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Objective To compare the effects of mizolastine intensive dose and mizolastine conventional dose+momestasone furoate on symptom score and laboratory index of patients with allergic rhinitis caused by pollen allergy.Methods From June 2016 to January 2018,one hundred and fifty allergic rhinitis patients caused by pollen allergy were chosen in the First People＇s Hospital of Taizhou and randomly divided into two groups according to the digital table,with 75 patients in each group.A group was treated with mizolastine intensive dose scheme,and B group was treated with mizolastine conventional dose +momestasone furoate. The short -term efficacy,rhinitis symptoms score,the levels of histamine,leukotrienes C4,IL-6,IL-8 and TNF-α before and after treatment,the incidence of adverse reactions and daily treatment cost of the two groups were compared.Results The short-term efficacy of B group was significantly better than that of A group(93.33% vs.81.33% ,χ2 =9.15,P<0.05).The rhinitis symptoms scores of B group[(0.49 ± 0.19)points,(1.02 ± 0.20) points,(0.95 ± 0.28) points,(0.84 ± 0.20)points] after treatment were significantly lower than those of A group [(0.87 ± 0.21) points,(1.40 ± 0.24) points,(1.63 ± 0.36)points,(1.19 ± 0.27) points] and before treatment[(3.13 ± 1.06) points,(2.88 ± 0.57) points,(2.81 ± 0.79)points,(2.85 ± 0.61)points](t=2.45,2.71,2.66,2.89,3.78,3.75,3.44,4.53,all P<0.05).The levels of histamine,leukotrienes C4,IL-6,IL-8 and TNF-α of B group[(15.76 ± 3.54) mg/L,(12.17 ± 3.58) mg/L, (1.23 ± 0.19)mg/L,(3.27 ± 0.62)mg/L,(3.96 ± 1.05)mg/L] after treatment were significantly lower than those of A group [(19.58 ± 5.25) mg/L,(15.44 ± 4.14) mg/L,(1.96 ± 0.33)mg/L,(5.40 ± 0.88) mg/L,(5.01 ± 1.40)mg/L] and before treatment[(24.57 ± 7.67) mg/L,(18.90 ± 6.33) mg/L,(2.58 ± 0.54) mg/L,(7.66 ± 1.17)mg/L,(6.81 ± 1.67)mg/L](t=2.31,2.50,2.53,2.39,3.05,3.60,3.10,3.57,3.90,all P<0.05).There was no statistically significant difference in the incidence rate of adverse reactions between the two groups ( P >0.05).The daily treatment cost of B group after treatment was significantly less than that of A group and before treatment[(7.56 ± 1.02)CNY vs.(6.88 ± 0.80)CNY,t=3.12,P<0.05].Conclusion Compared with mizolas-tine intensive dose scheme,mizolastine conventional dose + momestasone furoate in the treatment of patients with allergic rhinitis caused by pollen allergy can efficiently relieve the nasal symptoms, down - regulate the levels of histamine,leukotriene C4 and inflammatory cytokines,reduce the treatment cost and has the approved safety.
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Objective Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China,so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking.This study aimed to analyze the direct,indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China.Methods The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study.All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases.The direct expenditure included direct medical cost and direct non-medical cost.The indirect expenditure,including work loss of patients and caregivers,were calculated by using human capital method for urban and rural populations in 12 areas.The intangible expenditure were reflected by willing to pay and stochastic tournament.The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis.Results A total of 27 hospitals in 12 areas were included in the survey.A total of 4 718 cases were surveyed,the overall response rate was 77.7％.The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case,in which the highest proportion (61.2％)was medicine fees [10 365.10 yuan (RMB)].The average direct expenditure and indirect expenditure were consistent with the severity of illness,which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively,with the ratio of 3.85:1.The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)].It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures.Among the average indirect expenditure,the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)],The total direct and indirect expenditure was highest for liver transplantation,followed by severe hepatitis,hepatocellular carcinoma and decompensated cirrhosis,acute hepatitis B,compensated cirrhosis and chronic hepatitis B.The influencing factors for both direct and indirect expenditure were high hospital level,severity of hepatitis B,living in urban area,antiviral therapy,long hospitalization and monthly income of family.For average 3.74 outpatient visits and 1.51 hospitalization,the average annual direct,indirect and intangible expenditure for HB-related diseases were 30 135.30,6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)],accounting for 37.3％,7.7％ and 55.0％,respectively.Of the annual direct medical expenditure [28 402.80 yuan (RMB)],which were much higher than non-medical expenditure [1 732.50 yuan (RMB)],hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)].The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB),respectively.Of the annual intangible expenditure,the highest was that for/primary hepatocellular carcinoma,followed by cirrhosis,chronic hepatitis B,severe hepatitis B,liver transplantation and acute hepatitis B.Conclusions A heavy economic burden has been caused by HB-related diseases in China,and patients are more likely to rely on medical service rather than non-medical service.It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits.The influence of HB related diseases on mental health of the people can be reflected by an economics term,intangible expenditure.
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Objective Since eliminating hepatitis B in China would need considerable public health resources,the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue.The cost-effectiveness and affordability of the strategy were evaluated in this study.Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China,the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis.A cohort population aged 20-59 years was used as study subjects.The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention,respectively.The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives.The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER)were calculated for the comparison of the strategies.One-way and probability sensitivity analysis were performed for uncertainty of the results.And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies.Results In the Chinese aged 20-59 years,the ICER of CHB antiviral treatment was 37598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups,indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population.The ICER of hepatitis B vaccination was-64 000.0 yuan (RMB) per QALYs,indicating that hepatitis B vaccination is cost saving.The CER of CHB antiviral treatment ranged from 731.8 to 1813.3 yuan (RMB) pcr QALYs compared with hepatitis B vaccination,and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups,indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment.The price of antiviral drug,entercavir,can influence the cost effectiveness of CHB antiviral treatment.If the price of entercavir declined half,CHB antiviral treatment would be cost-saving.The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored,although the results of economics evaluation of CHB antiviral treatment were reliable.The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB),the probability of implementing the strategy was 42.6％ if the budget reaches 127 million yuan (RMB),and only when the budget reaches 269 million yuan (RMB),the goal of CHB antiviral treatment strategy can be fully realized.Conclusions Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective,it is not an appropriate public health measure due to the high cost.The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.
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Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.
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Objective To construct the Markov models to reflect the reality of prevention and treatment interventions against hepatitis B virus (HBV) infection,simulate the natural history of HBV infection in different age groups and provide evidence for the economics evaluations of hepatitis B vaccination and population-based antiviral treatment in China.Methods According to the theory and techniques of Markov chain,the Markov models of Chinese HBV epidemic were developed based on the national data and related literature both at home and abroad,including the settings of Markov model states,allowable transitions and initial and transition probabilities.The model construction,operation and verification were conducted by using software TreeAge Pro 2015.Results Several types of Markov models were constructed to describe the disease progression of HBV infection in neonatal period,perinatal period or adulthood,the progression of chronic hepatitis B after antiviral therapy,hepatitis B prevention and control in adults,chronic hepatitis B antiviral treatment and the natural progression of chronic hepatitis B in general population.The model for the newborn was fundamental which included ten states,i.e.susceptiblity to HBV,HBsAg clearance,immune tolerance,immune clearance,low replication,HBeAg negative CHB,compensated cirrhosis,decompensated cirrhosis,hepatocellular carcinoma (HCC) and death.The susceptible state to HBV was excluded in the perinatal period model,and the immune tolerance state was excluded in the adulthood model.The model for general population only included two states,survive and death.Among the 5 types of models,there were 9 initial states assigned with initial probabilities,and 27 states for transition probabilities.The results of model verifications showed that the probability curves were basically consistent with the situation of HBV epidemic in China.Conclusion The Markov models developed can be used in economics evaluation of hepatitis B vaccination and treatment for the elimination of HBV infection in China though the structures and parameters in the model have uncertainty with dynamic natures.
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Objective Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China,so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking.This study aimed to analyze the direct,indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China.Methods The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study.All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases.The direct expenditure included direct medical cost and direct non-medical cost.The indirect expenditure,including work loss of patients and caregivers,were calculated by using human capital method for urban and rural populations in 12 areas.The intangible expenditure were reflected by willing to pay and stochastic tournament.The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis.Results A total of 27 hospitals in 12 areas were included in the survey.A total of 4 718 cases were surveyed,the overall response rate was 77.7％.The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case,in which the highest proportion (61.2％)was medicine fees [10 365.10 yuan (RMB)].The average direct expenditure and indirect expenditure were consistent with the severity of illness,which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively,with the ratio of 3.85:1.The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)].It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures.Among the average indirect expenditure,the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)],The total direct and indirect expenditure was highest for liver transplantation,followed by severe hepatitis,hepatocellular carcinoma and decompensated cirrhosis,acute hepatitis B,compensated cirrhosis and chronic hepatitis B.The influencing factors for both direct and indirect expenditure were high hospital level,severity of hepatitis B,living in urban area,antiviral therapy,long hospitalization and monthly income of family.For average 3.74 outpatient visits and 1.51 hospitalization,the average annual direct,indirect and intangible expenditure for HB-related diseases were 30 135.30,6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)],accounting for 37.3％,7.7％ and 55.0％,respectively.Of the annual direct medical expenditure [28 402.80 yuan (RMB)],which were much higher than non-medical expenditure [1 732.50 yuan (RMB)],hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)].The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB),respectively.Of the annual intangible expenditure,the highest was that for/primary hepatocellular carcinoma,followed by cirrhosis,chronic hepatitis B,severe hepatitis B,liver transplantation and acute hepatitis B.Conclusions A heavy economic burden has been caused by HB-related diseases in China,and patients are more likely to rely on medical service rather than non-medical service.It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits.The influence of HB related diseases on mental health of the people can be reflected by an economics term,intangible expenditure.
ABSTRACT
Objective Since eliminating hepatitis B in China would need considerable public health resources,the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue.The cost-effectiveness and affordability of the strategy were evaluated in this study.Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China,the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis.A cohort population aged 20-59 years was used as study subjects.The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention,respectively.The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives.The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER)were calculated for the comparison of the strategies.One-way and probability sensitivity analysis were performed for uncertainty of the results.And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies.Results In the Chinese aged 20-59 years,the ICER of CHB antiviral treatment was 37598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups,indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population.The ICER of hepatitis B vaccination was-64 000.0 yuan (RMB) per QALYs,indicating that hepatitis B vaccination is cost saving.The CER of CHB antiviral treatment ranged from 731.8 to 1813.3 yuan (RMB) pcr QALYs compared with hepatitis B vaccination,and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups,indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment.The price of antiviral drug,entercavir,can influence the cost effectiveness of CHB antiviral treatment.If the price of entercavir declined half,CHB antiviral treatment would be cost-saving.The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored,although the results of economics evaluation of CHB antiviral treatment were reliable.The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB),the probability of implementing the strategy was 42.6％ if the budget reaches 127 million yuan (RMB),and only when the budget reaches 269 million yuan (RMB),the goal of CHB antiviral treatment strategy can be fully realized.Conclusions Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective,it is not an appropriate public health measure due to the high cost.The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.
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Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.
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Objective To construct the Markov models to reflect the reality of prevention and treatment interventions against hepatitis B virus (HBV) infection,simulate the natural history of HBV infection in different age groups and provide evidence for the economics evaluations of hepatitis B vaccination and population-based antiviral treatment in China.Methods According to the theory and techniques of Markov chain,the Markov models of Chinese HBV epidemic were developed based on the national data and related literature both at home and abroad,including the settings of Markov model states,allowable transitions and initial and transition probabilities.The model construction,operation and verification were conducted by using software TreeAge Pro 2015.Results Several types of Markov models were constructed to describe the disease progression of HBV infection in neonatal period,perinatal period or adulthood,the progression of chronic hepatitis B after antiviral therapy,hepatitis B prevention and control in adults,chronic hepatitis B antiviral treatment and the natural progression of chronic hepatitis B in general population.The model for the newborn was fundamental which included ten states,i.e.susceptiblity to HBV,HBsAg clearance,immune tolerance,immune clearance,low replication,HBeAg negative CHB,compensated cirrhosis,decompensated cirrhosis,hepatocellular carcinoma (HCC) and death.The susceptible state to HBV was excluded in the perinatal period model,and the immune tolerance state was excluded in the adulthood model.The model for general population only included two states,survive and death.Among the 5 types of models,there were 9 initial states assigned with initial probabilities,and 27 states for transition probabilities.The results of model verifications showed that the probability curves were basically consistent with the situation of HBV epidemic in China.Conclusion The Markov models developed can be used in economics evaluation of hepatitis B vaccination and treatment for the elimination of HBV infection in China though the structures and parameters in the model have uncertainty with dynamic natures.
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Objective To analyze the complications of transvaginal natural orifice transluminal endoscopic surgery( TV-NOTES) nephrectomy, and to explore effective measures to prevent and manage those complication.Methods From May 2010 to January 2015, a total of 178 females who had been married and given birth underwent TV-NOTES nephrectomy in our center.The average age was 47 ( ranging 23 to 71 ) years and the average BMI was 23.6 ( ranging 14.7 to 31.9 ) kg/m2.Pathological diagnosis included 142 cases of non-functional kidneys, 29 cases of renal tumors ( T1 N0-1 M0 25 cases, T2 N0-1 M0 4 cases) , and 7 cases of renal tuberculosis.One hundred and sixty hybrid TV-NOTES nephrectomy procedures (simple in 132, radical in 28) and 18 pure TV-NOTES nephrectomy procedures (simple in 17, radical in 1) were performed.Intraoperative and postoperative complications were graded according to Satava and Clavien-Dindo grade classifications.The major complications and relative treatments were analyzed.Results Among the 178 TV-NOTES nephrectomy procedures, there were 40 ( 22.5%) complications occurred, including 13 (7.3%) major complications, in which there were 11 cases of intraoperative complications (6.2%),2 cases of postoperative complications (1.1%).All the complications were successfully managed using organ repair or resection, embolectomy, hemostasis, and so on.No intraoperative and postoperative deaths occurred.There was no significant difference in major complications between hybrid TV-NOTES and pure TV-NOTES nephrectomy (6.9%vs.11.1%, P=0.620).The intraoperative major complications in the early developmental stage of TV-NOTES nephrectomy were more than that of the late stage (20.0%vs.3.4%, P=0.004).There was no significant difference in postoperative complications between the early and late developmental stage of TV-NOTES nephrectomy (13.3%vs.10.8%, P=0.751).Conclusions TV-NOTES nephrectomy is safe and feasible, but there are some major complications worthy of attention.Personal prevent and treatment strategy should be considered.
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From members in this local district from January 2011 to December 2013,a total of 150 patients with malignant cancer and chronic disease patients of lost of functions and their carers were recruited.A self-tailored interview was conducted via face-to-face communications.And according to 112 (74.7％) carers,as compared to hospitalization,the patients were more likely willing to be looked after at home.The 95 (63.3 ％) carers had a lack of professional caring knowledge and their caring techniques were insufficient.And 97 (64.7％) carers were willing receive professional training in nursing and protecting dying patients.In-house terminal care is indeed required by the patients.However its service is best supported by the following aspects.The supports from local medical services and resources; professional training organized by a local social (neighborhood) committee and providing the guidance of in-house caring techniques and information of the relevant disease management.Building up a mutual terminal care group and finalizing the caring standards as soon as possible are essentials.
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ObjectiveTo investigate the efficacy of rapamycin combined with CsA/Tacrolimus (Tac) in chronic allograft nephropathy (CAN).MethodsFifty-three cases of CAN accepted the quadruple immunosuppressive drug program,which contained rapamycin combined with CsA/Tac and MMF and prednisone,and CsA/Tac and MMF were reduced to the original amount of 25％ to 50％.After treatment for 12 months,more relevant indicators,including serum creatinine,glomerular filtration rate,serum cholesterol,triglycerides,urinary protein,GPT and bilirubin and other changes were observed.ResultsIn the patients receiving quadruple regimen of rapamycin during 12 months,the blood Ccr was decreased from (161.51 ± 106.48)μmol/L before treatment to (126.51 ± 56.2)μmol/L after treatment for 6 months (P＜0.05) and to (123.43 ± 54.18)μmol/L after for 12 months (P＜0.01).The GFR was increased from (0.754 ± 0.302) ml/s before treatment to (0.952 ± 0.347)ml/s after treatment for 6 months (P＜0.05) and to (1.007 ± 0.394) ml/s after treatment for 12 months (P＜0.01).Cholesterol and triglycerides in patients had no significant change before and after treatment.The positive rate of proteinuria after treatment showed an increasing trend from 9.4％ before treatment to 26.4％ after treatment for 12 months.ConclusionThe quadruple program of rapamycin combined with CsA/FK506 and MMF can significantly improve Ccr and GFR in patients with CAN,but it can increase the incidence of proteinuria in patients:
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Death education that began in the western countries,starting with the rise of thanatolography,is the important content of modern education which can not be ignored.This paper summarized the definition,content,subjects and course of death education by reviewing the literatures,aiming to provide some reference for the death education at present in our country.