Omnichannel integration strategy based on BOPS.

Technological innovation and the upgrading of consumer preferences have greatly accelerated the rapid development of the "new retail" omnichannel model. Meeting the personalized and seamless interactive experience expected by consumers requires integrating the advantages of both offline and online channels and expanding the integrated and intelligent omnichannel layout. This has emerged as a complex problem that the industry urgently needs to address. In order to tackle this issue, we conducted a study on a Buy-Online-and-Pick-up-in-Store (BOPS) pricing game between offline stores and e-commerce departments, considering factors such as match probability and network cost of return. Furthermore, we proposed the Buy-Online-and-Pick-up-in-Store-and-Return-Online (BORO) strategy and conducted an analysis on the variation in market share and revenue levels for both offline stores and e-commerce departments under this strategy. The results demonstrate that: (i) the omnichannel strategy of BOPS can increase the revenues of both offline stores and e-commerce departments only when the distance costs are moderate; (ii) the BORO strategy provides greater benefits to offline stores compared to e-commerce departments; and (iii) the effectiveness of the BORO strategy is influenced by factors such as match probability, distance cost, and product return. This research not only provides a theoretical foundation but also practical insights for the strategic channel management of omnichannel brand merchants.

Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases.

OBJECTIVE: Studies discussed few risk factors for specific patients, such as duration of disease; or surgical factors, such as duration and time of surgery; or C3 or C7 involvement, which could have led to the formation of hematomas (HTs). To investigate the incidence, risk factors especially the factors mentioned above, and management of postoperative HTs following anterior cervical decompression and fusion (ACF) for degenerative cervical diseases. METHODS: Medical records of 1,150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019 were identified and reviewed. Patients were categorized into the HT group (HT group) or normal group (no-HT group). Demographic, surgical and radiographic data were recorded prospectively to identify risk factors for HT. RESULTS: Postoperative HT was identified in 11 patients, with an incidence rate of 1.0% (11 of 1,150). HT occurred within 24 hours postoperatively in 5 patients (45.5%), while it occurred at an average of 4 days postoperatively in 6 patients (54.5%). Eight patients (72.7%) underwent HT evacuation; all patients were successfully treated and discharged. Smoking history (odds ratio [OR], 5.193; 95% confidence interval [CI], 1.058-25.493; p = 0.042), preoperative thrombin time (TT) value (OR, 1.643; 95% CI, 1.104-2.446; p = 0.014) and antiplatelet therapy (OR, 15.070; 95% CI, 2.663-85.274; p = 0.002) were independent risk factors for HT. Patients with postoperative HT had longer days of first-degree/intensive nursing (p < 0.001) and greater hospitalization costs (p = 0.038). CONCLUSION: Smoking history, preoperative TT value and antiplatelet therapy were independent risk factors for postoperative HT following ACF. High-risk patients should be closely monitored through the perioperative period. Postoperative HT in ACF was associated with longer days of first-degree/intensive nursing and more hospitalization costs.

Economic Evaluation of Transcatheter Aortic Valve Replacement Compared to Surgical Aortic Valve Replacement in Chinese Intermediate-Risk Patients.

Background: Aortic stenosis (AS) is a severe disease that causes heart failure and sudden death. Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are both recommended for patients with intermediate surgical risk, but the cost-effectiveness of TAVR compared to SAVR in China has not been investigated. Methods: A combined decision tree and Markov model were conducted to compare the cost-effectiveness of TAVR versus SAVR with a 5-year simulation. The primary outcome was the incremental cost-effectiveness ratio (ICER), a ratio of incremental costs to incremental quality-adjusted life-year (QALY). One-way sensitive analysis and probabilistic sensitivity analysis (PSA) were conducted to test the robustness of the model. Results: After a simulation of 5 years, the costs of TAVR and SAVR were 54,573 and 35,002 USD, respectively, and the corresponding effectiveness was 2.826 versus 2.712 QALY, respectively. The ICER for the TAVR versus SAVR comparison was 170,056 USD/QALY, which was three times higher than the per capita gross domestic product (GDP) in China. One-way sensitive analysis showed that the cost of the TAVR device impacted the ICER. The TAVR could be cost-effective only in the case where its cost is lowered to 29,766 USD. Conclusion: TAVR is currently not cost-effective in China, but it could be cost-effective with a reduction of costs to 29,766 USD, which is approximately 65% of the current price.

Epidemiology and Economic Burden of Atopic Dermatitis: Real-World Retrospective Data from a Large Nationwide Israeli Healthcare Provider Database.

INTRODUCTION: Real-world data on the epidemiology and economic burden of atopic dermatitis (AD) are limited. Here we describe the epidemiology and economic burden of AD using electronic healthcare data from Israel. METHODS: A retrospective study was performed using the Maccabi Healthcare Services database. AD incidence in 2008-2017 and point prevalence (ADprev) on 31 December 2017 were described using diagnosis codes for overall patients, and sex and age subgroups. For ADprev, severity was defined using recently dispensed treatments for AD. Annual healthcare resource utilization in AD prevalent patients was compared with non-AD matched controls using generalized linear modelling. Direct annual costs were estimated also. RESULTS: AD incidence was 7.0/1000 person-years; overall prevalence was 4.4% (female patients 4.5%, male patients 4.3%; age 0 to less than 6 months, 0.9%; 6 months to less than 12 years, 11.0%; 12 to less than 18 years, 5.8%; 18 years or older, 2.2%). Among ADprev (n = 94,483), mild, moderate, and severe AD comprised 57.7%, 36.2%, and 6.1% (adults 43.8%, 46.3%, 9.9%), respectively. Dermatologist and allergist visits and hospitalization rates (at least one) were 40.7%, 6.6%, and 3.8% in 2017. Compared with controls, overall and moderate-to-severe AD were associated with 36% and 52% increases in annual per-person costs (incremental costs $126 and $190). CONCLUSIONS: AD epidemiology in Israel is comparable with other real-world database studies. AD imposes an economic burden that increases with disease severity.

Occurrence and costs of atopic dermatitis in IsraelAtopic dermatitis is a disease that causes the skin to be inflamed and itchy. Atopic dermatitis is most common in children but can also occur in adolescents and adults. Using data from a large healthcare provider in Israel, this study aimed to describe how common atopic dermatitis is within the population. Costs related to the use of healthcare services (such as visits to dermatologists and creams to treat atopic dermatitis) in the year 2017 were compared between persons with versus without atopic dermatitis. For the years 2008 to 2017, approximately 7 out of 1000 people were newly diagnosed with atopic dermatitis each year (incidence). Among people alive on 31 December 2017, 4.4% had atopic dermatitis (prevalence), with 42.3% suggestive of moderate to severe disease. Patients with atopic dermatitis, particularly those with more severe disease, used healthcare services more frequently. Compared with people without atopic dermatitis, medical costs among patients with atopic dermatitis were 36% higher (corresponding to added costs of $126 per person per year). This study helps to better understand how many people have atopic dermatitis, and what healthcare resources are needed to manage this disease.

Assessment of Image Quality of Coronary Computed Tomography Angiography in Obese Patients by Comparing Deep Learning Image Reconstruction With Adaptive Statistical Iterative Reconstruction Veo.

OBJECTIVE: The aim of the study was to evaluate the image quality of coronary computed tomography (CT) angiography (CCTA) in obese patients by using deep learning image reconstruction (DLIR) in comparison with adaptive statistical iterative reconstruction Veo (ASiR-V). METHODS: We prospectively evaluated 60 obese patients (body mass index [BMI] ≥ 30 kg/m2) who underwent coronary CT angiography in a single center. All CT scans were performed with GE Revolution 256-row CT at 120 kV (group A; 20 men, 10 women; mean age = 54.3 years; mean BMI = 33.4 kg/m2) or 100 kV (group B; 18 men; 12 women; mean age = 56.8 years; mean BMI = 32.9 kg/m2). Images in group A were reconstructed using ASiR-V, whereas images in group B were reconstructed using ASiR-V, DLIR-medium (DLIR-M), and DLIR-high (DLIR-H). Three blinded independent readers assessed the subjective image quality and measured the objective image quality. Radiation dose estimates were calculated and compared between patients by using 0.014 and 0.026 mSv·mGy-1 cm-1 corresponding to chest and heart conversion coefficients, respectively. RESULTS: The subjective score was significantly higher for images reconstructed using 120-kV ASiR-V (3.8), DLIR-M (3.9), and DLIR-H (4.0) compared with those reconstructed using 100-kV ASiR-V (3.5). Image noise was significantly lower in images reconstructed using DLIR-H compared with those reconstructed using other reconstruction algorithm (P < 0.001, respectively). The contrast-to-noise ratio was significantly higher in the DLIR-H group than in the groups using other reconstruction algorithm (P < 0.001). The effective radiation dose was significantly lower in group B than in group A (P < 0.001). CONCLUSIONS: Compared with ASiR-V, DLIR improved image quality in obese individuals without comprising image quality or increasing the radiation dose.

Impact of Sublingual Nitroglycerin on the Assessment of Computed Tomography-derived Fractional Flow Reserve: An Intraindividual Comparison Study.

OBJECTIVE: The aim of this study was to investigate the impact of nitroglycerin (NTG) on the assessment of computed tomography-derived fractional flow reserve (CT-FFR). MATERIALS AND METHODS: Seventy-seven patients with suspected coronary artery disease were recruited, and they underwent computed tomography angiography (CCTA) before and after NTG administration. The CT-FFRs were compared at 2 CCTAs. The difference was compared using the Wilcoxon signed rank test. Patients were divided into normal and stenosis groups according to CCTA results. Vessels in the stenosis group were further divided into different groups based on coronary artery calcium score (CACS) and stenosis degree. The poststenotic CT-FFR differences before and after NTG (DCT-FFR) were calculated to evaluate the impact of stenosis degree and CACS. Terminal CT-FFRs derived from CCTAs before and after NTG in total and vessel-specific levels were compared in the normal group. RESULTS: Of 47 patients in the stenosis group, poststenotic CT-FFR was significantly increased after NTG at per-vessel level. By taking CT-FFR of 0.75 or lower as the threshold, 5 and 4 patients showed abnormal CT-FFR before and after NTG, respectively. No significant differences were noted among the various stenosis degree and CACS groups regarding DCT-FFR. Of 30 patients in the normal group, terminal CT-FFR was significantly increased after NTG in total level and vessel-specific level of left anterior descending and right coronary artery, but not in the left circumflex. CONCLUSIONS: Both post lesion and distal vessel CT-FFR significantly improved after the administration of GTN with the degree of change not affected by stenosis severity or CACS.

Toxic metals in outdoor/indoor airborne PM2.5 in port city of Northern, China: Characteristics, sources, and personal exposure risk assessment.

Outdoor and indoor PM2.5 samples were simultaneously collected over four seasons (2017-2018) in Caofeidian, China, and analyzed for 15 elements to investigate the characteristics, sources, and health risks of PM2.5-bound metals. Source-specific PM2.5-bound metals were analyzed using positive matrix factorization, combined with the conditional probability function and potential source contribution function model. The health risks were evaluated using the health risk assessment model, which included the exposure parameters of indoor and outdoor activities of Chinese residents. The annual median of PM2.5 concentrations (89.68 µg/m3) and total metals (2.67 µg/m3) from the outdoor samples significantly surpassed that of the indoor samples (51.56 µg/m3) and total metals (1.51 µg/m3) (P < 0.05). In addition, the indoor/outdoor concentration ratios indicated that most indoor metals mainly originated from outdoor emission sources. In the annual analysis of PM2.5-bound metal sources, this study identified five metal sources: coal combustion, resuspended dust, traffic emissions, fuel combustion sources, and industrial sources, among which industry sources (36.6%) contributed the most. The non-carcinogenic risks of metals for adults (2.81) and children (2.80) all exceed the acceptable non-carcinogenic risk level (1). The non-carcinogenic risk of Mn (1.46 for children, 1.48 for adults) was a key factor in the total non-carcinogenic risk. The total carcinogenic risk of metals for children (3.75 × 10-5) was above the acceptable level (1.0 × 10-6) but within the tolerant limit (1.0 × 10-4), and that for adults (1.48 × 10-4) was above the tolerant limit. The lifetime carcinogenic risk of Cr6+ had the highest proportion of the total carcinogenic risk for children (87.5%) and adults (87.8%). Our results revealed that both adults and children suffered carcinogenic and non-carcinogenic risks from the PM2.5-bound metals in Caofeidian. The corresponding emission control measures of metals in atmosphere should be considered.

Linking bait and feeding opportunities to fish foraging habitat for the assessment of environmental flows and river restoration.

The survival of aquatic biota in different life history stages depends on food availability, water quantity and specific hydrological conditions, and is particularly susceptible in degraded rivers due to the development of hydropower or are sensitive to climate change. Habitats with limited food availability and restricted feeding opportunities can strongly affect the habitat carrying capacity and fish growth with consequences for spawning. Few environmental flow regime frameworks are available that closely link bait and feeding opportunities to fish foraging habitat. In addition, river restoration has been widely implemented to resolve the conflict between ecological demand and power generation benefits. Nevertheless, whether in-stream structures are still suitable for the joint operation of foraging and spawning habitats remains unclear. In this study, a framework to integrate the requirements of both spawning and foraging habitats into environmental flow regime assessments was proposed by coupling the bait supply, fish spawning and fish feeding opportunities. Here, we used the Batang Reservoir, located in the Tibetan Plateau, as an example to determine the environmental flow regimes. The environmental flow regimes during Periods I, II and III for the conservation of the life history stages of Schizothorax dolichonem were determined, which provided high-quality food and was beneficial for increasing the probability of restoration success. After the implementation of measures, the ecological base flow rate decreased from 171.80 m3/s, 206.00 m3/s and 257.70 m3/s to 138.00 m3/s, 206.00 m3/s and 206.00 m3/s in Periods I, II and III, respectively. We concluded that traditional river restoration with the use of in-stream structures is still suitable for the joint operation of spawning and foraging habitats, but the design selection and placement of in-stream structures should be preoptimized. The framework proposed will help managers evaluate habitat conservation to protect degraded rivers or help develop strategies to build resilience to climate change.

Source Identification and Health Risk Assessment of Polycyclic Aromatic Hydrocarbon-Enriched PM2.5 in Tangshan, China.

Tangshan city in Hebei Province is one of the most heavily polluted cities in China, with substantial industrial emissions. The development of effective air pollution emission reduction policies requires knowledge of the sources and health risks of polycyclic aromatic hydrocarbon (PAH)-enriched fine particulate matter (PM2.5 ). We investigated the seasonal variation and source apportionment of 16 priority PAH-enriched PM2.5 samples in Tangshan during 2014 and 2015, and we assessed the health risks associated with inhalation exposure to PAHs. The PM2.5 samples were collected from April 2014 to February 2015. We analyzed the concentrations of PM2.5 and PAH-enriched PM2.5 , and used principal component analysis and molecular diagnostic ratios to identify potential sources. We explored the relationship between distribution and meteorological conditions, and used an incremental lifetime cancer risk (ILCR) model to quantitatively evaluate exposure from the inhalation risk of PAHs. The average mass concentration of PM2.5 was 196 µg/m3 , with a range 34.0 to 586 µg/m3 . The median ∑16 PAH values in PM2.5 were 190 ng/m3 , with a range of 60.2 to 862 ng/m3 over the sampling period. The order of ∑16 PAHs concentration was winter > autumn > summer > spring. The results show that the primary sources of PAH-enriched PM2.5 are coal combustion, vehicle exhaust, and biomass burning. The annual mean of benzo[a]pyrene (BaP) was 8.37 ng/m3 , more than 8-fold greater than the BaP annual standard (1 ng/m3 ) set by the Chinese State Environmental Protection Agency. The ILCR values for 3 groups (children, teenagers, and adults) over the 4 seasons were between 10-6 and 10-4 , indicating a potential health risk from PAHs in Tangshan. Environ Toxicol Chem 2020;39:458-467. © 2019 SETAC.

[Assessment values of procalcitonin, lactic acid, and disease severity scores in patients with sepsis].

OBJECTIVE: To investigate the assessment values of procalcitonin (PCT), lactic acid (LAC), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation II (APACHE II) score in patients with sepsis. METHODS: 140 patients with suspicious bacterial infection admitted to emergency department of Beijing Chaoyang Hospital of the Capital Medical University from August 2017 to June 2018 were enrolled. They were divided into three groups according to diagnostic criteria of Sepsis-3: non-sepsis group (n = 58), sepsis group (n = 66) and septic shock group (n = 16). The PCT, LAC, SOFA score, APACHE II score, 28-day prognosis, and positive detection rate of PCT and LAC were compared among three groups. Independent predictors of 28-day mortality were analyzed by Logistic regression; predictive values of PCT, LAC, SOFA score and APACHE II score for 28-day mortality in sepsis patients were analyzed by receiver operating characteristic (ROC) curve. RESULTS: PCT, LAC, SOFA score, APACHE II score at admission, and 28-day mortality in sepsis group and septic shock group were significantly higher than those in non-sepsis group, and PCT, LAC, APACHE II score, and 28-day mortality in sepsis shock group were further higher than those in sepsis group [PCT (µg/L): 38.1±12.6 vs. 4.6±2.3, LAC (mmol/L): 3.3±2.1 vs. 2.4±2.1, APACHE II score: 14.9±2.4 vs. 9.5±4.3, 28-day mortality: 75.0% vs. 24.2%, all P < 0.05]. The positive detection rate of PCT and LAC in sepsis group and septic shock group were higher than those in non-sepsis group (positive detection rate of PCT: 56.1%, 81.3% vs. 32.8%; positive detection rate of LAC: 42.4%, 62.5% vs. 13.7%; all P < 0.01). Logistic regression analysis showed that PCT, LAC, SOFA score and APACHE II score were independent predictors of 28-day mortality [PCT: odds ratio (OR) = 0.933, 95% confidence interval (95%CI) = 0.878-0.991; LAC: OR = 0.539, 95%CI = 0.347-0.838; SOFA score: OR = 0.291, 95%CI = 0.514-0.741; APACHE II score: OR = 0.808, 95%CI = 0.669-0.976; all P < 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) of PCT, LAC, SOFA score and APACHE II score predicting 28-day mortality was 0.76, 0.86, 0.81 and 0.87, respectively. The assessment values of APACHE II score and LAC were higher than PCT in predicting 28-day mortality (Z1 = 2.56, Z2 = 2.45, both P < 0.01), and the performance of SOFA score was similar to PCT. CONCLUSIONS: PCT, LAC, SOFA score and APACHE II score were reliable indexes to evaluate disease severity for patients diagnosed with infection. The assessment values of APACHE II score and LAC in 28-day mortality were superior to SOFA score and PCT.

Real-time shear wave elastography (SWE) assessment of short- and long-term treatment outcome in Budd-Chiari syndrome: A pilot study.

PURPOSE: The first aim of this study was to analyze the relationships between liver stiffness measurement, hepatic venous pressure and liver fibrosis. The second aim was to demonstrate the utility of real-time shear wave elastography for evaluation of Budd-Chiari syndrome patients before and after balloon hepatic venous angioplasty. MATERIALS AND METHODS: A total of 32 patients with Budd-Chiari syndrome slated for successful balloon angioplasty met the inclusion and exclusion criteria. Shear wave elastography was used to generate dynamic liver stiffness measurement 2 days before angioplasty and 2 days, 3 months, and 6 months after angioplasty. Hepatic venous pressures were measured during balloon angioplasty. Correlations among liver stiffness, hepatic venous pressure, and fibrosis were assessed. RESULT: Mean liver stiffness was 35.17 ± 10.60 kPa, 20.15 ± 5.47 kPa, 15.36 ± 4.34 kPa and 15.68 ± 5.58 kPa at baseline and 2 days, 3 months, and 6 months after angioplasty, respectively. Liver stiffness measured at 2 days and 3 months after angioplasty was significantly decreased (P < 0.001); liver stiffness measured at 6 months after angioplasty was not significantly different from that measured at 3 months after angioplasty (P = 0.636). Analysis of liver stiffness measurement and hepatic venous pressure before balloon angioplasty yielded a coefficient of correlation r = 0.701 (P < 0.001). Before and 2d after angioplasty, liver stiffness measurement did not correlated with fibrosis (r = - 0.170, P = 0.22), (r = 0.223, P = 0.220), respectively, while the LSM difference before and 2 days after angioplasty negatively correlated with stiffness severity (r = - 0.502, P = 0.003). Liver stiffness measured at 2 days and 3 months after angioplasty was significantly decreased (P < 0.001), remaining stable at 3 months, though still in the cirrhotic range. CONCLUSIONS: The liver stiffness of Budd-Chiari syndrome patients, measured by shear wave elastography, decreased considerably after hepatic venous recanalization, and significantly correlated with hepatic venous pressure though not with degree of fibrosis. Shear wave elastography may be effective in monitoring short- and long-term treatment outcomes in Budd-Chiari syndrome.

Repeatability of the "flash-replenishment" method in contrast-enhanced ultrasound for the quantitative assessment of hepatic microvascular perfusion.

This study aimed to evaluate the feasibility and repeatability of the flash-replenishment method in contrast-enhanced ultrasound (CEUS) perfusion imaging and assess quantitatively microvascular perfusion in the liver. Twenty healthy New Zealand rabbits were submitted to CEUS perfusion imaging with continuous intravenous infusion. Using flash-replenishment kinetics, the dynamic process of depletion and refilling of microbubble contrast agent was recorded. The hepatic microvascular perfusion parameters were calculated, including region of interest, peak intensity (PI), area under the curve (AUC), and hepatic artery to vein transit time (HA-HVTT). A consistency test was performed for multiple measurements by the same operator and blind measurements by two different operators. The hepatic perfusion imaging of 3×108 bubbles/min had minimal error and the best imaging effect and repeatability. The variability of the perfusion parameter measured at 3 cm depth under the liver capsule was at a minimum with coefficient of variation of 3.9%. The interclass correlation coefficient (ICC) of measurements taken by the same operator was 0.985, (95% confidence interval, CI=0.927-0.998). Measurements taken by two operators had good consistency and reliability, with the ICC of 0.948 (95%CI=0.853-0.982). The PI and AUC of liver parenchyma after reperfusion were lower than before blocking; and HA-HVTT was significantly longer than before blocking (P<0.05). The flash-replenishment method in CEUS perfusion imaging showed good stability and repeatability, which provide a valuable experimental basis for the quantitative assessment of hepatic microvascular perfusion in clinical practice.

Traumatic skull fractures in children and adolescents: A retrospective observational study.

OBJECTIVE: To investigate the epidemiological features of child and adolescent (≤18 years old) patients managed for traumatic skull fractures (TSKFs) and associated traumatic brain injury (TBI). DESIGN: 393 Patients who were children and adolescent who had TSKFs admitted to our university affiliated hospitals between January 2003 and December 2010. The incidence and patterns were summarized with respect to different age group, admission time and etiology. SETTING: Two university-affiliated hospitals from January 2003 to May 2010. RESULTS: The most common etiologies were motor vehicle collisions (MVCs) (166, 42.2%) and high fall (101, 25.7%). The most common skull fracture sites were parietal fractures (n=111, 28.2%) and basilar skull fracture (n=111, 28.2%). A total of 300 (76.3%) patients suffered TBI and 23 (5.9%) patients suffered OCI. The most common intracranial hemorrhage was epidural hemorrhage (n=94, 23.9%). The frequencies of emergency admission, medical insurance and associated injuries were 56.2% (n=221), 22.4% (n=88) and 37.2% (n=146). The frequencies of TBI and associated injuries were significantly increased from 53.45% to 76.3% and from 6.9% to 41.6% with age, respectively. CONCLUSIONS: MVCs were the most common etiologies. Parietal and basilar skull fractures, epidural hemorrhages were the most common fracture sites and intracranial hemorrhage.

Impact of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist in patients with type 2 diabetes uncontrolled on basal insulin: A longitudinal study of a US administrative claims database.

AIM: To evaluate the effect of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) on clinical and economic outcomes in patients with type 2 diabetes (T2D). METHODS: We conducted a retrospective observational claims study using IMPACT (Impact National Managed Care Benchmark Database) in adult patients with T2D who initiated basal insulin between January 1, 2005 and December 31, 2012, with or without OADs, who remained uncontrolled (glycated haemoglobin [HbA1c] ≥7.0%). Patients were categorized into 3 groups: early, delayed, and no intensification with a GLP-1 RA. We evaluated changes from baseline to follow-up at 12 months for HbA1c level, rate of hypoglycaemic events, and healthcare costs, and we assessed the association between baseline patient characteristics and subsequent treatment intensification. RESULTS: A total of 139 patients (9.0% of 1552 eligible patients) met criteria for inclusion in the early intensification group, 588 patients (37.9%) met criteria for inclusion in the delayed intensification group, and 825 patients (53.2%) met criteria for inclusion in the no intensification group. Mean baseline HbA1c values were 9.16%, 9.07%, and 9.34%, respectively. At follow-up, delayed intensification was associated with significantly smaller decreases in HbA1c from baseline (-0.68%) compared with early intensification (-1.01%). Rates of overall hypoglycaemia were numerically greater in the delayed intensification group than in the early intensification group (0.26 vs 0.06 events/patient-years of exposure, respectively). Change in semi-annual total healthcare costs was greater in the no intensification group (+5266 USD) compared with the early intensification group (-560 USD) and the delayed intensification group (+1943 USD). CONCLUSIONS: Timely addition of a GLP-1 RA to therapy for patients with T2D who were not adequately controlled with basal insulin is associated with better clinical and economic outcomes.

Repeatability of the "flash-replenishment" method in contrast-enhanced ultrasound for the quantitative assessment of hepatic microvascular perfusion

This study aimed to evaluate the feasibility and repeatability of the flash-replenishment method in contrast-enhanced ultrasound (CEUS) perfusion imaging and assess quantitatively microvascular perfusion in the liver. Twenty healthy New Zealand rabbits were submitted to CEUS perfusion imaging with continuous intravenous infusion. Using flash-replenishment kinetics, the dynamic process of depletion and refilling of microbubble contrast agent was recorded. The hepatic microvascular perfusion parameters were calculated, including region of interest, peak intensity (PI), area under the curve (AUC), and hepatic artery to vein transit time (HA-HVTT). A consistency test was performed for multiple measurements by the same operator and blind measurements by two different operators. The hepatic perfusion imaging of 3×108 bubbles/min had minimal error and the best imaging effect and repeatability. The variability of the perfusion parameter measured at 3 cm depth under the liver capsule was at a minimum with coefficient of variation of 3.9%. The interclass correlation coefficient (ICC) of measurements taken by the same operator was 0.985, (95% confidence interval, CI=0.927-0.998). Measurements taken by two operators had good consistency and reliability, with the ICC of 0.948 (95%CI=0.853-0.982). The PI and AUC of liver parenchyma after reperfusion were lower than before blocking; and HA-HVTT was significantly longer than before blocking (P<0.05). The flash-replenishment method in CEUS perfusion imaging showed good stability and repeatability, which provide a valuable experimental basis for the quantitative assessment of hepatic microvascular perfusion in clinical practice.

Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA.

AIMS: To evaluate short- and long-term glycaemic control and hypoglycaemia incidence in insulin-naïve patients ≥30 years of age with type 2 diabetes (T2DM) initiating basal insulin (BI) with or without oral anti-hyperglycaemic drugs (OADs). METHODS: This was an observational, retrospective longitudinal analysis of electronic medical records from 5 European countries and the USA. A multivariable logistic regression model assessed baseline and short-term (0-3 months post BI initiation) factors associated with long-term (3-24 months) glycaemic control and hypoglycaemia. RESULTS: Overall, 40 627 patients were included; 20.9% and 27.8% achieved the general HbA1c target of ≤7% at 3 and 24 months post BI initiation, respectively. Failure to achieve HbA1c ≤7% at 3 months was associated with increased risk of failing to achieve target at 24 months (odds ratio [OR], 3.70 [95% CI, 3.41-4.00]). Over 24 months, 8.9% of patients experienced a recorded hypoglycaemic event. Hypoglycaemia during the initial 3-month period was associated with longer-term risk of these events over the ensuing 3 to 24 months (OR, 5.71 [95% CI, 4.67-6.99]). CONCLUSIONS: Initiating BI with or without OADs is associated with short- and long-term suboptimal glycaemic control; the majority of patients fail to achieve HbA1c target ≤7% in the first 3 months, or after 2 years of BI treatment. Treatment response and hypoglycaemia incidence by 3 months post BI initiation are associated with longer-term glycaemic control and hypoglycaemic risk, respectively. These results support the need for early anti-hyperglycaemic interventions that more effectively control blood glucose levels without increasing the risk of hypoglycaemia.

Outcomes and healthcare resource utilization associated with medically attended hypoglycemia in older patients with type 2 diabetes initiating basal insulin in a US managed care setting.

OBJECTIVE: To assess health outcomes and the economic burden of hypoglycemia in older patients with type 2 diabetes initiating basal insulin (BI). RESEARCH DESIGN AND METHODS: Medicare Advantage claims data were extracted for patients with type 2 diabetes initiating BI and patients were stratified into two groups: those with medically attended hypoglycemia during the first year of BI treatment (HG group) and those without (non-HG group). Main outcome measures were hospitalization, mortality, healthcare utilization and costs 1 year before and 1 year after BI initiation. RESULTS: Of 31,035 patients included (mean age 72 years [SD 9.2]), 3066 (9.9%; HG group) experienced hypoglycemia during 1 year post-BI initiation. After adjustment for demographic, comorbidity and medication history, hypoglycemia was associated with risk of hospitalization (HR 1.59; 95% CI: 1.53-1.65) and death (HR 1.50; 95% CI: 1.40-1.60). Healthcare utilization was higher pre-index and showed greater increases post-BI initiation in the HG vs. the non-HG group. Per-patient healthcare costs were substantially higher for the HG group than the non-HG group, both pre-index ($54,057 vs. $30,249, respectively) and post-BI initiation ($75,398 vs. $27,753, respectively). CONCLUSIONS: Based on available claims data, hypoglycemia during the first year of BI treatment is associated with risk of hospitalization or death in older people, increasing healthcare utilization and costs. Due to the observational nature of this study, causality cannot be attributed, and further prospective studies into the effect of hypoglycemia on health outcomes in this population are warranted.

Enhanced Recovery Program Versus Traditional Care in Laparoscopic Hepatectomy.

Enhanced recovery after surgery (ERAS) has shown effectiveness in terms of reducing the hospital stay and cost associated with open liver resection. However, the benefit of ERAS in patients undergoing laparoscopic liver resection is still unclear, and clinical studies on this topic are limited.The ERAS program for laparoscopic liver resection was used in a group of 80 patients (ERAS group). The results were compared with those in a control group of 107 patients. All patients underwent laparoscopic liver resection. The primary endpoints were the postoperative hospital stay, defined as the number of days from surgery to discharge, and the hospitalization expense. The secondary endpoints were resumption of oral intake, readmissions, and complications.The median postoperative hospital stay was 6.2 ±â€Š2.6 days in the ERAS group, which was significantly shorter than that in the control group (9.9 ±â€Š5.9 d; P < 0.001). The hospitalization cost was $6871 ±â€Š2571 in the ERAS group and $7948 ±â€Š3630 in the control group (P = 0.020). The morbidity rate was 22.5% (18 of 80 patients) in the ERAS group and 43.9% (47 of 107 patients) in the control group (P = 0.002). There were no significant differences the in rate of readmission between the 2 groups.Enhanced recovery after surgery for laparoscopic liver resection is safe and effective. Patients in the ERPS group had a shorter hospital stay, fewer complications, and lower hospital costs.