Economic Evaluation of Factorial Trials: Cost-Utility Analysis of the Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes 2 × 2 × 2 Factorial Trial of Atorvastatin,Omega-3 Fish Oil,and Action Planning

ObjectivesWe applied principles for conducting economic evaluations of factorial trials to a trial-based economic evaluation of a cluster-randomized 2 × 2 × 2 factorial trial. We assessed the cost-effectiveness of atorvastatin, omega-3 fish oil, and an action-planning leaflet, alone and in combination, from a UK National Health Service perspective.MethodsThe Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes (AFORRD) Trial randomized 800 patients with type 2 diabetes to atorvastatin, omega-3, or their respective placebos and randomized general practices to receive a leaflet-based action-planning intervention designed to improve compliance or standard care. The trial was conducted at 59 UK general practices. Sixteen-week outcomes for each trial participant were extrapolated for 70 years using the United Kingdom Prospective Diabetes Study Outcomes Model v2.01. We analyzed the trial as a 2 × 2 factorial trial (ignoring interactions between action-planning leaflet and medication), as a 2 × 2 × 2 factorial trial (considering all interactions), and ignoring all interactions.ResultsWe observed several qualitative interactions for costs and quality-adjusted life-years (QALYs) that changed treatment rankings. However, different approaches to analyzing the factorial design did not change the conclusions. There was a ≥99% chance that atorvastatin is cost-effective and omega-3 is not, at a £20 000/QALY threshold.ConclusionsAtorvastatin monotherapy was the most cost-effective combination of the 3 trial interventions at a £20 000/QALY threshold. Omega-3 fish oil was not cost-effective, while there was insufficient evidence to draw firm conclusions about action planning. Recently-developed methods for analyzing factorial trials and combining parameter and sampling uncertainty were extended to estimate cost-effectiveness acceptability curves within a 2x2x2 factorial design with model-based extrapolation.     

hs-CRP、TAS联合血脂检测在早老性痴呆症诊断中的应用研究

[目的]研究超敏C反应蛋白（hs-CRP）、总抗氧化状态（TAS）联合血脂检测在早老性痴呆症诊断中的应用价值：[方法]选择浦东新区精神卫生中心早老性痴呆专科门诊患者54例，作超敏C反应蛋白、总抗氧化状态与血脂检测。[结果]与对照组比较，实验组hs-CRP、TAS差异非常显著，t1=4．55，t2=2．79，P1〈0．001，P2〈0．01；血脂中甘油三酯、低密度脂蛋白胆固醇、载脂蛋白B、Lp（a）差异显著；t1=3.01，P1〈0．01，t2=2．21，P2〈0．05，t3=2．64，P3〈0．01，t4=1．91，P4〈0．05。[结论]超敏C反应蛋白、总抗氧化状态联合血脂（甘油三酯、低密度脂蛋白胆固醇、载脂蛋白B、Lp（a））检测对实验室诊断早老性痴呆症具有较好敏感性和特异性，临床应用前景乐观。     

Erythropoietin production in healthy volunteers subjected to controlled hypobaric hypoxia: further evidence against a role for adenosine

Aims Objective of this study was to investigate whether adenosine modulates renal erythropoietin production.
Methods In the present study erythropoietin production was stimulated by hypobaric hypoxia by subjecting healthy volunteers to a simulated altitude of 4000  m in a low pressure chamber for 5.5  h. During exposure to hypoxia the subjects received i.v. in a randomized, single-blind, cross-over fashion the non-specific adenosine antagonist theophylline, the adenosine reuptake inhibitor dipyridamole and placebo.
Results Contrary to the working hypothesis, theophylline did not decrease and dipyridamole did not further boost erythropoietin concentrations.
Conclusions The results are in agreement with our earlier study using haemorrhage as a controlled physiological stimulus of erythropoietin production, and would question a major role for adenosine as a mediator of renal erythropoietin production.     

棕榈油对成人血脂和血小板功能的影响

报道了棕榈油（ＰＡ），花生油（ＰＥ）对血清总胆固醇水平（ＴＣ）在５．５～７．０ｍｍｏｌ／Ｌ的受试者血脂和血小板功能的影响。５１名受试者（男３１人，女２０人，年龄３０～６６岁之间）分为两组，一组男１５人，女１１人，称ＰＥ组；另一组男１６人女９人，称ＰＡ组，预备期３周，膳食以当地日常食用的花生油烹调，实验期６周。ＰＡ组受试者食用以棕榈油烹调的实验膳；ＰＥ组受试者仍食花生油烹调的膳食。脂肪约占膳食能量的３０％，其中６０％～６５％来自实验油。实验结果表明：与起始值相比，６周末ＰＡ组受试者血清ＴＣ，低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）和总胆固醇与高密度脂蛋白胆固醇比值（ＴＣ／ＨＤＬ－Ｃ）显著下降，血浆血栓素Ｂ２（ＴＸＢ２）／６－酮前列环素Ｆ１α、（６－ｋｅｔｏ－ＰＧＦ１α）比值显著下降，全血血小板聚集率未见显著变化。ＰＥ组受试者的血脂、血浆ＴＸＢ２、６－ｋｅｔｏ－ＰＧＦ１α及全血血小板聚集率等指标均未出现显著变化。提示，棕榈油作为我国居民家庭烹调用油并不会增加发生心血管疾病的危险。     

人血浆作为真皮支架对自体皮肤增殖的影响：组织学和免疫组织化学试验●☆

背景：组织工程是一个多学科研究的交叉学科，其目标是使人体损伤的组织和器官再生，通过这种假设，几乎所有的动物组织都可以在实验室进行培养。一般的方法是从需要移植的患者身上提取干细胞，在一定的支持条件下允许其生长、增殖、生产为可替换的组织。另一方面，寻找细胞能够互相联结并形成分层结构的合适的支持条件，如基质或支架等非常必要。目前用于烧烫伤治疗的材料有很多种，如胶原，透明质酸、纤维蛋白和聚乳酸及其共聚物。 目的：讨论以新型的生物材料自体血浆为支架对自体成纤维细胞和角质化细胞生长、扩张、增殖的影响。 设计：建立一种真皮再生的方法，将自体成纤维细胞浸于人血浆基质中，排除各种影响样本安全性和排斥反应的问题，应用同样的方法在新的真皮上获取角质化细胞。 时间及地点：实验于2008年在意大利曼多瓦C. Poma医院动物工厂完成。 材料：人角质化细胞和成纤维细胞取自1例58岁乳房切除患者的皮肤碎片。实验得到C. Poma医院独立伦理委员会批准，患者知情同意。 方法：从自体活组织皮肤样本中分离人角质化细胞和成纤维细胞，置于培养瓶中增殖，随后将自体血浆作为皮肤移植形成构造的支架，免疫和免疫组织化学特征显示与正常皮肤相似。 主要观察指标：将血浆样本用甲醛固定，埋入石蜡，苏木精-伊红染色，用显微镜进行细胞计数。所有样本均经免疫组织化学评估。 结果：在血浆基质上获得了多层规则形状的角质化细胞和成纤维细胞，基底膜的形成说明自体血浆是角质化细胞和成纤维细胞的生长、分化、扩展的良好支架，真皮和表皮细胞联结重建皮肤移植与正常皮肤无异。 结论：血浆作为角质化细胞和成纤维细胞分化、扩展的支架表现出良好的性能，同时实验还特别发现成纤维细胞浓缩血浆可以暂时替代皮肤，也是角质化细胞生长的强有力的支架。此外血浆还具有廉价，易于制备等优点。自体角质化细胞和成纤维细胞及自体血浆的应用，可以避免血种类型的免疫排斥反应。这种治疗方法给有慢性缺损并且需要连续移植的患者带来了希望。 doi:10.3969/j.issn.1673-8225.2009.47.001     

眼底动脉硬化与血压、血糖、血脂的多元分析与评估

目的探讨眼底动脉硬化与血压、血脂、血糖的相关性，评估中风危险度。方法对2004年5月至2008年10月就诊的患者335例，作为观察组，并与无症状的健康体检者180例作对照，动态检测眼底动脉硬化、血压、血糖、血脂的异常变化，并做综合量化评估。结果脑血管疾病与眼底动脉硬化、血压、血糖、血脂等因素密切相关。结论眼底动脉硬化、血糖、血脂、血压异常的量化评分，能够预估中风，以便采取预防性治疗。     

Human khat (Catha edulis) chewers have elevated plasma leptin and nonesterified fatty acids

In this study, the effect of regular khat (Catha edulis Forsk) chewing (200 and 400 g) in humans on plasma leptin, nonesterified fatty acid, triacyglycerol, and total cholesterol levels was investigated. The results presented show that khat chewing increases plasma leptin concentration particularly in individuals who chew 400 g of khat leaves. The significance of increased plasma leptin is in explaining the underlying mechanism of the observed effects associated with khat chewing such as loss of appetite, decreased body weight, and hyperthermia. The decreased body weight was evident from the significantly lower body mass index of the khat leaves chewers group as compared to the non–khat leaves chewers group (control). Moreover, like leptin, the plasma levels of nonesterified fatty acids were significantly higher in those chewing 400 g of khat leaves. On the other hand, the plasma levels of triacylglycerol were significantly lower in the 2 khat-chewers groups (200 and 400 g of khat leaves), whereas plasma cholesterol levels were not affected by the 2 levels of khat leaves used in this study. The significance of these results may suggest that khat leaves may contain a component(s) that has the ability to reduce body weight via decreasing appetite.     

Melatonin and Sperm Motility/Melatonin und Spermatozoenmotilität

Several substances can interfere with microtubular function eg. colchicine. Melatonin, a hormone secreted by the pineal gland has similar effects as colchicine on microtubules. In this study melatonin levels were determined in both plasma and seminal plasma of patients with good or impaired motility and forward progression. There was no statistically significant difference between the mean plasma and seminal plasma values of patients with good or impaired motility and forward progression. There was no correlation between seminal plasma melatonin and impaired motility or any other semen parameter. There was also no correlation between plasma and seminal plasma concentrations of melatonin. High seminal plasma melatonin concentrations were not necessarily associated with impaired sperm motility. From these it is concluded that seminal plasma melatonin plays no important role in sperm motility.     

Binucleated and multinucleated forms of plasma cells in synovia from patients with rheumatoid arthritis

A morphological examination of synovial tissue from 25 patients with rheumatoid arthritis revealed that binucleated or multinucleated plasma cells were present in all samples and absent in synovia obtained from 16 control patients. Plasma cells containing two, three of four nuclei constitutet a mean 3% of the total plasma cell population. They were aways found amongst plasma cell infiltrates and in close association with small blood vessels. Ultrastructural analysis found no evidence of cellular membranes separating the individual nuclei in binucleated or multinucleated plasma cells, suggesting that the cells did not arise from fusion. Some of these plasma cells had a diameter approaching 100 μm, and many were in intimate contact with macrophages. The demonstration of a few cells with mitotic figures within the infiltrates suggests that the maintenance of plasma cell numbers in rheumatoid synovium may depend, in part, upon their local proliferation. Received: 25 August 1997 / Accepted: 2 October 1997