Reining in Costs of Kidney Dialysis: US Supreme Court Offers Hope to End Predatory Pricing

PurposeTwo for-profit dialysis providers control >70% of the US kidney dialysis market. They use their excessive market power to force private insurers to pay nearly 4 times the Medicare rate, earning exorbitant profits for themselves at the expense of the health care system. Both the legislative and judicial systems have been called on to address this inequity, so far without success.MethodsWe examined the history of this issue as set forth in official Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Federal Trade Commission, and other regulatory documents as well as court filings and opinions. We analyzed the legislative efforts to address the problem and the judicial response.FindingsWe found that most efforts, to date, have failed. However, a 2022 US Supreme Court decision helps illuminate a path forward, in large part by defining the limits of judicial intervention.ImplicationsWe identify a path forward that would separate the monopolistic players using a multipronged effort involving US Department of Justice, Federal Trade Commission, Office of Inspector General, and states attorneys general. We also caution that, based on our research, the providers could challenge further efforts by deciding to withdraw services in certain areas or refuse to do business with certain insurers, resulting in patients having difficulty accessing dialysis.     

HPLC同时测定斑蝥酸钠维生素B6注射液中斑蝥酸钠和维生素B6的含量

目的 建立斑蝥酸钠维生素B₆注射液中斑蝥酸钠和维生素B₆含量的同时测定方法。方法 采用HPLC，色谱柱为Syncronis C₁₈（250 mm×4.6 mm，5 μm），流动相为0.02 mol·L^-1磷酸二氢钾溶液（磷酸调pH值至2.6）-乙腈，梯度洗脱，流速为1.0 mL·min^-1，检测波长为193，290 nm，波长切换法，柱温：30℃。结果 斑蝥酸钠回归方程为Y=1.926X+0.010（r=0.999 7），在0.064 6~0.322 8 mg·mL^-1内斑蝥酸钠与峰面积的线性关系良好，平均回收率为98.9%，RSD为1.2%（n=9）。维生素B₆回归方程为Y=24.153X+0.670（r=0.999 9），在0.535 9~2.679 7 mg·mL^-1内维生素B₆与峰面积的线性关系良好，平均回收率为100.2%，RSD为1.0%（n=9）；仪器精密度、稳定性和重复性试验的RSD均<2.0%。结论 所建立的方法结果准确、重复性好，可用于斑蝥酸钠维生素B₆注射液的质量控制。     

紫参胶囊质量标准研究

目的建立紫参胶囊的质量标准.方法采用薄层扫描法对紫参胶囊中的大黄素进行含量测定,展开剂正己烷乙酸乙酯-甲酸(30100.5),检测波长λs=442 nm,参比波长λR=610 nm;同时对制剂中的药材白芍、首乌藤、百合进行了薄层鉴别.结果大黄素在0.04～0.20μg范围内线性良好,r=0.995,平均加样回收率为98.1%,RSD=2.26%;薄层色谱鉴别斑点清晰,无干扰,易分辨.结论该法准确、简便、重复性好,可用于紫参胶囊的质量控制.     

Clinical Observation on Treatment of Knee Osteoarthritis with Acupuncture plus Tuina

目的观察针刺特定穴、手法调整膝关节肌力平衡疗法治疗膝骨关节炎的疗效.方法将105例患者随机分为两组,治疗组68例用针刺特定穴、手法调整膝关节肌力平衡疗法治疗,对照组37例用单纯针刺特定穴治疗.结果治疗组总显效率明显优于对照组(P＜0.05).结论针刺特定穴、手法调整膝关节肌力平衡疗法对膝骨关节炎的疗效满意.     

阿司匹林抵抗的产生机制与防治策略

阿司匹林属于非甾体类抗炎药,尽管被广泛应用于临床已有百余年,但有关其作用机制及临床应用的研究一直在进行。阿司匹林由最初的被用于解热、镇痛、抗炎等逐渐转变到用于抗血栓,尤其在心血管事件的二级预防中应用最广,减少了大约25%的心血管事件的发生。临床上有5%~60%的患者虽常规服用阿司匹林,却不能有效地抑制血小板的活性,这种现象被称为阿司匹林抵抗。导致这种现象的确切原因还不明确,可能与药物间的相互作用、剂量不足等有关。但到目前为止,仍无法用同一机制解释所有的阿司匹林抵抗,并且,很多研究所得出的结果是矛盾的。因此,认为在具有阿司匹林抵抗的人群中可能存在一定的群体特征性,也正因如此导致了阿司匹林抵抗的复杂性。期望用同一机制解释所有的阿司匹林抵抗现象是不可行的,应当针对不同群体做更多的研究工作。按照传统中医理论,结合心血管疾病多病程较长,且在存在阿司匹林抵抗的人群中多反复发作等特点,应将其归属于络病的范畴。联合应用具有扶正化浊,活血解毒通络功效的中药,发挥中医中药辨证论治和整体调节的优势,也许可以解决具有不同群体特征性的阿司匹林抵抗的问题,从而更有效地预防心血管疾病的发生。     

愈胃宁治疗慢性胃炎60例疗效观察

目的观察愈胃宁治疗慢性胃炎的临床疗效。方法运用随机对照，开放实验方法，分为治疗组60例和对照组38例，治疗组运用愈胃宁治疗，对照组运用西药治疗。2组治疗前后均做胃镜检查，观察临床疗效。结果治疗组有效率为88、33％，对照组为86、84％，治疗组对症状的缓解率明显优于对照组（P〈0．05）。结论愈胃宁治疗慢性胃炎的疗效与对照组相当，但对症状的缓解明显优于对照组，     

抗环瓜氨酸肽抗体检测在类风湿关节炎诊断中的应用

目的：探讨抗环瓜氨酸肽（抗-CCP）抗体对类风湿关节炎（RA）的临床应用价值,并比较与类风湿因子（RF）之间的相关性以及在临床诊断上的意义。方法：对75例RA患者血清标本和77例对照者的血清标本用酶联免疫吸附试验（ELISA）进行抗-CCP抗体检测,并测定RF,分析RF与抗-CCP抗体的相关性。结果：75例RA患者中,抗-CCP抗体阳性率为56%（42/75）,非RA对照组的阳性率为5.2%（4/77）,两者有显著差别。抗-CCP抗体对RA诊断的敏感度为56%,特异性为94.8%;阳性和阴性似然比分别为16.08和0.16。抗-CCP抗体和类风湿因子（RF）具有相关性。结论：抗-CCP抗体对RA诊断具有良好的敏感度和特异性,将是协助诊断RA的一个新的实验指标。     

肺气虚证的认识及内涵

通过对肺气虚证的生理病理的研究和诊断标准的历史沿革的回顾，对肺气虚证的内涵进行了初步的探讨，对于进一步研究肺气虚证具有重要的意义。     

44例肝豆状核变性患者P300的变化

目的观察肝豆状核变性(HLD)患者P300的变化及意义。方法对44例HLD患者依其症状和体征分为脑型和肝型组,分别进行P300检测,并对结果进行分析。结果与正常对照组相比,HLD患者P300潜伏期显著延长、波幅显著降低(P均<0.01);脑型HLD患者改变更为明显。结论HLD患者P300发生显著变化,推测该病患者存在认知功能降碍,且脑型HLD患者较肝型更明显。     

Effects of preventive acupuncture or moxibustion at the Guanyuan acupoint on expression of interleukin-2 and its receptors in hypothalamus, serum, and uterus of menopausal rats **☆

BACKGROUND： Previous studies have indicated preventive acupuncture and moxibustion at the Guanyuan point have positive effects on the immune system of menopausal rats. OBJECTIVE： To observe the effects of preventive acupuncture or moxibustion at the Guanyuan point on interleukin-2 （IL-2） and its receptor （IL-2R mRNA） levels in hypothalamus, serum, and uterus of menopausal rats. DESIGN： Randomized control animal experiment. SETTING： School of Acupuncture and Moxibustion, Beijing University of Chinese Medicine. MATERIALS： This study was performed at the Laboratory of Beijing University of Chinese Medicine from November 2004 to July 2005. The vaginal smear method was used to determine the estrus cycle of 9.5-month-old Sprague Dawley （SD） female rats. Three continuous estrus cycles were measured, and 160 rats with estrus cycle disorder, weighing （300 _＋ 20） g, were included in this study. The rats were randomly divided into four groups： preventive acupuncture group （n =48）, preventive moxibustion group （n =48）, model groups （n =48）, and 10-month-old group （n =16）. Sixteen 3.5-month-old healthy SD female rats, weighing （240 ± 20） g, were also assigned to the young group. All rats were clean grade and were purchased from the Laboratory Animal Center, Beijing University of Chinese Medicine. The experiment was in accordance with animal ethics standards. METHODS： Acupuncture was applied to the preventive acupuncture group at 10 months of age. The needle was inserted upward and perpendicularly two fen to a point that was two fen below the Guanyuan point. The rats freely moved around during needle retention （20 minutes）. Acupuncture was administered twice a week and continued for eight weeks. A moxa cone （small） moxibustion was applied to the preventive moxibustion group at 10 months of age. The rats were caught gently and kept at the same position as the preventive acupuncture group. The moxa cone was ignited and held to the Guanyuan point directly. Only one moxa