Clinical Pharmacokinetics of Semaglutide: A Systematic Review.

Purpose: The aim of this review was to provide all the pharmacokinetic data for semaglutide in humans concerning its pharmacokinetics after subcutaneously and oral applications in healthy and diseased populations, to provide recommendations for clinical use. Methodology: The PubMed and Embase databases were searched to screen studies associated with the pharmacokinetics of semaglutide. The pharmacokinetic parameters included area under the curve plasma concentrations (AUC), maximal plasma concentration (Cmax), time to Cmax, half-life (t1/2), and clearance. The systematic literature search retrieved 17 articles including data on pharmacokinetic profiles after subcutaneously and oral applications of semaglutide, and at least one of the above pharmacokinetic parameter was reported in all included studies. Results: Semaglutide has a predictable pharmacokinetic profile with a long t1/2 that allows for once-weekly subcutaneous administration. The AUC and Cmax of both oral and subcutaneous semaglutide increased with dose. Food and various dosing conditions including water volume and dosing schedules can affect the oral semaglutide exposure. There are limited drug-drug interactions and no dosing adjustments in patients with upper gastrointestinal disease, renal impairment or hepatic impairment. Body weight may affect semaglutide exposure, but further studies are needed to confirm this. Conclusion: This review encompasses all the pharmacokinetic data for subcutaneous and oral semaglutide in both healthy and diseased participants. The existing pharmacokinetic data can assist in developing and evaluating pharmacokinetic models of semaglutide and will help clinicians predict semaglutide dosages. In addition, it can also help optimize future clinical trials.

Agreement study of anterior segment parameters measured by two kinds of ocular biometry based on imaging principle of Scheimpflug / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the differences and agreement of anterior segment biometric parameters of myopic patients measured by domestic Scansys and the imported Sirius based on the principle of Scheimpflug imaging technique.METHODS: In this case series study, 103 cases(103 eyes)that underwent pre-refractive surgery(including small incision lenticule extraction, femtosecond laser-assisted in situ keratomileusis, transepithelial photorefractive keratectomy and implantable contact lens implantation)at Aier Excellent Eye Hospital from May 2022 to October 2022 were recruited. Preoperative keratometry(Km), central corneal thickness(CCT), anterior chamber depth(ACDEndo.), anterior chamber angle(ACA), anterior chamber volume(ACV), white to white(WTW)of patients were recorded.RESULTS: The results of Km, CCT, ACA, and WTW measured by Scansys and Sirius were 42.88(41.54, 44.60)and 42.98(41.56, 44.52)D,(541.52±29.08)and(549.55±29.62)μm, 42.70°±2.67° and 46.63°±5.13°, 12.10±0.60 and 11.98±0.47 mm, respectively, showing the difference was statistically significant(all P<0.01). The ACV measured by Scansys and Sirius was 194.26±31.06 and 191.47±25.65 mm3, and ACDEndo. was 3.40(3.17, 3.57)and 3.43(3.19, 3.56)mm, with no statistically significant difference(all P>0.05). The range of Km, CCT, ACA, ACDEndo., ACV and WTW values measured by the two instruments was small, with an average difference close to zero, and the points percentage of 95% limits of agreement(LoA)was <5%, which is of good consistency.CONCLUSIONS: Scansys and Sirius have small differences and good agreement in the parameters, which can be replaced by each other in clinical practice. Scansys could theoretically be used to extrapolate the implantable contact lens model or could be a new option for anterior segment parameter measurements.

Application value of new assistive technology in keratopathy-associated cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Keratopathy-associated cataract, that is, on the basis of corneal disease, and later the development of lens opacity, seriously damage visual quality. In order to avoid corneal transplantation for some patients, partial visual quality can be restored. A comprehensive and accurate evaluation of the effect of corneal opacity on visual function is of great improtance for determining cataract surgery alone. Due to the opacity of the cornea, the operation is very difficult and challenging. Therefore, it is of clinical value to develop and use new assistive technologies, including capsule staining, endoillumination, pupil dialation technology, femtosecond laser assisted technology, etc., avoiding problems such as limited visibility and decreased light flow caused by corneal opacity and facilitating cataract surgery. This article reviews progress of assistive technologies for keratopathy-associated cataract, hoping to guide clinical application.

Enhanced segmentation of gastrointestinal polyps from capsule endoscopy images with artifacts using ensemble learning.

BACKGROUND: Endoscopy artifacts are widespread in real capsule endoscopy (CE) images but not in high-quality standard datasets. AIM: To improve the segmentation performance of polyps from CE images with artifacts based on ensemble learning. METHODS: We collected 277 polyp images with CE artifacts from 5760 h of videos from 480 patients at Guangzhou First People's Hospital from January 2016 to December 2019. Two public high-quality standard external datasets were retrieved and used for the comparison experiments. For each dataset, we randomly segmented the data into training, validation, and testing sets for model training, selection, and testing. We compared the performance of the base models and the ensemble model in segmenting polyps from images with artifacts. RESULTS: The performance of the semantic segmentation model was affected by artifacts in the sample images, which also affected the results of polyp detection by CE using a single model. The evaluation based on real datasets with artifacts and standard datasets showed that the ensemble model of all state-of-the-art models performed better than the best corresponding base learner on the real dataset with artifacts. Compared with the corresponding optimal base learners, the intersection over union (IoU) and dice of the ensemble learning model increased to different degrees, ranging from 0.08% to 7.01% and 0.61% to 4.93%, respectively. Moreover, in the standard datasets without artifacts, most of the ensemble models were slightly better than the base learner, as demonstrated by the IoU and dice increases ranging from -0.28% to 1.20% and -0.61% to 0.76%, respectively. CONCLUSION: Ensemble learning can improve the segmentation accuracy of polyps from CE images with artifacts. Our results demonstrated an improvement in the detection rate of polyps with interference from artifacts.

Potential lipolytic regulators derived from natural products as effective approaches to treat obesity.

Epidemic obesity is contributing to increases in the prevalence of obesity-related metabolic diseases and has, therefore, become an important public health problem. Adipose tissue is a vital energy storage organ that regulates whole-body energy metabolism. Triglyceride degradation in adipocytes is called lipolysis. It is closely tied to obesity and the metabolic disorders associated with it. Various natural products such as flavonoids, alkaloids, and terpenoids regulate lipolysis and can promote weight loss or improve obesity-related metabolic conditions. It is important to identify the specific secondary metabolites that are most effective at reducing weight and the health risks associated with obesity and lipolysis regulation. The aims of this review were to identify, categorize, and clarify the modes of action of a wide diversity of plant secondary metabolites that have demonstrated prophylactic and therapeutic efficacy against obesity by regulating lipolysis. The present review explores the regulatory mechanisms of lipolysis and summarizes the effects and modes of action of various natural products on this process. We propose that the discovery and development of natural product-based lipolysis regulators could diminish the risks associated with obesity and certain metabolic conditions.

Ferroptosis as a Novel Therapeutic Target for Diabetes and Its Complications.

The global diabetes epidemic and its complications are increasing, thereby posing a major threat to public health. A comprehensive understanding of diabetes mellitus (DM) and its complications is necessary for the development of effective treatments. Ferroptosis is a newly identified form of programmed cell death caused by the production of reactive oxygen species and an imbalance in iron homeostasis. Increasing evidence suggests that ferroptosis plays a pivotal role in the pathogenesis of diabetes and diabetes-related complications. In this review, we summarize the potential impact and regulatory mechanisms of ferroptosis on diabetes and its complications, as well as inhibitors of ferroptosis in diabetes and diabetic complications. Therefore, understanding the regulatory mechanisms of ferroptosis and developing drugs or agents that target ferroptosis may provide new treatment strategies for patients with diabetes.

Piperazine ferulate prevents high-glucose-induced filtration barrier injury of glomerular endothelial cells.

Filtration barrier injury induced by high glucose (HG) levels leads to the development of diabetic nephropathy. The endothelial glycocalyx plays a critical role in glomerular barrier function. In the present study, the effects of piperazine ferulate (PF) on HG-induced filtration barrier injury of glomerular endothelial cells (GEnCs) were investigated and the underlying mechanism was assessed. Immunofluorescence was used to observe the distribution of the glycocalyx as well as the expression levels of syndecan-1 and Zonula occludens-1 (ZO-1). Endothelial permeability assays were performed to assess the effects of PF on the integrity of the filtration barrier. Protein and mRNA expression levels were measured by western blotting and reverse transcription-quantitative PCR analyses, respectively. In vitro experiments revealed that adenosine monophosphate-activated protein kinase (AMPK) mediated HG-induced glycocalyx degradation and endothelial barrier injury. PF inhibited the HG-induced endothelial barrier injury and restored the expression levels of heparanase-1 (Hpa-1), ZO-1 and occludin-1 by AMPK. In vivo assays demonstrated that PF reduced the expression levels of Hpa-1, increased the expression levels of ZO-1 and attenuated glycocalyx degradation in the glomerulus. These data suggested that PF attenuated HG-induced filtration barrier injury of GEnC by regulating AMPK expression.

Esculin protects against methionine choline-deficient diet-induced non-alcoholic steatohepatitis by regulating the Sirt1/NF-κB p65 pathway.

CONTEXT: Esculin, an active coumarin compound, has been demonstrated to exert anti-inflammatory effects. However, its potential role in non-alcoholic steatohepatitis (NASH) remains unclear. OBJECTIVE: This study explored the hepatoprotective effect and the molecular mechanism of esculin in methionine choline-deficient (MCD) diet-induced NASH. MATERIALS AND METHODS: Fifty C57BL/6J mice were divided into five groups: control, model, low dosage esculin (oral, 20 mg/kg), high dosage esculin (oral, 40 mg/kg), and silybin (oral, 105 mg/kg). All animals were fed a MCD diet, except those in the control group (control diet), for 6 weeks. RESULTS: Esculin (20 and 40 mg/kg) inhibited MCD diet-induced hepatic lipid content (triglyceride: 16.95 ± 0.67 and 14.85 ± 0.78 vs. 21.21 ± 1.13 mg/g; total cholesterol: 5.10 ± 0.34 and 4.08 ± 0.47 vs. 7.31 ± 0.58 mg/g), fibrosis, and inflammation (ALT: 379.61 ± 40.30 and 312.72 ± 21.45 vs. 559.51 ± 37.01 U/L; AST: 428.22 ± 34.29 and 328.23 ± 23.21 vs. 579.36 ± 31.93 U/L). In vitro, esculin reduced tumour necrosis factor-α, interleukin-6, fibronectin, and collagen 4A1 levels, but had no effect on lipid levels in HepG2 cells induced by free fatty acid. Esculin increased Sirt1 expression levels and decreased NF-κB acetylation levels in vivo and in vitro. Interfering with Sirt1 expression attenuated the beneficial effect of esculin on inflammatory and fibrotic factor production in HepG2 cells. CONCLUSIONS: These findings demonstrate that esculin ameliorates MCD diet-induced NASH by regulating the Sirt1/ac-NF-κB signalling pathway. Esculin could thus be employed as a therapy for NASH.

Piperazine ferulate attenuates high glucose­induced mesangial cell injury via the regulation of p66Shc.

Diabetic nephropathy (DN) is a severe microvascular complication of diabetes. Hyperglycemia­induced glomerular mesangial cells injury is associated with microvascular damage, which is an important step in the development of DN. Piperazine ferulate (PF) has been reported to exert protective effects against the progression of DN. However, whether PF prevents high glucose (HG)­induced mesangial cell injury remains unknown. The aim of the present study was to investigate the effects of PF on HG­induced mesangial cell injury and to elucidate the underlying mechanisms. Protein and mRNA expression levels were determined via western blot analysis and reverse transcription­quantitative PCR, respectively. IL­6 and TNF­α levels were measured using ELISA. Reactive oxygen species levels and NF­κB p65 nuclear translation were determined via immunofluorescence analysis. Apoptosis was assessed by measuring lactate dehydrogenase (LDH) release, as well as using MTT and flow cytometric assays. The mitochondrial membrane potential of mesangial cells was determined using the JC­1 kit. The results revealed that LDH release were increased; however, cell viability and mitochondrial membrane potential were decreased in the HG group compared with the control group. These changes were inhibited after the mesangial cells were treated with PF. Moreover, PF significantly inhibited the HG­induced production of inflammatory cytokines and the activation of NF­κB in mesangial cells. PF also attenuated the HG­induced upregulation of the expression levels of fibronectin and collagen 4A1. Furthermore, the overexpression of p66Src homology/collagen (Shc) abolished the protective effect of PF on HG­induced mesangial cell injury. In vivo experiments revealed that PF inhibited the activation of inflammatory signaling pathways, glomerular cell apoptosis and mesangial matrix expansion in diabetic mice. Collectively, the present findings demonstrated that PF attenuated HG­induced mesangial cells injury by inhibiting p66Shc.

A NAC nomogram to predict the probability of three-month unfavorable outcome in Chinese acute ischemic stroke patients treated with mechanical thrombectomy.

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is a standard care for most acute ischemic stroke (AIS) patients. For AIS patients underwent MT, predicting the patients at high risk of unfavorable outcome and adjusting therapeutic strategies accordingly can greatly improve patient outcomes. We aimed to develop and validate a nomogram for individualized prediction of Chinese AIS patients underwent MT. METHODS: We conducted a multicenter prospective study including 238 AIS patients who underwent MT from January 2014 to December 2018. The main outcome measure was three-month unfavorable outcome (modified Rankin Scale 3-6). A nomogram was generated based on multivariate logistic model. We assessed the discriminative performance by using the area under the receiver-operating characteristic curve and calibration of risk prediction model by using the Hosmer-Lemeshow test. RESULTS: In NAC nomogram, NIHSS (National Institutes of Health Stroke Scale) score on admission (OR: 1.193, p < 0.0001), Age (OR: 1.025, p = 0.037) and Creatinine (OR: 1.028, p < 0.0001) remained independent predictors of 3-month unfavorable outcome in Chinese AIS patients treated with MT. The NAC nomogram exhibited an area under the curve of 0.816 for predicting functional impairment. Calibration was good (p = 0.560 for the Hosmer-Lemeshow test). CONCLUSIONS: The NAC nomogram is the first nomogram developed and validated in Chinese AIS patients treated with MT and it may be used to predict 3 months unfavorable outcome for these patients.

Utilization and Demand of Health Care Service for Children with Mental Disabilities in China / 中国康复理论与实践

Objective:To investigate the utilization and demand of health care services for children with mental disabilities and provide implications for the development and update of related policies. Methods:Data of utilization and demand of health care services for children with mental disabilities aged 0 to 17 years were selected from The Second China National Sample Survey on Disability in 2006. The difference of utilization and demands of health care services for children was analyzed in socio-economic characteristics including gender, age, urban and rural areas, disabled level, parents' highest level of education and family income. Results:The utilization rate of health care service was relatively low (44.35%), and the demands was high (98.26%) among children with mental disabilities. Medical services and assistance, rehabilitation training and services, and aid and support for poor people with disabilities were the most-utilized and most-demanded services for children with mental disabilities. In terms of utilization, the utilization rates of medical services and assistance, and rehabilitation training and services were higher among children with mental disabilities in urban areas than in rural areas (χ2 > 11.028, P < 0.01). And the utilization rate of these two services also was higher among mentally disabled children from family with higher parental education and income than among the counterparts from families with low socioeconomic status (χ2 > 9.169, P < 0.05). In terms of demand, children with more severe mental disability had higher demand of aid and support for poor people with disabilities (χ2 = 17.822, P < 0.001). And higher demand of rehabilitation training and services was found among mentally disabled children with better family socio-economic status (χ2 = 7.797, P < 0.05). Conclusion:The demands for health care services among children with mental disabilities urgently need to be further met. Reinforcing the development of above three types of services, addressing the imbalance of health care services allocation between urban and rural areas, and improving the economic conditions of disabled families will effectively improve the utilization of the health care service for mentally disabled children.

Application of cases-based flipped class in hybrid teaching for neuroanatomy / 解剖学报

Objective To explore the effects of cases-based flipped class in the hybrid teaching for neuroanatomy. Methods A comparative study was conducted among 102 students majored in clinical medicine of 2019 grade, one was the experiment group (n = 51) and another was the control group (n = 51). The traditional teaching method was applied in control group, while the teaching during neuroanatomy based on cases-based flipped class was applied in experimental group. The teaching effects were evaluated by theory and experiment examination and investigated by the questionnaire of students' satisfaction with the new teaching mode. Results Most students supported the cases-based flipped class teaching and thought it was helpful to improve the autonomous learning ability. The satisfaction rate of experimental group on the cases-based flipped class teaching effectiveness was 98.04%. The total scores, the scores of neuroanatomy and the student number who got 81-90 and 91-100 of experiment group were significantly higher than those of control group, and the difference was statistically significant (P<0.05). Conclusion Cases-based flipped class could effectively improve the quality of neuroanatomy teaching and students' learning ability and effects for undergraduates.

Identification of a super-spreading chain of transmission associated with COVID-19

BackgroundSuper-spreading events were associated with the outbreaks of SARS and MERS, but their association with the outbreak of COVID-19 remains unknown. Here, we report a super-spreading transmission chain of SARS-CoV-2 involving an index patient, seven cancer patients, 40 health care workers and four family members. MethodsWe conducted a retrospective study to identify the index patient and the exposed individuals linked to a chain of transmission associated with COVID-19. We collected and analyzed the data on demographic features, exposure history, clinical presentation, laboratory investigation, radiological examination, and disease outcome of these patients. ResultsWe identified the index patient and another presumptive "super-spreader", who initiated and amplified a super-spreading transmission chain associated with COVID-19, respectively. There were 31 female and 21 male patients in this cohort, and the median age was 37 years (range: 22-79 years). Each of them had an exposure history with the index patient or his close contacts. Approximately 87% (45/52) of the patients had fever or other symptoms, 96% (50/52) had abnormal chest CT-scan findings, 86% of the tested patients (39/45) were positive for SARS-CoV-2 in the nasopharyngeal or throat swab specimen, 85% of the tested patients (29/34) were positive for SARS-CoV-2-specific IgM and/or IgG, 15% of the RT-PCR positive patients were tested negative for the specific IgM and/or IgG at the convalescent phase, and 15% of the RT-PCR negative patients were tested positive for the specific IgM and/or IgG. The severe patients experienced a significant decrease in oximetry saturation, lymphocyte, and platelet counts, along with a significant increase in C-reactive protein, D-dimer, and lactate dehydrogenase. All six fatal cases had comorbidities and five of the seven cancer patients (71%) died within 2-20 days of the disease onset. ConclusionsThe super-spreading events were associated with the outbreak of COVID-19 in Wuhan and its impact on disease transmission warrants further investigation. Cancer patients appeared highly vulnerable to COVID-19. The finding that a significant portion of SARS-CoV-2 infected patients were tested negative for the serum specific IgM and IgG at the convalescent phase should be addressed by additional studies.

Environmental policy, tax, and the target of sustainable development.

This paper examines whether governments should adopt stricter environmental policies-such as raising environmental taxes-in closed and open economies. It reconsidered the policy effects of enterprise heterogeneity in an open economy and studied the relationship between environmental policies and sustainable development. In the case of self-sufficiency, it is possible to replace punitive environmental policies with environmental subsidies, which is beneficial to sustainable development. However, when trade is opened up, as less productive enterprises withdraw from local and export markets, the stricter environmental policy is the optimal strategy for environmental and energy sustainable development.

Topical treatments for diabetic neuropathic pain.

Diabetic neuropathic pain (DNP) has a huge impact on quality of life and can be difficult to treat. Oral treatment is the most frequently used method for DNP, but its use is often limited by systemic side effects. Topical use of drugs as an alternative option for DNP treatment is currently gaining interest. In the present review, a summary is provided of the available agents for topical use in patients with DNP, including lidocaine plasters or patches, capsaicin cream, gel or patches, amitriptyline cream, clonidine gel, ketamine cream, extracts from medicinal plants including nutmeg extracts and Citrullus colocynthis extract oil, and certain compounded topical analgesics. Furthermore, the potential efficacy of these treatments is addressed according to the available clinical research literature. It has been indicated that these topical drugs have the potential to be valuable additional options for the management of DNP, with adequate safety and continuous long-term treatment efficacy. Compounded topical agents are also effective and safe for patients with DNP and could be another area worthy of further investigation based on the strategy of using low-dose, complementary therapies for DNP. The findings indicate that developing topical drugs acting on different targets in the process of DNP is a valuable area of future research.

Simple and rapid UPLC-MS/MS method for quantification of entecavir in human plasma: Application to a bioequivalence study
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A simple and fast ultra-performance liquid chromatography-tandem mass spectrometry method was developed and validated to determine entecavir in human plasma with the stable isotopically labeled internal standard entecavir-13C215N. Samples (100 µL each) were pretreated by protein precipitation with methanol, and then separated on an ACQUITY UPLC BEH C18 analytical column (2.1 × 50 mm, 1.7 µm) with a simple isocratic elution. The detection was operated by a positive ionization electrospray mass spectrometry in multiple reaction monitoring mode. The method had a short chromatographic run time of 2 minutes, and obtained sharp peaks of entecavir and the internal standard. Good linearity was found within 0.1 - 20 ng/mL. The intra- and inter-day precision and accuracy met the acceptance criteria, and no matrix effect was observed. This method was successfully applied in a bioequivalence study of two kinds of entecavir tablets in healthy Chinese volunteers. And the results showed that no significant differences were found between the test and reference preparations in pharmacokinetic parameters (p > 0.05) by ANOVA. The 90% confidence intervals for the geometric mean ratios (test/reference) of Cmax, AUC0-tlast, and AUC0-∞ fell within the bioequivalence acceptance criteria (80 - 125%). No significant difference was found in tmax between the two preparations. The two one-sided t-tests showed that these two products were bioequivalent.
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Prokaryotic expression and preparation of the polyclonal antibodies of E protein and domain Ⅲ in Zika virus / 中国人兽共患病学报

To clone,express and purify the E Protein and EDⅢ of Zika virus in E.coli and prepare two kinds of polyclonal antibodies,the virus was amplified by Vero E6 cell culture.Total RNA was extracted by RT-PCR and reverse transcribed into cDNA.The prokaryotic expression vectors pET32a/E and pET28a/EDⅢ were constructed by cDNA sequence of E and EDⅢ gene.Then,recombinant plasmids were transformed into E.coli BL21 and induced by IPTG,and purified by Ni+ column affinity chromatography.BALB/C mice were immunized with purified recombinant proteins.Antiserum was collected and titer was determined by indirect ELISA.Western blot was used to detect the specificity.Results showed that the recombinant proteins were successfully expressed and purified.The titer of the polyclonal antibodies both reached 1:409 600.Western Blot analysis showed that the polyclonal antibodies could specifically recognize the recombinant proteins.Thus,the specific polyclonal antibody were successfully prepared,laying a foundation for further study on the pathogenesis,detection methods and immune strategies of Zika virus.

Application value and safety evaluation of ESD in treatment of colorectal precancerous lesions / 中国内镜杂志

Objective To explore the application value and evaluate the safety of ESD in treatment of early colorectal cancer. Methods The clinical data of patients with early colorectal cancer admitted from May 2014 to May 2016 were retrospectively analyzed. According to the different operation methods, the patients were divided into EMR group and ESD group. The changes of clinical efficacy, safety and inflammatory index level were compared between the two groups. Results 126 patients were involved in the study. The operative time was longer than that of the lesion diameter < 2 cm (P < 0.05) when the lesion diameter was more than 2 cm. The operative time of ESD group was longer than that of EMR group. The resection rate and complete resection rate of lesion were higher than that of EMR group (P < 0.05). When the diameter of lesion was ≥ 2 cm, the operation time of ESD group was longer than that of EMR group. In EMR group, the whole and complete resection rate were lower than that in the diameter less than 2 cm (P < 0.05). There was no significant difference in the levels of TNF- α IL-6 and CD3+and CD4+between the two groups before operation (P > 0.05), but one week after operation, the levels of CRP, TNF- α and IL-6 was lower than that of EMR group (P < 0.05), while the levels of CD3+and CD4+were higher (P < 0.05). There was no significant difference in the incidence and recurrence rate of anastomotic leakage (P > 0.05). The incidence of hemorrhage in ESD group was higher than that in EMR group (P < 0.05). Conclusion ESD was effective in treatment of early colorectal cancer. The stress response was small and the recurrence rate was low, but the bleeding rate was higher than that in EMR group, so the monitoring should be strengthened.

Preliminary exploration on"bidding group"in medical supplies procurement system / 中国卫生政策研究

Objective: To summarize the typical experiences and practices based on the quality evaluation of medical consumables in foreign countries and the practice of drug bidding in China,and to explore the establishment of a bidding grouping scheme for medical consumables in China. Methods: Using literature analysis and evaluation method of combing foreign countries typical measures of medical consumables quality assessment,this paper summa-rized the construction of index system of bidding in China Pharmaceutical Group, and used simple statistical data to reflect the present policy of China's medical supplies such as lack of relevant policies,different levels of quality etc.. Results:There are many problems in the quality evaluation of medical consumables in China. However, the typical measures of extraterritorial quality evaluation and the practice of pharmaceutical bidding in China provide a solid theo-retical and practical basis for the establishment of medical consumable supplies bidding grouping. Conclusion:Estab-lishing bidding grouping scheme is necessary in the Chinese Medical supplies context. Based on a clear difference be-tween medical supplies and medicines,and according to the"three stage"our conceptualization gradually improved. On the basis of the existing data and practical situation,the establishment of scientific selection index bidding group division standard,has been in the exploration of the formation of China's medical supplies bidding grouping scheme.

Systematic review of the association of diuretics with falls in the elderly / 中华护理杂志

Objective To systematically evaluate the association of diuretics with falls in the elderly. Methods Data of case-control studies and cohort studies of diuretics with falls in the elderly were collected by searching eleven electronic databases:MEDLINE,Embase,CENTRAL,AMED,CINAHL,Web of Science,Wiley online library, CBM,CNKI,VIP and WanFang Data from inception to July 2017. Study quality was assessed by the NOS scale. Meta-analysis was conducted by RevMan 5.3 software. Results A total of 17 studies involving 78284 patients were included(seven case-control studies and ten cohort studies). Meta-analysis showed that:①Case-control studies:crude OR showed that diuretics would not increase the risk of falls in elderly patients [OR=0.95,95%CI (0.66,1.38),P=0.80];adjusted OR showed that diuretics would increase the risk of falls in elderly patients[adjusted OR=1.25,95%CI (1.15,1.36),P<0.05]. ②Cohort studies:crude OR showed that diuretics would increase the risk of falls in elderly patients[OR=1.16,95%CI(1.02,1.32),P=0.03];adjusted OR showed that diuretics would not increase the risk of falls in elderly patients[adjusted OR=1.06,95%CI(0.92,1.22),P=0.43]. ③There was no statistically sig-nificant difference in the risk of falls among the elderly at different places,and there was no significant difference in the risk of falls among various diuretics (P>0.05). Conclusion Based on meta-analysis results of cohort studies that controlled confounders,and the results of diuretics in different places and different kinds,diuretics will not in-crease the risk of falls in older adults. Due to limited quantity and quality of included studies,the results need to be further confirmed by more rigorous clinical trials in the future.