Difference in Survival in Early Kidney after Liver Transplantation Compared with Simultaneous Liver-Kidney Transplantation: Evaluating the Potential of the “Safety Net”

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Economic Evaluation of Factorial Trials: Cost-Utility Analysis of the Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes 2 × 2 × 2 Factorial Trial of Atorvastatin,Omega-3 Fish Oil,and Action Planning

ObjectivesWe applied principles for conducting economic evaluations of factorial trials to a trial-based economic evaluation of a cluster-randomized 2 × 2 × 2 factorial trial. We assessed the cost-effectiveness of atorvastatin, omega-3 fish oil, and an action-planning leaflet, alone and in combination, from a UK National Health Service perspective.MethodsThe Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes (AFORRD) Trial randomized 800 patients with type 2 diabetes to atorvastatin, omega-3, or their respective placebos and randomized general practices to receive a leaflet-based action-planning intervention designed to improve compliance or standard care. The trial was conducted at 59 UK general practices. Sixteen-week outcomes for each trial participant were extrapolated for 70 years using the United Kingdom Prospective Diabetes Study Outcomes Model v2.01. We analyzed the trial as a 2 × 2 factorial trial (ignoring interactions between action-planning leaflet and medication), as a 2 × 2 × 2 factorial trial (considering all interactions), and ignoring all interactions.ResultsWe observed several qualitative interactions for costs and quality-adjusted life-years (QALYs) that changed treatment rankings. However, different approaches to analyzing the factorial design did not change the conclusions. There was a ≥99% chance that atorvastatin is cost-effective and omega-3 is not, at a £20 000/QALY threshold.ConclusionsAtorvastatin monotherapy was the most cost-effective combination of the 3 trial interventions at a £20 000/QALY threshold. Omega-3 fish oil was not cost-effective, while there was insufficient evidence to draw firm conclusions about action planning. Recently-developed methods for analyzing factorial trials and combining parameter and sampling uncertainty were extended to estimate cost-effectiveness acceptability curves within a 2x2x2 factorial design with model-based extrapolation.     

循经冥想训练干预大学生抑郁情绪的效果分析

背景　现有研究表明，抑郁是影响大学生心理健康的重要原因之一。因此，有必要采取有效的方法干预大学生抑郁情绪。目的　探究循经冥想训练干预大学生抑郁情绪的效果。方法　2018年4月，在以循经冥想课题组的名义招募的某大学本科生中，发放抑郁自评量表（SDS），筛选出自愿接受循经冥想训练的60人。根据受试者性别比例，采用随机数字表法随机分为循冥组和静息组。其中循冥组30人进行4周循经冥想训练，在开始循经冥想训练前和循经冥想训练结束后填写SDS并进行E-prime情绪图片评价任务。静息组30人进行静息训练，其余与循经冥想组相同。比较两组前测、后测及前后测差值有无差异。结果　两组前测积极、中性、消极情绪图片评分比较，差异均无统计学意义（P>0.05）；两组后测积极、中性、消极情绪图片评分比较，差异均无统计学意义（P>0.05）；两组积极、中性、消极情绪图片评分前测与后测差值比较，差异均无统计学意义（P>0.05）。静息组前测与后测积极、中性、消极情绪图片评分比较，差异均无统计学意义（P>0.05）。循冥组后测积极情绪图片评分低于前测、消极情绪图片评分高于前测（P<0.05）。两组前测SDS评分比较，差异无统计学意义（P>0.05）。循冥组后测SDS评分低于静息组，SDS评分前测与后测差值高于静息组（P<0.05）。循冥组和静息组后测SDS评分均低于前测（P<0.05）。结论　循经冥想能降低大学生抑郁水平，可能是由于其能够改变人的情绪认知评价和睡眠质量，使人变得平和。     

绝经后女性2型糖尿病伴骨质疏松患者骨密度与骨代谢指标的相关性分析

目的分析研究绝经后女性2型糖尿病伴骨质疏松症患者骨密度与骨代谢指标的相关性。方法选取2013年10月至2017年05月于重庆医科大学附属第一医院内分泌内科住院的绝经后女性2型糖尿病患者385名。搜集其基本资料、骨代谢指标及骨密度等。根据T值将这些患者分为骨质疏松组(233例)、骨量减少组(101例)和骨量正常组(51例),比较三组间骨代谢指标的变化,并对骨密度(bone mineral density,BMD)与各项骨代谢指标进行相关性分析。结果 1型前胶原氨基末端前肽(Type I procollagen N-terminal propeptide,P1NP)、骨钙素(bone Gla protein,BGP)在骨质疏松组显著高于骨量减少组、骨量正常组(P0.05);随着骨密度的降低,1型胶原羧基端肽β特殊序列(β-Carboxyl terminal peptide,β-CTX)逐渐升高,骨质疏松组、骨量减少组与骨量正常组相比较差异有统计学意义(P0.05);Spearman等级相关分析示P1NP、BGP、β-CTX与骨密度呈负相关,25(OH)D_3与骨密度呈现正相关。结论绝经后女性2型糖尿病伴骨质疏松症患者骨密度与骨代谢指标有一定的相关性,有助于预测骨折风险并及时抗骨质疏松治疗。     

Role of zinc supplementation in the management of chronic liver diseases: A systematic review and meta-analysis

Introduction and objectivesZinc deficiency has been associated with poor prognosis in chronic liver disease. This systematic review and meta-analysis aimed to evaluate the role of zinc supplementation in the management of chronic liver diseases.Materials and methodsWe searched MEDLINE, LILACS, EMBASE, and Cochrane CENTRAL databases from inception to August 2018. We included randomized controlled trials evaluating adult patients with chronic liver disease of any etiology receiving zinc supplementation. Studies with other designs or evaluating chronic conditions other than liver disease were excluded. Two reviewers independently screened and extracted data from eligible studies. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomized studies.ResultsOf 1315 studies screened, 13 were included. Six assessed chronic hepatitis C treatment, with a relative risk of 0.83 indicating no protective effect of zinc supplementation on the improvement of sustained virological response. Three evaluated response to hepatic encephalopathy treatment, with a relative risk of 0.66 indicating a favorable effect of zinc supplementation on clinical improvement of this condition. Of four studies evaluating the management of cirrhosis, two analyzed the effect of zinc supplementation on serum albumin levels, with no statistical difference between zinc and placebo groups.ConclusionsClinical trials assessing zinc supplementation in liver diseases do not show benefits in terms of clinical improvement or disease halting. There are possible benefits of zinc supplementation on hepatic encephalopathy, however, this is based on limited evidence. This research question is still open for evaluation in larger, well-designed, clinical trials.     

他汀类药物对肝功能影响的研究

目的观察他汀类药物对肝功能的影响,探讨定期检测肝功能的必要性。方法选择2004年9月至2005年3月门诊就诊心血管病患者,了解其所用他汀类药物的种类和剂量,每月复查血脂水平和肝功能。结果所用他汀类药物有辛伐他汀、普伐他汀、洛伐他汀和阿托伐他汀,常用剂量为10～20mg/d,治疗后总胆固醇和低密度脂蛋白胆固醇显著降低,而肝酶在治疗前、后无显著变化,肝酶升高3倍以上者所占比例低。结论他汀类药物在低剂量应用时对肝脏损伤小,没有必要频繁监测肝功能。     

盐酸氟西汀对抑郁症模型小鼠神经肽Y表达的研究

目的 探讨盐酸氟西汀对慢性应激抑郁症模型小鼠下丘脑神经肽Y（NPY）的表达影响。方法 采用旷场试验（Open-Field）法，比较抑郁症模型小鼠与正常对照组行为学改变方面的差异。将慢性应激抑郁症小鼠模型随机分成盐酸氟西汀和阿米替林治疗组、模型对照组，同时设立空白对照组，利用半定量逆转录．聚合酶联反应（RT-PCR）法、细胞酶联免疫法和蛋白免疫印迹（Western-blot）技术，比较试验组小鼠下丘脑NPY的表达变化。结果 （1）与正常组比较，模型组在总路程缩短、活动斑数减少和体重增加幅度下降等方面具有显著性差异。（2）与正常组比较，抑郁症模型组下丘脑NPY的mRNA表迭下降。（3）经过3周的治疗，盐酸氟西汀组和阿米替林组小鼠下丘脑NPY的mRNA及蛋白表达没有明显差别，但是两组的表达结果显著高于模型对照组，与空白对照组的结果接近。结论 脑内NPY的mRNA及蛋白的表达增加可能是盐酸氟西汀治疗抑郁症小鼠的机制之一。     

Faut-il être adventiste du 7 Jour pour être en bonne santé ?

Many health-related research studies among Seventh-day Adventists (SDA) were published since 1958. Californian and Norwegian studies have shown that SDA have lower coronary mortality rates than the general population. This finding is usually attributed to the lifestyle advocated by the Seventh-day Adventist church with greater physical activity, lower median BMI, abstention from use of alcohol and tobacco, food habits characterized by a large intake of fruits, vegetables, cereal fiber, unsaturated fatty acids and a low consumption of saturated fats. The results about cancer incidence were discussed. Californian studies have shown significantly decreased relative risk in SDA than in the general population. Japanese studies have also reported lower risk of cancers in men with lifestyles similar to those of SDA. By contrast the Norwegian study of SDA has shown that the risk of cancer seems to be similar to that of the general population. Some studies reported a greater prevalence of type 2 diabetes in the non vegetarian SDA than the vegetarian. Compared with vegetarian, non vegetarian SDA reported more medication use, more chronic diseases, more hospitalizations and surgeries. Lifestyle choices of SDA as above described could prevent a great many coronary artery disease and type 2 diabetes. This lifestyle is now emphasized by French PNNS.     

卒中后抑郁患者的交感神经皮肤反应与事件相关电位对照研究

目的探讨交感神经皮肤反应(SSR)与事件相关电位(ERP)对卒中后抑郁患者的诊断价值。方法对55例卒中后抑郁患者和52例正常健康者分别进行了SSR和ERP测定,并将结果加以比较。结果卒中后抑郁组中SSR和ERP测定中的P300成分异常率分别为87.3%(48/55)和83.6%(46/55),两者异常吻合率为76.4%(42/55)。卒中后抑郁组SSR测定结果中,SSR潜伏期和波幅值较对照组延长和降低,其差异具有显著性(P<0.01),ERP测定中N2、P3波潜伏期和P3波幅较对照组分别延长和降低,存在显著性差异(P<0.01)。其中N2、P3波潜伏期与SSR测定中潜伏期以及波幅与波幅之间呈正相关(r=0.29~0.36,P<0.01),而两者潜伏期与波幅之间呈负相关(r=-0.32~-0.33,P<0.01)。结论交感神经皮肤反应和事件相关电位测定可作为卒中后抑郁患者的诊断指标应用于临床。