Expert consensus on late stage of critical care management / 中华内科杂志

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

Association of sleep duration and risk of frailty among the elderly over 80 years old in China: a prospective cohort study / 中华预防医学杂志

Objective: To explore the association between sleep duration and the risk of frailty among the elderly over 80 years old in China. Methods: Using the data from five surveys of the China Elderly Health Influencing Factors Follow-up Survey (CLHLS) (2005, 2008-2009, 2011-2012, 2014, and 2017-2018), 7 024 elderly people aged 80 years and above were selected as the study subjects. Questionnaires and physical examinations were used to collect information on sleep time, general demographic characteristics, functional status, physical signs, and illness. The frailty state was evaluated based on a frailty index that included 39 variables. The Cox proportional risk regression model was used to analyze the correlation between sleep time and the risk of frailty occurrence. A restricted cubic spline function was used to analyze the dose-response relationship between sleep time and the risk of frailty occurrence. The likelihood ratio test was used to analyze the interaction between age, gender, sleep quality, cognitive impairment, and sleep duration. Results: The age M (Q1, Q3) of 7 024 subjects was 87 (82, 92) years old, with a total of 3 435 (48.9%) patients experiencing frailty. The results of restricted cubic spline function analysis showed that there was an approximate U-shaped relationship between sleep time and the risk of frailty. When sleep time was 6.5-8.5 hours, the elderly had the lowest risk of frailty; Multivariate Cox proportional risk regression model analysis showed that compared to 6.5-8.5 hours of sleep, long sleep duration (>8.5 hours) increased the risk of frailty by 13% (HR: 1.13; 95%CI: 1.04-1.22). Conclusion: There is a nonlinear association between sleep time and the risk of frailty in the elderly.

Characterization of potential bitterness critical quality attributes in Xiaoer Ganmao Oral Liquid based on UHPLC-LTQ-Orbitrap MSn / 药学学报

To identify the bitter compounds of real-world Xiaoer Ganmao Oral Liquid sugar-free intermediates, an integrated strategy has been developed by using ultra-high performance liquid chromatography with linear ion trap-Orbitrap mass spectrometry (UHPLC-LTQ-Orbitrap MSn) method and BitterX database prediction. The chromatographic operating conditions were as follows, chromatographic column: Acquity UPLC BEH C18 (100 mm × 2.1 mm, 1.7 μm), mobile phase: 0.1% formic acid-water solution (A)-acetonitrile (B) with gradient elution. The data were collected in positive and negative ion modes, respectively. The accurate molecular mass and structural information of the target compounds were obtained based on quasi-molecular ions and fragmentation ions provided by high-resolution mass spectrometry. The compounds were identified by combining retention time, reference substances, reports, and other relevant data, and a total of 57 constituents including flavonoids, alkaloids, and phenylpropanoids were finally identified. Further, the BitterX database was used to predict binding probability of compounds to bitter receptors and identify potential bitter critical quality attributes, finally 33 potential bitter compounds, including kukoamine A and linarin, were predicted. This study comprehensively characterized the material basis of Xiaoer Ganmao Oral Liquid sugar-free intermediates, it provides an effective method for bitter compound screening and a reference for further improving the undesirable taste of Xiaoer Ganmao Oral Liquid.

Research on dynamic on-line monitoring method of moisture attribute in three honey-processed Chinese herbal slice based on in-situ general model / 药学学报

Aiming at the hysteresis and destructiveness of off-line static detection of critical quality attribute of the moisture content of the raw material unit of the traditional Chinese medicine manufacturing process, honey-processed Tussilago farfara, honey-processed Astragalus and honey-processed Glycyrrhiza uralensis were used as the research carriers, and the drying method was used to measure the moisture content as a reference value. The moving stage was used to simulate the movement process of samples on the conveyor belt in the actual on-site production process, and near-infrared (NIR) spectra were collected, combined with machine learning, to establish NIR on-site dynamic detection model of moisture content in multi-variety honey-processed Chinese herbal slice. The results show that the second derivative method is used to preprocess the spectrum. The number of decision trees (ntree), the number of random features (max feature), and the minimum number of samples for generating leaf nodes (node size) are selected: 46, 76, and 8, respectively. The quantitative analysis model of moisture content has the best effect. The prediction coefficient of determination (the prediction coefficient of determination, R2pre) and the root mean square error of prediction (root mean square error of prediction, RMSEP) of the model were 0.903 2 and 0.330 2, respectively. The NIR quantitative model for the moisture content of multi-variety honey-processed Chinese herbal slice established in this study has good predictive performance, and can achieve rapid, accurate and non-destructive quantitative analysis of the moisture content of honey-processed Tussilago farfara, honey-processed Astragalus and honey-processed Glycyrrhiza uralensis at the same time, and provides a method for determining the moisture content of honey-processed Chinese herbal slice of the raw material unit of the traditional Chinese medicine manufacturing process.

Identification of taste critical quality attribute and formulation optimization of Xiaoer Qingrening Granules based on electronic tongue and human senses / 药学学报

This study primarily concentrated on scientific problems of poor taste caused by unclear critical quality attributes of oral preparations manufactured by Chinese materia medica, successfully established an identification method for taste critical quality attribute and a taste improvement method combining electronic tongue with human senses, and determined the optimal taste formula, to improve patients' oral medication compliance. The study received ethical approval from the Review Committee of the Beijing University of Chinese Medicine. The results showed that the proportion of bitterness of Xiaoer Qingrening Granule was 61.8%, and its bitterness grade was 3.70, it was determined that bitterness is the critical quality attribute that caused the poor taste of Xiaoer Qingrening Granule. Additionally, the optimal taste formula per milliliter of Xiaoer Qingrening sugar-free intermediate was determined with allowable daily intake, solubility, and sweetness as the limiting conditions, which was 40 mg hydroxypropyl β-cyclodextrin, 180 mg trehalose, and 1.5 mg acesulfame potassium. Compared with the Xiaoer Qingrening Granule, the sensory evaluation score of the optimal taste formula was increased by 37.5 points. In conclusion, this study achieved the taste improvement of Xiaoer Qingrening Granule and formed a set of taste improvement strategies including the identification of taste critical quality attribute, the selection of the type and dosage of corrigent, and the optimization of taste formula, which provided a thought reference for the taste improvement of other oral preparations and a new perspective for quality control of intelligent manufacturing of traditional Chinese medicines.

Scarf osteotomy combined with soft tissue balance release for severe hallux valgus / 中国骨伤

OBJECTIVE@#To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus.@*METHODS@#Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief.@*RESULTS@#Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces(P<0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference(P<0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate.@*CONCLUSION@#Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.

Tetrazine bioorthogonal click-to-release reaction for releasing peptides / 药学学报

This paper aimed to investigate the release efficiency of peptide at carbon terminal triggered by tetrazine bioorthogonal click-to-release reaction, and further explored the potential application of this reaction in functional modification and mild cleavage in solid-phase peptide synthesis. Thirteen peptide derivatives modified by trans-cyclooctene (TCO) were designed and synthesized, which were reacted with tetrazine to release the peptides. The results showed that the release rates of peptide were 90.0% to 97.7% in one hour. The strategy has good compatibility with the functional side-groups and the length of peptides, which expands the applications scope of tetrazine bioorthogonal click-to-release reaction. At the same time, a novel bifunctional trans-cyclooctene molecule was designed and synthesized. The active peptide GIRLRG was modified by fluorophore on the solid-phase resin, and released through tetrazine click-to-release reaction under mild condition, providing a new strategy for the solid-phase modification and release strategy of the peptide.

Study on ecologic microorganisms in lesions of acute guttate psoriasis induced by upper respiratory tract infection / 天津医药

Objective To investigate the characteristics of lesions of acute guttate psoriasis induced by upper respiratory tract infection, and to compare the difference in the different species between patients and healthy controls. Methods A total of 11 cases of acute guttate psoriasis induced by upper respiratory tract infection and 11 cases of healthy control without skin lesions of any dermatosis were included in this study. The 16SrDNA sequencing technology was used for analyzing data. The aseptic cotton swabs were used for sampling. DNA extraction and quality inspection were then performed. PCR amplification, library construction, microbial gene extraction, purification and recovery process were also performed. Then the gene samples were sent to be sequenced and to annotate the species. Finally, the data were analyzed by α and β diversity analysis to find the differences in microbial species and the diversity of microbial community. LEfSe analysis was used to find the species with significant difference, and the results were verified by the rank test. Results There was no significant difference in α diversity analysis between the two groups. There was a trend of difference in β diversity analysis between the two groups. However, LEfSe analysis (LED Score was 4) and rank test (P＜0.05) found that acinetobacter was a statistically significant different species and played a major role in the lesions of acute guttate psoriasis. Conclusion The skin lesions of microbiota is developing from one steady state to another one in the primary or recurrent acute guttate psoriasis patients with the history of upper respiratory infection. The different species of acinetobacter may play a key role in this change. However there is no significant difference in the overall microbial community between two groups.

Effects of CHL1 deficiency,a cell adhesion molecule,on the inflammatory bowel disease / 中国应用生理学杂志

OBJECTIVE@#To investigate the effects of deficiency of CHL1 in inflammatory bowel disease (IBD).@*METHODS@#Dextran Sulfate Sodium (DSS)-induced colitis model was used to study the effects of deficiency of CHL1 on the development of IBD. Ten CHL1(+/+) mice in C57/BL6 background were randomly divided into CHL1(+/+) group and DSS-induced CHL1(+/+) group. Ten CHL1(-/-) mice in C57/BL6 background were randomly divided into CHL1(-/-) group and DSS-induced CHL1(-/-) group. DSS-induced CHL1(+/+) group and DSS-induced CHL1(-/-)group were fed with 1.5% DSS for 7 days, and then drinking distilled water for 2 days. CHL1(+/+) group and CHL1(-/-) group as control group were fed with distilled water for 9 days. The changes of weight, survival, fecal blood and the change of colon length in this study were observed.@*RESULTS@#On the 7 day, the weight of DSS-induced CHL1(-/-) group were reduced significantly, and DSS-induced CHL1(-/-) group had extreme mortality on the 9th day. The fecal blood of DSS-induced CHL1(-/-) group also had higher score than that of DSS-induced CHL1(+/+) group. In the DSS-induced CHL1(-/-) group,the length of colon was shortened obviously.@*CONCLUSIONS@#The loss of CHL1 aggravates the development of IBD.

An analysis on the effect of community management of multi - drug resistant pulmonary tuberculosis patients on treatment outcome / 预防医学

Objective To explore the outcome and its influencing factors of the Multi - drug resistant tuberculosis(MDR -TB)patients with community management,and to provide the scientific basis for the further implementation of the community management of MDR - TB patients. Methods Retrospective study was conducted on MDR - TB patients diagnosed and treated with MDR - TB from January 2009 to June 2012 and the patientsˊ willingness and influence factors of outcome in community management were analyzed. Results 220 MDR - TB patients were under community management and the cute rate was 65. 91% . The cure rate of patients with degree in college or above ,occupation for workers,new type of patients,patients with no adverse reactions during drug injection therapy was relatively high. The cure rate of the patients who injected in home(86. 67% )was higher than who injected in community(68. 15% )and others (54. 84% ). The cure rate of the patients whose injection distance from home ≤5 km(67. 74% )was higher than whose injection distance from home ﹥ 5 km(36. 36% ). The cure rate of the patients with community doctor/ nurse follow - up management(70. 39% )was higher than those who without community doctor/ nurse follow - up management(55. 88% ). Through the analysis of needs for the community management,the results showed that 65. 91% of the patients were willing to accept the injection in the community,and 94. 09% patients chose medication at home. Conclusion The cute rate of MDR - TB patients should be improved in community management . In the future ,we should pay more attention to the patientsˊ needs in the development of community management for MDR - TB patients according to the actual situation,and to further strengthen the psychological support and community care for MDR - TB patients.

Impact of Qi-invigorating traditional Chinese medicines on intestinal flora: A basis for rational choice of prebiotics / 中国天然药物

According to the theory of traditional Chinese medicine (TCM), Qi (vital energy) is regarded as a driving force of biological activities in human body, including both nutrient substances and organ functions. Qi-invigorating TCMs are widely used to treat various symptoms and disorders, such as fatigue, obesity, immunosuppression, intestinal flora imbalance, and gastrointestinal diseases, in which Qi is considered to be reduced or depleted. Interestingly, abundant clinical evidences suggest that these disorders are associated with the alternation of intestinal flora, which directly affects disease status. Herein we review the interaction between gut microbiota and Qi-invigorating TCMs under healthy and disease conditions and discuss the mechanisms of action and applications of Qi-invigorating TCMs in enhancing health status through microbial alternation. A better understanding of the role of Qi-invigorating TCMs in modulating microbial composition and the association between intestinal microbiota and diseases would help reveal the clinical consequences of microbiota alteration and explore opportunities to harness this symbiotic relationship to improve public health.

Multidrug-resistant Tuberculosis Burden among the New Tuberculosis Patients in Zhejiang Province: An Observational Study, 2009-2013 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Screening on multidrug-resistant tuberculosis (MDR-TB) has been limited to the serious TB subpopulations excluding the new TB patients. This study aimed to examine MDR-TB burden among the new TB patients.</p><p><b>METHODS</b>We conducted a study in Zhejiang Province during 2009-2013 to screen for MDR-TB patients among the low MDR-TB risk patients and five subpopulations of high MDR-TB risk patients. The number, prevalence, and trend of MDR-TB were compared while the logistic regression model was used to examine risk factors related to MDR-TB.</p><p><b>RESULTS</b>A total of 200 and 791 MDR-TB cases were, respectively, identified from the 9830 new TB cases and 2372 high-risk suspects who took MDR-TB screening from 2009 to 2013. The MDR-TB rates went down in both of the new TB patients and five MDR-TB high-risk groups over the study time, but the percentage of MDR-TB patients identified from the new TB patients in all diagnosed MDR-TB cases kept stable from 28.3% in 2011 to 27.0% in 2012 to 26.0% in 2013.</p><p><b>CONCLUSIONS</b>The study indicated that MDR-TB burden among new TB patients was high, thus screening for MDR-TB among the new TB patients should be recommended in China as well as in the similar situation worldwide.</p>

An analysis on the risk factors of discontinued therapy among patients with multi -drug resistant pulmonary tuberculosis / 预防医学

Objective To analyze the basic characteristics of the therapy discontinued patients with multi -drug resistant pulmonary tuberculosis (MDR -TB)and to find the causes of therapy discontinuing.Methods Using case -control study method,a questionnaire survey was conducted to analyze the causes of MDR -TB in the treatment of interruption,and to compare the characteristics with the treatment completed patients,and to analyze the risk factors of discontinued therapy among MDR -TB patients.Results The study included 45 cases of therapy discontinued MDR -TB patients,and 45 cases of MDR -TB patients who had completed the treatment as the control.Multivariate logistic regression analysis results showed that patients with over 65 years old(OR =8.69,95% CI =1.12,67.57),leak medication or drug withdrawal experience (OR =53.18,95% CI =5.90,479.27),were the risk factors of discontinued therapy(P <0.05).Patients with hospitalization for over 15 days was the protective factors for discontinued therpy(OR =0.09,95% CI =0.01,0.58), (P <0.05).Conclusion advanced age≥65 years old,low income,leak medication or drug withdrawal experience short hospitalization periods were related to the risk of MDR -TB patients therapy discontinuing.were the key targets for patient management in the future.

An analysis on the epidemic characteristics of tuberculosis drug resistance in Zhejiang Province / 预防医学

Objective To monitor the drug resistance of tuberculosis in Zhejiang Province and to provide scientific evidence for the control of drug resistant tuberculosis.Methods Thirty counties in Zhejiang Province were selected as sample during July 1,2013 and June 30 2014,and smear positive cases were selected to be monitored during study period. Results The rate of drug resistance was 30.88%,and the rate of multi drug resistance was 5.02%.The rate of the extensively drug -resistant tuberculosis was 0.32%.Among initial treatment cases,the rate of drug resistance was 29.22%,higher than 2008,and the rate of multi drug resistance was 3.21%.Among retreatment cases,the rate of drug resistance was 45.74%,and the rate of multi drug resistance was 21.28%.All kinds of monitored drugs were found resistance phenomenon.The drug resistant rate of SM was highest (15.28%),and aminoglycosides (2.35%)were relatively low.Conclusion The status of retreatment TB drug resistance suggested that we had reduced acquired TB drug resistance through implementation of DOTS strategy and standard short course chemotherapy treatment in Zhejiang Province. But it is still not optimistic to control TB drug resistance,and the status of initial treatment TB resistant suggested that resistant strains spread had not been effectively controlled in Zhejiang Province.So we should strengthen the early detection of drug resistant among TB patients,and to further improve the standard of conventional TB treatment.

A study on the application of MPB64 antigen detection of immune colloidal gold method for identification of Mycobacterium / 预防医学

Objective To know the application of MPB64 antigen detection of immune colloidal gold method for identification of Mycobacterium.Methods Taking the PCR amplified sequencing method as the 'gold standard',a total of 418 clinical isolated mycobacterium tuberculosis and 2 standard strains were tested by immune colloidal gold method,and was compared with the traditional method of PNB/TCH.Results Compared with sequencing method,the coincidence rate of immune colloidal gold method and PNB/TCH identification test was 95. 93%and 87. 08%respectively.The sensitivity, specificity,positive predictive value (PPV ) and negative predictive value (NPV ) of immune colloidal gold method identification were 88. 41%,99. 64%,99. 19% and 94. 58%respectively.It costs MPB64 immune colloidal gold method 15 minutes to carry out the results,less than 28 days of the traditional method,as well as 3 days of sequencing method. Conclusion Compared with PNB/TCH method,MPB64 immune antigen colloidal gold method has higher specificity and sensitivity,and could be applied in identification of Mycobacterium.

A case -case control study on risk factors of the re -treatment multidrug resistant pulmonary tuberculosis / 预防医学

Objective To explore the risk factors of patients with re -treatment multidrug resistant pulmonary tuberculosis (MDR -TB)and to provide suggestions for intervention.Methods A case -case control study was carried out between patients with or without re -treatment MDR -TB,with a questionnaire interview and multivariate logistic regression analysis to explore the risk factors of re -treatment MDR -TB.Results A total of 172 patients were enrolled in this study including 99 re -treatment MDR -TB patients and 73 re -treatment non -MDR -TB patients(P >0.05).There was no significant difference between case group and control group in gender,age,residence and marital status.The sick time,the anti -tuberculosis treatment time,the number of anti -tuberculosis treatments,the rate of adverse reactions,history of taking isoniazid or rifampicin and the number of treatment interruption were higher in cases than those in control group(P <0.05),while the months of first -treatment were lower than those in control group(P <0.05).The number of anti -tuberculosis treatments(≥3),adverse reactions during treatment,the months of first -treatment were significant risk factors by the multivariable regression model,with the adjusted ORs and 95%CIs of 5.07 (1.89,13.64),4.27 (2.04, 8.94)and 2.35(1.06,5.22),respectively.Conclusion The number of anti -tuberculosis treatments,adverse reactions during treatment,the months of first -treatment were risk factors of patients with re -treatment MDR -TB.

A study on patients’negative emotional reactions and its influencing factors at the diagnosis of pulmonary tuberculosis / 预防医学

Objective To investigate patients’negative emotional reactions and its influencing factors when pulmonary tuberculosis (PTB ) was diagnosed, and to provide evidence for health education and intervention. Methods A questionnaire survey was conducted among 440 PTB patients who were treated at the designated clinics of two counties in Zhejiang Province.Twenty patients at one clinic were randomly selected for a semi-structured interview.Results A total of 437 qualified questionnaires were collected and 19 patients were successfully interviewed.When they were told the result of diagnosis,58.58% patients felt worried,29.75% were shocked,20.37% tended to blame themselves,10.98% felt helpless and 35.70%had a sense of shame.In the semi-structured interview,the main reasons for negative emotions told by the patients were disbelieving the fact of getting the disease and misunderstanding TB was incurable.Old people felt more shocked (40.26%),worried (58.44%)and self-blaming (38.96%)about the diagnosis of TB.The divorced and widowed expressed more reactions of worry (95.24%), shock (6 1.09%), self -blame (6 1.09%), helpless (42.86%).Farmers had higher rate of shock (48.89%),worry (70.37%),and self-blame (43.70%).Conclusion Negative emotions or feelings were popular among TB patients when the disease was diagnosed.The elders,divorced or widowed people and farmers need to be attached more importance during the process of health education or intervention.

Medical cost analysis of initially-treated patients with tuberculosis under designated hospital mode / 预防医学

Objective To explore the direct medical cost of tuberculosis patients and its components under designated hospital mode,and to provide evidence for configuration optimization of tuberculosis prevention and control funds in Zhejiang Province.Methods A total of 7 counties including Cixi,were selected as study spots,and 50 initially-treated tuberculosis patients who completed treatment from each county were continually enrolled as study objects.Questionnaire survey and outpatient and inpatient medical records survey were carried out for each object.Results Average medical cost of initially-treated tuberculosis patients was 4 086 Yuan (RMB)which was 12.69% of their total yearly family income and 20.17% of patients occurred in debt.Average medical cost in designated hospital was 3 020 Yuan (RMB),of which 78.31% (2 365 Yuan)was used for DOT treatment in outpatient clinic.Examination cost of the outpatient constituted 25.24% (CT cost constituted 8.57%),and non -free medicine constituted 74.76% (hepatic protector medicine cost constituted 41.94%).Conclusion Tuberculosis patients suffered heavy economic burden because of self -paying auxiliary examination and drugs.To adjust existing funds usage of tuberculosis prevention and resource configuration is needed.

Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome / 世界急诊医学杂志（英文）

BACKGROUND: Acute liver failure (ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders, the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artificial liver treatments for patients with acute liver failure (ALF) complicated by multiple organ dysfunction syndrome (MODS). METHODS: Thirty-one patients with mid- or late-stage liver failure complicated by MODS (score 4) were randomly divided into three treatment groups: plasmapheresis (PE) combined with hemoperfusion (HP) and continuous venovenous hemodiafiltration (CVVHDF), PE+CVVHDF, and HP+CVVHDF, respectively. Heart rate (HR) before and after treatment, mean arterial pressure (MAP), respiratory index (PaO2/FiO2), hepatic function, platelet count, and blood coagulation were determined. RESULTS: Signifi cant improvement was observed in HR, MAP, PaO2/FiO2, total bilirubin (TBIL) and alanine aminotransferase (ALT) levels after treatment (P<0.05). TBIL and ALT decreased more signifi cantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.01). Prothrombin time (PT) and albumin were signifi cantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups (P<0.05). The survival rate of the patients was 58.1％ (18/31), viral survival rate 36.4％ (4/11), and non-viral survival rate 70％ (14/20). CONCLUSION: Liver function was relatively improved after treatment, but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites, especially bilirubin. The survival rate was significantly higher in the patients with non-viral liver failure than in those with viral liver failure.

Molecular characterization and phylogenetic analysis of porcine epidemic diarrhea virus field strains in central China during 2010-2012 outbreaks / 病毒学报

Since late 2010, porcine epidemic diarrhea virus (PEDV) has been re-emerging in central China. To explore the possible reason of the PEDV outbreaks, twelve PEDV field strains were isolated from different swine breeding farms in central China during 2010-2012, and molecular diversity, phylogenetic relationships of these strains with other PEDV reference strains were investigated. Sequence analysis of S, M and ORE3 genes revealed that the central China PEDV isolates had several specific nucleotides and amino acids which were different from PEDV reference strains. In addition, the entire S genes of eleven central China PEDV isolates were found to be nine nucleotides longer in length than CV777 and large number of amino acid variations was accumulated in the N-terminal region of S gene. Phylogenetic analysis showed that the central China PEDV isolates had close relationship with Korea strains (2007-2009), Thailand strains (2007-2008), Vietnam strains (2009-2010), Japan strains (2010), and other prevailing strains from other parts of China (2010-2012). However, they differed genetically from European strains (CV777, Brl/87), China strains (2003-2007) and the vaccine strains (CV777) used in China. These results imply that a rapid variation and evolution of central China PEDV strains has occurred in recent years, and a more efficient vaccine strain should be selected to prevent and control outbreaks of PEDV in China.