A Pilot First-in-Human Study of Embrace,a Polyethylene Glycol-Based Liquid Embolic Agent,in the Embolization of Malignant and Benign Hypervascular Tumors

PurposeTo investigate the safety and efficacy of an aqueous polyethylene glycol-based liquid embolic agent, Embrace Hydrogel Embolic System (HES), in the treatment of benign and malignant hypervascular tumors.Materials and MethodsA prospective, single-arm, multicenter study included 8 patients, 5 males and 3 females, with a median age of 58.5 years (30–85 years), who underwent embolization in 8 tumors between October 2019 and May 2020. Technical success was defined as successful delivery of HES to the index vessel, with disappearance of >90% of the targeted vascular enhancement or, for portal vein embolization, occlusion of the portal branches to the liver segments for future resection. The volume of HES administered, ease of use (5 point Likert scale), administration time, and adverse events (AEs) were recorded. Evaluation was performed at 7, 30, and 90 days via clinical assessment and blood testing, and follow-up imaging was performed at 30 days.ResultsEight patients were enrolled, and 10 embolizations were performed in 8 lesions. Tumors included hepatocellular carcinoma (n = 4), renal angiomyolipoma (n = 3), and intrahepatic cholangiocarcinoma (n = 1). Technical success was 100%, and the average ease of use was 3.3 ± 1.0 SD. The HES delivery time was 1–28 minutes (median, 16.5 minutes), and the HES volume injected was 0.4–4.0 mL (median, 1.3 mL). All patients reached 30-day follow-up with imaging, and 6 patients reached 90-day follow-up. There were 3 serious AEs in 2 patients that were unrelated to the embolic agent.ConclusionHES resulted in a 100% embolization technical success rate. The product ease of use was acceptable, and no target vessel recanalization was noted on follow-up imaging at 30 days.     

Challenges with Forecasting Budget Impact: A Case Study of Six ICER Reports

Background

Payers frequently rely on budget impact model (BIM) results to help determine drug coverage policy and its effect on their bottom line. It is unclear whether BIMs typically overestimate or underestimate real-world budget impact.

Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction

BackgroundCoronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%).MethodsWe analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively.ResultsIn 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]).ConclusionsHeart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization.     

实时校验本年盈余与预算结余差异调整法探讨

正确编制“本年盈余与预算结余差异调节表”是公立医院执行《政府会计制度》的一大难点,现有的几种差异调节方法存在诸多不足,核算正确与否依赖会计人员的基本素质,而且工作量巨大。以财务会计与预算会计差异产生的基本原理为基础,利用计算机软件实时校验并自动登记差异,是简便、高效、准确编制“本年盈余与预算结余差异调节表”的方法,本文对此进行了举例说明。     

术中电生理动态监护下显微手术切除椎管神经鞘瘤（附65例报告）

目的 探讨术中电生理监护对椎管神经鞘瘤显微手术中的作用及意义，提高对椎管内神经鞘瘤的治疗水平。方法 回顾性分析65例术中电生理动态监护下，显微手术切除椎管内神经鞘瘤。结果 治愈60例（占92．3％），好转5例（占7．7％），无死亡；肿瘤全切62例，次全切除3例，全切率95．4％。结论 常规动态电生理监测下显微手术切除椎管神经鞘瘤，能保全脊髓神经的功能，减少副损伤，提高手术安全性；显微手术有助于提高肿瘤全切率，可有效减少术后复发。对影响脊柱稳定性的行脊柱融合内固定。     

糖化血红蛋白及糖化血清蛋白与糖尿病肾功能衰竭患者的血糖监测

糖化血红蛋白(Hb)A1c是血糖监测的苇要指标,反映检测前2～3个月的平均血糖水平.慢性肾功能衰竭(CRF)患者存在贫血、酸中毒、氧化应激、胰岛素抵抗、血液透析及促红细胞生成素(EPO)的应用等因素,对HbA1c的测定会造成影响.糖化血清蛋白(GSP)反映检测前2～3周的平均血糖水平,仅受血浆蛋白的影响,几乎不受血红蛋白和EPO治疗等以上因素的影响,且对短时间内的血糖变化更为敏感.将GSP作为糖尿病肾功能衰竭患者血糖监测指标可能比HbA1c更理想.     

多部位采血快速血糖仪的临床应用

目的:探讨多部位采血快速血糖仪检测大鱼际毛细血管葡萄糖用于糖尿病患者血糖监测的准确性及优缺点。方法:对我科47例住院糖尿病患者在知情同意后进行血糖检测。行正常餐实验,在空腹时和正常餐后2h分别采静脉血用葡萄糖氧化酶法测定血糖、采手指血用乐康全血糖仪测定血糖、采手掌大鱼际血用Free- style多部位采血血糖仪检测血糖;同时进行采血疼痛感和使用方便性的主观调查,分最好、好、一般和差4级,转换为数字1、2、3、4进行评价。结果:3组的空腹血糖值差异无显著性(P>0.05);餐后2h血糖差异有显著性(P<0.05)。3组的空腹血糖及餐后2h血糖均有良好的线性相关(r=0.759～0.795,P<0.001)。3个部位的测试结果间均呈良好的线性相关,决定系数(R~2)=0.576～0.651(P<0.001)。两种血糖仪的使用方便性无明显差异.指尖采血的疼痛性要强于手掌大鱼际采血(P<0.05)。结论:多部位快速血糖仪(Freestyle)手掌大鱼际采血检测血糖的结果可靠,是糖尿病患者长期监测血糖的一种较为准确、方便、痛苦较少的方法。     

地高辛的体内分析方法应用与进展

目的总结地高辛血药质量浓度监测方法,寻求最适的测定方法。方法对近年来国内外与地高辛监测相关的文献进行检索综述分析。结果地高辛血药浓度测定方法很多,常用方法主要有:FPIA、酶免疫分析法、RIA、CLIA、乳胶免疫抑制法、干化学法、HPLC法等。结论通过比较分析其中RIA、CLIA、EIA和HPLC MS 4种方法更好。     

Principles and strategies of effective community participation

A framework is offered for understanding the conceptual basisand the strategic implications of community participation, inachieving Health for All goals. Special focus is given to themeaning, settings and levels of participation in official decision-makingstructures and at the community level. Questions such ‘howis participation facilitated?’, ‘who participates?’and ‘what are the benefits and obstacles to participation?’are geared primarily towards the needs of individuals who functionat the city level and expect practical strategic advice andguidance. The structure of the 1989 WHO Healthy Cities Symposiumwhich was devoted to community action was based on the frameworkand conceptual approach of this paper.