中国三明市医改下药品费用影响因素分析

目的：探讨三明市医药卫生体制改革期间药品费用变化情况,并分析药品价格、药品用量和用药结构对药品费用变化的影响,以期为今后药品费用改革决策提供视角和参考。方法：收集三明市1家医院（实验组）和福建其他地区18家医院（对照组）在2011-2016年期间的药品采购数据,采用"A.M"指数体系进行因素分析。结果：自2011年起实验组药品总费用保持平稳,年均增长率为1.4%,对照组涨速较快,年均增长率为6.4%;实验组和对照组价格因素及用量因素变化趋势一致、变化速度相近;在结构因素方面,实验组保持平稳,对照组涨速较快。结论：三明市医改明显降低了药品价格并抑制了"同类别药品高价药替代低价药"的趋势,控制结构因素是抑制药品费用上涨的有效手段。     

放射性同位素示踪技术在药物研发过程中的应用

药物的吸收、分布、代谢和排泄过程决定了药物分子在体内的过程和命运。作为常规生物样本检测技术的有效补充,放射性同位素标记示踪技术如今也被广泛应用于药物发现和开发过程中的各个阶段。特别是其高灵敏性、适用范围广的特点使其具有不可比拟的优势。通过对近年来放射性标记技术在药物评价领域中的应用进行了归纳和梳理,为药物研发相关领域研究人员提供可借鉴的参考。     

Five-year evaluation of implants placed at extraction and with dehiscences and fenestration defects augmented with ePTFE membranes: results from a prospective multicenter study

Background: Barrier membranes have been used to promote bone ingrowth on implants with dehiscences and fenestrations. Membranes also have been used to protect defects adjacent to implants placed at the time of extraction. The concept of guided bone regeneration relates to preferentially allowing cells from bone to migrate into various defects while excluding fibrous tissue and epithelium. The purpose of these procedures is to enhance bone-to-implant contact at the treated sites and to prevent mucosal complications. Purpose: The purpose of this article is to report clinical outcomes for implants placed at the time of extraction and augmented with expanded polytetrafluoroethylene (ePTFE) and followed for 5 years. The outcomes for implants with dehiscences and fenestrations augmented with ePTFE barriers and followed up to 5 years also are reported. Methods and Materials: Four treatment centers participated in this study (Tucson, Gothenburg, Spokane, and Leuven). In the extraction group, teeth were removed for varying reasons, and Brånemark implants were placed and stabilized within the host bone. Defects present at the coronal implant aspect were covered with ePTFE barrier membranes. Flaps were rotated to cover the membrane-treated sites. If exposure of the material occurred prior to second-stage surgery, the membranes were removed. Barriers remaining unexposed were removed at second-stage surgery. The implants were followed up to 5 years. In the fenestration and dehiscence group, implants with exposed threads were augmented with ePTFE barrier membranes. The barriers were removed at appropriate intervals, and the patients were followed up to 5 years. Radiographic measurements were made from nonstandardized periapical radiographs at abutment connection and 1, 3, and 5-year follow-up visits. Results: Forty patients participated in the extraction group. They received a total of 49 implants. Three implants failed prior to loading. The 5-year cumulative survival rates for implants placed at the time of extraction were 93.9% and 93.8%, respectively, for maxillary and mandibular implants. The average maxillary mesial and distal marginal bone loss (1–5 yr) was 0.3 mm (standard deviation [SD] = 1.5) and 0.3 mm (SD = 1.0). In mandibles, the average mesial and distal bone loss (1–5 yr) was -0.2 mm (SD = 0.5) and -0.05 mm (SD = 0.6), respectively. The dehiscence and fenestration group included 44 patients. Twenty-six were followed for up to 5 years. Eight patients experienced total implant failure. For dehiscences and fenestrations, the cumulative survival rates were 76.8% and 83.8% for maxillary and mandibular implants, respectively. The average maxillary mesial and distal bone loss (1–5 yr) was 0.4 mm (SD = 0.8) and 0.2 mm (SD = 0.9), respectively. In mandibles, the average mesial and distal marginal bone loss was 0.3 mm (SD = 0.9) and 0.3 mm (SD = 0.8), respectively. Conclusions: Implants placed at the time of extraction and augmented with ePTFE barrier membranes have favorable long-term predictability. On the other hand, long-term evaluation of implant dehiscences and fenestrations augmented with barrier membranes indicates that they have less favorable 5-year survival rates. Membrane augmentation of these may be questioned.     

基于脑-机接口的针刺手法量学规范化研究

基于脑-机接口技术分析针刺治疗中相关刺激量和效应评价等相关问题,对针刺手法量学规范化研究作初步论述。提出基于脑-机接口的针刺手法量学研究特点包括数据量巨大、数据流稳健、客观量化和自由度分析高等。认为针灸临床视角下的脑-机接口数据获取重点包括了神经元网络整体联结性,特定脑区活动,针刺干预中机体耐受/痛阈波动,皮质不同板层神经元动力学改变等4方面。以针灸干预中风后康复的疗效评价为例,说明基于脑-机接口的针刺手法量学规范化的研究特点和潜在优势。      

高龄女性累积胚胎后移植与非累积胚胎移植的妊娠结局分析

目的 比较40岁以上高龄女性累积胚胎后移植与非累积胚胎进行移植的妊娠结局。方法选择40岁以上且使用自身卵子进行冻融胚胎移植助孕229例不孕症妇女共338个周期资料,根据患者是否累积胚胎移植分为两组分析妊娠结局。 结果40~49岁女性随着年龄增高,基础卵泡刺激素水平升高（P<0.05）,获卵数减少（P<0.05）,临床妊娠率和持续妊娠率下降（P<0.05）。在40岁妇女中,累积胚胎移植组的临床妊娠率和持续妊娠率均高于非累积胚胎移植组（42.9% vs. 24.6%,P<0.05）,对于41岁、42岁、≥43岁,两组的临床妊娠率、持续妊娠率及早期流产率差异均无统计学意义（P＞0.05）。结论对于40岁不孕妇女,多次取卵累积胚胎后移植有助于提高临床妊娠率,对41岁以上女性累积胚胎对于助孕结局的益处有限。     

Self-reported sleep patterns in a British population cohort

ObjectivesSleep patterns have been linked to various health outcomes, but sleep patterns in the British population have not been extensively reported. We aimed to describe the sleep characteristics reported by the European Prospective Investigation of Cancer (EPIC)-Norfolk participants, with a particular emphasis on the comparison of measures of sleep quantity.MethodsFrom 2006 to 2007, a total of 8480 participants aged 45–90 years reported sleep timing, nighttime sleep duration, and sleep difficulties. Time in bed (TIB) was calculated from the difference between rise time and bedtime, and sleep proportion was defined as the ratio of sleep duration and TIB.ResultsOn average, the reported TIB was more than 1.5 h longer than sleep durations. Compared to men, women spent 15 min longer in bed, but they slept for 11 min less and reported more sleep difficulties. In multivariate analysis sleep duration and TIB varied with socioeconomic factors, but sleep proportion was consistently lower among women, nonworkers, and older individuals, as well as those who were widowed, separated, or divorced; those who reported sleep difficulties and more frequently used sleep medication; and those who had lower education, poorer general health, or a major depressive disorder (MDD).ConclusionsSelf-reported sleep duration and TIB have different meanings and implications for health. Sleep proportion may be a useful indicator of sleep patterns in the general population.     

基于UPLC特征图谱和Q-Marker量值传递评价经典名方半夏白术天麻汤颗粒剂的关键生产工艺

目的 基于特征图谱相关性和质量标志物（quality markers,Q-Marker）转移率评价半夏白术天麻汤（Banxia Baizhu Tianma Decoction,BBTD）颗粒剂的生产环节,明确关键控制点。方法 采用Acclaim^TM RSLC Lot Validation-120 C₁₈色谱柱（100 mm×2.1 mm,2.2 μm）进行分离,流动相为乙腈-水溶液,梯度洗脱,体积流量0.3 mL/min,检测波长235 nm,柱温30℃。以BBTD基准样品为参比,建立3批中试样品的UPLC指纹图谱,并进行相似度评价,分析Q-Marker在各生产环节的损失,评价生产工艺的合理性。结果 与BBTD基准样品相比,提取液、浓缩液、干膏粉、颗粒剂中均存在对应特征峰,以10种指标性成分及其总量表征的3批BBTD中试样品关键质量属性与其基准样品基本保持一致。结论 基于特征图谱和Q-Marker在各环节之间的量值传递,为经典名方BBTD制备工艺评价和质量控制提供了的理论依据。     

基于LF-NMR/MRI的维C银翘片制粒中润湿剂评价方法研究

目的应用低场核磁共振时域技术(low field nuclear magnetic resonance time domain technique,LF-NMR)、低场核磁成像技术(low field nuclear magnetic resonance imaging,LF-MRI)对高剪切制粒中润湿剂(乙醇)进行定性、定量分析。方法以维C银翘片高剪切湿法制粒为研究对象,采用LF-NMR建立润湿剂用量测定方法,结合横向弛豫时间(T2)和LFMRI测得的二位影像图对润湿剂分布与变化进行定性分析,探讨峰面积(A₂)与颗粒得率的关系。结果润湿剂用量与A₂呈现良好的相关性(R²=0.9575)。随着润湿剂用量增加,T2向右移动,A₂逐渐增加,质子在增加;LF-MRI表明随着润湿剂用量增加,影像图逐渐清晰,即非结合态质子(束缚态质子及自由态质子)在颗粒中逐渐增加。当润湿剂用量增加至20%~25%时,结合态质子含量不再增加,此时颗粒得率最高。结论LF-NMR和LF-MRI能快速、准确检测制粒中润湿剂用量变化和分布状态,为阐明润湿剂对颗粒性质的影响和成型机制提供评价方法。     

载药量对后交联祖师麻凝胶贴膏剂流变学及体外经皮渗透特性的影响

目的通过载药量对后交联凝胶贴膏流变学及体外经皮渗透特性的影响,考察后交联凝胶贴膏基质的载药量。方法采用流变学技术测定不同载药量时胶料的各项流变学参数,并以祖师麻乙醇提取物为模型药物,以祖师麻甲素的累积透过率及皮肤滞留率为指标,对成品贴膏进行体外经皮渗透试验,确定基质载药量。结果当载药量在4.0%～12.4%时,含药胶料的结构强度、黏弹性、耐温耐剪切性及抗变形能力、稳定性均符合要求,其中以载药量为6.8%时最佳;祖师麻甲素的累积透过率随载药量逐渐增大,皮肤滞留率分别变化不明显。结论通过比较流变学及体外经皮渗透试验结果,确定基质处方的最佳载药量为6.8%。