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OBJECTIVE@#This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline (BR) and the conventional treatment regimen (CR, not containing Bedaquiline) for the treatment of adults with multidrug-resistant tuberculosis (MDR-TB) in China.@*METHODS@#A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years. The model parameter data were synthesized from the literature, the national TB surveillance information system, and consultation with experts. The incremental cost-effectiveness ratio (ICER) of BR vs. CR was determined.@*RESULTS@#BR ( vs. CR) had a higher sputum culture conversion rate and cure rate and prevented many premature deaths (decreased by 12.8%), thereby obtaining more quality-adjusted life years (QALYs) (increased by 2.31 years). The per capita cost in BR was as high as 138,000 yuan, roughly double that of CR. The ICER for BR was 33,700 yuan/QALY, which was lower than China's 1× per capita Gross Domestic Product (GDP) in 2020 (72,400 yuan).@*CONCLUSION@#BR is shown to be cost effective. When the unit price of Bedaquiline reaches or falls below 57.21 yuan per unit, BR is expected to be the dominant strategy in China over CR.
Subject(s)
Adult , Humans , Antitubercular Agents/therapeutic use , Cost-Effectiveness Analysis , Cost-Benefit Analysis , Tuberculosis, Multidrug-Resistant/drug therapy , China/epidemiologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of transrectal ultrasound-guided microwave ablation of canine prostate tissue.</p><p><b>METHODS</b>Guided by transrectal ultrasound, we conducted microwave ablation on each side of the prostate in 12 male dogs, 6 at 40 W/ 120 s (group A) and the other 6 at 40 W/160 s (group B), and observed the changes in the thermal lesions using grayscale ultrasound. After thermal ablation, we measured the volume of the thermal lesions by contrast-enhanced ultrasound (CEUS). Then we harvested the whole prostate from the animals and determined the lesion volumes in the fresh tissue specimens.</p><p><b>RESULTS</b>Grayscale ultrasound revealed an echogenic area at the initiation of the microwave ablation procedure, which was enlarged with the increase of ablation time. At the end of the procedure, the lesions appeared as an irregular heterogeneous echogenic area. CEUS showed oval non-perfused areas, which appeared as well-defined non-echoic areas in sharp contrast with the surrounding normal prostate parenchyma with bolus injection of contrast material (Sonovue, 2.4 ml), and that the thermal lesion volumes of groups A and B were (1.18 +/- 0.23) cm3 and (1.52 +/- 0.23) cm3, respectively. The thermal lesions of the gross specimen exhibited an elliptical shape, pale color and clear margin, and their volumes were (1.13 +/- 0.20) cm3 and (1.48 +/- 0.20) cm3, respectively, in groups A and B.</p><p><b>CONCLUSION</b>Different combinations of time and power can produce coagulative necrotic lesions of different volumes in the local prostatic tissue. CEUS can accurately manifest the lesion area and thus avoid excessive or inadequate ablation treatment.</p>
Subject(s)
Animals , Dogs , Male , Catheter Ablation , Methods , Microwaves , Therapeutic Uses , Prostate , Diagnostic Imaging , UltrasonographyABSTRACT
Objective To explore the role of protein kinase C (PKC) in the mechanism of central sensitization of migraine.Methods Sixty healthy adult male SD rats,weighting from 200 to 250 g,were randomly divided into five groups:normal group,sham-operated group,migraine model group,chloroform treatment group and H-7 (the inhibitor of PKC) treatment group (n=12).Dural blood flow monitor was performed by laser Doppler blood flow imager and extracellular discharge frequency in the spinal trigeminal nucleus was observed by multi-conductive polygraph; the dural blood flow and discharge frequency changes were analyzed and compared.Results Two hours after the success of model making,the dural blood flow in the migraine model group increased obviously as compared with that in the sham-operated group (P<0.05); as compared with that in the migraine model group,the dural blood flow in the H-7 treatment group decreased obviously (P<0.05); as compared with sham operation group,blood flow decreased obviously in H-7 group (P<0.05).Extracellular discharge frequency in the spinal trigeminal nucleus increased 2 h after the success of model making; 2 hours after model making,the extracellular discharge frequency was (323.82±11.00) % of baseline level; as compared with that in the migraine model group,discharge frequency in the H-7 treatment group decreased obviously (P<0.05); as compared with that in the sham-operated group,discharge frequency in the H-7 treatment group had no obvious changes (P>0.05).Conclusion PKC may play an important role in the mechanism of central sensitization of migraine.
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<p><b>OBJECTIVE</b>To study the tuberculosis clustering areas and the changing trend, from 2008 to 2010, so as to provider the reference for tuberculosis control.</p><p><b>METHODS</b>Global spatial autocorrelation and SaTScan methods were used to detect and analyse the spatial clustering of total tuberculosis notification rate and the new smear-positive pulmonary tuberculosis notification rate, at the provincial level from 2008 to 2010.</p><p><b>RESULTS</b>The spatial clustering (SC) phenomenon was significant on total notification rate and new smear-positive pulmonary tuberculosis notification rate from 2008 to 2010 (P < 0.01). The coverages of clustering areas on total notification rate showed a reduction from 19 provinces to 14 provinces, distributed in the south, west and north-east areas of China. The coverages of clustering areas on new smear-positive pulmonary tuberculosis notification rate concentrated in 14 provinces which covered the south and north-east of China.</p><p><b>CONCLUSION</b>The disease burden and the risk of transmission in the clustering areas of tuberculosis both located in the south and the north-east of China. The disease burden of tuberculosis was high in the west of China, but not the areas with high risk of transmission.</p>
Subject(s)
Humans , China , Epidemiology , Cluster Analysis , Statistical Distributions , Tuberculosis , EpidemiologyABSTRACT
<p><b>OBJECTIVE</b>To establish a highly sensitive and specific assay to detect dengue virus (DENV) envelope protein domain III (EDIII) IgG antibody, and to explore its value in the diagnosis and seroepidemiological survey of dengue.</p><p><b>METHODS</b>The DENV EDIII IgG antibody capture ELISA was developed using the recombinant full-length DENV EDIII, which was prepared by Pichia yeast expression system as the capture antigen. The serum samples were collected from the same group of 35 DENV-1 patients of primary infection during disease period in 2006 and their follow-up phase in 2010; and the sensitivity of the assay was compared to that of the commercial Panbio DENV IgG ELISA.</p><p><b>RESULTS</b>The sensitivity of DENV EDIII IgG ELISA in detecting the serum samples from disease period and follow-up phase was 87% (20/23) and 94% (33/35), respectively; whereas the sensitivity of Panbio DENV IgG ELISA was 71% (25/35) and 0, respectively. The sensitivity of DENV EDIII IgG ELISA in detecting the serum samples from both periods was similar, without statistical significance (χ(2) = 0.946, P = 0.331). For serum samples from disease period, the sensitivity of DENV EDIII IgG ELISA was comparable with that of Panbio DENV IgG ELISA (χ(2) = 1.924, P = 0.165). However, DENV EDIII IgG ELISA demonstrated a significantly higher sensitivity than Panbio DENV IgG ELISA in detecting the serum samples from follow-up phase (χ(2) = 62.432, P = 0.000).</p><p><b>CONCLUSION</b>DENV EDIII IgG capture ELISA is highly sensitive in detecting IgG in the serum samples from either disease period or follow-up phase. This method might be a promising alternative for diagnosis and seroepidemiologic survey of dengue.</p>
Subject(s)
Humans , Antibodies, Viral , Blood , Dengue , Diagnosis , Allergy and Immunology , Virology , Dengue Virus , Allergy and Immunology , Enzyme-Linked Immunosorbent Assay , Methods , Immunoglobulin G , Blood , Protein Structure, Tertiary , Sensitivity and Specificity , Seroepidemiologic Studies , Viral Envelope Proteins , Allergy and ImmunologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility and safety of ultrasound-guided transrectal microwave ablation in reducing the prostate volume.</p><p><b>METHODS</b>Ultrasound-guided transrectal microwave ablation of both sides of the prostate was conducted on experimental dogs with the output volume of 30W for 120 seconds. The dogs were sacrificed on the very day of the ablation, and the prostate and its surrounding tissues were excised for observation of the thermal lesions and pathological examination.</p><p><b>RESULTS</b>A total of 12 thermal lesions were achieved on the two sides of the prostate. The ultrasonogram manifested dense echo and increasing extent in the ablated area, and then an irregular heterogeneous echogenic area and clearly differentiated margin. Pathological examination of the gross specimen showed a little stagnant blood under the rectal mucous, the urethra and bladder not injured, and the thermal lesions elliptical, clearly margined and with the mean size of (0.94 +/- 0.30) cm3.</p><p><b>CONCLUSION</b>Ultrasound-guided transrectal microwave ablation of the prostate can effectively cause coagulative necrosis of the local tissue without inflicting thermal injury upon the surrounding tissues. Conventional grayscale ultrasound can give a real-time'display of the extent of thermal lesion and the whole process of the ablation.</p>
Subject(s)
Animals , Dogs , Male , Catheter Ablation , Methods , Feasibility Studies , Microwaves , Prostate , Diagnostic Imaging , Rectum , Diagnostic Imaging , UltrasonographyABSTRACT
<p><b>OBJECTIVE</b>To study the effect of exogenous cytokine-stimulated decidual cells on IgG secretion of B lymphocytes and investigate the features of local immunological microenvironment of the decidua.</p><p><b>METHODS</b>Exogenous cytokines interferon-gamma (IFN-gamma), interleukin-2 (IL-2), IL-6 and epidermal growth factor (EGF) were added separately in cultured decidual cells, and the supernatant of the culture medium was prepared for stimulating human peripheral blood lymphocytes. IgG secretion of the B cells was measured by radio-immunological method.</p><p><b>RESULT</b>The decidual cells of normal early pregnancy stimulated B lymphocyte IgG secretion, and the supernatant of exogenous cytokine-stimulated decidual cells had the same effect, which, however, was depended not on the concentration and category of the cytokines, but only on the time of treatment.</p><p><b>CONCLUSION</b>The exogenous cytokines can increase the humoral immunity in the decidual immunological microenvironment, but such effect might result from a self-regulatory mechanism of the local immunological microenvironment of the decidua, which can be fundamental for maintenance of normal pregnancy.</p>