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OBJECTIVE To explore and analyze the adverse drug event （ADE） signals of darolutamide and provide a reference for its clinical safe use. METHODS ADEs related to darotamide were collected based on the US FDA adverse event reporting system （FAERS） database from the third quarter of 2019 to the third quarter of 2022. Data mining and analysis were conducted by the report odds ratio （ROR） and proportional reporting ratio （PRR） methods. RESULTS A total of 565 ADE reports related to darolutamide were extracted， 356 ADE reports about darolutamide as the primary suspected drug were included， 38 ADE signals with darolutamide as the primary suspected drug were excavated， involving 15 system organ class （SOC）， mainly concentrated in patients over 65 years old. The SOC of darotamide ADE signal mainly focused on various examinations， systemic diseases and various reactions at the administration site， benign/malignant tumors or those with unknown nature （including cystic and polypoid）， kidney and urinary system diseases. A total of 13 ADE signals not mentioned in the instructions included increased prostate-specific antigen， dysphagia， cognitive impairment， erectile dysfunction， rhabdomyolysis， gynecomastia and decreased platelet count， etc. CONCLUSIONS When using darolutamide， in addition to ADE in the drug instruction， we should pay close attention to potential ADE， such as increased prostate-specific antigen， rhabdomyolysis， gynecomastia and decreased platelet count， so as to avoid drug withdrawal or organ damage caused by ADE.
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Objective To evaluate the effect of pharmaceutical care provided by clinical pharmacists during the administration of Paxlovid for the treatment of COVID-19 in heart transplant patients.Methods During the treatment of COVID-19 with Paxlovid in 3 heart transplant patients,the clinical pharmacist provided pharmaceutical care in terms of the medicine indication,dosage,drug adjustment,drug interaction,adverse reaction etc,to develop individualised dosing regimens for patients.Results Clinical pharmacists are active in anticipating,identifying and resolving problems with Paxlovid in heart transplant patients,and monitoring the medication process to assist doctors in solving difficult problems.Conclusion Clinical pharmacists have explored the pharmaceutical monitoring methods for heart transplant patients during the use of Paxlovid to ensure the patients'safety and efficacy of patient medication and to improve the clinical cure rates.
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Objective@#To investigate the knowledge, attitudes and practice of AIDS control knowledge among students in a university in Hangzhou City, so as to provide the evidence for evaluating the effectiveness of AIDS control in universities.@*Methods@#The knowledge, attitudes and practice towards AIDS control were investigated among students in a university in Hangzhou City using self-designed questionnaires in 2020, and were descriptively analyzed.@*Results@#Totally 6 300 questionnaires were allocated, and 6 164 valid ones were recovered, with an effective recovery rate of 97.84%. The respondents included 2 837 male students ( 46.03% ) and 3 327 female students ( 53.97% ), and had a mean age of ( 18.20±0.76 ) years. The overall awareness of AIDS control knowledge was 73.49%. The awareness rates of “The rights of marriage, employment and school admission are protected among HIV-infected individuals by Chinese laws” ( 61.11% ) and “Homosexual contact in men is the current main transmission pattern among young students in China” ( 66.37% ) were relatively low. There were 768 university students with a history of sexual behaviors ( 12.46% ), and regular sex partners were the predominant sex partners at the first sexual contact ( 679 students, 90.78% ) and at the sexual behaviors during the past one year ( 402 students, 71.91% ). There were 515 students (67.14%) using condoms during the first sexual contact, and there were 300 ( 63.83% ) and 16 students ( 40.00% ) using condoms with regular and casual sex partners during the past one year, respectively. Among 20 men who had sex with men, only 5 students ( 25.00% ) used condoms at each sexual contact. Of students with sexual behaviors, there were 355 (46.22%) and 354 ( 46.09% ) students that considered to be infected with AIDS and other sex-transmitted diseases, and among the university students with sexual behaviors, there were 614 ( 79.95% ) students that were willing to receive HIV testing, and 409 ( 53.26% ) and 305 ( 39.71% ) students that were willing to receive HIV testing in hospitals and disease control and prevention institutions, respectively.@*Conclusions@# The awareness of AIDS control knowledge is low among students in the university in Hangzhou City, which does not reach the national goal of supervision and assessment for AIDS control in China. There are high-risk sexual behaviors and the rate of condom use is low.
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Background The contracted family doctor services are the embodiment of the implementation of the new medical reform policy, and the transformation of the grass-roots health service mode. Studies have proved that the occupational stress in medical staff was at a high level. The enhancement of professional identity will contribute to strengthen team building，alleviate job burnout, and reduce turnover intention of family doctors. Objective To investigate the current situation of occupational identity among family doctor teams in Chengdu, to examine potential influencing factors of occupational identity, and to provide a reference for promoting career development and team building of family doctor teams. Methods Multi-stage random cluster sampling was adopted to enroll study participants form 46 primary healthcare centers where family doctor contract services were implemented among 23 districts and counties in Chengdu between March 4 and 26, 2021. A total of 2 681 family doctors participated in this survey. A self-reported survey was conducted to collect participants' demographic and occupational data. The Effort-Reward Imbalance (ERI）questionnaire was implemented to assess occupational stress. The Professional Identity Scale was used to appraise occupational identity. Results A total of 2 327 valid questionnaires were collected, with a valid recovery rate of 86.80%, involving 1 715 females (73.7%) and 612 males (26.3%), with dominant age groups of 26−35 years (43.3%) and 36−45 years (30.4%), a high proportion of being married (82.8%), having college (36.0%) and undergraduate (47.3%) education, a high proportion of primary titles (66.0%) and informal work contract (66.1%). About 88.7% of family doctor team workers reported occupational stress. The average score of occupational identity was (3.68±0.62) points. There were significant differences in occupational identity scores among different professional title, work contract, working years in medical institutions, income, and effort/reward ratio (EER) groups (P < 0.05). ERR was negatively correlated with occupational identity (rs=−0.495, P<0.05）. The multiple regression model showed that occupational identity score in the non-staffed participants was lower than the score in the staffed ones (OR=0.429, 95%CI: 0.299−0.825). The occupational identity score in the participants having associate senior title or above was higher than in without professional title (OR=1.424, 95%CI: 1.194−2.328). The longer the working years, the higher the occupational identity score among the participants. The score of the more than 20 working years group was 1.820 times that of the less than 5 working years group (95%CI: 1.342−2.543). The higher the income, the higher the occupational identity score. The score of the 9001−12000 yuan per month group was 1.977 times that of the 1000−3000 yuan per month group (95%CI: 0.811−9.696) , and the score of the more than 12000 yuan per month group was 2.283 times that of the 1000−3000 yuan per month group (95%CI: 1.199−10.267）. Conclusion The family doctor team workers generally report occupational stress, and their occupational identity is at a medium level in Chengdu. Relevant managers should implement intervention measures against the main influencing factors to reduce their work tension and improve their occupational identity.
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Objective:To explore the different types and characteristics of rehabilitation exercise compliance of patients with first stroke at 2 weeks of onset, and analyze its influencing factors, so as to provide reference for the formulation of targeted health education.Methods:A cross-sectional investigation was conducted in Neurology Department of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June, 2021. 276 patients with first-episode stroke were investigated by the Questionnaire of Exercise Adherence at 2 weeks of the onset. The potential profile analysis was conducted to explore characteristics classification of the rehabilitation exercise compliance. And the chi-square test was used to compare demographic differences among different categories and ordered multi classification Logistic regression was used to explore the influencing factors of rehabilitation exercise compliance.Results:The patients were divided into 109 cases with high rehabilitation exercise compliance (39.5%), 114 cases with moderate rehabilitation exercise compliance (41.3%), and 53 cases with low rehabilitation exercise compliance (19.2%). There were statistically significant differences in education level, consciousness level at admission, complications and limb muscle strength among the three types of patients ( χ2 values were 6.17-31.50, all P<0.05). Ordered multi classification Logistic regression showed that the patient′s education level, the patient′s consciousness level at admission, whether there were complications and limb muscle strength would affect the rehabilitation exercise compliance of stroke patients ( P<0.05). Conclusions:There are three potential categories of rehabilitation exercise compliance in patients with first stroke. Patients with illiteracy, drowsiness, complications and poor limb muscle strength have poor rehabilitation exercise compliance.
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Studies have shown that plasma apolipoprotein B (ApoB) has a good predictive value for ischemic stroke and plays an important role in the prevention and treatment of ischemic stroke. More and more guidelines and consensus opinions began to recommend ApoB as a routine intervention target. This article reviews the biological characteristics, clinical detection advantages, and role and treatment prospect of ApoB in the prevention and treatment of ischemic stroke.
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Objective:To investigate the diagnostic value of high frequency ultrasound in benign and malignant thyroid partially cystic nodules.Methods:The preoperative ultrasound features of 159 thyroid cystic and solid nodules confirmed by surgery and pathology in Shenzhen Longgang Central Hospital from June 2017 to January 2021 were retrospectively analyzed. According to the ultrasonic manifestations, it can be divided into four types: type Ⅰ, band separation or flocculent echo in the interior; type Ⅱ, the small papillary middle echo process was seen on the wall; type Ⅲ, with band separation or flocculent echo and papillary medium echo process; type Ⅳ, the internal was mainly solid echo, and the inner part was irregular small piece echo and fissure echo free echo. The coincidence rate of ultrasonic diagnosis and pathological results of all types was observed.Results:Among 159 cystic and solid thyroid nodules, 22 were malignant and 137 were benign. The coincidence rate of ultrasonic diagnosis and pathological results of type Ⅰ, Ⅱ, Ⅲ and Ⅳ cystic solid thyroid nodules were 97%(61/63), 80%(45/56), 90%(9/10) and 67%(20/30), respectively. Type Ⅰ, type Ⅱ, type Ⅲ were mainly cystic components, with cystic components ≥ 50%; In type Ⅳ, solid component was the main component and cystic component was less than 50%.Conclusions:The internal zonal separation or flocculent echo was the characteristic ultrasonic manifestation of benign cystic solid nodules; It is easy to be misdiagnosed because of the lowest coincidence rate of ultrasound diagnosis for cystic and solid thyroid nodules with internal solid echo, irregular small piece like and fissure like anechoic. Careful observation of the characteristics can improve the accuracy of ultrasound diagnosis.
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Objective:To construct a random forest classification model of DNA double strand breaks (DSB) induced by ionizing radiation and investigate the genome-wide distribution of DSB.Methods:The GRCh38 reference genome was divided into 50 kilobase fragments. Then these genomic fragments were separated into low-level or high-level regions of ionizing radiation-induced DSB according to the sequencing data of MCF-7 cells. The data of eight epigenetic features were used as input. Two thirds of the data were randomly assigned to the training set, and the rest of the data was assigned to the test set. A random forest classification model with 100 decision trees was constructed. The importance of epigenetic features in the classification model was analyzed and displayed.Results:The accuracy score of the random forest classification model on the test set was 99.4%, the precision score was 98.9% and the recall score was 99.9%. The area under the receiver operating characteristic curve was 0.994. Among the eight epigenetic features, H3K36me3 and DNase markers were the most important variables. The enrichments of the two markers in DSB high-level regions were much higher than those in DSB low-level regions.Conclusions:The random forest classification model could precisely predict the genome-wide levels of DSB induced by ionizing radiation in the 50 kilobase window based on epigenetic features. Analysis revealed that these DSB might primarily distribute in the actively transcribed sites in the genome.
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The diagnosis and treatment of a case of primary renal synovial sarcoma was reported. The patient was diagnosed as malignant tumor of left kidney before operation and underwent laparoscopic radical nephrectomy. Renal synovial sarcoma was confirmed by pathological examination and gene test. After 6 courses of doxorubicin chemotherapy plus heavy ion radiotherapy for 15 days, no tumor metastasis or recurrence was found during the 14 months of follow-up. The diagnosis of this disease depends on molecular genetics. Surgery and chemotherapy are commonly used at present. Most patients have a poor prognosis.
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Objective:To investigate the correlation between venous collateral circulation and clinical data such as symptoms, parenchymal injury, and prognosis in patients with cerebral venous thrombosis(CVT).Methods:The clinical and imaging data of patients with CVT diagnosed in the department of Neurosurgery of the Third Affiliated Hospital of Southern Medical University from December 2011 to August 2018 were retrospectively analyzed. A total of 32 patients with CVT were included, 19 males and 13 females, aged from 20 to 60 (39±12) years. All patients underwent cerebral angiography, individualized delayed rotational phlebography. According to the number and diameter of collateral circulation and the phenomenon of flow delay of contrast medium, the collateral venous circulation scale (CVCS) was developed and divided into 3 levels. The clinical data (risk factors, course of disease, clinical symptoms), imaging data (parenchymal injury, thrombus site), treatment (endovascular treatment, decompressive craniectomy) and prognosis of all patients were recorded. The differences in clinical data, imaging appearances, parenchymal injury, and prognosis between patients with different CVCS were compared, and the correlation between variables with statistically significant differences and CVCS was compared using the Gamma method or Spearman correlation analysis.Results:Among the 32 patients with CVT, 9 were CVCS 0, 13 were CVCS 1 and 10 were CVCS 2. Among them, there were 19 cases of neurological deficit and 17 cases of brain parenchymal injury. There were significant differences in course of disease, neurological deficit, focal dyskinesia, language dysfunction, consciousness disorder, isolated headache, deep vein thrombosis, cortical vein thrombosis and prognosis across different CVCS ( P<0.05). Correlation analysis showed that CVCS was positively correlated with course of disease and isolated headache ( r=0.724, 0.637, P<0.001), and negatively correlated with neurological deficit symptoms, focal dyskinesia, disturbance of consciousness, brain parenchymal injury and deep vein thrombosis ( r=-0.797, -0.451, -0.782, -0.697, -0.427, P<0.05). The results of 90 days follow-up showed that there were 18 cases with mRS 0, 6 cases with mRS 1, 2 cases with mRS 2-4, and 1 case with mRS 5-6 points. There was a negative correlation between CVCs grading and mRS score at 90 days ( r=-0.732, P<0.001). Conclusion:Lower cerebral venous collateral circulation grade is associated with higher incidence of brain parenchymal injury, neurological deficit symptoms, and worse clinical prognosis.
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This paper reports two cases of mixed epithelial and stromal tumor of the kidney in elderly women.Both cases underwent radical nephrectomy and were confirmed by pathology.The patients were followed up for 10 months and 18 months respectively,without recurrence or metastasis.The purpose of this study was to further understand the disease by describing its clinical data and imaging manifestations.
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Objective:To analyze the laboratory tests in newly hospitalized patients with COVID-19 and their predictive values for the severity of the disease.Methods:83 patients, including 54 males and 29 females, with median interquartile range of 63(53-70)years diagnosed with covid-19 who were managed by Fujian medical team from January 27, 2020 to February 20, 2020 in Wuhan JinYinTan Hospital were studied retrospectively. According to the severity of the disease, they were divided into common, severe and critical groups. White blood cell (WBC), lymphocyte (LYM), loctate dehydrogenase (LDH), interleukin-6 (IL-6), procalcitonin (PCT), serum ferritin (SF), erythrocyte sedimentation rate (ESR), hypersensitive C-reactive protein (hs-CRP) and D-Dimer (D-D) on admission were analyzed retrospectively. And the predictive value of each indicator for critical group was analyzed by Logistic regression.Results:On admission, in common, severe and critical groups, WBC (×10 9/L) values were 7.10±3.88, 7.73±3.77 and 9.07±5.61, respectively ( F = 1.315, P=0.274); IL-6 (μg/L) values were 11.76(9.42-15.18), 11.93(10.15-15.63) and 11.24(8.06-13.75), respectively( Z=0.591, P=0.744);D-D (mg/L) values were 0.70(0.48-1.12), 1.67(1.07-7.14) and 1.96(0.71-8.18), respectively( Z=3.363, P=0.186).There were no significant differences among three groups. On admission, in common, severe and critical groups, LYM(×10 9/L) values were 1.10±0.33, 0.80±0.35 and 0.66±0.32, respectively( F=11.415, P<0.001); SF(μg/L) values were 470.83±283.43, 835.66±819.43, and 1341.15±949.54, respectively ( F=7.98, P=0.001); ESR(mm/h) values were 30.76±15.70, 42.55±22.51 and 51.04±25.09, respectively( F=5.181, P=0.008); LDH(U/L) values were 314.71±105.46, 325.69±109.85 and 444.03±181.07, respectively( F=7.17, P=0.001); hs-CRP(μg/L)values were 16(7.20-19.90), 31.00(20.00-87.60) and 80.50(33.70-113.00), respectively( Z=12.185, P=0.002);PCT(μg/L) values were 0.025(0.02-0.05), 0.05(0.02-0.13) and 0.09(0.05-0.39), respectively( Z=9.694, P=0.008). There were significant differences among three groups. Pairwise comparison showed that the LYM value in common group was higher than those in severe and critical groups, and the hs-CRP values in severe and critical groups were higher than that in common group,while SF, ESR, LDH and PCT values in critical group were all higher than those in severe and common groups( P<0.05). Conclusions:On admission, WBC, LYM, ESR and LDH are helpful to predict the severity of COVID-19. Although the level of IL-6 is increased, it may not be meaningful to judge the severity of COVID-19.
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This paper reports two cases of mixed epithelial and stromal tumor of the kidney in elderly women. Both cases underwent radical nephrectomy and were confirmed by pathology. The patients were followed up for 10 months and 18 months respectively, without recurrence or metastasis. The purpose of this study was to further understand the disease by describing its clinical data and imaging manifestations.
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Objective@#By implementing the best practice of bedtime and position after diagnostic adult lumbar puncture,we hope to establish a scientific and standardized nursing routine for lumbar puncture, shorten the bed-rest time after lumbar puncture, and improve the comfort of patients.@*Methods@#By reviewing literatures related to positions after adult lumbar puncture and post-dural puncture headache, six best practice were concluded. By combining the best evidence and the clinical circumstances, the evidenced-based criteria were established and then applied in the Neurology Department.@*Results@#After two rounds of reviews, the results showed that except the 93.3% compliance with the new evidence, all other four criteria had 100% complacence. Comparing before and after applying the evidence, there was no statistically significant difference for the occurrence of post-dural puncture headache or dizziness(P>0.05), there was a statistically significant reduction of back pain from 28.3%(30/106) to 15.1%(18/119)(χ2 value was 5.799, P<0.05) when the evidence was applied.@*Conclusions@#The best practice shows that patients needn′t lie on bed for 4 to 6 hours after lumbar puncture, the occurrence of back pain is lowered and the comfort level of the patient is improved in those who rest with pillow or activities.
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Objective:By implementing the best practice of bedtime and position after diagnostic adult lumbar puncture,we hope to establish a scientific and standardized nursing routine for lumbar puncture, shorten the bed-rest time after lumbar puncture, and improve the comfort of patients.Methods:By reviewing literatures related to positions after adult lumbar puncture and post-dural puncture headache, six best practice were concluded. By combining the best evidence and the clinical circumstances, the evidenced-based criteria were established and then applied in the Neurology Department.Results:After two rounds of reviews, the results showed that except the 93.3% compliance with the new evidence, all other four criteria had 100% complacence. Comparing before and after applying the evidence, there was no statistically significant difference for the occurrence of post-dural puncture headache or dizziness( P>0.05), there was a statistically significant reduction of back pain from 28.3%(30/106) to 15.1%(18/119)( χ2 value was 5.799, P<0.05) when the evidence was applied. Conclusions:The best practice shows that patients needn′t lie on bed for 4 to 6 hours after lumbar puncture, the occurrence of back pain is lowered and the comfort level of the patient is improved in those who rest with pillow or activities.
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Objective:To study the effect of sedative combined with cis-atracurium in rapid induction intubation in emergency department.Methods:From October 15, 2017 to April 15, 2019, 52 critically ill patients who needed tracheal intubation in emergency department of the People's Hospital of Changzhi were selected.And the patients were numbered according to the time sequence of enrollment, and then randomly divided into group A and group B according to the random number table, with 26 cases in each group.Group A was given sedatives combined with cis-atracurium to induce rapid intubation.Group B only received sedatives to induce intubation.The success rate of intubation, successful intubation time were compared between the two groups.Before and after endotracheal intubation, the heart rate, mean arterial blood pressure, pulse oxygen concentration and the change of catecholamine concentration were compared.Results:The success rate of intubation in group A was 100.0%, which in group B was 76.9%, the difference between the two groups was statistically significant (χ 2=12.15, P<0.05). The time required for successful intubation in group A was (5.2±0.8)s, which in group B was (8.5±2.5)s, the difference was statistically significant (χ 2=6.41, P<0.05). After intubation, the pulse oxygen concentration in group A was significantly increased compared with before intubation ( t=-7.99, P<0.05). After intubation, the heart rate, mean arterial pressure, and serum norepinephrine, dopamine levels in group A were reduced compared with before intubation, but there were no statistically significant differences (all P>0.05). The serum adrenaline level was higher compared with before intubation, but there was no statistically significant difference ( t=-1.03, P>0.05). In group B, the pulse oxygen concentration was significantly increased after intubation compared with before intubation ( t=5.74, P<0.05), but the heart rate, mean arterial pressure, and the change of blood catecholamine concentration levels in group B had no statistically significant differences ( P>0.05). Conclusion:In the airway management of critically ill patients in emergency department, the application of sedatives combined with cis-atracurium to rapidly induce intubation can improve the hypoxia symptoms of patients more rapidly and can keep patients' hemodynamics, catecholamine concentration is relatively stable, it has the characteristics of safety and efficiency.
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Objective:To observe the changes of blood cell count, and levels of hormone, glucose, and electrolytes at adrenocorticotrophic hormone (ACTH) and thyrotropic hormone (TSH) axes in patients with traumatic brain injury (TBI) at early stage, and explore the correlations among these indicators.Methods:Prospective selection of 93 patients with TBI (TBI group), admitted to our hospital from March 2018 to July 2019, and 18 health subjects accepted physical examination (control group) during the same period was performed. TBI patients were divided into mild, moderate, and severe subgroups according to Glasgow coma scale (GCS) scores at admission. The changes of blood cell count, and levels of hormone, glucose, and electrolytes of these TBI patients and the control subjects were detected on the 2 nd, 8 th, and 15 th d of TBI. Results:(1) The cortisol (COR) level in TBI group was significantly higher than that in control group on the 2 nd and 8 th d of TBI (P<0.05); COR level in TBI group was decreased on the 2 nd, 8 th, and 15 th d of TBI, successively. TSH level in the TBI group was significantly lower than that in control group on the 2 nd d of TBI; TSH level in patients from the TBI group on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI (P<0.05). Triiodothyronine (T3) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T3 level in TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; T3 level in the TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Tetraiodothyronine (T4) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T4 level in the control group was significantly higher than that in the mild and severe TBI subgroups on the 8 th d of TBI(P<0.05); patients in the severe TBI subgroup had increased T4 level successively on the 2 nd, 8 th, and 15 th d of TBI. Free triiodinated thyroxine (FT3) level in the control group, and mild, moderate and severe TBI subgroups decreased successively on the 2 nd d of TBI; and FT3 level in the TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; FT3 level in TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Free tetraiodothyronine (FT4) level in the control group and moderate TBI subgroup was significantly higher than that in the mild and severe TBI subgroups on the 2 nd and 8 th d of TBI (P<0.05). (2) The white blood cell (WBC) count of the TBI group was significantly higher than that of the control group on the 2 nd d of TBI (P<0.05); the WBC count in the moderate TBI subgroup, severe TBI subgroup, mild TBI subgroup and control group decreased, successively, on the 8 th d of TBI; the WBC count in the severe TBI subgroup, mild TBI subgroup, moderate TBI subgroup and control group decreased, successively, on the 15 th d of TBI; the WBC count in the patients of mild TBI subgroup on the 8 th and 15 th d of TBI was significantly lower than that on the 2 nd d of TBI, and that in patients of moderate and severe TBI subgroups on the 15 th d of TBI was significantly lower than that on the 2 nd and 8 th d of TBI (P<0.05). The red blood cell (RBC) count in the mild, moderate, and severe TBI subgroups, and control group were increased, successively, on the 2 nd, 8 th, and 15 th d of TBI. The platelet (PLT) count in the TBI group was significantly lower than that in the control group on the 2 nd d of TBI, and the PLT count in the mild and moderate TBI subgroups, and control group was significantly lower than that in the severe TBI subgroup on the 15 th d of TBI (P<0.05); the PLT count in the TBI group increased successively on the 2 nd, 8 th, and 15 th d of TBI. The blood glucose level in the control group, and mild, moderate and severe TBI subgroups increased, successively, on the 2 nd d of TBI, and the blood glucose in the severe TBI subgroup was statistically higher than that in the control group on the 8 th d of TBI; the blood glucose level in the TBI subgroup decreased, successively, on the 2 nd, 8 th, and 15 th d of TBI. Potassium level in the mild, moderate and severe TBI subgroups was significantly higher than that in the control group on the 15 th d of TBI; significantly higher potassium level on the 8 th and 15 th d of TBI was noted than that on the 2 nd d of TBI in patients from the moderate and severe TBI subgroups (P<0.05). The sodium content in the severe TBI subgroup was significantly higher than that in the mild and moderate TBI subgroups and control group on the 2 nd d of TBI; the sodium content in the severe TBI subgroup was statistically lower than that in the control group on the 15 th d of TBI (P<0.05). In patients from the severe TBI group, the sodium and chlorine contents on the 8 th and 15 th d of TBI were significantly lower than those on the 2 nd d of TBI. The blood calcium content in the moderate TBI subgroup and control group was significantly higher than that in the mild and severe TBI subgroups on the 2 nd d of TBI, and the calcium content in the severe TBI subgroup was significantly lower than that in the control group on the 15 th d of TBI; calcium content in the mild and severe TBI subgroups on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI ( P<0.05). (3) In TBI patients, WBC count and blood glucose level were positively correlated with COR, and negatively correlated with TSH, T3 and FT3 levels ( P<0.05). RBC count was negatively correlated with TSH level, and positively correlated with FT4 level ( P<0.05). PLT count was negatively correlated with COR and positively correlated with ACTH, TSH, T3, T4 and FT3 levels ( P<0.05). Potassium was positively correlated with TSH, T3, T4, FT3 levels, and negatively correlated with COR ( P<0.05). Sodium was negatively correlated with TSH, T4, FT3 and FT4 levels, and positively correlated with COR ( P<0.05). Chlorine was negatively correlated with COR, TSH, T4, FT3 and FT4 levels ( P<0.05). Calcium was positively correlated with T3, T4, FT3 and FT4 levels ( P<0.05). Conclusions:The more severe the injury of TBI patients, the more significant the decline of T3, FT3, and FT4 levels and RBC count, and the more significant the increase of WBC count and glucose level. Most of them gradually returns to normal within one-2 weeks of injury. It is recommended to evaluate ACTH axis and TSH axis functions when blood cell count, glucose, and electrolytes are abnormal after TBI.
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[This corrects the article DOI: 10.1016/j.apsb.2019.01.013.].
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OBJECTIVE： To compare the cost-effectiveness of long-effect and short-effect granulocyte stimulating factor in prevention and treatment of bone marrow suppression induced by chemotherapy for lung malignancies， and to provide reference for rational drug use in the clinic. METHODS： A retrospective analysis was conducted for 132 cases who used granulocyte stimulating factor to prevent and treat bone marrow suppression induced by chemotherapy for lung malignancies in the Affiliated Tumor Hospital of Zhengzhou University during Jan. 2017 to Jun. 2018. Among them， 60 cases were treated with Recombinant human granulocyte stimulating factor injection （short-effect， group A）， and 72 cases were treated with Polyethylene glycol recombinant human granulocyte stimulating factor injection （long-effect， group B）. Clinical efficacies， the occurrence of bone marrow suppression and ADR were compared between 2 groups. Cost was calculated， and cost-effectiveness analysis was conducted. Sensitivity analysis was conducted by down-regulating 20％ drug price. RESULTS： The total response rates of group A and B were 71.7％ and 75.0％， without statistical significance （P＞0.05）. There was no statistical significance in the incidence and duration of bone marrow suppression or the incidence of ADR （P＞0.05）. Average treatment costs of the two groups were （335.91±180.34） and （1 982.75±603.15） yuan； the cost of group A was significantly lower than that of group B （P＜0.05）. The cost-effectiveness ratio of them were 4.69 and 26.44， while group A as a reference， incremental cost-effectiveness ratio of group B was 494.55. The sensitivity analysis results were in agreement with the cost-effectiveness analysis. CONCLUSIONS： The effectiveness of Recombinant human granulocyte stimulating factor injection is similar to that of Polyethylene glycol recombinant human granulocyte stimulating factor injection for the prevention and treatment of bone marrow suppression induced by chemotherapy for lung malignancies. But the cost-effectiveness ratio of the former is lower than that of the latter.
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Objective To investigate the genetic characteristics and prognostic influencing factors of the middleˉhighˉrisk patients with multiple myeloma (MM) based on Mayo Stratification of Myeloma and RiskˉAdapted Therapy (mSMART) consensus guidelines. Methods A total of 179 hospitalized MM patients in Fujian Provincial Hospital from June 2009 to October 2017 were collected. Eventually, 49 patients were included except for the patients who were unable to perform mSMART stratification. According to the mSMART stratification criteria, the patients were divided into lowˉrisk group (24 cases) and middleˉhighˉrisk group (25 cases). The genetic characteristics of the two groups were analyzed to explore the relationship between mSMART stratification and clinical features. KaplanˉMeier method and logˉrank test were used to make survival analysis; logistic regression analysis was used to analyze the prognostic influencing factors in highˉrisk patients. Results The incidence of CSK1B gene amplification was the highest in the lowˉrisk group (41.7%, 10/24), while in the middleˉhighˉrisk group, the incidence of RB1 gene deletion was the highest (88.0%, 22/25). In the lowˉrisk group and the middleˉhighˉrisk group, there were no statistical differences in bone destruction, hypercalcemia, renal damage, anemia, β2 microglobulin abnormality, albumin abnormality, lactate dehydrogenase abnormality, and plasma cell ratio abnormality (all P> 0.05). Survival analysis showed that the median survival time of the middleˉhighˉrisk group was lower than that of the lowˉrisk group (23.19 months vs. 39.71 months, P＝ 0.043). Multivariate logistic regression analysis found that anemia and bone destruction were risk prognostic influencing factors for mSMART stratification as a middleˉhighˉrisk group (P＝ 0.044, P＝ 0.002). Conclusion mSMART stratification could indicate the poor prognosis for the patients with middleˉhighˉrisk, and the anemia and bone destruction are risk prognostic influencing factors for patients with middleˉhighˉrisk stratification.