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OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of generic drugs and original drugs of voriconazole. METHODS The information of patients who used voriconazole generic drugs selected in National Centralized Drug Procurement （generic drug group） or non-selected original drugs （original drug group） in the treatment of fungal infection was collected from the our hospital. The propensity score matching was carried out to eliminate bias. The comprehensive efficacy was evaluated according to clinical efficacy， image findings and microbiological test， and stratified analysis of different populations was conducted based on fungal species， underlying diseases， etc.， the efficacy of different stratifications was evaluated. Evaluation of safety was performed by using the incidence of adverse reactions. The total cost， defined daily doses （DDDs） and defined daily dose cost （DDDc） were used to evaluate the cost-effectiveness. RESULTS A total of 436 patients were included， and there were 190 patients in each group after matching. In terms of efficacy， the effective rates of voriconazole generic drugs and original drugs were 62.63% and 59.47% （P＝0.528）； in terms of safety， the incidence of adverse reactions caused by generic drugs and original drugs of voriconazole was 13.68% and 7.89%， respectively（P＝0.069）. In terms of cost-effectiveness， the average total cost of generic drugs was 4 636.26 yuan， and that of original drugs was 8 613.20 yuan （P＜0.001）. After the implementation of National Centralized Drug Procurement， replacement rate of generic drugs increased to 87.30%， and DDDc decreased by 59.08%. CONCLUSIONS The efficacy and safety of voriconazole generic drugs are similar to those of original drugs in the treatment of fungal infection， and it is more cost-effective in terms of treatment cost.
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OBJECTIVE To investigate the implementation effects of the national centralized drug volume-based procurement policy （abbreviated as “national centralized procurement policy”） in Guangxi Zhuang Autonomous Region prefecture， and to provide a reference for the future centralized drug procurement work of the medical institution. METHODS Drug procurement data before and after policy implementation were included in the study. The six secondary indicators （such as availability， affordability， and drug safety） and eighteen third-level indicators （such as completion rate of agreed purchase volume， affordability level， drug revenue proportion） were introduced， guided by the policy objectives and issues of concern to policy beneficiaries. Descriptive statistics was adopted to analyze the data before and after policy implementation （in 2019 and 2020） in terms of differences and change trends. RESULTS In terms of accessibility， the participation rate of medical institutions in Guangxi Zhuang Autonomous Region was 92.55%， the proportion of diseases involved and median completed procurement rate were 40.16%， and 287.82% respectively， and the total centralized delivery rate was 97.20%. In terms of affordability， the total reduction amplitude in drug price was 74.80% from 2019 to 2022； the charge for medicine per capita in hospitalization， the proportion of medicine used for outpatient service and hospitalization， decreased by 17.61%， 10.22%， and 20.10% in order； the burden levels on medical fares for patients were all below 1 in addition to chronic diseases， and anti-tumor drugs. In terms of the impact on medicine， the ratio of adverse drug reaction event cases in 2022 was 66.00%， an increase of 1.29% compared to the previous； since the implementation of the policy， 12 drugs from local pharmaceutical enterprises from Guangxi Zhuang Autonomous Region had passed the consistency evaluation， and the market concentration rate of the top 8 pharmaceutical companies was less than 20.00%. In terms of the impact on healthcare and medical insurance， the public medical institutions achieved generic substitution for originator drugs mostly until 2022； about 9.12% of drugs that were non- centrally purchased in the same category were used； 63.39% of people under investigation did not show a need for a second dressing change； drug expenditure decreased by 2.459 billion yuan. CONCLUSIONS The national centralized procurement policy achieves a significant effect in Guangxi Zhuang Autonomous Region. On the other hand， attention should be paid to these suggestions as follows: expanding the category of drugs used in clinic， conducting clinically comprehensive evaluation of selected drugs， and improving reasonable allocation strategy， etc.
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Colorectal cancer is one of the common malignant tumors with high morbidity， and changes in lifestyle， dietary structure and environment in China in recent decades have been associated with an increase in the incidence of colorectal cancer. A large number of studies have shown that traditional Chinese medicine（TCM） can be used as a complementary and alternative treatment for colorectal cancer after conventional western medicine treatment. TCM physicians have accumulated a lot of clinical experience in the treatment of patients with stage Ⅰ-Ⅲ colorectal cancer， and have proved that TCM has unique efficacy， but there is still a lack of relevant clinical practice guidelines to standardize and guide the diagnosis and treatment of TCM. Based on this， according to the guideline development process of the World Health Organization Handbook for Guideline Development and the Clinical Evidence Grading Criteria on TCM Based on Evidence Body， under the framework of relevant laws， regulations and technical guidance documents， combined with the evidence of relevant domestic and foreign clinical research in recent years for evidence grading and opinion recommendation， and then the Guidelines for TCM Intervention After Conventional Western Medicine Treatment for Stage Ⅰ-Ⅲ Colorectal Cancer were developed by expert consensus. This guideline introduces the etiology， pathogenesis， syndrome differentiation and treatment of TCM intervention for colorectal cancer， which can provide guiding opinions for TCM clinicians and clinicians of integrated traditional Chinese and western medicine engaged in the prevention and treatment of colorectal cancer.
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【Objective】 To investigate the serology and genotype identification method of B (A) subtype patients. 【Methods】 Test tube method (serology) was used to confirm the clinically difficult ABO blood group samples of 3 patients with ABO blood group; ABO blood group was genotyped by real-time PCR, and the ABO gene exon 1-7 was sequenced to determine the genotype. 【Results】 The forward and reverse blood typing result of three patients was B (A) subtype all with ABO genotype B/O2 and c.640A> G mutation on B allele of exon 7, which meets the characteristics of ABO * BA.04 genotype. 【Conclusion】 The combination of serological and genetic testing could identify difficult blood types such as ABO subtypes accurately and ensure the safety of clinical blood use.
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【Objective】 To investigate the factors affecting the length of hospitalization after the Sun's procedure in patients with type A aortic coarctation. 【Methods】 From January 2018 to June 2023, the clinical data, related laboratory indicators and perioperative blood transfusion data of patients with type A aortic dissection who underwent Sun's procedure in the First Hospital of Lanzhou University were collected. LASSO regression was used to screen the characteristics related to the length of hospital stay, and linear regression analysis was used to determine the risk factors for prolonged length of hospital stay. 【Results】 The statistical analysis of 242 patients showed that the amount of red blood cell transfusion, plasma transfusion, platelet transfusion and autologous blood transfusion were the influencing factors of the length of hospital stay in patients with type A aortic dissection after operation. The total sum of squared deviations of the linear regression equation fitting the total length of hospital stay was statistically significant (F= 10.504, P<0.001). 【Conclusion】 Perioperative red blood cell transfusion,plasma transfusion,platelet transfusion and autologous blood transfusion are risk factors for prolonged postoperative hospitalization in patients undergoing the Sun's procedure for type A aortic coarctation. Control of operation time and reduction of intraoperative blood loss may help to prevent prolonged postoperative hospital stay and other adverse conditions.
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Objective:To develop a grading prediction model of traumatic hemorrhage volume based on deep learning and assist in predicting traumatic hemorrhage volume.Methods:A retrospective observational study was conducted based on the experimental data of pig gunshot wounds in the time-effect assessment database for experiments on war-traumatized animals constructed by the General Hospital of the Chinese People's Liberation Army. The hemorrhage volume data of the study population were extracted, and the animals were divided into 0-300 mL, 301-600 mL, and > 600 mL groups according to the hemorrhage volume. Using vital signs indexes as the predictive variables and hemorrhage volume grading as the outcome variable, trauma hemorrhage volume grading prediction models were developed based on four traditional machine learning and ten deep learning methods. Using laboratory test indexes as predictive variables and hemorrhage volume grading as outcome variables, trauma hemorrhage volume grading prediction models were developed based on the above fourteen methods. The effect of the two groups of models was evaluated by accuracy and area under the receiver operator characteristic curve (AUC), and the optimal models in the two groups were mixed to obtain hybrid model 1. Feature selection was conducted according to the genetic algorithm, and hybrid model 2 was constructed according to the best feature combination. Finally, hybrid model 2 was deployed in the animal experiment database system.Results:Ninety-six traumatic animals in the database were enrolled, including 27 pigs in the 0-300 mL group, 40 in the 301-600 mL group, and 29 in the > 600 mL group. Among the fourteen models based on vital signs indexes, fully convolutional network (FCN) model was the best [accuracy: 60.0%, AUC and 95% confidence interval (95% CI) was 0.699 (0.671-0.727)]. Among the fourteen models based on laboratory test indexes, recurrent neural network (RNN) model was the best [accuracy: 68.9%, AUC (95% CI) was 0.845 (0.829-0.860)]. After mixing the FCN and RNN models, the hybrid model 1, namely RNN-FCN model was obtained, and the performance of the model was improved [accuracy: 74.2%, AUC (95% CI) was 0.847 (0.833-0.862)]. Feature selection was carried out by genetic algorithm, and the hybrid model 2, namely RNN-FCN* model, was constructed according to the selected feature combination, which further improved the model performance [accuracy: 80.5%, AUC (95% CI) was 0.880 (0.868-0.893)]. The hybrid model 2 contained ten indexes, including mean arterial pressure (MAP), hematocrit (HCT), platelet count (PLT), lactic acid, arterial partial pressure of carbon dioxide (PaCO 2), Total CO 2, blood sodium, anion gap (AG), fibrinogen (FIB), international normalized ratio (INR). Finally, the RNN-FCN* model was deployed in the database system, which realized automatic, continuous, efficient, intelligent, and grading prediction of hemorrhage volume in traumatic animals. Conclusion:Based on deep learning, a grading prediction model of traumatic hemorrhage volume was developed and deployed in the information system to realize the intelligent grading prediction of traumatic animal hemorrhage volume.
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Objective:To observe the changes of arterial blood gas indexes in pigs with the free-field primary blast lung injury (PBLI) model, and to explore the value of arterial blood gas indexes in predicting moderate to severe PBLI.Methods:Nine adult healthy Landrace pigs were selected to construct the pig free-field PBLI model. Arterial blood samples were taken 15 minutes before the explosion (before injury) and 10, 30, 60, 120, and 180 minutes after the explosion (after injury). Arterial blood gas indexes and pulse oxygen saturation (SpO 2) were measured, compare the changes of blood gas analysis indexes and SpO 2 levels at different time points, and observe the changes of gross injury scores and pathological injury scores of lung tissue. Analyze the correlation between the blood gas indicators. Results:As time prolonged, at each time point, pH, arterial partial pressure of oxygen (PaO 2), and SpO 2 were lower than those before the injury, and blood lactic acid (Lac) and arterial partial pressure of carbon dioxide (PaCO 2) were higher than those before the injury. Compared with that before the injury, the pH value in the blood decreased significantly 10 minutes after the injury (7.39±0.06 vs. 7.46±0.02, P < 0.05), and the Lac increased significantly (mmol/L: 3.61±2.89 vs. 1.10±0.28, P < 0.05), and lasts until 180 minutes after injury (pH value: 7.37±0.07 vs. 7.46±0.02, Lac (mmol/L): 2.40±0.79 vs. 1.10±0.28, both P < 0.05); while PaO 2 and SpO 2 decreased significantly at 180 minutes after injury [PaO 2 (mmHg, 1 mmHg = 0.133 kPa): 59.40±10.94 vs. 74.81±9.39, P < 0.05; SpO 2: 0.75±0.11 vs. 0.89±0.08, P < 0.05], PaCO 2 increased significantly (mmHg: 56.17±5.38 vs. 48.42±4.93, P < 0.05). Correlation analysis showed that the gross injury score of lung blast injury animals was positively correlated with the pathological injury score ( r = 0.866, P = 0.005); PaO 2 and SpO 2 were positively correlated ( r = 0.703, P = 0.000); pH value and Lac were negative Correlation ( r = -0.400, P = 0.006); pH value is negatively correlated with PaCO 2 ( r = -0.844, P = 0.000). Conclusion:This study successfully established a large mammalian free-field PBLI model, arterial blood gas analysis is helpful for the early diagnosis of PBLI, whether SpO 2 can be used to evaluate the severity of lung injury remains to be further verified.
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OBJECTIVE：To investigate the ru les and characteristics of pembrolizumab-induced immune-related myocarditis ， and to provide reference for rational drug use in clinic. METHODS ：Using“pembrolizumab/keytruda”“myocarditis”“cardiotoxicity” “Pembrolizumab/Keytruda”“Cardiac toxicity ”“Myocarditis”“Cardiotoxity”“Cardiotoxicity”as Chinese and English retrieval words ， CBM，VIP，CNKI，Wanfang database ，PubMed，Wiley Online Library and Embase database were searched on the case reports of pembrolizumab-induced immune-related myocarditis during the inception to Aug. 2020. After eliminating the suspected case literature and repetitive literature ，gender，age，medication cause ，medical history ，drug combination ，drug dosage ，occurrence time of ADR ，clinical manifestation ，intervention measure and outcome of patients in the included literature were analyzed. RESULTS & CONCLUSIONS：A total of 15 literatures were included ，involving 13 English literatures and 2 Chinese literatures. Totally 15 patients were involved ，including 12 males and 3 females，with an average age of 71.35 years. There were 4 cases of non-small cell lung cancer ，4 cases of melanoma ，2 cases of bladder cancer ，1 case of urothelial cancer ，1 case of multiple osteosarcomas，1 case of gastric cancer ，1 case of thymic cancer ，1 case of nasopharyngeal carcinoma. There were 6 patients with previous medical history ，of which 5 had no history of heart disease and 1 had hypertension and hyperlipidemia ；there were 9 patients recorded the combined use of drugs ；the dosage and frequency of pembrolizumab were recorded in 12 patients. Immunological myocarditis of 93.3％ patients occurred after the first to second cycle of pembrolizumab administration ，and the average occurrence time was 15.5 days after the last administration. The most common clinical symptoms were dyspnea ，fatigue， dizziness or syncope. 9 patients showed cardiac block on electrocardiogram. All patients were treated with glucocorticoids when they developed immune-associated myocarditis ，and 5 patients died after hospitalization ；another one patient was restarted with pembrolizumab for one cycle after control of immune-related myocarditis ，but developed a recurrence of myocarditis and died of myocarditis ADR. It is suggested that baseline examination and routine monitoring of cardiac function should be done well when patients are treated with pembrolizumab. Once the patient is su spected to have immune-related myocarditis ，they should timely improve the cardiograms and other cardiac function-relatedtests，and start the treatment of high-dose glucocorticoids as 198177） soon as possible ，and are alert to the risk of death due to recurrence of myocarditis after readministration.
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OBJECTIVE：To investigate the effect of increasing efficacy and decreasing toxicity of Limax extract （LE）on cyclophosphamide（CTX）in the treatment of hepatocellular carcinoma. METHODS ：The mice were randomly divided into normal group，model group ，CTX group （0.02 g/kg），LE low-dose ，medium-dose and high-dose groups （LEL，LEM，LEH group ，0.6，1.2，2.4 g/kg），CTX+LE low-dose ，medium-dose and high-dose combination groups （CTX+LEL，CTX+LEM，CTX+ LEH group ，the same dose as single drug group ），with 10 huangrenbin518@163.com mice in each group. Except for normal group ，other groups were inoculated with hepatoma cells H 22 in the left ar mpit to establish tumor bearing models. After 24 h of inoculation ，normal group and model group were intragastrically given normal saline ， and administration groups were intragastrically given corresponding drugs ，once a day ，for 10 days. On the second day after the last administration ，the general conditions of mice in each group were observed ；the body mass ，thymus index （LI），spleen index （SI）were measured ；the tumor inhibition rate was detected. The effect （q）of combination therapy was evaluated by King ’s formula . The counts of WBC ，RBC and PLT ，serum contents of ALT ，ALT，Scr and BUN were detected in model group ，CTX group and combination groups ，and the contents of MDA，SOD and GSH ，the levels of VEGF ，TNF-α and IL-6 in the tumor tissue were detected by colorimetry and ELISA in above groups. The protein expression of oncogenes （p53，Bcl-2 and Bax ）were detected by immunohistochemical method in model group，CTX group and CTX+LEM group. RESULTS ：The mice in the model group were in poor spirit and had symptoms of excessive drinking and eating ；although the body weight ，TI and SI were not significantly abnormal compared with normal group （P＞0.05），WBC count and AST content were significantly increased ，ALT and BUN contents were significantly decreased （P＜ 0.05 or P＜0.01）. Compared with model group ，above symptoms of mice were all improved in administration groups. The tumor weight of administration groups ，TI and SI of CTX group and TI of combination groups were decreased significantly ，but tumor weight of LEL group and LEH group ，TI and SI of LE single groups and combination groups were significantly higher than CTX group；tumor weight of combination groups were significantly lower than CTX group （P＜0.05 or P＜0.01）. The tumor inhibition rates of administration groups were 29.58％-72.08％. The q values of CTX+LEL group ，CTX+LEM group and CTX+LEH group were 1.03，0.97 and 0.86，respectively. Compared with model group ，WBC count ，AST and BUN contents of CTX group ，MDA contents of combination groups ，VEGF，TNF-α and IL-6 levels of administration groups ，the protein expression of Bcl- 2 in CTX group and CTX+LEM group were decreased significantly ；the activities of SOD and GSH of administration groups ，the protein expression of p 53 in CTX+LEM group and Bax in CTX group ，CTX+LEM group were increased significantly （P＜0.05 or P＜ 0.01）；WBC counts and AST contents of administration groups ，ALT content of CTX+LEM group ，SOD activity of CTX+LEH group and GSH activity of CTX+LEM group were all significantly higher than those of CTX group ；MDA content of CTX+LEH group，VEGF and TNF-α levels of CTX+LEM group and CTX+LEH group，IL-6 levels of administration groups were all significantly lower than CTX group （P＜0.05 or P＜0.01）. CONCLUSIONS ：LE combined with CTX can increase the anti-tumor effect，and LE can reduce the toxicity of CTX induced immunosuppression and bone marrow suppression in mice ，with effect of increasing efficacy and decreasing toxicity. The effect may be related to antioxidant stress ，inhibition of angiogenesis and secretion of inflammatory factors ，and regulation of apoptosis protein expression.
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Objective:To study the new mechanism of Xuebijing injection improving the function of pulmonary vascular barrier from the perspective of claudin-5 protein.Methods:Acute lung injury (ALI) model was induced by hydrogen sulfide (H 2S) exposure. ① In vivo study: Sprague-Dawley (SD) rats were divided into control group, H 2S exposure group (exposure to 300×10 -6 H 2S for 3 hours), Xuebijing control group (Xuebijing injection 4 mL/kg, twice a day, for 3 days), and Xuebijing intervention group (H 2S exposure after pretreatment of Xuebijing injection) according to random number method, with 6 rats in each group. At different time points (0, 6, 12 and 24 hours) after the model was made successfully, the total protein content in plasma and bronchoalveolar lavage fluid (BALF) of rats were detected respectively, and the pulmonary permeability index (PPI) was calculated (PPI = protein content in BALF/protein content in plasma), lung dry/wet weight ratio (W/D) was detected, and claudin-5 mRNA expression in lung tissue was measured by real time-polymerase chain reaction. ② In vitro test: human pulmonary microvascular endothelial cells (HPMECs) were divided into blank control group, NaHS treatment group (co-incubated with 500 μmol/L NaHS for 12 hours), Xuebijing control group (2 g/L Xuebijing injection for 24 hours), and Xuebijing intervention group (2 g/L Xuebijing injection pre-treated for 24 hours, then co-incubated with 500 μmol/L NaHS for 12 hours). The HPMECs claudin-5 protein expression and monolayer permeability changes were measured at different co-incubation time (1, 3, 6, 12 and 24 hours) by Western Blot and fluoresceinsodium. Results:① In vivo study: compared with the control group, the lung W/D ratio increased significantly at 6 hours and peaked at 12 hours after H 2S exposure in rats (4.67±0.11 vs. 4.26±0.06, P < 0.01). The expression of claudin-5 mRNA in lung tissue was significantly decreased, which was 89% of control group 6 hours after exposure ( P < 0.01). The total protein content in BALF and PPI at 12 hours after exposure were significantly higher than those in the control group [total protein content (mg/L): 262.31±14.24 vs. 33.30±3.09, PPI: (11.72±0.57)×10 -3 vs. (1.21±0.08)×10 -3, both P < 0.01], while the results in Xuebijing intervention group were significantly decreased [total protein content (mg/L): 153.25±7.32 vs. 262.31±14.24, PPI: (5.79±0.23)×10 -3 vs. (11.72±0.57)×10 -3, both P < 0.01]. ② In vitro test: compared with the blank control group, after incubating HPMECs with NaHS, the permeability of monolayer endothelial cells gradually increased, reaching the highest level in 12 hours, about twice of that in the blank control group, while claudin-5 protein expression decreased to the lowest level at 12 hours (claudin-5/β-actin: 0.42±0.03 vs. 1.03±0.05, P < 0.01). After intervention with Xuebijing, the permeability of endothelial cells was significantly improved (fluorescence intensity of fluorescein sodium: 1.46±0.10 vs. 1.89±0.11, P < 0.01), and the decrease of claudin-5 protein was reduced (claudin-5/β-actin: 0.68±0.04 vs. 0.38±0.03, P < 0.01). Conclusion:Xuebijing injection may improve pulmonary vascular barrier function in ALI by upregulating claudin-5 expression.
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OBJECTIVE： To analyze effectiveness and economy of domestic vancomycin hydrochloride for injection （trade name： Laikexin） vs. imported vancomycin hydrochloride for injection （trade name： Vancocin） in treatment of intracranial infection induced by MRSA， and to provide decision-making reference for the selection of clinical drugs. METHODS： Clinical data of patients with suspected MRSA intracranial infections receiving Laikexin or Vancocin were collected by retrospective study method from neurosurgery department of our hospital during Jan. 2016 to Jun. 2017， including 115 cases of Laikexin and 42 cases of Vancocin. Using response rate （including clinical cure and clinical improvement） as indexes， cost-effectiveness analysis was performed for Laikexin and Vancocin in the treatment of intracranial infection induced by MRSA by using decision tree model. Sensitivity analysis was conducted for 10％ decrease of cost and response rate. RESULTS： Response rate and excepted cost of Laikexin were 85.21％ and 13 125.96 yuan， cost-effectiveness ratio （CER） was 15 404.25. Response rate and excepted cost of Vancocin were 78.57％ and 15 619.17 yuan， CER was 19 879.31. There was no statistical significance in response rate between Laikexin and Vancocin （P＜0.05）. There was no difference between sensitivity analysis and cost-effectiveness analysis. CONCLUSIONS： The efficacy of Laikexin and Vancocin in the treatment of MRSA intracranial infection is similar， but the CER of Laikexin is lower than that of Wenkexin.
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Department of Emergency Medicine, The Second Xiangya Hospital of Central South University tried to establish the emergency and difficult disease ward since 2013, which specially treated patients with difficult complex involving multiple disciplines.After four years of operation, we obtained the ideal effects.The related information is as follows.(1) The necessity to establish the emergency and difficult disease ward:The necessity of the emergency rescue task is heavy, and difficult disease patients in the emergency department retention time is long, affects both the normal turnover of beds, also increased the economic burden of patients.(2) The feasibility to establish the emergency and difficult disease ward:The patient has the needs, and with the support of our hospital, we have the ability to do it well.(3) The exploration to establish the emergency and diffict disease ward:we defined the standard of treatment for patients with difficult problems, and established the diagnosis and treatment procedures of patients with difficult problems.(4) The results to establish the emergency and difficult ward:① In four years, patients with difficult diseases are effectively disposed of.② The levels of diagnosis and treatment of difficult diseases have been improved.③ Scientific research ability has been effectively improved.
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This study aimed to use the sika deer as a model to study the influence of IGF-1 on the expression of Col Ⅰ in antler chondrocytes.The chondrocytes were separated from sika deer antlers,cultured and were treated with recombinant human IGF-1 protein (rIGF-1),both rIGF-1 and PQ401,and transfected with IGF-1 over-expression plasmid or IGF-1 siRNA,respectively.The expression of Col Ⅰ which,a well-known marker for chondrocytes dedifferentiation,was detected by real-time PCR.The results showed that administration of rIGF-1 to antler chondroctyes resulted in an obvious decrease of Col Ⅰ mRNA levels,while PQ401 pretreatment could dramatically attenuate the effects of rIGF-1 on the expression of Col Ⅰ mRNA.After transfection with IGF-1 over-expression plasmid,the expression of Col Ⅰ mRNA was obviously reduced in antler chondrocytes compared with control.Conversely,knockdown IGF1 with specific siRNA could increase the expression of Col Ⅰ in antler chondrocytes.These results indicate that IGF-1 may play an important role in process of antler chondrocyte dedifferentiation.
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Objectives: To explore weather oxygen uptake efficiency slope (OUES) may predict the prognosis in patients with idiopathic pulmonary arterial hypertension (IPAH). Methods: The consecutive newly diagnosed IPAH patients in our hospital from 2010-11 to 2015-06 were prospectively enrolled and regular follow-up study was conducted to record cardiovascular events (death and lung transplantation). Kaplan–Meier curve, uni- and multivariate Cox regression analysis were performed to assess the survival rate in relevant patients. Results: A total of 210 IPAH patients at the mean age of (32±10) years were finished cardiopulmonary exercise test (CPET) and received regular follow-up study including 159 female. There were 31 patients died and 1 received lung transplantation over 41 months follow-up period. OUES was positively related to peak oxygen uptake (VO2)/body weight (r=0.71, P0.52 L/(min?m2) (41.9% vs 89.8%), P<0.0001.Conclusion: OUES as a submaximal CPET parameter may well predict the prognosis in IPAH patients.
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Objective:To construct the pleiotrophin (PTN )overexpression vector,and to explore the effect of PTN on the decidualization of uterine stromal cells in the mice.Methods:The specific primers containing restriction enzyme cutting sites were designed according to the PTN gene sequences published in GenBank for PCR amplification.The amplified fragment of PTN was recovered from the agarose gel and cloned into the pGEM-T vector.The pGEMT-PTN was cut by double enzyme digestion and ligated into pcDNA3.1 (+)to construct the PTN overexpression plasmid.After transfection with PTN overexpression plasmid,the expression levels of PTN mRNA in the uterine stromal cells and the expression levels of decidualization markers Prl8a2 and Prl3c1 were detected by qRT-PCR method.The uterine stromal cells transfected with pcDNA3.1 (+)empty vector were used as control group. Results:The results of identification by double enzyme digestion indicated that the bands of PTN overexpression plasmid were consistent with those of the target gene,and the clone sequencing results suggested that it had 100% homology with mouse PTN gene sequence published in GenBank.Compared with control group, the expression levels of PTN,Prl8a2 and Prl3c1 mRNA in mouse uterine stromal cells in PTN overexpression group were significantly increased (P < 0.05).Conclusion:PTN overexpression could increase the expression levels of decidualization markers in mouse uterine stromal cells,indicating that PTN might play an enhancement effect during uterine decidualization in the mice.
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OBJECTIVE:To systematically review the related evidence-based guidelines of purulent meningitis in children,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,CBM,Wanfang Data-base,CJFD and VIP,NGC,GIN,TRIP and websites of domestic and international medical associations and industry bodies,the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extrac-tion and quality evaluation. RESULTS:Finally 3 guidelines were enrolled in total,with development time ranging from 2004 to 2012,from USA,Britain and Australia,respectively. All of the recommendations were level B,scope and purpose and clarityshowed the higher scores in AGREEⅡ,more than 70%,and applicability showed generally low scores. Penicillin and cefotaxi-me were recommended in purulent meningitis of neonates,and vancomycin combined with cefotaxime or ceftriaxone were recom-mended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different,and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS:The recommendations of medicines for the treatment of pu-rulent meningitis are basically unanimous,with no regional difference,but there are some differences about dose and the course of treatment. In addition,the classification criteria of the levels of evidence and recommendation are still suboptimal,which needs fur-ther improvement. And guidelines on purulent meningitis should be improved inrigourandapplicabilityin future.
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Objective: To evaluate cardiopulmonary exercise testing (CPET) on sildenaifl effect for treating the patients with pulmonary arterial hypertension (PAH). Methods: A total of 25 PAH patients received sildenaifl treatment in our hospital from 2012-01 to 2014-01 were enrolled as PAH group, in addition, there were a Control group including 24 healthy subjects. The CPET, echocardiography, NYHA function class, 6-mimute walking distance (6MWD) and plasma levels of NT-proBNP at the baseline, (6-12) months and (13-18) months after sildenaifl treatment were assessed and compared between 2 groups. Results: Compared with Control group, PAH group showed decreased aerobic capacity (peakVO?2, Peak O2pulse) and ventilation efifciency (PETCO2@AT, VE?/VC?O2@AT), allP<0.05. At (8±2) months after sildenaifl treatment, aerobic capacity and ventilation efifciency was improved, meanwhile, NYHA function class, 6MWD and plasma levels of NT-proBNP were improved, allP<0.05. At (16±2) months after sildenaifl treatment, 6MWD was similar,P=0.26, while peak VO?2 and peak O2 pulse were decreased than they were at (8±2) months after sildenaifl treatment,P=0.04 and 0.06; the ventilation efifciency was elevated (as presented by increased VE?/VC?O2@AT and decreased PETCO2@AT,P=0.04 and P=0.04); plasma level of NT-proBNP was increased,P=0.05. Conclusion: CPET can effectively evaluate sildenaifl effect for treating PAH patients and therefore and guide the drugs therapy.
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Objective To systematically review articles about therapeutic drug monitoring of vancomycin in Chinese adults, so as to provide a reference of vancomycin trough concentrations for clinical evidence-based medicine.Methods Literature concerning vancomycin therapeutic drug monitoring were electronically retrieved in, CBM, Wanfang data, CNKI and Vip.Furthermore, the articles written in English by Chinese author in PubMed, EMbase were included.All the data were searched from inception of the database or network to Aug.2014.Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of literature using the Combieg and NOS.Analyzing the types of studies, the number of therapeutic monitoring of vancomycin, trough serum concentration, clinical outcome and renal function.Results A total of 35 studies including 32 cross-sectional studies and 3 cohort studies were included, all studies were observational studies.3099 patients with 5206 blood concentrations monitoring results were eligible for final analyses in all 32 cross-sectional studies.The rates of trough serum concentration in 5-15 mg/L was 53.6%.Compared with the trough concentrations between 5 and 15 mg/L, clinical cure rate was no significant difference in the trough concentrations of over 15μg/mL.However, the incidence rate was significantly reduced in renal toxicity in 5-15 mg/L trough serum concentration.Conclusions For adults, trough serum concentration of vancomycin should adopt the 5-15 mg/L in China.However, considering lack of high-level evidence, so it needs to be studied further.
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Objective To evaluate the effect of mouse nerve growth factor on fracture healing.Methods Cochrane library, Pubmed, EMbase, CNKI,VIP,Wanfang Data and CBM were searched for the randomized controlled trials(RCTs)of mouse nerve growth factor on fracture healing from the date of establishment of the databases to May 2014.Three independent rese archers evaluated the included studies using GRADE,according to recommend classification method of GRADE system by three researchers,crtical evaluated and data extracted of the quality of the included studies,which conform to the quality standard of RCT was analyzed by Meta analysis.The extracted data were analyzed by RevMan 5.0 and GRAED proiler.Results A total 5 trials were discovered and all of these were in Chinese.Compared with conventional treatment was improved a lot[MD =-8.74,95%CI( -9.79,-7.68),P<0.0001].However, adverse drug reaction in patients with mouse nerve growth factor were increased[OR =14.66,95%CI(1.89, 113.99),P=0.01].The both outcomes were low quality in the GRADE system.Conclusion Mouse nerve growth factor can improve fracture healing and the side effects will also increase.
ABSTRACT
Complex odontoma is a relatively rare dental dysplasia. In particular, a complex odontoma with dentigerous cyst is seldom observed. A case of complex odontoma with dentigerous cyst is reported in this paper.