Risk factor profile and achievement of treatment goals among hypertensive patients from the Israeli Blood Pressure Control (IBPC) program--initial cost utility analysis

Aims: Blood pressure (BP) reduction is crucial in reducing cardiovascular morbidity and mortality. The IBPC (Israeli Blood Pressure Control) program was initiated in order to enhance the control of modifiable risk factors among high-risk hypertensive patients under follow-up by general practitioners in Israel. The cost effectiveness of an intervention program is an important factor in the decision-making process of its implementation and therefore was evaluated here. The objective of this evaluation is to estimate the costs, monetary savings and benefits in terms of QALYs (quality-adjusted life years) that would be expected if the program were to be expanded to 100 clinics nationwide, enabling around 14 800 persons to be treated. Methods: Hypertensive patients were screened in 30 general practice clinics, supervised by specialists in family medicine, each seeing 1000-5000 patients; 50-250 hypertensive patients were diagnosed at each participating clinic. BP levels, body mass index (BMI), lipid and glucose levels, as well as target organ damage and medications were recorded for all patients. Results: A total of 4948 (2079, 42% males) were registered. Mean age was 64.8 ± 12 years. After 1 year of follow-up versus baseline, the various parameters were as follows: BP control was achieved in 46.4% vs 29% of all hypertensive patients. LDL control (JNC VI criteria) was achieved in 41.7% vs 31.2% of all patients. Fasting plasma glucose control (glucose 200 mg/dl. Obesity (BMI >30 kg/m[Formula: See Text]) was noted in 36.7% vs 43.8% at baseline. The cost utility analysis of the reduction in risk factors was calculated based on the international dicta applied to the reduction in risk factors as a result of treatment. For 100 clinics nationwide and 14 800 persons to be treated the net saving to health services would be $977 993 and the increase in QALYs would be 602 years. Conclusions: Better risk factor control in hypertensive patients by general practitioners could reduce morbidity and mortality as well as be cost effective.     

Metabolic profiles in closely controlled diabetic pregnancies during the third trimester

Summary In 5 closely controlled pregnant diabetics (duration of pregnancy 237–266 days) and 5 pregnant non-diabetics (duration of pregnancy 210–278 days) 4-hourly blood samples were taken throughout a 24 h period and analyzed for blood glucose, lactate, pyruvate, 3-hydroxybutyrate and acetoacetate, plasma non-esterified fatty acids (NEFA), glucagon and cortisol. 24 h urine specimen was analyzed for total catecholamines and 4-hydroxy-3-methoxymandelic acid. There were few significant differences in concentrations of metabolites and hormones in the two groups at any time, although the variations about the mean was usually greater in the diabetics. Thus for blood glucose in diabetics, mean value was 4.4 mmol/l, coefficient of variation 43%; in non-diabetics 4.1 mmol/l and 10% respectively. Mean plasma 3-hydroxybutyrate in diabetics was 0.47 mmol/l, coefficient of variation 55%; in non-diabetics 0.44 mmol/l and 37% respectively. Plasma non-esterified fatty acid levels were significantly higher in the diabetics (0.47 mmol/l) than in the non-diabetics (0.26 mmol/l). Coefficients of variation were 46% and 33% respectively. Two conclusions can be drawn; first, when near normal mean values for blood glucose are achieved, other metabolite and hormone levels are also near normal; second, even when the available means for diabetic control, strict diet and insulin-mixtures twice daily, are used at their maximum, metabolism in diabetics is more unstable than in non-diabetics.     

Effect of glucagon antibodies on plasma glucose,insulin and somatostatin in the fasting and fed rat

Summary A potent high-titre glucagon antibody pool was used to induce a state of acute glucagon deficiency in order to investigate the importance of glucagon in maintaining euglycaemia in the fed and fasted anaesthetised rat. Binding characteristics of the antiserum and evidence of its neutralisation of the biological effects of exogenous glucagon are described. The amount of antibody administered was capable of neutralising up to 12 times the total content of glucagon (approximately 1nmol) in the rat pancreas. The hyperglycaemic response to 1.43 nmol exogenous glucagon was significantly inhibited in the rat by glucagon antibodies given intravenously or intraperitoneally (p < 0.001). However, no changes in plasma glucose occurred in rats fasted 16 h (4.35±0.1 mmol/l or 24 h (4.0±0.05 mmol/l) after antibody administration. The same dose of glucagon antibodies produced no change in plasma glucose (6.1±0.2 mmol/l), immunoreactive insulin (1.85±0.05 g/l) or immunoreactive somatostatin (110±30 ng/l) in rats after antibody administration. Antibody excess, equivalent to a binding capacity for glucagon of 40 nmol/l in the plasma of recipient animals, was demonstrable at all times after passive immunisation. The absence of any affect on glucose concentrations following immunoneutralisation of glucagon suggests that glucagon secretion may not be a major factor in the maintenance of euglycaemia in the rat.     

An overview of regular dialysis treatment in Japan as of 31 December 2003

A statistical survey of 3750 nationwide dialysis facilities was carried out by the Japanese Society for Dialysis Therapy (JSDT) at the end of 2003, with answers to the questionnaires received from 3717 facilities (99.12%). The population of dialysis patients in Japan at the end of 2003 was 237,710, and the number of dialysis patients per million people was 1862.7. The crude death rate during a 1-year period from the end of 2002 to the end of 2003 was 9.3%. The mean age of patients newly introduced to dialysis was 65.4 years, and the mean age of the entire dialysis population was 62.3 years. The primary diseases in the patients newly introduced to dialysis in 2003 included diabetic nephropathy (41.0% of patients) and chronic glomerulonephritis (29.1% of patients). The mean serum neutral fat concentration for all the dialysis patients was 113.9 +/- 71.7 mg/dL (+/- SD). The mean serum low density lipoprotein (LDL)-cholesterol concentration was 90.8 +/- 30.9 mg/dL. Dialysate calcium concentrations ranging from 3.0 mEq/L to less than 3.5 mEq/L were used for majority of the dialysis patients (55.4%). Among anticoagulants given to the dialysis patients, heparins were the most commonly used in 79.3% of the dialysis patients. The relationship between blood pressure during dialysis and life expectancy for 1 year was analyzed for 43,465 patients who had undergone dialysis three times per week at the end of 2001. Results showed a significantly high mortality risk for patients who had systolic blood pressure of less than 100 mm Hg at the start of dialysis, systolic blood pressure of less than 100 mm Hg at the end of dialysis, and the greatest decrease (lowest) in systolic blood pressure of less than 120 mm Hg during dialysis. Patients who received vasopressor therapy during dialysis had a higher mortality risk than those who received no vasopressor therapy.     

术中护理对髋关节置换手术患者下肢深静脉血栓形成的影响

目的：探讨术中护理对髋关节置换手术患者下肢深静脉血栓形成的影响。方法选择2013年6月~2014年12月湖北省鄂州市中心医院收治的157例髋关节置换手术患者,按住院号单双分为观察组83例,对照组74例。对照组采用常规术中护理,观察组采用改进术中护理。比较两组手术前后血液流变学和凝血功能变化及下肢深静脉血栓形成情况。结果观察组出血量、术中输血量明显少于对照组(P<0.05)。观察组术后1 d全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数均明显低于术前1 d和对照组(P<0.05),凝血酶原时间、纤维蛋白原略低于术前1 d和对照组,但差异无统计学意义(P跃0.05);对照组术后1 d全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、凝血酶原时间、纤维蛋白原与术前1 d比较差异无统计学意义(P跃0.05)。观察组术后2例(2.41%)发生下肢深静血栓,对照组8例(10.81%)发生下肢静脉血栓,两组比较,差异有统计学意义(P<0.05)。结论改进术中护理提高手术室护理质量可有效改善髋关节置换患者血液高凝状态,降低术后下肢深静脉血栓形成发生率。     

帕金森病患者血糖和左心室射血分数的变化及其与预后的关系

目的 探讨帕金森病患者血糖和左心室射血分数(LVEF)的变化及其与预后的关系.方法 选取2010年10月～2012年10月广东省河源市人民医院(以下简称“我院”)收治的帕金森病患者48例作为观察组,另选取30例我院同期健康查体者作为对照组.检测两组空腹血糖(FBG)、LVEF和洛文斯顿作业疗法认知评定量表(LOTCA)得分.观察组患者均接受相应的治疗和为期2年的随访.比较治疗前后观察组FBG和LVEF水平变化、LOTCA得分变化及患者病死率,分析观察组FBG和LVEF水平与LOTCA得分及病死率的关系,并采用ROC曲线分析观察组FBG和LVEF水平对其预后和认知功能损伤的预测价值.结果 与对照组比较,观察组治疗前FBG水平升高,LVEF水平下降;治疗1个月和3个月FBG均较治疗前下降,LVEF和LOTCA得分则均较治疗前升高,差异有统计学意义(P＜0.05).观察组患者病死率为8.33％,且死亡患者FBG水平均高于存活患者,LVEF则低于存活患者(P＜0.05).Pearson相关性分析结果显示,帕金森病患者LVEF与其LOTCA得分呈弱相关(r=0.279,P＜0.05),FBG与其LOTCA得分则均呈显著负相关(r=-0.876,P＜0.05).进一步ROC曲线分析结果显示,帕金森病患者FBG及LVEF联合预测其认知功能损伤和不良预后的曲线下面积、灵敏度和准确性均较高.结论 帕金森病患者FBG和LVEF水平均与认知功能损伤和预后相关,且对其预后的预测价值良好,这可能与高血糖水平造成神经损伤和帕金森病患者心脑血管系统继发性改变相关.因此帕金森病患者FBG升高和LVEF降低时需警惕其不良预后的发生并及时干预以改善患者预后.     

糖尿病患者血清糖化低密度脂蛋白水平研究

目的研究糖尿病患者血清糖化低密度脂蛋白水平,为糖尿病并发冠心病的预防提供理论依据。方法选取我院收治的110例糖尿病患者作为观察组,选取同时期进行健康体检的健康者110例作为对照组,检测两组患者血清中的血糖、三酰甘油、载脂蛋白、胆固醇、糖化低密度脂蛋白、糖化血红蛋白等。结果观察组患者的GLDL水平明显高于对照组(P<0.05);但两组apo B100、LDL-C水平对比无统计学差异(P>0.05);apo A-Ⅰ与HDL-C的水平明显低于对照组(P<0.05);Clu、TG以及Chol水平明显高于对照组(P<0.05)。观察组的G-LDL水平与Glu呈正相关(r=0.631,P<0.05),与LDL-C、Hb A1c水平无相关关系(r=0.328、0.329,P>0.05)。结论糖尿病患者的血清糖化低密度脂蛋白水平显著提升,且与血糖值呈正相关关系。对评估糖尿病的治疗疗效有重要的临床价值。     

即时检验血糖仪检测指尖血及静脉全血血糖的临床分析

目的：探讨即时检验血糖仪检测指尖血及静脉全血血糖检验结果的临床可行性。方法随机选取该院2011年6月—2012年7月所接收治疗的50例糖尿病患者,采取静脉血和指尖血,采用即时检验血糖仪检测所有患者的血糖数值,同时,还在生化分析仪上进行检测血浆葡萄糖,对比分析两部位生化分析仪检测结果和血样检测结果的偏倚程度。结果即时检验血糖仪指尖血血糖为（9.38±4.28）mmol/L,静脉全血血糖为（9.17±4.05）mmol/L,生化仪测定血浆葡萄糖为（9.96±5.01）mmol/L,三者之间进行统计学分析,差异有统计学意义（P＜0.05）,两部位生化分析仪检测结果和血样检测结果的偏移程度都是负偏倚,其中,偏倚范围最高是13.8%,最低为1.4%,都没有超过20%。静脉全血血糖偏倚显著高于指尖血血糖偏倚,差异具备统计学意义（P＜0.05）。结论对于即时检验血糖仪检测指尖血及静脉全血血糖检验结果的临床可行性,不管是采用静脉采血,还是指尖采血,即时检验血糖的数值都在接受范围内,但是采取指尖血样,检测结果更加接近血浆葡萄糖。     

病毒感染导致的体温升高与血常规的变化关系

目的：分析研究病毒感染导致的体温升高与血常规的变化之间的关系,为临床诊断以及治疗提供重要依据。方法选取2013年5月—2014年5月在妇幼保健院接收的由病毒感染引发的发热病例100例,其中上呼吸道感染者58例（58%）;水痘病毒感染者42例（42%）,分析研究低（37.5～38℃）、中（38.1～39℃）、高热（39.1～40℃）患者的临床血液常规检查特点,根据检查结果对比呼吸道感染毒和水痘病毒血项的不同。结果100例患者平均体温在37.8±0.7℃。其中低温58例（58%）;中温23例（23%）;高温19例（19%）。该研究一共有100例病人,临床血液常规检查正常的一共有17例,占总体的17%,当中白细胞计数平均值在（8.2±2.7）×109/L,淋巴细胞计数百分比平均值在（16±5）%,中性粒细胞百分比平均值在（77.2±8.7）%;低热组病人的临床血液常规异常为79.3%;中度发热组临床血液常规异常为100%,高热组临床血液常规异常为100%,当中以NC升高为主,其次为LC降低,高热组、中热组血常规异常率均高于低热组、高热组、中热组LC降低幅度,NC升高幅度大于低热组,差异有统计学意义（P<0.05）;上呼吸道感染毒组WBC、NC高于水痘病毒感染组,LC低于水痘病毒感染组,差异有统计学意义（P<0.05）。结论病毒感染者体温升高的同时会伴随血常规异常的发生,上呼吸道感染和水痘病毒感染的血常规异常情况有所不同,应酌情结合患者临床症状采取治疗方案。