Research on the regulation of electronic prescription circulation under the mode of “medical science + pharmacy” / 中国药房

OBJECTIVE To provide reference for the regulation of electronic prescription circulation under the mode of “medical science + pharmacy”. METHODS Based on evolutionary game theory， a tripartite evolutionary game model was constructed for related parties of electronic prescription circulation （government agencies， internet hospitals and third-party drug platforms） under the mode of “medical science + pharmacy”. The influential factors of the three parties’ strategy selection were analyzed and verified by simulation. RESULTS & CONCLUSIONS The strategic choices of all parties in the game were affected by the other two parties. Reducing the cost of strict supervision or increasing the punishment for the other two parties would increase the probability of strict supervision of government agencies. Enhancing reputation losses， increasing penalties， and reducing the cost difference when choosing different strategies would have regulatory and binding effects on internet hospitals and third-party drug platforms. It is suggested that government agencies can introduce diversified supervision mode and establish an integrated “intelligent supervision + traceability” system； pay attention to the construction of reputation mechanism， and promote the coordinated linkage of all parties； increase the punishment for violations， provide policy support， reduce the cost of compliance behavior to promote the high-quality development of electronic prescription circulation under the mode of “medical science + pharmacy”.

Changes in the disease burden of liver cancer caused by nonalcoholic steatohepatitis in China 1990-2019 / 公共卫生与预防医学

Objective To describe and analyze the disease burden and its changing trend of liver cancer caused by nonalcoholic steatohepatitis (NASH) in China from 1990 to 2019, and to provide reference for reducing the morbidity and mortality of liver cancer in China. Methods Based on data from the Global Burden of Disease (GBD2019) study, different gender and age groups were selected. The morbidity, mortality, and disability adjusted life year (DALY) rate were used to analyze the disease burden of liver cancer caused by NASH in China from 1990 to 2019. The time trend was analyzed by using the Joinpoint regression model, and the annual percent of change (APC) and annual average percentage change (AAPC) of morbidity, mortality and DALY rate were calculated. Results Compared with 1990, the incidence rate, mortality rate and DALY rate of liver cancer caused by NASH in 2019 decreased by 4.05%, 12% and 25.79%, respectively. Age-standardized morbidity, standardized mortality and standardized DALY rates decreased by 49.50%, 54.72% and 58.45%, respectively. In 2019, the incidence rate, mortality data and DALY rate of liver cancer caused by NASH increased with age, and the highest mortality rate was among people over 85 years old. The average annual change percentage (AAPC) of age-standardized incidence rate, standardized mortality rate and standardized DALY rate of liver cancer caused by NASH from 1990 to 2019 were -2.65% ［95% CI（-3.09%，-2.21 %），P<0.001］, -2.86%［95% CI（-3.34%，-2.38 %），P<0.001］, and -2.91%［95% CI（-3.23%，-2.58%），P<0.001］，respectively. The AAPC of all indexes in males was higher than that in females. Conclusion From 1990 to 2019, the disease burden of liver cancer caused by NASH in China showed an overall downward trend. The AAPC of all indexes in males is higher than that in females, and the elderly population is a high-risk group.

Potential role of fractional flow reserve-guided coronary artery bypass graft surgery / 中华胸心血管外科杂志

Objective:To investigate the potential guiding role of fractional flow reserve(FFR) in surgical revascularization by comparing the relationship between coronary fractional flow reserve(FFR) and blood flow pattern status of bypass graft.Methods:A total of 86 patients with coronary artery disease between March 2016 to October 2019 were included in the study, with 59 males and 27 females; the age ranged from 42 to 77 years old, with an average of(58±12) years old. According to the measured FFR value of the left anterior descending artery, they were divided into severe ischemic group(FFR<0.75), boundary group(0.75≤FFR<0.80) and mild ischemic group(FFR≥0.80). Transit time flow meter(TTFM) was used to evaluate the blood flow status of the bridge vessel from the left internal thoracic artery to the left anterior descending coronary artery.Results:Mean graft flow(MGF) was measured at(21.24±5.71)ml/min, (18.25±7.72)ml/min, (16.47±7.83)ml/min in severe ischemic group, boundary group and mild ischemic group. The results of mean pulsatility index(PI) was 2.58±0.96, 3.14±1.19 and 3.53±1.34, the ratio of diastolic flow during the entire graft flow was 0.63±0.10, 0.55±0.11 and 0.53±0.11, patients appeared systolic reverse flow was 2 cases(3.6%), 3 cases(18.8%) and 3 cases (20.0%), respectively. There were statistically significant differences in MGF( P=0.027)、PI( P=0.007)、the ratio of DF( P=0.001) and the quantity of patients appeared systolic reverse flow( P=0.027) between the three groups. Conclusion:Due to increasing severity of coronary artery stenosis, MGF and the ratio of diastolic flow increased, and there appears to be an decreased PI and quantity of patients appeared systolic reverse flow. The chance of bypass graft occlusion may increase for the near and middle term in mild to moderate functional coronary artery stenosis(FFR≥0.75). For patients with severe functional coronary artery stenosis(FFR<0.75), it can obtain satisfactory flow parameters and ideal clinical outcomes.

Clinical characteristics and prognosis analysis of 37 patients with severe influenza / 中华危重病急救医学

Objective:To explore the clinical characteristics and prognostic risk factors of severe influenza.Methods:Clinical data of severe influenza patients admitted to the department of respiratory and critical care medicine of the Second Affiliated Hospital of Anhui Medical University from March 2014 to June 2019 were retrospectively analyzed. General information, laboratory test results, and etiological test results of the hospitalization outcomes for survival group and death group during the 28-day follow-up were analyzed using Logistic regression analysis.Results:Among the 37 patients, 29 were males and 8 were females. They aged 25-86 years old with an average of (59.59±15.16) years old. Twenty-one cases had chronic underlying diseases; 28 cases had co-infections, including 6 cases with bacterial infections, 7 cases with fungal infections, 3 case with other pathogens, and 12 cases with mixed infection. Among the 37 patients, 9 died during hospitalization and 5 died within 28-day of discharge. The overall mortality rate was 37.84%. Compared with the survival group, patients in the death group were older (years old: 66.57±3.94 vs. 55.35±14.53), British Thoracic Society's modified pneumonia score (CURB-65 score), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, neutrophil count, D-dimer, 48-hour C-reactive protein (CRP) and procalcitonin (PCT) were higher [CURB-65 score: 2 (2, 3) vs. 1 (0, 2), APACHEⅡ: 16.00±4.62 vs. 11.00±4.22, neutrophil count (×10 9/L): 8.87 (5.42, 11.33) vs. 3.58 (2.55, 7.13), D-dimer (mg/L): 7.97 (5.19, 12.68) vs. 2.91 (1.19, 5.02), 48-hour CRP (mg/L): 127.83±92.24 vs. 87.01±57.00, 48-hour PCT (μg/L): 1.79 (0.59, 4.44) vs. 0.37 (0.13, 0.99)], oxygenation index (PaO 2/FiO 2) and creatinine clearance rate were lower [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 109.52±49.30 vs. 204.82±67.61, creatinine clearance rate (mL·min -1·1.73 m -2): 55.49±21.23 vs. 77.59±29.73], and the differences were statistically significant (all P < 0.05). There was no significant difference in gender, combined chronic underlying diseases, lymphocyte count, albumin, lactate dehydrogenase (LDH), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), 24-hour CRP and PCT between the two groups. A total of 37 pathogens were cultured, including 17 Gram-negative bacteria (45.95%), 3 Gram-positive bacteria (8.10%), and 17 fungi (45.95%). The number of Acinetobacter baumannii infections in the death group was significantly higher than that in the survival group (cases: 7 vs. 2, P < 0.05). Logistic regression analysis showed that age, CURB-65 score, APACHEⅡ score, PaO 2/FiO 2, neutrophil count, creatinine clearance rate, combined Acinetobacter baumannii infection, deep vein catheterization, catheterization, and stomach preservation during hospitalization were risk factors for the prognosis of patients with severe influenza [hazard ratios ( HR) were 1.064, 4.920, 1.286, 0.975, 1.286, 0.965, 0.095, 0.083, 9.333, 0.089, respectively, all P < 0.05]. Multivariate analysis showed that low PaO 2/FiO 2 and Acinetobacter baumannii infection were risk factors for prognosis of severe influenza ( HR were 0.834 and 0.000, respectively, both P < 0.05). Conclusion:Old age, high CURB-65 score, high APACHEⅡ score, and co-infection are risk factors for the prognosis of patients with severe influenza.

Clinical analysis of 23 patients with coronavirus disease 2019 in Xinyang City of Henan Province / 中华危重病急救医学

Objective:To analyze the epidemiological characteristics and clinical features of the patients with coronavirus disease 2019 (COVID-19), so as to provide basis for clinical diagnosis.Methods:The epidemiology, clinical symptoms, laboratory and radiologic data of 23 patients with COVID-19 admitted to the Fifth People's Hospital of Xinyang City from January 22nd to January 29th, 2020 were retrospectively analyzed.Results:There was 23 patients with COVID-19, with 15 men and 8 women, and the median age was 46.0 (40.5, 52.0) years old (ranged from 27 years old to 80 years old). Nine patients had basic disease (39.1%), including hypertension (17.4%), cardiovascular diseases (17.4%), diabetes (8.7%), hypothyroidism (4.3%) and past history of tuberculosis (4.3%). All the 23 patients had contact history in Wuhan area or with confirmed cases. Clinical symptoms included fever (100%), cough (69.6%), expectoration (43.5%), myalgia (26.1%), headache (17.4%) and dyspnea (17.4%), and the less common symptom was diarrhea (4.3%). Blood routine tests showed leukocytopenia in 11 patients (47.8%), normal leukocyte counts in 10 patients (43.5%), and leukocytosis in 2 patients (8.7%); lymphopenia was found in 13 patients (56.5%). All 23 patients had different degrees of infective lesions in chest CT, with 7 patients (30.4%) on one side and 16 patients (69.6%) on both sides. There were 19 mild patients, 4 severe patients, and no critical or death case. Complications included acute respiratory distress syndrome (17.4%). No patient was reported with liver, kidney or heart dysfunction or secondary infection.Conclusions:Epidemic history of contact, fever, pneumonia signs of chest CT, normal or decreased count of leukocyte and lymphopenia are the clinical basis for diagnosis of COVID-19. However, at present, the treatment of patients has not been completed, and the effective treatment strategy and final prognosis are unclear.

Clinical analysis of 23 cases of 2019 novel coronavirus infection in Xinyang City, Henan Province / 中华危重病急救医学

Objective:To analyze the epidemiological characteristics and clinical features of the patients with 2019-nCoV infection, so as to provide basis for clinical diagnosis.Methods:The epidemiology, clinical symptoms, laboratory and radiologic data of 23 patients with 2019-nCoV infection admitted to the Fifth People's Hospital of Xinyang City from January 22,2020 to January 29, 2020 were retrospectively analyzed.Results:The 23 patients with 2019 nCov infection consisted of 15 men and 8 women, and the median age was 46.0 (40.5, 52.0) years (27-80 years); 9 of them had basic disease (39%), including hypertension (17%), cardiovascular diseases (17%), diabetes (9%), hypothyroidism (4%) and old tuberculosis (4%). All the 23 patients had contact history in Wuhan area or with confirmed infections. Clinical symptoms included: fever (100%), cough (70%), expectoration (43%), myalgia (26%), headache (17%) and dyspnea (17%), and the less common symptoms were diarrhea (4.3%). Blood routine test: white blood cells (WBC) < 4×10 9/L in 11 cases (48%), (4-10)×10 9/L in 10 cases (43%), >10 × 109/L in 2 cases (9%); lymphocytopenia in 13 cases (56%). All 23 patients had different degrees of infective lesions in chest CT examination, with 9 cases (39%) on one side and 14 cases (61%) on both sides. Classification: 19 mild cases, 4 severe cases, no critical or death case. Complications included acute respiratory distress syndrome [4 (17%)]. No case was reported with the damage of liver or kidney function and with secondary infection. Conclusions:Epidemic history of contact, fever, pneumonia signs of chest CT, normal or decreased count of WBC and lymphocytopenia are the clinical basis for diagnosis of the disease. However, at present, the treatment of patients has not been completed, the effective treatment strategy and final prognosis are not clear.

Clinical analysis of 23 cases of 2019 novel coronavirus infection in Xinyang City, Henan Province / 中华危重病急救医学

Objective@#To analyze the epidemiological characteristics and clinical features of the patients with 2019-nCoV infection, so as to provide basis for clinical diagnosis.@*Methods@#The epidemiology, clinical symptoms, laboratory and radiologic data of 23 patients with 2019-nCoV infection admitted to the Fifth People's Hospital of Xinyang City from January 22,2020 to January 29, 2020 were retrospectively analyzed.@*Results@#The 23 patients with 2019 nCov infection consisted of 15 men and 8 women, and the median age was 46.0 (40.5, 52.0) years (27-80 years); 9 of them had basic disease (39%), including hypertension (17%), cardiovascular diseases (17%), diabetes (9%), hypothyroidism (4%) and old tuberculosis (4%). All the 23 patients had contact history in Wuhan area or with confirmed infections. Clinical symptoms included: fever (100%), cough (70%), expectoration (43%), myalgia (26%), headache (17%) and dyspnea (17%), and the less common symptoms were diarrhea (4.3%). Blood routine test: white blood cells (WBC) < 4×109/L in 11 cases (48%), (4-10)×109/L in 10 cases (43%), >10 × 109/L in 2 cases (9%); lymphocytopenia in 13 cases (56%). All 23 patients had different degrees of infective lesions in chest CT examination, with 9 cases (39%) on one side and 14 cases (61%) on both sides. Classification: 19 mild cases, 4 severe cases, no critical or death case. Complications included acute respiratory distress syndrome [4 (17%)]. No case was reported with the damage of liver or kidney function and with secondary infection.@*Conclusions@#Epidemic history of contact, fever, pneumonia signs of chest CT, normal or decreased count of WBC and lymphocytopenia are the clinical basis for diagnosis of the disease. However, at present, the treatment of patients has not been completed, the effective treatment strategy and final prognosis are not clear.

Report of the first cases of mother and infant infections with 2019 novel coronavirus in Xinyang City Henan Province / 中华传染病杂志

Objective@#To report the first case of a neonatal pneumonia with 2019-nCoV infection, and the experience of successfully diagnosis and treatment in late pregnancy woman with novel coronavirus pneumonia (critical type) in Xinyang city.@*Methods@#The successfully diagnosis and treatment of a woman with 38 weeks singleton pregnancy complicated with novel coronavirus pneumonia (critical type), and a case of neonatal pneumonia with 2019-nCoV infection were retrospectively analyzed.@*Results@#A single male was successfully delivered at 38-week gestation of his mother by cesarean section under third level protection in operation room. The delivery woman was diagnosed with 2019-nCoV infection at day 2 of delivery. Dyspnea and severe hypoxemia soon developed, and invasive mechanical ventilation was given. After active rescue and treatment, the delivery woman had been taken off line successfully and the condition was stable. Pharyngeal swab specimen of the neonate was sent for examination 3 days after birth, and was positive for novel coronavirus nucleic acid by fluorescence reverse transcript polymerase chain reaction.@*Conclusion@#2019-nCoV may be transmitted vertically from mother to child.

Report of the first cases of mother and infant infections with 2019 novel coronavirus in Xinyang City Henan Province / 中华传染病杂志

Objective@#The successfully diagnosis and treatment of a woman with 38 weeks singleton pregnancy complicated with novel coronavirus pneumonia (critical type), and a case of neonatal pneumonia with 2019-nCoV infection were retrospectively analyzed.@*Methods@#The successfully diagnosis and treatment of a woman with 38 weeks singleton pregnancy complicated with novel coronavirus pneumonia (critical type), and a case of neonatal pneumonia with 2019-nCoV infection were retrospectively analyzed.@*Results@#A single male was successfully delivered at 38-week gestation of his mother by cesarean section under third level protection in operation room. The delivery woman was diagnosed with 2019-nCoV infection at day 2 of delivery. Dyspnea and severe hypoxemia soon developed, and invasive mechanical ventilation was given. After active rescue and treatment, the delivery woman had been taken off line successfully and the condition was stable. Pharyngeal swab specimen of the neonate was sent for examination 3 days after birth, and was positive for novel coronavirus nucleic acid by fluorescence reverse transcript polymerase chain reaction.@*Conclusion@#2019-nCoV may be transmitted vertically from mother to child.