American rules, OK: Difference and otherness in ‘Independence Day''

According to its advertisement copy, ‘Independence Day' delivers the ultimate encounter when powerful aliens launch an invasion against the human race. Does this ‘ultimate encounter' simply retrace the old fashioned Hollywood theme of good versus evil? Or is there a more sinister meaning woven into the text of the film? This paper deconstructs the narrative of the film to reveal the underlying monolithic, Americanised modernity and argues that ‘Independence Day' provides an allegorical legitimation for Pax Americana.     

Costs of hospital visits among patients with deep vein thrombosis treated with rivaroxaban and LMWH/warfarin

Background:

For many years, the standard of care for patients diagnosed with deep vein thrombosis (DVT) has been low-molecular-weight heparin (LMWH) bridging to an oral Vitamin-K antagonist (VKA). The availability of new non-VKA oral anticoagulants (NOAC) agents as monotherapy may reduce the likelihood of hospitalization for DVT patients.

Objective:

To compare hospital visit costs of DVT patients treated with rivaroxaban and LMWH/warfarin.

Methods:

A retrospective claim analysis was conducted using the MarketScan Hospital Drug Database for care provided between January 2011 and December 2013. Adult patients using rivaroxaban or LMWH/warfarin with a primary diagnosis of DVT during the first day of a hospital visit were identified (i.e., index hospital visit). Based on propensity-score methods, historical LMWH/warfarin patients (i.e., patients who received LMWH/warfarin before the approval of rivaroxaban) were matched 4:1 to rivaroxaban patients. The hospital-visit cost difference between these groups was evaluated for the index hospital visit, as well as for total hospital-visit costs (i.e., including index and subsequent hospital visit costs).

Results:

All rivaroxaban users (n?=?134) in the database were well-matched with four LMWH/warfarin users (n?=?536). The mean hospital-visit costs were $5257 for the rivaroxaban cohort and $6764 in the matched-cohort of patients using LMWH/warfarin. The $1508 cost difference was statistically significant between cohorts (95% CI?=?[?$2296; ?$580]; p-value?=?0.002). Total hospital-visit costs were lower for rivaroxaban compared to LMWH/warfarin users within 1, 2, 3, and 6 months after index visit (significantly lower within 1 and 3 months, p-values <0.05)

Limitations:

Limitations were inherent to administrative-claims data, completeness of baseline characteristics, adjustments restricted to observational factors, and lastly the sample size of the rivaroxaban cohort.

Conclusion:

The availability of rivaroxaban significantly reduced the costs of hospital visits in patients with DVT treated with rivaroxaban compared to LMWH/warfarin.     

叶酸受体介导靶向给药系统研究进展

靶向给药系统是诊断和治疗癌症的一种有效方法,因其副作用小、治疗效果好而受到广泛关注。叶酸受体在多数癌细胞表面过度表达,但在正常细胞表面低表达或未表达,与配体叶酸具有高度的亲和力。叶酸连接到药物载体上,可靶向作用于癌细胞。介绍了叶酸与叶酸受体,简述了叶酸受体介导靶向的作用机制,讨论了叶酸连接脂质体、胶束、纳米粒、聚合物载体、液晶叶酸纳米粒、负载药物通过叶酸受体介导诊治癌症的研究进展,分析了各自的优点和不足,提出了叶酸受体介导靶向给药系统的未来研究方向:一是对叶酸受体介导作用机制进行深入研究;二是对药物释放后载体的体内分布、代谢、排泄等过程做进一步探索;三是研究单一、易合成但高效的诊断或治疗剂,减少材料浪费,简化给药方式。     

LC-MS测定鸡肉中的24种β-受体激动剂的研究

采用LCMS联用方法测定鸡肉中的24种β-受体激动剂,结果表明:24种β-受体激动剂在0.100~10.000μg/L范围内线性良好;方法检出限和方法定量限分别介于0.004~0.025μg/kg和0.014~0.082μg/kg。     

固相萃取-液质联用分析饲料中24种β-受体激动剂类药物

本文建立了饲料中24种极性-中等极性β-受体激动剂类药物的可靠灵敏的检测方法。采用含乙腈-甲酸铵组合沉淀剂和正己烷双相提取净化,下层通过2%甲酸水溶液稀释后,经过混合阳离子交换固相萃取小柱(MCX)进一步净化。通过耐100%水相的反相C18色谱柱保留,UPLC-MS/MS电喷雾正离子模式下分析。结果表明,优化后的前处理方法能充分去除复杂基质的干扰,特异性好,灵敏度高。定量检测限范围在0.11μg/kg之间。基质添加曲线定量的线性良好,在猪饲料中3个添加水平的平均回收率范围在82.2%124.8%之间。添加回收重复性和日间精密度范围分别为0.8%14.9%和2.2%14.6%,均低于20%,符合欧盟2002/657/EC相关规定。     

Estimated cost savings associated with the use of valsartan in heart failure in a large US health plan

Summary

Results from a large, randomised clinical trial demonstrated reduced rates of hospitalisation and mortality, and reduced length of stay associated with valsartan added to the usual care of heart failure patients not currently receiving angiotensin-converting enzyme inhibitors (ACEIs). These results were used in a budget impact model for a large US health plan. Administrative claims data were used to estimate cost savings over 1 year. In the study health plan, 63,218 patients were identified with heart failure, with 55% not currently receiving ACEI or valsartan. Using health plan-specific cost data, care for the untreated heart failure patients with valsartan would reduce hospitalisation costs from $135 million to $43 million owing to averted heart failure-related hospitalisations and shortened length of stay for the remaining hospitalisations. Economic effects of other aspects of treatment with valsartan (e.g. outpatient or physician visits or adverse events) were not considered. Taking into account only hospitalisations and the costs of valsartan therapy, net savings in the study health plan would be expected to be $64 million.     

The burden of immune thrombocytopenia in adults: Evaluation of the thrombopoietin receptor agonist romiplostim

Abstract

Background:

Immune thrombocytopenia (ITP) is a chronic, immune-mediated disease characterized by a transient or long-lasting decrease in platelet counts. ITP is associated with numerous serious clinical consequences. Discussed here are clinical aspects of ITP, the humanistic and economic burden of ITP, and current treatment options with a focus on romiplostim, a thrombopoietin (TPO) receptor agonist. The aim of this review is to provide decision-makers with the background information necessary to evaluate the value of romiplostim.

Scope:

PubMed was searched for relevant, English-language papers published from January 2006 through November 2011 relating to the epidemiology and treatment options of chronic ITP, and, focusing on the TPO mimetic romiplostim, patient-reported outcomes (PRO) and economic burden. Recent select conference abstracts were also reviewed.

Findings:

The initial clinical management of ITP (e.g., corticosteroids, immunoglobulins) is often associated with adverse events and recommended for short-term use only. Splenectomy, a potentially curative second-line treatment, is associated with increased risks of bleeding and infection, and patients often require additional long-term drug intervention. ITP and its sequelae are associated with a substantial burden on patients’ health-related quality-of-life (HRQoL) and increased medical costs. Use of TPO receptor agonists in ITP patients may represent a more efficient use of healthcare resources than existing therapies.

Conclusion:

While this literature review is not a systematic review, e.g., it considers only approved therapies and published literature written in English, it provides a comprehensive overview of the clinical, humanistic, and economic factors that should be considered in treating ITP, particularly with new agents such as romiplostim. Among the limited number of safe and effective therapies currently available for chronic ITP, highly effective and well-tolerated medications such as romiplostim may reduce the healthcare resource utilization associated with ITP while improving patients’ HRQoL.     

Retrospective study comparing healthcare costs and utilization between commercially insured patients with type 2 diabetes mellitus who are newly initiating exenatide once weekly or liraglutide in the United States

Abstract

Objective:

To compare healthcare costs and utilization between commercially insured patients with type 2 diabetes mellitus (T2DM) in the United States newly initiating exenatide once weekly (QW) or liraglutide.     

慢性高眼压动物模型视网膜中睫状神经生长因子及其受体的表达

目的观察慢性高眼压动物模型视网膜中CNTF及CNTFRα的定位及表达变化。方法选取健康新西兰大白兔为实验对象建立兔慢性高眼压模型。选取造模成功的24只(48眼)兔慢性高眼压眼,随机分为4组慢性高眼压模型组,每组6只(12眼),分别存活7、14、21、28d。另设正常兔6只(12眼)为假手术对照组(简称对照组)。免疫组织化学染色方法测定兔视网膜中CNTF及CNTFRα的定位及表达变化。结果在对照组中,RGCs层均有大量的CNTF及CNTFα存在,在其它各层也存在散在颗粒状分布的CNTF及CNTFRα。慢性高眼压损伤后,CNTF及CNTFRα在视网膜各层显著增加,并呈弥漫性分布,造模后7、14d与正常对照组比较相差非常显著(P<0.01)。在造模后7d,是CNTF及CNTFRα在视网膜各层表达的高峰,在造模后28d两者的表达均显著高于正常对照组(CNTF:P<0.05;CNTFR:P<0.05)。结论慢性高眼压损伤导致视网膜CNTF和CNTFRα表达量的增加和分布的改变。     

A new angle for glp-1 receptor agonist: the medical economics argument

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are relatively new medications for diabetes that offer a weight-loss profile that can be considered desirable for patients with both type 2 diabetes (T2D) and obesity. GLP-1 RA are effective in combination with insulin, and even slightly superior or at least equal to short-acting insulin in T2D; however, since they work in the incretin system, they may not be effective in long-standing disease. Additionally, only recently have publications reported their cardiovascular safety, and there is limited evidence for long-term effectiveness. The work presented by Huetson et al. offers a much needed perspective through a medical economic model for the long term cost-effectiveness of GLP-1 RA. The authors found benefits in quality-adjusted life years and reduced lifetime healthcare costs. While there are a few limitations, this study contributes to the understanding of these agents and their impact on the epidemics of obesity in T2D, where weight management is no longer an option, but an essential component of the diabetes plan of care.