Kostnader ved høydosebehandling med autolog stam-cellestøtte ved fire norske sentra

Høydosebehandling med autolog stamcellestøtte (HMAS) er rutinebehandling hos selekterte grupper av pasienter med malignt lymfom og myelomatose. Hva er kostnadene ved denne type behandling? I perioden mai 2001-desember 2001 utførte vi en prospektiv kostnadsanalyse av behandlingsforløp som grovt kan deles i 3 faser: 1) den tumorreduserende kjemoterapifasen, 2) fasen med mobilisering, høsting og nedfrysing av autologe stamceller og 3) selve høydosefasen (HMAS-fasen). 30 pasienter med myelomatose ble fulgt ved tre forskjellige universitetssykehus og 10 pasienter med lymfom ble fulgt ved det fjerde sykehuset. Direkte pasientrelaterte kostnader ble registrert daglig. Indirekte kostnader ble fordelt på pasientene basert på estimater og ut fra forhåndsdefinerte fordelingsnøkler fra relevante avdelinger. Alle kostnadsdata ble beregnet i 2001 priser. Den gjennomsnittlige totale kostnaden for alle tre faser var kr. 306 904 kr (variasjonsbredde 244 035-379 127). Vi fant en statistisk signifikant korrelasjon mellom varighet av sykehusopphold og sykehusenes kostnader i alle tre behandlingsfaser. En stor del av kostnadene i høstefasen var knyttet til medikamenter brukt til stamcellemobilisering. I høydosefasen, som var den mest kostnadskrevende fasen, var de største kostnadene knyttet til sykepleiepersonalet. Det var betydelige variasjoner i kostnader mellom sykehusene. Den gjennomsnittlige totalkostnaden var vesentlig høyere enn full DRG-pris for myelomatose og myelomatose i 2001. Sykehusene måtte selv bære differansen mellom de reelle kostnadene og DRG-prisen. Per i dag (2008) er differansen redusert da det er etablert en sideutbetaling for HMAS- behandling.Kostnadsberegning; kreft; stamcelle; sykehus

Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS: We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS: Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10(-8)). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10(-4)), improved β-cell function (P = 1.1 × 10(-5)), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10(-6)). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS: We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis

The Arctic Nature Index (ANI). Challenges and Opportunities

This report summarizes the results of two joint pilot projects conducted by the Conservation of Arctic Flora and Fauna (CAFF), the biodiversity working group of the Arctic Council and the Norwegian Environment Agency (NEA), concerning the implementation of the Nature Index (NI) framework in Svalbard and the circumpolar Arctic. The aims of these two pilot projects were to (1) investigate the possibility of establishing the NI in the Arctic; (2) transfer competence to the CAFF secretariat to manage such implementation; and (3) establish a pilot website to test the NI-framework. This report discuss choices regarding area divisions, major ecosystems and indicators for the implementation of the Nature Index framework in the Arctic. It presents a pilot website designed to test indicators for Arctic areas. Basic spatial units have been selected and implemented in the pilot web-site for the Barents Sea, Iceland and Svalbard. For all areas, both marine and terrestrial, basic spatial units must be agreed upon before implementation in the website. Testing the website and methodology is only possible when basic spatial units are defined. Successful implementation of a useful Arctic Nature Index (ANI) and in Svalbard will depend upon the quality and extent of included indicator data series; broader inclusion of taxonomic and ecological functions will strengthen its value. We recommend that the already estab-lished expert groups within CAFF and Environmental monitoring of Svalbard and Jan Mayen (MOSJ) should define the indicators and the necessary ecological information. Scientists participating in the project should be in charge of selecting what nature indices are pre-sented, that is, indices presenting the state of biodiversity within a major ecosystem and/or area, or thematic indices on e.g., groups of species. The participating scientists should also be involved in writing reports/ papers based on these results as is the practice in Norway. The purpose of this pilot project is therefore to propose a platform to collect, standardize and present ecological information on these indicators – not to replace an already existing pro-ces

Conditional survival and excess mortality after high-dose therapy with autologous stem cell transplantation for adult refractory or relapsed Hodgkin lymphoma in Norway

Published under under a Creative Commons Attribution 3.0 License (CC BY 3.0). Obtained from Haematologica/the Hematology Journal website http://www.haematologica.or