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T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) is a new immune checkpoint protein. Studies have shown that TIGIT can cause dysfunction of immune cells, weaken the anti-tumor effect, thus leading to tumor immune tolerance and immune escape. Blocking TIGIT can reverse immune cell failure and exert anti-tumor effect, which is expected to become a new therapeutic target for multiple myeloma.
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BACKGROUND@#Decreased heart rate variability (HRV) is a predictor of autonomic system dysfunction, and is considered as a potential mechanism of increased risk of cardiovascular disease (CVD) induced by exposure to particulate matter less than 2.5 μm in diameter (PM@*METHODS@#An updated systematic review and meta-analysis of panel studies till November 1, 2019 was conducted to evaluate the acute effect of exposure to ambient PM@*RESULTS@#A total of 33 panel studies were included in our meta-analysis, with 16 studies conducted in North America, 12 studies in Asia, and 5 studies in Europe. The pooled results showed a 10 μg/m@*CONCLUSION@#Short-term exposure to PM
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Air Pollutants/analysis , Air Pollution/analysis , Heart Rate/drug effects , Particulate Matter/analysisABSTRACT
OBJECTIVE:To analyze the current status and problems of medicine purchase and distribution of county,township public medical institutions in Hubei province,and to propose targeted policy recommendations. METHODS:By stratified typical sampling,medicine data of 3 county medical institutions and 40 township medical institutions in 3 counties of Hubei province were collected from medicine bidding and purchasing platform of county health and family planning bureau and hospital information system (HIS). Medicine purchase and distribution,distribution rate,purchase and distribution of essential medicine,Chinese patent medicine and injection,general information of top 10 medicines in the list of purchase amount were analyzed in different levels of medical institutions. RESULTS:The medicine purchase and distribution amount of the township medical institutions were lower than those of county medical institutions, but the total amount and distribution rate were higher than county medical institutions. The purchase amount of essential medicine accounted for nearly 3/4 of the total amount (90.6％ of the township medical institutions,and 48.4％ of the county medical institutions);the purchase amount of Chinese patent medicine accounted for about 1/4 of the total amount (35.4％ of the township medical institutions,15.4％ of the county medical institutions);purchase amount of injection accounted for nearly half (34.6％ of the township medical institutions,and 59.3％ of the county medical institutions). The distribution rates of essential medicine,Chinese patent medicine and injection were 93.0％,93.3％,and 93.2％in township medical institutions,and 81.8％,78.6％ and 79.6％ in county medical institutions,respectively. The rate of medicine distribution of township medical institutions was higher than that of the county medical institutions. The top 10 medicines in the list of purchase amount included 6 kinds of antibiotics,and the top 5 medicines included 2 kinds of injection. CONCLUSIONS:The policy of essential medicine purchase is well implemented in Hubei province,and purchase rate of essential medicine meet the policy requirements(40％-50％);but the proportion of injection purchase can partly reflect the high usage of injection,which may indicate the abuse of injection, and Chinese patent medicine has become an integral part of medicine purchase. Moreover, medicines still have the status of distribution untimely,and medicine distribution of the township medical institutions is better than that of county medical institutions.
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OBJECTIVE:To provide reference for promoting the rational use of essential drugs in primary medical institutions. METHODS:Twenty-three rural primary medical institutions(8 township health centers,15 village clinics)were randomly selected from 2 poverty-stricken counties in Chongzuo city of Guangxi Zhuang Autonomous Region. The utilization of essential drugs was investigated and analyzed statistically through exporting hospital information system data and on-site interviews. RESULTS:The utilization rate of essential drugs in sample township health centers was 72.4％,and the amount of essential drugs accounted for 78.3％. The utilization rate of variety from National List of Essential Drug was 36.9％,which in the Autonomous Regions Essential Drug List Supplement was 47.2％(utilization rate of chemical drugs was 53.9％,and that of Chinese patent drugs was 39.7％). The utilization rate of essential drugs in sample village clinics was 64.4％;utilization rate of variety from National List of Essential Drug was 18.3％, which in the Autonomous Regions Essential Drug List Supplement was 10.5％. The amount of 5 major categories accounted for 47.9％ of total amount of chemical agents,among which that of antimicrobial agents took up the highest proportion,being 35.9％. Among top 10 drugs in the list of amount,there were 8 national essential drugs and 4 antimicrobial agents. There were 2.90 kinds of drugs in each outpatient prescription averagely in sample township health centers;the average proportion of antibiotic prescription was 43.0％;the cost of each prescription was 33.12 yuan in average. CONCLUSIONS:The utilization rate of essential drugs in primary medical institutions is lower than the requirements of policy. There are great difference in utilization rate between chemical agents and Chinese patent drugs of township hospital in Autonomous Regions Essential Drug List Supplement. The cost proportion of antimicrobial agents is high. The rationality of prescription drug use still needs to be improved. It is suggested to guarantee essential drugs supply,adjust Autonomous Regions Essential Drug List Supplement in time,control the price of main categories and strengthen antimicrobial agent use monitoring so as to further promote rational drug use.
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OBJECTIVE:To provide reference for promoting the rational use of essential medicines in primary medical institutions.METHODS:Twenty six rural primary medical institutions (13 township health centers,13 village clinics) were randomly selected from 2 poverty-stricken county (city) in Huanggang city of Hubei province.The utilization of essential medicine was investigated and analyzed statistically through exporting hospital information system data and on-site interviews.RESULTS:The utilization rate of essential medicine in sample township health centers was 76.9％,and the amount of essential medicine accounted for 93.0％;the utilization rate of essential medicine in sample village clinics was 89.7％.The utilization rate of variety from essential medicine list was 53.6％ in sample township health centers and 25.0％ in sample village clinics;the utilization rate of variety from National Essential Medicine List was higher than that of Provincial Essential Medicine List Supplement.The amount of 5 major categories as antimicrobial agents,cardiovascular agent in sample primary medical institutions accounted for 64.7％ of chemical agents.The top ten medicines in the list of amount were all essential medicine,9 of which were national essential medicines.There were 2.8 kinds of medicines in each outpatient prescription averagely in sample township health centers.The proportion of antibiotic prescription was 44.2％.CONCLUSIONS:The utilization rate of essential medicines in township health centers of this area is lower than WHO recommended value,and the ratio of amount meets the policy requirements.The utilization rate of variety from Provincial Essential Medicine List Supplement is in low level in primary medical institutions;the amount of anti-microbial drugs is in high level;the rationality of medicine use in prescriptions needs to be improved.It is suggested to adjust the type of provincial supplement list dynamically according to actual situation and control the price and amount of main categories strictly,the rationality of prescription.
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The pharmaceutical circulation policy reform is the key link of the three medical linkage reform with a view of deepening medical reform.The policy formulation and implementation will inevitably lead to interest redistribution.Therefore, it is an effective means to comprehensively understand the unexpected results of the reform and the scientific decision-making of the policy direction, while ensuring the smooth progress of the reform.Based on the research literature presented on pharmaceutical circulation reform and policies since the new medical reform, this paper revealed the prevailing problems and limitations of the existing researches, demonstrated that policy evaluation based on the scientific theory framework is a powerful tool to judge whether the reform goals are achieved.With the introduction of the stakeholder theory and the game theory in pharmaceutical circulation policy evaluation, the complex influence factors can be quantified under scientific theoretical framework, so that the causal mechanism of the policy effect can be learnt, which can help to have a clearer interpretation of the pharmaceutical circulation reform policy, and to provide a scientific and reasonable reference for future policy direction.
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OBJECTIVE:To evaluate the affordability of 3 anti-tumor targeted drugs gefitinib,trastuzumab and sunitinib in ur-ban and rural residents of Hubei province,and to provide reference for medical insurance price admission of anti-malignant tumor targeted drugs in China. METHODS:Referring to the incidence of malignant tumor stated in statistical yearbook of Hubei province and income data of urban and rural residents in Hubei province,based on the policy of reducing the price of imported drugs by 50% mentioned in the national drug price negotiations,and assume the drugs are included in the medical insurance reimbursement list,WHO/HAI standard survey method,catastrophic expenditure evaluation method and poverty effect evaluation method were ad-opted to calculate the affordability of 3 drugs. RESULTS:According to WHO/HAI standard survey method,increment of payment for 3 drugs were 64.00%-74.00% before and after 50% discount and reimbursement. According to catastrophic expenditure evalua-tion method,50% discount of gefitinib and reimbursement gefitinib,trastuzumab and sunitinib in urban area would result in cata-strophic expenditures of 20.00%、59.28% and 35.48% patients;in rural area,would result in catastrophic expenditures of 50.63%、74.72% and 75.93% patients. According to poverty effect evaluation method,50% discount of 3 drugs and reimbursement caused less than 31.95% urban and rural patients falling to poverty. CONCLUSIONS:Fifty percentage discount of 3 anti-tumor targeted drugs mentioned in the national drug price negotiations cause the economic burden more serious for rural residents than urban resi-dents. In the formulation of policies,the corresponding reimbursement ratio should be adjusted according to urban and rural areas, drug price and disease types for a balance of patients with different economic burden.
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Despite high coverage of vaccinations, incidence of pertussis (whooping cough) has been increasing throughout the world and large outbreaks were reported in several countries.Adolescents and adults with atypical pertussis symptoms have become the main sources of infants′ pertussis.Since clinicians are lack of experience in making diagnosis based on atypical symptoms, laboratory methods are needed.The currently recommended laboratory methods include bacterial culture, PCR and serology ELISA.It is well known that sensitivity and specificity of the above-mentioned methods may vary depending on many factors such as status of vaccination, timing of specimen collection and onset of symptoms.Serology ELISA to measure specific anti-pertussis toxin IgG antibodies in serum has been proven to be one suitable method for the diagnosis of pertussis infection in adolescents and adults.In this review, we summarize the current status of methods used in China and other countries for the laboratory diagnosis of pertussis and discuss the clinical relevance of serology ELISA for pertussis diagnosis.
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OBJECTIVE:To provide reference for introducing supply chain governance theory into essential medicine supply guarantee reform evaluation system in poverty and remote areas.METHODS:The literatures and reform policies in the field of essential medicine supply guarantee since the New Medical Reform were sorted out to analyze the problems and insufficiency of existing researches,and explore the feasibility of supply chain governance theory in the field of essential medicine supply guarantee.RESULTS:The research boundary of existing studies is not clear,and existing studies are lack of evaluation and analysis method,focus too much on using available data and the result of its quantitative,and lack of comprehensive analysis of combined quantitative and qualitative under theoretical framework.The introduction of supply chain governance theory reveal the mechanism of policy's effectiveness clearly,to provide the reference of policies' tendency.CONCLUSIONS:Through the establishment of theoretical framework based on supply chain governance theory,evaluation system will expand the study strategies and data collection technology in the field of drug circulation.Furthermore,supply chain governance theory and method can be generalized.It not only applies in poverty and remote areas and for the evaluation of essential medicine supply guarantee,but also can be used in the field of drug circulation reform.
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Objective:The aim of the present study was to conduct an international comparison of the high-val-ue drugs payment systems of some selected countries, and introduce them to the Chinese context. Australia, America and Germany's high-value drugs payment systems were selected to serve as references for China. Methods: The main content and characteristics of three countries' payment systems were analyzed in four aspects:expenditure copayment mode, paid-scope selection, drug price negotiation, and drug rational use management which were then compared with the Chinese status. Results:Through the difference in healthcare system tradition, the above countries have vari-ous copayment mode, but they all select paid-drug by cost-effectiveness analysis with corresponding control measures. Conclusions:China should: establish a co-payment mode for the high-value drugs on the basis of a critical illness medical insurance found;build a national pharmaco-economic evaluation index system and improve the national nego-tiation superiority, while emphasizing on risk-sharing mechanism; and make series specifications to guarantee the drug to be rationally used.
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Objective: To analyze the New Cooperative Medical System ( NCMS ) funds and Individual afford-ability of anti-tumor targeted drugs under different medical insurance entry price, and to provide the basis for establis-hing the access price for medical insurance. Methods: Choosing Conmana or Kemer ( the lung cancer targeted drug) and Herceptin (breast cancer targeted drug) to analyze the Wuhan NRCMS operating status from 2012 to 2014, use tumor surveillance data from Hubei Province during the period from 2011 to 2015;consult clinical experts to form expert consensus price, refer to the Jiangsu Province Access Price and National Negotiation Price, and explore the fund bal-ance and individual affordability when the afore-mentioned two kinds of drugs can be compensated by medical insurance under different price. Results:The basic account balances of NRCMS in Wuhan from 2016 to 2018 are-11. 948 million Yuan, 2. 513 million Yuan and 82. 955 million Yuan when Kemer can be compensated by medical insurance under Na-tional Negotiation Price. Taking the compensation of Herceptin under National Price after the bargaining, the basic ac-count balances are -26. 901 million Yuan,-35. 962 million Yuan and 17. 542 million Yuan respectively. The rate of poverty caused by illness falls to 33. 40% from 45. 85% when Conmana can be compensated by Medical Insurance un-der National Negotiation Price, while this rate falls to 45. 42% from 46. 00% for Herceptin. Conclusion:The two kinds of drugs can be afforded by the Wuhan NRCMS after the medical insurance access price is negotiated by the govern-ment, but the individual affordability of Herceptin at the National Negotiation Price is worse.
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Objective To investigate the effects of ciyelosporine-A(CsA).a calcinenrin(CAN)inhibitor,on electrophysiological propertiesof atria in canine tachycardia-induced model of AF.Methods Eighteen healthy adult mongrel canines weighing 17.0 to 23.2 kg(rangedfrom 2 to 4 years old)were randomized to 3 groups,Sham group(no pacemaker was implanted),atrial tachypacing group(ATP group)each group at baseline and after 8 weeks' tachypacing.Measurements included atrial effective refractory period(AERP),conductionvelocity(CV),wave length(WE),atrial fibrillation load and rate-adaptability. Results After 8 weeks' atrial tachypacing,ATP andCsA groups showed significant longer duration of the P wave,shorter AERP,decreased adaptation of AERE slower CV,shorter Wland longer AF duration compared to the shamg roup (all P＜0.05).AERP of the CsA group was longer than that of ATP group (P＜0.05),but there were no differences in rate-adaptability,CV,incidence of induced AF and AF duration between CsA group and ATP group.Conclusions Our results suggest that calcineurin pathway intervention by CsA have a positive effect on tachycardia-inducedelectrical remodeling of atria,but can not prevent or reverse AF.
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A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a smallleft circumflex,70-90%stenosis at the paroxysmal and middle part of a dominant fight coronary artery (RCA),and a normal left internalmammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occludedlesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davincirobot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then thepatient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique befeasible and safe in the treatment of elderly patient with multiple coronary diseases.
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Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography (OCT) in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI). Methods OCT was used in elderly patients undergoing percutaneous coronary interventions.Fifteen patients, 9 males and 6 females with mean age of 72.6±5.3 years (range 67-92 years) were enrolled in the study. Images were obtained before initial balloon dilatation and following stent deployment. The plaque characteristics before dilation, vessel dissection,tissue prolapse, stent apposition and strut distribution after stent implantation were evaluated. Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography. There were 7 lesions in the left anterior descending artery, 5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery. Among them,12 (80.0%) were lipid-rich plaques, and 10 (66.7%) were vulnerable plaques with fibrous cap thickness 54.2±7.3 μm. Seven ruptured culprit plaques (46.7%) were found; 4 in UA patients and 3 in NSTEMI patients. Tissue prolapse was observed in 11 lesions (73.3%).Irregular stent strut distribution was detected in 8 lesions (53.3%). Vessel dissections were found in 5 lesions (33.3%). Incomplete stent apposition was observed in 3 stents (20%) with mean spacing between the struts and the vessel wall 172±96 mm (range 117-436 mm).Conclusions 1) It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI. 2) Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque, vulnerable plaque, lipid-rich plaque, and stable plaque. 3) Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients. 4) Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions. 5) The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.
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Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.
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Objective To assess the safety and efficacy of a novel biodegradable polymer and rapamycin-coating stent, the EXCEL stent, in the treatment of coronary artery disease (CAD), as compared with the CypherTM stent. Methods In this prospective, non-randomized study, 60 consecutive patients with symptomatic CAD received either an EXCEL stent (n=32), or a CypherTM stent(n=28),according to their respective treatment intention. Follow-up angiography was performed at a mean of 180±40 days. The primary endpoint of the study was the occurrence of a major adverse cardiac event (MACE), including death, myocardial infarction, or target-vessel revascularization during the 6 months after stenting. The secondary end points included the in-stent late luminal loss (LLL), percentage of in-stent stenosis of the luminal diameter, and the rate of restenosis (luminal narrowing of 50 percent or more) at 6 months. Results There were no significant differences between the two groups in baseline characteristics, including the distribution of target vessel and lesion types. During the follow up period of 6 months, there were no occurrences of MACE in either group. Twenty-seven patients(84%) in the EXCEL group and 10 (36 %) in the CypherTM group underwent quantitative coronary angiography at 6 months. For these patients, no restenosis occurred, and there were no differences in the in-stent stenosis of the luminal diameter (5.98±5.52% vs 5.21 ±6.3%,P＞0.05) and the LLL (-0.02±0.09 mm vs -0.01±0.07 mm, P＞0.05). Conclusions Compared with the CypherTM stent, the EXCEL Stent with biodegradable polymer and rapamycin-coating showed similar efficacy in the prevention of neointimal proliferation, restenosis, and associated clinical events in CAD patients.
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Background and Objectives The relationship between left atrial (LA) size and congestive heart failure (CHF) is well recognized;however, there is little information on the association of pulmonary vein (PV) diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography (MSCT) angiography using a new 64-slice scanner. Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age- and sex-matched non-CHF controls. Compared with controls, CHF patients showed significant greater diameters of left superior pulmonary vein (LSPV) and right inferior pulmonary vein (RIPV) in both anteriorposterior(AP) and superior-inferior (SI) directions (P＜0.01), significant dilation of right superior pulmonary vein (RSPV) in AP direction (P＜0.05), as well as significant increase of LA transverse, AP, and SI diameters (P＜0.01). Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients. This anatomic and geometric changes may participate in the perpetuation of AF.
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Objective To evaluate the feasibility, and clinical efficacy of combined interventional procedure (CIP) in composite cardiovascular diseases (CCD). Methods Twenty one consecutive patients were diagnosed as CCD before the procedures. The algorithm of CIP were individualized by the operators and physicians. The criteria for a successful procedure were defined before the operation. The counterplan for predictable complications was also established beforehand. The successful rate, short and long term efficacy, the incidence of complications and adverse reaction associated with contrast medium and X-ray were observed. All the patients were followed up through special out-patient clinic, telephone, or letters. Results Seven cases accepted electrophysiological testing(EPT) + radiofrequency catheter ablation (RFCA)+coronary angiogram (CAG)+percutaneous transluminal coronary angioplasty (PTCA)+stent implantation (SI). Four cases accepted CAG+PTCA+SI+EPT. Three cases accepted EPT+RFCA+CAG. Six cases accepted CAG+PTCA+SI+peripheral artery angiogram (PAG). One cases accepted pacemaker implantation (PI)+CAG+PTCA+SI+percutaneous transluminal septal myocardial ablation (PTSMA). The symptoms of arrhythmia disappeared or alleviater in 19 cases during hospiatalization. Arrhythmia recurred in 2 cases 12 hours after the procedure and accepted RFCA again. No severe complications and adverse reaction occured. The successful rate was 90.5 percent. Two cases suffered from recurrent angina during the follow-up period and one of them had in-stent restenosis proved by CAG and accepted PTCA+SI again. The other patient received medicine therapy. Conclusion Combined interventional procedure operated by experienced interventional cardiologist in a conditioned catheterization laboratory is safe and feasible. The short-term outcomes are satisfied. The long-term outcomes will be proved by accumulating more cases' data. Individualized approaches, counterplans for complications and cautious operation are important to a successful procedure.
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Objective To observe the effectivity and security of the therapy of patients with non ST segment elevation acute coronary syndromes (ACS) Methods In 165 patients suffering from ACS in recent 1 5 years, 89 patiens were treated with emergency interventional procedure meanwhile 76 patients were treated after medical therapy All “culprit" lesions were treated “non culprit" lesions of 41patients were treated at the same time Results 134 stents were implanted after PTCA and 48 stents were implanted directly in 165 “culprit" lesions Angina symptom of 136 patients disappeared, untypical chest pain of eleven patients disappeared after twenty four hours The uncomfortable symptom disappeared in fifteen patients, and alleviated in three patients There were no death cases and patients who needed emergency CABG During follow up from two to eighteen months, twenty patients suffered from angina again, and fourteen patients had restenosis confirmed by coronary angiography Eleven of them accepted PTCA again, one case accepted PTCA and stenting, and two of them accepted CABG No patients suffered AMI, sudden death and aggravation of heart function Conclusion The interventional treatment of non ST segment elevation ACS is positive and effective in a conditioned interventional center We have had satisfied clinical results