Cost‐effectiveness analysis of sacral neuromodulation for faecal incontinence in the Netherlands

Aim Sacral neuromodulation (SNM) plays a major part in the algorithm of management of faecal incontinence, but there are limited data on its cost‐effectiveness. This study aimed to analyse this and the quality‐adjusted life‐years (QALYs) associated with two different treatment algorithms. The first (SNM?) included use of an artificial sphincter [dynamic graciloplasty (DGP) (50%) and artificial bowel sphincter (ABS) (50%)]. The second (SNM+) included SNM (80% of cases) and artificial sphincter (DGP 10%; ABS 10%) The incidence of sphincteroplasty was assumed to be equal in both algorithms. Method A Markov model was developed. A hypothetical cohort of patients was run through both strategies of the model. A mailed EuroQoL‐5D questionnaire was used to determine health‐related quality of life. Costs were reproduced from the Maastricht University Medical Centre prospective faecal incontinence database. The time scale of the analysis was 5 years. Results The former treatment protocol cost €22 651 per patient and the latter, after the introduction of SNM, cost €16 473 per patient. The former treatment protocol resulted in a success rate of 0.59 after 5 years, whereas with the introduction of SNM this was 0.82. Adhering to the former treatment protocol yielded 4.14 QALYs and implementing the latter produced 4.21 QALYs. Conclusion The study demonstrated that introducing SNM in the surgical management algorithm for faecal incontinence was both more effective and less costly than DGP or ABS without SNM. This justifies adequate funding for SNM for patients with faecal incontinence.     

Geographic factors are associated with increased risk for out-of hospital cardiac arrests and provision of bystander cardio-pulmonary resuscitation in Singapore

Background

Bystander Cardio-Pulmonary Resuscitation (BCPR) can improve survival for Out-of-Hospital Cardiac Arrest (OHCA). This study aimed to investigate the geographic variation of BCPR provision and survival to discharge outcomes among residential OHCA cases, evaluate this variation with individual and population characteristics and identify high-risk residential areas with low relative risk (RR) of BCPR and high RR of OHCA at the development guide plan (DGP) census tract levels in Singapore.

Methods

This was a retrospective, secondary analysis of two prospectively-collected registries in Singapore from 2001 to 2011. We used Bayesian conditional autoregressive spatial models to examine predictors at the DGP level and calculate smoothed RR to identify high-risk areas. We used multi-level mixed-effects logistic regression models to examine the independent effects of individual and neighborhood factors.

Results

We found a total of 3942 OHCA with a BCPR rate of 20.3% and a survival to discharge rate of 1.9% and 3578 cases eligible for BCPR. After adjusting for age, witnessed status, presumed cardiac etiology and longer response time, the risk of BCPR provision significantly increased by 0.02% for every 1% increase in the proportion of household size 5 and above in the DGP area (odds ratio1.02, 95%CI = 1.002–1.038, p < 0.026). We identified 10 high-risk residential areas with low RR of BCPR and high RR of OHCA.

Conclusion

This study informed that neighborhood household size could have played a significant role in the provision of BCPR and occurrence of high-risk areas. It demonstrates the public health potential of combining geospatial and epidemiological analysis for improving health.     

STZ联合饮食失节法诱导糖尿病胃轻瘫大鼠模型方法探讨

目的探讨以链尿佐菌素 (STZ)联合高热量不规则饮食诱导糖尿病胃轻瘫大鼠模型的制作方法.方法以 1% STZ按 50mg/kg的剂量给大鼠作左下腹腔一次性注射,并不规则喂食高热量饲料, 6周后测大鼠非空腹血糖变化和胃内残留率.结果造模组大鼠血糖值和胃内残留率显著高于对照组.结论 STZ联合饮食失节法可成功诱导糖尿病胃轻瘫大鼠模型.     

大剂量旋覆代赭汤治疗脾胃虚弱型糖尿病胃轻瘫临床观察

目的:观察旋覆代赭汤对糖尿病胃轻瘫(Diabetic gastroparesis,DGP)患者促胃肠动力作用量效关系研究。方法:将108例脾胃虚弱型患者随机分为治疗组:大剂量54例(一两为15.625g)和对照组54例,对照组药物口服吗丁啉,10mg,每日3次,连用4周;治疗组药物口服旋覆代赭汤,每日1剂,连用4周。免疫组化法观察治疗前后血浆中胃动素(MOT)、血管活性肠肽(VIP)、胃泌素(GAS)的分布变化。结果:治疗组血浆中MOT的含量显著升高(P<0.01)、VIP的表达明显减少(P<0.01)、显著降低血浆GAS表达(P<0.05)。结论:旋覆代赭汤的促胃肠动力作用可能与血浆中MOT的含量显著升高和VIP与GAS的表达降低有密切关系。     

半夏泻心汤桃核承气汤合方治疗糖尿病胃轻瘫的临床观察

目的：观察半夏泻心汤桃核承气汤合方治疗糖尿病胃轻瘫的临床疗效。方法：将60例糖尿病胃轻瘫患者随机分为治疗组和对照组,各30例。治疗组予半夏泻心汤桃核承气汤合方,对照组予吗丁啉口服。用药疗程均为30天。观察治疗前后胃排空率、血流变。结果：半夏泻心汤桃核承气汤合方能显著改善糖尿病胃轻瘫患者的胃排空功能和血液流变学的各项指标。结论：半夏泻心汤桃核承气汤合方治疗糖尿病胃轻瘫有显效。     

饮食护理干预对糖尿病性胃轻瘫患者血糖达标及胃排空的作用

目的探讨饮食护理干预对糖尿病性胃轻瘫(DGP)患者血糖达标及胃排空的作用。方法选取2015年1~12月门诊就诊的DGP患者72例,随机分为干预组和对照组。两组患者均予以药物控制血糖及适量运动等基础治疗。对照组患者予以常规饮食调整,干预组加以饮食护理干预,两组均干预12周。观察并比较两组患者干预后血糖达标的情况及临床效果,并随访观察其半年和1年的复发率。结果干预12周后,干预组患者FBG、2h PG和Hb A1C的达标率分别为94.44%、91.67%和86.11%,明显高于对照组的77.78%、72.22%和63.89%(P0.05),且干预组患者的临床总有效率为94.44%,明显高于对照组的75.00%(χ~2=5.21,P0.05)。干预后随访观察半年和1年,观察组患者的复发率分别为8.33%和19.44%,均明显低于对照组的27.78%和41.67%(χ~2=4.60、4.19,P0.05)。结论饮食护理干预用于DGP患者的近期疗效确切,有利于血糖及糖化血红蛋白的达标,促进胃排空,改善其临床症状,且其远期疗效亦较确切,能明显降低其复发率,具有减少或预防其复发的作用。     

基于血清代谢组学探讨香砂六君合半夏泻心汤治疗糖尿病胃轻瘫大鼠的作用机制

目的:采用血清代谢组学探讨香砂六君合半夏泻心汤治疗糖尿病胃轻瘫大鼠的作用机制。方法:除正常组外,其余大鼠给予腹腔注射链脲佐菌素及高脂饲料喂养建立糖尿病胃轻瘫大鼠模型。大鼠模型成功建立后随机分为模型组、莫沙比利组(1.56 mg·kg^-1)及香砂六君合半夏泻心汤组(9.3 g·kg^-1)。给予药物干预8周后,测定各组大鼠胃残留率;收集大鼠血清样本,采用GC-MS技术对血清样本进行高分辨质谱检测,应用PLS-DA多元模式进行血清代谢轮廓的比较以及生物标志物的鉴定,运用MetPa数据库分析相关代谢通路。结果:与正常组相比,模型组的胃残留率显著升高(P<0.01);香砂六君合半夏泻心汤组和莫沙必利组的胃残留率较模型组明显降低(P<0.05)。血清代谢组学结果显示:正常组和模型组的代谢轮廓具有明显的差异,香砂六君合半夏泻心汤组的代谢轮廓趋近正常组,并对血清中N-乙酰天门冬氨酸、葡萄糖-1-磷酸、塔格糖、3-6脱水-D-半乳糖、木糖醇和脯氨酸等13个生物标志物具有明显的回调作用,并筛选出2条相关的代谢通路。结论:香砂六君合半夏泻心汤对糖尿病胃轻瘫大鼠有一定改善胃动力作用,其作用机制可能与通过回调多种血清代谢产物的含量及调控多条代谢通路等相关。     

Synthetic Neoepitopes of the Transglutaminase–Deamidated Gliadin Complex as Biomarkers for Diagnosing and Monitoring Celiac Disease

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旋覆代赭汤治疗脾胃虚弱型糖尿病胃轻瘫量-效关系临床研究

[目的]研究旋覆代赭汤在治疗糖尿病胃轻瘫(Diabetic gastroparesis,DGP)患者时,促胃肠动力作用的量-效关系。[方法]将108例2010年2月至2012年1月我院门诊和住院脾胃虚弱型患者随机分为治疗组和对照组各54例。治疗组在基础治疗基础上,加服大剂量(1两为15.625g)旋覆代赭汤;对照组在基础治疗基础上,加服剂量(1两为3g)的旋覆代赭汤。两组用药均1剂/d,连用4周后判断疗效。免疫组化法观察治疗前后血浆中胃动素(MOT)、血管活性肠肽(VIP)、胃泌素(GAS)的分布变化。[结果]治疗组血浆中MOT的含量显著升高(P0.01)、VIP的表达明显减少(P0.01)、血浆GAS表达显著降低(P0.01)。[结论]旋覆代赭汤的促胃肠动力作用可能与血浆中MOT的含量显著升高和VIP与GAS的表达降低有密切的量-效关系。