Comprehensive assessment of patients with irritable bowel syndrome with constipation and chronic idiopathic constipation using deterministically linked administrative claims and patient-reported data: the Chronic Constipation and IBS-C Treatment and Outcomes Real-World Research Platform (CONTOR)

Abstract

Aims

To characterize a US population of patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) using CONTOR, a real-world longitudinal research platform that deterministically linked administrative claims data with patient-reported outcomes data among patients with these conditions.     

试探IGF2和H19基因与韦伯综合征的关系

笔者就韦伯综合征（Beckwith Wiedemannsyndrome,BWS）的特征,及IGF2与H19印迹基因各自生物学生性、印迹状况以及与BWS疾病的关系展开了详尽阐述。     

高速铁路40m箱梁现浇碗扣式支架施工技术及承载力检算

文章结合南广高速铁路右线贵港特大桥的具体施工实例,从支架基底处理、碗扣式支架搭设、通车门洞设置方面详细介绍了高速铁路现浇箱梁施工方案,并通过支架承载力检算,验证了方案的可行性,为今后类似工程的施工提供参考。     

Incorporating annoyance in airport environmental policy: noise, societal response and community participation

Airport capacity continues to be one of the air transport issues that creates the most concern. The major environmental constraint for airports is the noise generated by aircraft. Annoyed communities living around airports have become a limiting factor for airport capacity and operability. This paper brings together the existing literature in the fields of airport environmental capacity, non-acoustic factors of noise annoyance, NIMBYism and environmental conflicts. We also analyze the socio-environmental conflict between Barcelona airport and the community of Gavà Mar. This case shows that the lack of trust between parties, the impossibility of predicting noise exposure, the absence of opportunities for civil society to speak and the difficulty of accessing relevant information foster annoyance and mobilization in the communities that live around the airport. In addition, it is shown that, in such a situation, communities’ reactions can evolve to a post-NIMBY stage in which proactive attitudes replace reactive ones.     

瑞舒伐他汀与替格瑞洛联合用药方案治疗非ST段抬高型急性冠脉综合征患者的临床效果及不良反应

目的探讨瑞舒伐他汀与替格瑞洛联合用药方案治疗非ST段抬高型急性冠脉综合征(ACS)患者的临床效果及不良反应。方法选取2018年1月至2019年7月沈阳积水潭医院收治的70例非ST段抬高型ACS患者作为研究对象,依据随机数字表法分为对照组和观察组,每组35例。对照组采用替格瑞洛治疗,观察组采用瑞舒伐他汀与替格瑞洛联合用药方案治疗,比较两组临床疗效、心肌损伤指标、炎症介质水平、不良反应发生率。结果观察组治疗有效率高于对照组,差异有统计学意义(P<0.05);观察组肌酸激酶同工酶、肌钙蛋白水平低于对照组,差异有统计学意义(P<0.05);观察组炎症介质水平、不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论瑞舒伐他汀与替格瑞洛联合用药方案治疗非ST段抬高型ACS临床效果显著,不仅可以改善临床相关指标、心肌损伤,还可减轻炎症反应,且不良反应发生率低。     

老年综合征的评估研究

随着现阶段人口老龄化趋势越来越明显,我国的老年综合征患者数量逐渐增多,《老年综合征管理指南》对老年综合征有相关阐述,认为老年综合征是指老年人因多种非疾病原因或是疾病原因所引起的同一（或临床表现）老年病症,例如睡眠障碍、吞咽障碍、跌倒、褥疮等均属于老年综合征病症。     

Medical resource use and costs associated with chylomicronemia

Abstract

Background:

The prevalence of severe hypertriglyceridemia (TG?>?1000?mg/dl) is estimated at 150–400 per 100,000 individuals in North America. Severe hypertriglyceridemia in the fasting state is associated with increased acute pancreatitis risk and is a sign of chylomicronemia which reflects the accumulation in the bloodstream of chylomicrons, the large lipoprotein particles produced in the gut after a meal.

Objective:

To assess medical resource use and costs associated with chylomicronemia.

Methods:

Patients with chylomicronemia of different causes (≥2 diagnoses with ICD-9 code 272.3) were identified from a large US claims database (years 2000 to 2009) and matched 1:1 to controls free of chylomicronemia based on age, gender, demographics, comorbidities, and use of lipid lowering drugs. During a 1-year study period, medical resource use and costs associated with chylomicronemia or acute pancreatitis were compared between matched cases and controls.

Results:

Among 6472 matched pairs, annual per-patient medical costs, calculated independently of the occurrence of acute pancreatitis, were significantly greater by $808 for chylomicronemia cases vs controls ($8029 vs $7220, p?<?0.01), half of which was attributable to chylomicronemia-related services (p?<?0.01). Chylomicronemia cases with a history of acute pancreatitis (n?=?46) had greater rates of inpatient visits (p?<?0.05) and greater average costs for subsequent acute pancreatitis or abdominal pain (p?<?0.01) as well as greater total medical costs ($33,587 vs $4402, p?<?0.01) vs matched controls. The average episode of acute pancreatitis (n?=?104 episodes) generated medical costs of $31,820, almost entirely due to inpatient stays.

Limitations:

Triglyceride levels were not available to characterize disease severity.

Conclusions:

Patients with chylomicronemia, and especially those with a history of acute pancreatitis, incurred significantly greater total medical costs compared with individuals without chylomicronemia but with an otherwise comparable health profile.     

高速铁路40m箱梁现浇碗扣式支架施工技术及承载力检算

文章结合南广高速铁路右线贵港特大桥的具体施工实例,从支架基底处理、碗扣式支架搭设、通车门洞设置方面详细介绍了高速铁路现浇箱梁施工方案,并通过支架承载力检算,验证了方案的可行性,为今后类似工程的施工提供参考。     

城商行“发展转型综合症”及策略探讨--“新常态”下城商行发展辨析

伴随着中国经济及金融环境进入新常态,城商行面临发展的重要转折点。过去依赖宏观经济增长红利及监管制度套利,城商行取得规模及盈利水平的快速增长。然而,规模扩张过程中对批发性融资的依赖以及高同业资产配置,使城商行的资产负债结构及收入结构逐渐失衡。面对资本市场快速发展及互联网金融的兴起,城商行已有的商业模式无法有效满足需求结构的趋势性转变,内生增长动力不足,陷入转型发展困境。重塑业务增长模式、改变传统路径依赖、全方位强化内部管理能力、有效支持整体战略实施,是未来城商行转型发展亟须面对的重要课题。     

Healthcare costs for Crohn’s disease patients treated with infliximab: a propensity weighted comparison of the effects of treatment adherence

Objective:

The objective for the research was to evaluate the direct healthcare costs for Crohn’s disease (CD) patients categorized by adherence status.

Methods:

Adult patients with ≥1 claim for infliximab and ≥2 claims for CD who were continuously insured for 12 months before and after their first infliximab infusion (index date) were identified in a 2006–2009 US managed care database. Patients were excluded if they had rheumatoid arthritis claims, received infliximab billed as a pharmacy benefit, or received another biologic drug. Patients were categorized as being either adherent or intermittently adherent to infliximab using a pre-defined algorithm. Total and component direct costs, CD-related costs, rates of surgery, and days of hospitalization were estimated for the 360-day post-index period. Propensity weighted generalized linear models were used to adjust the cost estimates for potential confounding variables.

Results:

The total propensity weighted cost for infliximab adherent patients was $40,425 (95% CI?=?[$38,686, $42,242]), compared to $41,082 (95% CI?=?[$38,163, $44,223]) for the intermittently adherent (p?=?0.71). However, adherent patients had lower total direct medical costs, exclusive of infliximab, that were $13,097 (95% CI?=?[$12,141, $14,127]) compared with $20,068 (95% CI?=?[$17,676, $22,784]) for intermittently adherent patients as a result of substantially lower hospital and outpatient costs (p?Conclusions:

Greater drug-related costs for infliximab adherent patients were offset by lower costs from hospitalization and outpatient visits. These findings indicate that adherent patients have improved clinical outcomes, at a similar aggregate cost, than patients who are only intermittently adherent to therapy.