Diagnosis and management of hypertension: around-the-clock ambulatory blood pressure monitoring is substantially more effective and less costly than daytime office blood pressure measurements

ABSTRACT

The cost-effectiveness of ambulatory blood pressure (BP) monitoring (ABPM) versus traditional office BP measurement (OBPM) for the diagnosis and management of hypertension has been evaluated only by few studies and based solely on the reduction of medical care expenses through avoiding treatment of isolated-office hypertension. Data from the 21963 participants in the Hygia Project, a multicenter outcomes study that incorporates into routine primary care periodic, at least yearly, 48 h ABPM evaluation, were utilized to assess the cost-effectiveness – relative to vascular pathology expenditures countrywide in Spain – of ABPM versus OBPM. The actual reported Spanish healthcare expenditure for vascular pathology in 2015 – aggregate costs of medical examinations, outpatient and inpatient care, therapeutic interventions, plus non-healthcare services (productivity losses due to morbidity/mortality and informal family/friends-provided care) – was used to compare yearly costs when diagnostic and treatment decisions for hypertension are based on the OBPM versus the ABPM-model. Our economic analysis is based on the more realistic and feasible approach of restricting ABPM solely to high-risk individuals of age ≥60 years and/or with diabetes, chronic kidney disease, and/or previous cardiovascular event, who in the Hygia Project accounted for >90% of all documented events. The projected net benefit countrywide in favor of the proposed ABPM-model is ~5294M€/year, i.e., 360.33€/year (95%CI [347.52–374.85]) per ABPM-evaluated person. This highly conservative economic analysis indicates ABPM is a much more cost-effective strategy than repeated OBPM not only for accurate diagnosis and management of true hypertension but marked reduction of expenditures on elevated BP-associated vascular pathology.     

High expression level of antioxidants and pharmaceutical bioactivities of endophytic fungus Chaetomium globosum JN711454

In order to maximize antioxidant activity of pharmaceutical bioactive endophytic fungus Chaetomium globosum JN711454 during fermentation process, designed fermentation experiments of culture media for three levels of eight culture factors were performed using a Taguchi orthogonal array (OA) design with layout L18 (2¹ × 3⁷). The agitation and the potato extract were the most significant affecting factors, and their interaction contributed significantly to fungus activity. The production of antioxidants was more favorable for static condition with 25 g potato extract/100 m. The remaining factors had no strong impact when considered individually. The validation of statistically optimized medium indicated the improvement of antioxidant activity to a level of twofold with approximately overall 40% enhancement in activity. The extract of optimized medium was investigated for various pharmaceutical bioactivities; it revealed a moderate antimicrobial activity, strong anticancer activity against HepG-2, UACC62 cell lines, an antiviral activity against HSV-2 virus, and strong inhibitory activity to butyrylcholinesterase enzyme, one of the neurohydrolase enzymes that play a major role in development of Alzheimer’s disease. As a result of applying statistical fermentation designs, the optimized conditions of endophytic fungus C. globosum JN711454 developed a cost-effective production medium by using inexpensive commercial potato extracts statically, which can lower the energy requirement and could become an efficient, economic, and viable fermentation process for production of pharmaceutical secondary metabolites.     

A protocol for in vitro mass propagation of asiatic hybrids of lily through liquid stationary culture

Summary A simple, rapid and cost-effective in vitro scheme has been proposed for mass propagating two cultivars of Asiatic lily hybrids. An average of seven bulblets was formed after 17 d when 1×1 cm² bulb scale segments (explants) were cultured on Murashige and Skoog (MS) medium with 3% sucrose and 0.5 μM α-naphthaleneacetic acid (NAA). On MS medium containing 0.5 μM NAA and 6 or 9% sucrose, depending on the cultivar, large numbers of bulblets of increased size (3.5–5.0 cm in circumference) were formed under a 16/8 h photoperiod. A continuous system of mass propagation of bulblets was achieved through in vitro scale formation (secondary explants) on MS medium supplemented with 23 μM kinetin and 0.5 μM NAA, as well as scale proliferation on MS basal liquid stationary medium. Upon transplantation all bulblets sprouted, of which 40% flowered in the first season. Under ideal conditions, ca. 9.68×10⁵ bulblets can be produced from a single scale segment in 1 yr by following the systematic propagation steps proposed here.     

尿蛋白膜保存法与直接冻存法的成本效益分析

为了比较尿液蛋白PVDF膜富集保存法(尿膜)和尿液直接冻存法两种方法的优缺点。通过比较两种方法在时间、所占空间、费用、蛋白降解程度及大样本临床实践性方面的区别。发现在所占空间、电费方面及临床实践性方面尿膜保存法优于直接冻存法,而在时间及耗材花费方面直接冻存法优于尿膜保存法。因此尿蛋白的尿膜保存法比直接冻存法有更强的实际应用价值。     

Barley-based medium for the cost-effective production of <Emphasis Type="Italic">Bacillus thuringiensis</Emphasis>

Summary Studies conducted for the multiplication of Bacillus thuringiensis (Bt) using barley Hordeum vulgare as the carbon source led to the development of a protocol for the cost-effective, mass production of Bt. The production employs the simple shake flask method and can be easily adopted with a production potential of 1.5 kg Bt per day approximately at an overall production cost of Rs. 360 kg^-1 (8 US dollars). The protocol is suitable for promoting localized production of Bt at the village/district level. The product when tested as 0.1% (w/v) spray against the castor semilooper, Achoea janata proved highly effective, causing immediate feeding cessation of the larvae followed by 85% and 100% mortality by 48 and 72 h after treatment, respectively.     

Cost-effective multiplication of the entomopathogenic fungus Nomuraea rileyi (F) Samson

Cost-effective and rapid multiplication of Nomuraea rileyi is reported. The spore yields in semi-synthetic media were comparable or significantly higher to the standard medium. Maltose and peptone, carbon and nitrogen sources could be effectively replaced with 2% barley extract and 1% soybean extract respectively. However, replacement of yeast extract with dry yeast resulted in lower spore yields. Sporulation of the fungus multiplied on solid substrate was possible only when the bags used had a 0.2 m filter to facilitate passive exchange of sterile air. A high spore yield of 2.8 × 10⁹/g of substrate was realized on crushed sorghum.This revised version was published online in October 2005 with corrections to the Cover Date.     

Eradicating Helicobacter pylori in Peptic Ulcer Disease Reduces Medical Costs in the Community

Background: Eradicating Helicobacter pylori markedly reduces ulcer recurrence in patients with peptic ulcer disease (PUD). Many decision analysis studies have concluded that eradicating H. pylori in PUD patients is more cost‐effective than maintaining antisecretory therapy. In 1995, we introduced an H. pylori eradication program into a large transportation company that experienced increased incidences of PUD among its employees along with increased medical costs, and we performed trend analysis of the actual medical costs of PUD in this cohort. Methods: In this cohort, there were approximately 8500 employees. H. pylori‐positive PUD patients were identified at the annual health check up. The patients received eradication therapy with lansoprazole, amoxicillin, and clarithromycin. After eradication, the patients were followed up by a yearly health check up. The annual number of patients who received eradication was recorded, and the annual direct medical costs of PUD therapy were analyzed. Results: A total of 440 H. pylori‐positive PUD patients received eradication therapy in a 7‐year period. Based on an intention‐to‐treat analysis, the eradication rate was 84.5% (372 of 440). The largest number of patients who received eradication therapy was found in 1995 (n = 115), and from 1995 to 2001 this number decreased yearly by 12.5 (95% confidence interval (CI): 5 to 20). Between 1989 and 1995, the annual medical costs arising of PUD therapy increased by ¥2.25 million (95% CI: 1.19 to 3.31) per year, being highest (¥22.75 million) in 1995. Between 1995 and 2001, the costs decreased by ¥3.88 million (95% CI: 3.16 to 4.59) per year. The cost in 2001 was 5.7% of the cost in 1995. The eradication program was terminated in 2001 because the prevalence of PUD diminished markedly, and the associated medical costs decreased as well. Conclusions: H. pylori eradication could reduce the number of PUD patients and associated medical costs in the workplace setting.     

Comparison of Methods of Monitoring Wildlife Crossing-Structures on Highways

ABSTRACT Wildlife crossing-structures (e.g., underpasses and overpasses) are used to mitigate deleterious effects of highways on wildlife populations. Evaluating performance of mitigation measures depends on monitoring structures for wildlife use. We analyzed efficacy of 2 noninvasive methods commonly used to monitor crossing-structure use by large mammals: tracking and motion-activated cameras. We monitored 15 crossing-structures every other day between 29 June and 24 October 2007 along the Trans-Canada Highway in Alberta, Canada. Our objectives were to determine how species-specific detection rates are biased by the detection method used, to determine factors contributing to crossing-event detection, and to evaluate the most cost-effective approach to monitoring. We detected 3,405 crossing events by tracks and 4,430 crossings events by camera for mammals coyote-sized and larger. Coyotes (Canis latrans) and grizzly bears (Ursus arctos) were significantly more likely to be detected by track-pads, whereas elk (Cervus elaphus) and deer (Odocoileus sp.) were more likely to be detected by cameras. Crossing-event detection was affected by species, track-pad length, and number of animals using the crossing structure. At the levels of animal activity observed in our study our economic analysis indicates that cameras are more cost-effective than track-pads for study durations >1 year. Understanding the benefits and limitations of camera and track-pad methods for monitoring large mammal movement at wildlife crossing-structures will help improve the efficiency of studies designed to evaluate the effectiveness of highway mitigation measures.