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Objective To systematically evaluate the efficacy and safety of ceftazidime/avibactam(CAZ/AVI) in the treatment of carbapenem-resistant Enterobacteriaceae(CRE) or carbapenem-resistance Klebsiella pneumonia (CRKP), and to provide evidence-cased reference for clinic therapy. Methods A comprehensive literature search from PubMed, Embase, the Cochrane Library, CBM, CNKI and VIP database was conducted for the CAZ/AVI therapy on CRE/CRKP infections published before May.2020. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. The results were analyzed by RevMan 5.3 statistical software. Results Five studies in English involving 392 patients were included for the analysis. In terms of effectiveness, the results showed CAZ/AVI group significantly increased the clinical cure rate[OR=3.57, 95% CI (2.03, 6.26), P<0.00001] compared with the control group. Also CAZ/AVI group significantly decreased the 28/30 day all-cause mortality [OR=0.27, 95% CI (0.14, 0.50), P<0.0001]. There were no significant difference between the two groups in the clinical remission rate [OR=1.92, 95% CI (0.93, 3.97), P=0.08] and the infection recurrence rate [OR=0.44, 95% CI (0.11, 1.85), P=0.26]. In terms of safety, the incidence of adverse events in CAZ/AVI group were lower than those in control group [OR=0.29, 95% CI (0.10, 0.80), P=0.02]. There was no significant difference between two groups in the incidence of serious adverse events[OR=0.33, 95% CI (0.09, 1.19), P=0.09]. Conclusion The current evidence shows that CAZ/AVI therapy has advantage in survival rate for the treatment of CRE/CRKP infections without increase of SAEs. Limited by the quality and quantity of the included studies, the above conclusions need to be verified with more high-quality RCTs.
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OBJECTIVE： To systematically evaluate effectiveness of prophylactic application of carbapenems for severe acute pancreatitis （SAP）， and to provide evidence-based reference in clinic. METHODS： Retrieved from PubMed， Embase， Medline， Cochrane Library， CNKI and VIP database，randomized controlled trials （RCTs） about effectiveness of prophylactic application of carbapenems （trial group） versus placebo or non-prophylactic use of antibiotics （control group） for SAP were included， and the retrieval time was from establishment to Dec. 2018. After extracting data from clinical studies that met the inclusion criteria， methodological quality of included studies were evaluated by using Cochrane bias risk assessment tool 5.1.0 and modified Jadad scoring scale， and Meta-analysis was performed for pancreatic infection rate， extrapancreatic infection rate， surgical intervention rate and mortality rate by using Rev Man 5.3 statistical software. RESULTS： A total of 8 RCTs were included， involving 544 patients. Meta-analysis showed that there was no statistical significance in the pancreatic infection rate [RR＝0.84， 95％CI （0.58， 1.22）， P＝0.36]， extra-pancreatic infection rate [RR＝0.76， 95％CI （0.43， 1.35）， P＝0.35] and surgical intervention rate [RR＝0.93， 95％CI （0.65， 1.32）， P＝0.68] or mortality rate [RR＝0.99， 95％CI（0.59，1.65）， P＝0.97] between 2 groups. CONCLUSIONS： The prophylactic use of carbapenems can not reduce pancreatic or extra-pancreatic infection rate， surgical intervention rate and mortality rate.
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Objective · To investigate the prevalence of smoking and awareness of smoking hazards in a community-based elderly population in Changning District, Shanghai. Methods · A total of 1809 subjects were randomly selected from 18 communities based on the chronic non-communicable diseases cohort in an elderly population aged 65 and over in Changning District, Shanghai. Information on smoking status, health condition and awareness of smoking hazards were obtained through face to face interviews. Chi-square tests and non-conditional Logistic regression analyses were used to evaluate the risk factors of the awareness of smoking hazards and current smoking status. Results · The overall prevalence of current smoking was 15.6% among the investigated elderly population. Smoking prevalence was significantly higher in men than that in women (30.0% vs 2.1%, P=0.000). Also, it was higher in the men aged 65-69 than that in those aged 70 and over (34.3% vs 20.4%, P=0.000). The participants with middle school education had the highest prevalence (19.1%) in the population. Overall, the proportion of participants who knew "smoking causes heart disease" "smoking causes stroke"and "smoking causes cancer" was 45.1%, 43.3% and 64.4%, respectively. Among the participants, 36.4% knew all the three smoking hazards. With the confounders such as age and gender being adjusted, current smoking behavior was associated with the participants' awareness of smoking hazards (OR=0.74,P=0.000). Conclusion · Currently, the awareness of smoking hazards is generally low in Shanghai elderly population, especially in those with lower education level and current smoking behavior. More targeted educational interventions are necessary in specific population.
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Objective · To investigate the prevalence of smoking and awareness of smoking hazards in a community-based elderly population in Changning District, Shanghai. Methods · A total of 1809 subjects were randomly selected from 18 communities based on the chronic non-communicable diseases cohort in an elderly population aged 65 and over in Changning District, Shanghai. Information on smoking status, health condition and awareness of smoking hazards were obtained through face to face interviews. Chi-square tests and non-conditional Logistic regression analyses were used to evaluate the risk factors of the awareness of smoking hazards and current smoking status. Results · The overall prevalence of current smoking was 15.6% among the investigated elderly population. Smoking prevalence was significantly higher in men than that in women (30.0% vs 2.1%, P=0.000). Also, it was higher in the men aged 65-69 than that in those aged 70 and over (34.3% vs 20.4%, P=0.000). The participants with middle school education had the highest prevalence (19.1%) in the population. Overall, the proportion of participants who knew "smoking causes heart disease" "smoking causes stroke"and "smoking causes cancer" was 45.1%, 43.3% and 64.4%, respectively. Among the participants, 36.4% knew all the three smoking hazards. With the confounders such as age and gender being adjusted, current smoking behavior was associated with the participants' awareness of smoking hazards (OR=0.74,P=0.000). Conclusion · Currently, the awareness of smoking hazards is generally low in Shanghai elderly population, especially in those with lower education level and current smoking behavior. More targeted educational interventions are necessary in specific population.
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OBJECTIVE:To prepare Zuojin gastric-mucoadhesive tablets and evaluate their drug release properties in vitro. METHODS:Zuojin gastric-mucoadhesive tablets were prepared with hydroxypropyl methyl cellulose K15M(HPMC-K15M),car-bomer 934P and HPMC-E50 as the bioadhesive and matrix materials,and basic magnesium carbonate(foaming material),95% al-cohol solution(adhesive)and aerosil(glidant and lubricant)as the adjuvants. With the accumulative release of total alkaloids from Coptis chinensis Franch. at 2,6 and 10 h(Q2 h,Q6 h and Q10 h)as the indexes,orthogonal design test was conducted to optimize the amounts of HPMC-K15M,carbomer 934P,HPMC-E50 and basic magnesium carbonate,and verification was carried out. Drug re-lease properties in vitro of the preparation and Zuojin conventional tablets were observed and in vitro adhesion thereof determined. RESULTS:The optimal formulation was as follows as that for 50 tablets,HPMC-K15M of 0.7 g,carbomer 934P of 0.2 g, HPMC-E50 of 3.5 g and basic magnesium carbonate of 0.4 g. The Q2 h,Q6 h and Q10 h of three batches of prepared samples were 24.32%,56.10% and 77.04% respectively. 1-12 h drug release in vitro of prepared samples was in conformity with Ritger-Peppas equation. The Q2 h of Zuojin conventional tablets and Zuojin gastric-mucoadhesive tablets were 80.46% and 24.04%,Q12 h thereof 92.15% and 95.83% and gastric adhesion thereof 24.2 and 74.0 g/cm2,respectively. CONCLUSIONS:Zuojin gastric-mucoadhesive tablets which have sustained-release effect and adhesive property have been prepared successfully.
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Acromegaly is a rare clinical endocrine disorder related to systematic complications such as cardiovascular,respiratory and metabolic disorders which determine its prognosis.Hypertension is the main complication resulting in the increased frequency of morbidity.The mechanism of hypertension in acromegaly is still no real consensus.In this review,we examine the prevalence and danger of hypertension in acromegalic patients and discuss the clinical and experimental mechanisms on the cardiovascular system in order to define the possible pathogenetic factors involved in the development and/or maintenance of high arterial blood pressure in acromegaly.The modern object of acromegalic treatment is normalization of morbidity and the treatment of pituitary tumor involve surgery,medication and radiation.Besides,blood pressure control is also demanded.The lowering of blood pressure observed in a proportion of hypertensive acromegalics,and the normalization of serum GH and IGF-1 level is of great importance.