中药治疗缺血性脑卒中研究进展

缺血性脑卒中的发病率逐年上升,其病情凶险,病死率、致残率高.目前,针对此病尚无特异性手段.本文首先从葛根、丹参、川芎、当归、银杏、三七等方面分析了单味中药或中药单体,其次,分析了中药复方,今后应加强不同中药有效成分和治疗不同证候群的辨证方剂的研究,具有一定的参考价值.     

油画笔触感受浅议

笔触是画笔接触物体后所留下的痕迹,在油画的绘制实践中,画笔带着颜料或油质媒介在画布上塑造不同的形象,发挥不同的功用,这些不同的功用可以分成五个方面来分析：物象的造型体积塑造、色彩的对比与谐调,画面中空间效果的表达,画家情感（性格）的外露、材质与肌理美的展现。这五个方面也就是在画面整体意识的支配下笔触所完成的不同的任务。     

低流压高泵效井成因分析及治理措施

低流压、高泵效的油井一方面增加了杆管的疲劳损耗,降低杆管的使用寿命,减短了油井的检泵周期,增加开采成本;另一方面会降低动态控制图合理率,影响油井管理指标,极大影响了油田正常生产与油田生产管理。科学有效地对低流压、高泵效井进行成因分析与制定恰当的治理措施对于油田健康和谐发展具有重要意义。笔者在文中通过对理论泵效公式剖析及实例分析,分析了造成油井低流压高泵效的原因,并在此基础上提出了相应治理措施。     

Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation in the Japanese healthcare setting

Abstract

Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer’s perspective.

Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis.

Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (€1,011.11) per patient (1 JPY = 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2,873,499 (€24,446.42) per QALY.

Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases.

Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY.     

Cost-effectiveness analysis of tissue plasminogen activator in acute ischemic stroke in Iran

Aims: Tissue plasminogen activator (tPA) is used to treat acute ischemic stroke up to 4.5?h after symptom onset. Its cost-effectiveness in developing countries is not specified yet. This study aimed to study cost-effectiveness of tPA in Iran.

Methods: This is a cost-effectiveness analysis from the perspective of the third party payer to compare IV tPA with no tPA of ischemic stroke. A Markov model with a lifetime horizon was used to analyze the costs and outcomes. Cost data were extracted from the 94 patients admitted in two hospitals in Iran. All costs were calculated based on US dollars in 2016. Quality-adjusted life years (QALY) were extracted from previously published literature. Cost-effectiveness was determined by calculating ICER by TreeAge Pro 2011 software.

Results: Lifetime costs of no tPA strategy were higher than tPA ($10,718 in the no tPA group compared with $8,796 in the tPA group). The tPA arm gained 0.20 QALY compared with no tPA. ICER was $8,471 per QALY. ICER value suggests that tPA is cost-effective compared with no tPA.

Limitations: The limitations of the present study are the reliance on calculated QALY value of other countries and difficulty in accessing patients treated with tPA.

Conclusions: The balance of hospitalization and rehabilitation costs and QALYs support the conclusion that treatment with intravenous tPA in the 4.5-h time window is cost-effective from the perspectives of the third party payer and inclusion of tPA in the insurance benefit package being reasonable.     

高方平筛压紧机构分析

通对筛格垂直方向压紧的机构分析,面粉厂家使用现状简单介绍,随动压紧装置结构,提出使用的合理建议。     

脑卒中经济性评价研究进展

本文通过检索Springger、EBSCOhost、Pubmed等综合数据库和美国Stroke杂志等专业网站,以及中文CNKI数据库,查找1999～2009年国内外脑卒中经济性评价的相关研究文献,分析脑卒中经济性评价的现状,并采用卫生经济学研究质量评价（QHES）量表对文献进行评价。相比而言,欧美国家进行脑卒中经济性评价较为深入,国外相关研究QHES量表得分较高,平均分为82．7分。国内相关研究尚有限,且研究角度和研究方法较为单一。QHES量表得分普遍较低,平均分数为64．5分。     

Differences in utility elicitation methods in cardiovascular disease: a systematic review

Aims: Utility values inform estimates of the cost-effectiveness of treatment for cardiovascular disease (CVD), but values can vary depending on the method used. The aim of this systematic literature review (SLR) was to explore how methods of elicitation impact utility values for CVD.

Materials and methods: This review identified English-language articles in Embase, MEDLINE, and the gray literature published between September 1992 and August 2015 using keywords for “utilities” and “stroke”, “heart failure”, “myocardial infarction”, or “angina”. Variability in utility values based on the method of elicitation, tariff, or type of respondent was then reported.

Results: This review screened 4,341 citations; 290 of these articles qualified for inclusion in the SLR because they reported utility values for one or more of the cardiovascular conditions of interest listed above. Of these 290, the 41 articles that provided head-to-head comparisons of utility methods for CVD were reviewed. In this sub-set, it was found that methodological differences contributed to variation in utility values. Direct methods often yielded higher scores than did indirect methods. Within direct methods, there were no clear trends in head-to-head studies (standard gamble [SG] vs time trade-off); but general population respondents often provided lower scores than did patients with the disease when evaluating the same health states with SG methods. When comparing indirect methods, the EQ-5D typically yielded higher values than the SF-6D, but also showed more sensitivity to differences in health states.

Conclusions: When selecting CVD utility values for an economic model, consideration of the utility elicitation method is important, as this review demonstrates that methodology of choice impacts utility values in CVD.     

浅谈飞机航线维修中的外来物损伤及处理

本文针对飞机航线维修工作中常见的三类航空器外来物损伤的相关检查程序以及检查要点做出了概述,以便给机务工作者提供一个快速处理相关故障的思路。     

五华县中小学校防雷现状及防御措施

雷电灾害是联合国"减灾十年"公布的最严重的十种自然灾害之一。本文通过对五华县中小学校的防雷现状进行全面调查,并从建筑物防直击雷、防感应雷和防雷设施检测等方面,提出了中小学校防止雷电灾害的防御措施。