Clinical Characteristics and Survival Analysis of Carbapenem-Resistant Pseudomonas Aeruginosa Colonized or Infected Patients with Hematological Disorders / 中国实验血液学杂志

OBJECTIVE@#To observe the clinical characteristics and impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) colonized or infected patients with hematological disorders in order to provide evidence for the prevention and treatment of CRPA.@*METHODS@#The patients who were colonized or infected with CRPA in the Department of Hematology of The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2020 to March 2021 were selected as the research subjects, the clinical data such as hospitalization time, primary disease treatment regimen, granulocyte count, previous infection and antibiotic regimen of these patients were analyzed, meanwhile, antibiotic regimen and efficacy during CRPA infection, 30-day and long-term survival were also analyzed.@*RESULTS@#A total of 59 patients were included in this study, and divided into CRPA infection group (43 cases) and CRPA colonization group (16 cases). Univariate logistic regression analysis showed that ECOG score (P =0.003), agranulocytosis (P <0.001), and exposure to upper than 3rd generations of cephalosporins and tigecycline within 30 days (P =0.035, P =0.017) were the high-risk factors for CRPA infection. Multivariate logistic regression analysis showed that ECOG score of 3/4 ( OR=10.815, 95%CI: 1.260-92.820, P =0.030) and agranulocytosis ( OR=13.82, 95%CI: 2.243-85.176, P =0.005) were independent risk factors for CRPA infection. There was a statistically significant difference in cumulative survival rate between CRPA colonization group and CRPA infection group ( χ2=14.134, P < 0.001). Kaplan-Meier survival analysis showed that the influencing factors of 30-day survival in patients with CRPA infection were agranulocytosis (P =0.022), soft tissue infection (P =0.03), and time of hospitalization before CRPA infection (P =0.041). Cox regression analysis showed that agranulocytosis was an independent risk factor affecting 30-day survival of patients with CRPA infection (HR=3.229, 95%CI :1.093-3.548, P =0.034).@*CONCLUSIONS@#Patients with hematological disorders have high mortality and poor prognosis after CRPA infection. Bloodstream infection and soft tissue infection are the main causes of death. Patients with high suspicion of CRPA infection and high-risk should be treated as soon as possible.

Traditional Chinese medicine treatment for COVID-19: An overview of systematic reviews and meta-analyses / 中西医结合学报

BACKGROUND@#Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease that has caused an extensive burden to the world. Consequently, a large number of clinical trials have examined the efficacy of traditional Chinese medicine (TCM) for treating and preventing COVID-19, with coinciding proliferation of reviews summarizing these studies.@*OBJECTIVE@#This study aimed to evaluate the methodological quality and evidence quality of systematic reviews and meta-analyses on the efficacy of TCM.@*SEARCH STRATEGY@#Seven electronic databases, including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chongqing VIP, Wanfang Data and SinoMed, were searched for systematic reviews and meta-analyses in October 2021. Search terms such as "Chinese medicine," "Lianhua Qingwen" and "COVID-19" were used.@*INCLUSION CRITERIA@#Systematic reviews and meta-analyses of randomized controlled trials that evaluated the efficacy of TCM treatment of COVID-19 were included.@*DATA EXTRACTION AND ANALYSIS@#A Measurement Tool to Assess Systematic Reviews Version 2.0 (AMSTAR 2) was used to evaluate the methodological quality. The quality of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Data extraction and analysis were performed by two reviewers independently.@*RESULTS@#There were 17 meta-analyses included in our overview. The intervention group was defined as TCM combined with Western medicine, while the control group was Western medicine alone. The methodological quality of all the included studies was moderate to poor. A total of 89 outcome indicators were evaluated, of which, 8 were rated as moderate quality, 39 as low quality, and 41 as very low quality. Only one outcome measure was graded as being of high quality. The moderate quality of evidence indicated that, for the treatment of COVID-19, the clinical efficacy of TCM in combination with Western medicine was better, in terms of lung recovery, rate of conversion to severe/critical cases, symptom scores, duration of symptoms, mortality, and length of hospital stay.@*CONCLUSION@#Evidence from the included studies shows that, compared with conventional Western medical therapy alone, the addition of TCM to COVID-19 treatment may improve clinical outcomes. Overall, the quality of evidence of TCM for COVID-19 was moderate to poor. Meta-analyses of the use of TCM in the treatment of COVID-19 can be used for clinical decision making by accounting for the experiences of clinical experts, medical policies, and other factors.

Risk factors of aplastic anemia: A Meta-analysis / 预防医学

Objective To comprehensively evaluate the risk factors of aplastic anemia, and provide scientific evidence for the primary prevention of aplastic anemia. Methods The published Papers were searched by"aplastic anemia" "case control study" and"risk factors" as key words collected from Chinese National Knowledge Infrastructure, Chinese VIP journal database, PubMed, Cochrane library and Clinical Trial and other databases, ranged from the creation date of each database to September 2017 .A meta-analysis of studies on risk factors was performed to calculate the pooled odd ratios (ORs) with 95％ confidence intervals (CIs) with Software Stata 14.0. Results The database search resulted in the identification of 1, 094 articles. After screening, 22 case-control studies were included in the study with 16 factors. Ten risk factors were showed statistically significant differences, including paint exposure (OR=3.82, 95％ CI: 1.68-8.66), chloramphenicol (OR=3.21, 95％ CI: 1.98-5.20), benzene exposure (OR=2.94, 95％ CI: 2.11-4.11), glue exposure (OR=2.56, 95％CI: 1.28-5.12), history of hepatitis (OR=2.54, 95％ CI: 1.94-3.34) , hair dye exposure (OR=2.37, 95％ CI: 1.08-5.22) , pesticides exposure (OR=1.98, 95％ CI: 1.60-2.45), β-lactam (OR=1.77, 95％ CI: 1.03-3.06), sulfonamides (OR=1.64, 95％ CI:1.03-2.61) and fuel/oil exposure (OR=1.53, 95％ CI: 1.25-1.87) , and high economic income (OR=0.52, 95％ CI:0.43-0.63) is the protective factor. Conclusion The meta-analysis of case-control studies suggests that the risk factors of aplastic anemia mainly including four aspects: drug use, past history, socioeconomic status and occupational or environmental exposure to chemical toxic substances.

A blind technique used in randomized controlled trials of treatment based on changes of syndromes / 中国中西医结合杂志

Treatment based on syndrome differentiation is an essential feature of traditional Chinese medical diagnosis. The interventions based on changes of syndrome types in randomized controlled trials are complicated, leading to the difficulty of blind method enforcement. This article described a double-blind method. It could be used in randomized controlled trials under the condition of different syndrome types and different medications. It numbered drugs in two stages, and in two phases to achieve double-blind. This method not only guaranteed investigators and subjects to be in blinded conditions, but also achieved using different medications for patients of different syndromes. It also caused no drug waste. It was scientific and feasible.