海德堡激光扫描仪对糖尿病黄斑水肿治疗前后的疗效观察

糖尿病视网膜病变（DR）是最常见的视网膜血管疾病,而在DR中黄斑水肿是常见引起视力下降病因,具有隐匿性,常引起患者视力下降,会造成视网膜组织不可逆的损伤。因此早发现,早干预对DR 患者视力恢复有极其重要的意义。HRT-Ⅱ具有非侵入性,可重复性等特点,且能检测黄斑区视网膜厚度,具有定量检测的特点,是上述其它检查所无法比拟的,我院采用海德堡激光眼科诊断仪对DME 患者治疗前后黄斑区神经上皮厚度的测定来观察治疗效果。     

超脉冲二氧化碳点阵激光面部换肤治疗的临床观察

目的评价超脉冲二氧化碳点阵激光面部换肤进行治疗的临床效果。方法选择2012年11月至2013年11月我院门诊所收治的24例患者,均采用超脉冲二氧化碳点阵激光面部换肤治疗。结果治疗凹陷性痤疮瘢痕6例,均治疗2次,显效4例,有效2例;痤疮10例,显效8例,有效2例;光老化4例,显效3例,有效1例;毛孔粗大4例,有效3例,无效1例。本组患者在治疗后均出现了轻度水肿、红斑、疼痛、灼热的情况,但经过冷喷治疗及冰块冷敷后均得到明显减轻。结论凹陷性痤疮瘢痕、毛孔粗大、光老化皮肤、面部痤疮均可采用超脉冲二氧化碳点阵激光换肤进行治疗,安全有效,且色素减退和瘢痕形成的风险较低,尤其是对于治疗皮肤老化及以粉刺为主痤疮的临床效果较佳。     

老年患者麻醉临床应用分析

目的通过对我院围手术期老年患者不同方式的麻醉,探讨老年患者麻醉的处理及并发症的控制与预防。方法将我院133例需手术治疗的老年患者根据具体情况采取适合的麻醉方式,分别观察不同方式麻醉后的血压、心率、血氧饱和度变化及镇痛的效果。结果三组麻醉方式均存在血流动力学变化,但全麻相对较硬膜外麻醉与局部神经阻滞发生少,镇痛效果明显。结论老年人在选择麻醉手术方式应根据自身的情况具体分析,一定要保证手术麻醉的安全性,维持血流动力学稳定,全麻为老年患者首选的麻醉方法。     

杞菊地黄丸对孔源性视网膜脱离复位术后患者视网膜功能和形态的影响

目的观察杞菊地黄丸对孔源性视网膜脱离复位术后视网膜功能和黄斑视网膜形态的干预效果。方法采用前瞻随机对照研究方法将60例(60眼)RD术后患者分为治疗组和对照组,每组30例(30眼)。应用光学相干断层扫描(OCT)和视网膜电图(ERG)方法观察术后1、2、4、8周视网膜功能和形态的改变。结果 OCT检查表明,治疗组黄斑视网膜厚度在术后第4周明显改善,而对照组为术后第8周。与术后第1周ERG b波比较,治疗组第2周ERG b波即有显著的改变,而对照组延迟到第8周。术后第8周治疗组患者的最佳矫正视力与对照组的差异有统计学意义(P<0.05)。结论杞菊地黄丸在一定程度上能促进RRD术后视功能恢复和黄斑视网膜形态的改变。     

年龄相关性黄斑变性患者护理问题与对策

年龄相关性黄斑变性(AMD)是一种多发于45岁以上患者的黄斑区视网膜组织退行性病变[1],在临床上分为两型,即萎缩性和渗出性。萎缩性病变发展缓慢,现尚无有效的治疗方法。渗出性病变虽然发病率低,但对视力危害大,表现为脉络膜新生血管及黄斑部出血、渗出。目前治疗以光动力治疗及手术方法为主。随着我国人均寿命的延长及社会老龄化的到来,AMD的人数逐渐增多,已成为我国老年人的主要致盲性眼病之一,威胁着老年人     

以色列开发出新的激光恢复视力仪

以色列科学家用一种巧妙的方法将一种激发物激光发送到眼睛底部治疗可能导致视力失明的视网膜脱落取得成功。 传统的治疗视网膜脱落的方法是用手术刀、剪刀和镊子等手术器械。现在,以色列耶路撒冷的Hadassan医学中心已经开始应用激光发送仪来进行手术治疗。     

雷珠单抗和康柏西普玻璃体腔注射治疗视网膜分支静脉阻塞引起的黄斑水肿患者的有效性

目的探讨雷珠单抗和康柏西普玻璃体腔注射治疗视网膜分支静脉阻塞(BRVO)引起的黄斑水肿的有效性。方法选取2017年12月至2019年12月常熟市第一人民医院收治的132例BRVO所引发的黄斑水肿患者为研究对象,按照治疗方法不同分为对照组与观察组,各66例。对患者开展眼底血管荧光造影(FFA)、最佳矫正视力(BCVA)以及光学相干断层成像(OCT)检查分析。对照组患者应用雷珠单抗玻璃体腔注射治疗,观察组应用康柏西普玻璃体腔注射治疗,比较两组的治疗结果。结果与对照组比较,观察组注射次数更少,差异有统计学意义(P<0.05)。与干预前比较,两组患者干预后1、3、6及12个月黄斑中心凹厚度(CMT)下降,差异有统计学意义(P<0.05);各随访时间点组间比较差异无统计学意义(P>0.05)。干预后1、3、6及12个月,两组BCVA与干预前比较升高,差异有统计学意义(P<0.05);各随访时间点组间比较差异无统计学意义(P>0.05)。对照组以及观察组分别有2例患者出现球结膜下出血情况,未经特别处理,遂即好转。两组不良反应发生率比较差异无统计学意义(P>0.0...     

芪明颗粒治疗单纯型糖尿病视网膜病变疗效分析

目的评价芪明颗粒治疗单纯型糖尿病视网膜病变的临床疗效。方法抽取我院2011年1月~2013年3月收治的68例单纯型糖尿病视网膜病变患者,随机均分为对照组和实验组,对照组患者给予常规性治疗,实验组患者在对照组治疗的基础上再给予中成药芪明颗粒,治疗前、后分别对两组患者行常规眼科检查、眼底荧光造影和眼底检查,比较两组疗效。结果实验组治疗总有效率为91.2%,对照组治疗总有效率为61.8%,组间有统计学差异(P<0.05)。结论芪明颗粒在治疗单纯型糖尿病视网膜病变方面具有较好的临床效果,具有临床推广价值。     

血塞通在视网膜静脉阻塞中的临床应用

目的观察研究血塞通在视网膜静脉阻塞中的临床应用。方法回顾性分析48例48眼视网膜静脉阻塞患者的临床资料,应用中药血塞通静脉滴注,同时辅以维生素类、ATP、肌苷进行辅助治疗,并加强对高血压和糖尿病等原发病的共同治疗。结果 48例48眼患有视网膜静脉阻塞的患者,经过血塞通治疗,总有效率87.5%。结论应用血塞通治疗视网膜静脉阻塞是一种行之有效的治疗方法,值得在临床中推广应用。     

桃红四物汤在激光治疗糖尿病性黄斑水肿中的应用

目的观察桃红四物汤配合激光治疗糖尿病性黄斑水肿的临床疗效。方法将符合标准的72例患者（129眼）分为观察组35例（61眼）和对照组37例（68眼），对照组采用激光治疗和常规西医处理，观察组在对照组治疗的基础上加用中药桃红四物汤加味进行治疗。结果观察组显效24眼，显效率39.34%，总有效率96.72%。对照组显效15眼，显效率22.06%，总有效率83.82%。两组比较，显效率和总有效率差异均有显著性意义（P＜0.05）。两组视力与本组治疗前比较，差异有显著性意义（P＜0.05，P＜0.01）。两组比较，术后1周视力差异无显著性意义（P＞0.05），术后4周视力差异有显著性意义（P＜0.05）。观察组眼压降低时间快于对照组，术后第1周与对照组比较，差异有显著性意义（P＜0.05）。两组患者黄斑厚度与本组治疗前比较，差异有非常显著性意义（P＜0.01）。两组比较，有显著性意义（P＜0.05）。结论桃红四物汤配合激光治疗糖尿病性黄斑水肿，能促进黄斑水肿的吸收，提高患者视力，缩短病程，疗效优于单纯激光治疗。     

Cost-effectiveness of ranibizumab in the treatment of visual impairment due to diabetic macular edema

Objective Ranibizumab, an anti-vascular endothelial growth factor designed for ocular use, has been deemed cost-effective in multiple indications by several Health Technology Assessment bodies. This study assessed the cost-effectiveness of ranibizumab monotherapy or combination therapy (ranibizumab plus laser photocoagulation) compared with laser monotherapy for the treatment of visual impairment due to diabetic macular edema (DME).

Methods A Markov model was developed in which patients moved between health states defined by best-corrected visual acuity (BCVA) intervals and an absorbing ‘death’ state. The population of interest was patients with DME due to type 1 or type 2 diabetes mellitus. Baseline characteristics were based on those of participants in the RESTORE study. Main outputs were costs (in 2013 CA$) and health outcomes (in quality-adjusted life-years [QALYs]) and the incremental cost-effectiveness ratio (ICER) was calculated. This cost-utility analysis was conducted from healthcare system and societal perspectives in Quebec.

Results From a healthcare system perspective, the ICERs for ranibizumab monotherapy and combination therapy vs laser monotherapy were CA$24 494 and CA$36 414 per QALY gained, respectively. The incremental costs per year without legal blindness for ranibizumab monotherapy and combination therapy vs laser monotherapy were CA$15 822 and CA$20 616, respectively. Based on the generally accepted Canadian ICER threshold of CA$50 000 per QALY gained, ranibizumab monotherapy and combination therapy were found to be cost-effective compared with laser monotherapy. From a societal perspective, ranibizumab monotherapy and combination therapy provided greater benefits at lower costs than laser monotherapy (ranibizumab therapy dominated laser therapy).

Conclusions Ranibizumab monotherapy and combination therapy resulted in increased quality-adjusted survival and time without legal blindness and lower costs from a societal perspective compared with laser monotherapy.     

注射用七叶皂苷钠治疗脑水肿患者的真实世界研究

目的 探索真实世界中注射用七叶皂苷钠和甘露醇用于治疗脑水肿的安全性、住院情况和治疗费用.方法 通过电子病历数据库分析七叶皂苷钠和甘露醇在真实世界中的使用,数据库研究方法主要为回顾性队列研究,分为七叶皂苷钠单药组、甘露醇单药组和两药联合组.结果 3组患者数分别为138、2049、175例.不同级别的医院和不同科室在使用七...     

A United Kingdom-based economic evaluation of ranibizumab for patients with retinal vein occlusion (RVO)

Objective:

This study compares the cost-effectiveness of intravitreal ranibizumab vs observation and/or laser photocoagulation for treatment of macular edema secondary to retinal vein occlusion in a UK-based model.

Methods:

A Markov model was constructed using transition probabilities and frequency of adverse events derived using data from the BRAVO, CRUISE, and HORIZON trials. Outcomes associated with treatments and health states were combined to predict overall health costs and outcomes for cohorts treated with each option.

Results:

In branch retinal vein occlusion, ranibizumab produced a gain of 0.518 quality-adjusted life years at an incremental cost of £8141, compared with laser photocoagulation. The incremental cost-effectiveness ratio was £15,710 per quality-adjusted life year, and the incremental cost per month free from blindness was £658. In central retinal vein occlusion, ranibizumab produced a gain of 0.539 quality-adjusted life years at an incremental cost of £9216, compared with observation only. The incremental cost-effectiveness ratio was £17,103, and the incremental cost per month free from blindness was £423.

Conclusions:

These incremental cost-effectiveness ratios are below the £20,000–30,000 range typically accepted as a threshold for cost-effectiveness. This suggests that ranibizumab may be regarded as a cost-effective therapy for patients with macular edema secondary to retinal vein occlusion, relative to grid laser photocoagulation (for BRVO) and observation (for CRVO). Limitations include sparse data for utilities associated with the severity of visual impairment in the WSE in patients with RVO. A lack of direct comparative evidence between ranibizumab and the dexamethasone intravitreal implant for the treatment of BRVO and CRVO and the infeasibility of an indirect comparison due to significant heterogeneity in trial designs prevented the inclusion of this treatment as a comparator in the Markov model.     

托拉塞米与呋塞米治疗脑出血后急性脑水肿患者的临床效果

目的 探讨托拉塞米和呋塞米治疗脑出血后急性脑水肿患者的临床效果.方法 选取2015年6月至2018年3月解放军第四六三医院收治的脑出血后急性脑水肿患者68例作为研究对象,随机分为观察组与对照组,每组34例.两组给予甘露醇、水、电解质与营养支持等基础治疗.对照组在基础治疗上给予呋塞米进行治疗,观察组在基础治疗上采用托拉塞...     

基于延伸售后保证的第三方物流运作模式

提出将延伸售后服务保证外包于第三方物流,并构建了最优化模型。发现:在延伸售后服务市场中,应根据消费者价值采取不同的延伸售后保证策略;对制造商和第三方物流服务提供商的成本进行对比的结果表明,将延伸售后保证服务外包给第三方物流服务提供商可有效降低制造商的成本,同时可增强第三方物流服务提供商的综合竞争能力。最后探讨了延伸售后保证外包于第三方物流服务提供商的运作模式。     

供应链合作关系对供应链绩效的影响——基于长三角企业的实证研究

供应链合作关系中的信任和未来期许均对于供应链运作绩效中的产品质量和客户服务水平具有正向影响作用,而对于产品具有负向作用。但是供应链合作关系中的合作意愿仅仅对于产品质量和客户服务水平具有正向影响作用,但是对于成本的影响没有通过原来的假设。因此对于企业而言,要提高供应链运作绩效的水平,应综合考虑供应链合作关系的维度,可根据实际情况加强各种合作行为,全面提升双方合作的绩效。     

Modelling the lifetime economic consequences of glaucoma in France

Abstract

Objective: To estimate the lifetime economic consequences of glaucoma in France.

Methods: A Markov model estimated the average discounted outcome and cost of glaucoma treatment over a patient's lifetime. Clinical states were defined as first- to fourth-line drugs, no treatment, laser therapy, surgery, blindness and death. After each failure (always after the fourth-line drug) patients could receive either laser treatment or surgery followed by no treatment, or a new treatment. A societal perspective was adopted. Sensitivity analyses were performed.

Results: Discounted medical costs were €7,322 for ocular hypertension treatment (OHT) and €8,488 for a glaucoma patient. Social costs of OHT and glaucoma patients exceeded medical costs. First-line use of the most effective drug would reduce medical and social costs. Societal willingness to pay for the vision benefit would equal the medical costs. Treatment initiated with the most effective drug is a cost saving strategy.

Conclusions: Public health decisions in glaucoma treatment should take a broad economic view embracing the lifetime duration of the disease. There is still a place both within and outside the healthcare system for therapeutic innovations with important economic consequences that bring high added value to patients.     

复杂网络视角下的货币政策多目标体系研究

货币政策是各国进行宏观经济调控的重要手段之一。深入研究货币政策多目标之间的相互作用,对于正确理解货币政策的作用机制,从而使货币政策更好地发挥经济调控作用具有重大意义。运用复杂网络的系统科学方法,选用我国1993-2012年经济金融数据,对我国货币政策多目标之间的作用机制进行实证研究。结果表明：我国货币政策多目标体系具有明显的小世界特征;当前经济形势下,利率传导机制将扮演越来越重要的角色,同时,应继续坚持以控制通货膨胀作为我国货币政策调控的首要目标。     

公司治理结构模式的国际比较及其对我国的启示

本文通过全面回顾公司治理的相关文献,在对当今世界各国几种主要的公司治理结构模式进行比较分析的基础上,根据我国公司治理的具体环境和实际情况,明确提出完善我国国有企业公司治理结构应当吸收一批具有相当治理能力的大股东的参与,从而可以形成。一种双赢的局面;对于民营企业而言,家族式治理仍然是现阶段公司治理的主导模式。     

盐酸米诺环素联合Er,Cr:YSGG激光治疗慢性牙周炎的临床效果及对患者炎症介质的影响

目的 探讨盐酸米诺环素联合Er,Cr:YSGG激光治疗慢性牙周炎的临床效果及对患者炎症介质的影响.方法 选取2019年1月至2020年6月鞍山市中心医院收治的84例慢性牙周炎患者作为研究对象,采用随机数字表法分为对照组与观察组,各42例.对照组予以龈上洁治、龈下刮治与盐酸米诺环素治疗,观察组42例加用Er,Cr:YSG...