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Wu B.,Shanghai JiaoTong University | Kun L.,Center for Monitoring of Linyi | Liu X.,Shanghai JiaoTong University | He B.,Ren Ji Hospital
Cardiovascular Drugs and Therapy | Year: 2014

Purpose: To compare the lifetime cost and effectiveness of five alternative chronic atrial fibrillation (AF) management strategies: rivaroxaban, warfarin, aspirin plus clopidogrel, aspirin and no prevention. Methods: An individual-level state-transition model was developed to track the lifetime disease course associated with AF. The clinical and utility data were derived from published studies. The cost data were estimated based on local charges and current Chinese practices. Sensitivity analyses were used to explore the impact of uncertainty on the results. Results: For base-case patients with a CHADS 2 score of 3, the cost per additional quality-adjusted life-years (QALYs) gained for rivaroxaban compared with no prevention, aspirin, aspirin plus clopidogrel and warfarin was $116,884, $153,944, $155,979 and $216,273, respectively. CHADS2 score had a substantial impact on the model outcomes for different prevention strategies. The time distribution of warfarin international normalised ratio (INR), stroke and intracranial haemorrhage (ICH) risks, cost of rivaroxaban and utility of warfarin therapy had substantial impacts on the results. Based on a willingness-to-pay threshold of $16,350/QALY, no prevention strategy was the preferred therapy for a patient with a low risk for stroke and a high risk for ICH; aspirin was preferred for patients with a moderate risk for stroke and ICH; and warfarin was preferred for patients with a high risk for stroke and a low risk of ICH. Conclusion: In the context of limited health resources, rivaroxaban is unlikely to be cost-effective, although it provided more health benefits comparing with other strategies. Additionally, warfarin with good INR control might be more suitable for AF patients in developing regions. © Springer Science+Business Media 2013. Source

To evaluate the efficacy of the endovascular intervention for transatlantic inter society consensus (TASC) type C and type D femoropopliteal artery disease. We conducted a retrospective analysis on 95 cases (98 lower limbs) with TASC type C and type D femoropopliteal artery arteriosclerosis lesion treated by percutaneous transluminal angioplasty and/or primary stent implantation from January 2007 to April 2009. We used ankle brachial index (ABI), Fontaine stages, limb salvage percentage and primary patency to evaluate the efficacy of the endovascular intervention therapy. The technical success rate of the 98 limbs was 94.9%, the perioperation mortality was 4.2% and the total amputation rate was 5.1%. 81 cases (84 limbs) were followed-up for a mean time of (13 ± 7) months, whose average ABI in dorsalis pedis artery and posterior tibial artery were 0.58 ± 0.22 and 0.60 ± 0.21 and increased 0.14 ± 0.25 and 0.13 ± 0.22 respectively than the ABI before intervention therapy. The statistical analysis showed a significant difference in ABI. The limbs of critical limb ischemia (CLI) were of 16.4% in the follow-up period and of 73.5% before the intervention therapy. The statistical results showed a significant difference in the percentage of CLI. Percutaneous endovascular intervention is an effective and minimally invasive method, and has a curative clinical efficacy to treat TASC type C and type D femoropopliteal artery disease. Source

Miao Y.,Nanjing Medical University | Lu X.,Nanjing Medical University | Qiu Y.,Ren Ji Hospital | Jiang J.,Ren Ji Hospital | Lin Y.,Nanjing Medical University
Journal of Clinical Neuroscience | Year: 2010

The objective of this study was to examine the prognostic significance of health-related quality of life (HQOL) parameters combined with baseline clinical factors in patients undergoing neurosurgery for treatment of meningioma. A total of 147 patients (61 male, 86 female; mean age 43 years, range 5-77 years) who underwent resection of a meningioma between January 2002 and December 2004 were studied. HQOL was evaluated using a modified questionnaire based on the World Health Organization Quality of Life-100 Scale and the Karnofsky Performance Scale. The relationships between HQOL and clinical history, radiological findings, extent of resection, histological grade and recurrence were investigated using multivariate analysis. The mean HQOL score was 73.94 ± 1.79 for preoperative patients with meningioma, 84.88 ± 2.14 for postoperative patients, and 91.13 ± 1.61 for healthy controls. HQOL for patients with meningioma was significantly lower than that for normal controls (P < 0.001), and postoperative patients had a more satisfactory HQOL than preoperative (P < 0.05). Cox proportional hazards analysis showed that significant predictors of health-related quality of life were tumor size, extent of surgical excision, and histologic grade. Multivariate backward logistic regression yielded the regression equation HQOL = 119.1097 - 1.5002X3 - 8.6650X6 - 10.4210X7 (R = 0.7466; where X3 is tumor size, X6 is extent of surgical excision, and X7 is the histologic grade of the tumor). This equation can be used preoperatively to predict the HQOL of meningioma patients after neurosurgery. A specialized HQOL questionnaire for patients with meningioma provides useful information when planning the operative procedure, and may make it more likely that patients have a satisfactory HQOL after surgery. © 2009 Elsevier Ltd. All rights reserved. Source

Xu H.,Ren Ji Hospital | Ke K.,Ren Ji Hospital | Zhang Z.,Ren Ji Hospital | Luo X.,Ren Ji Hospital | And 3 more authors.
Journal of Craniofacial Surgery | Year: 2013

Background: Growth factors contained in platelet-rich plasma (PRP) have been reported to induce osteoblast differentiation in certain studies, while in others, osteogenesis has not been shown clinically. The aim of the present study was toverify the effect of PRP and its combination with rhBMP-2 as a controlled delivery system during sagittal suture distraction osteogenesis. Methods: Thirty-six-week male New Zealand white rabbits were randomly assigned to sagittal suture distraction osteogenesis groups treated with (1) PRP gel alone; and (2) PRP gel mixed with 10 Kg rhBMP-2 (PRP/rhBMP-2), and a control group untreated. A heavy 200-g continuous mechanical force was applied for 33 days using a nickel titanium open spring to distract the suture between 2 miniscrew implants. The suture morphology was evaluated radio-graphically and histologically after sacrifice. Results: The amount of suture separation in the control group and the PRP gel group were statistically greater (P < 0.05) than in the PRP/rhBMP-2 gel group. Compared to the control group, the micro-CTand histologic analysis showed that the local application of PRP gel not only stimulates the new bone formation between the suture gap but accelerates the suture wound healing during distraction without suture fusion. There was a percent of total suture height 15.3 ± 9.5% fusion in PRP/rhBMP-2 gel group and the average thickness of cranium bone in the PRP/rhBMP-2 gel group was statistically greater (P < 0.05) than in the control group and the PRP gel group. Conclusions: In this animal model, both PRP gel and PRP/rhBMP-2 gel are effective in improving new bone formation in suture distraction osteogenesis. PRP gel induces suture bone formation without suture fusion and accelerates the suture wound healing, while the PRP/rhBMP-2 gel group, in which the sutures fused prematurely, showed powerful bone formation ability aided by rhBMP-2. PRP can be alternatively use as a controlled release system for rhBMP-2, but caution should be used before proceeding with the application of high-dose growth factors around the growing craniofacial sutures. Copyright © 2013 by Mutaz B. Habal, MD. Source

Suo S.,Ren Ji Hospital | Chen X.,Ren Ji Hospital | Ji X.,Shanghai JiaoTong University | Zhuang Z.,Ren Ji Hospital | And 4 more authors.
Journal of Computer Assisted Tomography | Year: 2015

Objective: The objective of this study was to investigate the non- Gaussian water diffusion properties in bladder cancer and assess the efficacy of diffusion kurtosis imaging for estimating the histological grade of bladder cancer. Methods: Twenty-one patients with bladder cancer (high-grade, 12; lowgrade, 9) and 17 negative controls who underwent preoperative 3.0-T magnetic resonance imaging including multi-b value diffusion-weighted imaging (b values, 0, 500, 800, 1200, 1500, and 2000 s/mm2) were included. Besides apparent diffusion coefficient (ADC) maps, diffusion kurtosis imaging maps for diffusion coefficient (Dapp) and kurtosis (Kapp) were also obtained. Data were analyzed using the Mann-Whitney U test, Spearman correlation test, and receiver operating characteristic curves. Results: Bladder cancer showed significantly lower ADC values, lower Dapp values, and higher Kapp values compared with normal bladder wall (all P < 0.001). The Kapp values were significantly higher in high-grade than in low-grade tumors (P = 0.007). Significant correlations were found between Dapp and ADC (r = 0.901, P < 0001) as well as between Kapp and ADC (r = -0.910, P <0.001). The areas under the receiver operating characteristic curve were 0.843 and 0.796 for estimation of high-grade bladder cancer by using the Kapp values and ADC values, respectively. Conclusions: Diffusion in bladder cancer follows a non-Gaussian behavior. The new metric Kapp may potentially serve as a biomarker of grade of bladder cancer. © 2015 Wolters Kluwer Health, Inc. Source

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