A cost-effectiveness analysis of the use of a mechanical barrier system to reduce the risk of mistransfusion

BACKGROUND: A blood component is transfused to a patient other than the intended recipient because of patient and sample identification problems once in about every 24,000 transfusions. An investigation was performed of the cost-effectiveness of a barrier system to prevent mistransfusion of a unit of red cells through this kind of error. STUDY DESIGN AND METHODS: A decision analysis model was constructed that took into account nonfatal and fatal events, costs of patient care, and legal costs. The model was used to determine the cost-effectiveness of the barrier system in terms of cost per year of life saved and lives saved per million transfusions. RESULTS: The barrier system is predicted to save 1.5 lives per million transfusions when used as intended. If the cost-effectiveness calculations are based on an average damage award for a fatality of more than $725,000 and a chance of mistransfusion exceeding 1 in 16,700, use of the system results in reduced healthcare expenditures. If no legal costs are included in the cost-effectiveness calculations, use of the system costs $197,000 per year of life saved. Routine use of the system extends patient life by 1 year per 60,000 units transfused. CONCLUSION: The application of a barrier system to prevent mistransfusion and related morbidity and mortality can be cost-effective. If legal costs are included in the calculations, the use of a barrier system reduces total costs.     

组织工程化仿生人工骨修复兔桡骨节段性骨缺损

目的:观察自体骨髓基质细胞复合多孔仿生人工骨后修复节段性骨缺损的效果。方法:实验于2002-01/2003-05在解放军第四军医大学西京医院全军骨科研究所完成。①抽取成年家兔骨髓并分离、培养和诱导骨髓基质细胞。②采用纳米晶羟基磷灰石-胶原中羟基磷灰石和胶原的比例为4∶1,仿生材料中纳米晶羟基磷灰石和聚左旋乳酸的比例为1∶1;孔隙率>90%,孔径50～300μm;规格15mm×3mm×3mm材料。使用前分别经乙醇、无菌双蒸水和离心等处理。将第3代骨髓基质细胞按3×1010L-1接种于上述材料中常规培养。体外构建骨髓基质细胞和仿生基质材料复合体。③手术造成兔右桡骨干15mm骨缺损动物模型,随机分为实验组14只、对照组14只和空白组6只,实验组植入自体骨髓基质细胞/仿生材料复合体,对照组仅植入仿生材料,空白组不作任何处理。通过X射线、骨密度、组织学以及计算机图象分析等手段观察各组在不同时相的骨缺损修复情况。结果:34只兔全部进入结果分析。①骨髓基质细胞和多孔纳米晶羟基磷灰石-胶原/聚左旋乳酸材料体外复合培养结果:7d后细胞基本汇合成片,细胞表面和周围出现较多网状胶原纤维。②各组兔骨缺损区X射线检查:实验组术后24周骨缺损区密度较高,与截骨端骨性融合,接近形成正常骨干结构;对照组术后24周可见少量骨痂自截骨端向材料内长入,但未见材料表面连续性骨痂形成。空白组术后24周两截骨端硬化封闭,形成骨不连。③骨密度测定:术后16周、24周实验组骨缺损区骨密度明显高于对照组(16周:(0.152±0.041),(0.092±0.029)g/cm2,24周:(0.177±0.044),(0.113±0.026)g/cm2,t=2.67,2.80,P<0.05),而与对侧正常桡骨无明显差异。④组织学观察:实验组术后24周植入材料大部分降解并为新生骨替代,新生骨和两端皮质骨融为一体;对照组术后24周材料部分降解成颗粒状,缺损区中央为纤维组织充填,仅两端有部分新生骨组织;空白组术后24周断端封闭形成骨不连。⑤计算机图象分析:8,16,24周,实验组修复性新骨占原骨缺损面积百分数随着观察时间的延长而增加,并显著高于同一时间点对照组(t=8.971,11.240,12.836,P<0.01)。结论:①通过微创方式获取大量成骨性骨髓基质细胞,并将其与多孔纳米晶羟基磷灰石-胶原/聚左旋乳酸材料复合培养后植入骨缺损区,可以发挥多重成骨效应,从而较快地启动骨修复反应。②采用组织工程学技术修复节段性骨缺损是一条切实有效的治疗手段,有较广泛的临床应用前景。     

胶体磷酸铬^32P关节腔内注射改善佐剂型关节炎大鼠的相关指标

目的:观察胶体磷酸铬32P关节腔内注射治疗大鼠佐剂型关节炎的效果。方法:实验于2006-07/09在南京市第一医院动物实验室完成。选择6～8周龄清洁级SD雌性大鼠30只,按随机数字表法分为3组,正常对照组、模型组、胶体磷酸铬32P治疗组,每组10只。大鼠左足跖皮内注射完全弗氏佐剂0.1mL免疫法制备佐剂型关节炎模型。胶体磷酸铬32P治疗组于造模后10d左踝关节腔内注射37GBq/L胶体磷酸铬32P0.02mL,即0.74MBq,正常对照组和模型组分别给予等量生理盐水左踝关节腔内注射。①每2周观察1次大鼠左踝关节左右径宽度。②关节炎指数评定采用关节炎评分法(0～4分),分数越高,症状越重。③于用药后2,4,6周采用99Tcm-MDP显像感兴趣区分析法计算大鼠左踝关节区和右胫腓骨的放射性计数比。④于用药后4,6周测定血清肿瘤坏死因子和白细胞介素1β水平。⑤于用药后4,6周观察大鼠滑膜组织和软骨组织病理学改变。结果:纳入大鼠30只,均进入结果分析。①用药后2周模型组大鼠左踝关节左右径宽度大于正常对照组[分别为(7.82±0.36),(5.89±0.35)mm],差异有显著性意义(t=12.16,P<0.001),胶体磷酸铬32P治疗组大鼠左踝关节左右径宽度大于模型组,差异无显著性意义(P>0.05)。用药后6周胶体磷酸铬32P治疗组大鼠左踝关节左右径宽度小于模型组[分别为(6.87±0.27),(7.25±0.26)mm],差异有显著性意义(t=2.87,P<0.05)。②用药后2周和4周胶体磷酸铬32P治疗组大鼠关节炎指数高于模型组,用药后6周胶体磷酸铬32P治疗组大鼠关节炎指数低于模型组,两组间差异均无显著性意义(P>0.05)。③用药后2周模型组大鼠感兴趣区放射性计数比高于正常对照组(分别为2.05±0.20,1.46±0.15),差异有显著性意义(t=7.46,P<0.001)。用药后6周胶体磷酸铬32P治疗组大鼠感兴趣区放射性计数比低于模型组(分别为1.52±0.18,1.78±0.24),差异有显著性意义(t=2.45,P<0.05)。④用药后4,6周模型组大鼠血清肿瘤坏死因子和白细胞介素1β水平高于正常对照组,差异有显著性意义[用药后4周分别为(2.039±0.344),(1.115±0.192)μg/L;(0.305±0.034),(0.192±0.041)μg/L,t=7.42,6.71,P<0.001。用药后6周分别为(1.694±0.305),(1.126±0.256)μg/L;(0.259±0.027),(0.191±0.019)μg/L,t=4.03,5.83,P<0.01,0.001]。用药后4,6周胶体磷酸铬32P治疗组在血清肿瘤坏死因子和白细胞介素1β水平与模型组比较,差异无显著性意义(P>0.05)。⑤用药后4周胶体磷酸铬32P治疗组和模型组滑膜组织增生和炎症细胞浸润均较明显;用药后6周胶体磷酸铬32P治疗组与正常对照组比较仍有滑膜组织增生和炎症细胞浸润,与模型组比较滑膜组织增生程度明显减轻,而炎症细胞浸润程度稍轻。用药后6周胶体磷酸铬32P治疗组大鼠左踝关节的软骨组织未见有异常改变。结论:胶体磷酸铬32P关节腔注射可减轻完全弗氏佐剂免疫大鼠受注射关节的滑膜增生程度,改善关节肿胀症状,疗效肯定。     

脂联素水平与运动及机体肥胖的相关性

学术背景:脂联素在健康机体血浆中含量丰富,但在冠心病、肥胖、2型糖尿病及原发性高血压等疾病中,脂联素水平下降,且其下降程度与病情严重程度呈正相关.目的:分析近年来有关运动对肥胖与2型糖尿病患者机体脂联素水平的影响.检索策略:应用计算机检索PubMed数据库1995-01/2006-12有关脂联素与运动的文献.检索词“adiponectin,exercise“,限定文章语言种类为English.同时计算机检索中文数据库CNKI 1995-01/2006-12有关脂联素与运动的文献,检索词“脂联素,运动“,限定文章语言种类为中文.共收集到51篇相关文献.对资料进行初审,选取所有运动与脂联素水平相关的文献,并查找原文.纳入标准:重点选择有关探讨运动对肥胖及2型糖尿病患者脂联素影响的文献.排除标准:重复研究.文献评价:排除19篇因研究目的与本研究无关的文献,最终纳入符合标准的文献32篇.资料综合:脂联素是脂肪细胞特异分泌的一种激素蛋白,具有调节能量平衡、增强胰岛素敏感性、抗动脉粥样硬化及抗炎等广泛的生物学作用,是肥胖与糖尿病患者体内第一个下调的脂肪因子,与胰岛素抵抗的发生发展密切相关.运动作为一种对机体有益的刺激因子能否影响肥胖及糖尿病患者体内脂联素水平,或通过刺激内源性脂联素增加从而改善患者体内胰岛素抵抗,是近年来研究运动与脂联素的热点之一.文章在介绍脂联素生物学概况的基础上,对近年来有关运动对肥胖及糖尿病患者脂联素水平影响的研究进行了评述.结论:由于脂联素所具有的机体保护作用,近年来有关运动对肥胖及糖尿病患者脂联素水平影响的研究结果不够一致,仍需进一步的深入研究,尤其需要从机制方面进行探讨.     

Predictors of outcome in Cryptococcus neoformans var. gattii meningitis

In Papua New Guinea, <it>Cryptococcus neoformans</it> var. <it>gattii</it> meningitis has a high fatality rate even in immunocompetent patients. Our retrospective study attempted to identify marker of poor prognosis. Of 88 immunocompetent patients, 30 (34.1%) died, usually soon after admission, and mortality was higher in men (<it>p</it> = 0.025) and older patients (<it>p</it> = 0.039). Death was associated with altered consciousness (<it>p</it>&lt;0.001), a history of convulsions prior to treatment (<it>p</it> = 0.002) and a maximum systolic blood pressure of &gt;150 mmHg (<it>p</it> = 0.017). These data suggest that death results from raised intracranial pressure and subsequent tentorial herniation. However, CSF opening pressure measured on admission was raised in 29/36 (81%) patients and did not predict outcome. In survivors, relapse was uncommon and was not predicted by discharge serum cryptococcal antigen titres, which were frequently raised on completion of therapy in asymptomatic patients. Mortality may be reduced if efforts are made to lower intracranial pressure in those patients who present with markers of poor prognosis.      

Pharmacokinetics of perindopril and its metabolites in healthy volunteers

Perindopril, an angiotensin converting enzyme (ACE) inhibitor, is converted in vivo to its active diacid metabolite, perindoprilat and to a perindoprilat glucuronide. The pharmacokinetic parameters of perindopril, perindoprilat and perindoprilat glucuronide were evaluated after single administration to healthy volunteers (N = 12) of 8 mg of perindopril tert-butylamine salt by oral route (treatment A), by intravenous route (bolus in 5 min, treatment B) and of an equimolar dose of perindoprilat (6.1 mg) by intravenous route (infusion over 2 h, treatment C). The treatments were administered as a randomised 3-way cross-over design. Plasma samples were collected up to 96 h and urines up to 120 h. Perindopril is rapidly absorbed with an oral bioavailability of 95% and is mainly eliminated by metabolic processes. The formation of perindoprilat is slow and about 20% of the available parent drug is transformed into this metabolite. Elimination profile of perindoprilat is biphasic, with a rapid renal excretion of the free fraction and a long terminal half-life of the fraction bound to ACE. Perindoprilat glucuronide is mainly obtained from perindopril by a pre-systemic first pass metabolism.     

应用3.0T MRI评价缺血性脑血管病与鼻窦炎性病变的关系

目的:应用3.0TMRI从影像学角度探讨缺血性脑血管病与鼻旁窦炎性病变的关系及鼻旁窦炎性病变的MRI表现。方法:①分组及检测:2006-10/2007-08河北医科大学第二医院收治经临床及影像学证实为缺血性脑血管病患者218例为病例组,健康体检者218例为对照组,应用美国GE公司Signa Excite HD 3.0T高场强MR扫描仪常规行MRI及MRA检查。②评估指标:MRI图像观察以轴位T2-FSE、轴位T1-FLAIR序列为主,辅以轴位T2-FLAIR、矢状位T1-FLAIR序列,观察并记录脑实质MRI表现、鼻旁窦有无炎性病变。MRA图像观察以MIP重组后图像为主,辅以MRA源图像,观察并记录颅内血管异常情况。主要观察指标包括额窦、筛窦、蝶窦、上颌窦受累情况,各窦病变类型(黏膜增厚、炎性积液、黏膜下囊肿)及相应的MRI表现。结果:①病例组所有患者前循环及后循环系统血管均存在不同程度的动脉粥样硬化改变,143例患者脑实质出现缺血性病变;对照组脑实质及脑血管均未见异常改变。②病例组鼻旁窦有病变者123人次(56.4%),上颌窦病变96例,筛窦病变58例,蝶窦病变30例,额窦病变15例;对照组鼻旁窦有病变者54人次(24.8%),上颌窦病变8例,筛窦病变34例,蝶窦病变2例,额窦病变4例。病例组鼻旁窦炎性病变明显较对照组多(χ2=45.281,P=0.000)。相关系数C=0.91。结论:缺血性脑血管病患者鼻旁窦炎性病变发病率高,缺血性脑血管病与鼻旁窦炎性病变间有一定的相关性。     

Th1型细胞因子干扰素γ及Th2型细胞因子白细胞介素10水平在慢性心力衰竭患者接受己酮可可碱干预过程中的变化：随机对照

目的:观察己酮可可碱治疗心力衰竭患者后Th1型细胞因子干扰素γ及Th2型细胞因子白细胞介素10水平的变化,评价己酮可可碱对慢性心力衰竭患者免疫异常调节作用。方法:选择2005-09/2006-04华中科技大学同济医学院附属协和医院心内科收治的心力衰竭患者38例。①实验分组:随机分为常规治疗组20例,常规治疗包括利尿剂,洋地黄类药物,血管紧张素转换酶抑制剂,β-受体阻滞剂等。己酮可可碱治疗组18例,在常规治疗的基础上加用己酮可可碱400mg,3次/d,饭时口服。两组治疗时间为1周,且均禁用免疫抑制剂。另选取10例健康体检者作为健康对照组。②实验评估:采用流式细胞分析法对各组患者进行CD4 Th1型细胞因子干扰素γ和Th2型细胞因子白细胞介素10水平进行检测,从而测出相应Th1,Th2细胞的百分比。结果:参与常规治疗组实验患者均进入结果分析,参与己酮可可碱治疗组患者18例,脱落3例,余15例患者均进入结果分析。①慢性心力衰竭患者CD4 干扰素γ表达水平和Th1/Th2值高于健康对照组(P<0.05),CD4 白细胞介素10表达水平低于健康对照组(P<0.05)。②己酮可可碱治疗组治疗1周后,CD4 干扰素γ水平和Th1/Th2值低于常规治疗组(P<0.05)。CD4 白细胞介素10水平无显著性变化。结论:心力衰竭患者存在Th1/Th2失衡,己酮可可碱调节了慢性心力衰竭患者Th1/Th2的失衡,该效应可能是己酮可可碱改善慢性心力衰竭患者症状作用机制之一。     

Predictors of One Year Outcome in Lupus Nephritis: The Importance of Renal Biopsy

The short-term prognosis of lupus nephritis was evaluated byassessing serum creatinine 12 months after renal biopsy in 87patients with lupus nephritis. On univariate analysis, significantclinical and laboratory predictors of this outcome includedclinical signs of renal injury (serum creatinine, 24-hour urinaryprotein, prolonged renal disease, nephrotic syndrome, serumalbumin), as well as thrombocytopenia, older age, and coexistingillness or hypertension at the time of biopsy. On renal biopsy,diffuse proliferative nephritis, higher activity, chronicity,or tubulointerstitial scores, or subendothelial or subepithelialelectron dense deposits predicted a higher serum creatinine12 months after biopsy. A clinical predictive model was developed which included asindependent predictors serum creatinine, age, platelet countand 24-hour urinary protein. Any one of three biopsy variablesadded information to the clinical prediction model: a markedquantity of subendothelial deposits (p=0.02), a higher activityindex score (p=0.02), or the presence of diffuse proliferativelupus nephritis (p=0.05). However, the relative predictive accuracyof the clinical model did not improve with the addition of anyof the biopsy variables. The value of renal biopsy in lupus nephritis is discussed basedon the ability of biopsy information to confirm the prognosis,to add new predictive information for a group of subjects, andto improve predictive accuracy for individual patients.     

Establishment of a system to standardize acceptability criteria for alanine aminotransferase activity in donated blood

A multilaboratory study was conducted to develop a system for standardizing alanine aminotransferase (ALT) acceptability criteria ("cutoffs") for donated blood. Without standardized cutoffs, each laboratory must develop its own cutoff, and this may not make optimal use of ALT testing to reduce transmission of non-A, non-B hepatitis (NANB). Defining an ALT acceptability criterion in absolute terms is necessary because relative cutoffs based on local donor populations may be affected by the prevalence of NANB in each community. This study involved 16 laboratories using 23 different analytic systems. The ALT results of the analysis of a plasma reference sample could be used to translate mathematically a single, absolute cutoff to units applicable to each analytic system. The distribution of ALT results in 1.4 million donations from across the country was established; basing the cutoff on this sample avoids the problems inherent in using a local donor base to establish a cutoff. We propose the implementation of a system to standardize ALT acceptability criteria to an activity level defined by analysis of a nationwide donor sample.