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For wild natural medicine, unanticipated biodiversity as species or varieties with similar morphological characteristics and sympatric distribution may co-exist in a single batch of medical materials, which affects the efficacy and safety of clinical medication. DNA barcoding as an effective species identification tool is limited by its low sample throughput nature. In this study, combining DNA mini-barcode, DNA metabarcoding and species delimitation method, a novel biological sources consistency evaluation strategy was proposed, and high level of interspecific and intraspecific variations were observed and validated among 5376 Amynthas samples from 19 sampling points regarded as "Guang Dilong" and 25 batches of proprietary Chinese medicines. Besides Amynthas aspergillum as the authentic source, 8 other Molecular Operational Taxonomic Units (MOTUs) were elucidated. Significantly, even the subgroups within A. aspergillum revealed here differ significantly on chemical compositions and biological activity. Fortunately, this biodiversity could be controlled when the collection was limited to designated areas, as proved by 2796 "decoction pieces" samples. This batch biological identification method should be introduced as a novel concept regarding natural medicine quality control, and to offer guidelines for in-situ conservation and breeding bases construction of wild natural medicine.
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OBJECTIVE：To evaluate the economy performance of dexamethasone （DXM）combined with rituximab （RTX） for the first-line treatment of chronic primary immune thrombocytopenia （ITP）in adults. METHODS ：From the perspective of China ’s medical and health system ，Markov model for eight states was constructed with a period of 4 weeks and a time limit of 20 years， using DXM regimen as control. The cost-utility of DXM+RTX regimen for the treatment of chronic ITP in adults were evaluated. The parameters of clinical efficacy and utility value were derived from own published literature ；cost parameters were from the MENET website and the official websites of local health committees and medical insurance bureaus ；one-way sensitivity analysis ， probability sensitivity analysis and scenario analysis were performed to observe the uncertainty of model and data source. RESULTS：The average cost of DXM+RTX regimen was 51 064 dollars and that of DXM regimen was 50 455 dollars. Compared with DXM regimen ，DXM+RTX regimen yielded an additional 0.14 QALYs for each patient ；the incremental cost-effectiveness ratio（ICER）was 4 356 dollars/QALY，and was lower than the willingness-to-pay threshold of China ’s per capita gross domestic product（GDP）in 2020. In the one-way sensitivity analysis ，the cost of drugs was the main driver in the model. Probability sensitivity analysis demonstrated that DXM+RTX regimen had 57.5％-61.0％ probability of being cost-effective at a willingness- to-pay threshold of 1-3 times per capita GDP in 2020. The results of scenario analysis showed that DXM+RTX regimen would have obvious long-term benefits ，and the utility value had little impact on the conclusion. CONCLUSIONS ：DXM + RTX is more economical than DXM in the treatment of chronic ITP in adults ，but the results have the uncertainty.
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ObjectiveTo analyze the influencing factors of health-related behaviors for schistosomiasis prevention and control among primary and secondary school students in Sichuan Province using a multilevel and multivariate logistic model, so as to provide the theoretical evidence for developing the schistosomiasis prevention and control strategy among primary and secondary school students in Sichuan Province. MethodsA multi-stage sampling was conducted among 63 schistosomiasis-endemic counties (districts) in Sichuan Province. Five endemic townships were sampled from each county (district), and 100 Grade 4 to 6 students in each primary school and 100 Grade 1 to 3 students in each secondary school were sampled from each township as the study subjects. The health-related behaviors for schistosomiasis prevention and control were investigated using a questionnaire survey, and factors affecting infested water contact behaviors were identified using univariate and multilevel logistic analyses. Results Among the 62 200 questionnaires distributed, there were 59 134 recovered, and 56 510 were qualified. The qualified 56 510 respondents included 22 955 secondary school students and 33 555 primary school students, and 28 297 male students and 28 213 females. A higher proportion of infested water contacts was seen in male students than in females (P < 0.001), and the students living in heavily endemic areas had a higher proportion of infested water contacts than those in mildly endemic areas (P < 0.001). In addition, there was no significant difference in the proportion of infested water contacts between primary and secondary school students (P >0.05). Multilevel and multivariate logistic analyses revealed a lower proportion of infested water contacts with the increase of knowledge, belief and self-efficacy levels (P < 0.001), and there was a cluster of infested water contacts among students at a county scale (P < 0.001). Conclusions There is a cluster of infested-water contact behaviors among primary and secondary school students at a county scale in Sichuan Province. Individual and environmental factors should be considered during the formulation of health education strategy and interventions for schistosomiasis among primary and secondary school students.
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Objective: To study the effect of different wetness degrees in the root canal on the canal sealing. Methods: 160 root canal prepared single rooted teeth were divided into 4 groups (n = 40) by the root canal wetness degree (water content, V): (1) 0. 250 ～0. 299, (2) 0. 300 ～ 0. 599, (3) 0. 600 ～ 0. 899 and (4) 0. 900 ～ 1. 199 respectively. 80 teeth were divided into 4 groups (n = 20) for dye leakage test and another 80 for bacterial microleakage test. Zinc oxide paste (ZOP) and AH-Plus (AH-P) with vertical condensation of warm gutta-percha were respectively used to seal the canals in each group of the samples (n = 10) . The length of in vitro tooth dye penetration was measured by stereomicroscope; the time (days) of turbidity in the bacterial leakage model observed and compared. Results: Of all the canals sealed by ZOP or AH-P with the increase of the wetness the dye infiltration length increased significantly (P ＜0. 05) and the days in which the faecal intestine ball infiltrated into the lower chamber of the model was gradually decreased (P ＜0. 05) . Conclusion: The increase of root canal moisture may reduce the sealing of the root canal.
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Objective To identify 10 imported cases of Plasmodium ovale wallikeri infection in Sichuan Province from January to April in 2018, and to analyze the P. ovale wallikeri infection status of 1 079 malaria cases reported in this area from 2013 to 2017. Methods The 10 cases collected in 2018 were examined by microscopy, RDT, nested PCR and sequencing. Meanwhile, the retrospective detections of P. ovale wallikeri of the 1 079 blood samples from past 5 years were conducted by nested PCR using wallikeri-specific primers. Results For the 10 cases, the microscopic examinations were all positive for P. ovale, of which 2 were mixed infection with P. falciparum, and the results of RDT were all positive for Plasmodium. Except for 2 cases of P. falciparum infection, the routine nested PCR showed negative results for rest of the samples. The nested PCR for the specific detection of P. ovale wallikeri showed the 10 cases were all positive, and the following sequencing confirmed that the 10 cases were all infected with P. ovale wallikeri. The retrospective tests discovered 2 cases both reported in 2017 and recorded as simple P. falciparum infection tuned out to be mixed infection with P. falciparum and P. ovale wallikeri. Conclusion This is the first time that imported P. ovale wallikeri infection is founded in Sichuan Province.
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Objective To identify 10 imported cases of Plasmodium ovale wallikeri infection in Sichuan Province from January to April in 2018, and to analyze the P. ovale wallikeri infection status of 1 079 malaria cases reported in this area from 2013 to 2017. Methods The 10 cases collected in 2018 were examined by microscopy, RDT, nested PCR and sequencing. Meanwhile, the retrospective detections of P. ovale wallikeri of the 1 079 blood samples from past 5 years were conducted by nested PCR using wallikeri-specific primers. Results For the 10 cases, the microscopic examinations were all positive for P. ovale, of which 2 were mixed infection with P. falciparum, and the results of RDT were all positive for Plasmodium. Except for 2 cases of P. falciparum infection, the routine nested PCR showed negative results for rest of the samples. The nested PCR for the specific detection of P. ovale wallikeri showed the 10 cases were all positive, and the following sequencing confirmed that the 10 cases were all infected with P. ovale wallikeri. The retrospective tests discovered 2 cases both reported in 2017 and recorded as simple P. falciparum infection tuned out to be mixed infection with P. falciparum and P. ovale wallikeri. Conclusion This is the first time that imported P. ovale wallikeri infection is founded in Sichuan Province.
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Objective To investigate the influence of coix seed triglyceride combined with transcatheter arterial chemoembolization (TACE) therapy on AFP, CD4﹢CD25﹢regulatory T (Treg) cells and cellular immune function in patients with advanced primary hepatocellular carcinoma (HCC). Methods A total of 50 patients with inoperable HCC, whose imaging examination showed no distant metastasis, were divided into the study group (n=25) and the control group (n=25). Coix seed triglyceride together with TACE was employed for the patients of the study group, while only TACE was adopted for the patients of the control group. For the patients of the study group, transcatheter hepatic artery infusion of 100 ml coix seed triglyceride was carried out during the performance of TACE, and postoperative intravenous drip of coix seed triglyceride (200 ml/d) was used for 5 days. The peripheral blood samples were collected one week before and one month after the treatment to detect the changes of AFP and T lymphocyte subsets (CD3﹢, CD4﹢, CD8﹢,CD4﹢/CD8﹢ and Treg) levels. One month after the treatment, enhanced CT, MRI or PET-CT was performed to evaluate the necrosis degree of the tumor. Results After the treatment, AFP levels was decreased in both groups, when compared the preoperative data the differences were statistically significant (P0.05). In the study group, the percentage of Treg cells decreased from preoperative (8.27±6.65)%to postoperative (4.22± 1.59)%, the difference was statistically significant (P0.05). Conclusion In treating advanced primary HCC, coix seed triglyceride combined with TACE can reduce the percentage of Treg cells, thus, influence the patient’s cellular immune status and possibly decrease the recurrence rate of HCC after TACE therapy.
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<p><b>OBJECTIVE</b>To analyse the relationships among HBV genotypes, HBV DNA levels and histopathological features of the livers of familial grouped hepatitis B patients in the Tianjin area.</p><p><b>METHODS</b>One hundred familial grouped hepatitis B (CHB) patients were enrolled in this study. Thirty-five of the 100 patients were chronic asymptomatic HBsAg carriers (ASC) and 65/100 were mild CHB patients. Their HBV genotypes and HBV-DNA levels were detected and liver biopsies were performed for analyzing the pathological features.</p><p><b>RESULTS</b>Seven patients were of HBV genotype B (7%), and most of them had a HBV DNA level in the middle 10(3-5) copies/ml (57.14%). The histopathological features of the livers were of different degrees of injury. Eleven patients HBV was of genotype BC (11%); their HBV DNA levels were from 10(3-5) copies/ml (45.45%) to 10(6-7)copies/ml (36.36%). Their liver pathology showed slight or severe injuries (< or = G2 90.91%, < or = S(2) 81.82%). Eighty-two patients HBV was of genotype C (82%), and among the 82, 29 were ASC and 53 were CHB. Among the ASC, most of them had a high HBV DNA level (72.41%), and all of them had different degrees of liver injury. Among the CHB, their HBV DNA levels were 10(6-7) copies/ml (39.62%) and more than or equal 10(8) copies/ml (49.06%). The liver histopathological features were > or = G(2) in 38 patients (71.70%), and > or = S(2) in 25 patients (47.17%).</p><p><b>CONCLUSIONS</b>(1) In the majority, HBV of the family gathered hepatitis B patients living in Tianjin is of genotype C and they have a high HBV-DNA level and severe liver pathological injuries. These features of the family gathered hepatitis B patients are the main factors causing the unfavorable prognosis of the patients. (2) There is inflammation of different degrees in the livers and high HBV DNA levels in all the family gathered ASC patients. Antiviral therapy should be planned according to the pathological features in patients livers. (3) Liver biopsies should be performed routinely before their antiviral therapy.</p>