PGD9 Outcomes and Cost-Benefit of Inhaled Corticosteroid Therapy Introduction in Medicaid-Enrolled Asthmatic Children

OBJECTIVE: The purpose of this study was to assess the clinical and economic impact of the introduction of inhaled corticosteroid therapy for asthma in a cohort of children 12 years and younger who were North Carolina Medicaid enrollees.
METHODS: The North Carolina Medicaid claims database was used to retrieve clinical and economic variables for the purpose of this study. The case group, which was comprised of 84 children who started corticosteroid inhaler therapy between March 1994 and March 1995, was followed up for 1 year before and 1 year after the start of the therapy. The control group was comprised of 72 children with similar severity of asthma who remained on any other therapy other than corticosteroids for a continuous 2-year period. Paired t-tests were used to compare differences, and multiple regression analysis was used to adjust for potential confounders.
RESULTS: There was a 58% reduction in hospital visits, and a 19% reduction in physician visits in the case group after initiation of inhaled corticosteroids. In the control group, an increase of 34% in the number of outpatient visits occurred in the second year. All the decreases and increases were statistically significant. Children with regular patterns of inhaled corticosteroid refills were found to be significantly lower costing for Medicaid. However, after adjusting for potential confounders, no significant change in health care costs per asthmatic child occurred as a result of the introduction of inhaled corticosteroid therapy.
CONCLUSION: Overall, the study found that introduction of inhaled corticosteroids in a cohort of asthmatic children enrolled in Medicaid was beneficial to Medicaid because it brought about dramatic decreases in health care utilization without additionally increasing costs.     

Mortality and failure among tuberculosis patients who did not complete treatment in Vietnam: a cohort study

Background  

Tuberculosis treatment failure and death rates are low in the Western Pacific Region, including Vietnam. However, failure or death may also occur among patients who did not complete treatment, i.e. reported as default or transfer-out. We aimed to assess the proportion failures and deaths among new smear-positive pulmonary tuberculosis patients with reported default or transfer-out.     

苄基四氢巴马汀对表达于非洲爪蟾卵母细胞及中华大蟾蜍卵母细胞的延迟整流钾电流的抑制作用

苄基四氢巴马汀对表达于非洲爪蟾卵母细胞及中华大蟾蜍卵母细胞的延迟整流钾电流的抑制作用童秋生，夏国瑾，姚伟星，江明性，白小川，包永德（同济医科大学基础医学院药理学教研室，武汉４３００３０；中国科学院上海生理学研究所，上海２０００３１）苄基四氢巴马汀（ｂ...     

Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men

BACKGROUND: Nutrients with antioxidant properties or that influence cell growth and differentiation might reduce the risk of benign prostatic hyperplasia (BPH). OBJECTIVE: The objective was to evaluate the association of fruit, vegetable, and micronutrient intakes with BPH. DESIGN: The participants were members of the Health Professionals Follow-Up Study and were aged 46-81 y in 1992. In 1992 and biennially thereafter, the men reported having surgery for an enlarged prostate, and in 1992 and on 3 subsequent questionnaires they completed the American Urological Association symptom index (AUASI). BPH cases were men who reported having surgery or who had an AUASI score of 15-35 (n = 6092). Control subjects were men who had not had surgery and never had an AUASI score >7 (n = 18 373). Men with a score of 8-14 were excluded (n = 7800). Intakes of fruit, vegetables, and antioxidants were assessed with a food-frequency questionnaire in 1986. We calculated odds ratios (ORs) of BPH and 95% CIs using logistic regression. RESULTS: Vegetable consumption was inversely associated with BPH (fifth compared with first quintile-OR: 0.89; 95% CI: 0.80, 0.99; P for trend = 0.03), whereas fruit intake was not. Consumption of fruit and vegetables rich in beta-carotene (P for trend = 0.004), lutein (P for trend = 0.0004), or vitamin C (P for trend = 0.05) was inversely related to BPH. With increasing vitamin C intake from foods, men were less likely to have BPH (P for trend = 0.0009). Neither alpha- nor gamma-tocopherol intake from foods was associated with BPH (P for trend = 0.05 and 0.84, respectively). CONCLUSION: Our findings are consistent with the hypothesis that a diet rich in vegetables may reduce the occurrence of BPH.     

Sexually transmitted infections, prostatitis, ejaculation frequency, and the odds of lower urinary tract symptoms

Early life sexual factors, including histories of sexually transmitted infections, young-onset prostatitis, and frequency of ejaculation, were investigated in relation to lower urinary tract symptoms (LUTS) in a large case-control study nested within the Health Professionals Follow-up Study. In 1992, study participants were asked to provide information on their histories of sexually transmitted infections, prostatitis, ejaculation frequency, surgery for an enlarged prostate, and LUTS. Information on prostate surgery and LUTS was updated every 2 years. LUTS cases were defined as men who reported surgery for an enlarged prostate or high-moderate to severe LUTS (> or = 15 points on the American Urological Association symptom index) on any study questionnaires (n = 4,608). Controls were men who did not report surgery for an enlarged prostate and who scored 0-7 points on the American Urological Association symptom index on all questionnaires (n = 17,967). History of gonorrhea (adjusted odds ratio = 1.76, 95% confidence interval: 1.43, 2.15) or young-onset prostatitis (adjusted OR = 1.55, 95% confidence interval: 1.22, 1.96) was positively associated with LUTS. No association was observed between ejaculation frequency in early adulthood and LUTS. These results suggest that early genitourinary infections may contribute to later development of LUTS, although confirmation in additional population settings is warranted.     

A long-term prospective study of optic neuritis: evaluation of risk factors

Eighty-six patients with monosymptomatic optic neuritis of unknown cause were followed prospectively for a median period of 12.9 years. At onset, cerebrospinal fluid (CSF) pleocytosis was present in 46 patients (53%) but oligoclonal immunoglobulin in only 40 (47%) of the patients. The human leukocyte antigen (HLA)-DR2 was present in 45 (52%). Clinically definite multiple sclerosis (MS) was established in 33 patients. Actuarial analysis showed that the cumulative probability of developing MS within 15 years was 45%. Three risk factors were identified: low age and abnormal CSF at onset, and early recurrence of optic neuritis. Female gender, onset in the winter season, and the presence of HLA-DR2 antigen increased the risk for MS, but not significantly. Magnetic resonance imaging detected bilateral discrete white matter lesions, similar to those in MS, in 11 of 25 patients, 7 to 18 years after the isolated attack of optic neuritis. Nine were among the 13 with abnormal CSF and only 2 belonged to the group of 12 with normal CSF (p = 0.01). Normal CSF at the onset of optic neuritis conferred better prognosis but did not preclude the development of MS.     

Changes in tibial bone mass after primary cementless and revision cementless total hip arthroplasty in canine models

The purpose of this study was to examine right-left differences in tibial bone mass after unilateral (left) cementless total hip arthroplasty (THA). Of 39 dogs with THAs, 9 had primary cementless porous-coated femoral stems for 6 months and 15 had similar stems for 2 years. Five dogs had aseptically failed cemented hips, and 10 had aseptically failed cemented hips that were revised with cementless porous-coated femoral stems (5 without bone graft and 5 with autogenous bone graft). These animals were sacrificed 6 months after the revision surgery. The primary cementless dogs showed no right-left difference in tibial bone mineral content (BMC) or cortical bone cross-sectional geometry after 6 months, but after 2 years there was a distal right-left difference in BMC of 6% caused by expansion of the medullary canal in the tibia of the operated limb. Tibial BMC was more than 20% lower in the operated limb of the failed cemented dogs, approximately 15% lower in the nongrafted group, and 7% lower in the grafted group. The right-left tibial difference in BMC in the 2-year primary cementless group is most probably because of subclinical disuse of the operated limb. Among the dogs with failed cemented stems, the lower right-left difference in the two revised groups compared with the non-revised group suggests that improved limb function after cementless revision THA may cause gain of previously lost bone.     

Transient synovitis of the hip in children: role of US

Transient synovitis of the hip remains a common diagnostic problem for the clinician. The physical signs are not pathognomonic of the condition, and the classic technical examinations are of little help. Therefore, the authors retrospectively studied the value of hip arthrosonography in 46 children with clinical symptoms suggesting pathologic hip conditions. In 20 of the 21 patients with a final diagnosis of transient synovitis, articular effusion was detected on ultrasound (US). Conventional radiography showed an increased medial joint space in only eight of these patients. Increased echogenicity of the articular fluid was found in both transient synovitis and septic arthritis. The high sensitivity of US in detecting intraarticular fluid was demonstrated by cadaver studies.     

Cellulose Carbamates and Derivatives as Hemocompatible Membrane Materials for Hemodialysis

Dialysis membranes made from regenerated cellulose are under dispute because of their alleged lack of hemocompatibility. The introduction of membranes from synthetically modified cellulose, like cellulose acetate or Hemophan, has proven, however, that hemocompatible membranes can be fabricated from cellulose by means of chemical surface modifications. In addition to membranes made from modified cellulose like ethers or esters, which were investigated in earlier experiments, we looked for further cellulose modifications to be assessed for their hemocompatibility. For this purpose, we synthesized a series of cellulose carbamate derivatives to profit from the excellent hemocompatibility pattern of the urethane family. In vitro investigations on membranes made from these cellulose modifications proved a direct relationship between the degree of modification and hemocompatibility. This was proven for the following 3 representative hemocompatibility parameters: complement C5a generation, thrombin-antithrombin (TAT) III formation, and platelet count (PC). As already shown for modifications made from cellulose esters, a direct dependency between improved hemocompatibility and the degree of substitution (DS) in the cellulose molecule could be found. In our experiments, a degree of substitution below a value of 0.1 led to a nearly complete suppression of complement activation for all cellulose carbamates under investigation. In contrast to data on cellulose esters, we observed that molecular weight or molecular conformation of chemical substituents exerted only a minor effect on the hemocompatibility pattern. In addition, data on cellulose carbamate esters (e.g., cellulose succinate-phenyl-carbamate) show that a simultaneous but balanced substitution with hydrophilic and hydrophobic groups at the surface of the cellulose polymer is a further prerequisite for optimal hemocompatibility. It seems that the carbamate configuration per se has a positive effect on the hemocompatibility pattern of synthetically modified cellulose membranes.