宁夏地区住院回族糖尿病患者医疗费用影响因素15年对比分析

目的:观察宁夏地区回族糖尿病患者医疗费用分布情况,分析其影响因素。方法:①对1990-01-01/1994-12-31和2000-01-01/2004-12-31在宁夏回族自治区宁夏医学院附属医院和银川市第一人民医院内分泌科住院的回族糖尿病患者1434例病历资料进行分析,其中男827例,女607例,平均年龄(46±17)岁,平均病程(6.8±5.7)年。患者的直接医疗费用资料源自上述患者住院时的收费情况一览表。1990-01-01/1994-12-31收住此两家医院患者601例,其中合并慢性并发症、合并大血管并发症、合并微血管并发症患者占56.5%,55.4%,44.6%。2000-01-01/2004-12-31收住此两家医院患者833例,合并慢性并发症、合并大血管并发症、合并微血管并发症患者占74.3%,49.5%,50.4%。②依据中华医学会糖尿病分会统一制定的调查表格,对患者基本情况、本次入院情况以及医疗费用的情况等项目进行整理。结果:①有无并发症住院回族糖尿病患者住院费用对比:1990/1994无并发症和有并发症回族患者人均发生住院直接医疗费用分别为(1722±88)和(3002±98)元;在2000/2004相应医疗费用为(3151±118)和(6742±124)元。15年间无并症医疗费用增长率明显低于有并发症者[(83±14)%,(125±12)%,P<0.01]。②大、微血管并发症住院回族糖尿病患者住院费用对比:1990/1994伴有大血管和微血管并发症回族患者人均发生住院直接医疗费用分别为(3179±104)和(2760±145)元;2000/2004相应医疗费用分别为(8841±205)和(4676±105)元。15年间伴大血管并症患者医疗费用增长率明显高于微血管并发症患者[(177±15)%,(70±6)%,P<0.01]。③宁夏住院回族糖尿病患者不同系统并发症住院医疗费用分布情况:1990/1994合并心血管病变患者的住院医疗费用居首位[(3246±147)元],其次是合并脑血管并发症患者和肾脏病变、糖尿病足患者[(2996±144),(2965±128)元],周围神经病变患者医疗费用最低;2000/2004合并心血管病变患者住院医疗费用仍居首位[(10430±149)元],其次为合并肾脏病变和糖尿病足患者[(7039±178),(6188±158)元],周围神经病变患者医疗费用仍最低。结论:合并并发症为宁夏地区回族住院糖尿病患者医疗费用增长的主要因素,且大血管并发症影响最大。     

Intravascular imaging comparison of two metallic limus-eluting stents abluminally coated with biodegradable polymers: IVUS and OCT results of the DESTINY trial

We sought to compare, by means of IVUS and OCT imaging, the performance of a novel sirolimus-eluting drug-eluting stent (DES) with biodegradable polymer (Inspiron?) to the Biomatrix? DES. From the DESTINY trial, a total of 70 randomized patients (2:1) were enrolled in the IVUS substudy (Inspiron?, n?=?46; Biomatrix?: n?=?20) while 25 patients were evaluated with OCT (Inspiron?, n?=?19; Biomatrix?: n?=?06) at 9-month follow-up. The main endpoints were % of neointimal tissue obstruction (IVUS) and neointimal stut coverage (OCT) at 9 months. Patients treated with both DES had very little NIH formation at 9 months either by IVUS (% of NIH obstruction of 4.9?±?4.1?% with Inspiron? vs. 2.7?±?2.9?% with Biomatrix?, p?=?0.03) or by OCT (neointimal thickness of 144.2?±?72.5 µm Inspiron? vs. 115.0?±?53.9 µm with Biomatrix?, p?=?0.45). Regarding OCT strut-level assessment, again both devices showed excellent 9-month performance, with high rates of strut coverage (99.49?±?1.01?% with Inspiron? vs. 97.62?±?2.21?% with Biomatrix?, p?<?0.001) and very rare malapposition (0.29?±?1.06?% with Inspiron? vs. 0.53?±?0.82?% with Biomatrix?, p?=?0.44). Patients with any uncovered struts were more frequently identified in the Biomatrix? group (9.78?±?7.13 vs. 2.29?±?3.91?%, p?<?0.001). In the present study, midterm IVUS and OCT evaluations showed that both new generation DES with biodegradable polymer were effective in terms of suppressing excessive neointimal response, with very high rates of apposed and covered struts, suggesting a consistent and benign healing pattern.     

Serologic test for syphilis as a surrogate marker for human immunodeficiency virus infection among United States blood donors

BACKGROUND: This study evaluated the usefulness of the serologic test for syphilis (STS) in preventing the transmission of human immunodeficiency virus (HIV), hepatitis B and C viruses, and human T- lymphotropic virus via the transfusion of seronegative, infectious window-period blood. STUDY DESIGN AND METHODS: Demographic and laboratory information on blood donations made between January 1992 and June 1994 in 18 American Red Cross regions was analyzed. It was assumed that the same proportion of HIV-positive and HIV-infectious window- period donations reacted on STS and were negative on other screening tests (hepatitis B and C viruses and human T-lymphotropic virus). This proportion multiplied by the estimated number of HIV-infectious window- period donations is the number of post-screening HIV-infectious donations removed by STS. RESULTS: Of 4,468,570 donations, 12,145 (0.27%) were STS positive and 377 (0.008%) were HIV positive. Among donations that were negative on other screening tests, STS-reactive donations were 12 times more likely to be HIV positive (odds ratio = 11.9; 95% CI = 5,26). However, of an estimated 13 infectious window- period donations, 0.2 would have been removed because of a reactive STS, at a cost of over $16 million. CONCLUSION: STS is a poor marker and a costly strategy for preventing post-screening HIV infections and other blood-borne diseases.     

Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases

Two cases of proven coral snake bites were reported in Belém, Pará State, Brazil. The first case was a severe one caused by Micrurus surinamensis. The patient required mechanical ventilation due to acute respiratory failure. The second case showed just mild signs of envenomation caused by Micrurus filiformis. Both patients received specific Micrurus antivenom and were discharged without further complications. Coral snake bites are scarcely reported in the Amazon region and there is a broad spectrum of clinical manifestations, varying from extremely mild to those which may rapidly lead to death if the patient is not treated as soon as possible.     

Thalidomide in combination with oral daily cyclophosphamide in patients with pretreated hormone refractory prostate cancer: a phase I clinical trial

AIM: This is a phase I study investigating the toxicity and the potential efficacy of thalidomide and oral cyclophosphamide in patients with hormone refractory prostate cancer (HRPC), previously treated with docetaxel-based regimens. METHODS: Two dose levels of thalidomide (100 and 200 mg every day) were studied. Patients were accrued to each dose level in cohorts of 3 starting from dose 1 level (100 mg). Thalidomide was started on day 1 at the assigned dose and continued for four consecutive weeks; oral cyclophosphamide (50 mg for day) was given for four consecutive weeks (1 cycle) starting on the same day initiating thalidomide. Toxicity was evaluated every two weeks; changes in prostate-specific antigen (PSA) levels were evaluated every cycle. Treatment was planned for four cycles. RESULTS: Sixteen men were treated. Ten patients in cohort 1, and 6 in cohort 2 were enrolled respectively. Grade 1-2 constipation, peripheral neuropathy and fatigue were the most common side effects, noted in 6 (37.5%), 5 (31.25%) and 3 (19%) patients, respectively. Three patients stopped the treatment at level 2, during the first cycle, for toxicity. Those three patients were evaluable only for toxicity. The MTD was 100 mg thalidomide. Thirteen patients completed two cycles. Two patients (15%) had a >50% decrease in PSA, while in one patient (8%) the PSA decrease was less of 50%. Overall PSA decrease was of 23%. CONCLUSIONS: The oral combination of thalidomide and cyclophosphamide is well tolerated and appears to be associated with biochemical response in this population. Future phase II trials, in pre-treated and untreated patients, are needed to evaluate clinical efficacy of this regimen in HRPC.     

The SH2B1 obesity locus and abnormal glucose homeostasis: Lack of evidence for association from a meta-analysis in individuals of European ancestry

Background/AimsThe development of type 2 diabetes (T2D) is influenced both by environmental and by genetic determinants. Obesity is an important risk factor for T2D, mostly mediated by obesity-related insulin resistance. Obesity and insulin resistance are also modulated by the genetic milieu; thus, genes affecting risk of obesity and insulin resistance might also modulate risk of T2D.Recently, 32 loci have been associated with body mass index (BMI) by genome-wide studies, including one locus on chromosome 16p11 containing the SH2B1 gene. Animal studies have suggested that SH2B1 is a physiological enhancer of the insulin receptor and humans with rare deletions or mutations at SH2B1 are obese with a disproportionately high insulin resistance. Thus, the role of SH2B1 in both obesity and insulin resistance makes it a strong candidate for T2D. However, published data on the role of SH2B1 variability on the risk for T2D are conflicting, ranging from no effect at all to a robust association.MethodsThe SH2B1 tag SNP rs4788102 (SNP, single nucleotide polymorphism) was genotyped in 6978 individuals from six studies for abnormal glucose homeostasis (AGH), including impaired fasting glucose, impaired glucose tolerance or T2D, from the GENetics of Type 2 Diabetes in Italy and the United States (GENIUS T2D) consortium. Data from these studies were then meta-analyzed, in a Bayesian fashion, with those from DIAGRAM+ (n = 47,117) and four other published studies (n = 39,448).ResultsVariability at the SH2B1 obesity locus was not associated with AGH either in the GENIUS consortium (overall odds ratio (OR) = 0.96; 0.89–1.04) or in the meta-analysis (OR = 1.01; 0.98–1.05).ConclusionOur data exclude a role for the SH2B1 obesity locus in the modulation of AGH.     

合欢皮中新皂甙的结构鉴定

从合欢皮(Albizziae cortex)的95%乙醇提取物的正丁醇萃取部分中分离得到3个新的三萜皂甙,用化学方法及¹H-和¹³C-NMR,DEPT,COSY,TOCSY,HMQC-COSY,HMQC-TOCSY,HMBC,NOESY等波谱方法鉴定其结构为:I(1个三萜,9个糖,2个单萜),命名为合欢皂甙(julibroside)J₁;II(1个三萜,8个糖,2个单萜),命名为合欢皂甙J_{2;II(1个三萜,9个糖,2个单萜),命名为合欢皂甙J3。}     

柴胡皂甙q及其甙元的结构鉴定

从小叶黑柴胡(Bupleurum smithii Wolffvar;parvifolium ShanetY.Li)的根中得到3个化合物,柴胡皂甙元A和Q及柴胡皂甙q。柴胡皂甙元Q和柴胡皂甙q为新化合物,根据理化性质和波谱分析,确定其结构分别为齐墩果烷-11,13(18)-二烯-3β,16β,23,28,30-五醇和3β,16β,23,28,3O-五羟基齐墩果烷-11,13(18)-二烯-3-O-β-D-吡喃葡萄糖基(1→6)-[α-L-吡喃鼠李糖基(1→4)]-β-D-吡喃葡萄糖甙。     

ENPP1 gene, insulin resistance and related clinical outcomes

PURPOSE OF REVIEW: Insulin resistance plays a significant role in both morbidity and mortality of the general population. Understanding the molecular mechanisms of insulin resistance would help the identification of at-risk individuals in the presymptomatic stage, and the discovery of novel and more effective treatments. The transmembrane glycoprotein ectonucleotide pyrophosphatase phosphodiesterase 1 (ENPP1) inhibits insulin receptor signalling and has recently emerged as a key player in the development of insulin resistance. This review will summarize data available on the relationship between ENPP1 and insulin resistance. RECENT FINDINGS: Overexpression of ENPP1 in insulin target tissues is an early, intrinsic defect observed in human insulin resistance. A missense ENPP1 single nucleotide polymorphism, K121Q, has been recently described with the Q121 variant being a stronger inhibitor than K121 of insulin receptor function. In addition, the Q121 variant has been repeatedly associated with insulin resistance and related abnormalities including body weight changes, type 2 diabetes and macrovascular complications, thus suggesting a pleiotropic role of the ENPP1 gene on several metabolic abnormalities. SUMMARY: A deep understanding of ENPP1 mode of action and the mechanisms regulating its expression and function are likely to provide new tools for early identification and treatments of patients at risk for the devastating clinical outcomes related to insulin resistance.     

Expression of matrix metalloproteinase-2 and metalloproteinase-9 in the skin of dogs with visceral leishmaniasis

Parasitology Research - The skin is the first organ to be infected by the parasite in canine visceral leishmaniasis. The enzyme matrix metalloproteinase (MMP) acts towards degradation of the...