Cost-Effectiveness of Dapagliflozin in Heart Failure with Preserved or Mildly Reduced Ejection Fraction: the DELIVER Trial.

PURPOSE: The DELIVER trial demonstrated the efficacy of dapagliflozin in reducing primary endpoint (cardiovascular (CV) mortality or worsening heart failure) for heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). This study assessed the economic and clinical effects of incorporating dapagliflozin into a standard treatment regimen for HFpEF and HFmrEF cases in China. METHODS: A multistate Markov model was used to assess the clinical and economic effects of adding dapagliflozin to the usual treatment regimen for HFpEF and HFmrEF. A log-logistic formula was used to represent the cumulative incidence of hospitalization, readmission, and CV mortality. A 5% annual discount was applied to all costs. The health outcome was the incremental cost-effectiveness ratio (ICER), measured using quality-adjusted life years (QALYs) and life years (LYs). The findings were examined using sensitivity and scenario analyses to assess robustness. RESULTS: In the HFpEF or HFmrEF population, the 11.2-year incremental QALYs was 0.15 and LYs was 0.2, yielding an ICER of $10,615.87 per QALY and $7,763.08 per LY. These ICER values are lower than China's per capita gross domestic product (GDP) of $12,752 in 2022. The one-way sensitivity analysis revealed that non-hospital CV death was the most influential parameter. Furthermore, there was a 68% chance that dapagliflozin was cost-effective as an additional treatment, given a willingness-to-pay limit of three times the GDP ($38,256). CONCLUSIONS: Dapagliflozin adjunctive therapy was cost-effective in patients with HFpEF or HFmrEF from the perspective of Chinese national insurance.

Construction and application of tuberculosis medical and nursing integration cooperation model.

OBJECTIVE: To explore the clinical effect of the tuberculosis (TB) doctor-nurse integration management model METHODS: This study is a retrospective historical cohort study. The clinical data of 180 patients with TB in our hospital from 2019 to 2020 were analyzed retrospectively. In a control group, 90 cases were treated with the traditional medical care model. An observation group of 90 cases received clinical diagnoses, treatments, and nursing under a doctor-nurse integration management model. Comparative analyses between the two groups were conducted on various aspects, including the awareness level of TB prevention and control, medication compliance and patient satisfaction. Comparisons between the two groups were evaluated using independent-sample t-tests or Chi-squared tests RESULTS: Compared with the control group, the knowledge awareness levels of TB prevention and medication compliance in the observation group were significantly higher (p < .05). The appointment waiting times and hospitalization times in the observation group were significantly lower than in the control group (p < .05). The total average satisfaction score of the patients in the observation group was significantly higher than in the control group (p < .05). Compared with the control group, the patients in the observation group were significantly more satisfied with their nursing methods, operating techniques, psychological techniques, service attitudes, and ward management (p < .05). In addition, in the observation group, medical-nursing relationships and doctor-patient communication were better than in the control group; additionally, the satisfaction of doctors with nursing work was also higher than in the control group, which was a statistically significant difference (p < .05) CONCLUSION: The implementation of an integrated medical-nursing cooperation model for TB will help increase the awareness of health knowledge in patients with TB, improve patient medication compliance and enhance patient satisfaction.

Platelet parameters and risk of hypertension disorders of pregnancy: a propensity score adjusted analysis.

While the role of platelets in cardiovascular diseases among the general population has been widely reported, evidence is inconsistent regarding the association between platelet indices with hypertension in pregnant women. In this study, we explored the associations between platelet parameters before 20 gestational weeks, an understudied period, with hypertensive disorders of pregnancy (HDP), including preeclampsia/eclampsia (PEEC) and gestational hypertension (GH). Based on the Born in Guangzhou Cohort Study, 12053 singleton pregnant women with platelet parameters, including platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) measured at 14-19 gestational weeks were included. Conventional multivariable adjustment and propensity score analysis were used to control for confounders. The restricted cubic spline showed that the risk of PEEC increased linearly for PC, and non-linearly for PCT. For GH, the risk increased linearly for PC, MPV, and PCT, and non-linearly for PDW. When these indices were categorized into quintiles, women with higher PC and PCT were associated with increased risk of both PEEC and GH. Women with MPV exceeding the second quintile (≥ 8.8 fL) had a greater risk for GH, but not for PEEC. When HDP was classified into two groups (early- vs late-onset) based on the occurrence time, significant associations persisted for early-onset PEEC, early-onset GH, and late-onset GH. In conclusion, increased PC and PCT before 20 weeks of gestation were both associated with higher risk of PEEC and GH, while elevated MPV was only linked to GH.

Expression of WNT1 in ameloblastoma and its significance.

The present study aimed to measure the expression of WNT1 in ameloblastoma (AB). Immunohistochemistry was used to observe changes in WNT1 expression in 80 AB samples, 10 keratocystic odontogenic tumor (KCOT) samples and 10 normal oral mucosa (NOM) samples. Western blotting and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) were used to measure WNT1 protein and mRNA expression, respectively, in 30 AB samples, 5 KCOT samples, 5 NOM samples and 3 tooth germ samples. Ectopic cytoplasmic expression of WNT1 was detected in AB; 88.8% (71/80) of the samples were WNT1-positive. The western blotting results demonstrated that compared with NOM (0.57±0.05), WNT1 expression was significantly higher in AB tissue (1.74±0.36, P<0.05), whereas it was not significantly different between AB and KCOT samples (0.80±0.06, P>0.05). RT-qPCR revealed that the level of WNT1 gene expression in AB was increased 2.43-fold compared with normal mucosa, and 1.77-fold compared with tooth germ tissue. In conclusion, WNT1 protein and mRNA expression were increased in AB, and there was ectopic cytoplasmic expression. This indicates that WNT1 may serve an important role in AB occurrence and development.

Interaction of oxalic acid with methylamine and its atmospheric implications.

Oxalic acid, which is one of the most common dicarboxylic acids, is expected to be an important component of atmospheric aerosols. However, the contribution of oxalic acid to the generation of new particles is still poorly understood. In this study, the structural characteristics and thermodynamics of (C2H2O4)(CH3NH2) n (n = 1-4) were investigated at the PW91PW91/6-311++G(3df,3pd) level of theory. We found that clusters formed by oxalic acid and methylamine are relatively stable, and the more the atoms participating in the formation of a ring-like structure, the more stable is the cluster. In addition, via the analysis of atmospheric relevance, it can be revealed that clusters of (C2H2O4)(CH3NH2) n (n = 1-4) have a noteworthy concentration in the atmosphere, which indicates that these clusters could be participating in new particle formation. Moreover, by comparison with (H2C2O4)(NH3) n (n = 1-6) species, it can be seen that oxalic acid is more readily bound to methylamine than to ammonia, which promotes nucleation or new particle formation. Finally, the Rayleigh scattering properties of clusters of (C2H2O4)(CH3NH2) n (n = 1-4) were investigated for the first time to determine their atmospheric implications.

Hydration of the methanesulfonate-ammonia/amine complex and its atmospheric implications.

Methanesulfonate (MSA-), found in substantial concentrations in the atmosphere, is expected to enhance aerosol nucleation and the growth of nanoparticles, but the details of methanesulfonate clusters are poorly understood. In this study, MSA- was chosen along with ammonia (NH3) or three common amines and water (H2O) to discuss the roles of ternary homogeneous nucleation and ion-induced nucleation in aerosol formation. We studied the structural characteristics and thermodynamics of the clusters using density functional theory at the PW91PW91/6-311++G(3df,3pd) level. The analysis of noncovalent interactions predicts that the amines can form more stable clusters with MSA- than NH3, in agreement with the results from structures and thermodynamics; however, the enhancement in stability for amines is not large enough to overcome the difference in the concentrations of NH3 and amines under typical atmospheric conditions. In addition, the favorable free energies of formation for the (MSA-)(NH3/amines)(H2O) n (n = 0-3) clusters at 298.15 K show that MSA- could contribute to the aerosol nucleation process with binding NH3/amines and H2O up to n = 3. There are strong temperature and humidity dependences for the formation of complexes; higher humidity and temperature promote the formation of larger hydrates. Finally, for the (MSA-)(NH3/amines)(H2O) n clusters, the evaporation rates were determined to further investigate the atmospheric implications.

The impact of smoking on levels of chronic periodontitis-associated biomarkers.

OBJECTIVE: To investigate the effect of smoking on the expression levels of matrix metalloproteinase (MMP)-1, MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), and the concentrations of TNF-α and IL-10 in patients with chronic periodontitis (ChP). METHODS: This is an ex-vivo study. Our study consisted of 78 cases, all of which were diagnosed with ChP and were selected according to the inclusion and exclusion criteria. Among these 78 cases, 38 patients were classified into the smoking group (S-ChP group), and 40 patients in the non-smoking group (NS-ChP group). The clinical periodontal parameters of all patients were recorded, including the plaque index (PLI), probing depth (PD), loss of attachment (LA) and sulcus bleeding index (SBI). Serum was collected from forearm blood to establish a Porphyromonas gingivalis (Pg) internalizing KB cell model. Enzyme-linked immunosorbent assay (ELISA) was used to determine the concentrations of MMP-1, MMP-9 and TIMP-1 in the KB cell lysis solution as well as IL-10 and TNF-α in the gingival crevicular fluid (GCF). RESULTS: Fewer Pg internalizing KB cell colonies were observed in the NS-ChP group than in the S-ChP group (P<0.01). When 400µL serum was added, there were remarkable differences in the concentrations of MMP-1 and TIMP-1 secreted from the KB cells between the S-ChP and NS-ChP groups (MMP-1: t=-21.71, P<0.01; TIMP-1: t=64.35, P<0.001). Additionally, when 800µL serum was added, there were significant differences in the concentrations of MMP-1, MMP-9 and TIMP-1 in the KB cells between the S-ChP and NS-ChP groups (MMP-1: t=-81.89, P<0.001; MMP-9: t=-15.67, P<0.001; TIMP-1: t=109.4, P<0.001). The TNF-α levels were higher, but the IL-10 levels were lower in the GCF from the ChP patients in the S-ChP group than those in the NS-ChP group (both P<0.001). CONCLUSION: The serum of S-ChP patients can enhance the concentrations of MMP-1 and MMP-9, but reduce TIMP-1 secreted from Pg internalizing KB cells. However, the concentration of TNF-α was increased and IL-10 was decreased. Abnormal concentrations of ChP-associated biomarkers may be conducive to the development and progression of ChP.

Gestational diabetes mellitus does not increase the risk of adverse pregnancy outcomes in twin pregnancies / 中华围产医学杂志

Objective To evaluate the influence of gestational diabetes mellitus (GDM) on maternal and perinatal outcomes in twin pregnancies. Methods We retrospectively analyzed the clinical features of both twin and singleton pregnancies, which delivered in Guangzhou Women and Children's Medical Center between January 1, 2012 and December 31, 2013. The twin pregnancies were divided into two groups:those with (GDM-T, n=51) and without GDM (non-GDM-T, n=130), which were matched by maternal age and delivery time (within one month) in a ratio of 1∶2 among singleton pregnancies with (GDM-S, n=102) and without GDM (non-GDM-S, n=102), respectively. The differences of adverse maternal and perinatal outcomes among these four groups were examined. The overall assessment of pregnancy outcomes was completed using Delphi method. Statistical analysis was performed with one-way analysis of variance, t test, Kruskal-Wallis test, rank test, Chi-square test or Fisher's exact test. Results (1) When compared to GDM-S and non-GDM-S group respectively, less women conceived with the help of assisted reproductive technology, higher proportion of women underwent and gestational age at delivery tend to be earlier in GDM-T and non-GDM-T group (all P0.01). Similarly, no significant difference was found in prenatal glycosylated hemoglobin value between GDM-T and GDM-S group (P>0.01). (2) There was no significant difference in the incidences of hypertensive disorders of pregnancy, anemia, premature rupture of membranes, oligohydramnios, placental abruption, postpartum hemorrhage, asphyxia neonatorum, small for gestational age, hypoglycemia of newborn, hyperbilirubinemia of newborn and perinatal death between GDM-T group and the other three groups(all P>0.01). Higher incidences of hypertensive disorders of pregnancy and postpartum hemorrhage were shown in the GDM-T group than in the GDM-S and non-GDM-S groups, respectively (both P0.01). (3) The overall assessment of pregnancy outcomes did not show any difference between GDM-T group and the other three groups (χ2=6.707, P>0.01). However, the score for fetal outcomes in the GDM-T group was higher than in the GDM-S and non-GDM-S group, but lower than in non-GDM-T group [M(Q)=1.0(2.3), 0.0(3.0), 0.0(0.0), 1.0(2.8) score, χ2=122.818, P<0.01]. Conclusions GDM does not increase the risk of adverse pregnant outcomes in twin pregnancies.

Interaction of gas phase oxalic acid with ammonia and its atmospheric implications.

Oxalic acid is believed to play an important role in the formation and growth of atmospheric organic aerosols. However, as a common organic acid, the understanding of the larger clusters formed by gas phase oxalic acid with multiple ammonia molecules is incomplete. In this work, the structural characteristics and thermodynamics of oxalic acid clusters with up to six ammonia molecules have been investigated at the PW91PW91/6-311++G(3df,3pd) level of theory. We found that oxalic acid forms relatively stable clusters with ammonia molecules, and that ionization events play a key role. The analyses of the thermodynamics and atmospheric relevance indicate that the heterodimer (H2C2O4)(NH3) shows an obvious relative concentration in the atmosphere, and thus likely participates in new particle formation. However, with increasing number of ammonia molecules, the concentration of clusters decreases gradually. Additionally, clusters of oxalic acid with ammonia molecules are predicted to form favorably in low temperature conditions and show high Rayleigh scattering intensities.

[A comparative study of marginal microleakage using different cements in porcelain-fused-to-metal crown].

OBJECTIVE: To evaluate the marginal microleakage of porcelain-fused-to-metal crown using four different cements. METHODS: Sixteen porcelain-fused-to-metal crowns were built and randomly divided into 4 group, luted onto standard prepared human forward molars using four different cements (glass ionomer cement, resin-modified glass ionomer cement, PanaviaF, Super-Bond C&B adhesive luting system). After temperature cycling test, all the crowns were then submerged in 2% fuchsin for 24 h. The marginal microleakage at tooth cement interfaces was observed using light stereomicroscopy and evaluated in classification index. The marginal microleakage grade of 4 groups were analyzed by SPSS 13.0. RESULTS: The PanaviaF demonstrated the least marginal microleakage, Super-Bond C&B adhesive luting system, resin-modified glass ionomer cement showed an intermediate level of marginal microleakage, glass ionomer cement was associated with severe marginal microleakage (total, Chi2 = 157.60, P < 0.01; among the different groups, P<0.05). CONCLUSION: Adhesive resin luting system which is the first selection in clinical is better than glass ionomer cement and is good at porcelain-fused-to-metal crown.

A comparative study of marginal microleakage using different cements in porcelain-fused-to-metal crown / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the marginal microleakage of porcelain-fused-to-metal crown using four different cements.</p><p><b>METHODS</b>Sixteen porcelain-fused-to-metal crowns were built and randomly divided into 4 group, luted onto standard prepared human forward molars using four different cements (glass ionomer cement, resin-modified glass ionomer cement, PanaviaF, Super-Bond C&B adhesive luting system). After temperature cycling test, all the crowns were then submerged in 2% fuchsin for 24 h. The marginal microleakage at tooth cement interfaces was observed using light stereomicroscopy and evaluated in classification index. The marginal microleakage grade of 4 groups were analyzed by SPSS 13.0.</p><p><b>RESULTS</b>The PanaviaF demonstrated the least marginal microleakage, Super-Bond C&B adhesive luting system, resin-modified glass ionomer cement showed an intermediate level of marginal microleakage, glass ionomer cement was associated with severe marginal microleakage (total, Chi2 = 157.60, P < 0.01; among the different groups, P<0.05).</p><p><b>CONCLUSION</b>Adhesive resin luting system which is the first selection in clinical is better than glass ionomer cement and is good at porcelain-fused-to-metal crown.</p>

Cost-effectiveness analysis for integrated prevention of mother-to-child transmission of HIV / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the cost-effectiveness and economic efficiency of integrated prevention of mother-to-child transmission (PMTCT) of HIV in four high-incidence counties.</p><p><b>METHODS</b>Data of local resource investment and total cost for PMTCT in 4 counties in China from 2003 to 2006 were collected. Cost analysis and cost-effectiveness analysis were conducted. Average costs of a confirmed HIV case, a prevented case and a disability-adjusted life-year (DALY) saving were calculated.</p><p><b>RESULTS</b>Average cost of identifying one HIV-infected mother was yen5512. Costs of a pediatric HIV case prevention and per DALY saving were yen46 747 and yen1870 ($231), respectively, based on the total cost perspective.</p><p><b>CONCLUSION</b>The cost of integrated prevention of mother-to-child transmission of HIV was low. The PMTCT program was economical efficiency.</p>

Analysis of correlation between female HIV prevalence and policy resources invested for the prevention of mother-to-child transmission / 中国艾滋病性病

Objective To analyze correlation between female HIV prevalence and policy resources invested for the prevention of mother-tochild transmission(PMTCT).Methods Local policy documents concerning PMCTC published in different periods of time were collected from 4 HIV endemic counties in China,and their main components were analyzed in terms of their correlation with the recent infection rate in local women in general and single and married women of child bearing age in particular.Results The policy resources invested for PMTCT by the county governments had a logarithmic correlation with the female HIV infection rates.Conclusion With the rise of female HIV infection rates,policy resources invested for PMTCT has been increased,but after a rapid increase,recent female HIV infection has exerted little influence on the investment of policy resources.