS）. Note that the KOV alloy evenly infiltrated throughout the polycrystalline diamond （PCD） layer and WC-Co substrate in a short sintering time due to its low viscosity and high soakage capability. A transition layer confirmed the presence of the M^C phase near the interface of the PDC, which can make the diamond layer and WC-Co substrate combine as a complex material. X-ray diffraction （XRD） performed on the PCD layer confirmed the presence of cubic diamond, WC, cubic CoCx, the high tempera- ture cubic phase of c^-Co, the alloy phase of FeNix, and no graphite phase. Besides, a surface residual stress of the PCD layer, measured with reasonable accuracy using micro-Raman spectroscopy, is found to be a homogeneous compressive stress with an average value of 0.16 GPa, much lower than that of the powders-mixing method.展开更多
High quality grown polycrystalline diamond compact (PDC) with low residual stress was prepared using the infiltration method with nickel based alloys as the solvent under high temperature and high pressure (HPHT). Sca...High quality grown polycrystalline diamond compact (PDC) with low residual stress was prepared using the infiltration method with nickel based alloys as the solvent under high temperature and high pressure (HPHT). Scanning electron microscopy (SEM) was used to observe the micro morphology of the diamond layer and the diamond/WC substrate interface. It was found that dense and interlaced microstructure with diamond-diamond (D-D) direct bonding formed in the diamond layer of PDC. Micro-Raman spectroscopy was used to measure the Raman shift of diamonds in the polycrystalline diamond (PCD) layer and the residual stress was calculated based on the Raman shift of diamonds. Experimental results show that the residual stress of PCD layer is compressive stress, and the range of the residual stress is from 0.075 to 0.250 GPa in the whole PCD layer, much lower than that of other reports (up to 1.400 GPa). Moreover, the distribution of the residual stress from the diamond surface layer to the inner cross-section is homogeneous.展开更多
Thermal residual stress in Polycrystalline Diamond Compacts （PDCs） is mainly caused by the mismatch in the Coefficients of Thermal Expansion （CTE） between the polycrystalline diamond （PCD） layer and WC-Co substr...Thermal residual stress in Polycrystalline Diamond Compacts （PDCs） is mainly caused by the mismatch in the Coefficients of Thermal Expansion （CTE） between the polycrystalline diamond （PCD） layer and WC-Co substrate. In the PCD layer, the CTE of cobalt exhibit magnitudes four times larger than those of diamond. Cobalt content in the PCD layer has important effects on the thermal residual stress of PDCs. In this work, the effects of cobalt content on thermal residual stress in PCDs were investi- gated by the Finite Element Method （FEM）. The simulation results show that the thermal residual stress decreases firstly, and then increases with increasing cobalt content （1 vo1.%-20 vol.%）, which reaches a minimum value when the cobalt content is about 10 vol.%. The FEM analysis results are in agreement with our experimental results. It will provide an effective method for further designing and optimizing PDC properties.展开更多
Polycrystalline diamond compacts (PDC) were synthesized using diamond powder of average crystal size 3-20 μm by the Ni 70 Mn 25 Co 5 alloy infiltration technique at high temperature and high pressure (HPHT).The surfa...Polycrystalline diamond compacts (PDC) were synthesized using diamond powder of average crystal size 3-20 μm by the Ni 70 Mn 25 Co 5 alloy infiltration technique at high temperature and high pressure (HPHT).The surface residual stress of polycrystalline diamond (PCD) layer was measured using micro-Raman spectroscopy with hydrostatic stress model and X-ray diffraction (XRD).Measurements of the stress levels of PCDs show that the residual compressive stresses range from 0.12 to 0.22 GPa,which increase with the crystal size of diamond.Scanning electron microscopy (SEM) was used to observe the morphology of initial diamond grains and PCD cross-section.The results indicate that PCD has a dense and interlaced microstructure with diamond-diamond (D-D) direct bonding.And the smaller the crystal size of diamond,the better the growth of diamond direct bonding and the smaller the binder metal between diamond boundaries will be.展开更多
文摘目的:临床中治疗类风湿性关节炎的生物制剂多种多样,其疗效及安全性差异尚不明确,文章旨在比较不同生物制剂治疗类风湿性关节炎的有效性及安全性的差异。方法:检索中国知网、维普、万方、中国生物医学文献系统数据库、PubMed、Cochrane图书馆、Web of Science和Embase数据库的文献,收集各数据库建库至2022-10-01符合要求的关于类风湿性关节炎生物制剂治疗的随机对照试验。运用EndNote软件筛选文献,RevMan 5.3软件对纳入的文献进行质量评价;采用Stata 14.2软件对ACR20(美国风湿学会20%缓解率)、ACR50(美国风湿学会50%缓解率)、ACR70(美国风湿学会70%缓解率)、红细胞沉降率及不良反应指标进行直接Meta分析及网状Meta分析。结果:共纳入符合要求的文献39篇,5篇低风险文献,4篇含高风险文献,剩余30篇含有风险未知偏倚,共13种治疗措施。网状Meta分析结果:①在ACR20方面,英夫利昔单抗联合甲氨蝶呤(OR=5.54,95%CI:1.33-23.01,P<0.05)、阿巴西普+甲氨蝶呤片(OR=3.21,95%CI:1.13-9.10,P<0.05)、托珠单抗(OR=2.95,95%CI:1.61-5.44,P<0.05)的治疗效果均优于甲氨蝶呤片,且排名靠前;ACR20概率排序结果为:英夫利昔单抗+甲氨蝶呤片>阿巴西普+甲氨蝶呤片>托珠单抗>培塞利珠单抗>依那西普+甲氨蝶呤片。②在ACR50方面,依那西普联合甲氨蝶呤片(OR=4.04,95%CI:2.13-7.66,P<0.05)、英夫利昔单抗联合甲氨蝶呤片(OR=4.79,95%CI:1.19-19.26,P<0.05)、托珠单抗联合甲氨蝶呤片(OR=3.54,95%CI:1.36-9.22,P<0.05)治疗效果优于甲氨蝶呤片,且排名靠前;ACR50概率排序结果为:依那西普+甲氨蝶呤片>英夫利昔单抗+甲氨蝶呤片>托珠单抗+甲氨蝶呤片>托珠单抗>培塞利珠单抗+甲氨蝶呤片。③在ACR70方面,英夫利昔单抗联合甲氨蝶呤片(OR=8.00,95%CI:2.31-27.69,P<0.05)、依那西普联合甲氨蝶呤片(OR=4.26,95%CI:2.51-7.21,P<0.05)、托珠单抗+甲氨蝶呤片(OR=3.51,95%CI:1.82-6.80,P<0.05)的治疗效果优于甲氨蝶呤片;ACR70概率排序结果为英夫利昔单抗+甲氨蝶呤片>依那西普+甲氨蝶呤片>托珠单抗+甲氨蝶呤片>培塞利珠单抗>阿达木单抗+甲氨蝶呤片。④在红细胞沉降率方面,依那西普联合甲氨蝶呤片(SMD=-9.23,95%CI:-16.55至-1.92,P<0.05)治疗效果优于依那西普及甲氨蝶呤片(SMD=14.59,95%CI:7.28-21.91,P<0.05)。红细胞沉降率概率排序结果为依那西普+甲氨蝶呤片>英夫利昔单抗+甲氨蝶呤片>依那西普>阿达木单抗+甲氨蝶呤片>甲氨蝶呤片。⑤在不良反应方面,安慰剂(OR=0.62,95%CI:0.39-0.99,P<0.05)优于英夫利昔单抗和培塞利珠单抗(OR=0.44,95%CI:0.25-0.78,P<0.05)。不良反应概率排序结果为安慰剂>英夫利昔单抗>依那西普+甲氨蝶呤片>培塞利珠单抗>依那西普。结论:基于39篇随机对照试验的文献证据表明,英夫利昔单抗联合甲氨蝶呤片(高级强推荐)在临床中可作为治疗类风湿性关节炎首选,有效性及安全性相对较好,依那西普联合甲氨蝶呤片(高级强推荐)可作为次选。
文摘目的:临床研究发现柳氮磺吡啶、依那西普、注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(以下简称为益赛普)及沙利度胺等其他药品治疗强直性脊柱炎可明显改善患者症状,提高患者生活质量,但缺乏系统评价。文章以此系统评价不同药物治疗强直性脊柱炎的临床疗效和安全性的差异。方法:运用计算机检索中国知网、万方数据、维普、SinoMed中国生物医学文献服务系统、PubMed、Cochrane图书馆和Web of Science数据库,收集自建库至2020-09-30关于不同药物治疗强直性脊柱炎的随机对照试验类文章。运用EndNote软件筛选文献,采用Cochrane风险偏倚评估工具及RevMan 5.3对纳入的文献进行质量评价,采用Stata 14.2进行网状Meta分析。结果:文章共纳入29项随机对照试验,其中高风险文献21篇,低风险文献8篇;对照组治疗措施包括柳氮磺吡啶、益赛普、沙利度胺等3种用药措施,观察组采用益赛普、依那西普、沙利度胺及柳氮磺吡啶联合益赛普、益赛普联合沙利度胺治疗、沙利度胺联合柳氮磺吡啶、依那西普联合柳氮磺吡啶等7种用药措施。网状Meta分析结果显示:①临床总有效率:益赛普联合沙利度胺治疗(OR=0.07,95%CI:0.03-0.17,P<0.05)、益赛普治疗(OR=0.23,95%CI:0.13-0.40,P<0.05)、益赛普联合柳氮磺吡啶治疗(OR=0.18,95%CI:0.10-0.33,P<0.05)均优于柳氮磺吡啶治疗,总有效率排序结果为:益赛普+沙利度胺治疗(97.0%)>柳氮磺吡啶+益赛普治疗(67.7%)>沙利度胺+柳氮磺吡啶治疗(60.0%)>益赛普治疗(52.2%)>依那西普+柳氮磺吡啶治疗(47.9%)>依那西普治疗(45.4%)>沙利度胺治疗(29.7%)>柳氮磺吡啶治疗(0.2%);②不良反应发生率:益赛普治疗(OR=0.21,95%CI:0.05-0.81,P<0.05)、沙利度胺治疗(OR=0.32,95%CI:0.17-0.61,P<0.05)不良反应发生率较柳氮磺吡啶低,不良反应发生率由高到低排序为:依那西普治疗(91.8%)>柳氮磺吡啶治疗(84.8%)>依那西普联合柳氮磺吡啶治疗(58.8%)>柳氮磺吡啶+益赛普治疗(44.5%)>益赛普+沙利度胺治疗(32.3%)>沙利度胺治疗(24.9%)>益赛普治疗(12.9%)。结论:基于不同药物治疗强直性脊柱炎的29项随机对照试验结果,在提高临床疗效和降低不良反应方面综合考虑,益赛普联合沙利度胺联合疗法可作为首选药物治疗方案,而益赛普单独治疗可作为次选药物治疗方案。
基金supported by the National Natural Science Foundation of China (Grant Nos. 50801030 and 50731006)the Open Project of State Key Laboratory of Superhard Materials of Jilin University (Grant No.201201)
文摘A growth-type polycrystalline diamond compact （PDC） was synthesized under high temperature and high pressure （HPHT）. The infiltration technique was used with an Fe55Ni29Co16 （KOV） alloy as the sintering solvent. The morphology and weight ra- tio of the PDC were investigated through scanning electron microscopy （SEM） and electron dispersion spectroscopy （EDS）. Note that the KOV alloy evenly infiltrated throughout the polycrystalline diamond （PCD） layer and WC-Co substrate in a short sintering time due to its low viscosity and high soakage capability. A transition layer confirmed the presence of the M^C phase near the interface of the PDC, which can make the diamond layer and WC-Co substrate combine as a complex material. X-ray diffraction （XRD） performed on the PCD layer confirmed the presence of cubic diamond, WC, cubic CoCx, the high tempera- ture cubic phase of c^-Co, the alloy phase of FeNix, and no graphite phase. Besides, a surface residual stress of the PCD layer, measured with reasonable accuracy using micro-Raman spectroscopy, is found to be a homogeneous compressive stress with an average value of 0.16 GPa, much lower than that of the powders-mixing method.
基金supported by the National Natural Science Foundation of China (Grant Nos. 50572032 and 50731006)
文摘High quality grown polycrystalline diamond compact (PDC) with low residual stress was prepared using the infiltration method with nickel based alloys as the solvent under high temperature and high pressure (HPHT). Scanning electron microscopy (SEM) was used to observe the micro morphology of the diamond layer and the diamond/WC substrate interface. It was found that dense and interlaced microstructure with diamond-diamond (D-D) direct bonding formed in the diamond layer of PDC. Micro-Raman spectroscopy was used to measure the Raman shift of diamonds in the polycrystalline diamond (PCD) layer and the residual stress was calculated based on the Raman shift of diamonds. Experimental results show that the residual stress of PCD layer is compressive stress, and the range of the residual stress is from 0.075 to 0.250 GPa in the whole PCD layer, much lower than that of other reports (up to 1.400 GPa). Moreover, the distribution of the residual stress from the diamond surface layer to the inner cross-section is homogeneous.
基金supported by the National Natural Science Foundation of China (Grant Nos. 51071074,51172089 and 51171070)the Graduate Innovation Fund of Jilin University of China (Grant No.20111022)
文摘Thermal residual stress in Polycrystalline Diamond Compacts （PDCs） is mainly caused by the mismatch in the Coefficients of Thermal Expansion （CTE） between the polycrystalline diamond （PCD） layer and WC-Co substrate. In the PCD layer, the CTE of cobalt exhibit magnitudes four times larger than those of diamond. Cobalt content in the PCD layer has important effects on the thermal residual stress of PDCs. In this work, the effects of cobalt content on thermal residual stress in PCDs were investi- gated by the Finite Element Method （FEM）. The simulation results show that the thermal residual stress decreases firstly, and then increases with increasing cobalt content （1 vo1.%-20 vol.%）, which reaches a minimum value when the cobalt content is about 10 vol.%. The FEM analysis results are in agreement with our experimental results. It will provide an effective method for further designing and optimizing PDC properties.
基金supported by the National Natural Science Foundation of China (Grant Nos.50572032,50801030 and 50731006)
文摘Polycrystalline diamond compacts (PDC) were synthesized using diamond powder of average crystal size 3-20 μm by the Ni 70 Mn 25 Co 5 alloy infiltration technique at high temperature and high pressure (HPHT).The surface residual stress of polycrystalline diamond (PCD) layer was measured using micro-Raman spectroscopy with hydrostatic stress model and X-ray diffraction (XRD).Measurements of the stress levels of PCDs show that the residual compressive stresses range from 0.12 to 0.22 GPa,which increase with the crystal size of diamond.Scanning electron microscopy (SEM) was used to observe the morphology of initial diamond grains and PCD cross-section.The results indicate that PCD has a dense and interlaced microstructure with diamond-diamond (D-D) direct bonding.And the smaller the crystal size of diamond,the better the growth of diamond direct bonding and the smaller the binder metal between diamond boundaries will be.
