不利事件导致品牌信任破坏的外显和内隐研究

由于在应对潜在风险管理方面有重要的作用,品牌信任一直是市场营销学领域的研究热点。在可能破坏品牌信任的诸多因素之中,最普遍、最常见的因素是组织引起的事故。令人遗憾的是,很多组织对这个问题并没有给予足够的重视。目前,已有的对于消费者如何加工这方面的信息以及组织应该如何应对这种消极影响的研究还非常缺乏。因此,本研究运用品牌信任量表和内隐联想测验,从外显和内隐两个角度来研究不利事件对高、低忠诚度顾客的品牌信任破坏的影响。结果显示当面对严重不利事件时,高、低忠诚度顾客在内隐和外显两个层面都会出现明显的信任破坏。但是当面对轻微的不利事件时,高、低忠诚度顾客的反应出现差别:低忠诚度顾客仍旧在两个层面(内隐和外显)上都出现了信任破坏,但是高忠诚度顾客只有在外显层面出现了信任破坏,在内隐层面并没有出现信任破坏。

系统风险的概念及其计算方法

本文在风险概念的基础上,从风险的特性出发,阐述了风险的本质,并重新定义了风险的含义,对风险的内涵作了进一步延伸和扩展,指出风险是系统不利事件对作用对象的影响程度。衡量这种影响程度需要从不利事件发生的概率以及后果两个方面来刻画。由于不利事件的发生以及作用后果具有不确定性,因此刻画影响程度需要从特征量角度进行分析和计算,给出了风险特征量计算方法。本文提出的风险计算比经典风险的计算更能反映风险的本质,最后给出了系统不利事件发生概率的估计方法。

Comparative study: Vonoprazan and proton pump inhibitors in Helicobacter pylori eradication therapy

AIM To compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor(PPI)-based therapies to treat Helicobacter pylori(H. pylori).METHODS We retrospectively analysed data from first-line(vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d)(n = 1353) and second-line(vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d)(n = 261) eradication treatments for H. pylori- positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic, Japan. The primary endpoint was the eradication rate, which was assessed with a full analysis set. The secondary endpoints were adverse events and related factors.RESULTS After the first-line treatments, the eradication rates for vonoprazan, esomeprazol, rabeprazole, and lansoprazole were 87.9%(95%CI: 84.9%-90.5%), 71.6%(95%CI: 67.5%-75.5%), 62.9%(95%CI: 52.0%-72.9%), and 57.3%(95%CI: 50.4%-64.1%), respectively. The vonoprazan eradication rate was significantly higher than that of the PPIs(P < 0.01). Interestingly, smoking did not affect the H. pylori eradication rate in the vonoprazan group(P = 0.34), whereas it decreased the rates in the PPI groups(P = 0.013). The incidence of adverse events in the vonop-razan group was not different from the PPI group(P = 0.054), although the vonoprazan group exhibited a wider range of adverse events. Vonoprazan-based triple therapy was highly effective as a second-line treatment, with an eradication rate similar to that of PPI-based therapy.CONCLUSION Vonoprazan might be superior to PPIs in first-line H. pylori therapy, particularly for smokers. However, caution is required due to possible adverse events.

Adverse effects of oral antiviral therapy in chronic hepatitis B

Oral nucleoside/nucleotide analogues(NAs) are currently the backbone of chronic hepatitis B(CHB) infection treatment. They are generally well-tolerated by patients and safe to use. To date, a significant number of patients have been treated with NAs. Safety data has accumulated over the years. The aim of this article is to review and update the adverse effects of oral NAs. NAs can cause class adverse effects(i.e., myopathy, neuropathy, lactic acidosis) and dissimilar adverse effects. All NAs carry a "Black Box" warning because of the potential risk for mitochondrial dysfunction. However, these adverse effects are rarely reported. The majority of cases are associated with lamivudine and telbivudine. Adefovir can lead to dose- and time-dependent nephrotoxicity, even at low doses. Tenofovir has significant renal and bone toxicity in patients with human immunodeficiency virus(HIV) infection. However, bone and renal toxicity in patients with CHB are not as prominent as in HIV infection. Entecavir and lamivudine are not generally associated with renal adverse events. Entecavir has been claimed to increase the risk of lactic acidosis in decompensated liver disease and high Model for End-Stage Liver Disease scores. However, current studies reported that entecavir could be safely used in decompensated cirrhosis. An increase in fetal adverse events has not been reported with lamivudine, telbivudine and tenofovir use in pregnant women, while there is no adequate data regarding entecavir and adefovir. Further long-term experience is required to highlight the adverse effects of NAs, especially in special patient populations, including pregnant women, elderly and patients with renal impairment.

Clinical usefulness of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis

AIM To evaluate the therapeutic effects of ursodeoxycholic acid(UDCA) on autoimmune hepatitis(AIH).METHODS A total 136 patients who were diagnosed with AIH were included in our study. All of the patients underwent a liver biopsy, and had at least a probable diagnosis on the basis of either the revised scoring system or the simplified scores. Initial treatment included UDCA monotherapy(Group U, n = 48) and prednisolone(PSL) monotherapy(Group P, n = 88). Group U was further classified into two subgroups according to the effect of UDCA: Patients who had achieved remission induction with UDCA monotherapy and showed no sign of relapse(Subgroup U1, n = 34) and patients who additionally received PSL during follow-up(Subgroup U2, n = 14). We compared the clinical and histological findings between each groups, and investigated factorscontributing to the response to UDCA monotherapy.RESULTS In Group U, 34 patients(71%) achieved and maintained remission over 49(range: 8-90) mo(Subgroup U1) and 14 patients(29%) additionally received PSL(Subgroup U2) during follow-up. Two patients in Subgroup U2 achieved remission induction once but additionally required PSL administration because of relapse(15 and 35 mo after the start of treatment). The remaining 12 patients in Subgroup U2 failed to achieve remission induction during follow-up, and PSL was added during 7(range: 2-18) mo. Compared with Subgroup U2, Subgroup U1 had significantly lower alanine aminotransferase(ALT) levels at onset(124 IU/L vs 262 IU/L, P = 0.023) and a significantly higher proportion of patients with mild inflammation(A1) on histological examination(70.6% vs 35.7%, P = 0.025). When multivariate analysis was performed to identify factors contributing to the response to UDCA monotherapy, only a serum ALT level of 200 IU/L or lower was found to be associated with a significant difference(P = 0.013).CONCLUSION To prevent adverse events related to corticosteroids, UDCA monotherapy for AIH needs to be considered in patients with a serum ALT level of 200 IU/L or lower.

Efficacy of a newly developed dilator for endoscopic ultrasound-guided biliary drainage

AIM To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound(EUS)-guided drainage(ES Dilator).METHODS Fourteen consecutive patients who had undergone EUSguided choledochoduodenostomy(EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group.Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group.A historical cohort study was carried out comparing the two groups.The main outcome measurement was the procedure time.The technical success rate and early AE rate were also compared between the two groups.RESULTS There were no significant differences in age,sex and etiology of biliary obstruction.The utilization rate of a plastic stent was higher in the control group(36% vs 0%).The technical success rate was 100% in both groups.The mean procedure time was significantly shorter in the study group than in the control group(27 ± 7 min vs 44 ± 26 min,P = 0.026).Additionally,there were no patients who required more than 40 min for the procedure in the study group.Early adverse events occurred in 29%(4/14) of the control group whereas none in the study group.The adverse events in all 4 patients was bile peritonitis,including pan-peritonitis in one patient.All patientsrecovered with conservative treatment by medication.CONCLUSION The newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.

Widespread use of gastric acid inhibitors in infants:Are they needed? Are they safe?

Gastroesophageal reflux is a common phenomenon in infants,but the differentiation between gastro-esophageal reflux and gastroesophageal reflux disease can be difficult.Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related.Despite this,gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used,often without objective evidence or investigations to guide treatment.Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis.With a lack of evidence for efficacy,attention is now being turned to the potential risks of gastric acid suppression.Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections,bacterial overgrowth,adverse bone health,food allergy and drug interactions.

Surgical left atrial appendage occlusion during cardiac surgery： A systematic review and meta-analysis

AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation(AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n = 40107) met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke(OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of allcause mortality, AF, and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.

Factors associated with success of telaprevir-and boceprevir-based triple therapy for hepatitis C virus infection

AIM To evaluate new therapies for hepatitis C virus(HCV), data about real-world outcomes are needed.METHODS Outcomes of 223 patients with genotype 1 HCV who started telaprevir-or boceprevir-based triple therapy(May 2011-March 2012) at the Mount Sinai Medical Center were analyzed. Human immunodeficiency viruspositive patients and patients who received a liver transplant were excluded. Factors associated with sustained virological response(SVR24) and relapse were analyzed by univariable and multivariable logistic regression as well as classification and regression trees. Fast virological response(FVR) was defined as undetectable HCV RNA at week-4(telaprevir) or week-8(boceprevir). RESULTS The median age was 57 years, 18% were black, 44% had advanced fibrosis/cirrhosis(FIB-4 ≥ 3.25). Only 42%(94/223) of patients achieved SVR24 on an intention-totreat basis. In a model that included platelets, SVR24 was associated with white race [odds ratio(OR) = 5.92, 95% confidence interval(CI): 2.34-14.96], HCV sub-genotype 1b(OR = 2.81, 95%CI: 1.45-5.44), platelet count(OR = 1.10, per x 104 cells/μL, 95%CI: 1.05-1.16), and IL28 B CC genotype(OR = 3.54, 95%CI: 1.19-10.53). Platelet counts > 135 x 103/μL were the strongest predictor of SVR by classification and regression tree. Relapse occurred in 25%(27/104) of patients with an end-oftreatment response and was associated with non-FVR(OR = 4.77, 95%CI: 1.68-13.56), HCV sub-genotype 1a(OR = 5.20; 95%CI: 1.40-18.97), and FIB-4 ≥ 3.25(OR = 2.77; 95%CI: 1.07-7.22). CONCLUSION The SVR rate was 42% with telaprevir-or boceprevirbased triple therapy in real-world practice. Low platelets and advanced fibrosis were associated with treatment failure and relapse.

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris

BackgroundThe 左 atrial 尺寸被看作了不利心血管的结果的一个有用标记。然而，左 atrial 区域索引(LAAI ) 是否与不稳定的心绞痛(UAP ) 在病人为预后有预兆的价值，不是众所周知的。这研究被瞄准估计在 LAAI 之间的协会，在 UAP patients.MethodsWe 的结果注册了作为 UAP 诊断的 391 个在里面医院病人的一个总数。临床并且在基线的 echocardiographic 数据被收集。病人是跟随的 for&#x000a0； adverse&#x000a0 的发展； cardiovascular&#x000a0；(CV ) 事件，为心绞痛的包括的医院重新接纳，尖锐心肌的梗塞(AMI ) ，充血的心失败(CHF ) ，击和所有原因 mortality.ResultsDuring 26.3 &#x000b1 的一吝啬的后续时间；8.6 个月， 98 个不利 CV 事件发生了(为心绞痛，四 AMI，四 CHF，一中风和五所有原因死亡的 84 医院重新接纳) 。在一个 multivariate 考克斯模型， LAAI [或：1.140， 95% CI：1.016-1.279， P = 0.026 ] ，心脏舒张的血压(或：0.976， 95% CI：0.956-0.996， P = 0.020 ) 并且脉搏压力(或：1.020， 95% CI：1.007-1.034， P = 0.004 ) 为在 UAP patients.ConclusionsLAAI 的不利 CV 事件的独立预言者是独立于的不利 CV 事件的一个预言者临床并且在 UAP 病人的另外的 echocardiographic 参数。