胃蛋白酶原亚群测定与萎缩性胃炎相关性研究及效价比分析

目的：研究血清中胃蛋白酶原（pepsinogen）亚群（PGⅠ、PGⅡ）含量在健康体检者及胃部疾病患者中的水平,探讨血清中PG亚群测定对萎缩性胃炎及胃癌早期诊断的意义。方法：利用放射免疫法（RIA）测定35例健康体检者、18例胃溃疡患者、30例萎缩性胃炎患者、30例胃癌患者中PGⅠ、PGⅡ及PGⅠ／PGⅡ值的变化,在正常组（健康体检者）与各疾病组之间进行统计学比较,并比较胃蛋白酶原检测与胃镜和（或）病理检查费用的效价比。结果：（1）与正常组相比,消化性溃疡患者PGⅠ、PGⅡ升高,且PGⅡ增高明显,PGⅠ／PGⅡ比值降低;萎缩性胃炎组和胃癌组PGⅠ水平均呈下降趋势,但PGⅡ水平变化不明显,PGⅠ／PGⅡ比值下降。（2）与溃疡组相比,萎缩性胃炎和胃癌患者PGI、PGⅡ及PGⅠ／PGⅡ比值均明显降低。（3）与萎缩性胃炎组相比,胃癌患者PGⅠ、PGⅡ及PGⅠ／PGⅡ比值虽略低于萎缩性胃炎,但差异无统计学意义。（4）PGⅠ≤80ng／mL且PGⅠ／PGⅡ≤5时,检出萎缩性胃炎的特异度和灵敏度分别为94．3％和53．3％。结论：（1）血清PGⅠ和PGⅠ／PGⅡ比值的降低,是萎缩性胃炎及胃癌人群筛查和辅助诊断的一项血清学指标。（2）血清PGⅠ≤80ng／mL且PGⅠ／PGⅡ≤6检测萎缩性胃炎具有较好的特异度和灵敏度。（3）测定血清中PG亚群的方法简单易行,适用于初筛及胃镜检查禁忌者,且与直接行胃镜并取病理检查相比较为经济。     

自拟中药方剂养胃汤加减治疗慢性萎缩性胃炎患者的疗效

目的探讨自拟中药方剂养胃汤加减治疗慢性萎缩性胃炎患者的疗效。方法选取2018年11月至2019年11月营口市中医院收治的100例慢性萎缩性胃炎患者作为研究对象,随机分为胃复春片组与联合用药组,各50例。胃复春片组给予胃复春片,联合用药组在对照组治疗基础上采用自拟中药方剂养胃汤加减治疗,比较两组中医证候积分,炎症介质及胃泌素-17(G-17)、胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)水平,一氧化氮(NO)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平及不良反应。结果治疗后联合用药组胃刺痛、胃脘胀满、食少纳呆、消瘦及乏力积分低于胃复春片组(P<0.05);治疗后,联合用药组CRP、TNF-α及IL-6水平低于胃复春片组(P<0.05),G-17、PGⅠ、PGⅡ高于胃复春片组(P<0.05);治疗后,联合用药组NO、SOD水平高于胃复春片组(P<0.05),MDA水平低于胃复春片组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论自拟中药方剂养胃汤加减治疗慢性萎缩性胃炎能有效缓解患者症状,减轻机体炎症反应,未增加不良反应发生率。     

Cost of NSAID adverse effects to the UK National Health Service

Summary

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal problems, notably dyspepsia and bleeding. These adverse effects are costly both in terms of acute hospital admissions and in co-prescribing of gastroprotective agents. The costs of these interventions has been estimated for the National Health Service (NHS) in the UK on the basis of a typical Primary Care Group (PCG) of 100,000 people, the whole population, and for the average patient prescribed an NSAID. The annual burden of NSAID-related gastrointestinal adverse effects to the NHS is large. The middle estimate for an average PCG was £435,000 (range £290,000 to £633,000). The middle estimate for the UK was £251 million (range £166 million to £367 million). The middle cost per patient prescribed an NSAID was £48 (range £32 to £70). As much as half of all acid-suppressing prescribing in the UK may be for NSAID-related gastrointestinal effects.     

Carcinoma of the ampulla of Vater: Sonographic and CT diagnosis

Twenty patients with carcinoma of the ampulla of Vater were studied with sonography (N = 9) or both sonography and CT (N = 11). The tumor was shown by sonography in 16 patients (80%) as a small, round or oval, fairly well delineated mass in between the dilated distal common bile duct and duodenum which was delineated owing to luminal fluid or gas (N = 13); or as a polypoid mass within the dilated distal common bile duct resulting in abrupt obstruction (N = 3). In the remaining four patients, the mass was not delineated. Bile ducts were dilated down to the level of mass or ampullary region in all cases (100%), while the pancreatic duct was dilated in five cases (45%). We believe that sonography is the technique of initial choice in the diagnosis of carcinoma of the ampulla of Vater by identifying the mass at the distal end of the dilated common bile duct and/or pancreatic duct.     

Are labour-intensive efforts to prevent pressure ulcers cost-effective?

Abstract

Background:

Pressure ulcers are a major problem in Danish healthcare with a prevalence of 13–43% among hospitalized patients. The associated costs to the Danish Health Care Sector are estimated to be €174.5 million annually. In 2010, The Danish Society for Patient Safety introduced the Pressure Ulcer Bundle (PUB) in order to reduce hospital-acquired pressure ulcers by a minimum of 50% in five hospitals. The PUB consists of evidence-based preventive initiatives implemented by ward staff using the Model for Improvement.

Objective:

To investigate the cost-effectiveness of labour-intensive efforts to reduce pressure ulcers in the Danish Health Care Sector, comparing the PUB with standard care.

Methods:

A decision analytic model was constructed to assess the costs and consequences of hospital-acquired pressure ulcers during an average hospital admission in Denmark. The model inputs were based on a systematic review of clinical efficacy data combined with local cost and effectiveness data from the Thy-Mors Hospital, Denmark. A probabilistic sensitivity analysis (PSA) was conducted to assess the uncertainty.

Results:

Prevention of hospital-acquired pressure ulcers by implementing labour-intensive effects according to the PUB was cost-saving and resulted in an improved effect compared to standard care. The incremental cost of the PUB was ?€38.62. The incremental effects were a reduction of 9.3% prevented pressure ulcers and 0.47% prevented deaths. The PSAs confirmed the incremental cost-effectiveness ratio (ICER)’s dominance for both prevented pressure ulcers and saved lives with the PUB.

Conclusion:

This study shows that labour-intensive efforts to reduce pressure ulcers on hospital wards can be cost-effective and lead to savings in total costs of hospital and social care.

Key limitations:

The data included in the study regarding costs and effects of the PUB in Denmark were based on preliminary findings from a pilot study at Thy-Mors Hospital and literature.     

Fluctuations in convex models of endogenous growth, I: Growth effects

Is there a trade-off between fluctuations and growth? The empirical evidence is mixed, with some studies finding a positive relationship, while others find a negative one. Our objectives are to understand how fundamental uncertainty affects the long run growth rate and to identify important factors determining this relationship in a convex endogenous growth model. Qualitatively, we show that the relationship between volatility in fundamentals (or policies) and mean growth can be either positive or negative. The curvature of the utility function is a key parameter that determines the sign of the relationship. Quantitatively, an increase in uncertainty always increases the growth rate in our calibrated models. Though the changes we find are nontrivial, they are not large enough by themselves to account for the large differences in growth rates observed in the data. We also find that differences in the curvature of preferences have very substantial effects on the estimated variability of stationary objects like the consumption–output ratio and hours worked. For this reason, we expect that the models considered in this paper will provide the basis of sharp estimates of the curvature parameter.     

Yield spreads,currency movements,and recession predictability for southern border economies in the United States

Prior research establishes that the spread between long- and short-term bond yields often provides valuable information for predicting business cycle downturns. This study examines the predictive capacity of the yield spread for the United States metropolitan economies situated along the border with Mexico. Because of the location of these urban economies and various economic ties linking them with twin cities across the border, the Mexico yield spread, and the real dollar/peso exchange rate are also employed as potential recession predictors. Results suggest that a flattening of the yield curve for either country tends to increase the probability of recessions in border economies. Furthermore, declines in the real value of the peso, which are typically associated with greater cross-border manufacturing activity, are found to reduce recession likelihoods in the metropolitan economies examined on the north side of the international boundary.     

Economic outcomes among Medicare patients receiving bioengineered cellular technologies for treatment of diabetic foot ulcers

Abstract

Objective:

To assess the real-world medical services utilization and associated costs of Medicare patients with diabetic foot ulcers (DFUs) treated with Apligraf (bioengineered living cellular construct (BLCC)) or Dermagraft (human fibroblast-derived dermal substitute (HFDS)) compared with those receiving conventional care (CC).     

复方大黄制剂结合三联疗法治疗幽门螺杆菌感染疗效观察

目的观察中西医结合根除幽门螺杆菌的疗效。方法经胃镜和组织学检查,选择120例HP阳性的消化性溃疡或慢性萎缩性胃炎患者,随机分为两组,对照组采用标准三联疗法,治疗组采用标准三联的同时口服复方大黄制剂,疗程为1周,4周后复查胃镜及14C尿素呼气试验或快速尿素酶试验。结果中西医结合治疗组的根除率及胃镜组织学治愈好转率较标准三联对照组均有明显的提高,并有统计学意义,P〈0.05。结论复方大黄制剂可以提高幽门螺杆菌的根除率,并且促进胃炎、消化性溃疡患者的组织学修复,不良反应少。     

INSTITUTIONAL CHANGES NOW AND BENEFITS TOMORROW: HOW SOON IS TOMORROW?

This paper investigates the timing of the impact of changes in checks and balances on macroeconomic efficiency in a panel of countries. Using Battese and Coelli's one-stage approach, we find that increasing checks and balances results in greater efficiency. Furthermore, the impact of institutional changes on efficiency is delayed, with a full effect showing after five to six years. This finding remains robust after distinguishing developed and developing countries, including country-fixed effects and using alternative functional forms of the production frontier and alternative measures of checks and balances. The relation is also robust to controlling for endogeneity.     

On recursive utility and the superneutrality of money

This paper investigates whether a change in the growth rate of the money supply enhances the rate of capital accumulation in a cash-in-advance monetary model with recursive utility. Although money is superneutral in the steady state, the effect of the growth rate of money supply on the speed of capital accumulation depends not only on the curvature of the felicity, but also on the slope and curvature of the discount rate function. We find that when the discount rate decreases with consumption and the elasticity of marginal utility is greater than unity, inflation yields a slower speed of capital accumulation.     

Cost effectiveness of adding clostridial collagenase ointment to selective debridement in individuals with stage IV pressure ulcers

Objective: The purpose of this study was to determine the cost effectiveness (from a payer’s perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry.

Methods: A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years.

Results: Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of ?$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient.

Conclusions: In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost.     

Isolated gastric varices: Ultrasound detection

Isolated gastric varices (IGV) (resulting from varying etiologies) were diagnosed in six patients using ultrasound examination of the wall of the fluid-filled stomach. Small gastric varices are seen as circular or linear anechoic channels within the gastric wall without a significant intraluminal projection. Large varices are seen as anechoic, lobulated “bulging masses” projecting into the fluid-filled lumen of the stomach. Doppler technique assists in confirming the vascular nature of these lesions and thus avoids confusion with other hypoanechoic lesions of the gastric wall. The technique is simple, noninvasive, and extremely useful in diagnosing IGV in patients investigated for recurrent undiagnosed gastrointestinal bleeding.     

What should you pay to host a party? An economic analysis of hosting sports mega-events

Governments all over the world put huge amounts of money into bidding for, and then hosting, sports events like Football’s World Cup or the Olympic Games. They also give money to professional sports teams and other mega-events to encourage them to locate within a particular constituency. This article examines the statistical relationship between tourism and three Football World Cups and five Olympic Games, finding very little positive effect. Given this conclusion, the article looks at why governments continue to bid for these competitions. It presents evidence that shows that these sports contests make people happy, and argues that politicians capitalize on this feel-good factor; harnessing the hubris associated with these events for political gain. The article then contends that the best way to reduce the politics associated with bidding for mega-events is to allocate them via an auction, rather than the wasteful rent-seeking methods that are currently used.     

Small bowel enema and diagnosis of chronic nonischemic disturbance of superior mesenteric venous blood flow

Chronic nonischemic disturbance of mesenteric venous blood flow is reported in 11 patients with a mean age of 19 years. This entity, rarely discussed n the literature, is different from acute thrombosis and chronic thrombotic forms with portal hypertension or hypercoagulopathy. In eight patients this syndrome was secondary to organic lesions of different origin: mesenteric vein squeezed by fibrous bands or an abnormal jejunal artery (four cases), lymphoma involving the distal superior mesenteric veins (three cases), hemangioma causing microthrombi (one case). In three patients no etiology or predisposing factor was found. All patients presented with rectal hemorrhage. Small bowel enema showed a constant pattern in 11 patients: small nodules, modified by compression or peristalsis, involving the mesenteric border of the jejunoileal segment, and associated with thick, straight but regular folds. Mesenteric varices were suspected and led to angiographic studies which were normal in three cases, confirmed varices in eight cases, and thrombosis in four cases. Laparotomy was normal in three cases and established the etiological diagnosis in eight cases. Varices were shown in six cases. Arteriography and laparotomy were unable to reach a complete diagnosis.     

Impact of league restructuring on team sport attendances: the case of rugby league

An econometric analysis of attendances at Rugby Footbal League matches, in England, over the period 1966–1990 is presented. The major finding is that the move from one to two leagues, in 1973, had a substantial impact on attendances. Teams in the upper league experienced greater attendances ceteris paribuswhilst those in the lower league had reduced attendances.     

Optimal Taxation for Polluting Oligopolists with Endogenous Market Structure

This paper examines the optimal output taxes for polluting oligopolists under endogenous market structure, in the presence of external costs that vary exogenously with aggregate output. For general functional forms, we show that (i) the equilibrium number of firms in an industry may differ from the socially optimal number of firms and (ii) the second-best optimal taxes under imperfect competition could be less than, equal to, or greater than marginal external damages depending upon the curvature of market demand.     

Australian financial firms’ exposures to the level,slope, and curvature of the interest rate term structure

This study examines the risk exposure of Australian financial firms to changes in the term structure of interest rates. Non-linearity in the interest rate term structure is captured by the three-factor model of interest rate level, slope, and curvature. We observe that financial firms have negative exposures to the interest rate level, while non-financial firms have positive exposures. This finding suggests that financial firms need to hedge against rising interest rates, while non-financial firms need to hedge against falling interest rates. Small banks and insurance companies have a positive risk exposure to the slope factor, while real estate firms have a negative risk exposure to the curvature factor. Though the interest rate level is the most important factor, ignoring the slope and curvature factors could lead to underestimating a financial firm’s overall interest rate risk exposure. These findings are robust to controlling for the orthogonalized market return, time-varying equity risk premium, and the global financial crisis. This study offers practical tools to regulators, such as the Reserve Bank of Australia and Australian Prudential Regulatory Authority for assessing interest rate risk exposures of the financial and non-financial sectors.     

Educated dictators attract more foreign direct investment

Since political risk is greater in dictatorships than in democracies, this paper investigates the hypothesis that foreign investors scrutinize public information on dictators to assess this risk. It checks whether foreign investors use five relevant dictators’ characteristics: age, political experience, education level, education in economics, and prior experience in business. The study is performed on a sample of 100 dictatorial countries from 1973 to 2008. We find that educated dictators are more attractive to foreign investors. We obtain strong evidence that greater educational attainment of the leader is associated with higher FDI. We also find evidence that the leader having tertiary education in economics and prior experience in business is associated with greater FDI. By contrast, the leader's age, and political experience have no relationship with FDI.     

Flattening of the New Keynesian Phillips curve: Evidence for an emerging,small open economy

The flattening of the Phillips curve is a vigorously investigated phenomenon in many advanced economies. Still little evidence has been presented for emerging, small open economies facing persistently low inflation. In this paper I address this issue through rigorous estimation of a substantial number of stylized, open-economy hybrid new Keynesian Phillips curves for Poland. I find robust evidence of the flattening of the Phillips curve and the rising impact of external factors for both headline and core inflation. I conclude that during excessive disinflation in Poland the flattening of the Phillips curve can be partly explained by the underutilization of labour, whereas the stronger impact of global factors on core inflation suggests strengthening indirect effects. The changes in the estimated parameters indicate that the macroeconomic cost of bringing inflation back to the desired target has increased. Further identification of the reasons behind the flattening of the Phillips curve in an emerging, small open economy should provide useful insights for monetary policy.