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Objective:To analyze the costs and effectiveness of five common screening modes and genetic screening for thalassemia in China in order to find the optimal way and provide evidence for the implementation of thalassemia prevention and control projects in Hunan Province.Methods:From June 2020 to April 2021, 12 971 couples from 14 cities and autonomous prefectures in Hunan Province were selected as the study population. The diagnosis of thalassemia was based on the results of genetic testing. Results of routine blood test and hemoglobin electrophoresis were collected and analyzed. The efficacy of five screening modes, at the cut-off value of <80 fl or 82 fl for the mean corpuscular volume (MCV), was analyzed by positive predictive value, negative predictive value, Jorden index and cost-effectiveness ratio. Sensitivity analysis was used to assess the feasibility of genetic screening at different costs after fixing the costs of routine blood and hemoglobin electrophoresis. The five thalassemia screening models are as follows: Mode 1: The woman had a blood routine test first. If the result was positive, the spouse required a blood routine test. If both results were positive, a thalassemia gene test should be offered to the couple. Mode 2: Both husband and wife were screened by blood routine and hemoglobin electrophoresis. If one or both of them were positive, both would be tested for thalassemia gene. Mode 3: The couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing. Mode 4: The woman was screened by blood routine and hemoglobin electrophoresis. If any one of them was positive, the woman would be tested for thalassemia gene. If the gene test result was positive, the spouse should receive thalassemia gene. Mode 5: Both spouses conducted a blood routine test. If either was positive, both would conduct hemoglobin electrophoresis test. If both were positive, both spouses should receive thalassemia gene testing. Gene testing mode: The woman would be tested for thalassemia, and her spouse would have thalassemia test too if her result was positive.Results:When using MCV<80 fl as the cut-off for diagnosing thalassemia, the Youden indices of the five prenatal screening modes in Hunan Province were 0.551, 0.639, 0.898, 0.555 and 0.356, while when using MCV<82 fl as the cut-off, the Youden indices were 0.549, 0.629, 0.851, 0.548 and 0.356. When the MCV cut-off value was <80 fl, the missed diagnosis rates of the five screening modes were 44.44%, 0.00, 0.00, 18.52% and 62.96%, and the cost-effectiveness ratios were 21 709, 250 939, 76 870, 138 463 and 92 860 yuan (RMB)/couple, respectively. When the price of genetic testing was lower than 55 yuan (RMB), the cost-effectiveness ratio of genetic screening was lower than that of Mode 3.Conclusions:MCV<80 fl can be considered as the positive criteria in blood routine screening for thalassemia in Hunan Province, and the cost-effectiveness ratio of Mode 3 (the couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing) is the best. Genetic screening has certain advantages with the decreasing price.
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ObjectiveTo systematically evaluate the efficacy and safety of Jiedu Tongluo therapy in the treatment of diabetic kidney disease （DKD）. MethodDatabases including CNKI， Wanfang Data， PubMed， and Web of Science were systematically searched from January 2003 to December 2022 for clinical randomized controlled trials （RCTs） on the application of Jiedu Tongluo therapy for DKD treatment over the past 20 years. In these trials， the control group received conventional treatment （including diabetes and kidney health education， glycemic and blood pressure control， and lifestyle interventions）， along with western medicine or Chinese patent medicine treatment. The experimental group received primarily Jiedu Tongluo therapy via oral administration of Chinese medicine or in combination with western medicine. The Cochrane risk of bias assessment tool was used for the quality evaluation of the trials， and R 4.1.0 statistical software was used for analysis. ResultForty-one RCTs with 3 478 participants were included. The Meta-analysis results demonstrated that the experimental group， compared with the control group， showed significant improvement in overall clinical efficacy ［odds ratio （OR）=2.46， 95% confidence interval （CI） （2.08， 2.92）， I2=0%］， effective reduction of serum creatinine （Scr） levels ［mean difference （MD）=-15.83， 95% CI （-21.5， -10.37）， P< 0.01］， 24-hour urinary protein excretion rate （24 h-Up） ［MD=-350.88， 95% CI （-419.49， -282.28）， P< 0.01］， TCM syndrome score ［MD=-6.08， 95% CI （-7.81， -4.36）， P<0.01］， and effective regulation of fasting blood glucose （FBG） ［MD=-0.57， 95% CI （-0.75， -0.38）， P<0.01］. The treatment also demonstrated certain safety ［OR=0.99， 95% CI （0.35， 2.76）］. ConclusionJiedu Tongluo therapy in DKD treatment exhibits favorable clinical efficacy and safety. However， due to limitations in the quality and quantity of the included literature， these conclusions should be further validated through larger-scale， high-quality RCTs.
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Objective:To investigate the clinical value of zoledronic acid in improving the prognosis of osteoporotic hip fracture and preventing its sequential contralateral hip fracture.Methods:A retrospective study of 206 patients diagnosed with hip fragile fractures in China Medical University Affiliated Shengjing Hospital and treated with anti-osteoporotic drugs after surgery was conducted. The prognosis of patients with hip fracture using survival rate analysis and the risk factors of acute febrile complications with multivariate analysis after zoledronic acid treatment were evaluated. Furthermore, chi-square test and multivariate analysis was used to explore whether zoledronic acid decreases the occurrence of the contralateral sequential fracture.Results:The 3-year survival rate of patients with overall hip fracture was higher in zoledronic acid treatment group compared with control group( P=0.026), with the incidence of fever at 53.3%. The age [ OR=0.786, P=0.027, the area under receiver operating characteristic (ROC) curve was 0.724] and cardiopulmonary complications ( OR=0.043, P=0.025, the area under ROC curve was 0.628) were significantly correlated with the occurrence of acute febrile response. The incidence of sequential contralateral fractures in zoledronic acid treatment group was significantly lower than that in control group ( χ2=4.356, P=0.037). The application of zoledronic acid ( OR=0.160, P=0.007, the area under ROC curve is 0.586) and the type of femoral neck fracture ( OR=0.196, P=0.001, the area under ROC curve is 0.607) were statistically associated with the occurrence of sequential fractures. Conclusion:Zoledronic acid treatment improves the outcome of patients with osteoporotic hip fracture and reduces the incidence of sequential hip fractures, especially femoral neck fracture. Senile age and cardiopulmonary complications might be associated with lower risk of acute febrile reactions after zoledronic acid treatment.
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As a noninvasive technique that enables analysis of the arterial wall structure in vivo,high-resolution vascular wall magnetic resonance imaging has been widely used in the diagnosis and assessment of ischemic stroke.This article reviews the application of high-resolution vascular wall magnetic resonance imaging in patients with intraeranial atherosclerotic stroke.
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Objective To study the effects of transcranial magnetic stimulation (TMS) on learning and memory, and angiogenesis and the dendritic structure of hippocampal CA3 pyramidal neurons after cerebral infarction. Methods Forty-eight male Sprague-Dawley rats were divided into a sham operated group, a model group and a TMS group (n = 16). Rat models of focal cerebral infarction were established with unilateral middle cerebral artery (MCA) suture occlusion in the model and TMS groups. The rats of the TMS group were given 4 weeks of TMS treatment beginning 1 day after the infarction (2 times per day, 30 pulses per time). Their learning and memory abilities were tested with a Y-maze. Angiogenesis and the dendritic structure of their hippocampal CA3 pyramidal neurons were detected after 4 weeks. Results Compared with the model group, learning and memory improved significantly in the TMS group. The average microvessel density of the hippocampus in the TMS group was significantly more than in the model group. The total length of apical dendrites of hippocampal CA3 pyramidal neurons in TMS group was significantly longer than in the model group. Conclusions The improved learning and memory observed following TMS treatment are likely to be related to changes in angiogenesis, the dendritic.structure of the hippocampal CA3 pyramidal neurons, and enhanced synaptic plasticity.
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Objective To evaluate the effects of magnesium sulphate on the efficacy of postoperative patient-controlled intravenous analgesia (PCIA) with morphine. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes aged 45-60 yr weighing 48-70 kg scheduled for elective upper abdominal surgery were randomly allocated into 2 groups ( n = 30 each) : morphine group (group M) and magnesium sulphate-morphine group (group MS) . If the VAS score=3, PCIA was started. Patients in group M received morphine in a 0.015 mg/kg bolus dose. Patients in group MS received morphine 0.015 mg/kg and magnesium sulphate 0.9 mg/kg. The consumption of analgesic drugs was recorded at 4, 8, 16, 24 and 48 h after 1st attempt. The gastrointestinal function recovery time was recorded. Venous blood samples were taken before anesthesia induction and at the end of operation and analgesia to determine the serum magnesium and calcium ion concentrations. Results Compared with group M, the consumption of analgesic drugs was significantly decreased, and the gastrointestinal function recovery time after operation was significantly shortened in group MS (P < 0.05). The serum magnesium ion concentration in both groups was significantly lower at the end of operation and analgesia than before anesthesia induction ( P < 0.05) . The serum magnesium ion concentration in group MS was significantly higher at the end of analgesia than at the end of operation ( P <0.05) .There was no significant difference in the serum calcium ion concentration between M and MS groups. Conclusion Magnesium sulphate can ameliorate the efficacy of postoperative PCIA with morphine.
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Newborn screening is known as a two-blade sword like science and technology.For on the one hand,newborn screening has brought human being incredible advantages,while on the other hand,it has also led to some ethics-related issues.Based on research on current situation of newborn screening in Yueyang city,this article analyzes major reasons for these ethics-related issues,further puts forward some feasible countermeasures and principles to solve the issues.