Effects of roxadustat versus recombination human erythropoietin on coronary artery calcification in maintenance hemodialysis patients / 中国药房

OBJECTIVE To compare the effects of roxadustat and recombination human erythropoietin （rHuEPO） on coronary artery calcification in maintenance hemodialysis （MHD） patients. METHODS In retrospective analysis， MHD patients prescribed roxadustat in the Blood Purification Center of the First Affiliated Hospital of Chongqing Medical University from April 2019 to June 2021 were selected as the ROX group （56 patients）， and MHD patients prescribed rHuEPO during the same period were selected as the EPO group （60 patients）， and follow-up observation was conducted for 12 months. The differences in laboratory index， coronary artery calcification score （CACS）， and cardiac ultrasound parameters before and after treatment as well as the occurrence of cardiac and cerebrovascular adverse events during follow-up period were compared between the two groups. RESULTS There was no statistical difference in CACS between the two groups before and after treatment （P＞0.05）； but the difference of CACS in the ROX group was significantly lower than the EPO group （P＜0.05）. There was no statistically significant difference in cardiac ultrasound parameters and laboratory indexes between the two groups before and after treatment （P＜0.05）. The incidence of apoplexy and myocardial infarction in the ROX group was lower than that in the EPO group （P＜0.05）， and there was no statistically significant difference in the incidence of hospitalization due to heart failure between the two groups （P＞0.05）. CONCLUSIONS Compared with rHuEPO， roxadustat may have a positive effect on delaying coronary artery calcification in MHD patients and may be beneficial in reducing the incidence of myocardial infarction and apoplexy in MHD patients.

Enfermería transcultural como método para la gestión del cuidado / Transcultural nursing as an approach to care management

El objetivo general de la investigación fue describir la enfermería transcultural como método para la gestión del cuidado. Método: El planteamiento formulado por los investigadores se basó en el enfoque cuantitativo, con una metodología descriptiva con diseño no experimental. Se apoyó en el análisis documental­bibliográfico. Se organizó un proceso investigativo en donde la población de estudio se basó primordialmente en tesis y artículos científicos arbitrados. Resultados: Las desigualdades en la atención médica, causadas por las diferencias culturales en el acceso a la calidad de la atención, se manifiestan principalmente en edad, género, raza, etnia, educación, ingresos y discapacidad. En conclusión: La promoción de la enfermería transcultural se fortalece facilitando las herramientas, la formación y actualización de los profesionales existentes y las nuevas generaciones desde una preparación integral desde el conocimiento. Se deben desarrollar modelos para la gestión del cuidado, enfatizando en el respeto de los valores, creencias y patrones.

The overall objective of the research was to describe transcultural nursing as a method for care management. Method: The approach formulated by the researchers was based on the quantitative approach with a descriptive methodology with a non-experimental design, which was supported by documentary-bibliographic analysis. A research process was organized in which the study population was based primarily on theses and peer-reviewed scientific articles. Results: Inequalities in health care caused by cultural differences in access to quality of care and are manifested primarily in age, gender, race, ethnicity, education, income, disability. In conclusion: The promotion of transcultural nursing is strengthened by facilitating the tools, training and updating of existing professionals and new generations from a comprehensive preparation from knowledge, developing models for care management emphasizing respect for values, beliefs, patterns.

Effect of Tinnitus on Sleep Quality and Insomnia

Abstract Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objectives To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Dual orexin receptor antagonists for the treatment of insomnia: systematic review and network meta-analysis / Antagonistas duais do receptor de orexina para o tratamento da insônia: revisão sistemática e metanálise em rede

Abstract Background Several randomized clinical trials (RCTs) have shown that dual orexin receptor antagonists (DORAs) are effective in the treatment of chronic insomnia. However, the superiority of one particular DORA over the others remains unclear. Objective To perform a network meta-analysis to evaluate the efficacy of different DORAs in patients with chronic insomnia. Methods The Medline, Embase, and Cochrane Central databases were searched for RCTs that compared DORA with placebo in patients ≥ 18 years of age with a diagnosis of insomnia disorder. We pooled outcomes for wake time after sleep onset (WASO), latency to persistent sleep (LPS), total sleep time (TST), and adverse events (AEs). Results We included 10 RCTs with 7,806 patients, 4,849 of whom received DORAs as the intervention. Overall, we found that DORAs were associated with the improvement of all analyzed efficacy outcomes. Concerning TST, an apparent dose-dependent pattern was noticed, with higherdoses relating to a longerTST. Lemborexant 10mg provided the largest reduction in WASO (at month 1) in minutes (standardized mean difference [SMD] = −25.40; 95% confidence interval [95%CI] = −40.02- −10.78), followed by suvorexant 20/15mg (SMD = −25.29; 95%CI = −36.42- −14.15), which also appeared to provide the largest decrease in long-term WASO (SMD = −23.70; 95%CI = −35.89- −11.51). The most frequent AEs were somnolence, nasopharyngitis, and headache, with rates of up to 14.8%. Conclusion Our results suggest that DORAs are associated with greater efficacy when compared with placebo in the treatment of insomnia, a complex 24-hour sleep disorder. Additionally, dosing might play an important role in the management of chronic insomnia.

Resumo Antecedentes Inúmeros ensaios clínicos randomizados (ECRs) têm demonstrado que os antagonistas duais do receptor de orexina (dual orexin receptor antagonists, DORAs, em inglês) são eficazes no tratamento da insônia. Contudo, restam dúvidas quanto à superioridade de um DORA com relação aos outros. Objetivo Realizar uma meta-análise em rede para avaliar a eficácia de diferentes DORAs em pacientes com insônia. Métodos Foram feitas buscas nas bases de dados Medline, Embase e Cochrane Central por ECRs que comparassem DORAs e placebo em pacientes ≥ 18 anos de idade com diagnóstico de insônia. Os seguintes desfechos foram selecionados: tempo desperto após o início do sono (wake time after sleep onset, WASO, em inglês), latência para o sono persistente (latency to persistent sleep, LPS, em inglês), tempo total de sono (total sleep time, TST, em inglês), e efeitos adversos (EAs). Resultados Incluímos 10 ensaios clínicos com 7,806 pacientes, 4,849 dos quais receberam DORAs como intervenção. Os DORAs foram associados à melhoria de todos os desfechos de eficácia analisados. Em relação ao TST, um aparente padrão de dependência da dose foi identificado, com doses maiores se associando a um maior TST. Lemborexant 10 mg proporcionou a maior redução em WASO (no primeiro mês) em minutos (diferença padronizada das médias [standardized mean difference, [SMD], em inglês) = −25.40; intervalo de confiança de 95% [IC95%] = −40.02- −10.78), seguido de suvorexant 20/15mg (SMD = −25.29; IC95% = −36.42- −14.15), o qual também proporcionou a maior diminuição em WASO no longo prazo (SMD = −23.70; IC95% = −35.89- −11.51). Os EAs mais frequentes foram sonolência, nasofaringite e cefaleia, com taxas de até 14.8%. Conclusão Nossos resultados sugerem que os DORAs estão associados a uma maior eficácia quando comparados com placebo no tratamento da insónia, um complexo transtorno do sono de 24 horas. Além disso, a dosagem pode desempenhar um papel importante no manejo da insónia crônica.

A Study on Internet and Gaming Addiction, Hikikomori Trait and Insomnia Status among Medical Undergraduates at one of Cities of Western India

Background: College students appear more vulnerable in developing a dependence on the internet. Individuals with hikikomori are frequently reported to have social contact predominantly via the internet. Objectives: To find the prevalence of Internet addiction, gaming Addiction, Hikikomori Trait and Insomnia amongst medical undergraduates and to study their association with various determinants. Methodology: The present Cross-Sectional study was conducted among first to final-year medical students studying at various medical colleges in Indian City from February to May 2021. Data collection was done after obtaining the ethical permission of the Institute. A total of 400 students who gave consent were sent an electronic questionnaire. Results: The mean age of study participants was 20 ± 1.58 years. Internet addiction was present in 189(47.2%) participants, gaming addiction in 128 (32%) students and Hikikomori Trait was found in 98(24.5%) students. There was a statistically significant association between different grades of insomnia and internet, gaming addiction, and hikikomori trait (<?0.0001) in the present study. Conclusion: Internet addiction was present in almost half of the medical students while gaming addiction was seen in nearly one third of the students. Male gender and hostel stay had a statistically significant association with internet addiction, gaming addiction, insomnia and hikikomori trait.

Barreiras e facilitadores da implementação do pré-natal em grupo: um protocolo de scoping review / Barriers and facilitators to the implementation of group prenatal care: a scoping review protocol

OBJETIVO: Mapear modelos de Pré-Natal em Grupo (PNG) para identificar barreiras, facilitadores, desafios de implementação e manutenção do PNG. MÉTODO: Este protocolo descreve uma Scoping Review desenvolvida de acordo com a metodologia do Joanna Briggs Institute (JBI). A questão de pesquisa que norteia esta revisão é: "Quais são os modelos de PNG existentes, as barreiras, facilitadores e desafios na implementação e manutenção desses modelos?". A busca será conduzida em oito bases de dados e incluirá a pesquisa em literatura cinzenta. O software Rayyan será utilizado para gerenciar a seleção dos artigos. Dois revisores realizarão a avaliação do título e resumo dos artigos de forma independente. Aqueles que atenderem aos critérios de inclusão serão selecionados para a leitura completa. Em caso de divergências, um terceiro revisor será consultado para resolver as discordâncias. A síntese dos dados será realizada de forma descritiva, com um resumo narrativo dos resultados apresentado em tabelas, descrevendo como esses resultados se relacionam com o objetivo e a questão de pesquisa.

OBJECTIVE: To map group prenatal care (GPC) models to identify barriers, facilitators, implementation challenges, and maintenance of GPC. MÉTODO: This protocol describes a scoping review conducted using the methodology outlined by the Joanna Briggs Institute (JBI). The research question guiding this review is: "What are the existing GPC models, barriers, facilitators, and challenges in implementing and sustaining these models?". The search will be conducted in eight databases and include gray literature searches. Rayyan software will be used to manage the article selection process. Two reviewers will independently assess the title and abstract of the articles. Those that meet the inclusion criteria will be selected for full-text reading. A third reviewer will be consulted to resolve disagreements in case of discrepancies. Data synthesis will be performed descriptively, with a narrative summary of the results presented in tables, describing how these results relate to the objective and research question.

Calidad de sueño en docentes en una institución educativa durante la emergencia sanitaria COVID-19, Perú, 2021

Objetivo: La pandemia del COVID-19 afectó la calidad de vida de la población a nivel mundial. Los países tomaron varias medidas de protección para evitar el contagio como el aislamiento social, el teletrabajo y la educación a distancia. A medida que las escuelas cerraron, los maestros se encargaron principalmente de la enseñanza en línea. El objetivo principal fue determinar la calidad de sueño en los docentes de una institución educativa pública en el distrito de Máncora, Perú, durante el aislamiento social en pandemia por COVID-19. Materiales y métodos: Estudio observacional, transversal y prospectivo. Se usó el cuestionario de Índice de Calidad de Sueño de Pittsburgh en 59 docentes de los niveles educativos inicial, primario y secundario que utilizaron la modalidad de educación a distancia de marzo a diciembre del 2021. Resultados: La edad promedio fue 44,3 ± 8,89 años. Las mujeres fueron 64,4 %; los docentes con especialidad, es decir, el área que enseñaba el docente, 55,9 %. Los de nivel secundario fueron el 55,9 %; el nivel primario, 30,5 %, y el nivel inicial, 13,6 %. Los parámetros de calidad de sueño afectados fueron los siguientes: 69,5 % presentaron mala calidad de sueño; 67,8 %, inadecuada latencia de sueño, y 61,00 %, duración de sueño menor de 5 horas. El 27,1 % presentó eficiencia habitual del sueño menor al 65 % y 49,2 % reportó perturbaciones del sueño. Asimismo, 50,8 % usaron medicación hipnótica más de una vez a la semana. Por último, el 39 % presentó severa disfunción diurna. Se encontró asociación entre la calidad de sueño con los componentes calidad subjetiva del sueño, latencia de sueño, duración del sueño, eficiencia habitual del sueño y disfunción diurna. No hubo asociación con el sexo, nivel educativo y especialidad docente. Conclusiones: Los docentes de una institución educativa en Máncora presentaron alta prevalencia de mala calidad de sueño y los componentes más afectados fueron latencia de sueño, disfunción diurna y perturbaciones del sueño.

Objective: The COVID-19 pandemic affected the quality of life of the population worldwide. The countries took several protective measures to avoid contagion, including social isolation, teleworking and distance education. As schools closed, teachers took over primarily online teaching. The study main objective was to determine the sleep quality among teachers of a public educational institution in the district of Máncora, Peru, during the COVID-19 pandemic social isolation. Materials and methods: An observational, cross-sectional and prospective study. The Pittsburgh Sleep Quality Index was used to assess 59 preschool, primary and secondary school teachers who taught through distance education from March to December 2021. Results: The average age was 44.3 ± 8.89 years. Women accounted for 64.4 %, specialist teachers-i.e., those who have expertise in a particular field-55.9 %, secondary school teachers 55.9 %, primary school teachers 30.5 % and preschool teachers 13.6 %. The affected sleep quality parameters were the following: 69.5 % had poor sleep quality, 67.8 % inadequate sleep latency, 61 % sleep duration of less than five hours, 27.1 % habitual sleep efficiency of less than 65 % and 49.2 % sleep disturbances. Moreover, 50.8 % reported using a sleeping medication more than once a week and 39 % severe daytime dysfunction. There was an association between sleep quality and the components subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and daytime dysfunction. Nonetheless, there was no association with sex, educational level and teaching specialty. Conclusions: Teachers of an educational institution in Máncora had a high prevalence of poor sleep quality and the most affected components were sleep latency, daytime dysfunction and sleep disturbances.

Healthcare providers' satisfaction with participation in private health insurance scheme in a city in the southern Nigeria

Health insurance coverage in Nigeria is still very low as over 70% of health care expenditure is financed by out-of-pocket payment. Health care providers are critical participants in the private health insurance scheme, therefore, their perception and satisfaction with the scheme is fundamental in ensuring sustainability. This study assessed health providers' satisfaction with private health insurance scheme in Port Harcourt Rivers State.Method: A descriptive cross-sectional study which engaged a two-stage sampling method to recruit 60 participating health facilities and 180 responding health personnel by simple random sampling at each stage. A structured, pretested interviewer-administered questionnaire was used to collect data on the levels of satisfaction with the four major domains of satisfaction viz; billing rate, payment models, HMO administrative processes and claims management. Data was analysedusing of SPSS, version 26. Characteristics of the responding facilities were tabulated and compared. Level of satisfaction was deduced by Likert Scale according to the domains of satisfaction. Regression analysis with p-value was set at less than or equal to 0.05 was used to determine the predictors of satisfaction with participation in health insurance. The level of satisfaction with negotiated billing rates, payment models, HMO administrative processes and claims management were analyseddescriptively, and results were presented as means, standard deviation, frequencies and percentages, in tables, pie and bar charts

Progress of poly (ADP-ribose) polymerase inhibitor in advanced ovarian cancer / 肿瘤研究与临床

At present, ovarian cancer is one of the main diseases threatening women's life and health. The mortality ranks first among female reproductive system malignant tumors. Due to the hidden onset, more than 75% of them are at advanced stage once diagnosed. Advanced ovarian cancer is characterized with the Federation International of Gynecology and Obstetrics (FIGO) stage Ⅲ-Ⅳ, very poor prognosis and the 5-year survival rate less than 50%. In recent years, the exploration of maintenance treatment of ovarian cancer is in full swing. A large number of studies show that poly (ADP-ribose) polymerase (PARP) inhibitors are effective in patients with advanced ovarian cancer. Therefore, PARP inhibitors have gradually become an important part for treatment of ovarian cancer, and the indications have also been concerned by clinicians. This paper reviews the application of PARP inhibitors in advanced ovarian cancer.

Effectiveness of S-curve leakage testing method on flexible endoscope / 中华消化内镜杂志

To investigate the effects of the S-curve leakage testing method on the detection of flexible endoscope and occurrence of medium to high-level faults of flexible endoscope. A convenience sampling method was used to study the information of endoscopic leak detection at the digestive endoscopic centre of the First Affiliated Hospital of Air Force Medical University. From July 2016 to December 2017, 58 endoscopes which received conventional leakage testing were set as the control group (29 116 tests). From January 2018 to June 2019, 56 endoscopes which received S-curve leakage testing were set as the observation group (28 112 tests). The results showed that the detection proportion of angular abnormalities in the observation group was higher than that in the control group [65.6% (59/90) VS 40.4% (36/89), χ2=11.330, P<0.001]. However, the detection proportion of medium to high-grade faults such as damaged charge coupled device (CCD) components and broken insertion section in the observation group was lower than that in the control group [0.04% (10/28 112) VS 0.08% (23/29 116), χ2=4.680, P=0.030]. Moreover, the overall maintenance cost was lower in the observation group than that in the control group (313.7 thousand yuan VS 942.6 thousand yuan). It is indicated that the S-curve leakage testing method can detect low-level endoscopic faults early such as angular abnormalities, and reduce the occurrence of medium to high-level endoscopic faults, which contributes to cost reduction and efficiency increase.

Analysis on the development and influencing factors of frailty in elderly patients on maintenance hemodialysis / 中华老年医学杂志

Objective:To investigate the development and influencing factors of frailty in elderly patients on maintenance hemodialysis.Methods:A cross-sectional survey involved 146 elderly patients on maintenance hemodialysis at the blood purification department of the First Affiliated Hospital of Xi'an Jiaotong University.A self-designed demographic questionnaire was used to collect general information of patients, the Simple Physical Performance Scale(SPPB)was used to assess physical function, the 5-item SARC-F was used as a tool for rapid screening of sarcopenia, and the Hospital Anxiety and Depression Scale(HADS)was used for screening of anxiety and depression.The FRAIL scale was used for frailty assessment and participants were divided into a no frailty group, a pre-frailty group and a frailty group according to different frailty scores.Relevant influencing factors of frailty were analyzed.Results:Among 146 hemodialysis patients, 33(22.6%)were in the non-frailty group, 86(58.9%)in the pre-frailty group, and 27(18.5%)in the frailty group.Univariate analysis showed that there were statistically significant differences in sex( χ2=6.220, P=0.045), age( F=5.197, P=0.007), body type( χ2=31.927, P<0.001), SARC-F score( χ2=24.283, P<0.001)and SPPB score( χ2=26.773, P<0.001)between different groups.There were 3 patients(9.4%)at high risk for sarcopenia in the no frailty group, 13 patients(40.6%)at high risk for sarcopenia in the pre-frailty group, and 16 patients(50%)at high risk for sarcopenia in the frailty group, and differences in the occurrence of sarcopenia between the different subgroups of frailty were statistically significant( χ2=27.496, P<0.001). Multifactorial Logistic regression analysis showed that age, ( OR=1.04, 95% CI: 0.99-1.08, P=0.049), sex( OR=0.39, 95% CI: 0.17-0.87, P=0.021), body size( OR=0.07, 95% CI: 0.01-0.50, P=0.008), SARC-F( OR=0.14, 95% CI: 0.05-0.38, P<0.001)were independent influencing factors of frailty in elderly maintenance hemodialysis patients( P<0.05). Conclusions:The incidence of frailty is high in elderly patients on maintenance hemodialysis, and the development of frailty is affected by age, body mass index and sarcopenia.

Curative effects of Beck's cognitive therapy combined with transcranial magnetic stimulation on post-stroke sleep disorders in patients / 中国基层医药

Objective:To investigate the curative effects of Beck's cognitive therapy (BCT) combined with transcranial magnetic stimulation (TMS) on post-stroke sleep disorders in patients.Methods:A total of 120 patients with post-stroke sleep disorders who were diagnosed and treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January and December 2020 were included in this study. They were randomly assigned to undergo TMS (TMS group), BCT (BCT group), or TMS plus BCT (combined group) ( n = 40/group). Before and after treatment, sleep quality and mental state scores were evaluated in each group. Results:After treatment, the Pittsburgh Sleep Quality Index (PSQI) score in the combined group [(5.68 ± 0.33) points] was significantly lower than that in the TMS group [(9.11 ± 0.83) points] and BCT group [(11.37 ± 1.06) points, F = 512.63, P < 0.001]. Sleep efficiency in the combined group [(56.73 ± 2.62)%] was significantly higher than that in the TMS group [(39.55 ± 3.02)%] and BCT group [(35.23 ± 1.41)%, F = 863.59, P < 0.001]. The Self-Rating Anxiety Scale (SAS) scores and Self-Rating Depression Scale (SDS) scores were significantly lower in the combined group compared with the TMS and BCT groups ( F = 412.52, 310.60, both P < 0.001). Conclusion:BCT combined with TMS can effectively improve sleep quality and reduce negative emotions in patients with post-stroke sleep disorders.

Effects of low-frequency repetitive transcranial magnetic stimulation combined with music biofeedback on insomnia / 中国基层医药

Objective:To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with music biofeedback on insomnia.Methods:Sixty patients with insomnia who received treatment in Outpatient Department of Seventh People's Hospital of Dongyang from January to August 2021 were included in this study. They were randomly divided into an observation group ( n = 30) and a control group ( n = 30) using the random number table. The control group was given music biofeedback therapy and conventional drug treatment, and the observation group was treated with rTMS based on music biofeedback therapy. The changes in polysomnography sleep structure and Pittsburgh Sleep Quality Index score after 1 month of treatment relative to before treatment were determined in each group. Results:After 1 month of treatment, the total sleep time, sleep efficiency, rapid eye movement (REM) sleep, non-REM sleep phase II (N2%) and non-REM sleep phase III (N3%) in the observation group were (419.87 ± 42.63) minutes, (83.69 ± 13.39)%, (25.27 ± 3.26)%, (53.75 ± 11.36)% and (16.27 ± 2.25)%, respectively, and they were (388.74 ± 40.39) minutes, (76.38 ± 13.17)%, (23.16 ± 2.68)%, (51.62 ± 12.27)%, and (14.36 ± 2.21)%, respectively. There were significant differences in these indices between the two groups ( t = -2.90, -2.13, -2.22, -2.26, -3.31, P = 0.005, 0.037, 0.030, 0.027, 0.002). The sleep latency, actual wake time, numbet of awakenings, non-REM sleep phase I (N1%), and total score of Pittsburgh Sleep Quality Index in the observation group were (24.16 ± 7.82) minutes, (23.18 ± 6.95) minutes, (1.76 ± 0.28) times, (9.74 ± 2.12)%, (9.17 ± 1.56) minutes, respectively. They were (28.35 ± 7.74) minutes, (28.36 ± 7.21) minutes, (2.25 ± 0.79) times, (11.12 ± 1.17)%, and (10.26 ± 1.42) minutes, respectively in the control group. There were significant differences in these indices between the two groups ( t = 2.09, 2.83, 3.20, 3.12, 2.83, P = 0.041, 0.006, 0.002, 0.003, 0.038). Conclusion:rTMS combined with music biofeedback for the treatment of insomnia can effectively improve sleep quality in patients with insomnia.

Clinical efficacy of pemetrexed disodium in maintenance treatment of advanced lung adenocarcinoma / 中国基层医药

Objective:To investigate the clinical efficacy and adverse reactions of pemetrexed disodium in the maintenance treatment of advanced lung adenocarcinoma after chemotherapy with pemetrexed disodium and platinum.Methods:The clinical data of 35 patients with stage Ⅳ lung adenocarcinoma who received chemotherapy with pemetrexed disodium and platinum and were well treated in Beijing Huairou Hospital from January 2013 to August 2020 were retrospectively analyzed. Maintenance therapy with pemetrexed disodium was initiated after the completion of combination chemotherapy until disease progression. The clinical characteristics, therapeutic effects, adverse reactions, progression-free survival, and overall survival of the 35 patients were evaluated.Results:Among the 35 patients, no patients had complete remission, 11 patients had partial remission, 22 patients had stable disease, and 2 patients had progressive disease. The objective remission rate was 31.4%, disease control rate was 94.3%, median progression-free survival was 9.53 months, median overall survival was 18.21 months, 1-year survival rate was 68.6%, 2-year survival rate was 31.4%, and 3-year survival rate was 11.4%. Gender, age, smoking, and the baseline characteristics of patients undergoing first-line pemetrexed disodium or second-line pemetrexed disodium treatment had no effects on progression-free survival (all P > 0.05). Positive gene mutation and receiving four or more chemotherapy cycles had a protective effect on progression-free survival (both P < 0.05). Chemotherapy-related adverse reactions mainly included myelosuppression, nausea, elevated transaminase, and nephrotoxicity, all of which were mild and were relieved after symptomatic treatment. Conclusion:Pemetrexed disodium is effective and safe in the maintenance treatment of advanced lung adenocarcinoma. The results of this study are scientific.

Latent class growth model-based study of demoralization syndrome among maintenance hemodialysis patients in young and middle-aged adults / 中国实用护理杂志

Objective:To investigate distinct trahectories of demoralization of maintenance hemodialysis patients in young and middle-aged adults, and analyze the factors that affect the trajectory category, so as to provides reference for formulating individualized intervention strategies.Methods:This study was a cross-sectional survey. From April 2020 to April 2021, young and middle-aged maintenance hemodialysis patients fromShangyu People′s Hospital were collected by convenience sampling method and conducted 4-time follow-up investigation. The survey tools included general information questionnaire, Demoralization Scale Mandarin Version (DS-MV) and Experiences in Close Relationship Scale-Short Form (ECR-S). Latent class growth model was used to identify trajectory patterns of demoralization, Logistic regression was used to identify predictors of demoralization trajectories.Results:Totally, 105 patients were enrolled in the present study. Three distinct trajectories were identified and named as "table high level group" 24 cases, "slow reduction group" 39 cases and "continuous reduction group" 42 cases. Univariate analysis showed that age, occupational status, average income per person in family, number of comorbidities, attachment anxiety scores were related to the category of demoralization trajectories ( F = 15.92, χ2 values were 9.16-15.95, all P<0.05). Multivariate Logistic regression analysis showed that age, occupational status, average income per person in family, number of comorbidities, and attachment anxiety scores were important predictors of patterns of demoralization trajectories in young and middle-aged maintenance hemodialysis patients. Conclusions:This study identified three distinct demoralization trajectories in young and middle-aged maintenance hemodialysis patients, clinical nursing should formulate individualized intervention strategies according to the types of patients′ delirium trajectories.

Pharmacoeconomic evaluation of 2 kinds of inhalation schemes of budesonide for mild asthma / 中国药房

OBJECTIVE To evaluate the cost-utility of as-needed inhaled budesonide/formoterol versus budesonide maintenance therapy combined with as-needed inhaled terbutaline （hereinafter referred to as budesonide maintenance therapy） in patients with mild asthma from the perspective of the Chinese health service system. METHODS A Markov model of mild asthma was established based on an international multicenter randomized controlled clinical study （SYGMA 2 study）； the model cycle was one week， and the model had a whole horizon of 60 years. The cost only included direct medical cost， and utility value was derived from the data of EuroQol 5-Dimension 5-Level in the SYGMA 2 study and published literature. The total cost and total output of the above two inhalation therapies for patients with mild asthma were calculated， with discount rate of 5%. The stability of the model was evaluated by sensitivity analysis. RESULTS The total cost of as-needed inhaled budesonide/formoterol and budesonide maintenance therapy were 25 884 yuan and 45 822 yuan， respectively， and the effectiveness were 30.51 quality- adjusted life years （QALYs） and 30.50 QALYs， respectively. The former scheme was an absolute advantage. One-way sensitivity analyses showed that the price of drug （terbutaline and budesonide/formoterol） and average number of inhalations per day were the main influencing parameters， but they had little influence on the results of basic analysis. Probabilistic sensitivity analysis showed that the probability of as-needed budesonide/formoterol being cost-effective was 100%. CONCLUSIONS Compared with budesonide maintenance therapy， as-needed inhalation of budesonide/formoterol in mild asthma patients is more cost-effective.

Influencing factors of dropping-out from methadone maintenance treatment in Hangzhou City / 预防医学

Objective@#To analyze the factors affecting the dropping-out from methadone maintenance treatment (MMT) in Hangzhou City, so as to provide the evidence for improving the compliance to MMT.@*Methods@#One MMT clinic was sampled from each of the eight districts in Hangzhou City using a cluster random sampling method, and patients that received MMT and were at ages of 18 years and older and registered during the period from December 2020 through June 2021 were recruited. Participants' basic characteristics, illegality and crime within 6 months prior to MMT and family and social relationships were collected through questionnaire surveys, and factors affecting the dropping-out from MMT were identified using a multivariable logistic regression model. @*Results@#A total of 315 outpatients were included from MMT clinics. The participants had a mean age of (45.33±7.63) years, and included 245 men (77.78%) and 70 women (22.22%), with a dropping-out rate of 65.71%. Multivariable logistic regression analysis showed a low likelihood of dropping-out from MMT among patients at ages of 60 years and older (OR=0.080, 95%CI: 0.018-0.350), employees (OR=0.415, 95%CI: 0.236-0.727), patients without drug-related infectious diseases (OR=0.411, 95%CI: 0.231-0.731), patients with per dossing of 60 mL and higher (OR=0.431, 95%CI: 0.236-0.787) and patients without contact with drug-using friends (OR=0.328, 95%CI: 0.185-0.582), and a high possibility of dropping-out from MMT among patients with poor relationship with family members (OR=2.905, 95%CI: 1.127-7.488). @*Conclusion@#Age, working status, drug-related infectious diseases, dosing, relationship with family members and contact with drug-using friends affected the dropping-out from MTT in Hangzhou City.

Traditional Chinese Medicine Syndromes and Influencing Factors of Protein Energy Wasting in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis：a Cross-sectional Study / 中医杂志

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndrome types and influencing factors of protein-energy wasting （PEW） in chronic kidney disease （CKD） undergoing maintenance hemodialysis （MHD）. MethodsAccording to diagnostic criteria， 164 patients with MHD were divided into PEW group and non-PEW group. The clinical data of all patients were collected， including general information such as gender， age， height and weight， disease characteristics such as course， cormobidity， and haemodialysis duration， laboratory indicators such as blood routine， liver function， renal function， electrolyte， blood lipid， grip strength， and the four examinations. Logistic regression analysis was used to find the influencing factors of PEW by taking the clinical indicators with significant differences between the two groups （P＜0.05） as the independent variables， diagnosis of PEW as the dependent variable， and normal values as the reference. ResultsOut of 164 patients with MHD， there were 96 （58.5%） cases in PEW group and 68 cases （41.5%） in non-PEW group. Compared to the non-PEW group，PEW group had increased age， ratios of bedrest， deep vein preservation， edema， and low grip strength， percentages of comorbidities type 2 diabetes， cardiovascular and cerebrovascular diseases，infections and anemia， and levels of alanine aminotransferase and permine amin aminotransferase， as well as decreased body mass index， self-care ratio，internal arteriovenous fistula， red blood cell count， hemoglobin， serum total protein， serum albumin levels （P＜0.05）. The PEW group had significantly higher frequency of poor appetite and digestion， abdominal distension， fear of cold and preference of warmth， weak breathing and fatigue， poor appetite， oliguria， nausea and vomiting than non-PEW group （P＜0.05）. The incidence of both yin and yang deficiency syndrome and damp-turbidity syndrome were significantly higher in the PEW group than the non-PEW group， while that of liver-kidney yin deficiency syndrome and stirring of wind syndrome were lower （P＜0.05）. Logistic regression analysis showed that low BMI （＜22 kg/m2）， inability to take care of oneself， low grip strength，low serum albumin （＜38 g/L）， infection， older age， fear of cold and cold limbs，and poor appetite were the risk factors of PEW in patients undergoing MHD （P＜0.05）. ConclusionThe root syndrome of MHD-PEW patients is both yin and yang deficiency， concurrent with damp-turbidity syndrome. Low BMI， low serum albumin， infection and older age may be the influencing factors of PEW in patients undergoing MHD.

Advances of structure and mechanisms of bromodomain-containing protein 4 and its related research in tumors / 生物工程学报

The bromodomain and extraterminal domain (Bet) family are the regulators of the epigenome and also the pivotal driving factors for the expression of tumor related genes that tumor cells depend on for survival and proliferation. Bromodomain-containing protein 4 (Brd4) is a member of the Bet protein family. Generally, Brd4 identifies acetylated histones and binds to the promoter or enhancer region of target genes to initiate and maintain expression of tumor related genes. Brd4 is closely related to the regulation of multiple transcription factors and chromatin modification and is involved in DNA damage repair and maintenance of telomere function, thus maintaining the survival of tumor cells. This review summarizes the structure and function of Brd4 protein and the application of its inhibitors in tumor research.

Preservation and functional maintenance of lung allograft / 器官移植

As the final resolution for end-stage lung disease, lung transplantation can not only significantly prolong the survival, but also remarkably improve the quality of life of recipients. In recent decades, with the advancement of surgical techniques, immunosuppressants and post-transplantation management, the quantity of lung transplantation has been surged around the globe. However, the shortage of donor lung has severely restricted the development of lung transplantation. It is necessary to develop innovative approaches to expand the donor pool. The number of donors and effective preservation and functional maintenance of potential donor lungs play a key role in expanding the donor pool. The quality of donor lung is a critical precondition to ensure the long-term survival of lung transplant recipients. Preservation and functional maintenance of donor lung are of significance for guaranteeing the quality of lung allograft. In this article, research progresses on the management and maintenance of donor lung before procurement, the procurement of donor lung and the preservation and functional maintenance of lung allograft were reviewed, aiming to provide reference for the development of lung transplantation in clinical practice.