Cost-effectiveness of tobacco control policies in Vietnam: the case of personal smoking cessation support

Aims To examine the cost‐effectiveness of personal smoking cessation support in Vietnam. Design, setting and participants We followed‐up the population aged 15 years and over in 2006 to model the costs and health gains associated with five interventions: physician brief advice; nicotine replacement therapy (patch and gum); bupropion; and varenicline. Threshold analysis was undertaken to determine the price levels of pharmaceuticals for the interventions to be cost‐effective. A multi‐state life table model was constructed such that the interventions affect the smoking cessation behaviour of the age cohorts, and the resulting smoking prevalence defines their health outcomes. A health‐care perspective was employed. Measurements Cost‐effectiveness is measured in 2006 Vietnamese Dong (VND) per disability‐adjusted life year (DALY) averted. We adopted the World Health Organization thresholds of being ‘cost‐effective’ if less than three times gross domestic product (GDP) per capita (VND 34 600 000) and ‘very cost‐effective’ if less than GDP per capita (VND 11 500 000). Findings The cost‐effectiveness result of physician brief advice was VND 1 742 000 per DALY averted (international dollars 543), which was ‘very cost‐effective’. Varenicline dominated bupropion and nicotine‐replacement therapies, although it did not fall within the range of being ‘cost‐effective’ under different scenarios. The threshold analysis revealed that prices of pharmaceuticals must be substantially lower than the levels from other countries if pharmacological therapies are to be cost‐effective in Vietnam. Conclusions Physician brief advice is a cost‐effective intervention and should be included in the priority list of tobacco control policy in Vietnam. Pharmacological therapies are not cost‐effective, and so they are not recommended in Vietnam at this time unless pharmaceuticals could be produced locally at substantially lower costs in the future.     

Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan

Background and Aims: Proton pump inhibitors (PPI) have been rarely used for prevention of upper gastrointestinal bleeding (UGIB) induced by non‐steroidal anti‐inflammatory drugs (NSAIDs) and/or aspirin in Japan. The increased incidence of UGIB in the aged society is becoming a serious problem. The aim of this study was to retrospectively evaluate whether PPI can prevent UGIB. Methods: We examined records of 2367 patients (aged 67.9 ± 15.1 years, male 1271) attending the only hospital serving the rural area, with little population movement. We investigated the correlation between the frequency of usage of medicine (PPI, histamine 2 receptor antagonists [H2RA], NSAIDs, aspirin) and incidence of UGIB over 12 years. UGIB was defined as cases with hematemesis and/or melena and definite bleeding at upper gastrointestinal endoscopy. The annual incidence of UGIB of inhabitants (16 065 ± 375.3 persons/year) was evaluated. The frequency of usage of medicine was compared with the total number of patients prescribed any medication (1080 ± 33.2 persons/year). Results: The frequency of PPI usage has increased significantly 4.6%→30.8% (P < 0.05). NSAIDs and aspirin usage increased significantly in the latter half of the survey period (P < 0.05). The annual incidence of UGIB significantly decreased 160.8 →23.6/100 000 inhabitants per annum (P ≤ 0.05) due to widespread use of PPI. No patients died due to UGIB after 2006. The incidence of UGIB and the prevalence of PPI usage were found to have a negative correlation (r = ?0.804, P = 0.0016). Conclusions: By widespread use of PPI, UGIB and related death has declined significantly. This survey showed that continuous PPI treatment decreases UGIB and related death in community medicine.     

Acute effects of adaptive servo ventilation on hemodynamics, coronary flow, and flow reserve in a patient with idiopathic dilated cardiomyopathy

Adaptive servo ventilation (ASV) is reported to be effective for the treatment of heart failure. We treated a patient with idiopathic dilated cardiomyopathy using ASV and assessed the effects on hemodynamics, coronary flow, and flow reserve before and after ASV therapy. This case suggests that ASV might decrease myocardial oxygen demand, which was represented by the decreased resting coronary flow velocity (the improvement of coronary flow velocity reserve) on ASV.     

Photo-responsive azobenzene interactions promote hierarchical self-assembly of collagen triple-helical peptides to various higher-order structures

Collagen is an essential structural protein in animal tissues and plays key roles in cellular modulation. We investigated methods to discover collagen model peptides (CMPs) that would self-assemble into triple helices and then grow into supramolecular organizations with diverse morphological features, which would be valuable as biomaterials. This challenging undertaking was achieved by placing azobenzene groups on the ends of the CMPs, (GPO)_n (n = 3–10), Azo-(GPO)_n. In a dilute aqueous solution (80 μM), CD spectra indicated that the Azo-(GPO)_n (n > 4) formed triple helices due to strong hydrophobic azobenzene interactions, and that helix stability was increased with the peptide segment length. The resulting triple helices induced a specific azobenzene orientation through turned and twisted configurations as shown by CD spectra. TEM observations for the same solutions disclosed the morphologies for the Azo-CMPs. Azo-(GPO)₃, having the shortest peptide segment, showed no nanostructure, both Azo-(GPO)₄ and Azo-(GPO)₅ provided consistent well-developed nanofiber structures resembling the natural collagen fibers, and Azo-(GPO)_ns (n = 6–10) grew into flexible rod-like micelle fibers. In addition, alkyl chain-attached C_mAzo-(GPO)₅ displayed a toroidal morphology, and Azp-deg-(GPO)₅ having a hydrophilic spacer assembled into a bilayer vesicle structure. These diverse morphological features are considered to be due to the characteristics of the pre-organized triple helix units. Photo-isomerization of the azobenzene moiety brought about the disappearance of such characteristic nano-architectures. When the solution concentration was increased up to 1 wt%, only Azo-(GPO)₄ and Azo-(GPO)₅ spontaneously formed hydrogels exhibiting a satisfactory gel-to-sol transition upon UV irradiation.

Collagen is an essential structural protein in animal tissues and plays key roles in cellular modulation.     

Posterior ventricular septal perforation

We present a case in which the sandwich technique was successfully applied via right ventriculotomy for posterior infarction ventricular septal perforation 2 days after acute posterior myocardial infarction in a 73-year-old male patient. The sealant BioGlue was applied to the space between the two patches instead of gelatin–resorcinol–formaldehyde biological glue. The postoperative course was good, and the patient was discharged on day 24 after surgery with no recognized residual shunt.